Samj South African Medical Journal最新文献

{"title":"Case report: First reported case of spondylodiscitis caused by Gemella morbillorum in South Africa.","authors":"J Pillay, N-M Van der Linden","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pyogenic spondylodiscitis is an uncommon but important clinical condition that often requires medical and/or surgical management. We report a case of spondylodiscitis caused by a rare pathogen, Gemella morbillorum. To date, worldwide, only six such cases of confirmed spondylodiscitis infection with this rare pathogen have been documented, and this is the first reported case in South Africa. The patient was a 55-year-old female who presented to us with a 1-month history of severe back pain radiating to her left leg. She reported to us that she visited the dentist around the time of onset of the symptoms. A workup showed raised inflammatory markers, and a positron emission tomography scan indicated features of discitis at level L2/L3. Tissue cultures from a biopsy identified G. morbillorum species infection, and she was treated successfully with antibiotics for 6 weeks. It is important to have a high index of suspicion when a patient has a history of dental work, and to rule out associated infection such as endocarditis. Treatment with culture-driven antibiotics yields good results.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2022"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 pandemic and blood utilisation in South Africa.","authors":"R Swanevelder, P-L Wessels, V J Louw, A Swarts, M Lennards, K Van den Berg","doi":"10.7196/SAMJ.2024.v114i11.2001","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2001","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic, first reported in December 2019, affected every sector of every country worldwide. Health services were the first to experience the direct impact. Blood services were advised to decrease blood utilisation in anticipation of reduced blood collections. The South African National Blood Services (SANBS) saw a substantial decline in blood demand following the institution of strict national lockdown measures, but the impact of the epidemic and various mitigation strategies remained unknown.</p><p><strong>Objective: </strong>This retrospective study reviews red blood cell (RBC) utilisation during a 4-year period from 2019 to 2022 in the South African (SA) population, stratified by public and private healthcare sectors.</p><p><strong>Methods: </strong>To measure the impact of COVID-19, blood utilisation pre COVID-19 was compared with an acute COVID-19 period and a post-acute period. Each period covered 450 days. Blood utilisation was evaluated against the background of reported COVID-19 cases and national lockdown regulations.</p><p><strong>Results: </strong>With the onset of the COVID-19 pandemic, overall RBC utilisation dropped by ~17%. The initial decline was more pronounced in the public sector. Overall, utilisation recovered to pre-COVID-19 levels in the post-acute COVID-19 period, but at different rates in the public and private sectors.</p><p><strong>Conclusion: </strong>There was a significant change in RBC utilisation during the course of the COVID-19 pandemic, much more pronounced in the public sector, which services 85% of the SA population. During the post-acute COVID-19 period, blood utilisation recovered, but at a much slower rate in the public sector. The COVID-19 pandemic accentuated the differences in blood utilisation patterns between the public and private healthcare sectors in SA, and each sector's resilience in adapting to the challenges of the epidemic.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2001"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of emergency centre recidivism for interpersonal violence in a district-level hospital in Cape Town, South Africa.","authors":"J J Horn, L Bush, D J Van Hoving","doi":"10.7196/SAMJ.2024.v114i11.2373","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2373","url":null,"abstract":"<p><strong>Background: </strong>Interpersonal violence is a major cause of morbidity and mortality in low- and upper-middle-income countries. It is postulated that a significant portion of these patients have repeated presentations to an already overburdened healthcare system. Data describing the burden of interpersonal violence recidivism are poor.</p><p><strong>Objective: </strong>To determine and describe the burden of emergency centre recidivism for interpersonal violent injury presenting to Khayelitsha Hospital, Cape Town, over a 2-year period.</p><p><strong>Methods: </strong>An analysis of a prospectively collected observational database combined with a retrospective chart review was conducted of all trauma patients who presented to Khayelitsha Hospital from 1 October 2020 to 30 September 2022. All patients (aged ≥14 years) with ≥2 presentations for interpersonal violence-related injuries were included. Cases were limited to the inclusion of mechanisms of injury attributable to stab wounds, blunt assault, firearm injury and gender-based violence. Recidivist cases were identified by repeat hospital number on the electronic hospital patient system. Repeat cases were manually reviewed for inclusion. Summary statistics are used to describe all variables.</p><p><strong>Results: </strong>In total, 10 218 interpersonal violence presentations were identified over the study period, and 1 125 (11.0%) were attributed to recidivists (522 patients). The mean (standard deviation) age was 30 (7.7) years, and most were male (n=463, 88.7%). Stab wounds (n=583, 51.8%) and blunt assault injuries (n=456, 40.5%) were the main mechanisms of injury. Repeat presentation occurred within a median of 198 (25th - 75th percentile, 81.5 - 373.9) days. A total of 337 (64.6%) patients presented with higher acuity at one of their subsequent visits.</p><p><strong>Conclusion: </strong>Recidivist presentations represent a significant proportion of interpersonally violently injured patients, and are likely to be under-documented. Recidivism poses a measurable burden, and further research is needed to facilitate the identification of at-risk individuals, and specific secondary prevention strategies should be developed to prevent or reduce escalating patterns of injury associated with interpersonal violence.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2373"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of clinical, laboratory, radiographical and histopathological characteristics in patients with spinal tuberculosis in the context of HIV infection: An analysis of 52 patients from a South African tertiary hospital.","authors":"J Scherer, M Locketz, S Castelein, R Dunn, M Held, F Thienemann","doi":"10.7196/SAMJ.2024.v114i11.2065","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;South Africa (SA) has the highest prevalence of people with tuberculosis (TB) and HIV coinfection globally. People living with HIV have an increased risk of TB infection, and are more likely to develop extrapulmonary TB. Approximately 10 - 20% of extrapulmonary TB accounts for skeletal TB, with spinal involvement in 50 - 60% of instances. Previous studies have shown highly heterogenic results regarding the effect of HIV status on clinical and laboratory characteristics in patients with spinal TB (STB).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the clinical, laboratory, radiographical and histopathological characteristics of patients diagnosed with STB stratified by HIV status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from patients who were treated for STB at the Division of Orthopaedic Surgery, Groote Schuur Hospital, SA, between 2013 and 2016 were analysed. We compared clinical, laboratory, radiographical and histopathological parameters of STB patients with HIV infection to those without HIV infection. To assess differences in means between the two groups, an independent samples t-test was used for normally distributed continuous data, and a χ2 test for categorical data. To assess correlations between continuous data groups, the Pearson correlation coefficient was used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We assessed 52 patients with STB (mean (standard deviation (SD) age 38 (15.2) years, range 17 - 80 years), of whom 55.8% were female, and 59.6% HIV infected. Five (9.6%) patients were identified with multidrug-resistant TB of the spine, with four (19.0%) in the HIV-infected cohort and one in the HIV-uninfected cohort (p=0.058). Significantly more STB patients without HIV infection presented with neurogenic symptoms (29%, p=0.029). The mean (SD) overall erythrocyte sedimentation rate was 69.3 (35.9) mm/h, with no significant difference between HIV-infected and HIV-uninfected patients (p=0.086). The rate of vertebral collapse was higher in the HIV-infected cohort (39% v. 67%, p=0.048). HIV-infected patients showed a higher count of involved vertebrae (mean 3.0 v. 3.85; p=0.034). There was no correlation between CD4 count and the number of involved vertebrae. The mean (SD) number of granulomata per low-power field was 10 (12.6), with no difference between the two cohorts. However, we found a positive correlation between granuloma count and CD4 cell count in HIV-infected STB patients (Pearson 0.503, p=0.02), with significantly higher formation of granulomata at a CD4 cell count &gt;400 cells/μL (p=0.045).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In our cohort, HIV-infected patients with STB were more likely to present with vertebral collapse, and more vertebrae on average were diseased compared with HIV-uninfected patients with STB. CD4 cell count may affect granuloma formation, and it seems that HIV infection has a negative effect on cellular immunoresponse in STB, which emphasises the need for early antiretroviral therapy init","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2065"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fairway to fractures: Income inequality and violent crime as the driving factors for golf club-related assaults - a case series of 21 compound skull fractures.","authors":"R Grobler, E-M Geldenhuys, A J Vlok","doi":"10.7196/SAMJ.2024.v114i11.2268","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2268","url":null,"abstract":"<p><strong>Background: </strong>Golf club-related traumatic brain injuries are an uncommon occurrence in adults, and the use of golf clubs as a weapon of interpersonal assault resulting in compound skull fractures is rare.</p><p><strong>Objective: </strong>To present a case series of golf club-related compound skull fractures in adults secondary to assault, representing the largest study of this entity to date.</p><p><strong>Methods: </strong>A retrospective analysis was performed of a prospectively maintained database for patients admitted to Tygerberg Academic Hospital in Cape Town, South Africa, with golf club-related compound skull fractures between 1 January 2018 and 31 December 2021. Data on demographic details, computed tomography brain image findings, presenting Glasgow Coma Scale, surgical operative notes, septic complications and outcomes at discharge were collected.</p><p><strong>Results: </strong>A total of 21 patients were included. The majority were male (95.2%) and the mean age was 32.6 years. Fractures were most commonly seen in the frontal bone (n=9), followed by parietal (n=8), temporal (n=3) and occipital (n=1) bones. Depressed skull fractures were the most common type of injury, and local pneumocephalus was present in the majority of patients. The mean presenting Glasgow Coma Scale was 14, and most patients had no focal neurological deficits. Surgical debridement was required in the majority of patients, with a high rate of septic complications (33.3%). However, most patients had good neurological outcomes at discharge, and the mean length of stay was 11.9 days.</p><p><strong>Conclusion: </strong>This study highlights the potential dangers of golf clubs as a weapon of interpersonal assault, and the need for prompt and appropriate management of compound skull fractures to reduce the risk of complications.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2268"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: First reported case of spondylodiscitis caused by Gemella morbillorum in South Africa.","authors":"J Pillay, N M Van der Linden","doi":"10.7196/SAMJ.2024.v114i11.2022","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2022","url":null,"abstract":"<p><p>  Pyogenic spondylodiscitis is an uncommon but important clinical condition that often requires medical and/or surgical management. We report a case of spondylodiscitis caused by a rare pathogen, Gemella morbillorum. To date, worldwide, only six such cases of confirmed spondylodiscitis infection with this rare pathogen have been documented, and this is the first reported case in South Africa. The patient was a 55-year-old female who presented to us with a 1-month history of severe back pain radiating to her left leg. She reported to us that she visited the dentist around the time of onset of the symptoms. A workup showed raised inflammatory markers, and a positron emission tomography scan indicated features of discitis at level L2/L3. Tissue cultures from a biopsy identified G. morbillorum species infection, and she was treated successfully with antibiotics for 6 weeks. It is important to have a high index of suspicion when a patient has a history of dental work, and to rule out associated infection such as endocarditis. Treatment with culture-driven antibiotics yields good results.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2022"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ultraviolet C light and isopropyl alcohol for the disinfection of cellular phones in a paediatric intensive care unit setting.","authors":"L Thomas, J John, H Lochan","doi":"10.7196/SAMJ.2024.v114i11.2791","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2791","url":null,"abstract":"<p><strong>Background: </strong>A considerable proportion of cellular phones (cell phones) used by healthcare workers (HCWs) have been shown to be contaminated with pathogenic micro-organisms, making these devices reservoirs to infect susceptible patients. Although many units have well-defined infection control protocols, methods for the decontamination of cell phones are scarce.</p><p><strong>Objectives: </strong>To compare the efficacy of ultraviolet C (UVC) light with that of 70% isopropyl alcohol in disinfecting cell phones used by HCWs in a paediatric intensive care unit (ICU).</p><p><strong>Methods: </strong>A randomised controlled study in a paediatric ICU setting was conducted. Cell phones of HCWs or other personnel entering the ICU were swabbed prior to and after decontamination with either the 70% isopropyl alcohol or UVC light method. The reduction ratio of colony-forming units (CFUs) before and after intervention was analysed using the Mann-Whitney U-test. In addition, the effectiveness of the disinfection methods was compared using the Wilcoxon signed-rank paired test.</p><p><strong>Results: </strong>A total of 74 cell phones were acquired from HCWs working in the paediatric ICU. After excluding 5, 69 samples were therefore available for statistical analysis, with 34 samples subjected to disinfection using 70% isopropyl alcohol-based swabs and 35 samples treated with UVC light disinfection. Disinfection with 70% isopropyl alcohol (z=5.16; p<0.000001) and with UVC light (z=3.28; p<0.005) were individually statistically significantly effective in reducing CFUs. The CFU reduction ratio indicated that disinfection using a 70% isopropyl alcohol solution was 67% more effective than UVC light disinfection (Mann-Whitney U-test score 968; p<0.001).</p><p><strong>Conclusion: </strong>Although both 70% isopropyl alcohol and UVC light disinfection effectively reduced CFUs following decontamination, 70% isopropyl alcohol was determined to be much more effective.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2791"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal enuresis: A call for advocacy.","authors":"J John, A Wright","doi":"10.7196/SAMJ.2024.v114i11.2789","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2789","url":null,"abstract":"","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2789"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The South African guidelines on enuresis: 2024 update.","authors":"A Adam, A Badenhorst, F Claassen, T De Maayer, M Fockema, J Fredericks, E Gottlich, J John, N Lala, J Lazarus, S Leahy, H N Lourens, S Maharaj, K M Mathabe, E M Moshokoa, S B A Mutambirwa, K L Petersen, M B Radzuma, A Van der Merwe, I Van Heerden, C A Zietsman, F Alyami, A Deshpande, G H H Smith","doi":"10.7196/SAMJ.2024.v114i11.2790","DOIUrl":"10.7196/SAMJ.2024.v114i11.2790","url":null,"abstract":"<p><strong>Background: </strong>Enuresis, also referred to as nocturnal enuresis, is characterised by discrete episodes of urinary incontinence during sleep in children aged ≥5 years in the absence of congenital or acquired neurological disorders. This guideline is an update of the 2017 version.</p><p><strong>Recommendations: </strong>The guideline provides recommendations and suggestions for various therapeutic options for enuresis available in South Africa (SA). These options include behavioural modification, urotherapy, pharmaceutical therapy, alarm therapy, alternative therapies, neuromodulation, psychological support and biofeedback. Additionally, it explores the role of a voiding diary, additional investigations and mobile phone applications (apps) in treating enuresis. The document also outlines standardised definitions for clarity.</p><p><strong>Conclusion: </strong>This is an updated guideline endorsed by relevant key opinion leaders in SA, with additional input from international experts in the field.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2790"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological assessment of AIDS-defining malignancies in the gastrointestinal tract presenting with acute abdomen: Improving diagnostic timeliness and patient care.","authors":"M C Khaba, N E Mothata, M O Keetse, T Sumbana","doi":"10.7196/SAMJ.2024.v114i11.2034","DOIUrl":"https://doi.org/10.7196/SAMJ.2024.v114i11.2034","url":null,"abstract":"<p><strong>Background: </strong>While a large number of cases in an HIV setting may be attributed to infections, there has also been a rise in HIV- associated malignancies such as Kaposi sarcoma and aggressive B-cell lymphoma.</p><p><strong>Objective: </strong>To describe the clinicopathological features of cases with acute abdomen secondary to AIDS-defining malignancy in the gatrointestinal tract.</p><p><strong>Method: </strong>This is a retrospective analysis of all cases presenting with acute abdomen and histologically diagnosed AIDS-defining malignancies of the gastrointestinal tract over a period of 8 years in our centre. Clinicopathological characteristics were retrieved from the laboratory information system. Archived haematoxylin and eosin-stained sections and immunohistochemical stains were reap- praised.</p><p><strong>Results: </strong>A total of 13 cases, which consisted of 5 males and 8 females, with an average age of 35 years formed the study sample. All the patients were HIV-positive on antiretroviral therapy, and presented with acute abdomen. Intraoperatively, there were five intussusceptions, three strictures, three perforated tumours and two luminal occlusions. Histopathology confirmed five cases of Kaposi sarcoma and eight cases of high-grade B-cell lymphomas. Two patients with high-grade B-cell lymphomas died after surgical intervention.</p><p><strong>Conclusion: </strong>Expedited histopathological assessment of bowel resection in HIV-infected patients could improve clinical outcomes with early treatment.</p>","PeriodicalId":49576,"journal":{"name":"Samj South African Medical Journal","volume":"114 11","pages":"e2034"},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}