George Mwamnemo Nyale1, Ronald Anderson1, Atulkumar Ramanlal Patel1, Charles Feldman1. 1. 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
BACKGROUND: There are few studies that have documented the clinical presentation, complication rate and outcome of cardiothoracic referrals from a Pulmonology Service, particularly in developing countries. Furthermore, the impact of human immunodeficiency virus (HIV) status on such referrals and their outcomes is not well documented. METHODS: This was a retrospective audit of combined pulmonologist/cardiothoracic consultations, undertaken among the tertiary academic hospitals attached to the University of the Witwatersrand, Johannesburg, South Africa, over a 10 years period (2001-2010) in order to document the clinical features of these referrals and to determine any impact of HIV status on trends in disease presentations, complications and outcome. RESULTS: A total of 847 patients were evaluated on whom a variety of surgical procedures was performed, 50.4% being therapeutic, 32.8% diagnostic and 16.9% both therapeutic and diagnostic. HIV status was known in 488 cases. Of these 229 (46.9%) were HIV-seropositive and 259 (53.1%) -seronegative. The main reasons for referral were for infective conditions, including tuberculosis (TB), pleural disease/effusion/empyema, and other bacterial infections, with significantly more of the TB patients being HIV-seropositive (P<0.0001).There was a trend for increasing presentations for TB and pleural conditions, particularly during the last 4-5 years of the audit, coinciding with an increase in the numbers of HIV-positive referrals. HIV status had no impact on the frequency of surgical complications or mortality. CONCLUSIONS: The audit indicates an increasing referral rate of HIV-seropositive patients to cardiothoracic services in Johannesburg, particularly in association with TB and pleural diseases. However with careful cardiothoracic/pulmonologist evaluation of the cases the frequency of complications and mortality appear to be no different from that of HIV-seronegative cases.
BACKGROUND: There are few studies that have documented the clinical presentation, complication rate and outcome of cardiothoracic referrals from a Pulmonology Service, particularly in developing countries. Furthermore, the impact of human immunodeficiency virus (HIV) status on such referrals and their outcomes is not well documented. METHODS: This was a retrospective audit of combined pulmonologist/cardiothoracic consultations, undertaken among the tertiary academic hospitals attached to the University of the Witwatersrand, Johannesburg, South Africa, over a 10 years period (2001-2010) in order to document the clinical features of these referrals and to determine any impact of HIV status on trends in disease presentations, complications and outcome. RESULTS: A total of 847 patients were evaluated on whom a variety of surgical procedures was performed, 50.4% being therapeutic, 32.8% diagnostic and 16.9% both therapeutic and diagnostic. HIV status was known in 488 cases. Of these 229 (46.9%) were HIV-seropositive and 259 (53.1%) -seronegative. The main reasons for referral were for infective conditions, including tuberculosis (TB), pleural disease/effusion/empyema, and other bacterial infections, with significantly more of the TB patients being HIV-seropositive (P<0.0001).There was a trend for increasing presentations for TB and pleural conditions, particularly during the last 4-5 years of the audit, coinciding with an increase in the numbers of HIV-positive referrals. HIV status had no impact on the frequency of surgical complications or mortality. CONCLUSIONS: The audit indicates an increasing referral rate of HIV-seropositivepatients to cardiothoracic services in Johannesburg, particularly in association with TB and pleural diseases. However with careful cardiothoracic/pulmonologist evaluation of the cases the frequency of complications and mortality appear to be no different from that of HIV-seronegative cases.
Authors: T B Ferguson; S W Dziuban; F H Edwards; M C Eiken; A L Shroyer; P C Pairolero; R P Anderson; F L Grover Journal: Ann Thorac Surg Date: 2000-03 Impact factor: 4.330
Authors: A Laurie W Shroyer; Laura P Coombs; Eric D Peterson; Mary C Eiken; Elizabeth R DeLong; Anita Chen; T Bruce Ferguson; Frederick L Grover; Fred H Edwards Journal: Ann Thorac Surg Date: 2003-06 Impact factor: 4.330
Authors: Rachel C Numan; Houke M Klomp; Wilson Li; Dick R Buitelaar; Jacobus A Burgers; Johanna W Van Sandick; Michel W Wouters Journal: Lung Cancer Date: 2012-09-20 Impact factor: 5.705