Midlands Provincial Hospital

BACKGROUND: There is no local literature evaluating the outcomes of external fixator-assisted tibial nailing. This study aimed to investigate the peri- and postoperative outcomes of tibial nailing using either an unassisted or an external fixator-assisted nailing method, in patients with tibial fractures. METHODS: A prospective cohort study including skeletally mature (> 18 years) patients with tibial fractures presenting to one of three different hospitals within the Western Cape province of South Africa, and treated with intramedullary nailing, was conducted. Participant demographic, clinical and surgical characteristics were documented perioperatively up until six weeks post-surgery. Differences in operative time, fluoroscopy time, adequacy of reduction, and short-term complications in patients treated with external fixator-assisted versus unassisted tibial nailing were investigated. RESULTS: A total of 154 patients with tibial fractures (n = 74 fixator-assisted tibial nails; n = 80 unassisted nails) enrolled in the study. Fixator-assisted tibial nailing was associated with significantly longer operation (median 80, interquartile range [IQR] 60-95 minutes) and fluoroscopy times (median 140, IQR 96-214 seconds) compared to the unassisted group (60, IQR 50-90 minutes and 82.5, IQR 63-121 seconds, respectively) (p < 0.001 and p < 0.001, respectively). No differences were observed in the adequacy of reduction, or prevalence of complications, between groups. CONCLUSION: Comparing fixator-assisted tibial nailing to unassisted tibial nailing, this prospective cohort study suggests that both techniques are comparable when managing tibia fractures in terms of adequacy of reduction and the prevalence of short-term complications. The benefits of fixator-assisted tibial nailing include being relatively easy to apply by all orthopaedic surgeons regardless of surgical experience, maintaining reduction during all steps of tibial nail insertion, reduced need for open fracture reduction, reduced radiation exposure to the surgeon and assistant, and no added risk to the patient.

Viruses in the Orthobunyavirus genus, Peribunyaviridae family, are associated with encephalitis, birth defects and fatalities in animals, and some are zoonotic. Molecular diagnostic investigations of animals with neurological signs previously identified Shuni virus (SHUV) as the most significant orthobunyavirus in South Africa (SA). To determine if other orthobunyaviruses occur in SA, we screened clinical specimens from animals with neurological signs, abortions, and acute deaths from across SA in 2021 using a small (S) segment Simbu serogroup specific TaqMan real-time reverse transcription polymerase chain reaction (RT-PCR). Positive cases were subjected to Sanger sequencing and phylogenetic analysis to identify specific viruses involved, followed by next-generation sequencing (NGS) and additional PCR assays targeting the medium (M) segment and the large (L) segment. In total, 3/172 (1.7%) animals were PCR positive for Simbu serogroup viruses, including two horses with neurological signs and one aborted goat fetus in 2021. Phylogenetic analyses confirmed that the two horses were infected with SHUV strains with nucleotide pairwise (p-) distances of 98.1% and 97.6% to previously identified strains, while the aborted goat fetus was infected with a virus closely related to Shamonda virus (SHAV) with nucleotide p-distances between 94.7% and 91.8%. Virus isolation was unsuccessful, likely due to low levels of infectious particles. However, phylogenetic analyses of a larger fragment of the S segment obtained through NGS and partial sequences of the M and L segments obtained through RT-PCR and Sanger sequencing confirmed that the virus is likely SHAV with nucleotide p-distances between 96.6% and 97.8%. This is the first detection of SHAV in an aborted animal in SA and suggests that SHAV should be considered in differential diagnosis for abortion in animals in Southern Africa.

The first recorded outbreak of avian influenza (AI) in South African chickens (low pathogenicity H6N2) occurred at Camperdown, KwaZulu/Natal Province (KZN) in June 2002. To determine the source of the outbreak, we defined the phylogenetic relationships between various H6N2 isolates, and the previously unpublished gene sequences of an H6N8 virus isolated in 1998 from ostriches in the Leeu Gamka region (A/Ostrich/South Africa/KK98/98). We demonstrated that two distinct genetic H6N2 lineages (sub-lineages I and II) circulated in the Camperdown area, which later spread to other regions. Sub-lineages I and II shared a recent common H6N2 ancestor, which arose from a reassortment event between two South African ostrich isolates A/Ostrich/South Africa/9508103/95 and (H9N2) A/Ostrich/South Africa/KK98/98 (H6N8). Furthermore, the H6N2 sub-lineage I viruses had several molecular genetic markers including a 22-amino acid stalk deletion in the neuraminidase (NA) protein gene, a predicted increased N-glycosylation, and a D144 mutation of the HA protein gene, all of which are associated with the adaptation of AI viruses to chickens. The H6N2 NS1 and PB1 genes shared recent common ancestors with those of contemporary Asian HPAI H5N1 viruses. Our results suggest that ostriches are potential mixing vessels for avian influenza viruses (AIV) outbreak strains and support other reports that H6 viruses are capable of forming stable lineages in chickens.

A paramyxovirus with a thermostability of 60 min (typical of velogenic viruses) and a mean death time of > 90 h (typical of lentogenic viruses) was isolated from layers near Mooi River, South Africa. Our results, based on comparative nucleotide sequence data indicated that the virus is pigeon paramyxovirus 1 (PPMV-1), a variant of Newcastle disease virus. The F0 cleavage site contains a 112RRKKRF117 motif, and the virus had 98% sequence identity with PPMV-1 strains from the Far East. PPMV-1 was last reported in South Africa during the 1980s, with this being the first report of PPMV-1 isolated from chickens in South Africa.

Genetic comparisons were made of the fusion protein sequences of 155 Newcastle disease virus isolates collected in South Africa between 1990 and 2002. Their evolutionary relationships and origins are described. All of the lentogenic field isolates were shown to be derived from commercial vaccines. No true South African lentogenic wild type strain was identified. Furthermore, it was shown that almost all mesogenic isolates had avirulent F(0) cleavage site sequences. Three major epizootics occurred in South Africa during the period of this study. The first outbreak (1990/1991) was caused by viruses endemic to South Africa since the 1960's (genotype VIII) but were occasionally also isolated in 2000. Genotype VIIb viruses, implicated in the severe outbreaks during 1993/1994, persisted until 1999. Genotype VIId viruses, responsible for the most recent outbreak in 1999/2000, had their origins in the Far East like those of the two previous outbreaks.

Of 1,232 patients receiving psychiatric medication in outlying areas of South Africa more than half had diagnoses of schizophrenia. Significantly more men than women had substance-induced psychosis, while significantly more women had depressive and anxiety disorders.

During October 1998 a study was performed in the Caledon area to determine the presence of anthelmintic resistance in the southern Western Cape, which falls within the winter rainfall region of South Africa. The study took the form of an undifferentiated faecal egg count reduction test (FECRt) survey. The predominant worm genera of the region are Teladorsagia and Trichostrongylus, but Haemonchus causes occasional outbreaks in sheep. No resistance data for any area in the Western Cape Province are available at present. Resistance (< 90% FECR) was recorded on 73% of the farms included in the study, with 46% of these involving resistance to 1 drench, 36% to 2 drenches and 18% to 3 drenches. No moxidectin resistance was detected when it was administered at the therapeutic dosage of 0.2 mg/kg. The results of this study show clearly that resistance of nematodes to other anthelmintics occurs in the Caledon area.