173 research outputs found
Writing women in solitary: shifting narratives to make research count by Shanthini Naidoo
No full textAuthor Shanthini Naidoo reflects on her decision to change the focus of her Master’s dissertation in order to uncover the narratives of anti-apartheid women activists in South Africa. This research formed the basis of her recently published book Women in Solitary: Inside the Female Resistance to Apartheid, which focuses particularly on four women: Joyce Sikhakhane-Rankin, Shanthie Naidoo, Nondwe Mankahla and Rita Ndzanga. As the UK celebrates Black History Month in October, Naidoo reflects on the importance of uncovering stories that not only evidence bravery and courage, but also the power of love and friendship in daily life
Biological mechanisms underpinning the development of long COVID
No full text: As COVID-19 evolves from a pandemic to an endemic disease, the already staggering number of people that have been or will be infected with SARS-CoV-2 is only destined to increase, and the majority of humanity will be infected. It is well understood that COVID-19, like many other viral infections, leaves a significant fraction of the infected with prolonged consequences. Continued high number of SARS-CoV-2 infections, viral evolution with escape from post-infection and vaccinal immunity, and reinfections heighten the potential impact of Long COVID. Hence, the impact of COVID-19 on human health will be seen for years to come until more effective vaccines and pharmaceutical treatments become available. To that effect, it is imperative that the mechanisms underlying the clinical manifestations of Long COVID be elucidated. In this article, we provide an in-depth analysis of the evidence on several potential mechanisms of Long COVID and discuss their relevance to its pathogenesis
Book review: Women in solitary: inside the female resistance to apartheid by Shanthini Naidoo
No full textIn Women in Solitary: Inside the Female Resistance to Apartheid, Shanthini Naidoo offers a new account based around the narratives of four women – Joyce Sikhakhane-Rankin, Shanthie Naidoo, Rita Ndzanga and Nondwe Mankahla – who experienced detention and torture in South Africa in the late 1960s when the regime tried to stage a trial to convict leading anti-apartheid activists. This timely book not only accords the four women and others their place in the history of the struggle for freedom in South Africa, but also weaves their experiences into the historical development of the anti-apartheid movement, writes Tony Trew. If you are interested in this book review, you may also like to read an LSE RB essay by author Shanthini Naidoo on her decision to change the focus of her Master’s dissertation to uncover the narratives of anti-apartheid women activists in South Africa
TB epidemiology: where are the young women? Know your tuberculosis epidemic, know your response
No full textBackground
The global predominance of tuberculosis in men has received significant attention. However, epidemiological studies now demonstrate that there is an increased representation of young women with tuberculosis, especially in high HIV burden settings where young women bear a disproportionate burden of HIV. The role of the HIV epidemic, as well as changes in behavioural, biological, and structural risk factors are explored as potential explanations for the increasing burden of tuberculosis in young women.
Discussion
As young women are particularly vulnerable to HIV infection in sub-Saharan Africa, it is unsurprising that the TB epidemic in this setting has become increasingly feminised. This age-sex trend of TB in South Africa is similar to WHO estimates for other countries with a high HIV prevalence where there are more female than male cases notified up to the age of 25 years. The high prevalence of anaemia of chronic disease in young women with HIV is an additional potential reason for their increased TB risk. The widespread use of injectable medroxyprogesterone acetate contraception, which has been shown to possess selective glucocorticoid effect and oestrogen suppression, in young women may be an important emerging biological risk factor for tuberculosis in young women. Behavioural factors such as alcohol use and tobacco smoking patterns are further factors which may be responsible for the narrowing of the sex gap in TB epidemiology. In comparison to the significantly higher alcohol consumption rates in men globally, there is a narrowing gap in alcohol consumption between the sexes in South Africa with alarming rates of alcohol abuse in young women. There is a similar narrowing of the tobacco smoking gap between the sexes in South Africa, with increasing smoking prevalence in young women.
Conclusion
With nearly 70% of all TB patients being co-infected with HIV in our setting, it is not surprising that the age and sex distribution of TB is increasingly resembling the distribution of HIV in this region of dual hyperendemicity. New TB service design must begin to reflect the presence of young women as a significant group burdened by the disease
Long COVID: a review and proposed visualization of the complexity of long COVID
No full text: Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2) infection, or Long COVID, is a prevailing second pandemic with nearly 100 million affected individuals globally and counting. We propose a visual description of the complexity of Long COVID and its pathogenesis that can be used by researchers, clinicians, and public health officials to guide the global effort toward an improved understanding of Long COVID and the eventual mechanism-based provision of care to afflicted patients. The proposed visualization or framework for Long COVID should be an evidence-based, dynamic, modular, and systems-level approach to the condition. Furthermore, with further research such a framework could establish the strength of the relationships between pre-existing conditions (or risk factors), biological mechanisms, and resulting clinical phenotypes and outcomes of Long COVID. Notwithstanding the significant contribution that disparities in access to care and social determinants of health have on outcomes and disease course of long COVID, our model focuses primarily on biological mechanisms. Accordingly, the proposed visualization sets out to guide scientific, clinical, and public health efforts to better understand and abrogate the health burden imposed by long COVID
Risk of Nephrotoxicity in Patients With Drug-Resistant Tuberculosis Treated With Kanamycin/Capreomycin With or Without Concomitant Use of Tenofovir-Containing Antiretroviral Therapy
No full textBackground: The intersection of HIV and drug-resistant (DR) tuberculosis (TB) presents the challenge of managing convergent drug toxicities.
Methods: We conducted a retrospective study of adult patients with DR-TB treated with a kanamycin/capreomycin-based (KM) regimen, with or without concomitant antiretroviral therapy (ART). We estimated the incidence of nephrotoxicity (defined as an increase in serum creatinine greater than 26.5 µmol, or an increase in serum creatinine to 1.5 times the baseline value, or a decline in glomerular filtration rate to less than 60 mL/min/1.73 m), and evaluated the association between reported drug use and nephrotoxicity using Kaplan-Meier plots.
Results: A total of 215 patients with DR-TB were treated with a kanamycin/capreomycin-based regimen, with or without concomitant ART. The incidence rate of nephrotoxicity was 3.6 [95% confidence interval (CI): 1.4 to 7.3], 6.9 (95% CI: 5.2 to 9.0), and 12 (95% CI: 3.3 to 30.9) cases per 100 person-months of follow-up in the KM only group (n = 42), the KM + TDF (tenofovir disoproxil fumarate) group (n = 163), and the KM + Other ART group (n = 10), respectively. Using the KM only group as a reference, the hazard ratio was 2.06 (95% CI: 0.92 to 4.63) in the KM + TDF group, and 4.09 (95% CI: 1.17 to 14.25) in the KM + Other ART group. Advancing age was an independent predictor of nephrotoxicity (adjusted hazard ratio 1.29, 95% CI: 1.14 to 1.46).
Conclusions: Our findings provide evidence of a significant risk of nephrotoxicity during treatment with a kanamycin/capreomycin-based DR-TB regimen, with or without concurrent treatment with ART. This study lends further support to calls for the substitution of TDF during the intensive phase of DR-TB treatment and for close monitoring of renal function during DR-TB treatment, especially in settings where the use of kanamycin/capreomycin is unavoidable
Mycobacterium tuberculosis Intra-Host Evolution Among Drug-Resistant Tuberculosis Patients Failing Treatment
No full textRubeshan Perumal,1,2 Azraa Khan,1 Kogieleum Naidoo,1,2 Senamile L Ngema,1 Louansha Nandlal,1,2 Nesri Padayatchi,1,2 Navisha Dookie1,2 1Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, KwaZulu Natal, South Africa; 2South African Medical Research Council (SAMRC) – CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, KwaZulu Natal, South AfricaCorrespondence: Rubeshan Perumal, Doris Duke Medical Research Institute (2nd Floor), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, 4013, South Africa, Tel +27 31 260 4555, Fax +27 31 260 4566, Email [email protected]: Understanding Mycobacterium tuberculosis (Mtb) intra-host evolution of drug resistance is important for successful drug-resistant tuberculosis (DR-TB) treatment and control strategies. This study aimed to characterise the acquisition of genetic mutations and low-frequency variants associated with treatment-emergent Mtb drug resistance in longitudinally profiled clinical isolates from patients who experienced DR-TB treatment failure.Patients and Methods: We performed deep Whole Genome Sequencing on 23 clinical isolates obtained longitudinally across nine timepoints from five patients who experienced DR-TB treatment failure enrolled in the CAPRISA 020 InDEX study. The minimum inhibitory concentrations (MICs) were established on the BACTEC™ MGIT 960™ instrument on 15/23 longitudinal clinical isolates for eight anti-TB drugs (rifampicin, isoniazid, ethambutol, levofloxacin, moxifloxacin, linezolid, clofazimine, bedaquiline).Results: In total, 22 resistance associated mutations/variants were detected. We observed four treatment-emergent mutations in two out of the five patients. Emerging resistance to the fluoroquinolones was associated with 16- and 64-fold elevated levofloxacin (2– 8 mg/L) and moxifloxacin (1– 2 mg/L) MICs, respectively, resulting from the D94G/N and A90V variants in the gyrA gene. We identified two novel mutations associated with elevated bedaquiline MICs (> 66-fold): an emerging frameshift variant (D165) on the Rv0678 gene and R409Q variant on the Rv1979c gene present from baseline.Conclusion: Genotypic and phenotypic resistance to the fluoroquinolones and bedaquiline was acquired in two out of five patients who experienced DR-TB treatment failure. Deep sequencing of multiple longitudinal clinical isolates for resistance-associated mutations coupled with phenotypic MIC testing confirmed intra-host Mtb evolution.Keywords: tuberculosis, phenotypic resistance, drug resistance acquisition, whole genome sequencing, emerging mutations, bedaquilin
In Conversation with Beverley Naidoo: On Crossing Boundaries through Reading and Writing
No full textBorn into a white, middle-class family in Johannesburg, South Africa, children's author Beverley Naidoo grew up under the oppressive apartheid regime until the age of twenty-one. She has written a variety of children’s and young adult novels, picturebooks, collections of short stories, plays, and adult nonfiction. Her books have won many awards, including the Carnegie Medal for The Other Side of Truth, and she also published her PhD, called Through Whose Eyes? Exploring Racism, Reader Text and Context, which investigated the possibilities of challenging racism through reading in a school context. In this article Julia Hope, Head of the MA Children's Literature at Goldsmiths College, asks Beverley to talk about her own education, school themes that arise in her writing, her PhD, and wider perceptions of the educative power of literature
Experiencing the armed struggle : the Soweto generation and after
No full textIncludes bibliographical references (p. 354-369).This study explores the experiences of the rank-and-file soldiers of Umkhonto we Sizwe and the Azanian People's Liberation Anny. Extensive interviews by the author and other researchers reveal the voices of the soldiers themselves. The African National Congress and Pan African Congress archives at the University of the Western Cape and the University of Fort Hare supplement and verify these oral testimonies, as do some published sources. Most previously published materials about the armed struggle against apartheid have already focused on diplomacy, strategy and tactics, operations, leadership, and human rights abuses to the neglect of the soldiers' actual experiences. This study complements these with significant new oral history materials from the Soweto generation of soldiers and their successors. When dealing with MK, many authors have documented issues of the camp structure in Angola, and operations inside South Africa, so much of this detail is only addressed briefly, leaving space to explore the soldiers' experiences. In the case of APLA, very little has been written on its history, and more detail is provided on these subjects. This study therefore deals with the soldiers' politicisation and motivation for joining the armed struggle, their experiences in leaving South Africa and training in exile, the crises in exile which limited their effectiveness for a time, their return to fight in South Africa, and their difficulties in the "new" South Africa. These materials reveal that vast problems remain facing these veterans of the struggle against apartheid, and that they have the potential, if properly supported and employed, to contribute substantially to the development of present day South Africa. Conversely, if their neglect continues, they also have the potential to bring vast harm to the country. Further use of the investigative tools of oral history, especially if extended to the former soldiers' vernacular languages, is necessary to augment the history of South Africa, and these soldiers' contributions
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