Lentigo Maligna of the head and neck: A retrospective study assessing surgical excision margins in a South African population.

Background: Lentigo maligna (LM) is a subtype of melanoma in situ that occurs on sun-damaged skin and is associated with significant subclinical extension beyond the clinical margins of the lesion.

Objectives: This study aimed to determine if the standard recommended tumor excision margins for LM are adequate to achieve a 97% clearance rate and if any patient or tumor characteristics warranted wider margins.

Methods: This study is a retrospective chart review of all patients who were diagnosed with LM of the head and neck and treated with staged excision.

Surgical training during the COVID-19 pandemic - a single institution's trainee survey.

Background: Few studies have assessed the impact of COVID-19 on surgical training in low- and middle-income countries. The aim of this study was to survey the effect of the COVID-19 pandemic on postgraduate surgical training, research and registrar wellbeing in South Africa.

Methods: A cross-sectional study was conducted as an online survey from 5 October 2020 to 1 December 2020.

Targeted Gene Expression Profiling of Human Myeloid Cells From Blood and Lung Compartments of Patients With Tuberculosis and Other Lung Diseases.

Myeloid-derived suppressor cells (MDSC) have been identified in the peripheral blood and granulomas of patients with active TB disease, but their phenotype-, function-, and immunosuppressive mechanism- spectrum remains unclear. Importantly, the frequency and signaling pathways of MDSC at the site of disease is unknown with no indication how this compares to MDSC identified in peripheral blood or to those of related myeloid counterparts such as alveolar macrophages and monocytes. Most phenotypic and functional markers have been described in oncological studies but have not yet been validated in TB.

Analysis of registered radiological equipment in Kenya.

Introduction: diagnostic radiology plays a key role in healthcare. Proper planning of healthcare requires accurate and robust data. There´s, however, paucity of comprehensive figures on radiological equipment in the African setting.

Examining trends in the evidence base for the treatment of burns and a quality assessment of randomised controlled trials over an 11-year period.

Background: Previous articles assessed the evidence-base for the treatment of burns, but the latest was published in 2010, examining data up to and inclusive of 2008. The aim of this article is to examine the trend in the number of high-evidence publications over the subsequent 11-year period and quality-assess RCTs within this timeframe.

Materials And Methods: All articles published in Burns and Journal of Burn Care and Research (JBCR) were identified using PubMed Search Tools and its Single Citation Matcher function.

Pleural Tuberculosis.

Pleural tuberculosis (TB) is common and often follows a benign course but may result in serious long-term morbidity. Diagnosis is challenging because of the paucibacillary nature of the condition. Advances in Mycobacterium culture media and PCR-based techniques have increased the yield from mycobacteriologic tests.

Maternal mortality: near-miss events in middle-income countries, a systematic review.

Objective: To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and to evaluate its applicability in these settings.

Methods: We did a systematic review of studies on maternal near misses in middle-income countries published over 2009-2020. We extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ dysfunction.

Breast reconstruction during the COVID-19 pandemic in resource-limited settings.

The coronavirus disease 2019 (COVID-19) is a novel, rapidly changing pandemic. It has affected specialized medical services in unprecedented ways. Surgical decision making, always the most important aspect of care has taken on an added layer of complexity in the face of the COVID-19 pandemic.

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching.

Background: Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient.

Identification of Palliative Care Needs in Cancer Patients in a Surgical Emergency Center.

Background: Advanced cancer is associated with a significant symptom burden, and timely identification of palliative care (PC) needs, and provision of appropriate PC can improve treatment outcomes, reduce healthcare cost, and enhance patient and family satisfaction with care. Several tools have been used to identify PC needs in different clinical settings and patient groups.

Objective: The primary objective was to determine the prevalence and associated characteristics of PC needs among cancer patients admitted to the surgical emergency center (SEC) of a large academic hospital in South Africa (SA).

Corticosteroids in critical COVID-19: Are all corticosteroids equal?

The hyperinflammation seen as part of a dysregulated immune response to SARS-CoV-2 in its most severe form leads to acute respiratory distress syndrome (ARDS), multiorgan failure and death. Corticosteroid therapy targets this hyperinflammation, otherwise known as a cytokine storm. It is the only therapeutic agent to date with a mortality benefit, with clear guidelines from national and international health authorities guiding its use.

The tumor genetics of acral melanoma: What should a dermatologist know?

Dermatologists stand at the gateway of individualization of classification, treatment, and outcomes of acral melanoma patients. The acral melanoma genetic landscape differs in vital ways from that of other cutaneous melanomas. These differences have important implications in understanding pathogenesis, treatment, and prognosis.

Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings.

Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management.

Establishment of a Patient-Derived, Magnetic Levitation-Based, Three-Dimensional Spheroid Granuloma Model for Human Tuberculosis.

Tuberculous granulomas that develop in response to Mycobacterium tuberculosis (M. tuberculosis) infection are highly dynamic entities shaped by the host immune response and disease kinetics. Within this microenvironment, immune cell recruitment, polarization, and activation are driven not only by coexisting cell types and multicellular interactions but also by M.

New insights into spontaneous pneumothorax: A review.

A spontaneous pneumothorax is a pneumothorax that does not arise from trauma or an iatrogenic cause. Although the traditional classification of either primary or secondary spontaneous pneumothorax based on the absence or presence of overt underlying lung disease is still widely used, it is now well recognised that primary spontaneous pneumothorax is associated with underlying pleuropulmonary disease. Current evidence indicates that computed tomography screening for underlying disease should be considered in patients who present with spontaneous pneumothorax.

Angiotensin-converting enzyme 2 gene expression in human male urological tissues: implications for pathogenesis and virus transmission pathways.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection occurs through binding and internalization of the viral spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor on the host cell membrane. Pathological changes are caused by damage and failure of vital organs that express high levels of ACE2, including the lungs, the heart and the kidneys. The aim of this study was to investigate ACE2 gene expression in the human male urogenital tract using a public database.

Inflammatory and coagulative pathophysiology for the management of burn patients with COVID-19: systematic review of the evidence.

The pathogenesis of coronavirus disease 2019 (COVID-19) involves a prominent innate immune response to SARS-CoV-2 infection, including inflammatory cytokines, chemokines, the complement system and acute phase proteins. This hyperinflammatory response predisposes patients to thromboembolic disease, acute lung injury, acute respiratory distress syndrome and multiple organ dysfunction syndrome. In burn injuries, damaged tissues induce a local and systemic inflammatory response through pathways associated to COVID-19.

Relative Sparing of the Left Upper Zone on Chest Radiography in Severe COVID-19 Pneumonia.

The radiological findings of COVID-19 are well-described, including its evolution. In an earlier report of admission chest radiographs of patients with COVID-19, we anecdotally noted relative sparing of the left upper zone (LUZ). We subsequently aimed to describe the main chest radiograph findings in another cohort, focusing on zonal predominance.

Great saves or near misses? Severe maternal outcome in Metro East, South Africa: A region-wide population-based case-control study.

Objective: To assess the incidence of severe maternal outcome (SMO), comprising maternal mortality (MM) and maternal near miss (MNM), in Metro East health district, Western Cape Province, South Africa between November 2014 and November 2015 and to identify associated determinants leading to SMO with the aim to improve maternity care.

Methods: Region-wide population-based case-control study. Women were included in the study, if they were maternal deaths or met MNM criteria, both as defined by WHO.