Browsing by Subject "Clinical Research"

Now showing 1 - 6 of 6
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    Brachytherapy and endoresection in the treatment of choroidal melanoma a review of patients treated in South Africa
    (2012) Rice, James C; Myer, Landon
    This study is a retrospective cohort analysis of patients undergoing two different treatment modalities (brachytherapy and endoresection) for medium sized choroidal melanoma. Study methods involve the collection of baseline and follow-up data from three sources: 1) A database collected by the department of Radiation Oncology at Groote Schuur Hospital; 2) Private physicians responsible for patient follow-up following brachytherapy; 3) Private physicians responsible for endoresection surgery and patient follow-up. To date there has been limited publication of the outcomes of patients treated for choroidal melanoma in South Africa. The study aims to compare the outcomes of these procedures to help identify the possible benefits of each form of treatment.
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    Investigation of the management of tuberculous pericarditis (IMPI) registry : survival and outcomes sub-study
    (2012) Mubanga, Mwenya; Ntsekhe, Mpiko; Myer, Landon; Mayosi, Bongani
    Includes abstract. Includes bibliographical references.
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    Methamphetamine use and HIV risk among severely mentally ill inpatients
    (2013) Moodley, Aneshree; Temmingh, Henk
    Sub-Saharan Africa accounts for 69% of the global HIV burden. Due to a variety of social, economic and behavioural factors, mentally ill patients are more likely to engage in high risk sexual behaviours. In turn, co-morbid substance use which is present in up to 75% of mentally ill patients is a leading risk factor for sexual risk behaviours. Worldwide methamphetamines are the most commonly used illicit stimulant. Both injectable and noninjectable methamphetamines have evidenced associations with high risk sexual behaviours. Smoking and inhalation of crystal methamphetamine is the predominant mode of use in South Africa. The use of crystal methamphetamine amongst mentally ill persons in Cape Town has escalated over the last decade. We aimed to determine the occurrence of methamphetamine use and risky sexual practices amongst mentally ill patients. In addition we aimed to explore the associations between methamphetamine use and HIV sexual risk behaviours in a sample of mentally ill inpatients in Cape Town, South Africa.
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    Outcomes of Human Immunodeficiency Virus infected children admitted to a paediatric intensive care unit in Cape Town, South Africa
    (2015) Salie, Mogamat Shamiel; Argent, Andrew C
    During the mid to late 1990's, nearly all HIV infected children admitted to South African paediatric intensive care units died. This was in the context of an increasing HIV epidemic in Sub-Saharan Africa, a limited number of intensive care beds in public hospitals and the South African government refusing to supply antiretroviral medication to public sector patients. HIV infected children all die without ARV medication, and it resulted in an increase in the South African under-5 mortality rate. In this context critically ill HIV infected children were often denied PICU admission. Developed countries introduced ARV medication in the early 1990's and the South African government only started supplying ARV medication in late 2003. When ARV medication became available in South Africa, it was started on the basis of the individual child's clinical and immunological status and there was not much published data on initiation of ARV therapy in critical ill children in intensive care units. Many HIV infected children had recurrent hospital admissions and many children died before initiating ARV medication. HIV infected children are not only susceptible to the normal bacteria and viruses, but at increased risk of opportunistic and mycobacterial infections. CMV has increasingly been recognized as a common co-infection with PCP, but has been difficult to diagnose and treat effectively. We retrospectively reviewed all HIV exposed and infected children admitted to our PICU in 2009. In addition to our standard treatment, we initiated ARV medication as soon as logistically possible and children with suspected CMV infections were empirically treated with gancyclovir.
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    Short-term treatment outcomes of children starting ART in the ICU, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children’s Hospital (RCWMCH): a retrospective cohort study
    (2014) Pillay, Vashini; Eley, Brian; Davies, Mary-Ann
    Short-term treatment outcomes of children starting ART in the ICU, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children’s Hospital (RCWMCH): A Retrospective Cohort Study. Background: Antiretroviral therapy (ART) has proven to decrease morbidity and mortality in HIV-infected children and improve immunologic, virologic and clinical outcomes. As clinical management policies evolved, an emphasis on early infant testing was adopted resulting in an increasing number of children being diagnosed and commenced on therapy before the onset of severe disease progression. However, a fair proportion still remain untested and subsequently present to hospital with advanced immunosuppression and severe disease. Since the advent of the 2013 national Standard Treatment Guidelines which encourage expedited initiation of ART within 7 days of HIV diagnosis in all children under the age of 12 months and in those with advanced immunosuppression, it is likely that many HIV-infected children are being initiated on ART during hospitalisation in South Africa. No local published data on these outcomes exist. We assessed the short-term outcomes of children initiated on ART in the intensive care unit (ICU), general medical wards (GMWs) and outpatient HIV clinics (OHCs) at RCWMCH. Methods: Structured Literature Review A Pubmed search looking at outcomes of treatment naïve HIV-infected children and adolescents up to 19 years of age living in South Africa commenced on 1st line ART regimens in accordance to the national guidelines presiding at the time, over a 10 year period was performed. This served to identify gaps in knowledge around paediatric ART in a South African context warranting further research. Retrospective Cohort Study We conducted a retrospective cohort study of HIV-infected children <13 years of age, commenced on first line ART between January 2008 and December 2011 at RCWMCH. Outcome measures included death, virologic suppression and changes in CD4 count and percentage. Kaplan-Meier estimates, multivariate Cox proportional hazard ratios and logistic regression were used to estimate outcomes 6 months after ART initiation. Results: Structured Literature Review This review identified several knowledge gaps. One of these gaps, the treatment outcomes of children started on ART at different service levels within tertiary health care settings was addressed in our retrospective cohort study and described in section C of this dissertation Retrospective Cohort Study Seven hundred and forty-nine children were included: 106 were commenced on ART in the ICU, 509 in the GMWs and 127 in the OHCs. Four hundred and ninety-two (65.7%) children were <12 months old. Children in the ICU and GMW cohorts were significantly younger than the OHC cohort (median ages: 3 and 5 months respectively vs. 22 months) and had lower WAZ scores (-2.48 and -2.33 respectively vs -1.14). Three hundred and eighty-five (51.4%) children qualified for rapid ART initiation within 7 days of HIV diagnosis or hospitalisation, based on CD4 criteria in the 2013 national Standard Treatment Guidelines. Overall mortality was 6.4% (CI: 4.9 - 8.4). Mortality was significantly higher in the ICU cohort i.e. 14 (13.2%) deaths compared to 28 (5.5%) and 5 (3.9%) deaths in the GMWs and OHCs cohorts, logrank p=0.004. Predictors of mortality included being moderately underweight HR 2.4 (CI: 1.1 – 5.2; p=0.02), severely underweight HR 3.2 (CI: 1.6 – 6.5; p=0.001), absence of caregiver counselling sessions HR 2.9 (CI: 1.4 – 6.0; p=0.005) and ART initiation in ICU HR 2.6 (CI: 1.4 – 4.9; p=0.003). Conclusion: The findings of our retrospective cohort study serve as a basis for understanding the implications of ART initiation in children during hospitalisation.
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    A systematic review of the association between pulmonary tuberculosis and the development of chronic airflow obstruction in adults
    (2012) Allwood, Brian; Bateman, Eric D; Myers, L
    Pulmonary tuberculosis (TB) as a cause of COPD is debated, with some, but not all evidence suggesting an association between the two conditions. Aim: To systematically review evidence for the association between pulmonary tuberculosis and the development of chronic obstructive pulmonary disease. We performed a systematic review of original English language, peer-reviewed literature using the PUBMED/MEDLINE database. Chronic Airflow Obstruction was defined on spirometric data (FEV1: FVC Ratio < 0.70; or FEV1: FVC Ratio < lower limit of normal for age, with or without bronchodilator use). Conclusions: Evidence was found for an association between a past history of tuberculosis and the presence of COPD. This association is independent of cigarette smoking. Causality is likely but cannot be assumed.