Anthropometric profile of HIV-uninfected and HIV-infected women aged 25–44 years in Mangaung, Free State

Background: Obesity and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) affect significant numbers of black women in South Africa.Method: Using township maps, a random sample of 500 black women residing in Mangaung in the Free State was selected to participate in this study in the year 2000. The women were divided into two age groups, namely 25–34 years (n = 273) and 35–44 years (n = 215). Anthropometric measurements, including height, weight [to calculate the body mass index (BMI)] and waist circumference (WC) were taken. Fat percentage was measured with bioelectrical impedance. HIV status was determined using a microparticle enzyme immunoassay method. Socio-demographic status, health status, dietary intake, level of physical activity, body perception and attitude toward weight control, as well as prevalence and risk of lifestylediseases were determined as part of the larger study.Results: Sixty-one per cent of younger women (25–34 years) and 38% of older women (35–44 years) were infected with HIV. In younger HIV-infected women, median BMI, WC and fat percentage were significantly lower than in HIV-uninfected women.Conclusions: HIV infection rates were found to be higher among younger than older women. The prevalence of obesity was high overall. Median BMI values ranged between 24.4 kg/m2 and 27.6 kg/m2. A large percentage of all women fell in the unhealthy fat percentage category (excessive body fat), ranging between 65.9% of HIV-infected young women and 79.3%of older HIV-infected women. HIV, even in the asymptomatic stage, influences anthropometric indicators

Investigating the Effect of IMF Path Length on Pitch- angle Scattering Strahl within 1 au

Strahl is the strongly field-aligned, beam-like population of electrons in the solar wind. Strahl width is observed to increase with distance from the Sun, and hence strahl electrons must be subject to in-transit scattering effects. Different energy relations have been both observed and modeled for both strahl width and the width increase with radial distance. Thus, there is much debate regarding what mechanism(s) scatter strahl. In this study, we use a novel method to investigate strahl evolution within 1 au by estimating the distance traveled by the strahl along the interplanetary magnetic field (IMF). We do this by implementing methods developed in previous studies, which make use of the onset of solar energetic particles at ∼1 au. Thus, we are able to obtain average strahl broadening in relation to electron energy and distance, while also taking into account the general effect of IMF topology and adiabatic focusing experienced by strahl. We find that average strahl width broadens with distance traveled along the IMF, which suggests that strahl width is related to the path length taken by the strahl from the Sun to 1 au. We also find that strahl pitch-angle width broadening per au along the IMF length increased with strahl energy, which suggests that the dominant strahl pitch-angle scattering mechanism likely has an inherent energy relation. Our pitch-angle broadening results provide a testable energy relation for the upcoming Parker Solar Probe and Solar Orbiter missions, which are both set to provide unprecedented new observations within 1 au

Iron status and anaemia of chronic disease in HIV-infected African women in Mangaung, Bloemfontein

Background: Anaemia occurs widely among people living with HIV/AIDS. The aim of this study was to investigate the effect of HIV status on ironstatus, more specifically to investigate the nutritional health of women between 25 and 44 years of age.Methods: An epidemiological study was undertaken in Mangaung, a black residential community of Bloemfontein in the Free State (South Africa).A random sample consisted of 500 women in two age groups (25–34 [n = 273] and 35–44 years [n = 215]). Blood specimens were collected in ethyldimethylacetic acid collection tubes according to standard procedures. Respondents fasted overnight, abstained from exercise and avoided consuming alcohol and caffeine for 24 hours prior to collection of the blood specimens. All specimens were taken in the morning. A full blood count was performed using a Coulter Microdiff 18 Cell Counter. The metabolic variables haematocrit (Hct), haemoglobin (Hb), serum iron, ferritin and transferrin were determined. The red blood cell count was performed to calculate the mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). Age and HIV-status groups were described and compared by nonparametric methods. A p-value lower than 0.05 was considered significant. HIV-infected and -uninfected groups were compared by 95% confidence intervals for the difference in the percentage of women with parameters below or above the normal range.Results: Sixty-one per cent of the younger women and 38% of the older women were HIV infected. The percentage with serum ferritin levels below20 μg/L was higher in HIV-uninfected women, ranging from 0% in older HIV-infected women to 10.4% in younger HIV-uninfected women. A largepercentage of women had elevated transferrin values, ranging from 23.9% in older HIV-infected women to 44.8% in older HIV-uninfected women.A large percentage of women had anaemia of chronic disease, with HIV-infected women afflicted more often.Conclusion: The results of the study indicate that prevalence of HIV infection in Mangaung is high, especially among women between 25 and34 years of age. Although the parameters of iron status on average did not indicate iron deficiency in the different age and HIV-status groups, a large percentage of women did have anaemia of chronic disease, with HIV-infected women afflicted more often. Knowledge of the HIV status of a patient is of paramount importance in evaluating laboratory results of iron levels to determine future treatment or nutritional recommendations. HIV-infected and -uninfected individuals might not be comparable regarding their laboratory results to interpret iron store depletion, with consequences for further therapeutic actions in these two groups. The progression rate to AIDS might also be enhanced by certain interventions.Keywords: iron; HIV; nutrition; women; South Afric

Evaluation of energy and macronutrient intake of black women in Bloemfontein: A cross-sectional study

There is growing evidence that urbanization of black South Africans is associated with changes in the structure of dietary intake. The urban diet is more diverse than the rural diet, and includes more animalfoods, refined carbohydrates and fats, posing a potential risk to the health of urbanized populations. The objective of this cross-sectional study was to determine the macronutrient intake of non-pregnant,pre-menopausal black women living in Bloemfontein in South Africa. A representative group of 500 participants was randomly selected to participate. Women were divided into two age groups. Youngerwomen were 25 - 34 years old and older women 35 - 44 years old. Macronutrient intake was determined using a validated Quantitative Food Frequency Questionnaire (QFFQ). Median macronutrient intake was compared with the Dietary Reference Intakes (DRI) as applicable. Median energy, macronutrient and cholesterol intake of younger and older women was compared using non-parametric 95% confidenceintervals (CI’s). P-value less than 0.05 was considered significant. Median energy distribution of macronutrients was determined and compared with standard references. After being screened foreligibility, four pregnant women were excluded from the study, and 496 women qualified for participation. Median total energy, protein and carbohydrate intakes of all women exceeded the DRI. Median intakes of fibre were low, while median fat intakes were high. Younger women had significantly higher intakes of total fat (p = 0.034), saturated fat (p = 0.046) and PUFA (p = 0.015). Median energy distribution was 12% protein (both age groups), 32% fat (younger women) and 31% fat (older women) and 51% carbohydrates (younger women) and 53% carbohydrates (older women). The high median energy and macronutrient intakes may pose a potential risk for the development of chronic lifestyle diseases. The main focus of intervention should be to improve the quality of the diet, by decreasing fat intake and replacing this with fruit and vegetables. The benefits of a low glycaemic index and high fibre diet need to be emphasized

The metabolic profiles of HIV-infected and non-infected women in Mangaung, South Africa

Objective: To determine the biochemical nutritional status of HIV-infected women in Mangaung.Design: Cross-sectional.Setting: The community of Mangaung, Free State, South Africa.Subjects: A representative group of 500 black women (25–44 years) was selected randomly to participate.Outcome measures: Biochemical analyses were performed for total  lymphocytes, serum protein, serum albumin, plasma fibrinogen, serum insulin, serum glucose, serum triglycerides and serum cholesterol using standard methodology. Values were compared to standard references, and between HIV-infected and HIV-uninfected women.Results: After screening for eligibility, 488 women qualified. Sixty-one per cent of the younger women (25–34 years) and 38% of the older women (35–44 years) were HIV-infected. HIV-infected women had significantly lower median blood values for total lymphocytes (p = 0.0001 and p = 0.02 for younger and older group respectively) and serum albumin (p = 0.0001 for both age groups), but significantly higher median concentrations of serum protein (p = 0.0001 for both age groups) than uninfected women. Plasma fibrinogen and serum insulin concentrations were significantly lower in HIV-infected younger women than in their uninfected counterparts (p = 0.002 for both parameters). Older HIV-infected women had significantly lower total serum cholesterol values (p = 0.01) than older HIV-uninfected women. Serum glucose and serum triglycerides did not differ significantly between HIV-infected and HIV-uninfected women.Conclusions: The results indicate a possible impact of HIV infection on serum protein and serum albumin, which may adversely affect biochemical nutritional status and the course of HIV progression. Future research into the causes and possible treatment of metabolic changes in women in this community should be prioritised

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

The use of oral antibiotics and mechanical bowel preparation in elective colorectal resection for the reduction of surgical site infection.

Surgical site infection (SSI) is a major cause of morbidity following elective colorectal resection worldwide. Reduction in SSI rates can be achieved with the use of SSI reduction bundles. Debate about the role of mechanical bowel preparation and oral antibiotics (MOAB) in reducing SSI has persisted over decades with considerable variation in international practice. This article summarises the arguments for and against the routine use of MOAB in the elective setting, highlighting the areas of controversy and evidence gaps and provides pragmatic suggestions for colorectal practice.This topical debate paper was commissioned by the President and Executive of the Association of Coloproctology of Great Britain and Ireland. ACPGBI also funded the open access publication fee. The authors would like to thank Ms J Pipe for her comments from the patient perspective and Miss N Fearnhead for her support in developing this debate article

Are there biological differences between screen-detected and interval colorectal cancers in the English Bowel Cancer Screening Programme?

Background: We measured biomarkers of tumour growth and vascularity in interval and screen-detected colorectal cancers (CRCs) in the English Bowel Cancer Screening Programme in order to determine whether rapid tumour growth might contribute to interval CRC (a CRC diagnosed between a negative guaiac stool test and the next scheduled screening episode). Methods: Formalin-fixed, paraffin-embedded sections from 71 CRCs (screen-detected 43, interval 28) underwent immunohistochemistry for CD31 and Ki-67, in order to measure the microvessel density (MVD) and proliferation index (PI), respectively, as well as microsatellite instability (MSI) testing. Results: Interval CRCs were larger (P=0.02) and were more likely to exhibit venous invasion (P=0.005) than screen-detected tumours. There was no significant difference in MVD or PI between interval and screen-detected CRCs. More interval CRCs displayed MSI-high (14%) compared with screen-detected tumours (5%). A significantly (P=0.005) higher proportion (51%) of screen-detected CRC resection specimens contained at least one polyp compared with interval CRC (18%) resections. Conclusions: We found no evidence of biological differences between interval and screen-detected CRCs, consistent with the low sensitivity of guaiac stool testing as the main driver of interval CRC. The contribution of synchronous adenomas to occult blood loss for screening requires further investigation