1,720,978 research outputs found
High prevalence of metabolic syndrome in patients with SLE in the Western Cape
Full text linkINTRODUCTION: Patients with systemic lupus erythematosus (SLE) are at increased risk of the metabolic syndrome (MetS) and its complications. In the absence of published studies from sub-Saharan Africa, we investigated the prevalence and associations of the MetS amongst recent-onset SLE patients. METHODS: A cross-sectional study of recent onset (<5 years disease duration) patients with SLE meeting the SLICC SLE classification criteria. The MetS was defined by Joint Interim Statement criteria. Clinical and demographic data and a Functional Assessment of Chronic Illness Therapy score and the 36-Item Short-Form Healthy Survey were completed. RESULTS: Of 75 patients, the mean age was 37.1 (11.7) years, disease duration was 30.8 (23.6) months, 65 (86.7%) were female, 68.0% were of mixed ethnic ancestry and 29.3% were Black Africans. The mean SLEDAI score was 0.9 (1.6). The prevalence of MetS was 40.0%, and age and body mass index were the only significant features associated with MetS (p = 0.003 and 0.001 respectively). Increased waist circumference (WC) was the most frequently observed feature, present in 92.9% of MetS patients. Patients with an elevated WC were 32.5 times more likely to have MetS. CONCLUSION: This study shows a high prevalence of MetS amongst South Africans with recently diagnosed SLE. This calls for aggressive strategies to reduce the prevalence of Mets and atherosclerotic cardiovascular disease. Waist circumference is a useful and costeffective screening tool to identify SLE patients at risk of MetS
Determinants of patient and physician global assessment of disease activity and their discrepancies amongst South Africans with Rheumatoid Arthritis
Full text linkBackground: Patient and physician global assessments (PGA and PhGA) play a crucial role in treatment decisions, yet discordance in these assessments is common. Factors influencing PGA and PhGA and discordance in South African (SA) RA patients remain poorly understood. Methods: This cross-sectional study included consenting adults with RA attending a tertiary hospital. Demographic, disease-specific, and patient-reported outcome data were collected. A discordance score was calculated by subtracting the PhGA score from the PGA score, and discordance was defined as PGA-PhGA ≥ 2.5. Determinants of PGA, PhGA, and determinants were explored using correlation analyses, linear regression, and logistic regression. Results: Of 550 patients, most were female (84.9%), with a mean (SD) age and disease duration of 55.8 (12.9) and 11.5 (9.7) years. Discordance was seen in 27.5%. Pain severity significantly influenced PGA, while tender and swollen joint counts predominantly influenced PhGA. A large portion of the variance in PGA and PhGA (62.0 % and 50.3% respectively) was unexplained. Patients with discordance reported higher pain scores, and problems with usual activities but had lower swollen joint counts and were more likely to be in remission or low disease activity than concordant patients. Conclusion: Discordance in patient-physician assessments exists in a considerable proportion of SA RA patients. Pain severity and functional limitations greatly influence patient perceptions. Addressing pain and activity limitations could help reduce discordance, optimize disease management, and foster shared decision-making. Further longitudinal and qualitative research is essential for a more comprehensive understanding of our RA patients' perspectives
Anti-neutrophil cytoplasmic antibody (ANCA) testing at Groote Schuur Hospital: Adherence to indications for testing
Full text linkAppropriate use of laboratory investigations is increasingly important in resource-constrained environments. We receive the anti-neutrophil cytoplasmic antibody (ANCA) testing practices in a tertiary hospital in South Africa
Cigarette smoking amongst Rheumatoid Arthritis patients in a tertiary centre in South Africa
Full text linkBackground: Cigarette smoking is associated with worse outcomes amongst rheumatoid arthritis (RA) sufferers, with poorer disease control, increased extra-articular complications and comorbidities. There are currently no data from sub-Saharan Africa. Objective: To describe the prevalence of cigarette smoking, and explore disease control, comorbidities, extra-articular disease, and attitudes of smokers to their habit amongst RA patients in an outpatient clinic at tertiary level public hospital in South Africa. Further, we asked patients about the impact of prohibition during the COVID pandemic. Methods: A cross-sectional study of consenting adult outpatients with RA meeting the EULAR/ACR 2010 Classification Criteria. Demographic, clinical and patient-reported outcome measures (PROMs) together with a questionnaire about smoking and Fagerström test for nicotine dependence were collated. (1) Results: Of 632 patients (536 females), the mean (SD) age and disease duration were 55.4 (13.0) and 10.1 (9.3) years. The mean (SD) Clinical Disease Activity Index (CDAI) and HAQ-DI were 14.3 (11.8) and 1.5 (0.7). The cohort included 218 (34,5%) smokers, and 89 (14.1%) exsmokers, and more males smoked (p=0,0002). Compared to non- or ex-smokers, smokers had lower BMI (29.7 vs 32.9 p= 0.01), higher anxiety scores (p=0,048) and incidence of COPD (8,26 % vs 2,66%, p< 0.005). Smokers were more likely than non-smokers to have a positive Rheumatoid Factor (80,3% vs 69,8%, p=0.006). There were no significant differences in age of RA onset, disease duration, SES, number of comorbidities, CDAI nor its individual components, extra-articular diseases nor in HAQ-DI, FACIT, depression nor pain scores. Of 160 patients who completed the smoking questionnaire, only 83 (49,5%) believed smoking worsened their arthritis, yet 119 (71,6%) reported receiving smoking cessation advice at the RA clinic. Participants' most common reasons for smoking were emotional support (45.8%), nicotine craving (30.5%) and pain control (25,2%). The Fagerström score revealed mild, moderate and severe nicotine dependence in 67.5%, 24.4%, and 7.5% respectively. Although 50.1% felt that living with RA made quitting difficult, 86.9% had considered quitting, and almost half (45.6%) had previously quit for more than 3 months. Conclusion: In this cohort of RA patients, a third actively smoke. Smoking is a modifiable risk factor, although half of the smokers reported that their RA made quitting difficult despite only 7.5% having severe nicotine addiction. Adequate disease control along with behavioural support should be the basis of engaging around tobacco cessation
Axial Spondyloarthropathies in the Western Cape
Full text linkImpaired Health-Related Quality of Life and Work Productivity amongst South African patients with Axial Spondyloarthritis. Background: No studies have investigated health-related quality of life (HRQoL) or work productivity in patients with axial spondyloarthritides (axSpA) living in sub-Saharan Africa. Methods: This cross-sectional study of adults with axSpA collated demographic particulars and patient questionnaires: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); Bath Ankylosing Spondylitis Functional Index (BASFI); Bath Ankylosing Spondylitis Global Score (BASG); Medical Short Form (SF)-36; and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP). Results: Of 36 patients, the mean (SD) age was 40.3 (13.3) years and mean (SD) diagnostic delay was 8.7 (8.4) years. Most patients were male (80.6%) and of mixed racial ancestry (69.4%). Most (66.7%) patients were smokers and only 5 (13.9%) patients received tumor necrosis factor inhibitor (TNFi) therapy. The mean (SD) BASDAI was 5.3 (2.1), and 72.2% had a BASDAI ≥ 4. Patients with a high BASDAI (i.e. BASDAI ≥ 4) had higher BASG scores (p=0.003), higher WPAI:SHP activity impairment scores (p=0.003), and poorer SF-36 scores, particularly in the role-physical, bodily pain, and social functioning domains (p=0.0001, 0.001 and 0.02 respectively). Activity impairment according to the WPAI:SPH was 57.4%, with the BASDAI and activity impairment correlating closely (p=0.006). The SF-36 scores were low in physical (particularly role-physical, bodily pain, and general health) and mental (notably vitality and role emotional) domains. 6 Conclusion: This study describes a cohort of South African patients with axSpA who have poor prognostic features including diagnostic delay and cigarette smoking. Active disease, impaired function, poor physical- and mental HRQoL, and work disability are unmet needs
Health related quality of life, perceptions and experiences of female patients with Systemic Lupus Erythematosus in South Africa: exploring unmet needs using a mixed methods approach
Full text linkObjective: Systemic Lupus Erythematosus (SLE) is a multi‐system disease that predominately affects women. Considering the lack of data on health related quality of life (HRQoL) especially in sub‐ Saharan Africa, we undertook a literature review on HRQoL of SLE patients in developing countries to collate the existing evidence and identify information gaps. A mixed methods qualitative and quantitative study of lived experiences of South African women with SLE was performed. Methods: A literature search was conducted on medical databases using MeSH terms pertaining to HRQoL amongst SLE patients in the developing or low income countries to identify articles published between January 1975 and February 2018. The main study included 25 consenting SLE patients attending two tertiary hospitals in Johannesburg and Cape Town. Individual in‐depth interviews, using a topic guide, were conducted and analysed using NVivo software. In addition, participants completed the Short Form‐36 (SF‐36), Functional Assessment Instrument (FAI) and functional assessment of chronic illness therapy (FACIT) for fatigue questionnaires. The questionnaires were analysed per each tool's scoring method and SPSS software was used to calculate mean, standard deviations and correlations. Results The review of 31 articles, from 11 countries indicated that SLE women have a poor general HRQoL. In addition, we found relationships between disease factors including disease activity, organ damage, functioning, and mental health. Poor socioeconomic status worsened SLE outcomes by limiting patients' access to health care and psychosocial services. In the main study, the majority (72.0%) were black Africans, unemployed (76.0%), with low formal educational level and singlehood status (72.0%). The mean (SD) mental and physical composite SF‐36 scores were poor (50.9 (22.1) and 49.1 (20.5) respectively), and 68.0% of women had FACIT scores of severe fatigue. The mean (SD) FAI was 1.33 (0.8), showing that activities of daily living (ADL) were performed with difficulty. Major themes expressed were fatigue, pain, impaired functioning, depression, pregnancy, aesthetic concerns and sexuality issues. Disease chronicity, fatigue and pain were described by many participants as ‘taking over life' and impacting on performing ADL and career opportunities contributing to indigence. Negative pregnancy outcomes were frequently exacerbated by poor sexual relationships and miscommunication between patient and health care workers. Lack of understanding of SLE by patients, community and family as well as suicidal ideations and depressive symptoms were expressed. Although the quantitative tools measured these aspects, they were unable to explore complexities such as limitations in job acquisition, suicidal ideations, disease understanding and support systems. Conclusion This study underscores the complex, chronic and challenging life experiences, often exacerbated by poverty, of SA women with SLE. Quantitative tools may be inadequate in capturing important aspects of HRQoL that emerged from the qualitive interviews. Awareness of these limitations, together with psycho‐social support and education, might improve HRQoL. This thesis recommends multi‐centred, interventional longitudinal studies that incorporate mixed methods and focus on strategies to improve the negative outcomes in SLE
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A retrospective study of patients with biologics treatment at Groote Schuur and Red Cross Children's War Memorial Hospitals
Full text linkIntroduction. The high cost and concern of adverse events, particularly infections, limit the use of biologic disease-modifying anti-rheumatic (bDMARD) therapies. We undertook this retrospective study to document their use for immune-mediated diseases (IMDs) and explore the efficacy, safety, adherence and screening practices prior to initiating bDMARDs in a tertiary referral hospital. Methods. A folder review of all adult and paediatric patients treated for IMDs with bDMARDs at Groote Schuur and Red Cross Hospitals between January 2013 and December 2019. Clinico-demographic particulars, details of bDMARD therapy, and adverse events were collated. Changes in disease activity were measured by diseasespecific tools at 6, 12, 24-months and at the last available visit, and patient adherence to bDMARDs was explored by folder and pharmacy record review. Results. We studied 151 folders, with 182 bDMARDs uses (29 patients used more than 1 bDMARD). Patients were from rheumatology (n= 38: 13 rheumatoid arthritis; 10 spondyloarthritis, 5 Systemic Lupus Erythematosus (SLE) , 5 inflammatory myositis and 5 other conditions); gastroenterology (n=31; 26 Crohn`s and 5 Ulcerative Colitis), dermatology (n=9; psoriasis), neurology (n=4, ophthalmology (n= 25; 6 scleritis, 18 uveitis, 1 optic neuritis), and paediatrics (n= 45, 26 juvenile idiopathic arthritis , 12 SLE, 7 other conditions). The bDMARDs used were TNF inhibitors (112), rituximab (55), tocilizumab (10), anakinra (3), abatacept (1), and tofacitinib (1). The vast majority of patients had an excellent response and were in low disease activity or remission at their last available visit. Adverse events included severe infection (4), tuberculosis (TB) (2), mild infection (4), severe allergic reaction (3), mild skin reaction (14), elevated liver enzymes (2), and worsening interstitial lung disease ILD (1). bDMARD Therapy was discontinued in 18 patients, most commonly due to adverse reaction (9), lack of response (3), poor adherence (2), or remission (1). bDMARD Therapy was changed to alternative therapy in 29 patients, most commonly because of poor response (14), or adverse effects (9) or poor adherence (3). Poor adherence or patients lost to follow-up was noted in 18/182 (9.9%). Complete latent TB infection screening with chest x-ray and TB skin test was performed in only 55 (36.4 %) but INH prophylaxis was given to 51/88 (57.9%) of patients prescribed TNFi therapy. Hepatitis B screening performed in 93 (61.6 %) patients, but most patients (72.2 %) were not tested for Hepatitis B core ab. Hepatitis C screening was performed in 81 (53.6 %) patients. Only 88 (58.3%) patients had a recent HIV test. The majority (17.2%) received the influenza vaccine, but only 24 (15.8 %) received pneumococcal vaccination. Discussion and Conclusion. bDMARD therapy was an effective treatment, and the most common adverse effect was infection (7.2%), with 2 TB infections. Vaccination and screening for TB, viral hepatitis and HIV was suboptimal. Of concern, poor adherence to bDMARDs was frequently encountered
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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