Browsing by Author "Volmink, Jimmy A"

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    HIV infection is associated with a lower incidence of constriction in presumed tuberculous pericarditis: a prospective observational study
    (Public Library of Science, 2008) Ntsekhe, Mpiko; Wiysonge, Charles S; Gumedze, Freedom; Maartens, Gary; Commerford, Patrick J; Volmink, Jimmy A; Mayosi, Bongani M
    BACKGROUND: Pericardial constriction is a serious complication of tuberculous pericardial effusion that occurs in up to a quarter of patients despite anti-tuberculosis chemotherapy. The impact of human immunodeficiency virus (HIV) infection on the incidence of constrictive pericarditis following tuberculous pericardial effusion is unknown. Methods and RESULTS: We conducted a prospective observational study to determine the association between HIV infection and the incidence of constrictive pericarditis among 185 patients (median age 33 years) with suspected tuberculous pericardial effusion. These patients were recruited consecutively between March and October 2004 on commencement of anti-tuberculosis treatment, from 15 hospitals in Cameroon, Nigeria and South Africa. Surviving patients (N = 119) were assessed for clinical evidence of constrictive pericarditis at 3 and 6 months of follow-up. Clinical features of HIV infection were present in 42 (35.2%) of the 119 patients at enrolment into the study. 66 of the 119 (56.9%) patients consented to HIV testing at enrolment. During the 6 months of follow-up, a clinical diagnosis of constrictive pericarditis was made in 13 of the 119 patients (10.9 %, 95% confidence interval [CI] 5.9-18%). Patients with clinical features of HIV infection appear less likely to develop constriction than those without (4.8% versus 14.3%; P = 0.08). None of the 33 HIV seropositive patients developed constriction, but 8 (24.2%, 95%CI 11.1-42.3%) of the 33 HIV seronegative patients did (P = 0.005). In a multivariate logistic regression model adjusting simultaneously for several baseline characteristics, only clinical signs of HIV infection were significantly associated with a lower risk of constriction (odd ratio 0.14, 95% CI 0.02-0.87, P = 0.035). CONCLUSIONS: These data suggest that HIV infection is associated with a lower incidence of pericardial constriction in patients with presumed tuberculous pericarditis.
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    Lack of adherence to the national guidelines on the prevention of rheumatic fever
    (2005) Robertson, Katharine A; Volmink, Jimmy A; Mayosi, Bongani M
    Objectives. To explore the extent to which current practices for the secondary prevention of rheumatic fever (RF) in Cape Town adhere to those outlined in the national guidelines on the primary prevention and prophylaxis of RF and rheumatic heart disease (RHD) for health professionals at primary level. Methods. A combination of qualitative tools was used to evaluate the four priority issues identified in the guidelines as fundamental elements of a comprehensive programme for the secondary prophylaxis of RF/RHD: (i) health education and promotion; (ii) case detection of RF and RHD; (iii) secondary prophylaxis every 3 - 4 weeks at primary level; and (iv) notification of acute rheumatic fever (ARF). The qualitative tools included parent/child interviews of cases diagnosed with ARF in the Cape metropole area during the period 1999 - 2003; a physician questionnaire focused on awareness and adherence to the national guidelines; and a review of the records on acute rheumatic fever notification in the Cape metropole area from 1999 to 2003. Results. The evaluation revealed four key findings. First, patient knowledge on the disease was almost non-existent. Despite this lack of knowledge, adherence to secondary prophylactic treatment was good. Second, the physicians most likely to encounter a case of rheumatic fever were least likely to be aware of and to comply with the national guideline. Third, the guidelines do not clearly state how increased detection of ARF will be achieved. Finally, the RF notification system is dysfunctional, with discrepancies in the reporting of cases at hospital, city and provincial levels. Conclusions. Since the publication of the national guidelines in 1997, little progress has been made towards achieving the implementation of a comprehensive programme for the secondary prevention of RF/RHD.
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    Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa - the Awareness Surveillance Advocacy Prevention (ASAP) Programme
    (2006) Robertson, Kate A; Volmink, Jimmy A; Mayosi, Bongani M
    Over the last 150 years the developed world has experienced a dramatic decline in the incidence and prevalence of rheumatic fever and rheumatic heart disease (RF/RHD) through improved living conditions and the widespread use of penicillin for the treatment of streptococcal pharyngitis. Despite the proven effectiveness and availability of penicillin for both primary and secondary prevention of RF, developing countries continue to face unacceptably high rates of the disease.1 RF/RHD is the most common cardiovascular disease in children and young adults in the world, because 80% of the world’s population live in developing countries where the disease is still rampant. Recent research estimates that RF/RHD affects about 15.6 million people worldwide, with 282 000 new cases and 233 000 deaths each year. There are 2.4 million affected children between 5 and 14 years of age in developing countries, 1 million of whom live in sub-Saharan Africa, making the continent the major RF/RHD hotspot.2