An audit of traumatic haemothoraces in a regional hospital in KwaZulu-Natal, South Africa.

BACKGROUND: Haemothorax occurs in approximately 60% of all thoracic and polytrauma cases and is responsible for 15-30% of all trauma mortalities. Penetrating injuries to the thorax are a common presentation in South African hospitals. This study aims to audit the traumatic haemothoraces and their outcomes in regional hospitals in Durban, KwaZulu-Natal, South Africa. METHODS: In this study, patient characteristics were grouped as either continuous or categorical variables. Continuous variables, such as age were summarised as means (with standard deviations) or medians (interquartile range [IQR]), as appropriate. Categorical variables such as sex were summarised as proportions. Fisher's exact test was used to compare proportions. All analyses were performed using the Statistical Package for Social Sciences. RESULTS: A total of 118 patients were included comprising 110 (93%) males and eight (7%) females, with an average age of 29.7 years. Stab-chest was the most frequent mechanism of injury (76; 64.4%), followed by gunshot wound (GSW)- chest (27; 22.9%) and isolated blunt chest trauma (9; 7.6%). Other mechanisms of injury were stab-neck (3; 2.5%), stab-shoulder (2; 1.7%) and blunt chest trauma in the context of polytrauma (1; 0.8%). The most frequent type of injury was penetrating (108; 91.5%), with only 10 (8.5%) cases of blunt injury. This study found that there was a statistically significant association between patient age groups and type of injury. CONCLUSION: Haemothorax is a common sequela of chest trauma. Retained haemothorax (RH) results in worsened patient outcomes including increased hospital length of stay (LOS). This study points to the need for auditing of proper intercostal chest drain (ICD) positioning, which is crucial for the successful drainage of haemothorax.

Significance of HbA1c levels in diabetic retinopathy extremes in South Africa.

BACKGROUND: Diabetic retinopathy (DR) is one of the leading causes of blindness in sub-Saharan Africa and globally, placing a huge disease burden on patients and the public health system. DR varies in severity from non-proliferative to proliferative DR (PDR). OBJECTIVES: Using a monitor of medium- to long-term blood glucose control, to determine the association between glycated haemoglobin (HbA1c) levels in patients with PDR and those with no DR. METHODS: A prospective, cross-sectional study was conducted at McCord Provincial Eye Hospital in Durban, South Africa. We studied only patients diagnosed with diabetes mellitus (DM) for >1 year who had either PDR or no DR, and compared their HbA1c levels. Patients with non-proliferative DR were not included. RESULTS: Patients with PDR had significantly higher HbA1c levels than those with no DR. Patients with type 1 DM had higher HbA1c levels than patients with type 2 DM in both the PDR and no-DR groups. Older patients (>70 years) had lower HbA1c levels than younger patients. Gender, race and duration of diabetes had no influence on HbA1c levels. CONCLUSIONS: PDR was associated with higher HbA1c in type 2 DM in all races and age groups and was independent of duration of disease. The trend was the same for type 1 DM, but significance could not be reached, probably because of small numbers in this subset of patients.

An audit of upper gastrointestinal endoscopy performed on patients at Prince Mshiyeni Memorial Hospital in Durban, KwaZulu-Natal.

BACKGROUND: Resource constraints have resulted in upper gastrointestinal endoscopy (UGE) being deferred where possible. However, delayed investigation is costly and leads to disease progression. This study audits the UGE done at a single institution. It was motivated by the observation that public hospitals often experience an acute shortage of endoscopes, which are prone to frequent breaks and service delivery is further compromised by an increased workload. METHOD: This was a retrospective observational descriptive study of patients aged 20 to 45 years who had undergone gastrointestinal endoscopy (UGE) at Prince Mshiyeni Memorial Hospital (PMMH) in KwaZulu-Natal, during the period January 2015 to December 2015. One hundred and ninety-four patients' charts and UGE reports were reviewed. Data were analysed using SPSS Statistics version 24. The level of significance was set at p < 0.05. Variables were expressed as mean ± standard deviation or medians (interquartile range IQR) as appropriate. Mean ± standard deviation was compared using the Student's t-test. Proportions and categorical variables were compared using the Pearson's chi-square test or Fisher's exact test as appropriate. An ethical approval was obtained from the University of KwaZulu-Natal BREC (BE 447/17) and the KwaZulu-Natal Department of Health Ethics Committee. RESULTS: Epigastric pain was found to be the most common indication for UGE, with a total of 112 (57.7%) out of total of 194 patients, followed by upper gastrointestinal bleeding (UGIB) (42) (21.6%). Amongst patients presenting with epigastric pain, only 12(10.7%) patients could be confirmed that they had received acid suppression therapy prior to the testing. In the age group 20-25 years, there was a highest number of patients presenting with corrosive substance ingestion, 11 (25.0%). The commonest finding was gastritis in 99 patients (51.0%), followed by normal findings in 50 (25.7%) patients. CONCLUSION: Epigastric pain was the most common indication and gastritis was the predominant finding.

Is there an association between central venous pressure measurement and ultrasound assessment of the inferior vena cava?

INTRODUCTION: Early assessment of volume status is paramount in critically ill patients. Central venous pressure (CVP) measurement and ultrasound assessment of the inferior vena cava (IVC) are both used for volume assessment in the emergency centre. Recent data is conflicting over whether there is a correlation between CVP and ultrasound assessment of the IVC. METHODS: This was a retrospective review of an audit previously performed in the Emergency Unit of Ngwelezane Hospital in Kwazulu-Natal. The audit involved measuring inferior vena cava collapsibility index (IVC-CI) within 5 min of CVP measurement. In this retrospective study, audit data were analysed to determine if an association exists. RESULTS: Twenty-four patients were included. The median age of participants was 36 (IQR 42) years (95% CI 33-56). The median time to ultrasound was 18.6 (52.5) h (95% CI 7.5-36.2). The mean CVP was 13.7 ±â€¯7.7 cm H2O and mean IVC-CI was 39.4 ±â€¯17.8%. Based on a Pearson correlation test, there was a weak negative correlation between CVP and IVC-CI, which was not statistically significant (r = -0.05, n = 24, p = 0.81, 95% CI -0.5 to 0.4) for all participants. However, among females there was a moderate negative correlation between CVP and IVC-CI, which was not statistically significant (r = -0.43, n = 7, p = 0.34, 95% CI -0.9 to 0.5), while among males there was a weak positive correlation, which was not statistically significant (r = 0.16, n = 17, p = 0.53, 95% CI -0.3 to 0.6). DISCUSSION: There is no significant correlation between CVP and IVC-CI. Further validation research is required to support our preliminary findings of no significant correlation between CVP measurement and ultrasound assessment of the IVC. CVP and IVC ultrasound should be used as clinical adjuncts, and not as stand-alone measures of volume assessment.

Is there an association between central venous pressure measurement and ultrasound assessment of the inferior vena cava?

Introduction:Early assessment of volume status is paramount in critically ill patients. Central venous pressure (CVP) measurement and ultrasound assessment of the inferior vena cava (IVC) are both used for volume assessment in the emergency centre. Recent data is conflicting over whether there is a correlation between CVP and ultrasound assessment of the IVC.Methods:This was a retrospective review of an audit previously performed in the Emergency Unit of Ngwelezane Hospital in Kwazulu-Natal. The audit involved measuring inferior vena cava collapsibility index (IVC-CI) within 5 min of CVP measurement. In this retrospective study, audit data were analysed to determine if an association exists.Results:Twenty-four patients were included. The median age of participants was 36 (IQR 42) years (95% CI 33­56). The median time to ultrasound was 18.6 (52.5) h (95% CI 7.5­36.2). The mean CVP was 13.7 ±â€¯7.7 cm H2O and mean IVC-CI was 39.4 ±â€¯17.8%. Based on a Pearson correlation test, there was a weak negative correlation between CVP and IVC-CI, which was not statistically significant (r = −0.05, n = 24, p = 0.81, 95% CI −0.5 to 0.4) for all participants. However, among females there was a moderate negative correlation between CVP and IVC-CI, which was not statistically significant (r = −0.43, n = 7, p = 0.34, 95% CI −0.9 to 0.5), while among males there was a weak positive correlation, which was not statistically significant (r = 0.16, n = 17, p = 0.53, 95% CI −0.3 to 0.6).Discussion:There is no significant correlation between CVP and IVC-CI. Further validation research is required to support our preliminary findings of no significant correlation between CVP measurement and ultrasound assessment of the IVC. CVP and IVC ultrasound should be used as clinical adjuncts, and not as stand-alone measures of volume assessment