Corticosteroids in critical COVID-19: Are all corticosteroids equal?

BACKGROUND: The hyperinflammation seen as part of a dysregulated immune response to SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Corticosteroid therapy targets this hyperinflammation, otherwise known as a cytokine storm. It is the only therapeutic agent to date with a mortality benefit, with clear guidelines from national and international health authorities guiding its use. Objectives. To compare severity-of-illness indices, survival, length of intensive care unit (ICU) stay and potential ICU complications in patients treated with different corticosteroid regimens (high-dose hydrocortisone, high-dose methylprednisolone and lower-dose dexamethasone). Methods. In this single-centre descriptive retrospective observational study of a cohort of patients with severe COVID-19 admitted to a COVID-dedicated ICU, we compared patients treated with the three different corticosteroid regimens. Results. In 242 cases we could not demonstrate any statistically or clinically significant difference in the outcome of patients with critical COVID-19 treated with high-dose intravenous hydrocortisone (n=88) or methylprednisolone (n=46) compared with a relatively lower dose of dexamethasone (n=108). The survival rates were 38.6%, 39.1% and 33.3%, respectively (p=0.68). Patients treated with methylprednisolone tended to have a shorter length of ICU stay (median (interquartile range) 6 (4 - 10), 4 (2 - 8) and 5 (2 - 8) days; p=0.015) and fewer episodes of nosocomial sepsis (47.7%, 32.6% and 48.1%; p=0.01). Conclusions. Hydrocortisone or methylprednisolone can be given as an alternative to dexamethasone in the management of critical COVID-19, and this is a feasible alternative, especially in resource-constrained settings.

The utility of hand-held mobile spirometer technology in a resource-constrained setting.

BACKGROUND: Mobile phone-linked spirometry technology has been designed specifically for evaluating lung function at primary care level. The Air-Smart Spirometer is the first mobile spirometer accepted in Europe for the screening of patients with chronic respiratory diseases. OBJECTIVES: To prospectively assess the accuracy of the device in measuring forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in a South African population, and to investigate the ability of the device to detect obstructive ventilatory impairment. METHODS: A total of 200 participants were randomly assigned to perform spirometry with either the mobile spirometer connected to a smartphone or the desktop spirometer first, followed by the other. The FEV1/FVC ratio as well as the absolute FEV1 and FVC measurements were compared, using each participant as their own control. A Pearson correlation and Bland-Altman analysis were performed to measure the agreement between the two devices. We defined obstructive ventilatory impairment as FEV1/FVC <0.7 measured by desktop spirometry in order to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the Air-Smart Spirometer. RESULTS: There was a strong correlation between the absolute FEV1 and FVC values and FEV1/FVC ratio measured with the mobile Air-Smart Spirometer and more conventional pulmonary function testing, with r=0.951, r=0.955 and r=0.898, respectively. The Air-Smart Spirometer had a sensitivity of 97.6%, specificity of 74.4%, PPV of 73.0% and NPV of 97.8% for obstructive ventilatory impairment. CONCLUSIONS: The mobile Air-Smart Spirometer compared well with conventional spirometry, making it an attractive and potentially affordable tool for screening purposes in a primary care setting. Moreover, it had a high sensitivity and NPV for obstructive ventilatory impairment.

Caring presence in practice: facilitating an appreciative discourse in nursing.

AIM: To report on an appreciation of caring presence practised by nurses in South Africa in order to facilitate an appreciative discourse in nursing and a return to caring values and attitudes. BACKGROUND: Appreciative reports on caring presence are often overlooked. Media may provide a platform for facilitating appreciation for caring presence practised by nurses. Such an appreciation may foster further practice of caring presence and re-ignite a caring ethos in nursing. INTRODUCTION: This article provides an appreciative discourse on caring presence in nursing in the form of examples of caring presence practised by nurses. METHOD: An anecdotal approach was followed. Social media, namely narratives on caring presence shared by nurses on a Facebook page, and formal media, namely news reports in which nurses are appreciated for their efforts, were used. Deductive content analysis was applied to analyse the narratives and news reports in relation to a definition of caring presence and types of caring presence. FINDINGS: The analysis of the narratives and news reports resulted in an appreciative discourse in which examples of nurses practising caring presence could be provided. DISCUSSION: Examples of nurses practising caring presence could be found, and an appreciative discourse could be initiated. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: Appreciation ignites positive action and ownership of high-quality health care. Leadership should thus cultivate a culture of appreciating nurses, through using media, and encourage nurses to share how caring presence impact on quality in health care.

Anatrichosoma sp. in the footpads of a cat: diagnosis and pathology of Namibian case.

Anatrichosoma species are an unusual group of zoonotic trichuroid nematodes. Due to limited knowledge of their life cycle and diagnostic challenges, anatrichosomiasis has been reported only 3 times in domestic animals. A short-haired cat from central Windhoek, Namibia, presented with ulceration, swelling, and sepsis on all four paws, a severe generalized lymphadenopathy and considerable invasive eosinophilia. Histological analysis revealed epidermal hyperplasia, with severe serocellular crusting on the skin surface. One specimen revealed a series of thick-walled eggs within nematode segments with a few sections containing eggs with bioperculate appearance which is compatible with the Aphasmid group of nematodes, more specifically, the genus Anatrichosoma. Ivermectin treatment completely cleared the condition. This is the first report of Anatrichosoma sp. in the Republic of Namibia, identified from a unique location in the capital, Windhoek.

The pathology of acute Nolletia gariepina poisoning of cattle.

Toxicity in cattle by the shrub Nolletia gariepina was induced experimentally by intraruminal administration of 3 g/kg dried, milled plant material as a single dose. The animals had to be starved for 24 hours before dosing, as dosing on a full rumen did not induce any signs of toxicity during 5 days of observation and clinical pathology monitoring. Clinical signs were not specific and varied according to the duration (acute versus subacute) of the toxicological process. Clinical pathological parameters indicated renal and to a lesser extent hepatic damage, with raised serum concentrations of urea, creatinine, aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT). Increased urinary sodium and potassium concentration and GGT activity, as well as proteinuria, were evident. Histological and electron microscopic examinations revealed acute renal tubular epithelial cell degeneration and necrosis, especially of the proximal convoluted tubules. Mild hepatocellular degeneration was also noticeable.

Multiple eyelid apocrine hidrocystoma in a domestic short-haired cat.

A 12-year-old domestic short-haired cat was referred for evaluation of periocular masses. The tail had similar masses and was amputated previously by the referring veterinarian. On examination, multiple pigmented nodules, 3-15 mm in diameter, were found in the periocular skin, primarily involving the palpebral eyelid margin. A wedge excisional biopsy revealed small cuboidal cells forming multiple tubular and cystic structures indicative of apocrine cystadenomas, similar to apocrine hidrocystomas described in humans. The nodules were lanced followed by liquid nitrogen cryofreezing.

Reflecting on 'meaningful research': a qualitative secondary analysis.

Reflection on 'meaning' and 'meaningful research' led the researchers to further explore data obtained in an original study which aimed to develop a strategy to improve the contribution of nurses towards health research. The purpose of this further exploration, using a qualitative secondary analysis, was to explore and describe what important stakeholders in research, as well as nurses, see as meaningful research. It was expected that this analysis might contribute to refine the strategy and shed light on how research can be communicated to nurses as a more meaningful activity. The original data sets, namely 28 lists of open-ended questions and eight transcripts of focus group interviews, were analysed, using content analysis. The results show that there are similarities, but differing emphasis, between the viewpoints of the mentioned stakeholders and nurses. It is recommended that stakeholders in research, including nurses, need to establish and work in respectful, supportive, research capacity building partnerships when conducting research. Following this approach might lead to research being understood and experienced by nurses as a meaningful activity.

Mitigating the plight of HIV-infected and -affected nurses in Zambia.

AIM: This article responds to the challenge to nurses to ensue and write about successful HIV-related research projects. The article describes the highly valuable 'Caring for the Caregivers' project in Zambia, highlighting the development of the project, valuable lessons learnt and further developments. The article serves as a valuable guideline for nurses and health professionals from other disciplines in developing similar projects. BACKGROUND: In a sub-Saharan country hard hit by HIV/AIDS, nurses and midwives desperately need support. The Zambian Nurses' Association and the Norwegian Nurses' Organisation partnered to mitigate the plight of infected and affected nurses in Zambia in a sustainable manner. FOCUS OF THIS ARTICLE: This article highlights the successes of this partnership, as well as valuable lessons learnt. It reflects on a needs assessment survey carried out to identify the needs of nurses in caring for AIDS patients, and describes the ensuing recommendations and implementation of the 'Caring for the Caregivers' project, focusing on training, local support groups and monitoring. Further developments are mentioned briefly and the relevance of such a partnership and ensuing project for the discipline of nursing is also commented on.

Professional nurses' perceptions of the skills required to render comprehensive primary health care services.

As multidisciplinary health team members, professional nurses play a vital role in the delivery of primary health care services. They require specific knowledge and skills to function effectively in the primary health care settings. In South Africa, however, professional nurses followed various training programmes. This has made it difficult for the professional nurses to be competent in rendering the full spectrum of comprehensive primary health care services, focussing on preventive, promotive, curative as well as rehabilitative care. In a setting where professional nurses have different qualifications it is possible that they do not recognise their own limitations. The research aimed to explore and describe the perceptions of professional nurses about the skills required and their own level of skills to render comprehensive primary health care services. A further aim of the research was to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services, based on the findings. A qualitative design was followed. Participants were identified by means of purposive voluntary sampling and data was collected by utilising a semi-structured interview schedule. Twenty two participants were interviewed. After each interview field notes were written. Ethical aspects and confidentiality were taken into consideration. The researcher and a co-coder analysed the transcribed interviews by means of open coding. The findings indicated that the more comprehensively the professional nurses were trained, the more competent they felt. The less comprehensively trained, the more negative they experienced their work. They viewed their skills as ranging from adequate to inadequate, depending on their training. The conclusion was drawn that professional nurses' perceptions were congruent with the skills they possessed. Recommendations for nursing research, education and practice, including guidelines to facilitate trained professional nurses to truly render comprehensive primary health care, were formulated.

An investigation into natural resistance to African swine fever in domestic pigs from an endemic area in southern Africa.

A population of domestic pigs in northern Mozambique with increased resistance to the pathogenic effects of African swine fever (ASF) virus was identified by the high prevalence of circulating antibodies to ASF virus. An attempt was made to establish whether the resistance in this population was heritable. Some of these pigs were acquired and transported to a quarantine facility and allowed to breed naturally. Offspring of the resistant pigs were transferred to a high security facility where they were challenged with two ASF viruses, one of which was isolated from one of the Mozambican pigs and the other a genetically closely-related virus from Madagascar. All but one of the 105 offspring challenged developed acute ASF and died. It therefore appears that the resistance demonstrated by these pigs is not inherited by their offspring, or could not be expressed under the conditions of the experiment. The question remains therefore as to the mechanism whereby pigs in the population from which the experimental pigs were derived co-existed with virulent ASF viruses.

Reclassification of Lactobacillus casei subsp. casei ATCC 393 and Lactobacillus rhamnosus ATCC 15820 as Lactobacillus zeae nom. rev., designation of ATCC 334 as the neotype of L. casei subsp. casei, and rejection of the name Lactobacillus paracasei.

The type strain of Lactobacillus casei subsp. casei (ATCC 393) exhibits low levels of DNA homology with other strains of L. casei subsp. casei (8 to 46%) and strains of Lactobacillus paracasei (30 to 50%), but exhibits a level of DNA similarity of 80% with Lactobacillus rhamnosus ATCC 15820, the original type strain of "Lactobacterium zeae" Kuznetsov 1959. Strains ATCC 393T (T = type strain) and ATCC 15820T are members of one protein profile cluster that is separate from the other Lactobacillus spp. The randomly amplified polymorphic DNA PCR profile of strain ATCC 393T is also different from the profiles obtained for the other species. L. casei ATCC 334T is genetically closely related to L. casei subsp. casei strains (71 to 97%) and L. paracasei strains (71 to 91%), is a member of the same protein profile cluster as these organisms, and shares several DNA amplicons with L. paracasei strains. On the basis of these results, we propose that L. casei subsp. casei ATCC 393T and L. rhamnosus ATCC 15820 should be reclassified as members of Lactobacillus zeae nom. rev. (type strain, ATCC 15820), that strain ATCC 334 should be designated the neotype strain of L. casei subsp. casei, and that the name L. paracasei should be rejected.

Evaluation of random amplified polymorphic DNA (RAPD)-PCR as a method to differentiate Lactobacillus acidophilus, Lactobacillus crispatus, Lactobacillus amylovorus, Lactobacillus gallinarum, Lactobacillus gasseri, and Lactobacillus johnsonii.

The technique random amplified polymorphic DNA (RAPD)-PCR was evaluated as a method to differentiate Lactobacillus acidophilus, Lactobacillus crispatus, Lactobacillus amylovorus, Lactobacillus gallinarum, Lactobacillus gasseri, and Lactobacillus johnsonii. Representative strains, including the type of each species, were selected from different clusters obtained by numerical analysis of total soluble cell protein patterns. Results obtained by RAPD-PCR corresponded well with results obtained by numerical analysis of total soluble cell protein patterns. The type strains of each species displayed different RAPD profiles. Strains with identical L(+)- nicotinamide adenine dinucleotide-dependent lactic dehydrogenase (nLDH) electrophoretic profiles could be distinguished on the basis of their RAPD profiles.