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Nejthardt MB, Alexandris P, Bechan S, Bijli MFA, Chetty S, Dippenaar JM, Gibbs M, Johnson M, Kluyts H, Llewellyn R, Motiang M, Mogane P, Motshabi P, Mrara B, Roodt F, Singh U, Spijkerman S, Turton E, Van der Westhuizen J, Biccard B. The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus. S Afr Med J 2024; 114:e1306. [PMID: 38525581 DOI: 10.7196/samj.2024.v114i2.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy. OBJECTIVE To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations. METHODS A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses' screening tool for preoperative assessment. RESULTS Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery. CONCLUSION A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.
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Affiliation(s)
- M B Nejthardt
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - P Alexandris
- Department of Anaesthesia, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa.
| | - S Bechan
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa.
| | - M F A Bijli
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Chetty
- Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - J M Dippenaar
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa.
| | - M Gibbs
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - M Johnson
- Department of Anaesthesia and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - H Kluyts
- Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - R Llewellyn
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - M Motiang
- Department of Anaesthesiology and Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - P Mogane
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Chris Hani Baragwanath Hospital, Soweto, South Africa.
| | - P Motshabi
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia, Charlotte Maxeke Hospital, Johannesburg, South Africa.
| | - B Mrara
- Department of Anaesthesia and Critical Care, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa.
| | - F Roodt
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; George Provincial Hospital, George, South Africa.
| | - U Singh
- Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Albert Luthuli Academic Hospital, Durban, South Africa.
| | - S Spijkerman
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, South Africa.
| | - E Turton
- Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
| | - J Van der Westhuizen
- Department of Anaesthesia, University of the Free State, Universitas Hospital, Bloemfontein, South Africa.
| | - B Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa.
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Kusi-Mensah YA, Hayfron-Benjamin C, Chetty S, van der Linden EL, Meeks KAC, Beune E, Anokye-Danso F, Ahima RS, van den Born BJ, Agyemang C. Serum Adiponectin and Leptin Among Ghanaian Migrants in Amsterdam and Their Compatriots in Rural and Urban Ghana: The RODAM Study. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231218592. [PMID: 38107873 PMCID: PMC10725148 DOI: 10.1177/11795514231218592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
Background The rapidly rising cardiometabolic disease (CMD) burden in urbanizing sub-Saharan African populations and among sub-Saharan African migrants in Europe likely affects serum adiponectin and leptin levels, but this has not yet been quantified. Objectives To compare the serum levels of adiponectin and leptin among migrant, and non-migrant (urban and rural) populations of Ghanaian descent. Methods Cross-sectional analysis of serum leptin and adiponectin in the multi-centre Research on Obesity and Diabetes among African Migrants (RODAM) study. Logistic-regression models were used to examine the association between these adipocyte-derived hormones after stratification (sex, geographic area) and adjustments for potential confounders. Results A total of 2518 Ghanaians were included. Rural participants had the highest serum adiponectin and lowest leptin levels compared to Amsterdam and urban Ghanaians (P < .001). In fully adjusted models, participants living in urban Ghana had significantly higher odds of hyperleptinemia compared to rural participants (women-odds ratio 2.88; 95% CI, 1.12-7.38, P = .028 and men 43.52, 95% CI, 4.84-391.25, P < .001). Urban Ghanaian men also had higher odds of elevated leptin: adiponectin ratio (6.29, 95% CI, 1.43-27.62, P = .015). The odds of hyperleptinemia were only higher in Amsterdam Ghanaian men (10.56; 95% CI, 1.11-100.85, P = .041), but not in women (0.85; 95% CI, 0.30-2.41, P = .759). There was no significant association between hypoadiponectinemia and geographical location in both sexes. Conclusion Urbanization is associated with serum adiponectin and leptin levels after adjusting for confounding covariates in sub-Saharan Africans. These findings serve as a backdrop for further research on the role adipokines play in CMD epidemiology among Africans.
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Affiliation(s)
- Yaw A Kusi-Mensah
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesia and Critical Care, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University (Tygerberg Hospital), Cape Town, South Africa
| | - Charles Hayfron-Benjamin
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Physiology, University of Ghana Medical School, Accra, Ghana
- Department of Anaesthesia and Critical Care, University of Ghana Medical School, Accra, Ghana
| | - Sean Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University (Tygerberg Hospital), Cape Town, South Africa
| | - Eva L van der Linden
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn AC Meeks
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Erik Beune
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederick Anokye-Danso
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rexford S Ahima
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bert-Jan van den Born
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rossouw E, Chetty S. Acute kidney injury after major non-cardiac surgery: Incidence and risk factors. S Afr Med J 2023; 113:135-140. [PMID: 36876351 DOI: 10.7196/samj.2023.v113i3.16783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI post major surgery has been evaluated; however, there are no data available for South Africa (SA). OBJECTIVES To ascertain the incidence of AKI after major non-cardiac surgery at a tertiary academic SA hospital. Secondary outcomes wereto identify perioperative risk factors that are associated with an elevated risk to develop AKI in the postoperative period. METHODS The study was conducted at Tygerberg Hospital, a single tertiary centre in Cape Town, SA. Perioperative records of adults whounderwent major non-cardiac surgery were retrospectively collected. Variables pertaining to potential risk factors for AKI were captured,and serum creatinine levels were recorded up to 7 days postoperatively and compared with baseline measurements to determine whetherAKI had developed. Descriptive statistics along with logistic regression analysis were used to interpret results. RESULTS The overall incidence of AKI was 11.2% (95% confidence interval (CI) 9.8 - 12.6). Based on surgical discipline, trauma surgery(19%), followed by abdominal (18.5%) and vascular surgery (17%) had the highest incidence. Independent AKI risk factors wereidentified after multivariate analysis. These were: chronic obstructive pulmonary disease (odds ratio (OR) 2.19; 95% CI 1.09 - 4.37;p=0.005), trauma surgery (OR 3.00; 95% CI 1.59 - 5.64; p=0.001), abdominal surgery (OR 2.14; 95% CI 1.33 - 3.45; p=0.002), vascularsurgery (OR 2.42; 95% CI 1.31 - 4.45; p=0.004), urology procedures (OR 2.45; 95% CI 1.31 - 4.45; p=0.005), red blood cell transfusion(OR 1.81; 95% CI 1.21 - 2.70; p=0.004), emergency surgery (OR 1.74; 95% CI 1.15 - 2.65; p=0.009) and inotrope use (OR 2.77; 95% CI1.80 - 4.26; p<0.001). CONCLUSION The results of our study are in keeping with international literature regarding the incidence of AKI after major non-cardiacsurgery. The risk factor profile, however, is in several regards different from what has been found elsewhere.
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Affiliation(s)
- E Rossouw
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Zaslansky R, Baumbach P, Edry R, Chetty S, Min LS, Schaub I, Cruz JJ, Meissner W, Stamer UM. Following Evidence-Based Recommendations for Perioperative Pain Management after Cesarean Section Is Associated with Better Pain-Related Outcomes: Analysis of Registry Data. J Clin Med 2023; 12:jcm12020676. [PMID: 36675605 PMCID: PMC9864952 DOI: 10.3390/jcm12020676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Women who have had a Cesarean Section (CS) frequently report severe pain and pain-related interference. One reason for insufficient pain treatment might be inconsistent implementation of evidence-based guidelines. We assessed the association between implementing three elements of care recommended by guidelines for postoperative pain management and pain-related patient-reported outcomes (PROs) in women after CS. The analysis relied on an anonymized dataset of women undergoing CS, retrieved from PAIN OUT. PAIN OUT, an international perioperative pain registry, provides clinicians with treatment assessment methodology and tools for patients to assess multi-dimensional pain-related PROs on the first postoperative day. We examined whether the care included [i] regional anesthesia with a neuraxial opioid OR general anesthesia with wound infiltration or a Transvesus Abdominis Plane block; [ii] at least one non-opioid analgesic at the full daily dose; and [iii] pain assessment and recording. Credit for care was given only if all three elements were administered (= “full”); otherwise, it was “incomplete”. A “Pain Composite Score-total” (PCStotal), evaluating outcomes of pain intensity, pain-related interference with function, and side-effects, was the primary endpoint in the total cohort (women receiving GA and/or RA) or a sub-group of women with RA only. Data from 5182 women was analyzed. “Full” care was administered to 20% of women in the total cohort and to 21% in the RA sub-group. In both groups, the PCStotal was significantly lower compared to “incomplete” care (p < 0.001); this was a small-to-moderate effect size. Administering all three elements of care was associated with better pain-related outcomes after CS. These should be straightforward and inexpensive for integration into routine care after CS. However, even in this group, a high proportion of women reported poor outcomes, indicating that additional work needs to be carried out to close the evidence-practice gap so that women who have undergone CS can be comfortable when caring for themselves and their newborn.
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Affiliation(s)
- Ruth Zaslansky
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07747 Jena, Germany
- Correspondence: (R.Z.); (U.M.S.)
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Ruth Edry
- Acute Pain Service, Department of Anesthesiology, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Sean Chetty
- Department of Anaesthesiology& Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, South Africa
| | - Lim Siu Min
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Isabelle Schaub
- Department of Anesthesiology and Pain Clinic, Clinique St Jean, 1000 Brussels, Belgium
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Gynecology, Bonn University Hospital, 53127 Bonn, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07747 Jena, Germany
| | - Ulrike M. Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence: (R.Z.); (U.M.S.)
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Kaplan S, Grobler R, Chetty S. Post-traumatic Lemierres Syndrome: A rare presentation secondary to mandibular fracture. Trauma 2022. [DOI: 10.1177/14604086221106854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lemierre’s Syndrome is a rare phenomenon with a low prevalence and is characteristically seen in patients with an oropharyngeal infection that is complicated by thrombophlebitis of the internal jugular vein and secondary septic emboli. We present the case of a 16 year old previously well male who was diagnosed with a rare case of Lemierre’s syndrome secondary to a mandibular fracture. Blood tests and radiological imaging confirmed the diagnosis, with CT scan of the patients head and neck revealing a right mandibular fracture with abscess formation, bilateral parapharyngeal abscesses, bilateral internal jugular vein thromboses, left sigmoid sinus thrombosis, cavernous sinus thrombosis, post septal orbital cellulitis with enhancing infraorbital collections and a subdural empyema overlying the left tentorium cerebelli. The treatment is usually non-operative with antibiotics and in some instances surgical drainage. In this case a combination of surgical drainage for source control and antibiotics were used. Unfortunately, despite an initial improvement in the patient’s clinical status the patient died. This is the first case of Lemierre’s syndrome secondary to blunt facial trauma reported in the scientific literature. This case highlights the importance of clinicians having a high degree of suspicion of Lemierre’s syndrome when a patient presents with typical clinical features following facial trauma.
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Affiliation(s)
- Saul Kaplan
- Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ruan Grobler
- Division of Neurosurgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sean Chetty
- Department of Anaesthesiology & Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Forget P, Patullo C, Hill D, Ambekar A, Baldacchino A, Cata J, Chetty S, Cox FJ, de Boer HD, Dinwoodie K, Dom G, Eccleston C, Fullen B, Jutila L, Knaggs RD, Lavand’homme P, Levy N, Lobo DN, Pogatzki-Zahn E, Scherbaum N, Smith BH, van Griensven J, Gilbert S. System-level policies on appropriate opioid use, a multi-stakeholder consensus. BMC Health Serv Res 2022; 22:329. [PMID: 35277160 PMCID: PMC8917639 DOI: 10.1186/s12913-022-07696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies. METHODS We conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level. We aimed to provide consensus statements for current developments and priorities for future developments. RESULTS Twenty-five experts from a variety of fields with experience in acute pain management were invited to join a review panel, of whom 23 completed a modified Delphi survey of policies designed to improve the safety and quality of opioids prescribing for acute pain in the secondary care setting. Strong agreement, defined as consistent among> 75% of panellists, was observed for ten statements. CONCLUSIONS Using a modified Delphi study, we found agreement among a multidisciplinary panel, including patient representation, on prioritisation of policies for system-level interventions, to improve governance, pain management, patient/consumers care, safety and engagement.
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Affiliation(s)
- Patrice Forget
- grid.7107.10000 0004 1936 7291Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, UK
- grid.411800.c0000 0001 0237 3845Department of Anaesthesia, NHS Grampian, Aberdeen, AB25 2ZD UK
| | - Champika Patullo
- grid.416100.20000 0001 0688 4634Pharmacy Department, Queensland Opioid Stewardship Program, Clinical Excellence Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland 4069 Australia
| | - Duncan Hill
- grid.451104.50000 0004 0408 1979NHS Lanarkshire, Motherwell, ML1 2TP UK
| | - Atul Ambekar
- grid.413618.90000 0004 1767 6103National Drug Dependence Treatment Centre and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Alex Baldacchino
- International Society of Addiction Medicine (ISAM), Valletta, Malta
- grid.11914.3c0000 0001 0721 1626Psychiatry and Addictions, University of St Andrews, St Andrews, Scotland
- grid.492851.30000 0004 0489 1867NHS Fife Addiction Services, Fife, KY16 UK
| | - Juan Cata
- grid.267308.80000 0000 9206 2401MD Anderson Cancer Center, University of Texas, Houston, TX 77030 USA
| | - Sean Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Cape Town, 8000 South Africa
| | - Felicia J. Cox
- grid.421662.50000 0000 9216 5443Pain Management Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Hans D. de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Kieran Dinwoodie
- grid.421126.20000 0001 0698 0044Chronic Pain, Modernising Patient Pathway Programme, Scottish Government, Edinburgh, UK
- Calderside Medical Practice, Blantyre, South Lanarkshire G72 0BS Scotland, UK
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681University of Antwerp (UAntwerp, CAPRI), Antwerp, Belgium
- Psychiatric Center Multiversum, 2530 Boechout, Belgium
| | - Christopher Eccleston
- grid.7340.00000 0001 2162 1699Centre for Pain Research, The University of Bath, Bath, BA2 7AY UK
| | - Brona Fullen
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Liisa Jutila
- Pain Alliance Europe, Rue de Londres 18, 1050 Brussels, Belgium
| | - Roger D. Knaggs
- grid.4563.40000 0004 1936 8868School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - Patricia Lavand’homme
- grid.48769.340000 0004 0461 6320Anesthesiology Department, Cliniques universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Nicholas Levy
- grid.417049.f0000 0004 0417 1800West Suffolk Hospital, Bury St. Edmunds, IP33 2QZ UK
| | - Dileep N. Lobo
- grid.415598.40000 0004 0641 4263Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Esther Pogatzki-Zahn
- grid.16149.3b0000 0004 0551 4246University Hospital of Muenster, Muenster, Germany
| | - Norbert Scherbaum
- grid.5718.b0000 0001 2187 5445LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Blair H. Smith
- grid.416266.10000 0000 9009 9462Ninewells Hospital and Medical School, NHS Tayside, University of Dundee, Dundee, DD2 4BF Scotland, UK
| | | | - Steve Gilbert
- Belford Hospital, Fort William, PH33 6BS Scotland, UK
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Louw K, Naidoo R, Chetty S. Radiation exposure of anaesthesia providers in Africa: an occupational exposure study. Southern African Journal of Anaesthesia and Analgesia 2022. [DOI: 10.36303/sajaa.2022.28.2.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K Louw
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
| | - R Naidoo
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
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Isa AS, Chetty S. Physiology and pathophysiology of chronic pain (Part II): how does pain become chronic? Southern African Journal of Anaesthesia and Analgesia 2022. [DOI: 10.36303/sajaa.2022.28.1.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- AS Isa
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
- Department of Human Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, Ahmadu Bello University,
Nigeria
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
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Isa AS, Chetty S. Physiology and pathophysiology of chronic pain (Part I). Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.6.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- AS Isa
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
- Department of Human Physiology, Faculty of Basic Medical Sciences, College of Medical Sciences, Ahmadu Bello University,
Nigeria
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
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Breedt DS, Odland ML, Bakanisi B, Clune E, Makgasa M, Tarpley J, Tarpley M, Munyika A, Sheehama J, Shivera T, Biccard B, Boden R, Chetty S, de Waard L, Duys R, Groeneveld K, Levine S, Mac Quene T, Maswime S, Naidoo M, Naidu P, Peters S, Reddy CL, Verhage S, Muguti G, Nyaguse S, D'Ambruoso L, Chu K, Davies JI. Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach. BMJ Glob Health 2021; 6:bmjgh-2021-005629. [PMID: 34130990 PMCID: PMC8208008 DOI: 10.1136/bmjgh-2021-005629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.
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Affiliation(s)
- Danyca Shadé Breedt
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Balisi Bakanisi
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Edward Clune
- Department of Anaesthesia, University of Botswana, Gaborone, Botswana
| | | | - John Tarpley
- Department of Surgery, University of Botswana, Gabarone, Botswana
| | - Margaret Tarpley
- Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Akutu Munyika
- Department of Surgery, University of Namibia, Windhoek, Namibia.,Department of Surgery, Onandjokwe Lutheran Hospital, Oniipa, Namibia
| | | | | | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Regan Boden
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Sean Chetty
- Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rowan Duys
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Kristin Groeneveld
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Tamlyn Mac Quene
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Priyanka Naidu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shrikant Peters
- Executive Management, Groote Schuur Hospital, Department of Public Health and Familiy Medicine, University of Cape Town, Cape Town, South Africa
| | - Ché L Reddy
- Harvard Medical School, Boston, Massachusetts, USA
| | - Savannah Verhage
- Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Godfrey Muguti
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shingai Nyaguse
- Division of Anaesthesia, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Kathryn Chu
- Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Global Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kamerman PR, Bradshaw D, Laubscher R, Pillay-van Wyk V, Gray GE, Mitchell D, Chetty S. Almost 1 in 5 South African adults have chronic pain: a prevalence study conducted in a large nationally representative sample. Pain 2021; 161:1629-1635. [PMID: 32102020 DOI: 10.1097/j.pain.0000000000001844] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Limited information on the prevalence and risk factors for chronic pain is available for developing countries. Therefore, we investigated the prevalence of chronic pain and the association between this pain and various personal and sociodemographic factors by including questions in the South Africa Demographic and Household Survey 2016. The survey was conducted by face-to-face interviews with a nationally representative sample of the adult population (ages 15 and older, n = 10,336). Chronic pain was defined as pain or discomfort that had been experienced all the time or on and off for 3 months or more. The prevalence of chronic pain was 18.3% (95% confidence interval [CI]: 17.0-19.7). Women were more likely than were men to have chronic pain (men = 15.8% [95% CI: 13.9-17.8]; woman = 20.1% [95% CI: 18.4-21.8]), and the prevalence of chronic pain increased from 11.3% (95% CI: 9.6-13.3) for the age range 15 to 24 years to 34.4% (95% CI: 30.6-38.4) for the age range over 65 years. The body sites affected most frequently were the limbs (43.6% [95% CI: 40.4-46.9]), followed by the back (30.5% [95% CI: 27.7-33.6]). This article presents the prevalence of chronic pain in the general population of a middle-income African country. These data give much needed insights into the burden of, and risk factors for, chronic pain in low-resource settings, and identify priority groups for intervention.
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Affiliation(s)
- Peter R Kamerman
- Brain Function Research Group, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.,School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Victoria Pillay-van Wyk
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Glenda E Gray
- Office of the President, South African Medical Research Council, Cape Town, South Africa
| | - Duncan Mitchell
- Brain Function Research Group, Faculty of Health Sciences, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sean Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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Scribante J, Perrie H, Chetty S. How knowledgeable is the recovery room nurse you entrust your patient to about postoperative airway emergencies? Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.3.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Scribante
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,
South Africa
| | - H Perrie
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,
South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University,
South Africa
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Knoetze R, Lachman A, Moxley K, Chetty S. Caregiver anxiety and the association with acute postoperative pain in children undergoing elective ambulatory surgery in a lower-middle-income country setting. Paediatr Anaesth 2020; 30:990-997. [PMID: 32592506 DOI: 10.1111/pan.13954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/26/2020] [Accepted: 06/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Moderate to severe postoperative pain complicates surgeries performed on children in upper-income countries. The successful management of postoperative pain in children requires a biopsychosocial approach. Situational anxiety and anxiety disorders among caregivers influence a child's perioperative experience. This study aims to determine whether there is an association between caregiver's preoperative anxiety and children's postoperative pain in a lower-middle-income country (LMIC) setting. METHODS In this cross-sectional, descriptive study, we recruited 76 children aged 4-12 years, undergoing elective ambulatory tonsillectomy or adenotonsillectomy. Primary caregivers completed validated measures of anxiety (the Beck Anxiety Inventory [BAI] and the Kessler Psychological Distress Scale [K10]) prior to the children undergoing surgery. Postoperative pain was measured using the Wong-Baker Faces Pain Rating Scale 4 hours after surgery. RESULTS Caregiver anxiety was found in 31.7% of participants using the K10 and in 42.1% using the BAI. Moderate to severe postoperative pain was reported by 51% of children. There was a statistically significant correlation of moderate strength between anxiety scores of caregivers and children's self-reported postoperative pain scores (r = .47 for K10, r = .44 for BAI, P < .001 for both). Two median quantile regression models confirmed that K10 was positively associated with caregiver anxiety (WBFS) with slope = 0.16 and pseudo R2 = 0.25 (P = .002, 95CI: 0.06-0.26) as was BAI with slope = 0.12 and pseudo R2 = 0.22 (P = .013 95CI: 0.03-0.22). CONCLUSIONS This study showed that preoperative caregiver anxiety is significantly associated with postoperative pain in children undergoing elective, ambulatory surgery in a LMIC setting (correlation of moderate strength). Interventions aimed at reducing caregiver anxiety should become an important component of the biopsychosocial management of postoperative pain in children.
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Affiliation(s)
- Reynard Knoetze
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anusha Lachman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sean Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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15
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Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, Tiboni ME, Villar-Casares MDM, Tandon V, Tomas-Hernandez J, Teixidor-Serra J, Avram VRA, Winemaker M, Ramokgopa MT, Szczeklik W, Landoni G, Wang CY, Begum D, Neary JD, Adili A, Sancheti PK, Lawendy AR, Balaguer-Castro M, Ślęczka P, Jenkinson RJ, Nur AN, Wood GCA, Feibel RJ, McMahon SJ, Sigamani A, Popova E, Biccard BM, Moppett IK, Forget P, Landais P, McGillion MH, Vincent J, Balasubramanian K, Harvey V, Garcia-Sanchez Y, Pettit SM, Gauthier LP, Guyatt GH, Conen D, Garg AX, Bangdiwala SI, Belley-Cote EP, Marcucci M, Lamy A, Whitlock R, Le Manach Y, Fergusson DA, Yusuf S, Devereaux PJ, Veevaete L, le Polain de Waroux B, Lavand'homme P, Cornu O, Tribak K, Yombi JC, Touil N, Reul M, Bhutia JT, Clinckaert C, De Clippeleir D, Reul M, Patel A, Tandon V, Gauthier LP, Avram VRA, Winemaker M, de Beer J, Simpson DL, Worster A, Alvarado KA, Gregus KK, Lawrence KH, Leong DP, Joseph PG, Magloire P, Deheshi B, Bisland S, Wood TJ, Tushinski DM, Wilson DAJ, Kearon C, Le Manach Y, Adili A, Tiboni ME, Neary JD, Cowan DD, Khanna V, Zaki A, Farrell JC, MacDonald AM, Conen D, Wong SCW, Karbassi A, Wright DS, Shanthanna H, Coughlin R, Khan M, Wikkerink S, Quraishi FA, Lawendy AR, Kishta W, Schemitsch E, Carey T, Macleod MD, Sanders DW, Vasarhelyi E, Bartley D, Dresser GK, Tieszer C, Jenkinson RJ, Shadowitz S, Lee JS, Choi S, Kreder HJ, Nousiainen M, Kunz MR, Tuazon R, Shrikumar M, Ravi B, Wasserstein D, Stephen DJG, Nam D, Henry PDG, Wood GCA, Mann SM, Jaeger MT, Sivilotti MLA, Smith CA, Frank CC, Grant H, Ploeg L, Yach JD, Harrison MM, Campbell AR, Bicknell RT, Bardana DD, Feibel RJ, McIlquham K, Gallant C, Halman S, Thiruganasambandamoorth V, Ruggiero S, Hadden WJ, Chen BPJ, Coupal SA, McMahon SJ, McLean LM, Shirali HR, Haider SY, Smith CA, Watts E, Santone DJ, Koo K, Yee AJ, Oyenubi AN, Nauth A, Schemitsch EH, Daniels TR, Ward SE, Hall JA, Ahn H, Whelan DB, Atrey A, Khoshbin A, Puskas D, Droll K, Cullinan C, Payendeh J, Lefrancois T, Mozzon L, Marion T, Jacka MJ, Greene J, Menon M, Stiegelmahr R, Dillane D, Irwin M, Beaupre L, Coles CP, Trask K, MacDonald S, Trenholm JAI, Oxner W, Richardson CG, Dehghan N, Sadoughi M, Sharma A, White NJ, Olivieri L, Hunt SB, Turgeon TR, Bohm ER, Tran S, Giilck SM, Hupel T, Guy P, O'Brien PJ, Duncan AW, Crawford GA, Zhou J, Zhao Y, Liu Y, Shan L, Wu A, Muñoz JM, Chaudier P, Douplat M, Fessy MH, Piriou V, Louboutin L, David JS, Friggeri A, Beroud S, Fayet JM, Landais P, Leung FKL, Fang CX, Yee DKH, Sancheti PK, Pradhan CV, Patil AA, Puram CP, Borate MP, Kudrimoti KB, Adhye BA, Dongre HV, John B, Abraham V, Pandey RA, Rajkumar A, George PE, Sigamani A, Stephen M, Chandran N, Ashraf M, Georgekutty AM, Sulthan AS, Adinarayanan S, Sharma D, Barnawal SP, Swaminathan S, Bidkar PU, Mishra SK, Menon J, M N, K VZ, Hiremath SA, NC M, Jawali A, Gnanadurai KR, George CE, Maddipati T, KP MKP, Sharma V, Farooque K, Malhotra R, Mittal S, Sawhney C, Gupta B, Mathur P, Gamangati S, Tripathy V, Menon PH, Dhillon MS, Chouhan DK, Patil S, Narayan R, Lal P, Bilchod PN, Singh SU, Gattu UV, Dashputra RP, Rahate PV, Turiel M, De Blasio G, Accetta R, Perazzo P, Stella D, Bonadies M, Colombo C, Fozzato S, Pino F, Morelli I, Colnaghi E, Salini V, Denaro G, Beretta L, Placella G, Giardina G, Binda M, Marcato A, Guzzetti L, Piccirillo F, Cecconi M, Khor HM, Lai HY, Kumar CS, Chee KH, Loh PS, Tan KM, Singh S, Foo LL, Prakasam K, Chaw SH, Lee ML, Ngim JHL, Boon HW, Chin II, Kleinlugtenbelt YV, Landman EBM, Flikweert ER, Roerdink HW, Brokelman RB, Elskamp-Meijerman HF, Horst MR, Cobben JHMG, Umer M, Begum D, Anjum A, Hashmi PM, Ahmed T, Rashid HU, Khattak MJ, Rashid RH, Lakdawala RH, Noordin S, Juman NM, Khan RI, Riaz MM, Bokhari SS, Almas A, Wahab H, Ali A, Khan HN, Khan EK, Nur AN, Janjua KA, Orakzai SH, Khan AS, Mustafa KJ, Sohail MA, Umar M, Khan SA, Ashraf M, Khan MK, Shiraz M, Furgan A, Ślęczka P, Dąbek P, Kumoń A, Satora W, Ambroży W, Święch M, Rycombel J, Grzelak A, Gucwa J, Machala W, Ramokgopa MT, Firth GB, Karera M, Fourtounas M, Singh V, Biscardi A, Iqbal MN, Campbell RJ, Maluleke ML, Moller C, Nhlapo L, Maqungo S, Flint M, Nejthardt MB, Chetty S, Naidoo R, Guerra-Farfan E, Tomas-Hernandez J, Garcia-Sanchez Y, Garrido Clua M, Molero-Garcia V, Minguell-Monyart J, Teixidor-Serra J, Villar-Casares MDM, Selga Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Aguilar M, Mestre-Torres J, Colomina MJ, Guilabert P, Paños Gozalo ML, Abarca L, Martin N, Usua G, Martinez-Ripol P, Gonzalez Posada MA, Lalueza-Broto P, Sanchez-Raya J, Nuñez Camarena J, Fraguas-Castany A, Balaguer-Castro M, Torner P, Jornet-Gibert M, Serrano-Sanz J, Cámara-Cabrera J, Salomó-Domènech M, Yela-Verdú C, Peig-Font A, Ricol L, Carreras-Castañer A, Martínez-Sañudo L, Herranz S, Feijoo-Massó C, Sianes-Gallén M, Castillón P, Bernaus M, Quintas S, Gómez O, Salvador J, Abarca J, Estrada C, Novellas M, Torra M, Dealbert A, Macho O, Ivanov A, Valldosera E, Arroyo M, Pey B, Yuste A, Mateo L, De Caso J, Anaya R, Higa-Sansone JL, Millan A, Baños V, Herrera-Mateo S, Aguado HJ, Martinez-Municio G, León R, Santiago-Maniega S, Zabalza A, Labrador G, Guerado E, Cruz E, Cano JR, Bogallo JM, Sa-ngasoongsong P, Kulachote N, Sirisreetreerux N, Pengrung N, Chalacheewa T, Arnuntasupakul V, Yingchoncharoen T, Naratreekoon B, Kadry MA, Thayaparan S, Abdlaziz I, Aframian A, Imbuldeniya A, Bentoumi S, Omran S, Vizcaychipi MP, Correia P, Patil S, Haire K, Mayor ASE, Dillingham S, Nicholson L, Elnaggar M, John J, Nanjayan SK, Parker MJ, O'Sullivan S, Marmor MT, Matityahu A, McClellan RT, Comstock C, Ding A, Toogood P, Slobogean G, Joseph K, O'Toole R, Sciadini M, Ryan SP, Clark ME, Cassidy C, Balonov K, Bergese SD, Phieffer LS, Gonzalez Zacarias AA, Marcantonio AJ, Devereaux PJ, Bhandari M, Borges FK, Balasubramanian K, Bangdiwala SI, Harvey V, McGillion MH, Pettit SM, Vincent J, Vincent J, Harvey V, Dragic-Taylor S, Maxwell C, Molnar S, Pettit SM, Wells JR, Forget P, Borges FK, Landais P, Sigamani A, Landoni G, Wang CY, Szczeklik W, Biccard BM, Popova E, Moppett IK, Lamy A, Whitlock R, Ofori SN, Yang SS, Wang MK, Duceppe E, Spence J, Vasquez JP, Marcano-Fernández F, Conen D, Ham H, Tiboni ME, Prada C, Yung TCH, Sanz Pérez I, Neary JD, Bosch MJ, Prystajecky MR, Chowdhury C, Khan JS, Belley-Cote EP, Stella SF, Marcucci M, Heidary B, Tran A, Wawrzycka-Adamczyk K, Chen YCP, Tandon V, González-Osuna A, Patel A, Biedroń G, Wludarczyk A, Lefebvre M, Ernst JA, Staffhorst B, Woodfine JD, Alwafi EM, Mrkobrada M, Parlow S, Roberts R, McAlister F, Sackett D, Wright J. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. Lancet 2020; 395:698-708. [PMID: 32050090 DOI: 10.1016/s0140-6736(20)30058-1] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING Canadian Institutes of Health Research.
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Joynt GM, Gopalan PD, Argent A, Chetty S, Wise R, Lai VKW, Hodgson E, Lee A, Joubert I, Mokgokong S, Tshukutsoane S, Richards GA, Menezes C, Mathivha LR, Espen B, Levy B, Asante K, Paruk F. The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri). South Afr J Crit Care 2019; 35:10.7196/SAJCC.2019.v35i1b.380. [PMID: 37719328 PMCID: PMC10503493 DOI: 10.7196/sajcc.2019.v35i1b.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 11/08/2022] Open
Abstract
Background In South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences of limited resources daily. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are routinely necessary in SA, particularly in the publicly funded health sector. Purpose The purpose of this guideline is to utilise the relevant recommendations of the associated consensus meeting document and other internationally accepted principles to develop a guideline to inform frontline triage policy and ensure the best utilisation of adult intensive care in SA, while maintaining the fair distribution of available resources. Recommendations An overall conceptual framework for the triage process was developed. The components of the framework were developed on the basis that patients should be admitted preferentially when the likely incremental medical benefit derived from ICU admission justifies admission. An estimate of likely resource use should also form part of the triage decision, with those patients requiring relatively less resources to achieve substantial benefit receiving priority for admission. Thus, the triage system should maximise the benefits obtained from ICU resources available for the community. Where possible, practical examples of what the consensus group agreed would be considered appropriate practice under specified South African circumstances were provided, to assist clinicians with practical decision-making. It must be stressed that this guideline is not intended to be prescriptive for individual hospital or regional practice, and hospitals and regions are encouraged to develop specified local guidelines with locally relevant examples. The guideline should be reviewed and revised if appropriate within 5 years. Conclusion In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, this guideline has been developed to guide policy-making and assist frontline triage decision-making in SA. This document is not a complete plan for quality practice, but rather a template to support frontline clinicians, guide administrators and inform the public regarding appropriate triage decision-making.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - P D Gopalan
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Argent
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - R Wise
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Edendale Hospital,
Pietermaritzburg, South Africa
| | - V K W Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - E Hodgson
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
| | - A Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - I Joubert
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - S Mokgokong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - S Tshukutsoane
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Menezes
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Espen
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - K Asante
- African Organization for Research and Training in Cancer, Cape Town, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
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Joynt GM, Gopalan PD, Argent A, Chetty S, Wise R, Lai VKW, Hodgson E, Lee A, Joubert I, Mokgokong S, Tshukutsoane S, Richards GA, Menezes C, Mathivha LR, Espen B, Levy B, Asante K, Paruk F. The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri). South Afr J Crit Care 2019; 35:10.7196/SAJCC.2019.v35.i1b.383. [PMID: 37719327 PMCID: PMC10503494 DOI: 10.7196/sajcc.2019.v35.i1b.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 09/19/2023] Open
Abstract
Background In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. Purpose The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. Recommendations In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline should be reviewed and revised appropriately within 5 years. Conclusion In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, recommendations and a guideline have been developed to guide policy-making and assist frontline triage decision-making in SA. These documents are not a complete plan for quality practice but rather the beginning of a long-term initiative to engage clinicians, the public and administrators in appropriate triage decision-making, and promote systems that will ultimately maximise the efficient and fair use of available ICU resources.
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Affiliation(s)
- G M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - P D Gopalan
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - A Argent
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - S Chetty
- Department of Anaesthesiology and Critical Care, Stellenbosch University, Cape Town, South Africa
| | - R Wise
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Edendale Hospital,
Pietermaritzburg, South Africa
| | - V K W Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - E Hodgson
- Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, and Inkosi Albert Luthuli
Central Hospital, Durban, South Africa
| | - A Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - I Joubert
- Department of Anaesthesia and Peri-operative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - S Mokgokong
- Department of Neurosurgery, University of Pretoria, South Africa
| | - S Tshukutsoane
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - G A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Menezes
- Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - L R Mathivha
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B Espen
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - B Levy
- Netcare Rosebank Hospital, Johannesburg, South Africa
| | - K Asante
- African Organization for Research and Training in Cancer, Cape Town, South Africa
| | - F Paruk
- Department of Critical Care, University of Pretoria, South Africa
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Augustine TN, Cairns CJ, Chetty S, Dannatt LG, Gravett N, Grey G, Grobler G, Jafta Z, Kamerman P, Lopes J, Matsabisa MG, Mugabo P, Mulder M, Parry C, Rataemane S, Siegfried N, Steenkamp V, Thomas E, Van Zyl-Smit R. Priority areas for cannabis and cannabinoid product research in South Africa. Afr J Prim Health Care Fam Med 2018; 10:e1-e3. [PMID: 29943589 PMCID: PMC6018595 DOI: 10.4102/phcfm.v10i1.1711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/23/2018] [Indexed: 12/03/2022] Open
Affiliation(s)
- Tanya N Augustine
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand.
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Mccloskey C, Mongan A, Chetty S, McAteer D, Quinn S. Aflibercept in neovascular age related macular degeneration previously refractory to standard intravitreal therapy: An Irish perspective to compare against international trends. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Mccloskey
- Ophthalmology; Sligo General Hospital; Sligo Ireland
| | - A.M. Mongan
- Ophthalmology; Sligo General Hospital; Sligo Ireland
| | - S. Chetty
- Ophthalmology; Sligo General Hospital; Sligo Ireland
| | - D. McAteer
- Ophthalmology; Sligo General Hospital; Sligo Ireland
| | - S. Quinn
- Ophthalmology; Sligo General Hospital; Sligo Ireland
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Chetty S, Paruk F, Kamerman P. Abstract PR191. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492590.47304.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Variawa ML, Scribante J, Perrie H, Chetty S. The prevalence of chronic postmastectomy pain syndrome in female breast cancer survivors. Southern African Journal of Anaesthesia and Analgesia 2016. [DOI: 10.1080/22201181.2016.1191214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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23
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Chetty S, Paruk F. Delirium knowledge and assessment by ICU practitioners in South Africa: results of a national survey. Crit Care 2015. [PMCID: PMC4471072 DOI: 10.1186/cc14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Paruk F, Chetty S. Sedation practices in South African ICUs: results of a national survey. Crit Care 2015. [PMCID: PMC4470456 DOI: 10.1186/cc14577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Chetty S, Baalbergen E, Bhigjee AI, Kamerman P, Ouma J, Raath R, Raff M, Salduker S. Clinical practice guidelines for management of neuropathic pain: expert panel recommendations for South Africa. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- S Chetty
- Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - E Baalbergen
- Life Vincent Pallotti Rehabilitation Unit, Pinelands, Cape Town
| | - AI Bhigjee
- Department of Neurology, Nelson R Mandela School of Medicine, Mayville, University of KwaZulu-Natal, Durban
| | - P Kamerman
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg
| | - J Ouma
- Department of Neurosurgery, University of the Witwatersrand, Johannesburg
| | - R Raath
- Jacaranda Hospital, Muckleneuk, Pretoria
| | - M Raff
- Christiaan Barnard Memorial Hospital, Cape Town
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26
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Affiliation(s)
- S Chetty
- Department of Anaesthesiology, University of the Witwatersrand
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Raju R, Moodley SR, Jagarnath O, Chetty S, Shongwe B, Raju J. The migration of integrated library systems with special reference to the rollout of Unicorn in the province of KZN. South African Journal of Libraries and Information Science 2013. [DOI: 10.7553/73-2-1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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28
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Chetty S, Shephard E, Bowers D, Darby M, Horsnell W, Chapman R, Williamson A. A pantothenate suxotroph of BCG rxpressing Gag confers enhanced HIV-specific immunogenicity compared to wildtype and perfingolysin expressing strains. Retrovirology 2012. [PMCID: PMC3441340 DOI: 10.1186/1742-4690-9-s2-p315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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29
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Chetty S, Porichis F, Govender P, Zupkosky J, Pillay M, Walker B, Ndung’u T, Kaufmann D, Kasprowicz V. Co-infection with Mycobacterium tuberculosis impairs HIV-specific CD8+ and CD4+ T cell functionality. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bassett IV, Chetty S, Giddy J, Reddy S, Bishop K, Lu Z, Losina E, Freedberg KA, Walensky RP. Screening for acute HIV infection in South Africa: finding acute and chronic disease. HIV Med 2011; 12:46-53. [PMID: 20553336 DOI: 10.1111/j.1468-1293.2010.00850.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The yield of screening for acute HIV infection among general medical patients in resource-scarce settings remains unclear. Our objective was to evaluate the strategy of using pooled HIV plasma RNA to diagnose acute HIV infection in patients with negative or discordant rapid HIV antibody tests in Durban, South Africa. METHODS We prospectively enrolled patients with negative or discordant rapid HIV antibody tests from a routine HIV screening programme in an out-patient department in Durban with an HIV prevalence of 48%. Study participants underwent venipuncture for pooled qualitative HIV RNA, and, if this was positive, quantitative RNA, enzyme immunoassay and Western blot (WB). Patients with negative or indeterminate WB and positive quantitative HIV RNA were considered acutely infected. Those with chronic infection (positive RNA and WB) despite negative or discordant rapid HIV tests were considered to have had false negative rapid antibody tests. RESULTS Nine hundred and ninety-four participants were enrolled with either negative (n=976) or discordant (n=18) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6-2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3-3.1%) had chronic HIV infection (false negative rapid test). CONCLUSIONS One per cent of out-patients with negative or discordant rapid HIV tests in Durban, South Africa had acute HIV infection readily detectable through pooled serum HIV RNA screening. Pooled RNA testing also identified an additional 2% of patients with chronic HIV infection. HIV RNA screening has the potential to identify both acute and chronic HIV infections that are otherwise missed by standard HIV testing algorithms.
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Affiliation(s)
- I V Bassett
- Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.
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31
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Chetty S. The do’s and don’ts of arginine supplementation. South African Journal of Clinical Nutrition 2010. [DOI: 10.1080/16070658.2010.11734265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Batterman S, Chernyak S, Gouden Y, Hayes J, Robins T, Chetty S. PCBs in air, soil and milk in industrialized and urban areas of KwaZulu-Natal, South Africa. Environ Pollut 2009; 157:654-663. [PMID: 18838199 PMCID: PMC4365072 DOI: 10.1016/j.envpol.2008.08.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 08/13/2008] [Accepted: 08/14/2008] [Indexed: 05/25/2023]
Abstract
Information regarding polychlorinated biphenyls (PCBs) in environmental media in Africa is limited. This paper presents results of a monitoring program conducted in KwaZulu-Natal Province, South Africa designed to characterize levels, trends and sources of airborne PCBs. Particulate and vapor samples were sampled over the 2004-2005 period at three sites. The total PCB concentration averaged 128+/-47 pgm(-3), and levels were highest in winter. Tri- through hexa-congeners predominated, and the vapor fraction was predominant. Several tetra- through hexa-chlorinated congeners had levels comparable to those at urban sites in the northern hemisphere, but hepta- through deca-congeners resembled levels at background sites. PCB source areas, deduced using spatial and temporal patterns, compositional information and trajectory analyses, likely included local, regional and global sources. Soils at three rural sites showed high PCB concentrations, and milk from a local dairy showed PCB concentrations comparable to USA levels in year 2000.
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Affiliation(s)
- S Batterman
- Environmental Health Sciences, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.
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33
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Chetty S. A Policy Framework for Epidemiological Studies in Air Pollution: The Multi-Point Plan in South Africa. Epidemiology 2007. [DOI: 10.1097/01.ede.0000288372.50539.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Rabinovici GD, Furst AJ, O'Neil JP, Racine CA, Mormino EC, Baker SL, Chetty S, Patel P, Pagliaro TA, Klunk WE, Mathis CA, Rosen HJ, Miller BL, Jagust WJ. 11C-PIB PET imaging in Alzheimer disease and frontotemporal lobar degeneration. Neurology 2007; 68:1205-12. [PMID: 17420404 DOI: 10.1212/01.wnl.0000259035.98480.ed] [Citation(s) in RCA: 246] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The PET tracer (11)C-labeled Pittsburgh Compound-B ((11)C-PIB) specifically binds fibrillar amyloid-beta (Abeta) plaques and can be detected in Alzheimer disease (AD). We hypothesized that PET imaging with (11)C-PIB would discriminate AD from frontotemporal lobar degeneration (FTLD), a non-Abeta dementia. METHODS Patients meeting research criteria for AD (n = 7) or FTLD (n = 12) and cognitively normal controls (n = 8) underwent PET imaging with (11)C-PIB (patients and controls) and (18)F-fluorodeoxyglucose ((18)F-FDG) (patients only). (11)C-PIB whole brain and region of interest (ROI) distribution volume ratios (DVR) were calculated using Logan graphical analysis with cerebellum as a reference region. DVR images were visually rated by a blinded investigator as positive or negative for cortical (11)C-PIB, and summed (18)F-FDG images were rated as consistent with AD or FTLD. RESULTS All patients with AD (7/7) had positive (11)C-PIB scans by visual inspection, while 8/12 patients with FTLD and 7/8 controls had negative scans. Of the four PIB-positive patients with FTLD, two had (18)F-FDG scans that suggested AD, and two had (18)F-FDG scans suggestive of FTLD. Mean DVRs were higher in AD than in FTLD in whole brain, lateral frontal, precuneus, and lateral temporal cortex (p < 0.05), while DVRs in FTLD did not significantly differ from controls. CONCLUSIONS PET imaging with (11)C-labeled Pittsburgh Compound-B ((11)C-PIB) helps discriminate Alzheimer disease (AD) from frontotemporal lobar degeneration (FTLD). Pathologic correlation is needed to determine whether patients with PIB-positive FTLD represent false positives, comorbid FTLD/AD pathology, or AD pathology mimicking an FTLD clinical syndrome.
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Affiliation(s)
- G D Rabinovici
- Memory &Aging Center, University of California San Fransisco, San Francisco, CA 94117, USA.
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Mackraj I, Somova L, Chetty S, Carstens ME. Regulation of renal alpha 2-adrenoceptor activity in Dahl salt-sensitive rats by dietary sodium changes. Methods Find Exp Clin Pharmacol 1998; 20:755-60. [PMID: 10022029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The objective of the study was to evaluate the concept that genetically predisposed salt-sensitivity contributes to an increased adrenergic susceptibility and renal alpha 2-adrenoceptor (A2) abnormality in Dahl salt-sensitive hypertensive rats. The results showed: i) After 2 months of Na-loading (8% NaCl) Dahl salt-sensitive (DSS) rats expressed increased sodium and water retention which paralleled gradual development of diastolic hypertension. Low Na diet (0.5% NaCl) does not prevent hypertension but delays its development. ii) The increased activity of the sympathetic nervous system (SNS), in DSS rats corresponded to the development of hypertension and was stimulated by Na-loading. It was assessed by plasma catecholamine levels and heart rate changes. iii) The increased density of renal A2 by 29% was upregulated by high sodium diet, and coupled with increased norepinephrine level by 53%, only in DSS but not in DSR rats. iv) No strain renal A2 and epinephrine differences between DSS and DSR were found in weanling, prehypertensive rats, or in the adult DSS and DSR on low Na diet. By mediating an enhanced receptor-coupled response, such as increased proximal tubular sodium reabsorption during sodium loading, a genetic abnormality of renal alpha 2-adrenoceptors may contribute to some of the pathophysiologic derangements leading to hypertension in Dahl salt-sensitive rats.
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Affiliation(s)
- I Mackraj
- Department of Human Physiology and Physiological Chemistry, University of Durban-Westville, South Africa
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36
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Somova L, Mackraj L, Chetty S. Sympathetic and platelet adrenergic activity and salt sensitivity: an experimental study. Methods Find Exp Clin Pharmacol 1998; 20:657-65. [PMID: 9922981 DOI: 10.1358/mf.1998.20.8.487492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of the study was to evaluate the advanced hypothesis that genetically predisposed salt-sensitivity contributes to an increased adrenergic susceptibility and platelet activity and both these factors play a role in the pathogenesis of hypertension in a Dahl rat model. The results showed: i) Dahl salt-sensitive rats (DS) gradually develop a diastolic hypertension by the end of 3 months of age, in spite of the diet they are fed. Low-Na diet (0.5% NaCl) does not prevent hypertension but delays its development. High-Na diet (8%) exacerbates their hypertension. ii) After 2 months of Na-loading, DS rats expressed significantly increased sodium and water retention and increased plasma volume by 15%, compared with 2.8% in Dahl salt-resistant (DR) rats on high-Na diet. iii) The increased activity of the sympathetic nervous system (SNS) in DS rats paralleled the development of hypertension and was stimulated by Na-loading. It was assessed by their catecholamines status and heart rate changes. iv) Platelet activity of DS rats was increased as reflected in collagen-induced nonstimulated and adrenaline-stimulated aggregation, and an increased plasma T x B2/6-keto PGF1 alpha ratio. Na-loading further increased platelet activity. v) Both DR and DS rat platelets displayed alpha 2-adrenoceptors (A2) of low binding capacity (Bmax 25 and 35 fmol/mg protein, respectively) and low affinity (KD 5.6 nM for both groups), suggesting that platelet alpha 2 adrenoceptors in this strain of rats might not play a significant biological role in their increased platelet activity. The fact that platelet alpha 2-adrenoceptors do not define the stimulation of SNS in DS rat do not exclude their participation in development of salt-dependent hypertension, since a genetic defect(s) of these ubiquitous receptors (brain, kidney, blood vessels) could still contribute to the pathogenesis of the disease.
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Affiliation(s)
- L Somova
- Department of Human Physiology and Physiological Chemistry, University of Durban-Westville, South Africa
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Abstract
AIMS To assess the immunoexpression of cyclin D1 and retinoblastoma in a cohort of oesophageal squamous cell carcinoma cases from South Africa to see whether there is a relation between these two proteins. In addition, protein expression was correlated with clinicopathological features. METHODS Fifty biopsies and 30 oesophagectomy specimens were immunostained with commercially available antibodies to cyclin D1 and retinoblastoma proteins, following microwave antigen retrieval. RESULTS Twenty three of the 80 cases (29%) showed cyclin D1 protein expression. However, only five cases had > 50% of the tumour cells displaying immunopositivity. Three of the four cases with lymph node spread were cyclin D1 positive in the primary tumour and the metastasis. Fifty three cases were immunoreactive with the antiretinoblastoma antibody; 29 of these cases showing > 50% of cells with immunolabelling. Of the 23 cyclin D1 positive cases, 18 were also retinoblastoma positive. No correlation was observed between cyclin D1 and retinoblastoma protein expression and age, sex, race, or histological grade. CONCLUSIONS Cyclin D1 is expressed in a minority of cases of oesophageal squamous carcinomas from South Africa. However, three of four cases with lymph node spread were cyclin D1 positive, thus indicating that cyclin D1 positive tumours may have a greater propensity for spread. In addition, 18 of 23 cyclin D1 positive cases also expressed retinoblastoma protein. These findings suggest a possible relation between cyclin D1 and retinoblastoma proteins in a proportion of cases of oesophageal squamous.
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Affiliation(s)
- R Chetty
- Department of Anatomical Pathology, University of Natal School of Medicine, Congella, Durban, South Africa
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Abstract
Results of percutaneous mitral valvotomy were compared in two groups undergoing the procedure at our institution. Group I: 100 patients having had percutaneous valvotomy with the Schneider-Medintag bifoil (2 x 19 mm) or trefoil (3 x 15 mm or 3 x 12 mm) catheters, and group II; 150 patients in whom the procedure was performed with the Inoue balloon (24-30 mm). Baseline clinical (age, gender, NYHA class and echo score) and haemodynamic variables were similar in both groups. Haemodynamic improvement occurred in both groups. Although the reduction in left atrial pressure did not differ significantly between the two groups, the increase in mitral valve area was significantly (P < 0.001) higher for group I (0.8 +/- 0.2 to 1.9 +/- 0.7 and 0.8 +/- 0.3 to 1.6 +/- 0.3 cm2 respectively for mitral area, and 22 +/- 6 to 13 +/- 5 and 21 +/- 6 to 13 +/- 5 mmHg respectively for mean left atrial pressure). The increase in cardiac output was statistically significant in group I (3.2 +/- 0.7 to 4.0 +/- 0.9 l.min-1, P < 0.05) but not in group II (3.5 +/- 2.0 to 3.7 +/- 0.9 l.min-1, ns). Inter-atrial shunting immediately after valvotomy was recorded in 19% of group I patients compared with 6% in group II (P < 0.001). The overall incidence of significant mitral regurgitation (3+ or 4+) was similar in both groups (5% and 4% respectively). However, when the stepwise dilatation technique was employed in group II, the incidence had dropped to 2.1%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J Patel
- Cardiology Department, University of Natal/Wentworth Hospital, Durban, South Africa
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40
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Abstract
Percutaneous balloon mitral valvotomy was attempted in severely symptomatic (New York Heart Association class III or IV) pregnant patients (mean age 30 years) with tight mitral stenosis. Nineteen patients were pregnant (mean gestation 30 weeks, range 26 to 34) and one patient was in the immediate postpartum period. All patients had undergone a trial of diuretic therapy and 16 were also taking atenolol. Percutaneous valvotomy was performed with the Inoue catheter (18 patients) or the Schneider-Medintag bifoil (2 x 19 mm) balloon catheter (2 patients). The fluoroscopy time was 9.2 +/- 3.4 minutes. After percutaneous valvotomy the mean mitral gradient decreased from 17.9 +/- 6.2 to 5.9 +/- 2.4 mm Hg (p < 0.001). The mitral valve area (pressure half time) increased from 0.8 +/- 0.2 to 1.7 +/- 0.2 cm2 (p < 0.001). These hemodynamic changes were accompanied by immediate symptomatic improvement by at least one New York Heart Association functional grade in all patients. Moderate (3+) mitral regurgitation developed in one patient. Eighteen patients had normal infants delivered vaginally at term without assistance, and one patient had a normal infant delivered by cesarean section at 35 weeks' gestation. We conclude that percutaneous balloon mitral valvotomy for pliable mitral stenosis in pregnancy is safe for both the mother and fetus. We recommend that it be performed in symptomatic patients with tight mitral stenosis so as to avoid hemodynamic complications in the latter stages of pregnancy.
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Affiliation(s)
- J J Patel
- Cardiac Unit, Wentworth Hospital, Jacobs, South Africa
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Abstract
Even though one of the characteristic features of myotonic dystrophy (MyD) is the high level of circulating insulin, 125I-insulin-binding data in MyD have been controversial. In the present study we utilized cultured monocytes to avoid problems of reproducibility and variability in age, and examined the affinity and binding characteristics of 125I-insulin binding in MyD patients and controls. The Bmax and mean affinity constant, Ka, were significantly lower, while the number of receptors per cell had increased in the patient group as compared to the controls. The data confirm our earlier findings that there is no primary defect in insulin receptors in MyD, and the disturbed insulin response may be due to an abnormality in the membrane environment. Since the insulin receptor is an integral membrane protein, abnormal plasma membrane lipid composition may lead to impaired lipid-protein interactions, and hence affect the binding characteristics in MyD.
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42
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Patel JJ, Shama D, Mitha AS, Blyth D, Hassen F, Le Roux BT, Chetty S. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol 1991; 18:1318-22. [PMID: 1918709 DOI: 10.1016/0735-1097(91)90555-n] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Closed surgical mitral valvotomy is the procedure of choice in most patients with symptomatic pliable mitral stenosis in developing countries. The procedure is efficacious and safe. Mitral valvotomy performed with a balloon has shown similar good results, with infrequent complications in selected subjects. Because there is a paucity of studies comparing the two techniques, this study was undertaken to compare the results of percutaneous balloon mitral valvuloplasty with those of closed commissurotomy as determined by catheterization studies. Forty-five patients with tight pliable mitral stenosis were randomly assigned to one of two groups: 23 patients had balloon valvuloplasty by the single catheter technique (group I) and 22 underwent closed surgical valvotomy (group II). The two groups were similar with regard to clinical and hemodynamic findings before intervention. Mitral valve area increased from 0.8 +/- 0.3 to 2.1 +/- 0.7 cm2 in group I (p less than 0.001) and from 0.7 +/- 0.2 to 1.3 +/- 0.3 cm2 in group II (p less than 0.001). Pulmonary artery pressure and pulmonary vascular resistance decreased in both groups, but these changes did not reach statistical significance in group II. Treadmill exercise time increased from 3.8 +/- 2.3 to 7.3 +/- 2.6 min in group I (p less than 0.001) and from 4 +/- 2.6 to 5.6 +/- 2.6 min in group II (p less than 0.001). There were no deaths. One patient in each group developed moderate (3+) mitral regurgitation. A small interatrial shunt (less than 1.5:1) was detected in three patients in group I immediately after the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J Patel
- Division of Cardiology, University of Natal, Durban, South Africa
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43
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Naidoo DP, Mitha AS, Vythilingum S, Chetty S. Pulmonary hypertension in aortic regurgitation: early surgical outcome. Q J Med 1991; 80:589-95. [PMID: 1946939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A review of the haemodynamic data of 139 patients with isolated, severe, chronic aortic regurgitation revealed severe pulmonary hypertension (pulmonary artery systolic pressure of greater than or equal to 60 mmHg) in 34 (24 per cent). The left ventricular end-diastolic pressure was high in all patients, suggesting that pulmonary hypertension was a consequence of severe long-standing regurgitation with ventricular dysfunction. Aortic valve replacement was performed in 69 patients, 33 of whom had normal or mildly elevated pulmonary artery systolic pressure (less than 39 mmHg; group I) and 36 of whom had moderate or markedly elevated pulmonary artery systolic pressures (less than 40 mmHg; group II). There was no difference in mortality or prevalence of post-operative complications between these two groups of patients. Furthermore, New York Heart Association (NYHA) functional class and cardiothoracic ratio were similar in both groups at the six-month assessment. The pulmonary vascular resistance fell from 4.7 +/- 3.5 to 1.5 +/- 0.8 units x m2 in 13 of 17 patients who had repeat catheterization after surgery. Pulmonary artery systolic pressure reverted to normal in 10 of these 13 patients. It is concluded that pulmonary hypertension consequent upon raised left ventricular end-diastolic pressure is common in severe aortic regurgitation, is largely reversible, and does not influence the early outcome after aortic valve replacement.
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Affiliation(s)
- D P Naidoo
- Department of Medicine, Faculty of Medicine, University of Natal, Durban, Republic of South Africa
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44
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Chetty S, Mitha AS. Arrhythmias in idiopathic dilated cardiomyopathy. A preliminary study. S Afr Med J 1990; 77:190-3. [PMID: 2300853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Idiopathic dilated cardiomyopathy is second to valvular heart disease as a cause of congestive heart failure in blacks in southern Africa. The disease has a deteriorating clinical course with high mortality. More than half these deaths are sudden and have been related to arrhythmias. In a preliminary study of 20 black patients in congestive heart failure caused by dilated cardiomyopathy, 24-hour ambulatory ECG monitoring was used to assess the prevalence, type and clinical significance of arrhythmias. Eighteen of the 20 patients (90%) had arrhythmias. Supraventricular arrhythmias were detected in 17 (85% of the total), and 18 (90%) had complex ventricular arrhythmias. Eleven (55%) had non-sustained ventricular tachycardia (VT). There was no correlation between complex ventricular arrhythmia and clinical features, resting ECG, chest radiograph or echocardiographic data. Over a 3-year period 13 patients died (65%), half these deaths being unexpected. All 13 had complex ventricular arrhythmias, and those who died suddenly had non-sustained VT. This small prospective study shows that ventricular arrhythmias are common in dilated cardiomyopathy in blacks and are frequently complex and dangerous. Sudden death is common and is more than likely to be related to VT in the presence of an already poorly functioning left ventricle.
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Affiliation(s)
- S Chetty
- Cardiac Unit, Wentworth Hospital, Durban
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45
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46
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Chetty S, Mitha AS. High-dose oral amoxycillin in the treatment of infective endocarditis. S Afr Med J 1988; 73:709-10. [PMID: 3381154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Oral antibiotic therapy for infective endocarditis is not yet widely accepted. A study was undertaken to assess the efficacy of oral amoxycillin in this condition. Fifteen patients were treated with high-dose oral amoxycillin for 6 weeks. Twelve responded to treatment and remain well at 3 years. There were 3 deaths--1 at day 7 due to sudden aortic cusp rupture, and 2 late deaths due to pulmonary and cerebral embolism respectively. There was 1 relapse of streptococcal prosthetic valve endocarditis 8 weeks after oral treatment, but this responded to conventional intravenous therapy. Oral amoxycillin is effective in uncomplicated streptococcal endocarditis, and should not be used with prosthetic valve infections.
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Affiliation(s)
- S Chetty
- Cardiac Unit, Wentworth Hospital
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47
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Doi YL, McKenna WJ, Chetty S, Oakley CM, Goodwin JF. Prediction of mortality and serious ventricular arrhythmia in hypertrophic cardiomyopathy. An echocardiographic study. Heart 1980; 44:150-7. [PMID: 7191710 PMCID: PMC482374 DOI: 10.1136/hrt.44.2.150] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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48
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McKenna WJ, Chetty S, Oakley CM, Goodwin JF. Arrhythmia in hypertrophic cardiomyopathy: exercise and 48 hour ambulatory electrocardiographic assessment with and without beta adrenergic blocking therapy. Am J Cardiol 1980; 45:1-5. [PMID: 6101296 DOI: 10.1016/0002-9149(80)90212-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Submaximal treadmill exercise electrocardiography and 48 hour ambulatory electrocardiographic monitoring were performed in 30 patients with hypertrophic cardiomyopathy both with and without beta adrenergic blocking therapy. During ambulatory electrocardiographic monitoring 1 patient (3 percent) had no arrhythmia, 14 patients (46 percent) had supraventricular tachycardia or paroxysmal atrial fibrillation, 13 (43 percent) had multiform or paired ventricular extrasystoles and 8 (26 percent) had ventricular tachycardia. The frequency of these ventricular arrhythmias was almost identical with and without beta adrenergic blocking drugs (mean dose in "propranolol equivalents" 280 mg daily). With beta blocking therapy fewer patients had supraventricular tachycardia; however, the difference was not significant. During exercise testing 18 patients (60 percent) had ventricular extrasystoles and 3 patients (10 percent) had paired ventricular extrasystoles and the frequency was almost identical with and without beta adrenergic blocking therapy. No routine echocardiographic or hemodynamic measurement predicted the serious ventricular arrhythmias. It is concluded that asymptomatic ventricular arrhythmia is a common occurrence in patients with hypertrophic cardiomyopathy and its frequency is not reduced with beta adrenergic blocking therapy. Because occult arrhythmia may be the cause of sudden death it is important to detect it in these patients so that an effort can be made to improve prognosis with specific antiarrhythmic treatment.
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49
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Seedat YK, Grant W, Chetty S. Bilateral renal cortical necrosis: a report of 2 cases. S Afr Med J 1976; 50:933-6. [PMID: 1084581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Two cases of renal cortical necrosis, one of which occurred after an obstetric complication (abruptio placentae) and the other after postpartum haemorrhage, are described. The diagnosis was made by percutaneous renal biopsy, intravenous pyelography and selective nephro-angiography. Immunofluorescence studies of the kidney showed no abnormality in one patient, but showed the presence of IgM in the glomerular basement membrane in the second patient. Hypotension was not observed when anuria occurred. Both patients survived. The importance of prolonged haemodialysis is stressed, since one patient was oliguric for 57 days and required intermittent haemodialysis for 5 months, while the second patient was oliguric for 17 days, required haemodialysis for 5 months and now has established hypertension.
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50
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Holloway R, Chetty S, Moodley P. Net and gross lung failure among patients sent for pulmonary function testing. S Afr Med J 1972; 46:404-8. [PMID: 5025249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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