Search PubMed⌕ Search

Biomedical subjects

E Gouws

Publications and source records attributed to E Gouws.

At least 55 records · Page 3Linked to original sources
PubMed1997

Risk factors for neonatal tetanus in KwaZulu-Natal.

OBJECTIVE: To study cases of neonatal tetanus (NNT) in an intensive care unit (ICU) to support formulation of appropriate intervention strategies. SITE: Paediatric ICU, King Edward VIII Hospital, Durban. METHOD: (i) Trend in number of admissions with NNT between 1983 and 1993; (ii) prospective study of NNT cases admitted during 1993. RESULTS: The mean annual admission rate decreased from 41 cases before 1985 to 24 cases between 1985 and 1988 and 18 cases between 1989 and 1992. There were 27 cases in 1993. Most patients in 1993 were from informal settlements, squatter camps and rural areas (44%, 22% and 22% respectively). All 27 patients were delivered at home. Fourteen mothers (52%) had attended an antenatal clinic; 12 of them had attended at least twice. Fifteen mothers had used a clean sterile instrument to cut the cord. Only 1 mother had used cow dung to staunch blood flow from the severed cord. Ninety-three per cent of cases were severe; the overall mortality rate was 22%. The mean duration of ventilation was 23 days (range 17-60 days) and of ICU stay 35 days (range 13-87 days). CONCLUSIONS: These results suggest that the promotion of the maternal immunisation campaign is perhaps the most important factor for the elimination of NNT. Measures should be taken to ensure universal coverage with tetanus toxoid of all pregnant women, and coverage of all women of reproductive age in underserved areas.

Female↗
PubMed1997

An evaluation of the respiratory health status of automotive spray-painters exposed to paints containing hexamethylene di-isocyanates in the greater Durban area.

OBJECTIVE: A survey of automotive spray-painting establishments was undertaken to evaluate the respiratory health status of spray-painters exposed to paints containing hexamethylene di-isocyanates (HDIs). DESIGN: This was a cross-sectional study. SETTING: Spray-painting establishments in the Durban municipal area. PARTICIPANTS: Spray-painters from a random sample of 40 (25%) of the registered spray-painting establishments were studied. MAIN OUTCOME MEASURES: Responses to an Interviewer-administered standardised respiratory health questionnaire and a cross-shift spirometric lung function test were obtained for each spray-painter, questionnaires assessing the firm's compliance with the spray-painting safety requirements were also obtained. RESULTS: The mean cross-shift decrease in forced expiratory volume in 1 second (FEV1) was 130.5 ml (SD 203.19) (P = 0.0002). The lung function data indicated that of the 40 spray-painters examined, 10 (25%) showed clinically significant cross-shift decreases in FEV1, viz, decreases > 250 ml. Only 2 subjects had a diagnosis of asthma. Chronic respiratory symptoms of cough, wheeze and wheeze with breathlessness were similar to those noted in community-based studies. A high proportion had eye irritation (55%) and dermatitis of the hand (32%). The potential determinants of FEV1 were examined in a multiple linear regression analysis and only the isocyanate concentration levels approached statistical significance (P = 0.082), suggesting that other factors such as duration of exposure, spray-paint 'bounce-back' phenomenon, and 'healthy worker' effect may be more important. ('Bounce back' refers to the phenomenon whereby some of the mist from the spray-gun, after striking the surface being painted, is deflected back into the operator's breathing zone in the form of fine droplets or aerosols.) Forty per cent of the 40 spray booths had ventilation standards substantially below that specified in current South African legislation. Only 21 (55%) spray-painters were provided with the regulation respiratory protective equipment, and in the cases where it was provided, 7 (33%) of these spray-painters used the positive pressure air-line respiratory recommended by the leading manufacturers of isocyanate-based paints. CONCLUSIONS: The findings in this study confirm the risk of exposure to HDIs in the spray-painting industry and highlight the need for more stringent industrial hygiene controls.

Adult↗
PubMed1997

Haemodynamic response to tracheal intubation or laryngeal mask insertion in hypertensive patients.

The haemodynamic response to laryngeal mask insertion and tracheal intubation was studied in 27 hypertensive patients who underwent elective ophthalmic surgery. Both groups received alfentanil 15 micrograms/kg, thiopentone 3-4 mg/kg and vecuronium 0.1 mg/kg and were ventilated with oxygen, nitrous oxide and isoflurane for 3 minutes prior to laryngeal mask insertion or tracheal intubation. Blood pressure and heart rate decreased equally in both groups after induction of anaesthesia. Haemodynamic variables increased after tracheal intubation but were unchanged after laryngeal mask insertion (P < 0.05 for intergroup differences). Heart rate, but not blood pressure, increased above baseline levels in the tracheal intubation group. The anaesthetic technique used blunted the haemodynamic response to tracheal intubation, but completely blocked the response to laryngeal mask insertion.

Adult↗
PubMed1997

Lymphocyte subset changes between 3 and 15 months of age in infants born to HIV-seropositive women in South Africa.

The evolution of T-lymphocyte subsets during infancy in perinatally HIV-infected African babies has not been previously described. In a hospital-based cohort study, T-lymphocyte subset changes were investigated in 72 South African black children born to HIV seropositive mothers. Sixteen (22.2%; children were classified as infected and 56 (77.8%) as uninfected by 18 months of age. Four (25%) of the infected infants died before the age of 9 months from HIV-related disease. The CD4 and CD8 T-lymphocyte subsets, expressed in absolute numbers, as percentages, percentiles or as ratios, were clear indicators of HIV infection at all ages between 3 and 15 months. The most marked changes were a decreased percentage of CD4 cells and an increase in percentage of CD8 cells in the infected group. In the 4 infected infants who died, CD8 count and CD4:CD8 ratio clearly predicted poor clinical outcome at 3 months. Taken together, both CD4:CD8 ratio and CD4 percentage are reliable markers of HIV infection in an African paediatric population; however, a raised CD8 lymphocyte count rather than a CD4 count is a more specific prognostic marker of disease progression in HIV infected children.

Age Factors↗
PubMed1997

Development of a health programme in a peri-urban informal settlement in Besters, KwaZulu-Natal.

OBJECTIVES: The demographic, socio-economic and environmental status of the peri-urban informal settlement of Besters and its inhabitants' health, welfare and disability profiles were investigated for the development of a community-based health intervention programme. STUDY DESIGN: A cross-sectional study using a structured household questionnaire assessed community health status in July 1991 in order to identify specific health and development needs through focus group discussions and community consultations. A health and development programme was established during 1992. Community participation in this programme was then assessed by measurement of the components of the health and development programme, categorised as inputs (resources), processes (activities), outputs (effects) and outcomes. SETTING: Besters, an informal peri-urban settlement north of Durban, KwaZulu-Natal. SUBJECTS: Residents of Besters. RESULTS: The demographic, environmental and morbidity profiles of Besters were consistent with both South African and international studies of informal communities. Patterns of health service utilisation reflected inappropriate use of the tertiary hospital in the city centre, grossly fragmented patterns of utilisation--both for preventive and curative care and for antenatal and maternity services--and, finally, a discordance between community health needs and ability to pay for services. The interaction between input, process and output measures of community participation are discussed. CONCLUSION: Integration of health service provision with other infrastructural development, based on community perceptions, enhances health development and community participation. Important lessons emerged about the strengths and limitations of community participation and its relevance for other communities.

Community Health Planning↗
PubMed1997

Levels of health care at academic and regional hospitals in KwaZulu-Natal.

OBJECTIVE: To assess the levels of health care based on hospital bed utilisation at seven academic and regional hospitals in KwaZulu-Natal. DESIGN: A prospective study. The registrar in charge of patients documented the level of care needed for each patient over 7 consecutive days. Independent assessment by consultants was used to validate the results. SETTING: All wards in public sector regional and tertiary hospitals with acute general beds in Durban and Pietermaritzburg, except intensive care, coronary care and respiratory units. PARTICIPANTS: All inpatients present in the wards. The response rate of wards participating in the study varied between hospitals from 32% to 75%. Data on 14,858 patient days were analysed. OUTCOME MEASURES: Inpatients were classified according to levels of care based on patient days. RESULTS: The proportion of patients in the tertiary (King Edward) and regional hospitals requiring levels of care below that for which the hospital was designated ranged from 54% to 72% of the patient days. Wentworth Hospital, which is a tertiary referral centre, had 30% of its patient days judged to be below the designated level. Patient days below the designated level of care for that hospital were significantly higher in tertiary than in regional hospitals (P < 0.001). CONCLUSIONS: All seven hospitals admitted patients at levels of care below that for which the hospital was designated. These findings have important implications for the efficient utilisation and planning of health and hospital services, and for their evaluation and management.

Bed Occupancy↗
PubMed1996

The distribution of common intestinal nematodes along an altitudinal transect in KwaZulu-Natal, South Africa.

In order to study the effect of climate and topography on the distribution of common, intestinal nematodes in schoolchildren, changes in prevalence were investigated along an altitudinal transect from approximately 50 m above sea level (asl), near the coast, to approximately 1700 m asl, in the foothills of the Drakensberg Mountains, KwaZulu-Natal, South Africa. These changes were related to several permutations of temperature, rainfall and evaporation, using univariate and multiple regression analyses. A total of 693 primary schoolchildren aged between 7 and 15 years was examined from six communities along the 150-km transect. Changes in the prevalence of Trichuris trichiura were significantly correlated with temperature-derived variables whereas those of Ascaris lumbricoides and Necator americanus were correlated with rainfall-derived variables. A total of 17 parasite species was recovered along the transect but polyparasitism was negatively correlated with altitude.

Adolescent↗
PubMed1996

Thrombelastography changes in pre-eclampsia and eclampsia.

We have measured platelet count, bleeding time and thrombelastography (TEG) variables and the correlation between these variables in 49 pregnant patients presenting with pre-eclampsia or eclampsia. Eighteen patients (37%) had a platelet count < or = 150 x 10(9) litre-1 and seven (14%) had a platelet count < or = 100 x 10(9) litre-1. Bleeding time was prolonged > 9.5 min in 13 (27%) patients and the TEG was abnormal in four (8%). The TEG variables, k time and maximum amplitude (MA) had a strong correlation with platelet count (k time-platelet count < or = 150 x 10(9) litre-1, r = -0.68, P = 0.003, platelet count < or = 100 x 10(9) litre-1, r = -0.84, P = 0.02; MA--platelet count < or = 150 x 10(9) litre-1, r = 0.72, P = 0.001, platelet count < or = 100 x 10(9) litre-1, r = 0.78, P = 0.04). There was no correlation between bleeding time and thrombocytopenia (platelet count < or = 150 x 10(9) litre-1, r = -0.18, ns; platelet count < or = 100 x 10(9) litre-1, r = 0.09, ns). There was no correlation between bleeding time and any measured TEG variable. Of the 10 (20%) patients with an adequate platelet count (> 100 x 10(9) litre-1) but prolonged bleeding time, the TEG was normal, suggesting adequate haemostasis. An MA of 53 mm, which is the lower limit for normal pregnancy, correlated with a platelet count of 54 x 10(9) litre-1 (95% confidence limits 40-75 x 10(9) litre-1). Although the number of patients with severe thrombocytopenia was small, a platelet count of 75 x 10(9) litre-1 should be associated with adequate haemostasis.

Anesthesia, Conduction↗
PubMed1996

Sternomental distance as the sole predictor of difficult laryngoscopy in obstetric anaesthesia.

Sternomental distance and view at laryngoscopy were documented in 523 parturients undergoing elective or emergency Caesarean section under general anaesthesia. Eighteen (3.5%) had a grade III or IV laryngoscopic view (Cormack and Lehane's classification) and were classified as potentially difficult tracheal intubations. There was a significant difference between sternomental distance in those patients with a grade III or IV laryngoscopic view compared with those with a grade I or II (13.17 (SD 1.54) cm vs 14.3 (1.49) cm; P = 0.0013). A sternomental distance of 13.5 cm or less with the head fully extended on the neck and the mouth closed provided, using discriminant analysis, the best cut-off point for predicting subsequent difficult laryngoscopy. A sternomental distance of 13.5 cm or less had a sensitivity, specificity, positive and negative predictive values of 66.7%, 71.1%, 7.6% and 98.4%, respectively. While there was no association between sternomental distance and age, weight, height or body mass index (BMI), there was a significant association between grade of laryngoscopy (III and IV) and older (P = 0.049) and heavier (P = 0.0495) mothers. The results suggest that while sternomental distance on its own may not be an adequate sole predictor of subsequent difficult laryngoscopy the measurement should be incorporated into a series of quick and simple preoperative tests.

Adolescent↗
PubMed1996

Use of a mechanical simulator for training in applying cricoid pressure.

Using an airway management training model, we have assessed anaesthesia personnel in their use of correct cricoid force and ability to retain this skill after a short training programme. A perspex device, working on a hydraulic principle, was used to measure cricoid pressure when applied to the model. After initial assessment at two levels of cricoid force (20 and 40 N), participants undertook additional training on 3 consecutive days. Thereafter, available participants underwent reassessment at 14-21 days. Forty-nine anaesthetic assistants and anaesthetists underwent initial assessment and 18 completed the full training and reassessment. Untrained, the majority (63%) of participants applied inadequate cricoid force with a wide variation (mean 16.8 (SD 9.3) (range 4.5-43.0) at 20 N and 32.9 (13.3) (14.9-74) at 40 N). After a single training session there was a marked improvement in application of cricoid force. Two additional training sessions did not provide further improvement. After 14-21 days the ability of participants to apply correct cricoid force was retained by 72% of subjects. Those who applied inadequate cricoid force initially were more likely to do so even after training. Most subjects applied too great a cricoid force in the first 5 s of application followed by a progressive loss of force during the next 20 s. This trend improved after training. We conclude that the majority of untrained personnel apply inadequate cricoid force, placing patients at risk of aspiration of gastric contents. While a simple training programme improved application of cricoid force, retained for up to 3 weeks, there was often a substantial decrease in the force applied to the cricoid during a single application, even after training.

Anesthesiology↗
PubMed1996

Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound.

OBJECTIVE: To assess maternal middle cerebral artery flow velocity patterns as measured by transcranial Doppler ultrasound (TCD) in eclampsia and to investigate the effect of the anticonvulsants magnesium sulphate (MgSO4) and phenytoin on cerebral circulation. DESIGN: Prospective randomised study. SETTING: High care obstetric unit, King Edward VIII Hospital, Durban, South Africa. PARTICIPANTS: Twenty-four eclamptic patients: 13 received MgSO4 and 11 phenytoin. INTERVENTION: Middle cerebral artery flow velocity waveforms were measured using 2 MHz pulsed Doppler ultrasound via the transtemporal approach in eclamptic patients, before and 15 minutes after the loading dose of anticonvulsant. RESULTS: Magnesium sulphate significantly reduced the pulsatility index (P = 0.002) and mean flow velocity (P = 0.02) in the middle cerebral artery, whereas phenytoin failed to produce any statistically significant effect. However, differences between groups were not statistically significant. Systolic and diastolic blood pressures were reduced in both the MgSO4 and phenytoin groups. CONCLUSION: These findings provide firm evidence that MgSO4 relieves cerebral vasospasm, compared with phenytoin, and may therefore be the better drug for the prevention of eclamptic convulsion.

Adolescent↗
PubMed1996

Prognosis in posttraumatic acute renal failure is adversely influenced by hypotension and hyperkalaemia.

OBJECTIVE: To see if it is possible to predict mortality in isolated post-traumatic acute renal failure. DESIGN: Retrospective study 1984-1990 inclusive. SETTING: Teaching hospital, South Africa. SUBJECTS: Thirty-nine patients who developed isolated post-traumatic acute renal failure out of 106526 admissions for trauma. INTERVENTIONS: Standard aggressive management of traumatic injury and acute renal failure. MAIN OUTCOME MEASURE: Death. RESULTS: Fifteen of the 39 patients who developed post-traumatic acute renal failure died (39%). Blunt trauma from assaults was a major cause of acute renal failure (16/39, 41%). Hypotension and hyperkalaemia were the two main predictors of death having a mortality of 63% and 52%, respectively. CONCLUSION: Clinicians should be aware of the risks of hypotension and hyperkalaemia in injured patients. Preventive measures such as aggressive resuscitation and timely correction of serum electrolyte concentrations are essential in such patients.

Acute Kidney Injury↗
PubMed1996

Hepatitis B infection in black children from residential care facilities in KwaZulu-Natal. Implications for adoption and foster care.

OBJECTIVES: A study was undertaken to assess the prevalence of hepatitis B infection in selected residential child care facilities in Natal. DESIGN: All residents at three facilities in the Durban and Pietermaritzburg areas of KwaZulu-Natal were tested for markers of hepatitis B infection as part of a broader health status assessment. RESULTS: One hundred and ninety-five children between the ages of 3 and 194 months (78 +/- 47) were studied. Overall 66.2% of children had evidence of past exposure to hepatitis B virus. Of these 14.9% were positive for hepatitis B surface antigen, 13.3% for hepatitis B e antigen, 47.7% for hepatitis B surface antibody and 59.5% for hepatitis B core antibody. Relative rates of infection increased with age from 18.2%, 20% and 27.8% in the 1st, 2nd and 3rd years of life respectively to 72.2% and 88.2% in the 4th and 5th years of life. Relative rates of infection increased with duration of stay from 40% by the end of the 1st year to 100% by the end of the 5th year. CONCLUSIONS: This study has demonstrated a very high rate of infection with hepatitis B virus and a high prevalence of hepatitis B surface antigenaemia in residential care facilities. It has also shown that the infection is horizontally transmitted within these facilities, that infection increases with duration of stay, that there is a dramatic increase in infection rates after the 3rd year of life, that the highest carrier rates are occurring in children between the ages of 2 and 4 years, and that the vast majority of carriers are highly infectious. These children are not only at risk themselves for the long-term complications of this disease but also constitute an important reservoir of hepatitis B infection within the larger community. There is an urgent need for uniform national guidelines for the screening and management of children in residential care facilities and children being prepared for adoption or foster care. There is also a need for a wider investigation into conditions at residential care facilities previously designated for black children in this country.

Adolescent↗
PubMed1996

Severe and complicated malaria in KwaZulu-Natal.

OBJECTIVE: To describe severe and complicated malaria, including the common complications, causes of death and predictors of poor outcome. DESIGN: Retrospective case series. SETTING: King Edward VIII Hospital, Durban, Natal, a referral centre. PATIENTS: One hundred and forty-three consecutive patients (88 males, 55 females; median age 25 years, range 2-86 years) admitted with a microscopic diagnosis of Plasmodium falciparum malaria from 1984 to 1991. MAIN OUTCOME MEASURES: A univariate analysis comparing survival and death for categorical and continuous data for various complications was performed using the t-test or chi 2-test (or Fisher's exact test in the case of small cell sizes). Variables that showed significance on univariate analysis (P < 0.1) were used in a multivariate analysis to determine which contributed independently to survival or death. RESULTS: The case fatality rate was 11.1% (15/135) and the commonest complications were hyperparasitaemia (30%), renal failure (17%), acidaemia (14%), jaundice (10.4%) and cerebral malaria (6%). The commonest complications in patients who died were renal failure (10 patients), cerebral malaria (7), hyperparasitaemia (6) and severe anaemia (5). Multivariate analysis using a logistic regression model showed a high parasite load and cerebral malaria (relative risks of 11.9 and 51.8 respectively) and high urea levels to be the significant predictors of poor outcome (95% confidence intervals 1.53-91.9, 2.74-100.0 and 1.01-1.09, respectively). CONCLUSIONS: Patients with high parasite densities, cerebral involvement and renal dysfunction need urgent attention with parenteral chemotherapy, intravenous fluid replacement and early referral to a tertiary hospital with facilities for intensive monitoring and supportive treatment.

Adolescent↗
PubMed1995

Epidemiology and control of schistosomiasis mansoni in communities living on the Cuando River floodplain of East Caprivi, Namibia.

The Cuando River area of eastern Caprivi, Namibia, is highly endemic for Schistosoma mansoni whereas S. haematobium transmission, due to the scarcity of its intermediate host snail, Bulinus africanus, does not occur. Chemotherapy (6-monthly blanket treatments with praziquantel) combined with focal mollusciciding (monthly application of niclosamide) was used in a project in the area to control the disease. Although as many adults and pre-school children as possible were tested and treated, the project concentrated largely on school-age children. It took 3 years for prevalence to decline from > 80% to 20% because of a lack of proper sanitary facilities and piped water supplies and high rates of absenteeism and re-infection. However, intensity of infection decreased more rapidly, from an arithmetic mean of > 200 to < 5 eggs/g faeces. Hepatomegaly was common among school children when the project started but could be seen in only a small percentage of them after 3 years of control. Neither the bovine schistosome, S. mattheei, nor the lechwe schistosomes, S. margrebowiei and S. leiperi, were observed in the excreta of humans living in the area.

Adolescent↗
PubMed1995

Transcranial Doppler ultrasonography in hydrocephalic children with tuberculous meningitis.

Studies have shown a close correlation between congenital hydrocephalus (CH) and the Gosling pulsatility index (PI) determined by transcranial Doppler ultrasonography (TCD). There have not previously been similar studies in children with hydrocephalus from tuberculous meningitis (TBM), and in particular where arteritis is a prominent feature. Fifteen children from each of these two groups were prospectively examined by TCD before and after CSF diversion. Fifteen children without hydrocephalus were similarly evaluated as controls. The fall in PI following surgery was compared. The mean fall in PI in the congenital hydrocephalic group was 0.723 (SD, 0.42) as compared with 0.089 (SD, 0.16) in the TBM group (p = 0.0001). Ten of the 15 children in the TBM group had infarcts revealed by CT. In these, the PI significantly postoperatively (p = 0.004), (0.014; SD, 0.12) when compared with values obtained (0.24; SD, 0.11) in five children without infarcts. These findings indicate that the clinically relevant fall in PI following CSF diversion in children with congenital hydrocephalus does not necessarily occur in children with hydrocephalus secondary to TBM, especially when complicated by cerebral infarcts.

Blood Flow Velocity↗
PubMed1995

Skin-epidural distance in children.

The skin-epidural distance was measured in 274 children to assess the usefulness of 1 mm.kg-1 as a guideline. Children aged between 2 days and 16 years, weighing between 2 and 43 kg were investigated. Lumbar epidurals were performed under general anaesthesia using a midline approach in the L3-4 interspace with the patient in the lateral position. Good correlation between skin-epidural distance and age and weight was demonstrated. No statistical difference was shown when plotting the best fit regression line: skin-epidural distance (mm) = 0.8 weight (kg) + 3.93 (R2 = 0.74) and its 95% confidence limits and skin-epidural distance (mm) = weight (kg) for children between 6 months and 10 years. Poor correlation was noted below 6 months (n = 22) and over 10 years (n = 19). No dural puncture or bloody tap occurred. One mm.kg-1 body weight was shown to be a useful guideline for children between 6 months and 10 years of age.

Adolescent↗