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Safety and efficacy of herbal remedies: a review of the models for validation of herbal remedies of some neuropharmacological conditions
Get PDFBackground: Herbal remedies are making waves in many neurological conditions, and it will be wrong to assume that they do not have to be subjected to the same rigorous ethical investigational pathways as for the synthetic medicines/remedies. The primary and most important concern of pharmacologists in the team of drug developers is the safety of the remedy, whether herbal or synthetic. The remedies are aimed at the human body for the alleviation of the medical condition, so it makes sense to protect that body against further injury. In this context, there is no consideration for a different treatment when herbs are involved.Methods: This review is based on the teaching approaches of the author, with a view to explaining the rationale for some of the experimental steps in neuropharmacological experiments, particularly with herbs. The issues of experimental models are discussed, with sufficient explanations for the choice of the model, the indices to monitor and the interpretation of the indices. Supporting literature are also provided as appropriate.Conclusions: Appropriate conclusions are drawn and the target audience are put in a good stead of the appreciation of why they do what they do, while correcting what they have not done well
Households’ Willingness to Adopt Biogas Energy In the Birim North District of Ghana: Insights for Local Governments for Clean Energy Promotion
Get PDFRural Ghana has potential for widespread use of biogas energy by households, which would contribute to the achievement of UN’s Sustainable Development Goal 7 (affordable and clean energy). However, knowledge of households’ willingness to adopt it is still scanty. Therefore, this paper examines socio-economic factors that may influence the willingness of households in the Birim North District of Ghana to adopt biogas energy for cooking. Using survey data, the study analyses the effects of gender, age, education and occupation of household heads, household size, type of energy currently used for cooking, household expenditure on energy for cooking, income and prior awareness on willingness to adopt biogas. Data were collected from a random sample of 392 households, and analysed using chi-square and multiple binary logistic regression methods. With the exception of education, all the socio-economic variables stated above have significant effects on households’ willingness to adopt biogas technology. However, the exact nature of the influence of these variables (i.e. whether negative or positive) does not necessarily conform to what pertains elsewhere. The findings provide local governments and other stakeholders with relevant insights to properly target households with appropriate educational and marketing strategies for biogas adoption
Damage control laparotomy outcomes in a major urban trauma centre
Get PDFBackground: Damage control laparotomy (DCL) is associated with high mortality. The purpose of this study was to review the outcomes of DCL.Methods: All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were reviewed. Data retrieved were demographics, mechanism of injury, vitals, and biochemical parameters. Injury severity was described by the revised trauma score (RTS), penetrating abdominal trauma index (PATI), injury severity score (ISS) and trauma and injury severity score (TRISS). Indications for DCL, length of ICU stay, number of procedures and primary abdominal closure rates, complications and mortality were recorded.Results: Fifty-one patients underwent DCL and 47 patients sustained gunshot injuries. Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The medians for the different severity scores were RTS 7.36, ISS 20, and PATI 30. The organs most commonly injured, in decreasing frequency, were small bowel (33), large bowel (25), abdominal vasculature (22), liver (18), stomach (14), kidney (10), diaphragm (10), spleen (9) and pancreas (8). DCL procedures performed were abdominal packing (36), temporary bowel ligation (30), vascular (5) and ureteric (1) shunting. The median number of laparotomies performed per patient was three, with a primary fascial closure rate of 69%. The mortality rate was 29%.Conclusion: DCL in our centre is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24 hours and median PATI score more than 47 are independent risk factors associated with increased mortality
The spectrum and outcome of paediatric emergency surgical admissions – a regional hospital analysis
Get PDFBackground: Improving emergency surgical care for children requires information on the causes of admissions and the variables affecting outcome. There is a lack of such data in the South African context.Methods: This retrospective study was conducted from January 2016 to December 2017. Data was collected on all children (< 12 years of age) requiring admission with emergency surgical conditions. Infrastructure and staffing ratios were determined prior to data collection. Information was sourced from admission and discharge books, patient files and theatre registers. Variables of age, sex, referral source, diagnosis, length of stay, surgical treatment and outcome including death were collected.Results: Four hundred and thirty-five of the 1 048 children (42%) admitted were in the 0–2-year age group. Trauma (258), sepsis (564) and burns (226) were the main causes. The median hospital stay was 3 days (IQR 2–5), however, for burns patients, the median stay was 4 days (IQR 2–9). Surgery was performed on 279 (27%) admissions. Eight (0.8%) died, six of which were due to burns. Clinical status prior to death was poorly documented. A dedicated high care unit and burns isolation rooms were lacking. Surgeon/population and child/nurse ratios were respectively 1.48/100 000 an 7–12/1.Conclusion: This study found that the emergency paediatric surgical burden is significant. Sepsis and trauma combined are the leading cause of emergency admissions. Burns had the highest mortality. Although mortality was low, improvements of staff to patient ratios and the institution of an early warning system could reduce mortality
Strategies for recovery of a surgical service in the COVID-19 era
Get PDFThe COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of “elective” surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall survival. Delays in elective surgery also have significant consequences for the health system: added emotional strain on healthcare workers, a reduction in training opportunities, increased costs, and increased inequality in health-service provision. As the virus is likely to become endemic, the recovery of surgical services from the initial shock of the first three waves needs to be carefully planned, in order to mitigate the further loss of elective surgical services. This article presents a narrative review of the latest international guidelines and recommendations pertaining to surgical recovery strategies in the COVID-19 pandemic. To begin with, any recovery plan should be led by a local governance committee, who need to design and implement a number of strategies across the three phases of recovery. The preparation phase includes deciding on a system of case prioritisation, assessing and organising resources, and planning innovative ways to reorganise the service itself. The perioperative phase involves putting measures in place to reduce the risk of COVID-19 transmission. The post discharge phase includes the implementation of telemedicine for follow-up, as well as methods of service audit to enable continuous adjustment and improvement. Surgical service recovery presents many challenges; however, these also present a unique opportunity to reassess and improve the efficiency of surgical care delivery
Rectosigmoid screwdriver perforation presenting as a strangulated inguinal hernia
Get PDFWe present a case of a young male patient with no previously known medical, surgical or psychiatric history, who was referred to our institution as an irreducible left inguinal hernia with signs of strangulation. Intraoperative findings, however, revealed a retained foreign body at the rectosigmoid junction, which had previously perforated through the floor of the inguinal canal, essentially sealing off the contamination into the inguinal canal and contributing to the clinical presentation of a left inguinal hernia. This is, to our knowledge, the first published case report locally and internationally concerning rectosigmoid-inguinal canal perforation with the working end of a screwdriver
Experience and perceptions of laparoscopic appendectomy amongst surgical trainees in South Africa
Get PDFBackground: This study is a survey amongst surgical trainees in South Africa (SA) designed to document their exposure to laparoscopic appendicectomy (LA) and their perceptions about the procedure and to identify possible barriers to its uptake.Methods: A structured survey was developed using a combination of quantitative and qualitative questions designed to determine the clinical exposure of surgical trainees to laparoscopic appendectomy and then probe possible factors limiting their access to the procedure. A questionnaire was created online, and a link was distributed to various surgical trainees in Southern Africa. A list of trainees was obtained from the Surgreg Training Association of South Africa (STA).Results: One hundred and thirty-two (47%) trainees completed the survey out of an estimated 280 general surgery registrars. Ninety-five (72%) were male and 37 (28%) were female respondents. Their median age was 31 years (25–36). There were 14 (11%) year-1 and 21 (16%) year-2, 32 (24%) year-3, 37 (28%) year-4 and 28 (21%) year-5 trainees. The breakdown according to region was area 1 (inland and central) 47 (36%), area 2 (western seaboard) 12 (9%) and area 3 (eastern seaboard) 73 (55%). Forty-three (33%) respondents experienced face-to-face teaching on how to perform a LA. Forty-two (32%) had exposure to laparoscopic simulators. Respondents reported a general lack of experience in performing this procedure. Sixty-nine (52%) had performed this procedure without a senior (i.e., solo) and 13 (10%) had only assisted a senior to perform this procedure. Seventy-four (56%) respondents felt confident performing a LA independently. One hundred and thirteen (86%) respondents expected to be taught this procedure. One hundred and five respondents (80%) were keen to learn to perform LA. One hundred and five respondents (80%) stated that they would be interested in attending an online course on LA. The respondents felt that the following were the significant barriers to performing LA: resource constraints 49 (37%) and time constraints 46 (35%). Thirty per cent of respondents (22) in area 3 reported a reluctance by seniors to teach the procedure.Conclusion: There appears to be a lack of exposure to and confidence with LA amongst South African surgical trainees. This implies a deficiency in formal surgical training programmes. Addressing this deficiency will require innovative solutions
The spectrum of animal related injuries managed at a major trauma centre in South Africa
Get PDFBackground: Humans come into contact and interact with an array of animals in a number of areas and environments. We set out to review our experience with animal-related injuries in Pietermaritzburg, KwaZulu-Natal, South Africa.
Methods: All patients who sustained an injury secondary to an interaction with an animal in the period December 2012–December 2017 were identified from the Hybrid Electronic Medical Registry (HEMR).
Results: There were 104 patients in the study sample. The mean age of patients in the study was 32.8 years, with a range from 1 to 76 years old. 75% (n = 78) were male and 25% (n = 26) female. Out of the 104 animal-related injuries, 67 were blunt trauma, 39 penetrating trauma and 3 a combination of blunt and penetrating trauma. The species causing trauma included dogs (53), horses (29), cows (18), buffalo (1), warthog (1), impala (1) and a single goat (1). The median time from injury to hospitalisation was 46.62 hours (range from 0 to 504 hours). Injuries occurred to the head (n = 32), face (n = 9), neck (n = 32), abdomen (n = 22), urogenital system (n = 6), upper limb (n = 39) and lower limb (n = 39). The Injury Severity Score (ISS) mean for the patients was 8.16, the range 1–4, the median 9 and the standard deviation 6.88. In 49 patients the treatment was non-operative. In the remaining 55 patients, a total of 68 operative procedures were required. Operations included wound debridement/surgical washout (n = 38), laparotomy (n = 9), arterial repair/ligation (n = 8), skin graft (n = 4), craniotomy (n = 5), fasciotomy (n = 2), amputation (n = 1), and placement of an ICP monitor (n = 1). 49 of these operations were for patients with dog bite injuries. The mean hospital stay was 0.13 days with a range of 0–4 days. Four patients were admitted to the Intensive Care Unit (ICU) and two patients died.
Conclusion: Human interactions with animals may result in injuries which require surgical treatment. The most common animal injury is a dog bite but in the case of the larger domestic farm animals, blunt force type injuries and goring can result in significant injuries which require complex surgical interventions
Discrepancy in clinical outcomes of patients with gunshot wounds in car hijacking: a South African experience
Get PDFIntroduction: Discrepancy in outcomes between urban and rural trauma patients is well known. We reviewed our institutional experience with the management of gunshot wounds (GSWs) in the specific setting of car hijacking and focused on clinical outcome between rural and urban patients.
Methods: A retrospective review was conducted at a major trauma centre in South Africa over an 8-year period for all patients who presented with any form of GSWs in car hijacking settings. Specific clinical outcomes were compared between rural and urban patients.
Results: A total of 101 patients were included (74% male, mean age 34 years). Fifty-five per cent were injured in rural areas and the remaining 45% (45/101) were in the urban district. Mean time from injury to arrival at our trauma centre was 11 hours for rural and 4 hours for urban patients (p < 0.001). Seventy-six per cent (76/101) sustained GSWs to multiple body regions. Sixty-three of the 101 (62%) patients required one or more operative interventions. In individual logistic regressions adjusted for sex and number of regions injured, rural patients were 9 (95% CI: 1.9-44.4) and 7 (95% CI: 2.1- 24.5) times more likely than urban patients to have morbidities or required admissions to intensive care respectively. The risk of death in rural patients was 36 (95% CI: 4.5-284.6) times higher than that of urban patients.
Conclusions: Patients who sustained GSWs in carjacking incidents that occurred in rural areas are associated with significantly greater morbidity and mortality compared with their urban counterparts. Delay to definitive care is likely to be the significant contributory factor, and improvement in prehospital emergency medical service is likely to be beneficial in improving patient outcome. 
Correlation of white cell count and CRP in acute appendicitis in paediatric patients
Get PDFBackground: Ten per cent of children who present with abdominal pain at an emergency department are diagnosed with acute appendicitis. The diagnosis of which relies on clinical acumen, but addition of tests such as measurement of the white cell count (WCC) and C-reactive protein (CRP) are needed to decrease the morbidity associated with inappropriate surgical management. This study evaluates the sensitivity, specificity and accuracy of the WCC and CRP separately and when used in combination and evaluates whether an increased WCC and CRP are associated with complicated appendicitis.
Methods: A retrospective record review of all paediatric patients who underwent appendicectomy between June 2010 and December 2016 was conducted. Demographic data, the WCC, CRP and histology results were reviewed.
Results: 763 records were reviewed. The sensitivity and specificity of the WCC were 69.6% and 43.1% respectively and of the CRP were 95.4% and 24.5% respectively. The sensitivity was higher when both the CRP and WCC were elevated (97.47%). A normal WCC and CRP had a specificity of 98%, with an odds ratio of 8.69 of a patient not having appendicitis. There was a borderline significance between the WCC and the presence of acute appendicitis (p = 0.0494). The CRP was significant in patient with acute appendicitis (p < 0.0001). The WCC and CRP between uninflamed appendix specimens, uncomplicated appendicitis and complicated appendicitis was significant.
Conclusion: Both increasing CRP and WCC correlates with an increased likelihood of the presence of complicated appendicitis. The chance of a patient having appendicitis with both normal WCC and CRP is low