Theses and dissertations (Health Sciences)

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Clinical outcomes associated with intradialytic food ingestion in patients undergoing high volume online haemodiafiltration
(2021-05-27) Nundlal, Archal; Memela, Mduduzi E.; Jamila K., Adam
Introduction: The quality of haemodialysis (HD) treatment received by chronic renal failure patients is important for their overall well-being. Adequate HD improves patients quality of life, minimizes disease complications and hospitalizations. Dialysis inadequacy over a prolonged period exacerbates pre-existing conditions, increases morbidity and mortality, deteriorates patients health leading to a poor quality of life. Mitigating factors that may contribute to dialysis inadequacy is important for optimizing patient care and achieving good clinical outcomes. Dialysis centres often provide meals for patients while receiving their treatment. The aim of the study was to evaluate whether intradialytic food intake may affect dialysis adequacy in patients undergoing online haemodiafiltration (OL-HDF). In the present study Single- pool Kt/V and urea reduction ratio (URR) were the measurements of molecular clearance utilized to measure dialysis adequacy. Methodology: The study was conducted at Fresenius medical care dialysis clinics on adult patients undergoing OL-HDF treatment. Consent was obtained from the patients. Adequacy of dialysis was assessed using SpKt/V and URR. Patients underwent sampling of pre-dialysis and post-dialysis urea for the calculation of URR and SpKt/V was obtained from OCM® feature on the 5008s haemodialysis machine. The sampling was done on two consecutive mid-week treatments with and without food ingestion. The principal investigator also recorded MAP at 30 minute intervals for the assessment of post-prandial hypotension and pre- and post-Hgt for blood glucose stability during sessions with and without food ingestion. Results: Fifty-two adult chronic renal failure patients were enrolled into the study. Twenty-four were males and twenty 28 females. The two groups of participants included the AV-Fistula group which consisted of 38 participants (73.1%) and the Permanent catheter group 14 participants (26.9 %). The total sample was made of African, Indians and Whites. There were 21 Africans, 30 Indians and 1 White. The age distribution for AV-Fistula group was 55.29±8.45years (Mean±SD) and for Permanent catheter group was 56.86±10.35years. The mean URR with food ingestion 70.9±9.93 (p = 0.918) and without food ingestion 70.9±7.41 (p = 0.508). The mean spKt/V with food ingestion was 1.26±0.29 (p = 0.599) and without food ingestion 1.26±0.30 (p = 0.788). During sessions without food ingestion 13.5% of the patients were recorded to have hypotensive episodes and 86.5% did not experience hypotensive episodes. During sessions with food ingestion 38.5% patients were recorded to experience hypotensive episodes and 61.5% did not experience hypotensive episodes. There was a significant difference in the number of patients who did not have a hypotensive episode compared to those who did (p < 0.001). There wereno participants classified with hypoglycaemia as all of the minimum values were greater than 4.0mmol/L. The Mean±SD with food ingestion pre-dialysis was 9.12±4.93, post-dialysis 8.39±2.56. The Mean±SD without food ingestion predialysis was 9.39±4.38 and post-dialysis was 7.22±2.26. Discussion: The spKt/V and URR values for both the AV-Fistula and Permanent catheter groups were in optimal range as recommended by the KDOQI guidelines. There was no significant difference in the spKt/V and URR values achieved from the OL-HDF sessions with and without intradialytic food ingestion. Intradialytic food ingestion did not negatively impact dialysis adequacy, although it was noted that during sessions of food ingestion more patients did experience post-prandial hypotension as compared to without food ingestion and post-dialysis blood glucose levels were lower during sessions without food ingestion as compared to with food ingestion, there was no significant difference in these variables. Conclusion: Intradialytic food ingestion is recommended for patients undergoing OLHDF treatment. Patients that suffer severe malnutrition and low albumin levels should be considered to be treated with OL-HDF treatment and intradialytic feeding should introduced. This may contribute in an increase in quality of life in patients with CKD
Contributing factors affecting erythropoiesis and analysis of erythropoiesis bioassay in renal patients in KwaZulu-Natal
(2016) Benjamin, Sherilene Cheryl; Adam, Jamila Khatoon; Assounga, A.G.
Erythropoietin (EPO) is widely used in patients with chronic renal failure and is a necessity. However, due to the cost implications and the medical complications in our population it is imperative to review the factors affecting the process of erythropoiesis and the analysis of cell proliferation and cell viability in the bioassay. Complications such as hypertension and risk of worsening a malignancy cannot be ignored. We had previously analysed variations of erythropoietin levels in haemodialysis patients over a six month period. This study aims to evaluate erythropoiesis in conjunction with various laboratory, demographic, clinical parameters and inflammatory markers, in the population of haemodialysis patients. EPO, antibody level and antibody activity were analysed in the population groups as EPO responsive and EPO sensitive patients. This is a prospective, experimental and controlled study. Fifty nine patients were randomly selected from haemodialysis units of Addington and King Edward VIII Hospitals following an informed consent and 15 healthy individuals were also selected as controls. Demographic parameters (age, sex), clinical parameters (weight, height, skin folding, EPO doses and blood pressures (BP) were recorded. Pre-dialysis serum was used to measure laboratory markers (haemoglobin, transferrin, ferritin, albumin, ESR, C reactive protein, creatinine and urea). EPO levels and antibody levels were measured by ELISA, the optical density of each well was determined within fifteen minutes using the microplate reader set at 450 nm. All results were statistically analysed using SPSS statistical package version 21 (IBMR). Patients requiring very high doses of EPO to reach Hb of 11g/dL, and they remained anaemic after at least three months of adequate EPO doses were considered to be EPO resistant. Those who responded to the usual EPO doses were labelled EPO sensitive. The bioassay was used to quantify cell proliferation and cell viability in the presence of EPO. The UT 7 cells were cultured in medium, in the presence of serum from the EPO resistant, EPO sensitive patients and the healthy, control subjects. Luminescence was read with the Glorunner Microplate Luminometer and was recorded in relative light units (RLU). The analysis revealed: a non-significant positive correlation between haemoglobin and erythropoietin levels. However, a strong negative correlation was found between CRP and albumin level (R= -0.591; (p=0.001), which was not significant. No correlation was found between haemoglobin or erythropoietin levels and CRP or albumin. There was a positive correlation with systolic and diastolic blood pressures and mean arterial pressures which was statistically significant (p <0.05). EPO dosages and Hb levels were correlated significantly (p < 0.05). No correlation of EPO levels and Hb; age and Hb was found to be significant (p = 0.08). The UT 7 cells cultured in serum in medium alone with RHuEPO containing cells were statistically significant (p <0.01)). Reduction of ATP stimulation between medium and serum was observed. However, mean arterial pressures had a significant association with EPO resistance (p = 0.041) odd ratio- 1.066. In conclusion, EPO level is not a useful tool for the monitoring of its use as it does not correlate with EPO goal of red blood production in our patients. The neutralizing antibodies did not correlate with any of our variables contributing to erythropoiesis, and are therefore not confirmed as playing a major role in erythropoiesis. From the analysis of our results the key contributing factors of EPO doses, malnutrition and age were more significant in erythropoiesis. However the higher doses of EPO significantly increased the blood pressures and the mean arterial pressures (MAP). The analysis of the bioassay showed lack of difference between EPO responsive and EPO sensitive patients. This observation warrants further studies to clarify the role of serum of haemodialysis patients in erythropoiesis.
Development of a model to predict bulking in full-scale wastewater treatment plants, and the impact of bulking in the receiving environment
(2021-05-27) Deepnarain, Nashia; Bux, Faizal; Kumari, Sheena; Reddy, Poovendhree; Stenström, Axel
Sludge bulking has been a continuous operational hurdle affecting the solids-liquid separation in wastewater treatment plants (WWTPs) worldwide. Excessive growth of filamentous bacteria is the primary and common cause of sludge bulking, which can have negative impacts on the wastewater treatment efficiency. Filamentous bacteria serve as the backbone structure of flocs which assist in the sludge settling process, however, their prolific growth result in slow sedimentation due to inadequate settling of flocs. The main focus of this research was to develop a model to assist in a clearer understanding of the bulking sludge phenomenon in relation to filamentous bacterial growth and to identify predictors of bulking in different biological nutrient removal (BNR) WWTPs. The growth of filamentous bacteria and sludge bulking in different WWTPs and its association with sludge bulking incidents were evaluated using different statistical models [viz. artificial neural networks (ANN), principal component analysis (PCA), cluster analysis and Decision Trees]. In addition, the effect of bulking on pathogen discharge and its potential impact on the community was assessed using a microbial risk assessment model. A total of seven WWTPs were investigated to identify the most common and dominant filamentous bacteria during bulking and non-bulking periods. A total of ten filamentous bacterial species were identified in this study with their dominance varying across the selected WWTPS during the sampling period. Based on the filament index scale ranging from 1 (None filament) to 7 (Excessive filament), the developed ANN model predicted sludge volume index (SVI) in relation to the abundances of ten filamentous species as model inputs. Among the filamentous bacteria identified, Eikelboom Type 0041 attained the highest impact on SVI, followed by Gordonia spp., Nostocoida limicola, and Thiothrix spp. Developing a model for a WWTP, with proper calibration and validation against plant operational data, can allow for proper evaluation of filamentous bacteria associated to bulking, with effective mitigating strategies. Hence, in this study, a Decision Tree model was further implemented as a novel approach in the form of a case study to evaluate the effect of influent wastewater characteristics and plant operational parameters on the dominant filamentous bacteria and sludge bulking for prediction and control. Various factors such as pH, temperature, dissolved oxygen (DO), sludge retention time (SRT), food-to-microorganisms (F/M) ratio, soluble chemical oxygen demand (sCOD), total COD (tCOD), NH4 + -N, total Kjeldahl nitrogen (TKN), phosphorus as phosphate (PO4 3- -P), TP, and total suspended solids (TSS) were considered to have an impact on filamentous dominance. High bulking incidents were observed during long SRT and nutrient deficient (low F/M) conditions. However, a negative correlation was observed with soluble sCOD and ammoniumnitrogen (NH4-N). Type 0092 was the dominant species largely responsible for sludge bulking in the selected plants, which prevailed at low F/M (< 0.08 kg COD/kg MLSS d-1 ) conditions. The secondary filaments Candidatus Microthrix parvicella increased in their abundance at low temperature (< 15.5°C), causing an increase in SVI at lower ambient temperatures. In addition, an increase on Thiothrix spp. was linked with the unbalanced ratio between readily biodegradable COD and nutrient conditions. The last objective of this study provided an assessment from an environmental health perspective, by investigating the impacts of bulking on the receiving environment, using a quantitative microbial risk assessment (QMRA) approach. This was done by studying the difference in selected microbial pathogen abundance during bulking and non-bulking conditions using qPCR. Salmonella was the most dominant species of the investigated microorganisms, during the study period (2270– 96733 copies ng-1 of DNA) followed by E. coli (4133 – 76847 copies per ng of DNA); whereas, Mycobacterium was the least (542 – 3340 copies ng-1 of DNA). During high bulking with SVI >200 mL g-1 , positive correlations were found between the selected pathogens in the final effluent. The QMRA model was applied to investigate the safety of treated effluent for (a) children, women, and men during recreational activities, (b) farmers during irrigation practices, and (c) consumers of edible plants (vegetables). The QMRA values during all bulking events exceeded the tolerable risk of 10-4 (i.e. less than one case of infection per 10 000 people) per year, as recommended by the world health organization (WHO). In addition various disinfection scenarios such as chlorination, ultraviolet (UV) and ozonation were tested to control the risks associated with pathogenic bacteria, for further information of safe disposal and reuse of the treated effluent. The application of UV provided the most effective treatment to reduce the pathogenic bacteria, except for the case of children that were exposed to Salmonella infection. To the best of my knowledge, the probable health risks associated with the discharge or reuse of WWTPs effluents under different sludge bulking events have not yet been systematically evaluated using QMRA. This research can potentially lead to the development of appropriate model systems for bulking control in full-scale WWTPs, while highlighting some of the significant contributors, environmental impact and mitigation strategies. The outcomes of this research will contribute to the current global body of knowledge in relation to predictive models for filamentous bulking control in full-scale WWTPs.
The effect of a homoeopathic preparation in the control of tobacco mosaic virus
(1997) Webb, Kathleen A.; Da Graca, J. V.
Most economically important crop plants may become infected with viruses. Several of these virus diseases are limiting factors in agricultural production and have contributed to serious economic and social hardship in many countries, especially in tropical and subtropical regions. Homoeopathic microdoses have been investigated for their role in the control of virus diseases, with good results. However, few of the studies contain statistical analyses. The object of this study was to assess the effect of a homoeopathic preparation of a leaf infected with tobacco mosaic virus (TM Viricum) in the contol of tobacco mosaic virus (TMV). The potencies used were 6CH, 12CH, 30CH and 200CH. iv Trays of 24 tomato seedlings per tray were the subjects of this study. Tomato plants were systemically infected with TMV. Four trays were used per treatment. There was an uninoculated and an inoculated control group. The rest of the test population was divided into two groups. The
The effect of a homoeopathic preparation of sweetpotato whitefly (bemisia tabaci genn.) in the control of the invasion of tomato plants (lycopersicon esculentum l.) by sweetpotato whitefly
(1999) Carey, Angela Moira; Laing, Mark D.
The most common and difficult insect to control in the greenhouse is the whitefly. Sweetpotato whitefly (Bemisia tabaci Genn.) was the species of whitefly selected to be investigated in this trial. Sweetpotato whitefly is a major pest on a variety of plants, ranging from ornamental flowers to agricultural crops such as tomato and cotton, resulting in important financial losses. Effective control options of sweetpotato whitefly are limited.
The effect of homoeopathic Ozonum in various potencies on growth and yield of the Lollo Bionda Lobi cultivar of leafy lettuce (lactuca sativa) cultivated in a closed hydroponic system
(2013-11-13) De Pontes, Anthony; Steele, Richard; Maboko, Martin
Lettuce is a cool season crop and requires an optimum growing temperature of 18°C. Lettuce is popular in summer as a salad ingredient but supply cannot always keep up with demand due to high spoilage rates, because of bolting and tip-burn as a result of heat stress while growing (Maboko &Du Plooy 2007). Heat stress reduces oxygen availability. This study sought to demonstrate that administration of homoeopathic Ozonum to hydroponic nutrient solution in a nutrient film technique design improves the growth ability and quality of lettuce during the summer season by increasing or improving its ability to absorb oxygen. The research was conducted at the Agricultural Research Council – Vegetable and Ornamental Plant Institute (ARC-VOPI) facility at Roodeplaat (near Pretoria), South Africa. The trial was conducted in a 40% shade net structure in the summer months of February to April 2012. Purpose The general aim was to measure the effect of homoeopathic Ozonum 6CH, Ozonum 15CH and Ozonum 30CH compared to a placebo control (96% alcohol only) on the growth and yield of leafy lettuce, Lollo Bionda Lobi cultivar grown in a closed hydroponic system in South African summer climatic conditions. Objectives:  Determine the increase in growth and yield of leafy lettuce as affected by Ozonum concentration in terms of: (i) leaf fresh mass; (ii) leaf dry mass; (iii) number of leaves; (iv) leaf area; (v) chlorophyll content; (vi) root fresh mass; (vii) root dry mass;  Determine the impact of heat stress in terms of bolting and tip-burn;  Determine the differences in specific plant leaf mineral content between the experimental groups and control group; and,  Determine the differences between dissolved oxygen (DO) concentrations in the nutrient solution of the verum group and control group. Methodology This was a placebo controlled randomized plant experiment. A total of 384 plants were laid out in a randomized complete block design with 4 treatments (Ozonum 6CH, Ozonum 15CH Ozonum 30CH and a control) and replicated 4 times. The total number of plants per plot was 24 and the middle 8 plants were selected as data plants while other plants were regarded as border plants. Thus, data was gathered from 96 plants per treatment in total. Leafy lettuce seeds of cultivar Lollo Bionda Lobi, were sown in polystyrene trays. The seedlings were transplanted 28 days after sowing into a gravel-film technique hydroponic system. Ozonum and the placebo was added to the nutrient solution on the first day and every 6 days thereafter, at the same time as the nutrient solution was changed. Various daily measurements were recorded. Plants were harvested 27 days after transplanting when final measurements of nutrient content and growth were made. Data Analysis Data was collected over time as repeated measurements; the time factor was included as a sub-plot factor in the analysis of variance (ANOVA). All data items collected were subjected to an appropriate analysis of variance using the GenStat statistical system (VSN International, 2011). The residuals were examined for deviations from normality and outliers causing skewness were removed. Fisher’s protected t-LSD (Least Significant Difference) was calculated to compare treatment means of significant effects (Snedecor & Cochran, 1980). Results The results for (i) lettuce yield criteria, (ii) DO concentration, (iii) leaf chlorophyll content and (iv) specific mineral content of lettuce leaves (Appendix B) indicate that there was no significant difference between Ozonum treatments and the control. The incidence of bolting was not observed in lettuce plants among the treatment or control groups. Results showed a reduced tendency in tip-burn percentage for treatment Ozonum 30CH although not significantly different to Ozonum 15CH or the control. Conclusion The conclusion derived from this study is that homoeopathic Ozonum was not effective at improving dissolved oxygen levels in the nutrient solution, or in stimulating growth in lettuce under South African summer climatic conditions (February to April). Further research is needed to explore the effect Ozonum 30CH may have on tip-burn.
An epidemiological investigation of food-borne disease surveillance in the Ncera Villages, Eastern Cape, South Africa
(2018) Bisholo, Khanya Zukolwakhe; Ghuman, Shanaz; Haffejee, Firoza
An increase in food-borne disease burden in the world’s population has raised concerns over the reliability of surveillance systems. Research has shown the importance of food-borne surveillance systems used in the detection and management of food-borne illness. Government fiscals are increasingly burdened by the rapid spread of food-borne illness, although the exact economic impact is unclear in many countries. In recent years, food security has been the main agenda overshadowing food safety. A reactional approach to outbreaks is the trend instead of proactive systems. Food-borne disease is associated with low and high socio-economic status populations. More than 30 pathogens were identified as the major causes of food- borne outbreaks globally, and some food-borne pathogens have long term health consequences. Aim: The aim of the study was to investigate food-borne diseases surveillance in Ncera, Mpongo and Needscamp villages and local clinics, in the Eastern Cape, South Africa. Methodology: A retrospective, observational, quantitative study was conducted in two phases. The first phase included the screening of tick registers at Ncera, Mpongo and Needscamp clinics. The screening was to determine the number of food-borne cases that were reported at these clinics. In the second phase, a stratified random sampling method was used to interview 90 households from the above-mentioned villages to determine the number of villagers who suffered from food-borne diseases, symptoms experienced and food safety practices. Results from both phases were compared to determine whether the number of reported cases at the clinics reflected the same number of cases in the villages from 2012 to 2014. The total size of the study population was 5007 people. Respondents were invited to participate having signed informed consent. Data was summarised and described using descriptive statistics such as frequencies, means and standard deviations. Data was analysed using SPSS version 23; cross tabulations and Chi-square tests at a probability of p< 0.05 were done. Graphs and tables were used to graphically represent the data. Results: It was found that the majority of household heads were female (n = 51; 58.6%) and 33 (37.9%) of them were married. Most of the residents (n = 84; 96.5%) use the public health clinics for their medical condition treatment. Fifty-six (64.4%) household heads were HIV negative. The majority of households had a monthly income of R1 500 – R 3 500 (n = 45; 51.7). Less than a tenth (n = 6; 6.9%) of household heads were very concerned about the safety of food prepared at home. The relationship between food safety concern levels about food prepared at home and away from home was statistically significant (p = 0.000), reporting a significant difference in the way people perceive the preparation of food at home and away from home. More than a tenth of the villagers (n = 79; 19.7%) reported through the questionnaire, that they fell ill or thought that they fell ill from something they ate in the past 3 months. More than half (n = 56; 51.3%) of the participants who fell ill with food- borne diseases in these villages did not seek medical treatment for their illness whilst 6 (54.6%) did not see the need to seek medical treatment and reported that they got ill during weekends. Of those who sought medical treatment, 16 (39%) received prescribed medication while 3 (7%) reported that they were not provided with medication by healthcare providers when they suffered from food-borne illness. More than a quarter (n = 109; 27.3%) of household members fell ill from food-borne diseases in Ncera, Mpongo and Needscamp villages during the period 2012 to 2014. Whereas there were four food-borne cases reported to the clinics in the same period. Conclusion: This research gathered information regarding food-borne disease prevalence in Ncera, Mpongo and Needscamp villages. It was observed that there is a gap in the surveillance of food-borne illness in these villages. In some of the tick registers used by healthcare providers at clinics to collect data, vital surveillance information such as gender, age and diagnosis was missing. This study deepens the understanding of food-borne illness and food safety in a village setting.
An evaluation of the use of the human immuno-deficiency virus portion of the integrated management of childhood illness algorithm by nurses in selected primary health care clinics in KwaZulu-Natal
(2002) Haskins, Joan Lynette Mary; Grainger, Linda D.; Phillips, N.
The Integrated Management of Childhood Illness (IMCI) is an approach that aims to reduce the mortality and morbidity in children under the age of five years. When this programme was initiated, the conditions targeted were acute respiratory infections, diarrhoea, fevers associated with malaria and measles and malnutrition. As a result of the HIV pandemic in South Africa, the identification of children who are symptomatic of HIV infection was included. This study evaluates the use of the HIV portion of the IMCI algorithm by nurses in selected, public sector, primary health clinics in KwaZulu Natal. IMCI nurses were observed as they used the IMCI approach while consulting with sick children. Data was collected in relation to the accuracy with which the nurses used the algorithm and the extent to which the HIV portion of the algorithm was used to guide their management decisions when consulting with the children. Seventy-two observations were undertaken. In-depth interview were conducted with 13 IMCI nurses to establish factors that influenced the use of the HIV portion of the algorithm. The study showed a poor level of accuracy when using the HIV portion of the algorithm. In addition, as a result of poor accuracy when using the algorithm to assess and classify for symptomatic HIV infection, it appeared that nurses were not using the HIV portion of the algorithm to guide management decisions regarding children who were possibly symptomatic of HIV infection. I A general poor level of knowledge about HIV infection was identified which the researcher felt could be one of the factors influencing the use of the HIV portion of the algorithm. Death anxiety, low level of counselling skills and burnout also seemed to play some role in the use of the HIV portion of the algorithm.Recommendations were made to adapt future training of IMCI nurses and include an HIV training course and a course on growth monitoring of children in this age group. Further recommendations to continually evaluate the practice of nurses were made. Future areas for research were suggested.
Experiences of community care givers on nutritional assessment of children under 5 years in eThekwini District
(2017) Ndlovu, Pretty Gabisile; Sokhela, Dudu Gloria; Sibiya, Maureen Nokuthula
Introduction Malnutrition continues to be a major public health problem, especially in children under 5 years of age. Nutritional status is one of the indicators of overall well-being and human resources development of a nation. Aim of the study The aim of the study was to explore and describe experiences of Community Care Givers regarding the assessment of malnutrition in children under 5 years of age in eThekwini District Health Sub-district North area six. Methodology A qualitative, exploratory, descriptive study was used to conduct the study. Semi-structured individual face to face interviews were conducted with 13 participants. The study was guided by Pender’s Model of Health Promotion. Results The findings of the study revealed that participants were dissatisfied with mid upper arm circumference training. They reported lack of support and supervision in their performance such that mid upper arm circumference was non-prioritized. They were dissatisfied with remuneration and they worked under unsafe conditions. Conclusion In order to combat malnutrition in children under 5 years in the community, Community Care Givers need to be vigorously educated on the rationale of malnutrition assessment of children under 5 years in the communities so that they can have insight into what they are doing. Community Care Givers have multiple roles and may need to prioritize their work; this is not easy and requires specific guidance and training from skilled health professionals.
An exploration into the management and diagnosis of Polycystic Ovarian Syndrome by Complementary and Alternate Medical (CAM) practitioners in the eThekwini area
(2021-05-27) Khan, Faathimah N.; Maharaj, Madhueshwaree
Polycystic Ovarian Syndrome (PCOS) is a prevalent reproductive endocrinopathy which presents a significant clinical and public health problem (Morgante et al. 2015). PCOS can affect females throughout their lifespan leading to serious complications such as obesity, infertility, type two diabetes mellitus and cardiovascular disease (De Leo et al. 2016). The conventional approach to treating PCOS is guided by what symptoms affect the patient most such as infertility, hirsutism, acne and so forth. Many of the conventional treatments for PCOS such as metformin, anti-androgens and oral contraceptives can cause harmful adverse side-effects (Lamba et al 2018:65). Adverse side-effects, complications, dissatisfaction in various aspects of the patient- practitioner experience and failed therapies are among the main reasons that patients opt for Complementary and Alternative Medicine (CAM) therapy. CAM fulfils the expectations not met by conventional medicine, particularly the psychological impact of PCOS on patients, which are assessed by only a few conventional practitioners (Fauser et al. 2012). Aim of the study This study aimed to document existing therapeutic protocols in the management of PCOS from diagnosis to treatment used by practitioners within various disciplines of CAM in the context of their unique philosophical background. Furthermore, this information may be valuable in bridging any potential gap in information across the five CAM modalities investigated in this research with regards to PCOS. These modalities were: homoeopathy, Ayurveda (AV), Unani Tibb (UT), Traditional Chinese Medicine (TCM) and naturopathy. Methodology A qualitative approach was used to document the perceptions and protocols used in the diagnosis and management of PCOS by practitioners of the five selected CAM v modalities practicing within the boundaries of the eThekwini municipality. Stratified purposive sampling was implemented in order to select a sample frame of 12 participants. Data was collected by means of personalised, semi-structured interviews and the data collected was analysed using Tesch’s (Tesch 1990:329) and Creswell’s (Creswell 2014) methods. Results CAM philosophies are underpinned by the principles of innate healing, an individualised constitution and governing factors which manage homeostasis. TCM philosophy is guided by the yin and yang concept, homoeopathy by the vital force and miasms, AV by three doshas. UT by four humours and naturopathy by lifestyle factors. PCOS patients were generally classified as being sycotic and/or cancerinic (miasmatically) according to homoeopathy, having a melancholic, sanguineous temperament according to UT, presenting with excessive kapha and vata according to Ayurveda and a predominant yang deficiency with heat and moisture according to TCM. PCOS is a multi-faceted reproductive endocrinopathy which requires extensive management. The different roles of a family physician, endocrinologist, dermatologist, dietitian and gynaecologist in the diagnosis and holistic management of PCOS is performed collectively by a CAM practitioner. PCOS is considered an affliction of the woman and not merely as a disease of the ovaries and therefore much attention is drawn to the emotional drivers, particularly stress and abuse which affect these patients’ quality of life (QoL). Diagnostics reported by participants included: 1) A clinical diagnosis congruent with established diagnostic criteria such as the Rotterdam criteria which identified the pathognomonic features of PCOS and 2) A CAM-specific diagnosis which evaluated the entirety of the patient’s symptoms, emotions and characteristics in order to determine a constitutional weakness. vi This study found that management of PCOS, according to CAM participants, was aimed at correcting hormonal, ovulatory and menstrual imbalances, improving fertility, reducing obesity, managing infertility and improving the patient’s QoL. Management strategies generally comprised: 1) CAM-specific therapy which included medicines and/or procedures, 2) Adjunctive therapy which included supplements and the use of other modalities and 3) Lifestyle intervention which included dietary counselling, physical activity recommendations and emotional counselling. Conclusion In conclusion, PCOS is a multi-faceted condition which requires emotional support concomitantly with therapeutic support due to the clinical spectrum of changes that can have an impact on females’ psychological health.
A homoeopathic drug proving of Garcinia cambogia 30CH and a comparison of the substance to its repertorial differentials
(2018) Ramdiyal, Leshmee; Maharaj, Madhueshwaree
Introduction ABSTRACT This homoeopathic drug proving was conducted to elucidate the symptomology produced in healthy provers in response to Garcinia cambogia, in the thirtieth potency, so that it may be prescribed according to the Law of Similars. A subsequent comparison was made to those remedies that, on repertorisation, yielded the greatest similarities to the Mental, General and Physical symptomatology of Garcinia cambogia. Objectives It was hypothesized that there would be clearly observable signs and symptoms produced by healthy provers in response to Garcinia cambogia 30CH. Hence the information extrapolated will provide the homoeopathic Materia medica of the substance so that it may be prescribed according to the Law of Similiars. A further hypothesis was made that the comparison between Garcinia cambogia and those remedies that yielded the highest numerical values and total number of rubrics on repertorisation of the proving symptoms would highlight the similarities and differences between the remedy symptoms so that confusion is avoided in the indication of the remedy. It was hypothesized that a greater understanding of Garcinia cambogia and its relationship to other remedies would be recognized as a result of this proving. Methodology A double blind, placebo controlled trial was carried out on 30 healthy, consenting participants whom were randomly divided into two groups, 6 were assigned to the placebo group and 24 to the experimental group. A homoeopathic case history was taken and a physical examination was performed on each prover prior to the commencement of the proving (Appendix D). Provers began recording their signs and symptoms in a blank journal one week prior to the administration of the remedy as a baseline for the proving, they then continued to record while taking the remedy and thereafter following the administration of the remedy for a period of six weeks. On completion of the proving, the data obtained was correlated and evaluated by the two researchers, Ramdiyal and Diplal. The symptoms produced during the proving were interpreted into Materia medica and repertory language, and a homoeopathic depiction of the remedy was subsequently formulated. Thereafter the comparison of the remedies yielding the highest numerical value and total number of rubrics on repertorisation of the proving symptoms was completed. Results 1 An extensive array of symptoms was documented by provers. The results depict an inclination towards the mental- emotional plane. There were often polarity of symptoms and changeability of symptoms. The following were keynote feature: • Anger/irritability vs. calmness/tranquility; • Anxiety vs. calmness in stressful situations; • Depression/sadness vs. cheerfulness; • Confusion vs. concentration/clarity of mind; • Connection vs. disconnection; • Exertion desire vs exertion aversion; • Positivity vs. pessimism Numerous themes arising from dreams were recorded by provers, with some notable signs of danger and life-threatening circumstances. The main physical symptoms that surfaced were; feelings of dizziness, excessive weakness or extreme desire for activity, headaches of a pounding, hammering nature. There was also abdominal discomfort, seen in distension, burning sensations and flatus. There was ravenous hunger or complete loss of it and an unquenchable thirst, especially for cold drinks. Allergy-type symptoms also arose. Patients documented excessive sneezing, coryza, itchy eyes, lachrymation and dry itchy throat. Sleeplessness at night with excessive sleepiness during the day was evident. There were strong cravings for chocolate, pizza and alcohol. The comparison between the homoeopathic drug proving of Garcinia cambogia 30CH and the repertorisation of remedies brought many similarities to light, with most of these similarities relating to the mind, head and nose. Conclusion The proving of Garcinia cambogia 30CH did produce well defined symptoms that were clearly observed in healthy provers as proposed by the hypothesis. As hypothesized the comparison of Garcinia cambogia to remedies of repertorial similarity did highlight similarities and differences between existing homoeopathic remedies and Garcinia cambogia 30CH thereby clarifying the therapeutic range of this new remedy and its relative location in the Materia medica.
A homoeopathic proving of Garcinia cambogia 30CH with the subsequent comparison to its empirical clinical issues
(2021-12-01) Diplal, Kristica; Maharaj, Madhueshwaree
Introduction The purpose of this study was to investigate the homoeopathic indications of Garcinia cambogia in the thirtieth centesimal potency [30CH] through the homoeopathic drug provings so that it may be prescribed according to the law of similar, and subsequently to compare these results to the documented empirical use of Garcinia cambogia. Objectives The first objective was to determine the effect of Garcinia cambogia 30CH on a healthy individual so that it may be prescribed using the law of similars. This was achieved by a randomized, double blind placebo controlled homeopathic drug proving in the 30th Hahnemannian potency in 30 healthy volunteers of which 6 were on placebo. The second objective was to subsequently compare the materia medica of Garcinia cambogia 30CH to the known existing empirical use of the substance. Methodology This study took a form of a double-blind placebo controlled trail consisting of 30 participants whom met the inclusion criteria (Appendix B). The parpticipants were randomly divided into two groups, each consisting of 15 provers and supervised by two M.Tech Homoeopathy students. 24 provers received verum and 6 provers received placebo. Neither the supervisor nor the prover nor the researcher were aware of which prover was assigned to the verum or placebo until the study was completed. The proving substance was administered in the 30CH potency, in accordance with the Liga Medicorum Homoeopathic International (LMHI) and the European Committee for Homeopathy (ECH) Homoeopathic proving guidelines and Durban University of Technology Homoeopathic department guidelines. All provers were subjected to a pre-and post- proving consultations in which case history and physical examinations were performed. A pre-proving meeting was held for all provers and supervisor. The symptoms was obtained from prover journals which was then collated, edited and translated into repertory language. By identifying the empirical use of Garcinia cambogia and relating these rubrics derived from the proving of Garcinia cambigia 30CH, a comparison was performed in order to evaluate the overlap between the homoeopathic indications and empirical use of the proving substance. Results The proving of Garcinia cambogia 30CH produced a total of 1431 rubrics, 235 of which were newly formulated rubrics and 34 cured symptoms presented during the proving period. There were 969 Grade 1 rubrics, 216 Grade 2 rubrics and 11 Grade 3 rubrics. The majority of rubrics were represented in the MIND, HEAD, GENERALS, DREAMS, STOMACH and EXTREMITIES divisions in the repertory. After critical evaluation a large quantity of symptoms were recorded by provers. The results yielded greatly on the mental/emotional level. There were a clear demarcation in polarity of symptoms as well as changeability of symptoms. Keynote features were as follows:  Anger/irritability vs. calmness/tranquility;  Anxiety vs. calmness in stressful situations;  Depression/sadness vs. cheerfulness;  Confusion vs. concentration/clarity of mind;  Connection vs. disconnection;  Exertion desire vs exertion aversion;  Positivity vs. pessimism Countless themes originating from dreams were journaled by provers, in some cases signs of threat and deadly incidents. The chief physical symptoms that appeared were; feelings of dizziness, excessive weakness or extreme desire for activity, headaches of a pounding, hammering nature. There was also an abundance of abdominal discomfort, seen as distension, burning sensations and flatus. There was ravenous hunger or complete loss of it and an unquenchable thirst, especially for cold drinks. Allergy-type symptoms were noted as well. Provers recorded coryza, excessive sneezing, itchy eyes, lachrymation and dry itchy throat. Sleeplessness at night with excessive sleepiness during the day was evident. There were robust cravings for chocolate, pizza and alcohol. Carving of foods which aggravated was also prevalent. Critical analysis of the results presented an understanding of the similarities and differences of between the homoeopathic proving of Garcinia cambogia 30CH to the documented empirical use of Garcinia cambogia. Conclusions The hypothesis that the proving of Garcinia cambogia 30CH would produce symptoms in the provers participating in this study was accepted and acknowledged as it was evidently established. The second hypothesis was Garcinia cambogia 30CH would expand the understanding and clinical scope of the medicinal value of the remedy by correlating symptoms produced with the empirical uses of Garcinia cambogia 30CH was also achieved.
Modulating effects of Fumonisin B1 and Ochratoxin A on immune cells in human carcinoma
(2005) Adam, Jamila Khatoon
Fumonisin B1 (FB1) and ochratoxin A (OTA) represent examples of mycotoxins of greatest public health and agro-economic significance. They ex¬ert adverse effects on humans, animals and crops that result in illnesses and economic losses. Fumonisin B1 are cancer-promoting metabo¬lites of Fusarium proliferatum and F verticillioides, (formerly moniliforme), and are implicated in oesophageal cancer. Ochratoxins are metabolites of both Aspergillus and Penicillium species. These compounds are known for their nephrotoxic effects in all animal species and may promote tumours in humans. In man OTA exhibits unusual toxicokinetics, with a half-life in blood of 840 h (35 days) after oral ingestion. Although much is known regarding the toxicology of these toxins, little is known of the effects of these toxins on the immune system. The aim of this study was to determine and compare the immunomodulating effects of FB1 and OTA in human carcinoma. Initial experiments involved isolating lymphocytes and neutrophils from healthy volunteers. The isolated cells were exposed to either FB1 or OTA on a dose and time dependent level and LD50 of the toxins was determined. Thereafter, challenge tests were performed, whereby lymphocytes and neutrophils isolated from volunteers, oesophageal cancer patients and breast cancer patients were exposed to the LD50 dose of either FB1 or OTA for the appropriate time. The effect of the toxins was demonstrated by viability studies, light microscopy and electron microscopy. Cytokine receptors (CK, TNF and CSF) were evaluated by immuno-cytochemical methods and the levels of circulating cytokines (IL –1, IL-6, IL-8, IL-10 and TNF-) were determined using ELISA kits.
Occurrence and variations of cryptosporidium and giardia in wastewater treatment and receiving river basins
(2020-06-10) Adeyemo, Folasade Esther; Stenström, Thor Axel; Reddy, Poovendhree; Bux, Faizal
Wastewater disposal may be a source of environmental contamination of Cryptosporidium and Giardia. Releasing untreated wastewater into the environment may result in waterborne or foodborne outbreaks. The presence of Cryptosporidium and Giardia in wastewater is of major concern in human health when wastewater is used for irrigation. The infections influence morbidity with several cases of illnesses including diarrhoea and other gastrointestinal diseases. Mortality is of high incidence, especially among the immunocompromised. Worldwide, Cryptosporidium and Giardia are well-documented in outbreaks from drinking water, recreational water and food. The aim of the study was to demonstrate the level of occurrence of Cryptosporidium and Giardia in selected wastewater treatment plants (WWTP) as well as receiving water bodies and to account for the use of wastewater in irrigation in Ethekwini, South Africa. The occurrence and reduction of Cryptosporidium and Giardia in the WWTPs were investigated, the species determined and their viability assessed. The correlations between E. coli, Enterococci and the concentration of the protozoan parasites were included. Additional specific objectives relate to the effect of effluent chlorination, the seasonal variation and the impact on crops based on the occurrence and quantities of Cryptosporidium and Giardia in the irrigated water. Influent water concentrations reflect the endemicity level in the connected population. This together with water from the intermediate treatment steps and effluent samples in four wastewater treatment plants were investigated monthly (sampled September 2015-April 2016). Conventional filtration and centrifugation methods were used for the detection and enumeration of Cryptosporidium and Giardia. Immuno-magnetic separation (IMS) on concentrated water samples was performed using Dynal anti-Cryptosporidium and anti-Giardia beads and immune-magnetic antibodies and examined with epifluorescence microscopy. In addition, molecular methods were used to differentiate the species of Cryptosporidium and assemblages of Giardia based on polymerase chain reaction (PCR) and quantitative polymerase chain reaction (qPCR). The influent counts for Cryptosporidium oocyst varied between 1.83 to 3.02 log10 oocysts/L, with a corresponding concentration of Giardia cysts ranged from 2.39 to 3.15 log10 cysts/L. The overall mean reduction over the wastewater treatment plants was in the range of 1.35 log10/L to 1.61 log10/L and 1.35 log10/L and 1.62 log10/L for Cryptosporidium and Giardia respectively. Cryptosporidium and Giardia were present in the effluents from all wastewater treatment plants. In general, weak negative to poor positive correlation was found between E. coli, faecal enterococci and the presence of Cryptosporidium and Giardia in all WWTPs. Both Cryptosporidium and Giardia were further detected at the downstream sampling points. The PCR and qPCR speciation did not compare with the traditional specific antibody and microscopic counts. The 18s rRNA gene-based nested PCR resulted in 13 (27%) out of 48 wastewater sample positive for Cryptosporidium. C. parvum was the dominated species followed by C. hominis. In ß-giardin based qPCR, all wastewater samples were positive for Giardia Assemblage A and Giardia Assemblage B. The impact of wastewater on the rivers signifies the possible health risks associated with the use of the effluents for agricultural purposes and the receiving water bodies’ use for domestic and recreational activities. Crops irrigated with the river water from the study area gave concentrations of Cryptosporidium and Giardia in spinach samples of 67 to 480 and 3 to 27 per 100 g vegetable respectively. The contamination of the fresh vegetables analysed mainly arose from the use of the effluent from the WWTP B and the receiving river water used for irrigation. In a pilot study researching the effect of chlorine and UV irradiation, distilled water and wastewater samples spiked with environmentally derived Cryptosporidium oocysts and Giardia cysts which were exposed to different doses of chlorine and UV with different exposure times. Viability quantification and detection was done with microscopy and flow cytometry using two vital dyes, namely Syto9+PI and DAPI+PI. Giardia was affected to a much higher degree than Cryptosporidium, both in relation to chlorination and UV, where in the latter case close to zero percent remained viable even after a low dose. Cryptosporidium was found to be resistant to chlorination but responded well to high UV doses. This is in line with similar earlier investigations done in drinking water. In the comparative assessment between the vital dyes, DAPI+PI dyes gave a lower mean percentage viability value than Syto9+PI; and flow cytometry gave a higher mean percentage value than microscopy. The presence of Cryptosporidium and Giardia in all treated effluents from all investigated wastewater treatment plants exceeded World Health Organisation’s (WHO) risk-based values and South African National Standard’s (SANS:241) limit for raw water and irrigation respectively. Enforced regulations and alternative wastewater treatment methods may ensure a higher level of safety for the environment. Additional information on the occurrence of Cryptosporidium and Giardia in wastewater samples, which is currently lacking or limited in South Africa, will further increase our understanding in formulating risk assessment strategies to map out the level of infection to exposed population
Perceptions and management of paediatric allergies amongst registered homoeopathic practitioners in the greater eThekwini area
(2021-12-01) Pillay, Suvanya; Hall, Cornelia Maria
Paediatric allergies in South Africa are of significant concern in respect to the recent increase in prevalence, aetiologies, clinical presentation, diagnosis, treatment, and management thereof. The perceptions and management of paediatric allergies amongst registered Homoeopathic practitioners in the greater eThekwini area were of significance in understanding and improving the current knowledge of these from a Homoeopathic perspective. Furthermore, the study provided reliable data in support of the prescription and usage of Homoeopathic treatment. No study on the Homoeopathic treatment and management of paediatric allergies in eThekwini had been conducted. In conducting such study, it expanded the literature of paediatric allergies from a Homoeopathic perspective for the benefit of the researcher, Homoeopathic bodies, parents and caregivers, and the general public. Furthermore, it intended to advocate the use of Homoeopathy as the primary healthcare intervention and first line of treatment for paediatric allergies and associated conditions. The study aimed to explore the perceptions and management of paediatric allergies amongst registered Homoeopathic practitioners in the greater eThekwini area with regards to aetiologies and clinical presentation as these presented in practice, and the diagnostic approaches, and treatment and management protocols that they followed. METHODOLOGY An explorative, qualitative design was employed to conduct the research study amongst a minimum of 12 Homoeopathic practitioners who fulfilled an inclusion criteria, or until saturation of data via questioning was achieved. Interviews were conducted at the respective participants’ consultation rooms located in the greater eThekwini area and captured via audio-recordings. Data was analysed under the supervisor’s guidance, and Tesch’s 8-step procedure of data analysis was applied, from which themes and sub-themes were formed. RESULTS Following data analysis, 4 main themes and their sub-themes were formed, namely knowledge of paediatric allergies with regards to aetiologies, types, and signs and symptoms; diagnosis with regards to clinical presentation and blood tests; multidisciplinary care with regards to referrals and approach to conventional treatment; and treatment and management protocols from a Homoeopathic, nutraceutical, dietary, and educational approach. CONCLUSION Homoeopathic practitioners share mutual perceptions and general knowledge of paediatric allergies in spite of limited professional training of allergies that is available to them. Their expertise and knowledge within their capacity was nevertheless trusted by concerned parents or caregivers to accurately identify, diagnose, treat, and manage a suspected allergy as per their patient’s totality of symptoms. Furthermore, to flatten an allergic tendency with indicated Homoeopathic treatment and appropriate adjuncts so as to prevent any possibility of a subsequent allergy. However, practitioners ought to consider the possible impact of elimination diets on their patients and families, as nutritional deficiencies, malnutrition, emotional stress, and financial expense are all causes of concern. Further clinical evidence is required to advocate them, for which practitioners may consider in their diagnostic, treatment, and management protocol. While Homoeopathy was not the primary option of treatment for their patients’ allergic conditions and concerns, it nevertheless remains a successful modality of CAM for the treatment thereof.
The relationship between Anti-Müllerian Hormone (AMH) levels and pregnancy outcomes in patients undergoing in- vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI)
(2019-09-05) Umarsingh, Shalini; Adam, Jamila Khatoon; Ramdeo, Anil
Introduction ABSTRACT Woman are born with a lifetime supply of oocytes, these oocytes gradually decrease in both quantity and quality with age. Anti-Müllerian Hormone (AMH) is a hormone secreted by cells in the developing oocyte sacs (follicles). AMH has become an important predictor of ovarian reserve. Low AMH levels can forecast reduced response to gonadotropins in In-Vitro Fertilization (IVF) cycles a well as pregnancy rate. Accurate and detailed tests should be conducted that can aid in predicting the chance of a pregnancy through IVF. The clinician together with the patients can make an educated decision about whether to continue with the treatment or review other options that may be viable. Many medical studies have found that a woman’s AMH concentration in the blood can predict how many oocytes they can produce during IVF treatment. On this basis, tests have become available to measure AMH and other markers that indicate fertility changes and the state of advancement of ovarian ageing. Aim and Objectives The aim of the study was determine the relationship between Anti-Müllerian Hormone levels and pregnancy outcomes in patients undergoing in-vitro fertilization or intra- cytoplasmic sperm injection (ICSI). The objectives were as follows: (1) To determine whether there is a correlation in patients presenting with low AMH and low oocyte reserve; (2) To examine if AMH levels affect the oocyte quality; (3) To evaluate the correlation between AMH level and a positive pregnancy outcome. Methodology A total of 50 patients were recruited from C.A.R.E (Centre of Assisted Reproduction and Endocrinology) Clinic in Westville who were undergoing IVF treatment. The blood samples were taken at room temperature. Serum was used to determine estrogen (E2), progesterone (P4), luteinizing hormone (LH), anti-müllerian hormone (AMH), and follicle stimulating hormone (FSH) levels. Levels were determined using an ultra-sensitive enzyme-linked immunosorbent assays (ELISA) (Beckman Coulter). Two stimulation protocols were used to harvest a maximum number of oocytes. The long protocol used Lucrin Subcut 10 units daily and Lucrin Depo 3.75mg for down regulation. Stimulation drugs were Gonal F®, Menopur®, Puregon®, Clomid®, Fertomid® and Fostimon® The short protocol consisted of GnRH antagonist with Cetrotide 0.25mg primed with Logynon ED. No down regulation was required. The patient started on day 2 or day 3 of the menstrual cycle, Cetrotide 0.25mg is given to suppress the LH. The same drugs were used for stimulation as per the long protocol. The patients’ blood serum was tested to measure the amount of Estrogen in her body prior to the collection of oocytes. In all patient’s ovulation was induced using 5000 – 10 000 IU hCG (Pregnyl®, Ovitrel®) trigger injection, provided the lead follicle had reached a diameter of 19mm. Oocyte retrieval was performed trans-vaginally under ultra sound guidance 36 hours after the administration of the hCG. The fluid containing the oocytes was aspirated using an oocyte recovery needle and forwarded to the IVF laboratory where the oocytes were identified, rinsed in culture media and were incubated at 37°C in IVF incubators. After 2-4 hours incubation period the cumulus complex was removed from the oocyte using the enzyme hyaluronidase and glass pipettes. Following denudation, the oocytes were placed back into the incubator until the ICSI was performed. Maturation and morphological features of the oocytes were noted before the ICSI. The features of each oocyte were evaluated using an inverted microscope. Fertilization was assessed 19-21 hours after the ICSI was performed and was characterized by the presence of two pronuclei to show the result of the union between the male and female genetic material to form a zygote cell. Embryos were grown up to Day 3 (8 cell stage), Day 5 (blastocyst stage) or Day 6 (hatching blastocyst) and transferred into the patient. A pregnancy test was performed 14 days post transfer. Results 50 patients that met the inclusion criteria were recruited for the study. From the initial sample size of 50, 42 presented with data that could be analysed whilst 8 patients had oocytes that where abnormal and did not result in a transfer. The data from these 8 patients were not included in the study due to poor embryo development. According to the AMH levels, 52.4% of patients were in High Category, 40.5% were in the Normal and 7.1% were in the Low to Normal Category. A cross-tabulation of the number of oocytes retrieved; the number of oocytes mature, and the number of oocytes fertilized was done. Not all eggs obtained were at the metaphase 2 stages and had to be matured in the incubator overnight and injected with sperm the following day. A Chi-square test for Independence was performed to check whether there is an association between the number of oocytes fertilized and the AMH category. A Chi-squared value of 18.5, degrees of freedom = 12, with a p = 0.10 was found. Therefore, showing no statistically significant relationship between the numbers of embryo’s fertilized versus AMH category (p > 0.05). A Chi- squared test were done of AMH category and Number of embryos transferred was done resulting in a value of 6.384 with df = 4 and a cross tabulation ensued a p- value of 0.172. There was thus not a significant association between AMH category and No. of embryos transferred. A cross-tabulation and a Chi-square test were done of AMH category and the day of embryo transfer was done. A Chi-square value of 14.117, 6 degrees of freedom and p = 0.028 was observed. There was a statistically significant relationship between the AMH category and the day of embryo transfer (p< 0.05). A cross-tabulation of AMH category and Pregnancy outcome was calculated. It can also be seen that of the 22 cases reported in the High category, 6 resulted in a positive pregnancy, 17 cases where the AMH category was “Normal”, 6 resulted in a positive outcome (6/12 = 50.0%), while out of the 3 cases where the AMH category was “Low to Normal“ there were no pregnancies reported. The Chi-squared test for independence of AMH category and Pregnancy outcome gave a Chi-Squared value of 0.502, 2 degrees of freedom and p = 0.778. Race and pregnancy outcome were calculated using a cross tabulation and a Chi- square test for independence gave a Chi-squared value of 2.246, with 3 degrees of freedom and p = 0.532 (p > 0.05). To determine if a statistical significance exists between AMH and age, E2 and FSH a Pearson Correlations was performed. Table 12 shows the Pearson analysis between E2 and AMH. The Pearson Correlation coefficient of 0.151 with p = 0.341 (p<0.05) indicates a very weak/ no statistically significant relationship between E2 and AMH. AMH and age produced a coefficient of -0.028 thus showing a weak, negative correlation with p = 0.859 (p> 0.05). A stronger relationship between these two variables was expected as it is known that as age increase, AMH should decrease. Pearson Correlation between the AMH and FSH produced a coefficient of -0.185 thus showing a weak, negative correlation with p = 0.240 (p> 0.05). The Pearson Correlation between FSH and age also showed that there was no statistical significance, p = 0.583 (p > 0.05) but a very weak negative correlation (Pearson Correlation -0.087). Pearson correlation between the number of oocytes and age also did not show any statistically significant relationship (p = 0.082; p<0.05). Pearson Correlation value of -0.271 shows a weak negative relationship. No significant relationship was shown between AMH and number of oocytes using a Pearson Correlation test (p = 0.191), number of mature oocytes (p = 0.300) and number of oocytes fertilized (p = 0.146). The number of oocytes, mature oocytes and oocytes fertilized all showed a weak positive relationship to AMH (0.206, 0.164, and 0.228, respectively). Conclusion In conclusion, while appropriate reference values are being created per age category and until the consequences of having a low or high AMH for one’s age are being established, AMH should only be determined in the context of clinical studies. At present, the most important clinical role of AMH at this stage is to serve as a red-flag for reduced ovarian reserve in women of reproductive age who must undergo further diagnostics. As per the study conducted, we can deduce that AMH can accurately predict ovarian reserve but cannot predict the oocyte quality or a positive pregnancy outcome. The more oocytes obtained, increases a patient’s chance of more viable embryos and therefore, improving chances of a healthy pregnancy and ultimately a live birth. This thesis has established a definite role for AMH as a forecaster for both current and future individual fertility.
The relative effectiveness of homeopathic preparations of pythium spp. compared to Previcur (Propamocarb), in the control of pythium root rot (damping off) in cabbage and cucumber seedlings
(2002) Basson, Jo-Anne; Laing, Mark D.
The purpose of this study was to expand on the foundations laid by previous homeopathic research, using controlled agricultural experiments as an objective disease system. More specifically, these trials were to investigate and evaluate the efficacy of a fungicide (Previcur') against homeopathic preparations of a plant pathogenic fungus, Pythium, on seedlings infected with this fungus. Pythium is a worldwide problem and continues to cause substantial crop losses. Few chemical methods are available to control this disease and alternatives are being sought which are more cost-effective, safer for the environment and do not lead to pathogenic resistance. Relatively few trials using Homeopathy in plant pathology have been done to date. Furthermore, many of the earlier trials proved to have little scientific credibility, due to poor methods and insufficient data. More recent trials have shown interesting results, which have opened the doors for further investigation. This study compared the effects of Previcur\xAEagainst Homeopathic preparations of Pythium, on infected cabbage and cucumber seedlings. There were 28 trays for each crop and seven treatments per crop: four Homeopathic treatments (9CH, 15CH, 30CH and 200CH), two controls (one inoculated and the other un-inoculated) and Previcur'. The seedlings were treated twice weekly, using a 2.5ml drench per seedling, and were harvested three weeks after planting. The trial was run twice, in succession. Based on the nature of Pythium and the disease it causes, four parameters were measured in this trial. To assess the germination rate, the seedlings were counted three days after planting, to establish how many had broken the surface soil. To assess survival rate, the seedlings were counted at the time of harvesting. To assess growth, the seedlings were initially weighed wet (immediately after harvesting) and then dry (after 24 hours in an oven at 50\xB0C). The data was analysed by two methods: the General Linear Models Procedure (GLMP) produced ANOVA tables, which compared the variation between the four replicates of each of the seven treatments. The data was also analysed with the Student Newman Keuls (SNK) test, to determine the variation between the seven treatments. The results showed that Previcur®consistently produced the best or second best results, in terms of mean wet and dry weights, which was evident in the statistical analysis. However, a noticeable trend emerged with the 30CH treatment: it provided the lowest mean weights in seven of the eight parameters measured while showing evidence of consistent statistical significance from the other treatments throughout both trials. The implications were that this treatment had either enhanced the disease process or had suppressed plant growth. Student Newman Keuls (SNK) test, to determine the variation between the seven treatments. This trial raised issues regarding the effects of homeopathy on disease, as well as the internal mechanisms of disease control within plant structures. Further research into this area is encouraged, to further the platform already laid by statistically valid trials done thus far.
The relative effectiveness of homoeopathic potencies of Peronospora parasitica compared to Acrobat (dimethomorph and mancozeb) and Bravo (chlorothalonil) in the control of downy mildew in cabbage seedlings
(1998) Curnow, Janine Margaret; Laing, Mark D.
The downy mildews are fungal pathogens which cause severe epidemics on many crops, and are difficult to control by either management practices or fungicides. Homoeopathic medicines have been investigated for their control of fungi, with promising results. However, there are a few well conducted trials in the homoeopathic literature. In particular, the lack of statistical analyses is evident in most of the work done to date. The purpose of this study was to evaluate the efficacy of a homoeopathic remedy, prepared from a leaf infected with Peronospora parasitica, for the control of downy mildew of Brassicas. These results were compared to fungicides used to control downy mildew namely, Acrobat and Bravo. The subjects of this study were trays of cabbage seedlings. The seedlings were inoculated by introducing infected seedlings at a rate of one per tray. The potencies used in the trials were 9CH, 30CH, 200CH and 1M. Special attention was paid to preventative and curative functions of the treatment sprays. Four replicates of each treatment were used, in a randomised blocks design. The test population was divided into two groups. The first group, Batch A, was treated prophylactically and the second, Batch B, curatively. The trays were placed into randomised positions generated by a computer, in order to nullify subjectivity and the effect of tray position.
The risk factors of soil-transmitted helminth infections : a need for appropriate measurement methods
(2018) Amoah, Isaac Dennis; Stenström, Thor-Axel; Reddy, Poovendhree; Seidu, Razak
Soil-transmitted helminths are a major health concern, especially in tropical and sub-tropical regions. Poor sanitation and poverty are major pre-disposing factors contributing to increase in infections. Infection with STH is mainly through exposure to water, soil and food contaminated with the eggs of these parasites. Accurate detection and quantification of STH eggs in environmental samples is therefore critical for the determination of infection risks from exposure. Accurate detection of these eggs is also important in the adoption of risk reduction strategies. This thesis presents the development of a revised method for the accurate detection and quantification of STH eggs in different environmental matrices, such as wastewater, sludge etc. It further presents the application of this method in the comparative determination of STH egg reduction efficiencies of centralized wastewater treatment plants and decentralized wastewater treatment (DEWATS) plants in Durban, South Africa and Maseru, Lesotho. The concentration of viable STH eggs in dried sludge from Durban, South Africa and Dakar, Senegal was also determined and compared with both WHO guidelines and South African national standards for sludge reuse. The risks of infection with STHs for different populations exposed (directly and indirectly) to wastewater, wastewater contaminated surface water and sludge were determined using both quantitative microbial risks assessment and epidemiological approaches. Despite the plethora of methods available for the detection and quantification of STH eggs in the environment there is no internationally accepted method, however the most commonly used methods are based on the principles of sedimentation, differential flotation and microscopy. These are mainly adaptations of the WHO and USEPA methods. These methods were found to be similar with a few differences which affected the recovery rates reported. However, the major challenges with the conventional methods are the time needed for sample analysis and the use of reagents that could possibly affect the recovery of viable STH eggs. A new revised method was developed based on review of literature and laboratory experiments. In this method the heterogeneity of environmental samples was accounted for by the development of different pre-processing steps, involving the use of detergents to aid in the separation of eggs from particles in samples such as sludge, UD waste and untreated wastewater. Additionally, the use of sieves of different pore sizes ensured that the number of debris on the microscope slides was reduced considerably. The use of these sieves also reduced the time need for sample analysis, due to the elimination of the spontaneous sedimentation step, which is commonly used. This spontaneous sedimentation step takes between 12-24 hours therefore prolonging the time needed for sample analysis. Reagents such as acetoacetic acid and ethyl acetate were found to result in considerable loss of egg viability after just 5 minutes of exposure. This new method therefore does not involve their usage. The elimination of the use of acetoacetic acid and ethyl acetate step also reduces the number of steps involved in sample analysis. This reduces room for error as well as helping in fast analysis of samples. In addition to a much faster sample analysis the method has recovery percentages of 80.25% to 97.63% in sludge and wastewater samples respectively, with sensitivity of 2-3 eggs per liter in wastewater samples and 5-7 eggs per 20 gram of sludge. Exposure to STH eggs in the environment is mainly through wastewater, either treated or untreated, this exposure could therefore be eliminated through wastewater treatment. Centralized wastewater treatment systems are the most favored treatment options globally. These centralized treatment systems incur high cost of construction, maintenance and operations which may hamper the robustness in developing countries and rural areas. One of the most widely used alternative means of wastewater treatment is the anaerobic baffled reactors (ABRs) and planted gravel filters (PGFs) (collectively referred to as DEWATS in this thesis), which have been considered as low cost, effective wastewater treatment options. However, there is lack of comparative assessment of the STH egg removal efficiency of these two different wastewater treatment approaches. Eggs of Ascaris spp, hookworm, Trichuris spp, Taenia spp and Toxocara spp were the commonly recorded STH eggs in the untreated wastewater at the inlets of the centralized wastewater treatment plants as well as the DEWATS plants (except for Toxocara spp). There was variation in STH egg concentrations between and within the study areas, indicating difference in STH infections among the populations both in Durban and Maseru. STH egg removal varied between and within the different wastewater treatment plants as well. The DEWATS plants achieved 95-100% STH egg removals as compared to the 67 to 100% in the centralized wastewater treatment plants. This could be attributed to the difference in treatment processes. Among the different STHs, reduction in Ascaris spp eggs was significantly higher, irrespective of the type of treatment, which is attributed to the high relative density of the egg resulting in a higher settling velocity than the other STH eggs. Reduction or elimination of STH eggs through wastewater treatment is achieved by removing the eggs from the wastewater into the sludge. STH egg concentration in sludge is therefore mostly higher than in the wastewater. Sludge from Durban and Dakar after 60 days of drying under ambient environmental conditions contained very high concentration of viable STH eggs. Ascaris spp, hookworm, Trichuris spp, Taenia spp and Toxocara spp were the commonly recorded STH eggs, except for Dakar were Taenia spp and Toxocara spp were not detected in the sludge. STH egg concentrations were higher in Dakar than in Durban, with viable STH egg concentrations exceeding both the USEPA regulatory value (≤0.25 eggs/g TS) and the WHO guideline value (≤1 eggs/g TS). This variation in egg concentration could be attributed to the difference in prevalence and intensity of STH infections in the two study areas. Over a ten-month study period concentration of viable eggs in the sludge from Durban varied considerably, probably influenced by the environmental conditions. A decay rate of 0.0056 per day was calculated for egg die-off during drying. The rate of decay is low therefore drying alone cannot produce sludge meeting both local and international standards and guidelines for sludge reuse. Determination of STH infection risks due to exposure to wastewater and sludge either directly or indirectly is critical in the prevention of infection. Exposure to the effluents during wastewater irrigation is one major route of infection. STH egg concentrations in the final effluents from the centralized and DEWATS wastewater treatment plants were consistently higher than the WHO recommended guideline for unrestricted agricultural use (≤ 1 helminth egg/L), whereby the direct reuse of the effluents for agriculture was found to pose a higher risk than the WHO tolerable risk of infection (1 ×10-2 pppy) for farmers and consumers. Annually the use of effluents from the DEWATS plants poses the least risk of infection (1.9 ×10-2 (±2.4×10-4)), which is marginally higher than the WHO tolerable risk value. Well maintained DEWATS plants are more efficient in removing or reducing the concentration of STH eggs in wastewater and therefore pose the least risks of infection compared to centralized wastewater treatment plants. Consumers of vegetables from these farms are also at considerable risks of STH infections. Probabilistic assessment of the STH infection risks showed that farmers applying sludge from Durban and Dakar without adequate protective measures had risks of infections higher than the WHO tolerable risks figure (1×10-2 pppy). Based on the estimated risks of infection after decay, exposure to farm soil after 40-50 days of sludge application may reduce the risks of infection to levels lower the WHO tolerable risks value. However, this may not be practical due to the need for farmers to attend to their crops frequently. Incorporation of the decay of the eggs into the risks assessment also indicated that, using lettuce as a representative vegetable, harvesting of vegetables in Dakar could be done after 40 days of sludge application to reduce the risks of infection to the WHO tolerable value but in Durban harvesting after 30 days ensures that consumers are protected. Therefore, to protect both the farmers and consumers exposed to STH eggs through wastewater/sludge reuse in agriculture the implementation of the WHO multi-barrier approach to risk reduction is required. Risks of STH infections could be directly estimated using epidemiological approaches. By using this approach, the concept of STH infection risks for farmers using wastewater was assessed through direct measurements of the concentration of STHs both in wastewater used for irrigation and the farm soil, as well as the actual load of STHs ova in the stool of farmers and their family members. In Kumasi, Ghana, wastewater used for irrigation of vegetables and the farm soil contained high concentration of STH eggs. There was positive correlation between STH concentrations in the wastewater/soil and STH eggs load in stool of the exposed farmers. Stool analysis after 3 months, following deworming, showed a fast re-infection rate. Farmers exposed to the wastewater were three times more likely as compared to the control group of non-farmers to be infected with Ascaris spp (OR = 3.9, 95% CI, 1.15-13.86) and hookworm (OR = 3.07, 95% CI, 0.87-10.82). These risks of infection were higher in the rainy season than the dry season. This corresponds to a higher egg concentration in wastewater used for irrigation during this period. This indicates a relationship between STH infection and egg concertation in the environment. This study therefore contributes to the evidence-based conclusion that wastewater irrigation contributes to a higher incidence of STHs infection for farmers. In conclusion, this thesis therefore presents a new revised method that can be used to determine the STH egg concentration in different environmental samples. The development of this method also provides an opportunity to comparatively assess the STH egg reduction/removal efficiency of the more commonly used centralized wastewater treatment plants and DEWATS plants. The accurate quantification of viable STH eggs provide inputs for the probabilistic assessment of STH infection risks for different populations exposed to effluents from these two wastewater treatment approaches. This assessment of risks provides a public health perspective to the wastewater treatment. Additionally, it was concluded with the used of this method that drying of sludge for 60 days in Durban or Dakar does not produce sludge of good quality for agricultural application. This was confirmed by the estimates of STH infection risks determined using quantitative microbial risks assessment. This thesis therefore shows the importance of accurate quantification of STH eggs in the determination of infection risks either though QMRA or epidemiological approache
Semen analysis of renal transplant patients undergoing immunosuppressive treatment
(2017) Moodley, Neville Sivanandan; Adam, Jamila Khatoon; Naidu, S.
Introduction The prevalence of infertility is increasing at an alarming rate globally. Many couples are afflicted with infertility due to an array of diseases, trauma and psychological stresses. Renal disease is one such pathophysiological condition which is increasing amongst the younger age group. Often the progression of chronic renal disease leads to end stage renal failure that requires a renal transplantation. Post renal transplant, immunosuppressive agents are routinely prescribed to prevent allograft rejection. Immunosuppressive agents are potent drugs that can have deleterious side effects on semen parameters. However, the effects of the immunosuppressive agents on semen parameters in the literature are unclear and require further investigation. It is, therefore, important to assess the effects of immunosuppressive agents on semen, especially the three vital aspects of sperm concentration, motility and morphology which form the basis of male reproduction. Aims and Objectives of study This was a prospective observational study evaluating the effects of different immunosuppressive regimens on sperm parameters in post renal transplant male patients. The main aspects of semen parameters such as sperm concentration, motility and morphology that determine reproductive potential were assessed in the study patients and compared to the gold standard of semen analysis according to the World Health Organisation (WHO) reference values. Methodology Thirty-four renal transplant patients were recruited from the databases of both private nephrologists in the greater Durban area and the academic renal unit at Inkosi Albert Luthuli Central Hospital. Following bioethical approval and informed consent, patients were required to produce a semen sample by masturbation. A questionnaire documenting the patient’s lifestyle, aetiology of renal disease, transplant date and immunosuppressive duration and regimen were recorded. The semen samples were analysed comprehensively according to the protocol on semen analysis recommended by the WHO. This included the macroscopic investigation (volume, appearance, colour, viscosity, liquefaction time and pH) and microscopic evaluation (sperm concentration, total motility, morphology, IgG/IgA and vitality). Sperm concentration, total motility, morphology and vitality were examined and recorded in duplicate to strengthen the validity of the results. A biostatistician analysed the data and determined the statistical analysis. Descriptive statistics determined values of semen parameters in renal transplanted males and in each race demographic. The one sample t-test analysed the statistical significance between the mean study values and the WHO reference values. The effect of the immunosuppressive agent on semen parameters was determined using multiple linear regressions whilst ROC analysis determined the sensitivity and specificity of sperm concentration, total motility and morphology in predicting pregnancy from the patients that fathered children post renal transplant. Results The mean sperm concentration and morphology in the study patients were 14.0 mill/ml (95% Confidence Interval (CI) 10.2 – 17.7) and 3.3% (95% CI 2.7 – 3.9), respectively. Although values obtained were minimally lower than the WHO reference values, these results were within the 95% CI of the WHO guidelines. Motility evaluation revealed higher values of 43.2% (95% CI 36.6 – 49.7). In contrast, sperm vitality was considerably decreased, 47.5% (95% CI 40.6 – 54.4). All semen parameters exhibited no statistical significance (one sample t-test) when analysed against the WHO reference values except for sperm morphology, (p = 0.025; p< 0.05) which showed decreased morphology irrespective of immunosuppressive regimen. Semen volume 1.7 ml (95% CI 1.3 – 2.0) and pH 7.7 (95% CI 7.6 – 7.9) were both within the WHO guidelines. Descriptive statistics according to racial demographics showed no differences in semen values. An almost perfect linear relationship existed between total sperm motility and vitality (r = 0.967). Multiple linear regressions of duration and dosages of immunosuppressive drugs tacrolimus and mycophenolate mofetil, could not predict the effect of the immunosuppressive agents on sperm concentration, total motility and morphology. There was a significant difference in morphology between those with and without children post renal transplant. Those with children post renal transplant exhibited a higher morphology value, (p = 0.001; p< 0.05). Sensitivity and specificity analysis of the patients with children post renal transplant concluded that morphology is the most optimal indicator and predictor of pregnancy (AUC = 0.854). Tacrolimus was the common immunosuppressive agent used in the four patients that fathered children. This was more evident in patients that underwent therapy with Sirolimus followed by Cyclosporin A (CsA) and changed to Tacrolimus as the last immunosuppressive agent used for maintenance therapy. Conclusion The ability to procreate in renal transplanted males has become increasingly difficult and emotionally challenging. In this study sperm concentration and morphology of renal transplanted males exhibited parameters similar to the general fertile population. Total motility possessed a higher range of values in contrast to sperm vitality which showed a significant decrease from the WHO reference values. The effect of immunosuppressive treatment on semen parameters could not be clearly defined due to the number of immunosuppressive regimens that patients were subjected to intermittently resulting in small sample sizes within each immunosuppressive regimen grouping. The majority of patients underwent a triple maintenance therapy of tacrolimus, MMF and prednisone. The dosage and duration of these tacrolimus and MMF was inconclusive in determining a beneficial or detrimental relationship on semen parameters. Morphology was shown to be the most significant indicator in predicting pregnancy in patients that fathered children. Tacrolimus was a common immunosuppressive agent used in the majority of patients that fathered children. It may have protective effects on sperm parameters as shown in patients that fathered children. This was a study with a small sample size and further investigations are required in a larger cohort of patients to assess individualized effects of the different immunosuppressive agents on sperm parameters.