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SAMS team rose to meet these challenges, delivering world class COVID treatment with four newly established COVID hospitals complete with 100 ICU beds and state of the art equipment like ventilators, monitors, and oxygen generators. By using innovative technologies, SAMS’ physicians were able to s
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hare the knowledge they gained treating
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The publication of the of the Antimicrobial Treatment Guidelines represents the
culmination of the efforts of the Antimicrobial Stewardship Program of ICMR to publish treatment guidelines for common syndromes in India. These guidelines are targeted for the health care settings. It aims to rationali
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ze the usage of antibiotics on our Essential Medicines Formulary (EMF) and to establish consistency in the treatment of various infectious conditions.
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Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t
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reatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
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The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa.
The guidelines were developed by updating the Canadian
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Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment
and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts.
The recommendations in these guidelines are:
1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5%
(conditional recommendation: moderate-quality evidence).
2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence).
3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence).
4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence).
Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities.
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Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Pro
Bhana, S.; Naidoo, P.; Pillay, S.; et al.
Jornal of Medical Internet Research JMIR Publication Published on 13.2.2023 in Vol 12 (2023)
(2023)
CC
Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and pu
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blic health care systems. The private system is well resourced, whereas the public sector, which treats more than 80% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector.
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In recent decades, India has witnessed a rapidly exploding epidemic of diabetes.
Indeed, India today has the second largest number of people with diabetes in the
world. The International Diabetes Federation (IDF) estimates that there are 72.9 million people with diabetes in India in 2017, which is
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projected to rise to 134.3 million by the year 2045. The prevalence of diabetes in urban India, especially in large metropolitan cities has increased from 2% in the 1970s to over 20% at present and the rural areas are also fast catching up.
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The ICMR type 1 diabetes guidelines come at a time when the SARS-CoV-2 pandemic
has disproportionately affected people with diabetes population, exposing them to a
high risk for severe illness and mortality. Globally, diabetes was responsible for over fourmillion deaths in the year 2019. It was th
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e leading cause of end-stage kidney disease, adult-onset blindness and cardiovascular diseases. Further, there was a considerable heterogeneity in the prevalence of complications and deaths associated with diabetes across the countries.
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The article "Time to Align: Development Cooperation for the Prevention and Control of Non-Communicable Diseases" argues for greater international cooperation and investment in addressing non-communicable diseases (NCDs), especially in low- and middle-income countries. Traditionally, global health fu
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nding has focused on infectious diseases, but the growing burden of NCDs—such as cardiovascular diseases, cancer, and diabetes—necessitates new approaches to development assistance.
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The article "Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression" discusses the risks associated with the use of corticosteroids in pediatric asthma treatment. It highlights that prolonged corticosteroid use can suppress the hypoth
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alamic-pituitary-adrenal (HPA) axis, potentially leading to adrenal insufficiency, especially during stress. The article reviews diagnostic and screening approaches, recommending specific tests and management strategies based on current evidence. It emphasizes the need for monitoring children on corticosteroids to mitigate the risk of serious complications and suggests modifications in treatment to prevent HPA axis suppression.
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There is paucity of data on the burden and specific drivers operative in the pathogenesis of chronic obstructive pulmonary disease (COPD) in the African setting and populations. Lack of awareness and inadequate knowledge on the aetio-pathogenesis of the disease together with inadequate capacity for
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COPD care contributes to preventive and management challenges. Thus, the majority of patients with COPD are misdiagnosed, misclassified and mismanaged or undertreated. With the struggling improvement in the quality of healthcare in Africa, studies conducted over the last 10 years indicates the rising trends in both the risk factors and the burden of COPD. The role of new risk factors such as indoor pollution, infections with human immunodeficiency virus (HIV) and pulmonary tuberculosis (TB), in the pathogenesis of COPD in Africa is increasingly being recognized. This literature review attempts to collect and synthesize information that could be useful in improving COPD care and informing the governments to take appropriate actions for prevention, diagnosis and management of COPD in Africa.
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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE
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CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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The National Asthma Education Programme (NAEP) is a registered non-profit organisation whose mission is to provide asthma education to healthcare professionals, patients and the lay public. It was founded in 1994 by Dr Mike Greenblatt and Profs Dave Luyt and Robin Green. This year NAEP celebrates it
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s 25th anniversary and remains driven by the need to improve the daily lives of numerous asthmatics in South Africa (SA) and Africa.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this journal is to provide an eviden
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ce-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wi
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de variety of conditions that can phenotypically present with asthma-like symptoms.
This article provides an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions.
The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence.
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Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most importantly, on the clinical history and supported by inv
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estigations. Further, the appropriate drug and device must be chosen to achieve good asthma control. It explains that patients must be followed up regularly and their asthma control must be assessed so that the treatment can then be adjusted according to the level of control. Additionally, Asthma education and adherence are important components of management of the condition.
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This document, issued by the United Nations Medical Directors in July 2021, outlines vaccination and malaria prophylaxis recommendations for UN personnel travelling on official business and UN healthcare workers. The guidance aims to minimise the ri
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sk of vaccine-preventable diseases and malaria by focusing on three key areas:(1) routine vaccines, such as those for influenza, measles, polio, hepatitis B, varicella and SARS-CoV-2 (the virus that causes the disease known as 'Covid-19'), which are recommended for all staff regardless of their destination;
(2) destination-based measures, including mandatory vaccines (e.g. yellow fever, meningitis and polio), recommended vaccines depending on regional risks (e.g. cholera, typhoid, hepatitis A and rabies) and WHO-advised malaria prevention through mosquito protection and chemoprophylaxis. The third area covers vaccines for healthcare workers with direct patient or laboratory exposure, including hepatitis B, influenza, diphtheria, pertussis and others. The recommendations emphasise the importance of pre-travel medical consultations, adherence to host country requirements, and individualised risk assessments.
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Health Information Translations provides education resources in multiple languages for health care professionals and others to use in their communities. Resources are easy to read and culturally appropriate.
Clinical and Laboratory Diagnosis of Buruli Ulcer Disease: A Systematic Review
Sakyi; S.A.; Aboagye, S. Y.; Otchere, I. D. ; et al
The Canadian Journal of Infectious Diseases & Medical Microbiology
(2016)
C1
Volume 2016 | Article ID 5310718 | https://doi.org/10.1155/2016/5310718. Buruli ulcer (BU) is a necrotizing cutaneous infection caused by Mycobacterium ulcerans. Early diagnosis is crucial to prevent morbid effects and misuse of drugs. We review developments in laboratory diagnosis of BU, discuss li
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mitations of available diagnostic methods, and give a perspective on the potential of using aptamers as point-of-care.
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