Electronic Theses and Dissertations (Masters)
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Item A comparison of early onset pre-eclampsia and late onset preeclampsia(2024) Joomratee, J.Background: Early onset pre-eclampsia (EOPE) occurs before 34 weeks while late onset preeclampsia (LOPE) occurs after 34 weeks. The maternal and neonatal outcomes has are different with EOPE having a higher frequency of maternal and neonatal complications. Objectives To compare the clinical presentations, laboratory parameters, maternal and neonatal outcomes in women with EOPE and LOPE. Methods: This was a cross sectional prospective record review. Convenient sampling was performed every fifth day and recruited preeclamptic women that delivered at Chris Hani Baragwanath Academic Hospital (CHBAH) and Rahima Moosa Mother and Child Hospital (RMMCH). Descriptive statistics were employed. Results: There were 104 women of which 64 (61.5%) had EOPE and 40( 38.5%) had LOPE. A higher frequency of Posterior Reversible Encephalopathy Syndrome (P=0.040), blurred vision (P=0.009), headache (P= <0.001) eclampsia (P=0.011) and HELLP syndrome (0.004) was observed in EOPE. The number of still births (P<0.001), neonates with an APGAR of less than 7 at 5 minutes (p=0.001), and neonatal admissions (P= <0.001) were higher in EOPE. There was no difference in the outcome between the HIV positive and negative women Conclusion: With EOPE, end organs appear to be more severely affected than in LOPE. The HIV prevalence between the two groups was comparableItem A comparison of percutaneous tracheostomy and of surgical tracheostomy in patients in the Neurosurgical ICU at Charlotte Maxeke Johannesburg Academic Hospital(2024) Marais, RuanIntroduction A tracheostomy is a surgically created opening in the anterior wall of the trachea through which a tube can be inserted. Egyptian hieroglyphic paintings that depict a tracheostomy procedure can be dated back to 3100 BC.1 Tracheostomy is a procedure that is commonly performed on Intensive Care Unit (ICU) patients and, with an increasing need for intensive care services, the number of patient referrals for tracheostomy will likely increase as well. Aim The purpose of this study was to compare various clinical characteristics of patients who received either a percutaneous tracheostomy (PT) or a surgical tracheostomy (ST) during their stay in the Neurosurgical Intensive Care Unit (NSICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Method A retrospective study of the records of all patients who underwent a tracheostomy procedure during their stay in NSICU at CMJAH between 1st January 2017 and 31st December 2020 was undertaken. Clinical information collected for all patients included age, gender, Glasgow Coma Score (GCS), Simplified Acute Physiology Score (SAPS II), duration of stay in NSICU before and after tracheostomy, duration of mechanical ventilation pre- and post-tracheostomy and in-NSICU actual mortality. Predicted mortality percentage for each patient was calculated from SAPS II. A Glasgow Outcome Score (GOS) was assigned to each patient on discharge from NSICU. Patients were allocated to one of two groups. Those who received PT were allocated to GroupPT while those who received ST were allocated to GroupST. The percentage case fatality risk for each tracheostomy group was calculated. Results Of the 66 patients who underwent a tracheostomy procedure during the study period, 19 patients (28.8%) fell into GroupPT. The remaining 47 patients (71.2%) fell into GroupST. The median age of GroupPT was 28 years with lower and upper interquartile range (IQR) of 25 and 32 years, respectively. The median age of GroupST was 40 years (IQR 31, 54). This difference was statistically significant (p < 0.05). The median SAPS II score for Group PT was 41 (IQR 29, 47) and that of Group ST was 44 (IQR 30, 50). This difference was not significant. There were no differences in GCS, duration of stay in NSICU, number of days of mechanical ventilation pre- or post-tracheostomy procedure, actual mortality or GOS between the two groups. Conclusion In this group of 66 patients ST was the commoner of the two procedures performed. Even so, the findings of this study suggest that PT is a suitable procedure that may be performed safely on patients in the NSICU.Item A comparison of the warming capabilities of two Baragwanath Rewarming Appliances with the Hotline® fluid warming device(2024) Wilson, KyleBackground: Accidental intraoperative hypothermia is a common and avoidable adverse event of the perioperative period and is associated with detrimental effects on multiple organ systems and postoperative patient outcomes. In a resource limited environment the prevention of intraoperative hypothermia is often challenging. Resourceful clinicians overcome these challenges through creative devices and frugal innovations. This study aims to investigate the thermal performance of two such Baragwanath Rewarming Appliances (BaRA) against that of the Hotline® in an attempt to describe an optimal setup of these devices. Methods: This was a quasi-experimental laboratory study that measured the thermal performance of two BaRA devices and the Hotline® under a number of scenarios. Independent variables fluid type, flow rate, warming temperature and warming transit distance were sequentially altered and temperatures measured along the stream of fluid. DeltaT was calculated as the difference between entry and exit temperature for each combination of variables for each warming device. Results : A total of 219 experiments were performed. The BaRA A configuration at a temperature of 43ºC with a transit distance of 200 cm either matched or exceeded the DeltaT of the Hotline® over all fluid type and flow rate combinations. The BaRA B configuration does not provide comparable thermal performance to the Hotline®. Measured flow rates were noticeably slower than manufacturer quoted values for all intravenous (IV) cannulae used. Conclusion: A warm water bath at 43ºC with 200 cm of submerged IV tubing provides thermal performance comparable to the Hotline, with all fluid type and flow rate combinations.Item A cross-sectional study investigating knowledge, attitudes and health choices in relation to diabetes mellitus among nondiabetic patients attending Chiawelo community practice, Soweto, Republic of South Africa(2024) Tshibeya, M. R.Background: The knowledge, attitudes and health choices of non-diabetic patients in resourcelimited settings to prevent the onset of diabetes mellitus (DM) are poorly understood. Aim: The aim of this study was to investigate and describe the knowledge, attitudes and health choices of non-diabetic patients in relation to DM at the Chiawelo Community Practice (CCP), Soweto, South Africa. Methods: In this cross-sectional study, a self-reported questionnaire was administered to 165 adult participants attending the CCP from 2nd March to 17th April 2020. Descriptive analysis, Chi square and univariate logistic regression were included in the analysis. Multivariate analysis was done for variables with a p-value <0.25 Results: In total, the study had 165 participants, of whom 112 (68%) were women, 35% were older than 45 years and 16% were younger than 25 years of age. Almost half (49%) of participants had good knowledge of DM, with 60% indicating good attitudes and 52% making good health choices to prevent DM. Participants who received education from clinicians were 4.31 times more likely to develop better attitudes (p=0,003) and 3.34 times more likely to adopt better health choices (p=0.004) towards DM compared to those who obtained information from media or other sources. Conclusion: The study found that poor knowledge of DM does not necessarily translate into poor attitude towards the disease, which is noteworthy. The study also highlighted the important role of healthcare workers in influencing behaviour changeItem A retrospective audit of computed tomography angiography in penetrating wound of lower limb at Chris Hani Baragwanath Academic Hospital(2024) Abid, RabiaINTRODUCTION: There is high rate of violence-related injuries in South Africa. These injuries include gunshot wounds, stab wounds and blunt force trauma. Many patients with penetrating wounds present in the emergency department with vascular injuries. Penetrating wounds of lower limbs with or without arterial injuries are managed according to trauma protocols. Patients presenting hard signs vascular injury are transferred to theatre for immediate exploration and repair. Patients with soft signs are clinically examined and, if indicated, imaging is planned. Clinical examination is crucial in diagnosing arterial injuries in penetrating limb injuries and AnkleBrachial index (ABI) is an important parameter to rule out arterial injuries. Doppler ultrasound is a good, non-invasive imaging modality but is operator dependent. Computed Tomography Angiography (CTA) has excellent outcomes in diagnosing arterial injuries in penetrating wounds of lower limb, with a sensitivity and a specificity close to 100%. CTA is a non-invasive, rapid, and reliable modality, but subjects the patient to radiation exposure. This study aimed to determine the prevalence and type of vascular injuries in penetrating injuries of lower limb in on South African academic hospital. METHOD: A retrospective audit of CTAs done for penetrating wounds of lower limbs to rule out vascular injuries at Chris Hani Baragwanath Academic Hospital (CHBAH) was executed. Data of CTAs performed from January 2017 to December 2018 were retrieved from the imaging PACS of the CHBAH radiology department. Ethics approval was obtained from HREC of the University of Witwatersrand, and data was captured from the relevant records. RESULTS: Descriptive statistics were used to describe the characteristics of the population, in the form graphs and figures. Data of 91 CTAs were collected. The average age of subjects was 32.2 years, and 83 of the cohort were males. The most common mechanism of injury was a gunshot wound. Only one case out of 91 of the collected CTAs was positive for arterial injury. CONCLUSIONS: Low rate of positive CTA studies over span of a 2-year period emphasizes the need for thorough examination for the suitability of a CTA. This approach avoids unnecessary radiation exposure to the patients and is cost effective. In low-risk patients, doppler ultrasound should be considered for imaging of potential arterial injuries and has no radiation exposure. The use of lower threshold value of ABI is an option for patients presenting with soft signs of arterial injuries. Revising the management protocol for penetrating injuries of lower limb used by trauma surgeons at CHBAH for requesting CTAs will be cost effective by avoiding unnecessary imaging.Item A study to determine the causes of death in neonates weighing <1500g at Kleksdorp Hospital(2024) Mwala, NalisheboBackground: The continuing challenge of neonatal mortality in very low birth weight (VLBW) neonates in South African hospitals highlights the need to better understand the causes of these deaths as well as their associated modifiable factors. Objectives 1. Determine the causes of death and factors that contribute to death in VLBW neonates at Klerksdorp Hospital (KH) 2. Determine key modifiable factors to improve the survival of VLBW neonates at KH. Methods: Retrospective, descriptive study based on the review of 183 patient records (100 who survived and 83 who died) between January 2015 to December 2016. The study population is from the neonatal unit at a secondary hospital in the North-west province of South Africa. The unit consists of eight beds with ventilatory support. Fifty-five Perinatal Problem Identification Program (PPIP) forms were audited to determine causes of death and associated modifiable factors. Logistic regression analysis was used to determine predictors of death. Results: The most common causes of death were 1) sepsis (24%), 2) extreme multiorgan immaturity (20%) and with the most vulnerable neonates born between 26 and 32weeks’ gestation. An increase in birthweight is shown to incur protection against death (OR 0.993, CI 0.989-0.996, p = 0.000). Key predictors of death are metabolic acidosis during the course of their NICU admission (OR 17.785, CI 4.711-67.145, p = 0.000) and hypotension-requiring-inotropes (OR 26.074, CI 5.403-125.827, p = 0.000) secondary to septic shock. Critical modifiable factors include preventing nosocomial sepsis (18%), timely initiation of antenatal care (12%) and improving timeous health seeking behaviour (10%), administration of antenatal steroids (6%) and availability of adequately trained medical personnel (6%). Conclusion: Sepsis is the leading cause of death in very low birth weight neonates. Its complications in the form of metabolic acidosis and septic shock requiring inotropic support are key predictors 2 of 2 of death. Seventy seven percent the deaths occurred in the first week of life, highlighting a vital window for intervention. Key modifiable factors pertain to medical and patient factors. Barriers that may preclude this lie in the poor socio-economic setting of the population that is mostly peri urban with constrained resources.Item A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology(2024) Watermeyer, Benjamin DavidSouth Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.Item A survey of postdural puncture headache management practices within an academic department(2024) Monteith, KathrynBackground: Postdural puncture headache (PDPH) is a common consequence of neuraxial anaesthesia, especially among parturients, in whom it is associated with maternal morbidity, prolonged hospital stay, and increased healthcare costs. Although international guidelines for PDPH management are available, variable management practices exist. There are no published studies which document current practices, nor guidelines available, with respect to PDPH management in South Africa. This study aims to describe PDPH management practices within the Wits Department of Anaesthesiology, which may assist in future local guideline or protocol development. Methods: An electronic questionnaire was distributed to the Wits Department of Anaesthesiology. The survey instrument was developed following a literature review targeting recent evidence based PDPH management guidelines, including the Obstetric Anaesthetists Association (OAA) guidelines from 2018, after which it was reviewed for content and face validity. Data were downloaded, analysed, and presented with the aid of statistical software. Participant responses were then compared to the OAA guidelines, which were considered the standard of practice. A score relating to this was determined and compared to demographic variables to assess for possible correlations. Results: Participants’ practice with respect to conservative management strategies and the performance of EDBPs was in keeping with the OAA guidelines, despite evidence of limited provider experience with performing these procedures, as well as the lack of available departmental guidelines. Ninety six percent of anaesthetists perceived they would benefit from the institution of formal guidelines. Conclusions: Management practices for the treatment of PDPH among anaesthetists within the Wits circuit are variable, but generally consistent with current international guidelines, however, limited experience in treating PDPH has been demonstrated. The development, and institution, of formal guidelines to assist in the management of PDPH is recommended, as well as continuous medical education of staff, to ensure good patient outcomes.Item A tale of two sites: an audit of central nervous system metastases in two Johannesburg tertiary centres(2024) Molefe, MasechabaBackground: 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 globallyItem Adequacy of availability of antidotes for common and critical drug poisonings and doctors’ perspectives thereof: a study in teaching hospitals in the Southern Gauteng City-Region(2024) Fitchett, Margaret PenelopeBackground: Drug poisoning is an important area of study in South Africa (SA) as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in SA. Objectives: To assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. Methods: A data sheet assessing the availability of antidotes in the Emergency Departments (EDs) and pharmacies was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Results: N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol and pyridoxine were present in all EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate or pyridoxine (85.7%, 83.3%, 87.3% and 75.4% of 126 respondents respectively). Conclusion: The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply which will be an important avenue for further research.Item Admission hypothermia in very low birth weight newborns at Charlotte Maxeke Johannesburg Academic Hospital(2024) Mauree, Angidi PillayBackground: 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.Item An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital(2024) Gamede, NomdumisoBackground: 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.Item An audit of children with Type 1 diabetes mellitus presenting to a tertiary institution in Johannesburg, South Africa(2024) Gray, MeghannAt initial diagnosis, the rate of diabetes ketoacidosis (DKA) varies between countries (15- 67%) and may be associated with a lack of awareness of early signs and symptoms. Objectives: To describe the demographic, anthropometric, clinical and biochemical characteristics of children presenting with Type 1 diabetes mellitus (DM). Methods: A retrospective review of Type 1 DM children's medical records admitted to CHBAH from 01 January 2009 to 31 December 2018 was conducted. This ten-year period was further subdivided into two groups (Group 1: 2009-2013 (n = 75); Group 2: 2014-2018 (n=78)) to assess annual follow-up visit data in Group 1 for five years per patient and to compare data between the Group 1 and 2 time periods. Statistical differences between groups were analyzed by Mann-Whitney U test or Student t-tests, and for between the years of follow-up (Group 1), the paired student t-test was used. Results: The total number of newly diagnosed Type 1 DM children was 153. The median age at presentation was 10.5 years (IQR 7.4-12.3), 56% females and 88% black. The mean WAZ and HAZ were -0.8 (SD ± 1.5) and -0.4 (SD ± 1.6) respectively. Sixty-five percent (n = 100) presented in DKA, 56% of those being severe with a higher prevalence of DKA in group 2 compared to group 1 (72% vs 59%; p=0.08). At presentation, the median HbA1c was 12.5% (IQR 11.1-14.3) and C-peptide was 0.2ug/L (IQR 0.1-0.4) (normal range 1.1-1.4). Anti-GAD antibodies were positive in 82% (n=82/101) of the results available. In Group 1, HbA1c increased at year 3 follow up with advancing pubertal status. Despite changing to more intensive insulin therapy, mean HbA1c remained unchanged over the 5 years of follow-up. Conclusion: The majority of newly diagnosed children presented in severe DKA, similar to Red Cross War Memorial Children's Hospital (2005-2009), with an increasing prevalence over the ten vii years, which could be attributed to the lack of awareness of Type 1 DM in our population. An education campaign is needed to improve community knowledge about diabetes.Item 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.Item An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital breast imaging unit(2021) Christofides, Nicholas ChristopherBackground: 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.Item An audit of the practice of red packed cell transfusion in neonatal surgery in an academic hospital(2024) Govender, KushalBackground: 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.Item 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-LesediIntroduction: 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%.Item Antimicrobial resistance profiles in the paediatric burns unit at Chris Hani Baragwanath Academic Hospital(2024) Moodley, Mahavishnu MorganBackground: There has been a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistance patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to their pathogen profile. Objective: This study sought to compile unit-specific antibiograms by comparing the frequency of organisms and resistance trends at the paediatric burns unit at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019. Methods: A retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples for the study period. We analysed the frequency of Enterobacterales, nonfermenters, Gram-positive organisms, and yeasts as a percentage of total positive blood cultures. A comparative analysis of resistance trends was performed between 2015, 2017, and 2019 for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extreme drug-resistant (XDR) Acinetobacter baumannii, and methicillin-resistant Staphylococcus aureus (MRSA). Results For blood culture isolates, a statistically significant decrease in ESBL was noted with a rise in CREs. Majority of A.baumannii were XDR despite an appreciably decrease. A notable decrease in S.aureus and MRSA isolates with an increase in C.auris was observed. Conclusion: The results of this study encourage review of current antimicrobial choices in the unit for empiric antibacterial cover. Due to low numbers of yeasts, we cannot comment on institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.Item Assessing financial literacy amongst anaesthetists in an academic department(2024) Mohamed, Ayesha NoorBackground: Financial literacy is an important skill that is used to navigate the complex financial landscape. According to studies done in South Africa, wealth, income, racial classification, age, geographical location and level of education affect financial literacy levels. Higher financial literacy is associated with greater wellness and less financial concerns. Studies done in other countries show that doctors have low financial literacy. The financial literacy of anaesthetists in South Africa is not known. Objectives: The aim of this study was to assess financial literacy among anaesthetists in the Wits Department of Anaesthesiology and to identify demographic factors that could predict differences in financial literacy. Methods: This was a cross-sectional, contextual and descriptive study using an anonymous, self administered questionnaire. The questionnaire was an adaptation of the original used in the South African Social Attitudes Survey and was scored similarly. A mean financial literacy score was calculated for each anaesthetist using four domain scores (financial knowledge, financial planning, financial control and product choice and awareness) and used to make comparisons between demographic categories. Results: A total of 184 anaesthetists from the Wits Department of Anaesthesiology were included. The mean financial literacy score (0-100 scale) was 72. With the exception of White anaesthetists scoring higher than Coloured anaesthetists (p= .049), no other demographic category showed significant differences. Gender, age, relationship status and years of employment did not inform any enduring trend with regards to mean financial literacy scores. The mean scores for the individual domains were 79 for financial control, 76 for financial planning, 51 for product choice and 82 for financial knowledge. Between the domains, the mean financial knowledge score was higher than the mean financial planning score (p =.011). The product choice score was found to be the lowest (p<.0005) Only 35% of anaesthetists are confident in buying financial products and services by themselves while 8.2% of anaesthetists are very confident in their retirement planning. Anaesthetists who held an unsuitable financial product in their portfolio accounted for 40%, while 36% of anaesthetists experienced regret regarding financial decisions. It was also found that younger, junior, Coloured and Black anaesthetists have poorer financial preparedness. Conclusion: Anaesthetists in the Wits Department of Anaesthesiology have high levels of overall financial literacy, however, do not display adequate preparedness in planning for a secure financial future. A mandatory structured financial literacy programme during university, specialisation and fellowship training is recommended.Item Assessment of the management of inpatient hyperglycaemia by physicians and intensivists in South African hospitals(2024) Hewson, Peter Llewellyn BlanshardBackground 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.