South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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The recent substantial price reductions in insulin therapy by major manufacturers prompt an examination of their impact on South Africa (SA)'s healthcare. While Eli Lilly, Novo Nordisk, and Sanofi cut prices on long-acting basal insulin, among others, significantly, these insulins are not on SA's Essential Medicines List (EML) for primary healthcare. ⋯ The introduction of smart insulin pens adds a technological dimension, but concerns persist about equitable access. Urging policy-makers to re-evaluate guidelines and decolonise the EML, the article emphasises enhancing patient quality of life and reducing the disease burden.
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Primary ciliary dyskinesia (PCD) is an inherited ciliopathy that results in impaired mucous clearance and affects primarily the respiratory tract, causing upper airway disease, bronchial inflammation and bronchiectasis. The prevalence of PCD in low- and middle-income settings, including South Africa (SA), is unknown, largely owing to challenges with diagnosis, and identifying children or adults with PCD is challenging in a setting with a high prevalence of other infectious diseases, including lower respiratory tract infections and tuberculosis. No single test is diagnostic of PCD, and while some tests are costly, others are labour intensive and require highly specialised laboratory expertise. ⋯ In this commentary, we provide a pragmatic approach to identifying which children and adults require further investigations for PCD using a range of diagnostic tests or tools that are available. Furthermore, we recommend that designated centres of expertise for PCD diagnosis are created in SA. This would be an important step towards improving accessibility of diagnostic tests and developing local expertise to improving PCD diagnosis, especially in early childhood, to prevent long-term irreversible respiratory sequelae.
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Pathology of the hand causes functional impairment, with downstream effects for patient occupation, and consequently presents a socioeconomic burden. Investigation of the epidemiology of hand pathology in KwaZulu-Natal (KZN) can help reduce the burden of disease. Identifying where the greatest need is can direct patient awareness initiatives, medical training and appropriate allocation of resources. ⋯ HP represents approximately one-fifth of all orthopaedic presentations to regional health facilities in KZN offering orthopaedic care, and close to a quarter of orthopaedic trauma occurs in the hand. Based on these findings, targeted efforts to improve community awareness of precautions against trauma to the hand, osteopaenia and hand hygiene are suggested as preventive measures. Medical training should emphasise the appropriate management of DR fractures and hand infections, and resources should be differentially allocated to the management of these debilitating HPs to decrease the burden of disease.
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The incidence of medical negligence claims is well documented in South Africa (SA). Civil and criminal processes are in place to deal with this, and the matter may be reported to the Health Professions Council of SA (HPCSA). There is a school of thought that suggests that these processes do not provide sufficient relief to an affected party. ⋯ In addition to this, they may want to receive a sincere apology. Medical practitioners may also want to communicate with patients or family members of a patient who has passed away as a result of an iatrogenic event, but may be fearful of litigation. This article considers the current position in SA in relation to issuing an apology related to an iatrogenic event, and consults foreign jurisdictions for further guidance on the topic.