The fundamental function of medical journals therefore is to publish not the 'truth' per se, but rather the current state of knowledge derived from good research conducted and reported with the utmost integrity.
Generalized Anxiety Disorder across the Lifespan : an Integrative Approach, Michael E. Portman. Foreword by John H.G. Riskind, South African Medical Journal, 100 (1) 2010 : pp 31 : book review : erratum
A Sub-Saharan Africa Centre for Chronic Disease has been established at the University of Cape Town (UCT). It aims to develop, evaluate and disseminate methods and programmes to prevent chronic disease, improve the quality of care for patients with chronic disease and reduce risk factors. It will focus on surveillance, advocacy and prevention.
Zithulele Hospital is a deeply rural district hospital in the Eastern Cape province. Beset by staffing, procurement and infrastructure problems, the maternity service in 2005 was poorly organised and offered an inadequate standard of care. By our estimates, nearly 50% of women were still delivering at home. Three years of effort focused on regular auditing to identify problems and improve our service started to bear fruit in 2008, reflected in significantly increased deliveries and a sharp drop in the perinatal mortality rate. We consider some of the successes, which factors have contributed to them, and some remaining challenges.
Objectives. To assess the utility of an existing ultrasound machine for the purposes of focused assessment sonography in trauma (FAST) scanning in a developing world emergency department (ED).
Design. Prospective study undertaken over a 12-month period. Trauma patients attending the ED were FAST scanned by one of three trained emergency medicine doctors.
Setting. The ED at a government hospital in rural KwaZulu-Natal (KZN), the referral centre for 22 peripheral hospitals.
Subjects. All patients presenting to the ED who had sustained abdominal or thoracic trauma. Outcome measures. Scans were recorded as positive or negative for free intra-abdominal or pericardial fluid. All results were confirmed by computed tomography, laparotomy or a second trained ED ultrasonographer, followed by a period of clinical observation.
Results. 72 FAST scans were included, 52 for blunt trauma and 20 for penetrating trauma. Of the 72 scans, 15 (20.8%) were positive. FAST scanning had 100% specificity and overall sensitivity of 71.4%. When considering blunt trauma alone the sensitivity improved to 81.3%, while in penetrating trauma it was much poorer (62.5%).
Conclusions. We propose a valuable role for FAST scanning in all peripheral hospitals for the assessment of patients sustaining blunt trauma. In rural areas with limited resources FAST scans may assist in the appropriate timely transfer of trauma patients for further imaging or definitive surgical intervention.
Background. In 2001, North West Province took the decision to increase bed capacity at Brits Hospital from 66 beds to 267 beds. After careful consideration of costs and an assessment of available land, it was decided to demolish the existing hospital and rebuild the new hospital on the same site. It was planned that during this time clinical services would be moved to a temporary makeshift hospital and to primary health care clinics. This case study documents the consequences of this decision to move services to the makeshift hospital and how these challenges were dealt with.
Methods. A cross-sectional descriptive study was undertaken. Ten key members of staff at management and service delivery level, in the hospital and the district, were interviewed. Key documents, reports, correspondence, hospital statistics and minutes of meetings related to the move were analysed.
Results. The plan had several unforeseen consequences with serious effects on patient care. Maternity services were particularly affected. Maternity beds decreased from 30 beds in the former hospital to 4 beds in the makeshift hospital. As numbers of deliveries did not greatly decrease, this resulted in severe overcrowding, making monitoring and care difficult. Perinatal mortality rates doubled after the move. An increase in maternal deaths was noted. The lack of inpatient ward space resulted in severe overcrowding in Casualty. The lack of X-ray facilities necessitated patients being referred to a facility 72 km away, which often caused a delay of 3 days before management was completed. After-hours X-rays were done in a private facility, adding to unforeseen costs. Although the initial plan was for the makeshift hospital to stabilise and refer most patients, referral routes were not agreed upon or put in writing, and no extra transportation resources were allocated. The pharmacy had insufficient space for storage of medication. In spite of all these issues, relationships and capacity at clinics were strengthened, but not sufficiently to meet the need.
Discussion. Hospital revitalisation requires detailed planning so that services are not disrupted. Several case studies have highlighted the planning necessary when services are to be moved temporarily. Makeshift hospitals have been used when renovating or building hospitals. During war or disasters, plans have been made to decant patients from one facility to another. From the Brits case study, it would appear that not enough detailed planning for the move was done initially. This observation includes failure to appreciate the interrelatedness of systems and the practicality of the proposal, and to budget for the move and not just the new structure.
Conclusion. The current service offered at the makeshift hospital at Brits is not adequate and has resulted in poor patient care. It is the result of a planning process that did not examine the consequences of the move, both logistic and financial, in adequate detail. Committed hospital staff have tried their best to offer good care in difficult circumstances.
Background. Women who carry germline mutations in the breast-ovarian cancer susceptibility genes, BRCA1 and BRCA2, are at very high risk of developing breast and / or ovarian cancer. Both genes are tumour suppressor genes that protect all cells from deregulation, and there are reports of their involvement in other cancers that vary and seem to depend on the population investigated. It is therefore important to investigate the other associated cancers in different populations to assist with risk assessments.
Objectives. To assess the cancer risk profile in BRCA-mutation-positive and negative South African breast-ovarian cancer families, mainly of Caucasian origin.
Design. Descriptive study in which the prevalence of all cancers in the pedigrees of BRCA1- and BRCA2-mutation-positive groups and a group of families without mutations in either gene were compared with the general population.
Results. As expected, female breast and ovarian cancer was significantly increased in all three groups. Furthermore, male breast cancer was significantly elevated in the BRCA2-positive and BRCA-negative groups. Stomach cancer prevalence was significantly elevated in the BRCA2-positive families compared with the general population.
Conclusions. These results can be applied in estimation of cancer risks and may contribute to more comprehensive counselling of mutation-positive Caucasian breast and / or ovarian cancer families.
Objective. We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS).
Method. This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrations of amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) were analysed using routine clinical chemistryautomated methods (Konelab, Vantaa, Finland).
Results. All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (±26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) μg/l.
Conclusion. Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available.
Water-pipe smoking is growing in popularity, especially among young people, because of the social nature of the smoking session and the assumption that the effects are less harmful than those of cigarette smoking. It has however been shown that a single water-pipe smoking session produces a 24-hour urinary cotinine level equivalent to smoking 10 cigarettes per day.
Aim. We aimed to measure carboxyhaemoglobin (COHb) blood levels before and after water-pipe and cigarette smoking sessions.
Method. Self-confessed smokers older than 18 years (N=30) volunteered to smoke a water-pipe or a cigarette and have their blood COHb levels measured under controlled conditions.
Results. Mean baseline COHb levels were 2.9% for the 15 cigarette smokers and 1.0% for the 15 water-pipe smokers. Levels increased by a mean of 481.7% in water-pipe smokers as opposed to 39.9% in cigarette smokers.
Conclusion. The study demonstrated that water-pipe smokers had significantly higher increases in blood COHb levels than cigarette smokers during a single smoking session.