Cytomegalovirus-associated supraglottic mass in a patient on immunosuppressive therapy

A 33-year-old woman on chronic immunosuppressive treatment for rheumatoid arthritis with a history of inhaled methamphetamine use presented with respiratory failure requiring mechanical ventilation for a prolonged period. After being given plasma exchange, pulses of methylprednisolone and a dose of cyclosporine for suspected ANCA (anti-neutrophilic cytoplasmic autoantibodies) vasculitis, she developed an obstructive supraglottic laryngeal mass that required a tracheostomy to bypass. Biopsy findings revealed the mass to be an inflammatory pseudomass secondary to cytomegalovirus (CMV). The mass resolved after several weeks of intravenous ganciclovir therapy. This is an extremely unusual presentation of localised CMV disease, with only two or three similar cases having been reported worldwide

The outcome of HIV-positive patients admitted to intensive care units with acute kidney injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

The relationship between body mass index, energy intake and level of physical activity of HIV positive women (25-44 years) in Mangaung

Published ArticleObjective: To determine the relationship between body mass index (BMI), energy intake and levels of physical activity of HIV negative and HIV positive women. Design: Cross sectional study. Methodology: A random sample of 500 pre-menopausal women within the two age group categories of 25-34 and 35-44 years was selected. Data on physical activity was obtained using an adapted Baecke questionnaire and categorized into low, medium, and high levels of physical activity. Weight and height were used to calculate BMI. Dietary intake was determined by means of a standardized food frequency questionnaire. Results: Sixty-one percent of younger women and 38% of older women were HIV infected. The vast majority of women (91%) had low levels of physical activity, while only 9% of the sample had physical activity levels that fell within the normal to high category. More than 50% of respondents were either overweight or obese (BMI above 25 kg/m2). BMI of HIV positive younger women was, however, significantly lower than that of HIV negative women. Median energy intakes were high (more than 10 000 kJ) for both HIV positive and HIV negative women. Conclusions: Reverting to a more traditional lifestyle, including diet and physical activity, could assist in addressing unfavorable BMI parameters of these women and improve health status and quality of life of HIV infected women

The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

Extraordinary arousal from semi-comatose state on Zolpidem

A young semi-eomatose male patient was investigated using 99mTc hexamethyl-propylene amine oxime (99mTc HMPAO) brain single photon emission computed tomography (SPECT) before and after administration of the gamma-aminobutyric acid (GABA) agonist zolpidem. It was observed that 15 minutes after application of the drug the patient awoke from his semi-eomatose condition and remained awake for the next 3 - 4 hours. When drug action subsided he returned to his semi-comatose state. Brain SPECT before drug application showed large hypo-active areas in certain parts of the brain. Brain SPECT after drug application showed a generalised cortical activation relative to the cerebellum and a marked and amplified activation of the areas that were hypo-active before drug application

UNUSUAL BREEDING BY SEABIRDS AT MARION ISLAND DURING 1997/98

In 1997/98, breeding at subantarctic Marion Island was exceptionally good for five species of seabirds capable of foraging over wide areas and for a tern. The number of king penguin Aptenodytes patagonicus chicks surviving to the start of spring in 1997 was considerably more than previously recorded. Greater numbers of wandering Diomedea exulans and grey-headed Thalassarche chrysostoma albatrosses, northern giant petrels Macronectes halli and Kerguelen terns Sterna virgata bred than previously recorded, and more southern giant petrels M. giganteus did so than in any other year since 1994. For southern giant petrels, reproductive success was higher than in any other year, as was survival of chicks of northern giant petrels. Conversely, for two seabirds that feed close to the island, gentoo penguin Pygoscelis papua and Crozet shag Phalacrocorax [atriceps] melanogenis, 1997/98 was a particularly poor breeding season. Gentoo penguins initiated breeding later than usual and fledged few chicks. The number of Crozet shags that bred decreased; probably about 25% of the adult population did not breed. For two species with an intermediate foraging range that eat mainly crustaceans, macaroni Eudyptes chrysolophus and eastern rockhopper E. chrysocome filholi penguins, breeding was not noticeably different from normal except that chicks of rockhopper penguins fledged with a slightly heavier mass than in other years. However, for both these penguins, the mass of adults on arrival at colonies decreased substantially in the following (1998/99) breeding season. The unusual breeding by most of the seabirds coincided with the El Niño Southern Oscillation (ENSO) event of 1997/98. This synchrony contrasts with lagged responses to ENSO events of seabirds that breed farther south in the Southern Ocean. Continued monitoring of seabirds over well-separated sites in the Southern Ocean may elucidate how climatic perturbations operating at a global scale impact seabirds in the region.Afr. J. mar. Sci. 25: 453–46

DECREASE IN NUMBERS OF THE EASTERN ROCKHOPPER PENGUIN EUDYPTES CHRYSOCOME FILHOLI AT MARION ISLAND, 1994/95–2002/03

The number of eastern rockhopper penguins Eudyptes chrysocome filholi breeding at subantarctic Marion Island decreased from about 173 000 pairs in 1994/95 to about 67 000 pairs in 2001/02. During 1994/95–2002/03 pairs fledged on average 0.40 chicks per year, an amount thought insufficient to balance mortality of breeding adults, and there was a decrease in the mass at arrival at breeding colonies of both males and females. Except in 1997/98, the mass of chicks at fledging was less than that recorded at two other localities. These factors suggest an inadequate supply of food for rockhopper penguins at Marion Island. Decreases of rockhopper penguins at several other localities also have been attributed to inadequate food. Rockhopper penguins at Marion Island continued to feed mainly on crustaceans during chick rearing. There was a marked increase in the contribution of fish to the diet in 1999/00 that coincided with an increase in mass at arrival at colonies of both males and females. Trends in numbers of pairs breeding in different sections of Marion Island were not always consistent, indicating the need for island-wide monitoring to establish the overall trend. Afr. J. mar. Sci. 25: 487–49

A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy

Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication. Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis. Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity

Sepsis in obstetrics and the role of the anaesthetist

ABSTRACT Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion and infertility. Early recognition and timely response are key to ensuring good outcome. This review examines the clinical problem of sepsis in obstetrics and the role of the anaesthetist in the management of this condition

Neurodevelopmental evaluation and referral practices in children with congenital heart disease in central South Africa

Introduction: Children with congenital heart disease (CHD) are at higher risk for developmental delays than the general population. The American Heart Association (AHA) published a guideline to address these concerns in 2012. This study determined the neurodevelopmental evaluation and referral practices of practitioners in central South Africa.Method: An online survey was administered to practitioners (n=45) including paediatric cardiologists (n=4), cardiothoracic surgeons (n=4) and general paediatricians (n=37). Information on practitioner characteristics, awareness of the 2012 AHA guideline; and neurodevelopmental evaluation and referral practices was collected.Results: Twenty-one practitioners responded, including paediatric cardiologists (n=4), cardiothoracic surgeons (n=2) and paediatricians (n=15). Data for 20 practitioners was included. Despite most practitioners (n=18) indicating guidelines for the management of development were important, the majority (n=16; 80%) were unaware of the guideline. Most practitioners (n=18; 90%) failed to risk stratify children to identify those to be evaluated. Children with developmental delays were referred for formal developmental evaluation (n=11; 55%) and to intervention therapies (n= 15; 75%).Conclusion: Most practitioners are unaware of the 2012 AHA guideline. Awareness of the developmental risks associated with CHD and implementation of the guideline could promote early identification of developmental delays with referral to intervention therapies