The prevalence, characteristics and morbidity of neuropathic pain in AIDS patients, prior to the use of HAART, at the Kalafong Hospital HIV clinic, Pretoria

Includes bibliographical references (leaves 49-56).Neuropathic pain, of which a distal sensory polyneuropathy (DSP) is the most frequent cause, is a common problem in patients with HIV infection and AIDS. The researcher is concerned that neuropathic pain in patients with AIDS tends to be underdiagnosed and under-treated. There are several reasons for this, one of which may be a lack of awareness of the extent of the problem, as well as the impact it has on patients' lives. Several studies around the world have noted the problem of under-diagnosis and undertreatment of pain and more specifically, neuropathic pain, in patients with AIDS. A review of the literature reveals a wide variation in the prevalence of neuropathic pain and peripheral neuropathy in AIDS patients. To determine the prevalence, characteristics, severity and morbidity of neuropathic pain in AIDS patients, attending the Kalafong HIV Clinic, prior to the initiation of HAART.A prospective, cross sectional and descriptive study was done at the Kalafong Hospital HIV Clinic. Data was collected from a systematic sample of 354 AIDS patients, who were referred to this HIV clinic to be initiated on HAART. An interviewer-administered questionnaire and focused neurological examination were used. This included a recently validated instrument, the DN4, for identifying pain which is neuropathic in origin. Selected sections of the Brief Pain Inventory (BPI) were used to determine the severity of the neuropathic pain, as well as pain-related interference on aspects of daily living

Neuropathic pain in AIDS patients prior to antiretroviral therapy

Objectives: To measure the prevalence, severity and morbidity of neuropathic pain in AIDS patients, prior to the initiation of antiretroviral therapy. Design: A prospective, cross sectional and descriptive-analytical study. Setting: The Kalafong Hospital HIV clinic in Pretoria. Subjects: All patients with confirmed AIDS, who were referred to the Kalafong HIV clinic in order to be initiated on antiretroviral (ARV) therapy, during the period August 2006 to March 2007. Outcome measures: Data were collected regarding the presence and severity of neuropathic pain in each subject. Pain of predominantly neuropathic origin (POPNO) was identified using the Neuropathic Pain Diagnostic Questionnaire (DN4). Numerical rating scales (NRS), adapted from the Brief Pain Inventory, were used to measure pain severity and pain-related interference with six aspects of daily living. Results: Of the 354 patients studied, 20.9% (95% CI: 16.8% to 25.2%) had POPNO. This pain was significantly more frequent in patients who were male, had lower CD4+ counts or higher viral load levels and those using tuberculosis treatment. Eighty percent of patients with POPNO experienced significant pain (worst pain severity ≥ 5 out of 10 on a NRS). Pain-related interference was highest for enjoyment of life, mood and ability to work. There was a significant positive correlation between severity of pain and pain-related interference for all domains of daily living evaluated. Conclusions: POPNO results in significant suffering and impaired functioning in patients with AIDS. It is therefore imperative that clinicians should assess patients with AIDS for the presence and severity of neuropathic pain and manage it, using the most recent evidence based guidelines

The end of the line? A case of drug resistance to third-line antiretroviral therapy

HIV drug resistance has been described in all antiretroviral drug classes and threatens the long-term success of HIV treatment. Here, we describe the first reported case of acquired resistance to the integrase strand transfer inhibitors in South Africa. This case illustrates the dilemma of treatment in the context of inadequate adherence and poor psychosocial support and highlights the potential risk of transmission of multidrug-resistant virus.http://www.sajhivmed.org.zaam2016Family MedicineImmunolog

Active myofascial trigger points in head and neck muscles of patients with chronic tension-type headache in two primary health care units in Tshwane

BACKGROUND : The management of patients presenting with chronic tension-type headache (CTTH) can be challenging for primary health care practitioners. As with most chronic pain disorders, a multimodal management approach is frequently required. It has been postulated that myofascial pain syndrome (MPS) and its hallmark myofascial trigger points (MTrPs) found in specific muscle tissues may play a role in the chronic pain experienced by patients with CTTH. Little is known about the prevalence of MTrPs in patients with CTTH, in primary health care settings on the African continent. This study therefore aimed to investigate the prevalence of active MTrP’s in specific head and neck muscles/muscle groups in patients with CTTH. METHODS : A prospective, cross-sectional and descriptive study was done in two primary health care facilities situated in Tshwane, South Africa. The sample included 97 adult patients with CTTH. Five head and neck muscles/muscle groups were examined bilaterally for active MTrPs. Outcome measures were the prevalence and distribution of active MTrPs in these patients. RESULTS : Active MTrPs were found in 95.9% of the patients, the majority (74.2%) having four or more active MTrPs. The temporalis muscles and suboccipital muscle group exhibited the highest number of active MTrPs (prevalence 87.6% and 80.4% respectively). CONCLUSION : Our study suggests a strong association between MPS and CTTH in patients, presenting in the primary health care setting. This indicates the importance of a musculoskeletal assessment of neck and pericranial muscles in patients with CTTH. This can assist in determining the most appropriate treatment strategy in these patients.http://www.safpj.co.za/index.php/safpjhttp://www.tandfonline.com/oemdam2017Family Medicin

Screening for adult ADHD in patients with Fibromyalgia syndrome

OBJECTIVE: Fibromyalgia syndrome (FMS) is a common chronic pain disorder associated with altered activity of neurotransmitters involved in pain sensitivity such as dopamine, serotonin, and noradrenaline. FMS may significantly impact an individual’s functioning due to the presence of chronic pain, fatigue, and cognitive impairment. Dyscognition may be more disabling than the chronic pain but is mostly under-recognized. This study aimed to assess the potential co-occurrence of FMS and adult attention deficit hyperactivity disorder (ADHD), a chronic neurodevelopmental disorder also associated with impaired cognition and dopaminergic function. METHODS : In a cross-sectional observational study, 123 previously confirmed FMS patients were screened for adult ADHD using the World Health Organization Adult ADHD Self Report scale v1.1. The Revised Fibromyalgia Impact Questionnaire (FIQ-R) was used to assess the impact of FMS. Cognitive assessment was based on self-report in accordance with the 2011 modified American College of Rheumatology criteria and the FIQ-R, respectively. RESULTS : Of the 123 participants, 44.72% (N = 55) screened positive for adult ADHD. Participants with both FMS and a positive adult ADHD screening test scored higher on the FIQ-R score (64.74, SD = 17.66, vs 54.10, SD = 17.10). Self-reported cognitive impairment was rated higher in the combined group (odds ratio = 10.61, 95% confidence interval; 3.77–29.86, P < 0.01). CONCLUSIONS : These results indicate that the co-occurrence of adult ADHD in FMS may be highly prevalent and may also significantly impact the morbidity of FMS. Patients with FMS should be assessed for the presence of adult ADHD.https://academic.oup.com/painmedicine2019-09-01hj2018Family Medicin

Marcel Gautherot na revista Módulo - ensaios fotográficos, imagens do Brasil: da cultura material e imaterial à arquitetura

Este artigo tece considerações sobre as fotografias de Marcel Gautherot na Módulo, Revista de Arquitetura e Artes Plásticas fundada em 1955 por Oscar Niemeyer, quando ele já era conhecido nos anais da arquitetura internacional. O texto visa levantar questões de método diante das lacunas da historiografia dos periódicos no país e, sobretudo, destacar a importância daMódulo e de suas reportagens fotográficas, lembrando o seu papel na afirmação e difusão da arquitetura moderna brasileira, além de refletir sobre o anonimato de fotógrafos nas publicações do gênero. A revista evidencia que para os homens daquela geração, a nova arquitetura era indissociável da afirmação da identidade nacional, ao lado das artes plásticas, do patrimônio histórico, e das representações da cultura material e imaterial - arquitetura vernacular, folclore, jogo da capoeira, arte popular (carrancas de proa), e outros temas que são, justamente, os das séries fotográficas do acervo de Marcel Gautherot, figurando nos números da primeira fase da revista até os anos 1960. A análise destaca, especialmente, o registro fotográfico da construção de Brasília, foco principal da retórica programática do periódico

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London