Sudden and unexpected childhood deaths investigated at the Pretoria Medico-Legal Laboratory, South Africa, 2007 - 2011

Background. Sudden and unexpected death is well known to occur in infants, and although sudden deaths are less frequent after the first birthday, they still account for a significant proportion of childhood deaths. In 2009, 1.9% of the total deaths in the USA were childhood deaths. In South Africa (SA) this proportion was much higher at 11.85%. According to the law, sudden and unexpected deaths are generally investigated as unnatural deaths. Establishing an exact underlying anatomical cause of death will depend on available resources and can be difficult in a substantial proportion of cases.Methods. A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory (PMLL), SA, from 1 January 2007 through to 31 December 2011. All children aged 1 - 18 years who died suddenly and unexpectedly were included.Results. Ninety-eight cases were identified, which constituted nearly 1% of total admissions to the PMLL. The majority of the deaths were of children aged 1 - 5 years, and the male/female ratio was 1.04:1. In the largest proportion of cases (n=28, 28.6%), the medicolegal investigation, including autopsy and ancillary investigations, did not establish an underlying anatomical cause of death. In the cases where a cause of death was established, pneumonia was the most common diagnosis (n=22, 22.4%).Conclusions. The fact that the cause of the largest proportion of deaths could not be ascertained emphasises the need for consideration of additional investigative techniques, such as molecular/genetic screening, which have provided an underlying cause of death in a significant number of cases in other countries. There is a lack of published research on the causes and incidence of sudden unexpected deaths in children in SA, and further research in this area is needed

Sudden and unexpected childhood deaths investigated at the Pretoria Medico-Legal Laboratory, South Africa, 2007 - 2011

Background. Sudden and unexpected death is well known to occur in infants, and although sudden deaths are less frequent after the first birthday, they still account for a significant proportion of childhood deaths. In 2009, 1.9% of the total deaths in the USA were childhood deaths. In South Africa (SA) this proportion was much higher at 11.85%. According to the law, sudden and unexpected deaths are generally investigated as unnatural deaths. Establishing an exact underlying anatomical cause of death will depend on available resources and can be difficult in a substantial proportion of cases.Methods. A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory (PMLL), SA, from 1 January 2007 through to 31 December 2011. All children aged 1 - 18 years who died suddenly and unexpectedly were included.Results. Ninety-eight cases were identified, which constituted nearly 1% of total admissions to the PMLL. The majority of the deaths were of children aged 1 - 5 years, and the male/female ratio was 1.04:1. In the largest proportion of cases (n=28, 28.6%), the medicolegal investigation, including autopsy and ancillary investigations, did not establish an underlying anatomical cause of death. In the cases where a cause of death was established, pneumonia was the most common diagnosis (n=22, 22.4%).Conclusion. The fact that the cause of the largest proportion of deaths could not be ascertained emphasises the need for consideration of additional investigative techniques, such as molecular/genetic screening, which have provided an underlying cause of death in a significant number of cases in other countries. There is a lack of published research on the causes and incidence of sudden unexpected deaths in children in SA, and further research in this area is needed

High frequency of inactivating tetraspanin CD37 mutations in diffuse large B-cell lymphoma at immune-privileged sites

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The influence of rice husk ash addition on the properties of metakaolin-based geopolymers

This paper investigates the replacement of metakaolin (MK) with rice husk ash (RHA) in the production of alkali-activated binders or geopolymers. The influence of the RHA addition on compressive and flexural strength, as well as water absorption and apparent porosity were determined, in terms of the percentage of RHA in the mixture and molar ratios of the mixes. Fourier Transform Infrared (FTIR) spectroscopy and Energy Dispersive spectroscopy (EDS) were carried out to assess the changes in the microstructure of the geopolymer matrices with the RHA addition. Results have shown that RHA may be a supplementary precursor for geopolymers. The composition of the geopolymer matrices containing 0-40% RHA is very similar, which indicates that the additional Si provided by RHA is not incorporated to the geopolymer matrix. In addition, geopolymers with RHA content higher than 40% present a plastic behavior, characterized by extremely low strength and high deformation, which can be attributed to the formation of silica gel in formulations containing variable Si/Al ratio

Conservation conundrum – red listing of subtropical-temperate coastal forested wetlands of South Africa

Africa’s range-restricted and transitional subtropical-temperate coastal forested wetlands are facing interlinking threats of climate and anthropogenic pressures. We assessed their conservation status using the criteria of the International Union for Conservation of Nature (IUCN). Their total areal extent was hind-casted to the reference epoch 2000, followed by the quantification of subsequent total losses in areal extents for the epochs 2005, 2008, 2011 and 2017. South Africa had 120 km2 of coastal swamp and floodplain forests in 2000 of which the majority (116.5 km2) occurred on the Maputaland Coastal Plain (MCP). By 2011, 20% of the areal extent was lost, and at the lowest rate of decline we estimate that ≥ 80% of the rest will be lost in the next 50 years. An ecosystem collapse assessment therefore indicated that the habitat is very likely Critically Endangered. Fragmentation and types of transformations were used as degradation indices to show functional collapse. These results showed that forest patches became increasingly fragmented, from 511 to 1 145 patches between 2000 and 2017 and that > 23% of the areal extent showed severe transformation. Several faunal species, with a close association to the forested wetlands of the MCP, are considered threatened with numbers declining because of transformation to timber plantations or agriculture and coupled with a prolonged drought. Of these, a sub-species of the Samango monkey, Cercopithecus mitis erythrarchus, considered to be a primary ecosystem engineer of the habitat, was red listed with a restricted distribution, being endemic, Near Threatened and declining. Also under pressure, because of habitat fragmentation and degradation is the Peregrine crab (Varuna litterata), a euryhaline species requiring connectivity across the land-seascape, ranging from freshwater forested wetlands to estuarine and off-shore environments. Functionally, these coastal forested wetlands are therefore also considered Critically Endangered. The final IUCN conservation status of South Africa’s subtropical-temperate coastal forested wetlands are recommended to be very likely Critically Endangered. Irrespective of 62% of the areal extent of these forested wetlands being within protected areas, severe degradation (metrics of fragmentation and transformation) were observed even inside these areas for the past two decades. The conservation conundrum is that despite existing legislation and management measures, there has been no stop or reversal of the negative trends to date. As a supplementary method, we therefore recommend a transdisciplinary community-based approach to conservation practice, continued and improved monitoring of the habitat losses, the identifying priority areas for rehabilitation and addressing data deficiencies in important species associations.CSIR’s Parliamentary Grant Project P1BEO00/P1CCS02, titled “Marine Observational and Predictive System Capabilities (MAROPS)”; as well as the African Union Commission (AUC) Global Monitoring for Environment and Security (GMES) MARCOSOUTH (K8MARCO). The Department of Science and Innovation (DSI) and National Research Foundation (NRF) Chair in Shallow Water Ecosystems (UID 84375) supported time of Prof. Janine Adams.https://www.elsevier.com/locate/ecolindam2022Geography, Geoinformatics and Meteorolog

Semaphorin 6D regulates the late phase of CD4+ T cell primary immune responses

The semaphorin and plexin family of ligand and receptor proteins provides important axon guidance cues required for development. Recent studies have expanded the role of semaphorins and plexins in the regulation of cardiac, circulatory and immune system function. Within the immune system, semaphorins and plexins regulate cell–cell interactions through a complex network of receptor and ligand pairs. Immune cells at different stages of development often express multiple semaphorins and plexins, leading to multivariate interactions, involving more than one ligand and receptor within each functional group. Because of this complexity, the significance of semaphorin and plexin regulation on individual immune cell types has yet to be fully appreciated. In this work, we examined the regulation of T cells by semaphorin 6D. Both in vitro and in vivo T cell stimulation enhanced semaphorin 6D expression. However, semaphorin 6D was only expressed by a majority of T cells during the late phases of activation. Consequently, the targeted disruption of semaphorin 6D receptor–ligand interactions inhibited T cell proliferation at late but not early phases of activation. This proliferation defect was associated with reduced linker of activated T cells protein phosphorylation, which may reflect semaphorin 6D regulation of c-Abl kinase activity. Semaphorin 6D disruption also inhibited expression of CD127, which is required during the multiphase antigen-presenting cell and T cell interactions leading to selection of long-lived lymphocytes. This work reveals a role for semaphorin 6D as a regulator of the late phase of primary immune responses

Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults

OBJECTIVE: To assess whether treatment outcomes vary with age for adults receiving antiretroviral therapy (ART) in a large rural HIV treatment cohort. DESIGN: Retrospective cohort analysis using data from a public HIV Treatment & Care Programme. METHODS: Adults initiating ART 1(st) August 2004-31(st) October 2009 were stratified by age at initiation: young adults (16-24 years) mid-age adults (25-49 years) and older (≥50 years) adults. Kaplan-Meier survival analysis was used to estimate mortality rates and age and person-time stratified Cox regression to determine factors associated with mortality. Changes in CD4 cell counts were quantified using a piecewise linear model based on follow-up CD4 cell counts measured at six-monthly time points. RESULTS: 8846 adults were included, 808 (9.1%) young adults; 7119 (80.5%) mid-age adults and 919 (10.4%) older adults, with 997 deaths over 14,778 person-years of follow-up. Adjusting for baseline characteristics, older adults had 32% excess mortality (p = 0.004) compared to those aged 25-49 years. Overall mortality rates (MR) per 100 person-years were 6.18 (95% CI 4.90-7.78); 6.55 (95% CI 6.11-7.02) and 8.69 (95% CI 7.34-10.28) for young, mid-age and older adults respectively. In the first year on ART, for older compared to both young and mid-aged adults, MR per 100 person-years were significantly higher; 0-3 months (MR: 27.1 vs 17.17 and 21.36) and 3-12 months (MR: 9.5 vs 4.02 and 6.02) respectively. CD4 count reconstitution was lower, despite better virological response in the older adults. There were no significant differences in MR after 1 year of ART. Baseline markers of advanced disease were independently associated with very early mortality (0-3 months) whilst immunological and virological responses were associated with mortality after 12 months. CONCLUSIONS: Early ART initiation and improving clinical care of older adults are required to reduce high early mortality and enhance immunologic recovery, particularly in the initial phases of ART

Biomarkers of Therapeutic Response in the IL-23 Pathway in Inflammatory Bowel Disease

OBJECTIVES: Interleukin-23 (IL-23) has emerged as a new therapeutic target for the treatment of inflammatory bowel disease (IBD). As biomarkers of disease state and treatment efficacy are becoming increasingly important in drug development, we sought to identify efficacy biomarkers for anti-IL-23 therapy in Crohn's disease (CD). METHODS: Candidate IL-23 biomarkers, downstream of IL-23 signaling, were identified using shotgun proteomic analysis of feces and colon lavages obtained from a short-term mouse IBD model (anti-CD40 Rag2(-/-)) treated preventively with monoclonal antibodies (mAbs) to the IL-23 receptor (IL-23R). The biomarkers were then measured in an IBD T-cell transfer model treated therapeutically with a mAb to IL-23 (p19), confirming their association with IBD. To assess the clinical relevance of these markers, we assessed their concentrations in clinical serum, colon tissue, and feces from CD patients. RESULTS: We identified 57 proteins up or downregulated in diseased animals that returned to control values when the mice were treated with mAbs to IL-23R. Among those, S100A8, S100A9, regenerating protein 3β (REG), REG3γ, lipocalin 2 (LCN2), deleted in malignant tumor 1 (DMBT1), and macrophage migration inhibitory factor (MIF) mRNA levels correlated with disease score and dose titration of mAbs to IL-23R or IL-23(p19). All biomarkers, except DMBT1, were also downregulated after therapeutic administration of mAbs to IL-23(p19) in a T-cell transfer IBD mouse model. In sera from CD patients, we confirmed a significant upregulation of S100A8/A9 (43%), MIF (138%), pancreatitis-associated protein (PAP, human homolog of REG3β/γ; 49%), LCN2 (520%), and CCL20 (1280%), compared with control samples, as well as a significant upregulation of S100A8/A9 (887%), PAP (401%), and LCN2 (783%) in human feces from CD patients compared with normal controls. CONCLUSIONS: These studies identify multiple protein biomarkers downstream of IL-23 that could be valuable tools to assess the efficacy of this new therapeutic agent.Clinical and Translational Gastroenterology (2012) 3, e10; doi:10.1038/ctg.2012.2; published online 16 February 2012