Browsing by Author "Raine, Richard"

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    Assessing Knowledge of Obstructive Sleep Apnoea among 4th Year and 6th Year Medical Students, Internal Medicine Registrars and Medical Consultants at the University of Cape Town
    (2022) Mbena, Bulelwa Priscilla; Symons, Gregory; Raine, Richard
    Introduction: Obstructive sleep apnoea (OSA) is not frequently diagnosed, despite being a common medical condition. OSA is associated with increased cardiovascular morbidity. There is no data on the prevalence of OSA in South Africa. We set out to assess knowledge of OSA among students, registrars and consultants in the department of medicine of a large South African university. Methods: This is a descriptive, cross-sectional study. We distributed an anonymous online survey among 4th and 6th year medical students, registrars and consultants in the Department of Medicine at the University of Cape Town. Results: We had a 32% response rate to our survey. The mean knowledge score was 13/18. We found a weak but significant association between age and knowledge (R=0.45, p<0.001), with a weak correlation between age and attitude (R=0.31, p<0.001), and a weak association between attitude and knowledge (R=0.3, p =0.00022). There were significant differences in level of education between undergraduates and consultants (p=0.002) as well as between undergraduates and registrars (p=0.002). Our cohort agreed that OSA is an important clinical disorder, but they lacked confidence in their ability to identify and manage patients with OSA. Conclusion: More teaching time is needed at an undergraduate level to improve the ability of clinicians to recognise and manage OSA.
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    HIV positive patients in intensive care - a retrospective chart review
    (2016) Mkoko, Philasande; Raine, Richard
    Background: The indications for and outcomes of intensive care unit (ICU) admission of HIV - infected patients in resource - poor settings like Sub - Saharan Africa are unknown. Methods: We reviewed case records of HIV - infected patients admitted to the medical and surgical ICUs at Groote Schuur Hospital, South Africa from 1 January 2012 to 31 December 2012. HIV infection was defined as two positive antibody tests. Results: Seventy seven HIV - infected patients were admitted to ICU, 2 were younger than 18 years and were excluded from the final analysis. HIV infection was newly diagnosed in 37.3% of the patients admitted during this period. HIV - positive patients had a mean (± standard deviation) CD 4 count of 293.9 × 10 6 /L ± 247.2 × 10 6 /L. Respiratory illness accounted for 30.7% of ICU admissions, community - acquired pneumonia was responsible for the majority of the respiratory cases. ICU and hospital mortality was 25.3% and 34.7% respectively. Predictors of ICU mortality included an APACHE Ι Ι score >13 (Odds Ratio {OR } , 1.4; 95% confidence interval {CI } 1.1 - 1.7; p value 0.015), receipt of renal replacement therapy (OR, 2.2; 95% CI 1.2 - 4.1; P 0.018) and receipt of inotropes (OR 2.3; 95% CI 1.6 - 3.4; P <0.001). Predictors of hospital mortality were severe sepsis on admission (OR, 2.8; 95% CI 0.9 - 9.1;p 0.07), receipt of renal replacement therapy (OR, 1.9; 95% CI 1.0 - 3.6; p 0.056), receipt of inotropic support (OR, 2.0; 95% CI 1.4 - 3.2; p 0.001). Use of highly active antiretroviral therapy, CD4 count, detectable HIV viral load and the diagnoses at ICU admission did not predict ICU or hospital mortality. Conclusion Respiratory illnesses remain the main indication for ICU in HIV infected patients. HIV is diagnosed late with patients presenting in dire straits. Receipt of HAART, CD4 count and the diagnoses at ICU admission are not predictors of ICU or hospital mortality, but rather the severity of illness as indicated by a high APACHE ΙΙ score, multiple organ dysfunction requiring inotropic support and renal replacement.
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    ICU-Associated Acinetobacter baumannii Colonisation/Infection in a High HIV-Prevalence Resource-Poor Setting
    (Public Library of Science, 2012) Ntusi, Ntobeko B A; Badri, Motasim; Khalfey, Hoosain; Whitelaw, Andrew; Oliver, Stephen; Piercy, Jenna; Raine, Richard; Joubert, Ivan; Dheda, Keertan
    BACKGROUND: There are hardly any data about the incidence, risk factors and outcomes of ICU-associated A.baumannii colonisation/infection in HIV-infected and uninfected persons from resource-poor settings like Africa. METHODS: We reviewed the case records of patients with A.baumannii colonisation/infection admitted into the adult respiratory and surgical ICUs in Cape Town, South Africa, from January 1 to December 31 2008. In contrast to colonisation, infection was defined as isolation of A.baumannii from any biological site in conjunction with a compatible clinical picture warranting treatment with antibiotics effective against A.baumannii . RESULTS: The incidence of A.baumannii colonisation/infection in 268 patients was 15 per 100 person-years, with an in-ICU mortality of 26.5 per 100 person-years. The average length of stay in ICU was 15 days (range 1-150). A.baumannii was most commonly isolated from the respiratory tract followed by the bloodstream. Independent predictors of mortality included older age (p = 0.02), low CD4 count if HIV-infected (p = 0.038), surgical intervention (p = 0.047), co-morbid Gram-negative sepsis (p = 0.01), high APACHE-II score (p = 0.001), multi-organ dysfunction syndrome (p = 0.012), and a positive blood culture for A.baumannii (p = 0.017). Of 21 A.baumannii colonised/infected HIV-positive persons those with clinical AIDS (CD4<200 cells/mm 3 ) had significantly higher in-ICU mortality and were more likely to have a positive blood culture. Conclusion In this resource-poor setting A.baumannii infection in critically ill patients is common and associated with high mortality. HIV co-infected patients with advanced immunosuppression are at higher risk of death.