South African Medical Journal - September 2022 Vol 112 No 9

Introduction

The introduction of competency-based medical education for postgraduate training in South Africa

Specialist training has increasingly become the subject of public discourse, with greater demands for accountability from various stakeholders in safe delivery of healthcare. This includes the appropriate selection of specialist trainees, the assurance that these trainees are afforded suitable opportunity for achieving clearly outlined learning goals in appropriate contexts with adequate support, and the requirement that they are subjected to assessment that allows them to showcase their development over time.

Undiagnosed comorbidities among individuals hospitalised with COVID-19 in South African public hospitals

The National Institute for Communicable Diseases (NICD) established DATCOV, a national hospital surveillance system for COVID 19, in late March 2020. DATCOV receives data from all 666 public and private hospitals in the country on hospital admissions for patients diagnosed with COVID 19 on polymerase chain reaction (PCR) or antigen testing. DATCOV collects limited data on NCDs in patients hospitalised with COVID 19. We therefore conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals admitted with COVID 19. Sixteen secondary-level public hospitals in six of the nine provinces in SA were selected because of their relatively high COVID 19 case numbers, and because some were already conducting surveillance for severe acute respiratory infections. Data were collected between 1 November 2020 and 30 June 2021, which included patients admitted during the second and third waves dominated by the SARS-CoV-2 Beta and Delta variants, respectively 

Adult pure red cell aplasia at Universitas Academic Hospital, Bloemfontein, South Africa: A 9-year review

Pure red cell aplasia (PRCA) is a medical condition characterised by severe normochromic, normocytic anaemia, partial or complete absence of reticulocytes from the peripheral blood, and the absence of erythroblasts from an otherwise normal bone marrow. It can present as an acute disease in childhood and as either an acute or a chronic disease in adults. PRCA has no racial or geographical predilection, affects all age groups, and may be congenital or acquired. Acquired disease may present as a primary haematological disorder or secondary to several contributing factors and underlying conditions. A simplified classification of PRCA is presented in Fig. 1.

Impact of COVID-19 primary healthcare service restrictions on patients with chronic obstructive pulmonary disease in Cape Town, South Africa

During the first decade of this century, the global prevalence of chronic obstructive pulmonary disease (COPD) was estimated to be 11.7%, with a further estimate of 10.1% global prevalence at stage 2 or higher. Globally, COPD is under-diagnosed and undertreated. Patients experience multidimensional symptoms and concerns affecting their quality of life, particularly with, but not limited to, more advanced-stage disease, and persisting irrespective of COPD diagnosis or disease-orientated treatment. Undertreated physical symptoms are associated with an increased risk of depression. A study conducted in Africa and the Middle East reported a 7-day period prevalence of breathlessness for patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage C and D COPD of 84.6%, and 75.4% for coughing; 22% of patients with these symptoms described them as extremely severe. It has been reported from high-income countries (HICs) that after the first hospitalisation for an exacerbation of COPD, 50% of patients died within 3.6 years and 75% died within 7.7 years.

Evaluating the usefulness of the estimated glomerular filtration rate for determination of imipenem dosage in critically ill patients

Bacterial infections are major contributors to morbidity, mortality and healthcare costs in intensive care units (ICUs). Without appropriate treatment, sepsis and septic shock are rapidly fatal. It is therefore crucial to dose antibiotics correctly, especially in critically ill patients. Incorrect dosing of antibiotics in critically ill patients may result in increased morbidity and mortality, and the development of multidrug-resistant organisms. Antibiotic dosing in critically ill patients is complicated by differences in the pharmacokinetics of antibiotics between critically ill patients and healthy persons. The most important causes of these differences are related  to capillary leak syndrome, end-organ dysfunction, augmented renal clearance and hypoalbuminaemia. Imipenem/cilastatin is a combination of a broad-spectrum beta-lactam antibiotic and a dehydropeptidate-1 inhibitor. It is necessary to combine imipenem with cilastatin to prevent the rapid degradation of imipenem by the enzyme dehydropeptidase-1 in the kidneys. Imipenem/cilastatin is widely used to treat infections in critically ill patients in ICUs.

Every maternal near-miss counts: Need for a national audit in South Africa? A mixed-methods study

Improving maternal and neonatal health is a global health priority. The World Health Organization (WHO) introduced the maternal near-miss (MNM) approach (WHO-MNM) in 2009 to robustly identify maternal morbidities at the severe end of the spectrum of pregnancy-related disease. This approach is increasingly used as an additional tool to monitor and evaluate the quality of maternity care at various levels of the healthcare system. According to the WHO, an MNM is defined as ‘a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy’.