SAMJ: South African Medical Journal

HPCSA: a mess in the health department's pocket

Complications of tube thoracostomy for chest trauma

African traditional medicine

Arbitrary actions

Perversities - beware of being 'sucked in'

SA medical schools to rescue Zimbabwe's aspirant doctors

Alleged stem cell scam artists face extradition - finally

Cutaneous bacillary angiomatosis: a marker of systemic disease in HIV

Pharmaceutical latin

The eisbein cometh

Johan de Beer

Nagin Parbhoo (MB BS, FFA (SA), MD)

Nthato Motlana (16/02/1925 - 30/11/2008)

Does the impact factor have too much impact?

Management of anterior vaginal prolapse in South Africa: national survey

The quest for a groundless surgical procedure

Impact of the international Rugby Board's experimental iaw variations on the incidence and nature of match injuries in southern hemisphere professional rugby union

OBJECTIVE: To examine the epidemiology of match injuries in southern hemisphere professional rugby union and assess the impact of the International Rugby Board (IRB) Experimental Law Variations. SETTING: One-season whole population prospective cohort. SUBJECTS: Twenty-seven teams (813 players) taking part in the 2008 Super 14 and Vodacom Cup competitions. OUTCOME MEASURES: Incidence, severity, location, type and cause of injury. RESULTS: The incidence in the Super 14 competition (96.3 injuries/1 000 player-match hours; 95% confidence interval (CI) 69.0 - 111.7) was significantly higher (p=0.003) than that in the Vodacom Cup (71.2; CI 60.0 - 84.5); injury severity was significantly lower (p<0.001) in the Super 14 (mean 13.4 days; median 5) than the Vodacom Cup (mean 21.2; median 12). There were no significant differences between the two competitions in type or location of injury: lower limb muscle/ tendon (Super 14: 27.8%; Vodacom Cup: 25.7%) and joint (non-bone)/ligament (Super 14: 18.8%; Vodacom Cup: 24.3%) were the most common injuries. Injury causation was similar for the two competitions but there were significantly fewer ruck/maul (p=0.001) and more tackled (p=0.010) injuries in Super 14 compared with English Premiership rugby and fewer collision (p=0.002) and more tackling (p<0.001) injuries compared with Rugby World Cup. In the Vodacom Cup, there were significantly more tackling (p<0.001) injuries compared with Rugby World Cup. CONCLUSION: The incidence, nature and causes of injuries in southern hemisphere professional club rugby played under IRB Experimental Law Variations were similar to those for professional club rugby in the northern hemisphere and Rugby World Cup played under the previous Laws of Rugby.

Vasectomy under local anaesthesia performed free of charge as a family planning service: complications and results

OBJECTIVE: To evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service. METHOD: Men requesting vasectomy were counselled and given written instructions to use alternative contraception until two semen analyses 3 and 4 months after vasectomy had confirmed azoospermia. Bilateral vasectomy was performed as an outpatient procedure under local anaesthesia by junior urology registrars. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher's exact or Spearman's rank correlation tests as appropriate. RESULTS: Between January 2004 and December 2005, 479 men underwent vasectomy at Karl Bremer Hospital, Western Cape, South Africa; their average age was 36.1 (range 21 - 66) years, they had a median of 2 (range 0 - 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5 - 53) minutes. Complications occurred in 12.9%; these were pain (7.3%), swelling (5.4%), haematoma (1.3%), sepsis (1%), difficulty locating the vas (1%), vasovagal episode (0.6%), bleeding (0.6%), wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Of the men 63.3% returned for one semen analysis and 17.5% for a second. The vasectomy failure rate ranged from 0.4% (sperm persisting >365 days after vasectomy) to 2.3% (sperm seen >180 days after vasectomy and/or in the second semen specimen). No pregnancies were reported. The complication (5.6%) and failure rates (0%) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first one-third of procedures performed by each of the doctors with the last one-third, there was a significant decrease in average operating times but not in complication rates. CONCLUSIONS: Vasectomy can be performed safely and effectively by junior doctors as an outpatient procedure under local anaesthesia, and should be actively promoted in South Africa as a safe and effective form of male contraception.

Local reference ranges for full blood count and CD4 lymphocyte count testing

OBJECTIVE: Recent advances in full blood count and CD4 technology, coupled with the changing population demographics of the Gauteng region, have necessitated reevaluation of the reference ranges currently in use. METHOD: A cross-sectional study of 631 female and 88 male HIV-negative participants from the Gauteng region was performed. Full blood count, automated differential and CD4 count analyses were done using the latest internationally accepted technology. Reference ranges were compiled from the 2.5th and 97.5th percentiles for both male and female participant groups, and gender and ethnic comparisons calculated by non-parametric tests. RESULTS: Results of 41 females were removed from the statistical analysis because their results were suggestive of possible anaemia. Full blood count reference interval comparison confirmed gender-specific differences in red blood cell and platelet parameters. Ethnic-specific differences were found for some red blood cell parameters in the black female cohort. In addition, black males and females both generally had lower neutrophil and higher lymphocyte counts than a combined Asian/Caucasian/coloured ethnic group. CONCLUSION: Comparison of the currently calculated reference ranges with published data and reference values in use indicated that a separate ethnic-specific reference range should be introduced for the percentage/absolute neutrophil count and percentage lymphocytes. In addition, locally derived reference ranges for red cell distribution width (RDW) and CD4 percentage of lymphocytes should be implemented for routine diagnostic testing.

The incidence and clinical presentation of infantile rotavirus diarrhoea in Sierra Leone

OBJECTIVE: An effective vaccine is needed to protect against severe rotavirus disease, an important cause of gastroenteritis. Since there are no data on the incidence and antigenic diversity of rotavirus infection in Sierra Leone, we studied its epidemiology to enable an effective vaccine strategy to be designed. METHODS: Children between the ages of 3 and 30 months presenting with gastroenteritis to the Ola During Children's Hospital in Freetown, Sierra Leone, were enrolled. Stool specimens were tested in South Africa using polyacrylamide gel electrophoresis to confirm rotavirus infection. RESULTS: Over a 5-month period 143 children presenting with gastroenteritis were recruited. Stool samples obtained from 128 study subjects were tested for the presence of rotavirus; 45% were aged between 3 and 9 months (mean age 10.85 months), and 48 stool samples (37.5%) tested positive for rotavirus. The incidence of rotavirus infection was 20% higher in boys than in girls, a gender difference confirmed elsewhere in West Africa. The prevalence of rotavirus-positive stools peaked in August, coinciding with the rainy season. About 90% of the rotavirus-positive patients had severe diarrhoea, as opposed to only about two-thirds of the patients whose diarrhoea was not caused by rotavirus; this difference was statistically significant. CONCLUSIONS: There is a high incidence of rotavirus infection in Sierra Leone, with rotavirus causing 37.5% of the gastroenteritis in this study. Patients with rotavirus gastroenteritis almost all had severe diarrhoea. The high incidence of rotavirus infection and the severity of the disease presentation make the institution of a rotavirus vaccine programme in Sierra Leone imperative.

Guideline for the diagnosis, prevention and treatment of paediatric ventilator-associated pneumonia

OBJECTIVE: Ventilator-associated pneumonia (VAP) has been poorly studied in South Africa, but is likely to be a significant problem, with resulting increased morbidity and mortality in the paediatric intensive care unit population. This guideline is intended to review the evidence and recommendations for prevention and management of VAP in children and to provide, where possible, clear advice to aid the care of these children, to limit costly and unnecessary therapies and - importantly - limit inappropriate use of antimicrobial agents. EVIDENCE: The Working Group was constituted. Literature on the aetiology, prevention and management of paediatric VAP is reviewed. RECOMMENDATIONS: Evidence-based clinical practice guidelines are provided for VAP diagnosis and prevention in South Africa. In addition, the current status of antimicrobial use has been reviewed and clear recommendations are set out.

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