SUNScholar - Browsing by Author "Joubert, J. R."

Browsing by Author "Joubert, J. R."

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Allergic asthma in different population groups in the western Cape : causative and complicating factors
(Health and Medical Publishing Group -- HMPG, 1988-02) Joubert, J. R.; Brink, S.; Hentzen, G. M.
Allergic asthma is a disease with a well-defined aetiology, the recognition and elimination of which could be achieved with relatively simple and inexpensive prophylactic treatment. Some of the well-known factors - respiratory tract infections, exposure to cigarette smoke, specific antigens and regular application of prophylactic treatment - which could cause or complicate asthma were studied in groups of white and coloured patients. More respiratory tract infections occurred in coloured patients and they were more exposed to their own and secondary cigarette smoke. Pets and grass pollen allergenicity was more common among whites while allergy to Aspergillus fumigatus and Ascaris lumbricoides was found more frequently among coloured patients. Both white and coloured patients had problems with regular prophylactic control of their symptoms with inhaled β-stimulants, even after an average of two education sessions per patient, but this was of greater dimension for the coloured (60%) than the white group (27%) (P < 0.001). It is not possible to separate causative from genetic factors when studying asthma in different population groups, but recognition of prevailing causative factors for each group could stimulate an educational approach aimed at control by prevention rather than treatment of acute attacks.
Ascaris lumbricoides and allergic asthma. A new perspective
(Health & Medical Publishing Group, 1979-10) Joubert, J. R.; De Klerk, H. C.; Malan, C.
ENGLISH ABSTRACT: Infestation of humans with the parasite Ascaris lumbricoides may induce high total serium IgE levels, but the influence of this immunogenic respone on allergic asthma has not been defined. In this study, the specific antiparasitic IgE-mediated response as determined by skin-prick testing was related to the incidence of allergic asthma in Ascaris-infested patients. A limited number - 17% of the non-allergic controls and 51% of the allergic asthmatics - had a clinically detectable immunogenic response to the parasite. The predicted incidence of asthma was significantly higher than the observed incidence in the subjects in whom the Ascaris skin test was positive. This was not found in subjects in whom the Ascaris skin test was negative. Inhalation of Ascaris antigen induced asthmatic reactions in 7 of 8 patients who were Ascaris-positive on skin testing, but not in the negative controls. The groups of patients who repond immunogenically to parasite infestation need to be defined, as they may be predisposed to allergic diseases such as asthma.
Community-acquired pneumonia - factors influencing intensive care admission
(Health & Medical Publishing Group, 1988-01) Van Eeden, S. F.; Coetzee, A. R.; Joubert, J. R.
The mortality rate in critically ill patients with pneumonia who receive invasive vital organ support, including mechanical ventilation, in an intensive care unit (ICU) remains above 50%. The contribution of these costly life support systems to the survival of patients with extensive pneumonia is a matter for debate. The high mortality rate in this group of patients can be attributed in part to the fact that they are frequently referred for ICU care when their condition has already deteriorated to the point of no return. A retrospective study over 18 months of 34 cases of community-acquired pneumonia (17 patients required ventilatory support in the respiratory ICU) was undertaken to identify criteria which would justify early admission to an ICU. These were first-line clinical and biochemical factors, three of which were present in all patients on admission to hospital: (i) bronchopneumonia or lobar pneumonia involving more than two lobes (P < 0.001); (ii) respiratory rate > 30/min (P < 0.001); and (iii) partial arterial oxygen pressure < 8 kPa (P < 0.001). Other systemic factors associated with a poor prognosis and admission to the ICU were clinical signs of septicaemia, abnormal liver function and low serum albumin value. A scoring system for severity of pneumonia based on these factors is proposed. The possibility of an improved prognosis in a potentially reversible disease can become a reality if this approach is employed prospectively.
The effect of rooibos tea on the type I allergic reaction
(Health & Medical Publishing Group, 1982) Hesseling, P. B.; Joubert, J. R.
The hypothesis that Aspalathus linearis (rooibos tea) has anti-allergic properties was tested. The type I skin reaction was employed as a measurable criterion of allergic disease. Local application and the ingestion of rooibos tea failed to inhibit these reactions, and it is highly unlikely that this substance has any value in the treatment of this type of allergic disease.
Flunisolide nasal spray in the treatment of perennial rhinitis
(Health & Medical Publishing Group, 1983) Joubert, J. R.
Twenty patients with perennial rhinitis took part in a double-blind, randomized, cross-over comparison of flunisolide nasal spray (Syntaris; Syntex) and its vehicle. The sprays were used twice daily for 4 weeks and a total daily dose of 200 μg flunisolide was used. Flunisolide was superior to the placebo in relieving sneezing, runny nose and nose-blowing (P < 0.05). Patient and doctor treatment preferences were significantly in favour of the active spray. Side-effects were mainly confirmed to nasal irritation and occurred equally in both treatment groups.
Guideline for office spirometry in adults, 2004
(Health & Medical Publishing Group, 2004-07) Van Schalkwyk, E. M.; Schultz, C.; Joubert, J. R.; White, N. W.
Objective. To provide clinical guidelines for office spirometry in South Africa. Options. More stringent guidelines are required for diagnostic laboratories and research. Outcomes. To minimise variations in standard practice and improve the quality and usefulness of spirometry in the clinical setting. Evidence. Recommendations are based on key international publications as well as research publications regarding reference values for South Africans. Benefits, harm and costs. The medical, social and economic benefits and costs of standardisation of office spirometry in South Africa were considered in the recommendations. Validation. The document has been reviewed and endorsed by the South African Thoracic Society. Conclusions. The indications for spirometry must be specific and clear. Spirometry equipment must meet internationally accepted performance standards and carry proof of validation. Equipment must be regularly calibrated and maintained. Individuals performing spirometry must be adequately trained and demonstrate a high level of competence. Subject preparation, testing and quality control of results must be carried out according to published guidelines. Finally, test results must be interpreted according to current diagnostic guidelines, taking into account the purpose of the test, appropriateness of reference values and the clinical evaluation.
Inhalation therapy during acute asthma : the role of a combined steroid and beta-stimulant preparation
(Health & Medical Publishing Group, 1985) Joubert, J. R.; Burger, G.; Shephard, E.
A compound consisting of a β-stimulant, salbutamol (100 μg/puff), and a steroid, beclomethasone diproprionate (50 μg/puff), was studied to test the hypothesis that the corticosteroid could enhance the bronchodilator proporties of the β-stimulant during chronic asthma and simulated acute attacks (antigen challenge). Conventional doses (200 μg and 100 μg of salbutamol and beclomethasone respectively) were compared using a schedule which included a second administration 1 hour later. The results obtained on the baseline bronchial responsiveness of chronic asthmatics and during the delayed asthmatic response (simulated acute asthma) were similar. The compound was as effective as salbutamol alone but not more so. A significantly greater bronchodilator response was recorded in all patients after the second administration of both the compound and salbutamol alone. The practical advantages of having one rather than two inhalers are evident, but the appropriate application of this compound agent, probably in a prophylactic role, must be defined.
Inhaled beta-stimulants - a study of high-dose v. conventional-dose treatment in asthmatic outpatients
(Health & Medical Publishing Group, 1991) Bardin, P. G.; Joubert, J. R.
A randomised double-blind controlled trial was conducted in order to compare pulmonary function and protective effects of salbutamol 200 μg v. 1000 μg by inhalation. Twenty-three known asthmatics took part in the study for a period of 12 weeks. Pulmonary function tests were performed at home (peak expiratory flow-rate (PEFR)) and in the laboratory (vital capacity (VC), forced expiratory volume in 1 second (FEV1) and PEFR) before and after treatment. Bronchial responsiveness was measured as the provocative dose of histamine that caused a decrease of 30% of the area under the flow-volume curve (AFVE30) 90 minutes after pre-treatment with the study medication. The 20 patients (10 per treatment group) who completed the study were comparable at base-line in respect of physiological and pulmonary function measurements. Median PEFR, FVC and FVC1 did not differ between the treatment groups for the duration of study. Histamine challenge testing demonstrated a significant decrease in protection that was only seen after 8 weeks of treatment in the high-dose group (P < 0,05). Changes in pulse rate, blood pressure as well as side-effects were similar in the two groups. Thus treatment with higher doses of β-stimulants in outpatients had no demonstrable advantage. A significant impairment of the ability to protect against histamine-induced bronchoconstriction was shown; this may relate to β-receptor down-regulation and hence the development of tachyphylaxis.
Interstitial lung disease. Part I. A multidisciplinary approach to the diagnosis and assessment of disease activity
(Health & Medical Publishing Group, 1980) Joubert, J. R.; Rossouw, D. J.; Van der Walt, J. J.
The value of alveolar lavage as an investigative technique was determined in patients with interstitial lung disease. Alveolar cytology was related to defined histopathological degrees of disease activity found in transbronchial biopsy specimens. The degree of disease activity as assessed by these two techniques was compared with radiological evaluation. Adequate specimens of lung tissue for histopathological evaluation were obtained by transbronchial biopsy in 95% of the subjects during the first procedure and diagnostic histopathological changes were found in 60% of the patients. In the evaluation of disease activity, the lymphocyte-macrophage (L-M) ratio and, to a lesser extent, the total alveolar cell counts correlated well with graded histopathological changes of activity. A graded radiological evaluation of activity was accurate in 14 out of 17 patients, but in 3, extreme cellular disease was not recognized. Alveolar cytological examination can be employed as a supplement to the biopsy technique for increased accuracy in the initial and follow-up evaluation of active interstitial lung disease. An approach combining transbronchial biopsy, alveolar lavage and radiography, provides a safe and accurate alternative to open lung biopsy in most patients for determining the aetiology and degree of activity of interstitial lung disease.
An investigation of the wave energy resource on the South African Coast, focusing on the spatial distribution of the South West coast
(Stellenbosch : University of Stellenbosch, 2008-03) Joubert, J. R.; Bosman, D. E.; University of Stellenbosch. Faculty of Engineering. Dept. of Civil Engineering.
This thesis is an investigation of the wave power resource on the South African coast, focusing on the spatial distribution of wave power of the coastal region exposed to the highest wave power. The study’s main objective is to provide a detailed description of the spatial distribution of wave power to assist in the selection of locations for deployment of Wave Energy Converter (WEC) units in this zone. The study methodology employed to achieve this main objective entails an analysis of measured wave data recorded at wave recording stations distributed along the South African coast. The analysis provided a general description of wave power at locations for which wave data exist. From this analysis it was found that the South West Coast is exposed to the highest wave power, with an average wave power of approximately 40 kW per meter wave crest. The rest of the South African coast is exposed to average wave power between approximately 18 kW/m to 23 kW/m. The wave power characteristics on the South West Coast region (from Cape Point to Elands Bay) were therefore the focus of this thesis. The study objective was achieved by transferring deep sea wave data into the nearshore South West Coast study area with the Simulating WAves Nearshore (SWAN) wave model. The deep sea wave data was obtained from a 10 year period of available hindcast data. A simplified simulation procedure was required in order to make the study practically feasible. A sensitivity analysis was carried out to determine the validity of the simplified simulation procedure and it was found that the procedure slightly overestimate wave power in the shallower water regions due to the underestimation of energy dissipation processes. This overestimation was deemed acceptable for the dominant wave conditions and the simplified model was therefore applied in the study. An appropriate programming system was developed and used to transfer the available 10 year deep sea wave data into the selected South West Coast region. From this exercise spatial distribution of wave power and related statistical parameters were obtained for the study area. The accuracy of the modelled output was investigated by directly comparing it to wave data recorded during the overlapping recording period. It was found that the model slightly overestimates the monthly wave power resource compared to the measured data with a maximum overestimation of 9%; which is sufficiently accurate for the purpose of the study. The results of this investigation can be used for the identification of areas of high wave power concentration within the study area for the location of WEC units. Further numerical modelling is required for the detailed design of wave farms, especially if potential sites are located in shallow water (shallower than approximately 50 m).
A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part I. Clinical features
(Health & Medical Publishing Group, 1985) Van Eeden, P. J.; Joubert, J. R.; Van de Wal, B. W.; King, J. B.; De Kock, Annamarie; Groenewald, J. H.
Crimean-Congo haemorrhagic fever (CCHF) is a rare disease in South Africa. From 1981 to September 1984, 8 sporadic primary cases were reported. An outbreak of CCHF in a large university hospital is described; of 8 patients diagnosed 2 died (the index and a secondary case). Four patients were seriously ill and 2 had a mild illness. Problems were encountered in diagnosing the disease, which presents initially with influenza-like symptoms, differing only in severity from influenza. However, petechiae and other manifestations of a bleeding tendency distinguished it from influenza in the later phase of the disease. Special investigations, especially those revealing leucopenia and thrombocytopenia, were critically important in early diagnosis. The dilemma of handling this highly contagious disease is that definite virological diagnosis is time-consuming and is conducted in only one high-security laboratory 1600 km distant. A further case was admitted 3 months later from a different locality and confirmed virologically but no secondary cases could be confirmed or traced.
A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part II. Management of patients
(Health & Medical Publishing Group, 1985) Van Eeden, P. J.; Van Eeden, S. F.; Joubert, J. R.; King, J. B.; Van de Wal, B. W.; Michell, W. L.
During the outbreak of Crimean-Congo haemorrhagic fever (CCHF) at Tygerberg Hospital 8 patients were diagnosed positive. CCHF was diagnosed in another patient several months later. The treatment of these 9 cases is outlined. When it became evident that CCHF could present with a spectrum of severity, treatment was adjusted according to each patient's requirements. The essential components consisted of correction of haematological abnormalities combined with hyperimmune serum; the latter is particularly important for the severely ill patient with no antibodies to CCHF. The antiviral agents ribavirin and interferon were used but evidence to substantiate their application in future cases was inconclusive. Interferon was discontinued because of severe side-effects, many of which simulated the clinical features of CCHF. Objective improvement after corticosteroid treatment was noted in only 1 patient, but some of her symptoms could have been due to a transfusion reaction. Antibiotics were not routinely used. The 2 patients who died were diagnosed late, did not receive hyperimmune serum, and eventually developed multi-organ failure. The course of CCHF can probably be modified if the diagnosis is made early, if antiserum is given, and if the haematological abnormalities are promptly corrected.
A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part III. Clinical pathology and pathogenesis
(Health & Medical Publishing Group, 1985) Joubert, J. R.; King, J. B.; Rossouw, D. J.; Cooper, R.
Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in 8 patients; 7 were staff members at Tygerberg Hospital who had been infected by a patient in whom the disease had not initially been diagnosed. Two patients, the initial case and a staff member, died and 4 became seriously ill. The immunopathogenesis of CCHF appears to be multifactorial. Certain features were common to all patients - leucopenia, thrombocytopenia, elevated liver enzyme values and low serum total protein levels. Ultrastrucutral changes in and around skin capillaries, including intracytoplasmic endothelial tuboreticulated bodies, were found. Virus-like particles were found on electron microscopy. Important individual factors related to prognosis were identified. The patients who survived all mounted a good antibody response, and manifested no coagulation defect extensive enough to explain the haemorrhagic tendency. In the patients who died no evidence of antibody production was detected; both developed diffuse intravascular coagulation and in 1 evidence of immune complex formation and complement consumption was found. Hepatorenal failure and cardiovascular collapse characterized the terminal period. Early clinical recognition of CCHF with specific attention to factors amenable to treatment may vastly improve the prognosis.
A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part IV. Preventive and prophylactic measures
(Health & Medical Publishing Group, 1985) Van de Wal, B. W.; Joubert, J. R.; Van Eeden, P. J.; King, J. B.
During the Crimean-Congo haemorrhagic fever (CCHF) outbreak at Tygerberg Hospital a particular problem existed: a simultaneous influenza epidemic complicated the screening of contacts because of its very similar clinical picture to that of early CCHF. The methods of identifying and screening contacts are described. Of 459 listed CCHF contacts, 7 (1.5%) developed the disease; 6 were contacts of the index case and only 1 a contact of a secondary case. Two of the 7 CCHF patients had no direct contact with the index case; this caused a great concern about the dissemination, despite the otherwise full protective measures. Four of 46 blood contacts (8.7%) and 3 of 9 needle contacts (33%) developed the disease. Prophylactic interferon therapy had to be discontinued because of side-effects mimicking the symptoms of CCHF. Ribavirin was used prophylactically in 6 of the 9 inoculation contacts. One of the patients on ribavirin had a mild clinical course while 5 others who received the drug developed neither clinical CCHF nor antibodies to the virus. Two of the 3 needle contacts not treated with ribavirin had a severe clinical course. One contact with needle inoculation and 42 proven blood contacts who had not received ribavirin did not become infected. No firm conclusion can therefore be made about the protective value of prophylactic ribavirin.
Systemic sporotrichosis. Pulmonary complications of a well-known cutaneous fungal disease : a case report
(Health & Medical Publishing Group, 1982) Matthews, H. J.; Joubert, J. R.; Truter, F. C.; Van der Walt, J. J.
Pulmonary involvement during Sporotrichium schenkii infection can present as either primary pulmonary or systemic disease. The clinical and radiological features in the primary form closely resemble those of adult-type tuberculosis. On clinical, radiological and histopathological grounds pulmonary involvement during systemic spread can be difficult to distinguish from sarcoidosis. The diagnostic and therapeutic problems encountered in a woman with systemic sporotrichosis infection with pulmonary involvement are described.
Therapeutic equivalence study of two formulations (innovator v. generic) of beclomethasone dipropionate in adult asthmatic patients
(Health & Medical Publishing Group, 2001) Nell, H.; Louw, C. M.; Cyster, H.; Williams, Z.; Bardin, P. G.; Joubert, J. R.
Objective. To study the therapeutic equivalence of two formulations (innovator v. generic) of beclomethasone dipropionate (BDP) 400 μg twice daily administered per metered dose inhaler (MDI), in adults with moderate to severe asthma. Methods. A double-blind randomised parallel-group trial was performed with a 2-week run-in and an 8-week treatment period. Thirty-six symptomatic adult asthmatics on a mean daily dose of 750 μg inhaled corticosteroids during run-in, a mean forced expiratory volume in 1 second (FEV1) of 70% predicted normal and a mean histamine concentration provoking a 20% reduction in FEV1 (histamine PC20) of 0.11 mg/l were randomised to one of the two treatment groups. Primary variables were morning peak expiratory flow (mPEF), FEV1 and histamine PC20. Secondary variables were β2-agonist use, symptom score and nocturnal awakening. The Schuirmann two one-sided tests procedure was used for the statistical analysis. Ninety-five per cent confidence intervals (CIs) were calculated for the differences in means. Results. The mean differences end of treatment to baseline for the two formulations (Becotide and Beclate) respectively were: mPEF 5.6 l/min (CI-16.4 - 27.6) and -22.3 l/min (CI-35.6 - -9); FEV1 -2.9% (CI -11 - 5.2) and 0.2% (CI-4.8 - 5.2); Histamine PC20 -0.04 mg/ml (CI -0.15-0.06) and 0.02 mg/ml (CI -0.37 - 0.4). Changes in clinical variables were not conclusive. The mean differences with CIs for primary variables were contained within the limits set for equivalence. The sample size was sufficient to differentiate the groups for mPEF, but this was not of clinical significance. Conclusion. After 8 weeks of treatment the two formulations of BDP, delivered by MDI through a large-volume spacer, were therapeutically equivalent in moderate-to-severe asthmatic adults.

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