SARS-COV-2 (Covid-19) and male fertility: Where are we?

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), a single-stranded RNA virus, was found to be the causal agent of the disease called coronavirus disease. During December 2019, China informed the World Health Organization (WHO) of an outbreak of cases of pneumonia of unknown etiology, which caused severe-acute respiratory distress. The disease was termed coronavirus disease 2019 (Covid-19). Due to alarming levels of spread and severity, on the 11th of March 2020, the WHO declared the outbreak as a global pandemic. As of September 14, 2020, more than 29 million cases have been reported, with over 900,000 deaths globally. Since the outbreak, although not conclusive, discoveries have been made regarding the understanding of the epidemiology, etiology, clinical features, clinical treatment, and prevention of the disease. SARS-COV-2 has been detected in saliva, respiratory fluids, blood, urine, and faeces. Findings are however controversial regarding its presence in the semen or the testis. Hence, this review aimed to further analyse the literature concerning (i) the effects of previously identified human coronaviruses on male fertility (ii) the impact of Covid-19 on male fertility and (iii) the implication for general health in terms of infection and transmission.

'Self-collected upper respiratory tract swabs for COVID-19 test': A feasible way to increase overall testing rate and conserve resources in South Africa.

Disparity in the testing rate of SARS-CoV-2 amongst different countries and regions is a very big challenge in understanding the COVID-19 pandemic. Although some developed countries have a very high testing rate and subsequently a high number of confirmed cases, less developed countries have a low testing rate and an illusive positivity rate. Collection of the upper respiratory specimen is not often comfortable. The discomfort could be accompanied with epistaxis and headache in some patients. The trained personnel taking the swab is forced to protect self with personal protective equipment (PPE) to avoid infections that may result from the patient due to provoked cough, sneezing and spitting. This study looks into an efficient means of increasing the testing rate for COVID 19 without compromising the quality. A literature review was conducted on the different modalities of collecting upper respiratory specimens and assessing the efficacy of samples collected using different methods in terms of the laboratory yield of different pathogens. Self-collection of upper respiratory tract specimen for diagnostic purposes is not new. Studies have demonstrated that trained staff-collected nasal swabs are not in any way superior to self-collected or parent-assisted swabs. The laboratory yield of different specimens is not determined by who took the sample but by the anatomical site from where the specimen was collected. Self collection of the upper respiratory swabs will not only increase the testing rate but also preserve the scarce PPE and reduces health care worker's COVID 19 infection rate in South Africa.

Magnitude, trends and prevention of road traffic accidents in the Republic of South Africa.

Road traffic injuries (RTIs) constitute one of the five major disease burdens in South Africa with high mortality and morbidity. Thus far, the scientific enquiry into this burden has not been accompanied by successful government efforts to meet the challenge. Currently, more than 1.2 million people die and 20-50 million are with disabilities annually country-wide from RTIs. While there is a progressive reduction in mortality related to human immunodeficiency virus (HIV) conditions as a result of interventions, the mortality from RTI is seen to be progressively worsening as a result of increasing motorisation. There are disparities in the burden of RTI across different countries, with low- and middle-income countries bearing the highest burden. In Africa, 24.1 per 100 000 people die annually from RTI compared to 10.3 per 100 000 people in European countries. This opinion article investigates the magnitude, trends and prevention of RTI in South Africa.

Patients' perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa.

BACKGROUND: In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. AIM: This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. SETTING: Gugulethu Community Health Centre, Cape Town. METHODS: A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. RESULTS: All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. CONCLUSION: Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened.

Physiological adaptation to the humid tropics with special reference to the West African Dwarf (WAD) goat.

West African Dwarf (WAD) goats are widely distributed in the subhumid and humid zones of Africa but are particularly associated with less favourable environments. Adaptive features such as feeding behaviour, efficiency of feed use and disease tolerance enable WAD goats to thrive on natural resources left untouched by other domestic ruminants. In marginal environments this goat remains the only domestic species that is able to survive. Among its physiological features small body size and low metabolic requirements are important traits that enable the animal to minimize its requirements in area or season where food sources are limited in quality and quantity. Specialized feeding behaviour and an efficient digestive system enable the animal to maximize food intake. Coat colour plays an important role in the evolved adaptation of this goat type. Reproductive fitness as manifested by prolific breeding is a major factor of adaptation. Defence mechanisms against infectious agents enable this type to thrive well in the hot humid tropics. The mechanisms involved in the regulation of these physiological functions of WAD goat are discussed. An understanding of these mechanisms could result in the development of improved techniques for enhancing goat productivity in humid environments.

Antinociceptive effect of Russelia equisetiformis leave extracts: identification of its active constituents.

This study examines the antinociceptive effect of the whole plant extracts of Russelia equisetiformis. The result shows the ethylacetate fraction to be the most active, while the dichloromethane fraction exhibited least activity. The major isolated compound from the ethylacetate showed a tremendous activity on acetic acid induced writhing with less activity on tail-flick response in mice. The structures of the two compounds were assigned on the basis of spectroscopic data. Occurrence of these compounds in Russelia is reported here for the first time, and the results confirm the traditional uses of R. equisetiformis in the treatment of inflammation and pain.

Dermatoglyphics of mothers of Malawian children with spina bifida cystica: a comparative study with female controls.

UNLABELLED: Dermatoglyphic traits are formed under genetic control early in development and do not change thereafter, thus maintaining stability not affected by age. METHODOLOGY: We determined the dermatoglyphic traits of mothers of children with spina bifida cystica and compared then with controls matched for number, age and parity, by counting and classifying palmar, plantar and digital ridge pattern configurations of arches, loops, whorls and ridges based on standard techniques. RESULTS: Palmar pattern types, showed absence of arches, significantly higher frequency of whorls (P > 0.05), lower total finger ridge count (TFRC) and higher Pattern Intensity Index (PII) in these mothers than in the controls (P > 0.001). However, no significant differences were observed between both groups in atd angle and a-b ridge count (P = 130, 0.70 respectively). Plantar pattern types showed loops restricted to the first two digits and absence of arches in the first digit in these mothers compared to controls in whom there were loops in the first four digits and a 100% frequency of arches. Similarly, PII was higher and Dankmeijer's Index (DI) lower in these mothers than in controls. CONCLUSION: Our findings demonstrate dermatoglyphic differences between both groups that suggest that mothers presenting with these traits are more predisposed to giving birth to children with spina bifida cystica.

Quantitative analysis of gait pattern in hemiparetic patients.

OBJECTIVE: To characterise gait pattern in hemiparetic patients quantitatively using clinical footprint method. DESIGN: A case control study. SUBJECTS: Sixteen hemiparetic patients (12 males and 4 females) aged 16 to 64 years who attended neurological clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi. MAIN OUTCOME MEASURES: Stride length, step width, foot rotation angle measured using footprint method. RESULTS: The difference in mean values of the three variables of gait between affected and unaffected sides in hemiparetic patients was not significant. However, strides were significantly longer in controls than in patients (P<0.001) while patients had significantly broader steps (P<0.02). In the controls, foot was rotated externally in 87.7% of steps and internally in 14.3% of steps. In the hemiparetic patients, intoeing pattern was observed in 41.3% of steps. The difference in variability of stride length and foot angle between affected and non-affected sides of patients was not significant. Stride-to-stride variability in stride length in patients was 1.6 times higher than in controls. Variability of step width and foot progression angle was 1.4 and 1.6 times higher in patients than in controls. CONCLUSION: Footprint method provides fast and inexpensive tool for clinical gait analysis and is suitable for evaluation of hemiparetic patients. Our findings suggest that areas of emphasis for physical therapy of hemiparetic patients should include increasing stride length and decreasing step width and internal rotation of foot, particularly on the affected side.

Left-handedness as a risk factor for head injuries.

OBJECTIVE: To study prevalence of left-handedness among traumatic patients with head injuries. DESIGN: A case-control study. SETTING: Queen Elizabeth Central Hospital, Blantyre, Malawi. SUBJECTS: One hundred and sixty three traumatic patients newly admitted to a surgical ward at Queen Elizabeth Central Hospital, Blantyre during one month period with exception of patients with arm injury, severe injury and confused patients. MAIN OUTCOME MEASURES: Maximal grip strength of both hands, questionnaire on hand preferred for eight habitual activities. RESULTS: The overall prevalence of left-handers determined on the basis of bilateral asymmetry in maximal grip strength was non-significantly higher in traumatic than in the control group. Relative to the control group, lefties were over-represented among victims of head injury, while prevalence of left-handers among patients with leg and trunk injuries and among controls was similar. Left-handed patients were more likely to sustain head traumas during fighting, road transport accidents and sport activities. Possible reasons for increased level of traumatisation among sinistrals are discussed. CONCLUSION: Left-handedness is a risk factor for head injuries obtained during confrontational activities. Therefore, left handers should avoid such type of behaviour in order to reduce traumatisation rate.

Management of infantile hydrocephalus in Central Africa.

Hydrocephalus in children in the first year of life in the Central African countries of Malawi, Zambia and Zimbabwe is due mainly to congenital and infective causes. The children first present in hospital around the age of 3 months. The clinical diagnosis is confirmed by cranial ultrasonography. Ventriculo-peritoneal CSF diversion is performed using locally made shunts (Harare, Malawi) which have given satisfactory results comparable to those from conventional shunts. The use of ETV should be explored for the future treatment of hydrocephalus as an alternative to shunting procedures.

Influence of nickel supplementation from nickel sulphate hexahydrate and nickel-sodium monofluorophosphate on the performance of the West African dwarf kids.

The influence of nickel supplementation on the performance of the West African dwarf kids was studied. The investigation involved 12 kids, 3-4 months old with average weight of 5.99+/-0.18kg in a completely randomised design experiment. The treatments consisted of nickel in the forms of nickel-sodium monofluorophosphate (Ni-SMFP) and nickel sulphate hexahydrate (NiSO(4).6H(2)O) added to a corn-based diet at 10ppm of nickel. The control was the corn-based diet with no nickel supplement. Feeding was at 4% of body weight. Parameters for assessment were weight gain, feed intake, nitrogen intake and retention, urea, total protein, creatinine and glucose in serum, haemoglobin, erythrocyte and leucocyte counts. Feed intake, weight gain and nitrogen retention were affected (P<0.05) by treatment, Ni-SMFP having greater (P<0.05) influence than NiSO(4).6H(2)O. Nickel supplementation had no effect on serum creatinine, glucose, haemoglobin, erythrocyte and leucocyte counts. Ni-SMFP may be the better supplementary form of nickel in enhancing the performance of the young kid.

Hydranencephaly in Malawian children.

OBJECTIVE: To show that not all big heads in children are due to hydrocephalus. SETTING: The Queen Elizabeth Central Hospital (QECH), Blantyre, the teaching hospital of Malawi College of Medicine. It is the biggest and leading hospital in Malawi and the major referral centre for the whole country. DESIGN: A prospective study was made of all children who presented at QECH, Blantyre with the diagnosis of hydrocephalus during the study period. SUBJECTS: Fifteen cases of hydranencephaly were encountered. INTERVENTION: All cases of abnormally large heads were investigated with cranial ultrasonography, a few children had air ventriculography and CT scan of the brain. All patients had ventricular aspiration of cerebral spinal fluid (CSF) to verify the colour and condition of the fluid before performing ventriculo-peritoneal shunting for which our locally made Malawi unishunt was used. RESULTS: In hydranencephaly, the brain was found replaced by large fluid-filled cavity in contrast to hydrocephalus where brain was present and ventricular dilatation was encountered. Ventriculo-peritoneal shunting benefited children with hydrocephalus but not those with hydranencephaly. CONCLUSION: Hydranencephaly is one of the causes of abnormal head enlargement in children often confused with hydrocephalus. It is important to recognise hydranencephaly to avoid unnecessary operation which does not help the patient.

Scalp closure without fracture elevation does not reduce the risk of infection in patients with compound depressed skull fractures.

We conducted this study in order to determine whether suturing the scalp wound prior to referral for definitive surgery reduces the rate of wound infection in patients with compound depressed skull fracture and to propose guidelines for the initial management of the wound. We conducted a retrospective analysis of 79 patients with compound depressed skull fractures treated surgically in our unit between January, 1987 and August, 1998 and compared the rate of infection in patients who presented with open wounds with the rate in patients whose scalps were sutured prior to presentation to us. Adults and children were nearly equally represented in this study group. The male to female ratio was 3.6:1. Majority (49/79) of the fractures resulted from vehicular accidents. A total of 27 wounds were infected giving a rate of infection of 34%. Nine of the infections were present pre-operatively while the remaining 18 occurred post-operatively. Of the 52 patients with open wounds (OW) at presentation, 15 had wound infection. In the remaining 27 patients in whom the scalp had been sutured prior to referral (SW), there were 12 wound infections. There was no significant difference in the proportions of infected wounds between the two groups (X2 = 1.92, P > 0.5). In compound depressed skull fractures, suturing the scalp laceration alone prior to referral for definitive surgery did not reduce the rate of infection of the cranial wound. We recommend haemostasis, thorough irrigation of the scalp wound and application of sterile dressings prior to transfer for definitive management, in patients who do not have immediate access to neurosurgical care. Prospective studies are required to validate these findings.

Syndrome of cervical spondylosis in Blantyre, Malawi.

OBJECTIVE: To define the spectrum of clinical and radiological presentations of cervical spondylosis in Malawians. DESIGN: A prospective study. SETTING: The Queen Elizabeth Central Hospital, Blantyre which is the main referral hospital in Malawi and the teaching hospital of Malawi College of Medicine. SUBJECTS: Thirty seven patients (nineteen females and eighteen males) who presented with cervical spondylosis between February 1997 and September 1998. INTERVENTIONS: Treatment was conservative except one patient with cervical myelopathy who had laminectomy. RESULTS: Four of the patients were aged below 40 years; six were in the seventh decade, 13 in the fifth and fourteen in the sixth decades of life. All the 37 patients had discogenic disorder which manifested as brachial neuropathy. In addition, five (13.5%) had cervical myelopathy and two (5.4%) each had vertebro-basilar artery insufficiency, pseudoangina and dysphagia. Anterior osteophytes were three times as common as posterior osteophytes. CONCLUSION: In view of the various manifestations of cervical spondylosis the term cervical syndrome can be aptly applied to this disease.

Protrusion of ventriculo peritoneal shunt through the anus: report of two cases.

Two cases of spontaneous protrusion of the abdominal end of ventriculo peritoneal shunts through the anus are reported in two African children with hydrocephalus. In each case the protruding catheter was easily removed with successful outcome and without recourse to major abdominal surgery. Possible factors suggested that may predispose to this complication of ventriculoperitoneal shunting include a weak bowel musculature in myelomeningocele and the use of stiff peritoneal catheters.

Use of the Malawi shunt in the treatment of obstructive hydrocephalus in children.

In 1992, as a result of shortage of conventional shunts we devised our local Malawi shunt made from siliconised rubber tubing and right angled metal connector between its ventricular and peritoneal parts, like the Harare shunt from which it differs in a few ways. Between 1992 and 1995, eighty four Malawian hydrocephalic children underwent ventriculoperitoneal shunting with the Malawi shunt. The operation was routinely performed by the consultant assisted by residents. Parietal burr hole was made to introduce the ventricular catheter and the peritoneal catheter inserted by open surgery through an incision between the subcostal margin and the umbilicus. The average hospital stay after operation was eleven days. The shunt functioned satisfactorily immediately after insertion in 80% of cases; in the rest there was hyper-drainage which led to cranial collapse. The other complications noted included blockage ten at the proximal end and six at the distal; abdominal wound rupture two cases; shunt disconnection two cases and infection, one case. The blocked shunts were all revised successfully. The cases of cranial collapse recovered without neurological deficits but retained varying degrees of mild to moderate acquired craniostenosis.

Ultrasonographic study of children suspected of hydrocephalus at the Queen Elizabeth Central Hospital in Blantyre, Malawi.

Eighty Malawian children aged below 15 months who presented with rapidly enlarging head and were suspected of having hydrocephalus were investigated with anterior fontanelle ultrasonography at the Queen Elizabeth Central Hospital (QECH), Blantyre. Of the 68 (85%) who were found to have hydrocephalus, 35 (51.5%) were post infective, 14 (20.6%) were associated with lumbosacral myelomeningocele, 13(19.1%) were post haemorrhagic and the rest probably congenital or idiopathic. The remaining 12 patients with macrocephaly but without hydrocephalus comprised six children with hydranencephaly, five with subdural effusion and one with achondroplasia. Ultrasonography of the head is thus a simple, quick, non-invasive, economical diagnostic tool in the management of macrocephaly and to a limited sense as effective as CT scan. Its increased use in the investigation of infantile hydrocephalus is therefore recommended in developing countries with limited resources and without sophisticated imaging techniques.