RESUMEN

Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic. Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates.

Asunto(s)

RESUMEN

Introduction: Literature is limited on HIV and colorectal cancer (CRC) in sub-Saharan Africa despite it being the epicentre of the HIV epidemic, Purpose: To compare clinicopathological features and outcome of CRC in HIV-negative and HIV-positive patients. Methods: Retrospective analysis of a prospective CRC database. Demographic details, HIV status, anatomical site, disease stage, treatment and follow-up were documented. Results: Of 715 patients with CRC, 145 and 570 tested positive and negative respectively for HIV. Median age was 45 (IQR 36-53 and 57 (IQR 45-66) years among HIV-positive and HIV-negative patients respectively (p<0.0001). Tumour differentiation differed between the two groups (p=0.003) but staging was not different (p=0.6). Surgical resection rate was 52% for HIV-positive patients versus 59% for HIV-negative patients (p=0.07). Median follow-up was 9 (IQR 2-20.5) months for HIV-positive patients and 12 (IQR 6-29) months for HIV-negative patients (p=0.154). Recurrence rate was 14.7% among HIV positive patients and 6.8% in HIV negative patients (p=0.089). Conclusion: When compared with HIV-negative patients, HIV-positive patients with CRC presented at a younger age and tended to have lower surgical resection rates. There was no difference between the two groups with CRC in terms of anatomical sub-site distribution, disease staging and recurrence rates

Asunto(s)

RESUMEN

BACKGROUND: The COVID-19 pandemic is placing abnormally high and ongoing demands on healthcare systems. Little is known about the full effect of the COVID-19 pandemic on diseases other than COVID-19 in the South African setting. OBJECTIVE: To describe a cohort of hospitalised patients under investigation for SARS-CoV-2 that initially tested negative. METHODS: Consecutive patients hospitalised at Khayelitsha Hospital from April to June 2020, whose initial polymerase chain reaction test for SARS-CoV-2 was negative were included. Patient demographics, clinical characteristics, ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis, referral to tertiary level facilities and ICU, and all-cause in-hospital mortality were collected. The 90-day re-test rate was determined and comparisons were made using the χ2-test and the independent samples median test. RESULTS: Overall, 261 patients were included: median age 39.8 years, 55.6% female (n = 145). Frequent comorbidities included HIV (41.4%), hypertension (26.4%), and previous or current tuberculosis (24.1%). Nine (3.7%) patients were admitted to ICU and 38 (15.6%) patients died. Ninety-three patients (35.6%) were re-tested and 21 (22.6%) were positive for SARS-CoV-2. The top primary diagnoses related to respiratory diseases (n = 82, 33.6%), and infectious and parasitic diseases (n = 62, 25.4%). Thirty-five (14.3%) had a COVID-19 diagnostic code assigned (26 without microbiological confirmation) and 43 (16.5%) had tuberculosis. Older age (p = 0.001), chronic renal impairment (p = 0.03) and referral to higher level of care (all p < 0.001; ICU p = 0.03) were more frequent in those that died. CONCLUSION: Patients with tuberculosis and other diseases are still presenting to emergency centres with symptoms that may be attributable to SARS-CoV-2 and requiring admission. Extreme vigilance will be necessary to diagnosis and treat tuberculosis and other diseases as we emerge from the COVID-19 pandemic.

RESUMEN

Heart rate variability and fetal movement were used to classify active and quiet fetal periods. Fetuses at 28 to 30 weeks and at 38 to 40 weeks' gestation were compared. A period of fetal movement with increased variability of heart beat was classified as active and one with the absence of movement and diminished fetal heart beat was classified as quiet. The results demonstrated significant differences both in the number of active-quiet cycles per hour and in the length of the active periods. These findings suggest that analogs of fetal behavioral states may be present before birth and have cyclic patterns, and that the time spent in each fetal period is longer in older fetuses.

Asunto(s)

RESUMEN

The relationships between fetal heart rate (FHR) patterns and fetal movements (FM) were evaluated in 20 normal fetuses between 20 and 20 weeks' gestation. In 10 fetuses at 20 to 22 weeks' gestational age, 602 of the 620 observed FHR changes (97.1%) were decelerations. In this same group, most of the FHR changes (62.4%) were associated with FM. Similarly, 387 of 569 (68%) recorded FM between 20 and 22 weeks' gestation were associated with FHR changes. In a second group of fetuses between 28 and 30 weeks' gestation, in contrast to the less mature group, 227 of 670 FHR changes (33.9%) were decelerations. Among the remainder of the FHR changes, 240 (35.8%) were accelerations and 203 (30.3%) were accelerations with decelerations. As in the less mature group of fetuses, most of the FHR changes in these older fetuses were associated with FM (81.8%) and 548 of 611 (89.7%) recorded FM were associated with FHR changes. In summary, in normal pregnancy, FHR decelerations are common between 20 and 30 weeks' gestation. With advancing gestation, FHR decelerations are less commonly seen, and the frequency of acceleration and acceleration/deceleration patterns increases. The association between FHR and FM becomes stronger with advancing gestational age between 20 and 30 weeks. These findings suggest that the criteria for evaluating the health of the fetus before 30 weeks may be different from the criteria used later in pregnancy. Consequently, in the evaluation of low-birth weight fetuses between 20 and 30 weeks' gestation, new criteria for normal and abnormal nonstress monitoring tests must be developed.

Asunto(s)

RESUMEN

Antenatal detection of intrauterine growth retardation (IUGR) remains problematic. Previous animal and human studies have documented a relationship between increased substrate delivery to the fetus, e.g., in diabetes mellitus, and the birth of large-for-gestational age infants. The purpose of the study of 55 pregnancies, in which intravenous glucose tolerance tests (IVGTTs) were performed during the third trimester, was to examine the hypothesis that evidence of decreased availability of substrates for fetal growth precedes the birth of small-for-gestational age (SGA) infants; hence, the IVGTT might be useful for the detection of pregnancies complicated by IUGR. Increased glucose utilization rates (kt) and 10-minute plasma glucose concentrations and decreased plasma glucose concentrations at fasting and 60 minutes were found to be significantly associated with decreased infant birth weight, adjusted for gestational age. The Kt and 10- and 60-minute glucose values together could account for 40% of the variance in age-adjusted birth weight (r = 0.63, p less than 0.01). The IVGTTs in the pregnancies resulting in the birth of SGA infants were characterized by kt greater than 2 and plasma glucose levels at fasting of less than 64 mg/dl, at 10 minutes of greater than 193 mg/dl, and at 60 minutes of less than 82 mg/dl. When the kt was greater than 2, six (30%) of 20 infants were SGA; when the kt was less than or equal to 2, none (0%) of the 35 infants was SGA. These results suggest that, regardless of the underlying reason for the association, parameters of maternal glucose metabolism may be useful in detecting the pregnancy at risk for IUGR.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

A noninvasive method for measuring the antenatal human fetal systolic time intervals with the use of the transabdominal fetal electrocardiogram and Doppler cardiogram is described. Unique interactive computer routines were developed for rapid and accurate determination of the pre-ejection period (PEP), ventricular ejection time (VET), PEP/VET ratio, and fetal heart rate (FHR). Thirty normal patients were monitored between 20 and 40 weeks of gestation. A regression analysis of the fetal systolic time intervals and FHR against gestational age was done. PEP and PEP/VET ratio were significantly correlated to the gestational age, while VET and FHR were not.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)