Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> vol. 101 num. 7 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>'No more whispers': 30 years of HIV/AIDS and 10 years of HIV treatment in South Africa</b>]]> <link></link> <description/> </item> <item> <title><![CDATA[<b>Vaginal deliveries: is there a need for documented consent?</b>]]> <![CDATA[<b>Decriminalisation of drugs</b>]]> <![CDATA[<b>Richer punters win in SA's cancer treatment lottery</b>]]> <![CDATA[<b>Cancer data collection</b>: <b>blunt instruments get some honing</b>]]> <![CDATA[<b>Pre-NHI clean-up</b>: <b>Motsoaledi enlists private sector</b>]]> <![CDATA[<b>Improving operating theatre efficiency in South Africa</b>]]> <![CDATA[<b>A benefaction and its benefits</b>: <b>the Oxford Nuffield Medical Fellowship and South Africa</b>]]> <![CDATA[<b>A case of blinding abdominal pain</b>]]> <![CDATA[<b>Leslie E Whitfield</b>]]> <![CDATA[<b>Scale optimisation is important in hospital initiatives in South Africa</b>]]> <![CDATA[<b>Success of an integrated tuberculosis and HIV/AIDS project in 2009 in Uthukela District, KwaZulu-Natal</b>]]> <![CDATA[<b>High-altitude corneal oedema associated with acetazolamide</b>]]> <![CDATA[<b>HIV/AIDS influences blood and blood product use at Groote Schuur Hospital, Cape Town</b>]]> BACKGROUND: Use of blood and blood products in the medical wards at Groote Schuur Hospital, Cape Town, has increased substantially and significantly increased expenditure. It was suspected that the increased burden of HIV/AIDS could be a contributing factor. METHODS: Doctors voluntarily completed a structured questionnaire when blood or blood products were utilised over a 3-month period in 2009. Statistical analysis was performed using Microsoft Excel, SPSS and STATISTICA. RESULTS: Of 67 patients analysed, 46 (68.6%) were female, mean age 36.7 (standard deviation (SD) 8.7) years; 21 (31.3%) were male, mean age 39.3 (SD 13.5) years; and 41 (61.2%) were HIV positive, of whom 17 (41.5%) were on antiretroviral therapy (ART). HIV-infected patients were on average 10 years younger than HIV-uninfected patients (p=0.012). Anaemia was the cytopenia necessitating transfusion in 68.7% of cases, but its causes differed between HIV-infected and uninfected patients. The median CD4 count was 203 cells/µl (range 24 - 540) for HIV-infected patients on ART and 74 cells/µl (range 2 - 276) for those not on ART (p=0.012). The mean numbers of packed red cell and fresh-frozen plasma units transfused in the HIV-infected not on ART, HIV-infected on ART and HIV-uninfected groups were 3.3, 2.0 and 1.5 (p=0.013) and 13.5, 2.7 and 1.0 (p<0.001), respectively. ART in HIV-positive patients markedly decreased transfusion requirements (p<0.001). There was one minor transfusion reaction. CONCLUSION: HIV/AIDS is a significant factor contributing to the increased use of blood and blood products in the medical wards at Groote Schuur Hospital. Being on ART appeared to reduce the requirement for blood and blood products. <![CDATA[<b>Pathogenic lower genital tract organisms in HIV-infected and uninfected women, and their association with postpartum infectious morbidity</b>]]> OBJECTIVES: To determine the prevalence of vaginal pathogens during pregnancy and their impact on postpartum infectious morbidity among antiretroviral-naïve HIV-infected, and HIVuninfected, women. METHODS: Vaginal swabs were obtained during early labour by speculum examination prior to digital vaginal examination, and sent for microscopy and culture. Women were assessed for infectious complications within 24 - 72 hours of delivery, and up to 2 weeks postpartum. RESULTS: Laboratory results were available for 801 women who delivered vaginally (418 HIV infected and 383 uninfected). The baseline characteristics of the two groups were comparable, and the median CD4 count for HIV-infected women (N=391) was 416/µl. Fifty-five per cent (54.8%) of women had positive cultures (439/801), more among those who were HIV infected than uninfected (60% v. 49.1%, p=0.002). Women with positive cultures had slightly higher rates of infectious morbidity than those without (20.5% v. 15.2%, p=0.052). Trichomonas vaginalis and group B streptococci were significantly associated with sepsis (p=0.023 and <0.001, respectively), whereas the presence of Candida species seemed to be protective (relative risk 0.69, p=0.014). CONCLUSION: The study shows that a high proportion of pregnant women have pathogenic organisms in the lower genital tract that are associated with development of postpartum infectious morbidity. <![CDATA[<b>The prevalence of hepatitis B infection in a rural South African HIV clinic</b>]]> The prevalence of hepatitis B virus (HBV) infection in 1 765 HIVpositive patients in rural Eastern Cape was 7.1%. This is lower than the previously reported rural prevalence and is similar to urban prevalence. Male sex and baseline alanine aminotransferase (ALT) were significant predictors of HBV status. Most HBV-positive patients had normal baseline ALT, making ALT an insensitive screening test for HBV status. <![CDATA[<b>Associations between asthma and bronchial hyperresponsiveness with allergy and atopy phenotypes in urban black South African teenagers</b>]]> OBJECTIVES: To determine asthma and allergy phenotypes in unselected urban black teenagers and to associate bronchial hyperresponsiveness (BHR) with asthma, other atopic diseases and allergen sensitisation. METHODS: This was a cross-sectional study of 211 urban highschool black children of Xhosa ethnicity. Modified ISAAC questionnaires regarding asthma, eczema and rhinitis were administered. BHR was assessed by methacholine challenge using hand-held nebulisers. Skinprick tests (SPTs) were performed for 8 aeroallergens and 4 food allergens. RESULTS: Asthma was reported in 9%, and 16% demonstrated BHR. Rhinitis was reported in 48% and eczema in 19%. Asthma was strongly associated with BHR. Asthma was associated with eczema whereas BHR was associated with rhinitis. SPTs were positive in 34% of subjects, aeroallergens in 32%, and food allergens in 5%. The most common sensitivities were to house dust mites (HDM) and German cockroach. BHR was associated with sensitivity to any aeroallergen, cat, HDM, cockroach and bermuda grass. The number of positive SPTs was associated with asthma and BHR. With each level of SPT positivity, there was 40% increased prevalence of asthma and 70% increased prevalence of BHR. The rate of allergen sensitisation in subjects with BHR (72%) was much higher than those without BHR (28%); house dust mite sensitivity was 69% in subjects with BHR and 18% in those without. CONCLUSIONS: These are the highest rates of allergen sensitisation in subjects with BHR documented in an African setting and the widest difference in sensitisation rates between subjects with and without BHR. <![CDATA[<b>APRI</b>: <b>a simple bedside marker for advanced fibrosis that can avoid liver biopsy in patients with NAFLD/NASH</b>]]> BACKGROUND: Non-alcoholic steatohepatitis (NASH) can lead to cirrhosis and hepatocellular carcinoma. The NASH fibrosis score (NFS) has proven to be a reliable, non-invasive marker for prediction of advanced fibrosis. Aspartate aminotransferase-toplatelet ratio index (APRI) is a simpler calculation than NFS, but has never been studied in patients with non-alcoholic fatty liver disease (NAFLD). AIM: To validate APRI as a non-invasive marker of liver fibrosis in subjects with NAFLD to be used in clinical practice. DESIGN/METHODS: The cohort consisted of 111 patients with histological diagnoses of NAFLD. The biopsy samples were staged and graded according to the NASH clinical research network (CRN) criteria. These were grouped into fatty liver disease (FLD), NASH, no/mild fibrosis, and advanced fibrosis. The sensitivity and specificity of APRI were compared with NFS and aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratio. RESULTS: The APRI was significantly higher in the advanced fibrosis group. The area under receiver operating characteristic (ROC) curve for APRI was 0.85 with an optimal cut-off of 0.98, giving a sensitivity of 75% and a specificity of 86%. The NFS was significantly lower in the advanced fibrosis group. The ROC for NFS gave an area under curve (AUC) of 0.77 and a cut-off value of -1.3 with a sensitivity of 76% and specificity of 69%. The positive predictive value for APRI was 54% as opposed to 34% for NFS. The negative predictive value was 93% for APRI and 94% for NFS. CONCLUSION: APRI compared favourably to NFS and was superior to AST/ALT for the prediction of advanced fibrosis. We therefore propose the use of APRI in a new algorithm for the detection of advanced fibrosis. <![CDATA[<b>Genetic disorders in the Indian community of South Africa</b>]]> OBJECTIVES: To determine the range of genetic disorders in the Indian population of South Africa, assess relevant historical and demographic factors, and discuss the implications for medical and genetic care. METHODS: WSW reviewed the archived data pertaining to patients seen in his paediatric practice in Durban during the past 45 years. Likewise, PB reviewed case details of persons encountered since 1972 in Cape Town, at outreach clinics, and in special institutions for the handicapped throughout South Africa. Additional information was accessed through the Cape Genetic Heritage archive. RESULTS: In addition to the common ubiquitous worldwide genetic disorders, several rare heritable conditions are present in the Indian community of South Africa. These disorders are the consequence of the founder effect and reflect the biological heritage of the early immigrants. Demographic factors (notably endogamy) are also relevant in this respect. As a result of these processes, thalassaemia is by far the most common and important genetic disorder in the Indian population in the country. CONCLUSION: Awareness of the presence of specific genetic conditions in the Indian community of South Africa is important in the diagnostic process. In turn, diagnostic precision facilitates accurate prognostication and optimal medical and genetic management.