Outcomes of jaundice in advanced hepatocellular carcinoma - a sub-Saharan perspective.

BACKGROUND: Jaundice is a marker of advanced disease and poor outcomes in hepatocellular carcinoma (HCC). The aim of this study was to describe and analyse the management and outcomes of jaundiced HCC patients at a large academic referral centre in sub-Saharan Africa (SSA). METHODS: Treatment-naïve adult HCC patients who presented with jaundice between 1990 and 2023 were analysed. RESULTS: During the inclusion period, 676 HCC patients were treated at Groote Schuur Hospital. The mean age of the 126 (18.6%) who were jaundiced was 48.8 (± 13.2) years. Eighty-nine (70.6%) were male. Ninety-four (74.6%) patients with jaundice secondary to diffuse tumour infiltration had best supportive care (BSC) only. Thirty-two had obstructive jaundice (OJ); four were excluded because of missing hospital records. In 28 of these patients, 16 underwent biliary drainage (BD) and 12 received BSC only. The mean overall survival (OS) of the 126 patients was 100.5 (± 242.3) days. The patients with diffuse tumour infiltration had an OS of 105.9 (± 273.3) days. The patients with OJ survived 86.5 (± 135.0) days. There was no significant difference in OS between the three patient groups (p = 0.941). In the OJ group, patients who underwent BD survived longer than the BSC group (117.9 ± 166.4 vs. 29.2 ± 34.7 days, p = 0.015).

Medical Students' Knowledge About Brain Death: A South African Contribution.

BACKGROUND: Incorporating transplantation into undergraduate medical curricula can improve organ procurement rates. Intricacies related to the assessment of donor suitability, the clinical diagnosis of brain death, and relevant legal processes are key challenges for the newly qualified doctor. The aim of this study was to describe and analyze knowledge of medical students regarding the various aspects dealing with the diagnosis of brain death, with a view to designing an undergraduate training module. METHODS: A previously validated, self-administered, 26-item questionnaire was distributed to all medical students at the University of Cape Town. General data included age, sex, year of study, and career interests. Knowledge-specific questions explored the suitability of potential organ donors (8 items), the clinical diagnosis of brain death (7 items), and legal factors (11 items) thereof. Descriptive statistical methods were then used to analyze the data. RESULTS: There were 346 participants; 217 (63%) were pre-clinical students and 29 (8%) carried an organ donor card. The mean and median scores for the 26 items were both 12 (range, 0-25). Mean scores increased steadily with years of medical education: from 8 in the first year of study, 10 in the second year, and 17 in the final year. Demographics, year of study, organ donor status, and an interest in a surgical career did not influence knowledge levels (P > .05). CONCLUSIONS: Medical students have limited knowledge about brain death and identification of potential organ donors. This confirms the need for an educational intervention early in the medical curriculum.