South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR). ⋯ PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients.
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Observational Study
Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right?
The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success. ⋯ The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size.
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The proportion of HIV-exposed infants and young children infected with HIV in South Africa (SA) has declined markedly over the past decade as a result of the country's comprehensive prevention of mother-to-child transmission programme. This decrease has in turn reduced the positive predictive value (PPV) of diagnostic assays, necessitating review of early infant diagnosis (EID) algorithms to ensure improved accuracy. ⋯ Addition of the Xpert EID as a consecutive test for specimens with an HIV-detected PCR screening result has the potential to improve the PPV and reduce the indeterminate rate, thereby reducing diagnostic challenges and time to final status, in SA's EID programme.
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Cerebral palsy (CP) is a common worldwide disabling disorder. However, data about prevalence and causes of CP in developing countries are deficient because of high cost and limited availability of magnetic resonance imaging (MRI), the gold standard neuro-imaging modality for evaluation and management of CP in neonates. ⋯ Despite being performed a relatively long time - median of 6 years - after the suspected perinatal HII, MRI yielded a diagnosis in 92% and showed that only 76% were due to HII, and more importantly, that there was a preterm HII pattern of injury in 15%, which when added to the 16% of non-HII cases, could potentially save on litigation in a total of 31% of cases that are unlikely to be related to malpractice. MRI should be performed wherever possible in CP cases, even if no imaging exam was performed in the perinatal period.