South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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The Colorectal Cancer South Africa (CRCSA) study is an observational cohort of patients with colorectal cancer (CRC) in Johannesburg, South Africa (SA). We found that the mean age at the time of CRC diagnosis was 56.6 years, consistent with studies from SA and sub-Saharan Africa. In high-income settings, comorbidity adversely affects CRC survival, and patients are substantially older at the time of CRC diagnosis. Given the younger age at CRC diagnosis in the CRCSA cohort, we hypothesised that comorbidity may be less prevalent and have little impact on CRC survival. ⋯ In the CRCSA cohort from Johannesburg, comorbidity is uncommon, with no significant adverse effect on OS. If potentially curative treatment is initiated within 40 days of CRC diagnosis, OS could be improved. To fully understand the epidemiology of CRC in SA, population-based registries are essential, and future research should aim to identify health system failures that lead to delays in intervention beyond 40 days in patients with CRC.
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South Africa (SA) is known to have high levels of sexual and gender-based violence (SGBV) and HIV. Studies that explore the intersections of the two phenomena tend to be done at sites that provide services for survivors of SGBV, but few have explored experiences of SGBV of individuals attending HIV testing and treatment health facilities. Although HIV voluntary counselling and testing (VCT) services are generally well practised at ensuring pre- and-post-test counselling, there is little evidence that SGBV is included in routine screening. There is therefore a gap in knowledge of the prevalence of SGBV among patient populations in HIV testing and treatment settings. ⋯ Levels of SGBV are high among populations attending HIV testing and treatment facilities. Healthcare providers need to be able to identify SGBV and provide appropriate services to survivors of SGBV who are seen at HIV testing and treatment facilities.
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Atopic dermatitis (AD) is a common chronic inflammatory skin condition that disproportionately affects children and is associated with reduced quality of life. Zinc deficiency may contribute to the pathogenesis of AD because zinc plays a role in epidermal barrier integrity and the immune system. Systematic review evidence suggests that low zinc is associated with AD, but limitations of included studies support further investigation. ⋯ The inverse association between zinc status and AD in children aged 5 - 12 years in our setting is consistent with the international literature. The clinical importance of decreased zinc levels in AD is not yet known. Further investigation into relevant underlying mechanisms seems warranted given the global reach of AD, its effect on quality of life, and the low cost of potential zinc-based interventions.
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Previous work from KwaZulu-Natal (KZN) Province, South Africa, has suggested that public sector district hospitals are not providing adequate access to surgical care in the form of bellwether operations (caesarean section (CS), open reduction of fractures (ORF) and laparotomy). ⋯ Regional and tertiary hospitals are performing the bulk of non-obstetric bellwether operations in KZN. This imbalance has major implications for planning future delivery of surgical care in the province.
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Tuberculosis (TB) is currently the leading cause of death from a single infectious agent worldwide. Patients who receive dialysis are particularly vulnerable to TB infection owing to immune dysfunction. Nonetheless, there is a paucity of incidence data on dialysis patients infected with TB in high-burden countries, such as South Africa (SA). ⋯ Dialysis patients in the Eastern Cape region of SA are at extremely high risk of acquiring TB, with an incidence rate 4.1 times that of the local population and >5 times that of the general SA population. Only informal housing and a history of hospitalisation were identified as positive risk factors for TB in this young population with a low HIV prevalence. Isoniazid prophylaxis in this high-risk group might be of benefit, but further studies are required to inform such treatment.