South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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The 95-95-95 strategy implementation is a positive initiative for moving the HIV tide towards elimination, with a focus on addressing the huge inequalities in existence in access to HIV services. ⋯ This study has established positive progress made by the CoJ towards HIV testing, ART initiation, viral load suppression and HIV positivity rate. On the other hand, gaps in linkage to care after testing positive have been highlighted. It is therefore critical in the 95-95-95 strategy implementation era to focus on finding those missed during the 90-90-90 phase through revised and renewed innovative approaches.
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Endoscopic therapy is the first-line treatment of choice for control of acute variceal bleeding (AVB). In high-risk patients with persistent AVB despite pharmacological treatment and endoscopic intervention, percutaneous transjugular intrahepatic portosystemic shunting (TIPS) provides a minimally invasive salvage method to reduce portal pressure and control bleeding. ⋯ Salvage TIPS controlled variceal bleeding in 94% of patients after failed endoscopic therapy with 29% in-hospital mortality. The most significant predictors of mortality were C-P grade C, grade 3 ascites, inotrope requirement, endotracheal intubation and endoscopically uncontrolled bleeding.
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Case Reports
Recurrent venous thrombosis - an unusual first presentation of autoimmune polyendocrinopathy syndrome type 3B.
A 45-year-old female presented with unprovoked recurrent venous thromboembolism (VTE), in unusual sites, and pancytopenia, posing a complex diagnostic challenge. Work-up for inherited thrombophilia, antiphospholipid syndrome (APLS) and paroxysmal nocturnal haemoglobinuria were unremarkable. ⋯ Hyperhomocysteinaemia due to vitamin B12 deficiency was identified as a potential contributor to her recurrent VTE. This case highlights the unusual initial presentation of autoimmune polyendocrinopathy syndrome type 3B (APS-3B) with recurrent thromboembolism, and emphasises the importance of considering hyperhomocysteinaemia in unprovoked and atypical VTE cases.