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Biomedical subjects

S R Benatar

Publications and source records attributed to S R Benatar.

At least 73 records · Page 4Linked to original sources
PubMed1990

A unitary health service for South Africa.

Medicine throughout the world is facing many critical challenges. In South Africa these are exacerbated by the effects apartheid has had on the structure, funding, distribution and delivery of health care. The demographic, economic, political, ethical and management problems facing our health services and the arguments in favour of privatisation are briefly reviewed. The case against privatisation of health care is buttressed by moral, economic and sociological justification for developing a unitary national health service/insurance system. In a rapidly changing South Africa medical care could become the leading edge of an enlightened social policy, which may facilitate peaceful progress towards a better future for all in our country and sub-continent.

Economics↗
PubMed1990

The pattern of care in the medical wards of a teaching hospital.

The Appropriateness Evaluation Protocol was applied in the internal medicine unit of a major South African teaching hospital to determine the proportion of patient days justifying hospital care. A high proportion of total inpatient days was found to be justified (71%); this was similar to hospitals in the USA and better than a comparable hospital in the UK. Only a small proportion of the non-justified days (3%) was explained by the demographic and hospital variables examined. Inappropriate days occurred nearer the end of a stay, and were disproportionate in patients not from the city in which the hospital was situated. Cerebrovascular accidents accounted for close to 10% of total inpatient days. A significant proportion of patient days (23%) did not include a documented doctor contact. Nursing observations were applied routinely, with little association with other indicators of the severity of the patient's condition. This study method is simple, reliable, reproducible and informative. It should be used more widely as a means of launching discussion and evaluation of hospital activity, both in the public and the private sectors.

Evaluation Studies as Topic↗
PubMed1990

Ventilatory responses to carbon dioxide in four ethnic groups in Cape Town.

Ventilatory responses to carbon dioxide (Sco2) were measured in 80 healthy adult subjects from four ethnic groups living in Cape Town. The mean Sco2 was 1.77 +/- 0.14 l/min/mmHg in whites, 1.13 +/- 0.09 l/min/mmHg in mixed race people, 0.99 +/- 0.11 l/min/mmHg in Indians and 0.87 +/- 0.10 l/min/mmHg in blacks. The difference between whites and the other three ethnic groups was highly significant (P less than 0.0001), whereas the differences between blacks, mixed race subjects and Indians were not. However, correction of Sco2 for differences in lung size, i.e. Sco2/vital capacity, eliminated the differences between whites and the other groups.

Adult↗
PubMed1990

Miliary tuberculosis: rapid diagnosis, hematologic abnormalities, and outcome in 109 treated adults.

PURPOSE: The purpose of this study was to determine the clinical and laboratory characteristics, diagnostic methods, and prognostic variables in adults treated for miliary tuberculosis in the rifampicin era. PATIENTS AND METHODS: Computerized records of our community-based university teaching hospital over a 10-year period (1978 to 1987) were analyzed. A total of 109 patients were identified, including 12 who did not have miliary nodules on the chest radiograph (all of whom were shown to have hematogenous dissemination). Predisposing conditions were present in 46 patients. RESULTS: Clinical features were similar to those of previously reported series. Hematologic abnormalities were common: leukopenia (less than 4 x 10(9)/L) was present in 16 of 107 patients (15%), thrombocytopenia (less than 150 x 10(9)/L) in 24 of 104 (23%), and lymphopenia (less than 1.5 x 10(9)/L) in 82 of 94 (87%). Pancytopenia was found in six patients, three of whom recovered. Disseminated intravascular coagulation occurred in four patients, all of whom died. Adenosine deaminase levels were elevated in only seven of 11 serosal exudates and in seven of 12 samples of abnormal cerebrospinal fluid. Fiberoptic bronchoscopy was diagnostic in 44 of 51 patients (86%), bone marrow examination in 19 of 22 (86%), and liver biopsy in all 10 patients. Twenty-six patients (24%) died of miliary tuberculosis a median of 6 days after starting treatment. Survivors were followed up for a median of 51 weeks. Stepwise logistic regression identified aged (greater than 60 years), lymphopenia, thrombocytopenia, hypoalbuminemia, elevated transaminase levels, and treatment delay as independent predictors of mortality. CONCLUSIONS: Miliary tuberculosis commonly causes hematologic derangements, some of which are helpful prognostically. Fiberoptic bronchoscopy compares favorably to liver and bone marrow biopsy in sputum smear-negative cases. Mortality remains high and treatment should be begun as soon as the diagnosis is suspected.

Adolescent↗
PubMed1990

Experience with fibreoptic bronchoscopy in the diagnosis of pulmonary shadows in renal transplant recipients over a 12-year period.

Despite improvements in immunosuppressive therapy, pulmonary infections remain an important cause of morbidity and mortality in renal transplant recipients. Over a 12-year period (1 January 1977 to 31 December 1988) we prospectively assessed the value of fibreoptic bronchoscopy in diagnosing radiographic pulmonary shadows in this group of patients. Forty-eight bronchoscopies were performed on 46 patients. A definitive diagnosis was established in 28/48 (58%) procedures (and was partially definitive for one of two organisms ultimately identified in another). The procedure failed in 19/48 (40%), although in 15 of these, the radiographic shadows resolved on antibiotics (9) or spontaneously (3) or autopsy revealed acute pneumonia (3). In four instances a specific diagnosis was made by alternative means. Clinically useful information which led to changes in management was obtained in 17/48 (35%) procedures and bronchoscopy was thought to have favourably influenced survival in 16/48 (33%). Fibreoptic bronchoscopy is in our experience a safe (only one pneumothorax and no significant haemorrhage) and useful technique in evaluating pulmonary shadows in renal transplant recipients.

Adolescent↗
PubMed1990

Primary pulmonary hypertension and thromboembolic pulmonary hypertension--similarities and differences.

In a retrospective study of 36 patients with primary pulmonary hypertension (PPH) and 16 patients with chronic large vessel thromboembolic pulmonary hypertension (TPH) the diagnostic value of clinical features, chest radiographs, electrocardiographs, radionuclide lung scanning and cardiac catheterization was assessed. PPH patients were younger, had higher prevalence of Raynaud's phenomenon, right axis deviation, right ventricular hypertrophy on electrocardiograph and higher pulmonary artery pressures than TPH patients, but these features were not diagnostic. Although pulmonary angiography is considered by some to be necessary in distinguishing these two conditions, radionuclide lung scanning proved a safe and effective noninvasive method for this purpose.

Blood Pressure↗
PubMed1990

Prognostic and therapeutic considerations in clinical primary pulmonary hypertension.

Twenty-two patients with primary pulmonary hypertension were reviewed to assess the correlation of clinical and haemodynamic features with prognosis. A relationship between resting haemodynamic measurements and survival was sought in all 22 patients, and the effect of vasodilator therapy in 13 was reviewed. Those who survived 12 months or less (seven patients) or 40 months or more (seven patients) from catheterization were classified into short or long survival groups respectively. Clinical, haemodynamic and pulmonary angiographic features of patients in these groups were compared. In the whole group, mean pulmonary artery pressure and pulmonary vascular resistance were inversely related to survival. Multivariate analysis of mean pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), mean right atrial pressure (RAP), systemic vascular resistance (SVR) and cardiac index (CI) in the whole group identified RAP and PVR as the model which best predicted survival time. The short survival group had a higher prevalence of electrocardiographic evidence of right ventricular hypertrophy, higher mean pulmonary artery pressure and pulmonary vascular resistance than the long survival group. Our experience with vasodilator therapy was less encouraging than that described by other workers. Two of six patients on long-term treatment appeared to stabilize. Two other untreated patients showed spontaneous improvement. Prediction of prognosis in the individual patient is difficult.

Analysis of Variance↗
PubMed1989

Cape crusaders.

Explore the source record for details and available documents.

Hospitals, Teaching↗
PubMed1989

Traditional and evolving concepts in medical ethics.

Modern developments in science, technology and medicine have resulted in an unprecedented interest in ethical and moral issues in the practice of medicine. Changes threaten to erode the traditional ethos of practice and to transform medicine into a marketable commodity. The challenge of a new medical ethic and suggestions for a future course are discussed.

Africa, Southern↗