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Biomedical subjects

D Wilkinson

Publications and source records attributed to D Wilkinson.

At least 199 records · Page 11Linked to original sources
PubMed1997

Epidemic shigella dysentery in children in northern KwaZulu-Natal.

OBJECTIVES: To describe the epidemiology, clinical features, management and outcome of children with Shigella dysenteriae type I infection admitted to a rural district hospital. DESIGN: Prospective cohort study. SETTING: Hlabisa Hospital, KwaZulu-Natal. SUBJECTS: Children aged under 12 years admitted with a history of bloody mucoid diarrhoea between February and December 1995. MAIN OUTCOME MEASURES: Number of admissions, age, sex, clinical features, complications and outcome. RESULTS: Between February and December 1995, 158 cases of bloody diarrhoea were admitted, compared with 6 the previous year. Shigella dysenteriae type I, resistant to ampicillin, tetracycline, chloramphenicol, trimethoprim and sulphamethoxazole, but susceptible to nalidixic acid and ceftriaxone, was isolated. The mean age of patients was 30 months. Patients typically presented with frequent bloody mucoid diarrhoea, fever, abdominal pain and dehydration. One hundred and sixteen (73%) recovered, 17 (11%) were transferred for tertiary care, 4 (3%) absconded, and 21 died (case fatality rate = 13%; 95% confidence interval (CI) 8-20). Seventeen (11%) developed haemolytic uraemic syndrome and 4 (3%) a protein-losing enteropathy. The malnourished (adjusted relative risk (RR) 3.3, 95% CI 1.6-7.1; P < 0.01) and those aged less than 2 years (adjusted RR 4.2; 95% CI 1.0-17.2; P = 0.05) were more likely to die. Dysentery deaths accounted for 19% of total paediatric hospital mortality. CONCLUSION: A serious epidemic of shigella dysentery has established itself and is having a significant impact in this area. The virulence and drug resistance of the organism has resulted in high levels of morbidity and mortality. Broad public health measures will be needed to contain the epidemic. Further community-based surveillance is urgently needed, as is research to determine modes and risk factors for transmission.

Anti-Bacterial Agents↗
PubMed1997

The increasing burden of tuberculosis in rural South Africa--impact of the HIV epidemic.

OBJECTIVE: To determine the impact of the HIV epidemic on tuberculosis caseload in rural South Africa. SETTING: Hlabisa health district, KwaZulu-Natal. METHODS: Demographic and clinical data were extracted from the tuberculosis database for the period, May 1991-June 1995. The attributable fraction of HIV-infected tuberculosis cases was estimated from the prevalence of HIV infection in tuberculosis cases and the prevalence of HIV infection in women attending antenatal clinics. RESULTS: Between 1991 and 1995, the annual tuberculosis caseload increased from 301 to 839 cases. Tuberculosis accounted for 4.7% of all admissions in 1989 and 8.3% in 1995 (P < 0.0001). The incidence of tuberculosis increased from 154/100,000 in 1991, to 413/100,000 in 1995. The proportion with smear-positive pulmonary disease fell from 65% to 56% (P = 0.04), and pleural tuberculosis accounted for 7.5% of disease in 1991 and 18% in 1995 (P = 0.002). The minimum HIV prevalence in patients with tuberculosis increased from 8.7% in 1991 to 28.3% in 1995, and the proportion of tuberculosis cases attributable to HIV infection was estimated to be at least 44% in 1995. CONCLUSION: The burden of HIV-related tuberculosis is increasing rapidly in rural South Africa and is exerting a negative impact. Innovative approaches to control will be needed to cope with it effectively.

AIDS-Related Opportunistic Infections↗
PubMed1997

Costs and cost-effectiveness of alternative tuberculosis management strategies in South Africa--implications for policy.

OBJECTIVE: To conduct an economic analysis of the Hlabisa community-based directly observed therapy management strategy for tuberculosis and to project costs of three alternative strategies. SETTING: Hlabisa health district, KwaZulu-Natal, South Africa. METHODS: An economic analysis comparing the current tuberculosis management strategy in Hlabisa with three alternative strategies (the Hlabisa strategy prior to 1991 based on hospitalisation, the national strategy and sanatorium care) in terms of costs to both health service and patient and of cost-effectiveness. RESULTS: The current Hlabisa strategy was the most cost-effective (R3799 per patient cured), compared with R98307 for the strategy used prior to 1991, R9940 for the national strategy, and R11145 for sanatorium care. Between 71% and 88% of treatment costs lie with the health service, and hospitalisation (R119 per day) is the most expensive item. Prolonged hospitalisation is extremely expensive, but community care is cheaper (community clinic visit, R28; community health worker visit, R7). The total cost of supervising a patient in the community under the current Hlabisa strategy was R503, equivalent to 4.2 days in hospital. Drug costs (R157) are equivalent to just 1.3 days in hospital. CONCLUSION: Cost to both health service and patient can be substantially reduced by using community-based directly observed therapy for tuberculosis, a strategy that is cheap and cost-effective in Hlabisa. These findings have important national implications, supporting the goals of the new tuberculosis control programme.

Cost of Illness↗
PubMed1997

Maternal and child health indicators in a rural South African health district.

OBJECTIVE: To measure important maternal and child health indicators in a rural health district as part of the process of developing a comprehensive district health information system. DESIGN: A modified Expanded Programme on Immunisation cluster sample survey. SETTING: Hlabisa health district, KwaZulu-Natal. PARTICIPANTS: 480 mothers (or carers) of children aged 12-35 months surveyed in 32 clusters. INTERVENTIONS: A questionnaire was administered and Road-to-Health cards were examined. MAIN OUTCOME MEASURES: Proportion of women receiving antenatal care and delivering in a health facility; knowledge and understanding of vaccination; and recall of vaccination history. Proportion of children with a Road-to-Health card, overall coverage of each vaccine, coverage at 12 months of age and proportion receiving an immunogenic dose. RESULTS: Most mothers (91%) had attended antenatal care, 77% had received tetanus toxoid and 83% delivered in a health facility. Only 14 children (3%) had never received a Road-to-Health card and 73% had one available at the time of the survey. Overall immunisation coverage was high (80-98%), as was the proportion receiving an immunogenic dose of each vaccine (78-98%). However, only 76% had received all the vaccines due to a 12-month-old child, and only 88% of these had received all doses by 12 months of age. CONCLUSIONS: While the key maternal health indicators measured here are reassuring, there is still room for improvement in the child health indicators. The proportion of women receiving antenatal care and delivering in a health facility is very high, but the proportion of children receiving all vaccines can be improved upon, as can the timing of immunisation. The results of this survey are being used to strengthen further the primary health care services in the district.

Adult↗
PubMed1997

Cost-effective on-site screening for anaemia in pregnancy in primary care clinics.

OBJECTIVE: To determine the feasibility, accuracy and cost of developing a system of on-site screening for anaemia in pregnancy in primary care clinics. SETTING: Mobile clinic team in Hlabisa health district, KwaZulu-Natal. METHODS: Four hundred and forty-nine consecutive women attending antenatal clinics were screened for anaemia (haemoglobin < 10 g/dl) using copper sulphate solution; the results were compared with true haemoglobin levels as determined by an automated analyser. Three hundred women had haemoglobin concentration estimated with a portable haemoglobinometer and results compared with those from the automated analyser. RESULTS: Screening with copper sulphate solution was highly sensitive (95.7%) but had low positive predictive value for anaemia (37.2%). Haemoglobin concentration estimated by haemoglobinometer correlated highly with results from the analyser (r = 0.82; P < 0.0001), and the mean difference in concentrations between the two methods was 1.1 g/dl. The average cost of screening all women with copper sulphate solution (6 cents/sample) and determining the true concentration in those screened as possibly anaemia (R2.64/sample) was 72 cents per woman. The cost of using an automated analyser was R6.20 per sample. CONCLUSION: Combined use of copper sulphate solution and a haemoglobinometer is a feasible, accurate and cost-effective way of screening for and diagnosing anaemia in pregnant women, on-site, in primary care clinics.

Anemia↗
PubMed1997

Paediatric burns in a rural South African district hospital.

OBJECTIVES: To describe the epidemiology, clinical features, management and outcome of children with burns admitted to a rural district hospital. DESIGN: A retrospective analysis of the case notes of consecutive cases of paediatric burns. SETTING: Hlabisa Hospital, KwaZulu-Natal-a 450-bed rural district hospital serving approximately 200,000 people. SUBJECTS: All cases of paediatric burns (age < 12 years) admitted to Hlabisa Hospital in 1994. MAIN OUTCOME MEASURES: Number of admissions, month of admission, age, sex, time to presentation, site of burn, complications, number of surgical procedures, adherence to management protocol and outcome. RESULTS: One hundred and forty-nine children presented to the outpatient department in 1994 and 88 (59%) were admitted. The median age of those admitted was 36 months with 66 (75%) aged less than 5 years; 42 (48%) were boys. Thirty-nine children (44%) were admitted during the four winter months of May to August. The average interval from the time of the burn to presentation at hospital was 42 hours (range 1-120). Sixty-eight burns (77%) were due to hot fluid or food burning the legs, trunk or arms. There was a high level of morbidity. Nineteen (22%) children developed wound infections, 5 (6%) developed contractures and 20 (23%) required a total of 32 surgical procedures. There was 1 death. Burns were responsible for more paediatric patient days spent in hospital than any condition other than malnutrition, and a longer length of stay was associated with delay in presentation. Children presenting within 24 hours of the burn had a mean length of stay of 12.8 days, compared with 25.2 days (P = 0.03) for children presenting 24 hours or more after the burn. Twenty of the 22 children who stayed for longer than 3 weeks or who required transfer were judged to have been managed inadequately in at least one respect compared with 3 of 48 who were discharged within 2 weeks or not transferred (P < 0.001). CONCLUSION: This study shows that paediatric burns are an important cause of morbidity and contribute significantly to inpatient stay in this rural setting. The lengthy delay from time of burn to presentation at hospital is of serious concern and our results show that this delay is associated with increased hospital stay. As most burns were due to spillage of hot fluids or food there seems to be significant potential for preventive interventions. Community-based studies would help to estimate the true incidence of burns and would contribute to an understanding of the reasons for delay in presentation. The information gathered is being used to inform the development of a burns prevention programme.

Burns↗
PubMed1996

Cofactors provide the entry keys. HIV-1.

The identification of the cofactors required for HIV-1 entry into cells promises to provide new insights into viral transmission and pathogenesis, and opens new avenues for AIDS therapy and prophylaxis.

CD8-Positive T-Lymphocytes↗
PubMed1996

Choice of microbial host for the naphthalene dioxygenase bioconversion.

The use of whole cell biotransformations for single and multistep enzyme conversions is gaining widespread application. In this study the naphthalene dioxygenase nah A gene was transferred into Pseudomonas aeruginosa PAC 1R, Escherichia coli JM107 and Pseudomonas putida PpG 277. The effect of ethanol on these genetically engineered Gram-negative bacteria was studied by measurement of enzyme activity, stability and cell integrity. Ethanol has been used in biotransformations as a co-substrate carbon source for co-factor recycling and as a co-solvent increasing dissolved substrate and product levels. Ethanol increased the dissolved substrate (naphthalene) concentration slightly and dissolved product ((+)-cis-(1R,2S)-dihydroxy-1,2-dihydronaphthalene) by approximately 30% at 4% (w/v) ethanol. Both P. aeruginosa PAC 1R and P. putida PpG 277 showed decreased activity with increasing ethanol concentration whilst E. coli enzyme activity increased with increasing ethanol concentration being comparable to that when glucose was used as a carbon source. This project highlighted the many factors involved in the selection of microbial hosts for whole cell biotransformation processes.

Biotransformation↗
PubMed1996

A radioimmunoassay combined with solid-phase extraction for the determination of a novel anti-obesity agent, ARL 15849XX, in dog plasma.

A radioimmunoassay has been developed for the determination of ARL 15849XX, a cholecystokinin-8 (CCK-8) analogue, in dog plasma. The method incorporates solid-phase sample extraction and is suitable for the determination of the analyte at picogram per millilitre concentrations. The antiserum was raised in Suffolk-cross sheep following primary and booster immunisations with an immunogen prepared by conjugating ARL 16935XX, an analogue of ARL 15849KF, to bovine serum albumin. The radioligand was prepared by the no-carrier-added 125I iodination of a non-sulphated derivative, ARL 15745XX. The solid-phase extraction procedure, carried out using ion-exchange aminopropyl and octadecyl sorbents sequentially, was introduced to remove matrix interferences in the plasma and to enhance the method sensitivity. The calibration range is 20-1000 pg ml-1, using a 1 ml sample of undiluted dog plasma.

Amino Acid Sequence↗
PubMed1996

A radioimmunoassay for the determination of tipredane in human plasma.

A sensitive method for the determination of tipredane in human plasma has been developed. Prior to radioimmunoassay, proteins are removed from plasma by precipitation with acetonitrile. A [125I]iodohistamide derivative of tipredane is used as a heterogeneous radioligand. The primary antiserum is raised in sheep against a tipredane (O-carboxymethyl) oxime-bovine serum albumin conjugate. Donkey anti-sheep IgG antiserum is used as the secondary antiserum in a double antibody separation procedure. The limit of quantification of the method is 1 ng ml-1 for 500 microliters of plasma. There is no significant interference from either established or putative metabolites of tipredane, endogenous steroids or a wide range of other drugs. The assay was used to determine the concentrations of tipredane in plasma samples collected in pilot clinical studies.

Administration, Topical↗