Milpark Hospital

Objective: Acute ischemic stroke is caused by a reduction in cerebral blood flow, leading to brain ischemic and subsequent cell death. The therapeutic options available for this condition are limited. The inflammatory response associated with the ischemic injury may influence the outcomes of ischemic stroke. Clarithromycin is a widely used antibiotic in medical practice. This study aimed to investigate the effect of clarithromycin on brain ischemic injury. Methods: In this study, 38 Sprague Dawley female rats were used and divided into four main groups: the pure control group, the ischemia group, the sham/control group, and the ischemic+claritromycin group. A temporary clip was placed in the bilateral carotid arteries of rats for 45 minutes. One group administered a dose of clarithromycin, and the tissue and blood samples of all four groups underwent biochemical evaluation. The results were subjected to statistical analysis. Results: The administration of clarithromycin to animals resulted in a reduction in malondialdehyde levels in brain tissues within the study group. Furthermore, Bederson's motor scores were observed to be higher in the clarithromycin-treated group in comparison to the ischemia group (p=0.092). Conclusion: A potential correlation exists between post-stroke infections and prognosis, suggesting that prophylactic antibiotic treatment may be beneficial. This study indicates that clarithromycin exerts a neuroprotective effect on cerebral ischemic injury following a stroke.

Extracorporeal membrane oxygenation (ECMO) is an advanced, resource-intensive technology used in a limited capacity in South Africa (SA). Minimal data on the use of ECMO in SA are available. To describe the indications, early outcome and comorbidities of patients placed on ECMO in the highest-volume ECMO centre in SA. We performed a single-centre retrospective review of all adult patients supported with any form of ECMO from August 2016 to December 2018. Operative and clinical records were reviewed. The primary objective of this study was to review the outcome of patients placed on ECMO in the form of survival to hospital discharge. The secondary objectives were to identify population-specific comorbidities and indications for ECMO that could be associated with non-survival and to compare outcome with known risk scores in the form of the Respiratory ECMO Survival Prediction (RESP) and Survival After Venoarterial ECMO (SAVE) scores. One hundred and seven patients were identified. The primary indication for ECMO was respiratory support in 78 patients and cardiac support in 29 patients. Forty-seven patients were discharged from hospital, with a 44.0% overall survival rate. Gender (p=0.039), age (p=0.019) and hypertension (p=0.022) were associated with death in univariate logistic regression analysis. However, after adjusting for potential confounding in multivariate logistic regression analysis, the association was no longer significant. In the all respiratory support group, patients in risk class IV had better than predicted survival according to the RESP score, while risk classes I, II and III had worse than predicted survival. In the circulatory support group, all risk classes had worse than predicted survival according to the SAVE score. We report ECMO outcomes in SA for the first time. We identified very high mortality rates for patients transferred on ECMO from other facilities and for patients converted from venovenous ECMO to venoarterial ECMO. Although our outcomes were comparable in some of the risk classes, further external validation of the SAVE and RESP scores will be needed to compare our outcomes with these scores. What the study adds. We report on extracorporeal membrane oxygenation (ECMO) outcomes in South Africa for the first time. We identified a high mortality rate in patients transferred on ECMO from other facilities, and in patients converted from venovenous ECMO to venoarterial ECMO.Implications of the findings. Transferred patients had a high mortality rate. The reason for this should be further investigated and may highlight the need for possible protocols to assist with appropriate timing of patient transfers and possible earlier intervention or transfer.

Introduction. Intestinal helminths and microbiota share the same anatomical niche during infection and are likely to interact either directly or indirectly. Whether intestinal helminths employ bactericidal strategies that influence their microbial environment is not completely understood.Hypothesis. In the present study, the hypothesis that the adult hookworm Nippostrongylus brasiliensis produces molecules that impair bacterial growth in vitro, is tested.Aim. To investigate the in vitro bactericidal activity of Nippostrongylus brasiliensis against commensal and pathogenic bacteria.Methodology. The bactericidal effect of somatic extract and excretory-secretory products of adult Nippostrongylus brasiliensis on Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli, Salmonella enterica serovar Typhimurium, and Klebsiella pneumoniae) bacteria was assessed using growth assays. Minimum inhibitory concentration and minimum bactericidal concentration assays were performed using excretory-secretory products released from the pathogen.Results. Broad-spectrum in vitro bactericidal activity in excretory-secretory products, but not somatic extract of adult Nippostrongylus brasiliensis was detected. The bactericidal activity of excretory-secretory products was concentration-dependent, maintained after heat treatment, and preserved after repeated freezing and thawing.Conclusion. The results of this study demonstrate that helminths such as Nippostrongylus brasiliensis release molecules via their excretory-secretory pathway that have broad-spectrum bactericidal activity. The mechanisms responsible for this bactericidal activity remain to be determined and further studies aimed at isolating and identifying active bactericidal molecules are needed.

Disseminated Acanthamoeba species infection is likely an underrecognized and underdiagnosed opportunistic infection in patients with advanced human immunodeficiency virus (HIV) disease in South Africa. It presents a unique clinical challenge in that the diagnosis can be difficult to establish and management options are limited in low-resource settings. To our knowledge, there is a paucity of literature to date on the successful use of combination treatment options for patients in low-resource settings without access to miltefosine. We present a case describing the clinical improvement of disseminated Acanthamoeba infection in a patient with advanced HIV using a non-miltefosine-based treatment regimen. The case serves to highlight that Acanthamoeba sp. infection should be considered as a differential diagnosis for nodular and ulcerative cutaneous lesions in patients with advanced HIV in South Africa, and that although there are alternative options for combination treatment in countries without access to miltefosine, efforts should be made to advocate for better access to miltefosine for the treatment of acanthamoebiasis in South Africa.

BackgroundPatients with major burns suffer with pain, which impacts their physical function during hospitalisation.ObjectivesTo describe the demographics, burn characteristics, clinical course, physical function, complications developed after major burns and to establish predictors of non-independent physical function at hospital discharge.MethodRecords of all consecutive adult burn admissions to a Level 1 Trauma Centre between 2015 and 2017 were screened retrospectively against our study criteria, using the Trauma Bank Data Registry. Anonymised data from included records were captured on specifically designed data extraction forms. Descriptive statistics were used to summarise findings. A regression analysis was undertaken to establish predictors of non-independent function at discharge.ResultsMales represented 87.7% (n = 64) of included records (n = 73). Median age was 38 (interquartile range [IQR]: 22). Thermal burns were most reported (n = 47, 64.4%), followed by median total body surface area (TBSA) 31% and head and arms were most affected (60.3% and 71.2%). Injury severity was high with median intensive care unit (ICU) length of stay (LOS) of 17 (IQR: 34) and hospital LOS 44 (IQR: 31) days. Wound debridement was mostly performed (n = 27, 36.9%) with limb oedema as a common complication (n = 15, 21.7%). Muscle strength and functional performance improved throughout LOS. None of the variables identified were predictors of non-independent function at hospital discharge.ConclusionAdults with major burns were predominantly male, in mid-life and sustained thermal injury with a high injury severity. Decreased range of motion (ROM) of affected areas, ‘fair’ muscle strength and independent function were recorded for most patients at hospital discharge.Clinical implicationsThese findings contribute to the limited body of evidence on the profile, clinical course and outcomes of South African adult burn patients.

Background: Patients with major burns suffer with pain, which impacts their physical function during hospitalisation. Objectives: To describe the demographics, burn characteristics, clinical course, physical function, complications developed after major burns and to establish predictors of non-independent physical function at hospital discharge. Method: Records of all consecutive adult burn admissions to a Level 1 Trauma Centre between 2015 and 2017 were screened retrospectively against our study criteria, using the Trauma Bank Data Registry. Anonymised data from included records were captured on specifically designed data extraction forms. Descriptive statistics were used to summarise findings. A regression analysis was undertaken to establish predictors of non-independent function at discharge. Results: Males represented 87.7% ( n = 64) of included records ( n = 73). Median age was 38 (interquartile range [IQR]: 22). Thermal burns were most reported ( n = 47, 64.4%), followed by median total body surface area (TBSA) 31% and head and arms were most affected (60.3% and 71.2%). Injury severity was high with median intensive care unit (ICU) length of stay (LOS) of 17 (IQR: 34) and hospital LOS 44 (IQR: 31) days. Wound debridement was mostly performed ( n = 27, 36.9%) with limb oedema as a common complication ( n = 15, 21.7%). Muscle strength and functional performance improved throughout LOS. None of the variables identified were predictors of non-independent function at hospital discharge. Conclusion: Adults with major burns were predominantly male, in mid-life and sustained thermal injury with a high injury severity. Decreased range of motion (ROM) of affected areas, ‘fair’ muscle strength and independent function were recorded for most patients at hospital discharge. Clinical implications: These findings contribute to the limited body of evidence on the profile, clinical course and outcomes of South African adult burn patients.