Extrapulmonary tuberculosis among adults : Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

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Profile of cause of death assigned to adults on antiretroviral therapy in Soweto

This retrospective cohort study describes causes of death in 305 patients (baseline median CD4 count 26/ìl) from 2 943 adults on antiretroviral therapy. Acute sepsis (20%), tuberculosis (18%) and Mycobacterium avium complex (MAC) bacteraemia (14%) were the most common causes. Mortality owing to the disease was 66% for MAC bacteraemia and 23% for  non-Hodgkin’s lymphoma. In 37 patients dying beyond one year on ART, virological failure was present in 11 (30%), and non-HIV-related causes of death occurred in 10. The main causes were acute sepsis (6), tuberculosis (7) and chronic medical conditions (5). Initiating ART at higher CD4 counts should reduce early mortality

Occupational exposure of interns to blood in an area of high HIV seroprevalence

Objective. To determine the epidemiology of work-related exposure to blood among interns.Design. Interns were invited to complete anonymously a questionnaire concerning their past percutaneous and mucocutaneous exposures to blood.Setting. Chris Hani Baragwanath Hospital, Soweto, and Johannesburg Hospital, Gauteng, where HIV infection is common among patients.Results. Ninety-eight interns (96%) were surveyed. Sixty nine per cent of interns reported one or more percutaneous exposures to blood during the intern year, and 33% of interns recalled accidental percutaneous exposure to HlVinfected blgod. Forty-five per cent recalled a mucocutaneous exposure to IDV-positive blood. Only 28 (64%) of 44 percutaneous injuries from HIV-infected patients were reported. During their student clinical training, 56% of interns had suffered a penetrating injury, and 18% recollected needlestick injuries involving HIV infected patients. The most common mechanisms of injury included unexpected patient movement (23%), needle recapping (17%), and withdrawal of the needle (17%). Half of the injuries occurred during the first 4 months of internship. Only 22% of intern percutaneous exposures could have been avoided by following universal precautions.Conclusions. Intern and medical student exposure to blood is extremely common, but is markedly underreported. Strict compliance with universal precautions will not prevent the majority of exposures. Priorities should be the introduction of safer techniques and equipment, skills training and methods of reporting blood exposures

Clinical aspects and outcomes of patients with malaria at Chris Hani Baragwanath Academic Hospital,Johannesburg, South Africa

Background. South Africa (SA) is currently experiencing a significant increase in malaria cases despite having shifted focus from malaria control towards malaria elimination. The clinical features of malaria are nonspecific, but their relative frequency on presentation are not well described. HIV and malaria are both independently associated with high mortality in sub-Saharan Africa. There are important interactions between HIV and malaria.Objectives. To describe the population characteristics of patients with malaria at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, clinical and biochemical features of severity, the proportion of patients with HIV infection, management and outcomes.Methods. A prospective observational study was conducted whereby patients with a confirmed laboratory diagnosis of malaria were identified, approached and consented for study inclusion over the time period January 2017 - January 2018. Clinical and biochemical data were collected at the time of consent and later analysed.Results. The mean (standard deviation) age was 35.7 (12.98) years, and 72 (70.6%) of the 102 patients were male. Peak admissions for malaria were in January, with 58 patients (56.9%) admitted during January 2017 and 2018. All malaria cases were imported, with 74.5% associated with travel to Mozambique. The majority of the patients (61.8%) were expatriates living in SA. The most common presenting symptoms were chills (95.1%), weakness (94.1%), fever (91.2%), headache (90.2%) and lethargy (88.2%). The most common clinical signs were dehydration (31.4%), prostration (19.6%) and jaundice (13.7%). Among the 40 patients (39.2%) who had severe malaria, prostration was the most common feature of severity (19.6%), 8 (7.8%) were admitted to an intensive care unit, and 6 (5.9%) required haemodialysis. The median (interquartile range) duration of hospital stay was 5 (3 -6) (range 2 - 35) days. HIV status was known in 83 patients (81.4%), of whom 32 (38.6%) were HIV-positive. Malaria prophylaxis had been taken by only 8 patients. The all-cause mortality rate was 4.9%, and mortality attributable to malaria 3.9%.Conclusions. There was a high proportion of complicated malaria cases, particularly in January. The majority of patients were young expatriate males with a history of travel to southern Mozambique or Limpopo Province, with very few taking malaria prophylaxis. Most clinical signs and symptoms were constitutional and nonspecific. A large number of patients were found to be HIV-positive, and most were newly diagnosed. Mortality was high, at around five times the national average, and may have been an underestimate

Clinical aspects and outcomes of patients with malaria at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background. South Africa (SA) is currently experiencing a significant increase in malaria cases despite having shifted focus from malaria control towards malaria elimination. The clinical features of malaria are nonspecific, but their relative frequency on presentation are not well described. HIV and malaria are both independently associated with high mortality in sub-Saharan Africa. There are important interactions between HIV and malaria. Objectives. To describe the population characteristics of patients with malaria at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, clinical and biochemical features of severity, the proportion of patients with HIV infection, management and outcomes. Methods. A prospective observational study was conducted whereby patients with a confirmed laboratory diagnosis of malaria were identified, approached and consented for study inclusion over the time period January 2017 - January 2018. Clinical and biochemical data were collected at the time of consent and later analysed. Results. The mean (standard deviation) age was 35.7 (12.98) years, and 72 (70.6%) of the 102 patients were male. Peak admissions for malaria were in January, with 58 patients (56.9%) admitted during January 2017 and 2018. All malaria cases were imported, with 74.5% associated with travel to Mozambique. The majority of the patients (61.8%) were expatriates living in SA. The most common presenting symptoms were chills (95.1%), weakness (94.1%), fever (91.2%), headache (90.2%) and lethargy (88.2%). The most common clinical signs were dehydration (31.4%), prostration (19.6%) and jaundice (13.7%). Among the 40 patients (39.2%) who had severe malaria, prostration was the most common feature of severity (19.6%), 8 (7.8%) were admitted to an intensive care unit, and 6 (5.9%) required haemodialysis. The median (interquartile range) duration of hospital stay was 5 (3 -6) (range 2 - 35) days. HIV status was known in 83 patients (81.4%), of whom 32 (38.6%) were HIV-positive. Malaria prophylaxis had been taken by only 8 patients. The all-cause mortality rate was 4.9%, and mortality attributable to malaria 3.9%. Conclusions. There was a high proportion of complicated malaria cases, particularly in January. The majority of patients were young expatriate males with a history of travel to southern Mozambique or Limpopo Province, with very few taking malaria prophylaxis. Most clinical signs and symptoms were constitutional and nonspecific. A large number of patients were found to be HIV-positive, and most were newly diagnosed. Mortality was high, at around five times the national average, and may have been an underestimate

Pharmacological treatment of painful HIVassociated sensory neuropathy

Background. HIV-associated sensory neuropathy (HIV-SN) is a common and frequently painful  complication of HIV infection and its treatment. However, few data exist describing the frequency, type and dosage of pain medications patients are receiving in the clinic setting to manage the painful symptoms of HIV-SN.Objective. To report on analgesic prescription for painful HIV-SN and factors influencing that prescription in adults on combination antiretroviral therapy.Methods. Using validated case ascertainment criteria to identify patients with painful HIV-SN, we  recruited 130 HIV-positive patients with painful HIV-SN at Chris Hani Baragwanath Hospital,  Johannesburg, South Africa. Demographic and clinical data (including current analgesic use) were collected on direct questioning of the patients and review of the medical files.Results. We found significant associations, of moderate effect size, between higher pain intensity and lower CD4 T-cell counts with prescription of analgesic therapy. Factors previously identified as predicting analgesic treatment in HIV-positive individuals (age, gender, level of education) were not associated with analgesic use here. Consistent with national guidelines, amitriptyline was the most commonly used agent, either alone or in combination therapy. Importantly, we also found that despite the relatively high analgesic treatment rate in this setting, the majority of patients described their current level of HIV-SN pain as moderate or severe.Conclusion. Our findings highlight the urgent need for both better analgesic options for HIV-SN pain  treatment and ongoing training and support of clinicians managing this common and debilitating condition

Effect of amplification bandwidth on speech intelligibility

This paper was a study to examine the effect of bandlimiting on speech intelligibility

Influenza- and respiratory syncytial virus-associated adult mortality in Soweto

Background. Influenza and respiratory syncytial virus (RSV)infections cause seasonal excess mortality and hospitalisationin adults (particularly the elderly) in high-income countries. Little information exists on the impact of these infections on adults in Africa.Objectives. To estimate influenza- and RSV-related adult mortality, stratified by age and hospitalisation in Soweto.Study design. A retrospective hospital-based study in Sowetofrom 1997 to 1999 to estimate influenza- and RSV-related excess all-cause deaths and hospitalisation using a ratedifferencemethod. The study was based on influenza seasons of varying severity, provided by surveillance data.Results. Influenza seasons were significantly associated with excess mortality in adults across all 3 years, except for 18 - 64-year-olds in 1998. Excess mortality was highest in those .65 years of age: 82.8/100 000 population in the mild 1997 season and 220.9/100 000 in the severe 1998 season. Influenza significantly increased adult medical hospitalisation in the severe 1998 season alone. RSV did not significantly affect mortality or hospitalisation.Conclusion. Influenza-related mortality was substantial and disproportionately affected the elderly. Influenza vaccination for the elderly warrants consideration. The RSV-related burden was not significantly increased but merits observation over a longer period