Research Articles (Paediatrics and Child Health)

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    Maternal and infant outcomes among pregnant women treated for multidrug/rifampicin-resistant tuberculosis in South Africa
    (Oxford University Press, 2021-04) Loveday, Marian; Hughes, Jennifer; Sunkari, Babu; Master, Iqbal; Hlangu, Sindisiwe; Reddy, Tarylee; Chotoo, Sunitha; Green, Nathan; Seddon, James A
    Background Data on safety and efficacy of second-line tuberculosis drugs in pregnant women and their infants are severely limited due to exclusion from clinical trials and expanded access programs. Methods Pregnant women starting treatment for multidrug/rifampicin-resistant (MDR/RR)-tuberculosis at King Dinuzulu Hospital in KwaZulu-Natal, South Africa, from 1 January 2013 to 31 December 2017, were included. We conducted a record review to describe maternal treatment and pregnancy outcomes, and a clinical assessment to describe infant outcomes. Results Of 108 pregnant women treated for MDR/RR-tuberculosis, 88 (81%) were living with human immunodeficiency virus.. Favorable MDR/RR-tuberculosis treatment outcomes were reported in 72 (67%) women. Ninety-nine (91%) of the 109 babies were born alive, but overall, 52 (48%) women had unfavorable pregnancy outcomes. Fifty-eight (54%) women received bedaquiline, and 49 (45%) babies were exposed to bedaquiline in utero. Low birth weight was reported in more babies exposed to bedaquiline compared to babies not exposed (45% vs 26%; P = .034). In multivariate analyses, bedaquiline and levofloxacin, drugs often used in combination, were both independently associated with increased risk of low birth weight. Of the 86 children evaluated at 12 months, 72 (84%) had favorable outcomes; 88% of babies exposed to bedaquiline were thriving and developing normally compared to 82% of the babies not exposed. Conclusions MDR/RR-tuberculosis treatment outcomes among pregnant women were comparable to nonpregnant women. Although more babies exposed to bedaquiline were of low birth weight, over 80% had gained weight and were developing normally at 1 year.
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    Autonomy in asthma management
    (Allergy Society of South Africa (ALLSA), 2021-12) Kling, Sharon
    The principle of autonomy is one of the pillars of the four principles approach to medical ethics. Autonomous patients should be respected and have the right and the freedom to make their own decisions regarding their healthcare. This individualistic view of autonomy is particularly prevalent in Western cultures and clinical practice; a relational type of autonomy prevails in cultures which are communitarian in their approach. Autonomy and shared decision making are important concepts in managing asthma.
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    Life-threatening asthma in children: a review
    (Allergy Society of South Africa (ALLSA), 2021-12-01) White, Debbie A; White, William A; Kling, Sharon
    We present a case of a child presenting with well-described but poorly recognised symptoms of life-threatening asthma that were initially missed. We present a management protocol for life-threatening asthma, for which evidence in the literature is lacking.
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    Misinformation in the Covid-19 era
    (NeuroInterventional Surgery, 2020-08-14) Kling, Sharon
    Misinformation in the digital era has the potential to undermine the efforts of health authorities and professionals to keep the public informed. This is evident in the slew of misinformation around COVID-19 prevention, treatments and vaccines. Mis- and disinformation in the field of allergies is also prevalent. The consequences include harm to the public and increased healthcare costs.
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    Telemedicine, allergy and the COVID-19 pandemic
    (Allergy Society of South Africa (ALLSA), 2021-06) Kling, Sharon
    The global COVID-19 pandemic has changed the world and healthcare practice. Telemedicine is important in reaching underserved and rural populations. But it has also become important in limiting the exposure of patients and healthcare professionals to infection, while at the same time still providing access to healthcare consultations for patients with acute and chronic conditions.