Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South Africa

Background.The selection of pharmacotherapy for the treatment of alcohol withdrawal remains a clinical challenge. Research continues into the underlying pathophysiology of dependence and withdrawal. A spectrum of clinical presentations of alcohol dependence is emerging, yet recommendations and guidelines have remained unchanged for some time.  Objectives. To engage with the problem of translating research into practice, as reflected by the selection of pharmacotherapy for alcohol withdrawal by medical practitioners in the Free State Province, South Africa. Methods. A questionnaire-based survey and interviews were conducted among 121 professionals in both the private and public sectors across the province. A subgroup was formed comprising the 58 doctors who indicated that they prescribe for alcohol withdrawal. Participants worked in private general practice, specialist psychiatry practice, in a state hospital or in a treatment centre. Results. Prescribing practices varied based on practitioners’ geographical distribution and professional capacity. Deviation from standard recommendations included the routine use of clothiapine and antidepressants in withdrawal regimens. Prescribing clothiapine appears to be a local custom. While prescription of antidepressants may indicate unrealistic expectations of therapeutic benefit, there are clear indications that this is maintained to mask the diagnosis of an alcohol-related condition. Prescribing for alcohol withdrawal is therefore not necessarily determined by pathophysiology or efficacy of medication. Conclusion. Withdrawal regimens need to be reassessed by researchers, policy makers and funders, balancing new developments with the real-life experiences and challenges of prescribers and their patients

A new model for the pathophysiology of Alzheimer's disease: Aluminium toxicity is exacerbated by hydrogen peroxide and attenuated by an amyloid protein fragment and melatonin

Objectives. Although Alzheimer's disease (AD) is the leading cause of dementia in developed countries, there is an as yet unexplained lower prevalence of the disease in parts of Africa. AD is characterised by a catastrophic loss of neurons; free radicals (oxidative toxins) have been implicated in the destruction of the cells through the process of lipid peroxidative damage of cell membranes. Previously aluminium (Al) and a fragment of beta amyloid (Aβ 25 - 35) were shown to exacerbate tree-radical damage, while melatonin reduced this effect. The aim of the present study was: (i) to investigate the conditions detennining the toxicity of Al and Aβ 25 - 35; and (ii) to assess whether melatonin could attenuate the damage done by both aluminium and the amyloid fragment, thus suggesting a pathway for the aetiology of AD.Design. An in vitro model system was used in which free radicals were generated, causing lipid peroxidation of platelet membranes, thus simulating the disease process found in the brain.Results. 1. Al and Aβ 25 - 35 caused lipid peroxidation in the presence of the iron (II) ion (Fe2+, Al being more toxic than Aβ 25 - 35. 2. Aβ 25 - 35 attenuated the lipid peroxidation promoted by Al. 3. Hydrogen peroxide (H2O2 greatly exacerbated the toxicity of Al and Aβ 25 - 35. 4. Melatonin prevented lipid peroxidation by Al and Aβ 25 - 35 in the absence of H2O2, but only reduced the process when H2O2 was present.Conclusions. In the light of the results obtained from the present study, the following hypotheses are formulated. 1. In AD, excessive quantities of Al are taken up into the  brain, where the Al exacerbates iron-induced lipid peroxidatian in the Iysosomes. 2. In response, the normal synthetic pathway of amyloid protein is altered to produce Aβ fragments which attenuate the toxicity of Al. In the process of sequestering the Al and iron, immature plaques are formed in the brain. 3. Microglia are activated, in an attempt to destroy the plaques by secreting reactive oxygen species such as H2O2. At this point in the disease process, lipid peroxidation causes a catastrophic loss of brain cells. 4. Melatonin, together with other free radical scavengers in the brain, reduces the free-radical damage caused by Al and Aβ, except in the latter stages of the disease process. Since melatonin is produced by the pineal gland only in the dark, the excess of electric light in developed countries may help explain why AD is more prevalent in these countries than in rural Africa

Prevalence and occupational exposure to zoonotic diseases in high-risk populations in the Free State Province, South Africa

IntroductionZoonotic diseases are responsible for 2.5 billion human cases globally and approximately 2.7 million deaths annually. Surveillance of animal handlers and livestock for zoonotic pathogens contributes to understanding the true disease burden and risk factors within a community. This study investigated the prevalence of selected zoonoses in cattle, farm workers and occupational exposure to endemic zoonotic diseases and their associated risk factors.MethodsSputum samples from farmworkers were screened for Mycobacterium bovis. Blood specimens from farmworkers and archived sera were tested for serological evidence of Brucella sp., hantaviruses, and Leptospira sp. Communal and commercial cattle herds were tested for bovine tuberculosis and brucellosis.ResultsMycobacterium bovis was not isolated from human samples. A total of 327 human sera were screened, and 35/327 (10.7%) were Brucella sp. IgG positive, 17/327 (5.2%) Leptospira sp. IgM positive, and 38/327 (11.6%) hantavirus IgG positive (95% CI). A higher proportion of Brucella sp. IgG-positive samples were detected among veterinarians (value of p = 0.0006). Additionally, two cattle from a commercial dairy farm were bovine tuberculosis (bTB) positive using the bTB skin test and confirmatory interferon-gamma assay. A higher percentage of confirmed brucellosis-positive animals were from communal herds (8.7%) compared to commercial herds (1.1%).DiscussionThese findings highlight the brucellosis and M. bovis prevalence in commercial and communal herds, the zoonotic disease risk in commercial and subsistence farming in developing countries, and the occupational and rural exposure risk to zoonotic pathogens

Lichenoid Granulomatous Stomatitis - an oral medicine case book

Not applicabl

The effect of real network phase disturbances on the calculation of IEC 61000-4-30 parameters

Real life network dynamic phenomena are used to demonstrate how the calculation of IEC 61000-4-30 parameters can be affected. The voltage frequency can change instantaneously at a point in the network due to a shift in the position of zero crosses when large reactive power changes occur. Pseudo voltage swells can be recorded and spectral leakage incurred. It is proposed that a 10/12-cycle block value for frequency is used in addition to the IEC 61000-4-30 10-second value