Browsing by Author "Harvey, J."

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    The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children’s Hospital
    (Health & Medical Publishing Group, 2019-04-11) Kajee, Z.; Harvey, J.; Zollner, E. W.
    Background. A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients. Hence a DCT was introduced at Tygerberg Children’s Hospital (TCH) in 2009. Hypothesis. A DCT for T1DM patients improves HbA1c, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications. Methods. In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbA1c) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared. Results. HbA1c levels increased from 9.0% (7.85 - 10.15) in P1 to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02). The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in P1 to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01) to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00). Conclusion. After the introduction of the DCT, HbA1c levels were less variable and hospital admission and DKA rates decreased. Improvements were achieved with a multiple injection regimen at a lower daily insulin dose.
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    Neurodevelopmental status of HIV-exposed but uninfected children : a pilot study
    (Health & Medical Publishing Group, 2012-03-29) Springer, P.; Laughton, Barbara; Tomlinson, M.; Harvey, J.; Esser, M.
    Introduction. HIV affects children both directly and indirectly, with evidence of increased infectious mortality and morbidity in the HIV-exposed but uninfected (HEU) infant. There is little published research on neurodevelopmental outcome of HEU infants in Africa. Following the introduction of successful prevention of mother-to-child transmission programmes, it has become important to determine whether differences exist between HEU infants and infants born to HIV-negative mothers in order to guide current management policies of this rapidly growing group of infants. Objectives. To compare the developmental outcome of infants exposed to HIV in utero who remained uninfected (HEU) with that of infants unexposed to HIV in utero (HUU). Methodology. This was a prospective, blinded, hospital-based study. Infants aged between 17 and 19 months were assessed on the Griffiths Mental Developmental Scales (GMDS). Birth history, previous hospitalisation, maternal and infant characteristics, antiretroviral exposure, anthropometric measurements and abnormal clinical findings were documented. Results. Of the original 55 infants enrolled at 2 weeks of age, 37 (17 HEU and 20 HUU) underwent neurological and developmental assessment. There were no significant differences between the groups with regard to the GMDS general quotient or other subscales, apart from the Personal/social subscale, where the HEU group performed significantly more poorly than the HUU participants (p=0.026). This difference is probably a result of cultural differences between the groups, as 76% of HEU and only 15% of HUU participants were of Xhosa origin. Discussion. There was no difference in neurodevelopmental outcome at 18 months between the HEU and HUU groups.
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    Plasma sarcosine does not distinguish early and advanced stages of prostate cancer
    (Health and Medical Publishing Group (HMPG), 2012-08) Bohm, L.; Serafin, A. M.; Fernandez, P.; Van der Watt, G.; Bouic, P. J. D.; Harvey, J.
    Introduction. Diagnosis of prostate cancer by prostate specific antigen (PSA) is error-prone and cannot distinguish benign prostatic hyperplasia (BPH) from malignant disease, nor identify aggressive and indolent types. Methods. We determined serum sarcosine (N-methylglycine) in 328 cancer patients by gas chromatography (GC)/mass spectroscopy (MS) and searched for correlations with early (stage T1/T2) and advanced (stage T3/T4) disease. Results. Serum sarcosine of male control patients ranged from 1.7 μmol/l to 4.8 μmol/l. In prostate cancer patients, sarcosine ranged from 2.8 μmol/l to 20.1 μmol/l. Expressed as the sarcosine/alanine ratio, serum control values were 9.4±5.5x10 -3 (mean±SD) compared with 21.6±9.0; 28.5±16.6; 22.7±7.7 and 22.2±11.0 for patients diagnosed with T1, T2, T3 and T4 prostate tumours, respectively. The small differences between T1, T2, T3 and T4 patients were not statistically significant (p=0.51). However, the conventional PSA marker significantly correlated with T stage in these patients (r=0.63; p<0.009). Conclusions. The median sarcosine/alanine ratios among patients with early and advanced prostatic cancer ranged from 21.6±9.0 to 28.5±16.6 and were fairly constant, showing no statistically significant differences between T-stages. The results are consistent with published data in urine and serum which find differences between controls and patients with metastatic prostate cancer to be small and sarcosine to be uninformative regarding prostate cancer progression. By multi-comparison of PSA with T-stages in the same group of patients, we found significant correlations confirming the well-known merits and limitations of this marker.
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    Prevalence of and risk factors for retinopathy of prematurity in a cohort of preterm infants treated exclusively with non-invasive ventilation in the first week after birth
    (Health & Medical Publishing Group, 2013-01-14) Van der Merwe, S. K.; Freeman, N.; Bekker, A.; Harvey, J.; Smith, J.
    Objectives. To determine the current prevalence of retinopathy of prematurity (ROP) in premature babies treated with non-invasive ventilation at Tygerberg Children’s Hospital, Parow, Cape Town, South Africa, and to identify risk factors associated with the development of ROP. Methods. A retrospective medical records review of infants screened for ROP during a 2-year period (January 2009 - December 2010). Infants who did not receive invasive ventilation during the first week of life were included. Twenty-four previously reported risk factors for the development of ROP were identified for use in a multivariate logistic regression (MLR) analysis. Results. A total of 356 patients were included. The overall prevalence of ROP was 21.8% and that of clinically significant ROP (CSROP) 4.4%. The risk factors with a statistically significant association with the development of ROP on MLR analysis were severe apnoea (p=0.0005) and decreasing birth weight (p=0.0382). Conclusions. There is a low prevalence of ROP in the cohort of preterm infants treated exclusively with non-invasive ventilation in the first week of life. The risk factors of importance in our population were severe apnoea and lower birth weight. Birth weight is a practical and reproducible variable that can be used to aid development of ROP screening criteria.