Operationalizing the New Global Definition of ARDS: A Retrospective Cohort Study From South Africa.

Background: A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.

Research Question: How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?

Study Design And Methods: We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.

Results: Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.

Case Report.

The illegal practice of combining organophosphates (OPs) with other compounds such as carbamates and pyrethroids, creating 'streetpesticides', is common in South Africa. These agents contain mostly unknown quantities of unregulated toxins and contribute to atypicaland unpredictable clinical presentations following human ingestion. We present such a case in a patient with intentional rodenticideingestion.

Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa.

Background: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output.

Objectives: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa.

Methods: A retrospective review of morbidity and mortality data was conducted.

Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa.

Background: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output.

Objectives: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa.

Methods: A retrospective review of morbidity and mortality data was conducted.

Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study.

Background: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs.

Vital sign based shock scores are poor at triaging South African trauma patients.

Background: Traumatic shock cannot be diagnosed by a single physiological measurement and a number of vital sign based combined shock scores (CSS) have been proposed to identify and triage trauma patients with shock. This audit uses data from a prospectively entered electronic trauma registry to compare the ability of these CSS to predict in-hospital mortality, need for surgery, need for blood transfusion and ICU admission.

Materials And Methods: The data used in the study was obtained from the Hybrid Electronic Medical Record (HEMR) in Pietermaritzburg from January 2012-September 2015.

Predicting postoperative haemoglobin changes after burn surgery.

Background: Burn surgery is associated with significant blood loss and fluid shifts that cause rapid haemoglobin (Hb) changes during and after surgery. Understanding the relationship between intraoperative and postoperative (day 1) Hb changes may assist in avoiding postoperative anaemia and unnecessary peri-operative blood transfusion.

Objective: To describe the Hb changes into the first day after burn surgery and to identify factors predictive of Hb changes that would guide blood transfusion decisions.

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes.

Background: Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.

Objective: To determine the efficacy of the SSC using data from randomised controlled trials (RCTs).

Methods: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546).

Maternal death and caesarean section in South Africa: Results from the 2011-2013 Saving Mothers Report of the National Committee for Confidential Enquiries into Maternal Deaths.

Background: In the latest (2011-2013) Saving Mothers report, the National Committee for Confidential Enquiries into Maternal Deaths in South Africa (SA) (NCCEMD) highlights the large number of maternal deaths associated with caesarean section (CS). The risk of a woman dying as a result of CS during the past triennium was almost three times that for vaginal delivery. Of all the mothers who died during or after a CS, 3.

Oxytocin--ensuring appropriate use and balancing efficacy with safety.

Maternal deaths due to haemorrhage continue to increase in South Africa (SA). It appears that oxytocin and other uterotonics are not being used optimally, even though they are an essential part of managing maternal haemorrhage. Oxytocin should be administered to every mother delivering in SA.

'But it's just a spinal': combating increasing rates of maternal death related to spinal anaesthesia.

The number of women dying as a result of spinal anaesthesia during caesarean section in South Africa is steadily increasing in the triennial reports of the National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD). This article postulates some of the reasons behind this phenomenon. The concern is raised that spinal anaesthesia is being undertaken inappropriately by poorly trained practitioners.

Variations in levels of care within a hospital provided to acute trauma patients.

Introduction: Caring for trauma patients is a dynamic process, and it is often necessary to move the trauma patient around the hospital to different locations. This study attempted to document the quality of observations performed on acute trauma patients as they moved through the hospital during the first 24 hours of care.

Methodology: This study was a student elective and was undertaken at Grey's Hospital, Pietermaritzburg.

Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section.

Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml x kg(-1) of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload).