Management of upper gastrointestinal bleeding

This paper will describe the common symptoms, signs and causes of upper gastrointestinal bleeding. We will then provide advice on the management of upper gastrointestinal bleeding at primary care level

Susceptibility to hepatitis B infection, hepatitis B/HIV co-infections and hepatitis B immunity in HIV-positive patients starting HAART in Durban, South Africa

Background: HIV/HBV co-infection remains a global threat to HIV management despite the available effective hepatitis B vaccine and hepatitis B covering antiretroviral therapy. Many studies done in South Africa and internationally showed high prevalence of HIV/hepatitis B co-infection, which mandated routine screening for both infections before initiating HAARTFewer studies have highlighted the prevalence of hepatitis B susceptibility in the general population starting HAART and most of them were limited to children and high-risk groups. The aim of this study was to demonstrate the extent ofhepatitis B susceptibility, hepatitis B/HIV co-infections and hepatitis B immunity in general HIV-infected patients.Method: This was a retrospective review of 1 066 randomly sampled files of patients initiated on HAART between January 2012 and December 2014 at two Durban hospitals. Data collection included demographic characteristic, CD4 counts and hepatitis B serology. Data were analysed for the prevalence of hepatitis B susceptibility, HIV/HBV co-infection and hepatitis B immunity, while correlations between age, CD4 count and these three groups were demonstrated. Statistical analysis was performed using SAS version 9.3.Results: Total prevalence of HBV susceptibility was 69.7%, HBV immunity was 26.9% and true chronic HIV/HBV co-infection was 3.4%, while HBVsAg positivity accounted for 8.4% of the participants. Adults were more susceptible to HBV than children, with a median age of 36 years. Stratified for age, children were more immune (90%) to HBV than adults. Conclusion: This study demonstrated a significantly high number of HIV-infected persons who were susceptible to hepatitis B infection in Durban, South Africa, where both HIV and HBV are endemic, co-infection is high, and safe and effective HBV vaccine is available. Hepatitis B vaccination of the hepatitis B susceptible patients initiating HAART in South Africa is recommended to prevent further HIV/HBV co-infection

Compliance with local diabetic guidelines at a district hospital in KwaZulu-Natal, South Africa

Background: Diabetes mellitus (DM) represents a major health-related problem in South Africa and throughout the world. The management goals of diabetes are first to maintain normal blood glucose levels and second to prevent the development of complications. Local guidelines developed by the Society for Endocrine Metabolism and Diabetes South Africa (SEMDSA) have shown that tight glycaemic control and appropriate monitoring can prevent or delay the development of diabetic complications. The demographic profile of patients with type 2 DM and the compliance of doctors to the guidelines were determined.Methods: Five hundred records of patients with type 2 DM were selected from the medical outpatients' department (MOPD) by systematic sampling. Demographic information on age, sex and ethnicity was obtained. The performance and timing of recommended investigations were recorded and compared with the 2012 SEMDSA guidelines.Results: The mean age of patients was 61 years. Black and Indian patients formed the majority, comprising 44.4% and 43.0% respectively. Glycated haemoglobin was measured in 29.2% of patients once and 13.2% of patients twice in the past year.Lipid studies were done on 40.4% of patients. A serum creatinine (sCr), estimated glomerular filtration rate (eGFR) and serum potassium were done on 38.2% of patients. Eyeexaminations were done on 13.60% patients and examination of the foot was done on 7.8% of patients. Some 15% had a urine dipstick test done at least once in the past year and 10.4% had a urine albumin/creatinine ratio (ACR) requested. Only 21 patients (4.2%) were compliant with the SEMDSA guidelines. Measurements of blood pressure and blood glucose were 100% compliant. Anthropometric measurements (height, weight and body mass index), dietitian referral and foot examinations were the least compliant, being performed 4.2%, 5.0% and 7.8% of the time respectively. Conclusion: Black and Indian patients formed the majority of the study population. The screening for chronic complications of type 2 DM was poor in the majority of patients. Evaluation of selected records demonstrated compliance with the SEMDSA guidelines in only 4.2% of patients. There is an urgent need to review barriers to the implementation of guidelines in South Africa