South African Medical Journal - Volume 102, Issue 7, 2012
Volumes & issues
Volume 102, Issue 7, 2012
Author Janet SeggieSource: South African Medical Journal 102 (2012)More Less
South Africa (SA) is a hard drinking country. It is reckoned that we consume in excess of 5 billion litres of alcohol annually; this figure is likely to be higher still if sorghum beer is included, and equates to 9 - 10 litres of pure alcohol per person. According to a World Health Organization (WHO) report released in 2011, this is among the highest per capita consumption rates in the world, and it is continuing to rise.
Author E.M. MankazanaSource: South African Medical Journal 102 (2012)More Less
The issue raised by the Editor regarding selection criteria for medical school admission resonates well with my own views on this thorny issue. I believe that race-based criteria are counter-productive, and tend to reinforce the entitlement attitude, a post-apartheid tendency which remains unaddressed in our infant democracy today.
Author Colleen BamfordSource: South African Medical Journal 102, pp 589 –590 (2012)More Less
Source: South African Medical Journal 102, pp 591 –592 (2012)More Less
Progressive disempowerment and provincial healthcare under-budgeting in the Eastern Cape almost forced the resignation of its corruption-buster chief, Dr Siva Pillay and his most trusted administrators last month. The political moves were directly responsible for thousands of healthcare workers going without pay or being underpaid, for five months.
Source: South African Medical Journal 102, pp 593 –594 (2012)More Less
Three-quarters of doctors, mostly juniors, at Cape Metropole district and community level public health facilities are suffering clinically significant burnout, more than half are emotionally exhausted and 64% have developed a 'callous or depersonalised' perception of their patients.
Source: South African Medical Journal 102, pp 595 –596 (2012)More Less
Hundreds of doctors in the country's three main cities last month queued up for a discounted Discovery Health iPad boasting a multi-purpose application revolutionising administration and patient management - as the company moved to address misgivings by a bioethics expert.
Source: South African Medical Journal 102, pp 597 –598 (2012)More Less
Consider this: 'The use of violence to maintain dominance in interpersonal relationships forms a cross-cultural cornerstone of masculinity in South Africa'. Now read it again, slowly...
If you're male, chances are your first thought will be: 'Nah ... really! Cross-cultural cornerstone?'
The spread of carbapenem-resistant Enterobacteriaceae in South Africa : risk factors for acquisition and prevention : forum - issue in medicineSource: South African Medical Journal 102, pp 599 –601 (2012)More Less
New, effective antibiotics are only likely to become available in 15 - 20 years. To prevent deaths from untreatable Gram-negative infections in South Africa, the rights of any doctor, whether in general or in hospital practice, to indiscriminately prescribe whatever antibiotic they wish, and in whatever fashion, must be challenged. Furthermore, although prevention of the emergence and subsequent spread of carbapenem-resistant Enterobacteriaceae (CRE) has focused on acute and chronic care facilities and inter alia on antibiotic exposure in these institutions, CRE may soon become an issue within entire communities, highlighting a role for public health authorities in CRE prevention efforts.
A total ban on alcohol advertising : presenting the public health case : forum - issues in public healthSource: South African Medical Journal 102, pp 602 –604 (2012)More Less
Evidence from burden of disease and economic costing studies amply indicate that the public health burden from hazardous and harmful use of alcohol in South Africa warrants drastic action. Evidence that banning alcohol advertising is likely to be an effective intervention is reflected in WHO strategy documents on non-communicable diseases and harmful use of alcohol. Studies on young people furthermore support arguments refuting the claim that advertising only influences brand choice. Given the weakness of relying on industry self-regulation, the government is considering legislation to ban alcohol advertising, resulting in heated debate. Tobacco control and studies investigating the effect of alcohol advertising bans on consumption and alcohol-related deaths point to the effectiveness of such action - ideally supplemented by other policy interventions. Arguments against an advertising ban include possible communication sector job losses, but these are likely to have been exaggerated. Banning alcohol advertising will necessitate greater scrutiny of digital media, satellite television and merchandising to reduce the likelihood of subverting the ban.
Author Robert-Ian CaldwellSource: South African Medical Journal 102 (2012)More Less
Dear Aunt Ethel,
I saw the film War Horse the other day. A review in the media includes: 'a story about lost innocence and the atrocities of war ... perhaps the most moving, beautiful and inspirational movie of the year ... In the midst of cruelty, we see demonstrated humanity.'
The South African Paediatric Tumour Registry - 25 years of activity : forum - issues in child healthSource: South African Medical Journal 102, pp 605 –606 (2012)More Less
The South African Children's Tumour Registry was established 25 years ago as it was essential to collect data on malignant disease in the paediatric population that can be used for statistical research in an efficient and sustainable way. The Registry is a useful and significant repository of specific paediatric data, along with the recently revitalised National Cancer Registry, to serve the needs of the cancer research community.
Source: South African Medical Journal 102, pp 607 –608 (2012)More Less
Decades of poor medical and veterinary antibiotic prescribing and a lack of regard for the practice of infection prevention and control (IPC) in our hospitals have left South Africa, like the rest of the international community, on the brink of a return to an era of untreatable bacterial infection. The recent emergence in South Africa of bacteria carrying the highly mobile New Delhi metallo-β-lactamase-1 (NDM-1) gene, which has been associated with rapid spread of carbapenem-resistant Enterobacteriaceae (CRE), and, for the first time in Africa, Klebsiella pneumoniae carbapenemases (KPCs), will have a profound effect on the lives of our patients and on the health service. The acquisition of drug-resistant hospital-acquired infections (HAIs) increases morbidity, mortality and the cost of patient management to an already beleaguered health system by increasing the duration of hospital stay, often in expensive intensive care units (ICUs), and antibiotic prescribing costs.
Trends in alcohol prevalence, age of initiation and association with alcohol-related harm among South African youth : implications for policy : researchSource: South African Medical Journal 102, pp 609 –612 (2012)More Less
Objectives. To understand alcohol use trends and alcohol-related harm among youth in South Africa (SA) between 1998 and 2008, and discuss implications for the current alcohol policy process.
Methods. A review was conducted of 4 national prevalence and 2 sentinel surveillance studies. Data were extracted to Epi Info (version 7) and chi-square analyses undertaken.
Results. Lifetime alcohol use remained stable but high at 20 - 25% and 49.1 - 49.6% according to South African Demographic and Health Survey (SADHS) and Youth Risk Behaviour Survey (YRBS) data, respectively. Age of initiation remained stable; 12% of adolescents initiated alcohol use prior to age 13 years. Significant gender differences existed with more males having ever consumed alcohol, engaged in binge drinking, and driven or walked under the influence of alcohol (DUI and WUI, respectively). Binge drinking among females increased significantly from 27% to 36% (SADHS) and 18% to 27% (YRBS). DUI and WUI increased. Homicide/violence, suicide and unintentional deaths were significantly associated with blood alcohol concentration (BAC).
Conclusions. Although SA has made significant strides in alcohol control and prevention of alcohol-related harm over the past decade, early alcohol initiation remains a concern and binge drinking is increasing, especially among females. Significant associations exist between BAC and alcohol-related fatalities. Findings imply that regulatory policies are inadequate; additional efforts are required to ensure that control strategies translate into a reduction in harmful alcohol use by SA youth.
Antibiotic prescription practices and their relationship to outcome in South African intensive care units : findings of the Prevalence of Infection in South African Intensive Care Units (PISA) Study : researchSource: South African Medical Journal 102, pp 613 –616 (2012)More Less
Background. The emergence of multidrug-resistant, extensively resistant and pan-resistant pathogens and the widespread inappropriate use of antibiotics is a global catastrophe receiving increasing attention by health care authorities. The antibiotic prescription practices in public and private intensive care units (ICUs) in South Africa are unknown.
Objective. To document antibiotic prescription practices in public and private ICUs in South Africa and to determine their relationship to patient outcomes.
Methods. A national database of public and private ICUs in South Africa was prospectively studied using a proportional probability sampling technique.
Results. Two hundred and forty-eight patients were recruited. Therapeutic antibiotics were initiated in 182 (73.5%), and 54.9% received an inappropriate antibiotic initially. De-escalation was practised in 33.3% and 19.7% of the public and private sector patients, respectively. Antibiotic duration was inappropriate in most cases. An appropriate choice of antibiotic was associated with an 11% mortality, while an inappropriate choice was associated with a 27% mortality (p=0.01). The mortality associated with appropriate or inappropriate duration of antibiotics was 17.6% and 20.6%, respectively (p=0.42).
Conclusion. Inappropriate antibiotic prescription practices in ICUs in the public and private sectors in South Africa are common and are also associated with poor patient outcomes.
The relationship between trough concentration of vancomycin and effect on methicillin-resistant Staphylococcus aureus in critically ill patients : researchSource: South African Medical Journal 102, pp 616 –619 (2012)More Less
Objectives. The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in intensive care units in Malaysia is significant. Invasive MRSA infections are commonly treated with vancomycin. In clinical practice, the serum vancomycin trough concentration is used as a surrogate marker of vancomycin efficacy. A low concentration of vancomycin may result in less effective therapy and increase the risk of bacterial resistance. We evaluated the relationship between the resolution of MRSA infections and trough concentrations of vancomycin.
Methods. A total of 76 patients admitted between January 2005 and February 2011 were included in the study. Serum vancomycin trough concentration data were collected from the microbiology records. The clinical response was evaluated on the basis of clinical notes and culture test results.
Results. A total of 262 appropriate trough concentration data was included, with a median of 3 trough concentrations per patient. Fifty-four patients responded to vancomycin therapy. The initial trough concentration did not differ between responders and non-responders (p=0.135), but the corrected trough concentration was higher among responders than among non-responders (11.64±1.50 mg/l and 9.25±1.59 mg/l, respectively; p=0.036). The average total daily dose of vancomycin was significantly higher among the responders (p=0.008).
Conclusion. In this critically ill population, a vancomycin dose of 15 mg/kg/day was found sufficient to produce optimal trough concentrations to eradicate the MRSA infection. This study demonstrated the significant relationship between response to treatment of MRSA infection and serum vancomycin trough concentrations.
The clinical appearance of neonatal rotavirus infection : association with necrotising enterocolitis : researchSource: South African Medical Journal 102, pp 620 –624 (2012)More Less
Background. Rotavirus is the most important aetiological agent causing severe gastroenteritis in children <2 years of age in South Africa and worldwide. Most endemic neonatal nursery strains are thought to be asymptomatic. However, serious conditions have been reported to be associated with rotavirus infection, such as necrotising enterocolitis (NEC), diffuse intravascular coagulopathy, pneumonia, apnoea and seizures.
Methods. We studied newborns needing screening for sepsis in our Neonatal Unit. Rotavirus screening was included in the septic screen. The clinical signs and symptoms were studied in the control group (no rotavirus identified) and the study group (rotavirus identified in the stools).
Results. Of the 169 babies screened for sepsis, 44 (26%) were rotavirus positive. Of the remainder, 63 comprised the control group. Rotavirus-positive stools were identified from day 4 of life. The virus was excreted in the stools for a mean of 4 days per infection episode. Asymptomatic infection was only observed in one baby; the others had clinical signs and symptoms ranging from mild to severe, and there were even some deaths. Gastrointestinal symptoms were prominent manifestations of rotavirus infection. There was a high incidence of NEC (66% in the study group v. 30% in the control group). Of the rotavirus-infected babies, 9 died; 3 had no other pathogens identified, so that rotavirus infection could have been the cause of death.
Conclusions. Rotavirus infection in the neonate is rarely asymptomatic. It is a dangerous condition that may cause death. It is associated with, and probably a cause of, NEC.
Source: South African Medical Journal 102, pp 625 –626 (2012)More Less
South Africa has a rich history of lightning research; however, research on the clinical and pathological effects and features of lightning-related injury (keraunomedicine or lightning medicine) remains neglected locally. By providing an overview of keraunomedicine and focussing on South African perspectives, we hope to raise awareness and propose that a concerted and co-ordinated attempt be made to report and collate data regarding lightning strike victims in South Africa.
Source: South African Medical Journal 102, pp 627 –630 (2012)More Less
Background. Glutathione S-transferases (GSTs) detoxify environmental agents which influence the onset and progression of disease. Dysfunctional detoxification enzymes are responsible for prolonged exposure to reactive molecules and can contribute to endothelial damage, an underlying factor in coronary artery disease (CAD).
Objectives. We aimed to assess 2 common polymorphic variant isoforms in GSTM1 and GSTP1 of GST in young CAD patients.
Methods. All patients (N=102) were South Africans of Indian ancestry, a population associated with high CAD risk. A corresponding age-, sex- and race-matched control group (N=100) was also recruited. Frequency of the GSTM1 +/0 (v. +/0 and 0/0) and GSTP1 A105/G105 (v. wild-type A105/A105) genotypes was assessed by differential polymerase chain reaction (PCR) and PCR restriction fragment length polymorphism (PCR-RFLP), respectively.
Results. The GSTM1 0/0 and GSTP1 A105/A105 genotypes occurred at higher frequencies in CAD patients compared with the control group (36% v. 18% and 65% v. 48%, respectively). A significant association with CAD was observed in GSTM1 0/0 (odds ratio (OR)=2.593; 95% confidence interval (CI) 1.353 - 4.971; p=0.0043) and GSTP1 A105/A105 OR=0.6011; 95% CI 0.3803 - 0.9503; p=0.0377). We found a significant association between smoking and CAD; the presence of either of the respective genotypes together with smoking increased the CAD risk (GSTP1 A105 relative risk (RR)=1.382; 95% CI 0.958 - 1.994; p=0.0987 and GSTM1 null RR=1.725; 95% CI 1.044 - 2.851; p=0.0221).
Conclusion. Our findings support the association of genotypes GSTM1 0/0 and GSTP1 A105/A105 and smoking with CAD.
Confirmation of the recurrent ACVR1 617G>A mutation in South Africans with fibrodysplasia ossificans progressiva : researchSource: South African Medical Journal 102, pp 631 –633 (2012)More Less
Objective. Fibrodysplasia ossificans progressiva (FOP) is a rare genetic condition in which progressive ossification of fibrous tissue, tendons and ligaments leads to severe physical handicap. Most affected individuals who have been studied have a recurrent 617G>A mutation in the ACVR1/ALK2 gene that codes for activin A type 1 receptor/activin-like kinase 2. The majority of publications on the genetics of FOP have concerned whites or Asians, and no genetic information is available concerning sub-Saharan blacks. The aim of the project was to determine whether or not this mutation is present in affected persons in South Africa.
Method. Molecular mutational analysis was undertaken on genomic DNA from peripheral blood leukocytes from 6 affected South Africans of different population groups (4 Xhosa, 1 coloured, 1 white).
Results. The 6 persons with FOP were all heterozygous for the ACVR1/ALK2 617G>A mutation. This mutation was absent in 6 controls.
Conclusion. Confirmation of the presence of this recurrent mutation facilitates diagnostic accuracy in affected persons in South Africa, and allows researchers to narrow the search for molecular targets for rational intervention to the ACVR1/ALK2 domain.