BACKGROUND: Sleep deprivation is a problem for medical students and practitioners due to long and late working hours, which may result in a decline in their performance in practising medicineOBJECTIVES: To investigate whether educational practices require altering with regard to the time at which simulation classes are presented, or identify any other possible suggestions for improving the preparation of students for shift work in their profession as medical doctors as a potential solution to reduce sleep-deprivation-related adverse outcomesMETHODS: In this quantitative cross-sectional study, an anonymous questionnaire was distributed to 111 fourth-year and 141 fifth-year medical students at the Faculty of Health Sciences, University of the Free State (UFS), Bloemfontein, South Africa, during the second half of 2018. The researchers interpreted the responses and the Department of Biostatistics, UFS, analysed the dataRESULTS: The majority of the fourth-year (88.6%) and fifth-year (90.4%) student groups responded that late-night simulation classes between 01h00 and 04h00 would not be beneficial to their preparation for shift work. The motivation for negative responses was that it might worsen sleep deprivation due to time constraints in an already demanding course. The fourth-year (61.4%) and fifth-year (80.5%) student groups did not regard simulation as realistic and felt that late-night simulation training sessions would not prepare them better for future shift work. However, both groups believed 'practice makes perfect' and, as such, their confidence with procedures would improve as they practise more during simulationCONCLUSION: The majority of students were negative towards the idea of late-night simulation classes, because of the effect it would have on their already full programme. Students are familiar with the effects of sleep deprivation and felt that late-night simulation classes would add pressure to their busy lives and worsen their sleep deprivation. Further investigation and practical testing would be required to conclude the impact of late-night simulation classes in preparation for shift work of medical doctors and the resultant effect on clinical performance

Recent studies have shown that the detection of SARS-CoV-2 genetic material in wastewater may provide the basis for a surveillance system to track the environmental dissemination of this virus in communities. An effective wastewater-based epidemiology (WBE) system may prove critical in South Africa (SA), where health systems infrastructure, testing capacity, personal protective equipment and human resource capacity are constrained. In this proof-of-concept study, we investigated the potential of SARS-CoV-2 RNA surveillance in untreated wastewater as the basis for a system to monitor COVID-19 prevalence in the population, an early warning system for increased transmission, and a monitoring system to assess the effectiveness of interventions. The laboratory confirmed the presence (qualitative analysis) and determined the RNA copy number of SARS-CoV-2 viral RNA by reverse transcription polymerase chain reaction (quantitative) analysis from 24-hour composite samples collected on 18 June 2020 from five wastewater treatment plants in Western Cape Province, SA. The study has shown that a WBE system for monitoring the status and trends of COVID-19 mass infection in SA is viable, and its development and implementation may facilitate the rapid identification of hotspots for evidence-informed interventions.

BACKGROUND. Hypertension is common, affecting over one billion people worldwide. In sub-Saharan Africa, hypertensive disease not only affects the older population but is becoming increasingly prevalent in younger individuals. In South Africa (SA), >30% of the adult population has hypertension, making it the single most common cardiovascular risk factor and the predominant contributor to cardiovascular disease and mortality. Elevated blood pressure is the most common perioperative comorbidity encountered in non-cardiac surgical patients, with an overall prevalence of 20 - 25%, and it remains poorly controlled in low- and middle-income countries. Hypertension in the perioperative setting may adversely affect patient outcome. It therefore not only flags possible perioperative challenges to anaesthesiologists, but also identifies patients at risk of long-term morbidity and mortality. OBJECTIVES. To determine the prevalence and severity of hypertension in elective adult surgical patients in the Western Cape Province, SA. RESULTS. The study population included all elective surgical patients from seven hospitals in the Western Cape during a 1-week period. Hypertension, defined as having had a previous diagnosis of hypertension or meeting the blood pressure criteria of >140/90 mmHg, was identified in 51.8% of patients during preoperative assessment. Significantly, newly diagnosed hypertension was present in 9.9% of all patients presenting for elective surgery. Although 98.1% of the known hypertensive patients were on antihypertensive therapy, 36.9% were inadequately controlled. There are numerous reasons for this, but notably 32.1% of patients admitted to forgetting to take their medication, making patient factors the most common reason for treatment non-compliance. CONCLUSIONS. The perioperative period may be an important opportunity to identify undiagnosed hypertensive patients. The perioperative encounter may have a significant public health implication in facilitating appropriate referral and treatment of patients with hypertension to decrease long-term cardiovascular complications in SA.

The effect on production performance of a synthetic or natural antioxidant and lipid saturation in the finishing diets of lambs was investigated. The four dietary treatments consisted of the same basal diet (187 g CP, 355 g NDF, and 71 g EE per kg DM), differing only in regard to the supplemental lipid source (30 g/kg of either saturated beef tallow or unsaturated soybean oil) and type of antioxidant (125 g/ton of either a synthetic or natural antioxidant) included, in a 2 x 2 factorial design experiment. Eighty-four S.A. Mutton Merino lambs (27.64 ± 1.72 kg) were randomly allocated to the four dietary treatments (n = 21 lambs per treatment) and subdivided into 7 replicates per treatment (n = 3 lambs per replicate). After a dietary adaptation period of 8 days, all lambs received the respective experimental diets for the remaining period (41 days). The average daily DM feed intake, weight gain and feed efficiency was calculated accordingly. No significant differences in DMI, ADG and the efficiency with which ingested feed were utilized (FCR), were recorded for the treatments. However, the addition of unsaturated soybean oil to the diet significantly increased the efficiency with which the ME of the diet was utilized. In contrast with the natural antioxidant, the inclusion of unsaturated soybean oil in the diet containing a synthetic antioxidant, resulted in a significant lower MEI by the lambs - indicating that a lipid x antioxidant interaction occurred. Results of the present study seem to indicate that dietary lipid saturation in the finishing diets of lambs had no influence on their growth performance. However, a more efficient utilisation of ME in the finishing diet containing unsaturated soybean oil, compared to the saturated beef tallow, did occur.