Steve Biko Hospital

Vine snake (Thelotornis capensis) envenomation is rare but can cause life-threatening coagulopathy. We report the 10th documented case of envenomation: a 42-year-old male who misidentified a vine snake as a juvenile python and sustained a bite while filming snake handling. Initial laboratory investigations showed complete incoagulability within 28 minutes of the bite, with normal vital signs and minimal local symptoms. The patient later developed frank hematuria, highlighting the delayed onset of systemic bleeding typical of venom-induced consumptive coagulopathy. No specific antivenom exists for venom from the Thelotornis genus. Management was supportive, with close monitoring of coagulation parameters; blood products were planned if bleeding progressed, but were not ultimately required. The patient self-discharged against medical advice despite ongoing coagulopathy, but ultimately recovered fully without sequelae. This case reinforces the need for clinicians to be aware of delayed coagulopathy and the importance of supportive care in vine snake envenomation.

Background/Objectives: The 103Pd/103mRh in vivo generator represents a promising Auger electron-emitting system, in which both parent and daughter radionuclides emit predominantly Auger electrons with minimal accompanying radiation. This study investigates the release dynamics of daughter radionuclides from the 103Pd/103mRh in vivo generator and evaluates the underlying mechanisms governing bond rupture and daughter retention. Methods: Cyclotron irradiation of rhodium foils was performed in two separate batches, followed by radionuclide separation using conventional wet chemistry and a novel dry distillation technique. The purified 103Pd radionuclide was used to radiolabel DOTA-TATE, phthalocyanine-TATE, and DOTA-TOC chelators. The resulting complexes were immobilized on Strata-X and Strata-C18 solid-phase extraction columns. Scheduled elution experiments were conducted to quantify the release of the 103mRh daughter radionuclide. Results: The measured 103mRh release rates were 9.8 ± 3.0% and 9.6 ± 2.7% from Strata-X columns with DOTA-TATE and phthalocyanine-TATE, respectively, and 10.5 ± 2.7% and 12.0 ± 0.5% from Strata-X and Strata-C18 columns, respectively, with DOTA-TOC. These values are significantly lower than the ~100% release predicted based on the reported Auger electron yield of 186%. One explanation for this difference could be potential inconsistencies in decay data that may require correction; this needs further investigation. The results further demonstrated that delocalized π-electrons, introduced via phthalocyanine-based chelation, did not mitigate daughter release. Conclusions: The low observed daughter nuclide release represents a favorable characteristic for the future clinical translation of the 103Pd/103mRh Auger emitter pair. The findings support the conclusion that Auger electron cascades, rather than nuclear recoil energy, dominate bond rupture processes.

Diaphyseal non-union of forearm fractures that involve both the ulna and radius present unique challenges to treat. If left untreated, these non-unions may lead to severe instability of the forearm and/or chronic pain. Existing treatments include bone grafting, fibular grafts, and the Masquelet technique, however, currently no gold standard treatment exists. The “Road-to-Union” protocol is a two-stage surgical approach originally developed for managing complex tibial bone defects. It integrates debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and structured rehabilitation. This technique addresses challenges such as infection, bone loss, and deformity by providing a systematic pathway to achieve bone healing and restore function. While traditionally used in the lower limb, its application in the forearm has not been widely reported. This case series explores the adaptation of the “Road-to-Union” protocol for forearm reconstruction, aiming to restore structural integrity and function in complex non-union cases.

Neonatal encephalopathy with suspected hypoxic ischaemic encephalopathy (NESHIE) is a neurological disorder caused by oxygen deprivation and limited blood flow to a neonate’s brain. Although various antenatal and perinatal factors have been identified, their precise role in NESHIE pathogenesis remains unclear. The pathophysiology involves multiple molecular pathways that can be explored using a multi-omics approach, including epigenetics. Epigenetics involves heritable changes in gene expression without altering the DNA sequence, encompassing chemical modifications to DNA and histone proteins, as well as changes mediated by non-coding RNAs (ncRNAs). These epigenetic changes regulate gene expression and can be influenced by environmental factors, offering crucial insights into gene regulation and disease mechanisms. This review examines the role of epigenetic mechanisms in NESHIE, focusing on the modulation of hypoxia-inducible factor-1 alpha (HIF-1α) and ncRNA during hypoxic conditions. Additionally, epigenetic-mediated foetal programming may shed light on how maternal and antenatal risk factors contribute to NESHIE susceptibility. Understanding these epigenetic signatures could advance biomarker discovery and the development of novel therapeutic strategies for NESHIE.

Theranostics, the integration of diagnostic imaging with targeted radiopharmaceutical therapy, is reshaping the practice of nuclear medicine worldwide. This article provides a global perspective on how multidisciplinary teams deliver theranostics care in diverse health care systems. Contributions from experts across Asia, Europe, South Africa, Australia, Latin America, and the United States highlight the shared and region-specific roles of nuclear medicine physicians, technologists, radiopharmacists, physicists, and nurses in patient selection, radiopharmaceutical preparation, treatment delivery, and posttherapy care. A consistent theme across regions is the central role of the nuclear medicine physician in treatment oversight and the expanding responsibilities of nuclear medicine technologists in imaging protocols, radiopharmaceutical administration, patient care, and dosimetry. The roles of radiopharmaceutical scientists, medical physicists, nurses, and trial coordinators are variable but overall beneficial in delivering a successful theranostics service. Workforce shortages, financial barriers, and regulatory challenges continue to be significant obstacles to equitable patient access. Despite these challenges, multidisciplinary collaboration, tumor board integration, and shared care models are improving patient outcomes and advancing the field.

IntroductionThe Imagine programme is a school-based HIV prevention program offering preexposure prophylaxis (PrEP), condoms and other social and structural interventions to adolescent girls and young women (AGYW) in South Africa. PrEP uptake and adherence together with the provision of condoms has not been extensively studied in the school context. We explored the barriers to and facilitators of PrEP and condom usage among Imagine programme beneficiaries using the HIV prevention cascade framework.MethodsSixteen AGYW aged 16–20 years who had never taken PrEP, were on PrEP or had stopped PrEP were interviewed between November 2023 and March 2024. Interviews were audio-recorded, and transcripts were deductively coded according to the HIV prevention cascade steps: (1) Knowledge, (2) Motivation, (3) Access and (4) Effective use.ResultsHIV and pregnancy risk awareness was high. For condom use, the risk of HIV transmission and pregnancy was outweighed by fear of sexual or physical violence from male partners and a desire to maintain relationships, as asking to use condoms demonstrated a lack of trust. High levels of PrEP knowledge motivated participants to use PrEP, especially if their partner refused to use condoms. Fear of side effects and daily pill taking were barriers to PrEP uptake. PrEP and condom services in school were highly acceptable, while anticipated stigma remained a challenge at the community clinic.DiscussionBarriers to condom use persist in South Africa, but positive attitudes toward PrEP described in this study suggest that opinions about PrEP are still forming and can be strongly influenced by youth-friendly HIV programming in schools.

The increasing deployment of Advanced Metering Infrastructure (AMI) in smart grids necessitates secure and efficient communication between smart meters and utility providers. Power Line Communication (PLC) offers a cost effective and scalable solution by utilizing existing electrical wiring for data transmission. However, PLC networks are vulnerable to security threats, including eavesdropping, data manipulation, and unauthorized access. This paper proposes a Lightweight Secured Power Line Communication (LSPC) framework that enhances data confidentiality, integrity, and authentication while maintaining low computational overhead. The proposed scheme integrates NTRU-based lightweight cryptography to secure PLC-based AMI networks against adversarial attacks, ensuring robustness even in resource constrained environments. Simulation results and security analysis demonstrate the effectiveness of the LSPC framework in achieving a high level of security with minimal impact on communication latency and energy consumption. The proposed approach provides a viable security solution for next generation smart grid metering systems, enabling reliable and secure data exchange over PLC networks.

Abstract Background Literature has highlighted the gut microbiota’s role in metabolic functions, suggesting a potential link between gut microbiota composition and T2DM. The purpose of the study was to identify microbial signatures unique to T2DM patients and non-diabetic individuals, to compare microbial profiles between the two groups and to investigate how gut microbiota may be related to inflammation associated with T2DM. Methods A cross-sectional study was conducted involving 51 T2DM patients and 99 non-diabetic South African individuals. Faecal samples were collected and analysed using 16S rRNA gene sequencing to characterize the gut microbiota. Blood samples were obtained to perform HbA1c, CRP and ferritin tests. Bioinformatic and statistical analyses were performed to identify differences in microbial composition and diversity between the two groups. Results The gut microbiota in T2DM patients was predominantly composed of Firmicutes (47.7%), Bacteroidota (37.5%), and Proteobacteria (11.4%), while the non-diabetic group showed a slightly different microbial profile with higher Bacteroidota (41.9%) and a notable presence of Actinobacteriota (4.5%). Abundant families in the T2DM group included Bacteroidaceae (22.8%), Prevotellaceae (7.4%), Enterobacteriaceae (7.4%), Erysipelotrichaceae (6.0%) and Lachnospiraceae (5.2%). The non-diabetic group exhibited dominant families such as Lachnospiraceae 26.7%, Prevotellaceae (25.3%), Bacteroidaceae (12.7%), Ruminococcaceae (9.5%) and Oscillospiraceae (3.8%). At the genus level, Bacteroides (22.8%), Escherichia-Shigella (5.0%), Holdemanella (4.8%), Phascolarctobacterium (3.2%) and Blautia (2.8%) were prevalent in the T2DM group, while Prevotella_9 (22.1%), Bacteroides (12.7%), Agathobacter (6.7%), Blautia (6.3%) and Faecalibacterium (5.1%) were dominant in the non-diabetic group. Differential abundance testing revealed 5 phyla, 16 families, and 25 genera that were either enriched/depleted in T2DM patients relative to non-diabetic individuals. The comparison of alpha diversity metrics between the two groups revealed significant differences across all four measures (P < 0.001), with non-diabetic individuals showing higher values than T2DM patients. HbA1c and CRP levels showed correlations with the relative abundance of various gut microbes at various phyla, family, and genus levels, as well as with all alpha diversity metrics. Conclusion The study revealed distinct differences in gut microbiota composition between T2DM patients and non-diabetic individuals, with T2DM patients showing a higher prevalence of certain phyla, families, and genera linked to metabolic dysregulation. Non-diabetic individuals exhibited greater microbial diversity and beneficial taxa, highlighting a potential protective microbial profile.