Modified ZN stain does not improve diagnosis of TBM. Currently available tests are insensitive, but testing large CSF volumes improves performance. New diagnostic tests for TBM are urgently required.

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Junior medical researchers: A neglected community with great academic potential To the Editor: Medical research capacity development is a national priority to improve healthcare in South Africa (SA). [1] The 2011 National Health Research Summit set a target of training 1 000 doctoral candidates in health sciences over the next 10 years. [2-3] We advocate revitalised research training opportunities for junior clinicians to help achieve this target and to contribute to the creation of a thriving medical research network across SA. We acknowledge the need for community input to overcome challenges such as funding, adequate supervision and the time periods required to fulfil quality clinical and research training. We have created an organisation, the Junior Clinicians Research Initiative of South Africa (JUCRISA-www. jucrisa.co.za), to build a supportive community for junior clinicians who would like to be involved in research. We welcome support from the SA medical community to develop this movement further. Challenges. While efforts have been made to provide structured research programmes for undergraduate health science students, [4] little has been done for junior medical graduates (medical interns, community service medical officers (CSMOs) and junior medical officers). At present, medical graduates complete 3 years of public service in various medical fields, often in settings not conducive to academic development. An additional impediment is the perception that part-time studies such as the undertaking of honours or master's degrees are prohibited during this period. Junior clinicians usually have little training in research proficiencies, leading to missed opportunities for otherwise motivated and capable graduates. Rural research: A unique opportunity. SA's healthcare has the unique challenge of the HIV/tuberculosis syndemic intersecting with an increasing burden of non-communicable disease and trauma. [5] During CSMO training, junior clinicians are posted to rural areas where the need for medical personnel is dire and the above challenges are often at their greatest. Rural populations and healthcare sectors are seldom studied despite the value of clinical research in this setting. An example is the 2004 extensively drug-resistant tuberculosis outbreak in the rural Msinga area of KwaZulu-Natal, served by the Church of Scotland Hospital. Had it not been for the research initiated by the clinicians of this small hospital (later built on by the University of KwaZulu-Natal in collaboration with Yale University), the true burden of this fatal disease might have gone unchecked for many years. [6] Junior clinicians are uniquely positioned to contribute towards filling critical knowledge gaps in such areas. Suggestions for creating an environment conducive to junior clinicians' research capacity development: 1. Engage the Department of Health (DoH), the Health Professions Council of South Africa (HPCSA) and academic institutions to actively encourage research training and involvement for junior clinicians. The creat...

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