Maternal use of a combination of recreational and antiretroviral drugs (nyaope/whoonga): Case reports of their effects on the respiratory system in infants.

Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination of neuro-stimulatory illicit drugs such as antiretroviral drugs, heroin, cannabis, opioids, cocaine as well as common household powders such as flat-screen television glass powder. It is a very addictive substance and is used even during pregnancy. Its effects on the developing fetus have been described as causing neonatal abstinence syndrome (NAS), intrauterine growth restriction (IUGR) and neurological complications. There are no data in the literature that report its effect on the respiratory system (RS) of the fetus or neonates. We describe two children who were prenatally exposed to nyaope and presented with upper and lower respiratory tract obstructions associated with recurrent pneumonias. Further studies are required to describe the adverse effects of whoonga on the developing RS of prenatally exposed fetuses.

Case report: Airway management of a patient with popping pedunculated subglottic laryngeal polyp.

Management of airway is a great challenge to anesthesiologists. Sometimes though airway is apparently normal but lesion around it may give a concern for securing airway. Patient, 52 years, ASA grade I presented to otolaryngology clinic with important complaints of stridor and dyspnoea. There was no comorbidity. Routine investigations were normal. Indirect laryngoscopic examination revealed pedunculated mass (polyp) arising from subglottic region, with a size of 0.7 x 0.5 cm and its pedicle was around 1.5 cm long delicate structure. This polyp was not visible during inspiration but it popped out of the vocal cords during expiration. Microlaryngeal surgery was planned to remove this polyp. Intubation of trachea was a great challenge as polyp was visible only during expiration. Tracheal intubation under controlled ventilation and neuromuscular blockade might have caused rupture of polyp pedicle or dislodgement of polyp in the trachea (as its pedicle was quite thin and delicate) which would have resulted in respiratory obstruction in the patient. Fiberoptic guided awake intubation was planned during expiratory phase of spontaneous respiration in order to avoid any injury or damage to the polyp or its pedicle.

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.

The hearing profile among learners in schools in the Western Cape, South Africa.

The hearing profile amongst school learners in the Western Cape was investigated. The University of Cape Town's hearing-screening programme at 11 primary schools (n=1101) was audited and revealed a 13.8% referral rate amongst school-aged children. The possible effects of environmental noise on hearing-screening performance at 500Hz was investigated. When the hearing-screening results at 500Hz were excluded from the audit, the referral rate was reduced from 13.8% to 7.9%. The referral rate for hearing-screening failures amongst the learners in the sample was towards the high end of the range for developing countries (3.3-13.9%). More learners had unilateral than bilateral hearing failures while laterality, gender and geographical differences were minimal. This high referral rate suggests a strong need for hearing-screening of the school-aged population.

Complications after posterior dislocation of the hip.

Thirty-five consecutive patients with unilateral posterior dislocation of the hip were studied for complications at an average follow-up of 4.6 years (range 2-10 years). Thompson-Epstein type IV dislocation was most frequent (10/35), reflecting an increase in high-speed motor vehicles in the developing countries. It is also a severe injury that leads to a maximum number of complications, which include avascular necrosis, osteoarthosis, sciatic nerve injury and heterotrophic ossification. Avascular necrosis and osteoarthritis of the hip were observed maximally in type IV patients, even when reduction was achieved in less than twelve hours and may reflect the severity of initial injury. Heterotrophic ossification was observed in five of the ten patients with type IV dislocation and was associated with multiple attempts at reduction. Sciatic nerve injury did not recover completely in all cases, especially when reduction was delayed over twelve hours. Observing that the greatest numbers of complications were seen among patients with type IV dislocations, it may be prudent to warn such individuals about the likely prognosis at the outset, especially in today's world when the demands and expectations are high.

The role of inter-subunit ionic interactions in the assembly of Physalis mottle tymovirus.

Physalis mottle tymovirus (PhMV) is a small spherical plant virus with its RNA genome encapsidated in a protein shell made of 180 identical coat protein (CP) subunits. The amino acid residues involved in two interfacial salt bridges, Asp-83/Arg-159 and Arg-68/Asp-150 and Lys-153, were targeted for mutagenesis with a view to delineate the role of interfacial ionic interactions in the subunit folding and assembly of the virus. R159A and D83A-R159A recombinant CP (rCP) mutants formed stable T = 3 capsids, indicating that the D83-R159 interfacial salt bridge is dispensable for the folding and assembly of PhMV. However, D150A and R68Q-D150A mutant rCPs were present in the insoluble fraction, suggesting that the R68-D150 interfacial salt bridge is crucial for subunit folding and assembly. Similarly, K153Q, D83A-K153Q, and H69A-K153Q mutant rCPs were present in the insoluble fraction. Interestingly, the R68Q-D150A, D83A-K153Q, and H69A-K153Q double mutant rCPs could be refolded into partially folded soluble heterogeneous aggregates of 14-16 S. The results further confirm our earlier observation that subunit folding and assembly are concerted events in PhMV.

Cloning of the pelA gene from Bacillus licheniformis 14A and biochemical characterization of recombinant, thermostable, high-alkaline pectate lyase.

The pectate lyase gene pelA from alkaliphilic Bacillus licheniformis strain 14A was cloned and sequenced. The nucleotide sequence corresponded to an open reading frame of 1,026 bp that codes for a 39 amino acid signal peptide and a mature protein with a molecular mass of 33,451 Da. The mature PelA showed significant homology to other pectate lyases belonging to polysaccharide lyase family 1, such as enzymes from different Bacillus spp. and Erwinia chrysanthemi. The pelA gene was expressed in Escherichia coli as a recombinant fusion protein containing a C-terminal His-tag, allowing purification to near homogeneity in a one-step procedure. The values for the kinetic parameters K(m) and Vmax of the fusion protein were 0.56 g/l and 51 micromol/min, respectively. The activity of purified PelAHis was inhibited in the presence of excess substrate. Characterization of product formation revealed unsaturated trigalacturonate as the main product. The yields of unsaturated trigalacturonic acids were further examined for the substrates polygalacturonic acid, citrus pectin and sugar-beet pectin.

Management of bleeding oesophageal varices by draining lymph from the thoracic duct.

The thoracic duct was cannulated in six patients who were actively bleeding from varices and had not responded to conservative treatment but draining lymph from the thoracic duct did not control bleeding in five patients. There was no drop in intrasplenic pulp pressure following this procedure when recorded in three of these patients. Bleeding stopped in one patient after lymph had been drained for nine and a half hours, and there was only a modest change in intrasplenic pressure. The therapeutic use of this technique to control oesophageal varices could not be substantiated.

Portal hypertension in kala-azar.

The present study records haemodynamic studies in three patients with kala-azar, a parasitic disease. All the three patients had high intrasplenic pressure, mild to moderate elevation of wedged hepatic vein pressure, and increased or normal estimated hepatic blood flow. Liver histology showed marked proliferation and swelling of Kupffer cells in the sinusoids. One patient was studied serially for nine months following treatment which showed persistent elevation of intrasplenic pressure though wedge pressure and liver blood flow touched normal levels. Liver biopsy was essentially normal at this stage. These findings may have some relevance to the role of different parasitic infections in the pathogenesis of a heterogeneous group of non-cirrhotic portal fibroses.

Chronic Budd-Chiari syndrome due to obstruction of the intrahepatic portion of the inferior vena cava.

Clinical features of obstruction of the intrahepatic portion of the inferior vena cava were observed in five out of the 11 patients with the Budd-Chiari syndrome seen during the last four years. These patients apparently formed a distinct group from the remaining six and resembled in clinical course, biochemical features, haemodynamic findings, and radiological investigations the patients described as cases of membranous obliteration of the intrahepatic portion of the inferior vena cava. The present study reports five such patients diagnosed with the help of venous catheterization, percutaneous hepatography, and haemodynamic studies. The value of distinguishing these patients from those with obstruction due to hepatic vein occlusion is highlighted because of the difference in the prognosis and treatment.