South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
-
Review
Signal of harm in morphine use in adults with acute pulmonary oedema: A rapid systematic review.
Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. ⋯ Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects.
-
Personal information in health research commands utmost protection while also preserving the growth of health research. This paper aims to establish which legislation applies when processing personal information for health research. South Africa regulates health research on human subjects through a network of Human Research Ethics Committees. ⋯ Section 2(3)(b) of POPIA provides that POPIA does not apply where other legislation creates 'more extensive' conditions for the lawful processing of personal information than Chapter 3 of POPIA does. We show that the provisions of the sectoral legislation on health are more extensive than the conditions in Chapter 3 of POPIA and hence the sectoral legislation prevails. This simplifies the regulation of health research. One of the implications of this finding is that the definition of broad consent in the sectoral legislation for health research should be applied to the exclusion of the consent provisions in POPIA.
-
Angioedema is the most common acute allergic presentation to emergency centres (EC), with hospitalisation rates increasing in high-income countries. Angioedema can complicate with life-threatening laryngeal obstruction. There are no local data; therefore, we aimed to characterise acute angioedema cases presenting to ECs and develop a simple management algorithm. ⋯ Angioedema is the most common allergy presentation to two ECs in Cape Town, SA. Bradykinin-mediated angioedema secondary to ACE-I therapy is the single most common offender, and was not appropriately managed in more than a third of cases. Based on these findings, we have developed a management algorithm that easily stratifies patients into bradykinin or mast cell-mediated angioedema with a step-by-step management approach that is applicable to the SA context. Ongoing awareness and education on allergy emergencies are required to ensure accurate diagnosis of less common causes of angioedema (particularly bradykinin-mediated angioedema) and linkage to allergy specialist care.
-
Cavernous sinus thrombosis is a rare life-threatening complication of herpes zoster ophthalmicus (HZO). This case highlights the importance of at least considering the diagnosis in all cases of HZO, as the consequences of missing it can be disastrous.
-
Observational Study
The association between cytology and histopathology in thyroid nodules over a 6-year period in an urban hospital in South Africa.
Thyroid cancer is prevalent both internationally and locally, and is the most common cause of endocrine malignancies in Africa. The prognosis of thyroid cancer in general is quite good, but to achieve good outcomes, appropriate methods for diagnosis are important. A cytology result obtained from a fine needle aspiration and biopsy (FNAB) is one such method, and is less invasive and has less risk compared with obtaining a histological result via open surgery. However, there are accuracy differences that have been reported in different literature findings. ⋯ There was good correlation between cytology and histology for thyroid nodules. Differences were noted between the percentage of malignant cases in the different Bethesda categories compared with international standards as noted above. We recommend that further studies are conducted locally to improve knowledge on this topic.