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1.
S Afr Med J ; 107(10): 871-876, 2017 Sep 22.
Article in English | MEDLINE | ID: mdl-29022531

ABSTRACT

BACKGROUND: When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure. OBJECTIVE: To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. METHODS: We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors. RESULTS: Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. CONCLUSIONS: Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.

2.
S. Afr. med. j. (Online) ; 107(10): 871-876, 2017. ilus
Article in English | AIM (Africa) | ID: biblio-1271140

ABSTRACT

Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure.Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors.Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality.Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop


Subject(s)
Antiretroviral Therapy, Highly Active , Retrospective Studies , Sarcoma, Kaposi , South Africa , Survival
4.
S Afr Med J ; 101(11): 840-6, 2011 Nov 01.
Article in English | MEDLINE | ID: mdl-22272968

ABSTRACT

INTRODUCTION: Chronic myeloid leukaemia (CML) is a chronic myeloproliferative disorder characterised by a chromosomal translocation between the long arms of chromosomes 9 and 22 [corrected] resulting in the formation of the BCR-ABL fusion gene. The management of CML has undergone major changes over the past decade. Novel treatment approaches have had a dramatic impact on patient outcomes and survival. Nevertheless, these outcomes can only be achieved in the context of expert management, careful monitoring of disease response, appropriate management of adverse events and timeous adjustments to therapy when responses are not achieved within stated time-frames. AIM: With the advent of novel treatments providing molecular responses, both the monitoring and management of CML have become more complicated. The aim of these recommendations was to provide a pragmatic yet comprehensive roadmap to negotiate these complexities. METHODS: Recommendations were developed based on local expert opinion from both the academic and private medical care arenas after careful review of the relevant literature and taking into account the most widely used international guidelines. About five meetings were held at which these recommendations were discussed and debated in detail. RESULTS: A comprehensive set of recommendations was compiled with an emphasis on diagnosis, investigation, treatment and monitoring of disease. Careful attention was given to circumstances unique to South Africa, funding constraints, availability and access to laboratory resources, as well as the effects of concurrent HIV infection. CONCLUSION: Most patients with CML can live a reasonably normal life if their disease is appropriately managed. These recommendations should be of value to all specialists involved in the treatment of haematological disorders.


Subject(s)
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Adult , Benzamides , Comorbidity , Dasatinib , Disease Management , HIV Infections/epidemiology , Humans , Imatinib Mesylate , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology , Piperazines/administration & dosage , Piperazines/therapeutic use , Protein Kinase Inhibitors/administration & dosage , Protein Kinase Inhibitors/therapeutic use , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyrimidines/administration & dosage , Pyrimidines/therapeutic use , South Africa , Thiazoles/administration & dosage , Thiazoles/therapeutic use , Treatment Outcome
5.
S Afr Med J ; 101(12): 900-6, 2011 Nov 28.
Article in English | MEDLINE | ID: mdl-22273034

ABSTRACT

INTRODUCTION: Myelodysplastic syndromes (MDS) encompass a heterogeneous group of clonal haematopoietic disorders characterised by chronic and progressive cytopenias resulting from ineffective haematopoiesis. Treatment is complicated by differences in disease mechanisms in different subgroups, variable clinical phenotypes and risk of progression to acute myeloid leukaemia. RATIONALE: Changes in disease classification, prognostic scoring systems, the availability of novel treatment options and the absence of South African guidelines for the diagnosis and management of these complex disorders underpinned the need for the development of these recommendations. METHODS: These recommendations are based on the opinion of a number of experts in the field from the laboratory as well as clinical settings and came from both the private and institutional academic environments. The most recent literature as well as available guidelines from other countries were discussed and debated at a number of different meetings held over a 2-year period. RESULTS: A comprehensive set of recommendations was developed focusing on risk stratification, supportive management and specific treatment. Novel agents and their indications are discussed and recommendations are made based on best available evidence and taking into account the availability of treatments in South Africa. CONCLUSION: Correct diagnosis, risk stratification and appropriate therapeutic choices are the cornerstones of success in the management of patients with myelodysplastic syndromes.


Subject(s)
Myelodysplastic Syndromes/therapy , Practice Guidelines as Topic , Algorithms , Anemia/therapy , Disease Progression , Ferritins/blood , Hematinics/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Iron Chelating Agents/therapeutic use , Myelodysplastic Syndromes/blood , Myelodysplastic Syndromes/classification , Prognosis , Risk Assessment , South Africa
6.
Leuk Lymphoma ; 13(3-4): 353-6, 1994 Apr.
Article in English | MEDLINE | ID: mdl-8049655

ABSTRACT

Acute promyelocytic leukaemia (APL) (FAB-M3) is associated with fatal haemorrhagic complications in 10 to 20% of patients. Recently ALL-Trans Retinoic acid (ALL-Trans RA) therapy has been used with rapid correction of the coagulopathy. Although minimal haematologic toxicity has been reported, a number of potentially serious side-effect have been described. We report a case of bone marrow necrosis occurring in a patient with APL treated with ALL-Trans RA. The possible relationship of this complication to retinoid therapy is discussed. This patient subsequently recovered and not only achieved complete remission but tolerated two cycles of chemotherapy without problems.


Subject(s)
Bone Marrow/pathology , Immunologic Factors/adverse effects , Leukemia, Promyelocytic, Acute/complications , Tretinoin/adverse effects , Female , Humans , Immunologic Factors/therapeutic use , Leukemia, Promyelocytic, Acute/drug therapy , Leukemia, Promyelocytic, Acute/pathology , Leukemia, Promyelocytic, Acute/therapy , Leukocyte Count , Leukocytosis/chemically induced , Middle Aged , Mitoxantrone/therapeutic use , Necrosis , Pain/etiology , Prednisone/therapeutic use , Remission Induction , Tretinoin/therapeutic use
7.
S Afr Med J ; 61(15): 554, 1982 Apr 10.
Article in English | MEDLINE | ID: mdl-7064041

ABSTRACT

Thyrotoxicosis may manifest with dysphagia. The case of an elderly male with dysphagia as the initial symptom is discussed. It is suggested that thyrotoxicosis is included in the differential diagnosis of dysphagia in the elderly, particularly if muscle weakness is also present.


Subject(s)
Deglutition Disorders/etiology , Hyperthyroidism/complications , Aged , Deglutition Disorders/diagnosis , Diagnosis, Differential , Humans , Hyperthyroidism/diagnosis , Male
9.
Eur J Intensive Care Med ; 2(3): 139-41, 1976 Nov.
Article in English | MEDLINE | ID: mdl-991868

ABSTRACT

A case of fulminant bacteroides plus anaerobic streptococcus bacteraemia is reported. Therapy included the use of extracorporeal membrane oxygenation for the resultant acute respiratory failure. The problem of bacteroides infections is reviewed.


Subject(s)
Bacteroides Infections/therapy , Oxygenators, Membrane , Sepsis/therapy , Bacteroides Infections/complications , Humans , Male , Middle Aged , Streptococcal Infections/complications , Streptococcal Infections/therapy
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