South African Medical Journal (SAMJ)
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Assessment of people living with obesity
No full textRECOMMENDATIONS
We suggest that HCPs involved in screening, assessing and managing PLWO use the \u275As\u27 framework to initiate the discussion by asking for their permission and assessing their readiness to initiate treatment (Level 4, Grade D, Consensus).
HCPs can measure height and weight and calculate BMI in all adults (Level 2a, Grade B), and measure waist circumference in individuals with a BMI 25 - 35 kg/m2 (Level 2b, Grade B).
We suggest that a comprehensive history to identify root causes of weight gain as well as complications of obesity and potential barriers to treatment be included in the assessment (Level 4, Grade D).
We recommend measurement of blood pressure in both arms, fasting glucose or glycated haemoglobin and lipid profile to determine cardiometabolic risk and, where appropriate, alanine transaminase to screen for metabolic dysfunction-associated steatotic liver disease in PLWO (Level 3, Grade D).
We suggest that HCPs consider using the Edmonton Obesity Staging System to determine the severity of obesity and guide clinical decision-making (Level 4, Grade D
Response and remission after first-line corticosteroid therapy in primary immune thrombocytopenia
Get PDFBackground. Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterised by an isolated thrombocytopenia of <100 × 109/L in the absence of identifiable secondary causes. Treatment is indicated when the platelet count is <20 - 30 × 109/L, but may be commenced at higher platelet counts when the risk of bleeding is high. Corticosteroids are the backbone of initial treatment of ITP. There is a paucity of data in South Africa (SA) on the outcomes of newly diagnosed ITP patients treated with corticosteroids.
Objectives. To describe the response, remission and clinical outcomes of newly diagnosed primary ITP patients on first-line corticosteroids.
Methods. This was a retrospective cohort study of 68 patients with a new diagnosis of ITP, seen at the Clinical Haematology Unit at Groote Schuur Hospital, Cape Town, SA, over a 5-year period (2016 - 2020). Demographic and clinical data were obtained from paper and electronic record systems. All participants with secondary causes were excluded. The initial platelet responses to corticosteroids and the final outcomes at last follow-up were determined. Initial platelet responses were classified into no response (NR), partial response (PR) and complete response (CR) in accordance with consensus definitions. Remission was defined as maintenance of a CR after being off corticosteroids for ≤6 months. Categorical variables were described by frequencies and percentages, while numerical variables were described by medians and interquartile ranges (IQRs) as data were non-parametric.
Results. The majority of patients were female (88.2%) and the median (IQR) age at diagnosis was 36 (23.0 - 55.5) years. The female to male ratio was 7.5:1. Most (92.4%) patients responded to corticosteroids, with 74.2% achieving a CR and 18.2% achieving a PR. Only five patients failed to respond (7.6%). The median (IQR) time to achieve CR was 15 (8 - 25) days, and the median (IQR) time to achieve PR was 10.5 (8 - 22) days. Half of the patients went into remission. Following remission, two patients (6.1%) subsequently relapsed at day 344 and day 777, respectively. Hypertension and/or diabetes mellitus were newly diagnosed in 10.6% of patients.
Conclusion. Corticosteroids are effective first-line therapy for ITP, but are not remission-inducing in all patients. For those patients progressing to chronic ITP, there is a need to investigate cost-effective treatment. Some patients are at high risk of developing new hypertension and diabetes mellitus on corticosteroids, and should be monitored
In defence of South Africa’s National Health Research Ethics Council guidelines on heritable human genome editing
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The prevalence, risk factors and outcomes of retinopathy of prematurity at a tertiary care centre in South Africa
Get PDFBackground. Retinopathy of prematurity (ROP) is a significant cause of preventable blindness in premature infants. The prevalence of ROP is increasing, particularly in resource-constrained settings. Low birthweight (BW), low gestational age (GA) and other neonatal risk factors are identified as key contributors. In South Africa (SA), intravitreal bevacizumab (IVB) is commonly used for treating type 1 ROP due to its accessibility and cost-effectiveness.
Objectives. To evaluate the prevalence, risk factors and outcomes of ROP in a tertiary hospital in SA infants, with a focus on the use of IVB for type 1 ROP.
Methods. This retrospective file audit, conducted at Rob Ferreira Hospital, reviewed ROP referrals from January 2020 to December 2023. Infants were screened by a specialist ophthalmologist, and treatment with IVB was administered to those diagnosed with type 1 ROP according to the Early Treatment for Retinopathy of Prematurity study protocol. Follow-up was conducted until full vascularisation, or 60 weeks post menstrual age for the respective groups.
Results. A total of 267 infants were referred, with an ROP prevalence of 27.0%. Type 1 and type 2 ROP accounted for 31.9% and 68.1% of diagnoses, respectively. Of screened infants, 8.6% (n=23/267) required treatment with IVB, with no reported complications. Of the 72 infants diagnosed with any ROP, 40.3% did not return for follow-up until discharge was indicated.
Conclusion. This study highlights a similar ROP prevalence rate to other SA studies, but yields a markedly higher ROP treatment rate. IVB proved to be a safe and effective treatment option, with no observed complications. However, a 40.3% attrition rate underscores the need for strengthened follow-up systems and improved care pathways. Addressing follow-up challenges and exploring alternative treatment modalities, such as laser photocoagulation, may help to improve long-term outcomes for at-risk infants.
Tracking poison ingestion deaths for South Africa: The need for access to timely reliable data
Get PDFThe President of South Africa addressed the nation on 15 November 2024 regarding the rise in food-borne illnesses and related child deaths. In the absence of a clear profile of injury deaths from official cause-of-death data, we used empirical, nationally representative surveys from 2017 and 2020/21 to analyse poisoning deaths. For children (aged 0 - 17 years), deaths from poison ingestion increased in 2020/21 for Gauteng Province, and became more prominent in KwaZulu-Natal, Eastern Cape and Mpumalanga provinces. Adults (≥18 years) showed similar developments, but on a larger scale. Among children in 2020/21, poison ingestion deaths were mostly unintentional (274 cases). Adults had higher proportions for suicide-related poisoning, but unintentional poisoning deaths (791 cases) accounted for 43.8% in males and 32.5% in females. Overall, pesticides were the most common cause of poisoning deaths in children (42%) and adults (29%). A promising intervention is that suspected agricultural or stock remedy poisoning, as a notifiable medical condition (NMC), should now be reported to the NMC Surveillance System within 24 hours. For a rapid public health response to the country’s burden of disease, we call on the government for a collaborative approach, to improve the quality and timeliness of death notification data, and to implement electronic capturing of deaths nationally
