School of Clinical Medicine (ETDs)

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Has files: YesSubject: search.filters.subject.Chris Hani Baragwanath Hospital

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    A retrospective study on the outcomes of peripartum hysterectomies for puerperal sepsis at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2024) Olusola, Esther; Naidoo, Poovangela
    Background: Puerperal sepsis is a significant cause of maternal morbidity and mortality, especially in developing countries. Hysterectomy is often performed as a measure of source control for severe uterine infections when conservative treatment fails. The aim of this retrospective study was to examine the outcomes of peripartum hysterectomies performed for puerperal sepsis at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods: A retrospective cross-sectional study was conducted between 1 January and 31 December 2019, on all women who underwent hysterectomies for puerperal sepsis. Data pertaining to demographics, surgical characteristics, microbiological cultures, organ dysfunction scores, and histopathological findings, were extracted from medical records. Women with miscarriages or pregnancies less than 24 weeks’ gestation were excluded. Statistical analysis included descriptive methods and comparative tests using Stata 15.0 software. Organ dysfunction scores were calculated using MODS, SOFA, and qSOFA systems. Ethical approval was obtained prior to conduction of the study. Results: During the study period, 33 hysterectomies were performed for puerperal sepsis, representing 0.17% of the 18,458 deliveries at the hospital. The median age of women was 28 years of age with a median gestational age at delivery of 38 weeks. The majority (88%) underwent total abdominal hysterectomies, while 12% had subtotal hysterectomies. Eighty eight percent of women underwent caesarean section for a fetal distress. The most common organisms cultured in intra-abdominal fluid were Acinetobacter baumannii (26%), Escherichia coli (19%), Klebsiella species (14%) and Enterococcus faecalis (14%). A. baumannii was the predominant pathogen in all four culture mediums. The most common antibiotics used in this hospital for treatment were resistant against most organisms. Women with higher MODS and SOFA scores predominantly cultured resistant organisms. A. baumannii was strongly associated with worse outcomes. Two women (6%) died due to complications of ongoing sepsis. Histological examination revealed that surgeons often underestimated the extent of necrosis (30%) and presence of pus (44%), highlighting the importance of histopathological evaluation for accurate diagnosis and management. Conclusion: This study highlights the rising antibiotic resistance which complicates treatment and emphasises the need for revision of antibiotic stewardship in puerperal sepsis management. Women with higher MODS and SOFA scores predominantly cultured resistant organisms. Further research is required to explore improving surgical recognition of uterine sepsis and whether a total abdominal hysterectomy is actually superior to a subtotal hysterectomy in women with puerperal sepsis.
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    Avascular necrosis (AVN) of the hip in patients operated in the Orthopaedic Arthroplasty Unit at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2023-08) Mwoyofiri, Jephta; Magobotha, S.K.; Frey, C.; Jingo, M.
    Background: Avascular necrosis (AVN) of the femoral head is a progressive structural damage of the head of the femur because of interruption of blood supply to the subchondral bone resulting in the collapse of the head of the femur and secondary arthritis. Moreover, this chronic debilitating disease of the hip causes an immense contribution to the need for total hip arthroplasty (THA) and is common in young persons between the third and fifth decades of life. The aim of the study was to describe the causes of osteonecrosis of the femoral head (ONFH) in patients operated at Chris Hani Baragwanath Academic Hospital (CHBAH) Arthroplasty unit from 2017 to 2022. Methods: A retrospective review of all patients operated between the above-mentioned period, was conducted through collecting the patients’ demographic data, risk factors and treatment given. Results: The study had 285 participants with AVN from a total of 838 patients who had hip surgery. There were 149 (52%) females and 136 (48%) males. The mean age was 51.7 years with a SD 11.4 years. Majority of the patients were in the age group: 50 ‒ 59 years. The main risk factor of AVN was human immunodeficiency virus (HIV) with 117 (41%) patients. Those on highly active anti-retroviral therapy (HAART) were 115 (98%) patients. The median cluster of differentiation 4 (CD4) count was 584 (IQR 470 ‒ 711) and the viral load was undetected in 29 of the 32 (91%) patients with recorded viral load results. Ficat/Arlet stage 4 had 199 (70%) patients and all our patients had total hip replacement. Conclusion: ONFH contributes significantly to the burden of total joint arthroplasty in young patients. As our study has shown, there are several risk factors such as HIV, alcohol use and steroids being among the commonest. Our study draws attention to the significant burden that HIV has on hip pathology. HIV was the commonest cause of AVN at our local health institution and may be in the Sub-Saharan region. However, in our study we could not isolate HAART as a cause of AVN due to inadequate patient records. Majority of patients usually present with advanced stages of ONFH requiring a femoral head sacrificing operation due to late referral and long waiting list before surgery.