S. Thula - Academia.edu (original) (raw)

Papers by S. Thula

The Lancet, 2007

HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We ... more HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We aimed to measure predictors of treatment failure and the cause of non-responsive pneumonia in children admitted to hospital with severe pneumonia in Durban, South Africa. We investigated 358 children aged 1-59 months who presented with WHO-defined severe or very severe pneumonia. Children were recruited irrespective of HIV status and started on a standard antimicrobial regimen of benzylpenicillin and gentamicin. All infants also received high-dose trimethoprim-sulfamethoxazole. The primary outcome measure was treatment failure at 48 h. 242 (68%) children were HIV infected, 41 (12%) HIV exposed, uninfected, and 75 (21%) HIV uninfected. Failure to respond by 48 h was predicted by age under 1 year (adjusted odds ratio 6.38, 95% CI 2.72-14.91, p<0.0001), very severe disease (2.47, 1.17-5.24, p=0.0181), HIV status (HIV infected 10.3, 3.26-32.51; HIV exposed, uninfected 6.02, 1.55-23.38; p=0.0003), and polymicrobial disease (one organism 2.06, 1.05-4.05; two organisms 10.75, 4.38-26.36; p<0.0001) on logistic regression analysis. All children with three organisms failed treatment. 72/110 treatment failures had at least two organisms isolated. Three of nine HIV-exposed, uninfected infants, 29/74 HIV-infected, but no HIV-uninfected infants who failed study therapy had Pneumocystis jirovecii pneumonia. For children younger than 1 year, the WHO guidelines are inadequate and need to be revised since both HIV-infected and HIV-exposed, uninfected infants had more treatment failures than did HIV-uninfected infants. Polymicrobial disease is an important reason for treatment failure, and we need to identify rapid low-cost diagnostic methods to assist clinicians.

South African Respiratory Journal, 2016

Introduction. Propofol has been shown to be safe for sedation during flexible bronchoscopy, but d... more Introduction. Propofol has been shown to be safe for sedation during flexible bronchoscopy, but data for its use in medical thoracoscopy are limited. Objectives. We initiated a multicentre randomised study, to compare both the safety and adequacy of medical thoracoscopy performed with two different conscious sedation regimens (midazolam/fentanyl v. propofol/fentanyl) administered by a non-specialist anaesthetist. Methods. Either propofol or midazolam was given in boluses. Fentanyl was used in all. Procedure time, complications and patient discomfort were defined and documented. The adequacy of the sedation according to the endoscopist and recovery time were measured. Results. We enrolled 38 patients (mean 67.5 (standard deviation (11.9)) years, 23 males), with 18 patients randomised to propofol and 20 to midazolam. We observed no differences in procedure time (37.6 v. 36.2 min, p=0.57), recovery time (20.1 v. 20.8 min, p=0.86), or adequacy of sedation as perceived by the endoscopist (p=0.73). There were, however, 10 adverse events observed in the propofol group compared with 4 in the midazolam group (p=0.04). Adverse events in the propofol group included desaturation responsive to supplementary oxygen (n=6), desaturation requiring temporary bag valve ventilation (n=1), hypotension requiring intravenous fluid resuscitation (n=2) and the need to abort the procedure (n=1); this compared with the midazolam group which included desaturation responsive to supplementary oxygen (n=3) and hypotension not requiring intervention (n=1). Conclusion. Propofol is not the drug of choice for sedation during medical thoracoscopy, given the increased risk of complications.

South African Respiratory Journal, 2016

Hydatid disease is responsible for causing cystic disease. In children, it classically involves ... more Hydatid disease is responsible for causing cystic disease. In children, it classically involves the liver, lung and brain but can involve almost any organ or numerous organs simultaneously. e lung is the most common target organ in children, while in adults hepatic involvement is more common. We present three case reports of children who presented with hydatid disease with varying clinical manifestations of pulmonary hydatidosis and complications, and their related management.

South African Medical Journal, 2013

The Lancet, 2002

1. Lancet. 2002 Mar 23;359(9311):992-3. Vertical HIV transmission in South Africa: translating re... more 1. Lancet. 2002 Mar 23;359(9311):992-3. Vertical HIV transmission in South Africa: translating research into policy and practice. Abdool Karim S, Abdool Karim Q, Adhikari M, Cassol S, Chersich M, Cooper P, Coovadia A, Coovadia ...

African Journal of Thoracic and Critical Care Medicine

Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination o... more Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination of neuro-stimulatory illicit drugs such as antiretroviral drugs, heroin, cannabis, opioids, cocaine as well as common household powders such as flat-screen television glass powder. It is a very addictive substance and is used even during pregnancy. Its effects on the developing fetus have been described as causing neonatal abstinence syndrome (NAS), intrauterine growth restriction (IUGR) and neurological complications. There are no data in the literature that report its effect on the respiratory system (RS) of the fetus or neonates. We describe two children who were prenatally exposed to nyaope and presented with upper and lower respiratory tract obstructions associated with recurrent pneumonias. Further studies are required to describe the adverse effects of whoonga on the developing RS of prenatally exposed fetuses.

African Journal of Thoracic and Critical Care Medicine

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Transactions of the Royal Society of Tropical Medicine and Hygiene, 2003

Journal of Tropical Pediatrics, 2013

To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with c... more To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with chronic persistent/recurrent lung disease in whom routine cultures were negative and were non-responders to World Health Organization standard antimicrobial therapy. Non-bronchoscopic bronchoalveolar lavage (NBBAL) was performed on these non-responders. Fifty children were enrolled. Single isolates on NBBAL were seen in 28 cases, dual pathogens in 5 cases and no growth in 14 cases. Haemophilus influenzae (n = 12), Candida albicans (n = 5) and Mycobacterium spp. other than tuberculosis (n = 4) were the commonest pathogens seen. Eight cases with no growth had segmental or lobar collapse: in five cases, NBBAL was therapeutic and in two cases, a diagnosis of lymphoma was made on open lung biopsy. Thirty-two of the 38 cases (84%) had favorable outcomes on follow-up. Haemophilus influenzae, C. albicans and Mycobacterium spp. other than tuberculosis are important pathogens in children with HIV and HIV-associated chronic lung disease.

Archives of Disease in Childhood, 2008

AIDS, 1998

The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-inf... more The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children. Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months. One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma. This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.

South African Medical Journal, 2013

Acute asthma exacerbations remain a common cause of hospitalisation and healthcare utilisation in... more Acute asthma exacerbations remain a common cause of hospitalisation and healthcare utilisation in South African children. To update the South African paediatric acute asthma guidelines according to current evidence, and produce separate recommendations for children above and below 2 years of age. A working group of the South African Childhood Asthma Group was established to review the published literature on acute asthma in children from 2000 to 2012, and to revise the South African guidelines accordingly. Short-acting inhaled bronchodilators remain the first-line treatment of acute asthma. A metered-dose inhaler with spacer is preferable to nebulisation for bronchodilator therapy to treat mild to moderate asthma. Two to four puffs of a short-acting bronchodilator given every 20 - 30 minutes, depending on clinical response, should be given for mild attacks; up to 10 puffs may be needed for more severe asthma. Children with severe asthma or oxygen saturation (SpO2) <92% should receive oxygen and frequent doses of nebulised beta-2-agonists, and be referred to hospital. Nebulised ipratropium bromide (via nebulisation or multidosing via pMDI-spacer combination) should be added if there is a poor response to three doses of β2-agonist or if the symptoms are severe. Early use of corticosteroids reduces the need for hospital admission and prevents relapse; oral therapy is preferable. Assessment of acute asthma in children below the age of 2 years can be difficult, and other causes of wheezing must be excluded. Treatment of acute asthma in this age group is similar to that of older children. Effective therapy for treatment of acute asthma - primarily inhaled short-acting β2-agonists, oral corticosteroids and oxygen with appropriate delivery systems - should be available in all healthcare facilities and rapidly instituted for treatment of acute asthma in children. The guideline document was endorsed by the Allergy Society of South Africa (ALLSA), the South African Thoracic Society (SATS), the National Asthma Education Programme (NAEP), the South African Paediatric Association (SAPA) and the South African Academy of Family Practice.

The Lancet, 2007

HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We ... more HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We aimed to measure predictors of treatment failure and the cause of non-responsive pneumonia in children admitted to hospital with severe pneumonia in Durban, South Africa. We investigated 358 children aged 1-59 months who presented with WHO-defined severe or very severe pneumonia. Children were recruited irrespective of HIV status and started on a standard antimicrobial regimen of benzylpenicillin and gentamicin. All infants also received high-dose trimethoprim-sulfamethoxazole. The primary outcome measure was treatment failure at 48 h. 242 (68%) children were HIV infected, 41 (12%) HIV exposed, uninfected, and 75 (21%) HIV uninfected. Failure to respond by 48 h was predicted by age under 1 year (adjusted odds ratio 6.38, 95% CI 2.72-14.91, p<0.0001), very severe disease (2.47, 1.17-5.24, p=0.0181), HIV status (HIV infected 10.3, 3.26-32.51; HIV exposed, uninfected 6.02, 1.55-23.38; p=0.0003), and polymicrobial disease (one organism 2.06, 1.05-4.05; two organisms 10.75, 4.38-26.36; p<0.0001) on logistic regression analysis. All children with three organisms failed treatment. 72/110 treatment failures had at least two organisms isolated. Three of nine HIV-exposed, uninfected infants, 29/74 HIV-infected, but no HIV-uninfected infants who failed study therapy had Pneumocystis jirovecii pneumonia. For children younger than 1 year, the WHO guidelines are inadequate and need to be revised since both HIV-infected and HIV-exposed, uninfected infants had more treatment failures than did HIV-uninfected infants. Polymicrobial disease is an important reason for treatment failure, and we need to identify rapid low-cost diagnostic methods to assist clinicians.

South African Respiratory Journal, 2016

Introduction. Propofol has been shown to be safe for sedation during flexible bronchoscopy, but d... more Introduction. Propofol has been shown to be safe for sedation during flexible bronchoscopy, but data for its use in medical thoracoscopy are limited. Objectives. We initiated a multicentre randomised study, to compare both the safety and adequacy of medical thoracoscopy performed with two different conscious sedation regimens (midazolam/fentanyl v. propofol/fentanyl) administered by a non-specialist anaesthetist. Methods. Either propofol or midazolam was given in boluses. Fentanyl was used in all. Procedure time, complications and patient discomfort were defined and documented. The adequacy of the sedation according to the endoscopist and recovery time were measured. Results. We enrolled 38 patients (mean 67.5 (standard deviation (11.9)) years, 23 males), with 18 patients randomised to propofol and 20 to midazolam. We observed no differences in procedure time (37.6 v. 36.2 min, p=0.57), recovery time (20.1 v. 20.8 min, p=0.86), or adequacy of sedation as perceived by the endoscopist (p=0.73). There were, however, 10 adverse events observed in the propofol group compared with 4 in the midazolam group (p=0.04). Adverse events in the propofol group included desaturation responsive to supplementary oxygen (n=6), desaturation requiring temporary bag valve ventilation (n=1), hypotension requiring intravenous fluid resuscitation (n=2) and the need to abort the procedure (n=1); this compared with the midazolam group which included desaturation responsive to supplementary oxygen (n=3) and hypotension not requiring intervention (n=1). Conclusion. Propofol is not the drug of choice for sedation during medical thoracoscopy, given the increased risk of complications.

South African Respiratory Journal, 2016

Hydatid disease is responsible for causing cystic disease. In children, it classically involves ... more Hydatid disease is responsible for causing cystic disease. In children, it classically involves the liver, lung and brain but can involve almost any organ or numerous organs simultaneously. e lung is the most common target organ in children, while in adults hepatic involvement is more common. We present three case reports of children who presented with hydatid disease with varying clinical manifestations of pulmonary hydatidosis and complications, and their related management.

South African Medical Journal, 2013

The Lancet, 2002

1. Lancet. 2002 Mar 23;359(9311):992-3. Vertical HIV transmission in South Africa: translating re... more 1. Lancet. 2002 Mar 23;359(9311):992-3. Vertical HIV transmission in South Africa: translating research into policy and practice. Abdool Karim S, Abdool Karim Q, Adhikari M, Cassol S, Chersich M, Cooper P, Coovadia A, Coovadia ...

African Journal of Thoracic and Critical Care Medicine

Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination o... more Nyaope/whoonga is an indigenous street drug in South Africa (SA). It is made from a combination of neuro-stimulatory illicit drugs such as antiretroviral drugs, heroin, cannabis, opioids, cocaine as well as common household powders such as flat-screen television glass powder. It is a very addictive substance and is used even during pregnancy. Its effects on the developing fetus have been described as causing neonatal abstinence syndrome (NAS), intrauterine growth restriction (IUGR) and neurological complications. There are no data in the literature that report its effect on the respiratory system (RS) of the fetus or neonates. We describe two children who were prenatally exposed to nyaope and presented with upper and lower respiratory tract obstructions associated with recurrent pneumonias. Further studies are required to describe the adverse effects of whoonga on the developing RS of prenatally exposed fetuses.

African Journal of Thoracic and Critical Care Medicine

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Transactions of the Royal Society of Tropical Medicine and Hygiene, 2003

Journal of Tropical Pediatrics, 2013

To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with c... more To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with chronic persistent/recurrent lung disease in whom routine cultures were negative and were non-responders to World Health Organization standard antimicrobial therapy. Non-bronchoscopic bronchoalveolar lavage (NBBAL) was performed on these non-responders. Fifty children were enrolled. Single isolates on NBBAL were seen in 28 cases, dual pathogens in 5 cases and no growth in 14 cases. Haemophilus influenzae (n = 12), Candida albicans (n = 5) and Mycobacterium spp. other than tuberculosis (n = 4) were the commonest pathogens seen. Eight cases with no growth had segmental or lobar collapse: in five cases, NBBAL was therapeutic and in two cases, a diagnosis of lymphoma was made on open lung biopsy. Thirty-two of the 38 cases (84%) had favorable outcomes on follow-up. Haemophilus influenzae, C. albicans and Mycobacterium spp. other than tuberculosis are important pathogens in children with HIV and HIV-associated chronic lung disease.

Archives of Disease in Childhood, 2008

AIDS, 1998

The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-inf... more The causes of persistent lung disease (PLD) and chronic lung disease (CLD) are unknown in HIV-infected children in developing countries. We describe the causes and course of PLD and CLD in HIV-infected and uninfected children. Of 194 children with lung disease persisting for at least 1 month who were seen at the paediatric respiratory clinic over a 2-year period, 42 underwent invasive investigations after failed initial management over 3 months. PLD was defined as the presence of clinical and radiological features of lung disease for more than 1 month, and CLD as these features for more than 3 months. One hundred and thirty-eight (71%) of the 194 children with PLD were HIV-infected, 52 (27%) were not infected and four (2%) were of undetermined HIV status. Forty-eight per cent of the HIV-infected children and 52% of the HIV-uninfected children responded to initial treatment over 3 months; the presumptive diagnoses in these were tuberculosis, interstitial pneumonitis, bronchiectasis and post-ventilation lung syndrome. Of the 28 HIV-infected children with CLD who underwent invasive investigations 16 (57%) had lymphoid interstitial pneumonitis, eight (29%) had tuberculosis and four (14%) had non-specific interstitial pneumonitis. Of the 14 HIV-uninfected children with CLD who had invasive testing there were four cases (29%) each of tuberculosis and interstitial pneumonitis, three (22%) cases of bronchiectasis and one case of each of extrinsic allergic alveolitis, crytogenic fibrosing alveolitis and non-Hodgkin's lymphoma. This is the first set of data on the causes of CLD in HIV-infected children in a developing country. Every effort should be made to identify the infectious agent, whether M. tuberculosis or a secondary bacterial infection in LIP, in order to treat most appropriately these children with lung disease.

South African Medical Journal, 2013

Acute asthma exacerbations remain a common cause of hospitalisation and healthcare utilisation in... more Acute asthma exacerbations remain a common cause of hospitalisation and healthcare utilisation in South African children. To update the South African paediatric acute asthma guidelines according to current evidence, and produce separate recommendations for children above and below 2 years of age. A working group of the South African Childhood Asthma Group was established to review the published literature on acute asthma in children from 2000 to 2012, and to revise the South African guidelines accordingly. Short-acting inhaled bronchodilators remain the first-line treatment of acute asthma. A metered-dose inhaler with spacer is preferable to nebulisation for bronchodilator therapy to treat mild to moderate asthma. Two to four puffs of a short-acting bronchodilator given every 20 - 30 minutes, depending on clinical response, should be given for mild attacks; up to 10 puffs may be needed for more severe asthma. Children with severe asthma or oxygen saturation (SpO2) <92% should receive oxygen and frequent doses of nebulised beta-2-agonists, and be referred to hospital. Nebulised ipratropium bromide (via nebulisation or multidosing via pMDI-spacer combination) should be added if there is a poor response to three doses of β2-agonist or if the symptoms are severe. Early use of corticosteroids reduces the need for hospital admission and prevents relapse; oral therapy is preferable. Assessment of acute asthma in children below the age of 2 years can be difficult, and other causes of wheezing must be excluded. Treatment of acute asthma in this age group is similar to that of older children. Effective therapy for treatment of acute asthma - primarily inhaled short-acting β2-agonists, oral corticosteroids and oxygen with appropriate delivery systems - should be available in all healthcare facilities and rapidly instituted for treatment of acute asthma in children. The guideline document was endorsed by the Allergy Society of South Africa (ALLSA), the South African Thoracic Society (SATS), the National Asthma Education Programme (NAEP), the South African Paediatric Association (SAPA) and the South African Academy of Family Practice.