4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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Browsing 4. Electronic Theses and Dissertations (ETDs) - Faculties submissions by SDG "SDG-3: Good health and well-being"

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    A 5 year review of paediatric maxillofacial & oral surgery procedures performed at the Wits oral health centre
    (2021) Vally, M.
    Aim: To review paediatric maxillofacial and oral surgery procedures performed at the Wits Oral Health Centre (WOHC) over a 5-year-period. Materials and Methods: This was a retrospective record review study at WOHC, University of the Witwatersrand, Johannesburg. Records of paediatric patients who had treatment from 2013 to 2017 were included in the study. Data collected included the age of patients, gender, distribution of scope and type of treatment. Data was analysed and results presented as frequencies and percentages. Results: A total of 694 paediatric patients presented for treatment during the study period. There were more males (54.2%) than females (45.8%), and the majority of patients were in the 11-17-year age category. Oral surgery, treatment of pathoses and management of trauma were the most common procedures at 34%, 29% and 20.5% respectively. There was a statistically significant difference between the number of surgical procedures carried out under general anaesthetic and that under local anaesthetic (p < 0.001). The removal of third molars was more common than other oral surgical procedures. A high occurrence of paediatric trauma was observed in males aged between 11-17 years. Mandibular fractures, followed by dentoalveolar fractures, were the most common fracture types. The most commonly diagnosed pathological conditions were odontogenic cysts (23.15%), benign odontogenic tumours (22.31%) and fibro-osseous lesions (19.02%). Mucous extravasation cyst was the most common salivary gland pathology. Conclusion: Most oral and maxillofacial surgical procedures in paediatric patients are performed in the 11-17-year category. The removal of impacted 3 rd molars was the most common surgical procedure and the management of ameloblastomas appears to be the most common odontogenic tumour in this age group. Future studies are required to provide insight into the reasons, patterns and distribution of paediatric maxillofacial surgery. Results from such studies, especially prospective ones, will form the basis for design of educational campaigns and preventive strategies aimed particularly at the 11-17-year age group
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    A 15 -Year Review of Multiple Myeloma in HIV-1 Seropositive Patients at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2024) Baxter, Jayson McNeil
    Background: Multiple Myeloma (MM) is a haematological malignancy characterized by the malignant proliferation of plasma cells in the bone marrow and manifesting with skeletal related events as the clinical and radiological hallmark of the disease. The incidence of MM varies substantially across the different continents, with intermediate rates being encountered in Africa. MM occurs more commonly in people of Afro-Caribbean descent, with the incidence being 2-fold higher in African Americans compared to Caucasians. In South Africa, prior to the advent of and impact of HIV, MM was the most common haematological malignancy in adults. However, since 2002, Non-Hodgkin Lymphoma (NHL) has superseded MM, with MM being the second most common haematological malignancy encountered in adults, currently. At Chris Hani Baragwanath Academic Hospital (CHBAH), MM has been a stable disease since the 1970’s, with a noticeable increase in numbers since 2016. MM is characteristically a disease of middle-aged and elderly individuals. In the Western world, ninety-eight percent of cases occur over the age of 40 years with a peak in incidence in the seventh decade. The median age at diagnosis is 66 years. However, in Africa, the disease presents at a younger median age (approximately 5-10 years younger), with 7% of the patients being under the age of 40 years. In 2020, globally there were 36 million adults with HIV-1 of which 67% were living in sub- Saharan Africa. Women accounted for 63% of all new HIV-1 infections, compared to men with 37%. South Africa has the highest number of HIV-1 sero-positive individuals in the world and is home to approximately 8 million people living with HIV (PLWH). In South Africa, HIV has reached epidemic proportions and is impacting on a number of haematological malignancies, including MM. This study was undertaken to better characterize and describe the demographics, clinical, laboratory and radiological findings of patients presenting with HIV-1 sero-positivity and concomitant MM in our patient population. In addition, it describes the therapy, response to therapy, outcome and survival of the patients with this association. b. Patients and Methods: This is a retrospective study of all adult patients with a confirmed diagnosis of MM, together with HIV-1 sero-positivity, seen at the Clinical Haematology Unit, Department of Medicine, from January 2006 to December 2020 (15 years). Demographic, clinical, radiological and therapeutic data was retrieved from the patient files and laboratory data from the NHLS data base. Data was processed in Microsoft Excel and the appropriate statistical software was used to analyse the results. Descriptive analysis was conducted through the computation of frequency tables for categorical variables and appropriate measures of central tendency, i.e., mean, ± SD/median and (IQR), for continuous variables. Kaplan-Meier survival curves were plotted to determine the survival probability of the patients based on the clinical, laboratory and treatment characteristics. c. Results and Discussion: During the study period (01/01/2006 to 31/12/2020 – 15 years), a total of 601 patients were diagnosed with MM. 84 patients were HIV-1 seropositive (14%). Of these 84 patients, 14 were excluded. A total of 70 evaluable HIV-1 seropositive patients were included in this study (12%). Of these 70 patients, there were 42 females and 28 males with a female to male ratio of 1.5:1. The mean age for females was 49.9 years (range 31-77 years), and males was 50.6 years (range 36-73 years), while the mean age for the whole group was 50.2 years (range 31-77years). All the patients in the study were of Black African ethnicity, in keeping with the demographic of CHBAH, where >90% of the patients admitted to the hospital are of Black African ethnicity. The pertinent findings in this study were the following: 1. An increase in the number of MM patients from 165 (2006-2010) and 168 (2011-2015), to 268 (2016-2020), in the latter five years of the study. A corresponding increase in HIV seropositivity of 10.9% (2006-2010) and 10.1% (2011-2015), to 18.3% (2016-2020) in the latter 5 years of the study, with a background seroprevalence in Gauteng of 14.9% (2005) to14.4% (2008) and 18.8% (2012) to 18.7% (2017), 2. A younger mean age of 50 years, with a female predominance of 1.5:1, 3. More than half the patients (54.7%) had an ECOG PS ≥2, 4. Bone pain and anaemia were the dominant clinical features, 5. A higher proportion of cytopenias, including leucopenia, neutropenia and thrombocytopenia was noted in the study population compared to other studies done locally at CHBAH on MM. 6. Plasmacytomas were evident clinically in 29% of patients and radiologically in 52% of patients. 7. Biochemical features of note were: hypercalcaemia in 56% of patients, renal dysfunction in 33% of patients, hypoalbuminaemia in 65% of patients and an elevated B2M level in 96.3% of the patients. The mean CD4 count was 367 cells/ul, with a range of 23-964 cells/ul. Approximately a quarter of the patients (26.1%) had a CD4 count <200 cells/ul, 8. IgG isotype (74%) was the most common subtype of MM, 9. Lytic lesions were found in up to 77% of the patients on CT scan, with vertebral compression fractures being present in 77% of patients on MRI. 10. Most patients had advanced stage of disease, with DS stage III in 92% of the patients and ISS stage III in 70% of the patients. 11. Specific therapy in the form of chemotherapy (different combinations of cytotoxics, corticosteroids and immunomodulatory agents such as thalidomide etc.) was administered to 76% of the patients. Furthermore, 34% had radiotherapy and only 6% had an ASCT, 12. Despite the use of cART and specific therapy, the overall outcome was poor, with a median survival of 5.64 months (Interquartile range 0.82-19.24 months), 13. Survival was statistically significantly better in those who received chemotherapy and/or radiotherapy compared to those who received supportive care only (p=<0.001) and those who had ISS stage I and II disease, compared to ISS stage III disease (p=0.006), and 14. Although survival was better in those who had a higher CD4 count (≥200 cells/ul versus <200 cells/ul) (p=0.081), and those who achieved at least a PR versus
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    A Clot to Uncover: FOXP3 and SARS-CoV-2 Nucleocapsid Interactions and Their Effect on DNA Binding
    (University of the Witwatersrand, Johannesburg, 2024) Mcinnes, Keiran; Fanucchi, Sylvia
    During COVID-19, systemic coagulopathy, which can lead to strokes and embolisms, is often observed in COVID-19 patients and may also contribute to long COVID. This coagulopathy is the result of overactivated platelets in circulation that leads to inappropriate clot formation. FOXP3 is a transcription factor involved in platelet development and loss of FOXP3 function leads to platelets that resemble those seen during COVID-19. Thus, FOXP3 may be dysregulated in COVID-19. The SARS-CoV- 2 nucleocapsid (NC) is a multifunctional protein typically associated with viral genome packaging and virion assembly. However, it is also capable of binding DNA and is potentially able to alter regulation of host protein expression. Here, potential interactions between the DNA-binding forkhead domain (FHD) of FOXP3 and the SARS-CoV-2 NC were investigated. Identification of a novel interaction between FOXP3 and SARS CoV-2 NC may provide new clues as to the pathophysiology of COVID-19. To address this aim, both proteins were overexpressed in T7 E. coli, purified via immobilised metal affinity chromatography, and monitored for potential interactions in the absence and presence of DNA using pull-down assays and fluorescence anisotropy. A direct interaction was identified between the two proteins in the absence of DNA. Additionally, it was found that both proteins are capable of binding to DNA at the same time, but excess NC was found to cause FHD dissociation from the FHD- NC-DNA complex. This result implicates NC in FOXP3 dysfunction which may be associated with the coagulopathy and other symptoms seen during COVID-19. Additionally, NC DNA binding does not appear to be driven by the FOXP3 consensus sequence, indicating that FOXP3 may not be the only transcription factor potentially dysregulated by NC
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    A comparison between bone grafting and non-grafting of immediately placed implants in the molar area
    (2024) Van der Linden, Wynand Johan
    Aim: This study aims to investigate the outcome of placing a bone graft material into the residual socket space of a fresh molar extraction socket, treated flapless after an implant has been placed compared with a control group at three months. Methodology: This prospective, randomized, control, double-blind clinical trial will evaluate the difference in ridge width between a control and intervention (grafting) group at baseline and three months postoperatively. All cases were evaluated using pre-operative (T0) and three months postoperative (T1) impression models. Horizontal measurements were taken at 3 levels (2, 4, and 6mm). Vertical point measurements were done at 3 points (A, B, and, C) and compared between the two groups. Results: The study consisted of 22 participants, 11 in the control and 11 in the grafting group with a mean age of 49.5 years. Majority of the cases presented in the mandible (64%) with one case of implant failure. Bone loss was perceived to be greater in the control group after 3 months compared to the loss observed in the grafting group. The difference in the loss of ridge width between the control and grafting groups was insignificant (p-value>0.05). Conclusion: The difference in the loss of ridge width between the control and grafting group was insignificant (p-value>0.05), owing to the study’s small sample size. Less bone resorption was observed in the grafting group at 3 months post– implant placement, however, the long-term follow-up would be required to determine the effectiveness of the bone graft. Further studies with larger population samples and increased follow-up time (6 months, 12 months, and 24 months) should be considered to determine the long-term benefit of bone grafting done simultaneously with tooth extraction and immediate implant placement.
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    A comparison of malignant histopathological diagnoses on uterine curettings and hysterectomy specimens
    (2024) Ismail, Abdullah
    Background. Endometrial carcinoma (EC) is a common gynaecological malignancy in postmenopausal females. Diagnosis is made on endometrial biopsy, where histological subtype and tumour grade are used to predict disease progression and to plan surgical management. Objectives. We aimed to determine the accuracy of preoperative biopsies compared to the final diagnosis on hysterectomy specimens in our department. Methods. This was a retrospective, cross sectional study in which 126 biopsies and corresponding hysterectomy specimens, over a 3-year period, were reviewed. Patient demographics and histological features were recorded and statistically analysed. Results. The most prevalent tumours were endometrioid endometrial carcinoma (EEC) (48.5%), serous carcinomas (25.4%) and carcinosarcomas (16.7%). The majority (66.7%) of tumours were high-grade tumours on biopsy and hysterectomy specimens (58.7%). EECs had a poor sensitivity level (65.12%) compared to other subtypes but had a high specificity rate 90%. There was moderate agreement between biopsy and excision specimen diagnoses. High-grade tumours had a high sensitivity (94.29%) level. Conclusions. Our study showed moderate agreement between histopathological diagnoses on biopsy, and excision specimens. EEC was the most prevalent tumour subtype. There was a high sensitivity (94.29%) level for biopsies of high-grade tumours, concordant with other studies. The sensitivity of low-grade EECs (42-46%) was lower than international studies, likely due to the comparatively low prevalence of EECs in our population. Accurate preoperative tumour subtyping and grading are needed to guide surgical management. It is envisaged that use of a combined histological and molecular tumour classification will better guide patient treatment and allow for reproducible results.
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    A comparison of rebound and applanation tonometry in anaesthetised children with and without Primary Congenital Glaucoma: A cross-sectional comparative study
    (University of the Witwatersrand, Johannesburg, 2024) Kruger, Hester
    Intraocular pressure (IOP) measurement should be accurate in a paediatricpopulation with primary congenital glaucoma. Aim To investigate the difference between the change in IOP measurements using rebound tonometry (RBT) and handheld applanation tonometry (Perkins Applanation Tonometer / PAT) in patients with and without primary congenital glaucoma (PCG). Setting Soweto, South Africa. Methods Demographic data, including age and gender was analysed. IOP measurements were done under anaesthesia, using RBT and PAT at 0, 5 and 10 minutes after induction and prior to intubation. Corneal pachymetry and corneal diameters were measured. Results 65 children were included, 19 with PCG and 46 without PCG. The mean age (SD) was 3.2 (2.27) and 4.8 (2.42) years respectively. The overall mean difference in IOP between RBT and PAT across both PCG and non-PCG groups was found to be 4.92 mmHg (95% CI 2.80 – 7.03) p <0.001, with RBT having higher readings. This difference was greater in the PCG group, with the IOP difference of 9.05 mmHg (95% CI 2.6 – 15.5) p=0.004. Mean corneal pachymetry (SD) was 585.6 (81.48) μm in the PCG group and 518.31(39.90) μm in the non-PCG group. Univariate analysis showed that IOP was significantly related to corneal pachymetry, with a 11 mmHg increase in IOP for every 100 μm change in corneal thickness for measurements done with RBT (p<0.001), compared to 4mmHg using PAT. (p=0.008). Mean horizontal corneal diameter (SD) was 13.95(1.24) mm in the PCG group, compared to 11.09(0.32) mm in the non PCG group. Conclusions IOP measurements done with RBT in children with and without PCG were overestimated compared to PAT. This difference was more pronounced in PCG patients. In addition, IOP was significantly related to corneal thickness.
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    A comparison of the warming capabilities of two Baragwanath Rewarming Appliances with the Hotline® fluid warming device
    (2024) Wilson, Kyle
    Background: Accidental intraoperative hypothermia is a common and avoidable adverse event of the perioperative period and is associated with detrimental effects on multiple organ systems and postoperative patient outcomes. In a resource limited environment the prevention of intraoperative hypothermia is often challenging. Resourceful clinicians overcome these challenges through creative devices and frugal innovations. This study aims to investigate the thermal performance of two such Baragwanath Rewarming Appliances (BaRA) against that of the Hotline® in an attempt to describe an optimal setup of these devices. Methods: This was a quasi-experimental laboratory study that measured the thermal performance of two BaRA devices and the Hotline® under a number of scenarios. Independent variables fluid type, flow rate, warming temperature and warming transit distance were sequentially altered and temperatures measured along the stream of fluid. DeltaT was calculated as the difference between entry and exit temperature for each combination of variables for each warming device. Results : A total of 219 experiments were performed. The BaRA A configuration at a temperature of 43ºC with a transit distance of 200 cm either matched or exceeded the DeltaT of the Hotline® over all fluid type and flow rate combinations. The BaRA B configuration does not provide comparable thermal performance to the Hotline®. Measured flow rates were noticeably slower than manufacturer quoted values for all intravenous (IV) cannulae used. Conclusion: A warm water bath at 43ºC with 200 cm of submerged IV tubing provides thermal performance comparable to the Hotline, with all fluid type and flow rate combinations.
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    A cross-sectional study investigating knowledge, attitudes and health choices in relation to diabetes mellitus among nondiabetic patients attending Chiawelo community practice, Soweto, Republic of South Africa
    (2024) Tshibeya, M. R.
    Background: The knowledge, attitudes and health choices of non-diabetic patients in resourcelimited settings to prevent the onset of diabetes mellitus (DM) are poorly understood. Aim: The aim of this study was to investigate and describe the knowledge, attitudes and health choices of non-diabetic patients in relation to DM at the Chiawelo Community Practice (CCP), Soweto, South Africa. Methods: In this cross-sectional study, a self-reported questionnaire was administered to 165 adult participants attending the CCP from 2nd March to 17th April 2020. Descriptive analysis, Chi square and univariate logistic regression were included in the analysis. Multivariate analysis was done for variables with a p-value <0.25 Results: In total, the study had 165 participants, of whom 112 (68%) were women, 35% were older than 45 years and 16% were younger than 25 years of age. Almost half (49%) of participants had good knowledge of DM, with 60% indicating good attitudes and 52% making good health choices to prevent DM. Participants who received education from clinicians were 4.31 times more likely to develop better attitudes (p=0,003) and 3.34 times more likely to adopt better health choices (p=0.004) towards DM compared to those who obtained information from media or other sources. Conclusion: The study found that poor knowledge of DM does not necessarily translate into poor attitude towards the disease, which is noteworthy. The study also highlighted the important role of healthcare workers in influencing behaviour change
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    A Descriptive Study of MRI Findings of Children with Suspected Hypoxic Ischaemic Injury at a Tertiary Academic Hospital in Johannesburg, South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Lorentz, Liam; Mahomed, Nasreen
    Background: Hypoxic ischaemic brain injury and its clinical sequalae present a global health burden. MRI is the imaging modality of choice to investigate hypoxic ischaemic injury. As there is limited data from low and middle-income countries describing MRI findings of children with suspected hypoxic ischaemic brain injury, we describe the MRI findings of children with suspected hypoxic ischaemic brain injury in a resource-limited setting. Materials and methods: MRI studies performed for children under the age of 15 years, with clinically suspected hypoxic ischaemic injury were retrospectively evaluated over a 2- year period. A simplified MRI classification of injury, with a final, majority consensus reading was used at the data analysis phase. The 3 readers were blinded to each other and all clinical details, except for age. All clinical information available at the time of MRI was collated by the principal investigator, who was not an imaging reader. Results A total of 128 MRI studies were evaluated. MRI evidence of hypoxic ischaemic injury was found in 42.2% of children. Normal MRI findings were present in 41 (32.0%) children; and punctate periventricular white matter injuries in 19.5%, watershed injury in 3.1%, central injury in 10.2% and diffuse injury in 23.4% of MRI studies. Preterm infants more commonly demonstrated periventricular white matter injury. Conclusion: Periventricular white matter pattern of injury was the most common type in premature infants, congruent with international cohorts. Despite the majority of children with suspected hypoxic ischaemic injury being imaged beyond the infant period, MRI findings may have implications for medicolegal recourse
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    A fifteen year review of chronic lymphocytic leukaemia in adults, at Chris Hani Baragwanath academic hospital
    (University of the Witwatersrand, Johannesburg, 2024) Khosa, Cain Mikateko
    Background: Chronic Lymphocytic Leukaemia (CLL) is one of the four common types of leukaemia encountered in adults. CLL is characterized by the clonal proliferation and accumulation of small, mature, neoplastic, CD-5 positive, B-lymphocytes in the blood, bone marrow and lymphoid tissues. There are geographical variations in the incidence of CLL worldwide, with CLL being the commonest form of leukaemia in some parts of Europe and the Western World. The median age at diagnosis is approximately 70 years, with less than 10% of patients presenting under 45 years of age. Most studies show a male predominance of 1.5-1.9:1. While the incidence in Europe is similar to that reported in the United States, the incidence is lower in Asia and Africa. Moreover, in Africa, the disease tends to present in individuals who are 5-10 years younger, primarily because of the younger age structure of the African population. At Chris Hani Baragwanath Academic Hospital (CHBAH), CLL ranks 5th in order of frequency, amongst the haematological malignancies that are encountered in adult patients. Based on a small study done at CHBAH in 1994, the disease presents at a younger median age of 63 years, with a male predominance of 1.5:1. Although CLL is generally a stable disease at CHBAH, there has been a noticeable increase in the number of patients by 1.5 fold, from 2015 to 2019. This study was undertaken to better characterize and describe the demographics, clinical and laboratory features, staging and treatment outcome of adult patients with CLL, seen at our centre over a 15 year period. b. Patients and Methods: This was a retrospective study of all adult patients with a confirmed diagnosis of CLL, seen over a 15 year period (01/01/2005 to 31/12/2019), at the Clinical Haematology Unit, Department of Medicine, CHBAH (15 years). Demographic, clinical, and therapeutic data was retrieved from the patient files and laboratory data from the NHLS data base. Data was obtained retrospectively from patient files, captured onto a data sheet and entered onto an Excel spread sheet prior to statistical analysis, using a programme such as Stata/Statistica (and/with the assistance of a statistician). The patient demographics were summarized using descriptive statistics for dependent variables that are normally distributed, including means and standard deviations. For comparisons between normally distributed variables, a Student t-test was be used. For comparing the different staging systems, a Chi squared test was used. Where a comparison was required in more than two groups, the Anova test was used. When data was not normally distributed, the Mann-Whitney or Kruskal-Willis test was used for correlation between variables. For the purpose of statistical analysis, a 95% confidence interval, with a p-value (p<0.05) was considered significant c. Results and Discussion: The key findings in this study were: 1. A stable number of patients in the first ten years of the study (01/01/2005 to 31/12/2014), with a 1.5 fold increase in the latter 5 years of this study (2015-2019). 2. A younger median age of 64 years, with a male predominance of 1.87:1. 3. Most of the patients were symptomatic, with an ECOG PS ≥1 in 92.8% of the patients. 4. Fatigue (49.2%), loss of weight (47%) and fever (43%) were the most common symptoms at presentation. 5. Lymphadenopathy was the dominant physical sign (91.2%). Hepatosplenomegaly was evident in 49.2% of the patients. 6. The vast majority of patients had anaemia (82.9%), with a mean haemoglobin of 9.44 g/dl. The mean white cell count and lymphocyte counts were 173 x109/l and 158.7 x 109/l, respectively. The mean platelet count was 155 x 109/l. Clinical thrombocytopenia was present in 37% of the patients. 7. More than half the patients presented with advanced stage/high risk disease, with a Rai stage III and IV accounting for 62.5% and Binet C for 56.4% of the patients at presentation. 8. A diffuse pattern of bone marrow infiltration, indicating adverse prognosis was evident in 89.5% of the patients. 9. Cytogenetics showed a favourable genotype (13q) in 43%, an intermediate phenotyope (trisomy 12) in 31.7% and an unfavourable phenotype (11q and 17p) in 14% and 11%, of the patients, respectively. 10. HIV sero-positivity was present in 8.8% of the patients, with sero-positive patients showing a number of differences, including a younger median age at presentation, a more marked male predominance, similar clinical presentation and staging of the disease, a higher proportion of TB, hepatitis B and C, and a lower mean survival, with a similar median survival. 11. Supportive care only was offered to 22.7%, while chemotherapy was administered to 69% of the patients. 12. The outcomes of the patients at the end of study were: i) Lost to follow up (65.2%), ii) Deceased (31.5%) and Alive (3.3%). 13. The mean survival for the whole group was 32 months, with a median survival of 6 months, while for the HIV sero-positive group the median survival was 20 months, with a median survival of 6 months. d. Conclusions and future recommendations: Based on the findings of this study, the following conclusions and future recommendations are suggested: Education with regard to the key clinical manifestations of CLL, early suspicion of the possible diagnosis and timeous referral to a tertiary or specialized centre, so that the diagnosis can be confirmed and appropriate treatment (where indicated), can be initiated as soon as possible. Every effort should be made to improve compliance and attendance at follow up visits. This is vital in order to assess response to treatment and to detect early relapse or progression of the disease. Efforts to improve accessibility of ‘state of the art’ and novel therapies for public sector patients should be prioritised and ongoing. Prospective, randomised, multi-centre studies should be performed to assess the benefits of various therapeutic options and to compare existing therapies with novel treatment options in our local South African patient population (including both the private and public sector). Although HIV sero-positivity is not a major problem, the numbers of sero-positive patients is steadily increasing, with a doubling of the number in the latter 5 years, compared to the first 10 years of the study. In principle, these patients should be offered the same treatment options as HIV-1 sero-negative individuals, with the proviso that every attempt is made to achieve optimal virological suppression and immune reconstitution, with combination anti- retroviral therap
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    A laboratory based retrospective study of plasma cell myeloma in the public sector of South Africa from 2017 to 2019
    (University of the Witwatersrand, Johannesburg, 2024) Wilding, Bradley Thomas; George, Jaya
    Background Plasma cell myeloma is a haematological malignancy characterized by clonal proliferation of plasma cells. This malignancy is frequently associated with the production of a monoclonal protein in either serum and / or urine, referred to as an M protein, which is used as a screening test for patients. Patients are then further investigated to assess if they meet the International Myeloma Working Group (IMWG) diagnostic criteria for plasma cell myeloma. There is limited literature describing plasma cell myeloma in South Africa, particularly in people living with HIV. Objective The primary objective of this study was to describe plasma cell myeloma in patients diagnosed in the public sector of South Africa over a three-year period. The secondary objective was to compare demographic features (age, sex) and diagnostic criteria, between the myeloma patients living with HIV and the HIV negative myeloma patients. Methods A retrospective analysis was performed on data from 4518 patients who had a positive immunofixation on serum and / or urine from public sector hospitals, between 2017 and 2019. A total of 718 of the 4518 patients met the laboratory criteria for plasma cell myeloma and were included in the analysis. Demographics (age, sex) and laboratory investigations used in the diagnostic criteria for plasma cell myeloma were analysed and statistically compared across the different HIV status of patients. Results Plasma cell myeloma patients presented at a mean age of 59.46 years with a female to male ratio of 1.2:1. In the patients that met the diagnostic criteria the most common end-organ damage present was anaemia in 77.16% patients and the most common biomarker of malignancy was a bone marrow trephine biopsy plasma cell percentage t60% in 55.71% patients. IgG isotype was the most common paraprotein detected on serum immunofixation in 58.5% of the patients. Kappa was the most common Bence-Jones protein detected in 27.16% of patients which was 1.76 times more common than lambda Bence-Jones protein. People living with HIV were younger 55.11 (±9.79) as compared to their HIV negative counterparts (p value 0.010). No other statistically significant difference was noted when comparing HIV status groups Conclusion In conclusion, this study described the demographics, laboratory investigations and diagnostic features of plasma cell myeloma patients diagnosed in the South African public sector from 2017 to 2019. We found that people living with HIV were diagnosed at younger age when compared to their HIV negative counterparts
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    A model for the acceptance and use of mHealth in South Africa: A UTAUT and TTF perspective
    (University of the Witwatersrand, Johannesburg, 2023) Livhuwani Grace, Mongwe; Hughes, Mitchell; Kekwaletswe, Ray
    Scaling up high impact community based mHealth interventions is one of the agenda items mentioned in the National Digital Health Strategy of South Africa for the period 2019 -2024. Although many mHealth interventions have been explored, many of them end up in the pilot phase and do not reach full implementation. A common theme which was found as a possible driver of scalability is designing an mHealth application that considers usability and acceptability by users. The purpose of this study was to synthesize a model for the acceptance and use of mHealth in the South African health sector. A positivist research approach was used to test the adoption factors using the Task-Technology Fit (TTF) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Seven factors that could potentially impact the adoption of mHealth technology in South Africa were tested. The data for the study was collected through an online survey questionnaire which was shared through social media platforms. Results of this study were used to answer questions related to factors that have an impact on the adoption of mHealth applications in the health sector in South Africa. The study found that when adoption factors were combined into the UTAUT and TTF model, the only factor that was significant was facilitating conditions. The study findings in this regard were not consistent with other studies and it is therefore recommend that other scholars explore the reasons for these differences. The other factors were found to be significant when bivariate regression was used to compare the factors to the dependant variable of user acceptance and use of mHealth technology. The study further found that the combined model of Task Technology Fit has a positive impact on the adoption of mHealth technology in South Africa. The implication of the finding is that mHealth designers should build the functionalities of the innovation with the idea of making the task that the innovation supports easier to perform
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    A morphometric analysis of the growth of the immature and sub-adult human palate
    (2021) Onwochei-Bolum, Nkemakonam Vincent
    Postnatal nutrition in humans is associated with advancement in the mode of feeding from the neonatal and infancy period of growth to adulthood. During the neonatal and infancy periods, the palate functions in suckling, tongue manipulation and swallowing, while in adulthood and with dental eruption, the palate participates in both mastication and in the production of sound. It is anticipated that the transition in the role of the palate due to alterations in its function over time will cause morphological changes. Thus, the aim of this study was to analyse alterations in the shape and dimensions of the human palate from birth through the stages of dental eruption to the complete emergence of the permanent dentition in the sub-adult stages of life. Crania from 72 South African individuals were sourced from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand. The sample was divided into three age groups to correspond with the age ranges of the eruption of the deciduous dentition (birth to 5 years of age), mixed dentition (6 to 12 years of age) and the permanent dentition (13 to 20 years of age) respectively. A series of 14 osteological landmarks were digitized across the oral surface of the palate using an Immersion MicroScribe G2 unit. Landmark data were converted to linear distances and the length, width and elevation of the palate were assessed in relation to the state of the dentition. Analysis included both quantitative (linear measurements) and qualitative (wireframes) methods. The length and width of the palate in the permanent dentition group was significantly larger when compared to the mixed and deciduous dentition groups. While elevation of the palatal dome in the permanent dentition group was significantly greater than that of the palate in the mixed dentition group, no further significant differences were observed. Thus, changes in the morphology of the palate appear to be progressive with dental eruption and development across the different states of the dentition. By establishing the nature of the changes in the functional environment of the palate during development and growth, abnormalities in the postnatal development of the palate could be diagnosed.
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    A multicentre study to evaluate an in-house multiparameter immunophenotypic panel to identify precursor B-cells in the determination of measurable residual disease in paediatric B-cell acute lymphoblastic leukaemia
    (University of the Witwatersrand, Johannesburg, 2024) Nell, Zanre; Glencross, Deborah; Geel, Jennifer
    Background: Periodic assessment of measurable residual disease (MRD) is an important prognostic factor in the management of paediatric B-cell acute lymphoblastic leukaemia (ALL). Conventional polymerase chain reaction (cPCR) and multiparameter flow cytometry (MFC) are well-established in MRD determination, the latter with no current optimal immunophenotypic panel by international consensus. Objective: To determine whether an in-house immunophenotypic panel containing the discriminatory CD58-FITC (cluster of differentiation; fluorescein isothiocyanate) marker compares with cPCR in the detection of paediatric B-cell ALL MRD. Methods: This prospective descriptive validation study was performed on diagnostic and follow-up bone marrow aspirate samples, comparing an in-house immunophenotypic panel against the standardised commercial ClearLLab 10CTM B-cell/myeloid cell-2 (M2) panels in MRD assessment. These findings were then compared to cPCR to determine individual panel performance and predictive power. Results: Both immunophenotypic panels demonstrated 100% concordance in the identification of the leukaemia-associated immunophenotype (LAIP) on all diagnostic samples. The in-house immunophenotypic panel showed a higher sensitivity and specificity, and greater association with cPCR in MRD assessment in follow-up samples. In combination with shared backbone markers of the ClearLLab 10CTM B-cell/M2 panels, inclusion of CD58-FITC and CD81-APC-H7 (allophycocyanin- cyanine dye) proved most informative in accurate distinction between regenerating B-cell precursors and residual leukaemic cells. Conclusion: This work confirms the findings of previous studies, where discriminatory marker CD58- FITC in combination with backbone informative markers demonstrates both superior diagnostic and monitoring utility in paediatric B-cell ALL. The in-house immunophenotypic panel offers an attractive, comparable alternative in MRD determination in this patient population whilst awaiting cPCR results, raising the possibility of earlier clinical decision-making with potential improvement of morbidity and mortality outcomes
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    A pandemic shakes our pedagogy: Attempts to honour the integrity of a South African tertiary institution’s Applied Drama and Theatre curriculum in online learning platforms as a result of COVID-19
    (University of the Witwatersrand, Johannesburg, 2023-06) Mokoena, Moratoa Trinity; Janse van Vuuren, Petro
    A pandemic shook our pedagogy. The arrival of COVID-19 changed the face of higher education in South Africa and in many parts of the world. As an Applied Drama and Theatre department whose work is predominantly embodied and experiential, we were faced with the question: How do we migrate our kind of work online and honour its fundamental objectives? A characteristic Applied Drama and Theatre practice is embedded in principles of participation and collaboration, reflection through praxis and immersion in social contexts. All of these are largely experienced with physically present bodies in a common space for the purposes of social transformation and education. Due to the pandemic, the effects of the digital divide were rapidly exposed and its limitations on access, connectivity and synchronicity delayed the progress of teaching and learning. Can we honour the integrity of the complete Applied Drama and Theatre pedagogy online and remotely, especially when the digital divide impacts connection with students and the marginalised communities that the pedagogy is suited for? While we acknowledged that digitising our educational practices had become a progressive necessity, would online learning alone be sufficient for the teaching and learning of embodied curricula? Through ethnographic case study and as teaching assistant, I observed University of the Witwatersrand’s Drama for Life department and their Applied Drama and Theatre educators during their encounter of the COVID-19 pandemic and lockdown periods of 2020 and 2021. By use of interviews, field notes and documentation, this study inquired how we reacted to the pandemic and its anticipated implications on the pedagogy and the academic programme. Furthermore, I established the evident threats that online learning poses to the pedagogy and investigated the disconcerting effects of the digital divide on student access and content delivery. Central to the study is the exploration of these educators’ practical strategies and collective approaches in maintaining the integrity of the Applied Drama and Theatre pedagogy. Through a journey of trial and error, the department and its educators were tasked to re-envision the pedagogy and negotiate appropriate multimodal online modes of delivery, in efforts to save the academic programme and achieve its pedagogical intentions. Even though the data and literature demonstrate the possibilities of migrating similar pedagogies online, remote learning has certainly compromised the practical and physical demands of a conventional Applied Drama and Theatre experience. Additionally, even though the theoretical components could be negotiated online, the findings highlighted that the pedagogical objectives as a whole were fragmented. Thus, in the case of the professionalisation of students and the provision of the full Applied Drama and Theatre pedagogy – the educators’ efforts fell short. The pedagogy, though shaken, still stands. The study concludes that the pedagogy is highly dependent on uninterrupted physical presence and even if the digital divide is managed its integrity remains tainted without connection. The findings emphasise that we cannot do away with contact teaching post-pandemic and any idea of a pedagogical utopia requires a carefully negotiated balance of appropriately designed online and offline approaches. The discussions and findings in this study do not only impact the Applied Drama and Theatre fraternity, departments and practitioners alike, but also shed light on the available possibilities for other multidimensional pedagogies. Institutions are encouraged to take the full repertoire of the pedagogy into account when designing their Learning Management Systems, to provide adequate support for staff and student training and their digital affordances. Moreover, it is noteworthy to address the feasibility and equity of online learning within a particular South African context as a whole.
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    A Phenomenological Analysis of the Experiences of Black Female Volunteer Lay Counsellors from Marginalised Backgrounds in Gauteng!
    (University of the Witwatersrand, Johannesburg, 2023-09) Naidoo, Sherwyn; Patel, Ruby
    Within the South African context, Volunteer Lay Counsellors (VLCs) play a vital role in providing mental health care. Whilst Black female VLCs from marginalised backgrounds play an essential role in providing these services, there is a paucity of research in understanding their experiences. This study utilised a qualitative approach to explore the experiences of Black female VLCs from marginalised backgrounds in Gauteng. The researcher used non-probability purposive convenience sampling to recruit four participants who volunteered at a non-profit organisation (NPO) in Gauteng. The study collected data through in-depth semi-structured interviews. Insight was provided by this research into participants’ experiences of counselling from a position of their intersectionality to those who embody different intersectional identities. This was done by locating the research within the work of intersectional theorists Crenshaw (1989, 1991), McCall (2005), Tamale (2020), and Petsko and colleagues (2022). In keeping with this, the Interpretative Phenomenological Analysis (IPA) method allowed for an in-depth exploration of participants’ unique experiences through double hermeneutic interpretations. The themes illustrated that participants were motivated by the desperate need for access to mental healthcare in their socioeconomically disadvantaged communities. In addition, volunteering satisfied the prospects of fulfilling their career aspirations lost because of their subjection to gendered, racialised, and class oppression. Thirdly, themes highlighted how clients’ race, class, and gender impacted participants’ counselling experiences. Lastly, themes highlighted the psychological impact of counselling on participants and how helpful coping mechanisms developed from the survival of intersectional oppression and organisational training and support helped mitigate these psychological consequences. The provided understanding of participants’ experiences is essential for both praxis and policy within the area of VLC in South Africa.
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    A Phenotype Prediction Framework for Classifying Colorectal Cancer Patients’ Response to FOLFOX Treatment: An Integrated Approach
    (University of the Witwatersrand, Johannesburg, 2024) Mashatola, Lebohang; Kaur, Mandeep
    Colorectal cancer (CRC), characterised by its prevalence and heterogeneity, poses a significant challenge in understanding drug resistance, especially in the context of FOLFOX treatment. This study presents an innovative methodology that integrates diverse data analysis approaches to address the challenge of predicting the phenotype of CRC patients resistant or sensitive to FOLFOX. The initial analysis involved dierential and co-expression analyses, identifying pivotal hub genes crucial to drug resistance in CRC, regulating intricate molecular networks. Subsequent enrichment analysis revealed their significant roles in biological functions, particularly influencing DNA repair and nuclear division. To capture inherent topological characteristics within genetic expression data, a novel technique utilising topological data analysis (TDA) was employed. By applying persistence homology to generate persistence images, the Vietoris-Rips complex was constructed using the signed-topological overlap matrix, comprehensively capturing numerous topological features, including high-dimensional Betti-1 and Betti-2. This provided valuable insights into the structural patterns of gene expression between the hub genes. Furthermore, the integration of whole-slide images enhanced understanding of tissue anatomy, which is crucial for predicting cancer stages. Using a MobileNet architecture, a deep learning model classified cancer stages, contributing to a holistic understanding of colorectal tumor microenvironments. For predictive modelling of drug resistance, a multilayer perceptron applied topological summaries generated by TDA. The developed framework, GeTopology, exhibited remarkable performance metrics, achieving an overall 83% accuracy in predicting the FOLFOX response, demonstrating a 3% improvement over a previously published phenotype prediction framework (NSCLC ) that utilised similar data modes. Robust accuracies were consistently observed in independent datasets, classifying both cancer patients and healthy individuals. The results indicated an approximate 10% increase in model prediction accuracy compared to NSCLC, emphasising the potential clinical impact of this integrative approach. In conclusion, this study advances the understanding of drug resistance in CRC by proposing a novel approach that integrates topology with histopathological images, oering transformative insights into predictive modelling and precision medicine
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    A Philosophical Examination of Thomas Szasz on Mental Illness as a Myth
    (University of the Witwatersrand, Johannesburg, 2024) Fenderico, Alex; Vice, Samantha
    The field of psychiatry has encountered substantial scrutiny pertaining to its diagnostic and therapeutic modalities since the inception of the antipsychiatry movement in the 1960s. A prominent figure within this movement was Thomas Szasz, a Hungarian-American psychiatrist whose influence looms large. Szasz, inspired by the ideas of Michel Foucault, posited that psychiatry functions as a ‘locus of control’ designed to subjugate and pacify societal masses into compliance. His seminal work, "The Myth of Mental Illness," expressed the argument that the medicalisation of mental illness is inherently problematic, constituting a category error of profound significance and resulting in harmful stigmatisation. Szasz advocated for the extrication of mental illness, or as he preferred, 'problems in living,' from the view of the medical domain. Instead, he proposed a paradigm shift towards addressing these issues through social frameworks, particularly emphasizing psychotherapy or counselling as opposed to reliance on psychiatric medications. Szasz's perspectives yielded both enthusiastic support and strong criticism, and contemporary theorists, such as Gabor Maté, persist in echoing his sentiments to this day. The objective of this report is to critically examine Szasz's theoretical position, as well as to present a concerted effort to substantiate its enduring relevance in the current intellectual milieu.
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    A retrospective audit of computed tomography angiography in penetrating wound of lower limb at Chris Hani Baragwanath Academic Hospital
    (2024) Abid, Rabia
    INTRODUCTION: There is high rate of violence-related injuries in South Africa. These injuries include gunshot wounds, stab wounds and blunt force trauma. Many patients with penetrating wounds present in the emergency department with vascular injuries. Penetrating wounds of lower limbs with or without arterial injuries are managed according to trauma protocols. Patients presenting hard signs vascular injury are transferred to theatre for immediate exploration and repair. Patients with soft signs are clinically examined and, if indicated, imaging is planned. Clinical examination is crucial in diagnosing arterial injuries in penetrating limb injuries and AnkleBrachial index (ABI) is an important parameter to rule out arterial injuries. Doppler ultrasound is a good, non-invasive imaging modality but is operator dependent. Computed Tomography Angiography (CTA) has excellent outcomes in diagnosing arterial injuries in penetrating wounds of lower limb, with a sensitivity and a specificity close to 100%. CTA is a non-invasive, rapid, and reliable modality, but subjects the patient to radiation exposure. This study aimed to determine the prevalence and type of vascular injuries in penetrating injuries of lower limb in on South African academic hospital. METHOD: A retrospective audit of CTAs done for penetrating wounds of lower limbs to rule out vascular injuries at Chris Hani Baragwanath Academic Hospital (CHBAH) was executed. Data of CTAs performed from January 2017 to December 2018 were retrieved from the imaging PACS of the CHBAH radiology department. Ethics approval was obtained from HREC of the University of Witwatersrand, and data was captured from the relevant records. RESULTS: Descriptive statistics were used to describe the characteristics of the population, in the form graphs and figures. Data of 91 CTAs were collected. The average age of subjects was 32.2 years, and 83 of the cohort were males. The most common mechanism of injury was a gunshot wound. Only one case out of 91 of the collected CTAs was positive for arterial injury. CONCLUSIONS: Low rate of positive CTA studies over span of a 2-year period emphasizes the need for thorough examination for the suitability of a CTA. This approach avoids unnecessary radiation exposure to the patients and is cost effective. In low-risk patients, doppler ultrasound should be considered for imaging of potential arterial injuries and has no radiation exposure. The use of lower threshold value of ABI is an option for patients presenting with soft signs of arterial injuries. Revising the management protocol for penetrating injuries of lower limb used by trauma surgeons at CHBAH for requesting CTAs will be cost effective by avoiding unnecessary imaging.
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    A retrospective audit of the cytogenetic profile and management outcome in Acute Myeloid Leukemia patients treated at Charlotte Maxeke Johannesburg Academic Hospital (2017 - 2021)
    (University of the Witwatersrand, Johannesburg, 2022) Mpanza, Mbongi V.; Ruff, P.
    Acute Myeloid Leukemia (AML) is a highly heterogenous blood cancer that affects the non- lymphoid lineage. It is a most common acute leukemia in adults. The worldwide incidence is relatively low with inordinately high cancer mortality. The recent advances done by on-going research has elevated our understanding of cytogenetic and abnormalities associated with AML. This understanding further aids in stratifying AML patients into favourable, intermediate, and poor prognosis groups. However, despite these insights into disease, patient outcome often remains poor. In this review, we discuss findings in AML at CMJAH, with particular focus into cytogenetic profile and molecular gene mutations. These recurrent genetic alterations provide novel insights into the pathogenesis, clinical characteristics, and outcome of these patients. These alterations play a major role in prognosticating the outcome in AML and are also important in developing novel therapies. The most common type of AML, called de novo AML, occurs sporadically with no prior history of underlying myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN) or exposure to potentially leukaemogenic therapies or agents. The less common is secondary AML which has poorer prognosis and is define as any leukemic process which may arise from previous haematological disorder like MDS, NPM or can be a result of prior cytotoxic chemotherapy or radiation therapy (t-AML).T-AML is defined as AML that develops from prior cytotoxic drugs, radiation or immunosuppressive agents which was given for unrelated illness. T-AML accounts for 7%-8% of all AML and is known to have a dismal outcome with an adverse cytogenetic and molecular profile. To our current knowledge there is no local study that has previously analysed t-AML in detail hence this study may provide such critical data.