Prolonged shedding of SARS-CoV-2 at high viral load amongst hospitalised immunocompromised persons living with HIV in South Africa

Purpose

Methods & Materials

Results

Conclusion

Disparities in Breast Cancer: Private Patients Have Better Outcomes Than Public Patients

INTRODUCTION

Different outcomes in breast cancer have been reported for low and high socio-economic groups. We present data quantifying disparities between South African public and private patients.

METHODS

Records of 240 consecutive patients treated in 2008 in a public versus 97 patients in a private health facility were reviewed for demographic and oncologic data.

RESULTS

The average of patients was 56.2 versus 51.9 years (p = 0.032). Stage at presentation was 0 in 0.83 versus 25.8%, I in 4.5 versus 15.5%, II in 41.3 versus 37.1%, III in 37.1 versus 18.6% and IV in 16.3 versus 3.1% public versus private patients. Seventy-three percent of patients were symptomatic versus 57.7%. Of patients with stage 0-III disease, 17.9 versus 20% had simple tumour excision and 7.5 versus 14%, oncoplastic tumour excision. The mastectomy rate was similar (52 vs. 60%), but immediate reconstruction was performed in 10 versus 63%. Public patients were less likely to have radiotherapy. The pathology was similar, 27.2 versus 20, 54 versus 52, 87 versus 61% of patients with stage I, II and III disease, respectively, had chemotherapy. Hormonal therapy for premenopausal patients in private was a LHRH agonist in 9.3%, ovarian ablation/BSO in 11.7% of public patients; biologicals were given in 7.2 versus 0% of patients. Overall survival for public versus private was 66 versus 80% (p < 0.001) months. Better per stage survival of private patients 100 versus 100, 72.7 versus 93.3, 84.8 versus 88.9, 57.3 versus 77.8 and 33 versus 33% for stages 0, I, II, III and IV, did not reach statistical significance.

CONCLUSION

The greatest impact on outcome was stage at presentation, but more aggressive therapy for each stage resulted in a trend to better outcome for private patients.

The effectiveness of continuous passive motion on range of motion, pain and muscle strength following rotator cuff repair: a systematic review

Objective: To systematically review the evidence on the effect of continuous passive motion, combined with usual physiotherapy management, on increasing shoulder joint range of motion and muscle strength, and reducing shoulder pain in adults following rotator cuff repair, compared with standard physiotherapy.

Data sources: A comprehensive search in available bibliographic electronic databases was undertaken to locate eligible studies. Reference tracing was also used to locate studies.

Review methods: Randomized controlled trials reporting on the effect of continuous passive motion on increasing shoulder joint range of motion and muscle strength and reducing shoulder pain in adults following rotator cuff repair were included in the review. The PEDro scale was used to determine the methodological quality of the studies. Data were summarized in a narrative form because of their heterogeneity.

Results: Four randomized controlled trials were eligible for this review. One Japanese article was excluded as the text was unavailable in English. The methodological quality of the included studies averaged 7.67. Continuous passive motion was found to improve shoulder range of motion in two studies. One study found a decrease in pain in the intervention group and one study found that continuous passive motion improves muscle strength.

Conclusion: Continuous passive motion is safe to use with physiotherapy treatment following rotator cuff repair surgery. It may help to prevent secondary complications post operatively.

Analysis of penicillin-binding protein lb and 2a genes from Streptococcus pneumoniae

Fifty clinical isolates (penicillin MICs, 0.03-8 microg/mL) of Streptococcus pneumoniae were randomly selected from hospitals throughout South Africa, together with seven strains isolated in Hungary (penicillin MICs, 16-32 microg/mL). Penicillin-binding protein (pbp) 1b and 2a genes were amplified by PCR, and the purified DNA was digested with HinfI, StyI, and MseI + DdeI restriction enzymes. The fragments were radioactively end-labeled and separated on polyacrylamide gels, and the DNA fingerprints were visualized following autoradiography. A collection of isolates was further selected for sequence analysis of pbp1b and 2a. DNA fingerprint analysis revealed a uniform profile amongst all isolates for both genes. All isolates revealed a maximum of only seven nucleotide substitutions in their pbp1b genes, resulting in a maximum of three amino acid substitutions in PBP 1B. In the case of the pbp2a gene, up to 13 nucleotide substitutions were observed randomly distributed amongst penicillin-susceptible and resistant isolates, revealing a maximum of five amino acid substitutions in PBP 2A. No amino acid substitutions were found to be common amongst all penicillin-resistant isolates. Transformation experiments with pbp1b and 2a genes isolated from two resistant strains (MICs, 4 and 16 microg/mL) failed to transform pneumococcal strains to increased levels of penicillin resistance. These results show that the pbp1b and 2a genes examined here do not display the typical mosaic gene patterns observed in the pbp2x, 2b, and 1a genes of penicillin-resistant pneumococci. In addition, the transformation studies suggest that PBPs 1B and 2A may not play a role in the development of penicillin resistance in some pneumococci.

The use of chicken IgY in a double antibody sandwich ELISA for detecting African horsesickness virus

An indirect sandwich ELISA that can detect as little as 8 ng of African horsesickness virus (AHSV) was developed. Viral antigen was captured from suspension using an immobilized monoclonal antibody specific for an epitope on VP7, a protein that is a major constituent of the virus core. Egg-yolk derived chicken IgY directed against AHSV (serotype 3) was used as the secondary antibody. Since IgY and mouse IgG do not cross-react serologically, the secondary antibody was not labelled, but was instead detected with enzyme-coupled sheep antibodies directed against avian immunoglobulins. The assay recognized all nine AHSV serotypes, but not the Cascara isolate of equine encephalosis virus, a related orbivirus that also infects horses. In addition to being able to detect and quantify whole AHSV, the ELISA could show the presence of VP7 produced by recombinant baculoviruses.

Entrapment of platelets in the penis during and after erection

Because of the development of hypercoagulability and the deposition of fibrin in the penis during erection a study of the possible role of platelets in this process was undertaken. Platelet response was studied in 9 adult chacma baboons (Papio ursinus) using autologous in vitro indium-111-labelled platelets and sequential scintigraphy of the penis during erection. The blood pooling pattern was obtained using in vivo technetium-99m-labelled red cells in a similar investigation. A statistically significant retention of platelets occurred during and after erection, which could not be attributed to blood pooling (P less than 0,05). Entrapment of platelets could lead to enhanced activity and activation, and might play a significant role in hypercoagulability and fibrin deposition during erection. Therefore platelets could be an important factor in the pathogenesis of ageing impotence.

Beta-adrenergic blocking drugs and renal function

A baboon model was used to investigate the effects of atenolol, nadolol, sotalol and labetalol on renal function. The glomerular filtration rate (GFR) and renal blood flow (RBF) were measured, using radionuclides and a gamma camera, before and after 1 week's oral administration of these drugs. All the drugs caused an increase in the GFR, but this reached statistical significance only in the cases of sotalol (P less than 0,025) and labetalol (0,05 less than P less than 0,10). The RBF was not significantly changed, although it decreased in all cases.