The clinical utility of PET/CT scan and tissue biopsy in the management and follow-up of paediatric Hodgkin lymphoma in South Africa.

BACKGROUND: In low- to middle-income countries (LMICs) like South Africa, there is a need to understand the clinical practices surrounding diagnosis and surveillance of paediatric Hodgkin lymphoma (HL) to reduce the burden on health systems. Understanding the clinical utility of PET/CT scans may decrease repeated tissue biopsies during disease surveillance. METHODS: This is a retrospective cohort study of patients aged less than 18 years treated for HL at Chris Hani Baragwanath Academic Hospital from 1 January 2009 to 31 December 2018. RESULTS: Fifty-four patients were included in the study; male-to-female ratio was 5:1 with a mean age of 9 years. Seventy per cent of patients (n = 38) received a PET/CT and tissue biopsy during their initial diagnostic workup, whereas 20.4% (n = 11) of patients received a PET/CT and tissue biopsy during surveillance. Tissue biopsy and PET/CT showed slight agreement (κ = 0.14) in diagnosing relapsed disease during surveillance. The false negative rate for tissue biopsy during surveillance was 42.9%. Surveillance PET/CT showed a positive predictive value (PPV) of 66.7% and negative predictive value (NPV) of 100% when compared to tissue biopsy. CONCLUSION: This study is the first cohort to explore the clinical utility of PET/CT scans and tissue biopsies in a lowresourced setting. Our findings showed slight agreement between the modalities in diagnosing relapsed disease during surveillance. A portion of this discordance can be attributed to false negative tissue biopsy results. While the sample is limited, our findings are consistent with the high NPV of PET/CT scans of > 95% as is reported in the literature.

Occupational lung disease among Basotho ex-miners in a large outreach medical assessment programme

Background: Current initiatives in southern Africa to medically assess former migrant miners for silicosis and tuberculosis, including statutory and lawsuit derived compensation programmes, require burden of disease information. nObjective: To use clinical information collected on ex-miners examined at the Occupational Health Service Centre (OHSC) in Lesotho, operated under the Tuberculosis in Mining Sector in Southern Africa (TIMS) project, to measure the burden of lung disease and respiratory impairment. Methods: Demographic, occupational and medical history information, chest radiology, spirometry, GeneXpert testing for tuberculosis, and pulse oximetry outcomes were analysed, and descriptive summary measures calculated, in a group of ex-miners examined in 2017 and 2018. Results: The study sample comprised 2 758 Basotho former underground miners, with median age of 62 years and median length of service of 28 years. Among ex-gold miners (n = 2 678), disease prevalence was high: radiological tuberculosis (consistent with previous or current disease) 60.9%, silicosis 42.5%, HIV 30.7%, silicotuberculosis 25.7%, and current active tuberculosis 6.8%. Of those with tuberculosis diagnosed microbiologically, 6.7% had no radiological evidence of tuberculosis and 54.1% did not report cough. Conclusion: The findings have public health and compensation implications. There are large numbers of ex-miners with potentially compensable disease under both the statutory system and a settlement trust set up following litigation. This overlaps with a tuberculosis-HIV co-epidemic which requires screening and treatment for tuberculosis and HIV, and managing a considerable disability and care burden on families and the Lesotho health system. Coordinated planning and substantial resources are needed for these programmes to do justice to their mandates

Gender biases and discrimination: a review of health care interpersonal interactions.

A good interpersonal relationship between a patient and provider, as characterized by mutual respect, openness, and a balance in their respective roles in decision-making, is an important marker of quality of care. This review is undertaken from a gender and health equity perspective and illustrates that gender biases and discrimination occur at many levels in the healthcare delivery environment, and affects the patient-provider interaction which can result in health inequities affecting individual health seeking behaviour, access to good quality healthcare, and, ultimately, health outcomes. Interventions will have to be introduced at multiple levels, from health system legislation and policy and gender sensitive training to the development of women and men centred services and health literacy programmes.

The Profile of Indications for Radiography in the Neonatal Intensive Care Unit at Universitas Academic Hospital; Bloemfontein

Introduction. Radiography is a key diagnostic tool in paediatric care. A pro-active approach (including the use of radiography) is required to ensure effective management of these patients. Taking into account the widely documented harmful effects of ionising radiation and the small organ masses of neonates; the number of radiographs that neonates receive during hospital admission is of particular concern. A reduction in radiation exposure tailored to specific indications would be advantageous. The aim of this study was therefore to establish a profile of indications for radiographs in the Neonatal Intensive Care Unit at Universitas Academic Hospital; Bloemfontein; South Africa.Methods. A retrospective; descriptive study was conducted over a 1-month period (8 September - 8 October 2010). Information was obtained from the online Medi-Tech system used to request radiographs.Results. A total of 469 radiographs were performed on 51 neonates. Twenty-seven male and 24 female neonates received 226 (48.2) and 243 (51.8) radiographs; respectively. The radiographs were classified into routine (91.9) and urgent (8.1). Chest radiographs were requested most frequently (59.5). The most commonly recorded indication was prematurity (37.1); followed by respiratory-related indications (28.5). The highest number of radiographs performed on a single neonate was 46. Conclusions. All radiographs were requested online; supporting the validity of the study with regard to the number of radiographs performed and their respective indications. A representative profile of indications was successfully obtained; which can assist with the implementation of further research on the stratification of radiation exposure according to indications for radiographs

Oxidative degradation of indigocarmine by hypochlorite--a tool for determination of hypochlorite in commercial samples.

The oxidative action of hypochlorite on indigocarmine is investigated. Hypochlorite dissociates indigocarmine to produce isatin-5-monosulphonic acid, with a stoichiometry of 2:1. The probable mechanism is proposed. The suitability of reaction between hypochlorite and indigocarmine as an indicator reaction for the determination of high levels of hypochlorite in synthetic and commercial samples is investigated. A simple and reliable kinetic-analytical method is developed for the determination of hypochlorite ion at alkaline pH, based on its oxidizing activity.

Cost analysis of the basic package, resource utilisation and financing of health services at Halley Stott Health Centre and Umbumbulu Clinic in KwaZulu-Natal.

OBJECTIVES: A cost analysis study compared the package of health services, costs, resource utilisation (drugs and staff) and financing mechanisms at Halley Stott Health Centre and Umbumbulu Clinic with those of other primary care providers in KwaZulu-Natal. Options identified were used to improve efficiency, resource allocations and financing of health services in KwaZulu-Natal. DESIGN/OUTCOME MEASURES: The direct accounting method was used to calculate unit costs for the following cost centres--paediatrics and adult curative consultations, antenatal/postnatal care, family planning, the under-5s clinic and the mobile services. Staff efficiency was assessed using the Centre for Health Policy method based on workload estimates, while the International Network for the Rational Use of Drugs indicators were used to assess the efficiency of drug usage. RESULTS: There was considerable variation in the package of services provided at all the health facilities; the average costs ranged from R5.94 to R134.76 and the unit costs ranged from R29.30 to R161.92 for curative care. The bulk of the resources (64-73%) were spent on personnel costs, providing mainly curative care. Under-utilisation of antenatal care, the under-5s clinic and paediatric consultations were reflected in reduced time utilisation and lower levels of staff efficiency, while family planning services were over-utilised, which reflected a relative staff shortage. The components of health services provided at the two health facilities exceeded those recommended by the World Bank. CONCLUSIONS: Cost analysis has the potential to quantify staff and drug efficiency, facilitate resource allocation and improve health service efficiency. Defining the package of health services for each province contributes to the development of the nationally agreed basic package of health services, and enables managers and policy-makers to choose different options rationally, control costs, shift resources and achieve equity.

Perceptions and knowledge about AIDS among family planning clinic attenders in Johannesburg.

Many studies assessing the impact of national AIDS prevention programmes on knowledge, attitudes and practices have been published world-wide. Most have found that, while general knowledge increased, there was little change in behaviour. A survey of a random sample of 50 women attending a family planning clinic in Johannesburg determined the current knowledge, attitudes and practices of these sexually active women, aged 20-29 years. All selected respondents agreed to participate and a pretested structured questionnaire was completed. Most individuals had in excess of 7 years' schooling (78.0%), were single (58.0%) and domestic workers (28.6%). The majority were aware of AIDS (88.0%), but only 13.7% felt their knowledge was adequate. Fifty-two per cent knew sexual intercourse was a mode of transmission. Many misconceptions existed, 64.0% cited toilet seats, 47.1% sharing of utensils and 70.1% donating blood as routes by which HIV infection could be acquired. Only 47.1% and 34.1%, respectively, knew that the contraceptive pill and intra-uterine contraceptive device did not protect against HIV infection. Eighty-six per cent of the women were sexually active and 8.0% admitted to currently having more than one sexual partner. None used condoms and, generally, feelings regarding condom use were negative. Most (88.6%) believed AIDS patients should be hospitalised, 68.2% said in isolation wards, and 27.3% felt that AIDS patients should not be allowed to stay in the community. The implications of these findings are discussed and certain recommendations are made.