Neurological manifestations of syphilis-HIV coinfection in South Africa.

OBJECTIVE: Syphilis and HIV coinfection is highly prevalent in South Africa, and both can cause neurological complications. We describe the clinical presentation and outcome of neurosyphilis in patients with and without HIV coinfection diagnosed at a tertiary facility, Groote Schuur Hospital (GSH), in South Africa. METHODS: We retrospectively analyzed folders of adults with positive cerebrospinal fluid (CSF) fluorescent treponemal antibody absorption test in 2018 and 2019, with follow-up data collected until 2022. RESULTS: HIV-coinfection was identified in 35% of the 69 included patients. Patients with HIV-coinfection were more likely to be female (58% vs 25% female, p < 0.01), and present earlier (median age = 31 years vs. 40 years, p < 0.001). Neuropsychiatric manifestations (confusion, dementia, psychosis), and strokes were the commonest clinical presentations in both groups. Those with HIV-coinfection were significantly less likely to be diagnosed with neurosyphilis by the treating clinician (71% vs. 91%, p < 0.05), as were those with a negative CSF Venereal Disease Research Laboratory (74% vs. 94%, p < 0.05). Accurate diagnosis of neurosyphilis was associated with an increased 12-month survival (alive: N = 36 [63%]) relative to those who did not receive an accurate diagnosis (alive: N = 2 [17%], p < 0.05). Those who were optimally treated with antibiotics had significantly higher 12-month survival (alive: N = 33, 63%) compared to those with suboptimal treatment (alive: N = 5, 29%), p < 0.01. CONCLUSION: Neurosyphilis presented similarly in those with and without HIV-coinfection. Accurate identification and optimal antibiotic treatment of neurosyphilis, particularly in CSF VDRL negative patients and those with HIV-coinfection, is necessary to improve patient survival.

Post-TB health and wellbeing.

TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the '1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

Presentation and outcome of patients with intracranial tuberculoma in a high HIV prevalence setting.

SETTING: A referral hospital in South Africa.OBJECTIVE: To describe the clinical presentation, serial brain imaging findings during treatment and outcome of patients with intracranial tuberculoma in a high human immunodeficiency virus (HIV) prevalence setting.DESIGN: This was a retrospective observational study conducted over a 12.5-year period. Records of adults (age ≥18 years) who presented with neurological TB were screened. We included patients with tuberculoma in whom sequential brain imaging was performed.RESULTS: Of 66 patients enrolled, HIV status was known in 61; 47 (71%) were HIV-infected and 14 (21%) were non-HIV-infected. Clinical and imaging findings and outcomes were similar between these groups. Persistent tuberculoma was present at 18 months follow-up in 20/41 (49%) patients who underwent repeat imaging at that timepoint; those with persistent tuberculoma were more likely to have persisting neurological abnormalities (85% vs. 52%; P = 0.043). Larger tuberculoma size at presentation (≥3 cm) was the only factor significantly associated with tuberculoma persistence (multivariable logistic regression, OR 19.9, 95%CI 1.27-309.68; P = 0.033).CONCLUSION: Tuberculoma is a severely disabling TB manifestation regardless of HIV coinfection, with half of patients showing radiologically persistent lesions at 18 months follow-up. Large size of tuberculoma at presentation heralds lower chance of its resolution within 18 months.

Determination of lovastatin, mevastatin, rosuvastatin and simvastatin with HPLC by means of gradient elution.

A novel HPLC method with UV detection was developed and validated in skin penetration (in vitro) studies to identify and quantify lovastatin, mevastatin, rosuvastatin and simvastatin. A Venusil XBP C18 (2), 150 x 4.6 mm, 5 µm column (Agela Technologies, Newark, DE) was used with gradient elution (start at 45 % acetonitrile and increase linearly to 90 % after 1 min; hold at 90 % until 6 min and then re-equilibrate at start conditions) and the mobile phase consisted of (A) Milli-Q ® water and 0.1% orthophosphoric acid, and (B) HPLC grade acetonitrile. The flow rate was set at 1 ml/min, 240 nm UV detection and an injection volume of 10 µl. Linearity was obtained over a range of 0.50-200.00 µg/ml and correlation coefficients ranging from 0.998-1.000 were obtained. Average recovery ranged from 95.9-100.6 %. The LOD and LOQ values obtained from the slope of a calibration curve and the standard deviation of the response ranged from 0.0138-0.0860 µg/ml and 0.0419-0.2615 µg/ml, respectively, where lovastatin and simvastatin could be detected at a concentration similar to the other statins, but could only be quantified at a higher concentration than the remaining statins. The specificity of the method was proved as accurate and quantification of statins was found, even within the incorporation of other compounds.

Sulfonic Membrane Sorption and Permeation Properties: Complementary Approaches to Select a Membrane for Pervaporation.

In this contribution, the physical and chemical properties of the dense sulfonic membrane IonClad R4010 in the lithium form were studied to evaluate its potential application in pervaporation. To develop new membrane materials, it is necessary to know the influence of the membrane structure on the membrane equilibrium and transport properties. For this purpose, the sorption and permeation measurements of water and methanol in the liquid and vapor states were performed and correlated to the ion pairs/solvent interactions analyzed by the infrared spectroscopy. The IonClad R4010 equilibrium and transport properties were found to be quite different depending on the permeant nature. The sorption and diffusion behavior of water and methanol was well described by means of the type II sorption model (BET theory). The swelling capacity of the IonClad R4010 membrane in methanol was found to be much lower than that in liquid water. In contrast to methanol, the total dissociation of the ion pairs in the IonClad R4010 membrane was obtained in the presence of water but only at high activity (∼0.8). Besides, the dispersion of the water molecules in the membrane was found to be homogeneous. The infrared spectroscopy results revealed that the methanol molecules had weaker interactions with the sulfonic groups of IonClad R4010 in agreement with the sorption data. The permeation properties were investigated by means of the sweeping gas and gravimetric methods in order to evaluate the membrane performance for pervaporation. The permeation results are in accordance with those obtained by sorption, thus confirming the complementariness of the two approaches.

Layered Poly(ethylene-co-vinyl acetate)/Poly(ethylene-co-vinyl alcohol) Membranes with Enhanced Water Separation Selectivity and Performance.

A three-layered membrane based on poly(ethylene-co-vinyl acetate) (EVA) and hydrolyzed EVA-poly(ethylene-co-vinyl alcohol) (EVOH), was elaborated by the surface hydrolysis of a dense EVA membrane. Because of the chemical modifications, the three-layered EVOH/EVA/EVOH membrane was characterized by the particular microstructure (amorphous EVA and semicrystalline EVOH) and the tunable hydrophilic/hydrophobic balance. Also, these modifications led to the membrane with the selective barrier properties compared with the pure EVA and completely hydrolyzed EVOH membranes. The water barrier behavior was related to the strong hydrogen-bond interactions of water and vinyl alcohol groups, whereas the weak chemical interactions were revealed for gases (N2 and O2). Furthermore, the influence of the polymer rubbery or glassy state on the permeation kinetics was established. In the case of the three-layered membrane, the considerably high selectivity values were obtained for H2O/O2 (∼11 900) and H2O/N2 (∼48 000) at 25 °C. In addition to these highly selective properties, the three-layered structure does not present delamination features due to its elaboration procedure. Thus, these new layered membranes are very promising as selective materials for the water and gas separation and can be potentially used in food packaging or for the gas dehydration.

Water sorption behaviour of two series of PHA/montmorillonite films and determination of the mean water cluster size.

Biodegradable polyester-based films constituted of poly(hydroxyalkanoates) (PHA) were successfully extruded with various Cloisite 30B contents. The morphology was highly dependent on the matrix, poly(3-hydroxybutyrate-co-3-hydroxyvalerate) and poly(3-hydroxybutyrate-co-4-hydroxybutyrate), the polymer crystalline phase fraction, the matrix/nanoclay interfacial regions as well as the nanoclay content. Water vapour resistance was investigated through sorption kinetics, isotherms, modelling aspect, and diffusivity. A typical sigmoid-shaped isotherm was obtained in every case. It emerges that the nanoclay highly contributed to the increase of water solubility of matrices. The dependence of polymer crystallinity on the affinity of the nanocomposite films for water was highlighted. Thermodynamic and kinetic contributions of the sorption process were also correlated with the film morphology. According to the matrix used, water diffusivity in films was differently impacted by the sorbed water amount. The access of sorbed water molecules within films was examined through a mathematical modelling approach and the deduced mean cluster size of water vs. its activity was corroborated by sorption kinetics.

Structure-barrier property relationship of biodegradable poly(butylene succinate) and poly[(butylene succinate)-co-(butylene adipate)] nanocomposites: influence of the rigid amorphous fraction.

Composites composed of polyesters, poly(butylene succinate) (PBS) or poly[(butylene succinate)-co-(butylene adipate)] (PBSA), and 5 wt% of montmorillonite (CNa) or organo-modified montmorillonite (C30B) were melt-processed and transformed into films by either compression-molding or extrusion-calendering. XRD, rheological measurements and TEM images clearly indicated that films containing CNa are microcomposites, while nanocomposites were observed for those containing C30B. Using Flash DSC, it was possible, for the first time, not only to measure the heat capacity step at the glass transition of these two materials in their amorphous state, but also to investigate whether the preparation technique influenced the Rigid Amorphous Fraction (RAF) in our PBS- and PBSA-based nanocomposites. In this work, we have successfully shown the correlation between the microstructure of the films and their barrier properties, and especially the role played by the RAF. Indeed, the lowest permeabilities to gases and to water were determined in the films containing the highest RAF in both PBS- and PBSA-based materials.

Tunable water barrier properties of EVA by clay insertion?

Organo-modified Cloisite clays at varying contents were incorporated into poly(ethylene-co-vinyl acetate) (EVA) by melt blending. Nanoclay dispersion in films was first evaluated. The water transport properties were investigated by pervaporation and sorption measurements. A decrease of the water permeation flux was obtained when incorporating nanoparticles. This barrier effect is usually attributed to the increase of the diffusion pathways due to nanoclay-induced tortuosity effects. However, the diffusion coefficient was found to be dependent on water concentration, which generally reflects a plasticization effect of water. Besides, at 7 wt% of loading, an unexpected increase of water diffusivity was measured with a time-scale shift of the permeation flux. This was correlated with the formation of preferential diffusion pathways along interfacial regions due to free volumes existing between the EVA matrix and nanoclays as well as the water affinity of microfillers. As a consequence, water mass gain was found to be increased. The water-induced plasticization of sorbed water molecules was also highlighted through sorption kinetics. Eventually, some applications to these films in which water barrier behaviour is required were discussed.

Poly(3-hydroxybutyrate-co-4-hydroxybutyrate) based nanocomposites: influence of the microstructure on the barrier properties.

Poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (P3HB-co-4HB) films containing various contents of organo-modified montmorillonite C30B nanoclays were prepared by melt intercalation. Wide angle X-ray diffraction measurements and transmission electron microscopy observations evidenced aggregated and intercalated structures with individual nanoclay platelets in the nanocomposites and an orientation of nanoclays. Differential scanning calorimetry measurements showed that the nanoclay did not influence the crystalline structure of the matrix because it is mainly located in the polymer amorphous phase. The influence of the filler on the barrier properties of the film was evaluated by water diffusion, gas permeation (CO2, N2, O2) and liquid water sorption measurements. A decrease of the N2 permeability was measured due to the tortuosity effect of the filler associated with a decrease of the solubility within the matrix. The influence of the filler was more marked for O2 due to the larger decrease of O2 solubility. In contrast, the CO2 permeability increased whatever the filler content because of a facilitated transport mechanism due induced by the presence of quaternary ammonium cations on the C30B surface. The decrease of the water permeability with the filler was explained by a competition between the kinetic (diffusivity) and thermodynamic (solubility) contributions defining the permeability process.

Pressure impact of autoclave treatment on water sorption and pectin composition of flax cellulosic-fibres.

The tensile properties of flax fibres might permit them to be used in composites as reinforcement in organic resin, as long as their mechanical properties are reproducible and their water sorption are reduced. In this study, to minimise the variability of mechanical properties, several samples of flax fibres were blended as a non-woven fabric. In order to reduce the water absorption of this non-woven technical fibres, an autoclave treatment was performed which was expected to remove the pectins and then to reduce the water sorption on their negative charges. The impact of autoclave pressure (0.5, 1 and 2 bars) on water sorption was investigated by using a gravimetric static equilibrium method. The Park model based on the three sorption modes: Langmuir, Henry's law and clustering, was successfully used to simulate the experimental sorption data. The lowest pressure treatments impacted only the Langmuir contribution while the 2 bar autoclave-treatment positively impacted the water resistance in the core of fibres by reducing Henry's absorption rate. This was shown to be related to the chemical modifications at the surface and in the core of fibres. A schematic model is presented relating the water sorption and the pectic composition of the fabric.

Unwanted pregnancies in Gauteng and Mpumalanga provinces, South Africa: examining mortality data on dumped aborted fetuses and babies.

BACKGROUND: Across the world, millions of women unintentionally become pregnant and decide to terminate the pregnancy. Despite progressive abortion laws in South Africa (SA), evidence suggests that many women of all ages still resort to unsafe terminations outside legal, designated facilities. Media reports alert the public to an increase in the illegal dumping of fetuses and abandoned babies, suggesting an increase in unsafe termination practices as well as concealed births. OBJECTIVE: To examine mortality data to identify trends in the dumping of aborted fetuses and abandoned babies in SA. METHOD: This study utilised data from the National Injury Mortality Surveillance System in two provinces, namely Gauteng and Mpumalanga. A total sample of mortality data was used to analyse trends associated with this phenomenon from 2009 to 2011. Descriptive, exploratory statistics were used and included the calculation of crude population incidence rates for abortions and abandoned babies as well as figures (n) and percentages (%) for each category under investigation. RESULTS: An increase in the rate of discovery of non-viable fetuses was noted for both provinces over the 3-year period, while there was a significant decrease in the discovery of deceased abandoned babies in Gauteng only. CONCLUSION: The illegal dumping of fetuses and babies is a very real public health concern in both Gauteng and Mpumalanga. Information is insufficient for adequate surveillance, and improved data collection systems should be prioritised.

Management and control of agri-chemical pesticides: any progress?

Issues related to agri-chemical pesticides usage and poisonings in South Africa have been well documented. Under-reporting of information required to determine the size of the problem complicates current surveillance and prevention programmes. The study aimed to determine: the procedure for reporting and follow-up of cases of agricultural pesticide poisonings; which factors contributed to the poisoning cases; and whether a biological monitoring programme was in place at the time of 110 reported cases of agri-chemical poisonings on farms in the Boland Health District between 1997 and 2000. A retrospective descriptive survey design involving a record review was applied. The study found that the cases were poorly reported. The follow up system at the local level between local government officials and the farmers was not efficient for the prevention of agrichemical poisonings. The contributory factors were insufficient information and training; the incorrect use of personal protective equipment; the lack of safety of the agri-chemical store; and the absence of a monitoring system on the majority of farms. This study demonstrated that the notification of agricultural chemical poisoning was applied in a fragmentary manner between the different governmental levels and departments

Pectinase treatments on technical fibres of flax: Effects on water sorption and mechanical properties.

This study is focused on enzymatically upgrading the functional properties of flax fibres. Green flax fibres were treated with a polygalacturonase and a pectate lyase (PaL) and their properties were compared with dew-retted fibres. Morphological observations, vapour-sorption analyses and mechanical measurements showed that PaL-treatment was able not only to mime retting in terms of bundle division, but also to improve the mechanical properties of technical fibres. Conversely, these properties were shifted down after the polygalacturonase treatment, mainly due to the presence of contaminating glycanases. At the level of the elementary fibres, nanoindentation data indicated the highest stiffness of the secondary wall for PaL-treated fibres. The tensile properties exhibited equal, but moderate values of the Young's modulus (∼37±14GPa) and breaking strength (∼650±300MPa) for retted and PaL-treated fibres; we hypothesize an impact of the growth conditions on the fibre chemical structure with an excess of matrix pectins compared to the amount of glucomannan coating the cellulose microfibrils.

The neural correlates of intimate partner violence in women.

OBJECTIVE: To examine hippocampal volume and white matter tracts in women with and without intimate partner violence (IPV). METHOD: Nineteen women with IPV exposure in the last year, and 21 women without IPV exposure in the last year underwent structural magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) sequences. Additional data on alcohol use and presence of psychiatric disorder was collected. Differences in fractional anisotropy (FA) between the two groups were examined, using a statistical model that included demographic measures, alcohol use and psychiatric disorder. RESULTS: IPV subjects did not demonstrate significantly different hippocampal volumes compared to subjects without recent IPV. FA was, however, significantly reduced in the body of the corpus callosum of IPV subjects. Adjusting for age, alcohol use, smoking and psychiatric diagnosis did not change the significance of the result. CONCLUSION: Data on hippocampal volume in IPV are inconsistent, perhaps reflecting the fact that multiple factors influence this measure. Reduced FA in the body of the corpus callosum in IPV suggests altered integrity of this white matter tract; additional work is needed to address the underlying mechanisms and clinical correlates of this finding.

Effects of Non-Thermal Mobile Phone Radiation on Breast Adenocarcinoma Cells

Mobile phone usage currently exceeds landline communication in Africa. The extent of this usage has raised concerns about the long-term health effects of the ongoing use of mobile phones. To assess the physiological effects of radiation from mobile phones in vitro; MCF-7 breast adenocarcinoma cells were exposed to 2W/kg non-thermal 900-MHz mobile phone radiation. The effects investigated were those on metabolic activity; cell morphology; cell cycle progression; phosphatidylserine (PS) externalisation and the generation of reactive oxygen species and nitrogen species. Statistically insignificant increases in mitochondrial dehydrogenase activity were observed in irradiated cells when compared to controls. Fluorescent detection of F-actin demonstrated an increase in F-actin stress fibre formation in irradiated MCF-7 cells. Cell cycle progression revealed no statistically significant variation. A small increase in early and late apoptotic events in irradiated MCF-7 cells was observed. No statistically significant changes were observed in reactive oxygen and reactive nitrogen species generation. In addition; quantitative and qualitative analyses of cell cycle activity and nuclear and cytosolic changes; respectively; revealed no significant changes. In conclusion; exposure to 1 h of 900-MHz irradiation induced an increase in PS externalisation and an increase in the formation of F-actin stress fibres in MCF-7 cells. Data obtained from this study; and their correlation with other studies; provides intriguing links between radio frequency radiation and cellular events and warrant further investigation

Transport mechanisms of small molecules through polyamide 12/montmorillonite nanocomposites.

The aim of this work is to study the transport of small molecules through the hybrid systems polyamide 12 (PA12)/organo-modified montmorillonite (Cloisite 30B, C30B) prepared by melt blending, using two blending conditions. The transport mechanisms were investigated by using three probe molecules: nitrogen, water, and toluene. While a barrier effect appears clearly with nitrogen, this effect changes with the amount of fillers for water and disappears for toluene. The reduction of permeability for nitrogen is mainly due to the increase of tortuosity. For water and toluene, the permeation kinetics reveals many concomitant phenomena responsible for the permeation behavior. Despite the tortuosity effect, the toluene permeability of nanocomposites increases with C30B fraction. The water and toluene molecules interact differently with fillers according to their hydrophilic/hydrophobic character. Moreover, the plasticization effect of water and toluene in the matrix, involving a concentration-dependent diffusion coefficient, is correctly described by the law D = D(0)e(gammaC). On the basis of Nielsen's tortuosity concept, we suggest a new approach for relative permeability modeling, not only based on the geometrical parameters (aspect ratio, orientation, recovery) but also including phenomenological parameters deduced from structural characterization and permeation kinetics.

In vitro effects of 2-methoxyestradiol on morphology, cell cycle progression, cell death and gene expression changes in the tumorigenic MCF-7 breast epithelial cell line.

In the present study, the antiproliferative mechanism of action of 1 microM 2-methoxyestradiol (2ME) was investigated in the MCF-7 cell line. Measurement of intracellular cyclin B and cytochrome c protein levels, reactive oxygen species formation, cell cycle progression and apoptosis induction were conducted by means of flow cytometry. Morphological changes were evaluated using transmission electron microscopy and fluorescent microscopy by employing Hoechst 33342 and acridine orange. Gene expression changes were conducted by means of microarrays. 2ME-treated cells demonstrated an increase in cyclin B protein levels, hydrogen peroxide formation, intracellular levels of cytochrome c, as well as an increase in early and late stages of apoptosis. In addition, morphological data revealed the presence of autophagic processes. Fluorescent microscopy showed an increase in acridine orange staining and electron microscopy revealed an increase in vacuolar formation in 2ME-treated cells. The gene expression of several genes associated with mRNA translation, autophagy-related processes and genes involved in microtubule dynamics were affected. The study contributes to the mechanistic understanding of 2ME's growth inhibition in MCF-7 cells and highlights the possibility of both apoptotic and autophagic processes being activated in response to 2ME treatment in this cell line.

Neuroradiological features of the tuberculosis-associated immune reconstitution inflammatory syndrome.

SETTING: Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important complication in human immunodeficiency virus type I (HIV-1) infected tuberculosis (TB) patients who start combination antiretroviral treatment (ART). Neurological manifestations occur in more than 10% of TB-IRIS cases. Apart from a few case reports, the radiological features of neurological TB-IRIS have not been described. OBJECTIVE: To describe the neuroradiological findings of patients with paradoxical neurological TB-IRIS. DESIGN: Computed tomography (CT; n = 13) and magnetic resonance imaging (n = 3) findings of 16 patients were reviewed. RESULTS: IRIS manifestations included meningitis (n = 4), intracranial space occupying lesions (SOLs, presumed tuberculomas; n = 5), meningitis and SOLs (n = 5), radiculomyelitis (n = 1) and spondylitis (n = 1). In patients with tuberculoma IRIS, we observed a high prevalence of 1) low density lesions on non-contrast-enhanced CT (all lesions), 2) multiple lesions (in 5/10 patients) and 3) perilesional oedema (17/22 lesions). In patients with meningitis, meningeal enhancement (n = 2) and hydrocephalus (n = 1) were infrequently observed. CONCLUSION: This is the first substantial series to describe the radiological features of paradoxical neurological TB-IRIS. Compared to published radiological findings of tuberculomas in HIV-1-infected patients (not receiving ART), an increased inflammatory response is suggested in tuberculoma IRIS. However, this was not observed in patients with TB meningitis IRIS.

Effect of chemical treatments on water sorption and mechanical properties of flax fibres.

In this work, in order to improve the adhesion between a polyester matrix (unsaturated polyester resin) and flax fibres (Linum usitatissimum L.) and to increase their moisture resistance, chemical surface treatments have been used. These different treatments were performed with maleic anhydride (MA), acetic anhydride (Ac), silane (Si) and styrene (S). The modified flax fibres were characterized by means of infrared spectroscopy and surface energy analysis. The effect of these treatments on water sorption was investigated by using a gravimetric static equilibrium method. Water sorption isotherms were derived from kinetic data. The Park model based on the three sorption modes: Langmuir, Henry's law and clustering, was successfully used to simulate the experimental sorption data. It was found that the (Ac) and particularly (S) treatments reduced overall water uptake of flax fibres. We show that tensile modulus, breaking strength and breaking strain depend on the chemical treatment used.