Australasian Medical Journal
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The Traditional Health Practitioners Act No 22 (2007) of South Africa (Part 2: Resolutions)
No full textBackgroundBefore the promulgation of the Traditional Health Practitioners Act No 22 (2007), there was no formal guideline or training culture to steer traditional healing in South Africa. Training was and is still mostly informal. Sometimes a new healer is trained by other traditional healers. In many cases, the traditional healer is self-taught without any learning whatsoever.AimsThe present study aims to describe the various resolutions of the Act to plan, develop and manage traditional healthcare training in the future.Methods This is an exploratory and descriptive study in line with the modern historical approach of investigation and review. The emphasis is on using contemporary documentation, like articles, books and newspapers, as primary resources to reflect on the development and promulgation of the Traditional Health Practitioners Act No 22 (2007). The findings are offered in a narrative format.Results It seems that Act No 22 (2007) was promulgated without comprehensive research and in-depth discussion on training with all the role players who have a vested interest.ConclusionIt is clear that training ideals such as formal study programmes, qualified staff and institutional bodies to train and to educate future traditional healers are not immediately attainable. The nearly ten years of minimal activity to enact Act No 22 since its promulgation confirms this failure. Inexpensive and uncomplicated training paths are needed until a system can be developed. One such path is the continuation of informal in-house training with another traditional healer
The Danger of Chlorhexidine in Lignocaine Gel
Get PDFThis article describes a case of anaphylaxis secondary to chlorhexidine during urethral catheterisation. Despite little evidence for the use of antiseptic lubricants in preventing catheter-associated urinary tract infections, the distribution and use of such products continues to be widespread. Chlorhexidine-free lubricating gel is widely available and should be used for urological procedures wherever possible
Reversible dementia: The Imitation Game
No full textRapidly progressive dementia (RPD) is an emergency in behavioural or cognitive neurology. Many rare neuroinfections like Neurosyphilis may be missed, if they are not thoroughly evaluated. We report a patient with subacute onset and progressive cognitive decline, extrapyramidal involvement and myoclonic jerks who was initially suspected as probable autoimmune encephalitis or Creutzfeldt-Jakob disease (CJD). Investigations revealed positive serum and cerebrospinal fluid (CSF) Venereal Disease Research Laboratory test (VDRL). On treatment with penicillin, he developed Jarisch-Herxheimer reaction and was treated symptomatically. After two weeks of penicillin, he improved significantly and except for mild short term memory recall, he is asymptomatic for last two years
Type 2 diabetes mellitus: Link between diet, HbA1c and complications
Get PDFBackgroundDiabetes mellitus is now globally considered as a leading cause of morbidity and mortality. It is associated with high rates of microvascular and macrovascular complications. Regular consumption of high caloric food, poor dietary habits and adoption of sedentary life style has been linked with the development of type 2 diabetes mellitus.AimsThe purpose of this review is; to highlight the influence of diet on HbA1c in type 2 diabetics, to explore association between HbA1c and diabetes complications and to propose a dietary consultation model for more effective diabetes care.MethodsThe literature was reviewed intensively from January – March 2016 through PubMed central, Medscape, Google Scholar and other databases. The keywords and MeSH terms used in this search were “diabetes mellitus”, “glycated haemoglobin”, “type 2 diabetes mellitus”, “diet and type 2 diabetes mellitus” and “diabetes complications”.ResultsDietary management is a superior option for glycaemic control in type 2 diabetes mellitus. It is important to keep the HbA1c level in acceptable range to delay the onset and progression of diabetes complications. In this review, various food groups that can have beneficial and adverse effects on HbA1c have been identified. Moreover, Diabetic Retinopathy (DR) stood out as the most prevalent complication of poorly managed diabetes mellitus in Saudi Arabia.ConclusionThe dimensions of the proposed dietary consultation model are based on the assessment of diabetics’ diabetes mellitus knowledge, dietary knowledge, dietary attitude and dietary practices. This assessment if carried out at the initial stage of Diabetes mellitus can be helpful in delaying the early onset and progression of microvascular and macrovascular diabetes complications
Acute myeloid leukaemia presenting as bilateral proptosis in a young child
Get PDFBackgroundMyeloid sarcoma is an extramedullary manifestation of acute myeloid leukaemia (AML).AimsWe are reporting a paediatric case presenting with bilateral proptosis, which we were able to diagnose with peripheral blood smear (PBS) examination.MethodsCase ReportResultsThis case highlights the utility of simple routinely available PBS test in diagnosing this rare disease.ConclusionOur case highlights the importance of haemogram and peripheral blood smear in the initial evaluation of proptosis. Correct diagnosis of this rare entity is vital especially in cases where (myeloid sarcoma) MS is the presenting feature of AML
Efficacy of the Flinders chronic condition management program in obese patients with hip or knee osteoarthritis
Get PDFBackgroundObesity is a risk factor for osteoarthritis and total hip/knee joint replacement and can also lead to poorer outcomes following surgical interventions. Self-management programs are a recommended approach for addressing clinical features of osteoarthritis and obesity.AimsThis study investigates the relative efficacy of the Flinders chronic condition self-management program versus treatment as usual in obese patients with hip or knee osteoarthritis on a knee/hip joint replacement waiting list.MethodsObese (Body Mass Index or BMI≥30) osteoarthritis patients on a knee/hip joint replacement waiting list will be assessed for study eligibility. 95 consented patients will provide 80 per cent power to detect an effect size of 0.6 in the primary outcome measure of quality of life at 6 months and 10 months, at α=10 per cent level. A randomised sequence, stratified by gender and obesity class will be generated and administered by a computer-based system. Health-related quality of life outcomes will be collected using Short Form SF-36 and OAKHQOL at 6 and 10 months pre- and post-operatively. The main analysis will investigate differences in SF-36 scores between the intervention and treatment as usual groups on an intention-to-treat basis. Linear mixed effect models will be used to analyse outcome data.ConclusionThis study is designed to provide robust and transparent findings including randomisation sequence generation, allocation concealment and implementation and will therefore provide much needed quality evidence in the field of self-management and osteoarthritis.1 The Flinders Program has not been used in this type of patient cohort before and since it has been proven a successful self-management tool for other chronic conditions in Australian communities, the results of this study will add valuable knowledge to the chronic condition management
A single qualitative study can show same findings as years of quantitative research: Obstructive Sleep Apnea as an example
Get PDFBackgroundMany years of quantitative research led to our present knowledge of the symptoms and associated features (S&AF) of the obstructive sleep apnoea (OSA) syndrome.Aims1. To prove that a qualitative research approach may identify symptoms and associated features of OSA in less time/effort than that used in a quantitative approach.2. To describe the experience of patients with OSA and the effects of the syndrome on their quality of life and that of their spouses and families (issues that quantitative methods fail to recognize).MethodsWe used a narrative inquiry methodology (qualitative research). The sample was selected using the “snowball sampling technique";;;. The sample included 10 patients with moderate to severe OSA who had good adherence to CPAP and significant clinical improvement after treatment, and 3 of the patient’s spouses.ResultsThe following issues were identified: A long pre-diagnosis phase of OSA (20 years in one of the patients); Characteristic S&AF of the syndrome as experienced by patients and their spouses; The need for increased awareness of both the public and the medical establishment in regards to this disorder; Premature ejaculation (not reported previously) and nightmares (non-conclusive in the literature) were identified and improved with CPAP therapy.ConclusionWith the use of quantitative research methods it took decades to discover things that we found in one simple qualitative study. We therefore urge scientists to use more often these qualitative methods when looking for S&AF of diseases and syndromes
Immunosuppressive drug assaying: A challenge for renal transplantation
Get PDFBackgroundRenal transplant patients of the Northern Territory (NT) of Australia, suffer poor transplant outcomes including graft rejection, infection and increased mortality, therefore requiring stringent immunosuppressive drug assay monitoring. Best practice dictates that drug assay results should be received within 24 hours and at the most no later than 48 hours post blood collection. Assays from the Royal Darwin Hospital (RDH) are processed at an interstate laboratory, therefore prolonging the time to dosage adjustment.AimsTo assess the time delay that exists between blood sample collection at the Royal Darwin Hospital (RDH) and the faxing of results from an interstate laboratory to RDH.MethodsWe conducted a retrospective audit of immunosuppressive drug assay samples and results between the 4th of January 2013 and the 22nd April 2014. Time delay was divided into intervals: T1: Total time between collections to faxing of results back to RDH, T2: Time between blood collection, sending of samples and reporting at an interstate laboratory, T3: Time between results reporting and the faxing of results back to RDH.ResultsA total of 389 drug assays from 49 renal transplant patients were analysed. Median times in hours (interquartile ranges) were T1=53.48 (31.68-78.55), T2=47.18 (28.80-76.18), T3=2.70 (1.87-3.90). 13.3 per cent of the results led to the requirement for dosage changes with the potential risk of under-dosing or overdosing.ConclusionThe long median time delay between sample collection and receiving of results illustrates the challenges of immunosuppression in this setting and the need for on-site immunosuppressive drug assaying
Outbreak of measles in Sokoto State North-Western Nigeria, three months after a supplementary immunization campaign
Get PDFBackgroundWorldwide, measles infects about 20 million people with about 200,000 deaths annually. On February 12, 2016 an outbreak of measles was reported from Sokoto state, Nigeria.AimsA team of Nigeria Field Epidemiology and Laboratory Training Program (NFELTP) Residents was sent to confirm the existence of the outbreak, describe the socio-demographic characteristics and identify risk factors for the outbreak.MethodsWe defined cases according to the World Health Organization (WHO) criteria. We conducted an unmatched case-control study and descriptive study. We actively searched for cases across local government areas (LGAs) of the state, and administered questionnaires to parents of affected children. We analyzed the data using Epi-Info 7 and Microsoft Excel 2013.ResultsA total of 979 cases were recorded. Median age was 36 months with age range of 3–168 months. Ten deaths were recorded with a Case Fatality Rate (CFR) of 1.02 per cent. About 76.51 per cent of cases were under-five years of age. The outbreak spanned over a period of 10 weeks. Twenty-two out of 23 LGAs were affected. Eighty-nine cases (9.1 per cent) had their blood sample taken for laboratory confirmation, where 21 (23.6 per cent) tested positive for measles.A total of 238 respondents were interviewed; 128 cases and 110 controls. Mothers’ education (OR: 2.9, 95 per cent CI: 1.4–5.9), immunization status of children (OR: 2.0, 95 per cent CI: 1.1–3.4), and fathers’ occupation (OR: 0.2, 95 per cent CI: 0.1–0.5), are the factors that affect measles infection among children in the state.ConclusionOur investigation confirmed a measles outbreak in Sokoto state. Though with a low CFR, the majority of deaths occur in children are factors that adversely affect development of measles in Sokoto state
Speciation and susceptibility testing of Candida isolates from vaginal discharge
Get PDFBackgroundVaginal discharge is the frequently narrated complaint in the female sexually transmitted infection (STI) clinic. Vulvovaginal candidiasis (VVC) is the second most common reason for vaginal discharge. Treatment and prevention of VVC among the female population can reduce HIV acquisition and pregnancy related complications, in addition to improvement in their quality of life.AimsThis study aims to detect the percentage of VVC among patients with vaginal discharge, as well as speciate and perform antifungal susceptibility tests for the Candida isolates.MethodsTwo high vaginal swabs were collected from 130 female outpatients with complaints of vaginal discharge. Potassium hydroxide (KOH) mount, Gram’s stain and culture in Sabouraud’s dextrose agar were performed. Antifungal susceptibility tests were done by the disc diffusion method, Hicomb strips and broth microdilution method.ResultsIsolation of candida was 39.23 per cent in our study. Candida albicans (45.83 per cent) was the commonest species followed by Candida glabarata (22.91 per cent). Amphotericin B was 100 per cent effective for all Candida isolates.ConclusionThough C. albicans was the commonest species, more than 50 per cent of isolates were non-albicans Candida. Therefore identification of species is important for appropriate anti-fungal therapy. Speciation also helps to prevent treatment failure and dissemination of drug resistance