Browsing by Author "Kilborn, Tracy"

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    HIV Encephalopathy: pediatric case series description and insights from the clinic coalface
    (BioMed Central, 2015-01-17) Donald, Kirsten A; Walker, Kathleen G; Kilborn, Tracy; Carrara, Henri; Langerak, Nelleke G; Eley, Brian; Wilmshurst, Jo M
    Background: The Human Immune Deficiency Virus (HIV) can manifest neurologically in both adults and children. Early invasion of the central nervous system by the virus, affecting the developing brain, is believed to result in the most common primary HIV-related neurological complication, HIV Encephalopathy (HIVE). In countries such as South Africa where many children have not been initiated on antiretroviral treatment early, HIVE remains a significant clinical problem. Methods: Children were selected from a clinic for children with neurologic complications of HIV, located at the Red Cross War Memorial Children’s Hospital, South Africa 2008–2012. Eligible subjects fulfilled the following inclusion criteria: aged 6 months-13 years; positive diagnosis of HIV infection, vertically infected and HIVE as defined by CDC criteria. Each participant was prospectively assessed by a Pediatric Neurologist using a standardized proforma which collated relevant details of background, clinical and immunological status. Results: The median age of the 87 children was 64 months (interquartile range 27–95 months). All except one child were on antiretroviral treatment, 45% had commenced treatment <12 months of age. Delayed early motor milestones were reported in 80% and delayed early speech in 75% of children in whom we had the information. Twenty percent had a history of one or more seizures and 41% had a history of behavior problems. Forty-eight percent had microcephaly and 63% a spastic diplegia. CD4 percentages followed a normal distribution with mean of 30.3% (SD 8.69). Viral loads were undetectable (
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    How has the OSD affected our state hospitals?
    (2009) Parkes, Jeannette; Abratt, Raymond; Taylor, Allan; Le Feuvre, David; Murray, Elizabeth; Robertson, Barbara; Kotze, Tessa; Marais, David; Khan, Del; Kilborn, Tracy; Wieselthaler, Nicky; Gajjar, Himal; Handler, Lenny; Fagan, Johan; Spitaels, Ariane; Morrison, Adrian; Davidson, Alan; Salie, Shamiel; Urban, Mike; Rajkumar, Ash; Pretorius, Vincent; van Niekerk, Magriet; Ferreira, Germaine; Wolmerans, Marli; Cyster, Lyall; King, Darren; Okwuosa, Sebastian; van Staden, Sanet; van Niekerk, Margarethe; Winckler, Jana; Meissenheimer, Heinrich; Botes, Annie; Tait, Deon; Visagie, Jodine; Swarts, Steve; Klocke, Marina; Lomas, Vanessa; Marais, Ilke; Vijoen, Werner; Perry, Jennie; Nkosi, Nokwazi; Stuve, Katrin
    The long-awaited occupation-specific dispensation (OSD) process for state-employed doctors has now been concluded. The final offer, signed and accepted in the bargaining chamber despite being rejected by 92% of doctors in a SAMA survey, has not received much attention or fanfare. At the conclusion of this process, which has been drawn out over several years, many points have emerged that are extremely worrying for the future of health care in this country.
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    The utility of abdominal ultrasound in the diagnosis of paediatric abdominal tuberculosis: a single centre review
    (2020) Sood, Vishesh; Kilborn, Tracy; Eley, Brian
    Background: Childhood tuberculosis (TB) is a common disease worldwide, with an increased propensity for severe, disseminated disease in settings with a high burden of concomitant HIV infection. Ultrasound is commonly used in diagnosing abdominal TB, however the indications for its use are unclear and often vary amongst clinicians. Objective: In this study, we describe the findings of ultrasound examinations performed for suspected abdominal TB at a tertiary children's hospital and examine the variability in reporting patterns amongst radiologists performing these imaging investigations. Materials and methods: Ultrasound studies performed for “suspected abdominal TB” between 01 January 2013 – 31 December 2018 were reviewed. In studies reported as suggestive of abdominal TB, evidence of microbiologically confirmed disease was sought. Subsequently, a selection of images from these studies were independently reviewed by three paediatric radiologists to determine their level of agreement when interpreting imaging findings. Results: During the study period 1093 studies were performed for suspected abdominal TB, of which 166 (15%) had abnormal features suggestive of TB. Forty-seven percent of these patients (78/166) had microbiologically confirmed disease. The commonest reported features were lymphadenopathy, 77% (128/166) and splenic microabscesses, 55% (92/166) for which substantial inter-reader agreement was documented, Fleiss' kappa = 0.64 and 0.66 respectively. There was moderate inter-reader agreement in the diagnosis of abdominal TB among radiologists (Fleiss' kappa=0.47). Conclusion: Caution is advised when basing clinical decisions on ultrasound studies performed for suspected abdominal TB, as imaging features are non-specific and there is considerable variability in interpretation of studies among reporting radiologists.