BACKGROUND: South Africa (SA) has a high prevalence of HIV infection, which has been shown to affect the prevalence and severity of other infections and of sepsis, particularly in gallbladder (GB) disease. Empirical antimicrobial (EA) therapy for acute cholecystitis is based largely on bacterial colonisation of bile (bacteriobilia) and antimicrobial susceptibility patterns (antibiograms) obtained from the developed world, where the prevalence of HIV infection is very low. In an era of ever-increasing antimicrobial resistance, it is of vital importance to monitor and update local antibiograms OBJECTIVES: Owing to the paucity of data available locally to guide treatment, our objectives were to examine GB bile for bacteriobilia and to assess antibiograms in a setting with a high prevalence of HIV infection, in order to determine the need for review of our local antimicrobial policies for both EA therapy for GB infections and preoperative antimicrobial prophylaxis (PAP) for laparoscopic cholecystectomy (LC METHODS: A retrospective observational descriptive study was undertaken at King Edward VIII Hospital, Durban, SA. Hospital records were reviewed for all patients undergoing LC over a 3-year period. GB bacteriobilia and antibiograms were assessed and compared between people living with HIV (PLWH) and people who were HIV uninfected (HIV-U). The preoperative parameters of age, endoscopic retrograde cholangiopancreatography (ERCP), procalcitonin (PCT), C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) were assessed as predictors for bacteriobilia. Statistical analyses were performed using R for statistical computing, andp-values <0.05 were considered statistically significant RESULTS: There were no differences in bacteriobilia or antibiograms between PLWH and HIV-U. There was >30% resistance to amoxicillin/ clavulanate and cephalosporins. Aminoglycoside-based therapy had good susceptibility patterns, while carbapenem-based therapy demonstrated the lowest resistance levels. ERCP and age were predictors of bacteriobilia (p<0.001 and p<0.002, respectively), but PCT, CRP and NLR were not CONCLUSION: PLWH should follow the same PAP and EA therapy recommendations as HIV-U. For EA therapy, we recommend a combination of amoxicillin/clavulanate with aminoglycoside-based therapy (amikacin or gentamicin), or piperacillin/tazobactam as monotherapy. Carbapenem-based therapy should be reserved for drug-resistant species. For elective LC, elderly patients or patients who have previously undergone ERCP, we recommend selective use of cefazolin for PAP

The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.

ABSTRACT For computerized analysis of respiratory sounds to be effective, the acquired signal must be free from all the interfering elements. Different forms of noise which can degrade the quality of lung sounds are recording artifacts, power line/Radio Frequency (RF) interferences, ambient acoustic interferences, heart sound interference etc. Such interferences adversely affect the diagnostic interpretations. Powerful denoising techniques are necessary to resolve this issue. A denoising scheme for lung sounds, based on Savitzky-Golay (S-G) filter is proposed in this paper. The order and frame length of the SG filter is determined objectively using the Signal to Noise Ratio (SNR) and computational time as objective function. Maximum SNR is observed when the frame length is nearest to the value just higher than the polynomial order. This observation holds good for different levels of simulated addictive Gaussian noise. The polynomial order of 8 and frame size of 9 are found to be promising with SNR of 10.401db at computation time of 2.1ms.

ABSTRACT Red rot, caused by Colletotrichum falcatum Went is the most important disease of sugarcane in India inflicting substantial loss to both cane industry and cane growers. To keep in view the importance of red rot disease of sugarcane, 117 accession of sugarcane germplasm including different Saccharum species and Indian and foreign commercial hybrids were tested against red rot with Cf 07, Cf 08 & Cf 09 (national pathotypes) by plug method of inoculation. Out of 117, 6 were found resistant and 12 were moderately resistant against red rot and rest were moderately susceptible/susceptible/highly susceptible. Theses resistance and moderately resistant accession can be further utilize to produce resistance varieties against the most devastating pathogen of sugarcane.

A duplicate gall bladder was diagnosed at laparoscopy, having been erroneously diagnosed on ultrasonography as a dilated common bile duct with choledocholithiasis. Gallbladder duplication is a congenital abnormality with a rare incidence, occuring in approximately 1 in 4 000 births and 0.020% in al large autopsy series. This report highlights its existence to improve awareness and lessen the potential for biliary injury.

Wernicke's encephalopathy (WE) is a medical emergency. Although WE is commonly viewed in the context of alcoholism, it can be caused by thiamine deficiency secondary to persistent vomiting. Non-alcohol-related WE may be more catastrophic in onset and less likely to present with the classic features than WE with alcoholism as a cause. We describe three cases of WE due to persistent vomiting without alcoholism in patients with hyperemesis gravidarum, drug-induced hyperlactataemia, and an acute gastrointestinal illness in an already malnourished individual. Our cases highlight the importance of recognising WE when undernutrition, which may be caused by gastrointestinal disease or surgery, or malignancy, is compounded by vomiting. Expert guidelines suggest that WE must be considered in the emergency room in any individual with disturbed consciousness of unknown cause. Treatment is with parenteral thiamine before glucose administration.

Guidelines for starting phototherapy for neonatal jaundice in term neonates have been published by the American Academy of Pediatrics (AAP) and others, such as the National Institute for Health and Clinical Excellence (NICE), but the practical implementation of such guidelines and factors associated with possible non-adherence have not been studied. We report our experience at a self-paying tertiary-care hospital. Of the 155 term babies given phototherapy in our hospital between August 2012 and August 2013, 65 (41.9%) babies were found to have received phototherapy at serum bilirubin values lower than recommended AAP guidelines. Factors found responsible for non-adherence to guidelines were: (i) parents' request for early discharge, with unwillingness to come the next day for follow-up despite borderline serum bilirubin level noted in 25 (38.5%); (ii) clinical assessment of bilirubin was higher than reported laboratory value in 16 (24.6%); and (iii) babies were given phototherapy as parents had been counselled regarding the need for phototherapy by a referring paediatrician in 12 (18.5%).

Five spectrophotometric methods for determination of Amitriptyline HCl have been developed, validated and applied for the assay of the drug in pharmaceuticals. Methods A, B and C are based on ion pair complexation of drug, in acidic buffers, with triphenylmethane dyes viz., Bromothymol blue (BTB), Bromophenol blue (BPB) and Bromocresol purple (BCP). The complexes are extracted into chloroform and absorbance is measured around at 415 nm as function of concentration of the drug. The stoichiometry of the complex is found 1:1 in each case. Method D depends upon charge transfer complexation of neutralized drug with iodine which produces iodide ion whose absorbance at 366 nm is measured as function of concentration of the drug. This complex, too, has 1:1 composition as determined by Job's method. Method E is developed on the basis of oxidation of the drug with alkaline KMnO4 which generates green colored manganate ion with λmax 610 nm. As the intensity of green color increased with increasing time kinetics of the reaction is followed and calibration curves are constructed by using initial rate and fixed time methods. Excellent recovery studies with high accuracy and precision indicate that the methods can be successfully used in industries for the assay of drug in pure form and pharmaceuticals.

BACKGROUND: Paediatric and Perinatal HIV/AIDS remain significant health challenges in the Caribbean where the HIV seroprevalence is second only to Sub-Saharan Africa. METHOD: We describe a collaborative approach to the prevention, treatment and care of HIV in pregnant women, infants and children in Jamaica. A team of academic and government healthcare personnel collaborated to address the paediatric and perinatal HIV epidemic in Greater Kingston as a model for Jamaica (population 2.6 million, HIV seroprevalence 1.5%). A five-point plan was utilized and included leadership and training, preventing mother-to-child transmission (pMTCT), treatment and care of women, infants and children, outcomes-based research and local, regional and international outreach. RESULTS: A core group of paediatric/perinatal HIV professionals were trained, including paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data managers, information technology personnel and students to serve Greater Kingston (birth cohort 20 000). During September 2002 to August 2007, over 69 793 pregnant women presented for antenatal care. During these five years, significant improvements occurred in uptake of voluntary counselling (40% to 91%) and HIV-testing (53% to 102%). Eight hundred and eighty-three women tested HIV-positive with seroprevalence rates of 1-2% each year. The use of modified short course zidovudine or nevirapine in the first three years significantly reduced mother-to-child transmission (MTCT) of HIV from 29% to 6% (RR 0.27; 95% CI - 0.10, 0.68). During 2005 to 2007 using maternal highly active antiretroviral therapy (HAART) with zidovudine and lamivudine with either nevirapine, nelfinavir or lopinavir/ritonavir and infant zidovudine and nevirapine, MTCT was further reduced to an estimated 1.6% in Greater Kingston and 4.75% islandwide. In five years, we evaluated 1570 children in four-weekly paediatric infectious diseases clinics in Kingston, St Andrew and St Catherine and in six rural outreach sites throughout Jamaica; 24% (377) had HIV/AIDS and 76% (1193) were HIV-exposed. Among the infected children, 79% (299 of 377) initiated HAART, resulting in reduced HIV-attributable childhood morbidity and mortality islandwide. An outcomes-based research programme was successfully implemented. CONCLUSION: Working collaboratively, our mission of pMTCT of HIV and improving the quality of life for families living and affected by HIV/AIDS in Jamaica is being achieved.

ANTECEDENTES: El VIH/SIDA pediátrico y el perinatal continúan siendo retos significativos para la salud en el Caribe, donde la seroprevalencia de VIH ocupa el segundo lugar tras el África Subsahariana. MÉTODO: Se describe un enfoque colaborativo para tratamiento, prevención y cuidado de embarazadas, bebés y niños en Jamaica. Un equipo de personal académico y gubernamental vinculados a la salud, colaboraron para abordar la epidemia de VIH pediátrico y perinatal en Greater Kingston, como modelo para Jamaica (población de 2.6 millones, 1.5% seroprevalencia VIH). Se utilizó un plan de cinco puntos que incluyó liderazgo y entrenamiento, prevención de la transmisión madre a hijo (PTMAH), tratamiento y cuidado de mujeres, bebés y niños, investigaciones basadas en resultados, y outreach local, regional e internacional. RESULTADOS: Un grupo básico de profesionales del VIH pediátrico/perinatal, que incluía pediatras, obstetras, trabajadores de la salud, enfermeras, microbiólogos, administradores de datos, así como personal y estudiantes de la tecnología de la información, fue entrenado para servir en Greater Kingston (cohorte de nacimiento 20 000). De septiembre de 2002 hasta Agosto de 2007, más de 69 793 embarazadas se presentaron para recibir atención prenatal. Durante estos cinco años, tuvieron lugar mejoras significativos en cuanto a la recepción de asesoramiento (40% to 91%) y pruebas (53% to 102%) de VIH voluntarios. Ochocientos ochenta y tres mujeres resultaron VIH positivas en las pruebas, con tasas de seroprevalencia de 1-2% cada año. El uso de un ciclo corto modificado de zidovudina o nevirapina en los primeros tres años, redujo la transmisión madre a hijo (TMAH) de VIH significativamente de 29% a 6% (RR 0.27; 95% CI - 0.10, 0.68). Durante el 2005 hasta 2007, usando terapia antiretroviral altamente activa (TARAA) materna, con zidovudina y lamivudina con nevirapina, nelfinavir o lopinavir/ritonavir y nevirapina y zidovudina para niños, la TMAH se redujo a un estimado de 1.6 % en Greater Kingston y a .75% a lo largo de la isla. En cinco años, evaluamos 1570 niños en cuatro clínicas infecciosas pediátricas semanales en Kingston, Saint Andrew y Saint Catherine, así como en seis otros lugares destinados al servicio comunitario (outreach) por toda Jamaica; 24% (377) tenían VIH/SIDA y 76% (1193) estaba expuestos al VIH. Entre los niños infectados, 79% (299 de 377) iniciaron el TARAA, lo que trajo como resultado una reducción de la mortalidad y la morbilidad infantil atribuible al VIH, en todo el país. Se implementó exitosamente un programa de investigación basado en resultados. CONCLUSIÓN: Trabajando en colaboración, estamos logrando nuestra misión de prevenir la TMAH del VIH, y mejorar la calidad de vida de las familias que viven afectadas por el VIH/SIDA en Jamaica.