Open abdominal wall defects and open spina bifida at a regional hospital in northern KwaZulu-Natal - bellwether conditions for neonatal surgery capacity

BACKGROUND

Abdominal wall defects (AWDs), such as gastroschisis and omphalocele, and neural tube defects (NTDs) such as open spina bifida (SB) are common congenital anomalies. These anomalies are considered a leading cause of neonatal mortality and have been advocated as bellwether conditions to measure access to surgical care.

METHODS

Newborns with open SB or AWD presenting to the nursery at Queen Nandi Regional Hospital over four years (2018-2021) were retrospectively identified. Clinical and electronic database records were reviewed to determine if transfers to definitive tertiary care occurred timeously. Reasons for delays and associated morbidity and/or mortality were investigated.

RESULTS

Sixty-five patients were identified and two were excluded due to unavailable or incomplete records. It took a median of 8 days (IQR 2-18 days) to reach tertiary care, with SB cases waiting significantly longer (median 16 days,IQR 8-25 days) (p = 0.000). Lack of tertiary service capacity was the main reason for delays. The COVID-19 pandemic did not affect time intervals (p = 0.676). Complications were common and overall mortality at our facility was high (n = 11/63, 17.46%).

CONCLUSION

Newborns with open SB or AWDs experience marked delays in reaching definitive care. This is more pronounced for cases of SB and was not influenced by the pandemic. Lack of tertiary service capacity (including bed availability, limited staff, and theatre time) is the most important limiting factor.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

Community service physiotherapists – what do they know about hiv/aids?

Southern Africa  has  been  identified  as  the  heart  of  the  HIV/AIDS pandemic for more than two decades. At its heart lies KwaZulu Natal  with  more  than  a  third  of  its  ten  million  inhabitants  infected.  In  its effort  to  ensure  service  to  all,  the  South  African  National  Department  of Health  has  instituted  several  strategies  to  ensure  some  service  delivery to the rural and urban poor communities. One of these strategies was the introduction of community service in 2002, for physiotherapists and other health  care  professionals  for  one  year  following  successful  completion  of the University degree. In keeping with this, Physiotherapy curricula had to change with the changing needs of the increased demands placed on the new graduates. This study undertook to find out the knowledge, attitudes and experience of the 2004 community service physiotherapists in KwaZulu Natal with regard to HIV/AIDS in their community service year. Seventy-seven community service physiotherapists who serviced KwaZulu  Natal  in  2004  participated.  Of  the  59  contactable  subjects,  47  returned  their  questionnaires  and  only  44 were viable for analysis. The results showed that 100% of the participants had contact with HIV/AIDS patients during  their  community  service  year.  These  therapists  felt  that  a  physiotherapist  can  play  a  vital  role  in  the  care  of  these patients. Seventy five percent believed that their undergraduate programmes did not prepare them adequately to  cope with these patients in the community. However, their exposure to these patients improved their attitudes towards people with the syndrome. In conclusion although these young therapists started off being ill equipped, the exposure improved their ability to meet the challenges. This information is useful for curriculum development and transformation in physiotherapy.

Post-traumatic cholesteatoma... a rare occurrence

Temporal bone fractures and their acute complications have been well described in radiology and ENT journals. This is in contrast to the delayed and rare complication of implantation cholesteatomas. We present the CT findings of two cases of infiltrating cholesteatomas that developed many years following temporal bone trauma.

Imaging findings of meconiuim peritonitis

No abstrac available.

Self-actualization of youth in a summer camp

The self-actualization scores of 57 youths who attended a summer day camp for gifted students were assessed using the Reflections Of Self by Youth (ROSY). Significant sex differences were confirmed. Contrary to Lewis's significant difference (1996) in mean self-actualization between Grades 7 and 8, self-actualization scores in this study were uncorrelated with grade.

Intravenous glucose tolerance tests in women with twin pregnancy

Carbohydrate metabolism was evaluated in 20 twin gestations and 20 singleton pregnancies. The groups were matched for age, parity, weight, height, and gestational age. Intravenous glucose tolerance tests were performed on all women in the third trimester of pregnancy using a glucose load of 0.5 g/kg body weight. Venous plasma glucose and insulin level were measured and statistically compared. The glucose disappearance rates (K) were not different in the two groups. No significant differences in the mean insulin or glucose responses were found between singleton and twin pregnancies. Thus, twin gestations are not at higher metabolic risk of gestational diabetes than are singleton pregnancies.