South African Medical Journal - Volume 100, Issue 8, 2010
Volumes & issues
Volume 100, Issue 8, 2010
Author Dhamend LutchmanSource: South African Medical Journal 100 (2010)More Less
To the Editor : The incidence (or not) of intraventricular haemorrhage (IVH) in infants receiving surfactant remains controversial. Moreover, it is well known that the incidence of IVH, adjusted for known risk factors, varies across neonatal intensive care units (NICUs) in any country.
Author Brian RaynerSource: South African Medical Journal 100 (2010)More Less
To the Editor : I was asked to see a patient with poorly controlled hypertension and a strong family history of type 2 diabetes. In June 2010, glucometer readings were consistently raised (approximately 18 mmol/l) and his general practitioner did an HBA1C, which was markedly elevated at 10.9. A diagnosis of type 2 diabetes was made and he was commenced on metformin. A fasting lipogram showed significant dyslipidaemia consistent with metabolic syndrome.
Source: South African Medical Journal 100, pp 484 –486 (2010)More Less
Source: South African Medical Journal 100, pp 487 –490 (2010)More Less
Source: South African Medical Journal 100, pp 490 –491 (2010)More Less
Source: South African Medical Journal 100, pp 494 –497 (2010)More Less
The enormously profitable complementary medicines, dietary supplements and traditional medicines markets are largely unregulated internationally and in South Africa. Attempts to ensure that consumers are not exposed to harmful or ineffective products have met with varying success around the world.
Author Fathima DocratSource: South African Medical Journal 100, pp 498 –500 (2010)More Less
Natural disasters and acts of terrorism demonstrate a similar critical need for national preparedness. As one of a team of volunteers with a local South African NGO who recently went on a medical mission, I would like to share glimpses of our experience and reflect on the mistakes - and also to state the obvious : that we do not learn from our mistakes. A simple literature search has shown that the same mistakes happen repeatedly. 'Humanitarian disasters occur with frightening regularity, yet international responses remain fragmented, with organizations and responders being forced to "reinvent the wheel" with every new event.' This is the result of an obvious lack of preparedness.
Author Chris EllisSource: South African Medical Journal 100 (2010)More Less
With the arrival of the total body scanner and the ubiquitous ultrasound machine, I wonder if I really need to continue examining my patients? Should I discard my patella hammer and tuning fork and just bring my laptop and personal digital assistant to work? What would Charcot, Rhomberg or Babinski think of all those computer printouts revealing the answers in black and white, without having to touch the patient? Babinski would probably have dropped his patella hammer in dismay. His full name was Joseph Jules François Félix Babinski, which suggests that he might have been a Russian aristocrat, and a skilled swordsman to boot - but he was in fact a French neurologist of Polish descent. He is remembered for the eponymously named Babinski reflex. He was also a gourmet. This is rather an inconsequential piece of information, but I like to imagine him, after a vigorous day of testing reflexes, sitting at a pavement café in Paris, savouring a light lemon soufflé and elegantly sipping from a glass of vin extraordinaire.
Source: South African Medical Journal 100 (2010)More Less
With the death of Professor Lionel Shelsley (LS) Smith, we have lost an early icon of forensic medicine and pathology in South Africa. It was through his farsightedness and that of his colleague, Professor Theodor Gottfried Schwär, that the first Diploma in Forensic Medicine was instituted by the South African Colleges of Medicine of the time. Thereafter, the MMed in Forensic Pathology was simultaneously introduced at the universities of Cape Town, Stellenbosch, Durban, Pretoria, Wits, Medunsa and the Free State.
Author Bongani M. MayosiSource: South African Medical Journal 100 (2010)More Less
The National Department of Health has promulgated the first week of August as National Rheumatic Fever Week ever since rheumatic fever was made a notifiable condition in 1989. The results of the Heart of Soweto Study, however, show that very little progress has been made in reducing the burden of rheumatic heart disease over the past 20 years. This prospective study of 4 005 patients with heart disease who presented at Chris Hani Baragwanath Hospital during 2006/07 showed that 960 (24%) had valvular heart disease. The incidence of new cases of rheumatic heart disease for those aged <14 years in Soweto was 23.5 cases/100 000 per annum, which puts this urban community among the high-incidence communities of the world. It is not surprising that this preventable condition remains common, because of inadequate implementation of the guideline for the prevention of rheumatic fever in South Africa. A recent study showed that very few paediatricians were aware that rheumatic fever is a notifiable condition, and that the national notification system administered by the Department of Health was dysfunctional.
A paradoxical reduction in upper genital tract infection despite the massive HIV epidemic : scientific lettersSource: South African Medical Journal 100, pp 508 –509 (2010)More Less
To the Editor : Upper genital tract infection (UGTI), which is also referred to as pelvic inflammatory disease (PID), is one of the most common serious gynaecological disorders that affect women in their reproductive years, with very serious long-term consequences such as chronic pelvic pain, ectopic pregnancy and infertility. It is a sexually transmitted infection (STI) caused by many micro-organisms such as Nesseria gonorrhoeae, Chlamydia trachomatis and anaerobes. It can be clinically classified into uncomplicated (absence of tubo-ovarian abscess (TOA)) or complicated (presence of TOA).
Pleuro-pulmonary disease in central South Africa : a thoracic surgical deficiency : scientific lettersSource: South African Medical Journal 100, pp 510 –512 (2010)More Less
To the Editor : We wished to estimate the performance gap between thoracic surgical service provision and the burden of thoracic surgical disease in central South Africa (SA). We compared burden of disease data to the number of thoracic operations performed for inflammatory pleuro-pulmonary disease and primary lung cancer. The performance gap was estimated to be a factor of 1:20 for lung cancer and 1:10 for thoracic surgery as a whole. The extent of under-provision of thoracic surgical services in central SA demonstrates that urgent major health care system reforms are required at all levels to address the significant performance gap between service provision by thoracic surgery and the burden of disease in central SA.
Source: South African Medical Journal 100, pp 513 –515 (2010)More Less
Background and problem statement. The South African response to the Haitian earthquake consisted of two independent nongovernment organisations (NGOs) working separately with minimal contact. Both teams experienced problems during the deployment, mainly owing to not following the International Search and Rescue Advisory Group (INSARAG) guidelines.
Critical areas identified. To improve future South African disaster responses, three functional deployment categories were identified : urban search and rescue, triage and initial stabilisation, and definitive care. To best achieve this, four critical components need to be taken into account : rapid deployment, intelligence from the site, government facilitation, and working under the auspices of recognised organisations such as the United Nations and the World Health Organization.
Conclusion. The proposed way forward for South African medical teams responding to disasters is to be unified under a leading academic body, to have an up-to-date volunteer database, and for volunteers to be current with the international search and rescue course currently being developed by the Medical Working Group of INSARAG. An additional consideration is that South African rescue and relief personnel have a primary responsibility to the citizens of South Africa, then the Southern African Development Community region, then the rest of the African continent and finally further afield. The commitment of government, private and military health services as well as NGOs is paramount for a unified response.
Source: South African Medical Journal 100, pp 516 –520 (2010)More Less
Background. While countries such as the USA, South Africa and China debate health reforms to improve access to care while rationalising costs, Canada's health care system has emerged as a notable option. In the USA, meaningful discussion of the advantages and disadvantages of the Canadian system has been thwarted by ideological mudslinging on the part of large insurance companies seeking to preserve their ultra-profitable turf and backed by conservative political forces stirring up old fears of 'socialised medicine'. These distractions have relegated the possibility of a 'public option' to the legislative dustbin, leaving tens of millions of people to face uninsurance, under-insurance, bankruptcy and unnecessary death and suffering, even after passage of the Obama health plan. While South Africa appears to experience similar legislative paralysis, there remains room for reasoned health reform debate to address issues of equity, access, and financing.
Objective. Our aim is to contribute to the debate from a Canadian perspective, setting out the basic principles of Medicare (Canada's health care system), reviewing its advantages and challenges, clarifying misunderstandings, and exploring its relevance to South Africa. We periodically refer to the USA because of the similarities to the South African situation, including its health care system, which mirrors South Africa's current position if left unchanged.
Conclusion. While Medicare is neither flawless nor a model worthy of wholesale imitation, we contend that open discussion of Canada's experience is a useful component in South Africa's current policy and political efforts.
Source: South African Medical Journal 100, pp 521 –524 (2010)More Less
Background. No national South African institution provides a coherent suite of support, available skills and training for clinicians wishing to conduct randomised controlled trials (RCTs) in the public sector. We report on a study to assess the need for establishing a national South African Clinical Trials Support Unit.
Objectives. To determine the need for additional training and support for conduct of RCTs within South African institutions; identify challenges facing institutions conducting RCTs; and provide recommendations for enhancing trial conduct within South African public institutions.
Design. Key informant interviews of senior decision-makers at institutions with a stake in the South African public sector clinical trials research environment.
Results. Trial conduct in South Africa faces many challenges, including lack of dedicated funding, the burden on clinical load, and lengthy approval processes. Strengths include the high burden of disease and the prevalence of treatment-naïve patients. Participants expressed a significant need for a national initiative to support and enhance the conduct of public sector RCTs. Research methods training and statistical support were viewed as key. There was a broad range of views regarding the structure and focus of such an initiative, but there was agreement that the national government should provide specific funding for this purpose.
Conclusions. Stakeholders generally support the establishment of a national clinical trials support initiative. Consideration must be given to the sustainability of such an initiative, in terms of funding, staffing, expected research outputs and permanence of location.
Source: South African Medical Journal 100, pp 525 –528 (2010)More Less
Objective. To determine the epidemiological features and outcome of fireworks-related injuries among children 0 - 13 years old.
Design. A retrospective study from the trauma registry of a children's hospital from 2001 - 2009.
Results. Fifty-five children were treated for injuries from fireworks. The mean age was 8.8 years, 78% were boys, and the largest age group was 5 - 9 years old. Firecrackers accounted for 95% of the injuries; the most commonly injured body sites were hands (44%), eyes (42%) and face (31%); 47% of the patients had more than one injury. The most common injury type was burns (67%); 25 children were admitted, mostly to the burns and ophthalmology units. The mean length of hospital stay was 3.5 days. Surgical intervention was required in 38% of the patients. Most of the fireworks accidents occurred in or around the patients' homes. There were more fireworks-related injuries around Guy Fawkes Day (85%) than New Year's Eve (9%).
Conclusion. Consumer fireworks cause serious but preventable injuries to children, either as users or bystanders. Children and their families should be encouraged to enjoy pyrotechnical displays conducted by professionals at designated areas. All fireworks for individual private use should either be supervised by an adult or banned. Current legislation should be more strictly enforced, especially the sale to under-age children.
The microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand : original articlesAuthor Ian Paul OlwochSource: South African Medical Journal 100, pp 529 –533 (2010)More Less
Design. A retrospective chart review study at two referral hospitals identified 226 consecutive surgical patients with acute complicated sinusitis.
Subjects. One hundred and fifty-nine male and 67 female patients, with a mean age of 16.5 (standard deviation 0.7) years, underwent external fronto-ethmoidectomy with maxillary sinus washout and 13 had a concurrent craniotomy.
Results. A total of 233 micro-organisms were isolated from 163 patients (72.1%), and 63 (27.9%) were culture negative. Positive isolates included Streptococcus milleri (18.5%), Staphylococcus aureus (12.4%), β-haemolytic streptococci (10.8%), coagulase-negative staphylococci (8.6%), Haemophilus influenzae (8.6%) and the anaerobes, Peptostreptococcus (6.4%) and Prevotella (4.7%) species. The prevalences of S. pneumoniae (2.6%), methicillin-resistant S. aureus (MRSA) (1.3%) and Moraxella catarrhalis (0.4%) were low. Polymicrobial disease was present in 56 patients (34.4%). There was a significant difference between the two hospitals in the prevalences of some bacteria (p<0.05). Antibiotic resistance was highest towards the penicillins (64.3%) and cephalosporins (12.5%). Effective empiric treatment was achieved with metronidazole and a choice of amoxicillin-clavulanate or ampicillin plus cloxacillin or penicillin plus chloramphenicol.
Conclusion. The polymicrobial nature and severity of complicated sinusitis warrants a de-escalation approach to antimicrobial therapy. The combination of β-lactamase-resistant penicillins and metronidazole is a reasonable choice for initial empiric antibacterial therapy. Selection of drugs for empirical antibiotic therapy in patients with acute complicated sinusitis should be supported by knowledge of the local prevalence and antimicrobial susceptibilities of bacteria isolated from patients.
Source: South African Medical Journal 100, pp 534 –536 (2010)More Less
Background. Balantidium coli, a ciliated protozoan parasite that infects primates and pigs, and is the largest protozoan to infect humans, is a well-known cause of diarrhoea and dysentery in humans. Extra-intestinal disease is uncommon, however.
Objective. We describe a case of lung involvement, with severe pulmonary haemorrhage resulting in iron deficiency anaemia and respiratory failure, of a 20-year-old, immune-competent man.
Results. Diagnosis was made by bronchial biopsy and lavage, which showed numerous trophozoites compatible with B. coli with a background of acute inflammatory cells. The origin of infection was not clear, but inhalation of pig manure was postulated as there was no history of intestinal disease. The patient was treated with oxytetracyline and metronidazole, kept in an ICU, improved within 48 hours, and was discharged within 4 days.
Conclusion. B. coli infection should be considered as part of the differential diagnosis of pulmonary haemorrhage.