The accuracy of the Thompson score in predicting early outcome in neonates with hypoxic ischaemic encephalopathy treated with therapeutic cooling in a tertiary hospital.

BACKGROUND: Hypoxic ischaemic encephalopathy (HIE) is one of the major contributors to neonatal mortality and morbidity in developing countries. Scarcity of resources limits clinicians in optimally caring for these patients. Optimal utilisation of clinical tools such as the Thompson score (TS) can assist in improving care by classifying the severity of HIE followed by appropriate treatment. OBJECTIVES: The primary objective was to study the correlation of the TS and early neonatal outcomes in infants with HIE who received therapeutic hypothermia (TH). Secondary objectives were to investigate the correlation of blood gas values with the TS, need for resuscitation with TS, target organ damage (TOD) with TS and the most common risk factors associated with HIE in Tembisa Provincial Tertiary Hospital (TPTH). METHODS: This was a retrospective record review of infants admitted with HIE from January 2018 to August 2019 at the TPTH neonatal unit. Infants had to have successfully completed TH. RESULTS: Ninety-three infants met the inclusion criteria, with 32, 48 and 13 being classified into the mild, moderate and severe categories by TS, respectively. The median length of stay (LOS) was noted to rise with a rising TS, recorded to be 7, 8 and 9 days in the mild, moderate and severe groups, respectively. The mortality rate in the study was calculated to be 2.1%, and there was no significant difference across the groups (p=0.231). A need for antiseizure medication (ASM) on discharge was significantly associated with severe HIE (p=0.028). Hypertension was a frequent chronic illness, noted in 11.3% of the mothers. The most frequent perinatal risk factor was meconium aspiration (50.5%), followed by prolonged second stage of labour (PSSL) (17.2%). A higher TS (severe group) was associated with prolonged resuscitation for >10 minutes (p=0.001) and a need for adrenaline (p=0.008). The frequency of cardiac impairment, liver impairment and clinical seizures increased with a higher TS category (p=0.23, p=0.35 and p=0.51, respectively). On blood gas analysis, a low pH and a high base deficit were associated with severe HIE (p=0.027, p=0.061 respectively). CONCLUSION: The TS is still a useful clinical tool in the era of TH as it is able to predict some early neonatal outcomes such as LOS and a need for ASM at discharge. It is also able to demonstrate increased frequency of duration of resuscitation and a need for adrenaline in severely encephalopathic infants compared with mild. A high TS is also associated with severe metabolic acidosis and increased frequency of TOD. Maternal hypertension, meconium-stained liquor and PSSL are the common risk factors for HIE at TPTH.

Twelve Weeks of Additional Fish Intake Improves the Cognition of Cognitively Intact, Resource-Limited Elderly People: A Randomized Control Trial.

INTRODUCTION: Dietary omega 3 polyunsaturated fatty acids (PUFA) may reduce the risk of dementia. Many studies have investigated PUFA supplementation in high-income countries, yet food-based randomized control trials using omega 3 PUFA rich fish in lower to middle income countries, are lacking. OBJECTIVE: To determine the effect on cognition of adding either fish or non-fish foods for twelve weeks to an enhanced diet of cognitively intact, independently living, resource-limited elderly people. DESIGN: Randomized control trial (National Health Trial register: DOH-27-061-6026). SETTING: Retirement center in urban South Africa. PARTICIPANTS: Fifty-seven (74% female, mean age: 72±7 years) elderly participants with cognitive function exceeding 22 on the Mini Mental State Examination were randomized into an intervention (n=31) and control (n=26) group. INTERVENTION: The usual diets of both groups were enhanced with context-appropriate foods to mimic elements of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The intervention group additionally received canned pilchards and fish spread every week amounting to an additional (theoretical) intake of 2.2g omega 3 PUFA daily. The control group received canned meatballs and texturized soya every week. MEASUREMENTS: Cognition was measured twice before and once after the intervention phase using the Cognitive Abilities Screening Instrument (CASI). Adherence was assessed by a study-specific food frequency questionnaire and red blood cell (RBC) PUFA biomarkers. Data were analyzed using a non-parametric analysis of covariance (ANCOVA) with, and without, bootstrap imputation. RESULTS: Participants in the intervention group had a significantly higher post intervention (P=0.036) CASI score than the control group, when the model was fitted with imputation and controlled for baseline scores. Participants in the intervention group also had a significantly higher intake of calculated dietary omega 3 PUFA and higher levels of RBC eicosapentaenoic acid and docosapentaenoic acid content than the control group (P < 0.05). CONCLUSION: Twelve weeks of fish intake in the context of a modified MIND diet may improve the cognition of cognitively intact, resource-limited elderly people.

WASH infrastructure and practices in primary health care clinics in the rural Vhembe District municipality in South Africa.

BACKGROUND: South Africa has unique and diverse social and economic factors that have an impact on the provision of basic water, sanitation, hygiene and waste management infrastructure and practices at health care facilities in ensuring patient safety and prevent the spread of diseases. METHODS: The aim of this study was to evaluate water, sanitation and hygiene access and standards at 50 government owned public health care clinics in the rural region of the Vhembe district of South Africa during 2016/2017, using self-observation, an observation checklist, record reviews and interviews with clinic managers. Water quality from all available water sources on the clinic compound was analysed for Total coliform and E. coli counts using the Colilert Quanti-tray/2000 system. The prevalence of pathogenic diarrhea causing E. coli strains was established using multiplex-Polymerase Chain Reaction. RESULTS: The health care clinics in the Vhembe District generally complied with the basic WASH services guidelines according to the World Health Organisation. Although 80% of the clinics used borehole water which is classified as an improved water source, microbiological assessment showed that 38% inside taps and 64% outside taps from the clinic compounds had TC counts higher than guideline limits for safe drinking. Similarly, EC counts above the guideline limit for safe drinking water were detected in 17% inside taps and 32% outside taps from the clinic compounds. Pathogenic EAEC, EPEC, ETEC and EHEC strains were isolated in the collected water samples. Although improved sanitation infrastructures were present in most of the clinics, the sanitary conditions of these toilets were not up to standard. Waste systems were not adequately managed. A total of 90% of the clinics had hand washing basins, while only 61% of the clinics had soap present and only 64% of the clinics had adequate signs and posters reminding the staff, care givers and patients to wash their hands. CONCLUSIONS: Various WASH aspects within the primary health care system in South Africa needs to be improved and corrected. A more rigorous system that is inclusive of all role players in the WASH sectors, with regular monitoring and training sessions, should be used.

Allergic sensitisation in South Africa: Exploring regional variation in sensitisation.

BACKGROUND: Allergy is a common health problem in South Africa (SA), and a rational approach to allergy testing is essential to ensure cost-effective as well as optimal patient diagnosis and management. OBJECTIVES: To review allergy testing data with respect to current national testing recommendations, and to explore the regional variations in sensitisation. METHODS: Retrospective data review on allergy testing from a private pathology provider in SA over a 2-year period. Data on skin-prick testing (SPT) and allergen-specific IgE testing originating from all the provinces of SA were collected and analysed with regards to allergen positivity rate and regional sensitisation patterns. RESULTS: Among the patients (N=45 0320) tested for a suspected inhalant allergy, 46% tested positive. Only 45% of these received additional testing for the nine recommended inhalant allergens included in the current national testing protocol. Among the patients (N=6 775) who received SPT for a suspected inhalant allergy, 59% yielded one or more positive results. The most frequent sensitising allergens were house dust mite (Dermatophagoides pteronyssinus) and grass pollen. The house dust mite, Blomia tropicalis, was a significant sensitiser in coastal regions. SPT identified two other important regional allergens which are not included in the current recommendations for inhalant allergen-specific IgE testing. CONCLUSIONS: The current diagnostic recommendations include allergens that demonstrate significant sensitisation in all regions of SA. Two additional allergens that show significant regional sensitisation in the South African population were identified. These findings may aid the recommendations for the most appropriate and cost-effective approach to allergy testing of symptomatic patients in SA.

A comparison between decomposition rates of buried and surface remains in a temperate region of South Africa.

Several studies have been conducted on decomposition patterns and rates of surface remains; however, much less are known about this process for buried remains. Understanding the process of decomposition in buried remains is extremely important and aids in criminal investigations, especially when attempting to estimate the post mortem interval (PMI). The aim of this study was to compare the rates of decomposition between buried and surface remains. For this purpose, 25 pigs (Sus scrofa; 45-80 kg) were buried and excavated at different post mortem intervals (7, 14, 33, 92, and 183 days). The observed total body scores were then compared to those of surface remains decomposing at the same location. Stages of decomposition were scored according to separate categories for different anatomical regions based on standardised methods. Variation in the degree of decomposition was considerable especially with the buried 7-day interval pigs that displayed different degrees of discolouration in the lower abdomen and trunk. At 14 and 33 days, buried pigs displayed features commonly associated with the early stages of decomposition, but with less variation. A state of advanced decomposition was reached where little change was observed in the next ±90-183 days after interment. Although the patterns of decomposition for buried and surface remains were very similar, the rates differed considerably. Based on the observations made in this study, guidelines for the estimation of PMI are proposed. This pertains to buried remains found at a depth of approximately 0.75 m in the Central Highveld of South Africa.

Assessment of Atopobium vaginae and Gardnerella vaginalis concentrations in a cohort of pregnant South African women.

OBJECTIVES: The purpose of this cross-sectional study was to assess Atopobium vaginae and Gardnerella vaginalis concentrations in pregnant women of different age groups, gestational age groups, vaginal flora categories and HIV status, and also to determine which DNA concentrations best discriminated between bacterial vaginosis (BV)-positive and non-BV categories. METHODS: Self-collected vaginal swabs were obtained from 220 pregnant women attending an antenatal clinic in Pretoria, Gauteng, South Africa, from July 2012 to December 2012. BV was detected with the Nugent scoring system, and A. vaginae and G. vaginalis DNA was quantified with a multiplex quantitative real-time PCR assay. RESULTS: Median concentrations of A. vaginae and G. vaginalis were not significantly different among various age groups (A. vaginae p=0.98 and G. vaginalis p=0.18) or different trimesters (A. vaginae p=0.31 and G. vaginalis p=0.19), but differed significantly among the vaginal flora categories (A. vaginae p<0.001 and G. vaginalis p<0.001) and HIV status (A. vaginae p<0.001 and G. vaginalis p=0.004). The presence of A. vaginae (OR=5.8; 95% CI 1.34 to 25.21 and p value=0.02) but not that of G. vaginalis (OR=1.90; 95% CI 0.81 to 4.43 and p value=0.14) was associated with HIV infection. An A. vaginae DNA concentration of ≥107 copies/mL together with a positive G. vaginalis result (≥100 copies/mL) best discriminated between BV-positive (39/220) and non-BV categories (181/220) with a sensitivity of 85% (95% CI 0.70 to 0.94) and a specificity of 82% (95% CI 0.76 to 0.88). CONCLUSIONS: A. vaginae and G. vaginalis were present in high numbers and concentrations in this pregnant cohort. Threshold concentrations should be established for specific populations to ensure sensitive molecular assays for BV detection.

Phenotype-associated inbreeding biases estimates of inbreeding depression in a wild bird population.

Inbreeding depression is usually quantified by regressing individual phenotypic values on inbreeding coefficients, implicitly assuming there is no correlation between an individual's phenotype and the kinship coefficient to its mate. If such an association between parental phenotype and parental kinship exists, and if the trait of interest is heritable, estimates of inbreeding depression can be biased. Here we first derive the expected bias as a function of the covariance between mean parental breeding value and parental kinship. Subsequently, we use simulated data to confirm the existence of this bias, and show that it can be accounted for in a quantitative genetic animal model. Finally, we use long-term individual-based data for white-throated dippers (Cinclus cinclus), a bird species in which inbreeding is relatively common, to obtain an empirical estimate of this bias. We show that during part of the study period, parents of inbred birds had shorter wings than those of outbred birds, and as wing length is heritable, inbred individuals were smaller, independent of any inbreeding effects. This resulted in the overestimation of inbreeding effects. Similarly, during a period when parents of inbred birds had longer wings, we found that inbreeding effects were underestimated. We discuss how such associations may have arisen in this system, and why they are likely to occur in others, too. Overall, we demonstrate how less biased estimates of inbreeding depression can be obtained within a quantitative genetic framework, and suggest that inbreeding and additive genetic effects should be accounted for simultaneously whenever possible.

Soft tissue thickness values for black and coloured South African children aged 6-13 years.

In children, craniofacial changes due to facial growth complicate facial approximations and require specific knowledge of soft tissue thicknesses (STT). The lack of South African juvenile STT standards of particular age groups, sex and ancestry is problematic. According to forensic artists in the South African Police Service the use of African-American values to reconstruct faces of Black South African children yields poor results. In order to perform a facial approximation that presents a true reflection of the child in question, information regarding differences in facial soft tissue at different ages, sexes and ancestry groups is needed. The aims of this study were to provide data on STT of South African Black and Coloured children and to assess differences in STT with respect to age, sex and ancestry. STT was measured using cephalograms of South African children (n=388), aged 6-13 years. After digitizing the images, STT measurements were taken at ten mid-facial landmarks from each image using the iTEM measuring program. STT comparisons between groups per age, sex and ancestry were statistically analyzed. The results showed that STT differences at lower face landmarks are more pronounced in age groups per ancestry as opposed to differences per age and sex. Generally, an increase in STT was seen between 6-10 year old groups and 11-13 year old groups, regardless of ancestry and sex, at the midphiltrum, labiale inferius, pogonion, and beneath chin landmarks. This research created a reference dataset for STT of South African children of Black and Coloured ancestry per age and sex that will be useful for facial reconstruction/approximation of juvenile remains.

Effect of metformin therapy and dietary supplements on semen parameters in hyperinsulinaemic males.

Previous reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014, doi: 10.1111/and.12227). The aim of this study was to investigate the effect of metformin (Glucophage®) and antioxidant treatment (StaminoGro®) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre- and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.

The effect of body size on the rate of decomposition in a temperate region of South Africa.

Forensic anthropologists rely on the state of decomposition of a body to estimate the post-mortem-interval (PMI) which provides information about the natural events and environmental forces that could have affected the remains after death. Various factors are known to influence the rate of decomposition, among them temperature, rainfall and exposure of the body. However, conflicting reports appear in the literature on the effect of body size on the rate of decay. The aim of this project was to compare decomposition rates of large pigs (Sus scrofa; 60-90 kg), with that of small pigs (<35 kg), to assess the influence of body size on decomposition rates. For the decomposition rates of small pigs, 15 piglets were assessed three times per week over a period of three months during spring and early summer. Data collection was conducted until complete skeletonization occurred. Stages of decomposition were scored according to separate categories for each anatomical region, and the point values for each region were added to determine the total body score (TBS), which represents the overall stage of decomposition for each pig. For the large pigs, data of 15 pigs were used. Scatter plots illustrating the relationships between TBS and PMI as well as TBS and accumulated degree days (ADD) were used to assess the pattern of decomposition and to compare decomposition rates between small and large pigs. Results indicated that rapid decomposition occurs during the early stages of decomposition for both samples. Large pigs showed a plateau phase in the course of advanced stages of decomposition, during which decomposition was minimal. A similar, but much shorter plateau was reached by small pigs of >20 kg at a PMI of 20-25 days, after which decomposition commenced swiftly. This was in contrast to the small pigs of <20 kg, which showed no plateau phase and their decomposition rates were swift throughout the duration of the study. Overall, small pigs decomposed 2.82 times faster than large pigs, indicating that body size does have an effect on the rate of decomposition.

Prevalence of hyperinsulinaemia among normozoospermic donors at Medfem Clinic, South Africa.

The aim of this study was to investigate the prevalence of hyperinsulinaemia in a group of normozoospermic donors and the influence of insulin levels on in vitro fertilisation (IVF) outcome. Fasting insulin and 2 h post-eating insulin levels were determined for a group of thirty-four sperm donors. They were divided into three groups according to their insulin profiles. The association between insulin levels and embryo quality was determined in a clinical study for the different groups. The prevalence of raised insulin in the donor group was 44% with a 95% confidence interval of 27.2% and 62.1%. Donors with normal insulin levels produced more good quality blastocysts in the IVF programme than those with abnormal insulin levels. These differences were not statistically significant (P=0.8638). Embryo quality in an IVF programme may be influenced by male insulin levels. The role of insulin in male fertility needs to be investigated.

Medial pterygoid muscle and stylomandibular ligament: the effects on postoperative stability.

The postoperative skeletal stability following surgical advancement of the mandible can be influenced by several factors. The effect of the medial pterygoid muscle and the stylomandibular ligament on the stability of results following surgical advancement has possibly been underestimated. In this retrospective study, the long-term postoperative skeletal stability following surgical advancement of the mandible in two groups of patients was studied and compared. In one group the medial pterygoid muscle and the stylomandibular ligament were stripped from the medial side of the angle of the mandible during the bilateral sagittal split osteotomy (BSSO) procedure while for the other group of patients these muscles and ligaments were left attached. The long term skeletal stability of the two groups was compared and the group that had the muscles and the ligaments stripped proved to be more stable than the other group.

Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy.

The authors undertook a prospective study to evaluate the influence that the anatomical dimensions of the ramus of the mandible and the presence of lower third molar teeth may have on the sagittal split ramus osteotomy. The anatomical dimensions measured included the width of the anterior mandibular ramus, the height of the corpus posterior to the second mandibular molar and the antero-posterior anatomical position of the lingual. The influence that these dimensions of the mandible may have on the successful splitting of the mandibular ramus was investigated. The effect that the presence of wisdom teeth had on the difficulty of the procedure was also investigated. This study found that, unlike the presence of third molars, there was no single anatomical measurement that contributed to the level of difficulty of the sagittal split osteotomy. For descriptive purposes the authors proposes a classification of the four typical patterns of unfavourable splits.

HIV-related bronchiectasis in children: an emerging spectre in high tuberculosis burden areas.

BACKGROUND: Human immunodeficiency virus (HIV) infected children have an eleven-fold risk of acute lower respiratory tract infection. This places HIV-infected children at risk of airway destruction and bronchiectasis. OBJECTIVE: To study predisposing factors for the development of bronchiectasis in a developing world setting. METHODS: Children with HIV-related bronchiectasis aged 6-14 years were enrolled. Data were collected on demographics, induced sputum for tuberculosis, respiratory viruses (respiratory syncytial virus), influenza A and B, parainfluenza 1-3, adenovirus and cytomegalovirus), bacteriology and cytokines. Spirometry was performed. Blood samples were obtained for HIV staging, immunoglobulins, immunoCAP®-specific immunoglobulin E (IgE) for common foods and aeroallergens and cytokines. RESULTS: In all, 35 patients were enrolled in the study. Of 161 sputum samples, the predominant organisms cultured were Haemophilus influenzae and parainfluenzae (49%). The median forced expiratory volume in 1 second of all patients was 53%. Interleukin-8 was the predominant cytokine in sputum and serum. The median IgE level was 770 kU/l; however, this did not seem to be related to atopy; 36% were exposed to environmental tobacco smoke, with no correlation between exposure and CD4 count. CONCLUSION: Children with HIV-related bronchiectasis are diagnosed after the age of 6 years and suffer significant morbidity. Immune stimulation mechanisms in these children are intact despite the level of immunosuppression.

An assessment of the repeatability of pubic and ischial measurements.

Forensic anthropologists frequently use measurements of the human skeleton to determine sex and ancestry. Since the establishment of the Daubert criteria of admissibility of scientific evidence to court, methodologies used by anthropologists came under severe scrutiny. It is therefore important to ensure that the osteometric standards that are used in skeletal analyses are clearly explained, repeatable and reliable. Adams and Byrd (2002) found that measurements of the pelvis that originated from a point inside the acetabulum could not be repeated accurately. The purpose of this paper was to use three different sets of pubic and ischial measurements to establish whether they can be repeated with high precision between four different observers, and also by the observers themselves. Generally, high levels of repeatability were obtained, with intra-class correlations (ICC) above 0.8. Pubic and ischial measurements using a point in the acetabulum as origin performed the worst (ICC values of 0.82 and 0.79 respectively for inter-observer repeatability), whereas other methods performed better with ICC values above 0.9. It is advised that pubic and ischial measurements should be taken using the origin of the iliac blade as landmark.

Pro- and anti-inflammatory cytokines during immune stimulation: modulation of iron status and red blood cell profile.

Forty-eight patients were subdivided according to C-reactive protein (CRP) levels, resulting in 19 patients with normal (2.8 ± 2.8 mg/L) and 29 with elevated (82.2 ± 76.2 mg/L) CRP levels. The elevated CRP group had iron and red blood cell (RBC) profiles characteristic of chronic immune stimulation (CIS), and the normal CRP group, profiles of true iron deficiency. Normal relationships between storage iron, bioavailable iron, and RBC indices were absent in the elevated CRP group-implying the role of iron as major determinant of the RBC profile to be diminished during CIS. The elevated CRP group had significant increases in proinflammatory cytokines (INF-γ, TNF-α, Il-1ß, Il-6, and Il-8). Anti-inflammatory cytokine levels were normal, except for Il-10, supporting previous indications that Il-10 contributes to reducing bioavailable iron. Regression analysis suggested decreases in transferrin to be related to increases in Il-8 and an increase in ferritin to be related to a decrease in Il-12 levels. TGF-ß levels were positively related to transferrin and negatively to ferritin.

An evaluation of non-metric cranial traits used to estimate ancestry in a South African sample.

Establishing ancestry from a skeleton for forensic purposes has been shown to be difficult. The purpose of this paper is to address the application of thirteen non-metric traits to estimate ancestry in three South African groups, namely White, Black and "Coloured". In doing so, the frequency distribution of thirteen non-metric traits among South Africans are presented; the relationship of these non-metric traits with ancestry, sex, age at death are evaluated; and Kappa statistics are utilized to assess the inter and intra-rater reliability. Crania of 520 known individuals were obtained from four skeletal samples in South Africa: the Pretoria Bone Collection, the Raymond A. Dart Collection, the Kirsten Collection and the Student Bone Collection from the University of the Free State. Average age at death was 51, with an age range between 18 and 90. Thirteen commonly used non-metric traits from the face and jaw were scored; definition and illustrations were taken from Hefner, Bass and Hauser and De Stephano. Frequency distributions, ordinal regression and Cohen's Kappa statistics were performed as a means to assess population variation and repeatability. Frequency distributions were highly variable among South Africans. Twelve of the 13 variables had a statistically significant relationship with ancestry. Sex significantly affected only one variable, inter-orbital breadth, and age at death affected two (anterior nasal spine and alveolar prognathism). The interaction of ancestry and sex independently affected three variables (nasal bone contour, nasal breadth, and interorbital breadth). Seven traits had moderate to excellent repeatability, while poor scoring consistency was noted for six variables. Difficulties in repeating several of the trait scores may require either a need for refinement of the definitions, or these character states may not adequately describe the observable morphology in the population. The application of the traditional experience-based approach for estimating ancestry in forensic case work is problematic.

Expression of the H-subunit and L-subunit of ferritin in bone marrow macrophages and cells of the erythron during cellular immune activation.

BACKGROUND: The expression of the two types of ferritin subunits, the H-subunit and L-subunit, has been shown to be differentially regulated by cytokines. The primary aim of the present study was to quantitatively measure the expression of the H-subunit and L-subunit of ferritin in bone marrow macrophages and cells of the erythron in patients with chronic T-helper cell type-1 immune stimulation. METHODS: The expression of the H-subunit and L-subunit of ferritin in bone marrow macrophages and cells of the erythron was quantitatively evaluated by post-embedding immunolocalisation with immunogold transmission electron microscopy. RESULTS: The present study showed up-regulation of the H-subunit of ferritin in the bone marrow macrophage in patients with pronounced cellular immune activation (94.7±37.3 counts/µm(2); n=31 vs 72.4±34.0 counts/µm(2); n=13, p-value=0.037). CONCLUSION: This supports a possible role for H-subunit rich ferritins in the hypoferraemia of chronic disease.

Is orthodontics an option in the management of bimaxillary protrusion?

Successful orthodontic treatment is based on a clear perception by the clinician of a patient's facial preference and treatment needs. Bimaxillary protrusion is a normal facial trait seen in the Black population and the most acceptable bimaxillary facial profile in a sample of Black subjects was determined by Beukes et al in 2007. Variations from this ideal profile may require extractions as part of orthodontic treatment in order to attain the ideal. The objective of this study was to determine whether Black subjects with bimaxillary protrusion would want to change their facial profile to the ideal and at what financial cost. A sample of 586 school learners and 321 university students were presented with four silhouetted profiles of varying degrees of bimaxillary protrusion. One of the silhouette profiles represented the ideal and treatment procedures required to achieve this ideal were explained to the sample. They were then requested to answer a questionnaire that would assist in identifying their perception of their own profile and their desire to change their appearance. The ideal silhouette was confirmed to be the most attractive (91.51%) and the sample felt that any severe deviations from this ideal profile should be treated. The financial cost of treatment was found to be a concern, as more subjects (62.84%) would undergo the required treatment if it were free. Many subjects (43.55%) would be prepared to pay for the necessary treatment to achieve the ideal profile. Females were found to be more definite in their decision making, reflecting a greater awareness about their aesthetic appearance than their male counterparts. Findings from this study can serve as an essential tool to assist both orthodontists and maxillofacial surgeons in the treatment planning and management of Black patients with bimaxillary protrusion.

A cross-sectional analysis of age related changes in the osteometric dimensions of long bones in modern South Africans of European and African descent.

New techniques are continuously developed to establish individualizing characteristics of unknown skeletonized remains. However, the critical evaluations of older, and seemingly standardized, methods are also necessary. Since many of the methods to determine skeletal sex are used in a medico-legal arena, the application of proper techniques to achieve accurate results is paramount. The purpose of this study was to evaluate whether the osteometric variables that are often used in discriminant function formulae to determine sex, namely the dimensions of the proximal and distal articular surfaces and the mid-shaft diameters of the long bones, increase or decrease with the advancement of age. Twenty-three standard anthropometric measurements were taken from the long bones of 404 male (n=106 white, n=298 black) and 189 female (n=82 white, n=107 black) known skeletons housed at the medical schools of the Universities of Pretoria and the Witwatersrand in South Africa. Results indicated that males and females of both ancestral groups were sexually dimorphic for the long bone measurements. The mean size of these measurements demonstrated a statistically significant increase in size from young to old groups in white females and males, with black females remaining static for their measurements and changes with age. Reasons for an increase in size are multi-faceted and may include normal degenerative changes such as bone remodeling, microfractures at articular joint surfaces, and changes in the relationship of cortical and endosteal bone as well as disease (osteoporosis). Males also increase in robusticity long after their epiphyses had closed. These changes may pose challenges to the accurate determination of sex should only metric characteristics be used.