Clinical and Anthropological Analyses of a Case From 19th Century South Africa With a Confluence of Uncommon Cranial Pathological Conditions.

This study combines clinical and anthropological analyses to investigate the complex cranial pathology of a South African individual from the 19th century. The cranium was examined macroscopically and radiographically. Conducting a standard differential diagnosis was challenging given the complexity and uncommon nature of the pathology and required drawing on relatively sparse paleopathological and clinical case reports. Multiple conditions were identified including biparietal thinning, basilar invagination, platybasia, and complicated chronic frontal sinusitis, where the intracranial extension of sinus infection may likely have contributed to the individual's death. The authors urge for awareness of these uncommon conditions, as their presence can easily be overlooked or confound skeletal assessments. This clinical study contributes to the authors' understanding of uncommon and poorly described paleopathological diseases and will help to better facilitate their diagnosis in future research. It represents one of the first studies describing such an unusual cooccurrence of uncommon pathologies in an archeological individual.

Advancing African otolaryngology and head & neck surgery education and training through virtual academic platforms and multidisciplinary teams.

PURPOSE OF REVIEW: To overview the rise of virtual tools to propagate academia and clinical service within Africa, in the field of otolaryngology, propelled by the coronavirus disease 2019 (COVID-19) pandemic. RECENT FINDINGS: The rise of the COVID-19 virus saw a dramatic reduction in elective surgery and outpatient services with a subsequent reduction in experiential learning for trainees. This has spurred the rising trend to maintain the mission of education and clinical service, virtually. There have been unprecedented levels of international collaboration in the 'pandemic year of 2020' that has seen various platforms conceived to harmonize varying practices from global experts towards the ultimate goal of education propagation and improved patient care. The continent of Africa, amidst its own unique challenges, has boldly stepped into the virtual realm in form of a resident-centred platform coined University Of Cape Town-Africa Virtual ENT, and two multidisciplinary team (MDT) meetings: the African Head and Neck Society Virtual Tumour Board and the African Virtual Cochlear Implant Meeting. SUMMARY: The COVID-19 pandemic will have long-lasting effects on clinical practice and training programs globally. This has demanded academicians to re-imagine novel ways to buoy academia and maintain international collaboration in an inexpensive and convenient way to nourish the sacred mission of education and clinical service within our spirited continent.

Aminoglycoside-induced hearing loss in HIV-positive and HIV-negative multidrug-resistant tuberculosis patients.

Background. Ototoxicity following aminoglycoside treatment for multidrug-resistant tuberculosis (MDR-TB) is a significant problem. This study documents the incidence of ototoxicity in HIV-positive and HIV-negative patients with MDR-TB and presents clinical guidelines relating to ototoxicity. Methods. A prospective cohort study of 153 MDR-TB patients with normal hearing and middle ear status at baseline controlling for 6 mitochondrial mutations associated with aminoglycoside-related ototoxicity, at Brooklyn Chest Hospital in Cape Town. Pure tone audiometry was performed monthly for 3 months to determine hearing loss. HIV status was recorded, as was the presence of 6 mutations in the MT-RNR1 gene. Results. Fifty-seven per cent developed high-frequency hearing loss. HIV-positive patients (70%) were more likely to develop hearing loss than HIV-negative patients (42%). Of 115 patients who were genetically screened, none had MT-RNR1 mutations. Conclusion. Ototoxic hearing loss is common in MDR-TB patients treated with aminoglycosides. HIV-positive patients are at increased risk of ototoxicity. Auditory monitoring and auditory rehabilitation should be an integral part of the package of care of MDR-TB patients.

Malignant proliferating trichilemmal tumor involving the sinuses.

Proliferating trichilemmal tumor (PTT) is a rare adnexal neoplasm that arises from the outer sheath of the hair follicle. It is believed that PTTs originate in trichilemmal cysts. These tumors have the potential for malignant transformation; when this occurs, the tumor is known as a malignant PTT (MPTT). Recurrence after simple local excision is common, and it can cause considerable morbidity. We report a case of MPTT that was initially diagnosed as a benign PTT. The primary tumor had arisen from the skin over the glabella. It was excised, but it recurred 3 years postoperatively. The recurrent tumor involved the eyelid, nasal cavity, and frontal and ethmoid sinuses, and it extended into the orbit. The recurrent tumor was excised via combined endoscopic and open surgery. As far as we know, this is the first documented case of an MPTT that involved the sinuses.

Timing of removal of neck drains following head and neck surgery.

Studies of the volume of drainage over a 24-hour period that is sufficient to allow for the removal of a neck drain after head and neck surgery have not been reported, and thus the timing of drain removal varies among surgeons and institutions. We conducted a prospective study of 47 patients who had undergone major head and neck surgery to determine the safety and cost-effectiveness of removing a neck drain when the amount of drainage over a 24-hour period fell to 50 ml or less. When the volume reached that point in any given patient, the drain was clamped, and if no fluid collection was observed the following day, the drain was removed. We found that drain removal according to this protocol was successful in 91% of cases, as only 4 patients (9%) developed a seroma following removal. No other complications were observed. In a separate analysis, we retrospectively reviewed the cases of 22 other patients who had undergone surgery at a different institution. Their drains were not removed until the drainage volume fell to 25 ml over 24 hours. It took a median of 1.3 days (range: 1 to 3) for drainage to fall from 50 ml to less than 25 ml over 24 hours. We conclude that drains can be removed safely when the volume falls to 50 ml or less over a 24-hour period. This would result in less morbidity, shorter hospital stays, and significant cost savings.

Investigation of mitochondrial sequence variants associated with aminoglycoside-induced ototoxicity in South African TB patients on aminoglycosides.

A known side effect of aminoglycoside antibiotics is the development of permanent hearing loss. As South Africa is currently facing a tuberculosis (TB) epidemic, with an increasing number of multi-drug resistant tuberculosis (MDR-TB) infections, the use of aminoglycosides is on the increase. It is therefore important to determine whether the mitochondrial mutations associated with aminoglycoside-induced hearing loss occur at high frequencies in particular ethnic groups in our population. A total of 115 mainly MDR-TB patients all on aminoglycosides and 439 controls representative of the main ethnic groups in South Africa were screened for six mutations using the SNaPshot technique. Furthermore, the mitochondrial genomes of eight patients with ototoxicity were sequenced. Homoplasmic mutations were found in controls (A1555G in 0.9% of Black controls and A827G in 1.1% of Afrikaner controls) which reveal that a significant proportion of the South African population is genetically predisposed to developing aminoglycoside-induced hearing loss. The 961 delT+insC((n)) and T961G variants were found at frequencies of >1% indicating that both are probably non-pathogenic polymorphisms. Sequencing of the entire mitochondrial genome in eight patients did not reveal any mutations in the MT-RNR1 gene. However, two potentially pathogenic variants, T10114C (I19T in MT-ND3) and T15312C (I189T in MT-CYB) were found that may impact on the oxidative phosphorylation capacity and warrant further investigation for their possible role in this disorder. It is imperative that the genetic basis of this potentially preventable condition be investigated, particularly in countries where aminoglycosides are still commonly used, in order to identify individuals and/or ethnic groups who are at risk for this type of hearing loss.

A rapid method for detection of five known mutations associated with aminoglycoside-induced deafness.

BACKGROUND: South Africa has one of the highest incidences of multidrug-resistant tuberculosis (MDR-TB) in the world. Concomitantly, aminoglycosides are commonly used in this country as a treatment against MDR-TB. To date, at least five mutations are known to confer susceptibility to aminoglycoside-induced hearing loss. The aim of the present study was to develop a rapid screening method to determine whether these mutations are present in the South African population. METHODS: A multiplex method using the SNaPshot technique was used to screen for five mutations in the MT-RNR1 gene: A1555G, C1494T, T1095C, 961delT+C(n) and A827G. A total of 204 South African control samples, comprising 98 Mixed ancestry and 106 Black individuals were screened for the presence of the five mutations. RESULTS: A robust, cost-effective method was developed that detected the presence of all five sequence variants simultaneously. In this pilot study, the A1555G mutation was identified at a frequency of 0.9% in the Black control samples. The 961delT+C(n) variant was present in 6.6% of the Black controls and 2% of the Mixed ancestry controls. The T1095C, C1494T and A827G variants were not identified in any of the study participants. CONCLUSION: The frequency of 0.9% for the A1555G mutation in the Black population in South Africa is of concern given the high incidence of MDR-TB in this particular ethnic group. Future larger studies are warranted to determine the true frequencies of the aminoglycoside deafness mutations in the general South African population. The high frequencies of the 961delT+C(n) variant observed in the controls suggest that this change is a common non-pathogenic polymorphism. This genetic method facilitates the identification of individuals at high risk of developing hearing loss prior to the start of aminoglycoside therapy. This is important in a low-resource country like South Africa where, despite their adverse side-effects, aminoglycosides will continue to be used routinely and are accompanied with very limited or no audiological monitoring.