Browsing by Author "Van Zyl-Smit, Richard"

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    Obstructive pulmonary disease in patients with previous tuberculosis : pathophysiology of a community-based cohort
    (Health & Medical Publishing Group, 2017) Allwood, Brian W.; Gillespie, Rencia; Galperin-Aizenberg, Maya; Bateman, Mary; Olckers, Helena; Taborda-Barata, Luis; Calligaro, Gregory L.; Said-Hartley, Qonita; Van Zyl-Smit, Richard; Cooper, Christopher B.; Van Rikxoort, Eva; Goldin, Jonathan; Beyers, Nulda; Bateman, Eric D.
    Background. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmed in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype. Objective. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence of previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB. Methods. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied. Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (<–950 HU), gas trapping (<–860 HU) and fibrosis (>–200 HU). Findings in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features. Results. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=–17.7%; p=0.001) and inspiratory capacity (Δ=–21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively). Conclusions. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study.
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    Priority areas for cannabis and cannabinoid product research in South Africa
    (AOSIS, 2018-06) Augustine, Tanya N.; Cairns, Carel J.; Chetty, Sean; Dannatt, Lisa G.; Gravett, Nadine; Grey, Glenda; Grobler, Gerhard; Jafta, Zukiswa; Kamerman, Peter; Lopes, John; Matsabisa, Motlalepula G.; Mugabo, Pierre; Mulder, Michelle; Parry, Charles; Rataemane, Solomon; Siegfried, Nandi; Steenkamp, Vanessa; Thomas, Eileen; Van Zyl-Smit, Richard
    The legalisation of cannabis for medicinal use is a contentious space both politically and in the medical community. In 2014, the Medical Innovation Bill introduced by Mario Oriani-Ambrosini MP, aimed to shift the political and legal positions of cannabis as an illegal substance to one available for research and medical use. To date, progress on this has been slow. Cannabis and cannabinoid products are currently available for medicinal use in several countries, including the Netherlands and 29 states in the United States. Locally, anecdotal reports suggest that many of our patients with chronic medical conditions are using cannabis and cannabis-derived or cannabinoid products for symptom alleviation.