RESUMEN
BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.
Asunto(s)
COVID-19/complicaciones , Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Mortalidad Materna , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Embarazo de Alto Riesgo , Estudios Prospectivos , SudáfricaRESUMEN
SETTING: Treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) in South Africa have suffered as centralized, in-patient treatment programs struggle to cope with rising prevalence and human immunodeficiency virus (HIV) co-infection rates. A new treatment model is needed to expand treatment capacity and improve MDR-TB and HIV outcomes. OBJECTIVE: To describe the design and preliminary results of an integrated, home-based MDR-TB-HIV treatment program created in rural KwaZulu-Natal. METHOD: In 2008, a decentralized center was established to provide out-patient MDR-TB and HIV treatment. Nurses, community health workers and family supporters have been trained to administer injections, provide adherence support and monitor adverse reactions in patients' homes. Physicians assess clinical response, adherence and the severity of adverse reactions to MDR-TB and HIV treatment at monthly follow-up visits. Treatment outcomes are assessed by monthly cultures and CD4 and viral load every 6 months. RESULTS: Of 80 patients initiating MDR-TB treatment from February 2008 to April 2010, 66 were HIV-co-infected. Retention has been high (only 5% defaults, 93% of visits attended), and preliminary outcomes have been favorable (77% cured/still on treatment, 82% undetectable viral load). Few patients have required escalation of care (9%), had severe adverse events (8%) or died (6%). CONCLUSION: Integrated, home-based treatment for MDR-TB and HIV is a promising treatment model to expand capacity and achieve improved outcomes in rural, resource-poor and high HIV prevalent settings.
Asunto(s)
Atención Ambulatoria/organización & administración , Fármacos Anti-VIH/uso terapéutico , Antituberculosos/uso terapéutico , Coinfección , Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Salud Rural/organización & administración , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/efectos adversos , Antituberculosos/efectos adversos , Actitud del Personal de Salud , Recuento de Linfocito CD4 , Cuidadores , Estudios de Factibilidad , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Cumplimiento de la Medicación , Objetivos Organizacionales , Grupo de Atención al Paciente/organización & administración , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Apoyo Social , Sudáfrica/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Carga ViralRESUMEN
The kinetics of fenoprofen release from poly[alpha,beta-(N-2-hydroxyethyl-DL-aspartamide)]-fenoprofen conjugate (PHEA-Fen) in aqueous buffer solutions (pH 10 and 1.1), simulated gastric (SGF) and intestinal fluids (SIF) was studied. In borate buffer pH 10, the following rate constants were obtained: k=0.2659 (t=60 degrees C) and k=0.0177 h(-1) (t=37 degrees C) and in glycine buffer solution pH 1.1 k=0.0036 h(-1). In SGF and SIF fenoprofen release did not occur in significant extend within 12 h. The hydrolysis of the ester bond between the polymeric carrier and fenoprofen followed the pseudo first-order kinetics, with activation energy indicative for the breakage of a sigma bond (E(a)=100.6 kJ mol(-1)). The concentration of the released fenoprofen was determined by high performance liquid chromatography (HPLC).
Asunto(s)
Antiinflamatorios no Esteroideos/química , Fenoprofeno/química , Polihidroxietil Metacrilato/análogos & derivados , Polihidroxietil Metacrilato/química , Profármacos/química , Cromatografía Líquida de Alta Presión , Concentración de Iones de Hidrógeno , Cinética , SolubilidadRESUMEN
One of the requirements for a nursing model in any field of nursing is its practical implementation. The purpose of this article is to describe how the model for the development of nursing standards in a nursing service was implemented and evaluated. An exploratory and descriptive research design was followed, with a simple pilot study during which 9 nurses were requested to give their view on the model. The model was sucessfully implemented in the nursing service of an academic hospital. Evaluation revealed that the implementation facilitated quality nursing, the resocialising of values and the professional and personal growth of nurses in that nursing service.
Asunto(s)
Modelos de Enfermería , Atención de Enfermería/normas , Centros Médicos Académicos , Actitud del Personal de Salud , Humanos , Investigación en Evaluación de Enfermería/métodos , Servicio de Enfermería en Hospital/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Valores SocialesRESUMEN
Quality improvement is a process of standard formulation, evaluation whether nurses comply with these standards, as well as remedial action to improve the quality of nursing care rendered. This article describes guidelines for the professional development in the formulation of nursing standards. It is based on the Model for standard development and was successfully implemented in a nursing service. An exploratory and descriptive research strategy was utilised and executed in a nursing service of an academic hospital in Gauteng. The implementation of these guidelines should facilitate excellence in standard formulation.
Asunto(s)
Atención de Enfermería/normas , Servicios de Enfermería/normas , Humanos , Investigación en Evaluación de Enfermería , Filosofía en Enfermería , Práctica Profesional/normas , Calidad de la Atención de Salud , Valores Sociales , Socialización , SudáfricaRESUMEN
The management of swabs, needles and instruments in the operating theatre is a high-risk and problem-prone area for the operating theatre nurse. The purpose of this research is to formulate specific standards on the management of swabs, needles and instruments in the operating theatre to ensure the safety of the patient. An exploratory and descriptive research design was used and executed in 3 hospitals of a private hospital group in Gauteng. A structured two phase process was followed, i.e. the development phase and the validation phase. This last phase was done by means of deliberate debate. It is recommended that these standards be implemented, tested and validated on a national basis and a monitoring and evaluation system should be developed to ensure nursing compliance with these standards.
Asunto(s)
Enfermería de Quirófano , Esterilización/normas , Equipo Quirúrgico/normas , Instrumentos Quirúrgicos/normas , Humanos , Investigación en Enfermería/métodos , Guías de Práctica Clínica como Asunto , Muestreo , SudáfricaRESUMEN
The study investigated the extent and nature of work stress and burnout in a sample of 81 student nurses in a training hospital in the Natal Midlands. The Maslach Burnout Inventory (MBI), Sources of Stress Questionnaire (SSQ), Student Life Events Checklist (SLEC), and two coping scales, the Ways of Coping Checklist (WCC) and the Billings and Moos Coping Scale (BMCS) were used to measure the variable of burnout, stress, life events and ways of coping. Findings point to the fact that there were significantly higher levels of burnout as measured on the MBI sub-scales of Emotional Exhaustion and Depersonalisation in the sample, in comparison to other helping professionals in South Africa and the USA. These results are discussed in relation to the influence of gender, race and age of the sample. A small sub-sample of high burnout nurses was identified that differed from the rest of the sample in respect to coping styles. Sources of stress in the sample indicated issues relevant to the developmental stage of the sample that have implications for training and intervention. Style of coping and source of stress relating to home-work interface were found to be related to the experience of burnout. Implications of the findings are discussed in relation to training, intervention and further research.
Asunto(s)
Adaptación Psicológica , Agotamiento Profesional/psicología , Estudiantes de Enfermería/psicología , Adulto , Agotamiento Profesional/diagnóstico , Agotamiento Profesional/prevención & control , Femenino , Humanos , MuestreoRESUMEN
The effect of hyperglycemia on in vivo adipose tissue metabolism was studied with microdialysis in seven lean patients with insulin-dependent diabetes mellitus (IDDM) receiving a constant infusion of insulin (36 pmol.m-2.min-1). Glucose was infused in a randomized fashion to maintain either a lower glucose level (6.6 +/- 0.3 mM, mean +/- SE) or hyperglycemia (11.8 +/- 0.8 mM) for 3 h. For insulin concentrations of 84 +/- 12 and 96 +/- 12 pM, hyperglycemia (11.8 +/- 0.8 mM) did not alter the plasma glycerol or lactate levels significantly but resulted in a significant (P < 0.0001) increase in plasma free fatty acid levels (0.49 +/- 0.13 vs. 0.32 +/- 0.08 mM). Plasma catecholamine levels were unchanged during hyperglycemia. Interstitial glycerol concentrations, measured in abdominal subcutaneous adipose tissue as an index of lipolysis, were not significantly influenced by hyperglycemia when compared with concentrations at the lower glucose level (92 +/- 30 vs. 106 +/- 18 microM). Moreover, hyperglycemia did not change abdominal adipose interstitial lactate levels significantly (1,248 +/- 174 vs. 1,351 +/- 159 microM during euglycemia). It may be concluded that hyperglycemia has no independent antilipolytic effect in IDDM subjects. Furthermore, in these patients, hyperglycemia gives no further lactate production in the subcutaneous adipose tissue in the presence of low physiological insulin levels.
Asunto(s)
Tejido Adiposo/metabolismo , Diabetes Mellitus Tipo 1/metabolismo , Hiperglucemia/metabolismo , Adulto , Glucemia/metabolismo , Diabetes Mellitus Tipo 1/sangre , Femenino , Técnica de Clampeo de la Glucosa , Hemoglobina Glucada/análisis , Glicerol/sangre , Humanos , Cinética , Lactatos/sangre , Masculino , Microdiálisis/métodos , Persona de Mediana Edad , Distribución Aleatoria , Factores de TiempoRESUMEN
A patient with hypercalcaemia due to a parathyroid adenoma, and hypertrophic cardiomyopathy (HCM) is described. Although both conditions are common, it is suggested that the association between HCM and parathyroid hypercalcaemia may be more frequent than is accounted for by coincidence.
Asunto(s)
Adenoma/complicaciones , Cardiomiopatía Hipertrófica/complicaciones , Hipercalcemia/etiología , Neoplasias de las Paratiroides/complicaciones , Adulto , Electrocardiografía , Humanos , MasculinoRESUMEN
Transformation to an acute promyelocytic leukaemia occurred in a patient approximately 2 years after having been diagnosed as suffering from chronic myeloid leukaemia (CML). At this time, in addition to the Ph1 chromosomal aberration, an isochromosome 17q [i(17q)] was noted. The t(15:17) was absent. The implications of this are discussed.