Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420220004&lang=es vol. 112 num. 4 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Pandemic politics</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Call for the South African Health Products Regulatory Authority to revisit regulations relating to single-use medical devices</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Public health sector capacity and resilience building in Zimbabwe: An urgent priority as further waves of COVID-19 are imminent</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400003&lng=es&nrm=iso&tlng=es <![CDATA[<b>Telehealth opportunities for South Africa have been brought into focus by the COVID-19 pandemic</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400004&lng=es&nrm=iso&tlng=es <![CDATA[<b>Teenage births and pregnancies in South Africa, 2017 - 2021 - a reflection of a troubled country: Analysis of public sector data</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400005&lng=es&nrm=iso&tlng=es <![CDATA[<b>High prevalence of multimorbidity and non-communicable disease risk factors in South African adolescents and youth living with HIV: Implications for integrated prevention</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400006&lng=es&nrm=iso&tlng=es BACKGROUND: Adolescents and youth living with HIV (AYLHIV) face an elevated non-communicable disease (NCD) risk resulting from HIV, psychosocial challenges, and the complications of antiretroviral therapyOBJECTIVES: To investigate the prevalence of common NCDs and their risk factors among AYLHIV in urban Cape Town, South Africa, in order to inform an integrated approach to NCD screening and prevention in AYLHIVMETHODS: We conducted a cross-sectional study in six primary care facilities in Cape Town between March 2019 and January 2020. We collected sociodemographic information, and assessed dietary intake, physical activity and nutritional knowledge. We also screened for pre-existing and previously unidentified NCDs and modifiable risk factors in 92 adolescents and youth receiving treatment for HIV in primary care settings using self-report and objective measures. Differences between sexes and age groups were compared using parametric and non-parametric statistical testsRESULTS: Three out of four participants were female, and the median (interquartile range) age was 20.5 (18.9 - 22.9) years. More than a quarter were not in education, employment or training, and 44% were multidimensionally poor. Five percent of participants had measured hypertension, and 37% had central obesity. AYLHIV self-reported high levels of household food insecurity (70%), low daily fruit and vegetable consumption (28% and 52%, respectively), high refined sugar and sugar-sweetened beverage intake (31% and 29% daily intake, respectively), regularly skipping breakfast (42%), low nutritional knowledge (37% average score) and insufficient weekly physical activity levels (31%). A third (30%) were current smokers, and 24% engaged in binge drinkingCONCLUSIONS: Our findings of a high prevalence of NCDs and risk factors in AYLHIV highlight the importance of NCD risk screening as part of HIV care for AYLHIV. Such integrated approaches are needed to achieve the dual purpose of improving outcomes through early diagnosis of pre-existing NCDs as well as the prevention of NCD multimorbidity in AYLHIV. This study further demonstrates the need for early intervention on the social, environmental and economic determinants of NCDs targeting adolescents and youth <![CDATA[<b>Percutaneous left atrial appendage occlusion: A South African experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400007&lng=es&nrm=iso&tlng=es BACKGROUND: Atrial fibrillation (AF) is associated with all-cause mortality, heart failure and non-fatal stroke, and thromboprophylaxis is traditionally provided with oral anticoagulants (OACs). Percutaneous left atrial appendage occlusion (LAAO) with a dedicated device is an alternative approach to thromboprophylaxis in patients with AF who are: (i) intolerant to OACs (e.g. life-threatening haemorrhage); (ii) non-adherent to OACs; or (iii) at a high bleeding risk with OACs. Non-inferiority of LAAO compared with OACs was demonstrated in e.g. the WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial. Only very limited data are available on percutaneous LAAO in South Africa (SA), and no local outcome data have been reportedOBJECTIVES: To compare the safety and efficacy outcomes of an SA percutaneous LAAO programme with larger international seriesMETHODS: All patients undergoing percutaneous LAAO from 2013 to 2020 at a single centre (SAEndovascular, Kuils River Netcare Hospital, SA) were included from an ongoing registry. Survival analysis was performed with the Kaplan-Meier methodRESULTS: Of 101 LAAO recipients (mean (standard deviation) age 77 (10) years, 64% male) analysed, 90 (90%) had permanent AF, 1 (1%) persistent AF and 9 (9%) paroxysmal AF. The most common indication for LAAO was previous severe bleeding (n=23; 23%). The mean device size was 23 (3) mm and the procedural success rate was 98%. After a median (interquartile range) follow-up of 21 (5 - 41) months, 6 patients (6%) experienced stroke or all-cause mortality. Four patients (4%) had a life-threatening procedural complication (tamponade n=2 (2%) and device embolisation n=2 (2%)). These outcomes are comparable to large international series, e.g. PROTECT AFCONCLUSIONS: The safety and efficacy outcomes of an SA percutaneous LAAO programme were comparable to large international series. A successful percutaneous LAAO programme is feasible in a southern African context <![CDATA[<b>Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400008&lng=es&nrm=iso&tlng=es BACKGROUND: The global COVID-19 pandemic has resulted in increased acute hospitalisations, a high demand for intensive care and high in-hospital mortality, placing a huge burden on healthcare systemsOBJECTIVES: To assess in-hospital mortality outcomes and associated factors in acute hospitalised COVID-19 pneumonia patients in ZambiaMETHODS: We performed a retrospective cohort review of patients admitted to two tertiary-level hospitals in Zambia from 1 March 2020 to 28 February 2021. We examined the factors (demographic, clinical and laboratory) that were associated with in-hospital mortality using multivariate logistic analysis. Adjusted odds ratios with their 95% confidence intervals (CIs) are reportedRESULTS: Of 350 patients, 59.4% were aged >55 years and 52.6% were male. The commonest comorbidities were hypertension, diabetes mellitus (DM), HIV/AIDS and chronic kidney disease (49.6%, 28.5%, 22.0% and 8.1%, respectively). The overall in-hospital mortality rate was 42.6%, and mortality was significantly increased in patients aged >55 years (52.0% v. 48.0%) and in those with DM (52.1% v. 47.9%), cardiac disease (68.0% v. 32.0%), a Quick Sequential (Sepsis-Related) Organ Failure Assessment (q-SOFA) score >2 (75.4% v. 24.6%), and admission blood glucose levels >7.0 mmol/L (66.3% v. 33.7%). Compared with patients who survived, who spent a median (interquartile range) of 6 (3 - 10) days in hospital, the median time between admission and death in those who died was 2.5 (1 - 6) days. In multivariate logistic analysis, age >55 years, a q-SOFA score >2 and a random blood sugar level >7.0 mmol/L were predictors of in-hospital mortality, with adjusted odds ratios of 1.54 (95% CI 1.09 - 2.17), 2.17 (95% CI 1.40 - 3.38) and 1.65 (95% CI 1.18 - 2.30), respectively. Raised serum creatinine was not associated with in-hospital COVID-19 mortality after adjusting for other confoundersCONCLUSIONS: This study highlights that high in-hospital COVID-19 mortality was associated with a high q-SOFA score, hyperglycaemia on admission and older age. The study reinforces the need to invest in emergency healthcare services for optimal management of COVID-19 patients presenting with high q-SOFA scores in resource-limited countries <![CDATA[<b>Profile, presentation and outcomes of prosthetic valve endocarditis in a South African tertiary hospital: Insights from the Groote Schuur Hospital Infective Endocarditis Registry</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400009&lng=es&nrm=iso&tlng=es BACKGROUND: Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in South African retrospective studies ranges between 13% and 17%OBJECTIVES: To define the clinical profile and outcomes of patients with PVE, and compare them with those of native valve endocarditis (NVE) patientsMETHODS: We performed a prospective observational study of patients presenting or referred to Groote Schuur Hospital, Cape Town, with definite or possible infective endocarditis (IE) based on the 2015 European Society of Cardiology IE diagnostic criteria. Consenting adult patients who met the inclusion criteria were enrolled into the Groote Schuur Hospital Infective Endocarditis Registry, which was approved by the University of Cape Town Human Research Ethics Committee. This study is an analysis of the patients enrolled between 1 January 2017 and 31 December 2019RESULTS: During the study period, a total of 135 patients received a diagnosis of possible or definite IE (PVE n=18, NVE n=117). PVE therefore accounted for 13.3% of the overall IE cohort. PVE patients had a mean (standard deviation) age of 39.1 (14.6) years, and 56.6% were male. PVE occurred within 1 year of valve surgery in 50.0% of cases. Duke's modified diagnostic criteria for definite IE were met in 94.4% of the PVE cohort. Isolated aortic valve PVE was present in 33.3%, and a combination of aortic and mitral valve PVE in 66.6%. Tissue prosthetic valves were affected in 61.1% of cases. Of the PVE cases, 55.6% were healthcare associated. On transthoracic echocardiography, vegetations (61.1%), prosthetic valve regurgitation (44.4%) and abscesses (22.2%) were discovered. Staphylococcus and Streptococcus species accounted for 38.8% and 22.2% of PVE cases, respectively, and 27.8% of cases were blood culture negative. Valve surgery was performed in 38.7% of the PVE patients, and 55.6% of the patients died during the index hospitalisation. Secondary analysis indicated that the PVE patients were sicker than those with NVE, with a higher frequency of septic shock and atrioventricular block (22.2% v. 7%; p=0.02 and 27.8% v. 12%; p=0.04, respectively). In addition, in-hospital mortality was higher in PVE patients than NVE patients (55.6% v. 31.6%; p=0.04CONCLUSIONS: PVE was uncommon, mainly affecting tissue prosthetic valves and prosthetic valves in the aortic position. Patients with PVE were sicker than those with NVE and had high in-hospital mortality <![CDATA[<b>Erratum: The next generation: Pregnancy in adolescents and women living with perinatally acquired HIV in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742022000400010&lng=es&nrm=iso&tlng=es BACKGROUND: Prosthetic valve infective endocarditis (PVE) is associated with high morbidity and mortality. The prevalence of PVE in South African retrospective studies ranges between 13% and 17%OBJECTIVES: To define the clinical profile and outcomes of patients with PVE, and compare them with those of native valve endocarditis (NVE) patientsMETHODS: We performed a prospective observational study of patients presenting or referred to Groote Schuur Hospital, Cape Town, with definite or possible infective endocarditis (IE) based on the 2015 European Society of Cardiology IE diagnostic criteria. Consenting adult patients who met the inclusion criteria were enrolled into the Groote Schuur Hospital Infective Endocarditis Registry, which was approved by the University of Cape Town Human Research Ethics Committee. This study is an analysis of the patients enrolled between 1 January 2017 and 31 December 2019RESULTS: During the study period, a total of 135 patients received a diagnosis of possible or definite IE (PVE n=18, NVE n=117). PVE therefore accounted for 13.3% of the overall IE cohort. PVE patients had a mean (standard deviation) age of 39.1 (14.6) years, and 56.6% were male. PVE occurred within 1 year of valve surgery in 50.0% of cases. Duke's modified diagnostic criteria for definite IE were met in 94.4% of the PVE cohort. Isolated aortic valve PVE was present in 33.3%, and a combination of aortic and mitral valve PVE in 66.6%. Tissue prosthetic valves were affected in 61.1% of cases. Of the PVE cases, 55.6% were healthcare associated. On transthoracic echocardiography, vegetations (61.1%), prosthetic valve regurgitation (44.4%) and abscesses (22.2%) were discovered. Staphylococcus and Streptococcus species accounted for 38.8% and 22.2% of PVE cases, respectively, and 27.8% of cases were blood culture negative. Valve surgery was performed in 38.7% of the PVE patients, and 55.6% of the patients died during the index hospitalisation. Secondary analysis indicated that the PVE patients were sicker than those with NVE, with a higher frequency of septic shock and atrioventricular block (22.2% v. 7%; p=0.02 and 27.8% v. 12%; p=0.04, respectively). In addition, in-hospital mortality was higher in PVE patients than NVE patients (55.6% v. 31.6%; p=0.04CONCLUSIONS: PVE was uncommon, mainly affecting tissue prosthetic valves and prosthetic valves in the aortic position. Patients with PVE were sicker than those with NVE and had high in-hospital mortality