Faculty of Health Sciences (ETDs)
Permanent URI for this communityhttps://hdl.handle.net/10539/37925
Browse
209 results
Search Results
Item Validation of Roche immunoassay for severe acute respiratory virus 2/SARS-COV-2 in South Africa(University of the Witwatersrand, Johannesburg, 2023-01) Grove, Jurette Simone; George, Jaya; Mayne, ElizabethBackground: Serology testing is an important ancillary diagnostic to the reverse transcriptase polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate the performance of the Roche Elecsys™ chemiluminescent immunoassay (Rotkreuz, Switzerland), that detects antibodies against the SARS-CoV-2 nucleocapsid antigen, at an academic laboratory in South Africa. Methods: Serum samples were collected from 312 donors with confirmed positive SARS CoV-2 RT-PCR tests, with approval from a large university’s human research ethics committee. Negative controls included samples stored prior to December 2019 and from patients who tested negative for SARS-CoV-2 on RT-PCR and were confirmed negative using multiple serology methods (n = 124). Samples were stored at –80 °C and analysed on a Roche cobas™ 602 autoanalyser. Results: Compared with RT-PCR, our evaluation revealed a specificity of 100% and overall sensitivity of 65.1%. The sensitivity in individuals > 14 days’ post-diagnosis was 72.6%, with the highest sensitivity 31–50 days’ post-diagnosis at 88.6%. Results were also compared with in-house serology tests that showed high agreement in majority of categories. Conclusions: The sensitivity at all-time points post-diagnosis was lower than reported in other studies, but sensitivity in appropriate cohorts approached 90% with a high specificity. The lower sensitivity at earlier time points or in individuals without symptomatology may indicate failure to produce antibodies, which was further supported by the comparison against in-house serology tests.Item Microbiological epidemiology at Chris Hani Baragwanath Academic Hospital: Poly-microbial osteomyelitis analysis(University of the Witwatersrand, Johannesburg, 2023-10) Hlapolosa, Josiah Tiego; Kgagudi, Paul Marule; Jingo, MaxwellBackground: The majority of the patients seen and treated at our clinical setting present during chronic osteomyelitis stage, which is anecdotally likely to be poly-microbial. Adults with poly-microbial infection have a predilection for gram-negative bacteria and anaerobes, a scenario that hypothetically leads to a higher morbidity of poly-microbial osteomyelitis following high-energy trauma. Our study looks into the epidemiology of poly-microbial osteomyelitis treated at our Tumour and Infection unit. Methods: This was a retrospective study of patients treated for osteomyelitis from 1st of June 2016 to 30th of May 2021. Medical records of eligible patients were retrieved for examination. Demographic data such as age, sex and race were recorded. Clinical presentation, and organisms cultured, including their anti-microbial sensitivities were documented. Results: There were 63 participants in the study. Thirty-one (49.21%) participants had mono-microbial osteomyelitis with 32 (50.79%) participants having poly-microbial osteomyelitis. Majority of the poly-microbial patients presented with a draining sinus (68.75%) and most was located in the tibia (50%). Multiple mixed pathogens (both gram-positive and gram-negative) were cultured in combination in our patients and this comprised 71.21% of the total bacteria cultured. Staphylococcus Aureus was the commonest bacteria (30%) isolated, followed by Enterococcus faecalis (12%). The commonest gram-negative bacteriae cultured was Enterococcus cloacae (10%) followed by Acinetobacter baumannii at 7%. Most enterobacteriacae species were sensitive to Ertapenem and Ceftazidime. Conclusion: A slightly higher incidence of poly-microbial osteomyelitis was found in our study than that reported in literature. Furthermore, our study demonstrated a wide variety of organisms found in poly-microbial osteomyelitis, with a large contribution made by gram-negative anaerobic rod shaped bacteria. Cephalosporins were not shown to be valuable as broad-spectrum cover drugs, and most bacteria cultured were found to be insensitive to them. What we suggest is tailoring antibiotics to the specific cultured bacteria and sensitivity. Prompt management of patients with open fractures with early administration of intravenous antibiotics and adequate surgical management may lead to a reduction in the prevalence of chronic osteomyelitis.Item The profile of patients presenting with ST Elevation Myocardial infarction (STEMI) to a regional emergency department in Gauteng, South Africa(University of the Witwatersrand, Johannesburg, 2023-11) Kannai, Jerisha; Moodley, Pravani; Botha, MartinReasons for the research: Cardiovascular disease creates a significant health and socio-economic burden and accounts for 17 million deaths worldwide which equates to 31% of global deaths. (1) In addition, premature deaths from cardiovascular disease in the working population are predicted to increase by 41% by 2030. (2) STEMI is a global concern, with growing morbidity and mortality. (3, 4, 5, 6, 7) The continual increase in STEMI cases will burden our society and the economy. (3) There are few studies in South Africa (SA) on the STEMI population. Further baseline data on our population are required to inform efforts to improve our health system, patient care and to work towards international best practice. Aims: a. To describe the demographic characteristics of patients presenting with STEMI. b. To describe the clinical presentation (symptoms, signs, risk factors, time to treatment) of patients presenting with STEMI in a regional public hospital in Gauteng. c. To determine if age, gender, race, time of presentation and level of prehospital care is associated with adverse outcomes or the need for additional interventions. d. To compare outcomes of patients (admission to general ward / Cardiac Care Unit (CCU) / Intensive Care Unit (ICU) / death). Methods: This was a retrospective observational transverse / cross sectional registry study. Data was collected from a STEMI register maintained at the Emergency Department (ED) of Tambo Memorial Hospital (TMH) from June 2018 until 31 July 2020. Major results: In our study 68% of patients were male. The most common ages at presentation ranged from 40 - 69 years old, with a mean age of 54.4 years. The commonest risk factors included: being a smoker (77%), history of ischemic heart disease (71%), hypertension (55%). The highest prevalence - occurred in the Caucasian race group. Our population group was predominantly transported by private means (52%). Only 10.11% of patients scored red on triage and 30.34% scored orange. The mean duration of symptoms was less than 12 hours. The mean time: from door-to-ECG was 38.5 minutes, door- to- doctor’s assessment was 31,4 minutes, door- to-adjuncts was 53,9minutes and door-to-needle was 101.9 minutes. The majority of patients were transferred out of the ED to cardiology (46.87%) and the general ward (40.62%). Conclusion statement: Within the public sector, SA does not have sufficient data on the STEMI population. The aim of this study was to shed light on the population at TMH. It is crucial to treat STEMI patients speedily and effectively. The findings of this study suggest that patients presenting with STEMI at TMH are similar to patients in other studies, but the time to treatment is longer than the recommended target times. These findings suggest room for improvement in the management of STEMI at TMH. Due to a small sample size, we did not have significant results when analyzing the population group requiring special interventions.Item Avascular necrosis (AVN) of the hip in patients operated in the Orthopaedic Arthroplasty Unit at Chris Hani Baragwanath Academic Hospital(University of the Witwatersrand, Johannesburg, 2023-08) Mwoyofiri, Jephta; Magobotha, S.K.; Frey, C.; Jingo, M.Background: Avascular necrosis (AVN) of the femoral head is a progressive structural damage of the head of the femur because of interruption of blood supply to the subchondral bone resulting in the collapse of the head of the femur and secondary arthritis. Moreover, this chronic debilitating disease of the hip causes an immense contribution to the need for total hip arthroplasty (THA) and is common in young persons between the third and fifth decades of life. The aim of the study was to describe the causes of osteonecrosis of the femoral head (ONFH) in patients operated at Chris Hani Baragwanath Academic Hospital (CHBAH) Arthroplasty unit from 2017 to 2022. Methods: A retrospective review of all patients operated between the above-mentioned period, was conducted through collecting the patients’ demographic data, risk factors and treatment given. Results: The study had 285 participants with AVN from a total of 838 patients who had hip surgery. There were 149 (52%) females and 136 (48%) males. The mean age was 51.7 years with a SD 11.4 years. Majority of the patients were in the age group: 50 ‒ 59 years. The main risk factor of AVN was human immunodeficiency virus (HIV) with 117 (41%) patients. Those on highly active anti-retroviral therapy (HAART) were 115 (98%) patients. The median cluster of differentiation 4 (CD4) count was 584 (IQR 470 ‒ 711) and the viral load was undetected in 29 of the 32 (91%) patients with recorded viral load results. Ficat/Arlet stage 4 had 199 (70%) patients and all our patients had total hip replacement. Conclusion: ONFH contributes significantly to the burden of total joint arthroplasty in young patients. As our study has shown, there are several risk factors such as HIV, alcohol use and steroids being among the commonest. Our study draws attention to the significant burden that HIV has on hip pathology. HIV was the commonest cause of AVN at our local health institution and may be in the Sub-Saharan region. However, in our study we could not isolate HAART as a cause of AVN due to inadequate patient records. Majority of patients usually present with advanced stages of ONFH requiring a femoral head sacrificing operation due to late referral and long waiting list before surgery.Item Analysis of Cholecystectomies at Chris Hani Baragwanath Academic Hospital over three years(University of the Witwatersrand, Johannesburg, 2023-11) Musas, Jean Christian Mwana Mwenyi; Omoshoro-Jones, Jones A.O.; Kruger, DeirdreIntroduction: Laparoscopic cholecystectomy is a commonly performed operation globally. There has been an increasing trend noted worldwide. Reports from South African institutions are infrequent. This study aimed to analyse cholecystectomies performed in a major South African academic hospital over three years. Materials and Methods: A retrospective analysis of cholecystectomies performed at the Chris Hani-Baragwanath Academic Hospital, CHBAH, over a 3-year period (01st January 2017- 31st December 2019) was conducted. Data was obtained from specimens sent for histology and retrieved from the National Health Laboratory database. Annual cholecystectomy rates, age and gender distribution, histological diagnosis and seasonal trends were analysed. A comparison of this data is made with previously published studies. Results: Six hundred and forty-nine cholecystectomies were performed during the study period. Women underwent cholecystectomy more commonly than men (3.5:1; p= 0.001). The median age of patients undergoing cholecystectomy was 42 years (IQR 29-57). There were no cases of incidental gallbladder cancer on histology. There were no significant seasonal differences during the study period. There was a fivefold increase in the annual cholecystectomy rate when compared to a previous study done at CHBAH from 1983-1985. Conclusion: A fivefold increase was noted in the cholecystectomy rate at CHBAH when compared to previous studies. This is in keeping with international trends. This is presumably due to an increasing western lifestyle.Item Vitamin D status in COPD patients at Chris Hani Baragwanath Hospital(University of the Witwatersrand, Johannesburg, 2023) Kola, Imraan; van Blydenstein, S.A.; Omar, S.Background: There has been a growing interest in nutritional/ lifestyle factors, including vitamin D, that may impact Chronic Obstructive Pulmonary Disease (COPD). Most data are in Caucasian populations and temperate climates with minimal African (ethnicity and geographical) data. Objectives: The primary objective was to determine amongst COPD patients the prevalence of vitamin D deficiency (25 [OH]D ≤ 20 ng/ml) and insufficiency (25[OH]D - 21-29 ng/ml). Secondary objectives were to investigate the association between vitamin D and demographic/lifestyle factors; lung function parameters; markers of COPD severity and corticosteroid usage. Methods: A prospective, cross-sectional study of 76 COPD patients was conducted at a tertiary Johannesburg hospital. Patients were interviewed regarding demographic/lifestyle factors, COPD severity markers and corticosteroid therapy. The most recent spirometry was recorded. Blood samples were taken for calcium, alkaline phosphatase and vitamin D. Patients were stratified according to vitamin D status (deficiency and non-deficiency) and statistical analysis was performed to assess for associations. Results: The sample included 72% males and 63% black/ African patients. The prevalence of vitamin D deficiency and insufficiency were 48% (95% confidence interval [CI] 42 -54) and 35% (CI 30-41), respectively. The Modified Medical Research Council (MMRC) dyspnoea scale of ≥2 was associated with a relative risk of 1.34 (CI 1.05-1.7) for vitamin D deficiency in univariate analysis. In multivariate regression only sunlight exposure (<1 hour/day) was an independent predictor of vitamin D deficiency (Odds ratio 2.4, CI 1.3 -4.5) Conclusion: A high prevalence of suboptimal vitamin D levels exists within this sample COPD population. A higher MMRC score was associated with an increased risk of vitamin D deficiency while low sunlight exposure was the only independent predictor of vitamin D deficiency.Item Metataxonomic analysis demonstrates a shift in duodenal microbiota in South African patients with obstructive jaundice: A pilot study(University of the Witwatersrand, Johannesburg, 2023) Hart, Benjamin Mark; Bizos, Damon; Nweke, Emmanuel EkeneThe human gastrointestinal tract (GIT) is home to an abundance of diverse microorganisms, and the balance of this microbiome plays a vital role in maintaining a healthy GIT. The obstruction of the flow of bile into the duodenum, resulting in obstructive jaundice (OJ), has a major impact on the health of the affected individual. This study sought to identify changes in the duodenal microbiota in South African patients with OJ compared to those without this disorder. Mucosal biopsies were taken from the duodenum of nineteen jaundiced patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and nineteen control participants (non-jaundiced patients) undergoing gastroscopy. DNA extracted from the samples was subjected to 16S rRNA amplicon sequencing using the Ion S5 TM sequencing platform. Diversity metrics and statistical correlation analyses with the clinical data were performed to compare duodenal microbial communities in both groups. Differences in the mean distribution of the microbial communities in the jaundiced and non-jaundiced samples were observed; however, this difference did not reach statistical significance. Of note, there was a statistically significant difference between the mean distributions of bacteria comparing jaundiced patients with cholangitis to those without. On further subset analysis, a significant difference was observed between patients with benign (Cholelithiasis) and malignant disease, namely head of pancreas (HOP) mass (p-values of 0.01). Beta diversity analyses further revealed a significant difference between patients with stone and non-stone related disease when factoring in the Campylobacter-Like Organisms (CLO) test status (p=0.048). This study demonstrated a shift in the microbiota in jaundiced patients, especially considering some underlying conditions of the upper GI tract. Future studies should aim to verify these findings in a larger cohort.Item An observational retrospective audit of patients presenting to a private hospital group during specific timeframes before, during and after the comrades marathon over an 8- year period(University of the Witwatersrand, Johannesburg, 2023-06) Petrick, Friedrich Johann; Kramer, Efraim B.Introduction: This study examined the impact of the Comrades Marathon (CM) on the presentation of patients to the emergency departments (EDs) of a CM sponsoring private hospital group over an 8-year period. Methodology: A retrospective, quantitative secondary database analysis of all patients presenting to the designated EDs during 3 defined timeframes: a 48-hour weekend one week before the CM; a 48-hour period spanning over the CM; and a 48-hour weekend one week after the CM. Results: There was an increase in ED presentations during the CM timeframe compared to the weekends before and after the CM. There was a relatively greater increase in the CM female patient presentations (49.45%) compared to the registered number of female CM athletes (20%). All the EDs indicated an increased number of patient presentations during the CM “Up-run” years compared to the CM “Down-run” years (5 638 vs. 4 487, p-value 0.013). Musculoskeletal medical encounters appeared more common during the “Down-run” races (30.44% vs. 26.37%, p-value 0.318), with gastrointestinal (15.62% vs. 17.62%, p-value 0.043) and respiratory (11.99% vs. 13.25%, p-value 0.045) medical encounters more common during “Up-run” races. Fatigue (54.25% more common) and Electrolyte & Fluids (81.85% more common) medical encounters were common during the CM timeframe compared to both the Before and After timeframes. Conclusion: Epidemiologically, the CM “Up-run” and “Down-run” may present with two distinct clinical profiles, due to the different elevation nature of the CM, and not as a single race. Limitations related to the retrospective nature of this study makes comparability with other studies difficult.Item Public attitudes to corneal tissue donation in an urban South African population(University of the Witwatersrand, Johannesburg, 2023-08) Hajee, Faheema; Hollhumer, RolandBackground: Corneal pathology is the second leading cause of preventable blindness in Sub-Saharan Africa. Corneal disease is the cause of visual loss in 11% of blind or severely visually impaired children and 4% of blind adults in South Africa. In majority of cases, a corneal transplant or keratoplasty can restore or significantly improve vision. South Africa has an immense shortage of donor corneas, causing the burden of corneal disease requiring transplantation to continually rise. Aim: The aim of this study was to determine the public attitude towards corneal tissue donation in an urban South African population. Setting: The study was conducted at St John’s Eye Hospital, Soweto, South Africa. Method and Design: This was an observational, cross-sectional quantitative study of the current attitude of an urban South African population towards corneal tissue donation. A self-designed questionnaire was developed. The participants were asked about reasons for both willingness and unwillingness to donate their corneas. The study population included patients or escorts attending the out-patients clinic at Saint John’s Eye Hospital. Results: A total of 100 participants (60 females and 40 males) completed the questionnaire. The mean age (±SD) of the study participants was 41.26 (±14.7) years. Seventy-six percent of participants did not know about corneal donation. Sixty four percent of participants were willing to donate their corneas, whereas 25% were not willing to do so. The main reason for unwillingness to donate their corneas was cultural reasons. In this study there was no statistically significant correlation between the willingness to donate corneal tissue and age, gender, level of education and employment status. There was a statistically significant difference between the willingness to donate one’s solid organs as compared to the willingness to donate one’s cornea (p-value 0.029). Participants were more willing to donate their solid organs than they were willing to donate their corneas. Conclusion: There is a decreased level of awareness of corneal tissue donation in this urban South African population. However, many of the participants had a positive attitude towards corneal donations. Increasing the awareness of donation and its benefits may help increase the supply of corneal tissue.Item Clinical Characteristics and Outcomes of Patients with COVID Admitted to a Tertiary Care Centre: A Retrospective Study at Tshepong Hospital(University of the Witwatersrand, Johannesburg, 2023-11) Dullabh, Dixit Anil; Zachariah, DonIntroduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in China. It has since then rapidly spread across the globe causing millions to die. In March 2020, the WHO declared coronavirus disease 2019 (COVID-19) a pandemic. It’s clinical presentation and outcomes have been variable across the world. Thus, an analysis of the clinical characteristic and outcomes of patients with COVID-19 at a local setting, namely Tshepong Hospital. Objective: To determine the clinical presentation and outcomes, and correlate clinical and biochemical parameters to outcomes of patients admitted with COVID-19 at Tshepong Hospital. Method: This is a single centre retrospective review of all patients with COVID-19 admitted at Tshepong Hospital during the period 1 June – 31 July 2020. The study contains both inferential and descriptive elements. Results: A total of 200 patients were admitted with COVID-19 during this study period, of which 135 were female and 65 males. The mean age was 53 years with no significant gender differences. 63% of patients had hypertension as a coexisting condition while 35% had diabetes mellitus. Presence of co-morbid conditions were associated with severe disease. Dyspnoea (73%) and cough (94%) were the predominant symptoms. Laboratory parameters including elevated white cell count, C-reactive protein, urea, and creatinine were associated with severe disease. Of the 200 patients, 36 were deemed as severe. 34 of these patients required ICU admissions. 17 demised showing a case fatality rate of 8%. Treatment options given were in keeping with guidelines. Conclusion: COVID-19 has proven to be a clinical and therapeutic challenge. Its main factors being its novelty and variable presentation across the globe. This study has shown that a local setting, not all data is congruent with national or global trends. This speaks to the need of more centres and countries looking at their own variation of COVID-19 presentations, thus challenging the clinical and therapeutic decisions around the disease.