Medical Science

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An exploration of binge drinking and coping behaviour during covid-19 among students in a major tertiary institution in KwaZulu-Natal.
(2023) Faborode, Joy Adebowale.; Kathree, Tasneem.
Background: The COVID-19 pandemic has profoundly impacted human lives. At the emergence of the novel disease, several restrictive measures, including lockdowns, were implemented to mitigate the spread of COVID-19. These measures created stressful challenges that affected people’s mental wellbeing, including that of tertiary students. There is a dearth of information on the strategies students use to cope with COVID-19-related stress. This study aimed to understand how students experienced and coped with changes attributed to the lockdowns in South Africa, including factors that influenced alcohol use among students at a major tertiary institution in KwaZulu Natal during the COVID-19 lockdown. Method: A qualitative approach was used. Twenty students were recruited from two campuses at the University of KwaZulu-Natal (UKZN), Durban, South Africa, using purposive sampling. Individual indepth interviews were conducted using a semi-structured interview guide comprising open-ended questions. The NVivo software program was used for analysis. Results: The majority (60%) of participants were male and ranged from 20 to 36 years old. The results of this study indicate drinking patterns among the study sample. Results indicate that despite implementing an alcohol sale ban during the COVID-19 lockdowns, alcohol use was not eliminated, but there was some reduction in the intake of alcohol. Apart from alcohol restrictions, some factors influencing drinking included drinking location and people with whom participants consumed alcohol. Many participants also indicated that they preferred to consume alcohol with friends because it helped them to bond with their friends and improved their social interactions. In addition, over 50% of the students stated that they drank alcohol because they felt happy, socialized with others, had fun, and that they enjoyed the taste. In contrast, only a few (four) reported drinking as a coping mechanism. Respondents were also aware of the negative consequences of drinking alcohol, especially when it is in large quantities. Results also indicate that half of the participants felt stressed, depressed, anxious and sad during the lock down. In addition, they also experienced problems related to eating and sleeping. The study highlighted the various coping mechanisms participants used to deal with stress. These included emotion-based coping strategies such as social support, sleeping, exercise, reading, watching television, listening to music, and maintaining a positive attitude, problem-based coping strategies (e.g., positive thinking and planning), as well as avoidance forms of coping (such as ignoring the situation). Conclusion: This study found that alcohol misuse was common in this sample of university students prior to the onset of COVID-19, and they experienced some distress during the COVID-19 lockdown. Factors that influenced alcohol use were also identified in this study sample which provided insight into how they experienced and coped with changes directly caused by the lockdowns in South Africa. 11 Despite these findings, sampling students from only one tertiary institution in KwaZulu Natal and being unable to interview students in their home language or the language of fluency if this was not English are identified as limitations. This study recommends that health promotion and education on alcohol use and coping strategies should be encouraged at tertiary institutions to curb alcohol misuse and improve students’ wellbeing.
Molecular epidemiology of Antibiotic-Resistant Escherichia coli from companion animals attending veterinary practices in Durban, KwaZulu-Natal, South Africa.
(2023) Ntuli, Nondumiso Lungile.; Essack, Sabiha Yusuf.; Mbanga, Joshua.; Abia Akebe, Luther King.
Background: Companion animals are globally documented to harbour antibiotic-resistant E. coli. This study aimed to investigate the molecular epidemiology of antibiotic-resistant E. coli from companion animals presenting at veterinary practices in Durban, KwaZulu-Natal, South Africa. Methods: E. coli were isolated on selective media from rectal swabs sampled from dogs and cats attending veterinary practices in Durban, KwaZulu-Natal, South Africa. All isolates were confirmed using real-time polymerase chain reaction (PCR) of the uidA gene. Antibiotic susceptibility testing was done against 20 antibiotics using the Kirby-Bauer disk diffusion method. Selected antibiotic-resistance genes (ARGs) that confer resistance to third-generation cephalosporins (blaTEM, blaSHV, and blaCTX-M), tetracycline (tetA, and tetB), and tigecycline (tetX/X2, tetX3, and tetX4), were detected using conventional PCR. PCR amplicons were confirmed by DNA sequencing and bioinformatics analysis. Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) was carried out to determine the clonality of E. coli (101) isolates that showed resistance to at least one antibiotic. Results: A total of 330 E. coli isolates from dogs (234) and cats (96) formed the study sample. Overall resistance was high in tetracycline (24.2%), ampicillin (18.8%), trimethoprim-sulfamethoxazole (14%), cephalexin (11.2%) and nalidixic acid (9.7%). Whilst lower resistance was observed in amikacin (0.3%), ceftazidime (0.3%), and piperacillin-tazobactam (0.6%). Third-generation cephalosporin-resistant E. coli retrieved from cats (26%) was more prevalent compared to dogs (9.8%). E. coli from dogs (2.1%) and cats (2%) were resistant to forth-generational cephalosporins. E. coli (3%) retrieved from dogs was resistant to tigecycline, which is regarded as a medically important antimicrobial (MIA) in human medicine. No resistance was observed against carbapenems. Thirty-five (10.6%) E. coli were multidrug-resistant (MDR) and exhibited twenty-two different phenotypic patterns. Amongst the E. coli that were not susceptible to third-generation cephalosporin, and tetracycline, it was observed that the blaCTX-M-15 (8%), and tetA (24%) were the most prevalent resistance genes. Thirty-one (9.3%) isolates were non-susceptible to third-generation cephalosporins and had the corresponding extended-spectrum beta-lactamase (ESBL) genes. The blaCTX-M-15 type gene was prevalent in all 25 E. coli isolates that tested positive for the blaCTX-M. The blaTEM-1 (17) was the second most prevalent β-lactamase gene. A total of 80/330 (24%) isolates were phenotypically not susceptible to tetracycline and carried either one, or both of tetA and tetB resistance genes. Only one tetracycline-resistant E. coli isolate did not harbour either tetA, or tetB genes. The blaSHV, tetX/X2, tetX3, and tetX4 were not detected in all the isolates. Using a 75% similarity cut-off, forty-eight clusters with isolates from both dogs and cats were identified. The ERIC-PCR types depicted a variety of clusters within veterinary practices in Durban, indicating that a high diversity of E. coli is in circulation in Durban, South Africa. Conclusion: Companion animals are reservoirs of antibiotic-resistant E. coli and ARGs. However, there was no evidence of transmission of antibiotic-resistant E. coli in Durban, South Africa. Resistance of E. coli from companion animals to MIA for humans is of particular concern and requires measures to control the spread of antibiotic-resistant bacteria, and ARGs between companion animals, veterinary practice personnel, and owners.
Mortality trends during the first three waves of the covid- 19 pandemic at an urban district hospital in KwaZulu-Natal.
(2023) Hirachund, Omishka.; Naidoo, Mergan.
Introduction Severe Acute Respiratory Syndrome Corona Virus 2 (SARS COV 2) is the virus responsible for the COVID -19 (C19) pandemic. South Africa (SA) experienced multiple periods of increased transmission during which tertiary, regional and central hospitals were overwhelmed, resulting in a low acceptance rate of referrals from district hospitals (DHs). Thus, many severely ill, complex patients were managed at DHs while awaiting an Intensive Care Unit (ICU) bed. This study aims to describe mortality trends in a comparative analysis of the first three C19 waves at Wentworth Hospital (WWH). Literature Review Known risk factors for mortality are older age; male sex; Black African, Coloured and Indian compared to white race; admission in the public sector; comorbid diseases and obesity. Waves 2 and 3 had higher mortality rates compared to wave 1. Methods The study is a single-centre retrospective analysis of WWH’s clinical records and included all patients infected with C19 (based on clinical, biochemical or radiological features suggestive of infection) who were admitted and subsequently demised in-hospital during the defined waves. Data was collected using a pre-piloted data extraction tool. Demographic and presenting features of the patients along with investigations and management strategies were compared by the primary investigator across the three waves. Results Wave one, two and three yielded case fatality rates of 14.5%, 27.6% and 6.3%, respectively, and crude fatality rates of 16.7%, 33.0% and 12.2%, respectively. Black Africans were less likely to demise during the third wave (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.31 to 0.94). Obesity was most prevalent in the second wave (OR 1.87; CI 1.01 to 3.46). Patients in the second wave had clinical frailty scores of less than five (OR 2.51; CI 1.56 to 4.03). Severe ground glass appearance on chest radiographs was most common during the second wave (OR 2.37; CI 1.49 to 3.77). Conclusion The beta variant dominated the second wave and was the most virulent, as highlighted by the highest case- and crude fatality rates. This study identified the need to understand if case fatality 2 rates and mortality trends at a DH were significantly higher than those at regional or tertiary hospitals. It is hoped that this study will provide clinical and hospital managers, and provincial and national healthcare policy makers with insight into challenges faced in the health system in the public health sector and allow implementation of improved public health and planning strategies for future pandemics.
Type I, II, and III interferon responses in the female genital tract.
(2024) Ngubane, Slindile Brilliant Lyzeth.; Sivro, Aida.
Abstract available in PDF.
Waist circumference, waist-to height ratio, or body mass index: which is the better predictor of hypertension in patients living with diabetes mellitus in low-to-middle-income countries?
(2022) Konar, Kylie Divashnee.; Pillay, Somasundram.
Background Hypertension (HPT) in low and middle-income countries (LMICs) remains a leading preventable factor for death and disability. Approximately 20-60% of patients living with diabetes (PLWD) have HPT which doubles the mortality risk and accelerates the progression of complications. Obesity is a well-known preventable risk factor for HPT. Despite this, countries in Sub-Saharan Africa (SSA) faces an increasing challenge of obesity. Current evidence on anthropometric indices as a predictor for HPT in PLWD remain unclear. Methods A scoping review was performed to determine the association between anthropometry and HPT in PLWD in LMICs in SSA, by using PubMed, Google, Scopus and Cochrane between 2011- 2021. A total of 4590 records were identified. The associations between body mass index (BMI), waist circumference (WC) or waist-to-height ratio (WTHR) in PLWD and HPT in LMICs in SSA were assessed. Results We analyzed 21 studies with 11 057 patients included in this review. BMI was the most common anthropometric index used with more than 80% of studies suggesting a positive association with HPT. Varying associations between other anthropometric indices and HPT were found. Conclusions Our scoping review highlighted a positive association between HPT and anthropometry in most studies. Limited data was available comparing the different anthropometric indices. We found that additional studies are warranted to evaluate anthropometric indices in PLWD.

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