Browsing by Subject "Health Science"

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    Open Access
    An 8-year retrospective review of Pyogenic Liver Abscesses at Groote Schuur Hospital, Cape Town, South Africa
    (2023) Govender, Nieleshen; Kloppers, Jacobus
    Pyogenic liver abscess (PLA) is the most common abdominal solid organ abscess with significant associated morbidity and mortality (2-30%). High variance in the causative organism exists therefore identifying the responsible pathogens and providing targeted therapy is needed for optimal outcomes. This study aims to describe patient variables, outcomes and the local microbiome to guide future empiric antibiotic protocols. Methods We performed a retrospective review of 121 patients with PLA from 2012 to 2020 at Groote Schuur Hospital. We analyzed patient demographics, microbiology results from cultures of PLA (bile, percutaneous aspiration or intra-operative sampling) and blood samples, empiric antibiotic regimens used, interventions and outcomes. Results The five most common organisms cultured were Escherichia coli [26 (21%)], Klebsiella pneumoniae [24 (19.8%)], Pseudomonas aeruginosa [12 (9.9%)], Anaerobic organisms Isolated [11 (9%)] and Enterobacter cloacae Complex [7 (5.1%)]. Twenty different regimens were used to treat PLA. Primary intervention (antibiotics alone, percutaneous drainage, open surgery) was successful in 72 patients (60%). Further intervention was required in 49 patients (40%). Open surgical drainage was required in 16 patients (13%). 30-day mortality was 9.1% (n=11). Biliary sepsis was the most common cause of PLA (31%). Our study showed Gentamicin [52 isolates (65%)], Ciprofloxacin [49 isolates (61%)] and Co-Amoxiclav [46 isolates (46%)] to be the most effective in covering the five most common isolates. Conclusion Optimal PLA management remains challenging with multiple combinations of empiric antibiotic regimens initiated. Local data on the topic is sparse and this research is hypotheses generating for future research to improve outcomes. Abstract word count: 250 words
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    Open Access
    Prevalence, and outcomes of Rheumatic Heart Disease in Ethiopia: a systematic review and meta-analysis
    (2023) Dhodho, Munyaradzi; Engel, Mark
    Background: While eradicated in other parts of the world, Rheumatic Heart Disease, nevertheless, remains one of the most common acquired heart diseases in low- to middle- income countries; in sub-Saharan Africa, there was an estimated prevalence of 10 persons per 1,000 population in 2015. In the Global Burden of Disease estimates 1990-2015, Ethiopia was identified as having one of the highest burdens of RHD with a prevalence of 100-149 persons per 100,000 population. We therefore sought to estimate the prevalence of RHD, and clinical and post-operative outcomes, in Ethiopia. Objectives: We conducted a systematic review of the prevalence and outcomes of RHD according to a priori protocol. Data Sources: Studies included in this review were retrieved from PubMed and Web of Science. In addition, Google Scholar and approaching authors was used to complement the search. Data Extraction: Studies conducted after 2012 were included if the method of RHD diagnosis was echocardiography. A meta-analysis was done to measure the pooled prevalence and outcomes of RHD. Results: A total of nine studies were included in this review, 5 focusing on prevalence and 4 focusing on outcomes of RHD. The overall prevalence of asymptomatic echocardiographic RHD was per 21 per 1000 (95% CI, 12.27;32.03). In hospitalised patients, presentation included congestive heart failure, atrial fibrillation, and stroke. The 30-day mortality and post- operative mortality was 2.5 (95% CI, 0.00;12.81) and 32.8 (95% CI, 11.43;62.82) per 1000 respectively. The 60-day mortality and post-operative mortality was 33.5(95% CI, 0.00;111.38) and 161.7 (95% CI 125.54;201.27) per 1000 respectively. Conclusions And Relevance: The prevalence of asymptomatic RHD in Ethiopia is high while RHD in adults/children is associated with congestive heart failure, atrial fibrillation, and stroke. Mortality was high in patients with RHD-related heart failure; thus, to achieve the World Heart Federation target of a 25% reduction in the mortality due to RHD by 2025 in the under 25- year-olds might prove challenging.
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    Open Access
    Towards integrated service delivery for children with autism spectrum disorder in the Western Cape Province of South Africa
    (2023) Pillay, Sarosha; de Vries, Petrus; Duncan Eve
    Background The prevalence of autism spectrum disorder (ASD) in South Africa is unknown and there is little information on the educational service needs of children with ASD in the country. There are no standardized procedures for identification, diagnosis and management of children with autism. The Western Cape is one of the better resourced provinces in the country in terms of ASD services, yet educational opportunities for these children are limited. The Western Cape was therefore used as a case study to understand the landscape of education systems for children with ASD in South Africa. Objectives The objectives of the study were a) to determine the number and profile of children with ASD both in and out of schools in the Western Cape, b) to examine stakeholder views, perspectives and proposed solutions to meet the educational needs of children with ASD and their families, and c) to generate suggestions to strengthen ASD systems and services. Methods An exploratory mixed-methods approach was used across two phases. In the first phase, quantitative provincial educational data were used to describe the profile of children with ASD in the formal public sector education system as well as those waiting for educational services. The second phase used qualitative focus groups and semistructured individual interviews to examine the perspectives and recommendations of caregivers, service providers and government stakeholders about ASD services. Results A systematic database search for children with ASD in the whole provincial educational system, combined with the provincial ‘waiting list' of those waiting for school placement found very low rates of ASD (