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Gastro-esophageal reflux disease (GERD) is a common gastrointestinal disorder that occurs when backflow of the gastric contents into the esophagus results in troublesome symptoms. Though GERD has been extensively studied in Western populations, literature on the management of GERD in patients in Africa and Middle East (AME) is scarce.In this review, we provide an overview of the management of mild-to-moderate GERD in AME. Here we focus on the efficacy and safety of currently available treatments for GERD to help physicians and community pharmacists appropriately manage patients with mild-to-moderate GERD in the primary healthcare setting, detailing specific situations and patient scenarios that are relevant to the region, including management of GERD during Ramadan and post-bariatric surgery.Under-appreciation of the burden of GERD in the region has resulted in a lack of consensus on management. Barriers that currently prevent the adoption of treatment guidelines in the primary healthcare setting may include lack of availability of local guidelines and referral systems, a paucity of region-specific research, and dogmatic adherence to traditional practice. By increasing awareness, strengthening knowledge, and by more effective utilization of resources, physicians and pharmacists could optimize GERD management strategies to better support patients.

Background and aim The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. Methods This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. Results Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. Conclusion The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.

Scheduling problem has its origin in manufacturing industry.In this paper we describe a simple approach for solving the flow shop scheduling problem. The result we obtained has been compared with Palmers Heuristic and CDS algorithms along with NEH. It was found that our method will reach near optimum solution within few steps compared to CDS and NEHalgorithm and yield better result compared to Palmers Heuristic with objective of minimizing the Makespan for the horizontal rectangular matrix problems.

Objective Data on the prevalence of autoimmune thyroid disease (AITD) and gastric autoimmunity in type 1 diabetes mellitus (T1DM) in Africa are limited. The aim of this study was to assess the prevalence of antithyroid peroxidase (TPO-A) and antiparietal cell antibody (PCA) in patients with T1DM at a tertiary diabetes clinic in Durban, South Africa. Research design and methods This was a cross-sectional observational study among subjects attending the adult T1DM clinic at Inkosi Albert Luthuli Hospital. Information about history and clinical examination was collected. Blood tests included glutamic acid decarboxylase antibody (GADA), TPO-A, PCA, vitamin B12, folate, ferritin, thyroid stimulating hormone (TSH), free thyroxine, lipids and HbA1c. Results A total of 202 (M:F, 90:112) patients were recruited. The ethnic composition was African (black) (56.4%; n=114), Indian (31.7%; n=64), white (4.5%; n=9) and coloured (mixed race) (7.4%; n=15). Mean age and mean duration of diabetes were 26.4±11.4 and 10.7±9.1 years, respectively. Mean body mass index was 21.6±6.3 kg/m2. GADA was positive in 63.37% (n=128). The prevalence of TPO-A was 18.9% (n=39) and PCA 8.9% (n=17). The prevalence of overt hypothyroidism, subclinical hypothyroidism and Graves’ disease was 10.9%, 2.5% and 1.5%, respectively; vitamin B12 deficiency was noted in 3.5% (n=7) and iron deficiency in 19.3% (n=39). Conclusions Among patients with T1DM in this study, there was a high prevalence of coexistent AITD and gastric autoimmunity. Screening for hypothyroidism and thyroid autoimmunity should be undertaken in all patients at initial presentation. However, to assess the feasibility and optimal timing of subsequent testing in the African setting with limited resources, more collaborative research with longitudinal studies is required.

Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (

A set of equations for computing storm‐water detention storage‐capacity‐treatment‐rate combinations as a function of pollutant trap efficiency and relevant hydrologic statistics is provided. The hydrologic variables of runoff event depth, duration, and interevent time are treated as independent, exponentially distributed random variables. With the aid of a mass balance relationship at the detention unit and a first‐order pollutant load model, an expression for the expected pollutant wash‐off load is derived. This is used to obtain closed‐form expressions for the pollutant‐control isoquants in terms of the detention storage capacity, the treatment rate, the pollutant trap efficiency, and the statistics of the runoff process. For specified values of the treatment rate and pollutant trap efficiency, the isoquants are solved to obtain values of the required storage capacity. In addition, the expressions yield lower‐ and upper‐bound estimates of the storage capacity estimators. An illustrative example using da...

Introduction Higher rates of colon cancer are seen in African Americans (65:100,000) compared to rural South Africans ( Method This was a prospective, 2-week food exchange study. 20 middle aged healthy Native Africans (NA) and 20 African Americans (AA) (age 50–65, BMI 18.5–35 kg/m 2 ) were studied on their usual diet and after dietary modification to either a high meat and fat, low fibre western diet (protein 27%, fat 52%, carbohydrate 21%, total fibre 12 g/d) or a high fibre African diet under supervision for 2 weeks. Colonoscopy was performed for mucosal biomarkers of cancer risk from the colon (Ki67). Urinary and faecal samples were analysed by 600MHz 1HNMR (Bruker) and interpreted in Matlab v14a. Microbiome analysis was performed by the HITChip microarray. Metabolic reaction networks of metabolites found differentially expressed between different dietary comparisons, were created using the MetaboNetworks software. Results Orthoganol Partial Least Square Discriminant Analysis regression coefficient plots of AA (faecal: Q2Y = 0.66, R2X = 37.2%, urinary Q2Y = 0.51, R2X 20.8%) and and NA (faecal: Q2Y = 0.37, R2X = 30.7%, urinary Q2Y = 0.83, R2X 27.8%) samples demonstrated distinct metabolic phenotypes for each dietary intervention. Increased diversity of metabolites was seen in faecal water of NAs consuming their usual diet. Faecal metabolites demonstrated a higher number of significant correlations with faecal microbiota compared with urinary metabolites. Eubacterium rectale , Lachnospira pectinoschiza , Roseburia intestinalis and Lactobacillus bovis correlated strongly with butyrate, acetate and formate. The faceal metabolic network pathway analysis demonstrated reciprocal changes after dietary interventions reflecting reductions in short chain fatty acids and increases in glycosylated proteins and choline metabolism in NAs, and increased amino acid metabolism in AAs. Reciprocal changes in urinary metabolites derived from microbial metabolism of green vegetables, e.g. N -acetyl- S -methyl- L -cysteine sulfoxide (p 2 = 0.64), were observed, suggesting increased phytochemical consumption may influence mucosal inflammation. Conclusion A high fat low fibre western diet is associated with a specific, modifiable metabolic phenotype. This is significantly influenced by the gut microbiome, which in turn may have an important role in the cause of colon cancer. Disclosure of interest J. Li: None Declared, J. Kinross Grant/ Research Support from: Imperial BRC, Conflict with: Director of Getwell media, J. Posma: None Declared, L. Lahti: None Declared, V. Naidoo: None Declared, J. Ou: None Declared, K. Newton: None Declared, R. Gaskins: None Declared, E. Zoetendal: None Declared, S. O9Keefe: None Declared, J. Nicholson: None Declared.