A previously well 22-year-old woman presented with progressive weakness of her legs and urinary incontinence over 7 days. Clinically she was healthy, with no skin rashes. On neurological examination she had profound bilateral weakness of the lower limbs, hypertonia, hyperreflexia, a positive Babinski sign and a T6 sensory level. Tests for syphilis and HIV and screening for auto-immune conditions were negative. Magnetic resonance imaging (MRI) of the brain and spinal cord revealed extensive cord swelling between the craniocervical junction and T11, a high signal in the right optic nerve and a normal brain. Aquaporin 4 antibodies (neuromyelitis optica immunoglobulin G (NMO-IgG)) were positive with a titre of 1:1 000. These findings confirmed a diagnosis of NMO or Devic's disease.
While only some can claim to be physician/artists, like neurosurgeon Roger Melvill whose paintings featured frequently on the covers of CME, we can surely all claim to be physician/connoisseurs of the arts. This piece is sparked by the art of Dorothy Kay, an acclaimed portrait painter, whose paintings of surgeons and anaesthetists at work in Port Elizabeth in the late 1930s we feature in this edition. There is a growing trend towards integrating the arts into medical education with the aim of promoting creative and scholarly work at the intersections between the arts, humanities and medicine.
To the Editor: As is known, a significant amount of South Africa's (SA's) burden of disease is attributed to non-communicable diseases (NCDs) such as ischaemic heart disease (IHD). The South African National Burden of Disease Study 2000 showed that 58% of the Western Cape's burden of disease alone can be attributed to NCDs, with 12% due to IHD. The Global Register of Acute Coronary Events (GRACE) study showed that within 6 months after discharge, 15.8% of patients who have had a myocardial infarction (MI) will suffer a possibly fatal repeat event.
To the Editor: The main point of Dr Evenepoel's recent correspondence to the SAMJ appears to be that I misrepresented Case 2's real story. To insure that readers of this journal are party to the true facts, I invited that patient to respond directly to Dr Evenepoel's claims. This is the how the patient (Brian Berkman) responded: 'As the person referred to as Case 2 in Prof. Tim Noakes' paper, I would like to clear up some of the inaccuracies and wrong conclusions that Dr Luc Evenepoel suggests in his letter.
To the Editor: In their recent correspondence to the SAMJ, Drs Boyles and Wasserman make four points regarding my survey on low-carbohydrate, high-fat (LCHF) intake published in the November issue of the SAMJ.
To the Editor: In your November 2013 edition, Sturm et al. confirm quantitatively that which we clinicians have known qualitatively for many years, viz. that 'obesity and tobacco use are associated with significantly increased healthcare expenditure'. This, and other research papers on the same issue, prompt me to ask when the Commissioner of Medical Schemes will permit the various medical aids to charge non-smokers, and those of an appropriate body mass index, a lower monthly premium?
To the Editor: In his recent correspondence to the SAMJ, Dr Kapp argues that the case studies I reported in the November issue of the SAMJ are 'no more dramatic that the stories of patients we clinicians experience on a regular basis ... as a result of other diets, including the prudent diet'. This is not my experience. Most who wrote to me reported that they had tried numerous other diets, including the prudent diet, without lasting success and no obvious improvement in their health.
Debating whether the end of AIDS is 'a reality or myth' (given the 33% global reduction in deaths over the past decade, and the hugely successful up-scaling of treatment and prevention in South Africa) is 'misleading and dangerous', warn local civil society activists and researchers.
Dr Peter Jacobs was a pioneer of clinical and laboratory haematology in South Africa (SA). Although much of his career coincided with years of apartheid-related isolation, his enormous influence was felt internationally. He led the Department of Haematology at the University of Cape Town and later served as head of Clinical Haematology at Stellenbosch University. In the early 1970s, at a time when Cape Town was central to the field of organ transplantation, Jacobs' major achievement was the introduction of experimental and clinical bone marrow transplantation (BMT). He published the seminal report of hepatic veno-occlusive disease after BMT in the SAMJ.
Dr Eleanor Nash took up a position as a physician at Groote Schuur Hospital, Cape Town, in the 1970s. However, her interests changed in midcareer and she trained as a psychiatrist at the University of Cape Town, later becoming a senior and valuable member of the Department of Psychiatry. She made a significant contribution in helping to plan and organise psychiatric and educational programmes, was always available to help and gave wholeheartedly with advice and clinical expertise. For instance, she flew to the flood devastated Laingsberg in 1983 where she dealt with the psychological effects on survivors and those who had been devastated by the tragedy.
Professor Walter Hift, DM (Oxon), PhD, FCP (SA), died on 5 July 2013. He was born in Austria on 7 November 1921. Walter served the Department of Medicine at the University of KwaZulu-Natal (UKZN) as a consultant in general medicine and haematology for over three decades. He was loyal to the aspirations of the medical school and the university, a dedicated teacher and an expert clinician. His forte was in undergraduate teaching and formulation of teaching programmes, and he was passionate in the elicitation of physical signs at the bedside. He contributed substantially to research and to the medical literature on nutritional megaloblastic anaemia. The latter was the subject of the thesis for which he was awarded a DM from Oxford University.
Doctors who hasten the termination of the lives of their patients by withholding or withdrawing treatment or prescribing a potentially fatal palliative dose of medication satisfy the elements of intention and causation of a charge of murder against them. However, the courts have held that, for policy reasons based on 'society's legal convictions', such conduct is not unlawful if the patient consented to it or medical treatment would be futile or palliative treatment may hasten death. Doctors are not held liable for murder because society regards their omissions or acts as lawful - not because they did not have the intention in law to kill or did not cause the death of their patients.
This report outlines findings and recommendations of a national pharmacovigilance workshop held in August 2012 in South Africa (SA). A survey of current pharmacovigilance activities, conducted in preparation for the meeting, identified multiple programmes collecting drug safety data in SA, with limited co-ordination at national level. The meeting resolved that existing pharmacovigilance programmes need to be strengthened and consolidated to ensure that important local safety issues are addressed, data can be pooled and compared and outputs shared more widely. Pharmacovigilance activities should inform treatment guidelines with the goal of improving patient care. A variety of pharmaco-epidemiological approaches should be employed, including nesting drug safety studies within existing sentinel cohorts and the creation of a pregnancy exposure registry. The attendees agreed on key principles that will inform a national pharmacovigilance plan and compiled a list of priority pharmacovigilance issues facing public health programmes in SA.
Dorothy Kay, the acclaimed Irish-born Port Elizabeth artist, married Dr Hobart Kay, FRCSI, in Cape Town, South Africa, in 1910. She was an exceptional portrait painter, whose astute observation of detail and ability to empathise with her subject and convey character brought her much important work. Her traditional British realist-school style of painting, and ability to depict mechanical equipment accurately, led to several industrial commissions. In 1937 these skills combined to produce her largest painting, 'Surgery', which depicts a patient undergoing an abdominal operation in a Port Elizabeth hospital. The painting graphically captures the skill and care exhibited by the anaesthetist, together with the anaesthetic equipment used at that time. During the war Dorothy became an accredited war artist. Eight of her wartime paintings were purchased by the Union Government and are now housed in the Ditsong National Museum of Military History in Saxonwold, Johannesburg. Two of these paintings of medical interest are discussed. The first, entitled 'Operation in a Base Hospital', depicts surgery being performed in a base hospital and is very similar in composition to 'Surgery'. The second, entitled 'Blood to Save Lives', portrays a volunteer donating blood.
A new masters-level course, 'Medicine and the Arts', will be offered in 2014 at the University of Cape Town, setting a precedent for interdisciplinary education in the field of medical humanities in South Africa. The humanities and social sciences have always been an implicit part of undergraduate and postgraduate education in the health sciences, but increasingly they are becoming an explicit and essential component of the curriculum, as the importance of graduate attributes and outcomes in the workplace is acknowledged. Traditionally, the medical humanities have included medical ethics, history, literature and anthropology. Less prominent in the literature has been the engagement with medicine of the disciplines of sociology, politics, philosophy, linguistics, education, and law, as well as the creative and expressive arts. The development of the medical humanities in education and research in South Africa is set to expand over the next few years, and it looks as if it will be an exciting inter-disciplinary journey.
The Faculty of Health Sciences at the University of Cape Town is addressing the shortage of clinician-scientists in South Africa by introducing two research training tracks in parallel with the professional MB ChB programme, namely the intercalated BSc (Med) Hons/MB ChB track and the integrated MB ChB/PhD track. The BSc (Med) Hons/MB ChB track is available to MB ChB students who have completed the first two years of study. The track comprises a course in Molecular Medicine given concurrently with the MB ChB third-year curriculum, followed by a BSc (Med) Hons as a 'year out' of MB ChB. Subsequently students may enrol into the integrated MB ChB/PhD track that enables them to undertake a PhD concurrently with MB ChB studies, which will be spread over additional years, or alternatively to undertake a PhD after completion of the MB ChB. These tracks, which were launched in 2011, represent an opportunity to train a new cadre of young African clinician-scientists at the undergraduate level.
The World Health Organization definition of palliative care describes palliative care as 'an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness'. It also states that palliative care 'is applicable early in the course of illness, in conjunction with other therapies that are implemented to prolong life', and in describing palliative care for children that 'It begins when illness is diagnosed, and continues regardless of whether a child receives treatment directed at the disease.'