Rat bite injuries in children: description of a novel classification.

PURPOSE: Rats are common intruders into human settlements. Apart from their role as disease vectors, they can also cause bite injuries. We describe the clinical course of a series of children with rat bites, and characterise the injures. METHODS: A retrospective review of hospital records of children admitted for rat bites in a large regional hospital was undertaken. The demographics, wound characteristics, treatment given and clinical outcome of the patients are described. RESULTS: Fifty-nine children, with a mean age of 3.7 years, were admitted for rat bites. Three distinct types of wounds were treated: superficial scratches (Type I), deeper bites often with infection and ulceration (Type II) and full-thickness with loss of skin or underlying soft tissues (Type III). Few wounds displayed signs of inflammation. Only some Type II injuries required urgent local surgery in the form of drainage and debridement. Type III wounds required a skin graft. All patients recovered. CONCLUSION: We suggest that treatment of rat bites should be based on the wound type. Most patients do not require hospital admission or antibiotic treatment. Treatment should be mostly conservative wound care management. Surgery is only indicated for drainage of pus, debridement, skin graft or rarely reconstruction.

Motivators and deterrents to blood donation among Black South Africans: a qualitative analysis of focus group data.

BACKGROUND AND OBJECTIVES: South Africa has a markedly skewed representation where the majority of blood (62%) is presently collected from an ethnically White minority. This study seeks to identify culturally specific factors affecting motivation of donors in South Africa. MATERIALS AND METHODS: We performed a qualitative study to evaluate motivators and deterrents to blood donation among Black South Africans. A total of 13 focus groups, comprising a total of 97 Black South Africans, stratified by age and geographic location were conducted. Transcripts of the interviews were analysed using a coding framework by Bednall & Bove. RESULTS: Participants made 463 unique comments about motivators focusing primarily on promotional communications (28%), incentives (20%) and prosocial motivation (16%). Participants made 376 comments about deterrents which focused primarily on fear (41%), negative attitudes (14%) and lack of knowledge (10%). CONCLUSION: Although prosocial motivation (altruism) was the most frequently mentioned individual motivator, promotional communication elicited more overall comments by participants. As reported by many authors, fear and lack of awareness were strong deterrents, but scepticism engendered by perceived racial discrimination in blood collection were unique to the South African environment.

The antimicrobial susceptibility patterns of diabetic foot ulcers in the South African public healthcare sector.

BACKGROUND: Diabetic foot syndrome is defined as the presence of a diabetic foot ulcer (DFU) associated with neuropathy, peripheral artery disease and infection. While the use of antimicrobials in the treatment of DFU infection remains a mainstay, the choice of antimicrobial remains problematic owing to the presence of multidrug-resistant polymicrobial infections. In the South African public healthcare sector, the treatment of DFUs is based on the Standard Treatment Guidelines (STGs) and the Essential Drug List. These guidelines are developed using evidence-based medicine and are based on global susceptibility patterns rather than local susceptibility data, and may not provide the most appropriate treatment options. OBJECTIVES: To determine the antimicrobial susceptibility patterns of DFUs isolated from patients visiting selected Gauteng provincial public hospitals in order to determine a clinically effective treatment protocol for the management of these infections. METHODS: Sample swabs were taken from 51 DFUs using the Levine method. Each sample swab was spread onto blood agar plates, and thereafter individual pathogens were isolated. The antimicrobial susceptibility patterns of all isolated pathogens were determined using zone of inhibition measurements. Pathogens were grouped according to macromorphological characteristics as well as susceptibility patterns, and a representative isolate from each group was then identified. RESULTS: A total of 51 DFU ulcer swabs from 45 patients were included in the study. From the sample swabs, a total of 445 pathogens were isolated. The most effective antimicrobial was found to be gentamicin, followed by ciprofloxacin. Amoxicillin/clavulanic acid, the first-line treatment according to the STGs, was found to be ineffective for many of the isolated pathogens. The most commonly isolated pathogens were Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa. CONCLUSION: These findings demonstrate the urgent need to reassess the STGs and base treatment plans on local epidemiological data. This study provides valuable data on common causative pathogens in DFU infections, as well as the resistance patterns of these pathogens, forming a baseline on which to base future DFU treatment plans.

Profile of human papillomavirus genotypes in breast and oesophageal cancer patients in Pretoria, South Africa.

BACKGROUND: The association between human papillomavirus (HPV) and cervical cancer is well established, and cervical cancer can be prevented through HPV vaccination. Little has been reported on the association between HPV and breast carcinoma (BC) or oesophageal squamous cell carcinoma (OSCC) in Africa. It is possible that use of appropriate HPV vaccines against genotypes responsible for these cancers may also prevent their development. OBJECTIVES: To investigate HPV genotype prevalence in BC and OSCC patients in Pretoria, South Africa (SA). METHODS: A retrospective cross-sectional study of BC and OSCC patients managed at Steve Biko Academic Hospital from 2015 to 2019 was undertaken. Patient medical records were analysed, and DNA was extracted from their archived pathology material and amplified by polymerase chain reaction before hybridisation for HPV genotypes. RESULTS: There were 101 patients with BC and 50 with OSCC. The prevalence of HPV infection in BC patients was 77.2%, with 35.6% high- risk (HR) genotypes, and that in OSCC patients 90.0%, with 56.0% HR genotypes. The most prevalent HPV genotypes (>20% each) were HPV 16, 70 and 51 for BC and HPV 51, 70, 16 and 82 for OSCC, with 31.7% and 60.0% of patients, respectively, having co-infection with ≥2 genotypes. CONCLUSION: The high prevalence of infection with multiple HPV genotypes in BC and OSCC patients, with HPV 16, 51, 70, 35 and 82 the most common genotypes in these cancers, warrants expansion of the current SA bivalent HPV 16/18 vaccine for girls to include boys, and inclusion of HPV 51, 70, 35 and 82, in order to prevent BC and OSCC as well as cervical cancer.

Substrate temperature dependence of structure and optical properties of ZnTiO3:Er3+/Yb3+ thin films synthesized by pulsed laser deposition.

ZnTiO3:Er3+,Yb3+ thin film phosphors were successfully deposited by pulsed laser deposition (PLD) at different substrate temperatures. The distribution of the ions in the films was investigated and the chemical analysis showed that the doping ions were homogeneously distributed in the thin films. The optical response of the phosphors revealed that the reflectance percentages of the ZnTiO3:Er3+,Yb3+ vary with the silicon substrate temperature due to the differences in the thickness and morphological roughness of the thin films. Under 980 nm diode laser excitation, the ZnTiO3:Er3+,Yb3+ film phosphors displayed up-conversion emission from the Er3+ electronic transitions, with violet, blue, green, and red emission lines at 410, 480, 525, 545 and 660 nm from 2H9/2 â†’ 4I15/2, 4F7/2 â†’ 4I15/2, 2H11/2 â†’ 4I15/2, 4S3/2 â†’ 4I15/2 and 4F9/2 â†’ 4I15/2 transitions, respectively. The up-conversion emission was enhanced by increasing the silico (Si) substrate temperature during the deposition. Based on the photoluminescence properties and decay lifetime analysis, the energy level diagram was established and the up-conversion energy-transfer mechanism was discussed in detail.

The adjunctive use of carbimazole during radioactive iodine treatment reduces the cure rate of Graves' disease.

BACKGROUND: Radioactive iodine (RAI) is widely used in the treatment of hyperthyroidism. Adjunctive antithyroid drugs (ATDs) are commonly prescribed to treat the hyperthyroid state before the RAI has taken effect. However, there is no consensus on the use of or timing of adjunctive ATD treatment with RAI. OBJECTIVES: To determine the influence of the ATD carbimazole on the cure rate of RAI treatment for Graves' disease. METHODS: A retrospective chart review was conducted in the Department of Nuclear Medicine of the Steve Biko Academic Hospital in Pretoria. The cure rate of patients treated with RAI for Graves' disease was analysed. The effect of adjunctive carbimazole treatment with regard to its use and timing with RAI dosing was analysed. The cure rate was determined in patients treated with carbimazole either before RAI or before and after RAI administration. Cure rate was defined by the biochemical thyroid function status (thyroxine (T4), thyroid-stimulating hormone (TSH)) as euthyroid or hypothyroid from 3 months and sustained at 12 months. The need for a second dose of RAI was recorded. RESULTS: RAI treatment was administered to 171 patients with Graves' disease. The cure rate was higher in patients receiving a higher dose of RAI. The overall cure rate increased progressively from 3 months and was 91% at 12 months. The cure rate in 97 patients not receiving carbimazole was 98%. The cure rate of the 27 patients on carbimazole treatment given before RAI administration was 81%, and 73% in the 37 patients in whom it was resumed after RAI administration. The overall cure rate was lower in patients who received carbimazole (p<0.001), but especially in patients in whom carbimazole was continued after RAI administration (p<0.001). CONCLUSIONS: Adjunctive carbimazole treatment decreased the RAI cure rate of Graves' disease significantly.

Leucocyte count and C-reactive protein cannot be relied upon in the diagnosis of acute appendicitis in HIV-infected patients.

BACKGROUND: South Africa has the highest prevalence of human immunodeficiency virus (HIV) infection in the world, and is commonly found in association with appendicitis. Atypical presentation of appendicitis in the presence of HIV infection makes clinical diagnosis of appendicitis unreliable, and inflammatory markers are commonly used as adjuncts. The aim of this study was ascertain the value of inflammatory markers in the diagnosis of appendicitis in patients with and without HIV infection. METHODS: Patients with acute appendicitis were studied and divided into HIV-infected and HIV-uninfected groups. Symptoms, and systemic and local signs were recorded. Appendiceal pathology was classified as simple or as complicated by abscess, phlegmon or perforation. Total white cell count (WCC) and C-reactive protein (CRP) were chosen as inflammatory markers. Findings were compared between the two groups. RESULTS: The study population consisted of 125 patients, of whom 26 (20.8 per cent) had HIV infection. Clinical manifestations did not differ statistically, and there was no difference in the incidence of simple or complicated appendicitis between the two groups. The mean CRP level was significantly higher in HIV-infected patients (194.9 mg/l versus 138.9 mg/l in HIV-uninfected patients; P = 0.049), and mean WCC (x109/L) was significantly lower (11.07 versus 14.17×109/l respectively; P = 0.010). CONCLUSION: Clinical manifestations and pathology did not differ between HIV-infected and HIV-uninfected patients with appendicitis, except that the WCC response was significantly attenuated and CRP levels were generally higher in the presence of HIV infection.

Interferon gamma induces synthesis of complement alternative pathway proteins by human endothelial cells in culture.

Human umbilical vein endothelial cells grown in vitro under standard conditions contain a high level of mRNA specific for the complement regulatory factors H and I. An additional 1.8-kb mRNA encoding a truncated form of factor H is also present. IFN-gamma stimulation of the cells causes a 6-7 fold increase in both factor H mRNA species, and a greater than 10-fold increase in factor I mRNA. IL-1 and LPS slightly suppressed factor H mRNA, while TNF had no effect. mRNA for factor B is also detectable in IFN-gamma-stimulated cells, but messengers for C1q, C4bp, and CR3 beta chain were not found. Secretion of factor H protein was also stimulated by IFN-gamma. The presence of mRNA for factors H, B, and I, together with C3 secretion, demonstrated by others, suggests that endothelial cells can assemble the complete alternative complement pathway. Endothelial cell complement may be involved in leukocyte-endothelium interactions mediated by leukocyte C3 receptors.