South African Medical Journal - November 2022 Vol 112 No 11

Introduction

Usability study of a sleeve attachment device for enhancing ease of use of metered dose inhalers in children

Asthma is a heterogeneous disease characterised by chronic airway inflammation resulting in airway hyper-responsiveness and recurrent symptoms of wheezing, shortness of breath, chest tightness and cough that vary over time and in intensity. These episodes are usually associated with widespread but variable airflow obstruction within the lungs that is often reversible, either spontaneously or with treatment.

Incidence and follow-up of persistent lung perfusion abnormalities as a result of suspected air trapping or microthrombosis in non-hospitalised COVID-19 patients during the early half of the pandemic – experience in a tertiary institution in South Africa

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the ongoing coronavirus disease 2019 (COVID-19) global pandemic. Since its discovery, millions of cases have been recorded worldwide, with hundreds of thousands of deaths. The pathophysiology of SARS-CoV-2 in the lungs involves viral interaction with cells expressing angiotensin-converting enzyme 2 (ACE2) in the lungs.[1] This interaction is thought to involve ACE2-mediated cellular viral entry, tissue damage and systemic release of cytokines. This ACE2 receptor is also expressed throughout the airway tract, including the small airways. Available clinical data have highlighted that COVID-19 is associated with a long-term risk of persistent small airway disease as a result of small airway trapping, manifesting as mosaic hypoattenuation on computed tomography (CT) images, especially in patients with severe disease. This small airway disease could result from direct infection of the small airways by SARS-CoV-2. Being small in diameter, these small airways are susceptible to occlusion by inhaled toxins or pathogens, or by inflammatory damage. Small airway disease has also been known to be associated as a complication with the previous Middle East respiratory syndrome (MERS) and SARS respiratory infections.

Diabetes in the public healthcare sector of four South African provinces: A comparative analysis

Diabetes mellitus (DM) remains a common and costly disease in many countries. According to the International Diabetes Federation (IDF), the prevalence of DM in Africa is predicted to increase to unprecedented levels by an estimated 156%. This population will form part of the projected 700 million people living with diabetes (PLWD) worldwide by 2045. In South Africa (SA), the increasing threat of DM grows alongside the high prevalence of communicable diseases (CDs) such as tuberculosis (TB), HIV and AIDS and, more recently, the COVID-19 pandemic. For example, an HIV-positive patient is twice as likely to develop DM and is at triple the risk of developing TB. This vicious interaction between CDs and non-communicable diseases (NCDs) has manifested throughout the African continent, creating immense pressure for government welfare efforts, economic reforms and an already strained public health sector. More than 80% of the SA population is currently dependent on public healthcare. The recent COVID-19 pandemic has reinforced the need to strengthen this sector to facilitate speedier responses and more effective healthcare outcomes for the large populations served by the public sector.

Recognition of infants at high risk for vertical HIV transmission at delivery in rural Western Cape Province, South Africa

Halting new HIV infections among children is a critical, unmet step toward the World Health Organization’s global goal to end the AIDS epidemic by 2030. Achieving elimination status requires a final  vertical (perinatal and postnatal) HIV transmission (VHT) rate of  <5% and an annual paediatric HIV incidence of <50 per 100  000  live births. Despite attaining a VHT rate of 3.9% in 2021, South Africa (SA)’s paediatric HIV incidence exceeded 750 per 100 000  livebirths due to the high antenatal HIV prevalence of 30.7%. Reducing transmission further requires strategic optimisation of  VHT prevention interventions. One such intervention is risk stratified prophylaxis for infants born to women living with HIV (WLHIV), including augmented and prolonged prophylaxis for infants at high risk of VHT. Although guidelines recommend such a risk-based approach, it is unknown whether this is being implemented successfully. 

The characteristics and costs of severe theophylline toxicity in a tertiary critical care unit in Eastern Cape Province, South Africa

Theophylline has been used to treat obstructive airway diseases since the 1920s. In view of toxicity risk (particularly in the elderly), drug interactions, variable metabolism and inferior efficacy compared with long-acting beta-agonists, theophylline is no longer being recommended as a first- or second-line treatment in local guidelines for asthma and chronic obstructive pulmonary disease (COPD). In spite of this, its use is still widespread in the communities served by Livingstone Tertiary Hospital (LTH) in Eastern Cape Province, South Africa (SA). Severe theophylline toxicity is a common presentation of drug toxicity requiring admission to the LTH intensive care unit (ICU). An internal audit of admissions to this ICU over a 3-year period (2017 - 2019) found that 100 patients were admitted for drug toxicities. Of these, 29 were admitted for severe theophylline toxicity, making it the most common cause of admission for drug toxicity to the ICU.