The spectrum and outcome of surgical sepsis in Pietermaritzburg, South Africa

Background. Sepsis is a leading cause of morbidity and mortality worldwide, and the incidence appears to be increasing. In the resource-limited environment in low- and middle-income countries, the management of surgical sepsis (SS) continues to represent a significant portion of the workload for most general surgeons.Objective. To describe the spectrum of SS seen at a busy emergency department, and categorise the outcomes.Methods. The Pietermaritzburg Metropolitan Trauma Service (PMTS) and Pietermaritzburg Metropolitan Surgical Service (PMSS) in KwaZulu-Natal Province, South Africa (SA), maintain a prospective electronic registry. All patients with features of sepsis among emergency general surgical patients >15 years of age admitted to the PMSS over the period January 2012 - January 2015 were identified. From this cohort, all patients with sepsis that required surgical source control or who had a documented surgical source of sepsis (i.e. had SS) were selected for analysis.Results. Of a total of 6 020 adult surgical patients on the database, a cohort of 1 240 acute surgical patients with features of sepsis were identified, and 675 with SS were then analysed further. Of the 675 patients, 49.2% were male, and the mean age was 46 years (standard deviation (SD) 19); 47.0% presented to the PMSS directly from within the metropolitan area, while the remaining 53.0% were referred from hospitals outside the area. Physiological parameters (mean values) on presentation were as follows: systolic blood pressure 123 mmHg (standard deviation (SD) 23), respiratory rate 22 breaths/min (SD 5.2), heart rate 107 bpm (SD 19), temperature 37°C (SD 2) and white cell count 20 × 109/L (SD 8). Of the patients, 21.6% were known to be HIV-positive, 13.5% (91/675) were negative and 64.9% were of unknown status; 57.6% had intra-abdominal sepsis, 26.1% diabetes-related limb sepsis and the remaining 16.3% soft-tissue infections; 17.5% required intensive care unit admission, with a mean length of stay of 4 days (SD 4), and 30.7% developed complications. In this last group (n=207), a total of 313 morbidities were identified. The overall mortality rate was 12.7% (86/675). The mortality rate for intra-abdominal sepsis was 13.1%, for diabetic foot sepsis 14.2% and for necrotising fasciitis 27.3%.Conclusions. The spectrum of SS in SA is different to that seen in the developed world. Intra-abdominal sepsis is the most common SS and is overwhelmingly caused by acute appendicitis. Diabetic foot infection is a major cause of SS, reflecting the increasing burden of non-communicable chronic diseases in SA

Transplantation of benthic species to mitigate impacts of coastal development in Jamaica

Maintaining regional competitiveness and economic viability for Port Bustamante - Kingston Harbour, Jamaica, required improved accessibility to "Post Panamax" (too large to pass through the Panama Canal) container vessels. Removal of the northern portion of the shallow coral reef at Rackham's Cay, which was partially obstructing the western end of the east ship channel, was proposed. This aesthetically valuable reef was used by local fishermen and comprises part of the declared Palisadoes - Port Royal Protected Area. The proposal to transplant certain of the benthic species was advanced to mitigate loss of viable reef components. Between December 2001 and February 2002, sixty thousand items, consisting of reef building massive and branching corals; gorgonians; urchins (Diadema and Tripneustes spp.) and Thalassia meristems were relocated. During dredging, sedimentation rates from suspended solids in the water column were 0.003 g/cm(2)/day at the control site and 0.008 g/cm(2)/day at the dredge site. Coral cover in the relocation area increased from 15% to 20% while bare substrate decreased from 27% to 21%. This paper documents the mitigation required; some factors controlling the ecology of Rackham's Cay reef, the methodology of the relocation process; and the level of post-dredging survivorship of relocated corals. Political and economic realities of some proposed developments often override ecological considerations. Transplantation of important marine benthic species although time consuming, technically challenging, and expensive, may be one way for developers and ecologists to achieve sometimes disparate goals. This project cost US$1.7 million. The "items" moved were neither unique nor endemic and remain vulnerable to natural and anthropogenic impacts. This project increased public awareness and interest regarding the ecological and economic importance of reef ecosystems. It is anticipated that future coastal and inland developments will benefit from the lessons taught by these mitigative interventions

Carcinoma insular de tiroides: reporte de un caso de revisión de la literatura / Insular carcinoma of the thyroid: report of 1 case and review of the literature

El carcinoma insular de tiroides es un tumor poco frecuente. Fue descrito originalmente en 1907. Hasta la fecha, en la literatura mundial se ha informado de altededor de 100 casos. La importancia del carcinoma insular de tiroides resalta cuando se revisa la clasificación de tumores de tiroides. Para este fin se puede observar que las clasificaciones vigentes emplean una correlación clinicopatológica en la que se relaciona a las diversas morfologías conocidas con una conducta específica conocida. Con este concepto en mente podemos considerar neoplasias de relativamente buen pronóstico, como los carcinomas papilar y folicular de tiroides, y tumores de mal pronóstico, como el carcinoma anaplásico, como el carcinoma anaplásico de tiroides. De manera semejante tendríamos que considerar a los tumores poco diferenciados como formas intermedias entre los tipos descritos. El carcinoma insular de tiroides corresponde a una variante poco diferenciada, con potencial metastásico elevado., con una supervivencia menor a la de las formas diferenciadas de tumores malignos de tiroides, pero menos agresivo que los tumores anaplásicos de el mismo órgano. En el presente artículo presentamos un caso de carcinoma insular de tiroides y una revisión de la literatura relacionada con el tema

Neumonitis por radiación en pacientes con cáncer de mama tratados con radioterapia / Radiation neumonitis in patients with breast cancer treated with radiotherapy

La neumonitis por radiación es un síndrome acompañado de cambios radiológicos bien definidos a nivel pulmonar. Su presentación e intensidad están ralacionadas con diferentes factores. La frecuencia con que se presenta por irradiación a la mama y sus zonas linfoportadoras es variable. Para conocer la frecuencia y relación que guarda con el antecedente de patología pulmonar previa y asociación a tratamiento secuencial de radioterapia y quimioterapia se estudiaron 62 pacientes con cáncer de mama que recibieron radioterapia al tórax, con seguimiento radiológico mínimo de 52 semanas. En el 29 por ciento de las pacientes (18/62) se presentó el síndrome de neumonitis por radiacipon y el 45 por ciento (28/62) evolucionó a fibrosis pulmonar, con todas las pacientes asintomáticas al cierre del estudio. La patología pulmonar previa fue un factor de riesgo estadísticamente significativo (p=0.04) para el desarrollo de neumonitis y fibrosis pulmonar. Esto no se demostró con la asociación de radioterapia y quimioterapia.

Caring for children with HIV/AIDS in rural Zaire

HIV/AIDS presents a fascinating and major challenge to doctors working in developing countries such as Zaire. This challenge has to be met as part of the clinical work load because it is still true to say that more children are dying from malaria; respiratory diseases and diarrhea than from HIV infection at present. This may change and emphasises the need for intensive educational programmes now

Cáncer broncogénico: experiencia de 12 años en el Instituto Nacional de Cancerología / Bronchogenic cancer: 12 years experience in the National Institute of Cancerology

Se revisaron 629 expedientes clínicos de pacientes con diagnóstico de carcinoma broncogénico, vistos en el Instituto Nacional de Cancerología durante 12 años, de 1975 a 1986. El sexo con mayor frecuencia fue el masculino con el 70% (440 pacientes) y la edad de la 5a. a la 7a. década de la vida. El hábido tabáquico se detectó en el 80% de los enfermos (503). El tiempo de evolución del padecimiento antes de llegar al Instituto fué un promedio de 45 días. El 80% de los pacientes estaban en estado clínico III (503 pacientes). A diferencia de lo reportado en la literatura al respecto, el adenocarcinoma fue el tipo histológico más frecuente