Electronic Theses and Dissertations (Masters)

Permanent URI for this collectionhttps://hdl.handle.net/10539/37931

Browse

Filters

Settings

Search Results

Now showing 1 - 10 of 186
  • No Thumbnail Available
    Item
    The clinical spectrum of viridans group streptococcus bacteraemia in paediatric patients at Chris Hani Baragwanath Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2023-11) Shongwe, Nkosinathi Sifiso; Petersen, Karen L.; Mabena, Fikile C.
    Background: Viridans group streptococci (VGS) are often considered organisms of low virulence; however, infection can result in clinically significant sepsis and life-threatening complications in paediatric patients. Objectives: To describe the spectrum of clinical presentation of VGS bacteraemia in paediatric patients, to analyse risk factors, and to describe the antibiotics resistance patterns of VGS. Methods: Cultures of VGS in paediatric patients admitted to Chris Hani Baragwanath Academic Hospital in 2019 were retrieved from NHLS data base. Data was extracted from archived clinical records and analysed. Sepsis scores were calculated at the time of bacteraemia. Results: 133 cultures were identified; 64 (48.1%) polymicrobial cultures (64) and no records 4 (0.03%) were excluded; 65 (48.9%) were analysed. The median age was 1.5 months (range 0.03 to 168, Interquartile range (IQR) 0.2 to 13.25), 27/65 (42%) were neonates. The median duration of hospitalisation was seven days (IQR 3 to 21). The commonest diagnoses were neonatal sepsis 30.8% (n=20) and pneumonia 28% (n=18). The systemic inflammatory response syndrome (SIRS) score was ≥2 in 57% (16/28) patients; paediatric sequential organ failure assessment (pSOFA) score was >2 in 10/24 (42%). Fifty-seven (88%) patients were discharged; three (5%) required ICU admission and 8/65 (12.3%) died. Malnutrition was present in 50% of patients who died. Cephalosporins and penicillin had susceptibility of 89% and 55% respectively. Conclusion: VGS bacteraemia was common in neonates, and pneumonia was a common presentation in this cohort outside the neonatal period. VGS bacteraemia was associated with morbidity and deaths in this cohort. Contribution: VGS should be considered a significant organism when cultured and routine antibiotic susceptibility testing should be performed. Prospective studies are recommended.
  • No Thumbnail Available
    Item
    A retrospective study of the biochemical and radiological profile of children with genetic hypophosphatemic rickets and their response to conventional treatment
    (University of the Witwatersrand, Johannesburg, 2023-11) Isaac, Nikhila; Thandrayen, Kebashni
    Objectives: Assessing the biochemical and radiological profile of children with genetic hypophosphatemic rickets and their response to conventional treatment. Design: Retrospective descriptive study. Setting: Metabolic Bone clinic at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. Subjects: Children less than 18 years, attending the Metabolic Bone clinic from 1st January 2006 to April 2020, with genetic hypophosphatemic rickets, commenced on conventional treatment. Results: Seventy patients met the inclusion criteria. Majority of patients were black South African (n=54 (77%)). Positive family history seen in 32 (46%) patients. The patients were short statured with a mean height for age z score (HAZ) of - 3.4 ± 1.79. The mean calcium, phosphate, alkaline phosphatase, parathyroid hormone levels and median Thacher score was 2.3 ± 0.16 mmol/L, 0.84 ± 0.19 mmol/L, 776.6 ± 531 IU/L, 7.15 ± 4.8 pmol/L and 8 (4-8) respectively. Improvement on last follow up on treatment was seen in ALP (776 ±531 vs 525±232; p <0.001) and Thacher scores (8 (4-8) vs 2 (1-3.5); p =0.01) after 5 years, but no change in phosphate or HAZ. Conclusion: Conventional therapy for treatment of hypophosphatemic rickets is not associated with an improvement in HAZ despite an improvement in radiology and ALP. Adherence is a major challenge for the majority of patients.
  • No Thumbnail Available
    Item
    Assessment of genetic counselling and testing of patients diagnosed with invasive breast carcinoma in two South African breast units
    (University of the Witwatersrand, Johannesburg, 2023) Mukendi, Ilunga Valerien; Cubasch, Herbert; Nietz, Sarah; Rossouw, Bianca
    Genetic counselling and testing can be helpful and enable further management when a carrier is identified early. Mutations in BRCA 1/2 situated on chromosomes 17q21 and 13q12-13 are rare. BRCA 1/2 are tumour suppressor genes essential for preserving genomic integrity, and their mutations will lead to DNA repair deficiency and persistent impaired DNA replication. As a result, dysplasia and breast malignancy will occur. This study was conducted at Charlotte Maxexe Johannesburg Academic Hospital, the breast unit at Chris Hani Baragwanath Academic Hospital, the Division of Human Genetics at the National Health Laboratory Service and the University of the Witwatersrand. A total of 498 patients with breast cancer participated in the study. The study population was predominantly black (n=437; 87.75%), with 61 (12.25%) white patients. Most patients were in the 51-60 age group (n=134; 26.91%). There were 80 (16.06%) patients with a known family history of breast/ovarian cancer. Most patients (282; 56.63%) were not eligible for genetic counselling and testing. Of the 216 (43.37%) eligible patients, 39 (18.06%) received genetic counselling, 176 (81.4%) did not, and one (0.46%) refused counselling. All counselled patients received next-generation sequencing testing. Our findings show that next-generation sequencing is still underused in our health institutions. Most patients were not offered counselling despite meeting the criteria.
  • No Thumbnail Available
    Item
    The knowledge and practice of emergency department doctors in the management of calcium channel blocker overdose in South Africa
    (University of the Witwatersrand, Johannesburg, 2023-07) Pluymers, Nakita Ann; Wells, Mike; Stephen, Victoria Sarah
    Background: Calcium channel blocker (CCB) overdose (OD) has the highest mortality rate in comparison to other cardiovascular agents. The treatment of a severe CCB OD is challenging for emergency doctors with limited literature even in developed countries. It is important that in the South African (SA) setting that good knowledge and awareness of emergency doctors on CCB OD’s and their clinical presentations, would produce fewer patient mortalities. Objectives: To explore the knowledge and practice of SA emergency department (ED) doctors, in both public and private sectors, in the management of CCB OD as well as barriers and facilitating factors they encounter when managing such patients. Methods: A cross-sectional study was conducted among South African emergency medicine doctors using a self-administered electronic survey. The survey contained 39 questions including demographics and a combination of open, closed, case-based and Likert-scale based multiple-choice questions as adapted from Brassard et al. Results: A total of 119 doctors participated in the survey, 59 were state medical officers (MO), 30 were registrars and 30 worked in private EDs. The mean (SD) age of participants was 32.9 years (6.4). The mean knowledge (SD) score of all participants was 54% (13.3), which was the lowest for public MOs (48%) and significantly higher for private MOs (58.4%) and registrars (60.1%). Forty eight percent of participants didn’t know of any guidelines to treat a CCB OD. Current practice of EM doctors showed that fifty-five percent of the group would initiate HIET along with a vasopressor for CCB induced shock. Barriers to managing a CCB OD were highlighted with unavailability of infusion pumps, understaffing in the unit, and a full resuscitation unit being the most common with no significant differences between the subgroups. Thirty seven percent of participants agreed that the most popular facilitating factor was having past experience when managing a CCB OD. Conclusion: This study has highlighted the need to address ED doctor knowledge gaps on CCB OD management, further emphasising the importance of clinical toxicology education in South Africa. Guidelines are needed to improve EM doctor practices to ameliorate patient outcomes.
  • No Thumbnail Available
    Item
    Prevalence and spectrum of Cutaneous Tuberculosis in patients at Charlotte Maxeke Johannesburg Academic Hospital
    (University of the Witwatersrand, Johannesburg, 2023-11) Hargey, Naima; Pillay, Lushen; Ede, Chioma
    Tuberculosis (TB) is a communicable disease that belongs in the top 10 causes of death worldwide. World Health Organization (WHO) indicated that 90% of the world’s TB cases occurred in 30 countries, with South Africa being one of the countries listed. Cutaneous TB comprises 1-2% of the extrapulmonary TB cases. Cutaneous TB is a chronic skin infection mainly caused by Mycobacterium Tuberculosis. The aim of this study was to investigate the prevalence and spectrum of Cutaneous TB in patients at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). A retrospective study of 69 patients were confirmed on histopathology with cutaneous TB. This was further sub-divided into true TB and tuberculid forms. These forms were correlated with histopathological and clinical findings as well as the patient’s HIV status. The average age (SD) of the 69 patients was 39(12). Females were more common than males in the study (ratio 7.625:1). The average disease duration (SD) of 17(22) months. Tuberculids (81.2%) were the most common form of cutaneous TB with Erythema Induratum (76.8%) being the most common tuberculid. The most common form of true cutaneous TB was that of Lupus Vulgaris (13%). Acid fast bacilli stains were the most common histopathological investigation done on tissue biopsies. Panniculitis (35.4%) was the most common histological feature. The most common clinical manifestation was that of nodules (59.3%). Few patients presented with polymorphic manifestations (20.3%). The lower limbs were the most common affected site in cutaneous TB particularly Erythema induratum (p<0.001). Other key findings for Erythema Induratum were its prevalence in females (p<0.001), histopathological findings of granulomas, vasculitis, panniculitus and AFB negativity (p<0.001). 33 of the 69 patients were HIV positive but the HIV status did not show a relationship with any form of cutaneous TB (p=0.971). Erythema Induratum patients who were HIV positive, were more likely to be on ARV’s (p<0.001). Despite South Africa being at the forefront of the HIV/TB epidemic, cutaneous TB remains uncommon. The advent of ARVs being prescribed to all HIV positive patients may have played a role in these patients presenting in a similar clinical and histopathological manner as HIV negative patients.
  • No Thumbnail Available
    Item
    Short-term Outcomes in obese patients undergoing anterior minimally invasive total hip arthroplasty
    (University of the Witwatersrand, Johannesburg, 2023-07) Goga, Nabila; Pietrzak, Jurek Rafal Tomasz; Cakic, Josip Nenad; Magobotha, Sebastian Keith
    Introduction: Obesity affects over 774 million individuals worldwide. It is associated with an accelerated onset and progression of osteoarthritis, resulting in an increased need for total hip arthroplasty (THA). Obese patients have a higher risk of perioperative complications. The direct anterior approach (DAA) for THA is gaining popularity globally, however, there are concerns over its suitability for obese individuals. This study compares short-term clinical, functional, and radiological outcomes of obese and non-obese patients undergoing THA via the DAA. Methods: We conducted a retrospective study of 356 consecutive patients who underwent elective primary THA via the DAA using a specialised leg positioner (Medacta International, Switzerland) and intraoperative fluoroscopy. Obese patients (BMI - 30 kg/m2 ) were compared to the control group using baseline patient information, perioperative data and postoperative outcomes at minimum one-year follow-up. Results: The study included 107 (30%) obese patients. Cohorts were well-matched for age, sex, preoperative diagnosis and baseline PROMs. In the obese cohort, surgical time and blood loss increased by a mean of 8.32 - 6.9 minutes (p = 0.03) and 58.19 - 25.37 ml (p = 0.0003) respectively. There were no significant differences in intraoperative radiation (mGys), time to discharge and discharge destination between the groups. Obese patients had a higher incidence of wound-related complications (5.6% versus 2.4%), however overall complication rates were similar (9.3% versus 6.8%, p = 0.67). Functional outcomes were equivalent with a mean postoperative mHHS of 97.57 - 4.86 and 98.05 - 5.59 in the obese and non-obese cohorts respectively (p = 0.54). PROMs including the Forgotten Joint Score (p = 0.34), Patient Joint Perception score (p = 0.2) and patient satisfaction rates (p = 0.085) were comparable. Conclusion: The AMIS - DAA is a safe and effective approach for obese patients with excellent short-term outcomes, however an increased risk of wound-related complications remains.
  • No Thumbnail Available
    Item
    Clinical course and outcomes of confirmed and suspected Pneumocystis jirovecii pneumonia in Sowetan children living with HIV
    (University of the Witwatersrand, Johannesburg, 2022-07) Darji, Mohiniben; Moore, David Paul
    Introduction: Pneumocystis jirovecii is an important opportunistic pathogen in children living with HIV (CLWH), responsible for the majority of community acquired pneumonia (CAP) admissions in infancy. There is scanty evidence on long-term survival rates in children hospitalised with P. jirovecii pneumonia (PCP), especially in settings with a high burden of paediatric HIV. Methods: Admissions to general paediatric wards at Chris Hani Baragwanath Academic Hospital over the period 01 January 2011 to 31 December 2019 were assessed for a discharge diagnosis of PCP. PCP was classified as being confirmed or presumed, based on laboratory criteria. Only CLWH were included in the study. Results: Over the 9-year study period, 390 cases of PCP were diagnosed, of which 297 (76.2%) were in CLWH. The majority of the PCP episodes were presumed (262/297, 88.2%). Sixteen children had recurrent PCP admissions. There was no difference between the median age of children at admission with confirmed PCP or presumed PCP (4.07 months vs 3.66 months; P=0.590). Children with presumed PCP were significantly underweight (weight-for-age Z-score -2.88 vs -1.74; P<0.001) and wasted (weight-for-length Z-score -1.15 vs -0.38; P=0.039) compared to those with confirmed PCP. Children with presumed PCP had a higher prevalence of confirmed pulmonary tuberculosis (7/18 (38.9%) vs 1/35 (2.9%); P=0.002). The majority (56.1%) of patients were initiated on antiretroviral therapy (ART) one week after the PCP admission episode. Of 58 PCP episodes in which data on mechanical ventilation was available, 18 (31.0%) were ventilated. Case fatality was 44.4% in ventilated patients, and the overall in-hospital case fatality was 24.8%. One-hundred, twenty-five children were followed up at the outpatient ART Clinic, of which 42 (33.6%) were still in care at the end of the study. The median duration of co-trimoxazole preventive therapy was 1278 days. Conclusion: PCP was often the first presentation of HIV infection. Children with PCP still have poor outcomes. Despite the decline in PCP admissions, there was a high in-hospital mortality rate.
  • No Thumbnail Available
    Item
    Blood management strategies in posterior corrective surgery for idiopathic scoliosis
    (University of the Witwatersrand, Johannesburg, 2022-11) Aftab, Mohammad Hamza Sultan; Ukunda, U.N.; Robertson, A.J.F.; Milner, B.
    Background: Corrective surgery for idiopathic scoliosis is associated with large volumes of blood loss and a need for blood transfusion. The aim of the study was to measure blood loss and blood products used intra-operatively in corrective surgery, and to identify modifiable factors that may influence blood loss. Methods: The study was a retrospective review of patients who underwent posterior corrective surgery for idiopathic scoliosis between 2015 and 2020. A total of 43 patients were identified, of which 36 met the inclusion criteria. Sociodemographic data, intra-operative blood loss parameters, transfusion requirements, and use of tranexamic acid, intra-operative cell salvage and ultrasonic bone scalpel were documented. Data were analysed to identify factors affecting intra-operative blood loss and blood transfusion. Results: The 36 patients (30 female, 6 male) had a median age of 16 (interquartile range: 13-17) years. The mean duration of surgery was 355 (+/-75.38) minutes and the average number of segments fused was 10.25 (+/- 1.87). The mean estimated blood loss was 722.22 (+/-328.30) mL with the mean percentage blood loss being 22.99 (+/-11.61) %. A total of 11 patients (30.56%) received a blood transfusion; in these patients every 139.58 mL of blood lost resulted in 1 unit of blood being transfused (p=0.005). Statistically significant differences in mean estimated blood loss were found with the use of tranexamic acid (p=0.018) and ultrasonic bone scalpel (p=0.01). The use of intra-operative cell salvage did not result in statistically significant differences in mean estimated blood loss. A direct correlation was also found with estimated blood loss and the duration of surgery (p=0.025), and the number of segments fused (p=0.005). Conclusion: Modifiable factors affecting intra-operative blood loss include the use of tranexamic acid, ultrasonic bone scalpel, duration of surgery and the number of segments fused. A multifactorial blood management strategy should be implemented to decrease blood loss and reduce the need for blood transfusion in corrective scoliosis surgery.
  • No Thumbnail Available
    Item
    Language choices and mental health: Black South African medical doctors' view on teaching indigenous African languages to children
    (University of the Witwatersrand, Johannesburg, 2023-11) Kaaka, Mmaphuti Dorothy; Viljoen, Barry
    Background: In a rapidly globalising world, safeguarding cultural heritage and indigenous languages is crucial. This study examined the views of black South African medical practitioners on teaching indigenous African languages to children at home amid challenges posed by English being the main language of teaching in formal education. Aim: We explored the perceptions of black South African doctors working in psychiatry regarding teaching indigenous African languages to children and investigated their reasons and the perceived impact of these choices on children's mental health. Setting: Urban-dwelling black South African indigenous language-speaking doctors who worked at community psychiatry clinics near Johannesburg, South Africa, were interviewed. Methods: A qualitative, descriptive research design was used. One-on-one interviews of twelve purposively sampled participants were held and transcribed. The data was analysed thematically. Results: Five themes were generated. Participants emphasised teaching their children African indigenous languages for cultural preservation purposes. They held that formal English-medium education hindered fluency in indigenous languages when spoken by children. Parents reported anxiety during visits to rural parts of South Africa due to the English-speaking child's inability to speak the parent's indigenous language with other rural-based black people. Perceived ostracism by other black people and the impact thereof on their children's mental health was a concern. The future of African indigenous languages was feared to be bleak. Conclusion and contribution: In conclusion, this research demonstrates that black South African doctors working in psychiatry facilities value teaching indigenous African languages to children to preserve culture. It highlights concerns about the negative impact of English-medium education on indigenous African language fluency of children and the potential mental health consequences of social isolation from other black people due to language barriers. The study suggests more inclusive education and efforts to revive indigenous languages at home to mitigate these concerns.
  • Thumbnail Image
    Item
    Evaluation of knowledge, attitudes, and practice of basic life support among laypersons
    (University of the Witwatersrand, Johannesburg, 2022-05) Ihwo, Michael Ibanbeteliehe; Botha, Martin; Sofola-Orukotan, Sunday Oladapo
    Background: Out-of-hospital cardiac arrest (OHCA) constitutes a significant public health challenge accounting for the majority of deaths globally. There is an improved chance of survival when bystander cardiopulmonary resuscitation (CPR) is incorporated into the OHCA chain of survival. There is a paucity of local data on the knowledge, attitudes, and practice of basic life support (BLS) among laypersons. This study aimed to evaluate the knowledge, attitudes, and practice of BLS among laypersons in a church community in Johannesburg, South Africa. Methods: This was a prospective descriptive cross-sectional study. A self-administered questionnaire was used among the convenience sample of 205 participants. Adult worshippers of a church in South Africa who were 18 years and above were included. The study was conducted between December 06, 2020, and March 28, 2021. Results: The mean ± SD age of the participants was 36.6 ± 12.6, with the majority of 128 (62.4%) below 40 years. There were 104 (50.7%) females and the males were 101 (49.3%). A total of 30 (14.6%) participants had previous CPR training. Only 24 (11.7%) respondents knew all the signs of cardiac arrest, while the signs for evaluating unconsciousness and absent respiration were correctly identified by 51 (24.9%) and 114 (55.6%) participants respectively. Knowledge of CPR practical application was generally poor. The proportion of subjects who identified the correct answers are reflected as follows: compression to ventilation ratio (15.6%), compression site (11.7%), compression rate (20%), compression depth (22.9%), how to determine the adequacy of artificial breathing (31.7%), the meaning of CPR (19.1%) and function of an automated external defibrillator (AED) (11.2%). About one-third (34.1%) of the participants reported that they can perform both chest compression and mouth-to-mouth ventilation. Previous CPR training was associated with better knowledge of BLS and confidence in responding to OHCA. Overall, most of the participants stated that they would perform CPR on family members and friends without hesitation than on strangers, while 74.6% indicated a willingness to learn CPR. Age and sex generally had no significant effect on the knowledge, attitude, and skills of BLS among the respondents. The most important barrier to performing CPR was the fear of making a mistake. Conclusion: This study reflected insufficient knowledge but positive attitudes with regard to the practice of CPR. Knowledge of BLS is better among those with previous CPR training. The fear of making a mistake was the biggest concern for why participants will be reluctant to provide CPR. Programs, campaigns, and training targeting different segments of the community/society may improve knowledge of bystander CPR/BLS.