BACKGROUND. Optimal theatre utilisation is essential to reduce long waiting lists for elective surgeries and to increase cost-effective theatre operation. Utilisation rates well below the global benchmark of 80% have been reported for government hospitals in Johannesburg, South Africa (SA). OBJECTIVE. To investigate utilisation of three paediatric theatres at the Chris Hani Baragwanath Academic Hospital (CHBAH) in Johannesburg. METHODS. Surgery lists of the three theatres were reviewed for three one-week periods over a four-month study period. Preoperative, intraoperative and postoperative data were collected to create a timeline for each theatre and each surgical case, including reasons for cancellations, delays or expedited times. RESULTS. A total of 152 surgeries were scheduled during the reviewed study period, of which 44 cases were cancelled. The utilisation rate was 59.8% across the three theatres combined, with individual rates calculated as 62.7%, 58.2% and 57.0% in the burns, general and neonatal theatres, respectively. The primary factor contributing to under-utilisation was early completion of the scheduled list. Surgery delays were mainly due to delays in transferring the patient to the theatre and between anaesthetic induction and the start of surgery. CONCLUSION. Utilisation of the paediatric theatres at CHBAH is below the ideal benchmark of 80%; however, utilisation was better than expected when compared with findings from other public-sector hospitals in SA. However, theatre efficiency was found to be very low and perhaps better explains the reasons for backlogs in paediatric surgeries at CHBAH.

SUMMARY: The purpose of this study was to investigate the effect of age on peak torque (PT) relative strength measures of knee extensors (KE) and knee flexors (KF), bilateral strength ratio (Q:Q, H:H), and ipsilateral strength ratio (H:Q) in youth elite male football players.Elite male players (n = 70) from four age categories (U16: n = 20, U17: n = 20, U19: n = 15, U21: n = 15) performed isokinetic strength tests using a Cybex dynamometer. Results show a significant effect of age on PTKE (F3,142 = 4.54, p = 0.005, = 0.09) and PTKF (age: F3,142 = 3.07, p = 0.030, = 0.06). No significant effect of age on unilateral (F3,142 = 1.05, p = 0.375, = 0.02) or ipsilateral strength ratio (F3,142 = 2.63, p = 0.053, = 0.06) was found. Results revealed significant differences in PTKE for nondominant limbs between U16 and U21. Higher bilateral differences were detected for flexors (H:H = 7.94-11.47 %, Q:Q = 7.97-9.29 %) compared to extensors. Our study showed that 17-year-old players have levels of strength similar to U19 players. A higher bilateral difference of knee flexors than extensors was found, suggesting that more attention should be paid to knee flexors. No effect of laterality was found for strength and strength asymmetries. Future research should also focus on ipsilateral strength ratio in late stage of maturation.

RESUMEN: El objetivo de este estudio fue investigar el efecto de la edad en las medidas de fuerza relativa de torque máximo (TM) de los extensores de rodilla (ER) y flexores de rodilla (FR), la relación de fuerza bilateral (Q: Q, H: H) y la relación de fuerza ipsilateral (H: Q) en jugadores de fútbol masculino de élite en 70 sujetos de cuatro categorías de edad (U16: n = 20, U17: n = 20, U19: n = 15, U21: n = 15). Se realizaron pruebas de fuerza isocinética utilizando un dinamómetro Cybex. Los resultados mos- traron un efecto significativo de la edad en TMER (F3,142 = 4,54, p = 0,005, = 0,09) y TMFR (edad: age: F3,142 = 3,07, p = 0,030, = 0,06). No se observó efecto significativo alguno de la edad sobre la fuerza unilateral (F3,142 = 1,05, p = 0,375, = 0,02) o relación de fuerza ipsilateral (F3,142 = 2,63, p = 0,053, = 0,06). Los resultados indicaron diferencias significativas en TMER para miembros no dominantes entre U16 y U21. Se detectaron mayo- res diferencias bilaterales para los flexores (H:H = 7,94-11,47%, Q:Q = 7,97-9,29 %) en comparación con los extensores. Nues- tro estudio mostró que los jugadores de 17 años tienen niveles de fuerza similares a la de los jugadores sub-19. Se observó una mayor diferencia bilateral de flexores de rodilla que de extensores, lo que sugiere que se debe prestar más atención a los flexores de rodilla. No se encontró un efecto de lateralidad para fuerza y asimetrías de fuerza. Los estudios futuros también deben centrarse en la relación de fuerza ipsilateral en la etapa tardía de maduración.

BACKGROUND: South Africa has the largest antiretroviral therapy (ART) programme in the world. To optimise programme outcomes, it is critical that patients are retained in care and that retention is accurately measured. OBJECTIVES: To identify all studies published in South Africa from 2011 to 2015 that used loss to follow-up (LTFU) as an indicator or outcome to describe the variation in definitions and to estimate the proportion of patients lost to care across studies. METHOD: All studies published between 01 January 2011 and October 2015 that included loss to follow-up or default from ART care in a South African cohort were included by use of a broad search strategy across multiple databases. To be included, the cohort had to include any patient ART data, including follow-up time, from 01 January 2010. Two authors, working independently, extracted data and assessed risk of bias from all manuscripts. Meta-analysis was performed for studies stratified by the same loss to follow-up definition. RESULTS: Forty-eight adult, 15 paediatric and 4 pregnant cohorts were included. Median cohort size was 3737; follow-up time ranged from 9 weeks to 5 years. Meta-analysis did not reveal an important difference in LTFU estimates in adult cohorts at 1 year between loss to follow-up defined as 3 months (11.0%, n = 4; 95% CI 10.7% - 11.2%) compared with 6 months (12.0%, n = 4; 95% CI 11.8% - 12.2%). Only two cohorts reported reliable LTFU estimates at 5 years: this was 25.1% (95% CI 24.8% - 25.4%). CONCLUSION: South Africa should standardise a LTFU definition. This would aid in monitoring and evaluation of ART programmes, with the broader goal of improving patient outcomes.

A number of electron donor-acceptor complexes formed between boron trifluoride and nitrous acid have been studied, in order to ascertain which of the interacting monomers acts as the acid and which as the base. We have found four complexes in which electron donation occurs in the direction HONO νBF3. These complexes are bound through the hydroxyl O, the N and the nitrosyl O atoms, in decreasing order of strength of interaction, and in the last case two separate rotational isomers have been identified. The intermolecular structural parameters and the perturbations of the intramolecular bond lengths and angles are consistent with the trends in the interaction energies. The vibrational spectra have also been examined, and the wavenumber shifts and intensity ratios track with the energetic and structural data. The mechanism of complex formation in each case is donation of a lone pair of electrons on the N or O atoms into the π* orbital of BF3, with back donation in the case of the complex bound through the nitrogen atom from a lone pair on one of the F atoms of BF3 into the σ*(OH) orbital of HONO. The total amounts of charge transferred vary, in general, with the strengths of interaction, while the charge density topologies and their properties confirm the conclusions derived from the other characteristics discussed.

PROBLEM: In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. APPROACH: We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. LOCAL SETTING: Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. RELEVANT CHANGES: At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. LESSONS LEARNED: Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases.

PROBLEMA: En Camboya se está extendiendo masivamente la atención a las personas con infección por VIH/SIDA (prevalencia del 1,9%), pero la atención a las personas con diabetes de tipo 2 (prevalencia: 5%-10%), hipertensión arterial y otras enfermedades crónicas tratables sigue siendo muy limitada. ENFOQUE: Describimos la experiencia y los resultados de la oferta de atención integrada para la infección por VIH/SIDA, la diabetes y la hipertensión en el entorno de los dispensarios de enfermedades crónicas. CONTEXTO LOCAL: Se establecieron dispensarios de enfermedades crónicas en los hospitales de referencia provinciales de Siem Reap y Takeo, dos capitales de provincia de Camboya. CAMBIOS DESTACABLES: Tras 24 meses de aplicación de ese régimen de atención, el 87,7% de todos los pacientes con VIH/SIDA permanecían con vida y sometidos a seguimiento activo. Entre los pacientes con diabetes esa proporción era del 71%. De los pacientes con VIH/SIDA, el 9,3% habían muerto y un 3% se habían perdido en el seguimiento, mientras que las cifras para la diabetes fueron de 3 (0,1%) defunciones y un 28,9% perdidos en el seguimiento. De todos los pacientes con diabetes que permanecieron más de 3 meses en la cohorte, el 90% se encontraban aún sometidos a seguimiento a los 24 meses. ENSEÑANZAS EXTRAÍDAS: Durante los tres primeros años, los dispensarios de enfermedades crónicas han demostrado la viabilidad de la integración de la atención contra el VIH/SIDA y la proporcionada contra las enfermedades crónicas no transmisibles en Camboya. Las estrategias de apoyo a la observancia tuvieron un efecto complementario, lo que se tradujo en buenos resultados. Los servicios fueron bien aceptados por los pacientes, y eso tuvo un efecto positivo en la estigmatización relacionada con el VIH/SIDA. Esta experiencia demuestra que la atención a los pacientes con VIH/SIDA puede ser un estímulo para hacer frente a otras enfermedades crónicas comunes.

PROBLÉMATIQUE: Au Cambodge, l’offre de soins à l’intention des personnes vivant avec le VIH/sida (prévalence : 1,9 %) est en développement, mais pour les personnes atteintes de diabètes de type II (prévalence 5 à 10 %), d’une hypertension artérielle ou d’une autre maladie chronique pouvant être traitée, elle reste très limitée. DÉMARCHE Nous décrivons l’expérience et les résultats obtenus avec une offre de soins intégrée à l’intention des personnes vivant avec le VIH/sida, un diabète ou une hypertension, dans le cadre de dispensaires spécialisés dans les maladies chroniques. CONTEXTE LOCAL: Des dispensaires spécialisés dans les maladies chroniques ont été mis en place dans les hôpitaux spécialisés de Siem Reap et Takeo, deux capitales provinciales du Cambodge. MODIFICATIONS PERTINENTES: Au bout de 24 mois de soins, sur l’ensemble des patients vivant avec le VIH/sida, 87,7 % étaient encore vivants et faisaient l’objet d’un suivi actif. S’agissant des patients diabétiques, cette proportion était de 71 %. Parmi les patients contaminés par le VIH, 9,3 % étaient morts et 3 % étaient perdus de vue, tandis que parmi les diabétiques, on enregistrait 3 décès (0,1 %) et une proportion de 28,9 % de perdus de vue. Parmi l’ensemble des patients diabétiques restés plus de 3 mois dans la cohorte, 90 % étaient encore suivis au bout de 24 mois. ENSEIGNEMENTS TIRÉS: Sur les trois premières années, les dispensaires spécialisés dans les maladies chroniques ont prouvé la faisabilité d’une offre de soins intégrée pour les personnes vivant avec le VIH/sida et atteintes d’une maladie chronique non transmissible au Cambodge. La complémentarité des stratégies d’aide à l’observance a également été démontrée, d’où l’obtention de bons résultats. Ces services sont bien acceptés par ces patients, ce qui a un effet positif sur la stigmatisation dont ils souffrent. Cette expérience montre à quel point la prise en charge des personnes vivant avec le VIH/sida peuvent donner une impulsion à celle d’autres maladies chroniques courantes.