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Biomedical subjects

G Joubert

Publications and source records attributed to G Joubert.

At least 19 recordsLinked to original sources
PubMed2005

Oral tolerance and regulation of mucosal immunity.

Regulated mechanisms sustain the ability of the gut immune system to discriminate harmless food antigens (Ag) and commensal bacteria from pathogenic microorganisms, resulting in tolerance versus protective immunity, respectively. Antigens of the gut commensals are not simply ignored, but rather trigger an active immunosuppressive process, more commonly known as oral tolerance, which prevents the outcome of immunopathology. Both intrinsic properties of the gut microenvironment and cellular actors, as well as peripheral events induced by systemic dissemination of oral Ag, promote the induction of regulatory mechanisms that ensure maintenance of gut homeostasis. The aim of this review is to provide a synthetic update on the mechanisms of oral tolerance, with particular emphasis on the complex interplay between regulatory CD4+ T cells, dendritic cells and the gut microenvironment.

Animals↗
PubMed2004

Socioeconomic status and prevalence of allergic rhinitis and atopic eczema symptoms in young adolescents.

Environmental factors are known to influence the development of allergic rhinitis and atopic eczema in genetically susceptible individuals. Socioeconomic status (SES) may be an important indicator of risk for these conditions. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase 1 written questionnaire was used to determine the prevalence and severity of allergic rhinoconjunctivitis and atopic eczema symptoms in 4947 pupils aged 13-14 years attending 30 schools in socioeconomically diverse areas of Cape Town. Home addresses were used to stratify participants into five SES bands. Relationships between symptom prevalence and severity, and SES, recent urbanization and upward socioeconomic mobility were examined. Logistic regression was used to generate odds ratios (OR) and 95% confidence intervals (CI) in order to assess overall trends by SES. The prevalences of self-reported allergic rhinitis symptoms and recurrent itchy rash in the past year were 33.2% and 11.9% respectively. Girls had a significantly higher prevalence of all symptoms than boys. The prevalence of allergic rhinitis symptoms increased from lowest to highest SES (overall OR for rhinitis symptoms in past year = 1.16, 95% CI 1.11-1.21). There was no significant trend in reported eczema symptoms by SES other than for the question, 'Have you ever had eczema' (OR = 0.88, 95% CI 0.83-0.93). Longer period of urbanization was weakly associated only with recurrent itchy skin rash (OR = 1.05, 95% CI 1.01-1.09). 'Socially mobile' pupils, i.e. those resident in the lowest SES areas but attending highest SES schools showed significantly higher prevalences of eczema and some rhinitis symptoms than pupils attending lowest SES schools. These findings may reflect differences in reporting related to language, culture and access to medical care rather than real differences in prevalence.

Adolescent↗
PubMed2004

Use and care of an endotracheal/tracheostomy tube cuff--are intensive care unit staff adequately informed?

BACKGROUND: There is an apparent high incidence of tracheal stenosis in the Bloemfontein area. The aim of this study was to determine intensive care unit (ICU) staff knowledge of the use and care of endotracheal and tracheostomy tube cuffs. METHODS: One hundred and twelve qualified nurses, working in 11 different ICUs, were asked to complete an anonymous questionnaire regarding endotracheal/tracheostomy tube cuffs. RESULTS: The results highlight the following three areas of concern: (i) there was an overall misconception in 38% of the respondents that the function of the cuff was to secure the tube in position in the trachea to prevent self-extubation; (ii) accurate regulation of cuff pressure was not routine practice in any of the ICUs; and (iii) only half of the respondents felt their training regarding cuff care management was sufficient. CONCLUSIONS: ICU staff had misconceptions regarding the function and care of endotracheal/tracheostomy tube cuffs. The concept of a higher cuff pressure for better stabilisation of the tube is probably an important factor that could have caused the increase in tracheal stenosis in the Bloemfontein area. Critical care nursing needs to emphasise the use of current techniques, discourage routine cuff deflation, and encourage collaboration with ICU physicians on standards of care. A protocol that could be used in the ICUs regarding the use and care of an endotracheal/tracheostomy tube cuff is proposed.

Clinical Competence↗
PubMed2003

HIV infection in critically ill obstetrical patients.

OBJECTIVES: The effect of HIV-infection on the clinical course of critically ill obstetrical patients by means of a case-control study was evaluated. METHODS: Over one calendar year 440 patients were admitted to a high risk obstetrical unit. All patients were tested for HIV-infection. HIV-positive patients were included in the study group and two HIV-negative patients for every HIV-positive patient were included in the control group. RESULTS: No differences were found between the two groups regarding demographic data, diagnosis, antibiotic use, mode of delivery, duration of hospital stay and mortality. More complications occurred in the HIV-negative group. Eclampsia recorded for the HIV-negative group was 17.1% and 4.7% for the HIV-positive group (P=0.04; 95% CI: -17.1%; -0.9%) and lung edema was 18.2% and 6.2%, respectively (P=0.01; 95% CI: -19.3%; -3.5%). The median CD4/CD8 ratio was significantly lower in the HIV-positive group (0.43) than the HIV-negative group (1.37) (P<0.01; 95% CI: -1.04; -0.79). CONCLUSIONS: HIV-infection did not significantly alter the clinical course of critically ill patients in an obstetrical high care unit.

Adult↗
PubMed2003

A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. I: Mortality and morbidity.

Protein-energy malnutrition (PEM) remains one of the common causes of morbidity and mortality among children throughout the world. The supplementation of 10 mg elemental zinc, as zinc sulphate, was evaluated in the management of PEM in a randomized, controlled double-blind clinical trial in 300 children, aged 6-60 months (zinc, n = 150; control, n = 150) admitted to the Queen Elizabeth II Hospital, Maseru, Lesotho. Supplementation and follow-up were done for 3 months post-discharge from the hospital. Mortality during hospitalization was significantly lower in the zinc supplemented group (4.7 per cent), compared with 16.7 per cent in the control group. The prevalence of morbidity was significantly higher in the control group at 1, 2, and 3 month's follow-up. In the zinc supplemented group 58 per cent of the children were above the 80th percentile of expected weight-for-age 3 months after discharge, compared with 27.6 per cent in the control group. Dietary zinc supplementation resulted in a significant reduction in diarrhoeal disease, respiratory morbidity, and episodes of clinical anaemia, skin infections, and fever as well as vomiting in children with PEM. These findings suggest that interventions to improve zinc intake in their management may be of benefit to Basotho children in Lesotho with PEM.

Anthropometry↗
PubMed2003

A randomized controlled study of the impact of dietary zinc supplementation in the management of children with protein-energy malnutrition in Lesotho. II: Special investigations.

Protein-energy malnutrition (PEM) remains one of the common causes of morbidity and mortality among children throughout the world. The supplementation of 10 mg elemental zinc, as zinc sulphate, was evaluated in the management of PEM in a randomized, controlled, double-blind clinical trial in 300 children, aged 6-60 months (zinc, n = 150; control, n = 150) admitted to the Queen Elizabeth II Hospital, Maseru, Lesotho. Supplementation and follow-up were done for 3 months post-discharge from the hospital. Both the supplemented and the control groups presented with biochemically determined zinc deficiency on presentation. Despite supplementation the treated group only began to show evidence of biochemical increase in serum zinc at 60 days post-discharge from hospital. This may represent the period of replacement of the total body zinc. Zinc deficiency was more severe in those children in the control group that died after admission to hospital than those that survived, suggesting that low serum levels in children with PEM are associated with a poor prognosis. Zinc did not emerge as a predicator of poor prognosis in the supplemented group as very few children died in this group. The supplemented group also made significant gains as far as albumin levels were concerned, which probably reflects rehabilitation of their malnutrition. The associated improvement in haematological parameters has not been described before and may be secondary to the decreased burden of disease in the supplemented group. These findings suggest that not only were significant benefits of zinc supplementation shown for morbidity in mortality of children in Lesotho with PEM, but these trends were also demonstrated on biochemical profiles.

Child↗
PubMed2003

Weight gain in patients after therapy for hyperthyroidism.

OBJECTIVE: To determine the prevalence of obesity following therapy for hyperthyroidism and to assess the contributing factors associated with an undesirable weight gain. DESIGN: A retrospective analysis was undertaken of clinical records for 160 hyperthyroid patients attending an endocrine clinic in Bloemfontein (1994-2001). RESULTS: Of the 160 patients, 143 had Graves' disease and 17 patients had multinodular goitre. Most of our patients (N = 147) were treated with radioiodine, 10 patients with carbimazole and 3 patients had thyroidectomy. The median weight gain 6 months after therapy was 5.0 kg, after 12 months 9.0 kg, and after 24 months 12 kg, whereafter body mass stabilised. Before therapy 27.5% of patients had a body mass index (BMI) of < 22 kg/m2, 29.4% were overweight (BMI > 25 kg/m2) and 19.3% were obese (BMI > 30 kg/m2). Two years after treatment only 8.7% of patients had a BMI of < 22 kg/m2, 27.5% had a BMI > 25 kg/m2, and 51.3% had become obese. The main factors associated with weight gain 24 months after therapy were poor control of thyroid function on replacement therapy, diagnosis of Graves' disease and need for thyroxine replacement. CONCLUSION: This study has shown a large increase (32%) in the prevalence of obesity following treatment for hyperthyroidism. The main weight gain was during the first 2 years after therapy. The main factors contributing to excessive weight gain were need for replacement therapy and poor control of thyroid function.

Antithyroid Agents↗
PubMed2003

Antinuclear antibody testing in obstetric patients.

OBJECTIVES: To assess possible associations between the presence of antinuclear antibodies (ANAs) and pregnancy outcome in order to determine the significance of this test in obstetric practice. METHODS: A case-control study was performed on 408 patients admitted to an obstetric high care unit and on whom ANA testing was consecutively performed. The study group consisted of 46 patients who tested positive for ANAs and a control group of 92 patients who tested negative for ANAs. In addition to demographic data, indications for admission and pregnancy outcome were compared between the two groups. RESULTS: Of the 46 patients with a positive ANA result, 28 had an antinuclear pattern, 13 an anticytoplasmic pattern and 5 an antinuclear and an anticytoplasmic pattern. No significant differences were observed between the two groups (ANA-positive and negative) with regard to demographic data, indication for admission, clinical and laboratory data, and pregnancy outcome. The patients were also tested for anticardiolipin antibodies, and significantly more patients with severe pre-eclampsia tested positive (24% versus 4.7%, p = 0.01). No difference in HIV status and presence of autoantibodies was found between the two groups. CONCLUSION: The presence of ANAs was not associated with adverse pregnancy outcome. Therefore routine patient testing for ANAs in an obstetric high-care unit is not recommended.

Adult↗
PubMed2002

The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa.

OBJECTIVE: The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. DESIGN AND SETTING: The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. SUBJECTS: Initially 536 children were measured and, after two years of intervention, 815. RESULTS: Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. CONCLUSION: The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.

Anthropometry↗