Appropriateness of patient attendance at specialist clinics in public hospitals in eThekwini municipality.
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Cross-Sectional Studies↗
Biomedical subjects
K Naidoo
Publications and source records attributed to K Naidoo.
Disseminated nocardiosis masquerading as abdominal tuberculosis.
A 32-year-old patient was admitted with a community-acquired pneumonia. She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis. While in the ward she developed an acute abdomen necessitating laparotomy, at which a diagnosis of abdominal tuberculosis was made. Sputum and intraoperative pus specimens grew a multiresistant Nocardia brasiliensis. Microbiological investigations for tuberculosis were negative. The patient died after a short ICU admission from multiple organ dysfunction syndrome.
Adult↗
An epidemiological perspective of substance use among high school pupils in rural KwaZulu-Natal.
OBJECTIVES: To investigate prevalence and the factors influencing substance use among rural high school pupils in KwaZulu-Natal in order to develop and implement intervention programmes. DESIGN: Cross-sectional study. SETTING: Twenty-eight high schools in southern KwaZulu-Natal. SUBJECTS: One thousand three hundred and eighteen grade 10 pupils. OUTCOME MEASURES: An anonymous self-reporting questionnaire was used to investigate the use of alcohol, tobacco (cigarettes), cannabis and solvents. RESULTS: Of the male scholars, 52.9% (95% confidence interval (CI): 45.4-60.3) reported ever using alcohol, 16.9% (CI: 11.5-24.0) reported using cannabis, and 13.1% (CI: 7.2-22.5) had smoked more than one cigarette daily. Among male pupils 45.5% (CI: 38.6-52.6) had inhaled benzine and 34.6% (CI: 28.0-41.8), thinners; 7.4% (CI: 3.4-15.2) had used cocaine and 4.1% (CI: 1.0-10.6), crack. Female pupils reported significantly less use of alcohol (25.5%, CI: 17.6-35.3), cannabis (2.3%, CI: 1.3-4.1), cigarettes (more than one daily) (2.0%, CI: 1.0-4.1), and inhalation of benzine (18.8%, CI: 13.8-25.2) and thinners (10.8%, CI: 7.2-16). Logistical regression indicated that the odds of smoking cigarettes increased significantly (p < 0.0005) with use of the other substances. CONCLUSION: The results of this study confirm the prevalence of multi-substance use among pupils at the majority of rural high schools in this district and the need for targeted interventions to reduce/prevent this.
Adolescent↗
Pharmacokinetics of zidovudine and lamivudine in neonates following coadministration of oral doses every 12 hours.
A phase I, repeat-dose, open-label study was conducted to determine the pharmacokinetics and safety of zidovudine and lamivudine, coadministered orally every 12 hours, in 16 neonates whose mothers were infected with human immunodeficiency virus type 1 (HIV-1). The prospective mothers had been stabilized on a zidovudine/lamivudine regimen since week 36 of pregnancy to prevent mother-to-child transmission of HIV. During 1 week postpartum, the mothers received zidovudine 300 mg plus lamivudine 150 mg every 12 hours and breastfed. Neonatal treatment was initiated 12 hours following birth with 4 mg/kg of zidovudine suspension plus 2 mg/kg of lamivudine solution every 12 hours; this regimen was continued for 1 week. Between days 1 and 7 of neonatal treatment, the neonatal oral clearance (CL/F) of zidovudine and lamivudine increased by 2-fold (p < 0.001) and 1.6-fold (p = 0.004), respectively, possibly reflecting maturation of intestinal hepatic and renal function occurring during the first week of life. Day 7/day 1 ratios for exposure (area under the serum concentration-time curve [AUC]) and maximum observed serum concentration (Cmax) were 0.48 and 0.63, respectively, for zidovudine and 0.64 and 0.73, respectively, for lamivudine. At the time of delivery, the geometric mean cord/maternal concentration ratio was 1.24 for zidovudine and 1.12 for lamivudine, indicating free passage of each drug across the placenta. The maternal and neonatal treatment regimens were well tolerated. The results of this study confirm that in the neonate, a convenient regimen combining zidovudine 4 mg/kg and lamivudine 2 mg/kg, administered orally every 12 hours, provides zidovudine serum exposure very similar to that reported with the standard neonatal zidovudine regimen of 2 mg/kg every 6 hours, as well as lamivudine serum exposure within the range reported in adults receiving lamivudine 150 mg twice a day and children receiving 4 mg/kg twice a day.
Adult↗
Intracranial mass lesions in HIV-positive patients--the KwaZulu/Natal experience. Neuroscience AIDS Research Group.
BACKGROUND: Neurological disease heralds the development of AIDS in 10-20% of HIV-seropositive individuals. In over half of these cases the presentation will be that of an intracranial mass lesion (IML). In developed countries toxoplasmosis is the most frequent cause of IML in a positive patient, followed by primary central nervous system lymphoma. Less common causes include tuberculomas, cryptococcomas, abscesses and gummas. As a result of these observations, the algorithm adopted in developed countries calls for initial empirical treatment for toxoplasmosis. Biopsy of the IML is only considered if there is no response to treatment after 10-14 days. Whether such an algorithm would be applicable to the local population is unknown. OBJECTIVE: We undertook a prospective study to determine the type and frequency of IML in local HIV-seropositive patients. A secondary objective, based on the findings, was to develop a local algorithm of management. PATIENTS AND METHODS: Over a 17-month period HIV-seropositive individuals with an IML were entered into the study. Biopsy or aspiration of the lesion was performed either stereotactically or free-hand. Tissue obtained was processed for routine and special histological studies. RESULTS: In the 38 cases where tissue was obtained, the most frequent cause of the IML was toxoplasmosis followed by encephalitis of obscure origin', brain abscess and tuberculoma/mycobacterial infection. CONCLUSION: This study demonstrated that the spectrum of IML seen locally was similar to that in developed countries. The management protocol used elsewhere was therefore adopted for local patients.
Adolescent↗
Multiple cerebellar haemangioblastomas symptomatic during pregnancy.
A patient with von Hippel-Lindau disease presented during her seventh week of pregnancy with obstructive hydrocephalus and brainstem compression caused by multiple cerebellar haemangioblastomas. Surgery was performed to relieve the hydrocephalus and remove the right cerebellar tumour. The patient's subsequent course supports the hypothesis of vascular engorgement of cerebellar haemangioblastomas during pregnancy.
Adult↗
Granuloma inguinale (donovanosis): an unusual cause of otitis media and mastoiditis in children.
Granuloma inguinale (donovanosis) is seen predominantly in adults (it rarely occurs in children) and mainly affects genital skin and mucosa. Infection occurs at other skin and mucosal sites, and hematogenous dissemination to bone also has been described. The infection responds dramatically to appropriate antibiotic treatment. We present two cases of granuloma inguinale occurring in children (8 months and 5 months of age) causing mastoiditis and external ear discharges. A temporal lobe abscess also developed in the 8-month-old child. Subsequent computed tomography scans showed marked improvement in the brain lesion after treatment. The second child had a polypoid mass in the middle ear that on biopsy showed the features of granuloma inguinale. The mother of this child had biopsy-proven granuloma inguinale of the uterine cervix. These cases indicate that granuloma inguinale can be transmitted during vaginal delivery, and careful cleansing of neonates born to infected mothers is recommended.
Anti-Bacterial Agents↗
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↗
AIDS prevention programmes at the workplace.
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Acquired Immunodeficiency Syndrome↗
Renal function in urinary schistosomiasis in the Natal Province of South Africa.
Renal function was assessed in 101 schoolchildren with active urinary schistosomiasis by measuring serum creatinine, urate, urea, and B2-microglobulin, urinary B2 microglobulin, and the glomerular filtration rate. Glomerular function in all subjects was normal as were serum creatinine, urate, and urea levels. Serum B2-microglobulin was elevated in only 8% of subjects while urinary B2-microglobulin only was raised in 7% of subjects, indicating proximal tubular dysfunction, a previously unreported feature in urinary schistosomiasis. Urinary tract abnormalities were found in 43% of subjects consenting to an excretory urogram but no correlation with biochemical parameters of renal function was noted. Serum angiotensin converting enzyme level measured in 70 subjects was elevated in 11% of subjects and was regarded as a possible measure of increased granulomatous activity.
Adolescent↗
Markers of hepatitis B in nurses and domestic staff in an area of high endemicity.
Results obtained in two sero-epidemiologic surveys of hospital personnel in Durban were collated to yield information on 423 nurses and 141 domestic staff. The prevalence of antibodies to HBV was 14.9 per cent in 101 white nurses, 52.5 per cent in 322 African nurses and 51.8 per cent in 141 African domestics. This represents a greater than eight times increase for white nurses and a 50 per cent increase for African nurses and domestics over that seen in the equivalent blood donor groups (P less than 0.001 in each case). Antibody prevalence increased with age for all three staff groups, as did the number of individuals exhibiting a marker pattern (HBcAb greater than HBsAb) suggestive of persisting infection. No white nurses but 14 (4.3 per cent) African nurses and 17 (12.1 per cent) African domestics were HBsAg positive, the antigenaemia in domestics representing a significant increase (P less than 0.001) over the 4.0 per cent seen in female African blood donors. Six of the nurses and two of the domestics were also HBeAg positive. African nurses in adult medical wards showed greatest exposure (57 per cent) closely followed by nurses working in outpatient departments (54 per cent) and as theatre staff (52 per cent). Lower exposure rates (40 per cent) were seen in paediatric and renal unit nurses. This contrasts with results obtained for doctors in the two surveys which indicated that while Indian and white doctors are at significantly higher risk in the African hospital, African doctors are not, and that doctors working in surgical and renal departments are at higher risk than doctors on adult medical wards.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Biochemical changes in black and Indian hypertensive patients on diuretic therapy.
Thirty-seven patients (19 Blacks and 18 Indians) suffering from mild hypertension were given each of five diuretics separately for 4 weeks after a 'washout' period on placebo of the same duration. The diuretics used were hydrochlorothiazide 25 mg/d (Dichlotride; Frosst MSD), hydrochlorothiazide 25 mg plus triamterene 50 mg (Dyazide; SKF) 1 tablet per day, amiloride hydrochloride 5 mg plus hydrochlorothiazide 50 mg (Moduretic; MSD) 1 tablet per day, chlorthalidone (Hygroton; Geigy) 50 mg/d and indapamide (Natrilix; Servier) 2.5 mg/d. The study showed that during the acute phase of diuretic therapy for the treatment of hypertension plasma potassium levels were decreased by thiazide and thiazide-like diuretics and increased by potassium-sparing diuretics. However, despite the decrease in plasma potassium levels produced by thiazide diuretics and indapamide these levels did not fall to 3.0 mmol/l or less. All the diuretics were effective in lowering the standing mean arterial pressure when compared with placebo values. In the absence of significant hypokalaemia, the choice of a diuretic for the Black hypertensive patient should therefore be determined by its cost.
Adult↗