History provides wonderful insights into how society develops, providing innumerable lessons that can be used as individuals and institutions move into the future. The history of medicine provides ...particular value, yet it is so often overlooked by the present, society taking for granted what has often been a tremendous struggle to achieve. This overview of the history of paediatric surgery at the University of the Witwatersrand provides amazing insights into what has been achieved in a period spanning three centuries.
Background
The Global Initiative for Children's Surgery group published the Optimal Resources for Children's Surgery (OReCS) document outlining the essential criteria and strategies for children's ...surgical care in low‐resource settings. Limited data exist on subspecialties in pediatric surgery and their contribution to global surgery efforts. The study aimed to evaluate the development of subspecialty units within Chris Hani Baragwanath Academic Hospital (CHBAH) Department of Pediatric Surgery (DPS) from January 1, 2018 to December 31, 2021 using selected OReCS strategies for the improvement of pediatric surgery.
Methods
A retrospective descriptive research design was followed. The study population consisted of CHBAH PSD records. The following data were collected: number of patients managed in PSD subspecialty unit (the units) clinics and surgeries performed, number of trainees, available structures, processes and outcome data, and research output.
Results
Of the 17,249 patients seen in the units' outpatient clinics, 8275 (47.9%) burns, 6443 (37.3%) colorectal, and 2531 (14.6%) urology. The number of surgeries performed were 3205, of which 1306 (40.7%) were burns, 644 (20.1%) colorectal, 483 (15.1%) urology, 341 (10.6%) hepatobiliary, and 431 (12.8%) oncology. Of the 16 selected strategies evaluated across the 5 units, 94% were available, of which 16.4% was partly provided by Surgeons for Little Lives. Outcome data in the form of morbidity and mortality reviews for all the units is available, but there is no data for timeliness of care with waiting lists. There were 77 publications and 41 congress presentations.
Conclusion
The subspecialty units respond to the global surgical need by meeting most selected OReCS resources in the clinical service provided.
The evolution of social behavior depends on genetic changes, yet, how genomic variation manifests itself in behavioral diversity is still largely unresolved. Chromosomal inversions can play a pivotal ...role in producing distinct behavioral phenotypes, in particular, when inversion genes are functionally associated with hormone synthesis and signaling. Male ruffs exhibit alternative reproductive tactics (ARTs) with an autosomal inversion determining two alternative morphs with clear behavioral and hormonal differences from the ancestral morph. We investigated hormonal and transcriptomic differences in the pituitary and gonads. Using a GnRH challenge, we found that the ability to synthesize testosterone in inversion carriers is severely constrained, whereas the synthesis of androstenedione, a testosterone precursor, is not. Inversion morphs were able to produce a transient increase in androstenedione following the GnRH injection, supporting the view that pituitary sensitivity to GnRH is comparable to that of the ancestral morph. We then performed gene expression analyses in a second set of untreated birds and found no evidence of alterations to pituitary sensitivity, gonadotropin production or gonad sensitivity to luteinizing hormone or follicle-stimulating hormone across morphs. Inversion morphs also showed reduced progesterone receptor expression in the pituitary. Strikingly, in the gonads, inversion morphs over-expressed STAR, a gene that is located outside of the inversion and responsible for providing the cholesterol substrate required for the synthesis of sex hormones. In conclusion, our results suggest that the gonads determine morph-specific differences in hormonal regulation.
•A supergene constrains testosterone, but not androstenedione, synthesis.•Inversion morph males have low testosterone and high gonadal STAR expression.•Pituitary sensitivity to GnRH is similar across the three Ruff male morphs.•Pituitary progesterone receptor expression is reduced in Faeder ‘female-mimic’ males.
More than twice as much carbon is held in soils as in vegetation or the atmosphere, and changes in soil carbon content can have a large effect on the global carbon budget. The possibility that ...climate change is being reinforced by increased carbon dioxide emissions from soils owing to rising temperature is the subject of a continuing debate. But evidence for the suggested feedback mechanism has to date come solely from small-scale laboratory and field experiments and modelling studies. Here we use data from the National Soil Inventory of England and Wales obtained between 1978 and 2003 to show that carbon was lost from soils across England and Wales over the survey period at a mean rate of 0.6% yr-1 (relative to the existing soil carbon content). We find that the relative rate of carbon loss increased with soil carbon content and was more than 2% yr-1 in soils with carbon contents greater than 100 g kg-1. The relationship between rate of carbon loss and carbon content is irrespective of land use, suggesting a link to climate change. Our findings indicate that losses of soil carbon in England and Wales--and by inference in other temperate regions--are likely to have been offsetting absorption of carbon by terrestrial sinks.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background. Renal transplantation is the gold-standard therapy for end-stage renal disease. Decision-making around the acceptance of deceased-donor organs is complex and time sensitive. Risk scoring ...systems for both donors and recipients attempt to simplify the allocation of renal grafts to the most appropriate recipient. Objectives. To investigate the role of these transplant risk scores in the South African (SA) setting. Methods. A total of 188 adult deceased-donor organ referrals over the 9-year period 1 January 2013-31 December 2021 were included. The Kidney Donor Risk Index (KDRI) and the UK KDRI were calculated for each donor. Recipients who were allocated these grafts were characterised, and the Hennepin Transplant Risk Score and the Kidney Transplant Morbidity Index (KTMI) were calculated. Results. The median (interquartile range) KDRI was 1.2 (0.9-1.6), confirming that low- to average-risk donors were being utilised. Similarly, the median UK KDRI was 0.9 (0.8-1.2). Both these scores performed poorly in predicting graft and patient survival, with a C-statistic of 0.5. Renal recipient risk scores also demonstrated low- to average-risk patients being transplanted, with a median Hennepin score of 2-4 points and a KTMI of 2 points. These recipient scores predict increased recipient mortality at high scores, albeit with low sensitivity, and were not significantly associated with graft survival. Conclusion. Deceased-donor and renal recipient risk scores commonly used internationally performed poorly in predicting graft survival in our cohort, and should be used with caution in the SA setting. A conservative approach to organ donor referral and utilisation as well as renal transplant recipient listing was noted. S Afr Med J 2024;114(3b):e1321.
Background. South African transplant centres are faced with significant challenges in meeting the need for liver transplantation, owing to the low and ever-decreasing number of deceased-donor organs. ...To increase organ utility, deceased-donor split-liver transplant (DDSLT) and living-donor liver transplant (LDLT) programmes were initiated in the Wits Transplant Unit. Objective. To evaluate outcomes of the LDLT and DDSLT programmes. Methods. A retrospective analysis of de-identified recipient and donor variables from all adult and paediatric DDSLTs and LDLTs conducted between 2013 and 2021 was performed. Comparison of categorical study variables between graft types was done with the x2 test. Continuous variables were compared by means of the independent samples t-test. Cox proportional hazards regression was performed to examine the effect of graft type on recipient and graft survival. All comparisons were made unadjusted, and adjusted for recipient age, recipient ethnicity, donor sex, and graft-weight-to-recipient-weight ratio (GWRWR) (for the paediatric cohort); and for donor age and GWRWR (for the adult cohort). Results. A total of 181 paediatric and 48 adult liver transplants have been performed since the inception of the two programmes. Chronic liver failure, specifically intra- and extrahepatic cholestatic disease, was our main indication for liver transplantation in both cohorts. There were no significant differences between the DDSLTs and LDLTs in respect of pre- or post-discharge intervention, in-hospital mortality, length of stay, and recipient or graft survival within both the paediatric and adult groups. Our overall 1- and 3-year survival estimates (95% confidence intervals) were 77% (70%-83%) and 71% (64%-78%) for the paediatric cohort, and 77% (62%-87%) and 66% (50%-78%) for the adult cohort, respectively. Conclusion. The results of this study demonstrate comparable outcomes between DDSLT and LDLT, indicating that both methods are effective approaches to optimise organ utilisation for liver transplantation within our setting. S Afr Med J 2024;114(3b):e1366.
Background Road traffic accidents (RTAs) are a leading cause of injury and death globally, particularly among children. Pedestrians are most often injured, especially in middle- and low-income ...countries. The epidemiology, patterns and severity of injuries in children involved in RTAs in our community are hard to obtain.Objectives To evaluate the aetiological spectrum, injury characteristics and treatment outcomes of paediatric patients involved in RTAs, who presented to Chris Hani Baragwanath Academic Hospital (CHBAH), a tertiary hospital in Soweto, South Africa.Methods Patients ≤10 years old, who were involved in RTAs and seen at CHBAH, were included in the study.Results The study was conducted from 20 August 2017 to 31 March 2018, and included the data of 156 patients. Their ages ranged from 13 days to 10 years (65% were boys). Pedestrian vehicle accidents accounted for 78.8% of the injuries, with 60.8% of the children being unaccompanied by an adult. Motor vehicle accidents accounted for 19.2% of the injuries, with 92% of the children being unrestrained in the vehicle. Of the patients, 73.2% (n=112/153) underwent radiography and 44.4% required computed tomography (CT) scans, the majority being CT scans of the brain for suspected head injuries. Soft-tissue injuries accounted for 78.9% of cases, followed mainly by head (39.7%) and limb (16%) injuries. Only 12% of patients required surgical intervention, with 42% of the operations being for orthopaedic injuries.Conclusion The abovementioned data demonstrate that there is a lack of use of child restraints for children travelling as passengers in vehicles, and inadequate supervision of children on and around roads. This study supports other evidence, as it suggests that the paediatric population involved in RTAs is largely injured as pedestrians, and that males tend to be involved in more RTAs than females. The majority of injuries sustained involved the soft tissues, followed by head injuries.
Background
The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of ...paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH).
Methods
A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified.
Results
A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed.
Conclusion
The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.
In 2022, the Wits Transplant Unit performed 57 liver transplants: 33/57 adult (58%) and 24/57 paediatric (42%) recipients. At the beginning of 2022, 28 candidates were on the adult waitlist. ...Forty-six candidates were added to the waitlist during the year. Sixty-five percent of waitlisted candidate were transplanted. Adult candidates remained on the waitlist for longer than previous years, with 52% of them waitlisted for less than one year before undergoing liver transplantation. There was a decrease in adult pretransplant mortality to 9% in 2021 from 25% in 2020. The most common aetiology in waitlist candidates was alcoholic steatohepatitis (ASH)/non-alcoholic steatohepatitis (NASH) (36%) and in recipients cholestatic (primary sclerosing cholangitis (PSC) and primary biliary sclerosis (PBC)) (40%). Most adult recipients received a deceased donor graft (79%). Unadjusted recipient one- and three-year survivals were 75% (95% confidence interval (CI) 65-83) and 74% (95% CI 65-81), respectively. In the paediatric population, the most common aetiologies for both pretransplant candidates and transplant recipients remained cholestatic disease and acute liver failure. There was a decrease in paediatric pretransplant mortality from 27% in 2017 to 6% in 2021. Unlike the adult cohort, most paediatric recipients received a living donor graft (79%). Unadjusted one-year and three-year survival rates were 85% (95% CI 75-92) and 68% (95% CI 56-77), respectively. S Afr Med J 2024;114(3b):e1365.
Background. The Wits Transplant Unit in Johannesburg, South Africa (SA), performed its first paediatric liver transplant in 2005. Initial experiences from the unit were published in 2012 and 2014. ...Since then, significant progress has been made in building the capacity of the unit, improving outcomes and enhancing service delivery. Objectives. To present a broad overview and update of the unit's 17-year experience. Methods. We conducted a retrospective review of all paediatric liver transplants performed in Johannesburg from 1 January 2005 to 31 December 2021 with a minimum 1-year follow-up. Data were accessed from the Wits Donald Gordon Medical Centre Paediatric Liver Transplant Research Database (University of the Witwatersrand human research ethics approval ref. no. M190749). The following data were collected: donor and recipient sociodemographic and clinical characteristics, details of transplant procedures, and donor graft and recipient outcomes (postoperative complications, and graft and recipient survival). Results. A total of 270 transplants were performed during the review period. Two-thirds of the recipients (n=180; 66.7%) were aged <5 years at time of the transplant, and half (n=135; 50.0%) received a living-donor graft. The most common indication for liver transplant was biliary atresia, followed by acute liver failure. Unadjusted recipient survival was 80.1% (95% confidence interval (CI) 75-85) at 1 year and 68.2% (95% CI 59-75) at 5 years. Waiting-list mortality decreased from 27.3% in 2017 to 5.9% in 2021. One hundred and fifty-four recipients (57.0%) experienced at least one type of surgical complication that required intervention, the most common being biliary in nature (n=91; 33.7%). Conclusion. Over the past 17 years, a sustainable paediatric liver transplantation service has been established in Johannesburg. Livingdonor, split and ABO-incompatible liver transplants have been incorporated in response to the severe organ shortage in SA. However, our outcomes can be improved. Additionally, a national transplant initiative to co-ordinate timeous referrals and expand access to liver transplantation for children with severe acute and chronic liver failure is advised. S Afr Med J 2024;114(3b):e1190.
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