Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 - 2018.

BACKGROUND: The under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes. METHODS: This was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed. RESULTS: Of the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM. CONCLUSIONS: Despite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.

Research protocol: Cisplatin-associated ototoxicity amongst patients receiving cancer chemotherapy and the feasibility of an audiological monitoring program.

BACKGROUND: Cisplatin is an anti-cancer chemotherapy drug classified as an alkylating agent. It is used for the treatment of a variety of cancers such as cervical, breast, stomach, prostate, bladder and oesophageal, to name a few. However due to its expansive toxicity profile, patients receiving cisplatin can experience high frequency hearing loss, a side effect known as ototoxicity. The dearth of information on the extent and severity of cisplatin-associated ototoxicity in South Africa prevents the implementation of a context-specific audiological monitoring programme. METHODS: This study aims to determine the extent and severity of ototoxicity amongst patients with cervical cancer, receiving cisplatin-based chemotherapy and hence the feasibility of an ototoxicity monitoring program in the province of KwaZulu-Natal, South Africa. A concurrent mixed methods design will be employed in the study. This longitudinal study will involve interviewing oncology nurses, oncologists, pharmacists and audiologists to assess the level of awareness to ototoxicity, as well as conducting diagnostic audiological evaluations at regular intervals on 78 patients with cervical cancer to ascertain the progression of hearing loss during and after chemotherapy. The feasibility of the monitoring program will be assessed as a parallel process to the audiological evaluations, where patient outcomes and cost implications to the patient and the health sector will be considered. Data will be subjected to statistical analyses so as to strengthen knowledge in the field and inform appropriate policies, and healthcare providers. DISCUSSION: This study is the first longitudinal study in South Africa to determine the ototoxic effects of cisplatin therapy on patients diagnosed with cervical cancer. Thus, the results generated from this study is likely to bring novel information to the fore using an evidence-based approach that will influence policy and clinical practice which can vastly improve the quality of life of patients undergoing chemotherapy. Mitigation of any further loss in the quality of life of affected patients is of paramount importance and the data generated from this project can lay the basis for further effective dialogue towards policy formulation on an ototoxic monitoring programme and the resultant strengthening of health systems in limited resource settings.

Cochlear function in patients with chronic kidney disease.

OBJECTIVE: To evaluate cochlear functioning in patients (18-45 years old) with varying stages of chronic kidney disease (CKD). Using purposive sampling, 50 participants, 10 in each of the 5 stages of CKD, were selected and underwent pure tone audiometric testing and distortion product otoacoustic emissions (DPOAEs). RESULTS: Significant differences (p < 0.05) were found between pure tone audiometry and DPOAEs in detecting early cochlear dysfunction in the high-frequency range in stages 3 (6,000/5,000 Hz; p = 0.00), 4 (6,000/5,000 Hz; p < 0.03) and 5 (4,000/3,333 Hz; p < 0.01, 8,000/6,667 Hz: p < 0.05) with DPOAEs being more sensitive in identifying early cochlear dysfunction. Patients in stages 1 and 2 presented with normal puretone thresholds and DPOAEs, suggesting that cochlear functioning in these patients was normal. Early cochlear dysfunction, thereby indicating a subclinical hearing loss, was identified in stages 3, 4 and 5 by DPOAE testing. In addition, blood test results, drug intake and concomitant conditions were recorded and analysed which suggested a relationship between reduced cochlear functioning and increased electrolyte levels, treatment regimens and concomitant conditions. CONCLUSION: Participants in the later stages of CKD presented with early cochlear dysfunction, presenting with subclinical hearing loss. It was postulated that this subclinical hearing loss resulted from a combination of electrolytic, urea and creatinine imbalances, together with concomitant medical conditions and ototoxic drug intake. It was concluded that audiological monitoring be included in the management of patients with CKD and that DPOAEs be introduced as part of the test battery to monitor cochlear function in patients with varying degrees of CKD.

Bone density and depression in premenopausal South African women: a pilot study.

OBJECTIVE: It is posited that the effect of depression on BMD is dependent on the severity of depression. Conflicting evidence exists regarding this possible association. This study investigated the association between depression and low bone mineral density (BMD). METHODS: The hypothesis was investigated in a random sample of volunteers (n=40) and in premenopausal female psychiatric patients (n=5) diagnosed with recurrent severe major depression. The outcome measures were BMD (DEXA); depression (Beck Depression Inventory and Psychological General Well-being Scale) and 24-hour saliva cortisol levels (ELISA). In a comparison of women (4 of the 40 i.e. "control" subjects) with negligible symptoms of depression and the five patients with severe recurrent major depression- BMD, depression, saliva cortisol and bone turnover markers were measured and compared. Pro-inflammatory status (IL-1 and TNF-alpha) was investigated in the psychiatric patients only. RESULTS: In the random - non clinical - sample of women (n=40), 26 exhibited normal BDM and 14 exhibited low BMD. Drepressive symptoms and cortisol level were not significantly different between these two groups. Women with severe recurrent major depression (n=5)exhibited lower median BMD T-scores, higher overall bone turnover and higher 24-hour cortisol levels compared to "control" subjects (n=4). The psychiatric patients also exhibited elevated IL-1 levels. CONCLUSION: The effect of depression on BMD may be dependent on the depression severity, IL-1 and cortisol are possible mediators in depression-induced BMD loss.

Bone density and depression in premenopausal South African women: a pilot study

Objective: It is posited that the effect of depression on BMD is dependent on the severity of depression. Conflicting evidence exists regarding this possible association. This study investigated the association between depression and low bone mineral density (BMD). Methods: The hypothesis was investigated in a random sample of volunteers (n=40) and in premenopausal female psychiatric patients (n=5) diagnosed with recurrent severe major depression. The outcome measures were BMD (DEXA); depression (Beck Depression Inventory and Psychological General Well-being Scale) and 24-hour saliva cortisol levels (ELISA). In a comparison of women (4 of the 40 i.e. ""control"" subjects) with negligible symptoms of depression and the five patients with severe recurrent major depression- BMD; depression; saliva cortisol and bone turnover markers were measured and compared. Pro-inflammatory status (IL-1 and TNF-alpha) was investigated in the psychiatric patients only. Results: In the random - non clinical - sample of women (n=40); 26 exhibited normal BMD and 14 exhibited low BMD. Depressive symptoms and cortisol levels were not significantly different between these two groups. Women with severe recurrent major depression(n=5) exhibited lower median BMD T-scores; higher overall bone turnover and higher 24-hour cortisol levels compared to ""control"" subjects (n=4). The psychiatric patients also exhibited elevated IL-1 levels. Conclusion: The effect of depression on BMD may be dependent on the depression severity. IL-1 and cortisol are possible mediators in depression-induced BMD loss

Neurological Aspects of Stuttering : Summary Overview of Scientific Fingings

The aim of this article is to provide a summary overview of some of the more important scientific evidence of neurological differences between stutterers and non-stutterers. Stuttering is a complex disorder of speech fluency; the aetiology of which is still largely unclear. Although most of the knowledge about stuttering has been derived from clinical observations; essential information obtained through laboratory research delineated some important neurological differences between people with a stuttering problem and people who do not stutter. These differences are identified in terms of neuroimaging; speech production processes and even in terms of auditory perception and feedback mechanisms. The development of new and improved neuroimaging techniques has greatly enhanced the potential to investigate neurological correlates of stuttering. Current knowledge is indicative of a complex neurological basis for stuttering. However; on the basis of current scientific evidence any currently held theory cannot be conclusively substantiated

Diagnostic reference data for the monaural brain-stem auditory evoked response (BAER).

The objective of the investigation was to establish diagnostic reference data for the normal BAER. BAERs were elicited from the target (R) ear using clicks presented at 70dBnHL. Relevant latency and amplitude data were obtained from 60 selected normal hearing Indian undergraduate females (N = 30; mean age = 20.33 years) and male (N = 30; mean age = 21.33 years) students aged between 18 and 25 years (mean age = 20.73 years). Diagnostic reference data were established for the absolute latencies of peaks I to VI; relative latencies of peaks I-III; III-V and I-V; absolute amplitudes of peaks I and V and the relative amplitude ratio of peaks V:I. These results are discussed in terms of the literature and implications for clinical application and further research.