Molecular mechanisms of insulin resistance

This review discusses recent advances in understanding of the structure and function of the insulin receptor and insulin action, and how these relate to the clinical aspects of insulin resistance associated with non-insulin-dependent diabetes and other disorders. Improved understanding of the molecular basis of insulin resistance could ultimately lead to a better understanding of the causation of these conditions and the design of rational therapy to ameliorate them. Here, particular attention is devoted to the initial events that follow the binding of insulin to its receptor, including changes in insulin receptor phosphorylation. Receptor-mediated insulin resistance may be a consequence of various factors including increased serine/threonine phosphorylation of the receptor with decreased tyrosine phosphorylation, receptor densitisation, auto-antibodies to the receptor and inherited structural defects in the insulin receptor. Defects in insulin action could also arise at post-receptor events particularly glucose transport. Other circulating hormones, such as the newly characterised islet amyloid polypeptide (amylin), may also cause insulin resistance

The art of HIV elimination: past and present science

Introduction: Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges. Discussion: In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as preexposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resourcerich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive. Conclusion: Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal

Considering the role of social media: #BlackLivesMatter as a pedagogical intervention to decolonise curriculum

The COVID-19 pandemic resulted in a drastic transformation to schooling for students throughout the world. During this period, a number of issues arose in our local, national and global communities, including the death of George Floyd and subsequent protests and rallies organised by #BlackLivesMatter. Living through and witnessing many social issues, coupled with the new and enduring pandemic, furthered our understandings of how young people were engaging with these topics without the structures of schools to support them. This article presents the results of a case study where youth aged 15–17 years shared their experiences and understandings about many social justice issues they were observing. The most significant learning around these issues for youth occurred informally through social media as opposed to in the classroom, reinforcing that schools are not ethical spaces from which to challenge institutional, structural and systemic barriers to justice. As such, this article discusses the potential for formal education to be transformed into an ethical and decolonising space to learn about and challenge injustice

Parent, family and carer empowerment and neonatal mortality: Stretching the boundaries for neonatal units

This is an accepted manuscript of an article published by Elsevier in Journal of Neonatal Nursing on 08/08/2018, available online: https://doi.org/10.1016/j.jnn.2018.07.006 The accepted version of the publication may differ from the final published version.Published versio

The increasing burden of tuberculosis in pregnant women, newborns and infants under 6 months of age in Durban, KwaZulu Natal

Objectives. In spite of the global epidemic of tuberculosis (TB) which has been exacerbated by HIV, the impact of these coinfections on maternal and perinatal health has been limited. We document new evidence from Durban, KwaZulu- Natal, on the increasing effects of TB in pregnant women, neonates and infants.Method. Women with TB were prospectively tudied at the antenatal clinics and obstetric and labour wards at King Edward VIII Hospital, Durban, between 1996 and 1998. The incidence of TB was calculated, and the population attributable fraction of TB due to HIV infection in pregnancy was estimated. Concurrently, culture-confirmed cases of Mycobacterium tubaculosis in neonates and infants under 6 months of age at the hospital were documented.Results. One hundred and forty-six cases of maternal TB were detected. TB occurred in 0.1% and 0.6% of maternities in 1996 and 1998 respectively. Overall, TB rate for HIV non-infected maternities was 72.9/ 105, and for HIV-infected maternities , 774.5/ 105. The attributable fraction of TB related to HIV in pregnancy was 71.7%; 10.3% of these mothers died. There was a 2.2-fold increase in the caseload of culture-confirmed TB in neonates and young infants at the hospital.Conclusion. In regions where TB and HIV preval nee is high, efforts to improve maternal and perinatal health must include the detection of TB in pregnancy

Incisional Hernia: Experience in a single surgical unit

Background: Incisional hernias are a common problem in general surgery and they have a varied aetiology. The aim of this study was to document a single unit experience with the management of incisional hernias at King Edward VIII Hospital, Durban, South Arica.Patients and Methods: This was a prospective audit of incisional hernias in a single surgical unit from January 2001 to May 2004. All patients underwent open repair. Clinical data and intra-operative findings were documented.Results: A total number of 77 patients were seen of which 70 were female. Fifty three (68.8%) and 24 (31.2%) of patients underwent elective and emergency surgery respectively. A total of 56 patients had previously undergone gynaecological surgery compared to 21 who had undergone general surgery. There was a documented history of previous sepsis in 4 (7%) of patients. There was 1 sheath defect in 36 patients, 2 defects in 9 patients, 3 defects in 10 patients, 4 or more defects in 9 cases. In 55 patients the original suture could not be identified. Gangrenous bowel was present in 3 patients. Only 3 (3.9%) of the patients had a mesh repair. The rest (96.1%) underwent tissue repair. Morbidity rate was 17% and there were no deaths. Five patients needed management in the ICU. Hospital stay was 8 + 11 yearsConclusion: Most incisional hernias followed gynaecological surgery. There was no evidence of a nonabsorbable suture having been used at the original operation in over half of the patients. We recommend that meticulous technique is essential in closing the abdominal incision

Inadequacy of primary health care test request guidelines - lack of evidence base

Evidence suggests that 3 - 4% of patient encounters in primary health care result in blood tests being requested. There is compelling evidence of significant misuse and poor utilisation of many laboratory tests, which results in an economic burden and other problems including further investigation of false-positive results. Patients have high expectations that blood tests be performed and have little understanding of the limitations of testing. The frequency of test ordering is much higher in the USA and Canada, for example, than in the UK, without any overt difference in the quality of care. There are suggestions that 30 - 50% of tests are unnecessary, and that about 15% of abnormal results are not acted upon