South African Medical Journal - December 2022 Vol 112 No 12

Introduction

Cardiovascular deaths: What do the genes say?

Cardiovascular diseases (CVDs) are ever-increasing, and as such are considered to be one of the most concerning public health burdens worldwide. They remain the leading cause of death across the world (~17.7 million deaths were reported in 2015), accounting for 31% of all global deaths. More than 75% of these cardiovascular deaths occur in low- and middle-income countries, and although CVD is an acknowledged health concern in Africa, this priority area should receive much more attention than it currently does.

Postmortem genetic testing in young individuals: What clinical medical practitioners need to know

A general misconception regarding the field of forensic medicine seems to be that the purpose thereof is only to conduct medicolegal autopsies on cases that are criminal in nature, and to deal with the subsequent judicial matters resulting from such cases. However, forensic medical practitioners are in fact in a most fortunate and unique position, as they observe the  exact  pathology  of  various  diseases  (whether  or  not  these  are  attributed  as  the  cause  of  death)  in  thousands  of  autopsies  performed  each  year.  In most cases these medicolegal autopsies reveal an underlying, natural disease as the cause of death. All information pertaining to the cause and mechanism of these deaths are relayed to several entities, including the Department of Home Affairs and Statistics South Africa.  

Factors that influence parental and caregiver acceptance of routine childhood vaccination: Summary of a qualitative evidence synthesis

Immunisation is one of the most effective healthcare interventions to prevent serious illnesses and death in young children.  Yet in SA and elsewhere, there are parents who question vaccines, seek alternative vaccination schedulesand decide to delay or refuse vaccination for their children. Our understanding of the nature and drivers of childhood vaccination hesitancy is still limited.

Fatal infective necrotising fasciitis: Complication following Naja nigricincta nigricincta bite (western barred spitting cobra/zebra snake)

Naja   nigricincta   nigricincta(western   barred   spitting   cobra/zebra   snake)  (Fig.  1)  is endemic to central and northern Namibia as well as southern Angola.  It is responsible for most of the venomous snakebites seen in these areas of Namibia.  The majority of bites occur at night while the victims are asleep.  These are often babies and small children, who suffer high mortality.  The snake frequents human habitation, both urban and rural, and is often found inside dwellings.

Successful multi-organ donation from a district-level hospital without an intensive care unit – a case series of referrals over an 18-month period

Organ donation is typically felt to be beyond the remit of services offered outside of hospitals in major metropolitan areas.  District-level hospitals have no intensive care units and may not have blood gas machines or capacity and expertise to identify, refer and manage potential donors. In addition, they may lack the ability to accurately diagnose the cause of death in complicated cases.

Detection of karakin poisoning using a targeted mass spectrometric workflow

The high number of toxic endemic and alien plants in South Africa (SA) represents a health hazard, and plant toxicosis is common. Misidentification of toxic plants and ingestion of toxic components by pets or children can lead to severe toxicity. While most cases are treated symptomatically, if the plant or toxin is correctly identified, available antidotes may be considered. For example, the delirium of the anticholinergenic syndrome caused by belladonna alkaloids can be treated by physostigmine. Poisoning by alien plant species is especially dangerous as the lack of local knowledge makes timeous identification and treatment more difficult.

HLA class I and class II antigens in sarcoidosis

Sarcoidosis is a multisystem disease characterised by development of granulomas, with the lungs the most frequent site.  The precise cause of sarcoidosis is not known, but several genetic, environmental, occupational, and socioeconomic risk factors are implicated in its pathogenesis.  It has been suggested that the disorder arises in people who are genetically predisposed to react to certain as yet unknown environmental agents, which leads to an exaggerated inflammatory immune response resulting in granulomas developing.  The theory that genetic factors play a role in the pathogenesis of sarcoidosis is based on family groupings of sarcoidosis cases, increased monozygotic twin incidences in relation to non-twin siblings, and racial differences in disease expression, frequency and vulnerability.

COVID-19 in pregnant women in South Africa: A retrospective review

South Africa (SA) is a low- to middle-income country (LMIC) and, despite having made significant progress over the past two decades, the maternal mortality rate (MMR) remains approximately 100/100 000, significantly higher than that seen in high-income countries. The majority of maternal deaths in SA occur as a result of non-pregnancy-related infections, and pregnant women in SA have not been spared the burden of COVID-19.  A large SA study conducted at 36 hospitals across the country showed an overall high MMR (6.3%) in women infected with SARS-CoV-2.  The MMR was even higher (14.7%) in those admitted primarily for COVID-19, as opposed to those with incidental or asymptomatic disease

Risk factors and outcomes of sepsis-associated acute kidney injury in intensive care units in Johannesburg, South Africa

Sepsis is a clinical condition in which the inflammatory response to an infection causes organ dysfunction distal to the primary site of infection.  Sepsis-associated acute kidney injury (SA-AKI) has been shown to cause significant morbidity and mortality in both children and adults with severe illness. SA-AKI occurs in 35 - 70% of critically ill patients and increases both in-hospital morbidity and mortality. In the USA, a 22-year retrospective analysis of hospitalised patients from discharge records of non-federal acute care hospitals found that sepsis occurred at an annual rate of 13.7% of hospital admissions.