Edendale Hospital

Background: Metformin, widely used in diabetes treatment, is linked to reduced cobalamin (vitamin B12) levels, potentially exacerbating diabetic peripheral neuropathy (PN) and increasing the risk of lower limb amputations. Studies suggest that black individuals might be less prone to vitamin B12 deficiency, but the impact of metformin on vitamin B12 levels in this group is unclear. Objective: This study investigated the prevalence of vitamin B12 deficiency in diabetics on metformin and examined the relationship between metformin use and PN. Methods: A retrospective review of patient records from Edendale Hospital's diabetes clinic in Pietermaritzburg (January 1, 2017, to December 31, 2018) was conducted. Patients over 18 years of black descent with documented vitamin B12 levels were included. The study extracted data on diabetes treatment, vitamin B12 levels, and PN indicators. Results: Of 668 patients, 558 met the criteria. Metformin was used by 341 patients (61.1%), alone or with other treatments, while 217 (38.9%) did not use metformin. Glycaemic control was similar in both groups (median HbA1C 9.4% (IQR 7.8-11.0) in metformin users vs. 9.46% (IQR 7.1-11.0) in non-users, p = 0.80). Absolute vitamin B12 deficiency was equally rare in both groups (6 [1.8%] in metformin users vs. 4 [1.8%] in non-users, p = 1.0), but metformin users had significantly lower median vitamin B12 levels (299.0 pmol/l vs. 340.0 pmol/l in non-users, p < 0.05). PN prevalence was similar in both groups (31.7% in metformin users vs. 25.1% in non-users, p = 0.12). However, those with borderline-low vitamin B12 levels (<= 269 pmol/l) had a higher risk of PN (OR 1.6; 95% CI: 1.1-2.3, p = 0.015). Conclusion: Metformin users showed lower median serum vitamin B12 levels than non-users, with an association between metformin use and borderline-low vitamin B12 levels. Higher metformin doses correlated with lower vitamin B12 levels, yet a direct link between metformin use and PN was not established.

Background: Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods: This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July-November 2014) and GlobalSurg-2 (January-July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator ('LASSO')) and machine learning (extreme gradient boosting ('XGBoost')). Final model selection was based on prognostic accuracy and clinical utility. Results: There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept -0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion: The 'Global Surgical-Site Infection' score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.e the score is so simple, this is easy to use all around the world.

Introduction: The current standard management of full-thickness or deep dermal burns is early tangential excision and skin grafting. A conservative approach to deep burns without the option of skin grafting results in delayed wound healing, possibly leading to wound infection and is associated with hypertrophic scarring and increased morbidity and mortality. The aim of this study was to improve the understanding of the management and availability to perform skin grafting for burns on the African continent. It also sought to identify challenges and perceived improvements.Methods: A web-based, structured, closed-formatted, multinational survey was designed to gather information on the current state and availability of skin grafting of burn wounds on the African continent. The questionnaire consisted of 27 questions, available in English and French. It was reviewed within the GAP-Burn collaboration network and spread via the snowball system to African countries health care professionals.Results: The questionnaire was completed 84 times, of which 3 had to be excluded. Responses originated from 22 African countries. The majority 71 (87.7%) resulted from countries with a low Human Development Index (HDI), 7 (8.6%) from medium HDI countries. Split thickness skin grafting (STSG) is performed in 51 (63.0%%) centers. The majority considers STSG to reduce length of stay (72.8%) and improve scarring (54.3%), yet some indicated that STSG is associated with increased risk of donor site infection (8.6%) and severe bleeding (7.4%). Factors preventing increased grafting included lack of equipment and training.Conclusion: Skin grafting is not performed in a significant number of hospitals treating burns. The majority of the staff believe that more skin grafting would lead to a better outcome. Advocacy and improved infrastructure, human resources coupled with introduction to well-structured health coverage for all in African countries could help to better access and affordability in burn care.Funding: This study did not receive any funding.Declaration of Interest: The authors have nothing to declare.Ethical Approval: The ethical review of this study was waived by the Ethics Committee of the Hamburg Medical Association, as the project did not collect data on individual patients. Informed consent was obtained from the respondents before starting the questionnaire.

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

Sub-Saharan Africa is undergoing rapid population ageing and better understanding of the burden of musculoskeletal conditions is needed. We have estimated a large increase in the burden of hip fractures for South Africa over the coming decades. These findings should support preparation of hip fracture services to meet this demand. A better understanding of the burden of fragility fractures in sub-Saharan Africa is needed to inform healthcare planning. We aimed to use recent hip fracture incidence data from South Africa (SA) to estimate the future burden of hip fracture for the country over the next three decades. Hip fracture incidence data within the Gauteng, KwaZulu-Natal and Western Cape provinces of SA were obtained from patients aged ≥ 40 years with a radiograph-confirmed hip fracture in one of 94 included hospitals. Age-, sex- and ethnicity-specific incidence rates were generated using the 2011 SA census population for the study areas. Incidence rates were standardised to United Nations (UN) population projections, for the years 2020, 2030, 2040 and 2050, and absolute numbers of hip fractures derived. The 2767 hip fracture patients studied had mean (SD) age 73.7 (12.7) years; 69% were female. Estimated age- and ethnicity-standardised incidence rates (per 100,000 person-years) for the overall SA population in 2020 were 81.2 for females and 43.1 for males. Overall projected incidence rates were discernibly higher by the year 2040 and increased further by the year 2050 (109.0 and 54.1 for females and males, respectively). Estimates of the overall annual number of hip fractures for SA increased from approximately 11,000 in 2020 to approximately 26,400 by 2050. The hip fracture burden for SA is expected to more than double over the next 30 years. Significant investment in fracture prevention services and inpatient fracture care is likely to be needed to meet this demand.