ABSTRACT
BACKGROUND: People in sub-Saharan Africa frequently consult traditional healers before reaching the government health services (GHS). This can lead to delays in starting effective anti-tuberculosis chemotherapy. To our knowledge, no studies have shown a direct relationship between visiting traditional healers, increased morbidity and death from TB. METHODS: All patients starting on anti-tuberculosis chemotherapy at a rural hospital in South Africa in 2003 were included in the study. TB nurses interviewed the patients and established how long they had had symptoms before treatment was started, whether they had visited traditional healers before coming to the hospital, their performance status and, later, whether they had died. RESULTS: Of 133 patients, those who attended a traditional healer took longer to access anti-tuberculosis chemotherapy (median 90 days, range 0-210) than those who went directly to the GHS (median 21, range 0-120). Patients who visited a traditional healer had worse performance status (P < 0.001), and were more likely to die (24/77 [31%] vs. 4/33 [12%], P = 0.04). CONCLUSION: Treatment delay due to visiting traditional healers can have dire consequences for patients with TB. Efforts are required to engage with health care practitioners outside the government sector to improve the prospects for patients with TB.
Subject(s)
Medicine, Traditional , Tuberculosis, Pulmonary/mortality , Tuberculosis, Pulmonary/therapy , Humans , Rural Health , South Africa/epidemiology , Time FactorsABSTRACT
Eaton-Lambert myasthenic syndrome is rare. We report the first case of adenocarcinoma of prostate associated with this syndrome. Subsequent treatment by orchidectomy caused tumour regression and remission of the syndrome. The patient remains well 9 months after the treatment.
Subject(s)
Adenocarcinoma/complications , Lambert-Eaton Myasthenic Syndrome/complications , Prostatic Neoplasms/complications , Adenocarcinoma/diagnosis , Adenocarcinoma/physiopathology , Adenocarcinoma/surgery , Aged , Electromyography , Humans , Lambert-Eaton Myasthenic Syndrome/diagnosis , Lambert-Eaton Myasthenic Syndrome/physiopathology , Male , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/physiopathology , Prostatic Neoplasms/surgeryABSTRACT
A 15-day-old female child is presented with multiple joint dislocations who died during the neonatal period. She had additional features of metaphyseal dysplasia, deficient calcification of vault of the skull, growth retardation, a natal tooth, lymphoedema and facial dysmorphism. This may constitute a new syndrome of multiple joint dislocations with metaphyseal dysplasia.
