Steve Biko Academic Hospital

Pretoria, South Africa

Steve Biko Academic Hospital

Pretoria, South Africa
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Mshelia D.S.,Steve Biko Academic Hospital | Symonds M.E.,University of Nottingham | Sathekge M.,Steve Biko Academic Hospital
Nuclear Medicine Communications | Year: 2013

Background: The uptake of 18F-FDG in brown adipose tissue (BAT) may have important implications in understanding the pathophysiology of BAT and obesity. Because of the thermal implications of BAT uptake of 18F-FDG, this study aimed to contribute to existing knowledge by assessing patients scanned in a subtropical environment with particular reference to ethnicity. Patients and Methods: A retrospective study was carried out to determine the prevalence and pattern of BAT uptake in patients undergoing 18F-FDG PET-CT imaging in a PET facility located in a subtropical climatic zone. Standardized uptake values were obtained for regions of BAT uptake of 18F-FDG, and the distribution pattern was assessed according to anatomical region, sex, age, BMI and ethnicity. Results: Following a reveiw of a total of 386 scans, 38 patients showed BAT uptake of 18F-FDG (9.85%), with the mass and activity of BAT being greater in women than in men (11.95 and 6.88%, respectively). BAT uptake of F-FDG in the neck/supraclavicular, axillary and mediastinal regions was greater in adults whose BMI was less than 18 kg/m. However, perirenal BAT activity was shown to be greater in obese individuals. The frequency of BAT uptake of 18F-FDG was 55% in winter as against 45% during summer (P<0.012). There was no statistical difference in BAT uptake between black and white patients. Conclusion: This study shows the pattern and prevalence of BAT in patients in a subtropical environment. Although the average seasonal temperatures are higher in a subtropical climate, a seasonal variation in BAT expression was observed, although there were no differences with respect to patient ethnicity. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Schutte C.-M.,Steve Biko Academic Hospital | Townsend T.,Steve Biko Academic Hospital | Van Coller R.,Steve Biko Academic Hospital | Olorunju S.,Medical Research Council
South African Medical Journal | Year: 2013

Background. HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM. Aim. We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM. Methods. Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed. Results. 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients. Conclusion. Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common.

Meel R.,University of Pretoria | Meel R.,Steve Biko Academic Hospital | Goncalves R.,University of Pretoria | Goncalves R.,Steve Biko Academic Hospital
South African Medical Journal | Year: 2016

Background. Fibrinolytic therapy is a time-critical intervention proven to reduce mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Limited data exist in South Africa (SA) regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy. Objectives. To establish the proportion of STEMI patients receiving fibrinolytic agents at Steve Biko Academic Hospital (SBAH), Pretoria, SA, identify any delays to receiving fibrinolytic agents, and uncover reasons for those delays. The number of lives lost as a result of these delays was calculated. Methods. This prospective, observational study included 100 consecutive patients presenting with a STEMI to SBAH. Using a researcheradministered questionnaire, the times from symptom onset to receipt of fibrinolytic therapy and the reasons for delays were documented. The number of lives lost was then calculated. Results. Only 37% of patients received fibrinolytic therapy and only 3% received the medication within 1 hour. The median total delay in receiving fibrinolytic therapy was 270 minutes (range 45 - 584). The median time delays from onset of symptoms to call for help, between calling for help and arriving at hospital, and from hospital arrival to fibrinolytic agent administration, were 35 minutes (5 - 1 185), 55 minutes (12.5 - 670) and 62.5 minutes (16.5 - 282), respectively. Numerous delays were identified at all stages, with patient and transport delays being most significant. Strikingly, an additional 32 patients per 1 000 treated could have been saved if a fibrinolytic agent had been administered within 1 hour. Conclusions. This study highlights the important problem of delayed or non-administration of fibrinolytic therapy at a tertiary hospital. The problems identified will contribute to the implementation of a robust STEMI management network in SA, similar to those in developed countries. © 2016, South African Medical Association. All rights reserved.

Buchner A.,Steve Biko Academic Hospital | Omar F.E.,Steve Biko Academic Hospital | Vermeulen J.,Steve Biko Academic Hospital | Reynders D.T.,Steve Biko Academic Hospital
South African Medical Journal | Year: 2014

Background. Hepatitis B is an important public health concern in South Africa (SA). The hepatitis B virus (HBV) vaccine was introduced into the South African Expanded Programme on Immunisation (EPI-SA) in 1995. There is no 'catch-up' programme in place. The duration of protection after hepatitis B vaccination in the SA population is unknown. Waning of vaccine-induced immunity leaves people at risk of acquiring hepatitis B infection in settings where the prevalence of infection is high and horizontal transmission is likely. Objective. To assess immunity to HBV in patients at presentation to a paediatric haematology and oncology unit. Methods. An audit of hepatitis profiles was done of all new patients seen in the unit from January 2012 to December 2013. Patients were classified as immune (antibody levels to hepatitis B surface antigen (anti-HBs) >100 mIU/ml), low immune (anti-HBs 10-100 mIU/ml) and not immune (anti-HBs <10 mIU/ml). Results. Of the 210 patients included (median age 6.5 years), 84 (40.0%) had no immunity to hepatitis B despite presumed vaccination as part of the EPI schedule. Six patients tested positive for hepatitis B core antibody (anti-HBc), consistent with previous infection. No patients had active hepatitis B infection (hepatitis B surface antigen-positive). Most human immunodeficiency virus (HIV)-infected patients were not immune to HBV (80.0%). Conclusion. A significant number of children in SA are not immune to hepatitis B despite vaccination being part of the EPI-SA. Combined passive-active immunisation should be considered for all oncology patients in settings where exposure to HBV is possible. Consideration should also be given to offering booster vaccination to the population as a whole.

Karodia M.,Steve Biko Academic Hospital
Obstetrics and Gynaecology Forum | Year: 2016

Haematological abnormalities are frequently encountered in the obstetric patient. Cytopenias are common, with anaemia and thrombocytopenia predominating. Many other haematological conditions are seen during pregnancy, however, in this review, I intend to describe the common abnormalities and the management thereof.

Ueckermann V.,Steve Biko Academic Hospital | Van Zyl D.G.,Kalafong Hospital
Journal of Endocrinology, Metabolism and Diabetes of South Africa | Year: 2013

Objective: The purpose of this study was to determine the prevalence of subclinical hypothyroidism among patients with diabetes mellitus at the Kalafong Diabetes Clinic in Pretoria. Design: Cross-sectional study. Setting and subjects: Five hundred and sixty-five patients with diabetes mellitus (type 1, type 2 or unknown), who were following-up at the Kalafong Hospital Diabetes Clinic. Outcome measures: The thyroid stimulating hormone (TSH) levels of patients were evaluated. Patients with TSH levels > 5.66 IU/ml (upper reference limit of the Kalafong National Health Laboratory Services laboratory) subsequently underwent repeat thyroid function evaluation, including T4 level, to determine the prevalence of subclinical hypothyroidism. Results: A total of 563 patients met the inclusion criteria for this study and underwent TSH evaluation. The prevalence of subclinical hypothyroidism was found to be 0.9% in the study population, and 1.6% in a subgroup of patients with type 2 diabetes mellitus. Conclusion: The prevalence of subclinical hypothyroidism in this South African population of patients with diabetes was significantly lower than that stated in the literature. This holds true for both the general population and populations of patients with diabetes mellitus. To our knowledge, there is no data available for the prevalence of subclinical hypothyroidism in the general population in South Africa for comparison with the study group. © SEMDSA.

Masekela R.,Steve Biko Academic Hospital | Anderson R.,University of Pretoria | Moodley T.,Steve Biko Academic Hospital | Kitchin O.P.,Steve Biko Academic Hospital | And 3 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2012

BACKGROUND: Human immunodeficiency virus (HIV) infected children have an eleven-fold risk of acute lower respiratory tract infection. This places HIV-infected children at risk of airway destruction and bronchiectasis. OBJECTIVE: To study predisposing factors for the development of bronchiectasis in a developing world setting. METHODS: Children with HIV-related bronchiectasis aged 6-14 years were enrolled. Data were collected on demographics, induced sputum for tuberculosis, respiratory viruses (respiratory syncytial virus), influenza A and B, parainfluenza 1-3, adenovirus and cytomegalo virus), bacteriology and cytokines. Spirometry was performed. Blood samples were obtained for HIV staging, immunoglobulins, immunoCAP®-specific immunoglobulin E (IgE) for common foods and aeroallergens and cytokines. RESULTS: In all, 35 patients were enrolled in the study. Of 161 sputum samples, the predominant organisms cultured were Haemophilus influenzae and parainfluenzae (49%). The median forced expiratory volume in 1 second of all patients was 53%. Interleukin-8 was the predominant cytokine in sputum and serum. The median IgE level was 770 kU/l; however, this did not seem to be related to atopy; 36% were exposed to environmental tobacco smoke, with no correlation between exposure and CD4 count. CONCLUSION: Children with HIV-related bronchiectasis are diagnosed after the age of 6 years and suffer significant morbidity. Immune stimulation mechanisms in these children are intact despite the level of immunosuppression. © 2011 The Union.

Schoeman J.,Steve Biko Academic Hospital
Indian Journal of Cancer | Year: 2015

Nutritional status in children with cancer is an important prognostic factor. Assessment consisting of anthropometry, biochemistry, clinical, and diet that needs to be done on diagnosis and regularly to ensure that patient's nutritional status does not deteriorate. In developing countries, assessment will depend on the availability of all resources, but monitoring is essential. The development of malnutrition during treatment is possible and the reasons are multifactorial. Nutrition plays a deciding role and a key factor in children with cancer and can influence their outcome. © 2015 Indian Journal of Cancer | Pulished by Wolters Kluwer - Medknow.

Theron A.,Steve Biko Academic Hospital | Schultz C.,Steve Biko Academic Hospital | Ker J.A.,Steve Biko Academic Hospital | Falzone N.,Tshwane University of Technology
South African Medical Journal | Year: 2010

Water-pipe smoking is growing in popularity, especially among young people, because of the social nature of the smoking session and the assumption that the effects are less harmful than those of cigarette smoking. It has however been shown that a single water-pipe smoking session produces a 24-hour urinary cotinine level equivalent to smoking 10 cigarettes per day. Aim. We aimed to measure carboxyhaemoglobin (COHb) blood levels before and after water-pipe and cigarette smoking sessions. Method. Self-confessed smokers older than 18 years (N=30) volunteered to smoke a water-pipe or a cigarette and have their blood COHb levels measured under controlled conditions. Results. Mean baseline COHb levels were 2.9% for the 15 cigarette smokers and 1.0% for the 15 water-pipe smokers. Levels increased by a mean of 481.7% in water-pipe smokers as opposed to 39.9% in cigarette smokers. Conclusion. The study demonstrated that water-pipe smokers had significantly higher increases in blood COHb levels than cigarette smokers during a single smoking session.

Tshifularo M.,Steve Biko Academic Hospital | Tshifularo M.,University of Pretoria | Govender L.,Steve Biko Academic Hospital | Govender L.,University of Pretoria | And 2 more authors.
South African Medical Journal | Year: 2013

Background. Sub-Saharan Africa has the highest incidence of HIV infection. According to recent census statistics, 5.6 million people in South Africa (SA) are HIV-positive, the highest number of infected individuals worldwide. Over 80% of HIV-infected individuals will present with ear, nose and throat (ENT) manifestations. Previous studies show that oral diseases seem to be the most common ENT-related manifestation, reported in about 40 - 50% of HIV-infected patients. In SA, there is lack of local information regarding the otolaryngological and head and neck manifestations in HIV-infected individuals. Objective. To ascertain our local trends of ENT and head and neck manifestations in HIV-infected patients seen at our specialised ENT-HIV Clinic, Steve Biko Academic Hospital, Pretoria, Gauteng Province, SA. Methods. A 1-year prospective study involving 153 HIV-infected patients was conducted in the clinic from January to December 2011. Patient history was taken and examinations were performed based on the World Health Organization (WHO) HIV/AIDS classification system. Data analysis was performed using Epi Info 7 software. Results. The most common manifestations were adenoid hypertrophy/hyperplasia followed by cervical lymphadenopathy, chronic suppurative otitis media, otitis media with effusion and sensory-neural hearing loss. Conclusion. Patients typically presented with early manifestations during symptomatic WHO stages I and II in contrast to results reported in similar developing world studies from Iran, Nigeria and India. A possible explanation may lie in the SA government HIV Counselling and Testing campaign and the antiretroviral rollout programme, the effectiveness of which is becoming evident.

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