Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420080002&lang=en vol. 98 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The dilemma of the Palestinian health crisis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editor's Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200002&lng=en&nrm=iso&tlng=en <![CDATA[<b>An 'amnesty' for health professionals?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200003&lng=en&nrm=iso&tlng=en <![CDATA[<b>QF-PCR for prenatal diagnosis of common aneuploides in women of advanced maternal age</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Of HIV, grief and TOP</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Adverse events - at last a scientific way forward?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200006&lng=en&nrm=iso&tlng=en <![CDATA[<b>New local scanners transform forensic pathology</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Private sector cannot be left to 'own devices'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Top watchdog body lashes Zimbabwe - from Harare</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200009&lng=en&nrm=iso&tlng=en <![CDATA[<b>Recommendations pertaining to the use of viral vaccines</b>: <b>Influenza 2008</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Cutaneous cryptococcosis erroneously diagnosed as <i>Histoplasma capsulatum</i> infection</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Herophilus of Chalcedon and the practice of dissection in Hellenistic Alexandria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200012&lng=en&nrm=iso&tlng=en <![CDATA[<b>The Descent of Madness</b>: <b>Evolutionary Origins of Psychosis and the Social Brain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200013&lng=en&nrm=iso&tlng=en <![CDATA[<b>Lipidology</b>: <b>Adding value to tertiary services</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Payment of clinical trial participants</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200015&lng=en&nrm=iso&tlng=en <![CDATA[<b>Clinical trial remuneration</b>: <b>The patients' perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200016&lng=en&nrm=iso&tlng=en <![CDATA[<b>Falsely elevated plasma creatinine levels as a marker of nitromethane poisoning</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200017&lng=en&nrm=iso&tlng=en <![CDATA[<b>Familial hypercholesterolaemia</b>: <b>The Cape Town experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200018&lng=en&nrm=iso&tlng=en Familial hypercholesterolaemia (FH), an autosomal dominantly inherited disorder characterised by elevated plasma low-density lipoprotein (LDL) cholesterol levels, tendon xanthomata and premature ischaemic heart disease, is amenable to treatment with modern medication. The clinical and biochemical details of 1 031 patients with FH were analysed. FH is the most common monogenic disorder of lipoprotein metabolism presenting to the Lipid Clinic at Groote Schuur Hospital, accounting for about 20% of consultations. The hospital classified 55% of the FH patients as white, 43% as coloured, 1.5% as Asian and 0.5% as black. In the FH cohort (whose mean age at presentation was 44 years), 80% had tendon xanthomata, 36% had arcus cornealis, and 14% had xanthelasma. Tendon xanthomata was present in almost 90% of patients by the age of 50 years. Arcus cornealis was present in about 45% by the age of 40 years, further increasing in frequency with age. Cardiovascular complications included ischaemic heart disease (43%), stroke (1.5%), transient ischaemic attacks (1.3%), and peripheral vascular disease (3.7%). The mean age of death was 55 (±13) years; 51 (±10) years in men and 61 (±12) years in women. In 46% of the cohort, a defective gene was identified by testing for locally prevalent mutations. <![CDATA[<b>Severe hypertriglyceridaemia as a result of familial chylomicronaemia</b>: <b>The Cape Town experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200019&lng=en&nrm=iso&tlng=en Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and Red Cross Children's War Memorial Hospital in Cape Town. Criteria for inclusion were an initial plasma triglyceride concentration of >15 mmol/l and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from 0 to 43 years. The modes of presentation differed: pancreatitis (N=16), eruptive xanthomata (N=2), coincidental detection of hypertriglyceridaemia (N=2), screening relatives (N=7), and after death from pancreatitis (N=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction, and some patients sustained good control of the hyperlipidaemia. The onset of pancreatitis was earlier in patients of Indian ancestry, suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages, and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis. <![CDATA[<b>Prevalence of drug-drug interactions of antiretroviral agents in the private health care sector in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200020&lng=en&nrm=iso&tlng=en OBJECTIVES: Human immunodeficiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. DESIGN: Retrospective drug utilisation study using data from a national medicine claims database for the period 1 January to 31 December 2004. SETTING: A section of the private health care sector in South Africa. SUBJECTS: All ARV prescriptions (N=43 482) claimed during 2004. The possible DDIs found were classified according to a clinical significance rating described by Tatro (2005) in his book Drug Interaction Facts. RESULTS: A total of 5 305 882 medicine items were prescribed; of these, 1.92% (N=101 938) were ARVs. Of the total number of 2 595 254 prescriptions, 1.68% (N=43 482) contained ARVs. A total number of 18 035 DDIs (81 different types) were identified; of these, 83.89% (N=15 130) were DDIs between ARVs and other drugs, while 16.11% (N=2 905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, N=17) and 2 (moderate, N=1 436) represented 8.06% (N=1 453) of the total number of identified interactions. CONCLUSIONS: Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a need to understand and anticipate these DDIs and to overcome them by dose adjustments and patient education, so that they are not life threatening to HIV/AIDS patients. <![CDATA[<b>Pharmacologically active</b>: <b>Clinical trials and the pharmaceutical industry</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200021&lng=en&nrm=iso&tlng=en Multinational pharmaceutical companies ('pharmas') import and produce pharmaceuticals and also conduct clinical trials which are an important aspect of research and development (R&D). This may raise the question: Is South Africa a guinea pig for the pharmas? The Department of Trade and Industry National Industrial Policy Framework¹ designates chemicals, plastic fabrication and pharmaceuticals as a key value chain. So a second question could be: Can South Africa be a manufacturer for the pharmas, or can it leverage strengths in medical research and the conducting of clinical trials so as to develop a discovery-led industry? This paper analyses and quantifies the state of the clinical trials industry in South Africa, and concludes that: (i) a sizeable clinical trials industry exists, and that these trials are predominantly phase 3 and global in scope; (ii) South Africa is not a specific or unique guinea pig - a range of conditions is studied as part of global trials; and (iii) while South Africa has excellent prospects for increased clinical trials activity, R&D investment is too low to make it a major pharmaceutical contender. <![CDATA[<b>Incidence of nevirapine-associated hepatitis in an antenatal clinic</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200022&lng=en&nrm=iso&tlng=en OBJECTIVE: To describe the incidence, clinical presentation and management of nevirapine-associated hepatitis among antiretroviral-naïve pregnant women treated with nevirapine-based antiretroviral therapy at a dedicated antenatal antiretroviral clinic. METHODS: Retrospective analysis of pregnant women initiated on nevirapine-based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006. RESULTS: Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR) 26 - 32) years and median pre-treatment CD4 cell counts was 157 (IQR 104 - 193) cells/µl. Baseline alanine transaminase (ALT) was elevated in 2.8% of women (11/390). After initiation of nevirapine-based ART 8% (31/390) experienced an ALT elevation. Three of these patients developed clinical hepatitis with jaundice (0.8%, 3/390). The mean and median time to clinical presentation was 5 weeks. Hepatitis resolved following discontinuation of ART. Non-nevirapine regimens were initiated following biochemical and symptomatic improvement; symptoms did not recur. CONCLUSIONS: Among pregnant women, nevirapine-containing ART has a favourable safety profile, with a low incidence of serious hepatic events. <![CDATA[<b>'Look and Lletz' - a Chris Hani Baragwanath Hospital experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200023&lng=en&nrm=iso&tlng=en OBJECTIVES: An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short-term complications of Lletz (large loop excision of the transformation zone) at this clinic. DESIGN: A retrospective analysis of data from the colposcopy clinic database of patients, who were referred according to national guidelines. SETTING: Patients who are referred to Chris Hani Baragwanath Hospital. REULTS: Normal histology was found in 1.3% of patients, and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4%. The overall complication rate was 3%. CONCLUSION: The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIV-negative women were more likely to be overtreated than HIV-positive patients (p=0.03). <![CDATA[<b>Obstetric anaesthesia</b>: <b>The source of the crisis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200024&lng=en&nrm=iso&tlng=en OBJECTIVES: An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short-term complications of Lletz (large loop excision of the transformation zone) at this clinic. DESIGN: A retrospective analysis of data from the colposcopy clinic database of patients, who were referred according to national guidelines. SETTING: Patients who are referred to Chris Hani Baragwanath Hospital. REULTS: Normal histology was found in 1.3% of patients, and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4%. The overall complication rate was 3%. CONCLUSION: The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIV-negative women were more likely to be overtreated than HIV-positive patients (p=0.03). <![CDATA[<b>Guideline for the Treatment of Haemophilia in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000200025&lng=en&nrm=iso&tlng=en This guideline has been prepared by the authors for and on behalf of the Medical and Scientific Advisory Council (MASAC) of the South African Haemophilia Foundation to facilitate the appropriate management of individuals with haemophilia in South Africa. Individuals with haemophilia and their physicians should be advised by a Comprehensive Haemophilia Treatment Centre. Strategies that help to prevent bleeds include regular exercise to strengthen muscles, protect joints and improve fitness; maintaining a healthy body weight to avoid extra stress on joints; and avoiding contact sports. Acute bleeds should be treated early, ideally within 2 hours of onset. Patients with mild or moderate haemophilia A may be treated with desmopressin. Bleeding in patients with severe haemophilia A without inhibitors should be treated with factor VIII concentrate. Bleeding in patients with haemophilia B without inhibitors should be treated with factor IX replacement. Tranexamic acid can be used for mucous membrane bleeding in surgical or dental procedures. Bleeds in patients with inhibitors must be managed in consultation with a haemophilia treatment centre. Major bleeding episodes are large muscle or joint bleeds, bleeds resulting from severe injury, or bleeds that affect the central nervous system; gastrointestinal system; neck or throat; hip or iliopsoas; or the forearm compartment. These bleeds may cause death or musculoskeletal deformities, and advice on their treatment should be sought from a haemophilia treatment centre physician. Appropriate factor replacement therapy must be started urgently for major bleeds, and hospitalisation is usually required to maintain adequate factor levels.