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    A retrospective audit of computed tomography angiography in penetrating wound of lower limb at Chris Hani Baragwanath Academic Hospital
    (2024) Abid, Rabia
    INTRODUCTION: 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.
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    Comparison of 2 automated ferritin assays used at 2 large academic hospitals: are they interchangeable?
    (2024) Mona, Portia
    Background Serum ferritin (s-ferritin) measurement offers a non-invasive and rapid indication of iron stores. Decreased concentrations are associated with iron deficiency and increased concentrations with iron overload. Routine laboratory methodologies for s-ferritin measurement include electrochemiluminescence immunoassay (ECLIA) and particle-enhanced immunoturbidimetric assay (PETIA). The study aimed to compare the difference in analytical performance and the effect on clinical interpretation using both methods. Methods This was a method comparison study of 143 patient samples received at Chris Hani Baragwanath hospital laboratory. S-ferritin was measured in each sample with both ECLIA and PETIA methods. Analytical performance was assessed based on the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Biological Variation specifications. Various sferritin cut-offs along with serum iron, transferrin, haemoglobin, mean corpuscular volume and mean corpuscular haemoglobin results were used in the classification of the iron status. The differences in classification between the two methods were assessed for clinical impact. Results PETIA had a significantly higher median than ECLIA (83 vs. 62 µg/L, p<0.0001) in the iron deficiency anaemia group than PETIA when using the <15 µg/L cut-off for s-ferritin. Conclusion PETIA method overestimates s-ferritin concentrations and a greater bias is observed at lower clinically significant concentrations. ECLIA and PETIA methods should not be used interchangeably especially for patients with low iron status. Patients must be followed up with the same analytical method for comparability of results.
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    Clinicians’ perspective of pacs at Charlotte Maxeke Johannesburg Academic Hospital
    (2024) Tshalibe, Polite
    Background: Picture archiving and communication systems (PACS) are now an established means of capturing, storing, distribution and viewing of all radiology images. The study was conducted in a quaternary hospital, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), part of University of Witwatersrand teaching circuit, in South Africa. There are few studies conducted in our local environment evaluating the clinicians’ perception of PACS in public teaching hospitals. Objectives: To measure the clinicians’ perceived benefits and challenges of PACS. To document their perceived views on how the current PACS can be improved. Methods This was a cross-sectional observational study over a period of five months, from September 2021 to January 2022, carried out at CMJAH. Questionnaires were distributed to clinicians with PACS experience. Descriptive statistics were conducted. Categorical variables were presented as frequencies and percentages. The continuous variables were presented as mean ± standard deviation. Results: The response rate was 54%. The survey found the benefits most reported by clinicians were improved patient care, less time needed to review an exam, improved image comparison, and consultation efficiency. With respect to perceived challenges, the unavailability of images at the bedside, problems with access, and a lack of advanced image manipulating software were noted most frequently. The most frequent recommendations for improvements focused on the aforementioned challenges. Conclusion: Although a small majority of respondents found PACS beneficial, there were also significant issues with accessibility and functionality of the system. Contribution: The findings will assist in future hospital or provincial-wide PACS deployment projects.
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    The prevalence of autism spectrum disorders at Tara Hospital Child and Adolescent Clinic
    (2024) Pitjeng, Philemon M
    Introduction: There are limited studies on the prevalence of Autism Spectrum Disorders (ASD) in Africa as a continent, and in South Africa in particular. This study is aimed at determining the prevalence of Autism Spectrum Disorders at a specialised psychiatric hospital in Johannesburg. Method: This is a retrospective study based on a sample of 1370 patients aged between 1-17 years of age who were evaluated over a period of 6 years at the Tara Hospital Child and Adolescent Clinic. 76 received a clinical diagnosis of ASD as per the DSM-IV-TR or the DSM-5. All patients that were not diagnosed with ASD and those that were diagnosed with ASD but were above the age of 18, were excluded. Results: The prevalence of ASD was 5.5% with a 95% confidence interval of 4.4% to 6.9%. These children also presented with co-morbid psychiatric illnesses, the most common being ADHD at 72% followed by GAD at 34%. Patients that received OT made up 21%, while 17% were at remedial school as per the recommendation made by the multi-disciplinary team. Conclusion: The findings of this study correlate with other studies that have been conducted. There was also an incidental finding that indicated a higher paternal than maternal heritable contribution of ASD. Further research is recommended to measure the outcomes of the cases that were diagnosed.
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    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.
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    Identification of novel HIV-1 envelope mutations that confer resistance to VRC01
    (2024) Cohen, Paula
    The Antibody Mediated Prevention Trials showed that passively infused VRC01, a potent and broadly neutralizing antibody, was able to protect individuals against HIV-1 infection if they were exposed to sensitive viruses. However, breakthrough HIV-1 infections occurred when individuals in the VRC01 arms were exposed to viruses either resistant to VRC01 or to sensitive viruses when participants were in a VRC01 serum trough. We identified seven individuals with multi-lineage breakthrough HIV-1 infections, where one variant was resistant to VRC01 but another was VRC01 sensitive. By comparing the Env sequences of the resistant and sensitive clones from each participant, we identified mutations that were predicted to confer differential VRC01 neutralization phenotypes. These mutations were reverted to sensitive residues by site-directed mutagenesis, and the wildtype and mutant envelopes were screened against VRC01 and other CD4 binding site antibodies in TZM-bl neutralization assays. In four of the seven pairs of clones, a single mutation was sufficient to confer sensitivity to VRC01. In each case, the mutations responsible for the differential neutralization phenotypes occurred at different sites across the Env, such as 279 and 280 in loop D, 369 in the CD4 binding-loop and 459 between β23 and the V5 loop. In two cases, the resistant backbones were mutated (through generation of chimeras) to contain either the entire V1V2 region or the β23-V5 loop of their matched sensitive clones. This resulted in the transfer of 8 or 20 amino acid mutations to confer VRC01 neutralization sensitivity. We were unable to identify the mutations conferring VRC01 resistance in one participant, where the resistant and sensitive clones differed by both length and 100 amino acid changes. Interestingly, all VRC01 resistant clones were sensitive to other, clinically relevant, related CD4 binding-site bNAbs, such as VRC07-523 LS and N6, which are being tested in future passive immunization trials. Further studies will investigate the kinetics of VRC01 resistance mutations within the AMP multi-lineage transmissions over time.
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    Extended characterization of multi-drug resistant organisms colonising neonates at a tertiary hospital in Johannesburg, South Africa.
    (2024) Mntla, Nonkululeko Marcia
    Neonatal deaths remain high globally, particularly in sub-Saharan Africa. A third of deaths are due to infections, often secondary to multi-drug resistant (MDR) organisms. The purpose of this study was to investigate the prevalence of MDR ESKAPE+ C. auris colonisation amongst hospitalised neonates, to determine risk factors associated with MDR colonisation, and perform antimicrobial resistance characterization of these isolates. Two hundred and fifty-eight swabs were collected from 86 hospitalised neonates at a tertiary South African hospital between November and December 2020. A total of 135 ESKAPE+ C. auris isolates were identified; 68% were MDR. Majority of neonates (65%) were colonised with extended spectrum betalactamase (ESBL) producing Klebsiella pneumoniae, followed by extensivelydrug resistant (XDR) Acinetobacter baumannii. New Delhi metallo-beta-lactamase (NDM) producing A. baumannii were more prevalent than carbapenemase producing Enterobacterales (CPE). A prolonged hospital stay, median=14 days (p<.001) was identified as a risk factor for MDR organism colonisation. The high prevalence of MDR ESKAPE+ C. auris colonisation supports use of non-invasive samples to determine colonisation prevalence. More data are needed to develop improved surveillance systems which should incorporate colonisation swabs and clinical biomarkers in neonates with independently established risk factors.
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    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.
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    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.
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    Compliance of medical practitioners with diabetic treatment guidelines at Dr Yusuf Dadoo Hospital, West Rand Health District Gauteng
    (2024) Ohanson, NJ
    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
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    Economic perfomance and state-business relations in post-apartheid South Africa
    (2020-03) Nkgodi, Bruce Molefi
    In this study the main concern is state-business relations in post-apartheid South Africa. Guided by the political theory of corporatism, the study considers the influence of state-business relations on economic performance. The obvious assumption is that sound state-business relations correlate positively with impressive economic performance. Following the demise of the apartheid system of governance in South Africa, a corporatist institution known as the National Economic Development and Labour Council (NEDLAC) was established. Sub-optimal economic performance of post-apartheid South Africa has raised doubts about the efficacy of NEDLAC's role in fostering economic prosperity for the country. It is contended that in many studies a substantive comprehension of what economic performance entails is absent. To overcome the lack of coherence in the conception of economic performance, this study applies economic growth, public debt and unemployment to measure economic performance. The study found that overall, growing public debt, high levels of unemployment and poor economic growth point to unimpressive economic performance associated with state-business relations in post-apartheid South Africa.
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    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
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    Colonisation with ESKAPE organisms and Candida auris among primary caregivers and healthcare workers in a neonatal unit at a public sector tertiary South African hospital
    (2024) Rees, Nicki
    Background: Nosocomial neonatal infection remains a significant cause of mortality and morbidity, particularly in the high care and intensive care settings. Among implicated pathogens ESKAPE- C organisms are considered particularly worrisome due to their virulence, ability to gain resistance and propensity to affect multiple sites. Transmission to neonates is postulated to occur through contact with colonised adults. Objective: This study aims to describe the prevalence of colonisation of both primary caregivers and healthcare workers in contact with admitted neonates. As a secondary objective this study aims to identify the most common resistance patterns in ESKAPE-C organisms isolated from primary caregivers and healthcare workers in a neonatal unit. The overall aim of the study is to provide insight into how best to prevent hospital acquired infections in this group. Methods: This cross-sectional prevalence study describes colonisation of healthcare workers (HCW) and primary caregivers in a neonatal unit in a tertiary South African hospital. Over one week in August 2021, twenty-five primary caregivers and twenty-nine healthcare workers submitted specimens which were processed for the identification of ESKAPE-C organisms. Susceptibility was performed on identified organisms. Results: Of the healthcare worker participants 13,8% (4/29) were shown to be colonised with one or more ESKAPE-C pathogen, while 52% (13/25) of primary caregivers were shown to be colonised with one or more ESKAPE-C pathogens. Of the S. aureus organisms isolated 28,6% were MRSA, of the A. baumannii organisms isolated 66.7% were XDR and of the Enterobacteriaceae isolated 60% were ESBL producing. No CRE or VRE organisms were isolated in this study. Conclusion: This study demonstrates that the prevalence of colonisation of healthcare workers and primary caregivers is significant and reinforces the need for stringent infection prevention and control strategies to prevent transmission to vulnerable neonates.
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    Review of the use of cervical cerclage at Charlotte Maxeke Johannesburg Academic Hospital
    (2024) Malete, N
    Objective The aim of the study was to review the use of transvaginal cervical cerclages at Charlotte Maxeke Johannesburg Academic Hospital (CMAJH) for the period 1 June 2016 to 1 June 2017. Methods This is a retrospective review of 39 transvaginal cervical cerclages. The data collected included maternal demographic and pregnancy characteristics, previous pregnancies and outcomes, indications for the cerclages, antenatal and maternal complications, and neonatal outcomes. STATA software version 16 (Stata Corporation, USA) was used to analyse the data. Results There were 39 transvaginal cerclages, 28 (72%) of which were history-indicated (HI) and 11 (28%) ultrasound-indicated (UI). The overall live-born rate was 26/39 (67%). Seventy-one percent (20/28) and 55% (6/11) of history and ultrasound indicated cerclages culminated in livebirth respectively, however there were no statistical significance in terms of effectivity in preventing preterm birth between the two types of cerclages (p-value = 0.446>0.05). There was however higher incidence of PPROM in the ultrasound compared to the history indicated cerclage group (45.4% vs 10.7%) with a p-value= 0.05 respectively). Conclusion Transvaginal cervical cerclage remains an important intervention in the prevention of pre-term labour secondary to cervical incompetence. The use of cervical cerclage in this study resulted in a significant number of live birth rates and good neonatal outcomes regardless of the indications for the cervical cerclage.
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    Comparison of quality of life in patients with advanced chronic kidney disease undergoing haemodialysis, peritoneal dialysis and conservative management
    (2024) Mathew, Neelu Susan
    Introduction: Quality of life is an under-appreciated clinical target which affects patient and modality survival. Lack of dialysis slots in the state sector result in assignment to treatment modalities without regard to effects on these parameters. We assessed the effect of dialysis modality, demographic, and laboratory parameters on mental health and quality of life measurements. Methods: Size-matched voluntary cohorts were recruited from patients on haemodialysis (HD), peritoneal dialysis (PD), and patients on conservative management (CM). Responses to self-administered Hospital Anxiety and Depression Scale (HADS) and Kidney Disease Quality of Life Short Form 36 (KDQOL-SF36) questionnaires and demographic and baseline laboratory parameters were compared between treatment modalities using the Student t-test and Pearson Chi-square test. Linear regression was used to test for independent effect where significant difference was observed. Results: HADS anxiety score was highest (p <0.001) and KDQOL-SF36 emotional wellbeing was poorer in HD (p <0.001) Social functioning (p = 0.011) and physical limitation due to pain (p = 0.03) were poorer in PD. Unemployment (p = 0.044) was more frequent in HD; fewer PD patients required social support grants (p = 0.008). Significant independent effect was found for age (p = 0.009), employment (p = 0.007), and Haemoglobin (Hb) (p = 0.025) on anxiety; HD worsened (p = 0.037) and PD improved (p = 0.007) anxiety. Unemployment (p <0.001) and low Hb (p = 0.018) worsened depression. PD improved (p = 0.002) and HD worsened (p <0.001) emotional well-being. PD worsened social functioning (p = 0.0018). PD (p = 0.007) and higher phosphate (p = 0.022) worsened and HD (p = 0.01) and higher Hb (p = 0.02) improved physical discomfort / pain. Conclusion: Advanced CKD increases anxiety and depression and limits quality of life. PD improves mental health and emotional wellbeing and preserves ability to undertake economic activity but limits social functioning and causes greater physical discomfort. Targeting Hb and phosphate may ameliorate modality effects on mental health and quality of life.
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    Local control of Ewing sarcoma/peripheral primitive neuroectodermal tumour using multimodality treatment approach in children and adolescents in Johannesburg: a retrospective review
    (2024) Ndamase, Ncumisa
    Background Ewing sarcoma and peripheral primitive neuroectodermal tumours (ES/pPNET) are aggressive bone and soft tissue malignancies that are most common in children and adolescents. The use of a multimodality treatment approach improves outcome especially following advancement in systemic chemotherapy. Local treatment strategies for local disease control continues to show promise in improving overall survival and local control rates in patients with localized disease. Objective The objective of this study was to determine the effectiveness of treatment in ES/pPNET by comparing surgery and radiotherapy in overall disease and event free survival. Materials and Methods This was a retrospective analysis of medical records of ES/pPNET patients treated in a public academic institution in Johannesburg. Records of fifty-four (54) patients with localized tumours treated from January 2000 to December 2015 were included in the study. Five-year overall survival and event-free survival as well as incidence of recurrence were estimated using the Kaplan-Meier for the analyzed cohorts. Cox regression models were used for analysis of prognostic factors and estimating odd ratios with 95% confidence intervals. Results The estimated 2-year and 5-year overall survival (OS) was 88.9% (95% CI: 0.7693 – 0.9485) and 77.7% (95% CI: 0.6400 – 0.8664) respectively. Based on the local treatment received, the 5-year OS was 73.3% for surgery only, 83.3% for radiotherapy only and 76.0% for patients that had both surgery and radiotherapy In total, 18 (33.3%) of the 54 patients experienced recurrence; isolated distant recurrence occurred in 15 patients, the commonest site being the lungs (55.6%), followed by the [vi] spine (14.8%) and the pelvis (14.8%). Combined local and distant recurrence occurred in 3 patients. The site of local recurrence in these three (3) was the pelvis. The estimated 5-year event free survival (EFS) for all patients was 65.8% (95% CI: 0.5130 – 0.7691). The estimated 5-year EFS was 63.6% (95% CI: 0.2042 – 0.8045) for surgery only, while for radiotherapy only, 66.7% (95% CI: 0.3771 – 0.8234) and for both surgery and radiotherapy 66.2% (95% CI: 0.4347 – 0.8149). No patient in this cohort of ES/pPNET had isolated local recurrence or failure following local treatment. Patients with tumour size ≥ 8cm are 2.54 times likely to have local or distant tumour recurrence compared to patients with tumours < 8cm (OR: 2.54, 95% CI: 1.05-6.13, p=0.019). Patients with high pretreatment lactose dehydrogenase (LDH) level (at diagnosis), had approximately 5 times increased odds of recurrence compared with those with normal LDH (OR: 4.59, 95% CI: 1.34-15.74, p=0.010). The factors associated with recurrence were tumour size (OR: 2.64, 95% CI 1.08-6.45) and LDH (OR: 4.01, 95% CI 1.15-13.99). For mortality, LDH level (p<0.001) and disease recurrence (p<0.001). Conclusion Overall disease control in ES/pPNET is comparable for patients treated with surgery or definitive radiotherapy with chemotherapy. The risk of local failure is commoner in patients treated with definitive radiotherapy than surgery. Although radiation therapy is frequently applied in unfavorable disease group, local control outcomes are good and in many cases similar to surgical treatment outcomes. Distant failures account for the majority of relapses in this disease; therefore there is need for better and improved systemic therapies for both local and distant disease control
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    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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    Pattern of thyroid disorders in black population referred for thyroid scintigraphy at Chris Hani Baragwanath Hospital, South Africa
    (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.
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    Machine Learning on biochemical data for the prediction of mutation presence in suspected Familial Hypercholesterolaemia
    (2024) Hesse, Reinhardt
    Background Familial hypercholesterolemia (FH) is a common monogenic disorder and, if not diagnosed and treated early, results in premature atherosclerotic cardiovascular disease. Most individuals with FH are undiagnosed due to limitations in current screening and diagnostic approaches, but the advent of machine learning (ML) offers a new prospect to identify these individuals. Our objective was to create a ML model from basic lipid profile data with better screening performance than low-density lipoprotein cholesterol (LDL-C) cut-off levels and diagnostic performance comparable to the Dutch Lipid Clinic Network (DLCN) criteria. Methods The ML model was developed using a combination of logistic regression, deep learning and random forest classification and was trained on a 70% split of an internal dataset consisting of 555 individuals clinically suspected of having FH. The performance of the model, as well as that of the LDL-C cut-off and DLCN criteria, were assessed on both the internal 30% testing dataset and a high prevalence external dataset by comparing the area under the receiver operator characteristic (AUROC) curves. All three methodologies were measured against the gold standard of FH diagnosis by mutation identification. Furthermore, the ML model was also tested on two lower prevalence datasets derived from the same external dataset. Results The ML model achieved an AUROC curve of 0.711 on the high prevalence external dataset (n=1376; FH prevalence=64%), which was superior to that of the LDL-C cut off alone (AUROC=0.642) and comparable to that of the DLCN criteria (AUROC=0.705). The model performed even better when tested on the medium prevalence (n=2655; FH prevalence=20%) and low prevalence (n=1616; FH prevalence=1%) datasets, with AUROC curve values of 0.801 and 0.856 respectively. Conclusions Despite the absence of clinical information, the ML model was better at correctly identifying genetically confirmed FH in a cohort of individuals suspected of having FH than the LDL-C cut-off tool and comparable to the DLCN criteria. The same ML model performed even better when tested on two cohorts with lower FH prevalence. The application of ML is therefore a promising tool in both the screening for, and diagnosis of, individuals with FH.
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    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 comparable