Subject(s)
Physicians/supply & distribution , Private Sector , Emigration and Immigration , Humans , Public Sector , South AfricaABSTRACT
Patients who suffer acute myocardial infarction are heterogeneous and prognosis differs widely. High-risk patients are likely to derive the greatest benefit from treatment in an intensive care unit and from early thrombolytic therapy. A study was undertaken to determine those clinical parameters, available on admission to hospital, which would predict early death (within the first 30 days) and in this way to define high-risk patients. From July 1985 to December 1987, 233 patients admitted to J. G. Strijdom Hospital with acute myocardial infarction were prospectively evaluated. A total of 30 variables, including clinical, ECG and biochemical parameters, were recorded for each patient on admission. During the study period 36 patients (15.5%) died. The following variables were significantly associated with early mortality: age, Killip class, infarct location, height of ST-segment elevation and raised blood urea level. Using data readily available on admission to hospital, patients at highest risk of early death can be identified.
Subject(s)
Myocardial Infarction/mortality , Age Factors , Coronary Care Units , Electrocardiography , Humans , Patient Admission , Prognosis , Prospective Studies , Triage , Urea/bloodABSTRACT
During the period 11 November 1985 - 21 February 1986, 12 cases of Legionnaires' disease were identified at a Johannesburg teaching hospital. Only 2 patients definitely acquired the disease in hospital. Both responded well to treatment. An epidemiological investigation was initiated to determine the source of infection and mode of transmission of the causative agent (Legionella pneumophila), which may be recovered from a wide variety of water sources. Although L. pneumophila was cultured from the hospital hot-water system, there was no association between the location of patients and culture-positive water sites. Cases were clustered in the medical and surgical intensive care units. Being on a ventilator was a significant risk factor for acquiring Legionnaires' disease (relative risk 18,4; 95% confidence interval 2,4 - 142,2). The potential role of ventilators in the transmission of the disease is discussed together with the infection control measures adopted to interrupt the outbreak. To our knowledge this is the first investigation of an outbreak of Legionnaires' disease in South Africa.
