South African Family Practice - Volume 52, Issue 1, 2010
Volume 52, Issue 1, 2010
Source: South African Family Practice 52 (2010)More Less
The major scientific achievement of the Twentieth Century was the discovery of the double helix, and the mapping of the human genome in 2003. Contemporary medical and scientific knowledge in the field of gene therapy has the potential to inform us about many of the known inherited genetic conditions. In addition, medicine now has the ability to identify a significant number of diseases which may be inherited from us by our children. When we discuss the ethics of gene therapy, a distinction should be made between somatic (non-reproductive) and germ (reproductive) cell therapies. In this article, we focus on the ethical issues related to prenatal screening for genetic disorders which include autonomy, cost and maternal anxiety.
Author Gboyega A. OgunbanjoSource: South African Family Practice 52 (2010)More Less
This is the first issue of the SAFP journal for 2010 in which interesting articles have been put together for your reading pleasure. As South Africa prepares for the first FIFA World Cup on the African soil, we have decided to feature a relevant article on pain management in Sports Medicine, which will be discussed later in this editorial.
Source: South African Family Practice 52, pp 11 –16 (2010)More Less
Author J.A. KerSource: South African Family Practice 52 (2010)More Less
Much evidence points towards inflammation as a key regulatory process linking cardiovascular risk factors for atherosclerosis and its complications to an altered arterial biology. Systemic inflammatory conditions such as SLE, rheumatoid arthritis, Sjögren, systemic sclerosis, vasculitis, Crohn's disease and others are also associated with enhanced atherosclerosis.
Revision of the national guideline for first-line comprehensive management and control of sexually transmitted infections : what's new and why? : guidelineSource: South African Family Practice 52, pp 20 –24 (2010)More Less
A revised national guideline for the management and control of sexually transmitted infections (STIs) has recently been published by the National Department of Health according to the Essential Drugs List. Since 2004, there has been a marked rise in resistance to ciprofloxacin among Neisseria gonorrhoeae isolates in several South African cities, requiring a change from quinolones to cephalosporins to treat presumptive gonorrhoea. In keeping with WHO recommendations, acyclovir has been added as part of first-line therapy for the management of genital ulceration. The national guideline has been revised accordingly in order to improve management of several key STI syndromes.
Source: South African Family Practice 52, pp 27 –32 (2010)More Less
Over the last two decades, the health benefits associated with increased physical activity have been established.However, with increased participation in physical activity comes a subsequent increase in sports and exercise related injury. It is estimated that there are over 4.2 million visits to the emergency rooms for sport and exercise related acute injury in the United States alone, and at least that number of visits due to chronic sport and exercise related injury.This article will focus on the use of pharmacological agents in the acute management of these injuries.
Source: South African Family Practice 52, pp 34 –39 (2010)More Less
Hearing loss in children is common and can be difficult to identify, especially in young children. There are a variety of pathologies involved in these children, which make the problem challenging to diagnose and manage. This update describes how new technologies have evolved over the last 10 years to assist in the early detection of hearing loss even in very young children. The article aims to highlight the role and assist the general practitioner in managing these children, so that effective intervention and rehabilitation can occur and the long-term benefit, namely that the children become functioning members of the hearing world, is achieved. This article is not a comprehensive review on the subject, but aims to remind the reader of risk factors and gives guidelines for the clinical assessment of a child with hearing loss. In addition, middle ear disease is also widespread and impacts significantly on the quality of life in this age group, and therefore these problems are also discussed for the sake of completeness. The Ivan Tom's infant hearing screening programme based in Cape Town is presented as a pilot project for future universal neonatal screening projects in South Africa.
Source: South African Family Practice 52, pp 42 –43 (2010)More Less
Background: With the advent of real time ultrasonography of the abdomen, the spleen is no longer an inaccessible organ. Wandering spleen is a rare entity with less than 500 cases reported in literature so far.
Method: This case report presents a 16-year-old Nigerian girl who had been admitted to a medical centre. She was referred for ultrasonography on account of a clinical history of lower abdominal tenderness.
Result: The ultrasonography examination revealed that the spleen was not in its normal anatomical position. However, a well-defined acoustic signature of the spleen was seen in the pelvis.
Conclusion: Ultrasonography, which is not as expensive as magnetic resonance imaging (MRI), and computed tomography (CT) is a valuable diagnostic aid in this condition.
Author B. BromSource: South African Family Practice 52, pp 44 –46 (2010)More Less
Vitamins in general have had bad press recently. This is unfortunate because it tends to obscure the enormous amount of research that has already been done. A great deal more research has been done on most vitamins than on any drug on the market. With this extent of research it is not unusual that there are also many negative studies on vitamins as well as studies with contradictory results. The reason for this is biochemical individuality. Each person is unique and will respond to a drug, and also any nutrient, in a unique way.
Enhancing the educational interaction in family medicine registrar training in the clinical context : forumSource: South African Family Practice 52, pp 51 –54 (2010)More Less
The relationship between registrar and trainer functions best when the trainer consciously facilitates the registrar's learning and considers all their interactions as educational opportunities. The trainer's role is more that of an educational guide and less that of an authoritarian expert. Both the registrar and the trainer should be aware of their own learning styles and how these may be complementary or contradictory. A variety of conversations with different purposes should be structured and planned and not left to chance and a number of methods for observing and collecting the registrar's clinical experience should be developed and used regularly. Further attention needs to be paid to the development of useful, reliable and valid portfolios.
Author Pierre De VilliersSource: South African Family Practice 52, pp 51 –54 (2010)More Less
A lot of work goes into publishing a scholarly journal. It starts with the laborious work of planning and conducting research and writing the final manuscript. Once the manuscript is submitted to a scholarly journal, the process of evaluating the scientific rigour and contribution to science will start. This involves administrative staff, editors and peer reviewers. Once accepted for publication, the process of editing, page layout and proofreading follows involving copy-editors and layout artists. Behind all this is the business of running the journal. It is like any other business involving strategy, planning, resources and working with other people to make the enterprise a success. It is hard work and it can be risky, particularly in times of economic recession when sponsors, advertisers and authors are cutting back expenses.
A method of teaching clinical problem-solving skills to primary health care student nurses : original researchAuthor A. TruscottSource: South African Family Practice 52, pp 55 –59 (2010)More Less
The article provides a description of a method of teaching a clinical problem-solving process to primary health care nurses / clinical nurse practitioners (PHC nurses). The process was developed in the Soweto PHC Nurse Training Unit over the past 30 years as a result of the changing availability and role of nurse and doctor teaching staff. Students doing the diploma for nurse clinicians (Diploma in Clinical Nursing Science, Health Assessment, Treatment and Care) are guided in the use of mind maps, assisted by constant clinical practice and group discussions to develop their clinical problem-solving process. This method has assisted in clinical training .
Iron status and anaemia of chronic disease in HIV-infected African women in Mangaung, Bloemfontein : original researchSource: South African Family Practice 52, pp 55 –59 (2010)More Less
Background: Anaemia occurs widely among people living with HIV / AIDS. The aim of this study was to investigate the effect of HIV status on iron status, more specifically to investigate the nutritional health of women between 25 and 44 years of age.
Methods An epidemiological study was undertaken in Mangaung, a black residential community of Bloemfontein in the Free State (South Africa). A random sample consisted of 500 women in two age groups (25-34 [n = 273] and 35-44 years [n = 215]). Blood specimens were collected in ethyldimethylacetic acid collection tubes according to standard procedures. Respondents fasted overnight, abstained from exercise and avoided consuming alcohol and caffeine for 24 hours prior to collection of the blood specimens. All specimens were taken in the morning. A full blood count was performed using a Coulter Microdiff 18 Cell Counter. The metabolic variables haematocrit (Hct), haemoglobin (Hb), serum iron, ferritin and transferrin were determined. The red blood cell count was performed to calculate the mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). Age and HIV-status groups were described and compared by nonparametric methods. A p-value lower than 0.05 was considered significant. HIV-infected and -uninfected groups were compared by 95% confidence intervals for the difference in the percentage of women with parameters below or above the normal range.
Results: Sixty-one per cent of the younger women and 38% of the older women were HIV infected. The percentage with serum ferritin levels below 20 μg/L was higher in HIV-uninfected women, ranging from 0% in older HIV-infected women to 10.4% in younger HIV-uninfected women. A large percentage of women had elevated transferrin values, ranging from 23.9% in older HIV-infected women to 44.8% in older HIV-uninfected women. A large percentage of women had anaemia of chronic disease, with HIV-infected women afflicted more often.
Conclusion: The results of the study indicate that prevalence of HIV infection in Mangaung is high, especially among women between 25 and 34 years of age. Although the parameters of iron status on average did not indicate iron deficiency in the different age and HIV-status groups, a large percentage of women did have anaemia of chronic disease, with HIV-infected women afflicted more often. Knowledge of the HIV status of a patient is of paramount importance in evaluating laboratory results of iron levels to determine future treatment or nutritional recommendations. HIV-infected and -uninfected individuals might not be comparable regarding their laboratory results to interpret iron store depletion, with consequences for further therapeutic actions in these two groups. The progression rate to AIDS might also be enhanced by certain interventions.
Source: South African Family Practice 52, pp 64 –68 (2010)More Less
Introduction : The Term Breech Trial has led to obstetricians opting for Caesarean section as the mode of delivery for this presentation, even in poor countries. Concerns related to this approach are the resultant increase in Caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human-resource expertise constraints.
Method : This was a retrospective chart review of women who presented at term with a singleton breech presentation at the antenatal clinic and in labour, from January 2005 to December 2007, at a district level hospital in South Africa.
Results : There was a total of 19 197 deliveries, of which 466 were singleton term breech deliveries, giving a rate of 2.4%. Of the 297 women who had antenatal care and had been allocated to planned Caesarean section, 271 had the planned operation. There were no neonatal deaths in the planned Caesarean section group. The emergency Caesarean section group and the group in which no decision was made on the mode of delivery were associated with higher maternal complication rates than in the group that had planned Caesarean sections. The highest neonatal complication rate was in the group that had unplanned vaginal deliveries.
Conclusion : In a district hospital in South Africa, the mode of delivery for breech presentations is usually a planned Caesarean section. Unplanned vaginal deliveries are associated with significant perinatal mortality.
The value of pimecrolimus in improving quality of life of children with severe eczema - an open non-randomised study : original researchSource: South African Family Practice 52, pp 69 –71 (2010)More Less
Background: Atopic eczema is a common skin condition. It has the potential to severely impair quality of life in affected children. Pimecrolimus is currently registered for mild-moderate eczema but in clinical practice children with more severe disease are often treated with this therapy in an attempt to find a safe addition to long-term topical corticosteroid usage. The aim of this study was to test the value of pimecrolimus in improving quality of life in children with severe atopic eczema.
Methods: This a single site, phase 4, non-randomised, open label trial of pimecrolimus use in children aged 4 months to 12 years living with moderate to very severe atopic eczema. The study was conducted at Steve Biko Academic Hospital. Patients with unsatisfactorily controlled disease despite conventional topical therapy, adequate use of emollients, allergen avoidance and non-pharmacological skin hygiene were enrolled. A Parent Index Quality of Life Questionnaire was completed by parents before and three months after using pimecrolimus.
Results: A total of 24 patients were recruited, 20 of whom completed the study. Ninety per cent of patients had co-morbid asthma and allergic rhinitis. The Parent Index Quality of Life demonstrated a mean 33% score improvement after the use of pimecrolimus. There was an attendant reduction in cost of therapy to these patients.
Conclusions: Pimecrolimus usage should be extended to patients with more severe atopic eczema as the improvement in quality of life is important and demonstrable.
A risk-factor profile for chronic lifestyle diseases in three rural Free State towns : original researchSource: South African Family Practice 52, pp 72 –76 (2010)More Less
Background: Chronic diseases of lifestyle account for millions of deaths each year globally. These diseases share similar modifiable risk factors, including hypertension, tobacco smoking, diabetes, obesity, hyperlipidaemia and physical inactivity. In South Africa the burden of noncommunicable disease risk factors is high. To reduce or control as many lifestyle risk factors as possible in a population, the distinct risk-factor profile for that specific community must be identified. Therefore, the aim of this study was to assess the health status in three rural Free State communities and to identify a distinct risk-factor profile for chronic lifestyle diseases in these communities.
Methods: This study forms part of the baseline phase of the Assuring Health for All in the Free State project, which is a prospective and longitudinal epidemiological study aimed at determining how living in a rural area can either protect or predispose one to developing chronic lifestyle diseases. The communities of three black and coloured, rural Free State areas, namely Trompsburg, Philippolis and Springfontein, were evaluated. The study population consisted of 499 households, and 658 individuals (including children) participated in the study. Only results of adult participants between 25 and 64 years will be reported in this article. The study group consisted of 29.4% male and 70.6% female participants, with a mean age of 49 years. During interviews with trained researchers, household socio-demographic questionnaires, as well as individual questionnaires evaluating diet, risk factors (history of hypertension and / or diabetes) and habits (tobacco smoking and physical activity levels), were completed. All participants underwent anthropometric evaluation, medical examination and blood sampling to determine fasting blood glucose levels.
Results: Multiple risk factors for noncommunicable diseases were identified in this study population, including high blood pressure, tobacco smoking, high body mass index (BMI), diabetes and physical inactivity. The reported risk-factor profile was ranked. Increased waist circumference was ranked highest, high blood pressure second, tobacco smoking third, physical inactivity fourth and diabetes fifth. The cumulative risk-factor profile revealed that 35.6 and 21% of this study population had two and three risk factors, respectively.
Conclusions: The study demonstrated a high prevalence of risk factors for noncommunicable diseases, e.g. large waist circumference, high BMI, raised blood pressure, tobacco smoking and raised blood glucose levels. Serious consideration should be given to this escalating burden of lifestyle diseases in the study population. The development and implementation of relevant health promotion and intervention programmes that will improve the general health and reduce the risk for noncommunicable diseases in this population are advised.
Author H. KirbySource: South African Family Practice 52 (2010)More Less