Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79%... more Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79% of the global number of adult patients living with diabetes (PLWD). In addition, South Africa (SA), a LMIC, has the highest prevalence of HIV infection globally (13%). The literature suggests that poor glycaemic control is found in the younger PLWD while older PLWD have a poorer quality of life with greater disability. With the effective roll-out of anti-retroviral treatment (ART), patients are living longer and can develop diabetes mellitus as a result of longevity, ART and the HIV infection itself. Assessing the relationship between age in PLWD and HIV would help in developing effective strategies that can be implemented to optimise healthcare for this cohort of patients. Objectives: A study was undertaken to summarise publications on age and glycaemic control in PLWD within the context of an HIV infection. Methods: A scoping review was performed using online medical journal search engines with specific search terms according to the PRISMA guidelines. The Abstracts of articles were read and articles that matched the search criteria were downloaded and read in full. If they matched the chosen topic, they were summarised for analysis. Results: There were 260 results found across 3 medical search engines (55 from Cochrane; 59 from PubMed; 101 from Scopus). A Google search was conducted for completeness (45 results). Seventeen journal articles were identified for the scoping review with 45 095 patients included in these studies from 7 countries. Associations between age and glycaemia differed greatly, being dispersed among the ‘older age has worse glycaemia category’, ‘non-significant category’ and ‘older age has improved glycaemia category’. Conclusion: Varying data exist on the associations between glycaemic control and age in PLWD in the context of HIV infection. Further studies are recommended to determine associations in this regard, especially in LMIC where HIV and DM have a higher prevalence.
Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of de... more Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of developing hypertension (HPT). The presence of HPT in PLWD (PLWDH) accelerates diabetes-related complications (DRC). Scarce data exist from South Africa on the impact of HPT in PLWD. Methods: Data werecaptured from Edendale Hospital diabetes clinic datasheets from January 1, 2019 to December 31, 2019 and analysed to determine differences in demographic, clinical and biochemical variables between PLWD and PLWDH. Results: Data from 822 PLWD were analysed, the majority having HPT (71,386.74%). The prevalence of HPT, resistant HPT (RHPT) and the number of antihypertensives used increased with age and diabetes duration. PLWDH had statistically poorer lipid control (LC), higher creatinine, waist circumference (WC), increased prevalence of sensory peripheral neuropathy, non-proliferative and proliferative retinopathy, cerebrovascular accidents, proteinuria and renal impairment. The significant majority of PLWDH were not meeting diabetes targets (glycaemic, lipid, BMI, WC). The bulk of PLWDH were on combination antihypertensive therapy (p < 0.001) and performed significantly better than monotherapy for glycaemia, LC, BMI and WC. Proteinuria and blood pressure (BP) improved significantly as the number of antihypertensives increased. One-fifth (151, 18.37%) of PLWDH had RHPT;this was more common in females (p < 0.001). PLWD with RHPT had a significantly higher LDL cholesterol, BMI, and urine protein-creatinine ratio (p < 0.001). Over one-quarter (29.87%) of the PLWD without HPT had a BP over 140/90mmHg. Conclusion: It was shown that HPT, RHPT and obesity are significant comorbidities in PLWD and increase the risk of DRC. The majority of PLWDH are not meeting targets, which places them at increased risk of DRC. BP, glycaemic and LC and proteinuria improved in those on combination antihypertensive therapy. A significant proportion of PLWD without HPT had elevated BP, and thus were potentially undiagnosed hypertensives needing intervention.
Although echinococcosis is a common parasitic disease endemic to Africa, ocular echinococcosis is... more Although echinococcosis is a common parasitic disease endemic to Africa, ocular echinococcosis is rare. We present a case of intraocular echinococcosis in a HIV-infected patient. A 38-year-old South African HIV-infected woman presented to a district-level hospital in Kwa-Zulu Natal on 10 March 2020. Her main presenting complaint was that of progressive, painless, bilateral visual loss. A B-ultrasonography scan revealed tractional retinal detachment on the right eye, while the left eye had tractional bands with a ‘double-walled’ cystic cavity causing retinal traction. A systemic work-up revealed a positive Echinococcus ELISA IgG with a value of 1.3, eosinophilia of 5.70% (0.41 × 109), and elevated C-reactive protein and erythrocyte sedimentation rate of 47 mg/L and 93 mm/hr, respectively. Based on the above clinical, biochemical and ultrasonographical evidence, a diagnosis of ocular echinococcosis was made. Our differential diagnosis includes toxic optic neuropathy, Jarisch-Herxheime...
Background We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding ... more Background We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding duration and magnitude among persons living with human immunodeficiency virus (HIV, PLHIV). Methods From May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalized with symptomatic coronavirus disease 2019 (COVID-19) were enrolled and followed every 2 days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (2 consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed, and cycle-threshold (Ct) values < 30 were considered a proxy for high SARS-CoV-2 viral load. Factors associated with prolonged shedding were assessed using accelerated time-failure Weibull regression models. Results Of 2175 COVID-19 patients screened, 300 were enrolled, and 257 individuals (155 HIV-uninfected and 102 PLHIV) had > 1 swab...
Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79%... more Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79% of the global number of adult patients living with diabetes (PLWD). In addition, South Africa (SA), a LMIC, has the highest prevalence of HIV infection globally (13%). The literature suggests that poor glycaemic control is found in the younger PLWD while older PLWD have a poorer quality of life with greater disability. With the effective roll-out of anti-retroviral treatment (ART), patients are living longer and can develop diabetes mellitus as a result of longevity, ART and the HIV infection itself. Assessing the relationship between age in PLWD and HIV would help in developing effective strategies that can be implemented to optimise healthcare for this cohort of patients. Objectives: A study was undertaken to summarise publications on age and glycaemic control in PLWD within the context of an HIV infection. Methods: A scoping review was performed using online medical journal search engines with specific search terms according to the PRISMA guidelines. The Abstracts of articles were read and articles that matched the search criteria were downloaded and read in full. If they matched the chosen topic, they were summarised for analysis. Results: There were 260 results found across 3 medical search engines (55 from Cochrane; 59 from PubMed; 101 from Scopus). A Google search was conducted for completeness (45 results). Seventeen journal articles were identified for the scoping review with 45 095 patients included in these studies from 7 countries. Associations between age and glycaemia differed greatly, being dispersed among the ‘older age has worse glycaemia category’, ‘non-significant category’ and ‘older age has improved glycaemia category’. Conclusion: Varying data exist on the associations between glycaemic control and age in PLWD in the context of HIV infection. Further studies are recommended to determine associations in this regard, especially in LMIC where HIV and DM have a higher prevalence.
Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of de... more Introduction: Patients living with type 2 diabetes mellitus (PLWD) are at an increased risk of developing hypertension (HPT). The presence of HPT in PLWD (PLWDH) accelerates diabetes-related complications (DRC). Scarce data exist from South Africa on the impact of HPT in PLWD. Methods: Data werecaptured from Edendale Hospital diabetes clinic datasheets from January 1, 2019 to December 31, 2019 and analysed to determine differences in demographic, clinical and biochemical variables between PLWD and PLWDH. Results: Data from 822 PLWD were analysed, the majority having HPT (71,386.74%). The prevalence of HPT, resistant HPT (RHPT) and the number of antihypertensives used increased with age and diabetes duration. PLWDH had statistically poorer lipid control (LC), higher creatinine, waist circumference (WC), increased prevalence of sensory peripheral neuropathy, non-proliferative and proliferative retinopathy, cerebrovascular accidents, proteinuria and renal impairment. The significant majority of PLWDH were not meeting diabetes targets (glycaemic, lipid, BMI, WC). The bulk of PLWDH were on combination antihypertensive therapy (p < 0.001) and performed significantly better than monotherapy for glycaemia, LC, BMI and WC. Proteinuria and blood pressure (BP) improved significantly as the number of antihypertensives increased. One-fifth (151, 18.37%) of PLWDH had RHPT;this was more common in females (p < 0.001). PLWD with RHPT had a significantly higher LDL cholesterol, BMI, and urine protein-creatinine ratio (p < 0.001). Over one-quarter (29.87%) of the PLWD without HPT had a BP over 140/90mmHg. Conclusion: It was shown that HPT, RHPT and obesity are significant comorbidities in PLWD and increase the risk of DRC. The majority of PLWDH are not meeting targets, which places them at increased risk of DRC. BP, glycaemic and LC and proteinuria improved in those on combination antihypertensive therapy. A significant proportion of PLWD without HPT had elevated BP, and thus were potentially undiagnosed hypertensives needing intervention.
Although echinococcosis is a common parasitic disease endemic to Africa, ocular echinococcosis is... more Although echinococcosis is a common parasitic disease endemic to Africa, ocular echinococcosis is rare. We present a case of intraocular echinococcosis in a HIV-infected patient. A 38-year-old South African HIV-infected woman presented to a district-level hospital in Kwa-Zulu Natal on 10 March 2020. Her main presenting complaint was that of progressive, painless, bilateral visual loss. A B-ultrasonography scan revealed tractional retinal detachment on the right eye, while the left eye had tractional bands with a ‘double-walled’ cystic cavity causing retinal traction. A systemic work-up revealed a positive Echinococcus ELISA IgG with a value of 1.3, eosinophilia of 5.70% (0.41 × 109), and elevated C-reactive protein and erythrocyte sedimentation rate of 47 mg/L and 93 mm/hr, respectively. Based on the above clinical, biochemical and ultrasonographical evidence, a diagnosis of ocular echinococcosis was made. Our differential diagnosis includes toxic optic neuropathy, Jarisch-Herxheime...
Background We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding ... more Background We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA shedding duration and magnitude among persons living with human immunodeficiency virus (HIV, PLHIV). Methods From May through December 2020, we conducted a prospective cohort study at 20 hospitals in South Africa. Adults hospitalized with symptomatic coronavirus disease 2019 (COVID-19) were enrolled and followed every 2 days with nasopharyngeal/oropharyngeal (NP/OP) swabs until documentation of cessation of SARS-CoV-2 shedding (2 consecutive negative NP/OP swabs). Real-time reverse transcription-polymerase chain reaction testing for SARS-CoV-2 was performed, and cycle-threshold (Ct) values < 30 were considered a proxy for high SARS-CoV-2 viral load. Factors associated with prolonged shedding were assessed using accelerated time-failure Weibull regression models. Results Of 2175 COVID-19 patients screened, 300 were enrolled, and 257 individuals (155 HIV-uninfected and 102 PLHIV) had > 1 swab...
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