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Showing 601 - 800 of 893 Journals sorted alphabetically
Revista Clínica de Medicina de Familia     Open Access   (Followers: 4)
Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral     Open Access   (Followers: 2)
Revista Colombiana de Anestesiología     Open Access   (Followers: 1, SJR: 0.154, CiteScore: 0)
Revista Colombiana de Antropologia     Open Access   (Followers: 2, SJR: 0.232, CiteScore: 0)
Revista Colombiana de Biotecnología     Open Access   (Followers: 1)
Revista Colombiana de Cancerología     Open Access   (SJR: 0.106, CiteScore: 0)
Revista Colombiana de Cardiologia     Open Access   (SJR: 0.113, CiteScore: 0)
Revista Colombiana de Ciencias Químico-Farmacéuticas     Open Access   (Followers: 1)
Revista Colombiana de Educación     Open Access  
Revista Colombiana de Entomología     Open Access   (Followers: 1, SJR: 0.184, CiteScore: 0)
Revista Colombiana de Estadística     Open Access   (SJR: 0.361, CiteScore: 1)
Revista Colombiana de Matemáticas     Open Access   (Followers: 1, SJR: 0.136, CiteScore: 0)
Revista Colombiana de Psicología     Open Access   (SJR: 0.151, CiteScore: 0)
Revista Colombiana de Química     Open Access   (Followers: 1, SJR: 0.115, CiteScore: 0)
Revista Contabilidade & Finanças     Open Access   (SJR: 0.145, CiteScore: 0)
Revista Costarricense de Cardiología     Open Access  
Revista Costarricense de Psicología     Open Access  
Revista Cubana de Anestesiología y Reanimación     Open Access   (Followers: 1)
Revista Cubana de Angiología y Cirugía Vascular     Open Access  
Revista Cubana de Cirugía     Open Access  
Revista Cubana de Endocrinología     Open Access  
Revista Cubana de Enfermería     Open Access   (Followers: 2, SJR: 0.102, CiteScore: 0)
Revista Cubana de Estomatologí­a     Open Access   (SJR: 0.128, CiteScore: 0)
Revista Cubana de Hematología, Inmunología y Hemoterapia     Open Access   (SJR: 0.196, CiteScore: 0)
Revista Cubana de Información en Ciencias de la Salud     Open Access   (SJR: 0.229, CiteScore: 0)
Revista Cubana de Informática Médica     Open Access  
Revista Cubana de Investigaciones Biomédicas     Open Access   (Followers: 1, SJR: 0.13, CiteScore: 0)
Revista Cubana de Medicina     Open Access   (Followers: 2)
Revista Cubana de Medicina General Integral     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 0)
Revista Cubana de Medicina Militar     Open Access   (Followers: 1, SJR: 0.202, CiteScore: 0)
Revista Cubana de Medicina Tropical     Open Access   (SJR: 0.143, CiteScore: 0)
Revista Cubana de Obstetricia y Ginecología     Open Access   (SJR: 0.191, CiteScore: 0)
Revista Cubana de Oftalmología     Open Access   (Followers: 1)
Revista Cubana de Ortopedia y Traumatologí­a     Open Access   (SJR: 0.101, CiteScore: 0)
Revista Cubana de Plantas Medicinales     Open Access   (Followers: 1, SJR: 0.127, CiteScore: 0)
Revista Cubana de Salud Pública     Open Access   (SJR: 0.262, CiteScore: 0)
Revista da Educação Física : UEM     Open Access   (Followers: 1)
Revista da Escola de Enfermagem da USP     Open Access   (Followers: 2, SJR: 0.279, CiteScore: 1)
Revista da Faculdade de Educação     Open Access  
Revista da Sociedade Brasileira de Fonoaudiologia     Open Access  
Revista da Sociedade Brasileira de Medicina Tropical     Open Access   (SJR: 0.658, CiteScore: 1)
Revista de Administração - RAUSP     Open Access   (Followers: 1)
Revista de Administração Contemporânea     Open Access  
Revista de Administração de Empresas     Open Access   (Followers: 1, SJR: 0.16, CiteScore: 0)
Revista de Administração Pública     Open Access   (SJR: 0.294, CiteScore: 0)
Revista de Análisis Económico     Open Access   (SJR: 0.112, CiteScore: 0)
Revista de Antropologia     Open Access   (Followers: 4, SJR: 0.102, CiteScore: 0)
Revista de Bioética y Derecho     Open Access  
Revista de Biología Marina y Oceanografía     Open Access   (SJR: 0.23, CiteScore: 0)
Revista de Biología Tropical     Open Access   (Followers: 1, SJR: 0.326, CiteScore: 1)
Revista de Ciencia Politica     Open Access   (Followers: 2, SJR: 0.368, CiteScore: 1)
Revista de Ciencia y Tecnología     Open Access  
Revista de Ciências Agrárias     Open Access  
Revista de Ciencias Médicas de Pinar del Río     Open Access  
Revista de Ciencias Sociales     Open Access   (Followers: 1)
Revista de Cirugía     Open Access   (SJR: 0.121, CiteScore: 0)
Revista de Derecho     Open Access   (SJR: 0.364, CiteScore: 0)
Revista de Derecho (Concepción)     Open Access   (Followers: 2)
Revista de Derecho (Coquimbo)     Open Access  
Revista de Economía     Open Access   (Followers: 1)
Revista de Economia Contemporânea     Open Access   (SJR: 0.121, CiteScore: 0)
Revista de Economía del Caribe     Open Access  
Revista de Economia e Sociologia Rural     Open Access   (Followers: 2, SJR: 0.265, CiteScore: 0)
Revista de Economía Institucional     Open Access   (SJR: 0.141, CiteScore: 0)
Revista de Economia Poli­tíca     Open Access   (Followers: 1, SJR: 0.282, CiteScore: 0)
Revista de Enfermagem Referência     Open Access   (Followers: 2)
Revista de Estudios Historico-Juridicos     Open Access   (Followers: 1, SJR: 0.123, CiteScore: 0)
Revista de Estudios Sociales     Open Access   (Followers: 2, SJR: 0.166, CiteScore: 0)
Revista de Filosofia     Open Access   (SJR: 0.102, CiteScore: 0)
Revista de Filosofía Open Insight     Open Access  
Revista de Geografía Norte Grande     Open Access   (Followers: 1, SJR: 0.296, CiteScore: 1)
Revista de Gestão Costeira Integrada     Open Access   (SJR: 0.251, CiteScore: 1)
Revista de Historia (Concepción)     Open Access   (Followers: 1)
Revista de Historia Americana y Argentina     Open Access  
Revista de Historia del Derecho     Open Access   (Followers: 1)
Revista de Ingeniería     Open Access  
Revista de Investigacion Psicologica     Open Access   (Followers: 1)
Revista de la Academia Colombiana de Ciencias Exactas, Físicas y Naturales     Open Access   (Followers: 1)
Revista de la Asociación Española de Neuropsiquiatría     Open Access  
Revista de la Ciencia del Suelo y Nutricion Vegetal     Open Access   (SJR: 0.224, CiteScore: 0)
Revista de la Construcción     Open Access   (SJR: 0.234, CiteScore: 1)
Revista de la Facultad de Agronomía     Open Access   (Followers: 1)
Revista de la Facultad de Ciencias Veterinarias, UCV     Open Access  
Revista de la Facultad de Derecho     Open Access  
Revista de la Facultad de Derecho y Ciencias Políticas     Open Access  
Revista de la Facultad de Medicina (México)     Open Access   (Followers: 1)
Revista de la Sociedad Boliviana de Pediatría     Open Access  
Revista de la Sociedad Española de Enfermería Nefrológica     Open Access  
Revista de la Sociedad Química del Perú     Open Access   (Followers: 1)
Revista de la Sociedad Venezolana de Microbiologia     Open Access  
Revista de la Universidad Industrial de Santander. Salud     Open Access  
Revista de Medicina Veterinaria     Open Access  
Revista de Microbiologia     Open Access   (Followers: 1)
Revista de Nutrição     Open Access   (SJR: 0.282, CiteScore: 0)
Revista de Odontologia da UNESP     Open Access  
Revista de Odontologia da Universidade de São Paulo     Open Access  
Revista de Osteoporosis y Metabolismo Mineral     Open Access   (Followers: 2, SJR: 0.121, CiteScore: 0)
Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello     Open Access  
Revista de Protección Vegetal     Open Access  
Revista de Psicología del Trabajo y de las Organizaciones     Open Access   (SJR: 0.418, CiteScore: 1)
Revista de Psiquiatria Clínica     Open Access   (Followers: 1, SJR: 0.271, CiteScore: 1)
Revista de Psiquiatria do Rio Grande do Sul     Open Access   (Followers: 1)
Revista de Salud Animal     Open Access  
Revista de Salud Pública     Open Access   (Followers: 1, SJR: 0.171, CiteScore: 0)
Revista de Saúde Pública     Open Access   (Followers: 1, SJR: 0.807, CiteScore: 2)
Revista de Sociologia e Polí­tica     Open Access   (Followers: 2, SJR: 0.482, CiteScore: 0)
Revista del Instituto de Medicina Tropical     Open Access  
Revista del Nacional     Open Access   (Followers: 1)
Revista Dental Press de Ortodontia e Ortopedia Facial     Open Access   (Followers: 1)
Revista Diacrítica     Open Access  
Revista Direito GV     Open Access   (Followers: 1)
Revista do Colégio Brasileiro de Cirurgiões     Open Access   (SJR: 0.221, CiteScore: 1)
Revista do Departamento de Psicologia. UFF     Open Access  
Revista do Hospital das Clinicas     Open Access  
Revista do Instituto de Estudos Brasileiros     Open Access   (Followers: 1)
Revista do Instituto de Medicina Tropical de São Paulo     Open Access   (SJR: 0.669, CiteScore: 1)
Revista Dor     Open Access  
Revista Ecuatoriana de Neurología     Open Access   (Followers: 1)
Revista EIA     Open Access   (Followers: 1)
Revista electrónica de investigación educativa     Open Access   (Followers: 1, SJR: 0.187, CiteScore: 0)
Revista Electronica Educare     Open Access   (Followers: 2)
Revista Española de Cirugía Oral y Maxilofacial     Open Access   (Followers: 1, SJR: 0.117, CiteScore: 0)
Revista Española de Enfermedades Digestivas     Open Access   (SJR: 0.417, CiteScore: 1)
Revista Española de Salud Pública     Open Access   (SJR: 0.249, CiteScore: 1)
Revista Española de Sanidad Penitenciaria     Open Access   (SJR: 0.135, CiteScore: 0)
Revista Estudos Feministas     Open Access   (SJR: 0.208, CiteScore: 0)
Revista Facultad de Ciencias Económicas: Investigación y Reflexión     Open Access  
Revista Facultad de Ingenieria - Universidad de Tarapaca     Open Access   (Followers: 1)
Revista Facultad de Ingeniería Universidad de Antioquia     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Revista Facultad de Medicina de la Universidad Nacional de Colombia     Open Access   (SJR: 0.125, CiteScore: 0)
Revista Facultad Nacional de Agronomía, Medellín     Open Access   (SJR: 0.138, CiteScore: 0)
Revista Facultad Nacional de Salud Pública     Open Access  
Revista Gaúcha de Enfermagem     Open Access   (SJR: 0.225, CiteScore: 1)
Revista Geológica de América Central     Open Access  
Revista Geológica de Chile     Open Access   (Followers: 1)
Revista Gerencia y Políticas de Salud     Open Access   (SJR: 0.136, CiteScore: 0)
Revista Habanera de Ciencias Médicas     Open Access   (SJR: 0.211, CiteScore: 0)
Revista Historia y Sociedad     Open Access  
Revista IBRACON de Estruturas e Materiais     Open Access   (Followers: 1)
Revista Ingeniería Biomédica     Open Access   (Followers: 1)
Revista Ingenieria de Construcción     Open Access   (Followers: 1, SJR: 0.204, CiteScore: 0)
Revista Ingenierías Universidad de Medellín     Open Access  
Revista Integra Educativa     Open Access  
Revista Interamericana de Bibliotecología     Open Access   (Followers: 7)
Revista Internacional de Contaminación Ambiental     Open Access   (SJR: 0.152, CiteScore: 0)
Revista ION     Open Access  
Revista IUS     Open Access  
Revista Katálysis     Open Access  
Revista Lasallista de Investigación     Open Access   (SJR: 0.146, CiteScore: 0)
Revista Latino-Americana de Enfermagem     Open Access   (SJR: 0.339, CiteScore: 1)
Revista Latinoamericana de Bioética     Open Access  
Revista Latinoamericana de Derecho Social     Open Access   (Followers: 1, SJR: 0.101, CiteScore: 0)
Revista Latinoamericana de Desarrollo Económico     Open Access  
Revista Latinoamericana de Educación Inclusiva     Open Access   (Followers: 1)
Revista Latinoamericana de Filosofía     Open Access   (Followers: 1)
Revista Latinoamericana de Hipertension     Open Access   (SJR: 0.158, CiteScore: 0)
Revista Latinoamericana de Investigación en Matemática Educativa     Open Access   (SJR: 0.171, CiteScore: 0)
Revista Latinoamericana de Psicopatologia Fundamental     Open Access   (SJR: 0.201, CiteScore: 0)
Revista Medica de Chile     Open Access   (SJR: 0.259, CiteScore: 1)
Revista Médica del Hospital Nacional de Niños Dr. Carlos Sáenz Herrera     Open Access   (Followers: 1)
Revista Médica del Uruguay     Open Access  
Revista Médica Electrónica     Open Access  
Revista Médica La Paz     Open Access  
Revista Médico-Científica : Luz y Vida     Open Access  
Revista Mexicana de Análisis de la Conducta     Open Access   (SJR: 0.405, CiteScore: 1)
Revista Mexicana de Astronomía y Astrofísica     Open Access   (Followers: 2, SJR: 0.596, CiteScore: 1)
Revista Mexicana de Biodiversidad     Open Access   (SJR: 0.421, CiteScore: 1)
Revista Mexicana de Ciencias Agrícolas     Open Access   (Followers: 1)
Revista Mexicana de Ciencias Farmaceuticas     Open Access   (Followers: 1)
Revista Mexicana de Ciencias Geológicas     Open Access   (SJR: 0.308, CiteScore: 1)
Revista Mexicana de Ciencias Pecuarias     Open Access   (Followers: 1, SJR: 0.17, CiteScore: 0)
Revista Mexicana de Economía y Finanzas     Open Access  
Revista Mexicana de Física     Open Access   (SJR: 0.203, CiteScore: 0)
Revista mexicana de física E     Open Access  
Revista Mexicana de Fitopatología     Open Access  
Revista Mexicana de Ingeniería Biomédica     Open Access   (Followers: 1)
Revista Mexicana de Ingeniería Química     Open Access   (SJR: 0.328, CiteScore: 1)
Revista Mexicana de Investigación Educativa     Open Access   (Followers: 3, SJR: 0.291, CiteScore: 0)
Revista Mexicana de Micologí­a     Open Access  
Revista Mexicana de Sociologí­a     Open Access   (Followers: 9, SJR: 0.142, CiteScore: 0)
Revista Musical Chilena     Open Access   (SJR: 0.1, CiteScore: 0)
Revista MVZ Córdoba     Open Access   (SJR: 0.173, CiteScore: 0)
Revista Nutrícias     Open Access   (Followers: 1)
Revista Odonto Ciência     Open Access   (SJR: 0.101, CiteScore: 0)
Revista Opinión Jurídica     Open Access  
Revista Panamericana de Salud Pública     Open Access   (SJR: 0.452, CiteScore: 1)
Revista Paulista de Pediatria     Open Access   (SJR: 0.472, CiteScore: 1)
Revista Perspectivas     Open Access  
Revista Pilquen : Sección Ciencias Sociales     Open Access  
Revista Politécnica     Open Access   (Followers: 1)
Revista Portuguesa de Cirurgia     Open Access   (Followers: 1)
Revista Portuguesa de Enfermagem de Saúde Mental     Open Access  
Revista Portuguesa de Imunoalergologia     Open Access   (Followers: 2, SJR: 0.141, CiteScore: 0)
Revista Portuguesa de Ortopedia e Traumatologia     Open Access  
Revista Portuguesa de Saúde Pública     Open Access   (SJR: 0.155, CiteScore: 0)
Revista Portuguesa e Brasileira de Gestão     Open Access  
Revista Republicana     Open Access   (Followers: 1)
Revista Signos     Open Access   (SJR: 0.174, CiteScore: 0)
Revista Universitaria de Geografía     Open Access  
Revista Uruguaya de Cardiologia     Open Access  

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South African Journal of Surgery
Journal Prestige (SJR): 0.162
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Print) 0038-2361 - ISSN (Online) 2078-5151
Published by SciELO Homepage  [893 journals]
  • College of Surgeons general surgery final examination

    •  
  • An audit of the outcomes of the College of Surgeons general surgery
           final examinations

    • Abstract: BACKGROUND: An audit of the Fellowship of the College of Surgeons (FCS) of South Africa examination results has not been previously performed. The purpose of this study was to review and determine any predictors of outcome (pass or fail) METHODS: The results of the FCS(SA) final examinations from October 2005 to and including October 2014, were retrieved from the College of Medicine of South Africa database. The current format of the examinations consists of two written essay question papers, an objectively structured clinical examination (OSCE), two clinical cases and two oral examinations. These were retrospectively reviewed and analysed. Predictors of failure or success were determined. RESULTS: During the 10-year study period, 472 candidates attempted the examinations. A total of 388 (82%) candidates were successful in the written component of the examination and were subsequently invited to participate in the clinical component of the examinations. Overall, 296 (63%) candidates passed and 176 (37%) failed. There were 51 candidates who were invited to the oral examinations despite an average of less than 50% in the two papers, and 34 (67%) failed the overall examination. Similarly, 126 candidates were invited having failed one of the two papers of which 81 (64%) ultimately failed. A total of 49 candidates failed the OSCE, 82% of these candidates failed overall. There were strong correlations between the averages of the papers versus the orals (Spearman ρ = 0.51), the papers versus the cases (Spearman ρ = 0.50), and the papers versus the OSCE (Spearman ρ = 0.55). CONCLUSION: The written papers are the main determinant of invitation to the second part of the examination. Candidates with marginal scores in the written component had an overall failure rate of 67%. Failing one paper and passing the other, resulted in an overall failure rate of 64%. Failing the OSCE resulted in an overall 82% failure rate. With the high failure rate of candidates with marginal scores and with the inter-examination variability of the papers, it might be prudent to revisit both the process of invitation selection and the decision to continue with the long-form of the written component.
       
  • Compliance with the Surviving Sepsis Campaign guidelines for early
           resuscitation does not translate into improved outcomes in patients with
           surgical sepsis in South Africa

    • Abstract: INTRODUCTION: This project set out to audit our compliance with the 3-hour bundles of care for surgical sepsis and to interrogate how compliance or non-compliance impacts on the outcome of surgical sepsis in our institution. METHODS: All emergency surgical patients over the age of fifteen years were reviewed. All patients who fulfilled the ACCP/ SCCM criteria for sepsis or septic shock, with a documented surgical source of infection, were identified for review. RESULTS: A total of 677 septic patients with a documented surgical source of sepsis were included. Of the 677 patients, 53% (360/677) had intra-abdominal sepsis, 17% (116/677) had diabetic-related limb sepsis and the remaining 30% (201) had soft tissue infections. A total of 585 operative procedures were performed. Compliance with all components of the 3-hour bundle metrics was achieved in 379/677 patients (56%), and not achieved in 298/677 patients (44%). The only significant difference between the compliant and the non-compliant groups was respiratory rate greater than 22 breaths/minute (131 vs 71, p = 0.002) in the compliant cohort. Amongst the compliant cohort 77/379 patients (20%) required admission to ICU, whilst 41/298 patients (14%) in the non-compliant cohort required admission to ICU. This difference was statistically different (p = 0.026). There was no difference in the median length of hospital stay (6 days) between the two groups. Fifty-five patients in the compliant cohort died (15%), whilst 31 (10%) of the patients in the non-compliant cohort died. This difference was not statistically different (p = 0.111). CONCLUSION: Compliance with the SCC 3-hour bundle did not seem to improve mortality outcomes in our setting. This observation cannot be adequately explained with our current data and further work looking at management of surgical sepsis in our setting is required. Time to surgical source control is probably the single most important determinant of outcome in patients with surgical sepsis and other aspects of the care bundle are of secondary importance.
       
  • Admissions for post-discharge surgical site infection at a quaternary
           South African public sector hospital

    • Abstract: BACKGROUND: Reports of post-discharge admissions for surgical site infection (SSI) in African settings are lacking. This information could assist with allocating resources within hospitals, as well as developing targeted interventions aimed at reducing post-discharge SSI. The primary objective of this study was to determine trends in admissions for post-discharge SSI at a South African quaternary/teaching hospital. The secondary objective was to determine trends in mortality rates for these admissions METHODS: This was a retrospective review of adult admissions for post-discharge SSI at a quaternary/teaching South African hospital between 2006 and 2015. Admissions for post-discharge SSI were identified using the hospital administrative database and appropriate International Classification of Disease, 10th Revision codes. Mortality was determined from the discharge disposition for each admission. Data were analysed with simple regression and trend line statistics. The geospatial distribution of post-discharge SSI, based on the residential postal codes recorded on the hospital administrative database for each admission, was determined using the Power Map® software program RESULTS: There was no change in admissions for post-discharge SSI over the study period (p = 0.17). Mortality in elderly admissions declined during the study period (p = 0.03). Most admissions for post-discharge SSIs originated from urban areas. CONCLUSION: Despite the implementation of universal SSI prevention methods, admissions for post-discharge SSI remained consistent during the study period. Urban areas appeared to be more severely affected by post-discharge SSI than rural areas. Additional prevention methods for post-discharge SSI are required
       
  • Axillary lymph node dissection for patients with invasive breast cancer at
           Charlotte Maxeke and Chris Hani Baragwanath Academic Hospitals

    • Abstract: BACKGROUND: The extent of axillary surgery correlates with its morbidity and sentinel lymph node biopsy (SLNB) has become the standard of care in clinically node-negative (cN0) patients.This study aims to evaluate the application of SLNB and axillary lymph node dissection (ALND) and the associated risk factors for node-negative ALND in our units METHODS: We included female patients with primary breast cancer who underwent axillary surgery in the breast units at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital from March 2013 to March 2015. Univariate and multivariable logistic regression models were used to determine factors associated with pathological node-negative (pN0) ALND RESULTS: 505 patients were included and 344 patients were staged clinically node-positive (68.1%), 161 (31.9%) were assessed as clinically node-negative and deemed eligible for SLNB. Sensitivity of clinical nodal staging was 85.9% with a positive predictive value of 76.5%. The majority of patients (313, 61.9%) underwent primary surgery while 192 (38.1%) underwent surgery after NACT. We performed 118 SLNBs and 387 ALNDs of which 97 were pathologically node-negative. Risk was not increased after NACT (OR 1.06, p = 0.790). We identified a significant risk in patients with triple-negative and HER-2 enriched subtypes compared to hormone receptor-positive patients (OR 3.05, 95% CI: 1.6-5.7, p = 0.001 and OR 2.25, 95% CI: 1.1-4.8, p = 0.035 CONCLUSIONS: The prevalence of pN0 ALND was 25.06%. In our cohort a significantly higher risk was found in hormone receptor-negative tumours Preoperative nodal assessment needs to be optimised and include pathological confirmation. SLNB needs to be extended to patients after NACT despite resource-constraints.
       
  • Discrepancy in clinical outcomes of patients with gunshot wounds in car
           hijacking: a South African experience

    • Abstract: INTRODUCTION: Discrepancy in outcomes between urban and rural trauma patients is well known. We reviewed our institutional experience with the management of gunshot wounds (GSWs) in the specific setting of car hijacking and focused on clinical outcome between rural and urban patients. METHODS: A retrospective review was conducted at a major trauma centre in South Africa over an 8-year period for all patients who presented with any form of GSWs in car hijacking settings. Specific clinical outcomes were compared between rural and urban patients. RESULTS: A total of 101 patients were included (74% male, mean age 34 years). Fifty-five per cent were injured in rural areas and the remaining 45% (45/101) were in the urban district. Mean time from injury to arrival at our trauma centre was 11 hours for rural and 4 hours for urban patients (p < 0.001). Seventy-six per cent (76/101) sustained GSWs to multiple body regions. Sixty-three of the 101 (62%) patients required one or more operative interventions. In individual logistic regressions adjusted for sex and number of regions injured, rural patients were 9 (95% CI: 1.9-44.4) and 7 (95% CI: 2.124.5) times more likely than urban patients to have morbidities or required admissions to intensive care respectively. The risk of death in rural patients was 36 (95% CI: 4.5-284.6) times higher than that of urban patients. CONCLUSIONS: Patients who sustained GSWs in carjacking incidents that occurred in rural areas are associated with significantly greater morbidity and mortality compared with their urban counterparts. Delay to definitive care is likely to be the significant contributory factor, and improvement in prehospital emergency medical service is likely to be beneficial in improving patient outcome.
       
  • Renal trauma in a Trauma Intensive Care Unit population

    • Abstract: BACKGROUND: For the majority of renal injuries, non-operative management is the standard of care with nephrectomy reserved for those with severe trauma. This study in a dedicated Trauma Intensive Care Unit (TICU) population aimed to assess the outcomes of renal injuries and identify factors that predict the need for nephrectomy METHODS: Patients, older than 18 years, admitted to TICU from January 2007 to December 2014 who sustained renal injuries had data extracted from the prospectively collected Class Approved Trauma Registry (BCA207-09). Patients who underwent surgical intervention for the renal injury or received non-operative management were compared. The key variables analysed were: patient demographics, mechanism of injury, grade of renal injury, presenting haemoglobin, initial systolic blood pressure, Injury Severity Score and Renal Injury AAST Grade on CT scan in patients who did not necessarily require immediate surgery, or at surgery in those patients who needed emergency laparotomy RESULTS: There were 74 confirmed renal injuries. There were 42 low grade injuries (grade I-III) and 32 high grade injuries (5 grade IV and 27 grade V). Twenty-six (35%) had a nephrectomy: 24 with grade V injuries and 2 with grade IV injuries required nephrectomy. Six patients in the high injury grade arm had non-operative management. A low haemoglobin, low systolic blood pressure, higher injury severity score, and a high-grade renal injury, as well as increasing age were positive predictors for nephrectomy in trauma patients with renal injury CONCLUSION: Non-operative management is a viable option with favourable survival rates in lower grade injury; however, complications should be anticipated and managed accordingly. High grade injuries predict the need for surgery
       
  • Renal artery embolisation: indications and utilisation at Tygerberg
           Hospital

    • Abstract: BACKGROUND: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal haemorrhage, specifically in cases of non-iatrogenic origin. METHODS: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg Hospital. RESULTS: Renal artery embolisation was performed in a total of 92 patients. The indication was traumatic renal injury in 60 patients (65.2%), with mean age 28.2 years. The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%). Digital subtraction angiography (DSA) showed pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%. : 85% after one, 88.9% after a second attempt, with an overall success rate of 98.3% after two attempts. In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%). Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%). Embolisation was repeated in 16.3%, with eventual success rate of 93.8%. Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases. Of the 9 patients who returned for follow-up with renogram imaging, 4 had a differential function of> 20% of the embolised kidney. CONCLUSION: Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from trauma, malignancy, iatrogenic or other causes.
       
  • Correlation of white cell count and CRP in acute appendicitis in
           paediatric patients

    • Abstract: BACKGROUND: Ten per cent of children who present with abdominal pain at an emergency department are diagnosed with acute appendicitis. The diagnosis of which relies on clinical acumen, but addition of tests such as measurement of the white cell count (WCC) and C-reactive protein (CRP) are needed to decrease the morbidity associated with inappropriate surgical management. This study evaluates the sensitivity, specificity and accuracy of the WCC and CRP separately and when used in combination and evaluates whether an increased WCC and CRP are associated with complicated appendicitis METHODS: A retrospective record review of all paediatric patients who underwent appendicectomy between June 2010 and December 2016 was conducted. Demographic data, the WCC, CRP and histology results were reviewed RESULTS: 763 records were reviewed. The sensitivity and specificity of the WCC were 69.6% and 43.1% respectively and of the CRP were 95.4% and 24.5% respectively. The sensitivity was higher when both the CRP and WCC were elevated (97.47%). A normal WCC and CRP had a specificity of 98%, with an odds ratio of 8.69 of a patient not having appendicitis. There was a borderline significance between the WCC and the presence of acute appendicitis (p = 0.0494). The CRP was significant in patient with acute appendicitis (p < 0.0001). The WCC and CRP between uninflamed appendix specimens, uncomplicated appendicitis and complicated appendicitis was significant CONCLUSION: Both increasing CRP and WCC correlates with an increased likelihood of the presence of complicated appendicitis. The chance of a patient having appendicitis with both normal WCC and CRP is low
       
  • Scar wars

    • Abstract: BACKGROUND: Burn scars are common in the paediatric population. When involving the face, it diminishes quality of life. Ablative fractional laser (AFL) therapy is becoming the preferred choice for established scars due to its greater potential depth for thermal injury (4 mm), which leads to photothermolysis with subsequent neocollagenesis and collagen fibre realignment and remodelling. Combined with small z-plasties and topical steroids, it has been proven to: flatten and decrease the volume of scars, increase pliability and decrease pruritus and erythema. The purpose of the case series was to determine the clinical significance of a single session of AFL therapy, combined with small z-plasties and topical steroids on facial scars post burn injury. METHODS: Four cases of paediatric facial scarring post burns were selected to undergo a single treatment of AFL therapy, accompanied by small z-plasties and topical steroids. Modified Vancouver Scar Scores (MVSS) pre- and postoperatively at 3 and 6 months were evaluated RESULTS: Improvement of all components of the MVSS was achieved after 6 months, with major improvement in scar pliability and symptomatology. The mean MVSS improved from 14 (range 12-16) preoperatively to 5 and 5.5 respectively at 3 and 6 months postoperatively. Non-parametric analysis with Friedman Two-Way ANOVA by Rank showed a statistical significance between the pre- and postoperative MVSS (p = 0.024) CONCLUSION: AFL should form an integral part of the burn scar armamentarium.
       
  • Knowledge and attitude of patients undergoing lower extremity amputation
           at RK Khan Hospital, Chatsworth

    • Abstract: BACKGROUND: Amputation is one of the oldest and most commonly performed surgical procedures. OBJECTIVE: To review the knowledge and attitude of patients undergoing lower extremity amputations and describe the associated causative factors. METHODOLOGY: A questionnaire-based prospective study assessing patients either preoperatively or immediately postoperatively regarding their knowledge and attitudes toward lower extremity amputation was conducted between November 2016 and April 2017. Extracted data was captured into an Excel spreadsheet and imported into SPSS for statistical analysis. RESULTS: Sixty-three amputations were performed with males accounting for 56% of the study population. The majority were in the age group of 61-70 years (33%). The commonest indication for amputation was complication of diabetes mellitus or diabetes foot sepsis (65%). Below-knee amputation (BKA) was the most frequently performed procedure and accounted for 56% of all amputations. Seventy per cent of the participants had formal education and 60% knew that their condition could lead to an amputation, but only approximately 10% visited the foot clinic before their major amputation despite the service being available at RK Khan Hospital. Smoking was the commonest habit associated with amputation. CONCLUSION: Complications of diabetic mellitus are the most common indication for lower extremity amputation. A high percentage of patients knew their co-morbid condition could lead to limb loss but failed to seek medical assistance until late in their disease process.
       
  • Tuberculous prostatitis: a condition not confined to the
           immunocompromised

    • Abstract: Tuberculous (TB) prostatitis is rare; usually occurring in immunocompromised men. It can mimic benign prostatic hyperplasia (BPH), chronic prostatitis or prostate cancer. This report in an immunocompetent 72-year-old man adds to the clinical spectrum of the five prior reported cases. A low threshold for prostatic biopsy led to a histological evaluation and subsequent microbiological confirmation of TB. This attests to the value of such an approach in arriving at the correct diagnosis and the institution of appropriate anti-tuberculous therapy even amongst immune-competent men.
       
  • Malignant neuroendocrine tumour in an adult female diagnosed with
           Currarino syndrome

    • Abstract: Currarino syndrome is a rare, autosomal dominant condition of caudal anomalies, usually diagnosed in childhood. Adult presentation is rare and malignant transformation of the associated presacral mass even more so. We report a case of a 60-year-old female diagnosed with a malignant neuroendocrine tumour in the presacral mass in Currarino syndrome and describe the surgical management and pathological findings.
       
  • South African guidelines for receptor radioligand therapy (RLT) with
           Lu-177-PSMA in prostate cancer

    • Abstract: BACKGROUND: Prostate cancer is an important cause of morbidity and mortality in South Africa, as it is in the rest of the world. In African men, however, prostate cancer tends to follow a more aggressive course when compared to their European counterparts. This is attributed to a plethora of diverse factors of which an underlying genetic component has been shown to be an important aspect. Such differences highlight the need for individualised therapy and for local guidelines. The aim of this guideline is to aid nuclear physicians and other clinicians who manage patients with prostate cancer in the correct identification and treatment of patients who are likely to benefit from receptor radioligand therapy. RECOMMENDATIONS: There are a multitude of treatment modalities available for the treatment of prostate cancer and these therapies may be required at various time points during the course of the disease in any individual patient. A multidisciplinary approach is crucial in deciding which therapy, or combination of therapies, would be most advantageous at particular time points. The multidisciplinary team should include a urologist, oncologist and nuclear medicine physician as a minimum, and should ideally also involve a palliative/pain specialist, a dietician and a psychologist. CONCLUSION: Treatment with 177Lu-PSMA has emerged as a promising systemic modality, which involves the delivery of targeted radiation therapy in the form of β-particles to sites of tumour tissue. Therapy is provided on an outpatient basis, is well tolerated with relatively few side effects and has a positive effect on overall survival and quality of life. At present, it is used mostly in the setting of advanced, castrate-resistant cancer. Patients are selected (amongst other criteria) based on the prior PSMA-based SPECT/PET/CT imaging (99mTc-,68Ga- or 18F-PSMA), which should demonstrate sufficient receptor expression in order to consider PSMA-based targeted radionuclide therapy. Such imaging of an intended target prior to its therapeutic targeting is known as a theranostic approach.
       
 
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