Pulmonology

Permanent URI for this community

https://scholar.sun.ac.za/handle/10019.1/70604

Browse

Now showing 1 - 20 of 55

Adenocarcinoma the most common cell type in patients presenting with primary lung cancer in the Western Cape
(Health and Medical Publishing Group (HMPG), 2011-05) Koegelenberg, Coenraad F. N.; Aubeelack, Kushroo; Nanguzgambo, Aldoph B.; Irusen, Elvis M.; Mowlana, Abdurasiet; Von Groote-Bidlingmaier, Florian; Bolliger, Chris T.
Lung cancer is the most common cause of cancer-related mortality worldwide for men and women, causing approximately 1.2 million deaths per year. The absolute and relative frequencies of lung cancer have risen dramatically and in South Africa account for 17% of all cancer deaths. We found that adenocarcinoma is now the most common histological subtype of primary lung cancer diagnosed in the Western Cape and that almost 90% of all patients with non-small cell lung cancer have advanced local or metastatic disease at the time of diagnosis.
Asthma control
(Continuing Medical Education, 2008-04) Irusen, E. M.
The SA Thoracic Society and the Global Initiative for Asthma (GINA) have recently published updated guidelines to assist practitioners in the management of asthma. The guidelines were based on reports that asthma management is far from optimal. Despite a wealth of evidence on the inflammatory nature of asthma, inhaled corticosteroids (ICS) are still under-prescribed and even when issued, are under-utilised. Many doctors and patients have also aligned themselves to lower expectations: doctors who allow asthma to be uncontrolled and patients who accept that they will always be symptomatic. The consequences are unnecessary morbidity, exacerbations, time off work or school, and even mortality.
Chronic obstructive pulmonary disease in South Africa : under-recognised and undertreated
(Health & Medical Publishing Group, 2015) Allwood, Brian W.; Van Zyl-Smit, Richard N.
Chronic obstructive pulmonary disease (COPD) is a common, preventable but incurable condition currently ranked third in global mortality estimates. Worldwide, 65 million people are estimated to have moderate to severe COPD, and the disease accounts for 3 million deaths annually, of which 90% are said to occur in low- and middle-income countries. Yet, despite these staggering numbers, COPD remains both under-recognised and undertreated in most populations, also in South Africa (SA). There are many reasons for this, not least of which is the attitude of clinicians, which can often be fatalistic with regard to COPD. This edition of CME highlights key aspects of the diagnosis and treatment – pharmacological and non-pharmacological – and new developments in the management of severe disease. Furthermore, we have included articles focusing on non-smokingrelated COPD and tips for good spirometry.
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.
Complete resolution of apparently definite radiological and histological usual interstitial pneumonia
(Health & Medical Publishing Group, 2018-08-30) Simon, D.; Irusen, E. M.; Allwood, Brian W.; Rigby, J.; Koegelenberg, C. F. N.
ENGLISH ABSTRACT: Idiopathic pulmonary fibrosis is considered to be the most common form of pulmonary fibrosis. It is a progressive and irreversible disease with a reported median survival of ~3 years. The pathological correlate is usual interstitial pneumonia (UIP), and although antifibrotic agents can slow down lung function decline, they do not completely reverse the disease process. To date, there have been no case reports describing reversal of UIP. We present a case where both the imaging and histology were compatible with definite UIP, yet it reversed with immunosuppressive therapy without the use of antifibrotic agents.
Contemporary best practice in the management of malignant pleural effusion
(SAGE Publications, 2018) Koegelenberg, Coenraad F. N.; Shaw, Jane A.; Irusen, Elvis M.; Lee, Y. C. Gary
ENGLISH ABSTRACT: Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient’s wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
Corticosteroids in critical COVID-19 : are all corticosteroids equal?
(Health & Medical Publishing Group, 2021-06-04) Du Plessis, E. M.; Lalla, U.; Allwood, B. W.; Louw, E. H.; Nortje, A.; Parker, A.; Taljaard, J. J.; Ayele, B. T.; Nyasulu, P. S.; Koegelenberg, C. F. N.
Background. The hyperinflammation seen as part of a dysregulated immune response to SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Corticosteroid therapy targets this hyperinflammation, otherwise known as a cytokine storm. It is the only therapeutic agent to date with a mortality benefit, with clear guidelines from national and international health authorities guiding its use. Objectives. To compare severity-of-illness indices, survival, length of intensive care unit (ICU) stay and potential ICU complications in patients treated with different corticosteroid regimens (high-dose hydrocortisone, high-dose methylprednisolone and lower-dose dexamethasone). Methods. In this single-centre descriptive retrospective observational study of a cohort of patients with severe COVID-19 admitted to a COVID-dedicated ICU, we compared patients treated with the three different corticosteroid regimens. Results. In 242 cases we could not demonstrate any statistically or clinically significant difference in the outcome of patients with critical COVID-19 treated with high-dose intravenous hydrocortisone (n=88) or methylprednisolone (n=46) compared with a relatively lower dose of dexamethasone (n=108). The survival rates were 38.6%, 39.1% and 33.3%, respectively (p=0.68). Patients treated with methylprednisolone tended to have a shorter length of ICU stay (median (interquartile range) 6 (4 - 10), 4 (2 - 8) and 5 (2 - 8) days; p=0.015) and fewer episodes of nosocomial sepsis (47.7%, 32.6% and 48.1%; p=0.01). Conclusions. Hydrocortisone or methylprednisolone can be given as an alternative to dexamethasone in the management of critical COVID-19, and this is a feasible alternative, especially in resource-constrained settings.
COVID-19 in Africa : care and protection for frontline healthcare workers
(BioMed Central, 2020) Chersich, Matthew F.; Gray, Glenda; Fairlie, Lee; Eichbaum, Quentin; Mayhew, Susannah; Allwood, Brian W.; English, Rene; Scorgie, Fiona; Luchters, Stanley; Simpson, Greg; Mosalman Haghighi, Marjan; Duc Pham, Minh; Rees, Helen
Medical staff caring for COVID-19 patients face mental stress, physical exhaustion, separation from families, stigma, and the pain of losing patients and colleagues. Many of them have acquired SARS-CoV-2 and some have died. In Africa, where the pandemic is escalating, there are major gaps in response capacity, especially in human resources and protective equipment. We examine these challenges and propose interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics. Without adequate protection, COVID-19 mortality may be high among healthcare workers and their family in Africa given limited critical care beds and difficulties in transporting ill healthcare workers from rural to urban care centres. Much can be done to protect healthcare workers, however. The continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key resources, and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises human resources and reduces patient contact and thus infection risks. Importantly, healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale. Clearly there are multiple ways that international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s potentially devastating heath, socio-economic and security impacts on the continent.
The current aetiology of malignant pleural effusion in the Western Cape Province, South Africa
(Health & Medical Publishing Group, 2018-04) Koegelenberg, C. F. N.; Bennji, S. M.; Boer, E.; Schubert, P. T.; Shaw, J. A.; Allwood, Brian W.; Irusen, E. M.
Background: Malignant pleural effusion (MPE) represents a very common cause of pleural exudates, and is one of the most challenging pleural disorders to manage. This could be attributed to the paucity of high-quality experimental evidence, and inconsistent practice worldwide. South Africa (SA) currently has no data regarding the aetiology of MPE. Objectives: To identify the most common malignancies causing MPE in a population served by a large tertiary hospital in SA, and specifically the relative contribution of mesothelioma. A secondary objective was to evaluate the efficacy of chemical pleurodesis in a subset of patients. Methods: We retrospectively included all known cases of MPE evaluated at our institution over a 3-year period with a tissue diagnosis of MPE. Results: The most common causes of MPE in a total of 274 patients were lung cancer (n=174, 63.5%), breast cancer (n=32, 11.7%), unknown primary (n=22, 11.7%) and mesothelioma (n=27, 9.9%). Talc pleurodesis was performed in 81 of 194 patients (41.8%) referred to our division, and was radiologically successful in 22 of 25 (88.0%) followed up to 3 months. Conclusions: The main cause of MPE in our setting was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE in this population.
The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area
(Health and Medical Publishing Group, 2015) Du Toit, R.; Shaw, J. A.; Irusen, E. M.; Von Groote-Bidlingmaier, F.; Warwick, J. M.; Koegelenberg, C. F. N.
Background. Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing pulmonary mass lesions and specifically for estimating risk of malignancy. Tuberculosis (TB) is known to cause false-positive PET-CT findings. Objective. To investigate the utility of PET-CT in the evaluation of pulmonary mass lesions and nodules in a high TB prevalence setting. Methods. All patients referred for the evaluation of a solitary pulmonary nodule or mass and who underwent PET-CT scanning over a 3-year period were included. The PET-CT findings, including maximum standardised uptake value (SUVmax), were compared with the gold standard (tissue or microbiological diagnosis). The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for malignant disease were calculated according to the SUVmax cut-off of 2.5 and a proposed cut-off obtained from a receiver operating characteristic (ROC) curve. Results. Forty-nine patients (mean (standard deviation) age 60.1 (10.2) years; 29 males) were included, of whom 30 had malignancy. Using an SUVmax cut-off of 2.5, PET-CT had a sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for malignancy of 93.3%, 36.8%, 70.0%, 77.8% and 71.4%, respectively. After a ROC curve analysis, a suggested SUVmax cut-off of 5.0 improved the specificity to 78.9% and the diagnostic accuracy to 86.7%, with a small reduction in sensitivity to 90.0%. Conclusions. The diagnostic accuracy of PET-CT in the evaluation of pulmonary mass lesions using the conventional SUVmax cut-off of 2.5 was reduced in a TB-endemic area. An SUV cut-off of 5.0 has a higher specificity and diagnostic accuracy for malignancy, with a comparable sensitivity.
Does access to private healthcare influence potential lung cancer cure rates?
(Health and Medical Publishing Group, 2017) John, Thadathilankal-Jess; Plekker, Dante; Irusen, Elvis M.; Koegelenberg, Coenie F. N.
Background. Numerous studies show a link between poor socioeconomic status (SES) and late-stage cancer diagnosis. However, this has not been consistently shown looking at non-small-cell lung cancer (NSCLC) in isolation. Despite the extremely high prevalence of lung cancer and disparities in access to healthcare based on health insurance in South Africa, there is a paucity of data on the influence of health insurance (as a surrogate for SES) on stage at presentation of NSCLC. Objective. To assess the relationship between health insurance status (and invariably SES) and staging (and therefore resectability) of patients with primary NCSLC at the time of initial presentation. Methods. Health-insured patients with NSCLC (n=51) were retrospectively compared with NSCLC patients with no health insurance (n=532) with regard to demographics, tumour node metastasis (TNM) staging, and cell type at initial presentation. Results. Patients with no health insurance were younger (mean (standard deviation (SD)) 59.9 (10.1) years) than those with private health insurance (64.2 (9.6) years) (p=0.03). Poorly differentiated NSCLC was significantly more common in the privately health-insured group (23.6%) than among those with no health insurance (4.6%) (p<0.01). Six of 51 NSCLC patients (11.8%) with private health insurance presented with early-stage, potentially curable disease (up to stage IIIA), compared with 55 patients (10.3%) in the uninsured group (p=0.75). Conclusions. Access to private health insurance did not have a significant impact on stage at initial presentation. The only significant differences were the relatively advanced age at presentation and relatively higher percentage of poorly differentiated NSCLC seen in patients with health insurance.
Effect of exogenous surfactant on Paediatric Bronchoalveolar lavage derived macrophages’ cytokine secretion
(BMC (part of Springer Nature), 2019-12-05) Van Rensburg, Lyne; Van Zyl, Johann M,; Smith, Johan; Goussard, Pierre
Background: Bronchoalveolar lavage is a useful bronchoscopy technique. However, studies in “normal” children populations are few. Furthermore, the anti-inflammatory effects of exogenous pulmonary surfactants on the bronchoalveolar cellular components are limited. Methods: Thirty children, aged 3 to 14 years, underwent diagnostic bronchoscopy and bronchoalveolar lavage. Differential cytology, cytokine and chemokine measurements were performed on the fluid after exogenous surfactant exposure. The aim of the study was to investigate the potential anti-inflammatory effects of exogenous surfactants on the bronchoalveolar lavage fluid, specifically alveolar macrophages of healthy South African children. Results: Alveolar macrophages were the predominant cellular population in normal children. Patients with inflammatory pneumonopathies had significantly more neutrophils. Levels of inflammatory cytokines were significantly lower after exogenous surfactant exposure. Moreover, IL-10 and IL-12 cytokine secretion increased after exogenous surfactant exposure. Conclusion: This study provides the first data on bronchoalveolar lavage of healthy South African children. Bronchoalveolar lavage fluid from patients with pulmonary inflammation was characterised by neutrophilia. Finally, we propose that exogenous surfactant treatment could help alleviate inflammation in diseased states where it occurs in the tracheobronchial tree.
Endoscopic lung volume reduction in severe emphysema
(Health & Medical Publishing Group, 2015) Koegelenberg, Coenraad Frederik N.; Theron, Johan; Bruwer, J. W.; Allwood, Brian W.; Vorster, Morne J.; Von Groote-Bidlingmaier, Florian; Dheda, Keertan
ENGLISH ABSTRACT: Therapeutic options in severe emphysema are limited. Endoscopic lung volume reduction (ELVR) refers to bronchoscopically inducing volume loss to improve pulmonary mechanics and compliance, thereby reducing the work of breathing. Globally, this technique is increasingly used as treatment for advanced emphysema with the aim of obtaining similar functional advantages to surgical lung volume reduction, while reducing risks and costs. There is a growing body of evidence that certain well-defined subgroups of patients with advanced emphysema benefit from ELVR, provided that a systematic approach is followed and selection criteria are met. In addition to endobronchial valves, ELVR using endobronchial coils is now available in South Africa. The high cost of these interventions underscores the need for careful patient selection to best identify those likely to benefit from such procedures.
An endotracheal plasmablastic lymphoma
(S. Karger AG, Basel, 2019) Bots, Eva M. T.; Opperman, Johan; Bassa, Fatima; Koegelenberg, Coenraad F. N.
ENGLISH ABSTRACT: We describe an exceptionally rare case of a male patient with newly diagnosed advanced human immunodeficiency virus (HIV) infection, who presented with a plasmablastic lymphoma involving the right maxillary alveolar ridge with associated cervical lymphadenopathy. On a staging positron emission tomography computed tomography (PET-CT) scan, he was incidentally found to have an endotracheal tumour involving the anterolateral aspect of the mid-trachea. The tumour appeared to be well-vascularised at bronchoscopy and was confirmed as well-differentiated plasmablastic lymphoma. Plasmablastic lymphoma is a rare form of non-Hodgkin lymphoma and is associated with HIV. Tracheal involvement to the extent seen in our patient is exceptionally rare, and, to the best of our knowledge, has never been described.
Epidemiology of lower respiratory infection and pneumonia in South Africa (1997 – 2015) : a systematic review protocol
(BMJ Publishing Group, 2016) Roomaney, Rifqah A.; Pillay-van Wyk, Victoria; Awotiwon, Oluwatoyin F.; Dhansay, Ali; Groenewald, Pam; Joubert, Jane D.; Nglazi, Mweete D.; Nicol, Edward; Bradshaw, Debbie
Introduction: Lower respiratory infections (LRIs) and pneumonia are among the leading causes of death worldwide, especially in children aged under 5 years, and these patterns are reflected in the South African population. Local epidemiological data for LRIs and pneumonia are required to inform the Second National Burden of Disease Study underway in South Africa. The aim of this systematic review is to identify published studies reporting the prevalence, incidence, case fatality, duration or severity of LRI and pneumonia in adults and children in South Africa. Methods and analysis: Electronic database searches will be conducted to obtain studies reporting on the prevalence, incidence, case fatality, duration and severity of LRI and pneumonia in South Africa between January 1997 and December 2015. Studies that are assessed to have moderate or low risk of bias will be included in a meta-analysis, if appropriate. Where meta-analysis is not possible, the articles will be described narratively. Subgroup analysis (eg, age groups) will also be conducted where enough information is available. Ethics and dissemination: This systematic review will only include published data with no linked patientlevel information; thus, no ethics approval is required. The findings will be used to calculate the burden of disease attributed to LRI and pneumonia in South Africa and will highlight the type of epidemiological data available in the country. The article will be disseminated in a peer-reviewed publication.
Fatal tumour pulmonary embolism
(Wiley Open Access, 2017) Masoud, Salim Rashid; Koegelenberg, Coenraad Frederik Nicolaas; Van Wyk, Abraham Christoffel; Allwood, Brian W.
A 30-year-old female with no significant past medical history was referred to our facility with sudden onset of shortness of breath. She had a low clinical probability for pulmonary thromboembolism and a computed tomography angiogram showed enlarged pulmonary arteries but no in situ thrombi. She developed recurrent episodes of hypotension and hypoxia, and was transferred to the intensive care unit where she died despite active resuscitation. An autopsy revealed extensive lymphatic and pulmonary vascular tumour emboli as the immediate cause of death. Pulmonary tumour embolism is a very rare cause of death, but can occur in patients who have an occult neoplasm.
Five-year follow-up of participants diagnosed with chronic airflow obstruction in a South African Burden of Obstructive Lung Disease (BOLD) survey
(Health & Medical Publishing Group, 2018-02-01) Allwood, Brian W.; Gillespie, R.; Bateman, M.; Olckers, H.; Taborda-Barata, Luis; Calligaro, G.; Van Zyl-Smit, R.; Cooper, C. B.; Beyers, Nulda; Bateman, E. D.
Background. A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged >40 years. Objectives. To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey. Methods. Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005. Results. Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range –54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (–350 mL) than in stages 2 or 3 (–80 mL and +140 mL, respectively; p<0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by ≥1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD). Conclusions. The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease.
Fourteen-Day Bactericidal Activity, Safety, and Pharmacokinetics of Linezolid in Adults with Drug-Sensitive Pulmonary Tuberculosis
(2020-01) Diacon, Andreas; De Jager, Veronique R; Dawson, Rodney
Background: Linezolid is increasingly used for the treatment of tuberculosis resistant to first-line agents, but the most effective dosing strategy is yet unknown. Methods: Between November 2014 and November 2016, we randomised 114 drug-sensitive treatment-naïve pulmonary tuberculosis patients from Cape Town, South Africa, to one of six 14-day treatment arms containing linezolid 300 mg once daily (qd), 300 mg twice daily (bd), 600 mg qd, 600 mg bd, 1200 mg qd, 1200 mg three times per week (tiw) or a combination of isoniazid, rifampicin, pyrazinamide and ethambutol. Sixteen-hour sputum samples were collected overnight, and bactericidal activity characterized by the daily percentage change in time to positivity (TTP) and colony forming units (CFU). We also assessed the safety and pharmacokinetics of the study treatments. Results: Bactericidal activity increased with increasing doses of linezolid. Based on the daily percentage change in TTP, activity was highest for 1200 mg qd (4.5; 95% Bayesian confidence interval [BCI]: 3.3-5.6), followed by 600 mg bd (4.1; BCI: 2.5-5.7), 600 mg qd (4.1; BCI: 2.9-5.3), 300 mg bd (3.3; BCI: 1.9-4.7), 300 mg qd (2.3; BCI: 1.1-3.5) and 1200 mg tiw (2.2; BCI: 1.1-3.3). Similar results were seen with bactericidal activity characterized by the daily rate of change in CFU count. Antimycobacterial activity correlated positively with plasma drug exposure and percentage time over minimum inhibitory concentration. There were no unexpected adverse events. Conclusion: All linezolid doses showed bactericidal activity. For the same total daily dose, once daily dosing proved to be at least as effective as a divided twice daily dose. An intermittent dosing regimen, with 1200 mg given three times weekly, showed the least activity.
The global initiative for asthma 2019 recommendation for mild asthma – a critique
(AOSIS, 2020-03-05) Irusen, Elvis M.
Recognising that mild asthmatics are at risk of exacerbations and mortality, the Global Initiative for Asthma (GINA) issued an updated strategy in 2019. This was premised on two studies culminating in their recommendation that mild asthma should be treated by using a combination of a rapid and long-acting beta 2 agonist and an inhaled corticosteroid (ICS) administered as required. Their rationale is, however, debatable, as the studies actually showed that regular daily ICS administration was more effective for a number of asthma control endpoints. A patient-driven treatment strategy is also questionable, as there are a number of concerns about behaviour of patients suffering from asthma and perception of airway narrowing that should trigger medication intake but in fact does not do so. These deficiencies also influence a similar maintenance and reliever treatment (MART) approach that would be suboptimal. Intermittent ICS regimens are also inferior when compared to regular treatment. Not all asthmatics respond to the same dose of ICS. The best way to manage asthma is by adopting a step-up ICS approach, to encompass varying disease severity, with a long-acting beta agonist taken on a daily basis, ideally in a single combination inhaler.
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.

Browse

Browsing Pulmonology by Title

Results Per Page

Sort Options