Professional people participate in lifelong learning. Doctors have always done so without regulating bodies needing to measure our compliance in accumulating sufficient Continuing Education Units (CEUs) annually to remain on the register. Today, as always, medical journals are the mainstay for most doctors to keep up to date and to keep in touch with their profession.
Vuvuzela sound measurements, De Wet Swanepoel, James W. Hall III, Dirk Koekemoer
Pandemic flu (H1N1) 2009 and pregnancy, M.I. Andersson, G. van Zyl, W. Preiser, E. Langenegger, G. Theron
Medical electives in South Africa, Timothy C. Hardcastle
Childhood in-hospital mortality from acute gastro-enteritis in Cape Town, A. Westwood, J. Claassen
The South African government's recent policy decision to expand access to HIV care rapidly and 'ensure that all the health institutions in the country are ready to receive and assist patients and not just a few accredited ARV centres' represents a dramatic and welcome about-turn on years of hesitation and confusion in the country's response to the HIV epidemic. In the first 6 years of the antiretroviral therapy (ART) programme, approximately 900 000 people have been started on treatment.
While the Choice on Termination of Pregnancy Act (Choice Act) allows a female of any age to consent to a termination of pregnancy, there are other statutes, such as the Child Care Act and the Children's Act, that provide for different ages of consent for medical and surgical procedures. Doctors are not always certain whether young girls are legally capable of giving proper informed consent for certain associated procedures when undergoing a termination of pregnancy. Furthermore, the Criminal Law (Sexual Offences and Related Matters) Amendment Act (the Sexual Offences Act), which imposes a duty to report sexual offences against children, seems to undermine the girl-child patient's right to confidentiality.
A 26-year-old black man with a 3-year history of persistent joint pain and swelling of the wrists and ankles and enlargement of his hands and feet, also reported 'deformity' of his fingernails (clubbing) since childhood. His father had similar symptoms, but no siblings were affected. The subject had marked soft-tissue enlargement of the hands and feet and gross clubbing with increased curvature of the nail angle (Lovibond's angle), bogginess of the nailbed and typical 'drumsticking' (Fig. 1). There was bony overgrowth and tenderness at the wrists and ankles with marked limitation of movement, and hyperhidrosis of the face, hands and feet was noted. No other physical signs or abnormal biochemistry were noted.
Although no longer a formidable epidemic disease, measles is still responsible for up to 2 million deaths per annum - mainly among children in developing countries. It is an ancient disease, long confused with smallpox, from which it was clearly differentiated only in the 10th century. In this paper, the place of measles in the medical history of antiquity and the Middle Ages is reviewed.
Soccer fever is sweeping through South African streets - be they tarred, dusty or potholed. Stadiums are being polished until they shine, road signs repainted, and dank garden sheds converted into pricy bed & breakfasts. South Africa is putting its best foot forward, and wherever panic rears its head the FIFA Local Organising Committee and politicians are doing damage control.
Objectives and design. To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby.
Methods. We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died.
Results. SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance.
Conclusion. A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation.
Objectives. To review the incidence of all rugby-associated cervical spine injuries in the Western Cape and identify risk factors.
Methods. We reviewed case notes and X-rays of 27 male patients with rugby-related cervical spine injuries treated at the acute spinal injury (ASCI) unit at Groote Schuur Hospital from April 2003 to June 2008, and followed up with telephone interviews. Patient profile, rugby profile, subsequent injury management from the field to definitive surgery and neurological status on admission, discharge and follow-up using the American Spinal Injury Association (ASIA) classification were assessed.
Results. Average patient age was 25.3 years; 19% of them were scholars. The highest level of education among the adults was primary school in 70% of cases. Forwards and backs had the same injury rate. Most injuries occurred outside the metropole; more occurred in the tackling phase; 39% occurred during foul play; a third of players were not stabilised with a collar on the field; and 65% were taken to an inappropriate primary contact centre. A median of 10 hours elapsed before admission to the ASCI unit. Facet dislocations occurred in 59%; 8 presented neurologically complete and remained so; and 3 presented with residual sensation, with 2 improving to normal. Three presented as ASIA C improving to D, and all Ds improved to Es. Despite their injuries, 60% said they would advise their sons to play rugby. Only 22% regretted playing.
Conclusions. Despite a reduction in cervical spine injuries in rugby in the Western Cape, the latter mostly occur outside the metropole, where levels of education are lower, foul play is more often associated with the injury, and rapid access to medical care is generally unavailable.
Objectives. To determine (i) noise exposure levels of spectators at a FIFA 2010 designated training stadium during a premier soccer league match; and (ii) changes in auditory functioning after the match.
Methods. This was a one-group pretest-post-test design of football spectators attending a premier soccer league match at a designated FIFA 2010 training stadium in Gauteng, South Africa. Individual spectator noise exposure for the duration of the football match and post-match changes in hearing thresholds were measured with pure-tone audiometry, and cochlear functioning was measured with distortion product otoacoustic emissions (DPOAEs).
Results. The average sound exposure level during the match was 100.5 LAeq (dBA), with peak intensities averaging 140.4 dB(C). A significant (p=0.005) deterioration of post-match hearing thresholds was evident at 2 000 Hz, and post-match DPOAE amplitudes were significantly reduced at 1 266, 3 163 and 5 063 Hz (p=0.011, 0.019, 0.013, respectively).
Conclusions. Exposure levels exceeded limits of permissible average and peak sound levels. Significant changes in post-match hearing thresholds and cochlear responsiveness highlight the possible risk for noise-induced hearing loss. Public awareness and personal hearing protection should be prioritised as preventive measures.
The practice of general surgery in a prison population differs considerably from that in a general surgical practice. We audited surgical consultations at the Mangaung Correctional Centre from December 2003 to April 2009. We found a high incidence of foreign object ingestion and anal pathology. Understanding the medical and social aspects of prison life facilitates the treatment of inmates with surgical problems.
Children under 18 are legal minors who, in South African law, are not fully capable of acting independently without assistance from parents / legal guardians. However, in recognition of the evolving capacity of children, there are exceptional circumstances where the law has granted minors the capacity to act independently. We describe legal norms for child consent to health-related interventions in South Africa, and argue that the South African Parliament has taken an inconsistent approach to: the capacity of children to consent; the persons able to consent when children do not have capacity; and restrictions on the autonomy of children or their proxies to consent. In addition, the rationale for the differing age limitations, capacity requirements and public policy restrictions has not been specified. These inconsistencies make it difficult for stakeholders interacting with children to ensure that they act lawfully.