Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients?

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

International Urogynecology Journal ◽

10.1007/s00192-017-3396-2 ◽

2017 ◽

Vol 29 (3) ◽

pp. 383-389

Author(s):

Thinagrin Dhasarathun Naidoo ◽

Jagidesa Moodley ◽

Saloshni Naidoo

Keyword(s):

South Africa ◽

Genital Tract ◽

Case Series ◽

Tertiary Centre ◽

Tract Fistula

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Editorial note

African Journal of Nephrology ◽

10.21804/20-1-2452 ◽

2017 ◽

Vol 20 (1) ◽

Author(s):

M Razeen Davids

Keyword(s):

South Africa ◽

Renal Allograft ◽

Kidney Injury ◽

Short Review ◽

Editorial Note ◽

Osseous Metaplasia ◽

Creatinine Ratio ◽

Technique Survival ◽

Tertiary Centre ◽

Rural Patients

Now that we have successfully migrated to our new online platform, AJN has taken the additional step of adopting a “publish-as-you-go” strategy. Articles will be published once they have been accepted and there will no longer be the usual wait until the next issue is published. New articles will be added throughout the year and will therefore be available to be read and cited much sooner. The latest articles which we are now publishing include a short review by Halperin on the assessment of the renal response in patients with potassium disorders. Halperin first gave us the well-known transtubular K+ gradient (TTKG) but in recent years has been recommending the use of the urine K+/creatinine ratio instead. In this article he explains the reasons for this change. Kapembwa et al. present their data on technique survival in patients on peritoneal dialysis (PD) at Tygerberg Hospital in Cape Town. Successfully maintaining patients on PD is especially important when a PD-first policy is being followed, as is the case at their centre. The issue of the access of rural patients with chronic kidney disease to healthcare is the topic of the paper by Singh et al., who report on referral patterns at a tertiary centre in Durban, South Africa. The paper by Camara et al., from the Free State province, South Africa, describes the outcomes of patients with acute kidney injury who needed continuous renal replacement therapy. In their cohort, patients with HIV infection were substantially younger and had a much worse outcome. Finally, the report by Makhoba et al. describes a case of osseous metaplasia in a renal allograft.

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Penicillin Allergy At A Tertiary Centre in Cape Town, South Africa

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2012.12.1282 ◽

2013 ◽

Vol 131 (2) ◽

pp. AB174

Author(s):

Tamara Kerbelker ◽

Michael E. Levin

Keyword(s):

South Africa ◽

Cape Town ◽

Penicillin Allergy ◽

Tertiary Centre

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A Three-year-old Boy With an Epinephrine Ampoule in the Stomach: A Case Report

Case Reports in Clinical Practice ◽

10.18502/crcp.v5i2.3839 ◽

2020 ◽

Author(s):

Armen Malekiantaghi ◽

Behzad Mohammadpour Ahranjan ◽

Kambiz Eftekhari

Keyword(s):

Case Report ◽

Emergency Room ◽

Foreign Bodies ◽

Pediatric Patients ◽

Pediatric Population ◽

Upper Endoscopy ◽

Asymptomatic Patients

Ingested Foreign Bodies (FB) frequently occur in pediatric patients. The most commonly ingested foreign bodies are coins, magnets, batteries, small toys, jewelry, buttons, and bonesin decreasing order of frequency. A three-year-old boy referred to the emergency room with incidental ingestion of an ampoule of epinephrine. The radiography data demonstrated thelocation of the ingested ampoule in the stomach. The upper endoscopy was performed; however, the object had already passed through the pylorus. The following day, he passed theampoule without complications. Our case was pretty unique because the most commonly ingested FBs in the pediatric population include coins followed by magnets, batteries, and soon. Asymptomatic patients having no dangerous FB could be observed until either presenting something abnormal or uneventfully passing the FB.

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The contemporary study of acute myocarditis in South Africa – CAMISA

European Heart Journal ◽

10.1093/eurheartj/ehab724.1747 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

K M Hassan ◽

C G Kyriakakis ◽

L H Joubert ◽

A F Doubell ◽

S D Zaharie ◽

...

Keyword(s):

South Africa ◽

Acute Myocarditis ◽

Standard Of Care ◽

Position Statement ◽

Human Bocavirus ◽

Median Viral Load ◽

Funding Sources ◽

Tertiary Centre ◽

Contemporary Study ◽

Developed World

Abstract Introduction The aetiology and estimated incidence of acute myocarditis (AM) remains undefined in Africa. Whilst cardiac magnetic resonance (CMR) provides for a provisional non-invasive diagnosis, endomyocardial biopsy (EMB), which is infrequently clinically sought, remains the gold standard. The developed world has experienced a shift in the viral epidemiology of AM and the ESC's most recent position statement on myocarditis recommends both CMR and EMB as the standard of care in suspected cases. We report on the interim results of the study. Purpose To determine the nature of presentation, underlying aetiology, and outcomes of patients presenting with AM to a single tertiary centre in South Africa. Methods A cohort of patients from a single tertiary centre in South Africa will be recruited from January 2018 to December 2022. All patients presenting or referred to the centre with clinically suspected AM that are investigated according to the ESC recommendations on myocarditis, which includes blood tests (CRP, hsTNT, HIV and Hepatitis C serology, ANA), a standard twelve-lead ECG, TTE, coronary angiography, CMR and EMB, will be included. Enrolment is ongoing. Results A total of 102 (mean age 42.2±13 years, 64.7% male) cases of clinically suspected AM were identified between January 2018 and January 2021. AM was confirmed in 41 (40.2%) cases on CMR only, while 41 (40.2%) were also confirmed on EMB. 4 cases of sarcoidosis, 1 case each of eosinophilic myocarditis, amyloidosis and primary cardiac lymphoma were diagnosed. Viral genome was isolated by PCR in 60 (59.8%) patients. PVB19 (73.5%) was the most commonly identified virus in those with confirmed AM followed by EBV (12.2%), HHV6 (4.1%) and Human Bocavirus (2%). 3 were coinfected with PVB19/EBV, and 1 with PVB19/EBV/HHV6. PVB19 was also isolated in 9 patients with no evidence of AM on CMR or EMB, but with lower median viral load compared to those with AM (198copies/ml IQR 113 – 282 vs 483copies/ml IQR 366 – 1460, p=0.005). The virus-positive patients with confirmed AM tended to be older (43.1±13.4 years vs 37.6±12.2 years, p=n/s), had higher median CRP (24mg/L vs 16mg/L, p=n/s) but lower median hsTnT (326.5ng/L vs 434.5ng/L, p=n/s) at presentation, and were more likely to be EMB positive (60% vs 37.5%, p=0.04) when compared to the virus-negative group. To date 6 patients have demised, of which 4 were related to AM. Conclusion To our knowledge, this is the first study to evaluate AM in Africa, and the biggest cohort of AM patients outside of the developed world. It demonstrates the heterogeneity in presentations and provides insight into the viral pathogens within our local setting, which appears similar to those reported in the developed world. We were also able to highlight some differences in demographic and clinical characteristics between those with virus-positive and virus-negative AM. The background prevalence and causal role of PVB19 in our setting will also need to be further explored. FUNDunding Acknowledgement Type of funding sources: None.

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Evaluation and Management of Post-caustic Stenosis

Revista de Chimie ◽

10.37358/3700 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3700-3702

Keyword(s):

Surgical Treatment ◽

Endoscopic Treatment ◽

Signs And Symptoms ◽

Esophageal Stenosis ◽

Caustic Ingestion ◽

Upper Endoscopy ◽

Endoscopic Dilation ◽

Scoring Method ◽

Caustic Stenosis

After caustic ingestion, patients may be either asymptomatic or may exhibit a variety of initial signs and symptoms, depending on the digestive segment predominantly affected. The DROOL system is a noninvasive scoring method used for the evaluation of esophageal lesions and has a good correlation with the development of esophageal stenosis. Management of these patients depends on several factors, including the presence of the symptomatology, in addition to the nature of the caustic substance. Upper endoscopy is indicated in the first 48 hours or after the first two weeks, when it is recommended to start endoscopic dilation sessions. If endoscopic treatment is inefficient, surgical treatment is required. Keywords: caustic ingestion, esophageal stenosis, esophageal bypass

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Evaluation and Management of Post-caustic Stenosis

Revista de Chimie ◽

10.37358/rc.19.10.7627 ◽

2019 ◽

Vol 70 (10) ◽

pp. 3700-3702

Author(s):

Rodica Daniela Birla ◽

Petre Angel Hoara ◽

Valeriu Gabi Dinca ◽

Silviu Constantinoiu

Keyword(s):

Surgical Treatment ◽

Endoscopic Treatment ◽

Signs And Symptoms ◽

Esophageal Stenosis ◽

Caustic Ingestion ◽

Upper Endoscopy ◽

Endoscopic Dilation ◽

Scoring Method ◽

Caustic Stenosis

After caustic ingestion, patients may be either asymptomatic or may exhibit a variety of initial signs and symptoms, depending on the digestive segment predominantly affected. The DROOL system is a noninvasive scoring method used for the evaluation of esophageal lesions and has a good correlation with the development of esophageal stenosis. Management of these patients depends on several factors, including the presence of the symptomatology, in addition to the nature of the caustic substance. Upper endoscopy is indicated in the first 48 hours or after the first two weeks, when it is recommended to start endoscopic dilation sessions. If endoscopic treatment is inefficient, surgical treatment is required.

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EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-6720201500s100012 ◽

2015 ◽

Vol 28 (suppl 1) ◽

pp. 39-42 ◽

Cited By ~ 4

Author(s):

Maurício Saab ASSEF ◽

Tiago Torres MELO ◽

Osvaldo ARAKI ◽

Fábio MARIONI

Keyword(s):

Bariatric Surgery ◽

Gastrointestinal Endoscopy ◽

Control Group ◽

Upper Gastrointestinal Endoscopy ◽

Upper Endoscopy ◽

Obese Patients ◽

Endoscopic Findings ◽

Asymptomatic Patients ◽

Significant Difference ◽

Upper Gastrointestinal

Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control group. Method: A series of 35 obese patients in preoperative period for bariatric surgery compared with a control group of 30 patients submitted to upper endoscopy. There were analyzed clinical and endoscopic data. Results: The mean age of the group of patients was 43.54 years. Most individuals in the group of patients were female with median BMI of 47.26kg/m2and in control group 24.21 kg/m2. The majority of patients were asymptomatic. Upper endoscopy was altered in 81.25% of asymptomatic patients. Endoscopic findings in the patient group were 57.1% resulting from peptic ulcer disease and 34.3% associated with GERD. The analysis of endoscopic findings in patients showed no significant difference in relation of the control group. The prevalence of H. pylori infection was 60% in patients. Conclusion: It is recommended that the upper endoscopy should be made in all patients in the preoperative bariatric surgery period, although the degree of obesity is not related to a greater number of endoscopic findings. Obese patients do not have more endoscopic findings that non-obese individuals.

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Thrombotic Thrombocytopenic Purpura (TTP) Management at Foothills Medical Centre: A Retrospective Analysis Between 2005-2010 (Tertiary Centre, Calgary)

Blood ◽

10.1182/blood.v126.23.4654.4654 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4654-4654

Author(s):

Gwynivere Davies ◽

Karen Valentine ◽

Zahra Goodarzi ◽

Farzana Sayani

Keyword(s):

Conflicts Of Interest ◽

Treatment Strategies ◽

Rare Condition ◽

First Episode ◽

Diagnostic Code ◽

Refractory Disease ◽

Clinical Practices ◽

Tertiary Centre ◽

Asymptomatic Patients ◽

Wide Range

Abstract TTP is a rare condition of microangiopathic hemolytic anemia and thrombocytopenia with a reported incidence of 4 cases per million people. Untreated mortality is reported to be as high as 90%; plasma exchange (PLEX) has significantly reduced this to 28%. Given the heterogeneity in presentation and severity at diagnosis, there is a wide range of practice with regards to exchanges, management of refractory disease and relapse. The British Committee for Standards in Hematology (BCSH) released clinical guidelines first in 2003, updated in 2012 outlining evidence based approach to practice. Our goal was to examine clinical practices and effect on outcomes at our tertiary centre during 2005-2010, between release of the first and second edition guidelines. Patients were retrospectively identified by searching for the TTP diagnostic code with admission dates between 2005-2010. They were excluded if they were not primarily treated in Calgary, or their thrombotic microangiopathy (TMA) was felt to be due to another diagnosis. Thirty eight patients were identified, with an average age of 48.8 years, and mostly female (men=8 patients, 21%). Ten patients were excluded for alternate diagnoses or main treatment outside Calgary. TTP was classified as primary in 15/45 (39%), and in 33 patients (87%) this was their first episode. Secondary causes included underlying autoimmune disease (24% of patients), malignancy (16% of patients), and pregnancy (4% of patients). 4% of patients were receiving active chemotherapy at the time of diagnosis of TTP. ADAMTS13 level and inhibitor (antibodies) were only examined in 10 cases (26%), and reported in fewer. Measurement of antigen, activity and inhibitors is strongly emphasized in the literature for accurate diagnosis of TTP compared with hemolytic uremic syndrome (HUS), other TMA or congenital TTP, and this was underutilized in this tertiary centre likely due to laboratory availability. Duration in hospital was often long, with an average of 29 days. This is likely due to the frequency of refractory disease, seen in more than half of patients (23/38, 61%). 24% of cases were fatal; this result is consistent with previously reported mortality rates in the era of PLEX. 5 of 9 fatalities were associated with malignancy where there is felt to be no benefit from PLEX, although interestingly 2 patients with malignancy received 5 to 7 days of PLEX, recovered and were discharged from hospital. Two fatalities had a delay of 48 hours or more to initiation of PLEX through misdiagnosis, one developed severe neurologic symptoms during line placement and the other presented atypically with hematuria. The most common complications of TTP included bleeding (16 patients, 42%), neurologic changes without stroke (16 patients, 42%), requirement for hemodialysis (9 patients, 24%), and radiologically identified stroke (6 patients, 16%). 35 patients (92%) received PLEX, and the average number of days on PLEX was 16. Twice daily exchange at initiation or exacerbation was common (29%), as were tapers (60%), although literature now suggests tapering does not reduce relapses. Steroids are recommended in most cases for immunosuppression; only 21 of our patients (55%) received these in hospital. Secondary immunosuppression was occasionally instituted in refractory or relapsing cases including cyclophosphamide (13 patients, 34%), rituximab (5 patients, 13%), mycophenolate mofetil and vincristine (1 patient each, 3%). Rituximab is now routinely used in initial treatment to decrease relapses, for refractory disease, and occasionally as prophylaxis with low ADAMTS13 in asymptomatic patients, and other agents generally recommended against given its efficacy and safety, but this was not standardized in our group. Limitations for this project include small patient numbers, the change in definitions of HUS, TMA and TTP over time, and the retrospective nature of patient selection and data collection. In summary, diagnostic and treatment strategies for TTP have become significantly more standardized in the past 10 years. A protocolized strategy for initial investigations, PLEX and immunosuppressive therapies in line with previously published guidelines would be useful in our institution, potentially reduce relapses and improve rapidity of patient response, however our mortality statistics appear similar to those previously published. Disclosures No relevant conflicts of interest to declare.

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