3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Description of the children with aortic stenosis at the Chris Hani Baragwanath Academic Hospital over 20 years(2017) Mendes, Jacqueline FariaIntroduction Data about congenital heart disease, in particular aortic stenosis, remains scarce from the African continent. Aortic stenosis can be supravalvular, valvular or subvalvular. Anecdotal evidence in our setting suggested that the aortic stenosis subtype profile differed to that of western literature. A retrospective record review of all children presenting to Chris Hani Baragwanath Academic Hospital with aortic stenosis from 1984 to June 2015 was undertaken. Results The majority of the patients 76% (n=205), presented with subvalvular aortic stenosis. Boy and girl children were almost equally effected. The echocardiographical peak instantaneous gradient measured across the stenotic left ventricular outlet obstruction varied depending on the level of stenosis. The majority of subvalvular aortic stenoses 123 (62%) presented with mild peak instantaneous gradients (p<0.005) at presentation, most likely due to its copresence with ventricular septal defects. Furthermore, the majority of children with subvalvular aortic stenosis presented with co-existing cardiac lesions. Consequently, the majority of patients with discrete subaortic stenosis (n=116, 61%) required surgical intervention. Conclusion DSAS was highlighted as the predominant aortic stenosis subtype in this population. This is different to western literature where valvular aortic stenosis is most common. Boys were not found to be significantly more affected than girls, as reported in other countries. The majority of patients had associated cardiac lesions, and most of which required invasive surgical treatment. Key words Congenital cardiac lesions, aortic stenosis, valvular, subvalvular, peak instantaneous gradient, isolated discrete subvalvular stenosis.Item Outcomes of pregnant patients with cardiac disease at Chris Hani Baragwanath Academic hospital(2018) Mugwede, MaideiIntroduction: The incidence of cardiac disease in pregnancy ranges between 0.1 – 4.0%. It is the 5th leading cause of maternal deaths in South Africa. Management of pregnant cardiac patients involves pre-pregnancy counselling, with risk assessment and monitoring of the mother and fetus by a multidisciplinary team which includes an obstetrician, materno-fetal medicine subspecialist, cardiologist, neonatologist, geneticist and an anaesthetist. Objectives: To determine the maternal morbidity and mortality in cardiac patients presenting at Chris Hani Baragwanath Academic Hospital (CHBAH), as well as their neonatal outcomes and to obtain information about specific cardiac conditions in these patients, their obstetric management and the short-term effects of pregnancy on the underlying cardiac lesion. Methods: This was a prospective descriptive study where post-delivery cardiac patients were approached to enrol in the study from August 2013 to January 2014. Data was collected from the patients’ antenatal records and cardiology reports. Patients were also interviewed to determine more detailed information regarding previous pregnancy outcomes and cardiac complications which were not available in the antenatal records. Neonatal information was obtained by follow-up visits to the neonatal wards. Results: Acquired cardiac conditions accounted for 88.1% of the study patients (Rheumatic Heart Disease (RHD) 42.9% being the most common) while 11.9% were congenital. Most of the patients had a New York Heart Association (NYHA) class of I (85.4%) at antenatal booking. Of the participants in the study, 33.3% were human immunodeficiency virus (HIV) positive. Caesarean section accounted for 66.7% of v the deliveries while 33.3% were by normal vaginal delivery. There were 42.9% of women who experienced morbidities during their pregnancies with 27.5% suffering a decline in their NYHA class. Only eleven patients had a post-partum ECHO, in whom 82% showed a decline in the ejection fraction (EF). Intrauterine growth restriction (IUGR) complicated 44% of pregnancies. The perinatal mortality rate was 7%. There were no maternal deaths. Conclusion: Rheumatic heart disease is still the predominant underlying cardiac lesion. There is considerable maternal morbidity and perinatal morbidity and mortality in cardiac patients at CHBAH. The multidisciplinary team approach is improving the maternal and perinatal outcome in pregnant women with heart disease at CHBAH.Item Describe cardio-metabolic diseases and the associated cost in a district hospital in the North West Province(2014-10) Moalosi, Derrick MeritingBACKGROUND: Gelukspan District Hospital is situated in the Ngaka Modiri Molema District in the North West Province. The majority of patients admitted in the adult medical wards of this Hospital are due to two conditions namely (a) HIV/ AIDS and (b) Cardio-metabolic diseases. The Hospital regularly analyse data related to the HIV/ AIDS patients for HIV/ AIDS conditional grant. The information related to cardio-metabolic diseases are seldom analysed by the Hospital management, although there is a belief within the Hospital that more than one thirds of the patients admitted in these two wards are due to cardio–metabolic diseases. This study was planned against this background to systematically analyse the routinely collected data from the Hospital information system. The results of the study would hopefully provide the estimation of the prevalence of these diseases at a health facility level and the cost for managing these conditions. AIM: To describe the profiles of patients admitted of cardio–metabolic diseases in the Gelukspan District Hospital in the North West Province during one year study period (from 01 April 2010 to 31 March 2011). METHODOLOGY: This was a cross-sectional study based on retrospective review of routinely collected data from the Adult Medical Wards of the Gelukspan District Hospital during the one year study period (1 April 2010 to 31 March 2011). No primary data was collected for this study. The study variables included: the number of subjects with cardio-metabolic diseases among the subjects who were admitted in the Medical wards of the Hospital during one year study period; their profiles and the type and cost of laboratory tests performed for these patients at the time of admission. Permission to conduct the research at the Hospital was obtained from the North West Department of the Health and the University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. RESULTS: Number of admissions in male and female medical wards for noncommunicable diseases was 558. There were almost same number of female (n= 287) and male (271) admissions. The result showed that both males and females suffer equally from cardio-metabolic diseases. The age – group 8805634J DM Moalosi vi analysis showed almost a third of the subjects were below 50 years age and another third was above 65 years of age. More than 20% of the population were pensioners representing the age distribution of the study cohort. The majority of the subjects were black (97.8%) and unemployed (98%) representing the demographics of the catchment population. The majority of the women were single (55.4%). There was no significant difference between male and female patients in terms of primary clinical diagnoses. Thirty-nine percent of the males (n=108) and 56% (163) females stayed more than 3 days (the norms of average length of stay for District hospitals. The case fatality rate was 19.5% probably high in a district hospital setting, this implies that probably these patients were not managed properly at the PHC level and or at this The laboratory tests done at the time of admission included random and fasting blood glucose, and creatinine. No HbA1C, lipogram and other renal function tests were done at the time of admission contrary to the norms and guidelines for management of cardio-metabolic diseases. The laboratory test result showed the possibility of significant comorbidity among the patients. Fourteen percent of the subject probably had nephropathy. CONCLUSION: This was the first study conducted in this Hospital to systematically evaluate management of a particular group of patients. Hopefully, this study would assist the Hospital management to improve the management of patients admitted in this Hospital.Item An analysis of myocardial deformation with speckle tracking echocardiography in black patients on haemodialysis(2014-02-10) Yip, AnthonyCardiac disease is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Accurate evaluation of cardiac function is therefore important but difficult with commonly used imaging modalities such as echocardiography being subject to variable load changes in haemodialysis.Item Cardio-metabolic disease and associated risk factors in the Johannesburg Health District(2012-01-17) Moodley, NishilaIntroduction: The global burden of non-communicable diseases (NCDs) has long been neglected, with the omission of NCDs from the Millennium Development Goals (MDGs) bearing testament to this. The growing prevalence of chronic cardio-metabolic diseases in South Africa places huge demands on the health system. This study sought to determine the community prevalence of these cardio-metabolic diseases and associated risk factors in Chiawelo, Soweto – a township undergoing rapid urbanization in the Johannesburg Health District. Methods: The study comprised 337 participants: 124 male and 213 female. This was a community based cross sectional survey using questionnaires, anthropometric and biochemical measurement of HbA1c. Cluster sampling techniques identified eligible adult participants. Regression models were performed to identify factors associated with disease. Ethical approval to conduct the study was obtained from the University of the Witwatersrand and written informed consent was obtained from the participants. Results: The study population was black with middle to higher socio-economic status and education levels below Grade 12 mostly. The prevalence of diabetes mellitus (DM) in this study population was 14%, with many undiagnosed and those with disease poorly controlled. More than half the study population had hypertension (HPT) (58%) and most were poorly controlled. This was a markedly obese population (39%) with 54% of women having a body mass index (BMI) categorised as obese (BMI ≥ 30 kg/m2). Conclusions: The burden of chronic cardio-metabolic diseases in the Johannesburg Health District has been grossly underestimated. The prevalence of HPT and DM was high and both diseases were poorly controlled with obesity reaching epidemic proportions. Countering the burden of disease involves targeting females as a high risk priority group, engaging the community in health promotion and developing a NCD surveillance system. Clinically, it is the findings of this study to support the screening of cardio-metabolic diseases from as early as 30 years of age in males and 40 years of age in females.