Charlotte Maxeke Johannesburg Academic Hospital

Johannesburg, South Africa

Charlotte Maxeke Johannesburg Academic Hospital

Johannesburg, South Africa
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Feldman C.,Charlotte Maxeke Johannesburg Academic Hospital | Feldman C.,University of Witwatersrand | Anderson R.,University of Pretoria | Anderson R.,National Health Laboratory Service
Seminars in Respiratory and Critical Care Medicine | Year: 2012

Community-acquired pneumonia remains an important cause of disease and death in both developed and developing countries and therefore continues to have a major medical impact. The mortality remains high despite the ready availability of potent antimicrobial agents to which the organisms are susceptible. However, management of these infections is potentially complicated by the emerging resistance of many of the common pathogens to the different classes of antibiotics that are usually prescribed. Furthermore, it is also being recognized that antibiotic resistance or treatment failures may occur not only through traditional microbial antibiotic resistance mechanisms but also through less well defined mechanisms, particularly those developed by the microbes in relation to their quorum sensing/biofilm machinery. Much recent research in this field has been focused on evaluating the clinical impact of antibiotic resistance on optimal antibiotic treatment and antimicrobial choices, as well as alternative strategies to deal with antibiotic resistance and treatment failures. Copyright © 2012 by Thieme Medical Publishers, Inc.

Richards G.A.,University of Witwatersrand | Richards G.A.,Charlotte Maxeke Johannesburg Academic Hospital
South African Medical Journal | Year: 2015

Recent events in West Africa have highlighted the potential for the viral haemorrhagic fevers (VHFs) to cause considerable mortality and morbidity among heathcare workers. However, this is not a new threat as, although the risk is currently increased, it has always been present. In South Africa (SA) the only endemic haemorrhagic fever is Crimean-Congo haemorrhagic fever, transmitted by the Hyalomma tick, which is ubiquitous in cattle farming areas. Johannesburg, the commercial and transport hub of SA, is unusual in that all cases of VHF seen there are imported, either from rural areas in SA or from countries to the north. Johannesburg functions as the gateway to and from the rest of Africa, and as a destination for more affluent residents of neighbouring countries seeking medical attention. Numerous outbreaks of nosocomial infection have occurred in SA, and these are described in the form of brief case reports. © 2015, South African Medical Association. All rights reserved.

Feldman C.,Charlotte Maxeke Johannesburg Academic Hospital | Feldman C.,University of Witwatersrand | Anderson R.,University of Pretoria
Journal of Infection | Year: 2014

Pneumococcal polysaccharide vaccines (PPVs) and conjugate vaccines (PCVs), of which PPV23 and PCV13 are the current front runners, have had a significant, beneficial impact on public health. With regard to PPV23, there has been some debate, however, about its protective efficacy against all-cause pneumonia, as opposed to invasive pneumococcal disease, in high-risk cases. PCVs, on the other hand, have been included in many national immunisation programmes for prevention of severe pneumococcal disease in infants and young children, as well as for adults in various high-risk categories. Although innovative and effective, the protective efficacy of PCVs, the composition of which is based on the geographic prevalence and virulence of pneumococcal serotypes, is limited due to colonisation of the nasopharynx with non-vaccine serotypes. This phenomenon of serotype replacement has provided the impetus for development of new generation recombinant protein and whole cell pneumococcal vaccines with the potential to provide serotype-independent protection. In addition to an overview of the successes and limitations of PPVs and PCVs, this review is focused on emerging and pipeline protein-based and whole cell vaccines, preceded by a consideration of conserved pneumococcal virulence factors which are potential vaccine candidates. © 2014.

Feldman C.,Charlotte Maxeke Johannesburg Academic Hospital | Feldman C.,University of Witwatersrand | Anderson R.,University of Pretoria
Journal of Infection | Year: 2013

The predisposition of cigarette smokers for development of oral and respiratory infections caused by microbial pathogens is well recognised, with those infected with the human immunodeficiency virus (HIV) at particularly high risk. Smoking cigarettes has a suppressive effect on the protective functions of airway epithelium, alveolar macrophages, dendritic cells, natural killer (NK) cells and adaptive immune mechanisms, in the setting of chronic systemic activation of neutrophils. Cigarette smoke also has a direct effect on microbial pathogens to promote the likelihood of infective disease, specifically promotion of microbial virulence and antibiotic resistance. In addition to interactions between smoking and HIV infection, a number of specific infections/clinical syndromes have been associated epidemiologically with cigarette smoking, including those of the upper and lower respiratory tract, gastrointestinal tract, central nervous and other organ systems. Smoking cessation benefits patients in many ways, including reduction of the risk of infectious disease. © 2013 The British Infection Association.

Profyris C.,Chelsea and Westminster Hospital | Tziotzios C.,University of Cambridge | Do Vale I.,Charlotte Maxeke Johannesburg Academic Hospital
Journal of the American Academy of Dermatology | Year: 2012

Cutaneous scarring is often the epicenter of patient-related concerns, and the question "Will there be a scar?" is one that is all too familiar to the everyday clinician. In approaching this topic, we have reviewed the pathology, the embryology, and the molecular biology of cutaneous scarring. © 2010 by the American Academy of Dermatology, Inc.

Ibebuike K.,Charlotte Maxeke Johannesburg Academic Hospital | Ouma J.,Charlotte Maxeke Johannesburg Academic Hospital | Gopal R.,Chris Hani Baragwanath Academic Hospital
African Health Sciences | Year: 2013

Background: Worldwide there are varying reports on the prevalence of meningiomas among intracranial neoplasms. Different reports state intracranial meningiomas, gliomas or metastatic tumours as the most common tumour among intracranial neoplasms. We present our institutions' experience of patients with intracranial neoplasms and a comparison of our findings with those from the literature. Objective: To determine the relative frequency of intracranial meningiomas among intracranial neoplasms in our environment. Methods: Consecutive patients (151) seen at the CMJAH and CHBAH, Johannesburg, with histologically proven intracranial neoplasms over a 12 month period were analyzed. Results: The commonest histological types were meningiomas, gliomas and pituitary tumours. Forty eight (31.8%) patients had histologically confirmed intracranial meningiomas during the study period, 35 (23.2%) had pituitary adenomas and 32 (21.2%) had gliomas. The mean age of the patients was 43 years with a female-to-male ratio of 1.3:1. The peak age range at presentation was in the fifth (27.1%) and sixth (26.5%) decades. Conclusion: The study showed that meningioma is the most common tumour among intracranial neoplasms in our environment.

Kawonga M.,Charlotte Maxeke Johannesburg Academic Hospital
Global health action | Year: 2013

In light of an increasing global focus on health system strengthening and integration of vertical programmes within health systems, methods and tools are required to examine whether general health service managers exercise administrative authority over vertical programmes. To measure the extent to which general health service (horizontal) managers, exercise authority over the HIV programme's monitoring and evaluation (M&E) function, and to explore factors that may influence this exercise of authority. This cross-sectional survey involved interviews with 51 managers. We drew ideas from the concept of 'exercised decision-space' - traditionally used to measure local level managers' exercise of authority over health system functions following decentralisation. Our main outcome measure was the degree of exercised authority - classified as 'low', 'medium' or 'high' - over four M&E domains (HIV data collection, collation, analysis, and use). We applied ordinal logistic regression to assess whether actor type (horizontal or vertical) was predictive of a higher degree of exercised authority, independent of management capacity (training and experience), and M&E knowledge. Relative to vertical managers, horizontal managers had lower HIV M&E knowledge, were more likely to exercise a higher degree of authority over HIV data collation (OR 7.26; CI: 1.9, 27.4), and less likely to do so over HIV data use (OR 0.19; CI: 0.05, 0.84). A higher HIV M&E knowledge score was predictive of a higher exercised authority over HIV data use (OR 1.22; CI: 0.99, 1.49). There was no association between management capacity and degree of authority. This study demonstrates a HIV M&E model that is neither fully vertical nor integrated. The HIV M&E is characterised by horizontal managers producing HIV information while vertical managers use it. This may undermine policies to strengthen integrated health system planning and management under the leadership of horizontal managers.

Khan T.,Charlotte Maxeke Johannesburg Academic Hospital
Global health action | Year: 2013

In light of global concerns about insufficient numbers of doctors, midwives, and nurses, the World Health Organization (WHO) has identified the scale-up of the production of medical professionals who are competent and responsive to community needs as urgent and necessary. Coincident with this imperative, South African medical schools have also had to consider redressing apartheid-era inequities in access to medical education and changing the racial and gender profile of medical graduates to be representative of the population. In this article, we explore progress and challenges with regard to transformation, defined as intentional and planned changes aimed at addressing historical disadvantages, in the Gauteng Province of South Africa. A cross-sectional, descriptive analysis was conducted using data on medical school admissions and graduations from the Health and Education Departments for the period 1999-2011. Admission and graduation statistics of 1999, 2005, 2008, and 2011 were analysed according to race and gender. The results show that there has been progress in transforming the race and gender composition of medical students and graduates, in line with the transformation strategies of the South African government. In 1999, black African enrolments and graduates were conspicuously low in two of the three medical schools in the Gauteng province. By 2011, an almost six-fold increase in black African student enrolments was seen in one medical school that was previously designated as a white institution. In contrast, at the historically black medical school, whites only represented 0.40% of enrolments in 1999 and 7.4% in 2011. Since 1999, the number and proportion of female medical enrolments and graduates has also increased substantially. While there has been progress with redressing historical disparities and inequities in terms of race and gender, further efforts are needed to ensure that student intakes and graduations are in line with the South African population profile.

Veldsman L.,Charlotte Maxeke Johannesburg Academic Hospital
South African Journal of Clinical Nutrition | Year: 2015

The following case study was discussed at the South African Society for Parenteral and Enteral Nutrition (SASPEN) workshop on critcal care nutrition held at the 25th Congress of the Nutrition Society of South Africa and the 13th Congress of the Association for Dietetics in South Africa in Johannesburg in September 2014. It is a reflection of the general opinion of the audience, followed by a rationale of the latest literature on the topic. Here is a summarised discussion of the case. © 2015, Medpharm Publications. All rights reserved.

Kallenbach T.,Charlotte Maxeke Johannesburg Academic Hospital
Southern African Journal of Anaesthesia and Analgesia | Year: 2015

While beta thalassaemia is not a common disorder with an estimated 100 000 severely affected individuals worldwide, improved survival rates and increased global migration means an increased frequency of such patients being seen for various surgeries. The different aspects of this disorder have wide-ranging implications for anaesthesia. Thus, for safe anaesthetic care, the anaesthetist needs to have a good understanding of beta thalassaemia. Presented here is a case report of a 32-year-old gentleman with beta thalassaemia major presenting for elective laparoscopic cholecystectomy and splenectomy, followed by a discussion of the literature. © 2015 The Author(s).

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