Steve Biko Academic Hospital Research Articles

The association of smoking and alcohol in colorectal cancer in black patients - Case-control study.

Studies have focused on smoking and alcohol as risk factors for colorectal cancer (CRC). Caucasians and other populations have been studied worldwide, and both smoking and alcohol have been validated as causes of CRC. However, there are limited data on the black population; studies that have been performed in Africa have not specifically focused on these two risk factors but rather in combination with other risks. To determine how smoking and alcohol affect the incidence of CRC in the African black population. Steve Biko Academic Hospital's gastrointestinal clinic. Subjects used for the study included black African patients above 18 years who had undergone a colonoscopy for suspected CRC between 2016 and 2018. Cases used were confirmed CRC on histology; controls were negative on histology. A minimum of 68 cases and 136 controls were needed for this study according to sample calculation. Hundred and ten cases and 220 controls were obtained in the final analysis. Data were collected between June 2019 and March 2020. Smoking (odds ratio [OR] = 1.795, p = 0.049) was a significant risk factor for CRC among black patients who presented at the gastrointestinal clinic. Age > 50 years (OR = 3.742, p < 0.001), family history (OR = 12.457, p < 0.001), and the combination of smoking and alcohol (OR = 5.927, p = 0.008) were significant risk factors. Interestingly, alcohol alone was protective (OR = 0.205, p < 0.001). Both smoking and a combination of alcohol and smoking are significant risk factors in the development of CRC in the black African population. Smoking, as in most population groups, is a risk factor for CRC. The observed protective role of alcohol needs to be confirmed in larger studies representing the African population.

Change in the prevalence of extra-uterine growth restriction in very low birthweight infants, following the introduction of a written nutrition protocol, in a tertiary neonatal unit

Background: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. Objectives: This study’s main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. Methods: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. Results: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. Conclusion: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2.

Prevalence of Cognitive Impairment in Dialysis Patients in Gauteng Province, South Africa

Introduction: Cognitive impairment is defined as a new deficit in at least two areas of cognitive functioning. These may include disturbances in memory, executive functioning, attention or speed of information processing, perceptual motor abilities, or language. It has been shown that cognitive impairment is associated with the severity of kidney disease. Methods: The study was a descriptive research design, with participants purposively sampled from the general chronic kidney disease population which included haemodialysis and peritoneal dialysis patients at Steve Biko Academic Hospital in Pretoria, Gauteng Province, South Africa. Hundred and fifty-one participants (76 hemodialysis &amp; 75 peritoneal dialysis patients), 58% were males, and 42% were females aged 19-61 years. To establish the prevalence of cognitive impairment by testing the level of cognition the Mini-Mental State Examination was utilized to provide a brief screening test to quantitatively assess the cognitive abilities and cognitive changes of patients while on dialysis. Results: Ninety-nine percent (99%) of the recruited population reported no cognitive impairment, irrespective of dialysis modality, demographic characteristics, and socio-economic status. Conclusion: Despite the findings highlighting that the majority of the chronic kidney disease population at Steve Biko Academic Hospital reported no cognitive impairment, it is crucial to increase awareness of the potential effects of cognitive impairment on daily activities, quality of life, and treatment adherence. Early detection and management of cognitive impairment can significantly impact the quality of life and adherence to treatment among these patients. Further research is needed to understand the prevalence and impact of cognitive impairment in different populations and to develop effective interventions for its prevention and management.

What do women with epilepsy know about pregnancy?

Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy's impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE. From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use. The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p 0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20-25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p 0.05); and 68.5% had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness. The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives.Contribution:The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.

The Case for Pre-Emptive Pharmacogenetic Screening in South Africa.

Lack of equitable representation of global genetic diversity has hampered the implementation of genomic medicine in under-represented populations, including those on the African continent. Data from the multi-national Pre-emptive Pharmacogenomic Testing for Preventing Adverse Drug Reactions (PREPARE) study suggest that genotype guidance for prescriptions reduced the incidence of clinically relevant adverse drug reactions (ADRs) by 30%. In this study, hospital dispensary trends from a tertiary South African (SA) hospital (Steve Biko Academic Hospital; SBAH) were compared with the drugs monitored in the PREPARE study. Dispensary data on 29 drugs from the PREPARE study accounted for ~10% of total prescriptions and ~9% of the total expenditure at SBAH. VigiLyze data from the South African Health Products Regulatory Authority were interrogated for local ADRs related to these drugs; 27 were listed as being suspected, concomitant, or interacting in ADR reports. Furthermore, a comparison of pharmacogene allele frequencies between African and European populations was used to frame the potential impact of pre-emptive pharmacogenetic screening in SA. Enumerating the benefit of pre-emptive pharmacogenetic screening in SA will only be possible once we initiate its full application. However, regional genomic diversity, disease burden, and first-line treatment options could be harnessed to target stratified PGx today.

Outcomes of Right Ventricular Outflow Tract Stenting as a Palliative Procedure in Tetralogy of Fallot Patients

Background: Certain groups of tetralogy of Fallot (TOF) patients require a palliative procedure until factors permit a full surgical repair. An aorto-pulmonary shunt is the gold standard palliative procedure but requires a cardiothoracic surgeon in a well-equipped facility. In the government sector in a developing country this limited resource has an overwhelming caseload. Right ventricular outflow tract (RVOT) stenting via cardiac catheterization by a trained paediatric cardiologist is a possible alternative. Objectives: To demonstrate that RVOT stenting is a safe and effective palliative procedure in TOF patients in a resource limited setting. Method: A retrospective, cohort observational study at Steve Biko Academic Hospital from January 2014 to March 2021. Results: 37 patients required RVOT stent placement. Mean oxygen saturation increased from 65% to 95% post-stent insertion. Mean pulmonary artery (PA) growth, measured by McGoon ratio, increased from 1.36 to 2.05. Average Intensive Care Unit stay was 2 days with a zero 30-day mortality. Three stents fractured requiring replacement. Conclusion: Stenting the RVOT in TOF patients who present at an older age, with multiple comorbidities and often in extremis, has yielded good results. Significant improvement in oxygen saturations and PA growth permits majority of our patients to a full TOF surgical repair.

The impact of hypothermia in a tertiary hospital neonatal unit

Background. Neonatal hypothermia, defined as a body temperature &lt;36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care. Objectives. This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa. Methods. A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records. Results. The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p&lt;0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p&lt;0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p&lt;0.0001). Conclusion. The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.

EPIDEMIOLOGY AND PATTERN OF ORTHOPAEDIC INJURIES CAUSED BY DELIVERY MOTORBIKE ACCIDENTS (DMBA) AT A SOUTH AFRICAN TERTIARY HOSPITAL

Trauma patients present with different injuries and some of them require emergency surgical procedures. Orthopaedic department at Steve Biko Academic Hospital (SBAH) have seen an increasing number of patients presenting with serious orthopaedic injuries due to Delivery Motorbike Accidents (DMBA). The aim of the study was to establish the epidemiology and pattern of orthopaedic injuries sustained following Delivery Motorbike Accident.Motor Vehicle Accident (MVA) administration office at SBAH in emergency department was approached for patients registers used between 1 January 2020 and 31 December 2022. There patients were registered as Motor Vehicle Accident (MVA), Motorbike Accident (MBA) and Pedestrian Vehicle Accident (PVA) by the administration office. The details of patients classified as MBA were collected and used to obtain clinical data from medical and radiological records in the form of patient's files and PACS respectively.Approximately 240 patients presented to Emergency department with orthopaedic injuries following a motorbike accident. About 78 files could not be retrieved from the patient's records department. About 74patients had their occupation recorded as unknown or unemployed. Approximately 70 patients had their occupation indicated in the file by the Clinicians or Administration Clerks. About 40 patients had their occupation as delivery man or working for a delivery company. 16 patients did not have images on the PACS system. Most of the patients were males, presented after hours and sustained multiple injuries that were managed surgically. Very few patients had their helmet status indicated in the file.The study suggests that accidents due to delivery motorbikes are prevalent at SBAH and result in orthopaedic injuries. Almost 50% of patients who had their occupation indicated in the file were delivery employees. A follow up prospective study is recommended to ensure complete collection of data from patients at presentation to ED.

Profile of human papillomavirus genotypes in breast and oesophageal cancer patients in Pretoria, South Africa.

The association between human papillomavirus (HPV) and cervical cancer is well established, and cervical cancer can be prevented through HPV vaccination. Little has been reported on the association between HPV and breast carcinoma (BC) or oesophageal squamous cell carcinoma (OSCC) in Africa. It is possible that use of appropriate HPV vaccines against genotypes responsible for these cancers may also prevent their development. To investigate HPV genotype prevalence in BC and OSCC patients in Pretoria, South Africa (SA). A retrospective cross-sectional study of BC and OSCC patients managed at Steve Biko Academic Hospital from 2015 to 2019 was undertaken. Patient medical records were analysed, and DNA was extracted from their archived pathology material and amplified by polymerase chain reaction before hybridisation for HPV genotypes. There were 101 patients with BC and 50 with OSCC. The prevalence of HPV infection in BC patients was 77.2%, with 35.6% high- risk (HR) genotypes, and that in OSCC patients 90.0%, with 56.0% HR genotypes. The most prevalent HPV genotypes (>20% each) were HPV 16, 70 and 51 for BC and HPV 51, 70, 16 and 82 for OSCC, with 31.7% and 60.0% of patients, respectively, having co-infection with ≥2 genotypes. The high prevalence of infection with multiple HPV genotypes in BC and OSCC patients, with HPV 16, 51, 70, 35 and 82 the most common genotypes in these cancers, warrants expansion of the current SA bivalent HPV 16/18 vaccine for girls to include boys, and inclusion of HPV 51, 70, 35 and 82, in order to prevent BC and OSCC as well as cervical cancer.

Detection of Neutralizing Antibodies in COVID-19 Patients from Steve Biko Academic Hospital Complex: A Pilot Study

A correlation between neutralization activity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and protection against coronavirus disease 2019 (COVID-19) has been demonstrated by several studies. Here, we detect SARS-CoV-2 neutralizing antibody (NAB) production in COVID-19 patients from the Steve Biko Academic Hospital complex (SBAH), South Africa (SA). Samples from COVID-19 patients (mild to severe) were collected. SARS-CoV-2 rapid assays, genotyping (Delta and Omicron variants) and enzyme-linked immunosorbent assays (ELISA) were performed. IBM® Statistical Package for the Social Sciences (SPSS®) version 28 was used for inferential statistical analysis, and the data were presented using the Prism9 software (version 9.4.1). A total of 137 laboratory-confirmed COVID-19 patients, 12 vaccine recipients and 8 unvaccinated participants were evaluated. The production of SARS-CoV-2 NABs was observed in some of the COVID-19 cases, mainly in severe cases, although this should be noted with caution due to the small sample size of this pilot study. NABs were also observed in asymptomatic participants, with the most being found in recipients (n = 6) of the BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. We found a strong presence of NABs in COVID-19 patients, specifically in mild and severe cases. Severe infection was associated with higher NAB production (82%).

The effect of COVID-19 lockdown on the epidemiology of maxillofacial trauma at tertiary health facilities in Pretoria

Background: COVID-19 restrictions have reduced the number of consultations of patients including Maxillo-facial trauma patients.&#x0D; Aim: To analyse and compare the epidemiology of maxillofacial trauma during four months of the lockdown period and compare it with the same months from the previous year (2019 and 2020).&#x0D; Materials and Method: A retrospective record-based study was conducted with data drawn from all maxillofacial trauma patients who presented in the maxillofacial and oral surgery unit, of the University of Pretoria (UP) and Steve Biko Academic Hospital (SBAH) from April to July of 2019 and April to July of 2020. Data collected included age, gender, aetiology of injury, site of injury, severity and extent of injury, fracture pattern and site, waiting period for treatment and month of injury. Chi-square test was used to evaluate the association between variables. The level of significant was set at p ≤ 0.05.&#x0D; Results: A total of 197 patients were seen in the two institutions with maxillofacial injuries for the years 2019 and 2020 with ages ranging from 1 to 81 years and a mean of 36.24. Most patients were males 167(85%). Many patients were seen in 2019 at 139(71%). There was no association between the fracture site and the aetiology. The mandible was significantly the most common site of injury and more conservative treatment was done as compared to other forms of treatment (p &lt; 0.05).&#x0D; Conclusion: More Maxillofacial cases were seen in 2019 than in 2020 with more males as compared to females. The majority of injuries were assaults followed by motor vehicle accidents (MVA). The mandible was the common site of injury. More conservative treatment was done compared to other forms of treatment.

Features of Turner syndrome in patients managed at the adult endocrinology clinic, Steve Biko Academic Hospital

Features of Turner syndrome in patients managed at the adult endocrinology clinic, Steve Biko Academic Hospital

The SARS-COV-2 Seroprevalence among Oncology Patients.

Patients with cancer are presumed to be vulnerable to an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe clinical outcomes due to the immunocompromised state mediated by their underlying malignancies and therapy. The aim of this study was to estimate the SARS-CoV-2 seroprevalence, following second to fourth waves in solid tumour patients attending the Steve Biko Academic Hospital (SBAH) for diagnosis and treatment of cancer. We used the single-prick COVID-19 IgG/IgM Rapid Test Cassettes to detect SARS-CoV-2 IgG/IgM antibodies in 760 patients with solid tumours who were asymptomatic and who had never tested positive for coronavirus disease 2019 (COVID-19). Out of the 760 patients, 277 were male (36.4%), 483 were female (63.6%), and the mean age was 55 years (range 18−92). The estimated total seroprevalence was 33.2%. The seroprevalence status of the COVID-19 IgG/IgM antibodies rose significantly from the second wave (11.3%) to the third (67.38%) and then the fourth (69.81%) waves with roughly similar counts. A significant number of the seropositive patients were asymptomatic to COVID-19 (96%). There was a higher rate of seropositivity in cancer patients with hypertension (p < 0.05). Patients with breast, gynaecologic, and prostate cancers exhibited increased SARS-CoV-2 seropositivity. Although oncology patients may be susceptible to SARS-CoV-2 infection, our data indicate that these patients remained asymptomatic throughout various waves with an overall COVID-19 IgG/IgM antibody seropositivity of 33.16%, suggesting no risk of severe or fatal cases of COVID-19.

Adoption for the implementation of smart card technology in public healthcare

This study enhances the critical factors for the implementation of smart card technology (SCT) by proposing a conceptual framework based on the healthcare unified theory of acceptance of user technology model (2008), the DeLone and McLean information systems success model and the diffusion of innovation theory (2003) recommending the strategies to be used. The framework was tested using regression analysis on the collected data from 406 self-administered questionnaires from Steve Biko Academic Hospital, Tshwane District Hospital, Kalafong Hospital and Pretoria West Hospital. The structural equation modelling and principal component analysis methods in Statistical Package for Social Sciences were used to analyse the data. The findings of this study show that seven factors – behavioural intention, system use, information quality, service quality, communication, compatibility and trialability – were significantly accepted to ensure the adoption of SCT in public healthcare.Transdisciplinary contribution: The healthcare sector has not fully addressed the technology use for healthcare professionals. However, the sector exploited much for the patients’ needs to improve quality of healthcare. Therefore, this study recommends that this framework will contribute towards the implementation smart card technology within the public healthcare. The study will contribute to the implementation of SCT and ensure the quality of service delivery in public healthcare.

Evaluating the usefulness of the estimated glomerular filtration rate for determination of imipenem dosage in critically ill patients.

Antibiotic dosing in critically ill patients is complicated by variations in the pharmacokinetics of antibiotics in this group. The dosing of imipenem/cilastatin is usually determined by severity of illness and renal function. To determine the correlation between estimated glomerular filtration rates (eGFRs) calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and imipenem trough levels in critically ill patients. This prospective observational study was done in the surgical intensive care unit (ICU) at Steve Biko Academic Hospital, Pretoria, South Africa. Imipenem trough levels were measured by high-performance liquid chromatography and compared with eGFRs calculated with the CKD-EPI equation. Correlation was evaluated by the Pearson product-moment correlation coefficient. The study population consisted of 68 critically ill patients aged between 18 and 81 years; 43 (63%) were male, and the mean weight was 78 kg (range 40 - 140). On admission, 30 patients (44%) had sepsis, 16 (24%) were admitted for trauma, and 22 (32%) were admitted for miscellaneous surgical conditions. Acute Physiology and Chronic Health Evaluation II (APACHE II) scores ranged from 4 to 39 (mean 18). The 28-day mortality rate was 29%. The mean albumin level was 16 g/L (range 7 - 25), the mean creatinine level 142 μmol/L (range 33 - 840), and the mean eGFR 91 mL/min/1.73 m2 (range 6 - 180). Imipenem trough levels ranged between 3.6 and 92.2 mg/L (mean 11.5). The unadjusted Pearson product-moment correlation coefficient between eGFR and imipenem trough level was -0.04 (p=0.761). Considering the high mortality rate of sepsis in ICUs and the rapid global increase in antimicrobial resistance, it is crucial to dose antibiotics appropriately. Owing to the variability of antibiotic pharmacokinetics in critically ill patients, this task becomes almost impossible when relying on conventional dosing guidelines. This study found that eGFRs do not correlate with imipenem blood levels in critically ill patients and should not be used to determine the dose of imipenem/cilastatin. Instead, the dose should be individualised for patients through routine therapeutic drug monitoring.

Maternal experiences of care following a stillbirth at Steve Biko Academic Hospital, Pretoria, South Africa

&#x0D; Background. Despite improvements in obstetrics and neonatal care, the stillbirth rate remains high (23 per 1 000 births) in South Africa (SA). The occurrence of a stillbirth is a dramatic and often life-changing event for the family involved. The potential consequences include adverse effects on the health of the mother, strain on the relationship of the parents, and strain on the relationship between the parents and their other children. The standard of care in SA follows the Royal College of Obstetricians and Gynaecologists Green-top guidelines.Objectives. To explore maternal experiences of in-patient care received in cases of stillbirth.Methods. A descriptive phenomenological approach was performed in the obstetrics unit at Steve Biko Academic Hospital, Pretoria, SA. Post-discharge interviews were conducted with women who experienced a stillbirth. The healthcare workers in the obstetric unit were also interviewed on the care provided to these patients. Data analysis was performed using the Colaizzi’s method.Results. Data from the interviews with the 30 patients resulted in five themes relating to the maternal experience of stillbirth: ‘broken heart', ‘helping hand’, ‘searching brain’, ‘soul of service’ and ‘fractured system’. Healthcare worker participants emphasised the importance of medical care (the clinical guidelines) rather than maternal care (the psychosocial guidelines).Conclusion. While the medical aspects of the guidelines are adhered to, the psychosocial aspects are not. Consequently, the guidelines require adaptation, especially taking into consideration African cultural practices, and the inclusion of allocated responsibility regarding the application of the psychosocial guidelines, as this is the humanitarian umbilical cord between healthcare workers and those in their care.&#x0D;

Aspartame and Platelets in Type II Diabetic Patients

Background: For type II diabetes (T2D) subjects to better regulate carbohydrate consumption and manage blood glucose levels, a non-nutritive sweetener (aspartame) is prescribed as an alternative to natural sugar. Previous studies show that there was a 68% rise in the probability of aspartame consumers developing T2D compared with non-consumers. In diabetes and inflammation, deformed red blood cells (RBCs) and atypical fibrin fibre formation or an altered fibrin structure are especially prevalent. Objective: The aim of this study was to investigate, in subjects with T2D taking aspartame, clot viscoelasticity and platelet structure. Methodology: Blood was drawn from 12 T2D subjects from the diabetic clinic at the Steve Biko Academic Hospital, South Africa. Blood was used to perform a full blood count, thromboelastography (TEG) and scanning electron microscopy (SEM). Results: SEM showed increased platelet activation and abnormal TEG parameters in T2D consuming aspartame. Conclusion: A hypercoagulable state can increase the risk of thromboembolic complications and an increased incidence of vascular disease. This knowledge may be used to build awareness among consumers of aspartame.

Beauty from Ashes in the Season of COVID-19.

Steve Biko Academic Hospital, Pretoria, South Africa Funding/Support: Dr. Oyomno is the 2021 recipient of the American Society of Colon and Rectal Surgeons Career Development Award. Financial Disclosures: None reported. Correspondence: Meryl Oyomno, Steve Biko Academic Hospital, Private Bag X169 Pretoria 0001, South Africa. Email: [email protected]

Efficacy of deep brain stimulation of the anterior-medial globus pallidus internus in tic and non-tic related symptomatology in refractory Tourette syndrome

IntroductionAlthough refractory Tourette Syndrome (TS) is rare, it poses great challenges in clinical practice. Co-morbid psychiatric symptoms often occur, negatively impacting quality of life. Deep brain stimulation (DBS) targeting different brain structures seems effective for tics, but specific literature regarding response of psychiatric symptoms is more limited.This study aimed to assess the outcome of tics and non-tic related symptomatology in refractory TS treated with antero-medial globus pallidus interna (amGPi) DBS. MethodsWe included all patients with refractory TS (January 2013–August 2020) from the Brain Nerve Centre and Steve Biko Academic Hospital, Pretoria, South Africa, treated with bilateral amGPi DBS; retrospective baseline, early (up to 3 months) post-DBS follow-up assessment data, as well as prospective data from the latest follow-up (mean 37.4 months) were collected using standardised scoring tools and scales. ResultsFive patients were identified. Tics decreased by 63,9% (p = 0,002); quality of life improved by 39,8% (p = 0,015); self-injurious behaviour ceased; obsessive–compulsive symptoms resolved in all but one. The number of different chronic medications used more than halved. Transient stimulation-related adverse events occurred in four patients. ConclusionThis study contributes to the data of the efficacy of amGPi-targeted DBS in refractory TS, showing improvement in quality of life and both tic- and non-tic-related symptomatology..

Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a tertiary hospital in South Africa

Background. International literature has shown the prevalence of coeliac disease (CD) in children and adolescents with diabetes to range from 1 - 10%. Prevalence rates in African countries are limited or unknown. Objective. The objective was to describe the prevalence of CD in all children and adolescents with type 1 diabetes mellitus presenting to the paediatric and adult diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. Method. A retrospective review of the files of all children and adolescents in the paediatric and adult diabetic clinic with type 1 diabetes mellitus between August 2016 and June 2019 was conducted. Children requiring screening and/or intestinal biopsies were also prospectively included during this period. The setting of this study was Steve Biko Academic Hospital, a tertiary referral centre, in Pretoria, South Africa. Coeliac screening included anti-deaminated gliadin antibodies and anti-tissue transglutaminase antibodies (both IgA and IgG). All biopsies were obtained by a paediatric gastroenterologist or an experienced paediatric surgeon. Results. A total of 184 files were screened; 132 met inclusion criteria but only 108 patients in total had coeliac screening. Positive antibody screening for CD was found in 11 out of 108 patients (10.2%). Nine of the 11 serology-positive patients had biopsies performed. Out of the nine biopsies, two (22.2%) were positive for CD based on the Marsh-Oberhuber classification. Conclusion. This study found a prevalence of serology-positive CD in our local population of South African children with type 1 diabetes mellitus of 10.2%, while the prevalence of biopsy-confirmed CD was found to be 1.9%.