Octogenarians with blunt splenic injury: not all geriatrics are the same.

Geriatric trauma patients (GTP) (age ≥ 65 years) with blunt splenic injury (BSI) have up to a 6% failure rate of non-operative management (NOM). GTPs failing NOM have a similar mortality rate compared to GTPs managed successfully with NOM. However, it is unclear if this remains true in octogenarians (aged 80-89 years). We hypothesized that the failure rate for NOM in octogenarians would be similar to their younger geriatric cohort, patients aged 65-79 years; however risk of mortality in octogenarians who fail NOM would be higher than that of octogenarians managed successfully with NOM. The Trauma Quality Improvement Program (2010-2016) was queried for patients with BSI. Those undergoing splenectomy within 6 h were excluded to select for patients undergoing NOM. Patients aged 65-79 years (young GTPs) were compared to octogenarians. A multivariable logistic regression model was used to determine the risk for failed NOM and mortality. From 43,041 BSI patients undergoing NOM, 3660 (8.5%) were aged 65-79 years and 1236 (2.9%) were octogenarians. Both groups had a similar median Injury Severity Score (ISS) (p = 0.10) and failure rate of NOM (6.6% young GTPs vs. 6.8% octogenarians p = 0.82). From those failing NOM, octogenarians had similar units of blood products transfused (p > 0.05) and a higher mortality rate (40.5% vs. 18.2%, p < 0.001), compared to young GTPs. Independent risk factors for failing NOM in octogenarians included ≥ 1 unit of packed red blood cells (PRBC) (p = 0.039) within 24 h of admission. Octogenarians who failed NOM had a higher mortality rate compared to octogenarians managed successfully with NOM (40.5% vs 23.6% p = 0.001), which persisted in a multivariable logistic regression analysis (OR 2.25, CI 1.37-3.70, p < 0.001). Late failure of NOM ≥ 24 h (vs. early failure) was not associated with increased risk of mortality (p = 0.88), but ≥ 1 unit of PRBC transfused had higher risk (OR 1.88, CI 1.20-2.95, p = 0.006). Compared to young GTPs with BSI, octogenarians have a similar rate of failed NOM. Octogenarians with BSI who fail NOM have over a twofold higher risk of mortality compared to those managed successfully with NOM. PRBC transfusion increases risk for mortality. Therefore, clinicians should consider failure of NOM earlier in the octogenarian population to mitigate the risk of increased mortality

Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district

Objectives: The objectives of the study were to assess the perceptions of nursing staff on the Road to Health Booklet (RTHB), to assess their knowledge of the RTHB growth charts, and to determine whether the level of knowledge was acceptable for successful utilisation of the RTHB growth charts.Design: A cross-sectional descriptive survey.Setting: Twelve primary healthcare clinics in the Tygerberg subdistrict.Subjects: Nursing staff who were going to work with the RTHB on a daily basis.Outcomes measures: The knowledge and perceptions of the nursing staff on the new RTHB were measured using a self-administered questionnaire.Results: The study highlighted that the majority of the nursing staff did not possess sufficient knowledge to successfully utilise the RTHB. The mean score percentage for the total 12 knowledge questions was 55%. Less than a third (n = 13) of participants could correctly interpret the cut-off value for mid-upper-arm circumference. Only 38% and 52% correctly knew that -2 standard deviation for weight-for-age and weight-for-length represents underweight and wasting, respectively. Fifty-five per cent could correctly interpret the growth faltering graph. Forty-three per cent of participants felt the change to the RTHB was unnecessary, and 55% thought that mothers or caregivers would not easily understand the RTHB. More than half (n = 22) of the participants said that they had adequate knowledge to work with the RTHB, while the rest reported that they did not.Conclusion: The RTHB has the potential to decrease the prevalence of malnutrition in children. However, to achieve this, effective usage and understanding of the RTHB is critical.Keywords: Road to Health booklet, growth monitoring, primary healthcare clinics, knowledg

Management of severe malnutrition

CITATION: Shubl, C. 2010. Management of severe malnutrition. South African Journal of Clinical Nutrition, 23(1):Supplement:S22-S24.The original publication is available at http://sajcn.co.zaIn summary, if the Millenium Development Goals (MDGs) are to be addressed effectively, it is imperative that severe malnutrition be addressed at the international and national level, using strategies that work, and that additional resources are committed to improving hospital treatment and establishing community-based rehabilitation programmes.20 Many gaps still exist in our knowledge regarding the management of severe malnutrition at all levels. Until such time when research can fill these gaps, we will have to continue to use what guidelines have shown to produce positive results.http://sajcn.co.za/index.php/SAJCN/article/view/417Publisher's versio

Surgical rib fixation in traumatic rib fractures: is it warranted?

Traumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention. Over the past 20 years the indications and timing of SSRF has evolved. Once reserved mainly for the most extreme of injuries, expanding indications demonstrate that even minimally injured patients may benefit from intervention regarding pain control, respiratory complications, and overall mortality. SSRF has become more prevalent with improving outcomes for patients. Understanding the indications will help expand utilization and improve patient outcomes

The influence of socio-demographic factors on the nutritional status of children in the Stellenbosch area, Western Cape

CITATION: Kirsten, A. P., Marais, D. & Schubl, C. 2013. The influence of socio-demographic factors on the nutritional status of children in the Stellenbosch area, Western Cape. South African Journal of Clinical Nutrition, 26(3):124-131.The original publication is available at http://www.sajcn.co.zaObjectives: To determine the prevalence of overweight and obesity, as well as socio-demographic risk factors associated with childhood overweight and obesity in the Stellenbosch area, Western Cape province. Design: A cross-sectional, comparison study was conducted. Setting and subjects: A representative group of 638 children (aged 6-13 years) attending three randomly selected Stellenbosch primary schools. An additional school was selected for the pilot study. In the screening (first) phase, children were weighed and measured to calculate body mass index using international obesity task force guidelines to determine the prevalence of overweight and obesity. For the comparison (second) phase of the study, only 24 overweight and obese children and 21 children of normal weight (comparison group) (n = 45) were included. Outcome measures: Socio-demographic and eating behaviour data were collected using a structured questionnaire and compared between the overweight and obese group and the comparison group (normal weight) to identify associated risk factors. Results: The prevalence of overweight and obesity was 13%, of which 9% (n = 57) were overweight and 4% (n = 27) obese in the screening phase. In the comparison phase, socio-economic factors, such as maternal employment hours (p-value = 0.0462); family characteristics, such as the number of children in the household (p-value = 0.0231); and time spent participating in sport (p-value = 0.0450); were significantly associated with overweight or obesity. Conclusion: Preventative initiatives should proactively promote healthy eating behaviour and physical activity in children at an early age, based on previous research, particularly in girls. Involving families and schools in these initiatives is recommended, as well as a national childhood obesity monitoring system to identify children at risk, and tracking childhood obesity trends to guide evidence-based interventions to tackle this growing public health issue.http://www.sajcn.co.za/index.php/SAJCN/article/view/683Publisher's versio

Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district

CITATION: Cloete, I. et al. 2013. Knowledge and perceptions of nursing staff on the new Road to Health Booklet growth charts in primary healthcare clinics in the Tygerberg subdistrict of the Cape Town metropole district. South African Journal of Clinical Nutrition, 26(3):141-146.The original publication is available at http://www.sajcn.co.zaObjectives: The objectives of the study were to assess the perceptions of nursing staff on the Road to Health Booklet (RTHB), to assess their knowledge of the RTHB growth charts, and to determine whether the level of knowledge was acceptable for successful utilisation of the RTHB growth charts. Design: A cross-sectional descriptive survey. Setting: Twelve primary healthcare clinics in the Tygerberg subdistrict. Subjects: Nursing staff who were going to work with the RTHB on a daily basis. Outcomes measures: The knowledge and perceptions of the nursing staff on the new RTHB were measured using a self-administered questionnaire. Results: The study highlighted that the majority of the nursing staff did not possess sufficient knowledge to successfully utilise the RTHB. The mean score percentage for the total 12 knowledge questions was 55%. Less than a third (n = 13) of participants could correctly interpret the cut-off value for mid-upper-arm circumference. Only 38% and 52% correctly knew that -2 standard deviation for weight-for-age and weight-for-length represents underweight and wasting, respectively. Fifty-five per cent could correctly interpret the growth faltering graph. Forty-three per cent of participants felt the change to the RTHB was unnecessary, and 55% thought that mothers or caregivers would not easily understand the RTHB. More than half (n = 22) of the participants said that they had adequate knowledge to work with the RTHB, while the rest reported that they did not. Conclusion: The RTHB has the potential to decrease the prevalence of malnutrition in children. However, to achieve this, effective usage and understanding of the RTHB is critical.http://www.sajcn.co.za/index.php/SAJCN/article/view/684Publisher's versio

Primary Pure Squamous Cell Carcinoma of the Gallbladder Locally Invading the Liver, Duodenum, and Stomach: A Case Report and Literature Review

Primary pure squamous cell carcinoma (SCC) of the gallbladder is an exceptionally rare type of tumor that comprises only 1% of all gallbladder cancer. SCC of the gallbladder portends a worse prognosis than the more common adenocarcinoma variant because of its aggressive invasion to local structures and because it is often diagnosed at an advanced stage. Owing to its rarity, diagnosis and management can be challenging. Herein, we present the case of a 75-year-old female complaining of abdominal pain, nausea, and vomiting. Computed tomography and ultrasonography results of the abdomen were consistent with acute cholecystitis and cholelithiasis. Histologic evaluation of the resected mass revealed a malignant tumor with prominent keratinization, confirming the diagnosis of an invasive primary pure SCC of the gallbladder. Microscopic examination showed direct infiltration to the liver, duodenum, and stomach. This case report describes the hospital course of a patient with SCC of the gallbladder and suggests that gallbladder cancer should be considered as part of the differential diagnosis in elderly patients presenting with acute cholecystitis. In addition, this article will review existing literature to examine the utility of different diagnostic techniques and treatment modalities available in the management of gallbladder cancer

Comparing outcomes of cholecystectomies in white vs. minority patients.

BACKGROUND: This study aimed to investigate the disparity between white and minority patients undergoing cholecystectomies, including presentation, outcomes, and financial burden. METHODS: This was an IRB approved retrospective review of all cholecystectomies at an academic medical center from 2013 to 2018. Data collected include demographics, insurance type, charge of admission, and clinical outcomes. RESULTS: 1539 patients underwent cholecystectomies. Of those, 36.9% were white and 63.1% were minority. Minority patients presented at a younger age than white patients (45.5 vs 53.9, p < 0.01) and required emergent admission (76.2% vs 68.4%, p < 0.01). No significant difference was found for clinical outcomes between white and minority. Minority patients were more commonly uninsured (32.1%). Among the uninsured, self-pay had a higher charge than emergency MediCal (by 5.46 per 1000 dollars). CONCLUSION: Minority patients are more commonly disadvantaged at presentation and charged more due to insurance status despite similar outcomes after cholecystectomies