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

{"title":"A third-line antiretroviral therapy register to track patient clinical and virological outcomes.","authors":"K Naidoo, J Ramruthan, M Reddy, R Lancaster","doi":"10.7196/SAMJ.2022.v112i8.16695","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16695","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"511-512"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497910","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":"Carbapenem-resistant Enterobacterales in patients with bacteraemia at tertiary academic hospitals in South Africa, 2019 - 2020: An update.","authors":"M Lowe,&nbsp;L Shuping,&nbsp;O Perovic","doi":"10.7196/SAMJ.2022.v112i8.16351","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16351","url":null,"abstract":"<p><strong>Background: </strong>The emergence of carbapenem-resistant Enterobacterales (CRE) has become a serious and significant public health threat worldwide, owing to the limited antimicrobial therapy options, and the elevated mortality rates associated with these infections.</p><p><strong>Objectives: </strong>To present an update on the epidemiology of CRE bloodstream infections among hospitalised patients reported under the Group for Enteric, Respiratory and Meningeal Diseases Surveillance in South Africa (GERMS-SA) between January 2019 and December 2020.</p><p><strong>Methods: </strong>Patients of all ages with CRE bacteraemia were included and isolates, when available, were sent to the reference laboratory for confirmatory testing and molecular characterisation. Multivariable logistic regression analysis was performed to assess factors associated with in-hospital mortality.</p><p><strong>Results: </strong>We included 2 144 patients with CRE bacteraemia with a median age of 33 (interquartile range 1 - 51) years, of whom 1 145 (54.2%) were male. Klebsiella pneumoniae accounted for 79.8% of infections (n=863/1 082), of which 89.5% (n=611/683) were healthcare associated (HA). The most common carbapenemase genes were carbapenem-hydrolysing oxacillinase-48 (blaOXA-48-like) (76.8%; n=761/991), New Delhi metallo-β-lactamase (blaNDM) (21.1%; n=209/991) and Verona integron-encoded metallo-β-lactamase (blaVIM) (1.3%; n=13/991). None of the screened isolates with a colistin minimum inhibitory concentration >2 μg/mL harboured the mobilised colistin resistance (mcr)-1 to mcr-5 genes. The crude in-hospital mortality rate was 36.6% (n=377/1 029). Patients aged ≥60 years (v. 1.6 - 9 years) (adjusted odds ratio (aOR) 4.53; 95% confidence interval (CI) 2.21 - 9.28), those with comorbidities (diabetes, malignancy, renal and/or cardiovascular failure) (aOR 1.72; 95% CI 1.17 - 2.52), those with altered mental state (aOR 5.36; 95% CI 3.21 - 8.92) and those with previous antimicrobial use (aOR 1.88; 95% CI 1.27 - 2.77) had increased odds of in-hospital mortality.</p><p><strong>Conclusion: </strong>The epidemiology of CRE bloodstream infections remained similar compared with the previous surveillance report. Most infections were HA and caused by OXA-48-like carbapenemase-producing K. pneumoniae with no plasmid-mediated colistin resistance. Standard infection control measures should be strengthened.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"542-552"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497909","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":"Medicine and the Law.","authors":"M S Khan","doi":"10.7196/SAMJ.2022.v112i8.16577","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16577","url":null,"abstract":"<p><p>Cases of baby swapping in South Africa (SA) are very rare. In 1996 the first of these cases, Clinton-Parker v Administrator, Transvaal; Dawkins v Administrator, Transvaal, appeared before our courts. The parties in that instance decided to keep the babies who had been erroneously given to them, but the plaintiffs were awarded compensation for the emotional shock and injury they endured as the result of the defendant's negligence. In recent times we had the case of Child Law v NN and NS (GP), where the parties also decided to keep the children who had been erroneously given to them by the hospital staff. These scenarios, while difficult, have had amicable conclusions, with the parents electing not to pursue custody of their natural children. The situation would be more complex if either of the parties were to decide that they want their natural child back. A number of questions are pertinent here, and will guide the discussion in this article. Is it as simple as both of the 'psychological' parents returning the babies to their natural parents? Do the parents have a claim against the hospital staff? Unfortunately there is not a wealth of legal precedent to assist the SA courts in this regard. The article explores the jurisprudence that speaks to baby swapping, in an attempt to provide clarity and assistance in resolving these difficult cases.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"516-518"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497911","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":"Challenges of implementing an integrated electronic health record system in the Breast and Endocrine Clinic at Tygerberg Hospital, Cape Town, South Africa.","authors":"N B Mponda,&nbsp;V Beeka,&nbsp;D De Villiers,&nbsp;M Ismail,&nbsp;N Mongalo","doi":"10.7196/SAMJ.2022.v112i8.16633","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16633","url":null,"abstract":"<p><p>To the Editor: In low- to middle-income countries, the majority of patients with breast cancer are diagnosed with locally advanced disease. This remains a problem at the Tygerberg Hospital breast clinic in Cape Town, South Africa, with ~60% of all patients presenting with stage 3 or 4 disease at the time of diagnosis. The reasons cited are multiple and include fear, unawareness of disease severity, concerns surrounding losing a breast, unreliable transportation, referral difficulties and financial constraints.[1].</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"505"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33498371","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":"Medicine and the Law.","authors":"D J McQuoid-Mason","doi":"10.7196/SAMJ.2022.v112i8.16707","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16707","url":null,"abstract":"<p><p>The case involving Dr Tim De Maayer in Gauteng Province, South Africa (SA), raises the question whether there is a legal and ethical duty on public sector doctors whose complaints to hospital administrators have been ignored, to inform the public about harm to child patients due to intentional maladministration, negligence or indifference by the local and provincial authorities. An analysis of the SA Constitution, the National Health Act No. 61 of 2003, the Children's Act No. 38 of 2005, the Health Professions Act No. 56 of 1974 and the Rules and Guidelines of the Health Professions Council of South Africa (HPCSA) established in terms of the Health Professions Act indicates that Dr De Maayer acted both legally and ethically to protect the child patients at Rahima Moosa Hospital. As the complaints of harm caused to the patients because of conditions in the hospital were raised three times with the official functionaries concerned, and ignored by them, he was fully justified to try other measures to protect the patients. It seems that he hoped that by bringing the conditions at the hospital to the attention of the media, the public reaction would be such as to pressurise the administrators to redress the situation. The irony is that the officials who sought to discipline him were themselves guilty of violating the Constitution, the National Health Act and the Children's Act, and should be disciplined. Furthermore, if they are registered with the HPCSA, they should be reported and disciplined for violating the HPCSA's Ethical Rules of Conduct and its Ethical Guidelines on good practice.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"513-515"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497912","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":"Right of Reply.","authors":"S Andronikou,&nbsp;J W Lotz,&nbsp;I Bhorat,&nbsp;E Buchamann,&nbsp;P Soma-Pillay,&nbsp;E Nicolaou,&nbsp;L Pistorius,&nbsp;I Smuts","doi":"10.7196/SAMJ.2022.v112i8.16702","DOIUrl":"https://doi.org/10.7196/SAMJ.2022.v112i8.16702","url":null,"abstract":"<p><p>To the Editor: The article by Bhorat et al. [1] in the SAMJ, entitled 'Cerebral palsy and criteria implicating intrapartum hypoxia in neonatal encephalopathy - an obstetric perspective for the South African setting', starts off by raising concerns about 'steep rises in insurance premiums, placing service delivery under serious threat'. It does not acknowledge any service delivery issues that already exist in the public sector obstetric services in South Africa (SA). According to Whittaker,[2] in 2019, there were 303 obstetricians and gynaecologists employed in the SA public sector and 579 in the private sector, and of those employed in the public sector, 190 were performing private sector work. That a large number of the children with cerebral palsy (CP) were delivered in the public sector service was not noted by Bhorat et al.,[1] nor was the fact that the overwhelming majority of court cases are against the state (not against individual doctors) in provinces and hospitals with significant medical staffing and resource issues. For example, the liabilities for Eastern Cape Province in the 2019/20 period were ZAR36 751 207 v. only ZAR33 155 in Western Cape Province for the same period.[2].</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"506-508"},"PeriodicalIF":2.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497913","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":"Increase in linezolid resistance in staphylococci in the private sector in Western Cape Province, South Africa.","authors":"C Bamford,&nbsp;M Senekal,&nbsp;W Lowman","doi":"10.7196/SAMJ.2021.v111i11.16147","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.16147","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"13444"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39619986","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":"Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020.","authors":"J A George,&nbsp;S Khoza,&nbsp;E Mayne,&nbsp;S Dlamini,&nbsp;N Kone,&nbsp;W Jassat,&nbsp;K Chetty,&nbsp;C M Centner,&nbsp;T Pillay,&nbsp;M Maphayi,&nbsp;D Mabuza,&nbsp;I Maposa,&nbsp;N Cassim","doi":"10.7196/SAMJ.2021.v111i11.15669","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15669","url":null,"abstract":"<p><strong>Background: </strong>Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries.</p><p><strong>Objectives: </strong>To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa.</p><p><strong>Methods: </strong>This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity.</p><p><strong>Results: </strong>A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001).</p><p><strong>Conclusions: </strong>Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1078-1083"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635593","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":"Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response.","authors":"N Phaswana-Mafuya,&nbsp;O Shisana,&nbsp;W Jassat,&nbsp;S D Baral,&nbsp;Keletso Makofane,&nbsp;E Phalane,&nbsp;Khangelani Zuma,&nbsp;N Zungu,&nbsp;Martha Chadyiwa","doi":"10.7196/SAMJ.2021.v111i11.15812","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15812","url":null,"abstract":"<p><strong>Background: </strong>There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA).</p><p><strong>Objectives: </strong>To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19.</p><p><strong>Methods: </strong>Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values &lt;0.001.</p><p><strong>Results: </strong>Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100 000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100 000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites.</p><p><strong>Conclusions: </strong>The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1084-1091"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635594","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":"Post-laryngectomy simplified dysphagia score (SDS) tool: Potential for screening and comparison with the swallowing outcomes after laryngectomy (SOAL) tool.","authors":"R Blokland,&nbsp;A J Bruce-Chwatt,&nbsp;J W Loock","doi":"10.7196/SAMJ.2021.v111i11.15913","DOIUrl":"https://doi.org/10.7196/SAMJ.2021.v111i11.15913","url":null,"abstract":"<p><strong>Background: </strong>Our understanding of swallowing disorders after laryngectomy remains limited. A literature search found that documentation of swallowing function in the laryngectomee population is lacking. Furthermore, no consensus exists regarding a suitable evaluation tool to assess swallowing function. While conventional questionnaires are time consuming, cost and time constraints make regular objective swallowing investigations impractical.</p><p><strong>Objectives: </strong>To develop a 2-question simplified dysphagia score (SDS) screening tool for routine documentation of swallowing function at post-laryngectomy follow-up visits, and to test this new tool against an established dysphagia measuring tool for laryngectomees. We also sought to identify risk factors for poor swallowing outcomes.</p><p><strong>Methods: </strong>Cross-sectional surveys were used to compare results obtained from the validated swallowing outcomes after laryngectomy (SOAL) questionnaire and our novel SDS tool. The components of the SDS were guided by the experience and expertise of surgeons and speech therapists, as well as insights from patients and their families. Sixty laryngectomy patients (females, n=7; males, n=53) were enrolled in the study. All patients were &gt;18 years of age. Each participant was asked to complete the SDS and the SOAL questionnaires. The results of each tool were compared using non-parametric tests, with multiple pairwise comparisons using Bonferroni tests.</p><p><strong>Results: </strong>Both sets of results showed a linear relationship using the Kruskal-Wallis non-parametric analysis of variance (ANOVA) test. The SDS had a specificity of 96% (95% confidence interval (CI) 76 - 100%), a sensitivity of 81% (CI 64 - 91%), a positive predictive value of 97% (CI 81 - 100%) and a negative predictive value of 76% (CI 56 - 89%) against the SOAL scores. The SDS results yielded 7 false-negative and 1 false-positive result for dysphagia compared with the SOAL questionnaire. Outcomes of the secondary objectives did not reach statistical significance.</p><p><strong>Conclusions: </strong>The SDS is a 2-question, practical grading system that shows a statistically significant correlation with the recognised SOAL questionnaire, making it a useful alternative for everyday use, which provides outcome scores of direct practical value to patient and clinician. Prospective use of the SDS and higher patient numbers may allow a better understanding of dysphagia, its causes and risk factors.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":" ","pages":"1074-1077"},"PeriodicalIF":2.2,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39635592","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}