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Pretoria, South Africa

Kruger M.,Stellenbosch University | Reynders D.,University of Pretoria | Omar F.,University of Pretoria | Schoeman J.,Steve Biko Academic Hospital | And 2 more authors.
South African Medical Journal | Year: 2014

Introduction. Retinoblastoma (RB) is the most common eye cancer in children. Early detection is necessary for cure.Objective. To compare stage and outcome of children with RB treated at Kalafong Hospital, Pretoria, South Africa (SA), during two time periods (1993 - 2000 and 2001 - 2008, after outreach interventions in 2000 and introduction of compulsory community service for doctors in 1998).Methods. Data collected included demography (age, gender, date of birth), stage and treatment received. The main outcome measure was disease-free survival and the study end-point was 60 months after diagnosis.Results. There were 51 patients during the time period 1993 - 2000 (group 1) and 73 during 2001 - 2008 (group 2), with median ages of 32 and 26 months, respectively (marginally significantly younger in group 2; p=0.046). In group 1, the majority (57%) presented with advanced disease (stages III and IV), with a decline in this proportion in group 2 (40%) indicating a downward but not significant trend (p=0.075). Bilateral disease was diagnosed in 22% of patients in group 1 and 33% in group 2. Overall survival was 33% and 43% for groups 1 and 2, respectively. Excluding absconding patients, event-free survival was 50% in group 1, improving to 68% in group 2 (not statistically significant; p=0.18). Fewer patients needed radiotherapy during the second period (statistically significant; p=0.04), probably because of less advanced disease.Conclusion. Poor outcome is probably a result of late diagnosis. It is important to implement a strategy that will ensure early diagnosis and optimal management of RB in SA. © 2014, South African Medical Association. All rights reserved.

Karodia M.,Steve Biko Academic Hospital
Obstetrics and Gynaecology Forum | Year: 2016

Haematological abnormalities are frequently encountered in the obstetric patient. Cytopenias are common, with anaemia and thrombocytopenia predominating. Many other haematological conditions are seen during pregnancy, however, in this review, I intend to describe the common abnormalities and the management thereof.

Ueckermann V.,Steve Biko Academic Hospital | Van Zyl D.G.,Kalafong Hospital
Journal of Endocrinology, Metabolism and Diabetes of South Africa | Year: 2013

Objective: The purpose of this study was to determine the prevalence of subclinical hypothyroidism among patients with diabetes mellitus at the Kalafong Diabetes Clinic in Pretoria. Design: Cross-sectional study. Setting and subjects: Five hundred and sixty-five patients with diabetes mellitus (type 1, type 2 or unknown), who were following-up at the Kalafong Hospital Diabetes Clinic. Outcome measures: The thyroid stimulating hormone (TSH) levels of patients were evaluated. Patients with TSH levels > 5.66 IU/ml (upper reference limit of the Kalafong National Health Laboratory Services laboratory) subsequently underwent repeat thyroid function evaluation, including T4 level, to determine the prevalence of subclinical hypothyroidism. Results: A total of 563 patients met the inclusion criteria for this study and underwent TSH evaluation. The prevalence of subclinical hypothyroidism was found to be 0.9% in the study population, and 1.6% in a subgroup of patients with type 2 diabetes mellitus. Conclusion: The prevalence of subclinical hypothyroidism in this South African population of patients with diabetes was significantly lower than that stated in the literature. This holds true for both the general population and populations of patients with diabetes mellitus. To our knowledge, there is no data available for the prevalence of subclinical hypothyroidism in the general population in South Africa for comparison with the study group. © SEMDSA.

Moore S.W.,Stellenbosch University | Kirsten M.,Steve Biko Academic Hospital | Muller E.W.,Steve Biko Academic Hospital | Numanoglu A.,University of Cape Town | And 4 more authors.
Journal of Infectious Diseases | Year: 2010

Background. Intussusception is a common gastrointestinal emergency in children and appears to have a somewhat different clinical spectrum in developing countries. Its etiology is still unclear, but a link to infective agents and viruses has been highlighted. This study aimed to assess the clinical spectrum and prevalence of intussusception in children from the diverse South African population. Methods. Retrospective data were obtained from 9 participating pediatric referral units on the occurrence of intussusception in South African children (<14 years old) during a 6-year period (1998-2003). Results were correlated with national population statistics. Intussusception was anatomically classified into ileoileal, ileocolic, and colocolic types. The clinical features, management, outcome, and possible causes were examined. Results. We reviewed the occurrence and clinical spectrum of intussusception in 423 children (age, 0-14 years) presenting with acute intussusception to 9 pediatric surgical centers. The mean duration of symptoms was 1.5 days, but a delayed presentation was common (median delay, 2.3 days). Intussusception occurred throughout the year, with a peak in the summer months. The majority of patients (89%) were <2 years old, and 78% presented at age 3-18 months of age. Crude population estimates indicate an occurrence of 1 case per 3123 population <2 years old. Only 11% of patients presented after 2 years of age, and the age at presentation was significantly lower (P<.05) in black African patients. All ethnic groups were affected. In P < .05 84% of patients, intussusception occurred at the ileocolic region junction, in 7% it was ileoileal, and in 9% it was colocolic. Colocolic intussusception appeared more common in black African patients, and associated pathologic conditions (polyps and Burkitt's lymphoma) occurred mainly in older children. Surgical intervention was required in 81% of patients and involved resection of gangrenous bowel in 40%. Conclusion. Intussusception appears to be a relatively frequent occurrence in children in South Africa. Although the clinical spectrum appears to vary, there is an apparent link to intestinal infection, which requires further investigation. A collaborative approach is required to ascertain the relationship of intussusception to preventable infections and to improve its diagnosis and management. © 2010 by the Infectious Diseases Society of America.

Schutte C.-M.,Steve Biko Academic Hospital | Townsend T.,Steve Biko Academic Hospital | Van Coller R.,Steve Biko Academic Hospital | Olorunju S.,Medical Research Council
South African Medical Journal | Year: 2013

Background. HTLV-1 associated myelopathy (HAM), or tropical spastic paraparesis, is caused by a retrovirus, the human T-cell lymphotropic virus (HTLV). Although patients with HAM and HIV infection have been described, to our knowledge no direct comparison has been made between patients who are HIV positive and suffering from HAM (HHAM) v. those who are HIV negative and suffering from HAM. Aim. We aimed to compare clinical and radiological findings in HIV-positive and -negative patients with HAM. Methods. Adult patients who presented to the Neurology Unit at the Steve Biko Academic Hospital from May 2005 to June 2012 with a progressive myelopathy and HTLV seropositivity were retrospectively identified and their clinical and radiological data were collected and reviewed. Results. 21 patients with HAM were identified, of whom 9 were HIV-positive and 11 HIV-negative. One patient, whose HIV status had not been established, was not included in the study. Although the trend did not reach statistical significance, co-infected patients tended to present at an earlier age (HHAM 6/9 (66%) <40 years old; HAM 2/11 (18%) <40 years old) and presented to hospital earlier (HHAM 6/9 (66%) < 3 years symptomatic; HAM 7/11 (63%) > 3 years symptomatic). Cord atrophy occurred in 7/8 dually infected patients and 8/10 HIV-negative patients. Conclusion. Although the study is limited by the small number of patients, co-infected patients tended to have a younger age of onset and to present to hospital sooner, and thoracic cord atrophy was very common.

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