BackgroundWartime traumatic events are related to subsequent psychological and physical health, but quantifying the association is problematic. Memory changes over time and is influenced by psychological status.AimsTo use a large, two-stage cohort study of members of the UK armed forces to study changes in recall of both traumatic and ‘toxic’ hazards.MethodA questionnaire-based follow-up study assessed 2370 UK military personnel, repeating earlier questions about exposure to military hazards.ResultsThe κ statistics for reporting of hazards were good for some exposures, but very low for others. Gulf veterans reported more exposures over time (no significant rise in the Bosnia cohort). In the Gulf cohort only, reporting new exposures was associated with worsening health perception, and forgetting previously reported exposures with improved perception. We found no association between physical health, psychological morbidity or post-traumatic stress disorder symptoms and endorsement or non-endorsement of exposures.ConclusionsReporting of military hazards after a conflict is not static, and is associated with current self-rated perception of health. Self-report of exposures associated with media publicity needs to be treated with caution.

Objective To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre‐gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). Methods A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. Results Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2. Despite poor initial HbA1c for pre‐gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre‐gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV‐infected pregnancies (9.4%) than non‐HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide‐exposed group than the insulin‐alone group (12.2% vs 0%, P=0.025). Conclusion Obesity is a significant predictor for macrosomia and was high in all groups. In a low‐/middle‐income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.

Background: Understanding the association between maternal metabolic conditions in pregnancy and the risk of childhood overweight, a growing concern in sub-Saharan Africa (SSA), helps to identify opportunities for childhood obesity prevention. Aim: To assess the association between hyperglycaemia first detected in pregnancy (HFDP) (gestational diabetes mellitus [GDM] and diabetes in pregnancy [DIP]) and child obesity and adiposity in pre-school-aged children in South Africa, independently of maternal BMI. Subjects and methods: Measurement of anthropometry and fat mass index (FMI) by the deuterium dilution method was done for 102 3-6-year-old children born to mothers with HFDP and 102 HFDPunexposed children. Hierarchical regression analysis and generalised structural equation modelling (GSEM) were performed. Results: The prevalence of overweight/obesity was 10.5% and 11.1% in children exposed to GDM and DIP, respectively, and 3.9% in the HFDP-unexposed group. Log-transformed FMI was significantly higher in the DIP-exposed group (b ¼ 0.166, 95% CI ¼ 0.014-0.217 p¼ .026), but not when adjusting for maternal pregnancy BMI (b ¼ 0.226, 95% CI ¼ 0.003-0.015, p ¼ .004). GSEM showed significant total effects of maternal BMI and birth weight on FMI/BMI. Conclusions: Maternal pregnancy BMI seems to play a greater role in the development of childhood adiposity than maternal hyperglycaemia, requiring further research and identifying maternal BMI as a relevant prevention target in our setting.

The landscape of gestational diabetes mellitus (GDM) has remained dynamic, with the prevalence, definition, screening protocols, diagnostic criteria and therapeutic modalities continuously changing from as early as the 1960s. Most recently, GDM has been defined as a disorder of glucose intolerance first encountered during pregnancy that is not clearly overt diabetes. [1] GDM has far-reaching and wellknown ramifications for both mother and infant. [2] Global prevalence estimates are 16.9%, [3,4] with recent studies in South Africa (SA) showing prevalence figures ranging from 9.1% to 25.8%. [5,6] Traditionally, GDM is initially managed with dietary and lifestyle interventions alone. However, insulin is introduced if glycaemic goals are not achieved. [7-9] Oral hypoglycaemic agents (OHAs) are an attractive alternative if lifestyle measures fail, particularly in resource-poor countries, because of their low cost and ease of administration. However, their use for GDM is surrounded by much debate regarding efficacy and safety, and they are recommended by some guidelines [9-11] and omitted in others. [12] One meta-analysis that included 13 studies utilising various diagnostic tests and criteria for GDM, with representation from both high-and low-income countries, investigated the safety of OHAs compared with insulin when treating GDM. [13] It demonstrated a higher preterm birth rate (relative risk (RR) 1.51) in patients exposed to metformin monotherapy, with a reduced risk of both gestational hypertension (RR 0.54) and lowered postprandial glucose levels. A further metaanalysis of 15 studies showed an increased risk of macrosomia and neonatal hypoglycaemia in patients exposed to glibenclamide. [14] Research from SA has generally shown reassuring safety outcomes in terms of fetal anomalies and maternal glycaemic control for both This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Despite our current state of the art equipment these "masses" still pose a diagnostic challenge in distinguishing between solid thrombus and tumour as to determine the appropriate therapeutic approach. Surgical removal of Giant Atrial Thrombi appears to be the procedure of Choice.

BackgroundThyroid nodules are prevalent worldwide. Detection rates are increasing because of the use of ultrasonography. Ultrasound has become the first-choice imaging modality in evaluating nodules. The decision to perform an US-guided fine-needle aspiration (FNA) is based on a nodule’s sonographic features. Thus, it is essential to accurately risk stratify thyroid nodules so that they are appropriately referred for FNA.ObjectivesThe aim of this study was to correlate the ultrasound imaging features of thyroid nodules with FNA cytology and surgical histopathology results, and to risk stratify patients using the American Thyroid Association (ATA) classification for each imaging characteristic with the likelihood of the nodule being malignant.MethodRetrospective analysis of a thyroid ultrasound database at Chris Hani Baragwanath Academic Hospital, over the period 2015–2017. Frequencies and percentages were used to summarise the data. Univariate logistic regression analyses were used to assess the accuracy of sonographic features in predicting the histologically determined diagnosis for thyroid tumours.ResultsA total of 113 nodules underwent FNA, of which 104 were diagnostic. The best three ultrasound features that pose a higher risk for malignancy are absent halo, presence of microcalcifications and hypoechoic appearance. No single nodule feature is an absolute indicator for malignancy. There is a high agreement between ATA classification and cytopathology or histology when nodule features are grouped into clusters. Agreement between the ATA classification and cytopathology/histology was 86.7% with a kappa of 0.714. The agreement between the cytopathology FNA results and lobectomy histopathology was 98.8% with a kappa of 0.973.ConclusionThis study contributes to the paucity of data available for sub-Saharan Africa and provides reassurance that our results are consistent with international studies. The study confirms that the usage of a thyroid nodule classification system improves characterisation and increases accuracy in detecting thyroid malignancies, thus sparing many patients the morbidity of unnecessary thyroid surgery.

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Background: The long-term consequences for offspring born to mothers with hyperglycaemia first detected in pregnancy (HFDP) are not yet well understood and its influence on childhood blood pressure has not previously been assessed in sub-Saharan Africa.Objective: The objective of this study was to evaluate the association between maternal HFDP and offspring blood pressure in 3 to 6-year-old children in Soweto, South Africa.Methods: Oscillometric blood pressure was measured in 189 children born to mothers with and without HFDP diagnosed by 75 g 2-h oral glucose tolerance test. The 2017 AAP Guidelines for Childhood Hypertension were used as reference standard, and the term 'elevated blood pressure' referred to blood pressure readings above the 90th percentile for age, height and sex. The association between maternal HFDP and offspring blood pressure was analysed using multivariable linear regression.Results: Elevated blood pressure was identified in 49.7% of children. Maternal hyperglycaemia was not associated with offspring blood pressure when adjusted for offspring age, height and sex (SBP: 0.199, P ¼ 0.888; DBP: 0.185, P ¼ 0.837) or after multivariable adjustment (SBP: -0.286, P ¼ 0.854; DBP: 0.215, P ¼ 0.833). In the full model for SBP, child BMI age z-score was a significant predictor of blood pressure at 3-6years (1.916, P ¼ 0.008). Conclusion:Although maternal HFDP was not associated with childhood blood pressure at 3-6 years, the prevalence of elevated blood pressure in this group of preschool-aged children is concerning. Future research is needed to further evaluate childhood obesity as a modifiable risk factor to reduce hypertension and cardiovascular risk in an African setting.