The betrayal of Steve Biko – South Africa’s Initial Report to the UN Committee against Torture and responses from civil society

Lukas Muntingh reveals that South Africa ratified the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT) in 1998 and that its Initial Report, which was due a year later, was only submitted in 2005 and assessed by the UN Committee against Torture in November 2006. The Initial Report was incomplete, deviated from the guidelines and dealt superficially with obligations under CAT. In response to the Initial Report, six civil society organisations made written and oral submissions to the UN Committee against Torture during its 37th Session. This enabled the Committee to obtain a more informed view of steps taken, or not taken, by South Africa to give effect to its obligations under CAT. Many of the concerns raised by the civil society organisations found their way into the Committee’s Concluding Remarks on the Initial Report. The overall impression remains that the South African government has to date not regarded its obligations under CAT as a priority

Drugs in Aviation - A Review

The Aviation Medicine Department of the South African Civil Aviation Authority (SACAA), Aviation Medical Examiners (AME), and Institute for Aviation Medicine (IAM) receive numerous inquiries regarding the use of medication in the aviation environment. Flying an aircraft or controlling aircraft on the ground are highly demanding cognitive and psychomotor tasks, performed in an often inhospitable environment, with exposure to various sources of stress. It is therefore important for aviation personnel (i.e. aviation medical examiners, pilots, cabin crew and air traffic services personnel) to consider the effects that medicine or drugs may have on performance. Studies confirm that some pilots, and other crew members while on duty, used prohibited medications or illegal substances or performed duties while suffering significant unreported medical conditions. When considering aircraft mishaps and their causes, we tend to focus on the pilot. After all, he's in the driver's seat, there to troubleshoot any problems that may arise, and he's expected to bring the “on-loan” aircraft back to base, in one piece, after a mission. If a mishap occurs, investigators look for causes related to pilot error along with evidence of mechanical failure, weather factors, and runway condition and air traffic control (ATC) issues. Reviews of data from general aviation, commercial and military aircraft mishaps show that the two most often cited causal issues are pilot error and mechanical/logistical factors. If pilot error was identified, the question now arises: Are some instances of incorrect controlling of an aircraft due to human factors, such as poor diet or insufficient rest (self-imposed), fatigue, poor concentration, shift-work problems, inadequate training or lack of motivation? More specifically, the following in terms of pilot error have been identified in the USA: • Flying under the influence of alcohol – 15% • Conducting unwarranted manoeuvers – 30% • Penetrating known adverse weather conditions beyond pilot and aircraft capabilities – 40% • Drug impairment of the pilot (includes prescribed medication) – 6% • Miscellaneous – 9% Although these statistics relate to the pilot, they can no doubt be extended to other aviation personnel e.g. ATC, cabin crew (CC) and aircraft maintenance officers (AMO). Of note is that up to 6% of aircrew are ‘under the influence of medication' while operating an aircraft. Aircrew, like all of us, are prone to illness, but those who take medicine on an inadequately informed basis or undertake self-medication, not only endanger their lives but also jeopardise the safety of passengers and costly aircraft. The Aviation Medicine Department of the South African Civil Aviation Authority, Aviation Medical Examiners, and the Institute for Aviation Medicine receive numerous inquiries regarding the use of medication in the aviation environment. In addition, reports have been received relating to aviation personnel using unapproved medication or illegal drugs. Furthermore, a physician may prescribe medication for a patient while being unaware that the patient is performing duties within the aviation environment. Or, a pilot self-medicates because consulting an AME may result in flying privileges being withdrawn. Flying an aircraft or controlling aircraft on the ground are highly demanding cognitive and psychomotor tasks, performed in an inhospitable environment, with exposure to various sources of stress. It is therefore important for aviation personnel (i.e. aviation medical examiners, pilots, cabin crew and air traffic controllers) and non-aviation medical examiners to consider the effect that medicine or drugs may have on aviation performance. A study performed in 1994 by the FAA revealed that an estimated 14 000 US pilots flew while using prohibited medications or illegal substances or flew with significant unreported medical conditions.1 Greater understanding of the effects of medication in humans, and advances in drug development have now made possible the use of various medications by aircrew. In this context assessment of side effects which a drug may have on performance, has become an important part of its clinical profile and provides increased and more informed availability of potential therapy for aircrew. The aim of this review is to make the non-aviation medical examiner aware of, and to provide an understanding of the issues involved rather than to provide recommendations for drug use in aviation and to outline the various approaches that can be adopted to assess whether a drug can be used safely.South African Family Practice Vol. 49 (9) 2007: pp. 4

Anaemia – a pale ale?

Despite some modest improvements described recently, anaemia remains a significant global public health concern affecting both developed and developing countries. It affects a quarter of the global population, including 293 million (47%) children who are younger than five years of age. A prevalence of 42% and 30% has been described in pregnant and non-pregnant women, respectively. Children and women of reproductive age are at high risk, partly because of physiological vulnerability, followed by the elderly. Africa and Asia are the most heavily affected regions, accounting for 85% of the absolute anaemia burden in highrisk groups. According to the World Health Organization global database on anaemia (1993–2005), this disorder was considered to be a moderate public health problem in South African preschool children, pregnant women and non-pregnant women of reproductive age

A summary overview of the new, direct, target-specific oral anticoagulants

In the past 10 years or so, many alternatives to warfarin have been developed the first being the novel oral anticoagulants (NOAC) or better referred to as direct oral anticoagulants (DOAC) or target-specific oral anticoagulants (TSOAC). These drugs have some definite advantages and disadvantages that should be clear to physicians before prescribing any of them for patients. Many clinical trials have provided definitive information about the efficacy and safety of DOACs, yet many physicians remain sceptical about prescribing these drugs due to lack of answers to real world questions. The concerns are directed towards appropriate patient selection (the choice should be made according to age, renal function, compliance, cost, clinical condition, intake of other drugs), the mechanism of switching between agents, how these drugs affect routine laboratory tests and when monitoring is needed. Knowledge of other drugs that interact with the DOAC and management of severe bleeding will be reviewed and recommendations will be given to all of these concerns.www.tandfonline.com/oemdam2016Pharmacolog

“Alpha-1, are you in? (C)harlie (O)scar (P)appa (D)elta, over!”

Chronic obstructive pulmonary disease (COPD) is characterised by chronically poor air flow. Typically, it worsens over time. The main symptoms include shortness of breath, coughing and sputum production. Most people with chronic bronchitis have COPD. Tobacco smoking is the most common cause of COPD. A number of other factors, such as air pollution and genetics, play a smaller role. One of the common sources of air pollution is poorly vented cooking and heating fires in the developing world. Longterm exposure to these irritants causes an inflammatory response in the lungs, resulting in narrowing of the small airways and breakdown of the lung tissue, leading to emphysema. Genetic involvement, i.e. alpha-1 antitrypsin deficiency, is now a recognised cause. The diagnosis is based on poor air flow, as measured by lung function tests. In contrast to asthma, the air flow reduction does not improve significantly with the administration of a bronchodilator. COPD can be prevented by reducing exposure to known environmental risk factors. This includes an effort to decrease the rate of smoking and to improve indoor and outdoor air quality. COPD treatment includes stopping smoking, vaccinations, rehabilitation, and often inhaled bronchodilators and steroids. Some people may benefit from long-term oxygen therapy or lung transplantation. Increased use of medication and hospitalisation may be needed in those who have periods of acute worsening. Worldwide, COPD effects 329 million people, or nearly 5% of the population. In 2013, it resulted in 2.9 million deaths, up from 2.4 million deaths in 1990. The number of deaths is projected to increase owing to higher smoking rates and an ageing population in many countries. New treatments are also emerging very slowly.http://www.tandfonline.com/oemdhttp://www.safpj.co.za/index.php/safpjam2016Pharmacolog

Enige variante by die Werkwoord in die Habakuk-kommentaar

No abstract available

Do some of the newer COX-2 inhibitors cross-react with sulfonamide antibiotics? An overview

The professional information leaflets of three locally available specific cyclooxygenase-2 inhibitors indicate that these drugs are contraindicated in persons with a known allergy to sulfonamides. There are many concerns about cross-allergenicity between sulfonamide antibiotics and non-antibiotic sulfonamide-containing drugs including the sulfones, and these concerns continue to complicate drug therapy. Several elegant investigations have demonstrated lack of interaction between the sulfonamide group and either cellular or humoral immunity. The immunologic determinant of type I immunologic responses to sulfonamide antibiotics are the N1 heterocyclic ring, and non-antibiotic sulfonamides including the sulfones lack this structural feature. Reactive sulfonamide metabolites contribute many non-type I hypersensitivity responses to sulfonamide antibiotics. Metabolite formation demonstrates stereospecificity to the N4 amino nitrogen of the sulfonamide antibiotics, a structure not found on any non-antibiotic sulfonamide drugs and is also lacking in the sulfones. Apparent cross-reactivity responses to sulfonamide-containing drugs likely represent multiple concurrent, rather than linked, drug hypersensitivities.http://www.charpublications.co.za/C_JournalsORTH.as

Case study

During a dissection practical in the Anatomy Department of the University of Pretoria, students found an unknown tablet in the rectum of a male cadaver (Fig 1). The deceased was approximately 68 years of age and the cause of death was not known. However, it was noted that the deceased had an enlarged heart with ventricular hypertrophy.http://www.sapj.co.za/index.php/sapjam201

Vitamin D – the vitamin hormone

Vitamin D is a fat-soluble vitamin that plays an important role in bone metabolism and seems to have some anti-inflammatory and immune-modulating properties. For most people sunlight is the most important source of vitamin D. The time required to make sufficient vitamin D varies according to a number of environmental, physical and personal factors, but is typically short and less than the amount of time needed to damage the skin e.g. reddening and burns. Enjoying the sun safely, while taking care not to burn, can help to provide the benefits of vitamin D without unduly raising the risk of skin cancer. Vitamin D supplements and specific foods can aid in maintaining sufficient levels of vitamin D, particularly in people at risk of deficiency. However, there is still a lot of uncertainty around what are “optimal” or “sufficient” levels, how much sunlight different people need to achieve a given level of vitamin D, and whether vitamin D protects against chronic diseases such as cancer, heart disease and diabetes, and the benefits and risks of widespread supplementation.http://www.tandfonline.com/oemdhttp://www.safpj.co.za/index.php/safpjam2017Pharmacolog

A "site" for sore eyes

It is known that not all red eyes are caused by infections. Furthermore, not all eye infections will react to antibiotic eye drops. Most cases of conjunctivitis are due to viral causes, do not require antibiotic eye drops and are usually self-limiting. Serious ophthalmic conditions such as infectious keratitis can lead to blindness; it is an emergency that requires specialist treatment. Also infectious endophthalmitis has become more frequent with the use of intravitreal injections. Intravitreal antibiotics are needed to try and prevent visual loss. To ensure therapeutic local exposure ophthalmic antibiotic solutions should be applied frequently into the eye