Brynne Ascott-Evans

Safety of the omega-3 fatty acid, eicosapentaenoic acid (EPA) in psychiatric patients : Results from a randomized, placebo-controlled trial

Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA), are increasingly being used by psychiatric patients. Most studies have concentrated on efficacy aspects, while little is known about their safety and tolerability in psychiatric populations. This study aimed to assess the effects of EPA treatment on body mass, glucose metabolism, lipid profiles, prolactin secretion, bleeding time, haematology and liver functions. Eighty-four subjects with schizophrenia were treated with either EPA 2 g/day or placebo in addition to their antipsychotic medication for 12 weeks, in a randomized, controlled trial. Forty-seven entered a 40-week open-label extension phase of EPA 2 g/day. Seventy-four patients were included in the analysis. Six patients discontinued from the EPA group and 14 in the placebo group. Adverse event reporting was similar for the two groups. While there were no significant between-group differences, in the blinded phase the EPA group showed a significant increase in body mass index (BMI) and bleeding time. In the open-label extension, there was again a modest increase in BMI. Total cholesterol and HDL levels were significantly decreased. EPA 2 g/day is generally well tolerated. Clinicians should be aware of possible increases in bleeding time, as well as changes in weight and lipid metabolism.

NOFSA Guideline for the Diagnosis and Management of Osteoporosis

This document is an update of the clinical guideline published by the National Osteoporosis Foundation of South Africa (NOFSA) in 2000, which aims to improve the overall efficacy of the diagnosis and management of patients with, or at risk for, osteoporosis. The guideline is not limited to any particular patient group and targets all health care workers. This is a detailed summary, which is cross-referenced to the full guideline and is available on the NOFSA (www.osteoporosis.org.za) and JEMDSA (www. jemdsa.co.za) websites.

Position paper of the National Osteoporosis Foundation of South Africa (NOFSA) on the use of parathyroid hormone (PTH 1–34) in the treatment of osteoporosis

No Abstract. Journal of Endocrinology, Metabolism and Diabetes of South Africa Vol. 10(2) 2005: 51-53

The role of point-of-care blood testing for ketones in the diagnosis of diabetic ketoacidosis.

BACKGROUND Urine dipstick testing for ketones is widely used when diabetic ketoacidosis (DKA) is suspected in patients with hyperglycaemia. If urinary ketones are positive, patients are referred for further management--often inappropriately, as the test is a poor surrogate for plasma ketones. Plasma beta-hydroxybutyrate (β-OHB) levels>3 mmol/L are diagnostic of DKA, while levels<1 mmol/L are insignificant. OBJECTIVES To evaluate a hand-held electrochemical (point-of-care testing; POCT) ketone monitor and compare it with the gold-standard manual enzymatic method (MEM) for detection of plasma ketones. METHODS In a prospective and comparative study, we evaluated the measurement of β-OHB by means of POCT and the MEM in 61 consecutive samples from patients with suspected DKA at Tygerberg and Karl Bremer hospitals, Cape Town, South Africa. Capillary (for POCT) and plasma samples (for the MEM) were obtained simultaneously and compared for accuracy. Precision was assessed with control samples. RESULTS The POCT method was precise (coefficient of variation <4.5%), and there was a good correlation between the two methods (r=0.95). Regression analysis showed a proportional bias, with POCT reading higher than the MEM. However, when assessed at the relevant medical decision limits (β-OHB>3 mmol/L and <1 mmol/L), the total allowable error (bias+imprecision) was not exceeded. Patients will therefore still be classified correctly. The POCT method had a sensitivity of 100% and specificity of 89% for DKA (β-OHB>3 mmol/L), while at levels<1 mmol/L sensitivity was 100% and specificity 87.5%. CONCLUSION The POCT device provides an accurate and precise result and can be used as an alternative to the MEM in the diagnosis of DKA.

Pulmonary hypertension and thyrotoxicosis

Abstract Thyrotoxicosis is listed as a cause of pulmonary arterial hypertension (PAH). The aetiopathogenesis remains largely uncertain, but an autoimmune mechanism has been postulated, among others. In this setting, other causes of PAH need to be actively sought and excluded prior to attributing it to the thyrotoxicosis. The importance of recognising this condition is that it is usually reversible with restoration of a euthyroid state. We describe three patients who presented with thyrotoxicosis and features of PAH in whom other causes were excluded with various investigations. We also demonstrated reversibility of the pulmonary hypertension upon restoration of a normal thyroid state.

Hormone therapy in postmenopausal osteoporosis: 2008

Until 2002, hormone [replacement] therapy (HT) was first-line therapy for prevention (and treatment) of postmenopausal osteoporosis (PMOP). It was thought that any risks associated with HT were far outweighed by potential long-term benefits (mainly cardiovascular protection). Although there were rumblings from some smaller studies at the turn of the millennium, the Womens Health Initiative (WHI) results, published in 2002, changed the way in which we managed PMOP. In this large randomised study, there was now strong prospective evidence that HT did indeed decrease fracture risk at all major sites. However, the expected benefits in cardiovascular risk were not substantiated. Thereafter, the pendulum swung dramatically away from HT in PMOP; but newer evidence over the last 18 months is causing the pendulum to move back towards a central position. We now review the place of HT in postmenopausal osteoporosis in two parts: firstly, the accumulated evidence for bone protection and, secondly, the current benefits versus risk perspective, as well as up-to-date recommendations for its use.

Cardiac tamponade due to hypothyroidism: a case cluster report

This study reports on three patients who were seen at Tygerberg Hospital within a short period of six months, with a new diagnosis of biochemically severe primary hypothyroidism. Pericardial effusion was suspected on clinical and X-ray findings and confirmed with echocardiography in all cases. All had evidence of pericardial tamponade based on echocardiographic criteria. Pericardiocentesis was performed on all patients and other causes of pericardial effusions were excluded. Although infrequently described, hypothyroidism needs to be considered in patients presenting with unexplained large pericardial effusions and cardiac tamponade.

Latest diagnostic approaches to determine the cause of ACTH-dependent Cushing’s syndrome, in the South African setting

A case of a 50-year-old woman who was referred for the evaluation of possible ACTH-dependent Cushing’s syndrome (CS) is described. The localisation of ACTH-dependent CS remains difficult despite many advances in diagnostic approaches. No single test can accurately determine the location of ACTH excess and therefore a combination of non-invasive imaging, stimulation and suppression tests are advised. The recent advances, current utility and pitfalls of each of these tests are reviewed. If non-invasive tests fail to confidently localise the source of ACTH excess, inferior petrosal sinus sampling (IPSS) should follow. Recent advances improving the diagnostic accuracy of IPSS, such as DDAVP stimulation and simultaneous sampling for prolactin is discussed. Where ectopic ACTH production is suspected, newer nuclear medicine techniques, such as somatostatin receptor imaging that recently became available in South Africa, can be utilised. The role of nuclear medicine imaging in identifying ectopic ACTH production is discussed briefly.

Stephen (FS) Hough - 27 August 1947 - 5 December 2014

Stephen Hough was one of the finest clinician-scientists to have emanated from South Africa. In his early thirties, and already an established researcher with numerous degrees in medicine and science, he was earmarked by his mentors for advanced training in the USA. From 1979-1981, he worked at Washington University in St Louis, Missouri, while on a two-year research fellowship in Endocrinology and Metabolism. This centre was famed for its work in metabolic bone disease and jump-started Stephen’s lifelong passion for this field, and osteoporosis, in particular.

Telangiectatic osteosarcoma, a rare complication of Paget's disease of bone

Paget’s disease of bone (PDB) is the second most common metabolic bone disease. This condition, characterised by abnormal bone remodelling, has a prevalence of 5-8% in patients of European ancestry over the age of 55 years. 1-4 The majority of patients are asymptomatic. Diagnosis is based on the distinct radiological picture or on the elevation of serum alkaline phosphatase (ALP). Malignant sarcomatous degeneration is a rare ( 5-8 Osteosarcoma is considered to be a rare and devastating complication of PDB. We report on a confirmed case of very rare telangiectatic osteosarcoma in monostotic PDB.