Pharmaceutical ingredients from both prescription and over-the-counter drugs find their way into the environment during their production, use and disposal. They readily contaminate bodies of surface water such as rivers and lakes. Results from a recent study published in Environmental Toxicology and Chemistry indicate that pharmaceutical pollution is a problem that is affecting the world’s rivers.
Approximately 43.5% of the 1052 locations that were assessed in the study across 104 countries had concerning concentrations of pharmaceutical ingredients. Twenty-three pharmaceutical ingredients occurred at concentrations that exceeded ‘safe’ concentrations, including substances from drug classes including antidepressants, antimicrobials, antihistamines, benzodiazepines, and painkillers.
“This is the first truly global assessment of the impacts of single pharmaceuticals and mixtures of pharmaceuticals in riverine systems,” said corresponding author Alejandra Bouzas-Monroy, a PhD student at the University of York. “Our findings show that a very high proportion of rivers around the world are at threat from pharmaceutical pollution. We should therefore be doing much more to reduce the emissions of these substances into the environment.”
The origin of the mediaeval Black Death pandemic (AD 1346–1353) has long been studied because of its massive impact on population and society. However, most studies have focused on surviving European records, but they provide little insight into the actual origin of this world-changing pandemic. A new study published in Naturereconstructs the DNA of Yersinia pestis from ancient burial sites, suggesting that 1338 was the date of the first outbreak which would later go on to ravage Eurasia.
Conventional thinking puts the onset of the Black Death at 1346 in the Black Sea region. Recent analysis of historical, genetic and ecological data led to the suggestion that the emergence of Y. pestis branches occurred more than a century before the beginning of the Black Death. According to the proposed model, this initial diversification was linked with territorial expansions of the Mongol Empire across Eurasia during the early thirteenth century. But in this study, the researched present ancient Y. pestis data from central Eurasia supporting a fourteenth-century emergence – putting the emergence a full century later, closer to the conventionally accepted 1346 date.
Until now, the most debated archaeological evidence on the pandemic’s initiation came from cemeteries located near Lake Issyk-Kul in modern-day Kyrgyzstan.
These sites are thought to have housed victims of a fourteenth-century epidemic as tombstone inscriptions directly dated to 1338–1339 state ‘pestilence’ as the cause of death for the buried individuals.
Researchers analysed ancient DNA data from seven individuals exhumed from two of these cemeteries, Kara-Djigach and Burana. The combination of archaeological, historical and ancient genomic data implicates Y. pestis in this epidemic event.
Two reconstructed ancient Y. pestis genomes represent a single strain and are identified as the most recent common ancestor of a major diversification commonly associated with the pandemic’s emergence, here dated to the first half of the fourteenth century. Comparing these ancient genomes present-day diversity from Y. pestis reservoirs in the Tian Shan area where China, Kazakhstan and Kyrgyzstan meet supports a local emergence of the recovered ancient strain.
Exactly how Y. pestis made it to western Eurasia is unknown, but previous research suggested that both warfare and/or trade networks were some of the main contributors in the spread of Y. pestis. However, the lack of any military campaigns in this period and the proximity of trans-Asian networks plus trade items at the site suggest trade playing a role in Y. pestis dissemination.
The authors conclude that “Although the ancient Y. pestis genomes reported in this Article offer biological evidence to settle an old debate, it is the unique historical and archaeological contexts that define our study’s scope and importance. As such, we envision that future synergies will continue to reveal important insights for a detailed reconstruction of the processes that triggered the second plague pandemic.”
Christelike Maatskappy Raad Noord (CMRN), an NGO in Gauteng which focuses on children’s welfare through the use of social workers, has been defunded by the government. This amounts to just over half of its funding, according to marketing manager Anya le Cornu. Other NGOs have also had their funding cut, she said, as heard via the Auditor General’s office.
This comes in the wake of the COVID pandemic as CMNR had to cope with continuing to deliver services amidst lockdowns. If other NGOs are similarly impacted, . Founded in 1936, CMRN aims to eradicate child abuse and neglect, providing a wide range of child protection service from its 16 centres.
The NGO assists a large number of families of children: 6000 beneficiaries received material or skill support in 2020–2021, its Child Protection Awareness campaign reached 14 500 people, 622 children were protected through the legal system, and 900 children received speech or play therapy.
However, these services are obviously under threat from the significant loss of provincial government funding, which at R7 million, accounted for 53% of its income.
In order to cope, CMNR has been forced to restructure, reducing costs wherever possible. Unfortunately, it has having to slash its social workers from 28 to 17 as of 1 July.
Due to the lack of subsidy and other challenges, areas such as statutory work may be impacted.
According to le Cornu, CMRN will try and secure funding through every means possible. “We will maintain and strengthen our relationship with the NG church, our other funding partner,” she says. “We will also continue with our marketing and fundraising initiatives. Professional fees will also be applied where possible. We will also reach out to schools and other institutions where part time social work services are needed and contract these services out to generate an income stream.”
The organisation remains hopeful despite these challenges. “We do wish to have a good relationship with the Department of Social Development and would apply for government funding in specific programs where the objectives of these programs are aligned to our own and the communities we serve,” says le Cornu.
“The CMR North believes that we will survive this crisis and hope to be a beacon of light for other NGOs who might suffer the same fate. It is our passion to continue bringing hope to the vulnerable and we see these events as an opportunity to re-invent our services so that they can have a broader and positive impact in the communities we serve.”
Hopefully, additional funding can be found so that CMRN can continue to provide its services, but if this is part of a wider pattern, people in South Africa who are most in need and depend on these services will suffer the most.
On Sunday evening, another fire broke out at Steve Biko Academic Hospital – the second in two weeks. The fire damaged linen and prompted an evacuation but fortunately, there were no injuries resulting from the incident, Times Live reported.
Gauteng health department spokesperson Kwara Kekana said the cause of the latest fire was due to till-burning cigarette butts discarded by patients which “touched the ward linen room lights, burning the steel shelves and linen.”
Kekana said the damage was limited to a few items of linin. The fire started at around 6.15pm in a linen closet in a medical ward.
“The fire was quickly extinguished by staff. Patients were temporarily evacuated as a safety precaution because of smoke. By 8.15pm, patients were returned to the ward after the City of Tshwane declared the site safe,” Kekana said.
The previous fire at the hospital broke out at around 1:20am in a temporary storage area for COVID medical waste and as an in-transit corpse area. That fire affected temporary structures outside the hospital casualty area, and forced the evacuation of 18 patients.
This is the latest in a string of fires in Gauteng hospitals, such as the devastating fire at Charlotte Maxeke hospital – something which has caused concern for Gauteng Health MEC Nomathemba Mokgethi.
Speaking about the previous fire, she said that, “It looks like every year in the Department of Health we have to deal with fires. I will be getting a report the afternoon from the law enforcement agency, especially on the Charlotte issue.”
The problem of hospital fires is not confined to Gauteng: exactly a week earlier, a blaze broke out at Chatsmed Hospital in Durban.
The whistle-blowing paediatrician Dr Tim de Maayer who spoke out about appalling conditions at Rahima Moosa Mother and Child Hospital (RMMCH) was suspended yesterday, apparently in a retaliatory move.
In the widely-read open letter appearing on the Daily Maverick, he spoke of the preventable tragedy of babies dying due to lack of resources. This came shortly after a viral video showed pregnant mothers sleeping on the floor.
Presciently, the Daily Maverick, which broke the story, stated that there were two options: act to change the situation for the better, or “shoot the messenger”. As the newspaper wryly noted as it broke the news on Friday, 10 June, the option of shooting the messenger has been taken.
Although there appeared to be an initial positive response, Dr Maayer gave notice on Thursday evening that he was not able to come into work on Friday as he was being placed on suspension. RMMCH doctors then contacted the Daily Maverick.
His suspension leaves the hospital without its only paediatric gastroenterologist, according to an anxious doctor who got in touch with the Daily Maverick late Thursday night. The news has spread like wildfire across social media, with other doctors quick to come to Dr de Maayer’s defence.
A petition on Change.org to reinstate the paediatrician is being circulated by ordinary citizens and clinicians including Professor Shabir Madhi, who has been vocal in his support of Dr de Maayer.
Guy Richards, critical-care professor at Wits University tweeted that it was a “shocking response”.
The Progressive Health Forum (PHF) called for the suspension of Dr de Maayer to be overturned.
“Dr de Maayer has been suspended on the grounds that he has a voice, a conscience and a professional ethic and being a committed public health clinician. This pattern of victimisation has been repeatedly applied to clinicians who dare call out inadequacies of the administration and negative impact on clinicians and on the lives of patients,” the PHF said in a statement.
A US doctor has been hailed as a hero after he gave his life to stop a gunman firing upon a church congregation.
The Orange County Sherriff’s Department hailed the doctor’s ultimate sacrifice following the tragic shooting, which took place at a the Geneva Presbyterian Church in Laguna Woods, California, on Sunday afternoon.
John Cheng, MD, 52, was attending a church lunch with his mother when 68-year-old David Chou chained the doors shut and opened fire on a group of elderly parishioners.
Acting without hesitation, Dr Cheng, a prominent sports medicine physician, quickly tackled the suspect, allowing church members to restrain him, according to a statement from the Orange County Sheriff’s Department.
When he leapt to the defence, Dr Cheng sustained multiple gunshot wounds and succumbed to his injuries. He leaves behind his wife and two children, as well as devastated colleagues at his practice, who referred to him as a protector, ABC 7 reported.
“Officials said that were it not for the actions of Dr Cheng, there most certainly would have been many more lives lost,” said the California Medical Association in a statement released a day after the shooting.
“Our nation continues to be plagued by an epidemic of gun violence,” they wrote. “Physicians as healers are often on the front lines of these tragic events, treating the wounds of the victims of gun violence.”
Five other victims sustained gunshot wounds and were taken to local hospitals for treatment. The suspected shooter, who is in custody and being charged with murder and attempted murder, allegedly drove from Las Vegas to attack the church, at which members of the Taiwanese Presbyterian Church have had a space since 2009. He knew no-one at the church but spent about an hour mingling with them to gain their trust, NPR reported.
The shooting is being investigated as a hate crime, since the suspect was reportedly upset about political tensions involving China and Taiwan, the sheriff’s department noted.
At a media briefing, Orange County District Attorney Todd Spitzer praised Dr Cheng’s actions.
Dr Cheng knew that there were many parishioners at risk, Spitzer said. He charged across the room, and did everything he possibly could to disable the assailant. “He sacrificed himself so that others could live,” he added.
Don Barnes, the Orange County Sheriff-Coroner, was in agreement, saying that “there is no doubt that Dr. Cheng’s actions that day saved the lives of many other church members. He is a hero and will be remembered by this community as such.”
In an opinion piece, Neil Tabatznik reflects on how starting the Tshemba Foundation reignited his passion for his native South Africa.
South Africa is not only the most unequal country in the world, it also does not care well enough for its weak and sick. Its inequitable access to healthcare is iniquitous in many parts of the developing world. But to me, a former South African who left the country during one of South Africa’s darkest periods in history, which was rife with government oppression at the time, it reflects the legacy of apartheid.
Having departed for England in 1971, where I practiced law before leaving for Canada, South Africa became a distant and awful memory: I had planned to leave and never come back.
I stayed away for 36 years and cut all ties with the country.
However, seventeen years ago, I returned to South Africa, for personal reasons: my son’s bar mitzvah. With family dispersed across North America, Europe and Australia, South Africa felt like a central place to congregate. It was during the new, post-apartheid period in South Africa that I fell in love with the country all over again.
I started the Tshemba Foundation in Hoedspruit, Mpumalanga, out of complete selfishness initially: It was an excuse to come back to South Africa, while doing good.
At the time, The Tshemba Foundation approached the provincial health department, pitched the concept and offered to bring skilled medical volunteers to the region – and a partnership was born.
The Foundation operates a medical volunteer programme that serves as a model of public-private partnership in the healthcare sector. Initially, I had reached out to colleagues and friends approaching retirement in the UK and Canada, recognising that they had immense skills, time on their hands, and could easily be enticed to come and help while staying at a lodge we had set up on a game reserve in South Africa. The Health Professions Council of SA (HPCSA) proved to be a barrier to this idea, because they refused to register any doctor who had left SA during the Apartheid era (intending never to return) demanding that they pay membership fees accruing during the intervening years. Although this barrier remains, we have still been able to recruit hundreds of volunteers from South Africa and abroad.
Designed to connect skilled professionals from the medical and allied professions with a desire to give back to rural communities in need, we have operated out of the Tintswalo Hospital, a 423-bed public hospital, and surrounding clinics, since 2017.
The Foundation relies on medical volunteers to bridge the gaps in patient care in rural Mpumalanga: Professionals who give up their time and expertise to bring value to underprivileged and underserved communities, while supporting existing staff with training, educational opportunities and fresh perspectives. We assist volunteers with HPCSA registration, to allow them to volunteer in South Africa, but they have to make their own way to Mpumalanga and are provided with free lodging.
Tintswalo Hospital is one of the biggest in the province, serving a rural, underserved population of about 300 000. The hospital has no specialist doctor posts, and if any staff member leaves, from groundsman to senior doctor, it is extremely difficult to replace them due to severe budgetary constraints.
Our “leave of purpose” programme recruits both local and international medics to volunteer their services in these rural areas. They cover a wide range of disciplines, from generalists and dentists to ophthalmologists that perform cataract surgeries and specialist researchers who are spearheading a rural ultrasound project.
Our flagship projects, offered in partnership with the Mpumalanga Department of Health and Tintswalo Hospital, are a state-of-the-art eye clinic and cataract operating theatre, which screens and remedies common, treatable eye diseases, and the Hlokomela Women’s Clinic where pap smears, cryotherapy, and breast, pelvis, abdomen and pregnancy ultrasounds are offered. Women no longer need to travel vast distances to receive screening and treatment: they can get such specialist care at Tintswalo.
Tshemba’s eye clinic volunteers have helped over 700 elderly patients – many of whom were being cared for by grandchildren and other family members, thereby depriving them of access to education and employment.
The programme would not have been possible without the cooperation and enthusiasm of medics, the community, the Mpumalanga Department of Health and international benefactors.
To date, we have attracted about 200 local and global volunteers, mostly from the US, Canada, Europe and Australia, who have devoted the equivalent of over 9,000 healthcare professional days, treated 19,630 patients and held 294 training sessions. These training sessions not only assist local healthcare professionals with continuing professional development and informal clinical teaching, but they also ensure that the Foundation makes a lasting and sustainable impact on the quality of rural healthcare.
Now, the challenge is to make The Tshemba Foundation sustainable. We are registering it as a charity in the UK, Canada and the United States, but we need more support.
We hope to strengthen our relationship with the province to improve healthcare, without flooding hospitals with volunteers. Instead, we would like to build on the power of the clinics by posting medics to smaller healthcare centres.
Our work makes a real difference, not only in the lives of the communities who lack access to healthcare that people in urban centres take for granted, but also in the lives of those who volunteer their services.
Radio DJ Mark Pilgrim has revealed on Twitter that his latest scan results showed a ‘significant shrinkage’ of all of the tumours present in his lung, spine, leg and lymph nodes.
In March 2022, the radio star revealed that he had been diagnosed with stage 4 lung cancer, and that he was to start treatment “in a week”.
Speaking about his most recent diagnosis, he said: “I’m not Chuck Norris. Yes, I’m scared. I am also strong. Both emotions run parallel with each other. I’m under the care of incredible doctors and surrounded by love.”
It is not the first time the popular DJ has been through such difficult times. Pilgrim had already survived stage stage 4 testicular cancer in 1998 at the age of 18. The cancer had spread to his lungs and kidney, and he recalls that his oncologist said that his prognosis was “uncertain”. He endured 9 months of 4-hour chemotherapy sessions.
In 2008 he suffered heart damage from a massive myocardial infarction suffered in the doctor’s office, and last year he tested positive for COVID.
For patients with non-small cell lung cancer (NSLC), the most common form of lung cancer, half present at stage 4. In one Canadian study, only 14.9% of patients received chemotherapy as first-line treatment, with most patients receiving palliative radiotherapy.
While herbal supplements may be natural, they may not always be harmless. In Heart Rhythm Case Reports, doctors report on a patient who experienced dizziness and fainting and was diagnosed with a dangerous cardiac arrhythmia after taking hemp oil containing CBD and CBG and berberine supplements.
“More and more people are taking herbal supplements for their potential benefits. Yet their ‘natural’ character can be misleading, since these preparations can have serious adverse side effects on their own or if combined with other supplements or medications,” said Elise Bakelants, MD, Department of Cardiology, University Hospital of Geneva. “Their use should not be taken lightly, and dosing recommendations should always be respected.”
The reported case involves a 56-year-old woman who was admitted to the emergency department after experiencing dizziness and fainting without warning. She was diagnosed with a life-threatening cardiac arrhythmia after an ECG showed short runs of torsade de pointes, a rapid heartbeat originating in the ventricles, and a markedly prolonged QT interval, which means the heart’s electrical system takes longer than normal to recharge between beats.
Apart from low blood pressure, the patient’s physical examination and blood work were normal. The doctors were able to identify the cause as the herbal supplements she was taking to help her cope with a stressful work-life balance. She had started a regimen of six times the recommended dose of hemp oil four months earlier and had recently added berberine to the mix. All supplements were stopped during her hospital stay, resulting in a gradual decrease of her QT interval until it normalized after five days. At her three-month follow-up, she reported no new episodes of dizziness or fainting, and her ECG remained within normal range. With no other causative factors, her return to normal strongly validated that the diagnosis linked the supplements to the arrhythmia.
Herbal supplements has increased in popularity in recent years, especially those containing CBD (cannabidiol). Available without prescription, CBD has been shown to have anti-inflammatory, antiepileptic, analgesic, anxiolytic, antipsychotic, and immunomodulatory properties. Supplied as raw material or as ready-to-use products (eg, cosmetics, tobacco substitutes, scented oils), it does not contain THC (tetrahydrocannabinol), which causes the psychotropic effect of cannabis. Therefore, it is not subject to control by drug regulatory agencies. Berberine, found in the roots, rhizomes, and stem bark of many medicinal plants, is frequently used in traditional Chinese and ayurvedic medicine to treat infections, diarrhoea, type 2 diabetes, high cholesterol, and high blood pressure.
The e preparation of herbal supplements is largely unregulated and are widely perceived as safe. Exact composition can vary greatly from one distributor to another, and the pharmacodynamic and pharmacokinetic properties of these substances are not well known. Limited data are available regarding their effectiveness, toxicity, and potential for interactions. As a result, it is not always possible to foresee their negative consequences.
Dr Bakelants cautioned patients and physicians to be aware of possible side effects, respect dosing recommendations and consider possible interactions with other medications, particularly in patients with underlying cardiac disease or those already taking QT-prolonging medication.
Effective anti-vaping advertisements geared to teens have the greatest impact when they emphasise the adverse consequences and harms of vaping e-cigarettes, use negative imagery, and avoid memes, hashtags and other ‘teen-centric’ communication styles, according to a first-of-its-kind study by researchers in the journal Tobacco Control.
The researchers also found that certain messaging content currently being used, especially sweets and flavour-related imagery, increases the appeal of vaping and should be avoided when designing prevention messages.
“E-cigarettes and vaping have become a major public health concern, with nicotine addiction and other harmful outcomes looming large for youth,” said Seth M. Noar, PhD, the paper’s corresponding author and UNC Lineberger professor. “The percentage of teens vaping increased from about 5% in 2011 to over 25% in 2019,” Prof Noar said. “That is an alarming trend, making an understanding of effective vaping prevention messages especially urgent.”
Since the introduction of e-cigarettes, numerous US health departments have created their own anti-vaping messaging geared to teens, as have national health organisations such as the US Food and Drug Administration and Centers for Disease Control and Prevention.
The online study asked 1501 teens to rate seven randomly selected vaping prevention ads from a pool of more than 200 ads. Vaping prevention ads that clearly communicated the health harms of vaping, or compared vaping to cigarette smoking, were comparatively more effective. Neutral or less personally relevant content, such as referencing the environmental impact of vaping or the targeting of youth by the tobacco industry, was less impactful.
“Although we anticipated that vaping prevention ads with neutral or pleasant imagery would not be as effective, we were alarmed to find that flavour-related messages actually heightened the attractiveness of vaping,” said Marcella H. Boynton, PhD, first author
“In retrospect, it stands to reason that by reminding teens about pleasurable aspects of e-cigarettes, even within the context of a prevention ad, we run the risk of doing harm. Notably, we found that flavour-related prevention ad content was associated with vaping appeal among both users and non-users of e-cigarettes, which is a good reminder of how much candy and fruit flavours in e-cigarettes have driven the youth vaping epidemic.”
The researchers hope to next investigate the effects of other types of anti-vaping ads on a wide range of audiences. They also are developing a series of messages and a companion website to test the ability of a text message-driven intervention to reduce youth vaping. In that regard, Prof Noar noted that “We have been developing our own evidence-based messages based on the latest science about the harms of vaping. Our messaging approach has been greatly influenced by the insights generated by this study.”
The study used UNC’s Vaping Prevention Resource, a website designed to provide practitioners, researchers and communities with vaping prevention media content from around the world, as well as strategies and resources for youth vaping prevention. It is the largest repository of free, open-access vaping prevention materials, all available for download at https://vapingprevention.org/.