Steve A.S. Olorunju

Factors associated with female high-risk drinking in a rural and urban South African site

OBJECTIVE To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa. DESIGN Cross-sectional household survey using multistage sampling methods. Setting. A rural wine farming area of the Western Cape and an urban site in Gauteng. Subjects. Women of reproductive age (18 - 44 years). Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into high- and low-risk drinkers. RESULTS Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never/seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers. CONCLUSIONS High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.

Efficacy of a pectin-lecithin complex for treatment and prevention of gastric ulcers in horses.

The objective of this study was to evaluate the effect of a commercial feed supplement containing pectin-lecithin on squamous mucosa ulceration in horses exposed to an experimental ulceration model. Five mares were treated while five mares were controls for this crossover, blinded study. The mares were fed concentrates and hay and were stabled with a two-hour turn out per day for a period of four weeks. The pectin-lecithin complex was fed for the duration of the study on the treated group. At the end of a four-week period, all mares underwent a seven-day alternating feed deprivation (week 5). The study was repeated again after a four-week washout period. Gastroscopy was performed on days 1, 28 and 35 of the study and was digitally recorded. Independent evaluation of the recordings and scoring of the lesions using the Equine Gastric Ulcer Syndrome (EGUS), severity and number scores were performed by three experienced gastroscopists. The prevalence and severity of squamous ulcers significantly increased after intermittent feed deprivation (P<0.001). No significant effect of the treatment was observed (P>0.05). In this study, the addition of a commercially available pectin-lecithin complex to the feed of horses for five weeks did not prevent or minimise the risk for gastric ulceration of the squamous mucosa.

Cytomegalovirus viral load kinetics in patients with HIV/AIDS admitted to a medical intensive care unit: a case for pre-emptive therapy.

Background Cytomegalovirus (CMV) infection is associated with severe diseases in immunosuppressed patients; however, there is a lack of data for pre-emptive therapy in patients with HIV/AIDS. Method This was a retrospective study, which enrolled patients diagnosed with HIV/AIDS (CD4<200 cells/μl), who had detectable CMV viral load (VL) during their stay in an adult medical intensive care unit between 2009–2012. Results After screening 82 patients’ records, 41 patients met the enrolment criteria. Their median age was 37 (interquartile range [IQR]: 31–46), and median CD4 count was 29 cells/μl (IQR: 5–55). Sixteen patients (39%) had serial measurements of CMV VL before treatment with ganciclovir. Patients whose baseline CMV VL values were between 1,000–3,000 copies/ml had significantly higher values (median of 14,650 copies/ml) on follow-up testing done 4–12 days later. Those with undetectable VLs at baseline testing had detectable VLs (median of 1,590 copies/ml) mostly within 20 days of follow-up testing. Patients who had VLs >1,000 copies/ml at baseline testing had significantly higher mortality compared to those who had <1,000 copies/ml {hazard ratio of 3.46, p = 0.003 [95% confidence interval (CI): 1.55–7.71]}. Analysis of the highest CMV VL per patient showed that patients who had VLs of >5,100 copies/ml and did not receive ganciclovir had 100% mortality compared to 58% mortality in those who received ganciclovir at VLs of >5,100 copies/ml, 50% mortality in those who were not treated and had low VLs of <5,100 copies/ml, and 44% mortality in those who had ganciclovir treatment at VLs of <5,100 copies/ml (p = 0.084, 0.046, 0.037, respectively). Conclusion This study showed a significantly increased mortality in patients with HIV/AIDS who had high CMV VLs, and suggests that a threshold value of 1,000 copies/ml may be appropriate for pre-emptive treatment in this group.

Comparison of equations for the calculation of LDL-cholesterol in hospitalized patients

BACKGROUND The Friedewald equation is widely used to calculate LDL-C for cardiovascular risk prediction but is less accurate with comorbidities and extreme lipid values. Several novel formulae have been reported to outperform the Friedewald formula. METHODS We examined 14,219 lipid profiles and evaluated four formulae (Friedewald, Chen, de Cordova, Hattori) and compared these to direct measurement of LDL-C across various triglyceride (TG), total cholesterol (TC) and HDL-cholesterol (HDL-C) ranges using Beckman reagents and instruments. Linear regression and ROC analysis were performed. RESULTS The de Cordova formula showed a high correlation with directly measured LDL-C (r=0.90, P<0.001), comparable to the Friedewald calculated values for directly measured LDL-C (r=0.95, P<0.001). The de Cordova formula was favorable in some ranges of HDL, TC and the lowest TG range (r=0.97, P<0.001) but performed least well in comparison with the three other LDL-C calculations (AUC=0.8331), demonstrating inconsistent bias. The Chen formula performed better than Friedewald (AUC=0.9049). The Hattori formula outperformed all formulae including Friedewald over various ranges of lipid values (AUC=0.9097). CONCLUSIONS We observe favorable correlations of the de Cordova formula with Friedewald at low TG values. However, the Hattori formula appears to be best for application in hospitalized patients, even at extreme lipid values.

Phenotypic expression of the 3120+1G>A mutation in non-Caucasian children with cystic fibrosis in South Africa

INTRODUCTION Cystic fibrosis (CF) is the most common genetic disorder in Caucasians. Presentation of CF in non-Caucasians is less well studied. OBJECTIVE This audit was undertaken to determine the phenotypic expression of the 3120+1G>A mutation in black and mixed race children in South Africa. METHODS A multi-centre retrospective chart review of clinical, laboratory and spirometry data of non-Caucasian CF patients in four CF centres in South Africa was collected. Data was collected at diagnosis and after a five-year follow-up period. Ethical approval was granted for the study. RESULTS A total of 30 participants were enrolled of whom 14 (47%) were homozygous and 16 (53%) heterozygous for the 3120+1G>A mutation. The mean age of diagnosis was 13 months. Twenty-four (80%) patients had malnutrition (mean weight z-score -3.6) or failure to thrive (77%) at presentation. Twenty (67%) presented with non-specific abdominal symptoms, whilst fifteen (50%) had recurrent respiratory tract infections. Pseudomonas aeruginosa was detected at a mean age of 21 months. The mean FEV1 was 73% predicted (95% CI 54.0-91.1) at study entry and 68% predicted (95% CI 49.74-87.06) at follow-up. CONCLUSION Failure to thrive and a diagnosis of protein energy malnutrition (kwashiorkor) are the common presenting features of CF in children with the 3120+1G>A mutation. Meconium ileus is a rare presenting feature of CF in black and mixed race children with this deletion in South Africa.

Postictal headache in South African adult patients with generalised epilepsy in a tertiary care setting: A cross-sectional study

Postictal headache (PIH), although it occurs in 34–59% of epilepsy patients, has not been adequately studied. This study aims to describe clinical characteristics and associations of PIH in generalised epilepsy in a South African tertiary neurology clinic. Methods: Two-hundred consecutive adults with generalised epilepsy underwent semi-structured interviews, dividing them into study (with PIH) and control patients (no PIH), and data was statistically analysed. Results: PIH occurred in 104/200, with 63% having headache after every seizure. Pain duration was 4–24 hours in 43% and pain intensity severe in 55%. The criteria of the International Headache Society (2004), International Classification of Headache Disorders, second edition (ICHD-II) classified 47% as migraine, 38% tension-type and 15% unclassified (but 13% probable migaine). Self-medication occurred in 81% and interictal headache was significantly associated with PIH—present in 64% of study patients versus 5% of control patients. Conclusion: PIH occurs commonly in generalised epilepsy, mostly as migraine headache, with interictal headache a specific risk factor. PIH is underdiagnosed and undertreated, leading to self-medication. Optimal management should be elucidated in future studies.

Adiponectin and atherosclerosis risk factors in African hemodialysis patients: a population at low risk for atherosclerotic cardiovascular disease.

Atherosclerotic cardiovascular disease (CVD) is the major cause of morbidity and mortality in hemodialysis (HD) patients. Adiponectin (ADPN), a recently discovered collagen‐like protein, is secreted exclusively by adipocytes. It has anti‐atherogenic properties and reduced serum ADPN levels have been shown to be predictive of cardiovascular events. In this study, we determined the atherosclerotic risk and the significance of ADPN levels in our HD patients and also examined its relationship to other traditional CVD risk factors. A cross‐sectional study of 84 patients on maintenance HD (58 Blacks and 26 non‐Blacks) and 63 healthy controls matched for age, sex and race (35 Blacks and 28 non‐Blacks) was undertaken. Serum ADPN levels and other risk factors, including blood pressure, serum lipid, and C‐reactive protein, were studied in HD patients and were compared with the controls. Carotid artery intima‐media thickness and plaque occurrence was measured by B‐mode ultrasonography while echocardiography was done according to American Society of Echocardiography guidelines. Serum ADPN levels were higher in the HD group compared with the control subjects (22.19 ± 0.98 μg/mL vs. 9.93 ± 0.68 μg/mL; P < 0.001). Higher ADPN levels in HD patients were associated with lower triglyceride levels. ADPN correlated positively (r = 0.49, P < 0.0001) with left ventricular mass index (LVMI) in the total study population. ADPN levels were raised in HD patients and correlated with LVMI, possibly because of the confounding effect of low glomerular filtration rate. ADPN levels were inversely related to risk factors for atherosclerosis and may provide possible targets for therapeutic interventions.

A radiological evaluation of alveolar bone regeneration between the left and right mandibles and maxillae of the Chacma baboon

There is a lack of information in comparing the healing rate between the left and right sides of the maxilla and mandible. Osteogenesis of alveolar bone was evaluated with digital radiology by comparing differences in bone density (BD) at different time points within the left and right maxilla and mandible. Alveolar bone defects were created in five healthy Chacma baboons. Standardised x-ray images were acquired over time and the densities of the selected trauma areas were measured pre-operatively, post-operatively and at 3 and 6 weeks post-operatively. Differences in densities were statistically tested. There was no significant difference when the grey scale averages of the combined first and fourth quadrants (right side) and combined second and third quadrants (left side) were compared pre-operatively (t = 0.70), immediately post-operatively (t = 0.34), 3 weeks post-operatively (t = 0.40) and 6 weeks post-operatively (t = 0.66). There was also no significant difference between the values for the first and second quadrants (maxilla) pre-operatively (t = 0.37), immediately post-operatively (t = 0.30), 3 weeks post-operatively (t = 0.30) and 6 weeks post-operatively (t = 0.38); the third and fourth quadrants (mandible) were also not significantly different pre-operatively (t = 0.29), immediately post-operatively (t = 0.69), 3 weeks post-operatively (t = 0.07) and 6 weeks post-operatively (t = 0.06). However, the results showed an increased predisposition of the right side to regenerate faster than the left side and indicated sufficient information to investigate the effect of laterality and preferred side of mastication on the rate of healing and alveolar BD in the maxilla and mandible.

Prevalence of dental disorders in an abattoir population of horses in South Africa by oral examination of intact and bisected heads.

Dental care is an integral part of equine veterinary practice. The objectives of this cross sectional study were to describe the prevalence of dental disorders in an abattoir population of horses, and to compare oral examination of intact and bisected heads. Heads from 40 horses, 19 males and 21 females, were examined and divided into immature, adult or older horses based on dental age. Older horses had a significantly higher prevalence of infundibular caries (91.7%), diastemata (66.7%) and fractures (58.3%), whereas dental wear disorders affected all age groups. Gasterophilus spp. larvae were detected in 20% of the horses. A short oral examination performed on intact heads was adequate for diagnosing major disorders, but the occurrence of many conditions had only fair to poor agreement with the bisected heads. A more detailed oral examination may be needed for reliable diagnosis of many disorders.

Patterns of adherence to scheduling and dietary instructions among patients on antiretroviral therapy in Pretoria, South Africa.

BACKGROUND Adherence in antiretroviral therapy (ART) is the extent to which the HIV-infected persons behavior corresponds to the prescribed medical advice in terms of using antiretroviral (ARV) drugs. Adherence includes acts such as following instructions regarding dietary or fluid restrictions and taking medications at the prescribed time. This study aimed to determine the extent to which persons on ART followed the scheduling and dietary instructions of their ARV drugs. METHODS This was a cross-sectional descriptive study among 232 adult HIV-infected persons on ART using the AIDS Clinical Trials Group questionnaire. RESULTS Based on self-reported adherence, 89.6% (208/232) of the participants reported complete adherence with regards to taking their prescribed medications. The specific dosing schedule of their ARV drugs was strictly followed by 47.4% (110/232) of the participants. Of the 146 patients with specific dietary instructions on how to take their ARVs, only 43.1% (63/146) followed them all of the time, 10.9% (16/146) never followed these instructions and 45.8% (67/146) partially followed these instructions. Participants who were unemployed were twice more likely to adhere to ART dosing schedules compared to others (OR=1.75; CI: 1.03-2.96; p=0.05). CONCLUSIONS Participants in this study were adherent to taking prescribed medications only. They were found to be non-adherent to instructions regarding dietary or fluid restrictions and medication prescription time.