Maternal serum fructosamine values after delivery of macrosomic babies and unexplained stillbirths

Measurement of serum fructosamine and haemoglobin A, levels and glucose tolerance tests were performed in 75 women in the immediate postpartum period. None had predisposing factors to gestational diabetes. They were divided into three groups: group I consisted of 15 women who delivered an unexplained stillbirth; group 11 of 30 women who gave birth to babies weighing between 2500 g and 3900 g at term; and group III of 30 women who delivered babies weighing≥ 4000 g. There was a significant difference in the mean level of serum fructosamine between the unexplained stillbirth and control groups (P < 0,001). Although the HbA, values varied in the three groups, there was a significant difference between the unexplained stillbirth group and the macrosomic infant group (P < 0,05). All patients had normal glucose tolerance tests

Sedation for paediatric auditory electrophysiology in South Africa

Background: The sedation of children in the medical and allied professional fields has been a topic of controversy and debate internationally. Limited information is available on the use of sedation for auditory electrophysiology testing in South Africa.Objectives: The aim of this study was to determine how sedation information is recorded in electrophysiology audiology reports where diagnostic electrophysiology testing was used, and to obtain baseline information on sedation procedures and medications used during diagnostic electrophysiology testing.Methods: Audiology reports of 169 children undergoing auditory electrophysiology testing were reviewed for sedation information.Conclusion: Sedation data is not clearly documented and the use of medical or anaesthetist monitoring during sedation is not routinely included in reports. Sedation medication is varied and does not always include medications listed as safe for use with the paediatric population. This places doubt on procedures and protocols as well as the safety mechanisms in place for auditory diagnostic testing of children in South Africa.Keywords: auditory electrophysiology, diagnostic audiology, sedatio

Expectant management of early onset of severe pre-eclampsia in Durban

Fifty patients with severe pre-eclampsia who presented before 32 weeks' gestation were managed conservatively (sedation, bed rest, antihypertensive therapy and intensive fetal and maternal monitoring) until intervention was indicated. Twelve patients presented before 26 weeks ofpregnancy and there were no fetal survivors in this group; 23 presented between 26 and 29 weeks and 8(34,8%) of the babies in this group survived. The rate of perinatal loss in those presenting between 30 and 32 weeks was 26,6% (N =4). Patients who had a history of a hypertensive disorder in their previous pregnancy(ies) had a higher perinatal mortality rate; 23 such mothers experienced 16 perinatal losses compared with 27 mothers who had no such history and who had only 8 perinatal losses. There was 1 maternal death, there were 2 cases of eclampsia, 3 of pulmonary oedema, 4 of abruptio placentae and 1 case of renal failure; 2 patients had disseminated intravascular coagulation. The local indigent and underprivileged black population have a more aggressive form of early onset of severe pre-eclampsia than that reported for other population groups. The high maternal complication rate of 30,8% and the low fetal survival rate before 26 weeks indicate that there is no place in our setting for expectant management of severe pre-eclampsia in patients presenting before 26 weeks. This applies particularly to those with a previous history ofhypertension in pregnancy

Teacher leadership: a survey analysis of KwaZulu-Natal teachers’ perceptions

The notion of teacher leadership is implicit in official documentation in the South African education system post 1994, which emphasises a move towards a more shared and participatory approach to the practice of leadership and management in schools. The concept of teacher leadership is embedded in a distributed leadership theoretical framing which emphasises that leadership need not be located only in the position of the principal but can be stretched over a range of people who work at different levels in a school. We report on a study in which the perceptions of teachers’ on their understanding and experiences of teacher leadership were explored. The study adopted a survey approach and utilised closed questionnaires to gather data from 1,055 post level-one teachers across a range of schools of diverse contexts in KwaZulu-Natal. We found that while teachers supported the notion of shared leadership and believed they were equipped to lead, their leadership was largely restricted to their classrooms. There was some evidence of teacher leadership amongst teacher colleagues in certain curricular and extra-curricular activities. However, teacher leadership in relation to school-wide and community issues was almost non-existent. We signal two problematics regarding the leadership of school teachers and consider the implication of these for the distribution of leadership, and therefore change, in schools.Keywords: distributed leadership; education leadership; power; schoolmanagement teams; teacher leadership; teacher

Viewpoint: WHO world mental health surveys international college student initiative: implementation issues in low‐ and middle‐income countries

The university system and students are rapidly growing and changing in low‐ and middle‐income countries (LMICs). This growth can facilitate enhanced national productivity yet it can also bring potential risks to student mental health. The World Mental Health Surveys International College Student (WMH‐ICS) initiative could increase information and support in a relatively low‐cost manner for university students in LMICs—a group that is particularly vulnerable to mental health problems and who live in an environment where few targeted resources may be available. Effective implementation of the WMH‐ICS initiative, however, requires long‐term planning and consideration of the specific challenges present in LMIC settings. Planning as to what types of interventions would be needed and achievable in the next 10 to 15 years and consideration of local issues related to uptake, acceptability, appropriateness, feasibility, fidelity, and sustainability from the very beginning would be needed to ensure that the initiative would be useful in the future

PLoS Genet.

The Helicobacter pylori cag pathogenicity island (cagPAI) encodes a type IV secretion system. Humans infected with cagPAI-carrying H. pylori are at increased risk for sequelae such as gastric cancer. Housekeeping genes in H. pylori show considerable genetic diversity; but the diversity of virulence factors such as the cagPAI, which transports the bacterial oncogene CagA into host cells, has not been systematically investigated. Here we compared the complete cagPAI sequences for 38 representative isolates from all known H. pylori biogeographic populations. Their gene content and gene order were highly conserved. The phylogeny of most cagPAI genes was similar to that of housekeeping genes, indicating that the cagPAI was probably acquired only once by H. pylori, and its genetic diversity reflects the isolation by distance that has shaped this bacterial species since modern humans migrated out of Africa. Most isolates induced IL-8 release in gastric epithelial cells, indicating that the function of the Cag secretion system has been conserved despite some genetic rearrangements. More than one third of cagPAI genes, in particular those encoding cell-surface exposed proteins, showed signatures of diversifying (Darwinian) selection at more than 5% of codons. Several unknown gene products predicted to be under Darwinian selection are also likely to be secreted proteins (e.g. HP0522, HP0535). One of these, HP0535, is predicted to code for either a new secreted candidate effector protein or a protein which interacts with CagA because it contains two genetic lineages, similar to cagA. Our study provides a resource that can guide future research on the biological roles and host interactions of cagPAI proteins, including several whose function is still unknown

Evidence of neuroinflammation and blood–brain barrier disruption in women with preeclampsia and eclampsia

Cerebral complications in preeclampsia are leading causes of maternal mortality. Animal models suggest that an injured blood–brain barrier and neuroinflammation may be important but there is paucity of data from human studies. Therefore, we aimed to evaluate this in women with preeclampsia and eclampsia. We included women recruited to the South African Preeclampsia Obstetric Adverse Events (PROVE) biobank. Blood and cerebrospinal fluid (CSF) were collected around delivery. CSF was analyzed for neuroinflammatory markers interleukin 1β, interleukin 6, interleukin-8 and tumor necrosis factor alpha (TNF-alpha). The CSF to plasma albumin ratio was measured to assess blood–brain barrier function. Women with eclampsia (n = 4) showed increased CSF concentrations of all pro-inflammatory cytokines and TNF-alpha compared to women with normotensive pregnancies (n = 7) and also for interleukin-6 and TNF-alpha compared to women with preeclampsia (n = 4). Women with preeclampsia also showed increases in pro-inflammatory cytokines IL-6 and IL-8 but not TNF-alpha in the CSF compared to women with normotensive pregnancies. In particular, women with eclampsia but also women with preeclampsia showed an increase in the CSF to plasma albumin ratio compared to normotensive women. In conclusion, women with preeclampsia and eclampsia show evidence of neuroinflammation and an injured blood–brain barrier. These findings are seen in particular among women with eclampsia