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Biomedical subjects

A J Brink

Publications and source records attributed to A J Brink.

At least 19 recordsLinked to original sources
PubMed2004

Guideline for the management of upper respiratory tract infections.

INTRODUCTION: Inappropriate use of antibiotics for upper respiratory tract infections (URTIs), many of which are viral, adds to the burden of antibiotic resistance. Antibiotic resistance is increasing in Streptococcus pneumoniae, responsible for most cases of acute otitis media (AOM) and acute bacterial sinusitis (ABS). METHOD: The Infectious Diseases Society of Southern Africa held a multidisciplinary meeting to draw up a national guideline for the management of URTIs. Background information reviewed included randomised controlled trials, existing URTI guidelines and local antibiotic susceptibility patterns. The initial document was drafted at the meeting. Subsequent drafts were circulated to members of the working group for modification. The guideline is a consensus document based upon the opinions of the working group. OUTPUT: Penicillin remains the drug of choice for tonsillopharyngitis. Single-dose parenteral administration of benzathine penicillin is effective, but many favour oral administration twice daily for 10 days. Amoxycillin remains the drug of choice for both AOM and ABS. A dose of 90 mg/ kg/day is recommended in general, which should be effective for pneumococci with high-level penicillin resistance (this is particularly likely in children < or = 2 years of age, in day-care attendees, in cases with prior AOM within the past 6 months, and in children who have received antibiotics within the last 3 months). Alternative antibiotic choices are given in the guideline with recommendations for their specific indications. These antibiotics include amoxycillin-clavulanate, some cephalosporins, the macrolide/azalide and ketolide groups of agents and the respiratory fluoroquinolones. CONCLUSION: The guideline should assist rational antibiotic prescribing for URTIs. However, it should be updated when new information becomes available from randomised controlled trials and surveillance studies of local antibiotic susceptibility patterns.

Acute Disease↗
PubMed2004

Appropriate use of the carbapenems.

The carbapenems are a group of broad-spectrum beta-lactam antibiotic agents of which there are three parenteral preparations currently available in South Africa, namely imimpenem/cilastatin, meropenem and ertapenem. Owing to the fact that imipenem/cilastatin and meropenem have a broad spectrum of activity that includes Pseudomonas and Acinetobacter species, they are ideal antibiotics for treatment of severe nosocomial infections. In contrast, ertapenem has limited in vitro activity against the latter non-fermentative gram-negative bacteria and is therefore more suitable for the treatment of certain severe community-acquired infections. This statement arises out of concerns about the general abuse of antibiotics such as the carbapenems, with the primary intention of highlighting the appropriate use of these agents.

Anti-Bacterial Agents↗
PubMed1995

Shewanella (Pseudomonas) putrefaciens bacteremia.

Shewanella (Pseudomonas) putrefaciens is a rare pathogen in humans, and to our knowledge only 13 cases of S. putrefaciens bacteremia have ever been reported in the literature. In this retrospective study we describe 28 cases of S. putrefaciens bacteremia: 16 in premature and 1-day-old neonates, 9 in adults, and 3 in children younger than 1 year of age. All the babies presented with respiratory distress and/or pneumonia. Six of the adults had associated traumatic lesions of the lower extremity, and of the eight patients who died of sepsis, six were neutropenic. Polymicrobial bacteremia was seen in 18 cases. Three syndromes of bacteremic infection with S. putrefaciens appear to exist: the first is associated with prematurity and congenital pneumonia; the second with ulceration of the lower extremities; and the third (which is more fulminant), with an underlying debility. The findings in these 28 cases confirm the fact that S. putrefaciens can invade the bloodstream; however, the presence of concurrent bacteremia makes it difficult to determine the pathogenic role of this organism in septicemia.

Adolescent↗
PubMed1995

Atypical Mycobacterium and breast surgery.

An unusual case of atypical mycobacterium infection following breast ptosis correction is described. This was successfully treated with a combination antibiotic regime. Breast surgery and atypical mycobacterium is discussed with reference to diagnosis management and suggested treatment regimes.

Adult↗
PubMed1991

Women doctors in South Africa. A survey of their experience and opinions.

The proportion of women entering medical school has increased at some faculties but remains at around 20% at others. A postal survey of 2,626 women on the Medical Register of the South African Medical and Dental Council was conducted to investigate aspects related to their work. Fifty-five per cent responded, with a possible bias towards older doctors and graduates from Afrikaans-language faculties. Although a significant majority (86.5%) are in practice, about one-third (33.4%) are employed part-time and nearly one-third (29.4%) reported that they had experienced an interruption of their careers for periods of more than 5 years. Major factors relating to this wastage of medical resources identified by this study were the women's dual responsibility at home and at work, the one-time joint taxation system and discrimination in the workplace, in particular with regard to housing loans. Few women find their way into specialist practice (10.8%) [corrected], although 68.2% indicated that they would have liked to specialise. Home responsibilities (48.2%) and the structure of the curriculum (31.5%) were the commonly reported difficulties experienced with further study. In addition, the lack of part-time training and the geographical location of such facilities also played a role.

Adult↗
PubMed1988

Progressive familial heart block (type I). A follow-up study after 10 years.

A follow-up study was done on 55 patients, all members of families with type I progressive familial heart block (PFHB) examined during 1977. Of the 55 patients 5 had died, 17 had normal ECGs while 7 with previously abnormal ECGs remained unchanged. All the others had progressed to a more severe form of heart block and 8 of them had received permanent pacemakers. These findings again emphasize the importance of regular ECG follow-up examinations of members of PFHB families.

Adolescent↗
PubMed1988

Selection of medical students at a medical faculty in South Africa.

The selection procedure at one medical faculty in the RSA was investigated. Students were admitted to the M.B. Ch.B. course on the basis of school results. Four groups were studied: matriculants; those selected after completing the 1st year of a B.Sc. course; those who had completed a full B.Sc. course; and those who had experience and other qualifications after leaving school. The matriculants were by far the largest group and the analysis of their marks received emphasis. Students who registered for their 1st year in 1980-1983 were followed up until the middle of their 3rd year. In total 635 students were assessed. The students' school results were compared with their preclinical marks. Chi-square tests for independence, multiple regression analysis, Pearson correlation coefficients and canonical correlation analysis were carried out. Although the results reflected a significant relationship between good selection marks and preclinical achievement, the strength of the association was too small for selection marks to have any reliable predictive value for an individual student. There was a low drop-out rate (5.4%) during the 1st year of study, but this rate increased threefold to 17.2% during the remaining preclinical period. This may indicate that the selection criteria were not specific enough to avoid this relatively large loss of students.

Educational Measurement↗
PubMed1986

The internship year in the RSA--a need for change.

A survey of all interns doing their compulsory internship year in the RSA during 1982 and 1983 was carried out by means of a questionnaire (978 interns responded, a response rate of about 85%). Various problem areas were identified, most notably long working hours, insufficient opportunities to practice required procedures, heavy clerical duties leaving little time for training, lack of formal training, and negative attitudes engendered towards the medical profession. The significance and impact of the internship year is evaluated and the way in which South African Medical and Dental Council regulations are applied is examined. Recommendations for improvements in the effectiveness of interns' training are made.

Attitude↗
PubMed1986

Progressive familial heart block. Part I. Extent of the disease.

Progressive familial heart block (type I) has been identified in the RSA. Since 1977 many families have been referred for pedigree tracing. The present probands of some 9 pedigrees are the descendants of specific children of an immigrant; other genetic diseases appear in these pedigrees. The necessity of identifying, diagnosing and possibly treating the descendants of carriers is emphasized.

Heart Block↗