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South African cardiovascular risk stratification guideline for non-cardiac surgery

Alphonsus, C.; Naidoo, N.; Motshabi, P. et al. South African Medical Journal (2021) CC

The South African (SA) guidelines for cardiac patients for non-cardiac surgery were developed to address the need for cardiac risk assessment and risk stratification for elective non-cardiac surgical patients in SA, and more broadly in Africa. The guidelines were developed by updating the Canadian ...Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Non-cardiac Surgery, with a search of literature from African countries and recent publications. The updated proposed guidelines were then evaluated in a Delphi consensus process by SA anaesthesia and vascular surgical experts. The recommendations in these guidelines are: 1. We suggest that elective non-cardiac surgical patients who are 45 years and older with either a history of coronary artery disease, congestive cardiac failure, stroke or transient ischaemic attack, or vascular surgical patients 18 years or older with peripheral vascular disease require further preoperative risk stratification as their predicted 30-day major adverse cardiac event (MACE) risk exceeds 5% (conditional recommendation: moderate-quality evidence). 2. We do not recommend routine non-invasive testing for cardiovascular risk stratification prior to elective non-cardiac surgery in adults (strong recommendation: low-to-moderate-quality evidence). 3. We recommend that elective non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease should have preoperative natriuretic peptide (NP) screening (strong recommendation: high-quality evidence). 4. We recommend daily postoperative troponin measurements for 48 - 72 hours for non-cardiac surgical patients who are 45 years and older with a history of coronary artery disease, or stroke or transient ischaemic attack, or congestive cardiac failure or vascular surgical patients 18 years or older with peripheral vascular disease, i.e. (i) a baseline risk >5% for MACE 30 days after elective surgery (if no preoperative NP screening), or (ii) an elevated B-type natriuretic peptide (BNP)/N-terminal-prohormone B-type natriuretic peptide (NT-proBNP) measurement before elective surgery (defined as BNP >99 pg/mL or a NT-proBNP >300 pg/mL) (conditional recommendation: moderate-quality evidence). Additional recommendations are given for the management of myocardial injury after non-cardiac surgery (MINS) and medications for comorbidities. more

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2020 Heart Failure Society of South Africa perspective on the 2016 European Society of Cardiology Chronic Heart Failure Guidelines

Hitzeroth, J.; Mpe, M.; Klug, E. et al. The South African Medical Journal (2020) CC

Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t... more

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The increasing burden of asthma in South African children: A call to action

Masekela, R.; Gray, C.L.; Green, R.J. et al. The South African Medical Journal (2018) CC

BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed. OBJE... more

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Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Pro

Bhana, S.; Naidoo, P.; Pillay, S.; et al. Jornal of Medical Internet Research JMIR Publication Published on 13.2.2023 in Vol 12 (2023) (2023) CC

Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and pu... more

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Clinical management of East African trypanosomiasis in South Africa: Lessons learned

Frean J., Sieling W., Pahad H. et al International Journal of Infectious Diseases (2018) C2

Background: East African trypanosomiasis is an uncommon, potentially lethal disease if not diagnosed and treated in a timely manner. South Africa, as a centre for emergency medical evacuations from much of sub-Saharan Africa, receives a high proportion of these patients, mostly tourists and expatria... more

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Pathogenesis of chronic obstructive pulmonary disease: An African perspective

Allwood, B.; Calligaro, G. South African Medical Journal (SAMJ) (2015) CC2

The article discusses the significant impact of chronic obstructive pulmonary disease (COPD) as a global health issue, with cigarette smoking as the main risk factor. However, in developing countries, the causes of COPD are often multifactorial, involving environmental tobacco smoke, biomass fuel sm... more

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The National Asthma Education Programme and asthma in Africa

South African Medical Journal; SAMJ (2019) CC2

The National Asthma Education Programme (NAEP) is a registered non-profit organisation whose mission is to provide asthma education to healthcare professionals, patients and the lay public. It was founded in 1994 by Dr Mike Greenblatt and Profs Dave Luyt and Robin Green. This year NAEP celebrates it... more

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COVID-19 resources from Africa and beyond

South Sudan Medical Journal (2020) C2

A list of some of the many free documents and websites that can add to the information in the papers published in this issue of SSMJ. Many are regularly updated. Let us know of other resources relevant to those working in and with South Sudan.

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Cardiac Arrhythmias in Africa: Epidemiology, Management Challenges, and Perspectives

Bonny, A.; Ngantcha, M.; Scholtz, W. et al. Journal of the American College of Cardiology (2019) CC

Africa is experiencing an increasing burden of cardiac arrhythmias. Unfortunately, the expanding need for appropriate care remains largely unmet because of inadequate funding, shortage of essential medical expertise, and the high cost of diagnostic equipment and treatment modalities. Thus, patients ... more

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Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression

Zöllner, E.W. South African Medical Journal (2019) CC

The article "Asthma treatment in children: A guide to screening for and management of hypothalamic-pituitary-adrenal axis suppression" discusses the risks associated with the use of corticosteroids in pediatric asthma treatment. It highlights that prolonged corticosteroid use can suppress the hypoth... more

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The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma

Masekala, R.; Risenga, S.M.; Kitchin, O.P. et al. South African Medical Journal (2018) CC

Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wi... more

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Summary of childhood asthma guidelines, 2021: A consensus document

Manjra, A.I.; van Niekerk, A.; White, D.A. et al. South African Medical Journal (2021) CC

Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most importantly, on the clinical history and supported by inv... more

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Asthma traeatment in children: A pragmatic approach

Masekela, R.; Jeevanathrum, A.; Kling, S.; et al. South African Medical Journal (2018) CC

Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this journal is to provide an eviden... more

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Position statement for adult and paediatric spirometry in South Africa: 2022 update

Maree, D.M.; Swanepoel, R.A.; Swart, F. et al. African Journal of Thoracic and Critical Care Medicine (2022) CC

Spirometry is required as part of the comprehensive evaluation of both adult and paediatric individuals with suspected or confirmed respiratory diseases and occupational assessments. It is used in the categorisation of impairment, grading of severity, assessment of potential progression and response... more

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Antibiotic use and resistance in South Africa

Dr T Apalata, Dr C Bamford, Mr D Benjamin et al. South African Medical Journey SAMJ (2011) C2

Antimicrobial resistance (AMR) is an important public health concern shared by developed and developing countries. In developing countries the burden of infectious diseases is greater and exacerbated by limited access to, and availability and affordability of, antimicrobials required to treat infect... more

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Community health workers, recipients’ experiences and constraints to care in South Africa – a pathway to trust

Nonhlanhla Nxumalo, Jane Goudge & Lenore Manderson AIDS Care Psychological and Socio-medical Aspects of AIDSHIV (2016) CC

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Guidelines for the vaccination of HIV-infected adolescents and adults in South Africa

S. K. Dlamini; S. A. Madhi; R. Muloiwa; et al. Southern African Journal of HIV Medicine; AOSIS (2018) CC

Southern African Journal of HIV Medicine ISSN: (Online) 2078-6751, (Print) 1608-9693 http://www.sajhivmed.org.za Published: 23 May 2018

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Barriers to accessing and receiving mental health care in Eastern Cape, South Africa

Isabell Schierenbeck, Peter Johansson, Lena M. C. Andersson, Dalena van Rooyen Health and Human Rights Journal (2013) C1

The right to the enjoyment of the highest attainable standard of physical and mental health is enshrined in many international human rights treaties. However, studies have shown that people with mental disabilities are often marginalized and discriminated against in the fulfillment of their right to... more

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Guidelines for the management of asthma in adults and adolescents: Position statement of the South African Thoracic Society – 2021 update

Lalloo, U.G.; Kalla, I.S.; Abdool-Gaffar, S. et al. African Journal of Thoracic and Critical Care Medicine (2021) CC

sthma prevalence is increasing worldwide, and surveys indicate that most patients in developed and developing countries, including South Africa, do not receive optimal care and are therefore not well controlled. Standard management guidelines adapted to in-country realities are important to support ... more

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Training and Evaluation of Community Health Workers (CHWs): Towards Improving Maternal and Newborn Survival in an Urban Setting in KwaZulu-Natal, South Africa

Thoko Ndaba1, Myra Taylor, Musawenkosi Mabaso The Open Public Health Journal (2019) C1

CHWs demonstrated social commitment and purpose in the short term observed. The evaluation of the training of CHWs revealed that most demonstrated the necessary skills for referrals to prevent complications, caring for newborns and their mothers at home immediately after discharge from health care c... more