搜索结果：Journal of the colleges of medicine of South Africa

Diabetic ketoacidosis (DKA) is a common hyperglycaemic emergency in persons living with diabetes (PLWD), and outcomes of treatment depend on the precipitating factor. A cross-sectional prospective study of patients admitted in the adult high care unit of Nelson Mandela Central Hospital was carried out from 19 February 2022 to 19 January 2023. Patients were assessed for demographic, clinical profiles and outcomes concerning precipitating factors. The outcomes were duration of admission and discharge from the hospital as alive or dead. There were 55 PLWD, all black African, predominantly females, known with diabetes with a mean age of 38 ± 15.8 years. The main precipitants for DKA in descending order were infections (47%), treatment omission (30%) and a new diagnosis of diabetes (19%). The mean duration of admission for all patients was 8.2 ± 5.3 days. The length of hospital stay was 9.5 ± 5.2 days, 5.6 ± 2.2 days, and 8.6 ± 7.6 days, respectively (p = 0.118). The mortality in all patients was 9 (16.4%), and all but one death was associated with sepsis. There were no significant differences in the HbA1c among patients with infection (13.9 ± 3.8), those who omitted treatment (12.6 ± 4.7) and those newly diagnosed (12.2 ± 2.2) (p = 0.620). The high mortality rates in our DKA patients were mainly related to infections. The high HbA1c indicates poor glycaemic control preceding DKA. Improving glycaemic control, preventing infections, and early treatment of infections can reduce DKA-related mortality among patients. This study provides a comprehensive analysis of DKA in resource-limited settings, focusing on its precipitating factors, clinical profiles, and outcomes among adults in the Eastern Cape, South Africa. Infections were identified as the leading precipitant, with poor glycaemic control prevalent across all cases and a mortality rate of 16.4%, primarily due to sepsis. The findings highlight the urgent need for strategies to improve glycaemic control, prevent infections, and ensure timely interventions to reduce DKA-related mortality. This research aligns with the Journal of the Colleges of Medicine of South Africa's mission to advance clinical practice by addressing critical healthcare challenges in underserved communities, offering insights applicable across the region.

Clinical examination has long been central to diagnostic reasoning and to cultivating core professional attributes in internal medicine training; however, the relevance of clinical examination has been increasingly questioned in an era in which rapid access to specialised investigations is expanding. In the Eastern Metropole of Cape Town, the 'decentralisation' of specialised investigations, particularly radiological imaging and point-of-care ultrasound, has made these tools readily accessible at peripheral hospitals. While diagnostic efficiency has improved at peripheral centres, this improvement has occurred alongside a reduced emphasis on fundamental bedside skills among internal medicine registrars at the tertiary level. At our tertiary centre, the overburdened internal medicine admissions area leaves little time for detailed history taking or comprehensive physical examination. Consequently, investigations performed at referring centres often precede bedside assessment at our centre. This trend risks eroding the core competencies within internal medicine training, including diagnostic reasoning, observational proficiency and elements of the hidden curriculum such as communication, rapport-building and professionalism. In South Africa's resource-constrained environment, in which clinicians often confront advanced disease and complex pathology, the clinical examination remains indispensable. Training programmes should reaffirm the vital role of clinical examination, ensuring that registrars in internal medicine maintain mastery of bedside assessment, rather than relying on special investigations. The art of clinical examination remains fundamental to good medical practice and should be actively preserved within teaching hospitals.

Interventional radiology (IR) is a rapidly developing branch of medicine; however, the general awareness of the subspeciality among patients and medical colleagues is limited. Social media (SM) has become an integral part of information transfer globally, and its utility as an effective communication tool can be leveraged by IRs to bridge this knowledge gap. This study investigated the SM footprint of IR providers in South Africa. An online analysis of radiology practices (N = 100) registered on the Radiological Society of South Africa (RSSA) website was performed. The SM footprint of practices offering IR services was audited, and statistical analysis was performed to examine the level of SM uptake, the relationship between SM uptake in urban versus non-urban locations and between practice size. There were 38 practices offering IR services with 68% (n = 26) located in major metropolitan areas. A systematic online Google search revealed that 84% (n = 32) had a website and the most widely used SM platform was Facebook. There was a statistically significant correlation between the size of the radiology practices and the total number of SM accounts (p < 0.05). Most South African IR practitioners have a SM presence with larger radiology practices establishing a broad digital presence on SM. Poor SM visibility, particularly from smaller practices, on these platforms may limit their ability to reach their target audience. Improving the current usage of SM by IR practitioners may present an opportunity to display their services.

Family medicine (FM) is a clinical discipline that provides comprehensive, continuous, contextualised, first contact and person-centred health care. The practice of FM is not limited by the patient's age, gender or diagnosis, thus encompassing the broad scope of general medical practice. Given the current epidemiological landscape in South Africa, however, there is an increasing demand in primary healthcare spaces (district hospitals, community health centres, and clinics) for in-depth knowledge and advanced skills to respond to the burgeoning complex needs of the population. The potential benefits of FM subspecialty training in relevant areas are therefore significant, including broadening access to expertise and skills for patients and improving career pathing and job satisfaction for Family Physicians (FPs). Subspecialisation in FM can enhance the quality of clinical care by strengthening the district health system to deliver effectively on the nation's health priorities. Recognising this potential, the College of FPs (South Africa) set up a task team to explore subspecialisation in FM through a workshop at the 25th Annual South African Academy of FPs in August 2023. This report details the background, proceedings and significant findings of the workshop. It suggests a way forward, including a Delphi study to explore subspecialisation possibilities further and build consensus within the discipline and with other key stakeholders. This article reports on a national workshop convened by the College of FPs of South Africa to explore future subspecialisation pathways in FM. It represents an initial, exploratory phase of a broader research and policy development process rather than a hypothesis-driven empirical study. The purpose of sharing these findings is to document key deliberations, generate dialogue within the Colleges of Medicine, and inform the design of subsequent consensus-building steps, including a Delphi study.

Based on current evidence, the World Health Organization (WHO) recommends a restrictive approach to episiotomy, rather than routine performance, with a rate of between 5% and 10%. This study aimed to ascertain the rate and conformity to the restrictive patterns of episiotomy among women delivering at Mthatha Regional Hospital (MRH). A cross-sectional analytical study was conducted with 400 participants at MRH between January and June 2022. Demographic and obstetric data were collected and analysed using SPSS software. Continuous data were analysed using the student's t-test for normally distributed data and the Wilcoxon-Mann-Whitney U-test for skewed data, categorical data with the chi-square and Fisher's tests, and logistic regression for the independent predictors of episiotomy. A p-value < 0.05 was considered significant. The rate of episiotomy was 19% (74/400). The indications for episiotomy were macrosomia (8.1%), foetal distress during the second stage of labour (5.4%), delayed second stage of labour (5.4%), prolonged second stage (5.4%), previous C/S x2 in labour (2.7%), forceps delivery (2.7%) and tight perineum (1.3%); 74% (55/74) was undocumented. The factors associated with episiotomy were maternal age < 20 years (odds ratio [OR] 5.5, confidence interval [CI] 3.2-9.5) and primigravid status (OR 10.2, CI 5.2 - 19), p < 0.05. The rate of third-degree perineal tears among women without episiotomy was 0.3%. There were no fourth-degree tears. The practice of episiotomy at MRH exceeds the recommendation by the WHO. Young maternal age and primigravid women were risk factors for episiotomy. The low incidence of third- and fourth-degree tears among women without episiotomy reaffirms the advantages of a restrictive approach to the practice of episiotomy.

South Africa faces a shortage of anaesthetists, particularly in rural areas. The Diploma in Anaesthesia (DA) was created to address this gap, but its role may now serve as a preparatory step for specialist training. This study assessed DA graduates' career paths, perceived value of the diploma, geographical distribution and self-perceived clinical confidence. This cross-sectional study was conducted via virtual response to a questionnaire using Research Electronic Data Capture (REDCap&#xae;). Data were analysed using descriptive statistics. One hundred and ninety-two diplomates responded. Most DA candidates practised anaesthesia, with 44% working as DA anaesthetists and 41% pursuing the specialist route. Most candidates (60%) practised in urban areas, particularly in Gauteng (49%) and the Western Cape (17%). Eighty-six per cent of respondents viewed the DA as a step within the Fellowship of the College of Anaesthetists (FCA) curriculum. Most respondents felt the DA tested their competence (86.5%), safety (88%) and skills and knowledge (94.8%). Most diplomates practise within the urban setting, potentially limiting the diploma's value in enriching the quality of anaesthesia provided in rural areas. High perceptions of the DA's value in testing competence and safety suggest its continued relevance in anaesthesia training. The view that the DA is a preparatory step within the FCA process indicates a need for ongoing evaluation of the DA curriculum and its alignment with current workforce demands. This research will contribute to the optimisation of the DA, enhancing its utility for its intended purpose or improving its structure to better align with its current application.

Nyaope increasing use has become a major public health concern, not only because of its detrimental health effects but also because of its far-reaching social consequences. This situation has caused distress for families, communities and the users themselves, contributing to ongoing cycles of dependency and instability at the social, family and individual levels. The aim of this study is to explore the perspectives of users regarding the factors underlying their use of and dependency on nyaope. An exploratory descriptive qualitative design was employed. Data were gathered from 10 nyaope users through semi-structured interviews. Nyaope was widely and easily available, and purchases could be made with impunity. Factors such as peer pressure, boredom, poverty, unemployment and escapism all contributed to the initiation of nyaope use. Participants financed their habit through personal earnings, criminal activities and even support from family members. There was a pervasive sense of lawlessness associated with nyaope use, coupled with the stigmatisation and marginalisation of users by both their families and communities. Many users ultimately became part of a street-level nyaope brotherhood that perpetuated the use. Multisectoral and multifaceted interventions will be necessary to reduce the use of nyaope. Further research could quantify these factors and inform more effective prevention and treatment strategies. These findings, along with input from community and family members, provide a comprehensive understanding of the factors related to nyaope use.

Thyroid-associated ophthalmopathy (TAO) is a common and debilitating manifestation of Graves' disease (GD) associated with poor clinical outcomes including impaired quality-of-life (QoL) and socio-economic status. Data on TAO in Africa is scarce and unavailable in the South African population. This descriptive cross-sectional study focussed on GD patients attending the thyroid clinic at Groote Schuur Hospital, in Cape Town, South Africa. Participants were evaluated for TAO activity and severity according to the European Group on Graves' Orbitopathy (EUGOGO) criteria. Quality-of-life was assessed using the TED-QoL questionnaire. Thyroid-associated ophthalmopathy prevalence was 59.8%. The majority of TAO patients had mild disease (n = 73; 59.8%). Based on the severity score alone, moderate to severe disease (n = 41; 33.6%) and sight-threatening disease (n = 8; 6.6%) were identified and referred for further ophthalmological intervention. There was a statistically significant increase in the QoL score with an increase in the severity score (p < 0.05). The prevalence of orbitopathy was found to be higher than that reported from other continents, but our severity distribution was similar. This study emphasised the importance of evaluating severity as well as the psychosocial aspect of TAO to allow for the identification of and interdisciplinary management of patients to improve patient outcomes. This study was the first to attempt to determine the prevalence and severity of TAO in South Africa. The importance of early TAO detection using both, a clinical and psychosocial tool, is highlighted in this study to reduce the complications associated with TAO.

Economic evaluations of HIV pre-exposure prophylaxis (PrEP) and associated implementation strategies guide evidence-based policies, programmes and resource allocation. Since 2015, there has been an evolution in PrEP modalities, implementation strategies and prioritization of key populations with unmet HIV prevention needs, alongside the scale-up of other HIV prevention interventions. Our systematic review describes the evolving landscape of economic evaluations of PrEP to help identify evidence gaps relevant to the current HIV epidemic and response (PROSPERO: CRD42016038440). We searched five databases, without language restrictions, for peer-reviewed economic evaluations from inception to 21 August 2025. We describe the evolution of study characteristics over time, including the perspective of analysis, region, population, PrEP modality/implementation strategy and comparators. Of 5400 studies identified, 128 met inclusion criteria, of which 94 examined HIV epidemics in 2015 or later and 17 adopted a societal perspective. HIV epidemics studied primarily spanned countries in sub-Saharan Africa (N = 51) and in North America (N = 34). Modelled populations for receipt of PrEP primarily comprised: gay, bisexual and other men who have sex with men (N = 73), female sex workers (N = 26), serodifferent partnerships (N = 17) and persons who inject drugs (N = 12). Most evaluated oral, daily PrEP (N = 76), followed by long-acting injectable PrEP (N = 17), on-demand PrEP (N = 16) and others (e.g. vaginal ring, topical gel; N = 7). Twelve studies compared different PrEP modalities with each other. Five studies evaluated different implementation strategies to increase PrEP uptake, adherence and persistence. Of the 123 studies that compared PrEP to a combination of other HIV prevention interventions, only 31 scaled up at least part of the comparator over time. To support decision-making, future economic evaluations should consider costs and benefits beyond the health system (society) and consider comparators that better reflect the current HIV response across regions and populations. The increasing availability of novel PrEP modalities allows future studies to evaluate a mix of PrEP modalities and person-centred implementation strategies. The growing number of PrEP economic evaluations have not kept pace with emerging PrEP modalities or the current HIV epidemic/response, resulting in challenges in making evidence-based policies, programmes and resource allocation.

The Ahmed Glaucoma Valve (AGV) is a commonly used glaucoma drainage device (GDD) in the surgical management of glaucoma patients. Adjunctive mitomycin C (MMC) has demonstrated clear benefits in improving the surgical outcomes of trabeculectomy surgery. The effectiveness of MMC in improving the surgical outcomes of GDDs remains uncertain. This study seeks to compare the surgical outcomes of AGV implantation with and without the use of intraoperative MMC in an African cohort. This retrospective case series analysed 98 eyes in 95 patients who underwent AGV implantation from 01 January 2016 to 31 December 2021 at two units located in Cape Town, South Africa. The postoperative data collected included intraocular pressure (IOP), medication use, and complications. The eyes were categorised into the MMC use (n = 46) or non-MMC use (n = 52) group. In most eyes within the MMC use group (78.3%, n = 36), a concentration of 0.2 mg/mL was used. The mean preoperative IOP in the MMC group and the non-MMC group was 38 and 33, respectively (p = 0.12). At 1 year, the mean IOP in the MMC use group (n = 31) was 18 mmHg and 16 mmHg in the non-MMC group (n = 36) (p = 0.84). The frequency of complications and the hypertensive phase were comparable in the two groups. This study found no difference between the two groups in terms of IOP control, postoperative medication use, and complications. This may be attributed to the low concentration of MMC used in our cohort. This study provides insights into the role of MMC use in AGV implantation.

The College of Medicine South Africa (CMSA) has embarked on developing Entrustable Professional Activities (EPAs) for workplace-based training. There is currently limited guidance for developing EPAs in Chemical Pathology. This report explores factors that impact EPA development in Chemical Pathology, derived from health education theory and evidence, as well as relevant contextual variables impacting registrar training in South Africa. We discuss four factors to consider during the elaboration of EPAs for South African registrars in Chemical Pathology to enhance fitness for workplace-based assessment. Firstly, EPAs require the application of constructive alignment to link the national syllabus, core competencies and milestones, training methods, and formative assessment strategies during the trainee learning trajectory. Secondly, the elaboration of a complete EPA is assisted by utilising a standardised template with defined sectional headings and contents structured for laboratory medicine. Thirdly, quality assurance of draft EPAs requires validation to improve curriculum alignment, and facilitate EPA revision. Finally, a critical emergent issue for Chemical Pathology workplace-based training is the development of standardised learning opportunities for operationalising a national EPA programme. Charting the early steps in developing EPAs for training Chemical Pathology registrars in South Africa identifies the application of the educational tenet of constructive alignment, utilising a standardised template for EPA design, validating draft EPAs and creating equitable learning opportunities for all trainees.

Low-flow anaesthesia (LFA) is crucial in combating rising healthcare costs and the global threat of climate change. This study analysed the conduct of inhalational anaesthesia at a Johannesburg Academic Hospital to determine fresh gas flows (FGF) and liquid agent consumption (LAC) at various stages of anaesthesia. A prospective, contextual research design was followed. Purposive sampling method was used in 10 theatres equipped with Maquet Flow-i&#xae; anaesthetic machines. Calculated LAC values were compared to those measured by the anaesthetic machines. The average FGF during induction, maintenance and time-weighted case average were 7.07 L/min, 1.41 L/min and 1.73 L/min, respectively. The average end-tidal sevoflurane concentration during maintenance was 2.40%. The calculated average LAC for induction, maintenance and total case were 7.74 mL, 28.01 mL and 36.84 mL, respectively, while the hourly LAC was 16.71 mL/h. The calculated case average LAC overestimated the measured values by 4.14 &#xb1; 4.86 mL (12.98%), with 98.5% of values being within &#xb1; 1.96 standard deviation (s.d.). Despite its brevity, the induction phase accounted for 21% of the calculated LAC. The calculated liquid agent expenditure over time was ZAR54.32 &#xb1; 23.55/h. Case average FGF had a very high positive correlation with the calculated cost of sevoflurane, r = 0.86, p < 0.001. This study demonstrated that the prevailing use of medium-flow anaesthesia among anaesthetists at our institution resulted in significant sevoflurane wastage, increased expenditure and environmental pollution. The study provides insight into anaesthesia practices at an academic hospital. It highlights the need to implement policies to standardise LFA as a cost-saving and environmentally friendly strategy.

Little is known about the impact of coronavirus disease 2019 (COVID-19) on South African interventional radiology (IR) services. This study aimed to assess the influence of COVID-19 on IR procedures at a tertiary-level public sector South African (SA) hospital. A retrospective audit of IR procedures over three 9-week periods in 2020: Period (1) pre-strict lockdown (23 January-25 March), period (2) strict lockdown (26 March-27 May) and period (3) post-strict lockdown (28 May-30 June). Data were captured and stratified by patient demographics, procedure indication, nature (vascular or non-vascular), time (normal or after-hours) and location (IR suite or ward). Calculated incidence rates of categories per period were performed and then compared between the three periods. There were 288, 218 and 204 procedures performed in periods 1, 2 and 3, respectively, with no significant proportional variation in gender, age, after-hours or ward procedures across the periods. During period 2, the overall (n = 218, p = 0.002), non-vascular (n = 148, p = 0.001) and vascular procedures (n = 70, p = 0.999) decreased by 24.3%, 29.8% and 9.1%, respectively. During period 3, the overall (n = 204, p = 0.496) and non-vascular (n = 122, p = 0.590) procedures declined by a further 6.4% and 17.6%, respectively, while vascular procedures (n = 82, p = 0.410) increased by 17.1%. In period 3, the overall (n = 204, p = 0.001) and non-vascular procedures (n = 122, p &#x2264; 0.001) were 29.1% and 42.2% lower than period 1 levels, whereas vascular procedures (n = 82, p &#x2265; 0.999) demonstrated the so-called 'rebound phenomenon', exceeding period 1 by 6.5%. COVID-19 pandemic impacted non-vascular and vascular IR procedures with variable difference between periods of strict lockdown and post-strict lockown. This affords a perspective on the emerging role of IR in health systems across the African continent. This study provides unique insights into the impact of COVID-19 on SA IR services.

Medical doctor training has largely retained the historical context of biased resource allocation. However, lately, new medical schools have been added to the lot. The University of Limpopo Medical School was established in 2016. Although successful with undergraduate training, to date, the latter struggles with both recruitment and retention of specialist staff numbers for accreditation purposes. The private sector (hospitals and staff) potentially has the resources and human capital to aid in addressing the skills shortage that exists in the province and the university. This review aims to assess the available literature and evidence that supports the role that private doctors and hospitals can play in undergraduate and postgraduate medical teaching and training. A narrative review of the literature was conducted to peruse evidence on the status of private-public partnerships in medical teaching and training. There is growing evidence for private sector teaching both locally and internationally. The government, regulators and end-users seem aligned on private sector involvement in medical training. The medical teaching and training landscape is changing with demands for innovative solutions. Infrastructure, legislation and end-users may be poised for the implementation of the private hospital, university-led health sciences teaching and training (PHUHSTT) programmes. The evidence, therefore, exists as a foundation for further engagement and possible implementation of the latter. Our proposal is not a silver bullet, but a recommendation for tackling the current state of affairs in relation to challenges in medical teaching and training at the University of Limpopo (UL).

Illegible handwritten patient records pose a significant threat to clinical accountability and legal integrity in South Africa's healthcare system. Despite clear guidelines from the Health Professions Council of South Africa (HPCSA), poor documentation remains widespread, particularly in public sector facilities. A black-letter doctrinal analysis was conducted of South African law (Medicines and Related Substances Act General Regulations, HPCSA Booklet 9, and the National Health Act) and the evidentiary treatment of clinical records in case law. A focused comparative reference to a 2025 Punjab & Haryana High Court judgement was used to contextualise the normative stakes of legibility in another common-law system. South African primary law already requires legible prescriptions and legible, understandable clinical records; courts treat hospital notes as hearsay unless properly admitted, with clarity impacting the weight accorded to such documentation. The Indian judgement constitutionally frames legibility as part of the right to health and mandates interim capital-letter prescriptions pending digitisation. Clear documentation is essential for justice, safety and the dignity of patients. The article calls for curriculum reform, digitisation, policy enforcement and legal recognition of legibility as a component of the right to access healthcare. This article may assist legal and medical professionals in recognising legibility as a constitutional obligation, thereby strengthening medico-legal accountability and promoting patient-centred care.

Cognitive errors in anaesthesia may contribute significantly to medical error in the perioperative environment, but few studies have been conducted in this area. The framing effect is a cognitive bias that occurs when a problem is presented in different ways, potentially leading to changes in clinical decision-making. The authors conducted a single-centre, prospective, randomised, double-blinded study with the aim of determining the impact of the framing effect in medical officers who have recently passed their Diploma in Anaesthesia examination in the Pietermaritzburg Anaesthetic Department. All participants underwent the same simulated emergency scenario related to high airway pressures (because of a bronchial plug) in a ventilated patient under anaesthesia. Participants were allocated either to a control group (receiving a neutral handover) or to an experiment group (receiving a handover that included additional information relating to asthma). The authors also collected quantitative data related to clinical performance and qualitative data related to participants' experience of the scenario. The study included a total of 34 medical officers, with 17 in each group. There was no difference in median times to diagnosis (control group 240 [interquartile range {IQR} 195-240] vs experimental group 240 [IQR 162-240] s; z = -0.433, p = 0.6648). There were no differences in secondary outcomes. Participants reported a positive learning experience that may influence future training methods. The study was unable to demonstrate objective evidence for the framing effect in this simulation study. Future studies can use these findings to perform sample size calculations for larger studies to investigate this important area. This study offers insight into the relationship between cognitive bias and clinical decision-making within anaesthesia simulation training. The findings contribute to a better understanding of how framing effects may influence trainee responses in simulated clinical scenarios. This work aligns with the JCMSA's focus on medical education and training.

Retinopathy of prematurity (ROP) is a potentially blinding disorder. South Africa (SA) has national ROP screening guidelines to aid the timely diagnosis of infants requiring treatment. Several tertiary units in SA have published data on the prevalence of ROP; however, data from some provinces are lacking. An audit of ROP screening programmes, especially in these areas, is important to determine the ROP prevalence and whether screening is based on the national criteria. This retrospective audit included infants screened between 01 January 2019 and 30 June 2021 at a single tertiary unit in the Limpopo province, SA. The following criteria were used to identify eligible infants: birth weight (BW) < 1500 g or gestational age (GA) < 32 weeks. A total of 203 infants were screened. The mean BW and GA were 1250 grams (s.d. 239.0) and 30.4 weeks (s.d. 2.43), respectively. Nine (4.4%) infants were diagnosed with ROP and 2 (1.0%) infants required treatment. Most (95.1%,193) infants met the screening criteria. Screening was completed in 158 (77.8%) infants and 44 (22.0%) were lost to follow-up (LTFU). Although eligible infants were identified based on the national criteria, a low prevalence of ROP was found among screened infants. This is likely because of lack of screening, late screening and high LTFU. This study shows the value and importance of auditing ROP screening programmes even in countries with national screening guidelines to identify areas for improvement.

Pregnancy-related sepsis contributes significantly to maternal mortality. While there is substantial information on postpartum hysterectomy, information on outcomes of hysterectomy as source control for puerperal sepsis is limited. Knowledge of the common causative organisms and their antimicrobial sensitivity may assist with targeted antibiotic therapy to improve patient outcomes. This study described the indications and outcomes of surgery in patients following hysterectomy as source control for puerperal sepsis. In a retrospective study, we analysed the intra-operative and histological findings and the results of microbial culture and antibiotic sensitivity of women who underwent a hysterectomy for puerperal sepsis at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, from January 2019 to December 2019. Twenty-nine (88%) of the 33 women with hysterectomy for puerperal sepsis studied had a caesarean section (CS), 14 (48%) of whom had a CS performed for foetal distress. Eight of these 33 women (24%) had hypertensive-related disorders. The most common organisms cultured in the intra-abdominal fluid were Acinetobacter baumannii (n = 11, 26%), E. coli (n = 8, 19%), Klebsiella species (n = 6, 14%) and Enterococcus faecalis (n = 6, 14%) of a total of 42 organisms were identified from all sites. Puerperal sepsis was confirmed in 28 (85%) of the uterine histology samples, with a mortality rate of 6% in this study. Hysterectomy for puerperal sepsis was most frequently associated with CS, with hypertensive-related disorders the most common indication. Histological confirmation of sepsis is required, as the histological findings differed by 15% with surgical diagnosis. A. baumannii was the most common species isolated as the cause of infection.

Renal hyperparathyroidism is a frequent complication among patients with kidney failure. Data on outcomes following parathyroidectomy in patients undergoing kidney replacement therapy (KRT) remain limited in South Africa (SA). This study aimed to assess postoperative surgical and biochemical complication rates and disease recurrence. We conducted a retrospective cohort study of adult KRT patients who underwent parathyroidectomy for renal hyperparathyroidism at Tygerberg Hospital over 7 years. Kaplan-Meier and univariate logistic regression analyses were used to determine predictors of recurrence. Forty-six patients underwent parathyroidectomy. Two-thirds were female with a mean age of 40.7 &#xb1; 8.50 years. Preoperative serum calcium and parathyroid hormone (PTH) concentrations were 2.41 &#xb1; 0.27 mmol/L and 176.7 (interquartile range [IQR] 124.4-245.1) pmol/L, respectively. Most patients (80%) underwent subtotal parathyroidectomy. The most common postoperative complication was hungry bone syndrome (HBS), which occurred in 98% of patients, and the postoperative total calcium concentration was 1.63 &#xb1; 0.28 mmol/L, observed on day 4 or later. Overall, recurrence of renal hyperparathyroidism occurred in 15% of patients. There were no predictors of recurrence on univariate logistic regression. A lower recurrence rate was observed in total parathyroidectomy and a lower hypoparathyroidism rate in subtotal parathyroidectomy (SPTX). Hungry bone syndrome was found to be the most frequent postoperative complication, reflecting more advanced disease at the time of surgery. In the future, the focus at Tygerberg Hospital should be on earlier surgical referral considering our limited medical options, and the decision-making regarding the surgical procedure should be discussed in a multidisciplinary team, with a focus on individualised priorities.