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 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

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

Making Sense of Family Deaths in Urban Senegal: Diversities, Contexts, and Comparisons

Despite calls for cross-cultural research, Minority world perspectives still dominate death and bereavement studies, emphasizing individualized emotions and neglecting contextual diversities. In research concerned with contemporary African societies, on the other hand, death and loss are generally subsumed within concerns about AIDS or poverty, with little attention paid to the emotional and personal significance of a death. Here, we draw on interactionist sociology to present major themes from a qualitative study of family deaths in urban Senegal, theoretically framed through the duality of meanings-in-context. Such themes included family and community as support and motivation; religious beliefs and practices as frameworks for solace and (regulatory) meaning; and material circumstances as these are intrinsically bound up with emotions. Although we identify the experience of (embodied, emotional) pain as a common response across Minority and Majority worlds, we also explore significant divergencies, varying according to localized contexts and broader power dynamics

The attitudes of medical students to research

  Background. The workforce of ‘physician-scientists’ is ageing and decreasing in numbers. The responsibility to combat this trend rests on future generations of healthcare professionals and it is therefore valuable to evaluate medical students’ attitudes towards research. Objective. To establish the attitudes of University of Cape Town (UCT) medical students towards research and to investigate the factors influencing these attitudes. Methods. An anonymous, cross-sectional, self-administered questionnaire was administered to medical students from years 1 to 6 studying medicine at UCT in 2011. Questions were primarily closed-ended and consisted of Likert scales. Results. Out of a population of 1 195 medical students, 733 were sampled (63%); 65% were female, 53% were preclinical students (years 1 - 3) and 47% were in their clinical years (year 4 - 6). Overall, 61% of students had a positive attitude towards research and 74% felt that participation in research was important to their medical school education; 22% had been involved in voluntarily extracurricular research, 4% had presented at a scientific meeting and 3% had published in peer-reviewed journals. A number of perceived barriers to student research were identified including a lack of adequate training, time and research opportunities. Conclusion. Students believed that research was important and had a positive attitude towards it. However, few had been involved in voluntary research and produced work worthy of presentation and/or publication. Addressing identified barriers and improving students’ attitudes may begin to reverse the trend in declining numbers of physician-scientists.

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

The National Food Consumption Survey (NFCS): South Africa, 1999

Objective: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. Design: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. Subjects: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. Methods: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. Results: At the national level, stunting (height-for-age below minus two standard deviations (< -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age < -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. Conclusion: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa. © The Authors 2005.Conference Pape

Important HIV-associated conditions in HIV-infected infants and children

This article is the last in a series of 6 articles that discussed the management of HIV-infected children in a clinically orientated, practical and concise fashion. The topics covered previously include; 1) Preventing and diagnosing HIV-infection in infants and children, 2) Initiating anti-retroviral therapy in HIV-infected infants and children, 3) Maintaining HIV-infected infants and children on anti-retroviral therapy, 4) Common opportunistic infection in HIV-infected children: Part 1-respiratory infections and 5) Part 2 non-respiratory infections. South African Family Practice Vol. 49 (4) 2007: pp.19-2