South African Gastroenterology Review - Volume 9, Issue 1, 2011
Volume 9, Issue 1, 2011
Author Christo Van RensburgSource: South African Gastroenterology Review 9 (2011)More Less
We would like to welcome all delegates to the EHPBA/ ASSA SAGES congress at the Cape Town International Convention Centre from 12 - 16 April 2011. This ASSA SAGES conference is a joint venture with the 9th Congress of the European Hepato Pancreato Biliary Association (EHPBA). As this is an election year for a new SAGES council we would like to encourage members to please attend the AGM and vote.
Source: South African Gastroenterology Review 9, pp 6 –9 (2011)More Less
Background: The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. In Africa, where prevalence of bloodborne pathogens is often high and resources are often low, the risks are especially high for surgeons. This study systematically documents risk factors among South African surgeons regarding bloodborne pathogen transmission during surgery. Methods: A retrospective survey was conducted among surgeons attending the ASSA biennial meeting. The survey results reflect patterns of risk and availability and use of safety practices, garments and devices. Results: Of 96 surgeons participating in the survey, 70% reported at least one percutaneous injury during the previous year, with the average rate of percutaneous injury 2.75 per year. Suture needles were the most common source of injury (84%). More than half reported being splashed by blood or body fluids, with an annual average of 3.5, most often to the eyes. Sixty-nine percent reported complete HBV vaccination, and HIV Post-Exposure Prophylaxis (PEP) was readily available. Eyes were not sufficiently protected. Slightly more than half reported using hands-free passing, and more than one-third reported using blunt suture needles. Comparing surgeons who used a combination of hands-free passing and blunt sutures and those who did not revealed markedly different rates of injury. Conclusions: Risks of blood exposure among South African surgeons are high. Wider adoption of safe techniques, devices and personal protective equipment could reduce the risks. Recommendations for injury prevention and safe practice that can protect the health and lives of the surgical team are offered.
Source: South African Gastroenterology Review 9, pp 11 –14 (2011)More Less
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in Western countries, extending from steatosis (FLD) to steatohepatitis (NASH). Differentiation between NASH and nonprogressive NAFLD is difficult on clinical grounds, therefore a need exists to identify reliable biomarkers of disease progression. NAFLD is considered the hepatic manifestation of the metabolic syndrome and discrimination of patients at increased risk of cardiovascular disease (CVD) as apposed to the development of advanced liver disease poses an important clinical question. In this context, an overview of biochemical abnormalities and genetic risk factors implicated in NAFLD and the metabolic syndrome is provided. In addition to standard metabolic indicators, we studied low-density lipoprotein (LDL) particle size and APRI as biomarkers to distinguish between South African NAFLD patients at increased risk of CVD or advanced liver disease, respectively. In relation to gene expression patterns, TNF-α and IKKβ implicated in insulin resistance and inflammation showed the most significant association with NASH in the South African study cohort. There was virtually no knowledge of the existence or clinical consequences of NAFLD in the local population at initiation of this study in 2004. Today, South African patients can reap clinical benefits through increased awareness of NAFLD among South African medical practitioners and the public. A sound basis has also been provided for the application of cardio-vascular testing not only in patients with high cholesterol levels, but also in patients with features of the metabolic syndrome, to facilitate 1) diagnosis of treatable disease subtypes, 2) prevention of cumulative risk, and 3) formulation of individualised treatment plans guided partly by the genetic background.
Source: South African Gastroenterology Review 9, pp 16 –21 (2011)More Less
Viral hepatitis and HIV are important global public health problems with enormous economic and social consequences. In Africa these epidemics converge, compounding the effect of each. Sub-Saharan Africa harbours 70% of the world's prevalence of HIV, and has a HBV population prevalence of <8%. About 20% of those living with HIV are co-infected with HCV, with the highest reported prevalence rates in Asia and Africa. As HIV therapy has increased longevity, liver disease has emerged as an important cause of morbidity and mortality in this group of patients. The risk of liver related death is higher among HIV/HBV or HIV/HCV co-infected individuals than among those infected with either virus alone. The impact of co-infection is not only on the rate of progression of liver disease, but also on other factors like drug interactions and drug side effects.
Source: South African Gastroenterology Review 9, pp 23 –28 (2011)More Less
Osteoporosis is a systemic disease characterized by low bone mass (osteopenia) and micro-architectural deterioration, resulting in an increased risk of fracture. Gastroenterologists will encounter patients in their practices with osteoporosis/osteopenia, and practice guidelines about diagnosis, presentation and treatment would be useful.
Author Stephen GroblerSource: South African Gastroenterology Review 9, pp 29 –31 (2011)More Less
It is with deep sadness and disgust that we as healers now realise that we have been led along the pathway to nowhere: an underinsured third-party payor market has had the audacity to lay the blame for the spiralling healthcare costs at our feet ("the specialists"), along with the shelters we ply our trade in - the private hospitals (aka proud bastions and pillars of quality health care). This doctor (specialist) and hospital bashing is seen in many countries of late. Of note is the fact that aspects of the draconian reform measures touted in the USA have recently been declared unconstitutional - a US judge has ruled the introduction of the proposed compulsory health insurance to be unconstitutional and that the US congress would exceed its powers if implemented! The same question can be raised in the South African context; namely whether or not the constitution will 'allow' the compulsory public tax funding necessary to institute and sustain the forthcoming venture into an NHI.
Author Anna De JongSource: South African Gastroenterology Review 9 (2011)More Less
Cold, freezing cold, wind, 4 degrees Celsius, clouds, rain, mist... When you look out of the window, do you recognize, see or feel any of this? (except for the wind, which is, I must admit, impressing in Cape Town) My guess is you will not. Regrettably I do, since I am back home in Amsterdam. I am a sixth year, Dutch medical student. In August 2010 I got the once in a lifetime opportunity to do an elective in gastroenterology at the Groote Schuur Hospital. I decided to go for it and never regretted this. In fact, I would recommend an international elective or rotation to any medical student.
Author Galya ChinnerySource: South African Gastroenterology Review 9 (2011)More Less
Dear Prof Reid and the SAGES team
I would like to thank you all for sponsoring our trip to Cairo for the recent AMAGE Gastroenterology congress. I had never before been to Egypt and as such the experience was fascinating. A city of some 20 million people seems to function well by various degrees of organized chaos, with the six lane traffic crawling along highways originally intended for three lanes. Kilometers of apartment blocks make space the one commodity everyone is keen to acquire. The luxurious hotels we were accommodated in being in stark contrast to most of the local homes and apartments. In between all the hectic activity of a modern African city are constant reminders of the magnificent past that the Egyptian people originate from, and remain so proud of. The various rulers of the different dynasties have each added to the architectural, religious and cultural influences, some of which are fortunately still visible.
Author Amal B. SinghSource: South African Gastroenterology Review 9 (2011)More Less
I was fortunate to be invited to the Amsterdam Live Endoscopy Workshop, hosted by Professor Paul Fockens, held at the Hotel Okuda from the 13th to 15th of December 2010. From the previous workshops, this was billed to be a unique interactive 3 day experience of advanced endoscopic procedures, with a panel of international experts demonstrating their skills on a variety of interventions.