Physical inactivity has been referred to as a pandemic and is the fourth leading contributing cause of mortality worldwide. [1] The positive impact of physical activity on health is well known, and lack thereof is known to increase the risk of several non-communicable diseases such as hypertension, coronary artery disease and type 2 diabetes. [1,2] This increased risk has local significance, as South Africans have been found to be among the least active people on the African continent. [3] South Africans' physical inactivity unfortunately extends to healthcare professionals. Kunene and Taukobong [4] evaluated the level of physical activity of a mixture of healthcare professionals at Estcourt Hospital, KwaZulu-Natal Province, South Africa (SA). Despite potentially having more insight into the risks of physical inactivity than patients, 69% of these healthcare professionals were found to have moderate to low physical activity levels. [4] This finding is echoed in the limited international research that has been published on the physical activity of doctors specifically. [5-7] The recommendation to walk at least 10 000 steps per day is seen as an appropriate activity target for healthy adults, and achieving this goal is a predictor of good health. [8] However, to date, none of the studies assessing doctors' physical activity levels at work have shown that they achieve this suggested target. [5-7,9-16] The emergency department (ED) is a fast-paced and busy working environment, and emergency medicine is regarded as one of the most stressful specialties in medicine. [17] It was therefore surprising that this shortfall in achieving 10 000 steps also applied to ED doctors. [9,10] Objectives To determine whether failure to achieve the above physical activity target also holds true in the SA context. We hypothesised that ED doctors would walk well over the 10 000-step mark because of our busy, overburdened and understaffed departments. [18] Our primary objective was to determine how many steps per shift were taken by doctors in an SA ED. The secondary objectives were to assess what factors influenced the number of steps taken. Methods Study design and setting We undertook a prospective observational cohort study over a 1-month period at a tertiary academic teaching hospital in Johannesburg. The ED sees ~65 000 patients per annum and has 2 500 m 2 of floor space. It includes a 7-bed resuscitation area, a 6-bed acute observation area, an 8-bed 'surgical' area and an 8-bed 'medical' area, as well as triage, orthopaedic, psychiatric and radiology sections. Ethics approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand (ref. no. M150405). Participants Medical officers (MOs) and emergency medicine registrars working various day shifts in the ED made up the study population. Written informed consent was obtained from each participant prior to enrolment in the study. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

IntroductionAccess to neurosurgical facilities remains limited in resource-restricted medical environments worldwide, including Africa. Many hospitals refer patients to off-site facilities if they require intervention. Unnecessary referrals, however, can be detrimental to the patient and/or costly to the healthcare system itself. The aim of this study was to determine the frequency and associated intracranial pathology of patients who did and did not receive active neurosurgical intervention after having presented to an academic emergency centre at a hospital without on-site neurosurgical capabilities.MethodsA one-year, retrospective record review of all patients who presented with potential neurosurgical pathology to a tertiary academic emergency centre in Johannesburg, South Africa was conducted.ResultsA total of 983 patients received a computed tomography brain scan for suspected neurosurgical pathology. There were 395 positive scans; 67.8% with traumatic brain injury (TBI) and 32.3% non-traumatic brain injury (non-TBI). Only 14.4% of patients received neurosurgical intervention, mostly non-TBI-related. The main intervention was a craniotomy for both TBI and non-TBI patients. The main TBI haemorrhages that received an intervention were subdural (SDH) (16.5%) and extradural (10.4%) haemorrhages. More than half the patients with non-TBI SDHs as well as those with aneurysms and subarachnoid haemorrhages received an intervention.DiscussionBased on this study’s findings, in a resource-restricted setting, the patients who should receive preference for neurosurgical referral and intervention are (1) those with intracranial haemorrhages (2) those with non-traumatic SDH more than traumatic SDH and (3) those patients with non-traumatic subarachnoid haemorrhages caused by aneurysms.

In adults, foreign body aspiration is an uncommon clinical presentation. Aspiration can occur during a seizure and in the post-ictal period due to the loss of airway reflexes. Commonly aspirated contents include saliva, blood, or vomited gastric contents. Due to a common misconception that placing an object, such as a spoon, in a seizing person's mouth prevents tongue-biting, a variety of unusual items may also potentially be aspirated. With an unclear history, relatively small, radiolucent objects are often misdiagnosed or missed entirely. Chest pain or unexplained hemoptysis may be the only symptoms to suggest aspiration. In this report, the authors present a case of a patient with an unusual foreign body aspiration.