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Item A comparison between bone grafting and non-grafting of immediately placed implants in the molar area(2024) Van der Linden, Wynand JohanAim: 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.Item A comparison of early onset pre-eclampsia and late onset preeclampsia(2024) Joomratee, J.Background: Early onset pre-eclampsia (EOPE) occurs before 34 weeks while late onset preeclampsia (LOPE) occurs after 34 weeks. The maternal and neonatal outcomes has are different with EOPE having a higher frequency of maternal and neonatal complications. Objectives To compare the clinical presentations, laboratory parameters, maternal and neonatal outcomes in women with EOPE and LOPE. Methods: This was a cross sectional prospective record review. Convenient sampling was performed every fifth day and recruited preeclamptic women that delivered at Chris Hani Baragwanath Academic Hospital (CHBAH) and Rahima Moosa Mother and Child Hospital (RMMCH). Descriptive statistics were employed. Results: There were 104 women of which 64 (61.5%) had EOPE and 40( 38.5%) had LOPE. A higher frequency of Posterior Reversible Encephalopathy Syndrome (P=0.040), blurred vision (P=0.009), headache (P= <0.001) eclampsia (P=0.011) and HELLP syndrome (0.004) was observed in EOPE. The number of still births (P<0.001), neonates with an APGAR of less than 7 at 5 minutes (p=0.001), and neonatal admissions (P= <0.001) were higher in EOPE. There was no difference in the outcome between the HIV positive and negative women Conclusion: With EOPE, end organs appear to be more severely affected than in LOPE. The HIV prevalence between the two groups was comparableItem A comparison of malignant histopathological diagnoses on uterine curettings and hysterectomy specimens(2024) Ismail, AbdullahBackground. 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.Item A comparison of percutaneous tracheostomy and of surgical tracheostomy in patients in the Neurosurgical ICU at Charlotte Maxeke Johannesburg Academic Hospital(2024) Marais, RuanIntroduction A tracheostomy is a surgically created opening in the anterior wall of the trachea through which a tube can be inserted. Egyptian hieroglyphic paintings that depict a tracheostomy procedure can be dated back to 3100 BC.1 Tracheostomy is a procedure that is commonly performed on Intensive Care Unit (ICU) patients and, with an increasing need for intensive care services, the number of patient referrals for tracheostomy will likely increase as well. Aim The purpose of this study was to compare various clinical characteristics of patients who received either a percutaneous tracheostomy (PT) or a surgical tracheostomy (ST) during their stay in the Neurosurgical Intensive Care Unit (NSICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Method A retrospective study of the records of all patients who underwent a tracheostomy procedure during their stay in NSICU at CMJAH between 1st January 2017 and 31st December 2020 was undertaken. Clinical information collected for all patients included age, gender, Glasgow Coma Score (GCS), Simplified Acute Physiology Score (SAPS II), duration of stay in NSICU before and after tracheostomy, duration of mechanical ventilation pre- and post-tracheostomy and in-NSICU actual mortality. Predicted mortality percentage for each patient was calculated from SAPS II. A Glasgow Outcome Score (GOS) was assigned to each patient on discharge from NSICU. Patients were allocated to one of two groups. Those who received PT were allocated to GroupPT while those who received ST were allocated to GroupST. The percentage case fatality risk for each tracheostomy group was calculated. Results Of the 66 patients who underwent a tracheostomy procedure during the study period, 19 patients (28.8%) fell into GroupPT. The remaining 47 patients (71.2%) fell into GroupST. The median age of GroupPT was 28 years with lower and upper interquartile range (IQR) of 25 and 32 years, respectively. The median age of GroupST was 40 years (IQR 31, 54). This difference was statistically significant (p < 0.05). The median SAPS II score for Group PT was 41 (IQR 29, 47) and that of Group ST was 44 (IQR 30, 50). This difference was not significant. There were no differences in GCS, duration of stay in NSICU, number of days of mechanical ventilation pre- or post-tracheostomy procedure, actual mortality or GOS between the two groups. Conclusion In this group of 66 patients ST was the commoner of the two procedures performed. Even so, the findings of this study suggest that PT is a suitable procedure that may be performed safely on patients in the NSICU.Item A comparison of the warming capabilities of two Baragwanath Rewarming Appliances with the Hotline® fluid warming device(2024) Wilson, KyleBackground: 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.Item 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 changeItem A retrospective audit of computed tomography angiography in penetrating wound of lower limb at Chris Hani Baragwanath Academic Hospital(2024) Abid, RabiaINTRODUCTION: 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.Item A study to determine the causes of death in neonates weighing <1500g at Kleksdorp Hospital(2024) Mwala, NalisheboBackground: The continuing challenge of neonatal mortality in very low birth weight (VLBW) neonates in South African hospitals highlights the need to better understand the causes of these deaths as well as their associated modifiable factors. Objectives 1. Determine the causes of death and factors that contribute to death in VLBW neonates at Klerksdorp Hospital (KH) 2. Determine key modifiable factors to improve the survival of VLBW neonates at KH. Methods: Retrospective, descriptive study based on the review of 183 patient records (100 who survived and 83 who died) between January 2015 to December 2016. The study population is from the neonatal unit at a secondary hospital in the North-west province of South Africa. The unit consists of eight beds with ventilatory support. Fifty-five Perinatal Problem Identification Program (PPIP) forms were audited to determine causes of death and associated modifiable factors. Logistic regression analysis was used to determine predictors of death. Results: The most common causes of death were 1) sepsis (24%), 2) extreme multiorgan immaturity (20%) and with the most vulnerable neonates born between 26 and 32weeks’ gestation. An increase in birthweight is shown to incur protection against death (OR 0.993, CI 0.989-0.996, p = 0.000). Key predictors of death are metabolic acidosis during the course of their NICU admission (OR 17.785, CI 4.711-67.145, p = 0.000) and hypotension-requiring-inotropes (OR 26.074, CI 5.403-125.827, p = 0.000) secondary to septic shock. Critical modifiable factors include preventing nosocomial sepsis (18%), timely initiation of antenatal care (12%) and improving timeous health seeking behaviour (10%), administration of antenatal steroids (6%) and availability of adequately trained medical personnel (6%). Conclusion: Sepsis is the leading cause of death in very low birth weight neonates. Its complications in the form of metabolic acidosis and septic shock requiring inotropic support are key predictors 2 of 2 of death. Seventy seven percent the deaths occurred in the first week of life, highlighting a vital window for intervention. Key modifiable factors pertain to medical and patient factors. Barriers that may preclude this lie in the poor socio-economic setting of the population that is mostly peri urban with constrained resources.Item A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology(2024) Watermeyer, Benjamin DavidSouth Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.Item A survey of postdural puncture headache management practices within an academic department(2024) Monteith, KathrynBackground: Postdural puncture headache (PDPH) is a common consequence of neuraxial anaesthesia, especially among parturients, in whom it is associated with maternal morbidity, prolonged hospital stay, and increased healthcare costs. Although international guidelines for PDPH management are available, variable management practices exist. There are no published studies which document current practices, nor guidelines available, with respect to PDPH management in South Africa. This study aims to describe PDPH management practices within the Wits Department of Anaesthesiology, which may assist in future local guideline or protocol development. Methods: An electronic questionnaire was distributed to the Wits Department of Anaesthesiology. The survey instrument was developed following a literature review targeting recent evidence based PDPH management guidelines, including the Obstetric Anaesthetists Association (OAA) guidelines from 2018, after which it was reviewed for content and face validity. Data were downloaded, analysed, and presented with the aid of statistical software. Participant responses were then compared to the OAA guidelines, which were considered the standard of practice. A score relating to this was determined and compared to demographic variables to assess for possible correlations. Results: Participants’ practice with respect to conservative management strategies and the performance of EDBPs was in keeping with the OAA guidelines, despite evidence of limited provider experience with performing these procedures, as well as the lack of available departmental guidelines. Ninety six percent of anaesthetists perceived they would benefit from the institution of formal guidelines. Conclusions: Management practices for the treatment of PDPH among anaesthetists within the Wits circuit are variable, but generally consistent with current international guidelines, however, limited experience in treating PDPH has been demonstrated. The development, and institution, of formal guidelines to assist in the management of PDPH is recommended, as well as continuous medical education of staff, to ensure good patient outcomes.Item A survey of the professional quality of life of pharmacists and rehabilitation therapists at three public sector hospitals in Gauteng, South Africa(2024) Moyo, NonkazimuloBackground- The global goal of Universal Health Coverage (UHC) cannot be achieved without a wellmotivated and productive health workforce. Central to their motivation and productivity is the notion of professional quality of life (ProQOL) that captures both the positive and negative emotions of caring work. However, there is a dearth of empirical studies on the ProQOL of pharmacists and rehabilitation therapists, especially in an African setting. Study aim -The aim of the study was to examine the self-reported ProQOL of pharmacists and rehabilitation therapists at three public sector hospitals in the Gauteng Province of South Africa. Methodology- During 2021, a cross-sectional analytical study was conducted at three public sector hospitals in the Gauteng Province of South Africa. Following informed consent, all eligible pharmacists, pharmacist assistants, occupational therapists, physiotherapists and speech therapists and audiologists completed a self-administered questionnaire electronically. In addition to sociodemographic information, the questionnaire obtained information on compassion satisfaction, burnout, and secondary traumatic stress using the ProQOL scale (version 5) and work-related experiences during the COVID-19 pandemic. STATA® 17 was used for descriptive and multivariate analysis of the survey data. Results- A total of 118 pharmacists and rehabilitation therapists completed the survey. The majority were female (83.00%), single (63.46%), with mean age 30.77 years (SD=9.08). The results revealed moderate mean scores for compassion satisfaction (39.62; SD=5.48), burnout (24.26; SD=5.12) and secondary traumatic stress (23.03; SD=6.31). The predictors of compassion satisfaction were moderate positive COVID-19 experiences score (β=+2.61;95% CI 0.54; 4.68; p=0.014) and high positive COVID-19 experiences score (β =+ 2.68; 95%CI 0.40; 4.96; p=0.021); moderate overall job satisfaction score (β =+ 3.17; 95% CI 0.16; 6.18; p=0.039) and high overall job satisfaction score (β =+ 7.26; 95% CI 4.06; 10.47; p<0.001). The predictors of burnout were being single (β=+2.02 95% CI 0.07; 3.97; p=0.042), full professional registration (β=+4.23; 95% CI 1.79; 6.67; p=0.001), direct involvement in patient care (β=+3.24; 95% CI 0.22; 6.26; p=0.036) and reporting a heavy workload (β=+ 2.61; 95% CI 0.75; 4.48; p=0.007). The predictors of secondary traumatic stress were being male (β=+ 3.26; 95% CI 0.36; 6.15; p=0.028), and full registration (β=+ 5.72; 95% CI 2.41; 9.03; p<0.001). Conclusion- The ProQOL of pharmacists and rehabilitation therapists is influenced by a combination of individual, workplace, and health system factors, suggesting the need for a multifaceted approach to optimise their contribution to the achievement of UHC. Such approach should include provincial health, hospital management, and peer support as well as self-care activities.Item A tale of two sites: an audit of central nervous system metastases in two Johannesburg tertiary centres(2024) Molefe, MasechabaBackground: Literature reports the most common neoplasms of the CNS as metastases. Most studies are from the US and Europe with a paucity of data in the African setting. Objective: To provide information among patients with histologically confirmed CNS metastases treated at the neurosurgical units of the University of the Witwatersrand, namely at CHBAH and CMJAH. Methods: A retrospective record review of patients with histologically confirmed CNS metastases, presenting between 01 January 2015 and 31 December 2019 was conducted. The following data were collected and analysed: demographic, clinical, radiological and histopathological data. Results: 88 patients were included in the study. The frequencies of brain and spine metastases were 13% and 48% respectively compared to all other operated primary tumours. More females were prevalent at 51.7% in the brain metastases cohort, while males were more prevalent in the spine metastases cohort at 57.1%. In brain metastases patients the median age at presentation was 49 and for those with spine metastases the mean age was 47.1. The distribution for brain metastases was: 65% supratentorially; 20% infratentorially; 15% mixed. The distribution for spine metastases was: thoracic 32.1%; lumbosacral 28.5%; cervical 14.3%, mixed 25%. The most prevalent histopathologies for brain metastases were: lung 21.7%; breast 11.7%; melanoma 11.7%. The most prevalent histopathologies for spine metastases were lymphoma and plasma cell neoplasms each comprising 21.4%. Conclusion: More females presented with brain metastases and predominantly more males had spine metastases. There was a younger age of presentation compared to most studies conducted in Africa and globallyItem Activity and time spend patterns of residents in low-income settlements in the City of Johannesburg, South Africa(2024) Bhuda, Hope Prudence BoipeloBackground: Human health risk assessment is concern about estimating the population exposure (HHRA) for environmental pollutants or contaminants. Exposure assessment for population-level require time-activity pattern distributions in association to microenvironments where individuals reside and spend their time. Time-activity patterns in South Africa have not been adequately explored, which may lead to wrong dose estimation for health risk assessment. No in-depth and systematic analyses of time-activity patterns in low-income communities have been done to date in South African context. Aim: The aim of this study was to describe variations on time-activity patterns based on age, sex and socioeconomic status amongst residents of low-income communities in South African township (Matholesville informal settlement). Methodology: A cross-sectional study design was adopted to assess time-activity patterns amongst lowincome residents in South African townships. One Hundred and Thirty (130) households were selected randomly to participate in the study. A questionnaire survey comprising of key questions including demographics, type of household, type of activities conducting indoor, time spent on activities indoor and outdoor in a microenvironment, preferred season of the year and mode of transport commuting to different areas was administered to the study participants. In addition, diaries were used to get information on daily activity time pattern for seven (7) days. Completion of questionnaire were based on interviews with the study participants while diaries were self-administered by the participants daily over seven days. Results In this study, a total of 130 participants aged 18-35 and 36-75 years were included. Approximately 33% and 67% of the respondents were < 35 years and >35 years, respectively. This suggests that most of the households are headed by adults outside the youth age category. About 30 houses were found to be erected using bricks while 100 houses were made of corrugated iron. About 75%, 14%, 8% and 2% of the study respondents were found to fall into the following race, black, coloured, Indian and white. Approximately (83% brick, 71% shacks) of the study respondents attained secondary education the remainder of the respondents attained primary education. The most performed activities inside brick type dwellings are sleeping (100%), cooking (77%), cleaning (70%) and watching television (TV) (60%). While most performed activities indoors for shack dwellings are cleaning (87%), cooking (70%), sleeping (68%) and TV (37%). There is a high prevalence of none employed household heads at 53% for the brick dwelling and 63% for the shack dwellers. The average monthly income was found to be R4 304 and R3 650, for brick and shack type dwellings, respectively. Females were found to perform a larger proportion of indoor household activities than males. A total of 36% was spend on cooking and cleaning followed by 29% of the time watching TV in the brick type dwellings. For the brick dwellers spend 67% indoors and 33% outdoor while for the shack dwellers about 31% of the time is spend indoor. Conclusion: The study had hypothesised that females above 18 years old residing in low-income communities are likely to spend most of their time at home carrying out domestic duties compared to their male counterparts, who are expected to spend most of the time outside the residential spaces. Therefore, the hypothesis for this study is partially confirmed, meaning that women spend most of their time indoor performing household chores than males. It was also found that the time spent indoor is relatively lower than what is globally reported as known to be >80% of the time, people are said to be indoors. This implies that the variation on the socio-economic status and sub-population including country’s dynamic might be the biggest influencer of time-activity pattern. Data obtained from this study can be used to account variability in human health risk assessments and reduce uncertainty in the derived exposure dosage where time spent pattern is considered an important variable. Recommendations: ✓ Future studies may be carried out covering a larger population density to gain more detailed time activity patterns. ✓ This study focused on a low-income settlement which has different characteristics to semi-formal, rural, high tax yield settlements in South Africa. Therefore, a larger study focusing on different socio-economic classes need to be carried out to have a comprehensive time activity pattern dataset for South African population. ✓ The current project focused only on adult age group without considering vulnerable groups (toddlers, and elderly person) time activity pattern. An additional study focusing on children time activity pattern is required in order to gain an understanding on what activities children spend most time.Item Adequacy of availability of antidotes for common and critical drug poisonings and doctors’ perspectives thereof: a study in teaching hospitals in the Southern Gauteng City-Region(2024) Fitchett, Margaret PenelopeBackground: Drug poisoning is an important area of study in South Africa (SA) as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in SA. Objectives: To assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. Methods: A data sheet assessing the availability of antidotes in the Emergency Departments (EDs) and pharmacies was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Results: N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol and pyridoxine were present in all EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate or pyridoxine (85.7%, 83.3%, 87.3% and 75.4% of 126 respondents respectively). Conclusion: The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply which will be an important avenue for further research.Item Admission hypothermia in very low birth weight newborns at Charlotte Maxeke Johannesburg Academic Hospital(2024) Mauree, Angidi PillayBackground: Hypothermia is associated with increased morbidity and mortality rates. Very low birth weight (VLBW) newborns are at an increased risk of hypothermia especially within the first few hours after delivery. Objectives: To determine the prevalence, associated risk factors, and outcomes of admission hypothermia in VLBW newborns, at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a quaternary hospital in Johannesburg, South Africa. Methods: This was a retrospective descriptive study of all VLBW newborns born over a seven year period (from 1st January 2013 to 31st December 2019) at CMJAH. Comparisons between hypothermic and normothermic newborns as well as between moderately-to-severely hypothermic and mildly hypothermic newborns were done. Multivariate binary logistic regression with 95% confidence interval and a p-value of < 0.05 was used to identify variables which had a significant association. Results: Mean gestational age and birthweight of enrolled newborns was 28.9 ± 2.7 weeks and 1097 ± 250 g respectively. Prevalence of admission hypothermia was 61.5 % of which 54.3% was mild hypothermia, 43.9 % was moderate hypothermia and 1.8 % was severe hypothermia. VLBW newborns with hypothermia were more likely to have a birthweight < 1000 g [aOR 1.37 (1.12-1.68)] and less likely to be associated with early onset sepsis [aOR 0.51 (0.30-0.88)]. VLBW newborns with moderate to severe hypothermia were less likely than those with mild hypothermia to have received antenatal steroids [aOR 0.66 (0.48-0.89)]. There was no significant association of mortality in either VLBW newborns with hypothermia as compared to those with normothermia [aOR 0.95 (0.76-1.19), p value 0.67] or in VLBW newborns with moderate to severe hypothermia as compared to those with mild hypothermia [aOR 0.76 (0.46- 1.26), p value 0.29]. Conclusions: Prevalence of admission hypothermia in VLBW newborns is high and reinforces the need for thermoprotective measures in this population.Item An assessment of developmental anomalies in the thoraco-lumbosacral region of South Africans(2024) Nchabeleng, Elsie KoketsoDevelopmental anomalies, typically caused by epigenetic interactions, are very common in the human vertebral column. Many studies have been conducted to assess their prevalence in different populations. Several studies have shown differences in the prevalence and expression of vertebral anomalies among populations and between the sexes. These differences may be related to different geographical areas and the environmental conditions posed by these, socioeconomic status, diets, lifestyles and/or gender roles, to name a few. Therefore, this study aimed at assessing the prevalence and pattern of six developmental anomalies in the thoracolumbosacral regions and their possible associations with vertebral pathologies in South Africans. The study comprised skeletal remains of 902 individuals. The remains were procured from the Raymond A. Dart Collection of Modern Human Skeletons, the Pretoria Bone Collection and the Kirsten Bone Collection. The sample included South African Blacks (SAB) (n=325), South African Coloureds (SAC) (n=286) and South African Whites (SAW) (n=291). The most common vertebral developmental anomaly observed in this study was sacralisation (5.7%), followed by spina bifida occulta (4.5%), spondylolysis (4.5%), L6 (3.1%), and T13 (2.2%). The lowest prevalence was seen for lumbarisation at 1.9%. Overall, developmental anomalies were most prevalent in the SAB sample compared to the SAC or SAW. These anomalies were generally more prevalent in males of the total sample and within the three populations groups of the study. The high prevalence of most developmental anomalies in the SAB sample may be mostly related to the low socio-economic status associated with Black South Africans under the apartheid era. The presence of multiple anomalies was more prevalent in Blacks (44.4%). Blacks also had a higher prevalence for multiple anomalies accompanied by some form of spinal pathology (50%). Whites, on the other hand, had a higher prevalence of a single developmental anomaly accompanied by some form of spinal pathology (50%). In general, males were more prone to developing multiple anomalies accompanied by some form of spinal pathology. There was substantial variation observed with regards to the presentation of the six developmental anomalies in and between the samples under study. Therefore, inter- and intrapopulation differences, as well as sex differences, should be considered when dealing with the above developmental anomalies in biological anthropological and clinical settingItem An audit of cancellation of elective surgery in paediatric patients at Chris Hani Baragwanath Academic Hospital(2024) Gamede, NomdumisoBackground: Cancellation of elective surgery is one of the quality indicators of theatre operation worldwide. The cancellation of elective surgery in paediatric patients is a world-wide problem with the rates ranging from 0.21% to 44%. This study aimed to determine the rates and describe the reasons for cancellation of elective surgeries in paediatric patients at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: A retrospective study was conducted using theatre records from 01 January to 31 December 2019. The numbers and reasons for elective paediatric surgeries were reviewed. Data was collected using structured collection sheet and entered into Microsoft excel. Statistical Package for Social Sciences was also used to further analyse the data. Results were expressed as percentages in a graph and table forms. Results: In the year 2019, a total of 3399 elective paediatric procedures were scheduled in fourteen specialties at CHBAH. Of these, 634 (19%) were cancelled due to various reasons. The highest number of cases cancelled were from paediatric surgery and neonates (n=204, 31%), followed by ENT (n=99, 24%), burns (n=80, 20%) and paediatric orthopaedics (n=79, 16%). The lowest number of cancelled cases came from urology (n=3, 17%) and hands (n=3, 3%). The commonest reason for cancellation of elective surgery in paediatric patients at CHBAH was found to be time constraint (34%) followed by patients not arriving for surgery (16%). The reasons for cancellation in our study were mostly due to avoidable factors at 68% and non-avoidable at 32%. Conclusion: The rate of cancellation in our study was high but comparable to other African and South African studies. Majority of the causes for cancellation were avoidable.Item An audit of children with Type 1 diabetes mellitus presenting to a tertiary institution in Johannesburg, South Africa(2024) Gray, MeghannAt initial diagnosis, the rate of diabetes ketoacidosis (DKA) varies between countries (15- 67%) and may be associated with a lack of awareness of early signs and symptoms. Objectives: To describe the demographic, anthropometric, clinical and biochemical characteristics of children presenting with Type 1 diabetes mellitus (DM). Methods: A retrospective review of Type 1 DM children's medical records admitted to CHBAH from 01 January 2009 to 31 December 2018 was conducted. This ten-year period was further subdivided into two groups (Group 1: 2009-2013 (n = 75); Group 2: 2014-2018 (n=78)) to assess annual follow-up visit data in Group 1 for five years per patient and to compare data between the Group 1 and 2 time periods. Statistical differences between groups were analyzed by Mann-Whitney U test or Student t-tests, and for between the years of follow-up (Group 1), the paired student t-test was used. Results: The total number of newly diagnosed Type 1 DM children was 153. The median age at presentation was 10.5 years (IQR 7.4-12.3), 56% females and 88% black. The mean WAZ and HAZ were -0.8 (SD ± 1.5) and -0.4 (SD ± 1.6) respectively. Sixty-five percent (n = 100) presented in DKA, 56% of those being severe with a higher prevalence of DKA in group 2 compared to group 1 (72% vs 59%; p=0.08). At presentation, the median HbA1c was 12.5% (IQR 11.1-14.3) and C-peptide was 0.2ug/L (IQR 0.1-0.4) (normal range 1.1-1.4). Anti-GAD antibodies were positive in 82% (n=82/101) of the results available. In Group 1, HbA1c increased at year 3 follow up with advancing pubertal status. Despite changing to more intensive insulin therapy, mean HbA1c remained unchanged over the 5 years of follow-up. Conclusion: The majority of newly diagnosed children presented in severe DKA, similar to Red Cross War Memorial Children's Hospital (2005-2009), with an increasing prevalence over the ten vii years, which could be attributed to the lack of awareness of Type 1 DM in our population. An education campaign is needed to improve community knowledge about diabetes.Item An audit of clinically triaged women at low risk for breast cancer presenting to the Helen Joseph Mammography Unit, Johannesburg(2024) Naidu, Lavandhra R.BACKGROUND: The Helen Joseph Hospital (HJH) Breast Clinic utilises a clinical triage system to stratify patients based on their risk of breast cancer into high, medium, or low risk profiles. This allows for timeous imaging and subsequent management of those patients at increased risk for breast cancer. OBJECTIVES: The primary objective was to determine the cancer detection rate (CDR). The secondary objective was to correlate biopsy results with the Breast Imaging – Reporting and Data System (BI-RADS) risk-assessment. METHODS: A retrospective audit of the patients at low risk for breast cancer who were referred to the Breast Imaging Unit (BIU) in 2019 at HJH. Patients were clinically assessed as low risk based on a triage form (Figure 4) and were identified using the imaging files stored in the BIU. Results were recorded on Microsoft Excel and calculated as per the American College of Radiology guidelines. RESULTS: The total population sample consisted of 398 patients. Two patients were characterised as BI-RADS 4 and underwent breast biopsies. One patient was diagnosed with histologically proven breast cancer. The CDR was 2.51% and the most representative age group was the 60 to 69 years one. The most common BI-RADS breast density assessment was group B while the most common BI-RADS risk assessment was category 2. CONCLUSION: Amongst the low-risk population, both the CDR and spectrum of disease was comparable that of a screening population. This may be due to the use of a triage system prior to imaging, as well as an increase in clinical awareness of breast cancer within a tertiary institution.Item An audit of patients presenting with clinically benign breast disease to the Helen Joseph Hospital breast imaging unit(2021) Christofides, Nicholas ChristopherBackground: 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.