South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Advances in DNA sequencing technologies and computational tools over the past few years have led to vast improvements in the metagenomic analysis of the human microbiota. While this has also significantly improved our understanding of the role of the host-microbiome interaction in health and disease, the current clinical expectation is that testing, particularly of the gastrointestinal biome, can be used to diagnose, manage and treat patients. The authors outline the available technologies and highlight current limitations of these techniques to address this clinical demand. Through understanding the limitations of and need for more research and data collection, one can improve the appropriate utilisation and interpretation, as well as the current rational clinical application of these techniques.
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Delays to surgery for acute appendicitis in low- and middle-income countries lead to significant morbidity. ⋯ Delays to surgery beyond 72 hours significantly increased complicated appendicitis, an important risk factor for SSI. Access to facilities with surgical capability and the use of laparoscopic surgery are modifiable risk factors for SSI.
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Difficult or failed intubation of obstetric patients may be up to 8 times higher than in general surgical patients. A decline in obstetric intubation opportunities may be a contributing factor, resulting in reduced training opportunities for junior doctors, who therefore do not acquire airway management skills. ⋯ There are concerns regarding adequate anaesthetic preparation for interns to manage a difficult/failed intubation scenario in a full-term pregnancy. Despite the Essential Steps in Managing Obstetric Emergencies (ESMOE) airway module training, which all interns should receive, a high rate of success was not achieved in this study. Simulation-based training and assessment may be a valuable tool to improve intern training and preparedness.
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The COVID-19 pandemic has impacted on the global surgery landscape. ⋯ COVID-19 and the associated lockdown has heavily impacted on both orthopaedic inpatient and outpatient services. Lockdown led to a larger reduction in the orthopaedic trauma burden than in international centres, but the overall reduction in surgeries, outpatient visits and hospital admissions was less. This lesser reduction was probably due to local factors, but also to a conscious decision to avoid total collapse of our surgical services.
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Childhood obesity has become a global public health problem and is a known risk factor for type 2 diabetes, cardiovascular disease, hypertension, stroke, myocardial infarction and various cancers in later adulthood.Associations between adult obesity and economic growth, technological changes, socioeconomic status and economic inequities have been reported, but limited data are available for children and adolescents in countries that are undergoing an epidemiological health transition exhibiting both under- and overnutrition. ⋯ An increase in childhood and adolescent obesity over time was observed, while trend associations between obesity and EGIs exist.