Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV.

BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.

Randomised controlled trial of prophylactic antibiotic treatment for the prevention of endophthalmitis after open globe injury at Groote Schuur Hospital.

BACKGROUND/AIMS: Most post-traumatic acute infectious endophthalmitis occur within a week of open globe trauma, necessitating early antibiotic prophylaxis. There are few randomised studies that demonstrate the benefits of prophylactic antibiotics. This randomised controlled non-inferiority trial was aimed at determining the incidence of post-traumatic endophthalmitis using established intravenous/oral prophylaxis and comparing this to the incidence using oral antibiotics only. METHODS: All adult patients admitted with open globe injury were included. Those with proven endophthalmitis, high-risk features, who underwent primary evisceration and those allergic to the trial antibiotics were excluded. Patients were randomised to receive either intravenous cefazolin and oral ciprofloxacin or oral ciprofloxacin and oral cefuroxime for 3 days from admission. Acute endophthalmitis was the primary outcome. Patients completed the study if they were followed up for 6 weeks post injury. RESULTS: Three hundred patients were enrolled, with 150 in each arm. There were 99 exclusions. Seven patients developed endophthalmitis despite prophylaxis-2.0% (three cases) in the intravenous and oral arm, compared with 2.7% (four cases) in the oral-only arm-this difference was not statistically significant (p=0.703). CONCLUSIONS: The incidence of endophthalmitis with prophylaxis was 2-3%. Selected patients with open globe injuries (without high-risk features) may receive either intravenous cefazolin and oral ciprofloxacin, or oral cefuroxime and oral ciprofloxacin as prophylaxis against acute endophthalmitis-the latter regimen has the advantage of shortening patients' hospital stays and reducing costs. Non-inferiority study-design limitations should be taken into account, however.

Pulmonary angiocentric lymphoma (lymphomatoid granulomatosis) in a donkey.

A 36-year-old donkey developed dyspnoea, pyrexia, hypoalbuminaemia and oedema. Following continued clinical deterioration the donkey was humanely destroyed. Grossly, there were numerous nodules (5-10mm) scattered throughout the lung. Microscopically, the lung was infiltrated by an angiocentric and bronchocentric to diffuse mixed population of small mature and atypical lymphocytes, histiocytes, plasma cells and fewer eosinophils. The infiltrate was composed of numerous small mature and fewer atypical CD3(+) T lymphocytes. Low numbers of CD20(+) and CD79a(+) B cells, some atypical, accompanied the T cells. These infiltrates were consistent with an angiocentric lymphoma and resembled lymphomatoid granulomatosis, an Epstein-Barr virus (EBV)-associated human tumour. Immunohistochemistry for EBV latent membrane protein and polymerase chain reaction analysis for equine gamma herpesvirus DNA were negative. To the authors' knowledge this is the first case of angiocentric lymphoma reported in a donkey and the first case of lymphomatoid granulomatosis-type disease in an animal in which possible concurrent infection with a gamma herpesvirus has been investigated.

Hyperlipemia in a population of aged donkeys: description, prevalence, and potential risk factors.

BACKGROUND: Hyperlipemia is a common disorder of the donkey, with mortality rates of up to 80% reported. Such a poor prognosis makes prevention of this disorder or amelioration in the early stages crucial. OBJECTIVES: The objective of this study was to describe and determine the prevalence of hyperlipemia in a population of donkeys and to determine risk factors for development of the disease. ANIMALS: A total of 449 cases were investigated from a population of 3829 donkeys; donkeys were resident at The Donkey Sanctuary, a charity providing refuge for unwanted donkeys in the UK. Animals were selected on the basis of presence of clinical disease. METHODS: A retrospective case-control study design was used, and all donkeys presenting with hyperlipemia over a 4-year period were included. Each case was matched with 2 controls that had not suffered from hyperlipemia in the previous month. Multivariable analysis was carried out to determine risk factors. RESULTS: A total of 449 clinical cases of hyperlipemia were reported with an associated mortality rate of 48.5%. Concurrent disease was present in 72% of donkeys and was the greatest risk factor (OR = 76.98); others included cardboard bedding (OR = 3.86), movement (OR = 3.94), weight loss (OR = 6.4), dental disease (OR = 1.73), and concentrate feeding (OR = 1.87). CONCLUSIONS: This study shows that this population of donkeys in the UK often develops hyperlipemia, particularly in response to stress or primary illness, and provides useful insights in to health and management risk factors that may be addressed to decrease the risk of hyperlipemia both in the study population and in other similar donkey populations.

Retrospective analysis of post-mortem findings in 1,444 aged donkeys.

The aim of this study was to describe and report the prevalence of conditions found at necropsy examination of UK donkeys. Records from 1,444 donkeys over a 7-year period were included in the analysis. Sixty-one categories of post-mortem finding were identified from 9,744 observations. The four most prevalent conditions noted were dental disorder (78.7%), vascular disease other than aneurysm (60.9%), arthritis (55.4%) and foot disorder (44.8%). Gastric ulceration was found in 42% of the donkeys and gastrointestinal impaction in 18.6%. The most frequent combination of two post-mortem findings in the same animal was arthritis and dental disorder. The most common disorders were associated with age, body weight and/or body condition post mortem and, for some disorders, gender. For many of the post-mortem findings, crude associations were found between the presence of one finding and the odds of also having certain other post-mortem findings. This study is the first to summarize all conditions noted at necropsy examination for a large group of donkeys. The findings increase knowledge of diseases and conditions of this species and may be useful when investigating the relevance of various pathological conditions in the live animal.

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5(standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9of them would attend such courses. Also; 82of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Anatomical studies of maxillary cheek teeth infundibula in clinically normal horses.

REASONS FOR PERFORMING STUDY: Although clinical disorders of equine maxillary cheek teeth (CT) infundibula are common, anatomical knowledge of these structures is poor. HYPOTHESIS: Anatomical examinations of sectioned CT infundibula will better define their shapes and sizes and allow identification of infundibular cemental variations and changes. MATERIAL AND METHODS: Cheek teeth were extracted post mortem from 33 horses, aged 3-30 years, without a clinical history of dental disease. The CT were sectioned longitudinally in the bucco-palatal plane through the widest aspects of both infundibula. The infundibular surfaces were then assessed morphologically, including by measurements of areas of cemental variations and changes. Specimens from selected teeth were examined histologically. RESULTS: Infundibular length and infundibular surface area, and infundibular length as a proportion of dental crown length progressively decreased with age, e.g. infundibular length was up to 89 mm after eruption to 2 mm in one older horse. Triadan 06 and 09 positions had significantly shorter CT and therefore infundibula, than the other 4 Triadan positions. Only 11.7% of infundibula were filled completely with normal appearing cementum, 8.2% of infundibula (especially the 09 position) had complete cemental caries; 22.6% of infundibula had areas with cemental hypoplasia and the remaining 57.5% of infundibulae had a variety of other cemental appearances, including the presence of central defects, localised occlusal caries and cemental discolourations. Histology showed the presence of an apical blood supply to infundibular cement in younger horses. CONCLUSIONS: Anatomical variations of CT infundibular cement are very common and some changes, such as areas of localised cemental hypoplasia, may predispose to the development of infundibular caries. POTENTIAL RELEVANCE: This more complete description and quantification of CT infundibular anatomy should allow more rational assessment and treatment of equine CT infundibular disorders.

Morphological study of tracheal shape in donkeys with and without tracheal obstruction.

REASON FOR PERFORMING STUDY: There is limited information on the gross tracheal morphology of donkeys with or without tracheal abnormalities. OBJECTIVES: To: 1) examine the morphology of tracheas of donkeys with and without clinical and/or post mortem evidence of tracheal obstruction; 2) record the cross-sectional dimensions and shapes of tracheal rings at fixed sites; and 3) document prevalence, sites and characteristics of detected tracheal abnormalities. METHODS: The tracheas of 75, predominantly aged (median age 30 years, range 7-48 years) donkeys that died or were subjected to euthanasia on humane grounds were examined. Five had severe dyspnoea due to tracheal obstruction (with intercurrent lung disease in 3), while 7 had post mortem evidence of severe tracheal airway obstruction. Every 5th tracheal ring was dissected free and the inner and outer vertical and transverse dimensions and cross sectional areas were measured. Each dissected ring was photographed and the shape of the trachea was classified as normal or, in one of 6 abnormal grades, according to the type and degree of structural abnormality present. RESULTS: The tracheas had a mean of 43 (range 34-50) tracheal rings that tended to be more oval in shape in the distal cervical region. Only 31.2% of rings examined had a circular to oval shape. Dorso-ventral flattening was present in 0.9% of tracheal rings, dorsal ligament separation in 24.4%, slight cartilage deformity in 26.0%, moderate cartilage deformity in 10.4%, marked cartilage deformity in 1.9% and miscellaneous other abnormalities in 4.9% of tracheal rings. The 12 donkeys with ante or post mortem evidence of tracheal obstruction had significantly increased tracheal abnormality grade in comparison to the remaining donkeys. CONCLUSIONS AND POTENTIAL RELEVANCE: Structural tracheal abnormalities are present in most old donkeys, but generally do not cause clinical problems in these sedentary animals unless intercurrent pulmonary disease is present.

Primary Health Eye Care: Evaluation of the Competence of Medical Students in Performing Fundoscopy with the Direct Ophthalmoscope

Background: To evaluate the skill of fifth-year medical students at the University of Cape Town in the performance of fundoscopy at the end of their ophthalmology rotation.Methods: The design was a prospective cohort study. The study was conducted at Groote Schuur Hospital in Cape Town. The ability of fifth-year medical students to perform fundoscopy on mannequin heads fitted with fundus photographs using direct ophthalmoscopes was evaluated. The outcome measures used were ability to see the fundus and ability to recognise fundus pathology. Results: The fundus photographs could be seen in 95of cases. The correct diagnosis could be made in only 57of cases. Conclusion: Medical students at the University of Cape Town need more than the current one week of practical ophthalmology training to improve their fundoscopy skills

Clinical dental examinations of 357 donkeys in the UK. Part 1: prevalence of dental disorders.

REASONS FOR PERFORMING STUDY: Dental disorders have a high prevalence in older donkeys and horses, but the nature and pathogenesis of many of these disorders have yet to be established. OBJECTIVES: The identification and determination of the prevalence of important dental disorders in different age groups in a large single population of donkeys, to establish a better understanding of the nature and pathogenesis of these disorders. METHODS: A prospective cross-sectional study was performed on the donkey population at The Donkey Sanctuary with detailed oral examinations of 357 donkeys within 7 different age groups (age range 2-53 years) recorded. RESULTS: The prevalence of dental disease in all donkeys was 73%, increasing in prevalence from 28% in the youngest to 98% in the oldest age group. There was an increase in prevalence of commonly recognised dental disorders with increasing age, such as: diastemata (3.8% in youngest to 86% in oldest group); missing teeth (0-56%); overgrown teeth (15-86%); worn teeth (8-84%); displaced teeth (0-38%); and periodontal disease (0-28%). CONCLUSIONS: There was a significant increase in the prevalence of dental disorders with increasing age with the largest significant increase for most dental disorders occurring in the 15-20 year age group. POTENTIAL SIGNIFICANCE: Most dental disorders significantly increase in prevalence in the 15-20 year age group and, therefore, prophylactic geriatric dental treatment in donkeys should be commenced from age 15 years.

Clinical dental examinations of 357 donkeys in the UK. Part 2: epidemiological studies on the potential relationships between different dental disorders, and between dental disease and systemic disorders.

REASONS FOR PERFORMING STUDY: Dental disease has been shown to be a risk factor for weight loss and colic in horses. No extensive clinical studies in donkeys have investigated the potential relationship between different dental disorders, or between dental disease and systemic disorders. OBJECTIVES: To determine possible associations between dental disease and body condition score, weight loss, the need for supplemental feeding and prevalence of colic in donkeys of all ages, and to gain a better understanding of the pathogenesis of dental disease by the determination of associations between different dental disorders. METHODS: A prospective cross-sectional analysis of clinical dental examinations of 357 donkeys in The Donkey Sanctuary, Sidmouth was performed. Other epidemiological factors such as estimated age group, body condition score, weight loss, medical history and supplemental feeding were also recorded, and multiple regression analyses were performed to determine possible associations. RESULTS: Donkeys from older age groups were more likely to have dental disease, poor body condition score and suffered previous colic episodes. The presence of dental disease was also significantly associated with weight loss, colic, low body condition score and the need for supplemental feeding. The presence of diastemata, periodontal disease, wave mouth, smooth mouth and step mouth are frequently associated with the presence of other dental disorders. CONCLUSIONS: In addition to oral-related pain, dental disease can cause significant systemic disorders and so has increased welfare implications in donkeys. Some dental disorders promote the development of other types of dental abnormalities and thus increase the severity of dental disease in individual animals. POTENTIAL SIGNIFICANCE: Effective treatment of dental disorders slows down the progression of dental disease and decreases the risk of developing some medical disorders such as colic and weight loss that are associated with dental disease.

Dimensions of diastemata and associated periodontal food pockets in donkey cheek teeth.

Equine cheek teeth (CT) diastemata often cause deep periodontal food pocketing and are therefore regarded as a painful dental disorder of equidae. However there appears to be no information available on the size or shape of these diastemata. This post mortem study examined 16 donkey skulls (mean age = 32-years) containing 45 CT diastemata to define the anatomical shape and dimensions of these diastemata, and of the associated periodontal food pockets that occur with this disorder. Diastemata were found to more commonly involve mandibular (56.0%) compared with maxillary CT (44.0%), and 71.0% of these diastemata had adjacent intercurrent dental disorders that may have predisposed donkeys to the diastemata. The median widths of all diastemata were 2.0-mm at the occlusal surface and 3.1-mm at the gingival margin, with no diferences in widths between the lateral or medial aspects of diastemata. Diastemata were defined as open (60.00%) or valve (40.00%) based on their gross appearance. This classification was confirmed to be accurate by measurements that showed valve diastemata to have an occlusal to gingival width ratio of 0.4, in contrast to open diastemata where this ratio was 1.07. Food was impacted in 89.0% of diastemata, but all diastemata had adjacent periodontal disease. Periodontal food pocketing was present adjacent to 76.0% of diastemata, more commonly on the lateral aspect (73.0% prevalence; mean pocket depth = 4.1-mm) than the medial aspect (47.0% prevalence; mean pocket depth = 2.4-mm). The depth of periodontal pockets of diastemata was not associated with the height of the erupted crowns of adjacent CT.

Donkey dental anatomy. Part 2: Histological and scanning electron microscopic examinations.

Ten normal cheek teeth (CT) were extracted at post mortem from donkeys that died or were euthanased for humane reasons. Decalcified histology was performed on three sections (sub-occlusal, mid-tooth and pre-apical) of each tooth, and undecalcified histology undertaken on sub-occlusal sections of the same teeth. The normal histological anatomy of primary, regular and irregular secondary dentine was found to be similar to that of the horse, with no tertiary dentine present. Undecalcified histology demonstrated the normal enamel histology, including the presence of enamel spindles. Scanning electron microscopy was performed on mid-tooth sections of five maxillary CT, five mandibular CT and two incisors. The ultrastructural anatomy of primary and secondary dentine, and equine enamel types-1, -2 and -3 (as described in horses) were identified in donkey teeth. Histological and ultrastructural donkey dental anatomy was found to be very similar to equine dental anatomy with only a few quantitative differences observed.

Donkey dental anatomy. Part 1: Gross and computed axial tomography examinations.

Post-mortem examination of 19 donkey skulls showed that donkeys have a greater degree of anisognathia (27% width difference between upper and lower jaws) compared to horses (23%). Teeth (n=108) were collected from 14 skulls and examined grossly and by computed axial tomography (CAT). A greater degree of peripheral enamel infolding was found in mandibular cheek teeth (CT) compared to maxillary CT (P<0.001). A significant increase in peripheral cementum from the apical region to the clinical crown was demonstrated in all CT (P<0.0001). All donkey CT had at least five pulp cavities with six pulp cavities present in the 06s and 11s. A new endodontic numbering system for equid CT has been proposed. A greater occlusal depth of secondary dentine (mm) was present in older donkeys (>16 years) than in the younger (<15 years) donkeys studied. Based on gross and CAT examinations, donkey dental anatomy was shown to be largely similar to that described in horses.

Post mortem survey of dental disorders in 349 donkeys from an aged population (2005-2006). Part 1: prevalence of specific dental disorders.

REASON FOR PERFORMING STUDY: Donkey dental disorders are being recognised with increased frequency worldwide and have important welfare implications; however, no detailed investigations of dental disorders in donkeys appear to have been published. OBJECTIVES: To determine the prevalence of specified dental disorders in donkeys by performing a prospective post mortem study on donkeys that were subjected to euthanasia or died for other reasons at the Donkey Sanctuary, UK. METHODS: Post mortem examinations were performed on 349 donkeys over an 18 month period, 2005-2006. The presence and extent of specified dental disorders were recorded and these data analysed to determine their prevalence and common locations. RESULTS: A high prevalence (93%) of disorders was noted in the population with a median age of 31 years. In particular, cheek teeth diastemata (85% prevalence) were very common, often associated with advanced periodontal disease. Other disorders observed included missing teeth (in 55.6% of donkeys), displaced teeth (43%), worn teeth (34%), local overgrowths (15%), focal sharp overgrowths (3%) and dental-related soft tissue injuries (8%). CONCLUSIONS AND POTENTIAL RELEVANCE: Aged donkeys have a high prevalence of significant dental disease, especially cheek teeth diastemata. These findings highlight the importance of routine dental examinations and prophylactic dental treatments to improve the dental health and welfare of donkeys.

Post mortem survey of dental disorders in 349 donkeys from an aged population (2005-2006). Part 2: epidemiological studies.

REASON FOR PERFORMING STUDY: Dental disorders have recently been recognised as having major clinical and welfare implications in donkeys. However, no investigation appears to have examined the association of dental disorders with managemental factors and any intercurrent illness. OBJECTIVES: To determine the association of dental disorders observed in a post mortem study with age group, body condition score, time since last dental treatment, feeding and the illness that necessitated euthanasia or caused death. METHODS: A prospective study documented the type and prevalence of dental disorders in 349 mainly aged donkeys (median estimated age of 31 years) that were subjected to euthanasia over an 18 month period in 2005'Aì2006. The estimated age, body condition score, supplemental feed status, time since last dental treatment and nature of the intercurrent disease that necessitated euthanasia or caused death were also recorded. Multivariable analysis was performed to examine associations of these factors with specific dental disorders and between specific dental disorders. RESULTS: There was a high prevalence (93.4%) of significant dental disease. Age group was significantly associated with the presence of dental disorders and an older age range was a high risk factor for the presence of cheek teeth (CT) diastemata. There was a significant association between the presence of CT diastemata and the concurrent presence of displaced, missing and worn CT. There was also a significant association between the presence of diastemata and colic. CONCLUSIONS AND POTENTIAL RELEVANCE: Aged donkeys have a high prevalence of dental disorders especially of CT diastemata. Dental disorders and, in particular, the presence of CT diastemata were significantly associated with colic. Routine, prophylactic dental treatments should be performed, especially in aged donkeys.

The risk of sympathetic ophthalmia following evisceration for penetrating eye injuries at Groote Schuur Hospital.

BACKGROUND/AIMS: The aim of this study was to assess the incidence of sympathetic ophthalmia following evisceration for penetrating eye injuries and to assess whether evisceration is safe in this setting. METHODS: Data were obtained retrospectively from patients who were admitted to a tertiary hospital following penetrating ocular trauma over a 10-year period. RESULTS: A total of 1392 patients were included in the study. Of these, 1283 (99.4%) underwent surgery on admission (primary repair or primary removal of the globe). Of the surgical group 889 (64.3%) underwent primary repair, 491(35.5%) had primary eviscerations and three (0.2%) had primary enucleations. Secondary eviscerations were performed on 11 patients who had undergone primary repair. Two cases of sympathetic ophthalmia were identified in the non-surgical group and none in the surgical group. The incidence of sympathetic ophthalmia following penetrating trauma was 0.14%. CONCLUSION: The incidence of sympathetic ophthalmia was low, as found in previous studies. The lack of follow-up, as well as the statistically insufficient number of patients, did not provide conclusive proof that sympathetic ophthalmia does not occur after evisceration. It would appear, however, that evisceration after severe ocular trauma is an acceptable option with a low risk of sympathetic ophthalmia.

The South African experience with ingestion injury in children.

INTRODUCTION: The Red Cross Children's Hospital is the only children's hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database. AIM: To study our experience with ingested foreign bodies in children. MATERIALS AND METHODS: A retrospective study was performed using the CAPFSA database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included. RESULTS: To date, 241 folders have been analysed. DEMOGRAPHICS: Both sexes were equally affected (boys 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent (42%) had no symptoms. Removal: Fifty-seven percent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation. CONCLUSION: A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications.