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BACKGROUND: Diabetic foot syndrome is defined as the presence of a diabetic foot ulcer (DFU) associated with neuropathy, peripheral artery disease and infection. While the use of antimicrobials in the treatment of DFU infection remains a mainstay, the choice of antimicrobial remains problematic owing to the presence of multidrug-resistant polymicrobial infections. In the South African public healthcare sector, the treatment of DFUs is based on the Standard Treatment Guidelines (STGs) and the Essential Drug List. These guidelines are developed using evidence-based medicine and are based on global susceptibility patterns rather than local susceptibility data, and may not provide the most appropriate treatment options. OBJECTIVES: To determine the antimicrobial susceptibility patterns of DFUs isolated from patients visiting selected Gauteng provincial public hospitals in order to determine a clinically effective treatment protocol for the management of these infections. METHODS: Sample swabs were taken from 51 DFUs using the Levine method. Each sample swab was spread onto blood agar plates, and thereafter individual pathogens were isolated. The antimicrobial susceptibility patterns of all isolated pathogens were determined using zone of inhibition measurements. Pathogens were grouped according to macromorphological characteristics as well as susceptibility patterns, and a representative isolate from each group was then identified. RESULTS: A total of 51 DFU ulcer swabs from 45 patients were included in the study. From the sample swabs, a total of 445 pathogens were isolated. The most effective antimicrobial was found to be gentamicin, followed by ciprofloxacin. Amoxicillin/clavulanic acid, the first-line treatment according to the STGs, was found to be ineffective for many of the isolated pathogens. The most commonly isolated pathogens were Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa. CONCLUSION: These findings demonstrate the urgent need to reassess the STGs and base treatment plans on local epidemiological data. This study provides valuable data on common causative pathogens in DFU infections, as well as the resistance patterns of these pathogens, forming a baseline on which to base future DFU treatment plans.
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Antibacterianos , Pé Diabético , Testes de Sensibilidade Microbiana , Humanos , Pé Diabético/microbiologia , Pé Diabético/tratamento farmacológico , África do Sul/epidemiologia , Antibacterianos/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Setor Público , IdosoRESUMO
BACKGROUND: The association between human papillomavirus (HPV) and cervical cancer is well established, and cervical cancer can be prevented through HPV vaccination. Little has been reported on the association between HPV and breast carcinoma (BC) or oesophageal squamous cell carcinoma (OSCC) in Africa. It is possible that use of appropriate HPV vaccines against genotypes responsible for these cancers may also prevent their development. OBJECTIVES: To investigate HPV genotype prevalence in BC and OSCC patients in Pretoria, South Africa (SA). METHODS: A retrospective cross-sectional study of BC and OSCC patients managed at Steve Biko Academic Hospital from 2015 to 2019 was undertaken. Patient medical records were analysed, and DNA was extracted from their archived pathology material and amplified by polymerase chain reaction before hybridisation for HPV genotypes. RESULTS: There were 101 patients with BC and 50 with OSCC. The prevalence of HPV infection in BC patients was 77.2%, with 35.6% high- risk (HR) genotypes, and that in OSCC patients 90.0%, with 56.0% HR genotypes. The most prevalent HPV genotypes (>20% each) were HPV 16, 70 and 51 for BC and HPV 51, 70, 16 and 82 for OSCC, with 31.7% and 60.0% of patients, respectively, having co-infection with ≥2 genotypes. CONCLUSION: The high prevalence of infection with multiple HPV genotypes in BC and OSCC patients, with HPV 16, 51, 70, 35 and 82 the most common genotypes in these cancers, warrants expansion of the current SA bivalent HPV 16/18 vaccine for girls to include boys, and inclusion of HPV 51, 70, 35 and 82, in order to prevent BC and OSCC as well as cervical cancer.
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Neoplasias da Mama , Neoplasias Esofágicas , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Neoplasias do Colo do Útero , Masculino , Feminino , Humanos , Neoplasias do Colo do Útero/prevenção & controle , Papillomavirus Humano , Papillomavirus Humano 16/genética , Estudos Retrospectivos , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , África do Sul/epidemiologia , Estudos Transversais , Papillomavirus Humano 18/genética , Papillomaviridae/genética , Neoplasias Esofágicas/epidemiologia , Neoplasias da Mama/epidemiologia , Genótipo , PrevalênciaRESUMO
ZnTiO3:Er3+,Yb3+ thin film phosphors were successfully deposited by pulsed laser deposition (PLD) at different substrate temperatures. The distribution of the ions in the films was investigated and the chemical analysis showed that the doping ions were homogeneously distributed in the thin films. The optical response of the phosphors revealed that the reflectance percentages of the ZnTiO3:Er3+,Yb3+ vary with the silicon substrate temperature due to the differences in the thickness and morphological roughness of the thin films. Under 980 nm diode laser excitation, the ZnTiO3:Er3+,Yb3+ film phosphors displayed up-conversion emission from the Er3+ electronic transitions, with violet, blue, green, and red emission lines at 410, 480, 525, 545 and 660 nm from 2H9/2 â 4I15/2, 4F7/2 â 4I15/2, 2H11/2 â 4I15/2, 4S3/2 â 4I15/2 and 4F9/2 â 4I15/2 transitions, respectively. The up-conversion emission was enhanced by increasing the silico (Si) substrate temperature during the deposition. Based on the photoluminescence properties and decay lifetime analysis, the energy level diagram was established and the up-conversion energy-transfer mechanism was discussed in detail.
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BACKGROUND: Radioactive iodine (RAI) is widely used in the treatment of hyperthyroidism. Adjunctive antithyroid drugs (ATDs) are commonly prescribed to treat the hyperthyroid state before the RAI has taken effect. However, there is no consensus on the use of or timing of adjunctive ATD treatment with RAI. OBJECTIVES: To determine the influence of the ATD carbimazole on the cure rate of RAI treatment for Graves' disease. METHODS: A retrospective chart review was conducted in the Department of Nuclear Medicine of the Steve Biko Academic Hospital in Pretoria. The cure rate of patients treated with RAI for Graves' disease was analysed. The effect of adjunctive carbimazole treatment with regard to its use and timing with RAI dosing was analysed. The cure rate was determined in patients treated with carbimazole either before RAI or before and after RAI administration. Cure rate was defined by the biochemical thyroid function status (thyroxine (T4), thyroid-stimulating hormone (TSH)) as euthyroid or hypothyroid from 3 months and sustained at 12 months. The need for a second dose of RAI was recorded. RESULTS: RAI treatment was administered to 171 patients with Graves' disease. The cure rate was higher in patients receiving a higher dose of RAI. The overall cure rate increased progressively from 3 months and was 91% at 12 months. The cure rate in 97 patients not receiving carbimazole was 98%. The cure rate of the 27 patients on carbimazole treatment given before RAI administration was 81%, and 73% in the 37 patients in whom it was resumed after RAI administration. The overall cure rate was lower in patients who received carbimazole (p<0.001), but especially in patients in whom carbimazole was continued after RAI administration (p<0.001). CONCLUSIONS: Adjunctive carbimazole treatment decreased the RAI cure rate of Graves' disease significantly.
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Antitireóideos/uso terapêutico , Carbimazol/uso terapêutico , Doença de Graves/tratamento farmacológico , Radioisótopos do Iodo/uso terapêutico , Terapia Combinada , Seguimentos , Humanos , Estudos Retrospectivos , África do Sul , Neoplasias da Glândula Tireoide/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: South Africa has the highest prevalence of human immunodeficiency virus (HIV) infection in the world, and is commonly found in association with appendicitis. Atypical presentation of appendicitis in the presence of HIV infection makes clinical diagnosis of appendicitis unreliable, and inflammatory markers are commonly used as adjuncts. The aim of this study was ascertain the value of inflammatory markers in the diagnosis of appendicitis in patients with and without HIV infection. METHODS: Patients with acute appendicitis were studied and divided into HIV-infected and HIV-uninfected groups. Symptoms, and systemic and local signs were recorded. Appendiceal pathology was classified as simple or as complicated by abscess, phlegmon or perforation. Total white cell count (WCC) and C-reactive protein (CRP) were chosen as inflammatory markers. Findings were compared between the two groups. RESULTS: The study population consisted of 125 patients, of whom 26 (20.8 per cent) had HIV infection. Clinical manifestations did not differ statistically, and there was no difference in the incidence of simple or complicated appendicitis between the two groups. The mean CRP level was significantly higher in HIV-infected patients (194.9 mg/l versus 138.9 mg/l in HIV-uninfected patients; P = 0.049), and mean WCC (x109/L) was significantly lower (11.07 versus 14.17×109/l respectively; P = 0.010). CONCLUSION: Clinical manifestations and pathology did not differ between HIV-infected and HIV-uninfected patients with appendicitis, except that the WCC response was significantly attenuated and CRP levels were generally higher in the presence of HIV infection.
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Apendicite/diagnóstico , Proteína C-Reativa/análise , Infecções por HIV/complicações , Contagem de Leucócitos/métodos , Adulto , Apendicite/sangue , Apendicite/patologia , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto JovemRESUMO
PURPOSE: Rats are common intruders into human settlements. Apart from their role as disease vectors, they can also cause bite injuries. We describe the clinical course of a series of children with rat bites, and characterise the injures. METHODS: A retrospective review of hospital records of children admitted for rat bites in a large regional hospital was undertaken. The demographics, wound characteristics, treatment given and clinical outcome of the patients are described. RESULTS: Fifty-nine children, with a mean age of 3.7 years, were admitted for rat bites. Three distinct types of wounds were treated: superficial scratches (Type I), deeper bites often with infection and ulceration (Type II) and full-thickness with loss of skin or underlying soft tissues (Type III). Few wounds displayed signs of inflammation. Only some Type II injuries required urgent local surgery in the form of drainage and debridement. Type III wounds required a skin graft. All patients recovered. CONCLUSION: We suggest that treatment of rat bites should be based on the wound type. Most patients do not require hospital admission or antibiotic treatment. Treatment should be mostly conservative wound care management. Surgery is only indicated for drainage of pus, debridement, skin graft or rarely reconstruction.
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Antibacterianos/uso terapêutico , Mordeduras e Picadas/diagnóstico , Mordeduras e Picadas/tratamento farmacológico , Lesões Acidentais , Adolescente , Animais , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Ratos , Estudos Retrospectivos , PeleRESUMO
BACKGROUND: Thyroid nodules are common. Most patients with indeterminate fine needle aspiration cytology (FNAC) results are subjected to thyroidectomy for fear of malignancy. However, only 20-30% of these cases are found to be malignant. The aim was to determine the value of thyroid ultrasound in diagnosing malignancy in patients with indeterminate fine needle aspiration cytology results in our practice. Fine needle aspiration was performed after ultrasound, thereby preventing architectural distortion of the nodule and to ensure that the most suspicious nodule was biopsied. METHODS: A retrospective review of records of patients who presented to two University of Pretoria academic hospitals, in South Africa, from 2001 to 2015 with nodular thyroid goitre was undertaken. Patients had a thyroid ultrasound scan, FNAC and had undergone thyroid surgery. RESULTS: Records of 104 patients were retrospectively evaluated. Patients were predominantly female (93.3%). Histology report was available for 101 of the 104 patient records. Malignancy was identified in 23 (22.8%). The overall sensitivity and specificity of thyroid image reporting and data system (TIRADS) score in this study were 69.5% and 61.5% respectively. The TIRADS classification had high sensitivity amongst the 26 patients with indeterminate cytology, with sensitivity and specificity of 85.7% and 52.6% respectively, however it was not statistically significant (p = 0.28). CONCLUSION: There was poor identification of malignancy with the use of ultrasound TIRADS classification in cases of indeterminate FNAC results, Bethesda III or IV, in our study. This is probably related to the diversity of ultrasonographers in our practice. It is recommended that there should be a dedicated thyroid ultrasonographer for a better and consistent TIRADS classification that surgeons can rely on for guiding surgical intervention.
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Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia , Adulto , Biópsia por Agulha Fina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , África do Sul , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adulto JovemAssuntos
Proteínas de Transporte/genética , Neoplasias Esofágicas/genética , Carcinoma de Células Escamosas do Esôfago/genética , Ceratodermia Palmar e Plantar/genética , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Predisposição Genética para Doença , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Ceratodermia Palmar e Plantar/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: People infected with HIV are prone to venous thrombosis. Treatment of thrombosis is primarily with warfarin. No studies have addressed the effects of HIV infection on warfarin dose. The aims of this study were to determine whether the therapeutic dose of warfarin and induction time to therapeutic dose in HIV-infected patients differ from that in HIV-uninfected patients. METHODS: A prospective and retrospective descriptive study of induction time to therapeutic warfarin dose, as well as of ambulant therapeutic warfarin dose, was performed. HIV-infected and HIV-uninfected patients being treated after deep venous thrombosis with or without pulmonary embolism were compared. Sex and use of antiretroviral drugs (ARVs) were also compared in the groups. RESULTS: 234 patients were entered into the study. Induction time to therapeutic warfarin dose did not differ between the 2 groups. The mean therapeutic dose of warfarin was higher in the HIV-infected than the HIV-uninfected group: 6.06 vs 5.72â mg/day, but this was not statistically significant (p=0.29). There was no difference in therapeutic warfarin dose between ARV-naïve groups-HIV-uninfected and HIV-infected patients not on ARVs. CONCLUSIONS: There appears to be little effect of HIV infection on warfarin dosing. Warfarin therapy should be administered conventionally in HIV-infected patients.
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Anticoagulantes/administração & dosagem , Infecções por HIV/complicações , Trombose Venosa/tratamento farmacológico , Varfarina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Feminino , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/etiologia , Estudos Retrospectivos , África do Sul , Trombose Venosa/complicações , Adulto JovemRESUMO
BACKGROUND: Osteogenesis imperfecta is a heritable disorder of bone connective tissue. Type III has a high incidence in the black pop-ulation of South Africa. Affected people experience numerous fractures, bone pain and progressive disability. Until the introduction of bisphosphonates to reduce fracture incidence, treatment revolved around orthopaedic and supportive care. Objective. To assess the subjective attitude of patients towards pamidronate treatment. METHODS: Thirty black patients with osteogenesis imperfecta type III treated at Universitas Hospital were approached and 26 were included in this study. Patients or their parents were interviewed using a standardised researcher-administered questionnaire, either in person or by telephone. RESULTS: Most patients reported a reduction in symptoms, a feeling of increased wellbeing, increased strength and rated the pamidronate treatment highly. The intravenous route of administration and the side-effects experienced were bearable. Overall all patients would recommend this treatment to other affected persons. CONCLUSION: This is first study to look at bisphosphonate treatment for osteogenesis imperfecta type III in black South Africans. The treatment is well tolerated and highly rated by the patients. Reported improvements and side-effects are similar to those reported in other populations. Using this form of treatment in this population is supported by these findings.
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População Negra , Conservadores da Densidade Óssea/uso terapêutico , Difosfonatos/uso terapêutico , Osteogênese Imperfeita/tratamento farmacológico , Satisfação do Paciente , Adolescente , Atitude Frente a Saúde , Conservadores da Densidade Óssea/efeitos adversos , Criança , Pré-Escolar , Difosfonatos/efeitos adversos , Feminino , Humanos , Lactente , Masculino , Osteogênese Imperfeita/fisiopatologia , Pamidronato , África do Sul , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Helicobacter pylori is an important causative factor in gastric carcinogenesis; its role in extra-gastric gastrointestinal malignancies such as oesophageal cancer is controversial. H. pylori is thought to cause extensive gastric atrophy associated with squamous cell carcinoma of the oesophagus. We conducted a study to determine the prevalence of H. pylori infection in patients with squamous cell carcinoma of the oesophagus. METHOD: We collected biopsies from the antrum and corpus of 59 patients with confirmed squamous cell carcinoma of the oesophagus, two from each area. These were then examined by an experienced histopathologist using methylene blue staining for the presence of H. pylori. RESULTS: H. pylori was found in 30 (51 %) of the patients, a prevalence similar to that of the general population in South Africa. Five patients were found to have associated intestinal metaplasia, and all but two had chronic inflammation. CONCLUSION: The prevalence of H. pylori in our patients with squamous cell carcinoma of the oesophagus is 51 %, similar to that previously reported in the general population.
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Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Infecções por Helicobacter/complicações , Helicobacter pylori/crescimento & desenvolvimento , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
BACKGROUND AND OBJECTIVES: South Africa has a markedly skewed representation where the majority of blood (62%) is presently collected from an ethnically White minority. This study seeks to identify culturally specific factors affecting motivation of donors in South Africa. MATERIALS AND METHODS: We performed a qualitative study to evaluate motivators and deterrents to blood donation among Black South Africans. A total of 13 focus groups, comprising a total of 97 Black South Africans, stratified by age and geographic location were conducted. Transcripts of the interviews were analysed using a coding framework by Bednall & Bove. RESULTS: Participants made 463 unique comments about motivators focusing primarily on promotional communications (28%), incentives (20%) and prosocial motivation (16%). Participants made 376 comments about deterrents which focused primarily on fear (41%), negative attitudes (14%) and lack of knowledge (10%). CONCLUSION: Although prosocial motivation (altruism) was the most frequently mentioned individual motivator, promotional communication elicited more overall comments by participants. As reported by many authors, fear and lack of awareness were strong deterrents, but scepticism engendered by perceived racial discrimination in blood collection were unique to the South African environment.
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População Negra/psicologia , Doadores de Sangue/psicologia , Motivação , Adolescente , Adulto , Fatores Etários , Altruísmo , Atitude Frente a Saúde , Cultura , Seleção do Doador , Medo , Feminino , Grupos Focais , Infecções por HIV/sangue , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Educação em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Comunicação Persuasiva , Pesquisa Qualitativa , Racismo , Valores Sociais , África do Sul , Confiança , Adulto JovemRESUMO
INTRODUCTION: Penetrating injury may involve the major vessels in the abdomen. Injury to the abdominal inferior vena cava (IVC) is uncommon and is usually caused by gunshot wounds. Mortality from IVC injuries is high and has changed little over time. AIM: The aim of the study was to report a series of IVC injuries from an urban trauma unit and to compare this with reports from similar institutions. METHOD: A retrospective review of penetrating abdominal injuries at Kalafong Hospital from 1993 to 2010 was performed. All cases of injury to the IVC were retrieved and the following data recorded: patient demographics, incident history, origin of referral, description of the IVC injury, associated injuries, operative management, hospital stay and outcome. The results were compared to those from similar institutions. RESULTS: Twenty-seven patients with IVC injuries were treated. All were caused by gunshot wounds, and all had associated intra-abdominal injuries. The majority (56%) of injuries were infrarenal. The injury was managed most commonly by venorrhaphy and, when successful, all the patients survived. A third of patients with infrarenal injuries died, some after exploration of a stable peri-caval haematoma. Ten of the patients died (37%), half of them during surgery. These results are similar to those from similar institutions from earlier time periods. CONCLUSIONS: This report concurs with other studies. IVC injury carries a high mortality rate and that this has not improved over several decades. Less aggressive management of some stable patients or stable injuries is proposed by the authors for possible improvement of the mortality rate.
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Traumatismos Abdominais/terapia , Transfusão de Sangue/métodos , Ligadura/métodos , Centros de Traumatologia , Veia Cava Inferior/lesões , Ferimentos por Arma de Fogo/terapia , Traumatismos Abdominais/mortalidade , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Prognóstico , Estudos Retrospectivos , África do Sul/epidemiologia , Análise de Sobrevida , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , População Urbana , Veia Cava Inferior/cirurgia , Ferimentos por Arma de Fogo/mortalidadeRESUMO
OBJECTIVE: To document histological evidence of hypertrophy and ischaemia in sigmoid volvulus among Africans. DESIGN: Retrospective case series study of the histology of sigmoid volvulus over seven years with cadaveric controls. SETTING: King Edward VIII Teaching Hospital, University of Natal, Durban, South Africa. SUBJECTS: Fifty African patients with sigmoid volvulus and nine cadavers with normal sigmoid colon. RESULTS: There was hypertrophy of the submucosa, muscularis propria and nerve plexuses with features of ischaemia in the patients' specimens. Their veins were thrombosed and recanalized while mesentery and submucosa had fibrosis and vascular hyalinization. There was also hypertrophy and hyperplasia of Meissner's nerve plexus. In the autopsy study, normal African sigmoid specimen showed similar ischaemic features but specimens from the four Indian patients in the study did not have such abnormalities. CONCLUSION: We postulate that chronic ischaemia may account for postoperative anastomosis dehiscence in some cases where the resection margins involved the hypertrophic segment. The benefit of an extended resection with anastomosis being effected on the bowel with apparent normal thickness to avoid this possibility should be investigated.
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Colo Sigmoide/irrigação sanguínea , Obstrução Intestinal/complicações , Obstrução Intestinal/patologia , Isquemia/etiologia , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/patologia , Adolescente , Adulto , Biópsia , Cadáver , Criança , Doença Crônica , Humanos , Hipertrofia , Pessoa de Meia-Idade , Estudos Retrospectivos , África do SulRESUMO
A prospective study of 71 patients with hyponatraemia was undertaken over an 18-month period in one surgical unit at King Edward VIII Hospital, Durban, to study the incidence and pattern of hyponatraemia. Electrolytes and urea values were measured serially in all patients. Hyponatraemia was defined as a serum sodium level of < 130 mmol/l. The incidence of hyponatraemia was 2.2%, the most common type being normovolaemic hypotonic hyponatraemia. Hyponatraemia was either mild (sodium level 120-130 mmol/l) or moderate (111-120 mmol/l). No patient had severe hyponatraemia (< 110 mmol/l). Hyponatraemia was corrected within 1-6 days using normal saline; in 73% of patients it was corrected within 24 hours. No patient developed neurological symptoms. A mortality rate of 28% was attributed to underlying illness, and hyponatraemia per se was asymptomatic in this study. Aggressive sodium correction was therefore not indicated.
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Hiponatremia , Adolescente , Adulto , Idoso , Análise de Variância , Eletrólitos/sangue , Eletrólitos/urina , Feminino , Humanos , Hiponatremia/tratamento farmacológico , Hiponatremia/epidemiologia , Hiponatremia/metabolismo , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Solução Salina Hipertônica/uso terapêutico , África do Sul/epidemiologia , Estatísticas não Paramétricas , Procedimentos Cirúrgicos OperatóriosRESUMO
Renal ectopia is very rare and its associated pyelonephritis can simulate an appendix mass/ abscess or colonic tumour which may result in needless surgical exploration, as illustrated by our experience with 3 cases reported in this article. Careful ultrasonography and urinalysis can obviate this confusion and save unnecessary operation.
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Rim , Feminino , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Masculino , Pielonefrite/diagnóstico , Ultrassonografia , UrináliseAssuntos
HIV-1/fisiologia , Transplante de Células-Tronco Hematopoéticas , Transfusão de Linfócitos , Linfócitos/imunologia , Linfócitos/virologia , Animais , Sequência de Bases , Gonadotropina Coriônica Humana Subunidade beta/biossíntese , Gonadotropina Coriônica Humana Subunidade beta/genética , DNA , Primers do DNA , Sangue Fetal , Humanos , Linfonodos , Dados de Sequência Molecular , Oligonucleotídeos Antissenso , Papio , Reação em Cadeia da Polimerase , Baço , Replicação ViralRESUMO
OBJECTIVE: To see if it is possible to predict mortality in isolated post-traumatic acute renal failure. DESIGN: Retrospective study 1984-1990 inclusive. SETTING: Teaching hospital, South Africa. SUBJECTS: Thirty-nine patients who developed isolated post-traumatic acute renal failure out of 106526 admissions for trauma. INTERVENTIONS: Standard aggressive management of traumatic injury and acute renal failure. MAIN OUTCOME MEASURE: Death. RESULTS: Fifteen of the 39 patients who developed post-traumatic acute renal failure died (39%). Blunt trauma from assaults was a major cause of acute renal failure (16/39, 41%). Hypotension and hyperkalaemia were the two main predictors of death having a mortality of 63% and 52%, respectively. CONCLUSION: Clinicians should be aware of the risks of hypotension and hyperkalaemia in injured patients. Preventive measures such as aggressive resuscitation and timely correction of serum electrolyte concentrations are essential in such patients.