Using family and staff experiences of a botulinum toxin-A service to improve service quality.

BACKGROUND: The decision for families to proceed with botulinum toxin-A (BoNT-A) injections for managing childhood conditions involving hypertonia can be complex. Family-centred care is a service model that facilitates supporting families in this decision-making process. Understanding families' experiences of services is critical to developing family-centred care. The aim of this project was therefore to increase understanding of the experiences of families of children attending a BoNT-A service in order to improve the service and its family-centred approach to care. METHOD: Sixteen staff of a BoNT-A service participated in a patient journey mapping exercise. Nine families of the service participated in in-depth interviews. Interviews were audio-recorded and transcribed verbatim. Data from the staff session and interviews were analysed independently using grounded, hermeneutic thematic analysis. RESULTS: Staff sessions revealed 5 core themes that related to impacting on the family experience. Family interviews revealed 4 core themes, with 7 subthemes and 1 latent theme. CONCLUSIONS: Areas of importance identified by families relating to BoNT-A treatment included acknowledgement of individual needs, care coordination, empowerment of families and patients, consistency in service delivery, and the distressing nature of appointment and decision-making. Comparison of the data from the staff patient journey mapping and family interviews suggested that staff have a good but incomplete understanding of the factors important to families, highlighting the need for consumer engagement in establishing family-centred care. The themes identified can guide the provision of family-centred BoNT-A injection clinics.

Experimental infection of common warthogs (Phacochoerus africanus) and bushpigs (Potamochoerus larvatus) with classical swine fever virus. I: Susceptibility and transmission.

An incursion of classical swine fever virus (CSFV) into the domestic pig population in South Africa, identified in 2005, raised the concern that infection might spread to wildlife species and be maintained in these hosts. This study sought to determine whether two wildlife Suidae species present in South Africa, the bushpig (Potamochoerus larvatus) and the common warthog (Phacochoerus africanus), could support productive CSFV infection. Both species could be infected with CSFV and transmitted infection to in-contact animals of the same species. Viral antigen and RNA genome were detected in blood/serum and animals that survived initial infection seroconverted approximately 10-14 days post-inoculation. Viral RNA remained detectable in nasal and saliva secretions for prolonged periods until monitoring ended at 42-44 days after initial challenge. These data suggest that both Suidae species could serve to spread circulating CSFV within wild populations, with implications for disease control.

Experimental infection of giraffe (Giraffa camelopardalis) with SAT-1 and SAT-2 foot-and-mouth disease virus.

The potential role of giraffe (Giraffa camelopardalis) in the epidemiology and spread of foot-and-mouth disease (FMD) SAT types was investigated by experimental infection and detection of virus in excretions using virus isolation on primary pig kidney cell cultures. In two experiments separated by a period of 24 months, groups of four animals were needle infected with a SAT-1 or SAT-2 virus, respectively and two in-contact controls were kept with each group. Viraemia was detected 3-9 days post-infection and virus isolated from mouth washes and faeces only occasionally up to day 13. The SAT-1 virus was transmitted to only one in-contact control animal, probably via saliva that contained virus from vesicles in the mouth of a needle-infected animal. None of the animals infected with the SAT-2 virus had any vesicles in the mouth, and there was no evidence of transmission to the in-contact controls. No virus was detected in probang samples for the duration of the experiments (60 days post-infection), indicating that persistent infection probably did not establish with either of these isolates. Giraffe most likely do not play an important role in FMD dissemination. Transmission of infection would possibly occur only during close contact with other animals when mouth vesicles are evident.

Longitudinal study to investigate the role of impala (Aepyceros melampus) in foot-and-mouth disease maintenance in the Kruger National Park, South Africa.

A longitudinal study was performed in the Kruger National Park, South Africa to investigate the role of impala (Aepyceros melampus) in maintaining SAT serotypes of foot-and-mouth disease (FMD) virus. Three sampling sites with different histories of FMD outbreaks in impala and also of varying ecology were chosen. At three monthly intervals approximately 40 impala were bled and examined for clinical FMD at each of these sites for a period of 6 years, followed by 4 years of less frequent sampling. During the 10 years of the study, clinical disease was only observed once at a single sampling site, while at two of the three locations, serological evidence of infection was detected; in one locality this was a frequent occurrence. The discrepancy between clinically evident disease and serological evidence of infection indicated that sub-clinical infection with these viruses may be more regular than previously suspected. Furthermore, there was evidence that either SAT-serotype infection is maintained within local impala populations for prolonged periods or that re-infection of impala by buffalo occurs repetitively, sometimes at frequent intervals. A mixed-effects logistic regression model showed that females and older animals had a higher risk of seropositivity, while summer and autumn also represent periods when there is a heightened risk of seropositivity (as opposed to winter and spring which previous studies had shown to be associated with clinical disease). Comparison of impala and buffalo ratios in the three sampling regions indicated that the higher the impala density, the more likely disease transmission is from buffalo to impala, and that this is independent of buffalo numbers (presumably above an undetermined threshold). This study confirmed the potential role of impala for propagating FMD in southern Africa and this factor should therefore be considered when designing control strategies where wildlife and domestic animals interact.

Morphology and histochemistry of the glandular trichomes of Lippia scaberrima (Verbenaceae).

BACKGROUND AND AIMS: Lippia scaberrima, an aromatic indigenous South African plant, with medicinal application, potentially has economic value. The production of essential oil from this plant has not been optimized, and this study of the chemico-morphological characteristics was aimed at determining the location of oil production within the plant. Furthermore, the locality of other secondary metabolites important in medicinal applications needed to be ascertained. This information would be useful in deciding the protocol required for isolation of such compounds. METHODS: The morphology of the glandular trichomes was investigated using a combination of scanning electron and light microscopy. Concurrently, the chemical content was studied by applying various chemical reagents and fluorescence microscopy. KEY RESULTS: Three types of trichomes were distinguished on the material investigated. Large, bulbous peltate glands containing compounds of terpenoid nature are probably the main site of essential oil accumulation. Small glands were found to be both peltate and capitate and fluorescent stain indicated the possible presence of phenolic compounds. The third type was a slender tapered seta with an ornamented surface and uniseriate base, and evidently secretory in nature. CONCLUSIONS: This study linking the chemical content and morphology of the glandular trichomes of L. scaberrima has contributed to the knowledge and understanding of secretory structures of Lippia spp. in general.

Characterisation of a SAT-1 outbreak of foot-and-mouth disease in captive African buffalo (Syncerus caffer): clinical symptoms, genetic characterisation and phylogenetic comparison of outbreak isolates.

African buffalo (Syncerus caffer) play an important role in the maintenance of the SAT types of foot-and-mouth disease (FMD) in southern Africa. These long-term carriers mostly become sub-clinically infected, maintaining the disease and posing a threat to other susceptible wildlife and domestic species. During an unrelated bovine tuberculosis experiment using captive buffalo in the Kruger National Park (KNP), an outbreak of SAT-1 occurred and was further investigated. The clinical signs were recorded and all animals demonstrated significant weight loss and lymphopenia that lasted 100 days. In addition, the mean cell volume and mean cell haemoglobin values were significantly higher than before the outbreak started. Virus was isolated from several buffalo over a period of 167 days post infection and the molecular clock estimated to be 3 x 10(-5) nucleotide substitutions per site per day. Seven amino acid changes occurred of which four occurred in hypervariable regions previously described for SAT-1. The genetic relationship of the outbreak virus was compared to buffalo viruses previously obtained from the KNP but the phylogeny was largely unresolved, therefore the relationship of this outbreak strain to others isolated from the KNP remains unclear.

An investigation into natural resistance to African swine fever in domestic pigs from an endemic area in southern Africa.

A population of domestic pigs in northern Mozambique with increased resistance to the pathogenic effects of African swine fever (ASF) virus was identified by the high prevalence of circulating antibodies to ASF virus. An attempt was made to establish whether the resistance in this population was heritable. Some of these pigs were acquired and transported to a quarantine facility and allowed to breed naturally. Offspring of the resistant pigs were transferred to a high security facility where they were challenged with two ASF viruses, one of which was isolated from one of the Mozambican pigs and the other a genetically closely-related virus from Madagascar. All but one of the 105 offspring challenged developed acute ASF and died. It therefore appears that the resistance demonstrated by these pigs is not inherited by their offspring, or could not be expressed under the conditions of the experiment. The question remains therefore as to the mechanism whereby pigs in the population from which the experimental pigs were derived co-existed with virulent ASF viruses.

An appropriate method for extracting the insect repellent citronellol from an indigenous plant (Pelargonium graveolens L'Her) for potential use by resource-limited animal owners.

Veterinary needs appraisals in rural, peri-urban and urban areas have indicated a need for affordable and accessible veterinary health care. It was also found that farmers and animal owners used indigenous plants for treating animals. In Africa, insects such as Culex, Culicoides and Stomoxys may transmit diseases, cause irritation to animals or prevent wound healing. Insect repellents used topically are generally safer and cheaper than insecticides. Using readily available commercial sources of ethanol 43% v/v (brandy and cane spirits), it was shown that citronellol could be extracted from uncrushed leaves of the indigenous shrub Pelargonium graveolens L'Hér. Efficacy of extraction was compared to that using reagent grade absolute ethanol. The peak concentration of citronellol was achieved within 7 days of extraction and thereafter remained constant for 4 months. Extraction methods using tap water and cooking oil were not successful. The extraction was also less successful when the leaves were crushed or macerated before being placed into ethanol. Gas chromatography was used to monitor the concentration of citronellol in the different extracts.

Clinical experience with Repotin, a locally produced recombinant human erythropoietin, in the treatment of anaemia of chronic renal failure in South Africa.

OBJECTIVE: To evaluate the efficacy and safety of Repotin, a locally produced recombinant human erythropoietin (rHuEPO), in the treatment of the anaemia of chronic renal failure (ACRF). DESIGN: The study consisted of two multicentre non-randomised open stages. SETTING: Renal units at several teaching hospitals in South Africa. PARTICIPANTS: Haemodialysis patients with haemoglobin (Hb) levels less than 8.0 g/dl were recruited. The first stage examined 26 patients during a 12-week period in which the dose of intravenous rHuEPO was adjusted according to haematological response. In the second stage 27 patients were stabilised with intravenous rHuEPO and then maintained at a Hb level above 8.0 g/dl by subcutaneous administration for up to 1 year. OUTCOME MEASURES: In both stages, outcome was measured by clinical examination, blood pressure, full haematological parameters and blood chemistry. RESULTS: In stage 1, all patients responded to therapy with a statistically significant increase in Hb from geometric means of 6.28 g/dl to 8.50 g/dl (geometric SDs of 1.17 and 1.20 respectively). The doses used ranged from 25 IU to 125 IU/kg (average 47.1). In the second stage, Hb levels reached a mean of 8.06 g/dl (SD 0.9) and were maintained at target range with an average dose of 55.5 IU/kg three times a week. Apart from changes in serum iron, ferritin (associated with increased haematopoiesis) and potassium, there were no significant alterations in blood chemistry. The incidence of adverse events reported during the 12-month second stage was no greater than that reported for other forms of rHuEPO therapy. CONCLUSION: Repotin is a safe and effective rHuEPO preparation for the treatment of ACRF.

[The rebel ambulance of 1914]. / Die Rebelle-ambulans van 1914

The story of the so-called Rebel Ambulance of 1914 covers a period of about 6 weeks. During this time a group of people in Bloemfontein endeavoured to provide medical cover and comforts for casualties among those who participated in the armed protest of 1914 in the Orange Free State. Information about relevant historical facts, the collection of funds and equipment, and the work of the field ambulance are presented.