South African Journal of Child Health - Volume 1, Issue 1, 2007
Volume 1, Issue 1, 2007
Source: South African Journal of Child Health 1 (2007)More Less
The human body is an intricate structure with multiple different organ systems that, in health, function in unison. Life would be easy if there was a law dictating that dysfunction could only affect one organ at a time. A patient would, say, be under a neurologist forever - or at least until the neurological abnormality has resolved.
Source: South African Journal of Child Health 1, pp 6 –9 (2007)More Less
Since its identification in the 1980s, the prevalence of infection with the human immune deficiency virus (HIV), the cause of acquired immune deficiency syndrome (AIDS), has increased relentlessly in spite of concerted efforts to curb its spread. The majority (> 90%) of people infected with HIV live in low- and middle-income countries. Poverty, migration and their consequences are plausible explanations for the rapid spread of a disease that is mainly transmitted sexually and through contact with blood. However, they seem inadequate as explanations for the strikingly disproportionate burden of the epidemic in sub-Saharan Africa (which is home to only 10% of the world population yet accounts for over 60% of infected people). More data are needed to elucidate variables for disease spread, particularly those relating to behaviour. What specific behaviours, cultural or otherwise, make sub-Saharan Africans, or any other people, more susceptible to infection? Even though the magnitude of benefit from circumcision is debatable, the lower HIV prevalence and seroconversion rates (adjusted risk reduction of about 60%) in circumcised cohorts illustrates this point.
Improved survival of non-ventilated very-low-birth-weight infants at Madadeni Hospital, KwaZulu-NatalSource: South African Journal of Child Health 1, pp 10 –13 (2007)More Less
Most reports of survival of very-low-birth-weight (VLBW) babies focus on infants in tertiary care centres in large metropolitan areas. Extrapolating data from major centres to peripheral hospitals is problematic because of various factors, including poor socio-economic conditions, absence of intensive / special-care facilities and equipment, and limited number of staff with knowledge and skills in neonatal care in smaller hospitals. We were able to raise the survival rate (SR) from 21% to 40% following the use of low-cost measures between 2002 and 2005.
Source: South African Journal of Child Health 1, pp 14 –18 (2007)More Less
Background. Despite the fact that 71.6% of children at Chris Hani Baragwanath Hospital (CHBH) Asthma Clinic in Soweto, Johannesburg were found to have one or more positive skin-prick tests (SPTs) to common aero-allergens, they reported a low rate of positive family history for atopic conditions (22.2%). In the past this has minimised the importance of family history in determining the nature of chest symptoms in children in this population group, suggesting that some new environmental exposure, rather than the established familial factor, was creating the allergic milieu in this group.
Objective. To determine the predictive value of a family history of symptoms of atopic disease (and allergy) by seeking evidence for this condition in the parents of asthmatic children attending the CHBH Children's Asthma Clinic, and the reason(s) why a positive family history has been found so seldom in these children.
Methods. A random group of parents of the atopic asthmatic children attending the CHBH Children's Asthma Clinic completed a detailed questionnaire regarding their atopic status. Skin-prick testing was performed.
Results. Fifty-four sets of parents and 15 single mothers were studied. Of the 48 atopic children, 37 (77%) had at least 1 parent with a positive SPT. Fifty-five per cent of mothers had a positive SPT, while 48% of fathers had at least 1 positive SPT. Seven of 69 mothers (10%) had a definitive diagnosis of asthma. Of these, 5 (71%) were SPT-positive. Only 3 of the fathers (5.5%) had asthma. All had positive SPTs. However, if all the symptoms suggestive of asthma, namely chronic cough or wheeze, were taken into account, the number of potential atopic fathers and mothers increased to 10 (19%) and 18 (26%) respectively.
Conclusion. Simple questioning for family history of atopic disease is therefore not a good predictor of atopy in offspring in this cohort of patients. In order to get maximal yield from this question, parents must rather be asked about specific symptoms suggestive of asthma and / or allergic rhinitis.
Source: South African Journal of Child Health 1, pp 20 –25 (2007)More Less
During the 5-year period 1999 - 2003, we treated 36 children with a clinical diagnosis of mastoiditis. Post-auricular tenderness, swelling or abscess was the presenting feature in all cases. Twenty of these children had acute mastoiditis, 12 had acute-onchronic mastoiditis and 4 had a post-auricular abscess and no signs of mastoiditis on mastoid exploration (pseudomastoiditis). No pathogenic organisms were cultured from 25% of cases overall, but among those with positive culture Streptococcus Pyogenes and Staphylococcus aureus were the commonest organisms in the acute mastoiditis group and Proteus mirabilis was the commonest in the acute-on-chronic group.
In the acute mastoiditis group (20 patients) only 1 patient was successfully treated with antibiotics, the rest requiring cortical mastoidectomy.
In the acute-on-chronic mastoiditis group (12 patients) 9 children had cholesteatoma and underwent an open cavity procedure and the other 3, who underwent cortical mastoidectomy, all had positive histology / culture for tuberculosis.
Source: South African Journal of Child Health 1, pp 26 –32 (2007)More Less
Although Red Cross War Memorial Children's Hospital (RCCH) is renowned for its achievements in many branches of specialist paediatrics, one non-specialist service has provided care in extraordinary circumstances for hundreds of thousands of children. The Rehydration Unit for the management and treatment of infantile gastroenteritis (GE) has a 50-year history of adaptation and innovation in changing and demanding circumstances.
Evaluation of the safety of short-acting nifedipine use in children with severe hypertension secondary to acute post-streptococcal glomerulonephritis : short reportSource: South African Journal of Child Health 1, pp 34 –37 (2007)More Less
Hypertension occurs in about 80 - 97% of hospitalised children who present with acute post-streptococcal glomerulonephritis (APSGN). The hypertension develops rapidly over a few days. In the majority of cases the hypertension resolves with diuretic therapy within the first week of admission to hospital.
Source: South African Journal of Child Health 1, pp 38 –39 (2007)More Less
A 7-year-old girl was referred with a history of recurrent chest and upper respiratory tract infections since infancy. She had a chronic productive cough without features of asthma (e.g. worsening at night or with activity) and marked nasal symptoms (blocked nose, rhinorrhoea). Further history revealed no specific allergies although there was a vague history of atopy. The girl's mother had chronic sinusitis. The patient's stools were normal in consistency and frequency. Another major complaint pertained to her 'slowness'. Her mother noted that she was sometimes off balance.
Source: South African Journal of Child Health 1 (2007)More Less
To the Editor : As doctors involved in the management of children with asthma, we have noted with concern the recent debate on and adverse publicity given to the long-acting β2-agonists (LABAs) used to treat children with asthma. We feel that the issue needs clarification.
Author Kathie Buley-WalkerSource: South African Journal of Child Health 1 (2007)More Less
To the Editor: I registered as a first-year medical student in 1966, a time when UCT Medical School was not particularly 'woman-friendly'. The following are my reflections over four decades of association with the University of Cape Town (UCT) and Red Cross Children's Hospital (RXH). I ask you to join me in imagining the following.
Author Marian JacobsSource: South African Journal of Child Health 1, pp 43 –44 (2007)More Less
To the Editor: The history of Red Cross War Memorial Children's Hospital is very closely tied to the history of paediatric training at the University of Cape Town. In this context, a personal journey may provide insight into a perspective that has not often been publicised.