Browsing by Author "Nel, E. D."

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    An analysis of prognostic variables in acute lymphocytic leukaemia in a heterogenous South African population
    (1997) Wessels, G.; Hesseling, P. B.; Buurman, M.; Oud, C.; Nel, E. D.
    The records of all 96 children below the age of 15 years diagnosed with acute lymphoblastic leukaemia at Tygerberg Hospital in the Republic of South Africa between 1983 and 1995 were reviewed to determine risk factors which may predict poor outcome. Age < 2 and > 8 years, and white cell count > 20 x 109/l at diagnosis were significant predictors of poor outcome. Sex, FAB classification, immunophenotype, hepatomegaly, splenomegaly, BFM risk score, and the presence of mediastinal glands did not predict outcome. The presence of the established risk factors could not adequately explain the difference in 5-year event-free survival in the three ethnic groups which was 67 per cent in white, 17 per cent in black, and 38 per cent in children of mixed ethnic origin. In an attempt to improve survival in black children, our stratification of risk groups will in future be based on factors that include ethnicity, age and WCC ≤ 20 x 109/l at diagnosis. Pediatric oncology services in developing countries should adapt therapy to the risk factors of their local populations.
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    Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden
    (Health & Medical Publishing Group, 2013-08-30) Cooke, M. L.; Nel, E. D.; Cotton, M. F.
    Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described. Objectives. To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of diarrhoea. Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow, Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables were collected. Results. We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty–four (16.9%) were HIV-exposed, with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. Conclusions. Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, prehospital management and nutritional rehabilitation.
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    Problems related to cytomegalovirus infection and biliary atresia
    (Health and Medical Publishing Group (HMPG), 2012-11) Zabiegaj-Zwick, C.; Nel, E. D.; Moore, S. W.
    Background. Human cytomegalovirus (CMV) infection is related to biliary disease, being cholestatic in its own right. It has also been associated with intrahepatic bile duct destruction and duct paucity, indicating a possible role in the pathogenesis and progression of extrahepatic biliary atresia (BA). BA patients who are CMV-IgM-positive appear to have greater liver damage than uninfected patients, consequently affecting outcome. Methods. We reviewed the medical records of 74 patients diagnosed with hepatobiliary disease between 2000 and 2011, assessing clinical outcome and potential risk factors. Patients, categorised into those with and those without BA, were compared in terms of CMV infection. Results. The 74 patients included 39 (52%) BA and 35 non-BA patients; following the exclusion of patients due to insufficient data, 27 (69%) BA and 31 non-BA patients were reviewed. Twenty-one (78%) BA patients were CMV-positive (IgM/IgG), including 20 IgM-positive patients versus 8 in the non-BA group (p<0.01). Two (7.5%) CMV-IgM-positive BA infants were HIV-exposed versus 7 (35%) in the non-BA group (p<0.01). Long-term outcomes included 3 deaths in the non-HIV CMV-positive group and a higher rate of severe early liver damage, suggesting a poorer outcome in CMV affected patients. Conclusions. Our results suggest a correlation between CMV exposure/infection and BA which affects clinical outcome. HIV positivity does not preclude BA and should be investigated further.
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    TB or not TB? An evaluation of children with an incorrect initial diagnosis of pulmonary tuberculosis
    (Health & Medical Publishing Group, 1995) Gie, R. P.; Beyers, Nulda; Schaaf, H. Simon; Nel, E. D.; Smuts, N. A.; Van Zyl, S.; Donald, P. R.
    Object. The aim of the study was to identify diagnoses that are confused with pulmonary tuberculosis in children. Design. Prospective, investigative clinical study. Setting. Tertiary care teaching hospital and an urban tuberculosis clinic in an area with a very high incidence of pulmonary tuberculosis (> 800 new cases/100 000/year). Patients. Children suspected of having tuberculosis, children followed up for pulmonary infiltrates with eosinophilia and children with congenital pulmonary anomalies were investigated. Intervention(s), None. Outcome measure. Pulmonary tuberculosis was diagnosed using modified World Health Organisation criteria and the diagnoses of those children not suffering - from pulmonary tuberculosis were analysed. Results. Of the 354 children initially suspected of suffering from tuberculosis 71 (20%) were found to be suffering from other pulmonary disease, viz. pneumonia or bronchopneumonia (29%), bronchopneumonia with wheezing (18%), and asthma with lobar or segmental collapse (12%). Of 14 children suffering from pulmonary infiltrates with peripheral eosinophilia 6 (43%) were initially incorrectly diagnosed and treated for tuberculosis. Of 54 children with congenital pulmonary anomalies, 8 (15%) were treated for tuberculosis before the correct diagnosis was made. Congenital anomalies most often confused with tuberculosis were unilateral lung hypoplasia, bronchogenic cyst and tracheal bronchus with an; anomalous lobe. Conclusions. The criteria for diagnosing tuberculosis in children is complicated in areas with a high incidence of tuberculosis and poor socio-economic circumstances where many children presenting with conditions other than tuberculosis will be in contact with an adult case of pulmonary tuberculosis. The commonest conditions confused with tuberculosis are pneumonia, bronchopneumonia and asthma. Pulmonary infiltrates with peripheral eosinophilia and congenital lung abnormalities should be considered especially if the children have an atypical clinical picture or do not respond to tuberculosis treatment.
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    Viral Hepatitis in Children.
    (LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, USA, PA,19106-3621, 2012) Nel, E. D.; Sokol, R. J.; Comparcola, D.; Nobili, V.; Hardikar, W.; Gana, J. C.; Abarca, K.; Wu, J. F.; Chang, M. H.; Renner, J. K.