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.

Background: Enteral feeding is a widely accepted method to maintain nutrition in severely burnt patients who cannot eat. However, controversy exists over the safety of enteral feeding in an intensive care unit (ICU) setting where burns patients are haemodynamically unstable and on high-dose vasopressor support. Enteral feeding increases the oxygen requirements of the gastrointestinal mucosa. If vasopressor agents decrease the splanchnic blood flow, there is a risk of mucosal necrosis.Objective: The aim of this study was to determine the safety and efficiency of early and ongoing enteral feeding in a cohort of severely burnt patients in an ICU.Methods: This retrospective study was over a five-year period at the Chris Hani Baragwanath Academic Hospital (CHBAH), involving adult burns patients admitted to the ICU requiring vasopressor support and enteral feeding. Of the 1109 adult burns patients admitted to the adult burns unit at CHBAH, 475 patients required intensive care. Of these, 44 patients with burns, >20% of the total burnt surface area, required both ventilation and intravenous vasopressor support and were entered into the study.Results: Of the 44 patients, 11 (25%) experienced delayed gastric emptying with gastric aspirates >500 ml/6 h, 4 (9%) vomiting and 9 (20%) developed diarrhoea. However, 41 (93%) tolerated full enteral feeding after a temporary intolerance while receiving intravenous vasopressor support. In 3 (7%) patients, enteral feeding was discontinued due to persistent intolerance.Conclusion: In this cohort of severely burnt patients requiring ventilation and intravenous vasopressor support, there were no serious complications associated with enteral feeding.

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.

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.