African Journal of Thoracic and Critical Care Medicine最新文献

{"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}

{"title":"Vitamin B12 deficiency presenting with pulmonary embolism: An unusual presentation","authors":"L W Ndaba, S A Van Blydenstein, K E Hodkinson","doi":"10.7196/ajtccm.2023.v29i3.285","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i3.285","url":null,"abstract":"-","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135108527","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":"Silicosis and silicotuberculosis among respiratory hospital admissions: A cross-sectional survey in northern Tanzania.","authors":"E Dennis, H Mussa, M P Sanga, P Howlett, G Nyakunga","doi":"10.7196/AJTCCM.2023.v29i3.269","DOIUrl":"10.7196/AJTCCM.2023.v29i3.269","url":null,"abstract":"<p><strong>Background: </strong>There is little evidence describing respiratory disease among 40.5 million small-scale miners worldwide.</p><p><strong>Objectives: </strong>To describe the prevalence and clinical characteristics of adult respiratory inpatients with silicosis and silicotuberculosis in a tertiary hospital in Tanzania that serves a small-scale mining region.</p><p><strong>Methods: </strong>In this retrospective, cross-sectional survey, patient files from admissions between 2010 and 2020 were opportunistically selected and included if a respiratory diagnosis had been made.</p><p><strong>Results: </strong>Of 223 patients with respiratory conditions, 32 (14.3%; 95% confidence interval (CI) 10.0 - 19.6) were diagnosed with silicosis and 17 (7.6%; 95% CI 4.5 - 11.9) with silicotuberculosis. Mining was the most frequent occupation in those with silicosis (n=15/32; 46.9%) and silicotuberculosis (n=15/17; 88.2%). Of those with silicosis or silicotuberculosis, 26/49 (53.1%) were aged <45 years.</p><p><strong>Conclusion: </strong>Our study suggests that silicosis and silicotuberculosis are common among male and female respiratory inpatients with occupational exposure. The study highlights the role of occupational exposures in respiratory disease in developing economies.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This retrospective, cross-sectional survey describes the prevalence of silicosis and silicotuberculosis among adult respiratory inpatients admitted to a tertiary hospital in northern Tanzania. It is the first study to describe the prevalence and characteristics of respiratory inpatients with silicosis and silicotuberculosis in a small-scale mining region of Africa. A high prevalence of silicosis (14.3%) and silicotuberculosis (7.6%) was found. Patients were often aged <45 years, and the majority required oxygen therapy.<b>Implications of the findings.</b> The high prevalence of advanced silicosis and silicotuberculosis in miners presenting at a young age raises concerns about high occupational silica exposures and, importantly, suggests a need for community-based research, which our team is planning to undertake.</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/PMC10642396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650520","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":"Which side are they on? A review and case series of diagnosing primary ciliary dyskinesias in low- or middle-income countries.","authors":"S P Surdut, E Van der Merwe, P Goussard, M F Urban","doi":"10.7196/ajtccm.2023.v29i3.425","DOIUrl":"https://doi.org/10.7196/ajtccm.2023.v29i3.425","url":null,"abstract":"Primary ciliary dyskinesia (PCD) is a rare genetic condition with a variable clinical presentation, making its diagnosis a challenge. The authors describe two unrelated sibling pairs with PCD: adult siblings in the first and perinatal/neonatal in the second. Both families highlight the commoner and less common clinical manifestations of PCD. The authors use these cases to highlight (1) the current understanding of the underlying genetic and pathophysiological mechanisms of PCD, (2) the range of cardiac and respiratory features of PCD across a wide age-range (3), aspects of history and clinical exam that should raise suspicion of PCD, and (4) the role of NGS gene panel testing in confirmation of diagnosis.","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"350 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135108528","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":"Comparison of the diagnostic yield of transbronchial lung biopsies by forceps and cryoprobe in diffuse parenchymal lung disease.","authors":"M S Khot, A Chakraborti, J K Saini, P Sethi, S Mullick, R Saxena, A R Wani","doi":"10.7196/AJTCCM.2023.v29i3.799","DOIUrl":"10.7196/AJTCCM.2023.v29i3.799","url":null,"abstract":"<p><strong>Background: </strong>Transbronchial lung cryobiopsy (TBLC) in the diagnosis of diffuse parenchymal lung disease (DPLD) has shown a promising yield in recent times, with low post-procedural mortality and morbidity.</p><p><strong>Objectives: </strong>To compare the yield of TBLC and conventional transbronchial forceps lung biopsy (TBLB).</p><p><strong>Methods: </strong>A prospective study was carried out in patients with DPLD over a period of 1 year in a tertiary respiratory care institute in New Delhi, India. All 87 patients enrolled underwent both TBLB and TBLC. The procedures were performed in the bronchoscopy suite under conscious sedation and local anaesthesia, with an attempt to take a minimum of three biopsy specimens by conventional TBLB followed by TBLC. A 1.9 mm cryoprobe with a freezing time of 4 - 5 seconds was used. An Arndt endobronchial blocker was used to control bleeding along with locally administered medications.</p><p><strong>Results: </strong>TBLB and TBLC led to a definitive diagnosis in 27 (31.0%) and 69 (79.3%) cases, respectively. The commonest diagnoses were hypersensitivity pneumonitis, sarcoidosis and pulmonary tuberculosis. TBLC led to additional diagnoses in 42 cases (48.3%). Pneumothorax was observed in 12 cases (13.8%), and moderate bleeding occurred in 63 (72.4%). There were no procedure-related deaths.</p><p><strong>Conclusion: </strong>TBLC had a better diagnostic yield than conventional TBLB in DPLD. It has the potential to become a safe day-care procedure in a resource-limited setting, if certain precautions are taken.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Compared with transbronchial forceps lung biopsy, transbronchial lung cryobiopsy (TBLC) led to additional diagnoses in 42 (48.3%) of 87 patients with clinicoradiological features of diffuse parenchymal lung disease. Pneumothorax was observed in 12 cases (13.8%) and moderate bleeding in 63 (72.4%). TBLC without rigid bronchoscopy or advanced airway devices under conscious sedation had a good diagnostic yield with an acceptable adverse events profile.<b>Implications of the findings.</b> TBLC under conscious sedation is not resource intensive and can be carried out in settings with limited resources.</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/PMC10642398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650517","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":"Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension in Cape Town, South Africa.","authors":"S A Davies-van Es, T C Pennel, J Brink, G J Symons, G L Calligaro","doi":"10.7196/AJTCCM.2023.v29i3.294","DOIUrl":"10.7196/AJTCCM.2023.v29i3.294","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary endarterectomy (PEA) is the only definitive and potentially curative therapy for chronic thromboembolic pulmonary hypertension (CTEPH), associated with impressive improvements in symptoms and haemodynamics. However, it is only offered at a few centres in South Africa. The characteristics and outcomes of patients undergoing PEA in Cape Town have not been reported previously.</p><p><strong>Objectives: </strong>To assess the difference in World Health Organization functional class (WHO-FC) before and at least 6 weeks after surgery.</p><p><strong>Methods: </strong>We interrogated the adult cardiothoracic surgery database at the University of Cape Town between December 2005 and April 2021 for patients undergoing PEA at Groote Schuur Hospital and a private hospital.</p><p><strong>Results: </strong>A total of 32 patients underwent PEA, of whom 8 were excluded from the final analysis owing to incomplete data or a histological diagnosis other than CTEPH. The work-up of these patients for surgery was variable: all had a computed tomography pulmonary angiogram, 7 (29%) had a ventilation/perfusion scan, 5 (21%) underwent right heart catheterisation, and none had a pulmonary angiogram. The perioperative mortality was 4/24 (17%): 1 patient (4%) had a cardiac arrest on induction of anaesthesia, 2 patients (8%) died of postoperative pulmonary haemorrhage, and 1 patient (4%) died of septic complications in the intensive care unit. Among the survivors, the median (interquartile range) improvement in WHO-FC was 2 (1 - 3) classes (p=0.0004); 10/16 patients (63%) returned to a normal baseline (WHO-FC I).</p><p><strong>Conclusion: </strong>Even in a low-volume centre, PEA is associated with significant improvements in WHO-FC and a return to a normal baseline in survivors.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> South African patients undergoing pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) have a marked improvement in functional status, with many returning to a normal functional baseline. However, the small number of patients included in this study indicates that PEA is probably underutilised. Pre- and postoperative assessment is inconsistent, despite availability of established guidelines.<b>Implications of the findings.</b> More patients should be referred to specialist centres for assessment for this potentially curative procedure. Use of guidelines to standardise investigations and monitoring of patients with CTEPH may improve patient selection for surgery.</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/PMC10642406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650518","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}