Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420100007&lang=en vol. 100 num. 7 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Misplaced trust?</b><b> </b><b>Gaping flaws in drug approval and licensing</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Clinical trials in South Africa</b>: <b>need for capacity building and training</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Surviving in the public sector</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Meckel's diverticulitis revisited</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Mercury exposure in a low-income community in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Mother and child care services 'insufficient to save lives'- HSRC report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Gauteng MEC shifts corruption focus to health care workers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Crowded wards, lousy admin contribute to death and suffering</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700009&lng=en&nrm=iso&tlng=en <![CDATA[<b>Achieving the HIV and AIDS National Strategic Plan</b>: <b>a practical calculator for local target setting in district health facilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Reversible nephrotic syndrome secondary to pulmonary hydatid disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Lodewyk Adrian Vosloo (Vossie)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700012&lng=en&nrm=iso&tlng=en <![CDATA[<b>Andreas Vesalius</b>: <b>the Making, the Madman, and the Myth</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700013&lng=en&nrm=iso&tlng=en <![CDATA[<b>The scramble for influenza vaccine in 2010</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Validation of a dosing regimen for fixed-dose, weight-adjusted, subcutaneous unfractionated heparin for the acute treatment of venous thrombo-embolism in a population from a resource-constrained environment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700015&lng=en&nrm=iso&tlng=en <![CDATA[<b>Emergency centres lack defibrillator knowledge</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700016&lng=en&nrm=iso&tlng=en <![CDATA[<b>Potential for nosocomial transmission of multidrug-resistant (MDR) tuberculosis in a South African tertiary hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700017&lng=en&nrm=iso&tlng=en BACKGROUND: Tuberculosis (TB) is a major health problem in the Western Cape, with an incidence exceeding 900 per 100 000 people. Nosocomial transmission of TB, and particularly drug-resistant TB, is a potential risk that may be undetected. Rapid diagnosis and rapid institution of effective anti-TB treatment, combined with appropriate infection control measures, are essential to prevent nosocomial transmission of TB. To estimate the potential for nosocomial transmission, we aimed to determine the in-hospital delays in diagnosis and treatment of patients with multidrug-resistant (MDR)-TB at a tertiary care hospital. METHODS: A descriptive study, based on retrospective review of patient records and laboratory data, including all adult patients (>13 years) where TB culture and susceptibility testing confirmed MDR-TB on specimens submitted to Tygerberg Hospital's National Health Laboratory Service (NHLS) laboratory in 2007. RESULTS: Thirty-one patients with MDR-TB were identified. The median laboratory turnaround time (TAT) from collection of specimen to confirmation of MDR-TB was 40 days, while the median time from the time of first presentation at Tygerberg Hospital to institution of MDR treatment was 44 days. Twenty patients were considered infectious during their hospital stay, generating 345 inpatient infectious days. CONCLUSIONS: The study suggests that there is an ongoing substantial risk for nosocomial transmission of MDR-TB at Tygerberg Hospital. We propose improvements, including the use of rapid drug susceptibility testing. The consistent application of infection control measures to prevent nosocomial spread of TB, including MDR-TB, remains vital. <![CDATA[<b>The correlation between C-reactive protein and toxic granulation of neutrophils in the peripheral blood</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700018&lng=en&nrm=iso&tlng=en BACKGROUND: During inflammation, the serum concentrations of granulocyte colony-stimulating factor (G-CSF), plasma interleukin-6 (IL-6), and C-reactive protein (CRP) increase. A positive correlation between CRP and the percentages of neutrophils exhibiting toxic granulation during inflammation has been demonstrated, and that the fluctuations of CRP and toxic granulation of neutrophils were similar. OBJECTIVES: We studied whether grading of toxic granulated neutrophils can be used as a surrogate marker for infection or inflammation, and also be an easier method than previously described methods. MATERIALS AND METHODS: We graded 357 consecutive peripheral blood slides from patients on whom a full blood count with differential count and CRP level was performed, according to intensity of toxic granulation in the neutrophil population, according to a newly proposed grading system. RESULTS: The CRP range was between 1 and 530.3 mg/l. The results confirm the association between a rise in CRP and progressive intensity of toxic granulation in neutrophils in peripheral blood. Kruskal-Wallis equality of populations rank test showed a statistically significant difference between the graded categories (p=0.0001). The Trend test was also statistically significant (p=0.000). CONCLUSION: The proposed system can be applied to patients with inflammatory or infectious conditions, where grading of toxic granulation of neutrophils can possibly be used as a surrogate marker to assess infection or inflammation and their response to treatment. It may be of particular use in cases where traditional infectious or inflammatory markers cannot be used, owing to inherent problems associated with the respective conditions. <![CDATA[<b>Anaemia among clinically well under-fives attending a community health centre in Venda, Limpopo Province</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700019&lng=en&nrm=iso&tlng=en BACKGROUND: Anaemia has been reported to affect 20 - 75% of children in South Africa. The range suggests the effects that geography, health, and socio-economic status can have on the observed prevalence of anaemia within a specific community. Our objective was to investigate the prevalence of anaemia in children aged under 5 presenting for well-child examinations at a community health centre in Thohoyandou, Limpopo Province. DESIGN: A cross-sectional observational study was carried out in June and July 2007. Caregivers participated in a brief interview where demographic, health and nutritional information was collected. A blood sample was collected from each child, and haemoglobin levels were assessed with a point-of-care haemoglobin testing system. Anaemia was defined as having a haemoglobin value <2 standard deviations below age-altitude adjusted normal values. RESULTS: Three-quarters (39/52 - 75%) of children were anaemic. Girls were significantly more likely to be anaemic than boys (20/20 v. 19/32 respectively; p=0.001). Anaemic children were significantly less likely to be underweight compared with their peers (32/38 v. 5/12 respectively; p=0.007). There was no significant association between anaemia and infection with Helicobacter pylori (p=0.729), intestinal helminths (p=1.000) or food insecurity (p=0.515). CONCLUSION: We found a striking prevalence of anaemia among clinically well children <5 years old in Thohoyandou, Limpopo Province. The rates of anaemia were higher than those found in previous studies conducted in similar settings in South Africa. Future work should focus on aetiologies and interventions. <![CDATA[<b>Profile and management of patients at a memory clinic</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700020&lng=en&nrm=iso&tlng=en BACKGROUND: Anaemia has been reported to affect 20 - 75% of children in South Africa. The range suggests the effects that geography, health, and socio-economic status can have on the observed prevalence of anaemia within a specific community. Our objective was to investigate the prevalence of anaemia in children aged under 5 presenting for well-child examinations at a community health centre in Thohoyandou, Limpopo Province. DESIGN: A cross-sectional observational study was carried out in June and July 2007. Caregivers participated in a brief interview where demographic, health and nutritional information was collected. A blood sample was collected from each child, and haemoglobin levels were assessed with a point-of-care haemoglobin testing system. Anaemia was defined as having a haemoglobin value <2 standard deviations below age-altitude adjusted normal values. RESULTS: Three-quarters (39/52 - 75%) of children were anaemic. Girls were significantly more likely to be anaemic than boys (20/20 v. 19/32 respectively; p=0.001). Anaemic children were significantly less likely to be underweight compared with their peers (32/38 v. 5/12 respectively; p=0.007). There was no significant association between anaemia and infection with Helicobacter pylori (p=0.729), intestinal helminths (p=1.000) or food insecurity (p=0.515). CONCLUSION: We found a striking prevalence of anaemia among clinically well children <5 years old in Thohoyandou, Limpopo Province. The rates of anaemia were higher than those found in previous studies conducted in similar settings in South Africa. Future work should focus on aetiologies and interventions. <![CDATA[<b>Testicular cancer</b>: <b>management challenges in an African developing country</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700021&lng=en&nrm=iso&tlng=en BACKGROUND: Advances in oncology have greatly improved the prognosis of testicular cancer. In developing countries, however, the outcome is still poor. PATIENTS AND METHODS: Twenty-four patients managed for testicular cancer at two centres (University of Nigeria Teaching Hospital, Enugu, Nigeria, and JAMA Urological Clinic, Enugu) between April 1984 and March 2003 were prospectively studied. Histopathological data were obtained in all cases. RESULTS: Peak age incidence was 20 - 29 years. Testicular swelling was the principal complaint in 23 patients. The mean interval between onset of symptoms and presentation was 5.3 months. Two patients (8.3%) presented with stage 1 disease, 7 (29.2%) with stage 2, 7 (29.2%) with stage 3, and 8 (33.3%) with stage 4. Seventy-five per cent of tumours were right-sided, and 25% were left-sided. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in some patients. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminoma and embryonal carcinoma. A fifth of the patients died, while half were lost to follow-up. The mean follow-up period was 9 months. CONCLUSION: Morbidity and mortality of testicular cancer is high in developing countries. Late presentation, poverty, paucity of resources and the high cost of newer imaging modalities and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential. <![CDATA[<b>Snakebite</b>: <b>admissions at a tertiary health care centre in Maharashtra, India</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700022&lng=en&nrm=iso&tlng=en OBJECTIVES: To determine the outcome, seasonal variation, and death pattern of snakebite cases admitted at the tertiary health care centre in the last 10 years. METHODS: This was a record-based retrospective descriptive study at the Dr Shankarrao Chavan Government Medical College and Hospital in Vazirabad, a tertiary health care centre in Maharashtra, India. RESULTS: Out of 5 639 admitted snakebite cases, 65.24% were male. The 16 - 45-year age group accounted for 84.7% of cases; 46% were referred from other health centres, mostly from rural areas; 55.2% occurred during July to September, which coincided with the rainy season in this region; 94.6% of the snakebite patients survived; and 5.4% died. Case fatality rates were higher for females (8.78%) and for bites by neurotoxic snakes (8.91%). CONCLUSIONS: Snakebite is a common life-threatening emergency in the study area. Ready availability and appropriate use of antivenom, early referral when required and close monitoring of patients in the hospital will help to reduce mortality from snakebites. <![CDATA[<b>29 July - 1 August, Sandton Convention Centre, Johannesburg</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742010000700023&lng=en&nrm=iso&tlng=en OBJECTIVES: To determine the outcome, seasonal variation, and death pattern of snakebite cases admitted at the tertiary health care centre in the last 10 years. METHODS: This was a record-based retrospective descriptive study at the Dr Shankarrao Chavan Government Medical College and Hospital in Vazirabad, a tertiary health care centre in Maharashtra, India. RESULTS: Out of 5 639 admitted snakebite cases, 65.24% were male. The 16 - 45-year age group accounted for 84.7% of cases; 46% were referred from other health centres, mostly from rural areas; 55.2% occurred during July to September, which coincided with the rainy season in this region; 94.6% of the snakebite patients survived; and 5.4% died. Case fatality rates were higher for females (8.78%) and for bites by neurotoxic snakes (8.91%). CONCLUSIONS: Snakebite is a common life-threatening emergency in the study area. Ready availability and appropriate use of antivenom, early referral when required and close monitoring of patients in the hospital will help to reduce mortality from snakebites.