Breast Cancer and HIV: a South African perspective and a critical review of the literature.

BACKGROUND: The diagnosis of breast cancer and concurrent HIV in South Africa is common. The limited current evidence on this subject suggests that the patients thus afflicted appear to be younger, have a more advanced stage of breast cancer, have a higher treatment related complications and poorer outcomes. This paper reviews the literature related to HIV and breast cancer, with a view to improving the standard and quality of care of HIV positive breast cancer patients. METHOD: Pubmed, EBSCOhost, Google scholar and Science Direct electronic databases were searched from 2001 and 2015. using the terms ('HIV' OR 'human immunodeficiency virus' OR 'AIDS' OR 'Acquired Immunodeficiency Syndrome') and 'breast cancer' or 'breast carcinoma' to identify all publications related to HIV and breast cancer. Titles and abstracts were evaluated for eligibility and appropriate full text articles obtained. The data extraction variables included the type of study, year of publication, study setting, participants, sample size, outcome measures and main findings. RESULTS: Only five studies fulfilled the criteria, in respect of the aforementioned maladies, with twenty or more participants in each study. Evidence suggested that breast cancers develop at a much younger age in the HIV positive patient compared to the HIV negative patients, with more aggressive appearing tumour biology. Overall, it appears that HIV positive patients experienced a higher cancer-specific mortality than HIV negative patients, and this is independent of the stage of the cancer or the cancer therapy received, further the relationship between the HIV syndrome and breast cancer is currently marginal and inconclusive, and hence requires further investigation. CONCLUSION: The prescription and administration of chemotherapy is a challenge, with potential complications impacting on the morbidity and mortality in HIV positive patients. Currently there are no reliable predictors of those at risk to complications from chemotherapy; however, being on ART appears to provide an acceptable safety profile. HIV positive patients are best managed in the context of a multi-disciplinary team in order to achieve favourable outcomes in the treatment of cancer. Well-designed prospective trials to assess the response to multimodal therapy, and the long-term outcomes of HIV positive patients with breast cancer are needed.

HIV-associated salivary gland enlargement: a clinical review.

Salivary gland disease is well established as an important HIV associated oral lesion. It manifests as salivary gland swelling involving one or both parotid glands with or without xerostomia. In the context of HIV, the swelling may be due to a wide spectrum of pathological conditions that include reactive or inflammatory disorders, acute and chronic infections, and neoplasms. This paper reviews the epidemiology, pathogenesis, clinical presentation, aspects of diagnosis and management of HIV associated salivary gland enlargement, in particular parotid gland enlargement, due to benign lymphoepithelial cysts (BLEC). Parotid gland enlargement is typically an early manifestation in the HIV-positive patient and should alert healthcare professionals to the likelihood of HIV infection. FNAC of the parotid gland is required to confirm the diagnosis and instituting HAART forms an important part of the management. There is a shift away from surgery in the treatment of this essentially 'benign' condition.

Diabetes and lower extremity amputation - rehabilitation pathways and outcomes at a regional hospital.

BACKGROUND: Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes. METHODS: Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes. RESULTS: From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52-68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and crutches (7; 7.7%), and wheelchair-bound (4; 4.4%). CONCLUSION: Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways.

Experiences and rehabilitation needs of runners with anterior knee pain in under-resourced communities in Ekurhuleni, Gauteng, South Africa.

Background: Anterior knee pain (AKP) is a common knee injury resulting from overuse, and impact negatively on the quality of life of many runners. Runners with AKP in under-resourced poor communities present with poor health outcomes. Aim: To determine the experiences and rehabilitation needs of runners in under-resourced communities in Ekurhuleni, South Africa. Methods: The study was qualitative, based on the focus group interview method. Interviews were conducted with 12 runners. They were aged from 18 to 45 years and had a history of AKP. Permission was obtained from club managers and consent from each participant. An interview schedule with predetermined questions was used to collect the data. Two researchers conducted the interview, a facilitator and moderator. The interview session lasted for 80 minutes. Audio recordings of the interview session were made, transcribed verbatim and notes taken, with the final result provided in a written report. The data approach was thematic and deductive in nature. Results: All 12 recruited participants participated. The participants were comprised of six females and six males, eight youths and four adults; seven had ≤5 years of running experience and five had 10 years. The following themes and subthemes emerged: 1) The negative impact of AKP on health (physical, emotional and social); 2) Limited rehabilitation services (availability, accessibility, affordability, adequacy and appropriateness); 3) Rehabilitation needs (knowledge and professional intervention). Conclusion: The study showed the negative impact of AKP on health and the problem of the paucity of rehabilitation services. A community based rehabilitation programme is therefore recommended for runners.

An audit of upper gastrointestinal endoscopy performed on patients at Prince Mshiyeni Memorial Hospital in Durban, KwaZulu-Natal.

BACKGROUND: Resource constraints have resulted in upper gastrointestinal endoscopy (UGE) being deferred where possible. However, delayed investigation is costly and leads to disease progression. This study audits the UGE done at a single institution. It was motivated by the observation that public hospitals often experience an acute shortage of endoscopes, which are prone to frequent breaks and service delivery is further compromised by an increased workload. METHOD: This was a retrospective observational descriptive study of patients aged 20 to 45 years who had undergone gastrointestinal endoscopy (UGE) at Prince Mshiyeni Memorial Hospital (PMMH) in KwaZulu-Natal, during the period January 2015 to December 2015. One hundred and ninety-four patients' charts and UGE reports were reviewed. Data were analysed using SPSS Statistics version 24. The level of significance was set at p < 0.05. Variables were expressed as mean ± standard deviation or medians (interquartile range IQR) as appropriate. Mean ± standard deviation was compared using the Student's t-test. Proportions and categorical variables were compared using the Pearson's chi-square test or Fisher's exact test as appropriate. An ethical approval was obtained from the University of KwaZulu-Natal BREC (BE 447/17) and the KwaZulu-Natal Department of Health Ethics Committee. RESULTS: Epigastric pain was found to be the most common indication for UGE, with a total of 112 (57.7%) out of total of 194 patients, followed by upper gastrointestinal bleeding (UGIB) (42) (21.6%). Amongst patients presenting with epigastric pain, only 12(10.7%) patients could be confirmed that they had received acid suppression therapy prior to the testing. In the age group 20-25 years, there was a highest number of patients presenting with corrosive substance ingestion, 11 (25.0%). The commonest finding was gastritis in 99 patients (51.0%), followed by normal findings in 50 (25.7%) patients. CONCLUSION: Epigastric pain was the most common indication and gastritis was the predominant finding.

Anterior knee pain and its extrinsic risk factors among runners in under-resourced communities in Ekurhuleni, Gauteng, South Africa.

Background: Various factors predispose athletes to anterior knee pain (AKP), making a holistic assessment with rehabilitation inevitable. Due to minimal rehabilitation services in under-resourced communities, runners are less likely to report this injury to medical professionals compared to runners in better resourced communities. Objective: The purpose of this study was to report on the prevalence of AKP among runners in under-resourced communities and to determine the extrinsic risk factors for this injury. Methods: This was a cross-sectional study of 347 runners in total. Convenience sampling was used to recruit 183 participants aged between 13 and 55 years with no previous history of knee surgeries, traumatic or degenerative knee conditions. Questionnaires were used to collect data on the prevalence of AKP and extrinsic risk factors. The SPSS (version 25) was used to analyse the data. Data were presented as frequencies and percentages and the results from chi-square and logistic regression tests were provided. Results: Forty percent (40%) of participants presented with AKP, particularly males (n=106, 58%), young runners (n=94, 51%) and those with 3-5 years of running experience (n=57, 31%). Anterior knee pain was associated with age (X2=6.484, p=0.039) and running experience (X2=8.39, p=0.04). The following extrinsic risk factors contributed to AKP significantly: training load (p=0.04, odds ratio [OR]=1.23), warm-up (p=0.04, OR=1.57)' running shoe condition (p=0.04, OR=0.14) and running surface (p=0.05, OR=1.2). Conclusion: A substantial presence of AKP and its extrinsic risk factors were found among all participants. These outcomes suggest that extrinsic risk factors should also be considered when managing AKP among runners.

Autonomic cardiac regulation, blood pressure and cardiorespiratory fitness responses to different training doses over a 12 week group program in the elderly.

AIM: The study assessed the effects of different weekly training frequencies performed over a 12 week exercise programme (strength, endurance, balance) on autonomic cardiac activity, blood pressure and cardiorespiratory fitness (CRF) in elderly individuals. METHODS: Fifty-eight individuals participated in the study: 2TG (N=24, 71.1±6.4 yrs; 19 females, 5 males) performing two, 60min sessions/week; and 3TG (N=34, 72.3±7.9 yrs; 25 females, 9 males) performing three, 60min sessions/week. Time domain and spectral analysis of heart rate variability (HRV) quantified autonomic cardiac regulation. RESULTS: Natural logarithm (Ln) transformation was applied to all HRV parameters. There were significant reductions in total power (Ln TP) (p=0.006), low frequency (Ln LF) (p=0.013), high frequency (Ln HF) (p=0.013) and root mean square of successive differences (Ln rMSSD) (p=0.014) post training in 3TG after intervention. Diastolic BP (DBP) decreased significantly in both groups (2TG: P<0.001; 3TG: P<0.001). Both groups showed significant improvements in six-minute walk distance (2TG: P=0.003, 3TG: P=0.001). However, there were significant HRV differences between 2TG and 3TG for Ln TP (P=0.018), Ln LF (P=0.049), Ln HF (P=0.039) and Ln rMSSD (P=0.049). CONCLUSIONS: A combined exercise programme resulted in improved DBP and CRF irrespective of training two or three 60min sessions/week. However, training three, sessions/week induced negative health-related changes in autonomic cardiac activity through reducing HRV parasympathetic function, while HRV was maintained in the group training twice a week.

Waiting times for prostate cancer diagnosis in KwaZulu-Natal, South Africa.

BACKGROUND: There is currently no evidence in the South African (SA) literature to suggest how long patients with clinically suspected prostate cancer (an elevated prostate-specific antigen level or abnormal findings on digital rectal examination) wait to have a prostate biopsy. OBJECTIVES: To improve the overall efficiency of the prostate biopsy service offered at St Aidans Regional Hospital, Durban, SA, by quantifying the burden of disease and waiting times and to identify potential delays in management outcomes, thereby helping to alleviate patient anxiety during the stressful period of investigation. METHODS: We did a retrospective folder review of patients who underwent trans-rectal prostate biopsy at St Aidan's Hospital, where the vast majority of prostate biopsies in the KwaZulu-Natal state healthcare sector are performed, from January to June 2013. The Statistical Package for Social Sciences was used for data analysis. Results. One hundred and six patients (mean age 67.6 years, 69.8% black Africans) underwent biopsy during the 6-month study period; 49.1% were found to have adenocarcinoma, and of the 80.1% of these who had a bone scan, 73.8% had skeletal metastases (p=0.1379). The median period of time from referral to biopsy was 55 days, from referral to first follow-up date (when the diagnosis is given and treatment options discussed or instituted) 100 days, and from biopsy to first follow-up date (i.e. waiting period to retrieve histological diagnosis) 36 days. CONCLUSION: Despite the late presentation of prostate cancer in KZN, patients are waiting an average of 3 months from initial referral for a prostate biopsy to institution of definitive management.