Aetiology of pancytopenia: Experience of a South African tertiary academic centre

Background: Pancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis. Objective: This study aimed to determine the aetiology of pancytopenia in a South African population.Methods: A retrospective observational study of adult patients presenting with pancytopenia at Tygerberg Academic Hospital, South Africa, from January 2016 to December 2017 was performed. Data on pancytopenia cases were obtained from the laboratory information system and utilised to determine the causes of pancytopenia. Results: A total of 673 cases of pancytopenia were identified. The most common causes of pancytopenia were chemoradiation therapy (25%), sepsis (18%), haematological malignancy (9%), advanced HIV (7%), and megaloblastic anaemia (6%). The diagnostic yield of bone marrow examinations (BME) was 57% (n = 52/91). The aetiology of pancytopenia differed according to age, with malignancy being a more common cause of pancytopenia among the elderly. Conclusion: Several easily recognisable and treatable conditions can manifest as pancytopenia. Prompt management of such conditions, notably sepsis and megaloblastic anaemia, can result in the resolution of the cytopenias and negate the need for a BME. However, haematological malignancy and unexplained pancytopenia strongly rely on a BME to establish a diagnosis. Pancytopenia investigations, when guided by appropriate clinic-laboratory findings, can promptly identify the underlying aetiology, while also identifying cases where an expedited BME is required. This is valuable in resource-conscious medicine

Study of the prevalence of sodium and potassium disturbances in the elderly

Background: Electrolyte disturbances establish a broad problem among old individuals. A medication adverse effect that in youngsters would deliver just a trifling change in the plasma sodium and potassium may cause a major serious effect in the older, mostly because of aging. This study was directed to assess the commonness of sodium and potassium disturbances in the old. Methods: A Cross-sectional study was completed among old patients who were regular visitors to Internal Medicine Department outpatient clinics of the Zagazig University from February 2018 to February 2019. This examination included 100 older patients. Results: Our examination revealed the predominance of hypokalemia was 17% and hyperkalemia was 25%. While hyponatremia was 32% and hypernatremia was 4%. Diuretics were the most affecting medication on potassium and sodium levels. No significant difference was found in age among potassium and sodium gatherings. Conclusion: In this study, we found that disturbances in the sodium and potassium are commonly found in the old and a few sorts of medications are assosciated with these disturbances however diuretics were the most commonly to be found. Different components, including polypharmacy , disabled organ work and numerous ailments, put them at a more serious danger of medication induced changes in electrolyte homeostasis. Specialists should know about this hazard and screen both medication records and sodium and potassium levels ,so as to counteract and deal with these disturbances that may some way or another further affect the health of these old and frail patients

Determinants of Active Ageing in Zambia

"This study assesses the 2002 world health organisation Active Ageing Framework and how it applies to developing countries using data from Zambia. Up to date; there is little or no evidence of studies conducted to answer whether or not the 2002 world health organisation Active Ageing Framework is applicable to developing countries like Zambia. This study set out to (1) explore which of the determinants of the active ageing framework apply to Africa and Zambia in particular and; (2) the influence of HIV/AIDS on active ageing in general. A non-experimental exploratory research design was used to collect data for this paper. Snowball and purposive sampling was employed to select 690 respondents (284 males and 406 females) for the study. The study reveals that income accessibility (Economic Determinant); functional limitations (Health Determinants); low self-esteem and loneliness (Personal/Behavioural Determinants); low family and peer interactions (Social Determinants) and HIV/AIDS apply to Zambia in determining active ageing. The study suggests that focused research is needed to clarify and specify the role of each determinant; as well as the interactions between determinants in the active ageing process. In fact; the framework proposes that for such studies; a life course approach is required so as to take advantage of transitions and ""window of opportunity"" for enhancing health; participation and security at different stages. The study also recommends that policies on ageing should be structured to incorporate the applicability of the 2002 world health organisation active ageing framework's main determinants of active ageing to reflect the Zambian context."

Ageing and mental health resources for older persons in the African region of the World Health Organization

Africa is a region where a demographic transition from high child mortality and low life expectancy; to low child mortality and high life expectancy is only just beginning.Nevertheless; some countries already have a growing number of persons over the age of 60 - a number that is likely to increase rapidly. As a consequence; the number of older persons with mental disorders is likely to increase. To better understand the organisation of care for older persons; data are being collected to reduce the imbalance between 'disease information' and 'resource information' - information that addresses older persons' needs in terms of mental health care.This review presents some results from the continent. Mental health problems among older adults are still not a public health priority in Africa; but careful examination of each country nevertheless reveals certain specificities; such as divergent life expectancy and different values regarding ageing. The authors present some recommendations for the development of carefor old persons with mental disorders; based on the general recommendations made by the World Health Organization (WHO) in the World Health Report 2001 (WHR 2001); and by the WHO and the World Psychiatric Association (WPA) in some consensus statements on psychiatry of the elderly