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Record No. 10062 Record ID 010062 Publication type Journal Article Title Mechanisms of Oedema: the Minor Role of Hypoalbuminaemia Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Steyl, C.; Zyl-Smit, R. V. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(1) Pages 57-59 Language English Descriptor Hypoalbuminemia; Dehydration Descriptor-Geographic South Africa Abstract Objectives: Seriously ill patients often suffer from disorders of salt and water balance and present with clinical signs of either dehydration or oedema. The relationship of hypoalbuminaemia to oedema is complex and controversial and formed the central issue of this study. Design: Prospective study Setting: Medical wards of New Somerset Secondary Hospital, November 2004. Subjects: 50 patients admitted consecutively to the medical wards at New Somerset Hospital were evaluated. 26 males and 24 females participated. Outcome measures:. An attempt was made to correlate causes of salt and water imbalance with the clinical assessment of volume status, oedema formation, nutritional state and serum albumin levels. Results: Hypoalbuminaemia was not related to oedema in this study. From the 24 patients with serum albumin below 30 g/L, only 6 had oedema. These patients all had other abnormalities which could have resulted in the oedema: notably primary salt retention by failing kidneys, cor pulmonale and malignan- cy. None of the patients with serum albumin levels below 15 g/L had any signs of oedema. The combined insult of a chronic inflammatory disease and malnutrition had a marked effect on serum albumin levels. Conclusion: Significant hypoalbuminaemia was present in a substantial portion of the patients included in this study, yet oedema was detected infrequently and generally had an easily identifiable cause not related to low albumin levels. Most patients with hypoalbuminaemia presented with normal or positive water balance. This study supports the notion that hypoalbuminaemia is infrequently associated with oedema and plays a minor role in its formation Electronic Access :  Full Text-1

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Record No. 10061 Record ID 010061 Publication type Journal Article Title Rural Origin Health Science Students in South African Universities Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Tumbo, J. M.; Couper, I. D.; Hugo, J. F. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(1) Pages 54-56, fig., tab. Language English Descriptor Rural Health Services; Students; Education, Public Health Professional; Medically Underserved Area Descriptor-Geographic South Africa Abstract Background. Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-topopulation ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. Objective. To determine the proportion of rural- origin students at all medical schools in South Africa. Design. A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3). Results. Of the 7 358 students, 4 341 (59) were from cities, 1 107 (15) from towns and 1 910 (26) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine - 27.4, physiotherapy - 22.4, occupational therapy - 26.7, and dentistry - 24.8. Conclusion. The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas. Electronic Access :  Full Text-1

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Record No. 10060 Record ID 010060 Publication type Journal Article Title Procedure for Prolapsed Haemorrhoids Versus Excisional Haemorrhoidectomy: a Systematic Review and Meta-Analysis Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Madiba, T. E.; Esterhuizen, T. M.; Thomson, S. R. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(1) Pages 43-53, fig., tab. Language English Descriptor Hemorrhoids-surgery; Surgical Procedures, Operative Review Descriptor-Geographic South Africa Abstract Background. The procedure for prolapse and haemorrhoids (PPH) was introduced to address the postoperative pain following excisional haemorrhoidectomy (EH). Objective. To assess the efficacy of both procedures to treat haemorrhoids. Data sources. Literature review using MEDLINE. Articles addressing PPH and EH were included. Study selection. RCTs comparing EH and PPH with =20 patients. Data extraction. Primary endpoints were pain, operative time, hospital stay, satisfaction with procedure and time to return to normal activity. Secondary endpoints such as recurrence and complications were collated for descriptive analysis. A metaanalysis was performed using the random effects model on studies reporting `mean' and SD or SEM. Data synthesis. PPH was associated with less postoperative pain, less operative time, shorter hospital stay and earlier return to normal activities compared with EH. There appears to be no significant difference in satisfaction with the procedure. There was no difference between the two procedures in terms of complications. There were more recurrences after PPH. Conclusion. Compared with EH, PPH is associated with less postoperative pain, reduced operative time and hospital stay and earlier return to normal activity, and a trend towards improved patient satisfaction. The rate of recurrence appears higher with PPH. Electronic Access :  Full Text-1

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Record No. 10059 Record ID 010059 Publication type Journal Article Title Complications of Tube Thoracostomy for Chest Trauma Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Maritz, D. F. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(2) Pages 115-117, fig., tab. Language English Descriptor Thoracostomy; Chest Tubes; Wounds and Injuries Descriptor-Geographic South Africa Abstract Objective. To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. Methods. Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department's records and monthly statistics. Results. A total of 3 989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92) of these had been referred with an ICD in situ. An overall complication rate of 9.5was seen. Insertional complications numbered 7 (27), with 19 (73) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). Conclusion. Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion. Electronic Access :  Full Text-1

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Record No. 10058 Record ID 010058 Publication type Journal Article Title Surgeons and HIV: South African Attitudes Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Szabo, C. P.; Dhai, A.; Veller, M.; Kleinsmidt, A. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(2) Pages 110-113 Language English Descriptor General Surgery; HIV; Acquired Immunodeficiency Syndrome; Attitude Descriptor-Geographic South Africa Abstract Objectives. The HIV status of surgeons, in the context of the informed consent obtained from their patients, is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. Design. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa, regarding their attitudes to the preceding issues. Results. The salient findings included the view that a patientcentred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients, and that HIV-positive surgeons should determine their own scope of practice. Conclu- sion. Patient-centred approaches and restrictive policies, related to this issue, do not accord with clinician sentiment. In the absence of comparable local or international data, this study provides clinicians' views with implications for the development of locally relevant policies and guidelines. Electronic Access :  Full Text-1

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Record No. 10057 Record ID 010057 Publication type Journal Article Title Oesophageal Ulceration in Human Immunodeficiency Virus Infected Patients Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Epstein, D. P. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(2) Pages 107-109 Language English Descriptor Esophageal Perforation; HIV Infections; Cytomegalovirus Infections Descriptor-Geographic South Africa Abstract Objective. To determine the aetiology of oesophageal ulceration in HIV-infected patients. Design. A retrospective clinical, endoscopic and histopathological analysis of patients with confirmed HIV infection and an oesophageal ulcer diagnosed on endoscopy. Setting. A tertiary referral, gastrointestinal clinic in Cape Town. Results. Fifty-one patients with HIV infection and oesophageal ulceration were seen from January 2001 to December 2007. Median CD4 count was 26 cells/µl. Mean age was 35.5 years. Sixty per cent of patients were female. Forty-nine per cent of oesophageal ulcers were idiopathic while 23were caused by cytomegalovirus infection. The remainder were due to miscellaneous causes. Conclusion. A surprisingly small number of patients with HIV associated oesophageal ulceration were seen during the study period. This may reflect local referral practices or the fact that patients with severe immunosuppression succumb before developing oesophageal ulcers. As in other series, idiopathic oesophageal ulcers and cytomegalovirus ulcers made up the majority of cases. Correct biopsy technique and appropriate histological and microbiological investigations are associated with improved diagnostic yield in these patients. Electronic Access :  Full Text-1

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Record No. 10056 Record ID 010056 Publication type Journal Article Title Colorectal Cancer in South Africa: a Heritable Cause Suspected in many Young Black Patients Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Cronje, L.; Paterson, A.; Becker, P. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(2) Pages 103-106, fig., tab. Language English Descriptor Colorectal Neoplasms-anatomy & histology; Young Adult African Continental Ancestry Group Descriptor-Geographic South Africa Abstract Background. Colorectal carcinoma (CRC) has a low incidence among the black African population. Largely unrecognised in the scientific literature is the fact that a disproportionately large number of young black patients (50 years old) present with CRC. Objectives. To analyse those tumours, which we propose may link them to morphological features associated with known genetic pathways. Methods. A retrospective review of South African patients histologically diagnosed as having CRC by the Division of Anatomical Pathology, National Health Laboratory Service (NHLS) and the University of the Witwatersrand (1 732 patients from 1990 to 2003). The histology was fully reviewed in 609 patients (1997 - 2002), and all specimens from patients 50 years of age were subjected to immunohistochemistry tests for mismatch repair proteins, as well as APC and p53 proteins. Results. Most young patients (50 years) were black (41v. 10white; p=0.001). Blacks had predominantly proximal tumours and significantly more poorly differentiated and/or mucinous tumours (p=0.006), and loss of mismatch repair protein expression was more evident than in whites. Conclusions. It seems likely that CRC in young blacks develops through the accumulation of mutations, most probably via mis- match repair deficiency or promoter methylation, which in turn is linked to poor differentia- tion and a mucinous architecture. Electronic Access :  Full Text-1

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Record No. 10055 Record ID 010055 Publication type Journal Article Title Risks for preterm delivery and low birth weight are independently increased by severity of maternal anaemia Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Hussein, K. L.; Mogren, I.; Lindmark, G.; Massawe, S.; Nystrom, L. Journal Title South African Medical Journal ISSN 0256-9574 Place of Publication Pretoria Publisher Health and Medical Publishing Group Date of publication 2009 Volume and n° 99(2) Pages 99-102 Language English Descriptor Fetal Membranes, Premature Rupture; Infant, Low Birth Weight; Anemia; South Africa Abstract Objective. To estimate the effect of the severity of maternal anaemia on various perinatal outcomes. Design. A cross-sectional study. Setting. Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania. Methods. The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measu- red. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb =11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - Hb 7.0 - 8.9 g/dl; and severe - Hb 7.0 g/dl. Logistic regression analysis was performed to estimate the severity of anaemia. The following outcome measures were used: preterm delivery (37 weeks), Apgar score, stillbirth, early neonatal death, low birth weight (LBW) (2 500 g) and very low birth weight (VLBW) (1 500 g). Results. A total of 1 174 anaemic and 547 non-anaemic women were enrolled. Their median age was 24 years (range 14 - 46 years) and median parity was 2 (range 0 - 17). The prevalence of anaemia and severe anaemia was 68and 5.8, respectively. The risk of preterm delivery increased significantly with the severity of anaemia, with odds ratios of 1.4, 1.4 and 4.1 respectively for mild, moderate and severe anaemia. The corresponding risks for LBW and VLBW were 1.2 and 1.7, 3.8 and 1.5, and 1.9 and 4.2 respectively. Conclusion. The risks of preterm delivery and LBW increased in proportion to the severity of maternal anaemia. Electronic Access :  Full Text-1

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Record No. 9319 Record ID 009319 Publication type Journal Article Title Prevalence of Sexually Transmitted Infections in Women Attending Antenatal Care in Tete Province, Mozambique Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Luján, J.; Wouter Arrázola de Oñate; Delva, W.; Claeys, P.; Fernando, J.; Folgosa, E.; Sambola, F.; Temmerman, M. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(1) Pages 49-50, tab. Language English Descriptor Sexually Transmitted Diseases-epidemiology; Chlamydia trachomatis Neisseria gonorrhoeae Syphilis Risk Factors Pregnant Women Cross-Sectional Studies Descriptor-Geographic Mozambique-Tete Province; Abstract Objective. To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in pregnant women. Methods. A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemaggluti- nation (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique. Results. Blood and urine samples were collected from 1 119 and 835 women, respectively. The prevalence of CT was 4.1, and that of NG 2.5. The RPR test was positive in 5.2of the women, and 7.1had a positive TPHA test. Active syphiliswas found in 4.7. In univariate analysis, CT was associated with having had any level of education (p0.05), reactive RPR and TPHA were associated with illiteracy (p0.05), and TPHA was associated with age 25. Multivariate analysis did not show any significant association. In comparisonwith published data from 1993, a decline was observed for CT (p0.05), NG and syphilis (p0.001). Conclusions. Compared with available data, a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour, as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However, STI rates are still high, and the problem needs more concrete and sustained efforts for its control. Electronic Access :  Full Text-1

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Record No. 9318 Record ID 009318 Publication type Journal Article Title Implementation of the Mental Health Care Act (2002) at District Hospitals in South Africa : Translating Principles into Practice Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Burns, J. K. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(1) Pages 46-48 Language English Descriptor Mental Health; Health Plan Implementation; Health Manpower; Hospitals, District; Legislation, Medical Descriptor-Geographic South Africa Abstract Legislation prior to 2002 tended to reinforce the alienation, stigmatisation and disempowerment of mentally ill patients in South Africa. In line with international develop- ments in mental health legislation, the Mental Health Care Act (2002) was promulgated in South Africa. Its core principles - human rights for users; decentralisation and integration of mental health care at primary, secondary and tertiary levels of care; and a focus on care, treatment and rehabilitation - are progressive and laudable. However, the task of implementing the requirements of the Act at community and district hospital levels is fraught with problems. Lack of infrastructure, inadequate skills and poor support and training undermine its successful implementation.Health workers already burdened with enormous workloads and inadequate resources struggle to manage mentally ill patients at district hospitals. The 72- hour observation is a particular area of difficulty throughout the country. This paper outlines the rationale and sense behind this legislation, discusses the problems encountered at the 'rock face', and offers solutions to the problem of translating principles into practice. Electronic Access :  Full Text-1

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Record No. 9317 Record ID 009317 Publication type Journal Article Title Is the Western Cape at Risk for an Outbreak of Preventable Childhood Diseases ? Lessons from an Evaluation of Routine Immunisation Coverage Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Corrigall, J.; Coetzee, D.; Cameron, N. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(1) Pages 41-45, fig., tab. Language English Descriptor Immunization; Vaccination; Disease; Child; Cross-Sectional Studies; Cross-Sectional Studies Descriptor-Geographic South Africa-Western Cape; Abstract Objective: To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape. Design: Cross-sectional Household Survey using an adaptation of the '30x7' cluster survey technique. Setting: Households across the Western Cape. Subjects: 3705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. Outcome measures: Vaccination Status (1=fully vaccinated, 0= partially vaccinated) as recorded on a Road to Health card or given by history. Reasons for not vaccinating established from a questionnaire. Results: The immunisation coverage is 76.8for vaccines due by 9 months and 53.2for vaccines due by 18 months. The reasons given for not being immunised were clinic-related factors (47), lack of information (27), caregiver being unable to attend the clinic (23) and lack of motivation (14). Of clinic factors cited, the two commonest factors were missed opportunities (34) and being told by clinic staff to come back another time (20). Conclusion: While the coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunized are valuable pointers as to where interventions should be focussed Electronic Access :  Full Text-1

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Record No. 9316 Record ID 009316 Publication type Journal Article Title Mortality in Patients Treated for Tuberculous Pericarditis in Sub-Saharan Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Mayosi, B. M.; Wiysonge, C. S.; Ntsekhe, N.; Gumedze, F.; Volmink, J. A.; Maartens, G.; Aje, A.; Thomas, B. M.; Thomas, K. M.; Awotedu, A. A.; Thembela, B.; Mntla, P.; Maritz, F.; N'gu Blackett, K.; Nkouonlack, D. C.; Burch, V. C.; Rebe, K.; Parrish, A.; Sliwa, K.; Vezi, B. Z.; Alam, N.; Brown, B. G.; Gould, T.; Visser, T.; Magula, N. P.; Commerford, P. J. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(1) Pages 36-40, fig., tab. Language English Descriptor Pericarditis, Tuberculous-diagnosis; Pericarditis, Tuberculous-complications; Pericarditis, Tuberculous-therapy; Pericarditis, Tuberculous-mortality; HIV Infections Descriptor-Geographic Africa South of the Sahara; South Africa Abstract Objective: To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design: Between 1 March 2004 and 31 October 2004, we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon, Nigeria, and South Africa, and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study, with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression, we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results: We obtained the vital status of 174 (94) patients (median age 33; range 14-87 years). The overall mortality rate was 26. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40versus 17, P=0.001). Independent predictors of death during follow-up were: (1) a proven non-tuberculosis final diagnosis (hazard ratio [HR] 5.35, 95confidence interval 1.76 to 16.25), (2) the presence of clinical signs of HIV infection (HR 2.28, 1.14-4.56), (3) co-existent pulmonary tuberculosis (HR 2.33, 1.20-4.54), and (4) older age (HR 1.02, 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80, 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34, 0.10-1.19). Conclusion : A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africans. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease. Electronic Access :  Full Text-1

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Record No. 9315 Record ID 009315 Publication type Journal Article Title Obstetric Anaesthesia : the Source of the Crisis Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Lamacraft, G.; Schmidt, J. M.; Diedericks, B. J. S. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 123-124 Language English Descriptor Anesthesia, Obstetrical; Surgical Procedures, Operative; Clinical Competence; Maternal Mortality Descriptor-Geographic South Africa Abstract The Saving Mothers Reports have consistently shown that, out of all the provinces of South Africa, the Free State has one of the highest rates of maternal deaths arising from anaesthesia.The province's Department of Health requested the University of the Free State's Department of Anaesthesiology to investigate the problem. We examined possible factors, including training and experience of doctors administering anaesthesia, availability of suitable anaesthetic drugs and equipment, and use of regional anaesthesia. All the level 1 and 2 hospitals in which caesarean sections (CSs) were being performed were investigated. The foremost problems identified were lack of training andexperience in administering obstetric anaesthesia, and lack of senior anaesthetic assistance Electronic Access :  Full Text-1

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Record No. 9314 Record ID 009314 Publication type Journal Article Title "Look and Lletz" : a Chris Hani Baragwanath Hospital Experience Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Adam, Y.; Gelderen, C. G.; Newell, K. O. Journal Title South African Medical Journal Date of publication N D Volume and n° 98(2) Pages 119-122, fig., tab. Language English Descriptor Uterine Cervical Neoplasms-surgery; Colposcopy-methods; HIV Seropositivity HIV Seronegativity Women Descriptor-Geographic South Africa Abstract Objectives. An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006, to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own, colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short term complications of Lletz (large loop excision of the transformation zone) at this clinic. Design. A retrospective analysis of data from the colposcopy clinic database of patients, who were referred according to national guidelines. Setting. Patients who are referred to Chris Hani Baragwanath hospital. Results. Normal histology was found in 1.3 of patients, and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4. The overall complication rate was 3. Conclusion. The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIVnegative women were more likely to be overtreated than HIVpositive patients (p=0.03). Electronic Access :  Full Text-1

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Record No. 9313 Record ID 009313 Publication type Journal Article Title Incidence of Nevirapine-Associated Hepatitis in an Antenatal Clinic Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Black, V.; Rees, H. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 116-118 Language English Descriptor Antiretroviral Therapy, Highly Active Nevirapine-adverse effects; Nevirapine-toxicity; Hepatitis Pregnant Women Descriptor-Geographic South Africa Abstract Objective. To describe the incidence, clinical presentation and management of nevirapine-associated hepatitis among antiretroviral-naïve pregnant women treated with nevirapine based antiretroviral therapy at a dedicated antenatal antiretroviral clinic. Methods. Retrospective analysis of pregnant women initiated on nevirapine-based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006. Results. Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR) 26 - 32) years and median pre-treatment CD4 cell counts was 157 (IQR 104 - 193) cells/µl. Baseline alanine transaminase(ALT) was elevated in 2.8of women (11/390). After initiation of nevirapine-based ART 8(31/390) experienced an ALT elevation. Three of these patients developed clinical hepatitis with jaundice (0.8, 3/390). The mean and median time to clinical presentation was 5 weeks. Hepatitis resolved following discontinuation of ART. Non-nevirapine regimens were initiated following biochemical and symptomatic improvement; symptoms did not recur. Conclusions. Among pregnant women, nevirapine-containing ART has a favourable safety profile, with a low incidence of serious hepatic events. Electronic Access :  Full Text-1

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Record No. 9312 Record ID 009312 Publication type Journal Article Title Pharmacoligaclly Active : Clinical Trials and the Pharmaceuticals Industry Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Kahn, M. J.; Gastrow, M. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 114-115, tab. Language English Descriptor Drug Industry; Clinical Trial; Research; Economics, Pharmaceutical Descriptor-Geographic South Africa Abstract The global clinical trials industry is driven by the needs of pharmaceutical companies to bring new products to market, rapidly and in compliance with regulatory requirements. Many of the largest multinational pharmaceutical companies - the so-called 'pharmas' - are active in South Africa in importing and producing pharmaceuticals and in the conduct of clinical trials. This clinical trials industry now forms an important sub-sector of research and development (R&D) in the country. The release in August 2007 of the long-awaited Department of Trade and Industry national industrial policy framework designates four key value chains in the economy, one of which is chemicals, plastic fabrication and pharmaceuticals. This intention raises a key question: is South Africa to be a factory for the pharmas, or can it leverage its existing strengths in medical research and the conduct of clinical trials to develop a discovery-led local industry? This paper therefore offers an analytical and quantitative profile of the current state of the clinical trials industry in South Africa, to enquire as to its potential to grow a local pharmaceutical industry. Electronic Access :  Full Text-1

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Record No. 9311 Record ID 009311 Publication type Journal Article Title Prevalence of Drug-Drug Interactions of Antiretroviral Agents in the Private Health Care Sector in South Africa Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Katende-Kyenda, N. L.; Lubbe, M. S.; Serfontein, J. H. P.; Truter, I. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 109-113 Language English Descriptor Drug Interactions Antiretroviral Therapy, Highly Active-adverse effects; HIV Health Care Sector Descriptor-Geographic South Africa Abstract Human immunodefiency virus (HIV) infection can be effectively treated with highly active antiretroviral therapy (HAART), requiring concomitant administration of three to four different agents, often with a high potential for drug-drug interactions (DDIs). This study aimed to determine the prevalence of possible DDIs between antiretrovirals (ARVs) themselves and other drugs. Design. Retrospective drug-utilisation study using data from from a national medicine claims database for the period 1 January to 31 December 2004. Setting. A section of the private healthcare sector in South Africa. Subjects. All ARV prescriptions (N=43482) claimed during 2004. The possible DDIs found were classified according to a clinical significant rating as described by Tatro7 (2005) in his book, Drug Interactions Facts and comparisons. Results. A total of 5305882 medicine items were prescribed, of these, 1.92(N=101 938) accounted for ARVs. Of the total number of 2595254 prescriptions, 1.68(N=43 482), were ARVs. A total number of 18035 DDIs (81 different types) were identified, of these, 83.89, (n=15130) were DDIs between ARVs and other drugs, while 16.11(n=2905) were DDIs between ARVs themselves. Possible DDIs with a clinical significance level of 1 (major, n=17) and 2 (moderate, n=1436) represented 8.06(n=1 453) of the total number of identified interactions. Conclusions. Since concomitant use of ARVs and other drugs used to treat HIV complications is increasing, there is a great need of understanding and anticipating these DDIs, overcoming them by dose adjustments and patient education by pharmacists, so that they are not life threatening to HIV/AIDS patients. Electronic Access :  Full Text-1

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Record No. 9310 Record ID 009310 Publication type Journal Article Title Severe Hypertriglyceridaemia as a Result of familial Chylomicronaemia : the Cape Town Experience Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Pouwels, E. D.; Blom, D. J.; Firth, J. C.; Henderson, H. E.; Marais, A. D. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 105-108 Language English Descriptor Lipoprotein Lipase Hyperlipoproteinemia Type IV-adverse effects; Chylomicrons Descriptor-Geographic South Africa-Cap Town; Abstract Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective.We review the experience with familial chylomicronaemia in patients who attended the lipid clinics at Groote Schuur Hospital and the Red Cross Children's War Memorial Hospital in Cape Town. The criteria for inclusion were an initial plasma triglyceride concentration of 15 mmol/L and a typical type I Fredrickson hyperlipidaemia pattern on plasma lipoprotein electrophoresis. A total of 29 patients were seen over 25 years. The mean age of presentation was 10 years, but ranged from from 0 to 43 years. The modes of presentation differed: pancreatitis (n=16), eruptive xanthomata (n=2), coincidental detection of hypertriglyceridaemia (n=2), screening relatives (n=7) and after death from pancreatitis (n=1). Plasma triglycerides responded rapidly and dramatically to dietary fat restriction and some patients sustained good control of the hyperlipidaemia.. The onset of pancreatitis was earlier in patients of Indian ancestry suggesting a genotype/phenotype interaction within this disorder. Genetic work-up indicated founder effects in the Afrikaner and Indian patients. Lipaemic plasma should be taken seriously at all ages and necessitates work-up at specialised clinics where the diagnosis of chylomicronaemia or type I hyperlipidaemia facilitates appropriate dietary management that can prevent pancreatitis. Electronic Access :  Full Text-1

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Record No. 9309 Record ID 009309 Publication type Journal Article Title Familial Hypercholesterolaemia : the Cape Town Experience Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Firth, J. C.; Marais, A. D. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(2) Pages 99-104, fig., tab. Language English Descriptor Hyperlipoproteinemia Type II-diagnosis; Hyperlipoproteinemia Type II-therapy; Lipoproteins Xanthomatosis Descriptor-Geographic South Africa-Cape Town; Abstract Familial hypercholesterolaemia (FH), an autosomal dominantly inherited disorder characterised by elevated plasma LDL cholesterol levels, tendon xanthomata and premature ischaemic heart is amenable to treatment with modern medication. There is a paucity of clinical information on FH in South Africa. The clinical and biochemical details of 1031 patients who attended the lipid clinic at Groote Schuur Hospital with this diagnosis have been analysed. FH is the commonest monogenic disorder of lipoprotein metabolism presenting to the Lipid Clinic at Groote Schuur Hospital, accounting for about 20of consultations. The hospital classified 55of the FH patients as White, 43as Coloured, 1.5as Asian and 0.5as Black. In the FH cohort, whose mean age at presentation was 44 years, 80had tendon xanthomata, 36had arcus cornealis and 14had xanthelasma. Tendon xanthomata were present in almost 90of patients by the age of 50 years. Arcus cornealis was present in about 45by the age of 40 years, increasing further with age. Cardiovascular complications included ischaemic heart disease (43), stroke (1.5), transient ischaemic attacks (1.3) and peripheral vascular disease (3.7). The mean age of death was 55 (±13) years; 51 (±10) years in men and 61 (±12) years in women. In 46of the cohort a defective gene was identified by testing for locally prevalent mutations. FH is a common, serious disease that can be diagnosed by clinical manifestations and routine laboratory tests at primary healthcare level. FH affects all ethnic groups in South Africa Effective treatment is available to prevent early and debilitating coronary disease but requires recognition and referral. Electronic Access :  Full Text-1

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Record No. 9308 Record ID 009308 Publication type Journal Article Title Patients with Severe Mental Illness : a New Approach for Testing for HIV Source of Record WHO Regional Office for Africa, Library, Brazzaville, Congo Author(s) Joska, J. A.; Kaliski, S. Z.; Benatar, S. R. Journal Title South African Medical Journal Date of publication 2008 Volume and n° 98(3) Pages 213-217 Language English Descriptor HIV Infection-diagnosis; HIV Seroprevalence Mentally Ill Persons Descriptor-Geographic South Africa Abstract Background :The prevalence of infection with the Human Immuno-deficiency Virus (HIV) in South Africa is approaching 20of young adults. In severely mentally ill people, it is probably higher. Testing for infection is subject to stringent ethical principles. Undiagnosed HIV infection in people with severe mental illness increases costs and morbidity. Since effective treatments are available, it is imperative to diagnose HIV infection early in this high risk population. Methods : a literature review established the prevalence of HIV infection in in-patient populations with HIV infection. The pattern of testing for HIV over three years at a major psychiatric hospital was investigated. We surveyed public sector psychiatrists in the Western Cape to establish their attitudes to HIV in their patients. Results The HIV reported seroprevalence in psychiatric in-patients ranges from 0-59.3, with a mean of 10. Data show a clear trend towards an increase in prevalence: Pre 1996 the mean HIV seroprevalence was 7.4, while post 1996 the mean was 15. State psychiatrists in the Western Cape do not test routinely for HIV infection, mainly due to ethical constraints: 14.6of patients at Lentegeur Hospital were tested in 2006. Conclusions The high prevalence of HIV infection in South Africa, that is probably higher in patients with severe mental illness (most of whom are not competent to provide informed consent) and the availability of effective treatment, requires debate and a clear policy regarding testing for HIV infection to be implemented. We recommend a new approach to HIV testing in these patients. Electronic Access :  Full Text-1

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