South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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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.
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In South Africa (SA), district hospitals (DHs) have limited capacity to manage the high burden of traumatic injuries. Scaling up decentralised orthopaedic care could strengthen trauma systems and improve timely access to essential and emergency surgical care (EESC). Khayelitsha township in Cape Town, SA, has the highest trauma burden in the Cape Metro East health district. ⋯ This study outlines a successful example of a decentralised orthopaedic surgical service that increased EESC accessibility and alleviated the high burden of tertiary referrals compared with other DHs with fewer resources. Further research on the barriers to scaling up orthopaedic DH capacity in SA is needed to improve equitable access to surgical care.
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Forensic medical practitioners are in a unique position as they observe the exact pathology of various diseases in thousands of autopsies performed each year. Most medico-legal autopsies reveal an underlying, natural disease as the cause of death. Such data, relayed to the various stakeholders in the public health sector (including clinical medical practitioners), contribute to determining the population health status as well as identifying and dealing with priority areas. ⋯ An important particular subset of cardiovascular diseases in South Africa, is the sudden unexpected deaths in the young population. Research on these deaths has shown that post mortem genetic testing can detect an inherited cardiac arrhythmogenic disease as the cause of death in up to 40% of these cases. The high heritability of cardiac disorders and the fact that it is often treatable, genetic analysis of such cases provides significant clinical benefit with regard to the diagnosis and treatment of family members at risk for the same disease. The societal benefits from clinicians receiving such evidence-based findings associated with the cause of a patient's sudden death, is currently underutilized in South Africa.