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Background: The self-reported prevalence of constipation is higher in black South Africans when compared with other races. Delayed stool transit increases the time that the colonic lumen is exposed to carcinogens linked with colorectal cancer (CRC). Thus, constipation is a potential marker for identifying black African patients at risk for adenomatous polyps or CRC who could be fasttracked for colonoscopy in resource-limited settings. Objective: To describe the proportion of abnormal colonoscopies with findings of adenomatous polyps or CRC among black South Africans undergoing investigation for constipation. Methods: A retrospective chart review was performed involving 141 black African patients who underwent colonoscopy for constipation at a regional hospital in Durban, South Africa from October 2014-October 2017. Data extracted from each patient's chart included demographics and the colonoscopy findings. The data were analysed descriptively and with the z-test. Results: A total of 53/141 patients (37.6%) had abnormal colonoscopies. Of the 53 patients with abnormal colonoscopies, adenomatous polyps were identified in 4 patients (7.5%), while CRC was identified in 6 patients (11.3%). For patients with abnormal colonoscopies, the proportion of adenomatous polyps and CRC was similar in younger and older age groups (p=0.136 and p=0.342). The proportion of adenomatous polyps and CRC was similar in females and males with abnormal colonoscopies (p=0.246 and p=0.308). Conclusion: Approximately 1 in every 3 black South Africans with constipation had abnormal colonoscopies. A notable proportion of patients with abnormal colonoscopies had adenomatous polyps or CRC. Black South Africans presenting with constipation should be fast-tracked for colonoscopy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the breastfeeding practices of urban, predominantly isiZulu speaking, South African teenage mothers, and to examine factors associated with breastfeeding.Study design and methods: A cross-sectional study was conducted with 73 mothers (aged 15 to 19 years) who were attending a well-baby clinic for their infant’s scheduled 14-week immunisation visit. A face-to-face interview was conducted with each mother in isiZulu (n = 66) or English (n = 7) by a trained research assistant. Close ended questions included; socio-demographic characteristics; obstetric history; and, breastfeeding practices while open-ended questions explored reasons for early cessation of breastfeeding, and perceptions of how the family, health care workers, and the school could support teenage mothers with breastfeeding.Results: All 73 mothers had initiated breastfeeding; however, by the time of the interview, 31.5% had stopped breastfeeding.A multivariate logistic regression model was used to predict the likelihood of early breastfeeding cessation. The odds ratio of early breastfeeding cessation for teenage mothers below the age of ≤ 17 years was 17.3% higher compared to teenage mothers older than 17 years (OR 1.17, 95% CI:0.617-2.269); 8.6% higher for teenage mothers who completed their grade 11 and above compared those who did not complete grade 11 and above (OR 1.17, 95% CI:0.617-2.269); and, 79.5% (OR 1.795, 95% CI:0.565-5.739) higher for teenage mothers who experienced breastfeeding problems compared to mothers without breastfeeding problems. However, since the 95% CI for these odds ratios spanned the null value (1.0), the increased odds were not statistically significant.Conclusion: The elevated odds of early breastfeeding cessation were associated with a young maternal age (≤ 17 years) and experiencing breastfeeding problems. This highlights the importance of targeting adolescent mothers for support and promotion of breastfeeding, noting the influence of society and peer pressure. It is also clear that the healthcare workers, schools and communities have an important role to play in supporting breastfeeding teenage mothers, especially in providing accurate information and support for the prevention of breastfeeding problems. [ABSTRACT FROM AUTHOR]

The aim of this retrospective cohort study was to identify trends in the surgical-orthodontic management of skeletal Class III malocclusions in Western Australia between 1985 and 2016.

Valence order and fluctuations in the mixed-valence warwickite Fe2OBO3 have been explored by 57Fe Mössbauer effect spectroscopy at pressures up to 30 GPa in diamond anvil cell experiments. At room temperature a drastic disruption of charge order is evident at ∼11 GPa. There is coexistence of charge order and a progressively increasing abundance of fluctuating valence states in the range extending to ∼16 GPa. At P> 16 GPa only signatures of electron exchange relaxation, Fe2+ ⇔ Fe3+, where "⇔" represents the resonating mobile carrier, are discerned. Spectral signatures indicate that electron hopping is on a timescale of ∼50 ns, that is, in a time window to which the nuclear resonance technique is particularly sensitive. Low-temperature quenching (∼ 110K) at these high pressures (i) is not sufficient to inhibit electron exchange for charge order to reemerge and (ii) reveals that magnetic ordering typical of the charge-ordered phase at low pressure is completely altered to entail new spin dynamics. This evidences the strong interplay between charge order and magnetism and establishes P∼16 GPa as a new electronic phase transition boundary for this system. Nanosecond valence fluctuation signatures persist upon further pressurization to ∼30 GPa at 300 K, suggestive of continued confinement of the mobile carrier to the Fe2+ ⇔ Fe3+ pair at these extremes. [ABSTRACT FROM AUTHOR]

Magnetic-electronic studies of mixed-valence Fe2OBO3 have shown that ionic charge order (CO) is disrupted at ∼16 GPa. The pertinent minority-spin carrier exhibits persistent intersite electron exchange Fe2+ ⇔ Fe3+ to well beyond this pressure. Temperature-dependent electrical transport measurements over an extended pressure range presented here demonstrate that the electronic structure remains gapped to well beyond 16 GPa. Extrapolation of data to higher pressure suggests that metallization will only prevail at P > 50 GPa. Both the persistent gapped electronic state across the CO instability and signature of carrier confinement to Fe-Fe dimers in the Fe2+ ⇔ Fe3+ electron exchange are rationalized as crossover from a Wigner crystal (site centered) insulator to a dimer Mott (bond centered type) insulator-"Wigner-Mott transition" at ∼16 GPa. The dimer insulating state is a consequence of modulation of the relevant hopping parameter t in quasi-low-dimensional features in the structure (ribbons and chains). Complementary structural studies suggest that the a axis is appreciably more compressible than other crystallographic directions of the original monoclinic unit cell. Therefore, such a modulation in t may arise from Peierls type distortions along the a axis or else stems from intrinsic modulation in the c axis direction of the unit cell. This is aided by a monoclinic (P21/c) → orthorhombic (Pmcn) structural adjustment that is concurrent across the electronic transition. Pressure tuning of relative values of on-site Ult and intersite V/t Coulomb interaction parameters of the quasi-low-dimensional features evolve the system from site-centered to dimer-centered electron localization [ABSTRACT FROM AUTHOR]

Magnetic-electronic hyperfine interaction parameters of spectral components are obtained from in situ 57Fe Mössbauer spectroscopy pressure studies of the mixed-valence LuFe2O4 multiferroic, up to ∼30GPa and on recovered high-pressure phase samples. Temperature-dependent Mössbauer spectra of the low-pressure phase show that Fe2+ and Fe3+ sites are discernible, consistent with known site-centered charge order in the triangular (frustrated) Fe sublattice network. Magnetic spectra of the high-pressure phase, stabilized in a rectangular Fe sublattice network at P>8GPa, exhibit fingerprints of iron in an intermediate valence state only. Temperature-dependent resistivity pressure studies evidence thermally activated small polaron motion in the high-pressure phase. These experimental signatures, complemented by ab initio calculations of electronic structure, are considered evidence of asymmetric dimer formation Fe(2+Δ+)⇔Fe(3-Δ)+, where the minority-spin electron deconfinement coefficient is Δ=0.3-0.4. Bragg satellites discerned in electron diffraction patterns of the metastable high-pressure phase possibly stem from this admixture of site- and bond-centered localization (intermediate-state charge order) in a magnetic background. This breaks inversion symmetry and potentially renders LuFe2O4 in its high-pressure phase as a new charge order instigated (electronic) ferroelectric. [ABSTRACT FROM AUTHOR]

Background: Studies show that youth in low socioeconomic communities suffer significant disturbances in mental and emotional health because of exposure to violence and peer victimisation, manifesting in internalising disorders such as depression, anxiety and traumatic stress., Aim: To examine the relation between risks and exposure to community violence and peer victimisation., Setting: Low socioeconomic communities in Durban, KwaZulu-Natal., Methods: Data were collected via school and home interviews with youth and maternal caregivers using standardised schedules and instruments. These included the Demographics and Questions about Child's Health schedule, the Family History of Risk Questionnaire, the Child Behaviour Checklist, the Social Experiences Questionnaire and the Survey of Children's Exposure to Violence. Youth sample comprised 256 participants, with age range from 9 to 18 years, and 65% being female., Results: Sociodemographic risks were significantly associated with lifetime witnessing violence, victimisation and hearing about violence. Low maternal education was associated with overt peer victimisation and cyber-victimisation. Internalising conditions such as worry and oversensitivity, fear and concentration, youth anxiety and maternal anxiety were also significantly associated with violence exposure and peer victimisation., Conclusion: Predisposing risks for exposure to violence and victimisation occur in all domains, suggesting that interventions should target these domains to minimise their impact. Co-occurring experience of violence at the personal, proximal and distal levels perpetuate a cyclical loop of violence, intersecting and influencing each other., Contribution: Risk factors such as anxious attachment, avoidant attachment and anxiety, conceptually often seen as maladaptive outcomes, also serve as predisposing risks for violence exposure., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Competing Interests: Conflicts of interest: the authors declare they have no conflicts of interest.

Background: South Africa's public antiretroviral treatment (ART) programme has undergone progressive changes since its introduction in 2004. The effect of this on the burden of the AIDS-defining opportunistic infection, cytomegalovirus retinitis (CMVR), in SA, has not been fully appreciated., Objectives: To determine the effect of ART availability in the public sector of SA on the trend in the number of cases of newly diagnosed CMVR over time., Methods: This is a retrospective study from 01 November 2002 to 31 August 2017 that took place at a tertiary hospital in the KwaZulu-Natal (KZN) province., Results: A total of 383 participants were included in the study, with 60.1% being female and 94% of black African origin. The mean age of patients was 34.08 years (SD ± 7.24). A linear trend model suggested an overall linear decrease in the number of new cases of CMVR per year ( R 2 of 0.67). The average number of new cases of CMVR per year prior to ART being available to all persons living with HIV (PLWH) with a CD4+ ≤ 350 cells/μL and after was 34 and 13, respectively, and the difference (61.76%) between these values was statistically significant, P = 0.001. The median CD4+ count at diagnosis of CMVR was 22 (interquartile range: 9-51.25) cells/μL. An overall 51% of patients in this study were on ART at diagnosis of CMVR. There was a higher proportion of patients on ART ≤ 6 months (63.3%), compared with those on ART > 6 months (36.7%), and the difference was statistically significant, P < 0.01., Conclusion: ART has resulted in a decrease in the burden of CMVR on ophthalmic services for many in KZN, particularly following the introduction of ART for all PLWH with a CD4 ≤ 350 cells/μL., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)

Background: Mucocutaneous diseases (MCD) have been commonly described among human immunodeficiency virus (HIV) infected patients before the combined antiretroviral therapy (cART) era. There is limited data on the frequency and type of MCD in the cART era in African children and adolescents. This study aimed to describe the prevalence and spectrum of MCD in South African children and adolescents seropositive for HIV on cART., Methods: A cross-sectional study of 310 participants aged 0-19 years attending a public sector ART clinic at King Edward VIII Hospital, Durban, South Africa, was conducted. Demographic, clinical, and laboratory information was obtained from the participants and hospital records. Participants were examined. Data were collated and analyzed with SPSS version 23., Results: MCD were observed in 77.4% of HIV-infected children. The prevalence was higher among males and adolescents above 16 years old (83.9%). Infectious skin disorders (44.7%) were less common than noninfectious dermatoses (55.3%). More common disorders encountered included generalized pruritus (32.6%), fungal infections (20.9%), and inflammatory (20.4%) and pigmentary (20.4%) skin disorders. Tinea capitis and pedis were the most prevalent fungal infections, while oral candidiasis (0.2%) was the least. Inflammatory skin disorders and dyschromia appeared to be more common than in the pre-cART era., Conclusions: While MCD are still common in HIV-infected children and adolescents in the cART era, the pattern and types of disorders have changed to a predominance of non-infectious dermatoses., (© 2021 the International Society of Dermatology.)

Background: Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR)., Objectives: Using a monitor of medium- to long-term blood glucose control, to determine the association between glycated haemoglobin (HbA1c) levels in patients with PDR and those with no DR., Methods: A prospective, cross-sectional study was conducted at McCord Provincial Eye Hospital in Durban, South Africa. We studied only patients diagnosed with diabetes mellitus (DM) for &gt;1 year who had either PDR or no DR, and compared their HbA1c levels. Patients with non-proliferative DR were not included., Results: Patients with PDR had significantly higher HbA1c levels than those with no DR. Patients with type 1 DM had higher HbA1c levels than patients with type 2 DM in both the PDR and no-DR groups. Older patients (&gt;70 years) had lower HbA1c levels than younger patients. Gender, race and duration of diabetes had no influence on HbA1c levels., Conclusions: PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients.

Background: Sustained injudicious and indiscriminate use of antimicrobials has exerted selection pressure for developing antimicrobial resistance (AMR), requiring behaviour change from healthcare professionals (HCPs) based on their knowledge, attitudes and practices (KAP) on antimicrobials, AMR and antimicrobial stewardship (AMS)., Methods: A cross-sectional online questionnaire-based survey was conducted nationally amongst doctors, pharmacists and nurses from November 2017 to January 2018. The questionnaire comprised demographic information and KAP questions., Results: Respondents comprised of 1120 doctors, 744 pharmacists and 659 nurses. Antimicrobial resistance was considered a severe problem globally and nationally by majority of HCPs. Self-assessment of knowledge revealed gaps in understanding of antimicrobials, AMR and AMS. Confidence scores in prescribing by doctors, pharmacists and nurses were 57.82%, 32.88% and 45.28%, respectively. Doctors, 441 (45.2%) indicated no confidence in using combination therapy. Prescribing correctly showed a confidence level of 33.99% from 436 doctors, 41.88% from nine pharmacists and 35.23% from 107 nurses. Healthcare professionals (1600 [91.22%]) stated educational campaigns would combat AMR. Only 842 (40.13%) HCPs attended training on these topics and 1712 (81.60%) requesting more education and training., Conclusion: This is the first comparative survey on KAP of practising doctors, pharmacists and nurses in South Africa. Doctors had the highest knowledge score followed by nurses and pharmacists. Practice scores did not corroborate knowledge and the higher attitude scores. Gaps in KAP were evident. Healthcare professionals indicated the need for more education and training, thus requiring a review of pre-service and in-service education and training in addition to continued professional development programmes for practising HCPs., Competing Interests: S.Y.E. is the chairperson of the Global Respiratory Infection Partnership and a member of the Global Hygiene Council, both sponsored by unrestricted educational grants from Reckitt and Benckiser (Pty.), United Kingdom. R.B. and R.S. do not have any conflicts of interest., (© 2021. The Authors.)

Background: Patients with coronary artery disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention [(coronary artery bypass graft surgery (CABG) versus percutaneous coronary intervention (PCI)] influences the outcome., Objectives: We examined the prevalence of depression among myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression in patients who underwent CABG versus PCI., Methods: We evaluated the risk-factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularisation over a 15-month period (January 2017 to May 2018). The Beck depression inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA)., Results: One hundred patients were recruited (mean age: males 60.73 ± 4.52 years, females 60.29 ± 3.64 years) but five dropped out, leaving 95 patients for complete analysis. Most of the patients were low-income earners [53 (53.0%)], and 21 (21.0%) had tertiary-level education. The majority had multiple CAD risk factors and co-morbidities (79.0%). Prior to the LSM programme, 51 patients (51.0%) had depression and depressive traits [CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047]. After LSM the overall prevalence of depression and depressive traits fell to 33 patients (34.7%) [PCI eight (23.0%) vs CABG 25 patients (72.0%), p = 0.001]. The mean depression scores also fell from 21.11 ± 7.75 to 14.98 ± 9.61 ( p = 0.002). At baseline, PCI patients were more physically active compared to CABG patients [three (60.0%) vs two patients (40.0%), respectively, p = 0.715]. After LSM, more PCI patients undertook PA compared to CABG subjects [24 (60.0%) vs 14 patients (35.0%), respectively, p = 0.012]. The PA score was also higher among the PCI group compared to the CABG group [14.16 ± 9.73 vs 9.40 ± 10.94, respectively, p = 0.024]. In fully compliant subjects, the benefit derived was similar regardless of the mode of intervention [OR 1.10, 95% CI: 0.78-4.23, p = 0.191]. Using multivariate analysis, the main predictors of depression and depressive traits were female gender (OR 3.29, 95% CI: 1.51-11.03, p = 0.008), CABG (OR 1.86, 95% CI: 1.68-5.77, p = 0.003), heart failure (OR 2.65, 95% CI: 5.87-13.62, p = 0.000), kidney failure (OR 1.41, 95% CI: 1.30-5.23, p = 0.041), atrial fibrillation (OR 1.60, 95% CI: 1.40-4.77, p = 0.023), low PA (OR 1.97, 95%, CI: 11.23-33.20, p = 0.000), previous history of depression (OR 8.99, 95% CI: 1.90-7.89, p = 0.002) and low income (OR 2.21, 95% CI: 1.40-2.85, p = 0.000)., Conclusions: Depression and depressive traits are common among subjects undergoing coronary revascularisation, more so among CABG than PCI participants. LSM reduced the prevalence of depression and depressive traits, with fully compliant CABG versus PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in incidence of depression was recorded among LSM partly compliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.

Purpose: The purpose was to identify and describe patients with new-onset vernal keratoconjunctivitis-like (VKC-like) disease after puberty., Methods: The study consisted of two parts: a prospective observational descriptive study of patients with new-onset VKC-like disease, and a case-control study to determine the relationship of a CD4 count with VKC-like disease in adults, in the setting of human immunodeficiency virus (HIV). Patients were recruited between January 2016 and November 2017 from a Provincial Eye hospital, one of two large referral hospitals in KwaZulu-Natal, South Africa. Patients presenting to the eye clinic were screened and diagnosed at the Primary Eye Care Unit. Inclusion criteria: age 15 years and older with signs and symptoms of new-onset VKC-like disease. Exclusion criteria: a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who declined HIV testing. Data collected included HIV status, CD4 count, antinuclear antibodies and total serum immunoglobulin E., Results: Thirty-three patients were included; females n = 16 and males n = 17. The mean age at presentation was 32.45 ± 9.93 years, 95% CI = 28.94-35.97. Twenty-six patients (78.8%) were HIV positive, 95% CI (62-89). The proportion of HIV positive patients was statistically different from the HIV negative group, Chi-squared = 21.866, P value <0.0001. In the group of HIV positive patients, 72% were classified as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of VKC-like disease (Chi-squared = 4.992, P value = 0.0255)., Conclusion: In this cohort, a statistically significant association was found between VKC-like disease in adults and an HIV positive status. This association calls for more research on the subject., Competing Interests: None

Background: Discordant genotypic/phenotypic rifampicin susceptibility testing in Mycobacterium tuberculosis is a significant challenge, yet there are limited data on its prevalence and how best to manage such patients. Whether to treat isolates with rpoB mutations not conferring phenotypic resistance as susceptible or multidrug-resistant tuberculosis (MDR-TB) is unknown. We describe phenotypic and genotypic characteristics of discordant isolates and clinical characteristics and treatment outcomes of affected patients in KwaZulu-Natal, South Africa., Methods: We analyzed clinical isolates showing rifampicin resistance on GenoType MTBDR plus while susceptible on 1% agar proportion method. We measured rifampicin minimum inhibitory concentrations (MICs) using Middlebrook 7H10 agar dilution and BACTEC MGIT 960. Sensititre MYCOTB plates were used for drug-susceptibility testing, and rpoB gene sequencing was performed on all isolates. Local MDR-TB program data were reviewed for clinical information and patient outcomes., Results: Discordant isolates constituted 4.6% (60) of 1302 rifampicin-resistant cases over the study period. Of these, 62% remained susceptible to isoniazid and 98% remained susceptible to rifabutin. Rifampicin MICs were close to the critical concentration of 1 µg/mL (0.5-2 µg/mL) for 83% of isolates. The most frequent rpoB mutations were Q513P (25.3%), D516V (19.2%), and D516Y (13.3%). Whereas 70% were human immunodeficiency virus infected, the mean CD4 count was 289 cells/mm 3 and 87% were receiving antiretroviral therapy. Standard therapy for MDR-TB was used and 53% achieved successful treatment outcomes., Conclusions: Rifampicin-discordant TB is not uncommon and sequencing is required to confirm results. The high susceptibility to rifabutin and isoniazid and poor treatment outcomes with the current regimen suggest a potential utility for rifabutin-based therapy.

Background: Acute respiratory tract infections contribute significantly to morbidity and mortality among young children in resource-poor countries. However, studies on the viral aetiology of acute respiratory infections, seasonality and the relative contributions of comorbidities such as immune deficiency states to viral respiratory tract infections in children in these countries are limited., Methods: A retrospective analysis of laboratory test results of upper or lower respiratory specimens of children between 0 and 5 years of age collected between 1st January 2011 and 31st July 2015 from hospitals in KwaZulu-Natal, South Africa. Respiratory specimens were tested for viral respiratory pathogens using multiplex polymerase chain reaction (PCR), HIV testing was performed either by serological or PCR methods. Cytomegalovirus (CMV) respiratory infection was determined using the CMV R-gene PCR kit., Results: In total 2172 specimens were analysed, of which 1175 (54.1%) were from males. The median age was 3.0 months (interquartile range [IQR] 1-7). Samples from the lower respiratory tract accounted for 1949 (89.7%) of all specimens. Respiratory multiplex PCR results were positive in 834 (45.7%) specimens. Respiratory syncytial virus (RSV) was the most commonly detected virus in 316 (32.1%) patients, followed by adenovirus (ADV) in 215 (21.8%), human rhinovirus (Hrhino) in 152 (15.4%) and influenza A (FluA) in 50 (5.1%). A seasonal time series pattern was observed for ADV (winter peak), enterovirus (EV) (autumn), human bocavirus (HBoV) (summer), and parainfluenza viruses 1 and 3 (PIV1 and 3) (spring). Stationary or untrended seasonal variation was observed for FluA (winter peak) and RSV (summer). HIV results were available for 1475 (67.9%) specimens; of these 348 (23.6%) were positive. CMV results were available for 714 (32.9%) specimens, of which 416 (58.3%) were positive. There was a statistically significant association between the coinfection of HIV and CMV with ADV., Conclusions: In this study, we identified the most common respiratory viral pathogens detected among hospitalized children in KwaZulu-Natal. The coinfection between HIV and CMV was found to be associated with an increased risk of only adenovirus infection. Most viral pathogens showed a seasonal trend of occurrence. Our data has implications for the rational design of public health programmes.

Background: The diagnosis of diabetes has been described as a lifelong psychological burden on the patient and his or her family. Social support plays a pivotal role in patients with diabetes and is important in enabling them to cope effectively with the disease. There is a dearth of research on social support and coping in patients with diabetes in South Africa., Objectives: The aim of this study was to explore whether patients with poor perceived social support have lower levels of well-being and coping than patients with good social support., Method: A cross-sectional study was conducted at both public and private facilities on the north coast of KwaZulu-Natal, South Africa. The Diabetes Care Profile (DCP), the General Health Questionnaire (GHQ), the Social Support Questionnaire (SSQ) and the WHO-5 Well-being Index (WHO-5) were administered to 401 participants., Results: The findings indicate that there is an inverse relationship between social support and coping, which suggests that an increase in social support is associated with a decrease in emotional distress. There was a small positive correlation between the SSQ and the WHO-5, which suggests participants who had good support endorsed better levels of well-being. Although participants indicated that they were satisfied with their level of support, they had poor coping as indicated by the high mean score on the GHQ and the high HbA1c level. There was a small positive correlation between GHQ and HbA1c. There was no association between social support and HbA1c., Conclusion: Social support is important in helping the patient with diabetes cope with the disease and to improve adherence to treatment. Health care providers should take cognisance of psychosocial factors in the treatment regime of the patient. Family members should be educated about diabetes, the importance of adherence and long-term complications of the disease.

Background: We evaluated the shedding of human immunodeficiency virus (HIV)-1 particles into continuous ambulatory peritoneal dialysis (CAPD) effluents of HIV-positive patients with end-stage renal disease (ESRD)., Methods: A total of 58 HIV-positive patients with ESRD on highly active antiretroviral therapy (HAART) who had Tenckhoff catheters inserted between September 2012 and February 2015 were prospectively reviewed and followed for 18 months. Peritoneal dialysis (PD) effluent samples from functioning CAPD catheters and plasma samples were obtained at three points during regular clinic visits on days 45 ± 37, 200 ± 19 and 377 ± 13 after catheter insertion. All specimens were stored at -20°C, and each batch was analysed by Roche quantitative HIV-1 polymerase chain reaction assay to detect HIV-1 particles. Clustered logistic regression was used to test for independent predictors of HIV-1 detection in CAPD effluents., Results: HIV-1 RNA above 20 copies/mL assay limit was detectable in 19% (first batch), 26.3% (second batch) and 20% (third batch) of PD effluent specimens. HIV-1 RNA was detectable in PD fluid, without corresponding detection in the paired plasma in 3.4% (first batch), 5.3% (second batch) and 10% (third batch) of samples. Detection of HIV-1 in plasma sample (odds ratios 3.94; 95% confidence interval 1.14-13.55; P = 0.030), body mass index, serum albumin and HAART regimen were found to be significantly associated with HIV-1 detection in PD effluents., Conclusions: HIV particles are shed in detectable amounts into CAPD effluents even in patients with suppressed plasma viral load, raising concerns of a localized sanctuary site and potential infectivity of HIV-positive CAPD patients on a full complement of HAART., (© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Background: Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations., Methods: We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis., Results: The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42-7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73-2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure., Conclusions: HIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.

A Box-Behnken Design was employed to study the influence of boric acid, sodium sulfate, ammonia and n-propanol in the formulation of crosslinked ethylenic homopolymeric (CEH) gelispheres from native polyvinyl alcohol (PVA). The dependent variables studied included the size of the spherical gelispheres, drug encapsulation efficiency, in vitro dissolution after 30 min and textural parameters, namely fracture force and matrix rupture energy. Based on these responses, an optimized CEH gelisphere matrix was formulated and thereafter incorporated as a powder into a candidate crosslinked zinc-pectinate multiple-unit device to assess its effect on modifying drug release. In the case of the CEH-loaded zinc-pectinate gelispheres, it was determined via constrained optimization that a maximum drug encapsulation efficiency of 28.63% could be obtained under the conditions of 0% (w/v) CEH, 13 h of crosslinking and drying temperature of 60 degrees C. On the other hand, initial drug release could be significantly retarded when 0.10% (w/v) of CEH was included in the formulation and crosslinked for 24 h at 40 degrees C. In this regard, CEH induced a 4 h lag phase. Furthermore, zero-order drug release was produced and could be maintained over several weeks. Kinetic analysis of drug release further supported that CEH inhibits polymer relaxation (k2<

A Plackett-Burman design was employed to develop and optimize a novel crosslinked calcium-aluminum-alginate-pectinate oilisphere complex as a potential system for the in vitro site-specific release of Mentha piperita, an essential oil used for the treatment of irritable bowel syndrome. The physicochemical and textural properties (dependent variables) of this complex were found to be highly sensitive to changes in the concentration of the polymers (0%-1.5% wt/vol), crosslinkers (0%-4% wt/vol), and crosslinking reaction times (0.5-6 hours) (independent variables). Particle size analysis indicated both unimodal and bimodal populations with the highest frequency of 2 mm oilispheres. Oil encapsulation ranged from 6 to 35 mg/100 mg oilispheres. Gravimetric changes of the crosslinked matrix indicated significant ion sequestration and loss in an exponential manner, while matrix erosion followed Higuchi's cube root law. Among the various measured responses, the total fracture energy was the most suitable optimization objective (R2 = 0.88, Durbin-Watson Index = 1.21%, Coefficient of Variation (CV) = 33.21%). The Lagrangian technique produced no significant differences (P > .05) between the experimental and predicted total fracture energy values (0.0150 vs 0.0107 J). Artificial Neural Networks, as an alternative predictive tool of the total fracture energy, was highly accurate (final mean square error of optimal network epoch approximately 0.02). Fused-coated optimized oilispheres produced a 4-hour lag phase followed by zero-order kinetics (n > 0.99), whereby analysis of release data indicated that diffusion (Fickian constant k1 = 0.74 vs relaxation constant k2 = 0.02) was the predominant release mechanism.