26
|
Parker A, Nagar B, Thomas G, Badri M, Ntusi NBA. Health practitioners' state of knowledge and challenges to effective management of hypertension at primary level. Cardiovasc J Afr 2011; 22:186-90. [PMID: 21881683 PMCID: PMC3721906 DOI: 10.5830/cvja-2010-066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 08/19/2010] [Indexed: 01/19/2023] Open
Abstract
Background Patient- and physician-related factors impact on the management and control of hypertension. Objectives To systematically examine: (1) South African primary care doctors’ state of knowledge on the management of hypertension; (2) primary health practitioners’ knowledge on the South African hypertension guidelines; (3) current approaches to management of hypertensive patients; and (4) challenges to effective management of hypertension at primary level. Methods A cross-sectional, observational study using a semi-structured questionnaire was carried out in two large community health centres (CHCs) in the Cape Town metropole. All 16 doctors employed at both CHCs were voluntarily enrolled, seven (43.7%) of whom were female, with 14 (87.5%) younger than 40 years of age. The majority (81.2%) of the doctors surveyed had been practicing for less than 10 years. Results Ten (62.5%) of the doctors surveyed aimed to treat hypertension to target, and recommendations on lifestyle modifications were reportedly poorly done. While 11 (68.8%) of the doctors were aware of the South African hypertension guidelines, were (81.8%) of them were not conversant with the contents thereof. Doctors estimated that only 35% of their patients are treated to target. Poor patient adherence to prescribed treatment, language difficulty, heavy patient load, medical staff shortages, and patient loss to follow up were identified by the doctors as significant impediments to the effective management of hypertension at the primary level of care. Conclusion Primary healthcare practitioners’ knowledge regarding hypertension and the South African hypertension guidelines is poor. Management of hypertension by these doctors is sub-optimal. There are significant challenges to effective management of hypertension at this level of care.
Collapse
|
27
|
Wilson D, Mbhele L, Badri M, Morroni C, Nachega J, Chaisson RE, Maartens G. Evaluation of the World Health Organization algorithm for the diagnosis of HIV-associated sputum smear-negative tuberculosis. Int J Tuberc Lung Dis 2011; 15:919-24. [DOI: 10.5588/ijtld.10.0440] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Whitelaw A, Peter J, Sohn H, Viljoen D, Theron G, Badri M, Davids V, Pai M, Dheda K. Comparative cost and performance of light-emitting diode microscopy in HIV-tuberculosis-co-infected patients. Eur Respir J 2011; 38:1393-7. [PMID: 21659413 DOI: 10.1183/09031936.00023211] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Light-emitting diode (LED) microscopy has recently been endorsed by the World Health Organization (WHO). However, it is unclear whether LED is as accurate and cost-effective as Ziehl-Neelsen (ZN) microscopy or mercury vapour fluorescence microscopy (MVFM) in tuberculosis (TB)-HIV-co-infected subjects. Direct and concentrated sputum smears from TB suspects were evaluated using combinations of LED microscopy, ZN microscopy and MVFM. Median reading time per slide was recorded and a cost analysis performed. Mycobacterial culture served as the reference standard. 647 sputum samples were obtained from 354 patients (88 (29.8%) were HIV-infected and 161 (26%) were culture-positive for Mycobacterium tuberculosis). Although overall sensitivity of LED compared with ZN microscopy or MVFM was similar, sensitivity of all three modalities was lower in HIV-infected patients. In the HIV-infected group, the sensitivity of LED microscopy was higher than ZN microscopy using samples that were not concentrated (46 versus 39%; p = 0.25), and better than MVFM using concentrated samples (56 versus 44; p = 0.5). A similar trend was seen in the CD4 count <200 cells · mL(-1) subgroup. Median (interquartile range) reading time was quicker with LED compared with ZN microscopy (1.8 (1.7-1.9) versus 2.5 (2.2-2.7) min; p ≤ 0.001). Average cost per slide read was less for LED microscopy (US$1.63) compared with ZN microscopy (US$2.10). Among HIV-TB-co-infected patients, LED microscopy was cheaper and performed as well as ZN microscopy or MVFM independent of the staining (ZN or auramine O) or processing methods used.
Collapse
|
29
|
Dave JA, Engel ME, Freercks R, Peter J, May W, Badri M, Van Niekerk L, Levitt NS. Abnormal glucose metabolism in non-diabetic patients presenting with an acute stroke: prospective study and systematic review. QJM 2010; 103:495-503. [PMID: 20430755 DOI: 10.1093/qjmed/hcq062] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Non-diabetic patients presenting with an acute stroke often have hyperglycaemia. In most populations it is unknown whether the hyperglycaemia is transient and due to the acute stress response or whether it represents undiagnosed abnormal glucose metabolism. AIM To evaluate the prevalence and predictors of persistent hyperglycaemia in non-diabetic patients with an acute stroke. DESIGN Prospective observational study. METHODS Non-diabetic patients over 40 years old with an acute stroke were enrolled over a 2-year period. On admission patients were evaluated with an HbA(1c) and a 75 g oral glucose tolerance test (OGTT). The OGTT was repeated 3 months later. A meta-analysis was performed to interpret our results in the context of published data. RESULTS One hundred and seven patients were analysed. On admission 26 (24%) patients had diabetes, 39 (37%) had impaired glucose tolerance and 42 (39%) had normal glucose tolerance. Forty-four (68%) patients with hyperglycaemia on admission were re-investigated at least 3 months after discharge. Of these, 6 (14%) had diabetes, 12 (27%) had impaired glucose tolerance and 26 (59%) had normal glucose tolerance. A 2-h post-load glucose value >or=10 mmol/l predicted persistent hyperglycaemia with 72.2% sensitivity, 65.4% specificity and a positive predictive value and negative predictive value of 59.1 and 77.3%, respectively. A meta-analysis of prevalence data of impaired glucose metabolism in non-diabetic individuals 3 months after having had an acute stroke revealed a combined prevalence of 58% (95% confidence interval 25.4-90.5%). CONCLUSION In this study hyperglycaemia in the setting of an acute stroke was transient in the majority of patients.
Collapse
|
30
|
Horma S, Soulaymani A, Achour S, Mokhtar A, Ouammi L, Badri M, Soulaymani R. P414 - Épidémiologie des intoxications de l’enfant dans la région de Marrakech Tensift Al Haouz (Maroc). Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Horma S, Soulaymani A, Achour S, Mokhtar A, Ouammi L, Badri M, Soulaymani R. P339 - Intoxications aux produits ménagers chez l’enfant dans la région de Marrakech Tensift Al Haouz (Maroc). Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
32
|
Toilabiya L, Rhalem N, Hami H, Soulaymani A, Badri M, Ouammi L, Moukhtari A, Soulaymani R. P411 - Intoxications mortelles par les plantes dans la région de Taza-AlHoceima-Taounate. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70805-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Lenders L, Meldau R, van Zyl-Smit R, Woodburne V, Maredza A, Cashmore T, Semple P, Badri M, Zumla A, Dheda K. Comparison of same day versus delayed enumeration of TB-specific T cell responses. J Infect 2010; 60:344-50. [PMID: 20152856 DOI: 10.1016/j.jinf.2010.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 01/12/2010] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
|
34
|
Kalula SZ, Swingler GH, Sayer AA, Badri M, Ferreira M. Does chair type influence outcome in the timed "Up and Go" test in older persons? J Nutr Health Aging 2010; 14:319-23. [PMID: 20306006 DOI: 10.1007/s12603-010-0073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To test the effects of the use of a collapsible, portable chair (chair B), as opposed to a 'standard' chair (chair A), on the outcome of the timed "Up and Go" (TUG) test. DESIGN Cross-sectional. SETTING Multipurpose senior centres. PARTICIPANTS Mobile older persons (N=118, mean age 77 years (range 62-99 years)). OUTCOME MEASURES Time to complete the timed "Up and Go" test using chair A and chair B, and inter-rater agreement in the time scores. RESULTS Time taken to complete the TUG test did not differ by chair type [median (interquartile range, IQR) = 12.3 (9.53-15.9) and 12.6 (9.7-16.6)] seconds for Chair A and B respectively, p-value=0.87. In multiple regression analyses, factors that impacted on time difference in test performance for the two chairs were use of a walking aid during the test [Odds ratio (OR) = 3.7 95%CI 1.1-11.9, p=0.031], observed difficulty with mobility (OR= 27.7 95%CI 2.6-290, p=0.006), and a history of arthritis in the knees (OR= 2.9 95%CI 1.0-8.7, P=0.05). In an inter-rater agreement analysis, no significant difference was found between time scores recorded by the two raters; median (IQR) = 12.4 (10.9-15.9) and 12.3 (7.2-59.1) seconds for the occupation therapist and for the research assistant, respectively (Wilcoxon matched pairs test, p=0.124, Spearman correlation coefficient = 0.99, p < 0.001). CONCLUSION The use of a portable canvas chair with standardised specifications offers an acceptable alternative to the use of a 'standard' chair in assessments of fall risk using the TUG test in field settings where field workers are reliant on public transport.
Collapse
|
35
|
Souissi R, Boubakker A, Souissi H, Abdelrazek A, Badri M, Bziouech S, Jemel H. Prediction of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage using jugular bulb oximetry monitoring: preliminary results. Crit Care 2010. [PMCID: PMC2934009 DOI: 10.1186/cc8575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
36
|
Dheda K, van Zyl-Smit RN, Meldau R, Meldau S, Symons G, Khalfey H, Govender N, Rosu V, Sechi LA, Maredza A, Semple P, Whitelaw A, Wainwright H, Badri M, Dawson R, Bateman ED, Zumla A. Quantitative lung T cell responses aid the rapid diagnosis of pulmonary tuberculosis. Thorax 2009; 64:847-53. [DOI: 10.1136/thx.2009.116376] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
37
|
Hami H, Souleymani A, Ouammi L, Rhalem N, Badri M, Mokhtari A, Souleymani-Bencheikh R. Les intoxications mortelles par les plantes au Maroc. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Semlali I, Soulaymani A, Oufir GE, Benlarabi S, Aghandous R, Badri M, Soulaymani Bencheikh R. Stratégie marocaine de lutte contre les piqûres et les envenimations scorpioniques : évaluation épidémiologique des actions mises en place. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
39
|
Hami H, Souleymani A, Ouammi L, Rhalem N, Badri M, Mokhtari A, Souleymani-Bencheikh R. Tentatives de suicide au Maroc. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
40
|
Dheda K, van Zyl-Smit RN, Sechi LA, Badri M, Meldau R, Meldau S, Symons G, Semple PL, Maredza A, Dawson R, Wainwright H, Whitelaw A, Vallie Y, Raubenheimer P, Bateman ED, Zumla A. Utility of quantitative T-cell responses versus unstimulated interferon- for the diagnosis of pleural tuberculosis. Eur Respir J 2009; 34:1118-26. [DOI: 10.1183/09031936.00005309] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
41
|
Badri M, Zamani MR, Motallebi M. Effect of plant growth regulators on in vitro biological control of Fusarium oxysporum by Trichoderma harzianum (T8). Pak J Biol Sci 2007; 10:2850-5. [PMID: 19090187 DOI: 10.3923/pjbs.2007.2850.2855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study the effect of two plant growth regulators (indolacetic acid, IAA and gibberellic acid, GA3) and also Trichoderma harzianum (T8) on the phytopathogen fungus Fusarium oxysporium (F15) was investigated. IAA and GA3 with 15 and 30 ppm concentration have no significant effect on T. harzianum (T8) growth. The biocontrol activity of T. harzianum on F. oxysporum was slightly decreased by the presence of IAA and/or GA3. Addition of 40 ppm of GA3 to the culture medium of F. oxsporum increased polygalacturonase activity about 100%. A strong increasing effect on chitinase activity (60%) by T. harzianum (T8) was observed in the presence of phytopathogenic fungus F. oxysporum, but 40 ppm IAA and/or GA3 decreased about 47% of chitinase activity of T. harzianum.
Collapse
|
42
|
Badri Y, Zribi K, Badri M, Huguet T, van Berkum P, Aouani ME. Comparison of rhizobia that nodulate Medicago laciniata and Medicago truncatula present in a single Tunisian arid soil. Can J Microbiol 2007; 53:277-83. [PMID: 17496977 DOI: 10.1139/w06-130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The rhizobia present in a single arid region Tunisian soil that nodulate Medicago laciniata and Medicago truncatula were compared. All isolates, 40 from each host, were Sinorhizobium meliloti based on 16S rRNA polymerase chain reaction restriction fragment length polymorphism (PCR–RFLP) patterns and subsequent confirmation by sequence analysis of the 16S rRNA genes in four representatives from each host species. There was no apparent relationship between Medicago host species of isolation and the nodulating rhizobial genome as determined by repetitive extragenic palandromic PCR. The isolates of M. laciniata were distinguished from those of M. truncatula present in the same soil by variation in PCR–RFLP of nifDK, indicating that this dissimilarity is originally genetic and not geographic. While forming effective symbioses with their own respective isolates, both M. laciniata and M. truncatula formed ineffective true nodules, nodule-like structures, or no nodules at all in cross-inoculation tests, as confirmed by the histological observations.
Collapse
|
43
|
Badri M, Maartens G, Bekker LG, Wood R. The spectrum and prognosis of AIDS-defining illnesses in Cape Town. South Afr J HIV Med 2005. [DOI: 10.4102/sajhivmed.v6i2.587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
No abstract available.
Collapse
|
44
|
Soulaymani-Bencheikh R, Semiali I, Ghani A, Badri M, Soulaymani A. [Establishment and analysis of a log to record scorpion stings in Morocco]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2004; 16:487-98. [PMID: 15625804 DOI: 10.3917/spub.043.0487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Within the framework of a strategy against scorpion stings, an information system was established to track the indicators of morbidity and mortality caused by scorpion stings. The study of these indicators was carried out based upon a national record of scorpion stings. During the year 2001, 15,571 cases of scorpion stings were reported, that translates into an incidence rate of 1.2%. The patients were poisoned in 11.6% of the cases. Most of the patients (79.3%) were only put under clinical surveillance and did not receive any symptomatic treatment. The death rate was 6.3% and death only occurred in children of less than 15 years old (2.1% of the cases). This study demonstrated an improvement in morbidity and mortality indicators in comparison to the data collected before this campaign, all of which verifies the positive impact of the strategy which was put into place. However, it is necessary to continue monitoring until Morocco can overcome this problem.
Collapse
|
45
|
Soulaymani Bencheikh R, Faraj Z, Semlali I, Ouammi L, Badri M. [National strategy in the battle against scorpion stings and envenomations. Application and evaluation]. BULLETIN DE LA SOCIETE DE PATHOLOGIE EXOTIQUE (1990) 2003; 96:317-9. [PMID: 14717051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Scorpion stings represent the first cause of poisoning with an incidence of 30 to 50% of all declared cases in the Centre Anti Poison of Morocco (CAPM). Aware of this increasing problem, the CAPM paid special attention to this pathology. Thanks to its retrospective and prospective studies, the scorpion species mapping has been determined as well as the demographic features of stung patients, the nature and the chronology of clinical events in scorpion envenimation, and the epidemiological, clinical and therapeutical factors of severity. On this basis, the CAPM worked out a national strategy to struggle against scorpion stings whose aim was to decrease the morbidity and mortality caused by stings of scorpion as well as to rationalise economic expenses. The components of this strategy were based on the training of the medical and paramedical staff, on information, education, communication involving different sectors, on identification of needs and on follow-up and assessment. A nationwide campaign was implemented to change the population and health-care staff's behaviour regarding this pathology. Its evaluation permitted to improve the compilation of cases with census of 14104 cases, to reduce lethality rate and to rationalise expenses while banishing some medicines and avoiding useless hospitalization.
Collapse
|
46
|
Soulaymani-Bencheikh R, Faraj Z, Semlali I, Khattabi A, Skalli S, Benkirane R, Badri M. [Epidemiological aspects of scorpion stings in Morocco]. Rev Epidemiol Sante Publique 2002; 50:341-7. [PMID: 12442051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
47
|
Badri M, Ehrlich R, Pulerwitz T, Wood R, Maartens G. Tuberculosis should not be considered an AIDS-defining illness in areas with a high tuberculosis prevalence. Int J Tuberc Lung Dis 2002; 6:231-7. [PMID: 11934141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To assess the prognosis of human immunodeficiency virus (HIV) associated tuberculosis in a high tuberculosis prevalence setting. METHODS Survival and subsequent AIDS-defining illnesses (ADI) of patients with tuberculosis were compared with patients remaining tuberculosis-free in a prospective cohort study in two university-affiliated adult HIV clinics in Cape Town. RESULTS Tuberculosis without prior or simultaneous ADI was diagnosed in 141 patients. CD4+ T-lymphocyte count was >200 cells/microl in 67% of the incident tuberculosis cases. Survival in tuberculosis patients was comparable to that of patients with oral hairy leukoplakia and/or oral candidiasis (median = 23.6 vs. 27.8 months respectively; P = 0.59, adjusted hazard ratio [AHR] = 0.87; 95%CI 0.63-1.58), and better than in patients with AIDS (median = 11.5 months; P < 0.001, AHR = 2.37; 95% CI 1.93-4.66). Subsequent ADI were less frequent in tuberculosis than in AIDS patients (AHR = 0.36; 95%CI 0.23-0.58). Survival of patients with pulmonary or extra-pulmonary tuberculosis was similar (P = 0.32). CONCLUSION Tuberculosis in HIV-infected patients from areas endemic with tuberculosis occurs across a wide spectrum of immune suppression and has a considerably better prognosis than other ADI. Inclusion of tuberculosis in the clinical case definition of AIDS in such areas should be reconsidered.
Collapse
|
48
|
Badri M, Maartens G, Wood R. Predictors and prognostic value of oral hairy leukoplakia and oral candidiasis in South African HIV-infected patients. SADJ : JOURNAL OF THE SOUTH AFRICAN DENTAL ASSOCIATION = TYDSKRIF VAN DIE SUID-AFRIKAANSE TANDHEELKUNDIGE VERENIGING 2001; 56:592-6. [PMID: 11887444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Oral hairy leukoplakia and oral candidiasis diseases (OHL/OC) are common clinical manifestations of HIV/AIDS. Sparse literature exists from resource-limited countries on their incidence and impact on HIV-infected patients. OBJECTIVE To determine the predictors and prognosis of OHL/OC in HIV-infected patients. METHODS Patients were drawn from a cohort established in 1992 and prospectively followed until 1997 in the adult HIV clinics, University of Cape Town. Cox hazards regression models were fitted to determine the predictors of OHL/OC, and the association between OHL/OC and progression to AIDS and death. RESULTS 218 patients presenting with OHL/OC at their initial clinic visit were excluded. 205/772 patients developed OHL/OC (27.8 cases/100 years). White ethnicity (hazard ratio [HR] = 1.73, 95% CI 1.23-2.33), CD4+ count < 200 cells/(L (HR = 2.55, 95% CI 1.89-3.45), total lymphocyte count < 1250 cells/(L (HR = 1.72, 95% CI 1.28-2.31) and WHO stage 3 or 4 (HR = 2.61, 95% CI = 1.93-3.53) where variables predictive of increased hazard to developing OHL/OC. OHL/OC were independently associated with hazard of AIDS (HR = 3.65, 95% CI 1.89-6.69) and death (HR = 2.12, 95% CI 1.47-4.34). CONCLUSIONS The presence of OHL/OC in HIV-infected patients provides important prognostic information, and can be used as a cost-effective tool for screening patients in therapeutic interventions in resource-limited settings.
Collapse
|
49
|
Post FA, Badri M, Wood R, Maartens G. AIDS in Africa--survival according to AIDS-defining illness. S Afr Med J 2001; 91:583-6. [PMID: 11544975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
OBJECTIVE Evaluation of prognostic significance of the type of AIDS-defining illness (ADI) and performance status in a cohort of AIDS patients. DESIGN, SETTING, SUBJECTS, OUTCOME MEASURES A retrospective analysis of 280 patients with AIDS, as defined by the proposed World Health Organisation (WHO) clinical staging system, who attended two Cape Town-based HIV clinics between 1984 and 1997. Patients were stratified according to the type of initial ADI. Survival associated with each opportunistic event was determined by Kaplan-Meier analysis. Cox proportional hazard analysis was used to determine relative risk for death associated with three strata of ADI. RESULTS Median survival associated with various initial ADIs varied from less than 3 months (encephalopathy and wasting), to over 2 years (extrapulmonary tuberculosis and herpes simplex virus infection). This effect of ADI on outcome was most striking in patients with relatively preserved CD4 counts (CD4 > 50/microliter). A performance status score 4 predicted 50% mortality at 1 month, irrespective of co-morbidity. CONCLUSION The type of ADI is an important determinant of survival, particularly in patients with preserved CD4 counts. The stratification of patients by type of ADI and performance status may be useful in the management of patients with advanced HIV infection in resource-limited environments.
Collapse
|
50
|
Badri M, Ehrlich R, Wood R, Maartens G. Initiating co-trimoxazole prophylaxis in HIV-infected patients in Africa: an evaluation of the provisional WHO/UNAIDS recommendations. AIDS 2001; 15:1143-8. [PMID: 11416716 DOI: 10.1097/00002030-200106150-00009] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the proposed WHO/UNAIDS criteria for initiating co-trimoxazole prophylaxis in adult HIV-infected patients in Africa [WHO clinical stages 2--4 or CD4 count < 500 x 10(6) /l or total lymphocyte count (TLC) equivalent]. DESIGN Observational cohort study of 5-year follow-up. SETTING Adult HIV clinics, University of Cape Town, South Africa. METHODS Effect of prophylactic low dose co-trimoxazole (480 mg per day or 960 mg three times per week) on survival and morbidity was assessed in patients stratified by WHO clinical stage, CD4 T-lymphocyte count or TLC. Patients receiving antiretroviral therapy were excluded. RESULTS Co-trimoxazole reduced mortality [adjusted hazard ratio (AHR), 0.56; 95% confidence interval (CI), 0.33--0.85; P > 0.001] and the incidence of severe HIV-related illnesses (AHR, 0.52; 95% CI, 0.38--0.68; P < 0.001) in patients with evidence of advanced immune suppression on clinical (WHO stages 3 and 4) or laboratory assessment (TLC < 1250 x 10(6)/l or CD4 count < 200 x 10(6)/l). No significant evidence of efficacy was found in patients with WHO stage 2 or CD4 count 200--500 x 10(6)/l/TLC 1250--2000 x 10(6)/l. If we had applied the WHO/UNAIDS recommendations 88.3% of our patients would have received co-trimoxazole prophylaxis at their initial clinic visit. CONCLUSION Co-trimoxazole in HIV-infected adults from an area in which Pneumocystis carinii pneumonia is uncommon demonstrated a survival benefit consistent with previous randomized trials. Further studies are needed to assess the optimal time of commencement of prophylaxis, as widespread co-trimoxazole use will lead to increasing antimicrobial resistance to other major pathogens in Africa.
Collapse
|