Outcomes of Stevens­Johnson syndrome and toxic epidermal necrolysis in HIV-infected patients when using systemic steroids and/or intravenous immunoglobulins in Pietermaritzburg, South Africa

Background: Stevens­Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening mucocutaneous reactions. There is an ongoing controversy regarding the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) in SJS/TEN and their utility in HIV-infected patients.Objectives: The objective was to assess the outcome of a combination of intensive supportive care with oral corticosteroids in SJS and a combination of systemic steroids and IVIG for 3 consecutive days in HIV-infected patients with TEN. In addition, we assessed management in a general dermatology ward without implementing wound debridement.Methods: This was a retrospective cohort study of 36 HIV-infected adults with SJS/TEN admitted to a tertiary dermatology unit between 1st January 2010 and 31st July 2011. Standard-of-care protocols included identification and elimination of the possible causative drug, meticulous wound care without debridement, initiation of oral prednisone (1 mg/kg/day) on admission for 3 consecutive days, and the addition of IVIG (1 g/kg/day) for 3 consecutive days to those with TEN.Results: Of the 36 patients in the study, 32 were female. Nevirapine was the commonest drug implicated. A diagnosis of tuberculosis did not increase the case fatality rate.Complications included infections, anaemia, drug-induced hepatitis, ocular involvement, renal impairment, deep vein thrombosis, respiratory distress, Leucopenia, gastritis and hypernatremia. The overall survival rate was 97%.Conclusion: HIV-infected SJS and TEN patients were treated in a tertiary dermatology ward with a treatment plan of skin care, and a combination of systemic corticosteroids and IVIG respectively had a survival rate of 97%

The Burden of Diabetes Mellitus in Kwazulu-Natal' S Public Sector : A Year Perspective

Background: The global increase in the prevalence of diabetes mellitus is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu-Natal Province (KZN); South Africa. Data are routinely collected at all public healthcare facilities in the province and are aggregated per facility. Objective: To investigate the distribution; incidence and prevalence of diabetes in the public healthcare sector of KZN. Methods: Data collected by the DHIS for all patients with diabetes in KZN from 1 January 2010 to 31 December 2014 inclusive were analysed. Additional open-source databases were accessed to enable further exploration of the data collected. Results: The study showed that the majority (38.7%) of patients with diabetes on the public sector register were from the district of eThekwini. Positive correlations were found between the prevalence of diabetes; the mortality rate and the number of defaulters (patients with diabetes who did not return for regular treatment). Conclusions: Provincial estimates of the prevalence of diabetes in this study were higher than the known national prevalence. This may be due to the large proportion of Indians in KZN; who have a genetic predisposition to diabetes mellitus. However; allowance must be made for possible inaccurate data collection at source with miscounting of individuals. This study supports the global trend of an association between diabetes and urbanisation and highlights the need for regular diabetes screening and education; particularly in the public healthcare domain