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Truth telling in a South African tertiary hospital
South African Journal of Bioethics and Law , 2010,
Abstract: Introduction. Truth telling forms part of the contemporary debate in clinical bioethics and centres around the right of the patient to receive honest information concerning his or her medical condition/illness and the duty of the doctor to give this information to the patient. Many patients complain that they are not being informed, but on the other hand there may be patients who do not want a truthful answer about their health problems. Objectives. This study explores the preferences of patients at four Johannesburg General Hospital outpatient clinics regarding the practice of truth telling and their attitudes towards it. Methods. Four hundred and sixty-five participants voluntarily completed and returned a questionnaire. Results. The majority of the participants stated that the doctor had disclosed information about their condition (92.9%). Almost all were of the opinion that patients have the right to know about their condition (98.3%) and also that the doctor has the duty to inform them of their condition (98.0%). If they were suffering from a serious condition most participants (86.3%) would prefer to know about it, but a small but significant percentage (13.7%) would prefer not to know. Variables such as gender, age and level of education did not seem to impact significantly on the participants’ opinions about the truth telling process, with the exception of gender, as more females than males had knowledge of their condition (p=0.0176), and education, where more participants with higher education supported the right to disclosure (p=0.0430). Conclusion. The vast majority of participants supported the right of patients to disclosure, but the majority also considered that the level of information given to them was not satisfactory, even when they had asked for more. This implies a need to look at the way we give information to our patients and to seek ways in which this can be improved.
Radioiodine therapy in skeletal metastases from well-differentiated thyroid cancer: a Johannesburg experience
NS Perumal, MDTHW Vangu
South African Journal of Radiology , 2010,
Abstract: Aim.The purpose of this study was to examine the outcome of patients with skeletal metastases from well-differentiated thyroid carcinoma and analyse the effect of variables that influence the prognosis of this disease. Method. We retrospectively reviewed 352 patients treated and followedup at the Charlotte Maxeke Johannesburg Academic Hospital’s thyroid cancer clinic from 1982 - 1999. Findings. Skeletal metastases were diagnosed in 24 (6.8%), 17 at presentation to the thyroid clinic, and 7 at follow-up. Patients’ ages ranged from 30 - 77 years (mean 53.9 years) and the female:male ratio was 3.8:1. Based on the original pathology reports from resected tumours, 9 were papillary and 15 were follicular cancers. Twenty-three of the 24 patients underwent thyroid surgery as the initial management – total thyroidectomy in 18, subtotal thyroidectomy in 3, and lobectomy plus neck dissection in one. The diagnosis of thyroid cancer was based on lobectomy in a single subject. Radioactive iodine (RAI) was used as part of the original treatment; external radiation therapy (XRT) was mainly used to alleviate severe symptoms. Twenty-one patients (87.5%) were treated with RAI; 11 (45.8%) received radiotherapy. Seven patients died – 4 from neurological disease directly associated with bone metastases. Of the 17 surviving patients, 2 appeared to be disease-free, 8 were asymptomatic despite overt bony disease, and 7 had persistent symptoms which much improved in 5. Bone metastases were uncommon, and follicular cancer predominated in this survey. Conclusion. RAI therapy improves quality of life in most patients. There is a place for XRT
Case Report: Chilaiditi’s syndrome demonstrated by SPECT-CT
N Perumal, M-D-T Vangu, K Purbhoo, S Dhoodhat
South African Journal of Radiology , 2009,
Abstract: No
Helicobacter pylori infection is identified as a cardiovascular risk factor in Central Africans
Longo-Mbenza B, Nsenga JN, Mokondjimobe E, Gombet T, Assori IN, Ibara JR, Ellenga-Mbolla B, Vangu DN, Fuele SM
Vascular Health and Risk Management , 2012, DOI: http://dx.doi.org/10.2147/VHRM.S28680
Abstract: obacter pylori infection is identified as a cardiovascular risk factor in Central Africans Original Research (1368) Total Article Views Authors: Longo-Mbenza B, Nsenga JN, Mokondjimobe E, Gombet T, Assori IN, Ibara JR, Ellenga-Mbolla B, Vangu DN, Fuele SM Published Date August 2012 Volume 2012:8 Pages 455 - 461 DOI: http://dx.doi.org/10.2147/VHRM.S28680 Received: 29 November 2011 Accepted: 25 January 2012 Published: 15 August 2012 Benjamin Longo-Mbenza,1 Jacqueline Nkondi Nsenga,2 Etienne Mokondjimobe,3 Thierry Gombet,3 Itoua Ngaporo Assori,3 Jean Rosaire Ibara,3 Bertrand Ellenga-Mbolla,3 Dieudonné Ngoma Vangu,4 Simon Mbungu Fuele4 1Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; 2Division of Gastroenterology, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; 3Faculty of Health Sciences, University of Marien Ngouabi, Brazzaville, Democratic Republic of the Congo; 4Biostatistics Unit, Lomo Medical Center, Limete, Kinshasa, Democratic Republic of the Congo Background: Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis. Objective: To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor. Methods: Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999–2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris. Results: At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2–7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4–8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6–16; P < 0.0001), incident acute stroke (multivariate
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