Introduction

Persistent maternal tachycardia: A clinical alert for healthcare professionals providing maternity care in South Africa

Clinicians are traditionally taught that physiological changes during pregnancy lead to an increase in the heart rate of 10 - 20 bpm. Recent data from a large cohort study in the UK, however, suggest that the average maternal heart rate varies according to gestational age and that rates of ≥100 bpm occur in 10% of women at 18 weeks’ gestation, and rates of >105 bpm in 10% of women at 34 weeks’ gestation. These findings create challenges for clinicians in defining an absolute value for the upper limit of normal. If the threshold is set at 100 bpm, it may lead to over-investigation of normal women, and if set at 120 bpm, it may lead to missed diagnoses. Clinically, it seems practical and reasonable to initiate thorough history taking, physical examination and investigations in all pregnant women with persistent tachycardia of ≥110 bpm, to look for an underlying pathological cause.

Prophylaxis is the new standard of care in patients with haemophilia

Inherited bleeding disorders: Epidemiology and clinical phenotype

Inherited bleeding disorders are diverse in aetiology, clinical presentation and epidemiology. They include those caused by lack of Von Willebrand factor, factor VIII (FVIII) deficiency (haemophilia A), and factor IX (FIX) deficiency (haemophilia B). The causative gene mutations in these conditions are well characterised, and they can be inherited or acquired following spontaneous mutations. Mutation prevalence is the same globally, irrespective of race, ethnicity, geographical location or socioeconomic status. Of the 3 142 patients diagnosed with inherited clotting factor deficiencies in South Africa (SA), 1 986 have haemophilia A, 379 have haemophilia B, 659 have Von Willebrand disease, and 118 have other rare bleeding disorders (factor VII, X and XI deficiencies). The majority of these patients (85%) are managed in the public sector by 22 haemophilia treatment centres across the nine provinces. The clinical phenotype of clotting factor deficiency is characterised by spontaneous or trauma-induced bleeding, with predominantly mucocutaneous bleeding in Von Willebrand disease and haemarthroses in the haemophilias. Bleeding and bleed-related complications are lifelong, with consequent characteristic haemophilic arthropathies, reduced quality of life and reduced life expectancies of patients with these conditions.

Is open-identity gamete donation lawful in South Africa?

If one visits the websites of international gamete banks and gamete donation agencies, one will observe that it has become increasingly common that many donors are ‘identity-release’ or ‘open-identity’ donors. This is quite conspicuous, as the photos of open-identity donors as adults are published on some of these websites. Being ‘open identity’ typically means that the donors have agreed to have their identities released on request by the donor-conceived child once the child reaches the age of majority. In contrast, gamete banks and gamete donation agencies in South Africa (SA) at most only share early childhood photos of their donors and make it clear that all their donors are anonymous. The generally accepted belief in the SA fertility industry seems to be that gamete donation in SA must by law be anonymous and that it is unlawful to disclose the identity of a gamete donor. This belief is shared by the South African Law Reform Commission, a state agency that does legal research and makes proposals for legal reform to the legislature. It stated in a recent publication that ‘The legal position in South Africa is that gamete donors … must be anonymous and it is an offence to reveal the identity of a gamete donor …

Immunological and virological outcomes in children on lamivudine monotherapy: A South African public sector experience

After the launch of the national antiretroviral treatment (ART) programme in South Africa (SA) in 2004, an estimated 75% of HIV-infected children accessed ART in the public sector by 2016. With this expanding access, maintenance of long-term viral suppression remains a challenge for HIV-infected children. Rates of virological failure in the paediatric age group range from 19.3% to >32% in resource-limited settings. These rates are higher than those reported in SA, which range from 6% in KwaZulu-Natal Province to 15% in Cape Town.

Solid malignancies during the first year of life: A 20-year review at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Paediatric tumours are rare, representing ~1% of all new tumour cases each year. Their origin, behaviour and treatment differ from adult tumours. Childhood tumours represent a spectrum of different diseases that vary in patient demographics, histological features and site of origin. In order to improve outcomes for these patients, the different age distributions of various types of tumours need to be considered in research protocols. Among paediatric tumours, two groups stand out: neonatal tumours (during the first 28 days of life) and infantile tumours (during the first year of life), which respectively represent 2% and 10% of paediatric tumours. The distribution of paediatric tumours is different in different age groups, with neuroblastoma and nephroblastoma being prevalent in young children and osteosarcoma, for example, being more common in adolescence, and according to the literature the regional incidence of such tumours also varies. Unlike adult tumours, which are usually recorded by primary site, childhood tumours are more meaningfully grouped by histological type and primary site based on the International Classification of Childhood Cancer (ICCC).

Safety and efficacy of inclisiran in South African patients at high cardiovascular risk: A subanalysis of the ORION phase III clinical trials

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide, accounting for ~18.6 million deaths in 2019. In accordance, CVD is now the leading cause of non-communicable death in South Africa (SA). The marked shift in the disease landscape in SA mirrors increased urbanisation and associated lifestyle behaviours. Well-characterised factors contributing to increased CVD risk include hypertension, obesity, tobacco use, diabetes mellitus and dyslipidaemia, among others. With a focus on hypercholesterolaemia, it is important to note that the management of this condition in SA is suboptimal. Low-density lipoprotein cholesterol (LDL-C) is a major risk factor for atherosclerotic CVD (ASCVD) and is the primary target of cholesterol-lowering therapies.[8-10] Poor disease awareness, restricted access to high-intensity lipid-lowering therapies and clinical inertia may explain why a significant proportion of patients do not reach guideline-recommended target concentrations of LDL-C.

Diagnostic performance of dobutamine stress echocardiography: A South African experience

Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis and risk stratification of coronary artery disease, and has demonstrated high sensitivity and specificity, as well as an excellent safety record, in large meta-analyses. The use of DSE is not yet widespread in southern Africa, and there are no published data on the diagnostic performance of DSE in this geographical region. Since DSE is more cost-effective than other non-invasive diagnostic modalities for the identification of inducible ischaemia, e.g. adenosine stress cardiac magnetic resonance imaging and single-photon emission computed tomography, demonstrating its appropriate use in a resource-constrained environment is highly relevant.

Pharmacist-led medication therapy management of diabetes club patients at a primary healthcare clinic in Cape Town, South Africa: A retrospective and prospective audit

Diabetes mellitus (DM) is identified as one of the most challenging public health concerns. In 2019, there were an estimated 463 million adults with DM worldwide and 19.4 million in Africa. In South Africa (SA), the age-adjusted comparative prevalence of DM was 12.7% in 2019, and 23% of the health budget was spent on diabetes care, imposing an economic burden on the country’s fragmented health system. A Cape Town study (2008) further reported a high prevalence (28.2%) of type 2 DM. DM forms part of SA’s quadruple burden of disease that requires comprehensive management at a primary care level. Despite evidence demonstrating the benefits of attaining glycaemic control, management of this disease is still largely lacking. Glycaemic targets are not being met, which can lead to diabetic complications.  Suboptimal management of patients with DM at primary healthcare (PHC) level can be attributed to lack of prescriber adherence to guidelines and failure to draw blood samples for laboratory testing, while recording of the body mass index (BMI) is often overlooked. In Tshwane district, findings from a review of patient folders noted limited recordings of glycated haemoglobin (HbA1c), a lipogram or total cholesterol test result, and kidney function with a serum creatinine level.

Accreditation

Health Professions Council of South Africa

MDB015/MPDP/038/206

3 Clinical

Certification

Attempts allowed: 2

70% pass rate





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South African Medical Journal - June 2022 Vol 112 No 6