Browsing by Author "Workman, L"

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    Determining the prevalence of malnutritionin hospitalised paediatric patients
    (2006) Marino, L V; Goddard, E; Workman, L
    Aim. To determine the prevalence of malnutrition in hospitalised paediatric patients at Red Cross War Memorial Children’s Hospital. Method. A 1-day cross-sectional survey was completed in all medical and surgical wards and some specialist outpatient clinics. Results. A total of 227 children participated in the study. Thirty-five per cent of patients were moderately malnourished (b -2 z-score), of whom 70% had no road to health card with them. Thirty-four per cent of children under 60 months of age received supplements in addition to a normal ward diet, 7.8% were enterally fed and less than 1% were parenterally fed. Almost 14% of children were found to be overweight/ obese, which is higher than the national average of 6%. The prevalence of HIV infection on the day of the audit was 18% across all age groups compared with the Western Cape antenatal prevalence of 15.7% (2005). Conclusion. The overall prevalence of undernutrition was 34%, which is comparable with similar studies. However, the proportion of overweight children (14%) was greater than the national average. In view of the level of malnutrition seen, a nutrition risk-screening tool, identifying risk factors for malnutrition such as food access and vulnerability, should be developed. The tool should be used to assess nutrition status and risk during the course of hospitalisation, in addition to planning appropriate nutrition care plan interventions for discharge.
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    The interaction between artemether-lumefantrine and lopinavir/ritonavir-based antiretroviral therapy in HIV-1 infected patients
    (BioMed Central, 2016-01-27) Kredo, T; Mauff, K; Workman, L; Van der Walt, J S; Wiesner, L; Smith, P J; Maartens, G; Cohen, K; Barnes, K I
    Background: Artemether-lumefantrine is currently the most widely recommended treatment of uncomplicated malaria. Lopinavir–based antiretroviral therapy is the commonly recommended second-line HIV treatment. Artemether and lumefantrine are metabolised by cytochrome P450 isoenzyme CYP3A4, which lopinavir/ritonavir inhibits, potentially causing clinically important drug-drug interactions. Methods: An adaptive, parallel-design safety and pharmacokinetic study was conducted in HIV-infected (malaria-negative) patients: antiretroviral-naïve and those stable on lopinavir/ritonavir-based antiretrovirals. Both groups received the recommended six-dose artemether-lumefantrine treatment. The primary outcome was day-7 lumefantrine concentrations, as these correlate with antimalarial efficacy. Adverse events were solicited throughout the study, recording the onset, duration, severity, and relationship to artemether-lumefantrine. Results: We enrolled 34 patients. Median day-7 lumefantrine concentrations were almost 10-fold higher in the lopinavir than the antiretroviral-naïve group [3170 versus 336 ng/mL; p = 0.0001], with AUC(0-inf) and Cmaxincreased five-fold [2478 versus 445 μg.h/mL; p = 0.0001], and three-fold [28.2 versus 8.8 μg/mL; p < 0.0001], respectively. Lumefantrine Cmax, and AUC(0-inf) increased significantly with mg/kg dose in the lopinavir, but not the antiretroviral-naïve group. While artemether exposure was similar between groups, Cmax and AUC(0-8h) of its active metabolite dihydroartemisinin were initially two-fold higher in the lopinavir group [p = 0.004 and p = 0.0013, respectively]. However, this difference was no longer apparent after the last artemether-lumefantrine dose. Within 21 days of starting artemether-lumefantrine there were similar numbers of treatment emergent adverse events (42 vs. 35) and adverse reactions (12 vs. 15, p = 0.21) in the lopinavir and antiretroviral-naïve groups, respectively. There were no serious adverse events and no difference in electrocardiographic QTcF- and PR-intervals, at the predicted lumefantrine Tmax. Conclusion: Despite substantially higher lumefantrine exposure, intensive monitoring in our relatively small study raised no safety concerns in HIV-infected patients stable on lopinavir-based antiretroviral therapy given the recommended artemether-lumefantrine dosage. Increased day-7 lumefantrine concentrations have been shown previously to reduce the risk of malaria treatment failure, but further evidence in adult patients co-infected with malaria and HIV is needed to assess the artemether-lumefantrine risk : benefit profile in this vulnerable population fully. Our antiretroviral-naïve patients confirmed previous findings that lumefantrine absorption is almost saturated at currently recommended doses, but this dose-limited absorption was overcome in the lopinavir group.
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    Prevalence of bacterial contamination of powdered infant feeds in a hospital enviroment
    (2007) Marino, L V; Goddard, E; Whitelaw, A; Workman, L
    Background. The study arose as part of a best-practice nutrition model regarding the introduction of ready-to-use (RTU) infant feeds in place of powdered infant feeds (PIFs) as a standard formula for infants under the age of 1 year who are unable to be breastfed. Internationally and locally there is grave concern regarding the safety and efficacy of mixing PIFs, especially in a hospital setting, and the resultant bacterial contamination causing enteric infections, especially in premature, immunocompromised and sick infants. Objective. To evaluate the prevalence of bacterial contamination of PIFs given to infants at Red Cross War Memorial Children’s Hospital, Cape Town. Methods. Quantitative levels of bacterial contamination were determined and were expressed as colony-forming units (CFUs) per millilitre of sample. Aliquots of milk were inoculated onto agar, and the milk samples were then incubated at 25o C overnight (N = 10), 30o C overnight (N = 48) and 30o C for 6 hours (N = 34). Post-incubation milk samples were cultured again. Contamination was defined as any positive culture before administration (i.e. pre incubation) or > 102 CFU/ ml after administration (i.e. post incubation). Results. Fifty samples of PIFs (N = 82) were contaminated pre incubation, with 25/82 samples (30.4%) being heavily contaminated (≥ 104 CFU/ml). Post incubation, 43/92 samples (46.7%) were contaminated with > 102 CFU/ml. The acidified PIFs appeared to have some bactericidal effect against some of the organisms, but not all. Conclusions. RTU infant feeds are sterile and are recommended for use in all hospitalised infants. The results of this study indicate that even when milk is prepared in a controlled environment there is significant bacterial contamination of PIFs post production. As RTU feeds are now readily available in South Africa every attempt should be made to use a sterile RTU system for hospitalised infants