AMJ

Most research into non-attendance at medical appointments has focused on accessible patient populations where forgetfulness, access, patient expectations, and experience are found to influence attendance. Low socioeconomics status and low health literacy contribute to non-attendance for some groups, where locally modifiable factors such as reminder systems and transport are in place. Australia’s healthcare funding model encourages “5-minute medicine”, which is unlikely to modify the attendance behaviour of hard-to-reach populations, which have the greatest health needs.

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Last month’s editorial focused on whether society is ready for advanced genomic medicine (AGM). This issue follows up with a question posted by a sociologist of diagnosis: can medicine accommodate the social aspects of genetic diagnosis? Genetic testing has brought forth the social role of diagnosis in how health and illness are conceptualized.

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Mycobacterium tuberculosis is one of the most significant causes of death from an infectious agent. Rapid and accurate diagnosis remains a significant challenge. With GeneXpert MTB/RIF assay, laboratory confirmation of M. tuberculosis diagnosis is possible within 2 hours at a single office visit. This now provides potential to determine isolation of TB suspects and also to quickly rule out suspected TB cases, leading to better patient incomes and reduced risk of transmission in the community.

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Medicines shortages are a growing health issue. They have documented extensively in North America, and national and international recommendations have been offered to reduce the incidence and impact of such shortages. This brief report provides an insight into the range of medicines shortages experienced in South Africa, a middle-income country’s public health sector. Improved information sharing about medicines shortages and their causes can help to reduce the negative health impacts of such events.

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Supernumerary kidney is the rarest of all renal anomalies. It results from the aberrant division of the nephrogenic cord into two metanephric blastemas; two kidneys then form in association with a partially or completely duplicated ureteral bud. This case study discusses how contrast-enhanced computed tomography revealed two separate functional right kidneys and a mal-rotated gross hydronephrotic left kidney in a 14-year-old male patient who presented with repeated attacks of urinary tract infections. 

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The study reports a bilateral anatomical variation in the brachial plexus observed in a single cadaver. It reviews the morphological variants of the human brachial plexus, emphasizing the clinical implications of the brachial plexus variations, and raising the awareness of such variations in brachial plexus morphology. Clinicians and anatomists need to be aware of such variations as they are relevant to clinical practice for some procedures (e.g., nerve block).

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Haemotoxic snakebite is known to cause a venom-induced consumptive coagulopathy with bleeding manifestations leading to fatality. Thrombotic manifestations are rare. In this case study, the patient unusually developed a deep vein thrombosis of the lower limb, despite the presence of early disseminated intravascular coagulation (DIC) and prolonged coagulation times. Patients with haemotoxic snakebite and thrombotic indication (swelling) should be targeted for a Doppler sonographic examination, which enables timely detection of DVT. Anticoagulation, whilst appearing counterintuitive in such cases, may be limb-saving even in the setting of coagulopathy.  

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Antimicrobial resistance: global report on surveillance 2014

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