Masters Degrees (Clinical Medicine)

Permanent URI for this collectionhttps://hdl.handle.net/10413/7796

Browse

Now showing 1 - 20 of 31

Adherence to iron prophylactic therapy during pregnancy in an urban regional hospital in Durban, South Africa.
(2017) Mkhize, Princess Zinhle.; Moodley, Jagidesa.; Naicker, Thajasvarie.
Iron and folic acid supplementation plays a major role in prevention and control of iron deficiency anaemia in antenatal care. In South Africa, although all pregnant women receive iron, folate and calcium supplementation throughout pregnancy, anaemia is still common. Low adherence may be a key contributor to the ineffectiveness of supplementation programs.Therefore, this study was conducted to examine adherence to prophylactic iron supplementation during the antenatal period. An observational clinical study was conducted in a regional hospital from January- December 2016. Women (n=100 HIV uninfected and n=100 HIV infected) were recruited and subdivided into three groups: (a) 1st attendees ≤ 34 weeks (n=33), (b) 34-36 weeks (n =34) and (c) ≥ 37 weeks /birth (n=33) respectively. A structured questionnaire was used for data collection. Data were coded and computed onto an excel sheet for statistical analysis using SPSS software. Data from women (n = 24) from 1st visit attendees ≤ 34 weeks and 34-36 weeks subgroups indicated that pill count and self-reported data reflected 50% adherence and 46% non-adherence, being higher in the HIV infected women (75%). Nausea was the commonest side effect in all trimesters (79, 2%). Adherence (27.8%) and non-adherence (72.1%) to iron, folic acid and calcium supplementation were observed in 176 (88%) women. Promoting essential strategies on the importance of consumption and effectiveness of iron prophylactic therapy is essential to maintain and improve anaemia in antenatal attendees during pregnancy.
Admissions for pulmonary embolism at a tertiary South African hospital.
(2017) Kistensamy, Sivaisen Ricardo.; Moodley, Yoshan.; Brown, Susan Lynn.
Background: Published descriptions of pulmonary embolism (PE) from South African (SA) settings are rare. We sought to address this gap in the literature. Methods: This was a case series involving 61 adult patients admitted to a tertiary SA hospital over a five-year period with a primary diagnosis of PE. Data related to patient demographics, PE presentation, risk factors, treatment, and inpatient mortality were collected and analysed using appropriate statistical tests. Results: Most of our study population were younger (86.9%), female (67.2%), and of black African ethnicity (73.8%). Dyspnoea and chest pain were the most common symptoms (prevalence of 86.9% and 41.0%). Prevalent clinical signs included tachypnea (47.5%) and tachycardia (42.6%). The most prevalent established risk factors were cardiac failure (49.2%) and a history of deep vein thrombosis (up to 19.7%). Massive PE was diagnosed in 8.2% of study patients. Most patients received anticoagulation therapy (95.1%), with thrombolysis and embolectomy performed only in smaller proportions (24.6% and 11.5%) of patients. The incidence of inpatient mortality was 23.0%. Characteristics associated with mortality included: admission route (p=0.008), dyspnoea (p=0.002), tachycardia (p<0.001), and embolectomy (p=0.042). Conclusion: Our study findings have important implications related to the management of PE in SA.
Aerosolization during intubation and extubation and its associated risk of transmission of SARS-CoV-2 to healthcare workers: a scoping review.
(2023) Naidoo, Verushka.; Govender, Komalan.
Background: Healthcare workers, in particular anesthesiologists, are at risk for many infectious diseases that could potentially be transmitted during intubations and extubations. Although intubation and extubation are known to stimulate coughing and to promote the generation of aerosols, their risk of transmission of COVID-19 infection is still not clearly understood. Among the aerosol generating procedures, intubation and extubation is thought to be especially harmful due to the proximity of the anaesthetist to the patient’s airway. The aim this study is to explore and describe the risk of aerosolisation of SARS-CoV-2 to the anaesthetist during airway management. Methods: We conducted a scoping review of PubMed, MEDLINE, LANCET, and grey literature related to intubations and extubations, and the risk of transmission of infections to the anaesthetist. The scoping review was conducted using the Arksey and O’ Malley framework for scoping reviews. We conducted a narrative synthesis of the evidence gathered. There were no restrictions on study design, year of publication, and study location. The literature search was updated on the 15th of July 2023. Results: Our scoping review showed that healthcare workers involved in airway procedures specifically intubation and extubation are at an increased risk of contracting SARS-COV-1 and SARS-COV-2. Aerosol generation during these procedures has been shown to generate less aerosol than that of a cough. Extubations are particularly riskier regarding aerosol exposure than intubations. The relationship between aerosol exposure and virus transmission is uncertain. Conclusions: Anaesthetists are at increased risk of infection during intubations and extubations. There remains a lack of evidence of the exact mechanisms of transmission from patients to healthcare workers during aerosol-generating procedures. There is also a lack of consistency in the definition of aerosol-generating procedures.
Application of communication skills in an authentic clinical setting: assessing the communication competency of sixth year medical students during history taking.
(2017) Ntando, Ekanda Alfred.; Van Wyk, Jacqueline Marina.; Matthews, Margaret Glynnis.
The Nelson R. Mandela School of Medicine (NRMSM) launched a new 6 year MBChB programme in 2010. This curriculum includes a clinical communication course which emphasises the patient centred approach in line with the Health Professions Council of South Africa Core Competency Framework for undergraduate students. The Calgary-Cambridge Guide to the Medical Interview was adopted as a method for teaching communication. The 2015 final year medical students constituted the first cohort to have been taught clinical communication skills in this manner in the pre-clinical phase. Aim of the study The study was conducted to investigate the transfer of communication skills taught using the Calgary-Cambridge Method (CCM) in the pre-clinical phase to the clinical setting. This study focused mainly on the process skills of history taking and had the following objectives: 1. to determine whether students used the CCM as taught at medical school. 2. To measure and compare process skills of students in two different phases of MBChB programme. 3. To explore role modelling of the CCM by clinical teachers. 4. To describe challenges encountered by students for or in the application of the CCM. Methods The study was observational, analytical and cross-sectional. The population was the 2015 final year class of medical students (n=198) with exception of 13 students who were trained in a different method in Cuba. The study was conducted in the Internal Medicine wards of four teaching hospitals affiliated to the medical school in the Durban functional region. Results The population of the study comprised 185 eligible students; 107 participants were enrolled, and the final number of participants was 105 (57%). In response to the four objectives of the study, the findings revealed that most students used the CCM in a modified manner. There was a marked decline in some of the process skills of history taking, specifically in subcategories such as providing structure and eliciting the patients’ perspective. Educators in Internal Medicine wards did not model the use of the CCM and discouraged its application due to workload and time constraints. Challenges encountered by students included negative attitudes of clinical trainers towards the CCM and language barriers, as most patients spoke in isiZulu. Discussion Results demonstrated that the clinical communication teaching and learning of the pre-clinical phase had some positive impact on application, even if students only used the Calgary Cambridge Method in a modified manner in the clinical phase. The environment of clinical training influenced the transfer, development and the progress of the communication skills learnt in the pre-clinical phase. The decline of process skills in providing structure and eliciting the patient’s perspective was associated with negative attitudes and the poor role modelling of educators. This observation is contradictory to the increase shown in the process skills of building relationship and initiating the session, which probably reflects students’ accumulated experience in the wards. Students encountered challenges associated with language barriers and with different approaches used for personal and organizational reasons. Conclusion With regard to students’ attainment of the HPCSA core competency of communication, and despite communication teaching in the pre-clinical phase and its application in the disciplines of Family Medicine and Rural Health, communication was not equally valued or reinforced in all disciplines involved in undergraduate teaching on the MBChB programme. Key words: communication skills, transfer, application, clinical setting
Cardiovascular disease profile in patients with established rheumatoid arthritis at King Edward VIII Hospital.
(2018) Govender, Preesha.; Paruk, Farhanah.
Rheumatoid arthritis (RA) is one of the most common chronic systemic autoimmune inflammatory diseases, which is associated with an increased mortality rate, attributed to premature cardiovascular disease (CVD). Key drivers of mortality from CVD in RA are fuelled by multiple factors. Rheumatoid arthritis disease profiling, particularly seropositivity, presence of extra-articular disease and high disease activity, confer an increased mortality risk. Traditional CVD risk factors (hypertension, diabetes mellitus, dyslipidaemia, obesity) are influenced by both inflammation inherent to RA, and pharmacodynamics of anti-rheumatic drugs. Notwithstanding the above, the current paradigm shift recognises RA as an independent risk factor for CVD. Similar to the rest of Africa, local data on the prevalence of CVD in RA are limited. With an increase in non-communicable diseases and longevity, the RA burden in South Africa (SA) is expected to increase. Local studies are needed to stratify practice in cardio-protective strategies and improved long term outcomes in RA. This study aims to determine the prevalence of CVD in RA, describe the prevalence of CVD risk factors in RA and describe the relationship between RA disease activity and CVD. A retrospective, chart review of all patients with RA according to the American College of Rheumatology 1987/2010 Classification criteria, attending the arthritis clinic in King Edward VIII hospital, a tertiary public healthcare academic teaching hospital in KwaZulu-Natal, SA, during the period August 2017 to March 2018, was undertaken. Patients younger than 18 years of age, or with RA and any other concomitant connective tissue disease or overlap syndrome were excluded. The study group included 150 patients with RA. The demographic details, duration of the RA disease, traditional CVD risk factors, simplified disease activity index (SDAI) and health assessment questionnaire (HAQ) were documented. In addition, results of electrocardiogram, echocardiogram, haemoglobin, glycated haemoglobin, lipid studies and estimated glomerular filtration rate were recorded. Cardiovascular disease was found in 16% of the total study cohort, with an age, gender and ethnic differential. Coronary artery disease was the most common CVD finding in RA patients. The burden of traditional CVD risk factors in RA is high, with hypertension, diabetes mellitus, dyslipidaemia, physical inactivity and chronic kidney disease of particular concern. No significant correlation was observed between RA disease activity, seropositivity and CVD in RA however, extra-articular disease was more common among patients with CVD. Echocardiographic evidence of subclinical cardiac disease in RA is common. Significant disparity was observed between various CVD risk assessment models at different levels of risk, which cautions a comprehensive CVD risk assessment model that stratifies discriminately is needed in patients with RA. The study provides knowledge of CVD burden and risk in RA patients locally, and serves as a foundation for further research in preventative strategies that offer significant survival benefits. The main limitation in this study is that the study cohort consisted mainly of Black and Indian patients and therefore the findings may not be generalised across all ethnic groups. Furthermore as this was a relatively small study conducted in a single public hospital, which is urban based, conclusions from this study may not be applicable to a rural setting or to all socio-economic classes.
Clinical profile of rheumatoid arthritis associated interstitial lung disease at a tertiary hospital in KwaZulu-Natal, South Africa: a retrospective 5 year review.
(2020) Ghammo, Hosam Mohamed.; Nyamande, Kennedy.; Mitha, Mohamed.
Background: The prevalence, demographic distribution and treatment outcomes in Rheumatoid Arthritis associated interstitial lung disease (RA-ILD) has not been well described in Southern Africa. There is very limited data. Objective: The aim of the study was to determine the demographic profile of the disease as well as treatments used and their outcomes at Inkosi Albert Luthuli Central Hospital (IALCH), a tertiary hospital in Durban, South Africa. Methods. This was a retrospective electronic chart review of 61 patients who were diagnosed with RA-ILD between January 2010 and December 2015 at IALCH pulmonology clinic. Demographic and clinical data, symptom presentation, pulmonary function testing (PFT), high resolution computerised tomography (HRCT) features and treatment modalities were analysed as well as outcome based on symptoms, PFT and HRCT. Results. There were 61 subjects, the majority being female (90.2%). Approximately 86.9% were 50 years and older. The majority of the subjects were Indian 72.1% (n=44), followed by Black Africans 23% (n=14) and then Whites 4.9% (n=3). All patients were HIV negative. Patients treated with a combination of prednisone and azathioprine had a decline in FVC (mean 0.41, p value 0.04). There was no improvements or deterioration in patients treated with either drug alone. Conclusion. The management of RA-ILD is still a challenge. The combination of azathioprine and prednisone did not arrest disease progression in our study while either agent alone did not improve clinical and lung function parameters. Large randomised control studies are needed in Sub-Saharan Africa.
A cross-sectional descriptive study of pre-hospital care providers’ training, knowledge and skills in austere environments emergency medicine in South Africa: a framework for a consensus statement for Wilderness Emergency Medicine.
(2017) Matthew, Jaybalan Allan.; Maharaj, Roshen.; Clarke, Damian Luiz.
There is a lack of research into the resource capabilities and capacity for wilderness emergency medicine practice in South Africa (SA). This is despite SA having vast expanses of populated austere geography that remains difficult to access by conventional health care systems and the country increasingly becoming an attractive ecotourist destination. With increasing needs for skilled health care personnel to deal with medical emergencies in this environment, it is first necessary to determine the extent of the current resources present within SA. This research looked at the human resource potential to deal with medical emergencies in the wilderness emergency environment in SA. Chapter one considers the conceptual and contextual framework of this research in light of the above and a review of the available literature. Chapter two presents research from a study that determined the self-reported extent of training, knowledge and skills that capacitated Emergency Care Practitioners (ECP) registered with the Health Professions Council of South Africa (HPCSA) when operating in the wilderness environment and when dealing with medical emergencies. Chapter three examines data gained from a survey conducted among emergency medicine specialists regarding the competency in knowledge, training and skills that are ideally required in the practice of wilderness emergency medicine (WEM). Chapter four compares the self-reported knowledge, training and skills of ECPs in the wilderness emergency environment, with what is suggested by emergency medicine specialists as the expected level of knowledge, training and skills for practice in this field. Chapter five presents a published editorial that highlights the potential value of this specialised WEM practice in resource-limited countries. This editorial suggests that proper wilderness emergency medicine training, knowledge and skills could perhaps be an alternative solution for frugal innovation for resource-limited pre-hospital and inhospital practice. There is a need for further training and skills uptake in WEM. Additionally, a local framework for a consensus statement on the practice of WEM needs to be established.
Diagnostic evaluation of the BD Affirm™ VPIII assay as a point-of-care test for the diagnosis of bacterial vaginosis, trichomoniasis and candidiasis in a population of pregnant women from South Africa.
(2020) Dessai, Fazana.; Sebitloane, Hannah Motshedisi.; Abbai, Nathlee Samantha.
OBJECTIVE: Untreated Sexually Transmitted Infections (STIs) and Bacterial vaginosis (BV) pose a serious health risk to mother and child. Limited data exist on the use of the BD Affirm VPIII assay as a point-of-care test. This study compared the BD Affirm VPIII assay to the BD MaxTM Vaginal assay (reference test) for the detection of BV, Trichomonas vaginalis, and Candida spp. The prevalence of single and co-infections are also reported here. METHODS: The study enrolled 273 pregnant women from King Edward VIII hospital in Durban. Socio-demographic, sexual behaviour and clinical data were collected from all consenting women. The women provided two self-collected vaginal swabs for testing. The swabs were tested using the BD Affirm VPIII assay and the BD MaxTM Vaginal assay. The prevalence of BV, trichomoniasis and candidiasis was calculated as the percentage of women who tested positive for BV, T.vaginalis and Candida infection and 95% confidence intervals (CIs) were calculated for these percentages using the formulas for calculating CIs for proportions. The number of co-infections was calculated using chi-square analysis. The diagnostic accuracy of the BD AffirmTM VPIII assay compared to the BD Max assay was assessed through the calculation of sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) and their respective 95% confidence intervals. RESULTS: In this study population, 85% of the participants were unmarried; however, 84% reported having a regular partner, and 96.3% did not use a condom regularly. The prevalence of Bacterial Vaginosis, Candidiasis and Trichomoniasis was 49.4%, 57.2% and 10.3%, respectively. A large proportion of women (78.8%) in this study did not have a discharge despite being positive for one or more pathogens. The BD AffirmTM VPIII assay showed a moderate sensitivity (79.8%) and specificity (80.3%) for diagnosing BV in all participants. The assay had an excellent specificity for Candida and T. vaginalis of 97.4% and 100.0%; respectively, however, it exhibited poor sensitivities of 52.9% and 42.4%, respectively. CONCLUSION: Our findings show a higher prevalence of Bacterial Vaginosis in antenatal attendees than previously reported, while the prevalence of Candidiasis and Trichomoniasis was in keeping with previous reports. The high number of asymptomatic infections detected is of concern and indicates the need for the re-evaluation of the syndromic management approach, especially in the antenatal population. The BD AffirmTM VPIII assay was found to be unsuitable as a screening test for vaginal infections in pregnancy. The assay performed better as a confirmatory test and may serve useful if used in conjunction with other clinical parameters such as vaginal pH.
Does gender impact on female doctors' experiences in the training and practice of surgery?
(2016) Umoetok, Flora.; Van Wyk, Jacqueline Marina.; Madiba, Thandinkosi Enos.
Abstract available in PDF file.
The effect of lifestyle modification on depression amongst myocardial infarction patients after revascularization.
(2020) Arzet, Aminu.; Naidoo, Datshana Prakesh.
Background: Patients with Coronary Artery Disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention (coronary artery bypass graft surgery {CABG} vs percutaneous coronary intervention {PCI}) influences the outcome Objectives: We examined the prevalence of depression and depression traits amongst myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression and depression traits in patients who underwent CABG versus PCI Method: We evaluated the risk factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularization over a 15-month period (Jan 2017 to March 2018). The Beck Depression Inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA). Results: 100 patients were recruited (mean age males 60.73±4.52 yr and females 60.29±3.64 yr), with 5 dropouts leaving 95 patients for complete analysis. Most of the patients were low-income earners 53 (53.0%) and 21.0% had tertiary level education. The majority had multiple CAD risk factors and comorbidities (79.0%). Prior to the LSM program 51 patients (51.0%) had depression and depression traits {CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047)}. After LSM the overall prevalence of depression and depression traits fell to 33 patients (34.7%), {PCI 8 (23.0%) vs CABG 25 patients (72.0%), p = 0.001}. The mean depression scores also fell from 21.11±7.75 to 14.98±9.61 (p = 0.002). At baseline PCI patients were more physically active compared to CABG {3 (60.0%) vs 2 patients (40.0%), P = 0.715} respectively. After the LSM, more PCI patients undertook PA compared to CABG {24 (60.0%) vs 14 patients (35.0%) respectively, p = 0.012}. The PA score was also higher amongst the PCI group compared to CABG {14.16±9.73 vs 9.40±10.94 respectively, p = 0.024}. In fully compliant subjects the benefit derived was similar regardless of the mode of intervention {OR 1.10, CI 0.98-4.23,P = 0.191}. Using multivariate analysis the main predictors of depression and depression traits were female gender (OR 3.29, 95% CI 1.51-11.03, p = 0.008), CABG (OR 1.86, 95% CI 1.68-5.77, p = 0.003), heart failure (OR 2.65, 95% CI 5.87-13.62, p = 0.000), Kidney failure (OR 1.41, 95% CI 1.30-5.23, P = 0.041), atrial fibrillation (OR 1.60, 95% CI 1.40-4.77, P = 0.023), low PA (OR 1.97, 95%, CI 11.23- 33.20, P = 0.000), previous history of depression (OR 8.99,95% CI 1.90-7.89, p = 0.002) and low income (OR 2.21, 95% CI 1.40-2.85, p = 0.000). Conclusions: Depression and depression traits are common among subjects undergoing coronary revascularization, more so amongst CABG compared to PCI participants. Lifestyle modification reduces the prevalence of depression and depression traits, with fully compliant CABG vs PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in depression and depression was recorded amongst LSM partlycompliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.
Effect of mitral valve replacement on left ventricular function in subjects with severe rheumatic mitral regurgitation.
(2019) Maharaj, Sharen.; Naidoo, Datshana Prakesh.
Background. The outcome in patients with severe mitral regurgitation (MR) and impaired ejection fraction (EF) is poorly described in the developing world where rheumatic heart disease is endemic. Objective. This study describes the effects of mitral valve replacement (MVR) on left ventricular (LV) function in patients with rheumatic MR. Methods. This is a retrospective analysis of all subjects with severe rheumatic MR undergoing MVR over a 9 year period (2005-2013). Clinical and echocardiographic parameters were recorded pre-operatively, at 2 weeks, 6 weeks to 3 months and 6 months to 2 years following MVR. Results. Of 132 patients included in the study, 66% (n=87) were NYHA class III-IV, 38% (n=50) presented with clinical features of heart failure and 14% (n=19) had atrial fibrillation prior to MVR. The echocardiogram showed increased end systolic diameter (ESD, 39.9±7.2mm), left atrial size (LA, 61.2±12.6mm), and pulmonary artery systolic pressures (PASP, 59.5mmHg, IQR 45-80mmHg). Pre-operatively, 28% (n=37) of subjects had impaired LV function (EF <60%). At 6 months to 2 years following MVR (n=93), 1% of subjects were NYHA III-IV, 1% were in heart failure, and 7.6% had atrial fibrillation. Paired analysis of 83 patients with complete datasets revealed that the EF was >55% in 87% (n=72) pre-operatively, the number of patients with EF >55% dropped to 20% (n=17) at 2 weeks postoperatively (p<0.001, 95% CI 0.02-0.09) and thereafter an EF > 55% was recorded in 60% (n=53) at the 6 months to 2 year follow up (p<0.001, 95% CI 0.1-0.5). After feeding all clinical and echocardiographic variables into a predictive model only the ESD emerged as a significant predictor of postoperative LV dysfunction (EF< 50%) both on uni- and multivariate analysis. Conclusion. Most subjects with severe rheumatic MR who were subjected to surgery had advanced disease with heart failure, indicating that preoperatively, impairment of LV function was a frequent finding. The preoperative ESD was the only predictor of postoperative LV dysfunction. This study calls for careful clinical assessment with regular imaging and early referral for surgery in subjects with severe MR according to established guidelines in order to ensure preservation of ventricular function.
An explorative review of the distribution, incidence, prevalence, diabetes related amputations and defaulters of patients with diabetes mellitus and podiatrists in the public health care sector of KwaZulu-Natal.
(2015) Sahadew, Nikita.; Singaram, Veena S.; Brown, Susan Lynn.
The prevalence of diabetes is increasing globally, especially in African countries, where 62% of cases are undiagnosed and are seen by a medical professional only once complications have manifested. Among the tangle of complications, the diabetic foot is a cause of morbidity and mortality. The management of foot ulcerations, non-ulcerative pathologies and the prevention of subsequent amputation is a challenge, resulting in physiological, psychological and economic consequences. Including a podiatrist in the multidisciplinary healthcare team involved in the care of the lower limbs of the diabetic patient has the potential to improve patient outcomes and reduce the economic burden incurred by both the patient and the state. The global increase in the prevalence of diabetes is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu- Natal (KZN). Data is routinely collected at all public healthcare facilities in the province and is aggregated per facility. This study aimed to investigate the distribution of diabetic patients and podiatrists in the public health sector of the eleven KZN districts. A retrospective audit was conducted of the KZN Department of Health databases on diabetes in and between the years 2010 and 2014. The data was cleaned, tested for capture errors, verified and analysed. Using pivot tables, derived metrics, and graphs using Microsoft Excel were constructed. Additional open source databases were accessed to allow further exploration of the data collected. The prevalence of diabetes in the public health sector of KwaZulu-Natal was found to be 14.3% higher than national prevalence estimates. Thirty-eight per cent of the cases were found in the highly urbanised district of eThekwini. A total of 1 329 275 diabetic patients were recorded and, according to national guidelines for the treatment of diabetes, required podiatric care. However, only two podiatrists work in the KwaZulu-Natal public health sector. The number of podiatrists is totally insufficient to serve the growing diabetic population in this province’s public health sector. A major infusion of more podiatry graduates, appropriate distribution and inclusion of podiatric services into the diabetic foot care team needs to therefore be considered to enable compliance with national and international diabetic foot care guidelines. In the interim, existing public health care practitioners can be educated to offer diabetic foot care information to the patient and on the correct referral patterns to allow the patient access to a podiatrist. The findings of this study are consistent with the well-established relationship between diabetes and urbanisation. Correlation calculations support the assumption of a directly proportional relationship between diabetes prevalence and the number of diabetes-related amputations. This study highlights the need for at least 319 podiatrists in the province of KwaZulu-Natal to satisfy the national guidelines for minimal diabetic care regarding assessment, screening and education of patients only; not considering the treatment of existing and future foot complications. Short and long term recommendations such as changes in the data collection process at public health facilities and the assessment of existing tertiary medical institutions for the establishment of additional departments of podiatric medicine can greatly contribute to addressing the calculated shortage of podiatric practitioners in the public health sector.
Exploring the impact of experience-based medical learning on students' clinical preparedness : a case study of the South African-Cuban medical training collaboration programme at the University of KwaZulu-Natal, South Africa.
(2014) Motala, Munirah Ismail.; Van Wyk, Jacqueline Marina.
Background: The South-African-Cuban Medical Collaboration (SACMC) programme involves medical training being offered to rural South African (SA) origin students in Cuban facilities with the view of future medical practice in local rural SA settings. The students on the SACMC programme return to South African medical schools to complete their training and clinical practice in their 4th academic year. The students experience difficulty in adapting to local clinical demands and integrating their prior knowledge as required at the Nelson R Mandela, School of Medicine, (NRMSM) of the University of KwaZulu-Natal (UKZN) in Durban, South Africa as evidenced from examination board minutes. Aim: In an effort to inform educators of the extent to which students’ prior clinical training and experiences in Cuba matched the clinical skills taught at the NRMSM, this study investigated the similarity or difference in approach to the curriculum, clinical skills content and perceived competence of the SACMC students to a set of 75 core clinical skills which are deemed essential during training in years 1-3 at the institution. Methods: A mixed methodology study used a phenomenological approach to explore the clinical experiences of 11 South-African-Cuban medical collaboration students. Qualitative data collected by means of interviews and a questionnaire were used to determine the curriculum approach and content. A questionnaire generated quantitative data about students’ familiarity; exposure and perceived competence (ability to perform independently, with supervision or not at all) on 75 specific skills which are considered a prerequisite to enter the 4th academic year at the NRMSM. The skills in 9 major categories, included communication, resuscitation, adult examination, new-born examination, general procedural skills, specimen collection, obstetrics and gynaecology procedures, airway management procedures and radiological examination. Findings: The didactic, lecture intensive Cuban curriculum with its emphasis on primary health care principles and predominance of ward-based clinical training was found to be vastly different from the problem-based, systematic and practical oriented laboratory-based clinical training offered to local students. The majority of students self-reported a lack of exposure to 35 of the overall 75 identified skills. Most students claimed an inability to independently perform 95% (4 out of 75 skills- able to perform 5%) of clinical skills. The qualitative data revealed that many primary health care skills were neither taught nor practiced by students within the first 5 years of training in Cuba. Conclusion: This study has highlighted the mismatch between the focus and scope of clinical training offered to students on the South African-Cuban Medical Collaboration programme and those at the NRMSM. In the light of continued collaboration in health education and to ensure that returning students are adequately supported and integrated into the SA clinical setting, it is important that educators work towards improving the alignment of the training programs.
Feasability of focused parathyroidectomy in developing countries - a scoping review.
(2023) Rugnath, Kapil.; Suman, Mewa Kinoo.
Hyperparathyroidism (HPT) is characterized by pathologically excessive parathyroid hormone production. This may be as a consequence of pathology within the parathyroid gland (primary HPT) or as a sequela of pathology outside the parathyroid gland (secondary & tertiary HPT). The gold standard surgical management of HPT was bilateral neck exploration (BNE) but with improvement in localising methods, focused parathyroidectomy (FP) has made the gold standard contentious. BNE, entailing a large neck incision and 4 gland exploration, demonstrates excellent cure rates of 95%. FP, whereby a single targeted miniature incision is made over the offending gland, is possible in the category of primary HPT as in up to 80% of cases the aetiology is a single gland adenoma. The prerequisites to embarking on this minimally invasive operative technique are accurate pre-operative localisation of the exact site of the offending gland adenoma and assistance of intra-operative adjuncts to confirm successful excision. Considering the prerequisites required for FP, the initial concern of cost arose. Additionally, concerns of potential inferior success rates were initially entertained. Subsequently, numerous studies revealed this technique to be superior in terms of operative time; cost; convalescence; cosmesis; success rates and the ability to be performed under local anaesthetic, as a day case. As such, the current standard of care for primary HPT where a single gland adenoma is localised, is the FP. The majority of the studies and trials demonstrating the superiority of FP emanate from developed high-income countries where there is a relative abundance of resources, and as such, the questioning of applicability or relevance of these studies to developing middleincome countries is valid. With the natural hesitancy to adopt these recommendations uncritically in developing countries, where the lack of resources might impede this technique, this concern of applicability, and therefore feasibility, needed to be addressed. To address this, a scoping review of the literature was conducted, looking specifically at FP, pre-operative localisation and intra-operative adjuncts, in developing countries (upper and lower-middle income). The aim of this review was to ascertain if FP is feasible in these countries by assessing the availability and accuracy of pre-operative localisation, success of FP judged by cure rates and the availability and utility of intra-operative adjuncts. This review will benefit surgeons in developing countries by demonstrating that FP is not an esoteric procedure described in ivory towers to be entertained in reverie only. Dispelling the myth of non-applicability due to resource constraints, by establishing the technique to be feasible in developing countries, more local surgeons can now, for localised single parathyroid gland adenomas, diverge away from knee-jerk routine bilateral neck explorations. Reassured with support of relevant local literature, they may now confidently embark on learning and performing the technique of FP resulting in satisfied patients who enjoy the superior outcomes associated with this technique.
Genetic diversity of Gardnerella vaginalis in pregnant women diagnosed with intermediate and positive bacterial vaginosis.
(2019) Nzimande, Silondiwe Philiswa.; Abbai, Nathlee Samantha.
Bacterial vaginosis (BV) is the main cause of abnormal vaginal discharge in women of reproductive age. Gardnerella vaginalis, has been detected in almost all women with BV. However, there is limited information on the genetic diversity of G. vaginalis isolated from BV intermediate and positive cases. In this study we investigated the genetic diversity of G. vaginalis strains from South African pregnant women. Vaginal swabs were characterized by the Nugent method. A total of n= 87 samples were included in the genetic analysis, (n=50 BV positive) and (n=37 BV intermediate). The presence of G. vaginalis was detected by PCR using bacterium specific 16S rRNA primers. All PCR positive amplicons were sequenced by the Sanger method and the edited sequence data was used for the phylogenetic analysis using the PHYLIP software. The sialidase A gene was amplified by PCR using specific primers and the copy numbers of sialidase A gene was quantified by droplet digital PCR. To assess the diversity of the sialidase A gene, Sanger sequencing was performed. The 16S rRNA gene from G. vaginalis was amplified in all BV positive and BV intermediate samples. All PCR amplicons were successfully sequenced and the nucleotide BLAST results revealed 100% identify to G. vaginalis. The phylogenetic analysis revealed that there is no diversity in G. vaginalis present in BV positive and intermediate cases. The phylogenetic tree of sialidase A sequences from intermediate and positive BV cases revealed two major clades which showed differences related to sialidase A copy number. Quantification of sialidase A showed that the average number of copies per cell was much higher in the BV positive group compared to the intermediate group. Some of the intermediate cases showed high copy numbers for the virulence gene and clustered with the BV positive cases. In the present study the 16S rRNA sequences of the G. vaginalis from BV intermediate and positive women showed that there is no genetic diversity in G. vaginalis detected in BV positive and intermediate samples. The phylogenetic tree of sialidase A gene sequences of intermediate and positive BV revealed two major clades which showed differences related to sialidase A copy number. This data was previously lacking in our setting, especially in a pregnant population. We further demonstrate for the first time that the genetic information present within the sialidase A gene has a direct influence on BV status.
Genotyping of gardnerella vaginalis from pregnant women in Durban by amplified ribosomal DNA restriction analysis.
(2020) Pillay, Kayla.; Abbai, Nathlee Samantha.; Naicker, Meleshni.
Gardnerella vaginalis is one of the most frequently isolated microorganisms associated with bacterial vaginosis (BV). However, limited information concerning the genetic diversity of G. vaginalis isolated from BV positive and intermediate cases, has been documented. This study investigated the diversity of G. vaginalis in pregnant women, a currently under-researched area in South Africa. The study population included pregnant women recruited from a public hospital in Durban, South Africa. The women provided 2 self-collected vaginal swabs for microscopy and the genotyping assays. The BV status of the women was determined using Nugent scoring. A total sample of n=137 specimens was selected for analysis. The 16S ribosomal ribonucleic acid (rRNA) gene of G. vaginalis was used for the genotyping assays. The 16S rRNA gene polymerase chain reaction products were digested with TaqI to generate genotyping profiles and genotypic subtypes were determined by correlating BamHI and HindIII digestion profiles. Phylogenetic analysis was performed on the 16S rRNA gene sequences. The data analysis was performed in R Statistical Computing software, version 3.6.2. Restriction digestion with TaqI revealed the presence of two different genotypes i.e. GT1 and GT2. Within both BV positive and intermediate sample groups, GT1 was the most prevalent genotype (54%). Overall, 4 subtypes (1, 2B, 2AB and C) were shown to be present in the sample population. The most prevalent subtype was 2B (15/37, 40.5%), followed by subtypes 1 (11/37, 29.7%), 2C (4/37, 10.8%) and 2AB (4/37, 10.8%). The phylogenetic analysis of the 16S rRNA genes showed the presence of 5 clusters. The tree displayed clusters which contained groups of specimens from the same BV group with different genotypes and subtypes present. There were also clusters which contained specimens from across the BV groups carrying the same genotype and subtype. Finally, the study did not find a significant association (p>0.05) between reported symptoms of discharge and genotype harboured. This study provides the first report on the diversity of G. vaginalis in South African pregnant women. Diversity assessments of G. vaginalis with respect to genotypes and subtypes may aid in a greater understanding on the pathogenesis of this microorganism.
Morbidity and mortality in the modern antiretroviral treatment era in a tertiary teaching hospital in Durban, South Africa.
(2020) Riziki, Manimani Ghislain.; Magula, Nombulelo Princess.
Background: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is recognized as the chief cause of morbidity and mortality in Sub-Saharan Africa. South Africa is known to bear the highest number of people living with HIV globally, while KwaZulu-Natal is the worst affected province in this country. Aim: To identify the determinant of morbidity and mortality in the modern antiretroviral therapy (ART) era in South Africa. Study design: A cross-sectional study. To achieve the objective, a mixed data acquisition method was applied using qualitative and quantitative data. These included a systematic review and a retrospective chart review. Data collection and analysis: For the systematic review, relevant studies were searched from the following databases: Google Scholar, PubMed, CINAHL. Two review authors independently screened titles abstracts and full-text articles in duplicate, extract data and assess the bias. Discrepancies were resolved by discussion or arbitration of a third review author. The study used the Preferred Reporting Item of Systematic Review (PRISMA 2015) guideline. This study used R software version 3.6.2. to synthesis the data, graphic displays were used to visually compare the prevalence of comorbidities across the study region. With the retrospective chart review, we conducted a study of all patients admitted at King Edward medical wards, Durban, South Africa from January to December 2018. Data were obtained from medical records, including demographic profile, clinical attributes and laboratory records. Data were analysed using R software version 3.6.2. In addition, the association between the covariates was tested either with the Chi-Square test, Kruskal Wallis or Wilcoxon rank-sum test depending on the type of variables. A p-value < 0.05 was used as a benchmark for determining the level of statistical significance Results: For the systematic review a total of 409 articles were obtained from the database search, finally12 articles were eligible for data extraction. All 12 studies included were published between 2008 and 2018 in English and they were conducted in Sub-Saharan Africa. Among them, three were conducted in Nigeria, two were conducted in Uganda, three were conducted in South Africa, one in Gabon, one in Ethiopia, one in Ghana, and one in Burkina Faso. In most of the included studies, tuberculosis was the first commonest causes of hospitalization accounted for 40.7% followed by anaemia with 34.2% and toxoplasmosis with 29.3%. It was as well the first cause of death accounted for 44.3% followed by anaemia with 30.2% and toxoplasmosis 27.5%. Contrary one study reported anaemia as the first causes of hospitalization and two studies reported each respectively wasting syndrome and meningitis as the first causes of death. With regards to the chart review, a total of 577 (50.6%) females and 564 (49.4%) males were included in the study. The mean age of all the participants was 39.6±12.2, 506 (44.3%) patients had CD4 less than 200 cells /mm3 and 273 (23.9%) had VL ˃ 1000 copies/ml. Male gender [OR 1.39(1.07-1.8) p=0.015], age [OR1.02(1.01-1.03) p˂ 0.001], CD4 <200 cells/mm3 [OR 2.14(1.37-3.45) p=0.001], VL ˃ 1000 copies/ml [ OR 1.93(1.08-3.63) p=0.032] were associated with mortality among HIV infected patients admitted in the cohort. Tuberculosis (TB) was the most common diagnosis on admission and the leading cause of death which accounted for 257 (22.5%) and 73 (24.3%) respectively, followed by kidney disease with 83(7.2%) for admission and with 38(12.6) for death. Only 70% of patients had been reported to be on ART. Age, men gender, CD4 cell and viral load were associated with mortality. Association between CD4 cell count and viral load was found. Conclusion: Despite the recent improvement of modern antiretroviral treatment, HIV/AIDS still causes hospitalization and death among HIV infected patients. For the systematic review as well as for the chart review, tuberculosis was the commonest cause of hospitalization and death in Sub-Saharan Africa and South Africa, but it was always followed by other opportunistic infection and other non-AIDS related conditions. There is a need to prevent opportunistic infection (especially tuberculosis) and to tackle the non-communicable disease related to HIV infection. Also, a need to start antiretroviral treatment early for patients living with HIV. Keywords: Morbidity, Mortality, Antiretroviral therapy, Sub-Saharan Africa, South Africa.
Mortality rate in elderly patients over the age of sixty with a surgically treated hip fracture at a regional hospital in South Africa.
(2024) Mahomed, Farhaad.; Rajpaul, Jitesh.
Hip fractures are prevalent and serious injuries among patients over the age of 60, representing a significant public health issue with substantial morbidity, mortality, and healthcare costs. In recent decades, there has been a notable increase in the incidence of hip fractures, reflecting demographic shifts and an aging population. While conservative treatment may be appropriate for incomplete fractures, surgical intervention is typically required to restore mobility and reduce complications. Research indicates that several factors significantly influence the mortality rate in patients with hip fractures. Advanced age, poor physical status, male gender, and delayed treatment have been identified as critical determinants of mortality. These patients often present with significant comorbidities, such as cardiovascular disease, diabetes, and osteoporosis, which complicate their overall health status and elevate the risk of pre-operative and post-operative complications. Consequently, the mortality rate for hip fractures is higher compared to other types of fractures. The mortality rate following hip fractures is not only a measure of the severity of the injury but also serves as a crucial metric for evaluating the quality of care provided by healthcare facilities. It reflects the effectiveness of medical interventions, surgical procedures, and post-operative care. High mortality rates may indicate deficiencies in healthcare delivery, while improvements in these rates can signify advancements in medical practice and patient management. Understanding and identifying risk factors for increased mortality is essential for developing targeted interventions and improving patient outcomes. Anticipating potential complications and implementing strategies to mitigate these risks can enhance the overall care of patients with hip fractures. Given the importance of this issue, this study aims to determine the one-year post-surgery mortality rate of patients with hip fractures and to identify the comorbidities associated with these patients. By analysing these factors, the study seeks to provide insights into the prognosis of hip fracture patients and to inform clinical practices and healthcare policies aimed at reducing mortality and improving the quality of care for this vulnerable population.
Observed birth prevalence of structural congenital disorders among live births at a regional facility in South Africa.
(2021) Saib, Muhammad Zubayr.; Dhada, Barnesh Lalloo.
Congenital disorders (CDs) are a global health issue and an important contributor to childhood mortality and morbidity. In South Africa (SA), the size and nature of the problem is unknown because reporting of CDs has been unreliable. Inaccurate assessment and under-reporting have led to an underestimate of the contribution of CDs to the burden of disease. As SA undergoes a positive epidemiological transition, the CD burden will be expected to increase. This study aimed to fill the void in empiric CD data in the country. The objectives were to measure the birth prevalence of CDs of live births and describe the pattern of CDs at a regional hospital in KwaZulu Natal Province in 2018 using the Birth Defects Notification Tool (BDNT) developed by the National Department of Health. The collected data was then compared with existing published data in SA and country-specific modelled estimates. A retrospective, observational, descriptive review of CDs diagnosed within the neonatal service at Edendale Hospital (EDH) was conducted in 2018. All in-house live births diagnosed with CDs were included in the study. Stillbirths and neonates with identified CDs born elsewhere and referred to EDH after birth were excluded from the study. Data were obtained from the birth registry, neonatal admission register, and the individual BDNT. A total of 117 neonates were diagnosed and notified with a CD from the 7516 live births examined at EDH. The total birth prevalence for the study period was 15.57 per l000 live births, which equates to 1 in every 64 live births affected by a CD at EDH in 2018. The most affected systems were the musculoskeletal (31.6%) and circulatory systems (18.8%). Birth prevalence rates of key CDs were comparable to previously published SA data and are in line with current modelled estimates. This study responds to the paucity of birth prevalence data on CDs in SA and serves as a starting point for comparison locally and with other national and international data. It offers additional evidence on the health burden represented by CDs in SA and the need to address the surveillance, care and prevention of these conditions as a healthcare priority.
Prevalence and outcome of cryptococcal meningitis among HIV infected patients admitted to a tertiary level facility in an HIV endemic setting in art era.
(2018) Gasem-Agha, Najua.; Magula, Nombulelo Princess.; Naidoo, K.
Background: Cryptococcal meningitis (CM) is a common AIDS (acquired immunodeficiency syndrome) - defining illness that contributes to morbidity and mortality among HIV-infected adults in South Africa (SA). Methods: We conducted a retrospective study among HIV infected patients aged ≥13 years, admitted to medical wards to better understand factors that contribute to ongoing high mortality among patients presenting with cryptococcal meningitis. Results: There were 322 lumbar punctures (LP) received from medical wards, from patients presenting with features suggestive of meningitis. A total of 44 CSF samples were deemed abnormal.26 patients had confirmed cryptococcal meningitis. Among those patients, 51.8% (14/27) were female and 48.2% (13/27) were male. No further clinical data available for 3/27 patients due to missing charts,1/27 was HIV uninfected therefore excluded from the study. Headache was the most common 91.3% (21/23) presenting feature, with overall mean duration of symptoms of 2 weeks (range: 1 -3 weeks). On admission 87% (20/23) were known HIV positive, with 13.0% (3/23) confirmed HIV positive during admission. Mean length of stay was 18 days IQR (1-15 day). Lumbar puncture (LP) was done to 95.6% (22/23) and therapeutic LPs were done only in 31.8% (7/22). Renal impairment developed in 39 % (9/23), 2/23 (8.7%) patients developed hydrocephalus, 26.1% (6/23) died, 30.4% (7/23) required further care, while 43.4% (10/23) were discharged. XXII Conclusion: Improving medical management through more effective treatment and prevention services for cryptococcal disease is required.

Browse

Browsing Masters Degrees (Clinical Medicine) by Title