South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Hypotension is a common presentation following an overdose of quetiapine. Adrenaline is often used as the vasopressor of choice for hypotension not responding to intravenous fluids. We present a case of quetiapine overdose with hypotension unresponsive to high-dose adrenaline. ⋯ Alpha-2- and β2-agonism can reduce sympathetic outflow and cause vasodilation, respectively, further exacerbating the hypotension. Noradrenaline is the preferred vasopressor of choice for hypotension caused by quetiapine overdose, as it has less affinity for α2- and β2-receptors, but maintains α1-receptor agonism. Drugs with a similar mechanism of inducing hypotension should also be treated with noradrenaline as the vasopressor of choice.
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Young South Africans experience high rates of HIV infection. While nationally scaled medical male circumcision (MMC) can help to curb HIV infection rates in countries such as South Africa (SA), MMC uptake has not been consistent or universal, suggesting variable acceptability among men. Both MMC and traditional male circumcision (TMC) are practised in SA. For male circumcision to be most effective for HIV prevention, it should be performed prior to sexual debut with complete removal of the foreskin. ⋯ MMC was the preferred option for young men in Soweto compared with those in Cape Town, and this translated into practice. Despite knowledge of the benefits of early MMC, many participants delayed uptake, potentially reducing the MMC benefits before sexual debut. Programmes promoting circumcision should consider the influence of local practices. To realise full HIV prevention benefits, efforts should be made to ensure that circumcision is promoted, and that all circumcision is safe, performed prior to sexual debut, and contextually responsive.
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Testing for HIV in individuals informs them of their HIV status, which in turn enables them to receive prevention, treatment and care services. HIV services should ideally be accessed before an individual's immune system is severely damaged, which could also increase the prevention of new HIV infections. The national HIV testing services (HTS) programmes aim to identify HIV-infected individuals and link them to prevention, care and treatment services. Community-based (CB) HTS reaches community members who do not have access to such services at healthcare facilities. The Foundation for Professional Development (FPD) provided CB-HTS in a Mpumalanga district, South Africa, from 1 October 2016 to 30 September 2017 (Country Operating Plan (COP16)), where 65 691 clients were tested. ⋯ This study provides evidence that home-based HTS delivered the best positivity rate in the Mpumalanga district. The results should be used to replicate the programme in other districts. If similar findings are obtained in other studies, it could inform how future CB-HTS programmes should be rolled out, which could change future strategic planning and resource allocation for CB-HTS programmes.
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The legalisation of cannabis by the High Court of South Africa, which was confirmed by the Constitutional Court, imposes challenges to occupational medical practitioners acting as medical review officers in compliance testing and fit-for-service medical examinations. The lipophilic character of the psychoactive component of cannabis, delta-9-tetrahydrocannabinol (Δ9-THC), and its prolonged elimination half-life, create challenges for the ethically and scientifically correct management of the legal use of cannabis in risk-sensitive environments. Important issues to consider in testing for cannabis use are: the stance of 'zero tolerance'; screening and confirmation cut-off concentrations; and the bio-matrices used for testing. Constitutional rights relate to privacy, freedom, autonomy, freedom of religion and the equal enjoyment of rights and privileges, which must be balanced against the health and safety of others.