Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420080004&lang=en vol. 98 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>National health insurance on the horizon for South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editor's Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Inconsiderate CPD decision</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Discovering familial hypercholesterol-aemia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Pagophagia when ice is not available - drink cold water</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400005&lng=en&nrm=iso&tlng=en <![CDATA[<b>What did it cost to get you here?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400006&lng=en&nrm=iso&tlng=en <![CDATA[<b>What is the incidence of paediatric hypertension in South Africa?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Am I just an old-fashioned GP?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Electronic data interface in general practice improves debtor days</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400009&lng=en&nrm=iso&tlng=en <![CDATA[<b>Is diabetic screening <i>really</i> feasible in South African urban primary care?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Public sector ARV sites finding 'disturbing'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Australian surgeon's tenacity more than skin deep</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400012&lng=en&nrm=iso&tlng=en <![CDATA[<b>More than a pinch less salt needed</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400013&lng=en&nrm=iso&tlng=en <![CDATA[<b>Child mortality committee launch - a chance missed</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Co-trimoxazole prophylaxis in HIV</b>: <b>The evidence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400015&lng=en&nrm=iso&tlng=en <![CDATA[<b>HPV vaccines</b>: <b>Bring me your daughters!</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400016&lng=en&nrm=iso&tlng=en <![CDATA[<b>Auto-amputation of a breast due to ductal carcinoma</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400017&lng=en&nrm=iso&tlng=en <![CDATA[<b>Progressive multifocal leucoencephalopathy - a case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400018&lng=en&nrm=iso&tlng=en <![CDATA[<b>Petrus Nicolaas Smith</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400019&lng=en&nrm=iso&tlng=en <![CDATA[<b>Paediatric surgery</b>: <b>Birth of a new specialty or a coming of age?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400020&lng=en&nrm=iso&tlng=en <![CDATA[<b>A centile chart for fetal weight for gestational ages 24 - 27 weeks</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400021&lng=en&nrm=iso&tlng=en <![CDATA[<b>Eating disorders in South Africa</b>: <b>An inter-ethnic comparison of admission data</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400022&lng=en&nrm=iso&tlng=en <![CDATA[<b>Coping strategies and social support after receiving HIV-positive results at a South African district hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400023&lng=en&nrm=iso&tlng=en <![CDATA[<b>Medical management of opioid dependence in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400024&lng=en&nrm=iso&tlng=en Medical practitioners in South Africa are increasingly confronted with requests to treat patients with opioid use disorders. Many do not possess the required knowledge and skills to deal with these patients effectively. This overview of the medical treatment of opioid dependence was compiled by an elected working group of doctors working in the field of substance dependence. Recommendations are based on current best practice derived from scientific evidence and consensus of the working group, but should never replace individual clinical judgement. <![CDATA[<b>Medical futility and end-of-life care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400025&lng=en&nrm=iso&tlng=en Acceptance of the concept of medical futility facilitates a paradigm shift from curative to palliative medicine, accommodating a more humane approach and avoiding unnecessary suffering in the course of the dying process. This should not be looked upon as abandoning the patient but rather as providing the patient and family with an opportunity to come to terms with the dying process. It also does not entail withdrawal or passivity on the part of the health care professional. In addition to medical skills, the treating physician is responsible for guiding this process by demonstrating sensitivity and compassion, respecting the values of patients, their families and the medical staff. The need for training to equip medical staff to take responsibility as empathetic participants in end-of-life decision-making is underscored. <![CDATA[<b>Adjunctive corticosteroid treatment of clinical <i>Pneumocystis jiroveci</i> pneumonia in infants less than 18 months of age - a randomised controlled trial</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400026&lng=en&nrm=iso&tlng=en OBJECTIVES: To determine the efficacy and safety of adjunctive corticosteroid therapy in clinical Pneumocystis jiroveci pneumonia (PCP) in infants exposed to HIV infection. DESIGN. Double-blind randomised placebo-controlled trial. METHODS: Infants with a clinical diagnosis of PCP, based on an 'atypical' pneumonia with: (i) hypoxia out of proportion to the clinical findings on auscultation; (ii) C-reactive protein count less than 10 mg/l; (iii) lactate dehydrogenase level above 500 IU/l; (iv) compatible chest radiograph findings; and (v) positive HIV enzyme-linked immunosorbert assay (ELISA) were included in the study. Patients were randomised to receive either prednisone or placebo. The protocol provided for the addition of prednisone to the treatment at 48 hours if there was clinical deterioration or an independent indication for steroid therapy. Other treatment was carried out in accordance with established guidelines. The primary study endpoint was in-hospital survival. Secondary outcome was time from admission to the first day of mean oxygen saturation above 90% in room air. RESULTS: One hundred patients were included, 47 in the prednisone and 53 in the placebo group. Patients in the prednisone group had a 43% better chance of survival than the placebo group (hazard ratio (HR) 0.57, 95% confidence interval (CI) 0.30 - 1.07, p=0.08). No significant differences could be demonstrated between groups with regard to other parameters of recovery. CONCLUSIONS: In HIV-exposed infants with clinical PCP, adjunctive corticosteroid treatment does not appear to add benefit regarding time to recovery or oxygen independency, but early administration may improve survival. A large multicentred trial is needed to confirm these findings. <![CDATA[<b>A review of internal medicine re-admissions in a peri-urban South African hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400027&lng=en&nrm=iso&tlng=en OBJECTIVE. To measure the re-admission rate and the number of preventable re-admissions in a secondary-level South African hospital, and to identify factors predictive of re-admission. METHOD: The admission register for the medical wards at Cecilia Makiwane Hospital (CMH) was used to identify re-admitted patients, whose folders were then reviewed. A comparison group of patients who were not re-admitted was randomly generated from the same register. RESULTS: The re-admission rate for the 7 months ending October 2006 was 8.5% (262/3 083). Patients who were more likely to be re-admitted had chronic respiratory disease (odds ratio (OR) 4.2, 95% confidence interval (CI) 1.2 - 14.6), HIV infection (OR 5.0, CI 2.1 - 12.0), were older than 50 years (OR 5.2, CI 2.5 - 10.9), had a first admission of more than 8 days (OR 3.2, CI 1.5 - 6.6) or a booked medical outpatients follow-up (OR 5.1, CI 2.6 - 10.3). Age distribution of re-admissions was bimodal, with HIV-positive individuals (27.4% overall) accounting for 50% of all admissions younger than 50 years, but only 9.1% of those 50 years or older. In individuals older than 50 years, 42.1% of admissions were due to chronic cardiorespiratory illnesses. Half of re-admissions were judged to be potentially preventable, mainly through improved patient education. CONCLUSION: One in 12 general medical patients was readmitted. Chronic diseases and inadequate patient education and discharge planning accounted for the largest group of re-admissions in older patients. Re-admission of HIV/AIDS patients has generated a second peak in younger individuals, and the impact of the antiretroviral roll-out on admission rates warrants further scrutiny. <![CDATA[<b>Nuchal Translucency as a method of first-trimester screening for aneuploidy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400028&lng=en&nrm=iso&tlng=en OBJECTIVE: To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population. STUDY DESIGN: Descriptive study. SETTING: Chris Hani Baragwanath Hospital fetal medicine unit. OUTCOME MEASURES: An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group, all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. RESULTS: A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed, 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive, 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients, who had screened negative, 2 had an increase in the adjusted risk when the risk was compared with the background risk, and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality, and there were no abnormalities among them. CONCLUSIONS: The use of these screening methods has enabled prenatal karyotyping to become cost effective, and allows concentration on pregnancies at highest risk for chromosomal abnormalities, regardless of age. <![CDATA[<b>Management of Atopic Dermatitis in Adolescents and Adults in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000400029&lng=en&nrm=iso&tlng=en OBJECTIVE: To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population. STUDY DESIGN: Descriptive study. SETTING: Chris Hani Baragwanath Hospital fetal medicine unit. OUTCOME MEASURES: An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group, all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. RESULTS: A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed, 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive, 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients, who had screened negative, 2 had an increase in the adjusted risk when the risk was compared with the background risk, and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality, and there were no abnormalities among them. CONCLUSIONS: The use of these screening methods has enabled prenatal karyotyping to become cost effective, and allows concentration on pregnancies at highest risk for chromosomal abnormalities, regardless of age.