Background. The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data.
Methods. We drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership in gender-based violence.
Conclusion. Guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. We have no idea if the overall decrease in gunshot homicides applies to women in relationships, and therefore gun control should remain high on the legislative agenda.
Objective. To study the progress and challenges with regard to universal antiretroviral (ARV) access in Free State Province, South Africa.
Methods. Data from the first 4 years of the public sector ARV roll-out and selected health system indicators were used. Data were collected from the public sector ARV database in Free State Province for new patients on ARVs, average waiting times and median CD4 counts at the start of treatment. Information on staff training, vacancy rates and funding allocations for the ARV roll-out was obtained from official government reports. Projections were made of expected new ARV enrolments for 2008 and 2009 and compared with goals set by the National Strategic Plan (NSP) to achieve universal access to ARVs by 2011.
Results. New ARV enrolments increased annually to 25% of the estimated need by the end of 2007. Average waiting times to enrolment decreased from 5.82 months to 3.24 months. Median CD4 counts at enrolment increased from 89 to 124 cells/µl. There is a staff vacancy rate of 38% in the ARV programme and an inadequate increase in budget allocations.
Conclusion. The current vertical model of ARV therapy delivery is unlikely to raise the number of new enrolments sufficiently to achieve the goals of universal access by 2011 as envisaged by the NSP. The Free State is implementing a project (STRETCH trial) to broaden the ARV roll-out in an attempt to increase access to ARVs.
Background. Impaired fasting or glucose tolerance and/or diabetes can occur with hypertension, which theoretically predicts a worse cardiovascular risk profile, and consequently requires intensive cardiovasular risk management.
Objectives. To characterise the frequency of the occurrence of conventional cardiovascular risk factors among hypertensive subjects with impaired fasting blood glucose.
Methods. We studied 120 hypertensive subjects and 80 age and sex-matched normotensive controls. Relevant history, clinical examination, laboratory and other tests were undertaken. Body mass index was determined. Informed consent was obtained from all participants, and ethical approval was obtained.
Results. There was no statistically significant difference between the age and gender of the hypertensive subjects and the controls (55.1±10.83 v. 54.7±10.89 years, p=0.76). The serum fasting lipids were higher, but not statistically significantly, among the hypertensives than the controls (triglycerides 1.23±0.50 v. 1.22±0.48, p=0.900; total cholesterol 4.51±1.52 v. 4.38±0.84, p=0.842; LDL 2.51±1.41 v. 2.4±0.63, p=0.811, respectively). The prevalence of impaired glucose tolerance among newly presenting hypertensive subjects was 30.0%. Hypertriglyceridaemia (38.9% v. 6.0%, p=0.038), hypo-HDL cholesterolaemia (52.7% v. 31.0%, p=0.028) and visceral obesity (52.8% v. 27.4%, p=0.036) were statistically more prevalent among hypertensive subjects with impaired glucose tolerance than among those with normal glucose tolerance.
Conclusion. The prevalence of impaired glucose tolerance among newly presenting hypertensive subjects is very high, and they have more clusters of cardiovascular risks than those without impaired glucose tolerance. The former therefore need intensive cardiovascular assessment and appropriate preventive and treatment modalities. Glucose parameters of newly presenting hypertensive subjects must be determined to evaluate their cardiovascular risk profile.
Objective. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is an accurate non-invasive imaging test for differentiating benign from malignant solitary pulmonary nodules (SPNs). We aimed to assess its diagnostic accuracy for differentiating benign from malignant SPNs in a tuberculosis (TB)-endemic area.
Methods. Thirty patients, 22 men and 8 women, mean age 60 years, underwent dual time point FDG-PET/computed tomography (CT) imaging, followed by histological examination of the SPN. Maximum standard uptake values (SUVmax) with the greatest uptake in the lesion were calculated for two time points (SUV1 and SUV2), and the percentage change over time per lesion was calculated (%DSUV). Routine histological findings served as the gold standard.
Results. Histological examination showed that 14 lesions were malignant and 16 benign, 12 of which were TB. SUVmax for benign and malignant lesions were 11.02 (standard deviation (SD) 6.6) v. 10.86 (SD 8.9); however, when tuberculomas were excluded from the analysis, a significant difference in mean SUV1max values between benign and malignant lesions was observed (p=0.0059). Using an SUVmax cut-off value of 2.5, a sensitivity of 85.7% and a specificity of 25% was obtained. Omitting the TB patients from analysis resulted in a sensitivity of 85.7% and a specificity of 100%. Mean %DSUV of benign lesions did not differ significantly from mean %DSUV of malignant lesions (17.1% (SD 16.3%) v. 19.4% (SD 23.7%)). Using a cut-off of %DSUV <10% as indicative of malignancy, a sensitivity of 85.7% and a specificity of 50% was obtained. Omitting the TB patients from the analysis yielded a sensitivity of 85.7% and a specificity of 75%.
Conclusion. Our findings suggest that FDG-PET cannot distinguish malignancy from tuberculoma and therefore cannot reliably be used to reduce futile biopsy/thoracotomy.
Objectives. The study aimed to determine the clinical and laboratory predictors of a low CD4+ cell count (<200 cells/µl) in HIV-infected patients with pulmonary tuberculosis (PTB).
Design and setting. A prospective cohort study on HIV-positive patients with smear-positive PTB attending an outpatient clinic in Zimbabwe.
Participants. Consecutively consenting HIV-positive adults, aged 18 years and over, who had positive sputum smears for acid-fast bacilli and were naïve to both antituberculosis drugs and ART. Interventions. Baseline CD4+ cell count, full blood count, functional status using the Karnofsky Performance Status (KPS) score and body mass index (BMI, kg/m2) were determined for all participants. Univariate and multiple logistic regression analyses of the data were done.
Results. Of the 97 participants recruited, 59 (61%) were females. The overall mean age was 34 years (standard deviation (SD) 8). The median CD4+ cell count was 104.5 cells/µl (intraquartile range (IQR) 41 - 213 cells/µl). Patients with pleuritic chest pain were less likely to have a low CD4+ cell count than patients who did not (odds ratio (OR) 0.2; confidence interval (CI) 0.03 - 0.8). The following were statistically significant predictors of a CD4+ cell count of <200 cells/ µl: BMI <18 kg/m2 (OR 3.8; CI 1.2 - 12), KPS <54.4 (OR 3; CI 1.1 - 12) and haemoglobin concentration <8 g/dl (OR 13; CI 1.8 - 533).
Conclusions. HIV-infected sputum-positive PTB patients presenting with a BMI <18, KPS <54.4% and haemoglobin concentration <8 g/dl should have early initiation of ART since they are more likely to have a low CD4+ cell count, whereas those presenting with pleuritic pain are less likely to have a low CD4+ cell count.