RESUMO
The impact of poisoning can differ significantly depending on the specific substance consumed. Identifying toxic substances in a patient is crucial to obtaining a thorough medical history. Frontline healthcare providers in the emergency department often handle patients presenting with poisoning. Their clinical presentation can vary depending on their dose, duration of exposure, and pre-existing medical conditions. Initially, poisoning management entails administering supportive care such as absorption and enhancing the elimination of poison with charcoal and antidote administration after identifying the poisoning substances. This article aims to provide a basic overview of the concepts involved in evaluating and managing these individuals.
Assuntos
Assistência Ambulatorial , Centros de Controle de Intoxicações , Humanos , Medicina Baseada em Evidências , Antídotos/uso terapêutico , Carvão Vegetal/uso terapêuticoRESUMO
BACKGROUND: Diabetes is a non-communicable disease of global public health importance. Healthcare workers play a vital role in the management of this disease. AIM: This study aimed to explore healthcare workers' views on managing patients with type 2 diabetes at primary health care facilities. SETTING: The study was conducted at two primary health care facilities in Mthatha, South Africa. METHODS: This exploratory descriptive qualitative study included 28 primary health care workers. Data were collected through individual interviews and focus group discussions and analysed using a thematic analysis approach. RESULTS: Study participants' views of poor control of type 2 diabetes mellitus were categorised under patient- and healthcare system-related factors. The patient-related factors included poor adherence to an ideal diabetic diet, poor medication adherence, a lack of personal glucometers, and dearth of support systems. The healthcare system-related factors identified were inadequate patient education, long waiting times at the health facilities, high patient volumes, limited resources, and delayed service provision. Proposed solutions to address poor control of diabetes included improving patient health education, providing diabetic patients with glucometers, multi-stakeholder management of diabetes, allocating designated areas for patients with chronic illnesses, improved resource allocation, and regular staff training. CONCLUSION: Study participants perceived an improved level of control of diabetes among patients managed at the Community Health Centres. When designing interventions for the management of diabetes, both patient and healthcare system-related factors and the proposed solutions should be considered.Contribution: This study's findings could promote better management of diabetes at the primary health care level.
Assuntos
Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2 , Grupos Focais , Atenção Primária à Saúde , Pesquisa Qualitativa , Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , África do Sul , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pessoal de Saúde/psicologia , Entrevistas como AssuntoRESUMO
No abstract available.
Assuntos
Internato e Residência , Atenção Primária à Saúde , África do Sul , HumanosRESUMO
The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians (South Africa) (FCFP [SA]) examination. The series is aimed at helping family medicine registrars (and their supervisors) in preparing for this examination.
Assuntos
Avaliação Educacional , Bolsas de Estudo , Humanos , Competência Clínica , Medicina de Família e Comunidade/educação , Médicos de FamíliaRESUMO
BACKGROUND: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. METHODS: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. RESULTS: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. CONCLUSION: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI.Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.
Assuntos
Injúria Renal Aguda , COVID-19 , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , COVID-19/epidemiologia , COVID-19/terapia , COVID-19/complicações , Estudos Retrospectivos , África do Sul/epidemiologia , Fatores de Risco , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologiaRESUMO
Background: Hepatitis-B virus (HBV) co-infection among people living with HIV (PLWH) is highly endemic in South Africa. Despite the availability of an effective vaccine for the last four decades, chronic HBV infection is a major cause of morbidity and mortality among PLWH. Although the incidence of most opportunistic infections has been reduced in individuals with HIV since the implementation of the universal test and treat program in South Africa, HBV co-infection among PLWH is still accounting for high morbidity and mortality. Methodology: This cross-sectional descriptive survey was conducted in King Sabata Dalindyebo sub-district municipality in the Eastern Cape Province of South Africa to determine the prevalence of HBV co-infection among PLWH. Results: Two-thirds (65.5%) of the 602 PLWH who participated in the study had been screened for HBV co-infection. The mean age of the participants was 38.8±10.5 years and the majority (75.1%) were female. The prevalence of HBV co-infection among PLWH was 12.2%; among males were three times more frequently than females (OR=3, 95% CI 1.6-5.6, p=0.001). The median CD4 count of participants was 508 cell/mm3 (inter-quadrantile range = 307 to 715) and there was no significant association between HBV co-infection and CD4 count. Conclusion: There is a high prevalence of HBV co-infection among PLWH in the Mthatha region of South Africa. The high prevalence of HBV co-infection indicates the need for routine screening for hepatitis B among PLWH in South Africa.
Assuntos
Coinfecção , Infecções por HIV , Hepatite B , Herpesvirus Cercopitecino 1 , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Vírus da Hepatite B , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Prevalência , África do Sul/epidemiologia , Estudos Transversais , Coinfecção/epidemiologia , Hepatite B/complicaçõesRESUMO
BACKGROUND: Adherence to antiretroviral treatment (ART) is the primary factor determining how an individual responds to their treatment. Unfortunately, individuals who use substances experience suboptimal adherence to their treatment, but little is known about the exact effects of their use on ART adherence in primary health care settings. METHODS: The authors used a prospective cohort study to evaluate substance use's effects on ART adherence among people living with HIV (PLWH) who attend primary health care services in the Mthatha region of South Africa. RESULTS: During the study period, 601 PLWH were followed up for 6 months. The participant's mean age was 38.5 (standard deviation [s.d.] = 11) years, with a mean CD4 count of 491.7 (s.d. = 241). Suboptimal ART adherence and default rates were 20.2% and 9.3%, respectively. Among the substance users, suboptimal adherence to ART was statistically significantly higher than non-users (24.6% and 15.9%, respectively, p = 0.007). The authors also observed suboptimum ART adherence among people who presented with clinical comorbidities. CONCLUSION: Substance use has negatively affected ART adherence among PLWH who attend primary health care services in the Eastern Cape province of South Africa. Therefore, an integrated substance use management strategy in primary health care is recommended to achieve optimal adherence to ART.Contribution: Substance use disorder significantly affected the adherence to ART in primary health care. This is important since primary care is the gateway to the HIV care continuum. The study highlighted the role of integration of substance use management in primary care.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Prospectivos , Infecções por HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Continuidade da Assistência ao Paciente , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológicoRESUMO
BACKGROUND: The growing culture of substance use among people living with human immunodeficiency virus (PLWH) is a serious threat to the human immunodeficiency virus (HIV) pandemic. As the gatekeepers of comprehensive care, primary care providers are responsible for screening, assessing, and managing individuals who use substances. AIM: This study aimed to evaluate primary care providers' views and approaches to substance use management among PLWH who attend primary care services in Mthatha. SETTING: This study was conducted at Ngangelizwe and Mbekweni Community Health Centres (CHCs) in the Eastern Cape province's King Sabata Dalindyebo (KSD) sub-district municipality. METHODS: This qualitative phenomenological study involved the views of primary care providers. This study included 32 primary health care (PHC) providers. All participants were female except one male with a mean age of 48.6 years (range 27-64 years). Semi-structured interviews were conducted until saturation of the theme was reached. Then, the data from the transcribed interview were analysed with a thematic framework. RESULTS: Substance use among PLWH was reported to be associated with poor clinical outcomes and disruption of antiretroviral therapy (ART) adherence. The significant barriers reported for substance use management in PHC settings were a lack of resources, skilled providers and poor community participation. CONCLUSION: Substance use management programmes are not commonly offered in PHC because of the lack of human and infrastructural resources, the lack of skilled providers and poor community engagement.Contribution: This study provides a context-specific PHC providers' approach to substance use management.
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Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , HIV , Antirretrovirais , Transtornos Relacionados ao Uso de Substâncias/terapia , Infecções por HIV/complicações , Infecções por HIV/terapia , Pessoal de SaúdeRESUMO
No abstract available.
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Medicina de Família e Comunidade , África do Sul , Publicações Periódicas como Assunto/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricosRESUMO
South Africa is a multicultural society characterised by a rich diversity of languages. As a result, many healthcare providers and their patients often do not speak the same language, which makes communication challenging. The language barriers, when present, require an interpreter to ensure accurate and effective communication between the parties. In addition to assisting in a clear exchange of information, a trained medical interpreter also acts as a cultural liaison. This is especially true when the provider and the patient come from different cultural backgrounds. Based on the patient's needs, preferences, and available resources, clinicians should select and engage with the most appropriate interpreter. The effective use of an interpreter requires knowledge and skill. Patients and healthcare providers can benefit from several specific behaviours during interpreter-mediated consultations. This review article provides practical tips on when and how to use an interpreter effectively during clinical encounters in primary healthcare settings in South Africa.
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Pessoal Técnico de Saúde , Pessoal de Saúde , Humanos , Pacientes , Traduções , Atenção Primária à SaúdeRESUMO
There is an escalating interest in research capacity building across the globe. Research is an integral part of the continuous improvement process, clinical decision making and health system strengthening and should be embedded into the health system. The South African Family Practice Journal editorial team held a workshop on 19 August 2022 at the 24th National Family Practitioners Congress in Cape Town, with the aim of supporting primary care clinicians in their development from early-career researchers to established clinician-scientists. Small group and plenary discussions yielded valuable insights into the lived experiences of early career researchers and highlighted critical action areas to build the landscape of clinician-led research in the South African context.Contribution: This article contributes to current literature by providing insight into the lived experiences of early-career researchers and explores opportunities for research capacity-building.
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Fortalecimento Institucional , Atenção Primária à Saúde , Humanos , Tomada de Decisão Clínica , África do SulRESUMO
BACKGROUND: Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting. METHODS: A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests. RESULTS: Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively. CONCLUSIONS: HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.
Assuntos
Anemia Ferropriva , Anemia , Deficiência de Ácido Fólico , Infecções por HIV , Deficiências de Ferro , Tuberculose , Deficiência de Vitamina B 12 , Masculino , Humanos , Adulto , Feminino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Estudos Transversais , Anemia/epidemiologia , Anemia Ferropriva/epidemiologia , Ácido Fólico , Hemoglobinas , Deficiência de Ácido Fólico/epidemiologia , Deficiência de Vitamina B 12/epidemiologia , Infecções por HIV/epidemiologiaRESUMO
BACKGROUND: Novel mRNA vaccines provide a high degree of protection against COVID-19 infection, hospitalisation, and death. However, no vaccine claimed 100% effectiveness and it is expected that a small proportion of vaccinated individuals may develop a breakthrough infection. There is a concern relating to the ability of variants to evade vaccine-induced immunity that leads to asymptomatic infection or occasionally progress to disease. The extent of this ability is largely unknown. CASE REPORT: An 88-year-old male patient was brought to the emergency department on July 25, 2021, with a presentation of a lower respiratory tract infection. He was screened for SARS-CoV-2, and tested positive for the reverse transcription-polymerase chain reaction (RT-PCR) test for SARS-CoV-2. According to the patient, he was diagnosed with benign prostatic hyperplasia (BPH) after a prostate biopsy in 2015 but, at the time of admission, he was not taking any chronic medication. He received the first dose (batch no. FA7812) of the Pfizer-Biotech vaccine on June 8, 2021, and the second dose (batch no. FE2090) on July 20, 2021. He was admitted to the isolation ward with a diagnosis of vaccine breakthrough COVID-19 infection and BPH. CONCLUSION: This case report highlights the issue of vaccine breakthrough infections and the potential risk of contracting the COVID-19 disease despite successfully receiving two doses of the Pfizer-BioNTech vaccine six weeks apart.
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COVID-19 , Idoso de 80 Anos ou mais , Vacina BNT162 , COVID-19/diagnóstico , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Humanos , Masculino , SARS-CoV-2RESUMO
The development of new zoonotic diseases such as coronavirus disease 2019 (COVID-19) and monkeypox that can cause epidemics and high mortality rates have significantly threatened global health security. However, the increasing number of people with no immunity to poxvirus because of the end of the smallpox vaccination programme has created a vulnerable population for the monkeypox outbreak. On 23 July 2022, it was announced that the World Health Organization's director-general has determined that the multicountry outbreak of monkeypox constitutes a Public Health Emergency of International Concern. The monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar to smallpox but less severe. Many unanswered questions remain regarding monkeypox's pathogenesis, transmission and host reservoir. There is currently no evidence that transmission by individuals can sustain zoonotic infections during human-to-human transmissions; the continued emergence of these pathogens highlights the interconnectedness of animals and humans. The increasing number of monkeypox cases outside the endemic region has highlighted the need for effective global capacity building to prevent the spread of the disease and its impact on global health security. The priority now is to stop the spread of the disease and protect frontline healthcare workers and the most vulnerable individuals. This article aims to comprehensively analyse the various aspects of the transmission and epidemiology of monkeypox. It also explores possible diagnostic techniques, therapeutics and prevention strategies. A key recommendation is that primary care and public health professionals are expected to increase their efforts to be vigilant and contain any potential outbreaks.
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COVID-19 , Mpox , Varíola , Vírus da Varíola , Animais , Humanos , Mpox/epidemiologia , Mpox/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , Surtos de Doenças/prevenção & controle , Monkeypox virus , Zoonoses/epidemiologia , Zoonoses/prevenção & controleRESUMO
BACKGROUND: This study describes the profile, mechanism and pattern of injuries, and highlights important gaps in clinicians' consultations with patients who experienced interpersonal violence (IPV) in the predominantly black South African township of Mdantsane, Eastern Cape. METHODS: This retrospective cross-sectional study was conducted at the Cecilia Makiwane Regional Hospital, Mdantsane. Medical records of patients who received emergency care for trauma between 01 December 2017 and 31 March 2018 were reviewed. The records of patients identified with IPV were selected for further analysis. Data were disaggregated by demographics, mechanism of injuries and circumstances of the incidents using simple descriptive statistics. RESULTS: A total of 1064 patients reported IPV as the mechanism of injury for emergency department (ED) visits, accounting for 42.4% of all trauma-related injuries. The majority of patients with IPV were men (72.0%), unemployed (78.0%) and single (89.0%). Blunt force injury was the most common pattern of injury (53.3%); about half (50.5%) of the incidents took place in the patients' homes. The majority of the patients (68%) knew their assailants, and a quarter of them were an intimate partner of the assailant (27.6%). The flow of patient with IPV to the ED was skewed towards the weekend (weekend effect). Also, there was an upward trend in the flow of patients with IPV to the ED from 19:00 onwards, reaching a peak at 20:00. CONCLUSION: Interpersonal violence is the most prevalent mechanism of injury reported in this region. It is crucial to engage stakeholders in the design of interventions in order to reduce IPV-related injuries in the region.
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Serviço Hospitalar de Emergência , Violência , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Estudos Retrospectivos , África do Sul/epidemiologiaRESUMO
No abstract available.
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Inteligência Artificial , Atenção Primária à Saúde , África do SulRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic disrupted the provision or exacerbated the existing gap of access to essential healthcare services. An unanticipated effect on access to healthcare services emerged with the introduction of COVID-19 lockdown regulations. Violence against women is prevalent with varying degrees of severity in all spheres of society. METHODS: This study aims to evaluate the impact of the COVID-19 pandemic on the access to healthcare services for the victims of sexual assault in the Mthatha region of South Africa. This is a records review of victims of sexual assault survivors who visited and were treated at the Sinawe TCC at Mthatha Regional Hospital. The data on sexual assault cases at Sinawe TCC were compared with a time-matched control group from 2014 to 2020. RESULTS: There were 5747 sexual assault cases reported at Sinawe TCC between 01 January 2014 and 31 December 2020. There was a major drop in reported cases at Sinawe TCC during the 2020 year, with only about half (451) of the annual average cases being reported. CONCLUSION: The COVID-19 pandemic has an impact on access to healthcare services for the victims of sexual assault survivors in the Mthatha region of South Africa.