Series of rare cases of breast tumour: 8-year review at mankweng Breast Oncology clinic, Limpopo, South Africa

Breast cancer remains the most common cancer in many parts of the world, particularly for women. In March 2015, a Breast Oncology clinic for breast cancer patients was established at Mankweng Hospital. Invasive ductal carcinoma is the most common (87 %) tumour found in Limpopo, and occasionally, another rare tumour of the breast is presented in the Breast Oncology clinic. The aim: The main objective is to share the experience of a rare tumour of the breast came across over the past 8 years since the establishment of the Breast Oncology clinic. Material and Method: Series of rare case reports of Breast tumours and literature review from the Mankweng Breast Oncology Clinic. Result: Rare tumour encountered in Breast Oncology clinic: adenomyoepithelioma, micro-papillary carcinoma of the breast, primary malignant melanoma of the breast, primary non-Hodgkin's lymphoma of the bilateral breast, advanced breast cancer in a case of Down's syndrome, primary neuroendocrine invasive breast carcinoma, sarcoma of the breast. Conclusions: Most of these rare cases are presented to the Breast Oncology clinic in the advanced stage. Breast cancer awareness campaign is highly important for women in Limpopo, particularly when attending primary health care for any other conditions

Profile and pattern of histology specimen of thyroidectomy patients operated in Mankweng hospital, Limpopo province, South Africa

Object of study: To evaluate the histopathologic pattern of the thyroidectomy specimen in patients with goitre who underwent thyroidectomy operation at Mankweng Hospital and to review the profile of thyroid disease in relation to the age, gender & Distribution of thyroid disease which are referred to Mankweng hospital from the districts of Limpopo Province. The problem to be solved: The demographic profile of thyroidectomy patients in this hospital is identified. Hence outreach program can be initiated according to demographic profile. Main scientific results: Total of 62 patients analyzed: Male 2, female 60. Age range 15-70: District: Capricorn 23, Sekhukhune 33, Mopani 6. Histology: 62: Multinodular goitre 47, Papillary carcinoma 5: Hurtle cell carcinoma 3, colloid goitre 2, Diffuse colloid goitre 1, Cavernous haemangioma 1, follicular neoplasm 1, Hashimoto`s Thyroiditis 1, benign thyroid parenchyma with cyst 1 The area of practical use of research results: General surgery department in Regional & Tertiary hospital An innovative technological product: Patient demographic profile for health outreach program. Scope of application of an innovative technological product: General surgery department

Factors influencing of professional nurse resignation from Mankwneg Academic Hospital, Limpopo, South Africa

Professional nurses are registered nurses who provide comprehensive nursing treatment and care to patients at various levels of health care. Intentions to quit a job are frequently associated with employee motivation and job satisfaction factors. It has been observed that some of the health professional nurses are quitting Mankweng academic hospital more frequently and which is affecting the service delivery. There is no research done regarding the turnover of the Professional nurse from this institution. The aim: The main objective of the study is to figure out what factors concern Professional nurses to quit Mankweng Hospital. Material & methods: The study was a retrospective cross-sectional descriptive quantitative design to analyze the profile of all Professional nurses who quit Mankweng Academic Hospital for 5 years from January 2018 to December 2022. Result: A total of 47 professional nurses resigned over 5 years from different departments. Lack of promotions (34 %) was the key reason which made professional nurses quit their job at Mankweng Hospital. Poor working conditions (12.8 %) and work-related stress (12.8 %) are other important reasons for resigning. Conclusions: Lacks of promotions, poor working conditions, and work-related stress are important factors responsible for quitting jobs. Increased staffing, employee support, and enhanced promotion are vital to address to retain the employe

Primary tuberculosis of the breast from mankweng hospital

Object of study: To share our experience with a rare case of Primary Tuberculosis of Breast. The problem to be solved: Tuberculosis of the breast is a rare type of extrapulmonary tuberculosis and usually affects young lactating multiparous women. It accounts for less than 0.1 % of all breast pathologies. Tuberculosis of the breast is often misdiagnosed. Therefore, a high index of suspicion is needed when evaluating cases of breast abscesses, fistulae, or mass. Main scientific results: A case of a 27-year-old female with no known co-morbidities, HIV negative who presented to our Surgical Outpatient Department with a 1-year history of a painless left breast lump. No previous history of pulmonary tuberculosis was reported. Breasts ultrasonography indicated BIRADS (Breast Imaging-Reporting and Data System) V: lesion highly suspicious of malignancy. Histopathological analysis of the core biopsy showed features of a necrotizing granulomatous mastitis with adjacent fat necrosis. Ziehl-Neelsen stain was negative though histological results were worrisome of a mycobacterial infection. Patient responded well to antitubercular therapy as evidenced by lump regression, ulceration healed, peau d’orage currently resolved, and the overall size of the breast is going back to its normal state. The area of practical use of research results: Family medicine physicians, Primary health care center, District level or regional level hospital. An innovative technological product: a high index of suspicion tuberculosis is needed when evaluating cases of breast abscesses, fistulae, or mass. Awareness of this condition is important as it can clinically, and radiologically mimic breast carcinoma. Scope of application of an innovative technological product: Family medicine physicians, Primary health care center

Safety and affordability of an elective Saturday list at Pietersburg Hospital, Limpopo, South Africa

Background. The backlog of patients waiting for operations continues to be a problem in many public hospitals in South Africa (SA), with elective surgery procedures being postponed for up to 2 years.Objective. To determine the rate of death in hospital or out of hospital within 30 days of an elective procedure performed on a Saturday, and to determine the cost incurred by paying staff members who perform these operations.Method. A prospective, observational descriptive cohort study of all patients undergoing inpatient general surgery operations during weekdays and weekends between 1 September 2015 and 31 August 2016 (1 year) at Pietersburg Hospital (PBH), Limpopo, SA. Microsoft Excel 2010 (Microsoft, USA) was used to analyse and derive descriptive statistics. The finance department at the hospital calculated the overtime pay for theatre staff who operated on Saturdays.Results. The study included 1 352 operations (607 elective and 745 emergency procedures). Saturday elective operations contributed 133/607 (22%), and the rate of death for these operations was 1.5%. The most common procedures performed on a Saturday were hernia repair and amputation. The cost for 8 hours of work on a Saturday was ZAR13 900, amounting to a total of ZAR333 600 for 24 Saturdays.Conclusion. Performing minor surgery on a Saturday had a mortality rate of 1.5%, and a theatre staff cost of ~ZAR2 317 per patient, excluding surgeons’ fees. If surgeons were to be paid the costs would be ZAR3 450 per patient

Impact of 20-day strike in Polokwane Hospital (18 August - 6 September 2010)

Background. Doctors’ strikes have a negative effect on hospital performance indicators. Hospital mortality during such strikes is the most important indicator. Objective. To determine the effects of the 2010 strike on Polokwane Hospital. Methods. Information was collected from the Hospital Information System, Polokwane Hospital Casualty Department, wards and theatres. Results. During the 20-day strike, a total of 262 patients were admitted to Polokwane Hospital, with 40 patients to the surgical department; 96 operations were performed in the hospital and 40 in the surgical department; and 50 deaths were reported in the hospital (8 deaths in the surgical department). During 20 days of a non-striking period in May 2010, there were 975 admissions to the hospital, with 125 to the surgical department. In the entire hospital, 340 operations were performed, and 79 in the surgical department. For this period, 61 deaths were reported in the hospital and 12 in the surgical department. Conclusions. The total number of patients admitted to the hospital and the surgical department during the strike was significantly lower than during a non-striking situation. Total mortality during the strike in Polokwane Hospital decreased, compared with the normal situation, but it increased when judged against emergency cases. However, when mortality was qualified by the number of admissions, it showed a significant increase. Strikes seriously and significantly affect service delivery

Nodular thyroid disease and thyroid malignancy: Experience at Polokwane Mankweng Hospital Complex, Limpopo Province, South Africa

Background. Nodular thyroid disease is common throughout the world. Numbers of patients with goitre are increasing worldwide, as also noted in Limpopo Province, South Africa (SA). Globally, thyroid nodules have been reported in 4 - 7% of the population on neck palpation and in 30 - 50% by ultrasonography.Objectives. To review the profile of thyroid disease in patients with goitre presenting to the Department of Surgery at Polokwane Mankweng Hospital Complex (PMHC), Limpopo, SA, to characterise the pattern of malignancy in patients with goitre, and to determine the most common thyroid cancer.Method. A 6-year retrospective study (2003 - 2008) of all patients with thyroid nodules who underwent thyroid surgery at PMHC. Results. The study group included 90 patients (mean age 45 years, range 4 - 80). The male-to-female ratio was 1:17 (5 men, 85 women). Of these patients, 80 (89.9%) had benign lesions, of which 52 (57.8% of the total) were adenomas, 25 (27.8%) multinodular goitres (MNGs), 2 (2.2%) hyperplastic nodules and 1 (1.1%) Hashimoto’s thyroiditis. Ten patients (11.1%) had malignant lesions (7 follicular carcinomas and 3 papillary carcinomas), of which 2 were found in MNGs. Conclusions. Adenoma and MNG were the predominant non-malignant conditions (85.6%). The prevalence of thyroid cancer in our study was 11.1%, and of all 90 patients, 7.8% had follicular carcinoma. The risk of malignancy in MNG was 8.9%. Rates of thyroid nodules and carcinoma were highest in women aged 41 - 60 years. We advocate that total thyroidectomy be considered for MNG, because MNG can harbour incidental carcinoma.

Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa

Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital. Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions. Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January - December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatre booking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Infoversion 7 was used to analyse the data and derive the descriptive statistics. Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients’ condition improved significantly n=3 (1.3%), nurses’ strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860. Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients