Recurrent venous thrombosis - an unusual first presentation of autoimmune polyendocrinopathy syndrome type 3B.

A 45-year-old female presented with unprovoked recurrent venous thromboembolism (VTE), in unusual sites, and pancytopenia, posing a complex diagnostic challenge. Work-up for inherited thrombophilia, antiphospholipid syndrome (APLS) and paroxysmal nocturnal haemoglobinuria were unremarkable. Investigations revealed autoimmune thyroid disease, and a mixed iron/vitamin B12 deficiency due to pernicious anaemia and resultant atrophic gastritis. Hyperhomocysteinaemia due to vitamin B12 deficiency was identified as a potential contributor to her recurrent VTE. This case highlights the unusual initial presentation of autoimmune polyendocrinopathy syndrome type 3B (APS-3B) with recurrent thromboembolism, and emphasises the importance of considering hyperhomocysteinaemia in unprovoked and atypical VTE cases.

Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) first reported in Wuhan, China in December 2019 is a global pandemic that is threatening the health and wellbeing of people worldwide. To date there have been more than 274 million reported cases and 5.3 million deaths. The Omicron variant first documented in the City of Tshwane, Gauteng Province, South Africa on 9 November 2021 led to exponential increases in cases and a sharp rise in hospital admissions. The clinical profile of patients admitted at a large hospital in Tshwane is compared with previous waves. METHODS: 466 hospital COVID-19 admissions since 14 November 2021 were compared to 3962 admissions since 4 May 2020, prior to the Omicron outbreak. Ninety-eight patient records at peak bed occupancy during the outbreak were reviewed for primary indication for admission, clinical severity, oxygen supplementation level, vaccination and prior COVID-19 infection. Provincial and city-wide daily cases and reported deaths, hospital admissions and excess deaths data were sourced from the National Institute for Communicable Diseases, the National Department of Health and the South African Medical Research Council. RESULTS: For the Omicron and previous waves, deaths and ICU admissions were 4.5% vs 21.3% (p<0.00001), and 1% vs 4.3% (p<0.00001) respectively; length of stay was 4.0 days vs 8.8 days; and mean age was 39 years vs 49,8 years. Admissions in the Omicron wave peaked and declined rapidly with peak bed occupancy at 51% of the highest previous peak during the Delta wave. Sixty two (63%) patients in COVID-19 wards had incidental COVID-19 following a positive SARS-CoV-2 PCR test . Only one third (36) had COVID-19 pneumonia, of which 72% had mild to moderate disease. The remaining 28% required high care or ICU admission. Fewer than half (45%) of patients in COVID-19 wards required oxygen supplementation compared to 99.5% in the first wave. The death rate in the face of an exponential increase in cases during the Omicron wave at the city and provincial levels shows a decoupling of cases and deaths compared to previous waves, corroborating the clinical findings of decreased severity of disease seen in patients admitted to the Steve Biko Academic Hospital. CONCLUSION: There was decreased severity of COVID-19 disease in the Omicron-driven fourth wave in the City of Tshwane, its first global epicentre.

Identification of a subgroup of black South Africans with type 1 diabetes who are older at diagnosis but have lower levels of glutamic acid decarboxylase and islet antigen 2 autoantibodies.

AIMS: To compare the age at diagnosis and prevalence of islet autoantibody [glutamic acid decarboxylase (65 kDa) 65 and islet antigen 2] positivity in black and white participants with type 1 diabetes in South Africa, and to analyse the relationship between age at diagnosis and the presence of autoantibodies. METHODS: Participants were recruited from diabetes outpatient departments and autoantibodies to glutamic acid decarboxylase (65 kDa) and islet antigen 2 were measured by enzyme-linked immunosorbent assay. RESULTS: We recruited 472 (353 black and 119 white) participants with type 1 diabetes. Age at diagnosis of diabetes was later in black (19.7 ± 10.5) than in white participants (12.7 ± 10.8 years; P < 0.001) with a median (interquartile range) disease duration of 5.0 (2.0-10.0) and 8.5 (4.0-20.0) years (P < 0.001), respectively. An older age at diagnosis (≥ 21 years) was more frequent in black (152 of 340, 45%) than in white participants (24 of 116, 21%; P < 0.001). The prevalence of islet antigen 2 autoantibodies was 19% (66/352) in black and 41% in white participants (48/118; P < 0.001). There was no significant difference in glutamic acid decarboxylase (65 kDa) autoantibody positivity between black (212/353, 60%) and white participants (77/117, 66%; P = 0.269). In black, but not white, participants the prevalence of both glutamic acid decarboxylase (65 kDa) and islet antigen 2 autoantibody positivity was significantly lower in participants diagnosed at age ≥ 21 years (P < 0.001 for both comparisons). CONCLUSIONS: The older age at diagnosis, lower prevalence of islet antigen 2 autoantibodies and a distinct subgroup of participants with type 1 diabetes with age at diagnosis of > 20 years in the black compared to white population suggest a difference in the immunological aetiology of type 1 diabetes in these two population groups.

Titrating insulin in patients with type 2 diabetes using a structured self-monitoring blood glucose regimen.

BACKGROUND: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia, but there is currently no standardised approach to utilising these data to improve glycaemic control in patients with type 2 diabetes. OBJECTIVES: To assess the improvement in glycaemic control when an insulin titration algorithm was used in combination with SMBG in patients with poorly controlled, insulin-treated type 2 diabetes. METHODS: This 6-month prospective study recruited 39 poorly controlled (glycated haemoglobin (HbA1c) ≥8.5%; 69.4 mmol/mol) type 2 diabetes subjects using twice-daily biphasic insulin from two state hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using an algorithm guided by the data collected. The primary endpoint was the trend in HbA1c measured at baseline and 3 and 6 months. RESULTS: Mean HbA1c decreased over the study period by 1.89% (95% confidence interval (CI) -2.46 - -1.33; p<0.001). The hypoglycaemic event rate (<4.0 mmol/L) was 33.08 events per patient year. Total daily insulin use increased by a mean of 40.12 units over the study period (standard error 7.7; p<0.001) and weight increased by an average of 3.98 kg (95% CI 2.56 - 5.41; p<0.001). CONCLUSIONS: Monthly algorithmic insulin titration guided by structured SMBG can markedly improve glycaemic control in patients with type 2 diabetes by aggressively increasing insulin doses not previously expected in this population, with moderate hypoglycaemic events and weight gain observed.

Cytokine Profile and Clinical Correlates in HIV-Exposed Infants with Severe (Hypoxic) Pneumonia

Introduction. Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world; especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants; however; is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease. Objective. To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants Methods. In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia; paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.Results. A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml); while IP-10 was elevated in serum (mean 39.55 pg/ml); with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis. Conclusion. This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However; further investigation of this association is required

The prevalence of metabolic syndrome and its associated factors in long-term patients in a specialist psychiatric hospital in South Africa.

OBJECTIVE: The aims of this study were to determine the prevalence of metabolic disorders in long-term psychiatric patients, and the relationship between known risk factors and these metabolic disorders. METHODS: All psychiatric in-patients ≥18 years, who had been admitted ≥six months were invited to participate. Eighty-four patients participated. They were interviewed, examined, measured and blood tests conducted to determine several demographic and clinical variables including age, gender, weight, blood pressure and fasting blood glucose. RESULTS: The prevalence of the metabolic disorders were: metabolic syndrome 32%, hypertension 32%, diabetes mellitus 8%, cholesterol dyslipidaemia 32%, triglyceride dyslipidaemia 29%, low density lipoprotein (LDL) dyslipidaemia 50%, overweight 37%, and obesity 24%. Black African and female patients were more likely to have metabolic syndrome. Female patients were more likely to have cholesterol dyslipidaemia and obesity. Hypertension was associated with age. Ninety-six percent of patients with dyslipidaemia were newly diagnosed during the study. Three out of the seven previously diagnosed diabetic patients had raised fasting blood glucose levels. CONCLUSION: The prevalence of metabolic syndrome falls towards the lower limits of the expected prevalence rate. Race and gender showed a moderate statistical association with metabolic syndrome. There is a lack of screening for dyslipidaemia in this setting. Diabetic patients should be referred to specialist diabetic clinics for better monitoring and control.

Fluid management in diabetic-acidosis--Ringer's lactate versus normal saline: a randomized controlled trial.

OBJECTIVE: To determine if Ringer's lactate is superior to 0.9% sodium chloride solution for resolution of acidosis in the management of diabetic ketoacidosis (DKA). DESIGN: Parallel double blind randomized controlled trial. METHODS: Patients presenting with DKA at Kalafong and Steve Biko Academic hospitals were recruited for inclusion in this study if they were >18 years of age, had a venous pH >6.9 and ≤7.2, a blood glucose of >13 mmol/l and had urine ketones of ≥2+. All patients had to be alert enough to give informed consent and should have received <1 l of resuscitation fluid prior to enrolment. RESULTS: Fifty-seven patients were randomly allocated, 29 were allocated to receive 0.9% sodium chloride solution and 28 to receive Ringer's lactate (of which 27 were included in the analysis in each group). An adjusted Cox proportional hazards analysis was done to compare the time to normalization of pH between the 0.9% sodium chloride solution and Ringer's lactate groups. The hazard ratio (Ringer's compared with 0.9% sodium chloride solution) for time to venous pH normalization (pH = 7.32) was 1.863 (95% CI 0.937-3.705, P = 0.076). The median time to reach a pH of 7.32 for the 0.9% sodium chloride solution group was 683 min (95% CI 378-988) (IQR: 435-1095 min) and for Ringer's lactate solution 540 min (95% CI 184-896, P = 0.251). The unadjusted time to lower blood glucose to 14 mmol/l was significantly longer in the Ringer's lactate solution group (410 min, IQR: 240-540) than the 0.9% sodium chloride solution group (300 min, IQR: 235-420, P = 0.044). No difference could be demonstrated between the Ringer's lactate and 0.9% sodium chloride solution groups in the time to resolution of DKA (based on the ADA criteria) (unadjusted: P = 0.934, adjusted: P = 0.758) CONCLUSION: This study failed to indicate benefit from using Ringer's lactate solution compared to 0.9% sodium chloride solution regarding time to normalization of pH in patients with DKA. The time to reach a blood glucose level of 14 mmol/l took significantly longer with the Ringer's lactate solution.

Evaluation of circulating soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) to predict risk profile, response to antimicrobial therapy, and development of complications in patients with chemotherapy-associated febrile neutropenia: a pilot study.

The soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) is a useful marker of infection in patients with sepsis, but has not been adequately evaluated in patients with chemotherapy-associated febrile neutropenia (FN). The value of sTREM-1 in this setting has been tested in a retrospective, pilot study using stored serum from 48 cancer patients with documented FN. On presentation, patients were categorized according to the Talcott risk-index clinical score. Circulating soluble sTREM-1 was measured using an ELISA procedure, while procalcitonin (PCT) or interleukins 6 (IL-6) and 8 (IL-8), included for comparison, were measured using an immunoluminescence-based assay and Bio-Plex® suspension bead array system, respectively. Circulating concentrations of both sTREM-1 and PCT were significantly (P < 0.05) elevated in patients at high risk for complications or death, as predicted by the Talcott score and were significantly lower in patients who responded to empiric antimicrobial agents. Neither IL-6 nor IL-8 accurately predicted serious complications in patients with FN. These observations, albeit from a pilot study, demonstrate that sTREM-1 is indeed elevated in high-risk patients with FN and is potentially useful to predict their clinical course, either together with, or as an alternative to PCT.

Soluble triggering receptor expressed on myeloid cells in sputum of patients with community-acquired pneumonia or pulmonary tuberculosis: a pilot study.

Soluble triggering receptor expressed on myeloid cells (s-TREM-1) is upregulated on the surface of inflammatory cells in the presence of bacterial infections, apparently excluding those due to Mycobacterium tuberculosis. Therefore, sputum concentrations of s-TREM-1 may be of value in distinguishing bacterial pneumonia from pulmonary tuberculosis (PTB) in patients with respiratory infections. The current pilot study was designed to evaluate whether s-TREM-1 concentrations measured in the sputum of patients with suspected community-acquired pneumonia (CAP) allowed differentiation of those patients with PTB from other causes of pneumonia and to correlate s-TREM-1 with CURB-65, a marker of disease severity. Soluble s-TREM-1 concentrations were measured in sputum samples from patients admitted to a tertiary hospital with CAP or PTB by means of an ELISA procedure. Soluble-TREM-1 was readily detectable and quantifiable in sputum samples from patients with both CAP and PTB, with concentrations of 234±47 and 178±36 pg/ml respectively, but did not differ significantly between the two groups. However, patients with PTB had significantly lower leukocyte counts, 9±1.3 vs 15±1.4 × 10(9)/l compared with those without PTB. Interestingly, sputum s-TREM-1 concentrations correlated significantly with the CURB-65 pneumonia severity score calculated at the time of admission. Soluble-TREM-1 expression is upregulated in patients with both CAP and PTB, but does not differentiate between these two conditions. Sputum concentrations of s-TREM-1 may predict the severity of disease in patients with CAP.

Epidemiology of oral squamous cell carcinoma.

The National Cancer Registry (NCR) of South Africa publishes the pathology-based cancer incidence in the country and is the main cancer data source. The data published by the NCR have been used extensively in the development of the draft national guidelines for cancer prevention and control as well as for cancer research. The list of contributing pathology laboratories is fairly inclusive. Data from the NCR and the University of Limpopo, Department of Oral Pathology for the five years 1997-2001 were combined and then filtered for sites in the oral and oropharyngeal region. Age-Standardised Incidence Rates (ASIR) and the Cumulative Lifetime Risk (LR) for males and females in the different population groups were determined. Comprehensive reporting of oral and oropharyngeal cancer incidence will influence the allocation of government resources for prevention and treatment of oral cancers.

Providing clinicians with information on laboratory test costs leads to reduction in hospital expenditure.

OBJECTIVES: We aimed to ascertain the efficacy of an intervention in which laboratory test costs were provided to clinicians as a pocket-sized brochure, in reducing laboratory test costs over a 4-month period. METHODS: This was a non-randomised intervention study in the Internal Medicine wards at Steve Biko Academic Hospital, Pretoria, in which the intervention was laboratory test costs provided to clinicians as a pocket-sized brochure. The intervention period was the winter months of May - August 2008 and the pre-intervention period was the same months of the preceding year. In the two 4-month periods (2007 and 2008), the number of days in hospital and the laboratory tests ordered were computed for each patient admitted. For the intervention and control groups, pre- and post-intervention cost and days in hospital were estimated. RESULTS: The mean cost per patient admitted in the intervention group decreased from R2 864.09 to R2 097.47 - a 27% reduction. The mean cost per day in the intervention group as a whole also decreased, from R442.90 to R284.14 - a 36% reduction. CONCLUSION: Displaying the charges for diagnostic tests on the laboratory request form may significantly reduce both the number and cost of tests ordered, and by doing so bring about considerable in-hospital cost savings.

The reliability of chest radiographs in predicting left atrial enlargement.

INTRODUCTION: Estimates of left atrial size in patients with suspected cardiac disease play an important role in predicting prognosis and events, as well as treatment decisions. Two methods are commonly used to estimate left atrial size: chest radiography and cardiac ultrasound. This study aims to determine the test characteristics by comparing the use of radiographs to cardiac ultrasound (the gold-standard test). METHODS: Data from patients older than 18 years admitted to Steve Biko Academic Hospital during 2000-2003 who had both chest radiographs and cardiac ultrasound were included in this cross-sectional, retrospective analysis. Chest radiographs were classified into three quality classes, and the sub-carinal angle (SCA) and sub-angle distance (SAD) were measured twice in all available radiographs by two observers. Intra- and inter-observer variability (three methods) as well as the predictive value of the carinal angle and sub-angle distance measurements were determined using logistic regression (with left atrial enlargement - determined by ultrasound as comparator). RESULTS: Data for 159 patients were available (154 cardiac ultrasounds and 178 chest radiographs). Intra-observer variability for chest radiograph measurements was low with almost perfect concordance (p = 0.000). Inter-observer variability was higher for supine radiographs. Using logistic regression, a linear model was identified which was statistically significant only for erect radiographs. While goodness-of-fit analysis showed that the model fits the data, performance characteristics were poor, with high sensitivity and low specificity, and an area under the ROC curve of 0.62-0.63, depending on type of radiograph and measurement (SCA or SAD). Linearity in the logit of the dependent variable was assessed, and found to be present at the extremes of SCA measurements for the supine radiograph data and in the first three quartiles for erect radiograph data. A nonlinear model determined by fractional polynomial analysis did not perform significantly better than the original linear model. Cut-off values for the SCA of 72° and 84° (erect and supine radiographs, respectively) were found to give the best compromise between sensitivity and specificity. The corresponding cut-off values for SAD were 24.1 and 26.9 mm. CONCLUSION: Assessment of either SCA or SAD to determine left atrial size was equivalent and repeatable, both with the same observer and between two observers (less so for supine radiographs). While this measure was precise, it was found not to be very accurate. Therefore, chest radiographs are not reliable in predicting left atrial enlargement.

Profile of mortality of patients admitted to Weskoppies Psychiatric Hospital in South Africa over a 5-year period (2001-2005).

OBJECTIVE: Mortality in the psychiatric population, both from natural and unnatural causes, is higher than in the general population and this is despite an improvement in the delivery of care and treatment of mental illness in recent years. The study was conducted to determine a profile of mortality and standardized mortality rates within our psychiatric hospital. METHOD: A retrospective clinical case audit was conducted of deaths that occurred at Weskoppies Hospital between 1st January 2001 and 31st December 2005. Direct standardised mortality rates were calculated (gender specific adjusted for age according to the South African population). RESULTS: A total of 164 deaths were observed during this period. The gender-specific all cause mortality rates, standardised to the South African population, were 0.0177 (95% CI 0.0141, 0.0213) and 0.0163 (95% CI 0.0121, 0.0206) for males and females respectively. The all cause mortality rates for the South African male and female population were 0.0188 and 0.0170 respectively (not significantly different as it falls within the 95% confidence interval of the standardised rates). The predominant natural cause of mortality was infection. Ten of the deaths were due to unnatural causes, of these 7 were suicides. The mortality ratio for unnatural causes was 0.47. CONCLUSION: Mortality studies are important tools for determining quality of health care provisions to patients. Studies of this nature assist in making recommendations for optimal clinical practice and aid in developing preventative measures.

Erythromycin as an alternative to reduce interfering extra-cardiac activity in myocardial perfusion imaging.

OBJECTIVES: We sought to determine whether taking oral erythromycin prior to SPECT myocardial perfusion imaging with Tc99m-sestamibi would reduce the amount of interfering extra-cardiac activity and improve the image quality. METHODS: A total of 96 patients who were routinely referred for myocardial perfusion imaging were randomly assigned to one of two groups. Patients in group A received 500 mg of non-enterically coated erythromycin orally one hour prior to image acquisition (45 patients). Patients in group B received diluted lemon juice which comprises the current standard of care in our department (51 patients). A two-day protocol was followed and study participants received the same intervention on both days. Planar images of both the stress and rest images were assessed visually by three experienced nuclear medicine physicians for the presence of interfering extracardiac activity. Physicians were blinded to the detail of the protocol and independently assessed the images. RESULTS: The qualitative results favoured lemon juice in reducing the amount of interfering extra-cardiac activity. The overall incidence of interfering extra-cardiac activity was 46.15% in the lemon juice group vs 55.56% in the erythromycin group. However, this difference was not found to be statistically significant (p = 0.36). The use of a MYO:EXT ratio similar to the one described by Peace and Lloyd,11 appeared promising in quantifying interfering extra-cardiac activity. CONCLUSION: The difference between the effect of erythromycin and lemon juice on interfering extra-cardiac activity appears statistically insignificant and erythromycin could therefore be considered as a suitable alternative to lemon juice.

Profile of mortality of patients admitted to Weskoppies Psychiatric Hospital in South Africa over a 5-year period (2001-2005)

Objective: Mortality in the psychiatric population; both from natural and unnatural causes; is higher than in the general population and this is despite an improvement in the delivery of care and treatment of mental illness in recent years. The study was conducted to determine a profile of mortality and standardized mortality rates within our psychiatric hospital. Method: A retrospective clinical case audit was conducted of deaths that occurred at Weskoppies Hospital between 1st January 2001 and 31st December 2005. Direct standardised mortality rates were calculated (gender specific adjusted for age according to the South African population). Results: A total of 164 deaths were observed during this period. The gender-specific all cause mortality rates; standardised to the South African population; were 0.0177 (95CI 0.0141; 0.0213) and 0.0163 (95CI 0.0121; 0.0206) for males and females respectively. The all cause mortality rates for the South African male and female population were 0.0188 and 0.0170 respectively (not significantly different as it falls within the 95confidence interval of the standardised rates). The predominant natural cause of mortality was infection. Ten of the deaths were due to unnatural causes; of these 7 were suicides. The mortality ratio for unnatural causes was 0.47. Conclusion: Mortality studies are important tools for determining quality of health care provisions to patients. Studies of this nature assist in making recommendations for optimal clinical practice and aid in developing preventative measures

Effectiveness of influenza vaccination in the elderly in South Africa.

This study primarily aimed to estimate the association between influenza vaccination and the occurrence of hospitalization for acute respiratory or cardiovascular diseases, or all-cause death during the influenza season in an elderly population in South Africa. We conducted a nested case-control study using data from a cohort of 45 522 elderly members of a private medical funding organization during the moderate 2004 influenza season. In 1282 (2.8%) subjects the combined outcome occurred and the influenza vaccination rate in controls was 15.4%. After adjustments for measured confounders, vaccination was associated with a statistically significant reduction of 19% (95% confidence interval 3.1-32.9) in the combined outcome. Post-hoc sensitivity analysis of the potential impact of potential healthy user bias showed that confounding, if present, could have caused this finding. Our data were inconclusive regarding the benefits of influenza vaccination in elderly persons in South Africa and given the low vaccine uptake, long-term follow-up is warranted.

Global meta-analysis of the C-11377G alteration in the ADIPOQ gene indicates the presence of population-specific effects: challenge for global health initiatives.

Type II diabetes mellitus is currently globally one of the fastest growing non-communicable diseases, especially in developing countries. This investigation reports on a meta-analysis undertaken of the C-11377G locus within the adiponectin gene in a black South African, a Cuban Hispanic and a German Caucasian cohort. Genotyping was performed via a real-time PCR strategy. Both fixed- and random-effects models were tested to describe the diabetes risk at both the cohort and population levels. The 2,2 genotype may only be associated with increased diabetes risk in the Cuban Hispanic cohort. Population-specific effects may have masked these associations upon meta-analytical analysis, as no significant odds ratio could be determined. Thus, to examine diabetes risk, a more global approach including the design of population-specific experimental strategies should be used, which will be crucial in developing health education and policies in a global health programme.

Survey on knowledge and attitudes regarding diabetic inpatient management by medical and nursing staff at Kalafong

Objective. The objective of this study was to evaluate perceptions regarding current practices in the care of diabetic inpatients as well as the knowledge and attitudes of nursing and medical caregivers at a large secondary hospital. Design and methods. Doctors and nurses taking care of diabetic inpatients were surveyed to assess their knowledge of diabetes inpatient management and their attitudes towards diabetic patients. The survey made use of the diabetes knowledge questionnaire (O'Brien) and the DAS3 scale. results. The survey group comprised 115 health care providers; of whom 54 were doctors and 61 were nurses. The response rate was 82. The doctors achieved a mean score of 68.3(standard deviation (SD) 11.5) and the nurses 53.9(SD 16.3) for the diabetes knowledge questionnaire. The DAS3 questionnaire indicated that 80.9of health care personnel strongly agree that special training for managing diabetic patients is necessary; 90.5agree or strongly agree that type 2 diabetes is a serious condition; 92.2agree or strongly agree that tight glycaemic control is valuable; 85.2agree or strongly agree that diabetes has a significant psychosocial impact on patients; and 88.7agree or strongly agree that patients should have autonomy regarding their treatment. conclusions. Health care workers (doctors and nurses) in a large secondary hospital have average to poor knowledge about the care of diabetic inpatients. The DAS3 questionnaire; however; indicates that health care workers have a good attitude towards diabetic patients and realise that special training is necessary

Knowledge of Foot Care in People with Diabetes in a Tertiary Care Setting

Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with `at risk' feet (ARF) to those with `normal/not at risk' feet (NARF) and so assess whether the education effort by the clinic is effective. Methods. Patients attending the clinic completed an interviewer-assisted questionnaire with 11 questions concerning foot care knowledge. A knowledge score for each patient was calculated. Results. Possible scores ranged from 4 to 11 (maximum 11). The mean score for the ARF group was 8.9 (standard deviation (SD) 1.4) (range 4 - 11) compared with 8.9 (SD 1.4) for the NARF group (range 5 - 11) (p0.05). The most substantial difference between the two groups was that the ARF group gave 20more correct answers than the NARF group with regard to frequency of foot inspection (daily) (p=0.025). Conclusions. Both groups of patients had a reasonable knowledge regarding foot care. The patients at risk were more aware of the need for daily foot inspection

Elements of Effective Nutrition Education for Adults with Diabetes Mellitus in Resource-Poor Settings: a Review

This review article highlights the key factors that need consideration in planning an effective nutrition education programme for adults with type 2 diabetes mellitus in resource-poor settings. Type 2 diabetes is increasing to epidemic levels globally. Low socio-economic status is associated with poorer health outcomes and a higher economic burden. Individuals with diabetes cite dietary adherence as the most difficult self-care area. Effective nutrition education achieves the desired goals and outcomes; which include appropriate change in dietary behaviour; improved glycaemic control; plasma lipid levels; blood pressure and body weight; as well as improved potential mediators (knowledge; skills and attitudes). Elements that contribute to a successful nutrition education programme include interventions tailored to the needs; abilities and socio-cultural context of the target group; the active involvement of the patient; a behaviour-focused approach based on appropriate theory; suitable delivery methods and individual/group approaches. Adequate contact time with an educator ( 10 hours); the educator's competence; provision of social support and follow-up intervention are also crucial. Effectively educating diabetic individuals from resource-poor settings in nutrition is a challenging task. It needs innovative and skilled educators who are sensitive to the unique needs of the target group and who use appropriate approaches to address these needs