South African Medical Journal - latest Issue
Volumes & issues
Volume 107, Issue 3, Mar 2017
Improving our understanding of antibiotic resistance : the relevance of surveillance at the population levelSource: South African Medical Journal 107, pp 167 –167 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12357More Less
Bacterial infections are primarily treated with antibiotics. However, bacteria develop mechanisms enabling them to thrive in the presence of therapeutic doses of antibiotics, leading to antibiotic resistance, and to broad antibiotic resistance when a bacterium is not susceptible to more than one class of antibiotics.
Source: South African Medical Journal 107, pp 168 –169 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12344More Less
The Second National Burden of Disease Study has confronted the data-quality issues associated with vital registration of cause of death and derived updated estimates of the levels and causes of mortality for 1997 - 2012 for 140 specific causes, 23 categories and four broad cause groups. Estimates have been produced by age, sex, province and population group, providing unparalleled information about disease trends and health disparities in the country.
Reliable systematic review of low-carbohydrate diets shows similar weight-loss effects compared with balanced diets and no cardiovascular risk benefits : response to methodological criticismsSource: South African Medical Journal 107, pp 170 –170 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12382More Less
Author J. BovijnSource: South African Medical Journal 107, pp 171 –171 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12292More Less
Chronic kidney disease (CKD) remains a poorly recognised and ill-managed clinical entity. I reflect on three recent patient encounters at primary care level, hoping that these vignettes will serve to improve our clinical care of patients with, and at risk of developing, CKD.
Patients in whom surgical closure of terminal branches of external carotid arteries for migraine treatment resulted in reduced frequency of epileptic attacksAuthor Iraj DerakhshanSource: South African Medical Journal 107, pp 172 –172 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12280More Less
I read the recent case report by Shevel with regard to three cases of migralepsy with great interest. The author described postoperative improvement in migraine after surgical bilateral closure of terminal branches of external carotid arteries, which in every case was associated with marked reduction in occurrences of epilepsy in the same patients.
Source: South African Medical Journal 107, pp 173 –174 (Mar 2017)More Less
Keep mentally active to prevent cognitive decline
No obesity risk among children of pregnant women with a high BMI
No difference in outcomes with partial meniscectomy for traumatic or degenerative meniscal tears
Assisted partner services in Kenya increase HIV testing and case-finding
Little point in taking NSAIDs for back pain
Author J.P. de V. van NiekerkSource: South African Medical Journal 107, pp 175 –175 (Mar 2017)More Less
Dr James Barry, on dying, was discovered to be a woman. The transformation of the young woman, Margaret Bulkely, into a man – a disguise that she was able to maintain throughout her long and eventful medical career – was uncovered by Michael du Preez and first published in the SAMJ.
Carpe diem (‘Seize the day’) : building on the findings of the 2015 World Health Organization evaluation of the multidrugresistant tuberculosis (MDR-TB) programme to make the most of shortened MDR-TB treatment in South AfricaSource: South African Medical Journal 107, pp 176 –177 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12203More Less
South Africa (SA) has a high burden of multidrug-resistant tuberculosis (MDR-TB), i.e. TB resistant to isoniazid and rifampicin, the most effective TB drugs. The current MDR-TB regimen requires the use of multiple, toxic, poorly efficacious and expensive secondline drugs for 18 - 24 months. As a consequence of the often severe side-effects and lengthy unpleasant treatment, adherence is poor and failure to complete treatment common. Overall, treatment is successful in only half the patients treated.
Author T. PollockSource: South African Medical Journal 107, pp 178 –179 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12388More Less
Retinopathy of prematurity (ROP) is a growing problem in South Africa (SA), as it is in many parts of the developing world. The so-called ‘third epidemic’ of ROP is caused by a combination of high preterm birth rates, relatively good infant survival and inadequate oxygen monitoring in neonatal facilities. Increasing ROP incidence (due to these factors) has been identified particularly in Latin America and Eastern Europe. SA is generally accepted as having similar challenges in the care of preterm neonates, both in the private and public sectors.
Source: South African Medical Journal 107, pp 180 –181 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12251More Less
A discussion at an Ethics Alive symposium raised the issue of a commission for human responsibilities. Human rights are constantly discussed in South Africa (SA). However, the focus is often on rights, while little attention is paid to corresponding duties and responsibilities.
Source: South African Medical Journal 107, pp 182 –182 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12364More Less
Trauma has always accompanied humankind, but has only been recognised as a significant health issue for the last half a century. In South Africa (SA), the burden of trauma has been described as unprecedented, with an estimated 3.5 million people seeking healthcare for non-fatal injuries annually. Children, representing an estimated 40% of the SA population, are a vulnerable group. The impact of childhood trauma, whether intentional (through interpersonal violence, homicide or suicide) or unintentional (especially through road traffic crashes, drowning, burns, poisoning or falls), has become a major health and social problem. Childhood injuries may impact hugely on childhood health in terms of disability and, depending on their cause, circumstances and severity, and have grim psychological, educational, social and economic consequences.
Source: South African Medical Journal 107, pp 183 –187 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12365More Less
Accidental caustic and foreign body ingestion by young children lead to a high number of emergency department visits, especially in lower- and middle-income countries. Some of these cause minimal tissue injury or pass spontaneously and uneventfully through the gastrointestinal tract; others may cause major morbidity, or rarely mortality. Increased primary prevention of ingestion through community awareness and vigilant childcare in addition to legislative steps to ensure a safe environment for these vulnerable members of society are needed. Secondary prevention of long-term sequelae through timely and appropriate assessment and referral for endoscopy, laparotomy or other treatments can limit morbidity where primary prevention fails. Basic guidelines for management principles are suggested. Social lobby is required to further reform commercial risks to children in addition to creating caregiver awareness of common environmental hazards, particularly in developing countries such as South Africa.
Schoolbus driver performance can be improved with driver training, safety incentivisation, and vehicle roadworthy modificationsSource: South African Medical Journal 107, pp 188 –191 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12363More Less
In South Africa (SA), the school transport industry provides millions of children with a means of travelling to and from school. The industry has, however, been reported to be plagued by widespread safety concerns. The consequent road traffic incidents have often been attributed to driver factors, including driving in excess of legal speeds or at inappropriate speeds; driving while under the influence of alcohol, while sleepy or fatigued; or driving without using protective equipment for vehicle occupants. There are currently very few SA interventions that specifically target this important industry role-player. The Safe Travel to School Programme was recently implemented by a national child safety agency, with a focus on driver road safety awareness, defensive driver training, eye-testing, vehicle roadworthy inspections with selected upgrades, incentives for safe performance, and implementation of a vehicle telematics tracking system with regular, individual driving behaviour information updates. This quasi-experimental study offers an evaluation of the initial impact on safety performance of this telematics-based driver and vehicle safety intervention in terms of speeding, acceleration, braking, cornering, and time-of-day driving, and compares the school transport driver performance with that of general motorists. Despite concerns that some school transport vehicles are used for multiple purposes outside of school transport duties, at night, and for longer distances, overall these vehicles recorded lower percentages of speeding, lower harsh braking, and lower average harsh cornering and acceleration than general drivers.
Source: South African Medical Journal 107, pp 192 –195 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12035More Less
Healthcare-associated infection (HAI) is a frequent and serious complication affecting 4 - 8% of hospitalised children and neonates in high-income countries. The burden of HAI in South African (SA) paediatric and neonatal wards is substantial but underappreciated, owing to a lack of HAI surveillance and reporting. Maternal and child health and infection prevention are priority areas for healthcare quality improvement in the National Core Standards programme. Despite increasing recognition in SA, infection prevention efforts targeting hospitalised children and neonates are hampered by health system, institutional and individual patient factors. To ensure safe healthcare delivery to children, a co-ordinated HAI prevention strategy should promote development of infection prevention norms and policies, education, patient safety advocacy, healthcare infrastructure, surveillance and research. We present a framework for SA to develop and expand HAI prevention in hospitalised neonates and children.
Source: South African Medical Journal 107, pp 196 –198 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12062More Less
The debate over whether there should be a property or non-property approach with regard to human tissue is only the tip of the iceberg, because the issues involved are very complex, reflecting profound considerations on the nature of the self and the structuring of society; the balance of power between the citizen, the government and commercial interests; and human beings’ perceptions of themselves and their bodies. This article responds to a publication by Donrich Jordaan titled ‘Social justice and research using human biological material: A response to Mahomed, Nöthling-Slabbert and Pepper’ in the July 2016 SAMJ. The original article to which Jordaan’s critique refers and that provides the source for his response appeared in the South African Journal of Bioethics and Law in 2013, titled ‘The legal position on the classification of human tissue in South Africa: Can tissues be owned?’. It is our contention that Jordaan’s critique is based on a misinterpretation of the issues raised relating to the ownership of human tissue, an issue extensively debated in the academic sphere for many years. Jordaan’s critique focuses on selected aspects of the original article and draws unjustifiable inferences from these. The purpose of this article is to contextualise Jordaan’s critique and reaffirm the validity of the arguments made in the original article in 2013. There are, however, certain aspects of Jordaan’s critique that we as authors of the original article acknowledge and appreciate in the spirit of academic discourse.
Author D.W. JordaanSource: South African Medical Journal 107, pp 199 –200 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12337More Less
In their original article on the subject of research using human biological material, Mahomed, Nöthling-Slabbert and Pepper advanced the notion that the law regarding ownership of human biological material is uncertain, and proposed that our country’s healthcare policy of altruism be changed to mandatory profit-sharing by research participants. In my critique article, I took issue with the notion that the relevant law is uncertain, and suggested that Mahomed et al. failed to present a convincing argument in support of the proposed policy change from altruism to profit-sharing. In their response to my critique article, Mahomed et al. persist with the notion that the relevant law is uncertain; I suggest that this notion is erroneous, as our common law in this regard is well established, and as the authors base their argument exclusively on foreign case law. The authors further fail to make use of the opportunity to augment their argument in support of their proposed policy change from altruism to profit-sharing – in fact, they contradict themselves by disavowing their proposed policy change.
A review of patients with glutaric aciduria type 1 at Inkosi Albert Luthuli Central Hospital, Durban, South AfricaSource: South African Medical Journal 107, pp 201 –204 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.11332More Less
Glutaric aciduria type 1 (GA1) is an organic acidaemia. The objective of this study was to describe the profile of patients diagnosed with GA1 at Inkosi Albert Luthuli Central Hospital, Durban, South Africa from 2007 to 2015. We identified 6 children (4 girls, 2 boys) in a retrospective review. The mean age at diagnosis was 12 months. Clinical findings on presentation were encephalopathic crises (n=4), hypotonia (n=4) and macrocephaly (n=5). Other complications included seizures (n=4), dystonia (n=3) and bulbar dysfunction (n=4). Urine organic acid screens showed elevated glutaric acid levels (n=6). Five patients tested positive for the A293T mutation on the glutarylco-enzyme A (CoA) dehydrogenase gene. Abnormalities on magnetic resonance imaging screening included hyperintense basal ganglia (n=6), widened perisylvian fissures (n=6), and an abnormal signal in the cerebral peduncles (n=5) and central tegmental tract (n=4). All patients were treated with L-carnitine and dietary modification. Two patients had a static clinical course, 1 patient gained milestones, and 3 have shown further neuroregression.
Antibiotic resistance patterns and beta-lactamase identification in Escherichia coli isolated from young children in rural Limpopo Province, South Africa : the MAL-ED cohortSource: South African Medical Journal 107, pp 205 –214 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.12111More Less
Background. Antibiotic resistance is a growing problem worldwide. Mechanisms of resistance vary, and some can confer resistance to multiple classes of antibiotics.
Objective. To characterise the antibiotic resistance profiles of Escherichia coli isolates obtained from stool samples of young rural children exposed or unexposed to antibiotics.
Methodology. The samples were collected from children aged 4 - 12 months who were participants in the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) project at the South Africa research site. We isolated 87 E. coli samples (clones) from 65 individual participants, all of which were subjected to disc diffusion assay to determine resistance. We characterised the minimum inhibitory concentration of antibiotics in a subset of strains as well as the mechanism by which these strains were resistant to beta-lactam antibiotics.
Results. Our results revealed high resistance rates to co-trimoxazole (54.0%), penicillin (47.1%) and tetracycline (44.8%) in our isolates, and indicated that the beta-lactamase TEM-1 is a prevalent source of beta-lactam resistance. We also identified two isolates with the extended-spectrum beta-lactamase CTX-M-14.
Conclusions. This study identified antibiotic-resistant E. coli in children with and without prior exposure to antibiotics, with some isolates showing resistance to multiple classes of antibiotics. Clinicians should bear in mind that transmission of extended-spectrum betalactamase-resistant E. coli exists at the community level, and that children as young as 2 years may be harbouring these resistant phenotypes.
The efficacy of intravitreal antivascular endothelial growth factor as primary treatment of retinopathy of prematurity : experience from a tertiary hospitalSource: South African Medical Journal 107, pp 215 –218 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.11080More Less
Background. Retinopathy of prematurity (ROP) is a vasoproliferative disease affecting premature babies and a major cause of blindness in childhood. Appropriate screening and treatment can prevent blindness.
Objective. To report on the efficacy of using antivascular endothelial growth factor (bevacizumab) as first-line therapy in ROP.
Methods. This was a retrospective analysis of patients with ROP treated at St John Eye Hospital, Johannesburg, South Africa, over a 3-year period. Outcome measures were the clinical response to intravitreal bevacizumab (IVB) as well as the economic impact of IVB therapy.
Results. Twenty-three patients were treated for active ROP or type 1 disease, in 44 eyes. Two patients required treatment in one eye only. The mean birth weight of these patients was 1 074 g (range 810 - 1 480). Response to treatment outcome was available for 22 patients (43 eyes). The mean follow-up period was 9 months (range 1 - 18). Forty-one eyes (95.3%) showed complete regression or non-progression of the disease. Two eyes (one eye each in two patients) progressed to advanced disease. There were no short-term adverse events. A cost-effective model showed that IVB treatment was much more economical than laser therapy.
Conclusion. IVB is a safe and effective first-line treatment for ROP and should be considered in resource-limited centres.
Trends in admissions, morbidity and outcomes at Red Cross War Memorial Children’s Hospital, Cape Town, 2004 - 2013Source: South African Medical Journal 107, pp 219 –226 (Mar 2017) http://dx.doi.org/10.7196/SAMJ.2017.v107i3.11364More Less
Background. Routinely collected patient information has the potential to yield valuable information about health systems and population health, but there have been few comprehensive analyses of paediatric admissions at South African (SA) hospitals.
Objectives. To investigate trends in hospitalisation and outcomes at Red Cross War Memorial Children’s Hospital (RCWMCH), a major referral hospital for children in the Western Cape and SA.
Methods. Using routinely collected observational health data from the hospital informatics system, we investigated admissions between 2004 and 2013. Clinical classification software was used to group International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes to rank causes during 2008 - 2013, when ICD-10 codes were widely available. Analyses examined trends in medical and surgical admissions over time.
Results. There were 215 536 admissions over 10 years of 129 733 patients. Admissions increased by 9.3%, with increases in the general medical wards (5%), medical specialty wards (74%), the burns unit (73%), and the intensive care unit (16%). In contrast, admissions decreased in the trauma unit (21%) and short-stay medical wards (1%). In-hospital mortality decreased by 54% (p-trend <0.001) over 10 years. Diarrhoea and lower-respiratory tract illness were the most common causes for medical admissions, although admissions and deaths due to these conditions decreased between 2008 and 2013, which coincided with the national introduction of related vaccines. Similarly, tuberculosis admissions and deaths decreased over this period. These trends could be owing to a concurrent decrease in HIV comorbidity (p-trend <0.001). Trauma was the most common reason for surgical admission.
Conclusion. Paediatric in-hospital mortality decreased consistently over a decade, despite an overall increase in admissions. Pneumonia and diarrhoea admissions decreased markedly over a 6-year period, but remain the most important causes of hospitalisation.