Cytokine Profile and Clinical Correlates in HIV-Exposed Infants with Severe (Hypoxic) Pneumonia

Introduction. Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world; especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants; however; is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease. Objective. To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants Methods. In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia; paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.Results. A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml); while IP-10 was elevated in serum (mean 39.55 pg/ml); with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis. Conclusion. This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However; further investigation of this association is required

Profile of mortality of patients admitted to Weskoppies Psychiatric Hospital in South Africa over a 5-year period (2001-2005)

Objective: Mortality in the psychiatric population; both from natural and unnatural causes; is higher than in the general population and this is despite an improvement in the delivery of care and treatment of mental illness in recent years. The study was conducted to determine a profile of mortality and standardized mortality rates within our psychiatric hospital. Method: A retrospective clinical case audit was conducted of deaths that occurred at Weskoppies Hospital between 1st January 2001 and 31st December 2005. Direct standardised mortality rates were calculated (gender specific adjusted for age according to the South African population). Results: A total of 164 deaths were observed during this period. The gender-specific all cause mortality rates; standardised to the South African population; were 0.0177 (95CI 0.0141; 0.0213) and 0.0163 (95CI 0.0121; 0.0206) for males and females respectively. The all cause mortality rates for the South African male and female population were 0.0188 and 0.0170 respectively (not significantly different as it falls within the 95confidence interval of the standardised rates). The predominant natural cause of mortality was infection. Ten of the deaths were due to unnatural causes; of these 7 were suicides. The mortality ratio for unnatural causes was 0.47. Conclusion: Mortality studies are important tools for determining quality of health care provisions to patients. Studies of this nature assist in making recommendations for optimal clinical practice and aid in developing preventative measures

Elements of Effective Nutrition Education for Adults with Diabetes Mellitus in Resource-Poor Settings: a Review

This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings. Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes; which include appropriate change in dietary behaviour; improved glycaemic control; plasma lipid levels; blood pressure and body weight; as well as improved potential mediators (knowledge; skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs; abilities and socio-cultural context of the target group; the active involvement of the patient; a behaviour-focused approach based on appropriate theory; suitable delivery methods and individual/group approaches. Adequate contact time with an educator ( 10 hours); the educator's competence; provision of social support and follow-up intervention are also crucial. Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs

Inpatient Blood Glucose Management of Diabetic Patients in a Large Secondary Hospital

Background: Diabetes has become a major health problem worldwide; as well as in South Africa. This; coupled with the chronicity of the disease; relate to an increasing burden on health care facilities and an increasing number of hospital admissions of patients suffering from diabetes. Admissions are mostly related to diabetes itself; but the frequency of admissions for problems not related to diabetes is increasing as the prevalence of diabetes increases in the population. Proper inpatient glycaemic management is important for improving patient outcome and for reducing the risk of inpatient complications. Objectives: The objective of this study was to evaluate current practices in the care of diabetic inpatients as well as to assess the glycaemic control that is achieved during hospitalisation. Methods: An audit was done of clinical hospital records of adult diabetic patients admitted to Kalafong Hospital; a large secondary hospital in South Africa. All patients admitted who had type 1 or type 2 diabetes before admission; or who were newly diagnosed on admission or in hospital were included; irrespective of the discipline to which the patient was admitted. All patient admissions in the eight-month period preceding the initiation of the audit were included. Results: The hospital records of 164 diabetic patients were audited. With regard to glucose monitoring; 60.8of patients had irregular and erratic glucose monitoring; 37.2had regular (either four- or six-hourly) monitoring and only 2were monitored in relation to meals. Of the 164 patients; 160 were not fasting; 27 were treated with an insulin sliding scale at some stage during their admission; and in 14 (52) of the patients who were on sliding scales the scale was used inappropriately. Most hospital inpatients with diabetes; i.e. 48 (30.4); were treated with oral agents only; 29 (18.4) were treated with oral agents plus a daily dose of NPH insulin and 17 (10.8) with mixed insulin twice daily. Only three patients (1.9) received insulin supplemental to their regimen. The glycaemic control treatment schedule was appropriate in only 19.5of cases. Conclusions: Based on our findings; the monitoring and management of blood glucose in patients with diabetes during hospitalisation in a large secondary hospital in South Africa is currently inadequate. This calls for an educational intervention for doctors and nurses working with diabetic inpatients as well as the introduction of a blood glucose management protocol

Survey on knowledge and attitudes regarding diabetic inpatient management by medical and nursing staff at Kalafong

Objective. The objective of this study was to evaluate perceptions regarding current practices in the care of diabetic inpatients as well as the knowledge and attitudes of nursing and medical caregivers at a large secondary hospital. Design and methods. Doctors and nurses taking care of diabetic inpatients were surveyed to assess their knowledge of diabetes inpatient management and their attitudes towards diabetic patients. The survey made use of the diabetes knowledge questionnaire (O'Brien) and the DAS3 scale. results. The survey group comprised 115 health care providers; of whom 54 were doctors and 61 were nurses. The response rate was 82. The doctors achieved a mean score of 68.3(standard deviation (SD) 11.5) and the nurses 53.9(SD 16.3) for the diabetes knowledge questionnaire. The DAS3 questionnaire indicated that 80.9of health care personnel strongly agree that special training for managing diabetic patients is necessary; 90.5agree or strongly agree that type 2 diabetes is a serious condition; 92.2agree or strongly agree that tight glycaemic control is valuable; 85.2agree or strongly agree that diabetes has a significant psychosocial impact on patients; and 88.7agree or strongly agree that patients should have autonomy regarding their treatment. conclusions. Health care workers (doctors and nurses) in a large secondary hospital have average to poor knowledge about the care of diabetic inpatients. The DAS3 questionnaire; however; indicates that health care workers have a good attitude towards diabetic patients and realise that special training is necessary

Knowledge of Foot Care in People with Diabetes in a Tertiary Care Setting

Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with `at risk' feet (ARF) to those with `normal/not at risk' feet (NARF) and so assess whether the education effort by the clinic is effective. Methods. Patients attending the clinic completed an interviewer-assisted questionnaire with 11 questions concerning foot care knowledge. A knowledge score for each patient was calculated. Results. Possible scores ranged from 4 to 11 (maximum 11). The mean score for the ARF group was 8.9 (standard deviation (SD) 1.4) (range 4 - 11) compared with 8.9 (SD 1.4) for the NARF group (range 5 - 11) (p0.05). The most substantial difference between the two groups was that the ARF group gave 20more correct answers than the NARF group with regard to frequency of foot inspection (daily) (p=0.025). Conclusions. Both groups of patients had a reasonable knowledge regarding foot care. The patients at risk were more aware of the need for daily foot inspection

Adjunctive Corticosteroid Treatment of Clinical PCP Pneumonia in Infants Less than 18 Months of Age : a Randomized Controlled Trial

"Objectives. To determine the efficacy and safety of adjunctive corticosteroid therapy in clinical PCP pneumonia (Pneumocystis jiroveci pneumonia) in infants exposed to HIV infection. Design. Double blind randomised placebo-controlled trial. Methods: Infants with a clinical diagnosis of PCP; based on an ""atypical"" pneumonia with: 1) hypoxia out of proportion to the clinical findings on auscultation; 2) CRP less than 10 IU; 3) LDH above 500 IU; 4) compatible CXR findings and 5) positive HIV ELISA test were included in the study. Patients were randomised to receive either prednisone or placebo. The protocol provided for the addition of prednisone to the treatment at 48 hours if there was clinical deterioration or an independent indication for steroid therapy. Other treatment was carried out in accordance with established guidelines. in room air. Results. One hundred patients were included; 47 in the prednisone and 53 in the placebo group. Patients in the prednisone group had a 43 better chance of survival than the placebo group (HR 0.57; 95CI 0.30-1.07; p=0.08). No significant differences could be demonstrated between groups in respect of other parameters of recovery. Conclusions. In HIV exposed infants with clinical PCP pneumonia; adjunctive corticosteroid treatment does not appear to add benefit regarding time to recovery or oxygen independency; but early administration may improve survival. A large multi-centred trial is needed to confirm these findings.The primary study endpoint was in hospital survival. Secondary outcome was time from admission to the first day of mean oxygen saturation above 90"