Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420110012&lang=en vol. 101 num. 12 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>What price and what kind of journals?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200002&lng=en&nrm=iso&tlng=en <![CDATA[<b>The NHI</b>: <b>where should the passion of our focus be?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Afrikaanse geneeskunde-literatuurargief op Tygerberg</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200004&lng=en&nrm=iso&tlng=en <![CDATA[<b>'Wing and a prayer' days over for SA's healthcare system</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Ubuntu values lived out by rural award winner</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Nurture grassroots human capital and save lives</b>: <b>global award finalist</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Preventing disease and saving lives</b>: <b>the malaria season is upon us</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Stem cells</b>: <b>13 years since their isolation, is there any proven benefit to the patient?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200009&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>Edmond Bloch</b>: <b>(22/11/1923 - 04/09/2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200010&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>Haroon Moosa Ameen (1936 - 2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200011&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>Walter Beck</b>: <b>(1926 - 2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200012&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>AIDS, sex and culture</b>: <b>global politics and survival in Southern Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200013&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>Hair fashion trends and formaldehyde health risks</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200014&lng=en&nrm=iso&tlng=en ABSTRACT Stem cells are seen as the 'magic bullet'; while this may be true, their efficacy and safety in patients has not yetbeen established unequivocally. This article summarises the different types of stem cells and gives an overview of their advantages and disadvantages, their use, and potential uses in the patient setting. <![CDATA[<b>NDM-1 has arrived</b>: <b>first report of a carbapenem resistance mechanism in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200015&lng=en&nrm=iso&tlng=en The New Delhi Metallo-β-lactamase (NDM) resistance mechanism in Enterobacteriaceae threatens to render serious Gram-negative infections untreatable. The NDM-1 enzyme hydrolyses all available penicillin, cephalosporin and carbapenem antibiotics, and is commonly accompanied by additional resistance mechanisms to multiple antibiotic classes. Initially identified as a significant healthcare risk on the Indian sub-continent, it has rapidly become a global problem, posing significant diagnostic and management challenges. Here we report the first laboratory-confirmed case of NDM-1 in South Africa. <![CDATA[<b>Acute renal failure in four Comrades Marathon runners ingesting the same electrolyte supplement</b>: <b>coincidence or causation?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200016&lng=en&nrm=iso&tlng=en OBJECTIVES: To evaluate common factors associated with the development of acute renal failure (ARF) in Comrades Marathon runners. METHODS: This was a retrospective case series of 4 runners hospitalised post-race with ARF in the 89 km 2010 Comrades Marathon. The outcome measures were incidence of analgesic use, levels of creatine phosphokinase (CPK) and degree of electrolyte supplementation (sodium, potassium, calcium and magnesium). RESULTS: The prevalence of ARF was 1/4 125 runners. They presented with rhabdomyolysis (mean admission CPK of 36 294 IU) and hyponatraemia (mean admission blood sodium level of 133 mEq/l). All had ingested an analgesic during the run (3 ingested a non-steroidal anti-inflammatory drug) and the same readily available anti-cramp electrolyte supplement. The average amount of supplemental sodium (452 mg), potassium (393 mg), calcium (330 mg) and magnesium (154 mg) ingested via this particular electrolyte supplement before and during the run did not exceed the recommended upper limits of daily intake. Three of the runners were Comrades Marathon novices. CONCLUSIONS: There is a continuing need to clarify the specific cluster variants that cause ARF in Comrades Marathon runners, as the risk factors appear to have evolved since the first case was described over 40 years ago. <![CDATA[<b>One-year post-primary antibody persistence and booster immune response to a DTaP-IPV//PRP~T vaccine (Pentaxim) given at 18 - 19 months of age in South African children primed at 6, 10 and 14 weeks of age with the same vaccine</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200017&lng=en&nrm=iso&tlng=en ABSTRACT OBJECTIVE: To assess the immunogenicity and safety of a pentavalent diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Hib polysaccharide-conjugate vaccine booster. DESIGN, SETTING AND PARTICIPANTS: A DTaP-IPV//PRP~T vaccine (Pentaxim, a Sanofi Pasteur AcXim family vaccine) was given to 182 healthy children in South Africa at 18 - 19 months of age following priming with the same vaccine plus a monovalent hepatitis B vaccine at 6, 10 and 14 weeks of age. OUTCOME MEASURES: Seroprotection (SP) and seroconversion (SC) rates, geometric mean titres (GMTs) and concentrations (GMCs) were assessed before, and 1 month after, the booster dose. Safety was assessed using parental reports. RESULTS: One month after primary vaccination, at least 94.3% of participants were seroprotected against tetanus (>0.01 IU/ml), diphtheria (>0.01 IU/ml), poliovirus (>8 1/dil) and Haemophilus influenzae type b (Hib) infection (>0.15 µg/ml). Before the booster dose, the SP rates ranged from 65.7% to 100%. One month after the booster dose, SP rates were 97.7% for Hib (anti-PRP titre >1.0 µg/ml), 100.0% for diphtheria (>0.1 IU/ml) and 100% for tetanus (>0.1 IU/ml) and poliovirus types 1, 2, 3 (>8 1/dil). At least 95.7% of participants had fourfold post-booster increases in anti-pertussis antibody titres. GMTs increased from 11.21 to 465.51 EU/ml and from 12.89 to 520.35 EU/ml for anti-PT and anti-FHA respectively. Anti-PRP GMT increased from 0.35 to 47.01 µg/ml. The DTaPIPV// PRP~T vaccine booster was well tolerated, with fever >39.0ºC in only 1.7% of participants. CONCLUSIONS: Antibody persistence following priming was satisfactory. The pentavalent DTaP-IPV//PRP~T vaccine booster was highly immunogenic and well tolerated. <![CDATA[<b>Adolescent experiences in a vaccine trial</b>: <b>a pilot study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200018&lng=en&nrm=iso&tlng=en ABSTRACT Little is known about how adolescents experience clinical trials. We assessed the experiences of South African adolescent participants in a clinical trial, employing semi-structured interviews to gather qualitative data on the experiences and effects of trial participation. Despite misunderstanding certain concepts regarding assent and trial processes subsequent to enrolment, participants reported positive experiences overall. Subjects' motivations for participation included: an ability to help others; receipt of healthcare; and free blood screening. Participants expressed fears associated with trial procedures, such as phlebotomy; however, these apprehensions diminished as the trial progressed. We found that conducting qualitative research within a trial site is feasible, and can provide insight into the uptake and acceptability of interventions. <![CDATA[<b>Assessing care for patients with TB/HIV/STI infections in a rural district in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200019&lng=en&nrm=iso&tlng=en ABSTRACT SETTING: Despite the prioritisation of TB, HIV and STI programmes in South Africa, service targets are not achieved, have had little effect, and the magnitude of the epidemics continues to escalate. OBJECTIVE: To report on a participatory quality improvement intervention designed to evaluate these priority programmes in primary health care (PHC) clinics in a rural district in KwaZulu-Natal. METHODS: A participatory quality improvement intervention with district health managers, PHC supervisors and researchers was used to modify a TB/HIV/STI audit tool for use in a rural area, conduct a district-wide clinic audit, assess performance, set targets and develop plans to address the problems identified. RESULTS: We highlight weaknesses in training and support of staff at PHC clinics, pharmaceutical and laboratory failures, and inadequate monitoring of patients as contributing to poor TB, HIV and STI service implementation. In the 25 facilities audited, 71% of the clinical staff had received no training in TB diagnosis and management, and 46% of the facilities were visited monthly by a PHC supervisor. Eighty per cent of the facilities experienced non-availability of essential drugs and supplies; polymerase chain reaction (PCR) results were not documented for 54% of specimens assessed, and the mean length of time between eligibility for ART and starting treatment was 47 days. CONCLUSION: Through a participatory approach, a TB/HIV/STI audit tool was successfully adapted and implemented in a rural district. It yielded information enabling managers to identify obstacles to TB, HIV and STI service implementation and develop plans to address these. The audit can be used by the district to monitor priority services at a primary level. <![CDATA[<b>Assessment of routine laboratory screening of adult psychiatric patients presenting to an emergency centre in Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200020&lng=en&nrm=iso&tlng=en ABSTRACT Our study suggests that routine laboratory screening provides no additional information to that obtained from a thorough history and clinical examination in patients at high risk of having an underlying medical cause of presenting psychotic symptoms. <![CDATA[<b>Safety and efficacy of procedural sedation and analgesia (PSA) conducted by medical officers in a level 1 hospital in Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200021&lng=en&nrm=iso&tlng=en ABSTRACT OBJECTIVES: To study the efficacy and safety of procedural sedation and analgesia (PSA) administered by medical officers (MOs) without formal anaesthetic training. METHODS: A retrospective descriptive study in the Emergency Department (ED) of False Bay Hospital (FBH), situated in the southern suburbs of the Cape Town Metro Health District. The study included all patients who received PSA at FBH between 1 March 2007 and 31 August 2009. Variables recorded included age, gender, physical status as determined by the American Society of Anesthesiologists (ASA status), procedure, fasting and intoxication status, PSA medications, adverse effects, rescue manoeuvres performed, if any, and time to discharge. Analysis was largely descriptive and clinical and demographic data are presented as means (standard deviations), medians, ranges and proportions as appropriate. Success of sedation and incidence of adverse effects are presented as proportions. RESULTS: Of 166 patients, 140 (84.3%) showed a good level of sedation, 14 (8.4%) were inadequately sedated, 5 (3%) were too deeply sedated but showed no signs of respiratory compromise, and 7 (4.2%) developed respiratory side-effects. Respiratory complications were treated with simple airway manoeuvres; no patient required intubation or experienced respiratory problems after waking up. There was no significant difference in the risk of adverse effects between the fasted and non-fasted groups. Mildly intoxicated patients who received PSA were at a higher risk of adverse effects. CONCLUSION: PSA can be administered safely by medical officers. Future research should expand on PSA research in this setting and focus on safety and patient satisfaction. <![CDATA[<b>Guideline for the treatment of myelodysplastic syndromes (MDS) in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742011001200022&lng=en&nrm=iso&tlng=en ABSTRACT INTRODUCTION: Myelodysplastic syndromes (MDS) encompass a heterogeneous group of clonal haematopoietic disorders characterised by chronic and progressive cytopenias resulting from ineffective haematopoiesis. Treatment is complicated by differences in disease mechanisms in different subgroups, variable clinical phenotypes and risk of progression to acute myeloid leukaemia. RATIONALE: Changes in disease classification, prognostic scoring systems, the availability of novel treatment options and the absence of South African guidelines for the diagnosis and management of these complex disorders underpinned the need for the development of these recommendations. METHODS: These recommendations are based on the opinion of a number of experts in the field from the laboratory as well as clinical settings and came from both the private and institutional academic environments. The most recent literature as well as available guidelines from other countries were discussed and debated at a number of different meetings held over a 2-year period. RESULTS: A comprehensive set of recommendations was developed focusing on risk stratification, supportive management and specific treatment. Novel agents and their indications are discussed and recommendations are made based on best available evidence and taking into account the availability of treatments in South Africa. CONCLUSION: Correct diagnosis, risk stratification and appropriate therapeutic choices are the cornerstones of success in the management of patients with MDS.