Briony Chisholm

Encephalopathy after persistent vomiting: Three cases of non-alcohol-related Wernicke's encephalopathy

Wernickes encephalopathy (WE) is a medical emergency. Although WE is commonly viewed in the context of alcoholism, it can be caused by thiamine deficiency secondary to persistent vomiting. Non-alcohol-related WE may be more catastrophic in onset and less likely to present with the classic features than WE with alcoholism as a cause. We describe three cases of WE due to persistent vomiting without alcoholism in patients with hyperemesis gravidarum, drug-induced hyperlactataemia, and an acute gastrointestinal illness in an already malnourished individual. Our cases highlight the importance of recognising WE when undernutrition, which may be caused by gastrointestinal disease or surgery, or malignancy, is compounded by vomiting. Expert guidelines suggest that WE must be considered in the emergency room in any individual with disturbed consciousness of unknown cause. Treatment is with parenteral thiamine before glucose administration.

The impact of the National HIV Health Care Worker Hotline on patient care in South Africa

BackgroundSouth Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail.ResultsA questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients.ConclusionsThe information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.

The impact of the National HIV Health Care Worker Hotline

To the Editor: The National HIV Health Care Worker (HCW) Hotline was established in 2008, in collaboration with the Foundation for Professional Development (FPD) and PEPFAR/USAID, to support the safe and effective roll-out of antiretroviral treatment in South Africa. It is based in the Medicines Information Centre, Division of Clinical Pharmacology, UCT, and has access to the latest information and numerous clinical experts. The toll-free hotline operates weekdays, 8h30 - 16h30, providing up-to-date information to all health care workers on aspects concerning the treatment of HIV infection and related diseases. Use of the service has consistently increased to over 300 calls a month. HCWs who called the hotline in August and September 2009 with patient-specific queries were asked to complete a standardised questionnaire which evaluated whether the information provided was used and how this affected patient care. The most frequent users of the hotline were doctors (69%), pharmacists (14%) and nurses (11%), which may reflect the fact that doctors remain predominant in decisions around HIV care. Of those who called the hotline with a clinical query, 96% reported that they changed their patient management as a result of the information provided. Most actions that were a consequence of the advice given concerned direct treatment-related decisions; these included treatment initiation (34%), dose adjustment (19%), discontinuation (44%) and change of ART. A substantial proportion of actions concerned the overall management of patients, such as the initiation of further diagnostic procedures, referrals to specialist services and hospital admissions. These figures demonstrate that the hotline is used for medicine-specific questions and the overall management of patients. Almost all callers interviewed confirmed that the information provided was useful, timely and of benefit to the patient. The public health sector aims to substantially increase the number of HIV-infected individuals receiving ART. Nurse-initiated management of ART (NIMART) is a goal of the Department of Health, 1

Free service at the Medicines Information Centre

It is a well-known fact that the vast majority of Muslims throughout the world have been and are being immunised against polio as well as other infectious diseases. To say that immunisation activities in Nigeria were brought to a halt because of ‘exhortation against immunisation by Islamic clerics’ on the basis of flimsy evidence is therefore unbecoming of somebody with a scientific background. In fact, according to a recent report, it is people with a political agenda who appear to be responsible for such a state of affairs. More often than not lack of education among the people themselves rather than the words of clerics is the root cause of the failure to institute a mass immunisation programme in such countries.