Abstract The May Measurement Month (MMM) campaign, conducted in South Africa in 2023 aimed to raise awareness of raised blood pressure (BP). Adults aged ≥18 years were recruited through convenience sampling at university campuses, community centres, schools, sport complexes, public parks, shopping centres, hospitals, and through household visits. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg and/or already receiving BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 6,653 were screened, with a mean age of 38.8 years, the majority of whom were females (56.3%). Of all participants, 1,010 (15.2%) reported never having had a BP measured before, 2,500 (37.6%) had hypertension, of whom 1,170 (46.8%) were aware, and 1,098 (43.9%) were on antihypertensive medication. Of those on antihypertensive medication, only 633 (57.7%) had controlled BP, and of all participants with hypertension, only 25.3% had controlled BP. The MMM campaign in South Africa identified a substantial number of participants with untreated or inadequately treated hypertension. The high prevalence of hypertension, despite the young adult age, together with the high proportions of individuals unaware of their hypertension and with uncontrolled BP highlight the importance of hypertension screening and awareness campaigns, and more rigorous management of hypertension, especially among young adults.
BACKGROUND:Data on predictors of treatment failure in children starting antiretroviral therapy (ART) are limited, particularly on dolutegravir-based regimens (DTG). METHODS:ODYSSEY demonstrated superior efficacy of DTG versus standard-of-care (SOC). We assessed predictors at ART initiation of treatment failure by 96 weeks. RESULTS:Three hundred and eighty-one children started first-line ART (82% African). At ART-initiation, median age was 10.5 years (IQR: 6.5, 14.0, 67 < 3 years), CD4% 20% (IQR: 12, 28), BMI-for-age Z-score -.58 (IQR:-1.48, +.25). One hundred and eighty-nine children started DTG, 192 started SOC (91% ≥3 years started efavirenz; 79% <3 years started lopinavir). Seventy-five children experienced treatment failure (24 DTG, 51 SOC). Failure risk was lower on DTG than SOC (hazard ratio [HR] = 0.47, 95% CI: 0.29-0.77, P = .002). Lower BMI-for-age Z-score (HR = 0.82 for each unit gain, 95% CI: 0.70-0.96, P = .01) and being at an African site (HR = 2.09, 95% CI: 0.82-5.31, P = .09) were associated with higher failure risk. Risk was also higher at younger ages with the steepest increase in the youngest children and increased at lower CD4%, with a stronger CD4% effect at younger ages. At CD4% = 20, HRs relative to age 10 years were 2.40 (95% CI: 1.58-3.65) at age 1 year, 1.30 (95% CI: 1.15-1.48) at age 5 years, and 0.80 (95% CI: 0.72-0.89) at age 18 years. At age 1 year, HRs relative to CD4% = 20 were 1.39 (95% CI: 1.16-1.66) at CD4% = 15, and 0.52 (95% CI: 0.36-0.75) at CD4% = 30; at age 10, corresponding estimates were 1.07 (95% CI: 0.94-1.20) at CD4% = 15, and 0.88 (95% CI: 0.69-1.13) at CD4% = 30. CONCLUSIONS:Young age, low BMI-for-age, and low CD4% at ART initiation predicted higher risk of treatment failure and can guide targeted support.
Background:Many South African peripheral medical centres lack direct access to CT scans or neurosurgery. The Glasgow Coma Scale (GCS), used with or without other findings, remains widely utilised in traumatic brain injury (TBI) assessments with lack of standardisation between centres. There is limited data from South Africa (SA) correlating GCS scores to CT imaging in TBI. Objectives:This study aimed to assess CT findings at various GCS levels to determine whether GCS was a reliable indicator for imaging and referral. Method:A retrospective review of 385 patients categorised with mild, moderate or severe TBI was performed. The initial non-sedated post-resuscitation GCS score and initial CT brain findings were compared using the chi-square and Fisher's exact tests. Results:Increased intracranial pressure and subdural haemorrhage occurred in 41.7% and 53.7% of patients with GCS 9-12, respectively, and 30.5% and 41.4% of patients with GCS 13-15, respectively. The highest incidence of depressed skull fractures (51.3%; 95% confidence interval [CI], 43.2-59.3%; p < 0.001) and pneumocephalus (25.6%; 95% CI, 42.2-56.4; p < 0.001) were reported in the CGS 13-15 category. Neurosurgical intervention was required in 83.2% and 73.0% of patients with GCS scores of 9-12 and 13-15, respectively. Conclusion:The severe category of GCS predicts imaging and neurosurgery requirements while the mild to moderate categories underpredict the need for patient referral. Contribution:This study provides rationale for the development of a local, standardised assessment tool to guide referral of TBI patients for imaging in resource-limited settings.
Introduction Total alloplastic replacement of the temporomandibular joint (TMJ) is a viable treatment option for severe TMJ disorders (TMDs) unresponsive to conservative approaches, as well as for reconstruction of congenital or acquired TMJ defects. However, clinical data on indications, outcomes, complications and long-term effects remain limited, and no global registry currently exists. This study aims to address this gap by establishing an international registry to collect data from patients undergoing total alloplastic TMJ replacement systematically. The registry will document clinical indications and disease progression, explore relationships between treatments, outcomes and quality of life, identify predictors of favourable outcomes and inform future research.Methods and analysis This international, prospective, multicentre, observational registry will enrol approximately 200 patients with TMD requiring total alloplastic TMJ replacement, with follow-up lasting up to 5 years postoperatively. The data collected will include underlying disease, treatment details, functional outcomes, patient-reported outcomes and procedure-related adverse events. The registry will also monitor patients who decline surgery and record their reasons. All treatments will adhere to the standard of care at each participating centre.Ethics and dissemination Ethics approval was obtained from the responsible ethics committee (EC) at each participating site prior to TMJ surgery. All patients will be enrolled following an informed consent process approved by the relevant EC. Study results will be disseminated through peer-reviewed publications.Approving ECs include: Krishnadevaraya College of Dental Sciences and Hospital EC, KCDS/Ethical Comm/54/2022–23; Ethikkommission Nordwest- und Zentralschweiz, 2019–02387; University of Belgrade School of Dental Medicine EC, 36/19; National Videnskabsetisk Komité, 2401881; University of KwaZulu-Natal Biomedical Research EC, BREC/00001592/2020; Etikprövningsmyndigheten, 2019–04477; Ethikkommission Medizinische Hochschule Hannover, 8660_BO_K_2019; Ethik-Kommission an der Medizinischen Fakultät der Universität Leipzig, 080/21-lk; Comité de Ética de la Investigación con Medicamentos Hospital Universitario 12 de Octubre, 19/392; Landesärztekammer Rheinland-Pfalz EC, 2025–18012-andere Forschung/nachberatend; Local Ethical Committee at National Medical and Surgical Centre named after NI Pirogoov, LEC meeting 5; Ethikkommission bei der LMU München, 19–589; Komisja Bioetyczna przy Warmińsko-Mazurskiej Izbie Lekarskiej w Olsztynie, 12/2021; De Medisch Ethische Toetsings Commissie Erasmus MC, MEC-2019–0696 and Comissão Nacional de Ética em Pesquisa, 3.825.711.Trial registration number NCT03991728.
Introduction Invasive pneumococcal disease (IPD) poses an enormous burden for developing countries. The introduction of pneumococcal conjugate vaccines (PCVs) has resulted in global declines in invasive pneumococcal disease (IPD), and the World Health Organization recommends PCV inclusion in all national immunization programs (NIPs). This review assesses the pneumococcal serotypes causing IPD in North Africa and the Middle East and the potential prevention of IPD by different serotype-specific PCVs. Methods A search was conducted in PubMed for articles published from 2012 to 2025 evaluating the serotypes causing IPD in North Africa and the Middle East. Results Of 263 articles retrieved, the 30 that met inclusion criteria investigated IPD in 10 countries from 1994 through 2022: Algeria, Iran, Jordan, Kuwait, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, and Tunisia. The studies showed that the serotypes most responsible for IPD varied widely over time and across countries and often demonstrated an inverse relationship to vaccine uptake. The most common IPD-causing serotypes were 14 (≤57.0 %), 19A (≤46.2 %) and 19F (≤30.8 %), but the prevalence of serotypes 14, 19A, and 19F tended to decline after the introduction of 7-valent PCV and 13-valent PCV (PCV13) into NIPs. In contrast, percentages of IPD caused by non-vaccine serotypes remained high in some countries. Discussion Although limited data and variable results made major serotype distribution trends difficult to determine, IPD caused by PCV13 serotypes clearly declined after vaccine introduction whereas IPD caused by serotypes not included in the available vaccines tended to remain high or increase. Conclusion In North Africa and the Middle East, improved IPD serotype surveillance is needed. The introduction of higher valency vaccines into regional NIPs may alleviate IPD burden.
