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Biomedical subjects

G Joubert

Publications and source records attributed to G Joubert.

At least 55 records · Page 3Linked to original sources
PubMed1998

Hairy cell leukaemia in the Bloemfontein academic hospitals.

OBJECTIVES: To study the clinical presentation, treatment and outcome of patients diagnosed with hairy cell leukaemia (HCL) in the Bloemfontein Academic Hospitals during the past 21 years. DESIGN: Retrospective study. All HCL patients diagnosed from 1975 to 1996. SETTING: Haematology clinics of the Universitas and Pelonomi Hospitals in Bloemfontein. SUBJECTS: All HCL patients diagnosed from 1975 to 1996. MAIN OUTCOME MEASURES: To determine the clinical and demographic profile, as well as response to treatment, of HCL patients in this region. RESULTS: A total of 16 HCL patients were studied. There were more males (13) than females and the mean age of the patients was 58 years (35 to 82 year; SD14.8). No Black patients were diagnosed. The patients mostly presented with a cytopenia and splenomegaly was present in 12 of the 14 patients for which spleen size was noted. All of the patients had a splenectomy and six were also treated with 2'-deoxycoformycin (Pentostatin). All six of the patient showed a response to treatment with this purine analogue. CONCLUSIONS: The presentation of HCL in the Bloemfontein academic hospitals is similar to what is seen world-wide. However, to evaluate the durability of the response to treatment with the purine analogues. Long term follow up is needed.

Adult↗
PubMed1998

Generic substitution--comparing the clinical efficacy of a generic substitute for fluphenazine decanoate with the original product.

UNLABELLED: Long-acting neuroleptics have become the mainstay of the long-term treatment of schizophrenia, improving compliance and thus preventing relapse. Since schizophrenia is a common condition and treatment is usually long-term, this has important financial implications. OBJECTIVE: Generic substitution is an important cost-saving measure and generic psychopharmacological agents are also currently available in South Africa. There have been concerns about the quality of these products, but these often arise from anecdotal reports. This study was undertaken to compare the clinical efficacy of a generic substitute of fluphenazine decanoate with the original product. DESIGN AND SETTING: The study was a double-blind randomised trial involving two parallel groups--generic substitution v. original product. Chronic schizophrenics, aged between 18 and 65 years, who had been on a constant dose of fluphenazine decanoate for at least 3 months preceding the trial, all treated as outpatients in the community, were studied. The Positive and Negative Syndrome Scale (PANSS) (positive scale) was used as measuring scale and patients were evaluated at inclusion and then every 2 weeks for the next 12 weeks. RESULTS: Both groups had a median change of zero in PANSS scores over the 12-week period. No clinically significant differences between the change in PANSS score were found in respect of the two products. CONCLUSIONS: Generic substitution could play an important role in containing the costs of health care in South Africa. Concerns about the quality and efficacy of these drugs should be investigated. In this study, no significant differences in the efficacy of the two products were found.

Adolescent↗
PubMed1998

Constipation in elderly patients attending a polyclinic.

OBJECTIVE: To determine the prevalence of and risk factors for constipation in the elderly. Differences between the white and black elderly populations in this regard were examined. DESIGN: Cross-section hospital-based study. SETTING: The family medicine clinics at National and Pelonomi hospitals in greater Bloemfontein. PARTICIPANTS: 179 white and 188 black patients, born before 1930, visiting the clinics during December and January 1994/95 and seen by one doctor. MAIN OUTCOME MEASURES: Constipation. RESULTS: In both the black and white population groups 29% of the participants were constipated according to the definition used in this study. Depression was a risk factor for constipation in both population groups. Age over 80 years was a risk factor in the black participants. The fibre and fluid contents of participants' diets were not found to be associated with constipation. Pain during defaecation was positively associated with constipation. Forty-three per cent of the white and 76.6% of the black participants used laxatives. Of the white and black laxative users 14.3% and 21.5%, respectively, used more than one laxative at a time. CONCLUSION: The prevalence of constipation was high in both groups. Laxative use and abuse are very common in the black elderly population.

Age Factors↗
PubMed1997

Prevalence of Helicobacter pylori antibodies in children in Bloemfontein, South Africa.

BACKGROUND: An association of H. pylori infection with chronic gastritis, peptic ulceration and gastric cancer is known. METHODS: Prevalence of IgG antibodies to Helicobacter pylori in children in the Bloemfontein, South Africa area was studied. Children attending the general pediatric outpatient department at Pelonomi Hospital in Bloemfontein were grouped according to age. A minimum of 100 children was investigated in each age group. Baseline demographic and socioeconomic data were collected. RESULTS: The study showed a high prevalence of H. pylori antibodies. Prevalence increased with age: 13.5% in children 3 months-2 years, 48.5% at 2-5 years, 67.3% at 5-10 years and 84.2% at 10-15 years. Investigation of the socioeconomic data in relation to the prevalence of H. pylori was inconclusive. CONCLUSIONS: This high prevalence needs further study.

Adolescent↗
PubMed1997

Body fat estimation in black South Africans: a pilot study.

OBJECTIVE: To estimate and compare the percentage of body fat in Black South Africans by underwater weighing (using three different equations), skinfold thicknesses measurements and bioelectrical impedance, in order to ascertain whether existing equations for body fat estimation apply to this racial group. DESIGN: Blind comparison of techniques. SETTING: Academic hospital. SUBJECTS: 22 (11 female and 11 male) healthy Black South African volunteers were studied, for hydration reasons, we present the data of 14 (six female and eight male) with a Body Mass Index between 20 and 30 kg/m2. MAIN OUTCOME MEASURE: Percentage of body fat. RESULTS: The comparisons indicated that the different methods give results which are in the same direction (all correlations were 0.69 or higher), but apart from the three underwater weighing equations, the methods do not give results which are the same. The 95% limits of agreement indicated a difference of no larger than four units between the underwater weighing equations, whereas the skinfold estimate could differ from the underwater weighing estimates by as much as 14 units, and bio-impedance could differ from the underwater weighing estimates by as much as 18 units. CONCLUSION: From this pilot study we conclude that skinfold thickness measurements and bioelectrical impedance are unproblematic means for estimating percentage of body fat. Existing equations for body fat estimation by underwater weighing and skinfold thickness measurements seem to be applicable to this racial group, but we suggest that further research should be conducted to develop, ethnic-specific equations within racial parameters.

Adipose Tissue↗
PubMed1996

HTLV-I infection in the Free State region of South Africa: a sero-epidemiologic study.

Human T-lymphotropic virus type I (HTLV-1) is associated with tropical spastic paraparesis (TSP) and adult T-cell leukemia/lymphoma. HTLV-I infection is endemic in certain parts of the Natal/KwaZulu region of South Africa. No studies on the seroprevalence of HTLV-I infection in the Free State (FS) have been published. This study was designed to determine the prevalence of HTLV-I antibodies among different patient groups in the FS. Sera from 863 patients were analyzed. There were: 178 asymptomatic rural Blacks, 200 asymptomatic urban Blacks, 50 asymptomatic Whites, 60 patients with spastic myelopathy, 70 patients with other neurologic disorders, 12 patients with T-cell haematologic malignancies and 293 human immunodeficiency virus (HIV) seropositive patients. Sera were tested for the presence of HTLV-I/II antibodies using an enzyme linked immunosorbent assay (ELISA). Positive results were confirmed using a modified Western blot assay. None of the asymptomatic Whites were HTLV-I antibody positive (95 pc confidence interval (CI): 0 to 7 pc), while 2 pc (95 CI: 0.5 to 5 pc) of asymptomatic urban Blacks and 1.1 pc (95 pc CI: 0.14 to 4 pc) of asymptomatic rural Blacks had HTLV-I antibodies. Of the group of patients with spastic myelopathy 33.3 pc (95 pc CI: 21.7 to 46.7 pc had HTLV-I antibodies, while none of the patients with T-cell haematologic malignancies (95 pc CI: 0 to 26.5 pc) or other neurologic disorders (95 pc CI: 0 to 5 pc) had HTLV-I antibodies. Of the HIV seropositive patients 6.1 (95 pc CI: 4 to 9.5) were co-infected with HTLV-I. HTLV-I infection is present in the Free State. It is strongly associated with spastic myelopathy in this region. HIV seropositive patients have a high rate of HTLV-I co-infection.

Adult↗
PubMed1996

Spirometry of healthy adult South African men. Part I. Normative values.

AIM: To determine normative spirometric values for black and white South African men. METHODS: A population of 796 bank personnel were subjected to spirometry and anthropometric measurements. An exhaustive questionnaire and radiographic screening process was used to identify a healthy population. Spirometry was performed using two calibrated instruments, a sleeve sealed piston spirometer (Autolink) and a bellows spirometer (Vitalograph). The methodological guidelines of the American Thoracic Society were observed. In the regression analysis Mallow's CP statistic was used to identify the best prediction models. RESULTS: Compelling evidence was found in support of incorporating sitting height in prediction equations. For the Autolink studies the prediction equations (based on age, standing height and weight) for forced vital capacity (FVC) (litres) were as follows: blacks: 0.053 height-0.030 age- 3.54; and whites: 0.056 height-0.038 age-3.07; for forced expiratory volume in the 1st second (FEV1) (litres) blacks: 0.036 height-0.032 age-1.18; and whites: 0.042 height-0.038 age-1.45. For the Vitalograph the equations were: FVC: blacks 0.048 height-0.024 age- 3.08 L; whites 0.056 height-0.031 age-3.42; FEV1: blacks 0.029 height-0.027 age-0.535; whites 0.042 height-0.036 age-1.84. CONCLUSION: The Vitalograph yielded significantly lower values than the Autolink for FVC measurements despite absolute consistency in methods. In view of the fact that the present study was conducted on healthy men, free from noxious industrial exposure, using state-of-the-art methods, these prediction equations may be regarded as the definitive norms for adult South African males.

Adult↗
PubMed1996

Spirometry of healthy adult South African men. Part II. Interrelationship between socio-environmental factors and 'race' as determinants of spirometry.

AIM: To examine the interaction of socio-environmental background, 'race' and anthropometry on spirometry. METHODS: A study population of white and black bank workers with broadly comparable current socio-economic circumstances was identified. Detailed questionnaires regarding a number of indicators of socio-environmental status (SES) were administered in addition to anthropometric and spirometric measurements. Multiple linear regression analyses were performed. The Kappa statistic was used to determine the best predictors of SES. RESULTS: 'Race' was found to be the best predictor of SES. Within the black group a sub-classification of high and low SES was possible. In all respects the white SES indicators were higher than those of the black high SES group. Multiple regression analysis showed that sitting height was a better anthropometric predictor of spirometry than standing height. Replacing 'race' with other indicators of SES gave similar measures of prediction (by Mallow's CP statistic) of spirometry in the over-30-year age group. CONCLUSION: The impact of 'race' on spirometry can be reduced substantially by incorporating sitting height and indicators of SES in the regression equations. This observation lends support to the hypothesis that 'race' is not a direct genetic predictor of lung size, but may have an influence because of SES and anthropometric features associated with 'race'.

Adult↗
PubMed1995

Hypertrophic cardiomyopathy associated with tacrolimus in paediatric transplant patients.

Reported side-effects of tacrolimus, a potent immunosuppressive agent, have not included cardiotoxicity. We describe 5 consecutive paediatric transplant recipients (3 small bowel with or without liver and 2 liver) who received tacrolimus. 2 developed congestive heart failure and hypertrophic obstructive cardiomyopathy which resolved after changing to cyclosporin. In the other 3 patients the cardiomyopathy regressed or improved with a lower dose of tacrolimus or after stopping the drug.

Blood Pressure↗
PubMed1995

Methodological issues in a disablement prevalence study: Mitchells Plain, South Africa.

The Mitchells Plain Disability Survey was undertaken primarily to expand a community-based rehabilitation programme in an underprivileged South African urban community. This descriptive survey used a proportional stratified random cluster sampling strategy (sample size 2424), with stratification by suburb and clusters consisting of 15 adjacent plots. A household screening questionnaire (based on the WHO disability questionnaire), identified people who reported health problems affecting their functional ability, while a second follow-up interview confirmed disablement status and obtained a medical, disablement and demographic profile of the disabled and ascertained their needs. This paper discusses different methodological issues related to the survey design and emphasizes the need for standardization of methods in the disablement field. Sampling issues include sample loss in a multi-staged data collection strategy as well as the non-independence of observations when sampling entire house- holds. The trade-off between studying disability across diagnostic, disablement and age categories, and wide confidence intervals for specific prevalence rates, is discussed. Because of the prohibitive costs validation of disablement status is often omitted in a low-budget project (as this one was), weakening the design of such studies. Even if the 'disabled' are correctly identified, the criteria for identifying respondents determine what type of disablement prevalence will be obtained, Different diagnoses reported on screening yielded different positive predictive values of disability--the most debilitating conditions yielding the highest proportion of disabled people. The quality of the data--evaluated through comparisons of initial and repeat screening interviews, and proxy and self-reporting--is described. There is a need for disability research to continue developing suitable methods for a wide range of purposes. One such is a 'good-enough' survey design which can be implemented rapidly, at relatively low cost, to yield useful results at local level.

Activities of Daily Living↗
PubMed1995

Coronary heart disease risk factors in a rural and urban Orange Free State black population.

OBJECTIVE: To determine and compare the prevalence of ischaemic heart disease (IHD) risk factors in a rural and an urban black population. DESIGN: A survey to determine the prevalence of hypertension, diabetes mellitus, smoking, obesity, central obesity and dyslipidaemia in black subjects 25 years and older. SETTING: The indigenous black populations of QwaQwa and Mangaung. PARTICIPANTS: A random sample of 950 households was selected from each area. From each household an unrelated male and/or female subject was selected in a standardised way. From QwaQwa 853 subjects (279 men and 574 women) and from Mangaung 758 subjects (290 men and 468 women) participated in the study. The response rate was 68% and 62% respectively for QwaQwa and Mangaung. MAIN OUTCOME MEASURES: Few urban-rural differences in the prevalence of IHD risk factors were found in this study. A low prevalence of clustering of major IHD risk factors was noted. RESULTS: The age- and sex-adjusted prevalences of hypertension were 29% in QwaQwa and 30.3% in Mangaung. Diabetes was present in 4.8% of the QwaQwa sample and 6% of the Mangaung sample. The prevalence of heavy smoking in the Mangaung sample was almost double that of the QwaQwa sample and mostly confined to men. High-risk hypercholesterolaemia was present in 12.5% of QwaQwa and 6% of Mangaung men in the 25-34-year age group. The corresponding figures for moderate-risk hypercholesterolaemia were 34% and 44.8% and both levels of risk declined with increasing age. The mean body mass index of women in both samples exceeded 25 kg/m2. CONCLUSION: All the elements for a potential epidemic of atherosclerotic cardiovascular disease are present in the study populations. The similarity of findings in the two samples may be indicative of the advanced stage of urbanisation and westernisation of the rural group. It is alarming that subjects in the younger age groups tended to have the highest prevalences of moderate and even high-risk hypercholesterolaemia.

Adult↗
PubMed1995

Utilisation of maternity services by black women in rural and urban areas of the Orange Free State.

An epidemiological survey was undertaken to evaluate the utilisation of maternal services for black women in the Orange Free State. Two hundred and forty clusters were selected from the rural (farms) and urban (local authorities) black population and eight households were interviewed in each cluster. Information was gathered from 237 rural women (from 959 households) and 168 urban women (from 926 households) who had delivered a baby or aborted during the preceding year. Antenatal care was received by 71% of the rural women and 87% of the urban women. Rural women delivered at home in 60% of cases while 37% delivered in hospitals. Only 23% of urban women delivered at home while 67% of their deliveries were conducted in hospitals. Nurses supervised deliveries in both instances in more than 60% of cases, but in rural areas traditional midwives managed 26% of the confinements. The conclusions are that the maternity service was largely provided by nurses and was predominantly limited to hospitals and homes. It is recommended that the quality of service be upgraded and more emphasis placed on midwife obstetric units.

Adolescent↗
PubMed1995

Relative efficacy of hydrocortisone and methylprednisolone in acute severe asthma.

The relative clinical efficacy of different types of intravenous glucocorticosteroids in acute severe asthma is not clear in published studies. We conducted a randomised prospective study of asthma unit admissions over a 3-month period. Therapy consisted of 4-hourly nebulised salbutamol, intravenous aminophylline and either intravenous hydrocortisone 200 mg 4-hourly or intravenous methylprednisolone 125 mg 12-hourly. Three hundred and eighty-six patients were admitted to the asthma unit. After exclusions, 191 patients were included in the analysis (hydrocortisone--91, methylprednisolone--100). The groups were comparable in respect of baseline data. The median time to maximum peak expiratory flow rate was 19 hours for hydrocortisone and 23 hours for methylprednisolone (median test, P = 0.21). Median duration of asthma unit stay was 30 hours for hydrocortisone and 36 hours for methylprednisolone (median test, P = 0.01). A similar difference was evident on comparison of the trial medications in patients who had previously been on oral maintenance steroids. We conclude that, at the dosages selected, hydrocortisone is more effective than methylprednisolone in acute severe asthma.

Acute Disease↗
PubMed1994

Haematological condition of the San (Bushmen) relocated from Namibia to South Africa.

A cross-sectional study was undertaken to assess the haematological condition of the San (Bushmen) relocated from Namibia to South Africa. We studied 238 subjects--145 men and 93 women; none of the women was pregnant. We performed full blood counts and estimations of serum vitamin B12, folate, ferritin and erythrocyte folate concentrations. The mean haemoglobin concentration among the men was 14.7 g/dl and 19 (13%) were anaemic; among the women it was 13.8 g/dl and 18 (19%) were anaemic. Thirteen (9%) of the men and 22 (24%) of the women had low concentrations of serum ferritin, and 38 (26%) of the men and 22 (24%) of the women had erythrocyte folate concentrations of less than 270 nmol/l. Three (2%) men and 4 (4%) women had serum vitamin B12 concentrations of less than 120 pmol/l. Eighty-one (56%) of the men and 76 (82%) of the women had eosinophilia, probably because of parasitic infections. It would appear from this and previous studies that prolonged exposure of these hunter-gatherers to a Western lifestyle has resulted in a high prevalence of anaemia, caused by low iron and folate intakes, complicated by alcohol consumption.

Adolescent↗