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The effect of early childhood growth trajectories on nutritional status and body composition at 2 years of age
(2024) Masiakwala, Elizabeth
Background Paediatric obesity is rising globally, and the prevalence is rising faster in lowmiddle income countries (LMIC) than other regions. Early life growth patterns play critical role in shaping risks of chronic diseases later in life. However, the association between early childhood growth and adult disease risk may be mediated by body composition. However, there are few studies assessing the relationship between growth patterns and body composition during early childhood. The assessment of body composition early in infancy affords discernment into the fat mass and lean mass distribution; important factors for subsequent metabolic diseases. There is limited data on early childhood body composition in LMIC settings undergoing transition. Aims Therefore, the aims of this dissertation were to; (i) describe fat mass and fat-free soft tissue mass by air displacement plethysmography at birth, 1, 2, 3, 4 and 6 months, (ii) describe fat mass and fat-free soft tissue mass using deuterium dilution technique at 3, 6, 9, 12, 18 and 24 months; and to (iii) assess the association between childhood growth from birth to 24 months and fat mass and fat-free mass at 24 months in a cohort of South African urban infants. Methods The data for this dissertation was a secondary analysis of data drawn from the International Atomic Energy Agency Multicentre Body Composition Reference Study on singleton infants born in Soweto, South Africa between 2014 and 2019. The anthropometric measurements weight and length, skinfold thicknesses, and arm circumferences were collected at each visit. Fat mass (FM) (kg), fat free mass (FFM) (kg), Fat mass index (FMI), fat free mass index (FFMI), and percentage fat mass (%FM) were measured using Air displacement plethysmography (ADP) and isotope dilution method (Deuterium Oxide) from birth to 24 months. The birthweights were classified as: Small-for-gestational age (SGA) (below 10th percentile), appropriate-for-gestational age (AGA) (between 10th and 90th percentile) and iv large-for-gestational age (LGA) (above 90th percentile) using Intergrowth-21st growth standards. Age and sex adjusted height-for-age (HAZ), weight-for-age (WAZ) and weight-forheight (WHZ) z-scores were generated using the 2009 WHO child growth references (0 – 5 years) to assess nutritional status from birth to 2 years. The analyses of variance were used to assess differences in body composition between categories of birth weight. T-tests were used to assess differences in anthropometric measurements and body composition between sexes and levels of nutritional status. The multiple linear regression analyses were used to estimate the association between conditional growth 0-6months and 6-24months and body composition at 24 months. Results Boys had significantly higher weight at all ages, and were taller up to 15 months of age. Girls had higher FM at birth p<0.001) and 1 month (p<0.001) of age. There were no differences in FFM, FMI, and FFMI between sexes at all time points. SGA and AGA both had significantly higher %FM than LGA at 12 months. LGA had higher FM at 24 months. Children with stunting had significantly lower FM and FFM at 12 and 24 months. At 6 months, FFMI was significantly higher in children with stunting. Conditional relative weight 6-24 months had a stronger association with FM and FMI than conditional relative weight 0-6 months and birth weight. Conditional length in both 0-6 and 6-24 months was significantly associated with FM and FMI in females Conclusion The assessment of growth pattern and body composition early in infancy may prove valuable in understanding factors associated with prevalence of childhood obesity. Rapid weight gain beyond 6 months of age had a stronger associated with toddler body fat. SGA and LGA are disadvantaged extremes in infancy, likely to increase the risk for obesity.
The ethico-legal position of state-funded healthcare for foreign nationals in South Africa
(2024) Bekebu, Babalwa Zintle
As South Africa ages into its democracy, the exclusion of foreign nationals (particularly those from other African countries) from state-funded services, such as healthcare, has become a key concern. Foreign nationals face significant barriers to state-funded or public healthcare access, including xenophobic behaviours and treatment from healthcare providers and provincial directives recommending up-front payment in contradiction to National Department of Health directives. Thus, limiting their access to public healthcare as most are charged exorbitant fees, mistreated, and fear deportation. Above all, the public healthcare crisis in the country remains a key reason for the exclusion of foreigners from accessing state-funded healthcare. Policies and legislature regarding foreign nationals' access to state-funded healthcare exist, but there is a lack of implementation at the ground level. Furthermore, existing accounts in literature fail to account for the ethical need and obligation that the State has in providing state-funded healthcare to foreign nationals. In this dissertation, I argue that the State has an ethical and legal obligation to provide statefunded healthcare to foreign nationals despite the South African public healthcare crisis. The objectives are to defend the claim that the exclusion of foreign nationals from state-funded 2 healthcare would be in contradiction of the African Communitarian ethic of Ubuntu; it would be unlawful and inherently unjust. I also support their entitlement to socio-economic rights, particularly the right to access state-funded healthcare, on the basis that foreign nationals make valuable socio-economic contributions to the country, therefore, should not be excluded from state-funded healthcare services. This study is mostly analytically normative, involving a review of existing literature, drawing on ethical principles and the legislature to defend a thesis regarding why the State has an ethicolegal obligation to provide state-funded healthcare to foreign nationals. The analytical review showed that healthcare is not only a political or economic issue but a medical ethics issue. Consideration of ethical theories such as Utilitarianism, Kantian Ethics, African Communitarian ethic of Ubuntu, and Principlism show that even in a public healthcare crisis in South Africa, the exclusion of foreign nationals is not ethically justified. It is not in the interest of the common good and undermines human rights. According to the Constitution and existing South African legislature, it is also unlawful and inherently unjust. Thus, even in the most extreme state of the public healthcare system, the State still has an ethical and legal obligation to fulfil to all people in the land as per the South African Constitution of 1996. One life's value compared to another remains equal, and citizenship ought not to be a discriminating factor.
The factors contributing to delayed discharge of patients with suspected non-accidental injury in a quaternary paediatric orthopaedic ward
(2024) Simmons, Dina Yaeli
Introduction Child abuse is a critically important discussion within any society and poses challenges in the social, legal and medical systems. The international literature is rich with descriptions of patient and family based risk factors and suspicious injuries. Based on these descriptions, we have created a protocol for the identification and investigation of children with suspected non-accidental injuries. The paediatric orthopaedic ward is faced with many children being delayed in the ward once fit for discharge due to delays in investigations or regulatory body assessments of these cases. This study aimed to quantify those delayed discharges and describe the demographics and risk factors for abuse we see within the local population. Methodology After obtaining ethics clearance and hospital approval, the study was conducted as a retrospective review of records from the Teddy Bear Clinic, as well as admission records of the children. The study examined the demographic characteristics of the children, their family background, injury characteristics and referral to Child Welfare. The delay of discharge from hospital was quantified for each child in days and was then compared to the initial characteristics of each child. Results Records were collected from 1 January 2015 to 31 December 2020. Seventy-nine complete records were included in the review. There were 40 male and 39 female patients with an average age of 20 months. Sixty children (75.9%) were under the age of 36 months. Of the 35 (44.3%) foreign nationals, 31 were undocumented. Seventy-three (94.1%) of the cases sustained lower limb fractures of which 51 were femur fractures. Fifty-two of the cases showed a delayed discharge of the child. The delay ranged from 1 to 233 days. Examining patient characteristics showed an association between an age less than 36 months and delayed discharge. There were no significant correlations between caregiver characteristics and delayed discharge. The admission progress revealed that the later the day of completion of investigations, the more likely there was to be a discharge delay. There was also a statistically significant correlation between referral to Child Welfare and delayed discharge. Discussion The majority of the patients referred for investigation were below the age of 36 months which agrees with the literature that this is the highest risk group. We could not identify any specific caregiver characteristics which were risk factors for suspicion. Delayed discharge of patients was associated with age less than 36 months, upper limb fractures and referral to Child Welfare. Despite the delayed discharge, most children were returned to the same home environments and in two described cases they were placed back into a high risk situation. Conclusion This review investigated the demographics of the children in the paediatric orthopaedic ward with a suspected non-accidental injury. The study also highlighted the challenges of inadequate support from regulatory social services when trying to assist these children.
The frequency of HIV in patients with newly diagnosed Bell’s palsy at a tertiary centre
(2024) Visagi, Jan Christoffel
Background: Bell’s palsy is the most common disease affecting the facial nerve and presents with unilateral lower motor neuron (LMN) facial weakness. An immunologicallymediated pathophysiological process is suspected, with a viral pathogen being one of the possible precipitating factors. The exact cause is however still unknown, with numerous associated diseases that have been described, one of which is HIV, with facial palsy being the most common cranial neuropathy in HIV. Aims: To describe the sociodemographic characteristics and frequency of HIV in patients with newly diagnosed Bell’s palsy. Furthermore, to determine the mean CD4 and viral load of the HIV positive subgroup. Methods: This retrospective-prospective observational and descriptive study evaluated 58 adult patients (18 years and older) that presented with atraumatic LMN facial weakness (Bell’s palsy) between January 2019 and November 2021 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Academic Hospital (CHBAH) and Helen Joseph Hospital (HJH). Data was obtained from patients’ files and prospective patient interviews and annotated on data capturing sheets. It included demographic information, date of diagnosis of Bell’s and side of the face involved, as well as the HIV status and the CD4/Viral Load (VL) for all HIV positive patients. Furthermore, the HbA1c, TPHA/RPR and ANA tests were also obtained. Descriptive statistics were used to determine the frequency of HIV. For continuous variables (CD4/VL), the mean and standard deviation were determined for normally distributed data, whereas the median and interquartile range were determined for data not normally distributed. This was subsequently presented in a tabulated format. Results: Of the 58 patients included, the mean age was 42.2 years with an equal number of males and females. More than half (55.2%) of the patients had right sided weakness (p = vii 0.025), with only one patient that had bifacial weakness. The HIV frequency was 34.5% (20/58) of which 11/20 (55%) were known HIV positive prior to Bell’s diagnosis, and 9/20 (45%) were newly diagnosed HIV at the time of Bell’s diagnosis. Known HIV positive patients were more likely to present with right sided weakness (10/11; 90.9%). The mean CD4 count at Bell’s diagnosis did not show a statistically significant difference (p = 0.553) between the known HIV and newly diagnosed HIV group, namely 335 cells/µL for the former, and 243 cells/µL for the latter group. Among the HIV negative and newly diagnosed HIV positive patients, diabetes mellitus was the most common other associated co-morbidity. Conclusions: In this cohort of patients in whom LMN facial weakness (Bell’s palsy) was the presentation in all the patients, an HIV frequency of 34.5% was found. It can be the presenting problem in HIV or occur in the later stages of the disease. Right sided weakness was significantly more common in patients previously diagnosed with HIV and the mean CD4 count was > 200 cells/µL at presentation with Bell’s in both HIV positive subgroups. Diabetes mellitus is a co-morbidity commonly associated with Bell’s in HIV negative patients
The HPCSA must provide clearer guidelines on social media marketing for South African health professionals
(2024) Hopkins, Neil
There is a longstanding debate around the ethics and legality of advertising for health professionals. Recently advertising has seen a transition from traditional marketing towards social media marketing. Unfortunately, inappropriate social media marketing can result in exploitation, which is why guidelines are necessary to protect consumers from deceptive content. The Health Professions Council of South Africa (HPCSA) has published a set of ethical guidelines on social media. However, this report highlights that there is limited information in the guidelines pertaining to social media marketing. There is also no reference to South African legislation that should be considered when using social media marketing. The purpose of this report is to emphasise that the HPCSA has an ethical and legal obligation to create clearer social media marketing guidelines for South African health professionals. This report proposes that the HPCSA must update their social media guidelines to make them clearer and to provide more information on social media marketing
The impact of the COVID-19 pandemic on orthopaedic trauma admissions in a central academic hospital in Johannesburg
(2024) Foster, Matthew
Background: The Novel Coronavirus (SARS-CoV-2), commonly known as COVID-19, has caused a global economic and healthcare crisis. In response, many countries tried to curb the spread of the virus with the introduction of various lockdown alert levels to restrict transmission and prepare health care systems for an increase in COVID-19 admissions. The Republic of South Africa (RSA) implemented an alcohol ban as one of the lockdown restrictions. Objectives: To describe the effect of the lockdown alert levels and alcohol availability on orthopaedic trauma admissions, compared to the preceding two years. Patients and methods: A retrospective review of clinical records was conducted. The data collected included orthopaedic trauma admissions for the six-month time-period in a quaternary facility in Johannesburg from 01 March to 31 August in the years: 2018, 2019 and 2020, respectively. Lock down alert levels were categorised according to the Department of Health which included the ban, re-introduction and re-banning of alcohol consumption. Data collected for 2018, 2019 and 2020 included demographics of sex and age, as well as fracture location, open or closed injuries, polytrauma patients and those who suffered gun-shot wounds. Results: Overall, 785, 718 and 556 patients were admitted in 2018, 2019 and 2020, respectively. There was a significant decrease of 22.56% of orthopaedic trauma admissions during the five-month lockdown time-period in 2020 compared to 2019 (p-value = 0.01) and 29.17% from 2020 compared to 2018 ( p-value = 0.011). In 2020, admissions increased by 112% (n = 82) from alert level 4, when alcohol was banned, to alert level 3 (3a), when alcohol was reintroduced. Admissions decreased by 32.9% (n = 51) from alert level 3 (3a) to alert level 3 (3b), when alcohol was re-banned. Patients were 1.27 times more likely to be admitted in alert level 3 (3a) than alert level 3 (3b) (95% CI: 0.99, 1.65). Motor vehicle accidents (MVAs) were the commonest cause of admissions in alert level 3 (3a), accounting for 40.6% (n = 56) whereas in alert level 3 (3b), MVAs decreased to 12.4% (n = 12). COVID-19 tests were positive in 10.18% (n = 34) of the 346 tests performed on orthopaedic trauma admissions. 3 Conclusion: Our study showed the decrease in orthopaedic trauma admissions due to the COVID-19 lockdown regulations. Furthermore, our study demonstrated the impact of alcohol availability on orthopaedic trauma admissions in a central academic hospital in Johannesburg.
The prevalence of basal cell carcinoma and squamous cell carcinoma at the Helen Joseph Hospital
(2024) Mosojane, Karen Itumeleng
Background Basal cell carcinoma and squamous cell carcinoma account for the majority of nonmelanoma skin cancers. Although the diagnosis has a relatively low mortality in comparison to other malignancies, the patients incur significant morbidity and there is an immense financial burden on health care systems. Objectives To study the prevalence, demographic and histologic pattern of patients with basal cell carcinoma and squamous cell carcinoma at the Helen Joseph Hospital. Methods This was a retrospective study of adults who had histologically confirmed basal cell carcinoma and squamous cell carcinoma at Helen Joseph Hospital, Dermatology department for the duration of 1st June 2014 to 30th June 2019. Results Basal cell carcinoma A total of 394 patients were included. The prevalence was 1.4% with a mean age of 69.4 years (standard deviation of 11.5). Males were 209 (53.0%) and 137 (34.8%) were female, gender was not documented in 48 (12.2%). The male to female ratio was 1.5:1. HIV negative patients were 62 (15.7%) and 5 (1.3%) were HIV positive. Actinic keratosis was a risk factor for all the patients. A total of 393 (99.7%) patients were of Fitzpatrick’s skin phototype I or II, 1 (0.3%) patient had oculocutaneous albinism and 4 (1.0%) patients were smokers. A previous diagnosis of skin cancer was observed in 87 (22.1%) patients. The histologic subtypes that were diagnosed included nodular (69, 17.5%), metatypical/basosquamous and superficial both at 12 (3.1%) and ulcerated (11, 2.8%), however most patients (200, 50.7%) had a mixed subtype. Most of the lesions were located on the face 194 (49.2%) and upper limb 53 (13.5%). vi Squamous cell carcinoma Overall 85 patients were diagnosed with squamous cell carcinoma. The prevalence was 0.3%. The mean age was 68.7 years (standard deviation of 12.8). In the cohort, majority of our patients were male (61, 71.8%), 17 (20.0%) were female, and the male to female ratio was 3.6:1. Gender was not documented in 7(8.2%). There was no statistical significance between gender and age (p>0.05). HIV negative patients were 12 (14.1%) and 3 (3.5%) were HIV positive. Almost all patients in this cohort were of a lighter skin phototype 83 (97.6%). Most patients had multiple risk factors, except 1 (1.2%) who had epidermodysplasia verruciformis as the only risk factor identified. Moderately differentiated squamaous cell carcinoma was diagnosed in majority of the patients 59 (69.4%) and 3 (3.5%) patients had poorly differentiated squamous cell carcinoma. Most patients had an undocumented histologic variant 67 (85.9%). Squamous cell carcinoma occurred most commonly on the face 30 (35.3%), upper limb 16 (18.8%) and scalp 13 (15.2%) Conclusion Our findings are generally in line with other published reports. We noted that BCC has a higher prevalence than SCC. Both cancers were more common in elderly males. Fitzpatrick skin phototype 1 and 2, history of sun exposure, actinic keratosis and prior skin cancer are some of the risk factors that we elucidated. In our cohort these cancers occurred more frequently on sun exposed sites. Majority of our patients did not have a documented HIV status. There is lack of standardisation in history taking and documentation in our dermatology clinic, as well as histopathology reports which leads to important prognostic factors not being documented. These factors form a basis for patient treatment options and inform follow up plans.
The rates and patterns of decomposition of porcine remains buried in different soil types in the highveld of South Africa
(2024) Markov, Artem
Limited research is available with regards to decomposition processes of buried bodies, especially in South Africa, which has some of the highest murder rates worldwide. This study aimed to investigate the effects of endemic soil types, as well as mine tailings, which has not yet been investigated at all, on decomposition. The effects of soil pH were also noted, and the study was repeated during the warm and cold seasons to investigate the effects of weather and temperature holistically. A total of 30 piglet carcasses were buried approximately 10cm deep in containers filled with of one of three soil types: dolomite, quartzite, and gold mine tailing. This experiment was repeated for the cold and warm seasons of South Africa, using 15 carcasses in each season. The carcasses were partially exhumed at regular ADD intervals (50ADD for the first 400ADD, and every 100ADD thereafter) to record their state of decomposition, capture photographs, and take soil samples. It was found that mine tailing soil promoted decomposition more than the other soil types, while quartzite restricted it the most. TBS-ADD equations with high correlation coefficients were generated for each soil type in each season. Significant differences were found between the rate of decomposition during the warm and cold seasons of South Africa in all soil types tested. Notable fluctuations in pH were observed in the quartzite and mine tailing specimens, while dolomite specimens’ pH remained fairly consistent. The breadth of this research covers many unexplored aspects of subterranean decomposition in South Africa, and invites more focused investigation. It is hoped that the findings will be useful to forensic investigations involving buried remains in Gauteng province and South Africa.
The relationship between increased Body Mass Index and primary headache disorders in a group of antiretroviral therapy induced overweight and obese patients
(2024) Ganesh, Annsureeka
Introduction: Primary headache disorders are highly prevalent and may be found co-morbid with other diseases, including Human Immunodeficiency Virus (HIV). Recent literature has suggested a relationship between increased Body Mass Index (BMI) and primary headaches, although the exact mechanisms are largely unknown and likely diverse. Weight gain following initiation of Antiretroviral therapy (ART) has recently emerged as a complication amongst people living with HIV. This unique population with primary headaches may exhibit an artificially-induced state of obesity, which forms the basis of this study in order to describe the relationship between increased BMI and primary headache disorders. Methods: This was a cross-sectional study involving HIV positive patients on ART who had primary headaches. Participants who fulfilled inclusion criteria were enrolled in the study during their routine clinic visits. An anonymous interviewer-based questionnaire was used to record clinical and demographic data. Participants’ height and weight were measured in order to calculate BMI. Fischer’s exact test was used to investigate the association between the presence of primary headache, severity and frequency of headache and increased BMI. A pvalue of less than 0.05 was considered evidence for statistical significance. Results: There was a statistically significant association between female gender and increased BMI (OR 6.02, 95% CI, 1.32-26.21, p-value <0.02) Multivariate regression analysis demonstrated a higher risk of increased BMI amongst participants with features of tension type headache when compared to those with migraine, however this was not statistically significant (OR 2.47, 95% CI, 0.25-24.88, p-value 0.44). There was no statistically significant relationship 7 between increased BMI and the presence of primary headache, type of primary headache, severity, or frequency of headache in this study. Conclusion: This study did not find any statistically significant relationship between increased BMI and primary headache disorders, nor any of their associated characteristics. This may be due to the small sample size, and further studies are needed to corroborate these findings.
The role of geographical distance and referral patterns on stage at presentation in South Africa: a review of two South African breast units
(2024) Pothas, Catharina
Introduction: Historically breast cancer incidence has been low in Africa but now accounts for most cancer deaths in women in many sub-Saharan African countries. The purpose of this study is to examine the role of referral patterns and geographical distance on the stage at presentation. Methods: This retrospective cross-sectional study was undertaken at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH) breast units from July 2015 to September 2017. The participants were grouped into both early (I and II) and advanced (III and IV) stage breast cancer. Demographic data (age, residential distance, referral pattern) and histological characteristics (immunohistochemistry and grade) were compared. Bivariate logistic regression models were applied on all variables with a subsequent multivariate analysis on all statistically significant variables. Results: Of the 1008 participants enrolled in the cohort, 55% presented with advanced stage disease. Referral pattern was statistically significant on bi- and multivariate analyses with a 50% increased risk of having advanced disease following indirect referral (from secondary hospital or specialist) regardless of other socio-demographic or histological characteristics (p<0.001, OR = 1.49, 95%CI 1.13-1.97). Geographical distance had no influence on stage at presentation (p=0.075, OR = 1.36, 95%CI 1.03-1.80). Conclusion: Referral patterns play an important role as a barrier to care in the South African public sector. Direct referral routes are needed with simple access to specialised breast units
The socio-economic impact on health behaviour regarding blood pressure management amongst young adults
(2024) Mhlaba, Mimi
Hypertension (HTN) is a leading cause of cardiovascular disease (CVD), with hypertension prevalence among young adults (YAs) increasing on a global as well as local scale. In South Africa between 1998 and 2016, Hypertension (HTN) rates in YAs (age 15-34 years) have more than doubled. Research reports that the increasing prevalence of HTN in YAs is largely attributed to unhealthy behaviours, such as unhealthy diet, physical inactivity, smoking, drinking alcohol, and poor sleep, with YAs also perceiving themselves as invulnerable to developing HTN at a young age. Formative research has shown that lack of education, employment, and training (NEET status) presents a significant barrier to healthier behaviours in YAs. Currently, 44.7% of South African youth are NEET, indicating the increased risk of pro-HTN behaviour in this group and the need for urgent intervention. While many learnerships addressing NEET rates in the country have been implemented, few are focused on health. Therefore, this study aimed to investigate if transitioning from a NEET status to employment and health education training changes perceptions of HTN risk and health behaviour intentions. METHODS We conducted six focus group discussions (FGDs) comparing HTN-related beliefs and intention for behaviour change between NEET youth (n=20; not in employment, education, or training) and previously NEET youth on a health employment and education training initiative (HETI); n=20). All FGDs were approximately 70 minutes in duration and were recorded and transcribed verbatim. The study utilised the conceptual framework of the Health Belief Model (HBM) to inform the FGD topic guide and a deductive thematic analysis. Frequent debriefing and review sessions with research supervisors were conducted to ensure the quality of the analysis. RESULTS All youth were familiar with HTN but for NEET youth, who only knew it as “high-high” or “high blood”, this was mostly through experiences of others in their social network. While all youth viewed HTN as life-threatening if left untreated and expressed fear of lifelong medication use if diagnosed, only HETI youth felt empowered to implement positive health behaviours for disease prevention. Intention for behaviour change was related to personal relevance resulting from the practical application of HTN knowledge in their daily lives. In contrast, NEET youth felt chronic disease was inevitable at an older age and demonstrated no intention for behaviour change. Past negative experiences in local clinics and the fear of distress in the event of a possible diagnosis were described as major deterrents to blood pressure (BP) screening. CONCLUSION Results suggest that engaging NEET (Not in employment, education, or training) youth in similar HETI (Health employment and education training initiative) programs can increase personal relevance of health information, which serves as a motivator to increase intentions toward healthier behaviours for chronic disease prevention. This may also result in double-duty benefits, reducing a NEET status as well as the risk for chronic illness among the YA population.
The spectrum of male breast disease at Charlotte Maxeke Johannesburg Academic Hospital: a 3 year retrospective review
(2024) Rattray, Darren
Background: The spectrum of male breast disease (MBD) and their relative proportions is not well documented. This study aims to describe the demographics, clinical, radiological and histopathological characteristics of the spectrum of male breast disease managed at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This is a retrospective, descriptive study of all male patients diagnosed with MBD at CMJAH between 1 January 2016 and 31 December 2018. Patients’ data was extracted from the Breast Imaging Department, CMJAH Breast Clinic and the National Health Laboratory Services patients’ records. Data collected included patients’ demographics, clinical presentation, radiological findings and histopathological diagnosis, where available. The collected data was captured using REDCap™ and was analysed using Statistica 13 and SAS version 9.2. P value of 0.05 was used for statistical significance. Results: Of the 269 males imaged, 244 (91%) had a diagnosed breast condition, 90% of which were benign. Gynaecomastia accounted for 85% of all breast disease diagnosed. Patients who presented with benign breast disease were significantly younger than those with malignant breast disease, with a mean age of 45.59 years vs 58.29 years (p = 0.0007). 71% of patients had a known HIV status with 39% being HIV positive. There was a significant association between patients with HIV and benign breast disease (P=0.0129). Conclusion: Gynaecomastia is the most common male breast disease seen at CMJAH. There was a significant association between HIV and benign breast disease. This association should be explored further with respect to the direct effects of the virus and to those of the antiretroviral medication
The training and knowledge of radiation exposure among Wits University Orthopaedic Registrars and their implementation of radiation protective measures
(2024) Suliman, Imraan
Introduction: The use of fluoroscopy in the management of orthopaedic injuries has increased significantly in recent decades, particularly in the trauma setting. However, this has exposed the surgeon, hospital staff and patient to higher levels of radiation. This study aimed to evaluate the knowledge of WITS orthopaedic registrars on ionising radiation and assess their use of radiation protection. Methods: A survey addressing the knowledge of radiation and methods of protection was conducted amongst 50 registrars enrolled at the WITS training centre. Results: There was a 76% response rate and the data obtained was statistically evaluated. Although 87% know what ionising radiation is, only 34% believe they are adequately familiar with the effects of radiation and methods of protection. Focused education was particularly low with 26% of registrars having received formal lectures. Fifty percent of registrars were unfamiliar with the guidelines of radiation optimisation, and more concerning, even fewer implemented the basic methods of protection. There was no accurate record of individualised annual radiation exposure with only 3 registrars being equipped with dosimeters. Furthermore, registrars were found to be indifferent to the harmful effects of radiation with 76% of trainees regularly obtaining unjustified post-operative x-rays. ii Conclusion: Knowledge about ionising radiation and utilisation of protective measures were insufficient amongst Wits Orthopaedic trainees. These findings are consistent with other training institutions in South Africa and around the world. Authors recommend a structured program on radiation and radiation protection be introduced as part of the training program to reduce the detrimental effects of radiation on the surgeon, theatre staff and patient
Thyroidectomies at an academic hospital in Johannesburg-correlation between pre-operative cytology findings and post-operative histology results
(2024) Kilani, Lydia
BACKGROUND Pre-operative cytological assessments of thyroid nodules have become an inexpensive, uncomplicated and reliable way of making a diagnosis of malignancy, as well as useful in stratifying thyroid nodules according to risk. The Bethesda system for reporting thyroid cytopathology (BSRTC) provides a standardized method for reporting this and more accurately estimating risk. This study examines the correlation between BSRTC and final histology in patients undergoing Thyroidectomies at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) OBJECTIVES To determine the accuracy of pre-operative cytological diagnosis in patients undergoing thyroidectomies at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and also to determine the rate of reporting of each BSRTC category, the rate of malignancy of each category, and the demographics of the study population, which includes age, gender and race. METHODS This was a retrospective, observational study, which looked at 113 thyroidectomies performed between July 2013 and December 2016 at CMJAH. Data from each case was captured and analyzed, specifically analyzing pre-operative cytopathological diagnosis which is performed via ultrasound-guided fine needle aspiration FNA, with the post-operative histopathological diagnosis. RESULTS- A total of 174 patients underwent thyroid procedures during the study period, of which 113 fit the inclusion criteria. The majority of the patients were African (79%) and female (88%). A preoperative diagnosis of indeterminate (BSRTC categories 3 and 4) was made in 30.1% of cases. The most reported BSRTC category was category 2 which made up 42.5% of all pre-operative reports, and all v were confirmed benign on post-operative histology. BSRTC category 3 of “Atypia of unknown significance” (AFLUS) was made in 19 patients of whom 3 had thyroid cancer. BSRTC category 4 describes a “follicular neoplasm”: there were 15 patients in this category of whom 8 were found to be malignant. The diagnosis of BSRTC category 5 or “suspicious of malignancy” and category 6 of “proven malignancy” were made in 14 and 17 times, respectively. Only five of 14 BSRTC category 5 were confirmed cancers. The cancer risk for BSRTC 6 was 82.4% (14 of 17 patients). CONCLUSION Pre-operative cytological diagnosis was more accurate in BSRTC categories 2 and 6. A diagnosis of ‘indeterminate’ was made in a significant number of patients (n=19), where more than half of them were found to be malignant. Malignancy risk is lower than expected for BSRTC categories 5 and 6, which may indicate an element of ‘over-diagnosis’ in this institution. Further studies are required
Ventilatory support and surfactant use in extremely low birth weight infants over a decade at a tertiary hospital in Johannesburg, South Africa
(2024) Mavunda, Minah Nthodi
Background: In Southern Africa, extremely low birth weight infants (ELBWI) are a major contributor to neonatal mortality and morbidity. The ELBWI are at the greatest risk of respiratory distress syndrome (RDS), and the severity of RDS is inversely related to gestational age. Objective: To review ventilatory support and surfactant use in ELBWI and its effect on survival of ELBWI at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa. Methods: This was a secondary analysis of an existing database of ELBWI admitted at CMJAH neonatal unit from 01 January 2008 to 31 December 2017. The different modes of respiratory support were compared for survivors and non survivors. Results: A total of 1 184 ELBWI were enrolled in the study with a mean birth weight of 823.6g. Respiratory distress syndrome was diagnosed in 93.2% (1 103/1 184) infants, with 88.2% (1 044/1 184) receiving respiratory support. Respiratory support was offered in the form of surfactant replacement therapy (SRT), nasal continuous positive airway pressure (NCPAP) and/or conventional mechanical ventilation (CMV). Eighty one percent (706/902) of the infants received SRT, 62% (706/1 146) received NCPAP and 20% (225/1 135) received CMV. The survival of ELBWI who received SRT was 88.3% (p<0.001) and for infants who received NCPAP was 65.2% (p=0.019). Conventional mechanical ventilation was not associated with increased survival, 19.2% (p=0.677). The overall survival of ELBWI during the study period was 46% (540/1184). Conclusion: The implementation of SRT and NCPAP are effective in the management of RDS in ELBWI.
Vitamin D levels in young children with femur fractures at Charlotte Maxeke Johannesburg Academic Hospital
(2024) Pinkus, Daniella
Introduction: Fractures are common in children with healthy bones. However, the literature has shown that some of these fractures may be related to underlying bone pathology such as vitamin D deficiency. The aim of this study was to determine if there is vitamin D insufficiency or deficiency in children five years of age and younger with femur fractures at Charlotte Maxeke Johannesburg Academic Hospital. Methods: This study was a retrospective review of children with femur fractures admitted to the Charlotte Maxeke Johannesburg Academic Hospital paediatric orthopedic unit. The records of children admitted between 1 January 2017 and 31 December 2017 were retrieved. Demographic data were collected from clinical notes and electronic discharge summaries. Radiographs were assessed and blood results were retrieved. Results: Forty-five (n = 45) patients were enrolled for this study. The study sample comprised of 30 (66.7%) males with a mean age of 2.9 ± 1.3 (SD) years and 15 (33.3%) females with a mean age of 1.9 ± 1.1 (SD) years. The overall mean age for the sample population was 2.56 years (SD = 1.3, CI = 2.21 – 2.95). Of these patients, 42 (93.3%) were Black, 2 (4.5%) were White and 1 (2.2%) was Coloured. Falls accounted for the only mechanism of injury (n = 45). Spiral fractures accounted for the greatest proportion of fractures, followed by transverse fractures. Most patients (n = 34, 75.6%) came from inner city areas whilst the minority were from outer city areas (n = 11, 23.4%). Most children (68.9%) with femur fractures had low levels of serum 25-hydroxyvitamin D compared to children (31.1%) who had sufficient levels of serum 25-hydroxyvitamin D. Conclusion: This study showed that 68.9% of the children were vitamin D deficient or insufficient and 75.6 % were from inner city areas. This suggests that children aged five years and younger with femur fractures in our hospital may benefit from routine blood testing and vitamin D supplementation.

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