Research Publications (Health Sciences)
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Item The vaginal microbiota in women health and disease : current understanding and future perspectives : a review(Association of Biotechnology and pharmacy, 2017-04) Krishna, Suresh Babu Naidu; Wilson, Stacey L.; Adam, Jamila KhatoonVaginal Microbiota varies within individuals and between human populations. Colonization by Lactobacillus in the female genital tract is thought to be critical for maintaining genital health. Nevertheless, little is known about how genital microbiota influence host immune function and modulate disease susceptibility. This article discusses the advancement of new strategies for disease diagnosis and personalized treatments to promote health and improve the quality of women’s lives. Previous research on the use of vaginal products for sexual intercourse available over the counter used by women has primarily focused on gels, creams and ointments composed by natural origin drugs/excipients and applied by means of an applicator. General concerns and misconceptions related to use of vaginal products were rare. More research is needed from the medical community to guide women clarifying therapeutic outcomes of vaginal products.Item Nano silver particles in biomedical and clinical applications : review(Oriental Scientific Pub Co, 2015-11) Krishna, Suresh Babu Naidu; Govender, Patrick; Adam, Jamila KhatoonNanotechnology is most promising arena for generating new applications in medicine and advancing rapidly due to the great progress achieved in various fileds including electronics, machanics, cosmetics, food, etc. In order to successfully bifunctionalise nanoparticles for a given biomedical application, a wide range of chemical, physical and biological factors are to be taken into account. Silver nanoparticles (AgNPs) at nanoscale exhibits strong antibacterial activity vowing to their large surface to volume ratios and crystallographic surface structure. Nanosilver particles have been widely used in a range of biomedical applications including diagnosis, treatment, medical device coating, drug delivery and personal health care products. With the growing application of nanosilver particles in medical contexts, it is becoming necessary for a better understanding the mechanisms of action, biological interactions and their potential toxicity on exposure. This review aims to provide critical assessment of the current understanding of antibacterial activity, biomedical and clinical applications of silver nanoparticles.Item Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa(Taylor and Francis, 2016) Ngidi, Ndumiso Daluxolo; Moyo, Sibusiso; Zulu, Thobile; Adam, Jamila Khatoon; Krishna, Suresh Babu NaiduThe incidence of HIV and AIDS continues to be a source of great concern within universities in South Africa. Furthermore, university students constitute an important community in the intervention against the HIV/AIDS epidemic. Students in the age group of 15–24 years are at a greater risk of HIV infection than any other group in the country; yet, little is known about why they continue to engage in risky sexual practices. Objectives: This study was designed to explore the sexual behaviour of students in a metropolitan Durban University of Technology in KwaZulu-Natal to understand the social factors underlying their risk of HIV infection. Methods: This is a qualitative study that used cluster sampling where the population was stratified by campus and faculty. The study population was selected using a standard randomization technique. This was a part of a multi-phased research project aimed at providing a sero-prevalence baseline and an analysis of risk-taking behaviour at a Durban University of Technology in the eThekwini Metropolitan Municipality area. Results: The study highlights peer pressure among students as an influence in promoting high-risk sexual behaviour. Within this context, the findings revealed that university students lack the ability to negotiate risk-aware decisions especially regarding sexual relationships. Conclusion: This study draws attention to the perspectives of African university students regarding their risk-taking sexual practices and selected factors which influence such behaviour. The findings are not exhaustive in exploring contextual antecedents that shape students’ sexual practices. However, they provide an important basis in understanding key factors which expose students to HIV infections. The study provides insights into opportunities for further studies as well as preventative implications.Item 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, AnuSurgical 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.Item The characteristics and outcomes of patients undergoing percutaneous balloon pulmonary valvuloplasty in the paediatric population(The Society of Medical Laboratory Technologists of South Africa, 2013-06) Adam, Jamila Khatoon; Govender, S.; Hoosen, E. G. M.; Amod, A.; Rmaih, WafaaBackground The immediate results along with short term and medium term results of percutaneous balloon pulmonary valvulo-plasty (PBPV) for the treatment of pulmonary stenosis (PS) have been well documented in literature. On the other hand the results on long term follow up are few. The purpose of this study was to document the immediate, short and long term results of PBPV and, to analyse the characteristics and outcomes of patients who have undergone PBPV at Inkosi Albert Luthuli Central Hospital (IALCH) Department of Paediatric Cardiology in Durban South Africa. Methods The study comprised of 30 patients (20 females/67%, 10 males/33%) with isolated congenital pulmonary stenosis who underwent PBPV from June 2005 to June 2012. Their age ranged from 23 days to 11 years. Patients underwent clinical examination, angiography (Pre and post PBPV) and echocardiography on the day after the procedure, at 6 months and at one year. The difference in clinical examination and diagnostic findings were described over the above three time periods. Results The results were categorized as “excellent” when the Peak Transvalvular systolic gradient (PTSG) was reduced by more than 50mmHg after the procedure, “good” when the PTSG was reduced by 25-50mmHg and “poor” when the PTSG was less than 25mmHg. The mean pre PBPV pullback systolic pressure between the main Pulmonary Artery (MPA) to right ventricular outflow tract (RVOT) was 20.2±7.60 mmHg to 78.1±27.78 mmHg. The mean pre PBPV systolic pullback pressure gradient between the MPA to RVOT was 60.03±32.10. The mean post PBPV pullback systolic pressure between the MPA to RVOT was 20.13±8.22 mmHg to 48.13±24.47 mmHg. The mean post PBPV pullback systolic pressure gradient between the MPA to RVOT was 28.73±23.21 The mean±SD initial echocardiographic gradient was 110.1±35.58 mmHg. The mean±SD echocardiographic gradient the day after PBPV was 54.37±26.53 mmHg (excellent), the mean±SD echocardiographic gradient at the 6 months follow-up was 54.9±28.10 mmHg (excellent) and the mean±SD echocardiographic gradient at the one year follow-up was 53.2±32.27 mmHg (excellent). Patients with Mild Pulmonary stenosis 9/30(30%) showed mean±SD reduction in the gradient between pre-procedure echocardio-graphic findings and at one year follow-up by 41.30±20.10 mmHg (good). Patients with moderate pulmonary stenosis 9/30(30%) showed post PBPV with a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 70.92±24.90 mmHg (excellent). Patients who presented with severe pulmonary stenosis [12/30(40%)] showed a mean±SD reduction in the gradient between pre-echo and at the one year follow-up by 81.21±35.85 mmHg (excellent). Procedural complications included pulmonary regurgitation occurring in 16/30(53%) of patients and tear of a leaflet occurring in one patient 1/30(4%). The remaining 13/30(43 %) presented with no procedural complications. Conclusion In this study Percutaneous Balloon Pulmonary Valvuloplasty as a treatment option of pulmonary stenosis in children showed excellent immediate, short and long term results.Item An assessment of Erythropoietin levels in haemodialysis patients in Addington Hospital Durban, South Africa(Research India Publications, 2013) Adam, Jamila Khatoon; Benjamin, Sherilene Cheryl; Assounga, A. G.; Rmaih, WafaaItem Diagnostic value of signal-averaged electrocardiogram in arrythmogenic right ventricular cardiomyopathy patients(Global Advanced Research Journals, 2013-07) Adam, Waseem S.; Adam, Jamila Khatoon; Hendricks, NeilArrythmogenic right ventricular cardiomyopathy (ARVC) is the leading cause of sudden cardiac death (SCD) in people aged <35 years. Accordingly, a successful early diagnosis of ARVC can be life saving. The aim of this study was to re-examine the diagnostic and clinical value of the signal-averaged electrocardiogram (SAECG) in patients with ARVC. This was a retrospective and prospective descriptive study conducted at Groote Schuur Hospital, Cape Town, South Africa. Fifty one patients who had been diagnosed as either definite or possible ARVC using the international task force criteria 2010. They underwent SAECG to obtain RMS (root mean square), LAS (low amplitude signal) and fQRS (filtered QRS) recordings, which were then compared to the Groote Schuur Hospital protocol normal values, thus re-evaluating the importance of a SAECG in ARVC. Thirty six (71%) of the ARVC patients had an overall abnormal SAECGs, while 15 (29%) had normal SAECGs. Twenty one (58.3%) of the patients with overall abnormal SAECGs had definite ARVC while 15 (41.6%) had possible ARVC. SAECG can be a useful initial test before performing other procedures on the patient in order to meet the criteria for ARVC. An early abnormal SAECG would mean that the patient should be referred immediately for further tests as ARVC is a condition that should be treated early due to the risk of SCD.Item The predictive value of proBNP levels to determine the presence and severity of coronary artery disease in patients with a positive or inconclusive exercise stress test(Medical Technology SA, 2012-06) Adam, Jamila Khatoon; Pearce, A.; Naidoo, N.; Rmaih, WafaaBackground Several clinical studies have shown increased levels of N Terminal-Pronatriuretic Peptide (NT-proBNP) during epi- sodes of coronory ischaemia. Consistent with this observation, both Brain Natriuretic Peptide (BNP) and NT-proBNP correlated to severity, location, and extent of angiographic coronary artery disease (CAD). The main objective of this study was to identify the possible value of NT-proBNP level which indicates CAD. Methods Sixty patients with signs and symptoms of CAD were recruited for this study. They were divided into two groups; Group A, consisted of thirty patients with a positive Exercise Stress Test (EST) and Group B, consisted of thirty patients with an inconclusive EST. After the EST, all patients from both groups were required to have a NT-proBNP blood test, a left and right coronary angiogram and a left ventriculogram. Results Post EST NT-proBNP levels, in both groups, increased in the presence of CAD (p<0.001). For the positive EST group, the area under the ROC curve was 0.975 (p<0.001). A cut- off value of 120 pg/ml was identified with the highest sensitivity (95.7%) and specificity (100%). For patients in the inconclusive EST group, the area under the ROC curve was 0.912 (p<0.001). A cut-off value of 85 pg/ml was identified with the highest sensitivity (87.5%) and specificity (86.4%). Conclusion EST is relatively inaccurate at predicting CAD in patients with inconclusive ESTs. The need for an additional tool, such as NT-proBNP measurements post inconclusive EST is warranted in the determination of the presence of CAD.Item The use of probiotics and safety concerns : a review(Academic Journals, 2012-10-27) Krishna, Suresh Babu Naidu; Adam, Jamila Khatoon; Govender, P.Probiotics are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host’’. Most probiotics fall into the group of organisms’ known as lactic acid-producing bacteria and are normally consumed in the form of yogurt, fermented milks, cereal or other fermented foods. Many of the products currently available in the market are not clearly tied to research documenting beneficial effects. Probiotics are regulated by FDA and several reports are available now for mislabeling the product claiming health benefits. As live microbial products, probiotics are potential sources of risk and there exists skeptical attitude among medical professionals and consumers who have less than optimal experiences with probiotics. This review outlines information regarding probiotics, overview of proposed regulatory guidelines and commercial probiotic products available in the market considered as safe for humans.Item Two year clinical outcomes after sirolimus-eluting stent implantation for the treatment of coronary artery disease(Medical Technology SA, 2012) Adam, Jamila Khatoon; Dyer, Robby B.; Harrypaul, Ashika; Rmaih, WafaaBackground Coronary artery stents are known to reduce rates of restenosis after coronary stenting, but it is uncertain how long this benefit is maintained. Clinical data has raised concerns that drug-eluting stents are associated with increased rates of late stent thrombosis, death or myocardial infarction. Objectives To evaluate the safety and reliability of sirolimus-eluting stents in real-world practice out to two years. Methods From January 2008 to June 2008, 30 patients were enrolled in the study after implantation of one or more sirolimus-eluting stents. We evaluated clinical follow-up information for up to two years after the implantation of Cypher® Select stents in 30 patients with 35 lesions. Results Mean patient age was 62.33 +/- 10.99 years, 7 percent were diabetic and 30 percent presented with acute myocardial infarctions. The procedure’s success rate was 100 percent for the sirolimus-eluting stent implantation, and follow-up rates were 100 percent. Mean total stent length was 22.32 +/- 6.63 mm, with 13 percent receiving more than one stent. Two year freedom from mortality, myocardial infarction, target vessel revascularization and stent thrombosis was 100 percent. Dual antiplatelet therapy was taken by 100 percent at 1 month, 53 percent at 6 months, 40 percent at 1 year and 0 percent of patients at 2 years. The rate of survival free of myocardial infarction, bypass surgery and repeated angioplasty for stented lesions was 100% at two years. Conclusions Treatment of lesions with sirolimus-eluting stents is associated with a sustained clinical benefit two years after device implantation.