A Case Report on the Diagnosis of Acute Abdominal Aortic Occlusion Using Point-of-Care Ultrasound in the Emergency Department.

Point-of-care ultrasound (PoCUS) can be used to detect and evaluate for an aneurysm and/or a dissection of the abdominal aorta in suspected patients in the Emergency Department (ED). Despite the routine use of PoCUS for the assessment of the abdominal aorta in suspected aortic aneurysms and dissections, there is limited literature regarding its use in the diagnosis of acute abdominal aortic occlusions in the emergency setting. This is a case demonstrating the use of PoCUS in identifying an acute aortic occlusion in a 71-year-old female patient with known hypertension and diabetes mellitus. The patient presented with central abdominal pain and bilateral lower limb weakness to the ED. The patient had multiple differential diagnoses, including a possible acute aortic occlusion of the abdominal aorta. PoCUS of the aorta was utilized to diagnose an acute abdominal aortic occlusion in the ED. The rapid diagnosis expedited the referral to vascular surgeons for definitive management. Acute abdominal aortic occlusion is a time-sensitive and life-threatening emergency. PoCUS of the abdominal aorta to detect acute abdominal occlusions allows for a rapid diagnosis with the potential to improve outcomes. A protocol for detecting acute abdominal aortic occlusion should be included in the standard aorta PoCUS scan.

Massive purulent pericardial effusion with ultrasound features of tamponade secondary to non-typhoid Salmonella infection.

Purulent pericardial effusions are rare and represent the most severe form of bacterial pericarditis. The authors present a case of a male in his 40s with a massive purulent pericardial effusion due to non-typhoid Salmonella, who presented with ultrasound features of a cardiac tamponade. Invasive non-typhoid Salmonella cardiac infection is a rare but important consideration in immunocompromised individuals. This of particular concern in sub-Saharan Africa, where there is a high prevalence of HIV-infected individuals.

Clinical Profile of Acute Coronary Syndrome Presentation to the Ladysmith Provincial Hospital: High Prevalence Among the Minority Indian Population.

Background Cardiovascular diseases were responsible for 17% of the 460236 natural deaths in South Africa in 2015. Previous studies have reported a disproportionately higher incidence of ischemic heart disease (IHD) and its risk factors among individuals of Indian descent residing in South Africa. The aim of this study was to explore the clinical profile of patients presenting with a diagnosis of acute coronary syndrome (ACS) and to compare the characteristics of patients of Indian descent to those of non-Indian descent. Methods Retrospective data were derived from the medical charts of 160 consecutive patients presenting to the Ladysmith Provincial Hospital over a 44-month period with a diagnosis of ACS. Findings were described and compared. Results The mean (SD) age of study patients was 55.8 (±12.8) years. The majority of subjects were male (n=90, 56.3%) and unemployed (n=98, 62.3%). The racial distribution of the study sample comprised 103 (64.4%) Indian, 36 (22.5%) Black, and 21 (13.1%) White subjects. Compared to non-Indian subjects, a significantly higher proportion (p<0.05) of Indian subjects were male (64.7% vs 41.4%), cigarette smokers (52.0% vs 32.8%), had a previous history of ACS (37.3% vs 10.3%), were diabetic (33.3% vs 17.2%), and were hypertensive (58.8% vs 29.3%). Conclusion The disproportionately high frequency of ACS among the minority Indian population of Ladysmith is concerning. There is a need for rigorous public health interventions to create local awareness, encourage lifestyle modification, and thereby improve control of cardiovascular risk factors, especially among high-risk population groups.

Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.

In adults, foreign body aspiration is an uncommon clinical presentation. Aspiration can occur during a seizure and in the post-ictal period due to the loss of airway reflexes. Commonly aspirated contents include saliva, blood, or vomited gastric contents. Due to a common misconception that placing an object, such as a spoon, in a seizing person's mouth prevents tongue-biting, a variety of unusual items may also potentially be aspirated. With an unclear history, relatively small, radiolucent objects are often misdiagnosed or missed entirely. Chest pain or unexplained hemoptysis may be the only symptoms to suggest aspiration. In this report, the authors present a case of a patient with an unusual foreign body aspiration.

What intracranial pathologies are most likely to receive intervention? A preliminary study on referrals from an emergency centre with no on-site neurosurgical capabilities.

INTRODUCTION: Access to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities. METHODS: A one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted. RESULTS: A total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention. DISCUSSION: Based on this study's findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.