We report two cases of immunoglobulin light chain proteinuria (Bence Jones proteinuria) detected by simple side-room investigations: urine dipstick negative/1+, but with strong positive precipitation on addition of an equal volume of sulphosalicylic acid (SSA) 3%. We highlight a significant limitation of urine dipstick testing, namely specificity for albumin, and the utility of SSA testing for the detection of urinary free light chain immunoglobulins.
The SAMJ proudly publishes research that impacts on clinical practice in (South) Africa, reflecting the journal's byline 'Leading research impacting clinical care in Africa', which implies that we have been pleased, as readers will know, to have entertained work from researchers in other countries in Africa (see 'Sources of articles published in SAMJ/CME during 2014').
Renal disease and haemodialysis in HIV-positive patients
Linking cervical cancer screening to human papillomavirus (HPV) vaccination
Why is cancer not a priority in South Africa?
Non-communicable diseases (NCDs)
A letter in The Lancet in June 2014 reported on delays in legislating an alcohol advertising ban in South Africa (SA). These delays resulted from the addition of an independent regulatory impact assessment due to be completed in 2014. A Cochrane Review on restricting or banning alcohol advertising to reduce alcohol consumption was published in November 2014 and should inform policy deliberations.
We often read medical writing, e.g. assignments, dissertations and manuscripts, where the International System of Units (SI) is not used optimally. The abbreviation 'SI' is derived from Le Système International d'Unités, which refers back to the Metre Convention of 1875 in Paris. We want to share four hints that have helped us.
At a junior school reunion in Port Elizabeth a few years ago I renewed friendship with Philip Bateman, whom I so clearly remembered from my first evening as a boarder in 1956, far away from home. He had held out something edible and said: 'Quis?' 'Ego!' had yelled everyone but me. I learnt Latin fast after that.
The Health and Medical Publishing Group (HMPG), owned by the South African Medical Association (SAMA), has scored a coup in securing Hannah Kikaya, a former senior editor at The Lancet and a top South African (SA) health systems and communications strategist, as its new CEO.
Mediclinic and Stellenbosch University have successfully piloted the first standardised rotation of 4th- and 5th-year medical students through a private hospital - and plan to quadruple the intake to broaden the inadequate national training platform and diversify student disease profile exposure.
Just when you thought there was enough evidence to give up on our public and private healthcare sectors ever partnering to deliver quality, affordable care to a critical mass of South Africans - National Health Insurance (NHI) notwithstanding - along come several potentially game-changing training initiatives.
Mannie Stein was born in Lithuania a few days after Pesach (Passover), but as no exact records were kept, he celebrated his birthday on 1 April. Although the worst of the pogroms were over, there was still overt anti-Semitism and great economic hardship and many Jews emigrated. Emigration papers were hard to come by, but a brother of Mannie's mother, Sam Hackner, had emigrated earlier and sponsored the family. At the age of six Mannie set sail from Hamburg with his mother, his older brother Morris, and Hymie aged one. They arrived in Durban to join Mannie's father, who had preceded them six months earlier and started a small eatery.
Dawn Garisch is a medical doctor, writer, creative methods facilitator and dancer, who, in this memoir about the power of the body in motion, explores the connections between the body, mind and emotions. She courageously shares the personal narratives that have shaped her own life, and illustrates how dance has had different meanings for her - as escape and a way to cope with the difficulties of life, but also as a way to express exuberance and creativity.
Digoxin is one of the oldest of drugs acting on the heart and still one of the most frequently used. While in atrial fibrillation digoxin continues to have a valid role in the control of ventricular rate when added to beta-blockers and calcium antagonists, digoxin for heart failure is no longer a supportable option in view of the negative recent meta-analysis.
Prevention of influenza is the most effective management strategy. Influenza vaccine is administered each year before the influenza season. Here we provide recommendations for the use of influenza vaccines in anticipation of the 2015 Southern Hemisphere influenza season. For a review of the 2014 influenza season, please refer to the website of the National Institute for Communicable Diseases of the National Health Laboratory Service, www.nicd.ac.za.
Improving the delivery of efficient and effective surgical care in rural South Africa is a mammoth task bedevilled by conflict between the stakeholders, who include rural doctors, surgeons, ancillary staff, researchers, educators and administrators. Management training is not part of most medical school curricula, yet as they progress in their careers, many clinicians are required to manage a healthcare system and find the shift from caring for individual patients to managing a complex system difficult. Conflict arises when management-type interventions are imposed in a top-down manner on surgical staff suspicious of an unfamiliar field of study. Another area of conflict concerns the place of surgical research. Researchers are often accused of not being sufficiently focused on or concerned about the tasks of service delivery. This article provides an overview of management theory and describes a comprehensive management structure that integrates a model for healthcare systems with a strategic planning process, strategic planning tools and appropriate quality metrics, and shows how the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province, South Africa, successfully used this structure to facilitate and contextualise a diverse number of quality improvement programmes and research initiatives in the realm of rural acute surgery and trauma. We have found this structure to be useful, and hope that it may be applied to other acute healthcare systems.
The bioethical principles of patient autonomy, beneficence, non-maleficence and justice or fairness require doctors to disclose their fees before treating patients. The provisions regarding disclosures about fees in the Health Professions Act and National Health Act are in conflict. Those in the National Health Act are likely to be applied by the courts to impose a legal duty on healthcare practitioners to disclose their fees before treating patients. This is because the National Health Act is consistent with the access to healthcare provision in the Constitution, as the nature of the access is often determined by the patient's ability to afford the treatment. Given the unequal bargaining power between doctors and patients, very few patients may ask doctors what their fees are before being treated. It is feasible for doctors to provide such information, or an estimate, and ethically and legally they have a duty to do so.
To assess the evidence from systematic reviews on the effect on morbidity and mortality of blanket screening for hypertension or diabetes mellitus compared with targeted, opportunistic or no screening, we searched for relevant systematic reviews and conducted duplicate study selection, data extraction and quality appraisal. Results were summarised narratively. We included two completed reviews of moderate quality and one ongoing Cochrane review. In one completed review, general health checks had no effect on total morbidity or mortality or on healthcare services compared with no health checks. In the other, intensive hypertension screening methods were ineffective in increasing screening uptake or detecting new cases compared with less intensive methods. Both reviews included studies in high-income settings. There is insufficient evidence from currently available systematic reviews to confirm a beneficial effect of blanket screening for hypertension and/or diabetes compared with other types of screening methods in low- and middle-income settings. Scarce resources are being mobilised to implement mass screening intervention for diabetes and hypertension without adequate evidence of its effects. A systematic review is needed to assess clinical effectiveness, cost-effectiveness and overall impact on the health system of screening strategies, especially in low- and middle-income settings such as exist in South Africa. Robust evaluation of these outcomes would then be necessary to inform secondary prevention strategies.
Every year on our planet, 8.2 million people die of cancer. That number equals the population of a whole country such as Rwanda, Austria or Haiti. By 2050 it is estimated that the figure will more than double to approximately 17.5 million. As personal incomes increase in the developing world, lifestyles evolve towards the pattern seen in high-income populations, with obesity, excessive alcohol consumption, air pollution and smoking, all of which increase the risk of cancer. Already around 60% of all new cancer cases and 70% of related deaths occur in low- and middle-income countries.
South Africa (SA) has the highest prevalence of HIV/AIDS of any country in the world, with 6.3 million people living with HIV. This high rate of infection adds complexity to a health system already overwhelmed by chronic kidney disease (CKD), particularly that caused by hypertension, diabetes and chronic glomerulonephritis.
Background. The National Cancer Registry (NCR) was established as a pathology-based cancer reporting system. From 2005 to 2007, private health laboratories withheld cancer reports owing to concerns regarding voluntary sharing of patient data.
Objectives. To estimate the impact of under-reported cancer data from private health laboratories.
Methods. A linear regression analysis was conducted to project expected cancer cases for 2005 - 2007. Differences between actual and projected figures were calculated to estimate percentage under-reporting.
Results. The projected NCR case total varied from 53 407 (3.8% net increase from actual cases reported) in 2005 to 54 823 (3.7% net increase) in 2007. The projected number of reported cases from private laboratories in 2005 was 26 359 (19.7% net increase from actual cases reported), 27 012 (18.8% net increase) in 2006 and 27 666 (28.4% net increase) in 2007.
Conclusion. While private healthcare reporting decreased by 28% from 2005 to 2007, this represented a minimal impact on overall cancer reporting (net decrease of < 4%).