Introductory Editorial Hardcastle, T
South African medical journal,
05/2023, Letnik:
113, Številka:
5
Journal Article
Recenzirano
Odprti dostop
This is the introduction article and editorial that will address the latest approaches to safe management of snakebite in South Africa and shares the evidence and expert consensus from the recent ...South African Snakebite Symposium (SASS) meeting held in July 2022.
This introduction and editorial addresses the latest approaches to safe management of snakebite in South Africa (SA), and shares the evidence and expert consensus from the recent SA Snakebite ...Symposium (SASS) meeting held in July 2022.
Vascular injury management remains an extremely challenging task. The fundamental principles of management are bleeding arrest and flow restoration, to avoid death and amputation. With advances in ...medicine, there has been a shift from ligation to primary repair which has resulted in a fall in amputation rate from 50 % in World War II to less than 2 % in civilian injuries.
A retrospective cross-sectional study was conducted on ICU requiring polytrauma patients with vascular trauma admitted between January 2013 and December 2021. Additional data were collected prospectively from January 2022 to December 2022. All data was from an ethics approved Trauma Registry. The injury was either confirmed by imaging or via exploration. The pre-designed data proforma acquired the following variables: age, mechanism of injury, injured vessel, associated injury, management of the vessel, and management of the associated injury. The data were analysed using Stata version 17 (StataCorp, College Station TX). Frequencies and percentages were calculated to summarise numerical data An ethical clearance was granted by the University of KwaZulu-Natal BREC (BREC 0004353/2022) and the KZN Department of Health. All data were de-identified in the data collection sheet.
There were 154 arterial injuries and 39 venous injuries. The majority, 77 (50 %) of arterial injuries were managed via open strategies, and 36 (23 %) were managed via endovascular intervention. The majority, 20 (51 %) of venous injuries underwent open ligation, and 12 (31 %) were managed non-surgically. The highest number of endovascular interventions was observed in aortic injuries. For a total of 25 aortic injuries, 22 (83 %) were managed endovascular (TEVAR) and 2 (8 %) were managed non-operatively.
The choice between the endovascular and open approach depends on the injured blood vessel. The majority of venous injuries were treated with open ligation in this cohort.
Background: Improving emergency surgical care for children requires information on the causes of admissions and the variables affecting outcome. There is a lack of such data in the South African ...context. Methods: This retrospective study was conducted from January 2016 to December 2017. Data was collected on all children (< 12 years of age) requiring admission with emergency surgical conditions. Infrastructure and staffing ratios were determined prior to data collection. Information was sourced from admission and discharge books, patient files and theatre registers. Variables of age, sex, referral source, diagnosis, length of stay, surgical treatment and outcome including death were collected. Results: Four hundred and thirty-five of the 1 048 children (42%) admitted were in the 0-2-year age group. Trauma (258), sepsis (564) and burns (226) were the main causes. The median hospital stay was 3 days (IQR 2-5), however, for burns patients, the median stay was 4 days (IQR 2-9). Surgery was performed on 279 (27%) admissions. Eight (0.8%) died, six of which were due to burns. Clinical status prior to death was poorly documented. A dedicated high care unit and burns isolation rooms were lacking. Surgeon/population and child/nurse ratios were respectively 1.48/100 000 and 7-12/1. Conclusion: This study found that the emergency paediatric surgical burden is significant. Sepsis and trauma combined are the leading cause of emergency admissions. Burns had the highest mortality. Although mortality was low, improvements of staff to patient ratios and the institution of an early warning system could reduce mortality. Keywords: surgery, children, trauma, procedure, system, nursing
Snakebite management is largely driven by expert opinion and consensus. However, there are a few large retrospective studies and randomised controlled trials that have improved the quality of medical ...guidance currently available. South African snakes are different in venomous potential to snakes in other parts of the world, and it behoves the hospital provider and the average medical practitioner to know the current best practice concepts concerning assessment, treatment and antivenom use. The recent South African Snakebite Symposium meeting in July 2022 provided an update and national consensus from which this Hospital Care document is derived.
Background: This study aims to investigate any discrepancy in interpretation of computed tomography (CT) angiograms (CTA) in suspected traumatic arterial injury by vascular specialists and radiology ...specialists, and the influence of any discrepancies on patient outcome.Methods: A prospective observational comparative study of 6-month duration was undertaken at a tertiary hospital in Durban, South Africa. Haemodynamically stable patients with suspected isolated vascular trauma admitted to a tertiary vascular surgery service who underwent a CTA on admission were reviewed. The interpretations of CTAs were compared between vascular surgeons, vascular trainees and radiology trainees with the consultant radiologist report as the gold standard comparator.Results Of 131 CTA consultant radiologist reports, the radiology registrar concurred with 89%, which was less than the vascular surgeon who correctly interpreted 120 out of 123 negative cases with three false positives. There were no false negatives or descriptive errors. A 100% sensitivity (95% CI 63.06–100) and 97.62% (95% CI 93.20–99.51) specificity was noted for the vascular surgeon. Overall agreement was 97.71 % with Cohen’s kappa value = 0.83 (95% CI 0.64–1.00) indicating very good agreement. Apart from three negative direct angiograms, patient management and outcome were not impacted by the vascular surgeons’ errors in interpretation.Conclusion: There is very good inter-observer agreement in the interpretation of CTAs in trauma between the vascular surgeon and radiologist with no negative impact on patient outcome.
Snake bite management is largely driven by expert opinion and consensus, however there are a few large retrospective studies and RCT's that have improved the quality of medical guidance currently ...available. South African snakes are different in the venomous potential and it behooves the hospital provider and the average medical practitioner to know the current best practice concepts concerning assessment, treatment and antivenom use. The recent SASS meeting in July 2022 provided an update and national consensus from which this Hospital Care document is derived.
•Medical documentation in South African EMS has not been extensively researched.•Patient Report Forms (PRF) can help prevent the loss of information regarding the patient that commonly occurs during ...the patient handover process.•Medical records are now seen as part of patient care and the information recorded on the PRF serves as proof of how the patient was managed in the prehospital phase.•To our knowledge there is no recent study, especially in the African context that investigates the information that is required to be recorded on a PRF.
This review aimed to compile a list of essential variables from the patient assessment, care provided out-of-hospital and the patient handover over process that should be recorded on a Patient Report Form (PRF). A scoping review was conducted to identify articles concerning the recording of medical information on the PRF in the prehospital environment.
A three-step search strategy was used to systemically search published literature. A Boolean method using synonymous phrases related to patient handover variables required for PRF competition was developed based on an initial online search of key phrases. Using the Boolean phrase, a scoping review (guided by a protocol developed a priori) was conducted. The search was conducted using PubMed, CINAHL, Summon and Scopus. A PCC framework was used to guide the inclusion criteria of identified articles.
The database search yielded 2461 results. Duplicates (n = 736), articles published prior to the year 2000 (n = 260), and non-English results (n = 30) were removed. The remaining 1435 articles underwent title and abstract screening to determine the relevance to the study topic. This resulted in articles apparently relevant to the study (n = 47) and these underwent full-text review. Following full-text review 25 articles were included in the study. Patient related information and variables detailing the condition of the patient, including, patient demographics, vital signs, patient assessment and treatment initiated and the manner in which this information is transferred during the patient handover are factors that are important during patient hand over.
The information on the PRF prevents potential loss of critical patient information and details of the patient's condition and treatment from the prehospital field. The development of an appropriate checklist to quality assure PRF's by ensuring that all vital information is captured on the PRF is proposed.
Resistance to chemotherapy in ovarian cancer is poorly understood. Evolutionary models of cancer predict that, following treatment, resistance emerges either because of outgrowth of an intrinsically ...resistant sub-clone or evolves in residual disease under the selective pressure of treatment. To investigate genetic evolution in high-grade serous (HGS) ovarian cancers, we first analysed cell line series derived from three cases of HGS carcinoma before and after platinum resistance had developed (PEO1, PEO4 and PEO6; PEA1 and PEA2; and PEO14 and PEO23). Analysis with 24-colour fluorescence in situ hybridisation and single nucleotide polymorphism (SNP) array comparative genomic hybridisation (CGH) showed mutually exclusive endoreduplication and loss of heterozygosity events in clones present at different time points in the same individual. This implies that platinum-sensitive and -resistant disease was not linearly related, but shared a common ancestor at an early stage of tumour development. Array CGH analysis of six paired pre- and post-neoadjuvant treatment HGS samples from the CTCR-OV01 clinical study did not show extensive copy number differences, suggesting that one clone was strongly dominant at presentation. These data show that cisplatin resistance in HGS carcinoma develops from pre-existing minor clones but that enrichment for these clones is not apparent during short-term chemotherapy treatment.
Abstract Purpose This study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and ...trauma ICU. Methods We performed a retrospective observational study of 666 patients admitted to a trauma ICU from a level I trauma unit from March 2008 to March 2011. We conducted multivariable logistic regression to identify independent predictors for AKI and mortality. Results The overall incidence of AKI was 15% ( n = 102). Median injury severity score (ISS) was 25 (inter quartile range IQR 16–34) and mean age was 39 (SD 16.3) in the AKI group. Thirteen patients (13%) were referred with rhabdomyolysis associated renal Failure. Overall mortality in the AKI group was 57% ( n = 58) but was significantly lower in the rhabdomyolysis Failure group (23% versus 64%; p = 0.012). AKI was independently associated with older age, base excess (BE) < −12 (odd ratio OR 22.9, 95% confidence interval CI 1.89–276.16), IV contrast administration (OR 2.7 95% CI 1.39–5.11) and blunt trauma (OR 2.2 95% CI 1.04–4.71). AKI was an independent predictor of mortality (OR 8.5, 95% CI 4.51–15.95). Thirty-nine (38%) patients required renal replacement therapy. Conclusions AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden.
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