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Biomedical subjects

E A O'Keefe

Publications and source records attributed to E A O'Keefe.

15 recordsLinked to original sources
PubMed1998

Human immunodeficiency virus-related abdominal pain in South Africa. Aetiology, diagnosis and survival.

BACKGROUND: Abdominal pain in acquired immunodeficiency syndrome (AIDS) patients is often a marker of an underlying opportunistic pathologic condition. There are no data on HIV-related abdominal pain in Africa. METHODS: Forty-four consecutive Cape Town patients with advanced human immunodeficiency virus (HIV) infection (CD4 < 200) and abdominal pain were studied prospectively to determine aetiology and survival. RESULTS: A probable cause of pain was identified in 37 (84%): disseminated Mycobacterium tuberculosis infection in 11, cryptosporidiosis in 6, cytomegalovirus infection in 6, and atypical mycobacterial infection in 2. Gastrointestinal lymphoma and pancreatitis were not seen. Fever, hepatomegaly, respiratory symptoms, abnormal chest radiograph, and adenopathy, ascites, or abscesses on ultrasound had predictive diagnostic value for disseminated M. tuberculosis. Fifty-one per cent of abdominal pain patients survived 6 months, compared with 73% of all AIDS patients (P < 0.001). CONCLUSIONS: The aetiology of HIV-related abdominal pain in Cape Town reflects the high local prevalence of tuberculosis. Clinical and ultrasound features facilitate diagnosis. Abdominal pain is associated with poor survival.

AIDS-Related Opportunistic Infections↗
PubMed1996

The impact of human immunodeficiency virus (HIV) infection on quality of life in a multiracial South African population.

We set out to document quality of life in South African HIV subjects, using the Medical Outcomes Survey (MOS) SF-36 instrument, and to determine whether this was affected by race, gender or clinical stage of disease. A cross-sectional survey of 134 HIV outpatients (42 White, 49 Mixed race, 43 Black) and 114 healthy non-medical hospital personnel (36 White, 37 Mixed race, 42 Black) was carried out at a referral centre for HIV patients in the Western Cape region of South Africa. Scores on eight scales measuring different aspects of quality of life were calculated. Black female controls scored significantly lower on all scales (p < 0.05) except physical function. HIV-infected subjects of Mixed race (both genders) reported poorer physical function (p < 0.05) but no other scale was affected by race. HIV subjects scored significantly lower than controls on all scales (p < 0.01); the majority of the decline in function occurred early in disease by WHO stages 1 and 2. We conclude that HIV-infection impacts early on all aspects of quality of life and that this impact is largely independent of racial origin.

Adult↗
PubMed1996

AIDS in Africa.

HIV has infected more than 10 million people in sub-Saharan Africa with prevalence rates of up to 30% reported from some countries. Adult transmission of HIV in Africa is mainly heterosexual and over half of new infections are in women. About 40% of infants born to HIV-positive mothers are themselves infected. Diarrhoea occurs in 90% of African AIDS patients and 'slim disease' (prolonged diarrhoea and wasting usually due to coccidian parasites) is pathognomic of AIDS in Central Africa. Dual infection with HIV and tuberculosis is a major problem. African AIDS patients appear to succumb to virulent pathogens, especially Mycobacterium tuberculosis, before they become sufficiently immunosuppressed to develop the opportunistic infections typically associated with advanced HIV disease in developed countries.

AIDS-Related Opportunistic Infections↗
PubMed1996

Quality of life in HIV infection.

HIV infection gives rise to incurable, debilitating disease in young persons and treatments capable of prolonging survival are often associated with toxicity. Quality of Life (QOL) assessment is therefore important in the evaluation of clinical interventions in HIV-infected patients. It also has a role in determining the needs of individuals and directing healthcare resources. A wide range of QOL instruments is available and choice of instrument should be guided by the information required. As would be expected, poorer QOL is correlated with the presence of disease-related symptoms and advancing WHO clinical stage of disease. Psychological dysfunction, however, is evident from the time of diagnosis and should not be overlooked.

HIV Infections↗
PubMed1996

Constipation in an elderly community: a study of prevalence and potential risk factors.

OBJECTIVE: The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. METHODS: An age and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). RESULTS: The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. CONCLUSIONS: In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.

Age Distribution↗
PubMed1995

Bowel disorders impair functional status and quality of life in the elderly: a population-based study.

BACKGROUND: Little is known about the relationship between chronic colonic symptoms and quality of life in the elderly. Our aim was to evaluate whether functional bowel symptoms are associated with impaired functional status and well-being. METHODS: A random sample of 704 Olmsted County, Minnesota, residents 65 years of age or older was identified through the Rochester Epidemiology Project. They were mailed a valid symptom questionnaire which included the Medical Outcomes Survey. Colonic and non-colonic symptoms and health care-seeking behavior for gastrointestinal symptoms were assessed by the Elderly Bowel Symptom Questionnaire. Scores for physical, role and social functioning, mental health, bodily pain, and health perception were obtained from the Medical Outcomes Survey (MOS). RESULTS: The response rate was 75%. Irritable bowel syndrome and non-colonic symptoms were associated with overall poorer function. The following, in addition to age, gender, and overall functioning score, were found to discriminate asymptomatic controls from symptomatic groups: for constipation, only pain; for diarrhea, only role functioning; and for fecal incontinence, role functioning and current health. The presence of other chronic illness, defined by medication use and impact on activities, did not confound the relationship between colonic symptoms and MOS scores. CONCLUSIONS: Functional bowel disorders appear to interfere with daily living and quality of life in elderly persons.

Aged↗
PubMed1993

Olsalazine in maintenance of clinical remission in patients with ulcerative colitis.

Frequent minor side effects are associated with sulfasalazine. The realization that it is the 5-aminosalicylic acid moiety that is the active component of sulfasalazine and that the side effects are probably due to the sulfapyridine has prompted the search for a similar but safer compound. Olsalazine, consisting of two molecules of 5-ASA without sulfasalazine may avoid the problems due to sulfasalazine. One hundred one patients were entered into a double-blind placebo-controlled study of the use of olsalazine (2 g daily) in preventing relapse in patients who had recently recovered from an acute attack of ulcerative colitis. Patients were treated for 12 months. Forty-nine were randomized to olsalazine (39 with limited and 10 with extensive disease) and 52 to placebo (42 with limited and 10 with extensive disease). Life-table analysis showed that the median time to relapse in patients on olsalazine was 342 days, which was significantly longer than the 100 days in the placebo group (P = 0.024). The most important side effect experienced with olsalazine that necessitated withdrawal from the study was "drug-induced diarrhea" in 16% (8/49). There was a similar incidence of minor side effects reported in the two groups, and in no patients were major or dangerous side effects reported. In patients who did not develop diarrhea, olsalazine was well tolerated and successfully prevented rapid relapse in the recently ill patients entered into this study.

Adult↗
PubMed1992

Prevalence of gastrointestinal symptoms in the elderly: a population-based study.

The prevalence of chronic gastrointestinal symptoms and the irritable bowel syndrome (IBS) in the elderly, and their impact on health, is largely unknown. The prevalence of symptoms compatible with IBS was estimated in a representative sample of elderly community residents, and the impact of these symptoms was determined on presentation for health care. An age- and sex-stratified random sample of noninstitutionalized Olmsted County, Minnesota, residents aged 65-93 years were mailed a valid questionnaire; 77% responded (n = 328). The age- and sex-adjusted prevalence (per 100 persons) of frequent abdominal pain was 24.3 [95% confidence interval (CI), 19.3-29.2]. Chronic constipation and chronic diarrhea had prevalences of 24.1 (95% CI, 19.1-29.0) and 14.2 (95% CI, 10.1-18.2), respectively. Fecal incontinence more than once a week was reported in 3.7 per 100 (95% CI, 1.6-5.9). The prevalence of symptoms compatible with IBS (greater than or equal to 3 Manning criteria with frequent abdominal pain) was 10.9 per 100 (95% CI, 7.2-14.6). Among the subjects sampled who had abdominal pain, chronic constipation, and/or chronic diarrhea (n = 152), only 23% had seen a physician for pain or disturbed defecation in the prior year, and this behavior was poorly explained by the symptoms. It is concluded that complaints consistent with functional gastrointestinal disorders are common in the elderly, but symptoms are a poor predictor of presentation for medical care.

Abdominal Pain↗
PubMed1992

A bowel symptom questionnaire for the elderly.

While functional gastrointestinal complaints are common in the elderly, valid instruments for their assessment are lacking. We have developed the elderly bowel symptom questionnaire (EBSQ) and report its feasibility, reliability, and validity in medical outpatients and a larger sample of the community (aged 65-93). Reliability was measured by a test-retest procedure, while concurrent validity was documented by comparing physician interview and self-report data. Reliability (median kappa 0.65, interquartile range 0.49-0.79), and validity (median kappa 0.68, interquartile range 0.51-0.80) were very acceptable. A random sample of 424 independently living elderly persons was obtained; 77% replied to the mail survey. Medical record review showed that no current diagnosis of irritable bowel syndrome was missed by the questionnaire. Our results confirm that the EBSQ was easy to understand and well accepted, and was a reliable and valid measure of gastrointestinal symptoms in older persons; this instrument may have important clinical and research applications.

Aged↗
PubMed1991

Milk-induced malabsorption in malnourished African patients.

Fifty malnourished rural African patients were randomly assigned to whole milk (50 g lactose/L), acidified milk (24 g lactose/L), or a commercial lactose-free diet (LFD) as a constant nasogastric infusion for 3 d, starting at 2 L/d and increasing to 3 L/d if tolerated. During the first 2 d mild symptoms of intolerance developed in 63% of patients on whole milk, 37% on acidified milk, and 54% on LFD whereas severe intolerance, necessitating withdrawal, was encountered in 22% receiving whole milk and none receiving LFD. Stool weights and fat excretion on day 3 were greater (P less than 0.02) in the remaining milk-fed patients whereas nitrogen balance remained strongly positive in all three groups. Eighty-seven percent of patients were methane producers, and high excretion rates were associated with better milk tolerance. The results suggest that although undiluted cow milk will not form a suitable tube feed for malnourished African patients, products such as acidified milk may prove cost effective.

Adult↗
PubMed1989

Medium-term follow-up of Crohn's disease in Cape Town.

The 82 cases of Crohn's disease diagnosed in Greater Cape Town between 1970 and 1979 were followed up after a median time of 9.6 years from diagnosis. Sixty patients were contacted; 6 had died and 16 were not available for follow-up. Only 1 death was disease-related. Mortality in Crohn's disease was not increased. There were no cases of carcinoma of the colon. At diagnosis most patients had had moderately severe disease, and 10 years later, 80% had mild-to-moderate symptoms. The 5-year resection rate was 46% and the 10-year rate 68%; 23% of patients required a second resection within 5 years of the first, and 42% within 10 years. Surgery occurred earlier in those with ileitis. Ten patients were over the age of 60 years at diagnosis; there was no apparent difference between the extent of their disease and that in the group as a whole. However, the elderly patients appeared to have a better prognosis--59% having been symptom-free for more than 1 year, and none having required a second resection.

Adolescent↗
PubMed1989

Medium-term follow-up of ulcerative colitis in Cape Town.

The 114 patients with ulcerative colitis diagnosed in Greater Cape Town between 1970 and 1979 were followed up 11 years later. Ninety per cent of those contacted were in remission or had mild symptoms only. Eleven patients had died; 3 deaths (in total colitis patients) were disease-related but the overall mortality rate in ulcerative colitis was not increased. There was only 1 case of carcinoma of the colon. The 5-year surgical rate was 5% increasing to 23% 10 years after diagnosis. Six patients (35%) had had a Park's pouch, 3 (18%) ileorectal anastomosis, and 8 (47%) panproctocolectomy or colectomy with an ileostomy. The incidence of surgery was higher in those with total colitis. In those patients who did not have the rectum removed, there was a 100% recurrence of proctitis. Park's pouch patients remained well and incontinence was not a problem. Thirty-one per cent of patients with proctitis at diagnosis had evidence of extension of disease to the colon at follow-up. Ulcerative colitis may be a more benign disease than often believed, with mortality from the disease and need for surgery being associated almost exclusively with extensive disease.

Adolescent↗
PubMed1986

The epidemiology of inflammatory bowel disease in Cape Town 1980-1984.

Patients with inflammatory bowel disease diagnosed in the greater Cape Town area between the years 1980 and 1984 inclusive were studied to establish the incidence and presenting features of these diseases. Case details were obtained from the records of the Groote Schuur Hospital group and Tygerberg Hospital as well as from questionnaires completed by 97% of 731 medical practitioners in the area. There were 134 patients with Crohn's disease, 197 with ulcerative colitis and 16 with indeterminate colitis. The incidences of Crohn's disease in the coloured, white and black population groups were calculated to be 1.8, 2.6 and 0.3/100 000 per year respectively and those for ulcerative colitis 1.9, 5.0 and 0.6/100 000 respectively. Among Jews the incidence was higher for both Crohn's disease (10.4/100 000) and ulcerative colitis (17.0/100 000). Of patients with ulcerative colitis 35% had limited proctitis, 26% proctosigmoiditis, 12% left-sided disease and 27% total colitis. Of patients with Crohn's disease 27% had colonic involvement alone, 37% ileocolitis and 36% small-bowel involvement alone. The incidence of inflammatory bowel disease has increased in the greater Cape Town area over the last 10 years, while the pattern of disease has remained similar to that previously reported for this geographical area.

Adolescent↗
PubMedDate not supplied

Diabetes mellitus and operated peptic ulcer disease.

There is some evidence of an antagonism between peptic ulcer and diabetes mellitus. This antagonism is possibly related to anomalous insulin metabolism in duodenal ulcer patients. To evaluate this issue, 471 Rochester, Minnesota residents who had surgery for peptic ulcer were examined and then followed for up to 34 years. Their experience of diabetes mellitus was compared with that of Rochester residents generally, for whom data on diabetes incidence and prevalence were available. At surgery, the prevalence of diabetes was somewhat increased for gastric and slightly diminished for duodenal ulcer patients. Of the 445 patients who were free of diabetes at surgery, 27 developed it. By 20 years, the cumulative incidence of diabetes (9.1%) was less than expected (10.3%), but over the 20 years the difference was not significant for either gastric or duodenal ulcer patients. The risk of diabetes was not influenced by age, gender, or smoking status but analysis for relative weight at surgery indicated that obese patients had a 2.6-fold increase in risk of subsequent diabetes, whereas those with less than 1.2 relative weight had reduced risk. Relative weight was the only significant predictor of the time to subsequent diabetes in a proportional hazards regression analysis. The proposition of an antagonism between peptic ulcer and diabetes is not supported by the data.

Cohort Studies↗