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To provide society with the benefit of an effective emolument attachment order (EAO) environment, several role-players must fulfil essential interconnected functions. The process relies on the cooperation of the garnishee (the employer of the EAO debtor), who is responsible for the periodic deductions from the employees' salary and the transfer of these funds to the creditor(s). Employers therefore carry an administrative burden to maintain the human resource capacity and administrative systems necessary to properly enforce EAOs. In addition to this administrative duty, employers are at risk of incurring personal liability vis a vis the creditor as well as the debtor. This article will highlight the risk to employers in the administration of EAOs, specifically arising from the legal uncertainty regarding proportionality in EAO deductions. The article describes the current legislative framework and its relevant frailty. It then delineates the scope of the study by exploring the concept of proportionality within the context of EAOs. This is followed with a summary of the relevant historic and contemporary context, before dealing with the prevailing EAO-related challenges. Although a detailed comparative analysis falls outside the scope of this article, it also contains a brief overview of how these challenges regarding proportionality in wage garnishment are managed in England and the United States of America. The contribution concludes with recommendations based on the research findings. Ultimately, the author submits that employers are currently more at risk from liability for the maladministration of their employees' EAOs than they may generally appreciate and that proactive steps should be taken to address the situation. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, explores the feasibility of a single-session EUS-directed Transgastric ERCP (EDGE) using a dedicated over-the-scope fixation device. The study conducted a retrospective analysis of 11 consecutive EDGE procedures performed with the Stentfix device. The primary outcome was the migration of the stent, and the key secondary outcomes included adverse events and technical success. The results showed no stent migrations, a technical success rate of 90.9%, and one reported adverse event of postprocedural pain. The study suggests that the use of a dedicated over-the-scope stent fixation device can prevent stent migration during the same-session EDGE procedure. [Extracted from the article]

The impact of restricted access to sustainable energy is the worst in vulnerable urban poor areas, and so an alternative approach to energy innovations is needed. To explore the possibilities for energy innovations, gender needs to be taken into account. This is especially relevant in the sub-Saharan African context, as most households are female-headed. This paper aims to explore the current state of gendered energy innovations by using a multivocal approach; it thus focuses on the existing body of knowledge at the gender--energy interface. The study is conducted in two parts: first, 'state of the art' is conceptualised using a multilevel approach; second, a structured literature review on gendered energy innovations is conducted in light of the structured understanding of 'state of the art'. There is definitely room for new innovations to use gender as a strategy for solving energy security problems in urban poor environments. [ABSTRACT FROM AUTHOR]

Although Christianity was introduced to and embraced by Batswana over two centuries ago, some Batswana still hold dear to their traditions, customs and cultures, which, at times, are not in line with the Word of God. Volz (2008:112) concedes that, although European missionaries introduced Batswana to Christianity, they had hardly any control over how early Batswana converts perceived and adapted their teachings. In some instances, dikgosi,¹ as traditional leaders, are still facing a serious conundrum of being a Christian, on the one hand, and a custodian of culture, on the other. This is in line with the view expressed by Amanze (2003:43) that many Christians, especially members of the African Independent Churches, live a strange life, with one foot rooted in the African traditional beliefs and the other in Christian beliefs and practices. Given the statement "For there is only one God and one mediator between God and men, the man Christ Jesus" (1 Tim. 2:5), the question is: Where does this place traditions, customs and culture?. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to compare the infant-feeding practices of two subdistricts with different baby-friendly status in Mpumalanga province, South Africa. Design: This was a cross-sectional, descriptive, observational study with an analytical component. Eighteen fieldworkers assisted with the data collection, utilising two sets of interviewer-administered questionnaires -- one on socio-demographic information and the other on infant-feeding practices. Subjects: Mothers with infants from birth to six months old, attending postnatal care at public sector primary health care facilities in Emalahleni and Mbombela health subdistricts on the days of data collection were included. A total of 435 mother and infant pairs were included in the study. Outcome measures: Five infant-feeding indicators were used, namely the early initiation of breastfeeding, exclusive breastfeeding, exclusive replacement feeding and mixed feeding rates, as well as the age at which complementary food was introduced. Results: There was a significantly higher early initiation of breastfeeding (57% vs. 43%), exclusive breastfeeding rates (60% vs 48%), and a lower exclusive replacement feeding rate (18% vs. 33%) in Emalahleni subdistrict, where all the public sector maternity facilities are accredited as being baby friendly, compared to that in Mbombela subdistrict, where none of the public sector maternity facilities are baby friendly. The mixed feeding rate (19% vs. 15%) and the mean age of the introduction of complementary foods (50 days versus 35 days) did not differ significantly between the two subdistricts. Conclusion: Implementation of the Baby-Friendly Hospital Initiative (BFHI) in a health subdistrict was associated with more optimal infant-feeding practices in mothers with infants aged six months and younger. It is concluded that strengthening practices prescribed within the BFHI would improve infant-feeding practices at community level. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, discusses a new technique called balloon dilation-assisted stent extraction (BASE) for the treatment of obstructive biliary complications caused by embedded self-expandable metal stents (SEMS). The study evaluated the feasibility and outcomes of this technique in twelve patients. The results showed that BASE was successful in extracting the SEMS in 83.3% of cases, with only minor adverse events occurring. The authors suggest that BASE could be a viable option for the extraction of embedded SEMS, as it is effective and utilizes readily available endoscopic tools. [Extracted from the article]

Purpose: Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past. Methods: The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia. Results: Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a "wait and see" approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child–Pugh–Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances. Conclusion: Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis. [ABSTRACT FROM AUTHOR]

This article, published in the journal Endoscopy, presents the outcomes of lumen apposing metal stent (LAMS) placement in patients with surgically altered anatomy (SAA). LAMS is a procedure that allows access to different parts of the gastrointestinal tract for various interventions. The study, conducted at 19 tertiary-care centers across multiple countries, found that LAMS placement in patients with SAA had high technical and clinical success rates. However, the study also noted a noteworthy rate of adverse events, emphasizing the importance of these procedures being performed by experienced endoscopists. [Extracted from the article]

The traditional Zulu remedy impila (Callilepis laureola) can cause acute fatal hepatocellular necrosis, especially in children. We investigated the mechanism(s) of toxicity using HuH-7 hepatocytes. Impila tubers were extracted with boiling water and the aqueous extract was used at different concentrations to study the effects on the morphology of the cells. Flow cytometry and labelling with fluorescent antibodies to tubulin were also used. At high concentrations, necrosis occurred; however, at lower concentrations, the extracts gave rise to a variety of changes including hypercondensation of chromatin, multinucleate cells, nuclear fragmentation and apoptosis. In addition, we observed destruction of cytoplasmic tubulin. These findings give further insight into the mechanism of toxicity of herbal remedies containing atractyloside. [ABSTRACT FROM AUTHOR]

This article compares two procedures, enteroscopy-assisted ERCP (e-ERCP) and EUS-guided antegrade intervention (EUS-AI), for treating bile duct strictures and/or stones in patients with Roux-en-Y hepaticojejunostomy (HJ). The study found that both procedures had similar rates of technical success, but EUS-AI had a shorter procedure duration and facilitated easier biliary re-access and cholangioscopy if needed. Adverse event rates were similar between the two groups, and there was a numerical difference in recurrence rates, with more reinterventions performed in the EUS-AI group. The authors conclude that EUS-AI is a safe and effective alternative for patients with postsurgical anatomy. [Extracted from the article]

Purpose: The aim of this study was to quantify the overall burden of orthopaedic gunshot-related injuries at our institution over a four year period. Secondary aims included identifying complications from gunshot-related injuries and the additional burden it places on healthcare services. Methods: A retrospective review was conducted on all patients with gunshot injuries presenting to our hospital's trauma unit between January 2014 and December 2017. Patient data was recorded, and demographic data, number and type of implants, blood products used, duration of hospital admission, duration of ICU admission, radiological studies performed, and prevalence of complications were analysed. Results: A total of 1449 patients with a mean age of 28.2 ± 9.7 years (range 2.0–71.0) were included in this study. The majority of these gunshot-related orthopaedic injuries were sustained to the lower extremities and were treated non-operatively. The median duration of hospital stay was 7.0 (IQR 4.0–12.0). The most common complications identified were nerve injury (8.3%), vascular injury (6.5%), fracture-related infection (3.2%), non-union (3.1%), and compartment syndrome (1.6%). The total cost of care was ZAR 53,568,537 (USD 4,320,043) with an average cost per patient of ZAR 37,031 (USD 2986). Conclusion: This study highlighted the burden of gunshot injuries presenting to our hospital and the strain it places on its healthcare resources. The prevalence of complications was comparable to international studies on the subject. With improved understanding of this burden, more healthcare resources can be allocated to this problem and better prevention strategies can be planned. [ABSTRACT FROM AUTHOR]

Previously, we showed histamine-mediated sensitization of transient receptor potential (TRP) vanilloid 1 (TRPV1) in patients with irritable bowel syndrome (IBS). Sensitization of TRP ankyrin 1 (TRPA1) and TRP vanilloid 4 (TRPV4) are also involved in aberrant pain perception in preclinical models of somatic pain. Here, we hypothesize that in parallel with TRPV1, histamine sensitizes TRPA1 and TRPV4, contributing to increased visceral pain in patients with IBS. Rectal biopsies were collected from patients with IBS and healthy subjects (HS) to study neuronal sensitivity to TRPA1 and TRPV4 agonists (cinnamaldehyde and GSK1016790A) using intracellular Ca2+ imaging. In addition, the effect of supernatants of rectal biopsies on patients with IBS and HS was assessed on TRPA1 and TRPV4 responses in murine dorsal root ganglion (DRG) sensory neurons. Finally, we evaluated the role of histamine and histamine 1 receptor (H1R) in TRPA1 and TRPV4 sensitization. Application of TRPA1 and TRPV4 agonists evoked significantly higher peak amplitudes and percentage of responding submucosal neurons in biopsies of patients with IBS compared with HS. In HS, pretreatment with histamine significantly increased the Ca2+ responses to cinnamaldehyde and GSK1016790A, an effect prevented by H1R antagonism. IBS supernatants, but not of HS, sensitized TRPA1 and TRPV4 on DRG neurons. This effect was reproduced by histamine and prevented by H1R antagonism. We demonstrate that the mucosal microenvironment in IBS contains mediators, such as histamine, which sensitize TRPV4 and TRPA1 via H1R activation, most likely contributing to increased visceral pain perception in IBS. These data further underscore H1R antagonism as potential treatment for IBS. [ABSTRACT FROM AUTHOR]

Dead space is the portion of tidal volume that does not participate in alveolar gas exchange. The purpose of this study was to compare the dead space contribution of differently shaped masks, of the same size, by measuring the volume of each mask. The study was conducted in the Clinical Simulation Unit of the School of Medicine, University of the Free State (UFS) using formed masks with inflatable polyvinylchloride (PVC) cuffs and rounded masks with non-inflatable PVC cuffs. The masks were placed on the faces of the infant, child and adult part-task trainers as well as on a flat surface. The cuffs of the formed masks were inflated to 5 cm water and 70 cm water. Masks were filled with water and the volume was measured. The volumes (ml) of the masks on the flat surface were significantly larger than those measured on the part-task trainers’ faces. The volume of the rounded masks was greater than the volume of the formed masks. The amount of cuff inflation pressure (5 cm water vs. 70 cm water) did not lead to a significant change in mask volume: 102.3 ml (standard deviation [SD] 75.9) vs. 110.2 ml (SD 82.3), averaged for all sizes. Formed masks contribute less to anatomical dead space than rounded masks and are thus possibly the better choice. Cuff inflation pressure has insignificant influence on dead space volume. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Orthotopic liver transplantation (OLT) (LTx) using donation after circulatory death (DCD) donors is increasingly performed, but still considered to risk of poorer outcomes compared with standard donations after brain death (DBD)-OLT. Therefore we reviewed our results of DCD-OLT. Patients and Methods: Between 2003 and 2010, we performed 30 DCD-OLT (6% of all OLT). We retrospectively reviewed medical records of donors and recipients after DCD versus DBD-OLT to analyze biliary complications, retransplantation rates, and patient/graft survivals. Results: Median donor age was similar for DCD and DBD-OLT: 51 versus 53 years (P = .244). Median donor warm ischemia time (stop ventilation to cold perfusion in DCD donors) was 24 minutes. Median cold ischemia time was shorter for DCD (6 hours 54 minutes) compared with DBD-OLT (8 hours 36 minutes; P < .0001). Median laboratory model of end-stage liver disease score was 15 for DCD, and 16 for DBD-OLT (P = .59). Median post-OLT Aspartate Aminotransferase (AST) peak was higher after DCD: 1178 versus DBD-OLT 651 IU/L (P = .005). The incidence of nonanastomotic strictures was different: 33.3% for DCD versus 12.5% for DBD-OLT (P = .001). The overall retransplantation rate was 3% after both DCD and DBD-OLT. After DCD-LTx actuarial 1, 3- and 5-year patient survivals were 93, 85 and 85%, and corresponding graft survivals, 90%, 82%, and 82% respectively, and not different compared with DBD-OLT: 88%, 78%, and 72% (P = .348) and 85%, 74%, and 68% (P = .524) respectively. Conclusion: Despite substantial ischemic injury (high peak AST and biliary strictures) short- and long-term survival after DCD-OLT was comparable to DBD-OLT. Rapid donor surgery, careful donor and recipient selection, as well as short warm and cold ischemia times are key factors to optimize outcomes after DCD-OLT. However, strategies to reduce biliary complications remain warranted. [Copyright &y& Elsevier]

Abstract: Background: Wider utilization of liver grafts from donors ≥70 years old could substantially expand the organ pool, but their use remains limited by fear of poorer outcomes. We examined the results at our center of liver transplantation (OLT) using livers from donors ≥70 years old. Methods: From February 2003 to August 2010, we performed 450 OLT including 58 (13%) using donors ≥70 whose outcomes were compared with those using donors <70 years old. Results: Cerebrovascular causes of death predominated among donors ≥70 (85% vs 47% in donors <70; P < .001). In contrast, traumatic causes of death predominated among donors <70 (36% vs 14% in donors ≥70; P = .002). Unlike grafts from donors <70 years old, grafts from older individuals had no additional risk factors (steatosis, high sodium, or hemodynamic instability). Both groups were comparable for cold and warm ischemia times. No difference was noted in posttransplant peak transaminases, incidence of primary nonfunction, hepatic artery thrombosis, biliary strictures, or retransplantation rates between groups. The 1- and 5-year patient survivals were 88% and 82% in recipients of livers <70 versus 90% and 84% in those from ≥70 years old (P = .705). Recipients of older grafts, who were 6 years older than recipients of younger grafts (P < .001), tended to have a lower laboratory Model for End-Stage Liver Disease score (P = .074). Conclusions: Short and mid-term survival following OLT using donors ≥70 yo can be excellent provided that there is adequate donor and recipient selection. Septuagenarians and octogenarians with cerebrovascular ischemic and bleeding accidents represent a large pool of potential donors whose wider use could substantially reduce mortality on the OLT waiting list. [Copyright &y& Elsevier]

The article focuses on the high prevalence of helicobacter pylori (Hp) in developing countries. It states that Hp prevalence was variable due to ethnicity, geography, age, and socioeconomic factors. It mentions that Hp infection could only be treated through therapeutic vaccination. Furthermore, factors in treating such infection were discussed, along with choosing treatment regimens such as its resistance to antibiotics and bismuth availability.

Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6–12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Kotze MJ, de Villiers JNP, Bouwens CSH, Warnich L, Zaahl MG, van der Merwe S, Oberkanins C. Molecular diagnosis of hereditary hemochromatosis: application of a newly-developed reverse-hybridization assay in the South African population. A recently developed strip-assay for hemochromatosis provides a rapid method for simultaneous detection of multiple mutations, which among others includes the HFE gene mutations V53M, V59M, H63D, H63H, S65C, Q127H, E168Q, and C282Y, previously detected in the general South African population using gel-based mutation-screening methods. The objective of the study was to determine the frequency of the relatively rare mutations in samples selected for altered iron parameters or a family history of hereditary hemochromatosis (HH) as part of the validation process of the assay for routine diagnostic purposes. The study population consisted of 451 individuals previously screened for mutations C282Y and H63D by restriction enzyme analysis in order to confirm or possibly exclude a diagnosis of HH. These individuals were subjected to mutation screening using the commercially available hemochromatosis strip-assay. Previous positive results for mutations C282Y and H63D in 233 individuals confirmed the accuracy of the reverse-hybridization assay. Mutation S65C was detected in 13 Caucasians, including three compound heterozygotes. These constituted 2% (13/600) of the chromosomes without mutations C282Y or H63D. The African-specific HFE mutation V53M was detected in one out of 11 (9%) African subjects screened. Mutation E168Q was detected in a single Caucasian individual together with mutation H63D. Our data demonstrate the value of the strip-based technology in providing a rapid and reliable comprehensive test for simultaneous analysis of multiple mutations. [ABSTRACT FROM AUTHOR]

The article offers information on the guidelines to follow in the diagnosis and treatment of chronic pancreatitis (CP). It states that the Hepato-Pancreatic-Biliary Association (HPBASA) and the South African Gastroenterology Society (SAGES) guidelines provide assistance on the standard of care for the management of the disease. It cites that the guidelines give recommendations to help in the diagnosis, medical management as well as endoscopic and surgical interventions for CP treatment.