1993, the year I was appointed Editor of the SAMJ, turned out to be a Dickensian moment in the history of South Africa. As in The Tale of Two Cities, 'It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us.' In that year, the diverse parties concluded the political negotiations leading to the adoption of a new democratic constitution. At the same time, senseless political violence continued, typified by the deadly attack on worshippers at the St James Church in Kenilworth, Cape Town. Nelson Mandela and F W de Klerk were awarded the Nobel Peace Prize, and activist Chris Hani was assassinated by the right-wing fringe. The Proteas, newly readmitted to international competition after 21 years of the sports boycott of South Africa, walloped Sri Lanka and drew with Australia in test cricket; domestically, the defence force opened fire on a house of an anti-apartheid activist in Umtata, killing five schoolchildren. The atmosphere in the country was thick with trepidation and hope, anxiety and anticipation.
Women and girls welcome NHI
We doctors are still getting it wrong ...
'Reflex' screening for cryptococcal disease
ART for HIV-associated TB - so far we are failing such patients
High prevalence of antenatal depression in HIV-infected women
Seeking 'cognitive enhancement' ... doctors should be warned
Xhosa ritual male circumcision in Eastern Cape Province (ECP) has become a matter of significant concern, following the numerous deaths and injuries resulting from botched circumcisions that occur in this cultural practice. Preventing these adverse events is a priority of the Department of Local Government and Traditional Affairs of the Eastern Cape (DLGTA:ECP).
The arrest in August 2012 and subsequent prolonged detention in an Abu Dhabi prison of 78-year-old Emeritus Professor Cyril Karabus has justifiably been met with shock and outrage, both locally and globally. To quote our sister publication the British Medical Journal, this is nothing short of a disgrace.
This letter seeks to to shed some light and rationality on the recent confusion surrounding the Cancer Association of South Africa (CANSA)-initiated ultraviolet A (UVA) test results on some South African (SA) sunscreens.
Working privately during their official State working hours, nearly one in four specialists forensically reviewed and employed at the Nelson Mandela Academic Complex and/or Walter Sisulu University in Mthatha earned between R6 500 and R126 000 extra over six months last year.
In an unprecedented breast cancer busting campaign aimed at the medically uninsured, the NGO PinkDrive, tertiary hospitals and clinics in three provinces, plus MediClinic, are temporarily eliminating public sector mammography backlogs, potentially saving thousands of lives.
Under universal health coverage South Africa's general practitioners will reclaim their rightful place at the heart of the primary healthcare delivery system and slowly but surely increase their share of a hugely enlarged national 'medical aid' cake.
South African Indians (originally migrants from South Asia) have the highest rates of cardiovascular disease and diabetes in the country - and a fascinating contributor may be that their blood vessels are narrower than those of other race groups. Coronary angiograms and postmortem studies reveal this little known fact, according to Dr Alexander T Cohen, honorary consultant vascular physician at Kings College Hospital in London, who cautioned that the high diabetes rates were primarily responsible for the cardiovascular elevation.
Two academic stalwarts who have led the transformation of SAMA's general medical journals (SAMJ and CME) and its 10 specialist medical journals, last month left the helm of their sturdy purpose-crafted business ship, the Health and Medical Publishing Group (HMPG).
Solly Marks was born in Cape Town on 23 October 1926 and matriculated in Graaff Reinet in 1943. He obtained the BSc degree at UCT in 1945 and MB ChB in 1949. From 1950 to 1952 he was an intern and then a Senior House Officer at Groote Schuur Hospital. From 1953 to 1956 he was a registrar in the gastrointestinal unit at the Western Hospital in Edinburgh.
The quest for enhancement has been part of human culture for thousands of years. Progress in scientific developments and especially in medical science has enabled previously unimaginable advances to be employed in endeavours to improve human functioning in its various forms. Previously enhancement focused on aspects such as prolonging life, improving the immune system or cosmetic enhancements. Cognitive enhancement is currently receiving substantial attention. The use of stimulants such as methylphenidate, especially among students at tertiary institutions aiming to enhance their cognitive abilities, has raised concerns, ranging from safety issues and the risk of drug abuse to moral issues relating to the broader context of enhancement. We consider arguments used to debate both the promotion of enhancement therapies and the restriction and possibly even prevention of their use.
Despite widespread use, few empirical data on the efficacy of traditional medicine are available. We conducted systematic reviews of eight widely used African medicines and identified only one plant, Pelargonium sidoides, which has been extensively studied (including in a Cochrane systematic review). To address the need for rigorous science to underpin traditional medicine claims, the South African Herbal Science and Medicine Institute at the University of Western Cape launched the Multi-disciplinary University Traditional Health Initiative (MUTHI) in 2011. The European Union-funded initiative aims to build sustainable research capacity on plants for better public health in Africa. A 2011 needs analysis of clinicians and scientists from 14 African countries confirmed a lack of clinical trial methodology, knowledge and experience. In response, MUTHI deliverables include annual clinical trial methodology workshops in host countries and development of e-learning modules. The initiative provides a unique opportunity for developing African capacity to discover new medicinal products.
Cryptococcus neoformans is the most common cause of laboratory-confirmed meningitis in South Africa. Despite the increased coverage of antiretroviral treatment (ART), the country's incidence of cryptococcal meningitis remains high, and in routine care settings, the disease has a case-fatality ratio of >50% at 12 weeks post-diagnosis. Screening and pre-emptive antifungal treatment is desirable to prevent the development of cryptococcal meningitis and associated deaths.
Background. Implementation of National Health Insurance (NHI) commenced recently. With the promise of addressing drastic inequalities in the health sector, NHI has the potential to positively transform the health system. In particular, NHI could have a significant positive impact on females, who are disadvantaged under the current system, with higher rates of poor health and lower rates of medical scheme membership compared with males. Despite NHI's transformative potential, however, the public discourse on NHI as portrayed in the media suggests that it is an unpopular policy. The evidence presented in this paper is to the contrary.
Objectives. To assess the general public's opinion on NHI and to explore gender differences in perceptions.
Methods. This paper reports on findings from a 2010 cross-sectional nationally representative survey of the South African population that assessed social attitudes, including perceptions on NHI. Sex-disaggregated data were analysed in SPSS version 20.
Results and conclusions. There is broad public acceptance of NHI, indicating that an overwhelming majority of South Africans would prefer an NHI system to the current two-tiered system. Support for NHI has increased since similar studies in 2005 and 2008, with the simultaneous growth of public discourse on the policy. More females than males support NHI, reflecting the potential of the NHI system to have a positive impact on gender equality and the health of women and girls.
Sirolimus, a potent inhibitor of B- and T-cell activation, is a commonly used immunosuppressant after renal transplantation. Withdrawal of sirolimus from the immunosuppression regimen may reduce B-cell surveillance. We present a case of rapidly progressive central nervous system (CNS) polymorphic Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disorder following the withdrawal of sirolimus.
Objectives. To evaluate the efficacy of Ringer's lactate, isotonic saline and hypertonic saline on the clinical and biochemical recovery of athletes with exercise-associated hyponatraemic encephalopathy caused by fluid overload.
Methods. We retrospectively reviewed serial blood sodium concentrations (Na+) and qualitative signs of recovery and time to recovery in two healthy menstruant females hospitalised with dilutional exercise-associated hyponatraemic encephalopathy after withdrawal from the 2011 Comrades Marathon (89 km) and Argus Cycle Tour (109 km).
Results. Improvements in blood Na+ did not occur with intravenous administration of Ringer's lactate solution, but did occur with administration of isotonic and hypertonic saline. Qualitative improvements in mental status were not quantitatively related to the biochemical value of blood Na+ or subsequent return to normonatraemia.
Conclusions. Hyponatraemia should be suspected in all female athletes presenting to the medical area of endurance races with vomiting, altered mental status and a history of high fluid intake. If a diagnosis of exercise-associated hyponatraemia with cerebral encephalopathy is confirmed, the treatment of choice is administration of an intravenous bolus of hypertonic saline. Administration of Ringer's lactate should be discouraged, as this does not correct Na+ and appears to delay recovery.
Background. HIV-associated tuberculosis (TB) is common in South Africa. The optimal time for initiating antiretroviral therapy (ART) in co-infected patients is a clinical challenge.
Aim. We aimed to compare clinical outcomes of patients with HIV-associated TB who commenced ART at different stages of TB therapy.
Methods. A retrospective chart review was conducted of 458 patients who initiated ART at ≤28 days (immediate), 29 - 56 days (early) and ≥57 days (delayed) after commencing TB therapy, and clinical outcomes after 6 months of ART were compared.
Results. There was a higher mortality in the immediate group, although this was not significant. Renal impairment (hazard ratio (HR) 2.5; 95% confidence interval (CI) 1.3 - 4.9; p=0.004) and inpatient ART initiation (HR 3.7; 95% CI 1.6 - 8.2; p=0.001) were risk factors for HIV-associated TB mortality. A baseline haemoglobin concentration ≥10 g/dl (HR 0.2; 95% CI 0.1 - 0.6; p=0.003), extrapulmonary as opposed to pulmonary TB (PTB) (HR 0.3; 95% CI 0.1 - 0.7; p=0.005) and extrapulmonary plus PTB as opposed to PTB (HR 0.3, 95% CI 0.1 - 0.6; p=0.002) were significantly associated with decreased mortality.
Conclusion. The timing of initiation of ART after commencing TB therapy was not significantly associated with increased mortality or survival. Patients with more advanced disease were more likely to die. Early HIV testing and ART initiation is recommended to decrease mortality.