Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420080003&lang=pt vol. 98 num. 3 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Humans - a threat to humanity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Editor's Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Aspirin and air travellers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Huntington's disease-like 2 in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>ALCAT and IgG allergy and intolerance tests</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Integrative - or integral - medicine?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Eskom debacle</b>: <b>Health care risks, frustrations climb</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Finally - PMTCT <i>dual</i> therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Neonatal deaths - where's the national strategic intervention?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Uniquely South African</b>: <b>Time to consider offering HIV-positive donor kidneys to HIV-infected renal failure patients?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300010&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Treating adolescents in South Africa</b>: <b>Time for adolescent medicine units?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300011&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Multiple primary small-bowel carcinomas presenting with anaemia and intussusception</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300012&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Johannes Daniel Visser</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300013&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Lafras Marais Steyn</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300014&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Hans (Johannes Jacobus) Loock (4/11/1930 -17/9/2007)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300015&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Paediatric Trauma and Child Abuse</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300016&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Genetic testing for Huntington's disease in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300017&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Identifying flies used for maggot debridement therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300018&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Regional clinical registry data show increased incidence of cutaneous melanoma in Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300019&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Huntington's disease</b>: <b>Genetic heterogeneity in black African patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300020&lng=pt&nrm=iso&tlng=pt OBJECTIVE: Huntington's disease (HD) has been reported to occur rarely in black patients. A new genetic variant-Huntington's disease-like 2 (HDL2) - occurring more frequently in blacks, has recently been described. The absence of an expanded trinucleotide repeat at the chromosome 4 HD locus was previously regarded as a way of excluding classic HD. The objective of this paper is to describe a number of black patients with genetically proven HD and to review its occurrence in Africa. METHODS: Eleven black families (12 subjects), with genetically proven HD, are described: 9 from the Dr George Mukhari Hospital, and 2 from private practice in Tshwane. RESULTS: Chorea was present in all 12 patients and cognitive decline in 9. Nine had an age of onset between 30 and 50 years. Six families exhibited expansion of the trinucleotide repeat at the chromosome 4, IT 15 gene (HD), and 5 a junctophilin (JPH3) trinucleotide expansion at chromosome 16 (HDL2). The HDL2 subtype showed a tendency towards a later age of onset. CONCLUSIONS: The clinical presentation of the two genotypes (i.e. HD and HDL2) appears to be similar. The actual rate of occurrence of HD in blacks may require re-assessment. Considering the number of Huntington's chorea patients occurring in our area (Garankuwa), the possibility of clustering of the condition arises. <![CDATA[<b>Predictors of mortality in patients initiating antiretroviral therapy in Durban, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300021&lng=pt&nrm=iso&tlng=pt OBJECTIVE: To identify predictors of mortality in patients initiating antiretroviral therapy (ART) in Durban, South Africa. DESIGN: We conducted a retrospective cohort study analysing data on patients who presented to McCord Hospital, Durban, and started ART between 1 January 1999 and 29 February 2004. We performed univariate and multivariate analysis and constructed Kaplan-Meier curves to assess predictors. RESULTS: Three hundred and nine patients were included. Forty-nine (16%) had died by the conclusion of the study. In univariate analysis, the strongest predictors of mortality were a CD4 cell count <50/µl (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.96 - 7.14), a haemoglobin concentration <8 g/dl (HR 1.23, 95% CI 1.08 - 1.40), a history of oral candidiasis (HR 3.17, 95% CI 1.70 - 5.87) and a history of cryptococcal meningitis (HR 2.76, 95% CI 1.80 - 19.2). A CD4 cell count <50/µl (HR 3.08, 95% CI 1.54 - 5.88) and a history of oral candidiasis (HR 2.58, 95% CI 1.37 - 4.88) remained significant in multivariate analysis. A history of tuberculosis was not a significant predictor of mortality. CONCLUSIONS: Simple clinical and laboratory data independently predict mortality and allow for risk stratification in patients initiating ART in South Africa. Interventions enabling patients to be identified before they develop these clinical markers and earlier initiation of ART will help to ensure maximum benefits of therapy. <![CDATA[<b>Messages about dual contraception in areas of high HIV prevalence are not heeded</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300022&lng=pt&nrm=iso&tlng=pt BACKGROUND: Dual protection is recommended for prevention of unwanted pregnancies and protection against sexually transmitted infections, including HIV. It is critical for HIV-negative women to prevent seroconversion and HIV transmission to their infants during pregnancy and breastfeeding. METHODS: Women were followed up after delivery, monthly for the first 9 months and then 3-monthly to 24 months, in a cohort study investigating postnatal HIV transmission. Study nurses discussed family planning, including condom use, at each visit. Contraceptive methods used since the last visit were recorded. All women knew their HIV status, and most women breastfed for a minimum of 6 months. RESULTS: Among 1 137 HIV-positive and 1 220 HIV-negative women the most common contraceptive method was the hormonal injectable; few women used condoms alone or as dual contraception (0 - 3 months 6.8%; 7 - 12 months 16.3%; 19 - 24 months 14.4%). Compared with uninfected women, HIV-positive women were more likely to use condoms in years 1 and 2 after delivery (adjusted odds ratio (AOR) 1.72, 95% confidence interval (CI) 1.38 - 2.14, p<0.001; AOR 1.61, 95% CI 1.15 - 2.25, p=0.006 respectively). Compared with women with a flush toilet, those with a pit latrine were less likely to use condoms in years 1 and 2 (AOR 0.22, 95% CI 01.7 - 0.28, p<0.001; AOR 0.27, 95% CI 0.19 - 0.39, p<0.001). Older women were more likely to use condoms in the first postpartum year (AOR 1.78, 95% CI 1.03 - 3.09, p=0.040). CONCLUSIONS: More creative ways of promoting condoms and dual contraception need to be found if new HIV infections, in women and children, are to be prevented. <![CDATA[<b>Patients with severe mental illness</b>: <b>A new approach to testing for HIV</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300023&lng=pt&nrm=iso&tlng=pt BACKGROUND: The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. METHODS: A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. RESULTS: The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. CONCLUSIONS: The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients. <![CDATA[<b>Ethics and surgical training in ancient India - a cue for current practice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300024&lng=pt&nrm=iso&tlng=pt BACKGROUND: The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. METHODS: A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. RESULTS: The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. CONCLUSIONS: The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients. <![CDATA[<b>Influenza Guideline for South Africa - Update 2008</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000300025&lng=pt&nrm=iso&tlng=pt BACKGROUND: The prevalence of HIV infection in South Africa is approaching 20% of young adults. In severely mentally ill people it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high-risk population. METHODS: A literature review established the prevalence of HIV infection in inpatient populations with HIV infection. The pattern of testing for HIV over 3 years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. RESULTS: The reported HIV seroprevalence in psychiatric inpatients ranges from 0 to 59.3%, with a mean of 10%. Data show a clear trend towards an increase in prevalence: before 1996 the mean HIV seroprevalence was 7.4%, while after 1996 the mean was 15%. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly owing to ethical constraints: 14.6% of patients at Lentegeur Hospital were tested in 2006. CONCLUSIONS: The high prevalence of HIV infection in South Africa, which is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent), and the availability of effective treatment require debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients.