Chris Hani Baragwanath Hospital is a hospital in Johannesburg, South Africa, it is the largest hospital in Africa and third largest hospital in the world. It has 6,760 staff members, 3,400 beds and occupies 70 ha (170 acres). The hospital is located in the Soweto area south of Johannesburg. It is one of the 40 Gauteng provincial hospitals, and is financed and managed by the Gauteng Provincial Department of Health. It is a teaching hospital for the University of the Witwatersrand Medical School, along with the Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital and the Rahima Moosa Mother and Child Hospital. It is an accredited Level one trauma center.
Second primary malignancies are a recognised long-term complication of childhood cancer. Osteosarcoma arising as a second malignancy is uncommon, and chest-wall involvement is rarer still, raising particular difficulties in achieving clear margins, reconstructing the thoracic wall, and separating a new tumour from recurrence of the original disease. We report chondroblastic osteosarcoma of the rib arising nine years after treatment for high-risk neuroblastoma. A 12-year-old girl, treated at the age of three for stage III, N-MYC-amplified right adrenal neuroblastoma, presented with a two-week history of a painful right anterior chest-wall mass initially taken for a breast lump. Imaging showed an expansile mixed lytic-sclerotic lesion of the right fourth rib with chest-wall and pleural extension, and core-needle biopsy confirmed chondroblastic osteosarcoma (SATB2 positive; hormone-receptor negative). After neoadjuvant chemotherapy on the EURAMOS-1 protocol, en bloc resection of the right third to fifth ribs was performed with a porcine acellular dermal-matrix reconstruction. Positive deep, lateral, and medullary margins prompted re-excision a week later, which achieved clear margins. Tumour necrosis of 80
BACKGROUND:Antiretroviral therapies with long dosing intervals have the potential to improve virological outcomes and treatment satisfaction for people with HIV-1. We report the primary endpoint results from week 48 of ISLEND-2, a phase 3 trial evaluating the efficacy and safety of switching to once-weekly oral islatravir-lenacapavir from daily oral standard of care in virologically suppressed adults with HIV-1. METHODS:This randomised, open-label, active-controlled, phase 3 non-inferiority trial was conducted at 100 sites in 14 countries and territories. Eligible participants were adults (aged ≥18 years) with HIV-1 who had been virologically suppressed on daily oral standard-of-care treatment for at least 6 months and had no previous virological failure. Participants were randomly assigned (1:1), using interactive response technology and stratified by geographical region, antiretroviral class, and CD4+ T-cell count, to switch to the once-weekly, single-tablet oral regimen of islatravir (2 mg)-lenacapavir (300 mg) or to continue daily oral standard of care for at least 96 weeks. The primary endpoint was the proportion of participants with an HIV-1 RNA viral load of 50 copies per mL or higher at week 48 (as per the US Food and Drug Administration-defined Snapshot algorithm), with a non-inferiority margin of 4%, assessed in all randomly assigned participants who received any dose of the assigned treatment. This trial is registered with ClinicalTrials.gov, NCT06630299, and is active but closed to new participants. FINDINGS:From Oct 8, 2024, to April 30, 2025, 727 participants were screened, of whom 647 were eligible for the study, 634 were randomly assigned, and 626 received treatment: 314 with islatravir-lenacapavir and 312 with standard of care. Of 626 participants, 211 (34%) were female, 193 (31%) were Black, 119 (19%) were Asian, 123 (20%) were Hispanic or Latine, and 89 (14%) were aged 65 years or older. At baseline, 552 (88%) were on a single-tablet antiretroviral regimen and 478 (76%) were receiving regimens containing integrase strand transfer inhibitors. At week 48, one (0·3%) of 314 participants in the islatravir-lenacapavir group and four (1·3%) of 312 participants in the standard-of-care group had an HIV-1 RNA viral load of 50 copies per mL or higher (difference -1·0% [95·002% CI -3·0 to 1·1]), meeting the non-inferiority criteria. Treatment-related adverse events occurred in 58 (18%) of 314 participants in the islatravir-lenacapavir group and one (<1%) of 312 participants in the standard-of-care group. Two (1%) of 314 participants in the islatravir-lenacapavir group and one (<1%) of 312 participants in the standard-of-care group discontinued the study owing to adverse events, with adverse events of grade 3 or higher occurring in 24 (8%) and 28 (9%) participants and serious adverse events in 22 (7%) and 27 (9%) participants in the islatravir-lenacapavir group and standard-of-care group, respectively. There were three deaths: one in the islatravir-lenacapavir group and two in the standard-of-care group, none of which were considered treatment-related. INTERPRETATION:Once-weekly islatravir-lenacapavir showed non-inferior efficacy to the standard of care and was generally well tolerated. Longer-term safety data will provide further valuable insights beyond the week 48 data presented here. Islatravir-lenacapavir has potential to be the first once-weekly complete oral single-tablet regimen for HIV-1 treatment. FUNDING:Gilead Sciences and Merck Sharp & Dohme.
Background: Selective conservative management of asymptomatic patients with small pneumothorax (PTX) in the specific setting of thoracic stab wounds (SWs) has been demonstrated to be safe. However, the optimal timing in obtaining interval chest radiograph (CXR) remains unknown. Methods: A prospective study was conducted over a 14-year period on patients with isolated thoracic SWs who were asymptomatic with small PTX on CXR ( Results: Fifty patients were included (87% male, mean age: 24 years). 43 (86%) were male and the mean age was 27 years. All 50 were successfully managed without tube thoracostomy (TT), with no adverse outcome. 35 (70%) had their interval CXR obtained at 12 hours, 7 (14%) at 12-16 hours, 4 (8%) at 16-20 hours and 3 (6%) at 20-24 hours. All patients demonstrated complete resolution of PTX at each of the time intervals and remained asymptomatic. Conclusion: In patients with asymptomatic small PTX <0.5 cm, interval CXR at 12 hours invariably demonstrates complete resolution. As all patients remained asymptomatic, this may facilitate earlier patient discharge.
BACKGROUND:Lung cancer remains a major contributor to cancer mortality in sub-Saharan Africa (SSA), where late diagnosis, driven by low awareness, sociocultural barriers, and health system constraints, limits effective treatment. Despite the growing burden, evidence on patients' quality of life (QoL) and symptom experience in SSA is limited. OBJECTIVE:This study aimed to describe the common symptoms and QoL of patients with lung cancer treated at 2 hospitals in SSA, and to investigate the association of demographics, clinical characteristics, and symptom burden with QoL. METHODS:This was a cross-sectional study that consecutively recruited patients with lung cancer from 2 teaching hospitals in SSA: Bugando Medical Centre (BMC) in Tanzania and the University of the Witwatersrand Centre of Respiratory Excellence (WITS-CORE) in South Africa. Data collected included demographics, clinical information, and performance status using the Eastern Cooperative Oncological Group Performance Scale (ECOG-PS). Health-related QoL was assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The study followed all ethical procedures, and data were analyzed using both descriptive and inferential statistics in Stata 18. A P value of <.05 was considered statistically significant. RESULTS:A total of 174 patients with lung cancer were enrolled across the 2 sites. The score on the EORTC QLQ-C30 global health status/QoL subscale was low, with a median of 41.67 (IQR 33.33-41.67), and it varied by site. Patients from WITS-CORE demonstrated higher social functioning scores, while those from BMC reported greater financial difficulties. A low global health status/QoL score was independently associated with the BMC site (adjusted odds ratio [aOR] 3.5, 95% CI 1.3-9.3) and poor performance status (ECOG-PS 3-4; aOR 3.4, 95% CI 1.2-6.6). Furthermore, symptoms such as nausea and vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial struggles were all associated with a low global health status/QoL score. CONCLUSIONS:QoL among patients with lung cancer in SSA is poor. Low QoL is strongly associated with the Multinational Lung Cancer Control Program study site, poor performance status, and a range of symptoms and financial difficulties. Addressing these factors may help to improve patient outcomes and well-being in SSA.
Background: Routine application of cervical spine collar for immobilisation is a common practice but remains controversial in the setting of gunshot wounds (GSW) to the neck. Objectives: The aim of this study was to review the incidence of unstable cervical spine injuries (CSI) following GSW to the neck in a high volume, developing world setting. Methods: A retrospective study conducted over a 10 year period from December 2012 to December 2022 at a major trauma centre in South Africa (Pietermaritzburg Metropolitan Trauma Service). Results: A total of 221 patients with GSW were reviewed. Thirty two patients underwent immediate neck exploration and 189 (86%) patients underwent a computed tomography angiography (CTA). Of the 189 patients who underwent CTA of the neck, CSI was noted in 61 (32%). 13 of the 189 patients (7%) had a spinal cord injury. All 13 of these patients had evidence of neurological deficits documented on presentation. Of the 61 patients with CSI, only one patient had an injury considered to be an unstable CSI (comminuted fracture of C5) and underwent an anterior spinal fusion. For those with no neurological deficits on presentation, none developed neurological deficits during their hospital stay or after discharge. Conclusions: CSI in the specific context of GSW to the neck is not rare, but the incidence of unstable CSI is a rare entity. There appears to be minimal benefit from the routine application of cervical collar in this setting, especially for patients presenting without neurological deficit.
