Browsing by Author "Joubert, J. R."
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- 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.
- ItemCommunity-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.
- ItemGuideline 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.
- ItemInhalation 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.
- ItemA 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.
- ItemA 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.
- ItemSystemic 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.
- ItemTherapeutic 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.