wits school of clinical medicine biennial research day · 5 70 phakathi, b surgery survival of...

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WITS School of Clinical Medicine – Biennial Research Day

23rd October 2019, Faculty of Health Sciences

POSTER EXHIBITION: Public Health Reseources Centre

POSTERS Alphbetical List

No. PRESENTER DEPARTMENT/ENTITY POSTER TITLE

1 Akinpelu, T Emergency Medicine Lunar cycle, seasonal variation and prevalence of emergency urological presentations: correlation or coincidence? (Ref. 1)

2 Adam, MA Obstetrics & Gynaecology

Sonographic Measurement of the Uterine Lower Segment in women with one previous caesarean section to determine Uterine Lower Segment Thickness. (Ref. 182)

3 Aigobodion, SJ Emergency Medicine Occupational blood and body fluid exposure amongst medical interns in Gauteng. (Ref. 2)

4 Banderker, E Internal Medicine A descriptive study of adult mitral valve disease at a Tertiary Referral Center. (Ref 7)

5 Bandini, R Paediatrics and Child Health

Incidence of augmented renal clearance in the paediatric ICU of a tertiary referral hospital in Johannesburg, South Africa. (Ref. 8)

6 Botha, J Surgery Transplant Unit, WDHMC

Liver transplantation for unresectable metastatic colorectal carcinoma. (Ref. 12)

7 Botha, J Surgery Transplant Unit, WDHMC

Living Donor Liver Transplantation in South Africa - The Donor Experience. (Ref. 13)

8 Bunga, A Radiation Oncology Patterns of practice of breast cancer irradiation in the Department Of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital 2010-2012. (Ref. 15)

9 Candy, C Surgery Detection and quantification of different endogenous cardiotonic steroids by liquid chromatography tandem mass spectrometry. (Ref. 17)

10 Candy, C Surgery Evidence for association of Helicobacter pylori and hypertension. (Ref. 183)

11 Chandiwana, N WRHI Ezintsha Pregnancy outcomes among HIV-positive women on dolutegravir versus efavirenz-based antiretroviral therapy: week 48 analysis of the ADVANCE trial. (Ref. 20)

12 Christofides, C Surgery, Urology BAUX Score as a predictor of mortality at the CHBAH adult burns unit. (Ref. 22)

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13 de Jager, M Surgery Transplant Unit, WDHMC

18 month preliminary results - the Wits Transplant "Family Approach to Consent for Transplant Strategy"• (FACTS). (Ref. 24)

14 de Jager, P Public Health Is there an association between lead exposure and aggressive behavior in shooters? (Ref. 178)

15 Dempster, M Internal Medicine, WDGMC

Case Series: Adult Liver Transplant for Hepatocellular Carcinoma at Wits Donald Gordon Medical Centre in Johannesburg, South Africa. (Ref. 25)

16 du Plessis, J Orthopaedic Surgery Case Report: Single stage revision of total knee arthroplasty for metallosis. (Ref. 29)

17 Dulaze, MN Steve Biko Centre for Bioethics

QALYs, Justice and the Capabilities Approach. (Ref. 30)

18 Enyuma, C Emergency Medicine Hand washing practices amongst health care workers at a tertiary academic hospital Emergency Department. (Ref. 33)

19 Enyuma, C Emergency Medicine Role of the Ultrasonographic "Whirlpool Sign" in intestinal volvulus: A systematic review and meta-analysis. (Ref. 34)

20 Esteves, M Internal Medicine, WDGMC

Outpatient Colonoscopy at Wits Donald Gordon Medical Centre: Quality Indicators and Unusual Findings. (Ref. 37)

21 Fening, NY Anaesthesiology Music as an intervention to reduce preoperative anxiety in gynecological patients. (Ref. 40)

22 Geel, G Paediatric Oncology and Haematology

African Paediatric Oncology Services: finding the gaps in resources and implications for training and education. (Ref. 45)

23 Gerber, L Emergency Medicine A comparison of two handed versus single handed bag valve mask ventilation during two rescuer cpr on a simulation manikin. (Ref. 46)

24 Gerber, L Emergency Medicine Medication errors in an intensive care unit in Johannesburg; from transcription through to delivery. (Ref. 47)

25 Gerber, L Emergency Medicine The 'John Thomas' sign and pelvic fractures - Fact or humorous myth?: A systematic review and meta-analysis. (Ref. 48)

26 Govender, TR Surgery Minimally invasive repair of an intraperitoneal bladder injury secondary to blunt abdominal trauma. (Ref. 50)

27 Govender, TR Paediatric Surgery Vascular Rings: A Tale of Two Cases. (Ref. 51)

28 Grossberg, S Surgery The negative appendectomy rate at Charlotte Maxeke Johannesburg Academic Hospital:A 10 year review- stubbornly high. (Ref. 54)

29 Gumede, S WRHI Ezintsha Descriptive analysis of ART patients on second-line treatment in selected public health facilities in Johannesburg, South Africa: a retrospective cohort data analysis. (Ref. 56)

30 Hirschmann, A Orthopaedic Surgery Orthopaedic Terror Medicine: Are we ready to deal with the injuries sustained from an intentional mass casualty incident in South Africa? (Ref. 57)

31 Honiball, JW Emergency Medicine Department of

Near-infrared spectroscopy in the diagnosis of testicular torsion - valuable modality or waste of valuable time? A systematic review. (Ref. 59)

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32 Ismail, S Neurosciences Ophthalmology

Retinal nerve fibre layer thickness in a normal Black South African population. (Ref. 62)

33 Jonosky, J Surgery Urology Bowel Obstruction: a Rare Manifestation of Locally Advanced Prostate Cancer in a Young Man with a Genetic Mutation. (Ref. 63)

34 Medar, S Forensic Medicine and Pathology

A 10-year retrospective review on mob justice fatalities examined at the Germiston Forensic Pathology Medico-legal Service. (Ref.65)

35 Kinandu, K Surgery Outcomes of major trauma patients receiving pre-hospital adrenaline for haemodynamic instability at Charlotte Maxeke Johannesburg Academic Hospital. (Ref. 67)

36 Lindeque, S Neurosciences Ophthalmology

Canalicular lacerations: causes, related ocular injury, and management at St John Eye Hospital. (Ref. 70)

37 Lockhat , R Anaesthesiology Effect of transversus abdominis plane block on post-operative morphine consumption in total abdominal hysterectomy patients. (Ref. 71)

38 Louw, L Radiation Sciences Added benefit of SPECT/CT imaging in oncology. (Ref. 73)

39 Louw, L Radiation Sciences Resting MPI SPECT as a predictor of myocardial viability on 18F-FDG PET. (Ref. 74)

40 Louw, L Radiation Sciences Quantitative parameters of MPI SPECT assessment - does patient position matter? (Ref. 75)

41 Maharaj, S Neurosciences ENT Deep Neck Space Infections: A Case Series and review of the literature. (Ref. 79)

42 Mahomed, M Anaesthesiology Post-operative experiences of patients undergoing laparoscopic gynaecological surgery at an academic training hospital. (Ref. 81)

43 Malan, A Human Genetics, Pathology

The Quality of Life of Mothers who have Children with Developmental Disorders. (Ref. 83)

44 Malan, N Nuclear Medicine and Molecular Imaging

Thyroid cancer clinic - should serum calcium monitoring become a routine part of follow-up of patients receiving I-131 ablation / treatment? (Ref. 84)

45 Manful, A Public Health Changes in prevalence and isolated organisms of sepsis in very-low-birth-weight (vlbw) neonates at Charlotte Maxeke Johannesburg Hospital, 2013-2017. (Ref. 85)

46 Marcus, F Psychiatry An assessment of voting knowledge and related decisions amongst hospitalized mental health care users in South Africa. (Ref. 86

47 Mdluli, NT Internal Medicine The Wnt/Î²-catenin pathway in human colon adenocarcinoma cells is modulated by a histone deacetylase inhibitor. (Ref. 89)

48 Meel, R Internal Medicine Cardiology

Spectrum of Thoracic Ascending Aortic Aneurysms at a Peri-Urban Tertiary Hospital: An Echocardiography based study. (Ref. 91)

49 Mhlambi, N Surgery Novel targets in dysregulated signalling pathways to inhibit metastasis in pancreatic ductal adenocarcinoma. (Ref. 94)

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50 Mirza, S Internal Medicine Circulating Cancer Associated Fibroblasts and Circulating Tumor Stem Cells: The Symbiotic Siblings and Potential Drug Targets. (Ref. 95)

51 Mkansi, MA WRHI Ezintsha Implementer perceptions of participant experiences during enrolment into an m-Health study in Johannesburg clinics. (Ref. 97)

52 Mlotshwa, N Surgery Cardiothoracic Tracheal B cell lymphoma, Case presentation. (Ref. 99)

53 Mndebele, S Obstetrics and Gynaecology

Morbidity of Ectopic Pregnancy at Chris Hani Baragwanath Hospital. (Ref. 100)

54 Modi, D Internal Medicine Dermatology

A patient with recalcitrant oral pemphigus vulgaris successfully treated with a biologic drug- Rituximab. The first documented case in South Africa. (Ref. 101)

55 Mokwatsi, L Psychiatry Substance use prevalence and outcomes in a psychiatric outpatient population in Southern Gauteng. (Ref. 102)

56 Molopa, M Surgery Cardiothoracic Atrial Myxoma: A report of five cases. (Ref. 103)

57 Moolla, Y Radiation Oncology ‘Prostate Cancer’ information on the internet: fact or fiction? (Ref. 104)

58 Moorhouse, M WRHI Ezintsha Availability of third-line antiretroviral therapy in sub-Saharan Africa. (Ref. 105)

59 Morar, T Psychiatry Exploring burnout among psychiatry registrars at the University of the Witwatersrand. (Ref.107)

60 Motshabi, P Anaesthesiology Profile of adult patients presenting for rheumatic mitral valve surgery at an academic hospital. (Ref. 108)

61 Motshabi, P Anaesthesiology Audit of blood product transfusion in paediatric congenital heart surgery on cardiopulmonary bypass. (Ref. 110)

62 Mungul, S Neurosciences ENT Botulinum toxin A therapy for post-traumatic parotid sialocele - a case Report and review of the literature. (Ref. 114)

63 Mungul, S Neurosciences ENT Lingual fibrolipoma- a rare clinicopathological entity. (Ref. 115)

64 Naidoo, V Internal Medicine Oncology

Enrichment of tumour stage-specific glycoproteins from colorectal cancer cell lines. (Ref. 116)

65 Nakwa, FL Paediatrics Neonatology

Reduction of blood stream infection due to methicillin resistant Staphylococcus aureus through use of chlorhexidine skin baths in a neonatal unit. (Ref. 118)

66 Nel, CE Anatomical Pathology A prospective study of 112 cases investigating the discordance between receptor profiles of primary breast carcinoma and the involved ipsilateral lymph node metastases. (Ref. 120)

67 Ntombela, P Orthopaedic surgery Outcomes of Distal radius metaphyseal fractures in children. (Ref. 126)

68 Nweke, E Surgery Integration of proteomics and genomics data demonstrates novel potential targets of pancreatic ductal adenocarcinoma in African patients. (Ref. 127)

69 Osei, ED Orthopaedic Surgery Diagnostic accuracy of pre-operative clinical examination in zone v flexor injuries. (Ref. 131)

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70 Phakathi, B Surgery Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV. (Ref. 132)

71 Pillay, D WRHI Family Planning Services as a service entry point for HIV testing and prevention services for adolescent girls and young women: Reflections from 2 studies in South Africa. (Ref. 135)

72 Pillay, P Radiation Oncology Sexual quality of list in locally advanced cervical cancer patients treated with definitive concurrent chemoradiation. (Ref. 134)

73 Pillay, T Orthopaedic Surgery Prevalence of Asymptomatic Bacteriuria (ASB) in Patients Undergoing Total Joint Arthroplasty at an Academic Institution and Subsequent Risk of Early Surgical Site Infections (SSIs). (Ref. 136)

74 Purbhoo, K Nuclear Medicine and Molecular Imaging

Should Planar imaging be replaced by SPECT Ventilation-Perfusion (VQ) Scintigraphy? (Ref. 139)

75 Purbhoo, K Nuclear Medicine and Molecular Imaging

The impact of normal stress myocardial perfusion imaging with regard to cost saving of resources. (Ref. 140)

76 Rafferty, K Neurosciences Ophthalmology

Central Foveal Thickness as measured on Optical Coherence Tomography Pre- and Post-phacoemulsification Surgery in a South African Population. (Ref. 141)

77 Saggers, R Paediatrics and Child Health

An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at Charlotte Maxeke Johannesburg academic hospital. (Ref. 181)

78 Segal, B Public Health Biomedical Informatics

A comparison of predictive models for number of admissions and length of stay in a surgical unit of a South African Academic Hospital. (Ref. 144)

79 Shiba, PG Radiation Oncology The impact of venous thromboembolism on the outcomes of patients with cervical carcinoma, a retrospective audit from Jan 2015 to Dec 2016. (Ref. 49)

80 Simmons, D Orthopaedic Surgery, Paediatrics

Appropriate Age of admission in a paediatric orthopaedic ward at a tertiary hospital. (Ref. 148)

81 Simmons, D Orthopaedic Surgery, Paediatrics

Patient based outcome after in situ percutaneous pinning for slipped upper femoral epiphysis (SUFE). (Ref. 150)

82 Steyn, M Anatomical Sciences Patterning of fractures in a case of intimate partner homicide (IPH). (Ref. 156)

83 Strehlau, R Paediatrics and Child Health

Analytic Treatment Interruption Trial in Early-treated HIV-infected Infants. (Ref. 158)

84 Subramanian, K Internal Medicine Oncology

Effect of novel synthetic indoline derivatives on colorectal adenocarcinoma cell lines. (Ref. 159)

85 Subrayan, M Obstetrics and Gynaecology

Female Genital Mutilation: Knowledge, attitudes and beliefs of Obstetrics and Gynaecology doctors in South Africa. (Ref. 160)

86 Temenu, AV Obstetrics and Gynaecology

Post cesarean section wound infections at Rahima Moosa Mother and Child Hospital: microbiology pattern and antibiotic usage. (Ref. 161)

87 Thandrayen, K Paediatrics Bone mass and vertebral fractures in South African (SA) children on prolonged oral glucocorticoids (GCs) for

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chronic non-malignant illnesses. (Ref. 163)

88 Thom, J Human Genetics, Pathology

Awareness of Genetic Counselling Services Amongst Allied-Healthcare Professionals. (Ref. 165)

89 Vangu, M Nuclear Medicine and Molecular Imaging

Imaging prostate cancer today: a case for the use of 99mTc-PSMA in clinical settings with constraint resources. (Ref. 168)

90 Whitehead, A Orthopaedic Surgery The Burden of Tibial Diaphyseal Fractures at an Urban Academic Institution: Time Counts. (Ref. 169)

91 Woods, J WHRI Ezintsha A descriptive analysis of the role of a Whatsapp clinical discussion group as a forum for continuing medical education in the management of complicated HIV/TB clinical cases in a group of doctors in the Eastern Cape, South Africa. (Ref. 170)

92 Younus, A Orthopaedic Surgery Lumbo-sacral tuberculosis of spine with long term impact on the Sagittal balance. (Ref. 171)

93 Younus, A Orthopaedic Surgery Assessment of Efficiency of the Easy Go spinal Endoscopic spine system. Is this easy go or not so easy go system. (Ref. 173)

94 Yudelowitz, G Internal Medicine An audit of HIV Positive Patients Admitted to Helen Joseph Hospital in Johannesburg, South Africa. (Ref. 174)

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Ref Number

1

Type Poster

Surname Akinpelu

Name Tosin

Affiliation Emergency Medicine

Category MMed/Registar

Title Lunar cycle, seasonal variation and prevalence of emergency urological presentations: correlation or coincidence?

Co-authors Laher, Abdullah, Emergency Medicine, Adam, Ahmed, Urology, Chen, Andrew, Astronomy and Astrophysics

Intro/Aim The aim of our study was to conduct an audit of urological presentation to a tertiary academic Emergency Department (ED) and to explore the relationship between it and seasonal and lunar cycles within a South African setting.

Objective(s) The objective of this study was to evaluate the relationship between emergent urological presentations and the lunar/seasonal cycle.

Methods

The relationship was assessed by reviewing 60480 general Emergency Department (ED) visits (2017 calendar year), isolating 238 emergent urology presentations, with the resultant appraisal of 199 evaluable presentations. The data extracted included; demographic details, date and day of presentation, presenting complaints, investigations, radiological findings and final diagnosis. Emergent presentations were correlated with the respective lunar phase and seasonal variation.

Results

The median participant age was 49 (IQR 31 - 64) years with the majority (n=136, 68.3%) being male. Cystitis (n=55, 27.6%), prostate cancer related (n=30, 15.1%), BPH (n=29, 14.6%) and nephrolithiasis (n=29, 14.6%) were the most common clinical diagnosis. Ninety-six (48.2%) patients presented during the (waxing moon phase), while 85 (42.7%) presented during the (waning moon phase), 11 (5.6%) presented on the day of full moon and 7 (3.5%) patients presented on the day of the new moon. Most patients presented during the summer months (n=61, 30.7%). There was no significant association between the lunar cycle and emergent urological presentations (p=0.99).

Discussion There was no significant association between the lunar cycle and emergent urological presentations. However during the summer months more urology related emergency presentations to the ED were observed.

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Ref Number 182

Type Poster

Surname Adam

Name Mary Augusta

Affiliation Obstetrics and Gynaecology


Title Sonographic Measurement of the Uterine Lower Segment in women with one previous caesarean section to determine Uterine Lower Segment Thickness.

Co-authors Dr. J. Jeebodh, Dr. E. Bok-McMinn

Intro/Aim To measure the lower uterine segment (LUS) thickness in women with one previous caesarean section (C/S) at 36-38 weeks of gestation, and correlate intra-operative findings with scar thickness measurements.

Objective(s) To compare sonographic methods of scar thickness measurements. .

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Methods

The recruited patients (61) with one previous lower uterine CS at 36-38 were subjected to a history-taking questionnaire, ultrasound assessment tool and assessment tool of lower uterine segment intra-operatively. The LUS thickness was evaluated by both transabdominal and transvaginal ultrasound with a full and empty bladder by a single operator, a Maternal-Fetal Specialist. The intraoperative findings of all recruits using the Qureshi classification were correlated to the ultrasound findings. Class I was a well developed lower uterine segment ,Class II was a thin lower uterine segment however, the contents are not visible, Class III was a translucent lower uterine segment the contents are visible and Class IV was a well-circumscribed defect, either dehiscence or rupture in the lower uterine segment.

Results

During the study period 61 women were enrolled. The mean maternal age was 30.5 years (standard deviation [sd]=5.9). At delivery, twenty-five women (41.0%) had elective CS as planned, however, thirty-three women (58.8%) of women had undergone emergency CS. Using the classification by Qureshi,37 (60.7%) were Class I,14 (23.0%) were Class III, 3 (3.3%) and 2 (3.3%) were Class IV. There was a statistically significant relationship between the trans-abdominal reading (full bladder) and the Qureshi Class (p=0.04). There was no statistically significant relationship between Qureshi Class and trans-vaginal (full bladder), trans-vaginal (empty bladder) or trans-abdominal (empty bladder).

Discussion

Measuring the LUS trans-abdominally and with a full bladder was found to be the most accurate method. The ability to use ultrasound as a noninvasive tool to assess the LUS thickness antenatally and standardize measurement values even in a diverse population like Soweto requires further investigation.

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Ref Number 2

Type Poster

Surname Aigbodion

Name Sunday Joseph


Category Masters/Medical Scientist

Title Occupational blood and body fluid exposure amongst medical interns in Gauteng

Co-authors Motara, Feroza, Emergency Medicine; Laher, Abdullah, Emergency Medicine

Intro/Aim

Background: Health care workers (HCW) are constantly vulnerable to occupational blood and body fluid exposures (OBBFE’s). Exposed HCW experience emotional, physical and psychological trauma. Less experienced HCW such as medical interns are more prone to OBBFE’s.

Objective(s) The aim of this study was to investigate the prevalence and practices pertaining to OBBFE’s among a select group of medical interns in the Gauteng province of South Africa.

Methods A quantitative cross-sectional descriptive study using a questionnaire based on a practical model was used. Medical interns were recruited from four major hospitals in Gauteng.

Results

One hundred and seventy-five medical interns participated in the study. There was a total of 182 (mean=1.04, SD 0.88) reported OBBFE’s amongst 136 (77.7%) subjects. Most of the exposures occurred while subjects were working in surgery (n=50, 27.5%), obstetrics & gynaecology (n=49, 26.9%) and internal medicine (n=48, 26.4%) departments, were superficial wounds (n=69, 37.9%), were acquired during vascular puncture or intravenous line insertion (n=69, 37.9%) and occurred when subjects were working >12-hour shifts (n=101, 55.5%). HIV post-exposure prophylaxis was initiated in

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141 (77.5%) out of the 182 exposures. Only 90 (63.8%) subjects completed the recommended 28-day course of PEP. Two (1.1%) subjects reported that they had acquired HIV infection as a consequence of the OBBFE.

Discussion

OBBFE’s are common among medical interns. It is recommended that regular training, health education and monitoring compliance should be incorporated during the induction of interns in hospitals. Incorporation of a PEP regimen with fewer side effects will encourage compliance.

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Ref Number 7

Type Poster

Surname Banderker

Name Ebrahim

Affiliation Internal Medicine

Category PhD/Post-Doc/Consultant

Title A descriptive study of adult mitral valve disease at a Tertiary Referral Center

Co-authors

Intro/Aim In this study we aimed to systematically document the clinical, demographic and echocardiographic characteristics of patients with adult mitral valve disease (MVD) due to the paucity of data on this topic.

Objective(s)

Describe the clinical and demographic information of all participants Describe the aetiology, severity and complications of the mitral valve disease in adult patients Describe the management of patients with adult mitral valve disease

Methods This was a cross-sectional descriptive study on adult mitral valve disease at Chris Hani Baragwanath Academic Hospital (CHBAH) valve clinic. All data was extracted from clinic files and a preliminary analysis of patient’s data with MVD was performed.

Results

The study comprised 134 patients with MVD. The mean age was 50 Â± 13.3 years with 77 % being females. Majority were of African ethnicity (96%). Most patients were in New York Heart Association functional class II (54%). The predominant mitral valve lesion was mitral regurgitation (39%). Severe MVD was present in 51 percent of the patients. Thirty percent of the patients had concomitant involvement of other valves. The main co-morbidities were hypertension (30%) and HIV (12%). The main reason for initial hospitalisation was heart failure (HF) (78%). Ninety four percent of patients were on HF treatment. Fourteen patients were on rheumatic fever prophylaxis. None of the patients presented for surgery had coronary artery disease (75%). MVD was complicated with pulmonary hypertension (28%) and atrial fibrillation (14%) in 57 patients.

Discussion Mitral valve disease is common at CHBAH. The current patients tended to be older females with co-morbidities. The predominant aetiology was chronic rheumatic heart disease and acute rheumatic fever was rare.

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Ref Number 8

Type Poster

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Surname Bandini

Name Rossella

Affiliation Paediatrics


Title Incidence of augmented renal clearance in the paediatric ICU of a tertiary referral hospital in Johannesburg, South Africa

Co-authors Mer, Mervyn, Internal Medicine; Ballot, Daynia E, School of Clinical Medicine

Intro/Aim

In both adults and children in the ICU, renal function is used as an indicator of clinical status and therefore closely monitored. Augmented renal clearance (ARC) has been demonstrated in adult ICU patients, and it’s incidence varies between 30-85%. The root pathophysiologic causes of ARC are still under debate, and to date, there have been very few studies worldwide that investigated the incidence of ARC among the paediatric ICU population. The majority of antibiotic drugs from all classes are cleared by the kidneys, making ARC an import factor to consider in the fight against infection and prevention of sepsis. Enhanced clearance of drugs by the kidneys may result in suboptimal dosing, contributing to the development of resistance and ultimately treatment failure.

Objective(s)

The aim of the study was to investigate kidney function and any associated augmented renal clearance (ARC) in infants and children admitted to the paediatric and neonatal ICU. The primary objective of the study was to investigate the incidence of ARC in children admitted to the ICU The secondary objectives of the study were: 1) To assess sex differences in the incidence of ARC; 2) To determine age differences in the incidence of ARC; 3)To compare the short-term clinical outcome (i.e. survival to end of initial hospitalisation) of children with and without ARC treated in the ICU

Methods

In this cross-sectional single centre study, vital signs and laboratory measures were recorded daily for the first three days of admission. Blood for the estimated glomerular filtration rate (eGFR) on one day was obtained as part of routine care and eGFR was calculated using the Bedside Schwartz formula. eGFR values were compared to the normal ranges for the patient’s age to determine the presence of ARC. Mortality prediction formulae and survival to discharge were recorded. Statistical analysis was performed using SPSS (v25) on a sample of n = 29. Continuous variables were analysed using unpaired t-tests, and categorical variables were analysed using logistic regression.

Results

None of the categorical variables were statistically significant across the two groups: with ARC (n = 3) and without ARC (n = 26). One continuous variable showed a significant difference (pulse rate; p = 0.03), likely a clinically insignificant artefact due to the small numbers.

Discussion There is currently no evidence of ARC in our combined paediatric and neonatal ICU.

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Ref Number 12

Type Poster

Surname Botha

Name Jean

Affiliation Surgery Transplant Unit WDGMC


Title Liver transplantation for unresectable metastatic colorectal carcinoma

Co-authors

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Intro/Aim

Patients with non-resectable CRC metastases (CRC CLMâ€™s) receiving palliative chemotherapy have a poor prognosis. Overall survival rates vary between 5-15%. Until recently CRC metastases have been considered an absolute contraindication for liver transplantation. The SECA-I study from Oslo, Norway (n=21) demonstrated a 5 year overall survival of 60% after liver transplantation for non-resectable CRC metastases.

Objective(s)

To determine the overall and recurrence free survival in selected patients with CRC CLM undergoing liver transplantation at Wits Transplant

Methods

We included patients with CRC CLM’s (n=5). Main inclusion criteria were; hepatic only metastases confirmed by MRI/CT scan and FDG PET scan, prior resection of primary tumour and having completed at least first-line chemotherapy. Patients were only offered organs that had been declined for recipients on the regular waiting list.

Results

At median follow-up of 30 months (range 5-46 months), 4/5 (80%) of the patients are alive. Recurrence occurred in all patients at a median time to recurrence of 6 months (range 3-13). One patient had progressive disease on chemotherapy pre-transplant and developed rapid recurrence and progression to death, also being the only patient who was KRAS mutant. Pulmonary recurrence occurred in 3 patients, 2 have undergone pulmonary resections and are currently disease free.

Discussion

Liver transplantation, using marginal organs that would otherwise be discarded, potentially provides acceptable survival in patients with CRC CLM’s. In this small ‘proof of concept’ case series, survival exceeded that of palliative chemotherapy. It is hoped that more rigorous selection strategies may provide long-term survival comparable to standard indications for liver transplantation.

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Ref Number 13

Type Poster

Surname Botha

Name Jean



Title Living Donor Liver Transplantation in South Africa: The Donor Experience.

Co-authors Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine

Intro/Aim

Living donor liver transplantation (LDLT) plays a crucial role in liver transplant programmes worldwide, particularly in regions with a severe scarcity of deceased donor organs and especially those that take care of paediatric recipients. LDLT is a complex and demanding procedure which places a healthy living donor in harm’s way. Donor safety is therefore the overriding concern.

Objective(s) To report our standardized approach to the evaluation and technical aspects as well as the outcomes of LDLT donor hepatectomy at Wits Donald Gordon Medical Centre between 2013-2018.

Methods

The study population consisted of all patients undergoing LDLT donor hepatectomy since the inception of the programme in March 2013. A total of 65 living donor hepatectomies were performed. Primary outcome measures included; donor demographics, operative time, peak bilirubin, aspartate and alanine transaminase levels post-operatively, length of hospital stay and post-operative complications using the Clavien-Dindo classification.

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Results

The majority of the donors were female, most were parents with mothers being the donor almost 85% of the time. The median operative time was 374 minutes with a downward trend over time as experience was gained. The median length of hospital stay was 7 days. There was no mortality and the complication rate was 30% with the majority being minor (Grade 1).

Discussion

Living donor liver transplant from adult-to-child has been successfully initiated in South Africa. Living donor hepatectomy can be safely performed with acceptable outcomes for the donor. Wait-list mortality however remains unacceptably high. Expansion of LDLT as well as real change in deceased donor policy is required to address this issue.

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Ref Number 15

Type Poster

Surname Bunga

Name Antonia

Affiliation Radiation Oncology


Title Patterns of practice of breast cancer irradiation in the Department Of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital 2010-2012.

Co-authors Sharma, Vinay, Radiation Sciences/Radiation Oncology, Mahomed, Faiza, Radiation Sciences/Radiation Oncology

Intro/Aim

Treatment of breast cancer, the commonest cancer in women globally, may involve a combination of surgery, systemic therapy and radiotherapy. Conducting survival analysis aids facilitation of resource distribution to conditions that benefit most from intervention particularly for common cancers such as breast cancer. It also aids the institution in identifying potential areas for improvement.

Objective(s) Determination of local control, overall survival and type of disease progression. To ascertain factors that affect overall survival of the local population through a retrospective review of patient records.

Methods Ethical approval was obtained. 356 patient records randomly selected, 95 patient files met inclusion criteria. Data was entered into SPSS and analysed using descriptive statistics, Kaplan-Meier Survival and Cox Regression for univariate analysis.

Results

Median age at diagnosis was 50 years, 42.1% of the study population presented with early stage disease. After 5-year follow up Local Recurrence Rate of the entire study population was 6.4%, 20.2% had Distant Metastases while 54.7% had no progression. 5-year overall survival (time from diagnosis to death) was 69.1%, loss-to-follow-up rate was 23.5%, 1.1% in year 1, 4.8% in year 2, 11.8% in year 3, 20.8% in year 4, 23.5% in year 5. The mortality rate was 34% over 5 year follow up, 1.1% in year 1, 12.2% year 2, 9.5% in year 3, 6.6% year 4, 7.1% year 5. The only factor found to be significant on KM analysis was number of involved nodes (p=0.047). 72% of those that received hypofractionated irradiation were still alive at 60 months follow up.

Discussion

Hypofractionated radiotherapy has favourable outcomes in our setting. The loss-to-follow-up rate makes analysis reliable for descriptive statistics but not reliable in survival analysis. Provision of incentive to patients for attending follow-up clinics to reduce loss-to-follow-up. Identifying patients needing radiotherapy at Multidisciplinary Team Meetings to plan scheduling ahead of time.

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Ref Number 17

Type Poster

13

Surname Candy

Name Geoffrey

Affiliation Surgery


Title Detection and quantification of different endogenous cardiotonic steroids by liquid chromatography tandem mass spectrometry

Co-authors Leuschner, Machel; Pharmacology, University of Pretoria; Mullah, Hannah; Thiba Anza; Candy, Geoffrey; Surgery, University of the Witwatersrand; Cromarty, AD; Pharmacology, University of Pretoria

Intro/Aim Endogenous cardiotonic steroids (CTS) are positive inotropic agents that increase blood pressure and found in elevated concentrations in hypertensive patients.

Objective(s) The aim of this study was to validate a sensitive method for targeted detection and quantification of low concentrations of endogenous CTS present in biological samples.

Methods

Methods: An extraction method from whole blood was optimised using reversed phase-Solid Phase Extraction. A targeted LC-MS/MS method using an Agilent binary series 1100/1200 LC system with a Kinetex C18 RP column (100 x 2.1 mm, 2.6 Âµm) coupled to a Sciex 4000QTRAP tandem mass spectrometer was developed and validated for the detection and quantitation of 8 different CTS in both whole blood and solvent. The method was validated according to the International Conference on Harmonization guidelines and data analysis was performed with Analyst Software (version 1.5.2).

Results

Results: The CTS calibration curves were linear over a concentration range of 0.1-40 ng/mL with coefficients of determination greater than 0.990. The analytical method was selective with an estimated limit of detection (LOD) and limit of quantitation (LOQ) between 0.02-0.5 ng/mL and 0.1-2 ng/mL respectively. Accuracy and precision were found to be within acceptable limits of 20 % for all analytes and their stability in methanol at -20Â°C and -80Â°C was established for at least a month.

Discussion

The quantitative method was successfully validated, over expected in vivo concentration ranges for 8 different CTS. The method will be applied to biological samples to detect and quantify the presence of endogenous CTS in hypertensive patients.

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Ref Number 183

Type Poster

Surname Candy

Name Geoffrey

Affiliation Surgery, Clinical Medicine


Title Evidence for association of Helicobacter pylori and hypertension

Co-authors Idowu A, Nel M, Thiba A, Mullah H, Dinat S, 1 Rumbold K, 2 R Ally, 3 Zeille F, 3 Cromarty AD . Surgery and 1Microbiology, University of the Witwatersrand and 2Gastroenterology, CH-Baragwanath Hospital, Soweto; 3Pharmacology, University of Pretoria, Pretoria

Intro/Aim Metabolic syndrome is a cluster of risk factors - dyslipidemia, obesity, hyperinsulinemia, diabetes and hypertension (HT) associated with adverse outcome in cardiovascular disease. Although these factors are associated microbiome dysbiosis, the mechanism of how such dysbiosis may affect blood pressure (BP) has not been elucidated. Helicobacter pylori (HP) has been associated with HT from BP, epidemiological and eradication studies. HP is affected by two risk factors for HT as it rapidly glycosylates cholesterol and alters shape and gene expression and shows

14

enhanced growth in the presence of salt. This study shows data implicating HP in HT.

Objective(s)

Methods HP prevalence was determined from the Gastroenterology (GIT) and HT Clinics at the CH-Baragwanath Hospital using the Clo-test, PCR, the 14C-urea breath test (UBT) and culture (Odowu et al. accompanying abstract) 2) Patients with untreated HT (mean ambulatory awake SBP/DBP >135-159/>85-100mm Hg) were treated with optimal quadruple therapy (amoxicillin, clarithromycin, bismuth and PPI).

Results 1) HP prevalence rates (culture/PCR): GIT Clinic - overall: 52.7%; GIT Clinic with HT: 65%; HT Clinic (UBT, n=6/63): 90.5%. 2) Treatment: Successful eradication (UBT negative +8 weeks post-treatment) mean awake BP decreased SBP/DBP -5.4/-3.4 (p<0.05) vs +4.1/+0.5 mm Hg in unsuccessfully eradicated patients. Nighttime BP was unchanged.

Discussion Prevalence of HP was higher in patients with HT, with successful eradication of HP showing a significant decrease in BP, in keeping with literature. The presence of HP-positive patients without HT may be explained if the bacterium produces substances only under certain circumstances.

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Ref Number 20

Type Poster

Surname Chandiwana

Name Nomathemba

Affiliation WRHI Ezintsha


Title Pregnancy outcomes among HIV-positive women on dolutegravir versus efavirenz-based antiretroviral therapy: week 48 analysis of the ADVANCE trial

Co-authors

Godspower Akpomiemie 1, Lee Fairlie 2, Francois Venter 1, Andrew Hill 3, Matthew Chersich 2 , Celicia Serenata 1, Simiso Sokhela 1, Bronwyn Bosch 1, Masebole Masenya 2, Michelle Moorhouse 1 1. Ezintsha, Wits Reproductive Health and HIV Institute, WITS, Johannesburg, SA 2. Wits Reproductive Health and HIV Institute, WITS, Johannesburg, SA 3. Liverpool University, Pharmacology, Liverpool, United Kingdom

Intro/Aim Dolutegravir holds major advantages for antiretroviral therapy (ART), including in resistance profile, tolerability and cost. However, safety concerns of its use in the periconception period, pose significant ethical, equity and programmatic issues.

Objective(s) To describe pregnancy outcomes in women who become pregnant while enrolled in the ongoing South African ADVANCE trial (NCT03122262).

Methods

All women completed week 48, were on ART before conception, had first trimester gestational dating and second trimester foetal anomaly ultrasound examination. Women on dolutegravir were switched to alternative regimens if <8 weeks gestation. Adverse events included spontaneous abortion, elective termination, preterm birth (<37 weeks), small for gestational age (SGA; <10th percentile of weight for gestational age), stillbirth or neonatal death (<28 days from delivery), and birth defects. Infant HIV status was also assessed.

Results

Two thirds (54/83) of pregnancies occurred in women on a dolutegravir-based regimen. There were 37 (44.0%) live births, 15 (18.0%) spontaneous abortions, 18 (21.7%) elective terminations, and 10 (12.1%) pregnancies are ongoing with no neural tube defects recorded. One (1.2%) neonatal death and one stillbirth (1.2%) occurred in the DTG-TAF-FTC and EFV-TDF-FTC treatment arms respectively. Median birth weights were similar across treatment arms. Overall 7.1% of infants were born

15

prematurely and 17.2% of births were SGA. No HIV vertical transmissions and no NTDs occurred.

Discussion

Women on dolutegravir-based ART before conception did not have higher rates of adverse pregnancy outcomes. It is important to pool data on adverse outcomes including stillbirths and neonatal deaths across similar trials, on the safety of dolutegravir as well as newer antiretrovirals.

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Ref Number 22

Type Poster

Surname Christofides

Name Chris

Affiliation Surgery Urology


Title Baux score as a predictor of mortality at the CHBAH Adult Burns Unit

Co-authors Moore, Rachel, Acute Care Surgery Unit, Chris Hani Baragwanath Academic Hospita; Nel, Marietha, Department of Surgery, University of the Witwatersrand

Intro/Aim The Chris Hani Baragwanath Academic Hospital (CHBAH) Adult Burns Unit (ABU) often operates in excess of its capacity.

Objective(s) Our aim was to investigate the risk factor profile of the ABU population and to apply the Baux score as a model for predicting mortality and length of stay (LOS) to assist with appropriate resource allocation.

Methods

This study was a retrospective analysis of ABU admissions from 2005 to 2015. Variables included mortality, LOS, age, percentage total body surface area burn, Baux score, gender, inhalation injury, mechanism and intent of burn injury. Baux score was calibrated to the mortality rates in ABU burn population and the effects of various variables on mortality were assessed with Mann-Whitney U, Chi-Square tests and regression analysis.

Results

The overall mortality rate was 21.1%. The relationship between Baux score and mortality rate was characterised by this regression equation: y=-0.0002x3+0.0547x2-2.5815x+32.649, which was used to tabulate expected mortalities per Baux score band. Univariable regression analysis revealed Baux score, gender, inhalation injury, mechanism and intent each had statistically significant associations with mortality (p-values<0.05), while the multivariable model showed that only Baux score, gender and inhalation injury were statistically significant factors.

Discussion

Gender and inhalation injury are important factors to consider together with Baux score in predicting mortality. An increase in Baux score remains the most predictive and statistically significant risk factors and is easy to calculate. Thus, expected mortality can be determined using the Baux score band versus mortality table created in this study to assist with prioritising patients in a resource-limited environment.

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Ref Number 24

Type Poster

Surname de Jager

Name Marlize



16

Title 18 month preliminary results - the Wits Transplant "Family Approach to Consent for Transplant Strategy" (FACTS)

Co-authors

Etheredge, Harriet (Wits Donald Gordon Medical Centre, School of Clinical Medicine and Department of Internal Medicine, School of Clinicla Medicine, Wits University), Carla Wilmans (Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine), Russell Britz (Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine and Department of Surgery, School of Clinical Medicine, Wits University), Sharan Rambarran (Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine), Francisca van der Schyff (Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine) and Jean Botha Russell Britz (Transplant Unit, Wits Donald Gordon Medical Centre, School of Clinical Medicine and Department of Surgery, School of Clinical Medicine, Wits University)

Intro/Aim

In Gauteng in 2017, approximately 87% of families approached to donate the organs of a deceased loved one refused consent. Published research has suggested that the way in which procurement coordinators approach families could be adjusted to improve consent rates.

Objective(s) To quantify the 18 month results of a quality improvement intervention in the donor conversation, Wits Transplant FACTS.

Methods A prospective, longitudinal study at Wits Donald Gordon Medical Centre (WDGMC) was carried out by the procurement transplant coordinator. Descriptive statistics were used to analyse results.

Results

Using Wits Transplant FACTS, the PI has increased her consent rate from 25% (n=5) in 2017 to 71% (n = 31) in the past 18 months. Over the study period, 85 potential deceased donors were referred to the PI. 52% (n = 44) of referred families were approached by the PI and asked for consent to donate organs of a loved one using Wits Transplant FACTS. Consents were obtained from 70% (n = 31) of the families. 30% (n=13) families did not consent to organ donation. Reasons for refusal were cultural beliefs against donation 62% (n=8), family that was not in agreement with each other 38% (n=5).

Discussion

It appears that a structured communication system, as well as other initiatives undertaken at Wits Transplant, contributes to larger numbers of consented donors. There is scope to offer the system as a training intervention to assist in improving consent rates.

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Ref Number 178

Type Poster

Surname de Jager

Name Pieter

Affiliation Public Health

Category Undergraduate

Title Is there an association between lead exposure and aggressive behavior in shooters?

Co-authors Nisha Naicker, Pieter de Jager, Shan Naidoo, Angela Mathee

Intro/Aim Lead exposure has been associated with psycho-neurological disorders. Elevated blood lead levels have been found in shooters.

Objective(s) To study assess the association between the blood lead levels of shooters and their levels of aggression.

Methods

An analytical cross-sectional study was conducted in Gauteng, South Africa. Participants were recruited from four randomly selected shooting ranges with three randomly selected archery ranges used as a comparison group. A total of 118 (87 shooters and 31 archers) participants were included in the analysis. Aggressiveness was measured using the Buss-Perry Aggression Questionnaire

Results Shooters have a significantly higher BLL and aggressiveness compared to archers. However, elevated blood lead levels were significantly associated with hostility only.

17

Discussion Interventions need to be put in place to prevent continued exposure and routine screening of populations at risk should be implemented.

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Ref Number 25

Type Poster

Surname Dempster

Name Megan

Affiliation Internal Medicine, WDGMC


Title Case Series: Adult Liver Transplant for Hepatocellular Carcinoma at Wits Donald Gordon Medical Centre in Johannesburg, South Africa

Co-authors

Carolyn Bouter BHSc, Clinical Research Intern, Clinical Research Office, Wits Donald Gordon Medical Centre; Heather Maher Registered Nurse, Research Coordinator, Clinical Research Office, Wits Donald Gordon Medical Centre; Petra Gaylard PHD, biostatistician, Data Management and Statistical Analysis(DMSA), Johannesburg; Harriet Etheredge PHD, Medical Bioethicist, Clinical Research Office, Wits Donald Gordon Medical Centre; Adam Mahomed MD, Acting Clinical Head, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand; June Fabian MD, Director of Clinical Research at Wits Donald Gordon Medical Centre; Jean Botha MD, Head of Transplantation at Wits Donald Gordon Medical Centre

Intro/Aim

For those with unresectable hepatocellular carcinoma, liver transplantation is considered the treatment of choice. Since 2006, the transplant programme at Wits Donald Gordon Medical Centre (WDGMC) has offered liver transplantation for selected patients with hepatocellular carcinoma. While the number of patients transplanted was small, we are unaware of any published data from Southern Africa describing outcomes in this group of liver transplant recipients.

Objective(s) The aim of this study was to describe our experience as a case series.

Methods

The records of all patients with HCC who underwent deceased donor liver transplantation between April 2006 and March 2018 were reviewed retrospectively. Data were extracted from transplant clinic patient files, histopathology and pathology laboratory reports and an existing database of all liver transplant recipients at WDGMC. Patient survival was calculated from the time of transplant and survival estimates were determined by the Kaplan-Meier method.

Results

Thirty-one liver transplants were reviewed. The most common causes of underlying liver disease were infectious, mostly hepatitis B virus, and diseases of lifestyle including alcoholic/non-alcoholic steatohepatitis. Median age at transplant, 57 years (IQR 44 - 65 years), was younger than observed internationally, but consistent with reports from Africa. Male recipients predominated, in keeping with published trends. Overall, outcomes were worse than expected but for recipients were within the University of California at San Francisco (UCSF) criteria for transplantation, survival was comparable to previously published data.

Discussion Despite limitations, this is the first documented series of patients undergoing liver transplantation for HCC in South Africa and demonstrates that good results can be achieved in appropriately selected patients.

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Ref Number 29

Type Poster

Surname du Plessis

18

Name Jason

Affiliation Orthopaedic Surgery


Title Case Report: Single stage revision of total knee arthroplasty for metallosis

Co-authors De Bruin, Jana (Histopaathology); Greeff, Richard, Department of Orthopaedic surgery, Arthroplasty unit

Intro/Aim Metallosis is a rare cause of failure in total knee arthroplasty, and results as a consequence of abnormal metal-on-metal contact (1) resulting in osteolysis (2). Early recognition and revision could prevent the destructive osteolytic processes.

Objective(s) The purpose of this case presentation is to highlight the consequence of delayed revision in the case of metal-on-metal articulation in arthroplasty

Methods

Case Report Mr DL is a 74-year-old male with previous bilateral total knee arthroplasties (right 2003 and left 2009). He presents now with right knee pain and instability and no features of periprosthetic joint infection on workup (3). Radiographs showed loosening and wear of both the femoral and tibial components with medial contact of those components resulting from extensive polyethylene wear. He had a single stage revision where extensive metallosis was noted and thoroughly debrided from all soft tissues where possible. Constrained condylar implants were used with tibial and femoral stems. The patella was also resurfaced because of extensive bone loss.

Results Histological analysis was in keeping with an ALVAL grade 9 showing perivascular lymphocytic inflammation and surrounding giant cell reaction associated with black pigment.

Discussion

This case highlights the need to identify abnormal metal on metal articulations as early as possible in order to limit the amount of bone loss resulting from osteolysis.

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Ref Number 30

Type Poster

Surname Dulaze

Name Neo Nontsikelelo

Affiliation Steve Biko Centre for Bioethics / School of Clinical Medicine


Title QALYs, Justice and the Capabilities Approach

Co-authors

Intro/Aim

Undoubtedly, healthcare must be rationed to a certain degree and allocated appropriately. The fact remains that there are not enough medicines, body parts or an array of life-saving technologies. This calls into question on weather the current resource allocation method makes use of an appropriate selection criterion. The basis of this presentation will critique an influential approach, Quality adjusted life-years, to the allocation of scarce health resources and whether it is just.

Objective(s) To argue that Nussbaum’s approach indicates that the use of QALYs in healthcare rationing leads to treating people as commodities in a way that is inconsistent with human dignity.

Methods

The study design will be normative. It will be based on desktop and library-based research. No new data will be collected or analysed. The typical research methods and standards applicable to philosophical research will be employed. I use Martha Nussbaum’s capabilities approach framework to argue that the use of QALY

19

evaluation in healthcare is unjust.

Results QALY evaluations aim to maximize utility function as the goal for resource allocation. This has lead to the assumption that the commodification of human lives is acceptable.

Discussion

According to Nussbaum’s capability approach, it is concluded that judging lives on the value that they produce violates the social bases of self-respect. The bases of self respect require individuals to be treated as dignified beings who have inherent worth regardless of what they can provide. The QALY approach is unjust, because it undermines the social bases of self-respect by commodifying human lives.

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Ref Number 33

Type Poster

Surname Enyuma

Name Callistus



Title Hand washing practices amongst health care workers at a tertiary academic hospital Emergency Department

Co-authors Van Rooyen, Ljuba-Ruth, Emergency Medicine; Jawa Alli, Emergency Medicine; Adam Ahmed, Urology; Laher Abdullah, Emergency Medicine

Intro/Aim Introduction: Hospital acquired infections can be linked to the hands of healthcare workers. Adequate hand hygiene is critical to its prevention. However, poor compliance with hand hygiene among healthcare workers remains a challenge.

Objective(s) This study aims to determine the hand washing practices among healthcare workers in an Emergency Department (ED).

Methods

Study investigators observed and documented hand washing practices of staff at a tertiary level ED. In addition, compliance to bare below the elbow, hair above the shoulders and the correct use of gloves was also determined. To avoid bias, participant consent was obtained retrospectively.

Results

Fifty-eight clinical staff were observed over a 45-day period in a busy ED in Johannesburg. A total of 318 hand washing opportunities were observed out of which 56. 9% (n=181) required the use of soap and water. The compliance rate was 32.0% (n=58) although 13 (22.4%) participants used alcohol hand rub as an alternative. Overall, the final stages of hand hygiene were progressively not adhered to. About half (n=161; 50.6%) the time, participants were not bare below the elbow and approximately a quarter (n=42; 72.4%) of participants had their hair below their shoulder while hand gloves were not used in 39.9% (n=127) of the patient contacts.

Discussion

This study has not only demonstrated inadequate availability of hand-hygiene consumables but also poor compliance and incorrect technique with regards to hand washing practice. Provision of appropriate hand cleansing consumables, regular training and retraining of staff as well as regular audits may improve hand washing practices.

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Ref Number 34

Type Poster

Surname Enyuma

20

Name Callistus



Title Role of the Ultrasonographic "Whirlpool Sign" in intestinal volvulus: A systematic review and meta-analysis

Co-authors Aigbodion Sunday J, Emergency Medicine; McDowall Jared, Emergency Medicine; Gerber Louis, Emergency Medicine; Buchanan Sean, Emergency Medicine; Adam Ahmed, Division of Urology; Laher Abdullah E, Emergency Medicine

Intro/Aim

Intestinal volvulus is a potentially lifeâ€•threatening condition that occurs when loops of bowel twist around its supporting mesentery and associated vasculature. Clinicians often rely on various radiological investigations for prompt diagnosis to avoid complications such as bowel infarction.

Objective(s) This review assesses the clinical reliability of the ultrasonographic whirlpool sign (WS) in the diagnosis of intestinal volvulus.

Methods

In adherence with the PRISMA (Preferred Reporting Items for Systematic reviews and Metaâ€•analyses) statement, a systematic search of BMJ Best Practice, Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed (August 2017), using relevant search terms. Selected studies were ranked for quality and relevance using the CASP (Critical Appraisal Skills Program) tool.

Results

Results: Sixteen articles (1640 participants) were assessed. The mean and median sample size was 102.5 (SD ± 192.23) and 28 (range 7–770), respectively. The WS

was positive in 212 of 255 (83.1%) patients with intestinal volvulus. Meta‐analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of 87.42% (95% confidence interval (CI): 81.05–92.25) and 98.63% (95% CI: 97.88–99.18), respectively, with an estimated summary effect of 5.28 (95% CI: 4.47–6.08,

P < 0.001). There was negligible inter‐study heterogeneity, which was suggested by an I2 statistic of 0% (95% CI: 0.00–76.34) and a τ2 parameter of 0 (95% CI: 0.00–5.35).

Discussion Though the pooled sensitivity was less than ideal (87.42%), this review and meta-analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus.

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Ref Number 37

Type Poster

Surname Esteves

Name Martene

Affiliation Internal Medicine. WDGMC


Title Outpatient Colonoscopy at Wits Donald Gordon Medical Centre: Quality Indicators and Unusual Findings

Co-authors Multiple, please see attachment.

Intro/Aim

The Outpatient Endoscopy Unit (OEU) was established at Wits Donald Gordon Medical Centre (WDGMC) in 2006, which accommodates 12 endoscopists. There are no locally defined quality indicators for endoscopists. Therefore, internationally defined quality indicators were used to benchmark the OEU clinical practice.

Objective(s) To audit the clinical practice of our endoscopists using quality indicators and describe the clinical profile of patients undergoing colonoscopy.

Methods

We conducted a prospective, clinical practice audit of colonoscopies performed on adults (>18 years) between 1 March 2018 and 28 February 2019. The variables collected by the endoscopy nurse at time of procedure enabled calculation of caecal intubation rates (CIR), polyp and adenoma detection rates (ADR, PDR respectively). Sub-analysis of ADR and PDR included gender, age, ethnicity, withdrawal time and

21

bowel preparation.

Results

We performed 1642 colonoscopies; one third of patients were below the age of 50 and two-thirds were female. The most common indications for colonoscopy were screening (41.7%), polyp surveillance (9.7%), and cancer surveillance (8.7%). On screening colonoscopy, CIR was 96.3%; bowel preparation was adequate in 77.6% of outpatients; median withdrawal time was 6.3minutes; PDR was 27.2%; and ADR 15.6%. Black africans had a higher, but not significantly different, PDR (31.5% vs 27.5%) and ADR (18.5% vs 15.3%) than White patients.

Discussion

Quality indicators achieved by endoscopists at WDGMC serve as a baseline for ongoing improvement. Black Africans undergoing colonoscopy have a higher frequency of polyps and adenomas than other population groups, which contradicts other historical data from SA.

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Ref Number 40

Type Poster

Surname Fening

Name Nana Yaa

Affiliation Anaesthesiology


Title Music as an intervention to reduce preoperative anxiety in gynecological patients

Co-authors Perrie, Helen, Department of Anaesthesiology, Scribante, Juan, Department of Anaesthesiology

Intro/Aim Preoperative anxiety is a well-established phenomenon. Pharmacological methods have traditionally been used to alleviate this anxiety. Music had been identified as an alternative therapy to attenuate anxiety and improve postoperative outcomes.

Objective(s) To describe the effect of a music intervention on preoperative anxiety levels in patients going for elective gynaecological procedures at the Charlotte Maxeke Johannesburg Academic Hospital.

Methods

Patients undergoing gynaecological procedures were recruited preoperatively by convenience sampling from gynaecology elective lists and allocated to music intervention and control groups using simple random sampling. Patients in the music intervention group listened to 20 minutes of precompiled music. Patients in the control group received 20 minutes of quiet time. Demographic data and physiological parameters were recorded and anxiety levels were assessed using the State and Trait Anxiety Inventory. Data were analysed using descriptive and inferential statistics.

Results

There was a significant difference in anxiety levels in the music intervention group before and after the intervention (p-value > 0.0001) but not in the control group. There were no significant differences in the physiological parameters. Those who received the music intervention enjoyed the experience.

Discussion Music reduced preoperative anxiety in patients going for elective gynaecologic procedures. Music interventions are a cheap, easy way of reducing preoperative anxiety.

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Ref Number 45

Type Poster

22

Surname Geel

Name Jennifer

Affiliation Paediatric Oncology and Haematology


Title African Paediatric Oncology Services: Finding the gaps in resources and implications for training and education

Co-authors

J. Geel1, N. Ranasinghe2, J. Challinor3, K. Myezo4, J. Slone5, J. Libes6, R. Kunkel7, R. Hollis8, M. Zobeck9, E. Bouffet10. 1. University of the Witwatersrand- Faculty of Health Sciences, Division of Paediatric Haematology/Oncology- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. 2. Refinitiv, Transactions Product Management, London, United Kingdom. 3. University of California- San Francisco, School of Nursing, San Francisco, USA. 4. University of the Witwatersrand, Department of Bioethics, Johannesburg, South Africa. 5. Baylor College of Medicine- Texas Childrenâ€™s Hospital- Global HOPE, Division of Haematology/Oncology-, Houston, USA. 6. University of Illinois College of Medicine, Division of Paediatric Haematology/Oncology, Peoria, USA. 7. Arkansas Children's Hospital, Nursing, Arkansas, USA. 8. Leeds Children's Hospital, Nursing, Leeds, United Kingdom. 9. Baylor College of Medicine- Texas Childrenâ€™s Hospital, Section of Pediatric Hematology-Oncology, Houston, USA. 10. Hospital for Sick Children- Toronto. Paediatric Haematology/Oncology, International Society of Paediatric Oncology SIOP- Zug- Switzerland, Toronto, Canada.

Intro/Aim

The World Health Organisation (WHO) estimates a shortage of 4.3 million healthcare workers worldwide. WHO’s call for increased medical faculty, quality education, certification and competency maintenance, directly influences the quality of global childhood cancer care.

Objective(s) In 2018, the International Paediatric Oncology Society initiated a situational analysis by Global Mapping of Paediatric Oncology Services survey, starting with Africa, supported by a Sanofi Espoir Foundation My Child Matters grant.

Methods

A 55 item electronic survey was based on the SIOP Framework for Adapted Treatment Regimens and was made available in English, French and Portuguese. The survey was distributed in October 2018 to March 2019 to document centres and professionals treating children/adolescents with cancer.

Results

Responses from 46/52 African countries and 150 individual PO units were received; 192/240 (80%) responses were evaluable. Most responses (159; 83%) were from government/faith-based hospitals. One-third (61; 32%) had an established PO programme with basic services (few state-of-the-art services) while one fifth (40; 21%) had all essential services (most state-of-the-art services). One quarter (49; 26%) had severely limited PO inpatient facilities, impacting on training of healthcare workers.

Discussion

Results show significant gaps in healthcare and facilities, and marked inequities in access to adequate PO training. Initiation and continuation of appropriate PO education programmes within African academic and healthcare settings will require support from Ministries of Health, Education and Finance. The WHO Global Childhood Cancer Initiative will provide regional advocacy to reinforce the PODC ETWG’s efforts to improve access to specialised PO training for all health professionals in low- and middle-income settings.

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Ref Number 46

Type Poster

23

Surname Gerber

Name Louis



Title A comparison of two handed versus single handed bag valve mask ventilation during two rescuer CPR on a simulation manikin.

Co-authors Laher, Abdullah, Department of Emergency Medicine. Botha, Martin, Department of Emergency Medicine

Intro/Aim Bag valve mask ventilation remains a challenging skill to perform during resuscitation. Two handed ventilation has been proposed but data is lacking.

Objective(s) The goal of this study was to compare the effect of a modified two handed Bag-Valve-Mask (BVM) ventilation grip against the standard one handed technique during 2 rescuer cardiopulmonary resuscitation (CPR).

Methods

Forty university paramedic students were required to perform the standard and two handed BVM grips in a random order while doing 2 rescuer CPR on a simulation Manikin (Sim Man 3G, Laerdal Medical, Germany). The participants were required to perform two rounds of CPR each per ventilation method, translating to a total of eight minutes of CPR. This was followed by a five minutes break before the process was repeated using the outstanding BVM grips. CPR metrics (rate, compression depth and compression fraction) were recorded including the delivered tidal volume. The participants then completed a questionnaire rating perceived exertion (Borg scale)

Results

The mean difference between two handed and single handed BVM ventilation observed was 164.6 ml (95% CI, 130.61-196.59; p = 0.000). The CPR mean compression depth (44.6mm to 40.975mm) and compression fraction (76.51% to 75.98%) decreased while the compression rate (128,75 to 130.38) increased from the first to second round of CPR. The mean perceived exertion score for the standard and two handed ventilation grips were 12.5 and 13.05 respectively.

Discussion

Preliminary findings indicate that the two handed BVM grip significantly increased delivered tidal volume over the standard grip. The CPR quality markers remained relatively constant. Physical exhaustion may account for the decreased CPR fraction and compression depth. Participants Borg scores indicated that both manoeuvres had a fairly light to somewhat hard of perceived exertion.

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Ref Number 47

Type Poster

Surname Gerber

Name Louis



Title Medication errors in an intensive care unit in Johannesburg; from transcription through to delivery

Co-authors Laher, Abdullah, Emergency Medicine; Enyuma, Callistus, Emergency Medicine; Guy Richards Guy, Critical Care; Buchanan, Sean, Emergency Medicine

Intro/Aim

The ICU generates more medication prescription per patient day than any other units for critically ill patient. The complexity of the environment and patient mix predisposes to medication error with potential adverse events. This has not been researched extensively, especially in Johannesburg and this pilot study aims to describe an adult ICU medication error rate.

Objective(s) To assess the number and type of prescription and administration error per patient day in a Johannesburg intensive care unit

24

Methods

A retrospective convenient sampling of ICU charts corresponding to 400 patient days in a large tertiary hospital in Johannesburg. Ethical clearance and permission of the head of department and Hospital CEO was obtained before two independent reviewers initiated data collection. Unlike the ICU staffs, the reviewers were not blinded to the study objectives and were trained in data collection. The doctorâ€™s prescription and nurses administration section of the patients bed-side paper chart was searched for prescription, transcription and administration errors. The study data were captured and managed using a secured web-based mobile application, REDCap.

Results

Of the 395 (98.75%) patient days, 2,143 drugs (5.8 drugs per patient day) were prescribed while 2147 drugs (5.82 drugs per patient day) were administered. Prescription and administration error per patient day occurred in 62.51 %( n=274/395) and 77.72% (307/395) respectively while it was 38.21% (n=819/2143) PE per total prescribed and 64.56% (n=1386/2147) AE per total administered during the study period. Unit errors was the commonest prescription (n=205; 21.20 %) and administration (n=693; 3.59%) error type. There were more administration than prescription error per patient day, however, this did not reach statistical significance (p value=0.075).

Discussion

There is a considerably high occurrence of medication errors in this review, commonly during medication administration, with potential for adverse effect. Targeted interventions should be implemented to minimise the frequency of medication errors and risk to patients.

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Ref Number 48

Type Poster

Surname Gerber

Name Louis



Title The 'John Thomas' sign and pelvic fractures - Fact or humorous myth?: a systematic review and meta-analysis.

Co-authors

Laher, AE, Department of Emergency Medicine. Enyuma, COA, Department of Emergency Medicine. McDowall, J, Department of Emergency Medicine. Aigbodion, SJ, Department of Emergency Medicine. Buchanan, S, Department of Emergency Medicine. Adam, A, The Division of Urology

Intro/Aim

An incidental and sometimes humorous finding on an Antero-Posterior (AP) pelvis X-ray view is that of the John Thomas Sign (JTS), which is defined as positive, when the penile shadow points towards the side of a hip or pelvic fracture in male patients. Despite previous research reports and studies performed on the JTS sign, uncertainty with regards to its clinical relevance still remains.

Objective(s) The objective of this review was to assess the clinical validity and accuracy of this sign by performing a systematic review and meta-analysis.

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed (May 2017), using the following databases: BMJ best practice, Cochrane Database of Systematic Reviews, EMBASE, PubMed and Scopus. Studies comparing the predictability of the JTS were critically appraised. The summary effect (and 95% CI) was estimated using a random effect model and the Restricted Maximum Likelihood Method. The pooled sensitivity as well as the summary effect log odds ratio was determined. Selected studies were further ranked for quality and relevance using the Critical Appraisal Skills Program (CASP) (Oxford 2013) tool.

Results

In total, nine articles were isolated and assessed. A total of 1942 participants were included. The mean sample size amongst these included studies was 243 participants with a median of 198 participants. Since the necessary data needed for the Meta-analysis was only present in the 6/9 studies assessed, these 6 were analysed further.

25

The JTS was positive in 1089 out of 1439 patients with a pooled sensitivity of 75.7% (95%CI, 73.4%-77.9%). There was a large variation in the sensitivity and specificity amongst studies, accounting for a non-significant summary Odds Ratio effect of -0.03.

Discussion Based on this review, there is insufficient statistical evidence to support the reliability of the JTS to predict the laterality in the case of a hip fracture on the standard AP pelvis x-ray.

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Ref Number 50

Type Poster

Surname Govender

Name Tarlia Rasa

Affiliation Surgery


Title Minimally invasive repair of an intraperitoneal bladder injury secondary to blunt abdominal trauma.

Co-authors Dr Lunga, Zamalunga, General Surgery/ Trauma

Intro/Aim

The burden of trauma in South Africa is well known. Injury to the urogenital system occurs commonly in poly trauma patients but also in isolation. Bladder injuries are categorized as intraperitoneal (30%), extraperitoneal (60%) or both. The management of an intraperitoneal bladder injury is undisputedly surgical repair. Laparoscopic bladder repair is preferred over open surgery due to the obvious benefits that it is less invasive, less pain and required short hospital stay. However, for minimally invasive surgery to be used in trauma patients, the patients must meet specific requirements.

Objective(s) Demonstrating the role of minimally invasive surgery in the management of trauma patients with isolated injuries.

Methods Cases report- Information collected retrospective from the patient's file from Charlotte Maxeke Johannesburg Academic Hospital Trauma unit. This approved from HREC Wits.

Results With this case report we demonstrate successful results from a laparoscopic repair of an isolated intraperitoneal bladder injury secondary to blunt trauma.

Discussion

Most bladder injuries as a result of trauma require open surgical intervention due to poly trauma. This case however demonstrates that there are patients who are ideal candidates for laparoscopic intervention and that this repair is effective and has superior results for the patient and their recovery.

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Ref Number 51

Type Poster

Surname Govender

Name Tarlia Rasa

Affiliation Paediatric Surgery


Title Vascular Rings: A Tale of Two Cases

Co-authors Dr Zanini, Andreas, Paediatric Surgery

Intro/Aim

A vascular ring is a rare congenital abnormality resulting from aberrant regression or persistence of the embryologic aortic arches resulting in extrinsic compression of the trachea and oesophagus. The presentation of these rings is varied and is often not the first differential diagnosis when trachea and oesophageal conditions are considered. Of all vascular rings, the majority (up to 85%) are either a double aortic arch or a right

26

sided aortic arch with a left sided patent ductus arteriosus. The management is surgical division of the vascular ring to relief compression on the aerodigestive structures. We present two patients with vascular rings who were managed by our Paediatric Surgery Unit in Johannesburg.

Objective(s) These patients presented with common general pediatric surgical conditions and were found to have a vascular ring incidentally. Our objective is to define the role of the general pediatric surgeon in the management of vascular rings.

Methods Cases report- Information collected retrospective from the patients' files from Charlotte Maxeke Johannesburg Academic Hospital and the Chris Hani Bargwanath Academic Hospital Paediatric Surgery units. This approved from HREC Wits.

Results These case reports demonstrate the management of concurrent conditions and the incidental diagnosis of the vascular ring.

Discussion

Vascular rings are a rare congenital abnormality, and should be considered in the neonatal age group as part of the work up for tracheoesophageal abnormalities. As clinicians, we need a high index of suspicion for vascular rings when we encounter older children with dysphagia, and persistent respiratory and oesophageal symptoms. Because there is no specific screening done and no particular patient population at risk, the diagnosis is often found while investigating another cause.

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Ref Number 54

Type Poster

Surname Grossberg

Name Saul

Affiliation Surgery


Title The negative appendectomy rate at Charlotte Maxeke Johannesburg Academic Hospital: A 10 year review- stubbornly high.

Co-authors

Bizos,Eleni.L,Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital.Brener,Jason.D,Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital.Candy,Geoffrey.P,Department of Surgery, University of the Witwatersrand.Bizos,Damon.B,Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital,Department of Surgery, University of the Witwatersrand

Intro/Aim

The negative appendectomy rate (NAR) is defined as the rate of surgically removed appendices that are pathologically normal. An acceptable NAR is debated. Traditionally a higher rate was accepted as it implied that appendicitis was not being missed. With improved imaging, lower NARs are reported.

Objective(s) To determine trends of the NAR at Charlotte Maxeke Johannesburg Academic Hospital over a 10 year period and the role of imaging.

Methods

We retrospectively reviewed appendix specimens sent for histological assessment. Imaging data was obtained for the last 2 years. Patients who had interval and incidental appendectomies, pregnant patients and those under 18 years were excluded.

Results

1224 patients were identified (792 males/432 females). The median age of a negative appendix (NA) was 29 years and for appendicitis 31 years. The number of appendix specimens submitted per year remained similar. The overall NAR over 10 years was 19 % (male 14.9%, female 26.2%) and showed a non-significant downward trend. Female NAR decreased significantly (p<0.05). Premenopausal women had a significantly higher NAR as compared to postmenopausal women (26.7% to 12.5%, P<0.05). In the last 2 years: 47 % of patients had imaging (US: 32%, CT: 7 %, CT+US: 8%). 44% of patients with a NA underwent imaging. CT and ultrasound had reasonable PPV (88.5%/78.8%) but poor NPV (22.2%/17.6%).

27

Discussion The NAR was high but demonstrated a downward trend, with a significant decrease in females. Imaging (mostly ultrasound) was performed in 47% of cases, but when done did not seem to affect the NAR.

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Ref Number 56

Type Poster

Surname Gumede

Name Siphamandla

Affiliation Internal Med Ezintsha, School of Clinical Medicine


Title Descriptive analysis of ART patients on second-line treatment in selected public health facilities in Johannesburg, South Africa: a retrospective cohort data analysis

Co-authors

Fischer, Alex, Ezintsha, School of Clinical Medicine, University of Witwatersrand, Johannesburg-Venter, WD Francois, Ezintsha, School of Clinical Medicine, University of Witwatersrand, Johannesburg-Lalla-Edward, Samanta T, Ezintsha, School of Clinical Medicine, University of Witwatersrand, Johannesburg

Intro/Aim In South Africa, around 200 000 people are on second-line treatment, however little is known about these patients.

Objective(s) This study aims to describe second-line African patients in a large urban area.

Methods

A quantitative retrospective study of 825 second-line patients was performed in central Johannesburg (sub-district F), with data extracted from a South African ART monitoring system (TIER.Net). Demographic characteristics, treatment status and laboratory information were gathered, then analyzed with CD4 cell count, viral load and retention in care data as outcome variables.

Results

The average recorded time to viral load measurement after ART switch to a protease inhibitor-based regimen was 20 months. 83.1% (570/686) of those with a recent viral load achieved viral suppression while on second-line treatment. The most recent CD4 cell count levels were 286 cells/ul (IQR=160-478 cells/ul), which represented a 177 cells/ul increase from baseline CD4 cell count at start of first-line ART. Slightly less than three quarters (72.4%) of the population remained active in care from initiation on first-line ART. Being under 25 years of age, males and geographic transfer-in, independently predicted low CD4 cell count values and virological failure while on second-line treatment. Patients exhibiting virological failure were more likely (OR=3.13, CI=1.50-6.56) to be lost to follow-up after switch.

Discussion

Viral load suppression was high in patients on second-line treatment, but one fifth of patients were lost to follow-up. Younger patients, male patients, patients and patients from other treatment sites predicted poor treatment outcomes, highlighting opportunities for where adherence interventions need to be prioritised.

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Ref Number 57

Type Poster

Surname Hirschmann

Name Adam



Title Orthopaedic Terror Medicine: Are we ready to deal with the injuries sustained from an intentional mass casualty incident in South Africa?

Co-authors Gelbart, Bradley, Orthopaedic Surgery / Frey, Chris, Orthopaedic Surgery

28

Intro/Aim

Terror Medicine is an evolving specialty which incorporates multiple disciplines of which Orthopaedics has a significant role. Five of the worldâ€™s leading ten countries with the highest number of terror attack fatalities are in Africa. Studies have shown that prior preparation can significantly reduce the impact of the event on routine functioning of the health care system and improve patient care.

Objective(s) We conducted an extensive literature review and developed a model action plan. We then assessed the perceived and actual readiness of integral components of our hospital, the largest in the Southern Hemisphere, via a simple survey.

Methods

The literature highlights that prior planning can improve patient outcomes and mitigate the additional stress on the hospital system. An evaluation of the current plan for dealing with a terrorist attack at CHBAH was made.

Results Findings indicate the need for pre-hospital (EMS), nursing-care and administrative preparation as well as developing a state of readiness to rapidly provide definitive care to terror-attack casualties.

Discussion

The Orthopaedic Surgeon has a major role to play in these events as studies have shown that the majority of injuries sustained (up to 70%) are extremity related injuries. These injuries are the major reason for surgical management. Despite the local invaluable experience in trauma, we are not adequately prepared to deal with the magnitude and scope of terror-related injuries in a holistic way. The increasing number of terrorist attacks forces us to develop an attack response protocol, which will empower our healthcare professionals and enable us to save more lives.

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Ref Number 59

Type Poster

Surname Honiball

Name John William

Affiliation Emergency Medicine Department of

Category MMed/Registrar

Title Near-infrared spectroscopy in the diagnosis of testicular torsion: valuable modality or waste of valuable time? A systematic review

Co-authors Laher, Abdullah, Emergency Medicine; Swart, Marlize, Emergency Medicine; Adam, Ahmed, Urology

Intro/Aim Testicular torsion is a urological emergency that affects 1 in 4000 males younger than 25 years. Delays in the management of testicular torsion may result in testicular ischemia, testicular necrosis, orchidectomy and infertility.

Objective(s) This review assesses the validity of near-infrared spectroscopy (NIRS) as a diagnostic tool in the assessment and diagnosis of testicular torsion.

Methods

A systematic search of Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, PubMed, Scopus and Web of Science databases was performed in January 2019 using specific search terms. Selected studies were ranked and evaluated using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta analyses) guidelines and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies’-2) tool.

Results

A total of 9 studies that included 253 subjects (88 animals and 165 humans) with a mean sample size of 28.1 (SD 40.8) subjects were included. The mean difference in testicular tissue oxygen saturation between torsed and non-torsed testes (Δ%StO2) were 45%, 42% (±5%), 26% and 5%-18% in 4 animal studies and 2.0%, 3.0%, 6.7%, 6.8% and 23.0% in 5 human studies. The tissue oxygen saturation difference between contralateral healthy testes (controls) ranged from 1%-10% in the 5 studies that alluded to this.

29

Discussion

The current body of evidence does not support the use of NIRS in the work-up of testicular torsion. Well-designed clinical trials with large patient samples are required to determine whether NIRS may have some future role as a diagnostic modality in testicular torsion.

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Ref Number 62

Type Poster

Surname Ismail

Name Sarah

Affiliation Neuroscience Ophthalmology


Title Retinal nerve fibre layer thickness in a normal black south african population

Co-authors Ally, Naseer, Department of Neurosciences, Division of Ophthalmology

Intro/Aim

The retinal nerve fibre layer thickness (RNFLT) measured on spectral domain OCT (SD-OCT) is used to diagnose glaucoma. This is compared to built-in age- and gender- matched European normative databases. Differences in RNFLT occur between population groups. Therefore, using the built in European normative database as a comparison across all population groups could lead to erroneous results. Thus, the aim of the study is to see if the RNFLT in South African patients is different to that of the Europeans.

Objective(s) Objectives Primary: Compare the mean RNFLT of normal black South African patients to the normative database of Europeans.

Methods

Cross-sectional study at St John Eye OPD. Inclusion criteria: Normal eye examinations, >18 years, visual acuity of ≥6/9 with no history of diabetes, surgical or laser procedures. RNFLT was measured using the Spectralis OCT. A sample size of 128 patients calculated using a one-sample mean test, power of 80%, α-level of 0.05 and difference of 2.5µm (SD=10). The t-test, univariate and multivariate linear regressions were used. A Bonferroni correction was applied, and statistical significance was set at a p-value of 0.0024.

Results

The study comprised 132 patients (132 eyes). The mean age (SD) was 41.3 years (12.5). The RNFL sectors measured as follows: global (108.7µm, p<0.001), superotemporal (152.4µm, p<0.001), superonasal (132.6µm, p<0.001), inferotemporal (150.1µm, p<0.001), inferonasal (129.2µm, p<0.001), nasal (77.7µm, p<0.001), temporal 74.8µm, p=0.9534).

Discussion The RNFLT of normal black South Africans is significantly thicker than that of the European database on the Spectralis SD-OCT and early detection of glaucoma could be missed.

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Ref Number 63

Type Poster

Surname Jonosky

Name Jaclyn

Affiliation Urology


Title Bowel Obstruction: a Rare Manifestation of Locally Advanced Prostate Cancer in a Young Man with a Genetic Mutation.

Co-authors Adam A, N Wadee, N Devilliers

mailto:[email protected]

30

Intro/Aim

Prostate carcinoma is a common neoplasm affecting men from 55 onwards. Affected patients may either present to urology services with lower urinary tract symptoms or alternatively the carcinoma is detected via local screening protocols. Rarely is a prostate carcinoma diagnosed in men below the age of 45 unless a genetic component is present and bowel obstruction is an uncommon presentation of this specific carcinoma.

Objective(s) Case Report

Methods Case Report

Results

We present a young patient whose initial presentation was that of bowel obstruction requiring emergency diversion, with a mildly elevated PSA and a malignancy that appears to be locally aggressive with no evidence of distant metastatic disease. On genetic testing the tumour suppression gene PTEN was found to be deleted, on chromosome 10 and this specific mutation has been shown to be important in many malignancies, including prostate cancer.

Discussion Local invasion patterns of prostate carcinoma are also discussed. In addition the importance of screening family members in the case of suspected genetic variations is highlighted.

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Ref Number 65

Type Poster

Surname Medar

Name Sajida

Affiliation Forensic Medicine and Pathology


Title A 10-year retrospective review on mob justice fatalities examined at the Germiston Forensic Pathology Medico-legal Service

Co-authors Keyes, Craig and Jena Stuart, Shirley, Department of Forensic Medicine and Pathology, University of the Witwatersrand

Aim Mob justice fatalities are a gross violation of human rights as they represent extra-legal punishment. There is a paucity of research relating to the demographics of at-risk groups, nature of injuries, and the impact to the Forensic Pathology Service.

Objective(s)

This was a 10 year retrospective study (2006-2016) at Germiston Forensic Pathology Services Medico-legal Laboratory. The objectives were to describe the demographics of the deceased, identify the profile of at-risk groups, describe the trends in the causes of death, hospitalisation frequency, and the nature and location of injuries sustained.

Methods Data was collected from the South African Police Service death scene form (SAPS 180), hospital notes, final postmortem report, notification of death form (BI1663), and additional statements.

Results

There was a total of 354 cases of mob justice relate deaths (2006-2016). The at-risk population was South African (68.9%) black males (99.4%) in the 21-30-year age bracket (49.2%). Most deaths were due to blunt force head injury (136 cases), which were so severe that most deaths occurred within 24 hours of injury (56.3%). Injuries to the head were most common (96.3%) followed by injuries to the back (63.8%).

Discussion

A standardised operating procedure should be developed uniformly manage fatal mob justice cases. Adequate resources should be distributed to appropriate departments to enable a reasonable turnaround time of ancillary investigations and high incidence areas should receive sufficient and appropriately skilled resources to engage with and monitor the respective communities to curb these killings.

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Ref Number 67

Type Poster

Surname Kinandu

Name Kamau

Affiliation Surgery


Title Outcomes of major trauma patients receiving pre-hospital adrenaline for haemodynamic instability at Charlotte Maxeke Johannesburg Academic Hospital

Co-authors Nel Marietha; Moeng Maeyane; General Surgery

Intro/Aim

Traumatic shock is a major cause of morbidity and mortality in South Africa. Fluid resuscitation for shock is widely accepted, but there is debate vasopressor use in trauma patients. Whilst some studies show that early vasopressor usage may be associated with increased mortality, pre-hospital data is absent.

Objective(s) To determine if pre-hospital adrenaline use in hypotensive major trauma patients results in higher in-hospital mortality.

Methods

This was a retrospective study of CMJAH major trauma patients > 18 years with a pre-hospital systolic BP â‰¤ 90mmHg. Study period was 72 months (2011 to 2016). Demographic, physiology, interventional, pre-hospital adrenaline use, 24 hour and 30 day mortality data were collected. STATA V14 was used for statistical analysis. A p-value <0.05 was considered statistically significant. [Wits Ethics Number M160750]

Results

Four hundred and sixty (460) of 8210 major trauma patients were included. Thirty two (32) received prehospital adrenaline; 428 did not. Twenty four hour and 30 day mortality in patients receiving prehospital adrenaline was 37.5 % and 37.5% respectively in comparison to 7.2% and 12.4% in patients not receiving adrenaline. Patients receiving adrenaline were 7.7 times (95% CI 3.4 - 17.2; p = 0.21) and 4.2 times (95% CI 2.0 - 9.1; p = 0.52) more likely to have a 24 hour and 30 day mortality respectively than patients not receiving adrenaline.

Discussion Pre-hospital adrenaline use in major trauma patients showed a trend towards increased mortality at 24 hours and 30 Days. Careful use of adrenaline is therefore advised.

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Ref Number 70

Type Poster

Surname Lindeque

Name Steph

Affiliation Neurosciences Ophthalmology


Title Canalicular lacerations: causes, related ocular injury, and management at St John Eye Hospital

Co-authors

Dr Alberto, Kerry L, MB ChB, FC Ophth (SA), Clinical Head of Ophthalmology at Helen Joseph Hospital, Johannesburg, South Africa, Contribution: Supervision, concept review, protocol design revision, and final approval 2. Prof Trevor R Carmichael, MBBCh (Wits), FC Ophth (SA), PhD (Med), MSc (Med), Former Academic Head: Division of Ophthalmology, University of the Witwatersrand (1997-2017), Contribution: Co-Supervision, concept review 3. Dr Aubrey Makgotloe, MBBCH (Wits), FC Ophth (SA), MMed (Wits), Academic Head: Division of Ophthalmology, University of the Witwatersrand. Johannesburg, South Africa, Contribution: Critical revision and final approval

Intro/Aim Canalicular lacerations cause significant morbidity if unrepaired, and may be associated with serious ocular injuries. Few studies describe the causes of these injuries, and none of these were conducted in Southern Africa.

32

Objective(s) This study’s aim was to describe the incidence of canalicular lacerations in terms of their causes, associated ocular injuries, and management at St John Eye Hospital.

Methods This was a prospective descriptive study of all patients presenting with canalicular lacerations at St John Eye Hospital over a seven month period. Data was collected from the patient files and analysed using descriptive statistics

Results

78 patients presented at St John Eye Hospital with lid lacerations. Of these 78 patients, 26 (33.3%) had canalicular involvement. There was only mild male preponderance. The median age was 34 years. The most common cause of injury was assault (58%) usually involving a knife. 35% of the patients had an associated ocular injury. Globe rupture was relatively common (8%). All patients received lid repair under general anaesthetic. 19% received additional surgical procedures. The median duration of surgery was 103 minutes. Canalicular repair consumed 100 minutes of operating time per week.

Discussion

This study demonstrates that canalicular lacerations are relatively common at St John Eye Hospital. They are disproportionately caused by assault, and more often associated with serious ocular injuries than expected. They place considerable burden on already limited theatre resources, and may be of particular relevance in the South African setting.

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Ref Number 71

Type Poster

Surname Lockhat

Name Razeena



Title Effect of transversus abdominis plane block on post-operative morphine consumption in total abdominal hysterectomy patients

Co-authors Perrie, Helen, Anaesthesiology; Scribante, Juan, Anaesthesiology; Kleyenstuber, Thomas, Anaesthesiology

Intro/Aim Background and objectives: This study was conducted at the Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, amongst patients undergoing total abdominal hysterectomy.

Objective(s)

The primary objective was to assess the post-operative morphine consumption between patients who received a transversus abdominis plane (TAP) block, compared to those who did not receive a TAP block. The secondary objective was to assess any differences in Numeric Rating Scale (NRS) pain scores between the groups as well as the side effects at different time intervals.

Methods

One hundred and twenty six patient records were included in this retrospective study using a consecutive convenience sampling method. They were divided into the TAP block group and the non-TAP block group. The TAP block group received TAP blocks by the anesthetist after the induction of general anesthesia, whilst the non-TAP block group only received a general anesthetic. Both groups received intravenous analgesia as predetermined by the anesthetist. Boluses of morphine were administered through patient controlled analgesia pumps in the recovery room and in the post-operative period. The acute pain trainee documented the morphine consumption at Time 1, Time 2 and Time 3, as well as the NRS pain scores and any side effects experienced by the patient.

Results There was no significant difference between the morphine consumption in the TAP block versus the non-TAP block groups at Time 1, Time 2 or Time 3. There was no significant difference of pain scores between the two groups

Discussion TAP blocks did not decrease the amount of post-operative morphine consumed in patients who received a total abdominal hysterectomy, nor did it result in any differences in NRS pain scores between the two groups.

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Ref Number 73

Type Poster

Surname Louw

Name Lizette

Affiliation Radiation Sciences


Title Added benefit of SPECT/CT imaging in oncology

Co-authors Vangu MDT, Nuclear Medicine and Molecular imaging

Intro/Aim Oncology forms the cornerstone of Nuclear Medicine. Hybrid imaging with SPECT and X-ray computed tomography (SPECT/CT) is becoming more common, but remains expensive.

Objective(s) To demonstrate that more accurate localization of tracer uptake on CT may impact on patient management or provide prognostic information.

Methods

We report selected patients: A 10-year-old girl with left femur osteosarcoma and suspected lung metastases. 99mTc-methylene diphosphonate (MDP) staging bone scan was done. An adult male with previous pheochromocytoma presented with renal and cerebellar masses; suspected cerebellar haemangioblastoma. Restaging 123I- metaiodobenzylguanidine (MIBG) scan was done. An elderly male with previous prostate carcinoma and rising PSA levels had 99mTc-HYNIC-iPSMA imaging. Due to previous spinal metastases and spinal degeneration, CT and bone scan were inconclusive.

Results

99mTc-MDP SPECT/CT identified several pulmonary nodules, multiple skeletal foci, and involvement of mediastinal, abdominal and pelvic lymph nodes. These findings conveyed a worse prognosis. The parents could be counselled accordingly. 23I-MIBG SPECT/CT demonstrated metastatic pheochromocytoma with multiple skeletal foci. Intense uptake in the cerebellar mass and pituitary suggested a possible second, undiagnosed, haemangioblastoma. These findings, with the absence of uptake in the renal mass, raised a clinical suspicion for Von Hippel Lindau syndrome with renal cell carcinoma. Patient management plan was adjusted accordingly. 99mTc-HYNIC-iPSMA SPECT/CT localized uptake to the iliac blade, acetabulum, and a single left internal iliac lymph node, confirming disease progression.

Discussion SPECT/CT is cost-effective and increases the value of Nuclear Medicine’s contribution to clinical management decision making in oncology.

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Ref Number 74

Type Poster

Surname Louw

Name Lizette



Title Resting MPI SPECT as a predictor of myocardial viability on 18F-FDG PET


Intro/Aim 18F-FDG PET is the standard for myocardial viability assessment, but is expensive.

Objective(s) Determine if resting 99mTc-Sestamibi MPI SPECT parameters can predict myocardial viability.

34

Methods

Infarcted segments in 145 patients who had resting 99mTc-Sestamibi MPI and 18F-FDG PET scans were reviewed. Patient population table 1. Parameters recorded: segmental uptake score, summed rest score (SRS), extent of infarction and viability, resting left ventricular ejection fraction (RLVEF), left ventricular end diastolic and end systolic volumes (EDV; ESV), qualitative (RWMqualt) and quantitative (RWMquant) motion assessment, quantitated thickening.

Results

Viability was demonstrated in 51,3% of infarcted segments. No correlation found between SRS (p=0.086), RLVEF (p=0.776), EDV (p=0.345) or ESV (p=0.925) and myocardial viability. Uptake score, RWMqualt, RWMquant and thickening correlated with segmental viability (p=0.00). Using univariate logistic regression analysis, none of the uptake scores were found to predict viability, except uptake score of 4 which predicted viability absence OR=0.70 (95%CI: 0.52-0.94; p=0.017). RWMqualt akinesia or dyskinesia predicted a lesser likelihood of viability OR=0.46 (95%CI: 0.33-0.62; p=0.000) and OR=0.37 (95%CI: 0.27-0.50; p=0.000) respectively. Better motion and thickening predicted a higher viability likelihood, OR=2.96 (95%CI: 2.05-4.26; p=0.000) for motion >5.1mm and OR=3.58 (95%CI: 2.38-5.38; p=0.000) for thickening >21%.

Discussion

Infarcted segments with impaired motion and thickening are less likely to be viable, regardless of the uptake score. In resource constrained environments, 18F-FDG PET may be deferred in such patients. Infarcted segments without impaired motion and thickening on MPI still require 18F-FDG PET for definitive assessment of myocardial viability.

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Ref Number 75

Type Poster

Surname Louw

Name Lizette



Title Quantitative parameters of MPI SPECT assessment â€“ does patient position matter?


Intro/Aim

99mTc-Sestamibi SPECT myocardial perfusion imaging (MPI) is performed to assess coronary artery disease (CAD). Attenuation artefacts may cause false positive findings. Prone imaging is an alternative to transmission attenuation correction, but the impact on other parameters has not been well documented.

Objective(s) To assess the impact of prone imaging on commonly used imaging parameters.

Methods

All patients referred for MPI from September to December 2016 and who were imaged in supine and prone position were included. The MPI studies were processed and reviewed blindly on separate occasions and the following assessed: myocardial uptake score; and quantitative parameters (LVEF, EDV and ESV) using student t-test. Agreement between these quantitative measurement was analyzed using the Bland Altman method.

Results

Patient characteristics presented in table 1. Overall uptake score improved in 33 patients (29.20%) and worsened in 9 (7.96%). Improvement was mainly seen in the inferior, inferolateral and inferoseptal segments, and worsening in the anterior wall. No significant difference was found between the supine and prone LVEF (p=0.392), EDV (p=0.657) or ESV (p=0.601). The differences of means for all measured quantitative parameters were between the range of expected agreement: LVEF (d= -2.07), EDV (d=7.15) and ESV (d=4.33); CV=5%.

Discussion There is no significant difference between supine and prone position acquisition on measured left ventricular function parameters. Left ventricular function parameters from either method can safely be used.

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Ref Number 79

Type Poster

Surname Maharaj

Name Shivesh

Affiliation Neurosciences ENT


Title Deep Neck Space Infections: A Case Series and review of the literature

Co-authors Ahmed, Sumaya,Departement of Otorhinolaryngology

Intro/Aim

Deep neck spaces are regions of loose connective tissue filling areas between the three layers of deep cervical fascia, namely superficial, middle and deep layers. The superficial layer is the investing layer. The pre-tracheal layer is the intermediate layer and the prevertebral layer is the deepest layer.

Objective(s)

Deep neck infection (DNI) is defined as infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are purely aerobic and 25% with isolated Anaerobes

Methods

This study is a seven year (01/07/08 - 30/06/15) retrospective review of the microbiology of deep neck infections in 52 adult patients at an academic hospital. Micro-organisms isolated from patients with deep neck infections were analysed, including their antibiotic susceptibility patterns. The effectiveness of empiric usage of amoxicillin and clavulanic acid against commonly identified microbes and recommended alternative antibiotic usage were reviewed. The register records of 70 microscopy, culture, and antibiotic sensitivity results of specimens taken intraoperatively, in patients with deep neck infections who underwent surgical intervention, were analysed.

Results

The age distribution of patients ranged from 19 to 77 years with a mean of 40.9 (+ - 15.5) yrs. Figure 1 Age distribution of 52 patients The study population comprises 63% (n=33) males and 37% (n=19) females. The ratio of males: females was 1.74:1. The distribution of positive cultures is 69% (n=36) and that of negative cultures is 31% (n=16), per absolute count of 52 patients with DNIs. There were 26 different microorganisms isolated and identified on culture. Of these, 92% (n=24) of microorganisms were aerobic and 8% (n=2) anaerobic.

Discussion

The epidemiology of DNIs needs to be monitored for changing trends and the impact of underlying host immunity and developing microbial multi-drug resistance, established. Surveillance at a laboratory level should include mandatory susceptibility testing of all microbes commonly identified in adult DNI Microscopy and culture specimens (MC&S), to the then current loco- regional empiric antibiotics in use. The role of susceptibility testing of microbes not commonly identified in adult DNI MC&S specimens, to the then current loco- regional empiric antibiotics in use, needs further review, in selected patients on a clinical case by case basis.

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Ref Number 81

Type Poster

Surname Mahomed

36

Name Mishkah



Title Post-operative experiences of patients undergoing laparoscopic gynaecological surgery at an academic training hospital

Co-authors Chetty, Sean, Anaesthesiology and Buitenweg, Adriaan, Anaesthesiology

Intro/Aim Global trends suggest performing gynaecological surgery laparoscopically. The anaesthetic technique should complement the minimally invasive nature of the surgical

Objective(s) The objective was to describe patient pain scores and estimate the frequency and severity of side effects after laparoscopic gynaecological surgery.

Methods

A retrospective descriptive study was performed on available PAIN OUT data for patients having undergone a laparoscopic gynaecological procedure at an academic hospital in SA. Data on pain experiences and side effects was captured. PAIN OUT is an international pain database, the focus of which is to improve the management of post-operative pain. To facilitate this, data about post-operative pain from medical facilities internationally was collected and pooled into one database. The database provides feedback and benchmarking for staff about how patients are being managed especially with concern to pain patients may experience.

Results

Data representing 55% of cases for the period under review was available. The median age of all patients recruited was 37 years. Participants were of African descent. The median numerical rating scale score for “worst” and “least” pain since surgery for patients having undergone this procedure was 5 and 3 respectively; the difference statistically significant p<0.0001. Sixty percent of patients reported drowsiness, 48.2% experienced nausea/ vomiting and 22.7% experienced pruritus. The median scores for drowsiness, nausea/ vomiting and pruritus was 2, 0, and 0 respectively.

Discussion

Although most patients experienced post â€“ operative pain, and side effects experienced were higher than recommended standards, the severity of pain and side effects experienced was tolerable. Although side effects were noted, they were not statistically significant. Findings of this study do not clearly prove if the side effects were from opiates or from the surgical procedure.

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Ref Number 83

Type Poster

Surname Malan

Name Antonetta

Affiliation Human Genetics, School of Pathology


Title The Quality of Life of Mothers who have Children with Developmental Disorders

Co-authors Dr Shelley Macaulay and Ms Katryn Fourie

Intro/Aim

Limited research has been performed to establish how having a child with a developmental disorder affects the quality of life (QOL) of mothers in South Africa. Developmental disorders encompass developmental delay (DD) and intellectual disability (ID). Quality of life refers to an individualâ€™s sense of overall well-being. Having a child with a developmental disorder can have an impact on the QOL of the mothers caring for them. The aim of the study was to establish whether having a child with a developmental disorder significantly influences the QOL of their mothers.

Objective(s) The objectives were to compare the QOL scores between cases and controls, determine factors associated with a good/poor QOL and identify areas for intervention to improve QOL.

37

Methods

This was a descriptive case-control study using quantitative research methods. It was nested within two larger studies; Deciphering Developmental Delay (DDD) in Africa, and the Long-term Effects of Gestational Diabetes. Participants were recruited from the DDD Africa study to form the case group and the control group was recruited from the gestational diabetes study. Twenty participants were recruited in each group. The data collection tool was the World Health Organisation QOL Measure abbreviated version questionnaire (WHOQOL-BREF). It consisted of 26 questions assessing QOL in four domains: physical health, psychological, social relationships and environment.

Results There were significant differences in all four domains between cases and controls. Cases consistently scored lower than controls.

Discussion There is a need for intervention, such as support groups and appropriate referrals made by genetic counsellors for psychological care.

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Ref Number 84

Type Poster

Surname Malan

Name Nico

Affiliation Radiation Sciences, Nuclear Medicine and Molecular Imaging


Title Thyroid cancer clinic - should serum calcium monitoring become a routine part of follow-up of patients receiving I-131 ablation / treatment?

Co-authors Vangu, Mboyo-di-Tamba, Department of Nuclear Medicine and Molecular Imaging

Intro/Aim

Thyroidectomy is a procedure with well-known potential risks and complications, amongst others, hypocalcemia following surgery. Patients routinely undergo post-operative testing to exclude hypocalcemia following thyroidectomy as patients may initially be asymptomatic. Once patients are treated in our thyroid cancer clinic, there is no further routine investigation of serum-calcium levels, except if the patient becomes symptomatic. There have been reports in literature to suggest that some patients may become hypocalcemic following the administration of radioactive iodine, whether transient or permanent.

Objective(s) Identify asymptomatic patients requiring calcium supplementation timeously. This may indicate whether routine testing of serum-calcium should be performed in our institution.

Methods

This is a prospective study of patients referred to the Thyroid Cancer Clinic at Charlotte Maxeke Johannesburg Academic Hospital. The patients consented to be enrolled in the study. Serum calcium was measured and compared to the initial calcium levels following surgery. We aimed to enroll 50 patients for an audit of the incidence of patients that may have been hypocalcaemic or became hypocalcaemic.

Results

52 patients (5 males; 47 females) entered the study (mean age 49.7ï‚±13.7 years). Seven were found to be hypocalcaemic (s-Ca <2.15mmol/l) [normal 2.15 - 2.50mmol/l]. They had s-Ca levels ranging from 1.73mmol/l to 2.11mmol/l (mean 1.99mmol/l). Six patients were already hypocalcaemic following surgery and 1 patient had a normal calcium of 2.29mmol/l post-surgery. This patient received 5550MBq I-131 and now presents with a s-Ca of 2.11mmol/l and PTH = 1.2pmol/l (normal 1.60 - 6.0mmol/l). There were no obvious other causes that could account for the patient’s current hypocalcaemia other than I-131 therapy.

Discussion Routine measuring of s-Ca may assist in detecting patients that are not on optimal calcium replacement or may have become hypocalcaemic following treatment with radioactive iodine.

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Ref Number 85

Type Poster

Surname Manful

Name Adjei Charles

Affiliation Public Health, University of the WItwatersrand, School of


Title Changes in prevalence and isolated organisms of sepsis in very-low-birth-weight (vlbw) neonates at Charlotte Maaxeke Johannesburg Hospital, 2013-2017

Co-authors Tobias Chirwa, Daynia Ballot

Intro/Aim Sepsis is an important cause of morbidity and mortality in very low birth weight (VLBW) neonates

Objective(s) To identify and quantify factors influencing the changes in prevalence of sepsis in VLBW neonates

Methods

All VLBW neonate born or admitted to the neonatal unit at (CMJAH) between 1st January 2013 and 31st of December 2017 were involved in the analysis. Multivariate decomposition models were used to assess factors influencing the changes in prevalence of sepsis between two successive time points.

Results

During the 5-year period, the overall prevalence almost doubled between 2013 (23%) and 2015 (40%) and later decreased to about 35% in 2017. Prevalence of late Onset Sepsis (LOS) was substantially higher compared with Early Onset Sepsis (EOS). The proportion of infection caused by gram negative bacterial were between 46% and 53.4%. (similar trend was observed for both EOS and LOS). Difference in characteristics over time contributed significantly to the changes in prevalence of sepsis. There was an increase in prevalence of LOS by 8.7% between 2103 and 2014. The results from the decomposition model further show that, the difference in participantâ€™s characteristics significantly accounted for about two-thirds (66.3%) of the observed difference (increase) in the prevalence of LOS. The results from the decomposition models shows that increase in proportions of neonates who received blood transfusion significantly influence the changes in prevalence of LOS by 38.8%.

Discussion Sepsis remains prevalent among VLBW neonates with remarkable variation over time. LOS is more prevalent and mostly caused by gram negative bacterial.

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Ref Number 86

Type Poster

Surname Marcus

Name Felicity

Affiliation Psychiatry


Title An assessment of voting knowledge and related decisions amongst hospitalized mental health care users in South Africa

Co-authors Nel, Yvette, Department of Psychiatry

Intro/Aim

The South African Constitution protects the right to vote for every citizen. The Electoral Act (73 of 1998) states that persons may not be registered on the voter’s role if they have been “declared by the high court to be of unsound mind or mentally disordered” or if they are currently “detained under the Mental Health Care Act, 17 of 2002”. There is limited information regarding voting knowledge and subsequent voting related decisions amongst South African involuntary mental health care users and state patients.

Objective(s) To compare voting knowledge and related decisions between hospitalized mental

39

health care users (MHCU) and non-psychiatric hospitalized patients (controls).

Methods

A cross sectional survey was conducted using a modified Cognitive Assessment Tool for Voting (MCAT-V) questionnaire with 60 involuntary mental health care users and state patients at Sterkfontein Psychiatric Hospital (MHCU) and 30 patients in the orthopaedic ward (controls) at Chris Hani Baragwanath Academic Hospital. Scores on the MCAT-V were compared between the MHCU and control groups, along with socio-demographic and clinical variables such as age, gender, DSM 5 diagnosis, highest level of education and voting status.

Results

There was a significant association between group (MHCU vs control) and highest level of education (p=0.016), with the control group having a higher proportion of patients with Grade 12 or higher education. Although the median overall score for the control group (11; IQR 10-12) was significantly higher than that for the MHCU group (10; IQR 8-12) (p=0.043), when controlling for education level, there was no significant association between group (MHCU/control) and MCAT-V scores (p=0.011).

Discussion

The limitations and exclusions with the current voting rights of South African mental health care users are not supported by the findings of this study. MHCU and control groups displayed variable results on the MCAT-V questionnaire with regards voting knowledge and subsequent decisions. This was found to be dependent on educational attainment rather then membership group.

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Ref Number 89

Type Poster

Surname Mdluli

Name Nokubekezela Thembeka



Title The Wnt/Î²-catenin pathway in human colon adenocarcinoma cells is modulated by a histone deacetylase inhibitor.

Co-authors Kandhavelu J, Subramanian K, Khan A, Ruff P, Penny C, Department of Internal Medicine, Oncology Division

Intro/Aim Dysregulation of the Wnt pathway involving sustained activity of Î²-catenin results in excessive cell proliferation. Î²-catenin has many target genes, including hTERT, which regulates telomere maintenance and cellular immortalization

Objective(s) The potential role of the histone deacetylase inhibitor Vorinostat in regulating Î²-catenin and telomerase activity was assessed in the stage 2 HT29 colorectal cancer cell line.

Methods

HT29 colorectal adenocarcinoma cells were treated with Vorinostat at concentrations of 0.5ÂµM, 1ÂµM, 2.5ÂµM for 48 hours and at 5ÂµM for 24 hours. A live/dead cell count assessed cell death; and cell cycle arrest was evaluated using a cell cycle assay. Indirect immunofluorescence was performed to determine the subcellular Î²-catenin localization. Cell migration/scratch assays were employed to assess cellular response to Vorinostat; and gene profiling of human telomere associated genes was determined with a focussed PCR Array.

Results

Vorinostat treatment resulted in cell cycle arrest at G1/G0; and in dose-dependent cell death. At 5ÂµM, the translocation of Î²-catenin from the cytoplasm to the nucleus was reduced at 24 hours. Further, cell migration was impeded at high concentrations of drug. Though gene profiling failed to detect hTERT, SLX 4, EME1 and RTEL1, genes that prevent homologous recombination were upregulated. RFC1, a gene essential for DNA replication was markedly downregulated.

Discussion In HT29 colon cancer cells, Vorinostat may modulate cell proliferation via Wnt signalling through degradation of Î²-catenin. Resulting in an inhibition of cell proliferation, with cell cycle arrest occurring in G1/G0. Together with this, genes

40

associated with DNA replication and chromosomal regulation were modulated. Also, the impedance of cell migration by drug treatment, may indicate the regulation of epithelial to mesenchymal transitions. While hTERT was undetectable, it is unclear whether Vorinostat regulates telomere associated proteins.

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Ref Number 91

Type Poster

Surname Meel

Name Ruchika

Affiliation Internal Med Cardiology


Title Spectrum of Thoracic Ascending Aortic Aneurysms at a Peri-Urban Tertiary Hospital: An Echocardiography based study

Co-authors Moleboheng Molopa , Cardiothoracic Surgery, Shungu Mogaladi, Cardiothoracic Surgery, Merika Tsitsi, Internal Medicine, Michael Hasenkam ( Cardiothoracic surgery,Aarhus University

Intro/Aim Thoracic ascending aortic aneurysms (TAA) are an important cause of clinical disability that require early detection by imaging methods for rapid and effective management.

Objective(s) To describe the spectrum of TAA at Chris Hani Baragwanath Hospital.

Methods A descriptive study was conducted based on clinical and echocardiographic imaging data of patients with clinical diagnosis of TAA, from October 2017- April 2019.

Results

The study comprised 83 cases of TAA (37.9% females) with a median age of 48 (IQR 23-80). Majority were of African ethnicity (96%). Main aetiologies were hypertension (40 patients), HIV (35 patients), connective tissue disease (6 patients) and idiopathic disease in 2 patients. Forty- five patients presented in heart failure ( HF) and five patients presented with acute aortic dissection. Twenty percent of the patients were in New York Heart Association (NYHA) class I, 37.1% were in NYHA II, 1.7% in NYHA III and one patient was in NYHA functional class IV. Echocardiography revealed enlarged aortic dimensions. TAA was complicated by severe aortic regurgitation (AR) in 47 patients, 16 had moderate AR and 1 patient had mild AR. The left ventricular ejection fraction was 51.5Â±18.29%. Pulmonary artery systolic pressure was elevated at 43.5mmHg (IQR 23-101mmHg) and RV Sâ€™ velocity was 7.0cm/s (IQR 5.6-9.0). In the HIV group the CD4 count was 503 cells/ul (IQR 357-593). Majority of the patients were on anti-remodelling therapy for HF. Five patients underwent surgery, out of whom 2 demised.

Discussion TAA are common amongst a predominantly African population and are associated with considerable morbidity and mortality.

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Ref Number 94

Type Poster

Surname Mhlambi

Name Ntombikayise

Affiliation Surgery


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Title Novel targets in dysregulated signalling pathways to inhibit metastasis in pancreatic ductal adenocarcinoma

Co-authors Devar John,Department of Surgery, Omoshoro Jones, Surgery, Smith Martin, Surgery, Candy, Geoffrey, Surgery, and Nweke, Emmanuel, Surgery.

Intro/Aim

Pancreatic ductal adenocarcinoma (PDAC) is a deadly type of cancer with almost an equal amount of new cases and deaths observed yearly. PDAC has a poor prognosis despite several treatment strategies. Hence the discovery of potential new therapeutic targets is essential to improve outcomes. Dysregulation and mutation of several key signaling pathways occur during PDAC. These pathways have been identified to be involved in cellular proliferation, invasion and migration.

Objective(s) This study intends on utilizing pathway-based approach to identify mutated genes in dysregulated signalling pathways in South African PDAC patients.

Methods This study analyzed RNA-sequencing data obtained from 4 tissues (2 tumours and 2 corresponding normal) of South African PDAC patients and utilized a pathway-based approach to identify potential therapeutic targets.

Results

We observed that most upregulated genes in our tumour samples are involved in the Pancreatic cancer pathway and these analyses were performed using the KEGG software tool. Pathway analysis showed the top significantly upregulated pathways are those involved in signaling pathway implicated in metastasis such as WNT, NOTCH, VEGF, PDGF, IGFR, EGFR and CCKR. Additional analysis showed that majority of genes involved in these pathways share similar domains and are co-expressed.

Discussion

We confirmed the overexpression of crucial signalling pathways in PDAC. Likewise, some of the gene components of the pathways are both overexpressed and highly mutated especially in pathways known to be involved in the regulation of oncogenes/tumour suppressor. Targeting these genes might provide more effective strategies and lead to inhibition of biological processes that induce metastasis.

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Ref Number 95

Type Poster

Surname Mirza

Name Sheefa



Title Circulating Cancer Associated Fibroblasts and Circulating Tumor Stem Cells: The Symbiotic Siblings and Potential Drug Targets

Co-authors Jain N, Rawal R, Penny C

Intro/Aim

Accumulating evidence suggest behaviour of tumorigenic cells is highly influenced by tumor-microenvironment which plays a determinant role in emergence of CTSCs (circulating tumor stem cells). Moreover, CAFs-secreted (Cancer associated fibroblasts) cytokines confer a survival advantage to CTSCs (indicators of residual-disease) by evading immune system. Collectively, CAFs serve as an "incubator" for CTSCs by providing favourable "soil" for their subsequent growth in the circulation during EMT, thus considered as a target in diagnostic and therapeutic application.

Objective(s) Development of minimally invasive diagnostic and prognostic modalities for frequent monitoring of treatment response as a liquid-biopsy approach in order to improve clinical outcome for lung adenocarcinomas.

Methods

Pleurospheres (PS) were generated in serum-free media and their chemotherapeutic resistance was evaluated by MTT assay. EMT status was characterized by western-blot, immunofluorescence and immunocytochemistry. Furthermore, expressions of CSC and epithelial markers were assessed using flowcytometry. cCAFs were cultured in-vitro and characterized by western blot and qRT-PCR using Î±-SMA marker.

42

Results

PS had higher self-renewal potential in serum-free media suggesting their stem-like characteristics. MTT assay revealed their intrinsic drug-resistance towards gemcitabine at 100 µM higher concentration followed by significantly higher expression of MDR markers by qRT-PCR. Furthermore, CTSCs showed extensive expression of Vimentin as compared to E-cadherin suggesting occurrence of EMT. Flowcytometry revealed presence of higher CD44(+)/CD24(-) cell population having CK (5.6±0.3%) and EpCAM (0.5±0.4%), suggesting presence of CTSCs rather than CTCs. Expression of cCAFs at proteomic level was significantly higher than healthy individuals (p<0.0001). Moreover, qRT-PCR demonstrated all patients were positive for presence of cCAFs. Additionally, significant trend was observed between different stages of lung cancer patients (p < 0.014), suggesting its probable role in progression.

Discussion Companion biomarkers, cCAFs along with CTSCs, could enhance early detection and prove to be an efficient biomarker for metastasis as a new paradigm shift in treatment monitoring.

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Ref Number 97

Type Poster

Surname Mkansi

Name Mantsi, Annah



Title Implementer perceptions of participant experiences during enrolment into an m-Health study in Johannesburg clinics

Co-authors Mashilo N; Wits RHI Ezintsha, Mlati V; Wits RHI Ezintsha, Thomas R, Wits RHI Ezintsha, Nxumalo S, Wits RHI Ezintsha

Intro/Aim

Health telematics is being adopted to advance delivery of health services and improve patient clinical outcomes. iThemba is a mobile health application (app) designed to promote patient engagement in HIV care by providing viral load (VL) results (with interpretation guidance) directly from laboratory instruments to recipient’s phone.

Objective(s) To describe study staff’s perceptions of participants’ experiences and engagement with iThemba during enrolment.

Methods

Using purposive sampling in two high volume Johannesburg clinics, counsellors recruited people living with HIV who were waiting for a routine HIV viral load test. Eligible patients were consented and iThemba was installed on their Android phones. Study nurses completed processes related to the blood draw and facility shipping of samples.

Results

705 people were screened to enroll 500 participants. Participants displayed enthusiasm about iThemba and eagerness to enrol in the study after hearing that they will receive their VL results within 3-5 days through iThemba (much earlier than standard of care). In instances where patients were screened out because of type of phone they would return with their compatible phones to gain eligibility for enrolment. During interactions, participants indicated that they found iThemba simple to register and log into and the sample barcode scanning processes easy to execute.

Discussion

Participants displayed positive attitudes during screening, enrolment, app downloading and VL testing. The perceived willingness to be involved in the study highlights the need for improvement in HIV VL standards of care. iThemba has the potential to strengthen linkage to and retention in care for all people living with HIV.

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Ref Number 99

Type Poster

43

Surname Mlotshwa

Name Ncamiso

Affiliation Surgery Cardiothoracic Surgery Cardiothoracic


Title Tracheal B cell lymphoma, Case presentation

Co-authors Mogaladi, Shungu. Mustafa, Kash. Cardiothoracic unit

Intro/Aim Tracheal B-cell lymphomas are among the rarest tumors with only a few reported in the literature. Presentation is usually misdiagnosed as asthma and the treatment should respond well to chemoradiation.

Objective(s) Case presentation of a rare form of lymphoma of the trachea

Methods Case presentation

Results Tracheal B cell lymphoma seem to not respond to chemoradiation.

Discussion Tracheal B cell lymphoma is very rare, often misdiagnosed as asthma. The treatment does not seem to improve the outcome as they represent with irresectable .

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Ref Number 100

Type Poster

Surname Mndebele

Name Sbusiso

Affiliation Obstetrics and Gynaecology


Title Morbidity of Ectopic Pregnancy at Chris Hani Baragwanath Hospital

Co-authors Wise, Amy, Obstetrics and Gynaecology

Intro/Aim

Ectopic pregnancy (EP) is defined as a condition where a fertilized ovum implants outside the normal uterine cavity. It remains the commonest life-threatening surgical emergency, where most patients present with the ruptured variety. EP is responsible for thousands of hospital admissions, surgical interventions and blood transfusions.

Objective(s) To describe the demographics and risk factors of patients with EP. To describe the presentation and severity with respect to EP. To describe the diagnostic modalities used in our setting to diagnose EP. To describe the morbidity and management of EP

Methods

The study is a prospective cohort study. The site of the study was at Chris Hani Baragwanath Academic Hospital (CHBAH) in the three gynaecology wards. Eligible patients were recruited from the admission book in a 3-month period from August 2018 to October 2018 at CHBAH. Demographic data, presenting symptoms and signs, risk factors, diagnostic modality, management, features of the ectopic and morbidity were recorded on a Redcap data sheet.

Results

There were 201 cases included in the study. Signs of shock were present in 15% of the patients and acute abdomen present in 80% of the patients in our study. There were 175 (87.1%) patients who were diagnosed with ruptured EP. Transfusions were needed in 24,9% of patients. There were 187 laparotomies and 14 laparoscopies done with no mortality during the study duration.

Discussion To improve the morbidity there is need for proper evaluation of pregnancy with associated risk factors, early diagnosis and management of EP.

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Ref Number 101

Type Poster

Surname Modi

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Name Deepak

Affiliation Internal Medicine, Dermatology


Title A patient with recalcitrant oral pemphigus vulgaris successfully treated with a biologic drug- Rituximab. The first documented case in South Africa.

Co-authors Modi, Deepak, Internal Medicine. Dermatology: Gunduz, Ozge , Internal Medicine

Intro/Aim

Pemphigus vulgaris (PV) is a chronic idiopathic autoimmune blistering disease affecting mucous membranes and the skin. Rituximab (RTX) is a chimeric monoclonal antibody against CD20, which inhibits the production of pathogenic desmoglein-reactive antibodies from B-cells found in patients with PV. RTX has been recently approved by the FDA for patients with refractory PV.

Objective(s) We document the first case of refractory oral PV in South Africa that was successfully treated with RTX.

Methods

A 42-year-old woman with oral PV since 2006 was treated with evidence based immunosuppressants; systemic and intralesional steroids, intravenous immunoglobulins, cyclophosphamide, cyclosporine and mycophenolate mofetil. She responded periodically but never achieved complete remission. She endured a poor quality of life living on liquidised foods. She had recalcitrant PV.

Results

In 2016 we obtained authorisation and funding, and RTX was given according to the Lymphoma protocol in combination with prednisolone (20mg/day) and mycophenolate mofetil (2gr/day). Her lesions improved dramatically after two cycles of RTX given 4 weeks apart with no new lesions appearing to date four years later.

Discussion

RTX is an effective treatment of PV. The limitation of its use is based simply on cost. To the best of our knowledge this is a therapeutic first in South Africa. Documentation of this case will assist with motivations to medical schemes and public hospital therapeutic committees to provide patients with recalcitrant oral PV the benefit of RTX.

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Ref Number 102

Type Poster

Surname Mokwatsi

Name Lerato



Title Substance use prevalence and outcomes in a psychiatric outpatient population in Southern Gauteng

Co-authors Robertson, Lesley; Psychiatry

Intro/Aim

Substance use is commonly comorbid with mental illness. Comorbid substance use disorder (SUD) in patients with mental illness increases the likelihood of poorer outcomes of psychiatric care, including poor medication adherence, and increased frequency and length of stay of hospital admissions. South African studies have documented a prevalence of substance use of between 40-50% in a general hospital psychiatric setting.

Objective(s) Ascertain the prevalence of substance use, its clinical correlates, and relationship with hospital admissions among patients attending an urban community psychiatric clinic

Methods

Retrospective record review of patients who had attended a community psychiatric clinic Southern Gauteng over a 24-month period. Data regarding socio-demographic and clinical profiles were collected. Missed clinic appointments were used to measure adherence to care. Other outcomes measured were the number of hospital admissions and average length of hospital stay during 24-month period. Those with substance use and those with no substance use were then compared using these variables.

45

Results

368 clinical records were analyzed. The study sample consisted predominantly of males 52.2% with the population being mainly black 99, 2%, and single and with secondary schooling. The percentage of the sample was also unemployed. The most common psychiatric disorder was schizophrenia followed by substance induced psychotic disorder. Commonly used substance was cannabis, followed by alcohol. Those with schizophrenia had a higher comorbid SUD compared to other primary psychiatric disorder. A significantly higher number of missed clinic appointments (p=<0.0001) and number of hospital admissions (p=<0.0001) was found among those with a SUD than those without.

Discussion The study highlights the negative effect of substance use in patients with mental illness with regards to their adherence to clinic appointments, recurrent hospital admissions and longer duration of stay during hospital admission.

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Ref Number 103

Type Poster

Surname Molopa

Name Moleboheng

Affiliation Surgery Cardiothoracic


Title Atrial Myxoma: A report of five cases

Co-authors Mogaladi Shungu, Department of Surgery Cardiothoracic Division and Meel Ruchika Internal Medicine Department Cardiology Division

Intro/Aim Atrial myxomas are rare tumors with an occurrence of 0.02%. There are few case reports from Africa, the last report comprised 5 patients over 10 years. Herein, we report five cases of atrial myxoma over a short period of 1 year.

Objective(s) To review clinical, echocardiographic and histology of five cases of atrial myxoma.

Methods Retrospective case series of 5 atrial myxomas operated at Charlotte Maxeke Academic Hospital over a 1-year period.

Results

Five patients with atrial myxoma are described. The case series comprised 4 females and 1 male with a mean age of 44.8 years (youngest 23 and oldest 79 years) all Africans. Dyspnea and coughing being the most common presentations. Systemic embolic presentations included dry gangrene of the left hand 5th digit and expressive aphasia. Ascites and pedal edema were noted with right atrial (RA) myxoma. On echocardiography all had preserved ejection fraction, atrial myxoma was noted in the Left Atria in 60% of the patients and 40% in the RA. Forty percent of patients had functional tricuspid regurgitation and 40% had mitral inflow obstruction. The mean size of the myxoma on echocardiography was 12x22mm. Intraoperatively all specimens where pedunculated, friable gelatinous masses with a mean size of 10x25mm. Histological findings were in keeping with atrial myxoma in all cases. Mean postoperative stay was 5 days. All the patients had an uneventful hospital stay and were discharged home.

Discussion We have described five cases of atrial myxoma with unique presentations.

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Ref Number 104

Type Poster

Surname Moolla

Name Yusuf

46



Title ‘Prostate Cancer’ information on the internet: fact or fiction?

Co-authors

Adam, Ahmed, Urology; Department of Urology, Helen Joseph Hospital & Department of Paediatric Urology, Rahima Moosa Mother & Child (Coronation) Hospital, Division of Urology, Department of Surgery, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa ; Perera, Marlon, Department of Surgery, Austin Health, University of Melbourne, Victoria, and Department of Surgery, University of Queensland, Brisbane, Queensland, Australia ; Lawrentschuk, Nathan, Department of Surgery, Austin Health, University of Melbourne, and Olivia-Newton John Cancer Centre, University of Melbourne, and Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Intro/Aim In today’s information era, patients often seek information regarding health using the internet. We assessed reliability and validity of internet information regarding “Prostate Cancer” (PCa).

Objective(s) Thus, we aimed to objectively assess the quality and validity of Prostate Cancer information currently available on the internet, more specifically on the ˜Google” platform.

Methods Search term “Prostate Cancer” used on Google website (June 2017). Critical analysis performed of first 100 hits using JAMA benchmarks, DISCERN score, Health on the Net.

Results

33 500 000 hits returned. Top 100 hits critically analysed. Ten links (duplicate links (7/10) / book reviews (1/10) / dead sites (2/10) excluded, therefore 90 analysed. Subcategories assessed included: commercial (53,33%), University/Medical Centre (24,44%), Government (13,33%); NGO/NPO (8,89%). Sub-type of information content assessed included: factual (74,44%), clinical trials (18,89%); stories (5,56%); Q&A (1,11%). Validity scores rated as: HONCODE Score: HONcode seal positive (14,44%), and seal negative (85,56%). Website content based on JAMA Benchmarks: 0 benchmarks (4,44%), 1 benchmark (16,67%), 2 benchmarks (34,44%), 3 benchmarks (27,78%), 4 benchmarks (16,67%). DISCERN Score rated: 1 = 2 (2,22%), 2 = 25 (27,78%), 3 = 30(33,33%), 4 = 30 (33,33%), 5 = 3 (3,33%).

Discussion Overall quality observed to be accurate, but unreliable in itself as a source of information for patients. Urologists and patients need to be aware of this “quality vs quantity” discrepancy when sourcing PCa information on the internet.

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Ref Number 105

Type Poster

Surname Moorhouse

Name Michelle



Title Availability of third-line antiretroviral therapy in sub-Saharan Africa

Co-authors

Intro/Aim

World Health Organization (WHO) recommends antiretroviral therapy (ART) programmes in resource-limited settings develop policies for access to third-line ART. It is uncertain how many countries across sub-Saharan Africa (SSA) have implemented this, due to high cost of third-line ART and limited access to viral loads and genotype resistance testing. According to WHO, at least 14 countries in SSA are providing third-line.

Objective(s) This review seeks to assess the availability of third-line ART across SSA.

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Methods

In August 2019 a search was carried out on PubMed, Embase, and MEDLINE focussing on observational studies and randomised controlled trials (RCTs) of third-line in SSA countries. Additional exploration of grey literature was done through a search of the CROI conference database. Searches were restricted to English and to excluding modelling studies, but not publication year.

Results

Seventy nine abstracts were found. 12 studies were identified, of which four were excluded. The remaining eight studies comprised one RCT and seven observational cohorts. Only seven of forty-six countries in sub-Saharan Africa published outcomes on third-line ART; three have only published outcomes from an RCT so it is unclear whether third-line is available in public sector programmes.

Discussion

While WHO recommends countries develop third-line ART policies, there is little published data regarding third-line ART in SSA. It is likely that more countries are providing access to third-line ART than reported; however data are scarce which may be driven by lack of resources (time, human and financial) to publish. Support should be provided to RLS programmes to produce data regarding third-line ART.

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Ref Number 107

Type Poster

Surname Morar

Name Tejil



Title Exploring burnout among psychiatry registrars at the University of the Witwatersrand

Co-authors Supervisor: Marais, Belinda, Department of Psychiatry

Intro/Aim

The occupational phenomenon of burnout is increasingly recognised and gaining momentum as it is regarded as impairing and consequential. Psychiatry registrars are particularly vulnerable to burnout, yet there is a paucity of research among this population in South Africa.

Objective(s) To investigate the occurrence of burnout and associated factors among registrars in the Department of Psychiatry at the University of the Witwatersrand (WITS)

Methods

A cross-sectional study was executed via an anonymous self-administered questionnaire. The questionnaire comprised three sections: demographics, the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and questions relating to contributing factors, protective factors and consequences of burnout. The MBI-HSS is recognised as the leading measure of burnout and consists of three subscales: emotional exhaustion, depersonalisation and personal accomplishment.

Results

The questionnaire was anonymously completed and returned by 33 out of 58 psychiatry registrars (57% response rate). The prevalence of each MBI-HSS subscale was compared to normative data. Sixty-eight percent scored high in one or more subscales. Significant factors associated with the burnout experience included poor work and non-professional life balance, utilising annual leave days for work-related tasks, irregular holidays, the view that oneâ€™s work consists of excessive paperwork and financial debt. A protective factor against burnout was an amicable relationship with fellow registrars.

Discussion There is evidence of some degree of burnout in more than two thirds of participants. Associated factors lie largely at an organisational level and while optimising individual resilience is important, systemic support plays a key role.

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Ref Number 108

Type Poster

48

Surname Motshabi

Name Palesa



Title Profile of adult patients presenting for rheumatic mitral valve surgery at an academic hospital

Co-authors Corresponding Author: Nolwazi Fiona Mokitimi; Charlotte Maxeke Johannesburg Academic Hospital

Intro/Aim

Objective(s) Perioperative morbidity and mortality are increased in patients with rheumatic heart disease. Preoperative risk stratification is imperative for optimisation and better outcome.

Methods

This was a descriptive, retrospective, contextual study. A consecutive convenience sampling method was used. Eighty-nine patients who underwent mitral valve surgery at Charlotte Maxheke Johannesburg Academic Hospital between January 2014 and December 2015 were enrolled.

Results

Forty-seven patients presented with mitral regurgitation (MR), 35 had mitral stenosis (MS). Data included two mixed mitral valve disease patients with predominant regurgitation that were classified under the regurgitation group. Forty-five percent (39) had arrhythmias and 49% (42) congestive cardiac failure at presentation for surgery. The overall mean (SD) pulmonary pressure was 57 (20) mmHg and the mean left atrial size was 53 (11) mm. Those with mitral stenosis presented with mean (SD) mitral valve area of 0.9 (0.2) cm². Of the analysed MR patients, 51% presented with left ventricular ejection fraction (LVEF)<60%, and 55% with left ventricular end systolic diameter (LVESD)>40mm. Amongst the analysed MS patients, 59% had mitral valve area <1cm2. A substantial number (49% MR and 54% MS) of collected records were not eligible for analysis and stratification using the American Heart Association/American College of Cardiology Guidelines (ACC/AHA) for Valvular Heart Disease. Of the 24 MR patients analysed utilising the 2014/2017 AHA/ACC guidelines, 13 had a-symptomatic severe mitral regurgitation (Stage C) and 11 symptomatic severe mitral regurgitation (Stage D). One patient had progressive mitral stenosis (Stage B), 8 a-symptomatic severe mitral stenosis (Stage C) and 7 symptomatic severe mitral stenosis (Stage D).

Discussion

The majority of the patients presented in AHA/ACC Stage C and Stage D of disease progression. They also presented with concomitant clinical and echocardiographic features that placed them at high risk of perioperative morbidity, such as pulmonary hypertension.

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Ref Number 110

Type Poster

Surname Motshabi

Name Palesa

Affiliation Anaesth esiology


Title Audit of blood product transfusion in paediatric congenital heart surgery on cardiopulmonary bypass

Co-authors Palesa Motshabi

Intro/Aim Blood products are commonly transfused during cardiac surgery on cardiopulmonary bypass. This resulted in the initiative to audit transfusion practices at our hospital to improve practices if the need arises.

Objective(s) Audit blood transfusion practices in paediatric congenital cardiac surgery at a tertiary hospital.

Methods Retrospective, contextual, descriptive data of 105 patients were collected for the

49

period January to December 2014.

Results

The median age was 4 (1–6) years, weight 13 (8.4–20) kg, with mean lowest CPB haemoglobin of 8.3 g/dL. There was a statistically significant difference for median RPC, platelets and cryoprecipitate units per patient transfused across RACHS categories (RPC p=0.03, platelets p=0.0013, cryoprecipitate p=0.0001). A correlation occurred between transfused FFP units with CPB time (r=0.2634, p=0.0199) and RPC units (r=-0.4654, p<0.001). RPC, cryoprecipitate, and platelet transfusion were statistically significant between weight categories for RPC (p=0.001), platelets (p=0. 038), and cryoprecipitate (p=0.009).

Discussion Although no standardised transfusion guidelines were used, overall blood product transfusion was comparable to previous studies.

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Ref Number 114

Type Poster

Surname Mungul

Name Sheetal

Affiliation Neuro ENT


Title Botulinum toxin A therapy for post-traumatic parotid sialocele - a case Report and review of the literature

Co-authors Maharaj, Shivesh, ENT

Intro/Aim

Parotid sialocele is a collection of saliva in the subcutaneous tissue and may commonly present following traumatic injury to the parotid gland or duct. Management is controversial and numerous strategies including conservative and surgical modalities have been described. We hereby present a case of a patient who presented with sialocele after sustaining penetrating trauma to the right parotid area with transection of the parotid duct during a motor vehicle accident.

Objective(s) To present the efficacy of Botulinum Toxin A therapy in a patient with post-traumatic parotid sialocele

Methods Case report

Results The sialocele persisted following conservative treatment of repeated aspiration for seven days. Botulinum toxin A was then used as a safe, effective non-surgical therapeutic modality for persistent parotid sialocele.

Discussion Botox A was an effective therapeutic alternative to surgery in a patient with post-traumatic parotid sialocele

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Ref Number 115

Type Poster

Surname Mungul

Name Sheetal

Affiliation Neuro ENT


Title Lingual fibrolipoma- a rare clinicopathological entity

Co-authors Maharaj, Shivesh, ENT

50

Intro/Aim

Lipoma is a relatively common benign tumour occurring at sites of the body which are rich in adipose tissue. Due to sparsity of adipose tissue within the oral cavity, lipoma rarely presents in this region. Fibrolipoma of the tongue is a rare lesion. There are only 14 cases reported in the literature.

Objective(s) To raise awareness of this rare entity which may mimic a malignancy

Methods A case report is presented

Results

An 85-year-old patient presented with a painless mass on the tongue interfering with eating. There were no risk factors for malignancy and no family history of malignant diseases. Although intraoperatively the lesion was locally infiltrative, histopathology revealed a rare benign fibrolipoma. Mainstay of treatment is surgical excision

Discussion Lingual fibrolipoma may pose a dilemma for surgeons as difficulties associated with removal, due to the fibrous and adherent nature of the growth to surrounding tissue, may be mistaken for a cancerous growth.

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Ref Number 116

Type Poster

Surname Naidoo

Name Vivash

Affiliation Internal Medicine, Oncology


Title Enrichment of tumour stage-specific glycoproteins from colorectal cancer cell lines

Co-authors Kandhavelu Jeyalakshmi, Subramanian Kumar, Stoychev Stoyan, Ruff Paul and Penny Clement; Oncology Division, Faculty of Health Sciences, University of the Witwatersrand, Parktown 2050, Johannesburg, South Africa

Intro/Aim

Colorectal cancer (CRC), the second most prevalent cancer in South African men and the fourth most in women, is a leading cause of cancer-related mortality. It results from aberrant changes in gene expression and associated proteins over time. Glycosylation is one of the most important post-translational modifications made to proteins and moreover, is involved with carcinogenesis.

Objective(s) In this regard, the aim of this study is to profile tumour stage-specific glycoproteins in colon cancer cell lines using advanced mass spectrometry, to identify biomarkers for diagnosis and prognosis.

Methods

The SW480, HT29 and DLD1 CRC cell lines that represent early, mid and late stages of CRC were cultured in vitro. The total proteome was isolated from each cell line and in addition, N-glycoproteins were specifically enriched from each isolate using conA lectins. From this, glycoproteins associated with each tumour stage will be profiled using mass spectrometry (MS).

Results

Polyacrylamide gel electrophoresis (SDS-PAGE) of the total proteome demonstrated differential patterns of protein expression for each of the stage-specific cell lines. Further, SDS- PAGE analysis reflected a successful enrichment of N-glycoproteins following the conA lectin treatment. The profiling of these tumour stage-specific enriched glycoproteins will be achieved using MS.

Discussion

This study will aid in the identification of specific glycoprotein biomarkers to identify patients whose CRC may be more aggressive for appropriate treatment regimens. Ultimately, this study will provide a better understanding of the pathophysiology of colorectal cancer.

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Ref Number 118

51

Type Poster

Surname Nakwa

Name Firdose Lambey

Affiliation Paediatrics, Neonatology


Title Reduction of blood stream infection due to methicillin resistant Staphylococcus aureus through use of chlorhexidine skin baths in a neonatal unit

Co-authors

Nakwa, F.L1,, Motsoaledi E 2, Paruk, A3, Thomas R1, v. Kwawegen A1, Sepeng, L1, Seake K1, Ntuli N1, Sono L1, Kgwadi D1, Ondongo C1, Kesting SJ1, Maswabi H3, Jaglal P4; Wadula, J4, Dikgang S,3 , Velaphi S1.1Department of Paediatrics, Chris Hani Baragwanath Academic Hospital and the University of the Witwatersrand, 2 Department of Paediatric Nursing, Division of Infection Prevention andControl (IPC) Chris Hani Bargawanath Academic Hospital; 3 Pharmacy Department, 4National Health Laboratory Services

Intro/Aim

Methicillin resistant Staphylococcus aureus (MRSA) is one of the pathogens that causes healthcare-associated infections (HAI) and is associated with significant morbidity and mortality. Recommended strategies to reduce infections due to MRSA include reducing skin colonization.

Objective(s) To compare incidence of sterile site infections (SSI) due to MRSA before and after implementation of a quality-improvement project of using 0.2% chlorhexidine baths in neonates admitted to Chris Hani Baragwanath Academic Hospital (CHBAH)

Methods

After an outbreak in 2016, chlorhexidine baths were recommended to be applied daily to all admitted neonates as skin care. An audit of positive blood and cerebrospinal fluid cultures due to MRSA from 2014 to 2018 was conducted from a computerized microbiological database. Incidence of positive cultures from sterile site was compared before and after implementation of using chlorhexidine baths in the unit (year periods 2014-2015 versus 2017-2018).

Results

In 2014-2015, 1670 bacterial and fungal isolates were cultured from sterile sites of 7134 admissions. MRSA accounted for 15.7% (263/1670) of all isolates. The period of 2017-2018 had 8634 admissions of which 2654 isolates were cultured; MRSA accounted for 3.4% of isolates. The incidence rate of SSIs decreased from 16.1/1000 patient-days in 2014-2015 to 22.2/1000 patient days in 2017-2018, the incidence rate of SSIs due to MRSA decreased significantly from 2.53/1000 patient-days (2014-2015) to 0.75/1000 patient-days (2017-2018, p<0.001).

Discussion Daily chlorhexidine baths in neonates resulted in a more than three-fold reduction in incidence of SSIs due to MRSA. Daily chlorhexidine baths showed a sustained decline in MRSA sepsis rate.

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Ref Number 120

Type Poster

Surname Nel

Name Lisca

Affiliation Anatomical Pathology


Title A prospective study of 112 cases investigating the discordance between receptor profiles of primary breast carcinoma and the involved ipsilateral lymph node metastases.

Co-authors A. Mannell, Department of Sugery. J. Smilg and J. Haberfeld Deaprtment of radiology, S. Nietz Department of Surgery

52

Intro/Aim

Treatment targeting hormone and HER2/neu receptors in breast cancer cells has improved survival. The discordance between the receptor profile of primary tumours and the paired ipsilateral lymph node metastases occurs in up to 30% of breast cancer patients, with lymph node metastases exhibiting a more aggressive profile.

Objective(s) The aim of the study was to determine the rate of discordance in receptor profiles between primary breast carcinoma and lymph node metastases in treatment naive patients in relation to the age, race HIV status and clinical stage.

Methods

This is a prospective study of the receptor profiles of needle biopsies taken from 112 treatment naÃ¯ve patients presenting with breast carcinoma and synchronous lymph node metastases. Immunohistochemical analysis of the oestrogen receptor, progesterone receptor HER2/neu status and Ki-67 were performed simultaneously and interpreted by a single histopathologist.

Results

The results showed that 110 patients were female; with a mean age of 54 years; 89% were African. The HIV status was recorded in 103 patients in whom 79% tested negative, 13% positive and 8% were not tested. Most of our patients (94%) present late with stage 3 or 4 disease clinically. The discordance rate of the molecular subtypes of tumour and paired lymph node metastases was 8%. All the discordant cases changed to more aggressive subtypes in the lymph nodes. There was no significant association between HIV positivity and discordance.

Discussion Biomarker profiling of lymph nodes metastases at presentation may require treatment targeting these metastatic cell clones to ultimately improve patient survival.

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Ref Number 126

Type Poster

Surname Ntombela

Name Philani

Affiliation Orthopaedic surgery


Title Outcomes of Distal radius metaphyseal fractures in children

Co-authors Mukiibi Winifred, Ramokgopa Mmampatla, Ramguthy Yamesh, Orthopaedic surgery

Intro/Aim

Fractures in the distal third of the forearm account for 75% to 84% of all forearm fractures. Management of these fractures is controversial, ranging from manipulation under anesthesia with casting, or percutaneous pinning; use of above-elbow cast or forearm casting; the acceptable limits in cases of redisplacement.

Objective(s) To determine outcomes of management of distal radius fractures in children.

Methods Retrospective review of patients treated between January 2018 and December 2018 with a distal radius fracture. Short-term outcomes were reviewed.

Results

20 girls and 76 boys; average age of 9,1 years. 58% involved the right side and 42% the left. 53% of the fractures were from falling on an outstretched hand and 17% from soccer injuries. 39% of patients had an above-elbow cast, 40% below-elbow and 21% with k-wires plus forearm cast. Of the k-wire group, 2 needed open reduction. 100% union rate, average union time of 25,1 days. Overall complication rate was 8,3%. 2% needed re-operation, both requiring a re-manipulation and k-wires. Both had been treated in a forearm cast. Overall, 3% required the cast to be bivalved for swelling, none had compartment syndrome. No one from this group lost reduction, 2 were initially in a forearm cast and 1 in above-elbow cast. From the 21 patients treated with k wires, 14% developed mild pin tract sepsis. This resolved without chronic complications.

Discussion The complication rate associated with distal radius metaphyseal fractures is relatively low. The use k-wires is not a benign undertaking and should be reserved for specific cases that demand it.

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Ref Number 127

Type Poster

Surname Nweke

Name Ekene

Affiliation Surgery


Title Integration of proteomics and genomics data demonstrates novel potential targets of pancreatic ductal adenocarcinoma in African patients

Co-authors Naicker Previn, CSIR; Devar John, Surgery; Stoychev Stoyan, CSIR

Intro/Aim

Pancreatic cancer (PDAC) accounts for 2.8% of new cancer cases worldwide and is projected to become the 2nd leading cause of cancer-related deaths by 2030. Patients of African ancestry appear to be at increased risk for PDAC with worse severity and outcome. Integrating protein and genome expression profiles help identify and better understand molecular variations in disease.

Objective(s) This proposed study seeks to determine and integrate protein and genomic profiles of PDAC patients of African ancestry.

Methods

Thirty tissues (15 tumors and 15 corresponding normals) were obtained from consenting African PDAC patients undergoing Whipple procedure at Chris Hani Baragwanath and Donald Gordon Hospitals in Johannesburg (HREC-M150778). Samples were processed to obtain protein and DNA. Subsequently, SWATH-MS and DNA arrays were used to identify proteins and tumor-specific mutations, respectively. Functional and mutational analyses were conducted using STRING and VEP, respectively.

Results

We found 55 upregulated and 36 downregulated proteins. Upregulated genes in tumour samples were mostly involved in key biological processes, including hemostasis, signal transduction, neuronal system, and developmental biology. Genes such as E2F1, TGM2, NOS1, and ZFHX3 were found to be mutated which may play anti-tumorigenic roles. Of note, genes such as TGM2 were both upregulated and mutated.

Discussion

This study has shown protein expression and mutations observed in a cohort of South African PDAC patients, therefore highlighted novel targets in PDAC. Validation studies are required to determine the expression of the identified targets in a larger cohort and confirm their roles in PDAC.

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Ref Number 131

Type Poster

Surname Osei

Name Emmanuel Dwomoh



Title Diagnostic accuracy of pre-operative clinical examination in zone v flexor injuries

Co-authors M. C. Sathekga

Intro/Aim Zone V flexor is densely packed with 12 tendons, 3 nerves and 2 major arteries. Injuries to zone V flexor injuries can be very devastating to the patient and impair proper functioning of the hand. Most often, the intra-operative findings differ

54

significantly from the pre-operative clinical findings.

Objective(s)

This research was done to: 1. Analyze the demographic data of patients who present with zone V flexor injuries 2. Assess the diagnostic accuracy of pre-operative clinical examination in predicting injuries to structures in Zone V flexor injuries.

Methods

Ethics clearance was obtained for the study. 56 patients who sustained zone V flexor injuries and fulfilled the inclusion criteria were enrolled in the study after they signed a consent form. Demographic data of the patients were documented. Patients were examined pre-operatively by orthopaedic doctors at the casualty and findings were documented. Orthopaedic doctors in theatre documented their intra-operative findings. The frequency and proportions were reported for the demographic data. The pre-operative and intra-operative were analysed by cross-tabulation to assess the accuracy of the pre-operative clinical examination.

Results

The male to female ratio was 4.1:1. More than half of the patients were employed. Two-thirds of the injury occurred on the dominant hand of the patient. Assault or homicide was the leading cause of zone V flexor injury. 39% of the patients were drunk when the injury occurred. More than two-thirds of the injury occurred on weekends. There were 25 cases of spaghetti wrist and 16 cases of ulna triad injuries. Flexor digitorium superficialis injuries were missed more than flexor digitorium profundus injuries. 100% and 50% of superficial radial nerve and median nerve respectively were missed on clinical examinations. 75% and 48% of radial artery and ulnar artery injuries respectively were missed clinically. Only 5 out of 42 partially torn anatomical structures were accurately diagnosed pre-operatively.

Discussion

The study demonstrated a significant difference between pre-operative finding and intra-operative findings of zone V flexor injuries. Clinical examination skills, knowledge of functional anatomy of anatomical structures, lack of thorough examination, observer error and patient factors accounted for the high level of missed diagnosis.

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Ref Number 132

Type Poster

Surname Phakathi

Name Boitumelo

Affiliation Surgery


Title Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV.

Co-authors Herbert Cubasch, Sarah Nietz, Caroline Dickens, Therese Dix-Peek, Maureen Joffe4, Alfred I. Neugut,Judith Jacobson, Raquel Duarte, Paul Ruff

Intro/Aim

Breast cancer survival in Sub-Saharan Africa has been reported to be poor, with an estimated 5 years survival of about 50% when compared to 90% in high income countries. How HIV and ART affect the survival among breast cancer patients remains unknown.

Objective(s)

To analyse the survival of women with breast cancer receiving ARTs for HIV To determine the impact of the duration of HIV sero-positivity on the overall survival of women with breast cancer To determine the impact of ART use on overall survival of women with breast cancer

Methods

Participants were female patients newly diagnosed with invasive breast cancer from May 2015- September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital. We analysed the overall survival, defined as time from the histological diagnosis of invasive breast cancer to death. We also compared survival between the HIV positive and HIV negative patients. Among the

55

HIV positive group, we compared survival between patients who were HIV positive for less than or greater than one year, patients on ARVs and those not on ARVS as well as those patients with detectable and undetectable HIV viral load. Ethics clearance was obtained from Human Research Ethics Committee (Medical) committee at University of Witwatersrand.

Results

Of 1019 patients enrolled, 22% were HIV positive. With a median follow up of 23.2 months (12-31.8), the overall survival was 85%, 73.8% and 65.3% at 1 year, 2 years and 3 years, respectively. Corrected for stage of disease at presentation, the HIV status and the duration of HIV seropositivity did not affect the overall survival during the duration analysed. Patients not on ARTs at diagnosis had a poorer overall survival than those on ARTs (40.2 % vs 65.4 %).

Discussion

We did not find differences in survival except for patients not on ART who had a poorer survival compared to patients on ART at diagnosis. Our study is limited by sample size and a short follow-up. Long term follow up is required to confirm these findings.

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Ref Number 134

Type Poster

Surname Pillay

Name Prinitha



Title Sexual quality of life in locally advanced cervical cancer patients treated with definitive concurrent chemoradiation

Co-authors Minnaar Carrie, Radiation Sciences; Kotzen Jeffery, Wits Donald Gordon Medical Centre

Intro/Aim In cervical cancer the vagina is both the treatment target and an organ at risk.

Objective(s) To describe the sexual quality of life (QoL) of patients treated with chemoradiation for locally advanced cervical cancer.

Methods

A retrospective analysis of prospectively collected data from a phase-III RCT using chemoradiation from January 2014 to June 2017 in 76 participants from the control arm with a median follow-up of 12 months. QoL was assessed using EORTC QLQ-CX24 QoL questionnaires at baseline, every 3 months post-treatment during the first year, and every 6 months in the second.

Results

Worry that sex would be painful and poor body image, were present in 60% of participants at baseline and persisted throughout the first year post-treatment. Only 11% of participants reported being sexually active at baseline but this doubled by six months and tripled beyond nine months postâ€“treatment. 65% of reports of sexual activity included pain during intercourse while 77% found intercourse enjoyable. However 50% found it both enjoyable and painful, 26% enjoyed sex without pain and 14% who did not enjoy intercourse reported pain. The main vaginal symptom was discharge that was almost two times more prevalent than vaginal discomfort.

Discussion

The sexual QoL of participants were greatly impaired before treatment and their concerns persisted throughout the first year with an improvement in the subsequent year. Providing care on a daily basis without the in-depth understanding of what is most meaningful to our patients only widens the gap in our care. These findings can help health professionals to shape expectations and to reassure patients that there are improvements over time.

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Ref Number 135

Type Poster

56

Surname Pillay

Name Diantha

Affiliation WRHI


Title Family Planning Services as a service entry point for HIV testing and prevention services for adolescent girls and young women: Reflections from 2 studies in South Africa

Co-authors Murire, Mercy, Wits RHI , Stankevitz,Kayla, FHI360, Mullick,Saiqa, Wits RHI

Intro/Aim Family planning services are often the first entry point for females within the health system, and could be potential entry point for integrated health services.

Objective(s) To achieve HIV epidemic control, service entry points for HIV testing and prevention services to at-risk populations needs to be identified.

Methods

Reflections are drawn from two studies which enrolled females, 18 and above, the first, in 2016, attending family planning (FP) services at 12 public health facilities in North West Province and Gauteng. The second study, in 2017 enrolled female sex workers (FSW), aged 18 at PrEP implementing facilities. Clients were interviewed using a semi-structured questionnaires.

Results

The first study enrolled 257 clients, 22% (n=56), aged 18-24 accessing FP services, 59% (n=33) HIV negative and 32% (n=18) unknown status. Of 257 clients, 22% (n=57) initiated contraception between 12 -17 and 49% (n=127) between 18 -24. The second study enrolled 299 clients, 81 (27%) aged 18 to 24, 52 female and 29 male. Of female participants, 62% (n=32) ever accessed FP services at the facility and 54% (n=28) accessing FP on the day of the interview. Out of 52 AGYW, 60% (n=31) perceived themselves at risk of HIV, 68% (n=21) had tested for HIV less than 3 months ago.

Discussion

FP services could be an entry point for HIV testing and offering prevention services, as AGYW as young as 12 are entering facilities to seek FP services. Providing integrated FP, HIV testing and prevention services offers an opportunity to engage AGYW who perceive risk of HIV in care.

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Ref Number 136

Type Poster

Surname Pillay

Name Tristan



Title Prevalence of Asymptomatic Bacteriuria (ASB) in Patients Undergoing Total Joint Arthroplasty at an Academic Institution and Subsequent Risk of Early Surgical Site Infections (SSIs)

Co-authors Pietrzak Jurek, Orthopaedic Surgery/Grace, Shane, Orthopaedic Surgery/ Dimitriou, Dimitrios, Orthopaedic Surgery/ van der Jagt, Dick, Orthopaedic Surgery/ Mokete, Lipalo, Orthopaedic Surgery

Intro/Aim The urinary tract is a potential source of periprosthetic joint infections (PJI). The role of Asymptomatic Bacteriuria (ASB) before elective surgery and the subsequent risk of infection is controversial.

Objective(s)

We attempted to determine the prevalence of ASB among patients undergoing elective total hip (THA) and knee arthroplasty (TKA) in a single institution. We tried to ascertain whether ASB is associated with an increased risk of 30 day surgical site complications as well as PJI

57

Methods

We retrospectively reviewed all consecutive patients undergoing primary Total Joint Arthroplasty (TJA) for 9 consecutive months. All patients underwent routine pre-operative sterile mid-stream urine collection for Microscopy Culture and Sensitivity (MC&S). All patients were followed up post-operatively for 30 days.

Results

There were 179 successive primary elective Total Joint Arthroplasties (TJA) performed. This included 90 THAs and 89 TKAs. The mean age of these patients was years 61,5 years (33-83 years). No correlation existed between ASB and age, diabetes, HIV-infection, THA or TKA, smoking or obesity. There were 5 patients who had wound complications within 30-days post-operatively. Three of these patients had pre-operative ASB.

Discussion

The prevalence of ASB in our Arthroplasty population is low. ASB is more common in females. We demonstrated a greater risk of SSIs in patients with pre-operative ASB however, aetiology not directly associated with haematogenous seeding. We propose that ASB could be used as a surrogate marker for patients at risk of SSI as it was proven to be an independent risk factor for infection.

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Ref Number 139

Type Poster

Surname Purbhoo

Name Khushica

Affiliation Radiation Sciences Nuclear medicine


Title Should Planar imaging be replaced by SPECT Ventilation-Perfusion (VQ) Scintigraph?

Co-authors M Somi, Mdthw Vangu, Department Of Nuclear Medicine

Intro/Aim

It is not possible to confirm pulmonary embolism (PE) on clinical features alone. The diagnosis of PE is confirmed on a conclusive imaging test. Previously, VQ scans were reported according to the findings of perfusion defects on planar imaging. However with the advent of Single Photon Emission Computed Tomography (SPECT) VQ imaging, many centers are adopting new approach.

Objective(s) To compare the ability of planar vs. SPECT VQ scintigraphy.

Methods

All patients referred from November 2013 to June 2014 for VQ scintigraphy for suspected PE had planar and SPECT acquisitions. Planar imaging was reported according to the modified PIOPED criteria and SPECT with the use of the EANM criteria.

Results

There were a total of 69 patients, age range of 21 to 82 years. Both imaging modalities showed equal number of segmental perfusion defects. However, SPECT showed more subsegmental defects (35% versus 21%). Consequently two or more subsegmental defects on SPECT were considered as positive for PE. Only 9% of patients would have had positive PE on planar imaging versus 30% on SPECT imaging. There were 10% of patients with a non-diagnostic scan on planar imaging but none on SPECT

Discussion The value of SPECT over planar imaging would be in reducing and/or eliminating the indeterminate findings on planar imaging.

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Ref Number 140

Type Poster

Surname Purbhoo

Name Khushica

58

Affiliation Radiation Sciences Nuclear medicine


Title The impact of normal stress myocardial perfusion imaging with regard to cost saving of resources

Co-authors Young, Bruce; Vangu MDTHW, Department of nuclear medicine

Intro/Aim It has been validated that myocardial perfusion imaging (MPI) with Technetium (Tc-99m) radiopharmaceuticals, that the prognosis of low risk patients with normal stress images is similar to those with normal rest-stress protocol.

Objective(s) The aim of the study was to validate the stress first approach in our environment, and to evaluate the health economic impact of cost saving if we omitted the rest study.

Methods

All patients referred to nuclear medicine for from January 2015 to August 2016 were included in the study. Data on the stress and rest study were evaluated for perfusion, cavity dilatation, drop in EF and wall motion. With regard to the cost calculation, a time-drive activity based costing methodology was used to estimate the cost of a single rest MPI study

Results

There were a total of 1207 stress-rest MPIs done, of which 256 (21%) patients had normal stress perfusion imaging. All had normal rest perfusion. There were 4 patients (1.5%) that had left ventricular cavity dilatation on stress, and 56 patients (22%) that had a drop in ejection fraction of >7 units from rest to stress. The cost saving would the rest study have been omitted and was calculated as R989.09 per patient. On average, over the 20 months, with 8 normal studies per month, and cost saving of R7 714.88 per month

Discussion Stress only for normal MPI has many advantages, including, lower patient radiation exposure, time gain and cost saving implications for both the patient and the hospital.

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Ref Number 141

Type Poster

Surname Rafferty

Name Katherine

Affiliation Neurosciences Ophthalmology


Title Central Foveal Thickness as measured on Optical Coherence Tomography Pre- and Post-phacoemulsification Surgery in a South African Population

Co-authors Supervisor: Goolam, Saadiah, Department of Neurosciences, Ophthalmology Division

Intro/Aim Pseudophakic cystoid macular oedema (PCMO) is a well-documented event post cataract surgery. Detecting and managing it is pivotal to comprehensive patient care.

Objective(s)

To investigate the changes in the central foveal thickness (CFT) post-phacoemulsification surgery. To determine the incidence of pseudophakic cystoid macular oedema (PCMO) in a predominantly black South African population. To determine whether any factors influence CFT thickening and the incidence of PCMO.

Methods

A prospective, observational case series of 150 patients who underwent phacoemulsification surgery in a tertiary hospital setting. CFT measurements were taken at 2 time points: baseline on day 1 post-phacoemulsification surgery and between 4-6 weeks post-operatively. The data was then compared and analysed based on both the demographics of the patient and surgical factors.

Results

The incidence of PCMO was found to be 10.7%. The incidence of clinically significant PCMO was 0.7%. The median change in CFT was an increase of 22 ï•m (IQR 11-36; range -16 to 544) - a statistically significant change from baseline (p < 0.0001). Only the baseline CFT value had a significant effect on the change in CFT (t-test -2.62; p=0.01). No significant association between baseline CFT and PCMO development was found (p = 0.43)

59

Discussion

This study revealed a PCMO incidence similar to other international studies, revealing that our predominantly black population CFT behaves similarly to what is seen in other countries with a predominantly white population make-up. Our clinically significant PCMO incidence was low which is to be expected, and also in line with international studies.

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Ref Number 181

Type Poster

Surname Saggers

Name Robin

Affiliation Paediatrics and Child Health


Title An analysis of neonates with surgical diagnoses admitted to the neonatal intensive care unit at charlotte maxeke johannesburg academic hospital

Co-authors Daynia Ballot1, MB BCh, FCPaed (SA), PhD; Andrew Grieve2, MB BCh, FC Paed Surg (SA), MMed (Surgery)

Intro/Aim

The burden of neonatal surgical conditions is not well documented in lower to middle income countries (LMICs), yet neonatal surgical conditions are thought to be relatively common with a considerable proportion of neonates admitted to the neonatal intensive care unit (NICU) requiring surgical intervention.

Objective(s) To review neonates with surgical conditions admitted to the Neonatal Intensive Care Unit (NICU) in our hospital setting.

Methods

This was a retrospective, descriptive study of neonates admitted to the NICU at CMJAH with surgical conditions between 1 January 2013 and 31 December 2015. The characteristics and the survival of these neonates were described using univariate analysis.

Results Neonates with major surgical conditions account for one third of NICU admissions in the present study.

Discussion Paediatric surgical services must be a priority in planned healthcare interventions to reduce neonatal mortality in LMICs.

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Ref Number 144

Type Poster

Surname Segal

Name Brad

Affiliation Public Health Biomedical Informatics

Category Undergraduate

Title A comparison of predictive models for number of admissions and length of stay in a surgical unit of a South African Academic Hospital

Co-authors Klipin, Michael, Biomedical Informatics; Mare, Irma, Biomedical Informatics

Intro/Aim

In 2016, the Biomedical Informatics unit introduced an electronic surgical discharge summary system. This dataset has accrued thousands of patient records. This study aims to utilize the Charlotte Maxeke subset to produce predictive models for the number of patient admissions and their length of stay as well as to evaluate such models for their utility in clinical practice and for future advances to health informatic systems in South Africa.

60

Objective(s)

1. To construct and evaluate a model for the number of patient admissions to the surgical unit at Charlotte Maxeke 2. To construct and evaluate a model on patient lengths of stay utilizing classical statistical methods. 3. To develop and evaluate models of both number of admissions and lengths of stay utilizing machine as well as deep learning methods

Methods

1. The number of patient admissions will be modelled utilizing typical and Bayesian time series modelling. Accuracy will be evaluated through internal cross-validation and comparison to observed rates in 2019. 2. Length of stay will be predicted to differentiate patients staying more than five days. Variables will be selected through a genetic algorithm and utilized in generalized linear modelling. Coefficients will be transformed to odds ratios alongside p values and evaluated for their relevance to clinical practice. Accuracy will be evaluated through k-fold cross validation and a holdout sample. 3. Length of stay classification prediction will be repeated utilizing LASSO regression, support vector machines, random forest and deep learning and evaluated similarly.

Results Produced models were accurate and offered significant insight into admissions and length of stay

Discussion Model computation of a discharge summary dataset shows value in length of stay prediction and offers useful insight to clinical practice.

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Ref Number 148

Type Poster

Surname Simmons

Name Dina

Affiliation Orthopaedic Surgery, Paediatric


Title Appropriate Age of admission in a paediatric orthopaedic ward at a tertiary hospital

Co-authors Simmons, Dina, Robertson, Anthony, Paediatric Orthopaedics

Intro/Aim Changing admission policies in our hospital motivated an inquiry into the demographics of adolescent orthopaedic admissions. The age cut off needs to ensure optimal management for the unique requirements of adolescent patients.

Objective(s) We aimed to compare our policy to the national practices to deduce whether it is appropriate to reduce the age for transition from 16 to 14 years.

Methods

A retrospective audit over 30 months of patients aged 14 and older admitted to our ward was conducted to determine the spectrum of disease and treatment required. A survey of national paediatric orthopaedic admission practices and a literature review on appropriate age of transition was performed. No national standardised admission age exists for patients in the public sector in South Africa. Admission cutoffs vary from 12-16 years with concessions made to admit older patients with specific conditions.

Results

Our audit revealed total paediatric orthopaedic admissions of 2215 of which 158 fell between 14 and 16 year age group. The profile for this age group indicated 77 trauma related admissions, with 58% requiring paediatric specific management. Of the non-trauma admissions (45%) were general paediatric orthopaedic admissions. The remaining admissions fell under subspecialties. In total 117 admissions required specific paediatric orthopaedic management

Discussion

Decreasing the admission age to paediatric wards from 16 to 14 may negatively affect the management of these patients. They constitute a very small group when compared to the overall admission numbers and thus pose little burden in the paediatric ward. An individualised approach may be required to admission protocols.

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Ref Number 150

Type Poster

Surname Simmons

Name Dina

Affiliation Orthopaedic Surgery - Paediatrics


Title Patient based outcome after in situ percutaneous pinning for slipped upper femoral epiphysis (SUFE).

Co-authors Simmons, Dina, Robertson, Anthony, Orthopaedic Surgery - Paediatrics

Intro/Aim

Percutaneous in-situ fixation with a single screw is regarded as safe and remains the gold standard of treatment of SUFE. However, reliance is placed on subsequent remodelling of the femoral neck. Insufficient remodelling predisposes the patient to femoro-acetabular impingement and degenerative arthritis of the hip. Some surgeons advocate surgical hip dislocation and reduction of a severe acute SUFE

Objective(s) The aim of this study was to assess patient-based outcomes after in-situ pinning.

Methods

We studied a cohort of patients treated by in-situ pinning of a SUFE. Patients were identified from the surgical registers. They were all at least two years post-op. Outcome measures were a modified Harris Hip Score (HHS) and a Visual Analogue Score (VAS).

Results

Seventy-six SUFE patients were identified, 28 patients were available for follow-up. Two were excluded. Of the twenty-six patients included, 16 were male and 10 female. The mean age at surgery was 12.9 years. The mean follow-up was 3.3 years (2-7 years). Hips were classified into three groups; mild (13), moderate (12) and severe (11). There was a significant difference (p=0.003) between the three groups in terms of outcome. Mild and moderate slips had excellent outcome and severe slips had good results but with two complications (18%). The mean modified HHS for severe slips was 87.9 and mean VAS pain score was 2.36. The complication rate is 5.6%.

Discussion Our results suggest that in our population in situ percutaneous pinning is safe with low complication rates. High patient satisfaction suggests that remodelling is effective, even for severe slips.

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Ref Number 156

Type Poster

Surname Steyn

Name Maryna

Affiliation Anatomical Sciences


Title Patterning of fractures in a case of intimate partner homicide (IPH)

Co-authors Bacci Nicholas, School of Anatomical Sciences; Holland Shakeera, Department of Forensic Medicine

Intro/Aim A 1999 South African study found an intimate partner femicide rate of Â±8.8 per 100 000, which is amongst the highest worldwide. It is rare for such a case to present in a forensic anthropological setting.

Objective(s) The aim of this study is to demonstrate the patterns and repetitive nature of trauma in a case of IPH.

Methods The case is of a decomposed, middle-aged female victim who was found in a shallow grave. Standard, macroscopic methods of investigation were followed.

Results

A multitude of fractures were observed, including possible perimortem fractures to the face, many well-healed antemortem fractures and one recent, partially healed rib fracture. The healed fractures included three cranial vault fractures, repeated fractures through both maxillae, zygomae, the nasal aperture and orbits; a fracture of the

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mandible; fractures of the left scapula and clavicle; diaphyseal fractures of both humeri, right radius and ulna and the left fibula; three foot bone and several rib fractures. Most ribs were fractured with lower ribs demonstrating as many as six fractures. Several regions of additional bone growth, without fractures, were identified on the scapulae, humeri, os coxae and femorae which commonly result from healing soft tissue trauma. Possible perimortem trauma was observed in the right facial region. The injuries resulted from repetitive blunt force trauma.

Discussion Maxillofacial injuries as seen in this case are commonly present in intimate partner violence. This case of IPH is consistent with the victim sustaining chronic repeated blunt force injuries throughout her life, before ultimately succumbing to a violent death.

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Ref Number 158

Type Poster

Surname Strehlau

Name Renate

Affiliation Paediatrics and Child Health


Title Analytic Treatment Interruption Trial in Early-treated HIV-infected Infants

Co-authors

Kuhn, Louise, Department of Epidemiology, Columbia University. Shiau, Stephanie, Department of Epidemiology, Columbia University. Patel, Faeezah, Department of Paediatrics and Child Health, University of the Witwatersrand. Shen, Yanhan, Department of Epidemiology, Columbia University. Technau, Karl, Department of Paediatrics and Child Health, University of the Witwatersrand. Burke, Megan, Department of Paediatrics and Child Health, University of the Witwatersrand. Sherman, Gayle, Centre for HIV and STIs, National Institute for Communicable Diseases. Coovadia, Ashraf, Department of Paediatrics and Child Health, University of the Witwatersrand. Aldrovandi, Grace, University of California. Tsai, Wei-Yann, Department of Epidemiology, Columbia University. Tiemessen, Caroline, Centre for HIV and STIs, National Institute for Communicable Diseases. Abrams, Elaine J, Department of Epidemiology, Columbia University.

Intro/Aim Studies in adults and children suggest that starting antiretroviral therapy (ART) soon after infection positively influences early events in HIV infection raising the possibility of achieving remission.

Objective(s) To test the hypothesis that a sizable minority of HIV-infected neonates starting ART within 14 days of birth and maintained on ART for at least two years would maintain viral suppression when ART was withdrawn.

Methods

To yield the target cohort for the analytic treatment interruption (ATI) trial, 73 HIV-infected neonates identified at one hospital in Johannesburg, South Africa, were initiated on ART within 14 days of birth and maintained on ART tracking viral load (VL) decline and immune recovery. We describe the proportions a) attaining and sustaining VL <50 copies/ml by 48 weeks and b) sustaining CD4+ T-cell percentage >30%, which were the primary entry criteria for the ATI trial.

Results

Three HIV-infected infants (4.1%) died and nine (12.3%) were lost to follow-up before 48 weeks of age. Of those surviving, 52.5% attained and sustained VL <50 copies/ml and half of these sustained CD4+ T-cell percentage >30%. Proportions achieving ATI eligibility criteria were similar in the 46 infants starting ART <48 hours to 27 infants starting 2-14 days.

Discussion

Results suggest that very early ART on its own, using the regimens available at the time the trial was designed, is insufficient to attain the baseline criteria needed to justify our trial of ART interruption. Decisions about when to start ART should be based on considerations relating to maximizing adherence and ensuring long-term retention in care.

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Ref Number 159

Type Poster

Surname Subramanian

Name Kumar

Affiliation Internal Medicine, Oncology Division, School Clinical Medicine Department of


Title Effect of novel synthetic indoline derivatives on colorectal adenocarcinoma cell lines

Co-authors

Kandhavelu Jeyalakshmi1, Sandberg Ossi2, Ruff Paul1, Kandhavelu Meenakshisundaram2, Penny Clement1; 1 Oncology Division, Faculty of Health Sciences, University of the Witwatersrand, Parktown 2050, Johannesburg, South Africa; 2 Molecular Signalling Lab, Faculty of Medicine and Health Technology, BioMediTech, Tampere University and Tays Cancer Centre, P.O. Box 553, 33101 Tampere, Finland.

Intro/Aim

Colorectal cancer (CRC) is globally the most common cancer in men and women. The indole ring contained in both natural and synthetic compounds is an important chemical moiety with biological activities that confer anticancer properties against numerous cancers.

Objective(s) Here, the anti-cancer effect/s of synthesized novel Indoline derivatives (IDs) are evaluated in CRC cell lines and a mouse xenograft model.

Methods

In vitro cultures of HT29 and DLD1 CRC cell lines were treated with varying concentrations of the IDs to determine the IC50 values. Cell cycle (CC) and Reactive Oxygen Species (ROS) analyses were performed to evaluate the in vitro effects of lead IDs, using the Muse Cell Analyser. Alterations in oncogenic protein levels between treated and untreated cells were profiled using a focussed protein array panel. Finally, the effect of IDs was evaluated in a nude mouse xenograft model.

Results

CC analysis showed that treated HT29 cells were arrested in S-phase, while DLD1 cells were selectively arrested in both the S and G2/M phases. Intracellular ROS activity was induced in both cell lines. Further, CRC cell lines differentially expressed several oncogenic proteins after IDs treatment. In a nude mouse xenograft model, IDs reduced tumour size by some 50% (103 mm3), when compared with the control (203 mm3), after 9 weeks of treatment.

Discussion In conclusion, these novel IDs at micromolar concentrations, are able to induce CC arrest and impede cell proliferation to restrict tumour growth in CRC.

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Ref Number 160

Type Poster

Surname Subrayan

Name Marise

Affiliation Obstetrics & Gynaecology


Title Female Genital Mutilation: Knowledge, attitudes and beliefs of Obstetrics and Gynaecology doctors in South Africa

Co-authors Lombaard,Hendrick, University of Witwatersrand- O&G

Intro/Aim Female genital mutilation (FGM) is a dangerous cultural practice,that has become a domestic health issue due to mass migration to South Africa.

Objective(s) This study aims to assess the knowledge, attitudes and beliefs of FGM by Obstetrics and Gynaecology (O&G) doctors in South Africa.

64

Methods

A descriptive, cross-sectional study design was used. A self-administered, anonymous, online questionnaire assessing medical knowledge, attitudes and beliefs regarding FGM, was distributed to the members of the South African Society of Obstetricians and Gynaecologists (SASOG).

Results

51 participants completed the questionnaire. The majority of the doctors (78.4%) had a Knowledge Score of more than 50% (Knowledge Score higher than 26). Most doctors (60.8%) scored between 26 and 38. The median Knowledge Score was 33 (IQR: 26 - 37). There were significant associations between Knowledge Score and gender (p=0.02), prior training in FGM (p=0.002), prior training received by video/seminar/pamphlet (p=0.003) and prior management of a patient who had undergone FGM (p=0.04). While assessing attitudes and beliefs, common themes that emerged were: shock and anger, empathy and sadness, violation of human rights, sub-optimal training in FGM, concerns about obstetric complications and concerns for the patientâ€™s welfare. In gauging difficulties while managing FGM, common themes comprised of emotional and psychological trauma for doctors, difficulty in understanding cultural beliefs, difficulty in vaginal examinations and obstetric complications.

Discussion The majority of South African O&G doctors assessed have adequate FGM knowledge and experience comparable feelings and difficulties when managing patients that have undergone FGM.

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Ref Number 165

Type Poster

Surname Thom

Name Jamey

Affiliation Human Genetics, School of Pathology


Title Awareness of Genetic Counselling Services Amongst Allied-Healthcare Professionals

Co-authors Tabitha Haw, Department of Human Genetics

Intro/Aim

In South Africa, it has been reported that a minimum of 6.8% of births are affected by a congenital disorder and that of these 80.5% have a genetic or partially genetic cause. However, a large number of patients with genetic conditions are not being referred to genetic services. Individuals with genetic conditions often present with developmental delay, speech delay, feeding problems and low muscle tone and are frequently referred to allied-healthcare professionals for management. Therefore, the evaluation of referral patterns from allied-healthcare professionals may provide an opportunity to increase the number of referrals to genetic clinics. This has not yet been studied.

Objective(s)

This research aimed to determine whether allied-healthcare professionals are aware of genetic counselling services, whether they refer patients to genetic counselling and to identify inhibitors and facilitators that may prevent or promote referral to genetic services.

Methods Self-report questionnaires were administered to physiotherapists, occupational therapists and speech and language therapists based at three state hospitals in Johannesburg.

Results

Data was analysed quantitatively and revealed that allied-healthcare professionals acknowledge that patients would benefit from genetic services; however, referrals are limited by several factors. These factors included a lack of knowledge as to how to refer patients, limited knowledge about what genetic counsellors do and a lack of knowledge as to how to refer patients

Discussion The results of this research provided insight as to what interventions could be put in place to improve the genetics education of allied-healthcare professionals and ultimately how to improve the referral rate

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Ref Number 168

Type Poster

Surname Vangu

Name Mboyo

Affiliation Radiation sciences, Nuclear medicine


Title Imaging prostate cancer today: a case for the use of 99mTc-PSMA in clinical settings with constraint resources

Co-authors Tshisola Miji Kasapato Department of Surgery, Division of Urology, Thelle Mogoerane Hospital

Intro/Aim

Prostate cancer (Pca) remains the most common cancer in men. Imaging plays a crucial role in the management of these patients. Prostate specific membrane antigen (PSMA), a cell surface protein that is expressed in Pca, has been showing an increased interest as a promising target for both imaging and therapy

Objective(s) We compare PET/CT imaging with 68Ga-PSMA and 99mTc-PSMA imaging performed in the same patients

Methods

This is a prospective pilot study that selected consecutive newly diagnosed patients and histology was obtained in all of them with a Gleason score (GS). Imaging was done either the same day or with a difference of few weeks depending on logistics at the CMJAH. For 99MTc-PSMA imaging, participants underwent a whole body planar followed by SPECT and SPECT/CT of a region of interest. STATA package was used to measure difference and agreement. Permission was obtained from the Human Ethics Research Committee

Results

We enrolled 18 males aged between 54-80 years (median= 66.5, IQR: 63-70). A total of 26 sites of abnormal uptake were seen with 68Ga-PSMA and 17 sites with 99mTc-PSMA. Detailed analysis showed abnormal uptake in only 4 participants on 99mTc-PSMA planar imaging vs 12 with SPECT and SPECT/CT (p=0.004). The agreement between the 68Ga-PSMA and 99mTc-PSMA imaging was moderate with k=.57 (p=0.0036

Discussion The use of 99mTc-PSMA with SPECT/CT may improve the management of prostate cancer in geographic areas with limited resources

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Ref Number 169

Type Poster

Surname Whitehead

Name Alexis



Title The Burden of Tibial Diaphyseal Fractures at an Urban Academic Institution: Time Counts

Co-authors Du Plessis, J; Pietrzak, JRT; van Deventer, S; Robertson, A

Intro/Aim Approximately 26 tibial diaphyseal fractures occur per 100 000 population per year worldwide and represent a significant burden on theatre resources.

Objective(s) To evaluate this burden in terms of time taken for intramedullary nailing of a tibia fracture by registrars and medical officers on a dedicated orthopaedic trauma list.

Methods We conducted a retrospective chart review of all tibial diaphyseal fractures operated on at CMJAH from April 2016 to April 2018. All cases underwent intramedullary fixation. The operating time was deducted from the total theatre time to determine the

66

amount of time used for anaesthetic and set-up purposes.

Results

There were 2289 total orthopaedic trauma surgical procedures performed and intramedullary nailing of tibial fractures was the most common long bone trauma procedure done (n=238, 10.4%). A total of 169 tibial fractures in 165 patients were included (122 isolated, 43 polytrauma; 35 females, 130 males). There were 57% closed injuries (98) and 43% open fractures (71). The mean operating time was 88 minutes (45-210). The mean theatre time 149 minutes (80-260). The anaesthetic and setup time represented 41% of theatre time (mean 61 minutes, 15-140 minutes). Tibial nails done as isolated procedures were on average 17 minutes faster than those done as part of a polytrauma case (105, 60-135).

Discussion Intramedullary tibial nailing is a significant burden on trauma services. Non-operative tasks including set-up consume 41% of the time in the theatre. More judicious use of theatre time may expedite lists, save money and improve waiting lists.

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Ref Number 170

Type Poster

Surname Woods

Name Joana

Affiliation WHRI Ezintsha


Title A descriptive analysis of the role of a Whatsapp clinical discussion group as a forum for continuing medical education in the management of complicated HIV/TB clinical cases in a group of doctors in the Eastern Cape, South Africa

Co-authors Moorhouse, Michelle, Wits Health consortium, Ezintsha; Knight, Lucia, School of Public Health UWC

Intro/Aim

As South Africa’s HIV programme increases in size, HIV/TB cases occur that are often beyond the clinical scope of primary healthcare clinicians. In the EC, health facilities are geographically widespread, with a discrepancy in specialist availability outside of academic institutions. The aim of this study is to describe WhatsApp and its use as an alternative learning tool to improve clinician’s access to specialised management of complicated HIV/TB cases.

Objective(s) To analyse clinicians’ use of the WhatsApp chat group as a learning tool

Methods

An observational, cross-sectional study was conducted among a group of clinicians from the EC that formed part of a WhatsApp HIV/TB clinical discussion group. Data were collected using a structured anonymous Internet questionnaire and analysed with Epi Info, using descriptive and analytic statistics.

Results

The analysis found the majority of participants had gained new clinical confidence from group participation. This was associated with the increased group engagement in group follow-up (odds ratio [OR] 48.13 [95% confidence interval [CI] 4.99â€“464.49]); in posting questions (OR 3.81 [95% CI 1.02 - 18.48]); in reports of “new” clinical insights (OR 23.75 [95% CI 3.9 - 142.88]); in referencing old case material (OR 21.42 [95% CI 4.39 - 104.84]) and in the use of peer guidance to manage cases (OR 48.13 [95% CI 4.99 - 464.49]). However, there was a discrepancy in participant’s knowledge and actual use of informed consent when posting patient details on social media.

Discussion Our study findings support the use of WhatsApp in a medical setting as an effective means of communication, long distance learning and support between peers and specialists.

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Ref Number 171

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Type Poster

Surname Younus

Name Aftab



Title Lumbo-sacral tuberculosis of spine with long term impact on the Sagittal balance;

Co-authors Kelly, Adrian, Department of Orthopaedic / Helen Joseph Hospital / University of Witwatersrand, Aftab, Mohammad Hamza Sultan , Department of Orthopaedic, Chris Hani Baragwanath Hospital / University of Witwatersrand

Intro/Aim

Tuberculosis of the spine is one of the oldest diseases, known to Humankind. It was documented. According to an estimate, 1.5 million people died worldwide in 2014 due to tuberculosis. Another estimate 480,000 cases of multidrug-resistant tuberculosis (MDR-TB) in 2014. South Africa has the sixth-largest population in the world with tuberculosis. This is due to poor socio-economical condition and the high rate of human immune deficiency virus (HIV) prevalence in our population group. Lumbo-sacral tuberculosis accounts for 3% of spinal tuberculosis. It does affect the sagittal balance of the spine.

Objective(s) The objective of the study is to find out whether lumbosacral tuberculosis has a positive sagittal balance which leads to more severe backache, poor self-image and more severe neurology.

Methods

This study was done at Helen Joseph Hospital. We had 4382 patients with Pulmonary Tuberculosis from June 2015 to June 2017. We had 15 patients with Spinal tuberculosis which affect the lumbosacral junction. All of these patients presented to us with backache and pain on extension of the lumbar spine. Six of them presented to us with weakness in both legs. Eight complained of pain in the grain along with backache. All of these patients had a Blood test, chest X-ray, Lumboscrcal spine X-ray, CAT Scan and MRI Scan of the Spine. Pelvic incidence (PI) Pelvic tilt (PT) and sacral slope (SS) was measured. All of them were treated with anterior drainage of the psoas abscess. Six of them had anterior corpectomy and fusion of the L5/S1 level. Nine patients had posterior decompression and fusion of the L3/4 to L5/S1 level.

Results

We found that these patients with lumbosacral tuberculosis had positive sagittal balance. This leads to greater backache, lower physical function, Poor self-image and Poor social function. All these patients had improvement of neurology by one Frankel grade. The mean correction of Kyphosis was 10.85 degrees.

Discussion

The restoration of the different angle Pelvic incidence (PI), pelvic tilt (PT), Sacral Slop (SS) is paramount important. Posterior Surgery is preferred due to difficulty in accessing and instrumenting the anterior part of the spine. If you do not treat correctly Lumbosacral tuberculosis, then the patients will be in positive sagittal balance which may lead to persistent backache and poor quality of life.

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Ref Number 173

Type Poster

Surname Younus

Name Aftab



Title Assessment of Efficiency of the Easy Go spinal Endoscopic spine system. Is this easy go or not so easy go system.

Co-authors kelly, Adrain, Sekette, Allen, Aftab, Mohammad Hamza Sultan, Department of Orthopaedic / Helen Joseph Hospital

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Intro/Aim

With the advent of technology, endoscopic discectomy is becoming popular. The spine surgeon all over the world starts exploring this new technology. Although there are a steep learning curve and complication rate will be high in the early case. We assess the efficiency of new Easy-go endoscopic discectomy system by Karl storz. This system allows you to do discectomy thought 20 mm incision. Furthermore, we want to assess the clinical outcome, quality of life, neurological function and complications.

Objective(s) To evaluate the safety and efficacy of Easy-go endoscopic spine system in our patient population group.

Methods

We have 25 patients who have lumbar disc prolapse at a various level from 2017 to 2018. They were treated conservative for 3 to 6 months. Twenty of these Patient had neurology and reaming of had Sciatic. All of these patients had endoscopic discectomy by using Easy Go system. Two patient, we have to condemn the procedure and do open discectomy.

Results

These patients were followed up for one year. The technique problem and other clinical assessment were done. The duration of the operation was 2 to 3 hours. The author has difficulty in the initial case. The difficulties and complication which come across with this system are as followings. 1. Difficult to work through as 19 mm tube 2. Prolong operation time 3. Frequent fog and blood on the camera which requires frequent cleaning 4. Two patient had other complication, i.e, Dural tear, and nerve damage. 5. One patient developed a recurrence of disc prolapse in 6 monthsâ€™ time. However, the positive thing which we found about the system is following 1. Less bleeding 2. Less painkiller required by the patient 2. Early discharge from the hospital 3. Early return to work

Discussion

Lumbar endoscopic discectomy with Easy Go system (Storz) is not an easy system. First of all, itâ€™s work through a small size tubular retractor is difficult and technically demanding. In two patients we have nerve root damage and Dural tear. In two patients we have to condemn the procedure due to because of frequent fog and bleeding in the tubular retractor. There is a steep learning curve. Overall 72% of over patient was satisfied with the procedure. The complication are more than benefits.

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Ref Number 174

Type Poster

Surname Yudelowitz

Name Gregory



Title An audit of HIV Positive Patients Admitted to Helen Joseph Hospital in Johannesburg, South Africa

Co-authors Ive, Prudence, Division of Infectious Diseases, Department of Internal Medicine, Helen Joseph Hospital. Fox, Mathew, Department of Epidemiology and Global Health, Boston University

Intro/Aim

South Africa has the largest HIV population and the largest antiretroviral (ART) treatment programme in the world. There has been increasing access to ART in the last 15 years; with the current policy of universal test and treat regardless of CD4 cell count. Parts of the country are making promising progress toward the UNAIDS 90 90 90 targets but hospitals are still facing a large proportion of HIV positive admissions due to HIV related complications and treatment failure.

Objective(s) To determine the proportion of medical patients being admitted to medical wards that are HIV positive and to calculate the median CD4 count for these patients.

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Methods

Baseline admission data was collected from adult medical patients admitted to Helen Joseph Hospital, in Johannesburg, South Africa. Data collected included demographics, HIV status, baseline CD4 cell count and HIV viral load, ART history and reasons for admission

Results

42.4% of medical admissions were HIV positive. More than a quarter of HIV admissions were newly diagnosed on admission. 46.1 % of patients on treatment were failing ART. Over 10% of HIV patients had interrupted treatment with a similar number of patients not yet initiating treatment. Tb and Aids defining conditions accounted for more than 40% of reasons for admission.

Discussion

Large numbers of HIV patients are not accessing and disengaging from care having never started or interrupted therapy. This results in hospitals in the country suffering a large burden of disease from HIV related complications in an era of universal access to ART

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