African Journal of Thoracic and Critical Care Medicine最新文献

{"title":"Bridging hope: South Africa’s ECMO reporting journey begins","authors":"G. Calligaro, D. Thomson","doi":"10.7196/ajtccm.2023.v29i4.1727","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i4.1727","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"38 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139211563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hidden epidemic of post-tuberculosis bronchiectasis","authors":"R. Perumal","doi":"10.7196/ajtccm.2023.v29i4.1728","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i4.1728","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilator-associated pneumonia is ubiquitous and troublesome","authors":"R. I. Raine","doi":"10.7196/ajtccm.2023.v29i4.1611","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i4.1611","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139214683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa","authors":"G. Titus, MMed Fcp SA MB ChB, S. Hassanali, Mbbs MMed Feldman BSc, DSc DMed honoris causa MB BCh","doi":"10.7196/ajtccm.2023.v29i4.1017","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i4.1017","url":null,"abstract":"Background. Bronchiectasis, once rarely encountered, appears to be increasing in prevalence in South Africa (SA) and globally. There is a lack of published data on non-cystic fibrosis (CF) bronchiectasis, specifically in low- to middle-income countries, despite the high rates of risk factors such as HIV, pulmonary tuberculosis, and other infections. Objectives. Given this lack of data, to review the characteristics of adult patients with non-CF bronchiectasis at a tertiary academic hospital in Johannesburg, SA. Methods. This was a single-centre, retrospective record review, including all cases of non-CF bronchiectasis that were in the records of the adult pulmonology clinic at Charlotte Maxeke Johannesburg Academic Hospital as of April 2017. Results. There were 197 patients, with a slight predominance of males, and the patients were generally young. The HIV rate was higher than the national average (34.8% v. 13.7%), and the HIV-positive patients had a high TB prevalence (86.9%). Pseudomonas spp. were cultured from sputum in 15.3% of cases. Fewer than half of the cohort had the diagnosis of bronchiectasis confirmed by high-resolution chest tomography. Airway obstruction (forced expiratory volume in 1 second/forced vital capacity ratio <70%) was observed in 47.0% of patients. Treatment with a short-acting beta-2-agonist was prescribed in 62.9%, a long-acting beta-2-agonist in 43.6% and inhaled corticosteroids in 51.3%. Antibiotic therapy during exacerbations was used in 44.2%, mainly amoxycillin-clavulanate (66.7%). Conclusion. While single centre and retrospective, this study adds to the data on non-CF bronchiectasis in sub-Saharan Africa and should encourage further research to increase our understanding of adult non-CF bronchiectasis in SA.","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139209220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal membrane oxygenation in South Africa: Experience from a single centre in the private sector.","authors":"N L F van Zijl, J T Janson, M Sussman, A Geldenhuys","doi":"10.7196/AJTCCM.2023.v29i4.211","DOIUrl":"10.7196/AJTCCM.2023.v29i4.211","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) is an advanced, resource-intensive technology used in a limited capacity in South Africa (SA). Minimal data on the use of ECMO in SA are available.</p><p><strong>Objectives: </strong>To describe the indications, early outcome and comorbidities of patients placed on ECMO in the highest-volume ECMO centre in SA.</p><p><strong>Methods: </strong>We performed a single-centre retrospective review of all adult patients supported with any form of ECMO from August 2016 to December 2018. Operative and clinical records were reviewed. The primary objective of this study was to review the outcome of patients placed on ECMO in the form of survival to hospital discharge. The secondary objectives were to identify population-specific comorbidities and indications for ECMO that could be associated with non-survival and to compare outcome with known risk scores in the form of the Respiratory ECMO Survival Prediction (RESP) and Survival After Venoarterial ECMO (SAVE) scores.</p><p><strong>Results: </strong>One hundred and seven patients were identified. The primary indication for ECMO was respiratory support in 78 patients and cardiac support in 29 patients. Forty-seven patients were discharged from hospital, with a 44.0% overall survival rate. Gender (p=0.039), age (p=0.019) and hypertension (p=0.022) were associated with death in univariate logistic regression analysis. However, after adjusting for potential confounding in multivariate logistic regression analysis, the association was no longer significant. In the all respiratory support group, patients in risk class IV had better than predicted survival according to the RESP score, while risk classes I, II and III had worse than predicted survival. In the circulatory support group, all risk classes had worse than predicted survival according to the SAVE score.</p><p><strong>Conclusion: </strong>We report ECMO outcomes in SA for the first time. We identified very high mortality rates for patients transferred on ECMO from other facilities and for patients converted from venovenous ECMO to venoarterial ECMO. Although our outcomes were comparable in some of the risk classes, further external validation of the SAVE and RESP scores will be needed to compare our outcomes with these scores.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> We report on extracorporeal membrane oxygenation (ECMO) outcomes in South Africa for the first time. We identified a high mortality rate in patients transferred on ECMO from other facilities, and in patients converted from venovenous ECMO to venoarterial ECMO.<b>Implications of the findings.</b> Transferred patients had a high mortality rate. The reason for this should be further investigated and may highlight the need for possible protocols to assist with appropriate timing of patient transfers and possible earlier intervention or transfer.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 4","pages":"e211"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should a drain be inserted?","authors":"M J Mpe","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 4","pages":"e719"},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilator-associated pneumonia in an academic intensive care unit in Johannesburg, South Africa.","authors":"S Mazwi, S A van Blydenstein, M Mukansi","doi":"10.7196/AJTCCM.2023.v29i4.154","DOIUrl":"https://doi.org/10.7196/AJTCCM.2023.v29i4.154","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) has an estimated incidence of 10 - 41.5 events per 1 000 ventilator days in developing countries, and carries high mortality. Little is known about the incidence and outcomes of VAP in Johannesburg, South Africa.</p><p><strong>Objectives: </strong>To describe VAP in a tertiary public hospital in Johannesburg, assess the microbiological pathogens associated with VAP (both early and late), and outline the outcomes of these patients.</p><p><strong>Methods: </strong>The study was a retrospective record review of patients admitted to the Helen Joseph Hospital intensive care unit (ICU) between March 2013 and January 2016.</p><p><strong>Results: </strong>VAP developed in 24/842 ventilated patients (2.9%; 95% confidence interval (CI) 1.8 - 4.2), with an incidence of 23 events per 1 000 ventilator days, during the study period. Of these patients, one-third (29.2%) died and 70.8% were discharged from the ICU. Late-onset VAP (onset ≥5 days after intubation, incidence 45.8%) was associated with higher mortality (54.6%) than early-onset VAP (onset within 4 days after intubation, incidence 54.2% and mortality 7.7%). Commonly isolated organisms were <i>Klebsiellai</i> <i>pneumoniae</i>, <i>Acinetobacter</i> <i>baumannii</i> and <i>Pseudomonas</i> aeruginosa. There was a trend towards an increased risk of multidrug-resistant organisms with late-onset VAP (adjusted relative risk 2.26; 95% CI 0.92 - 5.57; p=0.077) and airway access through a tracheostomy (relative risk 1.68; 95% CI 0.78 - 3.57).</p><p><strong>Conclusion: </strong>The study showed a low to moderate incidence of VAP of 23 events per 1 000 ventilator days. A tracheostomy and late-onset VAP were associated with infection by drug-resistant organisms. The mortality rate was 29.2% in this setting, with a seven-fold increase in mortality with late-onset VAP.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This study helps to improve understanding of the incidence of ventilator-associated pneumonia in South Africa, a low- to middle-income country, and the commonly encountered causative pathogens. It indicates the importance of a short intensive care unit (ICU) stay as a target outcome for prevention of nosocomial infections and other complications.<b>Implications of the findings.</b> The study: reinforces the importance of preventive mesures in the ICU and keeping up to date with the evidence in the fieldhighlights the importance of knowing local microbial resistance patterns in order to develop precise antibiogramsshows the need for research in ICU care for people of advanced age, and the impact that admission rationing has on our ICU populations.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Silicosis and silicotuberculosis: Ancient diseases that are still not conquered.","authors":"W A J Meintjes","doi":"10.7196/AJTCCM.2023.v29i3.1495","DOIUrl":"10.7196/AJTCCM.2023.v29i3.1495","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A point-prevalence study of body mass indices in HIV-positive and HIV-negative patients admitted to hospital with COVID-19 in South Africa.","authors":"A Parker, A G B Broadhurst, M S Moolla, L Amien, R Ahmed, J J Taljaard, G Meintjes, P Nyasulu, C F N Koegelenberg","doi":"10.7196/AJTCCM.2023.v29i3.660","DOIUrl":"https://doi.org/10.7196/AJTCCM.2023.v29i3.660","url":null,"abstract":"<p><strong>Background: </strong>Obesity is now well recognised as a risk factor for severe COVID-19, but the true prevalence of obesity in hospitalised adults with COVID-19 remains unclear because formal body mass indices (BMIs) are not routinely measured on admission.</p><p><strong>Objectives: </strong>To describe the true prevalence of obesity measured by the BMI, and associated comorbidities, in patients hospitalised with severe COVID-19, including people with HIV (PWH).</p><p><strong>Methods: </strong>We conducted a point-prevalence study of measured BMI in consecutive patients with severe COVID-19 admitted to the medical COVID-19 wards in a tertiary academic hospital in Cape Town, South Africa (SA). Patients were enrolled over a 2-week period during the peak of the first COVID-19 wave in SA.</p><p><strong>Results: </strong>We were able to measure the BMI in 122 of the 146 patients admitted during the study period. The prevalence of HIV was 20% (n=24/122). Most of the participants were overweight or obese (n=104; 85%), and 84 (68.9%) met criteria for obesity. The mean (standard deviation) BMI was 33 (7.5), and 34.5 (9.1) in PWH. Of PWH, 83% (n=20/24) were overweight or obese and 75% (n=18) met criteria for obesity. Multimorbidity was present in 22 (92%) of PWH.</p><p><strong>Conclusion: </strong>We found that most patients, including PWH, met criteria for being overweight or obese. The high prevalence of obesity in PWH and severe COVID-19 reinforces the need for targeted management of non-communicable diseases, including obesity, in PWH.</p><p><strong>Study synopsis: </strong>What the study adds. We found that the true prevalence of obesity, including in people with HIV (PWH), measured with the formal body mass index in hospitalised patients with severe COVID-19 was much higher than reported previously.Multimorbidity was present in over half of all patients, and in 92% of PWH. Implications of the findings. Urgent public health measures are required to tackle the rise in obesity, including in low- and middle-income countries.HIV care must integrate management of non-communicable diseases, including obesity.The pathogenic mechanism of the link between obesity and severe COVID-19 needs further research.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic thromboembolic pulmonary hypertension: More options, more awareness.","authors":"B W Allwood, L Joubert, J Janson","doi":"10.7196/AJTCCM.2023.v29i3.1496","DOIUrl":"10.7196/AJTCCM.2023.v29i3.1496","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"29 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}