Research Articles (Surgery)

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The exposome perspective : environmental and infectious agents as drivers of cancer disparities in low- and middle-income countries
(MDPI, 2025-08) Dlamini, Zodwa; Alaouna, Mohammed; Marutha, Tebogo; Mkhize-Kwitshana, Zilungile; Mbodi, Langanani; Chauke-Malinga, Nkhensani; Luvhengo, Thifhelimbil E.; Marima, Rahaba; Hull, Rodney; Skepu, Amanda; Ntwasa, Monde; Duarte, Raquel; Damane, Botle Precious; Mosoane, Benny; Mbatha, Sikhumbuzo Z.; Phakathi, Boitumelo; Khaba, Moshawa; Chokwe, Ramakwana Christinah; Edge, Jenny; Mbita, Zukile; Khanyile, Richard; Molefi, Thulo; zodwa.dlamini@up.ac.za
Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations.
Therapeutic targeting of protein arginine methyltransferases reduces breast cancer progression by disrupting angiogenic pathways
(Elsevier, 2025-09) Maphalala, Kamohelo; Ramali, Dakalo Portia; Maebele, Lorraine Tshegofatso; Mulaudzi, Thanyani Victor; Mabeta, Peaceful Lucy; Dlamini, Zodwa; Damane, Botle Precious; botle.damane@up.ac.za
Protein arginine methylation is an epigenetic modification involved in transcription, splicing and signal transduction and is mediated by protein arginine methyltransferases (PRMTs). PRMTs regulate various tumor angiogenesis pathways, including vascular endothelial growth factor receptor-2 (VEGFR-2) signaling. PRMT1, PRMT4, and PRMT5 activate distinct stages of angiogenesis. For example, inhibiting PRMT5 suppresses VEGF-induced vessel sprouting in experimental models while impairing hypoxia-inducible factor 1-alpha (HIF-1α) stability and VEGFR-2 phosphorylation. PRMT1 and PRMT4 similarly influence VEGF isoform expression, leading to increased angiogenesis. Targeting PRMTs in experimental models results in suppressed angiogenesis and reduced cancer progression. Several small-molecule PRMT inhibitors, including GSK3326595 and EPZ015666, have entered early-phase clinical trials for solid tumors. These agents show promise in inhibiting tumor angiogenesis, although there are toxicity concerns. This review examines the mechanistic basis and therapeutic rationale for targeting PRMTs in breast cancer and discusses combination approaches to overcome resistance. We integrate preclinical and emerging clinical data to highlight the potential antiangiogenic and tumor-suppressive effects of PRMT inhibitors, providing insights for future therapeutic strategies for breast cancer. HIGHLIGHTS • Dysregulated arginine methylation may drive aberrant angiogenic signaling pathways in breast cancer. • Arginine methylation controls endothelial cell functions via cytokines, growth factors, and related mediators. • Inhibiting arginine methylation may help counteract dysregulated angiogenic signaling in breast cancer.
Routine upper gastro-intestinal tract endoscopy before elective cholecystectomy for symptomatic gallstones-justified
(Nature Research, 2024-06-18) Morrison, Sherwyn; Mokoena, Taole; taole.mokoena@up.ac.za
Gallstones are common in Western countries and increasing in developing countries through adoption of western lifestyle. Gallstones may cause life-threatening complications, including acute cholecystitis, acute cholangitis, and acute pancreatitis. Cholecystectomy is the treatment of choice for symptomatic gallstones. Presentation of symptomatic gallstones may be indistinguishable from that of other upper gastro-intestinal tract (UGI) pathologies. Some surgeons routinely perform preoperative UGI endoscopy to diagnose and treat concomitant UGI pathology. A prospective cross-sectional observational study was undertaken at University of Pretoria teaching hospitals to evaluate this practice. Patients aged 18 years and older, with symptomatic gallstones but did not satisfy Tokyo guidelines for acute cholecystitis were recruited. UGI endoscopy was performed before cholecystectomy. There were 124 patients, 110 (88.7%) females and 14 (11.3%) males, mean age 44.0 (13.2) (range: 22–78) years. Most common symptoms were right upper quadrant (RUQ) pain (87%), epigastric pain (59.7%), nausea (58.1%) and vomiting (47.9%). Clinically, 80% had RUQ tenderness and 52.4% epigastric tenderness. UGI endoscopy found 35.4% pathology, 28.2% were active, and comprised acute gastritis (27.4%), peptic ulcers (4.8%), duodenitis (3.2%) and oesophagitis (2.4%). Twelve patients had more than one pathology. This warranted treatment before elective cholecystectomy and justifies the practice of routine preoperative UGI endoscopy.
Renal transplant recipient and deceased-donor risk profiles at Wits Donald Gordon Medical Centre, Johannesburg, South Africa
(South African Medical Association NPC, 2024-03) Van der Schyff, F.; Barnard, M.; Strobele, B.; De Jager, M.; Britz, Retha Margaretha; Gaylard, P.; Loveland, J.; De Jager, M.B.; Barnard, M.B.
BACKGROUND : Renal transplantation is the gold-standard therapy for end-stage renal disease. Decision-making around the acceptance of deceased-donor organs is complex and time sensitive. Risk scoring systems for both donors and recipients attempt to simplify the allocation of renal grafts to the most appropriate recipient. OBJECTIVES : To investigate the role of these transplant risk scores in the South African (SA) setting. METHODS : A total of 188 adult deceased-donor organ referrals over the 9-year period 1 January 2013 - 31 December 2021 were included. The Kidney Donor Risk Index (KDRI) and the UK KDRI were calculated for each donor. Recipients who were allocated these grafts were characterised, and the Hennepin Transplant Risk Score and the Kidney Transplant Morbidity Index (KTMI) were calculated. RESULTS : The median (interquartile range) KDRI was 1.2 (0.9 - 1.6), confirming that low- to average-risk donors were being utilised. Similarly, the median UK KDRI was 0.9 (0.8 - 1.2). Both these scores performed poorly in predicting graft and patient survival, with a C-statistic of 0.5. Renal recipient risk scores also demonstrated low- to average-risk patients being transplanted, with a median Hennepin score of 2 - 4 points and a KTMI of 2 points. These recipient scores predict increased recipient mortality at high scores, albeit with low sensitivity, and were not significantly associated with graft survival. CONCLUSION : Deceased-donor and renal recipient risk scores commonly used internationally performed poorly in predicting graft survival in our cohort, and should be used with caution in the SA setting. A conservative approach to organ donor referral and utilisation as well as renal transplant recipient listing was noted.
In Reply : Comment on real-time automated measurements of optic nerve sheath diameter for noninvasive assessment of intracranial pressure in aneurysmal subarachnoid hemorrhage
(Springer, 2025) Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Sorteberg, Angelika; Padayachy, Llewellyn; Helseth, Eirik; Brekken, Reidar
No abstract available.
Guidance for the gastrointestinal evaluation and management of iron deficiency in Sub-Saharan Africa
(South African Medical Association, 2024) Simmonds, W.M.; Awuku, Y.; Barrett, C.; Brand, Martin; Davidson, K.; Epstein, D.; Fredericks, E.; Gabriel, S.; Grobler, S.; Gounden, C.; Katsidzira, L.; Louw, V.J.; Naidoo, V.; Noel, C.; Ogutu, E.; Ramonate, N.; Seabi, N.; Setshedi, M.; Van Zyl, J.; Watermeyer, G.
BACKGROUND : Over 30% of the world’s population is anaemic, with a significant proportion of these being iron deficient. As iron deficiency (ID) anaemia in men and post-menopausal women is mostly caused by gastrointestinal blood loss or malabsorption, the initial evaluation of a patient with ID anaemia involves referral to a gastroenterologist. The current drive towards patient blood management in sub-Saharan Africa (SSA) prescribes that we regulate not only the use of blood transfusion but also the management of patients in whom the cause of iron loss or inadequate iron absorption is sought. Recommendations have been developed to: (i) aid clinicians in the evaluation of suspected gastrointestinal iron loss and iron malabsorption, and often a combination of these; (ii) improve clinical outcomes for patients with gastrointestinal causes of ID; (iii) provide current, evidence-based, context-specific recommendations for use in the management of ID; and (iv) conserve resources by ensuring rational utilisation of blood and blood products. METHOD : Development of the guidance document was facilitated by the Gastroenterology Foundation of Sub-Saharan Africa and the South African Gastroenterology Society. The consensus recommendations are based on a rigorous process involving 21 experts in gastroenterology and haematology in SSA. Following discussion of the scope and purpose of the guidance document among the experts, an initial review of the literature and existing guidelines was undertaken. Thereafter, draft recommendation statements were produced to fulfil the outlined purpose of the guidance document. These were reviewed in a round-table discussion and were subjected to two rounds of anonymised consensus voting by the full committee in an electronic Delphi exercise during 2022 using the online platform, Research Electronic Data Capture. Recommendations were modified by considering feedback from the previous round, and those reaching a consensus of over 80% were incorporated into the final document. Finally, 44 statements in the document were read and approved by all members of the working group. CONCLUSION : The recommendations incorporate six areas, namely: general recommendations and practice, Helicobacter pylori, coeliac disease, suspected small bowel bleeding, inflammatory bowel disease, and preoperative care. Implementation of the recommendations is aimed at various levels from individual practitioners to healthcare institutions, departments and regional, district, provincial and national platforms. It is intended that the recommendations spur the development of centre-specific guidelines and that they are integrated with the relevant patient blood management protocols. Integration of the recommendations is intended to promote optimal evaluation and management of patients with ID, regardless of the presence of anaemia.
Possible factors missed while assessing optic nerve sheath diameter and deformability index in patients with severe traumatic brain injury
(Springer, 2025-10) Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik; Brekken, Reidar
BACKGROUND : Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. METHODS : We prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. RESULTS : Forty-four ultrasound examinations were performed in 26 patients. Both DI (R = − 0.28; 95% confidence interval [CI] R < − 0.03; p = 0.03) and ONSD (R = 0.45; 95% CI R > 0.23; p < 0.01) correlated with ICP. When including both parameters in a combined model, the estimated correlation coefficient increased (R = 0.51; 95% CI R > 0.30; p < 0.01), compared to using ONSD alone, but the model improvement did not reach statistical significance (p = 0.09). Both DI (area under the curve [AUC] 0.69, 95% CI 0.53–0.83) and ONSD (AUC 0.72, 95% CI 0.56–0.86) displayed ability to distinguish ICP dichotomized at ICP ≥ 15 mm Hg. When using both parameters in a combined model, AUC increased (0.80, 95% CI 0.63–0.90), and the model improvement was statistically significant (p = 0.02). CONCLUSIONS : Combining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted.
In reply: Possible factors missed while assessing optic nerve sheath diameter and deformability index in patients with severe traumatic brain injury
(Springer, 2024-08) Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik; Brekken, Reidar
We would like to thank authors Kapoor and Prabhakar for their interest in our article and appreciate their insights in this regard. In their comment, three matters are brought to attention relating to preexisting glaucoma, intercurrent seizure activity, and units of deformability index (DI) measurements. In this study, we aimed to evaluate the diagnostic ability of the DI, alone and in combination with optic nerve sheath diameter (ONSD), in a general traumatic brain injury (TBI) population requiring neurointensive care.
In reply : Noninvasive assessment of intracranial pressure : deformability index as an adjunct to optic nerve sheath diameter to increase diagnostic ability
(Springer, 2024-08) Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik; Brekken, Reidar
No abstract available.
Insights into bloodstream infections in South African paediatric burn patients : implications for antimicrobial stewardship
(BioMed Central, 2025-03) Christie, Michael; Avenant, Theunis; Nembudani, Masindi; Mnqandi, Anelisa; Muller, Chris; De Villiers, Mariza; Bhikhoo, Zeenat; michael.christie@up.ac.za
INTRODUCTION : Bloodstream infections (BSIs) significantly contribute to the morbidity and mortality in paediatric burn patients from low- and middle-income countries; with common pathogens like Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa frequently being multidrug resistant (MDR). Due to the growing prevalence of MDR BSIs, antimicrobial stewardship needs to be improved with perhaps more targeted initial antimicrobial use. The study describes the aetiology, and timing of burn-associated BSIs and MDR infections in paediatric burn patients admitted to two paediatric surgery units in Tshwane District, South Africa. METHODS : This multi-centre retrospective review analysed paediatric burn patients (ages 0–12 years) admitted between January 2020 and December 2022 to two public hospitals in Tshwane District, South Africa. Collected data was from patient records and the National Health Laboratory System TrakCare database. BSIs were defined according to the CDC criteria. RESULTS : Of 245 burn patients admitted, 18.8% (n = 46) developed BSIs. From 63 positive blood cultures, the most common isolates were S. aureus (n = 19; 30%), Acinetobacter baumannii (n = 18; 29%), and P. aeruginosa (n = 10; 16%). Collectively, gram negative bacteria were responsible for most BSIs (n = 41; 65%). Candida spp accounted for 9% (n = 5). Thirty-five pathogens (56%) were MDR; this included methicillin-resistant S. aureus (MRSA) (n = 7; 11%), carbapenem-resistant A. baumannii (n = 16; 25%), and P. aeruginosa (n = 6; 10%). The median time to the first positive blood culture was 5 days (IQR: 3–12) (gram positive organisms: median: 5 days [IQR: 3–15}); gram negative organisms: median: 8 days [IQR: 4–20]; Fungal: median: 9 days [IQR: 8–27]; p-value 0.37). In the first week, S. aureus caused 32% of infections, including five MRSA cases. Gram negative bacteria dominated weeks two and three, with fungal and polymicrobial infections mainly in weeks two and four. CONCLUSION : Our findings show that as gram positive and gram negative infections predominantly occurred early in the admission period, while polymicrobial infections are more frequently observed later. Consequently, initial targeted narrow-spectrum antimicrobial use is not possible. Instead, antimicrobial de-escalation should be prioritized once culture results are available. Efforts should shift from a focus on treating BSIs to preventing them through wound care and infection control measures. Broad-spectrum antibiotics should be used judiciously and quickly de-escalated to minimise antimicrobial resistance development.
Role of intraoperative ultrasound and MRI to aid grade of resection of pediatric low-grade gliomas : accumulated experience from 4 centers
(Springer, 2024-10) Dietvorst, Sofie; Narayan, Armen; Agbor, Cyril; Hennigan, Dawn; Gorodezki, David; Bianchi, Federico; Mallucci, Conor; Frassanito, Paolo; Padayachy, Llewellyn; Schuhmann, Martin Ulrich
PURPOSE : Pediatric low-grade gliomas (pLGG) are the most common brain tumors in children and achieving complete resection (CR) in pLGG is the most important prognostic factor. There are multiple intraoperative tools to optimize the extent of resection (EOR). This article investigates and discusses the role of intraoperative ultrasound (iUS) and intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of pLGG. METHODS : The tumor registries at Tuebingen, Rome and Pretoria were searched for pLGG with the use of iUS and data on EOR. The tumor registries at Liverpool and Tuebingen were searched for pLGG with the use of iMRI where preoperative CR was the surgical intent. Different iUS and iMRI machines were used in the 4 centers. RESULTS : We included 111 operations which used iUS and 182 operations using iMRI. Both modalities facilitated intended CR in hemispheric supra- and infratentorial location in almost all cases. In more deep-seated tumor location like supratentorial midline tumors, iMRI has advantages over iUS to visualize residual tumor. Functional limitations limiting CR arising from eloquent involved or neighboring brain tissue apply to both modalities in the same way. In the long-term follow-up, both iUS and iMRI show that achieving a complete resection on intraoperative imaging significantly lowers recurrence of disease (chi-square test, p < 0.01). CONCLUSION : iUS and iMRI have specific pros and cons, but both have been proven to improve achieving CR in pLGG. Due to advances in image quality, cost- and time-efficiency, and efforts to improve the user interface, iUS has emerged as the most accessible surgical adjunct to date to aid and guide tumor resection. Since the EOR has the most important effect on long-term outcome and disease control of pLGG in most locations, we strongly recommend taking all possible efforts to use iUS in any surgery, independent of intended resection extent and iMRI if locally available.
HIV-helminth co-infections and immune checkpoints : implications for cancer risk in South Africa
(MDPI, 2025-03) Damane, Botle Precious; Mulaudzi, Thanyani Victor; Kader, Sayed Shakeel; Naidoo, Pragalathan; Dlamini, Zodwa; Mkhize-Kwitshana, Zilungile Lynette; zodwa.dlamini@up.ac.za
South Africa has the highest HIV prevalence globally, often co-occurring with helminth infections in impoverished regions. The coexistence of these infections leads to immunological interactions, potentially enhancing oncogenesis by upregulating immune checkpoint molecules (ICs) among other effects. Notably, most ICs are overexpressed in cancer and correlated with its progression. Helminth infections trigger Th2-type immunity, increasing immunosuppressive M2 macrophages, regulatory T cells, and associated IC molecules. PD-L2 is reported to contribute to Th2-type immunity induced by helminth infections. Similarly, TIM-3, elevated during chronic viral infections, induces a similar immunosuppressive profile. CTLA-4 and PD-1 impact T-cell function by interacting with CD28, crucial for T-cell function. CD28 is downregulated in chronic infections and cancer. This study investigated the impact of HIV-helminth co-infection on co-stimulatory and co-inhibitory molecule profiles associated with antitumor immunity. Using 78 serum samples collected from March 2020 to May 2021, participants were categorized into uninfected control (no HIV and helminth infections), HIV-infected, helminth-infected, and HIV-helminth co-infected groups. Multiplex immune regulatory molecule assay analysis was conducted. The data were analyzed using multivariate regression analysis and adjusted for confounders (age, gender, BMI, ART, supplements, and other chronic diseases). The uninfected control group was used as the baseline reference group for analysis. HIV-infected individuals had higher PD-1 (adjusted β = 0.12, p = 0.034) and TIM-3 (adjusted β = 23.15, p = 0.052) levels, with the latter showing a trend toward significance. However, lower CD28 levels (adjusted β = −651.95, p = 0.010) were observed. Helminth-infected individuals had higher TIM-3 levels (adjusted β = 20.98, p = 0.020). The co-infected group had higher PD-1 (unadjusted β = 0.18, p = 0.0046) and PD-L2 (adjusted β = 7.95, p = 0.033) levels. A significant decrease in CD28 profile was observed across all infected groups: HIV-infected (adjusted β = −651.95, p = 0.010), helminth-infected (adjusted β = −674.32, p = 0.001), and co-infected (adjusted β = −671.55, p = 0.044). The results suggest that HIV-helminth co-infections alter immune checkpoint markers, potentially increasing cancer risk by promoting an immunosuppressive microenvironment that hinders anti-cancer immunity. CD28’s downregulation underscores immune inefficiency in chronic diseases. Addressing these co-infections is crucial for improving HIV care and potentially reducing cancer risks through targeted strategies.
Exosomal long non-coding RNAs in cancer : interplay, modulation, and therapeutic avenues
(KeAi Communications Co., 2024-09) Marima, Rahaba; Basera, Afra; Miya, Thabiso Victor; Damane, Botle Precious; Kandhavelu, Jeyalakshmi; Mirza, Sheefa; Penny, Clement; Dlamini, Zodwa; rahaba.marima@up.ac.za
In the intricate field of cancer biology, researchers are increasingly intrigued by the emerging role of exosomal long non-coding RNAs (lncRNAs) due to their multifaceted interactions, complex modulation mechanisms, and potential therapeutic applications. These exosomal lncRNAs, carried within extracellular vesicles, play a vital partin tumorigenesis and disease progression by facilitating communication networks between tumor cells and their local microenvironment, making them an ideal candidates for use in a liquid biopsy approach. However, exosomal lncRNAs remain an understudied area, especially in cancer biology. Therefore this review aims to comprehensively explore the dynamic interplay between exosomal lncRNAs and various cellular components, including interactions with tumor-stroma, immune modulation, and drug resistance mechanisms. Understanding the regulatory functions of exosomal lncRNAs in these processes can potentially unveil novel diagnostic markers and therapeutic targets for cancer. Additionally, the emergence of RNA-based therapeutics presents exciting opportunities for targeting exosomal lncRNAs, offering innovative strategies to combat cancer progression and improve treatment outcomes. Thus, this review provides insights into the current understanding of exosomal lncRNAs in cancer biology, highlighting their crucial roles, regulatory mechanisms, and the evolving landscape of therapeutic interventions. Furthermore, we have also discussed the advantage of exosomes as therapeutic carriers of lncRNAs for the development of personalized targeted therapy for cancer patients.
Noninvasive assessment of intracranial pressure : deformability index as an adjunct to optic nerve sheath diameter to increase diagnostic ability
(Springer, 2024-10) Netteland, Dag Ferner; Aarhus, Mads; Sandset, Else Charlotte; Padayachy, Llewellyn; Helseth, Eirik; Brekken, Reidar
BACKGROUND : Today, invasive intracranial pressure (ICP) measurement remains the standard, but its invasiveness limits availability. Here, we evaluate a novel ultrasound-based optic nerve sheath parameter called the deformability index (DI) and its ability to assess ICP noninvasively. Furthermore, we ask whether combining DI with optic nerve sheath diameter (ONSD), a more established parameter, results in increased diagnostic ability, as compared to using ONSD alone. METHODS : We prospectively included adult patients with traumatic brain injury with invasive ICP monitoring, which served as the reference measurement. Ultrasound images and videos of the optic nerve sheath were acquired. ONSD was measured at the bedside, whereas DI was calculated by semiautomated postprocessing of ultrasound videos. Correlations of ONSD and DI to ICP were explored, and a linear regression model combining ONSD and DI was compared to a linear regression model using ONSD alone. Ability of the noninvasive parameters to distinguish dichotomized ICP was evaluated using receiver operating characteristic curves, and a logistic regression model combining ONSD and DI was compared to a logistic regression model using ONSD alone. RESULTS : Forty-four ultrasound examinations were performed in 26 patients. Both DI (R = − 0.28; 95% confidence interval [CI] R < − 0.03; p = 0.03) and ONSD (R = 0.45; 95% CI R > 0.23; p < 0.01) correlated with ICP. When including both parameters in a combined model, the estimated correlation coefficient increased (R = 0.51; 95% CI R > 0.30; p < 0.01), compared to using ONSD alone, but the model improvement did not reach statistical significance (p = 0.09). Both DI (area under the curve [AUC] 0.69, 95% CI 0.53–0.83) and ONSD (AUC 0.72, 95% CI 0.56–0.86) displayed ability to distinguish ICP dichotomized at ICP ≥ 15 mm Hg. When using both parameters in a combined model, AUC increased (0.80, 95% CI 0.63–0.90), and the model improvement was statistically significant (p = 0.02). CONCLUSIONS : Combining ONSD with DI holds the potential of increasing the ability of optic nerve sheath parameters in the noninvasive assessment of ICP, compared to using ONSD alone, and further study of DI is warranted.
From incidence to intervention : a comprehensive look at breast cancer in South Africa
(Springer, 2024-03) Dlamini, Zodwa; Molefi, Thulo; Khanyile, Richard; Mkhabele, Mahlori; Damane, Botle Precious; Kokoua, Alexandre; Bida, Meshack; Saini, Kamal S.; Chauke-Malinga, Nkhensani; Luvhengo, Thifhelimbilu Emmanuel; Hull, Rodney; zodwa.dlamini@up.ac.za
The formidable impact of breast cancer extends globally, with South Africa facing pronounced challenges, including significant disparities in breast cancer screening, treatment and survival along ethnic and socioeconomic lines. Over the last two decades, breast cancer incidence has increased and now accounts for a substantial portion of cancers in women. Ethnic disparities in terms of screening, incidence and survival exacerbate the issue, leading to delayed diagnosis among Black patients and highlighting healthcare inequities. These concerning trends underscore the urgency of enhancing breast cancer screening while mitigating treatment delays, although obstacles within the healthcare system impede progress. The intersection of breast cancer and human immunodeficiency virus (HIV) further complicates matters and particularly affects the Black population. Tackling the aforementioned disparities in breast cancer in South Africa mandates a multifaceted strategy. Robust screening efforts, particularly those targeting marginalised communities, are crucial for early detection. Concurrently, expedited treatment initiation is imperative. Addressing HIV-related complexities requires tailored interventions to ensure effective care. These multifaceted disparities require pan African research and cooperation as well as tailored interventions to enhance breast cancer care within the African region.
Advances in nano-delivery of phytochemicals for glioblastoma treatment
(SpringerOpen, 2024-12) Ambele, Melvin Anyasi; Maebele, Lorraine Tshegofatso; Mulaudzi, Thanyani Victor; Kungoane, Tsholofelo; Damane, Botle Precious; melvin.ambele@up.ac.za
Glioblastoma (GBM) is an aggressive brain tumor characterized by cellular and molecular diversity. This diversity presents significant challenges for treatment and leads to poor prognosis. Surgery remains the primary treatment of choice for GBMs, but it often results in tumor recurrence due to complex interactions between GBM cells and the peritumoral brain zone. Phytochemicals have shown promising anticancer activity in in-vitro studies and are being investigated as potential treatments for various cancers, including GBM. However, some phytochemicals have failed to translate their efficacy to pre-clinical studies due to limited penetration into the tumor microenvironment, leading to high toxicity. Thus, combining phytochemicals with nanotechnology has emerged as a promising alternative for treating GBM. This review explores the potential of utilizing specific nanoparticles to deliver known anticancer phytochemicals directly to tumor cells. This method has demonstrated potential in overcoming the challenges of the complex GBM microenvironment, including the tight blood–brain barrier while minimizing damage to healthy brain tissue. Therefore, employing this interdisciplinary approach holds significant promise for developing effective phyto-nanomedicines for GBM and improving patient outcomes.
Gastric perforation biopsy : is it obsolete?
(Springer, 2024-04-27) Steyn, Petre Francois; Karusseit, V.O.L. (Otto); otto.karusseit@up.ac.za
PURPOSE The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. METHODS A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated. RESULTS Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up. CONCLUSION This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.
The anatomical location of the great saphenous vein at the thigh and ankle : a neonatal cadaver study
(Spanish Association of Anatomy, 2024-03) Van Tonder, Daniel Johannes; Kathrada, Ahmad; Lokhandwala, Adnan; Van Niekerk, Martin Louis; Van Schoor, Albert-Neels
No abstract available.
Anatomical analysis of proximal tibia : selecting ideal sites for pediatric intraosseous infusion
(Spanish Association of Anatomy, 2024-07) Van Tonder, Daniel Johannes; Al Safadi, Layla; Samaha, Paula; Suleman, Farhana Ebrahim; Van Niekerk, Martin Louis; Van Schoor, Albert; Van Schoor, Albert-Neels
Intraosseous access is a safe and efficient method to administer medications to patients that require advanced life support when intravenous access is not easily available. This study aims to narrow down the ideal insertion site for intraosseous access within the proximal tibia in a pediatric population. The study utilized computed tomography scans that were retrospectively collected from scans of five infant patients between four weeks and two-years old, seven young children between two-years and six-years old, and ten children between six-years and twelve-years of age. Analysis of the computed tomography scans started at 10mm and extended to 50mm distally to the tibial tuberosity at 10mm increments. The smallest cortical thickness to medullary space ratio and most desirable cortical thickness to anteromedial border ratio across all three groups – infants, young children, and child – was identified as 10mm inferior to the tibial tuberosity. Meanwhile, the largest medullary space to anteromedial border ratio was at 10mm inferior to the tibial tuberosity for the infants and young child groups, and at 30mm for the child group. This study showed that, overall, the ideal needle insertion site to gain vascular access for an intraosseous infusion procedure in the proximal tibial in infants, young child, and children is 10mm distal to the tibial tuberosity.
The clinicopathological landscape of thyroid cancer in South Africa—a multi-institutional review
(Wiley, 2024-12) Conradie, Wilhelmina; Luvhengo, Thifhelimbilu E.; Lubbe, Jeanne Adele; Afrogheh, Amir H.; Bestbier, Aneldi; Bhuiyan, Mirza; Bombil, Ifongo; Cacala, Sharon Raye; Cairncross, Lydia; Changfoot, Chanel; Edge, Jenny; Jackson, Brandon Spencer; Jehle, Hansjorg S.; Jonas, Lusanda; Lukusa, Mpoyi Ruphin; Makgoka, Malose; Martin, Lindi; Nel, Daniel; Patel, Mohamed Quraish; Sishuba, Nosisa Thabile; Razack, Rubina; Baatjes, Karin
BACKGROUND : In South Africa (SA), data on the incidence of thyroid cancer is limited. Papillary thyroid carcinoma is by far the most common malignancy in developed countries; however, a preponderance of follicular thyroid cancer in developing countries, despite iodized salt, has been observed. The aim of this study was to describe the national landscape of thyroid cancer in SA with reference to pathological subtypes, surgical outcomes, and treatments offered. METHODS : A multi-institutional retrospective review of thyroid cancer patients operated on between January 2015 and December 2019 was performed. Public hospitals with associated academic institutions were included. Data were collected from theater registers, pathology, and radiology records. Statistical analysis was done to determine intergroup significance. RESULTS : A total of 464 thyroid cancer cases from 13 centers across five SA provinces were identified. Most patients presented with a mass (67%). Ultrasound was performed in 82% of patients, and 16.3% underwent surgery without pre-operative cytology. Of the histologically confirmed thyroid cancers, 61.8% were papillary and 22.1% follicular thyroid cancer. There was a significant association between subtype and geographical area, and T-stage and operation performed. Surgical complication rates included hematoma in 1.8%, post-operative hypocalcemia in 28.7%, and recurrent laryngeal nerve injury in 3.5%. CONCLUSION : This first national review describes the landscape of thyroid cancer in SA, revealing considerable differences compared to international studies. It provides valuable insight into the unique South African experience with this disease. In addition, this study serves as an impetus towards a prospective national registry with real-world data informing contextualized guidelines.

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