This study was a retrospective chart review of all patients with a clinical diagnosis of stroke presenting to an ED of a regional hospital in rural KwaZulu-Natal from November 2018 to November 2019.Results: A total of 362 patient charts were screened, and 136 of the charts met the inclusion criteria for the study. Seventy per cent of the patients had pre-existing hypertension, only one patient was not on treatment and two patients were not on secondary prevention. In human immunodeficiency virus-positive patients (20.5%; n = 28), 17 patients were under 50 years old. The most common finding on computer tomography was ischemic strokes (74%, n = 100). Thrombolysis was given to five patients included in the study. The overall in-hospital mortality rate was 4.06%. Conclusion:This study adds to the limited data about stroke in South Africa. Our population represents a unique blend of infectious and lifestyle disease. More research in this setting is recommended to develop local guidelines on emergency stroke care.
Objective:To determine the burden of human immunodeficiency virus (HIV) disease and co-infection on a district-level Emergency Department (ED) in KwaZulu-Natal. Methods: A retrospective chart review was conducted of the case notes of adult medical patients who presented to the ED over a three-month period. Patients presenting with HIV disease and its complications were identified. Patient demographics, disease presentation and severity, investigations and procedures undertaken, and disposition of patients in the HIV-positive cohort were assessed. Results: 428 of the 861 (49.7%) medical patients presenting to the ED were HIV positive. Some 37% of patients did not know their HIV status. In the HIV-positive cohort, the median age of presentation was 37 years, with almost equal male-to-female distribution. Of the patients seen, 57.5% were referred and 68% of patients presented after hours. In total, 80% of patients were triaged as yellow code. The predominant systems involved were the respiratory and central nervous systems, with pulmonary tuberculosis, community-acquired pneumonia and meningitis being the most common diagnoses. X-rays and laboratory testing were the most common investigations requested. Lumbar punctures, pleural paracentesis and pericardiocentesis were common emergency procedures performed. The majority (89.3%) of patients were admitted to the medical ward. Of the HIV-positive patients, 33% were on anti-retroviral therapy. ED mortality was 1.9%. Conclusion: In South Africa, very little is known about the ED's ability to cope with the HIV epidemic. This study highlights the significant impact HIV places on the resources of an ED. Strengthening of the primary health care system with a more aggressive approach to HIV testing and ARV initiation may contribute positively to reducing the burden of HIV emergencies and co-morbidities presenting to the ED.
Background: Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal.Methods: A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data.Results: A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation (n = 383) and extended focused assessment with sonography for trauma (n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours.Conclusion: Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments.
Objective: To determine the burden of human immunodeficiency virus (HIV) disease and co-infection on a district-level Emergency Department (ED) in KwaZulu-Natal. Methods: A retrospective chart review was conducted of the case notes of adult medical patients who presented to the ED over a three-month period. Patients presenting with HIV disease and its complications were identified. Patient demographics, disease presentation and severity, investigations and procedures undertaken, and disposition of patients in the HIV-positive cohort were assessed.Results: 428 of the 861 (49.7%) medical patients presenting to the ED were HIV positive. Some 37% of patients did not know their HIV status. In the HIV-positive cohort, the median age of presentation was 37 years, with almost equal male-to-female distribution. Of the patients seen, 57.5% were referred and 68% of patients presented after hours. In total, 80% of patients were triaged as yellow code. The predominant systems involved were the respiratory and central nervous systems, with pulmonary tuberculosis, community-acquired pneumonia and meningitis being the most common diagnoses. X-rays and laboratory testing were the most common investigations requested. Lumbar punctures, pleural paracentesis and pericardiocentesis were common emergency procedures performed. The majority (89.3%) of patients were admitted to the medical ward. Of the HIV-positive patients, 33% were on anti-retroviral therapy. ED mortality was 1.9%.Conclusion: In South Africa, very little is known about the ED’s ability to cope with the HIV epidemic. This study highlights the significant impact HIV places on the resources of an ED. Strengthening of the primary health care system with a more aggressive approach to HIV testing and ARV initiation may contribute positively to reducing the burden of HIV emergencies and co-morbidities presenting to the ED.MeSH: Human Immunodeficiency virus (HIV); Emergency Department, South Africa, opportunistic infections; HIV testing
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