Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420160008&lang=es vol. 106 num. 8 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>2016 National Rheumatic Fever Week: The status of rheumatic heart disease in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Advice to health professionals: Use of lignocaine as a diluent to reduce the pain associated with the administration of benzathine penicillin G</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Haemotoxic snakebite in rural KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800003&lng=es&nrm=iso&tlng=es <![CDATA[<b>Umbilical hernia in children in a developing country: Does the season have an effect on the occurrence of strangulation?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800004&lng=es&nrm=iso&tlng=es <![CDATA[<b>Contribution of congenital disorders to under-5 mortality</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800005&lng=es&nrm=iso&tlng=es <![CDATA[<b>Emergency medical service workers struggle in violent election climate</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800006&lng=es&nrm=iso&tlng=es <![CDATA[<b>Médecins Sans Frontières moves to protect refugee healthcare</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800007&lng=es&nrm=iso&tlng=es <![CDATA[<b>Rape survivor care crisis - mines the worst?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800008&lng=es&nrm=iso&tlng=es <![CDATA[<b>HIV treatment under control - now for sexy prevention?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800009&lng=es&nrm=iso&tlng=es <![CDATA[<b>Devanandan Chetty (1935 - 2015)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800010&lng=es&nrm=iso&tlng=es <![CDATA[<b>Beyond the Stethoscope: Casebook of a Township Doctor</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800011&lng=es&nrm=iso&tlng=es <![CDATA[<b>Functional neurosurgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800012&lng=es&nrm=iso&tlng=es <![CDATA[<b>Surgical management of spasticity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800013&lng=es&nrm=iso&tlng=es The management of patients with cerebral palsy and other causes of spasticity is a challenge to an entire rehabilitation team and to caregivers. In South Africa, neurosurgeons have had limited involvement in this field owing to a perceived lack of options, leaving the care of these patients largely in the hands of paediatric neurologists and orthopaedic surgeons. A committed team-based approach, where a neurosurgeon is part of the decision-making process, can however significantly improve functional outcomes in patients with spasticity. Key to the evaluation and therapeutic decision-making is the focus on function - not only the range of movement or the presence of spasticity. Some techniques can completely remove spasticity and contractures, but these mostly leave a patient with more functional impairment than they had before the surgery. With the careful combination of botulinum toxin injections and oral baclofen, these patients, who may benefit from further orthopaedic and neurosurgical procedures, can be identified and helped in reducing the function-limiting spasticity. With the emphasis on function as an individualising factor, significant improvements may follow minor interventions, e.g. performing a surgical procedure to allow reduced hip adductor spasticity, thereby allowing improved hygiene and less pain in a child in whom it was previously not possible to abduct the hips enough to change a nappy. Functional improvement does not necessarily equate to walking. We describe the process of evaluating patients with spasticity and outline the surgical decision-making process that helps towards an individualised therapeutic strategy in managing this challenging group of patients. <![CDATA[<b>Surgical management of epilepsy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800014&lng=es&nrm=iso&tlng=es The fact that epilepsy can be cured or ameliorated with surgery is an often neglected and overlooked aspect of modern management. Epilepsy affects almost 50 million people worldwide. One-third of people who suffer from epilepsy are refractory to medication alone. It is this group of patients who may benefit from epilepsy surgery, which can be divided into three main categories, i.e. resection procedures, disconnection procedures, and neuromodulation procedures. The goal of surgery in epilepsy is to remove the epileptogenic region from the brain, or to disconnect it and thereby prevent spread to other parts of the brain. In cases where this is not possible owing to the location of the epileptic focus, certain neuromodulation techniques may benefit the patient. Successful outcomes of epilepsy surgery techniques vary from 50% to 80% in rendering patients free of their epilepsy; many more patients can expect improvement in the severity or frequency of their disabling seizures. The outcome depends on factors such as age, location of the epileptogenic zone, histology and cause of the seizures. Patients undergo a detailed and prolonged work-up to determine candidacy and to decide on the safest technique that will lead to the best outcomes. An experienced team should perform the surgery. This team should consist of multiple members who can attend to the medical, social, psychological and reintegration needs of the patient before and after surgery. <![CDATA[<b>Asymptomatic rheumatic heart disease in South African schoolchildren: Implications for addressing chronic health conditions through a school health service</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800015&lng=es&nrm=iso&tlng=es When new evidence comes to light, it compels us to contemplate the implications of such evidence for health policy and practice. This article examines recent research evidence on the prevalence of asymptomatic rheumatic heart disease (RHD) in South Africa and considers the implications for the Integrated School Health Programme (ISHP). RHD is still a major burden of disease in developing countries, and elimination of this preventable condition ranks high among World Heart Federation goals. If left untreated, it becomes a chronic health condition that individuals have to cope with into their adult lives. The ISHP regards the health needs of children with chronic health conditions, which include conditions such as RHD, as a key service component. However, the chronic health component of the ISHP is still poorly developed and can benefit from good evidence to guide implementation. A recent study to ascertain the prevalence of RHD in asymptomatic schoolchildren through mass screening affords an opportunity to reflect on whether, and how, asymptomatic chronic health conditions in schoolchildren could be addressed, and what the implications would be if this were done through a school-based programme such as the ISHP. <![CDATA[<b>A successful lifestyle intervention model replicated in diverse clinical settings</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800016&lng=es&nrm=iso&tlng=es Lifestyle interventions (Lis) can treat metabolic syndrome and prevent type 2 diabetes mellitus, but they remain underutilised in routine practice. In 2010, an LI model was created in a rural primary care practice and spread with few resources to four other rural practices. A retrospective chart review evaluated changes in health indicators in two practice environments by following 372 participants, mainly women (mean age 52 years). Participants had a mean body mass index of 37 kg/m² at baseline and lost an average of 12% of their initial body weight as a result of the intervention. Among participants at the first intervention site for whom cardiometabolic data were available, the prevalence of metabolic syndrome decreased from 58% at baseline to 19% at follow-up. Taken as a whole, our experience suggests that Lis are feasible and deliver meaningful results in routine primary care practice. <![CDATA[<b>Severe hypertension in pregnancy: Using dynamic checklists to save lives</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800017&lng=es&nrm=iso&tlng=es Severe hypertension is a major cause of morbidity and mortality. The South African Saving Mothers report (2011 - 2013) indicates that cerebral injury due to severe hypertension is resulting in avoidable maternal deaths. This demands that management of severe hypertension in pregnancy needs to be improved. A rapid-acting antihypertensive is recommended for the initial management of severe hypertension during pregnancy. A single dose of a rapid-acting agent may be ineffective, in which case incremental doses of the same medication or another antihypertensive may be required for adequate blood pressure control. To ensure that appropriate antihypertensives at the correct doses are administered, the use of a guideline in a dynamic checklist format is advocated and discussed in this article. It is envisaged that the use of dynamic checklists will be valuable to all healthcare professionals providing care during pregnancy and the puerperium. <![CDATA[<b>The World Health Organization's mechanisms for increasing the health sector budget: The South African context</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800018&lng=es&nrm=iso&tlng=es South Africa (SA) has limited scope for raising income taxes, and the proposed National Health Insurance (NHI) scheme will necessitate growth in the health sector budget. The NHI White Paper suggests five funding scenarios to meet the expected shortfall. These scenarios are a mixture of a surcharge on taxable income, an increase in value-added tax and a payroll tax. Five alternative options, suggested by the World Health Organization, are interrogated as ways to decrease the general taxation proposed in the White Paper. The five mechanisms (corporate tax, financial transaction levy, and taxes on tobacco, alcohol and unhealthy foods) were chosen based on their fund-raising potential and their mandatory element. A literature review provides the information for a discussion of the potential costs of each mechanism. Within specific assumptions, potential budgetary contribution is compared with the requirement. First, raising corporate tax rates could raise enough funds, but the losses due to capital flight might be too much for the local economy to bear. Second, a levy on currency transactions is unlikely to raise the required resources, even without a probable decrease in the number of transactions. Third, the increase in the tax on tobacco and alcohol would need to be very large, even assuming that consumption patterns would remain unchanged. Lastly, a tax on unhealthy food products is a new idea and could be explored as an option - especially as the SA Treasury has announced its future implementation. Implementing only one of the mechanisms is unlikely to increase available funding sufficiently, but if they are implemented together the welfare-maximising tax rate for each mechanism may be high enough to fulfil the NHI scheme's budgetary requirement, moderating the increases in the tax burden of the SA population. <![CDATA[<b>Implications of the 2015 World Health Organization isoniazid preventive therapy recommendations on tuberculosis prevention efforts in Namibia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800019&lng=es&nrm=iso&tlng=es The World Health Organization recently released guidelines recommending 36-month use of isoniazid preventive therapy in adults and adolescents living with HIV in resource-limited settings. Namibia continues to grapple with one of the highest incidences of tuberculosis (TB) worldwide. Implementation of these guidelines requires considerations of TB epidemiology, health infrastructure, programmatic priorities and patient adherence. This article explores the challenges Namibia currently faces in its fight against TB and the implications of the new guidelines on Namibian TB prevention efforts. <![CDATA[<b>Antifibrinolytic drugs for acute traumatic injury</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800020&lng=es&nrm=iso&tlng=es In South Africa, trauma is a major concern, with violence and road traffic accidents being the fifth and seventh leading causes of death, respectively. Antifibrinolytic agents have been used in trauma and major surgery to prevent fibrinolysis and reduce blood loss. We highlight an updated Cochrane review investigating the effect of antifibrinolytic drugs in patients with acute traumatic injury. The review authors conducted comprehensive literature searches in January 2015 with regard to all randomised controlled trials comparing antifibrinolytic agents after acute traumatic injury. Three randomised controlled trials, of which two (n=20 451) assessed the effect of tranexamic acid (TXA), were included. The authors concluded that TXA safely reduces mortality in trauma with bleeding without increasing the risk of adverse events. TXA should be administered as early as possible, and within 3 hours of injury. There is still uncertainty with regard to the effect of TXA on patients with traumatic brain injury; however, ongoing randomised controlled trials should shed more light on this. <![CDATA[<b>The microbiome in chronic inflammatory airway disease: A threatened species</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800021&lng=es&nrm=iso&tlng=es The human body is exposed to a multitude of microbes and infectious organisms throughout life. Many of these organisms colonise the skin, gastrointestinal tract (GIT) and airway. We now recognise that this colonisation includes the lower airway, previously thought to be sterile. These colonising organisms play an important role in disease prevention, including an array of chronic inflammatory conditions that are unrelated to infectious diseases. However, new evidence of immune dysregulation suggests that early colonisation, especially of the GIT and airway, by pathogenic micro-organisms, has deleterious effects that may contribute to the potential to induce chronic inflammation in young children, which may only express itself in adult life. <![CDATA[<b>Intravenous glutathione for skin lightening: Inadequate safety data</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800022&lng=es&nrm=iso&tlng=es BACKGROUND: Glutathione (GSH) is the most abundant naturally occurring non-protein thiol that protects mammalian cells from oxidative stress. Intravenous (IV) GSH for skin lightening is advertised by clinics in South Africa and internationally online, yet to date no published review on the subject exists. METHODS: We conducted a MEDLINE search (to 30 September 2015) of GSH use for skin lightening and of all indications in medicine, to evaluate its safety. RESULTS: Two controlled clinical trials (GSH capsules: 60 patients; 2% glutathione disulphide lotion: 30 patients) and a case series (GSH lozenges: 30 patients) reported a significantly decreased melanin index. A case series (GSH soap: 15 patients) reported skin lightening based on photography. Two systematic reviews of IV GSH for preventing chemo-induced toxicity and a third review of adjuvant therapy for Parkinson's disease altogether included 10 trials. Most trials reported either no or minimal GSH adverse effects, but all had treatment durations of a few doses (IV) or 4 - 12 weeks. No study reported long-term IV GSH use. CONCLUSION: In spite of widespread reported use, there are no studies of IV GSH use for skin lightening or of its safety for chronic use (for any indication). The switch from brown to red melanin production may increase the risk of sun-induced skin cancers in previously protected individuals. Regulatory assessment of systemic GSH administration for cosmetic use by the Medicines Control Council seems urgently warranted to protect consumers from potential side-effects and from complications of IV infusions. This is especially concerning because of reports of GSH bought online. Effective topical GSH may be useful for hyperpigmented skin disorders, but this requires scientific scrutiny. The debate on the merits of cosmetic skin lightening is best handled by multidisciplinary teams. <![CDATA[<b>When may doctors give nurses telephonic treatment instructions?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800023&lng=es&nrm=iso&tlng=es Doctors are expected to examine their patients before issuing telephonic instructions to nurses. However, in emergencies or when they are aware of the health status of their patients, it may be justified for a doctor to issue telephonic instructions to nurses without examining the patient. Doctors on call owe a special duty to patients, who they may have to examine or arrange for another doctor to do so before issuing telephonic instructions. In deciding whether doctors acted reasonably in issuing telephonic instructions to nurses, the courts will decide whether they exercised the same degree of skill and care as reasonably competent practitioners in their branch of the profession. Suggestions are made concerning doctors giving telephonic instructions to nurses regarding patients they have not examined. <![CDATA[<b>Cardiogenic shock - a look at acute functional mitral incompetence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800024&lng=es&nrm=iso&tlng=es A 44-year-old man presented with cardiogenic shock secondary to acute functional mitral incompetence as well as septic shock related to pneumonia. The patient deteriorated haemodynamically despite adequate medical therapy. An echocardiogram revealed a massive mitral incompetence and an ejection fraction of 32%. An intra-aortic balloon pump was placed and the patient improved dramatically. On day 6 after admission the echocardiogram was repeated, revealing a mild mitral incompetence and an ejection fraction of 58%. <![CDATA[<b>Fatal encephalopathy complicating persistent vomiting in pregnancy: Importance of clinical awareness on the part of healthcare professionals</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800025&lng=es&nrm=iso&tlng=es Women with persistent vomiting during pregnancy need early referral to appropriate health facilities. Delayed referral and inappropriate management may lead to metabolic encephalopathy from a variety of causes, including electrolyte derangements or thiamine deficiency (Wernicke's encephalopathy) (WE). We present a case of persistent vomiting in pregnancy in which there was delayed referral, inappropriate treatment and failure to associate neurological signs such as terminal neck stiffness with WE, resulting in poor fetomaternal outcomes. In this report, we discuss the following lessons: (i) the need for early transfer of a patient with persistent vomiting and enigmatic clinical features to a higher healthcare facility; (ii) failure to associate neurological signs with complications of hyperemesis gravidarum/WE; ( iii) lack of thiamine supplementation; and (iv) the advantages of magnetic resonance imaging over a computed tomography scan in the diagnosis of WE. <![CDATA[<b>A case of renal cell carcinoma and angiomyolipoma in an adolescent girl</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800026&lng=es&nrm=iso&tlng=es We describe a case of renal cell carcinoma in the right kidney together with an angiomyolipoma in the left kidney, encountered in an adolescent girl at Potchefstroom Provincial Hospital, North West Province, South Africa. <![CDATA[<b>Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800027&lng=es&nrm=iso&tlng=es BACKGROUND: Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality. OBJECTIVES: To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic. METHOD. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up. RESULTS: A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension. CONCLUSION: Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this. <![CDATA[<b>Pan computed tomography for blunt polytrauma: Are we doing too many?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800028&lng=es&nrm=iso&tlng=es BACKGROUND: Pan computed tomography (CT) is widely used in the evaluation of patients with blunt polytrauma, but there is growing concern about the radiation risks imposed. OBJECTIVES: To ascertain whether we were possibly overutilising pan CT in our trauma service, and whether we could safely cut down on scans without missing significant injuries. METHODS. We audited all pan scans performed in the Metropolitan Trauma Service, Pietermaritzburg, South Africa, during the 12-month period 1 January - 31 December 2012. An analysis was done to determine what injuries were identified and how these findings influenced our management. RESULTS: Of the 140 pan scans, 108 (77.1%) influenced management. These included the following components: 62 brain scans (44.3%), 16 cervical spine scans (11.4%), 50 chest scans (35.7%) and 31 abdominal scans (22.1%). The remaining 32 pan scans (22.9%) did not influence management. However, it turned out that many of these 'clinically negative' scans were in fact clinically important, ruling out injury in patients in whom clinical assessment was regarded as unreliable: 3 patients (2.1%) were hypoxic and had to be sedated, intubated and ventilated; 14 (10.0%) had a Glasgow Coma Score (GCS) of <15; and 9 (6.4%) had major distracting injuries. This left only 6 pan scans (4.3%) that were not regarded as clinically helpful. CONCLUSION: In our setting, the majority of pan scans influence management. By ruling out significant injuries, clinically negative scans are valuable in patients who are obtunded, intubated and ventilated, or have major distracting injuries. In patients with a GCS of 15, not sedated and ventilated and with no major distracting injuries, clinical assessment and alternative imaging modalities may suffice. <![CDATA[<b>South African healthcare provider perspectives on transitioning adolescents into adult HIV care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800029&lng=es&nrm=iso&tlng=es BACKGROUND: The first generation of South African (SA) children perinatally infected with HIV is entering adulthood, and there is now a pressing need for systematised transfer of these patients from paediatric to adult care. OBJECTIVES: Previous research has investigated the HIV healthcare transition in North America and Europe, yet none has been conducted in SA. Our study is the first to describe the perspectives of healthcare providers overseeing the transition in resource-limited settings. METHODS. We approached healthcare providers working in government paediatric HIV clinics and hospitals in the Western Cape Province, SA. Seven physicians and counsellors in adolescent/paediatric care, representing five clinics, were interviewed, and 43 completed a written survey. Interviews addressed the current state of the transition, barriers and facilitators, and model components. Interviews were assessed for major themes using framework analysis, while logistic regression was applied to survey responses to identify associations with measured covariates. RESULTS: Analysis of interview transcripts revealed several overarching perspectives that were corroborated by survey responses. One barrier identified was the healthcare providers' difficulty in letting go of their relationships with the adolescent patients. Since healthcare providers regarded their patients as particularly vulnerable, they felt a strong and protective attachment towards them. A second barrier identified was a lack of structure and effective communication between adult and paediatric providers; accordingly, healthcare providers feared that they were transferring their adolescents unprepared, to a judgemental, depersonalised and overburdened environment. All interviewees and a majority of survey respondents (>80%) agreed that the formation of adolescent support groups in adult care clinics as well as a later transition age would improve the transition process. CONCLUSION: This study highlights the need for a systematic healthcare transition for HIV-positive adolescents cared for in the Western Cape, while acknowledging the limitations of the current healthcare infrastructure. Several feasible recommendations have been identified, including forming support groups and greater involvement of adolescent healthcare providers to facilitate the transition. <![CDATA[<b>Sialendoscopic treatment of recurrent juvenile parotitis: A South African case series</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800030&lng=es&nrm=iso&tlng=es BACKGROUND: Recurrent juvenile parotitis (RJP) is a well-recognised cause of parotitis in childhood. Sialendoscopy has been extensively used for the investigation and treatment of many benign salivary disorders, and now offers a minimally invasive approach to RJP. OBJECTIVES: To investigate the epidemiology and disease profile of RJP, and review the efficacy of sialendoscopy for its investigation and treatment. METHODS: The relevant literature on RJP was reviewed, and a retrospective folder review was performed for all patients who had undergone sialendoscopy for RJP at two South African (SA) hospitals between April 2013 and September 2015. Patients' epidemiological and clinical data were recorded, as well as the findings and outcomes of ultrasonography and sialendoscopy. In particular, the time following treatment without any further recurrences was recorded as a measure of success. RESULTS: Five children underwent sialendoscopic investigation and treatment for RJP. Their demographic and disease profiles and the results of investigations and treatments were in keeping with published literature. No surgical complications occurred, and no patients reported any further symptoms postoperatively, with an average follow-up of 22 months. CONCLUSION: Although small in sample size, this is the first reported case series in the SA literature on the use of sialendoscopy for RJP, and the results are consistent with internationally published data. Sialendoscopy is regarded as safe and effective for the diagnosis and management of RJP, and should be considered for patients who remain symptomatic after conservative management. <![CDATA[<b>Salvageability of renal function following renal revascularisation in children with Takayasu's arteritis-induced renal artery stenosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800031&lng=es&nrm=iso&tlng=es BACKGROUND: Renal artery revascularisation procedures are usually carried out on children with renal artery stenosis from varied causes, including Takayasu's arteritis. Reports on the outcome of such procedures in children usually refer to the improvement in blood pressure, with only minimal mention of effects on renal function. OBJECTIVE: Salvageability of renal function in children who underwent renal revascularisation for Takayasu's arteritis-induced renal artery stenosis (TARAS) was the focus of this study. METHODS. We undertook a retrospective analysis of children aged <16 years with angiographically confirmed TARAS who underwent renal artery revascularisation procedures between 1990 and 2010. Outcomes of renal function were studied over a period of 2 years and were defined as: (i) improvement: &gt;20% increase in estimated glomerular filtration rate (e-GFR) from presurgery value; (ii) stabilisation: e-GFR within 20% of presurgery value; and (iii) failure: &gt;20% deterioration in e-GFR from presurgery value. The GFR was estimated using the Schwartz formula. RESULTS: Twenty children (9 males and 11 females, age range 2 - 14 years) had 27 renal artery revascularisation procedures. Thirteen of the patients (65.0%) had bilateral renal artery stenosis. The baseline mean e-GFR was 88.6 (standard deviation (SD) 25.4) mL/min/1.73 m² and the mean duration of follow-up was 28.80 (SD 25.62) months. All the patients had stable or improved renal function until the 2-year follow-up, when the proportion decreased to 92.3% (12/13), as failure was recorded in one child. Bilateral revascularisation was found to be significantly associated with improvement in renal function in the early postoperative period (p=0.04). CONCLUSION: Renal artery revascularisation procedures are successful in salvaging renal function in children with TARAS. <![CDATA[<b>Feasibility of Pulse Oximetry Pre-discharge Screening Implementation for detecting Critical Congenital heart Lesions in newborns in a secondary-level maternity hospital in the Western Cape, South Africa: The 'POPSICLe' study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800032&lng=es&nrm=iso&tlng=es BACKGROUND: Early detection of critical congenital heart disease (CCHD) through newborn pulse oximetry (POx) screening is an effective strategy for reducing paediatric morbidity and mortality rates and has been adopted by much of the developed world. OBJECTIVES: To document the feasibility of implementing pre-discharge POx screening in well babies born at Mowbray Maternity Hospital, a busy government hospital in Cape Town, South Africa. Parent and staff acceptance was assessed. METHODS: We conducted a prospective study of predischarge POx screening in one postnatal ward, following informed parental consent. RESULTS: During the 4-month study period, 1 017 of 2 256 babies discharged (45.1%) were offered POx screening and 1 001 were screened; 94.0% of tests took <3 minutes to perform, 4.3% 3 - 5 minutes and 1.7% &gt;5 minutes. Eighteen patients needed second screens and three required third screens. Only 3.1% protocol errors were made, all without consequence. The vast majority (91.6%) of nursing staff reported insufficient time to perform the study screening in addition to their daily tasks, but ~75% felt that with a full nursing staff complement and if done routinely (not part of a study), pre-discharge POx screening could be successfully instituted at our facility. Over 98% of the mothers had positive comments. Two babies failed screening and required echocardiograms; one was diagnosed with CCHD and the other with neonatal sepsis. The sensitivity and specificity were 50% (95% confidence interval (CI) 1.3 - 98.7%) and 99.9% (95% CI 99.4 - 100%), respectively, with a percentage correct of 99.8%. CONCLUSIONS: POx screening was supported and accepted by staff and parents. If there are no nursing staff shortages and if it is done routinely before discharge, not as part of a study, we conclude that POx screening could be implemented successfully without excessive false positives or errors, or any additional burden to cardiology services. <![CDATA[<b>Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800033&lng=es&nrm=iso&tlng=es BACKGROUND. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C). OBJECTIVES. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it. Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant. RESULTS. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this. CONCLUSION. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C. <![CDATA[<b>A clinical audit of the utilisation of red cell products in elective total hip replacement surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800034&lng=es&nrm=iso&tlng=es BACKGROUND: Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery. OBJECTIVE: To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG). METHODS. The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age, sex, clinical observations, indications for surgery, pre- and postoperative haemoglobin (Hb) values, comorbidities, length of hospital stay and transfusion history was recorded. RESULTS: The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p<0.05), and the mean age of transfused patients was significantly greater than that of untransfused patients (p<0.005). Although patients with comorbidities had a higher transfusion rate than those without, this did not reach statistical significance. Of 120 patients with complete data, 113 (94.2%) had a blood bank order, of which the vast majority, 102/113 (90.3%), were group-and-screen (G) requests; 29/113 (25.7%) were converted to a full crossmatch. CONCLUSIONS: Overall, the transfusion rate for both hospitals was 25.8%, which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines, with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary, and a G order is sufficient. <![CDATA[<b>Targeting composite treatment of type 2 diabetes in middle-income countries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000800035&lng=es&nrm=iso&tlng=es BACKGROUND: Previous studies have documented a marked variation in transfusion practice for total hip replacement (THR) surgery. OBJECTIVE: To audit red cell product utilisation for THR at two Western Cape tertiary referral hospitals (HY and HG). METHODS. The folders of 207 consecutive patients undergoing elective THR surgery from January 2013 to December 2013 were reviewed. Information relating to age, sex, clinical observations, indications for surgery, pre- and postoperative haemoglobin (Hb) values, comorbidities, length of hospital stay and transfusion history was recorded. RESULTS: The transfusion rate at HY (41.6%) was significantly higher than that at HG (10.0%). The mean postoperative Hb in the transfused patients at HG was 8.3 g/dL v. 9.1 g/dL at HY. Females had a significantly higher transfusion rate (33.0%) than males (15.0%) (p<0.05), and the mean age of transfused patients was significantly greater than that of untransfused patients (p<0.005). Although patients with comorbidities had a higher transfusion rate than those without, this did not reach statistical significance. Of 120 patients with complete data, 113 (94.2%) had a blood bank order, of which the vast majority, 102/113 (90.3%), were group-and-screen (G) requests; 29/113 (25.7%) were converted to a full crossmatch. CONCLUSIONS: Overall, the transfusion rate for both hospitals was 25.8%, which is well within published rates. A guideline Hb trigger of 8.0 g/dL is recommended as per published guidelines, with the caveat that the clinical judgement of the attending clinician whether a transfusion is indicated is paramount. Causes of preoperative anaemia should be investigated and treated. Routine cross-matching preoperatively is unnecessary, and a G order is sufficient.