Browsing by Author "Kalula, S.Z."

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    Clinical predictors of outcome in acute upper gastrointestinal bleeding
    (Health and Medical Publishing Group, 2003) Kalula, S.Z.; Swingler, G.; Louw, J.A.
    Objective: Endoscopy has traditionally been used to risk-stratify patients with upper gastrointestinal bleeding (UGIB). This is problematic in resource-poor environments. The study aimed to identify patients who would not require urgent endoscopy by identifying clinical variables before endoscopy that predict uneventful recovery. Design: Prospective, descriptive cross-sectional study. Setting. Groote Schuur Hospital, Cape Town. Subjects: Two hundred consecutive patients aged over 12 years, presenting with haematemesis and/or melaena. Outcome measures: Good outcome, i.e. no blood transfusion, endotherapy or surgery, and alive at 1 month following presentation. Results: Eighty patients (40%) had a good outcome. Haemoglobin > 10 g/dl (odds ratio (OR) 25.5, 95% confidence interval (CI): 8.9 - 74.8; p < 0.001), absence of melaena (OR 4.8, 95% CI: 1.79 - 12.94, p = 0.002) and absence of syncope (OR 4.0, 95% CI: 1.67 - 9.48; p = 0.002) were independent predictors of good outcome. The three variables combined as a positive test had the best association with good outcome when compared with a single variable or a combination of two variables. The three-variable model had sensitivity for good outcome of 34%, specificity of 98%, and likelihood ratio for a positive test of 13.5 and for a negative test of 0.68. Thirty patients (15%) had the combination for the prediction rule, i.e. haemoglobin > 10 g/dl, no melaena and no syncope; 3 (10%) had a poor outcome (required endotherapy). Conclusion: The prediction rule accurately excluded poor outcome, a priority in the clinical context, but did not predict good outcome. Clinical implications are a 15% reduction in unnecessary urgent endoscopies, with less than 5% of patients with poor outcome not undergoing urgent endoscopy. These findings may have particular clinical relevance in under-resourced health care environments.
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    Preventing fractures in the elderly in GP practice
    (Taylor & Francis, 2006) Dave, J.; Kalula, S.Z.
    Osteoporosis is a common bone disorder that increases the risk of a fragility fracture. The elderly are prone to the development of osteoporosis and have an increased propensity to fall thereby increasing their risk of fractures. Fractures (especially hip fractures) in the elderly are associated with a high morbidity and mortality, and are also costly, accounting for large portions of health budgets. To prevent fractures it is therefore prudent to identify those with or at risk of osteoporosis and those at risk of falling. Although there is a lack of consensus on which individuals gain most benefit from Dual Energy X-ray Absorptiometry (DEXA) screening, the majority would concur that individuals with known risk factors for osteoporosis and those at risk of sustaining a fracture should undergo DEXA screening. After a diagnosis of osteoporosis, secondary causes should be excluded and appropriate therapy initiated. Therapy may include treatment of a secondary cause, non-pharmacologic and pharmacologic measures. Pharmacologic therapy has been shown to significantly decrease the risk of both vertebral and non-vertebral fractures. Individuals not diagnosed with osteoporosis but at increased risk of falls have been shown to derive some benefit from calcium and vitamin D supplementation, a weight-bearing exercise regimen, and refraining from smoking and alcohol abuse.