scholarly journals The contemporary study of acute myocarditis in South Africa – CAMISA

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K M Hassan ◽  
C G Kyriakakis ◽  
L H Joubert ◽  
A F Doubell ◽  
S D Zaharie ◽  
...  
Keyword(s):  
South Africa ◽  
Acute Myocarditis ◽  
Standard Of Care ◽  
Position Statement ◽  
Human Bocavirus ◽  
Median Viral Load ◽  
Funding Sources ◽  
Tertiary Centre ◽  
Contemporary Study ◽  
Developed World

Abstract Introduction The aetiology and estimated incidence of acute myocarditis (AM) remains undefined in Africa. Whilst cardiac magnetic resonance (CMR) provides for a provisional non-invasive diagnosis, endomyocardial biopsy (EMB), which is infrequently clinically sought, remains the gold standard. The developed world has experienced a shift in the viral epidemiology of AM and the ESC's most recent position statement on myocarditis recommends both CMR and EMB as the standard of care in suspected cases. We report on the interim results of the study. Purpose To determine the nature of presentation, underlying aetiology, and outcomes of patients presenting with AM to a single tertiary centre in South Africa. Methods A cohort of patients from a single tertiary centre in South Africa will be recruited from January 2018 to December 2022. All patients presenting or referred to the centre with clinically suspected AM that are investigated according to the ESC recommendations on myocarditis, which includes blood tests (CRP, hsTNT, HIV and Hepatitis C serology, ANA), a standard twelve-lead ECG, TTE, coronary angiography, CMR and EMB, will be included. Enrolment is ongoing. Results A total of 102 (mean age 42.2±13 years, 64.7% male) cases of clinically suspected AM were identified between January 2018 and January 2021. AM was confirmed in 41 (40.2%) cases on CMR only, while 41 (40.2%) were also confirmed on EMB. 4 cases of sarcoidosis, 1 case each of eosinophilic myocarditis, amyloidosis and primary cardiac lymphoma were diagnosed. Viral genome was isolated by PCR in 60 (59.8%) patients. PVB19 (73.5%) was the most commonly identified virus in those with confirmed AM followed by EBV (12.2%), HHV6 (4.1%) and Human Bocavirus (2%). 3 were coinfected with PVB19/EBV, and 1 with PVB19/EBV/HHV6. PVB19 was also isolated in 9 patients with no evidence of AM on CMR or EMB, but with lower median viral load compared to those with AM (198copies/ml IQR 113 – 282 vs 483copies/ml IQR 366 – 1460, p=0.005). The virus-positive patients with confirmed AM tended to be older (43.1±13.4 years vs 37.6±12.2 years, p=n/s), had higher median CRP (24mg/L vs 16mg/L, p=n/s) but lower median hsTnT (326.5ng/L vs 434.5ng/L, p=n/s) at presentation, and were more likely to be EMB positive (60% vs 37.5%, p=0.04) when compared to the virus-negative group. To date 6 patients have demised, of which 4 were related to AM. Conclusion To our knowledge, this is the first study to evaluate AM in Africa, and the biggest cohort of AM patients outside of the developed world. It demonstrates the heterogeneity in presentations and provides insight into the viral pathogens within our local setting, which appears similar to those reported in the developed world. We were also able to highlight some differences in demographic and clinical characteristics between those with virus-positive and virus-negative AM. The background prevalence and causal role of PVB19 in our setting will also need to be further explored. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Evaluation of adherence monitoring system using evriMED with a differentiated response compared to standard of care among drug-sensitive TB patients in three provinces in South Africa: a protocol for a cluster randomised control trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Noriah Maraba ◽  
Catherine Orrell ◽  
Candice M. Chetty-Makkan ◽  
Kavindhran Velen ◽  
Rachel Mukora ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Success ◽  
Standard Of Care ◽  
Treatment Completion ◽  
Phone Call ◽  
Randomised Control Trial ◽  
Improve Medication Adherence ◽  
Tb Treatment ◽  
Differentiated Care

Abstract Background South Africa has achieved drug-susceptible TB (DS-TB) treatment success of only 77% among people with new and previously treated TB. Alternative approaches are required to improve medication adherence and treatment completion to limit transmission, TB relapse and the development of resistance. This study aims to implement and evaluate the use of adherence medication monitors (Wisepill evriMED 1000) with a differentiated response to patient care, among DS-TB patients in three provinces of South Africa. Methods In total, 18 public health clinics across three provinces were selected. Clinics were randomised to intervention or standard of care clinics. In each clinic, approximately 145 DS-TB patients are being enrolled to reach a total of 2610. All patients have their daily adherence monitored using medication monitors. In the intervention arm, patients are receiving medication monitor reminders and differentiated care in response to adherence data. This weekly review of daily real-time monitoring will be undertaken from a central database. The differentiated care model includes automated SMS reminders with a missed dose, research staff-initiated phone call to the patient with a second or third missed dose, a home visit if four or more doses are missed, and motivational counselling if four or more doses are missed repeatedly. Fidelity of the intervention will be measured through process evaluation. Patients in control clinics will receive medication monitors for adherence tracking, standard of care TB education, and normal clinic follow-up procedures. The primary outcome is the proportion of patients by arm with >80% adherence, as measured by the medication monitor. The feasibility and acceptability of the intervention will be assessed by in-depth interviews with patients, stakeholders, and study staff. A cost effectiveness analysis of the intervention and standard of care clinics will be conducted. Significance This trial will provide evidence for the use of an intervention, including medication monitors and differentiated care package, to improve adherence to TB treatment. Improved adherence should also improve TB treatment completion rates, thus reducing loss to follow-up rates, and TB relapse among people with TB. The intervention is intended to ultimately improve overall TB control and reduce TB transmission in South Africa. Trial registration Pan African Trial Registry PACTR201902681157721. Registered on 11 February 2019.

Genital tract fistula: a case series from a tertiary centre in South Africa

2017 ◽  
Vol 29 (3) ◽  
pp. 383-389
Author(s):  
Thinagrin Dhasarathun Naidoo ◽  
Jagidesa Moodley ◽  
Saloshni Naidoo
Keyword(s):  
South Africa ◽  
Genital Tract ◽  
Case Series ◽  
Tertiary Centre ◽  
Tract Fistula

scholarly journals Bond Portfolio Allocations in South Africa Emerging Markets

2016 ◽  
Vol 5 (1) ◽  
pp. 73-80
Author(s):  
Jinghua Wang ◽  
John Bilson
Keyword(s):  
South Africa ◽  
Emerging Markets ◽  
Financial Integration ◽  
Emerging Market ◽  
Dynamic Factor ◽  
Portfolio Performance ◽  
Varying Coefficients ◽  
Bond Portfolio ◽  
Time Varying Coefficients ◽  
Developed World

Over the past fifty years, economic growth in emerging markets has been supported by investments in capital and technology from the developed world. The benefit of this development for the emerging markets, as measured by growth in income, employment, and wealth, is immediately apparent. There have also been significant advantages for the developed world through opportunities for higher risk adjusted returns from investments in emerging markets. This study explores the benefits of the diversification of global government bond portfolio, and provides complete performance evaluations of DMs with or without South Africa emerging market (SAEM) bonds. The study examines the benefits of inclusion of SAEM bonds in DMs, the degrees of financial integration among the research markets, the relative bond returns of dynamic factor models with time-varying coefficients and the robust tests of bond portfolio performance between DMs with SAEM and bond index. The results of this study provide important implications for global investors by identifying diversification gains in SAEM.

Cost-effectiveness and budget impact of flucytosine as induction therapy in the treatment of cryptococcal meningitis in HIV-infected adults in South Africa

2020 ◽  
Author(s):  
Jacqui Miot ◽  
Trudy Leong ◽  
Simbarashe Takuva ◽  
Andrew Parrish ◽  
Halima Dawood
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Amphotericin B ◽  
Induction Therapy ◽  
Cryptococcal Meningitis ◽  
Budget Impact ◽  
Cost Effective ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
Oral Regimen

Abstract Background Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135 000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa. Methods A decision analytic cost-effectiveness and budget impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered four treatment arms: (a) standard of care; 2-week course of amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course of amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) and (d) oral course; 2-week oral fluconazole/flucytosine (oral). A sensitivity analysis was conducted on key variables. Results The highest total treatment costs were in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, then the 1-week AmBd/5FC with the lowest cost in the standard of care arm. Compared to standard of care the 1-week flucytosine course is most cost-effective at USD31/QALY, followed by the oral 2-week course at USD155/QALY and the 2-week flucytosine course at USD568/QALY. The budget impact analysis shows that the 1-week course has the lowest incremental cost, followed by the oral course and then the 2-week flucytosine course compared to what is currently spent on standard of care. Sensitivity analyses suggest that the model is most sensitive to the price of flucytosine and hospital costs, particularly length of stay. Conclusions The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective regardless of whether it is used as a 1-week, 2-week or oral regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.

Teacher Use of iPads in the Classroom of a South African Public School

2019 ◽  
pp. 251-276
Author(s):  
Vuyo P. C. Lupondwana ◽  
Emma Coleman
Keyword(s):  
South Africa ◽  
South African ◽  
Technical Support ◽  
Independent Learning ◽  
Specific Content ◽  
Subject Specific ◽  
Multi Media ◽  
Teacher Use ◽  
Effective Use ◽  
Developed World

This chapter argues that when implementing technologies such as iPads in developing country educational contexts, there are different factors to consider than when implementing in the developed world. It is important to consider these to reap benefits that improve the inclusivity of education for all. The chapter examines teacher use of iPads in the classroom of a township school in South Africa and the benefits and challenges experienced by teachers in using the devices. Qualitative data were collected through interviews with teachers. The findings of the study indicated that overall the effect of iPad use by the teachers was positive. The use of iPads resulted in the teachers having access to quality multi-media and educational apps to teach their subjects which led to learners' increased class involvement and independent learning. The study revealed that effective use of iPads requires teachers that are adequately trained to use the iPad in relation to subject specific content, a reliable wireless connection, technical support, and mitigation of learners' distractions.

Molecular epidemiology of human bocavirus infection in hospitalized children with acute gastroenteritis in South Africa, 2009‐2015

2019 ◽  
Vol 92 (8) ◽  
pp. 1124-1132 ◽  
Author(s):  
Rembuluwani Netshikweta ◽  
Lizyben Chidamba ◽  
Sandrama Nadan ◽  
Maureen B. Taylor ◽  
Nicola A. Page
Keyword(s):  
South Africa ◽  
Molecular Epidemiology ◽  
Acute Gastroenteritis ◽  
Human Bocavirus ◽  
Hospitalized Children

Examining the cost of community-based tuberculosis treatment in South Africa

2020 ◽  
Vol 24 (6) ◽  
pp. 612-618
Author(s):  
A. Moran ◽  
N. Kula ◽  
G. Jagwer ◽  
E. Broughton ◽  
Y. Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Success ◽  
Standard Of Care ◽  
Multidrug Resistant ◽  
National Standard ◽  
Eastern Cape ◽  
Community Based ◽  
Tb Treatment ◽  
Adherence Support ◽  
The Cost

SETTING: While South Africa has improved access to tuberculosis (TB) treatment and care, the 2015 treatment success rate for multidrug-resistant TB (MDR-TB) remains low, at 55%. Community-based TB treatment and care improves patient retention compared to the standard of care alone.OBJECTIVE: To assess the cost of a USAID-funded community-based TB model in Nelson Mandela Bay Health District (NMBHD), Eastern Cape Province, South Africa compared to the national standard of care alone.DESIGN: We estimated the cost of community-based DR-TB treatment and adherence support compared to the standard of care alone.RESULTS: Average overall costs were US$2827 lower per patient on the community-based model than the standard of care alone.CONCLUSION: The per-patient cost of the community-based model is lower than the standard of care alone. Assuming the costs and effects of a community-based model implemented in NMBHD were observed at a larger scale, implementing the model could reduce overall health system costs.

scholarly journals Trends and disparities in the use of neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Jonathan J. Duplisea ◽  
Ross J. Mason ◽  
Chad A. Reichard ◽  
Roger Li ◽  
Yu Shen ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Standard Of Care ◽  
Partial Cystectomy ◽  
Muscle Invasive Bladder Cancer ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Muscle Invasive ◽  
Contemporary Study ◽  
Over Time

Introduction: Neoadjuvant chemotherapy (NAC) prior to radical or partial cystectomy is considered the standard of care for eligible patients with muscle-invasive urothelial carcinoma. Despite guideline recommendations, adoption of NAC has historically been low, although prior studies have suggested that use is increasing. In this contemporary study, we examine trends in the use of NAC and explore factors associated with its receipt. Methods: We identified patients in the National Cancer Database who underwent radical or partial cystectomy for cT2-cT4N0M0 urothelial carcinoma from 2006–2014. The proportion of patients receiving NAC during each year was examined. Logistic regression models were used to evaluate clinical and socioeconomic factors associated with the receipt of NAC. Results: A total of 18 188 patients were identified who underwent radical or partial cystectomy for muscle-invasive bladder cancer. Overall, 3940 (21.7%) received NAC. We noted a significant increase in the use of NAC over time, from 9.7% in 2006 to 32.2% in 2014. Factors associated with lower use of NAC include older age, higher comorbidity score, lower cT stage, lower hospital radical cystectomy volume, treatment at a non-academic facility, lower patient income, and receipt of partial cystectomy (all p<0.001). Interestingly, neither sex nor race were associated with receipt of NAC. Conclusions: Use of NAC has increased significantly over time to a modest rate of 32%. However, disparities still exist in the receipt of NAC, and future efforts aimed at mitigating these disparities are warranted.

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