Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 99 num. 12 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>SAMA</b>: <b>from crises to cleansing (to crescendo?)</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>Private practice</b>: <b>adapt or die</b>]]> <![CDATA[<b>A fairer deal for pneumococcal vaccination</b>]]> <![CDATA[<b>A jaw for a tooth</b>]]> <![CDATA[<b>Millions of 'snips' will bolster our health system</b>]]> <![CDATA[<b>NHI will drive costs down</b>: <b>Shisana</b>]]> <![CDATA[<b>Collaborative push to address TB crisis on mines</b>]]> <![CDATA[<b>Bigglesworth MD</b>]]> <![CDATA[<b>Retained glass fragments in body tissues</b>]]> <![CDATA[<b>Flank pain, haematuria and poor patient compliance</b>: <b>beware the 'forgotten' JJ stent!</b>]]> <![CDATA[<b>Lionel Stein (26/10/1918 - 17/08/2008)</b>]]> <![CDATA[<b>Desmond Raubenheimer le Roux (19/09/1924 - 7/06/2009)</b>]]> <![CDATA[<b>Sula Walton (Wolff)</b>]]> <![CDATA[<b>Molecular medicine for clinicians</b>]]> <![CDATA[<b>The multifactorial burden of anaemia in Africa</b>]]> <![CDATA[<b>First do no harm</b>: <b>addressing respiratory morbidity in the newborn and child following elective caesarean section before 39 weeks' gestation</b>]]> <![CDATA[<b>Chakalaka-induced vasodilatation in patients with chronic myeloid leukaemia on tyrosine kinase inhibitors</b>]]> <![CDATA[<b>Acute renal failure in the medical ICU still predictive of high mortality</b>]]> BACKGROUND: We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. METHOD: We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes of renal failure or who developed renal failure following admission to the ICU. RESULTS: Of 198 medical patients admitted to the ICU, ARF occurred in 46 (23.2%). The leading cause of ARF was acute tubular necrosis. The ICU mortality for ARF patients was 47.8%, compared with 17.5% in ICU patients without ARF. Acute haemodialysis was performed in only 17.3% of the 46 ARF patients. Using Cox proportional hazard regression, we found that mean duration of stay (p<0.001), acute physiology and chronic health evaluation II (Apache II) score (p<0.001), mechanical ventilation (p<0.01), dialysis (p<0.04) and multi-organ failure (p<0.05) affected survival time. CONCLUSIONS: We found that ARF is still associated with a high mortality rate and longer duration of stay, higher Apache II score, and need for mechanical ventilation; dialysis and presence of multi-organ failure were indicators of a higher mortality rate. <![CDATA[<b>Anaemia among patients with congestive cardiac failure in Uganda</b>: <b>its impact on treatment outcomes</b>]]> BACKGROUND: Anaemia increases morbidity and mortality in patients with congestive cardiac failure (CCF). Few studies have examined the prevalence of anaemia and its impact among patients with CCF in sub-Saharan Africa. We assessed the prevalence of anaemia and its influence on treatment outcome in patients with CCF attending a large referral hospital in Kampala, Uganda. METHODS: Echocardiography was done and haemoglobin levels were determined in 157 patients with CCF admitted to Mulago Hospital. The patients were followed up for 2 weeks and their treatment outcome was recorded. RESULTS: Of the 157 patients, 101 (64.3%) had anaemia (mean haemoglobin concentration <11.9 g/dl for women and <12.9 g/dl for men) at admission. Increasing age and hypertensive heart disease were significantly associated with anaemia (odds ratio (OR) 2.92, confidence interval (CI) 1.41 - 6.05, p<0.01 and OR 0.31, CI 0.13 - 0.74, p< 0.01, respectively). In-hospital mortality at the end of the 2 weeks of treatment was 10.2% and was significantly higher among the anaemic patients than their non-anaemic counterparts (OR 4.9, CI 1.07 - 22.35, p<0.03). The mean duration of in-hospital stay was 7.5 (standard deviation 3.4) days. This did not differ significantly between anaemic and non-anaemic patients. CONCLUSION: The prevalence of anaemia among patients with CCF attending Mulago Hospital was high. Anaemia in these patients was significantly associated with mortality by the end of 2 weeks of treatment. <![CDATA[<b>Prevalence and morphological types of anaemia and hookworm infestation in the medical emergency ward, Mulago Hospital, Uganda</b>]]> INTRODUCTION: Anaemia is common worldwide, although the burden is highest in developing countries where nutrient deficiencies and chronic infections are prevalent. OBJECTIVE: To determine the prevalence and morphological types of anaemia and assess the hookworm burden among patients in the medical emergency ward at Mulago national referral hospital, Uganda. METHODS: In a cross-sectional descriptive study 395 patients were recruited by systematic random sampling and their socio-demographic characteristics and clinical details collected. A complete blood count and peripheral film examination were done and stool examined for hookworm ova. STATISTICAL ANALYSIS: Data were processed using Epi-Info version 6 and Stata version 9. The chi-square test was used for categorical variables and Student's t-test for non-categorical variables. Multiple logistic regression was used to determine factors predictive of anaemia. RESULTS: Of the patients 255 (64.6%) had anaemia. The prevalence was higher among males (65.8%) than females (63.7%). Fatigue (odds ratio (OR) 2.1, confidence interval (CI) 1.37 - 3.24), dizziness (OR 1.64, CI 1.07 - 2.44), previous blood transfusion (OR 2.83, CI 1.32 - 6.06), lymphadenopathy (OR 2.99, CI 1.34 - 6.66) and splenomegaly (OR 5.22, CI 1.78 - 15.28) were significantly associated with anaemia. Splenomegaly, low body mass index (BMI) (<19) and being HIV positive were independently associated with anaemia. The commonest type of anaemia was hypochromic microcytic (34.1%). Only 10.6% of anaemic patients had hookworm infestation. CONCLUSIONS: In our study the prevalence of anaemia (64.6%) was very high. Splenomegaly, HIV infection and low BMI were independently associated with anaemia. The commonest type of anaemia was microcytic hypochromic (34.1%). There was a low prevalence of hookworm infestation. <![CDATA[<b>Solubility tests and the peripheral blood film method for screening for sickle-cell disease</b>: <b>a cost benefit analysis</b>]]> OBJECTIVE: To determine the cost benefit of screening for sickle-cell disease among infants at district health centres in Uganda using sickling, solubility tests and the peripheral blood film method. METHODS: Pilot screening services were established at district health centres. Cost benefit analysis (CBA) was performed in four scenarios: A1 - where there are no sickle-cell screening services at district health centres and all children are referred either to Mulago national referral hospital or A2 - a regional hospital for haemoglobin (Hb) electrophoresis; B1 - when there are screening services at district health centres, only positive samples are taken either to Mulago Hospital or B2 - the regional hospital for confirmation using haemoglobin electrophoresis. Calculations were done in Uganda shillings (USh). RESULTS: Initial operational costs were high for all scenarios but variably reduced in the subsequent years. Scenarios A1 and A2 were very sensitive compared with B1 and B2. Scenario A1 had the highest screening costs in the subsequent years, costing over 62 000 USh per test in both eastern and western Uganda. Scenario B2 was sensitive and cheaper when using the sickling test, but was expensive and insensitive when using the solubility test and more insensitive though cheaper when using the peripheral blood film method. CONCLUSION AND RECOMMENDATION: Screening children in Mulago hospital using haemoglobin electrophoresis (A1) was very expensive although it was sensitive. Screening the children at four health centres using the sickling method and confirming positive samples at a regional hospital (B2) was both cheap and sensitive and is therefore recommended. <![CDATA[<b>Quality of asthma care</b>: <b>Western Cape Province, South Africa</b>]]> BACKGROUND: Asthma is the eighth leading contributor to the burden of disease in South Africa, but has received less attention than other chronic diseases. The Asthma Guidelines Implementation Project (AGIP) was established to improve the impact of the South African guidelines for chronic asthma in adults and adolescents in the Western Cape. One strategy was an audit tool to assist with assessing and improving the quality of care. METHODS: The audit of asthma care targeted all primary care facilities that managed adult patients with chronic asthma within all six districts of the Western Cape province. The usual steps in the quality improvement cycle were followed. RESULTS: Data were obtained from 957 patients from 46 primary care facilities. Only 80% of patients had a consistent diagnosis of asthma, 11.5% of visits assessed control and 23.2% recorded a peak expiratory flow (PEF), 14% of patients had their inhaler technique assessed and 11.2% were given a self-management plan; 81% of medication was in stock, and the controller/reliever dispensing ratio was 0.6. Only 31.5% of patients were well controlled, 16.3% of all visits were for exacerbations, and 17.6% of all patients had been hospitalised in the previous year. CONCLUSION: The availability of medication and prescription of inhaled steroids is reasonable, yet control is poor. Health workers do not adequately distinguish asthma from chronic obstructive pulmonary disease, do not assess control by questions or PEF, do not adequately demonstrate or assess the inhaler technique, and have no systematic approach to or resources for patient education. Ten recommendations are made to improve asthma care. <![CDATA[<b>Guideline for the management of chronic asthma in children - 2009 update</b>]]> OBJECTIVE: To revise the guideline for the diagnosis and management of chronic asthma in children in view of the following considerations: the existing South African Childhood Asthma Working Group (SACAWG) guideline was produced 10 years ago; diagnosis of asthma in young children remains a challenge; evidence-based treatment is the new paradigm; new treatment approaches to achieving and maintaining control; therapeutic roles of several medications have evolved; more studies and data on treatment in young children; new medications and formulations; a change of emphasis in assessing asthma control to guide treatment changes. The main aim of the guideline is to promote a better standard of treatment based on understanding of the pathophysiology and pharmacotherapy of asthma, and encouraging uniformity in asthma management. EVIDENCE: A detailed literature review by a working group of clinicians from relevant disciplines. The strategies recommended are classified according to the evidence category in Appendix B, and denoted as Evidence A, B, C and D. RECOMMENDATIONS: These include an appropriate diagnostic approach, environmental control measures, treatment options, definition of asthma control, and strategies to achieve control. ENDORSEMENT: The guideline document was endorsed by the South African Thoracic Society (SATS), the National Asthma Education Programme (NAEP), the South African Paediatric Association (SAPA) and the South African Academy of Family Practice.