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The role of increased gastrointestinal alcohol production in patients with the metabolic syndrome: Implications for the pathogenesis of non-alcoholic fatty liver disease
(University of the Witwatersrand, Johannesburg, 2006) Menezes, Colin Nigel; Immelman, Ronnie; Raal, Derick
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with hepatic histology that resembles alcoholic liver disease. It is a frequent cause of chronic liver disease and is attracting increasing scientific attention worldwide. I explored the possibility that increased gastrointestinal alcohol production may have a role as a “second hit” in the pathogenesis of NAFLD in study subjects with the metabolic syndrome. In an attempt to investigate this hypothesis, this study looked at blood, urine and breath levels of alcohol in patients with the metabolic syndrome versus matched age and ethnic group healthy controls. Of the twenty study subjects, 80% had dyslipidaemia, 60% had hypertension and 70% had type 2 diabetes mellitus. Their mean BMI was 35.1±8.2 kg/m² (mean ± SD, P < 0.0001 versus controls). The serum aminotransferases were significantly elevated in the study subjects, their ALT levels being 57.4±44.79 U/L versus 17.4±4.60 U/L in the controls (95% CI 18.02 – 61.42, P < 0.001), and their AST levels 52.5±36.21 U/L versus 23.4±4.86 U/L in the controls (95% CI 11.99 – 46.20, P < 0.01). Seventy five percent of the study group had sonar features suggestive of fatty liver disease. Two adipocytokines, adiponectin and leptin, mediators of insulin resistance, an important factor in the development and progression of NAFLD, were also measured. Adiponectin levels were significantly lower (6875 ng/L versus 15475 ng/L; median value, P < 0.01), and leptin concentration levels significantly higher (13.56 ng/L versus 3.05 ng/L; median value, P < 0.05) in the study subjects than in the control group. Alcohol was detected in 60% of the study subjects, of which 35% tested positive for ethanol, 55% tested positive for methanol, and 30% tested positive for both ethanol and methanol. This was a statistically significant result, as none of the control group tested positive for any of the alcohols. The ethanol concentration in the study subjects’ blood was 7.14±3.28 mg% (mean ± SD), in their urine 3.71± 12.87 mg% (mean ± SD) whilst none was detected in their breath. The methanol concentration in the study subjects’ blood was 16.17±17.95 mg% (mean ± SD), in their urine 6.8± 13.58 mg% (mean ± SD) while their breath level was 2.05±3.19 mg (mean ± SD). This study therefore suggests that endogenous alcohol production may be indeed be involved in the pathogenesis of NAFLD in subjects with the metabolic syndrome. Not only ethanol but also methanol was detected in the subjects tested. endogenous alcohol may therefore be responsible for the ‘second hit’ theory in the pathogenesis of NAFLD, and it is likely that formaldehyde, the metabolite of methanol may be a more potent toxin of the patocyte injury as opposed to acetaldehyde, the metabolite of ethanol. The most likely source of the alcohol is from intestinal bacterial flora. These findings provide further insight into the pathogenesis of NALFD, suggesting other therapeutic alternatives such as the use of antibiotics and probiotics as a potential treatment strategy for NAFLD.
The demographic profile, substance use, competence to stand trial and criminal responsibility among “ Observation Patients” admitted for forensic psychiatric evaluation at Sterkfontein Hospital, Gauteng, South Africa.
(2011-10-19) Pillay, Anben
A review of the literature indicates that young males, who are unemployed with low levels of education, predominate in populations of pre-trial criminal offenders suspected of having a psychiatric illness, also known as “Observation Patients” according to the Criminal Procedures Act of 1977 in South Africa. Other contributory factors include a history of mental illness and non-compliance on psychiatric medication, a previous forensic history, co-morbid substance abuse and being intoxicated at the time of the offence. Dual diagnosis is considered a key contributor to criminal behaviour in this group of patients. The review of the literature also shows a significant proportion of co-morbid intellectual disability among offenders found to be psychiatrically ill at the time of the criminal event. A previous study conducted 20 years earlier, in 1986 at the Sterkfontein Forensic Psychiatric Unit by Vorster (1986) showed that the typical profile was a single, unemployed, poorly educated male in his twenties, usually with a history of psychiatric treatment. This typical profile confirmed the evidence in the literatures at the time of the study.
The effect of temperature on the vector competence of culex univittatus theobald (diptera : culicidae) for West Nile and Sindbis viruses
(2015-02-13) Cornel, Anthony John; Swanepoel, R.; Jupp, P.G.
Dyslipidaemia in rheumatic diseases
(2021) Chen, Xiaohui
Background: It is well established that patients with rheumatic diseases are at high risk of atherosclerosis and cardiovascular disease. Dyslipidaemia is an important modifiable cardiovascular risk factor and in 2018 the Lipid and Atherosclerosis Society of Southern Africa (LASSA) published guidelines with recommended treatment targets for patients with dyslipidaemia. Objectives: To evaluate the prevalence of dyslipidaemia in patients with rheumatic diseases from a South African population, and identify the proportion of these patients receiving lipid lowering agents (LLAs). The aim was to determine the number of patients on LLAs reaching the low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) targets recommended by LASSA guidelines. Methods: This was a retrospective cohort study of 200 adult patients attending the Helen Joseph Hospital outpatient rheumatology clinic from 22 August to 12 December 2018. Clinical and laboratory data from patients with a confirmed diagnosis of rheumatic disease(s) and had their lipogram(s) measured since attending the clinic were analysed. Results: The median age of patients was 54 years (IQR 45-62) with a female predominance of 85.5% (n=171) and the majority 52.5% (n=105) being comprised of black African patients. Primary outcomes: Of the 200 patients enrolled, 127 (63.5%) met the criteria for dyslipidaemia based on their initial lipograms measured at the clinic but only 59 (46.5%) of these patients were on LLAs. At the time of the audit, 164 (82%) patients were eligible to receive LLAs as recommended by the LASSA guidelines, but only 77 (47.2%) were prescribed LLAs. Of these 77, only 22 (28.6%) met the recommended LDL-C targets for very high risk or high risk groups proposed by LASSA. Secondary outcomes: There was a high prevalence of cardiovascular risk factors present in 153 (76.5%) of patients – with hypertension being predominant in 132 (86.3%) patients. The majority of patients, 186 (93%), were on disease modifying agents for rheumatic diseases (DMARDs). A low proportion of 23 (11.5%) patients were on corticosteroids. Conclusion: Despite the high prevalence of dyslipidaemia in patients with rheumatic diseases, the majority of patients did not meet the recommended TC/LDL-C targets suggested by local guidelines. There is a need to raise awareness amongst healthcare practitioners treating this patient population regarding the pertinent aggressive control of dyslipidaemia. Furthermore, owing to the relationship between inflammation and lipids, rheumatic disease itself should perhaps be considered as an independent cardiovascular risk equivalent to other traditional cardiovascular risk factors
Correlation between ocular surface disease index and tear meniscus height in dry eye disease at a Johannesburg tertiary eye hospital
(2021) Erasmus, Daniel
Background: Dry eye disease is a common, and potentially vision-threatening problem. The Ocular Surface Disease Index is a well-established method of subjectively assessing dry eye disease. Objective means of diagnosing dry eye disease suffer from poor reproducibility, low sensitivity and specificity, are invasive, time consuming and often require specialized equipment. It is hypothesized that optical coherence tomography of the tear meniscus may address these problems. Aim: The primary aim of this study was to describe the correlation between the Ocular Surface Disease Index © and tear meniscus height in dry eye disease measured by optical coherence tomography. The secondary aim was to determine a useful diagnostic cut-off value for tear meniscus height in the diagnosis of dry eye disease. Setting: The study was conducted at St John Eye Hospital, Soweto, South Africa. Methods: This was a prospective, cross-sectional study of adults at a tertiary level eye clinic. Participants were included if they were older than 18 and excluded if they were contact lens wearers, had an established diagnosis of dry eye disease, or were known to have (or be taking any treatment for) any ophthalmological or medical condition that has the potential to influence dry eye disease. A control and investigative group was determined using the Dry Eye Ocular surface disease index. The inferior tear meniscus height of both groups was imaged using optical coherence tomography. Results: A total of 36 right eyes of 36 patients was included in this study. Patient ages ranged from 20 – 64 years, with a median age of 43 years. Overall there were more females (n = 27) than males (n = 9). There was a moderate negative correlation between the normal/dry eye group and tear meniscus height (rb = - 0.452, p = 0.032). Optimizing sensitivity and specificity yielded a diagnostic cut-off tear meniscus height of 296um. Conclusion: Tear meniscus height tends to decrease between Ocular Surface Disease Index classifications of ‘normal’ and ‘dry eye disease’. However, tear meniscus height performed poorly as an objective measure of dry eye disease in our study population limiting recommendations to adopt it as a diagnostic test. Keywords: Dry eye disease, Ocular Surface Disease Index , Optical Coherence Tomography, tear meniscus height.
An audit of the presence of coeliac disease associated human leukocyte antigen haplotypes in renal and bone marrow transplant donors and recipients from the South African National Blood Services
(2021) Mrubata, Kitso-Lesedi
Introduction: Coeliac Disease (CD) is an autoimmune condition occurring in genetically predisposed individuals exposed to an environmental trigger. The Human Leukocyte Antigen (HLA) haplotypes HLA DQ2.5 and HLADQ8 bear the strongest association with CD, and 90 -95% of patients with CD bear these haplotypes. The absence of these haplotypes has high negative predictive value. The susceptibility of the South African population to CD has not been studied previously. Methods The South African National Blood Services database was used to analyse the prevalence of HLA DQ2.5 and DQ8 in potential donors and recipients of organ transplants. Results The overall prevalence of HLA DQ2.5 and HLA DQ8 was 19.8%. The prevalence was lower in Black subjects (15%) than Caucasians (28%). Mixed race (22%) and Indian (17%) subjects had intermediate prevalence. The was no significant difference between potential transplant donors and recipients. Conclusion The prevalence of HLA DQ2.5 and HLA DQ8 differed among South African study participants of different ethnicities and was lower than the reported world-wide prevalence of 30-40%.
Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklis
(2021) Sima, Najiba
Background The WHO Surgical Safety Checklist (WHO Checklist) fosters communication and teamwork between the perioperative team and perceptions influence its acceptance and use. This study explores the perceptions of the perioperative team to the WHO Checklist in operating theatres at the University of the Witwatersrand affiliated hospitals. Methods A qualitative, contextual, exploratory research design was employed. Purposive sampling was used to invite theatre nurses, anaesthetists and surgeons to participate. Focus group interviews were held for each group. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results Ten nurses, 6 anaesthetists and 4 surgeons participated in the focus group interviews. Four themes relating to patient safety were identified namely, the prevalence of power struggles in theatre, a breakdown in communication, a culture of silence and the inadequate and siloed training. The perceptions of the perioperative teams interviewed describe a daily flight plagued by turbulence that may result in serious adverse events. Conclusion In a complex system such as a hospital theatre environment, the introduction of a simple tool such as the WHO Checklist has a limited impact on patient safety if the underlying supportive network is not intact. This study demonstrates the importance of interpersonal relationships, changing teams and lack of integration of teams, processes and training, on the use of the WHO Checklist as a safety tool in a South African hospital setting. A prevailing culture of safety is a prerequisite for successful implementation and use of the WHO Checklist.
An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital breast imaging unit
(2021) Christofides, Nicholas Christopher
Background: Benign breast pathology is a common presenting complaintand its assessment is important to characterize so as to not miss malignant pathology. At Helen Joseph Hospital (HJH) patients are triaged at the Breast Clinic according to the clinical suspicion of benign versus malignant disease. The patients are assigned a colourlabel based on their clinical presentation. This triage system affects waiting times between clinical examination and mammography appointments. This study aims to assess the association between clinical examination and the radiological and pathological findings of disorders deemed clinically benign and to ascertain the spectrum of benign breast disorders encountered at HJH. Method: A retrospective study of imaging results of patients at HJH presenting as clinically benign breast disorders from January –June 2018 was conducted. Assessed BIRADS score was noted and if core biopsies were performed, their results and patient demographics were documented. Results: Of the 1263 clinically benign patients presenting from January -June 2018 the radiological assessment was: BIRADS 1: 158 (12.5%), BIRADS 2: 685 (54.2%), BIRADS 3: 292 (23.1%), BIRADS 4a: 54 (4.3%), BIRADS 4b: 29 (2.3 %), BIRADS 4c: 21 (1.7%), BIRADS 5: 24 (1.9%). There were 133 biopsies (including 8 BIRADS 3 patients), with 46 (3.6%) confirmed malignancies. The combined specificity of mammography and ultrasound was 65.52 % (54.56% -75.39%) and combined sensitivity 91.30% (79.21% –97.58%). Conclusion: There is a vast spectrum of benign conditions presenting in this population group with only 3.6% confirmed malignancies, confirming an accurate triage system utilised at the breast clinic. Radiological imaging is highly sensitive but less specific emphasising the triad of clinical, radiological and histological assessment as the gold standard with regard to diagnosis of breast disease.
Attitudes and perceptions of caregivers regarding their presence at induction of anaesthesia
(University of the Witwatersrand, Johannesburg, 2021) Le Roux, Johannes Jacobus; Redelinghuys, Cara
Background Caregiver presence at their children’s induction of anaesthesia is practiced daily around the world. International studies demonstrated conflicting emotions in caregivers present at induction of anesthesia of their children. These positive and negative emotions ranged from comforting and reassuring, to traumatising and disturbing. Research exploring the attitudes and perceptions of caregivers regarding this practice is limited within the African context. Aims The aim of this study was to describe caregivers’ attitudes and perceptions regarding their presence at induction of their children’s anaesthesia. Methods This descriptive, phenomenological, qualitative study was conducted in 2020 at Chris Hani Baragwanath Academic Hospital, a 3200-bed facility in South Africa. Twenty caregivers of children (aged 2 to 8 years) undergoing elective surgery were recruited. Data was collected through face-to-face, in-depth, semi-structured individual interviews using purposive sampling. Interviews ranged between 11 and 55 minutes in duration and were conducted within 24 hours of induction of anaesthesia. The audio recorded interviews were transcribed and subjected to inductive reflexive thematic analysis. Results Six themes were developed: Fulfilment of caregiver role, A positive experience, A traumatic experience, Not prepared for the experience, My world is my reality, and Your world is a place different to mine. Conclusion A caregiver’s perception of the induction process is influenced by multiple factors. A finding specific to our cohort is the interplay between complex multifaceted cultural beliefs and anaesthesia of their children. By acknowledging and addressing these beliefs, a caregiver’s presence can be tailored to ensure a positive experience for all involved at induction
Emergence delirium in children undergoing botulinum toxin injections for strabismus correction
(University of the Witwatersrand, Johannesburg, 2021) Rapuleng, Aletta
Background Emergence delirium is an unpleasant complication that may occur in children after general anaesthesia. Botulinum toxin injections for strabismus correction is a short procedure with rapid recovery from anaesthesia, a risk factor for emergence delirium. The aim of this study was to describe the occurrence of emergence delirium and the associated risk factors in children undergoing botulinum toxin injections for strabismus correction at Chris Hani Baragwanath Academic Hospital. Methods A cross-sectional research study design was followed using convenience sampling. The study included ASA I and II children aged 2 – 6 years. Data collected consisted of the participants characteristics, the intraoperative course and the child’s anxiety level as evaluated at induction using the modified Yale Preoperative Anxiety Scale (mYPAS). The Paediatric Anaesthesia Emergence Delirium (PAED) score was used to diagnose emergence delirium in the recovery room. All children received a standardised anaesthetic. Results Sixty-one children were included in the study and 31 (50.8%) developed emergence delirium. Thirty-nine (63.9%) participants showed signs of anxiety with a mean (SD) mYPAS of 41.2 (17.9) out of 100. There was a very weak negative correlation between the highest PAED score and the highest mYPAS (r =-0.0287, p=0.8260). There was a moderate negative, statistically significant correlation between the highest PAED score and age (r =-4850, p=0.0001). Younger age (p=0.0001) and male sex (p=0.0002) were found to predispose participants to emergence delirium. The length of stay in the recovery room was longer in those who experienced emergence. Conclusion In this study, a high occurrence of emergence delirium was found following sevoflurane anaesthesia for botulinum toxin injections for strabismus correction, a short procedure with rapid awakening. Younger preschool children were more likely to develop emergence delirium. It was, however, self-limiting and seldom required treatment.
Attitude and perception of urology by 5th year (GEMPIII) students at the end of their mixed block rotation at Wits
(University of the Witwatersrand, Johannesburg, 2022) Tshiala, Alain Kabongo; Haffeje, Mohamed; Nel, Marietha
Background The University of the Witwatersrand Medical School has a six year MBBCh programme, of which the fifth year is more of a clerkship consisting of both didactic (lectures and assigned readings) and practical (work in hospital wards or in an outpatient clinic) study, consisting of seven blocks of six weeks each of which two weeks is mixed rotations in specialities such as ophthalmology, ear-nose-throat and urology. Methods This was a qualitative survey of fifth year medical students at Wits Medical School from September 2019 to February 2020. The survey was conducted by means of a questionnaire consisting of two parts: The first component covered the students perceptions of the urology rotation, and the second component contained the students self-evaluations. The aim of the study was to assess the current urology knowledge and confidence among undergraduate medical students regarding urological diagnostic and therapeutic procedures, in order to evaluate the current curriculum and the assess the possible need for improvement in urological knowledge and skill. Results Of 250 participants, 159 (63.6%) were female and 91(36.4%) were male. The majority of students considered their urology knowledge on lithiasis/stone disease and erectile dysfunction sufficient and were comfortable with male catheterisation. Voiding dysfunction, paediatric urology and uro-oncology were the subjects students had the most common deficit in. There was a statistical significant difference between females having a more positive attitude to urology than males (p = 0.02). No statistical significant difference in attitude to urology was found between students who rotated in CMJAH and those who rotated in CHBAH. Indeed, the majority of students had a negative attitude to urology at the end of the mixed block rotations regardless of the training location. Unattractivity and lack of knowledge were the most common reason for not choosing urology as a career. Conclusion The study reveals a need for improvement in basic urological knowledge and skills during the mixed block rotation. A more practical and adjusted curriculum, taking into account bedside teachings, attendance of urological clinics and more exposure to urological patients are some suggestions to be considered to improve the urological educational curriculum.
The knowledge and skill of registered nursing staff at Chris Hani Baragwanath Academic Hospital Emergency Units on endotracheal tube cuff manometry, before and after a training session
(University of the Witwatersrand, Johannesburg, 2022) Henning, Jandre; Hindle, Lucy
Introduction Appropriate management of endotracheal tube (ETT) cuff pressures is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments (EDs), it has become an increasingly important skill among registered nurses. Methods This prospective longitudinal interventional study was performed among registered nurses (RNs) at Chris Hani Baragwanath Academic Hospital’s EDs. The study aimed to determine their current knowledge and practical skills on ETT cuff manometry and assess the effectiveness of a training program. The training program involved theoretical and practical components. RNs theoretical knowledge was assessed with a pre- and post-training questionnaire. Theoretical and practical scores were compared pre- and post-training Results Of the 63 RNs employed in the ED, 95% (60 RNs) participated in this study. Only 38.9% used cuff manometry as standard practice and only 12.8% are checking it at appropriate 12 hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8% and post-training of 64.5% (p=0.001). The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1% and a post-training average of 93.3% (p=0.001). Conclusion This study showed the current lack of knowledge and skills on endotracheal cuff pressure manometry among emergency RNs. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training
A retrospective audit of the cytogenetic profile and management outcome in Acute Myeloid Leukemia patients treated at Charlotte Maxeke Johannesburg Academic Hospital (2017 - 2021)
(University of the Witwatersrand, Johannesburg, 2022) Mpanza, Mbongi V.; Ruff, P.
Acute Myeloid Leukemia (AML) is a highly heterogenous blood cancer that affects the non- lymphoid lineage. It is a most common acute leukemia in adults. The worldwide incidence is relatively low with inordinately high cancer mortality. The recent advances done by on-going research has elevated our understanding of cytogenetic and abnormalities associated with AML. This understanding further aids in stratifying AML patients into favourable, intermediate, and poor prognosis groups. However, despite these insights into disease, patient outcome often remains poor. In this review, we discuss findings in AML at CMJAH, with particular focus into cytogenetic profile and molecular gene mutations. These recurrent genetic alterations provide novel insights into the pathogenesis, clinical characteristics, and outcome of these patients. These alterations play a major role in prognosticating the outcome in AML and are also important in developing novel therapies. The most common type of AML, called de novo AML, occurs sporadically with no prior history of underlying myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN) or exposure to potentially leukaemogenic therapies or agents. The less common is secondary AML which has poorer prognosis and is define as any leukemic process which may arise from previous haematological disorder like MDS, NPM or can be a result of prior cytotoxic chemotherapy or radiation therapy (t-AML).T-AML is defined as AML that develops from prior cytotoxic drugs, radiation or immunosuppressive agents which was given for unrelated illness. T-AML accounts for 7%-8% of all AML and is known to have a dismal outcome with an adverse cytogenetic and molecular profile. To our current knowledge there is no local study that has previously analysed t-AML in detail hence this study may provide such critical data.
A Survey of Caudal Anaesthesia practice in an academic anaesthesia unit
(University of the Witwatersrand, Johannesburg, 2022) Julius, Sepheu Letshokge; Mamoojee, Anisah; Mogane, Palesa
Background Caudal blockade is a means of providing intra and postoperative analgesia and minimises the sympathetic stress response to abdominal and lower limb surgery. Clear anatomical landmarks and ease of performing the procedure make it one of the most commonly performed regional techniques in the paediatric population. Methods A prospective, contextual, descriptive study was conducted between 2020 and 2021 on anaesthetists working in an academic anaesthesia unit. Data was collected anonymously through a digital questionnaire and participation was voluntary. Results The study sample is made up of 40 consultants and career medical officers (27%), 87 registrars (61%), 15 medical officers (10.6%) and two community service medical officers (1.4%). Plain bupivacaine at 2.5mg/kg was found to be the local anaesthetic of choice. Most participants,90 (63.1%), did not use an adjunct in their caudal blocks, with the risk of excessive sedation and risk of postoperative apnoea being the most frequently cited reasons. Where an adjunct was used, the alpha-2 agonists; clonidine (64.5%) and dexmedetomidine (53.2%) were chosen. The majority,122 (85.1%), anaesthetists acquired consent specifically for caudal blocks. Potential complications of caudal blockade, the duration of analgesia and the technique of the caudal block were frequently discussed with patients and their caregivers when obtaining consent. Use of ultrasound is not in widespread practice, and block failure was reported by 91 (63.8%) participants. Paracetamol was the most regularly employed rescue analgesia. Conclusion This study found that the academic unit’s caudal blockade practice compared well with local and international literature. The use of adjuncts, ultrasound and caudal catheters is not a widespread practice, and clear guidelines may be beneficial in this regard. Use of standardised informed consent protocols may improve the patient and caregiver experience
Registrars’ perspectives towards virtual teaching in an academic department during the COVID-19 pandemic
(University of the Witwatersrand, Johannesburg, 2022) Mpemnyama, Lerato Nomonde
Background The COVID-19 pandemic brought about unprecedented times that resulted in measures of social distancing that had to be put in place. The Department of Anaesthesiology at the University of Witwatersrand had to comply with these regulations and switched the teaching of registrars from in-person format to a virtual platform. The study aimed to look at the perceptions registrars had towards virtual teaching during the COVID-19 pandemic. Methods This cross-sectional quantitative study was conducted in the Department of Anaesthesiology at the University of Witwatersrand via an online self-administered questionnaire that was distributed to the registrars registered in the department. The validated questionnaire that was used was developed following a literature search and an adaptation from two validated questionnaires. The study was conducted from December 2021 to February 2022. Results The department has a total of 100 registrars, and the response rate was 90%. The study highlighted that virtual teaching did have a positive impact in teaching in the academic department, with 91% (n=81) finding virtual teaching to be effective and 63.9% (n=53) of respondents preferring virtual teaching over in-person teaching. Conclusion The COVID-19 pandemic brought about a disruption to the academic programme in the Department of Anaesthesiology at the University of Witwatersrand, resulting in virtual teaching being implemented. This move has been met with a positive response among the registrars in the department.
A survey of the perceptions and knowledge of anaesthesia and anaesthetists possessed by Grade 12 learners in four Johannesburg districts
(University of the Witwatersrand, Johannesburg, 2022) Talane, Pulane Adelice
Background William J.G Morton (1816-1868) introduced the world to modern anaesthesia when he successfully anaesthetised a patient using Ether at Massachusetts General Hospital in Boston in October 1846. (1) Since then, advances in pharmacology have resulted in the safer use of anaesthetic drugs and technological advances have improved monitoring of patients under anaesthesia. Anaesthetists around the world are now involved in the fields of critical care, trauma and pain management. (2)This has brought a sense professional esprit de corps to the anaesthetic fraternity. Despite this radical growth and development of the speciality, there is still a lack of public knowledge regarding the discipline of anaesthesia, anaesthetists’ expertise, or the role played by the anaesthetist in the chain of health care delivery. (3) Methods A cross sectional study was carried out between June and September 2021 on Grade 12 learners in four Johannesburg districts. A questionnaire consisting of three sections and 26 questions was handed out at pre-selected schools. The first part of the questionnaire acquired demographic data, the second contained questions pertaining to anaesthetists and anaesthesia as a speciality, and the third part pertained to interest in the field of anaesthesia. Results Of the 595 learners that participated in this study, 335 (56.3%) were aware that an anaesthetist administers anaesthesia in the operating room. A considerable number of learners n=344 (57,8%) believed that a nurse monitored and recorded the patient’s vital signs during surgery. Only 95 learners (16%) correctly identified all the duties of the anaesthetist outside of the theatre environment. Overall, learners fared poorly, achieving an average score of 14% for the questionnaire. However, there was a statistically significant correlation between being from a high socioeconomic background and awareness that the anaesthetist administers anaesthesia. A high socioeconomic background was defined as having a suburban residence, a household income comprising a salary instead of social grants and care givers that possessed a university degree. Knowledge regarding the intraoperative duties of the anaesthetist was still poor, regardless of the socioeconomic background of the learner. Previous exposure to anaesthesia did not improve awareness about anaesthesia among the learners. Conclusion This study has shown that awareness regarding anaesthesia and anaesthetists is still lacking despite the radical growth in the field. This lack of awareness cannot be ignored; education of the general public should be intensified in order to empower people to ask the right questions as well as make informed decisions about their perioperative care in the future. More than half of the learners in the study (58.5%) believed that good medical education can reduce the burden of health care costs and medicolegal consequences; and 70% of them would request an anaesthetist to provide them with detailed information about their anaesthetic before the start of surgery. Therefore, despite lack of awareness, the majority of the learners displayed interest and willingness to know more about anaesthesia, and grade 12 learners would be a formidable target group to direct anaesthetic education campaigns
Post caesarean section outcomes of obstetric valvular heart disease patients at Charlotte Maxeke Johannesburg Academic Hospital
(University of the Witwatersrand, Johannesburg, 2022) Mfeka, Ntombizabanguni Glory
Background Valvular heart disease presents a unique set of conditions during pregnancy and delivery with the potential of adverse outcomes complicated by prior interventions and anticoagulation. The aim of this study was to describe the profile and outcomes of obstetric valvular heart disease patients who delivered via caesarean section at Charlotte Maxeke Johannesburg Academic Hospital. Methods A retrospective study was done using patient record files, anaesthetics forms and echocardiogram reports. The study period was a 5-year review from January 2016 to December 2020. Results Sixty-nine patients were included. The mean age ± SD of the patients in this study was 30.1 ± 5.6 years. A total of 83% had gravidity of 1-3 and 90% parity of 0-2. Majority of patients (57%) had elective caesarean section. General anaesthesia was the most common mode used and majority of patients had fixed interval analgesia (FIA) mode of analgesia postoperatively. 40.5% of the patients were on anticoagulants. A significantly higher percentage of those who needed anticoagulation (46%) had poorer outcomes when compared to those who did not (7%), (P<0.001). The was a univariable association between adverse maternal outcome and NYHA class and lack of use of anticoagulants [aOR 3.77, 95%CI 1.45 – 9.79, P=0.006 and aOR 0.11, 95%CI 0.018 – 0.67, P=0.017, respectively]. Low ejection fraction was univariably associated with adverse foetal outcome, uOR 0.94, 95%CI 0.90 – 0.99, P=0.032. One (1%) foetus demised. Conclusion Patients were younger and in relatively good functional status. They carried the pregnancies to term. Patients did experience adverse outcome related to bleeding and arrythmias predominantly, but none demised. One neonate was lost. A structured care plan for these patients, based on a multidisciplinary approach, to afford prehabilitation is necess
Retrospective case series of the anaesthetic management and outcomes of patients with Rasmussen’s aneurysms at an academic hospital
(University of the Witwatersrand, Johannesburg, 2022) Stuart-Clark, Hannah Elizabeth; Mogane, Palesa; Padi, Josias
Tuberculosis (TB) has a high burden of disease in South Africa and a Rasmussen’s aneurysm is a late complication of TB (1-5). Although rare, the risk for life- threatening complications is high (>50%) (6-9). Pulmonary artery embolization (PAE) is a highly specialised, minimally invasive technique used for the management of haemoptysis caused by a Rasmussen’s aneurysm which is not commonly performed in Lower Middle-Income Countries (10). There is a paucity of information regarding anaesthetic management guidelines for these patients undergoing PAE. The aim of this study was to describe the periprocedural anaesthetic management and outcomes of patients presenting with Rasmussen’s aneurysms treated with PAE in the interventional radiology suite at Chris Hani Baragwanath Academic Hospital. Methods This study was designed as a retrospective case series and arterial embolization (AE) records were collected over a 4.5-year period (January 2017 – June 2021) for evaluation. All patients identified with Rasmussen’s aneurysms were included in the study and the anaesthesia charts, patient hospital ward files, records from interventional radiology, the National Health Laboratory Service, and pulmonology patient records were then interrogated. Results The prevalence of Rasmussen’s aneurysms in patients presenting for PAE with haemoptysis at this institution was 9%. Of the sixteen patients included in the study, thirteen were male and three were female. Current or previous tuberculosis infection was noted in ten patients and five patients had a current or previous history of smoking. The median duration of the general anaesthesia procedures were 4 hours 5 minutes (interquartile range 03:03 - 05:33), with nine cases done electively andeight done as emergencies. A total of 15 patients were intubated using double lumen endotracheal tubes and 12 patients were done with both consultant and registrar anaesthesiology coverage. Median haemoglobin was 10.5g/dl and eleven patients did not receive periprocedural blood transfusions. All patients were embolised successfully using metallic coils and were sent to a high-dependency unit post- procedure. Conclusion Despite the limitations, this study provides several novel insights into the prevalence and anaesthetic management of Rasmussen’s aneurysms in patients presenting with haemoptysis for PAE in our setting and helped establish the need for protocolised guidelines for the management of these patients. This data also allowed for the development of a novel set of guide recommendations for the management of this unique subset of patients, which include the following: guidelines for pre-operative optimisation, invasive monitoring, anaesthesia technique and postoperative care
An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital
(University of the Witwatersrand, Johannesburg, 2022) Gamede, Nomdumiso
Background Cancellation of elective surgery is one of the quality indicators of theatre operation worldwide. The cancellation of elective surgery in paediatric patients is a world-wide problem with the rates ranging from 0.21% to 44%. This study aimed to determine the rates and describe the reasons for cancellation of elective surgeries in paediatric patients at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A retrospective study was conducted using theatre records from 01 January to 31 December 2019. The numbers and reasons for elective paediatric surgeries were reviewed. Data was collected using structured collection sheet and entered into Microsoft excel. Statistical Package for Social Sciences was also used to further analyse the data. Results were expressed as percentages in table forms. Results In the year 2019, a total of 3399 elective paediatric procedures were scheduled in fourteen specialties at CHBAH. Of these, 634 (19%) were cancelled due to various reasons. The highest number of cases cancelled were from paediatric surgery and neonates (n=204, 31%), followed by ENT (n=99, 24%), burns (n=80, 20%) and paediatric orthopaedics (n=79, 16%). The lowest number of cancelled cases came from urology (n=3, 17%) and hands (n=3, 3%). The commonest reason for cancellation of elective surgery in paediatric patients at CHBAH was found to be time constraint (34%) followed by patients not arriving for surgery (16%). The reasons for cancellation in our study were mostly due to avoidable factors at 68% and non-avoidable at 32%. Conclusion The rate of cancellation in our study was high but comparable to other African and South African studies. Majority of the causes for cancellation were avoidable
Low dose propofol as an effective method in attenuating the cardiorespiratory response to extubation: single-blinded randomised placebo- controlled trial
(University of the Witwatersrand, Johannesburg, 2023) Wakabayashi, Koji
Background Extubation at the end of general anaesthesia should be performed in a way that ensures patient comfort and minimizes cardiorespiratory changes to prevent harm. Several drugs have been shown to attenuate these changes during emergence. The aim of our study was to investigate if a sub-hypnotic dose of propofol is able to produce such favourable peri- extubation conditions. Methods Fifty ASA grade I-II patients (aged 18-70) undergoing elective abdominal or pelvic surgery under general anaesthesia with a volatile agent were randomly assigned to a propofol group (P=28) or a control group (C=22). At the end of surgery, once the minimal alveolar concentration reached 0.6, patients received either propofol 0.5 mg kg-1 or an equivalent volume of isotonic saline intravenously. The primary outcome was the incidence and severity of bucking and coughing observed during emergence, with the assessment performed by a blinded anaesthetist. Haemodynamic parameters, airway responses, extubation complications and time to extubation were evaluated during the emergence period at predetermined intervals. Results The demographic and clinical characteristics of the two groups were comparable prior to surgery. Results indicated the incidence and severity of bucking at extubation was significantly lower (21.4%) in the propofol group compared to the control group (68.2%) (p<0.001). Similarly, patients in the propofol group had significantly fewer heart rate (p=0.031) and systolic blood pressure changes at extubation (p=0.031). Conclusion The addition of propofol 0.5 mg kg-1 prior to extubation successfully attenuated cardiorespiratory responses following general anaesthesia in ASA I-II adult patients undergoing elective abdominal or pelvic surgery, but did not reduce the overall incidence of cough at extubation

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