BACKGROUND: During the era of the Millennium Development Goals (MDG), children were shown to have less access to human immunodeficiency virus (HIV) services than their adult counterparts; hence the call to prioritise children in the implementation of the Sustainable Development Goals (SDGs). However, South African (SA) national data in 2019 indicated that almost 3 years into the implementation of the 90-90-90 strategy, only 59% of children living with HIV had been tested for HIV compared to 90% of adults. OBJECTIVES: To evaluate the access of children to HIV services and record the viral load (VL) suppression rates during the implementation of the 90-90-90 strategy in the City of Johannesburg (COJ), South Africa. METHODS: This study applied a quasi-experimental interrupted time-series (ITS) design using the monthly District Health Information System (DHIS) and National Health Laboratory Services (NHLS) databases spanning the period from 2015 to 2020, that is, before and after the implementation and roll-out of the 90-90-90 strategy. Data were extracted from these databases into MS Excel 2010 spreadsheets and analysed with Stata 15 software from Stata Corp using a two-tailed t-test at a 5% level of significance RESULTS: Overall, a significant increase was observed in the number of individuals tested for HIV, n = 757, p = 0.0086, and retained in care n = 2523, p = 0.001 over the whole period of analysis beginning in April 2015. Adult HIV testing, antiretroviral treatment (ART) initiation and retention in care had been decreasing in absolute numbers over a 10-month period before the intervention. An increase in these three data elements was observed following the implementation of the 90-90-90 program. On the other hand, children aged 0-15 years had demonstrated a significant increase in absolute numbers tested for HIV, n = 171, p = 0.001, but an insignificant increase in number of ART initiations, n = 14.33, p = 0.252, before implementation but a decrease after this. The overall VL suppression rates for children were lower than those of adults. CONCLUSION: Although the COJ has recorded progress in adult HIV testing, ART initiation and retention, children living with HIV aged 0-15 years continue to experience less access to HIV services and lower VL suppression than youths and adults of ≥ 15 years. Therefore, to ensure that the 90-90-90 targets are achieved across different age groups, children must be prioritised so that they can equally access these services with adults

Objective: The objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure. Methods: A prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group 1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours. Results: A total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P<0.001). Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation. However, regression analysis revealed that only trisomy 21 (OR: 0.248; 95%CI: 0.176-0.701; P=0.001), low cardiac output syndrome (OR: 0.291; 95%CI: 0.267-0.979; P=0.001), multiple ventricular septal defect (OR: 0.243; 95%CI: 0.147-0.606; P=0.002) and vasoactive inotropic score (OR: 0.174 95%CI: 0.002-0.062; P=0.039) are strongest predictors for delayed extubation. Conclusion: Trisomy 21, low cardiac output syndrome, multiple ventricular septal defect and high vasoactive inotropic score are significant risk factors for delay in extubation. Age, weight, pulmonary artery hypertension, size of ventricular septal defect, aortic cross-clamp and cardiopulmonary bypass time did not affect early extubation.

Abstract Objective: Perventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique. Methods: Thirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance. In case of failure or complication, surgical closure of ventricular septal defect was performed through the same incision with cervical cannulation of common carotid artery and internal jugular vein for commencement of cardiopulmonary bypass. All the patients were postoperatively followed, and then discharged from hospital due to their surgical outcome, morbidity and mortality. Results: Procedure was successful in 35 patients. Two patients developed transient heart block. Surgical closure of ventricular septal defect was required in one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean intensive care unit and hospital stay were 1.88±0.74 days and 6.58±1.38 days, respectively. There was no in-hospital mortality. A patient died one day after hospital discharge due to arrhythmia. No patients developed wound related, vascular or neurological complication. In a mean follow-up period of 23.3±18.45 months, all 35 patients were doing well without residual defect with regression of pulmonary artery hypertension as seen on transthoracic echocardiography. Conclusion: Transverse split sternotomy incision is a safe and effective alternative to a median sternotomy for perventricular device closure of ventricular septal defect with combined advantage of better cosmetic outcomes and avoidance of cardiopulmonary bypass.

Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

CONTEXTE: Un déterminant important du comportement et de la performance d'un étudiant est l'environnement scolaire d'enseignement et d'apprentissage. L'évaluation de cet environnement peut permettre de développer des moyens pour améliorer les programmes d'enseignement et l'atmosphère académique OBJECTIF: Evaluer l'environnement éducatif du programme de Licence en Pratique de Médecine clinique, tel que le perçoivent les étudiants de l'Université du Witwatersrand, en Afrique du Sud CADRE: Cette étude transversale a été faite avec tous les étudiants de dernière année (n = 25) inscrits en 2011 avec un taux de réponse de 88% (n = 22). Les étudiants étaient dans deux groupes dans les provinces du Gauteng et du Nord Ouest, respectivement MÉTHODES: Les données ont été collectées au moyen du questionnaire de Mesure environnementale éducative de Dundee Ready qui a été distribué à tous les étudiants. On a calculé les notes totales et moyennes de toutes les questions des deux groupes RÉSULTATS: Les étudiants ont donné une note moyenne de 130/196 à l'environnement d'apprentissage. Les sous-domaines individuels montrent que 'la perception académique de soi-même' était la plus élevée (25/32) alors que 'la perception sociale de soi-même' avait la note la plus basse (13/24). Les aspects positifs du climat académique comprenaient: le développement de l'assurance et des compétences des étudiants; la participation des étudiants en classe; les critiques constructives formulées; la compassion dans la profession médicale; les amitiés créées. Les domaines à améliorer étaient notamment: les feed-back aux étudiants; l'horaire des cours; assurer des cours non-stressants; donner de bons systèmes de soutien aux étudiants; l'amélioration de la vie sociale CONCLUSION: La perception des étudiants de leur environnement d'apprentissage était 'plus positive'. Les résultats de cette étude seront utilisés pour tirer des leçons afin d'améliorer le programme scolaire et l'environnement d'apprentissage, de parfaire les processus administratifs et de développer les mécanismes de soutien aux étudiants pour améliorer leur expérience universitaire.

BACKGROUND: An important determinant of a student's behaviour and performance is the school's teaching and learning environment. Evaluation of such an environment can explore methods to improve educational curricula and academic atmosphere AIM: To evaluate the educational environment of the Bachelor of Clinical Medicine Practice programme as perceived by students at the University of the Witwatersrand, South Africa SETTING: This cross-sectional study was conducted with all final-year students (n = 25) enrolled in 2011, with a response rate of 88% (n = 22). Students were in two groups based in the Gauteng and North-West provinces METHODS: Data were collected using the Dundee Ready Educational Environmental Measure questionnaire, which was administered to all students. Total and mean scores for all questions were calculated for both groups RESULTS: The learning environment was given an average score of 130/196 by the students. Individual subscales show that 'Academic self-perception' was rated the highest (25/32), whilst 'Social self-perception' had the lowest score (13/24). Positive aspects of the academic climate included: student competence and confidence development; student participation in class; constructive criticism provided; empathy in medical profession; and friendships created. Areas for improvement included: feedback provision to students; course time-tables; ensure non-stressful course; provision of good support systems for students; and social life improvement CONCLUSION: Students' perceptions of their learning environment were 'more positive' than negative. Results from this study will be used to draw lessons for improving the curriculum and learning environment, improve administrative processes and develop student support mechanisms in order to improve their academic experience.