South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde最新文献

{"title":"The state of caesarean sections in South Africa: Challenges, unknowns and the way forward.","authors":"M Bhathena, S Maswime, S Fawcus, M Isiagi, M V Kinney","doi":"10.7196/SAMJ.2026.v116i2.4227","DOIUrl":"10.7196/SAMJ.2026.v116i2.4227","url":null,"abstract":"<p><p>The scarcity of safe and timely caesarean sections in much of Africa contrasts with SA's paradox of having one of the world's highest rates of caesarean section in the private sector - approaching 80% - yet persistently high maternal and perinatal mortality in rural public hospitals. This article addresses three challenges: (i) inequitable access to safe caesarean sections; (ii) high and rising caesarean section rates without evidence of better outcomes, raising concerns about overservicing, costs and respectful care; and (iii) research and data gaps. Closing these gaps requires action from all stakeholders to ensure equitable, high-quality and life-saving care for all.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4227"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-related pulmonary embolism: Clinical characteristics, management and outcomes in a South African academic hospital.","authors":"N Zulu, J Zamparini, H Rhemtula, E Schapkaitz","doi":"10.7196/SAMJ.2026.v116i2.3722","DOIUrl":"10.7196/SAMJ.2026.v116i2.3722","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a leading cause of death in pregnant and postpartum women.</p><p><strong>Objective: </strong>To evaluate the clinical presentation, management and outcomes of pregnancy-related PE managed by a multidisciplinary team.</p><p><strong>Methods: </strong>A retrospective review was conducted of pregnant and postpartum women diagnosed with PE between 2018 and 2024 at a tertiary hospital in Johannesburg, South Africa. Pretest probability scores (pregnancy-adapted YEARS and Geneva) were applied in a subgroup with D-dimers available.</p><p><strong>Results: </strong>Seventy-seven women were included: 33 with antepartum and 44 with postpartum PE. The median (interquartile range) age was 29 (9) years, and most were of black African ethnicity. PE risk factors were present in 85% of antepartum and 96% of postpartum cases. Women with antepartum PE more frequently presented with chest pain, shortness of breath and palpitations (p<0.05). Pretest probability scores were assessed in a subgroup with D-dimers available. Based on the pregnancy-adapted YEARS and Geneva scores, imaging would have been required to rule out PE in 87.8% and 73.5% of cases, respectively. Computed tomography pulmonary angiography was the preferred diagnostic modality in 74.0%. Most women (97.4%) were treated as inpatients, and 57% required management in the intensive care and/or high care units. The median length of hospital stay was 14 (8) days. Low-molecular-weight heparin was the most frequently prescribed anticoagulant, with a median treatment duration of 3 (1) months. The live birth rate was 84.4%. One maternal death occurred due to sepsis, unrelated to venous thromboembolism. Antepartum/secondary postpartum major bleeding and primary postpartum major bleeding occurred in 6.5% and 3.9%, respectively.</p><p><strong>Conclusion: </strong>Pregnancy-associated PE managed by a multidisciplinary team was associated with favourable maternal and fetal outcomes.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3722"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding a call to action on the prevention of fetal alcohol spectrum disorder.","authors":"H J Odendaal, H J Kinney","doi":"10.7196/SAMJ.2026.v116i2.4686","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i2.4686","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4686"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When will South Africa take the prevention of chronic HBV infection seriously?","authors":"T G Maponga, M I Andersson, W Preiser","doi":"10.7196/SAMJ.2026.v116i2.3771","DOIUrl":"10.7196/SAMJ.2026.v116i2.3771","url":null,"abstract":"<p><p>South Africa (SA) bears a significant burden of hepatitis B virus (HBV) infection, with a significant prevalence of hepatitis B surface antigen (HBsAg) among pregnant women. In response, the National Department of Health has recommended targeted birth-dose vaccination for infants born to HBsAg-positive mothers. While we commend the move towards antenatal HBsAg screening to identify infected pregnant women, we reiterate that a universal HBV birth-dose vaccination strategy would be a simpler, more equitable and more effective approach to preventing vertical transmission and reducing the overall HBV burden in SA.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3771"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and histological outcomes of appendectomies in a South African regional hospital, 2022 - 2023: A retrospective study.","authors":"A H Shulman, L Broderick, J Nel, G Shemesh, N N Tshabalala, M G Mendelow, M J Malapane, Y E Segal, S Raichund, Z F A Peermamode, L Nsakala, A Singh","doi":"10.7196/SAMJ.2026.v116i2.3689","DOIUrl":"10.7196/SAMJ.2026.v116i2.3689","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis is one of the most common surgical emergencies in South Africa (SA), yet local histopathological data on appendectomies remain limited.</p><p><strong>Objective: </strong>To determine the incidence and histological patterns of appendicitis at an SA regional hospital over a 2-year period.</p><p><strong>Methods: </strong>A retrospective review was conducted on all appendectomies performed at Tambo Memorial Hospital (TMH) in Boksburg, SA, from 1 January 2022 to 31 December 2023. Histological data, using Gomes score, which was correlated with microscopy and macroscopy from the SA National Health Laboratory Service, as well as patient demographics, were analysed. Logistic regression and χ2 tests were used to assess associations between variables.</p><p><strong>Results: </strong>A total of 283 appendectomies were reviewed. None was excluded. The cohort was predominantly male (64%), with a mean age of 26.99 years. Histologically normal appendices (grade 0) were found in 25.4% of cases. Grade 4 appendicitis (gangrenous/perforated) was the most prevalent pathological finding (39.9%). Males were significantly more likely to present with appendicitis, particularly advanced grades of appendicitis (p=0.00005; odds ratio (OR) 3.305, 95% confidence interval (CI) 1.869 - 5.915). Lymphoid hyperplasia was significantly associated with grade 0 appendices (p=0.00205; OR 0.282, 95% CI 0.125 - 0.631), suggesting possible alternative diagnoses such as gastroenteritis, mesenteric adenitis or pelvic inflammatory disease. Appendicular neoplasms (2.1%), faecoliths (17.3%) and parasites (1.4%) were not uncommon. No significant monthly variation was observed. The overall negative predictive value of clinician-directed appendectomy at TMH was 25.4%, in keeping with or better than rates reported at various tertiary hospitals - despite TMH lacking afternoon sonography and having no after-hours sonographic or radiological reporting services.</p><p><strong>Conclusion: </strong>Appendicitis at TMH showed a high rate of complicated cases, especially among males. Male sex was a significant predictor of appendicitis, whereas lymphoid hyperplasia was associated with negative histology and may represent an important clinical differential diagnosis. Other findings included benign neoplasms, faecoliths and parasites. These findings highlight clinical acumen in a resource- limited setting and the value of histological confirmation in appendicitis diagnoses.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e3689"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to correspondence regarding a call to action on the prevention of fetal alcohol spectrum disorder.","authors":"F Patel, R Pittrof, N Naidoo, V Lebese, S Mullick","doi":"10.7196/","DOIUrl":"10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 2","pages":"e4903"},"PeriodicalIF":1.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taking medicolegal mediation from principle to practice: A South African venture.","authors":"E C Muller, C M Strydom, B Hartslief, H Truter, P R Strauss","doi":"10.7196/SAMJ.2026.v116i1.4379","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i1.4379","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 1","pages":"e4379"},"PeriodicalIF":1.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent hypertension, albuminuria and low glomerular filtration rate in schoolchildren in Kano metropolis, Nigeria.","authors":"A Mudi, A Abdu","doi":"10.7196/SAMJ.2026.v116i1.3859","DOIUrl":"10.7196/SAMJ.2026.v116i1.3859","url":null,"abstract":"<p><strong>Background: </strong>Screening for persistent hypertension, albuminuria and low estimated glomerular filtration rate (eGFR) in children may allow for early detection of kidney disease, paving the way for early intervention to slow disease progression.</p><p><strong>Objective: </strong>To determine the prevalence of persistent hypertension, albuminuria and low eGFR and their associated factors in schoolchildren.</p><p><strong>Method: </strong>The study screened 228 schoolchildren (aged 5 - 15 years) from February 2020 to February 2021. Information about participants' sociodemographic profile and medical history was obtained through questioning. Participants' height, weight and blood pressure (BP) were measured. Their spot urine was assessed for albumin creatinine ratio (ACR), and blood for serum creatinine and eGFR. Participants with abnormal findings had a repeat assessment after a minimum of 3 months for BP, ACR and eGFR.</p><p><strong>Results: </strong>The median (range) age was 13.0 (11.1 - 14.0) years, with 117 males and 111 females. Seventy-eight of the children (34%) had at least one abnormality (hypertension 1.8%, albuminuria 28% and low eGFR 9%) at recruitment. At follow-up, 33 (42%) of the 78 children had persistent abnormal findings (hypertension 1.3%, albuminuria 10.1%, low eGFR 6%). Persistent albuminuria was seen more commonly in girls and in children with low eGFR. Older children (>10 years) were more likely to have low eGFR.</p><p><strong>Conclusion: </strong>A two-point, multiparameter screening of children may reveal high-risk groups for kidney disease that would require further evaluation and long-term follow-up. Such screenings can be integrated into school entry health assessment programmes to allow for early detection of kidney disease.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 1","pages":"e3859"},"PeriodicalIF":1.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical juncture: Reimagining a unified, integrated HIV response in South Africa.","authors":"K Rees, G Wolvaardt, T Chidarikire, J J Dietrich, L Ibisomi, T Kufa-Chakezha, T Mabuto, G Maimela, E Mudimu, L Scott, P Smith, N Sohaba, C Chetty-Makkan","doi":"10.7196/SAMJ.2026.v116i1.4454","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i1.4454","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 1","pages":"e4454"},"PeriodicalIF":1.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between depot medroxyprogesterone acetate and meningiomas: Emerging data and their relevance to the South African context.","authors":"R J Burman, R De Waal, K Cohen, M Blockman, M Patel, D Hockman, D M Fountain, S Jeyaretna, S Singh, H Mustak, B De John, D Lubbe","doi":"10.7196/SAMJ.2026.v116i1.4529","DOIUrl":"10.7196/SAMJ.2026.v116i1.4529","url":null,"abstract":"<p><p>In the past 2 years, evidence suggesting an association between depot medroxyprogesterone acetate (dMPA) use and meningioma has emerged. As dMPA remains one of the most widely used contraceptive methods worldwide, this finding has led to increasing media attention, and regulatory and legal proceedings. The South African Health Products Regulatory Authority (SAHPRA) has issued a statement acknowledging the association between dMPA exposure and the development for meningiomas. However, the paucity of local data on dMPA use and the incidence of and risk factors for meningioma in both the public and private health sector make it difficult to fully assess the implications in SA. This report discusses the relevance of the association between dMPA and meningiomas in the SA context. We provide a summary of the current data on the risk of meningioma with dMPA exposure, and suggest how this should impact on recommendations for the prescribing and use of dMPA from a public health perspective. We further identify gaps in local data, and propose where efforts should be directed to collect relevant data to inform a rational national contraceptive strategy.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 1","pages":"e4529"},"PeriodicalIF":1.2,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}