Electronic Theses and Dissertations (Masters)
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Item The analysis of a student-led university screening and testing programme for cardiovascular disease and diabetes(University of the Witwatersrand, Johannesburg, 2024) Qureshi, Umara Bibi; Orchard, AnéNon-communicable diseases (NCDs) have become the primary cause of both mortality and morbidity globally. Due to their insidious progression, regular screening and monitoring is imperative. The notable surge in these diseases may be attributed to the ongoing global and epidemiological transitions, leading to changes in people’s behaviours and lifestyles. Typically, these diseases remain undetected until they manifest clinically, often leaving limited opportunity for prevention or reversal of damage. Hence, the goal is to prevent, delay the onset and treat these diseases before irreversible end-organ damage occurs. As NCDs typically develop over decades, the presymptomatic phase is often undetected by individuals, with individuals unknowingly exacerbating their conditions through lifestyle choices, such as physical inactivity, unhealthy diets, tobacco consumption and harmful use of alcohol. The university environment, with its academic demands and stressors, often fosters these habits, thus contributing to the proliferation of NCDs. To address this NCD epidemic, empowering students to conduct screening and health promotion initiatives within the academic environment could prove beneficial in building a health enabling environment. Providing students with opportunities to practice their clinical skills and complement their theoretical knowledge with practical experience through work- based learning initiatives could be mutually beneficial to the public and the students. Students gain valuable skills and experience, while the public receives free screening, lifestyle advice, and early detection of CVD risk factors. This study aims to identify the occurrence of CVD related risk factors at a student-led screening event. The Wits university clinical pharmacy department initiated a work-based learning program for the fourth-year pharmacy students to improve their clinical skill set. After training in the clinical skills required to conduct Point-Of-Care Testing (POCT) services, understanding the clinical threshold values and the lifestyle advice regarding each condition, the students underwent competency assessment before participating in the screening event. There were 767 participants in this study, with their medical histories and demographical information collected using a questionnaire, followed by relevant tests such as blood pressure, blood glucose, blood cholesterol and their anthropometric measurements. Additional tests such as the glycated haemoglobin A1c (HbA1c) test and full lipid panel testing was offered to some viii participants. Following the screening, results were explained to the participants, who were then referred or offered appropriate lifestyle education. Those that were referred for CVD-related risk factors, were telephonically surveyed about their clinical findings and their interventions post-screening. The occurrence of self -reported hypertension (6.5%), diabetes (2.09%), cholesterol (2.87%) and obesity (3.91%) were lower in comparison to the measured results. Screening results show that there were 18.25% abnormal blood pressure readings, 2.83% had hyperglycaemia, and 11.36% had high cholesterol readings. Control levels amongst participants with self-reported diagnosed conditions were suboptimal, with 56% potentially having uncontrolled hypertension, 18.75% uncontrolled diabetes, 18.18% uncontrolled cholesterol and 50% confirmed obesity. In this sample, tobacco and alcohol consumption did not significantly influence CVD risk factors. However, the age and designation were significantly (P < 0.05) associated with disease occurrence, while obesity was strongly associated with all demographic characteristics (gender, ethnicity, age range and designation). Follow-up surveys revealed significant findings among 35% of the participants. Among them, three participants (43%) were diagnosed with hypertension or diabetes, two participants (29%) had uncontrolled conditions which required upscaling treatment and the remaining two participants were advised to monitor their conditions and implement lifestyle modifications to prevent disease progression. Most participants cited reasons such as the lack of perceived need, cost, and time constraints for not pursuing routine screening. Those who utilized this service appreciated the convenience offered by a screening event held at their working and study environment. It was found that most people are unlikely to pursue screening services unless they are offered screening at their education and working environment. This highlights the importance of creating a health enabling environment, encouraging proactive health behaviours among participants.Item Patient knowledge, attitudes, and perceptions towards cardiovascular disease, medication compliance and lifestyle modifications in a tertiary hospital in Johannesburg(University of the Witwatersrand, Johannesburg, 2024) Ayob, RumaanahBackground and Aim: Cardiovascular disease (CVD) is the leading cause of mortality in sub- Saharan Africa and the leading cause of disability adjusted life years worldwide. The burden of CVD varies across countries with over three quarters of deaths occurring in lower-to-middle-income countries (LMICs). Despite the effectiveness of medication, adherence to therapy is a challenge. The paucity of information of CVD in South Africans and low cardiovascular literacy highlights the knowledge gaps of CVD disorders and the overlooked risk factors which are significant barriers. An analysis of the disparities in the vulnerable communities may guide the prioritization of interventions and allow disadvantaged groups to be reached. Therefore, this study aimed to determine patients’ knowledge, attitudes, and perception of their disease as well as the need for regular monitoring, medication compliance and the impact of lifestyle modification, in a public tertiary hospital in Johannesburg, South Africa. Methods: A cross-sectional study with convenience sampling was conducted in the vascular and diabetic outpatient clinics at a state tertiary hospital. A questionnaire was used to gather responses and a point of care test (POCT), assessing blood pressure, glycated hemoglobin (HbA1c) and lipogram was done to assess patient perception of their disease control. Results: Of the 191 participants (64%-woman, mean age 54 years), 57% were familiar with the term CVD, and 97% acknowledged the importance of follow-up visits. L evel of education, socio- economic status, monthly income, and residential area were associated with CVD knowledge levels. Participants with increased CVD knowledge were more physically active. Although the negative implications of smoking were acknowledged, they were not eager to quit. Participants with higher levels of knowledge were more aware of the indication of their medication. Patient’s perceptions of their disease were not aligned with the values measured by the POCTs. One-third of the population achieved target blood pressure levels and a quarter of the population achieved target HbA1c levels. Conclusion: Low to moderate levels of knowledge of CVD were found; most participants understood the significance of follow- up visits and treatment adherence. Insufficient knowledge of CVDs continues to be important factors in health behavior. Knowledge levels were influenced by the level of education, place of residence and type of employment, therefore targeted educational material may improve level of comprehension and understanding. Awareness strategies should emphasize at end organ damage is preventable and strategies to assist individuals to comprehend and manage the risk factors.Item Knowledge, attitudes and beliefs of pharmacy students towards influenza vaccination in South Africa(University of the Witwatersrand, Johannesburg, 2024) Moyo, Princess Ayanda; Padayachee, NeelaveniBackground: Influenza poses a great threat due to its prevalence, severity, and tendency for antigenic shifts that increase pandemic potential. This virus causes a respiratory illness that spreads quickly through droplets or contact with contaminated surfaces. Outbreaks are seasonal, and vaccination (ideally before the season begins) remains the most effective preventive measure, along with cough etiquette, handwashing, and avoiding ill individuals. Globally, influenza causes millions of severe infections annually, and in South Africa, it places a significant burden on healthcare systems and individual households. Healthcare workers' (HCWs) risk is elevated, and their vaccination is recommended to protect vulnerable patients and maintain uninterrupted medical services. Pharmacy students are future pharmacists and custodians of medicines who will advise and assist various communities. Therefore, there is a need to assess influenza vaccine acceptability in this priority group since HCWs are widely involved in and are significant advocates for different vaccination initiatives, especially now that the world is still dealing with the residual effects of the coronavirus disease (COVID-19) pandemic. Aim of study: To investigate the knowledge, attitudes and beliefs of pharmacy students at nine pharmacy schools in South Africa regarding the influenza vaccine. Methods: A descriptive quantitative study was conducted among undergraduate Bachelor of Pharmacy (BPharm) students in universities across various provinces including Limpopo, KwaZulu-Natal, Western Cape, North-West, Gauteng and Eastern Cape in South Africa. While nine pharmacy schools were approached, only eight universities participated. The inclusion criteria was limited to those in the BPharm programme and 18 years old and above. Those that had participated in the pilot study as well as participants that had more than ten unanswered questions were excluded from the study. A participant information sheet with details on the purpose of the study was adapted from a WITS template to provide further information to those invited to participate in the study. A questionnaire was adapted from a similar survey to suit the needs of this study and used to collect data. The questionnaire was piloted prior to administration to a sample population for study data collection. To assess the pharmacy students' knowledge, affected by their year of study and Work Based Learning (WBL) experience, a nominal scale (correct and incorrect) was used. The participants had to decide which answer most applied to the specific question. A five-point Likert scale was used to examine students' attitudes and beliefs about influenza vaccination. This method had five viii options: “strongly disagree, disagree, neutral, agree and strongly agree” to assess students’ agreement with the statements provided. All analyses were performed using STATA version 14 (StataCorp, USA), and statistical significance was determined at a 5% level. Results: A total of 278 pharmacy students participated in the study. There were 77 questionnaires excluded, resulting in a total of 201 participants. Just over sixty percent were between 18 and 21 (123, 61.2%) years of age, with most participants being female (150, 74.6%). The study identified good knowledge among all participants with a mean average score of 5.7 out of 7. Almost all of the participants (195, 97.0%) expressed that they believed the influenza vaccine to be safe. The participants showed a positive attitude towards influenza with a mean score of 16.2 out of 20. Among the 83 participants who reported to have medical aid, 46 (55.40%) had been vaccinated for influenza. Among those who had been vaccinated before (102, 50.70%), only 47 (46.10 %) indicated that they had received influenza vaccines regularly while growing up. Of the 99 participants that did not vaccinate, (44; 44.44%) indicated that they did not vaccinate due to the low priority assigned to influenza prevention and 29 (29.29%) believed that their natural immune system offers sufficient protection from the flu. Conclusion: There is a disconnect between knowledge and action regarding influenza vaccination among pharmacy students. Despite above-average understanding of influenza and vaccines, vaccination rates remain low. This may affect their advocacy for vaccination amongst patients attended to during WBL. While factors like medical aid coverage play a role, the study suggests the potential for long-term benefits from childhood vaccination. Limited support for mandatory vaccination policies highlights a distinct perspective within pharmacy education. This underscores the need for multifaceted interventions that dispel misconceptions, emphasise the crucial role of pharmacists in promoting vaccination and foster discussions around policy considerations. Further research is needed to pinpoint barriers and design tailored strategies to increase vaccination uptake among pharmacy students for improved public health outcomes.Item Exploring the Knowledge, Attitude, Perceptions, and Practices of Pharmacists with Regards to Doping and Medication Use in Sports(University of the Witwatersrand, Johannesburg, 2024) Du Plessis, Nerine; Constantinou, Demitri; Shaikh, Rubina; Booth, ZelnaBackground: Sports medicine has become a more prominent field of specialization in recent years, with growing interest in appropriate medication use in athletes. However, pharmacists appear to have little involvement in sports medicine. Pharmacists are optimally skilled to manage medication-specific needs of patients and should play a more pertinent role in managing the use of medication in athletes. Efforts should consider the unique physiology and lifestyle of an athlete and align with World Anti-Doping Agency regulations. Limited literature reports on South African pharmacists’ perception or interest in this field, and the hindrances to potential involvement in sports medicine. Aim: The aim of the study is to explore the knowledge, attitudes, perceptions, and practices of pharmacy personnel with regards to medication use and doping in athletes, to better inform future actions and guidelines in South Africa. Method: An explanatory mixed-method research design was utilized to meet the objectives of the study as approved by the University of the Witwatersrand Health Research Ethics Committee. The initial quantitative phase relied on data collected through self-administered surveys completed by pharmacy personnel currently working in community pharmacies in Gauteng. The results were analysed and displayed through various means including descriptive statistics as well as Student T-test, ANOVA, and Kruskal-Wallis tests. The qualitative phase followed, relying on information collected through interviews, with the assistance of a semi-structured interview guide, with participants from the initial quantitative phase. These responses underwent thematic analysis to extract meaningful data. Results: A total of three hundred and thirty-two pharmacy personnel participated in the survey. The knowledge, attitude and perceptions, and practices scores obtained indicated that while participants have a positive opinion of sports medicine and pharmacy’s involvement in the field, with a mean score of 67% with regards to attitude and perception, barriers may exist that have affected participants’ opinions regarding their involvement. Participants’ self-declared knowledge received a mean score of 51%, which appears comparable with other studies. However, the tested knowledge of participants indicated much poorer knowledge with a mean score of 37%, suggesting possible poor education on the topic of sports medicine. Participants’ current practices with regards to sports medicine appeared to be limited with a mean score of 50%. The extent of involvement can be associated with the indicated limited knowledge and possible resultant lack of confidence in the field. Correlations indicated that qualification and associated professional affiliation have a significant impact on participants’ knowledge, attitude, perceptions, and practices related to doping and medication use in athletes. These results were further emphasised during the interview process. Seventeen pharmacists participated in the qualitative phase. Pharmacists have awareness of, and a positive perception towards the field of sports medicine, and agree that pharmacists can have an impact on anti-doping efforts and appropriate medication use. Specific limitations have hindered their involvement thus far. The most significant limiting factor to pharmacist involvement in sports medicine identified was limited knowledge, resulting in poor counselling and assistance on issues related to sports medicine. Additional limitations that have a notable impact were related to the regulation of supplements causing decreased involvement by pharmacists, as well as the outward perception of pharmacists’ potential impact. The positive response to the proposed implementation of specific local guidelines or courses related to sports medicine provides an indication of pharmacists’ willingness and interest to become better educated in the field, leading to increased confidence and thus involvement. Conclusions: The findings of this research confirmed pharmacist potential impact in sports medicine while alluding to specific problems that have hindered their involvement. With increased educational opportunities, the inclusion of appropriate resources, and efforts to include pharmacists in matters related to medication use in athletes, specifically in anti-doping, pharmacists can have a significant impact on the future of sports medicine.Item A descriptive survey of healthcare professionals on traditional, complementary and alternative medicine integration in hospitals in Gauteng(University of the Witwatersrand, Johannesburg, 2024) Mathoho, Mulanga; Booth , Zelna; Shaikh, Rubina; Leigh-de Rapper, StephanieBackground: Traditional, complementary, and alternative medicine (TCAM) use varies globally. The World Health Organisation (WHO) has estimated that 80% of the African population relies on TCAM as their first healthcare source. There is thus a high estimated prevalence of TCAM use in South Africa and studies showing potential for serious interactions between TCAM and conventional medicines. A common example of a fatal interactive profile has been demonstrated between a natural product, St. John’s Wort (Hypericum perforatum) and conventional antidepressants. Furthermore, garlic, gingko, and echinacea, are natural products that interact with conventional medicines since they can inhibit or induce cytochrome P450 liver enzymes. Medical history-taking is a vital process in the provision of healthcare, often assisting in identifying potentially such unwanted side effects or interactions. Aim: To determine the knowledge, attitudes, perceptions, and practices (KAP) of authorised prescribing and dispensing HCPs on TCAM use among the patient population, in three public, academic hospitals in Gauteng. Methods: A self-administered, cross-sectional survey was carried out among prescribing and dispensing HCPs working at Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Helen Joseph Hospital in Auckland and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). All analyses were performed using STATA version 14 (StataCorp, USA) and statistical significance was determined at the 5% level of significance. A t-test analysis, chi-square test, Spearman rank correlation, and a multiple linear regression model were used to analyse the data. Results: A total of 233 prescribing and dispensing HCPs participated in the study surpassing the initially intended sample size of 226. However, upon analysis, only 188 responses met the inclusion criteria, of which the majority of the participants were between 18 and 30 (112, 58.9%) years of age with most respondents being females (112, 58.9%). The study identified HCP's poor knowledge (69.0%) of TCAM but positive attitudes (90.0%) towards TCAM. Most participants (104, 55.3%) in this study reported that they were aware of the prevalence of TCAM use but 98 (51.1%) participants stated that they were unaware of the potential interactions between TCAM and conventional vii medicines. Participants showed a positive attitude towards TCAM incorporation in the medical curriculum and believed that TCAM incorporation into the health system would enhance patient care. With respect to practice, a few (80, 43.0%) HCPs would enquire about TCAM use during history-taking. The Spearman rank correlation revealed significant positive linear correlations between knowledge-attitudes (p < 0.05), knowledge-practices (p < 0.05), and attitudes-practices (p < 0.05). Conclusion: Healthcare professionals have sub-optimal knowledge (69.0%) of TCAM and a positive attitude (90.0%) towards TCAM. There is a need for interventions to make sure that HCPs have the knowledge and tools they need to encourage the inclusion of TCAM in history- taking procedures and within the health system. Guideline recommendations are based on scientific data; therefore, there is a need for evidence- based research on TCAM. A more equitable level of healthcare can be achieved by combining several healthcare systems that now coexist in the same space.Item Fabrication of a polymeric microneedle array for the decalcification of blood vessels(University of the Witwatersrand, Johannesburg, 2024) Moodley, Kimaya; Marimuthu, Thashree; Choonara, Yahya E.Blood tissue calcification involves the deposition of calcium and phosphate minerals, predominantly within blood vessel walls, impacting cardiovascular health. Blood vessel calcification remains a significant concern in cardiovascular health, contributing to various complications such as medial arterial calcification (MAC) and intimal atherosclerotic calcification. While traditional treatment options have limitations, emerging research suggests that ethylenediaminetetraacetic acid (EDTA) could serve as a promising chelating agent to reverse calcification. When delivered in close proximity to the calcification site, EDTA has shown potential for mitigating calcification progression and restoring vascular function. This study aimed to develop a dissolvable polymeric microneedle (MN) array to be loaded with EDTA to treat vascular calcification in a site specific manner. Two MN formulations were prepared, the first from a combination of chitosan, polyvinyl alcohol and hydroxypropyl cellulose and the second from a cross-linked sodium alginate solution using a mould-based method. EDTA was successfully loaded into both MN formulations for further evaluation. Chitosan MN arrays were loaded with 340 μg of EDTA while alginate arrays were loaded with 965.8 μg of EDTA. The arrays were analysed by, differential scanning calorimetry (DSC), powder x-ray diffraction (PXRD) spectroscopy and Fourier transform infrared (FTIR) spectroscopy. The morphological features and mechanical strength, were investigated by scanning electron microscopy and texture analysis respectively. The fabricated arrays were of 8 mm x 8mm patch size containing 10 x 10 needles. Each needle has a length of 300 μm, needle base of 100μm and needle pitch of 500μm. It was shown that MN arrays were mechanically sufficiently strong to penetrate the vascular tissue. The typical failure force ranged from 0.338 to 0.345 Newton per needle for chitosan and alginate MN arrays respectively. Chitosan MN arrays achieved a 315 μg release within 24 hours while alginate arrays released 789 μg in the same period. Drug permeation studies were carried out on porcine venous tissue and showed in enhanced permeation ability of the alginate arrays after 6 hours. The MN arrays also both showed good hemocompatibility via hemolysis testing, with no significant increase in hemolysis and calcium chelating ability based on the quantity of EDTA permeating the tissue layer. Overall, this study resulted in the successful preparation of two dissolvable, EDTA loaded MN arrays from natural polymers using a simple, mould-based method. These MNs were found to penetrate the vascular tissue with minimal application forces and release bioactive over a 24 hour period. These polymeric MNs could prove useful for the delivery of many other drugs to the vascular system which would benefit therapeutic outcomes of patients greatly.Item Investigating Patient-Specific Risk Factors for Chemotherapy-Induced Nausea and Vomiting in Patients with Cance(University of the Witwatersrand, Johannesburg, 2024) Rahim, Johara Irshaad; Khan, RazeeyaChemotherapy-induced nausea and vomiting (CINV) is the most common side effect of cancer treatment. Despite adequate antiemesis prophylaxis, this side effect remains poorly controlled and may decrease a patient’s quality of life and affect adherence to treatment, leading to poor therapeutic outcomes. Patients experiencing CINV are also susceptible to malnutrition, electrolyte imbalances and dehydration, hence, adequate control of this side effect is imperative. Studies have reported that patient-specific risk factors can contribute to the development of CINV. Tailoring CINV regimens to mitigate patient-specific risk factors could decrease the incidence of nausea and vomiting. Comprehensive treatment regimens could potentially be developed by utilising antiemetic guidelines in conjunction with patient-risk factor assessment allowing for further optimisation of antiemetic treatment regimens in patients that are high risk. This study was designed to investigate whether evaluating patient-specific risk factors for personalised antiemetic prophylaxis selection could aid in CINV treatment optimisation. A prescription record review and researcher-administered survey were conducted among cancer patients receiving chemotherapy at the outpatient department of a large academic hospital. The questionnaire comprised both open-and close-ended questions designed to investigate the incidence of CINV and the risk factors presenting in this cohort of patients. A total of 222 patients diagnosed with cancer participated in the study. Among them, 22.5% experienced isolated nausea, 45% reported both nausea and vomiting, and 32.4% remained asymptomatic during the overall phase of treatment. Adherence to antiemetic treatment guidelines was 75.2%, with the highest adherence rates observed in patients who did not develop CINV (p < 0.001). This underscores the essential role of appropriate prescribing practices in effectively managing CINV. Significant associations between race and CINV incidence (p=0.033) were evident. Patients who received four or more cycles of chemotherapy reported a higher incidence of nausea (44.0%) and nausea accompanied by vomiting (49.0%) during the overall phase. Anticipatory nausea and vomiting was significantly associated with CINV incidence (p < 0.001). The use of non-prescription medications, marijuana, and complementary therapies like ginger also influenced CINV prevalence, while alcohol consumption appeared to potentially mitigate these symptoms. This study underscores the pivotal role of adherence to established antiemetic guidelines in mitigating the burden of CINV, emphasising the need for individualised risk assessment to iv optimise antiemetic regimen selection. Incorporating patient-specific risk factors into treatment selection, may potentially enhance the effectiveness of antiemetic therapies and improve overall patient outcomes in the oncology setting.Item Sales of over-the-counter codeine-containing medicines in South Africa, 2019-2020: a retrospective observational study(University of the Witwatersrand, Johannesburg, 2024) Giuricich, Federica Maria; Shaikh, Rubina; Booth, Zelna; Padayachee, NeelaveniIntroduction and Rationale Codeine-containing medicines (CCMs), used mostly for its analgesic properties, with its addictive potential, contributes to irrational drug use in South Africa (SA). Furthermore, many CCMs are affordable and some available as over-the-counter (OTC) medicines, thus increasing risks of misuse. This leads to misconceptions of codeine’s safety due to its easy accessibility. Analysing OTC CCM sales trends and associations in SA, can provide valuable information for policy reform. Aim The study aimed to review the factors contributing to CCMs. The dissertation further aimed to describe the sales trends of OTC CCMs using a retrospective observational analysis of an IQVIA dataset. The dataset included sales data from retail pharmacies across all provinces in SA for the period of 1 January 2019 to 31 December 2020. Objectives I. To conduct a review of the factors contributing to CCM sales. II. Objective II was divided into parts a and b. a. To describe the sales trends of OTC CCMs across all provinces in SA. b. To assess any difference between the effect of the severe acute respiratory syndrome-related coronavirus 2 (Covid-19) pandemic on the sales trends of OTC CCMs across all provinces in SA. III. To determine the contributing factors associated with OTC CCM sales in the South African provinces of Gauteng, Mpumalanga and the North-West, identified as “codeine hotspots”. Methodology A quantitative retrospective observational analysis of South African codeine-sales data, from an IQVIA dataset was used for analyses, using STATA®, to determine the sales trends and associations significantly associated with OTC CCM sales across all provinces in SA. An overview of the factors contributing to CCM sales was discussed. Pearson chi-square tests were used to determine evidence to support the presence of any associations between the analysed variables. Descriptive results were plotted in v graphs to depict the trends and effects associated with OTC CCM sales. Univariate and multiple linear regressions were also conducted to determine the strengths of the contributing factors associated with OTC CCM sales in the three South African “codeine hotspot” provinces (Gauteng, Mpumalanga and the North-West). Results In total, 36 065 459 OTC CCM script line items were analysed. Cumulatively, the top five OTC CCM products sold, accounted for approximately 60% of the total percentage distribution of all the analysed products. These included Adco-Dol® (40s) (21.34%), Mybulen® (30s) (12.80%), Gen-Payne® (30s) (10.78%), Adco-Dol® (20s) (10.02%) and Accurate® (40s) (7.93%). Gauteng (40.95%) descriptively displayed the greatest amount of OTC CCM sales, with the Northern Cape (2.35%) showing the least amount of OTC CCM sales. Sales were greatest through cash payments in chain pharmacy groups, at the onset of winter. March 2020 demonstrated a significant sales spike, before plummeting in April 2020, indicative that sales were higher before Covid-19, with significant differences (p<0.001). Of the “codeine hotspot” provinces (Gauteng, Mpumalanga and the North-West), linear regressions showed significant results, with Gauteng displaying increased OTC CCM sales (p<0.001), particularly with the sale of generic (p<0.001) oral liquid products (p<0.001), acquired with cash (p<0.001) and purchased as smaller pack sizes (p<0.001). Conclusion From this study's findings, codeine use is still greatly prevalent in SA. Legitimate and irrational use of OTC CCMs is affecting the burden of medicine misuse and abuse in SA. The purchase of oral liquid form OTC CCM products is on the rise, particularly amongst the adolescent generation, as an easy and affordable illicit drug. Purchasing affordable OTC CCMs with cash and in smaller pack sizes is prevalent in SA’s top three “codeine hotspot” provinces (Gauteng, Mpumalanga and the North-West). It is therefore recommended that enhanced education, knowledge, and codeine policy reform surrounding the control of access to OTC CCMs is warranted to help combat irrational CCM misuse in SA.Item Design and evaluation of mesoporous silica nanoparticles for the targeted co-delivery of essential oils(University of the Witwatersrand, Johannesburg, 2024) Wadee, Ayesha; Choonara, Yahya E.Bromodosis, characterised by excessive foot odour, affects many individuals, particularly those who wear closed-toe shoes for extended periods of time. Current treatment options for bromodosis include zinc oxide powder, antibacterial agents, antiperspirants, botulinum toxin, laser therapy, or surgery. However, these treatments often manage symptoms rather than addressing the underlying causes. Additionally, they may require long-term use, which can be inconvenient and costly. Targeting and reducing the population of Brevibacterium spp. and Staphylococcus aureus, key culprits in bromodosis, could be an effective strategy for combating foot odour. Mesoporous Silica Nanoparticles (MSNs) are favoured over other nanoparticles for delivering essential oils due to their high drug loading capacity, controlled release capabilities, biocompatibility, stability, and ease of customisation, offering a versatile and effective approach for managing foot odour. Developing an essential oil-loaded MSNs formulation offers a promising solution against bromodosis. This research aimed to synthesise MSNs (~100-200 nm) encapsulating Styrax benzoin and Juniperus virginiana essential oil for targeted bromodosis treatment. A sol-gel method using two surfactants ensured precise particle size control and uniform pores within the nanoparticles for effective encapsulation. The MSNs suitability for essential oil encapsulation was confirmed, followed by essential oil loading via adsorption. Encapsulation efficacy (EE), loading capacity (LC), release, antibacterial and toxicity studies were conducted. Nanoparticles were primarily spherical with mesopores, confirmed by SEM and TEM images. The MSNs size was 182.27 ± 6.50 nm with a PDI of 0.14 ± 0.02 and a zeta potential of -19.8 ± 8.53 mV, confirming their nano-size, homogeneity and stability, facilitating successful encapsulation. Higher %EE was observed for 2:1 S. benzoin oil:MSNs (BEN-MSNs) and J. virginiana oil:MSNs (JUN-MSNs) ratio compared to a 1:1 ratio. Cumulative release at pH 5.2 and pH 6.5 ranged from 48.43% to 78.23%, catering to pH variations of foot perspiration. Antibacterial studies demonstrated a large reduction in S. aureus and B. linens, while B. agri and B. epidermidis showed lower colony forming unit reductions. The 1:1 ratio of BEN-MSNs with JUN-MSNs exhibited non-toxicity at both pH levels, indicating safety for topical use. This study underscores MSNs’ potential as effective essential oil carrier into the mesopores. Loading efficiency varies with essential oil type and compounds present but can be optimised through MSNs modification. These results support the development of pharmaceutical formulations utilising MSNs and essential oils for targeted antimicrobial activity against bromodosis pathogens while ensuring safety for topical use.Item Design and engineering of a bio-responsive, nano-enabled vitreous substitute for the treatment of retinal diseases(University of the Witwatersrand, Johannesburg, 2023-07) Naik, Kruti; Du Toit, Lisa C.; Choonara, Yahya E.The vitreous humour is a soft gel between the lens and the retina in the eye. It protects the surrounding ocular tissues functioning as a shock absorber and a vessel for oxygen and metabolite transport. Vitreous liquefaction leads to vitreous detachment resulting in ocular tissue damage such as retinal detachment and vitreous haemorrhage. Current treatment includes total vitreous replacement via pars plana vitrectomy utilising silicone oil. Cataracts, inflammation, and retinal toxicity as a result of silicone oil treatment have led to the need for a more effective long-term vitreous substitute. It is essential to treat vitreoretinal diseases concurrently with vitreous substitution. This study aimed to investigate and design the proposed concept of a thermoresponsive, nano-enabled vitreous substitute for the treatment of retinal diseases. An initial study in the selection of polymers for the hydrogel identified a blend of natural and synthetic polymers. Hyaluronic acid with a blend of two poloxamers of differing molecular weights were identified and optimisation allowed for their selection prior to nanoparticle loading and characterisation. Poly(ᴅ,ւ-lactide-co-lycolide) acid nanoparticles encapsulating triamcinolone acetonide were synthesised with a spherical morphology and mean diameter of 153 nm allowing nanoparticle penetration into the retinal layers from the vitreous. Hydrogel fabrication and nanoparticle loading within the hydrogel was confirmed via physicochemical analysis. Gelation studies indicated that hydrogels formed in nine minutes and 10 minutes for the unloaded and nanoparticle-loaded hydrogels respectively. The hydrogels displayed in situ formation properties and rheometric viscoelastic studies indicated the unloaded and loaded hydrogels to have modulus values similar to those of the natural vitreous at 37 °C. Administration of the hydrogels was possible via 26G needles allowing for clinical application and drug release of triamcinolone acetonide from the nanoparticle-loaded hydrogel indicated that a sustained drug release was visible over nine weeks. The hydrogels displayed minimal swelling, reaching equilibrium swelling within 12 hours for the unloaded hydrogel and eight hours for the nanoparticle-loaded hydrogel. Biodegradation in simulated vitreous humour with lysozyme showed < 20% degradation within nine weeks. Biocompatibility of both hydrogels was shown with mouse fibroblast and human retinal pigment epithelium cell lines. Lastly, a pilot in vivo study with a New Zealand White rabbit model displayed minimal toxicity with localised drug release behaviour. In conclusion, the unloaded and nanoparticle-loaded hydrogels developed in this research demonstrate their potential as vitreous substitutes that function as drug delivery systems following vitrectomy surgery.