Testicular torsion is a urological emergency requiring rapid diagnosis to prevent testicular loss, with the whirlpool sign on ultrasound being a critical indicator. In resource-limited settings, access to specialised ultrasound training is often constrained. To address this, we developed a cost-effective, reusable ultrasound training model that replicates the whirlpool sign using easily accessible materials. Our model consists of a boiled egg and coiled tubing set in gelatine, with iodine simulating blood flow. Emergency Medicine residents used the model during hands-on training sessions. This model offers a simple yet effective way to improve diagnostic skills in resource-constrained settings, potentially enhancing early detection and outcomes for testicular torsion.

Background: Emergency departments (EDs) are key settings for both occupational and non-occupational HIV prevention. While occupational post-exposure prophylaxis (PEP) is widely implemented, pre-exposure prophylaxis (PrEP) remains underutilised. Understanding clinicians’ knowledge, attitudes, and practices (KAP) is critical to strengthening ED-based HIV prevention. Objectives: To assess the KAP of ED doctors in Gauteng, South Africa, regarding HIV PrEP and PEP, and to identify barriers to their implementation. Method: A prospective, cross-sectional, questionnaire-based study was conducted between June and October 2024 across five university-affiliated adult EDs in Gauteng. A self-administered questionnaire assessed personal PEP experience, PrEP/PEP availability, knowledge, prescribing practices, and perceived barriers. Knowledge scores were compared across subgroups using t-tests and chi-square tests. Results: Of the 110 doctors recruited, 102 completed questionnaires. While 81.4% reported prior PEP use and demonstrated good knowledge of PEP (mean score 4.3/7), knowledge of PrEP was significantly lower (mean score 3.0/7; P 0.00001). Only 27.5% had ever initiated PrEP, and just 13.7% routinely offered it to at-risk patients. Barriers to PrEP prescribing included lack of rapid HIV testing (59.1%), time constraints (59.1%), and perceived inappropriateness for ED settings (54.5%). Higher knowledge scores were associated with having an HIV diploma and prior PEP use. Conclusion: ED doctors demonstrated high familiarity and confidence in prescribing PEP, but poor knowledge and uptake of PrEP. Addressing knowledge gaps, ensuring resource availability, and integrating PrEP into ED protocols are necessary to enhance comprehensive HIV prevention in high-burden settings.

People living with HIV comprise a substantial number of the patients admitted to intensive care. This number varies according to geography, but all areas of the world are affected. In lower-income and middle-income countries, the majority of intensive care unit (ICU) admissions relate to infections, whereas in high-income countries, they often involve HIV-associated non-communicable diseases diagnoses. Management of infections potentially resulting in admission to the ICU in people living with HIV include sepsis, respiratory infections, COVID-19, cytomegalovirus infection, and CNS infections, both opportunistic and non-opportunistic. It is crucial to know which antiretroviral therapy (ART) is appropriate, when is the correct time to administer it, and to be aware of any safety concerns and potential drug interactions with ART. Although ART is necessary for controlling HIV infections, it can also cause difficulties relevant to the ICU such as immune reconstitution inflammatory syndrome, and issues associated with ART administration in patients with gastrointestinal dysfunction on mechanical ventilation. Managing infection in people with HIV in the ICU is complex, requiring collaboration from a multidisciplinary team knowledgeable in both the management of the specific infection and the use of ART. This team should include intensivists, infectious disease specialists, pharmacists, and microbiologists to ensure optimal outcomes for patients.

Introduction: The outcome of paediatric emergency care is essential to the attainment of child-targeted sustainable development goals. We assessed the quality of paediatric emergency care among 34 tertiary Paediatric Emergency Departments (PED) in Nigeria. Methods: We conducted a cross-sectional process audit of recruited 34 PEDs in Nigeria. A paper questionnaire developed from the validated AAP/IFEM Guidelines for Care of Children in the ED was used to collect information on the PED settings, the processes of care and measurable patient outcome. Association between the regions, hospital volume category and other institutional attributes was conducted using chi-square, Results: The median (IQR) of paediatric visits and admissions to PEDs were 187.5 (120- 300) and 107.5 (67- 131) respectively. Over two-thirds (73.6 %,) of the PEDs had no set target Time-To-Physician consultation and the median (IQR) Length-of-Hospital Stay was 48 (0-72) hours. The majority of centres (90%) had patient safety tools but point-of-care-diagnostics (POCDs) were grossly deficient (23.5%). The mean protocol utilization score was 8.7 out of a maximum score of 34. The national crude death rate was 33.8 per 1000 children and there was no statistically significant relationship between the crude death rate and volume of hospital visits, (p-value=0.45) or geopolitical zones (p-value = 0.68). Conclusion: There was nationwide poor protocol utilization and non-availability of POCDs coupled with a high mortality rate at the PEDs. Development and utilization of locally relevant protocols and improvement in the availability of POCDs are essential.

Objective:To determine the utilization of barley and parsley for managing urolithiasis among the Saudi Arabian population. Methods:This is a prospective cross-sectional survey-based study. The survey comprised questions about the use of barley, parsley, and other therapies for managing urolithiasis. A WhatsApp® message with the link to the study survey was sent out to family, friends, patients, and other acquaintances residing in the Kingdom of Saudi Arabia (KSA). Results:A total of 1014 respondents completed the survey, of which 44.8% indicated that they utilized barley, 38.3% stated that they used parsley, and 4.2% indicated that they utilized other non-medical remedies to treat or prevent kidney stones. In contrast, only 29.5% stated that they utilized potassium citrate and/or magnesium citrate, and only 14.4% indicated that they consumed greater amounts of water to treat or prevent kidney stones. Conclusion:Our study findings indicate that among the Saudi Arabian population, non-conventional therapies such as barley and parsley are more commonly utilized for managing urolithiasis rather than established therapies such as increasing water intake and the use of potassium-citrate/ magnesium-citrate. There is a need to conduct large-scale clinical studies to evaluate the efficacy and safety of barley, parsley, and other non-conventional therapies for treating urolithiasis.

Background:Smartphone and mobile health (mHealth) applications (apps) have become an integral part of the day-to-day function of healthcare professionals, allowing quick, comprehensive, and up-to-date access to current clinical guidelines and other reference material.Objective:To evaluate the extent and nature of use of mHealth apps by paediatric department doctors in South Africa.Methods:E-mails requesting study participation were sent out to 285 paediatric department doctors employed at six hospitals affiliated to the University of the Witwatersrand. Willing participants were directed to complete the online study questionnaire.Results:A total of 150 respondents completed the questionnaire. All respondents owned a mobile device and already had one or more mHealth apps, 95.3% were unaware of any regulatory body responsible for regulating the use of mHealth apps, 86.0% did not have access to free Wi-Fi at work and 87.3% used an mHealth app at least once daily. Drug dosing (81.3%), diagnostic (59.3%) and clinical decision-making (44.7%) apps were the most common app categories with Medscape® (62.0%) and EMGuidance® (41.3%) being the most frequently used apps. Peer recommendation (76.0%), app credibility (74.0%) and app functionality (66.0%) were the most common factors that were considered by respondents prior to downloading or using an mHealth app.Conclusion:Medical apps are frequently used among paediatric medical doctors of all ranks. Drug dosing, diagnostic and clinical decision-making apps are the most common app categories in use. Improved awareness of the regulations pertaining to the use of mHealth apps amongst doctors is required.

OBJECTIVES:To identify and review the most up-to-date guidelines pertaining to bladder trauma in a unifying document as an updated primer in the management of all aspects relating to bladder injury. METHODS:In accordance with the PRISMA statement, the most recent guidelines pertaining to bladder injury were identified and subsequently critically appraised. An electronic search of PubMed and Scopus databases was carried out in September 2023. RESULTS:A total of six guidelines were included: European Association of Urology (EAU) guidelines on urological trauma (2023), EAU guidelines on paediatric urology (2022), Urotrauma: American Urological Association (AUA) (2020), Kidney and Uro-trauma: World Society of Emergency Surgery and the American Association for the Surgery of Trauma (WSES-AAST) guidelines (2019), Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma (EAST) (2019), and EAU guidelines on iatrogenic trauma (2012). Recommendations were summarised with the associated supporting level of evidence and strength of recommendation where available. CONCLUSION:Several widely recognised professional organisations have published guidelines relating to the diagnosis, investigation, classification, management, and follow-up related to bladder injury. There is consensus amongst all major guidelines in terms of diagnosis and management but there is some discrepancy and lack of recommendation with regards to the follow-up of bladder injuries, iatrogenic bladder injury, paediatric bladder trauma, and spontaneous bladder rupture. The role of increasing minimally invasive techniques seem to be gaining traction in the select haemodynamically stable patient. Further research is required to better delineate this treatment option.

Objectives: Nutritional support is a fundamental component of holistic patient care in the intensive care unit (ICU). There is a paucity of local data pertaining to nutritional support practices at ICUs in South Africa. The aim of this study was to determine nutritional support practices at an academic hospital ICU in Johannesburg, South Africa.Methods: In this cross-sectional, descriptive and retrospective study, a simple random sampling method was utilised to select 50 data collection days from a three-month period (1 August–31 October 2018). Data relevant to the study were extracted from the ICU charts of patients who received formulae-based enteral and/or parenteral nutrition on the selected days. Charts were categorised into acute phase days (≤ 72 hours from ICU admission) and recovery phase days (> 72 hours from ICU admission).Results: A total of 387 ICU charts were included in the final sample, comprising 114 acute phase and 273 recovery phase days. Overall, enteral nutrition was prescribed on 296 (76.5%) chart days while parenteral nutrition was prescribed on 111 (28.7%) chart days. The median daily fluid balance was approximately 600 ml positive. Target protein and calorie intake was achieved on 67 (17.3%) and 110 (28.4%) chart days respectively.Conclusion: Although protein and calorie intake was suboptimal in comparison with the recommended targets, it is in keeping with general international trends. Regular audits, training of staff, attention to minimising feeding interruptions and encouraging the timely initiation of enteral nutrition are recommended interventions that may be useful in achieving nutritional targets.

Background Sudden cardiac arrest can occur unexpectedly in any person and at any place including at medical schools. Improved outcomes after cardiac arrest are dependent on the initiation of early first responder high-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation. There is a lack of data pertaining to the knowledge, attitudes, and perceptions of non-medical staff at medical schools regarding CPR. The aim of this study was to determine the knowledge, attitudes, and perceptions of non-medical staff employed at a medical school in South Africa regarding CPR. Methods In this cross-sectional survey study, a paper-based questionnaire was administered to non-medical staff (i.e., all staff without a medical [MBBCh or equivalent] or nursing degree) employed at the medical school. Data were collected between August 1 and October 25, 2020. Results The final study sample comprised 150 participants. Of these, 103 (68.7%) were female, 109 (72.7%) were ≤ 40 years old, 62 (41.3%) had a postgraduate university degree, 72 (48.0%) had witnessed a medical emergency at the medical school premises and 46 (30.7%) had previously undertaken first aid or CPR training. The mean (SD) knowledge score was 4.4 ± 1.6 out of 10 with only 25 (16.7%) participants knowing what the first thing was to look out for during a medical emergency and 28 (18.7%) participants knowing the location of the automated external defibrillator. Most participants (n=136, 90.7%) indicated that CPR training should be mandatory for all employees. Conclusion Non-medical staff surveyed displayed suboptimal knowledge but positive attitudes and perceptions toward CPR. Although this was a single-center study, these results can be used to motivate CPR training of non-medical staff at all medical schools.

OBJECTIVES:To perform a systematic review of all cases of spontaneous rupture of the urinary bladder (SRUB) and to describe the demographic data, associated comorbidities, clinical presentation, diagnosis, relevant laboratory findings, associated factors, management, morbidity and mortality associated with the presentation of SRUB. METHODS:The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A search was carried out across the following electronic databases: PubMed, Web of Science, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews. Full texts of selected studies were analysed, and data extracted. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS:A total of 278 articles comprising 240 case reports and 38 case series, with a total of 351 patients were included. The median (interquartile range [IQR]) age of all included patients was 47.5 (33-65) years. The median (IQR) time to presentation was 48 (24-96) h, with the major presenting symptom being abdominal pain (76%). In patients in whom the diagnosis was made prior to any intervention, the condition was misdiagnosed in 64% of cases. The diagnosis was confirmed during explorative open surgery in 42% of cases. Pelvic radiation (13%) and alcohol intoxication (11%) were the most common associated factors. Intraperitoneal rupture (89%) was much more common, with the dome of the bladder being most frequently involved (55%). The overall mortality was 15%. CONCLUSION:This review identified a number of key factors that appear to be associated with an increased incidence of SRUB. It also emphasized the high rate of misdiagnosis and challenge in confirming the diagnosis. Overall, it highlighted the importance of the need for increased awareness and maintaining a high index of suspicion for this condition.

Background. With 23.5 suicide-related deaths per 100 000 population, South Africa (SA) has the eighth-highest age-standardised suicide rate in the world. Intentional self-poisoning is associated with significant morbidity, mortality and cost. In SA, self-poisoning is the leading method of suicide in females and the second leading method in males. Objectives. To determine the profile of patients presenting with intentional self-poisoning to the Charlotte Maxeke Johannesburg Academic Hospital emergency department. Methods. The study was a cross-sectional, retrospective audit of the medical records of patients who presented over a 12-month period with intentional self-poisoning. Results. Of the 288 patients included, 62.8% were female, 62.1% were aged 18 30 years, 22.2% were foreign nationals, 88.9% were single, 62.8% were unemployed, 82.3% reported that the episode was precipitated by an acute stressful event, 5.6% required intensive care unit (ICU) admission, and 4.5% died prior to hospital discharge. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning (25.3%) and was responsible for the majority of ICU admissions (81.3%), cases requiring hospitalisation for >6 days (56.5%) and deaths (69.2%). Conclusion. A large proportion of patients were female, 18 30 years of age, single, unemployed, and reported an acute stressful event as a precipitant. Organophosphate/carbamate pesticide ingestion was the most common method of self-poisoning and accounted for the majority of deaths and ICU admissions. Nationwide efforts should be aimed at enhancing awareness and implementing strategies to identify those at increased risk of suicidal behaviour.

Background Recurrent Testicular Torsion (RTT) is a rarely reported event after previous testicular torsion (TT) repair. Both conditions have similar signs and symptoms. Various techniques have been attempted to reduce the incidence of retorsion. This review assesses the presentation, diagnosis, risk factors, management and outcomes associated with RTT. Methods After PROSPERO Registration (CRD42021258997), a systematic search of PubMed, Google Scholar, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, Global Index Medicus and Cumulative Index to Nursing and Allied Health Literature (CIANHL) was performed using specific search terms. Study metadata including patient demographics, orchidopexy techniques, RTT rates and RTT timing were extracted. Results Twenty-six articles, comprising 12 case series and 14 case reports, with a total of 46 patients were included. Overall, the median (IQR) age of the pooled cohort was 18 (15-26) years, the median (IQR) time to presentation was 6 (3-36) hours from the onset of testicular pain. The most common presenting features were testicular pain (100%), testicular swelling (60.9%) and a high riding testicle (34.8%). The left testicle was most commonly affected (63.0%), RTT was on the ipsilateral side in relation to the primary episode of TT in 52.2% of cases, the median (IQR) interval between torsion and retorsion events was 4 (1.3-10.0) years, non-absorbable sutures were the most common suture material used during orchidopexy after RTT (88.9%). Conclusion RTT is a rare presentation to the Emergency Department. Even with a prior history of TT, RTT should be considered in patients presenting with classic symptoms.

Background Uretero-pelvic junction obstruction (UPJO) is a common cause of upper tract urinary obstruction. This condition is generally treated with various surgical options which include endoscopic (retrograde or anterograde), laparoscopic, open or robotic-assisted approaches. Herein, we describe a novel endoscopic retropelvic extra-luminal approach using a mini (14 Fr) nephroscope. Methods A 30-year-old male presented with symptomatic left UPJO and inferior pole renal stones, which were identified on computed tomography (CT) imaging. Mercaptuacetyltriglycine (MAG3) renogram demonstrated a functioning left kidney. With the patient positioned supine, a mini-perc (Karl-Storz) nephroscope was used to access the renal pelvis via the percutaneous route. The retropelvic space was thereafter accessed. Using a Holmium-YAG laser, the UPJO was splayed using an extra-luminal approach. Results Clear endoscopic vision, minimal bleeding, and overall satisfactory identification of the UPJO were achieved. At the 12-month follow-up, the patient remained stent and symptom-free. On follow-up CT imaging and MAG3 renogram, the system remained dilated with no obstruction noted. Conclusion Percutaneous anterograde retropelvic extra-luminal endopyelotomy is a novel approach that should be considered in patients with secondary renal calculi. This is the first report of the procedure being successfully performed utilizing the mini-perc access route.

Background Hypernatremia in the critical care setting is a major cause of morbidity and mortality. However, data pertaining to this has not been evaluated in South African hospitals. The aim of this study was to evaluate hypernatremia with regards to its prevalence, associated factors, and outcomes at an academic hospital intensive care unit (ICU) in Johannesburg, South Africa. Methods The ICU charts of patients admitted to the Charlotte Maxeke Johannesburg Academic Hospital adult general ICU from June 1, 2016 to May 31, 2017 were retrospectively reviewed. Subjects were categorized into three groups namely, ICU-acquired hypernatremia (IAH), pre-admission hypernatremia (PAH), and normonatremia. Data was compared between the three groups. Results Of the 833 subjects that were enrolled, 310 (37.2%) were hypernatremic. IAH was present in 144 (17.2%) and PAH in 166 (19.9%) subjects. Hypernatremia was significantly (p <0.05) associated with a higher rate of altered mental status, higher Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores, a higher rate and duration of mechanical ventilation, a greater need for inotropic/vasopressor support, longer ICU stay and higher ICU mortality. Conclusion Hypernatremia in ICU patients remains a significant contributor to morbidity, mortality, and ICU length of stay. The prevalence of hypernatremia was much higher than that reported in higher-income countries.

INTRODUCTION:More than half of South Africans live below the poverty line. Indirect medical costs can contribute significantly to the financial burden of patients seeking medical care. The aim of this study was to determine the expenses incurred by patients and/or their escorts during a visit to the emergency centre (EC).METHODS:Patients and/or their escorts presenting to an EC in Johannesburg were asked to complete the study questionnaire relating to expenses incurred during a visit to the EC.RESULTS:Of the total 396 participants that completed the questionnaire, 108 (27.2%) did not have any source of income, 146 (36.9%) were the sole breadwinner in their household and 36 (9.1%) belonged to zero-income households. Among those earning ≤R2000 per month, the mean expenses relating to the EC visit was R240 (SD R372), equating to an average of 33.2% of mean monthly income. Transport costs were the most common expense (n=302, 76.3%), while general practitioner (GP) fees incurred prior to the EC visit accounted for the bulk of the expenses (median R450, IQR 350-820). Participants that earned >R2000 per month were significantly more likely to incur GP fees (p =0.012), while those earning ≤R2000 per month were significantly more likely to take a loan to cover EC related expenses (p =0.014).CONCLUSION:A visit to the EC can have a substantial financial impact on patients and their accompanying escorts in South Africa. Strategies should be aimed at identifying and assisting those that are in need of financial assistance to cover indirect healthcare costs.

Improved access to antiretroviral therapy (ART) coupled with better HIV awareness has resulted in a 52% reduction in new HIV infections and a 64% reduction in HIV-associated mortality since their peak in 1997 and 2004, respectively. 1 UNAIDSGlobal HIV & AIDS statistics—fact sheet. https://www.unaids.org/en/resources/fact-sheetDate: 2021 Date accessed: December 19, 2021 Google Scholar HIV currently ranks as the 19th highest cause of global mortality after being ranked eighth in 2000. 2 WHOThe top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-deathDate: Dec 9, 2020 Date accessed: December 19, 2021 Google Scholar Outcomes of people living with HIV after hospital discharge: a systematic review and meta-analysisMore than a quarter of patients with HIV had an adverse outcome after hospital discharge with no evidence of improvement in the past 15 years. This systematic review highlights the importance of ensuring post-discharge referral and appropriate management, including ART, to reduce mortality and readmission to hospital among this group of high-risk patients. Full-Text PDF Open Access

Background Renal dysfunction is a potentially life-threatening condition that is commonly encountered in the emergency department (ED). This study aimed to describe the clinical profile of patients presenting with renal dysfunction to a tertiary-level hospital ED. Methods Medical records of patients presenting to the ED with renal dysfunction over a six-month period (July-December 2017) were reviewed. A descriptive analysis of the data was performed. Results Serum creatinine levels were measured in 7,442 (69.9%) of the 10,642 patients that were triaged into the ED. Of these, 208 (2.8%) were identified with renal dysfunction, of which 192 consented to study participation. The median age of study subjects was 49.5 (IQR 38.8-63.0) years; 108 (56.3%) were male; proteinuria on urine dipsticks was demonstrated in 108 (56.3%); 72 (37.5%) were HIV-positive; 66 (39.6%) required dialysis; 11 (5.7%) were admitted to the ICU; and 59 (30.7%) died prior to hospital discharge. More patients presented with acute kidney injury (AKI) (46.9%) compared to chronic kidney disease (CKD) (27.6%) and acute on chronic kidney disease (AoCKD) (25.5%). Sepsis was the most common precipitant of AKI (42.2%) and AoCKD (30.6%), while chronic hypertension (35.8%) and diabetes mellitus (34.0%) were the most common comorbidities in subjects with CKD. Conclusion Patients presenting to the ED with various risk factors and comorbidities, including HIV, sepsis, hypertension, and diabetes mellitus, may have underlying renal dysfunction. ED clinicians should therefore adopt a low threshold to screen for renal dysfunction in these patients.

Background: Exacerbations of acute asthma are frequent presentations to the Emergency Department (ED) and contribute to ED overcrowding and healthcare cost. The purpose of this study was to evaluate whether ED clinicians are implementing secondary asthma prevention measures prior to discharging patients after an acute asthma exacerbation and also to determine whether ED clinicians are able to correctly demonstrate how to use an asthma metered dose inhaler (MDI) device. Methods: Consenting doctors employed at four EDs situated in the Gauteng province of South Africa were asked to complete a questionnaire and thereafter demonstrate the technique of using an MDI device. Collected data was presented using descriptive statistics. Results: Eighty-six doctors were included in the study. Of these, 18 (20.9%) routinely checked that inhaler technique was correct, 50 (58.1%) routinely enquired regarding adherence to their asthma treatment, 8 (9.3%) routinely informed patients of the side effects of asthma medication, 16 (18.6%) routinely provided patients with a written asthma action plan, 7 (8.1%) routinely evaluated for the presence of concurrent allergic rhinitis and 53 (61.6%) routinely counselled patients regarding smoking cessation. With regards to correctly demonstrating how to use an MDI device, only 23 (26.74%) physician participants performed all eight steps correctly. Conclusion: This study indicates that secondary asthma prevention measures are not adequately addressed by clinicians prior to discharging patients from the ED after an acute asthma attack. It is recommended that ED clinicians are educated with regards to the importance of these measures. (C) 2022 Elsevier Inc. All rights reserved.

Background: Despite a significant reduction in the prevalence of neonatal sepsis over the past three decades, the prevalence still remains high, especially in low- and middle-income countries. The aim of this study was to determine the prevalence and presenting features of neonatal sepsis at a paediatric emergency centre (PEC). Methods: Medical records of all neonates presenting to an academic hospital PEC over a six-month period were analysed. Data was compared between neonates with and without sepsis. The odds ratio was calculated to determine factors associated with neonatal sepsis. Results: Of the 210 neonates who were included, 43 (20.5%) were diagnosed with neonatal sepsis. Of these, 19 (44.2%) presented within the first 72 hours of life (early-onset neonatal sepsis) and 4 (9.3%) died prior to hospital discharge. A history of maternal employment (odds ratio (OR) 2.38, p=0.021), preterm birth (OR 3.24, p=0.019), low birth weight (<2.5kg) (OR 2.67, p=0.026), perinatal human immunodeficiency virus exposure (OR 3.35, p=0.002), not being breast fed (OR 4.36, p=0.001), and signs of lethargy (OR 14.01, p<0.001), dehydration (or 11.14, p<0.001), poor feeding (OR 7.20, p<0.001), irritability (OR 6.93, p<0.001), fever (OR 5.50, p<0.001), vomiting (OR 4.14, p<0.001) and respiratory distress (OR 4.12, p<0.001) were significantly associated with neonatal sepsis. Conclusion: Among neonates presenting to the PEC, various clinical features on history and examination may be useful in predicting the diagnosis of neonatal sepsis. Clinicians working in the PEC must adopt a high index of suspicion when attending to neonates presenting with these features.

Background:Coronavirus disease 2019 (COVID-19) has an established impact on multiple organ systems, including the vascular and urogenital systems. Vascular effects may include venous thromboembolic disease, which could theoretically be a precursor to priapism-a urological emergency defined as an abnormal condition of prolonged penile erection lasting >4hours. To better explore this association, we critically appraised all the published COVID-19 cases associated with priapism.Materials and methods:After PROSPERO registration (CRD42021245257), a systematic search of Google Scholar, Scopus, Embase, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, and Cochrane Database of Systematic Reviews was performed using specific search terms. The following study metadata were extracted: age, requirement for respiratory support, cavernous blood gas findings, management of priapism, and patient outcomes.Results:Fifteen single-patient case reports were included in this review. Of these, all of the patients presented with ischemic priapism, 9 patients (60.0%) were >60years of age, 4 (26.7%) reported more than a single episode of priapism, 11 (73.3%) presented with pneumonia, 8 (53.3%) required mechanical ventilation, D-dimer was elevated in 5 of the 6 (83.3%) patients in whom this was reported, and among the 13 patients in whom mortality was reported, 4 (30.8%) died.Conclusions:Early reports suggest a prognostic relationship between COVID-19 and coexisting priapism. However, owing to commonalities in their pathophysiology and the small dataset reported in the literature, the probable association between COVID-19 and priapism is still theoretical. Further research is needed to confirm this association.