Browsing by Author "Mehta, Ushma"
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- ItemAdult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence(Elsevier, 2021) Mouton, Johannes P.; Jobanputra, Nicole; Njuguna, Christine; Gunter, Hannah; Stewart, Annemie; Mehta, Ushma; Lahri, Saad; Court, Richard; Igumbor, Ehimario; Maartens, Gary; Cohen, KarenIntroduction: South Africa has the world’s largest antiretroviral treatment programme, which may contribute to the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according to HIV status, to determine the contribution of drugs used in management of HIV and its complications to ADR-related EU presentations, and identify factors associated with ADR-related EU presentation. Methods: We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and preventability. Results: We included 1010 EU presentations and assessed 80/1010 (7.9%) as ADR-related, including 20/239 (8.4%) presentations among HIV-positive attendees. Among HIV-positive EU attendees with ADRs 17/20 (85%) were admitted, versus 22/60 (37%) of HIV-negative/unknown EU attendees. Only 5/21 (24%) ADRs in HIVpositive EU attendees were preventable, versus 24/63 (38%) in HIV-negative/unknown EU attendees. On multivariate analysis, only increasing drug count was associated with ADR-related EU presentation (adjusted odds ratio 1.10 per additional drug, 95% confidence interval 1.03 to 1.18), adjusted for age, sex, HIV status, comorbidity, and hospital. Conclusions: ADRs caused a significant proportion of EU presentations, similar to findings from other resourcelimited settings. The spectrum of ADR manifestations in our EUs reflects South Africa’s colliding epidemics of infectious and non-communicable diseases. ADRs among HIV-positive EU attendees were more severe and less likely to be preventable.
- ItemCOVID-19 in pregnancy in South Africa : tracking the epidemic and defining the natural history(Health & Medical Publishing Group, 2020-08) Fairlie, Lee; Sawry, Shobna; Patel, Faeezah; Balkus, Jennifer E.; Kalk, Emma; Mutevedzi, Portia; Technau, Karl-Gunter; Yates, Laura M.; Slogrove, Amy L.; Ballot, Daynia; Bandini, Rosella M.; Mehta, Ushma; Moodley, DhayendreENGLISH ABSTRACT: South Africa (SA) has seen a rapid increase in COVID-19 infections in recent weeks, with cases exceeding 40 000 in early June and anticipated to escalate rapidly as lockdown is eased. The country also has the largest HIV burden globally, and poor maternal and child health indices in many parts.