The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa

Background: Depressive disorders are associated with poorer health outcomes in people living with human immunodeficiency virus infection and acquired immunodeficiency syndrome (PLHIV) and have been shown to contribute to non-adherence to antiretroviral therapy (ART) in Western contexts. Limited data from developing countries are available. The aim of this study was to explore whether there was an association between depressive symptoms and adherence to ART among PLHIV in KwaZulu-Natal, South Africa.Method: A cross-sectional analytical study was undertaken in a population of HIV-positive patients accessing ART at a government funded, semi-urban clinic in the eThekwini Municipal District, KwaZulu-Natal, South Africa. The tools used to measure depressive symptoms and adherence were the Centre for Epidemiology Studies Depression Scale (CES-D)and clinic-based pill counts, respectively. Socio-demographic and clinical data were collected during interviews and from patient records.Results: Sixty-two per cent of the sample (n = 146) had higher-than-threshold levels on the depression scale, and 32% were less than 95% adherent to ART. High depression scores were associated with lower levels of education [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.0–4.1] and unemployment (OR 2.8; 95% CI, 1.3–6.0), while non-adherence was associated with unemployment (OR 2.4; 95% CI, 1.0–6.1) and mid-range CD4 counts (200–499 cells/ìl; OR 3.0; 95% CI,1.3–6.9). No significant association was found between depressive symptoms and non-adherence to ART (OR 0.5; 95% CI, 0.2–1.2; p-value, 0.125).Conclusion: The large percentage of participants who scored high on the CES-D suggests a high prevalence of major depression in the study population. No significant association was found between high depression scores and nonadherence to ART. Depressive symptoms were significantly linked to lower levels of education and unemployment, while non-adherence was associated with unemployment and mid-range CD4 counts (200–499 cells/ìl). The study had some limitations. Further studies are needed to determine the prevalence and causes of depression and its impact on PLHIV in this population and in the developing world

Adequacy of pain management in HIV-positive patients

Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence, severity, recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive, consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain, pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83% experiencing significant pain, in other words a “worst pain” rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients’ daily functioning. Pain was documented on 71% of the patients’ medical charts that were reviewed; however, only 34% were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients’ medical records, the management of pain was considered to be inadequate in a third of those experiencing pain.Keywords: HIV; pain; assessment; managemen

Maternal serum fructosamine values after delivery of macrosomic babies and unexplained stillbirths

Measurement of serum fructosamine and haemoglobin A, levels and glucose tolerance tests were performed in 75 women in the immediate postpartum period. None had predisposing factors to gestational diabetes. They were divided into three groups: group I consisted of 15 women who delivered an unexplained stillbirth; group 11 of 30 women who gave birth to babies weighing between 2500 g and 3900 g at term; and group III of 30 women who delivered babies weighing≥ 4000 g. There was a significant difference in the mean level of serum fructosamine between the unexplained stillbirth and control groups (P < 0,001). Although the HbA, values varied in the three groups, there was a significant difference between the unexplained stillbirth group and the macrosomic infant group (P < 0,05). All patients had normal glucose tolerance tests

Interleukin 1-Beta (IL-1) Production by Innate Cells Following TLR Stimulation Correlates With TB Recurrence in ART-Treated HIV-Infected Patients

BACKGROUND: Tuberculosis (TB) remains a major cause of global morbidity and mortality, especially in the context of HIV co-infection, since immunity is not completely restored following antiretroviral therapy (ART). The identification of immune correlates of risk for TB disease could help in the design of host-directed therapies and clinical management. This study aimed to identify innate immune correlates of TB recurrence in HIV+ ART-treated individuals with a history of previous successful TB treatment. METHODS: Twelve participants with a recurrent episode of TB (cases) were matched for age, sex, time on ART, pre-ART CD4 count with 12 participants who did not develop recurrent TB in 60 months of follow-up (controls). Cryopreserved peripheral blood mononuclear cells from time points prior to TB recurrence were stimulated with ligands for Toll like receptors (TLR) including TLR-2, TLR-4, and TLR-7/8. Multi-color flow cytometry and intracellular cytokine staining was used to detect IL-1β, TNF-α, IL-12 and IP10 responses from monocytes and myeloid dendritic cells (mDCs). RESULTS: Elevated production of IL-1β from monocytes following TLR-2, TLR-4 and TLR-7/8 stimulation was associated with reduced odds of TB recurrence. In contrast, production of IL-1β from both monocytes and mDCs following Bacillus Calmette-Guérin (BCG) stimulation was associated with increased odds of TB recurrence (risk of recurrence increased by 30% in monocytes and 42% in mDCs respectively). CONCLUSION: Production of IL-1β by innate immune cells following TLR and BCG stimulations correlated with differential TB recurrence outcomes in ART-treated patients and highlights differences in host response to TB

HIV/AIDS-associated Kaposi’s sarcoma of the gastrointestinal tract: A pictorial spectrum

We briefly report two cases of HIV/AIDS-associated Kaposi’s sarcoma affecting the gastrointestinal tract. Both patients were seen at Edenvale General Hospital, Johannesburg, South Africa

The introduction of an acute physiological support service for surgical patients is an effective error reduction strategy

AbstractIntroductionAcute surgical patients are particularly vulnerable to human error. The Acute Physiological Support Team (APST) was created with the twin objectives of identifying high-risk acute surgical patients in the general wards and reducing both the incidence of error and impact of error on these patients. A number of error taxonomies were used to understand the causes of human error and a simple risk stratification system was adopted to identify patients who are particularly at risk of error.ResultsDuring the period November 2012–January 2013 a total of 101 surgical patients were cared for by the APST at Edendale Hospital. The average age was forty years. There were 36 females and 65 males. There were 66 general surgical patients and 35 trauma patients. Fifty-six patients were referred on the day of their admission. The average length of stay in the APST was four days. Eleven patients were haemo-dynamically unstable on presentation and twelve were clinically septic. The reasons for referral were sepsis,4 respiratory distress,3 acute kidney injury AKI (38), post-operative monitoring (39), pancreatitis,3 ICU down-referral,7 hypoxia,5 low GCS,1 coagulopathy.1 The mortality rate was 13%. A total of thirty-six patients experienced 56 errors. A total of 143 interventions were initiated by the APST. These included institution or adjustment of intravenous fluids (101), blood transfusion,12 antibiotics,9 the management of neutropenic sepsis,1 central line insertion,3 optimization of oxygen therapy,7 correction of electrolyte abnormality,8 correction of coagulopathy.2ConclusionOur intervention combined current taxonomies of error with a simple risk stratification system and is a variant of the defence in depth strategy of error reduction. We effectively identified and corrected a significant number of human errors in high-risk acute surgical patients. This audit has helped understand the common sources of error in the general surgical wards and will inform on-going error reduction initiatives

Examining the effect of exposure time on the erosive potential of sour candy

This study aimed to evaluate the erosive potential of sour candy at a different time of exposure within a laboratory-based setting. Fifty human anterior tooth samples were randomly assigned into three groups, namely: sour candy, regular candy A, and deionized water (n=15). Each tooth sample was exposed to a solution containing the sample groups at different time intervals. Vickers hardness tester was used to measure the surface hardness pre- and postexposure. The mean surface hardness value measured was compared using a paired sample test (α =.05). Raman spectroscopy was used to study the change in the enamel structure in all sample groups. A significant difference in the surface hardness value was measured pre and post-exposure in all the sample groups (P<0.01). The samples exposed to sour candy had the highest tooth surface loss. In terms of the time of exposure, it was found that prolonged exposure had a significant effect on the surface hardness (P<0.01). The Raman intensity change confirmed that samples exposed to sour candy, after 2 hrs of exposure, had the highest loss of structural integrity. The study conclude that sour candies are very erosive and its impact enhances with time