Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 10 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Perpetual medical politics</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>HIV prevention and transmission the focus at International AIDS Conference</b>]]> <![CDATA[<b>The 30th Medical 10 run</b>]]> <![CDATA[<b>Media 'knight' breathes life into paediatric ICUs</b>]]> <![CDATA[<b>Metanalysis critical of blood alternative product challenged</b>]]> <![CDATA[<b>AIDS reality bedevils social security plans</b>]]> <![CDATA[<b>Has HIV prevalence peaked in South Africa? - Can the report on the latest antenatal survey be trusted to answer this question?</b>]]> <![CDATA[<b>Clinical excellence and the NICEties of value-based priority setting</b>]]> <![CDATA[<b>Neonatal circumcision does not reduce HIV/AIDS infection rates</b>]]> <![CDATA[<b>The nervous system in antiquity</b>]]> <![CDATA[<b>Basil W Myers (26/09/1914 -14/06/2008)</b>]]> <![CDATA[<b>Willem Vlietstra (28/10/1935 -24/07/2008)</b>]]> <![CDATA[<b>Lupus. Second edition: Fact series</b>]]> <![CDATA[<b>Zimbabwe: A crossroads for the health professions</b>]]> <![CDATA[<b>Rheumatic heart disease: Social and economic dimensions</b>]]> <![CDATA[<b>Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable</b>]]> <![CDATA[<b>Imaginary bugs, real distress: Delusional parasitosis</b>]]> <![CDATA[<b>HIV prevention needs to confront the elephant on the road</b>]]> <![CDATA[<b>Namaqua dwarf adder <i>(Bitis schneideri)</i> envenomation</b>]]> <![CDATA[<b>Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002</b>]]> OBJECTIVE: To investigate the nature of male circumcision and its relationship to HIV infection. METHODS: Analysis of a sub-sample of 3 025 men aged 15 years and older who participated in the first national population-based survey on HIV/AIDS in 2002. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model. RESULTS: One-third of the men (35.3%) were circumcised. The factors strongly associated with circumcision were age &gt;50, black living in rural areas and speaking SePedi (71.2%) or IsiXhosa (64.3%). The median age was significantly older for blacks (18 years) compared with other racial groups (3.5 years), p <0.001. Among blacks, circumcisions were mainly conducted outside hospital settings. In 40.5% of subjects, circumcision took place after sexual debut; two-thirds of the men circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% HIV positive in the circumcised group v. 12% HIV positive in the uncircumcised group). HIV was, however, significantly lower in men circumcised before 12 years of age (6.8%) than in those circumcised after 12 years of age (13.5%, p=0.02). When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% v. 13.6%, p=0.08.). There was no effect when adjusted for possible confounding. CONCLUSION: Circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy. <![CDATA[<b>Symptomatic hyperlactataemia in adults on antiretroviral therapy: A single-centre experience</b>]]> OBJECTIVE: There are limited data on symptomatic hyperlactataemia caused by antiretroviral therapy (ART) in resource-limited settings. We assessed individuals who developed symptomatic hyperlactataemia on ART in an outpatient clinic in South Africa. DESIGN: A retrospective record review was performed on patients attending the clinic from January 2004 to December 2005. RESULTS: Thirty-five patients, all on stavudine-containing regimens, developed symptomatic hyperlactataemia. The incidence in this population was 20.5 cases per 1 000 person-years of ART with an associated mortality of 21%. The major risk factor was being female (risk ratio (RR) 3.27). Significant clinical symptoms preceding symptomatic hyperlactataemia include nonspecific gastrointestinal symptoms, weight loss, and development of symptomatic neuropathy. CONCLUSIONS: The incidence of symptomatic hyperlactataemia in our population was high. Simple clinical measures, such as neuropathy symptoms and monitoring of weight, may alert the clinician to impending symptomatic hyperlactataemia. Early diagnosis expedites safe outpatient care and switching of ART regimens without interruption, in many cases. <![CDATA[<b>Surgical complications of bacille Calmette-Guérin (BCG) infection in HIV-infected children: Time for a change in policy?</b>]]> AIM: Bacille Calmette-Guérin (BCG) immunisation is well established as part of the South African national expanded programme for immunisation (EPI). The World Health Organization (WHO) currently recommends that BCG be given to all asymptomatic infants irrespective of HIV exposure at birth but does not recommend BCG vaccination for children with symptomatic HIV infection. This approach, however, has led to HIV-infected neonates who are asymptomatic at birth, developing severe vaccine-related complications. We present a surgical case series, representative of a minority of the cases in circulation, in support of a change to the timing of BCG administration to HIV-exposed neonates. METHODS: A case series of 17 HIV-infected patients with surgical complications of BCG vaccination. RESULTS: Seventeen patients are presented. The first two illustrate disseminated systemic BCG infection, resulting in BCG infection of the lymph nodes, liver, spleen and tibia, and the second with gastrointestinal involvement causing bowel obstruction. The other 15 patients represent a series of severe ulcerating lymphadenitis secondary to BCG. CONCLUSION: The risks of BCG in HIV-infected infants are significant. Current recommendations are not satisfactory, and a change in policy is required to prevent the harmful effects of this vaccine in a high-risk group of patients. We believe that there is sufficient need to adequately stratify patients and vaccinate them according to a protocol that takes impaired immunity into consideration. <![CDATA[<b>Does examiner bias in undergraduate oral and clinical surgery examinations occur?</b>]]> OBJECTIVE: Oral and long case clinical examinations are open to subjective influences to some extent, and students may be marked unfairly as a result of gender or racial bias or language problems. These concerns are of topical relevance in South Africa. The purpose of this study was to assess whether these factors influenced the marks given in these examinations. METHODS: Final-year surgery examination results from the University of Cape Town from 2003 to 2006 were reviewed. These each consisted of a multiple choice paper, an objective structured clinical examination, a long case clinical examination and an oral examination. RESULTS: The marks of 604 students were analysed. Students who spoke English as a home language performed better in all examination modalities. Female students scored slightly higher than males overall, but they scored similarly in the clinical and oral examinations. There were significant differences in the marks scored between the various population groups in all examination modalities, with white students achieving the highest scores, and black students the lowest. These differences were most marked in multiple choice examinations, and least marked in oral and clinical examinations. CONCLUSION: We could find no evidence of systemic bias in the oral and clinical examinations in our department, which reinforces the need for ongoing academic support for students from disadvantaged educational backgrounds, and for those who do not speak English as a home language.