Steve Biko Academic Hospital Research Articles

Determination Of Patient Dosage Proficiency Regarding Paracetamol-Containing Products And Relation To Socio-Demographic Factors In The Tshwane District, South Africa.

Paracetamol is an active pharmaceutical ingredient used for the treatment of pain and fever. Consuming more than the recommended dose of paracetamol leads to hepatic- and renal toxicity. In South Africa paracetamol is easily available due to its assigned medicine scheduling status.The aim was to determine the dosage calculation proficiency of patients using paracetamol-containing products attending family medicine clinics in the Tshwane district, South Africa and to relate this to socio-demographic factors. This was a cross-sectional, descriptive observational study conducted in the Tshwane district at Pretoria West Hospital, Steve Biko Academic Hospital, Tshwane District Hospital and Kalafong Academic Hospital in Gauteng, South Africa. Semi-closed ended questionnaires were distributed to patients attending Family Medicine Outpatient departments (1 January 2016 to 31 May 2016).Only patientsconversantin the English language were included in the study.Descriptive statistics from the questionnaires were presented as frequency counts, percentages and cross tables.All exploratory testing was done at the 0.05 level of significance.Significant differences were observed between sex (p=0.029) and household income brackets (p=0.031). The participants alluded to using 50 unique paracetamol-containing products and 55% indicated the use of more than one such product in the recent past. Regarding proficiency in calculating the correct dose of paracetamol, 97% of the participants are at risk for possible overdose.It is proposed that the scheduling status of paracetamol-containing products be revisited.

Survival of patients with Kaposi's sarcoma in the South African antiretroviral treatment era: A retrospective cohort study.

When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi's sarcoma (KS) patients shifted from symptomatic palliation to potential cure. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403)cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.

Corrigendum: Uterine artery embolisation as an effective choice for symptomatic fibroids: Five-year outcome

No abstract available.

Prevalence of Squamous Cell Carcinoma of the Esophagus in a Single Tertiary Center of South Africa: A Cross Sectional Analytic Study.

The incidence of esophageal cancer varies widely in the world. In the Middle East, Africa, and Asia and parts of Europe, squamous cell carcinoma of the esophagus dominates the esophageal cancer landscape. Worldwide the rates are highest in Northern China, South Africa, Turkey and Iran. In the United States, the black population has a five-fold higher incidence of esophageal squamous cell carcinoma than the white population. To determine the prevalence of squamous cell carcinoma of the esophagus in a single tertiary center in South Africa. Patients referred to Gastroenterology Division of Steve Biko Academic Hospital for upper gastrointestinal endoscopy were recruited. Those with a known diagnoses of squamous cell carcinoma of the esophagus were recorded and those with suspicious lesions had biopsies done. These were then evaluated by an experienced histopathologist. 6118 patients were recruited. Squamous cell carcinoma was found in 59 patients giving us a prevalence of 0.96% 95%CI. The cancer was found mainly in back elderly males. The prevalence of squamous cell carcinoma of the esophagus in this single center study is 0.96%, 95% confidence interval and is a disease of black elderly males as seen elsewhere. Bigger multicenter studies are needed to further clarify this findings.

Tissue factor levels in type 2 diabetes mellitus.

Type 2 diabetes mellitus is a pandemic associated with disturbance in haemostasis that could contribute to the development of diabetic vascular disease and accelerated atherosclerosis. In this population, hypercoagulation is prevalent, as well as pathological changes to erythrocytes. This is mainly due to upregulated circulating inflammatory markers. Here we looked at tissue factor (TF) levels using ELISA, in a sample of diabetics, with and without cardiovascular complications. Diabetic subjects were recruited from the diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. 20 diabetics with cardiovascular disease and 22 without were enrolled to participate. TF levels were significantly elevated in both diabetic groups when compared to the controls. We suggest that pathologic plasma TF activity, as marker of increased propensity of clot pathology, should be investigated. Agents that might lower TF levels might also possibly lower thrombotic complications.

Cerebral white matter lesions after pre-eclampsia.

Women who have had pre-eclampsia in their previous pregnancies demonstrate a greater prevalence of cerebral white matter lesions several years after the pregnancy than women who have been normotensive during their pregnancy. Both the pathophysiology and the timing of development of these lesions are uncertain. White matter lesions, in the general population, are associated with an increased risk of stroke, dementia and death. The objective of the study was to determine the prevalence of cerebral white matter lesions amongst women with severe pre-eclampsia at delivery, 6months and 1year postpartum and to establish the possible pathophysiology and risks factors. This was a longitudinal study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria South Africa. Ninety-four women with severe pre-eclampsia were identified and recruited during the delivery admission. Magnetic resonance imaging (MRI) of the brain was performed post - delivery and at 6months and 1year postpartum. Cerebral white matter lesions were demonstrated in 61.7% of women at delivery, 56.4% at 6months and 47.9% at 1year. Majority of the lesions were found in the frontal lobes of the brain. The presence of lesions at 1year post-delivery was associated with the number of drugs needed to control blood pressure during pregnancy (OR 5.1, 95% CI 2.3-11.3, p<0.001). The prevalence of WMLs at 1year was double in women with chronic hypertension at 1year compared to those women who were normotensive (65.1% vs 32.3%). Women who require 2 or more drugs to control blood pressure during pregnancy have an increased risk of developing cerebral white matter lesions after delivery.

Barriers to obstetric care among maternal near misses.

There are several factors in the healthcare system that may influence a woman's ability to access appropriate obstetric care. To determine the delays/barriers in providing obstetric care to women who classified as a maternal near-miss. This was a descriptive observational study at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. One hundred maternal near-misses were prospectively identified using the World Health Organization criteria. The 'three-delays model' was used to identify the phases of delay in the health system and recorded by the doctor caring for the patient. One or more factors causing a delay in accessing care were identified in 83% of near-miss cases. Phase I and III delays were the most important causes of barriers. Lack of knowledge of the problem (40%) and inadequate antenatal care (37%) were important first-phase delays. Delay in patient admission, referral and treatment (37%) and substandard care (36%) were problems encountered within the health system. The above causes were also the most important factors causing delays for the leading causes of maternal near-misses - obstetric haemorrhage, hypertension/pre-eclampsia, and medical and surgical conditions. Maternal morbidity and mortality rates may be reduced by educating the community about symptoms and complications related to pregnancy. Training healthcare workers to identify and manage obstetric emergencies is also important. The frequency of antenatal visits should be revised, with additional visits in the third trimester allowing more opportunities for blood pressure to be checked and for identifying hypertension.

Symptomatic pelvic organ prolapse: Experience at a tertiary urogynaecology clinic

Background. Pelvic organ prolapse (POP) is a common reason for gynaecological consultation, especially in the elderly. Associated symptoms have been shown to negatively affect bladder, bowel and sexual function, as well as general quality of life. Treatment options include either surgical repair with mesh or native tissue, or conservative management with vaginal pessaries. There is a lack of data regarding POP in South African (SA) women. Objectives. To determine the demographic characteristics in patients presenting with symptomatic POP to a tertiary urogynaecology clinic, and to compare patients who opt for surgical treatment with those who request vaginal pessary insertion. Methods. The study was conducted at the urogynaecology clinic at Steve Biko Academic Hospital, Pretoria, SA. Demographic information was recorded after a detailed history, physical examination and completion of a self-administered symptom questionnaire. Results. A total of 305 patients were included in this study. The mean age was 62 (range 24 - 96) years and the mean vaginal parity was 3.7 (range 0 - 13); 147 patients opted for surgical intervention and 158 for pessary treatment. Cystocoele was the most common type of prolapse found on clinical examination. One-quarter of patients were sexually active (25.5%, n=242). Awareness and visualisation or feeling of a lump was the most common symptom reported. Age (p=0.004) and mean vaginal parity (p=0.003) were statistically significant in the pessary group. Finding of a cystocoele was significantly greater in patients who opted for pessary insertion (p=0.005). Conclusion. Patients who opt for vaginal pessary insertion are older and more vaginally parous than patients who opt for surgical intervention, and cystocoele was statistically more significant in women opting for pessary insertion.

The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study

IntroductionBreast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly. AimThe aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups. MethodThe study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009–2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically. ResultsOne hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and –noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16). ConclusionThese results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.

Flow cytometric analysis of platelets type 2 diabetes mellitus reveals 'angry' platelets.

BackgroundThe function of platelets have extended way beyond the horizon of haemostasis and thrombosis, and are recognised as active participants in vascular inflammation, as well as in prothrombotic complications of cardiovascular diseases. We describe and compare platelet function in type II diabetes (with and without cardiovascular manifestation) and healthy individuals using scanning electron microscopy and flow cytometry.MethodsThirty subjects were recruited per group and informed consent was obtained from all participants. Diabetic patients were recruited from the diabetic clinic of the Steve Biko Academic Hospital (South Africa). Blood samples were drawn from all participants so that platelet specific antigens were analyzed in citrated whole blood. The platelet parameters used in the study were platelet identifiers (CD41 and CD42) and markers of platelet activation (CD62 and CD63).ResultsResults show that, compared to healthy individuals, both diabetic groups showed a significant difference in both platelet identifiers (CD41-PE, CD42b-PE) as well as markers indicating platelet activation (CD62P-PE and CD63-PE).InterpretationThe flow cytometric data shows that the platelet surface receptors and platelet activation are statistically elevated. This is suggestive of enhanced platelet activation and it appears as if platelets are displaying ‘angry’ behaviour. The lysosomal granules may play a significant role in diabetes with cardiovascular complications. These results were confirmed by ultrastructural analysis.

Serious bacterial infections in febrile young children: Lack of value of biomarkers

Background. Serious infections in children are difficult to determine from symptoms and signs alone. Fever is both a marker of insignificant viral infection, as well as more serious bacterial sepsis. Therefore, seeking markers of invasive disease, as well as culture positivity for organisms, has been a goal of paediatricians for many years. In addition, the avoidance of unnecessary antibiotics is important in this time of emerging multiresistant micro-organisms. Objective. To ascertain whether acute-phase reactant tests predict positive culture results. Methods. A prospective, cross-sectional study over a 1-year period included all documented febrilechildrenunder the age of 5 years (with an axillary temperature ≥38°C) who presented to Steve Biko Academic Hospital, Pretoria, with signs and symptoms of pneumonia, meningitis and/or generalised sepsis. Every child had clinical signs, chest radiograph findings, urine culture, blood testing (full blood count, C-reactive protein, procalcitonin) and blood culture results recorded. Results. A total of 63 patients were enrolled, all of whom had an axillary temperature ≥38°C. C-reactive protein, procalcitonin and white cell count did not predict the presence of positive blood culture or cerebrospinal fluid culture results, nor infiltrates on chest radiographs. No statistically significant correlations were found between the duration of hospital stay and the degree of fever ( p =0.123), white cell count ( p =0.611), C-reactive protein ( p =0.863) or procalcitonin ( p =0.392). Conclusion. Biomarkers do not seem to predict severity of infection, source of infection, or duration of hospitalisation in children presenting to hospital with fever. The sample size is however too small to definitively confirm this viewpoint. This study suggests that clinical suspicion of serious infection and appropriate action are as valuable as extensive testing.

Usefulness of ultrasonography and biochemical features in the diagnosis of cholestatic jaundice in infants

Background. Biliary atresia is a common cause of cholestasis. In our experience, patients with biliary atresia are referred late, with the diagnosis based on an absent gall bladder at ultrasonography. Such late referrals may render patients inoperable and not acceptable for formal intraoperative diagnosis. Objectives. To determine the usefulness of an absent gall bladder on ultrasonography, and of biochemical features, in differentiating biliary atresia from other causes of cholestasis, using liver needle biopsy as a gold standard. Methods. A retrospective file review of 150 infants presenting with cholestasis to Steve Biko Academic Hospital Paediatric Gastroenterology and Hepatology Unit from January 2008 to August 2014 was undertaken. Clinical, serum biochemical, abdominal ultrasonography and liver histology findings were analysed. Three groups were compared, based on liver histology findings, consisting of patients with biliary atresia, neonatal hepatitis, and other diagnoses, respectively. Results. A total of 66/150 patients had biliary atresia, based on liver histology findings of extrahepatic obstruction. Their mean age was 4.7 (2.9) months, higher than in the other groups. In those with biliary atresia, the age at diagnosis, splenomegaly, and gamma glutamyl transferase (GGT), aspartate transaminase (AST) and GGT/AST ratio values were significantly different from the other groups. Total and conjugated bilirubin levels were similar among the groups. Ultrasonography was 69.7% sensitive, 98.8% specific and had a positive predictive value of 97.9% for biliary atresia. Ultrasonography missed 30.3% of patients with biliary atresia. Conclusion. Ultrasonography has poor sensitivity but good specificity in screening for biliary atresia; however, other investigations are necessary to confirm the diagnosis.

A paradoxical cause of hypoxia and orthodeoxia in a stroke patient

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The Prevalence of Helicobacter pylori Infection in Bleeding and Non -Bleeding Gastric Ulcers: A Cross-Sectional Case-Control Study

Introduction: Helicobacter pylori is a known and important cause of peptic ulcer disease, and can result in many different complications, both gastrointestinal and systemic. The gastric complications include upper gastrointestinal bleeding. The costs associated with testing and treatment of complications of H. pylori infection is also high, both in private and public setting. Studies in Iran showed high prevalence of H. pylori infection, with figures as high as 89.2% in the adult population. In South Africa, patients with bleeding gastric ulcers receive empirical eradication therapy, an expensive practice in a resource limited country like South Africa. It is for this reason that we conducted a case-control study to determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Aim: To determine the difference in prevalence of H. pylori infection in bleeding and non-bleeding gastric ulcers. Methods: In this prospective cross-sectional case-control study, a total of 173 patients who underwent upper endoscopy at Steve Biko Academic Hospital were recruited. All patients with gastric ulcer on upper endoscopy had antral mucosal biopsy taken and CLO test done on this specimen, in addition to the CLO test, the 42 with a history of upper gastrointestinal bleeding had additional biopsies send for histology for detection of H. pylori. The CLO tests were evaluated 24 h later and results documented as either positive or negative. Results: From the 173 patients enrolled, 131 patients were found to have no history of upper gastrointestinal bleeding, while 42 patients were found to be bleeding on upper endoscopy or had a recent history of bleeding. Of the total of 173, 134(77.5%) tested negative for H. pylori infection on CLO test and 39(22.5%) tested positive. Of the bleeding group, 7(16.7%) were CLO test positive and 35(83.3%) were negative. In the non-bleeding group of patients, 99(75.6%) were CLO test negative and 32(24.4%) tested positive. There was a 100% correlation between CLO test and histology. Of the bleeding group 35(83%) tested negative on both CLO test and histology and 7(16.7%) tested positive. Conclusion: The prevalence of H. pylori infection in this South African population with bleeding gastric ulcer was found to be lower than in patients with gastric ulcers that were not bleeding. This was, however not statistically significant (p value 0.404). To our knowledge there is no South African data for comparison with our study group. The sensitivity of CLO test was as high as histology. This finding suggests that CLO test can be used reliably in bleeding peptic ulcer.

Lung function decline is accelerated in South Africans with cystic fibrosis

Background: Poor nutritional status has been shown to be associated with a significant decline in lung function in patients with cystic fibrosis. There are few data published on the lung function decline and the effects of nutritional status in cystic fibrosis (CF) in South Africa. Aim: To assess anthropometric parameters (weight, height, body mass index Z-score) in relation to lung function parameters in CF patients. Methodology: A retrospective chart review of clinical records of participants over the age of five years attending the CF clinic at Steve Biko Academic Hospital from 2005 to 2010. Results: Twenty files were reviewed for lung function, anthropometric measurements, gender and CF-causing mutations. For anthropometric measurements the average changes were –0.8, –0.5 and 2.0 for weight, BMI and height Z-scores, respectively. A decline in FEV1 of –25.3 (95% CI 39.4; –13.3) over the five-year period was noted, with an average decline of 5.3% per year. For FEF25-75, the average change was –22.4 (95% CI-34.6; –10.2) with a decline of 4.5% per year. Using multivariate analysis, the FEV1 was found to be significantly influenced by: age –3.96 (95% CI –7.4; –0.5); p = 0.03, weight 1.8 (95% CI –3.4; –0.9); p = 0.04, BMI Z-score 4.3 (95% CI 5.3; 23.3); p = 0.02 and gender (p = 0.02). The FEF25-75 was significantly influenced by BMI Z-score and gender. Conclusion: The average lung function decline per year for FEV1 was higher than that seen in developed countries. The decline in FEV1 was related to gender, age, weight and BMI. The decline in FEF25-75 was affected only by BMI Z-score and gender.

Time to fibrinolytics for acute myocardial infarction: Reasons for delays at Steve Biko Academic Hospital, Pretoria, South Africa

Fibrinolytic therapy is a time-critical intervention proven to reduce mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Limited data exist in South Africa (SA) regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy. To establish the proportion of STEMI patients receiving fibrinolytic agents at Steve Biko Academic Hospital (SBAH), Pretoria, SA, identify any delays to receiving fibrinolytic agents, and uncover reasons for those delays. The number of lives lost as a result of these delays was calculated. This prospective, observational study included 100 consecutive patients presenting with a STEMI to SBAH. Using a researcher-administered questionnaire, the times from symptom onset to receipt of fibrinolytic therapy and the reasons for delays were documented. The number of lives lost was then calculated. Only 37% of patients received fibrinolytic therapy and only 3% received the medication within 1 hour. The median total delay in receiving fibrinolytic therapy was 270 minutes (range 45-584). The median time delays from onset of symptoms to call for help, between calling for help and arriving at hospital, and from hospital arrival to fibrinolytic agent administration, were 35 minutes (5-1 185), 55 minutes (12.5-670) and 62.5 minutes (16.5-282), respectively. Numerous delays were identified at all stages, with patient and transport delays being most significant. Strikingly, an additional 32 patients per 1000 treated could have been saved if a fibrinolytic agent had been administered within 1 hour. This study highlights the important problem of delayed or non-administration of fibrinolytic therapy at a tertiary hospital. The problems identified will contribute to the implementation of a robust STEMI management network in SA, similar to those in developed countries.

Severe pneumonia in HIV-infected and exposed infants in a paediatric ICU

Background. Pneumocystis jiroveci pneumonia is still a common cause of severe disease in HIV-infected infants <5 months of age. Despite attention to the prevention of mother-to-child transmission programme in South Africa (SA), HIV testing remains incomplete and infants are still at risk. The management of Pneumocystis pneumonia requires ventilation strategies and combination antibiotics. Methods. A prospective but open intervention was performed on all HIV-exposed patients admitted with severe pneumonia to the paediatric intensive care unit (PICU) at Steve Biko Academic Hospital, SA, during a 3-year period from January 2009 to December 2011. All patients were treated with ampicillin, amikacin, co-trimoxazole, prednisone and intravenous gancilovir. Highly active antiretroviral therapy (HAART) was initiated in the PICU as soon as tuberculosis was excluded and HIV status confirmed with an HIV viral load (VL). Routine blood and tracheal specimens were cultured for bacteria and tested by direct fluorescent antigen testing for P. jiroveci . Cytomegalovirus (CMV) VL was tested. All infants were ventilated in a standard fashion and none were oscillated. Results. A total of 87 patients were admitted during the 3-year period. Of these, 29 patients were excluded from the study because they were HIV-unexposed. Ten patients died during the 3-year period. In a multivariate analysis of the presence or absence of P. jiroveci , HIV VL, CD4 count, timing of HAART initiation and CMV VL, no single factor was documented to influence mortality. Conclusion. Mortality from Pneumocystis pneumonia continues to decrease in this PICU. No single factor is responsible and yet all therapeutic strategies contribute to survival. A national policy and guideline is urgently required.

A South African family with oculopharyngeal muscular dystrophy: Clinical and molecular genetic characteristics.

Autosomal dominantly inherited oculopharyngeal muscular dystrophy (OPMD) is caused by a trinucleotide repeat expansion in exon 1 of the polyadenylate binding protein nuclear 1 (PABPN1) gene on chromosome 14q. A large family with OPMD was recently identified in Pretoria, South Africa (SA). Molecular studies revealed a (GCG)11(GCA)3GCG or (GCN)15 mutant allele. The (GCN)15 mutation detected in this family has been described previously in families from Uruguay and Mexico as a founder effect. To our knowledge, this is the first report of an SA Afrikaner family with molecularly confirmed OPMD. The proband, a 64-year-old woman, presented to the neurology outpatient department at Steve Biko Academic Hospital, Pretoria. A sibship of 18 individuals was identified, of whom eight had OPMD. Four patients were interviewed and examined clinically, and electromyographic studies were performed. Molecular analysis of the PABPN1 gene was performed by polymerase chain reaction amplification and direct sequencing of exon 1 in three of the patients. Patients presented with ptosis, external ophthalmoplegia, dysphagia, dysarthria and mild proximal weakness. High foot arches and absent ankle reflexes raised the possibility of peripheral neuropathy, but electromyography showed only mildly low sensory amplitudes, and myopathic units in two patients.

What patients with bipolar disorder and major depressive disorder perceive as adverse life events precipitating a current major depressive episode

Background. Adverse life events (ALEs) as precipitants of a major depressive episode (MDE) have been the subject of many studies. These studies indicate an increase in ALEs in the 6 months preceding an MDE. Objectives. The study examined what participants, suffering from major depressive disorder (MDD) or bipolar disorder (BD), perceived as the precipitating ALE of a current MDE. The severity and categories of ALEs were compared between these two patient groups. Methods. Consenting, adult inpatients were sourced from Weskoppies Hospital, Steve Biko Academic Hospital, Tshwane District Hospital, Denmar Psychiatric Hospital and Vista Clinic in the Pretoria area. A semi-structured questionnaire was used to obtain demographic data and the diagnosis. Information regarding the course of the disorder, including the number of previous MDEs and the age at which the first MDE occurred, was also obtained. The perceived precipitating ALE was detailed for each participant. A severity value referred to as a Life Change Unit Score (LCU score), based on the Recent Life Changes Questionnaire (RLCQ) by Miller and Rahe, was then assigned to each participant’s perceived precipitant. Results. Of the 64 participants, 12.7 % were experiencing a first MDE. In those participants who had experienced prior episodes the average number (standard deviation (SD)) of previous episodes was 3.86 (2.46). The mean approximate age (SD) at first onset of an MDE was 24.81 (10.9) years. The BD group had significantly more previous MDEs than the MDD group. Although the average LCU scores were higher in the BD group than the MDD group this did not reach statistical significance. Therefore, this study could not find a difference in the severity of the perceived precipitants between the BD group and MDD group. However, when the LCU scores were analysed within subcategories of the RLCQ, it was found that participants with BD perceived significantly more problems associated with the workplace as precipitants of a current MDE than individuals with MDD. Conclusion. Most participants could link an ALE to the onset of a current MDE. The study did not find a differential response to ALEs between patients with BD and MDD. The severity of the social precipitants did not differ significantly between the two groups. The notion of a ‘kindling effect’ could not be supported by the outcome of this study. Because some study participants experienced ALEs not accounted for by the RLCQ, a more comprehensive assessment instrument may be more appropriate for similar studies.

The prevalence and associations of erectile dysfunction in a South African male diabetic urban population

Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa.Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined.Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheral neuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups.Conclusion: This study confirms th...