South African Medical Journal - latest Issue
Volumes & issues
Volume 106, Issue 10, 2016
Passing the baton to pharmacists and nurses : new models of antibiotic stewardship for South Africa? : guest editorialSource: South African Medical Journal 106, pp 947 –948 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11448More Less
The decrease in effectiveness of antibiotics due to their overuse and misuse, resulting in increasing bacterial resistance, is a public healthcrisis of international concern, threatening modern medicine, animal health and food security. The recent identification of two new plasmid-mediated genes (mcr-1 and mcr-2) that confer resistance to colistin, an antibiotic of last resort in the treatment of multi-drugresistant Gram-negative bacteria, underscores a crisis that it is estimated will cause 10 million deaths per annum by 2050, result in huge morbidity, and wipe out in excess of USD100 trillion from the world's economy. An international One Health response is required, co-ordinated at the highest level.
The future cost of cancer in South Africa : an interdisciplinary cost management strategy : guest editorialSource: South African Medical Journal 106, pp 949 –950 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11375More Less
The exponential rise in cancer costs in South Africa (SA) was illustrated in a recent Sunday Times article entitled 'The cost of cancer can be a debt sentence'. Our minister of health talks of a 'war' against the high costs of cancer drugs, and epidemiologists project a sharply rising incidence. Eminent international medical journals, such as The Lancet, underline the fact that cancer cost is a growing international problem that confronts even the richest countries. Indeed, the question may be posed: if richer countries in the world are battling to cover the costs of cancer, what is the prognosis for SA?
Source: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11220More Less
To the Editor: A valuable overview of cancer research in South African (SA) academic and research institutions during 2013 - 2014 has recently been published. The titles of 556 research projects were reviewed and divided into basic science, clinical and public health domains. These domains contained 46%, 54% and 13% of the projects, respectively. The projects could fit into more than one domain, resulting in a total of 113%.
South Africa's adoption of the World Health Organization's 'test and treat' guidelines : are we too ambitious? : correspondenceAuthor Kumeren GovenderSource: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11308More Less
To the Editor: Health minister Dr Aaron Motsoaledi has announced that South Africa will adopt the World Health Organization (WHO)'s new 'test and treat' guidelines from September 2016, enabling all patients living with HIV to be eligible for antiretroviral therapy (ART).
Biomedical research and capacity building : bilateral collaboration between research institutes in South Africa and Cameroon : correspondenceSource: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11365More Less
To the Editor: Collaboration is important in standardising research practice. We established a successful partnership between the Virology/Immunology Unit at the Centre for the Study and Control of Communicable Diseases, University of Yaoundé I, Cameroon, and the Division of Medical Virology, Stellenbosch University, South Africa (SA). Our research is focused on HIV, hepatitis, HPV and tuberculosis and on capacity building. We briefly highlight the challenges we have faced. The majority of African countries are classified as low- or middle income countries. Many African countries do not have the capacity to perform much-needed basic health research. Factors that hamper progress include lack of resources, limited knowledge and the absence of financial incentives, and have resulted in gaps in basic scientific knowledge. There is a strong need to strengthen African research and development. Health research on the continent has focused on HIV/AIDS, malaria and tuberculosis, as these are the communicable diseases with the highest health burden. There are many areas of neglected research that could be strengthened, given the necessary resources. The most substantial research for the continent has come from SA, Nigeria and Kenya, contributing more than 50% of health publications. Collaboration has the potential to strengthen research capacity. African research institutions, however, do not collaborate with each other, but seek partnerships with the USA or Europe, in order to secure funding and insure high-quality outputs. Our study involves an African-African collaboration (middle to low income).
Alpha-thalassaemia trait as a cause of unexplained microcytosis in a South African population : correspondenceAuthor A.R. BirdSource: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11134More Less
To the Editor: I read the article by Loonat et al. with interest. In the early 1980s a study was undertaken at Red Cross War Memorial Children's Hospital, Cape Town, South Africa (SA), to assess the frequency with which a low red cell mean corpuscular volume (MCV) was associated with the presence of thalassaemia or an abnormal haemoglobin. Between January 1979 and December 1980, 730 patients with an MCV of ≤60 were investigated. Forty-six (6.4%) were found to carry a η-thalassaemia gene and 20 (2.7%) had an abnormal haemoglobin, most commonly Hb E. The prevalence of thalassaemia was highest in individuals of mixed ethnic origin, and abnormal haemoglobins were found exclusively in this population, although the numbers of white and black patients were much smaller in comparison. Alpha-thalassaemia was not tested for, as the technology was unavailable at the time owing to cost constraints. Nevertheless the findings confirmed that patients with persistent unexplained microcytosis/hypochromia should be screened for thalassaemia and haemoglobin variants.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11254More Less
To the Editor: When working in private practice, we all come across questions we are curious to explore, but clinical research has long been viewed as the domain of tertiary medical institutions, or so-called ivory towers. Research does not need to be relegated to academics alone, as integrating clinical research within private practice can be intellectually stimulating and rewarding on many levels. As research funding and grants become increasingly scarce, there will be an increasing need for private practitioners to participate in clinical research, both in cohort studies and in the further testing and development of new therapies.The purpose of this letter is to encourage colleagues in the private sector to participate in clinical research, which can transform the way they practise; however, the demands of doing research should not be underestimated. Those of us who work in the private sector see our main priority as the care and treatment of our patients, so we have significant time constraints with regard to conducting research. The simplest way to get started in clinical research is to look at your own practice and think of a difficult or interesting clinical conundrum that you would like to answer. This could be as simple as analysing data on your patients' outcomes or their pathways to care. The outcomes range from simple yet important events such as relapse or hospitalisations to more complex phenomena such as quality of life. In fact, you may already be collecting these data on your patients during routine clinical practice in order to improve the quality of your service.
Source: South African Medical Journal 106, pp 956 –958 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11435More Less
Strange things happen at election time. Patient care and doctor support can come a very poor second to tub-thumping and vote-collecting - that's if the stories of two hospital CEOs with impeccable and impressive track records, highly respected among their rural peers, can be believed. Weird as it may seem, this year's Rural Doctors of South Africa (RuDASA) Lifetime Achiever Award recipient Dr Victor Fredlund, age 60, CEO of Mseleni Hospital, spent nearly 4 months at home on officially enforced leave (until this July). Aspirant local political candidates and unions led a charge against his withdrawal of job offers from two cleaners and his firing of a third. Head office bureaucrats insisted that the removal of the veteran stalwart from the far northern KwaZulu- Natal (KZN) hospital was 'for his own safety', bickering, fudging and stalling way after any perceived threat to him had evaporated. Then, seemingly at a loss over how to justify his lengthy absence, they charged him in August - for doing exactly what they'd advised him to do.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11436More Less
From celebrating the work of a rare rural audiologist to lauding the selfless lifetime achievements of a veteran community change-agent, the Rural Doctors' Association of South Africa (RuDASA) awards at its 20th annual conference in Grahamstown on 8 August showcased vocation-driven talent. A near-gold-standard audiology service set up over the past 3 years at the remote but historically award-winning Eastern Cape Zithulele Hospital won the Rural Rehabilitation Worker of the Year for University of KwaZulu-Natal audiology graduate Lineo Lecheko. Enhancing Zithulele's multidisciplinary approach, Lecheko's screening of multidrug-resistant tuberculosis patients has led to vastly improved local hearing outcomes. Patients newly fitted with hearing aids (rare in rural areas) regularly travel long distances just to bring homegrown gifts to thank her for helping transform their worlds. Her initial impact drew the attention of the provincial treasury, which boosted her work with more than ZAR1 million of audiology equipment and facilitated the placement of an audiology community service assistant.
Source: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11437More Less
Rehabilitation healthcare professionals starting out in a rural hospital need to socialise with and educate clinicians, develop community networks and support groups and build referral systems, if they want to be effective and get to grips with a resource-scarce environment.
Author Kate JoynerSource: South African Medical Journal 106 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11460More Less
On 27 May 2016, the 69th World Health Assembly endorsed the global plan of action to strengthen the role of health systems within a national multisectoral response to address interpersonal violence, especially against women and children. This landmark plan was adopted with a resolution (EB 138.R3) co-sponsored by 44 member states. It will promote the achievement of the Sustainable Development Goals, including historic Goal 5 (achieve gender equality and empower all women and girls), Goal 16 (promote peace, justice and inclusive societies) and Goal 3 (ensure healthy lives and promote well-being for all at all ages). These initiatives coalesce with,and will add to, attaining the objectives of the new Global Strategy for Women's, Children's, and Adolescents' Health.
Intimate partner violence is everyone's problem, but how should we approach it in a clinical setting? : CMEAuthor C. GordonSource: South African Medical Journal 106, pp 962 –965 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11408More Less
Intimate partner violence (IPV) is a silent public health epidemic in South Africa (SA). Interpersonal violence in SA is the second highest burden of disease after HIV/AIDS, and for women 62% of the former is ascribed to IPV. SA, therefore, has the highest reported intimate femicide rate in the world. IPV has far-reaching consequences, stretching across generations. The cost to the economy and burden on health services are considerable. IPV presents in many ways, cutting across all medical disciplines. Therefore, all medical professionals should be conversant with this issue. This article provides essential, practical steps required for identifying and managing IPV, applicable to any setting. These steps are summarised as six Rs: Realise that abuse is happening (be aware of cues); Recognise and acknowledge the patient's concerns; Relevant clinical assessment; Risk assessment; cRisis plan; and Refer as needed for medical, social, psychological and/or legal assistance.
Author C. LopesSource: South African Medical Journal 106, pp 966 –968 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11409More Less
Violence against women is a significant problem that profoundly affects the physical and mental well-being of those affected. While medicolegal interventions in South Africa have been firmly established to respond to sexual offences, no formal protocols on intimate partner violence interventions at primary healthcare level are in place yet. In support of recent policy recommendations for the development of a combined health and social sector system response to intimate partner violence, this article provides health professionals with insight into domestic violence and current legal and psychosocial support services. It focuses on how to support and advise abused women about practicalities of obtaining protection orders and accessing shelter services.
Source: South African Medical Journal 106, pp 969 –972 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11410More Less
Intimate partner violence (IPV) and HIV are intersecting epidemics in South Africa (SA). Despite recognition that IPV and HIV are bidirectionally linked, less attention has been given to mental health - a key health condition that is at the nexus of both violence and HIV/AIDS. While SA healthcare professionals have made great strides in treating HIV, the corresponding conditions of IPV and mental health receive far less clinical care. Treating mental health has the potential to positively effect HIV care and treatment, but is also a powerful gateway to enhanced comprehensive health in patients. Improving skills in managing the mental health of patients will lead to better health for them and quality of life for affected families. It can also assist health systems to deal more effectively with complex cases that so rarely achieve positive health outcomes.
'Esprit de corps' : towards collaborative integration of pharmacists and nurses into antimicrobial stewardship programmes in South Africa : clinical updateSource: South African Medical Journal 106, pp 973 –974 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11468More Less
With the global threat of antimicrobial resistance now more emergent than ever, there should be wider collaboration between members of the multidisciplinary healthcare team. This article proposes possible ways of engagement between the pharmacist, nurse and doctor. The pharmacist and nurse are placed in an ideal position through united efforts (camaraderie) to redirect healthcare towards improved patient outcomes while also reducing antimicrobial resistance.
Molecular detection of carbapenemase-producing genes in referral Enterobacteriaceae in South Africa : a short report : clinical updateSource: South African Medical Journal 106, pp 975 –977 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11300More Less
Molecular confirmation of carbapenemase-producing Enterobacteriaceae (CPE) was introduced in South Africa (SA) at the end of 2011. We report on the detection of these resistance genes based on referral isolates. Enterobacteriaceae with non-susceptibility to any of the carbapenems according to defined criteria for antimicrobial susceptibility testing results were sent to a reference laboratory. A proportion of isolates had limited demographic, epidemiological and clinical data available. Organism identification was reconfirmed using reference laboratory methods, and the presence of carbapenemases was confirmed with a real-time polymerase chain reaction. We analysed 1 503 significant isolates received for confirmation from the National Health Laboratory Service and some private laboratories during 2012 - 2015 and confirmed one or more carbapenemase-producing genes in 68% of isolates, the most common organism being Klebsiella pneumoniae (60%). The most common carbapenemase genes were blaNDM, followed by blaOXA-48 and its variants. BlaOXA-48 and its variants demonstrated non-susceptibility to ertapenem in 89% of the isolates when analysed by the phenotypic method, and to ceftazidime in 34%. Overall, the detection rate for carbapenemases in K. pneumoniae blood isolates in the public sector was 1.9% during the 4-year period. This report indicates the presence of CPE in SA, and it is important for all healthcare workers to be aware of this major public health threat so that infection prevention and control measures can be implemented to prevent the spread of CPE in healthcare facilities.
Source: South African Medical Journal 106, pp 978 –980 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11172More Less
Clinical alert - cost considerations in determining the affordability of adjuvant trastuzumab in breast cancer : in practiceSource: South African Medical Journal 106, pp 981 –982 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11141More Less
The drug cost of adjuvant trastuzumab to benefit one patient with localised human epidermal growth factor receptor 2 (HER2)-positive breast cancer depends on the baseline survival rate (BLSR) of the prognostic group of the patient. This varies from ZAR13 752 900 (BLSR 90%) to ZAR4 006 100 (BLSR 60%). All treated patients are exposed to potential toxicity. The value and affordability of treatments need to be considered, as there are finite resources available in our healthcare system. All patients must have access to cost-effective treatments. However, patient selection for expensive treatments is important, as expenditure on patients where the gains are relatively small will result in resources not being available for other patients. The state, healthcare institutions and the pharmaceutical industry need to work together to optimise the benefits of treatment to patients.
Medicine and the law - sudden and unexpected childhood deaths investigated at the Pretoria Medico-Legal Laboratory, South Africa, 2007 - 2011 : in practiceSource: South African Medical Journal 106, pp 983 –985 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11028More Less
Background. Sudden and unexpected death is well known to occur in infants, and although sudden deaths are less frequent after the first birthday, they still account for a significant proportion of childhood deaths. In 2009, 1.9% of the total deaths in the USA were childhood deaths. In South Africa (SA) this proportion was much higher at 11.85%. According to the law, sudden and unexpected deaths are generally investigated as unnatural deaths. Establishing an exact underlying anatomical cause of death will depend on available resources and can be difficult in a substantial proportion of cases.
Methods. A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory (PMLL), SA, from 1 January 2007through to 31 December 2011. All children aged 1 - 18 years who died suddenly and unexpectedly were included.
Results. Ninety-eight cases were identified, which constituted nearly 1% of total admissions to the PMLL. The majority of the deaths were of children aged 1 - 5 years, and the male/female ratio was 1.04:1. In the largest proportion of cases (n=28, 28.6%), the medicolegal investigation, including autopsy and ancillary investigations, did not establish an underlying anatomical cause of death. In the cases where a cause of death was established, pneumonia was the most common diagnosis (n=22, 22.4%).
Conclusions. The fact that the cause of the largest proportion of deaths could not be ascertained emphasises the need for consideration of additional investigative techniques, such as molecular/genetic screening, which have provided an underlying cause of death in a significant number of cases in other countries. There is a lack of published research on the causes and incidence of sudden unexpected deaths in children in SA, and further research in this area is needed.
Case report - HIV/AIDS-associated Kaposi's sarcoma of the gastrointestinal tract : a pictorial spectrum : in practiceSource: South African Medical Journal 106, pp 986 –987 (2016) http://dx.doi.org/http://dx.doi.org/10.7196/SAMJ.2016.v106i10.11277More Less