Diagnosis and treatment of schizophrenia in a general hospital based acute psychiatric ward

Objectives: To review and describe the clinical profile and acute in-patient treatment of patients diagnosed with schizophrenia over a four-year period; to review and describe the documented evidence for the diagnosis of schizophrenia; and to identify possible associated or predictive factors in the acute in-patient treatment outcome of patients at an acute (designated for 72-hour assessments) ward – within a general hospital, Helen Joseph Hospital (HJH). Method: Routine discharge summaries were used in a retrospective clinical review of patients with schizophrenia. The demographic, clinical and treatment profile of these patients were described and the documented evidence for the diagnosis of schizophrenia was reviewed using descriptive and comparative statistics. Factors were evaluated to assess their association with the length of stay (LOS) as outcome variable, using “Generalized Linear Latent and Mixed Models” (GLLAMM). Results: A total of 436 patients were diagnosed with schizophrenia, constituting on average about 20% of the total numbers of admissions. The overall mean LOS was 19.5 days. Considering DSM IV-TR criteria for schizophrenia, behavior problems were confirmed in 71.8% (n=313), perceptual disturbances in 29% (n=126) and thought disorders in 83.5% (n=364). The duration of symptoms were specified in 68% (n=298) patients. Age (

Post traumatic stress disorder and resilience in veterans who served in the South African border war

Objective: The psychological impact of the South African border war on veterans has received little or no attention. This study determined the prevalence of post-traumatic stress disorder (PTSD), and extent of resilience among a cohort of veterans.Method: Of 1527 former students who matriculated from a Johannesburg high school from 1975 to 1988, only 109 were reachable for convenience and snowballing recruitment into this study. An anonymous, internet-based questionnaire was used to obtain information on demography, combat exposure, drug and alcohol use, traumatic events in later life, and recourse to medication and counselling. The Impact of Event Scale – Revised (IES-R) assessed for PTSD and the Connor Davidson Resilience Scale (CDRISC) measured resilience. Data were processed with STATA; version 11 statistical software package. Analysis included Chi square test and regression analysis.Results: The response rate was 49.5% (n=54). The prevalence of PTSD was 33% and significantly associated with combat exposure (p=.012). Despite high prevalence of PTSD in those exposed to combat, 94% showed normal to above-normal level of resilience. CD-RISC scores showed no association with the IES-R. Only current cannabis use was significantly linked with PTSD (p=.044).Conclusion: Although the prevalence of PTSD found in this sample was higher than in comparable international studies, this cohort of former SA national servicemen, showed high levels of resilience. The current use of cannabis within the context of prior exposure to military national service or combat should prompt clinicians to screen for the presence of PTSD-associated symptoms.Keywords: Combat Exposure; Post-traumatic Stress Disorder; National Service; Border War; South AfricaAfrican Journal of Psychiatry • November 2013, 16(6

The impact of highly active antiretroviral therapy on the burden of bacterial lower respiratory tract infections in children

Background. Respiratory diseases are common and associated with significant morbidity and mortality in children.Objective. To evaluate the prevalence and outcome of bacterial lower respiratory tract infections (LRTIs) in HIV-infected and uninfected children at a primary level hospital.Methods. A cross-sectional descriptive study of children aged 6 months - 18 years was conducted. Recruitment included HIV-positive children who had been on highly active antiretroviral therapy (HAART) for at least 6 months. A comparator group of HIV-negative children admitted with bacterial pneumonia was included. Laboratory data collected included CD4+ T-cell counts, HIV viral load and C-reactive protein (CRP). Data collected in both groups included demographic data, immunisation status, zinc supplementation, previous LRTIs, environmental exposures and treatment.Results. Fifty-nine HIV-infected and 20 uninfected children were enrolled. The HIV-positive children were older, with a mean age of 107.2 (standard deviation 50.0) months v. 12.0 (5.8) months (p<0.005). The HIV-infected group had a mean CD4 percentage of 31.5%, and had had an average of 3.9 visits for bacterial LRTIs. All were treated with amoxicillin with no complications. In the HIV-uninfected group, cough and rapid breathing were the most common presenting symptoms, and the mean CRP level was 463.0 mg/L. The mean hospital stay was 4 days.Conclusion. HAART is effective in reducing the burden of LRTIs in HIV-positive children, even when the diagnosis is delayed. Cough and fast breathing are still the most reliable presenting symptoms of pneumonia. The majority of children still respond to amoxicillin as first-line therapy, with low complication rates

Comparison of HTLV-associated myelopathy (HAM) in HIV-positive and HIV-negative patients at a tertiary South African hospital

Background. HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM.Aim. We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM.Methods. Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed.Results. 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients.Conclusion. Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common

Factors related to hospital readmissions in people with spinal cord injury in South Africa

Background. People with spinal cord injury (PWSCI) face various challenges after being discharged from rehabilitation that can result in readmission to hospital. Little is known about readmission of PWSCI in South Africa (SA). Readmission is costly, interrupts community involvement and negatively affects quality of life.Objectives. To investigate readmission rates within 5 years of rehabilitation, causes of readmission and factors related to readmission in PWSCI in Pretoria, SA.Methods. We quantitatively analysed retrospective data gathered from files of patients admitted to a private rehabilitation facility in Pretoria between January 2008 and December 2012. Data were analysed using Stata 13 statistical software. Descriptive statistics were initially presented. Univariate logistic regression was used to identify individual factors that had significant association with the outcome measure (readmission). Thereafter, multivariate logistic regression was used to identify risk factors for readmission. The level of statistical significance was set at p<0.5.Results. Data from 543 patient files were analysed. In total, 100 patients (18%) were readmitted between January 2008 and December 2012. Twenty-eight of the 100 readmitted patients had a subsequent second readmission, 10 patients had a third readmission, and 2 patients were readmitted for a fourth time. The most common reason for readmission was secondary health conditions (SHCs) (80%), followed by further rehabilitation, including gait rehabilitation (12%). Eight patients (8%) had undocumented reasons for readmission. The common SHCs in the first readmission were pressure ulcers (39%), followed by urinary tract infections (12%), deteriorating neurological status (6%) and constipation (3%). Patients with paraplegia had 2.3 times greater odds of readmission compared with tetraplegics (p=0.000, 95% CI 1.47 - 3.55). Those in the category T1 - T6 level of injury had 2.6 times greater odds of readmission (p=0.04, 95% CI 1.04 - 6.71, while those with incomplete spinal cord injury had 2.5 times greater odds (p=0.001, 95% CI 1.44 - 4.46).Conclusions. Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention.Â

Audit of antenatal care at a community health centre in Tshwane North subdistrict, Gauteng province

Objective: Few studies document the level of compliance with antenatal care protocols in primary health care in South Africa. The aim of this study was to conduct an audit of antenatal care at a community health centre in Tshwane North subdistrict in order to measure the level of compliance of maternity staff with antenatal care protocols. This study was part of a larger study on a quality improvement initiative in primary health care.Design and setting: A retrospective cross-sectional descriptive study was undertaken of women attending antenatal care at the study clinic. Data were collected through a review of the women’s antenatal cards using criteria from the Guidelines for maternity care in South Africa and the basic antenatal care (BANC) checklist. In addition, qualitative interviews of maternity staff were undertaken in order to investigate reasons for  noncompliance with the maternity care guidelines.Results: The overall rate of compliance of nurses was 85.1%. This is less than optimal. The response (decision-making and interpretation)  component of compliance was only 57.6%. This represents a significant missed opportunity in terms of quality of antenatal care. Important  protocols, such as that pertaining to the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus, were also not carried out correctly. The response to PMTCT protocols was 50% only, another significant opportunity missed. Administrative factors, patient-related factors and deficiencies in the knowledge and skills of nurses were identified and documented as reasons for noncompliance.Conclusion: The study has provided a detailed picture of the situation with regard to non-compliance with the maternity care guidelines in a primary health care facility. Therefore, these data are very important in terms of quality assurance of maternity services in primary health care

Factors related to hospital readmissions in people with spinal cord injury in South Africa

Background. People with spinal cord injury (PWSCI) face various challenges after being discharged from rehabilitation that can result in readmission to hospital. Little is known about readmission of PWSCI in South Africa (SA). Readmission is costly, interrupts community involvement and negatively affects quality of life.Objectives. To investigate readmission rates within 5 years of rehabilitation, causes of readmission and factors related to readmission in PWSCI in Pretoria, SA.Methods. We quantitatively analysed retrospective data gathered from files of patients admitted to a private rehabilitation facility in Pretoria between January 2008 and December 2012. Data were analysed using Stata 13 statistical software. Descriptive statistics were initially presented. Univariate logistic regression was used to identify individual factors that had significant association with the outcome measure (readmission). Thereafter, multivariate logistic regression was used to identify risk factors for readmission. The level of statistical significance was set at p<0.5.Results. Data from 543 patient files were analysed. In total, 100 patients (18%) were readmitted between January 2008 and December 2012. Twenty-eight of the 100 readmitted patients had a subsequent second readmission, 10 patients had a third readmission, and 2 patients were readmitted for a fourth time. The most common reason for readmission was secondary health conditions (SHCs) (80%), followed by further rehabilitation, including gait rehabilitation (12%). Eight patients (8%) had undocumented reasons for readmission. The common SHCs in the first readmission were pressure ulcers (39%), followed by urinary tract infections (12%), deteriorating neurological status (6%) and constipation (3%). Patients with paraplegia had 2.3 times greater odds of readmission compared with tetraplegics (p=0.000, 95% CI 1.47 - 3.55). Those in the category T1 - T6 level of injury had 2.6 times greater odds of readmission (p=0.04, 95% CI 1.04 - 6.71, while those with incomplete spinal cord injury had 2.5 times greater odds (p=0.001, 95% CI 1.44 - 4.46).Conclusions. Factors related to patient injury profile such as type, completeness and level of injury were associated with a significant risk of readmission. SHCs were the main cause of readmission, and there is a need for effective programmes for their prevention.

Lung function decline is accelerated in South Africans with cystic fibrosis

BACKGROUND : Poor nutritional status has been shown to be associated with a significant decline in lung function in patients with cystic fibrosis. There are few data published on the lung function decline and the effects of nutritional status in cystic fibrosis (CF) in South Africa. AIM : To assess anthropometric parameters (weight, height, body mass index Z-score) in relation to lung function parameters in CF patients. METHODOLOGY : A retrospective chart review of clinical records of participants over the age of five years attending the CF clinic at Steve Biko Academic Hospital from 2005 to 2010. RESULTS : Twenty files were reviewed for lung function, anthropometric measurements, gender and CF-causing mutations. For anthropometric measurements the average changes were –0.8, –0.5 and 2.0 for weight, BMI and height Z-scores, respectively. A decline in FEV1 of –25.3 (95% CI 39.4; –13.3) over the five-year period was noted, with an average decline of 5.3% per year. For FEF25-75, the average change was –22.4 (95% CI-34.6; –10.2) with a decline of 4.5% per year. Using multivariate analysis, the FEV1 was found to be significantly influenced by: age –3.96 (95% CI –7.4; –0.5); p = 0.03, weight 1.8 (95% CI –3.4; –0.9); p = 0.04, BMI Z-score 4.3 (95% CI 5.3; 23.3); p = 0.02 and gender (p = 0.02). The FEF25-75 was significantly influenced by BMI Z-score and gender. CONCLUSION : The average lung function decline per year for FEV1 was higher than that seen in developed countries. The decline in FEV1 was related to gender, age, weight and BMI. The decline in FEF25-75 was affected only by BMI Z-score and gender.http://www.safpj.co.za/index.php/safpjhttp://medpharm.tandfonline.com/loi/ojfp20#.VgJFAVQaJHgam2016Paediatrics and Child Healt

Anatomical variations in the origins of the lateral circumflex femoral arteries in a South African sample : a cadaver study

BACKGROUND : Clinically, the lateral circumflex femoral artery (LCFA) is used in a variety of procedures, these include anterolateral thigh flaps, aortopopliteal bypass, coronary artery bypass grafting and extracranialintracranial bypass surgeries. Variations in the anatomy of the LCFA, profunda femoris artery (PFA) and their branches have been noted in several studies. There are numerous clinical implications related to the inadequate anatomical knowledge of this region. METHODS : The study sample consisted of 55 cadavers of different ages, ancestry groups and varying body mass index. A total of 90 legs were dissected. The anterior thigh compartment was dissected and the common femoral artery (CFA), superficial femoral artery (SFA), PFA and LCFA further exposed. The course and variations were noted and results documented for further analysis. RESULTS : The LCFA was present in all the legs dissected. The origin of the LCFA was found to be the PFA in 75.6% of the left legs and 82.2% of the right legs dissected. In two cases, a male and female limb, the branching of the PFA from the CFA was observed directly from the external iliac artery, deep to the inguinal ligament. A variation was noted in a female cadaver, where the branches of the LCFA on the left limb had different points of origin. Another variation was noted on a male cadaver, the left limb had two different points of branching for the ascending and descending branches of the LCFA, a common trunk was absent. CONCLUSION : This study indicates that the most common site of origin for the LCFA was the PFA. The branching of the PFA from the CFA was found to be variable in 2.2% of the cases, where the PFA was a direct branch of the external iliac artery. The study also noted variations relating to the origin of the transverse branch of the LCFA, this branch was absent in 4.4% of the limbs dissected. Knowledge of the variations related to the origin of the PFA, LCFA and their branches is important in reducing the chances of intra-operative bleeding, during different surgical procedures.National Research Foundation (NRF).https://www.elsevier.com/locate/triadm2022Anatom