Research Articles (Office of the Dean: Health Sciences)

Permanent URI for this collectionhttp://hdl.handle.net/2263/3528

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Treatment outcomes and adverse drug effects of ethambutol, cycloserine, and terizidone for the treatment of multidrug-resistant tuberculosis in South Africa
(American Society for Microbiology, 2021) Van der Walt, Martha L.; Shean, Karen; Becker, Piet J.; Keddy, Karen H.; Lancaster, Joey
Treatment outcomes among multidrug-resistant tuberculosis (MDR-TB) patients receiving ethambutol, cycloserine, or terizidone as part of a standardized regimen were compared, determining occurrence of serious adverse drug events (SADEs). Newly diagnosed adult MDR-TB patients were enrolled between 2000 and 2004, receiving a standardized multidrug regimen for 18 to 24 months, including ethambutol, cycloserine, or terizidone. Cycloserine and terizidone were recorded individually. SADEs and factors associated with culture conversion and unfavorable treatment outcomes (default, death, treatment failure) were determined. Of 858 patients, 435 (51%) received ethambutol, 278 (32%) received cycloserine, and 145 (17%) received terizidone. Demographic and baseline clinical data were comparable. Successful treatment occurred in 56%, significantly more in patients receiving cycloserine (60%) and terizidone (62%) than in those receiving ethambutol (52% [P = 0.03]). Defaults rates were 30% in ethambutol patients versus 15% and 11% for cycloserine and terizidone patients, respectively. Terizidone was associated with fewer unfavorable outcomes (adjusted odds ratio [AOR], 0.4; P = 0.008; 95% confidence interval [CI], 0.2 to 0.8). Patients receiving cycloserine were more likely to achieve culture conversion than those receiving ethambutol or terizidone (AOR, 2.2; P = 0.02; 95% CI, 1.12 to 4.38). Failure to convert increased the odds of unfavorable outcomes (AOR, 23.7; P < 0.001; 95% CI, 13 to 44). SADEs were reported in two patients receiving ethambutol, seven patients receiving cycloserine, and three receiving terizidone (P = 0.05). Ethambutol was associated with high culture conversion and default rates. Cycloserine achieved higher culture conversion rates than terizidone. Fewer patients on terizidone experienced SADEs, with lower default rates. The differences that we observed between cycloserine and terizidone require further elucidation.
The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements
(Health and Medical Publishing Group, 2011-11) Mendes, J.F.; Mathee, A.; Naicker, N.; Becker, Piet J.; Naidoo, S.
Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, a community and a societal level.
Assessment of scapular position in patients suffering from shoulder dysfunction
(LAM Publications Limited, 2016-03) Korkie, Elzette; Van Rooijen, Agatha Johanna; Marais, A.M. (Annemarie); Becker, Piet J.; elzette.korkie@up.ac.za
Shoulder dysfunction inhibits 80% of competitive swimmers from performing optimally. The most common contributing factor to shoulder dysfunction is an altered scapula position. A standard for the distance between T4 and the medial border of the scapula is lacking. Measurements of the distance between T4 and the root of the scapula were made and the relationship of the distance and the function of trapezius middle fibres at resting length was tested. A Vernier caliper® (ICC 0.94) was used to measure the distance from T4 to the medial border of the scapula. Exercises and stretches to retrain and strengthen the middle fibres of the trapezius specifically were performed twice a week, scheduled around the swimmers’ regular training and strengthening sessions, for six weeks. The results showed that palpation of the scapula to measure the distance between T4 and the spinal root is reliable and valid. A normalisation index should be used to adjust for body build and posture. Furthermore, the distance between the thoracic spine and the scapula did not change, regardless of the statistical improvement in the function of trapezius middle fibres (p < 0.05). The research results are of importance for clinical practice, evaluation and treatment programmes for physiotherapists. The data obtained from this study can serve as a baseline for further studies.
Disagreement between common measures of asthma control in children
(American College of Chest Physicians, 2013-01) Green, Robin J.; Klein, Max; Becker, Piet J.; Halkas, Andrew; Lewis, Humphrey; Kitchin, Omolemo P.; Moodley, Teshni; Masekela, Refiloe; robin.green@up.ac.za
BACKGROUND: Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible, at least in principle, to control asthma with modern management. Control usually is assessed by history of symptoms, physical examination, and measurement of lung function. A practical problem is that these measures of control may not be in agreement. The aim of this study was to describe agreement among different measures of asthma control in children. METHODS: A prospective sequential sample of children aged 4 to 11 years with atopic asthma attending a routine follow-up evaluation were studied. Patients were assessed with the following four steps: (1) fraction of exhaled nitric oxide (F ENO ), (2) spirometry, (3) Childhood Asthma Control Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each test was coded as controlled or uncontrolled asthma. Agreement among measures was examined by cross-tabulation and k statistics. RESULTS: Eighty children were enrolled, and nine were excluded. Mean F ENO in pediatricianjudged uncontrolled asthma was double that of controlled asthma (37 parts per billion vs 15 parts per billion, P , .005). There was disagreement among measures of control. Spirometric indices revealed some correlation, but of the unrelated comparisons, those that agreed with each other most often (69%) were clinical assessment by the pediatrician and the cACT. Worst agreement was noted for F ENO and cACT (49.3%). CONCLUSION: Overall, different measures to assess control of asthma showed a lack of agreement for all comparisons in this study.
Disease progression unrelated to passive environmental tobacco smoke exposure in HIV-infected children
(International Online Medical Council (IOMC), 2012-02-16) Green, Robin J.; Becker, Piet J.; Labuschagne, Denise; Kitchin, Omolemo P.; Masekela, Refiloe; robin.green@up.ac.za
BACKGROUD: Studies in adults have shown that smokers have a higher risk of death and a higher risk of developing AIDS. Other studies have shown an increased risk of smoking HIV-positive adults to infections. There is, however, no available data on HIV-related disease progression in environmental tobacco smoke exposed children. AIM: The aim of this study was to determine if passive ETS exposure is a risk factor for HIVrelated disease progression in children. METHODS: An observational, descriptive study of children attending the HIV Clinic at a District Hospital during October 2007. RESULTS: 127 children were enrolled. 47 (37%) were living in households where adults smoke. There was no difference between passive tobacco smoke exposed children and those not exposed for CD4 percentage (p=0.66) or HIV stage (p=0.70). HIV-infected children were no more likely to be admitted to hospital if caregivers smoked (p=0.70). CONCLUSION: This study of HIV-infected children, did not reveal significant differences in objective measures of HIV status (CD4 count and HIV stage), nor increased rates of more severe illness (hospitalization) between children exposed to passive ETS and those not exposed. This is in contra-distinction to adult studies. The small sample size may limit comparison in this study.
Preliminary investigation of concurrent administration of phenylbutazone and romifidine in healthy horses
(Wiley-Blackwell, 2011-09) Kruger, Karin; Stegmann, George F.; Becker, Piet J.; frik.stegmann@up.ac.za
Malignant melanoma of the skin in black South Africans : a 15-year experience
(Health and Medical Publishing Group, 2010-08) Lodder, J.V.; Simson, W.; Becker, Piet J.
AIM: To document the anatomical distribution of melanoma, extent of disease, results of treatment and survival among black patients in the north-eastern part of South Africa. METHODS: All available histological material was reviewed. All available addresses of patients were consulted to establish the status of patients treated in the drainage areas of, or referred to, Kalafong Hospital or Pretoria Academic Hospital retrospectively and prospectively for the 15-year period 1969 - 1983. RESULTS: Of the 185 patients with melanoma who were documented, 10 were eliminated for various reasons. Among the remaining 175 patients there were 128 documented deaths, 35 patients having died of melanoma within 1 year of presentation. Thirty patients survived for more than 3 years. Because of late presentation and the nature of the disease, malignant melanoma has a very poor prognosis in black patients in South Africa.
Implementing recommendations arising from confidential enquiries into maternal deaths
(Elsevier, 2008-06) Pattinson, Robert Clive; Bergh, Anne-Marie; rcpattin@kalafong.up.ac.za; Pattinson, Bob
Implementing recommendations is a complex process involving all levels of health care. Effecting change in the health system can be broadly divided into four areas: policy, administration, clinical practice and training. Changes at the policy level require advocacy by lobby groups, as these changes are mainly political in nature. Changes at administrative level require a diversion of resources, and a clear policy framework must be in place within which the health administrator can work. Changes to clinical practice refer mainly changes in protocols of managing patients. The essential elements to change clinical practice include on-site, face-to-face teaching by a senior clinician; ineffective methods are lectures and memorandums on guidelines for practice posted to clinicians. Training refers to ensuring there are appropriate curricula for healthcare workers. Recommendations should also be phrased in such a way that targets can be established. These targets should be measurable and then be measured.
Scaling up kangaroo mother care in South Africa : 'on-site' versus 'off-site' educational facilitation
(BioMed Central, 2008-07-23) Bergh, Anne-Marie; Van Rooyen, Elise; Pattinson, Robert Clive; Pattinson, Bob
Background Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. Methods : Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care and participated in the trial. The hospitals were paired with respect to their geographical location and annual number of births. One hospital in each pair was randomly allocated to receive either 'on-site' facilitation (Group A) or 'off-site' facilitation (Group B). Hospitals in Group A received two on-site visits, whereas delegates from hospitals in Group B attended one off-site, 'hands-on' workshop at a training hospital. All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0-30. Successful implementation was regarded as demonstrating evidence of practice (score >10) during the site visit. Results : There was no significant difference between the scores of Groups A and B (p = 0.633). Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice. The median score for Group A was 16.52 (range 00.00-23.79) and that for Group B 14.76 (range 07.50-23.29). Conclusion : A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, did not influence the ability of a hospital to implement KMC. The choice of outreach strategy should be guided by local circumstances, cost and the availability of skilled facilitators.
Effect of nitrous oxide on spectral entropy during sevoflurane anaesthesia at an altitude of 1 400 metres
(Medpharm Publications, 2007) Spijkerman, Sandra; Smith, Francois Jacobus; Becker, Piet J.
No abstract available
Frequency of the metabolic syndrome in screened South African corporate executives
(Clinics Cardiv, 2007-01) Ker, James A.; Rheeder, Paul; Van Tonder, R.
The aim of the study was to determine the frequency of the metabolic syndrome in a specific group of people. The ATP III criteria were used to identify the metabolic syndrome in a group of 1 410 corporate executives belonging to a specialist health and fitness company in South Africa. The metabolic syndrome was common in a group of corporate executives.
Special report on South African Cardiovascular Risk Management Symposium
(Clinics Cardiv, 2007-01) Ker, James A.; Horak, Adi; Opie, L.; Sapire, K.E.
A recent update meeting, held in major centres in South Africa and sponsored by Bayer HealthCare, provided useful data and practical advice from South African experts on improving cardiovascular and diabetes risk management in daily practise.

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