Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 99 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>The Zimbabwe mayhem - how many people must die for the neighbours to act?</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>Medicines</b>: <b>effectiveness or cost</b>]]> <![CDATA[<b>Unhygienic male circumcision procedures and HIV transmission</b>]]> <![CDATA[<b>Circumcision and HIV</b>]]> <![CDATA[<b>'Show us you're serious - or stay home'</b>]]> <![CDATA[<b>HIV/AIDS on tertiary education campuses - data at last</b>]]> <![CDATA[<b>Climate change kills at least 300 000 every year</b>]]> <![CDATA[<b>Compulsory HIV testing of alleged sex offenders</b>]]> <![CDATA[<b>Marinus van den Ende</b>]]> <![CDATA[<b>Johan Gerber</b>]]> <![CDATA[<b>Jerome John Peter Bosman</b>]]> <![CDATA[<b>Time to keep African kids safer</b>]]> <![CDATA[<b>Sub-specialties in psychiatry</b>: <b>towards parity in mental health training and services</b>]]> <![CDATA[<b>Hereditary C1 esterase deficiency in a Zulu kindred</b>]]> <![CDATA[<b>Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy - a systematic review and meta-analysis</b>]]> BACKGROUND: The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH). OBJECTIVE: To assess the efficacy of both procedures to treathaemorrhoids. DATA SOURCES: Literature review using MEDLINE. Articles addressing PPH and EH were included. STUDY SELECTION: RCTs comparing EH and PPH with >20 patients. DATA EXTRACTION: Primary endpoints were pain, operative time, hospital stay, satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A meta-analysis was performed using the random effects model on studies reporting 'mean' and SD or SEM. DATA SYNTHESIS: PPH was associated with less postoperative pain, less operative time, shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. CONCLUSION: Compared with EH, PPH is associated with less postoperative pain, reduced operative time and hospital stay and earlier return to normal activity, and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH. <![CDATA[<b>Rural-origin health science students at South African universities</b>]]> BACKGROUND: Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-to-population ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. OBJECTIVE: To determine the proportion of rural-origin students at all medical schools in South Africa. DESIGN: A retrospective descriptive study was conducted in2003. Lists of undergraduate students admitted from 1999 to2002 for medicine, dentistry, physiotherapy and occupationaltherapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by meansof postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%). RESULTS: Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine - 27.4%, physiotherapy - 22.4%, occupational therapy - 26.7%, and dentistry - 24.8%. CONCLUSION: The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas. <![CDATA[<b>Mechanisms of oedema formation</b>: <b>the minor role of hypoalbuminaemia</b>]]> OBJECTIVES: Seriously ill patients often suffer from disorders of salt and water balance and present with clinical signs of either dehydration or oedema. The relationship of hypoalbuminaemia to oedema is complex and controversial and formed the central issue of this study. DESIGN: Prospective study. SETTING: Medical wards of New Somerset Secondary Hospital, November 2004. SUBJECTS: 50 patients admitted consecutively to the medicalwards at New Somerset Hospital were evaluated; 26 males and 24 females participated. OUTCOME MEASURES: An attempt was made to correlate causesof salt and water imbalance with the clinical assessment ofvolume status, oedema formation, nutritional state and serum albumin levels. RESULTS: Hypoalbuminaemia was not related to oedema inthis study. Of 24 patients with a serum albumin level below 30 g/l, only 6 had oedema. These patients all had other abnormalities that could have resulted in the oedema, notably primary salt retention by failing kidneys, cor pulmonale and malignancy. None of the patients with serum albumin levels below 15 g/l had any signs of oedema. The combined insult of a chronic inflammatory disease and malnutrition had a marked effect on serum albumin levels. CONCLUSION: Significant hypoalbuminaemia was present in many of our patients, yet oedema was detected infrequently and generally had an easily identifiable cause not related to low albumin levels. Most patients with hypoalbuminaemiapresented with normal or positive water balance. This study supports the notion that hypoalbuminaemia is infrequently associated with oedema and plays a minor role in its formation.