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Justin John Gandy, Johanna Petronella Meeding, Jacques René Snyman, Constance Elizabeth Jansen van RensburgDepartment of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South AfricaBackground: The purpose of this research was to determine the acute and subacute safety and proof-of-concept efficacy of carbohydrate-derived fulvic acid (CHD-FA).Methods: In this double-blind study, 30 male volunteers with predetermined atopy were randomly assigned to either Group A or Group B, each consisting of 15 participants. In part 1 of the study, the groups were administered increasing amounts of CHD-FA, ranging from 5 mL to 40 mL, provided that no adverse events had occurred at the previous dosage. In part 2, Group A participants received 20 mL of 3.8% CHD-FA twice daily for 3 days and were monitored for a week. Because no adverse events occurred, Group B received 40 mL of 3.8% CHD-FA twice daily for a period of 3 days. In part 3, both groups received either 40 mL of 3.8% CHD-FA or placebo twice daily for a period of one week, followed by a one-week washout period before crossover to the alternative treatment schedule. Parameters used to establish safety were electrocardiography, a physical examination, a health questionnaire, and hematology and biochemistry, determined at baseline, during regular calculated intervals, and at the end of each part of the study. A skin prick test was done as part of the screening process and, from the result, the allergen the participant was most allergic to was then selected, along with the positive histamine and negative control to be repeated at the start and end of each respective stage.Results: Safety parameters remained constant throughout the trial. A significant decrease in skin prick test results was observed.Conclusion: No severe adverse events occurred, establishing that CHD-FA to be safe at doses up to 40 mL twice daily for a week and that at this dosage CHD-FA acts as an anti-inflammatory agent. These findings confirm earlier animal data.Keywords: CHD-FA, safety, efficacy, anti-inflammatory

Background: Physical activity (PA) and nutrition in children have an impact on overall physical and mental well-being, cognitive, and social development. This study aims to report on the best current available evidence on PA, body composition proxies, and nutritional status of South African children and adolescents, based on the published findings between 2018 and 2022, which comprise the 2022 Healthy Active Kids South Africa Report Card., Methods: A comprehensive literature search of online databases, along with hand searching and a gray literature search, was conducted based on PA, body composition proxies, and nutrition indicators defined, in part, by the Active Healthy Kids Global Alliance., Results: Compared with the 2018 report card, there was an improvement in the majority of PA indicators which include overall PA (B-), active transportation (B-), physical fitness (B-), and government policy and programs (C). Body composition proxies and most of the nutrition indicators remained unchanged. The indicators that regressed from 2018 to 2022 included community and environmental influences (D), as well as participation in organized sport (D-)., Conclusions: Despite the apparent improvement in overall PA levels in children and adolescents, there is a lack of tangible evidence of actual implementation of policies and programs. There was also a lack of nationally representative data for most indicators. Overall, there is a need to identify intersectoral, equitable approaches for promoting PA and healthy eating in South African children and adolescents and ongoing monitoring and surveillance.

Background and Aims: Reduction of alcohol consumption is important for people undergoing treatment for HIV. We tested the efficacy of a brief intervention for reducing the average volume of alcohol consumed among patients on HIV antiretroviral therapy (ART)., Design, Setting and Participants: This study used a two-arm multi-centre randomized controlled trial with follow-up to 6 months. Recruitment occurred between May 2016 and October 2017 at six ART clinics at public hospitals in Tshwane, South Africa. Participants were people living with HIV, mean age 40.8 years [standard deviation (SD) = 9.07], 57.5% female, and on average 6.9 years (SD = 3.62) on ART. At baseline (BL), the mean number of drinks consumed over the past 30 days was 25.2 (SD = 38.3). Of 756 eligible patients, 623 were enrolled., Intervention: Participants were randomly assigned to a motivational interviewing (MI)/problem-solving therapy (PST) intervention arm (four modules of MI and PST delivered over two sessions by interventionists) or a treatment as usual (TAU) comparison arm. People assessing outcomes were masked to group assignment., Measurements: The primary outcome was the number of standard drinks (15 ml pure alcohol) consumed during the past 30 days assessed at 6-month follow-up (6MFU)., Findings: Of the 305 participants randomized to MI/PST, 225 (74%) completed the intervention (all modules). At 6MFU, retention was 88% for the control and 83% for the intervention arm. In support of the hypothesis, an intention-to-treat-analysis for the primary outcome at 6MFU was -0.410 (95% confidence interval = -0.670 to -0.149) units lower on log scale in the intervention group than in the control group (P = 0.002), a 34% relative reduction in the number of drinks. Sensitivity analyses were undertaken for patients who had alcohol use disorders identification test (AUDIT) scores ≥ 8 at BL (n = 299). Findings were similar to those of the whole sample., Conclusions: In South Africa, a motivational interviewing/problem-solving therapy intervention significantly reduced drinking levels in HIV-infected patients on antiretroviral therapy at 6-month follow-up., (© 2023 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Cardiopulmonary resuscitation (CPR) is performed to manually keep brain function intact until the patient's spontaneous blood circulation and breathing are restored. In South Africa, registrars, who are qualified doctors training to specialise in a medical field, are usually the team leaders and oversee junior doctors and nurses during resuscitation., Objectives: This study aimed to determine the accuracy of the execution of two-rescuer adult CPR on a Resusci-Anne® manikin performed by registrars from the University of the Free State, South Africa., Methods: A cross-sectional study was conducted. From a target population of 142 registrars, 47 participated, of whom 44 were included in the analysis. During five cycles of CPR, compression quality was assessed. During a subsequent five cycles, airway management was assessed. Participants were evaluated executing CPR on the Resusci-Anne® manikin, with a recently Basic Life Support trained student researcher as second rescuer. A modified version of the American Heart Association's tick sheet for two-rescuer adult CPR was completed by two student researchers. Department, gender and the date of the most recent CPR training attended were recorded., Results: The median total percentage score was 82.2% (range 33.3% to 100.0%). Results showed that 88.6% of registrars consistently demonstrated correct hand placement, 25.0% correct compression rate, 93.2% correct compression depth, and 61.4% allowed complete chest recoil during compressions. Consistently correct E-C technique was found in 77.3%, and correct ventilation rate in 93.2%. Only 63.6% correctly managed an open airway, and 61.4% achieved visible chest rise. A consistently correct compression-to-ventilation ratio was performed by 59.1% of registrars., Conclusion: The study found that registrars were not consistently performing high-quality CPR on a Resusci-Anne® manikin and identified areas needing attention. The results of this study highlight the need for compulsory CPR training and regular fire drills for registrars., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

Background: It is becoming more common for parents of children with chronic conditions to join research teams as partners. Parent partnerships can help align research with what is relevant and important to families. It is also common for parent partners to be asked to share information about a study through their personal networks, which supports study recruitment. In this parent-led study, we explored parents' experiences when working together with researchers in patient-oriented research studies, in relation to study recruitment., Methods: Demographic data were collected through a brief online survey (SurveyMonkey®) and analysed descriptively (n, %, median (interquartile range; IQR)). Qualitative data were collected through focus groups and interviews (July to October 2021), transcribed verbatim, and analysed thematically. Parent co-leads were involved in every stage of the study, including study design, recruitment, data collection, analysis, interpretation, and knowledge mobilization., Results: Fifteen parents (n = 14 women) who had research partnership experience participated in this study. Most (n = 13) participants self-identified as White or of European descent. The majority (n = 10) had partnered in 1-3 research projects, while five participants had partnered in 4 + projects. Parents had a median of 3 years (IQR: 5) of partnership experience. We identified the following three themes: motivations, authentic partnerships, and learned decision making. Each theme included reflections about recruitment, and about research partnership in general. Motivations included a personal connection to the research topic, a connection to the community impacted by the research topic, and a desire to create change. Authentic partnerships were important for a meaningful experience, and enhanced participant's willingness and ability to share study materials. Learned decision making reflected parents' evolving decisions and practices related to sharing study information or personal information to support research. We provide a summary of participants' recommendations for researchers who work with parent partners, and recommendations for parents as they approach research partnerships., Conclusions: Experiences shared by parents who have partnered in research provide valuable information to inform recruitment methods and improve team functioning. Parent partners expressed a willingness to support recruitment and valued a strong research team working together for a common outcome. This study yields a set of recommendations guiding future research that engages parents as team members., (© 2023. The Author(s).)

Background: Gastrointestinal tract illness (GITill) in rugby players is underreported. The incidence, severity (% time loss illness, days lost per illness) and burden of GITill with/without systemic symptoms and signs in professional South African male rugby players during the Super Rugby tournament (2013-2017) are reported., Methods: Team physicians completed daily illness logs of players (N.=537; 1141 player-seasons, 102738 player-days). The incidence (illnesses/1000 player-days, 95% CI), severity (% ≥1-day time-loss; days until return-to-play [DRTP]/single illness [mean: 95% CI]) and illness burden (IB: days lost to illness/1000 player-days) for the subcategories of GITill with/without systemic symptoms and signs (GITill+ss; GITill-ss), and gastroenteritis with/without systemic symptoms and signs (GE+ss; GE-ss) are reported., Results: The incidence of all GITill was 1.0 (0.8-1.2). Incidence was similar for GITill+ss 0.6 (0.4-0.8) and GITill-ss 0.4 (0.3-0.5; P=0.0603). Incidence of GE+ss 0.6 (0.4-0.7) was higher than GE-ss 0.3 (0.2-0.4; P=0.0045). GITill caused ≥1-day time-loss in 62% of cases (GE+ss 66.7%; GE-ss 53.6%). GITill caused an average of 1.1 DRTP/single GITill, which was similar for subcategories. IB of GITill+ss was higher than GITill-ss (IB Ratio: 2.1 [1.1-3.9; P=0.0253]). IB for GITill+ss is 2 times higher than GITill-ss (IB Ratio: 2.1 [1.1-3.9]; P=0.0253); and GE+ss >3 times higher than GE-ss (IB Ratio: 3.0 [1.6-5.8]; P=0.0007)., Conclusions: GITill accounted for 21.9% of all illnesses during the Super Rugby tournament, with >60% of GITill resulting in time-loss. The average DRTP/single illness was 1.1. GITill+ss and GE+ss resulted in higher IB. Targeted interventions to reduce the incidence and severity of GITill+ss and GE+ss should be developed.

Aim: The prostate bed is one of the common sites of early recurrence of prostate cancer. The currently used PSMA ligands ( 68 Ga-PSMA-11 and 99m Tc-PSMA) undergo early urinary clearance resulting in interfering physiological activity within and surrounding the prostate. This can result in sites of cancer recurrence being obscured. 18 F-PSMA-1007 has an advantage of delayed urinary clearance thus the prostate region is reviewed without any interfering physiological activity. The aim of this study was to determine the diagnostic performance of 18 F-PSMA-1007 PET/CT in patients with early biochemical recurrence after definitive therapy., Methods: Forty-six Prostate cancer (mean age 66.7±7.5, range 48-87 years) presenting with biochemical recurrence (median PSA 1.6ng/ml, range 0.1-10.0) underwent non-contrast-enhanced 18 F-PSMA-1007 PET/CT. PET/CT findings were evaluated qualitatively and semiquantitatively (SUVmax) and compared to the results of histology, Gleason grade, and conventional imaging., Results: Twenty-four of the 46 (52.2%) patients demonstrated a site of recurrence on 18 F-PSMA-1007 PET/CT. Oligometastatic disease was detected in 15 (32.6%) of these patients. Of these 10 (37.5%) demonstrated intra-prostatic recurrence, lymph node disease was noted in 11 (45.8%) whilst two patients demonstrated skeletal metastases. The detection rates for PSA levels 0-<0.5, 0.5-<1, 1-2, >2 were 31.3%, 33.3%, 55.6% and 72.2% respectively. 7 (29.2%) of the positive patients had been described as negative or equivocal on conventional imaging. An optimal PSA cut-off level of 1.3ng/ml was found., Conclusion: 18 F-PSMA-1007 demonstrated good diagnostic performance detecting sites of recurrence. Its ability to detect sites of recurrence in the setting of early biochemical recurrence will have a significant impact on patient management., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Patients with severe COVID-19 may require endotracheal intubation. Unique adjustments to endotracheal intubation and extubation practices are necessary to decrease the risk of SARS-CoV-2 transmission to healthcare workers (HCWs) while avoiding complications of airway management., Objectives: To investigate the practice of endotracheal intubation and extubation, resources available and complications encountered by clinicians performing endotracheal intubation and extubation of COVID-19 and suspected COVID-19 patients in South Africa (SA)., Method: A cross-sectional observational study was conducted during the initial surge of COVID-19 cases in SA. Data were collected by means of a self-administered questionnaire completed by clinicians in the private and public healthcare sectors after performing an endotracheal intubation and/or extubation of a patient with confirmed or suspected COVID-19., Results: Data from 135 endotracheal intubations and 45 extubations were collected. Anaesthetists accounted for 87.0% (n=120) of the study participants, specialist clinicians in their respective fields for 59.4% (n=82), and public HCWs for 71.0% (n=98). Cases from Gauteng Province made up 76.8% (n=106) of the database. Haemoglobin desaturation was the most frequent complication encountered during endotracheal intubation (40.0%; n=54). Endotracheal intubations performed at private healthcare institutions were associated with a significantly lower complication rate of 17.5% (n=7) compared with 52.6% (n=50) in the public healthcare sector (p&lt;0.001). Endotracheal intubations performed in theatre had the lowest complication rate of 10.4% (n=5; p&lt;0.001). Propofol was used in 90 endotracheal intubations (66.7%), and its use was associated with fewer complications relative to other induction agents. Minimising the number of intubation attempts (p=0.009) and the use of checklists (p=0.013) significantly reduced the frequency of complications encountered during endotracheal intubation. Intravenous induction technique, neuromuscular blocking agent used, intubating device used and time at which intubation was performed did not affect the incidence of complications. The majority of endotracheal extubations were uncomplicated (88.9%)., Conclusions: The study provides valuable insight into the resources used by clinicians and complications encountered when endotracheal intubations and/or extubations were performed. Data from this study may be used to guide future clinical practice and research, especially in resource-limited settings.

Objectives: To document incidence rate and severity of specific sub-categories of respiratory tract illness (RTill) in rugby players during the Super Rugby tournament., Design: Cross-sectional study., Methods: Team physicians completed daily illness logs in 537 professional male rugby players from South African teams participating in the Super Rugby Union tournaments (2013-2017) (1141 player-seasons, 102,738 player-days). The incidence rate (IR: illness episodes/1000 player-days) and severity [%RTill resulting in time-loss, illness burden (IB: days lost to illness/1000 player-days) and days until return-to-play (DRTP)/single illness (mean: 95% Confidence Intervals)] are reported for the following specific sub-categories of RTill: non-infective respiratory tract illness (RTnon-inf), respiratory tract infections (RTinf), influenza-like illness, infective sinusitis, upper respiratory tract infections (URTinf), lower respiratory tract infections (LRTinf)., Results: The overall IR of RTill was 2.9 (2.6-3.3). IR was higher for RTinf (2.5; 2.2-2.9) vs. RTnon-inf (0.4; 0.3-0.6) (p < 0.001). For sub-categories the highest IR was in URTinf (1.9; 1.7-2.2), while the % illness causing time-loss was influenza-like illness (100%), LRTinf (91.7%), infective sinusitis (55.6%), and URTinf (49.0%). IB was highest for URTinf (2.0; 1.6-2.5), and the DRTP/single illness was highest for LRTinf (3.2; 2.3-4.4), and influenza-like illness (2.1; 1.6-2.8)., Conclusions: RTinf accounted for >57% of all illness during the Super Rugby tournament, and mostly URTinf. Influenza-like illness. LRTinf caused time-loss in >90% cases. URTinf, LRTinf and influenza-like illness resulted in the highest burden of illness and LRTinf caused the highest DRTP. Prevention strategies should focus on mitigating the risk of RTinf, specifically URTinf, LRTinf and influenza-like illness., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: To describe the clinical outcomes of patients with type 2 diabetes (DM2) and hypertension (HT) who received treatment and care at a specialized primary healthcare facility., Methods: A cross-sectional study was conducted and data retrieved from 349 patient's records. The clinical outcomes were linked to individual risk factors and demographic profiles. Patients with HT who had at least four blood pressure (BP) measurements and patients with DM2 who had at least two HbA1c measurements in a 12-month period were included., Results: More females had controlled HT than males. There was no sex difference observed for the control of DM2. Patients with HT visited the clinic for a median period of 96 days (IQR 35-257). Among 59.1% (n = 159) patients who achieved at least one controlled BP measurement, 64.2% (n = 102) had a controlled BP at the last visit. Patients with DM2 visited the clinic for a median period of 851 days (IQR 449.5-1254). From a total of 34 patients (43.5%) who achieved at least one controlled HbA1c measurement, 55.9% (n = 19) had a controlled HbA1c at the last visit., Conclusion: Despite the difference in patient profiles, more than half of the patients who received specialised DM2 and HT care managed to achieve BP and HbA1c control., (Copyright © 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: The rising burden of the ongoing COVID-19 epidemic in South Africa has motivated the application of modeling strategies to predict the COVID-19 cases and deaths. Reliable and accurate short and long-term forecasts of COVID-19 cases and deaths, both at the national and provincial level, are a key aspect of the strategy to handle the COVID-19 epidemic in the country., Methods: In this paper we apply the previously validated approach of phenomenological models, fitting several non-linear growth curves (Richards, 3 and 4 parameter logistic, Weibull and Gompertz), to produce short term forecasts of COVID-19 cases and deaths at the national level as well as the provincial level. Using publicly available daily reported cumulative case and death data up until 22 June 2020, we report 5, 10, 15, 20, 25 and 30-day ahead forecasts of cumulative cases and deaths. All predictions are compared to the actual observed values in the forecasting period., Results: We observed that all models for cases provided accurate and similar short-term forecasts for a period of 5 days ahead at the national level, and that the three and four parameter logistic growth models provided more accurate forecasts than that obtained from the Richards model 10 days ahead. However, beyond 10 days all models underestimated the cumulative cases. Our forecasts across the models predict an additional 23,551-26,702 cases in 5 days and an additional 47,449-57,358 cases in 10 days. While the three parameter logistic growth model provided the most accurate forecasts of cumulative deaths within the 10 day period, the Gompertz model was able to better capture the changes in cumulative deaths beyond this period. Our forecasts across the models predict an additional 145-437 COVID-19 deaths in 5 days and an additional 243-947 deaths in 10 days., Conclusions: By comparing both the predictions of deaths and cases to the observed data in the forecasting period, we found that this modeling approach provides reliable and accurate forecasts for a maximum period of 10 days ahead.

Introduction: As a result of the increased utilization of neurosurgical arthroscopic techniques, investigations into population and sex-specific trends of anatomical considerations have become increasingly important. This study aimed to investigate and describe aspects of the neuroanatomical morphometry of lumbar spines in a cadaveric and magnetic resonance imaging (MRI) sample., Materials and Methods: Twenty white adult (>18 years) cadavers (9 males; 11 females) were obtained under Ethical clearance. The lumbar regions were dissected and the position of the dorsal root ganglion (DRG) and dimensions of Kambin's triangle were determined. Twenty-six black adult (>18 years) MRI scans (17 males; 9 females) were obtained from an Academic Hospital and were used to determine the dimensions of the neural foramen and the DRGs within., Results: The ganglia were mostly at the midline of the caudal pedicle. Similar to previous studies, the diagonal measurement from Kambin's triangle was the largest and the vertical measurement the shortest. Skeletal and soft-tissue measurements indicated distinct trends when moving caudolaterally in the spine. Soft-tissue parameters from the current study were within the upper limits of those from previous studies, whereas skeletal parameters were in agreement with those reported by previous authors., Conclusions: Results from this study suggest a variation of certain parameters between studies with varying population groups and therefore supports the need for and the importance of possible population-specific trends of anatomical parameters considered during surgical procedures., (© 2020 Wiley Periodicals, Inc.)

Objectives: To determine whether a team illness prevention strategy (TIPS) would reduce the incidence of acute illness during the Super Rugby tournament., Methods: We studied 1340 male professional rugby union player seasons from six South African teams that participated in the Super Rugby tournament (2010-2016). Medical staff recorded all illnesses daily (126 850 player days) in a 3-year control (C: 2010-2012; 47 553 player days) and a 4-year intervention (I: 2013-2016; 79 297 player days) period. A five-element TIPS was implemented in the I period, following agreement by consensus. Incidence rate (IR: per 1000 player days; 95% CI) of all acute illnesses, illness by main organ system, infectious illness and illness burden (days lost due to illness per 1000 player days) were compared between C and I period., Results: The IR of acute illness was significantly lower in the I (5.5: 4.7 to 6.4) versus the C period (13.2: 9.7 to 18.0) (p<0.001). The IR of respiratory (C=8.6: 6.3 to 11.7; I=3.8: 3.3 to 4.3) (p<0.0001), digestive (C=2.5: 1.8 to 3.6; I=1.1: 0.8 to 1.4) (p<0.001), skin and subcutaneous tissue illness (C=0.7: 0.4 to 1.4; I=0.3: 0.2 to 0.5) (p=0.0238), all infections (C=8.4: 5.9 to 11.9; I=4.3: 3.7 to 4.9) (p<0.001) and illness burden (C=9.2: 6.8 to 12.5; I=5.7: 4.1 to 7.8) (p=0.0314) were significantly lower in the I versus the C period., Conclusion: A TIPS during the Super Rugby tournament was associated with a lower incidence of all acute illnesses (59%), infectious illness (49%) and illness burden (39%). Our findings may have important clinical implications for other travelling team sport settings., Competing Interests: Competing interests: CR is the chairman of the South Africa Rugby Football Union Medical Committee., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

We evaluated the extent of measurement discordance between glucose oxidase and hexokinase laboratory methods and the effect of this on estimated gestational diabetes mellitus (GDM) prevalence in a routine clinical setting. 592 consecutive urban African women were screened for GDM. Paired venous specimens were submitted to two independent calibrated laboratories that used either method to measure plasma glucose concentrations. World Health Organisation diagnostic criteria were applied. GDM prevalence determined by the glucose oxidase and hexokinase methods was 6.9% and 5.1% respectively. The overall GDM prevalence was 9%. Only 34% of GDM positive diagnoses were common to both laboratory methods. Bland Altman plots identified a bias of 0.2 mmol/l between laboratory methods. Plasma glucose concentrations measured by the glucose oxidase method were more platykurtic in distribution. Low diagnostic agreement between laboratory methods was further indicated by a Cohen's kappa of 0.48 (p < 0.001). Reports of GDM prevalence using either the glucose oxidase or hexokinase laboratory methods may not be truly interchangeable or directly comparable.

Objectives: To determine the incidence and nature of injuries in the Super Rugby tournament over a 5-year period., Methods: 482 male professional rugby union players from six South African teams participating in the Super Rugby tournament were studied (1020 player-seasons). Medical staff of participating teams (2012-2016 tournaments) recorded all time loss injuries (total injuries and match injuries) and exposure hours (93 641 total playing hours; 8032 match hours). Injury incidence, injured player proportion, severity (time lost), anatomical location, tissue type and activity/phase during which injury occurred are reported., Results: The overall incidence of match injuries (per 1000 player-hours; 95% CI) for each year was as follows: 2012 (83.3; 69.4-99.2); 2013 (115.1; 98.7-133.5); 2014 (95.9; 80.8-113.1), 2015 (112.3; 96.6-129.9) and 2016 (93.2; 79.9-107.9). The injured player proportion for each year was as follows: 2012 (54.6%); 2013 (49.4%); 2014 (52.0%); 2015 (50.0%); and 2016 (39.8%). The thigh, knee, head/face and shoulder/clavicle are the most frequently injured locations, and muscle/tendon and joint/ligament injuries account for the majority of injuries. Most injuries (79%) occur in contact situations, in particular during a tackle (54%)., Conclusion: The incidence of match injuries and the injured player proportion in South African teams competing in the Super Rugby tournament is high. Match injury incidence is consistently higher than previously reported for senior male rugby players at elite/professional level. Targeted risk management strategies are therefore needed in the Super Rugby tournament to manage risk of injury., Competing Interests: Competing interests: CR is the chairman of the South African Rugby Football Union Medical Committee. The other authors declare no conflicts of interest., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine the impact of FDG-PET/CT in the initial staging of cervical cancer among women with and without HIV and to determine the abilities of FDG-PET/CT metabolic parameters in predicting the presence of distant metastasis., Methods: We reviewed the FDG-PET/CT images of women with FIGO stage IB2 to IVA carcinoma of the cervix. We compared the FIGO stage before and after FDG-PET/CT. Maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were determined. We compared these parameters between the HIV-infected and uninfected woman and also determined their abilities to predict the presence of distant metastasis., Results: 126 women, mean age 48.05 ± 11.80 years were studied. Seventy-three patients were HIV-infected. The disease was upstaged in 65 patients, 32 of which were upstaged to stage IVB. HIV-infected women were younger (43.36 ± 8.03 years versus 54.51 ± 13.12, p<0.001) and had more advanced disease (p = 0.022) compared with HIV-uninfected. In a univariate logistic regression adjusted for the FIGO stage of the disease, there were significant associations between MTV and TLG of the primary tumor and distant metastasis. SUVmax, SUVmean, MTV and TLG performed well in predicting the presence of distant metastasis with areas under the curves (AUCs) of 0.63, 0.66, 0.80 and 0.77 respectively. These performances improved after adjustment for the FIGO stage of the disease with AUCs of 0.80, 0.79, 0.84 and 0.82 for SUVmax, SUVmean, MTV and TLG respectively., Conclusion: Inclusion of 18F-FDG-PET/CT in the pre-therapy assessment of cervical cancer improves the accuracy of staging in about half of the patients. The metabolic parameters of the primary tumor perform well in predicting the presence of distant metastases., Competing Interests: The authors have declared that no competing interests exist.

Aims: We investigated the clinical and analytic accuracy of five plasma calibrated glucometers, the use of which is advocated by the World Health Organisation and the International Federation of Gynaecology and Obstetrics, to screen for and diagnose gestational diabetes mellitus (GDM) in low resource settings., Methods: 592 consecutive black African women underwent a 75 g oral glucose tolerance test (OGTT) at 24-28 weeks gestation at an urban South African community health clinic. Capillary glucose was measured by one of five glucometer brands, each paired with a routine laboratory hexokinase method of plasma glucose measurement. The laboratory results served as the gold standard reference test for GDM diagnosis. World Health Organisation GDM diagnostic thresholds were applied to glucometer and laboratory results., Results: Glucometer and laboratory determined GDM prevalence was 75/592 (12.7%) and 30/592 (5.1%) with an elevated fasting glucose diagnostic in 64/75 (85%) and 24/30 (80%) of cases respectively. The proportion of glucometer results fulfilling ISO 15197:2013 recommended analytic accuracy at fasting, 60, and 120 min of the OGTT was 92.4%, 49.8% and 61.5%, with Bland Altman method revealing a positive glucometer bias of 0.22 mmol/l (-0.69-1.12 mmol/l), 0.96 mmol/l (-0.65-2.56 mmol/l) and 0.73 mmol/l (-0.73-2.19 mmol/l) respectively. Only three of the glucometer brands evaluated fulfilled ISO 15197:2013 analytic accuracy requirements and this was only achieved at fasting. All glucometers tested were inaccurate at one and two hours of the OGTT., Conclusions: Not all glucometers may be suitable for GDM screening as only three were accurate compared to the reference test and then only at fasting of the OGTT. Importantly, laboratory fasting glucose was diagnostic of GDM in 80% of cases in this study population.

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load-including rapid changes in training and competition load, competition calendar congestion, psychological load and travel-and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Ecosystem function and resilience is determined by the interactions and independent contributions of individual species. Apex predators play a disproportionately determinant role through their influence and dependence on the dynamics of prey species. Their demographic fluctuations are thus likely to reflect changes in their respective ecological communities and habitat. Here, we investigate the historical population dynamics of the killer whale based on draft nuclear genome data for the Northern Hemisphere and mtDNA data worldwide. We infer a relatively stable population size throughout most of the Pleistocene, followed by an order of magnitude decline and bottleneck during the Weichselian glacial period. Global mtDNA data indicate that while most populations declined, at least one population retained diversity in a stable, productive ecosystem off southern Africa. We conclude that environmental changes during the last glacial period promoted the decline of a top ocean predator, that these events contributed to the pattern of diversity among extant populations, and that the relatively high diversity of a population currently in productive, stable habitat off South Africa suggests a role for ocean productivity in the widespread decline.

N-Trimethyl chitosan chloride (TMC; high molecular weight) and N-trimethyl chitosan oligosaccharide (TMO; low molecular weight) with different degrees of quaternisation were synthesised and evaluated for their absorption enhancing properties across mucosal epithelia. These quaternised chitosan derivatives (0.0625% w/v-0.5% w/v) showed a significant decrease in the transepithelial electrical resistance (TEER) of cultured rabbit tracheal epithelial cell monolayers as compared to the control. The degree of quaternisation and concentration of the compounds influenced the extent of the reduction in TEER. Higher degrees of quaternisation and an increase in the concentration of the compound were associated with a more pronounced reduction in the TEER. The TMO derivatives seemed to be more effective in lowering the TEER of tracheal cell monolayers as compared to the TMC polymers. Ciliary beat frequency (CBF) is the main defence mechanism of the respiratory tract and is therefore a useful parameter in evaluating the toxicity of nasally administered drugs and additives. The effect of the synthesised chitosan derivatives on the CBF of human nasal epithelial cells at pH 7.4 was determined by a method based on an analogue contrast enhancement technique. The TMO oligomers exhibited lower inhibition of the CBF of human nasal epithelial cells compared to that of the TMC polymers. It was proposed that this reduced effect on the CBF is due to the lower viscosity and molecular weight of TMO. However, no acute toxicity was found with any of the synthesised chitosan derivatives by means of the CBF tests conducted in this study.