Complications of inflammatory sinusitis in children: institutional review

Background: Complications of acute inflammatory sinusitis into orbital and intracranial sepsis is a common problem in paediatrics.A delay in making a diagnosis and early appropriate treatment has a high morbidity and mortality rate.The commonest presenting symptoms are throbbing headache and facial or periorbital swelling usually fallowing a two week history of upper respiratory tract infection..A high resolution Computed Tomography(CT) scan is very helpful in making a proper and accurate diagnosis.Appropiate early medical and surgical treatment has a good outcome.We are reporting our epidemiological study of complicated sinusitis of 59 cases treated at Dr George Mukhari Hospital ,ENT Department a Tertiary referral centre, Medunsa Campus,University of Limpopo, RSA. Methods: A prospective case series of all patients admitted with complicate inflammatory confirmed on CT scan between April 2004 to August 2005(Winter months).An interview data collection sheet was used to collect all clinical information . . Results: Fifty-nine (59) inpatients (50 males and 9 females) admitted and treated at DGMH for complicated pan-sinusitis.The mean age of the patients was 13 years, with a male:female ratio of 7:1. All patients presented with a sporadic first episode of sinusitis, occurring within two weeks of upper airway infection. The affected age group was mainly paediatric of peripubertal age. In almost all the patients, headache and facial (peri-orbital) swelling were the main presenting symptoms. Most patients (85%) were initially referred to other departments 59.3% (35) to Ophthalmology, 18.6% (11) to Neurosurgery, 6.7 % (4) to Paediatrics and only 15.2 % (9) directly to ENT (Otorhinolaryngology). Of these patients, 36 (61%) had intracranial complications confirmed on CT scan and were managed in consultation with the neurosurgeons and ophthalmologists. No major surgical complications were reported. Staphylococcus species were the most common organisms isolated; however, 50% of the pus swabs had a negative culture. Medical treatment based on culture and sensitivity, together with surgical drainage, achieved good results. Three females with severe complications died during the period of the study, but there were no male deaths reported in this study, even though more males than females were affected. Conclusions: Complications of septic sinusitis are a common problem in the paediatrics, with males more commonly affected than females. Females, however, had a poorer prognosis than males in this study. Complicated sinusitis should be suspected in any adolescent with orbital, facial or frontal swelling associated with headache always during the winter (cold) months. To prevent morbidity and mortality, a high resolution contrasted CT scan is mandatory for the exclusion of complicated sinusitis,medical and surgical treatments are effective management of complicated sinusitisSouth African Family Practice Vol. 48 (10) 2006: pp. 16-16

Otolaryngological and head and neck manifestations in HIV-infected patients seen at Steve Biko Academic Hospital in Pretoria, South Africa

Background. Sub-Saharan Africa has the highest incidence of HIV infection. According to recent census statistics, 5.6 million people in South Africa (SA) are HIV-positive, the highest number of infected individuals worldwide. Over 80% of HIV-infected individuals will present with ear, nose and throat (ENT) manifestations. Previous studies show that oral diseases seem to be the most common ENT-related manifestation, reported in about 40 - 50% of HIV-infected patients. In SA, there is lack of local information regarding the otolaryngological and head and neck manifestations in HIV-infected individuals.Objective. To ascertain our local trends of ENT and head and neck manifestations in HIV-infected patients seen at our specialised ENT-HIV Clinic, Steve Biko Academic Hospital, Pretoria, Gauteng Province, SA.Methods. A 1-year prospective study involving 153 HIV-infected patients was conducted in the clinic from January to December 2011. Patient history was taken and examinations were performed based on the World Health Organization (WHO) HIV/AIDS classification system. Data analysis was performed using Epi Info 7 software.Results. The most common manifestations were adenoid  hypertrophy/hyperplasia followed by cervical lymphadenopathy, chronic suppurative otitis media, otitis media with effusion and sensory-neural hearing loss.Conclusion. Patients typically presented with early manifestations during symptomatic WHO stages I and II in contrast to results reported in similar developing world studies from Iran, Nigeria and India. A possible explanation may lie in the SA government HIV Counselling and Testing campaign and the antiretroviral rollout programme, the effectiveness of which is becoming evident

Post-tonsillectomy haemorrhage following traditional uvulectomy in an adult patient

A 28-year-old IsiPedi-speaking black South Africa male patient presented with recurrent attackes of dry throat, dry cough, sore throat and globus pharyngeus. When asked what he thought was responsible for his symptoms, he said that he suspected an infection of the uvula (lelingwana) and according to \'Pedi\' culture would require surgical removal. After the physical examination, a clinical assessment of chronic tonsillitis and laryngopharyngeal reflux disease was made. The attending surgeon informed him that there was no indication for the removal of the uvula but he would benefit from tonsillectomy and anti-reflux medication. The patient reluctantly agreed to the suggested procedure and a day-case tonsillectomy under general anaesthesia using dry mono-polar diathermy dissection technique was performed. The procedure ws successful with dry tonsillar fossae. When the patient recovered from anaesthesia, he immediately enquired if his uvula was removed but was informed that the tonsils were the only tissues removed as indicated and and consented to. He was discharged and placed on amoxycillin and Myprodol (an analgesic). Later in hte day (19h00), he was rushed back to the casualty department with marked oropharyngeal bleeding and in severe hypovoleamic shock. He was immediately resuscitated and prepared for examination under anaesthesia in the theatre. The main finding was bleeding from a freshly cut uvula but the tonsillar fossae showed no active bleeding.SA Fam Pract 2005;47(1): 4

Sport and Arrhythmogenic Right Ventricular Cardiomyopathy

Sudden deaths have been reported in sportspersons and have been related to physical activity. It is possible that exercise may be a trigger of potentially lethal arrhythmias in susceptible individuals or may be the factor that converts a defect of genotype to an abnormal and arrhythmogenic phenotype. Patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)may be at higher risk of sports-related arrhythmias and sudden death. In the South African ARVC registry,56% of patients were involved in regular sport participation. Various potential mechanisms linking sport and exercise to arrhythmias in patients with ARVC may exist

South African Paediatric Surgical Outcomes Study : a 14-day prospective, observational cohort study of paediatric surgical patients

BACKGROUND : Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS : We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS : We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4–11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2–8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6–1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS : The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION : NCT03367832.Jan Pretorius Research Fund; Discipline of Anaesthesiology and Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department of Anaesthesia, University of the Witwatersrand; and the Paediatric Anaesthesia Community of South Africa (PACSA).https://bjanaesthesia.org2020-02-01gl2019Anaesthesiolog

Otosclerosis And Tgf-&#914;1 Gene In Black South Africans

Limited literature is available on the epidemiology and genetics of otosclerosis among SA Blacks in which it is extremely rare. We undertook this study as we had documented cases of clinical oval window otosclerosis confirmed surgically among South African Blacks. South African Medical Journal Vol. 98 (9) 2008: pp. 720-72

Tympanoplasty success based on surgeon and patient-reported outcomes perspectives: a 10-year review in a tertiary center

Abstract Background The latest international trends in healthcare put more emphasis on patients’ perspectives in reporting success in surgical procedures. A holistic approach in measuring surgical outcomes, defined as global success, should include the patient’s perioperative experiences, expectations, and outcome measures. In published literature, surgeons propose several definitions of post-operative successful surgical outcomes following tympanoplasty. Most surgical outcomes and the surgeon’s definition of success exclude the patient’s perspectives. Patient-reported outcomes would allow surgeons to understand and measure the benefit of the several procedures performed from the perspective of the patients. Current definitions of successful tympanoplasty do not capture patient reported outcomes which are important to patients. A divergence is frequently found between outcomes relevant to the patient and to the surgeon. Patient-reported outcomes would complement traditionally measured clinical outcomes by the surgeon to give a true global outcome measuring success. The main aim of the current study was to propose a definition of true global success following tympanoplasty by combining the patient’s and the surgeon’s reported satisfaction rate based on the indication and the goals for the operation. Results A total of 128 procedures were performed on128 ears in 125 patients, of which 52% (n = 57) were done on the right and 48% (n = 61) on the left side. There was no significant difference between the two groups (p = 0.07). There was a female preponderance, with 62% females and 44% males (p = 0.105). The majority of patients, 63% (n = 68), were between the age of 26 and 45 years, while 19% (n = 20) fell into the 46- to 60-year age range, with no significant difference between the groups (p = 0.21). There was complete graft take in 77% (107/128) of the ears in whereas 23% (21/128) of the ears the graft had not taken at the 6-month follow-up period. The true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001) compared to the 77% surgical success. Conclusion In assessing success in tympanoplasty, the patient- and surgeon-reported outcomes, when considered against agreed goals and indications, correlate well statistically. In this cohort, the true global success satisfaction rate was 92% (chi-square test = 119; p = 0.001 < 0.05) compared to 77% surgical success, based on graft take only. The combination of patient- and surgeon-reported outcomes would be beneficial in reporting true global success in tympanoplasty

Retropharyngeal abscess: an unusual turn of events in a baby with pneumonia

No Abstract. Central African Journal of Medicine Vol. 45 (1) 1999: pp. 21-2