Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420120012&lang=pt vol. 102 num. 12 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Signing off after two decades at the helm</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200001&lng=pt&nrm=iso&tlng=pt http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Professor Cyril Karabus</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Lack of communication kills</b>: <b>Botched circumcisions in the Eastern Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Sun protection factor of South African-tested sunscreens</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Speaking freely about our private health system</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>RWOPS abuse - Government's had enough</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Pink - the colour of hope for uninsured women</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>NHI will put GPs 'back at the centre' - Motsoaledi</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Indians have narrower blood vessels - international expert</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200010&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>HMPG's long-time torch bearers sally forth</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200011&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>I N 'Solly' Marks</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200012&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Moral perspectives on stimulant use by healthy students</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200013&lng=pt&nrm=iso&tlng=pt The quest for enhancement has been part of human culture for thousands of years. Progress in scientific developments and especially in medical science has enabled previously unimaginable advances to be employed in endeavours to improve human functioning in its various forms. Previously enhancement focused on aspects such as prolonging life, improving the immune system or cosmetic enhancements. Cognitive enhancement is currently receiving substantial attention. The use of stimulants such as methylphenidate, especially among students at tertiary institutions aiming to enhance their cognitive abilities, has raised concerns, ranging from safety issues and the risk of drug abuse to moral issues relating to the broader context of enhancement. We consider arguments used to debate both the promotion of enhancement therapies and the restriction and possibly even prevention of their use <![CDATA[<b>Herbal medicine, randomised controlled trials and global core competencies</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200014&lng=pt&nrm=iso&tlng=pt Despite widespread use, few empirical data on the efficacy of traditional medicine are available. We conducted systematic reviews of eight widely used African medicines and identified only one plant, Pelargonium sidoides, which has been extensively studied (including in a Cochrane systematic review). To address the need for rigorous science to underpin traditional medicine claims, the South African Herbal Science and Medicine Institute at the University of Western Cape launched the Multi-disciplinary University Traditional Health Initiative (MUTHI) in 2011. The European Union-funded initiative aims to build sustainable research capacity on plants for better public health in Africa. A 2011 needs analysis of clinicians and scientists from 14 African countries confirmed a lack of clinical trial methodology, knowledge and experience. In response, MUTHI deliverables include annual clinical trial methodology workshops in host countries and development of e-learning modules. The initiative provides a unique opportunity for developing African capacity to discover new medicinal products <![CDATA[<b>Phased implementation of screening for cryptococcal disease in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200015&lng=pt&nrm=iso&tlng=pt Despite widespread use, few empirical data on the efficacy of traditional medicine are available. We conducted systematic reviews of eight widely used African medicines and identified only one plant, Pelargonium sidoides, which has been extensively studied (including in a Cochrane systematic review). To address the need for rigorous science to underpin traditional medicine claims, the South African Herbal Science and Medicine Institute at the University of Western Cape launched the Multi-disciplinary University Traditional Health Initiative (MUTHI) in 2011. The European Union-funded initiative aims to build sustainable research capacity on plants for better public health in Africa. A 2011 needs analysis of clinicians and scientists from 14 African countries confirmed a lack of clinical trial methodology, knowledge and experience. In response, MUTHI deliverables include annual clinical trial methodology workshops in host countries and development of e-learning modules. The initiative provides a unique opportunity for developing African capacity to discover new medicinal products <![CDATA[<b>Gender differences in public perceptions on National Health Insurance</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200016&lng=pt&nrm=iso&tlng=pt BACKGROUND: Implementation of National Health Insurance (NHI) commenced recently. With the promise of addressing drastic inequalities in the health sector, NHI has the potential to positively transform the health system. In particular, NHI could have a significant positive impact on females, who are disadvantaged under the current system, with higher rates of poor health and lower rates of medical scheme membership compared with males. Despite NHI's transformative potential, however, the public discourse on NHI as portrayed in the media suggests that it is an unpopular policy. The evidence presented in this paper is to the contrary. OBJECTIVES: To assess the general public's opinion on NHI and to explore gender differences in perceptions. METHODS: This paper reports on findings from a 2010 cross-sectional nationally representative survey of the South African population that assessed social attitudes, including perceptions on NHI. Sex-disaggregated data were analysed in SPSS version 20. RESULTS AND CONCLUSIONS: There is broad public acceptance of NHI, indicating that an overwhelming majority of South Africans would prefer an NHI system to the current two-tiered system. Support for NHI has increased since similar studies in 2005 and 2008, with the simultaneous growth of public discourse on the policy. More females than males support NHI, reflecting the potential of the NHI system to have a positive impact on gender equality and the health of women and girls. <![CDATA[<b>Rapidly progressive post-transplant lymphoproliferative disease following withdrawal of sirolimus</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200017&lng=pt&nrm=iso&tlng=pt Sirolimus, a potent inhibitor of B- and T-cell activation, is a commonly used immunosuppressant after renal transplantation. Withdrawal of sirolimus from the immunosuppression regimen may reduce B-cell surveillance. We present a case of rapidly progressive central nervous system (CNS) polymorphic Epstein-Barr virus (EBV)-related post-transplant lymphoproliferative disorder following the withdrawal of sirolimus <![CDATA[<b>Avoid adding insult to injury - correct management of sick female endurance athletes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200018&lng=pt&nrm=iso&tlng=pt OBJECTIVES: To evaluate the efficacy of Ringer's lactate, isotonic saline and hypertonic saline on the clinical and biochemical recovery of athletes with exercise-associated hyponatraemic encephalopathy caused by fluid overload. METHODS: We retrospectively reviewed serial blood sodium concentrations (Na+) and qualitative signs of recovery and time to recovery in two healthy menstruant females hospitalised with dilutional exercise-associated hyponatraemic encephalopathy after withdrawal from the 2011 Comrades Marathon (89 km) and Argus Cycle Tour (109 km). RESULTS: Improvements in blood Na+ did not occur with intravenous administration of Ringer's lactate solution, but did occur with administration of isotonic and hypertonic saline. Qualitative improvements in mental status were not quantitatively related to the biochemical value of blood Na+ or subsequent return to normonatraemia. CONCLUSIONS: Hyponatraemia should be suspected in all female athletes presenting to the medical area of endurance races with vomiting, altered mental status and a history of high fluid intake. If a diagnosis of exercise-associated hyponatraemia with cerebral encephalopathy is confirmed, the treatment of choice is administration of an intravenous bolus of hypertonic saline. Administration of Ringer's lactate should be discouraged, as this does not correct Na+ and appears to delay recovery. <![CDATA[<b>Timing of antiretroviral therapy initiation in adults with HIV-associated tuberculosis</b>: <b>Outcomes of therapy in an urban hospital in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200019&lng=pt&nrm=iso&tlng=pt BACKGROUND: HIV-associated tuberculosis (TB) is common in South Africa. The optimal time for initiating antiretroviral therapy (ART) in co-infected patients is a clinical challenge. AIM: We aimed to compare clinical outcomes of patients with HIV-associated TB who commenced ART at different stages of TB therapy. METHODS: A retrospective chart review was conducted of 458 patients who initiated ART at <28 days (immediate), 29 - 56 days (early) and &gt;57 days (delayed) after commencing TB therapy, and clinical outcomes after 6 months of ART were compared. RESULTS: There was a higher mortality in the immediate group, although this was not significant. Renal impairment (hazard ratio (HR) 2.5; 95% confidence interval (CI) 1.3 - 4.9; p=0.004) and inpatient ART initiation (HR 3.7; 95% CI 1.6 - 8.2; p=0.001) were risk factors for HIV-associated TB mortality. A baseline haemoglobin concentration &gt;10 g/dl (HR 0.2; 95% CI 0.1 - 0.6; p=0.003), extrapulmonary as opposed to pulmonary TB (PTB) (HR 0.3; 95% CI 0.1 - 0.7; p=0.005) and extrapulmonary plus PTB as opposed to PTB (HR 0.3, 95% CI 0.1 - 0.6; p=0.002) were significantly associated with decreased mortality. CONCLUSION: The timing of initiation of ART after commencing TB therapy was not significantly associated with increased mortality or survival. Patients with more advanced disease were more likely to die. Early HIV testing and ART initiation is recommended to decrease mortality. <![CDATA[<b>Antiretroviral treatment uptake in patients with HIV-associated TB attending co-located TB and ART services</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200020&lng=pt&nrm=iso&tlng=pt BACKGROUND: Delivery of integrated care for patients with HIV-associated TB is challenging. We assessed the uptake and timing of antiretroviral treatment (ART) among eligible patients attending a primary care service with co-located ART and TB clinics. METHODS: In a retrospective cohort study, all HIV-associated TB patients (&gt;18 years old) who commenced TB treatment in 2010 were included. Data were analysed using basic descriptive statistics and log-binomial regression analysis. RESULTS: Of a total of 497 patients diagnosed with HIV-associated TB, 274 were eligible to start ART for the first time (median CD4 count, 159 cells/ul). ART was started during TB treatment by 220 (80.3%) patients. Among the 54 (19.7%) who did not start ART, 23 (42.6%) were either lost to follow-up (LTFU) or died before enrolling for ART; 12 (22.2%) were either LTFU or died after enrolling but before starting ART; 5 (9.3%) were transferred out; and 14 (25.9%) only started ART after completion of TB treatment. The median delay between starting TB treatment and starting ART was 51 days (IQR 29 - 77). Overall, only 58.6% of patients started ART within 8 weeks of TB treatment, and 12.7% of those with CD4 counts <50 cells/ul started ART within 2 weeks. CONCLUSIONS: In a setting with co-located TB and ART clinics, delays to starting ART were substantial, and one-fifth of eligible patients did not start ART during TB treatment. Co-location of services alone is insufficient to permit timely initiation of ART; further measures need to be implemented to facilitate integrated treatment. <![CDATA[<b>Antenatal depression and its risk factors</b>: <b>An urban prevalence study in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742012001200021&lng=pt&nrm=iso&tlng=pt OBJECTIVE: There has been a recent increase in interest in antenatal depression, which is associated with adverse obstetric, neonatal and maternal outcomes and has been overlooked and underdiagnosed. Local data on prevalence and risk factors are lacking. AIM: To determine the prevalence and risk factors associated with antenatal depressive symptoms in a KwaZulu-Natal population. METHODS: The Edinburgh Postnatal Depression Scale and a socio-demographic questionnaire in English and isiZulu were administered to 387 antenatal outpatients at King Edward VIII Hospital in Durban. RESULTS: Of the participants, 149 (38.5%) suffered from depression and 38.3% had thought of harming themselves in the preceding 7 days. Risk factors for depression included HIV seropositivity (p=0.02), a prior history of depression (p=0.02), recent thoughts of self-harm (p<0.000), single marital status (p=0.04) and unplanned pregnancy (p=0.01). CONCLUSION: The high prevalence of antenatal depressive symptoms and thoughts of deliberate self-harm supports a policy of routine screening for antenatal depression in South Africa, especially in HIV-seropositive women.