Genital tract fistula: a case series from a tertiary centre in South Africa

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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Identification and preservation of External Branch of the Superior Laryngeal Nerve during thyroid surgeries at NMCTH

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v13i3.18099 ◽

2017 ◽

Vol 13 (3) ◽

pp. 306-310 ◽

Cited By ~ 1

Author(s):

Rupesh Raj Joshi ◽

Anupama Shah Rijal ◽

Kundhan Kumar Shrestha ◽

Anup Dhungana ◽

Shova Maharjan

Keyword(s):

Case Series ◽

Superior Laryngeal Nerve ◽

Thyroid Neoplasms ◽

Laryngeal Nerve ◽

Type I ◽

Tertiary Centre ◽

External Branch ◽

Common Diagnosis ◽

Recurrent Laryngeal Nerves ◽

Nerve Identification

Background & Objectives:The most common reason for thyroid surgery is the presence of benign or malignant nodules. Subjective voice disturbance after thyroidectomy is very common, even without injury to the recurrent laryngeal nerves. One possible cause for postoperative dysphonia is injury to the External branch of superior laryngeal nerve (EBSLN). Cernea classification, which we followed in this study, is one of the most popular worldwide classifications of the EBSLN. The study was conducted with objectives to identify and classify EBSLN according to Cernia classification in Nepalese population and help surgeons understand the anatomy of the EBSLN and to preserve the nerve during thyroidectomy. Materials & Methods:A prospective observational case series of seventy-nine patients, who were diagnosed with thyroid neoplasms and underwent thyroid surgeries at the tertiary centre of Kathmandu between 1st January 2015 to 31st December 2016. All procedures were performed by transverse collar incision. We classified the anatomy of the EBSLN using Cernea classification. Results:There were total of 79 patients. Most common diagnosis and surgery were colloid goitre and hemithyroidectomies respectively. A total of 94 EBSLNs were evaluated. Cernia Type I was observed in 27.66%, type IIa in 46.80%, and type IIb in 14.89%. Incidences of types IIa and IIb, which put patients at greater risk for intra-operative injury, were observed in 61.69% in our study. The nerve could not be identified in 10.64%. Conclusion:It is possible to increase the rate of nerve identification and avoid the nerve injury even in the absence of sophisticated equipment.

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“Mummy, my eyelids are heavy”: A case series of juvenile myasthenia gravis

European Journal of Ophthalmology ◽

10.1177/1120672119867605 ◽

2019 ◽

pp. 112067211986760

Author(s):

Logeswari Krishna ◽

Nor Fadzillah Abdul Jalil ◽

Pooi Wah Lott ◽

Sujaya Singh ◽

May May Choo

Keyword(s):

Myasthenia Gravis ◽

Case Series ◽

Tertiary Centre ◽

Ocular Symptoms ◽

Ocular Myasthenia Gravis ◽

Life Threatening ◽

Receptor Antibodies ◽

Juvenile Myasthenia Gravis ◽

Anti Acetylcholine ◽

Second Twin

Purpose: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation. Method: A case series. Results: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis. Conclusion: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

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Aetiology, Clinical Presentation, and Outcome of Meningitis in Patients Coinfected with Human Immunodeficiency Virus and Tuberculosis

AIDS Research and Treatment ◽

10.1155/2011/180352 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Smita Bhagwan ◽

Kogieleum Naidoo

Keyword(s):

South Africa ◽

Human Immunodeficiency Virus ◽

Tuberculous Meningitis ◽

Clinical Presentation ◽

Case Series ◽

Antituberculous Therapy ◽

Endemic Region ◽

Neck Stiffness ◽

Immunodeficiency Virus ◽

Poor Outcomes

We conducted a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis. In an HIV TB endemic region we identified cryptococcus followed by tuberculosis as the leading causes of meningitis. We highlight the occurrence of tuberculous meningitis in patients already receiving antituberculous therapy. The development of meningitis heralded poor outcomes, high mortality, and relapsing meningitis despite ART.

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A high burden of asymptomatic genital tract infections undermines the syndromic management approach among adolescents and young adults in South Africa: implications for HIV prevention efforts

BMC Infectious Diseases ◽

10.1186/s12879-018-3380-6 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 19

Author(s):

Angela Kaida ◽

Janan J. Dietrich ◽

Fatima Laher ◽

Mags Beksinska ◽

Manjeetha Jaggernath ◽

...

Keyword(s):

South Africa ◽

Young Adults ◽

Hiv Prevention ◽

Genital Tract ◽

Adolescents And Young Adults ◽

Management Approach ◽

Syndromic Management ◽

High Burden ◽

Genital Tract Infections ◽

Tract Infections

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Prevalence of female genital tract tuberculosis in suspected cases attending Gynecology OPD at tertiary centre by various diagnostic methods and comparative analysis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192419 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2286

Author(s):

Diksha Sharma ◽

Anju Depan ◽

Kanti Yadav ◽

Suchitra Narayan ◽

Anubhav Sharma

Keyword(s):

Genital Tract ◽

Female Genital Tract ◽

Culture Method ◽

Diagnostic Methods ◽

P Value ◽

Genital Tuberculosis ◽

Diagnostic Modality ◽

Tertiary Centre ◽

Tb Pcr ◽

Female Genital

Background: The genital tract tuberculosis is one of the most common causes of tubal factor infertility. This study was conducted to compare the results of different diagnostic methods used in screening for female genital tuberculosis in suspected cases attending Gynecology OPD at RMC, Ajmer.Methods: This prospective study was conducted in department of obstetrics and gynecology, J. L. N. Medical College, Ajmer, Rajasthan, for studying incidence of genital tuberculosis by various diagnostic methods (viz. AFB smear examination, AFB Lowenstein Jensen culture method, TB-PCR and CBNAAT).Results: Prevalence of genital TB was 5.5% in study population of 200 selected women meting the inclusion criteria. 72% women were in between 20-30 years age group. Oligomenorrhoea (24%) was found to be significant symptom with P value of <0.05. TBPCR and CBNAAT were found to be statistically significant with P value of <0.001 for diagnosing FGTTB.Conclusions: We concluded that genital tuberculosis is paucibacillary disease, TBPCR and CBNAAT appears to be rapid and sensitive diagnostic modality.

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Molecular characterisation of Mycoplasma species isolated from the genital tract of Dorper sheep in South Africa

Journal of the South African Veterinary Association ◽

10.4102/jsava.v86i1.1199 ◽

2015 ◽

Vol 86 (1) ◽

Cited By ~ 2

Author(s):

Habu A. Kalshingi ◽

Anna-Mari Bosman ◽

Johan Gouws ◽

Moritz Van Vuuren

Keyword(s):

South Africa ◽

Genital Tract ◽

The United States ◽

Mycoplasma Species ◽

Local Alignment ◽

Large Colony ◽

Mycoplasma Mycoides ◽

Search Tool ◽

Dorper Sheep ◽

Arcanobacterium Pyogenes

Biochemical and molecular analysis were conducted on 34 strains of Mycoplasma species isolated between 2003 and 2009 from the genital tract of clinically healthy Dorper sheep and sheep with ulcerative vulvitis and balanitis. Earlier publications identified the causative agent as Mycoplasma mycoides mycoides large colony (MmmLC) and Arcanobacterium pyogenes. The aims of the study were to characterise Mycoplasma species isolated from the genital tract of Dorper sheep with polymerase chain reaction assay, cloning and gene sequencing. Basic Local Alignment Search Tool (BLAST) results revealed six predominant Mycoplasma species: Mycoplasma arginini, Mycoplasma bovigenitalium, Arcanobacterium laidlawii, MmmLC, Mycoplasma sp. ovine/caprine serogroup II and M. canadense. Sequencing of the 34 isolates were analysed using phylogenetic methods, and 18 (50%) were identified as M. arginini with 99% – 100% similarity to M. arginini from England and Sweden. Six isolates showed 99% similarity to M. bovigenitalium strains from Turkey and Germany. Two isolates had 99% similarity to an M. sp. ovine/caprine sero group II from the United Kingdom. BLAST for two isolates revealed 99% similarity to Acholeplasma laidlawii from India, another two were 99% similar to MmmLC strain from Sweden, two showed 98% similarity to Mycoplasma sp. Usp 120 from Brazil, and two isolates have a 97% – 99% similarity to M. mm. Jcv1 strain from the United States of America. Finally, one isolate showed similarity of 99% to Mycoplasma canadense strain from Italy. The findings support the hypothesis that ulcerative vulvitis and balanitis of Dorper sheep in South Africa (SA) is a multifactorial disease with involvement of different Mycoplasma species.

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Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2019-000423 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000423 ◽

Cited By ~ 6

Author(s):

Guy Simon Negretti ◽

WengOnn Chan ◽

Carlos Pavesio ◽

Mahiul Muhammed Khan Muqit

Keyword(s):

Case Series ◽

Vitreoretinal Surgery ◽

Endogenous Endophthalmitis ◽

Final Visit ◽

Retrospective Case ◽

Tertiary Centre ◽

Early Vitrectomy ◽

Exogenous Endophthalmitis ◽

Vitrectomy Surgery

Background/AimsTo analyse the complications and outcomes of vitrectomy surgery for endophthalmitis.MethodsThis was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications.Results33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%).ConclusionVitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.

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