Malignant Melanotic Nerve Sheath Tumor.

Malignant melanotic nerve sheath tumors are uncommon pigmented tumors of Schwann cell origin, most often found along the spinal nerves. Although well-described in the literature, the tumors are quite rare, making up <1% of nerve sheath tumors. Physicians are, therefore, often unfamiliar with both the appearance and the optimal treatment of such tumors. Morphologically, many imaging features overlap with schwannomas and neurofibromas. Nevertheless, the malignant melanotic nerve sheath tumors are crucial to identify. They can be extremely aggressive, and the management of these tumors is considerably different from their benign counterparts. In this radiology-pathology review, we will highlight the imaging appearance, histologic features, surgical resection, and subsequent therapeutic strategies in a patient with a lumbar malignant melanotic nerve sheath tumor.

The NOMA track module on nutrition, human rights and governance: Part 1. Perceptions held by Master's students

Background. A module on nutrition; human rights and governance was developed and presented jointly by academic institutions in Norway; South Africa and Uganda; under the NOrway MAsters (NOMA) programme; for their respective Master's degree programmes in nutrition. Consisting of three study units; it was presented consecutively in the three countries; with each study unit building on the previous one. Objectives. To document the perceptions of participating students on various aspects of the module; informing future curriculum endeavours. Methods. A mixed methods approach was followed. A module evaluation form completed by students for each study unit was analysed. In-depth telephonic interviews were voice recorded and transcribed. Through an inductive process; emerging themes were used to compile a code list and content analysis of the unstructured data.Results. An overall positive module evaluation by 20 participants (91% response rate) can be ascribed to the module content; enlightening study visits; expertise of lecturers and an interactive teaching style. Logistical issues regarding time management and administrative differences among the academic institutions caused some concerns. Students experienced some resistance against qualitative research in natural science faculties. Students benefited from being exposed to different teaching styles and education systems at universities in different countries. Constructive alignment of teaching and learning activities could be optimised through involvement and empowerment of all relevant lecturers.Conclusion. Successful implementation of the module not only provides nutrition Master's students with knowledge to operationalise a human rights-based approach during future interactions in their professional practice; but also serves as an example of the benefits and challenges of interdisciplinary and transnational collaboration in module development

The NOMA track module on nutrition, human rights and governance: Part 2. A transnational curriculum using a human rights-based approach to foster key competencies in nutrition professionals

Background. In response to the challenge of the global health needs of the 21st century; four academic institutions in Norway; South Africa and Uganda; each offering a Master's degree in nutrition; collaboratively developed the NOrwegian MAsters (NOMA) track module on nutrition; human rights and governance; integrating a human rights-based approach into graduate education in nutrition. Objective. To capture students' perceptions about the NOMA track module; focusing on the development of key competencies. Methods. Employing a qualitative approach; 20 (91% response rate) in-depth telephonic interviews were conducted with participating students; voice recorded and transcribed. Through an inductive process; emerging themes were used to compile a code list for content analysis of the transcribed text. Relevant themes were reported according to the professionals' roles described by the CanMEDS competency framework. Results. Participation in the module enhanced key competencies in the students; e.g. communication skills and the adoption of a holistic approach to interaction with people or communities. Their role as collaborator was enhanced by their learning to embrace diversity and cultural differences and similarities. Students had to adapt to different cultures and educational systems. They were inspired to contribute in diverse contexts and act as agents for change in the organisations in which they may work or act as leaders or co-ordinators during interaction with community groups and policy makers. Higher education institutions offering transnational modules should support lecturers to manage the inherent diversity in the classroom as a way of enhancing student performance.Conclusion. The development of future transprofessional modules will benefit from the inclusion of desirable key competencies as part of the module outcomes by following a competency by design process

Routine active surveillance for carbapenemase-producing Enterobacteriaceae from rectal swabs: diagnostic implications of multiplex polymerase chain reaction.

BACKGROUND: Screening for carriage of carbapenemase-producing Enterobacteriaceae (CPE) is considered an important infection prevention and control strategy. To date, screening has relied primarily on culture although polymerase chain reaction (PCR)-based screening is gaining momentum. Currently there is no gold standard screening method and consequently it is important to consider the implications of different diagnostic strategies used in active surveillance. AIM: To assess the utility of a multiplex PCR screening strategy, as a component of active surveillance, for detection of CPE in patients admitted to various hospitals. METHODS: A single rectal swab was collected from patients at various hospitals, considered to be at risk of colonization with CPE. Comparison of a modified US Centers for Disease Control and Prevention culture protocol with a PCR-based assay for the detection of the blaNDM, blaKPC, blaOxA-48-like, blaVIM, blaIMP, and blaGES genes was performed. FINDINGS: Of the 251 consecutive rectal swabs collected, 30 were PCR positive for one or more carbapenemase genes. Fifteen (50%) were culture positive and CPE only accounted for six isolates. PCR demonstrated excellent sensitivity (100%), specificity (89.8%), and negative predictive value (100%) for detection of CPE, but a positive predictive value of only 46.6% and 16.6% for detection of carbapenemase-producing Gram-negatives and CPE, respectively. CONCLUSION: The apparent excellent performance characteristics of PCR for detection of CPE from rectal swabs must be tempered by knowledge of CPE prevalence and be interpreted within a defined epidemiological context. Further comparative research with culture, evaluating the clinical utility of PCR-based assays as a screening tool, is needed.

Body temperature responses of Pekin ducks (Anas platyrhynchos domesticus) exposed to different pathogens.

Poultry, like mammals and other birds, develop fever when exposed to compounds from gram-negative bacteria. Mammals also develop fever when exposed to the constituents of viruses or gram-positive bacteria, and the fevers stimulated by these different pathogenic classes have discrete characteristics. It is not known whether birds develop fever when infected by viruses or gram-positive bacteria. Therefore, we injected Pekin ducks with muramyl dipeptide, the cell walls of heat-killed Staphylococcus aureus, or the viral mimic polyinosinic:polycytidylic acid and monitored their body temperature (T(b)). For comparative purposes we also injected a group of ducks with lipopolysaccharide, the only known pyrogen in birds. We then compared the T(b) invoked by each injection with the T(b) after an injection of saline. Muramyl dipeptide did not affect T(b). The cell walls of heat-killed S. aureus invoked long-lasting, dose-dependent fevers with relatively low magnitudes. Polyinosinic:polycytidylic acid invoked dose-dependent fevers with high febrile peaks. Fever is a well-known clinical sign of infection in mammals, and the results of this study indicate that the pattern of increase in T(b) could serve as an indicator for diverse pathogenic diseases in birds.

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

Use of Knee Height as a Surrogate Measure of Height in Older South Africans

The study aimed to determine whether knee height would be a more appropriate surrogate measurement than armspan in determining height and body mass index (BMI) in a group of South African older people (.. 60 years). A random sample of adults (older than 18 years) who attended selected clinics or who lived in selected old-age homes in the Western Cape volunteered to participate in the study. Subjects were divided into a study group of older people (.. 60 years of age; N = 1 233) and a comparative group of younger adults (18 - 59 years; N = 1 038).Armspan; knee height; standing height and weight were measured using standardised techniques. The standing height measurements were significantly different between the two groups (p = 0.0001); with a mean for adults of 1.61 m (standard deviation (SD) 0.09) compared with that of older peole (1.57 m (SD 0.09)). Mean standing height decreased with age. Knee-height measurements were not significantly different between the two groups; but when used to calculate height; the adults were significantly taller (p = 0.0001); with a mean height of 1.67 m (SD 0.06) compared with that of the older people (1.59 m (SD 0.08)). Mean armspan also decreased with age; and derived standing height was significantly different (p = 0.0001) between the two groups; with adults being taller (1.67 m (SD 0.11)) than the older people (1.63 m (SD 0.11)). In this study group; the knee-height measurements were more closely related to the standing height than the armspan. The BMI calculated from armspan-derived height tended to classify the older people towards underweight. Knee-height measurement would appear to be a more accurate and appropriate method to determine height in older people in South Africa

Small and Micro Enterprises - Aspects of Knowledge; Attitudes and Practices of Managers' and Food Handlers' Knowledge of Food Safety in the Proximity of Tygerberg Academic Hospital; Western Cape

Objective. This study determined hazard analysis and critical control point (HACCP) awareness among managers of food-producing small and micro enterprises (SMEs) as well as selected aspects of the knowledge;attitude and practices of respective food handlers regarding food safety.Setting. SMEs within a 30 km range of Tygerberg Academic Hospital.Methods. SMEs were divided into two categories: those providing food to clients at risk of illness (N = 64) and to clients free of illness (N = 81). SMEs were randomly selected and managers/employees completed validated questionnaires regarding HACCP (145 managers) and food safety (159 food handlers).Results. Only 6of managers reported awareness of HACCP being mandatory in South Africa. More than 70of managers and food handlers had received no formal training regarding food safety. The perception that food safety control should focus on general cleanliness still prevailed among 57.2of managers. Food handlers achieved an unsatisfactory score (46.0) on the basic principles of food safety. Ignorance among food handlers regarding important risk factors was as follows: ways of identifying contaminated food likely to cause food poisoning (77.5); period of keeping prepared food safe (50.9); correct way of cooling food (63.1) or reheating food (84.9); reason for checking date codes (68.1) and use of a thermometer (90.6). There was no significant difference in the results obtained between food handlers in SMEs providing food to healthy clients or clients at risk of illness. Conclusion. Creating awareness and understanding of HACCP among managers of SMEs and education regarding the control of risk factors remain crucial

A study of the litter loadings in urban drainage systems--methodology and objectives.

The recently completed report on "The removal of urban litter from stormwater conduits and streams" (by Armitage et al.) notes that little data is available on the nature and quantity of litter that finds its way into the stormwater drainage systems. The Council for Scientific and Industrial Research (CSIR) estimated in 1991 that 780,000 tonnes of waste a year was entering the drainage systems of South Africa, representing a potential removal cost in excess of two billion rand. There is thus a considerable need for finding ways to reduce litter loadings through better catchment management. Although suggestions have been made as to how this might be achieved, there is very little scientifically verified data from anywhere in the world to show that any of these proposed methods would be effective in South Africa. Only through an improved knowledge of the litter loadings in South African urban drainage systems can appropriate strategies to reduce litter loadings be arrived at. This improved knowledge is one of the twin objectives of the Water Research Commission Project No. K5/1051 entitled "The reduction of urban litter in drainage systems through integrated catchment management." Under this project a three-year monitoring programme has been instituted in nine catchments covering a range of different land uses, socio-economic levels and densities in the Cape Metropolitan Area. This paper focuses on the methodology behind the monitoring programme and the objectives it is hoped to achieve.

A fucoidan fraction from Ascophyllum nodosum.

A fucoidan fraction was purified from the brown alga Ascophyllum nodosum. The polysaccharide contained L-fucose and sulfate as the only constituents. Combination of methylation analysis, Smith degradation, FTIR and NMR spectroscopy on the native and the de-sulfated polymers demonstrated that the fucoidan consisted of a highly branched core region with primarily alpha-(1-->3)-linked fucosyl residues and a few alpha-(1-->4) linkages. Branch points were at position 2 of the -->3-linked internal residues. The side chains consisted of single and multi-unit fucosyl residues. The combined analytical data suggested also a complex sulfation pattern with substitution principally at position 2 and/or position 4. Such diversity in the structural features of this fucoidan may be of importance for its various biological properties.

Lipoprotein(a) determination and risk of cardiovascular disease in South African patients with familial hypercholesterolaemia.

OBJECTIVE: A raised plasma level of lipoprotein(a) (Lp(a)) is an established genetic risk factor for coronary heart disease (CHD), particularly in patients with concomitant elevation of low-density lipoprotein (LDL) cholesterol. The current study focused on the comparison of two commercially available Lp(a) assay kits to determine whether differences observed in measured Lp(a) levels could be deemed negligible in CHD risk assessment in familial hypercholesterolaemic (FH) patients. DESIGN: To compare results obtained on duplicate plasma samples using two commercially available Lp(a) measuring kits, the immunoradiometric assay (RIA) and the enzyme-linked immunoabsorbent assay (ELISA). SETTING: Division of Human Genetics, Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg, South Africa and the Institute for Medical Biology and Human Genetics, University of Innsbruck, Austria. SUBJECTS: Plasma samples were obtained from 146 family members of 65 molecularly characterised South African FH families for comparative analysis. RESULTS: Using the RIA method, 34 samples (23%) considered to be in the normal range by the ELISA technique, were placed in the high-risk group (> 30 mg/dl). Only one sample, considered to have a normal Lp(a) level with the RIA method, was categorised by the ELISA technique as high risk. CONCLUSION: Our data demonstrate that measurements of Lp(a) using the RIA method (the only assay available in South Africa at the time of this study) differ significantly from those obtained by the reference ELISA technique, suggesting that misclassification could lead to inaccurate CHD risk assessment. This is an important consideration in Afrikaner FH families, where plasma levels of Lp(a) have been shown to be elevated significantly in FH patients compared with non-FH individuals.

Structure of extracellular polysaccharide produced by lignin-degrading fungus Phlebia radiata in liquid culture.

The extracellular material (EM) produced by the white rot fungus Phlebia radiata cultured in an N-limited liquid medium was studied. Carbohydrate analysis showed maximum concentration of glucose as the major monosaccharide component of EM was found on postinoculation day 9. Beyond day 9 of cultivation the proportion of glucose decreased suggesting that the glucan component of EM had been further metabolized. The analysis of EM at day 9 revealed the presence of the following monosaccharides (in relative %): glucose (62); galactose (16); mannose (13); xylose (4); and fucose (5). The carbohydrate analysis together with the presence of protein in EM corresponds to a mixture of glucan and glycoprotein. Purification by trypsin treatment yielded an enriched glucose-containing extracellular polysaccharide (EPS). Methylation analysis identified EPS as (1-3)-beta-D-glucan highly branched at C-6. The structure of the glucan was confirmed by 13C-NMR spectroscopy. The results suggest that P. radiata's EPS is entangled with a glycoprotein in a complex that makes the extracellular sheath surrounding the hyphae.

Effects of a prudent diet containing either lean beef and mutton or fish and skinless chicken on the plasma lipoproteins and fatty acid composition of triacylglycerol and cholesteryl ester of hypercholesterolemic subjects.

In this two-phase crossover study, 39 hypercholesterolemic subjects followed a prudent diet with either lean red meat or fish and skinless chicken (treatment groups), and 13 subjects (reference group) followed their habitual diet. Fasting blood samples were analyzed for plasma total cholesterol, triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein one- and two-cholesterol, apolipoprotein-B, very low density lipoprotein cholesterol, and very low density lipoprotein TAG, and fatty acid composition of plasma TAG and cholesteryl ester (CE). Body mass and blood pressure were determined. Seven-day dietary records were kept once at baseline and twice during the treatment periods. Significant differences were observed in dietary intake between the baseline and treatment diets and between the two treatment diets. HDL-C (P < 0.05) and diastolic blood pressure (P < 0.01) were higher in patients on the red meat diet than in those on the chicken-fish diet. No other significant differences in lipoproteins were observed between the effects of the two treatment diets. The linoleic acid (%), eicosapentaenoic acid (%), and the eicosapentaenoic acid/arachidonic acid ratios in TAG and CE were higher (P < 0.01) in subjects on the chicken-fish diet than in those on the red meat diet. In conclusion, this study showed that the effect of two lipid-lowering diets containing either lean red meat or skinless chicken and fish on the atherogenic lipoproteins did not differ significantly. A prudent diet with skinless chicken and fish, however, had a more favorable effect on the fatty acid composition of the plasma TAG and the CE than did the lean red meat diet.

Plasma and red blood cell total phospholipid fatty acid status of nonpregnant female Vervet monkeys (Cercopithecus aethiops) on a high carbohydrate maintenance diet.

Nonhuman primates are of interest as models of human physiology to study the effect of multiple pregnancies on birth weight. Reference plasma and red blood cell (RBC) total phospholipids fatty acids were established in nonpregnant breeding female Vervet monkeys. Twenty-three clinically healthy nonpregnant Vervet monkeys (Cercopithecus aethiops), contained in a controlled closed environment and consuming a high carbohydrate diet (68 E%) that contained 20 E% fat and 12 E% protein were sampled for blood during a cross-sectional study. A low intake of omega3 fatty acids was reflected by a high omega6/omega3 ratio (66:1) of the diet. Inverse relations were seen between plasma and RBC total phospholipid fatty acids, 18:2omega6, 20:3omega6, and 20:4omega6, which suggested selective incorporation in membranes. Low levels of 20:5omega3 and 22:6omega3 of plasma and RBC total phospholipids render Vervet monkeys as ideal subjects to study the effect of omega3 fatty acid supplementation on pregnancy outcomes.

[Lymphadenopathy of dermatosis in the course of drug hypersensitivity. Cytologic, immunohisto- and immunocytologic, ultrastructural aspects. Report of a case]. / Lymphadénopathie des dermatoses au cours d'une hypersensibilité médicamenteuse. Aspect cytologique, immunohisto et immunocytologique, ultrastructural. A propos d'une observation.

In addition to the morphological details obtained from the imprints, a simple immunocytological study allowed us to diagnose one case of a dermopathic lymphadenopathy simulating a T cell lymphoma, following a drug-induced erythrodermia. We were able to identify the increase of CD1a+ and Prot. S100+ cells on acetone fixed imprints. The histological, immunohistological and ultrastructural investigations confirmed the value of the cytological study and that the dendritic cells were Langerhans cells (Birbeck granules+). Most of them were considered as migrating from the dermal lesions.

Sucrose in a lipid-rich meal amplifies the postprandial excursion of serum and lipoprotein triglyceride and cholesterol concentrations by decreasing triglyceride clearance.

Nineteen young male normolipidemic volunteers sequentially consumed three test meals consisting of cream only, sucrose only, or cream with sucrose. These oral fat-tolerance tests showed an amplification of the postprandial excursion of serum triglyceride and cholesterol concentrations when sucrose was included in a lipid-rich meal compared with both the cream-only meal and the sucrose-only meal. The triglyceride concentration increase occurred only in the late postprandial phase whereas the cholesterol concentration was increased for the entire 8 h studied. The increased triglyceride and cholesterol concentrations in the triglyceride-rich lipoprotein (TRL) fraction accounted for most of the increase. The clearance of an intravenous lipid emulsion was measured before and 2 and 4 h after a sucrose meal. The two postprandial clearance rates were 34% slower than the fasting value. These data indicate that sucrose-induced postprandial hypertriglyceridemia may be induced by an inhibition of the clearance of triglyceride. The slower rate of lipolysis may cause the accumulation of cholesterol in TRL.