Approach to the diagnosis and management of snakebite envenomation in South Africa in humans: Special patient groups and surgical aspects.

This article explores the management of snakebite to vulnerable patient groups, namely children and pregnant women as well as providing detail on the current best practice when caring for venom ophthalmia and surgical wounds resulting from snakebite. Finally, the optimal free-to-use medical record for accurate documentation of snakebite incidents is provided for use by South African practitioners.

The profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department, South Africa.

BACKGROUND: With 23.5 suicide-related deaths per 100 000 population, South Africa (SA) has the eighth-highest age-standardised suicide rate in the world. Intentional self-poisoning is associated with significant morbidity, mortality and cost. In SA, self-poisoning is the leading method of suicide in females and the second leading method in males. OBJECTIVES: To determine the profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department. METHODS: The study was a cross-sectional, retrospective audit of the medical records of patients who presented over a 12-month period with intentional self-poisoning. RESULTS: Of the 288 patients included, 62.8% were female, 62.1% were aged 18 - 30 years, 22.2% were foreign nationals, 88.9% were single, 62.8% were unemployed, 82.3% reported that the episode was precipitated by an acute stressful event, 5.6% required intensive care unit (ICU) admission, and 4.5% died prior to hospital discharge. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning (25.3%) and was responsible for the majority of ICU admissions (81.3%), cases requiring hospitalisation for >6 days (56.5%) and deaths (69.2%). CONCLUSION: A large proportion of patients were female, 18 - 30 years of age, single, unemployed, and reported an acute stressful event as a precipitant. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning and accounted for the majority of deaths and ICU admissions. Nationwide efforts should be aimed at enhancing awareness and implementing strategies to identify those at increased risk of suicidal behaviour.

Stroke: A retrospective review of the incidence and epidemiology in a South African academic hospital emergency department.

BACKGROUND: Stroke is a leading cause of morbidity and mortality. Most deaths occur in low- and middle-income countries, with the incidence predicted to increase as populations undergo socioeconomic and epidemiological changes. Knowledge of contributing factors in a South African (SA) population can be used to drive healthcare initiatives to modify this burden of disease. OBJECTIVES: To analyse epidemiological data on patients with stroke presenting to an emergency department in Johannesburg, SA. METHODS: The study was a 12-month descriptive, retrospective review of medical records, undertaken at a tertiary-level hospital. Patients' records were selected based on the presumptive diagnosis of stroke. Data collected included ethnicity, age, gender, risk factors, signs and symptoms at presentation, and computed tomography (CT) brain scan findings. RESULTS: Of 312 records reviewed, 160 were eligible for inclusion. The mean age of the patients included was 57.7 years, and 64 patients (40%) had CT-confirmed haemorrhagic strokes. Hypertension was the most common comorbidity/risk factor identified, in the sample as a whole (n=93; 58%) and in both patients with haemorrhagic (n=33; 52%) and ischaemic strokes (n=56; 61%). Diabetes was the second most common comorbidity/risk factor (n=23; 14%), and was three times more likely in patients with ischaemic strokes (n=19; 20%) compared with haemorrhagic strokes (n=4; 6%). CONCLUSIONS: Stroke is an important healthcare concern for SA. Our study demonstrated a lower mean age of patients presenting with stroke compared with high- and upper middle-income countries, and a higher proportion of haemorrhagic strokes. Several modifiable risk factors such as hypertension and diabetes were identified. Data collection on a regional and national level is important to drive targeted healthcare initiatives.

Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement.

SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic.

Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement

SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic