bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and Dermoscopic Approaches to Diagnosis of Frontal Fibrosing Alopecia: Results From a Multicenter Study of the International Dermoscopy Society
Authors: Starace Michela , Orlando Gloria , Iorizzo Matilde , Alessandrini Aurora , Bruni Francesca , Mandel Victor Desmond , Awatef Kelati , Cabo Horacio , Fabbrocini Gabriella , Hanane Baybay , Lanssens Sven , Lobato-Berezo Alejandro , Mernissi Fatima Zahra , Paoli John , Patrí Angela , Cohen Sabban Emilia Noemi , Sławińska Martyna , Sobjanek Michał , Zaar Oscar , Pellacani Giovanni , Piraccini Bianca Maria
Published: February 2022

Introduction: Frontal fibrosing alopecia (FFA) is a form of primary lymphocytic scarring alopecia characterized by a progressive recession of the fronto-temporal hairline. Although the clinical presentation of FFA is very typical, biopsy for histopathological examina­tion is still recommended to confirm the diagnosis. Currently, a growing number of skin and mucosal inflammatory diseases are diagnosed with modern noninvasive techniques such as dermoscopy without the necessity of a biopsy.
Objectives: The International Dermoscopy Society (IDS) aimed to test the ability of its members to diagnose classic FFA through clinical and dermoscopic parameters and to compare acquired data to the largest cohort studies published since 1994.
Methods: This is an observational, cross-sectional study describing patient demographics, clinical presentation and diagnostic tools used in a sample of FFA patients collected by IDS members. A literature search was then performed using Pubmed to review studies reporting more than 100 cases.
Results: IDS members submitted 188 cases demonstrating a predominant female population (98.4%). In 71.8% of the cases, the clinical presentation and the trichoscopic findings allowed for the diagnosis. Out of 24 revised studies, 13 showed that clinical and trichoscopic features were decisive for the diagnosis in almost all cases.
Conclusions: Demographic and clinical data of our cohort were mostly comparable to previous reported data on FFA. The relevant role of the clinical and trichoscopic features in diagnosing FFA was confirmed by our study and the reviewed literature. Trichoscopy could be considered a worldwide-acknowledged non-invasive technique for the diagnosis of FFA.
Epistemic Luck in Stoicism
Authors: Stojanović Pavle ,   Philosophy Documentation Center
Published: February 2022

The Stoics held that knowledge depends on the special kind of true appearances they called ‘apprehensive.’ Sextus Empiricus reports that they also thought that some true appearances are not apprehensive—and hence unable to lead to knowledge—because they are true merely ‘externally and by chance’, which suggests that the Stoics were aware of the problem of epistemic luck. Unfortunately, Sextus does not tell us what kind of appearances the Stoics thought are true by chance, and why. I argue that the appearances in question here are imaginations, and propose an explanation why the Stoics, who defined chance in terms of hidden causes, would have thought that imaginations can only be true by chance. The explanation stems from their view that the essential characteristic of imagination is that it leaves the actual cause of its representational content hidden from the subject.
False Differends
Authors: Vaziri Parisa ,   DePaul University
Published: February 2022

The Holocaust serves as a foundational critical resource in postwar philosophy. Interventions into the logic of its exemplarity tend to treat exemplarity as a matter of archival selection that ignores earlier histories of genocide and slavery. A recent example is Alexander Weheliye’s critique of Giorgio Agamben (Habeaus Viscus), which seeks to restitute racial slavery as a theoretically significant moment of biological precarity. In a continuation of this logic, this essay introduces the history of Indian Ocean slavery, which precedes transatlantic slavery but is comparatively lesser known. In doing so, I suggest that complaints against archival selection do not go far enough, for they do not address the problem of a kind of event whose very nature is to destroy its own archive. Reading Jean-François Lyotard’s differend as a critique of the modern genre-supremacy of historiography, I argue that the very ground of historical examples (namely, the demand that there be proof) demonstrates the regressive nature of exemplarity itself.
Phenomenology as Metaphysics
Authors: Trisokkas Ioannis ,   Canadian Society for Continental Philosophy
Published: February 2022

The article reflects on Heidegger’s “metaphysical” interpretation of Hegel’s Phenomenology of Spirit. This interpretation is driven by two theses Heidegger holds: (1) that the Phenomenology is a necessary part of Hegel’s “system of science” and (2) that the Phenomenology is metaphysics. These two theses contrast with Houlgate’s “epistemological” interpretation, which claims that the Phenomenology is not a necessary part of Hegel’s system of science and that it is not metaphysics. The article shows that while Heidegger has an argument that establishes, contra Houlgate, his second thesis, this very argument has consequences that undermine his first.
ESTRATÉGIAS EDUCATIVAS DE RESSUSCITAÇÃO CARDIOPULMONAR PARA LEIGOS: REVISÃO INTEGRATIVA DA LITERATURA
Authors: Siqueira Tainá Vilhar , Nascimento Juliana da Silva Garcia , Regino Daniela da Silva Garcia , Oliveira Jordana Luiza Gouvêa de , Pereira Larissa Andrade , Dalri Maria Celia Barcellos
Published: February 2022

RESUMO Objetivo: identificar as estratégias de ensino e aprendizagem da ressuscitação cardiopulmonar voltadas para pessoas leigas. Método: revisão integrativa realizada nas fontes National Library of Medicine; National Institutes of Health; Cumulative Index to Nursing and Allied Health Literature; Literatura Latino-Americana e do Caribe em Ciências da Saúde; Web of Science; e SCOPUS. Resultados: identificaram-se 932 estudos e incluíram-se 11. As estratégias foram: aula expositiva; treinamento com manequim/instrutor; manequim/instrutor/dispositivo de feedback; videoaula e web. Adotou-se, frequentemente, o manequim/instrutor, no entanto, demonstrou-se mais efetivo associar dispositivo de feedback e/ou videoaula. Os estudos foram considerados de boa qualidade pelo instrumento do Instituto Joanna Briggs e de moderada qualidade pelo Medical Education Research Study Quality Instrument. Conclusão: as evidências sobre o ensino da ressuscitação cardiopulmonar para leigos indicaram as principais e mais efetivas estratégias para a adoção de melhores práticas.
RECURSOS TECNOLÓGICOS EM NEONATOLOGIA: EVIDÊNCIAS SOBRE A TÉCNICA DE SELDINGER NO CATETERISMO VENOSO CENTRAL
Authors: Secco Izabela Linha , Pereira Higor Pacheco , Arrué Andrea Moreira , Danski Mitzy Tannia Reichembach
Published: February 2022

RESUMO Objetivo: identificar as evidências científicas acerca da técnica de Seldinger na inserção de cateteres venosos centrais em Neonatologia. Método: revisão integrativa nas bases de dados SCOPUS, MEDLINE, Web of Science, Science Direct, Alliance For Vascular Access Teaching and Research e em citações de interesse. Realizada no mês de dezembro de 2020, sem delimitação temporal. Resultados: foram encontrados 804 artigos. Destes, 18 foram incluídos. As publicações compreenderam o período de 1982 a 2016. Predominaram estudos internacionais, com níveis de evidência pouco robustos, desenvolvidos por médicos anestesistas e cirurgiões. A técnica de Seldinger foi considerada um método assertivo que garante mínima incidência de complicações e oferece segurança ao paciente. Além disso, é menos estressante comparada à punção direta. Conclusão: é uma tecnologia que carece de ampliação do número de pesquisas clínicas para estabelecer fortes evidências e incorporação na assistência qualificada e segura aos recém-nascidos.
Fixed point results via altering distance functions in relational fuzzy metric spaces with application
Authors: Bartwal Ayush , Dimri R. , Rawat Shivam
Published: February 2022

Some fixed point theorems are developed in fuzzy metric spaces using an altering distance function under binary relationship. We ensure the existence and uniqueness of the solution to ordinary differential equation using our results. We also give a non-trivial example to illustrate our primary result. Our results strengthen and extend the Theorem 3.1 of Shen et al. (Applied Mathematics Letters, 25 (2012), 138-141).
Modelling the closure of narrow oceanic basins by means of numerical simulations
Authors: Stanković Nikola
Published: February 2022

Numerical simulations represent an established approach in investigation of geodynamic processes in the Earth's interior and it is applied to a vast variety of geological problems. The closure of a narrow oceanic realm is modelled in this paper. Firstly, a simplified numerical model of a narrow ocean is established. The thermomechanical system is then simulated by solving Navier-Stokes and temperature equations. By imposing boundary conditions for velocity the convergent regime is simulated which leads to a subduction process along a predefined weak shear zone mantle. The subduction subsequently results in development of magmatism, the final closure of the oceanic realm and the onset of continental collision. Considerable amount of ophiolites were successfully obducted onto the overriding continent during the course of the simulation.
Integration of gender equality in the TRAFSAF Erasmus + project
Authors: Petrović Aleksandra , Gospić Nataša , Arsić Nebojša , Lindov Osman
Published: February 2022

Globally, when accessing and driving in public transport vehicles, women have a problem with fear, experiences of sexual harassment and violence. Women's daily trips are very different from those made by men. These factors make a woman more vulnerable, as standard public transport companies do not consider these characteristics enough. The safe public transport option also helps increase the number of women in economic activities. The way of traveling determines the type of work or shift that the woman will accept. Mobility provides women with financial strength and independence, and currently access to safe public transport, both in Sarajevo Canton and throughout Bosnia and Herzegovina, and it can be said that it is not at a satisfactory level in the region, so urgent actions need to be taken. The concept for the implementation of gender equality within the Erasmus + TRAFSAF project, modeled on EU projects, is that all project partners, both those coming from the segment of higher education and NGOs, keep gender statistics and that measures to promote enrollment must be provided. female populations at all levels of study. It is also a requirement for project participants to increase the participation of women as trainers, as well as to enhance the presence of women in trainings related to traffic safety during the project. These activities should continue after the completion of the project, bearing in mind that it is necessary to integrate gender equality in the segment of traffic safety.
Federación Latinoamericana de Semiótica. ¿Existen los semiólogos latinoamericanos?
Authors: Escudero Lucrecia
Published: February 2022

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semiótica en Puerto Rico
Authors: Colón Elíseo R.
Published: February 2022

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Nietzsche, Byron y el titanismo
Authors: Campíoni Giuliano
Published: February 2022

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retórica audiovisual. El reto de la imagen
Authors: Pulido Tirado Genara
Published: February 2022

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Antonio Domínguez Rey: La llamada exótica. El pensamiento de Emmanuel Lévinas. Eros, Gnosis, Poíesis. Madrid: Trotta/ UNED, 1997
Authors: Moreno Márquez César
Published: February 2022

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José Romera Castillo: LITERATURA, TEATRO Y SEMIOTICA: MÉTODO, PRÁCTICAS Y BIBLIOGRAFÍA (Madrid: Universidad Nacional de Educación a Distancia, 1998, 529 páginas)
Authors: Gullón de Haro Francisco
Published: February 2022

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Relationships between the Parity and Pelvimetry of Egyptian Buffalo Cows: Prediction of Dystocia and Estimation of Age
Authors: Sary Ramadan G. , Abdelrahman Hisham A. , Mohamed Ragab H. , Hussien Ahmed M. , Hussein Hassan A. , Khalil Karim M.
Published: February 2022

Background: The current study aimed to determine the most strongly correlated variable of pelvimetry with the parity in our native breed Egyptian buffaloes.

Methods: The study was conducted on 36 female buffaloes (nullipara, n=14, primipara n=6 and pluripara, n=16 with 2-4 births) aged between <15 months, n=15 and 65 months, n=21. The internal and external pelvic measurements were obtained using the rice pelvimeter and Freeman’s measuring tape.

Results: Strong positive linear relationships were found for the distance between ischiatic tuberosities and the distance between sacral tubercles with the correlation coefficients of 0.64 and 0.62, respectively. The conjugate diameter increased progressively with the age and number of births, with a correlation coefficient of 0.96. The pelvic area had a very strong positive linear relationship with a correlation coefficient of 0.89. The linear combination of the predictor variable (conjugate diameter), to predict the number of birth was developed successfully.

Conclusion: The strong relationship between the conjugate diameter and the number of births could be employed to predict the dystocia and estimate the age of female buffalo. Furthermore, these findings could be aid paleontologists in studying buffalo fossils.
Análise do potencial de emissão de microplásticos por lavanderias têxteis em Goiânia e impactos potenciais
Authors: Silva Alecricia Barros , Pimenta Sandro Morais , Capanema Marlon André , Abreu Ana Luiza Duarte de , Valverde Francislainy Teles Almeida , Lemos Guilherme Matheus Coelho de
Published: February 2022

Os microplásticos (MPs) são partículas plásticas com dimensões inferiores a 5 mm, com potencial significativo para adsorver e transportar Poluentes Orgânicos Persistentes (POPs) para o meio aquático, onde podem ser ingeridos por organismos, e, portanto, inseridos na cadeia alimentar. Inúmeras são as fontes de MPs, como por exemplo, as indústrias de pellets plásticos, a fragmentação dos macroplásticos e as fibras sintéticas advindas das lavagens de roupas. As lavanderias industriais apresentam alto potencial para emitir fibras plásticas no ambiente aquático por meio do efluente, pois durante o processo de lavagem dos artigos têxteis, ocorre o desprendimento de fibras sintéticas devido ao atrito exercido dentro da lavadora. Até o momento, não há trabalhos científicos que estimem a contribuição de fibras sintéticas liberadas por lavanderias têxteis industriais na Estação de Tratamento de Esgoto (ETE) de Goiânia. Baseado neste contexto, o intuito do presente trabalho foi de forma pioneira quantificar a concentração de fibras sintéticas, classificadas como microplásticos, emitidas por lavanderias industriais no sistema público de tratamento de esgoto da capital, assim como seus respectivos riscos à saúde humana e ao meio ambiente. A metodologia empregada baseou-se no levantamento e análise das informações contidas nos processos de licenciamento ambiental das lavanderias junto a Agencia Municipal do Meio Ambiente (AMMA) de Goiânia. Além disso, realizou-se uma pesquisa aprofundada em estudos publicados na literatura técnica e científica sobre a temática dos microplásticos, a quantidade de fibras recebidas e descartadas em ETEs e lavanderias e seus possíveis impactos. Apenas 37 lavanderias foram identificadas através da coleta de dados realizada na AMMA, dessas 14 tiveram seus processos físicos de licenciamento analisados e 11 informaram a vazão. Observou-se que de 26,4 a 52,9 bilhões de fibras podem estar contidas no efluente bruto total recebido diariamente pela ETE de Goiânia, das quais de 120 a 172 milhões são provenientes das 11 lavanderias analisadas, representando de 0,23% a 0,65% das fibras presentes no efluente bruto recebido pela ETE de Goiânia. Os microplásticos podem exercer efeitos adversos tanto no solo quanto na biota. Alguns estudos evidenciaram influência negativa dos MPs na taxa de crescimento, no sistema reprodutivo e no sistema gastrointestinal de alguns organismos. Os MPs foram encontrados até em fezes humanas. Por meio desse trabalho, foi possível apresentar uma estimativa do percentual de MPs contidos no efluente bruto e tratados e no lodo da ETE de Goiânia. Assim como no efluente de lavanderias industriais, apesar de provavelmente ter sido subestimado.
[The Multidisciplinary Management of Type 2 Diabetes: an Integrated Care Model]
Authors: Berra Cesare Celeste , Pradelli Lorenzo
Published: February 2022

Over the past 20 years, the prevalence of diabetes in Italy has been growing, up to the current estimated proportion of about 8.5%, which accounts also for undiagnosed patients. As most of these subjects are >65 years of age, the probability of having comorbidities is high. In addition, diabetes itself exposes patients to a wide spectrum of complications, that cover several therapeutic areas. This is why the optimal management of diabetes necessarily involves a multidisciplinary team.Several models of integrated care of chronic diseases may be set: for instance, the role assigned to GPs and specialists may differ among models. Indeed, a disequilibrium between GPs and specialists is deemed to be the main cause of the low patients’ participation in Progetto Cronicità (chronic diseases project), which started in Lombardia (a Northern region in Italy) in 2018.A help to understand how to build a proper integrated care model in diabetes comes from the experience of the Authors, that describe in detail their experience in IRCCS MultiMedica (Sesto San Giovanni, MI, Italy).This Supplement ends with a review of the evidence found in literature about the advantages of a multidisciplinary management of diabetes in terms of outcomes, costs, and patients’ satisfaction.
Aetiology and presentation of childhood pleural infections in the post-pneumococcal conjugate vaccine era in South Africa
Authors:   Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, Golden L , Chaya S , Reichmuth K , Visagie A , Ayuk A , Kwarteng Owusu S , Marangu D , Affendi N , Lakhan A , Gray D , Vanker A , Zar H , Zampoli M
Published: February 2022

Background. Complications of respiratory infections including pleural effusion (PE) are associated with a high morbidity. Differentiating between PE caused by Mycobacterium tuberculosis (Mtb) infection and other bacterial infections in endemic areas is difficult in children, thus, impacting treatment. Objective. To investigate the aetiology of PE and features distinguishing tuberculosis (TB) from bacterial PE in children. Methods. We conducted a prospective study in children with PE admitted to a tertiary hospital in Cape Town from December 2017 to December 2019. Clinical information and routine laboratory investigations were compared between children with bacterial, Mtb or unclassified PE, categorised according to study definitions. Results. A total of 91 patients were included in the present study and their median age was 31 months (interquartile range (IQR) 11.8 - 102.1). The aetiology was bacterial in 40% (n=37), Mtb in 39% (n=36) and unclassified in 20% (n=18) of patients. Staphylococcus aureus was the most common bacterial isolate, confirmed in 65% (n=24/37) patients, and Streptococcus pneumoniae was confirmed in only 8% of patients. TB was microbiologically confirmed in 33% (n=12/36) of patients. Patients with TB were older (91.6 v. 11.8 months; p<0.001), with more weight loss (28 v. 12 patients; p<0.001), and longer cough duration (10 v. 4 days; p<0.001) than those with other bacterial PE. In contrast, the latter had significantly higher serum C-reactive protein (median 250 v. 122 mg/L; p<0.001), procalcitonin (11 v. 0.5 mg/L; p<0.001), pleural fluid lactate dehydrogenase (7 280 v. 544 U/L; p<0.001), and adenosine deaminase levels (162 v. 48 U/L; p<0.001) and lower glucose levels (1.3 v. 4 mmol/L; p<0.001). Conclusion. Post 13-valent pneumococcal conjugate vaccine, S. aureus is the dominant cause of PE in children using traditional culture methods, while Mtb remains a common cause of PE in our setting. Useful clinical and laboratory differences between Mtb and other bacterial PE were identified, but the cause of PE in 20% of children was underdetermined. Molecular testing of pleural fluid for respiratory pathogens may be useful in such children.
Proximal airway obstruction caused by adenoid cystic carcinoma in a pregnant woman: A case report
Authors:   Division of General Thoracic Ward, Valiasr Hospital, Imam Khomeni Hospital Complex, Tehran, Iran, Divari H R , Vahedi M , Jahanbin B , Mireskandari S M , Mirzaiemoghaddam M , Hajipour A
Published: February 2022

Respiratory tumours are very rare during pregnancy. Here, we report a case of a primigravida woman diagnosed at 27 weeks’ gestation with stridor and dyspnoea, and a primary tracheal tumour. To the best of our knowledge, this is a 4th case report of tracheal adenoid cystic carcinoma during pregnancy. Our staged management of airway obstruction during pregnancy and definite treatment are discussed
Keep the old, in with the new: The changing face of pleural effusions
Authors:   Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa., Mphahlele R E M , Masekela R
Published: February 2022

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Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society – 2021 update
Authors:   Life Mount Edgecombe Hospital, Durban, South Africa, Lalloo U G , Kalla I S , Abdool-Gaffar S , Dheda K , Greenblatt M , Feldman C , Wong M L , van Zyl-Smit R N
Published: February 2022

Asthma prevalence is increasing worldwide, and surveys indicate that most patients in developed and developing countries, including South Africa, do not receive optimal care and are therefore not well controlled. Standard management guidelines adapted to in-country realities are important to support optimal care. The South African Thoracic Society (SATS) first published a guideline for the management of chronic persistent asthma in 1992, which has subsequently been revised several times. The main aim of the present document was to revise and update SATS’ statement on the suggested management of chronic asthma, based on the need to promote optimal care and control of asthma, together with the incorporation of new concepts and drug developments. This revised document reinforces optimal care and incorporates the following primary objectives to achieve the recent advances in asthma care: • continued emphasis on the use of inhaled corticosteroids (ICS) as the foundation of asthma treatment • to reduce the reliance on short-acting beta-2 agonist (SABA) monotherapy for asthma symptoms • to incorporate the evidence and strategy for the use of the combination of an ICS and formoterol for acute symptom relief (instead of a SABA) • to incorporate the evidence and strategy for the use of as-needed ICS-long-acting beta agonists (LABA) for patients with infrequent symptoms or ‘mild’ asthma • to incorporate the evidence and strategy for the use of a long-acting muscarinic antagonist (LAMA) in combination with ICS-LABA; and • to incorporate the evidence and strategy for the use of and management with a biologic therapy in severe asthma
Evolution of SARS-CoV-2 mutational variants: Hysteria or hope for the future?
Authors:   Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town, South Africa, Esmail A , Scott A J , Dheda K
Published: February 2022

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Sirenomelia with major cardiac anomalies
Authors:   Department of Paediatrics and Child Health, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Saggers R T , Charlton R , Nongena P , Velaphi S C
Published: February 2022

Sirenomelia is a rare and serious congenital anomaly characterised by fusion of the lower limbs, usually a single umbilical artery and malformations of the genitourinary and gastrointestinal tracts. In this report, we present clinical and radiological features, as well as autopsy findings, in a patient with sirenomelia diagnosed at the time of delivery. Major cardiac defects were observed, namely transposition of the great vessels and a hypoplastic left ventricle.
Orchiepididymitis in a 14-year-old boy with concurrent SARS-CoV-2 infection
Authors:   Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Poland, Wronowski M , Woźniak W , Wanke-Rytt M , Jażdzewski K , Kuchar E , Kloc M , Kubiak J Z
Published: February 2022

The symptoms of SARS-CoV-2 infection and COVID-19 provoked by this virus are poorly described in children. Here we analyse a case of orchiepididymitis associated with COVID-19 in a 14-year-old boy. We discuss the possibility of SARS-CoV-2-associated testicular inflammation. This report strengthens the necessity for more in-depth study of the clinical presentation of paediatric COVID-19 and the potential association with non-respiratory symptoms
Cochlear implantation in South Africa
Authors:   Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, South Africa, Bhamjee A
Published: February 2022

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Impact of a multidisciplinary approach to ultrasound- guided thyroid fine-needle aspiration biopsy at Tygerberg Hospital, Cape Town, South Africa: A retrospective audit
Authors:   Division of General Surgery, Department of Surgery, Faculty of Medicine and Health Sciences, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa, Conradie W , du Plessis A , Edge J , Baatjes K , Ruiters A , Razack R
Published: February 2022

Background. Thyroid nodules are common and mostly benign. Inadequate sampling generally occurs in 13 - 17% of thyroid fine-needle aspiration biopsies (FNABs), but the proportion was found to be as high as 45% on evaluating 100 ultrasound (US)-guided FNABs in a previous unpublished audit at Tygerberg Hospital, Cape Town, South Africa (SA). Objectives. Primary aim: To determine the diagnostic yield of US-guided thyroid biopsy after implementing changes to existing practices, involving the creation of a specialised clinic and applying protocols for referral and FNAB. Secondary aim: To compare the results with other centres in SA. Methods. A retrospective audit of 178 thyroid biopsies was conducted. All US-guided thyroid biopsies performed in the specialised clinic between January 2017 and July 2018 were included. Data were analysed using descriptive statistics. Results. The 178 nodules were biopsied in 159 patients. The mean age was 53.7 years, with a gender ratio of 9.6:1 (female/male). A reduction in non-diagnostic biopsies was noted compared with the historical cohort (45% v. 32.6%). Sixty-one nodules (34.3%) had previously been biopsied with inadequate cytology results. When repeat biopsies were excluded, only 16.2% (n=19) were classified as insufficient. Conclusions. These findings illustrate the importance of the multidisciplinary approach and standardisation of the US-guided biopsy procedure and the value of consistency and quality control in a health system. While nodular thyroid disease is common and FNAB is relatively simple, early referral to a central specialised unit to minimise the incidence of inadequate FNAB should be considered.
Underdiagnosis of hypertension and diabetes mellitus in South Africa
Authors:   Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Kamerman P
Published: February 2022

Background. Hypertension and diabetes mellitus (DM) are major causes of natural death in South Africa (SA). Underdiagnosis of these treatable diseases would hamper efforts to improve their management and hence reduce morbidity and mortality. Objectives. To assess the level of underdiagnosis of hypertension and DM in SA. Methods. Data from adult participants (≥15 years) in the 2016 South African Demographic and Health Survey, which draws a nationally representative sample of the population, was used. Using these data, the prevalence of hypertension and DM was assessed at the time of the study using objective criteria (hypertension: systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg; DM: glycated haemoglobin (HbA1c) ≥6.5%), and disease prevalence based on participant recall of having ever received a diagnosis of hypertension or DM from a healthcare professional. The difference between the objectively measured prevalence of the diseases and the prevalence based on recall was used to assess the level of underdiagnosis. Results. Of 10 336 adult participants who answered the question on the recall of a diagnosis, 8 092 had their blood pressure measured, and 6 740 had HbA1c assessed. The prevalence of hypertension based on recall was 18.9% (95% confidence interval (CI) 17.7 - 20.1), while the prevalence using blood pressure measurements was 37.1% (95% CI 35.3 - 38.9). Therefore, 49% of cases of hypertension are likely to be undiagnosed (~7.1 million people). The prevalence of DM based on recall was 4.5% (95% CI 3.9 - 5.1), and 11.4% (95% CI 10.4 - 12.4) based on HbA1c values. Therefore, 61% of cases of DM are likely to be undiagnosed (~2.7 million people). Conclusions. There is significant underdiagnosis of hypertension and DM in SA. The underdiagnosis of these two treatable conditions, which have high morbidity and mortality, has major population health implications.
Outcomes of patients with COVID-19 acute respiratory distress syndrome requiring invasive mechanical ventilation admitted to an intensive care unit in South Africa
Authors:   Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa, Arnold-Day C , van Zyl-Smit R N , Joubert I A , Thomson D A , Fredericks D L , Miller M G A , Michell W L , Semple P L , Piercy J L
Published: February 2022

Background. Up to 32% of patients with COVID-19 pneumonia may require intensive care unit (ICU) admission or mechanical ventilation. Data from low- and middle-income countries on COVID-19 acute respiratory distress syndrome (ARDS) are limited. Groote Schuur Hospital in Cape Town, South Africa, expanded its intensive care service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). Objectives. To report on patients’ characteristics and outcomes from the first two pandemic waves. Methods. All patients with COVID-19 ARDS admitted to the ICU for IMV were included in this prospective cohort study. Data were collected from 5 April 2020 to 5 April 2021. Results. Over the 12-month study period, 461 patients were admitted to the designated COVID-19 ICU. Of these, 380 met the study criteria and 377 had confirmed hospital discharge outcomes. The median (range) age of patients was 51 (17 - 71) years, 50.5% were female, and the median (interquartile range (IQR)) body mass index was 32 (28 - 38) kg/m2. The median (IQR) arterial oxygen partial pressure to fractional inspired oxygen (P/F) ratio was 97 (71 - 128) after IMV was initiated. Comorbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10.5%). Of the patients admitted, 30.8% survived to hospital discharge with a median (IQR) ICU length of stay of 19.5 (9 - 36) days. Predictors of mortality after adjusting for confounders were male sex (odds ratio (OR) 1.74), increasing age (OR 1.04) and higher Sequential Organ Failure Assessment (SOFA) score (OR 1.29). Conclusions. In a resource-limited environment, the provision of IMV support in the ICU achieved 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease.
COVID-19 vaccine hesitancy and anti-vaxxers – supporting healthcare workers to navigate the unvaccinated: Reflections from clinical practice
Authors:   Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa Peninsula Medical School, Faculty of Health, University of Plymouth, UK, Hoare J , Mendelson M , Frenkel L
Published: February 2022

An important step in preparation for the fourth COVID-19 wave is to provide healthcare workers (HCWs) with skills to facilitate behaviour change in vaccine-hesitant patients. Convincing members of the public who are vaccine hesitant rather than anti-vaxxers should be the focus of our efforts. Our experience is that vaccine-hesitant individuals and anti-vaxxers are generally distinct cohorts, with differing reasons for their vaccine reluctance. If we are to truly address hesitancy, we must take time to understand the reasons for an individual’s hesitancy. Developing a conceptual framework and skills for HCWs during encounters with unvaccinated individuals will be important not only for shifting some to get vaccinated, but also to manage the complex emotions that HCWs will undoubtedly be forced to confront during the fourth wave.
The impact of the SARS-CoV-2 epidemic on mortality in South Africa in 2020
Authors:   Centre for Actuarial Research, Faculty of Commerce, University of Cape Town, South Africa, Dorrington R E , Laubscher R , Nannan N , Bradshaw D
Published: February 2022

Background. The impacts on mortality of both the SARS-CoV-2 epidemic and the interventions to manage it differ between countries. The Rapid Mortality Surveillance System set up by the South African Medical Research Council based on data from the National Population Register (NPR) provides a means of tracking this impact on mortality in South Africa. Objectives. To report on the change in key metrics of mortality (numbers of deaths, life expectancy at birth, life expectancy at age 60, and infant, under-5, older child and adolescent, young adult, and adult mortality) over the period 2015 - 2020. The key features of the impact are contrasted with those measured in other countries. Methods. The numbers of registered deaths by age and sex recorded on the NPR were increased to account for both registered deaths that are not captured by the NPR and an estimate of deaths not reported. The estimated numbers of deaths together with estimates of the numbers in the population in the middle of each of the years were used to produce life tables and calculate various indicators. Results. Between 2019 and 2020, the number of deaths increased by nearly 53 000 (65% female), and life expectancy at birth fell by 1 year for females and by only 2.5 months for males. Life expectancy at age 60 decreased by 1.6 years for females and 1.2 years for males. Infant mortality, under-5 mortality and mortality of children aged 5 - 14 decreased by 22%, 20% and 10%, respectively, while that for older children and adolescents decreased by 11% for males and 5% for females. Premature adult mortality, the probability of a 15-year-old dying before age 60, increased by 2% for males and 9% for females. Conclusions. COVID-19 and the interventions to manage it had differential impacts on mortality by age and sex. The impact of the epidemic on life expectancy in 2020 differs from that in most other, mainly developed, countries, both in the limited decline and also in the greater impact on females. These empirical estimates of life expectancy and mortality rates are not reflected by estimates from agencies, either because agency estimates have yet to be updated for the impact of the epidemic or because they have not allowed for the impact correctly. Trends in weekly excess deaths suggest that the drop in life expectancy in 2021 will be greater than that in 2020.
Guiding equitable prioritisation of COVID-19 vaccine distribution and strategic deployment in South Africa to enhance effectiveness and access to vulnerable communities and prevent waste
Authors:   Right to Care, Centurion, Pretoria, South Africa, Ovens W , Tomescu S , Harrison E , Crampton T , de Nooy A , Jassat W , Banoo S , Pisa P , Sanne I
Published: February 2022

Background. In South Africa (SA), >2.4 million cases of COVID‑19 and >72 000 deaths were recorded between March 2020 and 1 August 2021, affecting the country’s 52 districts to various extents. SA has committed to a COVID‑19 vaccine roll-out in three phases, prioritising frontline workers, the elderly, people with comorbidities and essential workers. However, additional actions will be necessary to support efficient allocation and equitable access for vulnerable, access-constrained communities. Objectives. To explore various determinants of disease severity, resurgence risk and accessibility in order to aid an equitable, effective vaccine roll-out for SA that would maximise COVID‑19 epidemic control by reducing the number of COVID‑19 transmissions and resultant deaths, while at the same time reducing the risk of vaccine wastage. Methods. For the 52 districts of SA, 26 COVID‑19 indicators such as hospital admissions, deaths in hospital and mobility were ranked and hierarchically clustered with cases to identify which indicators can be used as indicators for severity or resurgence risk. Districts were then ranked using the estimated COVID‑19 severity and resurgence risk to assist with prioritisation of vaccine roll-out. Urban and rural accessibility were also explored as factors that could limit vaccine roll-out in hard-to-reach communities. Results. Highly populated urban districts showed the most cases. Districts such as Buffalo City, City of Cape Town and Nelson Mandela Bay experienced very severe first and second waves of the pandemic. Districts with high mobility, population size and density were found to be at highest risk of resurgence. In terms of accessibility, we found that 47.2% of the population are within 5 km of a hospital with ≥50 beds, and this percentage ranged from 87.0% in City of Cape Town to 0% in Namakwa district. Conclusions. The end goal is to provide equal distribution of vaccines proportional to district populations, which will provide fair protection. Districts with a high risk of resurgence and severity should be prioritised for vaccine roll-out, particularly the major metropolitan areas. We provide recommendations for allocations of different vaccine types for each district that consider levels of access, numbers of doses and cold-chain storage capability.
Blood culture contamination in the departments of paediatrics and child health at two tertiary training hospitals in central South Africa
Authors:   Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa, Krause R C
Published: February 2022

Background. Bloodstream infections are an important cause of mortality in children. Blood cultures (BCs) remain the primary means of identifying organisms and their antibiotic susceptibility profiles. A shortcoming of BCs is that up to 56% of positive cultures will represent contaminants. Poor adherence to standard practices applicable to BC sampling could explain an unacceptable contamination rate. Objectives. To determine: (i) the BC contamination rate in the departments of paediatrics and child health at two tertiary hospitals in central South Africa; and (ii) BC sampling practices among paediatric clinicians. Methods. The author determined the prevalence of BC contamination by analysis of laboratory data for the period 1 May - 27 August 2019, and assessed possible factors contributing to BC contamination by surveying paediatric medical staff with a self-administered BC practices questionnaire. Results. Of the 244 BCs reviewed, 25.4% were positive. The most commonly isolated pathogens were coagulase-negative staphylococci (CoNS) (33.3%), Escherichia coli (22.2%), Enterococcus faecium (16.7%) and Acinetobacter baumannii (11.1%). In total, 15.2% of the BCs yielded contaminants and 2.9% had polymicrobial growth. The most common contaminant was CoNS. Approximately 68% of clinicians were not aware of BC sampling guidelines, and even among those who were aware of the guidelines, non-compliance was reported. Conclusions. The BC contamination rate was higher than internationally accepted rates. Educating clinicians on specific BC sampling guidelines is strongly recommended to decrease the high rate of contamination observed in this study.
Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa
Authors:   School of Pharmacy, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa, Wehmeyer A , Coetzee R , McCartney J
Published: February 2022

Background. Venous thromboembolism (VTE) is regarded as the most preventable cause of inpatient death in hospital settings globally. VTE can be prevented through the provision of non-pharmacological and/or pharmacological thromboprophylaxis following individualised risk screening. The Caprini risk assessment model (RAM) offers a validated and well-established approach for VTE risk assessment in medical inpatients. Literature findings describe a trend towards inappropriate and under-prescribing of thromboprophylaxis in this population. Together with concerns regarding clinicians’ perceived importance of VTE risk assessment, the need to clarify these aspects of practice is evident. Objectives. To describe VTE risk assessment and prophylaxis practices of medical practitioners in public sector hospitals in Western Cape Province, South Africa (SA). Methods. A retrospective, cross-sectional study design was employed in the medical wards of two district hospitals and one regional hospital in the Cape Town metropole, Western Cape. Medical folders of adult medical inpatients admitted between January and July 2020 were reviewed to assess VTE risk using the Caprini RAM. Thromboprophylaxis therapy prescribed and contraindications to chemoprophylaxis were also evaluated. Results. Of 380 patients included in the review, 51.6% were female, and the average age was 52.1 years (range 18 - 96); 21.3% had their weight recorded, while none had their height documented. Infectious disease was the predominant diagnosis (49.2%) detected in the sample. Common VTE risk factors identified included bed rest/restricted mobility for <72 hours (76.3%) and serious infection (67.4%). A total of 97.1% of patients (n=369) were found to be at moderate or higher risk of VTE (Caprini score ≥2). Of this at-risk group, 24.1% were eligible to receive chemoprophylaxis, yet no prescription for thromboprophylaxis was identified. Seventy percent of patients (n=266) were prescribed chemoprophylaxis, with enoxaparin accounting for 98.5% of regimens. Contraindications to chemoprophylaxis were recorded in 13.4% of patients. Conclusions. Although rates of VTE prophylaxis in medical inpatients may be improving, thromboprophylaxis still remains critically underutilised in this population. This study highlighted a consequence of this trend, with inappropriate chemoprophylaxis prescribing becoming more evident. Mechanical prophylaxis prescribing in medical inpatients is lacking, despite the associated benefits. RAMs should be adapted for the SA setting, where infectious diseases are prevalent. Future research should assess RAM use by clinicians, as this could provide insight into improving RAM uptake and thromboprophylaxis prescribing.
Tenofovir alafenamide: An initial experience at Groote Schuur Hospital, Cape Town, South Africa
Authors:   Faculty of Health Sciences, University of Cape Town, South Africa, Geragotellis A , Patel S , A M , Wearne N , Barday Z , Sanglay L , Naicker V , Spearman C W
Published: February 2022

Background. Hepatitis B virus (HBV) remains endemic in South Africa (SA), with a concomitantly high prevalence of HIV co-infection. Chronic kidney disease in these subpopulations also has a high prevalence. Tenofovir is an important component of management, but the associated risk of nephrotoxicity makes dosing a challenge in patients with impaired kidney function. A new formulation, tenofovir alafenamide fumarate (TAF), with a more favourable renal toxicity profile, is now available. Objectives. To evaluate our initial experience of TAF use at Groote Schuur Hospital, Cape Town. Methods. We retrospectively reviewed patients with HBV mono-infection and HIV-HBV co-infection who were initiated on TAF since 2018. We recorded all relevant demographic, serological, virological and biochemical data from patient records. Adherence was documented by pill collection at the pharmacy. Results. A total of 26 patients were included in the evaluation, median (interquartile range (IQR)) age 48 (39 - 51) years, 73% (n=19) male, 27% (n=7) hepatitis B e-antigen-positive, and 46% (n=12) HIV co-infected. The median (IQR) duration of treatment with TAF was 13 (9 - 15) months. The median (IQR) baseline creatinine level was 180 (130 - 227) µmol/L, with significant improvement at 12 months, 122 (94 - 143) µmol/L; p=0.017. Reflecting this change, the estimated glomerular filtration rate improved significantly from baseline to month 12 (42 (25 - 52) and 51 (48 - 68) mL/min/1.73 m2, respectively; p=0.023). Similarly, serum alanine aminotransferase (ALT) normalised from a baseline of 33 (18 - 52) to 18 (15 - 24) U/L at month 12 (p=0.012). HBV DNA viral load also declined, from a baseline of log10 4.04 (2.5 - 7.8) IU/mL to a median of <log10 1.3 IU/mL at month 12. HIV viral load was less than the lower level of quantification at months 6 and 12. Conclusions. TAF was well tolerated, with stable and significantly improving kidney function throughout a 12-month follow-up period. Serum ALT normalised, mirrored by declining HBV viral load. HIV viral load remained undetectable at 6 and 12 months.
COVID-19 wave 4 in Western Cape Province, South Africa: Fewer hospitalisations, but new challenges for a depleted workforce
Authors:   Western Cape Government: Health, South Africa, Mendelsohn A S ,   Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa andrea.mendelsohn@westerncape.gov.za, de Sá A , Morden E , Botha B , Boulle A , Paleker M , Davies M-A
Published: February 2022

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Discriminations intersectionnelles et stratégies identitaires : les vécus et perceptions des Marocain·e·s LGBTQ+ de première génération d’immigration à Montréal
Authors: de Repentigny-Corbeil Mylène
Published: February 2022

Les discriminations vécues et perçues par les Marocains et Marocaines LGBTQ+ de première génération d’immigration à Montréal découlent de conjonctures historiques, sociales et politiques. En effet, les législations en place au Maroc criminalisant les rapports homosexuels, et l’interprétation majoritaire de l’islam condamnant l’homosexualité affectent les parcours migratoires, ainsi que les vécus dans le pays d’origine et le pays d’accueil notamment au sein des communautés marocaines et musulmanes. Également, le racisme systémique et l’aversion pour la religion, vécue et ressentie au sein des communautés LGBTQ+, engendrent des discriminations de nature islamophobe et raciste. Ainsi, prises entre des impératifs sociaux tant hétéronormatifs qu’homonormatifs, les Marocains et Marocaines LGBTQ+ se retrouvent à l’intersection de discriminations multiples au sein des structures politico-juridiques canadiennes et québécoises, ainsi qu’au sein des associations et lieux de solidarité communautaires. Cibles d’injonctions homonormatives séculières et hétéronormatives homophobes, ils et elles composent avec des conceptions et pressions inexistantes ou différentes de celles au Maroc, complexifiant leurs parcours migratoires et leurs questionnements identitaires. Cet article propose d’analyser les discriminations intersectionnelles et les stratégies de négociations identitaires des Marocains et Marocaines LGBTQ+ de première génération d’immigration à Montréal, abordées lors d’entretiens semi-dirigés effectués en 2018. De par la simultanéité et l’interactivité des oppressions et pressions normatives provenant de leurs diverses communautés d’appartenance, le coming-out devient, à ce titre, l’illustration de l’intersectionnalité des discriminations vécues et perçues.