South African Medical Journal - Volume 100, Issue 11, November 2010

CPD questionnaire : November 2010

At a global summit held in the year 2000, world leaders committed themselves to strive for the attainment by 2015 of a set of 8 far-reaching developmental mileposts known as the Millennium Development Goals (MDGs). Unlike previous global agreements (for example, the Alma Ata 'Health for All by the Year 2000' declaration), the MDGs were specifically tied to numerical benchmarks consisting of 21 quantifiable targets measured on the basis of 60 indicators. Goals 4 - 6 specifically target health issues, respectively to reduce child mortality, improve maternal health, and combat HIV/AIDS, malaria and other diseases. However, the rest of the goals (eradicate poverty and hunger; achieve universal primary education; promote gender equality; ensure environmental sustainability) are also inextricably tied to improved health outcomes.

MPS regulation drama

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Stroke guideline

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Helicobacter pylori in the Eastern Cape

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Maternal deaths associated with eclampsia

To the Editor: The Medicines Control Council of South Africa requires health care professionals and others involved in conducting clinical studies to attend a training course in good clinical practice (GCP) every 3 years. The need for standardised training and accreditation in South Africa is recognised. However, the way in which the accreditation of training courses is to be implemented from 2011 will result in conflicts of interest that would be best avoided.

To the Editor: In response to striking doctors, the HPCSA argues that it can investigate unprofessional conduct in the absence of a complaint because it is the custodian of professional morals.

Earlier HIV diagnosis - are mobile services the answer?, SAMJ 100 (10) 2010 : pp. 671-674 : erratum

To the Editor: 'Humanity is but a blip on the time-scale of life on earth. But that blip is all that we have, and our present global course guarantees its extinction.' Global overpopulation leads to poverty, overcrowding and pollution of air and water. These factors, together with increasing unemployment and food shortages, will decrease the quality of life for millions of people.

The Medical Protection Society (MPS), a financial and legal haven for 25 000 South African health care practitioners and reliable source of recompense for countless casualties of care, may be legislated out of the country.

One of the country's top patient litigators and a seasoned opponent of the Medical Protection Society (MPS), Mervyn Joseph, says forcing the MPS out would prove an 'unmitigated disaster' for patients and doctors alike.

Every public hospital, especially a rural one, needs a skonkwane or anchor person who shoulders responsibility, leads by example, initiates or maintains efficient systems and motivates staff. Yet few have one, let alone one who is black, female and a role model.

When most of the low-income folk in the 'ghost train' town of De Aar began remonstrating with any pregnant mother who was boozing, excited campaigners thought they'd broken through the 'tippling point'.

In response to criticism of ethical review of a South African clinical trial, we contrast aspects of the United States Common Rule with South African research ethics requirements. In the USA the Common Rule does not apply to all health research and allows many exemptions from ethics review and waivers of informed consent. At a structural level research ethics review in South Africa is in many cases equivalent to the US institutional review board (IRB) and Office for Human Research Protections (OHRP) oversight system, is wider reaching, and has no exclusions.

Hypertensive disorders of pregnancy (HDP) are the commonest medical complication in pregnancy, and remain the commonest direct cause of maternal mortality in South Africa. The latest (2005 - 2007) Saving Mothers report (SMR) indicates that there were 622 maternal deaths from HDP during this period, virtually the same as in the 2002 - 2004 report. Numbers of deaths reported in the two previous SMRs were 507 for 1999 - 2001 and 628 for 2002 - 2004; these differences probably indicate under-reporting in the triennium 1999 - 2001. The most recent reports, 2002 - 2004 and 2005 - 2007, better reflect the numbers of maternal deaths from HDP.

Gastro-intestinal cytomegalovirus (CMV) infection manifests as oesophagitis, gastritis, enteritis and colitis. Reports of duodenal involvement are rare. We found only one reported CMV-induced pseudotumour of the duodenum and 14 CMV-induced gastrointestinal pseudotumours.

This book lives up to its name and most definitely focuses on some uniquely African pathology, which is not included in most of the larger First-World surgical texts. Its stated role is that of a book for medical students at universities in the tropical belt of Africa to be used alongside a standard text. As such, the book achieves its goal.

Bryan Williams matriculated at Rondebosch Boys' High School. He attended the Naval Gymnasium as compulsory military training in keeping with the ideology of the South African government in the 1960s.

The genome is the full complement of genetic information of an organism. It occurs in the form of DNA and is inherited from our parents. DNA is a series of nucleotides (bases) abbreviated A, C, G and T. Every nucleated cell in the body contains a full complement of genetic information that is organised into 46 chromosomes (XX or XY sex chromosomes and 22 pairs of autosomes).

To the Editor: The ocular condition called pterygium (also known as web eye) is a triangular patch of hypertrophied subconjunctival tissue extending from the medial canthus of the eye to the border of the cornea or beyond, with the apex pointing towards the pupil. It is one of the most common conditions of the conjunctiva, and surgery to remove pterygia is practised widely.

The research objective was to gather and collate data that will enable dermatologists to quantify exposure to solar radiation so that they can give accurate advice to patients using heliotherapy, thereby minimising harm from sun exposure. Other patients can also be advised regarding ultraviolet index (UVI) and sun safety. The concept of minimal erythema dose per hour (MED/h) may be useful in future research into solar radiation and its effects on skin cancer.

Objectives. We examined Helicobacter pylori infection in patients with gastric-related morbidities at Livingstone Hospital, Port Elizabeth, to determine the prevalence and risk factors for infection according to race, endoscopic diagnosis, age and sex.

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Methods. Gastric biopsies were collected from 254 consecutive patients and H. pylori was isolated on Columbia agar base supplemented with 7% sheep's blood and Skirrow's supplement containing trimethoprim (2.5 mg), vancomycin (5 mg) and cefsulodin (2.5 mg). Amphotericin (2.5 mg) was added to the medium. Recovered isolates were identified following standard microbiology and biochemical techniques. Presumptive isolates were further confirmed by polymerase chain reaction (PCR) targeting the glmM gene. Fisher's exact test was used to assess the univariate association between H. pylori infection and the possible risk factors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated to measure the strength of association, using EPI INFO 3.41 software. p-values <0.05 were required for significance.

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Results. The overall prevalence of H. pylori was 66.1% (168/254). Of the 168 positive subjects, H. pylori prevalence was highest in patients with non-ulcer dyspepsia (NUD) (32.7%; 55/168), and lowest (0%; 0/168) in those with atypical oesophageal reflux disease and gastroduodenitis, respectively. The prevalence of infection was highest among coloureds (68.4%; 89/130) and lowest in whites (59.5%; 25/42). Prevalence increased with age.

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Conclusion. The prevalence of H. pylori is high in dyspeptic patients in Eastern Cape province. Gender, antibiotic treatment and alcohol consumption may be risk factors for infection. These findings are of clinical and epidemiological significance.