How to deal with stress.
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Adaptation, Psychological↗
Biomedical subjects
S Naidoo
Publications and source records attributed to S Naidoo.
Management of HIV patients.
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AIDS Serodiagnosis↗
A systematic review of the management of oral candidiasis associated with HIV/AIDS.
The purpose of this review was to investigate the management of oral candidiasis in HIV/AIDS patients and to evaluate the different guidelines available for its management. A number of topical and systemic antifungal medications are used to treat oral candidiasis in HIV-positive patients. Milder episodes of oral candidiasis respond to topical therapy with nystatin, clotrimazole troches or oral ketoconazole. Fluconazole has been extensively evaluated as a treatment for candidiasis. With HIV-infection, a cure rate of 82% has been achieved with a daily oral dose of 50 mg. Fluconazole was found to be a better choice of treatment for relapsing oropharyngeal candidiasis, resulting in either better cure rates or better prevention of relapse. Intravenous amphotericin B has been found to be effective in azole-refractory candidiasis and is well tolerated. Topical therapies are effective for uncomplicated oropharyngeal candidiasis; however, patients relapsed more quickly than those treated with oral systemic antifungal therapy. Nystatin appeared less effective than clotrimazole and the azoles in the treatment of oropharyngeal candidiasis. Clotrimazole was found to be just as effective for resolution of clinical symptoms as the azoles, except when patient compliance was poor. Fluconazole-treated patients were more likely to remain disease-free during the fluconazole follow-up period than those treated with other antifungal agents.
AIDS-Related Opportunistic Infections↗
Knowledge, attitudes, behaviour and prevalence of TB infection among dentists in the western Cape.
Tuberculosis (TB) remains the most important communicable disease in the world and in South Africa it accounts for 80% of all notifiable diseases. The impact of HIV on the TB epidemic is potentially catastrophic. HIV increases the susceptibility of the HIV-positive person to TB. The resurgence of TB as a public health problem has rekindled interest in this disease among oral health workers. The major concern is the risk of transmission in the dental setting. The aim of this study was to determine the prevalence of TB among dental practitioners and to assess their knowledge, attitudes and practices pertaining to TB. A cross-sectional survey was carried out. A structured questionnaire was used to obtain information on demography, infection control, TB status, behaviour, knowledge and perceived risk. In addition, Mantoux and multipuncture tests were performed to assess prevalence. The response rate was 78%. The sample consisted of 78 dentists, 80% male, with a mean age of 40 years. Ninety-two per cent reported always using gloves, 78% masks (68% surgical masks and 18% paper masks) and 50% glasses when treating patients. Two-thirds reported that they sterilise suction and three-in-one tips. Only 11% reported use of a rubber dam. No practitioner reported the use of high-volume externally vented aspirators or ultraviolet germicidal irradiation. Five per cent reported ever being diagnosed with TB, all after having qualified as a dentist. Half of the sample reported having being vaccinated against TB. The prevalence of those who developed a positive reaction was 33%. Thirty-one per cent reported having referred a patient suspected of having TB for further diagnosis and management. Dentists have a duty to take appropriate precautions to protect themselves, their staff and their patients from the risk of cross-infection. The implementation of infection control policies is critical to the provision of such protection. In addition, a dental health facility provides the opportunity for TB screening which has not as yet been tapped into to its fullest extent in a developing country setting where TB is endemic. Referral and integration of TB screening in high HIV and TB prevalence areas will provide early diagnosis, treatment of TB and possibly prevention and reduced risk of nosocomial infection.
Adult↗
Oral HIV lesions and oral health behaviour of HIV-positive patients attending the Queen Elizabeth II Hospital, Maseru, Lesotho.
AIM: The aim of the study was to determine the prevalence of oral mucosal lesions strongly associated with HIV infection and to assess the oral health behaviour among patients attending Queen Elizabeth II Hospital in Maseru. The objectives were: (i) to determine the prevalence of group 1 lesions in HIV-positive patients according to the ECC/WHO classification; (ii) assess the oral hygiene practices of these patients; and (iii) make recommendations based on the findings. METHODOLOGY: A questionnaire was administered by an interviewer to a sample of 270 patients with a serological diagnosis of HIV infection to assess their oral health behaviour; they were then examined for oral manifestations. The assessment of oral health behaviour involved determining the regularity and frequency of oral hygiene practices, and use of mouth wash, interdental and other adjunct cleaning aids. The presumptive criteria as defined by the ECC/WHO classification were used for diagnosis of the oral mucosal lesions. Results were entered and analysed using Epi info-6 statistical software RESULTS: The prevalence of specific oral mucosal lesions in order of occurrence was pseudomembranous candidiasis 27%, erythematous candidiasis 26%, angular cheilitis 14%, hairy leukoplakia 12%, ulcerations 12%, necrotising gingivitis 5%, linear gingival erythema 3%, and non-Hodgkin's lymphoma and Kaposi's sarcoma less than 1%. This pattern reflects the findings in other regional studies where pseudomembranous candidiasis is often the most common lesion found. Nearly all patients reported cleaning their mouths; 82% did it every day. Mouth wash and interdental cleaning aids were not often used. CONCLUSIONS: A high prevalence (73%) of oral mucosal lesions was found. Oral candidiasis was the most common group of lesions (54%). The oral hygiene practices reported by the patients were considered acceptable.
AIDS-Related Opportunistic Infections↗
Immunolocalisation and endothelin-1 values In pre-eclampsia: an immunocytochemical study.
Maternal plasma ET-1 levels and the immunolocalisation of ET1 in the fetal membranes of pre-eclamptic primigravidae at >/=28 weeks, gestation were studied. The levels of maternal plasma ET1 and immunoreactive ET-1 were increased in pre-eclampsia. Immunoreactive ET-1 was localised in the amnion, chorion and decidua of normal pregnant women as well as those with preeclampsia-eclampsia. Intense labelling was observed in moderate pre-eclampsia (BP 140/90 - 170/110 mmHg) with very intense labelling in severe pre-eclampsia (BP >170/110 mmHg), especially in the amniotic epithelium, chorionic villi, maternal blood vessels, cytotrophoblasts and giant cells of the decidua. The increased ET-1 levels demonstrated in fetal membranes of pre-eclamptic women are probably produced in a paracrine and/or autocrine manner, contributing to the hypertension, vasospasm and fetal growth restriction characteristic of the syndrome. A larger study would be required to show significant change in endothelin production in pre-eclampsia.
Journal Article↗
Perceptions of oral health: the South African Demographic and Health Survey of 1998.
Oral diseases are widespread in South Africa and affect large numbers of people in terms of pain, tooth loss, disfigurement, loss of function and even death. The majority of South Africans have no access to private services and are dependent on the government for oral health care services, but less than 10% of the population utilises public oral health services. This underutilisation is due to limited resources and inaccessibility. This article reports on the data collected on adults, 15 years and older, from the South African Demographic and Health Survey carried out in 1998, relating to perceptions of oral health. The questions dealt with oral health problems, utilisation of oral health services, loss of natural teeth, oral health practices and knowledge of water fluoridation. The results are discussed in terms of age, gender, education, place of residence, province and classification according to the previous population registration act. A high proportion (36%) of people had experienced oral health problems. Teeth problems were most commonly reported in the higher age groups, non-urban areas, Eastern Cape, Northern Cape and Free State, people with little education and those classified as non-urban Africans. Significant differences were found in regard to periodontal disease, tooth loss, knowledge of fluoride between groups according to age, geographic location, race and level of education. 62% of the respondents reported that they had lost some of their natural teeth and in some communities almost a third of the respondents were edentulous. In comparing the goals of the current draft national oral health policy with the findings of this survey the following implications for policy development should be noted: A higher priority needs to be given to oral health issues; Improve access by increasing primary health care facilities through the delivery of oral health care services; The high prevalence of hepatitis and HIV/AIDS infection poses a higher risk to oral health personnel and the public and The successful implementation of water fluoridation depends upon public knowledge, understanding and support.
Adolescent↗
Prevalence and impact of dental pain in 8-10-year-olds in the western Cape.
The purpose of this study was to investigate the prevalence of acute dental pain in 8-10-year-old schoolchildren in the Western Cape. The study sample was drawn from schools in Stellenbosch, Malmesbury, Mitchells Plain, Mossel Bay and Robertson. Eighty eight per cent reported that they had experienced dental pain and 70% within the last two months. The prevalence and severity of pain in this study is much higher than reported studies in England and the USA. A high percentage of children not only live with pain on a daily basis, but also missed school on account of it (70%). There is an urgent necessity for oral health to be given a greater priority within the district health system to improve access to integrated oral health care services with appropriate preventive and treatment measures.
Absenteeism↗
Benign mucous membrane pemphigoid--a case report.
Benign mucous membrane pemphigoid (BMMP) is a relatively rare, chronic vesiculobullous disease. It frequently affects postmenopausal women, although cases have been reported in younger individuals. Benign mucous membrane pemphigoid has a predilection to affect multiple mucosal surfaces including the gingivae, hard and soft palate, alveolar ridge, nose, pharynx, gastrointestinal tract, genitalia and the conjunctiva. It is seen clinically as bullae or erosions on the mucosae or gingivae. The bullae rupture after 24-48 hours and the erosions heal within 7-14 days, sometimes with scar formation. Scarring frequently occurs with ocular mucosa involvement and may contribute to blindness. In order to make a diagnosis, the clinical features must be correlated with microscopic and immunopathological findings. Benign mucous membrane pemphigoid is treated with high doses of corticosteroids and immunosuppressive agents. This paper is a presentation of a case report in a 36-year-old woman.
Adult↗
Infection control among dentists in private practice in Durban.
The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.
Adult↗
HIV/AIDS: the knowledge, attitudes and behaviour of dentists in Nairobi, Kenya.
The purpose of this study was to assess dentists' knowledge of HIV/AIDS, as it affects them in their workplace, attitudes pertaining to universal precautions and treatment of patients with HIV/AIDS and their behaviour toward their patients. A descriptive cross-sectional survey was carried out. A 34-item questionnaire was delivered to a random sample of 145 dentists based in Nairobi, Kenya. The response rate was 72% (N = 105). Just over half the sample (53%) knew that the first AIDS patient in Kenya was reported in 1984. Ninety eight per cent knew that the main mode of transmission of HIV/AIDS in Kenya is heterosexual contact. All the respondents reported the use of gloves during clinical procedures and use of an autoclave for sterilisation of instruments was reported by more than 85%. Most dentists indicated a willingness to treat HIV/AIDS patients while those with dissenting views preferred that they be treated in dedicated clinics or academic teaching hospitals. Nearly half felt that the risk of HIV transmission in the clinic is high. The incongruity between perceived knowledge, reported practise and attitudes suggests that there is a need for continuing education courses to enable dentists to practice their profession with due care as regards patients with HIV/AIDS. In addition, courses on working with patients with HIV/AIDS should be offered so as to remove ignorance and fear. Results from this survey show that there is a fair level of knowledge as far as HIV/AIDS is concerned. The results also indicate that a greater compliance with universally accepted guidelines for infection control is needed, as it remains low for dentists working in the capital city of a country that records a rising number of new HIV/AIDS cases every day.
Acquired Immunodeficiency Syndrome↗
The role of primary school teachers in HIV prevention in South Africa.
South Africa has the fastest growing HIV epidemic in the world. The need for an intensive campaign against its spread cannot be overemphasised. Such efforts may be particularly effective if introduced prior to the onset of risk behaviour. The purpose of this study was to investigate the knowledge of grade 3 and 4 schoolteachers on HIV/AIDS and their opinion on educating their pupils about HIV prevention. A self-administered questionnaire with knowledge, perception and sociodemographic variables was sent to all 120 grade 3 and 4 teachers in the Southern Bushveld district of Northern Province. Descriptive statistics and multiple regression analysis were used to analyse the data. The response rate was 67% (N = 81) and 87.7% were females. The mean age of the respondents was 37.7 (+/- 8.7 SD) years, 55% had a 3-year teacher's training qualification and 27% had a 4-year training qualification. The average teaching experience was 12 years. Most respondents (93.8%) had knowledge of what HIV/AIDS is, but only 85.2% indicated it could be prevented. 14.8% either did not know HIV/AIDS could be prevented or were not sure. Some teachers had an incomplete understanding of the transmission and prevention of HIV/AIDS. Furthermore only 9% mentioned education as a way to prevent HIV/AIDS and 16% abstinence. Of the respondents, 58% indicated teaching HIV prevention to their pupils. Of those who do not teach HIV prevention, 41.2% believed that the pupils were too young, and 20.6% claimed non-availability of guidelines and resources as reasons for not teaching. A significant negative correlation was found between level of qualification and teaching of HIV to pupils (p < 0.05). In conclusion, many primary school teachers were found to be wanting in their HIV/AIDS knowledge. This suggests that the schoolteachers would need to be adequately trained prior to their involvement in HIV/AIDS education to pupils. Grade 3 and 4 teachers may be considered suitable to provide HIV education to their pupils, but there is a need for structured educational programmes they can follow. This study also suggests that teachers were not aware of the Department of Education's HIV policy of providing age-appropriate education to all pupils.
Acquired Immunodeficiency Syndrome↗
Hepatitis C infection: an overview and implications for the oral health worker.
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Dental Auxiliaries↗
A profile of the oro-facial injuries in child physical abuse at a children's hospital.
OBJECTIVE: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa. METHOD: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out. RESULTS: The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures. CONCLUSIONS: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.
Adolescent↗
Detection of tissue kallikrein and kinin B1 and B2 receptor mRNAs in human brain by in situ RT-PCR.
Tissue kallikrein (TK) and kinin receptors have been immuno-localized in various areas of the human nervous system, suggesting that the kallikrein-kinin system (KKS) may be functionally active in the brain. The aim of this study was to determine the cellular expression of TK and kinin B1 and B2 receptor mRNAs in specific regions of the human brain by in situ reverse transcriptase polymerase chain reaction. Autopsy samples of the brain, spinal cord, kidney and salivary gland were embedded in paraffin. Sections (5 microm), adhered onto silane coated glass slides, were treated with Proteinase K and DNase, followed by reverse transcription polymerase chain reaction with specific KKS primers and digoxigenin-dUTP. Detection of the digoxigenin-label demonstrated localization of TK, B1 and B2 mRNAs in the cytoplasm of some neuronal cell bodies in the hypothalamus, thalamus, frontal cortex and spinal cord. TK mRNA was also observed in the ependymal cells lining the cerebral ventricles and epithelial cells of the choroid plexus. In the choroid plexus, only B1 gene expression was observed in some choroidal epithelial cells while no B2 labeling was detected. The identification of mRNAs to TK, B1 and B2 kinin receptors in human nervous tissue supports previous evidence for the presence of the KKS in the brain and confirms localized protein synthesis.
Adolescent↗
Expression of tissue kallikrein and kinin receptors in angiogenic microvascular endothelial cells.
Angiogenesis is the sprouting of new capillary blood vessels from pre-existing ones. The kinin family of vasoactive peptides, formed by the serine protease tissue kallikrein from its endogenous multifunctional protein substrate kininogen, is believed to regulate the angiogenic process. The aim of this study was to determine the expression of tissue kallikrein and kinin receptors in an in vitro model of angiogenesis. Microvascular endothelial cells from the bovine mature and regressing corpus luteum were used only if they reacted with known endothelial cell markers. At first the cultured endothelial cells began sprouting, and within four weeks formed three-dimensional, capillary-like structures. Immunolabelling for tissue prokallikrein and the mature enzyme was intense in the angiogenic endothelial cells derived from mature corpora lutea. Immunoreactivity was lower in non-angiogenic endothelial cells and least in angiogenic endothelial cultures of the regressing corpus luteum. Additionally, using specific antisense DIG-labelled probes, tissue kallikrein mRNA was demonstrated in cells of the angiogenic phenotype. Immunolabelled kinin B2 receptors, but not kinin B1 receptors, were visualised on angiogenic endothelial cells. Our results suggest an important regulatory role for kinins in the multiple steps of the angiogenic cascade that may occur in wound healing and cancer cell growth.
Amino Acid Sequence↗
HIV/AIDS: breaking the silence.
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AIDS Vaccines↗
Noma (cancrum oris): case report in a 4-year-old HIV-positive South African child.
Cancrum oris (noma) is a gangrenous infection that develops in the mouth and spreads rapidly to other parts of the face. The disease occurs mostly in conditions of poverty, poor hygiene and malnutrition. In sub-Saharan Africa the frequency in several countries is estimated to be 1-7 cases per 1,000 population, and as many as 12 cases per 1,000 in the most affected communities. About 90% of these children die without receiving any care, yet the disease can, and should, be prevented. With increasing numbers of children who are malnourished and who have compromised immune systems (compounded by the HIV pandemic) the prevalence of conditions such as noma is likely to increase. Among the earliest features of noma are excessive salivation, marked fetor oris, facial oedema and a greyish-black discolouration of the skin in the affected area. This devastating gangrenous lesion may involve the cheek, the chin, the infra-orbital margin, palate, nose, antrum and virtually any part of the face. This report describes a 4-year-old HIV-positive African girl, who was abandoned, discharged from the Plastics Unit and now lives in a child care sanctuary. Little is known about her history prior to her arrival at the home a few weeks previously. The clinical examination revealed a delay in growth and physical development equivalent to that of a 2-year-old child. The left cheek had a perforating ulcer in a healing phase. The perforation, about 1 cm in diameter, was surrounded by oedematous tissues showing a mild to moderate erythema. The peripheral oedema extended to the lower palpebral, the upper labial, left labial commissural, mandibular and pre-parotid regions. Submental, submandibular and cervical lymph nodes were mildly painful upon palpation. The child was not pyretic. The intra-oral examination revealed the features of acute necrotising gingivitis (ANG). ANG was generalised and showed classic interdental crater-like ulcers covered with whitish debris. Halitosis was pronounced. Examination of the second quadrant revealed a large ulcer extending from the distal aspect of the deciduous canine to the distal aspect of the second deciduous molar. The adjacent palatal mucosa was severely oedematous. The alveolar bone supporting the first and the second molars was completely exposed to the fundus of the vestibulum. It was not possible to obtain intraoral photographs or radiographs. Chlorhexidine gluconate (0.2% solution) and metronidazole tablets, 200 mg twice daily for 15 days were prescribed. The child was seen every alternate day for 10 days and her condition improved rapidly. Halitosis had subsided. She was then referred to the Johannesburg Hospital for further treatment under general anaesthesia. The proposed treatment plan was as follows: removal of dental accretions and polishing of all teeth, extraction of the left maxillary teeth supported by non-vital bone, resection of the necrotic bone in the left maxilla and reconstructive surgery in the left cheek.
AIDS-Related Opportunistic Infections↗