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Cape Town, South Africa

Symons G.,Groote Schuur Hospital
South African Medical Journal | Year: 2014

Warfarin, one of the vitamin K antagonists, has been used since 1940, when it was first approved for the treatment of venous thromboembolism. It is currently the most commonly used anticoagulant, although alternative drugs are available, such as aspirin, clopidogrel and dipyridamol, which have been studied in a number of scenarios. The newest agents available to clinicians are the broad group of novel anticoagulants, such as direct thrombin and direct factor Xa inhibitors, including molecules such as dabigatran, rivaroxaban, apixaban and edoxaban. Source

Kew M.C.,Groote Schuur Hospital
World Journal of Hepatology | Year: 2010

Occult hepatitis B virus (HBV) infection was shown to be present in 75% of Black Africans with hepatocellular carcinoma (HCC) in whom the tumor was hitherto not thought to be caused by chronic HBV infection. The association between chronic HBV infection and the development of the tumor is thus even closer than was originally thought. HBV viral load was found to be significantly higher in patients with HCC than in Black African controls. As in other populations, HBV e antigen-positive patients with hepatocellular carcinoma had significantly higher viral loads than patients negative for this antigen. The significance of this finding is discussed. The risk for HCC development with genotype A of HBV, the predominant genotype in African isolates, has not been investigated. Genotype A was shown to be 4.5 times more likely than other genotypes to cause HCC in Black Africans, and tumours occurred at a significantly younger age. Increasing numbers of patients with human immunodeficiency virus (HIV) and HBV co-infection are being reported to develop HCC. A preliminary case/control comparison supports the belief that HIV co-infection enhances the hepatocarcinogenic potential of HBV. A study from The Gambia provides the first evidence that dietary exposure to aflatoxin B1 may cause cirrhosis and that this may play a contributory role in the pathogenesis of aflatoxin-induced HCC. An animal model has provided experimental support for the clinical evidence that dietary iron overload in the African is directly hepatocarcinogenic, in addition to causing the tumor indirectly through the development of cirrhosis. © 2010 Baishideng. Source

Du Toit A.,Groote Schuur Hospital
South African Journal of Clinical Nutrition | Year: 2014

A fistula is defined as an abnormal communication between two organs, an organ and the skin, or an organ and a wound. Up to 70% of patients with fistulae present with malnutrition. Enteral nutrition (EN) has considerable advantages over parenteral nutrition (PN) support, including improved gut barrier function, a reduction in infectious morbidity and improved immune function. EN support remains the preferred route of nutrition support in patients with fistulae, unless it causes a significant increase in fistula output, abdominal pain or exacerbates diarrhoea. Fistuloclysis, i.e. enteral feeding via an intestinal fistula, is an effective means of providing nutritional support to these patients and can replace the need for PN support. © SAJCN. Source

Natha B.,Groote Schuur Hospital
South African Medical Journal | Year: 2014

Atherosclerosis is the leading cause of coronary, cerebrovascular and peripheral arterial disease (PAD) worldwide. Sedentary lifestyle, stress and high-fat/carbohydrate diets have contributed significantly to the rising prevalence of atherosclerosis in most populations. Preventive strategies are currently aimed at curbing the socio-economic burden of atherosclerotic disease and its consequences in healthcare systems. While myocardial infarction and cerebrovascular accidents are the two leading causes of mortality and long-term morbidity, atherosclerotic PAD remains an accurate marker of more generalised disease. Screening programmes for at-risk individuals with undiagnosed PAD should therefore be beneficial in preventing future cardiovascular and cerebrovascular events. This article reviews the evidence and benefits of selective screening for PAD. Source

Bosenberg M.,Groote Schuur Hospital
Southern African Journal of Anaesthesia and Analgesia | Year: 2011

Little consideration has been given to the environmental impact of gaseous anaesthetic use. All currently used volatile anaesthetics are halogenated and chemically similar to chlorofluorocarbons (CFCs), giving them the potential to impact the environment negatively via both ozone depletion and global warming. Overall contribution to climate change is dependent on both these environmental effects, as well as the quantities released into the atmosphere. This review of the current data provides an insight into the overall ecotoxicity of volatile agents and gives alternatives which may be employed to limit environmental load. Results from the studies reveal that global warming potential and ozone depletion potential are significant for all volatiles, especially when combined with nitrous oxide use. However, because atmospheric levels are estimated to be small when compared to gaseous emissions from industrial and agricultural sources, the actual percentage contribution to climate change is small. Despite these findings, the cumulative effects of small contributors to climate change should not be underestimated, especially with increasing numbers of future anaesthetics and a decreasing CFC load. The carbon footprint of an individual anaesthetist is significantly increased by the daily use of volatile anaesthetic agents and recognised alternatives may be utilised to minimise this. Source

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