bluuebunny/crossref_metadata_2025 huggingface dataset:
Enquêter sur la portée politique des rapports en public
Authors: Gayet-Viaud Carole , Bidet Alexandra , Le Méner Erwan
Published: September 2019

Ce dossier propose d’appréhender la sociabilité urbaine comme un centre de perspectives sur la dimension politique de la vie sociale. Les formes et épreuves de la coexistence y sont saisies comme une entrée empirique sur l’expérience du politique en tant que culture. L’hypothèse mise au travail par l’ensemble des contributions est que ces épreuves contribuent à forger l’expérience que chacun a du monde et des autres, à tester le périmètre des responsabilités des uns et des autres, des uns vis-à-vis des autres, quant à ce qui advient sous le regard public. S’y testent ainsi, en situation, des définitions de ce qui peut ou doit être fait en commun et un sens ordinaire de la communauté politique.
Les paradoxes d’une institution militante
Authors: Savinel Bérengère
Published: September 2019

À partir de l’étude de la Délégation aux droits des femmes de l’Assemblée nationale 2012-2017, cet article analyse les modalités de l’institutionnalisation de la cause des femmes au Parlement sous le double prisme des résistances institutionnelles opposées aux militantes de la cause des femmes et des usages stratégiques de la Délégation par ses membres. La mise en évidence de trois postures idéales-typiques des députés de la Délégation (les inactifs.ves, des intermittentes, des porte-parole) permet de penser les conditions de ses usages stratégiques.
Science et techniques au service du public
Authors: Souchier Côme
Published: September 2019

Cet article fait de l’étude du service de synchronisation des horloges à Paris dans les années 1870-1880 une voie d’entrée pour une socio-histoire de l’action publique municipale. Pour mieux comprendre la genèse de ce service public inédit, l’article revient, dans un premier temps, sur l’accroissement des besoins horaires et la diversité des horloges publiques parisiennes de cette période. Un second temps est consacré au rôle décisif des astronomes de l’Observatoire de Paris dans les questions liées à la standardisation horaire et dans la constitution du service public de l’heure. Un dernier temps se concentre sur les modalités d’exercice d’un gouvernement municipal des horloges publiques, en étudiant les relations entre conseillers municipaux, Direction des travaux et une entreprise privée, La Compagnie générale des horloges pneumatiques , qui commercialise un procédé de synchronisation des horloges concurrent de celui du service public. Les hésitations des conseillers et des services techniques de la ville entre deux techniques de synchronisation, électrique et pneumatique, et entre un dirigisme prononcé ou une simple surveillance des activités de La Compagnie témoignent d’une action publique municipale innovante mais qui peine à définir ses objectifs et ses moyens sur un domaine technique.
L’effet des coûts de licenciement sur la durée des emplois des travailleurs peu qualifiés en France
Authors: Cahuc Pierre , Malherbet Franck , Trapp Julien
Published: September 2019

Jusqu’en septembre 2017, les employeurs devaient verser au moins six mois de salaire aux employés dont l’ancienneté était supérieure à deux ans en cas de licenciement sans cause réelle et sérieuse dans les entreprises de plus de 11 salariés. À partir des données du ministère de la justice, nous observons que cette réglementation entraîne une hausse des indemnités de licenciement à deux ans d’ancienneté, ce qui engendre une augmentation significative du taux de destruction d’emplois avant le seuil des deux ans et une baisse juste après. Les coûts de licenciement et leur composante procédurale sont évalués grâce à l’estimation d’un modèle de recherche et d’appariement reproduisant l’évolution du taux de destruction d’emplois. Nous constatons que le coût total des licenciements augmente avec l’ancienneté et qu’il est environ quatre fois plus élevé que les indemnités légales et conventionnelles à deux ans d’ancienneté. Des exercices contre-factuels montrent que la fragilité des emplois de faible ancienneté implique que les coûts de licenciement réduisent la durée moyenne de l’emploi pour un large éventail de paramètres empiriquement pertinents.
Athlètes, Atlas et baccalauréat parental
Authors: Miano Éric
Published: September 2019

Nous sommes à une époque où la question de l’intérêt, des droits et des potentielles capacités de nos enfants est centrale. Leurs devenirs, et les nécessaires compétences de ceux qui vont devoir en garantir le respect et le développement sont étudiés de toutes parts et font l’objet de bien des débats. Faut-il désormais faire passer un baccalauréat option Compétences parentales suffisamment bonnes pour être autorisé à devenir parent ? Que demandons-nous à travers cette idée de maîtrise de compétence dont nous parlons si souvent ? Réussir l’éducation parfaite pour l’enfant parfait ? Nous verrons que non seulement les questions d’éducation et de parentalité ne peuvent être réduites à une simple affaire de compétence que l’on aurait ou non, mais aussi qu’il y a là, dans l’intérêt de nos enfants, quelque chose à penser de ce besoin constant de vouloir ainsi leur demander de devenir des êtres formidables, capables de porter le poids du monde et de nos faiblesses sur leurs compétentes épaules.
Simultaneous Implantation of Refractive Lenticule and Intracorneal Ring Segment in the Management of Pellucid Marginal Degeneration
Authors: Kalinnikov Yury , Leontyeva Galina , Zinovyeva Alexandra , Nevrov Denis
Published: September 2019

PURPOSE:

To describe a patient with pellucid macular degeneration suffering from visual deterioration due to high irregular astigmatism and intolerant to contact lenses, who underwent a new surgical procedure that combined intrastromal lamellar keratoplasty and a 359° intracorneal ring segment implantation, enabling both ametropia and corneal thinning correction.

METHODS:

Case report.

RESULTS:

Refractive lenticule obtained during a myopic small incision lenticule extraction procedure was used as the donor lamellar graft. The technique described allowed for partial cylinder reduction and reinforcement of the thinned cornea. Uncorrected distance visual acuity improved from 0.02 to 0.5 (decimal) and corrected distance visual acuity improved from 0.4 to 0.7 with a decrease of 4.50 diopters in corneal astigmatism.

CONCLUSIONS:

Despite the lack of long-term observation, the new technique described in this case report was successful for this specific patient and therefore might be effective and safe in severe stages of disease.

[
J Refract Surg.
2019;35(9):606–609.]
Editor’s introduction: qualitative research and the epistemics of experience
Authors: Bartesaghi Mariaelena
Published: September 2019

Not available.
Review of the book: Handicap et technologie en contextes africains [Disability and technology in african contexts] by Patrick Devlieger, Jori De Coster, Lambert Nieme and Léon Mbadu-Khonde
Authors: Mac-Seing Muriel
Published: September 2019

No abstract available.
First outbreak of vancomycin-resistant Enterococcus in a haematology unit in Durban, South Africa
Authors: Mahabeer Yesholata , Lowman Warren , Govind Chetna N. , Swe-Swe-Han Khine , Mlisana Koleka P.
Published: September 2019

Vancomycin resistant enterococci (VRE) are increasingly important causes of morbidity and mortality in developed countries. Although VRE is a significant cause of nosocomial sepsis in these countries, limited data is available on the role that this pathogen plays in South Africa. We describe the demographic, clinical and genotypic data of seven patients involved in the first outbreak of VRE in a haematology unit at a tertiary hospital in Durban and also report the isolation of VRE from six patients from other wards in this hospital and from hospitals outside Durban. The outbreak occurred from 19 April 2011 to 9 November 2011. Pulse Field Gel Electrophoresis (PFGE) was conducted on 15 clinical and environmental samples. Two closely-related clusters and a unique strain were identified from both clinical and environmental samples. Furthermore, the predominant cluster was found in other hospitals in KwaZulu-Natal. After infection control practices were reinforced, the outbreak terminated. Our study highlights that VRE is an emerging pathogen in KZN, especially in high risk units. The environment serves as a significant reservoir of VRE and infection control strategies should be directed to reduce the transmission of VRE from environmental sources.
Laboratory-based surveillance of Pneumocystis jirovecii pneumonia in South Africa, 2006–2010i
Authors: Du Plessis Desiree , Poonsamy Bhavani , Msimang Veerle , Davidsson Leigh , Cohen Cheryl , Govender Nelesh , Dawood Halima , Karstaedt Alan , Frean John
Published: September 2019

Background: We aimed to establish the characteristics of patients with confirmed Pneumocystis jirovecii pneumonia recruited by passive, sentinel laboratory-based surveillance.Method: The study design was prospective, observational, cross-sectional, laboratory-based sentinel surveillance. Laboratorybased surveillance of Pneumocystis jirovecii pneumonia (PJP), formerly known as Pneumocystis carinii pneumonia (PCP), was conducted in six South African provinces at 61 hospitals, of which 17 were sentinel sites, where surveillance officers collected clinical and demographic data from cases. A case was defined as a patient with a respiratory tract specimen that was confirmed positive for P. jirovecii by immunofluorescent microscopy or PCR test, either as a first diagnosis or ≥ 30 days after the last confirmed laboratory diagnosis of PJP. The chi-square test or Fisher’s exact test were used to compare the categorical variables.Results: From 2006–2010, 1 537 cases of PJP were recorded. Eighty-nine per cent (460/518) were found to be human immunodeficiency virus (HIV)-infected. This was a first diagnosis of HIV infection in 57% of the cases. The case fatality ratio was 34% (177/525). Recurrent infection was significantly more common in the 26- to 45-year age group, compared to children aged ≤ 5 years (odds ratio 1.7, 95% confidence interval: 1.1–2.8) (p 0.040). Treatment for tuberculosis was common in cases aged ≥ 5 years (37%, 85/229).Conclusion: PJP was the acquired immune deficiency syndrome-defining illness in more than half of the patients detected through laboratory-based surveillance. The high mortality rate and number of recurrent cases is noteworthy. This study may not have reflected the full spectrum of clinical presentation of the disease as case report forms were only completed for hospitalised patients at sentinel surveillance sites.
Randomisation in a clinical trial: is it feasible in the Ebola crisis? If it is, then which method is suitable?
Authors: Batidzirai Jesca M.
Published: September 2019

Randomisation is an integral component of any sensible clinical trial. Randomisation is the only way we can be sure that the patients have been allocated into the treatment arms with as minimum bias as possible, and that the treatment arms are similar before the start of the trial. The randomisation schemes used to allocate patients into the treatment arms play a role in achieving this goal. This study is motivated by the outbreak of Ebola in West Africa. Scientists claim to have developed some cure for the deadly disease. The question is: ‘Ethically, can the trials be non-randomised due to the crisis? If the trials are to be randomised, which randomisation method is suitable?’ An overview of the randomisation methods was done and recommended stratified randomisation of Ebola patients between any new treatment and the conventional care is provided. Each of the involved countries or centres was treated as the strata and, within each stratum, simple randomisation was then performed.
Audiological testing for ototoxicity monitoring in adults with tuberculosis in state hospitals in Gauteng, South Africa
Authors: Khoza-Shangase Katijah , Stirk Megan
Published: September 2019

Background: Ototoxicity monitoring during treatment of medical conditions, where the medications used are known to be toxic to the ear, is an important scope of practice of the audiologist; and, is an important clinical service aimed at enhancing patients’ quality of life.Aim: The aim of the current study was to determine audiological testing practices for ototoxicity monitoring in adults with tuberculosis in State Hospitals in Gauteng, South Africa. Specific objectives included establishing if ototoxicity (cochleotoxicity) monitoring occurs; determining the timing as well as frequency of monitoring; and, establishing what management protocols are followed once ototoxicity is established.Methodology: A retrospective data record review design was adopted where hospital records from tuberculosis treatment units were reviewed. A total of 191 participant files comprised the research sample. Data obtained was analysed using descriptive statistics.Results: Findings indicated that out of 5 hospitals recruited, only one had an ototoxicity monitoring programme in place. At this programme only 66% of participants were enrolled in an ototoxicity monitoring program in which baseline audiological measures were only conducted one month post treatment in 41% of the samples monitored. The majority of those monitored had repeat measures conducted once monthly. No clear and systematic medical management of ototoxicity, once identified, was found in the current sample. A small number of participants’ medication was adjusted as an intervention measure.Conclusion: Findings demonstrate the need for systematic and integrated ototoxicity monitoring programs in tuberculosis treatment centres in South Africa; as well as highlight the need for the development of evidence-based management protocols for ototoxicity within state hospitals in this South African context.
Correlates of bacterial ulcers and acute HSV-2 infection among men with genital ulcer disease in South Africa: age, recent sexual behaviours, and HIVi,ii
Authors: Leichliter Jami S. , Lewis David A.
Published: September 2019

Data from baseline surveys and STI/HIV laboratory tests (n=615 men) were used to examine correlates of bacterial ulcers (Treponema pallidum, Haemophilus ducreyi, or Chlamydia trachomatis L1-L3 detected in ulcers) and acute HSV-2 ulcers (HSV-2 positive ulcer specimen, HSV-2 sero-negative, and negative for bacterial pathogens) versus recurrent HSV-2 ulcers (seropositive), separately. Men with bacterial ulcers had larger ulcers compared to men with recurrent HSV-2 ulcers, but were less likely to be HIV-positive; whereas, men with acute HSV-2 ulcers were younger with fewer partners. Acute HIV was higher among men with bacterial and acute HSV-2 ulcers; however, this difference was not statistically significant.
A case of human survival of rabies, South Africa
Authors: Weyer Jacqueline , Msimang-Dermaux Veerle , Paweska Janusz T. , Le Roux Kevin , Govender Premi , Coertse Jessica , Markotter Wanda , Nel Louis H. , Blumberg Lucille H.
Published: September 2019

Human survival from rabies is exceptionally rare. We report a case of human survival (with severe neurological sequelae) in a child from South Africa. The patient was exposed to rabid dogs on two separate occasions and subjected to incomplete post-exposure prophylaxis for rabies.
Efficacy of antimicrobial lock solutions in preventing catheter-related blood stream infection in haemodialysis patients: a systematic review and meta-analysis of prospective randomised controlled trials
Authors: Yakasai Ahmad M. , Muhammad Hamza , Iliyasu Garba , Nalado Aisha M. , Dalhat Mahmood M. , Habib Zaiyad G. , Daiyabu Farouk , Edwin Chinagozi P. , Maiyaki Musa B. , Ibrahim Daiyabu A.
Published: September 2019

Background: Catheter-related blood stream infection (CRBSI) contributes to morbidity and mortality among patients on haemodialysis (HD). We carried out a systematic review and meta-analysis to assess the efficacy of antimicrobial lock solutions (ALS) in preventing CRBSI.Method: Electronic search of randomised controlled trials (RCTs) comparing ALS with other agents was performed up to January 2013. DerSimonian and Laird meta-analysis was performed to obtain pooled relative risk (RR) from which efficacy of ALS and numbers needed to treat (NNT) were calculated. In a restricted analysis, pooled RRs where compared using a test of interaction to calculate ratio of relative risks (RRR). Meta-regression analysis was employed to explore sources of heterogeneity.Results: Sixteen RCTs involving 2016 individuals met the inclusion criteria. The efficacy of ALS in preventing CRBSI was 80% with NNT of 3 patients to prevent one CRBSI. The RR of CRBSI was significantly lower with ALS compared with heparin-only lock solution [RR {95% confidence interval (CI)} = 0.20 (0.13-0.31)]. With low dose (≤ 5 mg/ml) and high dose (40 mg/ ml) gentamicin-containing ALS, the RR (95% CI) of developing CRBSI was 0.03 (0.01-0.13) and 0.18 (0.03-0.98), respectively, with no significant difference [RRR (95% CI) = 0.2 (0.02-1.61), p = 0.126]. Heterogeneity was explained by a statistically significant association between rate of CRBSI and catheter days (p = 0.037). Conclusion: ALS are effective in preventing CRBSI. Low dose gentamicin should be preferred over high dose gentamicin as an ALS because it offers similar benefit in preventing CRBSI with lesser risk of toxicity from systemic leakage and subsequent development of drug resistance.
Reliability of an adult respiratory symptom questionnaire in a community located near a mine dump in South Africa: pilot study
Authors: Nkosi Vusumuzi , Voyi Kuku
Published: September 2019

Background: Pretesting a questionnaire is an important activity before the start of the main epidemiological study.Aim: The study tested the reliability (internal consistency) of the modified ATS-DLD-78 adult respiratory diseases questionnaire developed by the British Medical Research Council.Results: The questionnaire was found to be reliable and admissible with an overall Cronbach’s alpha coefficient of α = 0.74.Conclusion: The questionnaire is a reliable instrument for data collection and can be a useful tool for collecting data in a developing country. The questionnaire will be used to study the association between respiratory and cardiovascular diseases among older people and community’s proximity to mine dumps
World Health Organisation staging, adherence to HAART and abnormal cervical smears amongst HIV-infected women attending a government hospital in Johannesburg, South Africa
Authors: Katumba Appolinaire C. , Reji Elizabeth , Gitau Tabither , Firnhaber Cindy
Published: September 2019

Introduction: South Africa (SA) has more people living with Human Immunodeficiency Virus (HIV) than any other country in the world. Women infected with HIV have a higher risk of developing cervical dysplasia and cancer than women who are not infected.Objective: To ascertain the correlation between the World Health Organisation (WHO) HIV staging and adherence to highly active antiretroviral therapy (HAART) with abnormal Pap smear results of HIV-infected women attending a government hospital in Johannesburg, SA.Methods: A cross-sectional descriptive study was performed by reviewing Pap smears of 390 HIV-positive women. Adherence was measured by the patient’s report and viral load. Data was collected through the use of self-administered questionnaires.Results: The prevalence of abnormal Pap smears was 57% and low grade squamous intraepithelial lesions (LGSIL) were the most common abnormality seen (142/390, 36%). WHO stage 3 participants were three times more likely to have abnormal Pap smears than those with WHO stage 1 (OR 3.3, 95% CI 1.23-9.04, p = 0.018). Abnormal Pap smears were seen more frequently in participants with a CD4 cell count ≤ 350 cells/μl compared to participants with CD4 cell count ≥ 500 cells/μl (p = 0.001, 95% CI 0.09-0.37). Participants who did not use HAART had more abnormal results compared to those who used HAART (p 0.028, 95% CI 0.28-0.93). Self-reported adherence to HAART did not show any association with abnormal Pap smears.Conclusion: Increased immune-suppression measured by WHO staging or CD4 count increases the risk of cervical cancer precursors. The high risk group in this study was found to be participants with CD4 350 cells/μl.
Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome
Authors: Manzini Thandekile C. , Gosnell Bernadett I. , John Melanie-Anne A. , Moosa Mahomed Y. S.
Published: September 2019

Background: Non-nucleoside reverse transcriptase inhibitors (NNRTI) are recommended as part of first-line treatment by the World Health Organisation (WHO) for antiretroviral treatment (ART) naïve subjects. Due to reports of cross-toxicity between nevirapine (NVP) and efavirenz (EFV), there is reluctance to substitute EFV for NVP when serious toxicity occurs. In such cases lopinavir/ritonavir (LPV/r) remains the only alternative. We report on our experience of patients with Stevens-Johnson Syndrome (SJS) secondary to NVP who were challenged with EFV under careful supervision.Methods: A retrospective chart review of patients who presented with SJS presumed to be secondary to NVP who were challenged with EFV and were followed up for at least 2 months.Results: The study included 13 patients. All were female, median age 28 years and median weight 66.5 kg. The median CD4 cell count at ART initiation was 160 cells/μl. Twelve patients (92%) developed a rash within 4 weeks of NVP. The median alanine transaminase at SJS presentation was 30 U/l. The median time to EFV challenge was 30 days. The median hospital stay for SJS was 30 days and median follow up was 19 months. Eleven (85%) patients tolerated co-trimoxazole rechallenge, two had no prior exposure. Median hospital stay for EFV challenge was additional 10 days. Twelve patients (92%) tolerated the EFV challenge. One patient developed a pruritic maculo-papular eruption within 3 days of challenge which led to discontinuation of EFV.Conclusion: The risk of recurrence of SJS with EFV challenge in patients with NVP induced SJS is low. It is safe to challenge patients with EFV with careful observation.
Characteristics of tuberculosis patients and the evaluation of compliance to the national TB management guidelines at clinics in a rural community from Mpumalanga province, South Africa
Authors: Musoke Jolly , Michel Anita L.
Published: September 2019

This study serves as baseline investigation into tuberculosis (TB) patient population characteristics and the compliance of clinics in rural settings to the national TB guidelines in terms of diagnosing the disease. A total of 62 TB positive patients’ files were reviewed. Patients were diagnosed using: smear microscopy (41.9%); chest radiography (37.1%); Xpert MTB/RIF (9.7%); symptoms (3.2%); abdomen sonar (1.6%); and, no record (6.5%). Lack of complete compliance was identified, including large dependencies on chest X-ray as the first line of diagnosis and inadequate diagnosis of extra-pulmonary TB. These findings could assist identifying health system gaps for provincial and national control programs.
Cholera and household water treatment why communities do not treat water after a cholera outbreak: a case study in Limpopo Province
Authors: Mudau Lutendo S. , Mukhola Murembiwa S. , Hunter Paul R.
Published: September 2019

Background: Cholera is one of the common diseases in developing countries caused by consumption of contaminated and untreated drinking water. A study was conducted 7 months after a cholera outbreak in Vhembe district, Limpopo, South Africa. The aim of the study was to assess if the communities were still conforming to safe water practices after an outbreak of cholera.Methodology: One hundred and fifty-two (152) participants from 11 villages were recruited to form 21 focus groups, with a mean of 7. The interview transcripts were coded and arranged based on the study themes.Results: Of the 21 groups in 11 villages, three villages were using water from boreholes, six were using river water and three were using mixed sources which included river, canal and spring water, three depended on municipal tanks and only six were using tap water. Only 19% of the respondents treated their water, even though the majority of communities reported treatment of water as a priority. Four villages claimed they never received environmental health education at all, while most of the villages confirmed they received education during a cholera outbreak.Conclusion: Regardless of the outbreak and health education efforts done, communities continued using unprotected water sources without any form of treatment, as they perceived it to be unimportant. Sustainable water supplies and environmental health education should be continued after an outbreak as it is important for public health gains.
An HIV-positive status and short term perioperative mortality – a systematic review
Authors: Moodley Yoshan , Govender Kumeren
Published: September 2019

Background: A contemporary summary describing the impact of an HIV-positive status on short term perioperative mortality is lacking.Objective: To collate and summarise published data related to short term perioperative mortality from studies comparing HIVpositive and HIV-negative patient groups.Method:  We conducted a systematic review of the published literature by performing structured searches of two medical literature databases. Pre-defined inclusion/exclusion criteria were used to identify potentially relevant manuscripts. Further screening of the reference lists of eligible manuscripts, as well as a prior systematic review was also performed to identify any additional manuscripts that may have been relevant. Data retrieved from eligible manuscripts included, amongst other variables: study and population descriptions, surgical category (cardiac or noncardiac surgery), as well the incidence of short term perioperative mortality. Crude odds ratios were calculated for each eligible manuscript to describe the association between HIV status and short term perioperative mortality.Results: Our systematic review consisted of 12 manuscripts describing 12 studies. The majority of manuscripts described studies conducted in countries with a low burden of HIV infection. Most manuscripts described findings from a noncardiac surgery setting. Crude associations between an HIV-positive status and a higher odds of short term perioperative mortality were noted for data from 2 of the 12 manuscripts, while the association was unclear in the remaining 10 manuscripts. Conclusion: Evidence supporting a higher odds of short term perioperative mortality in patients with an HIV-positive status is unconvincing. Further research is required to adequately investigate this.
SASOCP position statement on the pharmacist’s role in antibiotic stewardship 2018
Authors: Schellack N. , Bronkhorst E. , Coetzee R. , Godman B. , Gous A. G. S. , Kolman S. , Labuschagne Q. , Malan L. , Messina A. P. , Naested C. , Schellack G. , Skosana P. , Van Jaarsveld A.
Published: September 2019

Antibiotics are the most commonly prescribed medicines in global healthcare practice today. Their effectiveness is crucial and often life-saving in humanity’s battle against pathogens and infectious diseases. Antibiotic/antimicrobial stewardship strategies and programmes have become vital to the preservation of effective antibiotics and the optimisation of their use. The South African Society of Clinical Pharmacy (SASOCP) has written this guideline to outline the importance, role and purpose of pharmacists in such stewardship programmes, both in the public, as well as the private hospital sectors in South Africa. It also provides an overview of various approaches to antibiotic preservation, behavioural change, stewardship measures, and monitoring strategies.
The recovery and molecular identification of HAdV-D17 in raw sewage and mussel samples collected in the Eastern Cape province of South Africa
Authors: Vos Hillary J. , Knox Caroline M.
Published: September 2019

Human adenoviruses (HAdV) are a common cause of clinical infections in South Africa. However, there is a lack of information regarding the prevalence and molecular identification of this virus in the environment. The objective of this study was to investigate the recovery and molecular identification of HAdV in sewage and mussel samples. All samples were subjected to transmission electron microscopy, viral DNA extraction and nested PCR amplification using adenovirus-specific primers targeting a conserved region of the hexon gene. Amplicons were cloned and sequenced and BLAST analysis revealed a closest matched sequence (98% identity) belonging to HAdV-D17.
Detection of amoeba-associated Legionella pneumophila in hospital water networks of Johannesburg
Authors: Muchesa P. , Lelfels M. , Jurzik L. , Barnard T. G. , Bartle C.
Published: September 2019

The prevalence of free-living amoeba and associated Legionella spp. in hospital water systems may pose a risk of Legionnaires’ disease to immuno-compromised patients. This study investigated the occurrence of amoeba-associated Legionella pneumophila in three South African hospital water systems. A total of 98 water and/or biofilm samples were collected from the sterilisation unit, theatres, neonatal ward and intensive care units. Amoebae were isolated from 71 (72.4%) samples. Isolated amoebae were analysed using qPCR and culture methods to test for the presence of Legionella. L. pneumophila did not grow on selective media in any of the samples. A total of 7 out of the 71 (9.9%) amoeba-positive samples showed a positive reaction for L. pneumophila using qPCR. Although relatively few samples were positive for Legionella in this preliminary study, the association with amoeba still presents a potential public health risk to immuno-compromised patients when exposed to contaminated water.
Respiratory infections due to Streptococcus pneumoniae and the influenza virus in South Africans undertaking the Hajj
Authors: Parker Salim , Hoosen Anwar A. , Feldman Charles , Gamil Amgad , Naidoo Jerusha , Khan Shameema
Published: September 2019

The Hajj is the largest annual mass gathering on Earth. Respiratory infections are one of the leading causes of disease and hospitalisation during the pilgrimage, with pneumonia and influenza most common among these infections despite the availability of prophylactic vaccines. In fact, immunisation against influenza and pneumococcal disease is currently not a requirement for South African pilgrims entering Saudi Arabia. This review examines the burden of respiratory infections during the Hajj, particularly pneumonia and influenza, with a focus on pilgrims from South Africa. Although the number of South African pilgrims attending the Hajj has been capped at 2 000 since 2013, 30 000 South Africans perform the minor Umrah pilgrimage annually. Understanding the aetiology of disease in this group could have implications for medical resourcing during the Hajj.
Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work?
Authors: Armour Anne L. , Patrick Mark E. , Reddy Zelda , Sibanda Wilbert , Naidoo Logandran , Spicer Kevin B.
Published: September 2019

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.
Lateral Wall Decompression for Malunited Calcaneal Fractures
Authors: Agarwala Sanjay , Sobti Anshul Shyam
Published: September 2019

Aim

The purpose of this case series is to reintroduce Kashiwagi decompression as a viable treatment option for malunited calcaneal fractures, delineate the operative technique, and discuss its advantages.

Materials and methods

From August 2004 to May 2013, 18 patients with Sanders type I malunited calcaneal fractures with lateral heel pain and impingement were treated with the lateral wall decompression technique. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.

Results

Eleven patients were males and seven were females, with an average age of 48.4 years. Ten patients had left feet fracture and eight had right feet fracture. Among all the 18 patients with a ‘poor’ score at baseline, 2 (11.11%) scored ‘excellent’, 11 (61.11%) scored ‘good’ and 3 (16.67%) scored ‘fair’ during postoperative evaluation. The average time to return to daily activities was 10.2 weeks (8–12.5 weeks).

Conclusion

Lateral wall osteotomy and decompression effectively addresses the pathology in cases of lateral abutment due to a malunited calcaneal fracture. This technique has advantages of ensuring a reliable resolution with good clinical outcomes and produces fewer postoperative complications.

Clinical significance

Malunion is a common complication with calcaneal fracture. It affects normal function. In malunited calcaneal fractures, the lateral wall of the calcaneum forms a lateral wall exostosis that causes both subfibular impingement and peroneal tendinopathy or displacement. There is need for a viable treatment option for malunions with lateral wall exostosis after calcaneal fractures. This study describes a surgical technique as a solution for the above.

How to cite this article

Agarwala S, Sobti AS. Lateral Wall Decompression for Malunited Calcaneal Fractures. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):80-85.
Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery
Authors: Rachha Rajesh , Sugathan Hari Kovilazhikathu , Dalal Rakesh
Published: September 2019

Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries.

How to cite this article

Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):6-9.
Minimally Invasive Management of Fracture Calcaneum
Authors: Prabhakar Sharad , Gahlot Nitesh , Satish Bhava RJ
Published: September 2019

Modern usage of minimally invasive methods has been applied to fractures of the calcaneus with good effect in the 21st century. The Essex-Lopresti maneuver has been modified, distraction devices are being judicially used, and the advent of image intensifiers and small joint arthroscopes have allowed accurate visualization of the reduced fracture as well as joint surfaces. It is important to understand that the three-dimensional (3D) anatomy, Böhler and Gissane angles, and heel height have to be restored. The surgeon should be ready to convert to an open procedure at any time. We describe here the method we use in our institute, and this is one of the many methods of managing this complex injury.

How to cite this article

Dhillon MS, Prabhakar S, Gahlot N, Satish BRJ. Minimally Invasive Management of Fracture Calcaneum. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):47-52.
Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature
Authors: Rajasekaran S , Silvampatti Sundararajan
Published: September 2019

Irreducible dislocation of interphalangeal joint is a rare condition with only a few case reports in literature. Here, we report a case with irreducible dislocation of interphalangeal joint due to sesamoid bone interposition, which required open reduction. A 45-year-old male had a fall from height with irreducible dislocation of interphalangeal joint of great toe. Intraoperatively, the interposition of sesamoid bone over the dorsal aspect of proximal phalanx was identified. Displaced volar plate with sesamoid bone was reduced into the position, and the joint was stabilized with k wire. On follow-up, we observed that the patient had no discomfort or pain for 6 months. The displacement of sesamoid bone with volar plate and intact collateral ligaments locks the joint in extension and obstructs the reduction of interphalangeal joint dislocation. One should have the suspicion of possibility of open reduction after observing the interposition of sesamoid bone over the dorsal aspect of the proximal phalanx. Dorsal approach is usually advocated; medial approach can be used if there is wound over the plantar aspect.

How to cite this article

Silvampatti S, Rajasekaran S. Irreducible Dislocation of Great Toe Interphalangeal Joint by an Accessory Sesamoid Bone: A Case Report and Review of Literature. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):56-58.
Stress Fracture of the Fibular Sesamoid Bone of the Foot in Cricket: An Unusual Injury in Bowlers
Authors: Prabhakar Sharad , Dhillon Himmat , Dhillon Sidak , Behera Prateek
Published: September 2019

An unusual case of fibular sesamoid stress fracture in the back foot of a bowler is presented. The diagnosis was delayed due to the lack of awareness of the support medical staff of the cricketer. Special radiological views and computed tomographic scans confirmed the diagnosis; nonoperative measures cured the pain, but this recurred on subsequent bowling activities. The current player gave up the game, but the literature supports operative intervention in cases that fail conservative regimens. This case is presented to highlight the occurrence of this rare injury in fast bowlers, and we recommend careful examination of the foot when it is the trailing foot, because this has significant forefoot dorsiflexion during the stance phase.

How to cite this article

Dhillon H, Behera P, Prabhakar S, Dhillon S, Dhillon MS. Stress Fracture of the Fibular Sesamoid Bone of the Foot in Cricket: An Unusual Injury in Bowlers. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):59-62.
Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers
Authors: Serena Thomas E , Yaakov Raphael A , Mostow Eliot N
Published: September 2019

Introduction

The prevalence of diabetes has been rising sharply and the rise in chronic wounds parallels this trend. Lower extremity ulcers present a serious complication for people with diabetes. While debridement of necrotic tissue and off-loading plays an important role in wound healing, many patients with diabetic foot ulcers (DFUs) fail to heal with standard of care (SOC) alone. Unresolved ulcers can lead to complications, such as osteomyelitis and amputation. There continues to be a need for the evaluation of novel wound therapies that can accelerate wound healing and lower the cost of care associated with DFUs. This paper presents recent evidence for the use of cellular and/or tissue-based products (CTPs) and offers an approach for selecting an appropriate CTP.

Materials and methods

A systematic literature search was conducted using PubMed, Embase, Medline, Cochrane library, and NHS Economic Evaluation Database. Full-length articles in English were assessed for relevance to select studies on effectiveness and economic evaluations. Additionally, Google Scholar was used to gather relevant literature on commonly used CTPs, including Apligraf®, EpiFix®, and Dermagraft®.

Findings

Results from randomized controlled trials (RCTs) provided evidence for the superior efficacy of CTPs over SOC alone in treatment of chronic DFUs. In recent studies evaluating commonly used CTPs, significantly higher number of DFUs achieved complete closure with EpiFix® when compared to either Apligraf® or Dermagraft®. While cost-effectiveness studies continue to be limited, current literature suggests that CTPs can decrease the long-term costs associated with the care of DFUs by increasing the healing rate, reducing recovery time, and lowering the risk of infection and complications. Cellular and/or tissue-based products (CTPs) may result in higher average number of ulcer-free months and lower average number of amputations or resections compared to SOC alone.

How to cite this article

Serena TE, Yaakov RA, Mostow EN. Use of Cellular and Tissue-based Product in the Treatment of Diabetic Foot Ulcers. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):92-96.
Midfoot Charcot Arthropathy: Overview and Surgical Management
Authors: Rajasekaran S , Silvampatti Sundararajan , Nagaraja HS
Published: September 2019

Midfoot Charcot arthropathy is a progressive deforming condition characterized by recurrent ulceration leading to high morbidity and amputation with lack of timely intervention. Nonoperative treatment is largely reserved for acute phase disease. Recent trend in management is early surgical interventions which could alter deforming forces and prevent deformity progression, as well as surgeries which provide osseously stable plantigrade foot. However, there are no clear-cut evidencebased guidelines regarding timing of interventions and method of techniques in surgical stabilization. This study discusses about surgical technique in the management of midfoot Charcot.

How to cite this article

Silvampatti S, Nagaraja HS, Rajasekaran S. Midfoot Charcot Arthropathy: Overview and Surgical Management. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):97-106.
Lower Limb Refractory Ulcers and Postoperative Nonhealing Wound: Review of the Literature
Authors: Jha Shiva S
Published: September 2019

Lower limb ulcers including nonhealing postoperative wounds are challenging problems, especially to orthopedic surgeons. Such ulcers are recognized complications of rheumatoid arthritis but the scenario has changed for the better since the advent of aggressive disease-modifying antirheumatic drugs (DMARDs). Out of different types of lower limb ulcerations including venous, arterial, lymphatic, malignancies, infection, medication induced and inflammatory, autoimmune inflammatory conditions need to be delineated. They can be improved, though slowly with DMARDs. The pathogenesis is multifactorial but most prevalent are vasculitis. The various investigative tools for diagnosing the causes of these ulcers include plethysmography, ultrasound, angiography, computed tomography, magnetic resonance imaging, chromosomal analysis, and, most importantly, skin biopsy. Clinical presentation of the patient still remains the supreme disease tracker. Review of the literature is presented to ascertain the evidence for best clinical practice.

How to cite this article

Jha SS. Lower Limb Refractory Ulcers and Postoperative Nonhealing Wound: Review of the Literature. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):10-13.
Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon
Authors: Choudhry Karan R , Mandlewala Vishal N
Published: September 2019

Aim

To present a case of recurrence of giant cell tumor of the tendon sheath (GCT TS) and its management.

Background

The GCT TS is a solitary benign soft tissue tumor of the limbs. It usually appears as an enlarging painless mass and has a synovial origin. The GCT TS is approximately 1.6% of all soft tissue tumors. The GCT TS of tibialis posterior is very rare, and recurrence has not been reported.

Case report

A 21-year-old male patient presents with complaint of swelling over right ankle since 3 years. Patient was operated for swelling 10 years back, and histological examination revealed GCT TS. Patient was asymptomatic for 3 years after operation and then developed swelling since last 3 years. On local examination, hypertrophic scar mark 1 × 4 cm was present at right medial malleolus. Ultrasonography of right medial malleolus and magnetic resonance imaging were done for further evaluation. Under spinal anesthesia and tourniquet control, medial approach was taken extending from 7 cm above the medial malleolus posterior to the tibia up to the talar head. Tissue was cleared and was sent for histopathology, which confirmed the diagnosis of GCT TS. Patient is on regular follow-up since then, and there has not been any recurrence.

Conclusion

Though rare, recurrence of GCT TS can occur, and it should be properly investigated and completely excised.

Clinical significance

Though recurrence of GCT TS is rarely reported, it needs to be dealt with a high index of suspicion and treated aggressively.

How to cite this article

Choudhry KR, Mandlewala VN. Recurrence of Giant Cell Tumor of Posterior Tibialis Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):45-48.
Open Fractures of the Ankle: Management Options and Factors influencing Outcomes
Authors: Rajnish Rajesh K , Saini, Uttam C , Cheema, Udai
Published: September 2019

Open ankle fractures are rare injuries among all the ankle fractures and commonly occur after high-velocity trauma in road traffic accidents resulting in varying amounts of soft-tissue loss, periosteal stripping, microbial contamination, bone loss, and vascular injury. Management of open ankle fractures remains a daunting task due to the complex osseo-ligamentous complex, relatively thin soft-tissue coverage around the joint, propensity for wound infection and complications, and the risk of impaired functional ability. Management in the emergency trauma room includes initial stabilization of the patient, focused history, and detailed clinical evaluation determining the level and type of injury, extent of wound contamination, soft-tissue and/or bone loss, and neurovascular status of the injured limb followed by radiographic evaluation. Early antibiotics administration and wound assessment, irrigation, aseptic dressing, and temporary splintage form the cornerstone of initial orthopedic stabilization of open fractures. There is a general consensus that all open ankle fractures need early debridement and fixation to restore articular congruity and alignment of fracture fragments although the timing of internal/definitive fixation of open ankle fractures is still debatable. Common complications include superficial and deep infections, marginal skin necrosis, compartment syndrome, nonunion/malunion, and secondary osteoarthritis. Timely interventions improve orthopedic outcomes in these patients.

How to cite this article

Saini UC, Dhillon MS, Cheema U, Rajnish RK. Open Fractures of the Ankle: Management Options and Factors influencing Outcomes. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):69-76.