South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Tygerberg Hospital (TBH) is a tertiary-level hospital in Western Cape Province, South Africa, that provides healthcare to a large low- to middle-income population with services including centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region despite a high burden of communicable diseases, including HIV. ⋯ Use of a guideline-based approach to treating ACS in a low- to middle-income country setting yields mortality rates comparable to those in high-income countries. However, the lower-than-expected incidence rates of both STEMI and HR-NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and a relatively high proportion of STEMI, suggest potential under-recording of ischaemic heart disease in the region. The rate and outcomes of coronary artery disease (CAD) in people living with HIV were similar to those in people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.
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Preterm birth remains a global health concern and is one of the most common pregnancy complications associated with perinatal morbidity and mortality. Objective. This study investigated placental pathology and its associations with obstetric, maternal and neonatal outcomes in the Eastern Cape region of South Africa in order to help understand its associations with preterm birth in that region. Methods. In this prospective study, placentas were collected consecutively from patients attending a public tertiary referral hospital in South Africa, delivering preterm (n=100; 28-34 weeks gestational age) and term (n=20; >36 weeks gestational age). ⋯ Intrauterine demise (p=0.004), and alcohol abuse (p≤0.005) were significantly associated with term delivery. The number of mothers delivering preterm who were HIV positive was high (41%). Conclusion. The pathology identified in all preterm placentas supports the need to update institutional policies for submission of placentas from all preterm births for histopathology, particularly in countries with a high burden of preterm birth.
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Preterm birth remains a global health concern and is one of the most common pregnancy complications associated with perinatal morbidity and mortality. ⋯ The pathology identified in all preterm placentas supports the need to update institutional policies for submission of placentas from all preterm births for histopathology, particularly in countries with a high burden of preterm birth.
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Tygerberg Hospital (TBH) is a tertiary level hospital in the Western Cape of South Africa that serves a large, low to middle income population with centralised advanced cardiac care. Acute coronary syndrome (ACS) remains an important cause of death in the region, despite a high burden of communicable diseases, including people living with human immunodeficiency virus (PLHIV). Objectives. We sought to describe the incidence of ST elevation myocardial infarction (STEMI) and high-risk non-ST elevation ACS (HR-NSTEACS) in the TBH referral network, describe the in-hospital and 30-day mortality of these patients and identify important high-risk population characteristics. Methods. ⋯ The 30-day mortality rates were similar for STEMI (6.7%) and HR-NSTEACS (5.7%; p=0.83). PLHIV did not impact mortality. Conclusions. The use of a guideline-based approach to treating ACS in a low-middle income countries (LMIC) setting yields mortality rates comparable to high income countries. However, the lower-than-expected incidence rates of both STEMI and NSTEACS in a relatively young population with a high prevalence of traditional cardiovascular risk factors, and relatively high proportion of STEMI, suggests potential under recording of ischemic heart disease (IHD) in the region. The rate and outcomes of coronary artery disease (CAD) in PLHIV was similar to people without HIV, suggesting that traditional risk factors still drive CAD outcomes in the region.