Adult pure red cell aplasia at Universitas Academic Hospital, Bloemfontein, South Africa: A 9-year review.

BACKGROUND: Pure red cell aplasia (PRCA) is characterised by severe normochromic, normocytic anaemia and partial or complete absence of reticulocytes from the peripheral blood. With bone marrow of normal cellularity, an almost complete absence of erythroblasts but preservation of other cell lines is observed. It may be congenital or acquired, with the latter presenting as a primary haematological disorder or secondary to various contributing factors. Management focuses on treatment of the underlying cause and supportive transfusions. Occasionally, immunosuppression or intravenous immunoglobulin (IVIG) is required. OBJECTIVES: To describe the clinical characteristics, treatment and outcomes of adult patients diagnosed with PRCA at Universitas Academic Hospital (UAH) in Bloemfontein, South Africa, from 2010 to 2018. METHODS: A retrospective descriptive file review was performed. All adult patients diagnosed with PRCA and treated in the Division of Clinical Haematology at UAH during the study period were included. Variables recorded included demographic information, clinical details of the PRCA diagnosis, classification of the PRCA, HIV and parvovirus B19 test results, results of special investigations, medical and drug history, treatment and response to treatment. RESULTS: Twenty-seven patients' files were included, with a female predominance (n=22; 81.5%). The median age at diagnosis was 35 years (range 20 - 62). The median number of days from onset of symptoms to date of diagnosis was 61 days (range 27 - 114). Approximately half (n=13; 48.2%) of the patients presented with a haemoglobin concentration of 1 - 3 g/dL. Most patients (n=26; 96.3%) were infected with HIV, with 76.9% (n=20) having a suppressed viral load. Parvovirus B19 infection accounted for 44.4% of cases (n=12), and all these patients were HIV positive. Lamivudine was a probable cause of PRCA in 18.5% of cases, although the true causal relationship was uncertain. Corticosteroids and IVIG were first-line therapy in 44.4% (n=12) and 37.0% (n=10) of cases, respectively. Thirteen patients (48.2%) achieved a complete response and 7 (25.9%) a partial response, while 2 (7.4%) showed no response, with continued transfusion dependence. CONCLUSION: In this population, women were disproportionately affected by PRCA. HIV was the single most important cause of acquired PRCA, which was independent of virological control. Parvovirus B19 and drugs were also important causes of acquired PRCA and played a critical part in the evaluation and work-up of PRCA. Nearly half of the patients achieved a complete response to therapy, which was sustained over 24 months.

The spectrum of orofacial clefts and treatment logistics at Universitas Academic Hospital, Bloemfontein, South Africa.

BACKGROUND: Cleft lips and/or palates should be identified early and be operated on at specific ages according to international recommendations. In African countries, however, cleft lip and palate surgeries are often delayed. METHODS: A retrospective, descriptive study was done to determine the distribution, specific time delays, demographics and loss to follow-up of patients with cleft lip and/or palates treated at Universitas Academic Hospital over a 10-year period. Data was obtained from outpatient files from the Plastic and Reconstructive Surgery Department at Universitas Academic Hospital. Two hundred and three of 318 records (63.8%) had the defined variables documented. RESULTS: The median time from first presentation to specialist consultation was 1.9 months. The median ages for first presentation was 2.2 months and for specialist consultation 5.2 months. Patients mainly had isolated cleft palates (42.4%), followed by both cleft lip and palate (31%) and isolated cleft lips (24.6%). A quarter of patients (25.6%) were lost to follow-up. More than a third (36.5%) of patients were referred from the local Motheo district and 12.8% were referred from Lesotho. CONCLUSION: In our setting, patients with cleft lip and/or palate are generally diagnosed and referred late. These patients also have delayed access to specialist consultation. Often patients are only evaluated by specialists at ages whereby they should have already undergone their first surgeries. Too many patients are lost to follow-up.

Treatment outcomes of Acinetobacter baumannii -associated pneumonia and/or bacteraemia at the intensive care unit of Universitas Academic Hospital, Bloemfontein, South Africa.

BACKGROUND: Nosocomial infection with multidrug-resistant (MDR) Acinetobacter baumannii is associated with high mortality rates and the optimal treatment regimen is uncertain. OBJECTIVES: To compare outcomes, as well as ICU and in-hospital survival rates of patients with A. baumannii pneumonia and/or bacteraemia who were treated with colistin monotherapy v. colistin/tigecycline combination therapy. METHODS: This was a retrospective cross-sectional study of patients admitted to the multidisciplinary ICU of Universitas Academic Hospital, Bloemfontein, South Africa, between 1 January 2018 and 31 December 2019. RESULTS: Sixteen patients were included in the study. Nine patients were treated with a combination of colistin and tigecycline, while 7 patients were treated with colistin only. Seven out of 9 (77.8%) patients in the colistin/tigecycline combination therapy group were treated successfully and survived until discharge from ICU, as opposed to 2 out of 7 (28.6%) in the colistin monotherapy group (relative risk (RR) 2.7; 95% CI 0.80 - 9.24). Five out of 9 (55.6%) in the colistin/tigecycline combination therapy group v. 2 out of 7 (28.6%) in the colistin monotherapy group survived until discharge from hospital (RR 1.94; 95% CI 0.53 - 7.20). CONCLUSION: Although ICU survival in patients with A. baumannii infection was better when treated with colistin/tigecycline combination therapy compared with colistin monotherapy, a statistically significant difference could not be detected. Adequately powered prospective clinical trials are required to detect statistically significant differences in treatment outcomes.

Steps walked whilst at work, by University of the Free State medical registrars: an exploratory study

Background: Doctors may have physical disabilities affecting their mobility. If they wish to specialise, they need information regarding mobility requirements for various specialities to help them select an appropriate speciality. No research has been published on the differences in physical activity demands in different medical specialities. Objective: The aim of this study was to compare the physical activity of medical registrars from six specialist departments at a South African academic hospital. The inference was that those specialities where registrars walked the most would be more challenging for those with physical disabilities, thereby limiting mobility. Methods: The number of steps walked from 07:00 to 16:00 each day was measured, using Yamax CW-701 pedometers. Kruskall-Wallis tests were used to compare the steps taken in different specialities with the level of significance set at 0.05. Results: Twenty registrars participated in the study. Significant differences in the number of steps walked per day were observed between those from different specialities (p < 0.001). Surgery, paediatric and internal medicine registrars walked the most steps per day (median of 5 991, and 5 880, 5 489, respectively). Anaesthesiology and radiology registrars walked a median of 4 521 and 3 926 steps, respectively. Registrars in obstetrics and gynaecology walked the least steps (median of 1 918). There was considerable variation in steps between participants within a department, and for the same participants on different days. Conclusion: Registrars appeared to be more physically active in some medical specialities than others, in terms of mobility. The wide intra-speciality variation is probably related to differing daily duties. Future studies should include types of work duties (e.g. sedentary vs high physical mobility), cover more specialities, and include more participants.

Knowledge of the audiological effects, symptoms and practices related to personal listening devices of health sciences students at a South African university.

OBJECTIVE: This study aimed to determine the knowledge of first year health sciences students at a South African university regarding hearing loss and symptoms attributable to personal listening devices and their practices concerning the use of personal listening devices. METHOD: This was a cross-sectional study carried out using an anonymous self-administered questionnaire. RESULTS: Of 336 students, 269 (80.1 per cent) completed the questionnaire. While most participants could identify symptoms that could be caused by extensive use of personal listening devices, almost 30 per cent did not know that it could cause permanent hearing loss. Personal listening devices were used by 90.7 per cent of participants, with 77.8 per cent having used them for more than five years. Use was at a high volume in 14.9 per cent of participants and for more than 2 hours per day in 52.7 per cent. CONCLUSION: The findings indicate the need for an educational programme to inform students as to safe listening practices when using personal listening devices.

Burnout and associated factors in undergraduate medical students at a South African university

Background. Medical students are at risk of burnout owing to various challenges.Objectives. To investigate burnout and associated factors among undergraduate students at a South African medical school.Methods. In this cross-sectional study, findings of the Copenhagen Burnout Inventory (CBI), demographic data and information related to resilience were collected by means of an anonymous self-administered questionnaire. Associations between burnout subscales and various factors were determined.Results. Five-hundred students (preclinical, n=270; clinical, n=230) completed the questionnaire. CBI mean scores for preclinical and clinical students were 17.9 and 17.4 (personal), 22.3 and 21.9 (work related) and 24.8 (patient related; clinical students only), respectively. High scores on the subscale reflect low levels of burnout in related areas. Male students and students with high self-reported resilience and low stress had significantly lower burnout levels. White preclinical students had lower levels of personal and work-related burnout, and black clinical students had less patient-related burnout.High mean scores in all three burnout subscales indicated low burnout levels among students. Academic and personal stress, as well as perceived poor support from institutional structures, were associated with significantly higher personal and work-related burnout, but not patient-related burnout in clinical students

Simulation as an educational strategy to deliver interprofessional education

Background. Various educational methods are available to deliver interprofessional education (IPE) to prepare healthcare students for collaborative practice. One such method is simulation-based health education.Objectives. To identify current IPE methods used in undergraduate programmes in the Faculty of Health Sciences at the University of the Free State, Bloemfontein, South Africa, and to determine the opinions of module leaders on using simulation as a particular IPE teaching strategy.Methods. A quantitative, cross-sectional descriptive study design was employed. Structured interviews were conducted with 47 module leaders of the undergraduate programmes in the Faculty of Health Sciences. These programmes cover 66 modules in the Schools for Allied Health Professions (nutrition and dietetics, occupational therapy, physiotherapy and optometry), nursing and medicine.Results. At the time of the study, IPE activities were used in 29 (43.9%) of the modules, of which 17 (58.6%) were coincidental. Respondents' opinions on the potential use of simulation to address formalised IPE activities included the challenge of 'scheduling' (73.9%) and 'logistical and high cost issues' (19.6%). The most prominent advantage that was foreseen (41.3%) was better clarification of roles among the different professions.Conclusions. The module leaders had a positive attitude towards simulation and its potential use for IPE, with their major concern being logistical challenges. To improve role clarification, a scenario should be developed to engage students from all the relevant professions. The proposed type of simulation was to use standardised patients in a role-play scenario. The outcomes of these activities should be aligned with the principles of IPE

Control of rheumatoid arthritis with conventional disease-modifying antirheumatic drugs in a tertiary hospital in central South Africa.

BACKGROUND: Rheumatoid arthritis (RA) is a highly prevalent disease with a significant impact on morbidity and life expectancy. There is a paucity of literature relating to the current state of disease control in South Africa, and none on Free State Province. OBJECTIVES: To evaluate control of RA with conventional disease-modifying antirheumatic drugs (DMARDs) in the rheumatology outpatient department of Universitas Academic Hospital, Bloemfontein, and to determine the relative impact of various factors contributing to the prevention of disease control. METHODS: A cross-sectional study was undertaken over a period of 8 months from December 2016 to August 2017 in the rheumatology outpatient department of Universitas Academic Hospital. Data were collected by means of information sheets and questionnaires completed by attending doctors. The information pertained to disease activity, possible factors contributing to poor control, and relevant demographic data. RESULTS: Information was collected from 169 patients, and data analysis was performed on 161. The results revealed that RA was controlled in 34 patients (21.1%). Of the 127 patients with uncontrolled disease, 61 (48.0%) reported dispensing issues relating to poor drug availability. Seventy-two (56.7%) of the patients with uncontrolled disease were deemed to be on insufficient treatment for their disease state, of whom 33 (45.8%) also reported concomitant dispensing issues. Other factors such as transport/access problems, administrative issues, adverse events and poor compliance/insight contributed to the inadequate control of RA to a minor extent. In terms of monthly dispensing, 159 patients (98.8%) reported receiving all their DMARDs during the first month. The vast majority of these drugs were dispensed from Universitas Hospital. This figure decreased to 119 patients (73.9%) who received all their DMARDs during the second month, mostly from district units. Only 55.3% (n=89) of the patients reported receiving all of their DMARDs from their down-referral units. CONCLUSIONS: Control of RA at this institution is suboptimal compared with national and international standards. The main contributors to poor control appear to be problems relating to dispensing of medication and inadequate escalation of therapy by doctors. Most of the concern with the dispensing of medication lies with the poor availability of DMARDs in peripheral unit pharmacies. These factors are remediable and should be attended to.

Exploring the differences in psychological traits between surgical specialties at an academic hospital in Bloemfontein.

BACKGROUND: Studies have attempted to categorise undergraduate medical and postgraduate students and specialists into personality types, to determine what influences personality has on specialty choice and job satisfaction. This study explored the personality characteristics of doctors in four surgical and three consulting specialties at an academic hospital in Bloemfontein, South Africa. METHOD: This analytical cross-sectional study used the Zuckerman-Kuhlman Personality Questionnaire as a measuring tool which included five scales: impulsive sensation seeking (subscales impulsivity and sensation seeking), neuroticismanxiety, aggression-hostility, sociability (parties and friends and isolation intolerance), and activity ( work activity and general activity). Overall, 70 consultants and senior registrars from surgical specialties (anaesthesiology, obstetrics and gynaecology, orthopaedic surgery, surgery), (response rate 60.3%) and 58 consultants and senior registrars from three consulting specialties (internal medicine, paediatrics, family medicine) (response rate 71.6%) participated. RESULTS: Respondents from four surgical specialties had higher medians than the overall consulting group for the subscale sensation seeking. The subscale sensation seeking scored higher than impulsivity across surgical and consulting groups. The surgical group scored lower than the consulting group in neuroticism-anxiety, with anaesthesiology scoring the highest (42.1%) and orthopaedic surgery scoring the lowest (15.8%). Orthopaedic surgery scored the highest (50.0%) in aggressionhostility, sociability (52.9%), parties and friends (44.4%) and isolation intolerance (65.5%). The surgical group scored significantly higher than the consulting group for activity (p < 0.01). CONCLUSION: In exploring the personality types of specialists, the orthopaedic surgeons in specialist departments in Bloemfontein seem unique in their sociability and aggression-hostility traits, anaesthesiologists scored strongly on the sensation seeking and neuroticism-anxiety scales, while the obstetricians and gynaecologists did not manifest either of these traits strongly. This data contributes to a growing discussion on personality choice and job satisfaction.

Infantile hypertrophic pyloric stenosis: profile, management and outcome of patients admitted to a tertiary hospital in Bloemfontein, South Africa.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. This study aims to evaluate the profile, management and outcome of IHPS at a tertiary hospital in Bloemfontein, South Africa. METHOD: The study was a retrospective, descriptive record review including all patients with IHPS admitted to Universitas Hospital from January 2008 to February 2016. Of the 22 patients admitted, files for 19 patients were available for inclusion. RESULTS: Sixteen (84.2%) of the 19 patients were male. Of the 11 patients with available birth order, two were first-, two second-, six third- and one fourth-born. The patients' ages ranged from 27 to 194 days (median 51 days). The most common symptoms were projectile vomiting (78.9%) and poor weight gain (68.4%). Six patients had no ultrasound done, and 17 patients underwent a Ramstedt-pyloromyotomy. Eight patients received atropine as part of their initial management. The duration of symptoms ranged from 1 to 58 days (median 14 days). There was no reported mortality. The length of stay ranged from 2 to 60 days (median 7 days). CONCLUSION: The gender distribution and age at presentation were in keeping with the literature but not the birth order. The delay before surgery emphasises the poor general health and deranged biochemical state the patients present at the hospital.

#FeesMustFall2016: Perceived and measured effect on clinical medical students.

BACKGROUND: Medical students are under immense academic stress. Campus unrest can contribute to stress and influence academic performance, social behaviour, emotional stability and financial expenses. OBJECTIVES: To investigate the effects of #FeesMustFall2016 (#FMF2016) on the 2016 3rd-year (semester 6) clinical medical students at the University of the Free State (UFS), Bloemfontein, South Africa. METHODS: In phase 1 of the project, anonymous questionnaires were completed by the clinical students who experienced physical test disruption during #FMF2016. Opinions regarding academic performance, financial expenses, behaviour changes and stress levels were gathered. The students also completed a formal post-traumatic stress screening assessment. In phase 2 of the project, the academic performance of these students was compared with that of students not affected by #FMF2016. RESULTS: Of the target population of 138 students, 87.0% completed the questionnaires. Three-quarters of the respondents reported a negative effect on academic performance, and most did not believe that the delivering of lectures on Blackboard was a good way of training. Alcohol consumption increased in 31.9% of the students. Criteria for post-traumatic stress disorder (PTSD) were met in 12.7% of students. Compared with previous and later cohorts of students there were no clear differences regarding marks, but there was a tendency towards poorer performance and more failures the next year. CONCLUSIONS: Semester 6 medical students at UFS reported that the #FMF2016 protests had a negative effect on academic, social, financial and stress aspects. PTSD was present in 12.7% of students compared with 7.8% in similar populations.

The use, knowledge and attitudes regarding hormonal contraceptive products of female first-year students in a Faculty of Health Sciences

Background: Effective contraception plays a major role in the economic advancement of women. New hormonal products offer more effective solutions with fewer side effects. This study aimed to assess the use, knowledge and attitudes regarding hormonal contraception of female first-year students across various health profession courses. Methods: A descriptive study was conducted during August to October 2017 targeting all female first-year students of the Faculty of Health Sciences at the University of the Free State. Results: Self-administered anonymous questionnaires were completed by 261 students (response rate 81.6%). At the time of the study, 29.6% of the study population reported using hormonal contraceptive products; 51.7% of users cited acne as the indication. Among users of hormonal contraceptives, combined oral contraception was the most commonly used (86.0%), and was regarded as the most effective (33.2%). A third of the students (36.2%) were aware that some medication could influence the effectiveness of combined oral contraception. Half (52.3%) had no knowledge of the subdermal implant and 34.8% did not know what an intrauterine system was. According to 28.2%, post-coital use of hormonal products is not an acceptable method of contraception. Almost 90% (87.3%) indicated that an education intervention regarding hormonal contraception is needed at the university. Conclusion: The study population lacks detailed and sufficient knowledge of critical aspects of contraception, such as relative effectiveness, and factors that affect these; long-acting reversible contraceptives; and emergency contraception. A formal education intervention is proposed

Congenital heart defects in children with cleft lips and/or palates at an academic hospital in central South Africa

Background: Globally, cleft deformities are the most common craniofacial anomalies and show an association with congenital heart defects. Little research on cleft lips and/or palates (CL/P) and congenital heart defects has been reported from Africa, and none from South Africa. In 2001, it was proposed that CL/P be listed as one of six priority conditions for monitoring and notification to South African health authorities. This goal of creating a national registry has not been achieved. A near-fatal anaesthetic incident following a missed cardiac lesion in a child with a cleft lip and palate prompted this study. Objectives: To describe the prevalence of congenital heart defects diagnosed in children with CL/P presenting for corrective surgery during the Smile Week over three consecutive years (2013­2015) at an academic hospital in South Africa. Methods: A retrospective, descriptive file review of 62 patients with CL/P was performed. Since 2013, echocardiography has been performed on all patients with CL/P. Results: Twenty-three, 21 and 18 patients were operated in 2013, 2014 and 2015, respectively. Of these patients, 85.5% (n = 53) had no clinical evidence of a cardiac defect, of which eight did have clinically significant cardiac defects on echocardiography. Sixteen patients (25.8%) in total (n = 16/62) with a cleft deformity had a clinically significant congenital heart lesion. Of the 16 patients with a cardiac defect on transthoracic echocardiography, only four had clinical evidence of cardiac defect. Therefore, sensitivity of clinical examination was 25%, whereas the specificity was 89.1%. Three of the four patients with a syndrome had a clinically significant echocardiographic finding. Conclusion: A national guideline for the preoperative care of patients with CL/P, including routine echocardiography, is needed. Furthermore, a national registry is required for patients with CL/P with associated congenital anomalies

The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein.

BACKGROUND: Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries. METHOD: This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire. RESULTS: A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh. CONCLUSION: The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns.

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation.

BACKGROUND: We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma. METHODS: This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000-December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant). RESULTS: Among 65 patients (mean age 50.9 years, range 37-69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26-69) years in the HIV-positive and 57.2 years (range 26-89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma. CONCLUSION: Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age.

Association between personality factors and consulting specialty of practice of doctors at an academic hospital in Bloemfontein, South Africa

Background. Studies found an association between personality types and field of specialty. The current study could assist aspiring specialists in deciding which specialty they are best suited for by comparing their own personalities with the results.. To explore the personality characteristics of doctors in three consulting and four surgical specialties at an academic hospital in Bloemfontein,South Africa.Methods. In this analytical cross-sectional study, questionnaires, including the Zuckerman-Kuhlman Personality Questionnaire, were handed out.Overall, 58 consultants and senior registrars from the departments of Family Medicine, Paediatrics and Internal Medicine (response rate 71.6%) and 70 consultants and senior registrars from surgical specialties (response rate 60.3%) participated.Results. Family medicine had the lowest median score for impulsive sensation seeking (21.1%) and aggression-hostility (11.8%), and highest for parties and friends (33.3%). Paediatrics scored highest for neuroticism-anxiety (44.7%) and aggression-hostility (23.5%). Internal medicine scored highest for sociability (25.0%) and isolation intolerance (37.8%), and lowest for neuroticism-anxiety (36.8%) and activity (47.1%). Overall, the consulting group scored lower than the surgical group for impulsive sensation seeking, aggression-hostility, sociability and activity, and higher for neuroticism-anxiety. Conclusion. The study identified personality types of some specialties, and revealed differences between characteristics of local specialists compared with findings from studies elsewhere

The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein

Background: Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries. Aim: This study sought to determine the causes of burn wounds among adults admitted to the Burn Wound Unit at Pelonomi Tertiary Hospital in Bloemfontein for treatment.Methods: This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire. Results: A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh.Conclusion: The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation

Background: We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma.Method: This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000­December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant).Results: Among 65 patients (mean age 50.9 years, range 37­69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26­69) years in the HIV-positive and 57.2 years (range 26­89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma.Conclusion: Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age

Intravenous paracetamol ­ waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex­Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa. Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol. Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21­ 32.3 mg/kg). Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required