4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    The profile of patients presenting with ST Elevation Myocardial infarction (STEMI) to a regional emergency department in Gauteng, South Africa
    (University of the Witwatersrand, Johannesburg, 2023-11) Kannai, Jerisha; Moodley, Pravani; Botha, Martin
    Reasons for the research: Cardiovascular disease creates a significant health and socio-economic burden and accounts for 17 million deaths worldwide which equates to 31% of global deaths. (1) In addition, premature deaths from cardiovascular disease in the working population are predicted to increase by 41% by 2030. (2) STEMI is a global concern, with growing morbidity and mortality. (3, 4, 5, 6, 7) The continual increase in STEMI cases will burden our society and the economy. (3) There are few studies in South Africa (SA) on the STEMI population. Further baseline data on our population are required to inform efforts to improve our health system, patient care and to work towards international best practice. Aims: a. To describe the demographic characteristics of patients presenting with STEMI. b. To describe the clinical presentation (symptoms, signs, risk factors, time to treatment) of patients presenting with STEMI in a regional public hospital in Gauteng. c. To determine if age, gender, race, time of presentation and level of prehospital care is associated with adverse outcomes or the need for additional interventions. d. To compare outcomes of patients (admission to general ward / Cardiac Care Unit (CCU) / Intensive Care Unit (ICU) / death). Methods: This was a retrospective observational transverse / cross sectional registry study. Data was collected from a STEMI register maintained at the Emergency Department (ED) of Tambo Memorial Hospital (TMH) from June 2018 until 31 July 2020. Major results: In our study 68% of patients were male. The most common ages at presentation ranged from 40 - 69 years old, with a mean age of 54.4 years. The commonest risk factors included: being a smoker (77%), history of ischemic heart disease (71%), hypertension (55%). The highest prevalence - occurred in the Caucasian race group. Our population group was predominantly transported by private means (52%). Only 10.11% of patients scored red on triage and 30.34% scored orange. The mean duration of symptoms was less than 12 hours. The mean time: from door-to-ECG was 38.5 minutes, door- to- doctor’s assessment was 31,4 minutes, door- to-adjuncts was 53,9minutes and door-to-needle was 101.9 minutes. The majority of patients were transferred out of the ED to cardiology (46.87%) and the general ward (40.62%). Conclusion statement: Within the public sector, SA does not have sufficient data on the STEMI population. The aim of this study was to shed light on the population at TMH. It is crucial to treat STEMI patients speedily and effectively. The findings of this study suggest that patients presenting with STEMI at TMH are similar to patients in other studies, but the time to treatment is longer than the recommended target times. These findings suggest room for improvement in the management of STEMI at TMH. Due to a small sample size, we did not have significant results when analyzing the population group requiring special interventions.
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    A comparison of percutaneous tracheostomy and of surgical tracheostomy in patients in the Neurosurgical ICU at Charlotte Maxeke Johannesburg Academic Hospital
    (2024) Marais, Ruan
    Introduction 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.