Lifethreatening hyperkalaemia due to trimethoprim in a patient treated for Pneumocystis jirovecii pneumonia

Hyperkalaemia is a potentially life-threatening condition frequently encountered in hospitalised patients. Among the many causes of hyperkalaemia, drugs have often been implicated. In the South African context, with the high burden of HIV, there is an increased incidence of opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP), and consequently many patients receive high doses of trimethoprim-sulfamethoxazole. A lesser-known side-effect of the trimethoprim component of this combination antibiotic is hyperkalaemia. We report a case in which life-threatening hyperkalaemia developed after institution of high-dose co-trimoxazole for PJP

Life-threatening hyperkalaemia due to trimethoprim in a patient treated for Pneumocystis jirovecii pneumonia

Hyperkalaemia is a potentially life-threatening condition frequently encountered in hospitalised patients. Among the many causes of hyperkalaemia, drugs have often been implicated. In the South African context, with the high burden of HIV, there is an increased incidence of opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP), and consequently many patients receive high doses of trimethoprim-sulfamethoxazole. A lesser-known side-effect of the trimethoprim component of this combination antibiotic is hyperkalaemia. We report a case in which life-threatening hyperkalaemia developed after institution of high-dose co-trimoxazole for PJP

Prevalence and outcome of delirium among acute general medical inpatients in Cape Town, South Africa

Background. Delirium is a common, serious, underdiagnosed condition in medical and surgical inpatients with acute conditions. It is associated with increased risk of mortality and morbidity. Data of geriatric cohorts are largely limited to developed countries.Objectives. To describe prevalence, risk factors and outcomes of delirium among general medical patients admitted to two hospitals in Cape Town, South Africa.Methods. This was a prospective cohort study of patients with acute conditions admitted to a general medical inpatient service in secondary- and tertiary-level public hospitals in the Metro West area of Cape Town. Patients ≥18 years of age were recruited daily from all acute medical admissions. Patients were excluded if they were aphasic or their Glasgow coma scale was <8/15. Delirium was diagnosed using the validated confusion assessment method (CAM) tool and performed by trained neuropsychologists. Demographic data were collected by a clinical team and short- and long-term mortality data were obtained using linkage analysis of hospitalised patients and routinely collected provincial death certification records.Results. The median age of inpatients was 51 (interquartile range 36 - 65) years, 29% were HIV-infected and the overall prevalence of delirium was 12.3%. Multivariate predictors of delirium included the presence of an indwelling urinary catheter (odds ratio (OR) 4.47; confidence interval (CI) 2.43 - 8.23), admission with a central nervous system disease (OR 4.34; CI 2.79 - 7.90), pre-existing cognitive impairment (OR 3.02; CI 1.22 - 7.43) and immobility (OR 1.88; CI 1.01 - 3.51). HIV infection was not associated with increased risk of delirium. Delirium was associated with an increased risk of inhospital (delirium v. no delirium: 29% v. 12%; p<0.01) and 12-month (30% v. 20%; p<0.01) mortality, as well as increased length of hospital stay (7 days v. 5 days; p<0.01).Conclusions. In this cohort of medical inpatients (relatively young and with a high HIV prevalence) 1 of 8 (12.3%) patients was delirious. Delirium was associated with adverse outcomes. Delirium risk factors in this young cohort were similar to those in geriatric cohorts in developed countries, and neither HIV nor opportunistic infections increased risk

Medicinal plant cultivation for sustainable use and commercialisation of high-value crops

Many traditional healing systems are based on natural biological resources, and there is a general shift in most parts of the world towards natural medicine, with direct implications on the demand and supply of medicinal plants. This review highlights the economic importance of medicinal plants, their contribution to healthcare systems, and potential opportunities for rural economic development through cultivation.  A systematic literature review with specific search terms related to medicinal plants was used to collect scientific and non-scientific information from peer-reviewed literature and grey literature databases. The findings indicate that trade in medicinal plants is increasing, and although they are considered minor crops compared to major food crops, their value is among the highest in the list of traded plants globally. The trade also serves as a revenue source for many rural livelihoods, with women playing a significant role. Medicinal plants contribute to primary health care in many developing countries, and they are also an essential source of modern drug discovery. Cultivation of medicinal plants offers emerging rural farmers an opportunity to grow these plants as new and alternative crops, thus reducing unsustainable wild harvesting and competition with established commercial farmers who mostly focus on food crops. Furthermore, medicinal plant cultivation should be promoted as one of the options for local economic development and sustainability through job creation, the revival of the rural economy, and income generation for small businesses, such as the transport businesses, involved in the value chain. Land accessibility, financial resources, and direct market access for rural communities can elevate their contribution to the industry. Formalisation of the lower levels of the medicinal plant trade is also recommended. Significance:• Cultivation is a viable option for biodiversity conservation of medicinal plants and ensuring a goodquality supply of plant materials.• Cultivation of medicinal plants – a source of natural products used in product development – can contribute to job creation, income generation, and rural economies in developing countries.• This review underlines the importance of medicinal plants in product development, the contribution of the industry to economies of different countries, and the potential for cultivation

Bikeshare on a University Campus: Lessons from a Pilot Project at the University of Pretoria

In 2018 the University of Pretoria implemented a bikeshare system as a pilot project on its campus to test its feasibility, and to help develop the capacity of City of Tshwane officials to implement future bicycle promotion schemes. Innovative aspects of the pilot included the inclusion of both electric and manual bicycles in a hybrid fleet, the development of a web-based booking and registration system, and the continuous GPS tracking of bicycles for security and data collection purposes. Pre- and post surveys and focus groups provided information on the demand for bikeshare, and how it was used. The paper reviews this evidence, concluding that there is a demonstrated role for bikeshare in certain niche markets in South African cities. Bikeshare’s biggest benefit is its potential to expand the mobility of current pedestrians, although it also demonstrated a modest ability to capture trips from car users and to support public transport as a first/last kilometer solution.Papers presented at the 38th International Southern African Transport Conference on "Disruptive transport technologies - is South and Southern Africa ready?" held at CSIR International Convention Centre, Pretoria, South Africa on 8th to 11th July 2019

Saartjie Baartman, Nelisiwe Xaba, and me: the politics of looking at South African bodies

Dance Artist/Choreographer Nelisiwe Xaba’s They Look at Me and That Is All They Think (2006) ‘refers to the story of Sara[tjie] Baartman […] the “Hottentot Venus”’ (2006. 9th Jomba! Contemporary dance experience 2006 programme, p. 7) who was taken from her homeland South Africa, and exhibited in Europe in the nineteenth century. After Baartman died in 1815, her remains were displayed in a museum in Paris until 1982. Xaba parallels the story of Baartman to her own experience of performing in Europe as a black South African woman. This article considers how They Look at Me and That Is All They Think exposes the politics surrounding the act of looking at a particular racial and gendered body in both the historical and contemporary context, and how the concept and articulation of the ‘superior’ European subject was dependent on the classification of Baartman, and other black Africans, as exotic others. In my practice-based research project How I Chased a Rainbow And Bruised My Knee (2007), which was a choreographic response to Xaba’s work, I theatricalize my identity as a white South African woman to make visible whiteness, its associated privilege, and how it is dependent on the representation of a particular type of blackness

Epistemological access through lecture materials in multiple modes and language varieties: the role of ideologies and multilingual literacy practices in student evaluations of such materials at a South African University

This paper seeks to address the ways in which ideology and literacy practices shape the responses of students to an ongoing initiative at the University of the Western Cape aimed at diversifying options for epistemological access, specifically the language varieties and the modes in which parts of the curriculum for a third year linguistics module are delivered. Students’ responses to the materials in English and in two varieties of Afrikaans and isiXhosa (as mediated in writing vs orally) are determined, and used as basis to problematize decisions on language variety and mode in language diversification initiatives in Higher Education in South Africa. The findings of the paper are juxtaposed against particular group interests in the educational use of a language as well as differences in the affordances and impact of different modes of language use. The paper suggests that beyond the euphoria of using languages other than English in South African Higher Education, several issues (such as entrenched language practices, beliefs and language management orientations) require attention if the goals of transformation in this sector are to be attained

Chemical composition and antigenotoxic properties of Lippia alba essential oils

The present work evaluated the chemical composition and the DNA protective effect of the essential oils (EOs) from Lippia alba against bleomycin-induced genotoxicity. EO constituents were determined by Gas Chromatography/Mass Spectrometric (GC-MS) analysis. The major compounds encountered being citral (33% geranial and 25% neral), geraniol (7%) and trans-β-caryophyllene (7%) for L. alba specimen COL512077, and carvone (38%), limonene (33%) and bicyclosesquiphellandrene (8%) for the other, COL512078. The genotoxicity and antigenotoxicity of EO and the compounds citral, carvone and limonene, were assayed using the SOS Chromotest in Escherichia coli. The EOs were not genotoxic in the SOS chromotest, but one of the major compound (limonene) showed genotoxicity at doses between 97 and 1549 mM. Both EOs protected bacterial cells against bleomycin-induced genotoxicity. Antigenotoxicity in the two L. alba chemotypes was related to the major compounds, citral and carvone, respectively. The results were discussed in relation to the chemopreventive potential of L. alba EOs and its major compounds

The Lancet Breast Cancer Commission: tackling a global health, gender, and equity challenge

Breast cancer is an increasing global health, gender, socioeconomic, and equity challenge. In 2020, 2·3 million women were diagnosed with breast cancer and there were 685 000 deaths worldwide.1 Not only is breast cancer the highest incident cancer globally, but it is also the most prevalent, causing more disability-adjusted life-years lost than any other malignancy. Tackling breast cancer is a formidable task for health-care systems, policy makers, and other stakeholders. The numbers of people with metastatic breast cancer who go uncounted are concerning. Cancer registries record patients initially presenting with de-novo metastatic breast cancer, but data on those who develop metastases after a diagnosis of early breast cancer are scarce. In a world focused on breast cancer cure, these uncounted people living with metastatic disease face abandonment and stigma

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London