Congenital heart defects in children with cleft lips and/or palates at an academic hospital in central South Africa

Background: Globally, cleft deformities are the most common craniofacial anomalies and show an association with congenital heart defects. Little research on cleft lips and/or palates (CL/P) and congenital heart defects has been reported from Africa, and none from South Africa. In 2001, it was proposed that CL/P be listed as one of six priority conditions for monitoring and notification to South African health authorities. This goal of creating a national registry has not been achieved. A near-fatal anaesthetic incident following a missed cardiac lesion in a child with a cleft lip and palate prompted this study. Objectives: To describe the prevalence of congenital heart defects diagnosed in children with CL/P presenting for corrective surgery during the Smile Week over three consecutive years (2013­2015) at an academic hospital in South Africa. Methods: A retrospective, descriptive file review of 62 patients with CL/P was performed. Since 2013, echocardiography has been performed on all patients with CL/P. Results: Twenty-three, 21 and 18 patients were operated in 2013, 2014 and 2015, respectively. Of these patients, 85.5% (n = 53) had no clinical evidence of a cardiac defect, of which eight did have clinically significant cardiac defects on echocardiography. Sixteen patients (25.8%) in total (n = 16/62) with a cleft deformity had a clinically significant congenital heart lesion. Of the 16 patients with a cardiac defect on transthoracic echocardiography, only four had clinical evidence of cardiac defect. Therefore, sensitivity of clinical examination was 25%, whereas the specificity was 89.1%. Three of the four patients with a syndrome had a clinically significant echocardiographic finding. Conclusion: A national guideline for the preoperative care of patients with CL/P, including routine echocardiography, is needed. Furthermore, a national registry is required for patients with CL/P with associated congenital anomalies

'Look and Lletz/' ­ a Chris Hani Baragwanath Hospital experience

Objectives. An audit was undertaken of a 'colposcopy and treatment' clinic between April 2003 and December 2006; to determine: (i) the frequency of overtreatment with Papanicolaou smear on its own; colposcopy on its own or a combination of the two methods; (ii) differences in overtreatment between patients who are HIV positive and those who are HIV negative; and (iii) the short term complications of Lletz (large loop excision of the transformation zone) at this clinic. Design. A retrospective analysis of data from the colposcopy clinic database of patients; who were referred according to national guidelines. Setting. Patients who are referred to Chris Hani Baragwanath hospital. Results. Normal histology was found in 1.3 of patients; and cervical intraepithelial neoplasia (CIN) 1 or human papillomavirus (HPV) in 8.4. The overall complication rate was 3. Conclusion. The high loss to follow-up and the low early complication rate together with an acceptable overtreatment rate make this a justifiable approach in our situation. HIVnegative women were more likely to be overtreated than HIVpositive patients (p=0.03)

Obstetric Anaesthesia : the Source of the Crisis

The Saving Mothers Reports have consistently shown that; out of all the provinces of South Africa; the Free State has one of the highest rates of maternal deaths arising from anaesthesia.The province's Department of Health requested the University of the Free State's Department of Anaesthesiology to investigate the problem. We examined possible factors; including training and experience of doctors administering anaesthesia; availability of suitable anaesthetic drugs and equipment; and use of regional anaesthesia. All the level 1 and 2 hospitals in which caesarean sections (CSs) were being performed were investigated. The foremost problems identified were lack of training andexperience in administering obstetric anaesthesia; and lack of senior anaesthetic assistance