Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n1a1
L. Pillay, AR Sema-Ramashala, S. Jessop, N. Raboobee, R. Lehloenya, L. Moosa, A. Mosam
{"title":"Potential Dermatological Effects of Climate Change in Africa","authors":"L. Pillay, AR Sema-Ramashala, S. Jessop, N. Raboobee, R. Lehloenya, L. Moosa, A. Mosam","doi":"10.18772/26180197.2023.v5n1a1","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n1a1","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82397096","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}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n3a9
Elissa Z Faro, Joel Msafiri Francis, Kim Madundo, Blandina T Mmbaga
{"title":"Addressing Challenges with Mental Health and Substance Use Disorders Care with Implementation Science","authors":"Elissa Z Faro, Joel Msafiri Francis, Kim Madundo, Blandina T Mmbaga","doi":"10.18772/26180197.2023.v5n3a9","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a9","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134889748","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}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n2a5
A. Koufos, G. Modi
Porphyria is a rare disorder that results from mutations in the genes important in haem biosynthesis. Several types are described. Acute attacks lead to central, autonomic and peripheral nervous system manifestations. These acute attacks typically occur in acute intermittent porphyria, and less so in variegate porphyria. The neuropathy in this condition can mimic Guillain-Barré syndrome (GBS), and is often misdiagnosed and incorrectly treated. It is rare in general, but considered to be extremely uncommon in the black African population. We describe five black South African patients, three of whom were diagnosed with variegate porphyria, with the presenting manifestation of a severe neuropathy. The neuropathy was atypical in nature and variable in presentation and highlight the importance of considering porphyria in such patients.
{"title":"Porphyric neuropathy in black South Africans: a case series","authors":"A. Koufos, G. Modi","doi":"10.18772/26180197.2023.v5n2a5","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n2a5","url":null,"abstract":"Porphyria is a rare disorder that results from mutations in the genes important in haem biosynthesis. Several types are described. Acute attacks lead to central, autonomic and peripheral nervous system manifestations. These acute attacks typically occur in acute intermittent porphyria, and less so in variegate porphyria. The neuropathy in this condition can mimic Guillain-Barré syndrome (GBS), and is often misdiagnosed and incorrectly treated. It is rare in general, but considered to be extremely uncommon in the black African population. We describe five black South African patients, three of whom were diagnosed with variegate porphyria, with the presenting manifestation of a severe neuropathy. The neuropathy was atypical in nature and variable in presentation and highlight the importance of considering porphyria in such patients.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79774729","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}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n3a8
Shannon McMorrow
{"title":"Photovoice: An Opportunity to Connect Medicine with Community in South Africa to Advance Health, Racial, and Social Equity","authors":"Shannon McMorrow","doi":"10.18772/26180197.2023.v5n3a8","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a8","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134887478","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}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n3a2
Lazarus Yvette, Davies Malcolm, Nana Mitan, Paget Graham
Abstract Introduction Glomerular disease is an important cause of renal failure. We sought to describe the patterns of glomerular disease in patients undergoing native kidney biopsy at a large urban public hospital in South Africa during the period 2001–2010. Methods We retrospectively reviewed all native kidney biopsies undertaken during the study period. We further characterised and compared clinical, laboratory and demographic data between glomerular pathologies. Results The majority of patients undergoing biopsy were young (median age 34 years) and of Black African descent (83%). Proteinuria was the most common indication for biopsy. Secondary glomerular disease was more common than primary glomerular disease. HIV-associated glomerular diseases were the most common secondary glomerulopathies Focal segmental glomerulosclerosis (FSGS) was the most frequent primary glomerulopathy. Minimal change nephropathy (MCN) was more frequent in younger patients and membranous nephropathy (MN) more common in older patients. Renal function was poorer in FSGS and membranoproliferative glomerular disease. Conclusions HIV is an important contributor to the high rates of secondary glomerular disease. Primary glomerulopathy demonstrates geographic variation in South Africa with FSGS being dominant in Johannesburg. Although clinical parameters may suggest underlying glomerulopathy, an accurate diagnosis to facilitate directed treatment and prevent progression to renal failure requires a renal biopsy.
{"title":"Patterns of Glomerular Disease at a Large Urban Public Hospital in South Africa- Impact of HIV Infection","authors":"Lazarus Yvette, Davies Malcolm, Nana Mitan, Paget Graham","doi":"10.18772/26180197.2023.v5n3a2","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a2","url":null,"abstract":"Abstract Introduction Glomerular disease is an important cause of renal failure. We sought to describe the patterns of glomerular disease in patients undergoing native kidney biopsy at a large urban public hospital in South Africa during the period 2001–2010. Methods We retrospectively reviewed all native kidney biopsies undertaken during the study period. We further characterised and compared clinical, laboratory and demographic data between glomerular pathologies. Results The majority of patients undergoing biopsy were young (median age 34 years) and of Black African descent (83%). Proteinuria was the most common indication for biopsy. Secondary glomerular disease was more common than primary glomerular disease. HIV-associated glomerular diseases were the most common secondary glomerulopathies Focal segmental glomerulosclerosis (FSGS) was the most frequent primary glomerulopathy. Minimal change nephropathy (MCN) was more frequent in younger patients and membranous nephropathy (MN) more common in older patients. Renal function was poorer in FSGS and membranoproliferative glomerular disease. Conclusions HIV is an important contributor to the high rates of secondary glomerular disease. Primary glomerulopathy demonstrates geographic variation in South Africa with FSGS being dominant in Johannesburg. Although clinical parameters may suggest underlying glomerulopathy, an accurate diagnosis to facilitate directed treatment and prevent progression to renal failure requires a renal biopsy.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134889429","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}
Abstract Background : An estimated 11.8% of the South African population are living with diabetes. There is a paucity of data related to the clinical characteristics and glycaemic control in people living with T1DM within the South African public healthcare sector. Objective : To describe the clinical characteristics and glycaemic control of people living with T1DM in a public health care setting. Methods : The study was an observational study conducted at two tertiary public sector hospitals in South Africa by means of a chart review. The study involved adults living with T1DM treated with human insulin for 12 months prior to the date of informed consent. Results : A total of 224 patients with T1DM were enrolled, with 190 (84.8%) from Chris Hani Baragwanath Academic Hospital and 34 (15.2%) from Klerksdorp Tshepong Hospital Complex. One patient withdrew consent, leaving a total analysed population of 223. Of the 223 patients, 37 (16.6%) were controlled (most recent glycosylated haemoglobin (HbA1c) < 7%) while the remainder 186 (83.4%) were uncontrolled (most recent HbA1c ≥ 7%). The mean age of the study group was 33 ± 9 years. The majority of participants were female (122 [54.7%]) and of black ethnicity (215 [96.4%]). The mean number of hypoglycaemic events per patient-year was 151.4 (SD ± 213.9). Diabetic ketoacidosis occurred more frequently in the uncontrolled group. Conclusion : The majority of patients in this study did not achieve target HbA1c, placing them at higher risk for long-term diabetes complications. Poor glycaemic control, leading to long term complications, as well as hypoglycaemia and diabetic ketoacidosis adds further strain to the resource constrained public healthcare in South Africa.
{"title":"Clinical Characteristics and Glycaemic Control in Adults Living with Type 1 Diabetes: A 1-Year Retrospective Chart Review at Two South African Public Sector Tertiary Hospitals","authors":"Naidoo Poobalan, Pauly Bruno, Variava Ebrahim, Pillay Somasundram, Bayat Zaheer, Daya Reyna, Carrihill Michelle, Naidoo Kiolan, Sekhuthe Lauren, Bhana Sindeep","doi":"10.18772/26180197.2023.v5n3a1","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a1","url":null,"abstract":"Abstract Background : An estimated 11.8% of the South African population are living with diabetes. There is a paucity of data related to the clinical characteristics and glycaemic control in people living with T1DM within the South African public healthcare sector. Objective : To describe the clinical characteristics and glycaemic control of people living with T1DM in a public health care setting. Methods : The study was an observational study conducted at two tertiary public sector hospitals in South Africa by means of a chart review. The study involved adults living with T1DM treated with human insulin for 12 months prior to the date of informed consent. Results : A total of 224 patients with T1DM were enrolled, with 190 (84.8%) from Chris Hani Baragwanath Academic Hospital and 34 (15.2%) from Klerksdorp Tshepong Hospital Complex. One patient withdrew consent, leaving a total analysed population of 223. Of the 223 patients, 37 (16.6%) were controlled (most recent glycosylated haemoglobin (HbA1c) < 7%) while the remainder 186 (83.4%) were uncontrolled (most recent HbA1c ≥ 7%). The mean age of the study group was 33 ± 9 years. The majority of participants were female (122 [54.7%]) and of black ethnicity (215 [96.4%]). The mean number of hypoglycaemic events per patient-year was 151.4 (SD ± 213.9). Diabetic ketoacidosis occurred more frequently in the uncontrolled group. Conclusion : The majority of patients in this study did not achieve target HbA1c, placing them at higher risk for long-term diabetes complications. Poor glycaemic control, leading to long term complications, as well as hypoglycaemia and diabetic ketoacidosis adds further strain to the resource constrained public healthcare in South Africa.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134889758","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a13
Derek Raal
Wits Journal of Clinical Medicine Conversations presents Prof Derick Raal in conversation with Prof Pravin Manga (Editor of the WJCM) about new cholesterol lowering therapies to decrease cardiac risk: https://youtu.be/Fv9lTdUbbPU
《Wits Journal of Clinical Medicine Conversations》介绍了derrick Raal教授与Pravin Manga教授(WJCM编辑)关于降低心脏病风险的新胆固醇降低疗法的对话:https://youtu.be/Fv9lTdUbbPU
{"title":"WJCM Conversations","authors":"Derek Raal","doi":"10.18772/26180197.2022.v4n1a13","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a13","url":null,"abstract":"Wits Journal of Clinical Medicine Conversations presents Prof Derick Raal in conversation with Prof Pravin Manga (Editor of the WJCM) about new cholesterol lowering therapies to decrease cardiac risk: https://youtu.be/Fv9lTdUbbPU","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73306767","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a2
Tlou Boshomane, D. Simmons, A. Robertson
Background: Manipulation and cast immobilisation is the accepted gold standard for management of distal radius metaphyseal fractures in children, with the use of Kirschner wires (K-wires) in cases with potential instability. The primary aim of this study was to determine the outcome of these fractures treated with our current management protocol. We also sought to identify possible risk factors for redisplacement. Methods: A retrospective study was conducted on 61 children with displaced distal radius metaphyseal fractures under the age of 16 years. Fifty-three patients were treated with manipulation and casting only, while eight patients had K-wire fixation. The primary outcome measured was redisplacement during follow-up. Initial complete displacement, an associated ulna fracture, the quality of reduction, cast and padding indices were assessed as possible risk factors for redisplacement. Results: A redisplacement rate of 18.8% was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (P = 0.001), cast index (P = 0.030) and padding index (P = 0.031). Non-anatomical reduction resulted in 23.6 times more likelihood of redisplacement (P = 0.008) compared to anatomical reduction. Complete displacement and the presence of an ulna fracture had no effect on redisplacement. Conclusions: Our current treatment protocol is safe and effective based on the redisplacement rate of 18.8% which is marginally lower than current standards reported in the literature. Poor casting technique and non-anatomical reduction were found to be significant predictors of redisplacement. We suggest that K-wires be used if anatomical reduction is not achieved in older children with limited remodelling capacity.
{"title":"Outcomes of Paediatric Distal Radius Metaphyseal Fractures","authors":"Tlou Boshomane, D. Simmons, A. Robertson","doi":"10.18772/26180197.2022.v4n1a2","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a2","url":null,"abstract":"Background: Manipulation and cast immobilisation is the accepted gold standard for management of distal radius metaphyseal fractures in children, with the use of Kirschner wires (K-wires) in cases with potential instability. The primary aim of this study was to determine the outcome of these fractures treated with our current management protocol. We also sought to identify possible risk factors for redisplacement.\u0000Methods: A retrospective study was conducted on 61 children with displaced distal radius metaphyseal fractures under the age of 16 years. Fifty-three patients were treated with manipulation and casting only, while eight patients had K-wire fixation. The primary outcome measured was redisplacement during follow-up. Initial complete displacement, an associated ulna fracture, the quality of reduction, cast and padding indices were assessed as possible risk factors for redisplacement.\u0000Results: A redisplacement rate of 18.8% was reported. We found a statistically significant association between redisplacement and non-anatomical reduction (P = 0.001), cast index (P = 0.030) and padding index (P = 0.031). Non-anatomical reduction resulted in 23.6 times more likelihood of redisplacement (P = 0.008) compared to anatomical reduction. Complete displacement and the presence of an ulna fracture had no effect on redisplacement.\u0000Conclusions: Our current treatment protocol is safe and effective based on the redisplacement rate of 18.8% which is marginally lower than current standards reported in the literature. Poor casting technique and non-anatomical reduction were found to be significant predictors of redisplacement. We suggest that K-wires be used if anatomical reduction is not achieved in older children with limited remodelling capacity.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89132149","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a3
Bradley. Rae, Radha. Gihwala, A. Bentley
Background: Blood cultures (BCs) are the standard test for detecting bacteraemia but have come under scrutiny on their usefulness in the Emergency Departments (EDs) as they have a low yield, tend not to alter patient management and may be subject to high contamination rates especially in resource-limited settings. Identifying patients most at risk of bacteraemia may improve BCs’ usefulness. Methods: We conducted a retrospective observational, descriptive and comparative study. Reports from all BCs performed in the ED at Helen Joseph Hospital in 2017 were requested from the National Health Laboratory Service. Data from all positive BCs were used to audit cultured organisms and their sensitivity and resistance patterns. Second, clinical and laboratory data from 206 consecutively selected patients (103 positive and 103 negative BC results) were used to calculate the Shapiro score and the Systemic Inflammatory Response Syndrome (SIRS) criteria as screening tools for sepsis. Results: There was a total of 4011 BCs performed in 2017 of which 715 (17.8%) were positive. Pathogens were cultured in 400 (10.0%) of cases and 315 (7.9%) cultured known contaminants. A positive Shapiro score and SIRS criteria increased the likelihood of a positive BC by 5.6 and 2.3 times, respectively. Positive HIV status, rigors, pulse rate > 115 bpm, deranged mentation, white cells > 18 × 109 cells/L and creatinine > 177 μmol/L were risk factors for positive BCs. Conclusion: There was a low yield of positive BCs from the ED, and using the SIRS criteria or the Shapiro score improves the pre-test probability of positive BC results in patients with suspected sepsis.
{"title":"An Audit of Blood Cultures in an Emergency Department at a Johannesburg Academic Hospital","authors":"Bradley. Rae, Radha. Gihwala, A. Bentley","doi":"10.18772/26180197.2022.v4n1a3","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a3","url":null,"abstract":"Background: Blood cultures (BCs) are the standard test for detecting bacteraemia but have come under scrutiny on their usefulness in the Emergency Departments (EDs) as they have a low yield, tend not to alter patient management and may be subject to high contamination rates especially in resource-limited settings. Identifying patients most at risk of bacteraemia may improve BCs’ usefulness.\u0000Methods: We conducted a retrospective observational, descriptive and comparative study. Reports from all BCs performed in the ED at Helen Joseph Hospital in 2017 were requested from the National Health Laboratory Service. Data from all positive BCs were used to audit cultured organisms and their sensitivity and resistance patterns. Second, clinical and laboratory data from 206 consecutively selected patients (103 positive and 103 negative BC results) were used to calculate the Shapiro score and the Systemic Inflammatory Response Syndrome (SIRS) criteria as screening tools for sepsis.\u0000Results: There was a total of 4011 BCs performed in 2017 of which 715 (17.8%) were positive. Pathogens were cultured in 400 (10.0%) of cases and 315 (7.9%) cultured known contaminants. A positive Shapiro score and SIRS criteria increased the likelihood of a positive BC by 5.6 and 2.3 times, respectively. Positive HIV status, rigors, pulse rate > 115 bpm, deranged mentation, white cells > 18 × 109 cells/L and creatinine > 177 μmol/L were risk factors for positive BCs.\u0000Conclusion: There was a low yield of positive BCs from the ED, and using the SIRS criteria or the Shapiro score improves the pre-test probability of positive BC results in patients with suspected sepsis.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90817818","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}
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