Primate endocrine function after pancreatico-duodenal-splenic allotransplantation

In this study the endocrine function following intraperitoneal hetero- and orthotopic pancreatico-duodenal-splenic allotransplantation (PDS) in hemipancreatectomized, non-immune-suppressed chacma baboons was assessed. Significantly reduced K-values and insulin release together with glucose intolerance during IVGTT were observed in hemipancreatectomized recipients (HPS) without grafts. Orthotopic and heterotopic PDS transplantation improved the glucose intolerance of HPS recipients; orthotopically sited grafts rendering the best curves. Normal glucose tolerance was not achieved. Both orthotopic and heterotopic PDS transplantation rendered suboptimal insulin release during IVGTT; heterotopically draining grafts released significantly more insulin than orthotopic grafts. Hyperglucagonaemia during IVGTT was a constant feature in both groups, heterotopic grafts releasing the most glucagon during stimulation. C-peptide release was significantly lower in orthotopic grafts compared to normal animals or heterotopically drained insulin. It is concluded that glucose tolerance was not directly related to insulin or glucagon release in this study as orthotopic grafts rendered near-normal IVGTT curves in the presence of hypoinsulinaemia, hyperglucagonaemia, and reduced C-peptide values. The hormonal response after PDS transplantation was variable and the advantages of portal vs systemic insulin drainage remain to be defined.     

Analysis of neomycins A, B and C by high-performance liquid chromatography with post-column reaction detection

The analysis of the antibiotics neomycins A, B and C was investigated. The separation of the components was studied using reversed-phase and reversed-phase ion-pair chromatography. The optimum separation was obtained utilizing a Lichrosorb RP-2 column with a mobile phase consisting of 75 mg/l sodium dodecyl sulphate, 0.5M Na2SO4 and 0.015 M sodium acetate buffer at pH 7.0. Using this mobile phase, baseline separation was obtained for all three compounds in approximately 20 min. Detection was via post-column derivatization of the analytes with ortho-phthalaldehyde in the presence of mercaptoethanol to form fluorescent iso-indole products. This system is applied to the analysis of a number of formulated products containing neomycin.     

Predictors of return to work after anterior cervical discectomy

Return to previous level of employment after surgery is important to patients. Predictors of return to work have been well described in lumbar disc surgery. However, this information cannot be generalized to the population undergoing cervical discectomy. The authors retrospectively reviewed 67 consecutive patients who underwent anterior cervical discectomy. Strict inclusion criteria were used. Baseline demographics were recorded as well as other potential predictors of postoperative return to work such as number of levels of disease, smoking history, and disability claims. Follow-up information about work status was reviewed with each patient at office visit. Forty-five patients were found eligible for the study. At a mean follow-up of 2.8 years (SD 1.4), 38% had not returned to work by 1 year. Preoperative sick leave in this group was significantly greater than for those patients who returned to work within the year (p = 0.0014). Postoperative neck pain was more common in individuals who did not return to work after surgery (p = 0.01). Increasing age and disability claims also appeared to negatively impact the ability to return to work. Gender, type of work, smoking history, and number of levels of disc disease did not appear to have any association with postoperative return to work. The authors conclude that the duration preoperative sick leave and postoperative neck pain negatively impact postoperative work status in patients undergoing anterior cervical discectomy. Age and disability claims also influence return to work.     

The effect of delta-9-tetrahydrocannabinol on forebrain ischemia in rat

The purpose of the study was to evaluate the effect of delta-9-tetrahydrocannabinol (THC), the major psychoactive constituent of marijuana, on ischemic neuronal injury. A 12-min ischemic insult was induced by a reduction in systolic blood pressure to a mean of 50 mm Hg, followed by bilateral carotid artery occlusion at a middle ear temperature of 37.5 degrees C. THC at either a low (0.1 mg/kg; n=8) or high (10 mg/kg; n=8) dose was injected i.p. every 12 h for 7 days prior to ischemia. Non-treated ischemic (n=8) animals formed the control group. The animals were sacrificed 3 weeks post-ischemia for quantitative histopathology. THC at either dose did not significantly reduce ischemic neuronal damage in the hippocampus. The high dose THC-treated group showed significantly less neocortical injury, compared to either the control or low-dose THC groups (p<0.05). The striatum was markedly protected by both low and high dose THC (p<0.001). This regionally specific protection implies that either the hippocampus undergoes suprathreshold ischemic injury or that mechanisms of ischemic injury vary in different brain regions.     

Children's rights: reasoning and their level of moral development: an empirical investigation

Children's reasoning about their rights is largely determined by their level of development. Since rights-reasoning concerns essentially moral issues, the best foundation to contextualise the developmental process mentioned would be to consider a moral-developmental approach. In this regard Kohlberg's theory of moral development has been found to be the primary theory that researchers have built on. The article focuses on an empirical investigation done with 312 South African children of varying ages, cultures and language groups into their level of moral-development and rights-reasoning. The two questionnaires used were Kohlberg's Standard Issue Score (Form B) and Melton's Children's Rights Interview. The most important findings made were that Kohlberg's theory of universalizability and unvariant order of sequence along with its applicability to gender and culture was confirmed for this South African study. Furthermore an important correlation between rights-reasoning development and level of moral ethical development was made which implies that an interdependent relationship exists between them.     

A South African perspective on children's rights: general principles

South Africa has made rapid progress in the field of human and especially children's rights. This is in sharp contrast with it's apartheid history where even the basic principles of human rights were negated. In this article an overview will be given of the general principles on which the realization of children's rights in South Africa are based. More specifically information on the population, economic status, political climate and recent developments in this field is presented. This is followed by a discussion on the social-economic nature of children's rights, the courts as enforcement mechanisms, and the contents of the best interest standard as described both in convention on the rights of the child and the South African Constitution.     

A South African perspective on children's rights: pertinent issues in remedial and protection interventions

This article focuses on specific issues that pose a threat to the application of children's rights in South Africa. Under remedial interventions survival, development and the standard of living and health will be discussed; while issues pertaining to children's right to education and parental care are also addressed. As far as protection interventions are concerned attention will be paid to abuse and neglect, child labour and children in difficult situations such as violence, disabilities, juvenile justice and street children.     

Outpatient initiation of the ketogenic diet in children with pharmacoresistant epilepsy: An effectiveness,safety and economic perspective

BackgroundChildren with pharmacoresistant epilepsy usually receive ketogenic diet (KD) as an inpatient, which makes it an expensive treatment.ObjectiveTo compare the effectiveness, safety, and costs of outpatient versus inpatient initiated KD.DesignRetrospective observational non-inferiority study.Patients/settingPatients (1–18 years of age) who started KD either inpatient or outpatient.Main outcome measuresEffectiveness was defined as ≥50% seizure reduction. Safety was measured by the numbers of emergency visits and complications. Economic impact was analyzed by calculating total costs of treatment.Statistical analysesNon-inferiority of outpatient initiation was tested using 95% confidence intervals of the differences in effectiveness and safety endpoints between groups with non-inferiority margins of 10%. Nonparametric bootstrap techniques were used to derive a 95% confidence interval for the mean difference in total costs between the groups.ResultsHundred and five patients started KD in the period 2001 to 2017: 43 inpatient and 62 outpatient. At three months, the KD was effective in 61% of outpatients versus 63% of inpatients. The KD was considered safe in 36% of the outpatients, as compared to 29% in the inpatients. Outpatient initiation was shown to be non-inferior to inpatient initiation in terms of safety. Total health care costs of outpatient initiation were € 2901, as compared to € 8195 of inpatient initiation per patient (mean difference € 5294, 95% CI; -€ 7653 to -€ 2935).ConclusionsOur study suggests that outpatient KD initiation is no worse than inpatient initiation in terms of effectiveness and safety, while carrying lower health care costs.     

Staff attitudes and services provided by community-based organizations for alcohol and other drug users in Cape Town,South Africa: Implications for training and education

Aims: The aims of this study were: (i) to describe the nature of and the extent to which community-based organizations (CBOs) in Cape Town provide services to people who have alcohol and other drug (AOD) problems; (ii) to examine the relationship between CBOs’ attitudes towards individuals with AOD problems and the types of services provided; and (iii) to compare CBOs’ attitudes towards alcohol- and drug-using clients. Method: A cross-sectional survey of 51 health and social welfare CBOs in Cape Town, South Africa. Results: A high proportion of clients served at CBOs have alcohol- and drug-related problems. Findings suggest that CBOs may be more accessible to poor black South Africans and women than traditional AOD treatment centres. CBOs that hold more positive attitudes towards AOD-using clients tend to provide more AOD-related services and serve more clients with AOD-related problems. Findings also indicate that CBOs’ attitudes are more positive towards alcohol users than towards drug users. Conclusions: This study highlights the important role that CBOs play in the delivery of services for people with AOD-related problems in South Africa. It also reveals the need to increase capacity among the agencies via training and education.     

Measuring distress in South African children during burns dressing changes: A pilot study

Objectives: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children’s distress during burns dressing change. Methods: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors—(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children’s Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses’ perspectives of child’s distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children’s distress levels during burns dressing change phases. Results: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses’ qualitative perspectives of child’s distress. In combination, these tests were practical and sensitive to children’s distress. Discussion: South African children’s distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.