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

{"title":"Pre-transplant body mass index and survival after liver transplantation in an adult recipient cohort in Johannesburg, South Africa.","authors":"P Pillay, A Mahomed, J Fabian","doi":"10.7196/SAMJ.2026.v116i6.4005","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.4005","url":null,"abstract":"<p><strong>Background: </strong>Uncertainty exists regarding associations between recipient pre-transplantation body mass index (BMI) and survival after liver transplantation, particularly in terms of obesity as an exclusion criterion. There are no studies assessing these associations in southern Africa, which has implications for the selection of potential transplant candidates in the setting of limited liver transplant availability.</p><p><strong>Objectives: </strong>To determine associations between recipient pre-transplant BMI and survival after liver transplantation in Johannesburg, South Africa (SA).</p><p><strong>Methods: </strong>Adults aged ≥18 years who underwent liver transplantation for end-stage liver disease (ESLD) from August 2004 to January 2024 at Wits Donald Gordon Medical Centre were included in this cohort study. Multivariable Cox regression determined adjusted hazard ratios (HRs) and 95% confidence intervals (CIs), which were used for the associations of recipient pre-transplant BMI at listing and all-cause post-liver-transplant mortality. Survival at 1 and 5 years post transplantation was also assessed. BMI (kg/m2) was categorised using the World Health Organization classification: underweight <18.5; normal 18.5 - 24.9; overweight 25 - 29.9; obese: class I 30.0-34.9; class II 35.0 - 39.9; class III ≥40. Potential confounders adjusted for were age, sex, self-reported ethnicity, aetiology of ESLD, model for end-stage liver disease (MELD) score, ascites, diabetes, waitlist duration and postoperative complications. Effect modification by age, sex, self-reported ethnicity and MELD were assessed.</p><p><strong>Results: </strong>Among 489 adults, the median (interquartile range (IQR)) age was 53 (43 - 60) years; 290 (59.3%) were male; and in terms of ethnicity, 8 (1.6%) were Asian, 89 (18.4%) black, 35 (7.2%) Indian, 15 (3.1%) mixed and 338 (69.7%) white. Of these, 21 (4.3%) were underweight, 168 (34.4%) of normal BMI, 169 (34.6%) overweight, and 93 (19.0%) class I, 32 (6.5%) class II, and 6 (1.2%) class III obesity. After a median (IQR) of 5.3 (1.3 - 8.9) years follow-up, there were 187 (38.2%) deaths post liver transplantation. Using normal BMI as the reference category, there was no significant association with post-transplant mortality across BMI categories overall, except for class III obesity (HR 3.95; 95% CI 1.49 - 10.47). BMI was not significantly associated with 1- and 5-year post-transplant mortality.</p><p><strong>Conclusion: </strong>There was no significant association with post-liver-transplant mortality across BMI categories, except for class III obesity, which was positively associated. Owing to the limited number of participants with class III obesity, larger studies are needed to evaluate this further. The findings suggest that there is insufficient evidence to reliably use BMI as an exclusion criterion for liver transplantation, particularly for a BMI <40 kg/m2.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e4005"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687618","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":"Serum lipids and outcomes of COVID-19 patients admitted to a tertiary hospital in Johannesburg, South Africa.","authors":"F Mohamed, A M E Millen, C Dickens, F J Raal, I S Kalla","doi":"10.7196/SAMJ.2026.v116i6.4021","DOIUrl":"10.7196/SAMJ.2026.v116i6.4021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiometabolic disorders contribute significantly to global cardiovascular disease risk. COVID-19 can exacerbate underlying vascular and metabolic disturbances through immune and inflammatory pathways. Lipoprotein abnormalities may influence disease susceptibility and outcomes, as lipoproteins play key roles in viral entry, inflammation and immune regulation. These markers may therefore serve as potential biomarkers for predicting outcomes, yet data from African populations remain limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the association between admission lipid profiles and adverse clinical outcomes in hospitalised COVID-19 patients within a resource-constrained setting, in a predominantly black African population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational study was conducted at Charlotte Maxeke Johannesburg Academic Hospital between 6 March and 31 August 2020. Adults aged ≥18 years with confirmed SARS-CoV-2 infection who had admission lipid profiles were included. The association between lipid parameters and adverse clinical outcomes, including intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality, were determined by multivariable logistic regression analysis. Correlation analyses examined associations between lipids and inflammatory markers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 305 patients (mean (standard deviation) age 53 (13.8) years; 77% black ethnicity), non-survivors had significantly lower low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC), and higher fasting plasma glucose and inflammatory markers. Both LDL-C and TC were inversely correlated with procalcitonin (ρ=-0.44, 95% confidence interval (CI) -0.65 - -0.23, p=0.001; (ρ=-0.28, CI-0.52 - -0.05), p=0.03, respectively). Triglyceride (TG) levels were higher in ICU patients (p=0.01), and significantly correlated with an increasing white cell count (ρ=0.31, CI 0.09 - 0.53, p=0.01), neutrophil-to-lymphocyte ratio (ρ=0.27, CI 0.01 - 0.54, p=0.04) and fasting plasma glucose (ρ=0.39, CI 0.14 - 0.64, p=0.03), but were not independently predictive of mortality. High-density lipoprotein cholesterol was lower in ICU-admitted patients and inversely correlated with ferritin, but it was also not significantly associated with mortality. Lower LDL-C was an independent predictor of ICU admission (odds ratio (OR) 0.69, CI 0.50 - 0.96, p=0.03 ), mechanical ventilation (OR 0.55, CI 0.35 - 0.86, p=0.009 ) and mortality (OR 0.66, CI 0.48 - 0.91, p=0.01), with an LDL-C &lt;2.2 mmol/L associated with increased mortality(area under curve 0.62, CI 0.55 - 0.69), as shown in receiver operating characteristic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Non-survivors had significantly higher inflammatory markers compared with survivors, and low LDL-C and TC were independently associated with adverse outcomes. LDL-C also predicted ICU admission, mechanical ventilation and mortality, highlighting","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e4021"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687633","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":"Clarifying the interpretation of declining adolescent pregnancy trends: Implications for child protection and service provision.","authors":"S Bhamjee, Z Essack, S Goosen","doi":"10.7196/SAMJ.2026.v116i6.5255","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i6.5255","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 6","pages":"e5255"},"PeriodicalIF":1.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687485","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":"High-dose pyridoxine and peripheral neuropathy: Considerations for clinicians, pharmacists and policy-makers.","authors":"B Job, M Govender, T N Gengiah","doi":"10.7196/SAMJ.2026.v116i5.4610","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i5.4610","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e4610"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166746","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 clinical profiles and outcomes of patients with herpesviruses in cerebrospinal fluid: 2019 - 2022.","authors":"W P Du Plessis, M Saadiq Moolla, G Van Zyl, L Festus, L Nyasha Sigwadhi, A Parker","doi":"10.7196/SAMJ.2026.v116i5.3441","DOIUrl":"10.7196/SAMJ.2026.v116i5.3441","url":null,"abstract":"<p><strong>Background: </strong>Herpesviruses are ubiquitous and commonly cause neurological syndromes. A paucity of data exists describing the clinical profiles and outcomes of these viruses in cerebrospinal fluid (CSF).</p><p><strong>Objectives: </strong>To describe the clinical profile and outcomes of patients with a positive CSF viral panel testing for six herpesviruses (herpes simplex virus 1 and 2 (HSV1; HSV2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human herpesvirus 6 (HHV6)).</p><p><strong>Methods: </strong>A retrospective descriptive study included all hospitalised patients aged 13 years and older in whom a herpesvirus was detected by a herpesvirus panel performed on CSF. A folder review was performed to acquire demographic, clinical and laboratory information.</p><p><strong>Results: </strong>We identified 204 CSF herpesviruses in 184 patients. Most were people living with HIV (n=137/184, 74.5%). EBV was the most frequently identified herpesvirus (n=152/204, 74.5%). The herpesvirus was considered the cause of the clinical neurological syndrome in 20 patients (20/184, 10.9%), of whom most had VZV (7/20, 35%). Patients with VZV presented with encephalopathy (4/11, 36.4%), meningoencephalitis (3/11, 27.3%) and stroke (3/11, 27.3%). Encephalopathy, seizures and lower-limb weakness (n=5/19, 26.3%) were more common in patients with CMV. Those with HSV1 presented with seizures (n=2/5, 40%) and those with HSV2 with encephalopathy (n=3/6, 50%) and meningoencephalitis (n=2/6, 33.3%). EBV was the most common herpesvirus in patients with tuberculosis (TB) (45/49, 91.8%). Antiviral therapy was prescribed in 19/184 (10.3%) patients. The in-hospital mortality rate of all patients was 21.7%.</p><p><strong>Conclusion: </strong>EBV was the most common herpesvirus detected on CSF. Most patients with TB and HIV had EBV detected in their CSF, which may represent reactivation in these patients. This study highlighted the undertreatment of CMV and overtreatment of EBV. Greater awareness regarding the clinical indications for antiviral therapy in this setting is needed.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3441"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166767","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":"Clinical practice guidelines for the management of fever and neutropenia in South African children and adolescents with cancer.","authors":"G Naidu, D P Moore, T Reljic, N Azar, N Bhakta, A Cassim, K Coopasamy, H De Quintal, L Du Plessis, S-A Falcon, B Goodwin, L Johnson, M Jonas, V Moreno Berrio, F Naby, B Neethling, F Omar, A Omotola, H Rabie, A Van Zyl, A Whitelaw, S Licona, A Kumar, S Mukkada","doi":"10.7196/SAMJ.2026.v116i5b.4656","DOIUrl":"10.7196/SAMJ.2026.v116i5b.4656","url":null,"abstract":"<p><strong>Background: </strong>Infection poses a serious risk in children and adolescents with cancer, often leading to severe morbidity and occasionally, death. Inconsistent management of fever with neutropenia (FN) may affect clinical outcomes. Despite the frequent occurrence of this complication during cancer treatment, no South African (SA) clinical practice guideline (CPG) has been developed to support clinicians in its management.</p><p><strong>Objective: </strong>To develop an evidence-based CPG providing recommendations for diagnosis, prognosis and management of children and adolescents with FN undergoing cancer treatment in SA.</p><p><strong>Method: </strong>We developed an evidence-based CPG for managing this condition, tailored to the unique and diverse healthcare system in which children and adolescents with cancer are treated in SA. We established a working group comprising representatives from the clinical care pathway for SA children and adolescents with cancer. We then employed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to formulate the CPG recommendations.</p><p><strong>Conclusion: </strong>We present two definitions and 29 recommendations for managing children and adolescents with FN. The CPG development process has yielded recommendations similar to those of other FN CPGs; however, they reflect the unique context of SA, and guide elements such as tuberculosis evaluation, focusing on essential factors including availability, accuracy, affordability and diagnostic capacity. Furthermore, the systematic review conducted as part of the evidence synthesis emphasises the need for high-quality evidence from SA settings.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5b","pages":"e4656"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166773","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":"Proceedings of the 2^nd Data Driven Surgery Conference (DDSC 2025).","authors":"I Kleinhans, H Duvenage, H Kluyts","doi":"10.7196/SAMJ.2026.v116i5d.5334","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i5d.5334","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5D","pages":"e5334"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166752","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":"Gun violence - South Africa's neglected public health emergency.","authors":"D Peacock, P Navsaria, C Taylor","doi":"10.7196/SAMJ.2026.v116i5.4945","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i5.4945","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e4945"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166737","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":"SAMA Health Summit Abstracts.","authors":"Claudia Naidu","doi":"10.7196/","DOIUrl":"https://doi.org/10.7196/","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5C","pages":"e5331"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166738","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":"Depressive symptoms among community service doctors in South Africa.","authors":"T Morar, G M Purbrick","doi":"10.7196/SAMJ.2026.v116i5.3388","DOIUrl":"10.7196/SAMJ.2026.v116i5.3388","url":null,"abstract":"<p><strong>Background: </strong>Medical doctors face occupational stressors threatening their mental health, particularly junior doctors in South Africa. There is a higher prevalence of depressive symptoms among medical doctors compared with the general population. The consequences of this to health systems and the patients doctors treat is a major public health concern. In South Africa, prevalence of depressive symptoms among community service doctors servicing public sector healthcare is largely unknown.</p><p><strong>Objectives: </strong>To determine the prevalence of possible depression, and predictive factors thereof, among doctors in their community service year in South Africa.</p><p><strong>Methods: </strong>A national descriptive cross-sectional survey was distributed electronically between October and December 2022. The Patient Health Questionnaire 9 (PHQ-9) was used to screen for depression. Demographic, occupational and individual characteristics were included as potential predictive factors.</p><p><strong>Results: </strong>A total of 217 participants were included in the analyses. Prevalence of depressive symptoms was 96.3% (standard error 0.13, 95% confidence interval 92.87 - 98.40%). Predictors of higher scores included: women, drug use, feeling neutral or disagreeing that one worked outside of normal working hours, working in KwaZulu-Natal or North West, burnout (emotional exhaustion), working in orthopaedics, obstetrics and gynaecology departments or the National Health Laboratory Service, first choice of placement, financial difficulties, and accessing mental health services. Predictors of a lower score included: perceiving sufficient resources at work, using colleagues to cope, good work-life balance, and certain departments, particularly neurosurgery.</p><p><strong>Conclusion: </strong>There is an extremely high prevalence of depressive symptoms among community service doctors. Supporting these doctors at an individual, organisational and structural level should be a priority for national policy-makers.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3388"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166789","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}