3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Laparoscopic versus open surgery for complicated appendicitis: a randomized controlled trial to prove safety(2015) Thomson, John-EdwinBackground To date, no randomized control trial has been performed comparing open appendicectomy (OA) to laparoscopic appendicectomy (LA) in complicated appendicitis. A systematic review and meta-analysis in 2010 concluded LA is advantageous to OA with less surgical site sepsis in complicated appendicitis; however, the level of evidence is weak (level 3a). The aim of the study was to determine whether LA is safe in the treatment of complicated appendicitis. Methods One hundred and fourteen patients were randomized prospectively to either OA or LA using a computer generated blind method. Patients who were either less than 12 years of age, had previous abdominal surgery or were pregnant were excluded. A team of senior surgeons capable of doing both OA and LA performed all procedures. Primary outcome included all-cause mortality and procedure-related mortality; secondary outcomes included intra-operative duration, rates of wound sepsis and re-intervention, length of hospital stay and re-admission rates. The trial was registered with Current Control Trials (ISRCTN92257749). Results The intra-operative duration, the rate of wound sepsis, the number of re-operations, the length of hospital stay and the rate of re-admissions between the OA and LA groups did not differ statistically. Conclusion Laparoscopic appendicectomy is safe in complicated appendicitis.Item Spatial analysis of Schistosoma Haematobium infection among school children in a rural sub-district of South Africa: an application of geographical information systems (2009)(2009-11-24T09:58:38Z) Azongo, Kwaku DanielBackground Assessing risk of schistosomiasis requires knowledge of the spatial distribution of the disease and its association with demographic, socioeconomic, behavioural, and environmental factors over time and space. The objective of this study was to advance such knowledge by analyzing the spatial distribution of schistosoma haematobium infections in relation to the demographic attributes and environmental covariates of the Africa centre Demographic Surveillance Areas (DSA) in rural KwaZulu-Natal. The study also examined the association between household socio-economic conditions and rates of S. haematobium infection with particular emphasis on the impact of pipe water on rates of infection. Methods The study is a crosses sectional study, involving all 33 primary schools in Africa Centre DSA. 2110 grade five and six children took part in the study. Statistical analysis was done using chi square tests to compare statistical significant differences between sex and age groups. Bivariate and multivariate logistic regression models were used to explore factors that are significantly associated with infection. Spatial analysis was done to examine the spatial distribution of the disease using geographical information systems techniques. Microscopic analysis of the urine samples was done using the filtration technique. Results Of the 2110 school children who were screened for infection, 347 tested positive for the presence of iv S. haematobium, representing an overall prevalence of 16.6%. Prevalence levels were higher in boys (20.8%) than females (8.5%) (P<0.001). 57.6% were heavily infected (eggs ≥50 eggs per 10ml urine) as compared to 42.5% who had light infection (eggs<50 eggs/10ml of urine). Whereas, prevalence was significantly age-dependent (Pearson chi2 (3) = 28.4184, P< 0.001), intensity of infection was not significantly age dependent (Pearson chi2 (3) = 3.2579, P<0.354). Altitudinal variation, access to portable water, toilet, and distance to water bodies were significantly associated with infection. Prevalence of infection was clustered around the Eastern part of the study area. Conclusion While there may be several factors associated with schistosoma infection in the study area's school children; age, sex, water contact behaviour, homestead altitude and distance to permanent water bodies, were the most significant risk factors explaining the spatial distribution of S. haematobium infection in the Africa Centre DSA. Selective Mass treatment of S. haematobium infection in 7 clustered areas is recommended for the control of the disease.Item Studies on the epidemiology of toxoplasmosis in South Africa(2009-09-16T12:33:15Z) Kistiah, KesenthriToxoplasmosis is an infection of vertebrates caused by the obligate intracellular protozoan parasite, Toxoplasma gondii. It is one of the most common parasitic diseases of humans, infecting approximately one third of the world’s population. It is a significant cause of congenital disease and an important opportunistic pathogen which has become an increasing problem worldwide due to the AIDS epidemic. There is limited historical information about the disease in South Africa. More knowledge is needed at a regional level to properly consider solutions aimed at reducing the risk for this disease. The seroprevalence of T. gondii in samples of selected populations at risk, namely HIV-positive individuals and a more general population sample biased towards pregnant women, was therefore investigated and found to be 9.8% (37/376) and 6.4% (32/497) in the respective samples. The Pastorex Toxo latex agglutination test was evaluated and found to be a cheap, reliable method to screen for T. gondii exposure. PCR-based diagnostics were developed for direct diagnosis on tissue samples. Rodent T. gondii infection prevalence was investigated, but did not yield any positive results. This study helped to answer questions relating to the seroprevalence and diagnosis of T. gondii in South Africa. Many questions still remain to be answered, however to fully understand the impact of this parasite in our country.Item Neonatal hyperbilirubinemia bilirubin encephalopathy: investigations into the diagnosis, epidemiology, pathogenesis, management and treatment of the jaundiced newborn(2009-05-22T11:24:13Z) Maisels, Michael JeffreyJaundice is probably the most common newborn infant problem dealt with on a daily basis by the family practitioner and paediatrician. Jaundice occurs when the liver cannot clear a sufficient amount of bilirubin from the plasma. When the problem is excessive bilirubin formation or limited uptake or conjugation, unconjugated (i.e., indirect reacting) bilirubin appears in the blood and indirect hyperbilirubinemia is the predominant form of jaundice found in the newborn infant. In the vast majority of newborns, hyperbilirubinemia is transient and benign but, in rare cases, the serum bilirubin rises to a level that is toxic to the central nervous system. Understanding the pathogenesis and epidemiology of neonatal hyperbilirubinemia; recognizing, the problems involved in appropriate surveillance and monitoring of the jaundiced infant and the factors contributing to bilirubin encephalopathy; and implementing treatment of the jaundiced neonate in a timely fashion, are issues that have engaged clinicians and researchers for some 6 decades. This work will summarize my contributions to the field of neonatal hyperbilirubinemia and it includes papers published between 1971 and 2007. The description of this work will not follow its chronological sequence, but will be divided into the categories of diagnosis, epidemiology, pathogenesis, management, treatment, and bilirubin encephalopathy.Item Epidemiology of primary paediatric brain tumours at Johannesburg and Chris Hani Baragwanath hospitals from April 1995 to April 2005(2009-05-15T10:55:05Z) Nkusi, Agabe EmmyEpidemiology of primary paediatric brain tumours has been studied extensively in developed countries of the west. Such studies are lacking in developing countries especially sub-Saharan Africa. This study seeks to establish the epidemiology of primary brain tumours seen among children that were treated at Chris Hani Baragwanath and Johannesburg Hospitals from April 1995 to April 2005. The records of 252 patients who presented with this condition during the study period were reviewed, for the following details: ● Demographic details such as age, gender and race ● Diagnosis and the date when it was made ● The follow-up period at the hospital(s)/clinic(s) ● The anatomical location of the tumours; supratentorial or infratentorial ● The treatment that was given which included mainly surgery for tumour removal or biopsy, radiotherapy, chemotherapy and others which included ventriculoperitoneal shunt, external ventricular drain insertion. ● The outcome of treatment included: - alive - dead - presumed alive - lost to follow-up It was found: ● That 225 patients had full demographic details of race, gender and age. ● That there was a slight male predominance among children with primary brain tumour. ● That the majority of children with brain tumours were black, followed by whites which is in keeping with the country’s demographics. ● The three most common tumours were astrocytomas, medulloblastomas and brainstem gliomas in the descending order of frequency. ● Medulloblastomas were the commonest tumours in the infratentorial region while craniopharyngiomas were commonest tumours in the supratentorial region. ● More children had infratentorial tumours ● Younger children were more likely to have infratentorial tumours. ● Majority of patients had surgery either for diagnosis or for diagnosis and treatment. ● Few patients were presumptively diagnosed clinically and by imaging modalities ● Combination therapy of surgery, chemotherapy and radiotherapy had the best survival outcome while chemotherapy as the only form of treatment had the worst outcome. ● The overall 5 year survival rate for all the study participants was much lower than that of their counterparts in the literature. ● Children who had craniopharyngiomas and astrocytomas had better survival. ● Mortality incidence was slightly higher for whites than blacks but that could have been skewed by a high number of blacks that was lost to follow-up. ● A higher infratentorial tumour prevalence than in the literature was noted. It was noted that racial prevalence of primary paediatric brain tumours follows population demographics. From the results of this study, there is a need for a better record keeping and improved patients follow-up. There is also a need for a larger epidemiological study in the two hospitals. There is need to establish a specialized paediatric unit which will help start a paediatric team comprising of a paediatric neurosurgeon, paediatric oncologist, paediatric intensivist and neuroradiologist with dedicated neuropaediatric ICU. Such a team given resources will improve survival outcome of children with brain tumours.Item Analysis of the Genetic Diversity of Neisseria Meningitidis in South Africa(2006-11-15T07:58:01Z) Coulson, Garry BrianMeningococcal disease is an important cause of morbidity and mortality worldwide, particularly in children and young adults. Epidemics caused by Neisseria meningitidis continue to plague many countries on a global scale, none more so than countries of the African ‘meningitis belt’, where attack rates can reach up to 1000/100,000 population. It has been well recognized that most epidemic and endemic cases of meningococcal disease are caused by a limited number of genetically defined clonal groups. The objective of this molecular epidemiological study was to genotypically characterize strains of N. meningitidis collected in South Africa from July 1999 to July 2002. Characterization of meningococcal strains belonging to serogroup A, B, C, W135 and Y, by PFGE and MLST allowed us to determine the genetic population structure of N. meningitidis in South Africa, and thus identify the predominant clonal groups responsible for the majority of meningococcal disease in the country over this period. The results from the genotypic characterization revealed that the greatest majority of meningococcal disease in South Africa was caused by a strains belonging to only a few “hyperinvasive lineages”, most notably strains of the ST-44 complex (lineage III), ST-32 complex (ET-5 complex), ST-11 complex (ET-37 complex), and the ST-1 complex (subgroup I/II) which have all been responsible for major epidemics worldwide. These findings have direct implications on public health decision, particularly with regards to the development of effective intervention and control strategies, and emphasize the need for continuous long-term monitoring of the circulation of these strains in the population.