The impact of virtual medical student surgical conferences.

BACKGROUND: In recent years, the number of people pursuing a surgical career in the UK has decreased. The COVID-19 pandemic has led to the cancellation of surgical placements for medical students and has affected surgical education. This study evaluates the perceptions and impact of a 1-day virtual surgical conference for medical students considering pursuing a surgical career. METHODS: All delegates of the 2021 Barts and The London International Surgical Conference were invited to participate in two online surveys pre- and post-conference. Data were collected and analysed to evaluate delegates' reasons for attending the conference, and attitudes towards virtual conferences and a surgical career before and after the conference. RESULTS: Out of 132 participants, 106 (80.3%) completed both the pre- and post-conference surveys. Clinical students showed a statistically significant difference in interest in pursuing a surgical career after the conference than before (P=0.03), unlike pre-clinical students (P=0.12). Post-conference, 43 (40.6%) preferred a virtual to a face-to-face conference, which was a slight increase from 40 (37.7%) pre-conference, while 73 (68.9%) and 80 (75.5%) participants favoured virtual talks and presentations respectively. In contrast, only 12 (11.3%) and 21 (19.8%) students preferred workshops and networking virtually. Furthermore, delegates liked the global accessibility and environmentally-friendly nature of virtual conferences but found they can be less engaging and be disrupted by a poor internet connection. CONCLUSIONS: Virtual surgical conferences have many benefits and can help encourage medical students towards a surgical career. They could help bridge the surgical educational gap in medical school during these unprecedented times. Virtual conferences, which have a broader and more inclusive reach, could be an important complement to conventional conferences after the pandemic.

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines.

BACKGROUND: Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES: To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS: The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS: Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION: The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

Management of Atopic Eczema in primary care

@#Introduction: Atopic eczema (AE) is a common infammatory skin dermatosis that is increasing in prevalence. However, it can present in various clinical presentations, which leads to challenges in the diagnosis and treatment of the condition, especially in a primary care setting. Te Clinical Practice Guidelines on the Management of Atopic Eczema was developed by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2018. It covers the aspects of diagnosis, severity assessment, treatment, and referral.

Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults.

OBJECTIVES: Few studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults ( < 35 years) with CAD. METHODS: A 10-year (2003-2012) retrospective chart review was performed on patients less than 35 years diagnosed with CAD at Inkosi Albert Luthuli Central Hospital, Durban. RESULTS: Of the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects. CONCLUSION: Atherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.

Cutting the cost of South African antiretroviral therapy using newer, safer drugs.

Antiretrovirals are a significant cost driver for HIV programmes. Current first-line regimens have performed well in real-life programmes, but have a low barrier to virological resistance and still carry toxicity that limits adherence. New drug developments may mean that we have access to safer, more robust and cheaper regimens, but only if the appropriate clinical trials are conducted. We briefly discuss these trials, and demonstrate the large cost savings to the South African HIV programme if these are successful.

Psychosocial rehabilitation in a chronic care hospital in South Africa: views of clinical staff.

OBJECTIVE: The study was based at a South African hospital providing inpatient care for people with chronic mental disorders, and aimed at investigating the multidisciplinary team (MDT) members' views, understanding and attitudes towards psychosocial rehabilitation (PSR). METHOD: A survey method was used, with the MDT members completing a questionnaire that tapped, inter alia, their understanding of PSR, perceived aims and goals of PSR, adequacy of their professional training to implement PSR, availability of resources to implement PSR, and their views of chronic mentally ill patients, including their functional skills, needs and prognosis. RESULTS: Of 114 respondents, 19.3% felt they had sufficient knowledge of PSR practice, 53.5% reported that their professional training included teaching on PSR, 90.4% wanted to undertake further training in PSR, 64.9% believed that the hospital environment lends itself to PSR, and 23.7% felt the hospital had sufficient resources to perform PSR. Most (93%) believed that patients with chronic mental disorders can improve their functioning, and 65.8% thought that such patients could make decisions for themselves. CONCLUSION: It is not surprising that most of the clinical staff in this investigation do not feel sufficiently equipped to perform PSR interventions, considering that past mental health policies and training failed to emphasize this component of mental health care. The need for training programmes to address this deficit is evident.

Maternal Depression and Anxiety among Children with Mental Health Problems

Objective: The investigation sought to examine depression and anxiety levels in mothers of children with mental health problems. Method: A case control design was employed and self-reports of depressive and anxiety symptoms were measured in a group of women whose children were receiving mental health care; as well as a community control group and a group of women receiving outpatient psychiatric care. Results: No significant differences were noted in depressive and anxiety symptoms between the mothers of children with mental health problems and the community controls; although both of these groups showed significantly lower levels of depression and anxiety than the psychiatric patient group. These findings were not influenced by demographic variables. Conclusions: The findings are contrary to those of high income countries where mothers of children with mental health problems show higher levels of depression and anxiety. This disparity may be due to the sampling and mental health service usage patterns in low-income countries where mothers who seek mental health care for their children probably constitute a specific group of people who have awareness of mental health problems and available services. As a result their own mental health is likely to be better

Psycho-Legal Issues Surrounding the Rape of Children and Adolescents with Mental Retardation

The rape of individuals with mental retardation poses challenges for the judicial system as well as for the survivors themselves. As a result; the courts tend to refer these individuals for forensic mental health examination to assist them in proceeding with criminal trials. This sequence of events may appear unusual; considering that these individuals have already suffered significant trauma; and yet have to undergo mental health evaluation before the trial can begin. The questions posed by the courts to mental health experts deal with the cognitive assessment of the rape survivor; the survivor's ability to testify; and her/his capacity to consent to sexual intercourse. The paper provides an outline of this situation within the authors' work context in the KwaZulu-Natal Midlands; and also engages in a critical discussion of the issues involved in such forensic examinations; taking into consideration the implications for the expert witness and her/his approach to such examinations

Efficiency of solar water disinfection photocatalized by titanium dioxide of varying particle size.

Titanium dioxide photocatalysed water disinfection is induced by the interaction of light with TiO(2), which generates highly reactive free hydroxyl radicals (OH(*)). These free radicals create lethal damage that leads to bacterial death. Normally, decreasing TiO(2) particle size increases the area of light interaction. This may possibly increase the concentration of OH(*) generated and hence increases disinfection efficiency. Moreover, decreasing the particle size increases the force of attraction between the particles and cells, which could create aggregates that may contribute to the local OH(*) concentration. In the present investigation cells of Escherichia coli were used as the test microorganism, TiO(2) as the photocatalyst and sunlight as the light source. Four different surface areas of TiO(2) particles corresponding to 10, 50, 80-100 and > or =300 m(2) g(-1) were tested at a concentration of 1 g l(-1). Disinfection efficiency increased with increasing the surface area producing a maximum between 80-100 m(2) g(-1) followed by a reduction at > or =300 m(2) g(-1). The reduction in the efficiency at this relatively high surface area was attributed to the increase in the local concentration of OH(*). This increase may be high enough to initiate radical-radical interaction that would compete with bacterial cells and reduce the chance of bacterial cell-radical interaction taking place. Moreover, the phenomenon of TiO(2) aggregation with bacterial cells plays an important role, and the extent of aggregation increases with decreasing particle size. Such aggregation could augment the concentration of OH(*) within the cell vicinity. This suggests that surface area is a key factor in determining the efficiency of disinfection, and that concentration is a vital factor.

Mercury pollution from irrigation with treated sewage water (TSW).

The lack of potable water in arid countries leads to the use of treated sewage water (TSW) for crop growth. Mercury accumulation (up to 500 ng/g) in agricultural soil originating from daily irrigation with TSW was found at two sites fed separately from a hospital sewage plant and an industrial plant. A control site irrigated with potable water ([Hg] <0.01 ng/ml) had much reduced levels in soil (<12 ng/g). Cold-vapour analysis of TSW revealed that Hg concentrations fluctuated widely, and were between 10-100 times higher than those of potable water. The TSW data originated from a total of 46 samples (1 L each), from both plants, collected over a 6-month period. The Hg levels varied from 0.1 to 1.0 ng/ml, which suggested that the possible source of the accumulation could be found in continuous irrigation with comparatively higher Hg levels. Remedial measures could be approached from the perspective of curbing this inconsistency to produce more consistent Hg concentrations below 0.5 ng/ml. It was found that the electrical conductivity of TSW is a useful indicator to rapidly monitor fluctuations in treatment. A novel development in the study was the potential capacity of the plastic TSW discharge-pipes to behave as crude 'chromatographic' columns for possible Hg adsorption. If this property of the pipes is developed further it could have a considerable mitigating effect on the Hg levels. Possible recommendations for remediation to limit the Hg levels and promote sustainable development are discussed.

Molecular typing of Treponema pallidum strains from patients with neurosyphilis in Pretoria, South Africa.

OBJECTIVE: To evaluate the molecular typing system for Treponema pallidum using cerebrospinal fluid (CSF) specimens obtained from patients with neurosyphilis in Pretoria, South Africa. METHODS: CSF specimens were collected from 32 men and 18 women with suspected late neurosyphilis. Typing of T pallidum involved PCR amplification and restriction analysis of the tprE, G and J genes and determination of the number of 60 base pair tandem repeats within the arp gene by PCR amplification. RESULTS: Of 13 typeable specimens, 4 strain types were identified: 2i, 3e, 14a and 17e. Subtype 14a was identified in 7 specimens (53.8%), subtype 3e in 4 specimens (30.7%) and subtypes 17e and 2i in 1 specimen (7.6%) each. CONCLUSIONS: This study shows that the typing system can be applied to specimens which may contain low numbers of spirochaetes such as CSF.

Comparison of a TaqMan-based real-time polymerase chain reaction with conventional tests for the detection of Trichomonas vaginalis.

OBJECTIVE: To compare a TaqMan-based real-time polymerase chain reaction (PCR) with conventional PCR, culture, and wet-mount microscopy for the diagnosis of trichomoniasis in women. METHODS: Vaginal swabs from 119 women were tested for Trichomonas vaginalis by wet mount and culture. Paired vaginal lavage and urine specimens were tested by conventional and real-time PCR. RESULTS: Using an expanded "gold standard", defined as a positive culture result using vaginal swabs and/or a positive PCR test using TVK3/7 primers, the overall prevalence of T vaginalis in the study population was 65.5% (78/119). The detection rate of T vaginalis was 65.5% (78/119) and 36.9% (44/119) by conventional PCR using vaginal washings and urine specimens, respectively; 68.9% (82/119) by real-time PCR using vaginal washings and 61.3% (73/119) by real-time PCR using urine specimens. The sensitivities of conventional PCR using vaginal washings and urine and real-time PCR using vaginal washings and urine, compared with the gold standard were 100%, 56.4%, 100% and 76.7%, and the specificities of these tests were 100%, 97.6%, 82.9% and 97%, respectively. CONCLUSIONS: The real-time PCR test proved to be significantly more sensitive than culture and wet-mount microscopy, although its specificity was slightly lower than these tests. In addition, it was more sensitive, rapid and less time consuming than conventional PCR for the detection of T vaginalis.

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents. Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention. Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help. Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents.Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention.Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help.Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

Secondary School Learners' Essays on Suicide Prevention

Objectives: Considering the extent of the problem of suicidal behaviour among young people; the need for prevention programmes is paramount. The KwaZulu-Natal based 'Love to Live' campaign is a programme aimed at the prevention of suicidal behaviour among children and adolescents.Methods: The present study is an analysis of 63 essays written by secondary school learners on the subject of suicide prevention.Results: Just over two-thirds of the essays revealed reasonable knowledge without serious inaccuracies; with over half the sample citing conflict with parents as precipitants to suicidal behaviour. Over one-third of the essays blamed suicidal persons for being ineffective in dealing with their life problems; and over one-third identified mental health workers and parents as sources of help.Conclusions: The results are discussed in terms of adolescents' views of suicidal behaviour; as well as within the context of the limitations of the study methodology

Optimization of a high-performance liquid chromatography method to quantify bilirubin and separate it from its photoproducts: effect of column length, Ph, mobile phase composition, and flow rate.

A rapid reversed-phase (RP) high-performance liquid chromatography method for the isolation of bilirubin from its photoproducts (e.g., biliverdin) is reported. The method is based on isocratic elution using methanol:water as the mobile phase. A 24 full-factorial experimental design approach was adopted. For the optimization, the best separation was obtained using a flow rate of 1.50 mL/min, a mobile phase of 99:1 methanol:water (v/v) at pH 3.60, and a 150 x 4.6 mm id RP (C18) column containing 5-microm particles. These conditions produced the fastest total retention time of 3.38 +/- 0.055 min, and other chromatographic parameters were acceptable. Under the optimum conditions, a linear calibration curve for bilirubin was obtained over the 1.0-40.0 microg/L concentration range studied. The limit of quantification was 0.79 g/L and the limit of detection was 0.24 microg/L. Bilirubin in solution was monitored by ultraviolet detection at 450 nm.

Criminal capacity in children accused of murder: challenges in the forensic mental health assessment

Around the world there appears to have been an increase in child-perpetrated crimes; with South Africa being no exception. Of particular concern is the involvement of children in the perpetration of violent crimes; such as murder. This phenomenon is resulting in greater focus on the role of psychiatric and psychological testimony in the trials of accused youths. While mental health professionals have long been involved in the forensic assessment of adults; their role in the assessment of child accused is less well documented. As a result there is still a great deal of development and refinement needed in this area; in order that the task can be executed with more clarity and precision. Currently; South African law contains the presumption that a child under the age of seven years is doli incapax (i.e. he or she cannot be held criminally responsible); while there is a rebuttable doli incapax presumption in the case of children between the ages of seven and 14 years. The age of the accused; together with developmental and social competence indices; are crucial variables that influence the acceptance or rebuttal of the doli incapax presumption. The paper discusses the challenges in the forensic mental health assessment of children accused of murder

Criminal Capacity in Children Accused of Murder: Challenges in the Forensic Mental Health Assessment

Around the world there appears to have been an increase in child-perpetrated crimes; with South Africa being no exception. Of particular concern is the involvement of children in the perpetration of violent crimes; such as murder. This phenomenon is resulting in greater focus on the role of psychiatric and psychological testimony in the trials of accused youths. While mental health professionals have long been involved in the forensic assessment of adults; their role in the assessment of child accused is less well documented. As a result there is still a great deal of development and refinement needed in this area; in order that the task can be executed with more clarity and precision. Currently; South African law contains the presumption that a child under the age of seven years is doli incapax i.e. he or she cannot be held criminally responsible); while there is a rebuttable doli incapax presumption in the case of children between the ages of seven and 14 years. The age of the accused; together with developmental and social competence indices; are crucial variables that influence the acceptance or rebuttal of the doli incapax presumption. The paper discusses the challenges in the forensic mental health assessment of children accused of murder

Criminal Capacity in Children Accused of Murder: Challenges in the Forensic Mental Health Assessment

Around the world there appears to have been an increase in child-perpetrated crimes; with South Africa being no exception. Of particular concern is the involvement of children in the perpetration of violent crimes; such as murder. This phenomenon is resulting in greater focus on the role of psychiatric and psychological testimony in the trials of accused youths. While mental health professionals have long been involved in the forensic assessment of adults; their role in the assessment of child accused is less well documented. As a result there is still a great deal of development and refinement needed in this area; in order that the task can be executed with more clarity and precision. Currently; South African law contains the presumption that a child under the age of seven years is doli incapax i.e. he or she cannot be held criminally responsible); while there is a rebuttable doli incapax presumption in the case of children between the ages of seven and 14 years. The age of the accused; together with developmental and social competence indices; are crucial variables that influence the acceptance or rebuttal of the doli incapax presumption. The paper discusses the challenges in the forensic mental health assessment of children accused of murder