The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.

BackgroundHealthcare workers (HCWs) are constantly vulnerable to occupational blood and body fluid exposures (OBBFEs). Exposed HCWs experience emotional, physical and psychological trauma. Less experienced HCWs, such as intern doctors, are more prone to OBBFEs.ObjectivesThe aim of this study was to investigate the prevalence and practices pertaining to OBBFEs amongst a select group of intern doctors in the Gauteng province of South Africa.MethodsA quantitative cross-sectional descriptive study using a questionnaire based on a practical model was used. Intern doctors were recruited from four major hospitals in Gauteng.ResultsA total of 175 intern doctors participated in the study. There was a total of 182 (mean = 1.04, standard deviation [s.d] 0.88) reported OBBFEs amongst 136 (77.7%) subjects. The exposures occurred predominantly whilst subjects were working in surgery (n = 50, 27.5%), obstetrics and gynaecology (n = 49, 26.9%) and internal medicine (n = 48, 26.4%) departments; were superficial wounds (n = 69, 37.9%); were acquired during vascular puncture or intravenous line insertion (n = 69, 37.9%); and occurred when subjects were working >12 h shifts (n = 101, 55.5%). Human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was initiated in 141 (77.5%) out of the 182 exposures. Only 90 (63.8%) subjects completed the recommended 28-day course of PEP. Two (1.1%) subjects reported that they had acquired HIV infection as a consequence of the OBBFE.ConclusionOccupational blood and body fluid exposures are common amongst intern doctors. It is recommended that regular training, health education and monitoring compliance should be incorporated during the induction of medical intern doctors in hospitals. The availability of PEP regimens with better tolerability will encourage compliance.

Acute myocardial infarction (AMI) occurs as a manifestation of coronary atherosclerotic disease. The occurrence of erectile dysfunction (ED) following AMI is well documented and this association and pathophysiology is often interrelated. Few studies have objectively assessed the diagnostic value of ED as a risk factor for AMI, in general. In this review, we aimed to better outline the diagnostic predictability of ED as a precursor for ‘first/new onset' AMI. This review was performed using selective search terms, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Cochrane, Embase, PubMed, Scopus and Web of Science databases were searched (September 2018). Selected studies were further assessed for relevance and quality (Critical Appraisal Skills Program tool-Oxford). Four studies [573 participants; mean 143 (SD ± 76.3604) and median 141 participants] were eligible for analysis. Meta-analysis of the studies resulted in a pooled sensitivity of 51.36% (95% CI: 47.37-55.33%). For the single study which reported true negative and false positive cases, a specificity of 76.53% (95% CI: 68.57-83.00%) was calculated. The results of this systematic review and meta-analysis suggest that a history of ED should be used as a risk factor for new onset AMI.

Though the pooled sensitivity was less than ideal (87.42%), this review and meta-analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus.

An incidental and sometimes humorous finding on an Antero-Posterior (AP) pelvis X-ray view is that of the John Thomas Sign (JTS), which is defined as positive, when the penile shadow points towards the side of a hip or pelvic fracture in male patients. Despite previous research reports and studies performed on the JTS sign, uncertainty with regards to its clinical relevance still remains. The objective of this review was to assess the clinical validity and accuracy of this sign by performing a systematic review and meta-analysis. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was performed (May 2017), using the following databases: BMJ best practice, Cochrane Database of Systematic Reviews, EMBASE, PubMed and Scopus. Studies comparing the predictability of the JTS were critically appraised. The summary effect (and 95% CI) was estimated using a random effect model and the Restricted Maximum Likelihood Method. The pooled sensitivity as well as the summary effect log odds ratio was determined. Selected studies were further ranked for quality and relevance using the Critical Appraisal Skills Program (CASP) (Oxford 2013) tool. Results: In total, nine articles were isolated and assessed. A total of 1942 participants were included. The mean sample size amongst these included studies was 243 participants with a median of 198 participants. Since the necessary data needed for the Meta-analysis was only present in the 6/9 studies assessed, these 6 were analyzed further. The JTS was positive in 1089 out of 1439 patients with a pooled sensitivity of 75.7% (95%CI, 73.4%-77.9%). There was a large variation in the sensitivity and specificity amongst studies, accounting for a non-significant summary Odds Ratio effect of -0.03. Conclusions: Based on this review, there is insufficient statistical evidence to support the reliability of the JTS to predict the laterality in the case of a hip fracture on the standard AP pelvis x-ray.