Background: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and has several advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world. Objectives: To describe our patients’ demographics and clinical characteristics, our method of PD catheter placement within the Radiology Department at Kimberley Provincial Hospital, compare our early complication types and frequencies, overall peritonitis rate and one-year catheter survival rate with findings in the international literature and, by demonstrating comparable outcomes, propose that percutaneous placement be considered as a feasible alternative to conventional placement techniques. Method: We conducted a retrospective study on 25 patients who had their PD catheters inserted between January 2009 and May 2013. Medical records were reviewed for demographic and clinical information as well as type and frequency of early (within 30 days) and late (between 30 days and one-year) complications related to the PD catheter. Early complication types and frequencies were then compared with similar internationally published data. The overall peritonitis rate, in terms of episodes per patient-year, was calculated and compared with international recommendations, and our one-year catheter survival rate was calculated using the Kaplan Meier method and compared with similarly calculated international studies.Results: The study group comprised 16 male and 9 female patients with a median age of 44 years. Hypertension was the primary cause of end-stage renal disease (ESRD), and was found in 10 (40%) patients. Our early exit site infection rate of 12% was slightly higher than that found in the literature. Literature varies on the overall infection rates; however, our overall peritonitis rate of 0.75 episodes per patient-year was higher than that recommended by the International Society of Peritoneal Dialysis. This finding might be attributed to the lower socio-economic grouping of our patients and the small number in the study group. All but two peritonitis cases were successfully treated with antibiotics, and we had no major procedure-related complications. Our early peritonitis rate of 8%, as well as the other early complication types and rates, and our one-year catheter survival rate of 84%, compared favourably with international studies. Conclusion: Percutaneous PD catheter placement under conscious sedation with the aid of ultrasound and fluoroscopy is a sound alternative to conventional methods in the resourcelimited developing world.

Time-critical management is of particular significance in the trauma and emergency setting, where intervals from patient arrival to diagnostic imaging and from imaging to radiology report are key determinants of outcome. This study, based in the Trauma and Emergency Unit of a large, tertiary-level African hospital with a fully digital radiology department, assessed the impact of increased workload on computerised tomography (CT) efficiency. Sequential, customised searches of the institutional radiology information system (RIS) were conducted to define two weekends in 2016 with the lowest and highest emergency CT workloads, respectively. The electronic RIS timestamps defining the intervals between key steps in the CT workflow were extracted and analysed for each weekend. With the exception of radiologist reporting time, workflow steps were significantly prolonged by increased workload. This study highlights the potential role of the integrated digital radiology system in enabling a detailed analysis of imaging workflow, thereby facilitating the identification and appropriate management of bottlenecks.

Background and Objectives:Antiretroviral treatment (ART) era HIV-associated stroke data from Sub-Saharan Africa is limited. We determined the prevalence of HIV in patients presenting with acute symptomatic stroke, and compared risk factors, clinical characteristics, and brain imaging with age-matched stroke patients without HIV.Methods:We conducted a retrospective study of adults presenting with any type of stroke to Tygerberg Hospital in a 12-month period. Patients living with HIV (PLWH) and HIV-uninfected patients (HIV-) were matched on age group (1:2 ratio). Patients were identified by keyword search, while HIV status was ascertained from laboratory data. Clinical and imaging data were extracted from medical records.Results:Among 884 patients presenting with acute strokes, the minimum prevalence of HIV infection was 9.3% (95% CI: 7.4-11.2%), with 496 patients (56.1%) with negative HIV status and 306 patients with unknown HIV status (34.6%). Mean age at presentation in PLWH was 46 (± 11) years compared to 55 (± 14) years in HIV- (p<0.001). Smoking was less prevalent in PLWH with an adjusted relative risk of RR=0.58 (95% CI: 0.39–0.86). Concurrent infection was more prevalent in PLWH (25.6% vs 4.9%, p=<0.001) with an adjusted relative risk ratio of 2.07 (95% CI: 1.49–2.84), largely in patients with CD4 count <200 cells/mcL. PLWH with higher CD4 counts (≥200 cells/mcL, 51.3%) had more traditional risk factors and less concurrent infection. Among PLWH, 68.3% were on ART, and 39.3% of these had been started or restarted on ART within the past 6-months. Basal ganglia infarcts (35.6% vs 18.3%, p=0.014) and multiple vascular territory involvement (25.4% vs 7.7%, p=0.002) was more common in PLWH. Clinical presentation, ischaemic stroke type, and in-hospital outcomes did not differ between groups.Conclusion:Stroke patients with HIV were younger, had less traditional cardiovascular risk factors, and more concurrent infections than patients without HIV, especially those with a lower CD4 count. Recent ART initiation or reinitiation rates were high. Significant differences in CT brain imaging findings were seen. Understanding the multifactorial mechanisms underlying increased stroke risk, including associated infections and potential ART-associated immune reconstitution, is crucial and needs further study.