Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420140004&lang=en vol. 104 num. 4 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Neurosurgery in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Editor's Choice</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400002&lng=en&nrm=iso&tlng=en <![CDATA[<b>Hereditary haemorrhagic telangiectasia in North African and sub-Saharan patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400003&lng=en&nrm=iso&tlng=en <![CDATA[<b>Physician, heal thyself: Creative writing as a tool for self-care and enhancing care of others</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400004&lng=en&nrm=iso&tlng=en <![CDATA[<b>The neglected triple disease burden and interaction of helminths, HIV and tuberculosis: An opportunity for integrated action in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400005&lng=en&nrm=iso&tlng=en <![CDATA[<b>Palliative care: Definition of euthanasia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400006&lng=en&nrm=iso&tlng=en <![CDATA[<b>Palliative care: Preventing misconceptions</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400007&lng=en&nrm=iso&tlng=en <![CDATA[<b>WHIDMT: Rossouw and Howard blatantly miss the point</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400008&lng=en&nrm=iso&tlng=en <![CDATA[<b>Community service doctors 'slaves to the State' - court challenge</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400009&lng=en&nrm=iso&tlng=en <![CDATA[<b>E Cape health officials nearly turn TB victims into cash cows</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400010&lng=en&nrm=iso&tlng=en <![CDATA[<b>Quack remedy cast - 'We were pawns, not told, didn't know, won't say, don't care'</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400011&lng=en&nrm=iso&tlng=en <![CDATA[<b>Ivan James Nurick</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400012&lng=en&nrm=iso&tlng=en <![CDATA[<b>Hessel Utian</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400013&lng=en&nrm=iso&tlng=en <![CDATA[<b>A School of Struggle: Durban's Medical School and the Education of Black Doctors</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400014&lng=en&nrm=iso&tlng=en <![CDATA[<b>Diagnosis and management of Pompe disease</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400015&lng=en&nrm=iso&tlng=en Pompe disease (PD) is an autosomal-recessively inherited neuromuscular disease that, if not diagnosed and treated early, can be fatal. It can present from early infancy into adulthood. Due to the lack of acid a-glucosidase, there is progressive intracellular accumulation of glycogen. The severity of the disease is determined by age of onset, organ involvement including the degree of severity of muscle involvement, as well as rate of progression. PD is classified into two groups: infantile and late-onset, each having two subgroups. The need for two tests performed by separate methods (screening and confirmatory) is outlined. It is imperative to try to reduce the time to diagnosis and to recognise the possibilities of false-positive results. A multidisciplinary team approach to treatment of affected patients is optimum with, as team leader, a physician who has experience in managing this rare disorder. In this article, we present a brief overview of the disease and provide guidelines for diagnosis and management of this condition in South Africa. <![CDATA[<b>The Teddy Bear Clinic Constitutional Court case: Sexual conduct between adolescent consenting children aged under 16 years decriminalised and a moratorium on the reporting duties of doctors and others</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400016&lng=en&nrm=iso&tlng=en The Constitutional Court in the Teddy Bear Clinic appeal case held that the sections of the Sexual Offences Act that impose criminal liability for sexual offences on adolescent children under 16 years of age are invalid. The invalidity was suspended for 18 months to allow Parliament to correct the Act's defects. A moratorium was imposed on all investigations into, arrests in, prosecutions in, and criminal and ancillary proceedings regarding such section 15 and 16 offences. This includes the duty to report consensual sexual conduct between children under 16 years of age in terms of section 54 of the Act - pending Parliament's correction. However, it is submitted that the 'best interests of the child' principle in the Children's Act and the Constitution should guide all obligatory reporting situations involving sexual and other conduct of children, irrespective of whether they are adolescents under 16 years old or between 16 and 17 years old. <![CDATA[<b>The risks of gastrointestinal injury due to ingested magnetic beads</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400017&lng=en&nrm=iso&tlng=en Accidental ingestion of foreign bodies is a common problem in children. Magnetic bead toys are hazardous, having potentially lethal consequences if ingested. These magnets conglomerate in different segments of bowel, causing pressure necrosis, perforation and/or fistula formation anywhere along the gastrointestinal tract. A clinical diagnostic pitfall is that the appearance on the initial abdominal radiograph may be misinterpreted by the uninitiated as a single metallic object without any intervening intestinal wall. Symptoms do not occur until complications have developed, and even then, unless magnet ingestion is suspected, treatment may initially be mistakenly expectant, as with any other foreign body. After observing a case of multiple magnet ingestion that led to the rapid onset of small-bowel inter-loop fistulas and peritonitis, we attempted to reproduce the likely sequence of events in a laboratory setting using fresh, post-mortem porcine bowel as an animal model and placing magnetic toy beads within the bowel lumen. Pressure-induced perforation appeared extremely rapidly, replicating the operative findings in two of our cases. We propose that if magnet ingestion is suspected, early endoscopic or surgical retrieval is mandatory. Appropriate, rapid surgical intervention is indicated. Laparoscopy offers a minimally invasive therapeutic option. <![CDATA[<b>The safety of osteoporosis medication</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400018&lng=en&nrm=iso&tlng=en Osteoporosis is a common, costly and serious disease, which is still too often regarded as an inevitable part of the normal ageing process and therefore sub-optimally treated, especially in the elderly - in fact, only two out of every 10 patients who sustain a hip fracture receive any form of assessment or prophylactic therapy for osteoporosis. One out of five patients die within 1 year after a hip fracture, and <50% are capable of leading an independent life. Yet very effective anti-fracture therapy, capable of reducing fracture risk by 35 - 60%, is available. A number of publications have recently questioned the safety of drugs routinely used to treat patients with osteoporosis. This paper attempts to put the situation into perspective and expresses the National Osteoporosis Foundation of South Africa's view on the safety of these drugs. Their efficacy in preventing skeletal fractures and their cost-effectiveness are not addressed in any detail. The paper emphasises the fact that all osteoporosis medications have side-effects, some of which are potentially life-threatening. <![CDATA[<b>Acute intermittent porphyria presenting as progressive muscular atrophy in a young black man</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400019&lng=en&nrm=iso&tlng=en Acute intermittent porphyria, the most common porphyria affecting the nervous system, typically presents with neurovisceral crises followed by a motor neuropathy. We describe a 23-year-old black South African man presenting with a progressive stuttering, lower motor neuron syndrome developing over months. He had not experienced pain or neuropsychiatric symptoms. One year after symptom onset he was bed-bound with a flaccid quadriparesis. There was marked amyotrophy, but without fasciculations. Sensation was intact apart from a hypo-aesthetic patch over the thigh. Electrophysiological investigations showed an active motor axonopathy. Urinary porphyrins, δ-aminolaevulinic acid and porphobilinogen were elevated. Mutation analysis revealed the c445C>T (R149X) mutation in the porphobilinogen deaminase gene. The patient responded dramatically to haem arginate and could walk with assistance 2 weeks later. We identified the first molecularly confirmed acute intermittent porphyria in a black South African. The clinical presentation mimicked a progressive lower motor neuron syndrome. <![CDATA[<b>The neurological manifestations of the acute porphyrias</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400020&lng=en&nrm=iso&tlng=en Acute intermittent porphyria, the most common porphyria affecting the nervous system, typically presents with neurovisceral crises followed by a motor neuropathy. We describe a 23-year-old black South African man presenting with a progressive stuttering, lower motor neuron syndrome developing over months. He had not experienced pain or neuropsychiatric symptoms. One year after symptom onset he was bed-bound with a flaccid quadriparesis. There was marked amyotrophy, but without fasciculations. Sensation was intact apart from a hypo-aesthetic patch over the thigh. Electrophysiological investigations showed an active motor axonopathy. Urinary porphyrins, δ-aminolaevulinic acid and porphobilinogen were elevated. Mutation analysis revealed the c445C>T (R149X) mutation in the porphobilinogen deaminase gene. The patient responded dramatically to haem arginate and could walk with assistance 2 weeks later. We identified the first molecularly confirmed acute intermittent porphyria in a black South African. The clinical presentation mimicked a progressive lower motor neuron syndrome. <![CDATA[<b>Increased visibility and discoverability of South African health-related research</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400021&lng=en&nrm=iso&tlng=en Acute intermittent porphyria, the most common porphyria affecting the nervous system, typically presents with neurovisceral crises followed by a motor neuropathy. We describe a 23-year-old black South African man presenting with a progressive stuttering, lower motor neuron syndrome developing over months. He had not experienced pain or neuropsychiatric symptoms. One year after symptom onset he was bed-bound with a flaccid quadriparesis. There was marked amyotrophy, but without fasciculations. Sensation was intact apart from a hypo-aesthetic patch over the thigh. Electrophysiological investigations showed an active motor axonopathy. Urinary porphyrins, δ-aminolaevulinic acid and porphobilinogen were elevated. Mutation analysis revealed the c445C>T (R149X) mutation in the porphobilinogen deaminase gene. The patient responded dramatically to haem arginate and could walk with assistance 2 weeks later. We identified the first molecularly confirmed acute intermittent porphyria in a black South African. The clinical presentation mimicked a progressive lower motor neuron syndrome. <![CDATA[<b>High prevalence of cisplatin-induced ototoxicity in Cape Town, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400022&lng=en&nrm=iso&tlng=en BACKGROUND: Cisplatin is administered as the first-line treatment of soft-tissue cancers. It has a reported cure rate of up to 85%, but is associated with a high incidence of ototoxicity, characterised by irreversible bilateral hearing loss and affecting 23 - 50% of adults who receive the drug. OBJECTIVE: To determine the incidence of cisplatin-induced ototoxicity at Groote Schuur Hospital (GSH), Cape Town, South Africa. METHODS: A retrospective cross-sectional study of cisplatin-receiving cancer patients attending GSH between January 2006 and August 2011. RESULTS: A total of 377 patients were recorded as receiving cisplatin therapy during the study period. A 300% increase in new cisplatin-receiving patients receiving audiological monitoring was observed between 2006 and 2010. However, only patients with all clinical data as well as baseline and follow-up audiometric analyses were investigated. One hundred and seven such patients were identified, 55.1% of whom developed cisplatin-induced ototoxicity while receiving high-dose (>60 mg/m²) cisplatin treatment. Higher cumulative cisplatin dosages were associated with development of significant hearing loss (p=0.027). The odds of developing cisplatin-induced hearing loss were elevated for patients with head and neck tumours and lymphoma (p=0.0465 and p=0.0563, respectively) and were significantly lower for those with reproductive cancers (p=0.0371). CONCLUSION: Comprehensive audiological monitoring should be available for every patient during cisplatin treatment to minimise the development of disabling hearing loss. <![CDATA[<b>Angiotensin converting enzyme inhibitors v. angiotensin receptor blockers in the management of hypertension: A funder's perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400023&lng=en&nrm=iso&tlng=en BACKGROUND: Hypertension poses a huge financial risk to any funder/medical aid, including the risk-mitigating strategies provided by the managed care organisations that are required to manage patients with hypertension. The South African Hypertension Guideline states that the choice of therapy - an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) - should be based on cost and tolerability. OBJECTIVE: To assess the costs of ACEIs v. ARBs in the management of hypertensive patients and the prevention of cardiovascular complications for a private medical aid scheme in South Africa. METHODS: A Phase IV observational, retrospective cohort study of over 480 000 beneficiaries between 2010 and 2011 was undertaken. Hypertensive patients were identified by their chronic medication authorisation and were categorised into three groups: ACEI, ARB and combined groups. A cost-benefit analysis was performed on the claims data, comparing the input costs in rand against the downstream costs using analysis of variance. RESULTS: Data from 28 165 patients were included in the study. Based on the health economic analysis that was performed, there was no statistically significant difference in the input costs between the ACEI and the ARB groups. However, a statistically significant reduction in the downstream costs was observed in the ACEI group v. the ARB and combined groups (p<0.0001). CONCLUSION: It is more cost beneficial to treat chronic hypertensive patients with an ACEI than ARBs in preventing cardiovascular-related complications. It is recommended that managed care companies continue recommending ACEIs rather than ARBs in the treatment of hypertensive patients. <![CDATA[<b>Mammographic screening for breast cancer in a resource-restricted environment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400024&lng=en&nrm=iso&tlng=en BACKGROUND: Mammographie screening is carried out at public sector hospitals as part of clinical practice. OBJECTIVE: We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa. METHODS: All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients &gt;40 years of age and mammograms were read by experienced breast surgeons. Patients with BIRADS 3 and 4 lesions were recalled for short-term follow-up, further imaging or tissue acquisition. Patients with BIRADS 5 lesions were recalled for tissue acquisition. Further imaging, method of tissue acquisition, histology results and use of neo-adjuvant therapy were also recorded. RESULTS: Of 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were <10 mm in size. Of the invasive cancers, 40% were node-positive. CONCLUSION: The cancer diagnosis rate indicates a high breast cancer load in an urbanised population. <![CDATA[<b>Results of a pilot programme of mammographic breast cancer screening in the Western Cape</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400025&lng=en&nrm=iso&tlng=en BACKGROUND: Mammographic screening programmes are now established in developing countries. We present an analysis of the first screening programme in sub-Saharan Africa. METHODS: Women aged >40 years were identified at three primary healthcare centres in the Western Cape Province, South Africa, and after giving informed consent underwent mammography at a mobile unit. After a single reading, patients with American College of Radiology Breast Imaging Reporting and Data System (BIRADS) 3 - 5 lesions were referred to a tertiary centre for further management. RESULTS: Between 1 February 2011 and 31 August 2012, 2 712 screening mammograms were performed. A total of 261 screening mammograms were reported as BIRADS 3 - 5 (recall rate 9.6%). Upon review of the 250 available screening mammograms, 58 (23%) were rated benign or no abnormalities (BIRADS 1 and 2) and no further action was taken. In 32 women, tissue was acquired (biopsy rate for the series 1.2%); 10 cancers were diagnosed (biopsy malignancy rate 31%). For the entire series of 2 712 screening mammograms, the cancer diagnosis rate was 3.7/1 000 examinations. Of 10 cancers diagnosed at screening, 5 were TNM clinical stage 0, 2 stage I and 3 stage II. CONCLUSION: The low cancer detection rate achieved, and the technical and multiple administrative problems experienced do not justify installation of a screening programme using the model utilised in this series. <![CDATA[<b>Community v. non-community assault among adults in Khayelitsha, Western Cape, South Africa: A case count and comparison of injury severity</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400026&lng=en&nrm=iso&tlng=en BACKGROUND: Community assault (CA) or vigilantism is widespread in the township of Khayelitsha, Cape Town, South Africa (SA). Anecdotal evidence suggests that victims of CA are worse off than other assault cases. However, scientific data on the rate and severity of CA cases are lacking for SA. OBJECTIVE: To contribute to CA prevention and management strategies by estimating the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases. METHODS: We studied four healthcare centres in Khayelitsha during July - December 2012. A consecutive case series was conducted to capture all CA cases during this period. A retrospective folder review was performed on all cases of CA and on a control group of non-CA cases to compare injury severity and estimate survival probability. RESULTS: A total of 148 adult cases of CA occurred (case rate 1.1/1 000 person-years) over the study period. The Injury Severity Scores (ISSs) in the CA group were significantly higher than in the non-CA group (p<0.001), with a median (interquartile range) ISS of 3 (2 - 6) in CA cases v. 1 (1 - 2) in non-CA cases. Comparison between the CA v. non-CA groups showed that a Glasgow Coma Scale <15 (20.1% v. 5.4%, respectively), referral to the tertiary hospital (33.8% v. 22.6%, respectively), and crush syndrome (25.7% v. 0.0%, respectively) were all more common in CA cases. Survival probabilities were similar in both groups (CA v. non-CA 99.2% v. 99.3%, respectively). CONCLUSION: The rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases. <![CDATA[<b>Self-induction of abortion among women accessing second-trimester abortion services in the public sector, Western Cape Province, South Africa: An exploratory study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400027&lng=en&nrm=iso&tlng=en BACKGROUND: Despite South Africa's liberal abortion law permitting abortion on request in the first trimester and under restricted conditions for second-trimester pregnancies, the practice of unsafe self-induced abortion persists. However, the prevalence of this practice, the methods used and the reasons behind it are relatively under-researched. As part of a larger study seeking to improve abortion services in the Western Cape Province, we explored reports of prior attempts to self-induce abortion among women undergoing legal second-trimester abortion. OBJECTIVE: To describe the prevalence and methods of and factors related to unsuccessful attempts at self-induction of abortion by women presenting without complications and seeking second-trimester abortion at public health facilities in the Western Cape. METHODS: In a cross-sectional study from April to August 2010, 194 consenting women undergoing second-trimester abortion were interviewed by trained fieldworkers using structured questionnaires at four public sector facilities near Cape Town. RESULTS: Thirty-four women (17.5%; 95% confidence interval 12.7 - 23.4) reported an unsuccessful attempt to self-induce abortion during the current pregnancy before going to a facility for second-trimester abortion. No factors were significantly associated with self-induction, but a relatively high proportion of this small sample were unemployed and spoke an indigenous African language at home. A readily available herbal product called Stametta was most commonly used; other methods included taking tablets bought from unlicensed providers and using other herbal remedies. No use of physical methods was reported. CONCLUSION: The prevalence of unsafe self-induction of abortion is relatively high in the Western Cape. Efforts to inform women in the community about the availability of free services in the public sector and to educate them about the dangers of self-induction and unsafe providers should be strengthened to help address this public health issue. <![CDATA[<b>Clinicians ignore best practice guidelines: Prospective audit of cardiac injury marker ordering in patients with chest pain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400028&lng=en&nrm=iso&tlng=en BACKGROUND: Chest pain is a frequent presenting symptom and is a diagnostic challenge. Recent recommendations state that high-sensitivity cardiac troponin assays are the only biochemical test required in the diagnosis of acute coronary syndrome (ACS) and that other biomarkers such as myoglobin or creatine kinase (CK)-MB isoform are not indicated. OBJECTIVE: To establish whether clinician ordering in the setting of suspected ACS was in keeping with recent recommendations. METHODS: A prospective audit was undertaken of all requests for cardiac troponin I (cTnI) and CK-MB received at a large tertiary hospital in Durban, South Africa, during a 20-day period in December 2012. RESULTS: A total of 193 cardiac marker requests were received: 12 (6.2%) requests were for cTnI alone; 8 (4.1%) were for CK-MB alone; and the remaining 173 (89.7%) were for both cTnI and CK-MB. Therefore, a total of 181 (93.8%) incorrect requests were received during this period. A total of 103 (53.4%) patients had values below the cut-off point of 40 ng/l for cTnI, i.e. ACS was ruled out. Of these, 15 had CK-MB values above the reference interval. A total of 12 (6.2%) patients had cTnI values >500 ng/l, i.e. ACS was ruled in; 33.3% of this group had normal CK-MB values. CONCLUSION: Ordering patterns in the setting of ACS did not reflect current recommendations and were wasteful and potentially dangerous. <![CDATA[<b>Hepatitis B and HIV co-infection in pregnant women: Indication for routine antenatal hepatitis B virus screening in a high HIV prevalence setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400029&lng=en&nrm=iso&tlng=en BACKGROUND: Sub-Saharan Africa is endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections. HBV/HIV co-infection in women of reproductive age is of clinical and public health importance because these women constitute a significant reservoir for horizontal and perinatal HBV transmission. Childhood HBV vaccination from 6 weeks of age protects most children against chronic HBV infection. However, infants born to HBV/HIV co-infected women are more likely to be infected perinatally, with an increased risk of chronic hepatitis, than infants born to HBV mono-infected women. OBJECTIVE: The aim of our study was to establish the prevalence of HBV infection and HBV/HIV co-infection in pregnant women in KwaZulu-Natal, South Africa, to inform antenatal HBV screening and childhood immunisation policies in South Africa. METHODS: Stored plasma specimens obtained from 570 pregnant women were tested for hepatitis B surface antigen (HBsAg) and HBV infectivity, as characterised by the presence of hepatitis B e antigen (HBeAg) and/or HBV DNA load. RESULTS: The antenatal HIV prevalence and HBsAg prevalence in this study were 41.6% and 5.3% (95% confidence interval (CI) 3.4 - 7.1), respectively. Overall, 3.1% (95% CI 1.7 - 4.6) of pregnant women were HBV/HIV co-infected, with HBeAg positivity and the HBV DNA load being significantly higher in co-infected women. CONCLUSION: We report a 5.3% HBV prevalence and a 3.1% HBV/HIV co-infection prevalence in pregnant women from this HIV-endemic region. Routine antenatal HBV screening will allow early identification of neonates who require HBV active-passive immunoprophylaxis at birth. This strategy, together with antenatal antiretrovirals, will reduce the risk of perinatal HBV transmission, especially in high-risk HBV/ HIV co-infected pregnant women. <![CDATA[<b>Transition from child- to adult-orientated care for children with long-term health conditions: A process, not an event</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400030&lng=en&nrm=iso&tlng=en This month's CME component contains the second of a two-part series of continuing medical education articles on various aspects of spina bifida, with the focus on some of the longer-term management issues such as hydrocephalus and limb deformity, as well as quality of life. <![CDATA[<b>The orthopaedic management of myelomeningocele</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400031&lng=en&nrm=iso&tlng=en Despite improvement in antenatal care and screening, myelomeningocele remains the most common congenital birth defect, with a reported incidence of 1 - 2.5/1 000 patients in the Western Cape, South Africa. The multidisciplinary team involved in the Spinal Defects Clinic at Red Cross War Memorial Children's Hospital, Cape Town, South Africa consists of neurosurgeons, urologists, orthopaedic surgeons, stomatherapists and orthotists. Orthopaedic surgeons have a protean involvement in the management of myelomeningocele <![CDATA[<b>Hydrocephalus in spina bifida</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400032&lng=en&nrm=iso&tlng=en Hydrocephalus is one of the most common complications of spinal dysraphism. Although few patients require cerebrospinal fluid diversion immediately at birth or within the first few days of life, most patients with myelomeningocele, which comprises the most prevalent, clinically significant form of spina bifida, will eventually need surgical treatment for hydrocephalus at some point following closure of the spinal defect. Furthermore, symptomatic hydrocephalus needs to be dealt with timeously, as these patients not only face the usual ill-effects of raised intracranial pressure (ICP), but also have an increased risk of breakdown of the myelomeningocele repair. Poorly treated ICP may also cause the Chiari II malformation to become symptomatic <![CDATA[<b>Occult spinal dysraphism</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400033&lng=en&nrm=iso&tlng=en Occult spinal dysraphism refers to a diverse group of congenital abnormalities resulting from varying degrees of disordered neuro-embryogenesis. Several terms have been used to describe these conditions, including spina bifida occulta and closed neural tube defects <![CDATA[<b>Beyond the operating theatre: Long-term quality of life in spina bifida</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400034&lng=en&nrm=iso&tlng=en Long-term quality of life of a person born with spina bifida, as in any disability, is dependent on the challenges of that disability being recognised, met and overcome, to prevent patients becoming handicapped <![CDATA[<b>The International Federation for Spina Bifida and Hydrocephalus: Priorities in developing countries</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742014000400035&lng=en&nrm=iso&tlng=en The International Federation for Spina Bifida and Hydrocephalus (IF) is the global umbrella organisation for national and regional spina bifida and hydrocephalus associations. Currently, IF has 50 members, representing people with spina bifida and hydrocephalus from 46 countries. IF's mission is to increase the quality of life of persons living with disabilities associated with these conditions and to decrease the incidence of these impairments by primary prevention. IF members share this mission and work locally to achieve these goals