Mono- and polyresistant tuberculosis at TB focal point, Helen Joseph Hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine Johannesburg 2015Drug resistant (DR) tuberculosis (TB) is a rapidly emerging health problem in the Republic of South Africa (RSA). Multidrug resistant TB attracts a great deal of scientific attention not only worldwide but also in RSA, however, mono- and polyresistant TB is a relatively under studied disease entity. This study explored the demographics and characteristics of the types of mono- and polyresistant TB groups, and tried to determine if there were any associations between type of TB resistance and treatment outcome. The cohort studied consisted of 194 patients who had attended the Helen Joseph Hospital TB Focal Point. There were five major types of DR TB identified, including rifampicin (RIF) monoresistant (34%, 66 patients), isoniazid (INH) monoresistant (32.5%, 63 patients), INH polyresistant (20.1%, 39 patients), RIF polyresistant (4.6%, 9 patients) and phenotypically sensitive TB (8.9%, 17 patients). A concerning figure of 86.6% of the DR TB cohort tested HIV positive, compared to the national population where 10.2% are reported HIV positive. The median CD4 was 67 cells/mm3, and 30.4% of the HIV positive patients had a CD4 count of less than 50 cells/mm3. Only 36.6% of the HIV positive patients were on antiretroviral therapy at time of DR TB diagnosis. Neither serum albumin nor haemoglobin were found to be significant markers for the prediction of outcome in DR TB, and no significant differences in DR TB type nor outcome were found when looking at age groups and gender. Although the numbers were small RIF monoresistant TB emerged as the most common type of DR TB (34%), and as such represents a clinical entity that should be considered separately from MDR TB. Unfortunately due to small sample sizes, no significant interpretation could be made regarding the various subgroups of DR TB and the genetic mutations to understand if there are differences in clinical presentation, mortality and morbidity predictors and outcome, and this is a field that requires further investigation

Time to thrombolysis and factors contributing to delays in patients presenting with ST-elevation myocardial infarction at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Background. Acute coronary syndrome is a public health burden both worldwide and in South Africa (SA). Guidelines recommend thrombolysis within 1 hour of symptom onset and 30 minutes of hospital arrival for patients with ST-elevation myocardial infarction (STEMI) in order to prevent morbidity and mortality. There is a paucity of data pertaining to the time between onset of chest pain and thrombolysis in STEMI patients in SA. Objectives. To elucidate the time to thrombolytic therapy, establish the reasons for treatment delays, and calculate the loss of benefit of thrombolysis associated with delays in treatment of patients presenting with STEMI at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA. Method. A prospective observational study of 100 consecutive patients with STEMI was conducted at CHBAH (2021 - 2022). Results. The mean (standard deviation) age was 55.6 (11.6) years, with a male predominance (78%). Thrombolytic therapy was administered to 51 patients, with a median (interquartile range (IQR)) time to thrombolysis of 360 (258 - 768) minutes; 10 of the patients who received a thrombolytic (19.6%) did so within 30 minutes of arrival at the hospital. The median (IQR) time from symptom onset to calling for help was 60 (30 - 240) minutes, the median time from arrival of help to hospital arrival was 114 (48 - 468) minutes, and the median in-hospital delay to thrombolysis after arrival was 105 (45 - 240) minutes. Numerous reasons that led to delay in treatment were identified, but the most frequent was prehospital delays related to patient factors. Late presentation resulted in 26/49 patients (53.1%) not receiving thrombolytic therapy. Five patients died and 43 suffered from heart failure. Thirty per 1 000 participants could have been saved had they received thrombolytic therapy within 1 hour from the onset of chest pain. Conclusion. Prehospital and hospital-related factors played a significant role in delays to thrombolysis that led to increased morbidity and mortality of patients with STEMI

SARS-CoV-2 Ct values and COVID-19 symptoms in patients with haematological malignancies in South Africa

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (Ct) values serve as surrogate markers for estimating viral load. Their usefulness in patients with haematological malignancies and COVID-19 has not been studied in the South African context. Objectives: To evaluate if a Ct value 30 can predict COVID-19 symptom development in adult patients with haematological malignancies. Method: A retrospective cohort study on adult patients with haematological malignancies and COVID-19 was conducted at Chris Hani Baragwanath Academic Hospital from 01 July 2020 to 31 July 2021. The relationship between Ct values, symptoms and disease severity, along with changes over time were evaluated. Results: Among 53 patients (50.9% male, median age of 38 years), Ct values 30 did not significantly predict COVID-19 symptom development (p = 0.417). However, severe disease correlated with lower Ct values (p = 0.002). No significant difference in the duration (days) from positive to negative tests was found between symptomatic and asymptomatic patients, and by severity of disease in the symptomatic patients. Lymphopenia was associated with severe disease, and those with lymphoid malignancies experienced longer viral shedding. Conclusion: Patients with haematological malignancies can exhibit symptoms at any Ct value but lower Ct values indicate more severe disease. This information can be critical for chemotherapy timing to minimize adverse outcomes. Contribution: The findings suggest a potential benefit in delaying chemotherapy at any Ct value as patients could present with acute SARS-CoV-2 infection at higher Ct values, and therefore face increased risk of adverse outcomes with early chemotherapy initiation

The survival of velvet mesquite (Prosopis juliflora var. velutina) after fire

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