South Africa (SA) has high demand but inequitable access to palliative care (PC). Realising this need and the growing recognition of pharmacists' in PC globally, a study was undertaken regarding the ...role of pharmacists in the provision of PC services and support in SA.
A descriptive cross-sectional quantitative study was conducted among 540 community and hospital pharmacists. A self-administered, closed-ended questionnaire covering knowledge, attitude, current role, future role and barriers to PC was used. Data was coded and analysed using SPSS® Version 24.0. P-values < 0.05 were considered statistically significant.
Response rate was 48.7% (n = 263). Pharmacists (72.2%) were already playing a role in PC, however, only 20.5% reported frequent involvement in PC. Services provided included medicine supply (88.2%), side-effect/symptom management (82.1%), information sharing (60.8%), bereavement counselling (60.8%), treatment/care needs (57.4%) and spiritual support (52.1%). More pharmacists (96.6%) wanted to play a role in PC, beyond medicine supply to include PC team member (91.6%), medicine reviews (91.3%), referrals (80.2%) and patient visits (50.6%). Pharmacists had a good knowledge (71.4%) and a positive attitude (61.5%) towards PC despite many health system barriers such as lack of training (91.3%), inadequate clinical experience (90.5%) and insufficient resources (77.2%).
Pharmacists with their high level of knowledge, positive attitude and broad scope of practice are well-placed to play a role in PC. Further strengthening and integration of their roles into the continuum of care, will encourage the involvement of more pharmacists, enhancing availability, access and resources for PC.
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BFBNIB, FZAB, GIS, IJS, KILJ, NUK, OILJ, SBCE, SBMB, UL, UPUK, VSZLJ
In this trial, patients with tuberculous pericarditis were randomly assigned to prednisolone or placebo and to
Mycobacterium indicus pranii
or placebo. Neither therapy reduced the risk of the ...composite outcome of death, cardiac tamponade, or constrictive pericarditis.
Tuberculous pericarditis is a common cause of pericardial effusion, cardiac tamponade, and constrictive pericarditis in sub-Saharan Africa and parts of Asia.
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Patients with tuberculous pericarditis often have concomitant human immunodeficiency virus (HIV) infection.
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Despite antituberculosis therapy, pericardial drainage, or pericardiectomy, mortality and morbidity remain high.
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Mortality is as high as 26% at 6 months but is even higher (approximately 40%) among persons with the acquired immunodeficiency syndrome.
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The use of glucocorticoid therapy in patients with tuberculous pericarditis to attenuate the inflammatory response may improve outcomes and decrease the risk of death by reducing cardiac tamponade and pericardial constriction,
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but . . .
Optimal drug levels and minimal toxicity are critical factors in improving treatment outcomes for patients' prescribed new and repurposed medicine for drug-resistant (DR) tuberculosis (TB). The ...optimal dose of clofazimine (CFZ), a repurposed medicine for DR-TB, that is safe and effective in the South African (SA) population is unknown.
To report on dose-related final treatment outcomes in patients receiving CFZ plus a background regimen for DR-TB.
In a retrospective review of patient folders from 2012 to 2014, treatment outcomes documented for patients receiving high- (≥200 mg) and low-dose (100 mg) CFZ in a centralised DR-TB hospital in KwaZulu-Natal Province, SA, were investigated for an association between dose-weight interactions and outcomes.
A total of 600 patients were included, of whom 169 (28.2%) received 100 mg. Of these, 87 (51.5%) weighed <50 kg and 82 (48.5%) ≥50 kg. Four hundred and thirty-one (71.8%) received ≥200 mg, of whom 41 (9.5%) were <50 kg and 390 (90.5%) ≥50 kg. Overall 77.2% were HIV-positive, with 93.95% on antiretroviral medicine. The majority of patients presented with extremely drug-resistant TB (55.3%). Forty-seven and a half percent of patients received a standardised background regimen, and 52.5% received an individualised regimen containing a new or repurposed medicine including CFZ. On multivariate analysis, adjusting for age, gender, HIV status and concomitant antiretrovirals, previous TB history, type of TB and background regimen, patients ≥50 kg prescribed 100 mg CFZ were 60% less likely to have a successful outcome (adjusted odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2 - 0.8; p=0.009) compared with patients <50 kg receiving 100 mg CFZ. Patients <50 kg who received ≥200 mg were 40% less likely to have a successful treatment outcome (adjusted OR 0.6, p=0.3), and were found to have a higher risk of adverse events than patients <50 kg receiving 100 mg CFZ (82.9% v. 65.5%).
Dose-weight interaction plays a role in the odds of a successful outcome. There is an association between dose-weight interactions, outcomes and adverse events. Weight-based dosing in patients <50 kg and ≥50 kg must be considered to achieve optimal treatment outcomes and reduce adverse events. Active drug safety monitoring must be implemented as a package of care for patients receiving CFZ as part of a DR-TB treatment regimen.
Alterations in sleep duration and quality are linked to the development of cardiovascular risk factors and the metabolic syndrome (MetS). The aim of this study was to determine a sex stratified ...analysis on the role and associations of sleep duration on cardiometabolic risk factors, and the MetS.
Data from 1375 randomly selected participants (15-64 years) was collected for demographic, anthropometric, blood pressure and biochemistry data after overnight fasting, and derangements diagnosed according to published guidelines. Analysis of association between the MetS (harmonised criteria modified for South Asians), sleep duration (self-reported for a 24-hour period), and cardiometabolic risk factors was done using stepwise logistic regression.
The BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose, total cholesterol, low density lipoprotein were higher (p< 0.05) in subjects who slept <6 hours, with lower HDL. Under 6 hours of sleep was independently associated with raised FPG in men (OR 1.71 95% CI 1.53,5.52) only. More than 10 hours of sleep was independently associated with increased triglyceride levels in men (1.720.56, 5.23) and women (2.251.93,5.42).
The individual components of the Mets, particularly, increased triglycerides and blood glucose are associated with sleep deprivation or excess.
Background. Optimal drug levels and minimal toxicity are critical factors in improving treatment outcomes for patients prescribed new and repurposed medicine for drug-resistant (DR) tuberculosis ...(TB). The optimal dose and dose-related safety of clofazimine (CFZ), a repurposed medicine for DR TB, in the South African (SA) population are unknown.Objectives. To report on dose-related adverse events in patients receiving CFZ plus a background regimen for DR TB.Methods. In a retrospective review of patient folders from 2012 to 2014, adverse events documented for patients receiving high- (≥200 mg) and low-dose (100 mg) CFZ in a centralised DR TB hospital in KwaZulu-Natal Province, SA, were investigated for an association between dose-weight interactions and adverse events.Results. Of 600 patients included, 78.7% (n=472) weighed ≥50 kg. Of these, 17.4% (n=82) received 100 mg CFZ and 82.6% (n=390) received >200 mg. Of 128 patients (21.3%) who weighed Conclusions. There is an association between dose-weight interaction and adverse events. The odds of any adverse event occurring were higher when low-weight patients (
South Africa’s Plan for Higher Education identified equity and redress as key objectives guiding institutional transformation. This encompasses granting individuals fair opportunities to enter higher ...education and succeed therein. The COVID-19 pandemic which abruptly disrupted the 2020 academic year highlighted several challenges which have implications for student success. Academic continuity in the form of online learning was pursued by most higher education institutions. However, the remoteness of rural communities, which typifies the home environments for many South African students, threatened to exclude such students from online learning activities. The lack of access to digital devices as well as reliable internet connectivity in many of these communities impacted students’ ability to engage in online learning as well as access campus-based support services. The imposed lockdown therefore caused heightened anxiety and feelings of isolation from academic activities amongst the South African student population. Since access to on-campus support systems was no longer possible, student wellness and ongoing academic engagement was potentially compromised. Increasingly, the mental health cost of remote learning was becoming apparent, with higher education institutions compelled to rethink how student support services are delivered. In the absence of face-to-face support services during the hard lock-down period, the emergent need was to identify new ways of reaching out to displaced students who may be experiencing both academic and personal distress under conditions of daunting technological changes and virtual forms of engagement, social isolation, socio-economic disadvantage and psycho-social stressors. While blended learning and hybrid forms of holistic student support were accelerated by the advent of the Covid-19 pandemic, the blended approach has become an indelible reality of Higher Education that is here to stay. As such, reflections on how student support services at universities in South Africa have adapted and need to continuously evolve in the face of an uncertain world, is both timely and necessary if the goal of promoting equal access and success in Higher Education – for all - is to be fully realized.
The effect of interactions between organic solvents or water on the interfacial and bulk properties of 1-benzyl-3-methylimidazolium dicyanamide, BzMIMDCA and 1-benzyl-3-methylimidazolium ...bis{(trifluoromethyl)sulfonyl}imide, BzMIMNTf 2 were determined via measurement of activity coefficients γ ∞13 at infinite dilution for 64 solutes. The data were obtained using the gas–liquid chromatography technique. Measurements were undertaken at six temperatures, in 10 K intervals, in the range of 318.15 to 368.15 K. The solutes studied included both non-polar and polar compounds, such as alkanes, alkenes, and alkynes, as well as aromatic hydrocarbons, alcohols, water, ethers, ketones, acetonitrile, pyridine, 1-nitropropane, thiophene, and esters. Density, ρ , and viscosity η , measurements for a range of temperatures, T for the chosen ionic liquids (ILs), BzMIMDCA and BzMIMNTf 2 were also undertaken at pressure, p = 101 kPa. The gas–liquid partition coefficients, K L at infinite dilution, and the fundamental thermodynamic functions, partial molar excess Gibbs energy, enthalpy and entropy at infinite dilution were calculated from the experimental data measurements. The values of selectivity and capacity for three separation cases, viz. hexane/hex-1-ene, cyclohexane/cyclohexene, and ethylbenzene/styrene were calculated from γ ∞13 values and compared to literature for imidazolium-based or dicyanamide-based, or bis{(trifluoromethyl)sulfonyl}imide-based ionic liquids (ILs). The results from the study indicate that BzMIMDCA has large selectivity values for all three of the separation cases studied.
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IJS, KILJ, NUK, UL, UM, UPUK
The present work focussed on application of the environmental friendly 1-butyl-3-methylimidazolium bis(trifluoromethylsulfonyl) imide (BMIM+Tf2N−) ionic liquid for the separations of ...(alkane/aromatic), (alkane/alk-1-ene), (cycloalkane/aromatic) and (water/alkan-1-ol) using gas-liquid chromatography (GLC) technique. In this reason the activity coefficients at infinite dilution, γ13∞, for 31 organic solutes (alkanes, cycloalkanes, alkenes, alkynes, aromatics, alkanol and ketones) and water in ionic liquid were measured at temperatures of (323.15, 333.15, 343.15, 353.15 and 363.15) K. Stationary phase loadings of (42.83 and 68.66) % by mass were used to ensure repeatability of measurements. Density and viscosity values were measured to confirm the purity of ionic liquid. Partial molar excess enthalpies at infinite dilution, ΔH1E,∞, were also determined. The selectivities, Sij∞, and capacities, kj∞, were determined for the above separations. The separating ability of the investigated ionic liquid was compared with previously investigated ionic liquids and industrial solvents such as sulfolane, n-methyl-2-pyrrolidine (NMP) and n-formylmorpholine (NFM).
•Activity coefficients were measured in the ionic liquid BMIM+Tf2N−.•Selectivities for selected separations compared to other IL's and solvents•Capacities for selected separations were also calculated and discussed.•The expression and estimation of uncertainty have been described in detail.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
SETTING: Western Cape Province, South Africa.OBJECTIVES: To characterise tuberculosis (TB) epidemiology, disease presentation and treatment outcomes among adolescents (age 10-19 years) and young ...adults (age 20-24 years) in the Western Cape.DESIGN: A retrospective,
cross-sectional review of routine patient-level data from the Electronic TB Register (ETR.Net) for 2013. Site of TB disease, human immunodeficiency virus (HIV) status and TB treatment outcomes were analysed by 5-year age groups (<5, 5-9, 10-14, 15-19, 20-24 and 25
years of age). TB notification rates were calculated using census data.RESULTS: Adolescents and young adults comprised 18.0% of all new TB notifications in 2013. The notification rate was 141 TB cases/100 000 person-years (py) among 10-14 year olds, 418/100 000 py among
15-19 year olds and 627/100 000 py among 20-24 year olds. HIV prevalence among TB patients was 10.9% in 10-14 year olds, 8.8% in 15-19 year olds and 27.2% in 20-24 year olds. Older adolescents (age 15-19 years) and young adults (age 20-24 years)
with HIV co-infection had poor treatment outcomes: 15.6% discontinued treatment prematurely and 4.0% died.CONCLUSIONS: Young people in the Western Cape suffer a substantial burden of TB, and those with TB-HIV co-infection are at high risk of treatment discontinuation.
Objective:
Nitrogen oxide (NOx) pollution and human immunodeficiency virus (HIV)/AIDS intensify inflammation during pregnancy and linked with adverse birth outcomes (ABOs). MicroRNA (miRNA)-146a ...plays a crucial role in regulating inflammation in the NF-κB pathway. The G/C rs2910164 dampens miRNA-146a activity and linked with inflammatory diseases. The present study investigated whether HIV/AIDS and NOx exposure throughout pregnancy further intensifies ABO in Black South African women genotyped for the rs2910164.
Methods:
Pregnant women (n = 300) were subdivided into low, medium and high NOx exposure groups, genotyped for the miRNA-146a G/C rs2910164 using polymerase chain reaction-restriction fragment length polymorphism, and further stratified based on HIV status.
Results:
Unstratified data (HIV+ and HIV− mothers combined): Mothers from the high NOx group with the variant C-allele had low blood iron levels (p = 0.0238), and had babies with reduced birthweights (p = 0.0283). As NOx increased, the prevalence of preterm birth and low birth weight also increased in mothers with the variant C-allele versus wildtype G-allele. HIV-infected mothers: In all NOx exposure groups, mothers with the variant C-allele had higher systolic blood pressure (low: p = 0.0386, medium: p = 0.0367 and high: p = 0.0109) and had babies with lower Appearance, Pulse, Grimace, Activity and Respiration scores at 1 min (low: p = 0.0190, medium: p = 0.0301 and high: p = 0.0361).
Conclusion:
Maternal rs2910164 variant C-allele, NOx pollution and HIV/AIDS might collectively play a role in intensifying gestational hypertension and ABO.
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