Comparing cardiorespiratory fitness and physical activity levels between third- and fifth-year medical students in a South African university.

Background: Cardiovascular disease (CVD) risk factors such as sedentary behaviour, decreased physical activity (PA), and low cardiorespiratory fitness lead to an increased and accelerated risk of cardiovascular disease and mortality. Medical students tend to adopt sedentary lifestyles due to a demanding curriculum. This may have a negative effect on CVD risk factors and cardiorespiratory fitness levels of medical students. Objectives: To compare physical activity and cardiorespiratory fitness levels in a cohort of third- and fifth-year undergraduate medical students in a South African university. Methods: Data from 123 third-year and 139 fifth-year medical students in the Graduate Entry Medical Programme (GEMP) at the Faculty of Health Sciences, University of the Witwatersrand, were collected. Measurements included CVD risk factors, height, weight, blood pressure, waist circumference, cardiorespiratory fitness, physical activity vital signs and pre-participation health screening questionnaires. Descriptive statistics were presented as mean ± standard deviation or median [interquartile range] depending whether the data were normally distributed or not. Results: Both groups had low cardiorespiratory fitness when compared to norm values (GEMPI VO2 peak was 29.1 ± 5.9 ml.kg-1.min-1 and GEMPIII VO2 peak was 30.0[11.0] ml.kg-1.min-1). Most participants did not meet WHO physical activity requirements (GEMP I: 72%; GEMP III: 78%). There were significant differences in BMI (p=0.046), diastolic blood pressure (p=0.034) and VO2 peak (p=0.00001) between students meeting and not meeting WHO physical activity requirements (p<0.05). Conclusion: Third- and fifth-year medical students at a South African university fail to meet recommended WHO physical activity levels and are below cardiorespiratory fitness norms. Therefore, medical institutions should promote and implement targeted physical activity interventions to reduce the prevalence of low fitness levels and the associated health hazards among their students.

An analysis of the effect of COVID-19 pandemic on wildlife protection in protected areas of Zimbabwe in 2020.

The COVID-19 pandemic brought about unprecedented effects on the conservation and protection of wildlife in protected areas. In response to the COVID-19 pandemic, the government of Zimbabwe imposed lockdown measures to prevent and control the spread of the pandemic. The inability of researchers to conduct field-based research led to office-based research to determine the impacts of the pandemic on conservation. The objective of this study was to find out how the pandemic had affected the security of wildlife in protected areas of Zimbabwe in 2020. The researchers divided 2020 into three periods, 'no' lockdown, 'full' lockdown, and 'partial' lockdown. Data on wildlife protection, illegal activities and tourism performance was collected at the station level using a similar format and submitted to a central place for consolidation and analysis. Parametric and non-parametric tests were conducted based on the normality status of the data variables. The study findings are that (i) The number of rangers conducting law enforcement activities in 2020 remained the same, (ii) Rise in local poaching of wildlife with a peak in the dry season, increase in illegal fishing, and illegal mining activity during the period of 'full' lockdown, (iii) Tourist arrivals and revenue generated from regional and international tourism showed a significant decline during 'full' lockdown and 'partial' lockdown (iv) Domestic arrivals increased as expected during 'partial' lockdown. This study corroborates the potential negative implications of the COVID-19 pandemic on wildlife protection which would continue to worsen with the prolonging pandemic. One lesson from this study is that the Zimbabwe Parks and Wildlife Management Authority (ZPWMA) wildlife protection efforts in 2020 were sustained using financial reserves as a safety net and support from conservation partners. There is a need to ensure conservation safety nets through diversifying funding sources and creating financial reserves for conservation.

Hepatitis B infection in people living with HIV who initiate antiretroviral therapy in Zimbabwe.

SETTING: There is little information about the diagnosis and treatment of hepatitis B virus (HBV) infection in people living with HIV (PLHIV) in Zimbabwe despite recommendations that tenofovir (TDF) + lamivudine (3TC) is the most effective nucleoside/nucleotide reverse transcriptase inhibitor (NRTI) backbone of antiretroviral therapy (ART) in those with dual infection. OBJECTIVE: To determine 1) numbers screened for hepatitis B surface antigen (HBsAg); 2) numbers diagnosed HBsAg-positive along with baseline characteristics; and 3) NRTI backbones used among PLHIV initiating first-line ART at Mpilo Opportunistic Infections Clinic, Bulawayo, Zimbabwe, between October 2017 and April 2019. DESIGN: This was a cross-sectional study using routinely collected data. RESULTS: Of the 422 PLHIV initiating first-line ART (median age 34 years, IQR 25-43), 361 (85%) were screened for HBV, with 10% being HBsAg-positive. HBsAg positivity was significantly associated with anaemia (adjusted prevalence ratio [aPR] 2.3, 95%CI 1.1-4.7) and elevated ala-nine transaminase levels (aPR 2.9, 95%CI 1.5-5.8). Of 38 PLHIV who were diagnosed HBsAg-positive, 30 (79%) were started on ART based on tenofovir (TDF) and lamivudine (3TC), seven were given abacavir (ABC) + 3TC-based ART and one was given zido vudine (ZDV) + 3TC-based ART. CONCLUSION: In PLHIV, HBV screening worked well, the prevalence of HIV-HBV co-infection was high and most patients received appropriate treatment for both conditions. Recommendations to improve screening, diagnosis and treatment of HIV-HBV co-infection are discussed.

Surgical management of pulmonary hydatid cysts in children in KwaZulu-Natal Province, South Africa.

BACKGROUND: Pulmonary hydatid cyst disease is still a major problem in countries like South Africa (SA), where livestock farming is common. Hydatidosis has a variable clinical course depending on the size, location and complications of the cyst. For pulmonary cysts of any size, surgery remains the gold standard for treatment, with lung conservation surgery being the ideal. OBJECTIVES: To describe the epidemiology, clinical presentation, surgical management, and surgical outcomes of paediatric pulmonary hydatid disease in children referred to the Department of Cardiothoracic Surgery at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal Province, SA. METHODS: We retrospectively reviewed and analysed the medical records of 38 children between the ages of 0 and 18 years with pulmonary hydatid cysts, who were referred to the Department of Cardiothoracic Surgery at IALCH and underwent surgical management between 1 January 2008 and 31 December 2018. The medical records were evaluated for patients' demographics, clinical evaluation, surgical management strategies and surgical outcomes. RESULTS: Of the 38 patients, 60.5% were male, with a mean age of 6.5 years. More than two-thirds of the patients (68.4%) were from the Eastern Cape and 31.6% were from KwaZulu-Natal. The majority of the cysts (84.2%; n=32) were classified as large (5 - 9 cm in diameter) and giant (≥10 cm in diameter). Forty-eight surgical procedures were performed and lung preservation surgery by enucleation and capitonnage was preferred. Some patients developed postoperative complications such as prolonged air leaks from bronchopleural fistula (18.8%; n=9) and 88.9% (n=8) of these patients healed with chest tube drainage and physiotherapy. Lung resection was only required in 4% (n=2) of the patients. The mean (standard deviation) number of days spent in hospital was 7 (4) days. All children survived with no recurrences. CONCLUSION: Conservative surgical procedures such as enucleation of the cysts of any size are possible, safe, reliable and reproducible.

Disseminated nocardiosis in an immunocompetent patient.

Nocardiosis is a rare opportunistic bacterial infection. We describe an 8-year-old immunocompetent patient who presented with constitutional symptoms suggestive of probable tuberculosis (TB) in whom we confirmed a diagnosis of nocardiosis. Nocardia is a Gram-positive bacterium that is ubiquitous in soil and decaying vegetable matter. N. asteroides is the most common species. Despite the traditional description of nocardiosis as an opportunistic infection, case reports and case series of pulmonary nocardiosis have recently been reported in immunocompetent patients. Three clinical presentations of nocardiosis have been described; acute, subacute and chronic suppurative infections with episodes of exacerbations and remissions. We describe the presentation, diagnosis, management and prognosis of a rare case of disseminated nocardiosis managed initially as disseminated TB with no improvement.

Temperature fluctuations inside savanna termite mounds: Do size and plant shade matter?

Mound building termites are key ecosystem engineers of subtropical savanna regions. Mounds allow termites to maintain suitable conditions for termite reproduction and food cultivation ('fungus gardens'). We studied how the internal mound temperature of Macrotermes natalensis, a dominant mound-building termite of the subtropical savanna of southern Africa, responds to a number of environmental variables. We used general additive mixed models (GAMM) to determine how external temperature, mound size (volume) and the amount of vegetation shade affects mound internal temperature over a 24-h period. Internal mound temperature varied daily following changes of the external temperature, although the range of variation was much smaller. Active termite mounds maintained a higher internal temperature than inactive ones, and mound activity reinforced the positive effect of mound size and moderated the negative effect of vegetation shade on internal temperatures. In turn, external temperature fluctuations equally affected active and inactive mounds. Large mounds maintained near optimal internal temperatures compared to smaller sized mounds. We therefore conclude that termite mound size is a stronger determinant of internal mound temperature stability compared to plant shade cover.

The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study.

BACKGROUND: Numerous national guidelines have been issued to assist general practitioners' safe analgesic prescribing. Their effectiveness is unclear. The objective of this study was to examine trends in general practitioners' prescribing behaviour in relation to national guidelines. METHODS: This was a retrospective observational database study of registered adult patients prescribed an analgesic (2002-2009) from the Consultations in Primary Care Archive--12 North Staffordshire general practices. Prescribing guidance from the UK Medicines Regulatory Health Authority (MHRA) regarding non-steroidal anti-inflammatory drugs (NSAIDs) and co-proxamol, and the National Institute for Health and Clinical Excellence (NICE) osteoarthritis (OA) management guidelines were considered. Analgesic prescribing rates were examined, arranged according to a classification of six equipotent medication groups: (1) basic analgesics; (2)-(5) increasingly potent opioids and (6) NSAIDs. In each quarter from 2002 to 2009, the number of patients per 10,000 registered population receiving a prescription for the first time from each group was determined. Quarters associated with significant changes in the underlying prescribing trend were determined using joinpoint regression. RESULTS: A significant decrease in incident co-proxamol and Cox-2 prescribing occurred around the time of the first MHRA advice to stop using them and were rarely prescribed thereafter. The new prescribing of weak analgesics (e.g., co-codamol 8/500) increased at this same time. Initiating topical NSAIDs significantly increased around the time of the NICE OA guidelines. CONCLUSIONS: Significant prescribing changes occurred when national advice and guidelines were issued. The effectiveness of this advice may vary depending upon the content and method of dissemination. Further evaluation of the optimal methods for delivering prescribing guidance is required.

Understanding the ecological drivers of avian influenza virus infection in wildfowl: a continental-scale study across Africa.

Despite considerable effort for surveillance of wild birds for avian influenza viruses (AIVs), empirical investigations of ecological drivers of AIV prevalence in wild birds are still scarce. Here we used a continental-scale dataset, collected in tropical wetlands of 15 African countries, to test the relative roles of a range of ecological factors on patterns of AIV prevalence in wildfowl. Seasonal and geographical variations in prevalence were positively related to the local density of the wildfowl community and to the wintering period of Eurasian migratory birds in Africa. The predominant influence of wildfowl density with no influence of climatic conditions suggests, in contrast to temperate regions, a predominant role for inter-individual transmission rather than transmission via long-lived virus persisting in the environment. Higher prevalences were found in Anas species than in non-Anas species even when we account for differences in their foraging behaviour (primarily dabbling or not) or their geographical origin (Eurasian or Afro-tropical), suggesting the existence of intrinsic differences between wildfowl taxonomic groups in receptivity to infection. Birds were found infected as often in oropharyngeal as in cloacal samples, but rarely for both types of sample concurrently, indicating that both respiratory and digestive tracts may be important for AIV replication.

Women, violence and HIV / AIDS in Zimbabwe.

PIP: This paper presents evidence of the extent of violence against women in Zimbabwe. It also discusses the association of violence and the spread of HIV infection in southern Africa. Estimates on the different forms of violence (physical, psychological, sexual, and economically disempowering acts) were obtained by interviewing nearly 1000 women on their experiences. Findings confirmed that violence against women is widespread: adolescent girls, pregnant mothers, and married women experience violence. Of the women interviewed, 42% experienced some form of psychological abuse; 32% experienced physical abuse since age 16 years; 39% experienced economically disempowering forms of violence; and 37% experienced some form of sexual harassment or abuse. Notably, only 1 out of every 7 women interviewed did not report having experienced any form of violence. Likewise, it was noted that there were strong overlaps between the different forms of violence. Women's experiences of sexual harassment and abuse increase their vulnerability to HIV. Similarly, women's low status and lack of power severely limit the extent to which they can protect themselves against sexual violence and HIV infection, and women who adopt such prevention strategies are vulnerable to abuse. Therefore, recognition of the existing link between violence and HIV infection is important in the formulation of preventive strategies.^ieng