South African Medical Journal - Volume 102, Issue 2, 2012
Volumes & issues
Volume 102, Issue 2, 2012
Comparative MIC evaluation of a generic ceftriaxone by broth microdilution on clinically relevant isolates from an academic hospital complex in South Africa : original articleSource: South African Medical Journal 102 (2012)More Less
We evaluated the in vitro microbiological efficacy of a generic ceftriaxone product against several clinically significant organisms collected from sterile sites. The minimum inhibitory concentration (MIC) of each was determined simultaneously with the reference and the generic ceftriaxone product. Comparative analysis of MICs between the two products for each isolate was performed using both categorical (interpretive) agreement and essential (actual MIC value) agreement. A total of 260 isolates were tested. Overall, there was categorical agreement of 98.9% and essential agreement of 95.8%. The categorical agreement for all isolates (96.7 - 100%) accorded with international standards, as no very major errors were seen and the major error rate was less than 3%. Of the 90 isolates of E. coli (40), Klebsiella spp. (40) and Salmonella spp. (10), 87.6% had an MIC less than or equal to 0.12 mg/l. The generic ceftriaxone product showed equivalent efficacy by MIC determination to the reference formulation. Ceftriaxone remains a viable and useful antimicrobial agent against a variety of clinically relevant organisms in our setting.
Author Daniel J. NcayiyanaSource: South African Medical Journal 102 (2012)More Less
That the Walter Sisulu University medical school continues to exist and to produce competent health professionals is evidence of extraordinary institutional resilience. The school is located in a university with a troubled history. But even as the university has lurched from crisis to crisis and has periodically been under threat of closure, the medical school has developed and grown to become the university's premier centre of excellence and, it has often been said, its raison d'etre, thanks in large part to sheer grit, commitment and sense of mission on the part of its leaders and academic community.
Author J.P. Van NiekerkSource: South African Medical Journal 102 (2012)More Less
Acute-onset vomiting and diarrhoea is one of the most common illnesses of infancy and second only to respiratory illnesses as a cause of childhood deaths worldwide. Acute diarrhoea may lead to life-threatening dehydration and electrolyte disturbances. Caused by acute infection with a variety of viruses, bacteria and parasites, the condition is easily recognised by caregivers and is usually managed at home. The intestinal infection is caused by contamination of food, water or hands. Existing guidelines for management of diarrhoea are often ignored in public and private practice, possibly because of a perception that the guidelines are too simple, or because the expectations of the need to give 'real' drug therapy to stop diarrhoea. The guidelines in this issue are therefore a timely reminder of the management of a common and potentially dangerous condition.
Author Viroj WiwanitkitSource: South African Medical Journal 102 (2012)More Less
I read with great interest the article on the possible relationship between electrolyte supplementation drinking and renal failure. Based on the four indexed cases, Boulter et al. concluded that 'caution should be advised regarding liberal use of the product during prolonged exercise, despite ingested doses not reaching "toxic" dosages, based on current AI or UL recommendations'.
Source: South African Medical Journal 102 (2012)More Less
Retief and Cilliers suggest an interesting new theory about Akhenaten's physical appearance, but omitted to refer to previously suggested differential diagnoses: for example, schistosomiasis, myotonic dystrophy, elephantiasis and Antley-Bixler syndrome have also been suggested. More recently, we proposed homocystinuria as a possible cause. Since Kallman's syndrome is a hereditary disease, it is important to see how this diagnosis fits into Akhenaten's family tree. The fact that Akhenaten's wife, Nefertiti, and their children were similarly depicted implies that they suffered from the same disease. Akhenaten's parents, Amenhotep III and Tiye, were most probably healthy. The genetics of Kallman syndrome are still not fully understood. However, two of the best-described forms of Kallman syndrome are inherited autosomal dominant and X-linked disorder.
The fast neutron therapy programme for patients in South Africa should come to an end : correspondenceSource: South African Medical Journal 102 (2012)More Less
Neutron therapy for tumours was introduced globally and in South Africa to evaluate the possible improvement of results obtained with conventional photon radiotherapy. This was based on the radiobiological finding that neutron irradiation is more effective in killing all cells, including poorly oxygenated tumour cells which are relatively resistant to conventional photon radiation.
Author Susan LewallenSource: South African Medical Journal 102 (2012)More Less
Thank you for publishing the article by Lecuona and Cook on the important topic of cataract surgical rates (CSR) in the RSA. Indeed, the difficulty in increasing the CSR to the recommended annual target of 2 000 (to eliminate blindness from cataract) is exactly what others in Africa have experienced. Even in some very well-served districts with model programmes and high cataract surgical coverage, we find that a CSR of about 1 500 or less is all that we manage to achieve.
Source: South African Medical Journal 102, pp 62 –66 (2012)More Less
Source: South African Medical Journal 102, pp 68 –72 (2012)More Less
It's been eight years since South Africa's ailing Mental Health Care Act was completely revised to better protect the human rights of patients with mental illnesses, thus revealing some horrific systemic and social abuses, but a dim ray of hope is that the safety net can be made to work.
Author Barry SchoubSource: South African Medical Journal 102 (2012)More Less
Source: South African Medical Journal 102 (2012)More Less
A 52-year-old man presented with signs of a right middle cerebral artery stroke. A large pulsatile mass was noted at the right base of his neck, together with an overlying scar which the patient reported as being due to a stab wound sustained 22 years ago (Fig. 1). A computed tomography (CT) scan of the brain showed an infarct in the area of the right middle cerebral artery (Fig. 2). Computed tomographic angiography revealed a pseudo-aneurysm of the right common carotid artery at its origin with extensive surrounding thrombus (Fig. 3), as well as paucity of branches of the right middle cerebral artery (Fig. 4). Definitive management of the pseudo-aneurysm was achieved by vascular surgical intervention.
Author Melissa RaemaekersSource: South African Medical Journal 102 (2012)More Less
In Lifeblood, TIME's Africa Bureau Chief, Alex Perry, chronicles billionaire-turned-philanthropist Raymond Chambers' efforts in tackling the burden of malaria in Africa, as he pioneered a campaign that saved countless lives and revolutionised the provision of foreign aid in a global context. In a feat of rarely encountered success, the campaign, initiated in 2006, rallied the support of numerous highly influential individuals, corporations and organisations, and saw the distribution of 289 million mosquito nets in 7 of the African continent's countries most severely affected by the illness.
Author John SteerSource: South African Medical Journal 102 (2012)More Less
Challenging Beliefs is the fascinating story of the life of Tim Noakes, a world authority on sports science. Numerous challenges faced in pursuit of 'the truth' expose intellectual and scientific duplicity and the myth of accepting that peer review guarantees an elusive chimera of 'balanced opinions'. The commercialism of the sports industry, a massive marketing game with profit being the driving factor, not what's good for the athlete, is exposed.
Source: South African Medical Journal 102, pp 77 –78 (2012)More Less
At the International AIDS Conference in 2006, the UN envoy on AIDS, Stephen Lewis, described the South African government as 'Obtuse, dilatory and negligent about rolling out treatment', and its AIDS policy as 'more worthy of a lunatic fringe than of a concerned and compassionate state ... [and] wrong, immoral [and] indefensible ... The government has a lot to atone for. I'm of the opinion that they can never achieve redemption.' During this period, the media accused the government, under former President Mbeki, of being denialist and nicknamed the late Minister of Health, Manto Tshabalala-Msimang, 'Dr No' and 'Dr Beetroot' because of her antipathy towards antiretroviral therapy and for advocating the virtues of nutrition.
Source: South African Medical Journal 102, pp 79 –80 (2012)More Less
Under the National Health Insurance, a hospital is expected to provide service to patients based on its category. However, in reality the tertiary hospitals offer every level of care, resulting in poor quality of care and over-expenditure. The Polokwane/Mankweng Hospital Complex is a provincial tertiary hospital that delivers tertiary care as well as dealing with some secondary and primary care cases. This study evaluated the hospital casualty department in the Polokwane/Mankweng Hospital Complex. A sample of 250 patients' records was selected by simple random sampling from a cohort of 14 113 patients who attended the Polokwane Hospital Casualty Department during the 1-year study period. Most patients were admitted in the casualty department as a result of injuries (25%). Only 20% (N=51) of the patients were referred from other health facilities. Half of the patients could have been managed at a regional or district hospital. The overall expenditure for the casualty unit during the 1-year study period was R10 321 401.42 and the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs.
Referral systems must be strengthened to manage patients at regional and district level to reduce the burden on the Polokwane/Mankweng Hospital Complex. It is hoped that the Primary Health Care (PHC) Re-engineering Policy will address this by strengthening the referral system in PHC facilities.
Progress of preventing mother-to-child transmission of HIV at primary healthcare facilities and district hospitals in three South African provinces : scientific lettersSource: South African Medical Journal 102, pp 81 –83 (2012)More Less
Improving national prevention of mother-to-child transmission (PMTCT) services in South Africa has been challenging. PMTCT outcomes were analysed at 58 primary- and secondary-level antenatal facilities across seven high HIV burden sub-districts in three provinces, over an 18-month period during which new South African PMTCT clinical guidelines were implemented and a nurse quality mentor programme was expanded. Early infant HIV DNA polymerase chain reaction test positivity reduced by 75.2% from 9.7% (95% confidence interval (CI) 8.1 - 11.5%) to 2.4% (95% CI 1.9 - 3.1%) (p<0.0005). HIV test positivity at 18 months of age decreased by 64.5% from 10.7% (95% CI 7.2 - 15.1%) to 3.8% (95% CI 2.4 - 5.6%) (p<0.0005). PMTCT outcomes have improved substantially at these facilities.
Source: South African Medical Journal 102, pp 85 –89 (2012)More Less
Background. Patients in acute hospital care show a high risk for venous thromboembolism (VTE); 52% of patients globally are at risk, with approximately only half receiving appropriate prophylaxis.
Objectives. The TUNE-IN study's primary objective was to evaluate the use of VTE prophylaxis in the private sector in South Africa in hospitalised patients in relation to patient risk profile, via both a clinical assessment and utilising a modified risk assessment model (RAM). The secondary objective was to evaluate the relationship between prophylaxis and the level of mobility at discharge as well as on days 3, 7 and 14 post discharge.
Results. Of the 608 patients enrolled, 54.1% were evaluated to be at risk for VTE clinically whilst, with RAM assessment, 74.6% were assessed at risk. Adequate prophylaxis was given to only 70.9% of all patients.
Conclusion. Data appear to correlate with global findings (ENDORSE study): more than 50% of hospitalised patients are at risk for VTE. Clinical risk assessment does not correlate with RAM utilisation, resulting in possible over-diagnosis of VTE risk in low- and moderate-risk patients, with the converse happening in high- and highest-risk patients. Certain risk groups are easily defined for VTE risk (e.g. major orthopaedic surgery), but individual risk assessment is crucial as it often reveals underlying and overlooked risk factors, with BMI and age the most frequently overlooked risk factors.
Sudden and unexpected deaths in an adult population, Cape Town, South Africa, 2001-2005 : original articleSource: South African Medical Journal 102, pp 90 –94 (2012)More Less
Background. According to the regulations of the National Health Act, all 'sudden and unexpected' deaths in South Africa should be referred to Forensic Pathology Services (FPS) for further investigation.
Objectives. We aimed to determine the final outcomes of forensic postmortem examinations in 'sudden and unexpected' adult deaths referred to Tygerberg FPS between 2001 and 2005.
Methods. The study was a retrospective descriptive study. Demographic and autopsy data from adult cases of 'sudden and unexpected deaths' referred to Tygerberg FPS were collected and analysed.
Results. Some 816 adult cases of 'sudden' deaths were studied. The presumed manner of death was natural in 645 (79.0%) cases, unnatural in 99 (12.2%), and undetermined in 72 (8.8%). Diseases of the cardiovascular, respiratory and central nervous systems accounted for the majority of natural deaths. Infectious diseases accounted for most deaths in the youngest age group studied (18 - 29 years); however, ischaemic heart disease was the most prevalent cause of death in the total study population.
Conclusions. This study highlighted the lack of useful preautopsy information and therefore the performance of 'unnecessary' medicolegal autopsies in a resource-limited country. Clinicians could ease the burden by giving useful information when referring cases to FPS. Feedback should be given to family members, especially where the cause of death may have an impact on surviving family members.
Persistent failure of the COIDA system to compensate occupational disease in South Africa : original articleSource: South African Medical Journal 102, pp 95 –97 (2012)More Less
Cases of occupational disease, solvent encephalopathy and occupational asthma are used to exemplify failings of the workers' compensation system in South Africa, that include delays in processing claims, non-response to requests for information, and inadequate assessment of disability. These and other systemic deficiencies in administration of the Compensation for Occupational Injuries and Diseases Act of 1993 (COIDA) reduce access by workers with occupational disease to private medical care, and shift costs to workers and to public sector medical care. Another unintended effect is to promote under-reporting of occupational disease by employers and medical practitioners. Reforms have been tried or proposed over the years, including decentralisation of medical assessment to specialised units, which showed promise but were closed. Improved annual performance reporting by the Compensation Commissioner on the processing of occupational disease claims would promote greater public accountability. Given the perennial failings of the system, a debate on outsourcing or partial privatisation of COIDA's functions is due.
Nurse initiation and maintenance of patients on antiretroviral therapy : are nurses in primary care clinics initiating ART after attending NIMART training? : original articleSource: South African Medical Journal 102, pp 98 –100 (2012)More Less
Objectives. To determine the percentage of nurses initiating new HIV-positive patients on therapy within 2 months of attending the Nurse Initiation and Maintenance of Antiretroviral Therapy (NIMART) course, and to identify possible barriers to nurse initiation.
Methods. A brief telephonic interview using a structured questionnaire of a randomly selected sample (126/1 736) of primary care nurses who had attended the NIMART course facilitated by the Foundation for Professional Development (FPD) between October 2010 and 31 March 2011 at primary care clinics in 7 provinces. Outcome measures were the number of nurses initiating ART within 2 months of attending the FPD-facilitated NIMART course.
Results. Of the nurses surveyed, 62% (79/126) had started initiating new adult patients on ART, but only 7% (9/126) were initiating ART in children. The main barrier to initiation was allocation to other tasks in the clinic as a result of staff shortages.
Conclusions. Despite numerous challenges, many primary care nurses working in the 7 provinces surveyed have taken on the responsibility of sharing the task of initiating HIV-positive patients on ART. The barriers preventing more nurses initiating ART include the shortage of primary care nurses and the lack of sufficient consulting rooms. Expanding clinical mentoring and further training in clinical skills and pharmacology would assist in reaching the target of initiating a further 1.2 million HIV-positive patients on ART by 2012.