Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n2a8
P. Naidoo, S. Gounden, J. Maharaj, V. Rambiritch, R. Leisegang, S. Karamchand, A. Assounga, M. Moosa
Linezolid-induced lactic acidosis is rare and portends a poor prognosis. The mechanism of toxicity may be related to inhibition of mitochondrial ribosomes. We present the first case in the literature of a patient with HIV and multidrug resistant tuberculosis with fatal lactic acidosis secondary to linezolid re-exposure. The index case relates to a 37-year-old lady with a background medical history of HIV, on fixed combination antiretroviral therapy. In addition, she had multidrug resistant pulmonary tuberculosis and was being treated on a salvage antituberculosis regimen containing linezolid. She presented with a 1-day history of backpain, nausea and vomiting. Clinically she was severely acidotic with a lactate of 12 mmol/L, which peaked at 19 mmol/L. A presumptive diagnosis of lactic acidosis was made based on the history and exclusion of other causes. The patient demised despite management in the intensive care unit with continuous veno-venous haemodialysis (CVVH) and mechanical ventilation. The diagnosis of linezolid-induced lactic acidosis requires a high index of suspicion and exclusion of other causes. In the absence of definitive treatment, early diagnosis, drug discontinuation and prompt supportive management including continuous veno-venous haemodiafiltration are key in helping to reduce the high mortality associated with this toxicity.
{"title":"Severe lactic acidosis after re-exposure to linezolid in a person living with HIV and multidrug resistant tuberculosis: a case report","authors":"P. Naidoo, S. Gounden, J. Maharaj, V. Rambiritch, R. Leisegang, S. Karamchand, A. Assounga, M. Moosa","doi":"10.18772/26180197.2023.v5n2a8","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n2a8","url":null,"abstract":"Linezolid-induced lactic acidosis is rare and portends a poor prognosis. The mechanism of toxicity may be related to inhibition of mitochondrial ribosomes. We present the first case in the literature of a patient with HIV and multidrug resistant tuberculosis with fatal lactic acidosis secondary to linezolid re-exposure. The index case relates to a 37-year-old lady with a background medical history of HIV, on fixed combination antiretroviral therapy. In addition, she had multidrug resistant pulmonary tuberculosis and was being treated on a salvage antituberculosis regimen containing linezolid. She presented with a 1-day history of backpain, nausea and vomiting. Clinically she was severely acidotic with a lactate of 12 mmol/L, which peaked at 19 mmol/L. A presumptive diagnosis of lactic acidosis was made based on the history and exclusion of other causes. The patient demised despite management in the intensive care unit with continuous veno-venous haemodialysis (CVVH) and mechanical ventilation. The diagnosis of linezolid-induced lactic acidosis requires a high index of suspicion and exclusion of other causes. In the absence of definitive treatment, early diagnosis, drug discontinuation and prompt supportive management including continuous veno-venous haemodiafiltration are key in helping to reduce the high mortality associated with this toxicity.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75470820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n1a7
Reuben Ras, M. Haffejee, M. Nel
{"title":"Use of Petroleum Jelly Versus Ultrasound Gel in Renal Ultrasound Imaging","authors":"Reuben Ras, M. Haffejee, M. Nel","doi":"10.18772/26180197.2023.v5n1a7","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n1a7","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81831127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n3a3
Ruchika Meel, Ferande Peters, Elena Libhaber, Richard Nethononda
Abstract Background and Purpose Traditionally, echocardiography has been used for assessing mitral regurgitation (MR) severity. However, existing qualitative, semi-quantitative and quantitative parameters suffer from several limitations. The shortcomings of the current echocardiographic methods for MR severity assessment are especially pronounced in the context of eccentric MR jets. Cardiac magnetic resonance (CMR) imaging is useful for assessing valvular lesions as it is now the gold standard for assessing left ventricular and left atrial volumes. Therefore, we sought to study and compare echocardiography with CMR for assessment of chronic rheumatic MR severity. Methods Twenty-two patients with chronic rheumatic MR who underwent both CMR and echocardiography were studied. For the echocardiography part of the study, the MR severity was assessed as per current guidelines. The CMR measurements were performed per standard guidelines by a single operator experienced in this technique. Results The mean age of the study population was 36.3±13.9 years and 81% were females. There was overall poor agreement for the assessment of MR severity using the quantitative parameters for MR assessment between echocardiography and CMR. Although the measurements for end diastolic volume index (EDVi), end systolic volume index (ESVi), regurgitant volume (RV) and regurgitant fraction (RF) showed moderate correlation, these parameters displayed poor agreement between the two tests. We noted discrepant findings in terms of classification of valve lesion severity in seven patients. Six patients were reclassified after CMR to severe MR and one to moderate MR based on quantitative parameters of regurgitant volume (RV) and regurgitant fraction (RF). Conclusion In patients with severe chronic rheumatic MR with eccentric jets, when MR quantification by echocardiography is inadequate, CMR derived quantitative volumetric parameters may be useful for accurate classification of the severity of mitral regurgitation.
{"title":"Comparison of Chronic Rheumatic Mitral Regurgitation Severity between Cardiac Magnetic Resonance Imaging and Echocardiography","authors":"Ruchika Meel, Ferande Peters, Elena Libhaber, Richard Nethononda","doi":"10.18772/26180197.2023.v5n3a3","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a3","url":null,"abstract":"Abstract Background and Purpose Traditionally, echocardiography has been used for assessing mitral regurgitation (MR) severity. However, existing qualitative, semi-quantitative and quantitative parameters suffer from several limitations. The shortcomings of the current echocardiographic methods for MR severity assessment are especially pronounced in the context of eccentric MR jets. Cardiac magnetic resonance (CMR) imaging is useful for assessing valvular lesions as it is now the gold standard for assessing left ventricular and left atrial volumes. Therefore, we sought to study and compare echocardiography with CMR for assessment of chronic rheumatic MR severity. Methods Twenty-two patients with chronic rheumatic MR who underwent both CMR and echocardiography were studied. For the echocardiography part of the study, the MR severity was assessed as per current guidelines. The CMR measurements were performed per standard guidelines by a single operator experienced in this technique. Results The mean age of the study population was 36.3±13.9 years and 81% were females. There was overall poor agreement for the assessment of MR severity using the quantitative parameters for MR assessment between echocardiography and CMR. Although the measurements for end diastolic volume index (EDVi), end systolic volume index (ESVi), regurgitant volume (RV) and regurgitant fraction (RF) showed moderate correlation, these parameters displayed poor agreement between the two tests. We noted discrepant findings in terms of classification of valve lesion severity in seven patients. Six patients were reclassified after CMR to severe MR and one to moderate MR based on quantitative parameters of regurgitant volume (RV) and regurgitant fraction (RF). Conclusion In patients with severe chronic rheumatic MR with eccentric jets, when MR quantification by echocardiography is inadequate, CMR derived quantitative volumetric parameters may be useful for accurate classification of the severity of mitral regurgitation.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134889744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n1a6
C. Bouter, R. Britz, B. Strobele, S. Rambarran, F. van der Schyff, L. Brannigan, D. Demopoulos, M. Beretta, S. Berkenfeld, D. Parbhoo, B. Bobat, Aadila. Mahomed, M. Reynders, H. Maher, P. Gaylard, H. Etheredge, J. Botha, J. Fabian
{"title":"Adult and Paediatric Liver Transplantation: Wits Transplant Data 2020","authors":"C. Bouter, R. Britz, B. Strobele, S. Rambarran, F. van der Schyff, L. Brannigan, D. Demopoulos, M. Beretta, S. Berkenfeld, D. Parbhoo, B. Bobat, Aadila. Mahomed, M. Reynders, H. Maher, P. Gaylard, H. Etheredge, J. Botha, J. Fabian","doi":"10.18772/26180197.2023.v5n1a6","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n1a6","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78213540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n3a5
Aimee Domingo, Cynthia Molewa, Marietha Nel
Abstract Background: One million inguinal hernia repairs are performed annually in the USA. Although there are reports on the prevalence of inguinal hernias from sub-Sahara Africa, similar reports and guidelines are lacking for the South African population. The aim of this study was to address the epidemiology of inguinal hernias in a South African population. Methods: A retrospective review of all adult patients admitted with inguinal hernias to a public health facility in Johannesburg, was performed using a retrospective review of hospital patient records from August 2019 to May 2020. The patient records were analysed to identify the risk factors associated with inguinal hernias in this population. Results: Of the 125 patients, 91 were male (73%, mean age 50) and 34 were female (27%, mean age 47). Eighty-seven patients self-identified as Black African, 31 as White, four as Indian and three as mixed race. The right side predominated. Twenty patients had bilateral hernias. The mean BMI of males was 25, and 29 for females (p=0.002). Seventy-five patients were never-smokers, seven patients suffered from chronic obstructive pulmonary disease, and six had a family history of hernia. Fifteen patients indicated lifting heavy weights. Conclusion: Based on the study population, women had a nine-fold higher risk for developing an inguinal hernia, compared with women in Western countries. Further studies of inguinal hernia in women on the African continent are strongly advised.
{"title":"Risk Factors of Inguinal Hernia in Urban South Africa","authors":"Aimee Domingo, Cynthia Molewa, Marietha Nel","doi":"10.18772/26180197.2023.v5n3a5","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n3a5","url":null,"abstract":"Abstract Background: One million inguinal hernia repairs are performed annually in the USA. Although there are reports on the prevalence of inguinal hernias from sub-Sahara Africa, similar reports and guidelines are lacking for the South African population. The aim of this study was to address the epidemiology of inguinal hernias in a South African population. Methods: A retrospective review of all adult patients admitted with inguinal hernias to a public health facility in Johannesburg, was performed using a retrospective review of hospital patient records from August 2019 to May 2020. The patient records were analysed to identify the risk factors associated with inguinal hernias in this population. Results: Of the 125 patients, 91 were male (73%, mean age 50) and 34 were female (27%, mean age 47). Eighty-seven patients self-identified as Black African, 31 as White, four as Indian and three as mixed race. The right side predominated. Twenty patients had bilateral hernias. The mean BMI of males was 25, and 29 for females (p=0.002). Seventy-five patients were never-smokers, seven patients suffered from chronic obstructive pulmonary disease, and six had a family history of hernia. Fifteen patients indicated lifting heavy weights. Conclusion: Based on the study population, women had a nine-fold higher risk for developing an inguinal hernia, compared with women in Western countries. Further studies of inguinal hernia in women on the African continent are strongly advised.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134887482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n1a4
N. Patel, P. Sumaraj, T. Gabler, A. Grieve, P. Naidoo, K. Cronin, J. Loveland
{"title":"Knowledge of breastfeeding and human milk banks amongst mothers at Chris Hani Baragwanath Academic Hospital: A descriptive study","authors":"N. Patel, P. Sumaraj, T. Gabler, A. Grieve, P. Naidoo, K. Cronin, J. Loveland","doi":"10.18772/26180197.2023.v5n1a4","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n1a4","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88794441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n1a3
Adam Alnabi, E. Ndobe, A. Rooi, M. Nel
{"title":"Prospective observational study of Nipple–Areola Complex Position post breast reduction","authors":"Adam Alnabi, E. Ndobe, A. Rooi, M. Nel","doi":"10.18772/26180197.2023.v5n1a3","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n1a3","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86663147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n2a6
Nida Siddiqui, A. Mahomed
{"title":"Menstrual health in South Africa","authors":"Nida Siddiqui, A. Mahomed","doi":"10.18772/26180197.2023.v5n2a6","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n2a6","url":null,"abstract":"","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82237050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18772/26180197.2023.v5n2a3
Sara Glatt, L. Winchow, Merika Tsitsi, E. Musenge, C. Menezes
Background: Health care workers (HCWs) are at increased risk of coronavirus disease 2019 (COVID-19). Appropriate risk assessments and testing are essential to reduce transmission and avoid workforce depletion. Objective: To investigate the risk of COVID-19 infection among HCWs who fulfil the person under investigation case definition or had exposure to a confirmed COVID-19 contact. Methods: We conducted a retrospective review of HCWs who were exposed to and/or tested for COVID-19 during the first wave of the pandemic. Data collected included demographics, exposure type, risk level, and COVID-19 test result. Frequency distribution tables, bivariate analyses, univariate and multivariate analyses were conducted. Results: Among the 1111 HCWs reviewed, 643 were tested with 35.6% positive results. PUI's accounted for 62.4% of positive cases. Symptomatic HCWs with no known contact were at a greater risk of infection than those with a patient exposure (p═0.001). The risk of testing positive was higher after a patient exposure (p═0.000) compared to a co-worker contact. Patient-facing designations had a higher risk of SARS-CoV-2 infection than non-clinical designations (p═0.013). The exception to this was security personnel who were 28 times more likely to test positive than any other designation (p═0.000). Conclusion: There is a higher positivity rate among HCWs than the general population. The presence of symptoms warrants testing. Nosocomial transmission was derived from patients more than co-worker contacts. Precautions in the workplace need to be reinforced to protect the health and safety of HCWs during this pandemic. These findings should assist with preparedness for future pandemics.
{"title":"COVID-19 and health care worker exposure at Chris Hani Baragwanath Academic Hospital","authors":"Sara Glatt, L. Winchow, Merika Tsitsi, E. Musenge, C. Menezes","doi":"10.18772/26180197.2023.v5n2a3","DOIUrl":"https://doi.org/10.18772/26180197.2023.v5n2a3","url":null,"abstract":"Background: Health care workers (HCWs) are at increased risk of coronavirus disease 2019 (COVID-19). Appropriate risk assessments and testing are essential to reduce transmission and avoid workforce depletion. Objective: To investigate the risk of COVID-19 infection among HCWs who fulfil the person under investigation case definition or had exposure to a confirmed COVID-19 contact. Methods: We conducted a retrospective review of HCWs who were exposed to and/or tested for COVID-19 during the first wave of the pandemic. Data collected included demographics, exposure type, risk level, and COVID-19 test result. Frequency distribution tables, bivariate analyses, univariate and multivariate analyses were conducted. Results: Among the 1111 HCWs reviewed, 643 were tested with 35.6% positive results. PUI's accounted for 62.4% of positive cases. Symptomatic HCWs with no known contact were at a greater risk of infection than those with a patient exposure (p═0.001). The risk of testing positive was higher after a patient exposure (p═0.000) compared to a co-worker contact. Patient-facing designations had a higher risk of SARS-CoV-2 infection than non-clinical designations (p═0.013). The exception to this was security personnel who were 28 times more likely to test positive than any other designation (p═0.000). Conclusion: There is a higher positivity rate among HCWs than the general population. The presence of symptoms warrants testing. Nosocomial transmission was derived from patients more than co-worker contacts. Precautions in the workplace need to be reinforced to protect the health and safety of HCWs during this pandemic. These findings should assist with preparedness for future pandemics.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85114387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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