Adelin Muganza

Human amniotic membrane (hAM) is used as a biological dressing in burn care, and preservation methods may influence its structural and functional characteristics. This study evaluated the effects of a glycerol-based processing and preservation method on properties of hAM. Placentas were obtained from 142 consenting donors following elective caesarean section at a tertiary academic hospital. hAM was processed using ≥99.5% glycerol with agitation cycles and intermediate saline rinses following antibiotic-antifungal decontamination. Paired processed and unprocessed samples from 71 donors were assessed for biomechanical properties, optical transmittance, thickness, bacterial inhibition, and histological characteristics. Statistical analyses included paired t-tests, repeated-measures ANOVA, and effect sizes (Cohen’s d). Processing resulted in modest reductions in ultimate tensile strength (− 7.6%) and tensile stress (− 6.1%), with small effect sizes, while tensile strain was not significantly altered. Optical transmittance increased from 90.8 to 97.1% (p < 0.001; Cohen’s d −0.92), while thickness decreased by 2.9%. Following 12 months of refrigerated storage, glycerol-processed hAM produced larger inhibition zones than unprocessed hAM against all five tested bacterial species under the same conditions. Qualitative histological assessment demonstrated epithelial loss, reduced stromal cellularity, and altered stromal morphology, while the basement membrane remained visibly continuous. Processed hAM demonstrated measurable biomechanical properties and bacterial inhibition, together with increased optical transmittance, and processing-associated histological changes. These in vitro findings characterize the effects of the glycerol-based processing and preservation method but do not establish clinical efficacy. Further in vivo evaluation is required to determine whether these laboratory findings translate into safe and effective clinical performance.

Background and Clinical Significance: When burn patients develop cytopaenias, particularly thrombocytopaenia and anaemia, the aetiology is often multifactorial but usually linked to either systemic inflammatory response syndrome (SIRS) or wound sepsis. However, haematological derangements that are disproportionate to the burn severity pose a critical red flag and should raise suspicion for alternative pathology. The potential value of peripheral blood smear analysis in identifying alternative haematological pathologies in burn patients with unexpectedly severe cytopaenias is discussed. Case Presentation: We report a retrospective case review of a 12 year old female without co-morbidities, who sustained a minor 4% total body surface area scald burn and presented to a Burn Unit with severe gastrointestinal bleeding, thrombocytopaenia, anaemia, and leucocytosis unresponsive to conventional medical therapy. Investigations included gastroscopy, thromboelastography, blood cultures, and peripheral blood smear analysis. Management included fluid resuscitation, blood transfusions, antibiotics, pantoprazole, octreotide, and renal replacement therapy. The unexpectedly severe cytopaenia and poor response to transfusion support prompted peripheral blood smear analysis, which revealed findings consistent with acute promyelocytic leukaemia , confirmed by fluorescence in situ hybridisation demonstrating t(15;17) and PML/RARA fusion. The patient was commenced on All-Trans Retinoic Acid and Daunorubicin. Despite intensive multidisciplinary management, the patient developed multiorgan failure and died. Conclusions: This case illustrates how peripheral blood smear analysis helped identify an underlying haematological malignancy in a burn patient with unexpectedly severe or disproportionate cytopaenias, underscoring the importance of a broad differential diagnosis in this clinical context.

Background: Timely admission to a specialised burn unit is considered crucial for optimising outcomes in burn patients. However, the impact of delayed admission on hospital length of stay and clinical outcomes remains unclear, particularly in resource-constrained settings such as South Africa. This retrospective study aimed to determine whether admission to a burn unit more than 24 h after injury was associated with increased length of stay, sepsis, or mortality. Methods: A retrospective case-audit study was conducted at the Chris Hani Baragwanath Academic Hospital Adult Burn Unit, Johannesburg, from January 2018 to December 2022. Patients were categorised into early (≤24 h) and delayed (>24 h) admission groups. The primary outcome was length of stay; secondary outcomes included sepsis incidence and in-hospital mortality. Results: A total of 123 files were analysed; 71 (58%) were admitted within 24 h. The median length of stay was 14 days, with no statistical difference between the two groups (p = 0.7). The overall mortality rate was 13%, with 68% occurring in the early admission group. Sepsis occurred in 27% of patients. Multivariate analysis revealed that early admission was independently associated with longer length of stay. Conclusions: In this single-centre retrospective case note audit with a limited sample size and significant risk of selection bias, delayed admission to a burn unit was not associated with increased length of stay, mortality, or sepsis. However, these findings should be considered preliminary and require confirmation in larger, prospective studies. The higher rate of surgical intervention in the delayed admission group warrants further investigation.

Chemical burns worldwide are caused by highly concentrated acidic and alkaline substances being placed onto exposed skin surface with resultant tissue injury. These chemical substances have high toxicity and deep tissue penetrability causing significant morbidity and mortality to patients. This study describes the epidemiology and mortality of acid-related burn injuries to improve patient assessment and management strategies. A cross-sectional retrospective analysis of the records of 66 patients admitted to Chris Hani Baragwanath Academic Hospital Adult Burns Unit over a period of 9 years between 2015 and 2024. This study found that 91% of cases were due to assault, compared to 8% accidental injury. Patients admitted were predominantly male (n = 43; 65%). The mean total body surface area (TBSA) involved was 17.7% with the most common areas involved being the face and arms (n = 47, 72%). The neck was affected in 35 cases (54%), and the chest in 34 cases (52%). Other affected areas included the back (n = 24, 37%), eyes (n = 14, 22%), legs (n = 12, 19%), buttocks (n = 4, 6%), and genitalia (n = 3, 5%). Patient mortality is limited in cases where TBSA < 25%; however, when TBSA > 25% mortality is 75%, further increasing to 100% when patients were ventilated. This study showed a high rate of acid burns associated with domestic violence and assaults. Prevention strategies should be coordinated with strategies aimed at reducing interpersonal violence.

Background: Trauma injury scoring systems are essential for standardized assessment, treatment decisions, and outcome prediction in trauma patients. The mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure (MGAP) score offers a simplified approach that is particularly beneficial in resource-limited settings. This study aims to determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Objective: To determine the association between the MGAP scoring system and mortality outcomes in trauma patients presenting to the trauma emergency unit (TEU) in a resource-limited setting. Methods: A retrospective record review was conducted on priority 1 (P1) trauma patients aged 18 years or older who presented to the TEU of a hospital between 1 January 2022 and 31 December 2022. Data extracted from the TEU resuscitation register included age, sex, mechanism of injury, blood pressure (BP), and Glasgow Coma Scale (GCS). The primary outcome was survival versus death. MGAP scores were calculated, and statistical analyses were performed to assess the association between MGAP scores and mortality. Results: A total of 1220 patients were included in this study. The analysis revealed a statistically significant association between MGAP scores and mortality (p < 0.0001). Lower MGAP scores were associated with higher mortality rates. Specifically, patients with MGAP scores ≤ 18 had a mortality rate of 48.1%, while those with scores between 19 and 22 had a mortality rate of 23.5%. The mortality rate was 2.2% for MGAP scores between 23 and 29, and 0% for scores ≥ 30. GCS score and systolic blood pressure were also significantly associated with mortality (p < 0.0001 and p < 0.05, respectively), while the mechanism of injury was not significantly associated with mortality. Conclusions: The MGAP score is a valuable tool for risk stratification in trauma patients in resource-constrained settings, demonstrating a strong inverse correlation with mortality outcomes. Its simplicity and reliance on readily available parameters make it particularly useful for rapid triage and resource allocation in LMICs. These findings support the implementation of the MGAP score in trauma triage protocols and highlight the need for further research to validate its performance in diverse LMIC settings and explore its potential for integration into national trauma care guidelines.

Aim: The objective of this study is to clarify the contribution of CT scan in the diagnosis of porencephalic cavities among the range of congenital cerebral cavities. Methods: Congenital porencephalic cavities are rare conditions characterised by the formation of a cyst in the cerebral parenchyma, which causes certain physical symptoms. We present the case of an 18-month-old infant who was referred to our clinic for sudden onset of right spastic hypotonia. Results: The CT scan revealed the presence of a left fronto-parietal cerebral cystic cavity communicating with the ipsilateral lateral ventricle, pointing to the characteristics of a congenital porencephalic cavity. The differential diagnosis included: - Neuroglial cyst;- Schizencephaly; - Arachnoid cyst;- Holoprosencephaly.Conclusion: Due to its rarity and atypical presentation, porencephaly poses a challenge for clinicians. The pathogenesis and treatment of this condition are poorly understood. Imaging is essential for establishing a diagnosis and determining the best treatment option. MRI is the modality of choice for characterising cerebral cystic lesions. In countries with limited resources, CT scanning is a valuable tool for characterising lesions while ruling out other diagnoses.

Endocrine hypertension is believed to be underestimated worldwide especially in the developing countries. There is a scarcity of publications on endocrine hypertension in sub-Saharan Africa. The aim of this study was to reflect the profile of patients with endocrine hypertension of adrenal/paraganglioma origin at Chris Hani Baragwanath Academic Hospital (CHBAH). The objective was to determine the aetiology, the lead time to diagnosis of endocrine hypertension and to reflect on the surgical approach and outcome. This descriptive observational study reviewed all surgical procedures performed at CHBAH from 1 January 2013 to 31 December 2020. Parameters analysed included the demographics, the aetiologies, the location of the disease, the surgical approach, the histopathology, the incidence of malignancy, the lead time and the 30-days outcome. Of the 44 patients analysed, there were 66% female and 34% male. The mean age was 38 years. The majority of the cases were due to catecholamine secreting tumours (65.9%). Overall, 43.1% of the procedures were completed laparoscopically. Altogether, the mean lead time ranged from 5 to 12 years. The incidence of malignancy and the 30-day mortality were 15.9% and 4.5% respectively. The index presentation of endocrine hypertension was due to complications in 9% of the cases. Catecholamine producing tumours were the most common aetiology. Laparoscopy was successful in 43.1%. The lead time was long and there were more tumours on the left side. The mortality rate was 4.5%.

Serum procalcitonin (PCT) is a biomarker used to diagnose sepsis and infection. Following invasive bacterial infection, PCT is detectable in peripheral blood. The aim of our study was to determine if there is a relationship between serum PCT post-burn wound debridement and burn-related sepsis. In total, 34 participants were recruited from 1 November 2019 to 31 July 2020. Serum PCT levels were drawn on days 0, 1, 2, and 3, with day 0 being the day of the surgery. Blood culture samples were drawn on days 0 and 3. Statistical analyses were performed using STATA©. Descriptive statistics were presented as the median for continuous data and frequencies for categorical data. A two-sample Wilcoxon–Mann–Whitney test was performed to assess the correlation between the PCT values and blood culture positivity. In all, 33 burn debridement procedures were completed, and 1 patient demised before surgery. The median age was 35.5 years; 61.8% were male. Four patients had comorbidities. There was a trend of higher PCT values from day 0 to day 3. The median PCT on day 0 was 3.30 µg/L (IQR 0.78–15.10), compared to day 3 PCT which was 5.15 µg/L (IQR 1.35–18.55). The median values for serum PCT for days 0 to 3 were above the normal threshold regardless of BC positivity. There was a statistically significant difference in the PCT levels between positive and negative BC, with a p value of 0.0087 for day 3 serum PCT. The findings indicate an association of a high serum PCT level with a positive blood culture in a burn patient post-debridement surgery. A higher numerical threshold/cut-off of serum PCT should be used for this cohort of patients, to aid in the diagnosis of sepsis. A cut-off value could not be determined due to the small sample size.

Mediastinal goitres are rare and may be diagnosed late since they are likely to manifest with non-specific cardiorespiratory symptoms especially when there is no visible cervical component. The imaging modality of choice is a contrast-enhanced computed tomography (CT) scan of the neck and chest after incidental finding of goitre on chest X-ray indicated for a condition unrelated to goitre. This case series aims to highlight the peculiarity of mediastinal goitre in terms of clinical presentation, surgical approach, airway challenges at anaesthesia, specific complications and final histopathological report. Over a nine-year period, four cases of euthyroid mediastinal goitre underwent sternotomy. The mean age was 57.5 years (45-71) and all patients were female. Most patients presented with non-specific cardiorespiratory symptoms. The difficult airway set was used in all cases and there were two instances of damage to the recurrent laryngeal nerve (RLN). All histopathological reports were benign. The presentation of the mediastinal goitres was atypical. Cervical incision and sternotomy were performed in all cases. There were two instances of RLN injury and no malignant histopathology. Despite the potential threat to the airway, all intubations were uneventful.

Context: The time of debridement of burn wounds is controversial. This study assessed the outcomes of various times of excision of full-thickness thermal burns involving a total body surface area (TBSA) of 15%–40% when immediate grafting is not possible. Aims: This study aimed to compare mortality rate and hospital days between very early excision, delayed early excision, and delayed excision. Setting and Design: This was a retrospective observational research study of 103 patients older than 18 years with full-thickness thermal burns involving a TBSA of 15%–40%, admitted to our Adult Burns Unit from January 2014 to December 2016. Subjects and Methods: Only “traditional” burn wound dressings such as Jelonet, Melladerm, Anticoat, or bandages were used without immediate skin grafting. Using the STATA Version 14.2 (College Hill, TX) statistical program, the Mann–Whitney U-test was used to compare any two groups, the Kruskal–Wallis test to determine differences between any three groups and the Chi-square test to measure associations between gender and patient outcome. Linear regression was used to determine the predictors of the number of hospital days postsurgery. Results: With a median patient age of 34 years, 66% were male. The majority had delayed excision (41.7%), 34% had delayed early excision and 24.3% had very early excision. Conclusions: Where immediate cover after excision is not possible due to cost or availability, and the wound is only covered with “traditional” burn dressings, early excisions had no advantage over delayed excisions with regard to mortality rate or duration of hospital stay.