Performance of the South African triage score among HIV positive individuals presenting to an emergency department.

Introduction: Over a quarter of patients presenting to South African Emergency Centres (EC) have concurrent human immunodeficiency virus (HIV), yet it is unclear how this impacts their presenting complaints, the severity of illness, and overall resource needs in the EC. The primary objective of this study was to compare the performance of the South African Triage Score (SATS) in people living with HIV (PLWH) compared to HIV-negative patients. Secondary objectives included comparing the presentation characteristics and resource utilisation of these populations. Methods: A prospective cross-sectional observational study was conducted in the Livingstone Hospital EC, Gqeberha, South Africa, to compare triage designation and clinical outcomes in PLWH and HIV-negative patients. In this six-week study, all eligible patients received point-of-care HIV testing and extensive data abstraction, including SATS designation and EC clinical course. Descriptive statistical analysis was completed, and a log-binomial model was used to examine the association between HIV status and clinical outcomes using crude (unadjPR) and adjusted prevalence ratios (adjPR). Results: During the study period, 755 adult patients who consented to a POC HIV test were enrolled, of which 193 (25.6%) were HIV positive. HIV-positive patients were significantly more likely to be admitted compared to their HIV-negative counterparts when triaged as low acuity (adjPR 1.48, 95% CI 1.14-1.92, (p=0.003)). HIV-positive patients were also significantly more likely to receive laboratory testing when triaged as low acuity (adjPR 1.31, 95% CI 1.08-1.59 (p=0.006)) and as high acuity (adjPR 1.38, 95% CI 1.08-1.59 (p=0.034)) compared to HIV negative patients of the same triage categories. Conclusion: In our study, PLWH, compared to HIV-negative patients in the same category, were more likely to be admitted and require more EC resources, thus alluding to possible under triage of HIV-positive patients under the current SATS algorithm.

Post-rewarming Developmental Competence of in vitro Produced Buffalo (Bubalis Bubalis) Embryos Vitrified Using the Solid Surface Technique.

BACKGROUND: Vitrification is an ultra-rapid freezing technique for germplasm preservation under high salt concentration with very short exposure time. OBJECTIVE: To assess the post-thawed developmental potential of in vitro-produced buffalo embryos vitrified by solid surface technique using different concentrations of cryoprotectants. MATERIALS AND METHODS: The slaughterhouse derived oocytes were in vitro matured and fertilized with epididymal sperm. IVF embryos at the morula stage were vitrified under two protocols; (i) Protocol-1: ethylene glycol (35%) (ii) Protocol-2: ethylene glycol (15%) and dimethyl sulfoxide (15%). The vitrified-thawed embryos were in vitro cultured up to the blastocyst stage. RESULTS: Post-thawed development of embryos vitrified under Protocol-1 was significantly higher in terms of compact morula formation as compared to Protocol-2. However, blastocyst developmental rates were not significantly different between the two protocols. The developmental rates of the non-vitrified control were significantly higher than embryos vitrified by either protocols. CONCLUSION: The process of cryopreservation, under both protocols, significantly affected the developmental potential of pre-implant embryos as compared to fresh embryos. Hence the nature and concentrations of cryoprotectants needs to be optimized for efficient, viable embryonic development.

Cytomegalovirus retinitis and HIV: Case reviews from KwaZulu-Natal Province, South Africa.

BACKGROUND: Retinal cytomegalovirus (CMV) infection is a common opportunistic infection and remains a significant contributor to visual loss in patients with AIDS. We highlight the poor outcomes of CMV retinitis in three HIV-infected patients who were initiated on antiretroviral therapy (ART). We conducted a retrospective chart review of advanced stage HIV-infected patients with known CMV retinitis.Case 1. A 37-year-old man, with a CD4+ cell count of 35 cells/µL, presented for ART initiation with a 5-month history of visual loss in his left eye. Fundoscopy showed left eye CMV retinitis and right eye HIV retinopathy. ART and 5 months of weekly intravitreal ganciclovir injections (left eye) were commenced. Six-month outcomes included virological suppression, and visual acuity in the right eye of 6/6 and in the left eye of 3/60.Case 2. A 31-year-old woman, with a CD4+ cell count of 39 cells/µL and on tuberculosis therapy, presented for ART initiation. She presented with a 2-month history of decreased visual acuity. Fundoscopy showed bilateral CMV retinitis, which was more pronounced in the left eye. ART and 8 months of intravitreal ganciclovir injections were commenced. Six-month outcomes included virological suppression and visual acuity in the right eye of 6/9, and in the left eye of 6/24.Case 3. A 29-year-old woman, with a CD4+ cell count of 24 cells/µL, who was on tuberculosis therapy and ART, complained of blurred vision at her 2-month ART follow-up visit. Fundoscopy showed bilateral retinal detachment secondary to CMV retinitis. While silicone oil tamponade and subsequent retinectomy successfully repaired the right eye, extensive damage rendered the left eye irreparable. Six-month outcomes included virological suppression, with 6/120 visual acuity in the right eye and complete blindness in the left eye. CONCLUSION: CMV retinitis causes debilitating, permanent sequelae, which is preventable by ART initiation at higher CD4+ cell counts. Despite achieving virological suppression, vision could not be completely restored in these patients, irrespective of the severity of CMV retinitis.

Tuberculosis treatment outcomes among peri-urban children receiving doorstep tuberculosis care.

OBJECTIVE: To determine the optimal tuberculosis (TB) management strategy for children living in peri-urban, resource-limited settings. DESIGN: We compared TB treatment outcomes among children aged 0-15 years receiving doorstep care (n = 82) with those of a historical group (n = 97) receiving clinic-based care. RESULTS: The doorstep care and clinic-based groups had similar age and sex profiles; treatment default rates were 3.7% (3/82) vs. 38.1% (37/97, P < 0.0001), treatment completion rates were 65.9% (54/82) vs. 51.6% (50/97, P = 0.01), and cure rates were 13.4% (11/82) vs. 2.1% (2/97), respectively (P < 0.0001). CONCLUSION: Children living in peri-urban communities had improved TB treatment outcomes with doorstep care.