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In-hospital postoperative mortality of elderly patients with proximal femur fractures in a South African setting.
Mavuso, Ndumiso Briance.; Rosin, Rainer Christian.
Background: Epidemiological studies project that the incidence of proximal femur fractures in the elderly will triple within the next 30 years. These fractures are associated with significant morbidity and mortality despite ongoing efforts to improve outcomes. To improve outcomes, the American Academy of Orthopaedic Surgeons clinical practice guidelines recommend a multidisciplinary approach, a 48-hour window for surgical fixation, thromboprophylaxis as well as osteoporosis management. We aimed to determine the in-hospital mortality rate of surgically treated elderly patients with proximal femur fractures, as well as describe the series that died within the same admission and review the management of these fractures in a busy orthopaedic unit in rural KwaZulu Natal, South Africa.
Methods: We performed a retrospective analysis of the data collected from the clinical records of all deceased elderly patients with proximal femur fractures who underwent surgery at our hospital from 01 January 2017 to 31 December 2021. The in-hospital mortality rate, time from injury to admission, admission to surgery and from surgery to death were assessed. Additionally, the workup for osteoporosis and clinical management to this subset of patients was evaluated. Results: Of 358 patients who underwent surgery during the study period, 24 died in the same admission resulting in an in-hospital mortality rate of 6,7%. 15 (62,5%) were females. All patients sustained fractures due to low-energy falls at home. Apart from one patient, with a pathological fracture secondary to known metastatic breast cancer, a cause of the fragility fracture was never actively sought. The median time from injury to admission was four days (IQR 2-19) and from admission to surgery was seven days (IQR 5-26). The median time from surgery to death was four days (IQR1-22). Conclusions: The in-hospital mortality rate of 6,7% is in keeping with global figures. Delays in both injury-to-admission and admission-to-surgery intervals may contribute to this mortality. The absence of a fragility fracture workup and subsequent medical treatment highlights important potential gaps in current practices. Urgent attention to reducing waiting times and implementing multidisciplinary approaches may be crucial in enhancing the overall management and outcomes of elderly patients with proximal femur fractures.
Quantifying redox signals: a tool to investigate adaptive responses to oxidative stress.
(2024) Lind, Diane Justine.; Pillay, Che Sobashkar.
In the context of redox biology's oxidative eustress/distress model, the contrasting roles of ROS, such as hydrogen peroxide, under normoxic and toxic oxidative stress conditions has been more clearly elucidated. However, a fundamental question in the field has been understanding how dynamic redox signalling processes contribute to balancing the cellular response to oxidative eustress/distress.We employed a quantitative approach, evaluating redox signals based on area under the curve (AUC), signal amplitude, time, and duration. These parameters allowed us to investigate how dynamic profiles changed in response to various oxidants across three distinct experimental contexts. First, quantifying the dynamic response of the Tpx1/Pap1 redox-regulated pathway in Schizosaccharoymyces pombe revealed a graded signal and transcriptional response to input peroxide concentrations. Secondly, we applied this method to establish the upper and lower limits of detection for the redox probes HyPer7 and roGFP-TSA2/Tpx1 in Saccharomyces cerevisiae and S. pombe, providing a set of criteria for improved selection and comparison of probes. Thirdly, we quantitatively evaluated the dynamic response of the mammalian NRF2/Keap1 pathway following pre-exposure to DEM and tBHQ. Our findings revealed that, unlike the Tpx1/Pap1 pathway, this pathway showed that the timing of oxidant exposure influenced the NRF2 response. These metrics have therefore provided useful insights to several different pathways in both experimental and analytical contexts. Importantly, these measures allow for further exploratory questions to be asked and provide a fundamental framework for assessing dynamic responses of redoxregulated pathways associated with cell physiology and disease.
Economic challenges faced by wool and mohair farmers in the Leribe district of Lesotho.
(2024) Nyapisi, Thabiso Wilson.; Taylor, Simon Michael.
Abstract available in PDF.
Investigating the impact of the auditor-general at the greater Kokstad Municipality to improve service delivery.
(2022) Mzolo, Thembela Barba.; Chummun, Bibi Zaheenah.
The South African Government constitutes three spheres, namely, National, Provincial and Local government. Local government (through municipalities) is the closest sphere to the communities for which government provides basic services (Statistics South Africa, 2016). Most municipalities in the province of KwaZulu-Natal are confronted with service delivery challenges which, in some instances, culminate into service delivery protests. At the centre of the service delivery challenges experienced by municipalities, amongst other, are the ailing administrative systems of governance and internal controls, instances of non-compliance and sometimes ineffective oversight. The Auditor-general, through the Public Audit Act (2004), is mandated to conduct statutory external audits in municipalities based on the annual financial statements and performance reports prepared annually. This study entailed the investigation of the impact of the Auditor-General in improving service delivery, and was performed at the Greater Kokstad Municipality, in KwaZulu-Natal. The data for the study was collected using quantitative methods through the use of a questionnaire completed physically by 33 participants who comprised of councillors, audit committee, top management, middle management and operational employees of the municipality. The study revealed that in essence the audit process adopted by the auditor-general is participative (though perceived as not completely inclusive) and is relatively construed to constitute a favourable ambient for the auditee. The study further revealed that (to some extent) the external audit performed by the auditorgeneral has an impact in improving service delivery at the Greater Kokstad Local municipality. However, the study also revealed that the external audit (by auditorgeneral) does not necessarily add value, and this is influenced by, inter-alia, factors such as the perceived lack of service delivery orientation in the AG audit approach, and the less experienced auditors who lack requisite knowledge of the local government sector. Although physical verification of projects is performed during the audit there is perceived lack of technical skills to qualitatively audit core service delivery programs, coupled with inadequate interpretation and application of legislation on issues of supply chain management and the impact on service delivery. It is also generally perceived that the service delivery paradigm is not at the centre of the audit approach.
Impact of coronavirus on the motivation and performance of the sale team within a petroleum company in Southern Africa.
(2022) Govender , Thirumoney.; Mutambara, Emmanuel.
The unanticipated spreading of the Coronavirus 2019 (Covid-19) has had a devastating impact on the world, including South Africa. South Africa was susceptible to this impact as government enforced strict regulatory lockdowns, which required new ways of working in a workforce that was used to face-to-face business interaction. This study focused on retail sales employees within a petroleum company and the adaptation of their characteristics to drive work performance during the Coronavirus Pandemic. The main characteristic that this study focused on, was the motivational factors that influenced the employee’s lives for better or worse. The retail sales employees (Territory Managers) are responsible for the business development of service stations. Their roles include monitoring of fuel sales, convenience store sales, safety and regulatory compliance of the service station, environmental and disaster management of the site, routine corporate contractual monitoring of the equipment and infrastructure, and housekeeping of the site. Qualitative research was conducted via semi-structured interviews to 12 Territory Managers, from the perspective of the employees, to gain a better understanding of the impact of the Covid-19 pandemic. The non-probability purposive sampling method was used. The research methods consisted of secondary research from existing academic and corporate literature, as well as primary research from the interviews that were conducted with the retail sales employees. The research found that the impact of the pandemic touched every person’s life in some way or the other. Whilst some people found ways to cope with the pandemic, others gave in to the stress which impacted on their physical and mental wellbeing. The research also pointed out the gaps in the company’s support system for employees and the company’s readiness to deal with the impact of the crisis. This study's main goal was to offer suggestions to the business, to help decisionmakers support employees’ productive ability, so that the employees remain inspired and performance oriented during times of crisis.