Best practice recommendations for bladder management in spinal cord-afflicted patients in South Africa.

Recent research on the standard of care and related quality of life of the spinal cord-afflicted community in South Africa (SA) has revealed significant gaps in practice, and challenges regarding levels of care and access to services and supplies specifically related to the neurogenic bladder.

Performance evaluation of the microINR® point-of-care INR-testing system.

INTRODUCTION: Point-of-care International Normalised Ratio (INR) testing is used frequently. We evaluated the microINR® POC system for accuracy, precision and measurement repeatability, and investigated instrument and test chip variability and error rates. METHODS: Venous blood INRs of 210 patients on warfarin were obtained with Thromborel® S on the Sysmex CS-2100i® analyser and compared with capillary blood microINR® values. Precision was assessed using control materials. Measurement repeatability was calculated on 51 duplicate finger-prick INRs. Triplicate finger-prick INRs using three different instruments (30 patients) and three different test chip lots (29 patients) were used to evaluate instrument and test chip variability. RESULTS: Linear regression analysis of microINR® and Sysmex CS2100i® values showed a correlation coefficient of 0.96 (P < .0001) and a positive proportional bias of 4.4%. Dosage concordance was 93.8% and clinical agreement 95.7%. All acceptance criteria based on ISO standard 17593:2007 system accuracy requirements were met. Control material coefficients of variation (CV) varied from 6.2% to 16.7%. The capillary blood measurement repeatability CV was 7.5%. No significant instrument (P = .93) or test chip (P = .81) variability was found, and the error rate was low (2.8%). CONCLUSION: The microINR® instrument is accurate and precise for monitoring warfarin therapy.

Awareness of venous thromboembolism in mental health services for older people.

Venous thromboembolism (VTE) is an important safety issue in the inpatient mental health care of older people. In a survey of specialist mental health staff, knowledge of deep vein thrombosis was good. More variable awareness of the presentation and risk factors for pulmonary embolism indicates the need for training integrated into regular physical health care updates. Currently, failure to adequately screen and prevent venous thromboembolism (VTE) is estimated to cause between 25,000 and 32,000 potentially avoidable deaths annually in the United Kingdom. The authors aimed to assess the awareness of VTE in clinical staff working in Mental Health Services for Older People, Tees, Esk and Wear Valleys National Health Service Foundation Trust. A questionnaire was devised to assess knowledge of VTE symptoms, risk factors, prevention, and treatment in clinical staff working in Mental Health Service for Older Peoples' inpatient units. Forty-nine nurses, 12 consultant psychiatrists, and 11 clinical pharmacists responded. A significant proportion of staff had previous involvement in VTE treatment. Staff had significantly more limited knowledge of pulmonary embolism compared to deep vein thrombosis with areas for improvement in presentation, risk factors, and prevention. The study confirms a need for improved awareness among all clinical staff including nurses, pharmacists, and doctors, which can be met by including VTE awareness in First Response training, and encouraging use of the Department of Health VTE e-learning tool.

Characteristics and Factors Influencing Fast Food Intake of Young Adult Consumers in Johannesburg South Africa

Objectives: To determine fast food consumption patterns; socio-economic characteristics and other factors that influence the fast food intake of young adults from different socio-economic areas in Johannesburg; South Africa. Methods: A descriptive; cross-sectional study was undertaken; using an interviewer-administered; validated questionnaire to elicit the characteristics of the study population (adults aged from 19 to 30 years); their reasons for and frequency of fast food consumption; their specific fast food choices; and their attitudes towards health. Results: The study population (n = 341) consisted primarily of young working adults (n = 242) with at least a secondary education. Almost half (42; n = 102) of the employed participants earned less than R5 000 per month; but spent more than R200 on fast food per month.Twenty-one per cent of all participants had fast food at least once a week; while 27.6had it two to three times a week. Socio-economic group (SEG) and gender were significantly related to fast food intake (p 0.01); with a larger proportion of participants (65; n = 76) in the lower socio-economic group (LSEG) showing more frequent use. Males consumed fast food more frequently than females. The most popular fast foods consumed were burgers (69.5); pizza (56.6) and fried chicken (38.4). Soft drinks were the most popular beverage consumed (56). The main reasons for choosing fast food were time limitations (58.9); convenience (58.2) and taste (52.5). The majority of the participants were concerned about their health (93.3) and indicated a fear of becoming overweight (44.3). Seventy-eight per cent of all the participants would have chosen a healthier option if it had been available on the menu. Television was reported to be the most effective medium influencing their food choices. Conclusion: Fast food intake appears to be very common in this group of young South African adults. Various factors that influence fast food intake were identified that provide health educators and policy makers with useful information for health promotion

Characteristics and Factors Influencing Fast Food Intake of Young Adult Consumers in Johannesburg South Africa

Objectives: To determine fast food consumption patterns; socio-economic characteristics and other factors that influence the fast food intake of young adults from different socio-economic areas in Johannesburg; South Africa. Methods: A descriptive; cross-sectional study was undertaken; using an interviewer-administered; validated questionnaire to elicit the characteristics of the study population (adults aged from 19 to 30 years); their reasons for and frequency of fast food consumption; their specific fast food choices; and their attitudes towards health. Results: The study population (n = 341) consisted primarily of young working adults (n = 242) with at least a secondary education. Almost half (42; n = 102) of the employed participants earned less than R5 000 per month; but spent more than R200 on fast food per month.Twenty-one per cent of all participants had fast food at least once a week; while 27.6had it two to three times a week. Socio-economic group (SEG) and gender were significantly related to fast food intake (p 0.01); with a larger proportion of participants (65; n = 76) in the lower socio-economic group (LSEG) showing more frequent use. Males consumed fast food more frequently than females. The most popular fast foods consumed were burgers (69.5); pizza (56.6) and fried chicken (38.4). Soft drinks were the most popular beverage consumed (56). The main reasons for choosing fast food were time limitations (58.9); convenience (58.2) and taste (52.5). The majority of the participants were concerned about their health (93.3) and indicated a fear of becoming overweight (44.3). Seventy-eight per cent of all the participants would have chosen a healthier option if it had been available on the menu. Television was reported to be the most effective medium influencing their food choices. Conclusion: Fast food intake appears to be very common in this group of young South African adults. Various factors that influence fast food intake were identified that provide health educators and policy makers with useful information for health promotion

Post traumatic stress disorder: undiagnosed cases in a tertiary inpatient setting.

OBJECTIVE: Post traumatic stress disorder (PTSD) is a common, debilitating anxiety disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. Since it occurs commonly as a comorbid diagnosis with other mood- and anxiety disorders, we postulated that this disorder may be under- diagnosed in therapeutic wards where anxiety and mood disorders are treated. The study thus sought to determine the prevalence of undiagnosed PTSD in an inpatient population, and to compare the demographic details and comorbid diagnoses of subjects with and without PTSD. METHOD: The Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to 40 subjects who were inpatients in a therapeutic ward of a large psychiatric hospital and who had never had a diagnosis of PTSD before. RESULTS: 16 (40%) subjects met the DSM-IV criteria for PTSD. We did not find significant clinical differentiating factors between subjects with and without PTSD; however subjects with PTSD were more likely to use cannabis. CONCLUSIONS: PTSD remains undiagnosed in many patients admitted to therapeutic units.

The effects of insulin and beta-adrenergic stimulation on glucose transport, glut 4 and PKB activation in the myocardium of lean and obese non-insulin dependent diabetes mellitus rats.

Glucose uptake, glut 4 translocation and activation of protein kinase B were measured in Langendorff perfused hearts from (i) Wistar control, (ii) lean, neonatal Streptozotocin induced (Stz) and (iii) Zucker (fa/fa) obese diabetic rats of 10-12 weeks old. Hearts were subjected to stimulation with insulin, isoproterenol (beta-adrenergic agonist) or a combination of insulin and isoproterenol, during the perfusion protocol. Basal myocardial glucose uptake was impaired in both diabetic models, but could be stimulated significantly by insulin. In the Zucker rats, the time-course of insulin action was delayed. Insulin and beta-stimulation of glucose uptake were not additive. Evaluation of sarcolemmal membranes from these hearts showed that the affinity of glut 4 was significantly lower in the Zucker but not in the Stz hearts while a reduced affinity found with a combination of insulin and beta-stimulation in control hearts, was absent in both diabetic models. Total membrane lysates were analyzed for glut 4 expression while an intracellular component was generated to quantify translocation on stimulation as well as activity of protein kinase B (PKB). At this age, the neonatal Streptozotocin induced diabetic animals presented with more faulty regulation concerning adrenergic stimulated effects on elements of this signal transduction pathway while the Zucker fa/fa animals showed larger deviations in insulin stimulated effects. The overall response of the Zucker myocardium was poorer than that of the Stz group. No significant modulation of beta-adrenergic signaling on insulin stimulated glucose uptake was found. The PI-3-kinase inhibitor wortmannin, could abolish glucose uptake as well as PKB activation elicited by both insulin and isoproterenol.

Canine babesiosis in South Africa: more than one disease. Does this serve as a model for falciparum malaria?

South African canine babesiosis is caused by the virulent Babesia canis rossi. In recent years, this common disease has been detected in 12% of dogs presented at the outpatients' division of the University of Pretoria's (Onderstepoort) Veterinary Academic Hospital, and 31% of the affected dogs have been hospitalized as seriously ill. Of these hospitalized cases, 50% had severe anaemia at presentation, 32% had moderate anaemia and 18% were non-anaemic (often polycythaemic), frequently with central-nervous-system signs or multiple organ failure. A retrospective survey of 662 hospitalized cases revealed that the haematology, clinical biochemistry and patient profile (signalment) of the severely anaemic dogs were distinct from those of the non-anaemic, indicating that the babesiosis in these two groups of dogs should be viewed as two different disease in terms of the postulated, underlying, 'pathomechanisms'. The severely anaemic dogs exhibited hypoxic hepatic disease and an increase in serum urea (without a concomitant increase in creatinine), seldom had profound electrolyte imbalances and tended to have a much more profound leucocytosis, consisting of a left-shifted inflammatory leucogram, with higher numbers of circulating metamyelocytes, lymphocytosis and monocytosis. In contrast, the non-anaemic dogs exhibited severe azotaemia (which could be of renal or pre-renal origin) and often showed a marked electrolyte disturbance (reflecting acid-base abnormalities) and a very mild leucocyte response; such dogs often presented as leucopenic, many being lymphocytopenic. These results indicate that the severely anaemic dogs had developed haemolytic disease (possibly immune-mediated), whereas the non-anaemic dogs had developed an acute and overwhelming inflammatory response. The mean age of the non-anaemic dogs (2.66 years) was less than the dogs in the 'severe anaemia group' (0.83 years). Dogs belonging to the traditional fighting breeds (bull terriers, pit bull terriers and Staffordshire bull terriers) were noticeably over-represented in the non-survivors of the acute inflammatory response, possibly indicating an underlying genetic basis for the different presentations. It is evident that the inflammatory-response disease presentation, which is similar to complicated falciparum malaria in humans, amy serve as an animal model for the disease.

Desoxycorticosterone pivalate in the management of canine primary hypoadrenocorticism.

Primary hypoadrenocorticism in dogs may be poorly responsive to oral fluorocortisone treatment. Desoxycorticosterone pivalate is a suggested alternative treatment in these and all other cases of hypoadrenocorticism. Primary hypoadrenocorticism was diagnosed in a 3-year-old Cocker Spaniel bitch. Treatment with oral fluorocortisone at a dose rate of 0.13 mg 5 kg-1 d-1 was ineffective at maintaining serum electrolyte concentrations within normal limits. Administration of DOCP at a dose of 1.6-2.2 mg kg-1 intramuscularly every 28 d over a 5-year period, successfully maintained normal serum sodium and potassium concentrations. Side-effects encountered were minimal and were dose- or disease-related.

The influence of film processing temperature and time on mammographic image quality.

High image quality and low radiation levels are essential in mammography. This study investigates the effect of changes in processor temperatures and developing times on sensitometric findings. These findings were matched with the changes in the image quality during similar changes in the developing parameters. Temperatures ranging between 35 degrees C and 40 degrees C and developing times from 20 s and 50 s were investigated. Higher developing temperatures and increased developing times resulted in an increase in film speed and film contrast. A definite pattern of change could be demonstrated in film speed and film contrast during sensitometry. The same pattern of change could, however, not be demonstrated in the quality of phantom images under similar circumstances. The base plus fog level was not adversely affected. Sensitometric findings of film speed can be effectively used as an indicator of radiation exposure to the patient, but cannot be used to establish the developing parameters that will give the best image quality. Both these methods should be used to determine which processing variables should be used to obtain a combination of the best image with radiation as low as possible. Recommendations for optimum processing parameters are made for the films and processing chemistry investigated.

A differential analysis of time-use attitudes of high school students.

Time-use attitudes (TUA) of students contributes to our understanding of classroom behavior, but has received limited attention from investigators. This study empirically examined the major constructs or dimensions identified by other researchers (Baruch, Bruno, & Horn, 1987) of students' attitudes toward time use. Attention also was given to another dimension of TUA which has not previously been empirically explored, and to an analysis of differential developmental patterns of high school students. Three constructs of TUA were identified: passive fatalistic, egoistic, and conscientious. Several significant developmental patterns of TUA were found for males and females in Grades 8, 10, and 12.

[A comparison of three different techniques for measuring glomerular filtration rate]. / 'n Vergelyking van drie verskillende tegnieke vir die berekening van glomerulêre filtrasiespoed.

The clearance of inulin, creatinine and radioactive tracers from the blood may be used to measure glomerular filtration rate (GFR). These techniques, however, are usually invasive and time-consuming. Although the clearance of a radioactive tracer is usually applied in nuclear medicine for the determination of GFR, it is also possible to convert the concentration of the tracer in the kidneys to absolute GFR by means of a regression equation. As this new technique is much faster, we have compared it with the conventional technique. A good correlation was found with the standard radionuclide techniques (r = 0.91), but the reference method was under-estimated on the average by 14 ml/min. The new regression equation derived in our clinic will ensure future accurate GFR measurements within 6 minutes.

[Ainhum]. / Ainhum.

Ainhum is an ancient disease described in 1821 by Messum and its origin is still unknown. It is a tropical or semitropical disease seen in Blacks, Whites and Indians which affects the 5th and sometimes the 4th toe and causes spontaneous amputation. Females are more often affected than males, and there is a tendency to geographical clustering of cases and familial occurrence.

[Group A beta-hemolytic streptococci in a traditional black community]. / Groep A beta-hemolitiese streptokokke in 'n tradisionele Swart gemeenskap.

Throat swabs taken from a group of traditionally living people in a remote area of Venda, with no symptoms of sore throat, revealed the presence of Group A beta-haemolytic streptococci in 1,62% of subjects in the 5 - 25-year age group. This is significantly different from the picture in an urban population in Pretoria where the carrier rate was found to be 16,8%. The incidence is apparently not influenced by the low economic level in the rural area. The organisms in the rural area were found to be less sensitive to sulphafurazole than those in the urban area.

[Beta-hemolytic streptococci as a cause of sore throat in the Pretoria area]. / Beta-hemolitiese streptokokke as oorsaak van seerkeel in Pretoria en omgewing.

A study was performed in Pretoria on 232 unselected patients who presented with the complaint of sore throat. A throat swab was positive for Lancefield group A beta-haemolytic streptococci in 33,2% of these patients. The incidence was significantly higher in Black patients (45,5%) than in White patients (23,2%) and 12,1% of healthy controls showed a positive culture. No seasonal variation was detected. Throat swabs kept overnight at room temperature were falsely negative for beta-haemolytic streptococci in 43,2% of cases. A correlation was found with certain clinical signs.