South African Medical Journal - March 2023 Vol 113 No 3

Introduction

Impact of interventions for tuberculosis prevention and care in South Africa – a systematic review of mathematical modelling studies

South Africa (SA) remains one of the countries with the highest tuberculosis (TB) burden in the world. In 2021, an estimated 304 000 people developed TB, and 55 000 died from the disease; TB therefore remains the leading infectious disease cause of death in the country.  Recent measures to contain the spread of SARS-CoV-2 have led to considerable declines in individuals accessing healthcare services, TB testing and individuals diagnosed with TB, resulting in an expected increase in TB prevalence and mortality. These developments have also seriously affected SA’s progress towards the milestones and targets set for the World Health Organization (WHO)’s End TB Strategy that aims to reduce the number of TB deaths by 95%, the TB incidence rate by 90% (relative to 2015) and the  percentage  of TB-affected families facing catastrophic costs due to TB to zero by 2035.

Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Acute kidney injury (AKI) is a frequent complication in hospitalised patients worldwide.  AKI  negatively  impacts  patient  outcomes  and contributes to prolonged length of hospital stay and mortality. A delay in diagnosis of hospital-acquired AKI was observed in 43% of patients, as reported in the 2009 National Confidential Enquiry into Patient  Outcomes  and  Death  (NCEPOD)  in  the  UK.  The NCEPOD also stated that 20% of hospital-acquired AKI cases are preventable. Cost of care for AKI patients is higher than non-AKI patients, which is related to the increased need for renal replacement therapy (RRT) and intensive care unit (ICU) admission.

SARS-CoV-2 mutations on diagnostic gene targets in the second wave in Zimbabwe: A retrospective genomic analysis

The SARS-CoV-2 virus originated in Wuhan city in China in late December 2019, and was still ravaging the world a year after it was declared a pandemic by WHO in March 2020. The first  case  in  Africa was detected in Egypt in early February 2020. In Zimbabwe, the first case was reported on 20 March 2020 in a returning resident coming from the UK. Shortly after the first wave of infection hit Zimbabwe between April and August 2020, the second wave started around October 2020, reached its peak in the festive season, then eased in early February 2021, and was characterised by a steep rise in mortality.

Clinical impact of plasma concentrations of first-line antituberculosis drugs

Tuberculosis (TB) is the leading cause of earth from a curable infectious disease.  In 2020, there  were  an  estimated  10  million  new  cases of drug-sensitive TB, with almost half of the cases in southern Africa  occurring  in  individuals  with  HIV  co-infection. Despite  effective  treatment,  the  global  treatment  success  rate  is  85%  of  reported cases. There is significant variability in success rates across regions,  and  the  rate  is  considerably  lower  in  settings  with  a  high  TB/HIV  burden. Despite the high global cure rate, much lower levels of treatment success have been reported in some  parts of the world; only nine of the top 30 high TB burden countries reached or  exceeded  a  90%  treatment  success  rate,  and >1.5  million  people  experienced poor outcomes globally in 2020. The End TB Strategy has set the ambitious goal of improving treatment success to >90% by 2025 and reducing TB mortality to <5%. While the current multidrug regimen for TB has improved treatment success over the past decades, there have been few instructive pharmacokinetic-pharmacodynamic studies to guide optimisation of the regimen.