Opinions of South African dietitians on fistuloclysis as a treatment option for intestinal failure patients

Introduction: Intestinal failure is the consequence of diverse aetiologies and pathophysiological causes. Fistuloclysis is an effective means of nutritional support to selected intestinal failure patients. This study aimed to investigate the management of adult intestinal failure patients in hospitals in South Africa, determining how practical and acceptable fistuloclysis is.Methods: The current management of type 2 and type 3 intestinal failure patients in South African hospitals was investigated by means of occupation-specific questionnaires, evaluating perceptions and opinions among dietitians. Results: Twenty-seven dietitians indicated willingness to participate in the survey, the majority (67%) having been involved with patient management in this field for one to five years. All indicated correctly that high fistula outputs would be defined as intestinal failure. Only 47% gave the correct definition of fistuloclysis, while 28% were currently utilising it as a means of nutrition support. All respondents agreed that unsuccessful implementation of fistuloclysis was due to training shortfalls and resistance Conclusion : There is a positive perception and awareness of fistuloclysis; however, numerous stumbling blocks hamper the wider use of this novel

Nutritional Care and Support among Adults Living with HIV at Hawassa Referral Hospital; Southern Ethiopia: A Qualitative Study

Improving nutritional care and support for people living with HIV (PLHIV) is an integral part of comprehensive HIV treatment according to the National Nutritional Strategy of Ethiopia. However; there is no adequate published study that assesses the nutritional care and support services for adult people living with HIV/ AIDS (PLHIV) in this setting. Objective:The objective of the study was to identify the existing nutritional care and support services and determine the challenges facing adults living with HIV at Hawassa Referral Hospital in southern Ethiopia. A qualitative study was carried out using focus group discussions (FGDs); in-depth interviews and participant observation. Four FDGs were held and five in-depth interviews were conducted. A two-week participant observation was also conducted by trained nurses. All interviews and FDGs were tape-recorded and transcribed; those conducted in Amharic were translated back to eng. Finally thematic analysis of the transcripts was performed.Most of the FDG participants were unsatisfied with their nutritional care and support services and expressed difficulty with disclosing their HIV status for fear of stigma and discrimination. The in-depth interviews and participant observation showed results similar to those of the FDG. Some key informants expressed a fear that such poor nutritional care and support may threaten the quality of life of people living with HIV and suggested that all stakeholders work on improving the services. Current nutritional care and support services for people living with HIV are not well coordinated. They focus mainly on monthly supplementation of antiretroviral drugs and occasional handouts of food. The need to provide health education on antiretroviral drugs and nutrition; and to emphasise strategies aimed at improving the nutritional status of peoples living with HIV is critical. Furthermore; the study recommended strengthening the initiatives of some organisations regarding sustainable income-generating activities

Nutritional Management of the Burn Patient

The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas; but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2of the South African population is burned annually; with 50of individuals who suffer burns being younger than 20 years. The Red Cross Children's Hospital admits 650 to 900 children with burn injuries annually.1 Burn injury; the most severe type of injury from a metabolic point of view; is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition; requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors; one being the development and implementation of improved methods of nutritional support that optimise host defences; enhance wound healing and support the metabolic response to stress.2 The greatest threats to survival from burns are still infection/sepsis; with burn wound sepsis and nosocomial pneumonia; including ventilatorassociated pneumonia (VAP); being the leading causes of death.2;3 Effective medical nutrition therapy in patients with burn injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury; alterations in the immune system and the role of reactive oxygen species (ROS)

Infant feeding tube as urinary tract stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas.Aim: To document experience with infant feeding tubes as stents in the urinary tract.Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software.Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1(3); ureteric re-implantation 24.3(8); ureterolithotomy 9.1(3); and urethroplasty 57.6(19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available