Risk factors for tuberculosis in a low-income urban area of Cape Town, South Africa, with particular reference to the role of cannabis smoking

Background: The association between Mycobacterium tuberculosis infection and tobacco smoking has recently been highlighted. The reason for this association remains unclear, but is postulated to result from the effects of smoking on pulmonary host defences. Cannabis impairs the immune function of alveolar macrophages and has been reported to increase susceptibility to respiratory infections. Aim: To examine risk factors for both Mycobacterium tuberculosis disease and infection, in particular the effects of cannabis smoking. Methods: A cross-sectional population survey of 3512 persons aged ≥15 years was performed in a predominantly low-income urban area of Cape Town, South Africa. Information on a history of tuberculosis and various risk factors including cannabis smoking was collected by means of an administered questionnaire. Ziehl-Neelson stained sputum smears were examined for acid fast bacilli and cultured on Lowenstein Jensen slants. Tuberculin skin testing (TST) was performed and an induration of ≥10mm read after 48-72 hours was considered positive. One joint year is defined as one joint per day for one year. Results: The prevalence of ever smoking cannabis was 11.3% (23% in men; 2.6% in women) and 6.4% were current smokers. A history of tuberculosis was reported by 9.7%; current disease confirmed in 1 %, and 76% had a positive TST. After adjusting for age, sex, tobacco smoking, income, education, occupational exposure, incarceration, alcohol use and body mass index, persons with a cumulative cannabis exposure of >70 joint years (approximately equivalent to 20 tobacco packyears) had an increased risk of past/current tuberculosis disease (OR 3.2; Cl:1.8 - 5.6). Cannabis joint years did not show an association with tuberculosis infection. Conclusions: This population study shows that cannabis smoking is positively associated with past/current tuberculosis disease, suggesting that cannabis may be a risk factor in the development of tuberculous disease

Death on the table: anaesthetic registrars’ experiences of perioperative death

Background: A perioperative death can be a devastating event for which anaesthetists’ training does not necessarily prepare them. Previous authors have documented a range of reactions to this event. This study set out to explore individual personal and professional reactions amongst a group of senior anaesthetic trainees.Methods: A qualitative methodology was employed and purposive sampling used to select participants. Ten registrars in their fourth year of specialist training in the University of KwaZulu-Natal Department of Anaesthesia were interviewed. Transcripts of the interviews were thematically analysed.Results: Themes expressed by participants fell into three broad categories: professional role (responsibility, coping, functioning after a death), relationships with patients and families (nature of the case, emotional distress, bearing bad news), and personal impact (guilt, physical sequelae, support, desensitisation).Conclusion: Participants’ perceptions supported the notion of potential second (anaesthetist) and third (subsequent patient) victims after a perioperative death. These underscore the importance of the expressed need for debriefing and an interval before resuming duty. The phenomenon of desensitisation was expressed as a spectrum between being dissociated from the event and disconnected from the people involved, raising the possibility of perioperative death as a contributing factor to burnout. This study hopes to improve awareness of the potential consequences of perioperative death and the need for these consequences to be addressed.Keywords: anaesthesia training, debriefing, desensitisation, perioperative deat

Respiratory symptoms and chronic obstructive pulmonary disease : prevalence and risk factors in a predominantly low-income urban area of Cape Town, South Africa

Includes bibliographical references.The continuing worldwide increase in the incidence of chronic obstructive pulmonary disease (COPD) has led to international initiatives to improve surveillance and identify preventable risk factors for this and related chronic lung diseases. The studies reported here aimed to examine the prevalence and risk factors for respiratory symptoms and COPD; to introduce and test surveillance methodologies; and to inform treatment and control measures for this disease. The Lung Health Survey 2002 sampled 3512 individuals aged ≥ 15 years from an urban population of 36,334 in the predominantly low-income area of Ravensmead and Uitsig, Cape Town, South Africa. Information on respiratory symptoms, risk factors and healthcare utilisation was collected using a respiratory questionnaire which included questions that had been validated elsewhere. In 2005, a subsample of 960 persons aged ≥ 40 years participated in the Burden of Obstructive Lung Disease (BOLD) study comprised of a questionnaire and pre and postbronchodilator spirometry, in order to assess the prevalence of COPD. A high prevalence of respiratory symptoms of 38.3% was reported. Tobacco smoking showed a consistent positive association with chronic bronchitis, wheeze, dyspnoea and cough. Strong associations with cannabis smoking, pulmonary tuberculosis, occupational exposures and low socioeconomic status were found. The association of cannabis smoking with respiratory symptoms suggest that it may be a risk factor for COPD. The BOLD study revealed an exceptionally high prevalence of COPD in both men and women aged 40 years and older (29% and 20%, respectively) reflecting the very high prevalence of smoking in both sexes in the test area. The majority of those affected had moderate to severe disease, that is, symptoms with spirometric impairment (GOLD Stage II and higher). Even non-smoking women had a comparatively high prevalence of CO PO (12.6%), attributable to other risk factors such as tuberculosis and occupational exposures. Previous pulmonary tuberculosis was shown to be a strong predictor of COPD, which warrants further study. Review of healthcare utilisation confirmed significant under-recognition and under-treatment within local health services. These results confirm the need to prioritise preventative and treatment strategies for obstructive lung disease in South Africa

Some aspects of the nature and incidence of stuttering among Indian primary school children in Durban.

Thesis (M.A.)-University of Natal, Durban, 1971.Stuttering has been a complex problem ever since the early history of man. It has been found to exist in some cultures to a greater extent than in others. In certain primitive cultures the phenomenon of stuttering was reported to be unknown, yet when members of these cultures were influenced by western environments some incidence of stuttering occurred among them. The influence of the environment therefore cannot be disregarded when considering causes of stuttering. Although much research has been done by speech pathologists among various world cultures they have by no means completed their task for there are many groups, living in a variety of societies, which are yet to be studied. The present rudimentary investigation into stuttering among Indians living in Durban may be regarded as a contribution to the knowledge that has already been accumulated

Indian family businesses in Durban

From introduction: This is a study of Indian family businesses in the central business district of Durban, a sea port on the coast of Natal, in South Africa

Comparing the outcomes of nurse initiated management of antiretroviral therapy in Tuberculosis - Human immunodeficiency Virus (HIV) co-infected patients Vs HIV mono-infected patients.

Master of Public Health. University of KwaZulu-Natal, Durban, 2017.No abstract available

International research collaboration between South Africa and rest of the world: An analysis of 2012–2021 trends

South African higher education policies have since 1997 called for the expansion of research collaboration with the African continent and Global South. In this article, the authors’ analysed South Africa’s international research collaboration trends and patterns during the 2012–2021 period. Focusing on co-authored scholarly publications, the authors’ analysed bibliometric data from Scopus, highlighting the countries South African public universities have collaborated and produced knowledge with, and the parts of the world they have neglected in the past decade. The findings highlight the growth of South Africa’s international research collaboration and the expansion of the number of countries universities collaborate with. While the past decade has seen a growth in research collaboration with Brazil, Russia, India, China and Nigeria, South African universities continue to be largely Eurocentric and prioritise collaboration with the Global North while sidelining research collaboration with the African continent and Global South. Contribution: The findings presented in this article contribute to an understanding of South Africa’s international research collaboration footprint during 2012–2021 and highlight which parts of the world should be prioritised by universities in the expansion of research collaboration in the future

Risk factors for COPD spirometrically defined from the lower limit of normal in the BOLD project.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Chronic obstructive pulmonary disease (COPD) is predicted to become the third most common cause of death and disability worldwide by 2020. The prevalence of COPD defined by the lower limit of normal was estimated using high-quality spirometry in surveys of 14 populations aged ≥ 40 yrs. The strength and consistency of associations were assessed using random effects meta-analysis. Pack-years of smoking were associated with risk of COPD at each site. After adjusting for this effect, we still observed significant associations of COPD risk with age (OR 1.52 for a 10 yr age difference, 95% CI 1.35-1.71), body mass index in obese compared with normal weight (OR 0.50, 95% CI 0.37-0.67), level of education completed (OR 0.76, 95% CI 0.67-0.87), hospitalisation with a respiratory problem before age 10 yrs (OR 2.35, 95% CI 1.42-3.91), passive cigarette smoke exposure (OR 1.24, 95% CI 1.05-1.47), tuberculosis (OR 1.78, 95%CI 1.17-2.72) and a family history of COPD (OR 1.50, 95% CI 1.19-1.90). Although smoking is the most important risk factor for COPD, other risk factors are also important. More research is required to elucidate relevant risk factors in low- and middle-income countries where the greatest impact of COPD will occur.ALTANA Aventis AstraZeneca Boehringer-Ingelheim Chiesi GlaxoSmithKline Merck Novartis Pfizer Schering-Plough Sepracor University of Kentucky Boehringer Ingelheim China (Guangzhou, China) Turkish Thoracic Society Pfizer (Adana, Turkey) Merck Sharpe Dohme Salzburger Gebietskrankenkasse Salzburg Local Government (Salzburg, Austria) Research for International Tobacco Control International Development Research Centre South African Medical Research Council South African Thoracic Society GlaxoSmithKline University of Cape Town Lung Institute (Cape Town, South Africa) Landspitali-University Hospital GlaxoSmithKline Iceland AstraZeneca Iceland (Reykjavik, Iceland) GlaxoSmithKline Pharmaceuticals Polpharma Ivax Pharma Poland AstraZeneca Pharma Poland ZF Altana Pharma Pliva Krakow Linde Gaz Polska Novartis Poland Lek Polska Farmaceutyczne Polfa Starostwo Proszowice Skanska Zasada Agencja Mienia Wojskowego w Krakowie Telekomunikacja Polska Biernacki Amplus Bucki Skrzydlewski Sotwin Agroplon (Krakow, Poland) Pfizer Germany (Hanover, Germany) Norwegian Ministry of Health's Foundation for Clinical Research Haukeland University Hospital's Medical Research Foundation for Thoracic Medicine (Bergen, Norway) GlaxoSmithKline (Vancouver, Canada) Marty Driesler Cancer Project (Lexington, KY, USA) Philippine College of Chest Physicians Boehringer Ingelheim (Phil) Philippine College of Physicians United Laboratories (Phil) (Manila, Philippines) Air Liquide Healthcare P/L AstraZeneca P/L Boehringer Ingelheim P/L GlaxoSmithKline Australia P/L Pfizer Australia P/L (Sydney, Australia) UK Department of Health's Policy (London, UK) Swedish Heart-Lung Foundation Swedish Heart and Lung Association GlaxoSmithKline (Uppsala, Sweden) Adamed Lek Polska Biogra

Worldwide patterns of bronchodilator responsiveness: results from the Burden of Obstructive Lung Disease study.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Criteria for a clinically significant bronchodilator response (BDR) are mainly based on studies in patients with obstructive lung diseases. Little is known about the BDR in healthy general populations, and even less about the worldwide patterns. 10 360 adults aged 40 years and older from 14 countries in North America, Europe, Africa and Asia participated in the Burden of Obstructive Lung Disease study. Spirometry was used before and after an inhaled bronchodilator to determine the distribution of the BDR in population-based samples of healthy non-smokers and individuals with airflow obstruction. In 3922 healthy never smokers, the weighted pooled estimate of the 95th percentiles (95% CI) for bronchodilator response were 284 ml (263 to 305) absolute change in forced expiratory volume in 1 s from baseline (ΔFEV(1)); 12.0% (11.2% to 12.8%) change relative to initial value (%ΔFEV(1i)); and 10.0% (9.5% to 10.5%) change relative to predicted value (%ΔFEV(1p)). The corresponding mean changes in forced vital capacity (FVC) were 322 ml (271 to 373) absolute change from baseline (ΔFVC); 10.5% (8.9% to 12.0%) change relative to initial value (ΔFVC(i)); and 9.2% (7.9% to 10.5%) change relative to predicted value (ΔFVC(p)). The proportion who exceeded the above threshold values in the subgroup with spirometrically defined Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 and higher (FEV(1)/FVC <0.7 and FEV(1)% predicted <80%) were 11.1%, 30.8% and 12.9% respectively for the FEV(1)-based thresholds and 22.6%, 28.6% and 22.1% respectively for the FVC-based thresholds. The results provide reference values for bronchodilator responses worldwide that confirm guideline estimates for a clinically significant level of BDR in bronchodilator testing.ALTANA Aventis AstraZeneca Boehringer-Ingelheim Chiesi GlaxoSmithKline Merck Novartis Pfizer Schering-Plough Sepracor University of Kentucky Boehringer Ingelheim Schering Ploug

The immune reconstitution inflammatory syndrome after antiretroviral therapy initiation in patients with tuberculosis: findings from the SAPiT trial.

Background: Concerns about the immune reconstitution inflammatory syndrome (IRIS) remain a barrier to antiretroviral therapy (ART) initiation during antituberculosis treatment in co-infected patients. Objective: To assess IRIS incidence, severity, and outcomes relative to the timing of ART initiation in patients with HIV-related tuberculosis. Design: Randomized, open-label clinical trial. (ClinicalTrials.gov registration number: NCT00398996) Setting: An outpatient clinic in Durban, South Africa. Patients: 642 patients co-infected with HIV and tuberculosis. Measurements: In a secondary analysis of the SAPiT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) trial, IRIS was assessed in patients randomly assigned to initiate ART within 4 weeks of tuberculosis treatment initiation (early integrated treatment group), within 4 weeks of completion of the intensive phase of tuberculosis treatment (late integrated treatment group), or within 4 weeks after tuberculosis therapy completion (sequential treatment group). The syndrome was defined as new-onset or worsening symptoms, signs, or radiographic manifestations temporally related to treatment initiation, accompanied by a treatment response. Severity of IRIS, hospitalization, and time to resolution were monitored. Results: Incidence of IRIS was 19.5 (n = 43), 7.5 (n = 18), and 8.1 (n = 19) per 100 person-years in the early integrated, late integrated, and sequential treatment groups, respectively. Among patients with a baseline CD4+ count less than 0.050 × 10.9 cells/L, IRIS incidence was 45.5, 9.7, and 19.7 per 100 person-years in the early integrated, late integrated, and sequential treatment groups, respectively. Incidence of IRIS was higher in the early integrated treatment group than in the late integrated (incidence rate ratio, 2.6 [95% CI, 1.5 to 4.8]; P < 0.001) or sequential (incidence rate ratio, 2.4 [CI, 1.4 to 4.4]; P < 0.001) treatment groups. More severe IRIS cases occurred in the early integrated treatment group than in the other 2 groups (35% vs. 19%; P = 0.179), and patients in the early integrated treatment group had significantly higher hospitalization rates (42% vs. 14%; P = 0.007) and longer time to resolution (70.5 vs. 29.0 days; P = 0.001) than patients in the other 2 groups. Limitations: It was not possible to assess IRIS in more patients in the sequential treatment group (n = 74) than in the late integrated (n = 50) and early integrated (n = 32) treatment groups because of loss to follow-up, withdrawal, or death within 6 months of scheduled ART initiation. This study did not assess IRIS risk in nonambulatory patients or in those with extrapulmonary and smear-negative tuberculosis. Conclusion: Initiation of ART in early stages of tuberculosis treatment resulted in significantly higher IRIS rates, longer time to resolution, and more severe cases of IRIS requiring hospitalization. These findings are particularly relevant to patients initiating ART with a CD4+ count less than 0.050 × 10.9 cells/L, given the increased survival benefit of early ART initiation in this group