South African Medical Journal - Volume 100, Issue 3, 2010
Volumes & issues
Volume 100, Issue 3, 2010
Author Daniel J. NcayiyanaSource: South African Medical Journal 100 (2010)More Less
In June 2009, the World Health Organization (WHO) declared the influenza H1N1 virus a pandemic, the first such pandemic to be declared in 41 years. At that time, the new strain had infected 28 000 people worldwide, with 141 fatalities. Since then the pandemic has turned out to be a bit of a damp squib for much of the global public. Americans believe that the flu threat was overblown and the pandemic is over, and therefore do not intend to get the swine flu vaccine being pushed by US public health authorities, according to a recent poll of the Harvard School of Public Health.
High uptake of HIV testing for tuberculosis patients in anintegrated primary health care HIV / TB programme in rural KwaZulu-Natal : issues in medicine : SAMJ forumSource: South African Medical Journal 100, pp 146 –147 (2010)More Less
Tuberculosis (TB) is the leading cause of morbidity and mortality in the HIV-infected African population. The need for improved integration of HIV and TB services was highlighted by the World Health Organization (WHO) several years ago, but implementation of recommendations has been slow. HIV testing for TB patients is the gateway for combined HIV and TB treatment, care and prevention yet, in 2007, only 37% of TB patients in the WHO African region were tested for HIV. While some countries reported testing rates above 75%, a testing rate of only 39% was reported in South Africa, the country with the largest burden of HIV/TB co-infection. We describe our efforts to ensure high HIV testing rates in TB patients via an integrated programme at primary health care level in rural KwaZulu-Natal.
Source: South African Medical Journal 100, pp 148 –149 (2010)More Less
Cardiac tamponade secondary to tension pneumopericardium from penetrating chest trauma : clinical images : SAMJ forumSource: South African Medical Journal 100 (2010)More Less
Cardiac tamponade secondary to air is rare. Pneumopericardium is most commonly encountered in neonates, often secondary to positive pressure ventilation. In adults blunt trauma is the main cause of pneumopericardium. Cardiac tamponade occurs in roughly one-third of such patients.
Source: South African Medical Journal 100, pp 151 –152 (2010)More Less
Emeritus Professor Ralph Kirsch was a distinguished, well-known and much admired medical personality in South Africa and internationally. His eminence is founded on a lifetime of contribution and achievement in the arena of internal medicine, liver research, medical education, administration and leadership. He served South African health sciences at the highest professional, organisational and institutional levels.
World TB Day 2010 : eradicating tuberculosis in sub-Saharan Africa needs effective and committed north-south partnerships : editorialSource: South African Medical Journal 100, pp 153 –154 (2010)More Less
The World Health Organization (WHO) has designated 24 March of each year as 'World TB Day', to mark the anniversary of Robert Koch's discovery in 1882 of the cause of tuberculosis (TB), Mycobacterium tuberculosis. Regrettably, this is not a day for celebration. Instead, governments, policy makers, scientists and funders must reflect on the paradoxical fact that, although effective and cheap therapy has been available for over 60 years, TB kills nearly 1.8 million people every year, that is, 5 000 people every day! Together with HIV / AIDS and malaria, TB remains one of the most important causes of death from infectious diseases worldwide. World TB Day provides an opportunity to reflect on the poor state of TB control globally, particularly in sub-Saharan African countries (SSA).
Author P.C. PotterSource: South African Medical Journal 100 (2010)More Less
Source: South African Medical Journal 100, pp 156 –157 (2010)More Less
Mite and cockroach sensitisation in patients with allergic rhinitis in the Free State : original articleSource: South African Medical Journal 100, pp 160 –163 (2010)More Less
Background. Studies in patients with allergic rhinitis living in the Free State have shown grass pollens to be the predominant allergens, with house-dust mite sensitisation being less prevalent than in the coastal areas and a low rate of sensitisation to the storage mite Lepidoglyphus destructor. No studies have been conducted on sensitisation to the other storage mites, spider mites or cockroaches. We aimed to determine the prevalence of sensitisation to various housedust mites, storage mites, spider mites and cockroaches in patients with allergic rhinitis living in the Free State.
Methods. Fifty consecutive patients with allergic rhinitis attending the ear, nose and throat clinic at Universitas Hospital underwent skin-prick testing and / or ImmunoCAP RAST testing for common aero-allergens, house-dust mites, storage mites, spider mites and cockroaches.
Results. Forty-six per cent of patients were sensitised to one of the house-dust mites, with house mite sensitisation being significantly more common in patients who had previously lived at the coast. Storage mites were not common aeroallergens, while 46% of patients were sensitised to the spider mite Tetranychus urticae. Blatella germanica was the cockroach species to which patients were most commonly found to be sensitised on ImmunoCAP RAST testing, with 38% of patients being sensitised to this aero-allergen.
Conclusions. House-dust mites, T. urticae and the cockroach B. germanica appear to be important aero-allergens in the Free State. Storage mite sensitisation is not common.
Source: South African Medical Journal 100, pp 164 –167 (2010)More Less
House-dust mites (HDMs) are an important source of allergens that are reputed to act as a trigger for atopic disease. Climatic conditions in parts of South Africa are not suitable for their proliferation, and there is doubt whether they occur on the Highveld. We studied whether HDMs occur in homes in Bloemfontein, Free State.
Methods. Ten houses were sampled over a 1-year period. Dust was collected monthly or quarterly from a mattress, a bedroom floor and the living room floor of each house and examined for the presence of HDMs. Climate data were collected during the same period and a questionnaire was completed by home-owners to gather data on indoor factors that could influence mite proliferation.
Results. HDMs were regularly found in 3 houses (30%). Dermatophagoides farinae was the dominant species (97.5%). The highest numbers were found in winter, when climatic conditions were the least favourable. Climatic conditions never met the requirements for active proliferation of the mites. Indoor factors that may have promoted mite proliferation in some houses were artificial heating (especially under-floor heating), en-suite bathrooms and lack of adequate ventilation during the winter months.
Conclusion. HDMs do occur in central South Africa, owing to a microclimate created indoors. Adequate ventilation, to reduce indoor humidity, should suffice to reduce mite numbers and prevent a topic symptoms induced by them.
Non-alcoholic fatty liver disease (NAFLD) in the Western Cape : a descriptive analysis : original articleSource: South African Medical Journal 100, pp 168 –171 (2010)More Less
Background. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in Western countries, but the disease profile has not yet been described in South Africa. NAFLD affects all spheres of society, especially the poorest and least educated.
Aim. To investigate the demographics and clinical and biochemical features of South African patients diagnosed with non-alcoholic fatty liver and non-alcoholic steatohepatitis (NASH) in the Western Cape, South Africa.
Design / method. Overweight / obese subjects were screened by ultrasound and those with fatty liver / hepatomegaly were included. Liver biochemistry, insulin resistance (using the insulin resistance homeostasis model assessment method for insulin resistance, HOMA-IR) and body mass index were assessed and liver biopsies were performed on patients older than 45 years with persistently abnormal liver function and / or hepatomegaly.
Results. We screened 233 patients: 69% coloured, 25% Caucasian, 5% black and 1% Asian. The majority (73%) were female. NAFLD was confirmed histologically in 111 patients, of whom 36% had NASH and 17% advanced liver fibrosis. No black patient had advanced fibrosis. Subjects with NASH had higher mean triglyceride (p=0.03) and cholesterol (p=0.01) levels than subjects with NAFL. All patients were insulin resistant/diabetic. HOMA-IR and not the degree of obesity was strongly associated with advanced fibrosis (p=0.09).
Conclusion. This study is the first to describe the clinical characteristics of NAFLD in South Africa, albeit only in the Western Cape population. Insulin resistance was the universal factor present. The degree of obesity was not associated with severity of disease. The role of genetic risk factors in disease development and severity remains to be defined.
Hutchinson's sign as a marker of ocular involvement in HIV-positive patients with herpes zoster ophthalmicus : original articleSource: South African Medical Journal 100, pp 172 –174 (2010)More Less
Background. A positive Hutchinson's sign indicates an increased risk of ocular involvement in herpes zoster ophthalmicus (HZO). We examined the sensitivity of Hutchinson's sign as an indicator of ocular involvement in a consecutive series of patients presenting with HZO.
Methods. We conducted a descriptive observational prospective study of patients ≥18 years old presenting with HZO and consenting to pre- and post-test counselling and HIV and CD4 testing. A full ophthalmological examination focused on the extent of ocular involvement, and the presence of Hutchinson's sign was confirmed by two clinicians.
Results. Thirty-three patients were enrolled; 29 were HIV positive, of whom 18 (62%) had not been diagnosed with HIV prior to enrolment. Of the 29 HIV-positive patients, 21 (72%) were Hutchinson?s sign positive (HSP), all of whom had intra-ocular involvement (95% confidence interval 88 - 100%). Of the 8 HIV-positive, Hutchinson's sign-negative (HSN) patients, 4 did and 4 did not display intra-ocular involvement. Neither the mean CD4 count nor the average age in the HSP group differed significantly from the HSN group.
Conclusion. We confirmed that a Hutchinson's sign- and HIV-positive patient with HZO has a very high positive predictive value for intra-ocular involvement. Neither age nor CD4 count had predictive value for ocular involvement. Young adults presenting with HZO should be suspected of having HIV, and HIV-positive patients with HZO but HSN may still have ocular involvement. All patients with HZO should be seen by an ophthalmologist.
Source: South African Medical Journal 100, pp 175 –179 (2010)More Less
Objectives. To determine the factors associated with attempting to quit smoking and successfully doing so, among South Africans.
Methods. Data from the 1998 South African Demographic and Health Survey (the largest nationally representative survey dataset available to date) were used. We compared the characteristics of those who attempted to quit, with those of the entire population of smokers, and compared successful quitters with those who only attempted to quit. The data analysis included logistic regression analysis.
Results. Of those who ever smoked and who smoked ≥100 cigarettes, 68.1% (N=2 223) attempted to quit smoking, but only 14.1% succeeded of those who ever attempted to quit. Those who attempted to quit were significantly more likely to be female, white, ≥55 years old, have tertiary education, believe smoking is harmful, have been dependent on alcohol in the past, live in smoke-free homes, or smoke >20 cigarettes per day. Similar factors were associated with successful quitting, except that race was not a determinant of success, and those with 1 - 7 years' schooling (compared with no education or higher education) were most likely to succeed, while those currently dependent on alcohol were least likely to succeed.
Conclusions. Clinical interventions, programmes targeting alcohol-dependent smokers, and policies that will boost the number of smoke-free homes and increase knowledge about the adverse health effects of smoking, may increase the rate of smoking cessation in South Africa.
Factors associated with female high-risk drinking in a rural and urban South African site : original articleSource: South African Medical Journal 100, pp 180 –182 (2010)More Less
Objective. To assess and compare the extent of high-risk drinking and factors associated with high-risk drinking in the adult female population of a rural and an urban region in South Africa.
Design. Cross-sectional household survey using multistage sampling methods.
Setting. A rural wine farming area of the Western Cape and an urban site in Gauteng.
Subjects. Women of reproductive age (18 - 44 years).
Outcome measures. The extent of risky alcohol consumption measured using the Alcohol Use Disorders Identification Test (AUDIT) scale which categorises current drinkers into high and low-risk drinkers.
Results. Twenty-seven per cent (166/606) and 46% (188/412) of the women interviewed in Gauteng and the Western Cape respectively were current drinkers. In turn, 20% (33/166) of the Gauteng current drinkers and 68% (128/188) of the Western Cape current drinkers were classified as high-risk drinkers. Multivariate analysis indicated that employed people in Gauteng were less likely to be high-risk drinkers (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1 - 0.8). Living in a household that never / seldom went hungry was inversely associated with risky drinking for both sites (OR 0.3, 95% CI 0.1 - 0.9 for Gauteng and OR 0.2, 95% CI 0.3 - 1.2 for the Western Cape). Current smokers (Western Cape) (OR 7.6, 95% CI 3.1 - 18.9) and respondents with an alcohol problem in one or more family members (both sites) (OR 6.0, 95% CI 2.3 - 15.7 and OR 3.1, 95% CI 1.5 - 6.4) were more likely to be high-risk drinkers.
Conclusions. High-risk drinking by women is a major problem, especially in the Western Cape. Targeted interventions are needed for women with alcohol problems in the family setting, lower socio-economic status, and concurrent substance abuse.