Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?

BACKGROUND

Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths.

OBJECTIVES

To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources.

METHODS

The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets.

RESULTS

A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017.

CONCLUSION

The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.

The importance of including manner of (injury) death on the death notification form

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Enhanced Thermoelectric Properties of a Semiconducting Two-Dimensional Metal-Organic Framework via Iodine Loading

We report the first result of a study in which molecular iodine has been incorporated via incipient wetness impregnation into the two-dimensional semiconducting metal-organic framework (MOF) Cu₃(2,3,6,7,10,11-hexahydroxytriphenylene)₂ Cu₃(HHTP)₂ to enhance its thermoelectric properties. A power factor of 0.757 μW m^-1 K^-2 for this MOF was obtained which demonstrates that this provides an effective route for the preparation of moderate-performance thermoelectric MOFs.

Tunable Carrier Type of a Semiconducting 2D Metal-Organic Framework Cu3(HHTP)2

In this work, a switch from n-type to p-type conductivity in electrodeposited Cu3(2,3,6,7,10,11-hexahydroxytriphenylene)2 [Cu3(HHTP2)] has been observed, which is most likely due to oxygen molecular doping. The synthesis of electrically conductive 2D metal-organic frameworks (MOFs) has been achieved through the introduction of highly conjugated organic linkers coordinated to their constituent metal-ion centers. However, the porous structure and unsaturated metal sites in MOFs make them susceptible to ambient adsorbates, which can affect their charge transport properties. This phenomenon has been experimentally investigated by GIXRD, Hall effect and Seebeck measurements, and X-ray photoelectron spectroscopy.

The impact of the SARS-CoV-2 epidemic on mortality in South Africa in 2020

BACKGROUND

The impacts on mortality of both the SARS-CoV-2 epidemic and the interventions to manage it differ between countries. The Rapid Mortality Surveillance System set up by the South African Medical Research Council based on data from the National Population Register (NPR) provides a means of tracking this impact on mortality in South Africa.

OBJECTIVES

To report on the change in key metrics of mortality (numbers of deaths, life expectancy at birth, life expectancy at age 60, and infant, under-5, older child and adolescent, young adult, and adult mortality) over the period 2015 - 2020. The key features of the impact are contrasted with those measured in other countries.

METHODS

The numbers of registered deaths by age and sex recorded on the NPR were increased to account for both registered deaths that are not captured by the NPR and an estimate of deaths not reported. The estimated numbers of deaths together with estimates of the numbers in the population in the middle of each of the years were used to produce life tables and calculate various indicators.

RESULTS

Between 2019 and 2020, the number of deaths increased by nearly 53 000 (65% female), and life expectancy at birth fell by 1 year for females and by only 2.5 months for males. Life expectancy at age 60 decreased by 1.6 years for females and 1.2 years for males. Infant mortality, under-5 mortality and mortality of children aged 5 - 14 decreased by 22%, 20% and 10%, respectively, while that for older children and adolescents decreased by 11% for males and 5% for females. Premature adult mortality, the probability of a 15-year-old dying before age 60, increased by 2% for males and 9% for females.

CONCLUSIONS

COVID-19 and the interventions to manage it had differential impacts on mortality by age and sex. The impact of the epidemic on life expectancy in 2020 differs from that in most other, mainly developed, countries, both in the limited decline and also in the greater impact on females. These empirical estimates of life expectancy and mortality rates are not reflected by estimates from agencies, either because agency estimates have yet to be updated for the impact of the epidemic or because they have not allowed for the impact correctly. Trends in weekly excess deaths suggest that the drop in life expectancy in 2021 will be greater than that in 2020.

Toward sustainable syntheses of Ca-based MOFs

We report the use of benign and green precursors, including waste chicken eggshells and PET (polyethylene terephthalate) from recycled plastic bottles, for the facile synthesis of a variety of calcium-based metal-organic frameworks (Ca-MOFs), using water based and mechanochemical synthesis techniques.

COVID deaths in South Africa: 99 days since South Africa's first death

BACKGROUND

Understanding the pattern of deaths from COVID-19 in South Africa (SA) is critical to identifying individuals at high risk of dying from the disease. The Minister of Health set up a daily reporting mechanism to obtain timeous details of COVID-19 deaths from the provinces to track mortality patterns.

OBJECTIVES

To provide an epidemiological analysis of the first COVID-19 deaths in SA.

METHODS

Provincial deaths data from 28 March to 3 July 2020 were cleaned, information on comorbidities was standardised, and data were aggregated into a single data set. Analysis was performed by age, sex, province, date of death and comorbidities.

RESULTS

SA reported 3 088 deaths from COVID-19, i.e. an age-standardised death rate of 64.5 (95% confidence interval (CI) 62.3 - 66.8) deaths per million population. Most deaths occurred in Western Cape (65.5%) followed by Eastern Cape (16.8%) and Gauteng (11.3%). The median age of death was 61 years (interquartile range 52 - 71). Males had a 1.5 times higher death rate compared with females. Individuals with two or more comorbidities accounted for 58.6% (95% CI 56.6 - 60.5) of deaths. Hypertension and diabetes were the most common comorbidities reported, and HIV and tuberculosis were more common in individuals aged <50 years.

CONCLUSIONS

Data collection for COVID-19 deaths in provinces must be standardised. Even though the data had limitations, these findings can be used by the SA government to manage the pandemic and identify individuals who are at high risk of dying from COVID-19.

HIV/HCV/HBV testing in the emergency department: a feasibility and seroprevalence study

OBJECTIVES

The aims of this study were to to assess the feasibility of simultaneous testing for the blood-borne viruses (BBV), HIV, hepatitis C (HCV) and hepatitis B (HBV), in the Emergency Department (ED) and ascertain the seroprevalence for these three viruses in this setting.

METHODS

A pilot BBV testing program was undertaken as part of routine clinical care in the ED. All ED attendees aged between 16 and 65 years old who were able to consent were tested over a 55 week period on an opt out basis. Patients with positive test results were linked to clinical services. Interventions aimed at improving testing rates were implemented and evaluated by quality improvement (QI) methodology.

RESULTS

Of 25,520 age-eligible ED attendees, 6108 (24%) underwent BBV testing; an additional 1160 (4.5%) underwent a standalone HIV test (total of 7268 (28%) individuals).There were 83/7268 (1.1%) non-negative (ie reactive or equivocal) results for HIV and 103/6108 (1.7%) and 32/6108 (0.52%) for anti-HCV IgG and HBsAg, respectively. Of these, 12 (0.17%), 16 (0.26%) and 8 (0.13%) were new reactive tests for HIV, HCV and HBV, respectively, which were able to be confirmed on a second test. Specific QI interventions led to temporary increases in testing rates.

CONCLUSIONS

An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.

Communicating Scientific Findings to Communities With High Risk and Best Ways to Do That is a Challenge

Background: A national cytology cervical cancer screening program was introduced in South Africa as part of cancer control program policy more than a decade ago. Policy guidelines state that women attending the public sector services are entitled to three free Pap smears per lifetime starting at the age of 30 years or older, with a 10 year interval between each smear. However, the frequency in which women come for Pap smears is very low, with some getting diagnosed when the disease is at its advance stage. Consequently, cervical cancer incidence rates are very high with low survival rates. Fragmented evaluation of this program done in different provinces revealed that women lacked knowledge about cervical cancer. Women are also uninformed about the free national cytology cervical cancer screening. Furthermore, there is scarcity or no free public screening services especially in rural populations. In 2014, the National Health Ministry started HPV vaccination to girls at ages 11 years in schools. The expectation was that providing vaccines to young girls will reduce cervical cancer and its associated mortality in the next two to three decades. However, commitment to reduce the burden of cervical cancer should continue. Furthermore, it is important to intensely introduce health-seeking behavior to the population at high risk through community engagement and education around cervical cancer. This will reinforce early detection and prevention initiative thus reducing premature deaths due to this cancer and improving quality life. Aim: In 2017 a partnership between Committee of Health Programs under rural development and scientists of the South African Medical Research Council was initiated. This committee's mandate is managed by the Provincial House of Traditional Leaders in the Eastern Cape. Specific objectives include forming partnership with traditional leaders as key role players in reducing cervical cancer morbidity and mortality. As well as, to reduce high incidence of cervical cancer in the rural high-risk population. Methods: Eight villages were identified for intervention. Primary health clinic nurses working in identified villages were included to work as part of the team that will deliver the interventions. Intervention activities will include providing education about cervical cancer which will be done through awareness campaigns twice a year for the next 5 years. Another component of the intervention will be voluntary cytology screening for cervical cancer for all enrolled participants. Voluntary participants will form a cohort for follow-up. After five years the intervention will be evaluated. Conclusion: It is envisaged that this intervention initiative will be expanded to other provinces in South Africa.

Pollen-like ZIF-8 colloidosomesviaemulsion templating and etching

We report a one-pot emulsion-templating and post-synthetic etching strategy for the preparation of hierarchically structured ZIF-8 microcapsules.

Metal-Organic Frameworks at the Biointerface: Synthetic Strategies and Applications

Many living organisms are capable of producing inorganic materials of precisely controlled structure and morphology. This ubiquitous process is termed biomineralization and is observed in nature from the macroscale (e.g., formation of exoskeletons) down to the nanoscale (e.g., mineral storage and transportation in proteins). Extensive research efforts have pursued replicating this chemistry with the overarching aims of synthesizing new materials of unprecedented physical properties and understanding the complex mechanisms that occur at the biological-inorganic interface. Recently, we demonstrated that a class of porous materials termed metal-organic frameworks (MOFs) can spontaneously form on protein-based hydrogels via a process analogous to natural matrix-mediated biomineralization. Subsequently, this strategy was extended to functional biomacromolecules, including proteins and DNA, which have been shown to seed and accelerate crystallization of MOFs. Alternative strategies exploit co-precipitating agents such as polymers to induce MOF particle formation thus facilitating protein encapsulation within the porous crystals. In these examples the rigid molecular architecture of the MOF was found to form a protective coating around the biomacromolecule offering improved stability to external environments that would normally lead to its degradation. In this way, the MOF shell mimics the protective function of a biomineralized exoskeleton. Other methodologies have also been explored to encapsulate enzymes within MOF structures, including the fabrication of polycrystalline hollow MOF microcapsules that preserve the original enzyme functionality over several batch reaction cycles. The potential to design MOFs of varied pore size and chemical functionality has underpinned studies describing the postsynthesis infiltration of enzymes into MOF pore networks and bioconjugation strategies for the decoration of the MOF outer surface, respectively. These methods and configurations allow for customized biocomposites. MOF biocomposites have been extended from simple proteins to complex biological systems including viruses, living yeast cells, and bacteria. Indeed, a noteworthy result was that cells encapsulated within a crystalline MOF shell remain viable after exposure to a medium containing lytic enzymes. Furthermore, the cells can adsorb nutrients (glucose) through the MOF shell but cease reproducing until the MOF casing is removed, at which point normal cellular activity is fully restored. The field of MOF biocomposites is expansive and rapidly developing toward different applied research fields including protection and delivery of biopharmaceuticals, biosensing, biocatalysis, biobanking, and cell and virus manipulation. This Account describes the current progress of MOFs toward biotechnological applications highlighting the different strategies for the preparation of biocomposites, the developmental milestones, the challenges, and the potential impact of MOFs to the field.

Early Adhesion of Candida albicans onto Dental Acrylic Surfaces

Denture-associated stomatitis is a common candidal infection that may give rise to painful oral symptoms, as well as be a reservoir for infection at other sites of the body. As poly (methyl methacrylate) (PMMA) remains the main material employed in the fabrication of dentures, the aim of this research was to evaluate the adhesion of Candida albicans cells onto PMMA surfaces by employing an atomic force microscopy (AFM) single-cell force spectroscopy (SCFS) technique. For experiments, tipless AFM cantilevers were functionalized with PMMA microspheres and probed against C. albicans cells immobilized onto biopolymer-coated substrates. Both a laboratory strain and a clinical isolate of C. albicans were used for SCFS experiments. Scanning electron microscopy (SEM) and AFM imaging of C. albicans confirmed the polymorphic behavior of both strains, which was dependent on growth culture conditions. AFM force-spectroscopy results showed that the adhesion of C. albicans to PMMA is morphology dependent, as hyphal tubes had increased adhesion compared with yeast cells ( P < 0.05). C. albicans budding mother cells were found to be nonadherent, which contrasts with the increased adhesion observed in the tube region. Comparison between strains demonstrated increased adhesion forces for a clinical isolate compared with the lab strain. The clinical isolate also had increased survival in blood and reduced sensitivity to complement opsonization, providing additional evidence of strain-dependent differences in Candida-host interactions that may affect virulence. In conclusion, PMMA-modified AFM probes have shown to be a reliable technique to characterize the adhesion of C. albicans to acrylic surfaces.

Zinc-imidazolate polymers (ZIPs) as a potential carrier to brain capillary endothelial cells

Herein, we report the synthesis and characterization of nanospheres of a biodegradable zinc-imidazolate polymers (ZIPs) as a proof-of-concept delivery vehicle into human brain endothelial cells, the main component of the blood-brain barrier (BBB). The ZIP particles can readily encapsulate functional molecules such as fluorophores and inorganic nanoparticles at the point of synthesis producing stable colloidal dispersions. Our results show that these biodegradable particles are not cytotoxic, and are able to penetrate and release cargo species to human brain capillary endothelial cells in vitro thus exhibiting significant potential as a novel platform for brain targeting treatments.

Screening for asymptomatic lymphogranuloma venereum co-infection in men who have sex with men newly diagnosed with HIV, hepatitis C or syphilis

Patients diagnosed with lymphogranuloma venereum have high rates of co-infection with HIV, syphilis and hepatitis C. The aim of this enhanced surveillance was to screen all men who have sex with men (MSM) newly diagnosed with HIV, syphilis or hepatitis C for co-infection with asymptomatic lymphogranuloma venereum as part of the recommended sexual health screen. Of the 145 patients screened, 21 patients were diagnosed with rectal Chlamydia trachomatis, one with both rectal and urethral chlamydia and six with urethral chlamydia. One rectal chlamydia-positive sample, when tested, was equivocal for lymphogranuloma venereum. Our data suggested that there was not a pool of asymptomatic lymphogranuloma venereum infection in MSM recently diagnosed with HIV, hepatitis C and syphilis. However, there have been recent reports of an increased incidence of asymptomatic lymphogranuloma venereum, raising the question whether lymphogranuloma venereum should be screened for in high risk asymptomatic MSM. The prevalence of asymptomatic rectal chlamydia infections was 19%.

The clinical application of plasma Kaposi sarcoma herpesvirus viral load as a tumour biomarker: results from 704 patients

OBJECTIVES

The aim of the study was to evaluate the role of plasma Kaposi sarcoma herpesvirus (KSHV) as a diagnostic and prognostic biomarker in people living with HIV (PLWH) and diagnosed with KSHV-associated diseases.

METHODS

Using quantitative nested polymerase chain reaction (PCR) targeting the open reading frame-26 gene of KSHV, plasma levels of KSHV were measured in consecutive PLWH with KSHV-associated diseases or as part of the investigation of lymphadenopathy.

RESULTS

Plasma KSHV assays were performed on samples from 684 PLWH and 20 HIV-seronegative people with KSHV-associated malignancies. In PLWH, plasma KSHV was detected in 39% of those with KS, 99% of those with multicentric Castleman disease (MCD), 9% of those with non-Hodgkin lymphoma (NHL), 2% of those with non-AIDS-defining malignancies and 0% of those with nonmalignant lymphadenopathy. There was no significant difference in plasma KSHV viral load among those with KS, MCD and KSHV-associated NHL. The 5-year overall survival rate from KS diagnosis of 335 PLWH was 95.2% (95% confidence interval 92.6-97.8%). Plasma KSHV viraemia did not predict overall survival in those with KS (P = 0.73), nor when those with T0 stage KS (P = 0.52) or T1 stage KS (P = 0.62) were analysed separately.

CONCLUSIONS

Measuring the plasma levels of KSHV as a biomarker in KSHV-associated disease has a very limited value in either diagnosis or prognostication. The only potential role of clinical value is the suggestion that an undetectable plasma KSHV excludes a diagnosis of MCD in PLWH.

Magnetic MOF microreactors for recyclable size-selective biocatalysis

In this contribution we report a synthetic strategy for the encapsulation of functional biomolecules within MOF-based microcapsules. We employ an agarose hydrogel droplet Pickering-stabilised by UiO-66 and magnetite nanoparticles as a template around which to deposit a hierarchically structured ZIF-8 shell. The resulting microcapsules are robust, highly microporous and readily attracted to a magnet, where the hydrogel core provides a facile means to encapsulate enzymes for recyclable size-selective biocatalysis.

Direct photo-hydroxylation of the Zr-based framework UiO-66

We describe the direct post-synthetic hydroxylation of UiO-66 through the photogeneration of hydroxyl radicals. Three approaches have been investigated, and levels of conversion up to 77% have been observed within 48 h.

A colloidal water-stable MOF as a broad-range fluorescent pH sensor via post-synthetic modification

We report the pH dependent fluorescence of indole-functionalised UiO-66-NH₂ across the pH range 1–12.

Supramolecular templating of hierarchically porous metal–organic frameworks

This tutorial review summarises recent advances in the soft templating of metal–organic frameworks with hierarchical porosity across the micro- and mesoporous regimes.

Screening for HIV-related neurocognitive impairment in clinical practice: challenges and opportunities

With increasingly successful management of HIV, focus has shifted away from AIDS-related complications to other chronic co-morbidities. For HIV-related cognitive problems, the true aetiopathogenesis and epidemiology remains unclear. Rather than a systematic review, this paper presents the challenges and the opportunities we faced in establishing our own clinical service. Papers were identified using Pubmed and the terms "screening", "HIV" and "neurocognitive". This article covers the background of HIV-associated neurocognitive disorders (HAND) with a focus on HIV-related neurocognitive impairment (NCI), detailing classification, prevalence, diagnostic categories and diagnostic uncertainties. Screening is discussed, including a comparison of the available screening tools for cognitive deficits in HIV-infected patients and the importance of practice effects. Discussed also are the normal ranges and the lack thereof and potential investigations for those found to have impairments. We conclude by discussing the role of NCI screening in routine clinical care at the current time.

MOF-polymer composite microcapsules derived from Pickering emulsions

Hollow composite microcapsules are prepared by the assembly of pre-formed nanocrystals of metal-organic frameworks (MOFs) around emulsion droplets, followed by interfacial polymerisation of the interior. The micropores of the MOF crystals embedded within a semipermeable hierarchically structured polymeric membrane are an effective combination for the retention of encapsulated dye molecules. Release can be triggered however by acid dissolution of the MOF component.

Dimensionality transformation through paddlewheel reconfiguration in a flexible and porous Zn-based metal-organic framework

The reaction between Zn and a pyrene-based ligand decorated with benzoate fragments (H(4)TBAPy) yields a 2D layered porous network with the metal coordination based on a paddlewheel motif. Upon desolvation, the structure undergoes a significant and reversible structural adjustment with a corresponding reduction in crystallinity. The combination of computationally assisted structure determination and experimental data analysis of the desolvated phase revealed a structural change in the metal coordination geometry from square-pyramidal to tetrahedral. Simulations of desolvation showed that the local distortion of the ligand geometry followed by the rotation and displacement of the pyrene core permits the breakup of the metal-paddlewheel motifs and the formation of 1D Zn-O chains that cross-link adjacent layers, resulting in a dimensionality change from the 2D layered structure to a 3D structure. Constrained Rietveld refinement of the powder X-ray diffraction pattern of the desolvated phase and the use of other analytical techniques such as porosity measurements, (13)C CP MAS NMR spectroscopy, and fluorescence spectroscopy strongly supported the observed structural transformation. The 3D network is stable up to 425 °C and is permanently porous to CO(2) with an apparent BET surface area of 523(8) m(2)/g (p/p° = 0.02-0.22). Because of the hydrophobic nature, size, and shape of the pores of the 3D framework, the adsorption behavior of the structure toward p-xylene and m-xylene was studied, and the results indicated that the shape of the isotherm and the kinetics of the adsorption process are determined mainly by the shape of the xylene isomers, with each xylene isomer interacting with the host framework in a different manner.

Porous organic cages

Porous materials are important in a wide range of applications including molecular separations and catalysis. We demonstrate that covalently bonded organic cages can assemble into crystalline microporous materials. The porosity is prefabricated and intrinsic to the molecular cage structure, as opposed to being formed by non-covalent self-assembly of non-porous sub-units. The three-dimensional connectivity between the cage windows is controlled by varying the chemical functionality such that either non-porous or permanently porous assemblies can be produced. Surface areas and gas uptakes for the latter exceed comparable molecular solids. One of the cages can be converted by recrystallization to produce either porous or non-porous polymorphs with apparent Brunauer-Emmett-Teller surface areas of 550 and 23 m2 g(-1), respectively. These results suggest design principles for responsive porous organic solids and for the modular construction of extended materials from prefabricated molecular pores.

Control of porosity geometry in amino acid derived nanoporous materials

Substitution of the pillaring ligand in the homochiral open-framework [Ni(2)(L-asp)(2)(bipy)] by extended bipy-type ligands leads to a family of layer-structured, homochiral metal-organic frameworks. The 1D channel topology can be modified by the nature of the organic linker, with shape, cross-section and the chemical functionality tuneable. In addition, the volume of these channels can be increased by up to 36 % compared to the parent [Ni(2)(L-asp)(2)(bipy)]. The linker 1,4-dipyridylbenzene (3rbp) gives access to a new layered homochiral framework [Ni(2)(L-asp)(2)(3rbp)] with channels of a different shape. In specific cases, non-porous analogues with the linker also present as a guest can be activated to give porous materials after sublimation. Their CO(2) uptake shows an increase of up to 30 % with respect to the parent [Ni(2)(L-asp)(2)(bipy)] framework.