•The Drakenstein Child Health Study (DCHS) is a multidisciplinary birth cohort in South Africa.•We review the psychosocial measures used in the DCHS and provide initial data.•We found a high ...prevalence of antenatal depression, substance use, and intimate partner violence.•Perinatal psychosocial risk factors may affect child neurodevelopmental and health outcomes.•Longitudinal assessment may clarify the underlying mechanisms which impact on child health.
Early life psychobiological and psychosocial factors play a key role in influencing child health outcomes. Longitudinal studies may help elucidate the relevant risk and resilience profiles, and the underlying mechanisms that impact on child health, but there is a paucity of birth cohort data from low and middle-income countries (LMIC). We describe the rationale for and present baseline findings from the psychosocial component of the Drakenstein Child Health Study (DCHS).
We review the psychosocial measures used in the DCHS, a multidisciplinary birth cohort study in a peri-urban area in South Africa, and provide initial data on psychological distress, depression, substance use, and exposure to traumatic stressors and intimate partner violence (IPV). These and other measures will be assessed longitudinally in mothers in order to investigate associations with child neurodevelopmental and health outcomes.
Baseline psychosocial data is presented for mothers (n=634) and fathers (n=75) who have completed antenatal assessments to date. The sample of pregnant mothers is characterized by multiple psychosocial risk factors, including a high prevalence of psychological distress and depression, high levels of substance use, and high exposure to traumatic stressors and IPV.
These data are consistent with prior South African studies which have documented a high prevalence of a multitude of risk factors during pregnancy. Further longitudinal assessment of mothers and children may clarify the underlying psychobiological and psychosocial mechanisms which impact on child health, and so inform clinical and public health interventions appropriate to the South African and other LMIC contexts.
Many mechanisms, including oxidative stress, contribute to hypertension. This study investigated the possible associations between oxidative stress, blood pressure and arterial stiffness in black ...South Africans. Ambulatory blood pressure measurements were taken for 101 black South African men and 99 women. The stiffness indices included ambulatory arterial stiffness index (AASI) and pulse pressure (PP). Reactive oxygen species (ROS) levels (P<0.0001) were higher in the African women compared with men. ROS levels were also higher in hypertensive compared with normotensive men. The 24 h systolic blood pressure (SBP; P<0.01), 24 h diastolic blood pressure (DBP; P<0.0001) and pulse wave velocity (PWV; P<0.01) were significantly higher in African men compared with women. There were unadjusted positive associations of 24 h SBP (r=0.33; P=0.001), 24 h DBP (r=0.26; P=0.008) and 24 h PP (r=0.29; P=0.003) with ROS in African men only. A positive association between AASI and ROS existed only in hypertensive men (r=0.27; P=0.035), but became nonsignificant (B=0.0014; P=0.14) after adjustments. Adjusted, positive associations of 24 h SBP (B=0.181; P=0.018) and 24 h PP (B=0.086; P=0.050) with ROS were again only evident in African men. ROS is positively associated with SBP and PP in African men, suggesting that increased ROS levels may contribute to hypertension in this population group.
Background. Little is known about the current clinical profile and outcomes of patients with infective endocarditis (IE) in South Africa (SA).Objectives. To provide a contemporary and descriptive ...overview of IE in a representative SA tertiary centre. Methods. We conducted a retrospective review of the records of patients admitted to Groote Schuur Hospital, Cape Town, between 2009 and 2016 fulfilling universal criteria for definite or possible IE, in search of demographic, clinical, microbiological, echocardiographic, treatment and outcome information.Results. A total of 105 patients fulfilled the modified Duke criteria for IE. The median age of the cohort was 39 years (interquartile range (IQR) 29 - 51), with a male preponderance (61.9%). The majority of the patients (72.4%) had left-sided native valve endocarditis, 14.3% had right-sided disease, and 13.3% had prosthetic valve endocarditis. A third of the cohort had rheumatic heart disease. Although 41.1% of patients with left-sided disease had negative blood cultures, the three most common organisms cultured in this subgroup were Staphylococcus aureus (18.9%), Streptococcus spp. (16.7%) and Enterococcus spp. (6.7%). Participants with right-sided endocarditis were younger (29 years, IQR 27 - 37) and were mainly intravenous drug users (73.3%), and the majority cultured positive for S. aureus (73.3%) with frequent septic pulmonary complications (40.0%). The overall in-hospital mortality was 16.2%, with no deaths in the group with rightsided endocarditis. Predictors of death in our patients were heart failure (odds ratio (OR) 8.16, 95% confidence interval (CI) 1.77 - 37.70; p=0.007) and age >45 years (OR 4.73, 95% CI 1.11 - 20.14; p=0.036). Valve surgery was associated with a reduction in mortality (OR 0.09, 95% CI 0.02 - 0.43; p=0.001).Conclusions. IE remains an important clinical problem in a typical teaching tertiary care centre in SA. In this setting, it continues to affect mainly young people with post-inflammatory valve disease and congenital heart disease. The in-hospital mortality associated with IE remains high. Intravenous drug-associated endocarditis caused by S. aureus is an important IE subset, comprising ~10% of all cases, which was not reported 15 years ago, and culture-negative endocarditis remains highly prevalent. Heart failure in IE carries a significant risk of death and needs a more intensive level of care in hospital. Finally, cardiac surgery was associated with reduced mortality, with the largest impact in patients with heart failure.
Loss to follow-up poses a major problem for clinicians and researchers, and several factors that may increase its risk have been postulated. The objective of this study was to describe potential ...factors that contribute to loss to follow-up as seen in orthopaedic patients participating in a research study and attending the sole public orthopaedic service provider in the Northern Cape Province of South Africa (SA). All patients who underwent ankle fracture surgery at Kimberley Provincial Hospital between January 2012 and July 2013 were included, and the number of follow-up visits attended by each participant was recorded prospectively. Demographic information pertaining to travel distance, social circumstances and comorbid conditions was captured and reviewed. A total of 268 patients (male n=112, 41.8% and female n=156, 58.2%) were included. The mean (standard deviation (SD)) age was 42.3 (13.8) years (95% confidence interval (CI) 40.6 - 43.9, n=266) and the mean body mass index (BMI, kg/m2) was 28.0 (6.5) (95% CI 27.2 - 28.8, n=251), the BMI for females being 30.2 (6.1) (95% CI 29.3 - 31.2, n=152) compared with 24.6 (5.7) (95% CI 23.4 - 25.7, n=99) for males. After excluding local patients living within 5 km of the hospital (n=77), the mean travel distance was 460 km (range 10 - 910). There was a significant association between the number of follow-up visits attended and travel distance (incidence rate ratio (IRR) 0.999, 95% CI 0.999 - 1.000; p=0.030), BMI (IRR 0.980, 95% CI 0.966 - 0.994; p=0.004) and HIV status (IRR 0.841, 95% CI 0.725 - 0.975; p=0.022). The main factors identified in this study that influenced the number of follow-up visits attended were travel distance, BMI and HIV status. BMI was a unique finding in our study. It was identified to be a significant contributing factor to the loss to follow-up. BMI was not a contributing factor in other studies..
Trinervitermes trinervoides (Sjöstedt) (Termitidae: Nasutitermitinae) is principally a grass litterfeeding species common to the semi-arid and arid grasslands of southernAfrica. Abundance of sterile ...adult termites (workers and soldiers) at eight sites within an area of semi-arid grassland, northwest of Bloemfontein in the Free State Province, varied between 34 and 4871/m2 (mean=2261/m2) with a live biomass of 0.2 to 27.8 g/m2 (mean=12.9 g/m2). The numbers of live mounds in an area do not necessarily reflect termite abundance. At two sites at Bultfontein fewer termites and lower biomass were present on the site with 137 mounds/ha than that with 97 mounds/ha. Experimental studies on grass consumption of artificially fed field colonies of different sizes were used to estimate consumption by termites at the different sites. Consumption at the various experimental sites varied between 2.7 and 451.2 kg/ha/year (mean: 203.4 ± 175.1 kg/ha/year) and a marked seasonal periodicity in consumption was demonstrated. The impact of T. trinervoides within well-managed grassland ecosystems where the litter-feeding species forman important link in the food chain, is chiefly beneficial and far outweigh its harmful effects which tend to be associated with degraded, overgrazed grassland and drought.
Abstract
Various studies indicate a relationship between increased oxidative stress and hypertension, resulting in increased DNA damage and consequent excretion of 8-oxo-7,8-dihydro-2'-deoxyguanosine ...(8-oxodG). The aim of this study was to compare urinary 8-oxodG levels in African and Caucasian men and to investigate the association between ambulatory blood pressure (BP) and pulse pressure (PP) with 8-oxodG in these groups.
We included 98 African and 92 Caucasian men in the study and determined their ambulatory BP and PP. Biochemical analyses included, urinary 8-oxodG, reactive oxygen species (ROS) (measured as serum peroxides), ferric reducing antioxidant power (FRAP), total glutathione (GSH), glutathione peroxidase (GPx) and glutathione reductase (GR) activity.
The African men had significantly higher systolic (SBP) and diastolic blood pressure (DBP) (both p < 0.001). Assessment of the oxidative stress markers indicated significantly lower 8-oxodG levels (p < 0.001) in the African group. The African men also had significantly higher ROS (p = 0.002) with concomitant lower FRAP (p < 0.001), while their GSH levels (p = 0.013) and GR activity (p < 0.001) were significantly higher. Single and partial regression analyses indicated a negative association between urinary 8-oxodG levels with SBP, DBP and PP only in African men. These associations were confirmed in multiple regression analyses (SBP: R2 = 0.41; β = −0.25; p = 0.002, DBP: R2 = 0.30; β = −0.21; p = 0.022, PP: R2 = 0.30; β = −0.19; p = 0.03).
Our results revealed significantly lower urinary 8-oxodG in African men, accompanied by a negative association with BP and PP. We propose that this may indicate a dose-response relationship in which increased oxidative stress may play a central role in the up-regulation of antioxidant defence and DNA repair mechanisms.
The 2NN Study was a randomised comparison of the non-nucleoside reverse-transcriptase inhibitors (NNRTI) nevirapine and efavirenz.
In this multicentre, open-label, randomised trial, 1216 ...antiretroviral-therapy-naive patients were assigned nevirapine 400 mg once daily, nevirapine 200 mg twice daily, efavirenz 600 mg once daily, or nevirapine (400 mg) and efavirenz (800 mg) once daily, plus stavudine and lamivudine, for 48 weeks. The primary endpoint was the proportion of patients with treatment failure (less than 1 log
10 decline in plasma HIV-1 RNA in the first 12 weeks or two consecutive measurements of more than 50 copies per mL from week 24 onwards, disease progression new Centers for Disease Control and Prevention grade C event or death, or change of allocated treatment). Analyses were by intention to treat.
Treatment failure occurred in 96 (43·6%) of 220 patients assigned nevirapine once daily, 169 (43·7%) of 387 assigned nevirapine twice daily, 151 (37·8%) of 400 assigned efavirenz, and 111 (53·1%) of 209 assigned nevirapine plus efavirenz. The difference between nevirapine twice daily and efavirenz was 5·9% (95% CI −0·9 to 12·8). There were no significant differences among the study groups in the proportions with plasma HIV-1 RNA concentrations below 50 copies per mL at week 48 (p=0·193) or the increases in CD4-positive cells (p=0·800). Nevirapine plus efavirenz was associated with the highest frequency of clinical adverse events, and nevirapine once daily with significantly more hepatobiliary laboratory toxicities than efavirenz. Of 25 observed deaths, two were attributed to nevirapine.
Antiretroviral therapy with nevirapine or efavirenz showed similar efficacy, so triple-drug regimens with either NNRTI are valid for first-line treatment. There are, however, differences in safety profiles. Combination of nevirapine and efavirenz did not improve efficacy but caused more adverse events.
BCG vaccination prevents severe childhood tuberculosis (TB) and was introduced in South Africa in the 1950s. It is hypothesised that BCG trains the innate immune system by inducing epigenetic and ...functional reprogramming, thus providing non-specific protection from respiratory tract infections. We evaluated BCG for reduction of morbidity and mortality due to COVID-19 in healthcare workers in South Africa.
This randomised, double-blind, placebo-controlled trial recruited healthcare workers at three facilities in the Western Cape, South Africa, unless unwell, pregnant, breastfeeding, immunocompromised, hypersensitivity to BCG, or undergoing experimental COVID-19 treatment. Participants received BCG or saline intradermally (1:1) and were contacted once every 4 weeks for 1 year. COVID-19 testing was guided by symptoms. Hospitalisation, COVID-19, and respiratory tract infections were assessed with Cox proportional hazard modelling and time-to-event analyses, and event severity with post hoc Markovian analysis. This study is registered with ClinicalTrials.gov, NCT04379336.
Between May 4 and Oct 23, 2020, we enrolled 1000 healthcare workers with a median age of 39 years (IQR 30–49), 70·4% were female, 16·5% nurses, 14·4% medical doctors, 48·5% had latent TB, and 15·3% had evidence of prior SARS-CoV-2 exposure. Hospitalisation due to COVID-19 occurred in 15 participants (1·5%); ten (66·7%) in the BCG group and five (33·3%) in the placebo group, hazard ratio (HR) 2·0 (95% CI 0·69–5·9, p = 0·20), indicating no statistically significant protection. Similarly, BCG had no statistically significant effect on COVID-19 (p = 0·63, HR = 1·08, 95% CI 0·82–1·42). Two participants (0·2%) died from COVID-19 and two (0·2%) from other reasons, all in the placebo group.
BCG did not protect healthcare workers from SARS-CoV-2 infection or related severe COVID-19 disease and hospitalisation.
Funding provided by EDCTP, grant number RIA2020EF-2968. Additional funding provided by private donors including: Mediclinic, Calavera Capital (Pty) Ltd, Thys Du Toit, Louis Stassen, The Ryan Foundation, and Dream World Investments 401 (Pty) Ltd. The computations were enabled by resources in project SNIC 2020–5–524 provided by the Swedish National Infrastructure for Computing (SNIC) at UPPMAX, partially funded by the Swedish Research Council through grant agreement No. 2018–05,973.
Summary
Hypertension is not consistently associated with postoperative cardiovascular morbidity and is therefore not considered a major peri‐operative risk factor. However, hypertension may ...predispose to peri‐operative haemodynamic changes known to be associated with peri‐operative morbidity and mortality, such as intra‐operative hypotension and tachycardia. The objective of this study was to determine whether pre‐operative hypertension was independently associated with haemodynamic changes known to be associated with adverse peri‐operative outcomes. We performed a five‐day multicentre, prospective, observational cohort study which included all adult inpatients undergoing elective, non‐cardiac, non‐obstetric surgery. We recruited 343 patients of whom 164 (47.8%) were hypertensive. An intra‐operative mean arterial pressure of < 55 mmHg occurred in 59 (18.2%) patients, of which 25 (42.4%) were hypertensive. Intra‐operative tachycardia (heart rate> 100 beats.min−1) occurred in 126 (38.9%) patients, of whom 61 (48.4%) were hypertensive. Multivariable logistic regression did not show an independent association between the stage of hypertension and either clinically significant hypotension or tachycardia, when controlled for ASA physical status, functional status, major surgery, duration of surgery or blood transfusion. There was no association between pre‐operative hypertension and peri‐operative haemodynamic changes known to be associated with major morbidity and mortality. These data, therefore, support the recommendation of the Joint Guidelines of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society to proceed with elective surgery if a patient's blood pressure is < 180/110 mmHg.
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