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Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
Aims and Objectives:
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
In this article, medium-run cycles in wine production in South Africa are extracted and related to similar cycles in real GDP per capita during the same period. In addition to removing noise in the historical data, smoothing out short-run fluctuations also eliminates the short-run impact on agricultural production due to idiosyncratic shocks such as weather events, wars, and vine diseases. By isolating the medium-run cycles, it is possible to verify the timing and duration of each cycle, matching it with the historical narrative. In this regard, a 300-year annual data series of South African wine production explains the evolution not only of one of the largest agricultural sectors, but of the South African economy in general. (JEL Classifications: C10, N57, Q10).
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
Language, culture and intercultural communication
Undine S Weber, head of German Studies in the School of Languages and Literatures at Rhodes University.,
Rebecca Sc Domingo, former lecturer in German Studies at Rhodes University.,
Regine B Fourie, retired from the University of KwaZulu-Natal, where she was a senior lecturer in German.
In seeking to analyse the aims of our discipline at tertiary level, it soon becomes apparent that what should be (if the term ‘multilingualism’ is anything to go by) a hospitable environment to teach a language and culture in fact reveals itself to be a hostile one. Possible grounds for this may lie in the misconceptualisation highlighted by Banda (2009) whereby, in South Africa, what is commonly called multilingualism and promoted as such, would be more accurately described as ‘a case of multiple monolingualisms’ (2009: 5). His list of characteristic differences between African and Western conceptualisations of multilingualism goes some way towards helping us understand, in particular, the claim that ‘African multilingualism’ refers to ‘related (Bantu) dialects’, while ‘Western multilingualism’ ‘often involves unrelated languages’ (Banda 2009: 5). He further points out that the current Western discourse around multilingualism is premised on the integration of migrant/immigrant families into a majority language group, which is certainly not the case in South Africa. This ‘theoretically misleading’ (Banda 2009: 5) conflation has resulted in the adoption of ill-conceived language policies, better suited to Western linguistic realities, that also affect how European languages are perceived.
In a country aggressively promoting what should be renamed ‘African multilingualism’ so as to do away with any ambiguity, there seems, at first glance, little to justify governmental support of the study of German1 at a South African higher education institution. However, closer interrogation of the three main functions of universities shows clear scope for the discipline of German Studies, specifically in terms of functions two and three, namely finding ‘new applications for existing knowledge … [validating] knowledge and values through their curricula … [and providing] opportunities for social mobility’ (DHET 2013: 27).
German Studies in South Africa
A few decades ago, German Studies was taught like Germanistik in South Africa, in other words, the study of German literature as taught in the German-speaking countries, which required mother-tongue or near-mother-tongue competency on the part of the students. It incorporated some language study but hardly any cultural studies or translation studies, as the students were supposed to have gained insight into those fields either through their (German-speaking) upbringing or through their high school education.
To date, there has been no published textbook which takes into account changing sociolinguistic dynamics that have influenced South African society. Multilingualism and Intercultural Communication breaks new ground in this arena. The scope of this book ranges from macro-sociolinguistic questions pertaining to language policies and their implementation (or non-implementation) to micro-sociolinguistic observations of actual language-use in verbal interaction, mainly in multilingual contexts of Higher Education (HE). There is a gradual move for the study of language and culture to be taught in the context of (professional) disciplines in which they would be used, for example, Journalism and African languages, Education and African languages, etc. The book caters for this growing market. Because of its multilingual nature, it caters to English and Afrikaans language speakers, as well as the Sotho and Nguni language groups – the largest languages in South Africa [and also increasingly used in the context of South African Higher Education]. It brings together various inter-linked disciplines such as Sociolinguistics and Applied Language Studies, Media Studies and Journalism, History and Education, Social and Natural Sciences, Law, Human Language Technology, Music, Intercultural Communication and Literary Studies. The unique cross-cutting disciplinary features of the book will make it a must-have for twenty-first century South African students and scholars and those interested in applied language issues.
Xpert MTB/RIF (Xpert) is the preferred first-line test for all persons with tuberculosis (TB) symptoms in South Africa in line with a diagnostic algorithm. This study evaluates pre- and post-implementation trends in diagnostic practices for drug-sensitive, pulmonary TB in adults in an operational setting, following the introduction of the Xpert-based algorithm. We retrospectively analysed data from the national TB database for Greater Tzaneen sub-district, Limpopo Province. Trends in a number of cases, diagnosis and outcome and characteristics associated with death are reported. A total of 8407 cases were treated from 2008 until 2015, with annual cases registered decreasing by 31·7% over that time period (from 1251 to 855 per year). After implementation of Xpert, 69·9% of cases were diagnosed by Xpert, 29·4% clinically, 0·6% by smear microscopy and 0·1% by culture. Cases with a recorded microbiological test increased from 76·2% to 96·4%. Cases started on treatment without confirmation, but with a negative microbiological test increased from 7·1% to 25·7%. Case fatality decreased from 15·0% to 9·8%, remaining consistently higher in empirically treated groups, regardless of HIV status. Implementation of the algorithm coincided with a reduced number of TB cases treated and improved coverage of microbiological testing; however, a substantial proportion of cases continued to start treatment empirically.
Our work aims at the exploration of cortisol secretion in the Bedouin goat, native to the Algerian Sahara desert, to understand the mechanisms of adaptation to extreme hot climates. In the present study, diurnal and seasonal variations of cortisol concentrations were measured in basal conditions, as well as the response to ACTH stimulation tests across seasons in bucks. The plasma concentrations of cortisol showed no diurnal cycle but a large variation across seasons. The highest levels occurred in summer and winter when the environmental conditions are at their extreme levels. The rectal temperature showed nychthemeral and seasonal variations, and BW was also different across seasons with highest values in summer and lowest in winter. The results obtained after administration of two doses (2 or 10 μg/kg BW) of synthetic ACTH to three different age groups (kids, adults and elderly animals) showed a strong increase in plasma cortisol concentrations under all conditions with maximum levels achieved between 15 and 120 min. The analysis of the area under the cortisol curve showed no significant difference between the responses to the two doses of ACTH and between age groups, but showed seasonal variations with the lowest response in autumn than in other seasons. We conclude that season significantly affects secretion of cortisol in both basal state and under ACTH stimulation. However, the variation of adrenal reactivity to ACTH is not sufficient to explain seasonal differences, and in particular the summer peak in basal circulating cortisol concentrations. Further research should focus on the respective contribution of environmental factors (such as day length, temperature, humidity) and the mechanisms involved in cortisol regulation.