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Masters Degrees (Medicine)

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    A retrospective chart review of the demographics of patients presenting with urinary calculi to Inkosi Albert Luthuli Central Hospital Urology Department over a 2-year period.
    (2022) Naidoo, Dhesigan.; Ramloutan, Vishan Mohanlal.
    Abstract Racial differences in the characteristics of urinary calculi are poorly described in the South African context, limiting our local understanding of urolithiasis pathology, and thwarting our efforts in designing appropriate preventative interventions. We sought to investigate differences in urinary calculi characteristics amongst the main racial groups in KwaZulu-Natal, South Africa. We conducted a retrospective chart review of patients with urinary calculi at a quaternary hospital in KwaZulu-Natal, South Africa during 2018-2019. We collected data on the patient’s age, sex, race (Caucasian, Asian, Black African), residence, and pre-ureteric stenting. Five study outcomes were investigated across racial groups: number of calculi, location of the calculi, size of the calculi, density of the calculi (Hounsfield Unit measurement >600), and the number of operative interventions performed. Data was analysed with descriptive statistics, the chi-squared test, and unadjusted/adjusted logistic regression. Our study sample consisted of 147 patients (10.9% Caucasian, 55.8% Asian, 33.3% Black African). Most patients (86.4%) were from urban areas. A higher proportion of Black Africans had urinary calculi with Hounsfield Unit measurements >600 (p=0.002). In the logistic regression models, Black Africans had a higher probability of having urinary calculi with Hounsfield Unit measurements >600 (Unadjusted Odds Ratio: 7.17, 95% Confidence Interval: 2.00-27.80; Adjusted Odds Ratio: 18.75, 95% Confidence Interval: 3.37-157.57). Our analysis suggests that Black Africans are at higher risk of having harder urinary calculi than other race groups. This has implications for urolithiasis management and highlights the importance of primary prevention in this group. We recommend additional research to confirm our findings.
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    The clinical and angiographic profile of very young patients with coronary artery disease.
    (2016) Pillay, Ashegan Kandasamy.; Naidoo, Datshana Prakesh.
    Overview of thesis in a PDF.
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    The clinical spectrum and outcome of skin conditions in patients admitted to dermatology wards at King Edward VIII Hospital, Durban.
    (2016) Mazibuko, Mthobisi Neliswa.; Dlova, Ncoza Cordelia Noxolo.
    Overview of theses in a PDF.
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    Compliance with the guidelines for the management of cardiovascular risk factors in patients with hypertension and/or diabetes mellitus.
    (2022) Nqiwa, Khayakazi.; Magula, Nombulelo Princess.; Mbanjwa, Bavumile.
    Background: Globally, the burden of cardiovascular diseases (CVDs) is increasing. In South Africa (SA), evidence-based management guidelines and clinical tools containing symptom-based algorithms and checklists have been implemented as interventions for use by clinicians at the primary health care (PHC) level. Clinicians are expected to fully comply with these guidelines to improve the quality of care and clinical outcomes. Objective: To determine clinician compliance with Primary Care (PC) 101 guidelines for the management of cardiovascular risk factors in patients with hypertension (HTN) and diabetes mellitus (DM). Method: In this retrospective study, we reviewed medical records of patients aged 18 years and older who were receiving chronic care for HTN, DM, or both, at a PHC clinic, in KwaZulu Natal, SA, between June 2015 and August 2016, excluding newly diagnosed patients. Results: Of the 99 patients included, 82 (83%) were females, and 88 (89%) were black; 70 (71%) patients had HTN, 27 (27%) had both HTN and DM, and 2 (2%) had DM only. The mean (SD) age was 60 (12) years. Of those with HTN (n = 70), blood pressure (BP) was measured in 57 (81%) at baseline, 56 (80%) at 6 months, and 62 (87%) at 12 months; body mass index (BMI) was documented in 10 (14%) and an estimated glomerular filtration rate (eGFR) done in 59 (84%). In those diagnosed with both HTN and DM (n = 27), BP was measured in 25 (93%) at baseline, 26 (96%) at 6 months, and 24 (89%) at 12 months; glucometer reading (GR) was checked in 22 (82%) at baseline and 6 months, and 20 (74%) at 12 months; feet examination and urine dipsticks analysis were documented in 1 (4%), and eye examination and BMI in 2 (7%); eGFR was performed in 21 (78%) and hemoglobin A1c (HbA1c) in 16 (59%). Of the patients with DM only (n =2), BMI, eye and feet examination were recorded in 0% and urine dipsticks analysis done in 1 (50%). Conclusion: This study showed low rate of clinician compliance with PC101 guidelines at a PHC clinic. However, reasons for clinicians’ non-compliance were not explored. This emphasizes the need for future investigations to identify barriers to following guidelines.
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    The awareness and perceptions of sexually transmitted infections among students attending the University of KwaZulu-Natal.
    (2021) Mthembu, Funeka Nomvula.; Abbai, Nathlee Samantha.
    A high prevalence of sexually transmitted infections (STIs) have been reported among youth globally and this high prevalence calls for global efforts to improve sexual and reproductive health in this population. The prevalence of STIs in young South African women and men is 0.50% and 0.97% for Syphilis, 6.6% and 3.5% for Gonorrhoea and 14.7% and 6.0% for Chlamydia. Increased evidence on behavioural change is dependent on the comprehensive understanding and perception of one’s own risk. Updated evidence of awareness and perception of STIs in university students is needed to inform relevant sex education programmes. The purpose of this study is to assess awareness and perceptions of STIs in students enrolled at the University of KwaZulu-Natal. Methodology The study used a quantitative research approach. This study was conducted at the University of KwaZulu-Natal in Durban, South Africa. The sample consists of 142 undergraduate and postgraduate registered students between the ages of 18 and 35 years. The study used purposive sampling to obtain the sample. A self-administered survey assessing awareness and perceptions of sexual risk behaviour and STIs was administered. Data was analysed using descriptive statistics. Means and standard deviation were used for continuous variables. Analyses were stratified by gender using Chi-square tests as it was expected that there would be differences in awareness and perceptions regarding risky sexual behaviour and STIs.. Analyses were done with STATA version 15.1. Results The study found that 78% of the students were aware of STIs. There was a significant association regarding awareness of Chlamydia infections, p=0.015. Similar to the other infections, a higher proportion of males were aware of Chlamydia when compared to females (96.4% versus 82.8%, p=0.015). Similar to Chlamydia infections, there was a significant association regarding awareness of Trichomonas across the different genders (p=0.011). According to the analysis, females are exposed to awareness of STIs from a younger age when compared to their male counterparts. Most students (34.5%) had reported that they had received information on STIs from social media and from their school teachers. There was a significant difference in the responses related to same sex practices and STI risk (p=0.047). While some students had socially acceptable perceptions, there were some that were not acceptable including sexual debut (34,5%), concern about being at risk of STI (31%), condom-less sex as an STI risk (21.2%), ease of condom negotiation (41.5%), pregnancy being more risky than STIs (28.8%) and alcohol as an STI risk (28.2%). Conclusion This study had revealed the students have high awareness of STIs. Despite the high awareness, the students still have low risk perceptions especially towards condom use, alcohol consumption and age disparate relationships. These distorted attitudes will subsequently impact on the risk behaviours and further research needs to be conducted in order to fill the gap between awareness and perception. This study highlighted the clear discrepancy between the awareness of STIs and the reported perceptions of students. Future research to evaluate STI messaging and assess actual risk versus perceived risk in this population is recommended.
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    Outpatient treatment of drug-resistant tuberculosis in a hyperendemic setting.
    (2021) Pillay, Jashen.; Gounden, Strinivasen.; Sadhabiriss, Dhiren.; Magula, Nombulelo Princess.
    Background: The existence of multidrug-resistant tuberculosis (MDR-TB) represents a failure of effective infection control. There are over half a million new cases diagnosed annually with treatment success rates of only 57% reported in 2019. These numbers are highest in hyperendemic regions of the world, including South Africa, which has a high burden of tuberculosis and HIV co-infection. Treatment of MDR-TB is challenging and is usually managed at specialised centres. There is currently a transition into the decentralised treatment of MDR-TB for outpatients. Describing the features of DR-TB may influence improved treatment strategies for the future. Objectives: To determine the prevalence of DR-TB at a single, central outpatient site in a hyperendemic area of South Africa, and to evaluate known risk factors and their relationship with outcomes, including time between diagnosis and treatment initiation. Methods: A retrospective chart review of all new cases of DR-TB referred to a central hospital in Durban for outpatient care for the period 01/01/2017 to 31/03/2017 was conducted. Data included demographics, co-morbidities, time-to-treatment, treatment adverse effects and outcomes and were collected and collated from physical charts and the computerised registry. The data was then analysed using SPSS software. Results: The period prevalence of MDR-TB at the site was 44 cases/100 000 population. Of these cases, one hundred and eleven new cases of DR-TB were included in the analysis which comprised 57 (51.35%) males. Most patients were of African ethnicity (n = 107, 96.4%). Thirty-one (27.9%) patients did not have HIV co-infection. More than one-half of patients (n = 56, 51.5%) had a history of TB and was significantly higher in males than in females (n = 34, 59.6%) and n = 22, 40.7%) respectively; p= 0.020). Five (4.5%) patients had co-morbidities of hypertension, diabetes mellitus, or renal impairment. Most patients (n = 98, 88.3%) were treated within three months of diagnosis. The mean time-to-treatment was significantly longer in patients with extrapulmonary DR-TB (150.14 (±175.90) days compared to 53.21 (±66.01) days; p-value=0.002). Significantly more patients were treated within 6 weeks if they had a positive GeneXpert test (n = 35, 89.7% compared to n = 11, 17.5%, p=0.013). Fifty-one different treatment regimens were used, and 139 side-effects were reported, the most common being ototoxicity, hypothyroidism and peripheral neuropathy. Eighty-two (73.87%) patients completed follow-up until cure. Conclusion: The high burden of TB and HIV co-infection as well as a history of TB are associated with the elevated prevalence of MDR-TB in this setting. Side-effects are common and may impact toward poorer treatment adherence in addition to co-morbidities. Outcomes are favourable in specialised outpatient settings. A decentralised approach reduces the time-to-treatment in other studies, but large-scale implementation is recommended for further evaluation.
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    Clinical profile and outcome of autosomal dominant polycystic kidney disease at a tertiary hospital KwaZulu-Natal, South Africa: a retrospective 5-year review.
    (2022) Abulghasm, Taha Mohamed.; Assounga, Alain Guy Honore.; De Vasconcellos, Kim.
    No abstract available.
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    Clinical profile of scleroderma associated interstitial lung disease at a tertiary hospital in KwaZulu-Natal, South Africa: a retrospective 7 years review.
    (2021) Tanish, Salah.; Nyamande, Kennedy.; De Vasconcellos, Kim.
    Background: Interstitial lung disease (ILD) is one of the most serious complications among patients with scleroderma. It is associated with significant morbidity and mortality. Little is known about the epidemiology of scleroderma-associated interstitial lung disease in sub-Saharan Africa. Thus, we aimed to determine the prevalence, clinical characteristics and outcomes of patients with scleroderma-ILD. Methods: A retrospective electronic chart review was conducted of patients with systemic sclerosis seen between January 2010 and December 2016 in the Departments of Pulmonology and Rheumatology at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Results: A total of 146 patients with systemic sclerosis (SSc) were seen during the study period. Fifty-five patients had systemic sclerosis-associated ILD, giving a prevalence of 37.7%. The median age was 51 (IQR 41-60) years, 87% of patients were female and 56% were of Indian descent. Dyspnoea was the presenting complaint in 47 (85.4%) patients, while 16 (29.1%) presented with cough. Antinuclear factor (ANA) was positive in 50 patients (90.9%), anti-Scl-70 antibodies were positive in 21 (38.2%). Thirty-seven patients (67.3%) received immunosuppressants, with 27 (49.1%) receiving cyclophosphamide as induction therapy, while 18 (32.7%) patients did not receive any specific therapy. Most patient symptoms remained static during the period of observation. Usual interstitial pneumonia (UIP) pattern was the most common radiological diagnosis. Follow-up computer tomography (CT) scans were available in 48 (87%) patients, with the majority of patients showing no significant radiological changes between their first and last CT scans. Follow-up lung function testing showed a statistically significant decrease in median forced vital capacity (FVC) of 0.09l (p=0.011). Overall 20 (36.4%) patients had a significant decline in FVC, while 7 (12.7%) had an improvement in FVC. Conclusion: ILD is common in systemic sclerosis, affecting 1 in 3 patients with systemic sclerosis in this cohort. Immunosuppressant treatment may arrest or retard the rate of decline in lung function.
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    A retrospective study to determine the prevalence and degree of hyperkalaemia in adult patients with chronic kidney disease, attending the renal clinic at Inkosi Albert Luthuli Central Hospital.
    (2022) Bux, Tasneem.; Assounga, Alain Guy Honore.
    Chapter 1: Abstract Background: The presence of hyperkalaemia is a known risk factor for the development of cardiac rhythm disturbances and sudden cardiac death. The presence of chronic kidney disease (CKD) is also an independent risk factor for cardiovascular complications. The prevalence of hyperkalaemia in patients with CKD has previously varied widely between studies. The prevalence of hyperkalaemia in the patients attending the renal clinic at Inkosi Albert Luthuli Central Hospital (IALCH) has not been previously determined. Objectives: This study aimed to discover the prevalence of hyperkalaemia in patients attending the renal clinic at IALCH, as well as the degree of severity amongst the patients in whom hyperkalaemia was present. Demographic and other variables were also assessed for an association with hyperkalaemia. Methods: A retrospective review of outpatients attending the renal clinic at IALCH from 1 October 2016 until 30 September 2017. Results: The study consisted of 200 patients, of whom the majority were female (n=120, 60%). The prevalence of hyperkalaemia amongst these patients was found to be 16%. In those with stage 3 CKD, the prevalence of hyperkalaemia was 7.69%. In those with stage 4 CKD, the prevalence of hyperkalaemia was 20.5% and in those with stage 5 CKD the prevalence was 17.3%. There were no statistically significant associations between hyperkalaemia and demographic variables, nor with dietician intervention. There was a significant association with the use of sodium polystyrene sulfonate. Conclusion: CKD is a growing burden in the developing world. With CKD comes metabolic and other derangements, including electrolyte abnormalities as well as increased cardiovascular risk. Hyperkalaemia is associated with worsening CKD. In addition, hyperkalaemia puts patients at risk of cardiac dysrhythmias and sudden cardiac death. Pharmacological measures to manage CVD risk should be weighed up against the risk of hyperkalaemia related complications. Potassium lowering agents should be considered in order to allow for optimal CVD management in the setting of hyperkalaemia in CKD.
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    Capsular endoscopy: a single centre experience.
    (2021) Naicker, Nisholini.; Cassim, Bilkish.; Newton, Keith.
    Abstract Background: Capsule endoscopy (CE) is a relatively new modality in the assessment of obscure occult and obscure overt gastroenterological (GI) bleeding in South Africa. Objectives: The aim of this study was to describe the indications, findings and outcomes of CE at a referral hospital in the public sector in Kwa-Zulu Natal (KZN). Methods: Ethical approval was obtained from the Biomedical Research Ethics Committee of the University of Kwa-Zulu Natal (UKZN). A retrospective electronic chart review of 27 subjects who underwent CE from its introduction in 2013 to 2018 was undertaken. A structured data sheet was used to extract demographic and clinical details and the endoscopist‘s report. Indications were classified as obscure occult GI bleeding, obscure overt GI bleeding, suspected Crohn‘s disease and unexplained macrocytic anaemia (in a single subject). The findings at endoscopy were categorised as vascular (angiodysplasia, varices), inflammatory (villous oedema, erythematous mucosa erosions, ulcers or stenosis), normal, inconclusive or other (villous atrophy, polyps, tumours). Results: The mean age of the 27 patients was 51.2 years ± 21.3 years, with a majority of women (15, 56%) and 12 (44.4%) men. The most common indications for CE were either obscure occult GI bleeding or obscure overt GI bleeding. One patient each had unexplained anaemia and suspected Crohn‘s disease. All subjects had had previous oesophagogastroduodenoscopy (OGD) and colonoscopy prior to the CE, 15 subjects (55.5%) had had a CT scan of the abdomen and seven (26%) underwent red cell scans. Of the 14 subjects with occult GI bleeding, 12 had severe iron deficiency anaemia, with symptom duration ranging from one year to 40 years. These subjects had undergone a minimum of one up to a maximum of six OGDs, with a total of 38 OGDs prior to CE. Abnormal findings on CE were reported in nine subjects (64.3%), the commonest of which was inflammatory, and a definitive diagnosis was made in six (42.9%) subjects. The 11 subjects with obscure overt GI bleeding had undergone a total of 27 prior OGDs prior to CE. Abnormal findings on CE were reported in three of the 11 subjects (27.3%) with obscure overt GI bleeding and a definitive diagnosis made in two subjects (18%). In addition, the diagnosis was supported in the patient with Crohn‘s disease who had been symptomatic for eight years and had had several previous OGDs and colonoscopies. In the total group who underwent CE, nine (33.3%) subjects attained a definitive diagnosis. A further 18.5% attained a diagnosis following subsequent investigations. In three subjects (11.1%) the initial indication resolved requiring no further therapy or investigation and two patients (7.4%) were lost to follow up. Capsule retention occurred in two patients and the capsule was successfully retrieved via laparoscopic surgery. Conclusion: Capsule endoscopy is a useful modality to further investigate select patients with unexplained GI bleeding, including the identification of lesions outside the small bowel. A guideline for the application of CE in the South African context is required.
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    The profile of rheumatic heart disease at a tertiary hospital, KwaZulu-Natal, South Africa.
    (2021) Shange, Kwenzakwenkosi Siyabonga.; Naidoo, Datshana Prakesh.; Paruk, Farhanah.
    Abstract not available.
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    The association between renal sonography and renal function in chronic kidney disease at Inkosi Albert Luthuli Chief Hospital: a retrospective descriptive study.
    (2020) Frank, Astley Gershwyn.; Assounga, Alain Guy Honore.
    Background Non-communicable diseases (NCDs) are rapidly emerging as a major cause of chronic kidney disease (CKD) in Africa with a reported prevalence of 10.7% locally. At current, few high-quality studies assessing the epidemiology of CKD in South Africa have been published. Alarmingly, CKD is now at epidemic proportions and is a leading cause of mortality with significant cost implications. This study aims to investigate economic means of predicting renal function in CKD by exploring the association between estimated glomerular filtration rate (eGFR) and renal morphology evaluated by ultrasound (US). Methods This is a retrospective descriptive chart review conducted at the Department of Nephrology, Inkosi Albert Luthuli Central Hospital (IALCH), Cato Manor, Kwa-Zulu Natal from January 2016 to December 2016. A total of 455 patients who had met the Kidney Disease Improving Global Outcomes (KDIGO) definition of CKD with eGFR (MDRD) and renal US performed were included. Demographic, clinical, laboratory and renal morphological data (renal length (RL), increased echogenicity (IE) and loss of corticomedullary differentiation (LCMD)) on US were collected and analyzed with SPSS software (v. 27). Associations between eGFR, parameters on US and CKD risk factors were determined using logistic regression analysis. Results Black Africans 75.2% (n.342) and females 56.9% (n.259) predominated the sample. Whilst, Indians, Whites and Coloureds comprised of 20.4%, 2.42% and 1.98% of the study respectively. The median age was 45.8 ± 14.3 years. Hypertension 34.9%, diabetes 26.8%, HIV 27.5% and glomerulonephritis 9.89% were the four most frequently reported risk factors, of which Black Africans comprised more than 50% of cases (p <0.001). A significant proportion of patients 65.7% (n.307) had end-stage renal disease with a median eGFR of 14.4 ± 12.8ml/min/1.73m2 (p <0.001). The median right and left RL were short at 8.49 ± 2.16cm and 8.60 ± 2.20cm respectively. Black Africans were also found to have significantly shorter RLs and lower eGFRs (p <0.001). The dual effect of IE and LCMD predisposed to significantly shorter RLs and lower eGFRs than in the presence of one or no abnormality on US (p <0.001). IE [-9.29 OR; 95% CI (-13.8 - -4.77); p <0.001] and RL [right: 5.02 OR; 95% CI (3.44 – 6.60); p 0.04; left: 5.11 OR; 95% CI (3.56 – 6.66); p 0.04] were found to be significant predictors of eGFR. HIV was the only risk factor found to be negatively associated with all determined measures of renal function, as well as the sole predictor of IE [2.31 OR; 95% CI (0.17 - 3.15); p 0.02]. Conclusion The CKD epidemic is driven by the complex interplay between communicable (HIV) and NCDs (HPT/DM) and has emerged as an important public health and economic threat in Southern Africa. Africans are most vulnerable presenting with an advanced and accelerated disease course. GFR determination and US are inexpensive means of determining renal function particularly in resource limited settings. IE and RL are surrogate markers of renal function with an increased echogenic pattern being most predictive of renal dysfunction in CKD, particularly in HIV.
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    Surgical outcomes of HIV seropositive adult patients with intracranial hypertension secondary to cryptococcal meningitis.
    (2020) Mabovula, Ndyebo Samkelo.; Enicker, Basil Claude.
    Overview available in PDF.