Nightmares and sleep terrors

Nightmares are common in childhood and concern regarding underlying psychological or physical causes should only be investigated when nightmares become frequent, are present for a prolonged period of time or are associated with day-time behavioural or performance dysfunction. Sleep terrors may be provoked by a number of factors, such as: fever, sleep deprivation, urinary bladder distension, a noisy environment and central nervous system depressants. This article discusses the differences between nightmares and sleep terrors and provides a management approach for the family practitioner. South African Family Practice Vol. 49 (6) 2007: pp. 26-2

Anxiety and Hysterical Symptoms in Schizophrenia

The existence of both anxiety and hysterical symptoms have been described in schizophrenic populations. Various explanations exist. The issue of whether such symptoms represent discrete clinical entities or are intrinsic to the schizophrenic process, requires further research.Keywords: Schizophrenia, Anxiety, HystericalSouth African Psychiatry Review - November 200

Bacterial contamination of re-usable laryngoscope blades during the course of daily anaesthetic practice

Background and objectives. Hospital-acquired infections (HAIs) are largely preventable through risk analysis and modification of practice.Anaesthetic practice plays a limited role in the prevention of HAIs, although laryngoscope use and decontamination is an area of concern.We aimed to assess the level of microbial contamination of re-usable laryngoscope blades at a public hospital in South Africa.Setting. The theatre complex of a secondary-level public hospital in Johannesburg.Methods. Blades from two different theatres were sampled twice daily, using a standardised technique, over a 2-week period. Samples werequantitatively assessed for microbial contamination, and stratified by area on blade, theatre and time using Fisher’s exact test.Results. A contamination rate of 57.3% (63/110) was found, with high-level contamination accounting for 22.2% of these. Commoncommensals were the most frequently isolated micro-organisms (79.1%), but important hospital pathogens such as Enterobacter species and Acinetobacter baumannii were isolated from blades with high-level contamination. No significant difference in the level of microbial contamination by area on blade, theatre or time was found (p<0.05).Conclusions. A combination of sub-optimal decontamination and improper handling of laryngoscopes after decontamination results in significant microbial contamination of re-usable laryngoscope blades. There is an urgent need to review protocols and policies surrounding the use of these blades

Suicidal ideation and attempt among South African medical students

International data reveal that medical students are at higher risk of attempting suicide than the general population. We aimed to determine the prevalence of suicidal ideation and attempt among South African medical students from three universities and identify key predisposing risk factors. Data were collected via a questionnaire to medical students on demographics, mental health history, depressive symptoms, suicidal ideation and attempt. A total of 874 medical students from three universities were enrolled. We found a high prevalence of suicidal ideation (32.3%) and suicidal attempt (6.9%), which is three times higher than the general age-appropriate South African population. Simple screening questionnaires can identify such students, enabling universities to provide targeted and improved support for at-risk students.S Afr Med J 2012;102(6):372-37

Endotracheal Tube Cuff Pressures in Adult Patients Undergoing General Anaesthesia in Two Johannesburg Academic Hospitals

Background: Endotracheal tube (ETT) cuff pressure commonly exceeds the recommended range of 20–30 cm H₂O during anaesthesia. A set volume of air will not deliver the same cuff pressure in each patient and the pressure exerted by the ETT cuff can lead to complications, with either over- or under-inflated cuffs. These can include a sore throat and cough, aspiration, volume loss during positive pressure ventilation, nerve palsies, tracheomalacia and tracheal stenosis. No objective means of ETT cuff pressure monitoring is available in the operating theatres of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). The ETT cuff pressure of patients undergoing general anaesthesia is therefore unknown.Method: ETT cuff pressure of 96 adult patients undergoing general anaesthesia without nitrous oxide at CMJAH and CHBAH was measured by one researcher. A RUSCH Endotest™ manometer was used to measure ETT cuff pressure in size 7.0 – 8.5 mm ETTs. The cuff inflation technique that was used by the anaesthetist was also documented.Results: The mean ETT cuff pressure recorded was 47.5 cm H₂O (range 10–120 cm H₂O). ETT cuff pressures exceeded 30 cm H₂O in 64.58% of patients. Only 18.75% of patients had ETT cuff pressures within the recommended range of 20–30 cm H₂O. There was no statistically significant difference between the ETT cuff pressures measured at the two hospitals. Minimal occlusive volume was the most frequent technique used to inflate the ETT cuff (37.5%); this was followed by inflating the ETT cuff with a predetermined volume of air in 31.25% of cases and palpation of the pilot balloon (27.08%). There was no statistically significant difference between the ETT cuff pressure measured and the inflation technique used by the anaesthetist.Conclusion: ETT cuff pressures of the majority of patients undergoing general anaesthesia at two academic hospitals were higher than the recommended range. ETT cuff pressure should routinely be measured using a manometer.Keywords: Adults, Endotracheal Tube Cuff Pressures, General Anaesthesia, Manomete

Skeletal Divergence and Condylar Asymmetry in Patients with Temporomandibular Disorders (TMD): A Retrospective Study

Introduction. This study was aimed at evaluating the association between vertical skeletal patterns, condylar height symmetry, and temporomandibular disorders in adults. Methods. The study sample consisted of 200 patients (ages 18-30 years old) retrospectively recruited: 100 with temporomandibular disorders (TMD) and 100 without TMD (control), diagnosed by Diagnostic Criteria for the Temporomandibular Disorders (DC/TMD). For each subject, skeletal divergence was assessed on lateral cephalograms, and condylar height symmetry was evaluated by orthopantomography (Habets' method). Results. Subjects with temporomandibular disorders showed a strong association with condylar asymmetry (p0.29). Conclusions. Although it does not imply a direct cause-and-effect relationship, the present study suggests condylar asymmetry and hyperdivergent skeletal pattern are more likely to be associated with a higher risk of temporomandibular disorder joint diseases in adult patients

Clinical characteristics and premorbid variables in childhoodonset schizophrenia: a descriptive study of twelve cases from a schizophrenia founder population

Objective: To analyze clinical and demographic data of childhood-onset (12 years and younger) schizophrenia patients collected for a genetic study in schizophrenia, undertaken nationally in South Africa, using multiple parameters. Method: Patients with an onset of schizophrenia at 12 years or younger, were included. From the Diagnostic Interview for Genetic Studies (DIGS), patients’ information and summary report data was tabulated and analyzed. Specific subgroups were further compared. This sub-population of 12 subjects was further compared with a group of the adult sample. Results: Of the 12 patients recruited, prominent resultswere: male to female ratio of 1:1; all had insidious onset of psychosis; a third had all 3 multidimensional impairment (MDI) symptoms; all patients that received ADHD treatment had ADHD treatment failure; two thirds had milestone delay; 58% had birth complications; a third were predominantly bottle fed; 42% had family history of schizophrenia; a third had family history of other major psychiatric conditions; all patients had at least one non-psychotic deviant behaviour (NPDB); no patient used cannabis; alldelusions were paranoid; 92% had school achievement difficulty and a third had treatment resistance. Gender comparison included: earlier onset of psychosis in females; all females had aggression versus a third of males; more females had school achievement difficulty than males; males had more treatment resistance. Patients with MDI, compared to the sample average had: earlier onset of non-psychotic deviant behaviour; lower school drop-out rate; less social difficulty and no treatment resistance. Conclusion: The results compare well to previous research on this topic. The new concepts introduced by the present studyrequire further investigation

Suicidal ideation and attempt among South African medical students

International data reveal that medical students are at higher risk of attempting suicide than the general population. We aimed to determine the prevalence of suicidal ideation and attempt among South African medical students from three universities and identify key predisposing risk factors. Data were collected via a questionnaire to medical students on demographics, mental health history, depressive symptoms, suicidal ideation and attempt. A total of 874 medical students from three universities were enrolled. We found a high prevalence of suicidal ideation (32.3%) and suicidal attempt (6.9%), which is three times higher than the general age-appropriate South African population. Simple screening questionnaires can identify such students, enabling universities to provide targeted and improved support for at-risk students

Suicidal ideation and attempt among South African medical students

International data reveal that medical students are at higher risk of attempting suicide than the general population. We aimed to determine the prevalence of suicidal ideation and attempt among South African medical students from three universities and identify key predisposing risk factors. Data were collected via a questionnaire to medical students on demographics, mental health history, depressive symptoms, suicidal ideation and attempt. A total of 874 medical students from three universities were enrolled. We found a high prevalence of suicidal ideation (32.3%) and suicidal attempt (6.9%), which is three times higher than the general age-appropriate South African population. Simple screening questionnaires can identify such students, enabling universities to provide targeted and improved support for at-risk students.http://www.samj.org.z

Diode laser-assisted surgical therapy for early treatment of oral mucocele in a newborn patient : case report and procedures checklist

Mucocele (also known as ranula or salivary gland mucous cyst) of the newborn is a lesion present on the intraoral cavity, with the potential to interfere with respiration and feeding. In the present report, a case of mucocele in a 4-month female patient has been described. As conventional surgery can be followed by several complications such as intraoperative bleeding, difficulties in wound healing, and maintenance of sterility during surgery, in the present case, the use of diode laser has been planned. A topic anesthesia with lidocaine gel was performed. A diode laser (810 nm wavelength, continuous wave mode, power output of 3 watt, and 0.4 mm diameter fiber optic) was set for excising the lesion. The tip was directed at an angle of 10 to 15\ub0, moving around the base of the lesion with a circular motion. The procedure was completed in 3 minutes. The patient was visited with a follow-up of 2 weeks and 4 months after excision. The intraoral wound healed without complications, and no signs of infection or mass recurrence were noted. The histopathological examination confirmed the diagnosis of mucocele. On the basis of the results of the present case report, the use of diode laser can be easily performed also in a noncompliant newborn patient for successful excision of mucocele lesions, and checklist of clinical procedures has been described