Managed health care (MHC) has emerged in South Africa as an alternative system to control the cost of health care. Fears, negative perceptions and much uncertainty have surrounded this issue since its introduction in South Africa. The purpose of this study was to assess the understanding, perceptions and opinions of dentists residing in the Gauteng province about the emergence, benefits, impact, and future of MHC in South Africa. Eighty-six dentists (21.5%) out of the sample population of 400 responded to the questionnaire. The majority (66.7%) of the respondents perceived MHC to be a threat to their practices, with most feeling that MHC will interfere with the doctor-patient relationship. Forty-two per cent of the respondents were of the opinion that MHC will not succeed in South Africa. The results suggest that this sample of dentists do not consider MHC to be an alternative to the existing fee-for-service system. The introduction of MHC in South Africa is mostly based on models used in the USA, which might not be appropriate in the unique South African environment.

A course in Public Oral Health is currently offered by the Division of Public Oral Health (POH) to students in their final (6th year) of study for the degree of Bachelor of Dental Science. A fundamental aspect of this project was to shift the teaching methods from didactic to a participatory, student-centred approach, based on current local and international trends in medical, dental and general education. In 1999 the course covering core Public Health topics was presented over a period of 20 weeks to 49 students who were divided into three groups. Staff members were trained in participatory, student-centred teaching methods. An evaluation of students and staff was conducted at the end of the course. Results show that students were satisfied with the teaching methods employed and commended the Division on the organisation of the course. Students were unhappy with the amount of reading required in preparation for weekly seminars. They felt that the course was inappropriately positioned in their final year of study, due to pressure of achieving quotas for the clinical courses. Nevertheless, the main objectives of the Public Oral Health course were achieved through the adoption of a participatory, student-centred teaching approach.

Objective: To identify disease-causing variants in autosomal recessive axonal polyneuropathy with optic atrophy and provide targeted replacement therapy. Methods: We performed genome-wide sequencing, homozygosity mapping, and segregation analysis for novel disease-causing gene discovery. We used circular dichroism to show secondary structure changes and isothermal titration calorimetry to investigate the impact of variants on adenosine triphosphate (ATP) binding. Pathogenicity was further supported by enzymatic assays and mass spectroscopy on recombinant protein, patient-derived fibroblasts, plasma, and erythrocytes. Response to supplementation was measured with clinical validated rating scales, electrophysiology, and biochemical quantification. Results: We identified biallelic mutations in PDXK in 5 individuals from 2 unrelated families with primary axonal polyneuropathy and optic atrophy. The natural history of this disorder suggests that untreated, affected individuals become wheelchair-bound and blind. We identified conformational rearrangement in the mutant enzyme around the ATP-binding pocket. Low PDXK ATP binding resulted in decreased erythrocyte PDXK activity and low pyridoxal 5′-phosphate (PLP) concentrations. We rescued the clinical and biochemical profile with PLP supplementation in 1 family, improvement in power, pain, and fatigue contributing to patients regaining their ability to walk independently during the first year of PLP normalization. Interpretation: We show that mutations in PDXK cause autosomal recessive axonal peripheral polyneuropathy leading to disease via reduced PDXK enzymatic activity and low PLP. We show that the biochemical profile can be rescued with PLP supplementation associated with clinical improvement. As B6 is a cofactor in diverse essential biological pathways, our findings may have direct implications for neuropathies of unknown etiology characterized by reduced PLP levels. ANN NEUROL 2019;86:225–240.

Many studies and treatment guidelines have emphasized that the treatment of DM extends beyond glycaemic control, but include lowering lipids, and blood pressure in people living with DM. According to The Task Force on Diabetes and Cardiovascular Disease of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD), dyslipidaemia is strongly related to increased CVD risk. This study determined the prevalence of dyslipidaemia in Type 2 DM patients attending the OAUTHC, Ile Ife South West Nigeria from January to November 2014.Method: This cross-sectional descriptive study involved Three hundred (300) consecutive Type 2 diabetic presenting at OAUTHC, Ile-Ife. Relevant clinical information and physical examination was carried out. Venous blood was collected to determine total cholesterol, low density lipoprotein, high density lipoprotein and triglycerides. Lipid goals was based on total cholesterol <200 mg/dl, triglycerides <150 mg/dl, LDL <100 mg/dl and HDL <40 mg/dl in male and <50 mg/dl in female.
Results: A total of 300 type 2 Diabetes mellitus patients were recruited into the study. One hundred and three (35.3%) were males and 194 (64.7%) female. The mean age was 61.17+10.5 years with a mean age of 62.0+10.9 years for males and 60.7+10.3 years females respectively. Of the 300 participants, One hundred and eleven (37.0%) subjects achieved optimal lipid control while 187 (63.0%) of the study subjects had dyslipidaemia. 85 (28.3%) study participants had total cholesterol of >200 mg/dl, 115 (38.3%) with LDL cholesterol above 100 mg/dl and 24.7% with triglycerides of >150 mg/dl and 28.3% for HDL of <40 mg/dl in men and 50 mg/dl in women.
Conclusions: The proportion of patient with poor lipid goal was high. Adequate management of dyslipidaemia should be paramount in the management of type 2 diabetes patients.