1 |
A retrospective study to evaluate adherence to the South African guideline on the management of community-acquired pneumonia in adultsChetty, Anastacia 23 January 2013 (has links)
No description available.
|
2 |
The use of the CRB-65 severity of illness score to determine the need for admission of patients with community-acquired pneumonia presenting to an emergency departmentKabundji, Dalton Mulombe 17 January 2012 (has links)
Introduction: The decision as to the most appropriate site of care of a patient with
community-acquired pneumonia (CAP), especially whether hospitalisation is
warranted or not, is one of the most important decisions in the overall emergency
department management of such patients. It has consequences both with regard to
the level of treatment received by the patient as well as the overall costs of
treatment. Several tools have been developed to predict mortality and/or determine
which patients could be sent home and treated safely with good clinical outcomes.
The CRB-65 score is one of the validated severity of illness scoring tools
recommended. This scoring system may be of particular benefit in resourceconstrained
areas, as it is easier to use.
Study’s aim: To determine whether it would be useful to introduce the CRB-65
severity of illness score in the routine evaluation of patients with CAP in the Helen
Joseph Hospital Emergency Department (HJH ED).
Study’s objectives: To determine what criteria HJH ED doctors use in their
decision to admit or discharge CAP patients; to determine the frequency with which
the CRB-65 severity of illness score is used in current practice by the HJH ED
doctors for admitting or discharging CAP patients; and to determine the potential
performance of the CRB-65 severity of illness score in the management of patients
with CAP in the HJH ED.
Design: Prospective, observational, hospital-based study.Patients and methods: All patients 18 years of age and older with the diagnosis
of CAP constituted our study population. Data from 152 patients seen between
February 2011 and April 2011 was collected and analysed. Outcome measures
included hospital admission or discharge, time to clinical stability, length of hospital
stay, and mortality.
Results: Overall, 152 patients (79 females and 73 males) were included in the
analysis. The median age was 36.5 years, with a range from 20 to 87 years. The
chest radiograph was the commonest criterion (41%) used by the HJH ED doctors to
determine the need for admission of the patients with CAP, while the haemodynamic
parameters were the commonest criteria used (25.9%) for discharge decisions. On
only three occasions was the CRB-65 score utilised out of the 193 criteria
documented (1.55%).
There was a significantly shorter time to clinical stability (p = 0.0069), but no
tendency to a shorter length of hospital stay in patients with a lower CRB-65 score (p
= 0.5694). Patients with a higher CRB-65 score were at significantly higher risk of
death compared to patients with a lower CRB-65 score (p < 0.001). There were no
deaths from outpatients, but there were a total of five deaths observed from the inhospital
patients of which 3/5 patients (60%) would potentially have been classified
as intermediate mortality risk and the remaining 2/5 patients (40%) as high mortality
risk if the CRB-65 score had been the only criterion used as the standard for site of
care decisions by the HJH ED doctors.
Conclusion: The chest radiograph was the commonest criterion used by the HJH
ED doctors to determine the need for admission of the patients with CAP, while the
haemodynamic parameters were the commonest criteria used for discharge decision. The CRB-65 score is not frequently being used in current practice by the
HJH ED doctors for admitting or discharging CAP patients.
This study demonstrates the ability of the CRB-65 severity of illness score to
accurately predict both the time to clinical stability for patients hospitalised with CAP
and the risk of death associated. In addition, this study documents that the CRB-65
severity of illness score performed well in its ability to determine the initial site of care
for patients with CAP.
Setting: Emergency Department of the Helen Joseph Hospital.
|
3 |
Resolution of mixed dihydropteroate synthase (DHPS) genotypes in respiratory specimens from patients with Pneumocystis jirovecci pneumonia from Gauteng, South AfricaPoonsamy, Bhavani 20 June 2012 (has links)
M.Sc. (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Pneumocystis pneumonia (PCP) is one of the most prevalent diseases in HIV-positive and
other immunosuppressed patients. It is caused by the opportunistic fungal pathogen
Pneumocystis jirovecii. Dihydropteroate synthase (DHPS) mutations in P. jirovecii have
been linked to resistance to trimethoprim-sulphamethoxazole (cotrimoxazole), the main
treatment and prophylaxis used for PCP. DHPS mutations have been identified globally,
predominantly in developed countries. This study investigated the P. jirovecii DHPS
genotypes in PCP-positive patients from Chris Hani Baragwanath Hospital in Gauteng
Province, South Africa.
During the period March 2005 through June 2009, 266 patients were enrolled in the study
and 306 specimens were collected. P. jirovecii was identified in 67% (205/306) of these
specimens with quantitative real-time PCR (qPCR). The qPCR had a sensitivity of 98%
and a specificity of 70%, compared with the immunofluorescence assay (IFA). Using
sequencing and cloning techniques, 64% (110/173) of the nested PCR-positive specimens
contained P. jirovecii with mutant DHPS genotypes. There was no association between
patients harbouring P. jirovecii with mutant DHPS genotypes and in-hospital patient
outcome (p-value = 0.19). As part of this project the Roche MagNA Pure Compact
(RMPC) instrument and technology was validated for use as a new DNA extraction
method. The RMPC was quick and easy to use compared to the Qiagen manual extraction
method.
The specificity of the qPCR was compromised by the high number of apparent false
positive results obtained by the assay. However, as the IFA is an imperfect gold standard,
these are probably true cases of infection or colonisation. This study found a higher
proportion of P. jirovecii with DHPS mutant genotypes than wild type in PCP patients,
which is unusual. The most probable reason for this is the widespread use of sulfa drugs,
which are thought to select for these mutations. While this study did not find an
association between DHPS mutations and adverse patient outcome, there have been
contradictory findings. If further investigations reveal that DHPS mutations affect patient
treatment or outcome, it will have major implications for the management of PCP in the
country.
|
4 |
Microbial aetiology of community acquired pneumonia at a tertiary institution in Johannesburg, South AfricaMeiday, Parastu 27 March 2015 (has links)
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Clinical Microbiology and Infectious Diseases. Johannesburg, 2013 / Introduction
To determine the spectrum of aetiological agents in adult Community Acquired
Pneumonia (CAP) admitted to an academic hospital in Johannesburg using a novel
transport medium (PrimeStore™ MTM), in addition to traditional specimen
processing. PrimeStore™ MTM preserves released nucleic acids, including labile
RNA.
Materials and Methods
Forty-eight adult patients with radiologically confirmed CAP were prospectively
studied over three months. Microbiological investigation included culture from blood
and sputum, with pulmonary tuberculosis being excluded by sputum microscopy and
culture. Nasopharyngeal swabs (PrimeStore™ MTM) were analysed using two
commercial multiplex PCR assays for the detection of 6 major bacteria and 12 major
respiratory viruses. The BinaxNOW Legionella urinary antigen test was also used.
Results
A probable microbial aetiology of CAP was established for 62.5% (30 of the 48
patients) when the PCR platform was added to the conventional methods with the
use of the PrimeStore™ MTM swabs. In contrast, the definite bacterial aetiology
was 16.7% (8 of 48 patients) when conventional culture methods were used; none
had more than one bacterial species identified. Five patients had no aetiological
pathogens determined. The urine Legionella pneumophila antigen was negative in
all patients. Of the eight patients (16.7%) with a definite bacterial aetiology;
Streptococcus pneumoniae was isolated from blood cultures of all eight patients.
|
5 |
IncN group plasmids and plasmid regions determining the killing of Klebsiella pneumoniae and of immunity to killing.Gill, Santokh Singh, Carleton University. Dissertation. Biology. January 1985 (has links)
Thesis (M. Sc.)--Carleton University, 1985. / Also available in electronic format on the Internet.
|
6 |
The N system of bacterial conjugation; genetic analysis and relationship to phage sensitivity and the killing of Klebsiella pneumoniae.Thatte, Vinay, Carleton University. Dissertation. Biology. January 1985 (has links)
Thesis (Ph. D.)--Carleton University, 1985. / Also available in electronic format on the Internet.
|
7 |
Studies in pneumonia and its prevention.Douglas, Robert Matheson. January 1973 (has links) (PDF)
Thesis (M.D.)--University of Adelaide, Dept. of Medicine, 1974.
|
8 |
Pneumonia as a cause of death in North Dakota in 1941 a thesis submitted in partial fulfillment ... Master of Science in Public Health ... /Elkin, William F. January 1942 (has links)
Thesis (M.S.P.H.)--University of Michigan, 1942.
|
9 |
Pneumonia control programs in state health department a thesis submitted in partial fulfillment ... Master of Science in Public Health ... /Cohn, Arnold M. January 1940 (has links)
Thesis (M.S.P.H.)--University of Michigan, 1940.
|
10 |
Pneumonia control programs in state health department a thesis submitted in partial fulfillment ... Master of Science in Public Health ... /Cohn, Arnold M. January 1940 (has links)
Thesis (M.S.P.H.)--University of Michigan, 1940.
|
Page generated in 0.0209 seconds