South African Medical Journal (SAMJ)
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The horrific health crisis in Gaza – the World Medical Association and the entire medical community must unequivocally support healthcare professionals and advocate for the end of atrocities perpetrated by the Israeli government
No full textThe atrocities committed by the Israeli government in Gaza have included the killing of nearly 2 000 health workers and tens of thousands of Palestinian civilians. Gaza’s health workers deserve universal praise for their unwavering dedication to this population suffering under theIsraeli invader. The World Medical Association and the entire medical community have remained silent or have taken insufficientpositionsin support of these selfless individuals, and have
Maternal and neonatal outcomes in patients with type 1 diabetes mellitus in pregnancy in a South African cohort
No full textBackground. Women with type 1 diabetes mellitus (T1DM) are at high risk of maternal, pregnancy and neonatal complications. Limited data on this topic are available in Africa.
Objective. To describe characteristics of patients in South Africa with T1DM in pregnancy, and associated outcomes.
Methods. Clinical and biochemical data were collected on 273 women with T1DM: maternal clinical characteristics, glycated haemoglobin (HbA1c) and maternal and neonatal complications and outcomes.
Results. There was a statistically significant decline in HbA1c from first presentation to delivery (8.7% (standard deviation (SD) 2.2) v. 6.4% (SD 2.4)), respectively; p<0.00001). The perinatal mortality rate was 7.2%. In this cohort, 31.9% of patients experienced hypoglycaemia. Patients with hypoglycaemia had a significantly longer duration of diabetes, and higher HbA1C than those without hypoglycaemia (7.5 (SD 5.7) v. 6.1 (SD 4.5) years, p=0.002; 9.0% (SD 1.9) v. 8.5% (SD 2.3), p=0.04, respectively)).
Conclusion. This cohort showed a high perinatal mortality rate and a high prevalence of hypoglycaemia and caesarean section. Intensification in glycaemic control is important to improve outcomes, but comes with challenges. A significant HbA1C reduction can be achieved with regular follow-up and management with a multidisciplinary team. Despite poor baseline glycaemic control, the prevalence of congenital abnormalities and macrosomia was low
Effective psychological and behavioural interventions in obesity management
No full textRECOMMENDATIONS
1. The recommendations outlined below are summarised in the model presented in Fig. 1 and supported by the evidence summarised in Table 1.
2. Multi-component psychological interventions (combining behaviour modification [goal setting, self-monitoring, problem solving], cognitive therapy [reframing] and values-based strategies to alter nutrition and activity) should be incorporated into care plans for weight loss and improved health status and QoL (Level 1a, Grade A)[1-8] in a manner that promotes adherence, confidence and intrinsic motivation (Level 1b, Grade A).
3. HCPs should provide longitudinal care with consistent messaging to PLWO to support the development of confidence in overcoming barriers (self-efficacy) and intrinsic motivation (personal, meaningful reasons to change), to encourage the patient to set and sequence health goals that are realistic and achievable (Level 1a, Grade A), to self-monitor behaviour (Level 1a, Grade A), and to analyse setbacks using problem solving and adaptive thinking (cognitive reframing), including clarifying and reflecting on values-based behaviours (Level 1a, Grade A).
4. HCPs should ask patients’ permission to educate them that success in obesity management is related to improved health, function and QoL resulting from achievable behavioural goals, and not the amount of weight loss (Level 1a, Grade A).
5. HCPs should provide follow-up sessions consistent with repetition and relevance to support the development of self-efficacy and intrinsic motivation. Once an agreement to pursue a behavioural path has been established (health behaviour and/or medication and/or surgical pathways), follow-up sessions should repeat the above messages in a fashion consistent with repetition (the provider role) and relevance (the patient role) to support the development of self-efficacy and intrinsic motivation (Level 1a, Grade A)
An open letter: In solidarity with all children suffering in wars; to all who hold or share a concern for the wellbeing of children
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The association between comorbid conditions and CD4+ T-cell counts with in-hospital mortality of patients with moderate to critical COVID-19 disease
No full textBackground. COVID‑19 presents with variable severity, and identifying accessible prognostic markers is critical in resource-limited settings such as South Africa (SA), where the prevalence of HIV may influence immune response and outcomes.
Objectives. To assess the association between CD4+ T-cell count and in-hospital mortality among patients with moderate to severe COVID‑19 infection in SA, with a focus on specific comorbid conditions.
Methods. This cross-sectional analytical study analysed data from the first COVID‑19 wave, using an electronic database compiled during the first wave of the epidemic as well as clinical records. During this period, 336 patients with moderate to critical COVID‑19 were admitted to Kalafong Provincial Tertiary Hospital in Pretoria, SA. The analysis included only those patients in whom CD4+ T-cell counts (n=270) were done. Mean CD4+ T-cell counts were compared between survivors and non-survivors using non-parametric statistics. Logistic regression was performed to adjust for confounders, with survival status as the outcome variable.
Results. Sixty-nine of the 270 patients (26%) died. Mortality rates by severity of COVID were moderate (7/49, 14.3%), severe (55/211, 26.1%) and critical (7/10, 70%) (p=0.001). Patients who were positive for HIV had significantly higher mortality (19/52, 36.5%) than HIV‑negative patients (50/218, 22.9%) (p=0.0436). Non-survivors had significantly lower CD4+ T-cell counts (p<0.001). After adjusting for age, hypertension, diabetes, pre-diabetes, renal disease, critical COVID‑19 disease and HIV status, the CD4+ T-cell count remained significantly lower in non-survivors (p<0.001).
Conclusion. In patients with moderate to critical COVID‑19 disease, lower CD4+ T-cell counts were significantly associated with mortality, suggesting that this may serve as a useful marker for predicting outcomes.
