Samj South African Medical Journal最新文献

Respiratory syncytial virus (RSV) is the commonest cause of lower respiratory tract infection (LRTI) in children, particularly those aged <1 year. In South Africa (SA), increased hospitalisation rates during the RSV season, including access to intensive care facilities, place a huge burden on the healthcare system. Furthermore, RSV-LRTI during early childhood may lead to long-term respiratory sequelae, including recurrent wheezing, asthma, and impairment of lung function. Recently, two new RSV prevention strategies have emerged: nirsevimab, a long-acting monoclonal antibody, and a maternal RSV vaccine. Both strategies have shown high efficacy in reducing RSV-LRTI hospitalisation in infants and are being considered for licensure in SA. Implementation of these prevention strategies, combined with public engagement and collaboration between stakeholders, could significantly reduce RSV-related morbidity and mortality in SA.

Background: The Health Professions Council of South Africa implemented a compulsory research component for specialist practitioner registration through the Master of Medicine (MMed) degree in 2011, eliciting both commendation and critique. Chief among the concerns is the extended time required for MMed completion. This study explores the duration of each component of the MMed research thesis and discusses the potential problematic areas in terms of its timeous completion, about which there is currently a lack of data, with particular regard to the South African (SA) setting.

Objectives: To quantitatively delineate the various components of the MMed research thesis process, identify potential barriers to its completion, and formulate a recommended evidence-based proposed timeline allowing for successful and timeous completion of the MMed.

Methods: We conducted a retrospective review of MMed degrees completed by paediatrics registrars at the University of the Witwatersrand, Johannesburg, SA, from 1 January 2011 to 31 December 2018, and an electronic survey of former MMed students, detailing the duration of each of the components of the MMed research thesis process.

Results: The survey had a 70.5% response rate (n=148 respondents, of whom 141 fully completed the survey). The median (interquartile range) time to complete the MMed research thesis was 30 (21 - 42) months. While 78.0% of respondents deemed 4 years adequate for completion, 15.6% reported durations exceeding 4 years, and 2.1% had not completed the MMed. The components of the research thesis with the longest duration in terms of completion included development of a first draft of the research protocol, data analysis, and development of the first draft of the final report. Factors reportedly associated with successful completion of the thesis were a supportive supervisor and the provision of a research rotation.

Conclusion: A significant portion of candidates do not complete the MMed research thesis within the 4-year training period, hindering specialist registration. The major contributing factors appear to be related to candidates' inexperience regarding the research process and lack of exposure to it, as well as some of the administrative procedures involved. Utilisation of the recommendations and structured timeline will help identify problematic areas timeously and ensure successful completion of the thesis.

Peripheral spondyloarthritis (SpA) includes psoriatic arthritis (PsA), inflammatory bowel disease (IBD)-associated arthritis, reactive arthritis and undifferentiated peripheral SpA. These South African guidelines offer information on diagnosis, assessment and therapy of peripheral SpA. Emphasis is placed on a multidisciplinary team, and a treat-to-target strategy with escalation of therapy if the target of minimal or very low disease activity is achieved. Screening for and treatment of comorbidities are paramount.

Superior vena cava (SVC) syndrome constellates symptoms of plethora and facial and upper thoracic swelling with distension of neck veins, and the consequences of this condition range from mild discomfort to upper airway obstruction. The aetiology has a strong linkage with malignancy, and is always to be excluded. SVC syndrome is commonly a bilateral presentation, and unilateral SVC syndrome is rare, with very few non-malignant causes reported. Here, we demonstrate a unilateral occurrence with an uncommon cause.

Early diagnosis and prompt treatment initiation are essential in the management of axial spondyloarthritis (axSpA), also known as ankylosing spondylitis, remembering that underdiagnosis and overdiagnosis of axSpA are common. These South African guidelines offer screening tools and details of useful investigations, including imaging. Care of the axSpA patient requires a multidisciplinary holistic approach emphasising lifestyle interventions, particularly exercise, smoking cessation and psychosocial support. The ankylosing spondylitis disease activity score is recommended as a measure of disease activity, and a stepwise algorithm for therapy is provided. Screening for comorbidities and vaccination is advised.