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Sepsis and septic shock are key contributors to mortality in critically ill patients and thus prompt recognition and management thereof is central to achieving improved patient outcomes. Early initiation of appropriate antimicrobial therapy constitutes a crucial component of the management strategy and thus early identification of the causative pathogen is essential in informing antimicrobial therapeutic choices. The BioFire FilmArray blood culture identification (BCID) panel is a US Food and Drug Administration (FDA) approved rapid, multiplex polymerase chain reaction assay for use on positive blood cultures. This study evaluated its clinical utility in the intensive care unit (ICU) setting, in terms of amendment of empiric antimicrobial therapy in critically ill patients with sepsis. The assay proved useful in this setting as final results were made available to clinicians significantly earlier than with conventional culture methods. This, in turn, allowed for modification of empirical antimicrobial therapy to more appropriate agents in 32% of patients. Additionally, the use of the BioFire FilmArray BCID panel permitted the prompt implementation of additional infection prevention and control practices in a sizeable proportion (14%) of patients in the study who were harbouring multidrug resistant pathogens. These findings support the use of the BioFire FilmArray BCID panel as a valuable adjunct to conventional culture methods for the diagnosis and subsequent management of critically ill patients with sepsis.

Early career and academic foundation Jenkins began his career in medicine in the United Kingdom, qualifying in 1956, before embarking on a journey that would take him to Rhodesia (now Zimbabwe) and eventually South Africa. His initial work as a mine medical officer provided him with early exposure to the diverse populations of southern Africa, an experience that would later inform his genetic research. Jenkins taught and did research in the field of human genetics and founded genetic counselling clinics and diagnostic and research laboratories throughout his career.1 With the support and encouragement of Professor Phillip Tobias, Jenkins' transition to human genetics came in 1969 when he took up the positions of Head of the Human Sero-Genetics Unit at the SAIMR and part-time lecturer in human genetics in the Department of Anatomy (Wits). This marked the beginning of his systematic approach to establishing human genetics as a distinct discipline in southern Africa.2,3 Together with Tobias, he conducted field research on local communities, motivated by his curiosity about population history and why some diseases, like the sickle cell trait, were prevalent in some community groups he encountered as a doctor working in Zimbabwe.

Introduction Bloodstream infections (BSIs) significantly contribute to the morbidity and mortality in paediatric burn patients from low- and middle-income countries; with common pathogens like Staphylococcus aureus, Escherichia coli , and Pseudomonas aeruginosa frequently being multidrug resistant (MDR). Due to the growing prevalence of MDR BSIs, antimicrobial stewardship needs to be improved with perhaps more targeted initial antimicrobial use. The study describes the aetiology, and timing of burn-associated BSIs and MDR infections in paediatric burn patients admitted to two paediatric surgery units in Tshwane District, South Africa. Methods This multi-centre retrospective review analysed paediatric burn patients (ages 0–12 years) admitted between January 2020 and December 2022 to two public hospitals in Tshwane District, South Africa. Collected data was from patient records and the National Health Laboratory System TrakCare database. BSIs were defined according to the CDC criteria. Results Of 245 burn patients admitted, 18.8% ( n  = 46) developed BSIs. From 63 positive blood cultures, the most common isolates were S. aureus ( n  = 19; 30%), Acinetobacter baumannii ( n  = 18; 29%), and P. aeruginosa ( n  = 10; 16%). Collectively, gram negative bacteria were responsible for most BSIs ( n  = 41; 65%). Candida spp accounted for 9% ( n  = 5). Thirty-five pathogens (56%) were MDR; this included methicillin-resistant S. aureus (MRSA) ( n  = 7; 11%), carbapenem-resistant A. baumannii ( n  = 16; 25%), and P. aeruginosa ( n  = 6; 10%). The median time to the first positive blood culture was 5 days (IQR: 3–12) (gram positive organisms: median: 5 days [IQR: 3–15}); gram negative organisms: median: 8 days [IQR: 4–20]; Fungal: median: 9 days [IQR: 8–27]; p -value 0.37). In the first week, S. aureus caused 32% of infections, including five MRSA cases. Gram negative bacteria dominated weeks two and three, with fungal and polymicrobial infections mainly in weeks two and four. Conclusion Our findings show that as gram positive and gram negative infections predominantly occurred early in the admission period, while polymicrobial infections are more frequently observed later. Consequently, initial targeted narrow-spectrum antimicrobial use is not possible. Instead, antimicrobial de-escalation should be prioritized once culture results are available. Efforts should shift from a focus on treating BSIs to preventing them through wound care and infection control measures. Broad-spectrum antibiotics should be used judiciously and quickly de-escalated to minimise antimicrobial resistance development. Highlights • The most common initial isolate was Staphylococcus aureus. • Acinetobacter baumannii was the leading cause of gram negative bloodstream infections, in contrast to the global trend where Pseudomonas aeruginosa is more commonly implicated. • The majority of gram positive and gram negative pathogens identified were multidrug resistant. • Central line-associated bloodstream infections accounted for nearly one-third of all bloodstream infections.

IntroductionEffective community-based disease management is essential for public health. In low- and middle-income countries, sustainable strategies for timely diagnosis and treatment are a research priority. This study aims to assess the feasibility of a non-invasive saliva self-sampling method, paired with digitally linked molecular point-of-care diagnostics, for detecting respiratory infections among paediatric patients in the Tshwane District, South Africa.Methods and analysisA field study will be conducted at Steve Biko Academic Hospital to compare saliva collection using the CandyCollect lollipop device and standard mouth swabs. The spiral groove of the lollipop device captures pathogens, which are stored in DNA/RNA preservation media and later analysed using quantitative PCR and commercially available rapid antigen tests. The multiplex respiratory pathogen panel, based on TaqMan real-time PCR technology, targets key paediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, respiratory syncytial virus (RSV) and influenza A/B. Nucleic acids will be extracted using standard viral extraction kits and analysed following manufacturer protocols. Internal controls will be included in each qPCR run, and samples with CT values below defined thresholds will be considered positive. Rapid antigen tests will detect common pathogens such as influenza A/B, RSV and SARS-CoV-2 for comparative analysis. User experience and acceptability will be assessed via child-friendly and caregiver surveys following sample collection. The study will be implemented in two phases: diagnostic performance evaluation and user feedback assessment. The protocol is aligned with the Standard Protocol Items: Recommendations for Interventional Trials 2013 checklist.Ethics and disseminationEthical approval has been granted by the University of Pretoria (509/2023) and the Gauteng Department of Health (GP_202406_032). The study is registered in the Pan African Clinical Trial Registry (PACTR202411743094783). Findings will be disseminated through peer-reviewed journals, conferences and stakeholder briefings. The study complies with South Africa’s Protection of Personal Information Act. Data collection is scheduled from November 2024 to February 2025, with project completion expected within 1 year.Trial registration numberPan African Clinical Trial Registry (PACTR202411743094783).

Occult hepatitis B virus (HBV) infection (OBI) is defined as the presence of HBV DNA in the absence of HBV surface antigen (HBsAg) serological markers. Despite the high prevalence of HBV infection in many communities, OBI prevalence among people with haemophilia (PWH) remains poorly characterised in South Africa. The aim of the study was to determine the prevalence of OBI and characterise viral complications of patients attending haemophilia clinics in three tertiary hospitals in Gauteng, namely, the Steve Biko Academic Hospital (SBAH), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Dr George Mukhari Academic Hospital (DGMAH). This descriptive cross-sectional study was approved by the ethics committees of each participant centre. Haemophilia patients of any severity or inhibitor status with positive serological markers of HBV infection and immunity were excluded from the study. We measured Hepatitis B DNA of those with negative serological markers using a quantitative hepatitis B PCR assay. Of the 76 patients screened, 66 male patients were included in the study. The median age was 29 years. Haemophilia A and haemophilia B comprised 89% and 11% of the cohort, respectively. The majority of patients were taking prophylactic factor replacement therapy (72%) as opposed to episodic therapy (28%). A total of 10 patients (15%) had inhibitors. Five patients (8%) were HIV seropositive. Ten patients (15%) had no documented evidence of being vaccinated against hepatitis B infection. Anti-hepatitis B core antibodies were positive in 5 patients (8%). All patients had a negative hepatitis B surface antigen result. All patients demonstrated negative hepatitis B PCR results. In this cohort of PWH from 3 centres, none showed evidence of occult HBV infection.

Background Ralstonia species are Gram-negative bacilli of low virulence. These organisms are capable of causing healthcare associated infections through contaminated solutions. In this study, we aimed to determine the source of Ralstonia mannitolilytica bacteraemia in affected patients in a haemodialysis unit. Methods Our laboratory noted an increase in cases of bacteraemia caused by Ralstonia mannitililytica between May and June 2016. All affected patients underwent haemodialysis at the haemodialysis unit of an academic hospital. The reverse osmosis filter of the haemodialysis water system was found to be dysfunctional. We collected water for culture at various points of the dialysis system to determine the source of the organism implicated. ERIC-PCR was used to determine relatedness of patient and environmental isolates. Results Sixteen patients were found to have Ralstonia mannitolilytica bacteraemia during the outbreak period. We cultured Ralstonia spp. from water collected in the dialysis system. This isolate and patient isolates were found to have the identical molecular banding pattern. Conclusions All patients were septic and received directed antibiotic therapy. There was 1 mortality. The source of the R. mannitolilytica infection in these patients was most likely the dialysis water as the identical organism was cultured from the dialysis water and the patients. The hospital management intervened and repaired the dialysis water system following which no further cases of R. mannitolilytca infections were detected. A multidisciplinary approach is required to control healthcare associated infections such as these. Routine maintenance of water systems in the hospital is essential to prevent clinical infections with R.mannitolilytica .

This article involves a close reading of two African American authors, Zora Neale Hurston, an acclaimed novelist and Katie Cannon, an influential theological ethicist. Texts from Steve Biko on black consciousness and from James Cone on liberation theology are used as methodological tools in trying to ascertain the degree to which Hurston and Cannon espouse a black (womanist) consciousness. A strong resonance of black consciousness will indeed be found in Hurston’s and Cannon’s texts. The conclusion drawn is that not only is there a resonance of black consciousness, but both writers also give proof of a black womanist consciousness that reveals new knowledge. Cannon’s oeuvre also begs the question of epistemological privilege. In addition, an animated critique is registered between these women scholars and male colleagues, in the world of fiction (Richard Wright) and academia (white European males).ContributionThis article demonstrates a link from South African black consciousness (Biko) to black womanist thinkers in the United States (Hurston and Cannon). A connection is also made between male, black liberation theology (Cone) and black womanist thinking, while expounding the womanist approach, liberated from (white) male dominance, on par with all others.

IntroductionCancer is the second leading cause of death globally. However, cancer care services are often concentrated in urban centres. Two of South Africa’s hospitals have decentralised cancer care delivery since February 2018 and August 2019, respectively. This study aims to describe the demographic, epidemiological and clinical profile of various cancers at Nelson Mandela Academic Hospital (NMAH) and Rob Ferreira Hospital (RFH), in South Africa’s Eastern Cape and Mpumalanga provinces, respectively.Methods and analysisThis study will be conducted in the Eastern Cape and Mpumalanga provinces. A mixed-methods study design will be undertaken to gain insight on the characteristics of randomly sampled patients who are treated for cancer at NMAH and RFH between 1 March 2018 and 28 February 2022. A validated, researcher-administered survey questionnaire will be used to assess demographic characteristics, and prevalence of different cancers among patients. Concurrently, a document review will be undertaken on patients with cancer using a patient registry to ascertain the duration of diagnosis, type of cancer(s), management plan and patient survival time. STATA V.17 will be used for data analysis. The Shapiro-Wilk test will be used to explore the distribution of numerical variables. The χ2 or Fisher’s exact tests will be used depending on the value of the expected frequencies to compare categorical variables. Kaplan-Meier survival estimates will be used to determine the survival time. Hazard ratios will be used to determine the predictors of death. The level of statistical significance will be set at p value ≤0.05. The 95% CI will be used for the precision of estimates.Ethics and disseminationEthics approval was obtained from the Human Research Ethics Committees of the University of the Witwatersrand (M210211) and Walter Sisulu University, South Africa (Ref: 040/2020). Findings will be reported through peer-reviewed journal(s), presentations at conferences and at partner meetings.

Turner syndrome is a multisystem disease with varied clinical features influenced by genetic composition and possibly ethnicity. To review local data and identify the clinical features more common in our population. A retrospective review of the clinical, biochemical features and karyotype of all patients with a confirmed diagnosis of Turner syndrome receiving treatment at the adult endocrinology clinic, Steve Biko Academic Hospital, was performed. Seventeen patients with complete data sets were identified. Our population group had a higher percentage of mosaic Turner syndrome than that described in the literature. The clinical features also differed significantly from the classic features described, with the exception of the universal presence of short stature and hypogonadism. This may explain the delayed age of diagnosis. Screening programmes are necessary, and the consistent finding of short stature can be used as a screening tool in early childhood to identify more patients who will benefit from referral.

To determine the impact of FDG-PET/CT in the initial staging of cervical cancer among women with and without HIV and to determine the abilities of FDG-PET/CT metabolic parameters in predicting the presence of distant metastasis. We reviewed the FDG-PET/CT images of women with FIGO stage IB2 to IVA carcinoma of the cervix. We compared the FIGO stage before and after FDG-PET/CT. Maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were determined. We compared these parameters between the HIV-infected and uninfected woman and also determined their abilities to predict the presence of distant metastasis. 126 women, mean age 48.05 ± 11.80 years were studied. Seventy-three patients were HIV-infected. The disease was upstaged in 65 patients, 32 of which were upstaged to stage IVB. HIV-infected women were younger (43.36 ± 8.03 years versus 54.51 ± 13.12, p<0.001) and had more advanced disease (p = 0.022) compared with HIV-uninfected. In a univariate logistic regression adjusted for the FIGO stage of the disease, there were significant associations between MTV and TLG of the primary tumor and distant metastasis. SUVmax, SUVmean, MTV and TLG performed well in predicting the presence of distant metastasis with areas under the curves (AUCs) of 0.63, 0.66, 0.80 and 0.77 respectively. These performances improved after adjustment for the FIGO stage of the disease with AUCs of 0.80, 0.79, 0.84 and 0.82 for SUVmax, SUVmean, MTV and TLG respectively. Inclusion of 18F-FDG-PET/CT in the pre-therapy assessment of cervical cancer improves the accuracy of staging in about half of the patients. The metabolic parameters of the primary tumor perform well in predicting the presence of distant metastases.