Research Articles (General Medicine)
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- ItemAdvancing research ethics training in Southern Africa (ARESA)(Health and Medical Publishing Group (HMPG), 2012-12) Moodley, Keymanthri; Rennie, StuartSouthern Africa is a research-rich environment in which research ethics review is critical. The research ethics review system is well established but considerable variability in capacity and training exists among the various research ethics committees (RECs) in the region. The ARESA programme comprises a Postgraduate Diploma in Health Research Ethics, an annual seminar, a newsletter and an association of REC members. The programme has been developed to promote health in the region via capacity development in the field of research ethics.
- ItemAlcohol, aspirin, depression, smoking, stress and the patient with a gastric ulcer(Health and Medical Publishing Group -- HMPG, 1976-02) Bock, O. A. A.It would seem that a gastric ulcer is the product of an interaction between chronic gastritis, the acid (and pepsin) of the gastric juice, and one or more precipitating factors. In a group of 194 consecutive patients with gastric ulceration particular note was made of whether they smoked, drank alcohol, used salicylates, were depressed or had experienced recent stress. There was an extraordinarily high incidence of depression among White women.
- ItemAllergic 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.
- ItemAmoebic lung abscesses : a case report(Health and Medical Publishing Group -- HMPG, 1989-04) Snyders, F. A.; Welke, H. G. E.A case of multiple amoebic lung abscesses without indication of direct extension from a subclinical liver abscess, which delayed correct diagnosis, is reported. Severe constitutional symptoms, life-threatening haemoptysis and large pulmonary lesions were the prominent clinical manifestations. The response to metronidazole was dramatic. It is postulated that haematogenous spread was responsible. The rarity of this form of amoebiasis is evident on published reports.
- ItemBrucella-keratokonjunktivitis(Health & Medical Publishing Group, 1981) Van Rooyen, M. M. B.A case is described in which the rubber cap of a vial containing Brucella abortus vaccine came off accidentally and some of the contents splashed in the eyes of a veterinarian. A uni-ocular keratoconjunctivitis developed. The other eye was similarly affected 1 week later. Brucella tests were negative. Two months later the Br. abortus titre was 1/640 and the Br. melitensis titre 1/320. Systemic treatment with tetracyclines, co-trimoxazole and streptomycin and local treatment with chloramphenicol and atropine had no effect. Two attacks of acute keratoconjunctivitis subsequently occurred within hours of handling Brucella vaccine. In the right eye a corneal abscess developed, as well as uveitis and cataract. Extracapsular lens extraction was performed. Panophthalmitis followed and the eye was enucleated. The literature is reviewed and the possibility of a Brucella keratoconjunctivitis indistinguishable from viral keratoconjunctivitis is discussed.
- ItemChallenges in biobank governance in Sub-Saharan Africa(BioMed Central, 2013-09) Staunton, Ciara; Moodley, KeymanthriBackground: Biological sample and data transfer within and out of Africa is steeped in controversy With the H3Africa project now aiming to establish biobanks in Africa, it is essential that there are ethical and legal governance structures in place to oversee the operation of these biobanks. Such governance is essential to ensuring that donors are protected, that cultural perspectives are respected and that researchers have a ready availability of ethically sourced biological samples. Methods: A literature review of all legislation, regulations, guidelines and standard operating procedures on informed consent, confidentiality and the transfer of biological samples amongst countries in Sub-Saharan Africa was conducted. In addition, an examination of the websites of departments of health and national ethics committees was performed. Researchers and research ethics scholars in the field in various African countries were contacted for assistance. A literature review of all studies examining participants views on issues related to biobanking in Africa was carried out and five separate studies were found. Results: It was found that biobanking guidelines differ substantially across Sub-Saharan Africa regarding biobanking and often conflicted across borders. This has the potential to negatively impact collaboration. Furthermore, the guidelines in place often do not recognise the ethical difficulties arising from the transfer of biological samples and are unsuitable to regulate biobanks. Additionally, there is insufficient research into the views of research participants and stakeholders on the use of biological /samples. Conclusion: Collaboration is necessary to ensure the success of biobanking projects in Africa. To achieve this, there should be some harmonization of guidelines across Africa which would aid in transferring biological samples across borders. These guidelines should reflect the unique ethical issues arising out of the storage and secondary uses of biological samples. Finally, further research into the views of research participants is necessary. Such studies should aid in the drafting of any new harmonization guidelines.
- ItemClinical experience with amikacin, a new aminoglycoside antibiotic(Health & Medical Publishing Group, 1977) Theron, F. P.; De Kock, M. A.[No abstract available]
- ItemCoordinated autophagy modulation overcomes glioblastoma chemoresistance through disruption of mitochondrial bioenergetics(Nature Research, 2018-07-09) Kriel, Jurgen; Muller-Nedebock, Kristian; Maarman, Gerald; Mbizana, Siyasanga; Ojuka, Edward; Klumperman, Bert; Loos, BenGlioblastoma Multiforme (GBM) is known to be one of the most malignant and aggressive forms of brain cancer due to its resistance to chemotherapy. Recently, GBM was found to not only utilise both oxidative phosphorylation (OXPHOS) and aerobic glycolysis, but also depend on the bulk protein degradation system known as macroautophagy to uphold proliferation. Although autophagy modulators hold great potential as adjuvants to chemotherapy, the degree of upregulation or inhibition necessary to achieve cell death sensitisation remains unknown. Therefore, this study aimed to determine the degree of autophagy modulation necessary to impair mitochondrial bioenergetics to the extent of promoting cell death onset. It was shown that coordinated upregulation of autophagy followed by its inhibition prior to chemotherapy decreased electron transfer system (ETS) and oxidative phosphorylation (OXPHOS) capacity, impaired mitochondrial fission and fusion dynamics and enhanced apoptotic cell death onset in terms of cleaved caspase 3 and cleaved PARP expression. Therefore, coordinated autophagy modulation may present a favourable avenue for improved chemotherapeutic intervention in the future.
- ItemCorrelative Light-Electron Microscopy detects lipopolysaccharide and its association with fibrin fibres in Parkinson’s Disease, Alzheimer’s Disease and Type 2 Diabetes Mellitus(Nature Research, 2018-11-14) De Waal, Greta M.; Engelbrecht, Lize; Davis, Tanja Andrea; De Villiers, Willem J. S.; Kell, Douglas B.; Pretorius, EtheresiaMany chronic diseases, including those classified as cardiovascular, neurodegenerative, or autoimmune, are characterized by persistent inflammation. The origin of this inflammation is mostly unclear, but it is typically mediated by inflammatory biomarkers, such as cytokines, and affected by both environmental and genetic factors. Recently circulating bacterial inflammagens such as lipopolysaccharide (LPS) have been implicated. We used a highly selective mouse monoclonal antibody to detect bacterial LPS in whole blood and/or platelet poor plasma of individuals with Parkinson’s Disease, Alzheimer’s type dementia, or Type 2 Diabetes Mellitus. Our results showed that staining is significantly enhanced (P < 0.0001) compared to healthy controls. Aberrant blood clots in these patient groups are characterized by amyloid formation as shown by the amyloid-selective stains thioflavin T and Amytracker™ 480 or 680. Correlative Light-Electron Microscopy (CLEM) illustrated that the LPS antibody staining is located in the same places as where amyloid fibrils may be observed. These data are consistent with the Iron Dysregulation and Dormant Microbes (IDDM) hypothesis in which bacterial inflammagens such as LPS are responsible for anomalous blood clotting as part of the aetiology of these chronic inflammatory diseases.
- ItemDiet and heart disease in the 1980s(Health & Medical Publishing Group, 1983) Rossouw, J. E.In a climate of increasing concern about the high incidence of coronary heart disease in South Africa, calls are increasingly being made for South Africans to alter their diet. Can this exhortation be justified, and are the right foods being singled out as culprits? If changes in the eating habits of a nation are advocated, the advice must not only be soundly based in terms of likely benefit but must also take account of potential hazards. Critical perusal of the current literature leads to the conclusion that advice promoting a fat-modified, lower-salt diet is sound, safe and likely to be effective, especially as regards the younger segment of the westernized population.
- ItemDiscourse of final-year medical students during clinical case presentations(Health and Medical Publishing Group (HMPG), 2011-06) Botha, H.; Van Schalkwyk, G. I.; Bezuidenhout, J.; Van Schalkwyk, S. C.Introduction: The need for medical students to adopt a discourse appropriate to the field is repeatedly emphasised by teaching staff during lectures and ward rounds. The acquisition of such discourse is often not assessed, resulting in inconsistency between the levels used among students of similar academic backgrounds. Objective: The aim of this study was to determine the extent to which appropriate discourse was adopted by 9 medical students early in their final year during clinical case presentations, and to compare this usage with the students’ final results. Methods: Transcriptions of recorded case presentations by 9 students were assessed by 2 experts and a peer evaluator, using a rubric which drew on prior research in medical discourse, and included the prominent themes of terminology and thematic staging. These were then compared with their academic results. Results: Our findings show that most students are able to use the appropriate terminology when they reach their final year of study. However, our data also support the hypothesis that students with similar academic backgrounds may display considerable variation in their level of discourse. Although it appears as if the students were all beginning to shift towards a more mature form of medical discourse, the degree to which this occurs is sporadic. The apparent absence of a relationship between discursive competencies and academic achievement may suggest that the ability of assessment to encourage the adoption of disciplinary discourse is perhaps not being optimally applied, although further research is required.
- ItemEnhanced oxidative stress and other potential biomarkers for retinopathy in type 2 diabetics : beneficial effects of the nutraceutic supplements(Hindawi, 2015) Roig-Revert, Maria J.; Lleo-Perez, Antonio; Zanon-Moreno, Vicente; Vivar-Llopis, Barbara; Marin-Montiel, Juan; Dolz-Marco, Rosa; Alonso-Munoz, Luis; Albert-Fort, Mara; Lopez-Galvez, Maria I.; Galarreta-Mira, David; Garcia-Esparza, Maria F.; Galbis-Estrada, Carmen; Marco-Ramirez, Carla; Shoaie-Nia, Kian; Sanz-Gonzalez, Silvia M.; Vila-Bou, Vicente; Bendala-Tufanisco, Elena; Garcia-Medina, Jose J.; Nucci, Carlo; Gallego-Pinazo, Roberto; Arevalo, J. Fernando; Pinazo-Duran, Maria D.; Valencia Study on Diabetic Retinopathy (VSDR)We have studied the global risk of retinopathy in a Mediterranean population of type 2 diabetes mellitus (T2DM) patients, according to clinical, biochemical, and lifestyle biomarkers. The effects of the oral supplementation containing antioxidants/omega 3 fatty acids (A/ω3) were also evaluated. Suitable participants were distributed into two main groups: (1) T2DMG (with retinopathy (+DR) or without retinopathy (−DR)) and (2) controls (CG). Participants were randomly assigned (+A/ω3) or not (−A/ω3) to the oral supplementation with a daily pill of Nutrof Omega (R) for 18 months. Data collected including demographics, anthropometrics, characteristics/lifestyle, ophthalmic examination (best corrected visual acuity, ocular fundus photographs, and retinal thickness as assessed by optical coherence tomography), and blood parameters (glucose, glycosylated hemoglobin, triglycerides, malondialdehyde, and total antioxidant capacity) were registered, integrated, and statistically processed by the SPSS 15.0 program. Finally, 208 participants (130 diabetics (68 +DR/62 −DR) and 78 controls) completed the follow-up. Blood analyses confirmed that the T2DMG+DR patients had significantly higher oxidative stress , inflammatory , and vascular risk markers than the T2DMG−DR and the CG. Furthermore, the A/ω3 oral supplementation positively changed the baseline parameters, presumptively by inducing metabolic activation and ameliorating the ocular health after 18 months of supplementation.
- ItemEssential items for reporting of scaling studies of health interventions (SUCCEED) : protocol for a systematic review and Delphi process(BMC (part of Springer Nature), 2020-01-11) Gogovor, Amede; Zomahoun, Herve Tchala Vignon; Charif, Ali Ben; McLean, Robert K. D.; Moher, David; Milat, Andrew; Wolfenden, Luke; Prevost, Karina; Aubin, Emmanuelle; Rochon, Paula; Ekanmian, Giraud; Sawadogo, Jasmine; Rheault, Nathalie; Legare, FranceBackground: The lack of a reporting guideline for scaling of evidence-based practices (EBPs) studies has prompted the registration of the Standards for reporting studies assessing the impact of scaling strategies of EBPs (SUCCEED) with EQUATOR Network. The development of SUCCEED will be guided by the following main steps recommended for developing health research reporting guidelines. Methods: Executive Committee. We established a committee composed of members of the core research team and of an advisory group. Systematic review. The protocol was registered with the Open Science Framework on 29 November 2019 (https://osf. io/vcwfx/). We will include reporting guidelines or other reports that may include items relevant to studies assessing the impact of scaling strategies. We will search the following electronic databases: EMBASE, PsycINFO, Cochrane Library, CINAHL, Web of Science, from inception. In addition, we will systematically search websites of EQUATOR and other relevant organizations. Experts in the field of reporting guidelines will also be contacted. Study selection and data extraction will be conducted independently by two reviewers. A narrative analysis will be conducted to compile a list of items for the Delphi exercise. Consensus process. We will invite panelists with expertise in: development of relevant reporting guidelines, methodologists, content experts, patient/member of the public, implementers, journal editors, and funders. We anticipated that three rounds of web-based Delphi consensus will be needed for an acceptable degree of agreement. We will use a 9-point scale (1 = extremely irrelevant to 9 = extremely relevant). Participants’ response will be categorized as irrelevant (1–3), equivocal (4–6) and relevant (7–9). For each item, the consensus is reached if at least 80% of the participants’ votes fall within the same category. The list of items from the final round will be discussed at face-to-face consensus meeting. Guideline validation. Participants will be authors of scaling studies. We will collect quantitative (questionnaire) and qualitative (semi-structured interview) data. Descriptive analyses will be conducted on quantitative data and constant comparative techniques on qualitative data. Discussion: Essential items for reporting scaling studies will contribute to better reporting of scaling studies and facilitate the transparency and scaling of evidence-based health interventions.
- ItemEstimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa(Public Library of Science (PLOS), 2008-08) Auvert, Bertran; Marseille, Elliot; Korenromp, Eline L.; Lloyd-Smith, James; Sitta, Remi; Taljaard, Dirk; Pretorius, Carel; Williams, Brian; Kahn, James G.Background: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. Methods: We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. Results: In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245).The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). Conclusion: A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. Copyright: © 2008 Auvert et al.
- ItemEvaluation of factors and patterns influencing the 30-day readmission rate at a tertiary-level hospital in a resource-constrained setting in Cape Town, South Africa(Health & Medical Publishing Group, 2019) Dreyer, R.; Viljoen, A. J.Background. Factors contributing to and causes of hospital readmissions have been investigated worldwide, but very few studies have been performed in South Africa (SA) and none in the Western Cape Province. Objectives. To investigate possible preventable and non-preventable factors contributing to readmissions to the Department of Internal Medicine at Tygerberg Hospital (TBH), Cape Town, within 30 days of hospital discharge. The researchers tested a risk-stratification tool (the LACE index) to evaluate the tool’s performance in the TBH system. Methods. A retrospective analysis was conducted of all 30-day readmissions (initial hospitalisation and rehospitalisation within 30 days) to the Department of Internal Medicine at TBH for the period 1 January 2014 - 31 March 2015. Potential risk factors leading to readmission were recorded. Results. A total of 11 826 admissions were recorded. Of these patients, 1 242 were readmitted within 30 days, representing a readmission rate of 10.5%. The majority of patients (66%) were readmitted within 14 days after discharge. The most important risk factor for readmission was the number of comorbidities, assessed using the Charlston score. The study also identified a large burden of potentially avoidable causes (35% of readmissions) due to system-related issues, premature discharge being the most common. Other reasons for 30-day readmission were nosocomial infection, adverse drug reactions, especially warfarin toxicity, inadequate discharge planning and physician error. Conclusions. Despite TBH being a low-resource, high-turnover system, the 30-day readmission rate was calculated at 10.5%. Global readmission rates vary from 10% to 25%, depending on the reference article/source used. We found that 35% of 30-day readmissions were potentially avoidable. Venous thromboembolism was a minor contributor to readmission but was associated with a very high mortality rate. A secondary outcome evaluated was the utility of the LACE and modified LACE (mLACE) index in the TBH environment. The risk tool performed well in the TBH population, and a high LACE and mLACE score correlated with an increased risk of 30-day readmission (p<0.001).
- ItemExploring the factors that affect new graduates’ transition from students to health professionals : a systematic integrative review protocol(BMJ Publishing Group, 2020-05-15) Opoku, Eric Nkansah; Van Niekerk, Lana; Jacobs-Nzuzi Khuabi, Lee-AnnIntroduction: To become a competent health professional, the nature of new graduates’ transition plays a fundamental role. The systematic integrative review will aim to identify the existing literature pertaining to the barriers during transition, the facilitators and the evidence-based coping strategies that assist new graduate health professionals to successfully transition from students to health professionals. Methods and analysis: The integrative review will be conducted using Whittemore and Knafl’s integrative review methodology. Boolean search terms have been developed in consultation with an experienced librarian, using Medical Subject Heading terms on Medline. The following electronic databases have been chosen to ensure that all relevant literature are captured for this review: PubMed, EBSCOhost (including Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier, Health Science: Nursing and Academic Edition), Scopus and Web of Science. A follow-up on the reference list of selected articles will be done to ensure that all relevant literature is included. The Covidence platform will be used to facilitate the process. Ethics and dissemination: Ethical approval is not required for this integrative review since the existing literature will be synthesised. The integrative review will be published in a peer-reviewed journal once all the steps have been completed. The findings will also be presented at international and national conferences to ensure maximum dissemination.
- ItemGastric juice carcino-embryonic antigen estimation : a useful additional test in the diagnosis of gastric carcinoma?(Health & Medical Publishing Group, 1987) Van Eeden, P. J.; Bezuidenhout, D. J. J.; Kock, J.There is a high incidence of gastric carcinoma in the coloured population of the Western Cape. Diagnostic tests other than barium meal examination or gastroscopy were investigated. In this study 50 patients were assessed and grouped according to the gastroscopic and histological findings. Twenty-five patients with gastric carcinoma and 25 with benign gastric ulcer and/or chronic atrophic gastritis and/or intestinal metaplasia were tabulated. The gastric juice and plasma carcino-embryonic antigen (CEA) levels were evaluated and compared in the two groups. The gastric juice CEA level was more useful than the plasma CEA level as an aid in diagnosing malignant gastric lesions. No correlation was evident between CEA values and the extent of the gastric carcinoma and or histological typing. An elevated gastric juice CEA level was an additional aid in diagnosing gastric carcinoma. Markedly elevated values may also identify the high-risk patient who is prone to develop gastric carcinoma.
- ItemDie Geneeskunde Opleidingskompleks, Parowvallei(Health & Medical Publishing Group, 1975) Brink A. J.The building complex erected for training in the area of medicine is described in relation to the thinking which forms the background for these physical facilities. Provision is made for training of students in medicine, nursing and the paramedical services of physiotherapy and occupational therapy. The Faculty of Dentistry of the University of Stellenbosch is also on the site. Facilities exist for training of a wide spectrum of medical technologists and technicians, and nursing colleges have been established for the training of both White and Coloured nurses. There are supporting services such as workshops, a laundry and animal facilites. A creche for the children of working mothers, both White and Coloured, has been established, and a post office have also been built on the site. The Tygerberg Hospital provides a comprehensive service to patients and is planned to accommodate all ethnic groups under one roof with particular provision of facilities for the most specialised services. The emphasis is on the training of students in medicine, both undergraduate and postgraduate.
- ItemHigh HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa(Health & Medical Publishing Group, 2020) Parker, A.; Koegelenberg, C. F. N.; Moolla, M. S.; Louw, E. H.; Mowlana, A.; Nortje, A.; Ahmed, R.; Brittain, N.; Lalla, U.; Allwood, B. W.; Prozesky, H.; Schrueder, N.; Taljaard, J. J.Background. South Africa (SA) has a high prevalence of HIV and tuberculosis. Cape Town was the SA metropole most affected in the early stages of the COVID-19 pandemic. Early observational data from Africa may provide valuable insight into what can be expected as the pandemic expands across the continent. Objectives. To describe the prevalence, clinical features, comorbidities and outcome of an early cohort of HIV-positive and HIV-negative patients admitted with COVID-19. Methods. This was a descriptive observational study of an early cohort of adults with COVID-19 pneumonia admitted from 25 March to 11 May 2020. Results. Of 116 patients (mean age 48 years, 61% female) admitted, 24 were HIV-positive (21%). The most common symptoms reported were cough (n=88; 73%), shortness of breath (n=78; 69%), fever (n=67; 59%), myalgia (n=29; 25%) and chest pain (n=22; 20%). The most common comorbidities were hypertension (n=46; 41%), diabetes mellitus (n=43; 38%), obesity (n=32; 28%) and HIV (n=24; 21%). Mortality was associated with older age (mean (standard deviation) 55 (12) years v. 46 (14) years; p<0.01); the presence of hypertension or hypertension along with diabetes and/or obesity; lower partial pressure of arterial oxygen to fraction of inspired oxygen ratio; and higher urea level, white cell count, neutrophil count, and C-reactive protein, lactate dehydrogenase and ferritin levels, and high neutrophil to lymphocyte ratio. The overall survival rate for all hospital admissions was 86/116 (73%). In this early cohort, survival was similar in patients with HIV (n=18; 75%) compared with those without HIV (n=67; 75%) (p=1). Of the 74 patients admitted to the wards, 63 (85%) survived, whereas 22 of 42 (52%) admitted to the intensive care unit survived. Conclusions. Patients with HIV infection represented a large proportion of all COVID-19 admissions. The presentation and outcome of patients with HIV did not differ significantly from those of patients without HIV.
- ItemHIV infection is associated with a lower incidence of constriction in presumed tuberculous pericarditis : a prospective observational study(Public Library of Science (PLOS), 2008-04) Ntsekhe, Mpiko; Wiysonge, Charles S.; Gumedze, Freedom; Maartens, Gary; Commerford, Patrick J.; Volmink, Jimmy A.; Mayosi, Bongani M.Background: Pericardial constriction is a serious complication of tuberculous pericardial effusion that occurs in up to a quarter of patients despite anti-tuberculosis chemotheraphy. The impact of human immunodeficiency virus (HIV) infection on the incidence of constrictive pericarditis following tuberculous pericardial effusion is unknown. Methods and Results: We conducted a prospective observational study to determine the association between HIV infection and the incidence of constrictive pericarditis among 185 patients (median age 33 years) with suspected tuberculous pericardial effusion. These patients were recruited consecutively between March and October 2004 on commencement of anti-tuberculosis treatment, from 15 hospitals in Cameroon, Nigeria and South Africa. Surviving patients (N = 119) were assessed for clinical evidence of constrictive pericarditis at 3 and 6 months of follow-up. Clinical features of HIV infection were present in 42 (35.2%) of the 119 patients at enrolment into the study.66 of the 119 (56.9%) patients consented to HIV testing at enrolment. During the 6 months of follow-up, a clinical diagnosis of constrictive pericarditis was made in 13 of the 119 patients (10.9%, 95% confidence interval [CI] 5.9-18%). Patients with clinical features of HIV infection appear less likely to develop constriction than those without (4.8% versus 14.3%; P = 0.08). None of the 33 HIV seropositive patients developed constriction, but 8 (24.2%, 95%CI 11.1-42.3%)of the 33 HIV seronegative patients did (P = 0.005). In a multivariate logistic regression model adjusting simultaneously for several baseline characteristics, only clinical signs of HIV infection were significantly associated with a lower risk of constriction (odd ratio 0.14, 95% CI 0.02-0.87, P = 0.035). Conclusions: These data suggest that HIV infection is associated with a lower incidence of pericardial constriction in patients with presumed tuberculous pericarditis. © 2008 Ntsekhe et al.
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