Establishing a South African national framework for COVID-19 surgical prioritisation.

BACKGROUND: Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelines on surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need for context-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the South African National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a national framework for COVID-19 surgical prioritisation. OBJECTIVES: To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculatorfor operative care. METHODS: The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and local recommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the available literature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated. RESULTS: A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to draw up six recommendations for preoperative COVID-19 screening and testing as well as the use of appropriate personal protective equipment. Ninety-nine perioperative practitioners from eight SA provinces evaluated the COVID-19 surgical risk calculator, which had high acceptability and a high level of concordance (81%) with current clinical practice. CONCLUSIONS: This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable and personalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.

Prevalence of hypercholesterolemia in Nigeria: a systematic review and meta-analysis.

OBJECTIVES: Elevated blood cholesterol (hypercholesterolemia) is a significant cause of cardiovascular disease. We aimed to estimate national and zonal prevalence of hypercholesterolemia in Nigeria to help guide targeted public health programs. STUDY DESIGN: This is a systematic review and synthesis of publicly available epidemiologic data on hypercholesterolemia in Nigeria. METHODS: We systematically searched MEDLINE, EMBASE, Global Health, and Africa Journals Online for studies on the prevalence of hypercholesterolemia in Nigeria published between 1990 and 2018. We used a random-effects meta-analysis (Freeman-Tukey double arcsine transformation) and meta-regression model to estimate the prevalence of hypercholesterolemia in Nigeria in 1995 and 2015. RESULTS: In total, 13 studies (n = 16,981) were retrieved. The pooled crude prevalence of hypercholesterolemia in Nigeria was 38% (95% confidence interval: 26-51), with prevalence in women slightly higher (42%, 23-63) compared with men (38%, 20-58). The prevalence was highest in the South-south (53%, 38-68) and lowest in the South-west (3%, 2-4) and North-east (4%, 2-7). Urban dwellers had a significantly higher rate (52%, 24-79) compared with rural dwellers (10%, 6-15). We estimated over 8.2 million persons (age-adjusted prevalence 16.5%) aged 20 years or more had hypercholesterolemia in Nigeria in 1995, increasing to 21.9 million persons (age-adjusted prevalence 25.9%) in 2015. CONCLUSIONS: Our findings suggest a high prevalence of hypercholesterolemia in Nigeria. Urbanization, lifestyles, diets, and culture appear to be driving an increasing prevalence, especially among women. Population-wide awareness and education on reducing elevated cholesterol levels and associated risks should be prioritized.

Position sense and reaction angle after eccentric exercise: the repeated bout effect.

The purpose of the present investigation was to examine the effects of a repeated eccentric exercise on position sense and muscle reaction angle. Fourteen healthy women underwent an isokinetic exercise session on their knee flexors, which was repeated after 4 weeks. Muscle damage indices, position sense and joint reaction angle of the knee were examined before, immediately after, as well as at 1, 2, 3, 4 and 7 days after exercise. The second exercise bout induced significantly lesser effects in all muscle damage indices as well as lesser disturbances in position sense and reaction angle when compared to the first one. The main finding of this study is that position sense and joint reaction angle to release of the lower limbs may adapt in response to a repeated bout of eccentric exercise, leading to less disturbances in position sense and reaction angle after the second bout of exercise.

Lower limb flexibility norms: some racial, gender and limb symmetrical considerations.

The joint flexibility of the lower limb of 400 undergraduate students (200 males and 200 females) whose ages ranged between 20 and 25 years were measured with the standard goniometer. The measured range of motion were hip flexion, extension, abduction, adduction, medial and laterial rotation, knee flexion and ankle dorsiflexionn and plantarflexion. Overall it was found that Nigeria adults demonstrated more lower limb joints flexibility than those reported by the American Academy of Orthopaedic Surgeons (AAOS) (1963). Females exhibited higher flexibility in hip extension, adduction, medial and lateral rotation, ankle dorsiflexion and plantarflexion, but were lower in hip flexion and abduction as compared to males. For both sexes, only slight asymmetrical variation were observed in the joint measurements obtained for the right and left lower limbs. Our findings suggested that the application of universal joint flexibility norms for different racial groups may be clinically inappropriate. Thus flexibility norms may be specific to the racial population from which it was derived. It also alerts physical therapists on the need to discriminate joint mobilities between male and female patients. It is envisaged that the findings of this study will further assist physical therapists while assessing young adult patients who may suffer musculoskeletal dysfunction affecting the lower extremity. In treating a patient, the unaffected contra-lateral limb joint may validly be used as a standard for the affected one.