Precipitating factors and clinical outcomes of diabetic ketoacidosis in Eastern Cape, South Africa

Background: Diabetic ketoacidosis (DKA) is a common hyperglycaemic emergency in persons living with diabetes (PLWD), and outcomes of treatment depend on the precipitating factor. Methods: A cross-sectional prospective study of patients admitted in the adult high care unit of Nelson Mandela Central Hospital was carried out from 19 February 2022 to 19 January 2023. Patients were assessed for demographic, clinical profiles and outcomes concerning precipitating factors. The outcomes were duration of admission and discharge from the hospital as alive or dead. Results: There were 55 PLWD, all black African, predominantly females, known with diabetes with a mean age of 38 ± 15.8 years. The main precipitants for DKA in descending order were infections (47%), treatment omission (30%) and a new diagnosis of diabetes (19%). The mean duration of admission for all patients was 8.2 ± 5.3 days. The length of hospital stay was 9.5 ± 5.2 days, 5.6 ± 2.2 days, and 8.6 ± 7.6 days, respectively (p = 0.118). The mortality in all patients was 9 (16.4%), and all but one death was associated with sepsis. There were no significant differences in the HbA1c among patients with infection (13.9 ± 3.8), those who omitted treatment (12.6 ± 4.7) and those newly diagnosed (12.2 ± 2.2) (p = 0.620). Conclusion: The high mortality rates in our DKA patients were mainly related to infections. The high HbA1c indicates poor glycaemic control preceding DKA. Improving glycaemic control, preventing infections, and early treatment of infections can reduce DKA-related mortality among patients. Contribution: This study provides a comprehensive analysis of DKA in resource-limited settings, focusing on its precipitating factors, clinical profiles, and outcomes among adults in the Eastern Cape, South Africa. Infections were identified as the leading precipitant, with poor glycaemic control prevalent across all cases and a mortality rate of 16.4%, primarily due to sepsis. The findings highlight the urgent need for strategies to improve glycaemic control, prevent infections, and ensure timely interventions to reduce DKA-related mortality. This research aligns with the Journal of the Colleges of Medicine of South Africa’s mission to advance clinical practice by addressing critical healthcare challenges in underserved communities, offering insights applicable across the region

Atypical HIV-vacuolar myelopathy: a case report :

vital:54741Background: Here, we report an atypical HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodefciency virus associate vacuolar myelopathy (HIV-VM) and immunoglobu‑ lin therapy response. Case: A 26-year-old lady who was 4 weeks postpartum presented to us with acute faccid quadriparesis, with no sen‑ sory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed difuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglob‑ ulin, ARVs, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died. Discussion: In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this patho‑ logical process also afected the spinal cord’s cervical region, leading to faccid tetraplegia, with high CD4 level, with‑ out response to the treatment, including intravenous immunoglobulin. Keynotes: Vacuolar myelopathy, HIV, Immunoglobulin therapy, faccid tetraplegia, hypokalaemia. Renal failure. Keywords: Human immunodefciency virus, Associated lesions of the nervous system, Human immunodefciency virus-associated myelopathy, Intravenous immunoglobulin administration, Case report, HIV-vacuolar myelopath

Pregnancy and contraceptive use among participants of childbearing potential in the HVTN 705 HIV vaccine trial in Southern Africa

BackgroundHIV vaccine trial participants include sexually active cisgender females who agree to avoid pregnancy during the active vaccination period. Nevertheless, some pregnancies occur in almost all studies. We examined contraceptive use, pregnancy incidence, and the relationship between pregnancy and HIV seroconversion in one HIV vaccine trial.MethodsWe performed an exploratory analysis of data collected for HVTN 705/HPX2008, a phase IIb HIV vaccine trial enrolling cisgender women across 23 sites in five southern African countries. Baseline characteristics and contraceptive use were assessed among participants who became pregnant and those who did not during the active vaccination phase (months 0–15). Pregnancy incidence rates were calculated for this phase and the duration of follow up (36 months). Cox regression analysis was used to assess factors associated with incident pregnancy.ResultsThere were 2,636 participants who received at least one vaccine or placebo dose (mean age: 23 years, standard deviation: 3 years). At enrolment, when contraception was required, 62.9% reported using injectable contraceptives. Overall pregnancy rate was 2.95 per 100 person-years (95% CI: 2.40, 3.58), with 101 pregnancies reported by month 15. Cumulative incidence of pregnancy at month 15 was similar between trial arms (log-rank p = 0.688). Each additional year of age was associated with an 8% decrease in pregnancy incidence (p = 0.014). Women aged 31–35 years had the lowest pregnancy incidence [1.75 (0.48, 4.48) per 100 person-years]. In a Cox regression analysis covering months 0–15, all contraceptive methods significantly reduced the incidence of pregnancy compared to no contraceptive use. Oral contraception was associated with the least reduction in pregnancy risk; implants were associated with the most reduction in pregnancy risk (p < 0.001).ConclusionsIn HVTN 705/HPX2008, higher incidence of pregnancy was associated with younger age and oral contraception (compared to other methods). These data may inform future designs of HIV prevention or vaccine trials

Physicochemical and microbiological quality of tanker waters in Bengaluru urban for safe water supply

This study investigated the water quality of tanker waters that was collected from Bengaluru urban areas to assess its suitability for domestic purpose. A total of 50 samples were collected in dry (March 2019) season. All samples were analyzed for various hydrochemical parameters, such as pH, total dissolved solids (TDS), electrical conductivity (EC), turbidity, dissolved oxygen (DO), total hardness (as CaCO3), calcium (CaCO2+), chloride (CaCO−) and nitrate (NO3−). Bacteriological analyses of water samples were analyzed for total coliform count. A very high level of total hardness (186 - 434.6 mg L-1) was determined in 27 water samples tested in this study indicating the necessity of water treatment before used for domestic purpose. Of the 50 samples tested, 7 showed a most probable number (MPN) index of < 23 and 9 showed < 240 and the remaining 34 were unsatisfactory with an MPN index of > 1600 per 100 ml. In some locations, the presence of high MPN index, in particular, rings the bell before using the tanker water in houses and restaurants. Exploration of the mechanisms by which water quality deteriorates during supply chain and potential implication for regulatory policy for monitoring of tanker water while distribution is the need of the hour

198 A Novel ‘Virtual Simulation’ for The Advanced Life Support Group, Making a Dream a Reality: A Beginner’s Guide

In the UK, it is a requirement for staff involved in paediatric critical care to remain up to date with advanced paediatric life support (APLS). To do so there is an expectation to participate in face-to-face courses on a four-yearly basis. The Advanced Life Support Group (ALSG), an organization dedicated to supporting professional education, sought to add to their resources in line with advances in online capabilities. With stakeholder input, the goal emerged to develop an engaging, interactive and entirely novel educational product. Here we present the pilot stages of our project.The aim of this project was to produce an educationally effective and novel product that learners of APLS would engage with and enjoy.Stage 1 involved determining clearly defined learning objectives mapped to the APLS curriculum. At a round table with stakeholders, educationalists, and a technologist an outline of the project was formed and the scenario of a sick baby with bronchiolitis chosen for a pilot. Informed by literature on serious game design, a branching narrative was created. Stage 2 involved collating resources. A photoshoot at Leicester Royal Infirmary A&amp;E (Accident and Emergency) created a set of images. A video shoot at the Royal London Hospital A&amp;E generated a series of videos. These were then edited and used to create a Microsoft PowerPoint slide set. Voiceovers to text, sound effects to add a hospital atmosphere and questions were then added. Stage 3 involved taking this draft and translating it into an interactive final product utilizing Articulate Software. This enabled its usage across smartphone, desktop, and laptop devices. Testing followed with anonymous online feedback informed by the 7Is framework We launched the pilot version at the RCPCH (Royal College of Paediatrics and Child Health) Conference 2021. Feedback was collected from delegates and continues to be collected via online participants. It is hoped that ongoing quality improvement cycles will assist in assuring a finished fully functional online virtual advanced paediatric life support simulation for release in 2022. Further stakeholder review is pending. Thus far it has been met with universal approval, i.e. all learners questioned expressed that they would like to utilize this novel style of education again. The average duration to complete the virtual simulation was 15 minutes. All learners rated their knowledge and skills in APLS to be either unchanged/revised or improved. Finally, interactivity online was felt to need improvement by most participants. Interactivity is key if high levels of engagement are to be achieved. Future testing will determine whether any educational impact is maintained across time. The current pilot version can be accessed at the following webpage </jats:p

A Review for an Effective Approach towards Hydroelectric Power Generation Using In-Pipe Mesoscale Submersible Turbine

Abstract: Turbines are playing a massive role in our day-to-day lives in the back-end portion of lifestyles where they have been efficiently providing us energy through tidal, hydrological, and many such other mediums. A dominant explanation for the need for energy production has been introduced in the 1800s since the requirement for a high consumption of energy in various forms has started taking place. A very common method that has been observed in today’s innovative mannerism is the use of turbines in dams, undersea, elsewhere at locations where the flow of fluid induces better outputs. Vertical axis turbines, Francis turbines as well as Kaplan turbines have frequently opted for such purposes but after studying over 65 works done by adepts, professionals, and experts; the purposely implemented input that is required to fulfill the output doesn’t have to always be a necessity, it seemed to be the new designing restructured platform for users as well as providers. An overture to install micro versioned turbines of macro hydroelectric power plants within a residential or commercial structure at the main water-supply connections either at their junctions or directly near the overhead water tanks cannot just provide subtle but fortifying and tireless inputs since the flow of water will be anticipated naturally by the implicated outcomes through day-to-day chores performed. Hydrokinetic conversion systems may appear suitable in harvesting energy from such renewable resources, despite the fact that they are still in the early stages of development. Contrary to what has been assumed, there are numerous possibilities for the utilization of this energy for common areas/public zones such as signals, street lights, or any such productive amenities to bestow leading-edge facilities without any hitch regarding external contriving inputs. Keywords: Turbine, CFD Simulations, Archimedes screw, Water distribution logistics, Mini-Hydro-Power Plant, In-Pipe electricity generation, Inline hydroelectric generation.</jats:p

Neurodynamic test of peroneal nerve: Study of the sensory response in patients with lumbar radiculopathy

BACKGROUND: Neurodynamic tests (NDT) have shown to be useful in evaluating neural tissue involvement. Clinicians evaluate NDT using range of motion, sensory responses like location or quality of symptoms, Nerve conduction values and compare its results with normal values. Currently, there are no studies in lumbar radiculopathy patients that define the normal response to peroneal neurodynamic test (NDTPER) PURPOSE: To study the sensory responses to neurodynamic testing of peroneal nerve in patients with lumbar radiculopathy. DESIGN: A cross sectional study design. METHODS: NDTPER was performed on 57 patients with lumbar radiculopathy. Hip flexion angle was taken at the onset of symptoms (P1) and point of maximally tolerated symptoms (P2), quality and distribution of symptoms were recorded. Sensory nerve conduction velocity measure (SNCV) was also noted in those patients. MAIN RESULTS: The descriptor of nature of sensory responses most often used by patients was tingling (28.07%) in the lateral foot (26.32%). Hip flexion was significantly higher at P2 than P1 (mean difference: 22.54±3.73°; 95% CI: 21.55°, 23.54°; p &lt; 0.0001). The SNCV of affected limb was marginally reduced but not statistically significant compared to contralateral limb (mean difference: –1.467±0.8013; 95% CI: –3.054, 0.1209; p = 0.0698). CONCLUSION: This study describes the hip angle at which symptoms are reproduced, nature and distribution of sensory responses to the NDTPER in patients with lumbar radiculopathy. However, the sensory nerve conduction velocity of affected limb was reduced marginally but not statistically significant as compared to unaffected limb.</jats:p