South African Medical Journal - Volume 104, Issue 6, 2014
Volumes & issues
Volume 104, Issue 6, 2014
Author J. P. de V. Van NiekerkSource: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8335More Less
'Legalise marijuana for medical purposes' was the cry in Parliament that prompted the response by Charles Parry and Bronwyn Myers in this issue of SAMJ. Much parliamentary and public sentiment favoured such an action. But is this the wisest course to follow? The abuse of drugs is harmful to the individual, families and communities. Declaring war on drugs, as US President Nixon did in 1971, therefore has emotional appeal. However, despite this escalating war, the use of drugs has increased worldwide. While the war had noble intentions, it resulted in harmful unintended consequences. Criminalisation of drug use had the effect of hugely increasing the number of prisoners, who are later likely to resort to other criminal activities. The USA, the leader of the war, has the world's highest proportion of jailed citizens (707/100 000, as opposed to South Africa at 294/100 000 and India at 30/100 000). The huge profits from the drug trade corrupt users, politicians, police and financial institutions - the fight for turf by drug cartels in Mexico for drugs destined for the USA has been responsible for tens of thousands of murders and disappearances. While the effects of drugs are harmful, the consequences of the war on drugs are far worse.
Source: South African Medical Journal 104, pp 389 –390 (2014) http://dx.doi.org/10.7196/SAMJ.8242More Less
Few consumers are aware of the ethyl ester (EE) content of South African (SA) omega-3 fatty acid supplements. We wish to draw the attention of SAMJ readers to the findings of a recent survey on the omega-3 fatty acid content of fish oil supplements available on the SA market.
Source: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8211More Less
To the Editor: An adequate and safe blood supply remains a challenge in South Africa (SA), and voluntary blood donors are a vital section of our healthcare system. Regular donors (people who make ≥3 donations in a year) are of key importance, because they are the source of a constant flow of blood to the South African National Blood Service (SANBS). The donor gives one unit of whole blood, which involves a venesection of approximately 480 ml (SA law prohibits more). The donor loses approximately 180 mg of iron per donation. The upper limit of frequency of blood donation for both men and women is 6 units/year. By law in SA, a donor cannot donate more frequently than every 56 days. During the 2013 SANBS financial year, 797 623 donations were collected, of which 756 358 were whole-blood collections.
Source: South African Medical Journal 104 (2014) http://dx.doi.org/10.7196/SAMJ.8179More Less
To the Editor: In 2009 a meeting took place between the then Chief of Operations of the Gauteng Health Department, Dr A Rahman, and the academic and clinical heads of Internal Medicine at the three academic hospitals of the University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital (CHBAH), Helen Joseph Hospital (HJH) and Charlotte Maxeke Johannesburg Academic Hospital. Two problems were highlighted: the Department of Internal Medicine had too few subspecialty training posts to accommodate the large number of applicants; and the three cluster hospitals (Sebokeng, Leratong and Edenvale) served by the department were unable to fill their vacant specialist posts.
Source: South African Medical Journal 104, pp 391 –393 (2014) http://dx.doi.org/10.7196/SAMJ.8085More Less
An official in the Medicines Control Council (MCC)'s national law enforcement inspectorate and a Port Elizabeth district health manager have been suspended following an illegal trial of an unregistered Californian-manufactured 'immune-boosting' spray on public sector clinic patients. This was confirmed to Izindaba by both Ms Precious Matsoso, National Director-General of Health, and the Registrar of the Medicines Control Council (MCC), Ms Mandisa Hela, who added that the local importers/distributors of Immutides Spray, Saulez Agencies CC, also face potential criminal charges.
Source: South African Medical Journal 104, pp 394 –395 (2014) http://dx.doi.org/10.7196/SAMJ.8436More Less
An internal wrangle over how all racial groups are fairly represented in the South African Medical Association (SAMA) led to all-time record attendance at an Extraordinary General Meeting in Pretoria last month, where an 89% majority backed a pragmatic redefinition of non-racialism.
Source: South African Medical Journal 104, pp 395 –397 (2014) http://dx.doi.org/10.7196/SAMJ.8438More Less
Author Lynda Albertyn-CrossSource: South African Medical Journal 104 (2014)More Less
Christian George Albertyn was born on 13 December 1920 in Bethal, Transvaal. He started studying medicine at the University of the Witwatersrand in 1939. His studies were interrupted by World War II, and he joined up in 1941 and served in Egypt and Italy. He returned home in 1945, graduated in 1949, and did his internship at Edenvale Hospital.
Source: South African Medical Journal 104 (2014)More Less
Leaving his GP practice in the UK at age 39, Warren Durrant took a medical officer post in Ghana. This was followed by an appointment at a mine hospital in Zambia and a trip home via the Congo River. Realising that Africa had got under his skin, he settled in what was then Rhodesia, where he married much later and had a family.
Source: South African Medical Journal 104 (2014)More Less
Legalising medical use of cannabis in South Africa : is the empirical evidence sufficient to support policy shifts in this direction? : forum : opinionSource: South African Medical Journal 104, pp 399 –400 (2014) http://dx.doi.org/10.7196/SAMJ.8135More Less
Inkatha Freedom Party MP Mario Oriani-Ambrosini's impassioned plea to legalise the medical use of cannabis must be understood in the context of his own condition as well as legislative changes in at least ten countries. This article argues that any decisions to shift policy must be based on a consideration of the evidence on the risks and benefits associated with the medical use of cannabis for the individual and broader society. It concludes that there are important gaps in the evidence base, particularly in human trials supporting the efficacy of cannabis use for treating and preventing medical conditions and alleviating negative symptoms associated with these conditions. South African researchers should be enabled actively to support development of the necessary evidence base by conducting preclinical and clinical research in this area. Human trials to establish the efficacy of the use of cannabis/cannabinoids in addressing AIDS wasting syndrome and other negative sequelae of HIV and AIDS are especially needed.
Haemophagocytic lymphohistiocytosis : a fulminant syndrome associated with multiorgan failure and high mortality that frequently masquerades as sepsis and shock : forum - clinical alertSource: South African Medical Journal 104, pp 401 –406 (2014) http://dx.doi.org/10.7196/SAMJ.7810More Less
Acquired haemophagocytic lymphohistiocytosis (HLH) is a condition involving cytokine overproduction by defective cytotoxic T lymphocytes and natural killer cells, resulting in life-threatening cytopaenias and multiorgan infiltration and dysfunction. Triggers for acquired HLH vary and include viruses, malignancies and autoimmune conditions. Recent reports suggest that HLH may be underdiagnosed owing to variable clinical presentations, diagnostic criteria and a low level of awareness on the part of medical personnel, thus delaying prompt treatment and contributing to high mortality rates. Five patients in whom acquired HLH was diagnosed, following bone marrow investigations, during the period of May - September 2013 are presented. All were at an advanced stage of their disease at time of diagnosis.The three patients who were HIV-positive had a coexisting malignancy at the time of HLH diagnosis, which may have triggered HLH. A definite trigger was not identified in the remaining two HIV-negative patients despite early concerns regarding autoimmune disease.Two patients received timeous diagnosis, started chemotherapy and are currently improving. The remaining three succumbed to their illness. Aquired HLH in adults may be more common in the acute care setting than currently appreciated. As awareness of this condition and its treatment is currently low, it may remain undiagnosed until the disease has evolved into multiorgan failure. Fever in the absence of infectious agents, marked hyperferritinaemia, unexplained cytopenias, organomegaly or liver dysfunction should raise the suspicion of HLH. Timeous introduction of therapy will improve outcomes.
'Urban insight' : a high level of undiagnosed need reflects limited access to and availability of eye-care services in South Africa : forum - issues in public healthSource: South African Medical Journal 104, pp 407 –408 (2014) http://dx.doi.org/10.7196/SAMJ.8100More Less
Findings from an urban community optometry clinic in a poor area of Johannesburg, South Africa (SA), highlighted a high level of undiagnosed need, raising questions concerning access to and availability of eye-care services in SA. It is imperative that we understand vision as a requisite for poverty alleviation, and the need for a public health approach to service delivery.
Author T.S. DouglasSource: South African Medical Journal 104, pp 408 –409 (2014) http://dx.doi.org/10.7196/SAMJ.7915More Less
Additive manufacturing (AM) constructs 3D objects layer by layer under computer control from 3D models. 3D printing is one example of this kind of technology. AM offers geometric flexibility in its products and therefore allows customisation to suit individual needs. Clinical success has been shown with models for surgical planning, implants, assistive devices and scaffold-based tissue engineering. The use of AM to print tissues and organs that mimic nature in structure and function remains an elusive goal, but has the potential to transform personalised medicine, drug development and scientific understanding of the mechanisms of disease.
Source: South African Medical Journal 104, pp 410 –411 (2014) http://dx.doi.org/10.7196/SAMJ.8408More Less
The recent adoption of the Memorandum of Incorporation (MOI) and Rules of the South African Medical Association (SAMA) represents an appropriate time to pause and reflect. For purposes of compliance with the new Companies Act, the MOI and Rules were in fact adopted in 2013, with recent amendments needing to be added. This does, however, provide an opportunity to critically evaluate where the Association is in the year in which, as a country, we celebrate 20 years of democracy. It is often said that to understand the present one needs to look to the past. Two articles from 1996 by Mlisana et al. and Hanekom et al. provide a useful context of the situation just before the formation of SAMA, as well as insights into the development of the process of unity in the profession. Furthermore, the ideals of a professional association stated at that time provide a measure by which we can assess our progress.
Author Jonathan CarrSource: South African Medical Journal 104, pp 411 –412 (2014) http://dx.doi.org/10.7196/SAMJ.8390More Less
Neurodegenerative diseases are important causes of disability and death, with prominent examples including Alzheimer's disease, Parkinson's disease (PD) and motor neuron disease. Although familial clustering of these illnesses was well known before the advent of modern molecular genetics, meaningful strides in identifying the origin of neurodegenerative diseases have really only begun to be made in the past two decades. All these disorders are characterised by a small percentage of affected patients those disease is clearly the result of Mendelian inherited genetic illness, either recessive or dominant. In particular, dominant disease is exemplified in the case of Alzheimer's disease by presenilin 2 mutations that arose in German immigrants from the Volga river region in the 17th century, and in PD by mutations in the LRRK2 protein that are linked to a founder effect dating back to the 2nd century, probably in Ashkenazi Jews.
Identification of a common founder couple for 40 South African Afrikaner families with Parkinson's disease : researchSource: South African Medical Journal 104, pp 413 –419 (2014) http://dx.doi.org/10.7196/SAMJ.7747More Less
Background. Afrikaners are a unique ethnic group in South Africa (SA) with well-documented ancestral records spanning a period of over 350 years. They are mainly descended from Dutch, German and French settlers to SA in the 17th and 18th centuries. Today several disorders in this population occur at relatively high frequencies as a result of founder effects.
Objective. To determine whether a founder effect for Parkinson's disease (PD) is present in the Afrikaner population.
Methods. Study participants were recruited from the Movement Disorders Clinic at Tygerberg Hospital in Cape Town, SA, and from support groups of the Parkinson's Association of South Africa. Standard methods for genealogical research in SA on hereditary diseases were used including interviews and searches in sources such as state archives, the Huguenot Museum in Franschhoek, marriage and baptismal records, and tombstone inscriptions.
Results. For 40 of the PD families, there was only a single most recent ancestral couple common to all of the families. On average there are between three and four ancestral lines to the founder couple per proband (range 1-14).
Conclusion. If genetic studies confirm the presence of a founder effect for PD in Afrikaners, this would imply that there is a large number of individuals from this ethnic group who may potentially be at risk of developing this debilitating condition. This study illustrates and reinforces the concept that genealogical analysis is a powerful tool for identification of founder effects for various disorders in the Afrikaner population.
No evidence for association of insulin receptor substrate-1 Gly972Arg variant with type 2 diabetes mellitus in a mixed-ancestry population of South Africa : researchSource: South African Medical Journal 104, pp 420 –423 (2014) http://dx.doi.org/10.7196/SAMJ.7419More Less
Background. The most common single-nucleotide polymorphism in the insulin receptor substrate-1 (IRS1) gene is Gly972Arg, which is associated with a 25% increased risk of developing diabetes. The mixed-ancestry population of South Africa (SA) has one of the highest prevalences of type 2 diabetes mellitus (T2DM) in Africa.
Objective. To report the frequency of IRS1 Gly972Arg and investigate its associations with cardiometabolic traits.
Methods. DNA from 856 mixed-ancestry adults drawn from an urban community of Bellville South, Cape Town, SA, was genotyped by two independent laboratories. Oral glucose tolerance tests were performed and cardiometabolic risk factors measured.
Results. A total of 237 (24.7%) participants had T2DM. The IRS1 Gly972Arg variant was present in 7.9% of the individuals studied and only one participant (non-diabetic) carried the homozygous A/A variant. In linear and logistic regression analyses, Gly972Arg was not associated with obesity, insulin resistance/sensitivity or T2DM.
Conclusions. The prevalence of the Gly972Arg variant in the mixed-ancestry population of SA is comparable to that reported in African Americans, but its presence is not associated with cardiometabolic traits. This suggests that the Gly972Arg variant may not aid diabetes risk evaluation in this setting, nor can such information help explain the high prevalence of diabetes previously reported in this population.