Hypertriglyceridaemia in adolescents may have serious complications

Acute pancreatitis due to severe hypertriglyceridaemia should be considered in children and adolescents presenting with acute abdominal pain. Unrecognised recurrent hypertriglyceridaemic pancreatitis may cause significant morbidity and mortality, and early recognition and appropriate referral to specialised clinics is advisable to prevent complications. Lipaemia noted on a laboratory report should be investigated. This report presents two adolescent females with diabetes mellitus (DM), hypertriglyceridaemia and acute pancreatitis. Hypertriglyceridaemic pancreatitis is an often-overlooked cause of acute abdominal pain, especially in children and adolescents. The first patient developed DM after recurrent episodes of pancreatitis and severe pancreatic destruction. The second developed acute hypertriglyceridaemic pancreatitis as a result of poorly controlled DM. The first patient has polygenic hypertriglyceridaemia and the second patient has an inhibitor to lipoprotein lipase (LPL). Both patients responded well to dietary fat restriction.

The complexity of neuropsychiatric manifestations of COVID-19 in South Africa

SARS-CoV-2 was first identified in Wuhan City, China, in December 2019. The virus is predominantly transmitted through respiratory droplets and has subsequently spread from China throughout the world. The first case of COVID-19 in South Africa (SA) was reported on 5 March 2020. Initially, SARS-CoV-2 was implicated in the development of  a spectrum of pulmonary disease, ranging from mild upper respiratory tract infection to severe acute respiratory syndrome. Subsequently, research showed that various organ systems are affected, including the haematological, cardiac and neurological systems. Neurological manifestations of COVID-19 have been identified since 2019, with a study in Wuhan City showing that of 214 patients with severe infection, 36% had neurological, including neuropsychiatric, manifestations such as depression, anxiety, mood disturbances and new-onset psychosis. In a UK-wide surveillance study using an online case report notification platform, CoroNerve, psychosis was identified in 10 of the first 153 neuropsychiatric patients surveyed. Although data are scarce, psychosis related to COVID-19 has been reported to be associated with confusion and disorganised behaviour, particularly in patients who had been admitted to an intensive care unit. Those who present with psychosis typically recover rapidly after treatment with a low dose of antipsychotics.

The role of the Minister of Health in the National Health Insurance Bill: Challenges and options for the Portfolio Committee on Health

Parliament’s Portfolio Committee on Health (PCH) is responsible for obtaining public input on the National Health Insurance Bill (the Bill), reviewing the Bill based on the inputs, and then presenting the final Bill to the National Assembly. The PCH conducted public hearings across the country and received over 100 000 submissions. More than 130 individuals, organisations and institutions requested to make oral presentations, which commenced on 18 May 2021. Within the wide range of concerns raised, concerns about governance were particularly prominent, specifically related to the role and powers of the Minister of Health (MoH). In total, 123 clauses in the Bill refer to the MoH. The Bill makes the MoH responsible for the overall governance and stewardship of the National Health Insurance Fund (the Fund) (clause 31(1)), requiring the Fund to ‘account to the Minister for the performance of its functions and the exercise of its powers’ (clause 10(1)(m)). Considering the governance failures plaguing national and local government, the Department of Health and the MoH, and state-owned enterprises and public entities, if National Health Insurance (NHI) is to be successfully implemented it is imperative that the Bill establishes robust governance and accountability mechanisms.

Echocardiographic features of infective endocarditis in South Africa: A prospective cohort study

Infective endocarditis (IE), an infection of the endocardial surface of the heart or any prosthetic material within the heart, continues to be associated with significant morbidity and mortality. Current diagnostic algorithms place a high importance on organism identification with a view to optimising antibiotic therapy. A diagnosis of IE is initially suspected on the basis of clinical and imaging (echocardiography in particular) features, with some delay until microbiological confirmation. During the period  awaiting identification of the causative organism, patients are treated with empirical antimicrobial therapy targeted at the most common causative organisms. In a number of patients, no causative organism is identified and these patients will remain on empirical therapy for the duration of treatment. The fact that some patients with IE will require empirical therapy that is determined by local causative organisms highlights the importance of accurate local data on these organisms and the need for using additional modalities to predict the most likely causative organism in the absence of microbiological confirmation.

Where have we come from and where are we going? The paediatric HIV programme in Johannesburg, South Africa, from 2004 to 2018: A retrospective analysis of programme trends

Following diagnosis, HIV-positive children then need to be linked to ART. While initiation of ART on the same day is recommended, barriers such as lack of healthcare worker confidence in managing these children remain a challenge. Lastly, retaining children in care and ensuring adherence to ART are more challenging than in adults. This is supported by an analysis of the long-term outcomes of children and adolescents in the IeDEA-Southern Africa Collaboration, which showed that adolescents with perinatally acquired HIV had suboptimal retention and adherence to ART during adolescence, attributed to more frequent clinic visits as well as delaying disclosure to the child. Lower retention and adherence affect virological suppression, which is the goal of ART.

Human papillomavirus prevalence among unvaccinated young female college students in Botswana: A cross-sectional study

Human papillomavirus (HPV) is the most common sexually transmitted pathogen. Its peak prevalence is observed in adolescent girls and young women soon after sexual debut, and prevalence decreases with increasing age. Most individuals will be infected with at least one HPV genotype during their lifetime. The majority of HPV infections clear spontaneously within a couple of months. However, viral persistence of cervical infection for over a year is strongly associated with an increased risk of cervical cancer. Globally, the prevalence of HPV varies across populations, and higher HPV prevalence has been found in less developed regions. In Africa, HPV prevalence ranges from 7% to 60%, without consideration of cytological findings.

Mandrax use, sexual risk, and opportunities for pre-exposure prophylaxis among out-of-school adolescent girls and young women in Cape Town, South Africa

In South Africa (SA), an estimated 7.5 million people are living with HIV. Adolescent girls and young women (AGYW) aged 15 - 24 years account for nearly 25% of all new HIV infections in the country, double the figure for their male peers. The intersection of substance use and sexual risk continues to drive the HIV epidemic among AGYW. For example, methaqualone, also known as Mandrax, is a synthetic sedative-hypnotic that has a long history of illicit recreational use in SA and may affect HIV risk among AGYW. Typically in SA, Mandrax tablets are crushed and mixed with  cannabis and tobacco before being smoked in a pipe, called ‘white pipe’. The effects of smoking Mandrax include a euphoric high followed by drowsiness, temporary unconsciousness or passing out, with potential sedation lasting up to 5 hours. Given its sedative effects, Mandrax may affect women’s ability to negotiate condom use during sex, refuse sex without a condom, or consent to sex, thereby increasing their risk for HIV. Consequently, it is critical to understand how Mandrax use affects HIV risk among AGYW and to assess awareness of and willingness to use biomedical HIV prevention methods, such as pre-exposure prophylaxis (PrEP), among AGYW who use Mandrax.

The profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department, South Africa

The global prevalence of non-fatal suicidal behaviour is estimated to be 10 - 40 times higher than that of (fatal) suicide. While physical methods such as hanging and firearm-related injuries are more commonly employed methods of suicidal behaviour in higher-income countries, intentional self-poisoning is the most common method employed in lower-income countries. Risk factors for suicidal behaviour include relationship problems, family conflict, unwanted pregnancy, unemployment, type of occupation, family history of suicide, drug and alcohol abuse, mood disorders and other psychiatric illnesses, mental illness, chronic illnesses, and being diagnosed with serious medical conditions such as cancer and heart disease. Intentional self-poisoning is the deliberate ingestion of a substance for the purpose of committing suicide, attention-seeking behaviour or expressing distress, or as a means of seeking revenge. In SA, non-fatal intentional self-poisoning accounts for ~90% of cases of non-fatal suicidal behaviour and is associated with significant morbidity and mortality. A study conducted in Eastern Cape Province reported that drug overdoses were responsible for an average of 29 intensive care unit (ICU) admissions every month. Studies have shown that among patients presenting to SA hospitals with a history of intentional self-poisoning, <5% die prior to hospital discharge. However, this figure does not account for deaths occurring prior to hospital presentation. A study that analysed trends in suicide mortality in SA between 1997 and 2016 reported that there were 8 573 recorded suicides during this period, with poisoning the leading method of suicide in females (38.8% of cases) and the second leading method in males (15.2%). 



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South African Medical Journal - May 2022 Vol 112 No 5