Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 99 num. 9 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>The true purpose of CPD</b>: <b>the MPS gets it right</b>]]> <![CDATA[<b>South African guidelines on venous thromboembolism</b>]]> <![CDATA[<b>Olfactory reference syndrome in DSM-V</b>]]> <![CDATA[<b>Cavernous sinus thrombosis</b>: <b>a possible lethal complication of facial abscess manipulation</b>]]> <![CDATA[<b>OSD deal</b>: <b>a flicker of hope for mid-level doctors</b>]]> <![CDATA[<b>G8 failure on AIDS funding 'obscene'</b>]]> <![CDATA[<b>Veil of silence falls over Health department kickback probe</b>]]> <![CDATA[<b>Microbicide research already benefiting thousands</b>: <b>experts</b>]]> <![CDATA[<b>Does the 2008 HSRC survey indicate a turning tide of HIV prevalence in children, teenagers and the youth?</b>]]> <![CDATA[<b>National population-based HIV surveys</b>: <b>the method of choice for measuring the HIV epidemic</b>]]> <![CDATA[<b>Is scaling up enough to curb the HIV epidemic in southern Africa?</b>]]> <![CDATA[<b>Healers, helpers and hospitals (volumes 1 and 2)</b>]]> <![CDATA[<b>Improving data to reduce the burden of disease</b>: <b>lessons from the Western Cape</b>]]> <![CDATA[<b>Death certificates</b>: <b>let's get it right!</b>]]> <![CDATA[<b>Tracheal stenosis</b>: <b>preventable morbidity on the increase in our intensive care units</b>]]> <![CDATA[<b>Only skin deep</b>: <b>limitations of public health understanding of male circumcision in South Africa</b>]]> <![CDATA[<b>Quality of cause of death certification at an academic hospital in Cape Town, South Africa</b>]]> OBJECTIVES: To investigate the quality of cause of death certification and assess the level of under-reporting of HIV/AIDS as a cause of death at an academic hospital. DESIGN: Cross-sectional descriptive retrospective review of death notification forms (DNFs) of deaths due to natural causes in an academic hospital in Cape Town during 2004. Errors in cause of death certification and ability to code causes of death according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) were assessed. The association between serious errors and age, gender, cause of death and hospital ward was analysed. A sample of DNFs (N =243) was assessed for level of under-reporting of HIV/AIDS. RESULTS: A total of 983 death certificates were evaluated. Almost every DNF had a minor error; serious errors were found in 32.2% (95% confidence interval (CI) 29.3 - 35.1%). Errors increased with patient age, and cause of death was the most important factor associated with serious errors. Compared with neoplasms, which had the lowest error rate, the odds ratios for errors in endocrine and metabolic diseases and genito-urinary diseases were 17.2 (95% CI 8.7 - 34.0) and 17.3 (95% CI 7.8 - 38.2), respectively. Based on the sub-sample, the minimum prevalence of HIV among the deceased patients was 15.7% (95% CI 11.1 - 20.3%) and the under-reporting of deaths due to AIDS was 53.1% (95% CI 35.8 - 70.4%). CONCLUSION: Errors were sufficiently serious to affect identification of underlying cause of death in almost a third of the DNFs, confirming the need to improve the quality of medical certification. <![CDATA[<b>Monitoring the South African national antiretroviral treatment programme, 2003 - 2007</b>: <b>the IeDEA Southern Africa collaboration</b>]]> OBJECTIVES: To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007. DESIGN AND SETTING: Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal. SUBJECTS: Adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. RESULTS: Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17 835 patients per site. Among 45 383 adults and 6 198 children combined, median age (interquartile range) was 35.0 years (29.8 - 41.4) and 42.5 months (14.7 - 82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/µl (44 - 164) and was lower among males than females (86, 34 - 150 v. 110, 50 - 169, p<0.001). Median CD4% among children was 12% (7 - 17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67 - 111 cells/µl, p<0.001) and for those in stage IV (39 - 89 cells/µl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5 - 16.0%, p <0.001). CONCLUSIONS: IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting. <![CDATA[<b>Estimation of adult antiretroviral treatment coverage in South Africa</b>]]> OBJETIVES: To estimate the annual numbers of individuals receiving antiretroviral treatment in South Africa up to mid-2008, and the coverage of antiretroviral treatment in adults according to various definitions of need. METHODS: Antiretroviral coverage is defined as the number of patients receiving antiretroviral treatment at a point in time, divided by the number needing treatment. Numbers of patients receiving antiretroviral treatment are estimated from public sector data, and data provided by disease management programmes and NGO programmes. The unmet need for treatment in adults is estimated using a Markov model of HIV progression in adults, combined with estimates of annual new HIV infections from a national AIDS and demographic model. RESULTS: By the middle of 2008, 568 000 adults and children were receiving antiretroviral treatment in South Africa, with the public health sector accounting for 79% of this total. Using the current Department of Health criteria for defining antiretroviral eligibility (CD4+ count <200/µl or World Health Organization (WHO) stage 4), antiretroviral coverage in adults was 40.2% in 2008 - up from 4.9% in 2004. Coverage increases to 54.2% if eligibility is based on WHO stage 4 only, but falls to 22.2% if the Southern African HIV Clinicians Society guidelines are used to define eligibility. Coverage in 2008 varied between provinces, from 25.8% in the Free State to 71.7% CONCLUSIONS: Significant progress has been made in expanding access to antiretroviral treatment in South Africa since 2004, but a substantial unmet need for treatment in adults remains. <![CDATA[<b>Potential for medical error</b>: <b>incorrectly completed request forms for thyroid function tests limit pathologists' advice to clinicians</b>]]> BACKGROUND: Various publications have highlighted the significance of laboratory errors in the pre- and post-analytical phases and their impact on results. Thyroid-stimulating hormone (TSH) is a first-line thyroid function test and, if abnormal, reflex thyroxine (T4) or tri-iodothyronine (T3) testing is requested, depending on clinical and medication data provided. Interpretative comments are added to all TFT results. OBJECTVES: In view of the paucity of articles describing such errors, we audited laboratory request forms requesting thyroid function tests (TFT), received from primary care clinics and regional hospitals at our laboratory. DESIGN: We assessed 482 laboratory request forms for TFT from primary health care clinics for specific parameters. RESULTS: A total of 482 forms were analysed. Medication/s used by the patient (74.5%) and doctor's contact number (65.1%) were the most commonly incomplete parameters. Of the 123 patients with medication details, 62 (50.4%) were on thyroxine. CONCLUSION: There are few studies examining the frequency and impact of incomplete laboratory forms on laboratory errors, and even fewer studies examining interpretative comments accompanying clinical biochemistry results. We studied how pre-analytical errors in completing request forms may lead to incorrect interpretative comments and inappropriate reflex testing, and so influence the quality of the post-analytical phase. <![CDATA[<b>Allergenicity of latex rubber products used in South African dental schools</b>]]> BACKGROUND: Latex sensitisation is recognised as a health problem among health care workers (HCWs) using latex products. The aim of this study was to quantify specific latex allergens in latex devices used in South African academic dental schools. The current study also compared the total protein content and the levels of specific allergens in these products. METHODS: Fourteen latex examination gloves (powdered and non-powdered) and five dental rubber dams, representing 6 brands, from five dental academic institutions were analysed for latex allergens and total protein. Total protein content was determined using the BioRad DC protein assay kit and natural rubber allergen levels using a capture enyme-linked immunosorbent assay (ELISA) specific for Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02. RESULTS: Hev b 6.02 was found in higher concentrations than other natural rubber latex (NRL) allergens in the products analysed. Hev b 5 content ranged from 0 to 9.2 µg/g and Hev b 6.02 from 0.09 to 61.5 µg/g of sample. Hev b 1 levels were below the detection limit (DL) for 79% of the samples (15/19). Dental dams showed higher allergen levels (median 80.91 µg/g) than latex gloves (median 11.34 µg/g). Powdered rubber samples also showed higher allergen levels (median 40.54 µg/g) than non-powdered samples (median 5.31 µg/g). A statistically significant correlation was observed between total protein and total allergen (r=0.74, p<0.001) concentrations. CONCLUSION: NRL allergen concentrations differ significantly by product and brand. This study has demonstrated that NRL allergens in latex-containing products used in South African dental institutions are present at sufficiently high levels to pose an allergic health risk.