Bioprinting: Prospects, considerations and challenges for application in South African clinical environments.

Bioprinting advances have revolutionised drug discovery and are set to disrupt biomedical research and medical application through the development of reproducible, fine-tuned functional 3D tissues and, eventually, whole organs. This intersectional bottom-up approach of additive manufacturing requires collaboration between tissue engineers, materials chemists, software and electrical engineers and medical practitioners for the software, hardware and wetware required by this disruptive technology. This review provides a current overview of the state of the art of bioprinting and the biomaterials/bioinks required, as well as the challenges and prospects for medical application in South Africa.

Bioprinting: Prospects, considerations and challenges for application in South African clinical environments

Bioprinting advances have revolutionised drug discovery and are set to disrupt biomedical research and medical application through the development of reproducible, fine-tuned functional 3D tissues and, eventually, whole organs. This intersectional bottom-up approach of additive manufacturing requires collaboration between tissue engineers, materials chemists, software and electrical engineers and medical practitioners for the software, hardware and wetware required by this disruptive technology. This review provides a current overview of the state of the art of bioprinting and the biomaterials/bioinks required, as well as the challenges and prospects for medical application in South Africa

Doctors' Use of Laboratory Tests in the Diagnosis and Treatment of Patients

The provincial health budgets in South Africa are under enormous pressure and; annually; budgets are exceeded by most hospitals and clinics. Laboratory tests requested by clinicians are contributing to the problem of over-expenditure. The aim of this study was to determine from patients' files whether doctors were using laboratory tests prudently during their treatment of patients in the outpatient department (OPD) of the National District Hospital in Bloemfontein. A descriptive study was carried out using all the files of patients who visited the OPD in a three-month period (1 July to 30 September 2005) for whom laboratory tests were requested by the attending physician. The majority (31.3) of patients for whom laboratory tests were requested presented to the OPD with cardiovascular complaints or diagnoses; followed by endocrine (27.8) and musculoskeletal (16.3) complaints or diagnoses. Between one and three tests were requested for most patients; i.e. 33and 15; respectively. The most frequently requested tests were erythrocyte sedimentation rate (8.1); urea and electrolytes (7.7); urine microscopy; culture and sensitivity (6.4); cholesterol (6.1); full blood count (5.7) and thyroid profile (TSH 4.6; T4 2.6and thyroid functions 2.3). In 70.4of cases; results were documented and; in 59.1; the physician's management plans indicated the incorporation of laboratory test results into the patient's treatment regimen. Our findings indicated inappropriate documentation and application of test results. Interventions to improve physician behaviour include education; guidelines; feedback; leadership and redesign of requisition forms

Occupational Exposure to Bloodborne Viruses amongst Medical Practitioners in Bloemfontein; South Africa

Background : The possibility of occupational exposure to bloodborne viruses such as HIV; hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality to health care workers. This study reports on doctors' extent and outcome of exposure to bloodborne viruses in Bloemfontein. Methods : descriptive study was done. Doctors (n=441) actively involved in public and/or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV; HBV; and HCV). Results : A response rate of 51.7 was obtained. More than half (54.2; 95 CI [ 47.7 ; 60.5 ]) of respondents were exposed to bloodborne viruses; 48.3 occurring with HIV positive patients and 4.3with known HBV positive patients; and no positive HCV patients. After exposure occurred; 68.9 of patients were tested for HIV; 10.9 for HBV and only 4.2 for HCV infection. The frequency of serological testing for doctors immediately after exposure was 65.3 for HIV; 21.7 for HBV and 8.2 for HCV. No seroconversion to HIV or HCV was reported; while two seroconversions to HBV were reported. Most exposures occurred as a result of needle stick injury (85) and occurred in the operating theatre during . The majority (59.8procedures 59.3)of exposed doctors did not take any prophylactic treatment and those who did; did not always complete the treatmentConclusion : The risk of seroconversion to HIV after occupational exposure was as expected; while seroconversion to HBV was less than expected. The lack of adequate follow up serological testing after occupational exposure is alarming. It is the responsibility of the occupationally exposed doctor to adequately comply with prophylactic measures and undergo serological testing to ensure the least possible risk of contracting infection from a bloodborne virus

Good Short-Term Outcome of Kangaroo Mother care in Low Birth Weight Infants in a Rural South African Hospital

Objective: The aim of the study was to determine the outcome of kangaroo mother care (KMC) in low birth weight infants at a community hospital. Methods : This descriptive study included 87 mothers and their low birth weight infants who were in a stable condition and eligible for KMC at Dr JS Moroka Hospital; Thaba Nchu. The infants were assessed four times: at birth; twice during hospitalisation; and a week after discharge. Infants received breast milk exclusively.Results : Regarding the mothers' obstetric history (n=87); gravidity ranged from 1 to 7 (median 3); with a 43 incidence of miscarriage. The median birth weight of the infants (n=87) was 1.5 kg (first assessment); the discharge weight (third assessment) was 1.8 kg; and a week after discharge (fourth assessment) it was 2.2 kg. Initially the infants lost weight significantly from birth to the second assessment (95 CI for median decrease [-0.02; -0.01]); but significantly gained weight from the second to the third (95 CI for median decrease [0.27; 0.33]) and from the third to the fourth assessment (95 CI for median decrease [0.32; 0.45]). Approximately half (49) of the infants had developed jaundice by the time of second assessment. These babies had a significantly lower birth weight [0.12;0.30]. Conclusion : Our findings confirm that infants with a low birth weight treated with KMC can have a good growth pattern; and exclusive breast milk is sufficient to guarantee such growth. Kangaroo mother care is a safe method for stable infants with a low birth weight in a community hospital

Profile and associated factors for re-admitted epileptic patients with complications in a South African hospital.

OBJECTIVE: The profile and associated factors for re-admitted epileptic patients with complications was determined. Repeated re-admission to Komani Hospital initiated the study to identify preventable factors aimed at reducing readmission of these patients. DESIGN: Descriptive study. SETTING: Komani Hospital, Queenstown, South Africa. SUBJECTS: 101 patients previously diagnosed with epilepsy and who were re-admitted to Komani Hospital with post-ictal complications, were included. MAIN OUTCOME MEASURES: Epileptic patients were identified on admission and were interviewed. Information of the post-ictal events was gathered from people accompanying the patient and who had witnessed the seizure. Patient information about associated factors like substance abuse, level of education, employment status, compliance, drug regimes and other issues were explored. RESULTS: Many (63%) patients were unemployed, 54% of the patients used alcohol and 24% had a history of substance abuse (cannabis). Most patients (71%) gave no family history of epilepsy. 10% of the patients had frequent seizures (once a week or once every two weeks) and 55% of the patients had infrequent seizures (once a month). More than a third (35%) of the patients had good control of seizures (once a year up to a maximum of three attacks per year). Most patients (97%) were on monotherapy. For (35%) of patients this was a second admission, with second and third admission representing more than 60% of patients. Most patients (56.4%) experienced myoclonic seizures (data gathered from patient notes, referral letters and collateral information) with a seizure frequency of at least once a month. Post-ictal psychosis was the most common cause of admission (68%). CONCLUSION: The onset of epilepsy in most patients was on or after 20 years of age. According to patient notes, referral letters and-collateral information, the majority of patients experienced myoclonic type seizures with a frequency of at least once a month or more. Most patients were stabilized on monotherapy and post-ictal psychosis was the most common cause of re-admission. Cannabis and alcohol use in the study group is of note.

Scientific Letter : Knowledge of Sexually Transmitted Diseases and HIV/AIDS Symptoms of Women Receiving Termination of Pregnancy; Bloemfontein

In 2002; we conducted a cross-sectional study to determine the profile of women seeking termination of pregnancy (TOP) in the Free State and to find out whether TOP was being used as a family planning method. The participants' contraceptive use and termination of pregnancy profile have been described elsewhere. This letter describes the knowledge of STD and HIV/AIDS symptoms of women seeking TOP

Profile of registrars and reasons for specialisation

Introduction The shortage of general practitioners is a worldwide phenomenon and occurs in countries such as Canada; the United States of America and Saudi Arabia. Increasingly fewer students are interested in general practice as an occupation. Choosing a speciality is a complex process and is dependent on a wide range of intrinsic and extrinsic factors; including preference at the start of studies; experience during undergraduate training; and environmental factors such as cultural and socio-economic background. The aim of this study was to determine the profile of registrars at theFaculty of Health Sciences (University of the Free State); as well as their reasons for specialisation. Method All departments were contacted and the first author circulated questionnaires and informed consent forms during the academic afternoons. Questionnaires and informed consent forms were available in Afrikaans and eng. Results Of the 150 questionnaires handed out; 109 were used for analysis (122 were received; of which 13 were incomplete). Most of the respondents were Afrikaans speaking (81.7

Is pregnancy termination being used as a family planning method in the Free State?

"Background: This study determined the profile of women seeking termination of pregnancy (TOP) in the Free State and whether TOP was used as a family planning method. Methods: Seven hundred and fifty women (15-47 years old) seeking TOP at the Reproductive Health Unit of the National Hospital in Bloemfontein were included in this cross-sectional study. The women who gave verbal consent completed a questionnaire during counselling. Results: The median age of the participants was 24 years and 77.3 were single. Most participants (73.3) were not using any family planning method at the time of the study. One-fifth (19.1) had previously had at least one TOP; while for 80.9 of the participants it was their first visit. Some participants (16.6) considered TOP a family planning method; 39.7 were unsure and 43.7 indicated that TOP is not a family planning method. Thirty-nine women failed to answer this question. When asked the reason for TOP; 3.5 chose the option ""contraceptive method"". Conclusions: The relatively high percentage of participants who consider TOP a contraceptive method or are unsure; associated with the fact that most were young; single; not using contraception and had applied for induced abortion just because the conception represented an unwanted pregnancy; implies that some of our population is not aware that termination of pregnancy is not a family planning method."

A paramedian approach for epidural block: an anatomic and radiologic description.

BACKGROUND AND OBJECTIVES: Certain factors, such as intervertebral disc herniation, previous spinal surgery, and osteoarthritis may cause problems during the midline epidural procedure. The purpose of this study was to investigate the placement of the needle tip in an alternative paramedian approach in a cadaver, and radiographically measure the target interlaminar area at different levels (L3/L4; L4/L5; L5/S1) in different age groups. METHODS: The placement of epidural needles by an anesthetist using an alternative paramedian approach on 36 cadavers was evaluated by subsequent dissection along the needle to determine the location of the needle's terminal end. Radiographic measurements performed on anteroposterior lumbar spine x-rays in different age groups were used to determine the dimensions of the interlaminar area (horizontal, left vertical paramedian, and right vertical paramedian). RESULTS: Measurements of the interlaminar area significantly diminished with increasing age at L3/L4 (except for the horizontal measurement), L4/L5 (except for the vertical left paramedian measurement), as well as at L5/S1 in all measurements. CONCLUSION: This anatomically-based study confirms needle placement through the interlaminar space using an alternative paramedian approach and may explain the difficulties encountered during placement of an epidural needle with increasing age.

A comparison between medicine from an African (Ubuntu) and Western philosophy.

I consider the Ubuntu way of caring for the sick in terms of the Ubuntu world-view by systematizing the scattered views. I argue that this world-view is underpinned by the regulative concept of sharing and that caring in Ubuntu-thinking can only be understood correctly in terms of sharing. I substantiate my exposition in terms of what Africans themselves claim Ubuntu is and relate its meaning to African thinking in general. I consider the uniqueness of this world-view by showing how an African thinker compares it to Western World-views on causality and critically consider these comparisons. I apply this world-view to African medicine and evaluate the Ubuntu idea of causes in medicine in comparison with causality in Western thinking by considering the two frameworks of medical care in terms of their viability respectively. I conclude that causal patterns in medicine are controversial in both thinkings but argue that it sets the framework for intercultural communication that can lead both to a better understanding of each other and to some positive developments in medicine. These ways of dealing with the topic represents the significance of this article as an addition to existing knowledge.

Sperm chromatin packaging as an indicator of in-vitro fertilization rates.

The development of a sequential diagnostic schedule for patients consulting for infertility disturbances would be an ideal method of approach for clinicians in the absence of an aetiological or pathophysiological diagnosis. Since sperm morphology recorded by strict criteria has often been correlated with fertilization failure, the present study aimed to evaluate the relationship between normal morphology as well as in-vitro fertilization (IVF) rates, with chromatin staining among fertile and subfertile men. Two semen smears were prepared from each specimen obtained from 72 men to record normal morphology and chromatin packaging as recorded by chromomycin A(3) (CMA(3)) staining. Following the semen analyses, the 72 men were divided into the two morphological groups, namely <4% and >4% normal forms. Significantly different percentages of CMA(3) staining (mean +/- SE) were recorded between the two morphological groups, namely 65.9% +/- 3.5 and 44.5% +/- 1.7 (P +/- 0.001). A highly negative significant correlation existed between percentage of normal morphology as recorded by strict criteria and CMA(3) staining. A highly significant and positive correlation was recorded for normal morphology and IVF rates (r +/- 0.45, P +/- 0.0001). A significant negative correlation (r +/- -0.51, P +/- 0.0001) existed between CMA(3) values and IVF rates. The discriminating power of nuclear maturity, as recorded by CMA(3) staining, to identify abnormal morphology values and poor IVF rates was calculated with receiver operator characteristic (ROC) analyses. The areas under the ROC curves were 0.86 for sperm morphology and 0. 74 for IVF rates. The calculated threshold values for CMA(3) staining to distinguish between morphology groups were 48 and 50% for IVF. Chromatin packaging assessment is a valuable addition to the sequential diagnostic programme in an assisted reproductive arena.