Jantjie Taljaard | University of Stellenbosch (original) (raw)

Papers by Jantjie Taljaard

South African Medical Journal, Jul 1, 2022

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

The Southern African Journal of Epidemiology and infection, 2008

Epidemiology and Infection

Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Af... more Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Africa Region. The natural history of HBV infection in this population is poorly characterised, and may differ from patterns observed elsewhere due to differences in prevailing genotypes, environmental exposures, co-infections, and host genetics. Existing research is largely drawn from small, single-centre cohorts, with limited follow-up time. The Hepatitis B in Africa Collaborative Network (HEPSANET) was established in 2022 to harmonise the process of ongoing data collection, analysis, and dissemination from 13 collaborating HBV cohorts in eight African countries. Research priorities for the next 5 years were agreed upon through a modified Delphi survey prior to baseline data analysis being conducted. Baseline data on 4,173 participants with chronic HBV mono-infection were collected, of whom 38.3% were women and the median age was 34 years (interquartile range 28–42). In total, 81.3% of c...

Journal of Virus Eradication

High profile international goals have been set for the elimination of hepatitis B virus (HBV) inf... more High profile international goals have been set for the elimination of hepatitis B virus (HBV) infection as a public health threat by the year 2030. Developing and expanding equitable, accessible translational HBV research programmes that represent real-world populations are therefore an urgent priority for clinical and academic communities. We present experiences and insights by an expert interdisciplinary group focusing on barriers that impede adults living with HBV infection from participating in clinical studies. Our viewpoint describes barriers we have identified through working in a variety of settings across South Africa, including lack of education and awareness, experiences of stigma and discrimination, challenges for governance and data management, and a burden of complex morbidity. Through identifying these challenges, we propose solutions and interventions, highlight new approaches, and provide a framework for future research.

African Journal of Thoracic and Critical Care Medicine, 2021

Background The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute ... more Background The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Beta variant, has been reported to be associated with increased severity in South Africa (SA). Objectives To describe and compare clinical characteristics, management and outcomes of COVID-19 patients admitted to an intensive care unit (ICU) in SA during the first and second waves. Methods In a prospective, single-centre, descriptive study, we compared all patients with severe COVID-19 admitted to ICU during the first and second waves. The primary outcomes assessed were ICU mortality and ICU length of stay (LOS). Results In 490 patients with comparable ages and comorbidities, no difference in mortality was demonstrated during the second compared with the first wave (65.9% v. 62.5%, p=0.57). ICU LOS was longer in the second wave (10 v. 6 days, p<0.001). More female admissions (67.1% v. 44.6%, p<0.001) and a greater proportion of patien...

Cardiovascular Diagnosis and Therapy

Background: Infective endocarditis (IE) in South Africa is associated with significant morbidity ... more Background: Infective endocarditis (IE) in South Africa is associated with significant morbidity and mortality, despite occurring in younger patients with fewer co-morbidities. Possible contributors include the high rates of blood culture negative endocarditis, high rates of mechanical valve replacement and the lack of inter-disciplinary coordination during management. Methods: The Tygerberg Endocarditis Cohort (TEC) study prospectively enrolled patients with IE between November 2019 and April 2021. All patients were managed by an Endocarditis Team with a set protocol for organism detection and a strategy of early surgery limiting the use of prosthetic material. Results: Seventy-two consecutive patients with IE were included, with a causative organism identified in 86.1% of patients. The majority of patients had a guideline indication for surgery (n=58; 80.6%). The in-hospital mortality rate was 18%, with a 6-month mortality rate of 25.7%. Surgery was performed in 42 patients (58.3%), with prosthetic valve (PVE) replacement in 32 (76.2%), conventional repair surgery in 8 (19.1%) and mitral valve reconstruction in 2 (4.8%) of patients. Patients who underwent surgery had a significantly lower in-hospital (4.8% vs. 56.3%; P<0.01) and 6-month (4.9% vs. 75.0%; P<0.01) mortality rate as compared with patients with an indication for surgery who did not undergo surgery. Conclusions: We have observed a reduction in the 6-month mortality rate in patients with IE following the establishment of an Endocarditis Team, adhering to a set protocol for organism detection and favouring early repair or reconstruction surgery. Patients who underwent surgery had a significantly lower mortality rate than patients with an indication for surgery who did not undergo surgery. Preventable residual mortality was driven by surgical delay.

BMC Infectious Diseases

Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVI... more Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVID-19) among people living with human immunodeficiency virus (PWH) and those co-infected with tuberculosis (TB), particularly in areas where these conditions are common. We describe the clinical features, laboratory findings and outcome of hospitalised PWH and human immunodeficiency virus (HIV)-uninfected COVID-19 patients as well as those co-infected with tuberculosis (TB). Methods We conducted a multicentre cohort study across three hospitals in Cape Town, South Africa. All adults requiring hospitalisation with confirmed COVID-19 pneumonia from March to July 2020 were analysed. Results PWH comprised 270 (19%) of 1434 admissions. There were 47 patients with active tuberculosis (3.3%), of whom 29 (62%) were PWH. Three-hundred and seventy-three patients (26%) died. The mortality in PWH (n = 71, 26%) and HIV-uninfected patients (n = 296, 25%) was comparable. In patients with TB, PWH had a h...

South African Medical Journal

Background. Historically, infective endocarditis (IE) in South Africa (SA) was associated with th... more Background. Historically, infective endocarditis (IE) in South Africa (SA) was associated with the viridans group of streptococci affecting patients with underlying rheumatic heart disease (RHD). A changing IE bacteriological profile raises the question of whether the profile of underlying valvular abnormality has changed. Objectives. To investigate the prevalence of underlying structural valve abnormalities and their aetiologies associated with IE in SA, and describe the typical imaging findings. Methods. The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021. Patients underwent detailed transthoracic and transoesophageal echocardiography to assess their underlying cardiac and valvular structure. Results. Among 71 patients included, a predisposing endocardial abnormality was detected in 49.3%, with RHD the most common single identifiable aetiology (16.9%). The in-hospital mortality rate was similar in patients with and w...

ABSTRACTObjectiveIn sub-Saharan Africa, hepatitis B is the principal cause of liver disease. Non-... more ABSTRACTObjectiveIn sub-Saharan Africa, hepatitis B is the principal cause of liver disease. Non-invasive biomarkers of liver fibrosis are needed to identify patients requiring antiviral treatment. We assessed aspartate aminotransferase-to-platelet ratio index (APRI), gamma-glutamyl transferase-to-platelet ratio (GPR) and FIB-4 to diagnose significant fibrosis and cirrhosis in an individual patient data (IPD) meta-analysis.DesignIn total, 3,549 patients from 12 cohorts of HBsAg positive individuals in 8 sub-Saharan African countries were included. Transient elastography was used as a reference test for cirrhosis (>12.2 kPa), excluding patients who were pregnant, had hepatitis C, D, or HIV co-infection, were on hepatitis B therapy, or had acute hepatitis. A bivariate Bayesian IPD model was fitted with patient-level covariates and study-level random effects.ResultsAPRI and GPR had the best discriminant performance (area under receiver operating curve 0.81 and 0.82) relative to FIB-...

South African Medical Journal, 2021

Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor ... more Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor clinical outcomes and the development of antimicrobial resistance. Knowledge of the local infectious disease burden and antibiotic resistance patterns can assist with development of strategies, updating of guidelines and subsequent improvement in initial empirical therapy. Objectives. To determine whether the empirical antibiotic choice for treatment of septic episodes at a district-level hospital was appropriate according to national guidelines, and to describe the epidemiological features of the septic episode population being studied and depict their antibiotic susceptibility profile. Methods. This was a retrospective, descriptive study of adult inpatients with bloodstream infections at Karl Bremer Hospital, Cape Town, South Africa. Laboratory and clinical data were obtained and analysed for the period 1 July 2017 - 30 June 2018. Septic episodes were subdivided into community-acquired...

Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021

Subacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding vira... more Subacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding viral infection. Patients typically present with complaints of anterior neck pain associated with a tender enlarged thyroid gland. The coronaviruses have never before been implicated in the aetiology of subacute thyroiditis. It is postulated that the pathogenesis related to thyroid disease in Coronavirus disease 2019 (COVID-19) is multifactorial. Contributory factors include effects of the virus-related cytokine storm and direct action of the virus on SARS-CoV-2 receptors in the thyroid. This article further reviews the association between thyroiditis and COVID-19. The clinical characteristics, diagnostic workup and management of a patient who presented with subacute thyroiditis following COVID-19 are discussed. Furthermore, complications are entertained and suggestions for the management of thyroiditis following COVID-19 are provided.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2020

This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on th... more This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on the convergence of infectious diseases such as coronavirus infections and non-communicable diseases including DM. The mechanisms for the interaction between COVID-19 and DM are explored, and suggestions for the management of DM in patients with COVID-19 in South Africa are offered.

South African Medical Journal, 2021

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

South African Medical Journal, 2020

EClinicalMedicine, 2020

Background: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-1... more Background: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. Methods: We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. Findings: The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (P a O2/FiO 2) was 68 (54À92) in 293 enroled patients. Of these, 137/293 (47%) of patients [P a O2/FiO 2 76 (63À93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3À9) in those successfully treated versus 2 (1À5) days in those who failed (p<0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31À0.60), as was use of steroids (AHR 0.35, 95%CI 0.19À0.64). A ROX-6 score of 3.7 was 80% predictive of successful weaning whilst ROX-6 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). Interpretation: In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.

South African Journal of Surgery, 2020

Background: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in preventio... more Background: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in prevention of gunshot woundrelated (GSW-related) infection in resource restricted areas. At Tygerberg Hospital, South Africa, it is standard care for GSW patients to receive one dose of broad-spectrum AP. For various reasons, this protocol is not consistently followed. This study aimed to assess the efficacy of AP in the reduction of in-hospital GSW-related infection and to identify opportunities for practice improvement. Methods: All patients admitted with GSW over a three-month period were eligible for inclusion. Patients who did and did not receive AP were identified retrospectively the morning of admission; thereafter, data was collected prospectively. Data regarding circumstances of the incident, injury characteristics, type of AP and surgery was obtained. The occurrence of in-hospital GSW-related infection was recorded over 30 days or until discharge. Propensity score matching (PSM) and inverse probability weighting (IPW) methods were utilised to assess the effect of AP on the prevention of GSW-related infection. Results: 165 consecutive patients were assessed, of which 103 received AP according to protocol within 12 hours of admission. PSM showed a reduced in-hospital GSW infection risk of 12% (95% CI, 0.2-24%, p = 0.046) with AP. IPW showed that AP reduced the risk for infection by 14% (95% CI, 3-27%, p = 0.015). Conclusions: Providing AP to GSW patients in a civilian setting appeared to result in a modest but clinically relevant lower risk of in-hospital GSW-related infection. In this study setting, optimisation of AP for all patients with GSWs should significantly lower the burden of wound infection.

South African Medical Journal, 2020

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

South African Medical Journal, 2020

[1] and a pandemic 40 days later. [2] COVID-19 is caused by the severe acute respiratory syndrome... more [1] and a pandemic 40 days later. [2] COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus, emerging in early December 2019 in Wuhan, Hubei Province, China, [3] has since spread explosively throughout the world. Most of Europe and the USA has been severely affected in recent weeks despite their relatively high income per capita and robust public healthcare systems. In contrast, African countries are poorly resourced, have a sizeable vulnerable population, and in recent years noticeably demonstrated vulnerability to epidemics. [4] Many South Africans of all ages have significant risk factors for severe COVID-19 outcomes. The pre-existing colliding epidemics of HIV infection and tuberculosis (TB), as well as the high prevalence of non-communicable diseases such as hypertension, diabetes and cardiovascular disease, place a large segment of the population at high risk. [5] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. HEALTHCARE DELIVERY

South African Medical Journal, 2017

HIV-positive patients in the intensive care unit To the Editor: We read the retrospective audit b... more HIV-positive patients in the intensive care unit To the Editor: We read the retrospective audit by Mkoko and Raine [1] on HIV-positive patients requiring intensive care unit (ICU) admission with great interest. Although we acknowledge that intensive care is a scarce resource in South Africa (SA), and clear guidelines are needed to assist clinicians to allocate resources appropriately, we cannot concur with the authors' conclusion that ICU care may have to be withheld from HIV patients with higher Acute Physiology and Chronic Health Evaluation ΙΙ (APACHE II) scores and the need for organ support such as renal replacement therapy and inotropes. The authors also erroneously suggest that 'this is the first study that has determined the outcomes of HIV-positive adults admitted to an SA ICU'. In a prospective study performed by Balkema et al. [2] in the same city (Cape Town, SA), during the same period and on a similar population, ICU mortality of all HIV patients was 38.9%. ICU mortality was associated with an AIDS-defining diagnosis (odds ratio 7.97, p=0.003). Non-survivors had higher APACHE II scores (25.8 v. 18.6; p=0.001) and lower mean admission CD4+ counts (102.5 v. 225.2 cells/µL; p=0.014). Multiple logistical regression analysis confirmed the independent predictive value of World Health Organization (WHO) stage IV disease (p=0.008), lower mean CD4+ counts on admission (p=0.057), and higher APACHE II scores (p=0.010) on ICU mortality, and of WHO stage IV disease (p=0.007) and higher APACHE II scores (p=0.003) on 30-day mortality. In a post hoc analysis, the same investigators retrospectively validated a simple six-point scoring system based on the presence of: (i) AIDS; (ii) a CD4+ count of <50 cells/µL; (iii) extrapulmonary tuberculosis; (iv) Pneumocystis carinii pneumonia; (v) septic shock; and (vi) renal dysfunction. More than 80% of patients with a score of ≥3 died, and no patient with a score of ≥4 survived. [3] The ICU mortality in Mkoko and Raine's study [1] was 25.3% in patients with a mean (standard deviation) APACHE II score of 21.6 (8.4). This would be anticipated, as the predicted mortality with an APACHE II score in the range of 20-24, regardless of HIV status, is up to 40%. Moreover, the APACHE II score was designed as an estimate of mortality after 24 hours of ICU care and not as a guide to offer or withhold critical care. [4] The need for inotropic support is also widely regarded as an independent predictor of mortality in HIV-negative ICU patients. The 47% mortality described in the study would therefore also be anticipated and may not be indicative of mortality specifically attributable to HIV infection in this setting. [5] We therefore cannot concur with the authors' interpretation to 'withhold' ICU care in only the HIV population with these general critical illness severity indices. In the absence of randomised studies or higher levels of evidence, it is still safer to discuss referrals on a case-by-case basis and to consider all comorbidities.

South African Medical Journal, 2018

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

South African Medical Journal, Jul 1, 2022

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

The Southern African Journal of Epidemiology and infection, 2008

Epidemiology and Infection

Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Af... more Approximately 80 million people live with chronic hepatitis B virus (HBV) infection in the WHO Africa Region. The natural history of HBV infection in this population is poorly characterised, and may differ from patterns observed elsewhere due to differences in prevailing genotypes, environmental exposures, co-infections, and host genetics. Existing research is largely drawn from small, single-centre cohorts, with limited follow-up time. The Hepatitis B in Africa Collaborative Network (HEPSANET) was established in 2022 to harmonise the process of ongoing data collection, analysis, and dissemination from 13 collaborating HBV cohorts in eight African countries. Research priorities for the next 5 years were agreed upon through a modified Delphi survey prior to baseline data analysis being conducted. Baseline data on 4,173 participants with chronic HBV mono-infection were collected, of whom 38.3% were women and the median age was 34 years (interquartile range 28–42). In total, 81.3% of c...

Journal of Virus Eradication

High profile international goals have been set for the elimination of hepatitis B virus (HBV) inf... more High profile international goals have been set for the elimination of hepatitis B virus (HBV) infection as a public health threat by the year 2030. Developing and expanding equitable, accessible translational HBV research programmes that represent real-world populations are therefore an urgent priority for clinical and academic communities. We present experiences and insights by an expert interdisciplinary group focusing on barriers that impede adults living with HBV infection from participating in clinical studies. Our viewpoint describes barriers we have identified through working in a variety of settings across South Africa, including lack of education and awareness, experiences of stigma and discrimination, challenges for governance and data management, and a burden of complex morbidity. Through identifying these challenges, we propose solutions and interventions, highlight new approaches, and provide a framework for future research.

African Journal of Thoracic and Critical Care Medicine, 2021

Background The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute ... more Background The second wave of coronavirus disease 2019 (COVID-19), dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Beta variant, has been reported to be associated with increased severity in South Africa (SA). Objectives To describe and compare clinical characteristics, management and outcomes of COVID-19 patients admitted to an intensive care unit (ICU) in SA during the first and second waves. Methods In a prospective, single-centre, descriptive study, we compared all patients with severe COVID-19 admitted to ICU during the first and second waves. The primary outcomes assessed were ICU mortality and ICU length of stay (LOS). Results In 490 patients with comparable ages and comorbidities, no difference in mortality was demonstrated during the second compared with the first wave (65.9% v. 62.5%, p=0.57). ICU LOS was longer in the second wave (10 v. 6 days, p<0.001). More female admissions (67.1% v. 44.6%, p<0.001) and a greater proportion of patien...

Cardiovascular Diagnosis and Therapy

Background: Infective endocarditis (IE) in South Africa is associated with significant morbidity ... more Background: Infective endocarditis (IE) in South Africa is associated with significant morbidity and mortality, despite occurring in younger patients with fewer co-morbidities. Possible contributors include the high rates of blood culture negative endocarditis, high rates of mechanical valve replacement and the lack of inter-disciplinary coordination during management. Methods: The Tygerberg Endocarditis Cohort (TEC) study prospectively enrolled patients with IE between November 2019 and April 2021. All patients were managed by an Endocarditis Team with a set protocol for organism detection and a strategy of early surgery limiting the use of prosthetic material. Results: Seventy-two consecutive patients with IE were included, with a causative organism identified in 86.1% of patients. The majority of patients had a guideline indication for surgery (n=58; 80.6%). The in-hospital mortality rate was 18%, with a 6-month mortality rate of 25.7%. Surgery was performed in 42 patients (58.3%), with prosthetic valve (PVE) replacement in 32 (76.2%), conventional repair surgery in 8 (19.1%) and mitral valve reconstruction in 2 (4.8%) of patients. Patients who underwent surgery had a significantly lower in-hospital (4.8% vs. 56.3%; P<0.01) and 6-month (4.9% vs. 75.0%; P<0.01) mortality rate as compared with patients with an indication for surgery who did not undergo surgery. Conclusions: We have observed a reduction in the 6-month mortality rate in patients with IE following the establishment of an Endocarditis Team, adhering to a set protocol for organism detection and favouring early repair or reconstruction surgery. Patients who underwent surgery had a significantly lower mortality rate than patients with an indication for surgery who did not undergo surgery. Preventable residual mortality was driven by surgical delay.

BMC Infectious Diseases

Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVI... more Background There is still a paucity of evidence on the outcomes of coronavirus disease 2019 (COVID-19) among people living with human immunodeficiency virus (PWH) and those co-infected with tuberculosis (TB), particularly in areas where these conditions are common. We describe the clinical features, laboratory findings and outcome of hospitalised PWH and human immunodeficiency virus (HIV)-uninfected COVID-19 patients as well as those co-infected with tuberculosis (TB). Methods We conducted a multicentre cohort study across three hospitals in Cape Town, South Africa. All adults requiring hospitalisation with confirmed COVID-19 pneumonia from March to July 2020 were analysed. Results PWH comprised 270 (19%) of 1434 admissions. There were 47 patients with active tuberculosis (3.3%), of whom 29 (62%) were PWH. Three-hundred and seventy-three patients (26%) died. The mortality in PWH (n = 71, 26%) and HIV-uninfected patients (n = 296, 25%) was comparable. In patients with TB, PWH had a h...

South African Medical Journal

Background. Historically, infective endocarditis (IE) in South Africa (SA) was associated with th... more Background. Historically, infective endocarditis (IE) in South Africa (SA) was associated with the viridans group of streptococci affecting patients with underlying rheumatic heart disease (RHD). A changing IE bacteriological profile raises the question of whether the profile of underlying valvular abnormality has changed. Objectives. To investigate the prevalence of underlying structural valve abnormalities and their aetiologies associated with IE in SA, and describe the typical imaging findings. Methods. The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021. Patients underwent detailed transthoracic and transoesophageal echocardiography to assess their underlying cardiac and valvular structure. Results. Among 71 patients included, a predisposing endocardial abnormality was detected in 49.3%, with RHD the most common single identifiable aetiology (16.9%). The in-hospital mortality rate was similar in patients with and w...

ABSTRACTObjectiveIn sub-Saharan Africa, hepatitis B is the principal cause of liver disease. Non-... more ABSTRACTObjectiveIn sub-Saharan Africa, hepatitis B is the principal cause of liver disease. Non-invasive biomarkers of liver fibrosis are needed to identify patients requiring antiviral treatment. We assessed aspartate aminotransferase-to-platelet ratio index (APRI), gamma-glutamyl transferase-to-platelet ratio (GPR) and FIB-4 to diagnose significant fibrosis and cirrhosis in an individual patient data (IPD) meta-analysis.DesignIn total, 3,549 patients from 12 cohorts of HBsAg positive individuals in 8 sub-Saharan African countries were included. Transient elastography was used as a reference test for cirrhosis (>12.2 kPa), excluding patients who were pregnant, had hepatitis C, D, or HIV co-infection, were on hepatitis B therapy, or had acute hepatitis. A bivariate Bayesian IPD model was fitted with patient-level covariates and study-level random effects.ResultsAPRI and GPR had the best discriminant performance (area under receiver operating curve 0.81 and 0.82) relative to FIB-...

South African Medical Journal, 2021

Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor ... more Background. Incorrect empirical antibiotic therapy is one of the factors that contribute to poor clinical outcomes and the development of antimicrobial resistance. Knowledge of the local infectious disease burden and antibiotic resistance patterns can assist with development of strategies, updating of guidelines and subsequent improvement in initial empirical therapy. Objectives. To determine whether the empirical antibiotic choice for treatment of septic episodes at a district-level hospital was appropriate according to national guidelines, and to describe the epidemiological features of the septic episode population being studied and depict their antibiotic susceptibility profile. Methods. This was a retrospective, descriptive study of adult inpatients with bloodstream infections at Karl Bremer Hospital, Cape Town, South Africa. Laboratory and clinical data were obtained and analysed for the period 1 July 2017 - 30 June 2018. Septic episodes were subdivided into community-acquired...

Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021

Subacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding vira... more Subacute thyroiditis is a granulomatous inflammatory disorder often triggered by a preceding viral infection. Patients typically present with complaints of anterior neck pain associated with a tender enlarged thyroid gland. The coronaviruses have never before been implicated in the aetiology of subacute thyroiditis. It is postulated that the pathogenesis related to thyroid disease in Coronavirus disease 2019 (COVID-19) is multifactorial. Contributory factors include effects of the virus-related cytokine storm and direct action of the virus on SARS-CoV-2 receptors in the thyroid. This article further reviews the association between thyroiditis and COVID-19. The clinical characteristics, diagnostic workup and management of a patient who presented with subacute thyroiditis following COVID-19 are discussed. Furthermore, complications are entertained and suggestions for the management of thyroiditis following COVID-19 are provided.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2020

This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on th... more This article reviews the association between diabetes mellitus (DM) and COVID-19. We report on the convergence of infectious diseases such as coronavirus infections and non-communicable diseases including DM. The mechanisms for the interaction between COVID-19 and DM are explored, and suggestions for the management of DM in patients with COVID-19 in South Africa are offered.

South African Medical Journal, 2021

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

South African Medical Journal, 2020

EClinicalMedicine, 2020

Background: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-1... more Background: The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. Methods: We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. Findings: The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (P a O2/FiO 2) was 68 (54À92) in 293 enroled patients. Of these, 137/293 (47%) of patients [P a O2/FiO 2 76 (63À93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3À9) in those successfully treated versus 2 (1À5) days in those who failed (p<0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31À0.60), as was use of steroids (AHR 0.35, 95%CI 0.19À0.64). A ROX-6 score of 3.7 was 80% predictive of successful weaning whilst ROX-6 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). Interpretation: In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.

South African Journal of Surgery, 2020

Background: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in preventio... more Background: Limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in prevention of gunshot woundrelated (GSW-related) infection in resource restricted areas. At Tygerberg Hospital, South Africa, it is standard care for GSW patients to receive one dose of broad-spectrum AP. For various reasons, this protocol is not consistently followed. This study aimed to assess the efficacy of AP in the reduction of in-hospital GSW-related infection and to identify opportunities for practice improvement. Methods: All patients admitted with GSW over a three-month period were eligible for inclusion. Patients who did and did not receive AP were identified retrospectively the morning of admission; thereafter, data was collected prospectively. Data regarding circumstances of the incident, injury characteristics, type of AP and surgery was obtained. The occurrence of in-hospital GSW-related infection was recorded over 30 days or until discharge. Propensity score matching (PSM) and inverse probability weighting (IPW) methods were utilised to assess the effect of AP on the prevention of GSW-related infection. Results: 165 consecutive patients were assessed, of which 103 received AP according to protocol within 12 hours of admission. PSM showed a reduced in-hospital GSW infection risk of 12% (95% CI, 0.2-24%, p = 0.046) with AP. IPW showed that AP reduced the risk for infection by 14% (95% CI, 3-27%, p = 0.015). Conclusions: Providing AP to GSW patients in a civilian setting appeared to result in a modest but clinically relevant lower risk of in-hospital GSW-related infection. In this study setting, optimisation of AP for all patients with GSWs should significantly lower the burden of wound infection.

South African Medical Journal, 2020

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

South African Medical Journal, 2020

[1] and a pandemic 40 days later. [2] COVID-19 is caused by the severe acute respiratory syndrome... more [1] and a pandemic 40 days later. [2] COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus, emerging in early December 2019 in Wuhan, Hubei Province, China, [3] has since spread explosively throughout the world. Most of Europe and the USA has been severely affected in recent weeks despite their relatively high income per capita and robust public healthcare systems. In contrast, African countries are poorly resourced, have a sizeable vulnerable population, and in recent years noticeably demonstrated vulnerability to epidemics. [4] Many South Africans of all ages have significant risk factors for severe COVID-19 outcomes. The pre-existing colliding epidemics of HIV infection and tuberculosis (TB), as well as the high prevalence of non-communicable diseases such as hypertension, diabetes and cardiovascular disease, place a large segment of the population at high risk. [5] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. HEALTHCARE DELIVERY

South African Medical Journal, 2017

HIV-positive patients in the intensive care unit To the Editor: We read the retrospective audit b... more HIV-positive patients in the intensive care unit To the Editor: We read the retrospective audit by Mkoko and Raine [1] on HIV-positive patients requiring intensive care unit (ICU) admission with great interest. Although we acknowledge that intensive care is a scarce resource in South Africa (SA), and clear guidelines are needed to assist clinicians to allocate resources appropriately, we cannot concur with the authors' conclusion that ICU care may have to be withheld from HIV patients with higher Acute Physiology and Chronic Health Evaluation ΙΙ (APACHE II) scores and the need for organ support such as renal replacement therapy and inotropes. The authors also erroneously suggest that 'this is the first study that has determined the outcomes of HIV-positive adults admitted to an SA ICU'. In a prospective study performed by Balkema et al. [2] in the same city (Cape Town, SA), during the same period and on a similar population, ICU mortality of all HIV patients was 38.9%. ICU mortality was associated with an AIDS-defining diagnosis (odds ratio 7.97, p=0.003). Non-survivors had higher APACHE II scores (25.8 v. 18.6; p=0.001) and lower mean admission CD4+ counts (102.5 v. 225.2 cells/µL; p=0.014). Multiple logistical regression analysis confirmed the independent predictive value of World Health Organization (WHO) stage IV disease (p=0.008), lower mean CD4+ counts on admission (p=0.057), and higher APACHE II scores (p=0.010) on ICU mortality, and of WHO stage IV disease (p=0.007) and higher APACHE II scores (p=0.003) on 30-day mortality. In a post hoc analysis, the same investigators retrospectively validated a simple six-point scoring system based on the presence of: (i) AIDS; (ii) a CD4+ count of <50 cells/µL; (iii) extrapulmonary tuberculosis; (iv) Pneumocystis carinii pneumonia; (v) septic shock; and (vi) renal dysfunction. More than 80% of patients with a score of ≥3 died, and no patient with a score of ≥4 survived. [3] The ICU mortality in Mkoko and Raine's study [1] was 25.3% in patients with a mean (standard deviation) APACHE II score of 21.6 (8.4). This would be anticipated, as the predicted mortality with an APACHE II score in the range of 20-24, regardless of HIV status, is up to 40%. Moreover, the APACHE II score was designed as an estimate of mortality after 24 hours of ICU care and not as a guide to offer or withhold critical care. [4] The need for inotropic support is also widely regarded as an independent predictor of mortality in HIV-negative ICU patients. The 47% mortality described in the study would therefore also be anticipated and may not be indicative of mortality specifically attributable to HIV infection in this setting. [5] We therefore cannot concur with the authors' interpretation to 'withhold' ICU care in only the HIV population with these general critical illness severity indices. In the absence of randomised studies or higher levels of evidence, it is still safer to discuss referrals on a case-by-case basis and to consider all comorbidities.

South African Medical Journal, 2018

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