Electronic Theses and Dissertations (Masters)

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Dyslipidaemia in rheumatic diseases
(2021) Chen, Xiaohui
Background: It is well established that patients with rheumatic diseases are at high risk of atherosclerosis and cardiovascular disease. Dyslipidaemia is an important modifiable cardiovascular risk factor and in 2018 the Lipid and Atherosclerosis Society of Southern Africa (LASSA) published guidelines with recommended treatment targets for patients with dyslipidaemia. Objectives: To evaluate the prevalence of dyslipidaemia in patients with rheumatic diseases from a South African population, and identify the proportion of these patients receiving lipid lowering agents (LLAs). The aim was to determine the number of patients on LLAs reaching the low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) targets recommended by LASSA guidelines. Methods: This was a retrospective cohort study of 200 adult patients attending the Helen Joseph Hospital outpatient rheumatology clinic from 22 August to 12 December 2018. Clinical and laboratory data from patients with a confirmed diagnosis of rheumatic disease(s) and had their lipogram(s) measured since attending the clinic were analysed. Results: The median age of patients was 54 years (IQR 45-62) with a female predominance of 85.5% (n=171) and the majority 52.5% (n=105) being comprised of black African patients. Primary outcomes: Of the 200 patients enrolled, 127 (63.5%) met the criteria for dyslipidaemia based on their initial lipograms measured at the clinic but only 59 (46.5%) of these patients were on LLAs. At the time of the audit, 164 (82%) patients were eligible to receive LLAs as recommended by the LASSA guidelines, but only 77 (47.2%) were prescribed LLAs. Of these 77, only 22 (28.6%) met the recommended LDL-C targets for very high risk or high risk groups proposed by LASSA. Secondary outcomes: There was a high prevalence of cardiovascular risk factors present in 153 (76.5%) of patients – with hypertension being predominant in 132 (86.3%) patients. The majority of patients, 186 (93%), were on disease modifying agents for rheumatic diseases (DMARDs). A low proportion of 23 (11.5%) patients were on corticosteroids. Conclusion: Despite the high prevalence of dyslipidaemia in patients with rheumatic diseases, the majority of patients did not meet the recommended TC/LDL-C targets suggested by local guidelines. There is a need to raise awareness amongst healthcare practitioners treating this patient population regarding the pertinent aggressive control of dyslipidaemia. Furthermore, owing to the relationship between inflammation and lipids, rheumatic disease itself should perhaps be considered as an independent cardiovascular risk equivalent to other traditional cardiovascular risk factors
Correlation between ocular surface disease index and tear meniscus height in dry eye disease at a Johannesburg tertiary eye hospital
(2021) Erasmus, Daniel
Background: Dry eye disease is a common, and potentially vision-threatening problem. The Ocular Surface Disease Index is a well-established method of subjectively assessing dry eye disease. Objective means of diagnosing dry eye disease suffer from poor reproducibility, low sensitivity and specificity, are invasive, time consuming and often require specialized equipment. It is hypothesized that optical coherence tomography of the tear meniscus may address these problems. Aim: The primary aim of this study was to describe the correlation between the Ocular Surface Disease Index © and tear meniscus height in dry eye disease measured by optical coherence tomography. The secondary aim was to determine a useful diagnostic cut-off value for tear meniscus height in the diagnosis of dry eye disease. Setting: The study was conducted at St John Eye Hospital, Soweto, South Africa. Methods: This was a prospective, cross-sectional study of adults at a tertiary level eye clinic. Participants were included if they were older than 18 and excluded if they were contact lens wearers, had an established diagnosis of dry eye disease, or were known to have (or be taking any treatment for) any ophthalmological or medical condition that has the potential to influence dry eye disease. A control and investigative group was determined using the Dry Eye Ocular surface disease index. The inferior tear meniscus height of both groups was imaged using optical coherence tomography. Results: A total of 36 right eyes of 36 patients was included in this study. Patient ages ranged from 20 – 64 years, with a median age of 43 years. Overall there were more females (n = 27) than males (n = 9). There was a moderate negative correlation between the normal/dry eye group and tear meniscus height (rb = - 0.452, p = 0.032). Optimizing sensitivity and specificity yielded a diagnostic cut-off tear meniscus height of 296um. Conclusion: Tear meniscus height tends to decrease between Ocular Surface Disease Index classifications of ‘normal’ and ‘dry eye disease’. However, tear meniscus height performed poorly as an objective measure of dry eye disease in our study population limiting recommendations to adopt it as a diagnostic test. Keywords: Dry eye disease, Ocular Surface Disease Index , Optical Coherence Tomography, tear meniscus height.
An audit of the presence of coeliac disease associated human leukocyte antigen haplotypes in renal and bone marrow transplant donors and recipients from the South African National Blood Services
(2021) Mrubata, Kitso-Lesedi
Introduction: Coeliac Disease (CD) is an autoimmune condition occurring in genetically predisposed individuals exposed to an environmental trigger. The Human Leukocyte Antigen (HLA) haplotypes HLA DQ2.5 and HLADQ8 bear the strongest association with CD, and 90 -95% of patients with CD bear these haplotypes. The absence of these haplotypes has high negative predictive value. The susceptibility of the South African population to CD has not been studied previously. Methods The South African National Blood Services database was used to analyse the prevalence of HLA DQ2.5 and DQ8 in potential donors and recipients of organ transplants. Results The overall prevalence of HLA DQ2.5 and HLA DQ8 was 19.8%. The prevalence was lower in Black subjects (15%) than Caucasians (28%). Mixed race (22%) and Indian (17%) subjects had intermediate prevalence. The was no significant difference between potential transplant donors and recipients. Conclusion The prevalence of HLA DQ2.5 and HLA DQ8 differed among South African study participants of different ethnicities and was lower than the reported world-wide prevalence of 30-40%.
Perceptions of the perioperative team regarding the use of the WHO Surgical Safety Checklis
(2021) Sima, Najiba
Background The WHO Surgical Safety Checklist (WHO Checklist) fosters communication and teamwork between the perioperative team and perceptions influence its acceptance and use. This study explores the perceptions of the perioperative team to the WHO Checklist in operating theatres at the University of the Witwatersrand affiliated hospitals. Methods A qualitative, contextual, exploratory research design was employed. Purposive sampling was used to invite theatre nurses, anaesthetists and surgeons to participate. Focus group interviews were held for each group. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Results Ten nurses, 6 anaesthetists and 4 surgeons participated in the focus group interviews. Four themes relating to patient safety were identified namely, the prevalence of power struggles in theatre, a breakdown in communication, a culture of silence and the inadequate and siloed training. The perceptions of the perioperative teams interviewed describe a daily flight plagued by turbulence that may result in serious adverse events. Conclusion In a complex system such as a hospital theatre environment, the introduction of a simple tool such as the WHO Checklist has a limited impact on patient safety if the underlying supportive network is not intact. This study demonstrates the importance of interpersonal relationships, changing teams and lack of integration of teams, processes and training, on the use of the WHO Checklist as a safety tool in a South African hospital setting. A prevailing culture of safety is a prerequisite for successful implementation and use of the WHO Checklist.
An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital breast imaging unit
(2021) Christofides, Nicholas Christopher
Background: Benign breast pathology is a common presenting complaintand its assessment is important to characterize so as to not miss malignant pathology. At Helen Joseph Hospital (HJH) patients are triaged at the Breast Clinic according to the clinical suspicion of benign versus malignant disease. The patients are assigned a colourlabel based on their clinical presentation. This triage system affects waiting times between clinical examination and mammography appointments. This study aims to assess the association between clinical examination and the radiological and pathological findings of disorders deemed clinically benign and to ascertain the spectrum of benign breast disorders encountered at HJH. Method: A retrospective study of imaging results of patients at HJH presenting as clinically benign breast disorders from January –June 2018 was conducted. Assessed BIRADS score was noted and if core biopsies were performed, their results and patient demographics were documented. Results: Of the 1263 clinically benign patients presenting from January -June 2018 the radiological assessment was: BIRADS 1: 158 (12.5%), BIRADS 2: 685 (54.2%), BIRADS 3: 292 (23.1%), BIRADS 4a: 54 (4.3%), BIRADS 4b: 29 (2.3 %), BIRADS 4c: 21 (1.7%), BIRADS 5: 24 (1.9%). There were 133 biopsies (including 8 BIRADS 3 patients), with 46 (3.6%) confirmed malignancies. The combined specificity of mammography and ultrasound was 65.52 % (54.56% -75.39%) and combined sensitivity 91.30% (79.21% –97.58%). Conclusion: There is a vast spectrum of benign conditions presenting in this population group with only 3.6% confirmed malignancies, confirming an accurate triage system utilised at the breast clinic. Radiological imaging is highly sensitive but less specific emphasising the triad of clinical, radiological and histological assessment as the gold standard with regard to diagnosis of breast disease.
An audit of the practice of red packed cell transfusion in neonatal surgery in an academic hospital
(2024) Govender, Kushal
Background: Neonates undergoing surgery are at greater risk of requiring red packed cells transfusion. Pediatric transfusion practices vary widely between countries and institutions, especially in the management of neonates. Aims: The aim of this study was to describe the practice of intraoperative red packed cells transfusion primarily, and blood products and fluid transfusion secondarily in neonates presenting for surgery. Methods A retrospective contextual and descriptive study was conducted at Chris Hani Baragwanath Academic Hospital. A total of 1077 anesthetic records of neonates who underwent surgery from 1 January 2015 to 31 December 2019 were reviewed. Descriptive and inferential statistics were used to analyze the data. Results: Three hundred and twenty seven (30%) neonates received intraoperative red packed cells transfusion. The median (IQR) volume of red packed cells, fresh frozen plasma, platelets and clear fluid administered was 15 (10 - 21.8) ml/kg, 12.3 (10 - 23.5) ml/kg, 13.6 (10 - 20.5) ml/kg and 19 (9.1 - 28.8) ml/kg respectively. Very low weight, low preoperative hemoglobin, long total anesthetic time, emergency surgery and major surgery were independently associated with blood product transfusion. Post-conceptional age, low and very low weight, blood product transfusion and major surgery were independently associated with the composite adverse outcomes. 3 Conclusions: Intraoperative blood product transfusion occurred up to three times more frequently in our study than in comparative studies. Weight-based dosing of red packed cells, blood products and clear fluids were in keeping with current recommendations. Further prospective cohort studies are recommended to inform an institution specific patient blood management program.
Comparison of ultrasound and magnetic resonance Imaging findings in patients with suspected placenta accreta spectrum at Chris Hani Baragwanath Academic Hospital
(2024)
Background: Placenta accreta spectrum (PAS) is a serious condition that is increasing in prevalence with an increase in the caesarean section rate. This condition is associated with significant haemorrhage. Accurate diagnosis and adequate surgical planning are associated with favourable outcomes. Ultrasound and MRI are used in prenatal diagnosis of this condition. • Objectives: To compare ultrasound and MRI report findings with histopathology or surgical findings in patients with suspected PAS at Chris Hani Baragwanath Academic Hospital. To compare the diagnostic accuracy of PAS between the junior and senior (>5 years’ experience) radiologists’ MRI reports. Method: A retrospective comparison of 14 MRI and 18 ultrasound report findings of patients with suspected PAS were compared with histopathologic or surgical report findings. These imaging modalities' sensitivity, specificity, accuracy, true positive, true negative, false negative and false positive values were determined. The accuracy, sensitivity and specificity of MRI reports were determined based on radiologists’ experience. Results: Ultrasound correctly diagnosed PAS in 10/18(56%) of the patient reports. MRI correctly diagnosed PAS in 6/14(43%) of reports. Ultrasound reports had sensitivity and specificity of 90.9% and 28.6%, respectively, while MRI reports had sensitivity and specificity of 20% and 75%, respectively. The senior radiologists correctly diagnosed PAS in 3/7(42%) of reports, while junior radiologists correctly diagnosed PAS in 4/6(67.7%) of MRI reports. Conclusion: There was no statistically significant difference in the accuracy of Ultrasound and MRI in diagnosing PAS. There was no statistically significant difference in diagnosis of PAS between junior and senior radiologists
Characteristics of tetralogy of Fallot in children seen at Chris Hani Baragwanath Hospital over last two decades
(2024) Afrika, Jesmine Kamogelo
Background: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart defects seen in children. There is limited data on the characteristics of TOF in African children. Objective: To determine the clinical features, investigation findings, surgical interventions and outcomes of children with TOF in a South African tertiary care setting over a period of 20 years. Methods: A retrospective, descriptive analysis was done on patients with TOF at the Chris Hani Baragwanath Academic Hospital (CHBAH), who had surgery between June 1998 and June 2018. Results: One hundred, seventy-nine patients were included in the analysis. The median age of diagnosis was 13 months (IQR, 2.7 - 44.8 months). Hypercyanotic spells were documented in 90/179 (50.3%) patients. The most common associated genetic syndrome was 22q11 microdeletion (16/45; 8.9%). Associated cardiac anomalies included patent ductus arteriosus (4.5%), patent foramen ovale (11.2%), true atrial septal defect (5.6%) and atrioventricular septal defects (1.1%). Normal coronary artery variations were comprised of conus or infundibular arteries arising from the RCA which were mostly small (42/179; 23.4%), with fewer large vessels (6/179; 3.6%). Anomalous coronary arteries included a single coronary artery origin (7/179; 3.9%) and large LAD arising from the RCA and crossing the RVOT (2/179; 1.1%). A left-sided aortic arch (LAA) was diagnosed in 135/179 (75.4%) patients and a right-sided aortic arch (RAA) in 44/179 (24.6%) patients. Systemic-to-pulmonary shunts were performed in 19/179 (10.6%) patients, while 160/179 (89%) patients had corrective surgery. Severe pulmonary regurgitation was seen in 27/51 (52.9%) patients who had a transannular patch repair, with 18/27 (66.7%) subsequently having a pulmonary valve replacement. Conclusion:This study shows that the characteristics of TOF in children in our centre are similar to those in other centres inside and outside of Africa.
Audit of evolving roles of laparoscopy in the current surgical practice at Chris Hani Baragwanath Academic Hospital: a 5 year review
(2024) Ngwisanyi, Weludo
Objective: The objective of this study was to determine the evolution of LS in selected procedures. Design: This was a retrospective cross-sectional study to investigate and analyse the frequency of nine selected procedures (MAS versus open) performed from January 2014 to December 2019. Setting: The study was conducted at the Chris Hani Baragwanath Academic Hospital. Outcome measures: Data were collected from theatre registries. Statistical analysis was performed using the software IMB SPSS. The data were analysed using descriptive statistics of mean and standard deviation for age, and percentage and frequencies for categories of variables. Results: Of the 3745 patients involved in the study, 59.1% were males and 40.9% were females. The mean age of the patients was 35.17±17.30 years. Laparoscopic surgery was represented in 43.2% of the procedures, with laparoscopic appendicectomy (46.73%) and laparoscopic cholecystectomy (32.69%) being the most commonly performed procedures.. Twenty-five adrenalectomies were performed over the study period, and of those 12 (52%) were performed laparoscopically. All the thymectomies (12) were performed thoracoscopically, with one conversion. Conclusion: The findings of this study suggest that there has been an increase in the overall incidence of laparoscopic surgery in selected procedures at CHBAH.
Efficacy of antero lateral thigh flap in head and neck reconstruction
(2024) Machaka, Leah Mokgadi
Background: Head and neck defects commonly from excision of cancer, require complex reconstruction. Our reconstructive goals are aimed at achieving safety, form and function. Escalation to the highest option on the ladder of reconstruction is obligatory. With the discovery of free anterolateral thigh flaps our reconstructive goals could be attained. Antero lateral thigh flap offered more to the reconstructive options than what it was initially described as. Antero lateral thigh flap not only gained popularity but also became the workhorse flap in head and neck reconstruction. Research has been done all over the world on the application of Antero lateral thigh flap but nothing is reported from South Africa. The aim of the study was to determine the efficacy of antero lateral thigh flap in head and neck reconstruction in plastic surgery department at Charlotte Maxeke Johannesburg Academic Hospital. Methodology: A retrospective medical record review was conducted at Charlotte Maxeke Johannesburg Academic Hospital which included all adult patients reconstructed with antero lateral thigh flap. Theatre and ward registration were used to identify the patients during the five-year period from 01 January 2014 – 31 December 2018. The number of patients with head and neck cancer during this period totalled 80, of which 33 met the study inclusion criteria: Adults with head and neck cancer reconstructed with antero lateral thigh flap. Main Outcome Measures – Flap survival, recipient and donor complications and length of hospital stay. Results: The study comprised 33 patients who had undergone a wide local excision, with/without neck dissection and reconstructed with antero lateral thigh flap. The mean age of the patients was 55.89 +/- 12.77 years. Most participants were male (n=24: 72.73%), female (n=9:27.27%), smokers (n=18: 56.25%) and 25 (78.13%) had SCC diagnosis, there were 15 (44.12%) patients with comorbidities and the average duration of the operation was 10.12+/- 2.65 hours. The most frequent anatomical site was the oral cavity (n=15: 50%). Maximum ICU stay was 2 days (n=31.93: 94%), The median hospital stay was 38 days with an interquartile range of 34-44 days. Post operation complications were experienced by 7 patients – recipient site complication (n=3,9%) and donor site complication (n=4, 12%), with a total flap survival of 94%. Conclusion: Our experience has given us the confidence to use this flap in a variety of head and neck defects. The antero lateral thigh flap is highly versatile, has a high survival rate and a low complication rate. Antero lateral thigh flap has found a permanent and highly valued place in head and neck reconstruction.
Clinical spectrum and outcomes of idiopathic inflammatory myopathies at Chris Hani Baragwanath Academic Hospital
(2024) Birch, Candice Tatum
Background: Idiopathic inflammatory myopathies (IIM) are rare diseases for which there is a paucity of data in Africa. We undertook a retrospective records review of clinical and laboratory features of patients with IIM attending a tertiary service in Gauteng, South Africa. Patients and methods: Case records of patients seen between January 1990 and December 2019 and fulfilling the Bohan and Peter criteria for IIM were reviewed for demographics, clinical features, special investigations and drug therapy. Results: Of 94 patients included in the study, 65 (69,1%) had dermatomyositis (DM) and 29 (30,9%) had polymyositis (PM). Overall, the mean (SD) age at presentation and disease duration were 41,5 (13,6) and 5,9 (6,2) years, respectively. 88 (93,6%) were Black Africans. The most common cutaneous features in DM patients were Gottron’s lesions (72,3%) and abnormal cuticular overgrowth (67,7%). Dysphagia was the most common extra-muscular feature (31,9%), more so in PM than DM (p=0,02). Creatine kinase, total leucocyte count and CRP were similarly higher in PM than DM patients (p=0,006, 0,002, 0,01, respectively). Anti-nuclear and anti-Jo-1 antibodies were positive in 62,2% and 20,4% of patients tested, respectively, the latter significantly more in PM than DM patients (OR=5.1, p=0,03) and more likely to be positive with ILD (p=0,001). Corticosteroids were prescribed in all patients, 89,4% had additional immunosuppressive drugs and 6,4% required intensive/high care. Malignancies occurred in three patients, all of whom had DM. There were seven known deaths. Conclusion: The present study provides further insights into the spectrum of clinical features of IIM, especially cutaneous features of DM, anti-Jo-1 antibodies and associated ILD, in a cohort of predominantly black African patients.
Lymphocyte ratio, oxidative stress, cell death and metabolic profiling in acute pancreatitis: implications for disease monitoring
(2024) Mazibuko, Jeanet
Acute pancreatitis (AP) is the autodigestion and inflammation of the pancreas that clinically presents with nausea, vomiting, abdominal pain, and increased amylase and/or lipase levels. Mild acute pancreatitis (MAP) is associated with no organ dysfunction and quick recovery. Moderately severe acute pancreatitis (MSAP) has transient organ dysfunction, while severe acute pancreatitis (SAP) is characterized by a significant systematic inflammatory response associated with varying degrees of organ dysfunction. Current systems use many variables to diagnose AP, which are unsuitable for identifying high-risk patients, prognosis, and management. This study aimed to identify metabolic indicators for monitoring AP severity by measuring the CD4:CD8 ratio, apoptosis, hydroperoxides, and metabolites, key pathological responses to the activated immune system. Fifty patients of different severities of AP as well as ten healthy controls (HCs) were recruited from the Chris Hani Baragwanath Academic Hospital. Whole blood samples were collected from the patients within 72 hours (Day 1) of experiencing epigastric pain and every 48 hours for an additional 3 days (Days 3, 5 and 7). The peripheral blood mononuclear cells (PBMCs), plasma and serum were prepared according to standard operating procedures. Flow cytometry was used to quantify the CD4:CD8 ratios while apoptotic gene expression, hydroperoxides and metabolites were analyzed by polymerase chain reaction (PCR), DEPPD assay and nuclear magnetic resonance (NMR) spectroscopy, respectively. As expected, the HCs and the MAP groups had the highest percentage of CD4:CD8 compared to the other AP severity groups. Caspase 7 expression was high in MAP compared to the HCs, although not statistically significant, while its expression in MSAP patients was statistically significant (p = 0.0029) compared to the HCs. Over time, the expression of caspase 7 expression in MSAP patients increased on day 5 (p = 0.00994) and slightly on day 7 (p = 0.0249). The expression of caspase 7 in SAP patients decreased over time from day 5 to day 7. The MSAP group displayed the highest levels of hydroperoxide on day 5 with statistical significance to the HC than the other groups in both serum (p = 0.0012) and plasma (p = 0.0008), between the SAP and the HC in serum on day 5 (p = 0.0009) as well as in plasma (p = <0.0001 between MAP and the HC. An unsupervised analysis of metabolites separated the AP patients into two clusters consisting of MAP+MSAP and another of MSAP+SAP patients. The main metabolites differentiating the groups were phenylalanine 0.54 (p< 0.001); mannose 0.57 (p< 0.001); lactate 0.67 p< 0.001), acetoacetate 0.63 (p<0.001), 3- hydroxybutyrate 0.46; (p< 0.003) lipid alpha-CH2 0.45(p=0.006) with AP severity. Ascorbate 0.46 (p< 0.003); glutamine -0.55 (p<0.001); methanol -0.46 (p< 0.003); ethanol -0.64 (p<0.001); lipid=CH-CH2-CH=-0.55(p<0.001), lipid beta-CH2 -0.52 (p<0.001), lipid-CH3 - 0.44(p=0.005) and protein-NH -0.75 (p<0.001) decreased as severity increased. Taken together, the measured parameters i.e., CD4:CD8 ratio, apoptosis, ROS, and metabolites, suggest that as AP severity increases, integrating immune and metabolomics data may help in understanding the pathophysiological conditions of AP for early stratification, management, and prognosis of patients. MSAP represents the earliest shift toward progression without the comorbidities associated with SAP
Conjoint tobacco and alcohol use, and depressive symptoms among hiv positive patients in Sedibeng District, Gauteng
(2024) Akahilem, Kenneth E.
Background: Psychosocial challenges among HIV positive patients may promote substance use disorders. In this study, we explored the relationship between conjoint tobacco and alcohol use and depression symptoms among HIV positive patients in Sedibeng district, South Africa. Methods: In a cross-sectional study of 404 participants, a questionnaire collected information on socio-demography, tobacco and alcohol use, and depression symptoms. Outcome measures included the prevalence of conjoint tobacco and alcohol use, and its association with depression. Results: The mean participant age was 43.2 years. Most completed secondary school 62.9% (253/402), were black 99.0% (400/404), female 65.8% (266/404), unemployed 53.6% (216/403) and on ART for >1 year 97.8% (393/402). Current tobacco use was reported by 23.3% (94/404) participants with most smoking cigarette (73.7%) and having low nicotine dependence (75.5%). Current alcohol use was reported by 43.6% (176/404) participants, and 36.9% were categorised as harmful users. Only 7.7% (31/404) participants screened positive for depression; most of these (83.3%) previously undiagnosed. The prevalence of conjoint tobacco and alcohol use was 19.6% (79/404) and this was not associated with depression (p=0.438). Harmful alcohol users were more than five times likely to report conjoint tobacco and alcohol use (p=0.000) but women were less likely to report it (p=0.000).
Audit of ultrasound in adult patients presenting with scrotal pathology at Chris Hani Baragwanath Academic Hospital
(2024) Nkosi, Winile
BACKGROUND: Scrotal ultrasound is one of the most frequently requested and performed radiological procedures worldwide. It is cheap, easily accessible and can significantly reduce the morbidity and mortality if prompt diagnosis and treatment are provided. OBJECTIVES: To determine the frequencies of the most common scrotal symptoms and scrotal ultrasound findings in adult patients presenting at Chris Hani Baragwanath Academic Hospital(CHBAH). METHOD: Reports of all scrotal ultrasounds completed at CHBAH from the 1st of January 2020 - 31st of December 2020 were retrospectively reviewed. The indication for and the findings of each ultrasound were recorded. Subjects were then categorized based on corresponding indications and ultrasound findings. RESULTS: There were a total of 267 scrotal ultrasounds performed with 141 studies meeting the inclusion criteria. CONCLUSIONS: Routine scrotal ultrasound places a significant burden on radiology services in our clinical setting. In view of the significant percentage of benign and normal ultrasounds (about 97.9 %) with only 6.4 % presenting with organ threatening pathology, the referring clinicians should reconsider which patients to send for imaging based on their clinical findings and assessment.
Patients’ experience of postponement of surgery for an elective caesarean delivery
(2024) Dhulab, Jaimal Ashok
Background Surgical postponement has been shown to be an indicator of quality of care and management of the operating theatre. In South African government hospitals there are many factors that lead to postponement of surgery such as staff shortages and issues relating to infrastructure. Postponement of surgical procedures results in a misuse of valuable scarce resources. Postponement of surgery may have a significant bearing on the parturient. Patients presenting for elective caesarean delivery are known to be at high risk for developing perinatal anxiety. There is limited research into the experiences of obstetric patients that have been postponed for elective caesarean delivery. Objectives To identify, explore, and relate experiences of patients who have experienced a postponement of surgery for an elective caesarean delivery. Methods A qualitative, exploratory, descriptive and contextual design was followed using phenomenological and observational methods to describe the experience of elective caesarean section delivery patients who were postponed at Rahima Moosa Mother and Child Hospital. Semi-structured, open-ended interviews were undertaken with participants between May 2021 and August 2021. Data saturation was achieved after eight interviews and the data were analysed using inductive thematic analysis. Results A complex interlink of six themes was identified revealing poor communication, which resulted in anger and frustration, as well as fear and anxiety. Patients’ interactions with healthcare workers also brought to light experiences of guilt and disempowerment. Patients indicated that support structures and coping strategies were utilized to maintain a sense of trust and reassurance in the treatment and care that they received. Conclusion Postponement of surgery has detrimental effects on patients presenting for elective caesarean delivery. Early and effective communication may improve patients’ experience of postponement. Inter-professional communication and collaboration among doctors and nurses are key to providing quality patient care.
Pattern of thyroid disorders in black population referred for thyroid scintigraphy at Chris Hani Baragwanath Hospital, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Zergoug, Nadia
Background: Most endocrine disorders are due to thyroid dysfunction with varying etiologies. Different management protocols exist for the different endocrine disorders, and it is crucial to determine the specific cause due to thyroid dysfunction. This study aimed to describe the spectrum of thyroid diseases in patients who undergo thyroid scintigraphy and to assess the agreement with biochemistry and scintigraphy. Methods: This was a retrospective study to assess the pattern of thyroid disorders in the patients referred for thyroid scintigraphy at Chris Hani Baragwanath Hospital (CHBAH). All cases diagnosed with thyroid dysfunction based on biochemical results and referred for 99m Tc scintigraphy to nuclear medicine from January 2017 to December 2018 were reviewed. All records reviewed were >18 years of age and were a total of 780. Result s Of the 780 patients reviewed, 631 (80.9%) were black while the remaining 19.1% comprises White, Indian, and Coloured individuals. Among the Blacks, 84% were females and 16% were males. Graves’ disease was the commonest thyroid disease diagnosed on scintigraphy in the entire population and among the blacks, constituting 72% (n=454/631) of patients. Other thyroid disorders among the black population include toxic multinodular goitre (13%, n=80/631), non-toxic multinodular goitre (7%, n=45/631), toxic adenoma (3%, n=17/631), and thyroiditis (3%, n=21/631). The black patients’ mean age was 47.3 years with a standard deviation (SD) of ±15.1 years. Graves’ disease as well as other thyroid disorders affected all age groups but were most prominent in the 40-59 years age group in both females and males. The median thyroid stimulating hormone (TSH) was 0.001 mIU/L while free thyroxine (fT4) ranged from 7.4 – 160 pmol/L in black population diagnosed with hyperthyroidism. Conclusion: Graves’ disease is the commonest cause of thyroid disorders among individuals referred for thyroid scintigraphy, being most prevalent in Black females in the reproductive age group. Thyroid scintigraphy is useful for aetiological diagnosis in patients presenting with thyroid disorders.
Prevalence of osteoporosis in HIV infected patients initiating antiretroviral drugs living in Johannesburg
(2024) Khumalo, Mzwakhe
Background: Low-energy fractures complications are a major public health issue that make osteoporosis even worse. In sub-Saharan Africa, the prevalence of osteoporosis varies from 18.2% to 65.8%. In wealthy nations, it affects one-third of white women over 50. There was no change in bone mineral density (BMD) between HIV-infected and non-HIV-infected women in Sub-Saharan Africa, where human immunodeficiency virus (HIV) is widespread. Other investigations that demonstrated that HIV-infected people had poor BMD both before and after starting anti-retroviral treatment did not consistently show a low BMD finding. Inflammation-mediated bone remodelling has been associated with low BMD in HIV-infected patients. Antiretroviral Therapy (ART) has been demonstrated to exacerbate bone loss in addition to the pre-existing intrinsic risk of developing osteoporosis. Nucleoside reverse transcriptase (Tenofovir) has been shown to cause the most significant bone loss, followed by protease inhibitors (Lopinavir/Ritonavir). On the other hand, integrase inhibitor (Raltegravir) has the least noticeable effects on BMD, despite its pathophysiological causes of decreased BMD in patients on ART being poorly understood. Research question: Is there loss of bone in HIV-infected patients before initiating ART? Methodology: The case files of patients who were HIV-positive and enrolled in the ADVANCE research were retrospectively reviewed on a desk. All of the 1053 individuals in the ADVANCE research had a DXA scan performed to evaluate BMD as part of the initial screening and recruitment approach. The ADVANCE research enrolled HIV-positive people and randomly assigned them to three ART arms. The original pre-treatment data points on bone mineral density were used in this study to respond to the research question. Results: A total of 400 black patients were reviewed. Of these 400 records reviewed, 62.3% were female. The female to male ratio was 1.6:1. Eighty percent of the participants were younger than 40 years old, and only 3% were older than 50 years. Eighty two percent were virally suppressed with less than 50 viral copies. The prevalence of osteopenia was 25.5% and osteoporosis was 2.8%, observed in predominantly African female participants aged between 30 and 39 years. Conclusion: The findings of this study confirm that there is pre-existing bone loss among HIV-infected ART naïve individuals. Approximately twenty eight percent (28.3%) in our study v had clinically confirmed evidence of bone loss and of these, 2.8% of the entire cohort had osteoporosis. Bone loss was most prevalent in black females who are virologically suppressed.
Method optimization for the identification of proteins associated with pancreatic ductal adenocarcinoma in plasma using mass spectrometr y
(2024) Dubazana, Sinegugu
Background: Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths. The poor survival rate for PDAC is mostly due to the lack of effective biomarkers for early diagnosis. This study aimed to develop a standard operating procedure for a highthroughput mass spectrometry-based workflow that can be used for plasma-based biomarker discovery studies. Methods: Total protein was extracted from a master pool consisting of 28 PDAC samples (M211158). SDS-PAGE was conducted to visualize the dynamic range of the plasma proteins. Three sample preparation methods were compared, Method 1: plasma diluted 25X with buffer (50mM Tris-HCl pH 8 with 2% SDS), Method 2: plasma diluted 5X with 50mM TEAB buffer, and Method 3: precipitation (using 80% and 100% acetone) followed by resuspension in 50 mM Tris-HCl, 2% SDS. The Hydrophilic Interaction Liquid Chromatography (HILIC) and protein aggregation capture (PAC) based protocols were compared for clean-up and digestion of the proteins. Low pH reverse phase chromatography was applied to separate the peptides and SWATH-MS analysis was conducted for label-free quantification. The methods were compared based on reproducibility, ease of automation and the number of peptides identified. A pilot study including 6 PDAC, 6 Chronic pancreatitis, and 6 healthy individuals was conducted to test the selected optimized method. Results: The combination of the 25-fold dilution of Method 1 and the 2 hrs HILIC bead-based method (with a Trypsin and LysC combination) were effective in protein sample clean-up and digestion, yielding the highest number of peptides (mean: 2856). The combination of Trypsin and LysC enzymes contributed to the improvements in technical variation and peptide quantitation. The preliminary analysis identified 25 differentially expressed proteins (22 downregulated and 3 upregulated) between the healthy and PDAC patients. Most of these proteins are associated with tumorigenesis. Conclusion: This study developed a standard operating procedure for processing plasma samples and can be applied in future studies for the identification of potential markers for PDAC.
Development of a list of essential obstetric anaesthetic knowledge and skills for interns in a department of anaesthesiology
(2024) Nibe, Zibele
Background Community service medical officers often practice obstetric anaesthesia without supervision, and complications can occur if they are not adequately equipped with the necessary knowledge and skills. This study aims to develop a list of essential obstetric anaesthetic knowledge and skills for interns in a department of anaesthesiology. Methods and results A prospective, exploratory, and instrumental study design using Lynn’s Model of determination and quantification of content validity was followed. The Developmental Stage involved an extensive literature review, followed by a peer group discussion with expert local anesthesiologists with a special interest in obstetric anaesthesia. Each item on the list was debated until consensus was reached. This stage resulted in a list with 59 items. In the Judgement -Quantification Stage, this list was sent to expert anaesthesiologists with a special interest in obstetric anaesthesia nationally for validation. The anaesthesiologists used a four-point Likert scale ranging from unnecessary to essential information to grade each item. Fifty-seven of the 59 items were deemed essential and retained. This entire list was quantified using the content validity index (CVI). Lynn suggests that a content list should have a CVI of at least 0.8. The list was content valid with a CVI of 0.98. Conclusion This study presents a comprehensive list of essential knowledge and skills for interns in obstetric anaesthesia in the Wits Department of Anaesthesiology that may contribute to interns practising obstetric anaesthesia more safely.
Knowledge and attitude towards cardiopulmonary resuscitation by non-medical staff at a medical school in Gauteng
(2024) Jarghon, Saeb
Background: Sudden cardiac arrest can occur unexpectedly to any person and at any place including at medical schools. Improved outcomes after cardiac arrest are dependent on the initiation of early first responder high quality cardiopulmonary resuscitation (CPR) and rapid defibrillation. There is a lack of data pertaining to the knowledge, attitudes, and perceptions of non-medical staff at medical schools regarding CPR. Objective: To determine the knowledge, attitudes and perceptions of non-medical staff at a medical school in South Africa regarding CPR. Methods: A paper-based questionnaire was administered to non-medical staff fulfilling inclusion criteria at the medical school. Data was collected between 01 August and 25 October 2020. Results: The final study sample comprised of 150 participants. Of these, 68.7% were female, 72.7% were ≤ 40 years old, 41.3% had a postgraduate university degree, 48.0% had witnessed a medical emergency at the medical school premises and 30.7% had previously undertaken first aid or CPR training. The mean knowledge score was 4.4 ± 1.6 out of 12 with only 16.7% knowing what was the first thing to look out for during a medical emergency and 18.7% knowing the location of the automated external defibrillator. Most participants (90.7%) indicated that CPR training should be mandatory for all employees. Conclusion: Non-medical staff surveyed displayed suboptimal knowledge but positive attitudes and perceptions towards CPR. Although this was a single centre study, these results can be used to motivate for CPR training of non-medical staff at all medical schools.

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