South African Medical Journal - April 2023 Vol 113 No 4

Introduction

Autoimmune encephalitis: Epidemiology, pathophysiology and clinical spectrum (part 2)

General diagnostic criteria for possible AE Previous diagnostic criteria for any form of encephalitis required a clinical picture of an encephalopathy characterised by an altered mental state, and evidence of inflammation. In the absence of tissue to demonstrate inflammation, clinical features such as fever or seizures at onset, cerebrospinal fluid (CSF) abnormalities, imaging and/or electroencephalogram (EEG) findings are used to ascertain an inflammatory pathology. However, the clinical presentation of an AE does not always correspond to these criteria and patients might present without a reduced level of consciousness, fever or abnormal CSF results, and neuroimaging may be normal or nonspecific. In addition, the results of antibody testing are typically only available after several days or even weeks. To assist in the diagnosis of AE, clinical criteria not relying on antibody testing were developed. These criteria can guide clinicians in suspected cases to establish a diagnosis and, after reasonable exclusion of other causes, start immunotherapy early. In_ Table_ 1, the_ diagnostic criteria for possible AE are summarised.

The leading causes of medicolegal_claims_and possible solutions

Medicolegal claims, normally meaning claims based on instances of medical negligence or malpractice, have markedly increased in the South African (SA) health sector, skyrocketing since about 2007. This is clearly shown by recent figures indicating a growth rate of 30% for contingent liabilities, a loss that may occur in future, and 23% for medicolegal claims in the public sector since 2014. These percentages translated to ZAR99.2 billion and ZAR2 billion, respectively, in the 2018/2019 National Treasury Budget Review reporting period. In_2020/2021, >ZAR6.5 billion was awarded in medicolegal claims.

The state of kidney replacement therapy in Eastern Cape Province, South Africa: A call to action

The burden of end-stage kidney disease (ESKD) continues to increase worldwide. The prevalence of chronic kidney disease (CKD) in South Africa (SA) is estimated to range from 6% to 17% and is predicted to worsen in the future, for several reasons. Despite being considered an upper middle-income country,[8] SA is ranked as the most unequal country in the world, with a Gini index of 63.[9] The country also has a dual burden of non-communicable diseases, including hypertension and diabetes mellitus, and communicable diseases such as HIV, that are risk factors for CKD. Poor infrastructure, absence of screening and prevention programmes for kidney disease and the recent COVID-19 pandemic are systemic factors that further accentuate this risk.

Barriers effecting COVID-19 vaccination in Phalombe District, Malawi: A qualitative study.

The COVID-19 pandemic has had an unprecedented impact worldwide. Apart from loss of life, the response to the pandemic has negatively affected global health, education, trade, agriculture and socioeconomic growth. When COVID-19 was first reported, most people adopted public health preventive, mostly non-pharmaceutical, measures that included frequent hand washing with soap, maintaining social distancing and using face masks. Scientific communities across the globe went to great lengths to rapidly develop several types of COVID-19 vaccines.

Understanding the impact of the COVID-19 pandemic on healthcare services for adults during three waves of COVID-19 infections: A_South African private sector experience

COVID-19 infections were first reported on 31_December 2019 by the World Health Organization, and the disease was declared a global pandemic on 11_March 2020. As at 31 December 2021, over 280_ million people globally were confirmed to have contracted the infection, with over 5.5_ million deaths reported. South Africa (SA) reported its first COVID-19 case on 5_March 2020, and as at 31_December 2021, over 3.5_million people had been confirmed COVID-19 positive and over 91_000 deaths recorded.

Prevalence and correlates of 30-day suicidal ideation and intent: Results of the South African National Student Mental Health Survey

Suicide is the second leading cause of death among young people aged 15 - 29 years worldwide, with as many as one-third of all suicides occurring among adolescents. There is also growing awareness globally of the high rates of suicidal behaviour among university students, with one study of 13_ 984 first-year students across 19_universities in 8_countries reporting 12-month prevalence estimates for suicidal ideation, plan and attempt of 17.2%, 8.8% and 1.0%, respectively. A systematic review of epidemiological studies among university students found pooled 12-month prevalence estimates of 10.6% (95% CI 9.1_-_12.3%) for suicidal ideation, 3.0% (95% CI 2.1_-_4.0%) for a plan and 1.2% (95% CI 0.8_-_1.6%) for an attempt. First onset of suicidal ideation and behaviour is typically during late adolescence when many young people transition into higher education. University campuses are therefore potentially good sites for early identification and targeted interventions for young people at risk of suicidal behaviour. Much of what is known about the epidemiology of suicidal behaviour among students comes from high-income Western countries, with comparatively little good quality data from countries in Africa. Reliable epidemiological data are needed to plan evidence-based suicide prevention programmes and establish priorities for student mental health, especially in resource-constrained environments such as Africa.

The impact of a decentralised orthopaedic service on tertiary referrals in Cape Town, South Africa

Traumatic injury is a leading cause of disability and is associated with an annual estimated 5.8 million deaths worldwide, with 90% of the deaths occurring in low- and middle-income countries (LMICs). The burden of death due to intentional and unintentional injury is disproportionately high in LMICs, where economic growth often outpaces the development of road safety infrastructure and trauma care systems. The vast majority of acute orthopaedic conditions in LMICs are traumatic fractures, which can result in excess morbidity and mortality due to infection, malunion or disability if left untreated. Sub-Saharan Africa (SSA) has limited capacity to manage its large burden of traumatic fractures and other acute orthopaedic conditions, as many hospitals lack surgical providers with orthopaedic training and formal emergency departments.

Placental histopathology, maternal characteristics and neonatal outcome in cases of preterm birth in a high-risk population in South Africa

Preterm birth (PTB) is defined as birth before 37 weeks’ gestation, with subcategories of extremely preterm (<28 weeks), very preterm (28_-_32 weeks), moderate preterm (32_ -_ 34 weeks) or late preterm (34_ -_ 37 weeks), according to gestational age. PTB is one of the most common pregnancy complications and is the leading cause of perinatal morbidity and mortality.[2] Latest global PTB estimates, published in 2019, indicate that there were an estimated 14.84_million live PTBs in 2014, with Asia and sub-Saharan Africa accounting for 12 million of these.[3] The global PTB rate is highest in low- to middle-income countries, as the global rate was estimated at 9.8% (confidence interval (CI) 8.3_-_10.9) in 2000, and 10.6% (CI 9.0_-_12.0) in 2014, compared with South Africa ( SA) at 10.04% (CI 7.3_-_13.29) in 2000, and 12.43% (CI 8.63_-_17.13) in 2014. PTB is often multifactorial in nature and can be divided into indicated or spontaneous PTB. Risk factors associated with indicated PTB include pre-eclampsia, abruptio placentae, fetal distress and intrauterine growth restriction. Spontaneous PTB, along with preterm labour and preterm premature rupture of membranes (PPROM), is regarded as a syndrome and has multiple aetiologies such as infection, inflammation, uterine overdistension and maternal and fetal/placental vascular disease. Maternal risk factors for PTB include previous PTB, high blood pressure, diabetes, periodontal disease, multiple gestations, race, weight, stress, substance abuse and intrauterine infections.