Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 99 num. 11 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>NHI or bust - the road of no return to health care reform</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>A foreign doctor's experiences with the HPCSA</b>]]> <![CDATA[<b>Facebook is smoking</b>]]> <![CDATA[<b>The costs of a bullet - the true cost of labour</b>]]> <![CDATA[<b>Linezolid dosing for staphylococcal pneumonia in children</b>]]> <![CDATA[<b>'Breakthrough' thai hiv vaccine trial controversy</b>]]> <![CDATA[<b>Time to 'stop pedalling backwards' - Motsoaledi</b>]]> <![CDATA[<b>Breast cancer breakthrough in gene profilings?</b>]]> <![CDATA[<b>Osd strikers</b>: <b>possible censure in 6 months</b>]]> <![CDATA[<b>Resistance to pyrazinamide and ethambutol compromises MDR/XDR-TB treatment</b>]]> <![CDATA[<b>How has the OSD affected our state hospitals?</b>]]> <![CDATA[<b>Medical electives in South Africa</b>]]> <![CDATA[<b>Persistent pain following ankle sprain</b>: <b>bilateral accessory soleus muscles</b>]]> <![CDATA[<b>Lucy Wagstaff (1930 -2009)</b>]]> <![CDATA[<b>Hendrik (Henk) Kayser (25/09/1925 7/09/2009)</b>]]> <![CDATA[<b>Book reviews</b>]]> <![CDATA[<b>Mental health services for HIV/AIDS patients are long overdue</b>]]> <![CDATA[<b>Plummeting corneal donations at the Gauteng cornea and eye bank</b>]]> <![CDATA[<b>Primary health workers' proficiency in using malaria rapid diagnostic tests in Limpopo province</b>]]> <![CDATA[<b>Peripheral arterial disease and intermittent claudication</b>: <b>efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home</b>]]> OBJECTIVE: To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD). DESIGN: 30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to 'walk as much as possible at home' (CONT). Before and after intervention groups performed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2) , heart rate and perceived pain were measured. RESULTS: MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9±79% v. 7.0±19.8% v. 7.3±46%; CER v. UBST v. CONT p=0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4±20 v. -6.2±15 v. -1.0±21%; CER v. UBST v. CONT p=0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37±47% v. 27±71% v. -30±29%; CER v. UBST v. CONT p=0.03), and perceived pain decreased in the CER group compared with the UBST group (-24±39% v. 27±48%; CER v. UBST p=0.01). CONCLUSION: CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of management. <![CDATA[<b>Is routine pathological examination required in South African children undergoing adenotonsillectomy?</b>]]> OBJECTIVE: We aimed to determine the incidence of abnormal pathological findings in the tonsils and/or adenoids of children undergoing tonsillectomy and/or adenoidectomy, and the incidence of tuberculosis of the tonsils and adenoids; suggest criteria to identify children at risk for adenotonsillar tuberculosis; and investigate the association between HIV and adenotonsillar abnormality, the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histological examination. METHODS: We undertook an 8-month prospective study on all children (>12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children's Hospital. Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing, and all tonsils and adenoids were examined histologically. A cost-benefit analysis was done to determine the cost-effectiveness of adenotonsillectomy routine pathology. RESULTS: A total of 344 tonsils were analysed from 172 children (102 boys, 70 girls); 1 patient had nasopharyngeal tuberculosis, and 1 lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average cost of detecting a clinically significant abnormality was R22 744 (R45 488 ÷ 2 abnormalities). CONCLUSIONS: The following criteria could improve cost-effectiveness of pathological examination of adenotonsillectomy specimens: positive tuberculosis contact at home, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3 cm, suspicious nasopharyngeal appearance, HIV-positive patient, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence, routine pathological investigation for South African children does not seem to be justified. <![CDATA[<b>Field evaluation of a malaria rapid diagnostic test (ICT Pf)</b>]]> BACKGROUND: Malaria rapid diagnostic tests (MRDTs) are quick and easy to perform and useful for diagnosing malaria in primary health care settings. In South Africa most malaria infections are due to Plasmodium falciparum, and HRPII-based MRDTs have been used since 2001. Previous studies in Africa showed variability in sensitivity and specificity of HRPIIbased MRDTs; hence, we conducted a field evaluation in Limpopo province to determine the accuracy of the MRDT currently used in public sector clinics and hospitals. METHODS: A cross-sectional observational study was conducted to determine the sensitivity and specificity of an ICT Pf MRDT. We tested 405 patients with fever with ICT Pf MRDT and compared the results with blood film microscopy (the gold standard). RESULTS: The overall sensitivity of the ICT Pf MRDT was 99.48% (95% confidence interval (CI) 96.17 - 100%), while specificity was 96.26% (95% CI 94.7 - 100%). The positive predictive value of the test was 98.48 (99% CI 98.41 - 100%), and the negative predictive value was 99.52% (95% CI 96.47 - 100%). CONCLUSIONS: The ICT Pf MRDT is an appropriate test to use in the field in South Africa where laboratory facilities are not available. It has a high degree of sensitivity and acceptable level of specificity in accordance with the World Health Organization criteria. However, sensitivity of MRDT at low levels of parasitaemia (<100 parasites/µl of blood) in field conditions must still be established. <![CDATA[<b>Severe snakebites in northern KwaZulu-Natal</b>: <b>treatment modalities and outcomes</b>]]> OBJECTIVE: We aimed to study the outcomes of severe snakebites in patients admitted to Ngwelezana Hospital in north-eastern KwaZulu-Natal, the seasonal variations, and the effectiveness and complications of antivenom. DESIGN: A prospective observational outcomes study was conducted over one year (1 June 2007 to 31 May 2008). The study group was from the north-eastern KwaZulu-Natal region of South Africa, with a population of approximately 3 million people, and included all patients bitten by snakes and admitted to the Ngwelezana Hospital Emergency Medicine Unit (EMU). Departmental practice guidelines were documented and followed. OUTCOME MEASURES: End-points for patient outcomes included transfer from the EMU to the ward, discharge home from the EMU, and follow-up of patients who required surgery or ICU care. RESULTS: A total of 243 snakebite patients were recorded. The highest incidence was in the summer months; 46 (18.93%) patients experienced one or more severe complications; 29 (11.93%) patients received some form of definitive management in hospital; and 22 (9.05%) of the latter patients received antivenom. Antivenom was administered to more children than adults. Adverse reactions to antivenom were common: an allergic response occurred in 4 (15.4%) patients, and anaphylaxis in 6 (23.1%); the highest incidence occurred in the <10-year-old age group. No deaths were recorded. CONCLUSIONS: Snakebites are common in the summer months in north eastern KwaZulu-Natal. Children are particularly vulnerable to snakebites and the effects of antivenom. Adverse reactions to antivenom are common. Severe snakebites that require antivenom should be managed in a hospital setting with advanced airway support. The syndromic approach to treatment is simple and effective. <![CDATA[<b>Lead-based paint on playground equipment in public children's parks in Johannesburg, Tshwane and Ekurhuleni</b>]]> OBJECTIVE: To determine the use of lead-based paint in public playgrounds in the municipalities of Johannesburg, Tshwane and Ekurhuleni. METHODS: Forty-nine public parks were selected from the municipalities of Johannesburg, Tshwane and Ekurhuleni. Lead levels in paint on playground equipment were measured in situ using a hand-held Thermo Scientific NITON XLP 700 Series X-ray fluorescence (XRF) analyser. RESULTS: Playground lead levels ranged from 'too low to detect' to 10.4 mg/cm². The mean and median lead concentrations were 1.9 mg/cm² and 0.9 mg/cm² respectively. Forty-eight per cent of lead paint measurements exceeded the internationally accepted reference level of 1 mg/cm². CONCLUSION: The study shows that lead-based paint is widely used in public playgrounds in the three study municipalities, and most likely throughout South Africa. We suggest key actions to ensure that children's playgrounds in South Africa are lead-free zones, and that childhood lead exposure in these settings is prevented. <![CDATA[<b>Atopy in HIV-infected children in pretoria</b>]]> INTRODUCTION: The development or aggravation of a pre-existing atopic state in patients with human immunodeficiency virus (HIV) has not been thoroughly investigated in South Africa. HIV-infected adults have been shown to have a higher prevalence of atopy in some international studies, but this has not been documented in children. METHODS: A prospective convenience sample of 50 children aged between 3 months and 12 years attending the Tshwane District Hospital Paediatric HIV clinic in Pretoria was recruited. Their personal and family histories of atopy, World Health Organization (WHO) HIV clinical staging and Centers for Disease Control (CDC) immunological staging with CD4 counts were documented. An age- and sex-matched control group of 50 HIV-negative children was included. Skin prick tests (SPTs) to identify common aeroallergens were conducted on all patients. RESULTS: One hundred children were enrolled, with 50 in each group. Ten per cent of the HIV-infected patients compared with 16% of controls had positive SPTs to aeroallergens. A higher percentage of the HIV-infected patients had chronic rhinitis and eczema (60% and 68%, respectively). There was no relationship between CD4 count and positive SPTs (p=0.61), mean log CD4 count and presence of reported asthma (p=0.71), and CD4 count and presence of reported dermatitis (p=0.84). The CD4 count was not statistically different between children with and without a family history of atopy (p=0.68). CONCLUSION: It appears that the stage of HIV disease does not influence the development or expression of allergy. There is a high prevalence of dermatitis and chronic rhinitis in HIVinfected children, probably not atopic in origin.