South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2008
OBJECTIVE To determine the mortality rate and its predictors in patients with a presumptive diagn... more OBJECTIVE To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. DESIGN Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. RESULTS We obtained the vital status of 174 (94%) patients (median age 33; range 14 - 87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Ind...
In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disabili... more In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disability in nearly half of those affected. Attenuation of the inflammatory response in TB pericarditis may improve outcome by reducing cardiac tamponade and pericardial constriction, but there is uncertainty as to whether adjunctive immunomodulation with corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and morbidity. The primary objective of the IMPI Trial is to assess the effectiveness and safety of prednisolone and M. w immunotherapy in reducing the composite outcome of death, constriction, or cardiac tamponade requiring pericardial drainage in 1,400 patients with TB pericardial effusion. The IMPI trial is a multicenter international randomized double-blind placebo-controlled 2 × 2 factorial study. Eligible patients are randomly assigned to receive oral prednisolone or placebo for 6 weeks and M. w injection or placebo for 3 months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6 during the intervention period and 6-monthly thereafter for up to 4 years. The primary outcome is the first occurrence of death, pericardial constriction, or cardiac tamponade requiring pericardiocentesis. The secondary outcome is safety of immunomodulatory treatment measured by effect on opportunistic infections (eg, herpes zoster) and malignancy (eg, Kaposi sarcoma) and impact on measures of immunosuppression and the incidence of immune reconstitution disease. IMPI is the largest trial yet conducted comparing adjunctive immunotherapy in pericarditis. Its results will define the role of adjunctive corticosteroids and M. w immunotherapy in patients with TB pericardial effusion.
INTRODUCTION Capital accumulation in South Africa started off as a process of ‘accumulation by di... more INTRODUCTION Capital accumulation in South Africa started off as a process of ‘accumulation by dispossession’ (Harvey, 2010: 48–49). War, violence, predation, thievery, criminality, fraud … these were the means by which the indigenous people were dispossessed of their communal lands, and by which the basis to wealth in this country passed into the hands of the capitalists. South Africa was incorporated into the world economy as an enclave – as a colonial economy established by imperialist class interests primarily for the exploitation of its raw material resources (Mhone, 2001). Our economy was typically characterised by a capital-intensive sector co-existing with a capital-starved traditional economy. Although often described as ‘dual’, they are by no means ‘separate’. The capitalist sector, particularly the gold mining industry, was critically dependent on the traditional economy for the ongoing supply of ‘ultra-cheap, ultra-exploitable’ supplies of labour (Johnstone, 1976). By pr...
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2008
OBJECTIVE To determine the mortality rate and its predictors in patients with a presumptive diagn... more OBJECTIVE To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. DESIGN Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. RESULTS We obtained the vital status of 174 (94%) patients (median age 33; range 14 - 87 years). The overall mortality rate was 26%. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40% v. 17%, p=0.001). Ind...
In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disabili... more In spite of antituberculosis chemotherapy, tuberculous (TB) pericarditis causes death or disability in nearly half of those affected. Attenuation of the inflammatory response in TB pericarditis may improve outcome by reducing cardiac tamponade and pericardial constriction, but there is uncertainty as to whether adjunctive immunomodulation with corticosteroids and Mycobacterium w (M. w) can safely reduce mortality and morbidity. The primary objective of the IMPI Trial is to assess the effectiveness and safety of prednisolone and M. w immunotherapy in reducing the composite outcome of death, constriction, or cardiac tamponade requiring pericardial drainage in 1,400 patients with TB pericardial effusion. The IMPI trial is a multicenter international randomized double-blind placebo-controlled 2 × 2 factorial study. Eligible patients are randomly assigned to receive oral prednisolone or placebo for 6 weeks and M. w injection or placebo for 3 months. Patients are followed up at weeks 2, 4, and 6 and months 3 and 6 during the intervention period and 6-monthly thereafter for up to 4 years. The primary outcome is the first occurrence of death, pericardial constriction, or cardiac tamponade requiring pericardiocentesis. The secondary outcome is safety of immunomodulatory treatment measured by effect on opportunistic infections (eg, herpes zoster) and malignancy (eg, Kaposi sarcoma) and impact on measures of immunosuppression and the incidence of immune reconstitution disease. IMPI is the largest trial yet conducted comparing adjunctive immunotherapy in pericarditis. Its results will define the role of adjunctive corticosteroids and M. w immunotherapy in patients with TB pericardial effusion.
INTRODUCTION Capital accumulation in South Africa started off as a process of ‘accumulation by di... more INTRODUCTION Capital accumulation in South Africa started off as a process of ‘accumulation by dispossession’ (Harvey, 2010: 48–49). War, violence, predation, thievery, criminality, fraud … these were the means by which the indigenous people were dispossessed of their communal lands, and by which the basis to wealth in this country passed into the hands of the capitalists. South Africa was incorporated into the world economy as an enclave – as a colonial economy established by imperialist class interests primarily for the exploitation of its raw material resources (Mhone, 2001). Our economy was typically characterised by a capital-intensive sector co-existing with a capital-starved traditional economy. Although often described as ‘dual’, they are by no means ‘separate’. The capitalist sector, particularly the gold mining industry, was critically dependent on the traditional economy for the ongoing supply of ‘ultra-cheap, ultra-exploitable’ supplies of labour (Johnstone, 1976). By pr...
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Papers by Basil Brown