Patient blood management: A solution for South Africa.

For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.

A retrospective study of human immunodeficiency virus infection and drug-resistant tuberculosis in Durban, South Africa.

SETTING: King George V hospital, a specialist referral hospital for tuberculosis (TB) patients in Durban, South Africa. OBJECTIVE: To investigate the relationship between drug-resistant TB and human immunodeficiency virus (HIV) infection. DESIGN: Retrospective descriptive study of 295 patient records, for the period January 1991 to April 1994, which were reviewed to collect data on HIV status, drug susceptibility and outcome as well as age, race, gender and previous TB treatment. RESULTS: Overall, 42 patients (14.2%) were HIV-seropositive while the rate of multidrug-resistant TB (MDR-TB) was 10.2%. Of those previously treated, 6.1% were HIV-seropositive while of those with no known history of previous TB, 5.4% were HIV-seropositive. A history of previous antituberculosis treatment was the strongest predictor for the presence of organisms resistant (Odds Ratio = 3.1; P = 0.0016) to one or more of the antituberculosis drugs. The prevalence of HIV infection was 13.1% in patients with drug-resistant TB and 14.9% in patients with drug-sensitive TB. CONCLUSION: The HIV epidemic has not exacerbated the occurrence of drug-resistant TB. History of previous TB treatment, and not HIV infection, was the principal factor associated with TB which is resistant to at least one primary anti-TB drug. However, as the HIV epidemic progresses in a milieu of high TB prevalence, the link with drug-resistant TB warrants constant monitoring and investigation.

Morphometric analysis of the renal veins.

BACKGROUND: Although the vascularisation of the kidney has been the topic of repeated anatomical investigations, statistical analyses, and descriptions, it is surprising to find that there is no unanimity in the literature regarding its detailed morphometry. This information acquires special surgical significance, e.g., in renal transplantation and "shunt" surgery. The purpose of this study was to detail the measurements of the left and right renal veins in morphologically normal kidneys. METHODS: This study detailed the measurements of the renal veins in 100 pairs of morphologically normal cadaveric kidneys. Resin casts of the venous system were prepared and various segments of the renal veins were measured. RESULTS: The lengths and diameters of the renal veins were:-left: 5.9 +/- 1.5 cm and 1.2 +/- 0.2 cm and right: 2.4 +/- 0.7 cm and 1.2 +/- 0.2 cm, respectively. The left renal vein comprised a proximal segment (length: 2.6 cm; diameter: 1.1 cm) and a distal segment (length: 3.2 cm; diameter: 1.2 cm). CONCLUSIONS: This morphometric analysis of the renal veins, which corroborates and augments previous anatomical studies, has embryological and surgical significance.

Additional renal veins: incidence and morphometry.

Modern surgical and radiological techniques dictate a reappraisal and definition of the renal venous anatomy. The purpose of this study was to investigate the incidence and morphometry of additional renal veins. One hundred fifty-three morphologically normal en bloc renal specimens were randomly selected from post-mortem examinations. Single additional renal veins were common on the right side (26%), while it was rare on the left side (2.6%). Second additional renal veins occurred infrequently on the right side (5%). Since additional renal veins may be encountered more than occasionally, it is worthwhile emphasizing their presence particularly to the transplant surgeon and the angiologist.

Levels of catecholamine in plasma and cerebrospinal fluid in aneurysmal subarachnoid hemorrhage.

Despite intensive investigation into the cause of cerebral vasospasm (focal ischemic deficit) after subarachnoid hemorrhage, the morbidity and mortality associated with this condition remain high. Various studies have shown levels of catecholamine in plasma and cerebrospinal fluid (CSF) to be increased in subarachnoid hemorrhage, and it is possible that these vasoactive substances play an important role in the subsequent vasospasm. In an attempt to elucidate this possibility, the study presented here was undertaken to investigate the relationship between catecholamine levels in plasma and CSF and focal ischemic deficit (FID); the rupture of aneurysms on blood vessels supplying the hypothalamus as compared with the rupture of aneurysms on blood vessels supplying other areas of the brain; and the clinical outcome of the patients. Concentrations of adrenaline and noradrenaline in plasma and CSF samples obtained from 21 patients who had suffered aneurysmal subarachnoid hemorrhage were determined by a radioenzymatic technique. Significantly higher levels of adrenaline were found at the time of surgery in the CSF of patients with FID. A similar trend, though not statistically significant, was also observed for plasma. Patients with a rupture of aneurysms on blood vessels supplying the hypothalamus showed a tendency towards higher catecholamine levels in plasma and CSF. Subjects with a bad clinical outcome (i.e., those who were severely disabled or had died) had significantly higher levels of catecholamine in plasma than did those with a good clinical outcome (i.e., those with moderate or no disability). Further detailed analysis of the interrelationships showed that, within the group of patients with FID, those with rupture of aneurysms on blood vessels supplying the hypothalamus had significantly higher catecholamine levels in plasma than did those with rupture of aneurysms on other cerebral vessels. Furthermore, in the group of patients with rupture of aneurysms on blood vessels supplying the hypothalamus, those with a bad clinical outcome had significantly higher catecholamine levels in plasma than did those with a good clinical outcome. These findings lend support to the possibility that damage to the hypothalamus and subsequent elevations in catecholamine levels may be associated with FID and poor clinical outcome.

The theophylline content of bronchodilator preparations on the South African market.

The availability of over 40 different theophylline-containing preparations on the South African market poses a therapeutic dilemma when a change in bronchodilator becomes necessary, or when a patient on theophylline therapy self-medicates with an over-the-counter theophylline-containing cough medicine. This occurs because of the lack of uniformity in stating the theophylline content on the label. For example, a change in a patient's prescription from Choledyl 200 mg (200 mg oxtriphylline equivalent to 127.2 mg anhydrous theophylline) to Theodur 200 mg (200 mg anhydrous theophylline) will result in an increase in theophylline dose of over 56%. This potential for toxicity is not apparent because the label indicates the mass of the 'salt' rather than the anhydrous theophylline content. A table of currently available theophylline containing preparations on the South African market is presented.