Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 7 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Does the power of overripe tomatoes and dusty photos equal that of the bomb?</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>Dr Ivan Toms - a true hero</b>]]> <![CDATA[<b>The child rape epidemic</b>]]> <![CDATA[<b>Services for child sexual abuse lacking</b>]]> <![CDATA[<b>Algae an answer to biofuels?</b>]]> <![CDATA[<b><i>Citrus aurantium</i></b><b> - beware of the bitter orange</b>]]> <![CDATA[<b>Of HIV, grief and TOP</b>]]> <![CDATA[<b>Chris Barnard - a further tribute</b>]]> <![CDATA[<b>Proposed health price regulations stir up hornet's nest</b>]]> <![CDATA[<b>Blind former British Home Secretary backs new cell phone initiative</b>]]> <![CDATA[<b>Lack of 'warm hands' will render health care system 'impotent'</b>]]> <![CDATA[<b>Beleaguered hospitals - help at last?</b>]]> <![CDATA[<b>The South African Bone Marrow Registry (SABMR) and allogeneic bone marrow transplantation</b>]]> <![CDATA[<b>MRI features of disseminated 'drop metastases'</b>]]> <![CDATA[<b>Was Stalin mad?</b>]]> <![CDATA[<b>A society in transition</b>]]> <![CDATA[<b>Essays in Medical Biography</b>]]> <![CDATA[<b>What do the xenophobic attacks reveal about the health of South African society?</b>]]> <![CDATA[<b>Xenophobic violence</b>]]> <![CDATA[<b>Medication storage temperatures in primary response vehicles</b>]]> <![CDATA[<b>Bipolar diathermy for the outpatient control of posterior epistaxis</b>]]> <![CDATA[<b>The mechanism of bleomycin in inducing haemangioma regression</b>]]> <![CDATA[<b>Bleomycin plasma spill-over levels in paediatric patients undergoing intralesional injection for the treatment of haemangiomas</b>]]> <![CDATA[<b>The prevalence of hepatitis B co-infection in a South African urban government HIV clinic</b>]]> OBJECTIVE: There are an estimated 350 million hepatitis B carriers worldwide. In South Africa the prevalence of monoinfection with hepatitis B has been estimated to range from 1% in urban areas to approximately 10% in rural areas. The exact prevalence of hepatitis B in the HIV-infected population has not been well established. Hepatitis B screening is not standard practice in government HIV clinics. Co-infection with hepatitis B and HIV can influence antiretroviral treatment and prognosis of both diseases. The purpose of this study was to evaluate the prevalence of hepatitis B/HIV coinfection. DESIGN: This is believed to be the first prospective observational report on the prevalence of hepatitis B/HIV co-infection in South Africa. Patients on whom hepatitis B serological tests could not have been done previously were recruited from an HIV clinic in a regional hospital in Johannesburg. Standard hepatitis B serological tests were performed. RESULTS: Five hundred and two participants were screened. The cohort's average age was 37±9 years and the average CD4 count was 128 cells/µl. Twenty-four (4.8%) were hepatitis B surface antigen positive. Nearly half (47%) of the participants showed some evidence of hepatitis B exposure. The risk of hepatitis B co-infection was not significantly different when analysed in terms of sex, race, CD4 count or age. Liver function tests were not a good predictor of hepatitis B infection. CONCLUSION: The rate of hepatitis B infection, as defined by hepatitis B surface antigen positivity, in HIV-infected individuals in urban South Africa was 5 times the rate in people who were not HIV-infected. A 5% rate of hepatitis B/HIV co-infection is a reason to increase the accessibility of tenofovir/emtricitabine (Truvada) for first-line treatment for this population. <![CDATA[<b>Pre-operative clinical assessment for anaesthesia and the effect of HIV infection</b>]]> BACKGROUND: HIV infection is common in South Africa, often remaining clinically latent and liable to be missed during clinical pre-operative assessment, despite the patient having a severe degree of immune compromise. OBJECTIVES: The primary objective was to determine the pre-operative physical status of patients presenting for anaesthesia, and to compare this with subsequent HIV tests and the CD4 counts of the HIV-positive patients. The secondary objective was to determine the prevalence of HIV infection in this group and in selected subgroups. METHOD: A sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital were interviewed pre-operatively, examined, and their American Society of Anesthesiologists physical status grading determined. In those who were confirmed HIV positive by blood sample, a CD4 count was checked. Further data were collected to determine trends in the characteristics of HIV-positive patients. RESULTS: HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (odds ratio (OR) 2.1). HIV-positive patients with CD4 counts &gt;200 cells/µl were more likely to be ASA 1 or 2 (OR 3.88). Of HIV-positive patients with CD4 counts <200 cells/µl, significantly more were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three patients with CD4 counts <50 cells/µl were classified as ASA 1 or 2. The overall prevalence of HIV infection was 29.4%. Females, patients presenting for obstetric surgery, and younger age groups had higher disease prevalence rates. Patients aged 30 - 39 years (43.0%) had the highest prevalence of HIV infection; the lowest was in patients aged 60 years or older (7.7%). CONCLUSIONS: Routine clinical pre-operative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise being missed in a significant number of patients. <![CDATA[<b>An evaluation of the District Health Information System in rural South Africa</b>]]> BACKGROUND: Since reliable health information is essential for the planning and management of health services, we investigated the functioning of the District Health Information System (DHIS) in 10 rural clinics. DESIGN AND SUBJECTS: Semi-structured key informant interviews were conducted with clinic managers, supervisors and district information staff. Data collected over a 12-month period for each clinic were assessed for missing data, data out of minimum and maximum ranges, and validation rule violations. SETTING: Our investigation was part of a larger study on improving information systems for primary care in rural KwaZulu-Natal. OUTCOMES: We assessed data quality, the utilisation for facility management, perceptions of work burden, and usefulness of the system to clinic staff. RESULTS: A high perceived work burden associated with data collection and collation was found. Some data collation tools were not used as intended. There was good understanding of the data collection and collation process but little analysis, interpretation or utilisation of data. Feedback to clinics occurred rarely. In the 10 clinics, 2.5% of data values were missing, and 25% of data were outside expected ranges without an explanation provided. CONCLUSIONS: The culture of information use essential to an information system having an impact at the local level is weak in these clinics or at the sub-district level. Further training and support is required for the DHIS to function as intended. <![CDATA[<b>Cardiac disease in pregnancy: A 4-year audit at Pretoria Academic Hospital</b>]]> BACKGROUND: Pre-existing medical disease constitutes one of the five major causes of maternal death in South Africa. Increasing numbers of women with heart disease reach adulthood as a result of advances in diagnoses and treatment of heart disease in childhood. OBJECTIVE: To assess the profile of cardiac disease and the maternal and fetal outcome of pregnant patients at Pretoria Academic Hospital (PAH). METHODS: A retrospective analysis was carried out on 189 pregnant cardiac patients who delivered at PAH between January 2002 and December 2005. RESULTS: Nearly 1% of all mothers who delivered at PAH had underlying cardiac disease. Most cardiac lesions were valvular disease secondary to childhood rheumatic heart disease. Pulmonary oedema was associated with the greatest morbidity and mortality. The severe morbidity rate was 11.6% and the case fatality rate 3.3%. The mean gestational age at delivery was 35 weeks; 18 (9.7%) babies were born before 34 weeks. CONCLUSION: Cardiac disease in pregnancy is associated with high morbidity and mortality rates for mothers and their babies. Multidisciplinary evaluation with discussion of risk factors, appropriate family planning and optimising of the cardiac state before conception is advised. <![CDATA[<b>Changing gender profile of medical schools in South Africa</b>]]> BACKGROUND: Since 1994, higher education policy has been committed to equity of access for all, irrespective of race and gender. OBJECTIVES: We investigated progress towards these goals in the education of medical doctors, with an emphasis on gender. METHODS: Databases from the Department of Education (DoE), Health Professions Council of South Africa (HPCSA) and University of Cape Town (UCT) Faculty of Health Sciences were used to explore undergraduate (MB ChB) trends at all eight medical schools and postgraduate (MMed) trends at UCT. RESULTS: Nationally women have outnumbered men in MBChB enrolments since 2000, figures ranging between 52% and 63% at seven of the eight medical schools in 2005. However, the rate of change in the medical profession lags behind and it will take more than two decades for female doctors to outnumber male doctors. A study of UCT postgraduate enrolments shows that females had increased to 42% of MMed enrolments in 2005. However, female postgraduate students were concentrated in disciplines such as paediatrics and psychiatry and comprised no more than 11% of enrolments in the surgical disciplines between 1999 and 2005. CONCLUSIONS: The study provides a basic quantitative overview of the changing profile of medical enrolments and raises questions about the career choices of women after they graduate and the social factors influencing these choices.