To the Editor : In the emergency centre (EC), a number of essential items of equipment are needed to manage a wide variety of acute life-threatening emergencies. Their correct use depends heavily on the training and experience of personnel.
When a medical practitioner writes a prescription, he or she takes it on faith that the substance he or she is prescribing is safe (within the bounds of disclosed potential adverse effects) and efficacious by virtue of its having been rigorously tested, approved and registered by a statutory regulatory agency such as the Medicines Control Council (MCC) in South Africa, the Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK, or the Food and Drug Administration (FDA) in the USA. The FDA mandate as stated on its website echoes that of other regulatory agencies, namely to be 'responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products ... [and] medical devices'.
To the Editor : I have read the latest Med-e-Mails from SAMA with increasing distress. The apparent failure of our new Minister of Health to solve the problem of enabling doctors to negotiate just salary increases, because of labour legislation, is sad indeed. The obvious anger that this has evoked among members of the profession is very serious.
To the Editor :The Lancet recently highlighted the importance of prioritising clinical research in South Africa. However, public hospitals do not encourage young medical professionals into clinical research. A plan to revitalise clinical research in South Africa is urgently needed.
To the Editor : I read the recent article on mercury exposure with a great interest. Oosthuizen et al. concluded that 'As primary health facilities will be the first point of entry for individuals experiencing symptoms of mercury poisoning, South African primary health care workers need to take cognisance of mercury exposure as a possible cause of neurological symptoms in patients.'
To the Editor : Meckel's diverticulum, a true congenital diverticulum, is a small bulge in the intestine present from birth. It is a vestigial remnant of the original yolk sac or vitello-intestinal duct and was originally described by Johann F Meckel in 1809.
In spite of 77% of infants being born in hospital with the help of a skilled birth attendant, 'massive problems' with South Africa's maternal and child health services contribute to 23 000 stillbirths and a neonatal mortality rate of 21 per 1 000 live births yearly.
As the Hawks Special Investigating Unit last month began probing nine suspect contracts worth almost R1 billion awarded by Gauteng's Health Department, its Health MEC, Qedani Mahlangu, singled out rogue health care workers.
Unpaid debts, poor infection control and slack administration cost at least half a dozen babies their lives and caused unnecessary suffering for thousands of patients at several public sector hospitals and clinics in Gauteng and KwaZulu-Natal in May.
The South African HIV National Strategic Plan (NSP) aims to provide access to appropriate treatment, care and support to 80% of the HIV-infected population by 2011. By mid-2008, highly active antiretroviral treatment (HAART) was being dispensed to about half the HIV-infected population in need. Reaching the NSP targets will require full mobilisation of all of South Africa's health facilities. While the NSP has broad political and programmatic support from the Department of Health and civil society, and managers are able to recite the national targets, it has been difficult for these managers to relate the targets to their own geographical areas of responsibility. National, regional and district targets for HIV care have been set from South Africa's relatively good census, modelling and epidemiological data. However, few practical tools are available to help clinicians and managers understand their facility's actual contribution to the district regional and national NSP targets for each step of the HIV care pathway (HIV testing, CD4 testing, HAART referral and initiation). The calculation of HAART initiation targets is complicated by the anticipated additional demand for treatment that will be generated by a change in the recommended CD4-count threshold for initiation of treatment. Accordingly, we provide a data-based tool that is readily available, and that district and facility managers can use to calculate their annual steady-state HIV testing, CD4 testing and HAART initiation requirements. These calculated values can be used for local and regional planning and to assess and improve current performance at facility level.
Stephen Joffe has done an admirable job of resurrecting the late Dr Vesalius for me and bringing him back to life. Perhaps my choice of words is not ideal, as Vesalius himself was not averse to digging up the recently deceased in order to dissect the body for the benefit of knowledge, but I now understand so much more about this important Renaissance anatomist - compliments of Dr Joffe.
Vossie is op 4 September 1932 op Harrismith gebore. Hy het met onderskeiding aan die Hoër Seunskool Worcester gematrikuleer. In 1958 het hy as dokter (MB ChB) aan die Universiteit van Kaapstad gekwalifiseer. As student was hy lid van die Medical Residence House Committee, die UCT Rugby Club, en die befaamde Namaqualand Touring Team. Vossie het dikwels gespot dat hy destyds die tweede beste skrumskakel in Suid-Afrika was, want hy het gereeld vir die universiteit se tweede span gespeel omdat die bekende Springbok Tommy Gentles hom uit UCT se eerste XV gehou het!
In 2009 South Africa, like the rest of the world, experienced the 'swine flu' pandemic caused by influenza A (H1N1) 2009 virus (H1N1). The influenza epidemic curve for South Africa during 2009 testified to the introduction of the virus, as it superseded the influenza A H3N2 strain (H3N2) as the predominant circulating virus at the end of the season. Predicting patterns of influenza is difficult, and although most influenza cases in South Africa in 2010 may also be due to H1N1, it is uncertain to what degree H3N2 and influenza B will play their parts. Mercifully, H1N1 in 2009 caused mild influenza-like illness (ILI) in most infected persons; with 12 640 laboratory-confirmed cases (a portion of the true number), only 93 laboratory-confirmed H1N1-associated deaths occurred.
To the Editor : A study in Canada and New Zealand (Kearon et al.) suggested that fixed-dose unmonitored subcutaneous (SC) unfractionated heparin (UFH) is as effective and safe as low-molecular-weight heparin (LMWH) for the acute treatment of venous thrombo-embolism (VTE). While this trial has limitations, it provides evidence to support the use of SC UFH in a resource-constrained environment. However, because public sector patients with VTE in South Africa often have multiple co-morbidities and are thinner and younger than those in that study, the local validity of the published dosing regimen is unclear.
Background. Tuberculosis (TB) is a major health problem in the Western Cape, with an incidence exceeding 900 per 100 000 people. Nosocomial transmission of TB, and particularly drug-resistant TB, is a potential risk that may be undetected. Rapid diagnosis and rapid institution of effective anti-TB treatment, combined with appropriate infection control measures, are essential to prevent nosocomial transmission of TB. To estimate the potential for nosocomial transmission, we aimed to determine the in-hospital delays in diagnosis and treatment of patients with multidrug-resistant (MDR)-TB at a tertiary care hospital.
Methods. A descriptive study, based on retrospective review of patient records and laboratory data, including all adult patients (<13 years) where TB culture and susceptibility testing confirmed MDR-TB on specimens submitted to Tygerberg Hospital's National Health Laboratory Service (NHLS) laboratory in 2007.
Results. Thirty-one patients with MDR-TB were identified. The median laboratory turnaround time (TAT) from collection of specimen to confirmation of MDR-TB was 40 days, while the median time from the time of first presentation at Tygerberg Hospital to institution of MDR treatment was 44 days. Twenty patients were considered infectious during their hospital stay, generating 345 inpatient infectious days.
Conclusions. The study suggests that there is an ongoing substantial risk for nosocomial transmission of MDR-TB at Tygerberg Hospital. We propose improvements, including the use of rapid drug susceptibility testing. The consistent application of infection control measures to prevent nosocomial spread of TB, including MDR-TB, remains vital.
Background. During inflammation, the serum concentrations of granulocyte colony-stimulating factor (G-CSF), plasma interleukin-6 (IL-6), and C-reactive protein (CRP) increase. A positive correlation between CRP and the percentages of neutrophils exhibiting toxic granulation during inflammation has been demonstrated, and that the fluctuations of CRP and toxic granulation of neutrophils were similar.
Objectives. We studied whether grading of toxic granulated neutrophils can be used as a surrogate marker for infection or inflammation, and also be an easier method than previously described methods.
Materials and methods. We graded 357 consecutive peripheral blood slides from patients on whom a full blood count with differential count and CRP level was performed, according to intensity of toxic granulation in the neutrophil population, according to a newly proposed grading system.
Results. The CRP range was between 1 and 530.3 mg/l. The results confirm the association between a rise in CRP and progressive intensity of toxic granulation in neutrophils in peripheral blood. Kruskal-Wallis equality of populations rank test showed a statistically significant difference between the graded categories (p=0.0001). The Trend test was also statistically significant (p=0.000).
Conclusion. The proposed system can be applied to patients with inflammatory or infectious conditions, where grading of toxic granulation of neutrophils can possibly be used as a surrogate marker to assess infection or inflammation and their response to treatment. It may be of particular use in cases where traditional infectious or inflammatory markers cannot be used, owing to inherent problems associated with the respective conditions.
Background. Anaemia has been reported to affect 20 - 75% of children in South Africa. The range suggests the effects that geography, health, and socio-economic status can have on the observed prevalence of anaemia within a specific community. Our objective was to investigate the prevalence of anaemia in children aged under 5 presenting for well-child examinations at a community health centre in Thohoyandou, Limpopo Province.
Design. A cross-sectional observational study was carried out in June and July 2007. Caregivers participated in a brief interview where demographic, health and nutritional information was collected. A blood sample was collected from each child, and haemoglobin levels were assessed with a point-of-care haemoglobin testing system. Anaemia was defined as having a haemoglobin value <2 standard deviations below age-altitude adjusted normal values.
Results. Three-quarters (39/52 - 75%) of children were anaemic. Girls were significantly more likely to be anaemic than boys (20/20 v. 19/32 respectively; p=0.001). Anaemic children were significantly less likely to be underweight compared with their peers (32/38 v. 5/12 respectively; p=0.007). There was no significant association between anaemia and infection with Helicobacter pylori (p=0.729), intestinal helminths (p=1.000) or food insecurity (p=0.515).
Conclusion. We found a striking prevalence of anaemia among clinically well children <5 years old in Thohoyandou, Limpopo Province. The rates of anaemia were higher than those found in previous studies conducted in similar settings in South Africa. Future work should focus on aetiologies and interventions.