BACKGROUND: Neonatal hypoxic ischaemic encephalopathy (HIE) is a leading cause of term neonatal death worldwide, with a higher incidence in low- to middle-income settings OBJECTIVE: To investigate whether nucleated red blood cell (nRBC) counts could predict severity of HIE and outcomes in term neonates treated with therapeutic hypothermia (TH METHODS: We conducted a retrospective sub-study at Tygerberg Hospital in Cape Town, South Africa. The review included all cooled neonates' clinical records and blood samples from a National Health Laboratory Services database. One experienced neurodevelopmental expert assessed patients over a period of 12 months RESULTS: Twenty-five files out of a total of 100 were excluded owing to missing data. In accordance with the Thompson HIE score, the cohort was classified as mild (56%), moderate (27%), and severe (17%). All included patients (n=75) had full blood counts within 6 hours of delivery. nRBC were detected in 52% of the samples. There was no correlation between nRBC category and HIE severity (p=0.265). Raised nRBCs (>30 cells/100 white blood cells (WBCs)) were more frequent in infants who died than in those who survived (p=0.008). Infants with nRBC counts >30 cells/100 WBCs had an increased likelihood of having cerebral palsy or impaired neurodevelopment (p=0.013 CONCLUSION: The study demonstrated a significant association between an early increase in nRBC counts in HIE infants treated with TH, and both short- and long-term outcomes. A larger multicentre study is required to better understand the relationship between nRBC counts and HIE in the era of cooling in our local setting

AIM: A pursuit to And a healthy alternative to sucrose with less cariogenic potential, which can potentially lower the incidence of Early Childhood Caries (ECC), by means of comparison. METHODS: Primary tooth enamel blocks (n=32) were randomly divided into four groups and exposed to 5% concentrations of the respective test groups (sucrose, xylitol, erythritol and stevia). All samples were inoculated with S. mutans standard strain (ATCC 25175) at room temperature. Analysis of Colony Forming Units (CFUs), acidity measurements (pH) and Scanning Electron Microscopy (SEM) observations were done after 6, 12, 18 and 24 h and compared. RESULTS: After 6 h, the marginal mean CFU count indicated equal S. mutans growth in all groups. Stevia showed lower CFU counts compared to other groups at 12, 18 and 24 h. The pH levels for all non-fermentable sugar substitutes (NSS) initially decreased but never below the critical pH=5.5 and stabilized from 12 to 18 h. The pH levels of sucrose dropped and remained below pH=5.5 at all time intervals. The SEM analysis of S. mutans supported the CFU results indicating growth in the presence of sucrose and reduction in the presence of the NSS. CONCLUSIONS: Compared to sucrose, xylitol, erythritol and stevia have less cariogenic potential with reduced growth of S. mutans and subsequent acidity levels. Stevia had the least cariogenic potential of all the NSS tested, followed by erythritol and then xylitol.

To conserve fresh water resources and comply with environmental regulations, DRDGOLD, a South African gold producer re-treating surface tailings, has transitioned to a fully closed water circulation system. Consequently, the accumulation of contaminants, as well as addition of reagents, has led to changes in water composition that have compromised leach performance and overall gold recovery. A two-sample t-test confirmed a significant difference in gold recoveries between the use of Rand Water, which was used as a benchmark, and untreated process water. Atomic absorption analysis of ERGO's process water, confirmed the presence of iron, nickel, zinc, and manganese. A study of the effect of the identified contaminants on gold recovery showed that iron, nickel, and zinc have the largest negative effect on gold recovery, with iron and nickel being more detrimental than zinc. Sulphates were shown to have a possible passivation effect, which also influenced gold recoveries, although to a lesser extent than the heavy metals. Calcium, when present in excess, had a positive influence on gold recovery indicating the possible formation of a calcium aurocyanide complex. Lime softening successfully reduced the heavy metal and sulphate concentrations, and the gold recoveries obtained with the treated process water were similar to those as achieved with Rand Water.

BACKGROUND. In South Africa (SA), healthy term newborns are usually discharged <72 hours after delivery. Discharged babies remain at risk for severe hyperbilirubinaemia if it is not identified early. Hyperbilirubinaemia is an important cause of readmission, and also leads to neonatal mortality and morbidity. Use of transcutaneous bilirubin (TcB) screening before hospital discharge has been controversial.OBJECTIVES. To test the clinical benefits of TcB screening of healthy newborns before discharge for the outcomes of readmission for jaundice and severe hyperbilirubinaemia in a randomised controlled trial (RCT).METHODS. This was a RCT. We compared predischarge TcB screening with visual assessment (alone) for jaundice in apparently healthy newborns at a public tertiary hospital in Cape Town, SA. Patients or study participants were not involved in the study design and implementation.RESULTS. Of the 1 858 infants, 63% were black, 35% of mixed race and 1% white. There was a significant reduction in the rate of readmission for jaundice (risk ratio (RR) 0.25; 95% confidence interval (CI) 0.14 - 0.46; p<0.0001) and in the incidence of severe hyperbilirubinaemia (RR 0.27; 95% CI 0.08 - 0.97; p=0.05) with the use of TcB screening compared with visual inspection.CONCLUSIONS. Predischarge TcB screening is superior in identifying newborns at risk of severe hyperbilirubinaemia compared with visual inspection. We recommend that every newborn, regardless of skin pigmentation, should receive objective bilirubin screening before hospital discharge. Universal bilirubin screening in newborns could potentially reduce hyperbilirubinaemia-related morbidity and mortality.

BACKGROUND. Neonatal hypotension remains one of the most controversial topics in neonatology. Various definitions are used but lack an evidence base. Owing to the variation in defining a low blood pressure (BP), significant differences in pharmacological manipulation of BP are evident. OBJECTIVES. The aim of the present research was to determine (1) the diagnostic criteria for neonatal hypotension and (2) management strategies for neonatal hypotension in South Africa. Methods. A 29-point questionnaire was designed to determine the criteria used by South African neonatologists and paediatricians to diagnose and manage neonatal hypotension. The survey was conducted at two different time points in 2017. RESULTS. The combination of the two surveys resulted in a 9.3% (47/507) response rate. A BP below the gestational age (in weeks) was the most common definition used for neonatal hypotension (75%). Most clinicians (86%) administered fluid prior to initiating inotrope therapy. Dopamine, dobutamine and adrenaline were the most common first-, second- and third-line anti-hypotensive drugs used. Most clinicians (77%) did not use a hypotension management guideline. CONCLUSION. Neonatal hypotension definition and management in South Africa are similar to international patterns, despite a lack of evidence to support the diagnosis and management strategies.

Abstract Due to the importance of the use of lactic acid bacteria (LAB) in the food industry, the objective of this study was to isolate, characterize and identify microorganisms associated with the fruit of tempesquitle from the mixteca region. A first macroscopic and biochemical characterization led to the identification of eight gram-positive cultures and seven gram-negative, in three phenological states of tempesquitle and in the processing type brine. In green tempesquitle fruit samples, microorganism growth was not observed. The molecular characterization of the cultures by 16S ribosomal region sequencing allowed the identification at gender and specie level of the isolations. Bacillus subtilis was the most abundant microorganism of the lactic acid bacteria, this was isolated from the fruit of stained, mature and processed tempesquitle, while Leuconostoc mesenteroides and Bacillus amyloliquefaciens were isolated from samples of mature and processed tempesquitle. Results suggest that from tempesquitle fruit lactic acid bacteria can be isolated, with biotechnological potential in foods for the improvement of organoleptic and commercial characteristics in the food industry. The evaluation of the biotechnological potential of the isolated bacteria in the present study will be the objective for future research.

Resumen Dada la importancia del uso de las bacterias ácido lácticas (BALs) en la industria alimentaria, el objetivo de este estudio fue aislar, caracterizar e identificar microorganismos asociados al fruto del tempesquistle de la región mixteca. Una primera caracterización macroscópica y bioquímica llevó a la identificación de ocho cultivos Gram positivos y siete Gram negativos en tres estados fenológicos del tempesquistle y en el procesado del tipo salmuera. En muestras de fruto de tempesquistle verdes, no se observó crecimiento de microorganismos. La caracterización molecular de los cultivos mediante secuenciación de la región 16S ribosomal permitió la identificación a nivel género y especie de los aislamientos. Bacillus subtilis fue el microorganismo más abundante de las bacterias ácido lácticas, estas fueron aisladas del fruto de tempesquistle pintón, maduro y procesado, mientras que Leuconostoc mesenteroides y Bacillus amyloliquefaciens fueron aislados de muestras de tempesquistle maduro y procesado. Los resultados sugieren que del fruto del tempesquistle pueden ser aisladas bacterias ácido lácticas, con potencial biotecnológico en alimentos para la mejora de las características organolépticas y comerciales en la industria alimenticia. La evaluación del potencial biotecnológico de las bacterias aisladas en el presente estudio, será el objetivo de trabajos futuros.

BACKGROUND. Cervical cancer is a major cause of cancer-related deaths, especially in the context of the HIV epidemic. OBJECTIVE. To examine awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women. METHODS. Interviewer-administered structured questionnaires were administered to HIV-positive women (aged >18 years) enrolled in a cervical cancer screening study at the Themba Lethu Clinic, Johannesburg, South Africa, from November 2009 to December 2011. Modified Poisson regression with robust standard errors was used to identify factors at enrolment associated with awareness, perceived risk and adequate practice related to cervical screening. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) are presented. RESULTS. Of the 1 202 women enrolled, 71.3% and 18.2% were aware of the Pap smear and HPV, respectively. Of the 1 192 participants with data evaluated, 76.5% were worried and 23.5% were not worried about cervical cancer; 28.6% of the women had adequate screening practice. Older age (40 - 49 years or >50 years v. 18 - 29 years) (aRR 1.63, 95% CI 1.12 - 2.37; aRR 2.22, 95% CI 1.44 - 3.41), higher education (tertiary v. less than grade 10) (aRR 1.39, 95% CI 1.00 - 1.93), initiation on combination antiretroviral therapy (aRR 1.36, 95% CI 1.00 - 1.85) and awareness of Pap smear screening (aRR 16.18, 95% CI 7.69 - 34.01) were associated with adequate screening practice. CONCLUSIONS. High levels of Pap smear awareness and low levels of Pap smear screening uptake were observed. However, Pap smear awareness was associated with adequate screening practice. More research into effective health education programmes to address these gaps is needed.

Persistent pulmonary hypertension of the newborn is a neonatal emergency with a high mortality rate in spite of several advances in the management thereof. The underlying pathophysiology is complex and multifactorial. The gold standard of treatment is inhaled nitric oxide, yet up to a third of patients will not respond to standard treatment. This article reviews treatment modalities available, as well as the evidence to support the use of these treatment options.

Even though Serratia marcescens is not one of the most common causes of infection in neonates, it is associated with grave morbidity and mortality. We describe the evolution of brain parenchymal affectation observed in association with S. marcescens infection in neonates. This retrospective case series details brain ultrasound findings of five neonates with hospital-acquired S. marcescens infection. Neonatal S. marcescens infection with or without associated meningitis can be complicated by brain parenchymal affectation, leading to cerebral abscess formation. It is recommended that all neonates with this infection should undergo neuro-imaging more than once before discharge from hospital; this can be achieved using bedside ultrasonography.

OBJECTIVES: To determine the current prevalence of retinopathy of prematurity (ROP) in premature babies treated with non-invasive ventilation at Tygerberg Children's Hospital, Parow, Cape Town, South Africa, and to identify risk factors associated with the development of ROP. METHODS: A retrospective medical records review of infants screened for ROP during a 2-year period (January 2009 - December 2010). Infants who did not receive invasive ventilation during the first week of life were included. Twenty-four previously reported risk factors for the development of ROP were identified for use in a multivariate logistic regression (MLR) analysis. RESULTS: A total of 356 patients were included. The overall prevalence of ROP was 21.8% and that of clinically significant ROP (CSROP) 4.4%. The risk factors with a statistically significant association with the development of ROP on MLR analysis were severe apnoea (p=0.0005) and decreasing birth weight (p=0.0382). CONCLUSIONS: There is a low prevalence of ROP in the cohort of preterm infants treated exclusively with non-invasive ventilation in the first week of life. The risk factors of importance in our population were severe apnoea and lower birth weight. Birth weight is a practical and reproducible variable that can be used to aid development of ROP screening criteria.

The feedwell performance in gravity thickeners and clarifiers relies on the efficient mixing between solid particles and flocculant to achieve effective flocculation, as well as energy dissipation of the incoming feed stream. A population balance-computational fluid dynamics (PB-CFD) model has been developed and validated to provide new insights into the operation and performance of industrial feedwells. In particular, the PB-CFD model enables the efficacy of the main functions of a feedwell to be investigated for a wide range of feedwell designs and process conditions. This paper describes how PB-CFD was used in the design and development of a new feedwell concept for the flocculation of particles in a solid-liquid stream. The patented feedwell design includes an upwardly converging flow diverter to create two separate compartments for energy dissipation and flocculation. PB-CFD simulations of this simple and easy-to-retrofit feedwell design illustrate a superior performance in terms of flocculation and energy dissipation compared to typical feedwells over a wide range of flow conditions. The potential benefits include reduced flocculant consumption, better de-aeration, greater stability and the ability to cope with a wider variation in volumetric throughput, better flocculation and fines capture, and a more symmetrical discharge that may also offer improved overflow clarity in some applications. The new feedwell design has been installed in a full-scale thickener at an Anglo American Platinum site in South Africa. A number of operational factors complicate this application, but indications are that the new feedwell has led to improvements in stability and underflow properties.

ABSTRACT OBJECTIVE: Previous mosquito surveys performed in the Federation of St Kitts and Nevis identified Anopheles albimanus in Nevis but there is no recorded occurrence of this mosquito in St Kitts. To determine the presence of this and other species in St Kitts and Nevis, a mosquito survey was conducted. METHODS: Surveys were performed in two phases - the dry season (March 16-23, 2010, in St Kitts), and the rainy season (October 18-25, 2010) in St Kitts and Nevis. BG SentinelTM mosquito traps baited with BG Lure® and CO2 were set in a variety of habitats (urban, rural, semi-urban, dry forest and mangrove). Identification was performed using morphological keys. RESULTS: The most abundant species during both phases were Culex quinquefasciatus, Aedes taeniorhynchus and Aedes aegypti. A new record for St Kitts was Anopheles albimanus which was trapped during the rainy season near a mangrove site. CONCLUSION: This is the first time a potential malaria vector has been identified in St Kitts.

OBJETIVO: Las encuestas previas sobre mosquitos realizadas en la Federación de Saint Kitts y Nevis identificaron al Anopheles albimanus en Nevis, pero no hay registro de este mosquito en Saint Kitts. El objetivo de esta investigación fue determinar la presencia de esta u otra especie de mosquito en Saint Kitts. MÉTODOS: Se realizaron encuestas en dos fases - la estación seca (16-23 de marzo de 2010, en Saint Kitts), y la estación lluviosa (18-25 de octubre de 2010) en Saint Kitts y Nevis. Trampas BG SentinelTM para mosquitos preparadas con BG Lure® y CO2 se colocaron en diversos habitats (urbano, rural, semi-urbano, bosque seco y manglar). La identificación fue realizada usando claves morfológicas. RESULTADOS: Las especies más abundantes durante ambas fases fueron Culex quinquefasciatus, Aedes taeniorhynchus y Aedes aegypti. Un nuevo registro para Saint Kitts fue Anopheles albimanus, atrapado durante la estación de lluvias cerca de un manglar. CONCLUSIÓN: Esta es la primera vez que se identifica un vector potencial de la malaria en Saint Kitts.

A biphasic hyperelastic model with spherical symmetry is presented to study hydrocephalus. The model can take into account the biphasic nature of brain tissue, non-linear stress-strain curves through an Ogden-type compressible strain energy function, a nonlinear variation of hydraulic conductivity with deformation, a constant production of cerebrospinal fluid (CSF) as well as a fluid absorption rate proportional to pressure. The biphasic equations were implemented in an updated Lagrangian finite element code where a novel procedure was devised to consider the constant generation of CSF in the ventricles. Results of a non-communicating model showed strains in the range of 35-45% in the peri-ventricular area and pore pressure and radial displacement distributions that were not significantly affected by material nonlinearities. High circumferential stresses documented in acute hydrocephalus suggest that the tissue may suffer damage at the ventricular surface while a communicating model was not capable of reproducing normal pressure hydrocephalus. Overall results suggest that normal pressure hydrocephalus cannot be explained with models that consider an elastic law for the solid phase of the material.