South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
-
Letter by Venter et al. on editorial by Schoub (Dial down the rhetoric over COVID-19 vaccines. S Afr Med J 2021;111(6):522-523. https://doi.org/10.7196/SAMJ.2021.v111i6.15740).
-
Comparative Study Observational Study
Corticosteroids in critical COVID-19: Are all corticosteroids equal?
The hyperinflammation seen as part of a dysregulated immune response to SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Corticosteroid therapy targets this hyperinflammation, otherwise known as a cytokine storm. It is the only therapeutic agent to date with a mortality benefit, with clear guidelines from national and international health authorities guiding its use. Objectives. ⋯ The survival rates were 38.6%, 39.1% and 33.3%, respectively (p=0.68). Patients treated with methylprednisolone tended to have a shorter length of ICU stay (median (interquartile range) 6 (4 - 10), 4 (2 - 8) and 5 (2 - 8) days; p=0.015) and fewer episodes of nosocomial sepsis (47.7%, 32.6% and 48.1%; p=0.01). Conclusions. Hydrocortisone or methylprednisolone can be given as an alternative to dexamethasone in the management of critical COVID-19, and this is a feasible alternative, especially in resource-constrained settings.
-
Pregnant women are at greater risk of severe COVID-19 than non-pregnant women. Despite limited safety data on use of COVID-19 vaccines in pregnancy, many international societies have recommended their use when pregnant women are at particularly high risk of acquiring COVID-19, or have suggested that vaccines should not be withheld from pregnant women where no other contraindications to COVID-19 vaccination exist. A number of vaccines, including those against influenza, tetanus and pertussis, have been shown to reduce both maternal and infant morbidity and mortality when used antenatally. We explore the role of COVID-19 vaccination in the setting of pregnancy, discuss the limited data available, and summarise current international guidelines.
-
The World Health Organization (WHO) has urged countries to conduct tuberculosis (TB) prevalence surveys to better understand the burden of TB and to enable the WHO to conduct global estimates. Until the report from the first-ever prevalence survey in South Africa (SA), the country had to rely on WHO estimates. ⋯ This review notes the key findings of the 2018 prevalence survey. The high prevalence of TB in SA continues to be a major cause for concern, and calls for a significantly improved response to reach the End TB targets set by the WHO.