Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420120005&lang=en vol. 102 num. 5 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Less food for thought</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500001&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Neutron radiotherapy in South Africa</b>: <b>A different perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Neutron radiotherapy in South Africa</b>: <b>Neutron radiotherapy should continue</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500004&lng=en&nrm=iso&tlng=en <![CDATA[<b>Neutron radiotherapy in South Africa</b>: <b>Abratt reply</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Neutron radiotherapy in South Africa</b>: <b>Society comments</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Neutron radiotherapy</b>: <b>Abratt supported</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500007&lng=en&nrm=iso&tlng=en <![CDATA[<b>Traumatic rhabdomyolysis (crush syndrome) in the rural setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500008&lng=en&nrm=iso&tlng=en <![CDATA[<b>False-positive HIV DNA PCR testing of infants</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500009&lng=en&nrm=iso&tlng=en http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Bhisho corruption-busting now <i>the</i> national pilot</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Mabasa - one good SAMA man into the breach</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500012&lng=en&nrm=iso&tlng=en <![CDATA[<b>Old-age care - relatives 'at the mercy' of homes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500013&lng=en&nrm=iso&tlng=en <![CDATA[<b>Surgeons stitch it together</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Jean ('Dokkie') Nel (20/04/1941 - 08/09/2011)</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500015&lng=en&nrm=iso&tlng=en <![CDATA[<b>Emile Welgemoed</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500016&lng=en&nrm=iso&tlng=en <![CDATA[<b>The rational use of systemic isotretinoin in acne</b>: <b>A call for moderation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500017&lng=en&nrm=iso&tlng=en <![CDATA[<b>Osteoporosis, osteopenia and fracture risk</b>: <b>Widening the therapeutic horizons</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500018&lng=en&nrm=iso&tlng=en The majority of women with fragility fractures have osteopenia rather than osteoporosis. In post hoc analyses of trials of alendronate and strontium ranelate, women with osteopenia had significant reductions in the incidence of fragility fractures and specific therapies may be mandated in women with osteopenia, as well as those with osteoporosis. Increasing numbers of fractures of the spine and hip occur in very elderly women and men over the age of 80, but in this age group it is often considered too late in life to start long-term specific therapies. In clinical trials of very elderly women, risendronate significantly reduced vertebral fractures and strontium ranelate significantly reduced vertebral, non-vertebral and symptomatic clinical fractures within 1 year of starting treatment. The indications for specific therapies for osteopenia and osteoporosis, as well as other measures for the prevention and treatment of fragility fractures, urgently need to be increased and widened <![CDATA[<b>Scholarship success</b>: <b>Umthombo Youth Development Foundation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500019&lng=en&nrm=iso&tlng=en The majority of women with fragility fractures have osteopenia rather than osteoporosis. In post hoc analyses of trials of alendronate and strontium ranelate, women with osteopenia had significant reductions in the incidence of fragility fractures and specific therapies may be mandated in women with osteopenia, as well as those with osteoporosis. Increasing numbers of fractures of the spine and hip occur in very elderly women and men over the age of 80, but in this age group it is often considered too late in life to start long-term specific therapies. In clinical trials of very elderly women, risendronate significantly reduced vertebral fractures and strontium ranelate significantly reduced vertebral, non-vertebral and symptomatic clinical fractures within 1 year of starting treatment. The indications for specific therapies for osteopenia and osteoporosis, as well as other measures for the prevention and treatment of fragility fractures, urgently need to be increased and widened <![CDATA[<b>Obesity in childhood and adolescence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500020&lng=en&nrm=iso&tlng=en The majority of women with fragility fractures have osteopenia rather than osteoporosis. In post hoc analyses of trials of alendronate and strontium ranelate, women with osteopenia had significant reductions in the incidence of fragility fractures and specific therapies may be mandated in women with osteopenia, as well as those with osteoporosis. Increasing numbers of fractures of the spine and hip occur in very elderly women and men over the age of 80, but in this age group it is often considered too late in life to start long-term specific therapies. In clinical trials of very elderly women, risendronate significantly reduced vertebral fractures and strontium ranelate significantly reduced vertebral, non-vertebral and symptomatic clinical fractures within 1 year of starting treatment. The indications for specific therapies for osteopenia and osteoporosis, as well as other measures for the prevention and treatment of fragility fractures, urgently need to be increased and widened <![CDATA[<b>The efficacy of endoscopic therapy in bleeding peptic ulcer patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500021&lng=en&nrm=iso&tlng=en BACKGROUND: Endotherapy is the primary modality for the control of bleeding from peptic ulceration. OBJECTIVE: To assess the efficacy of endoscopic intervention for high-risk bleeding peptic ulcer disease and to benchmark our surgical and mortality rates. METHODS: Two hundred and twenty-seven patients with peptic ulcers stratified by Rockall and Forrest scores as being at high risk for rebleeding underwent therapeutic intervention (adrenalin injection) between January 2004 and December 2009. The median age of the patients was 57 years (range 19 - 87 years); 60% were males. RESULTS: Primary endoscopic haemostasis failed in 51/227 patients (22.5%); 18 patients (7.9%) required surgery for bleeding not controlled at initial or second endoscopy; and 29 patients (12.8%) died, 12 by day 3 and 17 by day 30. Fifteen patients, all with significant medical co-morbidity, died after successful primary endotherapy, and 4 died after surgery. Surgical patients required more blood (odds ratio (OR) 1.45, p=0.0001) than those not undergoing surgery, but had similar mortality. Rebleeding was the only predictor of death in patients who died by day 3 (OR 18.77). A high Rockall score was the only predictor of death by day 30 (OR1.98). CONCLUSION: The overall surgical and mortality rates were 7.9% and 12.8%, respectively. Over half the deaths resulted from medical co-morbidity, despite successful primary endotherapy. This finding is supported by the use of the Rockall score as a predictor of mortality at day 30. Improving the technical success of primary endoscopic haemostasis, currently 77.5%, has the potential to reduce rebleeding after primary endotherapy, a predictor of death at day 3 in this study <![CDATA[<b>Tricyclic antidepressant overdose necessitating ICU admission</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500022&lng=en&nrm=iso&tlng=en Tricyclic antidepressant (TCA) overdose necessitating intensive care unit (ICU) admission remains a significant problem in the Western Cape. In this retrospective study, we reviewed the course of life-threatening TCA overdose in our centre to identify potential prognostic indicators. TCA levels >1 000 ng/ml were associated with QT and QRS prolongation and convulsions. However, no single parameter predicted non-survival. The overall mortality of TCA overdose was very low. Our findings should encourage clinicians to offer medical care including ICU admission, if necessary, to patients with TCA overdose. <![CDATA[<b>The importance of carotid artery stiffness and increased intima-media thickness in obese children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500023&lng=en&nrm=iso&tlng=en BACKGROUND: Atherosclerosis that starts in childhood invariably advances during adulthood. AIM: We aimed to study the effect of obesity on main carotid artery intima-media thickness (CIMT) and arterial stiffness. MATERIAL AND METHODS: A total of 78 children were studied from October 2010 to February 2011. They were divided into obese (n=42, group 1) and normal (n=36, group 2). All children were subjected to physical examination, routine biochemical and haematological analysis, carotid ultrasonography and echocardiographic measurements. A detailed medical history was obtained. Body mass index (BMI) was calculated by dividing participants' weight in kilograms by the square of their height in metres. Stiffness index β was calculated using blood pressure and diameter of the systolic and diastolic artery. Intima-media thickness was also measured. RESULTS: The mean age of the obese and normal (control) groups was 10.12±2.12 years and 9.78±1.78 years, respectively. Weight, BMI, and systolic and diastolic blood pressure values were significantly higher in the obese group (all p<0.001). In terms of arterial stiffness and CIMT measurements, all parameters were higher in the obese group than the control (p<0.001). There was a relationship between the degree of obesity and CIMT or stiffness index p. In addition, dilatation and hypertrophy levels in the left ventricle were higher in obese children. CONCLUSIONS: Obese children with risk factors for multiple atherosclerosis could have increased CIMT dimensions and, consequently, should be screened for these risks. Ultrasonographic CIMT and arterial stiffness measurements can detect vascular damage at an early stage of development in children with cardiovascular risk factors. <![CDATA[<b>Aspects of birth history and outcome in diplegics attending specialised educational facilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500024&lng=en&nrm=iso&tlng=en AIM: We aimed to study functional mobility and visual performance in spastic diplegic children and adolescents attending specialised schools. METHODS: Spastic diplegia (SD) was confirmed by clinical examination. Birth and related history were added to explore relationships between SD, birth weight (BW) and duration of pregnancy. Place of birth, BW, gestational age (GA) and length of hospital stay were obtained by means of parental recall. Outcome measures included the functional mobility scale (FMS) and Beery tests of visuomotor integration (VMI) and visual perception (VIS). RESULTS: Forty participants were included (age 7 years 5 months - 19 years 6 months). Term and preterm births were almost equally represented. Functional mobility assessments showed that 20 were walking independently in school and community settings and the remainder used walking aids or wheelchairs. There were no significant correlations between BW or GA and outcomes (FMS, VIS-z-scores or VMI-z-scores) and z-scores were low. VIS scores correlated significantly with chronological age (p=0.024). There were also significant correlations between VIS and VMI scores and school grade appropriateness (p=0.004; p=0.027, respectively). INTERPRETATION: Both term and preterm births were represented, and outcomes were similar regardless of GA. VIS and VMI were affected in both groups. Half of the group used assistive mobility devices and three-quarters were delayed in terms of their educational level. These problems require specialised teaching strategies, appropriate resources and a school environment that caters for mobility limitations <![CDATA[<b>Piloting a trauma surveillance tool for primary healthcare emergency centres</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500025&lng=en&nrm=iso&tlng=en OBJECTIVE: We aimed to pilot a trauma surveillance tool for use in a primary healthcare emergency centre to provide a risk profile of injury patterns in Elsies River, Cape Town. METHODS: Healthcare workers completed a one-page questionnaire capturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days. RESULTS: Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence. CONCLUSION: Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities. <![CDATA[<b>Trauma unit workload at King Edward VIII Hospital, Durban, KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500026&lng=en&nrm=iso&tlng=en Each year, 70 000 South Africans are killed by trauma, and a further 3.5 million seek trauma care. We analysed 1 465 trauma patients at the regional-level King Edward VIII Hospital (KE8H) in eThekwini Municipality. Mean patient age was 29 years. Peaks in patient numbers were observed mid-month, at month-end, between 08h00 and 12h00 daily and on Saturday and Sunday nights. Most injuries occurred on roads, at informal settlements and at bars/shebeens. More than 44% of injuries had a violent cause. The pattern of presentation was more in line with a primary healthcare setting than a referral centre. Reliable and accurate injury trend information is required for effective strategies to curb South Africa's high injury mortality and morbidity rates. Epidemiological databases are needed, as well as safe, robust and ethical systems for collecting, collating, analysing and disseminating non-fatal injury-related data. <![CDATA[<b>Phadiatop testing in assessing predisposition to respiratory tract symptoms of allergic origin in athletes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500027&lng=en&nrm=iso&tlng=en OBJECTIVES: To validate the use of the Phadiatop test as a predictor of allergy-associated respiratory tract symptoms (RTS) in trail runners. METHODS: The incidence of self-reported RTS was documented in 16 runners for 31 days and related to the Phadiatop status and circulating markers of allergic responses (changes in concentrations of serum IgE (sIgE), differential leucocyte counts) at 8 time points before, during and after a 3-day 95 km trail run. RESULTS: Twelve (75%) athletes, of whom 7 (58%) were Phadiatop-positive, presented with post-race RTS. A peak sIgE concentration >100 IU/ml accompanied RTS in only 4 (57%) of the symptomatic Phadiatop-positive subjects. There was no significant difference between the eosinophil and basophil concentrations of the positive and negative groups (p>0.05). One Phadiatop-negative subject presented with RTS as well as a peak sIgE concentration >100 IU/ml. CONCLUSION: The Phadiatop assay does not accurately predict the development of post-exercise RTS of allergic origin in trail runners. <![CDATA[<b>Clinical practice guidelines for management of neuropathic pain</b>: <b>Expert panel recommendations for South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012000500028&lng=en&nrm=iso&tlng=en Neuropathic pain (NeuP) is challenging to diagnose and manage, despite ongoing improved understanding of the underlying mechanisms. Many patients do not respond satisfactorily to existing treatments. There are no published guidelines for diagnosis or management of NeuP in South Africa. A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for diagnosis and management of NeuP in South Africa. Following accurate diagnosis of NeuP, pregabalin, gabapentin, low-dose tricyclic antidepressants (e.g. amitriptyline) and serotonin norepinephrine reuptake inhibitors (duloxetine and venlafaxine) are all recommended as first-line options for the treatment of peripheral NeuP. If the response is insufficient after 2 - 4 weeks, the recommended next step is to switch to a different class, or combine different classes of agent. Opioids should be reserved for use later in the treatment pathway, if switching drugs and combination therapy fails. For central NeuP, pregabalin or amitriptyline are recommended as first-line agents. Companion treatments (cognitive behavioural therapy and physical therapy) should be administered as part of a multidisciplinary approach. Dorsal root entry zone rhizotomy (DREZ) is not recommended to treat NeuP. Given the large population of HIV/AIDS patients in South Africa, and the paucity of positive efficacy data for its management, research in the form of randomised controlled trials in painful HIV-associated sensory neuropathy (HIV-SN) must be prioritised in this country.