Adverse effects of copper, manganese and mercury, alone and in mixtures on the aorta and heart of Spraque-Dawley rats.

Cardiovascular diseases (CVD) are a common global cause of death and are therefore a major health concern. Inhaled or ingested environmental heavy metals contribute to the development of CVD. The aim of this study was to address the limited information available on the effect of relevant dosages of metals in mixtures. Three metals with reported effects on the cardiovascular system (CVS) were identified, and these metals were copper (Cu), manganese (Mn) and mercury (Hg). In Sprague-Dawley rats, the adverse effects of copper (Cu), manganese (Mn) and mercury (Hg), alone and as part of mixtures, on the blood parameters, the aorta and heart were investigated. Forty-eight male Sprague-Dawley rats were randomly divided into eight groups (n = 6): control, Cu, Mn, Hg, Cu + Mn, Cu + Hg, Mn + Hg and Cu, Mn + Hg. The seven experimental groups received the metal mixtures at 100 times the World Health Organisation (WHO) safety limit for drinking water (2 mg/L for Cu, 0.4 mg/L for Mn and 0.06 mg/L for Hg) via oral gavage for 28 days. After 28 days, compared with the control, red blood cell levels were increased for Cu + Hg. All other measured blood parameters were unchanged. Morphological changes in the tunica media were connective tissue deposition and an abundance of collagen type I in the metal exposed aortic tissues. In the cardiac tissue of metal-exposed rats, changes in the cardiomyocyte and myofibrillar arrangement, with an increase in collagen type I and III was observed. Ultrastructurally, the aortic collagen and elastin band arrangement and the cardiac mitochondrial and myofibrillar arrangement and structures were altered in the experimental groups. These changes indicated that exposure to these metals in rats caused minor changes in the blood parameters, however, the changes in tissue and cellular structure indicated an increased risk for the development of CVD.

Oxidative and haemostatic effects of copper, manganese and mercury, alone and in combination at physiologically relevant levels: An ex vivo study.

Water contamination with metals due to anthropogenic activity is increasing and subsequent exposure increases the risk of associated toxicity. Exposure is not limited to a single metal but usually involves mixtures of different metals at different concentrations. Little is known about the contribution of this type of exposure, in humans, to the development of non-communicable diseases such as cardiovascular disease, and an increased risk to thrombosis. The World Health Organization has established limits for metal levels in drinking water and this includes levels for copper (Cu), manganese (Mn) and mercury (Hg). In this study, at 100X these limits, the ability of the metals' oxidative effects as catalysts of the Fenton reaction and/or ability to bind glutathione (GSH) were determined. The haemostatic effects of these metals, alone and in combination, at the World Health Organization limit were then evaluated. The ultrastructural and viscoelastic alterations of exposed ex vivo whole blood were also evaluated using scanning electron microscopy and thromboelastography® (TEG), respectively. Cu, alone and in combination with Mn and/or Hg, induced hydroxyl radical formation and reduced GSH levels. Ex vivo exposure caused deformation of erythrocytes and accelerated platelet activation especially for Cu, alone and in combination, with Mn. Reduction in the lysis potential of the clot was also observed for all combinations, especially Cu in combination with Hg as well as Mn alone. Although the TEG findings were not statistically significant, the trends indicate that the exposure to these metals, alone and in combination, adversely affects thrombus formation in ex vivo blood, thereby potentially increasing the risk in exposed individuals for thrombosis.

Guideline for the diagnosis and management of multiple sclerosis: a Southern African perspective.

Before making a diagnosis of multiple sclerosis (MS), it is imperative that alternative diagnoses are considered and excluded. This is particularly important in South Africa, which is a moderate prevalence MS area, has a high burden of neurological infections and where the majority of the people are black - an ethnic group that has a very low frequency of MS. Before applying diagnostic criteria, there should be no better explanation for the patient's presentation. This guideline, written on behalf of the Multiple Sclerosis Society of South Africa, aims to assist in the diagnosis and treatment of MS in Southern Africa. 

The dominant methicillin-resistant Staphylococcus aureus clone from hospitals in Cape Town has an unusual genotype: ST612.

There is currently limited information available on the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in South Africa. A molecular characterization of 100 MRSA from five hospitals in Cape Town was carried out in this study. The strains were separated into six clusters by pulsed-field gel electrophoresis, indicating transmission of MRSA between local hospitals. None of the strains carried the Panton-Valentine Leukocidin gene. SCCmec typing, multilocus sequence typing and spa typing were used to further characterize the MRSA. Three clones corresponded to frequently described pandemic clones: ST239-MRSA-III, ST36-MRSA-II and ST5-MRSA-I. ST239-MRSA-III and ST36-MRSA-II were minor clones and collectively accounted for 16% of the isolates. ST5-MRSA-I was the second-most prevalent clone and accounted for 37% of the isolates. The dominant local clone was the infrequently described ST612-MRSA-IV (44% of isolates), which has only been described in South Africa and Australia.

Salt gland adenitis associated with bacteria in Blue Penguins (Eudyptula minor) from Hauraki Gulf (auckland, New Zealand).

Three Blue Penguins (Eudyptula minor) were rescued between July 2006 and January 2007 off the east coast of Auckland, New Zealand. They were taken to a rehabilitation center, where they subsequently died in May 2007 and were submitted for necropsy. There was unilateral enlargement of the salt glands with disseminated small, pale, and firm foci in all birds. Histologic examination of the affected glands demonstrated the presence of multifocal granulomas and areas of severe squamous metaplasia of the collecting ducts. The remaining gland had areas of hyperplasia, dysplasia, and necrosis with a severe granulomatous inflammatory reaction. Intralesional gram-negative bacteria were detected, but, unfortunately, bacterial culture was unrewarding. No further cases were observed in penguins in the subsequent year, and the primary cause of the salt gland adenitis remains uncertain.

Salt gland adenitis associated with bacteria in Blue Penguins (Eudyptula minor) from Hauraki Gulf (auckland, New Zealand)

Three blue penguins (Eudyptula minor) were rescued between July 2006 and January 2007 off the east coast of Auckland, New Zealand. They were taken to a rehabilitation center, where they subsequently died in May 2007 and were submitted for necropsy. There was unilateral enlargement of the salt glands with disseminated small, pale, and firm foci in all birds. Histologic examination of the affected glands demonstrated the presence of multifocal granulomas and areas of severe squamous metaplasia of the collecting ducts. The remaining gland had areas of hyperplasia, dysplasia, and necrosis with a severe granulomatous inflammatory reaction. Intralesional gram-negative bacteria were detected, but, unfortunately, bacterial culture was unrewarding. No further cases were observed in penguins in the subsequent year, and the primary cause of the salt gland adenitis remains uncertain.

Measuring the quality of life of residents in SADC communities affected by HIV.

About a third of all people living with HIV are found in Southern Africa. Local and regional organisations work in and with communities subjected to high HIV prevalence rates. It is necessary to measure the Quality of Life (QoL) of community members affected by HIV to improve monitoring and evaluation of project impact. This study aimed to measure the QoL and to investigate the QoL scale as a rapid cross-cultural assessment tool. QoL surveys were conducted in 14 community sites in seven countries, including: Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. These communities are amongst the most severely affected by the HIV/AIDS epidemic in the region. Face-to-face interviews, using a structured questionnaire, were conducted by teams of trained fieldworkers. The studies included 2176 participants, including 37% males. Results indicated evidence of the heavy burden of the disease. More than 30% of the households had a member who was ill for more than three months and more than 10% of the households lost a member after an illness of three months in the past 12 months. More than 35% of the households housed an orphan. Unemployment rates in the communities were very high. QoL was measured using four domains: General Health, Psychological Wellbeing, Social Relationships and Environmental factors. General Health and Environmental quality consistently rated lower than Psychological Wellbeing and Social Relationships. The QoL questionnaire seems to be appropriate in measuring QoL of community members cross-culturally. Results will enable programmes and organisations to tailor and develop projects. It will assist organisations to continuously monitor activities and its impact.

Human cytomegalovirus infection in infants with prolonged neonatal jaundice.

BACKGROUND: Although human cytomegalovirus (HCMV) infection in infants has been associated with liver disease, the role of HCMV in infants presenting with prolonged neonatal jaundice is unclear as this clinical picture can be caused by a broad spectrum of underlying conditions. OBJECTIVES: This study aimed to determine a possible role for HCMV infection in infants with prolonged cholestatic neonatal jaundice that could facilitate the appropriate use of diagnostic assays and specific treatment in this condition. STUDY DESIGN: HCMV immunohistochemical staining was performed on liver biopsy specimens received for histopathological examination from 85 infants (mean age 3 months) with a clinical history of prolonged neonatal jaundice. HCMV serology was also performed. RESULTS: One infant with a histological diagnosis of HCMV hepatitis was also positive by immunohistochemical staining, while all other tissue specimens were negative for HCMV. HCMV IgG was positive in 92.3% and HCMV IgM in 39.7% of the infants (n=78). CONCLUSIONS: The serological results confirm the ubiquitous nature of HCMV with many primary infections occurring within the first year of life. Despite this, HCMV hepatitis was uncommon in this cohort.

Analysis of trace amounts of carbon dioxide, oxygen and carbon monoxide in nitrogen using dual capillary columns and a pulsed discharge helium ionisation detector.

Gas mixtures of trace amounts of carbon dioxide (CO(2)), dioxygen (O(2)), and carbon monoxide (CO) in dinitrogen (N(2)) were separated and quantified using parallel dual capillary columns and pulsed discharge helium ionisation detection (PDHID). The detection limits (9 x 10(-9) mol mol(-1) for CO(2), 7 x 10(-9) mol mol(-1) for O(2) and 37 x 10(-9) mol mol(-1) for CO) were lower than those reported previously for similar methods. Uncertainties were calculated and results were validated by comparison of the CO and CO(2) results with those obtained using conventional methods. The method was also used to analyse nitrogen, carbon dioxide and carbon monoxide in oxygen.

A comprehensive programme addressing HIV/AIDS and gender-based violence.

A survey was administered to 304 respondents participating from three areas near Welkom, South Africa. Face-toface interviews were conducted with women from randomly selected households to evaluate the impact of a service provision programme targeting women living with HIV/AIDS and gender based violence. Gender based violence (GBV) awareness and knowledge was high. Respondents had high perceived levels of risk. They reported making various behavioural changes to avoid GBV.The respondents were aware of their legal rights pertaining to GBV. HIV/AIDS knowledge levels and attitudes were acceptable. Behavioural changes included condom use, abstinence and being faithful to one partner. Disclosure of HIV was lower than disclosure of GBV.Awareness and knowledge of female condoms were high, yet usage low. Participants reported that they would be able to introduce condoms to a relationship and negotiate usage with relative ease. Perceived levels of GBV and HIV were high, and stigma levels towards the affected women were also relatively high.The awareness and knowledge levels of GBV and HIV of older respondents were lower than younger respondents.The key findings of this study support the notion of using a holistic approach, targeting more than one issue. There is lower stigma levels associated with combined conditions, which might allow easier access to vulnerable groups. Coordination and collaboration of services are however needed to enable this benefit.

Spondyloenchondromatosis with D-2-hydroxyglutaric aciduria: a report of a second patient with this unusual combination.

Spondyloenchondromatosis (SEM) is a rare skeletal dysplasia which presents with multiple enchondromata in the metaphyses of the long bones associated with dysplastic vertebral bodies. It is probably heterogeneous. We have investigated and documented a male infant in South Africa with spondyloenchondromatosis and persistent D-2-hydroxyglutaric aciduria (D2HA). D2HA is a neurometabolic disorder whose enzymatic basis is still undefined. A girl in England with a similar clinical, radiological and biochemical phenotype has previously been reported by Talkhani et al. [(2000). Skel Radiol 7:215-2921]. There is at present a lack of a plausible pathogenetic relationship between the two components of the disorder but a contiguous gene syndrome or a pleiotropic gene could be considered. Whatever the underlying mechanism this case report confirms its nosological entity.

Plasmid analysis of Neisseria gonorrhoeae isolates and dissemination of tetM genes in southern Africa 1993-1995.

One group (145 isolates) of Neisseria gonorrhoeae was collected from municipal clinics in Bloemfontein in 1994 and a second group (65 isolates) in 1995. Penicillin and tetracycline MICs were determined and plasmid analysis performed to monitor antimicrobial susceptibilities in conjunction with the occurrence of plasmids in these isolates. The prevalence of penicillin resistance caused by beta-lactamase plasmids remained constant at 9% during the study period. Three high-level tetracycline-resistant strains (MICs 16 mg/L), the first to be detected in South Africa, were isolated in 1994. Although there was a reduction in the percentage of isolates harbouring 24.5 MDa conjugative plasmids (from 79% in 1994 to 46% in 1995), this was partially counteracted by an increase in TetM-encoding conjugative plasmids (25.2 MDa) from 2% to 18.5%. The tetM genes of 13 isolates shown to exhibit high-level tetracycline resistance were characterized as the American type. The American-type tetracycline resistance plasmid was demonstrated in 11 isolates. Digestion with Bg/l showed that two isolates harboured tetM-encoding plasmids that differed from the American- and Dutch-type plasmids described previously: one isolate contained a plasmid that produced two fragments of different sizes from those of the American-type plasmid and the second isolate possessed an American/Dutch hybrid plasmid. Auxotyping/serotyping and random amplified polymorphic DNA analysis revealed a predominant tetracycline-resistant family (NR/IA-6, genomic group I) in Bloemfontein. As there is a high incidence of chlamydial infections in southern Africa requiring tetracycline therapy, selective pressures exist in the environment for the maintenance and rapid spread of high-level tetracycline-resistant N. gonorrhoeae. It is possible that tetM genes may have emanated from Botswana and/or Namibia to Bloemfontein. The establishment of high-level tetracycline-resistant N. gonorrhoeae in Bloemfontein was seen to be complex as a related group of strains was identified, plasmid dissemination was evident and two new TetM-encoding plasmids were demonstrated. The appearance of these TetM-encoding plasmids indicates either that the American- and Dutch-type plasmids are continuing to evolve or that tetM genes are being introduced into different families of 24.5 MDa conjugative plasmids.

[Nursing study on the occurrence of unplanned home births in Tygerberg Hospital]. / 'N verpleegkundige ondersoek na die voorkoms van onbeplande tuisgeboortes by die Tygerberghospitaal.

A retrospective, descriptive study was conducted from March to May 1992 to investigate the incidence, factors associated with, and neonatal and maternal complications of babies born before arrival (BBA) at the Tygerberg Hospital and its peripheral clinics. This was done by means of a personal interview with 30 of the mothers within 6 hours after the birth of their babies, representing 44% of the study population during the period the study was undertaken. The incidence of BBA over the period was 5.3%. The typical patient who presented with BBA, was found to have little education, no or small income, gravida 2 and between the ages of 20 and 25 years. As much as 47% of patients did not have transport available. Only 53% of patients received specific guidance as to when to come to the hospital or clinic. The majority of these "informed" respondents, did not fully understand the information given to them. Maternal complications included vaginal and perineal lacerations, retained placenta and abruptio placentae. 47% of babies developed complications. Neonatal death, breech presentation, prematurity and umbilical cord around the neck, featured prominently. The lack of transport and inadequate or ineffective prenatal guidance and information as well as relative illiteracy were identified as the most important causative factors. The solution to the problem lies at least partially in better prenatal guidance, which includes specific reference to the symptoms of the onset of labour and the timely arranging of transport.

Immunity to rabies after administration of prophylactic human diploid-cell vaccine.

The immune status to rabies of 14 volunteers was determined using the commercially available Trousse Platelia Rage (Diagnostics Pasteur) enzyme immunoassay test system. Twelve subjects were evaluated before and between 6 months and 60 months after prophylactic intramuscular (deltoid) administration of rabies human diploid-cell vaccine, while the effect of booster doses on a further 2 volunteers was evaluated over an 11-year period. Optical density values were converted to international units to allow correlation with World Health Organisation seroneutralisation references. Values of greater than or equal to 0.5 IU are considered protective. The results showed that most individuals were still immune 2 years after vaccination; there was a tendency for serum antibody levels to decrease over a 5-year post-vaccination period. Antibody levels rose sharply after booster immunisation, after which they decreased at a much slower rate. In general, results revealed that after the first booster, additional booster vaccinations at 5-yearly intervals would provide adequate prophylactic immunity. There was, however, much individual variation, which emphasises the need to evaluate each individual at regular and shorter intervals to determine the need for booster vaccine doses. The test method employed is economical and well suited to such evaluations.

The incidence of hospital fungal infections--yeast fungaemia.

In order to determine the incidence and the causative agents of fungaemia, a survey was undertaken of blood culture specimens received from the Bloemfontein academic hospitals. Over a period of 1 year, 5,017 successive blood cultures were examined; 1,030 (20.5%) had growth of which 106 (2.1%) yielded yeasts. Candida albicans (42%), C. tropicalis (26%) and C. parapsilosis (20%) were the species most frequently isolated. Fungaemia occurred most often after broad-spectrum antimicrobial therapy and abdominal disorders.

[Rapid identification methods of yeasts during fungaemia]. / Vinnige identifikasiemetodes van giste tydens fungemie.

A wet preparation method, modified serum test and a modified disc diffusion method were evaluated in order to identify yeasts more rapidly during fungaemia. A total of 2,932 blood cultures were processed, of which 54 (1.8%) yielded yeasts. By using these methods, Candida albicans was identified within 3 hours, after yeast growth in the blood culture was confirmed by Gram stain. The wet preparation examinations were accurate in 60% of cases and the serum test in 95% of cases. After growth was detected, yeast species other than C. albicans were identified within 24 hours using the modified disc diffusion method. C. albicans (50%), C. tropicalis (22%) and C. parapsilosis (22%) were the species most frequently isolated. Fungaemia occurred most often after antimicrobial therapy and abdominal conditions.

Frail aged persons residing in South African homes for the aged who require hospitalisation. Part I. Urban areas.

The numbers and characteristics of white residents identified by medical and nursing staff as requiring more staff time and/or expertise and/or medical equipment than is available in homes for the aged were assessed. Only 27 out of 2,447 (1.1%) extremely infirm aged persons resident in 93 homes for the aged would, in the opinion of institutional staff, benefit by admission to a long-term care hospital catering for chronically ill. The conditions affecting these residents are described and recommendations relating to their management made.

Frail aged persons residing in South African homes for the aged who require hospitalisation. Part II. Rural areas.

The numbers and characteristics of white residents identified by medical and nursing staff to require more staff time and/or expertise and/or medical equipment than was available in rural homes for the aged in the Orange Free State were assessed. In the opinion of institution staff, 12.6% of extremely infirm aged persons would benefit by admission to a hospital catering for the chronically ill. The conditions affecting these residents are described and recommendations relating to their management are made.