Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 98 num. 12 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>You're stepping on my turf!</b>]]> <![CDATA[<b>Editor's Choice</b>]]> <![CDATA[<b>Neuropathic pelvic pain - a personal experience</b>]]> <![CDATA[<b>Some aspects of medical insurance in Russia</b>]]> <![CDATA[<b>Arenavirus deaths - emergency air services tighten up</b>]]> <![CDATA[<b>Manana's costly machinations: Naude vindicated</b>]]> <![CDATA[<b>Business lights HIV/AIDS afterburners as recession looms</b>]]> <![CDATA[<b>Willem Alberts</b>]]> <![CDATA[<b>Stroke: Facts Series</b>]]> <![CDATA[<b>Payment of trial participants can be ethically sound: Moving past a flat rate</b>]]> <![CDATA[<b>The Children's Amendment Act and the Criminal Law (Sexual Offences and Related Matters) Amendment Act: Duty to report child abuse and sexual offences against children and mentally disabled persons</b>]]> <![CDATA[<b>Penetrating the acoustic shadows: Emergency ultrasound in South African emergency departments</b>]]> <![CDATA[<b>How can South Africa's medical profession contribute to humanitarian action?</b>]]> <![CDATA[<b>Occupational health in health care facilities in South Africa</b>: <b>Where does infection control stop and occupational health start?</b>]]> <![CDATA[<b>Re-estimated provincial HIV antenatal survey prevalence for 2007 and a reinterpretation of the national trend</b>]]> <![CDATA[<b>Peritonitis in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis</b>]]> <![CDATA[<b>Effect of African potato <i>(Hypoxis hemerocallidea)</i> on the pharmacokinetics of efavirenz</b>]]> PURPOSE: The purpose of this study was to evaluate the effect of the African potato (AP) on the pharmacokinetics of efavirenz. METHODS: A single-dose, two-phase sequential study was conducted over 31 days in 10 healthy volunteers. On day 1 of the study, volunteers were administered a 600 mg efavirenz tablet, and blood samples were collected before dosing and at 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 12, 18, 24, 36 and 48 hours after dosing. From day 16, a traditionally prepared AP decoction was administered daily until day 30. On day 29, volunteers were administered a single 600 mg dose of efavirenz, as was done on day 1. Plasma samples were harvested immediately after blood sample collection and frozen at -80°C until assayed. Plasma concentrations of efavirenz were determined by a validated high performance liquid chromatography (HPLC) method with UV detection, and pharmacokinetic parameters were calculated. Geometric mean ratios of Cmax and AUC0-48 of efavirenz before and after co-administration of 14 successive daily doses of AP were compared. RESULTS: All subjects completed the study. The geometric mean ratios of Cmax and AUC0-48 were 97.30 and 102.82 with corresponding 90% confidence intervals (CIs) of 78.81 - 120.14 and 89.04 - 118.80, respectively. CONCLUSION: Pharmacokinetic data generated during this study indicated that AP did not significantly alter the pharmacokinetics of efavirenz. Hence, co-administration of AP is unlikely to affect the clinical usage of efavirenz. <![CDATA[<b>Performance data of screening mammography at a dedicated breast health centre</b>]]> BACKGROUND: Mammographic screening has become part of routine health care. We present a first analysis of screening mammography in a dedicated breast health centre in Africa. OBJECTIVE: To establish a performance benchmark and provide data for health care policy and funding decisions on screening mammography.Method. All mammography performed between January 2003 and August 2008 was entered into a prospective database. Mammography was performed exclusively by certified mammographers and double-read by experienced readers. RESULTS: Outcomes were classified in a simplified classification system based on the Breast Imaging Reporting and Data System (BIRADS). In 40 - 49-year-old women, 3 192 mammograms led to a recall rate of 4.7%, a biopsy rate of 1.9% and a cancer diagnosis rate of 3.8 per 1 000 examinations; for women of 50 years and older, the corresponding figures were 4 446, 5.4%, 2.6% and 9.7 per 1 000. Of the cancers detected, 31% were in situ and, of the invasive cancers, 81% were node-negative. These figures were established by a dedicated surgeon-led team and fall within the range expected in organised screening programmes in resource-rich environments, providing a first benchmark for screening mammography in Africa. <![CDATA[<b>Endovascular cerebral aneurysm treatment: Long-term outcomes</b>]]> INTRODUCTION: The International Subarachnoid Aneurysm Trial confirmed endovascular treatment as the treatment of choice for intracranial 'berry' aneurysms. The durability of coiling and the relevance of stable neck remnants needed to be addressed next. METHODS: We retrospectively assessed the follow-up angiograms of patients who presented with subarachnoid haemorrhages or third-nerve palsies and had berry aneurysms treated endovascularly between 2002 and 2003. Patients were phoned to assess their wellbeing and to see whether they were back at work or not. Angiograms were assessed to ascertain the percentage of the aneurysm coiled at the initial procedure, and then stability was assessed by percentage change in the residual aneuysm neck on later angiograms. RESULTS: Over a 1-year period 75 patients were treated endovascularly; 100% occlusion was achieved in 52% at the initial procedure, and although only 40 and 34 respectively attended for 3-month and 1-year follow-up angiograms there was a trend toward progressive thrombosis in 65% and 82% respectively. In only 1 of the neck remnants was growth noted at the 3-month angiogram. One patient bled after missing his 3-month follow-up angiogram. Although only 40% of the patients were contactable at 4 years there were no rebleeds among them. CONCLUSION: Coiling is durable, as shown by our results over a 4-year period, and while neck remnants that look unchanged are generally stable any growth should be viewed as grounds for concern and treated either endovascularly or surgically if required. The 5-year angiogram may be unnecessary, which is of importance in our setting where socio-economic factors influence patient follow-up. <![CDATA[<b>Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication</b>]]> OBJECTIVE: To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). DESIGN: The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. SETTING: Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. SUBJECTS: Thirty-one patients diagnosed with PAD were included in the study. OUTCOME MEASURES: During a GTT, peak oxygen consumption (VO2peak), peak minute ventilation (VEpeak), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Ankle-brachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. RESULTS: Peak venous lactate concentrations did not correlate significantly with either PFWD (r=-0.08; p=0.3) or MWD (r=-0.03; p=0.4). Resting ABI did not correlate with either MWD (r=0.09; p=0.64) or PFWD (r=-0.19; p=0.29). Subjects terminated exercise at significantly (p<0.05) lower levels of cardiorespiratory effort and venous lactate concentrations than did a sedentary but otherwise healthy comparison group: peak heart rate 156±11 v. 114±22 beats per minute (BPM); p=0.001; and peak venous lactate concentration 9.7±2.7 mmol/l v. 3.28±1.39 mmol/l; p=0.001. CONCLUSION: Perceived discomfort in these patients is not caused by elevated blood lactate concentrations, a low ABI or limiting cardiorespiratory effort but by other factors not measured in this study.