RESUMEN

BACKGROUND: The recent listeriosis outbreak in South Africa (SA) received widespread attention in the media. More than 1 000 laboratory-confirmed cases of listeriosis occurred during an 18-month period, with a case fatality rate of 28%. Acute bacterial meningitis due to listeriosis was extremely rare at Steve Biko Academic Hospital in Pretoria until 2017/18, when we saw two very sick adults with this condition during the listeriosis outbreak. OBJECTIVES: To describe the presentation, treatment and outcome of these patients to raise awareness of this potentially fatal but treatable infection that does not respond to empirical third-generation cephalosporins. CASE REPORTS: Case 1: A 60-year-old man collapsed at home after being discharged from hospital for treatment of Listeria meningitis. On readmission he had neck stiffness and a depressed level of consciousness with right-sided hemiparesis. A computed tomography (CT) scan of the brain showed possible subarachnoid haemorrhage, but on CT angio- and venograms, extensive thrombosis of the superior sagittal, right transverse and bilateral sigmoid sinuses extending into the right internal jugular vein was noted. Patient 2: A 55-year-old HIV-positive hypertensive man on highly active antiretroviral therapy and antihypertensives visited the emergency department complaining of a new-onset headache. He was discharged on pain medication, but was readmitted the next day with a depressed level of consciousness, neck stiffness, low-grade fever and generalised tonic-clonic convulsions. A lumbar puncture revealed active cerebrospinal fluid that was culture-positive for L. monocytogenes. The patients received ampicillin and gentamicin for 3 weeks; the cerebral venous thrombosis was treated with unfractionated heparin. In both cases, the course of the disease was complicated. The first patient remained confused and suffered from psychotic episodes for 5 weeks. He was finally discharged after 6 weeks in hospital and continued to improve to the extent that he was able to return to work. The second patient needed intubation and ventilation and was treated in the intensive care unit. He improved over the next week and was finally discharged home with no residual neurological sequelae. CONCLUSIONS: Our two cases demonstrate that the listeriosis outbreak should change the way we view bacterial meningitis in SA: according to the National Institute for Communicable Diseases, empirical treatment for meningitis should include ampicillin and gentamicin in all adult patients with features of meningitis. There may be a need for an updated meningitis treatment guideline in SA.

Asunto(s)

RESUMEN

For several years the School of Nursing Science and the School of Psychosocial Behavioural Science, of a specific university, have been offering health care services in response to some of the health needs of a disadvantaged community as part of their students' experiential learning. However, these health care services were rendered independently by these two schools, implying that no feedback system existed to evaluate the worth and quality of these student-rendered health care services. The objectives of this research were to explore and describe the experiences of senior nursing and social work students, the experiences of health service delivery organisations concerned and the experiences of the disadvantaged community members receiving such health care services, as well as to investigate which communication models were apparent with regard to the major factors within health communication. An exploratory descriptive qualitative research design was used. Focus group discussions were held, interviews were conducted and field notes taken. Focus group discussions and interviews were transcribed and analysed by the research team to determine themes and sub-themes using the open coding technique. The results of the three groups showed similarities. The health service delivery organisations also identified a communication barrier, although the students were prepared to bridge it. The health service delivery organisations and the community felt positive towards the students and what they offered to the organisations and to the patients. A greater need for multi-disciplinary team work was recognised by al parties concerned. Recommendations focus on improved student accompaniment by lecturers; extending health care delivery to include a multi-disciplinary team approach by students; as well as improving the delivery of health care services.

Asunto(s)

RESUMEN

Most mastreviruses (family Geminiviridae) infect monocotyledonous hosts and are transmitted by leafhopper vectors. Only two mastrevirus species, Tobacco yellow dwarf virus from Australia and Bean yellow dwarf virus (BeYDV) from South Africa, have been identified whose members infect dicotyledonous plants. We have identified two distinct mastreviruses in chickpea stunt disease (CSD)-affected chickpea originating from Pakistan. The first is an isolate of BeYDV, previously only known to occur in South Africa. The second is a member of a new species with the BeYDV isolates as its closest relatives. A PCR-based diagnostic test was developed to differentiate these two virus species. Our results show that BeYDV plays no role in the etiology of CSD in Pakistan, while the second virus occurs widely in chickpea across Pakistan. A genomic clone of the new virus was infectious to chickpea (Cicer arietinum L.) and induced symptoms typical of CSD. We propose the use of the name Chickpea chlorotic dwarf Pakistan virus for the new species. The significance of these findings with respect to our understanding of the evolution, origin and geographic spread of dicot-infecting mastreviruses is discussed.

Asunto(s)

RESUMEN

Background: Sub-Saharan Africa is home to 25.8 million people living with HIV/Aids. In November 2003; the South African government approved The Operational Plan for Comprehensive Treatment and Care for HIV and Aids; which aimed to provide antiretroviral treatment to 500 000 patients by the end of 2007. The successful implementation of this operational plan requires many healthcare providers trained in aspects of HIV. This study aimed to establish and compare the views of general practitioners and pharmacists on the role of the pharmacist in HIV/Aids management and to elucidate an appropriate role for pharmacists. Ethical approval was obtained from the MEDUNSA Research Ethics and Publications Committee. Methods: The study population consisted of general practitioners in the province of Gauteng and community pharmacists in Gauteng and the Western Cape. Two hundred medical practitioners were selected at random from the 7 157 registered in Gauteng. Pharmacist respondents (293 from 879 community pharmacies in Gauteng and 200 from 493 in the Western Cape respectively) were selected randomly. The respondents were contacted individually by telephone and asked to complete a pilot-tested 10-statement questionnaire on their views of aspects relating to a role for pharmacists in HIV/Aids management. Results: Mean values for positive responses were calculated and analysed (two-sided t test). The response rates for general practitioners and pharmacists were 44.5and 38.1respectively. The responses were grouped into two categories; dispensing and advice and testing and treatment. Both groups agreed about the dispensing and advice category. Of the general practitioners surveyed; 95.5agreed that pharmacists should counsel patients on the correct use of medications and 100agreed that the pharmacist should be aware of all related side effects and drug interactions of HIV medications; i.e. the general practitioners were comfortable with pharmacists providing a dispensing and advisory role. The groups differed significantly about the testing and treatment category. Conclusion: GPs were generally not in favour of pharmacists being involved in the testing and treatment of HIV/Aids. The pharmacists surveyed; on the other hand; indicated their willingness to assume an expanded role in HIV/Aids management. A potential role for pharmacists was elucidated. It complements the role of the pharmacist in HIV/Aids management described in the South African Pharmacy Council Position Paper. The differences in views identified in the survey hold serious implications as South Africa struggles to contend with the HIV/Aids epidemic

Asunto(s)

RESUMEN

ABSTRACT Maize streak virus (MSV) is best known as the causal agent of maize streak disease. However, only a genetically uniform subset of the viruses within this diverse species is actually capable of producing severe symptoms in maize. Whereas these "maize-type" viruses all share greater than 95% sequence identity, MSV strains isolated from grasses may share as little as 79% sequence identity with the maize-type viruses. Here, we present the complete genome sequences and biological characterization of two MSV isolates from wheat that share approximately 89% sequence identity with the maize-type viruses. Clonal populations of these two isolates, named MSV-Tas and MSV-VW, were leafhopper-transmitted to Digitaria sanguinalis and a range of maize, wheat, and barley genotypes. Whereas the two viruses showed some differences in their pathogenicity in maize, they were both equally pathogenic in D. sanguinalis and the various wheat and barley genotypes tested. Phylogenetic analyses involving the genome sequences of MSV-Tas and MSV-VW, a new maize-type virus also fully sequenced in this study (MSV-VM), and all other available African streak virus sequences, indicated that MSV-Tas and MSV-VW are close relatives that together represent a distinct MSV strain. Sequence analyses revealed that MSV-VM has a recombinant genome containing MSV-Tas/VW-like sequences within its movement protein gene.

RESUMEN

OBJECTIVES: An in vivo study under well-controlled conditions was undertaken to determine the effect of Haemaccel, a colloidal plasma volume expander, on normal haemostasis. METHODOLOGY: Twenty patients, who were admitted for reduction mammaplasty, were included in this study. A standardised anaesthesia protocol was followed with all patients. Ten patients received 500 ml Haemaccel and 10 controls received 1,500 ml Ringer's lactate, a crystalloid solution. The solutions were administered intravenously during surgery over a period of 30-40 minutes. Standardised clinical observations and haematological tests were done at the following time intervals: after anaesthesia but before infusion of the plasma substitute, immediately after infusion was completed, and 20, 40 and 60 minutes after infusion. RESULTS: The blood pressure, pulse rate and O2 saturation levels were not influenced by the treatment given. Haemodilution was similar for the two patient groups. The platelet count and plasma levels of fibrinogen decreased in parallel with haemodilution. Thereafter the platelet count gradually increased to pre-infusion counts at 60 minutes. The prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT) and platelet aggregation in response to adenosine diphosphate (ADP) and collagen were not affected by the plasma volume expander given. Arachidonic acid-induced aggregation decreased significantly after Ringer's lactate was given but did not change when Haemaccel was given. The bleeding time was prolonged slightly, but not significantly, from 7.4 +/- 1.6 minutes to 8.8 +/- 1.6 minutes with Ringer's lactate and from 6.9 +/- 2.0 to 9.7 +/- 3.7 minutes with Haemaccel. CONCLUSIONS: We could not find any scientific evidence that Haemaccel affects haemostasis; neither does it increase bleeding relative to Ringer's lactate.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

The numbers of patients treated for seven types of carcinoma during 1977 at 10 hospitals in South Africa have been reviewed. The total number of patients admitted to the 10 hospitals in 1977 was 286 373. Slightly more than 1%, namely 3 409, of these patients suffered from carcinoma of the cervix, oesophagus, breast, lung, liver, stomach or colon. Carcinoma of the cervix was commonest among Black patients and carcinoma of the colon among Whites. The relative incidence of the different types of carcinoma among Whites was almost the opposite of the sequence among Blacks.

Asunto(s)

Asunto(s)