A Retrospective Audit of Single Versus Multigland Disease in Primary Hyperparathyroidism at a Single Centre in South Africa

Background: The performance of laboratories can be objectively assessed using the overall turn-around time (TAT). However, TAT is defined differently by the laboratory and clinicians; therefore, it is important to determine the contribution of all the different components making up the laboratory test cycle.Objective: We carried out a retrospective analysis of the TAT of full blood count tests requested from the haematology outpatient department at Tygerberg Academic Hospital in Cape Town, South Africa, with an aim to assess laboratory performance and to identify critical steps influencing TAT.Methods: A retrospective audit was carried out, focused on the full blood count tests from the haematology outpatient department within a period of 3 months between 01 February and 30 April 2018. Data was extracted from the National Health Laboratory Service laboratory information system. The time intervals of all the phases of the test cycle were determined and total TAT and within-laboratory (intra-lab) TAT were calculated.Results: A total of 1176 tests were analysed. The total TAT median was 275 (interquartile range [IQR] 200.0–1537.7) min with the most prolonged phase being from authorisation to review by clinicians (median 114 min; IQR: 37.0–1338.5 min). The median intra-lab TAT was 55 (IQR 40–81) min and 90% of the samples were processed in the laboratory within 134 min of registration.Conclusion: Our findings showed that the intra-lab TAT was within the set internal benchmark of 3 h. Operational phases that were independent of the laboratory processes contributed the most to total TAT.

Download Full-text

Primary repair of duodenal injuries: a retrospective cohort study from a major trauma centre in South Africa

Scandinavian Journal of Surgery ◽

10.1177/1457496918822620 ◽

2019 ◽

Vol 108 (4) ◽

pp. 280-284 ◽

Cited By ~ 1

Author(s):

R. D. Weale ◽

V. Y. Kong ◽

W. Bekker ◽

J. L. Bruce ◽

G. V. Oosthuizen ◽

...

Keyword(s):

South Africa ◽

Primary Repair ◽

Significant Risk ◽

Trauma Centre ◽

Duodenal Injury ◽

Trauma Service ◽

Retrospective Audit ◽

Major Trauma Centre ◽

Significant Difference ◽

Duodenal Injuries

Background and Aims:The management of duodenal trauma remains controversial. This retrospective audit of a prospectively maintained database was intended to clarify the operative management of duodenal injury at our institution and to assess the risk factors for leak following primary duodenal repair.Materials and Methods:This was a retrospective study undertaken at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa. Operative techniques used for duodenal repair were recorded. Our primary outcome was duodenal leak in the postoperative period. Patients from January 2012 to December 2016 were included. All duodenal injuries were graded according to the American Association for the Surgery of Trauma (AAST) grading. Only patients who had a primary repair were included in the final analysis.Results:During the five-year data collection period, a total of 562 patients underwent a trauma laparotomy; of which 94 patients sustained a duodenal injury. A primary pyloric exclusion and gastro-jejunostomy (PEG) was performed in three patients. These three were then excluded from further analysis. Of the 91 primary duodenal repairs, seven (8%) subsequently leaked. These were managed by PEG in three and by secondary repair and para-duodenal drainage in four. The two physiological parameters most associated with subsequent leak were lactate and pH level. There was a significantly higher mortality rate for those who leaked vs those who did not leak. Chi-squared test revealed a significant difference in the leak rate between AAST I (0%), AAST-II (1.6%) and AAST-3 (66.7%) grade injuries (p <0.01).Conclusion:The trend towards primary repair of duodenal injuries appears to be justified. However duodenal leak remains a significant risk in certain high risk patients and strategies to manage injuries in this subset requires further work.

Download Full-text

The effects of add-on corticosteroids on renal outcomes in patients with biopsy proven HIV associated nephropathy: a single centre study from South Africa

BMC Nephrology ◽

10.1186/s12882-019-1208-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Nicola Wearne ◽

Charles R. Swanepoel ◽

Maureen S. Duffield ◽

Bianca J. Davidson ◽

Kathryn Manning ◽

...

Keyword(s):

South Africa ◽

Single Centre ◽

Centre Study ◽

Renal Outcomes ◽

Single Centre Study

Download Full-text

Improved mortality with the implementation of an MDT to determine patient selection for percutaneous endoscopic gastrostomy (PEG) insertion–A retrospective audit; single centre experience

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2018.09.027 ◽

2018 ◽

Vol 28 ◽

pp. 253

Author(s):

A. Dhaliwal ◽

S. Smith ◽

T. Haldane

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Patient Selection ◽

Single Centre ◽

Endoscopic Gastrostomy ◽

Retrospective Audit ◽

Single Centre Experience ◽

Selection For

Download Full-text

Paediatric surgery outreach: analysis of referrals to a tertiary paediatric surgery service to plan an outreach programme Kwa-Zulu Natal, South Africa

Tropical Doctor ◽

10.1177/0049475517718103 ◽

2017 ◽

Vol 47 (4) ◽

pp. 305-311

Author(s):

Yashoda Manickchund ◽

GP Hadley

Keyword(s):

South Africa ◽

Tertiary Care ◽

Tertiary Level ◽

Paediatric Surgery ◽

Single Centre ◽

Total Delay ◽

Referral Patterns ◽

Surgical Disease ◽

Kwazulu Natal ◽

Outreach Programme

Paediatric surgical disease is a neglected health problem. Patients travel great distances to tertiary level care for management. This study aimed at analysing referral patterns to design an outreach programme for paediatric surgery in KwaZulu Natal. Data forms of patients referred to the service between January and July 2016 were correlated with the clinical record. Delays in management were compared to morbidity and mortality. Out of 781, 158 referrals were accepted as emergencies. The majority (62%) were children aged < 1 year. Gastro-intestinal problems (38.4%) and congenital anomalies (26.9%) formed the majority. Patients who died had a significantly longer delay in transfer. Longer total delay was associated with statistically significant greater morbidity. In a setting where a large rural population is served by single-centre tertiary care, delays exist and contribute to morbidity. The authors advocate the establishment of an outreach programme to address these issues.

Download Full-text

AB169. The value of chest radiography in the acute surgical assessment unit: a single-centre retrospective audit

Mesentery and Peritoneum ◽

10.21037/map.2020.ab169 ◽

2020 ◽

Vol 4 ◽

pp. AB169-AB169

Author(s):

Natasha Khullar ◽

Thomas Hefferon ◽

Rena Al-Zubaidy ◽

Frederik Pretorius

Keyword(s):

Chest Radiography ◽

Single Centre ◽

Retrospective Audit ◽

Assessment Unit

Download Full-text

A single centre retrospective analysis of cinacalcet therapy in primary hyperparathyroidism

Endocrine Connections ◽

10.1530/ec-21-0258 ◽

2021 ◽

Author(s):

Daniel Bell ◽

Julia Hale ◽

Cara Go ◽

Ben George Challis ◽

Tilak Das ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Retrospective Analysis ◽

Adverse Reactions ◽

Not Given ◽

Efficacy And Safety ◽

Single Centre ◽

Bridging Therapy ◽

Endocrine Disorder ◽

Severe Hypercalcaemia ◽

Higher Doses

Primary hyperparathyroidism (pHPT) is a common endocrine disorder that can be cured by parathyroidectomy, and patients unsuitable for surgery can be treated with cinacalcet. Availability of surgery may be reduced during COVID-19 and cinacalcet can be used as bridging therapy. In this single centre retrospective analysis, we investigated the efficacy and safety of cinacalcet in patients with pHPT receiving cinacalcet between March 2019 and July 2020, including pre-parathyroidectomy bridging. We reviewed and summarised the published literature. 86 patients were identified, with most achieving target calcium (79.1%) with a mean dose of 39.4 mg/day for a median duration of 35 weeks. Calcium normalised in a median time of 5 weeks. The majority of patients commenced cinacalcet 30 mg/day (78; 90.7%) with the remainder at 60 mg/day (8; 9.3%). 57.8% of patients commenced on lower dose cinacalcet (30 mg/day) achieved a target Ca without requiring 60 mg/day. Baseline PTH was significantly higher in patients requiring higher doses of cinacalcet (p=0.014). 18.6% of patients reported adverse reactions and 4.7% discontinued cinacalcet. Patients treated with cinacalcet pre-parathyroidectomy required a higher dose and fewer achieved target calcium compared to those treated medically with cinacalcet alone. Post-operative calcium was similar to patients not given pre-parathyroidectomy cinacalcet. In summary, cinacalcet at an initial dose of 30 mg/day is safe and effective for achieving target calcium in patients with symptomatic or severe hypercalcaemia in pHPT, including those treated pre-parathyroidectomy. We propose a PTH threshold of >30 pmol/L to initiate at a higher dose of 60 mg/day.

Download Full-text