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The Society for Melanoma Research (SMR) was created 20 years ago and has unequivocally contributed to the vast progress of the field, particularly for the treatment of melanoma patients with metastatic disease by facilitating synergistic collaborations between clinicians, researchers at the bench, and industry. In commemoration of the 20th anniversary of the first SMR International Congress (held in 2003 in Philadelphia), we look to the future by highlighting the perspectives of the next generation of rising stars, medical, and graduate students across six continents. [ABSTRACT FROM AUTHOR]

Bronchoalveolar lavage (BAL) is becoming a common procedure for research into infectious disease immunology. Little is known about the clinical factors which influence the main outcomes of the procedure. In research participants who underwent BAL according to guidelines, the BAL volume yield, and cell yield, concentration, viability, pellet colour and differential count were analysed for association with important participant characteristics such as active tuberculosis (TB) disease, TB exposure, HIV infection and recent SARS-CoV-2 infection. In 337 participants, BAL volume and BAL cell count were correlated in those with active TB disease, and current smokers. The right middle lobe yielded the highest volume. BAL cell and volume yields were lower in older participants, who also had more neutrophils. Current smokers yielded lower volumes and higher numbers of all cell types, and usually had a black pellet. Active TB disease was associated with higher cell yields, but this declined at the end of treatment. HIV infection was associated with more bloody pellets, and recent SARS-CoV-2 infection with a higher proportion of lymphocytes. These results allow researchers to optimise their participant and end assay selection for projects involving lung immune cells. [ABSTRACT FROM AUTHOR]

Adherence to anti-seizure medication (ASM) by people diagnosed with epilepsy in sub-Saharan Africa remains low. The factors for low adherence are not well understood. To improve adherence, it is important to understand the perceptions and views of healthcare professionals delivering epilepsy care to this population. The aim was to investigate the factors influencing ASM adherence. This study uses a brief online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of six questions and was a mix of multiple choice and Likert scale questions. There were 217 healthcare professionals who replied to the questionnaire. The most important factors believed to be influencing adherence from a healthcare professional perspective are; lack of availability of medication for epilepsy (71 %), affordability of medication (60 %), the patient, family, carer lacking in understanding of medication (43 %), cultural misconceptions about epilepsy (40 %) and side effects of the medication (32 %). The survey was answered by many different healthcare professionals; 65 participants were doctors and 152 were other healthcare professionals such as nurses (59 %) pharmacists (10 %) and when comparing them, the three most important categories were consistent across groups. Healthcare workers in Sub-Saharan Africa identify that the primary factors impacting adherence to ASMs, in their view, is affordability and availability of ASMs.Addressing this issue may reduce the treatment gap. • Anti-seizure medication (ASM) adherence in sub-Saharan Africa is a concerning issue. • To improve adherence local healthcare professionals' perceptions needs understanding. • We solicited healthcare professionals' views of factors influencing ASM compliance. • Main factors identified influencing adherence are ASM availability, cost & ignorance. • Addressing ASM lack of availability & cost in Sub-Saharan Africa is a pressing issue. [ABSTRACT FROM AUTHOR]

• Maternal care in women with epilepsy in sub-Saharan Africa (SSA) is challenging. • We seek the perspective of SSA healthcare professionals to understand challenges. • 203 healthcare professionals respondents from over 10 SSA countries responded. • Training to counsel women with epilepsy on reproductive health was the main concern. • Information deficit on anti-seizure medication effect on pregnancy is another concern. Epilepsy prevalence in sub-Saharan Africa is high with a significant treatment gap. In this context, epilepsy presents substantial challenges to effective and safe reproductive and maternal healthcare. To improve this, it is important to understand the views and perceptions of healthcare professionals delivering epilepsy care to this population. This study uses an online questionnaire which asked healthcare professionals (both from nursing and medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire consisted of 21 questions and was a mix of multiple choice and Likert scale questions on managing reproductive health in women in local settings. Of 203 healthcare professionals respondents from over 10 countries majority were doctors (48%) or nurses (36%). The Gambia (28.6%), Nigeria (22.2%), Cameroon (13.3%) and Zambia (9.4%) accounted for nearly three-quarters of respondents. Over half (54%) felt that they have the necessary training to counsel women with epilepsy on reproductive health and pregnancy. Only 40% reported they regularly discuss family planning. Carbamazepine was reported to be the most used anti-seizure medication (ASM) for childbearing age women. Key challenges outlined were epilepsy awareness among patients and their families, information deficit on ASMs and pregnancy and access to a sufficient range of ASMs. Understanding the challenges faced by health professionals in sub-Sharan Africa, provides better comprehension of the specific "treatment-education gap" in counselling women with epilepsy on ASM risks and benefits. [ABSTRACT FROM AUTHOR]

Blue whales are rarely sighted off the coasts of South Africa due to their low numbers and offshore habitat preference. Visual observations to search for marine mammals were conducted onboard a platform of opportunity during the Integrated Ecosystems Programme survey in November 2019. A cow–calf pair of blue whales Balaenoptera musculus was sighted offshore Kleinzee (30°05′02.4" S, 14°24′53.2" E) at a water depth of 1670 m on the west coast of South Africa in the southern Benguela Current System. The pair was identified as Antarctic blue whales B. m. intermedia based on the size of the cow (~ 29 m), "torpedo-shaped" body of the cow, known distribution ranges and recent acoustic data showing that pygmy blue whales B. m. brevicauda do not occur in these waters. The calf was likely born in the Benguela ecosystem given its relatively small size. This is the first sighting of Antarctic blue whale cow–calf pair in South African waters post whaling, indicating that animals might still use this area as a calving or nursing ground. Improved protection of this region in the low latitudes might benefit the recovery and conservation of the species. [ABSTRACT FROM AUTHOR]

Purpose: Transracial adoption (TRA), where parents from one race adopt a child from another race, usually occurs with Black children being adopted by White parents in South Africa.Using multiple case studies (seven children) and a qualitative research design, the self-identity (personal and social) of six- to ten-year-old TRA children was explored. Data were collected from the adoptive parents and teachers by means of semi-structured interviews and the Child Behaviour Checklist. Additionally, parents completed a questionnaire and a Likert-style response scale. Participating children were assessed by an independent psychologist using three projective techniques. The data generated were thematically analysed.There were six emergent themes, all conducive to healthy self-identity development by securing primary identity motivators of belonging and acceptance. The children exhibited advanced communicative skills and a novel approach to group membership, increasing their social accessibility and inclusion. A distinctive theme was a desire for a dedicated personal space and possessions symbolizing permanence in the family. The universal adoptive elements of loss and rejection was confirmed, possibly more prevalent due to an observable adoptive status and physical dissimilarity from the adoptive family. Intentional parenting promoting healthy self-identity was apparent. Lastly, the importance of placing the children in an accommodating and sensitive school environment was noted.While not a comparative study, and with only seven children, it appears that these TRA children, with the acquisition of positive social skills and a sensitive and purposeful home and school environment, possessed the building blocks necessary to nurture a healthy self-identity.Method: Transracial adoption (TRA), where parents from one race adopt a child from another race, usually occurs with Black children being adopted by White parents in South Africa.Using multiple case studies (seven children) and a qualitative research design, the self-identity (personal and social) of six- to ten-year-old TRA children was explored. Data were collected from the adoptive parents and teachers by means of semi-structured interviews and the Child Behaviour Checklist. Additionally, parents completed a questionnaire and a Likert-style response scale. Participating children were assessed by an independent psychologist using three projective techniques. The data generated were thematically analysed.There were six emergent themes, all conducive to healthy self-identity development by securing primary identity motivators of belonging and acceptance. The children exhibited advanced communicative skills and a novel approach to group membership, increasing their social accessibility and inclusion. A distinctive theme was a desire for a dedicated personal space and possessions symbolizing permanence in the family. The universal adoptive elements of loss and rejection was confirmed, possibly more prevalent due to an observable adoptive status and physical dissimilarity from the adoptive family. Intentional parenting promoting healthy self-identity was apparent. Lastly, the importance of placing the children in an accommodating and sensitive school environment was noted.While not a comparative study, and with only seven children, it appears that these TRA children, with the acquisition of positive social skills and a sensitive and purposeful home and school environment, possessed the building blocks necessary to nurture a healthy self-identity.Results: Transracial adoption (TRA), where parents from one race adopt a child from another race, usually occurs with Black children being adopted by White parents in South Africa.Using multiple case studies (seven children) and a qualitative research design, the self-identity (personal and social) of six- to ten-year-old TRA children was explored. Data were collected from the adoptive parents and teachers by means of semi-structured interviews and the Child Behaviour Checklist. Additionally, parents completed a questionnaire and a Likert-style response scale. Participating children were assessed by an independent psychologist using three projective techniques. The data generated were thematically analysed.There were six emergent themes, all conducive to healthy self-identity development by securing primary identity motivators of belonging and acceptance. The children exhibited advanced communicative skills and a novel approach to group membership, increasing their social accessibility and inclusion. A distinctive theme was a desire for a dedicated personal space and possessions symbolizing permanence in the family. The universal adoptive elements of loss and rejection was confirmed, possibly more prevalent due to an observable adoptive status and physical dissimilarity from the adoptive family. Intentional parenting promoting healthy self-identity was apparent. Lastly, the importance of placing the children in an accommodating and sensitive school environment was noted.While not a comparative study, and with only seven children, it appears that these TRA children, with the acquisition of positive social skills and a sensitive and purposeful home and school environment, possessed the building blocks necessary to nurture a healthy self-identity.Discussion: Transracial adoption (TRA), where parents from one race adopt a child from another race, usually occurs with Black children being adopted by White parents in South Africa.Using multiple case studies (seven children) and a qualitative research design, the self-identity (personal and social) of six- to ten-year-old TRA children was explored. Data were collected from the adoptive parents and teachers by means of semi-structured interviews and the Child Behaviour Checklist. Additionally, parents completed a questionnaire and a Likert-style response scale. Participating children were assessed by an independent psychologist using three projective techniques. The data generated were thematically analysed.There were six emergent themes, all conducive to healthy self-identity development by securing primary identity motivators of belonging and acceptance. The children exhibited advanced communicative skills and a novel approach to group membership, increasing their social accessibility and inclusion. A distinctive theme was a desire for a dedicated personal space and possessions symbolizing permanence in the family. The universal adoptive elements of loss and rejection was confirmed, possibly more prevalent due to an observable adoptive status and physical dissimilarity from the adoptive family. Intentional parenting promoting healthy self-identity was apparent. Lastly, the importance of placing the children in an accommodating and sensitive school environment was noted.While not a comparative study, and with only seven children, it appears that these TRA children, with the acquisition of positive social skills and a sensitive and purposeful home and school environment, possessed the building blocks necessary to nurture a healthy self-identity. [ABSTRACT FROM AUTHOR]

Background: Colonoscopy is a valuable tool for diagnosing various colonic pathologies. There is little recent research regarding the use of colonoscopy in South Africa. Objective: To describe the findings of the audit done on the practice of colonoscopy in a specialised gastroenterology unit (GEU) of a tertiary teaching hospital. Design: A retrospective audit of colonoscopies performed between the 01 January 2008 and 31 March 2010 in a single gastroenterology unit at Charlotte Maxeke Johannesburg Academic Hospital(CMJAH) was conducted. Details of colonoscopy records were obtained from an administrative database of patient files. No patient specific inclusion or exclusion criteria were applied. Results: In total 1143 colonoscopies were performed during the study period, and 989 were analysed. The mean age was 63.04 years (10 - 93), 61.58% female, 61.48% were Caucasians and 25.88% were of black ethnicity. The indications for colonoscopies were; screening for colorectal cancer (22.95%), case findings (14.16%) and surveillance (14.96%). Caecal intubation rate (CIR) was 80.08%. Findings included macroscopically normal colons (38.12%), polyps (28.18%) and diverticular disease (23.15%). Of the biopsies obtained during colonoscopy procedures 30.50% were reported as normal colonic mucosa, 10.40% revealed adenocarcinoma and 55.37% were tubular adenomas. Conclusions: The audit identified a number of shortfalls, which include: poor colonoscopy performance quality as reflected by the low CIR, non standardised colonoscopy reporting format resulting in paucity of information on scope reports, underrepresentation of the black community, to mention a few. It therefore would appear, based on the findings from this study that there is room for improvement in a number of areas in the practice of colonoscopy in this unit. Further studies may be of value to identify reasons behind these shortfalls. [ABSTRACT FROM AUTHOR]

• Status epilepticus (SE) is a common serious condition disproportionately affecting many African countries. • There are significant delays for patients with SE to present to hospital in the surveyed African countries. • Low rate of use of prehospital benzodiazepine use is noted in the surveyed African countries. • Staff training and access to medications are perceived to be major barriers to good SE care. Status epilepticus (SE) is a serious condition disproportionately affecting Sub-Saharan African (SSA) countries. Little is known about healthcare provider experiences. This study investigated the healthcare provider perspective of SE care. A pilot questionnaire was developed for healthcare professionals in SSA countries. It was distributed online at a conference concerning epilepsy care and local coordinators distributed the questionnaire in their networks. It was available online between 16th Jan and 1st Feb 2021. The unvalidated questionnaire questioned practitioner demographics, experience, confidence in SE care, common etiologies encountered, anticipated prognosis in their setting, available treatments, and barriers to care. We assessed practitioner perceptions not their knowledge base around SE care. Thematic analysis was used for open-ended questions. Fifty nine responses were received from 11 countries. Respondents (44% nurses, 46% doctors) reported poor level of adequate SE training (mean self-reported confidence in training 2.9/10 (0/10 very inadequate and 10/10 very adequate training). Delays in arriving at hospital were common with 15 (32%) taking three or more hours and 28 (62%) proposing transport issues and distance were the main reasons for delay. Urban location was significantly associated with clinician confidence. Less than 20% used prehospital benzodiazepine treatment. 46 (78%) stated benzodiazepines were first-line hospital drug management, and 52 (88%) indicated alternative second-line hospital treatments were available. A substantial perceived treatment gap in the management of SE in SSA is identified by staff working in SSA. Key issues are around staff training, patient education, medication access, and compliance. [ABSTRACT FROM AUTHOR]

Type 2 diabetes (T2D) increases susceptibility to tuberculosis (TB) with the underlying mechanisms remaining unknown. To determine whether immune dysfunction in the lung contributes to TB susceptibility, we obtained paired human alveolar macrophages (HAMs) and monocyte-derived macrophages (MDMs) from TB-exposed individuals with/without T2D. Upon infection with Mycobacterium tuberculosis ( M.tb), T2D-HAMs had more M.tb growth and produced more TNF. There were fewer neutrophils in the bronchoalveolar lavage of T2D patients which was inversely correlated with M.tb growth. Both T2D-HAMs and MDMs expressed less CD32, with T2D patients having fewer M1-like MDMs. T2D-MDMs produced less IL-1RA and CSF2. Overall M.tb -induced gene expression was delayed in T2D-HAMs, but genes involved in negative regulation of neutrophil migration were upregulated. T2D-HAM DNA was hypermethylated compared to control HAMs, however genes linked to TNF signalling were hypomethylated. We show here the first in-depth analysis of T2D-HAMs providing an explanation for more severe TB in T2D patients., Competing Interests: CONFLICT OF INTEREST The authors declare no conflict of interest.

Bronchoalveolar lavage (BAL) is becoming a common procedure for research into infectious disease immunology. Little is known about the clinical factors which influence the main outcomes of the procedure. In research participants who underwent BAL according to guidelines, the BAL volume yield, and cell yield, concentration, viability, pellet colour and differential count were analysed for association with important participant characteristics such as active tuberculosis (TB) disease, TB exposure, HIV infection and recent SARS-CoV-2 infection. In 337 participants, BAL volume and BAL cell count were correlated in those with active TB disease, and current smokers. The right middle lobe yielded the highest volume. BAL cell and volume yields were lower in older participants, who also had more neutrophils. Current smokers yielded lower volumes and higher numbers of all cell types, and usually had a black pellet. Active TB disease was associated with higher cell yields, and higher proportions of granulocytes, but this declined at the end of treatment. HIV infection was associated with lower cell yields and more bloody pellets, and recent SARS-CoV-2 infection with a higher proportion of lymphocytes. These results allow researchers to optimise their participant and end assay selection for projects involving lung immune cells.

Hepatitis B markers were determined by radioimmunoassay of serum samples from 1 495 Black subjects representative of the resident population of Kangwane, a rural area with a high incidence of chronic liver disease and hepatocellular carcinoma. Pregnant women formed an important part of the study group, since it was intended to assess the frequency of perinatal transmission and the passive immunity of their infants, two factors which would markedly influence an infant immunization programme. A high overall marker positivity rate was found, indicating that hepatitis B is endemic. The hepatitis B surface antigen (HBsAg) carrier rate was 14,6% in adult males and 4,6% in adult females, while 82.6% of adult males and 69,4% of adult females were positive for at least one marker, indicating that infection had been present at some stage. Of infants under 1 year of age 34,5% were positive for antibodies to HBsAg (anti-HBs), compared with 9,3% at 13-24 months, which indicates that transplacental transfer of anti-HBs is frequent. Other markers were acquired even in the 1st year of life, with the sharpest increase at 3-11 years. Perinatal transmission was not common, however, and horizontal transmission during early childhood seemed to play an important role. It was concluded that the risk and frequency of infection justified a vaccine trial in this population and that the target group for vaccination should be infants under 1 year of age.