South African Family Practice - Volume 49, Issue 5, 2007
Volume 49, Issue 5, 2007
Analysis of impact of HIV / AIDS on deaths certified at Mosvold Hospital, Ingwavuma, Northern KwaZulu-Natal from 2003 to 2006 : original researchAuthor C.H. Vaughan WilliamsSource: South African Family Practice 49 (2007)More Less
Background: Mosvold Hospital is a government district hospital situated in northern KwaZulu-Natal, a province with an antenatal HIV prevalence of 39%. A previous study indicated that 45% of deaths certified at Mosvold Hospital were due to HIV / AIDS. The antiretroviral roll-out programme commenced at Mosvold Hospital on 16 September 2004.
Methods: Data from deaths certified at Mosvold Hospital from 1 January 2003 to 31 December 2006 were analysed for trends in diagnosis and age at death. The period included 20 months prior to the start of the antiretroviral roll-out at the hospital in September 2004, and the first 28 months of the programme.
Results: Of the deaths between 2003 and 2006, 53% were certified as having HIV/AIDS as the underlying cause of death. Between 2003 and 2005 there was a significant reduction in the average age at death for males and females, with an increase in mortality in the zero to four years age group. In 2006 there was a significant increase in the average age at death of females compared to 2005, although this increase was not demonstrated to be due to an improvement in mortality from HIV/AIDS.
Conclusion: HIV / AIDS continues to be the dominant public health concern in the sub-district. To date, public health measures such as the antiretroviral roll-out programme cannot be demonstrated to have affected mortality from the disease.
Good short-term outcomes of kangaroo mother care in infants with a low birth weight in a rural South African hospital : original researchSource: South African Family Practice 49 (2007)More Less
Objective: The aim of the study was to determine the outcome of kangaroo mother care (KMC) in low birth weight infants at a community hospital.
Methods: This descriptive study included 87 mothers and their low birth weight infants who were in a stable condition and eligible for KMC at Dr JS Moroka Hospital, Thaba Nchu. The infants were assessed four times: at birth, twice during hospitalisation, and a week after discharge. Infants received breast milk exclusively.
Results: Regarding the mothers' obstetric history (n=87), gravidity ranged from 1 to 7 (median 3), with a 43% incidence of miscarriage. The median birth weight of the infants (n=87) was 1.5 kg (first assessment), the discharge weight (third assessment) was 1.8 kg, and a week after discharge (fourth assessment) it was 2.2 kg. Initially the infants lost weight significantly from birth to the second assessment (95% CI for median decrease [-0.02; -0.01]), but significantly gained weight from the second to the third (95% CI for median increase [0.27; 0.33]) and from the third to the fourth assessment (95% CI for median increase [0.32; 0.45]). Approximately half (49%) of the infants had developed jaundice by the time of second assessment. These babies had a significantly lower birth weight [0.12;0.30].
Conclusion: Our findings confirm that infants with a low birth weight treated with KMC can have a good growth pattern, and exclusive breast milk is sufficient to guarantee such growth. Kangaroo mother care is a safe method for stable infants with a low birth weight in a community hospital.
An evaluation of postprandial glucose excursions in type 2 diabetic mellitus subjects on Monotard(R) HM (ge) versus Humulin N(R) or Humulin L(R) insulin, each in combination with metformin : original researchSource: South African Family Practice 49 (2007)More Less
Background: There is increasing evidence that postprandial hyperglycaemia is implicated in the development of macro- and microvascular diabetic complications. Thus, control of postprandial glucose levels (PPG), in addition to control of fasting blood glucose (FBG), will ensure overall glycaemic control in diabetic patients. This study evaluated the effectiveness of a current anti-diabetic regimen on PPG in patients with type 2 diabetes mellitus.
Method: A total of 31 type 2 diabetic subjects on combination treatment of either Humulin N(R) (HN), Monotard HM (ge)(R) (M) or Humulin L(R) (HL) insulin, with metformin, participated in a controlled, prospective, one-day visit study at a tertiary referral state diabetes clinic. The objective was to evaluate the effectiveness of the combination treatment of either M (n = 11) versus HN (n = 10) or HL (n = 10) insulin, each in combination with metformin, on PPG in this study cohort. Each subject was given a standardised meal after completing baseline procedures. Prescribed insulin doses were taken the night prior to the study day and metformin doses were taken with the standardised meal on the following morning, the study day. After completion of the meal, blood glucose levels were determined every half an hour at 0, 30, 60, 90, 120 and 150 minutes, thus providing a postprandial glucose profile for each subject. The data was analysed using ANOVA.
Results: The study cohort was South African, predominantly of Indian origin (54.8%), with a mean age of 59.2 + 8 years, and 71% of the cohort was female. The subjects had a mean duration of diabetes of 11.4 + 6.6 years, with 71% (n = 22) having a positive family history. The study cohort was obese (BMI 32.3 + 6.2kg/m2, WHR 0.9 + 0.1). A total of 61.3% (n = 19) of the study cohort was hypertensive, while 29% (n = 9) presented with at least one cardiovascular event and 48.3% (n = 15) had high total cholesterol. On entry to the study, the mean (+ SD) FBG (10.3 + 3.7mmol/l), fructosamine (369.9 + 78.8mol/l) and glycosylated haemoglobin (9 + 2%) were elevated. Each insulin group, HN, M and HL, was statistically matched for the above-mentioned and was therefore compared.
There was no statistically significant difference in the effectiveness of HN, M and HL, each in combination with metformin, on postprandial glucose levels (AUC glucose 0-150 minutes was 2100, 2212.5 and 2362.5mmol.min.l-1, per group respectively). Each insulin group presented with mean postprandial hyperglycaemia (PPH) at all time intervals (30, 60, 90, 120 and 150 minutes). Peak glucose levels were observed at 90 (16mmol/l), 90 (16.9mmol/l) and 60 minutes (17.6mmol/l) for HN, M and HL groups respectively. Since there was no statistically significant difference in PPH between and amongst the insulin groups at 60, 90 and 120 minutes, an approximation of PPG at 60 minutes would not adversely affect the determination of PPG compared to the recommended two hours. Within the HN, M and HL groups, a statistically significant difference in blood glucose levels was observed at 0 and 120 minutes (p = 0.003, 0.009 and 0.019 respectively). Groups with a higher FBG (at 0 minutes) had higher PPG (at 120 minutes), thus showing that the extent of FBG determines the degree of postprandial glycaemia.
Conclusion: In this study, HN, M and HL, each in combination with metformin, were not effective in controlling postprandial hyperglycaemia. HN was most effective in lowering the postprandial profile, although this was not statistically significant. The current treatment of the study cohort was also reviewed, as both FBG and PPG were not controlled. The use of a combination of short / rapid-acting insulin with a newly- formulated basal insulin is recommended, as both FBG and PPG should be treated to achieve overall glycaemic control.
The dissemination and implementation of national asthma guidelines in South Africa : the use of outcome mapping : open forumSource: South African Family Practice 49, pp 5 –8 (2007)More Less
Asthma is an important chronic inflammatory disorder with significant morbidity and mortality in South Africa. The development of national asthma guidelines by the South African Thoracic Society and National Asthma Education Programme has been one approach to try and improve the quality of care. The effectiveness of previous guidelines has been limited by the lack of an effective approach to dissemination, implementation and evaluation. The newly revised guidelines will be completed in 2007 and this paper outlines how Outcome Mapping has been used to create a detailed and comprehensive approach to bridging the gap between the guidelines and clinical practice.
Author M. DaveySource: South African Family Practice 49, pp 32 –35 (2007)More Less
Cardiovascular disease (CVD) is the leading cause of death in women older than 50 years. Risk factors for CVD differ in some aspects from those in men. The prevention of CVD in women has undergone a reappraisal with the publication of studies looking at the use of menopausal hormone therapy for both primary and secondary prevention. Although these studies concluded that there was no place for the use of hormone therapy for prevention of CVD, recent data suggests that the issue is still not resolved as regards the younger woman in early menopause. Until more data is available in this regard, the main focus of prevention should be on interventions to decrease risk factors for cardiovascular disease.
Author S. KlingSource: South African Family Practice 49, pp 36 –40 (2007)More Less
Patients who continue to have symptoms with frequent attacks of asthma despite being adherent to treatment with multiple asthma medications, have severe asthma. Severe asthma has significant implications for the affected individual and utilise a disproportionate share of the health care costs associated with asthma.
Source: South African Family Practice 49, pp 42 –45 (2007)More Less
Pheochromocytomas are catecholamine-producing neuroendocrine tumours that arise from the adrenal medulla or extramedullary pheochromoblasts with highly variable clinical presentation, including episodes of headache, sweating, palpitations and hypertension. Due to the non-specificity of the symptoms there is usually a delay between the onset of symptoms and the final diagnosis. To make a firm diagnosis, biochemical testing of the blood (catecholamines) or urine (metanephrines and VMA) are mandatory. Many stimuli increase circulating catecholamines and metabolites and must receive due attention to prevent false-positive results. Therapeutically, surgery is the gold standard. To minimise complications during and post surgery the lesion(s) should be carefully localised via imaging studies. Adequate pre- and postoperative medical treatment is important. The history, diagnosis and therapy of two patients - the one with a paraganglioma of the organ of Zuckerkandl, the other with a intra thoracic paraganglioma are presented.
The Descent of Madness : Evolutionary Origins of Psychosis and the Social Brain, by Jonathan Burns : book reviewAuthor Bonga ChilizaSource: South African Family Practice 49 (2007)More Less