Masters Degrees (Medicine)

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A 10-year institutional review of surgery for structural valve dysfunction in the developing world.
(2017) Chih-Yuan, Chen.
Background Prosthetic heart valves do not fulfil the requirements for an ideal valve, resulting in the development of prosthetic dysfunction or complications over time. Structural valve dysfunction may be influenced by multiple components which include patient’s factors, valve related factors and intraoperative factors. The inter-relation of these factors has a significant impact on morbidity and mortality associated with reoperative surgery for prosthetic valve dysfunction, particularly in a developing world where a large burden of communicable diseases together with lack of health care resources affect surgical outcome. In this study we examined the clinical records of the patients who underwent reoperative valve surgery to evaluate the clinical profile and factors that affect the surgical outcome after reoperation at a large tertiary referral center in a developing country. Objectives 1) To describe the demographic profile of patients with malfunctioning prosthetic heart valves and define their clinical presentation 2) To describe the clinical presentation of valve dysfunction 3) To determine the possible mechanisms of mechanical and bioprosthetic valve failure 4) To determine the factors affecting the immediate surgical outcomes in subjects undergoing redo cardiac prosthetic valve surgery. Materials and methods A retrospective analysis of the clinical, perioperative and follow-up data of patients who underwent redo cardiac valve surgery for structural valve dysfunction between January 2005 and December 2014 at Inkosi Albert Luthuli Central Hospital, Durban, South Africa was undertaken. Patients were identified using the Speedminer software program which is a Data Warehouse software package used to store data collected on the hospital Medicom database. The file of each of patient who underwent redo cardiac prosthetic valve replacement for structural valve dysfunction was accessed and data were extracted on age, gender, potential risk factors for valve thrombosis, symptomatology, investigations including International normalized Ratio (INR) status and follow up. All patients were evaluated preoperatively by the cardiologist and the cardiothoracic surgical team and submitted for either an elective or emergency valve replacement. Excluded from the study were those patients who underwent cardiothoracic surgery for nonvalvular reasons, i.e. coronary artery bypass surgery and congenital heart disease. Results During the ten year period (2005 to 2014) 2618 valve replacement operations were performed. During the same period 128 reoperations (4.9%) were performed in 113 patients (mean age 35.59 (SD±16.66) years). The majority of the patients were Black (72.6%) and female (75%). Fifteen patients (13.3%) were HIV infected and nine were pregnant. Acute dyspnoea (NYHA class III 34.37% and class IV 21.88%) was the presenting feature in 72 patients (56.25%). Clinical presenting features of an obstructed valve (flash pulmonary oedema with or without clinically audible prosthetic valve clicks) were documented in the clinical records of 44 of the 128 (34.4%) reoperations. In seventeen instances subjects presented with acute onset of cardiac failure (13.3%) and in eleven the presentation was characterised by signs of low cardiac output state (5.3%). There were no clinical indicators of an obstructed valve in the remaining 56 (43.8%). Of these 56 patients: 38 presented with change in effort tolerance and 18 where asymptomatic. Valve dysfunction was detected by echocardiography and confirmed fluoroscopically in 71/128 cases (55.47%). In the remaining patients the diagnosis was made either at fluoroscopy (11.72%) or on echocardiography (32.81%). The ejection fraction (EF) was severely impaired (EF<40%) in 7.08% of patients. The mean left atrial size was 52.28mm and mean pulmonary systolic pressure 45mmHg (range 26-104). Mechanical valve dysfunction was documented in 110/128 reoperations (obstructed valve (100) and prosthetic infective endocarditis (10). In almost two thirds of instances with obstructed mechanical prostheses levels of anticoagulation achieved were poor (INR<2.0); 30/110 (27.27%) were within therapeutic ranges of 2-4 and 9/110 (8.18%) was >4.0. HIV status did not influence the outcome of surgery and did not appear to be the main mechanism of valve obstruction. The bioprosthetic valve group comprised the remaining 18 of 128 reoperations. In this group 13/18 patients had structural valve deterioration with periprosthetic leaks, and remaining 5 had prosthetic infective endocarditis (aortic root abscess (1) and annular dehiscence (4).Emergency surgery was performed in 54.7% of the study population, of which 60.2% were in the mitral position. There was a total of 13 early in-hospital deaths (11.5%) of which one “on table” death was due to a low cardiac output state (LCOS). Postoperative mortality was related to prosthetic endocarditis (5/13) and high grade dyspnoea at presentation (7/13). Multivariate analysis revealed that bypass time >3.5 hours (HR 5.58, 95%CI 1.24-24.95), cross clamp time >120 minutes (HR 4.48, 95%CI 1.25-18.73), and third time redo operations (HR 4.26, 95%CI 1.23-14.75) were the independent predictors for early in-hospital mortality. Conclusion Our study shows a 4.9% reoperation rate after the previous valve replacement surgery with 11.5% perioperative mortality. Our results confirm that reoperative surgery is associated with significant morbidity and mortality. More than half the patients presented acutely for mechanical valve obstruction which was due to inadequate levels of anticoagulation and required emergency surgery. Early mortality was related to poor NYHA class at presentation and to the presence of infective endocarditis. An important finding of this study was the high rate of valve obstruction associated with poor anticoagulation in patients who received the Cryolife On–X valve. They had a shorter interval to valve obstruction requiring redo valve replacement compared to the other mechanical prostheses.
Abnormal IgA1 O-glycosylation in a multi-ethnic population of IgA nephropathy patients in KwaZulu-Natal, South Africa.
(2013) Nansook, Prishani.; Assounga, Alain Guy Honore.
Background: The pathogenesis of IgA Nephropathy (IgAN) is poorly understood globally and curative therapy currently does not exist. Variable presentation among IgAN patients globally may be indicative of various underlying pathogenic mechanisms. Pathogenetic data on IgAN in Africa is scarce to nil. The current study provides the first O-glycosylation data for IgAN in South Africa or Africa. Methods: An enzyme-linked immunosorbent assay-type lectin binding assay was used to compare the serum IgA1 O-galactosylation in 19 IgAN patients and 20 controls. During 2007, 2009, and 2011, blood was extracted from consenting biopsy-diagnosed South African IgAN patients of African, Caucasian, Indian (predominantly) and mixed-race descent in KwaZulu Natal. The mean absorbance value corresponding to the degree of degalactosylation for the IgAN group was compared to that of the normal control group for each test. A non-parametric Wilcoxon matched-pairs test was used accordingly. The two-tailed p-value was used to assess for statistical significance between the groups. The low number of attending and consenting IgAN patients precluded IgA1 O-galactosylation analyses between race, gender, and disease stage. Results: The average means of the experiments for the IgAN group is 0.3678 ± 0.0790 (SEM) and is statistically significantly greater than the normal control group which is 0.2969 ± 0.0586 (SEM); (p = 0.0076). Conclusion: Thus, IgAN patients exhibited abnormal IgA1 O-glycosylation with a greater level of terminal degalactosylation of IgA1 in comparison to controls. Such a finding is consistent with other studies in Caucasian and Asian populations globally. Future specific therapeutic strategies that target the formation of abnormal glycosylation in IgA1 may be potentially beneficial in the study population.
Anatomical variations of the frontal sinus outflow tract in the paediatric population in KwaZulu-Natal: a cause of complicated sinusitis with intracranial complications?
(2021) Nandkishore, Tanusha.; Rennie, Carmen Olivia.; Schlemmer, Kurt.
Thesis overview in a PDF.
An assessment of DSP pharmacy medication delivery for HIV treatment in a family practice in KwaZulu-Natal.
(2014) Reddy, Vinothan Vadival.; Mahomed, Ozayr Haroon.
Abstract available in PDF file.
An assessment of ENT scope and training perceptions amongst general practitioners and primary care physicians in KwaZulu-Natal.
(2017) Mungar, Reshna.; Naidu, Tesuven Krishna.
An overview of dissertation is available in a PDF.
Assessment of the immune response in kidney transplant patients.
(2009) Omarjee, Saleha.; Assounga, Alain Guy Honore.
Background: Management of a transplant recipient involves the use of multiple immunosuppressant drugs. Currently there is no test that reflects the overall immune status of the patient. This results in under or over suppression of the immune system and consequently increases in morbidity and mortality rates. Evaluation of the proliferative response of PBMC's to a mitogen PHA by measurement of intracellular ATP was evaluated as a tool to assess the immune response in kidney transplant patients. Method: PBMC's were separated from the blood samples of healthy controls and kidney transplant patients on cyclosporine, sirolimus, and tacrolimus based regimens by density gradient centrifugation, cells were counted and incubated overnight with and without PHA. The luciferin-Iuciferase enzyme reaction which induces bioluminescence and the Turner Biosystem luminometer were used to measure intracellular ATP levels in relative light units (RLU). An A TP standard curve was generated for each test. Results: The ATP (nglml) levels measured in the transplant recipients were lower and statistically significantly different (p< 0.0001) than the healthy controls. No statistically significant difference was measured between the cycIosporine and sirolimus drug groups. Patients on tacrolimus gave a statistically significant (p501 nglml ATP). Conclusion: Future studies to determine the predictive value of the A TP assay in directing immunosuppressive therapy are required. The assay described in this study is simple, sensitive and rapid and has possible application in immunological monitoring in a variety of conditions that affects the immune system. Keywords: kidney transplantation, immunosuppression, bioluminescence, lymphocyte, Adenosine Triphosphate (A TP), Phytohemmagglutinin (PHA)
Assessment of the liver in an HIV era: clinical, laboratory and radiological abnormalities.
(2020) Mbanjwa, Bavumile.; Magula, Nombulelo Princess.
Background: Liver – related mortality and morbidity are an increasing burden worldwide. Aim: To outline the pattern of liver abnormalities at a tertiary hospital in KwaZulu Natal (KZN), Durban, South Africa, during the era of the HIV epidemic. Methods: This cross-sectional, retrospective study conducted medical records review of all patients found to have liver abnormalities based on clinical, laboratory, and radiological profile, admitted to the medical wards for the period between June 2016 to December 2016. Results: A total of 157 patients were included, of which 63.1% were males, and 91.7% were black, with a median age of 41 years (IQR, 32–54). Sixty – six (42.0%) patients were HIV negative; 91 (57.9%) were HIV infected, of which 51 (56.0%) were on antiretroviral therapy. Only 15 (29.4%) had an HIV viral load of < 50 copies/mL and 21 (30.9%) with a CD4+ count of ≥ 200 cells/mm3. In HIV negative, heart failure (48.5%) was the main cause of liver abnormalities (p-value < 0.001), whereas in HIV infected, abdominal TB (24.2%) and DILI (18.7%) were the commonest. Sixty- seven (42.7%) patients died while admitted, and leading causes were HIV/AIDS (40.3%), hypertension (13.4%), and metastatic cancer (13.4%). Conclusion: In HIV infected patients, abdominal TB was common, which was consistent with the common presenting symptoms of fever and vomiting in this group; whereas in HIV negative, heart failure was the commonest which was also consistent with the leading presenting symptoms of abdominal distension and ascites, and comorbid conditions of hypertension, diabetes mellitus, and dyslipidaemia which are all risk factors of cardiac diseases. Also, mortality was significantly high, and the leading causes were HIV/AIDS, hypertension, and advanced malignancy, which underscores the need to strengthen community-based screening programs for both communicable and noncommunicable disease for early detection and referral to care.
An assessment of tne successes and shortfalls of the national birth defects databases and an improved data collection method of the databases.
(2018) Mtyongwe, Vuyiswa; Malherbe, Helen.; Aldous, Colleen Michelle.
The Constitution of South Africa (SA) together with the National Health Act (63 of 1977) govern the provision of health services to the residents of the country. With a three-tier system of governance consisting of national, provincial and local (district) government, each tier functions autonomously, though in unison. The National Health Act outlines the health system whilst specifying services per level of governance. In this document, medical genetic services, amongst others, are included as a health issue that needs to be addressed as part of the functions of the National Department of Health (NDOH). At this level, these services form part of the Maternal and Child Health services. Although neglected, medical genetics services are important for the prevention and management of congenital disorders (CDs) in the community. These services are implemented through the development and implementation of policy guidelines. Data on CDs form the basis for policy development, decision making and planning for services. Without empirical data, services for this vulnerable group of individuals, cannot be adequately provided. Collection of CD data was initiated in 1980, with multiple surveillance systems available in the country by the early 1990s. One system in particular (Birth Defects Surveillance System-BDSS) was successful, with its data (from 1992-2004) being submitted to the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS), whose functions include the exchange of CD birth prevalence among member countries and the promotion of epidemiologic studies. In 2006, the NDOH developed the standardized birth defect notification tool (BDNT), with the intention of substituting all existing CD surveillance systems with one notification tool and system for the entire country. The primary objective of this study was to measure the effectiveness of this system, taking into account the challenges experienced in the reporting period. This was done by analyzing the data and comparing it to other surveillance systems globally and locally. The secondary objective was to develop an improved surveillance system for the country. Data from the BDNT was analyzed for a nine year period, 2006 until 2015. Analyzed data included the number of CDs reported per year, per province and per district. CDs of all pregnancy outcomes were included e.g. live births, stillbirths, terminated pregnancies and miscarriages. Birth prevalence was calculated based on aetiology, (whether the CD was genetically or environmentally determined), and per priority condition (This list of priority conditions was defined by the NDOH in their 2001 Birth defects policy guidelines. The number of priority CDs reported by doctors versus nurses was also determined). Priority conditions are, Down syndrome, fetal alcohol syndrome, neural tube defects, oculocutaneous albinism orofacial clefts and talipes equinovarus. A total of 17 761 notifications were received from across SA, of which 16 395 (92.13%) were CD notifications and 1 366 (7.69%) were zero notifications (these are notification tools that were completed by the health facility in months when no CDs were identified by the health viii facility). Compliance was erratic with KwaZulu-Natal province reporting the most CDs, n=9 732 (59.36%), and Western Cape province reporting the least, n=389 (2.37 %). KwaZulu-Natal province’s success is largely attributed to the good medical genetics services that were administered by Professor William Winship while he was alive. Overall, the districts where medical genetics facilities are located reported more CDs. When compared to modelled estimates, the BDNT surveillance system showed an underreporting rate of 98%. Malformations accounted for most of the reported CDs with a birth prevalence of 1.02 per 1 000 live births. Birth prevalence for CDs categorized by aetiology were: single gene disorders 0.07 per 1 000 live births; chromosomal disorders 0.13 per 1 000 live births; multifactorial disorders 0.09 per 1 000 live births; CDs caused by Rh (rhesus factor) incompatibility 0.00 (0.0032) per 1 000 live births and 0.01 per 1 000 live births for CDs caused by teratogens. Birth prevalence for each priority CD was as follows: Down syndrome 0.12 per 1 000 live births, fetal alcohol syndrome 0.01 per 1 000 live births, neural tube defects 0.09 per 1 000 live births, oculocutaneous albinism 0.03 per 1 000 live births, orofacial clefts 0.10 per 1 000 live births and talipes equinovarus 0.10 per 1 000 live births. Over half (57.80%) of all reported CD cases were diagnosed by nursing staff. Following analysis of data from the BDNT, a new surveillance system was developed containing the following factors: the types of CDs to be monitored, approaches to data collection, classification of collected data and the use of data received. Initially, the new CD surveillance system was going to be integrated into the national notifiable medical conditions surveillance system. In addition, an electronic system (with a backup paper-based notification system) was developed together with colleagues responsible for notifiable medical conditions surveillance and the National Institute for Communicable Diseases (NICD) which is yet to be piloted. Upon further research, certain elements were lacking in the system which could negatively impact upon implementation. As a way forward, certain considerations were identified for future implementation of a CD surveillance system. These were categorized into mandatory and elective factors. The former includes political commitment to CDs as a health issue, legislation prescribing CD services including surveillance, vital registration of CDs at birth and death, and NDOH facilitating the coordination of CD surveillance systems in the country. The latter includes the use of a district based approach to data collection with specific personnel identified to collect data using an electronic system. This study lays the foundation for national CD surveillance in SA. Various surveillance systems or patient registries are available, but none operate data at a national level. This study further identified the need for coordination between the different surveillance systems and/or patient registry data sets (e.g. non-governmental organisations and laboratories) which are not included in the BDNT. The national CD surveillance system could serve as a link between the various stakeholders (provinces, academic institutions, laboratories and non-governmental institutions), allowing each entity to have a system that is suitable to their needs while collating data from these systems. The CD surveillance system should also follow patients from the point of diagnosis to treatment/management and/or death, allowing for the true burden of CDs to be measured.
The association between headache presentation, clinical examination and neuroimaging findings: a retrospective analysis of patients presenting to a tertiary referral centre.
(2021) Moodley, Sharania.; Bhigjee, Ahmed Iqbal.
Abstract available in a PDF.
The association between renal sonography and renal function in chronic kidney disease at Inkosi Albert Luthuli Chief Hospital: a retrospective descriptive study.
(2020) Frank, Astley Gershwyn.; Assounga, Alain Guy Honore.
Background Non-communicable diseases (NCDs) are rapidly emerging as a major cause of chronic kidney disease (CKD) in Africa with a reported prevalence of 10.7% locally. At current, few high-quality studies assessing the epidemiology of CKD in South Africa have been published. Alarmingly, CKD is now at epidemic proportions and is a leading cause of mortality with significant cost implications. This study aims to investigate economic means of predicting renal function in CKD by exploring the association between estimated glomerular filtration rate (eGFR) and renal morphology evaluated by ultrasound (US). Methods This is a retrospective descriptive chart review conducted at the Department of Nephrology, Inkosi Albert Luthuli Central Hospital (IALCH), Cato Manor, Kwa-Zulu Natal from January 2016 to December 2016. A total of 455 patients who had met the Kidney Disease Improving Global Outcomes (KDIGO) definition of CKD with eGFR (MDRD) and renal US performed were included. Demographic, clinical, laboratory and renal morphological data (renal length (RL), increased echogenicity (IE) and loss of corticomedullary differentiation (LCMD)) on US were collected and analyzed with SPSS software (v. 27). Associations between eGFR, parameters on US and CKD risk factors were determined using logistic regression analysis. Results Black Africans 75.2% (n.342) and females 56.9% (n.259) predominated the sample. Whilst, Indians, Whites and Coloureds comprised of 20.4%, 2.42% and 1.98% of the study respectively. The median age was 45.8 ± 14.3 years. Hypertension 34.9%, diabetes 26.8%, HIV 27.5% and glomerulonephritis 9.89% were the four most frequently reported risk factors, of which Black Africans comprised more than 50% of cases (p <0.001). A significant proportion of patients 65.7% (n.307) had end-stage renal disease with a median eGFR of 14.4 ± 12.8ml/min/1.73m2 (p <0.001). The median right and left RL were short at 8.49 ± 2.16cm and 8.60 ± 2.20cm respectively. Black Africans were also found to have significantly shorter RLs and lower eGFRs (p <0.001). The dual effect of IE and LCMD predisposed to significantly shorter RLs and lower eGFRs than in the presence of one or no abnormality on US (p <0.001). IE [-9.29 OR; 95% CI (-13.8 - -4.77); p <0.001] and RL [right: 5.02 OR; 95% CI (3.44 – 6.60); p 0.04; left: 5.11 OR; 95% CI (3.56 – 6.66); p 0.04] were found to be significant predictors of eGFR. HIV was the only risk factor found to be negatively associated with all determined measures of renal function, as well as the sole predictor of IE [2.31 OR; 95% CI (0.17 - 3.15); p 0.02]. Conclusion The CKD epidemic is driven by the complex interplay between communicable (HIV) and NCDs (HPT/DM) and has emerged as an important public health and economic threat in Southern Africa. Africans are most vulnerable presenting with an advanced and accelerated disease course. GFR determination and US are inexpensive means of determining renal function particularly in resource limited settings. IE and RL are surrogate markers of renal function with an increased echogenic pattern being most predictive of renal dysfunction in CKD, particularly in HIV.
The association between risk factor profile and angiographic severity in young patients presenting with acute myocardial infarction: single centre study.
(2022) Hlophe, Mbuso Alpha.; Ranjith, Naresh.
No abstract available.
Association between thyroid dysfunction and conventional risk factors in patients with acute coronary syndromes.
(2019) Ben Hkouma, Mustafa Mansur Mohame.; Brown, Susan Lynn.
Abstract not available.
An audit of the infection prevention and control program at Port Shepstone Regional Hospital.
(2019) Chetty, Sivathasen Kasaven.; Saman, Selvarajah.
BACKGROUND Infectious diseases are the leading cause of death in South Africa. The treatment of these diseases and their complications consume huge amounts of already limited healthcare resources. Antibiotic resistance is growing global concern and the strategy to contain it has 3 main components; Infection Prevention and Control (IPC) programs, microbiological resistance testing and antibiotic stewardship programs (ASP). South Africa has recently embarked on a journey to upgrade and develop its own Antimicrobial Program which encompass these 3 components. Emphases have been placed on developing antibiotic stewardship programs and recent literature reflects this. At the 400 bed Port Shepstone Regional Hospital (PSH), in contrast, the most developed of these components is the IPC program. We aim to describe the core component of PSH’s antimicrobial program and compare its IPC program with that of an established program. OBJECTIVE To use the CDC’s Infection Control Assessment Tool for Acute Care Hospitals (USA) to evaluate the infection control program at PSH and report on the Core Elements of the hospital’s Antibiotic Stewardship Program METHOD A prospective descriptive study with a quantitative component was conducted at PSH between February to March 2018. The first part of the study determined which of the CDCs 17 core components of an infection control program were operative at PSH. The assessed components were leadership commitment, pharmacy services, laboratory services, a dedicated specialist team, infection control policy, guidelines for antibiotic use, antibiotic rotation, personal protective equipment policies, protocols for prevention of catheter-related UTI, protocols for central line use, protocols for injection safely, protocols for prevention of ventilator-associated events, protocols for surgical site infection, services for environmental cleaning , infrastructure for isolation of contagious patients, policies for clostridium difficile infection, and policies for tracking of infective patients between institutions. In the second part, in each of the 11 adult long-stay wards, responders (nurses) were identified for completion of 5 selected elements of the CDC tool. The tool elicited if responders knew which policies were in place, their knowledge of the protocol, the level of education and training and the ongoing auditing practices. These areas were Handwashing (15 questions), Personal protection equipment (19Q), Catheter-associated Urinary Tract Infections (38Q), Injection safety (16 Q) and surgical site infection (31Q) After collection, the data was entered into an excel workbook. A positive answer received a score of 1 while a negative or unknown received a 0. Overall performance was graded arbitrarily into excellent (>80%), good (60 to 80%) and poor (<60%) RESULTS Part 1 The infection control program at PSH has 10 of the 17 components that were considered important. It has leadership commitment, pharmacy services, laboratory services, infection control policy, guidelines for antibiotic use, personal protection equipment, a protocol for prevention of catheter- related UTI, protocols for injection safely, protocols for surgical site infection, and services for environmental cleaning PSH does not have a dedicated specialist team, infrastructure for isolation of contagious patients, policies for the prevention of central line-associated bloodstream infection, policies for clostridium difficile infection, antibiotic rotation, a protocol for prevention of ventilator-associated events, or tracking of infective patients between institutions. Part 2: Comparison of 11 wards in 5 components Handwashing: The score per ward ranged from 11 to 15 (68% to 100%). The questions where respondents performed poorly were because of poor initial education and poor auditing skills or systems. Personal protective equipment: The score ranged from 16-19 (84% to 100%). The worst scoring questions were because PSH did not have a respiratory protection program. Catheter-associated Urinary tract infections (CAUTI) – The scores ranged from 20 to 34 (52% to 89%). PSH does not have a system in place for a CAUTI database. There is no ongoing collection of data and thus no dissemination of information back to the wards. Injection Safety: The score ranged from 10 to 14 (62% to 87%) Poor performance was due to lack of any protocol to identify tampering and on-going education. The Surgical Site Infections: Lowest score being 0 and highest 31 (0% - 85%). Non -surgical wards did not know the process so could not answer questions at all. The surgical wards were poor in the auditing process. OVERALL PERFORMANCE. The total possible score was 119. The highest scoring ward was the gynaecology ward 110 (95%). The lowest was in the psychiatric ward, which scored 64 (53%). 8 wards had excellent performance (>80% [total score>95]): High care, ICU, Post-natal, Gynaecology, Labour ward, Surgical male, Surgical female, Orthopaedic. 2 Wards had a Good performance (60%-80% [71-95]): Medical Male, Medical Female One ward performed poorly <60% [71]): Psychiatry The best overall performance was in handwashing. The worst performance was surgical site infections. Poor auditing practices were identified. Wards with a surgical focus performed the best. This is probably related to the fact that the staff working in surgical wards has to have additional familiarity with protocols and processes related to wound care. Units with no surgical expertise (medicine and psychiatry) do not usually have surgical patients under their care so do not have much-specialised knowledge. The psychiatric ward additionally usually does not often deal with patients that have any infectious diseases, so the staff is understandably less knowledgeable. CONCLUSION The South African literature is scanty and tends to favour Antibiotic Stewardship Programs above Infection Prevention and Control programs. Core strategies and coordination of audits and research are in the early stages. This audit is timely in the assessment of an IPC program in a provincial hospital in the public sector. The results of the audit performed at PSH are encouraging and the strengthening of the entire IPC program should be possible. To achieve the proper application of the IPC program more emphasis needs to be placed on constantly auditing existing practice and giving feedback to staff.
Autoerotic and assisted sexual asphyxias.
(1993) Book, Robert Gene.; Botha, J. B. C.
Abstract available in PDF.
The awareness and perceptions of sexually transmitted infections among students attending the University of KwaZulu-Natal.
(2021) Mthembu, Funeka Nomvula.; Abbai, Nathlee Samantha.
A high prevalence of sexually transmitted infections (STIs) have been reported among youth globally and this high prevalence calls for global efforts to improve sexual and reproductive health in this population. The prevalence of STIs in young South African women and men is 0.50% and 0.97% for Syphilis, 6.6% and 3.5% for Gonorrhoea and 14.7% and 6.0% for Chlamydia. Increased evidence on behavioural change is dependent on the comprehensive understanding and perception of one’s own risk. Updated evidence of awareness and perception of STIs in university students is needed to inform relevant sex education programmes. The purpose of this study is to assess awareness and perceptions of STIs in students enrolled at the University of KwaZulu-Natal. Methodology The study used a quantitative research approach. This study was conducted at the University of KwaZulu-Natal in Durban, South Africa. The sample consists of 142 undergraduate and postgraduate registered students between the ages of 18 and 35 years. The study used purposive sampling to obtain the sample. A self-administered survey assessing awareness and perceptions of sexual risk behaviour and STIs was administered. Data was analysed using descriptive statistics. Means and standard deviation were used for continuous variables. Analyses were stratified by gender using Chi-square tests as it was expected that there would be differences in awareness and perceptions regarding risky sexual behaviour and STIs.. Analyses were done with STATA version 15.1. Results The study found that 78% of the students were aware of STIs. There was a significant association regarding awareness of Chlamydia infections, p=0.015. Similar to the other infections, a higher proportion of males were aware of Chlamydia when compared to females (96.4% versus 82.8%, p=0.015). Similar to Chlamydia infections, there was a significant association regarding awareness of Trichomonas across the different genders (p=0.011). According to the analysis, females are exposed to awareness of STIs from a younger age when compared to their male counterparts. Most students (34.5%) had reported that they had received information on STIs from social media and from their school teachers. There was a significant difference in the responses related to same sex practices and STI risk (p=0.047). While some students had socially acceptable perceptions, there were some that were not acceptable including sexual debut (34,5%), concern about being at risk of STI (31%), condom-less sex as an STI risk (21.2%), ease of condom negotiation (41.5%), pregnancy being more risky than STIs (28.8%) and alcohol as an STI risk (28.2%). Conclusion This study had revealed the students have high awareness of STIs. Despite the high awareness, the students still have low risk perceptions especially towards condom use, alcohol consumption and age disparate relationships. These distorted attitudes will subsequently impact on the risk behaviours and further research needs to be conducted in order to fill the gap between awareness and perception. This study highlighted the clear discrepancy between the awareness of STIs and the reported perceptions of students. Future research to evaluate STI messaging and assess actual risk versus perceived risk in this population is recommended.
Capsular endoscopy: a single centre experience.
(2021) Naicker, Nisholini.; Cassim, Bilkish.; Newton, Keith.
Abstract Background: Capsule endoscopy (CE) is a relatively new modality in the assessment of obscure occult and obscure overt gastroenterological (GI) bleeding in South Africa. Objectives: The aim of this study was to describe the indications, findings and outcomes of CE at a referral hospital in the public sector in Kwa-Zulu Natal (KZN). Methods: Ethical approval was obtained from the Biomedical Research Ethics Committee of the University of Kwa-Zulu Natal (UKZN). A retrospective electronic chart review of 27 subjects who underwent CE from its introduction in 2013 to 2018 was undertaken. A structured data sheet was used to extract demographic and clinical details and the endoscopist‘s report. Indications were classified as obscure occult GI bleeding, obscure overt GI bleeding, suspected Crohn‘s disease and unexplained macrocytic anaemia (in a single subject). The findings at endoscopy were categorised as vascular (angiodysplasia, varices), inflammatory (villous oedema, erythematous mucosa erosions, ulcers or stenosis), normal, inconclusive or other (villous atrophy, polyps, tumours). Results: The mean age of the 27 patients was 51.2 years ± 21.3 years, with a majority of women (15, 56%) and 12 (44.4%) men. The most common indications for CE were either obscure occult GI bleeding or obscure overt GI bleeding. One patient each had unexplained anaemia and suspected Crohn‘s disease. All subjects had had previous oesophagogastroduodenoscopy (OGD) and colonoscopy prior to the CE, 15 subjects (55.5%) had had a CT scan of the abdomen and seven (26%) underwent red cell scans. Of the 14 subjects with occult GI bleeding, 12 had severe iron deficiency anaemia, with symptom duration ranging from one year to 40 years. These subjects had undergone a minimum of one up to a maximum of six OGDs, with a total of 38 OGDs prior to CE. Abnormal findings on CE were reported in nine subjects (64.3%), the commonest of which was inflammatory, and a definitive diagnosis was made in six (42.9%) subjects. The 11 subjects with obscure overt GI bleeding had undergone a total of 27 prior OGDs prior to CE. Abnormal findings on CE were reported in three of the 11 subjects (27.3%) with obscure overt GI bleeding and a definitive diagnosis made in two subjects (18%). In addition, the diagnosis was supported in the patient with Crohn‘s disease who had been symptomatic for eight years and had had several previous OGDs and colonoscopies. In the total group who underwent CE, nine (33.3%) subjects attained a definitive diagnosis. A further 18.5% attained a diagnosis following subsequent investigations. In three subjects (11.1%) the initial indication resolved requiring no further therapy or investigation and two patients (7.4%) were lost to follow up. Capsule retention occurred in two patients and the capsule was successfully retrieved via laparoscopic surgery. Conclusion: Capsule endoscopy is a useful modality to further investigate select patients with unexplained GI bleeding, including the identification of lesions outside the small bowel. A guideline for the application of CE in the South African context is required.
The clinical and angiographic profile of very young patients with coronary artery disease.
(2016) Pillay, Ashegan Kandasamy.; Naidoo, Datshana Prakesh.
Overview of thesis in a PDF.
The clinical and biochemical severity of plasmodium falciparum malaria in Natal/KwaZulu.
(1992) Soni, Paresh Nathalal.; Gathiram, Chaiteshwar Vinodh.
Abstract available in PDF.
The clinical manifestations and response to treatment in South Africans with Lupus nephritis.
(2016) Mody, Priyesh G.; Assounga, Alain Guy Honore.
Systemic lupus erythematosus (SLE) is an uncommon disease which is being recognised with increasing frequency in Africa, including South Africa. It is most common in young women and is associated with a significant morbidity and mortality due to involvement of many organ systems. Lupus nephritis (LN) occurs in about 40 - 60% of patients with SLE and is one of the most common causes of morbidity and mortality in SLE. Reviews of LN in Africa have reported on the spectrum of histological involvement in SLE but there is limited information on the degree of renal impairment at presentation and the response to treatment and outcome. Over the past decade mycophenolate mofetil (MMF) has been widely used as an effective and safer treatment option compared to cyclophosphamide in the management of LN. However, MMF has only been used in 0.4 -15.6% of patients with LN in Africa. This study was undertaken as an audit of our clinical practice to determine the histological classification and renal function at presentation in patients with LN seen at Inkosi Albert Luthuli Central Hospital (IALCH). We also undertook an assessment of the response to induction and maintenance therapy for LN and outcome of treatment during routine care in a tertiary referral centre. We wished to assess whether the presentation and response to treatment in Durban, South Africa is similar to the experience in other parts of the world. The multi-ethnic cohort of predominantly African blacks and Indians seen at our hospital, provided an opportunity to undertake an inter-ethnic comparison of the spectrum of histological classification, stage of chronic kidney disease at presentation, response to treatment and outcome. We conducted a retrospective descriptive study by reviewing the hospital records of patients with SLE who were seen in the Departments of Nephrology and Rheumatology at Inkosi Albert Luthuli Central Hospital from 2003 to 2012. All the patients who had renal involvement and in whom the results of a baseline renal biopsy and baseline laboratory tests were available, were included in the study. The demographic data, results of the renal biopsy and baseline haematological, biochemical and immunological tests were recorded. The records of patients who had Class III and Class IV LN, with or without Class V changes, and patients with Class V LN alone, were analysed further to assess the response to 6 months’ induction therapy and 12 months’ maintenance therapy. The treatment for LN and results of the follow up laboratory results were recorded. The age at diagnosis of LN, gender, results of biochemical and immunological tests, histological classification, treatment and outcome were analysed for all the patients in the study, and separately for African Blacks and Indians as they comprised the majority of the patients in the study. A separate analysis was performed for only those patients who required induction and maintenance therapy for LN (excluding patients with Class I, Class II and Class VI LN). We conducted an analysis of the demographic data, spectrum of histological classification, laboratory findings, stage of chronic kidney disease, treatment and outcome for all the treated patients and also compared the findings between African Blacks and Indians. A comparison of the patients with proliferative LN with membranous LN was undertaken to identify any differences in the demographic data, biochemical or immunological parameters, response to treatment and outcome. The response to treatment was determined for 6 months of induction therapy and after maintenance therapy for 12 months. Patients who achieved a partial or complete remission were classified as responders and patients who did not respond to treatment, were lost to follow up or died, were classified as non-responders. A further analysis of the responders and non-responders was undertaken to identify predictors of a poor response. We identified 105 patients with LN who comprised 52 (49.5%) Indians, 47 (44.8%) African Blacks, 4 (3.8%) Whites and 2 (1.9%) Mixed ethnicity. We found that Class V LN was more common (34.3%) than generally reported in most other studies. There was a higher prevalence of the milder Class II histology in our Indians while severe impairment of renal function (chronic kidney disease stage 5) was more common in African Blacks. There were 87 patients who required treatment for their LN. We found that 81.6% of our patients showed a response to induction therapy and 73.6% showed a response to maintenance therapy. Eight of our patients were lost to follow up prior to their final analysis and they were classified as non-responders, thus contributing to lowering our response rate. International literature has shown a better response to MMF in African Americans compared to Caucasians. We have been able to confirm the efficacy of MMF as induction and maintenance therapy for the first time in our Indians and African Blacks. Our study emphasizes the need to raise awareness of SLE among health professionals so that earlier diagnosis of LN can be made and patients can be treated before there is impaired renal function. We found that nearly 15% of our patients had stage 4 or stage 5 chronic kidney disease (eGFR <30 ml/min) at presentation, indicating significant impairment of renal function. We also found that there was a significant reduction in the response to treatment in patients who had a creatinine ≥132 μmol/l at presentation. This study contributes to the literature on lupus nephritis in Africa and we have shown that MMF is effective in our patients with LN. Thus it provides an alternative safer treatment option than the use of IV CYC.
The clinical natural history of snakebite victims in Southern Africa.
(2000) Blaylock, Roger.; Robbs, John Vivian.
The author wrote a dissertation for the Mmed Sc degree entitled The Clinical Natural History of Snakebite in Southern Africa, which dealt with the epidemiology of snakebite and the clinico-pathological events in snakebite victims. This thesis is a sequel on the management of snakebite victims. Publications on the overall management of snakebite in the Southern African region that include original scientific research are those of F.W. Fitzsimons (1912), F.W. Fitzsimons (1929) (assisted by V.F.M. Fitzsimons), P.A. Christensen (1955, 1966, 1969) and Christensen & Anderson (1967). Subsequent books, pamphlets and journal articles have rehashed this knowledge or advocated methods of treatment developed in other countries. An example of the latter is the pressure immobilisation prehospital measure advocated for snakebites in Australia (Sutherland et aL, 1979, 1981, 1995), which I regard as benefiting less than 1% of snakebite victims here and being deleterious in most cases. In view of the paucity of research done in Southern African in recent years, many questions remain unanswered, and some strongly held views are without logical or scientific foundation. Most of these questions arose prior to the writing of this thesis, and others arose when the data were analysed. The following are some questions on the management of snakebite that have still have to be addressed. Is vaccination against snakebite possible and practical? Are folk and traditional remedies advantageous or deleterious? How commonly are they used? Immobilisation of the bitten part and the patient is an internationally recognised aid measure, but is this relevant to the Southern African situation? Tourniquet use in the case of necrotising venoms is considered to aggravate or precipitate necrosis. Does immediate active movement following a bite ameliorate or prevent necrosis without increasing mortality? The majority of clinicians recommend antibiotic prophylaxis, but is this necessary for all snakebites, against which bacteria should antibiotics be administered, and what is the source of these bacteria? Should antivenom be administered to all snakebite victims: for species-specific bites, only if envenomation is present, for severe envenomation, or not at all? Acute adverse reactions to South African manufactured snakebite antivenom has been variously recorded as less than 1% (Visser & Chapman 1978) up to 76% (Moran et al., 1998). What is the truth? Is syndromic management of snakebite efficacious or is it essential to identify the particular snake species? Is the present liberal use of fasciotomy necessary? Is there an optimum time to debride necrotic areas and is surgery necessary at all? Is paresis or paralysis due to neurotoxic envenomation always the result of a post-synaptic block? Would such a block respond to neostigmine or prostigmine in a similar way to post-synaptic anaesthetic muscle relaxants? Is heparin of value when procoagulant toxins induce a consumption coagulopathy? Do fibrinstabilising agents or fibrinolytics have a role? Does the management of pregnant snakebite patients differ from that of non-pregnant patients? Is snake venom teratogenic? Does snake venom ophthalmia frequently lead to blindness? Are steroids, NSAIDs and antihistaminics, which are commonly used in the management of snakebite, of proven value? This thesis attempts to answer these questions and more, and comprises six sections. The first section deals with pre-hospital management, the second with infection which may occur at the bite site wound, the third with SAIMR snakebite antivenom, the fourth with the three envenomation syndromes, the fifth with snakebite in pregnancy, venom ophthalmia and other treatment modalities, and the sixth section includes a summary, appendix and references. Unless otherwise stated, the materials and methods of each chapter are based on 336 snakebite victims admitted to Eshowe Hospital, KwaZulu-Natal, from January 1990 - July 1993 and other victims treated by the author, the data of which have been prospectively maintained. This has been an ongoing process up to the present time.

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