Effect of diet on the incidence of and mortality owing to gastritis and renal disease in captive cheetahs (Acinonyx jubatus) in South Africa.

Seventy-two adult cheetahs were evaluated for the degree of gastritis by endoscopic biopsy and for renal disease by serum creatinine. Cheetahs free of Grade 3 gastritis and renal disease were placed on Trial A; remaining cheetahs were placed on Trial B, which ran concurrently. All cheetahs were monitored for 4 years. Cheetahs exited Trial A and entered Trial B if they developed Grade 3 gastritis or renal disease. Cheetahs exited Trial B if they developed clinical gastritis or renal disease that required a dietary change or aggressive medical therapy or died owing to either disease. Cheetahs on Trial A were fed either a supplemented meat diet (N = 26) or commercial cat food (N = 22). Cheetahs on Trial B were fed either the same meat diet (N = 28) or a commercial dry cat food formulated for renal disease (N = 16). Cheetahs fed meat on Trial A had a daily hazard of developing Grade 3 gastritis 2.21 times higher (95% CI 0.95-5.15) than cheetahs fed commercial cat food. This hazard was not statistically significant (P = 0.07). Mean gastritis scores were not significantly different between the two groups. Cheetahs fed commercial cat food in both Trials had lower serum urea levels and higher creatinine levels than those fed meat. Evidence for the effect of diet in cheetahs with gastritis and/or renal disease (Trial B) was inconclusive. The number of cheetahs dying of gastritis or renal disease at the facility has dropped markedly since the study began. These results indicate that diet may play an important role in the incidence of Grade 3 gastritis and that dietary and/or therapeutic management of gastritis may reduce mortality owing to gastritis and renal disease in captive cheetahs.

Captive breeding of cheetahs in South Africa--30 years of data from the de Wildt Cheetah and Wildlife Centre.

The de Wildt Cheetah and Wildlife Centre was established in 1971 and the first cheetah cubs were born in 1975. During the period 1975-2005, 242 litters were born with a total of 785 cubs. Mean cub survival from 1 to 12 months and greater than 12 months of age was 71.3 and 66.2%, respectively. The majority of losses (84.9%) occurred during the first month postpartum whereas only 15.1% deaths took place between 1 and 12 months of age. Females were first bred at an age of approximately 3 years, reached maximum reproductive age at 6-8 years, where after fertility declined. Males reached peak reproduction at 6 and maintained this for up to 12 years of age. Male fertility was best correlated with sperm morphology. During recent years, for practical purposes, males were allocated to 'good' (>or=70% normal), 'fair' (40-70% normal) and 'poor' (<40% normal) categories according to sperm morphology count. The breeding males were selected from the good (preferably) and fair categories but poor category males were also used at times. Average litter sizes for 'good', 'fair' and 'poor' males were 3.44 (n = 21), 3.14 (n = 18) and 2.28 (n = 18), respectively. In females the heritability for litter size was high at 0.5848 (532 progeny, 1975-2007) and the maternal heritability for cub mortality was estimated to be 0.596. The data from the de Wildt Cheetah and Wildlife Centre and two other centres in the world (Kapama and Wassenaar) demonstrate that cheetah can be bred successfully in captivity.

The quality of nursing care regarding personal hygiene of patients admitted to a selected hospital in the Kavango region.

The aim of the study was to determine the quality of nursing care regarding personal hygiene of patients admitted to a hospital in the Kavango region of Namibia. The study was prompted by repeated media reports over the radio. Commentators and listeners expressed concern over the seeming lack of adequate hygienic measures, specifically with regard to patient care. To objectively quantify and describe the extent of this problem, a single objective was stated, namely to measure the quality of nursing care with regard to patient hygiene. A descriptive survey design was chosen to explore and describe the problem. A check-list was developed to observe thirty patients (the total population) over a period of one week. The results indicated that certain aspects of hygienic care needed improvement. These aspects (parts) were the care of male patient's beards; perineal care; and mouth care. Other aspects of care were indirectly negatively influenced due to incomplete record keeping. On completion of the study recommendations were made with regard to in-service education, management and research.

"To know or not to know": service-related barriers to voluntary HIV counseling and testing (VCT) in South Africa.

Voluntary HIV Counselling and Testing (VCT) is still in its infancy in South Africa, and although the necessary infrastructure in terms of clinics and hospitals exists, a VCT culture is not yet established in the country. The purpose of this study was to determine the needs, attitudes and beliefs of a sample of South Africans towards VCT, and to investigate possible barriers affecting participation in VCT programs in South Africa. A semi-structured questionnaire was used to survey the views of 1422 people. Results indicate that while subjects were not opposed to VCT in principle, 33% would go to clinics where nobody would know them. The following problems with VCT services were mentioned: Logistical problems (not enough counsellors, long lines, lack of privacy); no trust in the health care system or fearing a breach of confidentiality; fear of rejection; and a lack of follow-up support after diagnosis. Suggestions are made on how to improve VCT services in South Africa.

A comparison of propofol and remifentanil for sedation and limitation of movement during periretrobulbar block.

STUDY OBJECTIVES: To compare clinical conditions in patients sedated with propofol or remifentanil during combined peri-bulbar and retrobulbar block (PRBB) for cataract surgery. DESIGN: Prospective, randomized, double-blind study. SETTING: Private clinic. PATIENTS: 106 ASA physical status I and II patients scheduled for cataract surgery. INTERVENTIONS: Patients were randomized to receive either 0.5 mg/kg propofol (Group P) or 0.3 microg/kg remifentanil (Group R) as an intravenous (IV) bolus 1 minute prior to PRBB. At the same time, patients in both groups also received 0.5 to 1 mg midazolam IV. Movement of the hands, arms, head, and eyes were counted during each stage of the procedure by an observer who was blinded to the sedation used. Heart rate (HR), blood pressure (BP), respiratory rate (RR), expiratory CO(2) (PECO(2)), and hemoglobin oxygen saturation (SaO(2)) were recorded every minute for 10 minutes after the PRBB. Anesthetic complications, recall, and the pain experienced with the block and surgery were compared between the two groups. Means and variance of the results were compared with one-way analysis of variance and Fisher's exact test. MEASUREMENTS AND MAIN RESULTS: Movements of the hands, arms, and head were significantly greater in Group P during all stages of the block. Almost no movements were recorded in the remifentanil group. Immediately after the PRBB (1 to 6 min), HRs were higher in Group P (73 +/- 11 bpm vs. 67 +/- 10 bpm; p = 0.0075), whereas the RRs were slower in Group R for the period 1 to 5 minutes after the PRBB (16 +/- 5 breaths/min vs.14 +/- 4 breaths/min; p = 0.0206). At these times, the mean PECO(2) was higher in Group R (36 +/- 7 mmHgvs. 32 +/- 9 mmHg; p = 0.0125). Nineteen patients in the propofol group sneezed during the medial peribulbar injection compared with none in the remifentanil group. Anesthetic and surgical complications were unremarkable and similar for the two groups. CONCLUSIONS: Respiratory depression with remifentanil was mild and not clinically significant. Remifentanil sedation for this application was superior to sedation with propofol.

Prevention of acute graft-versus-host-disease by selective depletion of T cells reactive with minor histocompatibility antigens on epithelial cells.

Graft-versus-host disease (GVHD) is a major obstacle in allogeneic hematopoietic stem cell transplantation (HSCT). Mature donor T-cells present in the graft play a pivotal role in the development of acute GVHD. On the other hand, mature donor T-cells in the graft are also crucial for the elimination of residual tumor cells still present in the patient after HSCT. Whether donor T cells act non-specifically against the patient, including an overlapping GVHD/GVL reactivity, or some donor T cells have GVHD reactivity while other donor T cells have GVL reactivity is still unclear. Some in-vitro data are suggestive that selective T cell depletion techniques are possible by which GVHD-reactive T cells can be eliminated while GVL-reactive T cells are preserved. Here we update some approaches of selective T cell depletion that have been developed in our laboratory.

"Why me and not my neighbour?" HIV/AIDS care and counselling in a traditional African context.

HIV/AIDS in Africa places a tremendous burden on the nursing profession. Hospitals are inundated with very sick and dying AIDS patients and nurses often find that their role as healers has shifted to a great extent to that of caregivers, counsellors and educators. AIDS also calls for nurses to go beyond the strict Western-based bio-medical model to be able to help and understand patients who come from a traditional African background. This article discusses relevant aspects of the traditional African worldview by explaining what health, sickness and sexuality mean in traditional Africa. Traditional African perceptions of the causes of illness (God, ancestors, witches, pollution and germs), perceptions of sexuality, the importance of having children, cultural beliefs inhibiting the usage of condoms, the importance of community life, as well as the controversial issue of confidentiality in Africa are discussed. The implications for AIDS care and counselling in Africa are explored and suggestions on how to use traditional beliefs and customs to the advantage of AIDS education, are offered.

Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study.

Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

Chlamydia trachomatis lower respiratory tract infection in infants.

Chlamydia trachomatis may be an important cause of lower respiratory tract infection (LRTI) in infants born to mothers amongst whom there is a high prevalence of sexually transmitted disease. A study of 100 ambulatory infants with signs of LRTI in South Africa showed that 6% had C. trachomatis infection. The majority of the infected infants had received chloramphenicol eye ointment as prophylaxis. Half had previously visited a health facility for the same illness but the infection has been misdiagnosed. Infants with C. trachomatis infection were According to the Centers for Disease Control (CDC) guidelines, 85% were younger than uninfected infants (mean (SD) age of 3.8 weeks (3.2) vs 8.7 weeks (5.4); p=0.03). Clinical signs significantly associated with chlamydial infection were the presence of eye discharge (p = 0.02) or conjunctivitis (p = 0.01). There was a greater rate of rhinorrhoea (p = 0.06) and wheeze (p = 0.03) amongst patients without chlamydial infection. H. influenzae, M. catarrhalis, S. pneumoniae, S. aureus and N. gonorrhoeae were cultured from five different patients infected with chlamydia. The majority of infants with chlamydial infection had mild disease requiring only outpatient anti- biotic therapy.

Perianal candidosis--a comparative study with mupirocin and nystatin.

OBJECTIVE: To assess the efficacy and clinical outcome of 2% mupirocin in a polyethylene glycol base and nystatin cream as treatment regimens in diaper candidosis. DESIGN: A prospective randomized comparative study. METHODS: In vitro. The susceptibility of 20 clinical isolates of Candida albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed. RESULTS: In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 microg/mL in one case, 256 microg/mL in six cases, 200 microg/mL in 10 cases and 400 microg/mL in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication of all Candida organisms was achieved within 2-6 days (mean, 2.6 days) in 10 patients receiving topical mupirocin therapy with rapid healing of the excoriated wounds (mean, 4.7 days). Both Gram-positive and Gram-negative bacteria were eradicated from the infected area within the trial period. Ten patients received topical nystatin cream and, in each case, Candida was successfully cleared within 5 days (mean, 2.8 days). Only three wounds were clinically healed within the trial period, however. The remaining seven wounds showed evidence of improved, but ongoing excoriated dermatitis and a heavy growth of polymicrobial organisms. CONCLUSIONS: Both agents eradicated Candida, the major difference being the marked response of the diaper dermatitis to mupirocin. Mupirocin should be applied topically 3-4 times daily or with each diaper change and is an excellent antifungal agent.

An assessment of the quality of care given to, and hygiene on patients at a teaching hospital in Namibia.

An assessment was done during 1991 to evaluate the quality of care with regard to mouth hygiene rendered to patients in a teaching hospital in Namibia. The sample was drawn from nine wards. By means of a type of quota sampling, the patients were categorised as dependent, interdependent or independent. The nursing process was used as a framework for the study. From the assessment it became evident that no policies existed with regard to oral hygiene. Planning was not in every case based on assessment, and it seemed that when planning(s) were done, it was not always implemented. Record keeping was the aspect most poorly attended to.

Symptomatic HIV infection in infancy--clinical and laboratory markers of infection.

OBJECTIVE: To investigate the usefulness of immunological tests in the diagnosis of HIV infection in young symptomatic children (< 15 months of age). DESIGN: Tests were evaluated in HIV-infected (HIV antibody- and PCR-positive) patients and non-infected individuals. SETTING: Hospitalised patients in a referral centre (Red Cross War Memorial Children's Hospital, Cape Town). PATIENTS: All admissions under 15 months of age who had HIV antibody requested were eligible, provided there was sufficient serum (150 microliter) for further study. Overall, there were 201 symptomatic cases and 49 healthy controls. Twenty of the symptomatic cases were HIV antibody-positive and 19 of these were HIV-infected on the basis of a positive PCR for HIV viral product. RESULTS: Of the tests we evaluated (total IgG, IgM, IgA and rheumatoid factors of the same classes), raised total IgG level (cut-off 18 g/I or above) was the most useful. We used a commercial radial immunodiffusion plate which was found to have excellent reproducibility (inter-assay coefficient of variation 3.2%). The test detected 16 of 19 infected infants (sensitivity 84%, negative predictive value 98%). With the exception of the finding of oral thrush (odds ratio 7; P < 0.001), the clinical signs at presentation did not distinguish those who were HIV antibody-positive from those who were negative. CONCLUSIONS: In our study of hospital admissions, the finding of elevated IgG and HIV antibody was diagnostic of HIV infection. (The positive predictive value of the combination was 100%.) Likewise, the presence of raised IgG levels and oral candidosis had a high specificity for HIV infection (98%) but the sensitivity was low (37%). Measurement of total IgG levels by radial immunodiffusion is simple, relatively inexpensive (< 10% of the cost of PCR), helpful in diagnosing HIV infection in symptomatic infants and able to be performed in areas with minimal laboratory back-up.

An evaluation of the quality of nursing care rendered to patients with intravenous infusions in the Windhoek Hospital Complex.

Patients on intravenous infusions are commonly seen in the Windhoek Hospital Complex. There was concern regarding the type of nursing care these patients received which led to a survey on the quality of care rendered to these patients. The findings showed that care delivered ranged from very poor to good. Some startling information became evident in that legal aspects were often ignored and that basic things such as calculating and charting the daily intake and output, were omitted. Most of these problems can be rectified through in-service education.

CT of intracranial tuberculomas with specific reference to the "target sign".

The CT appearances of 30 patients with a total of 58 intracranial tuberculomas are discussed. Of specific interest in this study is the relatively high incidence of patients who presented with the target sign. To date there has been only 1 report of 4 cases with this appearance on CT. Four basic patterns of post contrast enhancement are described. As suggested by Welchman this study concludes that the target sign is pathognomonic of an intracranial tuberculoma.

Ringworm of the scalp in children.

Scalp scrapings were collected from 651 children in the Cape Peninsula and along the Western Cape coast to determine which dermatophytic fungi occur in these areas. Fungi were isolated from 61% of specimens, by far the commonest being Trichophyton violaceum. Only half of these specimens showed fungal elements on direct microscopy. Among patients with scaly scalp lessons of varying severity the isolation rate was 64%, but dermatophytic fungi were also isolated from 16% of 50 asymptomatic children. Carriers of fungi without obvious ringworm may play an important role in the spread of the disease.

Unique seminal quality in the South African cheetah and a comparative evaluation in the domestic cat.

Analysis of 40 semen samples collected by electroejaculation from 18 cheetahs revealed no major differences in seminal traits among Transvaal, South West (Namibia) or hybrid (Transvaal X South West) males. However, mean spermatozoal concentration (14.5 X 10(6) spermatozoa/ml of ejaculate) and percent motility (54.0%) were less in cheetahs than in domestic cats (147.0 X 10(6) spermatozoa/ml of ejaculate, 77.0% motility) subjected to the same electroejaculation regimen. On the average, cheetah ejaculates contained 71.0% morphologically abnormal spermatozoa compared to 29.1% aberrant spermatozoal forms in the domestic cat. These results indicate that seminal characteristics in the cheetah are markedly inferior compared to the domestic cat, particularly with respect to the incidence of pleiomorphic spermatozoa. Because a recent parallel study demonstrates that the cheetah lacks genetic variation, it appears likely that spermatozoal abnormalities are a genetic consequence of genomic homozygosity characteristic of this endangered species.