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1.
S Afr Med J ; 107(9): 781-787, 2017 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-28875888

RESUMO

BACKGROUND: Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation. OBJECTIVE: To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients. METHODS: A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions. RESULTS: HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens. CONCLUSIONS: On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.

2.
S. Afr. med. j. (Online) ; 107(9): 781-787, 2017.
Artigo em Inglês | AIM (África) | ID: biblio-1271171

RESUMO

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Mieloma Múltiplo , Neoplasias de Plasmócitos
3.
S. Afr. med. j. (Online) ; 107(9): 781-787, 2017. tab
Artigo em Inglês | AIM (África) | ID: biblio-1271179

RESUMO

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases


Assuntos
Estudos de Coortes , Infecções por HIV , Soropositividade para HIV , Mieloma Múltiplo/diagnóstico , Neoplasias de Plasmócitos , África do Sul
4.
S. Afr. fam. pract. (2004, Online) ; 51(3): 211-215, 2009.
Artigo em Inglês | AIM (África) | ID: biblio-1269857

RESUMO

Background: The migration of doctors from their home countries is not a new phenomenon. Apart from voluntary migration due to various reasons; medical professionals; often from sub-Saharan Africa; are actively recruited by developed countries. Doctors in South Africa are esteemed for the high standard of training they receive locally; a quality which renders them prime candidates for employment. Various factors are involved in the push-pull theory of migration. It has; however; been reported extensively that push factors usually play a much greater role in doctors' decision to leave their countries of origin; than the pull factors in the host or recipient country. Push factors motivating migration most frequently include dissatisfaction with remuneration packages and working conditions; high levels of crime and violence; political instability; lack of future prospects; HIV/AIDS; and a decline in education systems. In addition to a depletion of intellectual resources through losing highly qualified and skilled individuals; source countries also face substantial monetary implications caused by the migration of doctors. The cost of training medical students is subsidised by the government; and could be regarded as a lost investment when young graduates seek permanent employment abroad. The aim of the study was to investigate the profile of South African qualified physicians who emigrated from South Africa. Methods: The investigation was conducted in 2005 as a descriptive study where the participants were primarily found by the snowball sampling method. The initial group of participants were known to the researcher. Participants had to be graduates from South African medical schools/faculties; living abroad and in possession of a permanent work permit in the countries where they were employed. Short-term locum doctors were not included. Information; consent letters and questionnaires were either hand-delivered or e-mailed; and completed forms and questionnaires were returned via these routes. Participation was voluntary. Results: Twenty nine of 43 potential participants responded; of which 79.3were male and 20.7female between the ages of 28 and 64 years (median 47 years). The year of graduation ranged from 1964 to 2000 (median 1985); and the year of leaving the country ranged from 1993 to 2005 (median 2002). The majority (72.4) were in private practice before they left; 27.5had public service appointments and 17.3were employed by private hospitals. Seventy nine percent of respondents had postgraduate qualifications. Countries to which migration occurred included New Zealand; United Arab Emirates; Bahrain; United Kingdom; Canada; Yemen; and Australia. Forty one percent of respondents indicated that they would encourage South African young people to study medicine; although 75would recommend newly graduate doctors to leave the country. Financial factors were indicated as a reason for leaving by 86.2of the respondents; better job opportunities by 79.3; and the high crime rate in South Africa by 75.9. Only 50of the respondents said that better schooling opportunities for their children played a role in their decision to leave the country. Approximately one-fifth (17.9) of the respondents indicated that they already had family abroad by the time they decided to emigrate. Conclusions: Financial reasons were the most important motivating factor in this particular group of doctors who relocated to overseas destinations; followed by working conditions and the rate of crime and violence in the country. In comparison to other investigations published previously; the results presented here clearly indicate a tendency that more doctors offer financial and crime-related reasons for migration from South Africa than before. In order to prevent the loss of medical expertise from a society already in need of quality healthcare; issues compelling doctors to look for greener pastures should be addressed urgently and aggressively by stakeholders


Assuntos
Emigração e Imigração , Motivação , Médicos , Salários e Benefícios
5.
Antimicrob Agents Chemother ; 42(10): 2752-5, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9756791

RESUMO

The activities of a panel of currently available antibiotics and the investigational agents LY 333328, linezolid, CL 331,002, CL 329,998, moxifloxacin (BAY 12-8039), trovafloxacin, and quinupristin-dalfopristin against 274 clinical isolates of enterococci were determined. No vancomycin resistance or beta-lactamase production was observed. Except for 12 isolates (all non-Enterococcus faecalis) showing reduced susceptibility to quinupristin-dalfopristin (MIC, >/=4 microg/ml), the new agents exhibited promising in vitro antienterococcal activity.


Assuntos
Antibacterianos/farmacologia , Enterococcus/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Humanos , Testes de Sensibilidade Microbiana , África do Sul
6.
S Afr Med J ; 88(5): 564-5, 1998 May.
Artigo em Inglês | MEDLINE | ID: mdl-9638125

RESUMO

The study aimed to determine the antibacterial therapy effective in the cure of endocarditis caused by Enterococcus faecalis resistant to clinically achievable levels of vancomycin. Isolation of the causative enterococcus had been achieved by direct inoculation of the resected valve into the culture medium in theatre. The patient was known to have had an aortic valve defect since childhood and had recently undergone splenectomy following trauma. Blood cultures were negative prior to valve replacement. A perivalvular abscess was noted at operation. In vitro minimal bactericidal results and serum activity were the basis of the postoperative choice of drugs. The minimal bactericidal level of teicoplanin was 250 micrograms/ml and that of amoxycillin 64 micrograms/ml. Neither is achievable with the advocated dosage. A combination of these two cell-wall-active agents successfully eliminated the infection. Acting at two different sites in the synthesis of the bacterial cell wall, teicoplanin and amoxycillin were found to be bactericidal in vitro at the trough levels of the antibiotics in the serum. The patient recovered fully.


Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Penicilinas/uso terapêutico , Teicoplanina/uso terapêutico , Adulto , Resistência Microbiana a Medicamentos , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino
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