Cape Town Research Articles

Comparing gene expression profiles of adults with isolated spinal tuberculosis to disseminated spinal tuberculosis identified by 18FDG-PET/CT at time of diagnosis, 6- and 12-months follow-up: classifying clinical stages of spinal tuberculosis and monitoring treatment response (Spinal TB X cohort study)

BackgroundTuberculosis (TB) is one of the top ten causes of death worldwide, with approximately 10 million cases annually. Focus has been on pulmonary TB, while extrapulmonary TB (EPTB) has received little attention. Diagnosis of EPTB remains challenging due to the invasive procedures required for sample collection. Spinal TB (STB) accounts for 10% of EPTB and often leads to lifelong debilitating disease due to devastating spinal deformation and compression of neural structures. Little is known about the extent of disease, although both isolated STB and a disseminated form of STB have been described. In our Spinal TB X cohort study, we aim to describe the clinical phenotype of STB using whole-body 18FDG-PET/CT, identify a specific gene expression profile for different stages of dissemination and compare findings to previously described gene expression signatures for latent and active pulmonary TB.MethodsA single-centre, prospective cohort study will be established to describe the distributional pattern of STB detected by whole-body 18FDG-PET/CT and gene expression profile of patients with suspected STB on magnetic resonance imaging (MRI) at point of diagnosis, six months, and 12 months. Blood biobanking will be performed at these time points. Specimens for microbiology will be obtained from sputum/urine, from easily accessible sites of disease (e.g., lymph nodes, abscess) identified in the first 18FDG-PET/CT, from CT-guided biopsy and/or surgery. Clinical parameters and functional scores will be collected at every physical visit. Data will be entered into RedCap® database; data cleaning, validation and analysis will be performed by the study team. The University of Cape Town Ethics Committee approved the protocol (243/2022).DiscussionThe Spinal TB X cohort study is the first prospective cohort study using whole-body 18FDG-PET/CT scans in patients with microbiologically confirmed spinal tuberculosis. Dual imaging techniques of the spine using 18FDG-PET/CT and magnetic resonance imaging as well as tissue diagnosis (microbiology and histopathology) will allow us to develop a virtual biopsy model. If successful, a distinct gene-expression profile will aid in blood-based diagnosis (point of care testing) as well as treatment monitoring and would lead to earlier diagnosis of this devastating disease.Trial registration: The study has been registered on ClinicalTrials.gov (NCT05610098).

What does a just transition mean for urban biodiversity? Insights from three cities globally

Just transitions – responses to environmental change that minimise negative impacts on the most affected people and places, while ensuring nobody is left behind – are gaining scholarly and policy significance in areas beyond their original focus on carbon-intensive jobs and sectors. Yet attention to what a just transition means for biodiversity, as another aspect of the global environmental crisis, remains limited. Given the critical role that biodiversity plays in supporting livelihoods and wellbeing, this is a notable gap. This paper assesses what a just transition means for biodiversity, focusing on urban environments as the spaces in which many people encounter biodiversity globally. We undertake interview research across three case study cities representing different geopolitical and environmental contexts: Bristol (UK); Yubari (Japan); and Cape Town (South Africa) and ask two questions: what does biodiversity tell us about the concept of just transitions in the lived environment; and what are the consequences of considering just transitions in the context of biodiversity in the lived urban environment? Based on our findings, we set out six principles for a just transition in relation to urban biodiversity, as areas for further empirical enquiry: a shared sense of what a just transition and biodiversity mean in the local context; diverse social and ecological knowledge systems informing decision-making; integration and cohesion across policies; inclusive, meaningful and early engagement; supporting communities during and after implementation; and measures for assessing the effectiveness of outcomes from an ecological and a social perspective.

Investigating the standard design and production procedure of heritage mortars for compatible and durable masonry restoration

Historic buildings ensure generational knowledge of past events, milestones, construction developments and evolution of materials, architectural designs, and practices throughout the centuries. It is indisputable that heritage buildings' survival against deterioration factors has proven the use of durable materials for their construction. However, they suffer inevitable decay due to ageing. Therefore, restoring the monuments to their original appearance and strength is always necessary for long-term survival. This paper discusses solutions for the design and development methods of new compatible restoration mortars for the architectural heritage, covering four significant aspects, namely: i) visual analysis of the heritage building in question, ii) experimental analysis of the original mortar samples for their physical, mineralogical and chemical properties, iii) characterization of the potential raw materials (available in the study area) that are close to the original, and iv) assessment of the new mortar durability. The mortars collected from the Castle of Good Hope, an important and ancient colonial edifice in the Western Cape Province (South Africa), were earth (samples SK7 to SK9) and hydraulic lime-based (SK1 to SK6), with 21–38 % porosity. The raw materials used on this monument include feldspar aggregates, possibly from the West Coast (Cape Town) and hydraulic lime for SK1, SK3 and SK5 mortars. For the restoration of the lime mortars (SK1, SK3 and, SK5), a hydrated lime-based mortar with a binder-to-aggregate ratio of 1:3, made of west coast sea sand and 5 % seashell additives, with a porosity of 24 %, has proved to be the most durable. The aesthetics for all the restoration mortars M1 to M9 is difficult to achieve considering the original material ageing factor, thus, the use of color-enhancing pigments is recommended.

Ongoing Implementation and Prospective Validation of Artificial Intelligence/Machine Learning Tools at an African Drug Discovery Center.

Artificial intelligence (AI) and machine learning (ML) are anticipated to accelerate drug discovery programs. Following our development of an end-to-end virtual screening cascade at the University of Cape Town (UCT) Holistic Drug Discovery and Development (H3D) Center, we report the ongoing implementation of open-source AI/ML tools for use in resource-constrained settings.

Understanding the impacts of the COVID-19 response measures on Deaf adults in Cape Town.

International literature has evidenced that Deaf people have been disadvantaged during the COVID-19 pandemic; however, there is currently little research published within the South African context. This study investigated the ways in which the COVID-19 pandemic and its consequent response measures impacted Deaf adults in Cape Town. Using a descriptive approach, semi-structured, qualitative interviews were held with 15 Deaf adults in Cape Town, South Africa. Participants were purposively selected through a local Deaf organisation. Data were analysed using thematic analysis. Data revealed the challenges experienced when accessing information, the impact of communication barriers on daily life, and how the response measures impacted access to healthcare. The findings of this study demonstrate how the needs of the Deaf community were overlooked and their voices disregarded during the planning of the national pandemic response, ultimately having detrimental consequences. Therefore, the authors argue for greater inclusion of Deaf representatives to ensure equal access to information and resources, especially during a crisis. This study contributes to the growing body of knowledge on the consequences of the COVID-19 pandemic in the field of disability and insights can inform both future research and interventions to promote equity and inclusion for Deaf people.

Adoption and desirable characteristics of Information and Communication Technologies for urban small-scale food producers in South Africa

Small-scale food producers can benefit significantly from the adoption and effective utilization of Information and Communication Technologies (ICTs). For example, ICTs can help improve food production and access to markets, which is particularly valuable in many Sub-Saharan African countries that both urbanize rapidly but whose food systems still rely significantly on small-scale food producers. This study examines the adoption patterns and desirable characteristics of ICTs, as well as the factors influencing them, among small-scale food producers engaged in urban agriculture in South Africa. We administered 85 in-person surveys through referrals from local producers’ network in disadvantaged areas of Cape Town (n = 21; Gugulethu, Philippi, Khayelitsha) and Johannesburg (n = 64; Central Business District, Soweto, Orange Farm). A substantial proportion of the respondents articulated the need for food-related mobile applications with functions that facilitate price comparisons, and the sharing of best practices and health advice. User-friendliness, low internet data use, and affordability were perceived as the most important characteristics for such food-related mobile applications. Redundancy analysis (RDA) reveals that the socioeconomic and demographic characteristics of respondents significantly influence the desired functionalities of food apps and their preferred activities among the respondents. Producers that are married and have more children, have higher income and education, and own larger land holdings, show very distinct patterns in terms of desirable functions and uses for food apps. Our research underscores the need for comprehensive approaches to the development and promotion of food-related ICTs when targeting small-scale food producers. The barriers and needs identified here can help ICT developers, development agencies and policy-makers design fit-for-purpose interventions and policies to facilitate ICT adoption among urban small-scale food producers in rapidly urbanizing areas.

Finding Home: An Exploration of South African Art Music through the Classical Saxophone and Collaborative Practice

This research project explores South African Art Music through collaborative practice and the classical saxophone. It begins by investigating the discourse surrounding South African Art Music through testimony collected from various conversations with South African composers, musicians and academics such as Dr Kevin Volans, Dr Antoni Schonken, Professor Hendrik Hofmeyr, Dr Cara Stacey and Arthur Feder. I began collecting the scores of South African saxophone compositions which led to the development of an online catalogue system to document these works -The South African Saxophone Catalogue. This catalogue forms the base - as well as the network - for how this research was developed. To further investigate the South African repertoire, I embarked on creative journeys with four South African composers through performer-composer collaboration. I decided to use this means of investigation as the relationship formed between myself and these composers shows a different level of engagement with this music, first-hand experience in the creation of this music as well as creating an open space for discourse. These collaborations were documented through reflections, audio and video recordings and are investigated in the form of case studies. The final artistic product was a concert featuring these new compositions in Cape Town, South Africa. The data collected was organised through an amalgamation of critical reflection and thematic analysis. Through this collective music-making, I discovered the variety in thought surrounding South African Art Music and paradoxically those who vigorously deny this term. I discovered the complexity both politically and socially that the term South African Art Music implies. In conjunction with my personal reflections, this exposition explores the ideas, opinions and art of individuals in various fields in the South African classical music scene who represent a variety of South African cultural backgrounds and generations.

LGG-42. TWENTY YEARS OF PROGRESS IN MANAGING LOW GRADE GLIOMA: THE EXPERIENCE OF THE UNIVERSITY OF CAPE TOWN’S COMBINED PAEDIATRIC NEURO-ONCOLOGY SERVICE FROM 2001 TO 2022

Abstract BACKGROUND This study aimed to review the management of childhood low grade gliomas (WHO I and II) by the University of Cape Town’s combined neuro-oncology service at Red Cross War Memorial Children’s and Groote Schuur Hospitals. METHODS All patients diagnosed with low grade glioma between 2001 and 2022 were included in this retrospective study. Real time decision-making during the study period was achieved via a weekly neuroimaging meeting, and surveillance by a combined monthly clinic attended by paediatric endocrinology and educational psychology. Despite state of the art surgical and radiotherapy facilities, molecular diagnostics, monoclonal antibodies and small molecules were only available to selected patients. RESULTS Among 129 children, aged 0.38 to 14.58 years [median 5.36], six had Tuberous Sclerosis and 11 had Neurofibromatosis-1. The commonest sites were cerebellum (26%), hypothalamus (17%) and optic pathway (16%), and 12 patients (9%) had metastatic disease, mostly grade I supratentorial tumours. Twenty-three patients were diagnosed on imaging without histology, six of whom were biopsied subsequently, yielding a total of 96 grade I and 16 grade II tumours. Initial management was expectant in 16% (including 8 of the 11 Nf-1 tumours), surgery in the form of debulking or total resection in 53%, chemotherapy in 24% and radiotherapy in 8%. Ultimately 36% received chemotherapy and 29% radiotherapy (almost all of them focal RT), and only 16% of those treated with radiotherapy progressed. Estimated 5-year Overall Survival (OS) and Progression Free Survival (PFS) was 90.5% and 52.6% for the whole group. Patients treated with chemotherapy had an OS of 87.2% and a PFS of 39.2%. PFS and OS were inferior for metastatic disease but not for grade II tumours. CONCLUSIONS Low grade glioma can be managed effectively in a middle-income country setting. Multidisciplinary team management is crucial to achieving positive outcomes regardless of context.

Linda-Gail Bekker: Mentorship is critical for anyone in STEM.

Linda-Gail Bekker is a professor, chief executive officer of the Desmond Tutu HIV Foundation, and director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. Her research interests include HIV treatment and prevention and tuberculosis, and she is active in developing community projects to promote education and research. We talked to Linda-Gail about her career, the importance of mentorship, and how rewarding it is to collaborate, mentor, and uplift other scientists.

Using cloud computing techniques to map the geographic extent of informal settlements in the greater Cape Town Metropolitan Area

Although remote sensing approaches offer unprecedented opportunities to understand urban land cover dynamics including informal settlements areal extent, challenges such as spectral confusions still persist, particularly when segregating land cover types like informal settlements from planned formal settlements. The improvements in Earth Observation (EO) data analytic tools such as introduction of Google Earth Engine (GEE) cloud computing platform, provide prospects to improve separability of these settlements from other urban land cover classes, via their advanced data processing and filtering algorithm, which allows for the synergic use of multisource and multi-temporal data, thus improving detection and monitoring of these settlements. This study harnessed the advance data analytic powers of GEE cloud computing platform coupled with higher resolution Sentinel-2 data to map the geographical extent of informal settlement in the Cape Town Metropolitan Area. The classification yielded six land cover classes: formal settlements, informal settlements, water, bare or built-up areas, vegetated lands, and croplands. Built-up formal settlement was the most dominant class, accounting for 70% of the total Cape Town surface area, while open water was the least dominant, accounting for 2%. Informal settlements accounted for approximately 7% of all settlements. Although overall accuracy was within acceptable limits (68%), some classes, such as vegetated lands and formal settlements, reported low class accuracies due to spectral similarities with other classes. The findings highlight the importance of the GEE platform, as well as the interaction of contextual and spectral characteristics, as well as various sentinel-2 derived water, built up, and vegetation indices in mapping informal settlements. These findings are critical for the facilitation of improved urban planning, provision of services and assisting in alleviating social as well as environmental issues within the Cape Town Metropolitan area.

An incentive-based text-messaging intervention to reduce maternal alcohol use during pregnancy and lactation in South Africa (MaRISA study): Findings from a single-arm pilot study.

South Africa has the highest rate of fetal alcohol spectrum disorders (FASD) globally. As with alcohol use during pregnancy, alcohol consumption while breastfeeding adversely impacts infant development. We pilot tested an incentive-based text-messaging intervention to reduce alcohol use during pregnancy and lactation in South Africa. A single-arm pilot trial was conducted over 3 months in healthcare facilities in Cape Town, South Africa. Pregnant and breastfeeding participants tested positive for recent alcohol use by urinalysis. The three-month intervention had two components, contingency management of alcohol abstinence confirmed by urinalysis twice weekly and weekly health-related text messaging from an evidence-based brief intervention. We collected twice weekly urine samples for measurement of ethyl glucuronide (EtG), an alcohol biomarker, and measures of self-reported alcohol and drug use, violence exposure, and mental health at six weeks and three months post-enrollment. Sixty participants were enrolled, of whom 31 were pregnant and 29 lactating. The number of days with four or more drinks in the past month decreased from 9 days at baseline, on average, to 1-3 days (p-value range: 0.144-0.010) at follow-up timepoints. There were statistically significant increases in the proportions of participants with alcohol-negative urine tests (p < 0.001). The percentages of participants breastfeeding while using alcohol decreased from baseline to the end of 3 months in the overall sample and among those enrolled postpartum, though these were not significant (p-value range: 0.255-0.147). Maternal depression scores also decreased among participants enrolled postpartum (p = 0.054). Emotional abuse by the main partner, but neither physical nor sexual abuse, significantly decreased at both follow-ups in the overall sample (p = 0.032) and among participants enrolled while pregnant (p = 0.015). This study is among the first to pilot test an incentive-based text-messaging intervention for maternal alcohol use and other outcomes such as depression and violence exposure. Further testing is warranted in a well-powered, randomized controlled trial.

Universities and Artificial Intelligence

The general objective of the research was to determine the advances related to the universities and artificial intelligence. The specific objectives of the research are to identify the universities that invest the most in artificial intelligence and the best global universities for artificial intelligence. Methodology, in this research, 42 documents have been selected, carried out in the period 2018 – 2024; including: scientific articles, review articles and information from websites of recognized organizations. Results, AI is becoming increasingly important in all areas of human activity, which is why standards are being established for its proper use. Education is an important aspect in the development of people, which is why it must be invested at an international level. Innovation is very important for any type of organization and especially for universities. Conclusions, artificial intelligence is gaining more followers in university higher education, due to its important contribution. In addition, some principles have been formulated to guide its development. The top global university is the MIT – Massachusetts Institute of Technology (The United States of America); the top university in Latin America and the Caribbean is the Universidade de São Paulo (Brazil); the top university in Europe is the University of Oxford (United Kingdom); the best university in Asia is the Tsinghua University (China); the top university in Africa is the University of Cape Town (South Africa); the top university in Oceania is the University of Melbourne (Australia). The university that invests the most in artificial intelligence was Johns Hopkins University. The best global universities for artificial intelligence were Tsinghua University, Nanyang Technological University, Chinese University of Hong Kong, Stanford University, University of California – Berkeley and Massachusetts Institute of Technology.

Tourism resilience to drought and climate shocks: The role of tourist water literacy in hotel management

The large water demands of tourism threaten the sector's economic viability during climate shocks. Cape Town, South Africa provides an example where the threat of a water “Day Zero” in 2018 caused substantial losses in tourist arrivals, revenues, and subsequent job securities. However, Cape Town's tourism industry also contributed to unprecedented water conservation across the city. Through qualitative analysis of semi-structured interviews with hotel employees in Cape Town (n = 18), this paper reveals how internal conservation campaigns not only reduced water use, but also helped mitigate economic impacts, eased political tensions, and upheld their excellent standing among visitors. Our results suggest that during severe water crises, hotel managers can model and enforce water conservation efforts while maintaining customer satisfaction.

‘I haven’t gotten my head around that.’: cisheterosexual school-attending youths’ accounts of how cisheteronormativity features in their sexuality education curriculum.‘

ABSTRACT Comprehensive Sexuality Education is vital in educating youth about gender and sexuality diversity, and yet there has been a growing debate about including LGBTIQ+ content. Using focus group interviews with 11 cisheterosexual school-attending youth in Cape Town, South Africa, this article considers their accounts of whether and how cisheteronormativity features in their sexuality education curriculum. The participants’ responses are a mixed bag, indicating that while they appear to support their LGBTIQ+ peers and an inclusive sexuality education curriculum, there is little recognition of how cisgender and heterosexual privilege features in schooling. The paper concludes that cisheteronormative structures, discourses, and practices have deep roots that mediate and continue to shape the teaching and learning of sexuality education, ensuring that schools remain as normative spaces that enable just straight bodies to extend into them.

Wellbeing, infrastructures, and energy insecurity in informal settlements

IntroductionUnderstanding the intricate relationship between energy and wellbeing in informal urban settlements is essential for developing effective interventions that address the diverse needs of residents. This paper explores this nexus through a multi-dimensional lens, examining the complexities and dynamics involved in off-grid renewable energy interventions, focusing on solar microgrids in an informal settlement in Cape Town, South Africa.MethodsThe paper is based on empirical research analysed through a theoretical framework articulating the pathways through which energy insecurity influences various dimensions of wellbeing, encompassing economic, physical, social, and environmental aspects. By applying this framework to our empirical research, the paper reveals the intricate interplay between neighbourhood factors, housing conditions, social processes, and economic insecurities, shedding light on both the challenges and opportunities associated with off-grid energy interventions.ResultsThe understanding of wellbeing presented in the paper is based on what we term the energy-wellbeing-informality nexus. Understanding the nexus necessitates: (a) moving past universalist and technocratic understandings of wellbeing, and towards a relational and networked basis for wellbeing analysis; (b) moving beyond conventional narratives of off-grid electrification as mere technical fixes, emphasizing the importance of recognizing informal settlements as sites of innovation and experimentation; (c) understanding the multi-sectoral nature of energy-related wellbeing impacts, extending beyond energy provision to encompass broader dimensions such as education, health, and social cohesion.DiscussionThe paper not only advances theoretical understanding but also offers practical insights for policymakers and practitioners. It emphasizes the need for context-sensitive policymaking that acknowledges the complexities of informal settlements and fosters innovative approaches to energy service provision. By integrating energy interventions into broader development strategies and adopting a multi-sectoral perspective, stakeholders can work towards more equitable and resilient solutions that enhance the overall wellbeing of residents in informal urban contexts.

Comparison of machine learning and statistical approaches for Digital Elevation Model (DEM) correction: interim results

Abstract. The correction of digital elevation models (DEMs) can be achieved using a variety of techniques. Machine learning and statistical methods are broadly applicable to a variety of DEM correction case studies in different landscapes. However, a literature survey did not reveal any research that compared the effectiveness or performance of both methods. In this study, we comparatively evaluate three gradient boosted decision trees (XGBoost, LightGBM and CatBoost) and multiple linear regression for the correction of two publicly available global DEMs: Copernicus GLO-30 and ALOS World 3D (AW3D) in Cape Town, South Africa. The training datasets are comprised of eleven predictor variables including elevation, slope, aspect, surface roughness, topographic position index, terrain ruggedness index, terrain surface texture, vector ruggedness measure, percentage bare ground, urban footprints and percentage forest cover as an indicator of the overland forest distribution. The target variable (elevation error) was derived with respect to highly accurate airborne LiDAR. The results presented in this study represent urban/industrial and grassland/shrubland/dense bush landscapes. Although the accuracy of the original DEMs had been degraded by several anomalies, the corrections improved the vertical accuracy across vast areas of the landscape. In the urban/industrial and grassland/shrubland landscapes, the reduction in the root mean square error (RMSE) of the original AW3D DEM was greater than 70%, after correction. The corrections improved the accuracy of Copernicus DEM, e.g., &gt; 44% RMSE reduction in the urban area and &gt;32% RMSE reduction in the grassland/shrubland landscape. Generally, the gradient boosted decision trees outperformed multiple linear regression in most of the tests.

A Retrospective Study Evaluating Neonatal Vancomycin Loading Doses to Achieve a Therapeutic Target

Background: Vancomycin is a glycopeptide antibiotic that has been used to treat hospital-acquired gram-positive infections for more than 5 decades. However, the literature is divided regarding the therapeutic advantages of vancomycin loading doses in neonates. Objectives: This study aimed to investigate the effect of vancomycin loading doses on therapeutic target attainment in neonates with sepsis. Methods: A retrospective cohort study was conducted to compare the vancomycin target attainment (area under the curve 0–24 hours/minimum inhibitory concentration ≥400) in neonates before and after the 2019 change in vancomycin prescription guidelines at a neonatal unit in Cape Town, South Africa. As the standard of care, Bayesian modelling software was used to compute the area under the curve from the trough concentrations. Results: Two hundred ten neonates were included. Multivariate regression analysis showed a 2-fold increase in the odds of target attainment among neonates receiving a loading dose of vancomycin. Early target attainment (within 8–12 hours of treatment initiation) was significantly higher in the loading dose group compared with the no loading dose group [97/105 (92.4%) versus 64/105 (61.0%); P &lt; 0.001]. However, the overall proportion of neonates achieving target attainment at 24 hours was similar between groups [73/105 (69.5%) in the loading dose group versus 62/105 (59.0%) in the no loading dose group; P = 0.110]. The nephrotoxicity rates were low [2/105 (1.9%) in the loading dose group and 2/105 (1.9%) in the no loading dose group]. Conclusions: The addition of a vancomycin loading dose to neonates may facilitate early therapeutic target attainment.

Performance analysis of Bayesian optimised gradient-boosted decision trees for digital elevation model (DEM) error correction: interim results

Abstract. Gradient-Boosted Decision Trees (GBDTs), particularly when tuned with Bayesian optimisation, are powerful machine learning techniques known for their effectiveness in handling complex, non-linear data. However, the performance of these models can be significantly influenced by the characteristics of the terrain being analysed. In this study, we assess the performance of three Bayesian-optimised GBDTs (XGBoost, LightGBM and CatBoost) using digital elevation model (DEM) error correction as a case study. The performance of the models is investigated across five landscapes in Cape Town South Africa: urban/industrial, agricultural, mountain, peninsula and grassland/shrubland. The models were trained using a selection of datasets (elevation, terrain parameters and land cover). The comparison entailed an analysis of the model execution times, regression error metrics, and level of improvement in the corrected DEMs. Generally, the optimised models performed considerably well and demonstrated excellent predictive capability. CatBoost emerged with the best results in the level of improvement recorded in the corrected DEMs, while LightGBM was the fastest of all models in the execution time for Bayesian optimisation and model training. These findings offer valuable insights for applying machine learning and hyperparameter tuning in remote sensing.

Dyslipidaemia in women with polycystic ovary syndrome referred to a teaching hospital in Cape Town, South Africa.

The polycystic ovary syndrome (PCOS) imparts health risks including dyslipidaemia, diabetes and cardiovascular disease that are amenable to lifestyle adjustment and/or medication. We describe dyslipidaemia in women referred to a gynaecological endocrine clinic. Clinical data and endocrine and lipoprotein investigations comprising fasting triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDLC) and calculated low density lipoprotein cholesterol (LDLC) were studied along with electrophoresis patterns of apolipoprotein B-containing lipoproteins. The 1721 participants comprised black, mixed ancestry, white and Indian individuals (9.8%, 83.2%, 5.8% and 1.2%, respectively). The mean ± standard deviation of the age, body mass index (BMI) and waist/hip ratio were 26.0 ± 5.9 years, 32.3 ± 8.3 kg/m2 and waist/hip ratio 0.88 ± 0.11, respectively. Overweight status (BMI 26-30 kg/m2) and obesity (BMI >30 kg/m2) involved 272 (15.8%) and 1010 (58.7%) individuals, respectively. Morbid obesity (BMI >40 kg/m2) was present in 309 (17.9%) individuals. The TG, TC, HDLC and LDLC concentrations were 1.22 ± 0.86, 4.77 ± 1.02, 1.3 ± 0.36, 2.94 ± 0.94 mmol/L, respectively. LDL hypercholesterolaemia occurred in 753 (43.7%) and exceeded 5 mmol/L in 39 (2.3%) women. Low HDLC (<0.9 mmol/L) affected 122 (7%), hypertriglyceridaemia (>1.7 mmol/L) affected 265 (15.4%) and exceeded 2.5 mmol/L in 91 (5.3%) women. Mixed hyperlipidaemia (TG >1.7, TC >5.0 mmol/L) occurred in 176 (10.2%). Electrophoresis revealed small LDL particles in 79 (4.6%) and dysbetalipoproteinaemia in 13 (0.76%) of the cohort. Small LDL associated with obesity, blood pressure, TG and glucose concentration and higher androgenic state. Many women with PCOS had unfavourable lipoprotein results: mostly moderate changes in TG, HDLC and LDLC. Small LDL is not rare, may aid risk assessment and is best determined directly. Incidental monogenic disorders of lipoprotein metabolism included dysbetalipoproteinaemia, familial hypercholesterolaemia and severe hypertriglyceridaemia. Dyslipidaemia in PCOS requires more careful diagnosis, individualised management and research.

Making a Difference: 5 Years of Cardiac Surgery Intersociety Alliance (CSIA)

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing "Cape Town Declaration" constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of "assisting only." In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its "Seal of Approval" for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.