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Biomedical subjects

B L Meel

Publications and source records attributed to B L Meel.

At least 19 recordsLinked to original sources
PubMed2006

HIV/AIDS, psychiatric disorder and sexual assault in Transkei: a case report.

HIV infection and psychiatric disorders have a complex relationship. HIV infection could lead to psychiatric disorders, and psychiatric patients are more vulnerable to HIV infection. HIV is not only an illness which is associated with stigmatization and discrimination, but also has several risks attached including physical and sexual abuse. There is a scarcity of literature on HIV, mental illness and sexual assault although they are a common trio. The author describes an HIV-positive woman with a psychiatric disorder. She suffered from AIDS and periodic psychotic epidsodes. On a day when she had such an episode she became a rape victim. The history, and physical and genital examination has been described. The need for further research in the area of HIV/AIDS and mental health has been discussed. Preventive strategies have been recommended for HIV-infected individuals in poor health resource settings.

Adult↗
PubMed2005

Ethical issues related to HIV/AIDS: case reports.

The continents of Africa and Asia have the highest number of HIV infected persons in the world. Worldwide there are 42 million and 29.7 million (70%) are in sub Saharan Africa [United Nations AIDS (UNAIDS). Available from: www.unaids.org]. The stigma and discrimination attached to HIV/AIDS are hampering control of the disease. Family life has greatly been disrupted by the pandemic. AIDS causes illness, disability and death as well as severe economic and emotional disruptions to the families. The epidemic is well established in South Africa. The mortality will be doubled over the next five years. A broad range of coercive measures has been considered to be applied internationally in the interest of controlling the spread of HIV. Responsibility of the employers to their HIV/AIDS employees at workplace, choice of termination of pregnancy when a woman is HIV positive, attitude of health care provider to their HIV infected patients, informed consent for taking blood to protect from transmission of infection in a case of accidental prick, and forced resignation from employment, are discussed in this manuscript. The ethical problems are highlighted, and possible solutions recommended.

Abortion, Induced↗
PubMed2005

HIV-seroconversion following sexual abuse.

Transkei is a poverty stricken former black homeland, now a part of the Eastern Cape Province. Unemployment and the incidental violence are very high. Women are mainly responsible for bringing up their children. Single parenting is also common in this community. Sexual abuse of children is selected to be under-reported. This reports the case of a 13-year-old girl who was raped twice within three months and brought to the Sinawe Centre of the Nelson Mandela Academic Hospital. Failure to adhere to post exposure prophylaxis (PEP) has undermined the implementation of antiretroviral roll out programme by the government. The history, physical examination and laboratory investigations of this case are given. Preventive steps are suggested.

Adolescent↗
PubMed2005

Criminal abortion and concealment of birth in Transkei region, South Africa.

The objective was to estimate the incidence of criminal abortions and concealment of births in Transkei. This paper presents a review of the records of the medico-legal register at Umtata General Hospital from 1993-2003. There were 37 cases of premature concealed births and conceptus material brought to the attention of medico-legal investigators between 1993 and 2003. Of these, 26 (70.3%) were concealed births, and 11 (29.7%) were abortion products. There is great variability in the incidence of abortion and concealment of births during this period. There were nine cases in 1993 and three in 2003. No case was reported in 1994. There was only a single case reported in each of the years 1995, 1997 and 2001, and four cases in each of the years 1996, 1998 and 2002. In 1998 there were eight cases, the highest for any year after promulgation of the Abortion Act. There is no significant difference in the number of cases reported for medico-legal investigation of criminal abortion and concealment of births before and after the Abortion Act which came into effect in 1997.

Abortion, Illegal↗
PubMed2005

HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa.

An earlier study (Meel, 2003) showed that more than 90% of victims of sexual assault in Transkei region, South Africa, were HIV-seronegative at the time of the incident. This was despite the fact that the community had a high prevalence of HIV. In sexual assault cases post-exposure prophylaxis (PEP) is recommended to prevent HIV transmission. Therefore, therapy with zidovudine (AZT) and lamivudine (3TC) is justified. The purpose of this study is to describe the demographic characteristics of the victims, to assess the outcome of HIV transmission and to evaluate the success of PEP after its implementation in Transkei. There were 594 victims of sexual assault during the study period at Sinawe Centre from 2000-2003. Of these, 346 (58.2%) were children under the age of 15 years. Seventeen children (2.9%) were found to be HIV positive at the first test. Among the adults, 58(9.8%) tested HIV positive. Of the 225 who attended after PEP was introduced, only two were found to be HIV seropositive at the time of the incident. A second test was recommended after four weeks and a third after 12 weeks. The majority of the victims did not report for the second test, but all 35 who did come to be tested were seronegative. who did come to be tested were seronegative. Seventeen of those were between 11-15 years of age. Only seven victims came for the third test, and they, too, were negative. Nausea and vomiting were the commonest side effects of PEP treatment in four patients and one developed a generalized rash. Only one victim seroconverted.

Adolescent↗
PubMed2005

Incidence of HIV infection at the time of incident reporting, in victims of sexual assault, between 2000 and 2004, in Transkei, Eastern Cape, South Africa.

BACKGROUND: HIV/AIDS epidemic and sexual assault have emerged as the most serious public health problems in South Africa. The country has about 5-million HIV infected individuals. About a million women are raped every year. OBJECTIVES: To study the incidence of HIV infection in victims of sexual assaults. DESIGN: This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program. METHODS: This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program. RESULTS: Eight hundred and thirty one cases of sexual assaults (rape) were reported in last 5-years (2000-2004). Increase in sexual assaults by three-times, and one-and-half-fold increase in HIV seropositivity has recorded over the period of 5 years. In 2000, 76 (9.7%) sexual assault cases were registered, and in 2004, 237 (28.5%) cases. Of them, 443 (53.3%) were children under 15-years of age. A total of 114 (13.7%) tested positive for HIV, and 23 (2.7%) were children less than 15 years. In 2000, only 8 (10.5%) tested positive for HIV, and this had climbed to 39 (16.5%) in 2004. There is significant difference in HIV seropositivity among children compared to adults, p<0.05, and Paired t=3.45 with 3df. CONCLUSION: There is an increasing incidence of HIV infection among victims of sexual assaults in this study.

Adolescent↗
PubMed2005

Firearm fatalities in the Transkei region of South Africa, 1993-2004.

BACKGROUND: Firearms are a causative factor in much violence-related morbidity and mortality, including suicide. Interventions focus on stricter gun control. In South Africa multisectoral collaboration is needed in this regard. OBJECTIVE: To determine the incidence of firearm-related deaths in the Transkei region and to understand the underlying causative factors. METHOD: A record review was undertaken of 10,860 medicolegal autopsies performed between 1993 and 2004 at Umtata General Hospital. RESULTS: Between 1993 and 2004 10,860 autopsies were performed on patients who died as a result of trauma and other causes at Umtata General Hospital. The average number of gunshot related-deaths during this period was 48.4 per 100,000 of the population per year. The rate increased from 27/100,000 in 1993 to 42/100,000 in 2004. Firearm-related deaths accounted for 29% of all traumatic deaths, and males (82%) outnumbered females 4.6:1, although there is an increasing incidence among females. About 50% of these deaths were in the 21-40-year age group. Interpersonal violence, poverty, and use of drugs and alcohol were common underlying factors. CONCLUSION: There is a high incidence of firearm-related deaths in Transkei. Stricter gun control is required.

Adolescent↗
PubMed2004

Pre-hospital and hospital traumatic deaths in the former homeland of Transkei, South Africa.

This retrospective descriptive study on 274 medicolegal cases was to determine the issues related to pre-hospital and hospital deaths in injured patients and to determine whether any of the deaths were preventable in the area. Interviews of the family members were conducted individually before carrying out autopsies. Time of survival after trauma, place of death, and the cause of death were recorded along with the demographic information -- age, sex, occupation, and personal habits. Umtata General Hospital in the Eastern Cape Province is the referral hospital for a surrounding population of about 400,000. Seventy four percent (74%) of the victims had been declared, 'presumably dead' at the scene by the community or police, and taken to mortuary without any death certification by a physician. The rest (26%) were taken to hospital where later they succumbed to trauma. Out of these only 4% underwent surgery. The majority (68%) of the victims were young ( < 40 years). The causes of deaths were: motor vehicle accidents (MVA) 32%, gunshot 24%, stab injury 17%, blunt trauma 9% and miscellaneous (fall from height, burns, etc.) 17%. Head and chest injuries were the commonest 50%. Only 17% survived from days to weeks. About 75% subjects died within 6 h of the trauma. There is a very high pre-hospital (74%) mortality of trauma patients in the Transkei region. The fact that members of the community or police and not a medical practitioner confirmed deaths raises the ethical issue of right to life. Some may actually be alive when they are considered dead. As it appears that 12% of pre-hospital deaths are preventable, employing more medical personnel in the rural areas along with an effective ambulance service would seem to be required.

Accidents, Traffic↗
PubMed2004

Fatal systemic allergic reaction following acrylic cranioplasty: a case report.

South Africa has a high death rate as a result of motor vehicle collisions. The motor vehicle accident fund is struggling with compensation claims made by the next of kin of the deceased. This report presents an unusual case of death as a result of systemic allergic reaction to acrylic material used to cover the frontal bone defect in a head injury patient. In independent forensic pathologist hired by the independent complaint directorate concluded that the cause of death was not related to the motor vehicle accident, and therefore the family cannot be compensated. The history, post mortem findings, management and issue of compensation claim are discussed.

Accidents, Traffic↗
PubMed2004

Incidence and patterns of violent and/or traumatic deaths between 1993 and 1999 in the Transkei region of South Africa.

BACKGROUND: Incidence and patterns of violent and/or traumatic deaths among 4,525 victims over a 7-year period in the Transkei region of South Africa were investigated. METHOD: Retrospective review and analysis was performed of all medicolegal autopsies (n = 6,181) between January 1993 and December 1999, of which 4,525 were violent or traumatic deaths. RESULTS: During the 7-year period (January 1993-December 1999), violent and/or traumatic deaths in the Transkei region accounted for an average annual rate of 162 per 100,000 of the population. The common causes of deaths per 100,000 of population per year were as follows: motor vehicle collisions, 63; firearm injuries, 43; stab wounds, 32; and blunt trauma, 24. Male subjects outnumbered female subjects by a 3.3:1 ratio. The murder rate in female subjects was 18 per 100,000 population. The murder rate in this area increased from 94 per 100,000 in 1993 to 121 in 1999. Nearly 50% of the violent and/or traumatic deaths occurred in the 21- to 40-year age group. There has been an increase in nontraumatic deaths such as hanging (1.5 times) and poisoning (5 times). CONCLUSION: The average annual incidence of violent and/or traumatic deaths in the Transkei region of South Africa is 162 per 100,000 population. Firearm-related deaths, at 43 per 100,000 of the population per year, have contributed substantially to this high incidence. This is a major cause of concern.

Accidents, Traffic↗
PubMed2003

Fatal pulmonary thromboembolism following physical torture.

Although perpetrators of torture usually use common methods to torture their victim, occasionally they devise novel techniques. Doctors are often called upon to examine victims of torture. This case report is intended to highlight 'the helicopter technique' (also called the, 'parrots perch' in Latin America in 1970s and 1980s) and 'chicken kebab' in Iran (more recently) and the complication of venous thromboembolism. This is a report of a victim who was arrested by the police and subsequently tortured. He died 2 weeks later from pulmonary embolism. The history, physical examination, treatment and autopsy findings of this case are discussed.

Journal Article↗
PubMed2003

Certification of deaths at Umtata General Hospital, South Africa.

BACKGROUND: Audited information on the causes of death is one of the basic components of a country's health information system. Data are usually derived from death certificates. There are many shortcomings in the routine collection of such information. A critical analysis of Umtata General Hospital's (UGH) death certification was done establish how these shortcomings might influence reporting. Such an audit is simple, cheap and useful for monitoring the quality of mortality information. It can be used in health planning and management. OBJECTIVES: To determine the accuracy of death certification by doctors in Umtata General Hospital. METHOD: The study was carried out at UGH. Three hundred and four (304) death notification forms collected over a period of 1 year from January 1999 to December 1999 were studied. These forms were obtained from different clinical departments. RESULTS: The majority of deaths (78.9%) were certified as cardiorespiratory failure. In the remaining (21.1%) cases the causes of death were stated as due to esophageal carcinoma, lobar pneumonia, severe shock, diarrhea, and unknown. CONCLUSION: Doctors at Umtata General Hospital are not experienced in death certification. Cardiorespiratory failure is neither a cause of death nor a mechanism of death. RECOMMENDATIONS: There is need for continuing education on death certification by doctors at UGH.

Journal Article↗
PubMed2003

A study on the prevalence of HIV-seropositivity among rape survivals in Transkei, South Africa.

BACKGROUND: South Africa has the highest incidence of rape, including child rape, in the world. The country has about 5-million individuals infected with HIV/AIDS. HIV/AIDS is becoming a life-threatening consequence of rape. It is therefore important to provide anti-retroviral drugs and some provinces have already begun to do so. OBJECTIVE: To estimate the prevalence of HIV-seropositivity in the victims of rape in Transkei. METHODS: All the victims of rape who attended Sinawe Rape Crisis Center in Umtata General Hospital during daytime from Monday to Friday between November 2000 and May 2002 were included in the study. All were tested for VDRL and HIV. RESULTS: A total of 243 victims were examined. 22 (9%) were seropositive for HIV. Two blood results were not available. One hundred and sixty six (68.3%) were less than 20 years old, 57 (23.4%) were less than 10 years, and 12 (4.9%) were less than 5 years of age. The highest HIV-positivity (2.8%) was found among the adolescents (15-19 years). No children of less than 5 years were infected with HIV. Only 5 (2.2%) returned for the second HIV test, and one (0.4%) seroconverted after 3 months. CONCLUSION: There were 219 (90%) rape victims who were HIV negative at the time of the incident. Serious consideration must be given to cover rape victims with anti-retroviral agents to prevent them contracting HIV infection.

Journal Article↗
PubMed2003

Determinants of suicide in the Transkei sub-region of South Africa.

BACKGROUND: South Africa has a history of traumatized citizens and is a society in transition. Suicidal behavior among the black population group in South Africa appears to be on the increase. Under the post-apartheid dispensation they are undergoing a lot of stresses especially in relation to their as yet unmet expectations and demands from the government. OBJECTIVE: To identify the possible determinants of suicide in the Transkei sub-region of South Africa. METHODS: Interviews with relatives of suicide victims, and analysis of victims' demographic, socioeconomic, and psychosocial data. RESULTS: Rural people (> 90%) were much more likely to commit suicide than urban dwellers (< 10%). Suicide notes were left by 13% of the victims. Hanging was the method of choice in 57%, gunshot in 30%, and poisoning in 13%. Among those who died by hanging and by gunshot injuries, males far outnumbered the females (82% and 89%, respectively). By contrast, females constituted the greater proportion of deaths by poisoning (75%). Apparent precipitating factors included economic hardship (87%), alcohol abuse (23%), health related issues (17%), marital problems (13%), and social disputes (10%). The uneducated (70%) and unemployed (64%) used hanging as the method of choice. The highly educated 5 (17%) were all employed, and used a firearm in committing suicide. Family disputes 5 (17%) and separation of parents from teenage children were recorded in 17% of the cases. CONCLUSION: Financial hardship was the main underlying reason, identified in 87% victims of suicide. To break this vicious cycle of unemployment, alcohol abuse, and poor health, a comprehensive poverty alleviation program along with community education could be an important step towards reducing suicides in the Transkei sub-region of South Africa.

Journal Article↗
PubMed2003

A study on the incidence of suicide by hanging in the sub-region of Transkei, South Africa.

BACKGROUND: Transkei is a former black homeland in South Africa. It is a historical place and well known for spearheading the freedom fight of South Africa because most of the African National Congress leaders are from this region. It was therefore deprived of development by the apartheid government and is now a poverty stricken area. Transkei is characterized by the lack of infrastructure, and hence a, high rate of unemployment. The majority of individuals are dependent on either the income of migrant mineworkers or subsistence farming at home. OBJECTIVE: To estimate the incidence of suicides in the sub-region of Transkei. METHOD: This is a retrospective record review of deaths due to hanging during the period of January 1993-December 2000 at the Umtata General Hospital. All medico-legal autopsies were recorded in a register at the mortuary. The names, addresses, age, and causes of deaths are found recorded in the register. The catchment areas of these autopsies are Umtata and Nqgeleni magisterial areas which have a population of about 300,000. All autopsy records were collected and analyzed manually. RESULTS: There has been an increasing trend of hanging since 1993, with an overall suicidal death rate increasing from 23.7 per 100,000 in 1993 to 38.6 per 100,000 in 2000. It is observed to be higher in November 32 (13%) and least in September 12 (5%). Over half the deaths 32 (51%) due to hanging were young adults (16-30 years) and 8 (13%) adolescents less than 15 years of age. Twelve (19%) deaths were 31-45 year olds and 5 (7%) were over 61 years. CONCLUSION: There is increasing incidence of deaths due to hanging in Transkei. Nearly two-thirds of them were young adults less than 30 years. RECOMMENDATION: Suicidal tendency in terms of young adults is emerging as an important mental health issue that needs to be addressed. There is need of a well-planned prospective study to be carried out in Transkei.

Journal Article↗
PubMed2003

Mortality of children in the Transkei region of South Africa.

This study attempted to unfold, perhaps for the first time, the problem of childhood mortality resulting from trauma in the Eastern Cape Province of South Africa. This study was carried out in the Umtata and Ngqeleni magisterial districts, which have a combined population of about 400,000. Most people there have very few resources and have historically relied on money repatriated by migrant workers. In the Transkei region, unemployment is at a very high level: 48.5%. Assault on children is very common in this region, and this may result in death. The aim of this study was to establish the state of deaths resulting from pediatric trauma, and to formulate recommendations that could probably help prevent or reduce these deaths. The objective was to gather epidemiologic information on the victims of pediatric trauma. The study was designed as a descriptive study, using reviews of traumatic deaths in pediatric age groups during the period January 1993 to December 1999. This study was carried out on cases that were brought to the medicolegal laboratory at Umtata General Hospital, Umtata, in the Transkei region of the Eastern Cape Province, South Africa. There were 6181 autopsies conducted from 1993 to 1999. All the medicolegal autopsies were divided into two groups: pediatric (15 years of age or younger) and adult (older than 15 years). Of the autopsies, 89.4% (n = 5587) were in the adult group, and 10.6% (n = 594) were in the pediatric group. Of the pediatric deaths, 64% (n = 383) were related to trauma. The highest numbers were in the 11- to 15-year (n = 146, 38%) and the 6- to 10-year (n = 135, 34%) age groups. Of the children who died of trauma, 112 (28%) were aged 0 to 5 years. Unintentional injuries from motor vehicle accidents were the leading cause of death (59%), whereas intentional injuries (41%) were associated with murder. Nearly a quarter (22%) of pediatric traumatic deaths were due to penetrating injuries: stab (12%) and gunshot (10%) wounds. Most of the pediatric deaths occurred during the festive months of December, January, and April; the death toll during these months was three to four times higher than in the rest of the year. It was concluded that 64% of pediatric deaths in the Transkei region were the result of trauma. This represents 1 pediatric trauma death for every 10 adult trauma deaths. Forty-one percent of the child trauma deaths were due to intentional injuries, usually murder. It is recommended that the government set targets and put into place strategies for the reduction of pediatric deaths due to trauma. The different deaths so called "rule of reversal" could be considered as an indicator of social health.

Accidents, Traffic↗
PubMed2003

1. The myth of child rape as a cure for HIV/AIDS in Transkei: a case report.

South Africa has one of the highest cases of HIV/AIDS infection in Africa, and Transkei, a former black homeland, now a part of the Eastern Cape Province, is one locality with a large number of HIV/AIDS sufferers. The unemployment level is very high and crime, including child rape, is very common. This report presents the case of a victim of rape, a nine-year old female child who was brought to the Umtata General Hospital, a victim of the mistaken belief that sex with a virgin will cure an HIV-infected person or AIDS sufferer of his illness. The alleged rapist was an HIV-positive uncle of the child. The myth of the 'HIV/AIDS virgin cure' is prevalent in the community. The history, physical examination and laboratory investigations of this case are given. A conclusion is drawn and preventive methods are suggested.

Attitude to Health↗