Tygerberg Hospital is a tertiary hospital located in Parow. The hospital was officially opened in 1976 and is the largest hospital in the Western Cape and the second largest hospital in South Africa, with the capacity for 1899 beds. It acts as a teaching hospital in conjunction with the Stellenbosch University's Health Science Faculty. To become a patient at Tygerberg, a person must be referred by a primary or secondary health care facility. Over 3.6 million people receive health care from Tygerberg, either directly or via its secondary hospitals, such as Paarl and Worcester Hospital. During the normal working day there are about 10,000 people on hospital grounds..
Background: Trauma is the third largest contributor to the global burden of disease with 90% of the trauma-related mortality occurring in low to middle income countries (LMICs) such as South Africa. The Acute Physiology and Chronic Health Evaluation (APACHE) II is widely used, but was developed in a first-world setting. This study sought to evaluate the APACHE II's ability to predict intensive care unit (ICU) mortality among trauma patients in a LMIC and to identify predictors of mortality within this population. Methods: This retrospective study was conducted by analysing data records of 284 ICU patients over 2 years. Performance of the APACHE II was assessed with calibration and receiver operator characteristic curves. Survivors and non-survivors were compared using descriptive statistics, and logistic regression identified independent risk factors. Results: An overall mortality rate of 18.8% was observed. Sensitivity of the APACHE II was 0.74, and specificity 0.68. The model showed good discrimination (area under receiver operating curve (AUROC) 0.82, 95% confidence interval) and calibration (Hosmer-Lemeshow p > 0.3). The cut-off value for APACHE II was 20.2. Community assault and intubation were more common in the demised cohort (p <0.01, odds ratio (OR) 4) although the APACHE II remained the strongest predictor of mortality when adjusting for confounders (p < 0.001). Conclusion: APACHE II is a valid mortality prediction tool in polytrauma patients. Patients with scores above 20 were at highest risk of mortality. Intubation and community assault were significant risk factors of mortality, however, they aren't included in the APACHE II score, highlighting the need to consider additional risk factors in the trauma population.
Published end-to-end validation data for 10 MV photon beams in mixed-vendor radiotherapy environments remain limited. A 10 MV photon beam from an Elekta Synergy Agility linear accelerator was commissioned in Eclipse (version 17.1), and the dosimetric performance of AAA and Acuros XB was evaluated using end-to-end testing. Beam data were measured in a PTW Beamscan water phantom and then imported into Eclipse to generate beam models for AAA and AXB. Eclipse was integrated with the Mosaiq oncology information system to enable better workflow. Following IAEA TECDOC-1583 guidelines, end-to-end test plans were created in Eclipse and delivered to a CIRS thorax phantom (model 002LFC) containing soft-tissue, lung, and bone-equivalent inserts. Absolute dose measurements were compared for AAA, AXB dose-to-water (Dw), and AXB dose-to-medium (Dm), with stopping-power corrections applied for lung and bone regions. End-to-end testing demonstrated good overall agreement for both algorithms. AAA showed consistent performance in soft tissue and closer agreement in bone-equivalent regions, while AXB performed better in lung-equivalent regions. Larger deviations were observed for AXB in posterior beam arrangements where the beam passed through bone before reaching the target. The 10 MV photon beam was successfully commissioned and verified for clinical use in the Eclipse system. Both AAA and AXB demonstrated clinically acceptable accuracy for 3DCRT. Although algorithm-dependent differences were observed in heterogeneous conditions, AAA remains suitable for 3DCRT planning when AXB is unavailable. This work contributes new end-to-end validation data for a 10 MV Elekta-Eclipse configuration, addressing a current gap in the literature for mixed-vendor radiotherapy systems.
A 6-day-old neonate presented with persistent reticulated violaceous patches from birth that were unresponsive to warming and associated with subtle cutaneous atrophy and limb hypotrophy. The findings were diagnostic of cutis marmorata telangiectatica congenita, distinguished from physiological cutis marmorata by its persistence and associated atrophy. Recognition is important to prompt screening for associated extracutaneous anomalies.
Aims:Surgical management of intermediate and malignant tumours in the pelvis is complex. Complications are frequent and either related to the surgery itself or to post-surgical failure of the reconstruction technique. This systematic review and meta-analysis aims at analyzing all reported complications following PI to PIII pelvic resections for intermediate and malignant tumours. Methods:Based on a systematic literature search on PubMed adhering to the PRISMA guidelines, 1,683 study records were identified, of which we included 90 original studies published until 22 July 2025. Overall complication rates were assessed with random-effects meta-analysis. Differences in complication rates between reconstruction types (i.e. megaprosthetic, mostly biological, none) were evaluated with meta regression analysis. Results:Data on 2,199 patients (1,250 males (57%)) with mainly PI to PIII pelvic resections were analyzed. The most common reconstruction types were custom-made implants (21%; n = 451) and ice-cream cone prostheses (14%; n = 312). Pooled rates of infections, wound healing problems, nerve injuries, and deep vein thrombosis (DVT) amounted to 15% (95% CI 12% to 18%), 13% (95% CI 10% to 15%), 7% (95% CI 5% to 9%), and 4% (95% CI 2% to 6%), respectively. Further, pooled implant revision/removal and secondary external hemipelvectomy rates were 14% (95% CI 11% to 17%) and 4% (95% CI 3% to 5%). Mostly biological reconstructions were associated with higher rates of nerve injuries (p < 0.001), construct failures (p = 0.010), and secondary implant revision/removal (p = 0.003) compared to megaprosthetic reconstruction. Further, biological reconstructions were associated with increased secondary external hemipelvectomy rates compared to megaprosthetic reconstructions (p = 0.005) or no reconstructions (p = 0.001). Conclusion:Treatment of pelvic malignancies is challenging, with technically demanding resections and complex reconstructions. Across all reconstruction techniques following sacrum-sparing pelvic resections, infections and wound healing problems are the most common complications, yet there is also a considerable proportion of patients with neurovascular complications and DVTs.
BACKGROUND:Patients are at increased risk for recurrent ischemic events after an acute coronary syndrome event. Milvexian, an oral factor XIa inhibitor, may reduce the risk of major adverse clinical events with minimal bleeding risk. METHODS:In this phase 3, randomized, placebo-controlled trial, we evaluated the efficacy and safety of milvexian when added to standard antiplatelet therapy within 7 days after an acute coronary syndrome event. Patients were assigned in a 1:1 ratio to receive oral milvexian (25 mg twice daily) or matched placebo. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or ischemic stroke as evaluated in a time-to-event analysis. The principal safety outcome was Bleeding Academic Research Consortium (BARC) type 3c or 5 bleeding (intracranial or intraocular bleeding that compromises vision or fatal bleeding). RESULTS:After a planned interim analysis that was based on 556 adjudicated efficacy end points, the trial was terminated for futility. A total of 14,194 patients had been enrolled, with 7094 assigned to receive milvexian and 7100 to receive placebo. After a median follow-up of 12.2 months, a primary efficacy outcome event had occurred in 384 patients (5.4%) in the milvexian group and in 365 patients (5.1%) in the placebo group (hazard ratio, 1.05; 95% confidence interval, 0.91 to 1.21; P = 0.50). BARC type 3c or 5 bleeding occurred in 23 patients (0.3%) in the milvexian group and in 22 patients (0.3%) in the placebo group (P = 0.88). CONCLUSIONS:Among patients with a recent acute coronary syndrome event, milvexian did not decrease the risk of cardiovascular death, myocardial infarction, or ischemic stroke but did not increase the risk of intracranial or fatal bleeding, as compared with placebo. (Funded by Janssen Research and Development and Bristol Myers Squibb; LIBREXIA ACS ClinicalTrials.gov number, NCT05754957.).
