Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 9 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>'Health for All' Alma-Ata Declaration - an elusive Holy Grail</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>Doctors' dress code</b>]]> <![CDATA[<b>What's in a name? Terminology in emergency care in South Africa</b>]]> <![CDATA[<b>Gay community to test HIV prevention pill</b>]]> <![CDATA[<b>Slow progress in doctor placement kickback probe</b>]]> <![CDATA[<b>Runaway TB epidemic - Can we catch up?</b>]]> <![CDATA[<b>Alp-Health dept TB skirmish to bear fruit?</b>]]> <![CDATA[<b>Imagining the Elephant: A Biography of Allan MacLeod Cormack</b>]]> <![CDATA[<b>Community health workers in South Africa: Where in this maze do we find ourselves?</b>]]> <![CDATA[<b>Interpersonal violence prevention: Prioritising interventions</b>]]> <![CDATA[<b>Road traffic injury: Prioritising interventions</b>]]> <![CDATA[<b>The eye in antiquity</b>]]> <![CDATA[<b>Alma-Ata Declaration on Primary Health Care: 30th anniversary</b>]]> <![CDATA[<b>Reducing the burden of injury: An intersectoral preventive approach is needed</b>]]> <![CDATA[<b>Rheumatoid arthritis functional disability in a public health care clinic</b>]]> <![CDATA[<b>Reliability of HIV rapid tests is user dependent</b>]]> <![CDATA[<b>Intestinal parasitic infections in adult patients in KwaZulu-Natal</b>]]> <![CDATA[<b>Closed suction drainage versus closed simple drainage in the management of modified radical mastectomy wounds</b>]]> OBJECTIVE: To compare the outcomes of modified radical mastectomy wounds managed by closed wound drainage with suction and without suction. METHOD: A prospective randomised trial was conducted at the University College Hospital in Ibadan, and the University of Nigeria Teaching Hospital in Enugu. Fifty women who required modified radical mastectomy for breast cancer were randomised to have closed wound drainage with suction (26 patients) and closed wound drainage without suction (24 patients). RESULTS: There was no significant difference in the intraoperative and postoperative variables. Suction drainage drained less volume of fluid and stayed for a shorter time in the wound, but the differences were not significant. There was no difference in the length of hospital stay, time to stitch removal, and number of dressing changes. More haematomas and wound infections occurred in the simple drain group while more seromas occurred in the suction drain group, but these were not significant. The suction drain was more difficult to manage and the cost was 15 times higher than the simple drainage system. CONCLUSION: Closed simple drains are not inferior to suction drains in mastectomy wounds and, considering the cost saving and simplicity of postoperative care, they are preferable to suction drains. <![CDATA[<b>Fatal road traffic accidents in the Mthatha area of South Africa, 1993 - 2004</b>]]> BACKGROUND: Trauma is one of the leading causes of death in the Mthatha area, which is one of the least developed regions of South Africa. Road traffic accidents (RTAs) contribute substantially to the number of such deaths. OBJECTIVE: To estimate the number of fatal RTAs in the Mthatha area, and analyse age and sex of the deceased. METHODS: A review of autopsies performed in the Mthatha General Hospital mortuary was conducted. Data were analysed using the GENSTAT 9 package with a Poisson regression model. RESULTS: There were 2 736 deaths from RTAs over the 12-year period 1993 - 2004 in the Mthatha area. These casualties constituted an average annual rate of 57 deaths per 100 000 population. The highest (69.4/100 000) was in 1998, and the lowest (40.2/100 000) in 2001. Males outnumbered females by 2.6:1 (95% confidence interval (CI) 2.13 - 3.22), and the rate showed a decline of 0.97/100 000/year (95% CI 0.95 - 0.99) for the 1998 - 2001 period. The rate of decline was the same for males and females. The highest annual rate was 14.2 per 100 000 population in the age group 21 - 30 years, and the lowest, of 2.6 per 100 000 population, in the group above 70 years of age. The death rates were related to sex (p<0.001) and calendar year (p<0.049). There was no significant connection between year and sex, implying that the effect of year (time) was the same for men and women. These results are statistically significant despite the very high variability in the data (S²=5.53). CONCLUSION: RTA-related deaths in the Mthatha area are 3 times higher than the global average. <![CDATA[<b>Otosclerosis and TGF-β1</b> <b>gene in black South Africans</b>]]> Limited literature is available on the epidemiology and genetics of otosclerosis in South African blacks, among whom it is extremely rare. We undertook this study because we had documented and surgically confirmed cases of clinical oval window otosclerosis in this population. <![CDATA[<b>Cryptococcus and lymphocytic meningitis in Botswana</b>]]> We retrospectively reviewed microbiological data from a tertiary care hospital in Botswana, and found that Cryptococcus neoformans was cultured from 15% (193/1 307) of all cerebrospinal fluid (CSF) specimens submitted for analysis, making it the most common diagnosed cause of meningitis in this population. Moreover, almost 70% of CSF samples with significant lymphocytosis did not yield a pathogen, suggesting that many causes of lymphocytic meningitis go undiagnosed. <![CDATA[<b>The quality of operative notes at a general surgery unit</b>]]> AIM: With the increasingly litigious nature of medical practice, accurate documentation is critical. This is particularly true for operative procedures, and medical councils have identified this and published guidelines to aid surgeons. However, these remain a frequently cited weakness in their defence in medico-legal cases. This study assessed the accuracy of operative notes in a general surgery unit in order to improve our practice. METHOD: An audit of 100 consecutive operative notes was performed, and notes were assessed using the Royal College of Surgeons guidelines. The quality of note-taking of trainees was compared with that of consultant surgeons. A series of operation note pro formas was designed in response to the findings. RESULTS: Of the notes, 66% were completed by trainees. The vast majority of notes had no diagram to demonstrate the surgical findings or illustrate the actions. Specialist surgeons were more likely to describe the actions accurately, but less likely to describe wound closure methods or dressings used. They were also less likely to complete adequate postoperative orders. CONCLUSIONS: This study identifies key areas of weakness in our operative note-keeping. Pro formas should be introduced and made available for commonly performed procedures, and diagrams should be used wherever possible.