South African Medical Journal - August 2022 Vol 112 No 8

Introduction

Is there 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 at the local and provincial level?

The recent case involving Dr Tim De Maayer, a paediatrician based at Rahima Moosa Mother and Child Hospital in Gauteng Province, South Africa (SA), raises the question of 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.

How does South African law handle cases involving baby swapping?

The phenomenon of baby swapping can be traced back to the times of King Solomon: the Bible tells the story of two women who lived together and delivered their babies at around the same time. Unfortunately one child died during the evening, and the mother of the child who died sought to assert that the living child was her own. The women quarrelled over their biological right to the surviving child, and the dispute was finally decided upon by King Solomon. He suggested that the child be split in half: one mother agreed with this, and the other said she would give up her right to the child if it meant that the child would survive. Solomon then ruled that the mother who was prepared to give up her rights to the child be given the child, declaring that this was in fact in the child’s best interests.

First report of an imported case of haemorrhagic fever with renal syndrome in South Africa

Hantaviruses are negative, single-stranded RNA viruses harboured by small mammals (including bats, rodents, moles and shrews) and have wide geographical distribution across the Americas, Europe and Asia. In humans, hantavirus infection may cause two distinct forms of disease, known as haemorrhagic fever with renal syndrome (HFRS) or hantavirus cardiopulmonary syndrome (HPS). The latter is endemic to the Americas and is more severe than HFRS, with reported case fatality rates (CFRs) of 35 - 50%. Predominantly, Sin Nombre virus (SNV) is associated with a severe form of HPS, but it can be caused by infection with one of 25 currently identified hantaviral species. HFRS is endemic to several Asian and European countries, and is associated with CFRs of 1 - 15%. Dobrava virus (DOBV), Hantaan virus (HTNV), Seoul virus (SEOV) and Puumala virus (PUUV) are primarily associated with HFRS. Hantaviruses are transmitted from host rodent species to humans through aerosolised excreta. In the case of HFRS, clinical case presentation is characterised by the triad of fever, haemorrhage and acute kidney dysfunction. Infection presents in phases with distinctive indicators such as fever, hypotension, oliguria and diuresis. Prodromal HPS symptoms are typically those of a nonspecific febrile illness (fever, myalgia, dizziness, headaches and gastrointestinal symptoms) progressing to hypotension, shock and pulmonary oedema, signalling the onset of the cardiopulmonary phase of the disease, often requiring hospitalisation.

Ivermectin exposures reported to the Poisons Information Helpline in South Africa during the COVID-19 pandemic

COVID-19 is a novel viral infection that has caused a global pandemic leading to millions of deaths. Definitive treatment options for established COVID-19 disease are limited, and the development of effective vaccines has shifted the global focus to preventive strategies. Nevertheless, research into curative strategies for COVID-19 is ongoing, including the repurposing of promising drugs with direct or indirect activity against the SARS-CoV-2 virus. The anthelmintic drug ivermectin is primarily used in the veterinary sciences, and can also be used in humans for filarial and resistant scabies infections. In June 2020, ivermectin was reported to be effective against SARS-CoV-2 in vitro,  supporting previous preclinical studies showing that ivermectin has antiviral and antiinflammatory activity. Together these findings sparked global interest in ivermectin as potential prophylaxis and treatment for COVID-19, and led to several randomised controlled trials and subsequent meta-analyses. However, the South African (SA) National Department of Health and the World Health Organization (WHO) do not currently recommend the use of ivermectin for COVID-19, citing significant methodological limitations of most trials without clear evidence of benefit. Despite this, ivermectin has attracted a great deal of public interest globally 

He tragedy of smoking, alcohol, and multiple substance use during pregnancy

Substance use during pregnancy is on the increase worldwide and is a significant public health concern. In South Africa (SA), use of multiple substances during pregnancy is common. In a survey of 5 232 pregnant women visiting midwife obstetric units in Cape Town, it was found that 36.9% used alcohol and drugs, 34.9% alcohol only, and 1.6% drugs only. Also in Cape Town, a substudy of the Safe Passage Study (SPS) of the PASS (Prenatal Alcohol in Sudden infant death syndrome and Stillbirth) Network, on the value of maternal serum alpha-fetoprotein measurements, found that 61% of pregnant women smoked, 55% drank alcohol, and 9% and 5% used marijuana and methamphetamine, respectively. Methamphetamine use in pregnancy is associated with poorer neonatal outcomes, especially decreased birthweight, head circumference and body length. The effects of marijuana use during pregnancy are less clear, with reports ranging from no adverse effect with regard to the likelihood of prematurity or low birthweight (LBW) to a reduction in birthweight, length and head circumference and an increase in preterm births and growth restriction (GR).

A paediatric pain assessment and management survey at Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa

Pain, defined as an unpleasant physical or emotional experience that is associated with actual or potential tissue damage, is a personal and subjective experience. It is prevalent in the paediatric population, as part of both surgical and medical pathology. The gold standard of pain assessment is by self-report. This method proves difficult in children whose neurodevelopmental immaturity precludes coherent description of painful experiences and competent requests for analgesia when needed. Cognitively impaired patients are a particularly vulnerable group. Depending on their level of ability, some depend only on non-verbal communication. This unique set of circumstances has led to the development of several validated pain assessment tools for children of all ages, as well as for children with cognitive impairment.

Carbapenem-resistant Enterobacterales in patients with bacteraemia at tertiary academic hospitals in South Africa, 2019 - 2020: An update

Enterobacterales are Gram-negative bacteria that cause healthcareassociated (HA) and community-associated (CA) infections. With the increased use of carbapenems (i.e. doripenem, ertapenem, imipenem and meropenem), the emergence of carbapenem-resistant Enterobacterales (CRE) has become a serious and significant public health threat worldwide. The European Centre for Disease Control and Prevention reported that mortality is >50% in patients with CRE bloodstream infections.