Electronic Theses and Dissertations (Masters)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37977
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Item The patterns and distribution of maxillofacial fractures at Pelonomi hospital(University of the Witwatersrand, Johannesburg, 2023-10) Mvala, Boyisile Stephen; Rikhotso, Risimati EphraimBackground: Despite large volumes of trauma patients treated, no study has analysed the epidemiology of craniofacial trauma at Pelonomi Hospital. Such studies could provide insight into the aetiologies and treatment modalities of maxillofacial injuries; and allow for development of strategies to ensure efficient and optimal utilization of limited health resources. Aim: To analyse the patterns and distribution of maxillofacial fractures at Pelonomi Hospital (PH). Methods: We designed and implemented a retrospective, descriptive cross-sectional study whose sample consisted of patients treated for maxillofacial fractures at PH, Frees State, South Africa, between January 1, 2017, and December 31, 2019. Data was collected from the patient’s clinical and radiographic records. Variables recorded included demographic data (gender, age), aetiology of the trauma, type of fractures and type of treatment provided. The delay in treatment was determined from date of injury to the day of treatment. The referral letters were assessed to determine district from which the patients were referred. Descriptive statistics of frequency and percentage were used to analyse the data. Fischer’s exact test was used to determine the association between the independent and dependent variables. The level of significance was set at a p-value less than 0.05. Results: A total of 307 patients with craniofacial fractures were included in the study. Females constituted 21.8% (n=67) and males were by far the majority of the participants at 78.2% (n=240). Individuals in the 20-29 age group had the most maxillofacial fractures (41.2%) and majority of patients in the study were Black (81.1%). The major cause of these injuries was interpersonal violence (60.9%). Alcohol contributed in 64.50% of the injuries. The most frequent fracture was a mandible fracture (70.7%). Majority of fractures in the study were treated with closed reduction (52%) and the waiting period prior to treatment was found to be 2 weeks. Conclusion: Blunt trauma sustained under the influence of alcohol in young individuals is responsible for majority of maxillofacial fractures at Pelonomi Hospital. Future prospective studies with large patient numbers and post treatment follow up are recommended.Item Spectrum of glaucomatous disease at Charlotte Maxeke Johannesburg Academic Hospital: A retrospective clinical audit(University of the Witwatersrand, Johannesburg, 2024) Walters, Ingrid; Williams, Susan E. I.Background: Glaucoma is the second most common cause of blindness worldwide. A disproportionately high number of these patients live in low- and middle-income countries, placing a huge burden on the health care system. The purpose of this study was to describe how glaucoma patients presented to a dedicated glaucoma clinic at a large referral centre/tertiary hospital in central Johannesburg, South Africa. The objectives were to describe the spectrum of glaucomatous disease in these patients as well as the demographics, risk factors and severity of disease in this patient population. The secondary objective was to describe how glaucoma was being managed in the glaucoma clinic patient population. Methods: This study was a retrospective descriptive study which was a clinical audit of the Charlotte Maxeke Johannesburg Academic Hospital’s (CMJAH) glaucoma REDCap database. 787 patient records were included in the study which were patients seen and managed in a 5-year period. This study and the database had valid ethical clearance. Results: Of the 787 patients assessed the mean age at presentation was 59 years (n=739, SD=16), 50.3% were female and 49.7% male. The majority (74.9%) were black African, and the most common diagnosis was Primary Open Angle Glaucoma (POAG) (59%). Patients with secondary glaucoma (excluding exfoliation glaucoma) were significantly younger (49 years +/-18years) whereas patients with exfoliation glaucoma were older (68 years +/-10 years), P<0.001. Black African patients with POAG were significantly younger than other racial groups, p<0.001, with 7% being younger than 35 years. 23.3% of patients had a family history of glaucoma. The median intraocular pressure (IOP) was 15 mmHg (n=690) and median vertical cup to disc ratio (VCDR) was 0.9 (n=605). Using World Health Organisation (WHO) definitions, 32.2% patients had visual acuity (VA) ≤6/120 in the better seeing eye fulfilling criteria for blindness (n=686) and 64.6% of patients had VA≤6/18 in the better eye fulfilling criteria for visual impairment. 68% (n=722) patients were on medical therapy and most patients received on average three agents. There were 426 laser procedures performed, selective laser trabeculoplasty (SLT) accounting for the bulk (65.3%) and 210 glaucoma surgeries were performed. Conclusion: This study supports and reinforces the notion that black South African glaucoma patients are most likely to have POAG, present at a younger age and have more advanced disease with very high rates of visual impairment and blindness. The management of these patients is largely medical with more than one medication. Glaucoma surgery is an important management tool in advanced glaucoma and is being underutilised