Glycated haemoglobin (HbA1c) use and glycaemic control in patients living with diabetes mellitus attending public healthcare facilities in KwaZulu-Natal Province, South Africa.

BACKGROUND: Ideal control of diabetes mellitus (DM) remains a global goal, which has not yet been reached. As part of an integrated public healthcare strategy, data with subsequent analysis of diabetes control achieved in patients living with DM (PLWD) need to be available. Diabetes control data from KwaZulu-Natal (KZN) Province, South Africa, are scarce. Smaller studies conducted in public and private healthcare sectors of KZN have shown suboptimal DM control. OBJECTIVES: To identify the percentage of glycated haemoglobin (HbA1c) tests done in KZN public healthcare facilities, and to provide a glimpse into diabetes control being achieved in each KZN district municipality. METHODS: Data regarding the number of HbA1c tests performed, number of patients with an HbA1c ≤7% and number of diabetes visits were accessed from the KZN Department of Health Information Systems and analysed. RESULTS: The majority of HbA1c tests were performed in the metro municipality of eThekwini (p<0.001). Approximately two-thirds (64.5%) of PLWD in whom HbA1c tests had been performed, were suboptimally controlled. In 5 of the 11 KZN district municipalities more than two-thirds of PLWD had an HbA1c >7%. Most of the patients in 9 of the 11 district municipalities showed suboptimal control of their DM. The total number of HbA1c tests performed in KZN represents approximately one-tenth of the total number of diabetes treatment visits. This trend was prevalent in all 11 district municipalities, where the incidence of DM was on an upward trajectory. CONCLUSIONS: Our study demonstrated that the majority of PLWD visiting public healthcare facilities in KZN have suboptimal glycaemic control. They are at increased risk of developing diabetes-related complications, further burdening the healthcare fiscus of low- to middle-income countries. We also showed that the number of HbA1c tests being performed, in the presence of suboptimal control, was well below par. This finding serves to emphasise the need for strategies to be implemented to increase awareness of HbA1c testing for the monitoring of glycaemic control, and for making point-of-care HbA1c testing readily available in these healthcare facilities.

Intensive care unit hospitalisation costs associated with road traffic crashes at a central hospital in KwaZulu-Natal for the 2017/18 financial year.

BACKGROUND: The financial and physical impacts of road traffic crashes are borne by the individual, the extended family, society, the health sector and the economy of the country. The main contributors to these costs are the loss of productivity and the accrual of ongoing healthcare costs over a long-term period. There is limited information available on the cost of admitting seriously injured patients post accidents to a central hospital intensive care unit. METHODS: Cost data was obtained from the electronic database for all patients admitted for more than 24 hours to the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital. A mixed costing approach was used. Data was collected on surgical procedures, imaging, laboratory tests, trauma receiving fees, pharmaceuticals, goods and services and compensation of employees. RESULTS: The total cost of treating road traffic crash patients for the 2017/18 financial year equated to R21 140 475.49. The three main cost drivers comprised the compensation of employees (R12 135 848.41; 57.4%), goods and services (R5 083 182.12; 24%) and surgery costs (R1 429 321.00; 6.8%). The average cost per admission was R163 879.65, with the average cost per inpatient day equating to R12 727.56. Male patients admitted from motorcycle crashes had the highest cost per admission, followed by motor vehicle crashes and pedestrian vehicle crashes. CONCLUSION: The cost and burden associated with road traffic crashes is reflective of national and international trends and will require a comprehensive strategy to reduce accidents as well as better management at the scene and at lower levels of care.

The burden of hypertension in KwaZulu-Natal Province, South Africa: A 6-year perspective.

BACKGROUND: Hypertension (HPT) and its complications continue to pose a global threat and contribute to premature mortality worldwide. The adverse interactions between HPT, obesity and COVID-19 are currently being witnessed globally and represent a collision of pandemics. Understanding the burden that this non-communicable disease (NCD) poses in KwaZulu-Natal (KZN) Province, South Africa (SA), would help in developing improved public healthcare strategies. OBJECTIVES: To describe the burden of HPT in all the districts of KZN over a 6-year period. METHODS: HPT data are routinely collected from all KZN public health facilities (both clinics and hospitals) as part of the District Health Information System (DHIS). In this retrospective study, we accessed HPT records from the DHIS over a period of 6 years (2014 - 2019, inclusive). Data collected included the number of patients screened, diagnosed and initiated on therapy for HPT, together with the number of obese patients. RESULTS: The slopes for HPT screening were positive at both clinics and hospitals in KZN (considerably more at clinics than hospitals, with a difference in elevations of slopes of p<0.001), with a significantly greater percentage of the population having been screened at rural clinics than at hospitals (difference in elevation of slopes p<0.001). A significantly greater number of patients aged <40 years (p<0.001) were being screened for HPT at clinics than at hospitals (2017/18, 2018/19, 2019/20), while hospitals screened considerably more patients aged ≥40 years in 2017 - 2018 (p<0.001). The numbers of new hypertensives diagnosed and having treatment initiated were on an upward slope at both clinics and hospitals, with clinics having a greater elevation of slope than hospitals (p<0.001), irrespective of patient age. A significantly greater number of patients aged ≥40 years (p<0.05) were diagnosed with HPT at both clinics and hospitals in KZN (2017/18, 2018/19, 2019/20). KZN clinics remained the first port of call for known hypertensives throughout the study period. Obesity was prevalent at both clinic and hospital level, although figures were significantly higher at clinics. Over 80% of the obesity burden was carried by the rural clinics and hospitals. CONCLUSIONS: Screening, diagnosis, treatment initiation and chronic management of HPT occur mainly at rural clinic level. The SA government needs to heed these findings and redirect resources (staffing and equipment) to this level. The prevalence of obesity was highest at rural healthcare facilities (clinics more than hospitals). More needs to be done to combat the obesity pandemic if we are to win the battle against NCDs (HPT and diabetes mellitus). A significant number of patients aged <40 years are being screened for HPT, which bodes well for the province, as early diagnosis and treatment of HPT are vital to prevent complications.

Thermal neutron-induced γ-ray background in 124Sn.

The thermal neutron-induced gamma-ray background in 124Sn is investigated in connection with neutrinoless double beta decay (0νßß) studies in 124Sn. For this purpose, a 99.26% enriched 124Sn sample was irradiated with a thermal neutron fluence of 3×1015/cm2 in the Dhruva reactor at the Bhabha Atomic Research Centre, Mumbai. The gamma ray spectra of the irradiated sample were measured in a low background counting setup to study both long-lived and short-lived activities. The present data give an independent measurement of the half-life of 125Sn*(32+) and 125Sn(112-) as 10.01(8) min and 9.63(2) d, respectively. The impact of the observed high-energy gamma rays and the residual activity due to 125Sb, on the background in the region of interest around the Qßß value of 124Sn (~2.291 MeV) is discussed.

Study of the effect of external noise pickups on the performance of a cryogenic bolometer.

This paper reports the detailed noise characterization, investigation of various noise sources, and its mitigation to improve the performance of a cryogenic bolometer detector for the TIN.TIN experiment. The noise spectrum has been measured for a sapphire bolometer test setup with an indigenously developed neutron transmutation doped Ge sensor in the cryogen free dilution refrigerator system at Mumbai. The effect of external noise, arising either from ground loops in the system or from the diagnostic and control electronics of the cryostat, on the performance of the bolometer is assessed. A systematic comparison of the influence of different noise pickups on the bolometer resolution is also presented. The best-achieved resolution (σE) at 15 mK is ∼15 keV for heater pulses and appears to be mainly limited by the noise due to the pulse tube cryocooler.

The effect of pre-eclampsia on retinal microvascular caliber at delivery and post-partum.

BACKGROUND: The retinal microcirculation provides a unique view of microvessel structure by means of non-invasive, retinal image analysis. The aim of the study was to compare the retinal vessel caliber at delivery and one-year post-partum between women who have had pre-eclampsia during pregnancy to a normotensive control group. METHODS: Digital photos of the eye were taken at delivery and one-year post-partum. Retinal vessels were analysed and summarised as the corrected central retinal arteriolar equivalent and corrected central retinal venular equivalent. RESULTS: The corrected central retinal arteriolar equivalent and corrected central retinal venular equivalent were significantly lower in the pre-eclamptic group compared to the control group both at delivery and one-year post-partum (p < 0.001). CONCLUSION: Retinal artery and venular caliber changes that occur during pregnancies affected by pre-eclampsia persist for up to one-year post-partum. These changes may reflect a permanent, long-term microvascular dysfunction and may be useful as a biomarker of future vascular risk.

Continuous wave terahertz radiation from antennas fabricated on C¹²-irradiated semi-insulating GaAs.

We demonstrate continuous wave (CW) terahertz generation from antennas fabricated on C12-irradiated semi-insulating (SI) GaAs substrates. The dark current drawn by the antennas fabricated on irradiated substrates is ∼3 to 4 orders of magnitude lower compared to antennas fabricated on un-irradiated substrates, while the photocurrents decrease by only ∼1.5 orders of magnitude. This can be attributed to the strong reduction of the carrier lifetime that is 2.5 orders of magnitude, with values around τ(rec)=0.2 ps. Reduced thermal heating allows for higher bias voltages to the irradiated antenna devices resulting in higher CW terahertz power, just slightly lower than that of low-temperature grown GaAs (LT GaAs)at similar excitation conditions.

Predicting venous insufficiency in flaps raised on the deep inferior epigastric system using computed tomography (CT) angiography.

Computed Tomography Angiogram (CTA) has become a routine part of pre-operative assessment of vascular anatomy and design in perforator flaps. We conducted a retrospective cohort study of flap raised on the deep inferior epigastric system (DIES) at our institution in order to identify CTA signs that might predict venous congestion in these flaps. 98 consecutive patients who had 124 DIES flaps raised from 2008 to 2012 were studied. Of these 124 flaps, four (3.2%) developed venous congestion. Our results showed that a Superficial Inferior Epigastric Vein (SIEV) that is larger than the DIEV at origin is highly predictive of congestion (5.2 vs 3.5 mm, p = 0.007). The findings of an axial non-arborising superficial system (96.7% vs 0, p < 0.001), without connection to deep system perforators (38.1 vs 88.8%, p < 0.001) and a type I pedicle were also predictive (75 vs 64.2%, p = 0.22). These results show the importance of CTAs as a pre-operative study for the identification of risk factors for venous compromise, and their use should prompt a robust discussion of the risk of flap failure with patients, and contingency planning to augment venous drainage with the superficial system if required.

Carbon irradiated semi insulating GaAs for photoconductive terahertz pulse detection.

We report here a photoconductive material for THz detection with sub-picosecond carrier lifetime made by C(12) (Carbon) irradiation on commercially available semi-insulating (SI) GaAs. We are able to reduce the carrier lifetime of SI-GaAs down to sub-picosecond by irradiating it with various irradiation dosages of Carbon (C(12)) ions. With an increase of the irradiation dose from ~10(12) /cm(2) to ~10(15) /cm(2) the carrier lifetime of SI-GaAs monotonously decreases to 0.55 picosecond, whereas that of usual non-irradiated SI-GaAs is ~70 picosecond. This decreased carrier lifetime has resulted in a strong improvement in THz pulse detection compared with normal SI-GaAs. Improvement in signal to noise ratio as well as in detection bandwidth is observed. Carbon irradiated SI-GaAs appears to be an economical alternative to low temperature grown GaAs for fabrication of THz devices.

Electromagnetic transition from the 4+ to 2+ resonance in 8Be measured via the radiative capture in 4He + 4He.

An earlier measurement on the 4+ to 2+ radiative transition in 8Be provided the first electromagnetic signature of its dumbbell-like shape. However, the large uncertainty in the measured cross section does not allow a stringent test of nuclear structure models. This Letter reports a more elaborate and precise measurement for this transition, via the radiative capture in the 4He + 4He reaction, improving the accuracy by about a factor of 3. Ab initio calculations of the radiative transition strength with improved three-nucleon forces are also presented. The experimental results are compared with the predictions of the alpha cluster model and ab initio calculations.

Anterior thigh compartment syndrome after prone positioning for lumbosacral fixation.

We report a case of a patient who developed anterior thigh compartment syndrome after being positioned prone for instrumented lumbar spine surgery. Although rare, clinicians should be aware that compartment syndrome is a possible complication of spinal surgery.

Modern Rutherford experiment: tunneling of the most neutron-rich nucleus.

A modern variation of the Rutherford experiment to probe the tunneling of exotic nuclear matter from the measurement of the residues formed in the bombardment of (197)Au by extremely neutron-rich (8)He nuclei is presented. Using a novel off-beam technique the most precise and accurate measurements of fusion and neutron transfer involving reaccelerated unstable beams are reported. The results show unusual behavior of the tunneling of (8)He compared to that for lighter helium isotopes, highlighting the role of the intrinsic structure of composite many-body quantum systems and pairing correlations.

Exploring fusion at extreme sub-barrier energies with weakly bound nuclei.

Results of measurement of residues formed in fusion of (6)Li with (198)Pt in the energy range of 0.68 < E/V(b) < 1.3 using a new sensitive off-beam technique are reported. The fusion excitation function and the derived average angular momenta do not indicate a change of slope at deep sub-barrier energies, contrary to recent observations. The present results for a system with weakly bound projectile confront the current understanding of the fusion hindrance at these low energies, underlying the role of internal reorganization on the dynamical path towards fusion.

1n and 2n transfer with the Borromean nucleus 6He near the Coulomb barrier.

Angular distributions for 1n and 2n transfer are reported for the 6He+65Cu system at E_{lab}=22.6 MeV. For the first time, triple coincidences between alpha particles, neutrons, and characteristic gamma rays from the targetlike residues were used to separate the contributions arising from 1n and 2n transfer. The differential cross sections for these channels, elastic scattering, and fusion were analyzed using a coupled reaction channels approach. The large measured ratio of the 2n-to-1n cross section and the strong influence of 2n transfer on other channels indicate that the dineutron configuration of 6He plays a dominant role in the reaction mechanism.

Magnetic resonance image findings in the early post-operative period after anterior cervical discectomy.

If early neurological deterioration occurs following anterior cervical discectomy, the patient should be evaluated by urgent MRI scanning. In order to interpret such a scan it is essential to know what the normal post-operative MRI appearance is following an uncomplicated procedure. In the lumbar spine it is well recognized that early post-operative imaging following discectomy is difficult to interpret with a high rate of false positive scans. The normal appearance of MRI in the early post-operative period was evaluated prospectively in 15 patients undergoing anterior cervical discectomy without fusion for either cervical radiculopathy or myelopathy. MRI was performed on the first post-operative day, at 6 weeks and 6 months. The successful outcome of the procedure was validated by uniform improvement of Visual Analogue Scale measurement for neck and arm pain, the Neck Disability Index and European Myelopathy Score as appropriate. In contrast to the established findings following lumbar discectomy, only two cases showed a persistent epidural mass in the first post-operative scan and this had completely resolved at 6 months. All patients had foraminal narrowing and root or cord compression pre-operatively. Sixty six percent of cases showed persistent foraminal narrowing on sequential imaging up to 6 months despite showing good symptomatic improvement. All cases demonstrated high signal in the operated disc space on T2 weighted imaging on the first post-operative day and this finding persisted in 13 of 15 scans performed at 6 weeks. Post contrast imaging demonstrated no enhancement of operated disc space and adjacent vertebral body on the first post-operative day, whereas all scans at 6 weeks showed enhancement and such enhancement persisted at 6 months in 50%. Persistent epidural filling defects are uncommon following successful anterior cervical discectomy but persistence of foraminal narrowing is common despite successful outcome. Enhancement of the disc space is also common and does not in itself imply infection.

An unusual case of a compound depressed skull fracture after an assault with a stiletto heel.

Compound depressed skull fractures occur commonly from assault with various sharp and blunt objects. The use of a stiletto heeled shoe as an offensive weapon has not been reported before as a cause of such an injury. However unusual the history of assault, a clear picture of the mechanism of the injury is vital. Patients with scalp lacerations following a direct blow to the head must be evaluated thoroughly. Early investigation and treatment are necessary to reduce the risk of complications, as illustrated by this case.

Older patients' utilisation of emergency department resources: a cross-sectional study.

A cross-sectional study was conducted to investigate older patients' utilisation of emergency department resources. Patients aged > or = 65 years, compared with adults < 65 years, were more likely to be triaged to higher clinical urgency categories. They have a higher hospital admission rate and longer length-of-stay even after adjusting for triage category. Patients > or = 80 years, compared with 65-79 years, were more likely to be triaged to higher urgency categories. These groups had similar hospital admission rates and lengths-of-stay. Patients > or = 65 years presented in similar numbers during office-hours and after-hours, but after-hours attendances were more likely to be triaged to higher urgency categories. The greater emergency department resource utilisation by older people has implications for the provision of health services in an aging population.

Parental decisions following prenatal diagnosis of sex chromosome aneuploidy: a trend over time.

Research over the last 20 years has considerably changed the understanding of the natural history and prognosis for individuals with a diagnosis of sex chromosome aneuploidy (SCA). A cross-sectional retrospective analysis of factors influencing parental decisions following a prenatal diagnosis of SCA during the time period of 1971-97 was performed. The records of 169 fetuses with a prenatal karyotype of 45,X, 47,XXX, 47,XXY, and 47,XYY were reviewed. Mosaic karyotypes for SCA were also included. Information reviewed involved: parental decision, the type of SCA, the presence or absence of mosaicism, the presence or absence of a fetal anomaly diagnosed by ultrasound examination, indication for prenatal diagnosis, prenatal procedure performed, parental age, marital status, previous pregnancy history, family history, ethnicity, religion, education, and profession. A significant correlation was found between the decision to continue a pregnancy and the type of SCA and the presence of fetal abnormalities on ultrasound examination. In addition, this study examined differences in parental decisions over time for the years in question. A statistically significant trend was observed with a higher rate of pregnancy continuation in the more recent years.