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Item Aesthetics and resistance: aspects of Mongane Wally Serote's poetry.(1990) Frielick, Frielick StanleyThe literature produced by writers who align themselves with national liberation and resistance movements presents a serious challenge to dominant standards of literary . aesthetics. Resistance writing aims to break down the assumed division between art and politics. and in this view literature becomes an arena of conflict and struggle. This dissertation examines certain aspects of the poetry of Mongane Wally Serote in order to explore the relationship between aesthetics and resistance in his writing. Over the last two decades, Serote has made a significant contribution to the development of South African literature, and his work has important implications for literary criticism in South Africa. Chapter 1 looks at some of these implications by discussing the concept of resistance literature and the main issues arising from the debates and polemics surrounding the work of Serote and other black political writers. Perhaps the most important here is the need to construct a critical approach to South African resistance literature that can come to terms with both its aesthetic qualities and political effects. This kind of approach would in some way attempt to integrate the seemingly incompatible critical practices of idealism and materialism. Accordingly, Chapter 2 is a materialist approach to aspects of Serote's early poetry. The critical model used is a simplified version of the interpretive schema set out by Fredric Jameson in The Political Unconscious. This model enables a discussion of the poetry in relation to ideology, and also suggests ways of examining the discursive strategies and symbolic processes in this particular phase of Serote's development. Serote's later work is 'characterised by the attempt to create a unifying mythology of resistance. Chapter 3 thus looks at Serote's long poems from an idealist perspective that is based on the principles of myth-criticism, As this is a complex area, this chapter merely sketches the main features of Serote' s use of myth as a form of resistance, and then suggests further avenues of exploration along these lines. The dissertation concludes by pointing towards some of the implications of recent political developments in South Africa for Serote and other resistance writers.Item Analysis and interpretation of Iron studies and Vitamin C levels in paediatric patients with chronic renal failure(2010-08-24) Lutz, Tracey LeighThis prospective observational study analysed iron studies and vitamin C levels in patients with chronic kidney disease attending Johannesburg Hospital Paediatric Nephrology Clinic. The rationale behind this study was to determine the extent of iron deficiency among patients in chronic renal failure. Vitamin C deficiency is common among dialysis patients, it is easy to test for and easy to prevent. This study may assist in guiding future management with regards to vitamin C supplementation in patients with chronic renal insufficiency on dialysis. The study contained 45 patients of which 27 (60 %) were male and 18 (40 %) were female. The ages of the children varied from 2 years 1 month to 19 years and 7 months. The study included patients from all ethnic groups; 9 were Caucasian, 33 African, 2 Indian and 1 Coloured. Two male patients did not have Vitamin C levels analyzed. The patients were divided into 3 distinct groups; firstly those patients on haemodialysis (12 patients), those on peritoneal dialysis (22 patients) and those not yet dialysed (11 patients). In all patients who were not yet on dialysis the GFR ranged between 18.1 and 45 ml/min/1.73m2. There were no statistically significant differences between the three groups when the results of the iron studies were analysed. However, despite iron treatment 26.6 % of patients were iron deficient as indicated by their transferrin saturation which was less than 20 %. Vitamin C levels were also analysed in this study. Forty one percent of children in chronic renal failure were vitamin C deficient. There was no statistically significant variability among the three groups. Two patients (4.6%) were noted to be Vitamin C toxic. One of these patients was haemodialysed; the other was not yet on dialysis. Vitamin C deficiency in chronic renal insufficient patients on dialysis is easily correctable when identified. Vitamin C in specific well documented doses is safe to administer to this group of patients. It will also enhance the absorption of iron and thereby have an indirect effect on anaemia.Item An analysis of coverage of gender-based violence, sourcing patterns and representation of victims in Sowetan, January-March 2008(2014-10-22) Ndlovu, SikhonzileDespite its pervasiveness, gender-based violence is one of the least talked about violations of women’s rights as most of it takes place within the private domain and is never reported (Gender Links 2002). Gender-based violence is mostly common at family and community level and mostly affects women (Omarjee, 2006). Family attitudes and pressures ensure that this remains hidden from the outside world (IPS, 2009). People Opposing Women Abuse (POWA South Africa) estimates that only one in nine gender-based violence incidences are reported. Violence against women continues partly because women do not seem to acknowledge violence perpetrated against them and are unlikely to seek help when it occurs (Rasool, 2002). The Noord taxi rank ‘miniskirt’ incident, as it came to be known, exposed the sad realities of gender-based violence in contemporary South Africa. In February 2008, a 25 year old woman was sexually harassed for wearing a miniskirt at the Noord Taxi Rank. This incident, described by Nyar (2008) as degrading and shocking, is part of the fabric of South African life. The way that media represents gender-based violence has a significant role to play in curbing this social ill. Sadly, media often emphasise the need for women to be extra vigilant when moving around at night. This in essence is saying that women should take responsibility for the fact that they may be attacked at any time (Gqola, 1997). This scrutiny is also reflected in the way that media have also questioned the morals of victims of gender-based violence especially rape (Carter and Weaver, 2003). This study analysed Sowetan’s daily media output for the months of January to March 2008 to establish patterns in coverage of gender-based violence, sourcing and representation of victims. Key words Gender, gender-based violence, victims, feminist theory, patriarchy, power, media, representation, sourcingItem An analysis of reasons for exclusion of potential live kidney donors(2009-03-23T07:34:50Z) Levy, Cecil StevenItem An argument for a paid and regulated living-unrelated kidney donation system in South Africa(2021) Ewing (Naude), Susan LesleyOne of the biggest challenges that global healthcare is experiencing is the shortage of kidney organ donors. Globally, the demand for organs is far greater than the supply and as a result, people who are on waiting lists will not get a chance to receive a kidney. Those who are waiting for transplants will require ongoing dialysis to survive (Nath & Fervenza, 2018). Dialysis is extremely costly and burdens the healthcare systems. Given the enormous gaps between supply and demand, this report seeks to answer the question: “Should South Africa follow the model of a paid and regulated living unrelated kidney donation system?” I begin with an analysis of South Africa’s current structure, the effects of this system and ultimately seeing the need for a different solution. I analyzed the various models globally in kidney donation, including the only country that allows for a paid system and the objections thereto. Currently, the sale of organs is prohibited in South Africa. My view is that our current South African model is lacking in solutions to the shortage of organ donors, particularly kidneys. There is a need for a better solution as the current system is failing to meet the needs of patients. In this paper, I use the principlism framework consisting of the four bioethical principles namely, autonomy, beneficence, non-maleficence and justice, to highlight the constitutional conflicts and the ethical dilemmas when considering a paid donation system. As I am arguing for a paid system in South Africa, I have included the ubuntu theory to show why objections to a paid and regulated system would fail. In conclusion, a paid and regulated living-unrelated kidney donation system is argued to be the most ethically and practically appropriate system in South Africa, to improve kidney donation rates and the livelihoods of the peopleItem Assessment of GFR in the evaluation of potential living kidney donors at the Wits Donald Dordon Medical Center (WDGMC) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH)(2018) Okuthe, Jacktone OdhiamboEquations that estimate GFR (eGFR) are widely used in clinical practice to estimate kidney function in sub-Saharan Africa, but have not been validated for use in this region. This study assessed the performance of eGFR equations in adults evaluated for suitability for live kidney donation against a gold standard radionuclear GFR measurement (mGFR) and determined their usefulness for screening live kidney donors in South Africa. This study was a retrospective record review of 350 adults evaluated for living kidney donation from 1996 – 2013 at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC). Their eGFR was calculated using CG, 4-v MDRD and CKD-EPI equations. Plasma clearance of 51Cr-EDTA was used as a reference method for mGFR. The 4-v MDRD (with and without ethnicity adjustment) and the CKD-EPI (without ethnicity adjustment) equations underestimated the mGFR (negative bias of -8 mL/min/1.73m2, -16 mL/min/-1.73m2 and -6.4 mL/min/1.73m2 respectively).However, the bias associated with the average mGFR using the CG and CKD-EPI (with ethnicity adjustment) equations was not significant (2.3 mL/min/1.73m2 and 0.6 respectively).Use of the ethnicity factor resulted in overestimation of mGFR for both the 4v-MDRD equation (by 24.2ml/min/1.73m2 compared to 6.8 ml/min/1.73m2 without it) and the CKD-EPI equation (by 21.8ml/min/1.73m2, compared to 7.6ml/min/1.73m2, without the ethnicity factor). In conclusion, this study showed that almost half of adults screened for living donation in Johannesburg were not eligible due to comorbid hypertension, diabetes and unexplained kidney disease. In addition, the error statistics worsened as mGFR increased and all four prediction equations had a low sensitivity for determining individuals with a GFR <80 ml/min/1.73m2. Based on the findings in this study, use of a gold standard measured GFR should be the preferred method for assessing kidney function in potential living kidney donors in South Africa.Item Attitudes and beliefs of patients with chronic kidney disease in the Rustenburg area, North west regarding kidney dysfunction(2016-02-10) Njoro, Mmampu MagdelineAim: The aim of this study was to investigate the attitudes and beliefs of patients with chronic kidney disease regarding kidney dysfunction in the Rustenburg area. Background: Kidney disease is still regarded as a low risk disease in Rustenburg, particularly among the rural community with low literacy level. Some of the people believe that chronic kidney is caused by driving heavy duty vehicles and hard labour whilst some associate the symptoms of chronic kidney disease with cultural disease resulting from failure to undergo cultural practices after the death of spouse or life partner. Low awareness of kidney disease results in patients seeking traditional cure that may cause further deterioration of their kidney dysfunction and progress to end stage renal disease, and therefore need lifelong dialysis or kidney transplantation. Research Methods: An explorative, descriptive qualitative research method was chosen for this study. Participants were patients with chronic kidney disease attending haemodialysis treatment at a dialysis unit of a level II public sector hospital. This dialysis unit provides both acute and chronic haemodialysis treatment and peritoneal dialysis training, and has eight chronic and two acute haemodialysis machines. Individual, face-to-face, semi-structured interviews were conducted using an interview guide (Appendix A). Participants were conveniently sampled until point of saturation was reached, and nine participants constituted the sample. Inclusion criteria were 18 years old and above, men and women, on haemodialysis for more than six months and willing to be interviewed. Patients who did not attend haemodialysis on the day of the interviews were excluded from the study. The interviews were audio-taped, transcribed verbatim and analysed according to Tesch’s method of qualitative data analysis. Significance of the study: This study uncovered the attitudes and beliefs of patients with chronic kidney disease regarding kidney dysfunction. Uncovering their attitudes and beliefs has enlightened nephrology nurses on future renal care initiatives that may improve both patients and the community’s attitudes and beliefs regarding kidney disease. Findings: The study has shown that chronic kidney disease has a profound and devastating impact on the patient, his family and significant others. The study further revealed that traditional healing and cultural health is still widely practiced by most of the patients with chronic kidney disease particularly in the rural areas. There is poor awareness of kidney disease as well as risk factors associated with kidney disease among this community. Conclusion: This rural population was not knowledgeable about kidney disease nor the risk factors associated with this condition. Nephrology nurses should conduct kidney awareness campaigns in order to educate the patients and public about kidney disease order to correct their attitudes and beliefs towards chronic kidney disease.Item Audit of acute rejection in renal allografts(2020) Thomas, Riju MathewAcute graft rejection is acknowledged to have a negative impact on graft survival in renal transplantation. South Africa provides for limited renal transplantation amidst the increasing burden of chronic kidney disease in the local context. Despite this suboptimal provision and limited resources, amongst many other concerns, the role of acute graft rejection on graft survival has not been characterized in the context of South Africa, as well as the African continent. This study is an audit, characterising acute graft rejection diagnosed at the Charlotte Maxeke Johannesburg Academic Hospital over a ten-year period (2003-2012). The study revealed the incidence of acute rejection in renal transplants to be 34.5%, similar to that reported in international studies. The majority of acute rejections occurred within the first year of transplantation (53.8%), which was lower than that reported in other studies, with 40% of patients having recurrence of acute rejection. The main form of rejection diagnosed was acute cellular rejection (predominantly BANFF grades 1A and 1B), followed by Borderline acute cellular rejection, the combination of which comprised the majority (86.9%) of all rejections diagnosed. This population was found to be a male dominant and Black African dominant study group, in keeping with the racial distribution of the dialysis population of South Africa, commonly influenced by treatment-seeking behaviour. Cadaveric donor grafts were engrafted in 77.7% of this population and 77.8% of the population had less than 40% of HLA antigens in common with their donor. Delayed graft function was observed in 22.4% of recipients with a significant association with more severe acute graft rejection. Hypertension was the most dominant primary aetiology leading to chronic kidney disease of native kidneys in this population. Immunosuppressive regimen, including cyclosporin, mycophenolate mofetil and prednisone, was used in 80% of recipients, with 97.6% of recipients on mycophenolate mofetil and prednisone. The five-year survival of grafts developing acute rejection was 61.7%. Graft function deteriorated more dramatically amongst recipients who progressed to graft loss, with recovery of graft function observed to be more prominent amongst recipients with surviving grafts. This study adds to the literature on this topic, and also describes the characteristics and outcomes of this entity.Item Barriers to protection: gender-related persecution and asylum in South Africa(2009-10-12T12:24:42Z) Middleton, JulieAbstract In 1998, South Africa became the first country to explicitly state within its refugee law that genderrelated persecution is a binding basis for asylum, further distinguishing South Africa as a state with outstanding legal commitments to gender equality. Creating further visibility within the law, however, is only one step in the process. How the law is implemented determines its real worth and effectiveness. This study assesses the manner in which asylum decisions are made, particularly in cases of gendered harm, questioning readily accepted and essentialised notions of women and gender. It looks at how the South African asylum system defines legitimate refugees, and the interplay of fluid interpretations of gender, culture, violence and the political within these constructions. Through interviews with officials and asylum seekers, the study identifies trends in the refugee system, and interrogates the reliance on narrow understandings of the political and personal, as well as the nature of conflict and culture.Item Cardiovascular risk profile of kidney transplant recipients at the Charlotte Maxeke Johannesburg Academic Hospital.(2014-04-25) Muhammad, Aminu SakajikiINTRODUCTION Cardiovascular diseases (CVD) are more common in kidney transplant recipients (KTRs) than in the general population. The high incidence of CVD in the KTRs can be attributed to traditional risk factors, additional risk factors associated with graft dysfunction and those specifically related to transplantation. Carotid intima-media thickness (cIMT) is a proven surrogate of atherosclerosis; it correlates with vessel pathology and is precisely imaged using ultrasound technology. This study was aimed at determining the prevalence and predictors of cardiovascular risk among KTRs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to examine the relationship between cardiovascular risk factors and carotid intima media thickness. METHODS Patients aged 18 years and above who received a kidney transplant at the CMJAH between January 2005 and December 2009 were recruited. A questionnaire that captured cardiovascular risk factors was administered. Patients records were assessed for information on their post transplant follow up. All patients had echocardiography and carotid doppler done for measurement of intima-media thickness. The Framingham Risk Score was used to categorize patients into low, moderate, high risk and very high risk groups. Results were analyzed using statistical package for social sciences (SPSS) version 17, p value of 0.05 was considered significant. RESULTS One hundred (KTRs) 63 male (63%) and 37 female (37%) were recruited ranging in age from 19 to 70 years, with a mean age of 42.2 ± 12.42. Thirty six patients (36%) were found to have high cardiovascular risk. Multiple regression showed proteinuria (p = 0.022), higher cumulative steroid dosage (p = 0.028), elevated serum triglycerides (p = 0.04) and the presence of plaques in the carotid artery (p = 0.012) as predictors of higher cardiovascular risk.Carotid intima-media thickness correlates with higher CVD risk. Fourteen patients (14%) had a carotid artery plaque. Twenty five patients (25%) had cIMT of >0.7 mm. CONCLUSION Kidney transplant recipients in CMJAH were found to have high cardiovascular risk (36%) and carotid intima-media thickness correlates with this high CVD risk. Routine follow up of KTRs should include measurement of cIMT as it provides a simple non-invasive assessment of subclinical atherosclerosis.Item Challenges faced by Gauteng nephrology nurses regarding implementing evidence based practice(2020) Dube, Elizabeth LeratoIntroduction: Evidence-based practice is an expected core competence of all health care clinicians regardless of discipline. Melnyk and Fineout-Overholt (2014) noted that although there is an explosion of scientific evidence available to guide clinical practice, the implementation of evidence-based care by health professionals is typically not the norm in many healthcare systems across the globe. The researcher undertook this study to gain an understanding of what is preventing the nurses from implementing EBP in the nephrology nursing departments in Gauteng. Purpose of the study was to describe challenges related to EBP implementation that were faced by nephrology nurses in clinical practice and to describe the recommendations that will assist them to successfully implement. Methods. This study followed a qualitative, exploratory, descriptive and contextual approach and was conducted in nephrology units in Gauteng Province. The population of this study included trained nephrology nurses registered with the South African Nursing Council (SANC) and meeting the eligibility criteria. Data was collected from three phases and analysed using Hsieh and Shannon (2005) conventional data analysis method. Results: Sixteen sub categories emerged which were condensed to three categories of Management Practices, Perceived organizational support and leadership practices and Training and Development. Results included studies recommending the middle manager to be the link between nurses at the operational level and top management, who can successfully drive EBP and assist in alleviating experienced challenges. Recommendations were describedItem Changes in how English FAL learners appreciate poetry when indigenous poetry is brought into the classroom: a practitioner case study of grade 11 learners in Gauteng(2019) Mavhiza, GraceA vigorous poetry tradition has existed throughout South African history. It represents in many ways a truly original contribution to the literature in the English first additional language (FAL) classroom. The benefits of poetry in enhancing intellectual, emotional social and linguistic development in learners are well documented. Surprisingly, there is a negative attitude towards poetry by learners and teachers as they prefer other literary genres particularly in a secondary school where this research was carried out. I have realised that the oral traditional poetry which is an African form of poetry practice is largely absent in the classroom today. Through a practitioner case study, this research sought to elicit the Grade 11 learners’ changes in appreciation of classroom poetry when indigenous poetry is brought into the English FAL classroom. This study presents previous research regarding perceptions accorded to classroom poetry. This is a qualitative study in which data gathered through questionnaires, face-to-face interviews, poetry texts analysis and reflective writing was presented to answer the primary question; what could be the changes in the appreciation of classroom poetry if indigenous poetry is brought into the classroom? The findings show that learners of English FAL do not appreciate classroom poetry due to the reasons that; classroom poetry is distant from the learners‘ life experiences making them struggle to interpret the poetry prescribed for them. Learners also said that classroom poetry is boring and this is due to the teaching methods employed in the classroom which are book centred and assessment driven. However, this study concluded through the intervention that encouraging learners to respond to poetry by presenting poems in a range of modes is more likely to boost their interest than focusing on the “traditional” line by line analysis of poems. The other important finding is that if indigenous poetry is brought into the classroom, learners’ attitudes towards classroom poetry will positively changeItem Combined paediatric liver-kidney transplantation: analysis of our experience(2014-08-27) Strobele, BerndBackground. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.Item 'Credible' child perpetrators: A critical discourse analysis of South African juvenile murderers(2019) Masuku, KwaneleConstructions of violence constrain women and children to victims and men to perpetrators, and imply that children are, at all times pure, innocent and, vulnerable. As such, child perpetrated crimes contradict these normative constructions, thus rendering child perpetrators inconceivable. The aim of this research was thus to identify resistance discourse that oppose these normative constructions of violence. This was achieved by interviewing incarcerated juvenile-offenders from juvenile correctional centres in South Africa. After the interviews were transcribed, the transcripts were subjected to Parker’s (1992, 2004) critical discourse analysis. The findings illustrate how normative constructions of childhood and violence render child perpetrators inconceivable. Additionally, the analysis surfaced resistance discourse which challenge normative constructions of childhood and violence, and provide counter-knowledge on violence and crime within South Africa.Item A cross-sectional observational study of the vitamin D status in children with chronic kidney disease at Charlotte Maxeke Johannesburg academic hospital(2016-11-04) Raga, Shirika VIntroduction Vitamin D has numerous important functions in the human body. There is limited data available regarding vitamin D status in children with Chronic Kidney Disease (CKD) in South Africa. Objectives To determine the vitamin D status, as well as factors that affect it, in children with CKD in Johannesburg, South Africa. Methods A cross-sectional observational study was performed on 69 patients who attended the Renal Outpatient Clinic, and required routine phlebotomy, at Charlotte Maxeke Johannesburg Academic Hospital, Division of Paediatric Nephrology, between 20/08/2013 and 20/05/2014. Results 71% (n=49) of patients in our study sample were vitamin D sufficient. Significant factors that influenced vitamin D status included albumin levels and the presence of Nephrotic syndrome with relapse. There was a statistically significant positive correlation between albumin and vitamin D (p=0.00). As albumin levels increased so did the vitamin D levels. Patients with Nephrotic Syndrome with relapse had significantly lower vitamin D levels compared to patients with Nephrotic Syndrome in remission (p=0.00). Conclusion The majority of children with Chronic Kidney Disease in Johannesburg, South Africa, are vitamin D sufficient. This is reassuring as it implies that there is no need for routine vitamin D supplementation in this sample of children. However patients, especially those with nephrotic syndrome with relapse, still need to be screened for vitamin D deficiency and insufficiency and supplemented if necessary.Item The demographic profile, substance use, competence to stand trial and criminal responsibility among “ Observation Patients” admitted for forensic psychiatric evaluation at Sterkfontein Hospital, Gauteng, South Africa.(2011-10-19) Pillay, AnbenA review of the literature indicates that young males, who are unemployed with low levels of education, predominate in populations of pre-trial criminal offenders suspected of having a psychiatric illness, also known as “Observation Patients” according to the Criminal Procedures Act of 1977 in South Africa. Other contributory factors include a history of mental illness and non-compliance on psychiatric medication, a previous forensic history, co-morbid substance abuse and being intoxicated at the time of the offence. Dual diagnosis is considered a key contributor to criminal behaviour in this group of patients. The review of the literature also shows a significant proportion of co-morbid intellectual disability among offenders found to be psychiatrically ill at the time of the criminal event. A previous study conducted 20 years earlier, in 1986 at the Sterkfontein Forensic Psychiatric Unit by Vorster (1986) showed that the typical profile was a single, unemployed, poorly educated male in his twenties, usually with a history of psychiatric treatment. This typical profile confirmed the evidence in the literatures at the time of the study.Item Effects of Methanolic Extract of Moringa oleifera leaves on Fructose-Induced Metabolic dysfunction in growing Sprague Dawley Rats(2017) Muhammad, NasiruExcess dietary fructose intake has been associated with an increase in metabolic disorders. Traditionally, these disorders are managed by physical exercise, lifestyle modification, and by conventional drug therapy. A significant proportion of the population also depends on the therapeutic/prophylactic properties of natural plants for their medical problems. The tree Moringa oleifera is well recognized for its medicinal and nutritional properties. The plant is said to possess antiobesity, antilipidaemic, antidiabetic and hypotensive effects amongst other medicinal properties. Most previous studies that explored the effects of Moringa oleifera on metabolism used adult male experimental animal models without considering adult female and young growing animal models, despite the increasing prevalence of metabolic syndrome in females and growing children. This study thus investigated the impact of a methanolic extract of Moringa oleifera leaves on fructose-induced metabolic dysfunction in growing Sprague Dawley rats of both sexes. One hundred and two (102), 21 day old, weaned male and female pups were randomly allocated to six groups that were sex matched. All groups received standard commercially sourced rat chow ad libitum throughout the study. In addition, Group I (negative control) received tap water for drinking and plain gelatine cubes. Group II received 20% fructose solution as drinking fluid and plain gelatine cubes. Group III received 20% fructose solution as their drinking fluid and 400 mg.kg-1 body weight of methanolic extract of Moringa oleifera leaves suspended in gelatine cubes. Group IV received 20% fructose solution as their drinking fluid and 100 mg.kg-1 body weight of fenofibrate (positive control) suspended in gelatine cubes. Group V received 400 mg.kg-1 body weight of the methanolic leaf extracts of Moringa oleifera in gelatine cubes and had plain drinking water. Group VI received 100 mg.kg-1 body weight of fenofibrate in gelatine cubes and had access to plain drinking water. After 10 weeks of the interventions, the rats were euthanased by anaesthetic overdose following an overnight fast; and samples of blood and tissue were collected. The outcomes of the interventions on growth performance, morphometry of the gastro-intestinal tract organs, circulating metabolites, adiposity, liver lipid accumulation and general health markers were assessed. Data were expressed as mean ± standard deviation and analyzed by one-way or two-way analysis of variance (ANOVA) depending on the variables. The statistical significance of analyzed values was set at ≤ 5%. Administration of 20% fructose solution significantly elevated hepatic lipid content in both sexes (P<0.0001) and the concentration of circulating triglycerides in female rats (P<0.0001) compared with negative controls. These lipid elevations were prevented by the administration of 400 mg.kg-1 body weight of methanolic extract of Moringa oleifera leaves and by 100 mg.kg-1 body weight of fenofibrate (P≤0.05). The effect of fenofibrate was more pronounced than that of Moringa. Fenofibrate treated groups (both sexes) had hepatomegaly (P<0.0001), higher fasting blood glucose (FBG) (P<0.0001), higher alkaline phosphatase activity in plasma (P<0.05) and lower (P<0.05) epididymal fat relative to tibial length (males) compared with the other treatment groups. The plasma triglycerides and cholesterol levels were higher in females than in males (P<0.05). The absolute and relative visceral fat pad masses were also higher in females (P<0.05). There were no significant differences in the hepatic lipid content and creatinine levels between the two sexes (P>0.05). However, male rats had significantly higher levels of FBG, liver enzymes (ALT and ALKP), blood urea nitrogen (BUN), urea to creatinine ratio and higher organ morphometry than their corresponding females (P<0.0001). No adverse effects were observed with fructose or Moringa on growth, organ morphometry, determinants of metabolic dysfunction and surrogate markers of general health. However, hepatomegaly was observed in fenofibrate treated groups (P<0.0001). In the present study, sex differences were observed in the metabolic responses of growing Sprague Dawley rats to a high-fructose diet. In addition, the methanolic extract of Moringa oleifera leaves was beneficial in preventing the hypertriglyceridaemia and abnormal deposition of hepatic lipids in high-fructose fed animals. However, the extract was not effective in preventing fructose-induced visceral obesity in male animals. The use of methanolic leaf extracts of Moringa oleifeira should be further explored as a possible candidate prophylactic intervention in the fight against the global epidemic of diet induced metabolic dysfunction.Item Enhancing the doctor-patient relationship: living, dying and use of the living will(2009-10-21T10:58:09Z) Etheredge, HarrietThe research aims to establish whether processes around the consideration and execution of the living will help enhance the doctor-patient relationship. Studies have shown that the living will is not used frequently, and that the doctor-patient relationship is often deficient. The research explores the two primary topics – the living will, and the doctor-patient relationship – separately. Each primary topic is approached via a consideration of the relevant literature, and each is then analyzed from a theoretical–ethical point of view. A synthesis of these separate investigations is presented. This synthesis concludes that the living will can help enhance the doctor-patient relationship.Item Establishment of a flow cytometric assay in the setting of renal transplant for T and B cell crossmatching(2014-02-17) Ramparsad, NarishaDonor specific crossmatching is performed prior to renal transplantation in order to determine the presence of pre-existing antibodies against donor HLA antigens which can result in hyperacute rejection. Flow cytometric crossmatching is reported in the literature to be a more sensitive and objective method of testing than the complement dependent cytotoxicity (CDC) method that is currently used in the Gauteng Province. A prospective analysis of the flow cytomeric crossmatch (FCXM) assay using the Luminex technology as the reference method was conducted. Forty-three samples were analysed. The T cell crossmatch (using a cutoff value of 2) revealed a sensitivity of 66.7%, a specificity of 83.8%, a positive predictive value (PPV) of 40% and negative predictive value (NPV) of 93.9%. The B cell crossmatch (using a cutoff value of 5) gave a sensitivity of 100%, specificity of 92.7%, and a PPV and NPV of 40 and100%, respectively. In addition, a retrospective analysis of clinical data for all patients transplanted during the period January 2008 to May 2009 was performed. Of a total of 50 patients assessed post transplant, none of the patients showed signs of hyperacute rejection, while twelve percent (12%) of patients revealed signs and symptoms suggestive of acute rejection. The validation of the flow cytometric crossmatch analysis was complex as there is no gold standard reference method. The assay was validated based on the clinical relevance of its high negative predictive value and the absence of hyperacute rejections in the clinical follow up. The rate of acute rejection found in this study is similar to that reported in literature.Item Evaluation of potential kidney donors and outcomes post-donation at Charlotte Maxeke Johannesburg acdemic hospital (1983 - 2015) a(2019) Dayal, ChandniBackground Living kidney donation has emerged as a key therapeutic modality for end-stage kidney disease due to the global chronic shortage of renal allografts. However, the potential benefits to the recipient of a living donor kidney must be balanced against donor safety. In demographically diverse populations, there is a paucity of data regarding the living donor evaluation process and outcomes following donation. Objectives This study was undertaken to describe donation patterns, characterise reasons for nondonation and evaluate long-term morbidity and mortality following living kidney donation in the South African context. Methods A retrospective analysis of all Potential Living Donors (PLDs) evaluated at a single centre over a 32-year period was conducted. Of the total cohort of 1208 PLDs, 298 were Accepted Living Donors (ALDs), resulting in 910 Failed Living Donors (FLDs). Data collected included donor demographics. In addition, in the ALD group, clinical and laboratory parameters at various points in donor follow-up, as well as mortality data was noted. In the FLD group reason for donor exclusion was documented. Results Of the 1208 PLDs, 697 (58%) were female. The majority (559; 46%) were of Black African descent, and related to the intended recipient (991; 82%). Outcome of PLD evaluation varied significantly by race (p<0.001), with only a third of Black PLDs being accepted for donation. Black vs. Caucasian PLDs were more likely to fail workup (52.1% vs. 39.3%; p<0.001) and be excluded for medical reasons (44% vs. 35%; p<0.001). Leading medical exclusions included hypertension, HIV and obesity. In the ALD cohort, median follow-up time was 44 months (IQR 13.8 – 93.5 months). Hypertension was documented in 12.8% of ALDs at most recent follow-up compared to 4.7% of ALDs pre-donation (p=0.06). There was a significant increase in Albumin Excretion Rate (AER) following donation (p<0.001). There was a significant decline in the CKD-EPI eGFR between pre-donation (91.7 ± 19.1 ml /min/1.73 m2) and the most recent visit postdonation (72.5 ± 20 ml/min/1.73 m2; p<0.001). 27% of ALDs had a CKD-EPI eGFR<60 ml/min/1.73 m2 at most recent visit, however none required renal replacement therapy. There were 5 documented deaths, all unrelated to the development of renal dysfunction. Black ethnicity was not associated with increased risk of adverse outcome following donation. Conclusions There is a high exclusion rate for PLDs. Black PLDs are more likely to be excluded than Caucasian counterparts due to significant comorbidity. Although limited by high rates of donors lost to follow-up, it is concerning that a quarter of ALDs developed an eGFR<60 ml/min/1.73 m2 at last follow-up, with a significant increase in AER.
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