South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Observational Study
Microbiological analysis and predictors of gallbladder infection with antimicrobial susceptibility patterns in an HIV setting.
Background South Africa has a high prevalence of people living with human immunodeficiency virus (HIV; PLWH) who have shown to affect the prevalence and severity of infection and sepsis particularly gallbladder disease. Empirical Antimicrobial (EA) therapy for acute cholecystitis (AC) is based largely on bacteria colonisation of bile (bacteriobilia) and antimicrobial susceptibility patterns (antibiograms) obtained from the developed world where the prevalence of PLWH is very low. In an ever-emerging era of increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Objective Due to the paucity of data available locally to guide treatment we found it pertinent to examine gallbladder bile for bacteriobilia and antibiograms in a setting with a high prevalence of PLWH to determine if this may demand a review of our local antimicrobial policies for gallbladder infections for both EA and pre-operative antimicrobial prophylaxis (PAP) for laparoscopic cholecystectomies (LC). Methodology A retrospective observational descriptive study was undertaken at King Edward VIII Hospital, Durban, KwaZulu-Natal, South Africa. ⋯ For EA, we recommend, a combination of amoxicillin/clavulanate with aminoglycoside-based therapy (amikacin or gentamycin) or piperacillin/tazobactam as monotherapy. Carbapenem-based therapy should be reserved for drug resistant species. For PAP, we recommend the routine use in older patients and patients with history of ERCP undergoing LC.
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Safe and effective termination of pregnancy (ToP) services have helped to resolve the uncertainty that surrounds unwantedpregnancies globally and in South Africa (SA). It is important to determine the demographic profile of women requesting ToP and to assessthe reasons for ToP and the beliefs and experiences of women seeking these services in order to improve service delivery. ⋯ Unemployment and financial dependency appeared to be common reasons for seeking ToP in our study population. Most ofthe women were single and many had not used any contraception prior to the pregnancy.
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South Africa is confronted with multi-morbid chronic physical and mental disorders. The relationships between these conditions are often multidirectional and result in a variety of adverse mental and physical health outcomes. The risk factors and perpetuating conditions in multi-morbidity are potentially modifiable through effective behaviour change. ⋯ The large body of evidence supporting Behavioural Medicine has afforded the field global recognition. Yet, it remains an emerging field in South Africa and on the African continent. The purpose of this paper is to contextualise the field of Behavioural Medicine in South Africa and present a way forward to establish the field in our context.
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African countries with limited healthcare capacity are particularly vulnerable to the novel coronavirus. The pandemic has left health systems short on resources to safely manage patients and protect health care workers. South Africa is still battling the epidemic of HIV/AIDS and tuberculosis which have had their programme/services interrupted due to the effects of the pandemic. Lessons learned from the HIV/AIDS and TB programme have shown that South Africans delay seeking health services when a new disease presents itself. ⋯ Assessing demographic and clinical risk factors for COVID-19 mortality within 24-hours of admission aids in understanding and prioritising patients with severe COVID-19 and hypertension. Finally, this will provide guidelines for planning and optimising the use of LDoH healthcare resources and also aid in public awareness endeavours.
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Alcohol is a significant contributor to injury-related morbidity and mortality in South Africa (SA). During the COVID-19global pandemic, restrictions to movement and to legal access to alcohol (i.e. ethanol) were introduced in SA. ⋯ There was a clear decrease in injury-related deaths in the WC during the COVID-19-related lockdown periods, whichcoincided with the alcohol ban and restriction of movement, and an increase following relaxation of restrictions on alcohol sales andmovement. The data illustrate that mean BACs were similar between all periods of alcohol restriction compared with 2019, apart from hardlockdown in April - May 2020. This coincided with a smaller mortuary intake during the level 5 and 4 lockdown periods.