Dangers of food poisoning in psychiatric patients.

food poisoning can be fatal in patients with chronic constipation. We report the investigation and management of a probable outbreak of food poisoning among psychiatric patients in Cape Town, South Africa, in 2013.

Fresh frozen plasma for on-demand hereditary angioedema treatment in South Africa and Iran.

Background: International guideline-recommended on-demand treatments for hereditary angioedema (HAE) include: C1-esterase inhibitor (plasma-derived or recombinant), or bradykinin-receptor antagonists. In most low- and middle-income countries (LMIC) these products are not registered or are unaffordable. Solvent-detergent, fresh or freeze-dried plasma therapy is thus the only available on-demand treatment in these settings; but published data on efficacy and safety are limited.

Rib fracture fixation as a tool for extubation in a resource-poor environment.

An elderly female with multiple comorbidities was involved in a pedestrian vehicle accident and sustained blunt chest trauma, arriving at a resource-poor hospital in rural South Africa. She had multiple bilateral rib fractures with a unilateral flail segment that caused her to develop respiratory failure. She was intubated and sent to the intensive care unit (ICU) for ventilation.

Bishop-Koop jejunostomy in an adult following proximal small bowel anastomotic breakdown.

This case involves a proximal penetrating small bowel injury and the use of a Bishop-Koop anastomosis in a 33-year-old man. This case highlights the use of alternative methods used to prevent a proximal small bowel stoma in a rural setting. The Bishop-Koop anastomosis was originally designed for neonates in cases of intestinal anomalies such as atresia, volvulus and apple-peel syndrome.

HIV-associated neurocognitive disorder in a KwaZulu-Natal HIV clinic: A prospective study.

Introduction: HIV-associated neurocognitive disorder (HAND) is a consequence of HIV infection of the central nervous system. The prevalence ranges between 15% and 60% in different settings.

Objectives: This prospective study determined the prevalence of HAND at a peri-urban HIV clinic in KwaZulu-Natal.

Knowledge of symptoms and self-management of hypoglycaemia amongst patients attending a diabetic clinic at a regional hospital in KwaZulu-Natal.

Background: Diabetic patients on insulin and sulphonylureas are at risk of developing hypoglycaemia. Many patients do not respond appropriately because of poor knowledge and understanding of the symptoms of hypoglycaemia, which if not promptly treated can lead to permanent neurological and renal damage. Hypoglycaemic complications can be avoided if patients have a good knowledge of the early symptoms of hypoglycaemia and know how to respond appropriately.

Delayed implants sepsis in HIV-positive patients following open fractures treated with orthopaedic implants.

Background: There has been concern that HIV-positive patients may be more susceptible to delayed infection (>1 month) after treatment of open fractures with orthopaedic implants. To date, the longest published follow-up for such patients is 6 months.

Aim: Long-term follow-up to identify rates of delayed implant sepsis in open fractures treated with internal fixation, in HIV positive patients and controls.

Emergency focussed assessment with sonography in trauma (FAST) and haemodynamic stability.

Background: Focussed assessment with sonography in trauma (FAST) has assumed a key role in the rapid non-invasive assessment of thoracoabdominal trauma and assists in decreasing disposition time. This study evaluates FAST's efficacy with respect to haemodynamic stability in a South African emergency department (ED).

Methods: Data were collected prospectively by four emergency medicine doctors trained in emergency ultrasonography.

Misdiagnosis of diaphragmatic rupture in a trauma setting.

Distinguishing diaphragmatic eventration from rupture in the trauma setting can be a considerable challenge. We present a case involving a man suffering from chest pain and with a raised left hemidiaphragm on the chest radiograph after a motor vehicle injury. A review of the literature discusses the use of imaging modalities and subsequent surgical diagnostic procedures in the face of uncertainty.

Burns in rural Kwa-Zulu Natal: epidemiology and the need for community health education.

Introduction: Burns are one of the leading causes of accidental deaths in South Africa. The northern Kwa-Zulu Natal (KZN) area, in which this study was conducted, has a population at high risk of burn. A large proportion of the population of KZN live in rural settlements and use traditional methods of cooking and heating.

Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual.

Endemic to over 70 countries and resulting in 200 million infected individuals and 500,000 deaths each year, the Schistosoma trematode worm can result in multisystem morbidity. Bowel obstruction secondary to this parasite has previously been described, but we report the first case of schistosomiasis affecting the sigmoid colon and resulting in perforation in a male positive for human immunodeficiency virus.

Massive bilateral tarsal ankylosis and surgical correction: a case report.

Tarsal ankylosis is described as a feature of advanced juvenile or rheumatoid arthritis. Ankylosis involving more then one tarsal segment is uncommon. Incidental reports of massive tarsal ankylosis have been described in a case of juvenile spondyloarthropathy, a case of familial tarsal ankylosis, and, more recently, it was discovered in a prehistoric skeleton dating back to the Iron Age.

Femoral torsion in patients with Blount's disease: a previously unrecognised component.

In 1937 Blount described a series of 28 patients with 'Tibia vara'. Since then, a number of deformities in the tibia and the femur have been described in association with this condition. We analysed 14 children with Blount's disease who were entered into a cross-sectional study.

Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study.

Background: Childhood tuberculosis often presents non-specifically and is a common differential diagnosis in high prevalence areas. Current diagnostic tools have poor sensitivity and cannot reliably exclude tuberculosis, so overdiagnosis is common. HIV co-infection exacerbates this problem and accounts for an increasing proportion of paediatric tuberculosis worldwide.

HIV-exposed infants with acute respiratory failure secondary to acute lower respiratory infections managed with and without mechanical ventilation.

Objectives: The decision to provide mechanical ventilation (intermittent positive pressure ventilation (IPPV)) to HIV-exposed infants in resource-poor settings has remained difficult owing to problems in confirming HIV infection and the lack of data on outcome. We evaluated the predictive value of the HIV antibody test in confirming infection in infants requiring mechanical ventilation for acute lower respiratory infections (ALRIs), and compared the outcome for children denied access with the outcome for similar subjects who were ventilated.

Setting And Design: This investigative study was conducted over a 12-month period at the paediatric intensive care unit (PICU) at King Edward VIII Hospital (KEH) in Durban, and at Ngwelezana Hospital in northern KwaZulu-Natal.

Health status of the children in a high density town near Harare, Zimbabwe.

Objectives: To determine the health status of the children for conditions associated with poverty.

Design: Cross sectional.

Setting: Households in Chitungwiza, a dormitory town of Harare, Zimbabwe.

Housing conditions in a high density town near Harare, Zimbabwe.

Objectives: To determine the living conditions of people and to compare the results with census figures.

Design: Cross sectional.

Setting: A high density dormitory suburb of Harare, Zimbabwe.

Sexually transmitted pathogens in pregnant women in a rural South African community.

One hundred and ninety three consecutive pregnant women attending peripheral antenatal clinics attached to Ngwelezana Hospital, Empangeni, Kwa-Zulu, were examined for evidence of sexually transmitted pathogens. The following incidences were found: Trichomonas vaginalis 49.2% (95), Candida spp 38.

Mutilating granuloma inguinale after rape. A case report.

A woman with extensive mutilating lesions of genital granuloma inguinale following rape is described. As far as is known granuloma inguinale has not previously been reported in a rape victim.

Observations on the bite of the southern burrowing asp (Atractaspis bibronii) in Natal.

The burrowing asp, Atractaspis bibronii, causes a significant proportion of cases of snakebite near Empangeni, Natal. Data from 8 cases are presented. All were in rural Zulus, and the bites were usually inflicted on the foot during summer nights, in or near the patient's home.