Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.

BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.

The role of endoscopic retrograde cholangiopancreatography in the treatment of hepatic cystic Echinococcus in a high HIV prevalence population: a retrospective cohort study.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a useful, minimally invasive intervention in managing complicated hepatic cystic echinococcosis (HCE). This study aims to assess the use of ERCP in a South African HCE cohort with and without human immunodeficiency virus (HIV) co-infection. METHODS: An analysis was performed of patients with HCE who were assessed for surgery and underwent ERCP at a tertiary hospital in South Africa between 2011 and 2023. Demographics, clinical data, imaging characteristics, operative management, and postoperative complications were compared between HIV-negative (HIV-) and HIV-positive (HIV+) cohorts. RESULTS: Of the 91 patients assessed, 45 (mean age 34.6 years, 73.3% females, 23 HIV+) required ERCP. HIV status did not significantly affect cyst characteristics or surgical outcomes. HIV+ patients had a higher incidence of intraoperative bile leaks (p = 0.025). There were 18 patients who underwent preoperative ERCPs, mainly for biliary-cyst complications primarily causing obstructive jaundice. A total of 40 patients required postoperative ERCPs, mainly for bile leaks. There were no ERCP-related mortalities and only one case of pancreatitis. ERCP success rates were comparable in both cohorts, with an overall success rate of 86.7%. CONCLUSION: HIV co-infection did not significantly impact the clinical course or outcomes of cystic echinococcosis (CE) patients undergoing ERCP. Perioperative ERCP proved effective in managing biliary complications of HCE as well as postoperative complications, regardless of HIV status. This study underscores the importance of endoscopic interventions in the comprehensive management of CE.

Study of the effect of implantation temperature on the migration behaviour of Xe implanted into glassy carbon.

The effect of implantation temperature on the migration behaviour of xenon (Xe) implanted into glassy carbon and the effect of annealing on radiation damage retained by ion implantation were investigated. Glassy carbon substrates were implanted with 320 keV Xe+ to a fluence of 2 × 1016 cm-2. The implantation process was performed at room temperature (RT) and 100 °C Some of the as-implanted samples were isochronally annealed in vacuum at temperatures ranging from 300 °C to 700 °C in steps of 100 °C for 10 h. The as-implanted and annealed samples were characterized using Rutherford backscattering spectrometry (RBS) and Raman spectroscopy. The RT implanted depth profiles indicated that the migration of Xe towards the surface of glassy carbon was accompanied by a loss of Xe ions. The samples implanted at 100 °C indicated no diffusion or loss of Xe after annealing at 300 °C. However, annealing at temperatures ranging from 400 °C to 700 °C resulted in a slight shift in the Xe profile tail-end towards the bulk of glassy carbon. The diffusion coefficients (D) in the temperature range of 300 °C-700 °C for the RT and 100 °C implanted samples, activation energies (Ea), and pre-exponential factors (Do), were extracted. The values of D ranged from (9.72 ± 0.48) × 10-21 to (1.87 ± 0.09) × 10-20 m2/s with an activation energy of (6.25 ± 0.31) × 10-5 eV for RT implanted samples, and the samples implanted at 100 °C, D ranged from (3.85 ± 0.19) × 10-21 to (6.96 ± 0.34) × 10-20 m2/s with activation energy of (4.10 ± 0.02) × 10-5 eV. The Raman analysis revealed that implantation at the RT amorphised the glassy carbon structure while the samples implanted at 100 °C showed mild damage compared to RT implantation. Annealing of the RT-implanted sample resulted in some recovery of the damaged region as a function of increasing annealing temperature.

Ferromagnetic frozen structures from the dipolar hard spheres fluid at moderate and small volume fractions.

We study the magnetic phase diagram of an ensemble of dipolar hard spheres (DHSs) with or without uniaxial anisotropy and frozen in position on a disordered structure by tempered Monte Carlo simulations. The crucial point is to consider an anisotropic structure, obtained from the liquid state of the DHS fluid, frozen in its polarized state at low temperature. The freezing inverse temperatureßfdetermines the degree of anisotropy of the structure which is quantified through a structural nematic order parameter,λs. The case of the non zero uniaxial anisotropy is considered only in its infinitely strong strength limit where the system transforms in a dipolar Ising model (DIM). The important finding of this work is that both the DHS and the DIM with a frozen structure build in this way present a ferromagnetic phase at volume fractions below the threshold value where the corresponding isotropic DHS systems exhibit a spin glass phase at low temperature.

Adult pure red cell aplasia at Universitas Academic Hospital, Bloemfontein, South Africa: A 9-year review.

BACKGROUND: Pure red cell aplasia (PRCA) is characterised by severe normochromic, normocytic anaemia and partial or complete absence of reticulocytes from the peripheral blood. With bone marrow of normal cellularity, an almost complete absence of erythroblasts but preservation of other cell lines is observed. It may be congenital or acquired, with the latter presenting as a primary haematological disorder or secondary to various contributing factors. Management focuses on treatment of the underlying cause and supportive transfusions. Occasionally, immunosuppression or intravenous immunoglobulin (IVIG) is required. OBJECTIVES: To describe the clinical characteristics, treatment and outcomes of adult patients diagnosed with PRCA at Universitas Academic Hospital (UAH) in Bloemfontein, South Africa, from 2010 to 2018. METHODS: A retrospective descriptive file review was performed. All adult patients diagnosed with PRCA and treated in the Division of Clinical Haematology at UAH during the study period were included. Variables recorded included demographic information, clinical details of the PRCA diagnosis, classification of the PRCA, HIV and parvovirus B19 test results, results of special investigations, medical and drug history, treatment and response to treatment. RESULTS: Twenty-seven patients' files were included, with a female predominance (n=22; 81.5%). The median age at diagnosis was 35 years (range 20 - 62). The median number of days from onset of symptoms to date of diagnosis was 61 days (range 27 - 114). Approximately half (n=13; 48.2%) of the patients presented with a haemoglobin concentration of 1 - 3 g/dL. Most patients (n=26; 96.3%) were infected with HIV, with 76.9% (n=20) having a suppressed viral load. Parvovirus B19 infection accounted for 44.4% of cases (n=12), and all these patients were HIV positive. Lamivudine was a probable cause of PRCA in 18.5% of cases, although the true causal relationship was uncertain. Corticosteroids and IVIG were first-line therapy in 44.4% (n=12) and 37.0% (n=10) of cases, respectively. Thirteen patients (48.2%) achieved a complete response and 7 (25.9%) a partial response, while 2 (7.4%) showed no response, with continued transfusion dependence. CONCLUSION: In this population, women were disproportionately affected by PRCA. HIV was the single most important cause of acquired PRCA, which was independent of virological control. Parvovirus B19 and drugs were also important causes of acquired PRCA and played a critical part in the evaluation and work-up of PRCA. Nearly half of the patients achieved a complete response to therapy, which was sustained over 24 months.

Chromium speciation in solid matrices and regulation: a review.

In recent years, the extensive use of chromium in industrial processes has led to the promotion of several directives and recommendations by the European Union, that try to limit and regulate the presence of Cr(VI) in the environment and to protect industrial workers using chromium and end-users of manufactured products. As a consequence, new standard methods and analytical procedures have been published at the EU level for Cr(VI) determination in soil, sludge, sediment, and similar waste materials, workplace atmospheres, cement, packaging materials, industrially produced samples, and corrosion-protection layers on some components of vehicles and electrical and electronic equipment. The objective of this article is to summarize the different directives and recommendations and to critically review the currently existing standard methods and the methods published in the literature for chromium speciation in the above mentioned solid matrices, putting the emphasis on the different extraction procedures which have been developed for each matrix. Particular attention has been paid to Cr(III) and Cr(VI) inter-conversions that can occur during extraction and efforts to minimize these unwanted reactions. Although the use of NaOH-Na(2)CO(3) solutions with hot plate extraction seems to be the more widespread procedure, species transformation can still occur and several studies suggest that speciated isotope-dilution mass spectrometry (SIDMS) could be a suitable tool for correction of these interconversions. Besides, recent studies have proved the role of Cr(III) in chromium toxicology. As a consequence, the authors suggest an update of standard methods in the near future.

Haemophagocytic lymphohistiocytosis: Five years' experience at tertiary hospitals in Free State Province, South Africa.

Background: Haemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome if not recognised and managed early. It involves an uncontrolled pathological activation of the immune system, and it is either genetic or acquired. It presents with clinical and laboratory features of severe inflammation. Early initiation of effective therapy may reduce mortality from 95% to 35%. Objectives: To raise awareness of HLH among healthcare professionals, particularly intensivists. Methods: We report nine cases of secondary HLH seen at tertiary hospitals in Bloemfontein, South Africa. Results: All patients presented with fever, hypertriglyceridaemia, hyperferritinaemia, transaminitis and cytopenia. Haemophagocytosis was noted on bone marrow biopsy in 66.7% (n=6/9) of the patients. More than one-third (44.4%; n=4/9) of the cases were triggered by a lymphoma, 44% (n=4/9) were associated with infection and 11% (n=1/9) were associated HIV. Finally, 11.1% (n=1) of the patients were triggered by an underlying autoimmune disease. More than half (55.6%; n=5/9) of the cases had a fatal outcome. Conclusion: A high index of suspicion may promote the accurate diagnosis of HLH in patients presenting with fever, transaminitis and unexplained cytopenia. Contributions of the study: HLH is a rare, life-threatening condition that may be missed in the intensive care setting. This report emphasises the importance of clinical suspicion, early diagnosis and appropriate intervention.

Structure of highly confined fluids: mixture of polar and nonpolar macroparticles in an external field.

In this paper we study the structure of highly confined mixtures of polar and nonpolar macroparticles in an external field by Monte Carlo simulation in the canonical ensemble. Without attempting a systematic investigation of the model, several effects including confinement, polarization, and solvation forces are considered. In particular, we show that layering at different length scales can be obtained in mixtures of differently sized particles subject to an external electric field.

Controlling the composition of a confined fluid by an electric field.

Starting from a generic model of a pore/bulk mixture equilibrium, we propose a novel method for modulating the composition of the confined fluid without having to modify the bulk state. To achieve this, two basic mechanisms-sensitivity of the pore filling to the bulk thermodynamic state and electric field effect-are combined. We show by Monte Carlo simulation that the composition can be controlled both in a continuous and in a jumpwise way. Near the bulk demixing instability, we demonstrate a field induced population inversion in the pore. The conditions for the realization of this method should be best met with colloids, but being based on robust and generic mechanisms, it should also be applicable to some molecular fluids.

Dynamics of field-driven population inversion in a confined colloidal mixture.

We study, using Langevin dynamics simulations, the change in composition of a binary colloidal mixture confined in a finite-length channel, induced by an external field. The field-induced transition from a near-bulk composition to an inverted population is studied as a function of time, for different field strengths and system parameters. For state points corresponding to reversible field cycles, the cyclic filling and emptying of the channel by the minority species are compared. Extrapolation of the physical relaxation times to the colloidal regime is performed through a series of simulations at increasing value of the damping parameter. For state points at which the mixture is unstable at zero field, reproducible irreversible cycles are illustrated. For reversible field cycles, the scaling with the particles size of the characteristic cycling time is discussed.

Attractive forces in sterically stabilized colloidal suspensions: from the effective potential to the phase diagram.

The potential of mean force for macroparticles at infinite dilution is computed for several models of solvent-solvent and solvent-macroparticle interactions by using the reference hypernetted chain (RHNC) integral equations with Rosenfeld's density functional theory bridge functions. The phase diagram of the associated effective fluid is obtained from the RHNC free energy for the fluid branch and the perturbation theory for the solid one. The computation of the effective potential and of the fluid branch is tested by comparison with Monte Carlo simulation. The important modifications with respect to the pure hard spheres that were previously reported are confirmed. The possibility of inverting the relative stability of the fluid-fluid and the fluid-solid transitions by appropriate combination of the interaction parameters is shown. The importance of a fine description of the interactions is illustrated in the example of the role of the range of the solvent-solvent interaction potential.

When mixtures of hard-sphere-like colloids do not behave as mixtures of hard spheres.

The validity of the concept of "hard-sphere-like" particles for mixtures of colloids is questioned from a theoretical point of view. This concerns the class of pseudobinary mixtures in which the nonsteric interactions between the colloids are "residual" (with very small range and moderate strength). It is shown that contrary to common expectation, such interactions may have unexpected consequences on the theoretical phase diagram. The distinction between this situation and true solute-solvent mixtures is emphasized.

Toward chromium speciation in solids using wavelength dispersive X-ray fluorescence spectrometry Cr Kß lines.

The determination of chromium speciation in solid samples is critical for environmental and industrial purposes. Several analytical methods exist to perform such a determination either directly in solid state or liquid state after an extraction step, each of them having some limitations. In this study, the use of a high-resolution wavelength-dispersive X-ray fluorescence spectrometer to determine and quantify chromium species is investigated by looking at the differences in the Kß transition profiles between Cr(0), Cr(III) and Cr(VI) compounds. Three different approaches were tested and compared to determine the Cr(VI) fraction of known mixtures: relative height and peak fitting using calibration mixtures, partial least square regression (PLS) of pure compounds, and principal component regression (PCR) of pure compounds. The accuracy of these methods was found to be about the same with an average relative error in the range of 15%. However, PLS and PCR can be easily implemented in an automated way contrary to peak fitting which can be sometimes perceived as analyst-dependant. Another advantage of using PLS and PCR is that information concerning the other oxidation states present in the sample can be retrieved. Finally, PLS and the peak height approach can be used up to 0.5% total chromium which make the XRF an alternative technique to X-ray induced photoelectron spectroscopy (XPS) for chromium speciation in solid state.

Counting the cost: the consequences of increased medical malpractice litigation in South Africa.

We live in uncertain times. The recession in Europe and ongoing political instability in the Middle East are each examples of what could legally be termed a 'statement of fact'. The rising cost of healthcare in South Africa is another fact. This phenomenon is accompanied by an even more disturbing trend: a steep rise in medical malpractice litigation. An important question to consider is what effect this increase is having on healthcare provision in South Africa generally.

Binary mixture adsorbed in a slit pore: Field-induced population inversion near the bulk instability.

The recently proposed method for modulating through an external field the composition of a binary fluid mixture adsorbed in a slit pore is discussed. The population inversion near the bulk (demixing) instability is first analyzed in the case of a symmetric mixture of nonadditive hard spheres, without field. It is next investigated for a mixture comprising dipolar particles subject to an external field. The influence of several factors on the adsorption curves including bulk composition, pore width, field direction, polarizability versus permanent dipoles, and temperature on this field induced population inversion is shown by Monte Carlo simulation.

Structure of highly asymmetric hard-sphere mixtures: an efficient closure of the Ornstein-Zernike equations.

A simple modification of the reference hypernetted chain (RHNC) closure of the multicomponent Ornstein-Zernike equations with bridge functions taken from Rosenfeld's hard-sphere bridge functional is proposed. Its main effect is to remedy the major limitation of the RHNC closure in the case of highly asymmetric mixtures--the wide domain of packing fractions in which it has no solution. The modified closure is also much faster, while being of similar complexity. This is achieved with a limited loss of accuracy, mainly for the contact value of the big sphere correlation functions. Comparison with simulation shows that inside the RHNC no-solution domain, it provides a good description of the structure, while being clearly superior to all the other closures used so far to study highly asymmetric mixtures. The generic nature of this closure and its good accuracy combined with a reduced no-solution domain open up the possibility to study the phase diagram of complex fluids beyond the hard-sphere model.

Potential of mean force in confined colloids: integral equations with fundamental measure bridge functions.

The potential of mean force for uncharged macroparticles suspended in a fluid confined by a wall or a narrow pore is computed for solvent-wall and solvent-macroparticle interactions with attractive forces. Bridge functions taken from Rosenfeld's density-functional theory are used in the reference hypernetted chain closure of the Ornstein-Zernike integral equations. The quality of this closure is assessed by comparison with simulation. As an illustration, the role of solvation forces is investigated. When the "residual" attractive tails are given a range appropriate to "hard sphere-like" colloids, the unexpected role of solvation forces previously observed in bulk colloids is confirmed in the confinement situation.