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A tale of two sites: an audit of central nervous system metastases in two Johannesburg tertiary centres
(2024) Molefe, Masechaba
Background: Literature reports the most common neoplasms of the CNS as metastases. Most studies are from the US and Europe with a paucity of data in the African setting. Objective: To provide information among patients with histologically confirmed CNS metastases treated at the neurosurgical units of the University of the Witwatersrand, namely at CHBAH and CMJAH. Methods: A retrospective record review of patients with histologically confirmed CNS metastases, presenting between 01 January 2015 and 31 December 2019 was conducted. The following data were collected and analysed: demographic, clinical, radiological and histopathological data. Results: 88 patients were included in the study. The frequencies of brain and spine metastases were 13% and 48% respectively compared to all other operated primary tumours. More females were prevalent at 51.7% in the brain metastases cohort, while males were more prevalent in the spine metastases cohort at 57.1%. In brain metastases patients the median age at presentation was 49 and for those with spine metastases the mean age was 47.1. The distribution for brain metastases was: 65% supratentorially; 20% infratentorially; 15% mixed. The distribution for spine metastases was: thoracic 32.1%; lumbosacral 28.5%; cervical 14.3%, mixed 25%. The most prevalent histopathologies for brain metastases were: lung 21.7%; breast 11.7%; melanoma 11.7%. The most prevalent histopathologies for spine metastases were lymphoma and plasma cell neoplasms each comprising 21.4%. Conclusion: More females presented with brain metastases and predominantly more males had spine metastases. There was a younger age of presentation compared to most studies conducted in Africa and globally
Admission hypothermia in very low birth weight newborns at Charlotte Maxeke Johannesburg Academic Hospital
(2024) Mauree, Angidi Pillay
Background: Hypothermia is associated with increased morbidity and mortality rates. Very low birth weight (VLBW) newborns are at an increased risk of hypothermia especially within the first few hours after delivery. Objectives: To determine the prevalence, associated risk factors, and outcomes of admission hypothermia in VLBW newborns, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a quaternary hospital in Johannesburg, South Africa. Methods: This was a retrospective descriptive study of all VLBW newborns born over a seven year period (from 1st January 2013 to 31st December 2019) at CMJAH. Comparisons between hypothermic and normothermic newborns as well as between moderately-to-severely hypothermic and mildly hypothermic newborns were done. Multivariate binary logistic regression with 95% confidence interval and a p-value of < 0.05 was used to identify variables which had a significant association. Results: Mean gestational age and birthweight of enrolled newborns was 28.9 ± 2.7 weeks and 1097 ± 250 g respectively. Prevalence of admission hypothermia was 61.5 % of which 54.3% was mild hypothermia, 43.9 % was moderate hypothermia and 1.8 % was severe hypothermia. VLBW newborns with hypothermia were more likely to have a birthweight < 1000 g [aOR 1.37 (1.12-1.68)] and less likely to be associated with early onset sepsis [aOR 0.51 (0.30-0.88)]. VLBW newborns with moderate to severe hypothermia were less likely than those with mild hypothermia to have received antenatal steroids [aOR 0.66 (0.48-0.89)]. There was no significant association of mortality in either VLBW newborns with hypothermia as compared to those with normothermia [aOR 0.95 (0.76-1.19), p value 0.67] or in VLBW newborns with moderate to severe hypothermia as compared to those with mild hypothermia [aOR 0.76 (0.46- 1.26), p value 0.29]. Conclusions: Prevalence of admission hypothermia in VLBW newborns is high and reinforces the need for thermoprotective measures in this population.
An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital
(2024) 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 a graph and 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.
An audit of clinically triaged women at low risk for breast cancer presenting to the Helen Joseph Mammography Unit, Johannesburg
(2024) Naidu, Lavandhra R.
BACKGROUND: The Helen Joseph Hospital (HJH) Breast Clinic utilises a clinical triage system to stratify patients based on their risk of breast cancer into high, medium, or low risk profiles. This allows for timeous imaging and subsequent management of those patients at increased risk for breast cancer. OBJECTIVES: The primary objective was to determine the cancer detection rate (CDR). The secondary objective was to correlate biopsy results with the Breast Imaging – Reporting and Data System (BI-RADS) risk-assessment. METHODS: A retrospective audit of the patients at low risk for breast cancer who were referred to the Breast Imaging Unit (BIU) in 2019 at HJH. Patients were clinically assessed as low risk based on a triage form (Figure 4) and were identified using the imaging files stored in the BIU. Results were recorded on Microsoft Excel and calculated as per the American College of Radiology guidelines. RESULTS: The total population sample consisted of 398 patients. Two patients were characterised as BI-RADS 4 and underwent breast biopsies. One patient was diagnosed with histologically proven breast cancer. The CDR was 2.51% and the most representative age group was the 60 to 69 years one. The most common BI-RADS breast density assessment was group B while the most common BI-RADS risk assessment was category 2. CONCLUSION: Amongst the low-risk population, both the CDR and spectrum of disease was comparable that of a screening population. This may be due to the use of a triage system prior to imaging, as well as an increase in clinical awareness of breast cancer within a tertiary institution.
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.
An audit of the practice of red packed cell transfusion in neonatal surgery in an academic hospital
(2024) Govender, Kushal
Background: Neonates undergoing surgery are at greater risk of requiring red packed cells transfusion. Pediatric transfusion practices vary widely between countries and institutions, especially in the management of neonates. Aims: The aim of this study was to describe the practice of intraoperative red packed cells transfusion primarily, and blood products and fluid transfusion secondarily in neonates presenting for surgery. Methods A retrospective contextual and descriptive study was conducted at Chris Hani Baragwanath Academic Hospital. A total of 1077 anesthetic records of neonates who underwent surgery from 1 January 2015 to 31 December 2019 were reviewed. Descriptive and inferential statistics were used to analyze the data. Results: Three hundred and twenty seven (30%) neonates received intraoperative red packed cells transfusion. The median (IQR) volume of red packed cells, fresh frozen plasma, platelets and clear fluid administered was 15 (10 - 21.8) ml/kg, 12.3 (10 - 23.5) ml/kg, 13.6 (10 - 20.5) ml/kg and 19 (9.1 - 28.8) ml/kg respectively. Very low weight, low preoperative hemoglobin, long total anesthetic time, emergency surgery and major surgery were independently associated with blood product transfusion. Post-conceptional age, low and very low weight, blood product transfusion and major surgery were independently associated with the composite adverse outcomes. 3 Conclusions: Intraoperative blood product transfusion occurred up to three times more frequently in our study than in comparative studies. Weight-based dosing of red packed cells, blood products and clear fluids were in keeping with current recommendations. Further prospective cohort studies are recommended to inform an institution specific patient blood management program.
Assessment of the management of inpatient hyperglycaemia by physicians and intensivists in South African hospitals
(2024) Hewson, Peter Llewellyn Blanshard
Background Hyperglycaemia is highly prevalent in patients admitted to hospital and is associated with prolonged hospital stay, increased costs, morbidity and mortality. As there is currently limited local data on the management of hyperglycaemia, this study aimed to investigate physician practices in the management of inpatient hyperglycaemia in South African hospitals Methods: A survey investigated the practices of 154 physicians in general medical wards and intensive care units (ICUs) in the state and private sectors. To validate these responses, an audit of 100 general medical and 111 ICU patient files was performed at three major Johannesburg academic hospitals. Patients with inpatient hyperglycaemia related to diabetes mellitus (DM) or hospital-associated factors were included, while patients admitted with diabetic emergencies were excluded. Results: In the general medical wards, oral hypoglycaemic agents (OHAs) were used in the majority of survey respondents (94.5%) and audited files (64%). In the ICU, OHAs were used by 34.9% of survey respondents and 14.4% of audited patient files. Of the OHAs, metformin use was most frequently reported (93.8% in the survey) and used (64% in the audit) agent in the general medical wards, followed by sulfonylureas (SUs) (75.8% in the survey and 5% in the audit). In the critical care setting, the survey demonstrated frequent use of metformin followed by dipeptidyl peptidase-4 inhibitors (DPP4-i), while the audit showed that metformin and SU use was 14.4% and 0.9% respectively. Surveyed clinicians in general medical wards report most frequently using the basal insulin plus sliding scale insulin (SSI) regimen (36.6%), while the audit showed that SSI alone (36%) or premix insulin-based regimens (34%) are used most often. In the critical care setting, more surveyed clinicians reported using an insulin infusion (34.9%) compared to other insulin regimens, while the audit demonstrated that the majority of patients (59.5%) were managed with SSI alone. Four-to-six hourly glycaemic monitoring was noted as the standard of care in both surveys and audits. While the majority of clinicians reported daily review of their glycaemic management (91.7% and 87.3% of participants in the general medical wards and ICU, respectively), the audit revealed that this was noted in just 34% and 3.6% of participants in the general medical wards and ICU, respectively. Conclusion: Both the survey and audit demonstrated significant discrepancies from current clinical guidelines. This highlights a significant impact on patient care, in particular, as OHAs have not been recommended for use in the ICU setting, one in every three critical care patients may be exposed to potential complications as a result of the use of such agents. The findings of this study suggest further investigations regarding inpatient hyperglycaemia practices as well as implementation of education and in-hospital protocols are needed in the South Africa healthcare context in order to improve clinical outcomes.
Clinical spectrum and outcomes of idiopathic inflammatory myopathies at Chris Hani Baragwanath Academic Hospital
(2024) Birch, Candice Tatum
Background: Idiopathic inflammatory myopathies (IIM) are rare diseases for which there is a paucity of data in Africa. We undertook a retrospective records review of clinical and laboratory features of patients with IIM attending a tertiary service in Gauteng, South Africa. Patients and methods: Case records of patients seen between January 1990 and December 2019 and fulfilling the Bohan and Peter criteria for IIM were reviewed for demographics, clinical features, special investigations and drug therapy. Results: Of 94 patients included in the study, 65 (69,1%) had dermatomyositis (DM) and 29 (30,9%) had polymyositis (PM). Overall, the mean (SD) age at presentation and disease duration were 41,5 (13,6) and 5,9 (6,2) years, respectively. 88 (93,6%) were Black Africans. The most common cutaneous features in DM patients were Gottron’s lesions (72,3%) and abnormal cuticular overgrowth (67,7%). Dysphagia was the most common extra-muscular feature (31,9%), more so in PM than DM (p=0,02). Creatine kinase, total leucocyte count and CRP were similarly higher in PM than DM patients (p=0,006, 0,002, 0,01, respectively). Anti-nuclear and anti-Jo-1 antibodies were positive in 62,2% and 20,4% of patients tested, respectively, the latter significantly more in PM than DM patients (OR=5.1, p=0,03) and more likely to be positive with ILD (p=0,001). Corticosteroids were prescribed in all patients, 89,4% had additional immunosuppressive drugs and 6,4% required intensive/high care. Malignancies occurred in three patients, all of whom had DM. There were seven known deaths. Conclusion: The present study provides further insights into the spectrum of clinical features of IIM, especially cutaneous features of DM, anti-Jo-1 antibodies and associated ILD, in a cohort of predominantly black African patients.
Comorbidities in a cohort of privately insured South Africans with systemic lupus erythematosus
(2024) Ntumba, Mbombo Henriette Ngandu
Background: Comorbidities in systemic lupus erythematosus (SLE) impact negatively health related quality of life and life expectancy. We undertook a retrospective study of the burden of comorbidities in privately insured South Africans with SLE. Methods: Data review of patients insured with Discovery Health Medical Scheme (DHMS), ≥16years at diagnosis, ≥6months follow-up and diagnosed with SLE based on ICD 10 codes. Demographics, drug therapy and comorbidities listed in the Charlson Comorbidity Index (CCI) and other comorbidities occurring commonly in SLE patients were documented. Results: Of 520 patients with SLE ICD 10 codes, only 207 met the other inclusion/exclusion criteria for data analysis. Most were women (90.8%), median (IQR) age and follow-up duration of 39 (30.3-53.0) and 6.1 (3.7-8.1) years, respectively. All patients had at least one comorbidity, the most frequent CCI comorbidities being pulmonary disease (30.9%), congestive heart failure (CHF) (15%) and renal disease (14.5%). Common CCI comorbidities were hypertension (53.1%), mood and anxiety disorders (46.9%), infections (urinary tract infections (UTI) (37.7%) and pneumonia (33.8%)). Independent predictors of 1) CHF were renal disease (OR=855), dyslipidaemia (OR=15.3) and male gender (OR=43.0); 2) hypertension were age at diagnosis (OR=1.03), type 2 diabetes (OR=4.45) and renal disease (OR=4.34); and 3) mood and anxiety disorders were female gender (OR=3.98), cerebrovascular accident (OR=3.18), UTI (OR=2.39) and chloroquine use (OR=1.94). Conclusion: Comorbidities in this cohort of privately insured South Africans with SLE were common, with all patients having at least one comorbidity. Hypertension, infections and mood and anxiety disorders were the leading comorbidities.
Compliance of medical practitioners with diabetic treatment guidelines at Dr Yusuf Dadoo Hospital, West Rand Health District Gauteng
(2024) Ohanson, N.J.
Background: Diabetes (DM) is a common chronic condition. The prevalence is increasing globally and has become a common health care problem associated with multiple complications. Guidelines have been formulated to standardise care among people living with DM, with aim of optimising patient care and thus minimising the complications. Aim: The aim of this study was to assess how well health care practitioners in Dr Yusuf Dadoo Hospital complied with the most recent diabetic treatment guideline, SEMDSA 2017. Setting: This study was conducted in the out-patient department of Dr Yusuf Dadoo hospital in the Westrand Health district of Gauteng. Methods: A retrospective cross-sectional review of patient record living with diabetes was done. Three hundred and twenty-three Record of patients seen from August 2019 to December 2019 were reviewed and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017. Results: Files were audited in 4 main categories. Comorbidities, Examinations. Investigations, presence of complications. In terms of monitoring parameters, only 40(12.4%) had HbA1c assessed 6monthly, with annual creatinine assessed in 179(55.4%) and lipogram 154(47.7%) of patients. More than 70% of patients had uncontrolled glycaemia. More than 70% of patients had uncontrolled glycaemia. The most frequently documented target organ screening/examinations were foot related at 8.7% (28) and all of them had established complications. Only 2 people were screened for erectile dysfunction. Conclusion: Adherence to DM treatment guidelines was found to be poor. Monitoring and control parameters were infrequently done as per guideline recommendation. The resultant effect are poor glycaemic control and therefore numerous complications. The study site and thus the West rand needs targeted strategies to improve medical practitioner adherence to guidelines including adequate interpretation of results, timely intervention, when necessary, as a way to improve DM care and thus minimise the risk of complications amongst patients in the district
Evaluation of medical interns’ knowledge and confidence in orthopaedic surgery at the University of the Witwatersrand's academic hospital complex in Johannesburg, South Africa
(2024) Terreblanche, Michael Harland
Background Junior doctors’ knowledge and confidence in the assessment and treatment of musculoskeletal disorders and injuries has previously been shown to be limited, both locally and internationally. This has far-reaching consequences, not least of which is sub-optimal patient care. The aim of this study was to evaluate the effectiveness of current undergraduate orthopaedic training in South Africa. Materials and methods Medical interns rotating through the orthopaedic departments of three academic hospitals in Johannesburg, South Africa were surveyed, using a validated questionnaire consisting of twenty-five questions, to assess their knowledge of orthopaedic surgery. Furthermore, they were asked to rate their self-perceived confidence levels relating to various aspects of the care of individuals with musculoskeletal problems using a 5-point Likert scale. The future career interest of the interns was also recorded. Results Seventy-eight completed questionnaires were included in this study for analysis. Ninety six percent (96%) of the medical interns in this study failed to achieve basic cognitive competency concerning knowledge of orthopaedic surgery. Three out of seventy-eight medical interns in this study achieved basic theoretical competency in orthopaedic surgery. The interns’ mean score in the 25-question examination was 40.7% (SD 13.4%) with a range of 17 – 69%. Ninety two percent (92.3%) of participants reported that they were either confident or highly confident in orthopaedic surgery. Future career choice had no influence on the knowledge of orthopaedic surgery. Conclusion The effectiveness of South African undergraduate training of orthopaedic surgery is deficient. Recent South African medical graduates’ knowledge of orthopaedic surgery is inadequate, with a mean score of 40.7% in the Freedman and Bernstein questionnaire, and only 3.8% of interns achieving theoretical competency. The graduates demonstrated inappropriate confidence in orthopaedic surgery with only 7.7% acknowledging a lack of confidence. Interns’ future career interest was not found to have a significant association with knowledge of orthopaedic surgery. This study suggests that, in South Africa, orthopaedic undergraduate training needs reform.
Evaluation of outcomes in patients with pancreatic cancer and Human Immunodeficiency Virus at Chris Hani Baragwanath Academic Hospital and the Donald Gordon Medical Centre, Johannesburg
(2024) Wing, Jessica Roberta
Background: Cancers which are not associated with Acquired Immune Deficiency Syndrome (AIDS) are increasing in incidence and mortality in the HIV-positive population. Pancreatic cancer (PC) is projected to be the second most common cause of cancer-related death by 2030. No literature exists on patients with PC and concomitant human immunodeficiency virus (HIV) infection in South Africa (SA), which has the highest number of HIV-positive people in the world. Objectives: To compare the demographics, stage, histological grade of disease, and survival outcomes of HIV-positive compared to HIV-negative patients diagnosed with PC. Methods: Records of patients diagnosed with PC were collected from Chris Hani Baragwanath Academic Hospital (CHBAH) and the Wits Donald Gordon Medical Centre (DGMC) from the 1 st of January 2013 to the 31st of December 2018. A total of 240 patients’ records were obtained. Demographic, clinical, and survival data were collected. Results: There were predominantly black Africans (64.6%) and males (54.6%) in the study. Although overall survival between the HIV-positive and negative patients did not differ (p=0.051), the median time of survival from presentation was significantly shorter in the HIV-positive compared to the HIV-negative patients (2.1 months; IQR 1.2-6.0 vs. 4.7 months; IQR 1.6-13.0; p=0.017). The HIV-positive cohort presented at a significantly younger age compared to the negative cohort (54.6; ±9.6 vs 62.4; ±11.1; p=0.0001) and at a more advanced stage of disease (72.2% vs. 43.1%; p=0.017). No difference was found between the histological grade of PC in both cohorts (p=0.298). The median survival time for HIV-positive patients on therapy at presentation was significantly longer compared to patients who were not (3.0; IQR 1.3-7.8 vs 1.1 months; IQR 0.9-1.9; p=0.037). Overall survival in patients who underwent pancreaticoduodenectomy at Wits DGMC was shown to be higher compared CHBAH V (41.7% vs. 12.5%; p=0.049). The majority of the patients presented with regionally advanced (30.6%) and metastatic (50.3%) disease. Conclusion: This is the first study in SA to provide insight into the clinical disease profile and survival outcomes of HIV-positive patients diagnosed with PC. This study has shown that HIV-infected patients with PC have a specific disease profile. Therefore, testing for HIV infection should be included in the management of all patients with PC, a higher index of suspicion for cancer should be maintained in younger HIV-positive patients and initiation of Antiretroviral treatment (ART) must be timeous.
Obese patients reported dissatisfaction with weight, body image and interaction with clinicians at Dr Yusuf Dadoo District Hospital
(2024) Kanozire, Buhendwa
Background: Obesity in South Africa has created a public health crisis that warrants a multilevel intervention. Patients’ perceptions and clinicians’ challenges hinder the management of obesity in primary care. Aim: The study aimed to assess obese patients’ dissatisfaction with weight and body image and their perspectives on interaction with clinicians in a primary care setting. Setting: Dr Yusuf Dadoo District Hospital, outpatient department. Method: Cross-sectional study of 213 adult obese patients. A semi-structured questionnaire, a body image assessment tool and patient medical records were used for data collection. Results: The study found that, contrary to popular belief, obese patients were dissatisfied with their weight (78.9%) and body image (95.3%). Many felt comfortable discussing weight reduction with clinicians, although 37.1% reported never engaging with a doctor, and 62.9% never interacted with a nurse on the subject. Only six percent reported receiving adequate information on weight reduction measures, and 19.7% were followed-up. Clinicians’ advice was mainly associated with patients’ high BMI and waist circumference. Doctors were less likely to recommend weight reduction to employed obese women, while nurses were more likely to engage Zulu-speaking patients. Patients were more likely to be followed up if there were young and excessively obese. Conclusion: The study found that most obese patients were dissatisfied with their weight and body image and perceived their interaction with clinicians inadequate Contribution: The study highlights a possible shift in obese patients’ weight and body image perception compared to previous reports. It also brings to light clinicians’ deficiencies that warrant further education on obesity management.
Obstetric trauma admissions in a level 1 trauma centre in South Africa: a 5-year retrospective review
(2024) Moyo, Njaya Bruce
Background: Trauma is one of the leading causes of morbidity and mortality in pregnancy and remains the most common cause of fetal mortality worldwide. The severity of injury as well as early and aggressive management of injuries are significant factors that determine maternal and fetal outcomes. Objectives: The aim of this study was to describe the characteristics, mechanisms of injury, clinical interventions performed as well as maternal and fetal outcomes of obstetric trauma admissions to our institution. Methods: This was a retrospective review of data of all pregnant patients admitted to Chris Hani Baragwanath Academic Hospital from 01 January 2015 to 31 December 2019 with trauma. Patients were identified from admission registries from the departments of obstetrics and gynaecology, emergency medicine, general surgery, orthopaedics and intensive care. Data collected included demographic data, mechanisms of injury, clinical interventions, as well as maternal and fetal outcomes. Results: Data of 800 patients was included in the study during the five-year period. The median age and gestational ages were 31.00 years and 26.00 weeks respectively. The majority of pregnant trauma patients self-identified as black Africans (n= 713; 89.1%). Five hundred and sixty-two patients were of single marital status (70.3%) and 484 identified as unemployed (60.5%). Assaults were the most frequent cause of trauma (n= 330; 41.3%), followed by falls (n= 265; 33.1%) and motor vehicle accidents (n= 204; 25.5%). Hundred and forty-one patients (18.0%) were documented to have consumed alcohol on the day of the injury. Four patients (0.5%) were admitted to ICU, of these one died in ICU. Ten fetal deaths were recorded, of these three were delivered by patients admitted to ICU. Eleven neonates were delivered before 37 weeks. Conclusion: Trauma in pregnancy is associated with significant morbidity and negative pregnancy outcomes. We identified unemployed pregnant patients of single marital status as being at increased risk of obstetric trauma. Assaults followed by falls and motor vehicle accidents were the commonest causes of maternal trauma in our population. The implementation of strategies aimed at detecting and preventing intimate partner violence as well as road safety may contribute significantly to a reduction of maternal and fetal mortality
Pattern of thyroid disorders in black population referred for thyroid scintigraphy at Chris Hani Baragwanath Hospital, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Zergoug, Nadia
Background: Most endocrine disorders are due to thyroid dysfunction with varying etiologies. Different management protocols exist for the different endocrine disorders, and it is crucial to determine the specific cause due to thyroid dysfunction. This study aimed to describe the spectrum of thyroid diseases in patients who undergo thyroid scintigraphy and to assess the agreement with biochemistry and scintigraphy. Methods: This was a retrospective study to assess the pattern of thyroid disorders in the patients referred for thyroid scintigraphy at Chris Hani Baragwanath Hospital (CHBAH). All cases diagnosed with thyroid dysfunction based on biochemical results and referred for 99m Tc scintigraphy to nuclear medicine from January 2017 to December 2018 were reviewed. All records reviewed were >18 years of age and were a total of 780. Result s Of the 780 patients reviewed, 631 (80.9%) were black while the remaining 19.1% comprises White, Indian, and Coloured individuals. Among the Blacks, 84% were females and 16% were males. Graves’ disease was the commonest thyroid disease diagnosed on scintigraphy in the entire population and among the blacks, constituting 72% (n=454/631) of patients. Other thyroid disorders among the black population include toxic multinodular goitre (13%, n=80/631), non-toxic multinodular goitre (7%, n=45/631), toxic adenoma (3%, n=17/631), and thyroiditis (3%, n=21/631). The black patients’ mean age was 47.3 years with a standard deviation (SD) of ±15.1 years. Graves’ disease as well as other thyroid disorders affected all age groups but were most prominent in the 40-59 years age group in both females and males. The median thyroid stimulating hormone (TSH) was 0.001 mIU/L while free thyroxine (fT4) ranged from 7.4 – 160 pmol/L in black population diagnosed with hyperthyroidism. Conclusion: Graves’ disease is the commonest cause of thyroid disorders among individuals referred for thyroid scintigraphy, being most prevalent in Black females in the reproductive age group. Thyroid scintigraphy is useful for aetiological diagnosis in patients presenting with thyroid disorders.
Perinatal outcome of all maternal deaths at Chris Hani Baragwanath Academic Hospital from January 2014 to June 2019
(2024) Afolayan, Nomshado Sthembile
Background: Maternal death is a tragic event. Out of the total number of maternal deaths, 99% occur in lowand middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on the fetal and neonatal outcome in the short and long term. Objectives: To determine the perinatal outcomes of pregnancies that end in a maternal death at CHBAH over a 5-year period, to describe the causes of maternal death and to determine the stillbirth rate and early neonatal death rate within this population. Methods A retrospective cross-sectional study of the maternal deaths in women with a viable pregnancy from January 2014 till June 2019 at CHBAH. All maternal deaths with gestation > 26 weeks or neonatal weight >500g were included in the study. Data was extracted from maternal and neonatal files. The following information was retrieved; demographics, booking status, antenatal care, pregnancy outcome, fetal and neonatal outcome. The data was analyzed using STATA. Approval from the University of Witwatersrand Human Research Ethics Committee (Protocol number: M1911143) and the CEO was obtained. Results: There was a total of 184 maternal deaths during the study period and 147 were included in this study. The iMMR was 135 deaths per 100 000 live births. Hypertension was the highest direct cause of death at 37% (27/74) followed by pregnancy related sepsis 27.4% (20/74) and then obstetric hemorrhage 20.6% (15/74). Non-pregnancy related infections (NPRI) made up 52.1% (38/73) of indirect causes, with HIV and HIV-related complications contributing 84.2% of the NPRI causes, followed by the medical and surgical disorders respectively. One hundred and thirty-seven neonates were delivered and 14 were undelivered at the time of maternal death. There were also two set of twins and one set of triplets. Ninety-one (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 live births 6 (6.5%) had an early neonatal death. Of the 51 stillbirths, 14 (27.5%) were from undelivered maternal deaths and 11 (21.1%) were from perimortem caesarian sections. The SBR was 347 per 1000 total maternal deaths and an ENND rate was 66 per 1000 live births. The PNMR was high at 388 per 1000 maternal deaths which is12 times higher than the general population. Conclusion: Maternal deaths are associated with very poor perinatal outcomes, resulting in unacceptably high stillbirth rate, early neonatal death rate and perinatal mortality rate. The health of the mother has a significant impact on the perinatal outcomes of the pregnant woman. Most of the causes of death were mostly women with comorbidities , we therefore postulate that prenatal care and stringent antenatal care may assist in optimizing women and thus reducing maternal deaths and ultimately the perinatal outcomes.
Prevalence and correlates of common mental disorders in persons living with HIV in public primary care facilities in Ekurhuleni District
(2024) Edet, Aniekan
Background The prevalence of common mental disorders (CMDs) in people living with human immunodeficiency virus (PLHIV) is estimated to be more than in the general population. These CMDs are associated with poor HIV treatment outcomes. Therefore, guidelines recommend that healthcare workers screen for CMDs in PLHIV. The CMD prevalence in PLHIV in Ekurhuleni District was not previously found. Aims To determine the prevalence and correlates of CMDs in PLHIV in primary healthcare facilities in Ekurhuleni District. Setting A cross-sectional study conducted across seven primary health facilities in the eastern sub-district of Ekurhuleni District. Methods Data was collected from 403 randomly selected participants, using a questionnaire incorporating the scores of the PHQ-9, GAD-7 and substance use disorder (SUD) criteria of DSM 5. The proportion screening positive for CMDs was calculated. Univariate and multivariate analysis was done using ’R’ statistical software. A 95% confidence interval was adopted. Results Of the 403 participants studied, 63% were female, and the mean age was 43±11 years. Forty percent of participants screened positive for CMDs, 16.6% for depression, 15.1% for generalised anxiety disorder (GAD) and 24.1% for SUD. CMDs were associated with poor adherence and unsuppressed viral load, while being female and increasing age were associated with reduced risk of CMDs. Also, males were 11 times more likely to have severe SUD. Healthcare workers in the facilities screened only 16%, 14% and 40% of the cohort for depression, GAD and SUDs, respectively.
Review of factors associated with prolonged hospital stay in very low birth weight infants at a teriary hospital in South Africa
(2024) Thambe, Amelia N.
Background: Many factors have been shown to influence the duration of hospital stay, namely gestational age, birth weight and neonatal morbidities. In middle-income countries with limited resources such as South Africa, understanding factors associated with PHS will assist in resource planning, policy amendments and highlight areas for quality improvement projects. Objectives: Our objectives were to determine the prevalence of PHS in VLBW infants and maternal, postnatal and neonatal factors associated with PHS and compare the characteristics of neonates with and without PHS. Methods: This was a retrospective observational study. The population included all neonates with a 500 to 1500-gram birth weight, born at Charlotte Maxeke Johannesburg Academic hospital (CMJAH) in Johannesburg, South Africa, between 1 January 2013 and 31 December 2017. Pre-hospitalisation maternal and neonatal factors and complications were analysed. Maternal and neonatal characteristics of infants with PHS were compared to those without, defined by a hospital stay of 60 days or more. Results: The survival rate in this study was 87.3%, and the prevalence of PHS was 11,8%. The mean birth weight was 993 grams (SD 186.144), and the average gestational age was 28.27 weeks (SD2.179). Lower birth weight and gestational age were associated with PHS. NOS (odds ratio 2.329; 95% Confidence interval 0.3 – 3.1), BPD (odds ratio: 4.9; 95% Confidence interval 1.93 – 5.424) and PDA (odds ratio: 2.702; 95% Confidence interval:0.33 – 5.424) a were associated with PHS. Discussion: This study showed that 11.8 % of VLBW preterm infants at CMJAH have PHS. Prematurity is an independent risk factor for PHS. Complications associated with the latter, such as NOS, BPD, PDA and lower gestational age, prolongs the hospital stay further. However, an association between PHS with PDA was unique to our current study. Conclusion: It is critically important to modify risk factors and morbidities associated with PHS.Prevention of BPD and PDA are required to reduce PHS in our setting. This will ultimately maximize the resource and reduce financial burden in our hospitals.
Support programme for healthcare professionals involved in adverse events in public hospitals in Gauteng
(2024) Nkosi, Elizabeth Malefu
Background: Adverse events in the healthcare services result not only in administrative and financial costs to the healthcare institution, but also in personal costs to the patients and their families, who are often angry, disappointed, and sad. In the current litigious healthcare climate, relatives, supported by legal advisors, often seek redress as a way of managing their distress. Thus, patients are not the only victims of adverse events. The healthcare professionals that are directly involved often shoulder the blame, sometimes fairly, and sometimes unfairly, while they too need psychological support. A culture of blame in institutions can lead to healthcare professionals involved in an adverse event being marginalised, feeling personally responsible for the event and that they have failed the patient, and they are left to suffer in silence. While anecdotal evidence exists that such stress may lead to negative coping mechanisms, the researcher has not identified any research study conducted in public hospitals in Gauteng, South Africa that identifies and describes the influence that the involvement in an adverse event has on healthcare professionals. Such evidence is required to develop a support programme that could assist healthcare professionals who have been directly involved in adverse events, to minimise the concomitant stress, and to enable these professionals to continue to provide quality care after such an event. Aim: The purpose of this study was to develop, describe, and evaluate the implementation of a support programme for healthcare professionals involved in adverse events in public hospitals. Methodology: A sequential, multimethod research design was used. The study was conducted in five phases. Phase 1 consisted of a scoping review of the international literature that focused on the experiences of the nurses and doctors. The question asked in the scoping review was: What is known from existing literature about the support programmes for healthcare professionals involved in adverse events in clinical settings, and are they effective? Phase 2 involved storytelling that explored the impact of adverse events on involved healthcare professionals. Smith and Liehr’s (2005) methodology was used, that is, healthcare professionals who were directly involved in or affected by one or more adverse events in the public hospitals in Gauteng narrated their experiences. Phase 3 used semi-structured interviews with the managers to explore how best to support health professionals involved in adverse events. Phase 4 involved developing a support programme according to the Wits Trauma Model developed by Eagle, Friedman and Shumkler, from the Psychology Department of the University of the Witwatersrand, in 1993 (Eagle, 2000). Phase 5 focused on confirming and validating the programme to support healthcare professionals involved in adverse events in public hospitals. This phase was subdivided into two sections: Phase 5.1 comprised the Delphi group; and Phase 5.2 comprised the Focus group. In the first round involving the Delphi group, technical data was collected from the experts who validated the programme by means of the survey that was distributed on Research Electronic Data Capture. Concerns arising out of the first round with the Delphi group and that required attention were addressed during the Focus group discussion. Results: Hospitals were not aware of the magnitude of second victimhood and hence the delay in reviewing the structures in place to provide support to those involved. Just (fair) culture principles were not adhered to as there were no guidelines for their implementation, hence the second victims were left traumatised and in isolation following their involvement in adverse events, and they experienced blaming by management instead of being provided with much needed support. Limitations: The limitations to the study include the small sample size during the data collection phases, due to the Coronavirus disease of 2019 pandemic. Due to the restrictions that were implemented it was not possible to contact all the staff as they had been relocated to other healthcare facilities, were absent, or had resigned. Those who were snowballed were no longer at the facilities where they were originally identified, and therefore the researcher was unable to capture their experiences. Objectivity was not maintained as the documents for the Delphi group were hand-delivered, participants were able to identify the researcher, and hence the social desirability concern. The face-to-face encounters made adherence to anonymity impossible. The model components were not practical in terms of the developed programme. Round two of the Delphi group could not be scheduled, thus challenging the study model. Conclusion: The impact of adverse events on healthcare professionals remains an underestimated health concern. Experiences are magnified by unsupportive work environments, and are evident in increased hostility, blaming, fear of punishment, and reputational harm. The second victims require support to enable them to recover and learn from their involvement. The programme was developed, which included the summarised structure and the detailed process for implementation by hospital management on how to manage the adverse events in public hospitals in Gauteng.
The occurrence of hyponatraemia amongst patients with severe mental illness admitted at Solomon Stix Morewa Memorial Hospital, Johannesburg
(2024) Nhiwatiwa, Natsai Marjory Sekai
Background: Morbidity in patients with severe mental illness is known to be higher than in the general population. Numerous factors contribute to this, including the propensity to have comorbid conditions and the effects of long-term treatment with psychotropics. Hyponatraemia is the most common electrolyte abnormality found in hospitalised patients. Patients with severe mental illness are vulnerable to the development of hyponatraemia due to psychogenic polydipsia, comorbid conditions and the long-term use of psychotropics. Aim: To evaluate the occurrence of hyponatraemia in patients with severe mental illness that are admitted at Solomon Stix Morewa Memorial Hospital and to determine the associations between the hyponatraemia and the patients’ demographic and clinical variables. Objectives: To assess and quantify the occurrence of hyponatraemia in patients with severe mental illness. To establish the cases, grades of severity and the trends of hyponatraemia in the study sample. To make possible associations between the development of hyponatraemia and the various clinical profiles. To analyse the trends of sodium testing in the study participants. Results: 32% of the patients had hyponatraemia on admission to Solomon Stix Morewa Memorial Hospital, significantly higher than that of the general population. Female patients and patients on antihypertensive medications were more likely to have hyponatraemia. Other medical conditions such as hypertension, type 2 diabetes mellitus and chronic obstructive pulmonary disease were significant predictors for the development of hyponatraemia. Patients on combination antipsychotics (first- and second-generation antipsychotics) were also more likely to develop hyponatraemia than those not on combination antipsychotics. Conclusion: Hyponatraemia was found in a significant proportion of the study participants. Patients with severe mental illness are more likely to have co-morbid illnesses that can be overlooked. The comorbid illnesses render the patients more likely to develop complications such as hyponatraemia that worsens their outcomes and mortality. More research is required to establish the role of combination antipsychotics as a possible cause of the development of hyponatraemia in psychiatric patients. Definitive monitoring guidelines are required in the long-term management of patients with severe mental illness. More recognition of hyponatraemia as a significant adverse effect of comorbid illness, psychiatric illness and chronic medication is required in patients with severe mental illness.

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