The prevalence of HIV associated oral lesions among adults in the era of HAART.

INTRODUCTION: The overall prevalence of HIV associated oral lesions among adults has decreased since the advent of highly active anti-retroviral therapy (HAART). AIMS AND OBJECTIVES: This study describes the prevalence and types of oral mucosal lesions in adults, who accepted a dedicated oral and dental programme for HIV-infected patients. The incidence of oral lesions and the CD4 cell counts on those patients, were related to cases receiving HAART and to those who were not. DESIGN: This was a retrospective, descriptive cross-sectional study. METHODS: Patients were interviewed, using a structured questionnaire to obtain information regarding medical history, current medications and demographic details. Data relating to CD4 cell counts were extracted from clinical medical records of the patent. In each case, the oral cavity of the sitting patient was examined under artificial light, by a clinician using a mouth mirror. Oral lesions were categorised in accordance with EC-Clearinghouse diagnostic criteria. RESULTS: The prevalence of HIV-associated oral lesions was significantly reduced (p < 0.001) in patients receiving HAART. There was, however, no significant difference (p = 0.29) in mean CD4 counts between patients receiving HAART and those not receiving HAART. The presence of oral lesions was statistically significantly, associated with both CD4 counts of < 200 cells/mm3 (p < 0.001) and the absence of HAART (p = 0.033). CONCLUSIONS: The study confirmed that the incidence of oral lesions and of pseudo-membranous candidiasis in particular, were statistically significantly reduced in patients receiving HAART.

Incidence of Adverse Drug Reactions in Patients on Antiretroviral Therapy: A study of Pharmaceutical Care in HIV Interventions in Nigeria

Background: Over 415;000 HIV-infected patients are receiving antiretroviral therapy (ART) in Nigeria but studies documenting their adverse reactions are limited. Objectives: This study determined the incidence and type of ADRs of severity grades II to IV in ART patients following pharmaceutical care directed active ADR surveillance program in Nigeria. Methods: This was a longitudinal study. A study-specific pharmaceutical care daily work sheet and national ADR reporting form were used for ADR screening and reporting respectively. Study population included 73;589 ART patients who were screened for ADR from April 2009 to December 2010 in 69 HIV treatment centres. All individual case safety reports (ICSRs) of severity grades II to IV in these patients were collated and analyzed. Chi-square was used to test the association between groups of variables at 95 Confidence Interval. Results: A total of 4600 ICSRs of severity grades II to IV reported were analyzed. Mean age of patients was 35.5(95CI; 35.2-35.9) years; 68.1 were females; and 7002 ADRs were reported; an average of 1.5 ADR perpatient. ADR incidences were 18.2 for d4T/3TC/EFV; 13.9 for d4T/3TC/NVP; and 4.4 for AZT/3TC/NV Pregimens; however overall incidence was 6.3. Major reported ADRs included skin rash (16.5); peripheral neuropathy (12.7); and headache (9.4). ADR occurrence was associated with specific ART regimens; concomitant medicines and age groups (p0.05); unlike gender. Lipodystrophy was associated withd4T/3TC/NVP [OR

Adherence to Antiretroviral Therapy; Virologic Failure and Workload at the Rustenburg Provincial Hospital

Background: Adherence to antiretroviral therapy (ART) is a strong predictor of progression to AIDS and death. It remainsthe most important potentially alterable factor that determines treatment outcomes.Methods: The study is a cross-sectional survey of self-reported adherence to ART and associated factors. It included arandomly selected sample of 100 adult patients who began ART between June 2006 and December 2007. A modified Adult AIDS Clinical Trials Group questionnaire was used. The analysis compared self-reported adherence levels by factor and viral load test results. Results: Only 71of patients had an adherence 95. Poor adherence was related to changes in daily routines (being away from home [21] and busy with other things [17]). All patients with symptoms suggestive of clinical depression had virologic failure. More unemployed patients (50.7) had virologic failure than did employed patients (40) (p = 0.05). The clinic had a tenfold increase in patient enrolment and a ninefold decline in staff-to-patient ratio; and the proportion of patients lost to follow-up doubled in the preceding four years. Conclusion: Adherence to ART was poor. The capacity of the clinic to manage patients adequately has declined significantly. Decentralisation of ART services to primary health care facilities should be considered

Adherence to Antiretroviral Therapy; Virologic Failure and Workload at the Rustenburg Provincial Hospital

Background: Adherence to antiretroviral therapy (ART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcomes. Methods: The study is a cross-sectional survey of self-reported adherence to ART and associated factors. It included a randomly selected sample of 100 adult patients who began ART between June 2006 and December 2007. A modified Adult AIDS Clinical Trials Group questionnaire was used. The analysis compared self-reported adherence levels by factor and viral load test results. Results: Only 71of patients had an adherence 95. Poor adherence was related to changes in daily routines (being away from home [21] and busy with other things [17]). All patients with symptoms suggestive of clinical depression had virologic failure. More unemployed patients (50.7) had virologic failure than did employed patients (40) (p = 0.05). The clinic had a tenfold increase in patient enrolment and a ninefold decline in staff-to-patient ratio; and the proportion of patients lost to follow-up doubled in the preceding four years. Conclusion: Adherence to ART was poor. The capacity of the clinic to manage patients adequately has declined significantly. Decentralisation of ART services to primary health care facilities should be considered

Sexually transmitted infections -- factors associated with quality of care among private general practitioners.

OBJECTIVES: To study the factors associated with quality of sexually transmitted infection (STI) care among private general practitioners in Gauteng. METHODS: We analysed 1 194 records of patients attending 26 randomly selected GP practices in the first 3 months of 2000 and 2002, for 3 STI syndromes, namely urethral discharge, pelvic inflammatory disease and genital ulcers. We assessed adherence to nationally accepted STI treatment guidelines and analysed the influence of patient and practice-level variables on effectiveness of STI drug regimens and trends over time. RESULTS: After controlling for syndrome mix, district and time period, appropriate drug treatment for STIs was significantly associated with the client having medical aid (p < 0.001), recent graduation as a medical practitioner (p < 0.001) and male GP gender (p = 0.007). Between 2000 and 2002, STI care improved for clients with medical aids but for not cash clients. CONCLUSIONS: There was variation in the quality of prescribing for STIs among GPs and positive trends in this prescribing. There is a need for interventions that address the financial incentives that may hamper quality of STI care for cash clients.

Improving the quality of STI care by private general practitioners: a South African case study.

OBJECTIVES: Evaluation of an intervention to improve quality of sexually transmitted infections (STI) care among 64 private general practitioners (GPs) working in two urban districts in Gauteng Province, South Africa. METHODS: We implemented a multifaceted intervention, the core of which were four interactive continuing medical education seminars. Changes in STI treatment practices were evaluated through record reviews before and after the continuing medical education intervention in 17 randomly selected practices in the intervention districts and in nine randomly selected practices from a reference GP group (n = 34). RESULTS: There were statistically significant improvements in the quality of drug treatment for urethral discharge but not pelvic inflammatory disease among both intervention and reference GPs. CONCLUSIONS: Improvements in STI quality were possibly the result of a background secular trend rather than the intervention itself. Further research is needed on financial and other incentives to improved quality of STI care in the private sector environment.

Impaired tooth eruption: a review.

Eruption is the continuous process of movement of a tooth from its developmental location inside the jaw to its functional location in the mouth. Impaired tooth eruption, where this process is disturbed, is common in dental practice. It may manifest either as delayed or complete absence of eruption. Although unerupted teeth are usually asymptomatic, they may cause cosmetic and pathologic complications. The purpose of this article is to provide a review on the pathogenesis and differential radiographic interpretation of impaired tooth eruption.

Digital radiography: update for oral health care workers.

Digital Radiography is an imaging system that does away with the use of films. It constitutes an advance in computer technology and has made a significant impact on the field of Maxillofacial- and Dental Radiology. This paper presents an overview of the basic concepts and applications of dental digital radiography and compares it with conventional film-based imaging. In addition, it provides a thorough understanding of the direct, semi-direct and indirect dental digital imaging systems with their advantages and disadvantages. Universal acceptance of digital radiographic imaging as a diagnostic tool makes it important for oral health care workers to understand the principles thereof and to master the techniques involved in acquiring a diagnosable digital radiographic image.

The procedural skills of rural hospital doctors.

OBJECTIVES: To describe the spectrum of procedures performed by general medical officers in South African rural hospitals, and the attitudinal issues associated with these tasks. DESIGN: A descriptive study combining quantitative and qualitative methods: a quantitative audit of operating theatre records of 15 rural hospitals in KwaZulu-Natal and 4 rural hospitals in Northern Province, and a qualitative analysis of 8 focus group discussions in which rural hospital doctors discussed their procedural work. OUTCOME MEASURES: Quantitative results included patient age, type of anaesthetic, type of procedure, and whether a separate anaesthetist was present or not for each recorded procedure performed in the operating theatre. Qualitative results comprised major and minor themes that arose from the focus group discussions. RESULTS: Quantitative results revealed a high proportion of obstetric and general surgical procedures, often performed by a single doctor acting as anaesthetist as well as surgeon. The range of surgical procedures undertaken varied widely between hospitals. Anaesthetic usage patterns revealed extensive use of ketamine and spinal anaesthetics, with relatively more general anaesthetics being administered in the Northern Province. Qualitative results revealed two scenarios in the rural hospital situation: one where doctors felt that they were coping and learning from the work under the supervision of peers or senior colleagues, and the other where they felt stressed by being alone and having to deal with emergencies, especially when short-staffed. CONCLUSIONS: The broad range of skills demanded in rural hospital practice requires specific preparation and ongoing support. Without it, a vicious cycle is established leading to poor output and morale. The phenomenon of the single-handed anaesthetist-surgeon that emerged from this study deserves specific attention, particularly with regard to staff shortages in rural areas. Under circumstances of adequate staffing and support, the rural hospital is an ideal learning site for generalists. This study has significant implications for the proposed introduction of obligatory vocational training for all medical graduates.