There have recently been safety concerns regarding an increased risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) following administration of SARS-CoV-2 adenoviral vector vaccines. The Southern African Society of Thrombosis and Haemostasis reviewed the emerging literature on this idiosyncratic complication. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by independent international experts to avoid local bias. We present concise, practical guidelines for the clinical management of VITT.

There have recently been safety concerns regarding an increased risk of vaccine-induced immune thrombotic thrombocytopenia (VITT) following administration of SARS-CoV-2 adenoviral vector vaccines. The Southern African Society of Thrombosis and Haemostasis reviewed the emerging literature on this idiosyncratic complication. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by independent international experts to avoid local bias. We present concise, practical guidelines for the clinical management of VITT.

BACKGROUND. A complete ban on alcohol advertisements has been proposed for South Africa (SA), but there has been limited local research on the association between exposure to alcohol advertisements and alcohol consumption. OBJECTIVES. To examine the role of demographic factors, exposure to alcohol marketing and liking of alcohol advertisements in predicting use of alcohol in the past 6 months among older adolescents in Tshwane, Gauteng Province, SA. METHODS. Participants comprised the adolescent sub-sample (N=869) of the International Alcohol Control study survey that was conducted in SA. They consisted of 408 males and 461 females aged 16 and 17 years who took part in structured interviews on their alcohol consumption and various alcohol-related attitudes and behaviours. A multiple survey logistic regression analysis of the dependent variable alcohol use in the past 6 months on the independent variables age, gender, educational status, socioeconomic status, exposure to alcohol brand marketing and liking of alcohol advertisements was used. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS. The prevalence of drinking in the past 6 months was 10.6% (95% CI 5.9 - 18.3). The number of modes of alcohol brand/product advertising to which the adolescents were exposed was positively associated with alcohol use in the past 6 months. An additional mode of alcohol brand/product advertising exposure led to a relative increase of 1.13 (95% CI 1.01 - 1.28) in the odds of alcohol use in the past 6 months (e.g. a participant who was exposed to advertisements via seven different channels was 2.08 times more likely to have used alcohol in the past 6 months than a participant with exposure via a single channel). Having a strong dislike of alcohol advertisements was associated negatively (protective) with alcohol use in the past 6 months, with the odds ratio being 0.35 (95% CI 0.19 - 0.64). Having only a moderate dislike or a liking of alcohol advertisements was positively associated with alcohol use in the past 6 months among the study participants (OR 2.90 and 2.84, respectively). Age, gender, educational status and socioeconomic status were not independently associated with alcohol consumption. CONCLUSIONS. Exposure to alcohol marketing and not being strongly averse to advertisements of alcohol brands and products were associated with alcohol use among adolescents. The results have implications for policies on alcohol marketing in SA.

ABSTRACT During image acquisition, is usually chosen scenes with a lesser cloud cover to avoid loss of spectral information. However, when training samples are collected for image classification, the user finds shadowed areas. Such situation is similar to the presence of clouds since spectral information of these classes is the same in all optical bands of the sensor. This fact becomes more pronounced in mountainous relief areas due to shadow projection on the terrain, which can vary among all seasons during the solar year. With the goal to obtain images with a lower presence of shadow, it was simulated, under the same relief conditions, shading variation in function of latitude (0° to 40° S). Solar radiation models were processed for the days and times passages of the Landsat TM and ETM+ satellite on the Southern Hemisphere. It was verified that over 30° S and 40° S latitudes, a loss of shading area varying between 27% to 91 % and that images should be preferentially taken between October and February. For latitudes comprising 0° and 10° S, the loss was considered negligible, when we set a 10% threshold of loss in the total valid area in an image. According to the amount of radiation in a terrain, South and West areas received less direct solar radiation over the year for all analyzed latitudes in the modeling.

BACKGROUND. A performance measurement system - the Service Quality Measures (SQM) initiative - has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation. OBJECTIVE. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers. METHODS. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system. RESULTS. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system. CONCLUSION. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation.

BACKGROUND: In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. OBJECTIVE: To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. METHODS: We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. RESULTS: Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. CONCLUSION: Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Pulmonary arterial hypertension (PAH) is a potentially lethal disease mainly affecting young females. Although the precise mechanism of PAH is unknown, the past decade has seen the advent of many new classes of drugs with improvement in the overall prognosis of the disease. Unfortunately the therapeutic options for PAH in South Africa are severely limited. The Working Group on PAH is a joint effort by the South African Heart Association and the South African Thoracic Society tasked with improving the recognition and management of patients with PAH. This article provides a brief summary of the disease and the recommendations of the first meeting of the Working Group.

BACKGROUND: Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. OBJECTIVE: To assess indicators of improved survival. METHODS: This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) who underwent haemodialysis (HD) over a period of 5 years. Information on pre-hospital and in-hospital resuscitation, trauma scores and physiological scores and daily ICU records were collected. The majority of the patients were dialysed with continuous venovenous haemofiltration in the early years of the study and later with sustained low-efficiency dialysis. RESULTS: Of the 64 patients 47 died, giving an overall mortality rate of 73%. Mortality was highest in the burns patients (84%). Survival in all patients, irrespective of injury, was unrelated to the Revised Trauma Score, Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score or Trauma Injury Severity Score. The duration of HD did not differ significantly between the three trauma groups, and age was not a significant predictor of survival. Patients who were polyuric at the time of the initiation of HD had a lower mortality rate than those who were oliguric, anuric or normouric, although this did not reach statistical significance (p=0.09). CONCLUSIONS: Acute renal failure in trauma patients is associated with a low survival rate. Controversial conclusions have been presented in the literature. In this study, none of the parameters previously reported to affect survival proved to be valid, although the number of patients was comparable with those in other studies. Since understanding of the predictors and course of renal failure in trauma patients is still at an early stage, there is a need for multicentre prospective studies.

This is a case report of extra-peritoneal rectal injury, secondary to a gunshot, that was managed nonoperatively. A 57-year old male presented with a single gunshot to the right buttock and had blood per rectum. Extra-peritoneal rectal injuries were seen on proctoscopy and he had no genitourinary injury. He was managed successfully without rectal injury repair or faecal stream diversion.

Éste es un reporte de caso de una lesión rectal extra-peritoneal, secundaria a una herida por disparo, tratada de forma no operatoria. Un hombre de 57 años acudió con una herida de bala en la nalga derecha y presentaba sangramiento por vía del recto. Las lesiones rectales extra-peritoneales fueron vistas con proctoscopio, pero no presentaba lesión genitourinaria. Fue tratado exitosamente sin reparación de la lesión rectal o diversión de la corriente fecal.

The phyllosphere, i.e., the aerial parts of the plant, provides one of the most important niches for microbial colonization. This niche supports the survival and, often, proliferation of microbes such as fungi and bacteria with diverse lifestyles including epiphytes, saprophytes, and pathogens. Although most microbes may complete the life cycle on the leaf surface, pathogens must enter the leaf and multiply aggressively in the leaf interior. Natural surface openings, such as stomata, are important entry sites for bacteria. Stomata are known for their vital role in water transpiration and gas exchange between the plant and the environment that is essential for plant growth. Recent studies have shown that stomata can also play an active role in limiting bacterial invasion of both human and plant pathogenic bacteria as part of the plant innate immune system. As counter-defense, plant pathogens such as Pseudomonas syringae pv tomato (Pst) DC3000 use the virulence factor coronatine to suppress stomate-based defense. A novel and crucial early battleground in host-pathogen interaction in the phyllosphere has been discovered with broad implications in the study of bacterial pathogenesis, host immunity, and molecular ecology of bacterial diseases.

OBJECTIVE: To determine the mean level of adherence and factors contributing to non-adherence in patients on Highly Active Antiretroviral Therapy (HAART). METHODS: An observational study was done on 101 HIV/AIDS patients attending the Centre for HIV/ AIDS Research, Education and Services (CHARES) - University Hospital of the West Indies, between May 2006 and August 2006. A questionnaire was administered asking questions re: prescribed and actual dosing frequency and number of antiretroviral tablets for the previous week, reasons for non-adherence, duration of Highly Active Antiretroviral Therapy, age, employment status and level of education. Mean levels of adherence were calculated using self and social worker/nurse reported dosing frequency and number of tablets. Good adherence was defined as 95% or greater. Multiple regression analysis was used to determine factors impacting on adherence. RESULTS: Ninety-six patients were included for final analysis. Mean levels of adherence were as follows: 87.66% - self-report for tablets; 88.70% - self-report for dosing frequency; 87.02% - social worker/ nurse report for tablets; 88.10% - social worker/nurse report for dosing frequency. There were significant positive correlations between self and social worker/nurse reports using dosing frequency (Spearman Rho correlation coefficient 0.943, p = 0.01) or number of tablets (Spearman Rho correlation coefficient 0.955, p = 0.01). Adherence to self-reported number of tablets and dosing frequency were 58.4% and 56.4% respectively. Duration of HAART was found to have a significant negative correlation with the level of self-reported adherence to tablets (p = 0.002). CONCLUSION: Adherence to HAART is sub-optimum in patients at the CHARES. This must be urgently addressed to prevent the development of resistant HIV strains and treatment failure.

OBJETIVO: Determinar el nivel medio de adhesión y los factores que contribuyen a la no adhesión en pacientes bajo terapia antiretroviral altamente activa (TARAA). MÉTODOS: Se realizó un estudio observacional a 101 pacientes con VIH/SIDA, que asistían al Centro de Investigación, Educación y Servicios de VIH/SIDA (CHARES), del Hospital Universitario de West Indies, entre mayo del 2006 y agosto del 2006. Se administró una encuesta con preguntas sobre la frecuencia de la dosificación prescrita y real y el número de tabletas antiretrovirales para las razones de la semana previa para la duración de la no adhesión al TARAA, la edad, el estatus de empleo y el nivel de educación. Los niveles medios de adhesión fueron calculados usando frecuencias de dosificación auto-reportadas, o reportadas por enfermeras o trabajadoras sociales, y el número de tabletas. Una adhesión era definida como buena si alcanzaba el 95% o más. Para determinar los factores que tienen un impacto sobre la adhesión se recurrió al análisis de regresión múltiple. RESULTADOS: Noventa y seis pacientes fueron incluidos en el análisis final. Los niveles medios de adhesión fueron los siguientes: 87.66% - auto-reportes de tabletas; 88.70% - auto-reportes de frecuen-cia de dosificación; 87.02% reportes de tabletas por enfermeras o trabajadoras sociales; 88.10% reportes de frecuencia de dosificación por parte de enfermeras o trabajadoras sociales. Hubo correlaciones positivas significativas entre los auto-reportes y los reportes de las enfermeras y trabajadoras sociales que usaron frecuencia de dosificación (coeficiente de correlación rho de Spearman 0.943, p = 0.01) o número de tabletas (coeficiente de correlación rho de Spearman 0.955, p = 0.01). Según los auto-reportes, la adhesión al número de tabletas y a la frecuencia de dosificación fueron 58.4% y 56.4% respectivamente. Se halló que la duración del TARAA tiene una correlación negativa significativa con el nivel auto-reportado de adhesión a las tabletas (p = 0.002). CONCLUSIÓN: La adhesión a la Terapia Antiretroviral Altamente Activa es sub-óptima en los pacientes del Centro CHARES. Esto es algo que requiere atención urgente si se quiere prevenir el desarrollo de cepas resistentes de VIH y el fracaso del tratamiento.

Neste trabalho, avaliou-se a biodigestão anaeróbia de dejetos de suínos. Para isso, foi utilizado esquema laboratorial, constituído de 24 digestores com volume total de 14 L, sendo cada um abastecido com dejetos de suínos em fase de terminação, diluídos em água, perfazendo 10 L de volume útil de substrato com concentração inicial de sólidos totais de 6%. Três grupos formados por oito desses biodigestores foram expostos a três temperaturas (25; 35 e 40 ºC) e a dois níveis de agitação (com e sem) do substrato. A análise da fase de partida foi feita com base na produção média acumulada de biogás, num período de 71 dias. Os resultados demonstraram que a agitação não interferiu e que o melhor desempenho, inclusive o menor tempo gasto para atingir determinado nível de produção de biogás, foi verificado na temperatura de 35 ºC.

In this work was evaluated the anaerobic digestion of swine wastes. For that, a laboratory scheme was used, consisting of 24 digesters whose total volume was 14 L, being each one supplied with ending swine wastes, diluted in water, resulting on 10 L of net volume of substratum, with initial total solids concentration of 6%. Three groups formed by eight of these biodigesters were exposed to three temperatures (25; 35 and 40 ºC) and to two substratum agitation levels (with and without). The departure phase analysis was based in the average accumulated biogas yield along the period of 71 days. Results showed that agitation didn't contribute and that the best performance, including the minor time requested to obtain a specific biogas yield level, was verified in the temperature of 35 ºC.

O objetivo deste trabalho foi caracterizar as secas do Estado do Ceará, com base no índice de severidade de seca de Palmer. Foram utilizadas séries históricas de dados pluviométricos e de temperatura do ar de 21 localidades desse Estado, fornecidas, respectivamente, pela Superintendência de Desenvolvimento do Nordeste - SUDENE, e pela Fundação Cearense de Meteorologia e Recursos Hídricos - FUNCEME. Foi constatado a ocorrência de secas com diferentes graus de severidade, no Estado do Ceará, sendo as secas moderadas e severas as mais freqüentes.

The objective of this work was to characterize the droughts in the State of Ceará based on the Palmer drought severity index. Historical data series of rainfall and air temperature of 21 localities of this State, were provided by the "Superintendência de Desenvolvimento do Nordeste - SUDENE", and by the "Fundação Cearense de Meteorologia e Recursos Hídricos - FUNCEME", respectively. The occurrences of droughts of different degrees of severity were verified in the State of Ceará, with frequent moderate and severe droughts.