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The multifaceted nature of COVID-19 permeates all dimensions of human life. In this article, we argue that the COVID-19 crisis might teach us something about dealing with ruptures of this kind and scope in the future. The pandemic challenges our Being-in-the-world and it has the potential to help us realise the authentic possibilities of our own being – a freedom we have in our being-towardsdeath. We contemplate the extent to which this pandemic has caused existential angst and resultant reflection. To this end, we analyse, with reference to the work of Martin Heidegger, the existential and technological challenges that accompany the pandemic. We postulate that the pandemic has forced us to think about our existence more authentically, away from the “fallenness” of the ontological structure of Dasein in its everydayness. It proffers the opportunity to reconsider what authentic existence, technology, and embodiment entail amidst COVID-19 and for the future.

Background. In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA, has the highest trauma burden in the Cape Metro East health district.Objectives. The primary objective of this study was to describe the impact of Khayelitsha District Hospital (KDH) on acute orthopaedic services in the health district, with a focus on the volume and type of orthopaedic services provided without tertiary referral. Methods. This retrospective analysis described acute orthopaedic cases from Khayelitsha and their management between 1 January 2018 and 31 December 2019. Orthopaedic resources and the proportion of cases referred to the tertiary hospital by all DHs in the Cape Metro East health district are described.Results. In 2018 - 2019, KDH performed 2 040 orthopaedic operations, of which 91.3% were urgent or emergencies. KDH had the most orthopaedic resources and the lowest referral ratio (0.18) compared with other DHs (0.92 - 1.35). In Khayelitsha, 2 402 acute orthopaedic cases presented to community health clinics. Trauma (86.1%) was the most common mechanism of injury for acute orthopaedic referrals. Of clinic cases, 2 229 (92.8%) were referred to KDH and 173 (7.2%) directly to the tertiary hospital. The most common reason for direct tertiary referral was condition related (n=157; 90.8%). Conclusion. This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared with other DHs with fewer resources. Further research on the barriers to scaling up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.

BACKGROUND: Clubfoot is a common congenital condition with a global incidence estimated at 1 in 1 000 live births. There is a paucity of information regarding the epidemiology and incidence of clubfoot in South AfricaOBJECTIVES: To describe the epidemiology, clinical characteristics, and the treatment outcomes of children with clubfoot who were treated at a tertiary hospital in South Africa. A secondary objective was to determine the incidence rate of clubfoot in our direct catchment area (within 40 km from Tygerberg hospital) for the study periodMETHODS: We conducted a retrospective cohort study of all records of children with clubfoot from 2014 - 2018. Demographic and clinical information, treatment progression and short-term outcomes including early relapse were collected. A subset of the total cohort, including only clubfoot patients from the direct catchment area of the hospital, together with the number of live births in the direct catchment area, was utilised to calculate the incidence rate of clubfoot in our settingRESULTS: A total of 197 patients were included over a 60-month period. Two-thirds of the patients were male (63.5%; n=125). A positive family history was reported in 12.2% (n=24) of cases, and 88.8% (n=175) and 11.2% (n=22) of patients were diagnosed as having idiopathic clubfoot or syndromic clubfoot, respectively. Relapsed clubfoot was diagnosed in 22.9% (n=40) and 22.7% (n=5) of patients with idiopathic and syndromic clubfoot, respectively. The overall incidence rate of idiopathic clubfoot in our direct catchment area was 1.02 per 1 000 live birthsCONCLUSION: The epidemiology, treatment outcomes and incidence rates observed at our institution are like those reported globally. We report a low positive family history and relapse rate, which could be under reported and should be the focus of future investigations

Acquired haemophilia A is a rare coagulation disorder, which can lead to life-threatening haemorrhages if not identified and treated promptly. It is characterised by the presence of autoantibodies (inhibitors) to factor VIII. Acquired haemophilia A associated with HIV is a rare but well described phenomenon with limited directions to its management. We comparatively describe four patients - two with HIV and two without - that presented with unusual bleeding episodes with a prolonged activated partial thromboplastin time secondary to factor VIII inhibitors. An empiric observation is that the patients with acquired haemophilia A associated with HIV had higher antibody titres at presentation, that required more prolonged immunosuppressive therapy to induce remission.

Background: Pembrolizumab is active in head and neck squamous cell carcinoma (HNSCC), with programmed cell death ligand 1 (PD-L1) expression associated with improved response. Methods: KEYNOTE-048 was a randomised, phase 3 study of participants with untreated locally incurable recurrent or metastatic HNSCC done at 200 sites in 37 countries. Participants were stratified by PD-L1 expression, p16 status, and performance status and randomly allocated (1:1:1) to pembrolizumab alone, pembrolizumab plus a platinum and 5-fluorouracil (pembrolizumab with chemotherapy), or cetuximab plus a platinum and 5-fluorouracil (cetuximab with chemotherapy). Investigators and participants were aware of treatment assignment. Investigators, participants, and representatives of the sponsor were masked to the PD-L1 combined positive score (CPS) results; PD-L1 positivity was not required for study entry. The primary endpoints were overall survival (time from randomisation to death from any cause) and progression-free survival (time from randomisation to radiographically confirmed disease progression or death from any cause, whichever came first) in the intention-to-treat population (all participants randomly allocated to a treatment group). There were 14 primary hypotheses: superiority of pembrolizumab alone and of pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival and progression-free survival in the PD-L1 CPS of 20 or more, CPS of 1 or more, and total populations and non-inferiority (non-inferiority margin: 1·2) of pembrolizumab alone and pembrolizumab with chemotherapy versus cetuximab with chemotherapy for overall survival in the total population. The definitive findings for each hypothesis were obtained when statistical testing was completed for that hypothesis; this occurred at the second interim analysis for 11 hypotheses and at final analysis for three hypotheses. Safety was assessed in the as-treated population (all participants who received at least one dose of allocated treatment). This study is registered at ClinicalTrials.gov, number NCT02358031. Findings: Between April 20, 2015, and Jan 17, 2017, 882 participants were allocated to receive pembrolizumab alone (n=301), pembrolizumab with chemotherapy (n=281), or cetuximab with chemotherapy (n=300); of these, 754 (85%) had CPS of 1 or more and 381 (43%) had CPS of 20 or more. At the second interim analysis, pembrolizumab alone improved overall survival versus cetuximab with chemotherapy in the CPS of 20 or more population (median 14·9 months vs 10·7 months, hazard ratio [HR] 0·61 [95% CI 0·45–0·83], p=0·0007) and CPS of 1 or more population (12·3 vs 10·3, 0·78 [0·64–0·96], p=0·0086) and was non-inferior in the total population (11·6 vs 10·7, 0·85 [0·71–1·03]). Pembrolizumab with chemotherapy improved overall survival versus cetuximab with chemotherapy in the total population (13·0 months vs 10·7 months, HR 0·77 [95% CI 0·63–0·93], p=0·0034) at the second interim analysis and in the CPS of 20 or more population (14·7 vs 11·0, 0·60 [0·45–0·82], p=0·0004) and CPS of 1 or more population (13·6 vs 10·4, 0·65 [0·53–0·80], p

Buccopalatal collapse of the postextraction ridge is a significant challenge in restorative and implant dentistry. A variety of ridge preservation techniques using tissue and augmentative materials have been proposed in the literature. A slightly different approach is to use the tooth itself. Root submergence has been reported in the literature for more than 4 decades, and it has been demonstrated that the submerged tooth root retains the periodontal tissues and preserves the bone in pontic sites or below dentures to retain the ridge. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results that are highly promising to esthetic implant treatment. The pontic shield technique preserves the alveolar ridge at sites intended for pontic development where the root submergence technique is not possible. The aforementioned techniques collectively may be termed partial extraction therapies (PET), a term newly introduced into the literature and clinical environment. This article is a review of these ridge preservation therapies, providing a classification and a guide to their application.

Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal ligament apparatus. Root submergence has been demonstrated to retain the periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.

DPhil, North-West University, Potchefstroom Campus Digital technology is a contemporaneous, encompassing phenomenon that necessitates philosophical investigation, particularly with regard to how the individual relates to digital technology artefacts. However, contemporary methodologies in Philosophy of Technology, that became prominent after the empirical turn, such as pragmatism and social constructivism, reduce the phenomenon of digital technology to a form of social epistemology far removed in scope from the individual. On the other hand, posthumanism as approach towards technology questions the inherent embodied facticity of the individual by speculatively postulating a modification and alteration of the human being in such inquiries. These methodological approaches suggest a rationalistically motivated disembodiment that underlies descriptions of the phenomenon of digital technology - in such accounts there is little recognition of the individual beyond the social, little recognition of facticity in terms of the individual's embodiment, and little understanding of the digital technology artefact beyond the artefactual. A full understanding of the richly intertwined and mutable dialectical relation between the embodied individual and the digital technological artefact is absent. Embodiment, per the phenomenology of Merleau-Ponty, presents an alternative methodological approach for seeing this relationship within the phenomenon of digital technology anew. The facticity of the individual's body serves as vital framework for perception of the world and for interpersonal interaction, while also presenting a crucial point of access to the phenomenon of digital technology (which is itself continually changing and which may become hidden through continued use). Merleau-Ponty's concept of embodiment (and his later ontological concept of flesh) suggest the potential for a re-conceptualization of the phenomenon of digital technology by means of the concept of the Embodied Screen, which encompasses the embodied individual and the digital technology artefact to enlighten unique emergent characteristics in the phenomenon of digital technology that arise in this relation. These characteristics, rather than being tangential, must vitally be accounted for to allow a foundational, encompassing and multimodal description of the phenomenon of digital technology. Digital technology artefacts challenge the individual's perceptual faith through the constant immersion of the individual by digital technology artefacts. This challenge to perceptual faith necessitates imaginative signification, but through the Embodied Screen a continual and prominent level of imaginative signification is revealed that alters the individual's perception and behaviour. Furthermore, language use is revealed to be an ontologically concretizing force by means of the Embodied Screen. Such emergent characteristics fundamentally alter the individual's sense-making of the self, the world and the other, through the phenomenon of digital technology. The Embodied Screen thus also allows a re-evaluation of the digital technology artefact itself, which is seen to function as conduit for the individual's sense-making of the world by its capacities for latticing storytelling. Doctoral