AJOL - African Journals Online
Not a member yet
221688 research outputs found
Sort by
Severe jejunitis masquerading as intussusception in a case of Henoch-Schönlein purpura
Full text linkIntussusception is a well-known complication of Henoch-Schönlein purpura (HSP).1 Diagnosis of intussusception is based on well-defined clinical and radiological features, but certain conditions can mimic intussusception, both clinically and radiologically, so closely as to result in unnecessary invasive procedures. Authors here present a case of HSP complicated by severe acute jejunitis, masquerading as jejuno-jejunal intussusception on ultrasound
Alarm features as predictors of major findings in a rural South African upper endoscopic service
Full text linkBackground: Alarm features are commonly used to identify patients who require an endoscopy to rule out significant upper-gastrointestinal (GI) pathology. Validation of these features in a rural South African (SA) setting has implications for the provision of endoscopy services and was the aim of this study.
Methods: This was a retrospective chart review of 1 000 consecutive endoscopies performed at a rural SA regional/referral hospital over three years. Demographic data, indication for endoscopy (upper GI bleed, dyspepsia, dysphagia, anaemia, weight loss, age) and major endoscopic findings (defined any tumour, ulcer, or stricture) were recorded. A multivariate logistic regression analysis was done to identify risk factors for major endoscopic findings.
Results: The median age of the study sample was 51.0 (range14.0–88.0) years. Males (306/1 000) accounted for 30.6% of the study population. The prevalence of alarm features in the study sample was as follows: upper GI bleed – 16.6%; dyspepsia – 58.4%; dysphagia – 10.3%; anaemia – 3.5%; weight loss – 0.3%. The following alarm features were statistically significant in detecting a major endoscopic finding: age > 60 (OR: 2.67, CI: 1.82–3.96), male gender (OR: 1.52, CI: 1.03–2.24), dysphagia (OR: 12.16, CI: 4.33–34.19) and upper GI bleed (OR: 2.77, CI: 1.03–7.47), p < 0.05.
Conclusion: Dysphagia, age > 60, male gender, and upper GI bleed are identifiable risk factors for major endoscopic findings. Not all the alarm features for major endoscopic findings that are established elsewhere can be applied in our rural SA setting
Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study
Full text linkBackground: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period.Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA.Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics.Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately
Relationship between hypothyroidism and gestational diabetes mellitus: a retrospective cohort study
Full text linkBackground: Approximately 2–10% of pregnant women experience subclinical hypothyroidism during pregnancy. Although some studies have shown that primary hypothyroidism increases the risk of gestational diabetes mellitus (GDM), there are contradictory results. Hence, this study aimed to determine the relationship between hypothyroidism and GDM.Methods: This is a retrospective cohort study in which the researchers followed up 340 pregnant women (170 with hypothyroidism as exposed group and 170 without hypothyroidism as unexposed group) for GDM. To analyse the data, chi-square, Fisher’s exact test and independent t-test were employed.Results: The incidence of GDM in the hypothyroidism group was higher than that of the group without hypothyroidism (11.8% vs. 10.6%, p = 0.731). Moreover, the risk of GDM (95% CI:0.61; 2.02) was 1.11 times higher among women with hypothyroidism. However, the observed association was not statistically significant. The mean two-hour oral glucose tolerance test (OGTT) level in pregnant women with hypothyroidism (108.94 ± 19.89 mg/dl) was significantly higher than in the other group (104.49 ± 18.43 mg/dl) with a p-value of 0.033.Conclusions: This study displayed that the risk of GDM is 11% higher among women with hypothyroidism. Furthermore, the difference in the mean two-hour OGTT level in pregnant women with hypothyroidism was 4.4 mg/dl higher than in the other group
Mealtime challenges and food selectivity in children with autism spectrum disorder in South Africa
Full text linkBackground: Children with autism spectrum disorder (ASD) have a number of associated feeding difficulties and problematic mealtime behaviours. These problems can have a negative impact on the child’s nutritional intake and little is known about the food preferences and characteristics of food choices. In addition, these difficulties can be exacerbated for children and caregivers living in low- and middle-income countries such as South Africa due to limited access to food, resources and health care.Objectives: The purpose of this study was to determine (1) types of feeding difficulties prevalent in children with ASD, (2) food items that children in South Africa prefer, (3) the relationship between age and ASD severity on food preferences.Method: A cross-sectional quantitative research design was employed using an online questionnaire. There was a total of 40 respondents from different provinces in South Africa. The data were analysed using descriptive statistics as well as multiple linear correlation analysis.Results: The study has identified common feeding difficulties in children with ASD and those being diagnosed as picky eaters in South Africa and compared them with difficulties that were found in the international literature. The study also highlighted the food groups that were preferred by children with ASD, showing a preference for starches and snack items compared with fruits and vegetables. In addition, there were significant correlations between ASD severity and ASD age on food preferences, suggesting that both age and severity may be predictors of food choices made by children with ASD, and highlighted a need for multidisciplinary intervention.Conclusions: This study adds to the existing literature on feeding difficulties in children with ASD but provides additional insights into children living in low- and middle-income countries and can be used to improve appropriate and responsive interventions. This study provides evidence that supports the influence of context and family environment regarding feeding in children with ASD
Getting better – health profession knowledge is key to improving deceased donation practices in South Africa
Full text linkNo abstract
Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital – a 4-year retrospective review
Full text linkBackground. Hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality and adverse outcomes. A previous study in the intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa, in 2000 found 10.5% mortality among eclampsia patients.
Objectives. To describe the mortality and adverse neurological outcomes associated with HDP in a tertiary ICU, compare these with results from 2000 and describe factors associated therewith.
Methods. The data of 85 patients admitted with HDP to ICU at King Edward VIII Hospital from 2010 to 2013 were retrospectively reviewed. Mortality and adverse neurological outcome (Glasgow Coma Scale (GCS) ≤14 on discharge from ICU) were assessed. Two sets of analyses were conducted. The first compared those alive on discharge from ICU with those who died in ICU. The second compared good neurological outcome with poor outcome (adverse neurological outcome, or death).
Results. The mortality was 11.6%, and overall, 9% had adverse neurological outcomes. There was no significant difference in mortality between patients with eclampsia in 2010 - 2013 (11.0%) and those in 2000 (10.5%) (p=0.9). Factors associated with mortality were: intra- or postpartum onset of seizures; twins; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; respiratory failure; and lower respiratory tract infections. Factors associated with poor outcomes (adverse neurological outcome, or death) were: parity (better outcomes in primiparous patients); time of antenatal onset of hypertension (worse if earlier onset); HIV infection; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; use of anticonvulsants other than magnesium sulphate or benzodiazepines in eclampsia.
Conclusion. The lack of improvement in ICU eclampsia mortality demonstrates a need to develop and implement a protocol for HDP management
Goldilocks and endotracheal tube cuff pressure management: Not too high, not too low. Just right …
Full text linkNo Abstract
Decision-making in the ICU: An analysis of the ICU admission decision-making process using a ‘20 Questions’ approach
Full text linkBackground. Deciding to admit a patient into the intensive care unit (ICU) is a high-stakes, high-stress, time-sensitive process. Elucidating the complexities of these decisions can contribute to a more efficient, effective process.
Objectives. To explore physicians’ strategic thought processes in ICU triage decisions and identify important factors.
Methods. Practitioners (N=29) were asked to decide on ICU referrals of two hypothetic cases using a modified ‘20 Questions’ approach. Demographic data, decisions when full information was available, feedback on questions, rating of factors previously identified as important and influence of faith and personality traits were explored.
Results. Of the 735 questions asked, 95.92% were patient related. There were no significant differences in interview variables between the two cases or with regard to presentation order. The overall acceptance rate was 68.96%. Refusals were associated with longer interview times (p=0.014), as were lower ICU bed capacity (p=0.036), advancing age of the practitioner (p=0.040) and a higher faith score (p=0.004). Faith score correlated positively with the number of questions asked (p=0.028). There were no significant correlations with personality trait stanines. When full information was available, acceptances for Case A decreased (p=0.003) but increased for Case B (p=0.026). The net reclassification improvement index was –0.138 (p=0.248). Non-subspecialists were more likely to change their decisions (p=0.036).
Conclusion. Limiting information to what is considered vital by using a ‘20 Questions’ approach and allowing the receiving practitioner to create the decision frame may assist with ICU admission decisions. Practitioners should consider the metacognitive elements of their decision-making
An evaluation of feeding practices and determination of barriers to providing nutritional support in a multidisciplinary South African intensive care unit
Full text linkBackground. Adequate nutritional support is crucial to optimising intensive care unit (ICU) outcomes.
Objectives. To assess adherence to current nutritional guidelines in critically ill patients in South Africa (SA). To identify risk factors for non-adherence to guidelines.
Methods. Retrospective observational chart review of nutritional practices, from 1 December 2017 to 31 May 2018, during the first week of ICU admission in adult patients admitted to a tertiary, multidisciplinary ICU in Durban, SA, for >48 hours.
Results. The study cohort (N=150) had a median age of 39 years and an ICU mortality of 28%. Surgical patients accounted for 50.7% of admissions. Ninety-eight percent of patients received mechanical ventilation, 75% required inotropic support, and 56% had acute kidney injury. The median time to initiation of enteral nutrition (EN) was 3 days, with EN being initiated within 48 hours in 39% of patients, and by day 7 80% of patients had received EN. Goal feeds were reached in 23% of patients by discharge, death or day 7. Parenteral nutrition was initiated in 16.7% of patients. There was an association between shock, acute kidney injury, increasing sequential organ failure assessment score and inotrope dose, and failure to initiate EN. Failure to initiate EN was predominantly due to unavoidable factors, but a number of clinical and administrative areas were identified to improve EN delivery.
Conclusion. Adequate nutrition is associated with reduced morbidity, ICU length of stay, mortality and improved functional outcomes. More attention to avoiding barriers to adequate ICU nutrition and enhanced adherence to feeding protocols should be encouraged