Browsing by Author "McCulloch, Mignon"
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- ItemOpen AccessA 15-year retrospective review of urodynamic studies in Children at Red Cross War Memorial Childrens Hospital (RCWMCH), Cape Town, South Africa(2022) Mosalakatane, Thembisile Dintle; Coetzee, Ashton; Wright, Anne; Raad, Jeanette; Lazarus, John; Nourse, Peter; Howlett, Justin; McCulloch, MignonBackground: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.
- ItemOpen AccessAcute post streptococcal glomerulonephritis at Red Cross War Memorial Children's Hospital, Cape Town, South Africa - a five-and half-year descriptive review(2022) Abugrain, Khadija; Buys, Heloise; McCulloch, MignonBackground: Acute post streptococcal glomerulonephritis (APSGN), although not a common cause of progressive kidney failure, is an important cause of paediatric hospital admission, parental worry, and acute kidney injury (AKI). In well-resourced settings, there has been a decline over the last three decades in the incidence of APSGN in children with this condition almost disappearing in Central Europe. However, this is not the case in less privileged countries such as in South Africa (SA) where APSGN is still a major public health problem and a frequent cause of paediatric hospital admission and AKI. Nevertheless, APSGN in South Africa has not been studied adequately in recent times and not currently addressed as an important public health issue. Objectives: In this retrospective study we describe the occurrence of APSGN, the aetiology, clinical presentation, and complications among children (<14years) admitted to the Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, SA from January 2015 to June 2020. Methods: The hospital electronic database with recorded ICD-10 coding was used to identify potential cases of acute nephritic syndrome. Children were included if they presented with at least two signs of acute nephritis, associated with evidence of activation of an alternative pathway complement system (low C3 serum level) or clinical and serological evidence of previous or current streptococcal infection. Demographic, clinical features, investigations, management, and outcome data were collected. Data were presented as median and interquartile ranges (IQR) or means and standard deviation (SD) depending on normality of data while proportions of categorical data were presented as percentages. Population incidences were calculated from the four major health districts within the drainage areas for RCWMCH. This study was conducted in accordance with the 2013 Declaration of Helsinki and was approved by RCWMCH administration and the University of Cape Town's Human Research Ethics Committee, (HREC: 623/2020). Results: There were 157 children with suspected acute nephritic syndrome (haematuria, oedema, oliguria and hypertension), of whom 96 met the inclusion criteria and were recruited. Of the 96 children included in the study, 89 (93%) cases had confirmed APSGN, and seven (7%) children had a clinical diagnosis of rapidly progressive glomerulonephritis (RPGN), with positive streptococcal serology and crescentic glomerulonephritis in the kidney biopsy. APSGN occurred in 61 (63%) children aged five to ten years with 62 (65%) males (ratio of 1.9:1). APSGN was more often associated with streptococcal skin infections (55%). The majority 95 (99%) of cases presented with haematuria, while proteinuria was noted in 85 children. Seventy-one (74%) children presented in stage 2 hypertension, with 10 (10%) presenting with hypertensive seizures. Serum C3 levels were low in 83 (87%) children. 90 (94%) children had elevated anti-deoxyribonuclease B antibodies (anti-DNase-B) levels, and 77 (80%) also had elevated anti-streptolysin O titres (ASOT) titres at presentation. Eighty-eight (92%) children received a diuretic agent, 60 (63%) required an anti-hypertensive agent, and 90 (94%) received a penicillin antibiotic for 10 days. The median length of hospital stay was five (IQR 3-6) days. There were no deaths. Eighty-one (85%) children with APSGN recovered. Five (5%) progressed to end stage kidney disease (ESKD). A percutaneous kidney biopsy was indicated in eleven (11%) children. Seven (64%) biopsies confirmed type II crescentic glomerulonephritis, and four (36%) biopsies showed histological features of post-infectious nephritis. Conclusion: APSGN during childhood remains an important health problem in SA and commonly follows streptococcal skin infection. The outcome is favourable in most children; however, our study revealed an important sub-group with crescentic glomerulonephritis who progressed to ESKD. We recommend active case seeking at primary care level by checking urine dipstick, blood pressure and serum creatinine and better post-discharge follow up.
- ItemOpen AccessAn audit of pelvi-ureteric junction obstruction at Red Cross Children's Hospital : a six year review(2010) Ocheke, Isaac Ejembi; McCulloch, Mignon; Gajjar, Priya; Nourse, PeterPelvi-ureteric junction obstruction is an important cause of congenital renal and urinary tract abnormality. It is the commonest cause of antenatally detected hydronephrosis. The increasing use of antenatal ultrasound as a screening tool for congenital abnormalities in the developing foetus has resulted in a more frequent rate of detection of foetal hydronephrosis with the likely consequence of significant anxiety among parents. This is because most of these infants with antenatally detected hydronephrosis will be subjected to frequent radiological and other investigations and there will also be concern about outcome. Knowing what postnatal investigations are necessary for any child with this condition and when to do it becomes a priority. This is because it is known that a significant percentage of children with antero-posterior (AP) diameter of 12mm or less experienced complete and spontaneous resolution of the hydronephrosis in early life. This study is a retrospective folder review of one hundred children with PUJ obstruction managed at Red Cross Children’s Hospital over a six-year period from Jan 2002 to Dec 2007.
- ItemOpen AccessAudit of posterior urethral valve (PUV) in children at Red Cross Children Hospital, Cape Town, January 2002 - January 2009(2009) Antwi, Sampson; McCulloch, Mignon; Gajjar, Priya; Nourse, PeterPosterior urethral valve (PUV) is a congenital obstructing membrane of the male urethra. It is the commonest cause of bladder outlet obstruction in male children. PUV as a cause of obstructive uropathy is an important cause of end stage renal failure (ESRF) in children. Early detection and surgical intervention can slow down progression to ESRF.
- ItemOpen AccessClinico-pathological characteristics and outcomes of nephrology adolescents and young adults in Cape Town: a single centre study(2022) Barday, Zibya; Davidson, Bianca; Wearne, Nicola; Jones, Erika; McCulloch, MignonBackground Adolescents and young adults [AYA] are important users of the nephrology health care services. Worldwide, there is a paucity of data on AYA kidney disease and outcomes. This study evaluates kidney outcomes, survival and challenges faced by AYA in a South African setting. Methods This 5-year retrospective study included AYA [aged 10-24] with chronic kidney disease, at a tertiary nephrology service in South Africa. Descriptive analysis characterised the aetiology of kidney disease. A comparative analysis of baseline characteristics, outcomes and social challenges were performed between patients attending a dedicated AYA clinic and those attending the standard adult clinics [non-AYA clinics]. Primary composite outcome assessed included doubling of creatinine, reduction of eGFR >40%, end-stage kidney disease and death. Logistic regression evaluated associations between relevant variables, death and lost to follow up [LTFU]. Results The total AYA cohort consisted of 292 patients, 111 (38.0%) attended the AYA clinic and 181 (62.0%) the non-AYA clinics. The main aetiologies of disease were glomerular 212 (72.6%), congenital anomalies of the urinary tract 31 (10.6%), and hereditary conditions 24 (8.2%). There was a significantly lower mortality (p=0.007) and reduction in LTFU (p=0.012) in the cohort attending the AYA clinic. A statistically significant composite outcome (p=0.018), with improved kidney survival was found in the AYA clinic group. High proportions of nonadherence (33.9%) and substance use (25.0%) was demonstrated in both cohorts. Conclusion This study adds to the dearth of literature on AYA kidney disease. A dedicated nephrology AYA clinic is shown to have lower mortality, less LTFU and improved kidney outcomes, which is essential in a resource-limited setting where access to kidney replacement therapy is restricted.
- ItemOpen AccessIndication for and outcomes of continuous Positive Airways Pressure (CPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) in children admitted to Red Cross War Memorial's Hospital (RCWMCH) excluding those with primary respiratory aetiologies(2017) Browde, Kate; Morrow, Brenda M; McCulloch, MignonAim: Noninvasive Continuous Positive Airway Pressure (nCPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) are non-invasive ventilation (NIV) modalities appropriate for children in developing countries. There is minimal literature describing nCPAP and HFNC use in children with respiratory compromise secondary to non-pulmonary disease. This study aimed to describe the characteristics and outcomes of all children without primary lung pathology, who received nCPAP and HFNC during their admission to Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods: This was a prospective observational study of routinely collected data, between August 2015 and January 2016. Primary and secondary outcome measures were NIV failure (progression to intubation and invasive ventilation) and Paediatric Intensive Care Unit (PICU) admission respectively. Comparative statistics were conducted using Mann-Whitney U tests. Data significantly associated with the primary and secondary outcomes on univariate analysis were entered into backward stepwise logistic regression models to determine independent predictive factors. Results: There were 31 cases of nCPAP and one case of HFNC use in 31 patients (median (IQR) age 3.5 (1.8 – 7.6) months. The majority (n=23; 71.9%) presented with primary diarrhoeal disease. There were two deaths (6.5%), 17 (53.1%) Paediatric Intensive Care (PICU) admissions, and five (15.6%) cases received invasive ventilation (NIV failure). Median (IQR) duration of hospital stay was 11.50 (6.0 – 17.5) days. Patients who failed NIV had lower admission SaO2 than those without treatment failure (95 (95-99)% vs 100 (100-100)%; p = 0.03). On multiple logistic regression, lower temperature (OR 0.19; 95% CI 0.05 – 0.78; p = 0.02) and receiving inotropes in the emergency setting, (OR 23.05; 95% CI 1.64 – 325.06; p = 0.02) were independently associated with PICU admission. Conclusions: nCPAP is used clinically for the management of children with respiratory compromise secondary to non-pulmonary illnesses, particularly diarrhoeal disease. Larger controlled clinical studies are needed to determine the effectiveness and utility of nCPAP in this population. HFNC was not commonly used, and this modality requires further investigation in this population.
- ItemOpen AccessLeaving the party - withdrawal of South African essential medicines(2005) Wilmshurst, Jo M; Blockman, Marc; Argent, Andrew; Gordon-Graham, Eugenie; Thomas, Jenny; Whitelaw, Andrew; McCulloch, Mignon; Ramiah, Malitha; Dyeshana, H; Ireland, JoeIn August 2004 pharmacies and drug depots were advised that the sole supplier of parenteral phenobarbitone in South Africa, essential for the management of status epilepticus in children, was stopping production at the end of the same year. Alternative protocols for the management of status epilepticus resulted in more children requiring intensive care intervention (N = 9) at the Red Cross Children’s Hospital, over a 2-month period, than had occurred in any 12-month period since 2000 (2000 N = 3, 2001 N = 1, 2002 N = 1, 2003 N = 2, 2004 N = 7). Other agents that have suffered or are at risk of the same fate are sodium nitroprusside, labetalol and esmolol. Sodium nitroprusside is used extensively in the peri-operative period in cardiac patients requiring after-load reduction. There are no other nitrates with equivalent efficacy. Supply was stopped in 2005 and only reinstated after the pharmaceutical company was contacted directly. Supply of labetalol and esmolol was stopped without warning. Without access to these products it is necessary to resort to agents that are not appropriate for paediatric use. Acetylcysteine (Parvolex), used in the management of acetaminophen overdose, also became unavailable and the supply was re-established only after direct communication with the pharmaceutical company.
- ItemOpen AccessProteinuric kidney disease in children at Queen Elizabeth Central Hospital, Malawi(BioMed Central, 2018-01-31) Mwanza, Zondiwe V; McCulloch, Mignon; Drayson, Mark; Plant, Timothy; Milford, David V; Dreyer, GavinBackground: There is a paucity of data on paediatric kidney disease in developing countries such as Malawi. Descriptive research on kidney disease is essential to improving patient outcomes. Methods: We conducted a cross-sectional study at a tertiary hospital in Malawi from 2012 to 2013. Children under 14 years with proteinuric kidney disease were enrolled from paediatric wards and outpatient clinics at Queen Elizabeth Central Hospital (QECH). Demographic, clinical and laboratory data were collected from patients at enrolment and at 3 months review at which point clinical status and disease outcome were ascertained. Results: Thirty-four (22 male) patients were studied, mean age 8.54 (SD = 3.62 years). Glomerular disease (n = 25, 68%) was the most common presumed renal lesion at presentation. Nephritic syndrome (10) was characterised by a lower baseline complement C3 than nephrotic syndrome (p = 0.0027). Seven (47%) cases of nephrotic syndrome achieved complete remission. Eight (80%) cases of nephritic syndrome improved with supportive therapy. Nineteen (56%) patients presented with clinically significant renal damage with eGFR< 60 ml/min/1.73m2 . Six patients presented in chronic kidney disease (CKD) stage 5 of unclear aetiology, five (83%) died. Three (9%) patients had impaired kidney function and obstructive uropathy demonstrated on ultrasound, two recovered after surgery and one died. Eight (24%) patients had acute kidney injury (AKI) due to primary kidney disease, three of these patients progressed to CKD stage G3a. Seven (21%) patients were lost to follow up. Conclusion: Kidney disease is a significant cause of mortality and morbidity in children at QECH. Less than half of Nephrotic syndrome cases achieved complete remission. Mortality is highest in children with CKD of unclear cause. Some patients with AKI secondary to primary renal disease progressed to CKD. Understanding the aetiology of paediatric kidney disease and improving patient outcomes by developing enhanced diagnostic and clinical services are priorities at QECH and within Malawi.