Nelson Mandela in 1994 stated that 'A critical, independent and investigative press is the lifeblood of any democracy.' But now South Africa's highly contested Protection of Information Bill (the Bill) provides a useful hook on which to hang some thoughts on media freedom. 'Worldwide, most freedom of information laws exclude the private sector from their jurisdiction. Information held by the private sector cannot be accessed as a legal right. This limitation has serious implications, because the private sector is performing many functions that were previously the domain of the public sector. As a result, information that was previously public is now with the private sector, and the private contractors cannot be forced to disclose information.'
A corruption cleanout by Eastern Cape Health Director-General, Dr Siva Pillay, has so far landed eight of his top health care administrators in court and could eventually restore nearly R1 billion to his budget, but has endangered his life and that of his family.
For an annual extra R35 of health care spending per person, South Africa could provide universal coverage of key interventions for maternal and infant health and prevent 49 500 annual deaths, saving the affected families a lifetime of heartache.
Joy, Tony, Rob and Sven say goodbye to John. Husband, father, one of South Africa's great doctors and the humblest of gentlemen, John passed away on 10 April 2011. John has enlightened the many lives he has touched and devoted his career to the children of Africa. While he lives on in us and inspires so many of our lives, the world is a better place for the gift of his time with us.
Ramesh Chhotu Bhikha was born in Vavra Village, Gujerat, India, on 15 September 1946, and moved to Cape Town when he was 6 years old. He attended Battswood Primary School and South Peninsula High School before proceeding to UCT, where he graduated MB ChB in 1971.
Hello Doctor, a new telemedicine business providing cheap, accessible health information and advice, put its call centre on ice last month after the Health Professions Council of South Africa (HPCSA) said it was violating patient rights.
If the University of Cape Town's Lung Institute was a long-distance runner it would have the capacity to consistently outstrip many other peer research outfits in the country, garnering marathon medals by the fist-full.
A recent major report, commissioned by the South African Government, examines alternative long-term scenarios for the costs and benefits of HIV prevention and treatment, and care for orphans and others affected by AIDS in South Africa. Not considered by the report is what one might call 'treatment-centred prevention' (TcP), by which we mean a combination of regular testing for HIV, immediate highly active antiretroviral therapy (HAART) offered to all infected individuals, and other proven HIV prevention methods. Such an approach could dramatically reduce infectiousness of HIV-positive people, leading to critical reductions in the rate of new infections.
Given the significant disease burden of tuberculosis (TB) and TB/ HIV co-infection in South Africa, disseminated TB and tuberculous lymphadenitis are common and important causes of morbidity. Despite this relationship, Horner's syndrome secondary to tuberculous lymph node compression of sympathetic nerves is rare.
Breaking news to a patient of an illness feared to be serious or life-threatening has always caused difficulties, both moral and ethical, among doctors and all other health care providers. Moreover, there are distinct differences in the approach to this topic among various religious and cultural groups. In any diverse society, such as that in South Africa, it is helpful for doctors to familiarise themselves with the practices and philosophies of various groups, faiths and cultures, in matters relating to life and death. This article attempts to define a Jewish approach, and hopefully create better understanding of the subject among all doctors and health-care providers. (To avoid clumsy repetition, the term 'doctor' will hereafter be used and will denote all health care providers.)
Dilated cardiomyopathy (DCM) is a relatively common condition in sub-Saharan Africa, accounting for a substantial portion of patients admitted for heart failure. In the Heart of Soweto study it was the most common cardiovascular disease. Two important contributions to our understanding of this puzzling condition appear in this issue.
To the Editor: Health-related quality of life (HRQOL) in the workplace is receiving increasing attention, probably because of findings that better functioning, general health and wellbeing and lower levels of pain are associated with higher productivity, dependability and creativity, overall higher work quality and lower absenteeism. However, no research has been conducted on HRQOL in the South African mining industry.
Background. Studies from Europe and North America suggest that 20 - 50% of patients with dilated cardiomyopathy (DCM) may have familial disease. There is little information on the frequency and clinical genetics of familial DCM in Africa.
Purpose. To determine the frequency and probable mode of inheritance of familial DCM in patients referred for investigation of the cause of DCM at a tertiary centre in Cape Town.
Methods. We conducted a retrospective analysis of consecutive patients diagnosed with DCM between 1 February 1996 and 31 December 2009 to determine the frequency of familial disease.
Results. Of 109 unrelated patients with DCM, 29 (26.6%) had familial disease. Their mean age of onset of cardiomyopathy (28.01 (standard deviation (SD) 15.33) years) was significantly younger than that for non-familial cases (39.1 (SD 12.6) years) (p=0.001). Male predominance (N=21, 72.4%) and racial distribution (15 (48.3%) coloured patients, 10 (34.5%) black Africans, 4 (13.8%) white individuals, and 1 (3.4%) of Indian descent) of familial DCM probands were similar to the non-familial cases. Of the 29 patients with familial DCM, 2 (7%) had at least one relative diagnosed with peripartum cardiomyopathy. Pedigree analysis of the 29 families was consistent with autosomal dominant inheritance in 72.4%, autosomal recessive inheritance in 17.2% and X-linked recessive inheritance in 10.4%.
Conclusions. Familial DCM affects at least a quarter of African patients with DCM, presents at a young age, is associated with peripartum cardiomyopathy, and follows an autosomal dominant pattern of inheritance in the majority of families. Family screening for familial DCM is indicated in all cases of unexplained DCM, including patients with peripartum cardiomyopathy.
Background. It is not known whether there are differences in clinical characteristics and outcomes of patients with familial and idiopathic dilated cardiomyopathy (DCM) in an African setting.
Purpose. To compare the clinical characteristics and outcomes of familial and idiopathic DCM.
Methods. We performed a retrospective study of familial and idiopathic DCM at Groote Schuur Hospital, Cape Town, between 1 February 1996 and 31 December 2009. Clinical, electrocardiographic (ECG) and imaging characteristics were compared, in addition to treatment and survival.
Results. Eighty patients with idiopathic DCM and 40 familial cases were studied. ECG T-wave inversion was significantly more frequent in familial DCM (87.5%) than in idiopathic cases (68.8%) (p=0.014), whereas idiopathic patients had a higher prevalence of pathological Q waves (32.5%) than familial cases (12.5%) (p=0.028). Cardiac chambers were significantly more dilated with poorer systolic function in idiopathic than familial cases. A mortality rate of 40% after a median follow-up of 5 years was, however, similar in both groups. The presence of New York Heart Association functional class III and IV symptoms was an independent predictor of mortality (odds ratio (OR) 3.85, 95% confidence interval (CI) 1.30 - 48.47, p<0.001), while heart transplantation was an independent predictor of survival (OR 4.72, 95% CI 1.31 - 72.60, p=0.026) in both groups. Digoxin use without serum monitoring was a significant predictor of mortality in idiopathic DCM (OR 1.62, 95% CI 1.04 - 3.98, p=0.037).
Conclusion. Patients with idiopathic DCM have greater cardiac dysfunction than those with familial disease, but mortality is similarly high in both groups. Digoxin use without drug level monitoring may be associated with increased mortality in idiopathic DCM.
Background. Neuroleptic malignant syndrome (NMS) is a rare side-effect of neuroleptic medication. Most NMS reports have been on adults, and the incidence in children and adolescents is unknown.
Objective. This report reviews cases of NMS to highlight possible risk factors for the development of NMS in adolescents.
Method. Four cases of probable NMS in adolescents diagnosed in the Western Cape between February 2009 and March 2010 are presented.
Results. Risk factors in the development of the syndrome in adolescents in the Western Cape may be male gender, polypharmacy, the use of zuclopenthixol acetate (clopixol acuphase), a previous history of extra-pyramidal side-effects or NMS, and a history of substance misuse - in particular methamphetamine.
Conclusion. Caution must be applied in the apparent overuse of intramuscular antipsychotics, and especially zuclopenthixol acetate (clopixol acuphase), in neuroleptic-naïve and agitated psychotic adolescents where the short-term use of benzodiazepines is more appropriate.
HIV testing uptake at 3 antenatal clinics in Johannesburg was 53% (1 333/2 502) during 4 months when lay counsellors were unpaid, which was lower than the 7 months when payment was provided (79%; 3 705/4 722; p<0.001), and a subsequent 12-month period (86.3%, 11 877/13 767; p<0.001) when counsellors were paid. Consistent remuneration of lay counsellors could markedly improve services for preventing mother-to-child HIV transmission.