A blended teaching and learning model for family-medicine registrar training at a South African university.

Effective primary healthcare is essential in developing countries but faces several challenges, including the lack of standardised training across decentralised sites. In response to unsatisfactory registrar examination outcomes in 2013, the Department of Family Medicine at the University of the Witwatersrand in South Africa introduced a blended teaching and learning programme. The aim of the new programme was to level the playing field by providing uniform online resources on a course site on the university's learning management system.

Changes in patient-reported outcomes during admission to a South African psychiatric facility.

Background: Patient-reported outcome measures (PROMs) are used as part of clinical practice to determine the impact of the condition and treatment interventions on a patient's health and quality of life. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered diagnostic tool that has been widely adopted for the detection and monitoring of depression.

Aim: This analysis reports the change in PHQ-9 scores from admission to discharge in patients admitted for depression to a South African acute psychiatric facility and aims to quantify the treatment effect of the admission using the PHQ-9 as the measurement tool.

An approach to persons who are not willing to engage in behavioural change.

With its unique position, primary health care (PHC) can provide health promotion and prevention services, including lifestyle behavioural counselling. Unhealthy lifestyle behaviours are very prevalent among patients attending PHC, with many patients unwilling to change or in the precontemplation stage. While patients in the contemplation stage are better managed using the 5As approach of motivational interviewing counselling, those unwilling or not ready for change necessitate a different approach, such as the 5Rs of motivational interviewing (MI) counselling.

Obese patients' dissatisfaction with weight, body image and clinicians' interaction at a district hospital; Gauteng.

Background: Obesity in South Africa has created a public health crisis that warrants a multilevel intervention. However, patients' perceptions and clinicians' challenges hinder the management of obesity in primary care.

Aim: The study aimed to assess obese patients' dissatisfaction with weight and body image and their perspectives on interaction with clinicians regarding obesity management in a primary care setting.

Compliance of medical practitioners with diabetic treatment guidelines in West Rand, Gauteng.

Background: Diabetes mellitus is increasing globally and is associated with multiple complications. Guidelines have been formulated to standardise care among people living with diabetes mellitus (DM), but research shows poor compliance with treatment guidelines. The aim of this study was to assess how well healthcare practitioners in a district hospital in Gauteng complied with the most recent diabetic treatment guideline, Society for Endocrinology Metabolism and Diabetes South Africa (SEMDSA) 2017.

Cardiac muscle patches containing four types of cardiac cells derived from human pluripotent stem cells improve recovery from cardiac injury in mice.

Aims: We have shown that human cardiac muscle patches (hCMPs) containing three different types of cardiac cells-cardiomyocytes (CMs), smooth muscle cells (SMCs), and endothelial cells (ECs), all of which were differentiated from human pluripotent stem cells (hPSCs)-significantly improved cardiac function, infarct size, and hypertrophy in a pig model of myocardial infarction (MI). However, hPSC-derived CMs (hPSC-CMs) are phenotypically immature, which may lead to arrhythmogenic concerns; thus, since hPSC-derived cardiac fibroblasts (hPSC-CFs) appear to enhance the maturity of hPSC-CMs, we compared hCMPs containing hPSC-CMs, -SMCs, -ECs, and -CFs (4TCC-hCMPs) with a second hCMP construct that lacked hPSC-CFs but was otherwise identical [hCMP containing hPSC-CMs, -AECs, and -SMCs (3TCC-hCMPs)].

Methods And Results: hCMPs were generated in a fibrin scaffold.

Alterations in heparan sulfate proteoglycan synthesis and sulfation and the impact on vascular endothelial function.

The glycocalyx attached to the apical surface of vascular endothelial cells is a rich network of proteoglycans, glycosaminoglycans, and glycoproteins with instrumental roles in vascular homeostasis. Given their molecular complexity and ability to interact with the intra- and extracellular environment, heparan sulfate proteoglycans uniquely contribute to the glycocalyx's role in regulating endothelial permeability, mechanosignaling, and ligand recognition by cognate cell surface receptors. Much attention has recently been devoted to the enzymatic shedding of heparan sulfate proteoglycans from the endothelial glycocalyx and its impact on vascular function.

"We Are Not Truly Friendly Faces": Primary Health Care Doctors' Reflections on Sexual History Taking in North West Province.

Introduction: Doctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction.

Aim: The aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses.

Methods: This qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa.

The Development of Normal Fetal External Genitalia Throughout Gestation.

In this review, we describe normal development of fetal genitalia throughout gestation as well as the identification of normal male and female genitalia on ultrasound. We use abnormal and ambiguous genitalia as illustrative tools to assist with the identification of normal genitalia and recognition of some of the most common abnormalities in external genitalia development.

A three-dimensional culture system for generating cardiac spheroids composed of cardiomyocytes, endothelial cells, smooth-muscle cells, and cardiac fibroblasts derived from human induced-pluripotent stem cells.

Cardiomyocytes (CMs), endothelial cells (ECs), smooth-muscle cells (SMCs), and cardiac fibroblasts (CFs) differentiated from human induced-pluripotent stem cells (hiPSCs) are the fundamental components of cell-based regenerative myocardial therapy and can be used as models for mechanistic studies and drug testing. However, newly differentiated hiPSC-CMs tend to more closely resemble fetal CMs than the mature CMs of adult hearts, and current techniques for improving CM maturation can be both complex and labor-intensive. Thus, the production of CMs for commercial and industrial applications will require more elementary methods for promoting CM maturity.

A study on willingness to take the COVID-19 vaccine at a tertiary institution community in Johannesburg, South Africa.

Background:  South Africa is aiming to achieve herd immunity against the coronavirus disease 2019 (COVID-19) by the first quarter of 2022. The success of the COVID-19 vaccination roll-out depends primarily on the willingness of the population to take the vaccines.

Aim:  This study aimed to examine the willingness to take the COVID-19 vaccine, along with the factors of concern, efficacy and preferences of the individual, which may increase the willingness to be vaccinated.

Perspectives on sexual history taking in routine primary care consultations in North West, South Africa: Disconnect between patients and doctors.

Background:  Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking.

Aim:  This study aimed to explore doctors' and patients' perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction.

Glycocalyx heparan sulfate cleavage promotes endothelial cell angiopoietin-2 expression by impairing shear stress-related AMPK/FoxO1 signaling.

Angiopoietin-2 (Ang-2) is a key mediator of vascular disease during sepsis, and elevated plasma levels of Ang-2 are associated with organ injury scores and poor clinical outcomes. We have previously observed that biomarkers of endothelial glycocalyx (EG) damage correlate with plasma Ang-2 levels, suggesting a potential mechanistic linkage between EG injury and Ang-2 expression during states of systemic inflammation. However, the cell signaling mechanisms regulating Ang-2 expression following EG damage are unknown.

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked.

Background:  Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction.

Aim:  This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations.

Setting:  The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas.

Engineering of thick human functional myocardium via static stretching and electrical stimulation.

Human cardiac-muscle patches (hCMPs) constructed from induced pluripotent stem cells derived cardiomyocytes (iCMs) can replicate the genetics of individual patients, and consequently be used for drug testing, disease modeling, and therapeutic applications. However, conventional hCMPs are relatively thin and contain iCMs with fetal cardiomyocyte structure and function. Here, we used our layer-by-layer (lbl) fabrication to construct thicker (>2.

What Are the Double Lines of the Fetal Cavum Septi Pellucidi on Ultrasound?

Objective: To demonstrate the significance of the double line appearance of the septi pellucidi laminae (SPL) on fetal ultrasound.

Method: A total of 522 uncomplicated singleton pregnancies (15 to 39 weeks' gestational age) with fetal ultrasounds were enrolled. The presence of a single versus double line SP as well as measurement of the cavum septi pellucidi (CSP) was determined retrospectively.

TT-10-loaded nanoparticles promote cardiomyocyte proliferation and cardiac repair in a mouse model of myocardial infarction.

The meager regenerative capacity of adult mammalian hearts appears to be driven by the proliferation of endogenous cardiomyocytes; thus, strategies targeting mechanisms of cardiomyocyte cell cycle regulation, such as the Hippo/Yes-associated protein (Hippo/Yap) pathway, could lead to the development of promising therapies for heart disease. The pharmacological product TT-10 increases cardiomyocyte proliferation by upregulating nuclear Yap levels. When intraperitoneal injections of TT-10 were administered to infarcted mouse hearts, the treatment promoted cardiomyocyte proliferation and was associated with declines in infarct size 1 week after administration, but cardiac function worsened at later time points.

Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.

Objectives: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients.

Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa.

Background: Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire.

Aim: The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios.

Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa.

Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken.

Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa.

Bioreactor Suspension Culture: Differentiation and Production of Cardiomyocyte Spheroids From Human Induced Pluripotent Stem Cells.

Human induced-pluripotent stem cells (hiPSCs) can be efficiently differentiated into cardiomyocytes (hiPSC-CMs) via the GiWi method, which uses small-molecule inhibitors of glycogen synthase kinase (GSK) and tankyrase to first activate and then suppress Wnt signaling. However, this method is typically conducted in 6-well culture plates with two-dimensional (2D) cell sheets, and consequently, cannot be easily scaled to produce the large numbers of hiPSC-CMs needed for clinical applications. Cell suspensions are more suitable than 2D systems for commercial biomanufacturing, and suspended hiPSCs form free-floating aggregates (i.

Food insecurity and its impact on glycaemic control in diabetic patients attending Jabulani Dumani community health centre, Gauteng province, South Africa.

Background: To the best of our knowledge no studies have been conducted to assess the relationship between food insecurity and poor glycaemic control in diabetic patients in peri-urban settings of the South African context.

Aim: The study aimed to assess food insecurity and its relationships with glycaemic control and other patient characteristics amongst diabetic patients attending Jabulani Dumani Community Health Centre.

Setting: The study was conducted in a primary healthcare facility in the south sub-district of Ekurhuleni health district, the Gauteng province, South Africa.

Neglected sexual dysfunction symptoms amongst chronic patients during routine consultations in rural clinics in the North West province.

Background: Sexual dysfunction contributes to personal feelings of loss and despair and being a cause of exacerbated interpersonal conflict. Erectile dysfunction is also an early biomarker of cardiovascular disease. As doctors hardly ever ask about this problem, it is unknown how many patients presenting for routine consultations in primary care suffer from symptoms of sexual dysfunction.

Layer-By-Layer Fabrication of Large and Thick Human Cardiac Muscle Patch Constructs With Superior Electrophysiological Properties.

Engineered cardiac tissues fabricated from human induced pluripotent stem cells (hiPSCs) show promise for ameliorating damage from myocardial infarction, while also restoring function to the damaged left ventricular (LV) myocardium. For these constructs to reach their clinical potential, they need to be of a clinically relevant volume and thickness, and capable of generating synchronous and forceful contraction to assist the pumping action of the recipient heart. Design prerequisites include a structure thickness sufficient to produce a beneficial contractile force, prevascularization to overcome diffusion limitations and sufficient structural development to allow for maximal cell communication.

FundAl Retroflexion (FAR) Angle is a Novel Sonographic Marker Associated With Cesarean Scar Pregnancies in the First Trimester: A Case-Control Study.

Objectives: Early diagnosis of Cesarean scar pregnancies (CSP) remains difficult. This study describes a novel sonographic marker, the FundAl Retroflexion (FAR) angle, that may be used in the first trimester. The objective of the study is to compare the FAR angle between CSP and normal pregnancies.