Browsing by Author "Nyamande, Kennedy."

Now showing 1 - 5 of 5

Clinical profile of rheumatoid arthritis associated interstitial lung disease at a tertiary hospital in KwaZulu-Natal, South Africa: a retrospective 5 year review.
(2020) Ghammo, Hosam Mohamed.; Nyamande, Kennedy.; Mitha, Mohamed.
Background: The prevalence, demographic distribution and treatment outcomes in Rheumatoid Arthritis associated interstitial lung disease (RA-ILD) has not been well described in Southern Africa. There is very limited data. Objective: The aim of the study was to determine the demographic profile of the disease as well as treatments used and their outcomes at Inkosi Albert Luthuli Central Hospital (IALCH), a tertiary hospital in Durban, South Africa. Methods. This was a retrospective electronic chart review of 61 patients who were diagnosed with RA-ILD between January 2010 and December 2015 at IALCH pulmonology clinic. Demographic and clinical data, symptom presentation, pulmonary function testing (PFT), high resolution computerised tomography (HRCT) features and treatment modalities were analysed as well as outcome based on symptoms, PFT and HRCT. Results. There were 61 subjects, the majority being female (90.2%). Approximately 86.9% were 50 years and older. The majority of the subjects were Indian 72.1% (n=44), followed by Black Africans 23% (n=14) and then Whites 4.9% (n=3). All patients were HIV negative. Patients treated with a combination of prednisone and azathioprine had a decline in FVC (mean 0.41, p value 0.04). There was no improvements or deterioration in patients treated with either drug alone. Conclusion. The management of RA-ILD is still a challenge. The combination of azathioprine and prednisone did not arrest disease progression in our study while either agent alone did not improve clinical and lung function parameters. Large randomised control studies are needed in Sub-Saharan Africa.
Clinical profile of scleroderma associated interstitial lung disease at a tertiary hospital in KwaZulu-Natal, South Africa: a retrospective 7 years review.
(2021) Tanish, Salah.; Nyamande, Kennedy.; De Vasconcellos, Kim.
Background: Interstitial lung disease (ILD) is one of the most serious complications among patients with scleroderma. It is associated with significant morbidity and mortality. Little is known about the epidemiology of scleroderma-associated interstitial lung disease in sub-Saharan Africa. Thus, we aimed to determine the prevalence, clinical characteristics and outcomes of patients with scleroderma-ILD. Methods: A retrospective electronic chart review was conducted of patients with systemic sclerosis seen between January 2010 and December 2016 in the Departments of Pulmonology and Rheumatology at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Results: A total of 146 patients with systemic sclerosis (SSc) were seen during the study period. Fifty-five patients had systemic sclerosis-associated ILD, giving a prevalence of 37.7%. The median age was 51 (IQR 41-60) years, 87% of patients were female and 56% were of Indian descent. Dyspnoea was the presenting complaint in 47 (85.4%) patients, while 16 (29.1%) presented with cough. Antinuclear factor (ANA) was positive in 50 patients (90.9%), anti-Scl-70 antibodies were positive in 21 (38.2%). Thirty-seven patients (67.3%) received immunosuppressants, with 27 (49.1%) receiving cyclophosphamide as induction therapy, while 18 (32.7%) patients did not receive any specific therapy. Most patient symptoms remained static during the period of observation. Usual interstitial pneumonia (UIP) pattern was the most common radiological diagnosis. Follow-up computer tomography (CT) scans were available in 48 (87%) patients, with the majority of patients showing no significant radiological changes between their first and last CT scans. Follow-up lung function testing showed a statistically significant decrease in median forced vital capacity (FVC) of 0.09l (p=0.011). Overall 20 (36.4%) patients had a significant decline in FVC, while 7 (12.7%) had an improvement in FVC. Conclusion: ILD is common in systemic sclerosis, affecting 1 in 3 patients with systemic sclerosis in this cohort. Immunosuppressant treatment may arrest or retard the rate of decline in lung function.
Community acquired pneumonia in HIV and non-HIV infected patients presenting to a teaching hospital in KwaZulu-Natal : aetiology, distribution, and determinants of morbidity and mortality.
(2004) Nyamande, Kennedy.; Lalloo, Umesh Gangaram.
No abstract available.
An investigation into the clinical outcomes of women with peripartum cardiomyopathy at Klerksdorp/Tshepong Hospital Complex.
(2015) Sigauke, Farai Russell.; Nyamande, Kennedy.
Introduction: Peripartum Cardiomyopathy (PPCM) is defined on the basis of 4 criteria:  The development of cardiac failure in the last month of pregnancy and up to 5 months after delivery;  Absence of an identifiable cause of cardiac failure,  Absence of a recognizable structural heart disease prior to the last month of pregnancy;  And left ventricular dysfunction demonstrated by classic echocardiographic criteria, such as depressed fractional shortening <30% or ejection fraction <45% and left ventricular end diastolic dimension >2.7 cm/m2. The incidence of PPCM is not always known because population-based estimates are not available as data is primarily based on case series from single centres. In the USA it ranges from 1 per 3000 to 1 per 4000. Some studies conducted in South Africa showed an incidence of 100-300 per 100 000 live births. Aim of the study: The aim of the study was to investigate the factors which contribute to the clinical outcomes of peripartum cardiomyopathy (PPCM) at Klerksdorp/Tshepong Hospital Complex in Klerksdorp South Africa, by means of quantitative research. Methods: A single centre, non randomised, retrospective cohort, chart review together with prospective assessment of patient outcomes was done on 34 patients attending Specialist Medical Outpatient Department Clinic at Klerksdorp/Tshepong Hospital Complex from January 2011 to September 2014. The patients would have delivered between January 2011 and March 2014. Recruitment followed the inclusion and exclusion criteria based on the definition of peripartum cardiomyopathy. The patient files were reviewed at the time of diagnosis and at six months looking at the background history, therapy, clinical progression and outcome. The last assessment was done with the patient. Demographic data, obstetric and medical history, clinical progression measured by serial signs and symptoms were collected. Chest radiograph, electrocardiograph and echocardiograms were also registered and correlated to the clinical outcome. Findings: A total of 38 patients were recruited with a diagnosis of peripartum cardiomyopathy. Four patients were excluded from the study. Of the 34 patients who completed the study 47% recovered, whilst 26.5% remained stable and 26.5% progressively declined. Three patients, 8.8% died. Thromboembolic phenomena were noted in 20.6% of patients whilst 33.3% were on anticoagulants. The period prevalence was 0.33% (3 per thousand live births). The mean proportion in different clinical outcome groups was compared using Tukey’s Studentised Range (HSD) test for result. There was a significant difference in the mean proportions between the three groups (p=0.0001). In the pairwise comparisons, the mean proportion of the recovered group was significantly higher than that of the stable (p<0.05). There was no difference in the mean proportion of the recovered and deteriorated groups (p>0.05). All the patients received standard cardiac failure treatment. Discussion: The prevalence of PPCM at Klerksdorp/Tshepong Hospital Complex was higher than other parts of South Africa. The clinical outcome distribution from the study faired with the reported 50% recovery, 25% stable and 25% progressive deterioration. The patients received standard medical therapy. Low usage of anticoagulants could have attributed to the high rate of thromboembolic events. Device therapy is indicated in refractory heart failure if resources permit. It was recommended that a high-quality, large, multicenter prospective study be conducted to better understand the clinical outcomes of PPCM and its influencing factors. Conclusion: PPCM is a rare condition, multifactorial in origin with a good clinical outcome in the majority of cases if treated appropriately. It should be considered in any patient who presents with acute dyspnea in the perinatal period. Patients with PPCM are being optimally treated at Klerksdorp/Tshepong Hospital Complex. Anticoagulation is recommended in patients with low ejection fractions. Further, large progressive studies are required to fully understand the aetiology and the effect of novel therapies.
Local experience of patients with connective tissue associated interstitial lung disease who were treated with cyclophosphamide.
(2021) Singh, Swasti Gitesh.; Nyamande, Kennedy.; Mitha, Mohammed.
Introduction: Interstitial lung disease (ILD) is a major cause of death amongst individuals with connective tissue diseases (CTD). Although there is no cure for CTD-ILD the need to retard disease progression is vital, hence early detection and treatment is necessary. Cyclophosphamide (CYC) is a potent immunosuppressant that has efficacy in inducing and maintaining remission in autoimmune diseases. Objectives: The purpose of this study was to assess the clinical, radiological and pulmonary function responses of patients who received intravenous CYC for CTD-ILD at Inkosi Albert Luthuli Central Hospital (IALCH) in Durban, Kwa-Zulu Natal, South Africa over a ten year period from January 2009 to December 2018. Methodology: This was a retrospective electronic chart review conducted at IALCH, the main quaternary public sector hospital in the province of Kwa-Zulu Natal, South Africa. Patients 18 years and older with CTD-ILD treated with CYC were included. Patients were given CYC every 2 weeks for 9 months with a total of 18 doses. Demographic and clinical data, as well as data from special investigations, were captured from medical records. Treatment outcomes were assessed using symptoms, pulmonary function and HRCT changes. Results: There were 62 subjects, 88.7% being female with the majority between the ages of 40-59 years old (64.5%). Approximately 50% were black Africans followed by ethnic Indians at 43.5% and then Whites at 6.5%. Most patients had Systemic Sclerosis, followed by Mixed Connective Tissue disease and then Systemic Lupus Erythematosus. There was no significant difference in pre and post treatment, symptoms, lung function and HRCT in those who were treated with CYC. Conclusion: In our setting, the use of 18 doses of CYC every 2 weeks, did not have a significant impact on disease progression.