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- Volume 16, Issue 3, 2011
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 16, Issue 3, 2011
Volume 16, Issue 3, 2011
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 120 –121 (2011)More Less
Three separate and unrelated issues are briefly addressed in this editorial of the final 2011 issue of JEMDSA, namely, comments on some of the articles the journal hosts, a reminder of our Combined SEMDSA-NOFSA Congress in Cape Town in April 2012, and an invitation to reassess and revisit the aims and objectives of our journal, including its Editorial Board.
Should haemoglobin A1c be used for the diagnosis of diabetes mellitus in South Africa? : review articleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 122 –127 (2011)More Less
Diabetes is an important medical problem in sub-Saharan Africa. It has traditionally been diagnosed by means of fasting plasma glucose, random blood glucose or an oral glucose tolerance test. Each of these has limitations and, in 2009, an expert committee of the American Diabetes Association recommended using the haemoglobin A1c (HbA1c) to diagnose diabetes mellitus. The aim of this paper is to analyse the advantages and disadvantages of using HbA1c as a diagnostic method for diabetes, and its applicability in the South African setting.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 130 –136 (2011)More Less
Type 1 diabetes is a serious, debilitating disease, with life-threatening complications, and the financial burden associated with the management of this disease is enormous. Early diagnosis and intervention can improve morbidity and mortality. Unfortunately, in Africa, type 1 diabetes is poorly characterised, and there is sparse information regarding the aetiology andepidemiology of this disease. However, there is some evidence of a later age of onset in African type 1 diabetic patients, compared to European diabetics, and it is thought that the prevalence of type 1 diabetes is lower in African populations than in the Western world.
Metabolic surgery : a concise overview and understanding of potential complications : review articleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 138 –144 (2011)More Less
Bariatric surgery, despite a relatively short history, has had a tremendous impact on the discipline of surgery. In addition, it has had a profound influence on the development of laparoscopic surgery and the treatment of the worldwide epidemic of obesity. Contrary to the expectations of the 1990s, that obesity surgery would converge into a single procedure, there has been a trend favouring the safest and least invasive surgery on the one hand, and a diligence towards the most effective and complicated surgery on the other hand. The latter, being the biliopancreatic diversion with duodenal switch, requires advanced laparoscopic skills and an experienced medical team. This review will focus predominantly on the laparoscopic Roux-en-Y bypass, a recognised procedure which is performed in 80% of patients going to theatre for bariatric surgery.
Assessing maths literacy skills in type 1 diabetic children and their caregivers : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 146 –153 (2011)More Less
Background: It is essential that children have adequate numeracy and literacy skills in order to manage their diabetes effectively. The objective was to undertake a pilot study to assess the level of numeracy skills in type 1 diabetic children and their caregivers, and to ascertain if there was a deficit in these skills. This cross-sectional descriptive study comprised 53 children and 37 primary caregivers, who attended the paediatric diabetic clinics at the Chris Hani Baragwanath Academic and Charlotte Maxeke Johannesburg Academic hospitals from March to September 2009.
Method: The participants were interviewed and completed a diabetes mathematical questionnaire. Patient records were accessed.
Results: The mean age of the children was 12.92 ± 2.96 years. The children and the caregivers performed poorly in the applied maths section, and had lower "functional" grades (grades achieved on testing) compared to their actual grades. An inverse relationship was also found between the HbA1c levels and numeracy scores.
Conclusion: Educational programmes need to accommodate patients and caregivers with lower numeracy skills, and should incorporate numeracy training as a core component of diabetes education.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 16, pp 155 –158 (2011)More Less
Background: The authors report a case of euthyroid hyperthyroxinaemia and the systematic approach that led to the diagnosis. The related literature is also reviewed in an attempt to increase awareness of this condition.
Case report: A 47-year-old female patient was referred for further investigation and management of "hyperthyroidism." The patient was clinically euthyroid and had previously been treated with carbimazole, but self-discontinued therapy as she felt unwell on treatment. A careful review of this patient's blood results revealed elevated free thyroxine and unsuppressed thyroid-stimulating hormone (TSH). This is atypical of primary hyperthyroidism, in which case suppressed TSH would have been expected. In view of the clinical euthyroidism, euthyroid hyperthyroxinaemia was considered the most likely diagnosis and an appropriate work-up was initiated. Following on the consultation with the Chemical Pathology Unit, assay interference was established as the likely cause and the patient was reassured. She remains well, with no treatment.
Conclusion: Thyroid function tests should not be interpreted in isolation and, if the clinical picture and biochemistry are discordant, it is imperative to consider assay interference. It is also important to apply basic physiological principles in interpreting endocrine blood results. In this patient, both the clinical euthyroidism and the unsuppressed TSH, which are atypical of primary hyperthyroidism, prompted further work-up.