Browse
Recent Submissions
Item Open Access Stevens-Johnson syndrome and toxic epidermal necrolysis at Universitas Academic Hospital: a 4-year review(University of the Free State, 2021-11) Moosa, Fatima; Armour, Claire; Van Rooyen, CornelBackground: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening dermatologic conditions that are part of the same disease spectrum. Drugs are the main inciting factor of this delayed (type IV) hypersensitivity reaction which produces epidermal and mucosal detachment. Despite morbidity and mortality being high, there are limited data available on SJS and TEN in South Africa. The objective of this study was to characterise patient demographics, aetiology and implicated drugs, treatment, and outcome in patients with SJS and TEN at a tertiary academic hospital in the Free State, South Africa. Methods: A retrospective, cross-sectional descriptive single centre study which included participants managed at Universitas Academic Hospital, South Africa between 2016 and 2020 was performed. Results: Fifty-five cases meeting the inclusion and exclusion criteria were included in this study. The cohort comprised TEN, SJS-TEN and SJS (n=40, n=10 and n=5 respectively). The mean age of the cohort was 37-years (range: 21- 67). Seventy percent were HIV-infected. Antibiotics (58%) and antiretroviral therapy (30%) were the most common drug classes implicated, with trimethoprim-sulfamethoxazole (22%) and nevirapine (16%) being identified as the most commonly implicated drugs. The major complication in the cohort was sepsis (42%). Supportive care formed the mainstay of treatment and the mortality rate was 14.5%. Conclusion: The majority of the patients in this cohort were HIV infected, with antiretroviral therapy (specifically nevirapine) and antibiotics (specifically trimethoprim-sulfamethoxazole, used for prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in the HIV-infected population) being commonly implicated causes of SJS and TEN. In resource-limited settings such as our facility, supportive care forms the predominant mode of treatment with a relatively good outcome.Item Open Access Physician career satisfaction across thirty medical specialties: a South African national survey study(University of the Free State, 2019-11) O’Kennedy, Jeremy David; Maruma, FransBackground. Specialty satisfaction likely influences quality of work, physician burnout rates and occupation-specific depression and suicide risk. Satisfaction with relative compensation, work-life balance and perception of met expectations within specialty, all likely influences career satisfaction within specialty as well as overall satisfaction with specialty choice. Specialty-specific physician career satisfaction data are collected and published annually in the United States of America (U.S.) and parts of Europe. These data and survey results are freely available to medical professionals, medical students, companies and the public. They are also widely publicised in journals, magazines and interest articles. No such relatable comparative data exists for practising South African medical specialists. Objective. To determine and compare the specialty-specific career satisfaction amongst practising South African medical specialists across 30 distinct medical specialties, via an electronic (email) questionnaire-based, respondent survey in 2018. Methods. This was an electronic, email-administered, questionnaire-based, respondent survey study conducted via SurveyMonkey. Response data representing practising South African medical specialists across 30 distinct medical specialties (incl. general practice) were obtained and analysed for the period 1 May to 31 July 2018. A specialty-specific global career satisfaction score (GSS) was formulated, calculated and compared with the use of five separate parameters, measuring scale-weighted responses within each individual questionnaire. Results. A total of 1610 practicing medical specialists were invited via email survey invitation. A total of 420 complete and qualifying response data sets were included). The response rate was 26%. A total of 17 specialties met the minimum respondent number of 10 respondents. Respondents represented specialists practicing in all nine Provinces. 60.95% of respondents indicated solo private, 15.71% combined (State/academic and private), 15.24% partnership private and 5.24% State/academic only, as their respective practice settings. 125 (29.76%) respondents were female. The most satisfied practising specialists according to the survey data are Dermatologists (75%), Ophthalmologists (74%), Oncologists (72%) and Radiologists (72%). The most dissatisfied specialists are General Internists (52%), Obstetrician and Gynaecologists (52%), General Practitioners (52%) and Nephrologists (54%). The mean GSS response is 12.34 and the median is 13 (standard deviation =4.01) Conclusion. This survey study demonstrated a significant inter-speciality variability in career satisfaction parameters amongst practising South African specialists. Specialty-specific satisfaction score trends were comparable to similar survey studies done in the U.S. and parts of Europe. The international trend towards job dissatisfaction within certain medical specialties, is concerning and warrants further investigation, possible interventional analysis and the development of turn-around strategies.Item Open Access A cross-sectional study of the practice, knowledge and perception of suncreen use among dermatology patients at Universitas Academic Hospital(University of the Free State, 2021-02) Maepa, Jeannett Reabetswe; Maruma, FransBackground: Sunscreens are produced to protect the skin from cutaneous acute and chronic adverse effects of ultraviolet radiation. Their correct use is pivotal in determining their efficacy. Objectives: To assess the practice, knowledge, and perception or understanding with regards to sunscreen use in dermatology patients visiting Universitas dermatology clinic in Bloemfontein, Free State province; by comparing patients with personal skin cancer history and/or risk factors and the group of patients that do not have skin cancer history or risk factors. Methods: Using a questionnaire as a data collection tool, a cross-sectional study was carried out on the days of adult clinic over a period of three weeks. All new and old patients attending the Universitas Academic hospital dermatology clinic, aged 18 years and older, and agreeing to participate, were included in the study. Different parameters were used to measure the practice, knowledge, and perception regarding sunscreen use and its benefits. Results: 131 out of 150 completed questionnaires qualified to be included in the data analysis. Majority of the respondents were female (64. 6%) and >60 years of age (46.9%). Risk factors for developing skin cancer were used to classify the high risk group which had a total number of 74 respondents (56.5%). The high risk group was compared with the lowrisk group when analysing response data for the practice, knowledge, and perception of sunscreen use. The study revealed that 46 respondents (62.2%) from the high risk group wear sunscreen in comparison with 19 respondents (45.2%) in the low risk group. A significant number of respondents from both groups (21% from the high risk group versus 14.1% from the low risk group) do not use sunscreen correctly. Assessment of the knowledge about sunscreen use demonstrated that 46.7% of the high risk group had slightly more knowledge on proper use of sunscreen as compared to 30% of the low risk group. Although both groups had differing opinions on whether sunscreen is a an over-the-counter drug or merely a cosmetic product, they both acknowledged its protective benefits to the skin. Conclusion: Assessment on the practice and knowledge of sunscreen use highlighted the suboptimal and inappropriate use of sunscreen by dermatology patients, as well as inadequate knowledge about correct use of sunscreen in contrast to having a good perception regarding the protective role of sunscreen against skin cancer. There is a dire need for more education or counselling of all dermatology patients on regular and correct use of sunscreen, particularly for the reduction of skin cancer in high risk individuals.Item Open Access Intralesional cryotherapy to treat exophytic keloids: the Universitas Hospital Bloemfontein experience(University of the Free State, 2019) Makhakhe, Lehlohonolo; Mosam, A.; Dlova, N.; Maruma, F.The skin is composed of labile cells, which to some extent can regenerate, but in cases of deep and significant damage, healing occurs by secondary intention with subsequent scar formation. Keloids are wound scars that grow beyond the original wound site and are characterized by an overabundance of collagen at the injured site, in a craw like fashion that distinguish them from hypertrophic scars. They result from dermal injury, mostly from trauma, infection and burns, and at times, they occur spontaneously. Keloids commonly occur on the earlobes, back, shoulders and chest and can be a major source of embarrassment and anxiety. These scars can also be painful and itchy. The prevalence of keloids is higher among patients with darker skin especially in Africans and Asians. Treatment options for these scars vary, however, a high recurrence rate after such treatments have been reported. Some modalities have sporadically yielded better outcomes, more so when used in combinations. It is therefore important to find a treatment that is safe, non-toxic and with reduced chances of recurrence in affected individuals. Intralesional cryotherapy is a treatment for keloid scars in which liquid Nitrogen is used to freeze the scar from inside. This study therefore sought to treat exophytic keloids with intralesional liquid Nitrogen (Cryotherapy) as a deep-freeze from the core of the keloid under local anaesthetic. This adds a newer method of keloid management contributing towards standardizing exophytic keloid management. A prospective case series was conducted among twelve patients attending the Dermatology outpatient department, at Universitas Hospital in Bloemfontein from 1 August 2016 to 01 March 2017. These patients were seen at the initial visit, then at six weeks and six months respectively. All the subjects were Africans, with 7 (58.3%) being female and 5 (41.7%) male. A third of the patients (4) (33.3%) had more than one site of involvement. Significant reduction in the exophytic keloidal mass post deep-freezing, irrespective of the keloid area, duration, gender and cause was observed among these patients. Two-thirds of these patients were either satisfied or very satisfied with the clinical outcome of the scar at six months. The use of intralesional cryotherapy for exophytic keloids has potential to become the main modality of treatment in future. Our study had some limitations including a small sample size, relatively high rate of patients lost to follow up (33.3%) and some unanticipated technical difficulties.Item Open Access Association between a favourable clinical response to anti-tuberculosis treatment and a positive PCR test for mycobacterium tuberculosis in histologically proven erythema induratum/nodular vasculitis(University of the Free State, 2016-02) Botha, Anton R.; Sinclair, WernerBackground: Polymerase chain reaction (PCR) has been used for many years to detect Mycobacterium tuberculosis (M.tb) DNA in biopsy tissue of erythema induratum (EI)/nodular vasculitis. Studies to ascertain the association between a positive PCR and clinical response to anti-tuberculosis (TB) therapy are lacking. Objectives: Our aim was to determine the association between a favourable clinical response to anti-TB treatment and a positive PCR for M.tb in histologically proven EI. Methods: Twenty-four cases of histologically proven EI were identified that had been biopsied in our department between 1 January 2009 and 31 December 2014. The response to anti-TB therapy was then determined retrospectively, establishing in which patients the subcutaneous nodules of EI had resolved on treatment. Thereafter the formalin-fixed paraffin-embedded tissue sections were sent for PCR. Results: All patients included in our study received anti-TB treatment. The clinical response was favourable in eighteen patients (75%), no response to treatment was observed in five (20,8%) and in one patient (4,1%), who was lost to follow-up, the response could not be determined. The PCR for M.tb was positive in only one sample (4,1%) whereas the other twenty-three samples (95,8%) had a negative PCR for M.tb. Conclusion: The PCR technique on formalin-fixed tissue remains subject to multiple technical pitfalls. Thus only positive results are meaningful, whilst negative results are inconclusive.