Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420080008&lang=pt vol. 98 num. 8 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>The virtues of doing nothing (dangerous)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Editor's Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Impact of withdrawal of Ritalin LA in the Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Task shifting in the public health sector - what is the evidence?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The blight of bureaucracy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Neurologists come in for over-servicing flack</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Lack of humanity our biggest disability</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Trailblazer HIV clinician and 'temporary resident' honoured</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>AIDS denialism gets nastier at Manguzi</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Emergence of extensive drug resistance (XDR) among Gram-negative bacilli in South Africa looms nearer</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800010&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The earliest example of the hyperactivity subtype of attention deficit hyperactivity disorder (ADHD) in Jan Steen's 'The Village School' (<i>c</i>. 1670)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800011&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Jim Peters' collapse in the 1954 Vancouver Empire Games marathon</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800012&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Orthopaedic injuries in state hospitals compromised</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800013&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Drug management and use: Patients' knowledge and perception</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800014&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Iron deficiency anaemia in healthy South African women despite iron fortification</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800015&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Oral fluid detection of hepatitis B vaccine-induced antibodies can improve vaccination programmes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800016&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Temporal evolution of cerebrospinal fluid following initiation of treatment for tuberculous meningitis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800017&lng=pt&nrm=iso&tlng=pt OBJECTIVE: Clinicians often perform follow-up lumbar punctures (LPs) on patients with tuberculous meningitis (TBM) to document changes occurring in the cerebrospinal fluid (CSF). Normalisation of the CSF then serves as indirect confirmation of the diagnosis. However, changes occurring in CSF following the initiation of anti-tuberculosis (TB) treatment are not well described. We undertook a retrospective study to determine the temporal evolution of CSF in patients with TBM on anti-TB treatment in an attempt to provide a more rational basis for the interpretation of repeat LPs. METHODS: Patients diagnosed with TBM at King George V Hospital in Durban from 1994 to 2003 were identified. Demographic, clinical, laboratory and radiological data were recorded. We examined the change in CSF lymphocyte cell count, polymorphonuclear (PMN) cell count, glucose concentration and protein concentration. Initially, scatter plots of the data modelled over time were produced and random effects models were then used to model the predicted changes in CSF over time. RESULTS: Ninety-nine patients were identified, and a total of 327 LPs were done. The average number of LPs per patient was 3 (range 3 - 9). Statistically significant changes in all four variables (lymphocytes, PMN cells, glucose and protein) were demonstrated, with a p value <0.001. The predicted models showed that lymphocyte count and protein concentration change slowly over time. PMN cells and glucose concentration changed rapidly in an exponential manner. CONCLUSIONS: Our results demonstrate the tendency for CSF to normalise over time. The slow change in lymphocyte count and protein concentration limits clinical use. The rapid change in PMN cells and glucose concentration allows us to make reasonable clinical decisions. If a repeat LP does not show definite improvement in these two parameters, it should be considered atypical for TBM. <![CDATA[<b>Antioxidant and oxidative stress status in type 2 diabetes and diabetic foot ulcer</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800018&lng=pt&nrm=iso&tlng=pt OBJECTIVE: Oxidative stress (OS) has been implicated in the aetiology and progression of diabetic complications including diabetic foot ulcer. In this study, the levels of lipid peroxides (LPO) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) as well as the enzymatic antioxidant activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) in type 2 diabetes mellitus and diabetic foot ulcer subjects were assessed and compared with apparently healthy normal subjects to understand the involvement of OS in the subjects. METHOD: The abovementioned OS markers were measured in 50 subjects for each of the following groups: type 2 diabetes mellitus (DM), diabetic foot ulcer (DF) and non-diabetic control (NC). RESULTS: Significant elevated values of LPO (39.86%) and 8-OHdG (45.53%) were found in DM subjects compared with the NC subjects. This increase in both parameters was greater for DF subjects: 80.23% and 53.91% respectively. SOD activities were significantly reduced in DM (14.82%) and DF (4.09%) subjects in contrast with elevated activities of GPx observed in DM (21.87%) and DF (20.94%) subjects. Glycated haemoglobin/fasting plasma glucose (HbA1c/FPG) correlated positively with LPO, 8-OHdG and GPx, whereas a negative correlation was observed for SOD. CONCLUSION: Increased oxidation subsequent to diabetic conditions induces an over-expression of GPx activity suggesting a compensatory mechanism by the body to prevent further tissue damage in the subjects. <![CDATA[<b>Hypertension and diabetes: Poor care for patients at community health centres</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800019&lng=pt&nrm=iso&tlng=pt OBJECTIVES: To identify health care provider-related determinants of diabetes and hypertension management in patients attending public sector community health centres (CHCs). METHODS: A random sample of 18 CHCs in the Cape Peninsula providing hypertension and diabetes care was selected. Twenty-five patients with diabetes and 35 with hypertension per clinic were selected and interviewed by trained fieldworkers, and their medical records were audited. Regression analyses identified predictors of controlled hypertension (<140/90 mmHg) and diabetes (HbA1c <7%). In-depth interviews with nurses and doctors explored their experiences in working at the CHCs. Height, weight and blood pressure (BP) were measured for all patients and random blood samples collected for lipids, glucose, HbA1c and creatinine. RESULTS: Of the participants 923 had hypertension and 455 diabetes (289 had both conditions). Of the hypertensive patients 33% had a BP <140/90 mmHg, while 42% of the patients with diabetes had non-fasting glucose levels below 11.1 mmol/l. Patients' knowledge about their conditions was poor. Prescriptions for drugs were not recorded in medical records of 22.6% of the patients with diabetes and 11.4% of those with hypertension. CONCLUSIONS: Primary care for patients with hypertension and diabetes at public sector CHCs is suboptimal. This study highlights the urgent need to improve health care for patients with these conditions in public sector clinics in the Cape Peninsula. <![CDATA[<b>Advances in endoscopic sinonasal and anterior skull base surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800020&lng=pt&nrm=iso&tlng=pt Endoscopic transnasal surgery is rapidly replacing more radical external 'open' procedures. At Groote Schuur Hospital, Cape Town, we performed 94 advanced endoscopic sinonasal and anterior skull base procedures over a 2-year period. Most of these would previously have been performed using large external incisions requiring more invasive surgery with significantly higher morbidity. Endoscopic surgery is more cost-effective than open procedures because it reduces duration of hospitalisation, operating time and theatre consumables and obviates the need for postoperative intensive care unit admission. We have had no complications other than 2 cerebrospinal fluid leaks, but the potential risks of endoscopic sinonasal and skull base surgery are significant and proper training is required. <![CDATA[<b><i>Pseudomonas aeruginosa</i></b><b> bacteraemia in an academic hospital in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800021&lng=pt&nrm=iso&tlng=pt OBJECTIVES: The aim of the study was to determine the clinical manifestations, outcome of and prognostic factors associated with Pseudomonas aeruginosa bacteraemia at Chris Hani Baragwanath Hospital, Johannesburg, during the period 1998 -1999, to describe and quantify resistance to antipseudomonal drugs, to characterise bacteraemic isolates, and to investigate the clustering and genotype distribution of drug-susceptible and multiply-resistant strains in the hospital. METHODS: Clinical and laboratory investigations, culture and antimicrobial susceptibility testing were performed. Bacteraemic isolates were typed by endonuclease macrorestriction. Those with >97% band pattern similarity were assigned genotype status. RESULTS: Of 91 P. aeruginosa blood isolates, 52 (57.1%) were nosocomially acquired. Underlying conditions associated with episodes were burns in 24 (28%) and HIV infection in 21 (24%). Multidrug resistance was present in 14 (15.4%) of isolates from 91 episodes. In 79 episodes where the outcome was known, 37 (46.8%) of the patients died. Case fatality rates were 75% in adults and 25% in children. Being a child, receiving appropriate antimicrobial treatment and admission to a specialised care unit were significantly associated with improved prognosis. CONCLUSION: P. aeruginosa bacteraemia was associated with outbreaks caused by two multiply-resistant genotypes. Eighteen antimicrobial-susceptible isolates from bacteraemic episodes in paediatric wards, 9 in HIV-seropositive children, could be linked to small outbreaks in both hospitalised and community-based children. <![CDATA[<b>SAGES 2008 - 'Trends in Gastroenterology'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742008000800022&lng=pt&nrm=iso&tlng=pt OBJECTIVES: The aim of the study was to determine the clinical manifestations, outcome of and prognostic factors associated with Pseudomonas aeruginosa bacteraemia at Chris Hani Baragwanath Hospital, Johannesburg, during the period 1998 -1999, to describe and quantify resistance to antipseudomonal drugs, to characterise bacteraemic isolates, and to investigate the clustering and genotype distribution of drug-susceptible and multiply-resistant strains in the hospital. METHODS: Clinical and laboratory investigations, culture and antimicrobial susceptibility testing were performed. Bacteraemic isolates were typed by endonuclease macrorestriction. Those with >97% band pattern similarity were assigned genotype status. RESULTS: Of 91 P. aeruginosa blood isolates, 52 (57.1%) were nosocomially acquired. Underlying conditions associated with episodes were burns in 24 (28%) and HIV infection in 21 (24%). Multidrug resistance was present in 14 (15.4%) of isolates from 91 episodes. In 79 episodes where the outcome was known, 37 (46.8%) of the patients died. Case fatality rates were 75% in adults and 25% in children. Being a child, receiving appropriate antimicrobial treatment and admission to a specialised care unit were significantly associated with improved prognosis. CONCLUSION: P. aeruginosa bacteraemia was associated with outbreaks caused by two multiply-resistant genotypes. Eighteen antimicrobial-susceptible isolates from bacteraemic episodes in paediatric wards, 9 in HIV-seropositive children, could be linked to small outbreaks in both hospitalised and community-based children.