Browsing by Author "Nel, D. G."

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    Acute renal failure in the medical ICU still predictive of high mortality
    (Health and Medical Publishing Group (HMPG), 2009) Friedericksen, D. V.; Van der Merwe, L.; Hattingh, T. L.; Nel, D. G.; Moosa, M. R.
    Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes of renal failure or who developed renal failure following admission to the ICU. Results. Of 198 medical patients admitted to the ICU, ARF occurred in 46 (23.2%). The leading cause of ARF was acute tubular necrosis. The ICU mortality for ARF patients was 47.8%, compared with 17.5% in ICU patients without ARF. Acute haemodialysis was performed in only 17.3% of the 46 ARF patients. Using Cox proportional hazard regression, we found that mean duration of stay (p<0.001), acute physiology and chronic health evaluation II (Apache II) score (p<0.001), mechanical ventilation (p<0.01), dialysis (p<0.04) and multiorgan failure (p<0.05) affected survival time. Conclusions. We found that ARF is still associated with a high mortality rate and longer duration of stay, higher Apache II score, and need for mechanical ventilation; dialysis and presence of multi-organ failure were indicators of a higher mortality rate.
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    Cognitive changes in alcohol-induced psychotic disorder
    (BioMed Central, 2017-04) Hendricks, Melany L.; Emsley, R. A.; Nel, D. G.; Thornton, H. B.; Jordaan, G. P.
    ENGLISH SUMMARY : Aims: This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol ependence. Methods: Participants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital. Results: The groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking. Conclusion: This study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.
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    Determinants of serum 25-hydroxyvitamin D levels in healthy young adults living in the Western Cape, South Africa
    (South African Academy of Family Physicians, 2019-10-28) Visser, Janicke; Knight, K.; Philips, L.; Visser, W.; Wallace, M.; Nel, D. G.; Blaauw, Renee
    Background: Vitamin D deficiency is fast emerging as a global pandemic. In South Africa few studies have been conducted to determine the vitamin D status of the healthy population. Methods: This prospective study with an analytical component investigated vitamin D status of healthy undergraduate students at two time points (winter and summer) at Stellenbosch University. Serum 25(OH)D was determined, anthropometric measurements taken and dietary vitamin D intake estimated (food-frequency questionnaire). Skin tone was determined (Fitzpatrick skin type classification), and a skin reflectometry device used to measure dermal melanin content. Results: Results of 242 students indicated a mean serum 25(OH)D of 63.80 ± 41.35 ng/ml and a high prevalence of vitamin D sufficiency (88%). Significantly more females experienced suboptimal vitamin D levels than males (18 vs. 5%; p < 0.01). Participants with lighter skin tones had higher levels of 25(OH)D than those with darker skin tones (chi-square = 24.02; p = 0.02). The majority (60.74%) had a normal BMI, although there was no significant relationship between BMI and serum 25 (OH)D (Spearman’s r=–0.11; p = 0.09). Total mean dietary vitamin D intake was 7.99 ± 13.81 mcg, with 87.2% having inadequate intake (< 15 mcg). The relationship between total vitamin D intake and serum 25(OH)D was found to be significant in winter (p < 0.001) and summer (p = 0.01). Serum vitamin D levels were significantly higher in the winter phase (p < 0.001). Conclusions: A low prevalence of vitamin D deficiency was found amongst healthy young adults, despite low dietary vitamin D intakes. Significant relationships were found between serum 25(OH)D and gender, skin tone and vitamin D intake. Further studies need to be conducted, especially in high-risk groups, before results are applied to the greater South African public.
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    Evaluation of nutrition care to adult patients on HAART attending primary healthcare facilities in Mpumalanga
    (MedPharm Publications, 2019-03-06) Schiever, J. F.; Visser, Janicke; Van der Merwe, M.; Nel, D. G.
    Objectives: This study aimed to evaluate nutrition care and nursing professional knowledge received by adults on highly active antiretroviral therapy attending primary health care (PHC) facilities Design: Cross-sectional, descriptive study. Subjects and setting: The study was conducted on 263 adults and 75 nursing professionals, recruited from 19 facilities in the Mbombela sub-district, Mpumalanga. Outcome measures: Interviewer-administered questionnaires were completed for each patient. Nursing professionals completed a self-administered questionnaire. Assessment tools were completed for each facility. Results: Some 41% of patients were either overweight or obese, and most females (n = 87; 51.8%) had a BMI ≥ 25 kg/m2. Based on waist circumference, 52.7% (n = 88) of females and 8.4% (n = 8) of males showed increased risk of cardiovascular disease. Although nurses were aware of a nutrition supplementation programme, knowledge of national nutrition guidelines was inadequate. Clinical judgement, rather than eligibility criteria, was used to identify suitable patients, with 13.3% (n = 35) receiving supplementation whereas only 4.9% (n = 13) qualified. Facilities generally had sufficient equipment and fair storage conditions, but stock shortages of nutrition supplements were problematic. Conclusions: Whilst certain positive findings emerged, nutrition care could be improved, largely through adequate training and support to professional nurses. Training should focus on correct execution of assessment measurements and appropriate nutritional counselling, emphasising balanced eating, food security and prevention of over-nutrition. Nurses should be familiarised with national nutrition guidelines and have access to a constant nutrition supplementation supply. Improved monitoring and evaluation of nutrition care to adults on treatment at PHC facilities is needed.