South African Medical Journal - Volume 102, Issue 6, 2012
Volumes & issues
Volume 102, Issue 6, 2012
Author Daniel J. NcayiyanaSource: South African Medical Journal 102 (2012)More Less
The headline-grabbing story of Sean Davison, a non-medical professor at the University of the Western Cape who assisted his 86-year-old mother - herself a medical doctor - to kill herself by taking an overdose of morphine tablets dissolved in water, has evoked much interest, and unleashed an online campaign, Dignity SA, to legalise euthanasia in South Africa. The cancer-stricken doctor had already tried in vain to starve herself to death. 'Help me, you are a good boy. I want to die today,' she had pleaded with Sean.
Source: South African Medical Journal 102, pp 336 –337 (2012)More Less
Imprisonment and torture of doctors in Bahrain
SAMA speaks out about the victimisation of doctors in Bahrain
Legal imperatives for consent for children participating in research
Stem cell therapy and amyotrophic lateral sclerosis
Hydatid cysts of the breast and parotid gland
Source: South African Medical Journal 102, pp 338 –340 (2012)More Less
Tagged as victims of 'the world's biggest, longest running industrial disaster; dwarfing Chernobyl', 10 000 known silicosis-affected southern African gold miners are finally set to negotiate a payout that could induce a painful paroxysm of shareholder coughing across the Johannesburg Stock Exchange.
Source: South African Medical Journal 102, pp 341 –343 (2012)More Less
Africa's health researchers last month took greater collective responsibility for cultivating their continent's historically neglected and under-funded work when an international forum in Cape Town agreed on co-operative strategies to translate their findings into improving more lives on the ground.
Source: South African Medical Journal 102, pp 343 –345 (2012)More Less
The trumpeting by the Health Professions Council (HPCSA) of screening guidelines for emergency care workers handling victims of domestic violence - while welcomed - got a muted response from emergency medicine chiefs in the country's most brutal province last month. The two people heading the Western Cape's clinical protocols and training for emergency medicine and overall emergency medicine services, had reservations as to how practical - or user-friendly - the guidelines are in high-pressure or dangerous situations encountered by their staff.
Source: South African Medical Journal 102, pp 345 –346 (2012)More Less
Government is to fund 1 000 PhDs across health disciplines over the next decade and add clinical research centres to hospitals earmarked for revitalisation so that it can build relevant evidence-based knowledge into the public health system - and begin tackling the crisis in clinical research.
Author Johan KrugerSource: South African Medical Journal 102 (2012)More Less
'One brief shining moment', soos die lewe van John F Kennedy dikwels beskryf is, so was die lewe van Willie Cronjé. Willie is op 20 Maart 1967 gebore. Op die ouderdom van 44 jaar, op 17 Januarie 2012, sterf hy in 'n wildkamp op sy plaas naby Boshof in die Vrystaat. Sy eie buffel se horing penetreer sy borskas en ruptuur sy pulmonale vena in 'n fratsongeluk. Hy sak inmekaar en sterf voor sy seun Willem.
Transplantation of the heart : an overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town - Part I. Surgical experience and clinical studies : forum - history of medicineSource: South African Medical Journal 102, pp 347 –349 (2012)More Less
The heart transplant programme at Groote Schuur Hospital and the University of Cape Town has continued uninterruptedly since the first human transplant in 1967. Orthotopic heart transplantation was followed by the heterotopic method in 1974, considerably improving the clinical results. In 1983, owing to the advent of cyclosporin A, the orthotopic method was once again predominantly adopted. Early graft failure for various reasons remains a major complication, and heterotopic heart transplantation is perhaps the best way to deal with it.
Transplantation of the heart : an overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town - Part II. Laboratory research experience : forum - history of medicineSource: South African Medical Journal 102, pp 350 –352 (2012)More Less
Extensive experimental research on various aspects of heart transplantation was undertaken during the first 2 decades. An overview of this work is presented, and some still unpublished work has been included. Experimental laboratory investigation was an integral activity of the cardiac transplantation programme at the University of Cape Town over these years, and has remained so ever since. These studies provided invaluable fundamental information upon which future clinical work was based. It is therefore necessary to briefly mention and discuss this information, most of which has been published in detail by the various investigators concerned.
Author David McQuoid-MasonSource: South African Medical Journal 102, pp 353 –354 (2012)More Less
Hospital-acquired infections (nosocomial infections) are acquired in healthcare settings by patients admitted for reasons unrelated to the infection or not previously infected when admitted to the facility. Liability for hospital-acquired infections depends on whether the hospital: (i) has introduced best practice infection control measures; (ii) has implemented best practice infection control measures; or (iii) will be vicariously liable for negligent or intentional failures by staff to comply with the infection control measures implemented. A hospital and hospital administrators may be held directly liable for not introducing or implementing best practice infection control measures, resulting in harm to patients. The hospital may also be held vicariously liable where patients have been harmed because hospital staff negligently or intentionally failed to comply with the infection control measures that have been implemented by the hospital, during the course and scope of their employment.
Source: South African Medical Journal 102 (2012)More Less
Amidst the seeming desolation here, I feel inspired each morning when I wake up to the sound of the cock crowing, and the morning star twinkling above the mountain backdrop. This feeling has been matched only by the sense of opportunity I perceive at the hospital every day. There might be a lot more hospital now than some 20 years ago, but there is still so much that can and must be done here. It is not surprising that the revolutionary work of Sydney Kark, and many others, emanated from their experiences in this very setting. Necessity is, after all, the mother of invention.
Dermatological manifestations of measles infection in hospitalised paediatric patients observed in the 2009 - 2011 Western Cape epidemic : researchSource: South African Medical Journal 102, pp 356 –359 (2012)More Less
Introduction. Measles is an acute vaccine-preventable infection common in childhood. In this study, the common dermatological signs of measles were designated the 'classic dermatological measles syndrome'.
Methods. We attempted to ascertain the prevalence of 'nonclassic' dermatological measles presentation in 69 paediatric patients admitted to New Somerset Hospital, Western Cape, during the recent South African measles outbreak. The patients were examined and photographed, after informed consent had been obtained, and findings were assessed by 1 dermatology consultant and 6 dermatology registrars. Measles infection was confirmed in 38 of the patients by means of IgM testing. The data were analysed using Stata version 11.1 statistical software.
Outcomes. Of the group, 17.4% (95% confidence interval (CI) 8.2 - 26.6%) displayed a 'classic' measles dermatological picture, although all had been clinically diagnosed and admitted as complicated measles cases. Of those serologically confirmed to have measles (N=38), 26.3% (95% CI 11.6 - 40.9%) conformed to the 'classic' dermatological picture. Therefore, a significant majority of these patients presented with what was considered in this study to be a 'non-classic' dermatological picture.
Conclusions. Measles infection in a paediatric population requiring admission may frequently present without a full-house 'classic' dermatological picture. Recognised signs in isolation may be of greater value than the classically described syndrome as a whole. 'Non-classic' dermatological forms may occur more frequently than anticipated in complicated cases needing admission. Skin necrosis may be associated with measles.
Delay in commencing treatment for MDR TB at a specialised TB treatment centre in KwaZulu-Natal : researchSource: South African Medical Journal 102, pp 360 –362 (2012)More Less
Background. According to the National Department of Health (NDoH) guidelines, patients diagnosed with multidrug-resistant tuberculosis (MDR TB) must be referred to a specialised treatment centre for initiation of effective therapy. MDR TB is difficult to diagnose and the centralised referral model is beset with challenges that contribute to treatment delays, increased patient morbidity and mortality, and MDR TB nosocomial transmission. Culture and drug sensitivity testing (DST) takes 8 weeks or longer to obtain results while line probe assays (LPAs) can give a result in hours. LPAs and the GeneXpert MTB/Rif (GX) are ground-breaking discoveries for TB diagnosis. However, they are not easily accessible or available to those needing it, so culture and sensitivity testing remains the gold standard for diagnosis.
Aim. This study aimed to assess the delay in the initiation of MDR TB treatment and profiled the patients being referred to a specialised drug-resistant treatment centre in KwaZulu-Natal.
Results. Of all the patients, 75% referred showed a mean delay of 12.4 weeks from the date of sputum collection for culture and drug sensitivity testing to the start of treatment. Most of the patients were symptomatic for TB and HIV-positive.
Discussion. Our findings suggest that current policy on the initiation of effective treatment needs urgent revision. Staff should be appropriately trained in LPA and GX technology to reduce delays in initiating treatment for MDR TB. The NDoH's plans for rapid diagnosis and reducing the treatment burden on centralised MDR TB management facilities are in the early phases of implementation and will take years to achieve favourable and significant outcomes.
Conclusion. There is a significant delay in initiating definitive management for MDR TB.
Aminoglycoside-induced hearing loss in HIV-positive and HIV-negative multidrug-resistant tuberculosis patients : researchSource: South African Medical Journal 102, pp 363 –366 (2012)More Less
Background. Ototoxicity following aminoglycoside treatment for multidrug-resistant tuberculosis (MDR-TB), is a significant problem. This study documents the incidence of ototoxicity in HIV-positive and HIV-negative patients with MDR-TB and presents clinical guidelines relating to ototoxicity.
Methods. A prospective cohort study of 153 MDR-TB patients with normal hearing and middle ear status at baseline controlling for 6 mitochondrial mutations associated with aminoglycosiderelated ototoxicity, at Brooklyn Chest Hospital in Cape Town. Pure tone audiometry was performed monthly for 3 months to determine hearing loss. HIV status was recorded, as was the presence of 6 mutations in the MT-RNR1 gene.
Results. Fifty-seven per cent developed high-frequency hearing loss. HIV-positive patients (70%) were more likely to develop hearing loss than HIV-negative patients (42%). Of 115 patients who were genetically screened, none had MT-RNR1 mutations.
Conclusion. Ototoxic hearing loss is common in MDR-TB patients treated with aminoglycosides. HIV-positive patients are at increased risk of ototoxicity. Auditory monitoring and auditory rehabilitation should be an integral part of the package of care of MDR-TB patients.
Source: South African Medical Journal 102, pp 366 –367 (2012)More Less
Despite available guidelines on indications for fresh-frozen plasma (FFP) transfusion, inappropriate use is increasing worldwide. We evaluated FFP administration to patients admitted to the Steve Biko Academic Hospital over 4 months, including indications for use and completeness of requisition forms. Transfusions were considered inappropriate for 39.5% of units administered. Of request forms submitted, only 22% had sufficient information for the blood transfusion services of the indication for transfusion. Transfusion with FFP is a medical intervention that carries risks and should be undertaken with care. Although this study was conducted in one centre, it is evident that clinicians' lack of knowledge of the indications for administration of FFP is widespread. Intervention is necessary to improve patient outcomes and reduce expenditure.
Helicobacter pylori eradication : a randomised comparative trial of 7-day versus 14-day triple therapy : researchSource: South African Medical Journal 102, pp 368 –371 (2012)More Less
Background.Helicobacter pylori is associated with several upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor-based triple therapies are considered the standard regimens for H. pylori eradication, but the optimal duration of therapy is controversial. To prevent infection and complications, local studies should be undertaken to evaluate H. pylori eradication rates in a country.
Objectives. We compared 7-day and 14-day regimens to determine the optimum duration of triple therapy for H. pylori eradication.
Methods. We undertook a prospective randomised comparative trial of 7-day and 14-day triple therapy regimen for H. pylori eradication at the Aga Khan University Hospital, Nairobi; 120 patients with dyspepsia and H. pylori infection were randomised to receive esomeprazole, amoxicillin and clarithromycin for either 7 days (EAC 7) or 14 days (EAC 14). Compliance and side-effects were assessed 2 weeks after the start of therapy and H. pylori eradication was assessed by stool antigen tests 4 weeks after treatment.
Results. Both the intention-to-treat (ITT; N=120) and per protocol (PP; N=97) analyses showed no significant differences between the eradication rates of EAC 7 (ITT 76.7%; PP 92%) and EAC 14 (ITT 73.3%; PP 93.6%) (ITT p=0.67; PP p=0.76). Poor compliance was reported in one patient in the EAC 14 group. The incidence of adverse events was comparable in the two groups.
Conclusion. One-week and 2-week triple treatments for H. pylori eradication are similar in terms of efficacy, safety and patient compliance.
Source: South African Medical Journal 102, pp 372 –373 (2012)More Less
International data reveal that medical students are at higher risk of attempting suicide than the general population. We aimed to determine the prevalence of suicidal ideation and attempt among South African medical students from three universities and identify key predisposing risk factors. Data were collected via a questionnaire to medical students on demographics, mental health history, depressive symptoms, suicidal ideation and attempt. A total of 874 medical students from three universities were enrolled. We found a high prevalence of suicidal ideation (32.3%) and suicidal attempt (6.9%), which is three times higher than the general age-appropriate South African population. Simple screening questionnaires can identify such students, enabling universities to provide targeted and improved support for at-risk students.
A randomised controlled trial of suture materials used for caesarean section skin closure : do wound infection rates differ? : researchSource: South African Medical Journal 102, pp 374 –376 (2012)More Less
Objective. The aim of this study was to determine wound complication rates following the use of suture materials and staples for skin closure at caesarean section (CS).
Study design : A randomised, controlled, prospective study was undertaken.
Results. A total of 1 100 women was assigned randomly into 3 groups: polyglycolic acid (PGA) suture group (N=361), skin staple (SS) group (N=373) and nylon suture group (N=366). The overall wound infection rate was 7%. There was no difference in respect of number of patients, age, parity and gestation between the study groups. Those who had nylon sutures as opposed to PGA sutures were 9.5 times more likely to experience wound infection (p=0.055). Women who had SS were at 6.93 times higher risk of wound infection than those who had PGA sutures (p=0.014). Other factors influencing wound infection rates included: rupture of membranes >12 hours were 13.7 times (95% confidence interval (CI) 3.9 - 47.9, p<0.0001) more likely to have wound infection than those with rupture of membranes <12 hours. For every 1-minute increase of surgery duration, the risk of infection increased 1.094 times (95% CI 1.046 - 1.145; p<0.0001). HIV-infected women were 53.4% less likely to develop wound infection than their uninfected counterparts (odds ratio 0.466, 95% CI 0.238 - 0.913; p=0.026). As the time period of observation increased from baseline to day 3 and from day 3 to day 10, wound infection risk increased by 35 times (95% CI 8.155 - 150.868; p<0.001).
Conclusion. The use of SS for CS wound closure is associated with a significantly greater risk of wound infections. SS for wound closure at CS is not recommended for use in South African district hospitals.
Source: South African Medical Journal 102 (2012)More Less
This special edition was mooted at a meeting of our Dean, Professor Marian Jacobs, and colleagues to discuss ways to mark the Centenary of the Faculty of Health Sciences (FHS) of the University of Cape Town (UCT). We volunteered to seek and edit articles from colleagues to showcase the work of the Faculty.