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

{"title":"Early Online.","authors":"S Mahomed, M V Ncube, A Dhai, W Janneker, M Nodikida","doi":"10.7196/SAMJ.2026.v116i5.5072","DOIUrl":"10.7196/SAMJ.2026.v116i5.5072","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly reshaping clinical practice, and has prompted the Health Professions Council of South Africa to publish Booklet 20 - its first ethical framework for AI use in healthcare. This review critically evaluates Booklet 20 through the lens of the South African Medical Association AI Task Team, examining its alignment with national legislation, emerging regulatory mechanisms, broader policy commitments and the ethico-social context. Drawing on the Protection of Personal Information Act, the South African Health Products Regulatory Authority's 2025 guidance for AI‑enabled medical devices, the National AI Policy Framework and the 2024 National Health Research Ethics Council ethics guidelines, the analysis identifies key operational gaps relating to human oversight, disclosure, data sovereignty, equity, accountability and risk categorisation. The article argues that while Booklet 20 establishes an important foundation, its principles require concrete implementation tools, including risk‑tiered safeguards, structured consent templates, meaningful governance co-ordination and context‑appropriate standards for transparency, explainability and bias mitigation. Grounding these enhancements in South Africa's communitarian ethic of ubuntu highlights the need for relational accountability, fairness and community participation to ensure safe and equitable AI integration. The article concludes with a set of practical recommendations aimed at strengthening ethical governance and supporting patient trust and professional integrity as AI becomes embedded in clinical workflows.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e5072"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166743","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 National Health Insurance Act - was there meaningful public participation?","authors":"A Dhai","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 5","pages":"e5332"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166729","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 rare case of paraneoplastic dermatomyositis secondary to smouldering multiple myeloma referred for proteinuria.","authors":"S Meel","doi":"10.7196/SAMJ.2026.v116i5.3970","DOIUrl":"10.7196/SAMJ.2026.v116i5.3970","url":null,"abstract":"<p><p>Dermatomyositis (DM) is often associated with malignancies but less commonly with plasma cell dyscrasias. Myoglobin nephropathy is an uncommon complication of inflammatory myopathies. This case describes a patient who presented with proteinuria because of myoglobin nephropathy caused by dermatomyositis. The dermatomyositis was paraneoplastic with an underlying smouldering multiple myeloma (SMM) diagnosed on investigation. Case report. A 58-year-old mixed-race gentleman was referred for sub-nephrotic proteinuria. Further history taking revealed a 1-month history of proximal muscle weakness and a 5-month history of skin changes suggestive of dermatomyositis. Additional testing showed no associated albuminuria. There was haematuria on the urine microscopy which, with the accompanying raised creatine kinase levels, suggested myoglobinuria. Kidney biopsy confirmed myoglobin nephropathy. Further testing was done to exclude paraneoplastic DM. Investigations for solid organ malignancies were negative. Plasma cell dyscrasia screening revealed an IgA kappa monoclonal band, which was confirmed with serum free light chain testing. A bone marrow biopsy confirmed the diagnosis of SMM based on the revised working group diagnostic criteria for multiple myeloma. This case serves as a reminder of the importance of clinical history and examination. Investigation in this case revealed an extrarenal cause of the proteinuria, and recognition of the presentation of DM led to further investigation for secondary causes. Routine screening for plasma cell dyscrasias is recommended as part of DM work-up to allow the diagnosis to be made early, prior to organ damage.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3970"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166683","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":"On behalf of the South African Medical Association (SAMA), The Scientific Committee of the SAMA Health Summit, is pleased to pesent this abstract issue, showcasing the posters and oral presentations delivered at the Summit, which was held from 22-24 May 2026.","authors":"Z Farina, D Hagemeister","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":"e5333"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166779","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":"Agreement between various non-invasive blood pressure measurement sites in the obese population using the VitalStream system as control.","authors":"L M Van Dyk, N Mdzinwa","doi":"10.7196/SAMJ.2026.v116i5.3341","DOIUrl":"10.7196/SAMJ.2026.v116i5.3341","url":null,"abstract":"<p><strong>Background: </strong>The incidence of obesity and hypertension, with all their associated complications, is on the rise globally. Non-invasive blood pressure (NIBP) is often difficult to measure in obese individuals owing to the increased circumference and conical shape of the upper arm. The forearm and ankle may serve as convenient alternatives to measure NIBP. The aim of this study was to identify the most accurate site for NIBP monitoring in obese patients.</p><p><strong>Objectives: </strong>To statistically determine an agreement between different NIBP sites (upper arm, forearm and ankle) and our control blood pressure (BP). A secondary objective was to investigate agreements between different NIBP sites, anthropometric variables (body mass index (BMI)/mid-upper arm circumference/conicity index) and the control, with the goal of deriving a correction formula for BP.</p><p><strong>Methods: </strong>A prospective cross-sectional study was conducted at a provincial tertiary hospital in Gauteng Province, South Africa. Fifty participants aged 20 - 60 years, with BMI 35 - 40 kg/m2, were recruited. Using appropriately sized cuffs, NIBP measurements were obtained from the left upper arm, forearm and ankle. Simultaneous continuous BP measurements were recorded using the VitalStream device on the contralateral hand. Bland-Altman plots and regression analyses were employed to evaluate agreement and derive correction formulas for each measurement site.</p><p><strong>Results: </strong>Bland-Altman analysis revealed significant biases across sites, with ankle systolic BP showing the greatest deviation (mean bias +14.44 mmHg, 95% confidence interval 8.26 - 20.62). Regression analyses identified significant agreements for mean arterial pressure at the upper arm, enabling a correction formula with high reliability (p<0.001). Forearm and ankle measurements demonstrated wider limits of agreement and were prone to overestimation, especially in systolic and diastolic pressures.</p><p><strong>Conclusion: </strong>Upper arm NIBP measurements were the most accurate in the obese population. Alternative sites, such as the forearm and ankle, demonstrated inconsistent reliability, and require careful interpretation. Correction formulas can enhance the accuracy of NIBP readings but may be cumbersome for routine clinical use. Future studies should focus on refining measurement protocols and evaluating the efficacy of conically shaped cuffs for improved accuracy.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3341"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166724","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":"LDL-cholesterol targets and lipid-lowering therapies - a plea to medical schemes and the Council for Medical Schemes.","authors":"A D Marais, D J Blom, D M Blackhurst, F J Raal","doi":"10.7196/SAMJ.2026.v116i5.4971","DOIUrl":"10.7196/SAMJ.2026.v116i5.4971","url":null,"abstract":"<p><p>-.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e4971"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166734","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":"Thomas Micheal Guntram Ignaz Rehle (1951 - 2025).","authors":"Public Health Societies And Belonging Phsb Research Division, School Of Public Health, O Shisana, L Simbayi, R Ehrlich, L London, A Boulle","doi":"10.7196/SAMJ.2026.v116i5.5071","DOIUrl":"https://doi.org/10.7196/SAMJ.2026.v116i5.5071","url":null,"abstract":"","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e5071"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166723","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":"Analysis of adverse events following COVID-19 vaccination and infection: A retrospective, comparative cohort study using a claims database from Discovery Health, a managed care organisation in South Africa.","authors":"K Bernhardt, S Collie, D W C Jacobs, P Mekgwe, G Gray, J Peter, L-G Bekker","doi":"10.7196/SAMJ.2026.v116i5.3941","DOIUrl":"10.7196/SAMJ.2026.v116i5.3941","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adverse events following COVID-19 vaccination have been studied extensively in recent years. However, there remains a paucity of data directly comparing adverse events among COVID-19 vaccinees and individuals with SARS-CoV-2 infection within the insured population in South Africa (SA). Moreover, the breadth of conditions assessed in this study exceeds that of most existing research, providing a unique perspective on potential immune-mediated outcomes. This study therefore contributes to a more comprehensive understanding of the risk-benefit profile of COVID-19 vaccination across different age groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the rate of adverse events occurring in COVID-19 vaccinees compared with individuals who have had SARS-CoV-2 infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study, matching vaccinated individuals and those who have had a SARS-CoV-2 infection with comparable unexposed counterparts. Incident risk rates for 99 possible immune-mediated adverse events were compared between populations over a 42-day observation period to estimate relative risk ratios and confidence intervals. We used data from Discovery Health, a large managed care organisation in SA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 3 112 918 individuals aged ≥12 years who received a COVID-19 vaccination were included in the study, with an average of 76% successfully matched to a suitable comparator based on their risk profile. Additionally, 443 220 individuals with documented SARS-CoV-2 infection were analysed, with an average of 99.7% matched to an appropriate comparator. For recipients of the BNT162b2 vaccine, aged 12 - 17 years, we found an increased risk of lymphadenopathy and vertigo, compared with an increased risk of appendicitis, arrhythmia, encephalomyelitis, lymphadenopathy, myocarditis, seizure, syncope, type 1 diabetes and vertigo post SARS-CoV-2 infection. For those aged ≥18 years, we found no increased risk for any conditions post BNT162b2 vaccination. Additionally, no conditions post AD26.COV2.S vaccination had an increased risk for any age group. Post documented SARS-CoV-2 infection for persons in age groups 18 - 39, 40 - 59 and ≥60 years, we found an increased risk of acute kidney injury, anaemia, appendicitis, arrhythmia, axonal and neuronal neuropathy, cerebrovascular accident, deep-vein thrombosis, encephalomyelitis, endometriosis, eosinophilic oesophagitis, fibrosing alveolitis, glomerulonephritis, inflammatory bowel disease, intracranial haemorrhage, lymphadenopathy, myocardial infarction, myocarditis, myositis, pericarditis, pulmonary embolism, rheumatic fever, seizure, syncope, thrombocytopenia, type 1 diabetes, urticaria, vertigo, multiple sclerosis, cholangitis and/or pancreatitis. Notably, not all conditions presented with an increased risk in each age group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Across all age subgroups analysed, the risks associated with SARS-C","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3941"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166722","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":"Doxorubicin-induced early-onset chronic progressive cardiotoxicity, pharmacogenetics and survival among breast cancer patients in Zimbabwe.","authors":"T Mazhindu, V A Nyangwara, M Z Borok, C Masimirembwa, T Flaig, T B Campbell, N Ndlovu","doi":"10.7196/SAMJ.2026.v116i5.3655","DOIUrl":"10.7196/SAMJ.2026.v116i5.3655","url":null,"abstract":"<p><strong>Background: </strong>Early-onset chronic progressive cardiotoxicity (ECPC) is a significant cause of morbidity and mortality among patients who receive doxorubicin-based chemotherapy for breast cancer.</p><p><strong>Objective: </strong>To establish incidence of ECPC in black Zimbabwean women with breast cancer treated with doxorubicin and the resultant survival, and to describe the pharmacogenomic biomarkers' association with prognosis.</p><p><strong>Method: </strong>A prospective observational study was conducted in Zimbabwe with 50 participants who received doxorubicin-based treatment and were actively followed up to 12 months, with 3-monthly echocardiography and vital status determined at 60 months for all-cause mortality analysis.</p><p><strong>Results: </strong>ECPC was observed in 10% of participants. Median survival for participants who developed ECPC and those without was 11.9 v. 40.8 months. Participants with ECPC had 5-year overall survival (OS) of 0% v. 42% (hazard ratio (HR) 4.19, 95% confidence interval (CI) 1.27 - 13.79; p=0.018) for participants with no ECPC recorded. Median survival was significantly shorter for patients on calcium channel blockers (p=0.01). Cardiotoxicity, pre-existing hypertension and histological grade showed no significant association. Using multivariate analysis, poor OS was observed with ECPC (HR 4.19, 95% CI 1.27 - 13.79; p=0.018) and calcium channel blocker use (HR 2.38, 95% CI 1.07 - 5.32; p=0.034); no association was observed with pharmacogenomic biomarker risk categorisation based on SLC28A3, UGT1A6 and RARG (HR 1.39, 95% CI 0.46 - 4.25; p=0.561).</p><p><strong>Conclusion: </strong>Breast cancer patients with doxorubicin-induced ECPC had poorer OS. The risk of doxorubicin cardiotoxicity and poor survival could not be explained using SLC28A3-scoring pharmacogenomic profile. Breast cancer therapies with lower cardiotoxicity are needed in Zimbabwe and other low-resource settings.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3655"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166778","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 changing fortunes of the District Health System in SA (1994 - 2020): A retrospective review.","authors":"E Whyle, T Assegaai, M Smuts, P Barron, T Masilela, K Vallabhjee, B Engelbrecht, L Gilson, H Schneider","doi":"10.7196/SAMJ.2026.v116i5.3215","DOIUrl":"10.7196/SAMJ.2026.v116i5.3215","url":null,"abstract":"<p><strong>Background: </strong>The District Health System (DHS) forms the foundation of South Africa (SA)'s public health system. Following years of fragmentation and inequity during the apartheid era, building the DHS was seen as a vital element of the strategy to reform the health system in line with the principles of primary healthcare (PHC). SA has made great strides in establishing and strengthening the DHS, and to date there are 52 districts and 240 subdistricts. This process unfolded in a complex, and often challenging, social and political context.</p><p><strong>Objectives: </strong>To present an historical account of the DHS as a focus of national-level policy and strategy from 1994 to present. In doing so, we aim to illuminate the factors influencing DHS development over time, and contribute to an historically aware understanding of SA's DHS and its contemporary challenges.</p><p><strong>Methods: </strong>We conducted a retrospective scoping review of literature on the DHS in SA from 1994 to 2020. We used database searches to identify primary and secondary documentary evidence, supplemented by purposive searches of databases and institutional repositories, and published and unpublished documentary evidence from the personal archives of key stakeholders. We extracted data on the timing of policy developments and contextual factors influencing DHS prioritisation and strategy using a structured data extraction sheet. Once extracted, this information was organised into a timeline.</p><p><strong>Results: </strong>After full-text review, 134 items were included for analysis. Based on the data analysis, we divided the events of the policy timeline into three periods: 1994 - 2000 (developing the legislative framework for the DHS, establishing local government boundaries and building district-level capacity), 2001 - 2009 (finalisation of the National Health Act, and the effects of the HIV epidemic and vertical health programmes on the DHS), and 2010 - 2020 (development of National Health Insurance legislation and associated efforts to strengthen PHC). This periodisation reflects differences in the pace of policy change, the extent of political prioritisation of the DHS and contextual factors influencing its development.</p><p><strong>Conclusion: </strong>Sustained political commitment to DHS development in SA is evident. However, the development and implementation of the DHS have been both enabled and constrained by various contextual realities, and is best understood in relation to wider health system and sociopolitical dynamics. Further in-depth analyses of the nature, focus and limits of DHS strengthening efforts are warranted. In particular, history-sensitive analyses of the sociopolitical factors that shaped the development of the DHS will inform strengthening efforts going forward.</p>","PeriodicalId":520778,"journal":{"name":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde","volume":"116 5","pages":"e3215"},"PeriodicalIF":1.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166733","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}