World Food Day (WFD) will be 'celebrated' on October 16 in honour of the founding of the United Nations (UN) Food and Agriculture Organization (FAO) in 1945. This year's theme is 'Sustainable Food Systems for Food Security and Nutrition'.
Although the recent article in the SAMJ entitled 'Evidence-based medicine - are we boiling the frog?' by Muckart can evoke a true discussion, I feel that it could worsen the prejudice some people already have regarding evidence-based medicine (EBM).
There is a growing body of literature regarding the impact of biofilm on device-associated infections (DAI). It has been estimated that DAIs will cost the USA alone more than US$1 billion. Much of the literature is in the context of the use of orthopaedic, cardiovascular, and plastic surgical prostheses, especially joint and breast implants, but biofilm has been implicated in all surgical fields where foreign materials are placed.
We compliment the team of investigators from Mumbai, India, for their critical evaluation of the utility of a peripheral blood smear examination, an immunochromatographic antigen test and polymerase chain reaction (PCR) towards diagnosis of malaria, though the utility of any point-of-care (POC) test to diagnose malaria would be unpredictable at very high and very low ambient temperatures.
Gene-based therapies for inherited retinal degenerative diseases (RDDs) have gained momentum in the past 5 years, and there are currently several early-stage clinical trials underway that have the potential to intervene in disease processes and provide clinical benefit to patients. However, knowledge of a patient's specific underlying genetic mutation(s) is a prerequisite for participation in these trials. Identification of the mutations in patients with RDDs is challenging and costly; there are more than 200 genes associated with RDDs, and each can carry hundreds of potential mutations. Finding the one or two mutations responsible for the RDD in a patient is daunting, so the best candidate gene to screen is often determined by the clinical manifestations of the disease and the inheritance pattern observed.
The Academy of Science of South Africa (ASSAf) would like to invite all practising life scientists in research and diagnostic facilities to take part in a nationwide survey. The survey is based on a questionnaire designed by the World Health Organization that has been tailored to meet the needs of the South African life science community.
A national pilot scheme aims to give power back to clinicians and hospital managers, unraveling the crisis of mismanagement, poor planning and endemic corruption that has long compromised and even prevented healthcare delivery at Johannesburg's top tertiary hospitals.
Health Minister Dr Aaron Motsoaledi's bid to overhaul dysfunctional and often inept leadership at public hospitals has got off to a solid start, with his custom-made Academy for Leadership and Management in Health Care tackling 'a couple of fire-fighting tasks'.
Careworn, skeletally-staffed and under-equipped: that was Zithulele Hospital, snagged in a dusty web of rutted roads atop a coastal hill near Coffee Bay, 99 km from Mthatha, eight years ago. Today the hospital is a rare beacon of hope, efficiency and delivery in a sea of rural public healthcare apathy, dysfunction and maladministration.
Lawyers acting for former Red Cross Children's Hospital oncology veteran Professor Cyril Karabus are suing his former United Arab Emirates (UAE) hospital employers for millions. They are also exploring a similar action against Emirates Airlines, which flew him to Dubai, where he was arrested and informed that he had been found guilty in absentia (under Sharia law) of patient manslaughter 10 years earlier.
Isabel is skielik op 8 Mei 2013 oorlede a.g.v. 'n hartprobleem. Sy is gebore in die Paarl, en na haar skooldae gaan sy in 1953 na die Universiteit van Pretoria met die idee om vir 'n BCom-graad te studeer. Haar oom, Jantjie, self 'n algemene praktisyn, oorreed haar om geneeskunde te studeer.
Kenneth Margolis was born on 1 May 1936 in Cape Town, 20 minutes before his twin brother, Frank. He later specialised in obstetrics and gynaecology. After a long illness, he died on 12 July 2013 in Brisbane, Australia.
Despite the recognition of specialists in emergency medicine and the professionalisation of prehospital emergency care, international guidelines and consensus are often ignored, and the lag between guideline publication and translation into clinical practice is protracted. South African literature should reflect the latest evidence to guide resuscitation and safe patient care. This article addresses erroneous details regarding life-saving interventions in the South African Medicines Formulary, 10th edition.
Isoniazid preventive therapy (IPT) prevents tuberculosis (TB) in immunocompetent children <5 years of age after exposure to an infectious TB source case. Routine IPT has been advocated in all HIV-infected children without TB, but has been controversial. Antiretroviral therapy markedly reduces the risk for TB in HIV-infected children, especially when started early in infancy. In HIV-infected children, as in HIV-uninfected children, we recommend post-exposure IPT after each TB exposure episode; but in HIV-infected children, this should be given irrespective of age or antiretroviral therapy. However, evidence for routine IPT without known exposure to TB in HIV-infected children is not convincing and is therefore not recommended.
Our current way of eating makes us ill, divides us, and harms our planet. The health burden of our current diet is considerable, and there is increasing evidence that it is not environmentally or socially sustainable. Yet food and nutrition continue to receive little attention in health policy and professional training, locally and internationally. This is particularly true when the urban scale is considered. National food security and nutrition policy focuses disproportionately on rural populations. We argue that a revitalised public health agenda focusing on the conditions that shape what we eat would have significant benefits for current and future generations of South Africans. This has implications for how we educate the future generation of medical and healthcare professionals in South Africa (SA).
Background. Malnutrition substantially impacts the health outcomes of children. Globally, the childhood prevalence of overweight and obesity has increased, while underweight and stunting (though decreasing) continues to pose a major public health challenge. In low- to middle-income countries, a mixed pattern of over- and undernutrition (nutritional transition) can exist in communities.
Objective. To describe the prevalence of malnutrition among female learners in the Nongoma and Ceza districts in Zululand, KwaZulu-Natal (KZN).
Methods. We performed a secondary analysis of anthropometric data collected during the 2011 HPV Vaccination Demonstration Project. School health teams, comprising trained nurses, measured the height (in cm) and weight (in kg) of 963 female learners in 31 primary schools. Internationally accepted standardised measures were used as cut-offs for defining overweight, obesity, underweight and stunting.
Results. We found evidence of both under- and overnutrition. Overall, 9% of female learners were overweight, 3.8% obese, 4% underweight and 9.2% stunted (using WHO/NCHS criteria). The highest levels of stunting were in the 11 - 12-year age groups, of underweight in the 10-year age group, of overweight and obesity in the 9 - 10-year age groups. Moreover, a proportion of underweight (17.4%), overweight (11.1%) and obese (22.9%) learners were also stunted.
Conclusion. Our study describes the prevalence of overweight and obesity, wasting and stunting of female learners in KZN and suggests the presence of a nutritional transition in these rural communities; however, further studies are needed. Our findings emphasise the need for health promotion and education programs in schools.
Background. Patients with first-onset seizures commonly present to emergency centres (ECs). The differential diagnosis is broad, potentially life-threatening conditions need to be excluded, and these patients need to be correctly diagnosed and appropriately referred. There are currently no data on adults presenting with first-onset seizures to ECs in South Africa.
Objective. To review which investigations were performed on adults presenting with first-onset seizures to six ECs in the Western Cape Province.
Methods. A prospective, cross-sectional study was conducted from 1 July 2011 to 31 December 2011. All adults with first-onset seizures were included; children and trauma patients were excluded. Subgroup analyses were conducted regarding HIV status and inter-facility variation.
Results. A total of 309 patients were included. Computed tomography (CT) scans were planned in 218 (70.6%) patients, but only performed in 169; 96 (56.8%) showed abnormalities judged to be causative (infarction, intracerebral haemorrhage and atrophy being the most common). At least 80% of patients (n=247) received a full renal and electrolyte screen, blood glucose testing and a full haematological screen. Lumbar puncture (LP) was performed in 67 (21.7%) patients, with normal cerebrospinal fluid findings in 51 (76.1%). Only 27 (8%) patients had an electroencephalogram, of which 5 (18%) were abnormal. There was a statistically significant difference in the number of CT scans (p=0.002) and LPs (p<0.001) performed in the HIV-positive group (n=49).
Conclusion. This study demonstrated inconsistency and wide local variance for all types of investigations done. It emphasises the need for a local guideline to direct doctors to appropriate investigations, ensuring better quality patient care and potential cost-saving.
Background. Undifferentiated embryonal sarcoma of the liver (UESL) is a rare neoplasm, and the third-most common paediatric hepatic malignancy. However, no treatment guidelines exist. No randomised, controlled trials support specific combinations of therapy.
Objective. To compare presentation and management of UESL with other series, review the literature, and formulate treatment guidelines.
Methods. A retrospective chart review of all hepatic malignancies was conducted from 1996 to 2007 and 5 children with UESL were identified. Management and outcomes were documented. The literature regarding treatment modalities up to September 2012 was reviewed.
Results. Over a period of 11 years, 5 patients presented. All underwent surgery and 4 received chemotherapy. One received radiotherapy at relapse. Three are disease-free with follow-up of 58 - 184 months. One died after relapse, as did the patient whose family declined chemotherapy.
Conclusion. The improved outcomes are consistent with the international experience and are probably related to combined treatment modalities and advances in supportive care. Pre-operative percutaneous biopsy provides no benefit if the lesion is resectable because it may not prove to be diagnostic, and may cause recurrence in the biopsy tract. If resectable, the recommended treatment is primary excision and adjuvant chemotherapy, with radiotherapy in selected cases. If unresectable, open biopsy is necessary to document histology, and neoadjuvant chemotherapy is given prior to resection. If deemed unresectable, liver transplantation is considered.
Background. While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity.
Methods. We conducted a retrospective chart review of all children undergoing MS for non-cardiac indications between January 2007 and September 2012 and describe the pathology, number of ventilated days, duration of intensive care unit stay and analgesic requirements.
Results. Our experience over the past 6 years includes 14 children, aged between 8 months and 13 years. Indications for surgery included penetrating mediastinal trauma (1), anterior and posterior mediastinal masses (4), acquired tracheo-oesophageal fistulas secondary to button battery impaction (2), bronchial foreign bodies (2) and bilateral pulmonary metastases secondary to malignancy (5). The range of postoperative ventilation required was 0 - 34 days (median 1 day) and the range of duration of stay in the paediatric intensive care unit 1 - 39 days (median 4 days). Postoperative analgesia was provided with intravenous or oral paracetamol with or without the addition of morphine. All the children tolerated the procedure well with no sternotomy-related complications on follow-up.
Conclusion. This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.