Nelson Mandela Academic Hospital

Early identification of high-risk surgical neonates is essential in resource-limited settings. Risk stratification tools such as the Score for Neonatal Acute Physiology with Perinatal Extension II (SNAPPE II) are widely used in neonatal intensive care units but have not been validated in surgical neonatal populations in sub-Saharan Africa. This study evaluated outcomes and the prognostic utility of SNAPPE II in surgical neonates. A 5-year retrospective cohort study was conducted including neonates admitted under general paediatric surgery to the neonatal intensive care unit at Nelson Mandela Children's Hospital. SNAPPE II scores were calculated within 12h of admission. Associations between SNAPPE II and mortality were assessed using relative risk, odds ratios, and receiver operating characteristic (ROC) analysis. 380 neonates were analysed. Overall mortality was 22.6%, with sepsis accounting for 65.1% deaths. SNAPPE II demonstrated strong prognostic performance: scores > 20 were associated with markedly increased mortality (relative risk 9.2, odds ratio 43.7), and no neonates survived with scores ≥ 40. ROC analysis showed excellent discrimination (AUC 0.88), with an optimal cut-off of 25. SNAPPE II reliably predicts mortality in surgical neonates and supports early triage, rational resource allocation, and informed family counselling in resource-limited neonatal surgical units.

Background. Endocrine-disrupting chemicals (EDCs) such as pesticides, plasticisers and food-related compounds are ubiquitous environmental pollutants linked to increased breast cancer risk. While substantial evidence exists from Western settings, limited data address these associations in African populations, where exposure patterns and regulatory frameworks differ markedly. Objectives. To synthesise global epidemiological evidence on EDC exposure and breast cancer, with a focus on identifying disparities between African and Western regions. Methods. A systematic review of PubMed (MEDLINE) was conducted by Mahasa et al. from 30 November 2024 to 14 July 2025, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search used keywords including ‘endocrine disruptors’, ‘breast cancer’, ‘climate change’, ‘air pollution’, ‘water pollution’, ‘global warming’ and ‘greenhouse effect’, and included both case-control and cohort studies. Results. The search identified 172 eligible studies. Most were from Western countries and used biomarker-based exposure assessments. Most studies were conducted in Western countries, mainly the USA, Canada and parts of Europe, by authors such as Wolff, Brody, Stellman, Eskenazi and Rusiecki, who used biomarker-based methods to assess exposure to key endocrine-disrupting chemicals (EDCs) including dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), bisphenol A (BPA), phthalates and polychlorinated biphenyls (PCBs). These Western studies consistently linked higher levels of DDT/DDE, PCBs and certain phthalates to increased breast cancer risk. In contrast, there were only a few studies from African countries such as South Africa, Nigeria and Egypt, despite higher potential exposure through agriculture and food systems, and these were limited in scale and methodological depth, providing less conclusive evidence. Conclusion. Regional gaps in data limit our understanding of EDC-related breast cancer risk in Africa. Targeted research and region- specific policies are urgently needed.

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A posterior cloacal variant is a congenital malformation where a urogenital sinus terminates anterior to a normally placed anus. These are rare malformations with highly variable anatomy. We report on three cases of a novel phenotype of posterior cloaca encountered at our institutions between October 2021 and November 2023. Three newborn girls were referred with ambiguous external genitalia and an anorectal malformation. In all cases, a midline sac, which is likely fused labioscrotal folds, replacing the clitoris was noted anterior to the perineal orifices. Two of the three patients demised as a result of renal failure. The third patient underwent reconstruction and is well. This posterior cloacal phenotype appears to be frequently associated with severe renal insufficiency. In survivors of the neonatal period, a good cosmetic outcome is achievable. Functional outcomes remain to be assessed.

ABSTRACTBackgroundAlopecia areata (AA) is a common non‐scarring alopecia. Data continue to emerge on associations with autoimmune and other conditions. Janus kinase inhibitors (JAKi) are increasingly used to treat AA.ObjectivesThe aim was to assess variation in laboratory testing in patients with AA among hair experts internationally and to compare subspecialized clinical practice to current guidelines.MethodsThirty hair experts from 14 countries and six continents contributed to develop a 24‐item survey collecting demographic information on respondents; methods of severity assessment; and laboratory testing practices in AA for mimics, contributory factors, associations, and workup for systemic therapy. The survey was distributed to a global network of expert hair specialists.ResultsOf 214 respondents, 79.9% (171/214) had special interest/expertise in hair loss disorders, and 35.5% (n = 76) were based in Europe. Most cared for both adults and children (87.9%, n = 188). For clinical assessment, almost two‐thirds (63.6%, n = 136) used the Severity of Alopecia Tool and 38% (n = 84) used the Dermatology Life Quality Index. Only 24.3% (n = 52) typically tested for alternative infectious or inflammatory diagnoses, 39.7% (n = 85) typically tested for contributory conditions such as nutritional deficiencies, and 50.9% (n = 109) typically tested for co‐existent autoimmune illnesses. Thyroid function testing was routinely performed in 73.4% (n = 157) and complete blood count (CBC) was checked in 65.9% (n = 141). Compared to conventional systemic therapy, experts were more likely to check lipid levels, creatine kinase, coagulation profiles, thrombophilia screens, tuberculosis blood testing, hepatitis B and C serology before prescribing JAKi.ConclusionsReal world practice of laboratory testing for AA by hair experts, who may see more severe or complex alopecia, is variable. Most experts routinely perform thyroid function and CBC testing. We discuss evidence for indications for testing for AA mimics, contributory factors, associated autoimmune conditions, and before systemic therapy. Further research is required to characterise the role of laboratory testing in AA.

Despite the investments in the picture archiving and communication system (PACS) in the South African health facilities, it is unclear whether clinicians in the rural tertiary hospitals are using this tool maximally. This study determines the level of knowledge, utilisation, and challenges associated with the use of PACS among doctors in a rural tertiary hospital in the Eastern Cape Province. In this cross-sectional descriptive study, a total of 66 medical doctors drawn from different departments completed a structured questionnaire at the Nelson Mandela Academic Hospital, Mthatha. Relevant items on knowledge and use of PACS, including challenges experienced, were obtained. The mean age of the respondents was 36 (± standard deviation 9.58) years. The majority of the doctors (n = 42; 63.7%) demonstrated moderate to good knowledge of PACS. Similarly, a substantial majority (n = 55; 83.3%) have used PACS for years, for both images and reports (49.2%). The highest proportion of the respondents had at least 1year of PACS experience (63.5%). Though there was no association between the sociodemographics and level of knowledge, the duration of use (p = 0.025) and frequency of use (p = 0.025) were significantly associated with moderate to good knowledge of PACS. Internet connectivity and mobile PACS were the major challenges identified. The study found moderate to good knowledge of PACS among the final sample of 66 clinicians. A substantial majority of the clinicians had used PACS for years; however, there is considerable room for strengthening and expanding the use of PACS in the study setting.

BACKGROUNDWide disparities in neurosurgical-oncologic care and treatment outcomes exists globally despite recent improvements in diagnostics and cancer therapy. To better understand the challenges to neurosurgical-oncologic care in low resource settings, we collected data on national neurosurgery capacity and hospital diagnostic and treatment capacity across 7 national referral hospitals in 7 countries Sub-Saharan Africa (SSA).METHODSA 42-item self-administered questionnaire was distributed to partner neurosurgeons at the 7 sites via REDCap in April 2023 to provide country and hospital level capacity data on neurosurgical-oncologic care. RESULTSNeurosurgical and neurosurgical-oncologic care was reported to be available in a limited number of provinces/states/regions in 6 out of the 7 countries. The neurosurgery and pediatric neurosurgery workforce density across the 7 countries ranged between 0.03 – 0.67 per 100,000 and 0 – 0.05 per 100,000 respectively. Three hospitals had no pediatric ICU with the remaining four having between 2-8 bed-capacity pediatric ICU. One hospital did not have both CT and MRI scanner available and relied solely on private diagnostic facilities for neuroimaging. Histopathology services were largely limited to basic hematoxylin and eosin (H&E) and/or advanced histopathology staining. Molecular subtyping was available at only one hospital. None of the 7 hospitals had neurocritical care expertise, neuroradiologist, or neuropathologist. Four hospitals had a pediatric anesthesiologist. Only one hospital had a neuro-oncologist, but none had a pediatric neuro-oncologist. Both adjuvant chemotherapy and radiotherapy was unavailable at 3 hospitals. Rehabilitation was largely limited to basic physical and occupational therapy at all 7 hospitals. Although all 7 countries had a multiple health payer system, the payment structure differed across the 7 hospitals for different neurosurgical-oncologic services with patients making out-of-pocket payments for all services in some cases. Financial constraint was reported as a major barrier to care. CONCLUSIONSystem-level interventions are needed to strengthen neurosurgical-oncologic care capacity in SSA.

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