Browsing by Author "Moodley, Yoshan."

Now showing 1 - 4 of 4

Admissions for pulmonary embolism at a tertiary South African hospital.
(2017) Kistensamy, Sivaisen Ricardo.; Moodley, Yoshan.; Brown, Susan Lynn.
Background: Published descriptions of pulmonary embolism (PE) from South African (SA) settings are rare. We sought to address this gap in the literature. Methods: This was a case series involving 61 adult patients admitted to a tertiary SA hospital over a five-year period with a primary diagnosis of PE. Data related to patient demographics, PE presentation, risk factors, treatment, and inpatient mortality were collected and analysed using appropriate statistical tests. Results: Most of our study population were younger (86.9%), female (67.2%), and of black African ethnicity (73.8%). Dyspnoea and chest pain were the most common symptoms (prevalence of 86.9% and 41.0%). Prevalent clinical signs included tachypnea (47.5%) and tachycardia (42.6%). The most prevalent established risk factors were cardiac failure (49.2%) and a history of deep vein thrombosis (up to 19.7%). Massive PE was diagnosed in 8.2% of study patients. Most patients received anticoagulation therapy (95.1%), with thrombolysis and embolectomy performed only in smaller proportions (24.6% and 11.5%) of patients. The incidence of inpatient mortality was 23.0%. Characteristics associated with mortality included: admission route (p=0.008), dyspnoea (p=0.002), tachycardia (p<0.001), and embolectomy (p=0.042). Conclusion: Our study findings have important implications related to the management of PE in SA.
Peri-operative studies of hypertension.
(2015) Moodley, Yoshan.; Biccard, Bruce McClure.
Abstract available in PDF file.
Preoperative factors associated with extended postoperative length of stay in patients undergoing primary hip arthroplasty.
(2017) Dlamini, Nkanyiso Freedom.; Ryan, Paul Vincent.; Moodley, Yoshan.
Orthopaedic disorders of the hip are becoming more common in many countries around the world, including South Africa. Conservative medical treatment of severe hip disorders might sometimes be ineffective in reducing pain or restoring hip function in some patients. In these patients, surgical intervention, through primary hip arthroplasty, remains the only viable option for reducing pain and restoring hip function. The increasing demand for primary hip arthroplasty in South Africa poses a problem for many resource-limited orthopaedic units in the country. It is possible that many of these orthopaedic units will be forced to consider fast-track surgery and recovery protocols to cope with the increased demand for primary hip arthroplasty. These protocols aim to shorten postoperative LoS, reduce complications, and allow for more efficient financial expenditure and resource allocation per patient. An understanding of which characteristics are associated with extended postoperative length of stay (EPLoS) in primary hip arthroplasty patients would have important implications for fast-track postoperative protocols being implemented in South African settings. This was the impetus for the current study. This study was a retrospective chart review involving 185 South African primary hip arthroplasty patients. Univariate and multivariate data analysis were performed to identify crude and independent associations between various characteristics and EPLoS. There were three preoperative risk factors (gender, fixed flexion deformity, patient’s maximum walking distance) and one intraoperative risk factor (extended duration of surgery) which were independently associated with EPLoS following primary hip arthroplasty in South African patients.
Surgical site infections at a quaternary South African Hospital: epidemiology and impact on healthcare resources.
(2021) Naidoo, Natasha.; Moodley, Yoshan.; Madiba, Thandinkosi Enos.
ABSTRACT Background: Studies focused on the epidemiology of surgical site infection (SSI) and its impact on healthcare resource utilisation in resource-constrained African settings are rare. This information is important for two reasons: 1) It facilitates the development of setting-specific risk stratification tools for identifying patients who might benefit fro m additional preventative interventions, and 2) It can guide public health specialists’ decisions around resource and budget allocations to surgical units and the degree to which this can be optimised through SSI prevention. The research comprising this PhD thesis sought to address these gaps in the knowledge. Methodology: This research is comprised of five stand-alone analyses involving surgical patient dataobtained from a South African quaternary hospital. The data was collected through patient medical chart review, as well as accessing the hospital’s and service laboratory’s administrative systems. Study designs used in this research include cohort, trend analysis, geospatial analysis, case-control, and prognostic study designs. Results: The incidence of SSI in high-risk laparotomy patients was 16.6%. Risk factors for SSI in this group included infectious indication for surgery, preoperative non-steroidal anti-inflammatory use, preoperative hypoalbuminemia, Bogota bag use, and perioperative blood transfusion. A 10-year trend analysis of all surgeries performed at the hospital found no change in admissions for post-discharge SSI. Mortality in elderly SSI admissions declined. The geospatial analysis found that most postdischarge SSI admissions originated from urban areas. Analysis of the laparotomy dataset showed that SSI resulted in an additional 1.06 days of hospitalisation (additional cost of ZAR8900/ $1180), but only in patients who already had short hospital stays. While preoperative hypoalbuminemia demonstrates a similar prognostic performance to the more complex SENIC/NNIS risk stratification methods (Cstatistic 0.677 versus 0.652/0.634), preoperative serum sodium is unlikely to have the same prognostic utility. Conclusions: SSI is common among South African patients undergoing high-risk surgery. A settingspecific, multifactorial risk stratification tool might be of benefit in this population. Inpatient and postdischarge SSIs contribute to unnecessary healthcare utilisation a expenditure in this resource constrained setting. There is also great potential for certain routine preoperative laboratory tests to be used as simple, cost-effective SSI risk stratification tools in African settings. Isizinda: Ucwaningo lugxile ekwakhiwenisimo sendawo ehlinziwe yokutheleleka (SSI) nomthelela wakho wokusetshenziswa komthombo wokunakekela ngokokwelapha ezizindeni esivaleleke e-Afrika nokungavamile. Lolu lwazi lubalulekile ngezizathu ezimbili: 1) Kusebenzisa intuthuko yamathuluzi okuchaza ingcuphe egxile esizindeni esiqondile sokuhlonza iziguli ezingazuza emizamweni eyongeziwe yokuvimbela, nokuthi 2) ingahola izinqumo zongoti bezempilo yomphakathi ngomthombo nokwabiwa kwezimali kuya ezikhungweni zokuhlinzwa kanye nezinga lapho enganyuswa khona ngokuvimbela nge-SSI. Ucwaningo okusekelwe kuyo le PhD kuhloswe ngalo ukubhekana nalezi zikhala olwazini. Indlelakwenza: Lolu cwaningo lunohlaziyo oluyisihlanu oluzimele olufaka imininingo yesigulo esihlinziwe olutholakele esibhedlela esisezingeni lesine. Imininingo iqoqwe ngokubuyekeza ishathi lokwelapha lesiguli, kanjalo nokufinyelela ezinhlelweni zesibhedlela kanjalo nezinsiza zaselabhorethri. Uhlelosakhiwo locwaningo olusetshenziswe kulolu cwaningo lufaka ikhohothi, ukuhlaziya okwenziwa kuleso sikhathi, ukuhlaziya umumomhlaba, ukulawula ucwaningonto, nohlelosakhiwo locwaningo oluyinhlonzasifo. Imiphumela: Ukwenzeka kwe-SSI ezigulini ezisengcupheni yelapharathomi ingama-16.6%. Izizathu zengcuphe ze-SSI kuleli qembu elifakwe izinkomba zokutheleleka, isidambisikuvuvukala okunganasteroydi angesikhathi sokuhlinzwa. Ukuhlaziya okwenzeka eminyakeni eyi-10 kokuhlinza okwenziwa esibhedlela akutholanga shintsho ekungenisweni esibhedlela emva kokukhishwa. Ukufa kwabadala ekufakweni esibhedlela nge-SSI kusukela ezindaweni zasemadolobheni. Ukuhlaziya kwedathasethi yelapharothomi ikhombise ukuthi i-SSI inomphumela wezinsuku ezi-1.06 ezongeziwe zokulaliswa esibhedlela (izindleko ezongeziwe zama-ZAR8900/$1180), kodwa yiziguli esezike zahlala kafushane esibhedlela. Ngesikhathi i-hypoalbuminemia ngaphambi kokuhlinzwa ikhombisa ukusebenza kokuhlonzwa kwesifo ezindlelenikwenza zokuchaza ingcuphe eyinkimbi ye-SENIC/NNIS (istathistikhi i-C0677 uma siqhathaniswa ne-0.652/0.634), isiramu yesodiyamu yangaphambi kokuhlinzwa okungenzeka ibe nenhlonzasifo efanayo. Iziphetho: I-SSI ivamile ezigulini zaseNingizimu Afrika ezisezingcupheni ezinkulu. Isizinda esiqondile, ithuluzi lokucacisa ingcuphe enezizathu eziningi zokuzuza eqoqwenibantu. Iziguli ezelashelwa esibhedlela nama-SSI emva kokukhishwa esibhedlela kufaka ukusetshenziswa kokunakekelwa ngokwezempilo nokusetshenziswa kulesi sizinda esincishelwe yimithombo. Kuphinde kube nokukwazi okusezingeni ngokwezivivinyo ezilungiswe ngaphambi kwesikhathi elabhorethri ukuba zisetshenziswe, njengamathuluzi alula, nashibhile okuchaza ingcuphe yama-SSI ezizindeni zase-Afrika.