Wits journal of clinical medicine最新文献

{"title":"Walls of Silence","authors":"G. Kantor","doi":"10.18772/26180197.2021.v3n3a9","DOIUrl":"https://doi.org/10.18772/26180197.2021.v3n3a9","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81232561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All you need to know about COVID-19 and Vaccines (National Institute for Communicable Diseases)","authors":"","doi":"10.18772/26180197.2021.v3n1a16","DOIUrl":"https://doi.org/10.18772/26180197.2021.v3n1a16","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90600510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronavirus Disease 2019 (COVID-19) and Psychiatric Sequelae in South Africa: Anxiety and Beyond.","authors":"Ugasvaree Subramaney, Andrew Wooyoung Kim, Indhrin Chetty, Shren Chetty, Preethi Jayrajh, Mallorie Govender, Pralene Maharaj, EungSok Pak","doi":"10.18772/26180197.2020.v2n2a2","DOIUrl":"10.18772/26180197.2020.v2n2a2","url":null,"abstract":"<p><strong>Background: </strong>The 2019 coronavirus (COVID-19) pandemic has brought unprecedented challenges to the health sector nationwide and internationally. Across all disciplines, unique and novel modes of presentation with substantial morbidity and mortality are being encountered, and growing evidence suggests that psychiatric comorbidity is likely among COVID-19 patients.</p><p><strong>Objective: </strong>This article aims to broaden the current discussion on the psychiatric sequalae of COVID-19, which has largely focused on anxiety, and examine the recently documented psychiatric sequelae of COVID-19 infection, the secondary effects of the pandemic on public mental health, and future psychiatric conditions that may arise due to COVID-19.</p><p><strong>Methods: </strong>We conducted an in-depth review of the current global psychiatric literature and describe the wide range of psychopathological presentations reported among past COVID-19 patients worldwide and those that are expected to emerge.</p><p><strong>Results: </strong>Current discussions in the psychiatric literature on COVID-19 report anxiety and anxiety disorders as a predominant set of clinical presentations during the pandemic. The impacts of direct COVID-19 infection, associated psychopathological sequelae, and drastic lifestyle changes due to the COVID-19 pandemic in South Africa, are associated with a broad range of psychopathologies and other neuropsychiatric presentations. Pre-existing societal conditions and burdens on the health system in South Africa prompt healthcare providers and public health planners to accordingly prepare for the expected rise in new psychiatric presentations.</p><p><strong>Conclusion: </strong>Greater awareness of the various psychiatric conditions attributed to COVID-19 infection may allow for earlier screening, more effective treatment, and greater positive health outcomes and better prepare health systems to address the growing pandemic in South Africa.</p>","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162198/pdf/nihms-1661700.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9153785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronavirus Disease 2019 (COVID-19) Resources","authors":"","doi":"10.18772/26180197.2020.v2nsiamr","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nsiamr","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74544053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should ACE Inhibitors and Angiotensin Receptor Blockers Be Withdrawn in the Current Setting of COVID-19 Infection?","authors":"P. Manga","doi":"10.18772/26180197.2020.v2nSIa4","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nSIa4","url":null,"abstract":"At the end of February 2020 and early March 2020, the British Medical Journal and the Lancet Respiratory Medicine Journal, respectively, published reports which hypothesized that patients with cardiac diseases, hypertension or diabetes, who are treated with angiotensin converting enzyme ACE inhibitors or angiotensin receptor blockers (ARBs), were more susceptible to COVID-19 (SARS-CoV-2) infection.(1,2) In one of the largest published series in Wuhan, China, cardiovascular comorbidities such as hypertension, coronary artery disease and diabetes have reported to be common in patients admitted to hospital with COVID-19 infection.(3) In this study of 1099 patients with confirmed COVID-19 infection and of 173 who were classified as having severe diseases, hypertension was reported to be prevalent in 23.7%, diabetes mellitus in 16.2% and coronary artery disease in 5.8%.(3) Although these conditions are often treated in hospitals with ACE inhibitors and ARBs, the effects of these treatment strategies on mortality were not assessed in this study.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77357117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Ethical Challenges in the Covid-19 Crisis in South Africa","authors":"K. Behrens","doi":"10.18772/26180197.2020.v2nsia5","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nsia5","url":null,"abstract":"In a recent paper, the USA-based Hastings Center, which addresses social and ethical issues in health care, science and technology, observes that in public health emergencies a shift needs to take place away from the ethical norms of standard clinical practice, which is patient-centred and responsive to individual patient preferences, towards public health ethics, which is concerned with safeguarding the health of the population by means of the best use of resources. This can entail limiting individual rights and choices.(1) They assert that “public health emergencies may feature tragically limited resources that are insufficient to save lives that under normal conditions could be saved”.(1) This necessitates decisions about how to allocate limited resources: “In a public health emergency featuring severe respiratory illness, triage decisions may have to be made about level of care ...; initiation of life-sustaining treatment ...; withdrawal of life-sustaining treatment; and referral to palliative ... care if life-sustaining treatment will not be initiated or is withdrawn”.(1) This is equally true in the South African context. However, clinicians here may be more accustomed to working with limited resources and rationing decisions, and the tension between the patient-centred and public health orientations might not be as unfamiliar or stark for them. However, this does not change the fact that triage decisions take their toll on health-care workers, emotionally. The Hastings Center asserts that one important way in which this emotional distress can be alleviated is by ensuring that there are clear rules in place for public health emergencies, for instance, “triage protocols ... help first responders to swiftly prioritize patients for different levels of care based on their needs and their ability to respond to treatment given resource constraints”.(1) Unclear rules or rules that cause patient distress can lead to moral distress in caregivers, especially in situations in which protocols require the withholding or withdrawing of treatment against the wishes of patients or their families. Thus, there is a critical need and an ethical obligation for ethics guidelines for decision-making about treatment allocation to be in place before the pandemic reaches the level where tragic choices need to be made. The question now is, what would an ethically sound policy for rationing in a health emergency look like? In a recently published paper entitled “Fair allocation of scarce medical resources in the time of Covid-19”, Emanuel et al. write that the literature on resource allocation in pandemics emphasizes four main values that should inform policies: “Maximizing the benefits produced by scarce resources, treating people equally, promoting and rewarding instrumental value and giving priority to the worst off ”.(2) They go on to make six recommendations derived from these four principles. It is not possible to discuss these in any detail here, and only the f","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75767616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient guide - COVID 19","authors":"","doi":"10.18772/26180197.2020.v2nsiapg","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nsiapg","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81179758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Study: A Patient with Asthma, Covid-19 Pneumonia and Cytokine Release Syndrome Treated with Corticosteroids and Tocilizumab","authors":"G. Schleicher, W. Lowman, G. Richards","doi":"10.18772/26180197.2020.v2nSIa9","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nSIa9","url":null,"abstract":"Severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) is the novel coronavirus first detected in Wuhan, China, that causes coronavirus disease 2019 (Covid-19) and pneumonia. Covid-19 pneumonia is defined by a positive result for SARS-CoV-2 on a reverse-transcriptase– polymerase-chain-reaction (RT-PCR) assay of a specimen collected from the upper or lower respiratory tract together with radiological features of pneumonia and clinical features of hypoxaemia and dyspnoea. Although more than 80% of patients with Covid-19 infection have mild disease and make a full recovery, a significant proportion of patients progress to pneumonia, and about half of these cases will develop severe acute respiratory syndrome (ARDS). Initial reports from China suggested that age >65 years and medical comorbidities are risk factors for poor outcomes.(1) The need for ICU admission and mechanical ventilation once ARDS develops is associated with a high mortality, ranging from 39% to 72%.(2,3) Current guidelines recommend that corticosteroids or immunosuppressive therapy should not be used in patients with Covid-19 pneumonia unless there are other indications, such as shock, asthma or exacerbation of chronic obstructive pulmonary disease.(4) However, the role of systemic corticosteroids is currently being re-evaluated in mechanically ventilated adults with ARDS, with some guidelines now suggesting their use.(5) We describe a case of a patient with Covid-19 infection, progressive pneumonia, development of a hyperinflammatory state and cytokine release syndrome (CRS) who was successfully treated with steroids and tocilizumab. CASE REPORT","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82498234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Impact of SARS-CoV-2 Infection in HIV-positive Patients in South Africa","authors":"C. Feldman","doi":"10.18772/26180197.2020.v2nSIa3","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nSIa3","url":null,"abstract":"ABSTRACT Coronaviruses are important causes of infection in both humans and animals. While in the past they were considered to be relatively harmless respiratory pathogens, outbreaks of infection with severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, and currently SARS-CoV-2, have confirmed how serious these pathogens can be in respiratory tract infections. Certain conditions and underlying comorbidities are known to be risk factors for SARS-CoV-2 infection, and for associated severe disease, including older age, underlying chronic cardiovascular and respiratory conditions and diabetes mellitus. There are a number of additional conditions and comorbidities that are suspected as being important risk factors, but for which hard evidence is currently lacking. This includes underlying human immunodeficiency virus infection, which represents the major focus of this current survey of the scientific literature.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85267026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Dimensions of COVID-19 in South Africa: A Neglected Element of the Treatment Plan","authors":"L. Baldwin-Ragaven","doi":"10.18772/26180197.2020.v2nSIa6","DOIUrl":"https://doi.org/10.18772/26180197.2020.v2nSIa6","url":null,"abstract":"Notwithstanding moments of shared elation – Nelson Mandela’s triumphant release from prison 30 years ago, those halcyon weeks in 2010 when we were hosts to the Soccer World Cup, or more recently Siya Kolisi’s diverse team of players overcoming enormous odds to achieve a global rugby victory – the unity and transcendence of the rainbow nation largely have eluded us. While a pandemic is not the occasion to point fingers, it does expose the structural fault lines that undermine social cohesion. In “normal” times, these fissures are mostly tucked away safely in the recesses of our national collective consciousness. It is as if the virus, anthropomorphised, has pulled back the veil, baring the naked truth of our imperfect realities. There is no place to hide; and, to be totally honest, we are afraid.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80664308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}