King Edward VIII Hospital

The May Measurement Month (MMM) campaign was carried out in South Africa in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically at university campuses, community centres, schools, sport complexes, public parks, shopping centres, hospitals, and through household visits. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP < 140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 4602 were screened, with a mean age of 31.9 years and 61.9% of whom were female. Of all participants, 1217 (26.5%) had hypertension, of whom 456 (37.5%) were aware, and 406 (33.4%) were on antihypertensive medication. Of those on antihypertensive medication, 205 (50.5%) had controlled BP, and of all participants with hypertension, 16.8% had controlled BP. The MMM campaign in South Africa identified significant numbers of participants with either untreated or inadequately treated hypertension. The high prevalence of hypertension, despite the young adult age, together with the high proportions of individuals unaware of their hypertension and with uncontrolled BP highlights the need for hypertension screening and awareness campaigns, and more rigorous management of hypertension.

BackgroundCervical cancer is a common cancer worldwide, with > 85% of deaths occurring in Lower- and Middle-Income Countries where resources for screening programs are limited. Women living with HIV (WLHIV) are at increased risk. HPV test-and-treat is a screening strategy where women with HPV are offered ablative treatment of the cervix to reduce the risk of invasive cancer. WLHIV tend to have more extensive cervical lesions, necessitating more specialised surgical treatments.MethodACTG A5282 was a randomised, open-label, Phase 2 trial conducted in seven countries that compared a cytology-based screening strategy to HPV test-and-treat for cervical cancer prevention in WLHIV. Women with cervical lesions inappropriate for ablative treatment were assigned to Arm C and underwent colposcopy and directed biopsies. Loop electro-excision procedure was performed if high-grade lesions (bHSIL) were present on cervical biopsies. Women were followed 26 weeks later for repeat evaluations. The Clopper-Pearson exact method was used to construct the 95% confidence interval for the proportion of WLHIV with lesions inappropriate for cryotherapy. Logistic regression models were used to assess the factors associated with these lesions.ResultsOf 1046 women screened, 156 (88%) were Black/Non-Hispanic, with a median age of 36 years; 80% were on ART, and 73% had an HIV-1 RNA < 200 copies/mL. On cervical colposcopy, 17% (179/1046, 95% CI 14.9–19.4%) had cervical lesions inappropriate for cervical ablation. Among 428 (44%) women with High-risk HPV (hrHPV) detected, 112 (26%, 95% CI 22.2%, 30.5%) had cervical lesions inappropriate for ablative therapy. hrHPV was found more commonly among women having lesions inappropriate for ablative therapy as compared to lesions appropriate for ablative therapy (70% vs 54%, p < .001). Among 128 women with extensive cervical lesions undergoing colposcopic biopsies, 43 (34%) had bHSIL detected. Among women undergoing LEEP treatment of bHSIL, 24% had bHSIL detected 26 weeks later.ConclusionCervical lesions inappropriate for ablative therapy were common among WLHIV. This has implications for cervical cancer programs as these lesions can only be optimally treated with surgical therapies such as loop electroexcision procedures, and the capacity for this procedure should be increased to maximise cervical cancer prevention outcomes.

Background. Meconium-stained amniotic fluid (MSAF) may reflect normal fetal gut maturation or may indicate fetal compromise. Protocols on the management of newborns with grade 3 MSAF exposure who do not require immediate resuscitation at birth, are required. Objectives. To determine the outcomes of newborns born through grade 3 MSAF. Methods. A retrospective chart review was conducted at King Edward VIII Hospital (KEH) in Durban, KwaZulu-Natal (KZN), South Africa (SA) from 1 January to 31 December 2018. Data were collected from 238 newborns born through grade 3 MSAF to determine the incidence of neonatal sepsis, respiratory complications and neurological complications associated with grade 3 MSAF exposure. Descriptive statistics were used. Result. Neonatal sepsis was suspected in 10.5% of the grade 3 MSAF-exposed newborns and confirmed in 1.7% of the cases. Respiratory distress occurred in 18.9% of newborns, with 9.2% requiring supplementary oxygen. Neurological complications occurred in 2.9% of grade 3 MSAF- exposed newborns and 2.2% of newborns complicated with seizures Conclusion. There was a low rate of neonatal sepsis, respiratory distress, neurological complications and perinatal asphyxia in newborns exposed to grade 3 MSAF. Neonates who are stable at birth can be observed in the postnatal ward for a short period after birth before discharge.

Background: Metformin, widely used in diabetes treatment, is linked to reduced cobalamin (vitamin B12) levels, potentially exacerbating diabetic peripheral neuropathy (PN) and increasing the risk of lower limb amputations. Studies suggest that black individuals might be less prone to vitamin B12 deficiency, but the impact of metformin on vitamin B12 levels in this group is unclear.

Background: Therapeutic inertia (TI), the clinicians' hesitancy to either instigate or escalate therapeutic measures despite clinical evidence, has been identified as a significant hindrance in achieving ideal glycaemic management in type 2 diabetes mellitus (T2DM) patients globally, including in South Africa.

Abstract Four developed machine learning algorithms are proposed to prognosticate the CO2solubility in amino acid salt solutions, blended with amine solutions as additives, in broad ranges of temperature and pressure. From literature 375 experimental data points for CO2solubility were collected. The results from the applied algorithms indicated that the CO2solubility is estimated acceptably close to the experimental values. In the best case, the developed network estimates CO2solubility in the stated solutions with an average relative deviation of 6.53 % and a correlation coefficient of 0.9892.

Background:The incidence of depression is increased by 200-300% in patients living with diabetes mellitus (DM), with both conditions overlapping in about 10-15% of patients.Methods: A scoping review was conducted through reputable medical search engines to find articles that mentioned an association between magnetic resonance imaging (MRI) brain findings in patients with concurrent depression and type 2 diabetes mellitus (T2DM).Results: There were 12 studies found (with 8 790 patients) with publication dates ranging from 2007 until 2020.Most studies utilised a cross-sectional study design with the mean age ranging between 53.8 and 74.5 years.The associations between depression and T2DM varied across the studies, with both comorbidities independently shown to decrease brain size.Two studies suggested that DM decreased the size of the brain (independent of depression), while two other studies suggested that comorbid DM and depression decreased the size of the brain.In addition, decreased myo-inositol concentrations, cerebral hypoperfusion, and abnormal electrical activity of the brain were also observed in those patients with comorbid DM and depression, which differs from patients without these comorbidities.Conclusion: We recommend that future prospective studies be conducted to establish a consensus on how these comorbidities affect the brain.

Global surgery broadly refers to a rapidly expanding multidisciplinary field concerned with providing better and equitable surgical care across international health systems. Global surgery initiatives primarily focus on capacity building, advocacy, education, research, and policy development in low- and middle-income countries (LMICs). The inadequate surgical, anesthetic, and obstetric care currently contributes to 18 million preventable deaths each year. Hence, there is a growing interest in the rapid growth of artificial intelligence (AI) that provides a distinctive opportunity to enhance surgical services in LMICs. AI modalities have been used for personalizing surgical education, automating administrative tasks, and developing realistic and cost-effective simulation-training programs with provisions for people with special needs. Furthermore, AI may assist with providing insights for governance, infrastructure development, and monitoring/predicting stock take or logistics failure that can help in strengthening global surgery pillars. Numerous AI-assisted telemedicine-based platforms have allowed healthcare professionals to virtually assist in complex surgeries that may help to improve surgical accessibility across LMICs. Challenges in implementing AI technology include the misrepresentation of minority populations in the datasets leading to discriminatory bias. Human hesitancy, employment uncertainty, automation bias, and role of confounding factors need to be further studied for equitable utilization of AI. With a focused and evidence-based approach, AI could help several LMICs overcome bureaucratic inefficiency and develop more efficient surgical systems.

No abstract available.