South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Long-haul flights have been associated with a two- to four-fold increased risk of aviation-related thrombosis (ART). Several studies have investigated the extent to which hypoxic hypobaric exposure, dehydration and prolonged immobilisation during air travel induce changes in haemostasis. ⋯ Air travel at high altitude induced a hypercoagulable state in healthy volunteers. Future research should focus on whether thromboprophylaxis can significantly obviate the activation of coagulation in response to high altitude.
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Ciara Goslett's account of childhood tuberculosis (TB) sheds light on the challenges faced by children diagnosed with TB in South Africa (SA). Children are particularly vulnerable to TB infection and to dangerous forms of disseminated TB such as TB meningitis, which can cause death or major lifelong disability. They have distinct challenges with diagnosis, and TB treatment for adults is not necessarily child- friendly. ⋯ These include delays in the development and accessibility of child-friendly medication, vaccine shortages and a lack of educational support for hospitalised children under school-going age. Some positive progress has been made through the establishment of the paediatric working group in the TB Think Tank, and SA's contribution to pivotal childhood TB research studies. Additional steps could be the inclusion of children's feedback in community-led monitoring efforts and engagement between child TB activists and the SA TB Caucus, a collective of parliamentarians.
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Traumatic brain injury (TBI) can result in significant morbidity and mortality if not diagnosed in a timely manner. Brain computed tomography (CT) is the diagnostic gold standard but is of limited availability in most South African public hospitals, resulting in transfer of TBI patients to tertiary hospitals. ⋯ More than half of patients referred for a CT scan were discharged from the Trauma Centre within 24 hours of admission, which indicates additional costs and inefficiencies in the health system. These data are useful to guide resource planning and allocation for district hospitals, since less expensive point-of-care modalities now exist to diagnose TBI, and which are useful in indicating the prognosis of patients.