Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 99 num. 8 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Health systems</b>: <b>chaos requires software renewal</b>]]> <![CDATA[<b>Stroke in the community</b>]]> <![CDATA[<b>Universitas Academic Health Complex</b>: <b>national asset or provincial liability?</b>]]> <![CDATA[<b>'A jaw for a tooth'</b>: <b>a biased report</b>]]> <![CDATA[<b>At the heart of healing</b>: <b>nursing</b>]]> <![CDATA[<b>A little carrot and a big stick</b>: <b>OSD beds down</b>]]> <![CDATA[<b>Up to its eyeballs in sewage</b>: <b>government pleads for help</b>]]> <![CDATA[<b>Mandatory health insurance</b>: <b>a gathering storm</b>]]> <![CDATA[<b>Legislating for nurse/patient ratios 'clumsy and costly'</b>: <b>experts</b>]]> <![CDATA[<b>Inadequacy of primary health care test request guidelines</b>: <b>lack of an evidence base</b>]]> <![CDATA[<b>Overpopulation and modern ethics</b>]]> <![CDATA[<b>The need for a community-based model for stroke care in South Africa</b>]]> <![CDATA[<b>Pandemic influenza (H1N1) 2009 (swine flu)</b>]]> <![CDATA[<b>The partogram</b>: <b>a missed opportunity</b>]]> <![CDATA[<b>Community-based care of stroke patients in a rural African setting</b>]]> BACKGROUND: To develop a community-based model of stroke care, we assessed discharge planning of stroke patients, available resources and continuity of care between hospital and community in a remote rural setting in South Africa. We sought to determine outcomes, family participation and support needs, and implementation of secondary prevention strategies. METHODS: Thirty consecutive stroke patients from the local hospital were assessed clinically (including Barthel index and modified Rankin scores) at time of discharge and re-assessed 3 months after discharge in their homes by a trained field worker using a structured questionnaire. RESULTS: Two-thirds of all families received no stroke education before discharge. At discharge, 27 (90%) were either bed- or chair-bound. All patients were discharged into family care as there was no stroke rehabilitation facility available to the community. Of the 30 patients recruited, 20 (66.7%) were alive at 3 months, 9 (30%) had died, and 1 was lost to follow-up. At 3 months, 55% of the remaining cohort were independently mobile compared with 10% at discharge. Of the 20 surviving patients, 13 (65%) were visited by home-based carers. Only 45% reported taking aspirin at 3 months. CONCLUSIONS: The 3-month mortality rate was high. Most survivors improved functionally but were left with significant disability. Measures to improve family education and the level of home-based care can be introduced in a model of stroke care attempting to reduce carer strain and reduce the degree of functional disability in rural stroke patients. <![CDATA[<b>Hospital and community isolates of uropathogens at a tertiary hospital in South Africa</b>]]> AIM: To investigate the profile of common uropathogens isolated from urine specimens submitted to the diagnostic microbiology laboratory at a tertiary teaching hospital and assess their antimicrobial susceptibility patterns to commonly used antimicrobial agents. METHODS: We conducted a retrospective analysis of laboratory reports for all urine specimens submitted for investigations over a 1-year period. Isolates were tested by means of the Kirby-Bauer disc diffusion method for susceptibility to amoxicillin, ciprofloxacin, gentamicin, co-trimoxazole and nitrofurantoin, and for extended-spectrum beta-lactamase (ESBL) production. RESULTS: Out of the total specimens (N=2 203) received over the 1-year study period, 51.1% (1 126) of the urine samples were culture-positive, the majority (65.4%) having come from females. The most common isolate was Escherichia coli (39.0%) followed by Klebsiella species (20.8%) and Enterococcus faecalis (8.2%). The Gram-negative isolates displayed a very high level of resistance to amoxicillin (range 43 - 100%) and co-trimoxazole (range 29 - 90%), whereas resistance to gentamicin (range 0 - 50%) and ciprofloxacin (range 0 - 33%) was lower. E. coli isolates were susceptible to nitrofurantoin (94%), and ESBL production was significantly higher (p=0.01) in the hospital isolates, compared with those from the community referral sites. CONCLUSIONS: The culture-positive rate for uropathogens was high, with a greater incidence among females. E. coli was the most common aetiological agent identified, and remained susceptible to nitrofurantoin. Resistance levels to amoxicillin and co-trimoxazole were very high for all Gram-negative isolates, and it is recommended that these antibiotics should not be used for the empiric treatment of urinary tract infections. <![CDATA[<b>Neurocysticercosis in patients presenting with epilepsy at St Elizabeth's Hospital, Lusikisiki</b>]]> OBJECTIVE: To survey the prevalence of neurocysticercosis in patients treated for epilepsy in Lusikisiki, E Cape. DESIGN: This was a descriptive study. Variables considered were age, gender, symptoms and type of seizure, serological data, electroencephalogram and computed tomography (CT) findings, treatment, and ownership of pigs. Prevalence and risk assessment were determined by statistical analysis. SUBJECTS AND SETTING: 113 patients presenting with epilepsy at St Elizabeth's Hospital, Lusikisiki, E Cape. OUTCOME MEASURES: Prevalence of neurocysticercosis in patients presenting with epilepsy. RESULTS: CT scans indicated that 61.1% of the patients had neurocysticercosis-associated epilepsy, the prevalence being highest in the 10 - 19-year-old age group (12.4% of the total). Neuro-imaging studies showed that calcified lesions were frequent, while active lesions were often associated with positive serological results. Non-commercial pig farming was not a significant risk factor for neurocysticercosis in the sample studied. CONCLUSION: Neurocysticercosis was common in patients presenting with and undergoing treatment for epilepsy. <![CDATA[<b>Fifty years of thoracic surgical research in South Africa</b>]]> AIM: To investigate the scope and trends in clinical research in South African thoracic surgery between 1955 and 2006 and to measure its impact on clinical practice. METHOD: A systematic review of all SA thoracic surgical publications was performed. RESULTS: There were 252 general thoracic publications and a marked decrease in publications was noted after the peak period of productivity of the 1980s. There was a shift toward the private sector as an origin of articles and toward a local, non-indexed journal. Inflammatory lung disease was the most frequent topic of publication. Case series and case reports were the most frequent type of article. CONCLUSION: The vulnerability of a small specialty in a developing country is illustrated by the clear trends that emerged. The study provides important indicators for future research, highlights the need for a national database of clinical experience, and emphasises the importance of rekindling interest and a culture of research in thoracic surgery.