Browsing by Author "Symons, Gregory"

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    Open Access
    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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    Clinical diagnostic utility of IP-10 and LAM antigen levels for the diagnosis of tuberculous pleural effusions in a high burden setting
    (Public Library of Science, 2009) Dheda, Keertan; Van-Zyl Smit, Richard N; Sechi, Leonardo A; Badri, Motasim; Meldau, Richard; Symons, Gregory; Khalfey, Hoosein; Carr, Igshaan; Maredza, Alice; Dawson, Rodney
    BACKGROUND: Current tools for the diagnosis of tuberculosis pleural effusions are sub-optimal. Data about the value of new diagnostic technologies are limited, particularly, in high burden settings. Preliminary case control studies have identified IFN-γ-inducible-10kDa protein (IP-10) as a promising diagnostic marker; however, its diagnostic utility in a day-to-day clinical setting is unclear. Detection of LAM antigen has not previously been evaluated in pleural fluid. METHODS: We investigated the comparative diagnostic utility of established (adenosine deaminase [ADA]), more recent (standardized nucleic-acid-amplification-test [NAAT]) and newer technologies (a standardized LAM mycobacterial antigen-detection assay and IP-10 levels) for the evaluation of pleural effusions in 78 consecutively recruited South African tuberculosis suspects. All consenting participants underwent pleural biopsy unless contra-indicated or refused. The reference standard comprised culture positivity for M. tuberculosis or histology suggestive of tuberculosis. Principal FINDINGS: Of 74 evaluable subjects 48, 7 and 19 had definite, probable and non-TB, respectively. IP-10 levels were significantly higher in TB vs non-TB participants (p<0.0001). The respective outcomes [sensitivity, specificity, PPV, NPV %] for the different diagnostic modalities were: ADA at the 30 IU/L cut-point [96; 69; 90; 85], NAAT [6; 93; 67; 28], IP-10 at the 28,170 pg/ml ROC-derived cut-point [80; 82; 91; 64], and IP-10 at the 4035 pg/ml cut-point [100; 53; 83; 100]. Thus IP-10, using the ROC-derived cut-point, missed ∼20% of TB cases and mis-diagnosed ∼20% of non-TB cases. By contrast, when a lower cut-point was used a negative test excluded TB. The NAAT had a poor sensitivity but high specificity. LAM antigen-detection was not diagnostically useful. CONCLUSION: Although IP-10, like ADA, has sub-optimal specificity, it may be a clinically useful rule-out test for tuberculous pleural effusions. Larger multi-centric studies are now required to confirm our findings.
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    Pulmonary Alveolar Proteinosis: The first South African insight into this rare disease
    (2021) Vorajee, Nadia; Symons, Gregory
    Background: Pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by excessive accumulation of intra-alveolar surfactant related, lipoproteinaceous material. With the exception of a single pediatric case report of PAP, no data exists in Sub Saharan Africa. The aim of the study is to describe the epidemiological and clinical features of patients with PAP treated at Groote Schuur Hospital since May 2009 and their outcome after the first therapeutic whole lung lavage. Methods: 11 patients with PAP were identified using the Pulmonology whole lung lavage register. A retrospective folder review was undertaken for demographic and clinical data which was captured via a paper data capture sheet and then entered into a REDCap database for ease of statistical analysis. Findings: The median age at diagnosis was 42 years, with a male to female ratio of 1:1.2 . All the patient's tested negative for HIV. A history of smoking was seen in 63.6% (7) with median pack years of 21.5. Common symptoms at presentation included: dyspnoea (100%), dry cough (45.5%), productive cough (45.5%) and weight loss (54.5%). All patients were hypoxic at diagnosis with an average Pa02 on room air of 7.75 kPa (±1.59) and, a mean FEV1/FVC ratio of 87.60% (±7.02) of predicted. Although 36.4 % (4) were unable to perform 6 min walk tests at presentation, the remaining patients had a median distance of 287 m. No mortality was seen at 12 months, despite all patients requiring whole lung lavage during this period. Conclusions: This small, retrospective cohort offers the first insight into the demographic and clinical features of patients in Sub-Saharan Africa with PAP. Interestingly, no patients in this cohort were HIV positive. Within this small cohort very few statistically significant details can be drawn but rather a description of a rare condition. Future plans to continue data collection prospectively and expand to other centres will improve deductions made.