Research Publications (Health Sciences)

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An analysis of the need for accredited training on the administration of intravenous contrast media by radiographers : results of an online survey
(The South African Radiographer, 2012) Swindon, Lynda; Friedrich-Nel, Hesta; Isaacs, Ferial; Munro, Leonie
Role extension has been debated amongst South African radiographers for a number of years. However, the administration of contrast media still remains outside their scope of practice. The Society of Radiographers of South Africa (SORSA) has received anecdotal reports that radiographers are administering contrast media. This practice is a direct infringement of the rights of patients who are required to be treated and examined by health professionals who practice within their legal scope. The aim of this survey was to investigate the views and opinions of South African radiographers regarding the injecting of contrast media and the type of training needed if it were included in the scope of practice of South African radiographers. A questionnaire was sent to 845 radiographers using an online survey programme (SurveyMonkey). The questions related to biographical information, work experience, training and the medico-legal aspects of intravenous contrast media injection by radiographers. The response rate was 21% (n=177). Eighty-one percent (81%) were diagnostic radiographers. Seventy-three percent (73%) practice radiography in a major city. There was an equal representation of the public and private sector, namely 43% for both. Of those from the public sector 47% were from a tertiary healthcare facility. More than seventy-eight percent (>78%) practice radiography in a health facility that provides radiology services. Seventy-three percent (73%) were aware of mild to moderate adverse reactions to contrast media; 45% were aware of severe adverse reactions to contrast media in their workplace. Eighty-five percent (85%) thought that accredited training should include the administration of contrast media as well as resuscitation of a patient. Sixty-two percent (62%) thought the accredited training should include pharmacology and advanced resuscitation. Ninety-three percent (93%) thought the main advantage would be an increase in service delivery to patients; 85% thought the main disadvantage would be potential risk of criminal or civil litigation. Ninety-seven percent (97%) were of the opinion that radiographers who introduce contrast media to patients must have current malpractice insurance. The results of this survey provide new information on the current status of contrast media administration to the patient whose safety and rights remain at the centre of our focus. It is recommended that the statutory body, namely the professional board for radiography and clinical technology (RCT) of the Health Professions Council of South Africa (HPCSA) takes cognizance of the outcome of this study and embarks on a more extensive survey to include a larger sample which would be more representative of the South African radiography population.
Antidiabetic potential of Brachylaena discolor
(0189-6016, 2015) Mellem, John Jason; Baijnath, Himansu; Odhav, Bharti
Background: The traditional African herbal medicinal system has many reports of anti-diabetic food plants with no known side effects. Such plants and their products have been widely prescribed for diabetic treatment with little known mechanistic basis of their functioning. Therefore, these natural products need to be evaluated scientifically in order to confirm antidiabetic property claims. Materials and Methods: In this study, leaves of Brachylaena discolor were evaluated for potential to inhibit α-amylase and α-glucosidase. The leaves were also screened for toxicity and free radical scavenging capacity. Results: Results from the study show that the methanolic extract gave a higher α-glucosidase inhibition potential and was able to effectively scavenge free radicals better than the aqueous extract. The toxicity, cytotoxicity and mutagenicity screen also showed that both plant extracts are safe for use. Conclusion: These results therefore indicate that B. discolor has the potential for use as a potential dietary adjunct or therapy for the treatment of diabetes.
Antimicrobial and antioxidant activities of substituted halogenated coumarins
(Academic Journals, 2014-02-03) Kasumbwe, K.; Venugopala, Katharigatta Narayanaswamy; Mohanlall, Viresh; Odhav, Bharti
Pathogens frequently display resistance to current drugs, which frequently lack selectivity/efficacy and have detrimental side effects. Thus, there is a constant need for novel therapeutic agents. Coumarins belong to the family of lactones, having a benzopyrone system that can be isolated from plants as well as total synthesis that can be carried out in the laboratory. To date, many chemical reactions have been established that can be used to synthesize coumarins. The synthesis of coumarins and their derivatives has attracted the attention of organic and medicinal chemists, as these are widely used as fragrances, pharmaceuticals and agrochemicals. In the present study, the antimicrobial and antioxidant activities of substituted coumarin analogue compounds have been screened. 3-(2-bromoacetyl)-2H-chromen-2-one (CMRN3) and 3-(2, 2-dibromoacetyl)-2H-chromen-2-one (CMRN6) showed bacterial growth inhibition for all the tested species except Klebsiella pneumonia and Bacillus stearothermophilus. CMRN4 and CMRN5 displayed moderate bacterial inhibition against Bacillus cereus, Micrococcus luteus, Staphylococcus aureus. CMRN3 and CMRN6 had a minimum inhibition concentration at 0.75 mg/ml against B. cereus, Bacillus coagulans, and Streptococcus faecalis. They displayed a minimum inhibitory concentration (MIC) of 1.5 mg/ml against Escherichia coli and S. aureus. (CMRN5) displayed an MIC at 0.75 mg/ml against M. luteus and 1.5 mg/ml against S. aureus. Compounds3-(2-bromoacetyl)-6-chloro-2H-chromen-2-one (CMRN4), 3-(2-aminothiazol-4-yl)-6-bromo-2H-chromen-2-one(CMRN7), 3-acetyl-6-bromo-2H-chromen-2-one (CMRN1) exhibited potent antioxidant activity at 85, 61 and 56%, respectively, as evaluated by the DPPH free radical method.
Antimicrobial and antioxidant activities of substituted halogenated coumarins
(Academic Journals, 2014-02) Kasumbwe, K.; Venugopala, Katharigatta Narayanaswamy; Mohanlall, Viresh; Odhav, Bharti
Pathogens frequently display resistance to current drugs, which frequently lack selectivity/efficacy and have detrimental side effects. Thus, there is a constant need for novel therapeutic agents. Coumarins belong to the family of lactones, having a benzopyrone system that can be isolated from plants as well as total synthesis that can be carried out in the laboratory. To date, many chemical reactions have been established that can be used to synthesize coumarins. The synthesis of coumarins and their derivatives has attracted the attention of organic and medicinal chemists, as these are widely used as fragrances, pharmaceuticals and agrochemicals. In the present study, the antimicrobial and antioxidant activities of substituted coumarin analogue compounds have been screened. 3-(2-bromoacetyl)-2H-chromen-2-one (CMRN3) and 3-(2, 2-dibromoacetyl)-2H-chromen-2-one (CMRN6) showed bacterial growth inhibition for all the tested species except Klebsiella pneumonia and Bacillus stearothermophilus. CMRN4 and CMRN5 displayed moderate bacterial inhibition against Bacillus cereus, Micrococcus luteus, Staphylococcus aureus. CMRN3 and CMRN6 had a minimum inhibition concentration at 0.75 mg/ml against B. cereus, Bacillus coagulans, and Streptococcus faecalis. They displayed a minimum inhibitory concentration (MIC) of 1.5 mg/ml against Escherichia coli and S. aureus. (CMRN5) displayed an MIC at 0.75 mg/ml against M. luteus and 1.5 mg/ml against S. aureus. Compounds3-(2-bromoacetyl)- 6-chloro-2H-chromen-2-one (CMRN4), 3-(2-aminothiazol-4-yl)-6-bromo-2H-chromen-2-one(CMRN7), 3- acetyl-6-bromo-2H-chromen-2-one (CMRN1) exhibited potent antioxidant activity at 85, 61 and 56%, respectively, as evaluated by the DPPH free radical method.
Are point-of-decision prompts in a sports science and medicine centre effective in changing the prevalence of stair usage? : a preliminary study
(2009) Pillay, Julian David; Kolbe-Alexander, Tracy; Achmat, Masturah; Carstens, Madelaine; Lambert, Estelle V.
Objective. To determine the impact of a signed intervention on promoting stair versus lift usage in a health and fitness facility. Design. A 3-week observational study in which a simple timeseries design of collecting data before, during and after the introduction of an intervention was used. Setting. The Sports Science Institute of South Africa (SSISA): a 5-storey building with a centrally located lift lobby and internal stairwell. Method. Observers were placed unobtrusively on the ground floor, with good visibility of lift/stairwell, to observe ascending movement of students, staff, tenants, visitors and patients 4 hours/day (07h00 - 09h00, 16h00 - 18h00), 4 days/week for 3 weeks. During week 2, motivational signs were displayed on the wall next to the lift and stairs and on the floor leading to the stairwell. In week 3, signage was removed. Factors considered in predicting stair use were gender, phase of intervention, and whether persons were staff/students or visitors. Results. A total of 4 256 person-counts were recorded. Prevalence of stair use increased from 43% before the intervention to 53% during the intervention to 50% after the intervention. Odds of using the stairs during the intervention increased by 45% (odds ratio (OR) 1.45, 95% confidence interval (CI) 1.25 - 1.68) (p<0.00001), were 41% higher for staff/students compared with visitors (p<0.00001) and were 55% greater for women (p<0.00001). These effects did not change significantly after the intervention and stair use remained modestly higher than before the intervention. Conclusion. Signed intervention produced significant increases in stair usage during and after the intervention. These findings support the effectiveness of point-of-decision prompts for changing behaviour, and highlight potential factors influencing the impact of such messages.
Assessing infection control knowledge and compliance of cardiovascular perfusionists in theatre at a private hospital in Kwazulu-Natal, South Africa
(Durban University of Technology, 2023) Naidoo, Elizabeth; Akpa-inyang, Francis; Odayan, Myenderan; Adam, Jamila
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.
Assessment of the use of the new maternity case record in improving the quality of ante natal care in eThekwini District, KwaZulu-Natal
(Elsevier, 2015) Sibiya, Maureen Nokuthula; Cele, Reginah Jabulisile; Ngxongo, Thembelihle Sylvia Patience
The national guidelines for maternity care in South Africa recommend that a standardised maternity case record be used by all facilities at all levels of care in order to improve the quality of care for pregnant women. This will facilitate continuity and quality of care for women during pregnancy, labour and post-partum. The aim of the study was to assess the use of the maternity case record in improving the quality of the antenatal care for pregnant women. An exploratory, descriptive study using both quantita-tive and qualitative design was used to conduct the study. Data was collected through a retrospective record review using a checklist for the quantitative strand, and from midwives using unstructured inter-views for the qualitative strand. The quantitative data set was analysed using the Statistical Package for the Social Sciences version 21.0 and the qualitative strand was analysed using the Tesch’s method of data analysis. The results of the record review revealed that although the recording was done fairly well, there were a number of activities and interventions that were recorded poorly or not recorded at all in some primary health care clinics. The midwives verbalised that many mistakes and mismanagement of ante-natal care clients emanated from the structure and the design of the new maternity case record.
Balance and stability-focused exercise program improves stability and balance in patients after acute stroke in a resource-poor setting
(American Academy of Physical Medicine and Rehabilitation, 2014-12) Puckree, Threethambal; Naidoo, Pooveshni
Objective: To compare the effect of a balance and stability - focused outpatient community-based rehabilitation and a regular physiotherapy program on balance, stability, and perceptions of improvement after acute stroke. Design: A randomized controlled trial in a community-based therapy center. Participants: Fifty consecutive patients with a first stroke, who reported to a community-based therapy center over a 7-month period were allocated to the control group (regular physiotherapy) or the experimental group (balance and stability - focused rehabilitation). Intervention: A program of physiotherapy focused on balance and stability exercises. The control group received the regular physiotherapy program. Main Outcome Measurements: The Postural Assessment Scale for Stroke Patients (PASS) and the Berg Balance Scale (BBS) monitored stability and balance. The normalized data (PASS and BBS) were analyzed by using analysis of covariance. Qualitative data were thematically described. Results: Internal consistency of baseline PASS and BBS scores was high (Cronbach a , .964 and .974, respectively). PASS overall pretest scores increased from 21.96 +- 21.41 (mean +- standard deviation) and 21.52 +- 8.43 to 67.67 +- 28.42 and 80.16 +- 22.60 posttest in the control and experimental groups, respectively. Posttest scores were significantly different ( P ¼ .004). The effect size was medium (.490). The overall BBS scores showed overall mean (standard deviation) increases from 44.71 +- 22.24 and 43.43 +- 17.11 pretest to 48.71 +- 23.18 and 59.71 +- 18.20 posttest for the control and experimental groups, respectively. The effect size was considered medium (.532). Conclusion: The balance and stability - focused community-based rehabilitation program was more effective in improving stability and balance in patients with stroke compared with the regular physiotherapy program in resource-poor settings.
Cervical cancer screening among University students in South Africa : a theory based study
(PLOS, 2014-11) Hoque, Muhammad Ehsanu; Ghuman, Shanaz; Coopoosmay, Roger; Hal, Guido Van
Introduction: Cervical cancer is a serious public health problem in South Africa. Even though the screening is free in health facilities in South Africa, the Pap smear uptake is very low. The objective of the study is to investigate the knowledge and beliefs of female university students in South Africa. Methods: A cross sectional study was conducted among university women in South Africa to elicit information about knowledge and beliefs, and screening history. Results: A total of 440 students completed the questionnaire. The average age of the participants was 20.39 years (SD = 1.71 years). Regarding cervical cancer, 55.2% (n = 243) had ever heard about it. Results indicated that only 15% (22/147) of the students who had ever had sex and had heard about cervical cancer had taken a Pap test. Pearson correlation analysis showed that cervical cancer knowledge had a significantly negative relationship with barriers to cervical cancer screening. Susceptibility and seriousness score were significantly moderately correlated with benefit and motivation score as well as barrier score. Self-efficacy score also had a moderate correlation with benefit and motivation score. Students who had had a Pap test showed a significantly lower score in barriers to being screened compared to students who had not had a Pap test. Conclusion: This study showed that educated women in South Africa lack complete information on cervical cancer. Students who had had a Pap test had significantly lower barriers to cervical cancer screening than those students who had not had a Pap test.
Challenges of Directly Observed Treatment Strategy implementation in eThekwini Municipality, South Africa
(AFAHPER-SD, 2014-06) Rajagopaul, Althea; Reddy, Poovendhree; Kistnasamy, Emilie Joy
EThekwini Municipality in Kwazulu-Natal, South Africa has a high prevalence of Tuberculosis (TB) and reported a defaulter rate of 18.9% in 2007, in spite of the Directly Observed Treatment Short Course (DOTS) which was adopted in 1996. While numerous quantitative studies have evaluated aspects of the DOTS programme in South Africa, there are limited qualitative data on this issue. The aim of this study was to determine the challenges associated with the implementation of the DOTS programme in the eThekwini Municipality. Five participants, who were all involved in TB management and control within the municipality, were interviewed. Textual data were content analysed. Three themes relating to healthcare personnels’ reports on the challenges associated with implementing DOTS in the municipality emerged from the inductive analysis of transcripts namely; inadequate follow up and tracing of patients, training of health care personnel and choice of DOTS supporters and DOTS sites. In spite of the eThekwini Municipality’s commitment to TB control and management, problems with implementation of DOTS persist. Communication, reporting and co-ordination between the different levels of the TB programme are essential to optimise patient benefit from both the TB programme and community or home based care.
Chemoprevention of Azoxymethane-induced Colonic Carcinogenesis in Balb/c mice using a modified Pectin Alginate Probiotic
(International Institute of AntiCancer Research, 2015) Odun-Ayo, Frederick Oluwasheyi; Naicker, Thajasvarie; Reddy, Lalini; Mellem, John Jason
Background: Increased intake of probiotic dietary fibre reduces colonic cancer risk. Modified citrus pectin (MCP) requires optimal bioactivity to inhibit galectin-3 (GAL-3) and vascular endothelial growth factor (VEGF). This study evaluated the preventative effect of modified pectin alginate (MCPA) probiotic microbeads on azoxymethane (AOM)-induced colonic carcinogenesis in Balb/c mice. Materials and Methods: Optimization of AOM dose duration: 10-15 mg/kg was administered for 2-4 weeks. The optimal AOM dose was initiated prior to intake of MCPA, alginate probiotic (AP) microbeads and MCP in Balb/c mice for 16 weeks; samples were analyzed for colonic histopathology and immunohistochemistry. Results: AOM at 15 mg/kg for 4 weeks induced optimal GAL-3 and VEGF immunostaining. Furthermore, MCPA treatment reduced GAL-3 expression in the colon of AOM-treated mice compared to MCP. Conclusion: MCPA probiotic microbeads increase bioactivity and chemopreventative effect against pre-cancerous colonic lesions and adenocarcinoma through inhibition of GAL-3 and VEGF in the Balb/c mouse model of colonic carcinogenesis.
Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
(National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
Correlation between glutathione S-transferase Mu 1 (GSTM1) and glutathione S-transferase pi gene (GSTP1) polymorphisms and markers of inflammatory stress in pregnant females
(Academic Journals, 2013-03) Reddy, Poovendhree; Naidoo, Rajen N.; Chuturgoon, Anil A.; Asharam, Kareshma; Naidoo, Dhaneshree; Phulukdaree, Alisa; Gounden, Shivona
The Mother and Child Environmental Cohort (MACE) study piloted in South Africa in 2010 to 2011, collected genetic, biochemical and clinical data from pregnant females residing in south and north Durban. We evaluated birth outcomes and the influence of GSTM1pos→GSTM1null and the GSTP1 (Ile105Val; AA→AG/GG) polymorphisms on the extent of DNA damage and with biomarkers [glutathione (GSH) and malondialdehyde (MDA)] related to oxidative stress in mothers with different levels of pollutant exposure. There was no significant difference in adverse birth outcomes or genotype distribution between mothers from the exposed and lower exposed areas. Mean GSH and comet tail length did not differ significantly between GSTM1pos and GSTM1null genotypes. When stratified by genotype, mean MDA levels was higher among GSTM1 null mothers compared to the GSTM1pos mothers (p = 0.01). When each of the genotypes was stratified by exposure, mean GSH concentration was significantly higher in north Durban for the GSTM1pos, GSTM1null and GSTP1AG+GG genotypes (p < 0.05), and mean comet tail length was significantly increased in south Durban among participants with the GSTM1pos, GSTM1null, and the GSTP1AG+GG genotypes. The expression of GSTM1 and GSTP1 polymorphic genotypes may lead to varying susceptibility to the adverse effects of pollutants by modifying the response to oxidative stress.
Critical issues underpinning the safe transfer of ill neonates : a review of the literature
(Faculty of Health, Engineering and Science, Edith Cowan University, 2021-05-18) Bhagwan, Raisuyah
Introduction Critically ill neonates often require urgent transport to a neonatal care facility shortly after birth. The safe transfer of ill neonates is a critical part of their continuum of care. Methods A review of the empirical work and literature around the safe transfer of ill neonates was undertaken to explore what factors influence a safe transfer. Results What emerged was that a multitude of adverse events influence the clinical deterioration of the neonate, including the physiological condition of the neonate, equipment-related challenges and the unpreparedness of those involved to deal with neonatal clinical emergencies. Conclusion This review highlights the necessary equipment required, the nature of clinical emergencies that may arise, and the need to consider utilising specialised neonatal transfer units to effect the safe transfer of the critically ill neonate.
A descriptive study of inpatient admissions for cerebrovascular disease at a tertiary hospital in KwaZulu-Natal, South Africa
(Stellenbosch University, 2021-07-29) Moodley, Yoshan; Adam, Jamila Kathoon
Background: We sought to provide a descriptive report of inpatient admissions for cerebrovascular disease (CVD) at a tertiary hospital in KwaZulu-Natal, South Africa. Methods: We conducted a retrospective, descriptive study involving 1 017 patients admitted to the Inkosi Albert Luthuli Central Hospital for treatment of CVD during 2005 - 2015. Patients were identified using the hospital’s electronic administrative system. Demographics, inpatient length of stay, surgical procedures, and survival status at discharge were also obtained for each patient. Descriptive statistics were used to analyse the data. Results: The median age of CVD patients was 50.0 years, and 50.4% were male. The median inpatient length of stay was 13.0 days. Surgery was performed in 38.8% of patients. The mortality rate was 22.5%. Conclusion: The resource burden that CVD places on tertiary healthcare services and the high mortality in afflicted patients highlights the need for effective primary and secondary prevention interventions in our setting.
Directly-observed treatment strategy implementation practices in a hospital in eThekwini health district
(OASIS Open Journals, 2014-09-09) Miya, Respect M.
Background: The incidence rate of tuberculosis (TB) in South Africa remains high, with the country ranked as having the 14th-highest incidence rate internationally; 646 per 100 000 people are infected with TB nationally, whilst KwaZulu-Natal has a provincial incidence of 1466 per 100 000. The Directly-Observed Treatment Strategy (DOTS) programme is intended to ensure both treatment completion and cure of TB, as well as its evaluation. Despite improved DOTS coverage – the focus of most DOTS studies – the incidence of drug-resistant TB suggests that issues of non-compliance are centrally responsible for ongoing concerns about the implementation and practices related to DOTS. Objectives: The aim of the study was to explore and describe DOTS implementation practices. The objectives of the study were to explore and describe the DOTS implementation practices of professional nurses and to describe modifiable barriers to DOTS. Method: A qualitative, descriptive, explorative study was conducted through individual interviews until saturation was reached. Results: The study revealed that DOTS implementation was not in accordance with World Health Organization prescripts. Participants reported barriers such as limited human and material resources, ineffective communication of policy and procedural guidelines, ineffective communication between service delivery institutions and lack of continuity of care, as well as a lack of recording and reporting. Conclusion: The study recommended a comprehensive recruitment process to facilitate greater training and employment of more permanent health professionals to combat TB in the community; and to re-launch the DOTS programme in underperforming facilities. This would give much needed momentum to efforts targeted at preventing treatment defaults amongst patients.
Directly-Observed Treatment Strategy implementation practices in a hospital in eThekwini health district
(AOSIS OpenJournals, 2014-09-09) Miya, Respect M.
Background: The incidence rate of tuberculosis (TB) in South Africa remains high, with the country ranked as having the 14th-highest incidence rate internationally; 646 per 100 000 people are infected with TB nationally, whilst KwaZulu-Natal has a provincial incidence of 1466 per 100 000. The Directly-Observed Treatment Strategy (DOTS) programme is intended to ensure both treatment completion and cure of TB, as well as its evaluation. Despite improved DOTS coverage – the focus of most DOTS studies – the incidence of drug-resistant TB suggests that issues of non-compliance are centrally responsible for ongoing concerns about the implementation and practices related to DOTS. Objectives: The aim of the study was to explore and describe DOTS implementation practices. The objectives of the study were to explore and describe the DOTS implementation practices of professional nurses and to describe modifiable barriers to DOTS. Method: A qualitative, descriptive, explorative study was conducted through individual interviews until saturation was reached. Results: The study revealed that DOTS implementation was not in accordance with World Health Organization prescripts. Participants reported barriers such as limited human and material resources, ineffective communication of policy and procedural guidelines, ineffective communication between service delivery institutions and lack of continuity of care, as well as a lack of recording and reporting. Conclusion: The study recommended a comprehensive recruitment process to facilitate greater training and employment of more permanent health professionals to combat TB in the community; and to re-launch the DOTS programme in underperforming facilities. This would give much needed momentum to efforts targeted at preventing treatment defaults amongst patients. Agtergrond: Die voorkomskoers van tuberkulose (TB) in Suid-Afrika bly steeds hoog, waar die land internasionaal beskou word as met die 14de hoogste voorkomskoers; 646 per 100 000 mense is nasionaal met TB besmet, terwyl KwaZulu-Natal ’n provinsiale voorkoms van 1466 per 100 000toon. Die punte program (DOTS) is bedoel om beide die voltooiing van behandeling en genesing van TB en die evaluering daarvan te verseker. Ten spyte van verbeterde DOTS-dekking, wat die fokus van die meeste DOTS studies is, dui die voorkoms van dwelm-weerstandige TB daarop dat die kwessie van nie-nakoming sentraal verantwoordelik is vir voortgesette kommer oor die implementering en praktyke wat verband hou met DOTS. Doelwitte: Die doel van die studie was om die implementering van DOTS–praktyke te ondersoek en te beskryf. Die doelwitte van die studie was om die DOTS- implementeringspraktyke van professionele verpleegkundiges te ondersoek en te beskryf asook om veranderbare hindernisse ten opsigte van DOTS te beskryf. Metode: ’n Kwalitatiewe, beskrywende, ondersoekende studie is uitgevoer deur middel van individuele onderhoude tot die versadigspunt bereik was. Resultate: Die studie het getoon dat DOTS-implementering nie in ooreenstemming is met die WHO voorskrifte nie. Deelnemers berig struikelblokke soos beperkte menslike en materiële hulpbronne, oneffektiewe kommunikasie van beleid- en prosedureriglyne, oneffektiewe kommunikasie tussen dienslewerings-instellings en die gebrek aan kontinuïteit van sorg, sowel as ‚n gebrek aan optekening en verslaggewing. Gevolgtrekking: Die studie beveel ’n omvattende werwingsproses aan wat groter opleiding en indiensneming van meer permanente gesondheidswerkers om TB te bekamp in die gemeenskap sal fasiliteer, asook om die DOTS-program in gemeenskappe met onderpresterende geriewe herbekend te stel. Dit sal broodnodige momentum gee aan pogings wat gerig is op die voorkoming van onderbreekte behandeling onder pasiënte.
The dysregulation of adipokines in the synergy of diabetes and HIV infection
(2022) Sydney, Clive; Moodley, M.; Haffejee, Firoza; Adam, J.
Background: Dysregulated production or secretion of adipokines from adipose tissue may contribute to the pathogenesis of obesity-linked complications such as diabetes mellitus. Although adipokines have anti-inflammatory activity it is also capable of causing inflammation. Human immunodeficiency virus (HIV) infection predisposes an individual to the development of diabetes. Notwithstanding the side effects of antiretroviral therapy (ART), these may also exacerbate adipokine release and thereby promoting metabolic abnormalities. Aim: This study reviews adipokines in the synergy of diabetes comorbid with HIV infection. It also examines the ameliorative action of ART on adipokines in diabetes. Method: Multiple databases were used to search for each of the adipokines listed in the study. The role and expression of these adipokines were highlighted in its relationship to diabetes mellitus and HIV. Relevant articles were identified, selected and used to write this review article. Results: This narrative review compares adipokine levels among HIV-infected and uninfected patients who are diabetic and have insulin resistance (IR). It also addresses the side effect of ART and its contribution to diabetes mellitus in HIV-infected patients. Adipokines are dysregulated in diabetes and insulin resistance, as well as in patients receiving ART. Conclusion: Antiretroviral therapy, particularly protease inhibitors and non-nucleoside reverse transcriptase inhibitors, promotes IR and metabolic abnormalities. Nonetheless, obesity, physical inactivity, immune dysregulation and inflammation are also contributing factors to IR and diabetes mellitus in HIV-infected patients. Finally, circulating levels of adipokines are dysregulated in diabetes mellitus and further investigations are necessary
The effect of optimising cerebral tissue oxygen saturation on markers of neurological injury during coronary artery bypass graft surgery
(Elsevier, 2013-07-30) Harilall, Yakeen; Adam, Jamila Khatoon; Biccard, Bruce; Reddi, Anu
Surgical revascularisation of the coronary arteries is a cornerstone of cardiothoracic surgery. Advanced age and the incidence of preoperative co-morbidity in patients presenting for coronary artery bypass graft surgery increases the potential for stroke and other perioperative outcomes. It is hypothesised that by using interventions during cardiac surgery to improve cerebral oxygenation, the risk of patients enduring adverse neurological outcomes would be reduced. Methods Forty patients (mean age 55.3, standard deviation 9.74 and range from 39 to 72 years) undergoing on-pump coronary artery bypass graft surgery were recruited at Inkosi Albert Luthuli Central Hospital, South Africa. Patients were randomised into a control group (n = 20) and interventional group (n = 20). Intraoperative regional cerebral oxygen saturation (rSO2) monitoring with active display and Murkin treatment intervention protocol was administered for the interventional group. Arterial blood samples for the measurement of serum S100B were taken pre and postoperatively. An enzyme immunoassay (ELISA) was used for the quantitative and comparative measurement of human S100B concentrations for both groups. A prioritised intraoperative management protocol to maintain rSO2 values above 75% of the baseline threshold during cardiopulmonary bypass was followed. Results There was a highly significant difference in the change in S100B concentrations post surgery between the interventional (37.3 picograms per millilitre) and control groups (139.3 pg/ml). The control group showed a significantly higher increase in S100B concentration over time than the intervention group (p < 0.001). There was a significant difference in cerebral desaturation time (p <0.001) between the groups. The mean desaturation time for the control group was 63.85 min as compared to 24.7 min in the interventional group. Cerebral desaturation occurred predominantly during aortic cross clamping, distal anastomosis of coronary arteries and aortic cross clamp release. Predictors of cerebral oxygen desaturation included, partial pressure of carbon dioxide (pCO2), temperature, pump flow rate (LMP), mean arterial pressure (MAP), haematocrit, heart rate (HR) and patient oxygen saturation (SpO2). Conclusion Monitoring brain oxygen saturation during on-pump CABG together with an effective treatment protocol to deal with cerebral desaturation must be advocated.
Effect of religious beliefs on substance use among South African high school students
(Pubmed, 2015-03) Ghuman, Shanaz; Hoque, Muhammad Ehsanu
Substance use is a common problem among South African youth. We conducted this study to determine whether religious beliefs influenced substance use among South African youth. We conducted a cross sectional study of 704 students from five high schools in South Africa. We used a questionnaire to assess self reported substance use and religious beliefs among the study subjects. We used binary logistic regression analysis to evaluate the relationship between the subjects' religious beliefs and substance use. Thirty-six point six percent of students reported being very religious. More female students reported being very religious than male students (p = 0.039). Fifty-four percent of students had ever consumed alcohol. Comparing alcohol and drug use between religious and non-religious students, it was found that alcohol and drug use were more common among non-religious students (28.3%, 30.4%) than very religious students (8.4%, 11.5%) (p < 0.05). Those who considered themselves religious had lower odds of substance use. Religious beliefs had an influence on substance use among South African youth in our study.