Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Background. Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions.Objectives. To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. Methods. We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups.Results. During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165).Conclusions. In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease

'Pain and stress are part of my profession': Using dental practitioners' views of occupation-related factors to inform dental training

Background. Stress is prevalent among dental workers and students. A possible means to address this would be to include stress management programmes in undergraduate dental programmes. The purpose of this study was to establish how the current cohort of dental practitioners incorporate occupational health and self-care principles into professional practice, and their potential relevance to future curriculum design.Objectives. To gain input from participants regarding stress and burnout ­ their causes, implications and prevention ­ as linked to their practice in dentistry.Methods. A qualitative research design was used, with a purposive sampling technique. The study population consisted of dentists, dental therapists, hygienists and specialists. A total of 36 participants participated in four focus-group discussions to explore dental education, occupational health, stress and self-care. The data were thematically analysed.Results. Dental training in the South African context, occupational health experiences, self-care, coping strategies and education were the main themes that emerged. Dental services in the public sector were reported to be overwhelmed by high patient volumes and shortages of staff and resources, which added to these stressors. The coping strategies adopted were exercise, stretching, reducing workload and encouraging teamwork. The participants believed that the causes of musculoskeletal disorders, and their impact, should be taught in dental training, as students do not perceive this as a potential problem. A multidisciplinary approach and teamwork training are the recommendations for curricula.Conclusion. Stress management techniques and workplace posture assessment should be taught in preclinical training to make students aware of managing stress and correct working postures. A multidisciplinary approach should be used. Dental curricula should include occupational health safety principles

Evaluation of locally manufactured patient-specific custom made implants for cranial defects using a silicone mould

Background: Cranial vault defects can pose a significant problem for neurosurgeons where autologous bone is no longer available for cranioplasty. Numerous materials exist to create implants which include polymethyl methacrylate (PMMA) and titanium. A technique using 3-dimensional CT scan reconstruction of a cranial defect and creating a silicon mould which can be autoclaved in theatre to create a PMMA implant was developed. Objectives: The aim of this study is to evaluate the efficacy, cosmetic result, safety and cost-effectiveness of this procedure and compare this to existing techniques.Methods: An ambispective study was performed in patients requiring cranioplasty with a custom made implant. Patients were assessed for risk factors and cosmetic outcome, surgical technique was described and complications and cost compared to existing literature between 2010 and 2016.Results: Thirty retrospective and 30 consecutive prospective patients were recruited into the study. Overall sepsis rate was 8.3%. All septic cases had superficial sepsis of which 2 grafts were removed due to cerebrospinal fluid leakage resulting in wound breakdown. A 100% accurate implant to defect ratio was achieved leading to a high satisfaction rate. Average cost was 5 times cheaper than the closest market related product.Conclusion: Patient specific moulds using PMMA to create custom implants are safe, have excellent cosmetic results and are a very cost-effective option to manage cranial defects. Accurate planning strategies for large craniotomies, where bone will potentially be discarded, add to surgical effectiveness and cost-saving to the patient

Tympanoplasty surgery: a retrospective audit of surgical outcomes at a regional hospital

Background: Chronic Suppurative Otitis Media (CSOM) is a common condition in our setting, resulting in tympanoplasty surgery being one of the common surgical procedures performed. Little is published regarding outcomes of tympanoplasty surgery in patients living with Human Immunodeficiency Virus (HIV), which has a high prevalence in South Africa.Aims:To audit the outcomes of tympanoplasty surgeries performed, including outcomes in patients with HIV.Methods:A retrospective review of all tympanoplasty surgeries performed at our institute. Outcomes of surgery according to patient demographics, documented HIV status, seniority of surgeon, type and techniques of graft placement and hearing outcomes were reviewed.Results:Successful closure of perforations was 84.4%. Closure rates in the 10 patients known to be HIV positive were 100%. The number of patients meeting the criteria for The Belfast Rule of Thumb (BROT) increased from 26.3% (n = 20) preoperatively to 68.4% (n = 52) postoperatively.Conclusions:The results are comparable to both the results obtained at a tertiary hospital and those published internationally. Successful outcomes are obtainable in patients infected with HIV; however, as to the optimal timing of this surgery, this would require further investigation

Dust Exposure; Respiratory Symptoms and Disease among Informal Quarry Workers in Lusaka Province; Zambia

Background: Research into dust exposure and respiratory outcomes in quarry workers has not been extensively conducted in Zambia. Methods: This study determined total and respirable dust levels associated with respiratory symptoms and disease among Zambian informal quarry workers. A cross-sectional study in 2013 among quarry workers (n=400) used an adapted American Thoracic Society respiratory health questionnaire. Area gravimetric dust samplers assessed dust levels. Multivariate models tested for associations between demographics; dust levels; smoking; occupational history and respiratory symptoms and disease. Results: Doctor-diagnosed respiratory disease ranged from 22.2 (bronchitis) to 5.0 (pneumonia); respiratory symptoms ranged from 22.5 (cough) to 8.5 (breathlessness). Dust exposure for ? 6.7 years and exposure to a cumulative total dust concentration of ? 36.7 mg-yrs/m3 were associated with having phlegm and coughing for three or more months; respectively. Conclusion: Dust exposure and respiratory symptoms in this population indicate a need for dust control to prevent disease

An Evaluation of the Triage Early Warning Score in an Urban Accident and Emergency Department in KwaZulu-Natal

Objective: Triage is an essential first step in the efficient and effective running of any emergency department. A good triage tool saves lives and reduces mortality. The Triage Early Warning Score (TEWS) is a useful tool used to identify patients in emergency departments who are at risk of deterioration and who may require admission. As this triage tool has only been evaluated to a limited extent; this study assessed its effectiveness in identifying patients at risk of early deterioration to enable timely medical intervention.Design and setting: This was a retrospective study of medical records within the accident and emergency department of an urban public hospital. Outcome measures: The calculated TEWS was compared to one of four possible outcomes viz. discharge within 24 hours; admission to the ward; admission to the intensive care unit (ICU); or death in hospital. Pearson's chi-squared tests and cross-tabulation was used to determine the statistical significance of the association. Results: Of the 265 patient records analysed; 233 (87.9) had a TEWS of 7. Of patients with a TEWS of 7; 53.7were discharged; compared to 18.7with a score ? 7; who were discharged. The average score of the four patients who died was 9.5; and 8.2 for the three admitted to ICU. Higher TEWS were significantly associated with increased admission to hospital and in-hospital deaths (p-value 0.032). Conclusion: An effective triage scoring system ensures that those requiring emergency care are appropriately categorised. Prompt intervention will either reverse further physiological decline or facilitate timely referral to the appropriate service level; including ICU

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71of the patients' medical charts that were reviewed; however; only 34were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain.Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Adequacy of Pain Management in HIV-Positive Patients

"Background: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence; severity; recognition and management of pain in adult patients with HIV infection in a South African hospital setting. Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive; consenting HIV positive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain; pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life. Results: Ninety-one per cent of participants reported pain with 83 experiencing significant pain; in other words a ""worst pain"" rating of five or above on the BPI (short form) questionnaire. The correlation analysis between the severity of pain and its interference with daily life suggests that moderate and severe pain interferes with the patients' daily functioning. Pain was documented on 71 of the patients' medical charts that were reviewed; however; only 34 were considered to be adequately managed for their pain. Conclusion: Pain prevalence is high in the sample. While pain was recognised and noted in the majority of patients' medical records; the management of pain was considered to be inadequate in a third of those experiencing pain."

Dog Bites to the Head; Neck and Face in Children

Dog bites are a poorly understood and complex public health problem. Children are most frequently the victims of dog bites and the face is often the favoured target. A review of dog bite wounds in small children presenting to the Red Cross War Memorial Children's Hospital was carried out over a period of 13.5 years (1991-2004). One thousand eight hundred and seventy-one dog bite wounds were admitted from a total of 125;677 patients treated. From 1;871 patients presenting with dog bite injuries; we identified 596 children who sustained injuries to the head; face or neck. Dog bites to the head; face or neck were responsible for 0.5of all trauma unit presentations and 32of all dog bite injuries. The mean age of the children was 5.1 years. Male children accounted for 68of the patients. The peak incidence was noted in children aged 2 to 4 years old. One hundred and seventy-two (29) bites occurred between the summer months of December and February. Two hundred and forty-nine (42) patients presented to hospital between the hours of 12:00 and 18:00 hours and 275 (46) children presented between 18:00 and 0:00 hours. A large proportion of all attacks occurred either inside or outside the victim's own home and at the home of friends or family. Superficial injuries were treated with wound cleaning; suturing and dressing. There were no fatalities. Dog bites are relatively common in small children; but do not represent a major cause of morbidity and mortality

The Prevalence and Health Implications of Violence in Impoverished Communities in Johannesburg

The experience of violent crime can have a significant impact on the physical and psychological well-being of victims and their families. This paper looks at household experience of violence in five impoverished sites in the city of Johannesburg; South Africa. Five sites were purposefully selected to reflect the prevailing housing profiles in settings of relative impoverishment in Johannesburg. A structured questionnaire was used to obtain information on demographic profiles; socioeconomic data; environmental conditions and health status. Bivariate analyses were conducted to assess the relationship between household experience of violence; and potential risk factors and health/social outcomes. Overall; members of 28of households had been a victim of violence in the year preceding the study. Across sites; experience of violence within households ranged from 21to 36. Perceptions of drug abuse (p=0.01) and drug peddling (p=0.03) as being major problems in the neighbourhood; and living in a house of poor quality (p=0.01); were significantly associated with household experience of crime. In households with experience of violence; fear of crime (p=0.03) and depression (p 0.001) were elevated; and levels of exercise in men were decreased (p

Access to oral health care and treatment needs of HIV positive paediatric patients / Acesso aos serviços de saúde bucal e necessidade de tratamento de pacientes infantis

Objective: An assessment of the oral manifestations, oral health status and treatment needs of paediatric patients with HIV infection. Method: This is a descriptive study of 55 patients presenting at the special paediatric clinic of the Lagos University Teaching Hospital. A pre-tested questionnaire was used to determine oral health status and treatment needs. Results: Fifty five children made up of 29 (52.7%) males and 26 (47.3%) females were examined. Age range was 6 months to 16 years. Over two-thirds (69.1%) of the children had good oral hygiene. Fourteen (25.5%) had gingivitis. Dental caries was seen in about a third, 17 (30.9%). The most common mucosal lesion was candidiasis. Most of the patient would benefit from oral health counseling. However over a third, 38.2% would require restorative treatment. Conclusion: Paediatric dentists should collaborate with health professionals for effective management of these patients.

Objetivo: Avaliar as manifestações orais, o estado de saúde bucal e as necessidades de tratamento de pacientes infantis com HIV. Método: Trata-se de um estudo descritivo de 55 pacientes atendidos na clínica infantil do Hospital Escola da Universidade de Lagos. Um questionário pré-testado foi utilizado para determinar o status de saúde oral e as necessidades de tratamento. Resultados: Vinte e nove crianças eram meninos (52,7%) e 26 (47,3%) eram meninas. A idade variou de 6 meses a 16 anos. Mais de dois terços [69,1%] das crianças possuíam uma boa higiene oral. Catorze crianças (25,5%) tinham gengivite, enquanto 17 apresentavam lesões de cárie dentária (30,9%). A lesão mais comumente encontrada foi a candidíase. A maioria dos pacientes poderiam se beneficiar de orientação de saúde bucal. Entretanto, mais de um terço, 38,2% necessitavam de tratamento restaurador. Conclusão: Odontopediatras devem contribuir com os demais profissionais de saúde para o efetivo manejo destes pacientes.

Self-perceived and unmet general health need among PLWHA in Nigeria

Objective: This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population. Methods: A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex; Ile-Ife and General Hospital; Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medica- tion; Dental; Mental; Home care; Hospital admission; access to antiretroviral therapy and emergency services. Results: One or more unmet needs were reported by 79.4of the sample. Needs for medication; home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p0.05). Conclusions: Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs

Fracture Patterns in Non-Accidentally Injured Children at the Red Cross Children's Hospital

Background: Unexplained fractures in infants and children often suggest abuse. The fracture patterns with high specificity for abuse are well documented; however; in practice these patterns occur infrequently and abused children may present with a wide spectrum of bony injuries. The Child Accident Prevention Foundation of South Africa (CAPFSA) keeps a database of children treated at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town. Methods: The medical records of all children admitted between January 1991 and October 2005 were reviewed and children with fractures resulting from non-accidental injury (NAI) were included in the study. Results: During the 14-year study period; 99586 trauma patients were treated at RXH; of which 1037 (1.04) were diagnosed with non-accidental injury. The majority was male (64). An the average age was 44.8 months. Of the 1037 patients diagnosed with NAI; 121 (11.7) sustained a total of 149 fractures; 21 (17.3) with multiple fractures (16 had 2 fractures; 3 had 3 fractures and 2 had 4 fractures). The head and neck was the most frequently fractured anatomical area (53); followed by the upper limb (24) and lower limb (18). Only 7 fractures of the trunk were seen. Children sustaining fractures of the head and neck were significantly younger than those sustaining fractures to other areas. Discussion: Although the established consensus on fracture patterns in NAI is that long bone fractures are the most frequently experienced in clinical practice; the principal finding of our study was that skull fractures were considerably more common; nearly 40of all fractures were skull fractures. Skull fractures were associated with violent injury; approximately one-third were reported to have been inflicted with an implement/weapon and one-quarter of these children had multiple fractures at the time of presentation. This underlines the importance of local studies; as socio-cultural issues underpin many of the aetiological factors related to disease burden in general; and to child abuse in particular

How Successful is South Africa in Decreasing Communicable Diseases?

The success of the public health sanitation movement included the use of vaccines; and antibiotics led many to assume that all infectious diseases would sooner or later succumb to medical technology and public health measures. Unfortunately this did not happen. Late in the 20th century and now early in the 21st century we see the onset of new communicable diseases such as HIV/ AIDS and severe acute respiratory syndrome (SARS) and the resurgence of old communicable diseases such as tuberculosis (TB) and malaria. The persistence of measles as a major killer of over one million children per year represents a failure in effective use of both the vaccines and the health systems in developing countries. Nowhere else can we see these problems better than in our own backyard

Ethics in occupational health research in South Africa

Occupational health research encompasses the same ethical issues that apply to all research on human subjects; together with unique challenges related to the workplace setting. This article covers the main principles of research ethics relating to the occupational environment; illustrated by the authors' experiences related to ethical challenges in conducting occupational research; and reports an analysis of submissions made to the Research Ethics Committee of the University of the Witwatersrand during the period 2004 to 2006 and some lessons learnt in that regard. It also provides an overview of the international and national ethical guidelines pertinent to occupational health research with a view to assisting researchers in doing ethically acceptable research