Browsing by Author "Levin, M"
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- ItemOpen AccessAcute severe childhood asthma(South African Academy of Family Physicians, 2012) Levin, M; Weinberg, EAsthma is the most common chronic disease of South African children, affecting 10-20% of the population. Correct treatment of chronic asthma with regular antiinflammatory controller therapy prevents symptoms, asthma exacerbations, hospitalisation and mortality. Modern treatment of asthma focuses on an assessment of asthma control in order to enable the child to lead a normal life by: • Growing and developing normally • Attending school regularly • Sleeping well at night • Participating in sport and activities • Staying out of hospital. With good controller treatment, less acute attacks of severe asthma will take place. However, to ensure fewer hospitalisations and less mortality, optimal treatment of acute attacks by families and health care professionals is critical.
- ItemOpen AccessBacterial meningitis in neonates and children South Africa(2013) Thomas, Karla Mari; Levin, MAcute bacterial meningitis is defined as the inflammation of the meninges. It is caused by various bacteria and the specific aetiology is age dependant. In the neonatal period the causative organisms are: Group B streptococci, Gram - negative bacilli (e.g.: E. coli, Klebsiella spp, Enterobacter spp, Salmonella spp) and Listeria monocytogenes. In infants and children up to the age of 5 the most common causative organisms include: Streptococcus pneumoniae, Haemophilus influenzae type B (Hib)and Neiseria meningitidis. The two chief causes of bacterial meningitis in children older than 5 are S. pneumoniae and N. meningitidis. Various studies have been performed to look at the profile of meningitis among the paediatric population. Objective: To investigate the aetiology of acute bacterial meningitis in South African newborns and children from 2005 - 2010.
- ItemOpen AccessChildhood Asthma(South African Academy of Family Physicians, 2011) Levin, M; Weinberg, EAsthma is the most common chronic disease of South African children, affecting growth and development and quality of life. Features supporting the diagnosis are a family or personal history of atopy, night cough, exercise-induced cough and/or wheeze and seasonal variation in symptoms. Asthma is on the increase in both developed and developing countries, in both rural and urban communities. The first part of this series aims to give a brief overview of the epidemiology, pathophysiology and diagnosis of childhood asthma.
- ItemOpen AccessDiagnosis of childhood asthma(South African Academy of Family Physicians, 2011) Levin, M; Weinberg, EChildhood asthma is characterised by episodes of wheezing and coughing, particularly at night. The cough is typically non-productive of sputum and is irritating and persistent. It is most troublesome in the early hours of the morning, especially between 1-2 am. Chronic cough may be a presenting symptom in young children. Wheezing, chest tightness, and shortness of breath become more obvious in children older than three years. Acute exacerbations of asthma are frequently associated with viral upper respiratory tract infections, but may also be triggered by exercise, particularly in cold and dry weather, laughter, crying, and exposure to allergens and irritants such as petrol or paint fumes. There may be a seasonal variation in symptoms, and it is common to find a diurnal variation with waking in the early hours of the morning, and increased symptoms on getting out of bed.
- ItemOpen AccessMillennial trends in inpatient paediatric care at New Somerset Hospital Cape Town(2012) Westwood, A; Moller, G; Levin, M; Richards, M; Jacobs, K; Mahomed, SThe first decade of this millennium witnessed considerable changes and challenges in child health in South Africa. Census figures have shown major migration towards urban centres such as Cape Town. Child mortality rates were very high and not improving. The prevalence rates for HIV infection peaked, and efforts to prevent mother-to-child-transmission (PMTCT) of HIV were introduced and then scaled up. New techniques of neonatal care such as nasal continuous positive airway pressure ventilation for small preterm babies with immature lungs were introduced.
- ItemOpen AccessPaediatric admissions to hospitals in the Cape Town Metro district: A survey(Health and Medical Publishing Group, 2012) Westwood, A; Levin, M; Hageman, JA point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2007 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised.
- ItemRestrictedReconstitution of antimycobacterial immune responses in HIV-infected children receiving HAART(2006) Kampmann, B; Tena, G; Nicol, MP; Levin, M; Eley, BSObjective: Recent epidemiological studies in adults suggest that HAART can prevent the development of tuberculosis in HIV-infected individuals, but the mechanisms are incompletely understood and no data exist in children. We investigated whether changes in mycobacterial-specific immune responses can be demonstrated in children after commencing antiretroviral therapy. Design: We measured mycobacterial growth in vitro using a novel whole-blood assay employing reporter-gene tagged bacillus Calmette–Guérin (BCG) in a prospective cohort study in the tuberculosis-endemic environment of South Africa. Key cytokines were measured in supernatants collected from the whole-blood assay using cytometric bead array. Patients: A cohort of 15 BCG-vaccinated HIV-infected children was evaluated prospectively for in-vitro antimycobacterial immune responses before and during the first year of HAART. All children had advanced HIV disease. Nine children completed all study timepoints. Results: Before HAART, blood from children showed limited ability to restrict the growth of mycobacteria in the functional whole-blood assay. The introduction of HAART was followed by rapid and sustained reconstitution of specific antimycobacterial immune responses, measured as the decreased growth of mycobacteria. IFN-γ levels in culture supernatants did not reflect this response; however, a decline in TNF-α was observed. Conclusion: This is the first study using a functional in-vitro assay to assess the effect of HAART on immune responses to mycobacteria in HIV-infected children. Our in-vitro data mirror the in-vivo observation of decreased susceptibility to tuberculosis in HIV-infected adults receiving antiretroviral agents. This model may be useful for further characterizing immune reconstitution after HAART.
- ItemOpen AccessTreating childhood asthma(South African Academy of Family Physicians, 2011) Levin, M; Weinberg, EAsthma is the most common chronic disease of South African children, affecting 10-20% of the population. It is sometimes difficult to diagnose. Where uncertainty exists, it may be more beneficial to treat the child as asthmatic, and then wean him or her off the medication later once it is under control, than neglect to administer the correct therapy to a true asthmatic. The treatment of asthma is often problematic, not because of lack of access to appropriate medication, but because of the central role played by additional factors, such as patient adherence and administration of medication technique. It is always necessary to treat the child as an individual, but some measures apply in all cases. It is important to allay anxiety about the diagnosis. This is best done by carefully explaining the nature and causes of asthma, what to do if an attack occurs, why medicines are prescribed, and how they are given. Patients must be able to understand the difference between controller and reliever therapy. The importance of regularly using controller medication needs to be emphasised. Time spent on the initial explanation and educating the parents and the child is always well rewarded by the response to treatment. Regular follow-up of these children, preferably by the same doctor, is very important.