Profile and management of acute coronary syndromes at primary- and secondary-level healthcare facilities in Cape Town.

BACKGROUND: Little is known about the clinical profile and management of patients with acute coronary syndromes (ACS) in the South African public sector. METHODS: We conducted a retrospective study of patients presenting with ACS to a secondary-level healthcare facility in Cape Town during a one-year period to study the clinical profile and management of these patients. RESULTS: Among the 214 patients in this cohort, 48 (27.5%) had ST-segment elevation myocardial infarction (STEMI), 43 (24.7%) had non-ST-segment elevation myocardial infarction and 83 (47.7%) unstable angina pectoris. We identified high rates of >12-hour delays in first medical contact after symptom onset (46%) and inaccurate ECG diagnosis of STEMI (29.2%), which were associated with low rates of thrombolysis (39.6%). High rates of non-adherence and ACS recurrence were also observed. CONCLUSION: To address the local challenges in ACS management highlighted in this study, we propose the development of a regional referral network prioritising access to expedited care and primary reperfusion interventions in ACS.

A high-repetition-rate, fast temperature-programmed gas chromatograph and its online coupling to a supercritical fluid chromatograph (SFC × GC).

We present a fast gas chromatographic system that can be used as a second dimension in comprehensive two-dimensional (supercritical fluid × gas) chromatography (SFC × GC). The temperature of the short (1 m long) capillary column is controlled by a resistively heated coaxial stainless-steel tube. The electrical resistance and, therefore, temperature of the stainless-steel tube are measured by continuous monitoring of the current/voltage ratio. Highly repeatable heating rates of up to 2100 °C min-1 (35 °C s-1) are obtained, which should be high enough for the most demanding fast chromatograms. To reduce the cooling time between temperature programs, the column is cooled by injecting evaporating carbon dioxide into the space between the coaxial heater and the column. This gives cooling rates of 5100 °C min-1 (85 °C s-1), which allows quick succession of temperature programs. More repeatable heating profiles with stable GC retention times together with faster cooling are significant improvements on previous SFC × GC systems. Cycle times of four gas chromatograms per minute could readily be achieved, which allows efficient coupling to high-resolution stop-flow SFC in the first dimension. We demonstrate the fast chromatograph by separating fatty acid methyl esters, yielding information that would be useful in the food and biodiesel industries.

The burden of depression and anxiety among medical students in South Africa: A cross-sectional survey at the University of Cape Town.

BACKGROUND: Depressive and anxiety disorders occur at very high rates among medical students. For instance, an international review and meta-analysis estimated the overall pooled crude prevalence of depression or depressive symptoms at 27.2%. However, South African (SA) data are very limited. OBJECTIVES: To determine rates of depression and anxiety among medical students and to examine the associations with various sociodemographic variables (biological sex, gender identity, household income, ethnicity, and clinical v. pre-clinical students). We also examined whether the 'mini-semester' of 2017 resulting from the 2016 'Fees Must Fall' student protests was associated with increased depression/anxiety. METHODS: The study was a cross-sectional electronic survey conducted in the Faculty of Health Sciences, University of Cape Town, using an anonymous, self-administered online questionnaire. The questionnaire included basic sociodemographic questions, the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale. RESULTS: The sample consisted of 473 medical students, 333 (70.4%) female and 140 (29.6%) male. Based on ethnic self-identification, 165 (35.6%) were black, 144 (31.1%) white, 88 (19%) coloured, 52 (11.2%) Indian and 8 (1.7%) Asian. There were 239 pre-clinical students (50.5%) and 234 clinical students (49.5%). Of the sample, 36.4% were above the cut-off for major depressive disorder and 45.9% for anxiety disorder. Reported rates of disorders diagnosed by a health professional were 25.0% for depressive disorder and 20.5% for anxiety disorder, and 28.1% of all students were receiving psychotropic medication. Female sex was associated with both depression (prevalence ratio (PR) 3.7; p<0.001) and anxiety diagnoses (PR 4.7; p<0.001). None of the other sociodemographic characteristics showed significant associations. Interestingly, students who undertook the 2017 mini-semester showed an increased rate of depression (PR 2.1; p<0.05) and anxiety diagnoses (PR 2.1; p<0.05). CONCLUSIONS: Nearly one in four students reported depression/anxiety diagnoses and were on psychotropic medication, significantly more than age-based expectations. Even more screened positive for risk of depression/anxiety. Our findings indicate that medical students, particularly females, are at a significantly increased risk of depression and anxiety disorders. Results suggest that the 2016 student protests may have had a direct impact on the mental state of students. Multidisciplinary efforts should be targeted at initiatives to strengthen mental wellbeing and institutional culture around mental health. These efforts may help build resilience in the next generation of health professionals in SA ahead of work in an overburdened health and health education system.

Surgical anatomy of the pudendal nerve and its branches in South Africans.

Dissection of the pudendal nerve (PN) and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in South Africans. The course of the PN from the gluteal region into the perineum was dissected in an adult sample of both sexes and of African and European ancestry. Distances between PN and branches to applicable landmarks were measured. Basic descriptive statistics and comparisons were carried out between groups. In 5/13 African females, the inferior rectal nerve (IRN) entered the gluteal region separately and in 12/13 cases it passed medial to the ischial spine with the PN. The dorsal nerve of the clitoris or penis (DNC/DNP) was closer to the bony frame in those of European ancestry. The IRN branches were more superficial in females, but deeper in males of European ancestry. In African females, a PN block and Richter stitch should be placed more medial. Outside-in transobturator tape procedures might endanger the DNC/DNP in obese individuals. In females of European ancestry the IRN branches are compromised during ischioanal abscess drainage. In males of European ancestry, the dorsal penile nerve block might be less effective. Predictions should be verified clinically.

A systematic review of counselling for HIV testing of pregnant women.

BACKGROUND: Evidence-based strategies have made it possible to limit mother-to-child transmission of the HI-virus to a large extent and enable HIV-positive women to stay healthy for longer, provided their HIV status is known. Although voluntary counselling and testing for HIV is part of routine antenatal care in South Africa, the uptake of testing varies and a large number of pregnant women's HIV status is not known at the time of birth. AIM: The aim of the study was to establish research evidence regarding factors influencing counselling for HIV testing during pregnancy by means of systematic review, forming part of a larger study using a variety of evidence to develop best practice guidelines. DESIGN: Systematic review. METHODS: The question steering the review was: 'What factors influence counselling for HIV testing during pregnancy?'. A multi-stage search of relevant research studies was undertaken using a variety of sources. A total of 33 studies were retrieved and critically appraised. Data were extracted from the studies and assessed according to its applicability in the South African context. RESULTS: The results are presented according to the following themes: effects of counselling, quality of counselling, group vs. individual counselling, ways of offering HIV testing, rapid testing, counselling and testing during labour, couple counselling and testing, counsellor and organisational factors. CONCLUSIONS: According to research evidence, factors such as whether counselling is presented in a group or individually, different ways to present HIV testing as well as counsellor and organisational factors can influence counselling for HIV testing during pregnancy. When developing best practice guidelines for settings very dissimilar from where the research was done, research evidence must be contextualised. RELEVANCE TO CLINICAL PRACTICE: Implementation of the best practice guidelines may lead to the increased uptake of HIV testing in pregnancy in developing countries like South Africa and thus to an increase in the number of women whose status is known when their babies are born.

Assessment of the quality of interaction in distance learning programmes utilising the Internet (WebCT) or interactive television (ITV).

INTRODUCTION: This study focuses on the quality of interaction in interactive TV (ITV), WebCT bulletin boards (BBs) and chat rooms (CRs) and addresses the question of how effectively new collaborative electronic technologies have been married with new pedagogical ideas to create effective learning for distance education students. METHODS: Fifteen (out of 68) BB, 14 (out of 32) CR and 13 (out of 25) ITV conversations were randomly selected for coding using a modified exchange structure analysis. The roles that students and lecturers took in the conversations were determined from this. RESULTS: The percentage of turns made by lecturers as opposed to students was 51% in CRs, 14% in BBs and 68% in ITV. The percentage of turns spent on actual coursework was 73% in CRs, 89% in BBs and 82% in ITV. Comparisons between tutors' and students' roles within as well as between ITV, BBs and CRs were all statistically significant with P < 0.05. In CRs the main roles of both students and lecturers were those of elaborators, inquirers and explainers. In BBs the main roles of students and lecturers were those of explainers and evaluators. In ITV sessions students' main roles were those of elaborators and explainers, whereas lecturers' main roles were those of lecturers, elaborators, inquirers and evaluators. CONCLUSION: In terms of creating a constructivist and active learning community that can operate within a distance learning paradigm, WebCT appears superior to ITV.

Claviceps cyperi, a new cause of severe ergotism in dairy cattle consuming maize silage and teff hay contaminated with ergotised Cyperus esculentus (nut sedge) on the Highveld of South Africa.

During December/January 1996/97 typical summer syndrome (hyperthermia and a 30% drop in milk yield) occurred in succession in two Holstein dairy herds (n=240 and n=150 milking cows, respectively) on the South African Highveld. These farms are situated in the midst of the prime maize and dairy farming areas of South Africa where this condition had never been diagnosed before. The individual components of the concentrate on both farms were negative for ergot alkaloids. Endophytic fungi and/or ergot infestation of teff and other grasses fed to the cows were then suspected of being involved, but neither endophytes nor ergot alkaloids could be implicated from these sources. By measuring the serum prolactin levels of groups of sheep (n=5) fed the first farm's total mixed ration (TMR) or its three individual fibre components for a period of 11 days, the source of the ergot alkaloids was identified. A statistically significant decrease in the level of this hormone occurred only in the group on maize silage (which constituted 28% on dry matter base of the TMR). The involvement of the maize silage was further chemically confirmed by the high levels of total ergot alkaloids, predominantly ergocryptine, found by LC-MS in the silage as well as in the TMR (115-975 ppb and 65-300 ppb, respectively). The ergot alkaloid content (mainly ergocryptine) of the maize silage on the second affected farm was 875 ppb. Withdrawal of contaminated silage resulted in gradual recovery of stock on both farms. Nut sedge (Cyperus esculentus and Cyperus rotundus of the family Cyperaceae) has a world-wide distribution and is a common weed in annual crops, and can be parasitized by Claviceps cyperi. Careful examination of the maize silage from both farms revealed that it was heavily contaminated with nut sedge and that it contained minute sclerotia, identified as those of Claviceps cyperi, originating from the latter. Nut sedge was abundant on both farms and it is believed that late seasonal rain had resulted in mature, heavily ergotised nut sedge being cut with the silage. Claviceps cyperi sclerotia, collected on the affected fields in the following autumn contained 3600-4000 ppm ergocryptine. That the dominant alkaloid produced by this particular fungus was indeed ergocryptine, was confirmed by negative ion chemical ionization MS/MS. In one further outbreak in another Holstein herd, teff hay contaminated with ergotised nut sedge and containing 1200 ppb alkaloids, was incriminated as the cause of the condition. This is the first report of bovine ergotism not associated with the Poaceae infected with Claviceps purpureum or endophytes but with the family Cyperaceae and this particular fungal phytopathogen.

Corneal disease in rural Transkei.

A survey of external eye diseases was undertaken in Transkei; a total of 1,519 people were examined. A high incidence of climatic droplet keratopathy was found in the population, and this was a common cause of blindness in elderly men. Only 7 people had pterygia - all women. Both climatic droplet keratopathy and pterygia are believed to result from actinic damage, therefore the discrepancy noted in the prevalence of these two degenerative disorders was unexpected. Xerophthalmia was observed in 5 children, all of whom had mild forms of vitamin A deficiency eye disease. Although the number of children with overt vitamin A deficiency was small (0.58% of children aged less than 15 years), the importance of this finding lies in the possible pool of children without clinical disease but with low levels of vitamin A and therefore more likely to develop and to succumb to infections of the respiratory and alimentary systems. A further 20 people had corneal changes similar to those found in xerophthalmia; but since associated conjunctival signs were absent it is improbable that these changes were secondary to vitamin A deficiency.

[Countercurrent distribution of polysulfonated proteins (author's transl)]. / Gegenstromverteilung von poly-sulfonierten Proteinen

The reaction of bovine beta-lactoglobulin AB with reagents 4-(isothiocyanato) benzene sulfonic acid, 5-(isothiocyanato) benzol-1,3-bis(sulfonic acid) and 7-(isothiocyanato) naphthalene-1,3,5-tris(sulfonic acid) is described. The blocking of the epsilon-amino groups of lysine is quantitative. The thus modified protein can be analysed in the countercurrent distribution apparatus and can be split very rapidly at the arginine residues with trypsin.

Naja melanoleuca (forest cobra) venom. Purification and some properties of phospholipases A.

Three phospholipases A (Fractions DE-I, DE-II and DE-III) were purified from Naja melanoleuca (Forest cobra) venom by a combination of gel filtration on Sephadex G-50 and chromatography on DEAE-cellulosemthe purified phospholipases A were homogeneous by various physicochemical criteria. Whereas Fraction DE-I contains 118 amino acid residues, Fractions DE-II and DE-III comprise 119 residues. The three enzymes are cross-linked by seven disulphide bridges, have asparagine as N-terminal amino acid and the C-terminal is glutamic acid or glutamine. The molecular weights of the three phospholipases A from sedimentation analysis at pH 2.1, also by the sodium dodecylsulphate-gel method and calculated from the amino acid composition, were close to 13 000. Studies of circular dichroism in the spectral region between 195 to 305 nm showed that the three phospholipases A contain similar helical contents but revealed conformational differences between their side-chain chromophores.