Aortobifemoral bypass for aorto-iliac occlusive disease in the population of KwaZulu-Natal: an in-depth assessment.

Masters Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Quality of scanned PDF has been compromised owing to poor condition of original document

Knowledge of cardiovascular disease in South African HIV-positive surgical patients – A pilot survey

Background: Medical and surgical HIV-positive patients are at risk of cardiovascular disease (CVD). Surgical patients are admitted to hospital for a few days around the time of their surgeries, allowing sufficient opportunity for health promotion interventions. Health promotion could improve CVD knowledge and encourage lifelong healthy behaviours. However, this approach requires that baseline CVD knowledge first be established. This study sought to determine the knowledge of CVD in HIV-positive South African (SA) surgical patients.Methods: This was a prospective pilot survey of HIVpositive surgical patients who attended a tertiary hospital in Durban, South Africa, between 1 October 2016 and 31 March 2017. Patients completed 2 questionnaires: (1) a demographic characteristics questionnaire, and (2) a CVD knowledge questionnaire (identifying risk factors and signs/symptoms of myocardial infarction and stroke). All data were analysed using descriptive statistical methods.Results: The study sample consisted of 39 HIV-positive surgical patients. Correct responses for the items on the CVD knowledge questionnaire ranged between 0.0% and 61.5% for risk factors, and between 0.0% and 89.7% for signs/symptoms.Conclusion: Knowledge of CVD risk factors and signs/ symptoms in this study was less than desirable. Levels of CVD knowledge are likely a function of educational attainment

Clinical spectrum, management, and outcome of rectovaginal fistulae

Background: There are limited reports on rectovaginal fistulae in South Africa. Methods: This was a prospective analysis of all patients undergoing treatment for RVF at a tertiary referral hospital. Data was extracted from the database between2006 and 2018 and analysis included demographics, aetiology, management, and outcome. The main outcome measure was healing of the fistula. Results: Fifty patients were identified [Median age 36 (IQR 28-42) years]. HIV status was positive (31), negative (5) and unknown (14). Commonest causes were obstetric (17), perineal sepsis (14) and spontaneous (8) (Table 2). Median duration of symptoms was 34.5 months (IQR 5-72) (Diagram 1). Forty-two patients underwent 55 surgical procedures (including 14 redos). In 32 patients RVF repair was undertaken under colostomy cover and 28/42 fistulae healed after the initial repair (66.7%), final success rate was (41/42) 97.6%. Two of eight fistulae healed after non-operative management (25%). Conclusion: Obstetric injury was the leading cause of RVF. HIV positive patients predominated. Spontaneous fistulae were seen in immunocompromised patients. Success rate was 97.6% over a healing time of 3 months. Non-operative management led to healing in 25% of cases

Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis.

OBJECTIVES: The present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity. SETTING, PARTICIPANTS AND OUTCOME MEASURES: We sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality. RESULTS: The study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant. CONCLUSIONS: On the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate-sugar diets. PROSPERO REGISTRATION NUMBER: CRD42015023257

Incidence And Risk Factors For Surgical Site Infection Following Laparotomy At A South African Quaternary Hospital

Published ArticleBackground: A published report of surgical site infection (SSI) incidence and risk factors following laparotomy in a South African (SA) setting is lacking. This information would have important implications for SSI clinical prediction rules in SA patients undergoing this common surgical procedure. This study sought to determine the incidence and associated risk factors for SSI following laparotomy in a SA setting. Methods: This was a retrospective chart review study of 439 patients who underwent laparotomy at a SA quaternary hospital over a 5-year period. Demographic information, comorbidities, medication use, and surgery-related variables were collected for each patient. The Centers for Disease Control definition of SSI was used in this study. The incidence of SSI was determined using conventional epidemiological methods. Logistic regression was used to identify risk factors for SSI. Results: The incidence of SSI was 16.6% (CI: 13.4-20.4%). Risk factors for SSI included infectious indication for surgery (Odds Ratio, OR: 3.32, CI: 1.16-9.47; p=0.003), preoperative non-steroidal anti-inflammatory use (OR: 2.82, CI: 1.33-5.95; p=0.007), preoperative hypoalbuminemia (OR: 2.47, CI: 1.12-5.42; p=0.025), Bogota bag use (OR: 2.23, CI: 1.05-4.74; p=0.036), and perioperative blood transfusion (OR: 2.51, CI: 1.33-4.75; p=0.004). Conclusion: The incidence of SSI in SA patients undergoing laparotomy is higher than that reported for mixed surgical populations. Several risk factors for SSI were identified. The prognostic relevance of these risk factors, and the reduction in SSI risk when these factors are addressed requires further investigation

Incidence of chemotherapy-induced neutropenia in HIV-infected and uninfected patients with breast cancer receiving neoadjuvant chemotherapy.

BACKGROUND: Chemotherapy-induced neutropenia (CIN) can result in poor tolerance of chemotherapy, leading to dose reductions, delays in therapy schedules, morbidity and mortality. Actively identifying predisposing risk factors before treatment is of paramount importance. We hypothesised that chemotherapy is associated with a greater increase in CIN and its complications in HIV-infected patients than in those who are not infected. OBJECTIVE: To establish the incidence of CIN in HIV-infected and uninfected patients undergoing chemotherapy. METHODS: A retrospective chart review and analysis was conducted in the oncology departments at Inkosi Albert Luthuli Central Hospital and Addington Hospital, Durban, South Africa. The study population consisted of 65 previously untreated women of all ages with stage II - IV breast cancer and known HIV status treated with neoadjuvant chemotherapy from January 2012 to December 2015. RESULTS: HIV-infected patients formed 32.3% of the group, and 95.2% of them were on antiretroviral therapy. The mean age (standard deviation (SD)) of the cohort was 48.5 (13.2) years (40.6 (9.6) years for the HIV-infected group v. 52.0 (13.1) years for the uninfected group; p<0.001). Ninety-five neutropenia episodes were observed (rate 0.85 per 1 year of follow-up time). Following multivariate adjustment, patients with HIV infection were almost two times more likely to develop CIN (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.06 - 2.92; p=0.029. A high baseline absolute neutrophil count (ANC) (HR 0.80, 95% CI 0.68 - 0.95; p=0.005) remained significantly associated with protection against CIN. CONCLUSIONS: HIV-infected patients were younger than those who were not infected, and presented at a more locally advanced stage of disease. HIV infection was an independent predictor for CIN. HIV-infected patients had an almost two-fold increased risk of developing CIN and developed neutropenia at a much faster rate. A high baseline white cell count and ANC were protective against CIN

Knowledge and practice of diabetic foot care – a scoping review

BACKGROUND AND AIMS : This review aims to systematically map global evidence on foot-care knowledge and practices in relation to diabetes mellitus (DM) and identify areas that need further research. METHODS : Database searches were undertaken using Google Scholar, Medline (PubMed), Academic Search Complete (EBSCOhost), and Medline (EBSCOhost). Studies were initially sought by title and focused on knowledge of diabetic foot ulcer burden. The framework by Arksey and O’Malley and the PRISMA-SCR guidelines were used to guide the methodology. The themes explored were principles of foot-care knowledge and practice and these were reported using content analysis. The mixed-methods appraisal tool (MMAT) was employed to appraise the quality of the primary studies. RESULTS : Fifty-eight studies published between 2008 and 2018 met the inclusion criteria. Participants in various studies had varying degrees of foot-care knowledge and practice, including foot inspection, foot hygiene, glycaemic control, and foot protection. Many people had knowledge of the various aspects of foot care but fewer practiced proper foot care. The MMAT showed the majority of the articles to be of high quality. CONCLUSIONS : Level of foot-care knowledge and practice varied in the studies. A need for intervention on foot care was highlighted.http://www.elsevier.com/locate/dsx2022-04-07hj2022School of Health Systems and Public Health (SHSPH