Electronic Theses and Dissertations (Masters)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37931
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Item The clinical spectrum of viridans group streptococcus bacteraemia in paediatric patients at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2023-11) Shongwe, Nkosinathi Sifiso; Petersen, Karen L.; Mabena, Fikile C.Background: Viridans group streptococci (VGS) are often considered organisms of low virulence; however, infection can result in clinically significant sepsis and life-threatening complications in paediatric patients. Objectives: To describe the spectrum of clinical presentation of VGS bacteraemia in paediatric patients, to analyse risk factors, and to describe the antibiotics resistance patterns of VGS. Methods: Cultures of VGS in paediatric patients admitted to Chris Hani Baragwanath Academic Hospital in 2019 were retrieved from NHLS data base. Data was extracted from archived clinical records and analysed. Sepsis scores were calculated at the time of bacteraemia. Results: 133 cultures were identified; 64 (48.1%) polymicrobial cultures (64) and no records 4 (0.03%) were excluded; 65 (48.9%) were analysed. The median age was 1.5 months (range 0.03 to 168, Interquartile range (IQR) 0.2 to 13.25), 27/65 (42%) were neonates. The median duration of hospitalisation was seven days (IQR 3 to 21). The commonest diagnoses were neonatal sepsis 30.8% (n=20) and pneumonia 28% (n=18). The systemic inflammatory response syndrome (SIRS) score was ≥2 in 57% (16/28) patients; paediatric sequential organ failure assessment (pSOFA) score was >2 in 10/24 (42%). Fifty-seven (88%) patients were discharged; three (5%) required ICU admission and 8/65 (12.3%) died. Malnutrition was present in 50% of patients who died. Cephalosporins and penicillin had susceptibility of 89% and 55% respectively. Conclusion: VGS bacteraemia was common in neonates, and pneumonia was a common presentation in this cohort outside the neonatal period. VGS bacteraemia was associated with morbidity and deaths in this cohort. Contribution: VGS should be considered a significant organism when cultured and routine antibiotic susceptibility testing should be performed. Prospective studies are recommended.Item An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2022) 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 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 avoidableItem 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.