South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Practice Guideline
South African Rheumatism and Arthritis Association 2024 guidelines for the management of axial spondyloarthritis.
Early diagnosis and prompt treatment initiation are essential in the management of axial spondyloarthritis (axSpA), also known as ankylosing spondylitis, remembering that underdiagnosis and overdiagnosis of axSpA are common. These South African guidelines offer screening tools and details of useful investigations, including imaging. ⋯ The ankylosing spondylitis disease activity score is recommended as a measure of disease activity, and a stepwise algorithm for therapy is provided. Screening for comorbidities and vaccination is advised.
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The Health Professions Council of South Africa implemented a compulsory research component for specialist practitioner registration through the Master of Medicine (MMed) degree in 2011, eliciting both commendation and critique. Chief among the concerns is the extended time required for MMed completion. This study explores the duration of each component of the MMed research thesis and discusses the potential problematic areas in terms of its timeous completion, about which there is currently a lack of data, with particular regard to the South African (SA) setting. ⋯ A significant portion of candidates do not complete the MMed research thesis within the 4-year training period, hindering specialist registration. The major contributing factors appear to be related to candidates' inexperience regarding the research process and lack of exposure to it, as well as some of the administrative procedures involved. Utilisation of the recommendations and structured timeline will help identify problematic areas timeously and ensure successful completion of the thesis.
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Case Reports
Unilateral superior vena cava syndrome: An uncommon complication of a commonly used procedure.
Superior vena cava (SVC) syndrome constellates symptoms of plethora and facial and upper thoracic swelling with distension of neck veins, and the consequences of this condition range from mild discomfort to upper airway obstruction. The aetiology has a strong linkage with malignancy, and is always to be excluded. SVC syndrome is commonly a bilateral presentation, and unilateral SVC syndrome is rare, with very few non-malignant causes reported. Here, we demonstrate a unilateral occurrence with an uncommon cause.
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Adverse events are common, and impact patients and healthcare systems negatively. Large international systems investigate adverse events at length, but South African data are lacking. ⋯ Adverse events are common, and their aetiology is multifactorial. A sustained and multi-faceted approach is needed to address the challenge they pose.