Profile of surgical complications in gynaecology at a teaching hospital in South Africa

BackgroundThis study investigated the burden and predictors of canine E. coli urinary tract infections (UTI) and antimicrobial resistance among dogs presented at a veterinary teaching hospital in South Africa, 2007–2012.MethodsThe Cochran-Armitage trend test was used to investigate temporal trends while logistic regression models were used to investigate predictors (age, sex, breed, year) of E. coli infections and antimicrobial resistance (AMR).ResultsA total of 22.3% (168/755) of the urinary specimens tested positive for E. coli. A significant (p = 0.0004) decreasing temporal trend in the percentage of E. coli positive isolates was observed over the study period. There were high levels of AMR to penicillin-G (99%), clindamycin (100%), tylosine (95%), cephalothin (84%) but relatively low levels of resistance to enrofloxacin (16%), orbifloxacin (21%). Almost all (98%, 164/167) the isolates exhibited multidrug resistance (MDR), while only 11% (19/167) and 2% (4/167) exhibited extensive drug resistance (XDR) and pan-drug resistance (PDR), respectively.ConclusionsAlthough, the risk of E. coli UTI declined during the study period, the risk of AMR increased. The high levels of AMR and MDR as well as the presence of XDR and PDR is concerning as these have the potential of affecting prognosis of UTI treatments.

This study aims to assess the surgical practices, learning curve, and outcomes of 2 obstetrics and gynecology specialists during the first 18 months of their careers, focusing specifically on minimally invasive gynecological procedures. Data from 277 procedures performed by 2 recently specialized gynecologists in Turkey during the first 18 months of their specialization were retrospectively analyzed. Procedures included total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), abdominal hysterectomy (TAH), and other gynecological surgeries. Surgical cases were divided into three 6-month periods, and outcomes such as surgical indications, operative time, length of hospital stay, and complications were evaluated. The study included 277 procedures performed during the first 18 months of a newly specialized obstetrics and gynecology specialist’s practice. TLH was the most frequently performed procedure, with 140 cases, followed by VH with 35 cases and total abdominal hysterectomy (TAH) with 22 cases. The study showed a significant reduction in major complications, with only 4 recorded over the 18 months, including bowel injury and bladder injury. Minor complications, such as wound infections and hematuria, were reported in 8 cases (2.9%), and these decreased significantly over time (P = .01). Operation times were shortest in the TLH group (99.6 minutes), and the average hospital stay was shortest for TLH (1.6 days). Overall, 98.6% of surgeries were completed without major complications, with a 100% success rate in the last 6 months. This study highlights the challenges and successes of early surgical practice in gynecology. TLH emerged as the preferred method due to its advantages, while VH was emphasized as the preferred approach when feasible. Regular simulation training, higher case volumes during residency, and mentorship contributed to successful outcomes. These findings underscore the importance of structured training and continuous practice in advancing competency in minimally invasive gynecological surgery.

BackgroundAntimicrobial resistance is becoming increasingly important in both human and veterinary medicine. This study investigated the proportion of antimicrobial resistant samples and resistance patterns of Staphylococcus isolates from cats presented at a veterinary teaching hospital in South Africa. Records of 216 samples from cats that were submitted to the bacteriology laboratory of the University of Pretoria academic veterinary hospital between 2007 and 2012 were evaluated. Isolates were subjected to antimicrobial susceptibility testing against a panel of 15 drugs using the disc diffusion method. Chi square and Fisher’s exact tests were used to assess simple associations between antimicrobial resistance and age group, sex, breed and specimen type. Additionally, associations between Staphylococcus infection and age group, breed, sex and specimen type were assessed using logistic regression.ResultsStaphylococcus spp. isolates were identified in 17.6% (38/216) of the samples submitted and 4.6% (10/216) of these were unspeciated. The majority (61.1%,11/18) of the isolates were from skin samples, followed by otitis media (34.5%, 10/29). Coagulase Positive Staphylococcus (CoPS) comprised 11.1% (24/216) of the samples of which 7.9% (17/216) were S. intermedius group and 3.2% (7/216) were S. aureus. Among the Coagulase Negative Staphylococcus (CoNS) (1.9%, 4/216), S. felis and S. simulans each constituted 0.9% (2/216). There was a significant association between Staphylococcus spp. infection and specimen type with odds of infection being higher for ear canal and skin compared to urine specimens. There were higher proportions of samples resistant to clindamycin 34.2% (13/25), ampicillin 32.4% (2/26), lincospectin 31.6% (12/26) and penicillin-G 29.0% (11/27). Sixty three percent (24/38) of Staphylococcus spp. were resistant to one antimicrobial agent and 15.8% were multidrug resistant (MDR). MDR was more common among S. aureus 28.6% (2/7) than S. intermedius group isolates 11.8% (2/17). One S. intermedius group isolate was resistant to all β-lactam antimicrobial agents tested.ConclusionS. intermedius group was the most common cause of skin infections and antimicrobial resistance was not wide spread among cats presented at the veterinary academic hospital in South Africa. However, the presence of MDR-Staphylococcus spp. and isolates resistant to all β-lactams is of both public health and animal health concern.

Due to the advantages of laparoscopic surgery, such as less bleeding, small trauma, rapid recovery, shorter hospitalization duration and so on, it has been widely used in clinical. At present, more and more gynecological surgeries can be completed by laparoscopic surgery. With the popularization and application in gynecological surgery, the grasp of laparoscopic surgery operation indications and expanding of operation scope, complication rate in gynecological laparoscopic operation decreased obviously. However, the complications of absolute number and kinds of complications increased obviously. Gynecological laparoscopic surgery complications include: urinary system injury, bowel injury, stomach injury, bleeding, subcutaneous emphysema, lower limb venous thrombosis, pelvic infection, poor healing of incision, poor union of vaginal stump, tissue ectopic implantation, etc.. In this paper, the authors would review the injuries, clinical characteristics and prevention and treatment measures of these complications, to provide references for clinical prevention and treatment of gynecological laparoscopic surgery complications. Key words: Laparoscopes; Gynecologic surgical procedures; Wound and injuries; Complications; Preventive measures; Female

B ackground and Aim: Being the most common pathologic cause of hydronephrosis in children, we characterized and evaluated the long-term outcome of Ureteropelvic junction obstruction (UPJO) at a tertiary hospital in South Africa Methods: Children confirmed to have UPJO between 1985 and 2016 were characterized based on demographic and baseline clinical data. Long term outcomes were need for surgical intervention, loss to follow up rates, anthropometric measures, renal outcomes (Glomerular Filtration Rate and Blood pressure). Results: Of 107 children, 74.8% were male, 47% had hydronephrosis identified antenatally, 47.7% had the left kidney unilaterally affected, 31.8% had an additional urogenital anomaly, 19.6% presented with an abdominal mass, and 37.4% had a urinary tract infection. On enrolment, 54.2% and 30.8% had normal systolic and diastolic BP, 59.8% had normal BMI for age and 72% had normal length/height for age. The median follow-up time was 35(9.0 - 191.0) months, 65% had surgery with a median time to surgery of 2 (0 - 6.8) months. Children lost to follow-up had a higher proportion of extrinsic causes of UPJO (12.0% vs. 0%, P =0.041) and other urogenital anomalies (38.7% vs. 15.6%, P=0.019). There was no significant effect of time or surgical intervention on mean BMI and height for age, blood pressure percentile and eGFR for age. Conclusion: In our setting, UPJO has an early presentation, with an early time to surgery. Long-term outcome is favorable, but loss to follow-up presents a significant drawback that needs to be addressed. Keywords: Ureter; Hypertension; Congenital anomalies of kidney and urinary tract; CAKUT; Urological Diseases; Hydronephrosis.

This study aimed to quantify the incidence of anesthesia-related and perioperative mortality at a large tertiary pediatric hospital in South Africa. This study included all children aged <18years who died prior to discharge from hospital and within 30days of their last anesthetic at the Red Cross War Memorial Children's Hospital between January 1, 2015 to December 31, 2015. A panel of three senior anesthetists reviewed each death to reach a consensus as to whether: (i) anesthesia caused the death; (ii) anesthesia may have contributed to or influenced the timing of death; or (iii) anesthesia was entirely unrelated to the death. There were 47 deaths within 30days of anesthesia prior to discharge from hospital during this 12-month period. The in-hospital mortality within 24h of administration of anesthesia was 16.5 per 10000 cases (95% confidence intervals [CI]=7.8-25.1) and within 30days of administration of anesthesia was 55.3 per 10000 cases (95% CI=39.5-71.2). Age under 1year (OR 4.5; 95% CI=2.5-8.0, P=.012) and cardiac surgery and interventional cardiology procedures (OR 2.5; 95% CI=1.2-5.2, P<.01) were both independent predictors of increased risk of perioperative mortality. The overall 24-h and 30-day anesthesia-related and in-hospital perioperative mortality rates in our study are comparable with other similar studies from tertiary pediatric centers.

Several complications can occur during laparoscopic gynecological surgery. The insertion of trocars and the induction of pneumoperitoneum are essential steps, but they can still pose potential risks during laparoscopic surgery. Bowel injuries are the most common during gynecological procedures as a result of thermal damage and trocar placement, while vessel injuries may carry a high mortality rate. Gynecologic surgeons should be aware of the risks associated with laparoscopic procedures and be able to prevent and treat potential complications. We conducted a literature search using three electronic databases (Pubmed/MEDLINE, Google Scholar, Embase) from inception to May 2024 to identify the most common intraoperative gynecological laparoscopic complications, including those related to trocar insertion, bowel, urinary, and vessel injury. The aim of this narrative review is to describe the most common complications during gynecological laparoscopic surgery and to outline the safety rules and techniques necessary for their prevention and treatment.

Women considering risk reduction surgery after a diagnosis of breast/ovarian cancer and/or inherited cancer gene mutation face difficult decisions. The safety of combined breast and gynecologic surgery has not been well studied; therefore, we evaluated the outcomes for patients who have undergone coordinated multispecialty surgery. We conducted a retrospective review of patients undergoing simultaneous breast and gynecologic surgery for newly or previously diagnosed breast cancer and/or an inherited cancer gene mutation during the same anesthetic at a single institution from 1999 to 2013. Seventy-three patients with a mean age of 50years (range 27-88) were identified. Most patients had newly diagnosed breast cancer or ductal carcinoma in situ (62%) and 28 patients (38%) had an identified BRCA mutation. Almost all gynecologic procedures were for risk reduction or benign gynecologic conditions (97%). Mastectomy was performed in 39 patients (53%), the majority of whom (79%) underwent immediate reconstruction. The most common gynecologic procedure involved bilateral salpingo-oophorectomy, which was performed alone in 18 patients (25%) and combined with hysterectomy in 40 patients (55%). A total of 32 patients (44%) developed postoperative complications, most of which were minor and did not require surgical intervention or hospitalization. Two of the 19 patients who underwent implant reconstruction (11%; 3% of the entire cohort) had major infectious complications requiring explantation. Combined breast and gynecologic procedures for a breast cancer diagnosis and/or risk reduction in patients can be accomplished with acceptable morbidity. Concurrent operations, including reconstruction, can be offered to patients without negatively impacting their outcome.

Benign gynecologic conditions among participants in the Breast Cancer Prevention Trial

Introduction Splenic rupture is a rare postoperative complication in gynecological practice. In the literature, there are only isolated reported cases of ruptured spleen after gynecological procedures. Splenic rupture has been reported following hysterectomy, cesarean section, laparoscopy, and ruptured ectopic pregnancy. Aim Presentation of splenic rupture as a complication of gynecological surgery. Case study A case of 68-year-old patient operated for giant ovarian tumor with spontaneous splenic rupture following total abdominal hysterectomy with bilateral salpingo-oophorectomy is described. Internal hemorrhage was a main clinical presentation. Diagnosis was made intraoperatively. Splenectomy was performed in cooperation with a surgical oncologist. Results and discussion Diagnosis of splenic rupture as a postoperative complication after gynecological surgery is frequently established intraoperatively due to the suddenness of symptoms of shock and the need for immediate surgical intervention. Conclusions Possibility of complications such as splenic rupture in the postoperative period needs to be taken into account by gynecologists in the case of postoperative intra-abdominal hemorrhage. Cooperation between gynecologist and general surgeon is advisable for management of splenic rupture.

This study aimed to compare the surgical outcomes in patients with endometrial cancer who underwent either single-port laparoscopic hysterectomy (SPLH) or multi-port laparoscopic hysterectomy (MPLH). We conducted a systematic literature search from the earliest records available up to May 2023. The databases searched included PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library. A total of 12 studies were included in the analysis. Both the SPLH and MPLH groups had similar operative times (MD = -4.27, 95% CI [-35.75, 27.22], p = 0.98), conversion rates (odds ratio [OR] = 1.43, 95% CI [0.57, 3.59], p = 0.44), blood transfusion rates, intraoperative complications (bladder injury, bowel injury, and vascular injury), and postoperative complications (umbilical hernia, fever, fistula, lymphocyst, and wound-related issues). However, the SPLH group showed significant advantages in certain areas. There was a notable reduction in estimated intraoperative blood loss (EBL) compared to the MPLH group (mean difference [MD] = -23.80, 95% CI [-42.99, -4.62], p = 0.02) and a shorter hospital stay duration (MD = -0.33, 95% CI [-0.46, -0.20], p < 0.00001). Although there was some debate about postoperative pain, SPLH tended to have more favorable outcomes. Despite these advantages, the SPLH group was less efficient in para-aortic lymph node clearance compared to the MPLH group (MD = -0.96, 95% CI [-1.57, -0.35], p = 0.002). No significant differences were observed in overall lymph node dissection (MD = -0.91, 95% CI [-2.52, 0.70], p = 0.27) and pelvic lymph node dissection (MD = -1.22, 95% CI [-3.82, 1.27], p = 0.36) between the two groups. Additionally, both groups showed similar therapeutic results, with no significant differences in overall survival (OS) and progression-free survival (PFS). SPLH and MPLH techniques are equally effective in treating endometrial cancer, with both showing low rates of surgical complications with similar rates of surgical complications and therapeutic outcomes. However, SPLH offers additional benefits, including smaller incisions, reduced estimated intraoperative blood loss, and shorter hospital stays, making it an increasingly popular option for treating endometrial cancer.

This study was a retrospective case series over one year. The purpose was to review the clinical presentation, travel history, laboratory findings and outcome of Plasmodium falciparum malaria. The study was conducted in the medical wards of Dr. George Mukhari Hospital, a teaching hospital in South Africa that serves mainly black patients. Fifty-nine patients were evaluated. The mean age was 34 years. Twenty-three patients (39%) had strictly defined severe malaria. Ninety-eight percent acquired Plasmodium falciparum in Sub-Saharan Africa. The death rate was 1.7%. Virtually all patients had a travel history obtained in the emergency department and the diagnosis was confirmed in all cases within 24 hours of admission. In our study population, the differences in the percent parasitemia, platelet count, haemoglobin and bilirubin were not statistically significant between the cases with severe and those with less severe malaria. Plasmodium falciparum malaria should not carry a high mortality in adequately equipped centers, when the diagnosis is made early and therapy is instituted promptly.

BACKGROUND Primary malignant bone tumors (PMBTs) are rare. The incidence of PMBTs varies by geographical location. In our African context, osteosarcoma is the most common PMBT seen; however, there is a variable representation of other PMBTs, likely due to some risk factor in the involved environment. PMBTs have not been studied concerning their geographical location and the role the environment can play as a risk factor. Our study aimed to retrospectively review children and adults treated for PMBTs at our center between 2016 and 2021. MATERIAL AND METHODS We performed a records review of patients treated for primary malignant bone tumors over 5 years. Admission, surgery, and laboratory records were searched for data extraction and analyzed using Microsoft Excel and Stata 18.0. RESULTS A total of 123 patients' records were retrieved; 91% were African, and 58.5% were female. The mean age for our cohort was 35.38 years. Osteosarcoma was the most common PMBT, followed by multiple myeloma and chondrosarcoma, in that order. Most of our patients with PMBTs reported pain as their main symptom at presentation. The overall chemosensitivity rate was at a low of 33%, due to poor compliance, while Ewing sarcoma was the most chemosensitive tumor in our cohort. CONCLUSIONS The most common PMBT at our hospital is osteosarcoma. There were variations in the incidence of the other PMBTs, in keeping with the literature. We had poor patient follow-up, leading to a poor chemotherapy response analysis. Our patients also had negligible knowledge of exposure to agricultural pesticides.

Red blood cell magnesium and hypoxic-ischaemic encephalopathy.

Study objectives: To determine the safety and efficacy of the use of oral anhydrous caffeine and intravenous aminophylline in the neonatal population using therapeutic drug levels and clinical effects as markers for determination.Design: Prospective randomised study.Patients: Thirty-one neonates admitted (aminophylline n = 16, caffeine n = 15) with a gestational age of less than or equal to 34 weeks for prevention of apnoea of prematurity (AOP) were enrolled.Results: Oral anhydrous caffeine or intravenous aminophylline were administered using prescribed study regimens. One peak level was taken for the two drugs on day 4 of treatment 2 hours after the maintenance dose was administered. The two regimens were clinically monitored using cardiovascular, respiratory, gastro-intestinal and central nervous system parameters four hourly. The two groups did not differ significantly for gestational age (p = 0.782), birth weight (p = 1), gender (p = 0.722), and Apgar scores determined at 5 minutes (p = 0.068). Serum concentrations were within range (5–20 μg/ml) for both study groups. The median pulse rate (beats per minute) for two days; day 7: 160 vs. 148 (p = 0.019); day 9: 168 vs. 147 (p = 0.020) and median respiratory rate (breaths per minute) for five days; day 3: 68 vs. 61 (p = 0.039); day 4: 67 vs. 57 (p = 0.014); day 5: 64 vs. 58 (p = 0.045); day 7: 65 vs. 50 (p = 0.021); day 8: 66 vs. 56 p = 0.014) were significantly higher in the aminophylline study arm.Conclusion: The findings of the study indicated that caffeine is an effective alternative for intravenous aminophylline in prevention of AOP. The oral administration of caffeine may also have an advantage in a resource-poor setting.