3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Systemic lupus erythematosus: the Johannesburg experience(1986) Morrison, Richard C. A.This study is a predominantly retrospective analysis of patients in Johannesburg who presented with Systemic Lupus Erythematosus at 12 years of age or older. Johannesburg is situated at high altitude and has a high level of ultraviolet light irradiation/ a known exacerbating factor of the disease. This study draws comparisons with reported disease characteristics of lupus patients elsewhere in the world. In addition/ it examines differences in the clinical manifestations of the disease amongst the principle South African racial groups.Item Comparative analysis of test performance of South African learners on index/scales of the Wechsler Intelligence Scale for Children, Fifth edition (WISC-V) and the Kaufman Assessment Battery for Children, Second edition (KABC-II)(2020) Cassoojee, ZainubThe use of psychological assessment for the purposes of placement, diagnosis, curricular planning, and intervention is widespread among South African practitioners. However, test development within South Africa is scarce, which results in the use of internationally developed measures that have not been standardised or normed for the South African population. This practice brings into question the validity and applicability of these measures in South Africa. This research investigated and compared the construct and concurrent validity of the Wechsler Intelligence Scale for Children, fifth edition (WISC-V) and the Kaufman Assessment Battery for Children, second edition (KABC-II). More specifically, the Verbal Comprehension Index (VCI) on the WISC-V was compared to the Knowledge Scale (Gc) on the KABC-II; the Visual Spatial Index (VSI) on the WISC-V was compared to the Simultaneous Processing Scale (Gv) on the KABC-II; the Fluid Reasoning Index (FRI) on the WISC-V was compared to the Planning Scale (Gf) on the KABC-II; and the Working Memory Index (WMI) on the WISC-V was compared to the Sequential Processing Scale (Gsm) on the KABC-II. The theoretical underpinning of each assessment measure indicates that these indexes/scales assess similar cognitive abilities and processes. The purpose of the comparison was to determine not only the nature of the relationship between the indexes/scales on the WISC-V and KABC-II but also whether there is a significant difference between the scores achieved on those indexes/scales that claim to measure the same/similar underlying constructs. The method used to carry out this research was a non-experimental, within-group, correlation quantitative study. The sample was 50 referred learners from a private remedial school in the South of Johannesburg. The data was analysed using the Pearson correlation and a paired samples t-test. The results indicated good construct validity: strong correlations were identified between the VCI and Gc; VSI and Gv; FRI and Gf; WMI and Gsm; and, interestingly, WMI and Gc. The WMI was designed to measure constructs of short-term memory. However, a strong correlation with the Gc scale suggests a significant association between WMI and knowledge, crystallised intelligence, and prior learning on the WISC-V as compared to the KABC-II. The t-test found differences between all four scales: the VCI/Gc and WMI/Gsm comparisons were statistically significant. These results showed an incongruence in the inclusion and exclusion of narrow abilities on the WISC-V and KABC-II – specifically between the inclusion of the Digit Span Backward subtest on the WMI and the Verbal Knowledge Scale on the KABC-II (which allows for pointing responses that reduces the influence of language and verbal input). The research conclusion was that although these tests show good construct validity, the score discrepancy is significant, and they can therefore not be used interchangeably in the South African contextItem The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa(2018) Bakuwa, TakondwaBackground: Cerebral palsy (CP) is one of the most complex disabling disorders in children that newly qualified therapists face in practice. Newly qualified therapists do not feel prepared to deal with complex conditions despite being expected to. Short practical training courses could potentially help bridge this gap in readiness. The aim of the study was to determine the value of the practical training course on CP to the practice of newly qualified therapists. Methods: Secondary analysis of therapists’ course evaluation records from eleven short practical training courses was done. Mixed methods were used to establish expectations of course participants, change in their level of CP knowledge, aspects of the course deemed useful for CP practice and change in attitudes, perceptions and practice intents. Results: Course expectations of the majority of the therapists were met, most of whom reported having also gained skills and confidence. Significant change was observed in the self-perceived level of knowledge in various aspects of CP after the course (p < .001). Aspects on communication and play therapy showed the most significant difference (p < .001). Therapists appreciated adult teaching and learning methods, conducive learning environment, the relevant and organised content and holistic approach of the course. They reported readiness to adopt positive attitudes and perceptions and practice. Conclusion: A short practical training course was therefore valuable in addressing the perceived lack of readiness amongst newly qualified therapists working with children with CP. It was capable of improving their knowledge and changing their attitudes, perceptions and practice intentions positively.Item Role of molecular evolution in respiratory syncytial virus antigenic proteins during annual epidemics in South Africa(2004-05-28) Agenbach., Elizabeth.Respiratory syncytial virus (RSV) is a major cause of pneumonia in children worldwide and there is currently no vaccine available. Molecular analysis of annual RSV epidemics in Soweto (1997 to 2000), revealed co-circulation and displacement of dominant genotypes. However in 1999 to 2000, one genotype GA2, predominated. To further elucidate the molecular epidemiology of RSV in South Africa the 2001 RSV epidemic in Soweto was characterised. Phylogenetic analysis of the G-protein revealed subtype B dominance (89%). Sequences clustered in genotypes GA2, GA5, SAA1, GB3, SAB1 and SAB3. SAB3 dominanted (69%) followed by SAB1 (18%), thereby displacing GA2, which dominated the previous two seasons. Evidence of positive selection may account for the genetic variability observed and may contribute to the reestablishment of annual epidemics. To investigate if this influences evolution of other RSV antigenic proteins the F-protein of South African genotypes was characterised. Most amino acid differences identified within known neutralising and CTL epitopes were conserved within subtype A, and although this does not suggest immune selection these epitopes may not be recognised efficiently by antibodies or CTL specific to subtype B virusesItem Characterization of genes conferring v factor independence in haemophilus parainfluenzae and haemophilus ducreyi(1994-12-18) Windsor, Helen. MarieHaemophilus influenzae and Haemophilus parainfluenzae are obligate human parasites that form part of the flora of the mucous membranes. They are normally present in the mouth and upper respiratory tract of healthy individuals. H. influenzae is known as a major pathogen in children while H. parainfluenzae is an opportunistic pathogen which is also found in the urogenital tract. H. ducreyi, however, has only been isolated from genital ulcers in patients suffering from chancroid. The various species of the genus Haemophilus are characterised by their requirements for two growth factors, X factor or haemin and V factor or nicotinamide adenine dinucleotide (NAD).Item The impact of haemophilus influenzae type b (hib) vaccine on pneumonia and meningitis among children under the age of 1 year in the Klerksdorp district of the North West Province(2000-11-07) Sebekedi ( Nee Mhele), Otsile, CalviniaThe purpose of this study was to determine the impact of Hib vaccine on pneumonia and meningitis in children under the age of 1 year in the Klerksdorp district of the North West Province.Item Genetic variation in gp 120 V1?V2 and neutralization sensitivity of HIV-1 subtype C isolates from children with rapid and slow disease progression(2003) Choge, Isaac Ang' Ang' AThis project explore genetic variation and antibody neutralization sensitivity in gp 120 V1/V2 and C2-V5 region amongst HIV-1 subtype C pediatric isolates. Isolates from 25 slow progressing children and 16 rapid progressing infants were used in subtyping and quasispecies analysis performed with a novel V1/V2 heteroduplex mobility assay (HMA)Item A pilot study evaluating depression in mothers with children diagnosed with Down syndrome in state healthcare(2017) Swanepoel, MelissaParenting a child who has an intellectual disability has been shown to increase the risk for developing depression. The purpose of this study was to screen for depression in mothers with a child diagnosed with Down syndrome in state health care in Johannesburg, and to identify associated sociodemographic variables. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression in participants along with a 10-item sociodemographic questionnaire, administered to 30 biological mothers of children postnatally diagnosed with Down syndrome. Eight mothers (26.7%) screened positive for depression with an EPDS score of 13 or greater. A statistically significant association was found between an HIV positive status and mothers who had an EPDS score of 13 or greater (p = 0.01). No significant association between a positive screening score for depression and various other sociodemographic factors were identified. Mothers with children diagnosed with Down syndrome, may be vulnerable towards developing depression.Item Comparison of coronal minimum intensity projection CT reconstructions with flexible bronchoscopy for airway compression in children with Lymphobronchial TB(2018) Krim, Ahmed Omar AliINTRODUCTION Tuberculosis (TB) remains one of the most important causes of morbidity and mortality in children in Africa, as well as the rest of the world. Lymphobronchial TB (LBTB) occurs when tuberculous adenopathy affects the airways, either by direct involvement (inflammation and erosion) or by indirect involvement (compression and stenosis). Endobronchial TB (EBTB) is the inflammation of the tracheobronchial tree, which is caused by tuberculosis, and is secondary to the rupture of lymph nodes into the bronchi, or the extension thereof to the peribronchial region, by lymphatic drainage. Identification of airway compromise due to any of these processes can be performed invasively using flexible bronchoscopy or non-invasively with CT scanning, including post processing techniques such as minimum intensity projections (MinIP). AIM This retrospective study aimed to generate standardised coronal minimum intensity projection (MinIP) CT reconstructions, and compare these with fibreoptic bronchoscopy in children with LBTB. METHOD Standardised coronal MinIP reconstructions were performed from CT scans in children with LBTB and the findings of three readers were compared with flexible bronchoscopy (FB), regarding airway abnormalities. Intraluminal lesions, the site of the stenosis, and the degree of stenosis were evaluated. The length of stenosis was evaluated by CT MinIP only, and no comparison to FB has been made. RESULTS 65 children with LBTB met the inclusion criteria (38 males; 58.5% and 27 females; 41.5%), with ages ranging from 2.5 to 144 months. Coronal CT MinIP demonstrated a sensitivity of 96% and specificity of 89% against FB. The most common site of stenosis was the bronchus intermedius (91%), followed by the left main bronchus (85%), the right upper lobe bronchus RUL (66%), and the trachea (60%). Agreement between coronal CT MinIP and FB ranged from 36.9% at the carina to 84.6% at the RLL in normal and abnormal airways. CONCLUSION This study has proven that a standardised coronal CT MinIP reconstruction is useful in demonstrating airway stenosis in children with lymphobronchial TB, with sensitivity of up to 96% and specificity up to 89%. The most common sites of stenosis found by the coronal MinIP CT reconstruction were the BI (91%), followed by the LMB (85%), the RUL (66%), and the trachea (60%). The coronal CT MinIP had additional advantages over FB in that it allowed objective measurement of the diameter of the stenosis, measurement of the length of the stenosis as well as visualisation of the post-stenotic segments of the airways. CT MinIP was also able to provide information about lung parenchymal abnormalities. Standardised coronal MinIP reconstructions are easily performed, as described in our paper, and should be provided with each set of cross sectional MDCT images in children with LBTB. This one single image can provide easily appreciable and useful airway information and additional information not available from FB.