Theses and dissertations (Health Sciences)
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Item An investigation into the association between Fabry disease, its clinical manifestations and chronic renal failure in patients attending public hospitals in KwaZulu-Natal(2023-08) Singh, Jillian; Benjamin, S. C.; Assounga, A. G.Fabry disease is characterized as a genetic, progressive, lysosomal storage disorder. It is inherited in an X-linked manner in which the mutated gene inhibits the functioning of the alpha-Galactosidase-A enzyme causing a deficiency or absence of the enzyme. This results in the accumulation of glycolipids, particularly globotriaosylceramide (Gb3) in the lysosomes causing progressive damage to tissues and major organs. Fabry nephropathy is progressive and is one of the major organ complications after cardiovascular manifestations caused by Fabry disease. Left untreated, Fabry nephropathy can result in end-stage kidney disease. To our knowledge, no research has been conducted to determine the association between Fabry disease, its clinical manifestations, and chronic kidney disease in KwaZulu-Natal. Methods: This study was a prospective, quantitative study. A total of 200 male patients with chronic kidney disease (CKD stage 2-5D) were enrolled in three dialysis clinics at Inkosi Albert Luthuli Central Hospital, Addington Hospital and St Aidan’s Hospital in KwaZulu-Natal. A control group of 14 healthy males was also enrolled for this study. The ELISA technique was employed to determine the alpha Gal-A enzyme concentration levels in the plasma. A questionnaire using the MSSI scoring system was presented to the participants to identify clinical manifestations. Results: A cut-off value for the alpha Gal-A enzyme concentration levels of <500pg/ml was calculated using the standard deviation and mean. A total of 17 participants from the patient group (n=11) and the control group (n=6) displayed alpha-Gal-A enzyme levels <500pg/ml. A p-value of <0.05 was considered to be statistically significant. A statistically significance result was exhibited between alpha-Gal levels of <500pg/ml and demographic parameters such as age (p=0.007), where the mean age was 30.5 years. Clinical parameters such as heat or cold intolerance, MSSI scores and hypertension also displayed significance. Heat and cold intolerance displayed a p-value of 0.049, where 2 patients reported the manifestation. MSSI scores displayed a negative association where p=0.001. Low MSSI scores should correlate with high alpha-Gal levels, however, in this study, all the patients displayed low MSSI scores between 9 and 12.5 with low alpha-Gal levels. Hypertension also presented with a significance of p<0.001. A total of 4 patients were diagnosed with hypertension. Conclusion: Fabry disease is suspected in a total of 17 participants with alpha-Gal levels of <500pg/ml. The cause of CKD nephropathy raises interest as conditions such as FSGS have been associated with FD. The low levels of the alpha-Gal enzyme and presentation of the clinical manifestations can be used as preliminary findings. It is recommended that confirmatory tests such as DNA analysis or Gb3 and GL3 analysis should be performed to confirm the diagnosis.Item An exploration into the lifeworld of patients with cluster headache in South Africa(2023-05-31) Tschirpig, Tanya; Varatharajullu, DesireeCluster headache is an excruciatingly painful condition that greatly affects the lived experience of those who suffer from it. There is a general paucity of information on the condition, and with little literature about headaches in the African continent; this is a novel investigation into the experience of cluster headaches within the South African context using an explorative and qualitative approach. Aim: The aim of this study was to describe and reflect on the lifeworld of individuals’ with cluster headaches within a South African context. Methodology: the study was a qualitative study exploring the lifeworld and experiences of eight South Africans with cluster headache. Data were collected using in-depth semi-structured interviews. Transcriptions were systematically reviewed to find common themes and subthemes using appropriate qualitative methodology. Results: The participants were equally distributed with regard to gender; there were four male and four female participants within an age range of 20 to 62 years. Of the eight participants, six were white, one Indian and one black. All but one patient had the episodic sub-type. Only one participant utilised the public healthcare system. Five main themes emerged: a) the inexplicable intensity of the pain, b) the reality of a disease-experience outside of head pain c) anxiety as a complexly recurring reaction, d) the perceptions of healthcare sought-out, and e) the value of a diagnostic label. Conclusion: The interpretation of results revealed that individuals with cluster headache perceived to have a massive impact on most aspects of their life, with emotional and psychological ramifications being significant. These experiences were exacerbated by misdiagnosis and mismanagement, as well as the perception of the impacts of a variety of stigmas. Cluster headache individuals in this cohort expressed a desperate need for empathetic care alongside more effective and accessible treatments and desire for more awareness of the condition within the medical field.Item Lived experiences of post-penectomy for patients receiving healthcare from a public hospital in KwaZulu-Natal : a phenomenological study(2023-05-31) Ndlovu, Virginia Vuyokazi; Sokhela, Dudu Gloria; Sibanda, M.Penile cancer is a rare malignancy with prevalence higher in areas of high Human Papilloma Virus (HPV) such as Africa, Asia and South America. In middle- and low income countries where circumcision is not routinely practiced, the rate of penile cancer could be ten times higher. A penectomy refers to a procedure which all or parts of the penis are surgically removed. Total penectomy involves the removal of the entire penis. During this procedure, a new opening is created in the perineum through which urine can pass. In some cases, the testicles, scrotum and lymph nodes may be removed. A partial penectomy involves the removal of part of the penis and typically leaves the shaft intact. Surgical treatment is inevitably mutilating. Despite its therapeutic effectiveness, total penectomy leads to mutilations that affect the ability of patients to void urine while upright. It also affects the patient’s corporal image, genital sensibility, and self-esteem. Purpose: The purpose of the study was to explore the lived experiences of post penectomy patients receiving care in a Public Hospital in KwaZulu-Natal. Methodology This was a qualitative study based on Edmund Husserl’s descriptive phenomenology which is described as the science of the essence of consciousness or inquiry into the consciousness of the patient. Purposeful sampling was used for the study. Data was collected using face-to-face in-depth interviews with patients who had penectomy surgery and were receiving follow-up health care in the selected public hospital. These patients were a year or more post-surgery therefore had sufficient experience to provide rich data. Participants were met and told about the study when they came to the hospital’s outpatient department for their follow up visits, and interviews were conducted where they are most comfortable such as at their homes. Results The data was analysed by means of content analysis and raw data was coded and sorted into sub-categories and categories. Sub-categories were: feeling severe pain, beliefs about causation of illness, feelings of loss of life, sense of self care, coping mechanisms, support system, loss of self-esteem, fear of people knowing about the surgery performed, bodily discomfort from disfigurement, being able to have sexual satisfaction, and use of sexual gadgets. The underlying meaning of categories were formulated into themes which were: thought processes before penectomy surgery, psychological effects of penectomy surgery, difficulty in urination, and sexual function post penectomy surgery. All participants had penile cancer. Pain was the main reason for these participants to make a decision to have the penectomy surgery; participants had severe sores around their penile area and these sores were not healing. Other reasons during their thought processes before making a decision for the penectomy surgery was the penile cancer itself, with participants being worried that if they delay or they do not agree to the surgery the cancer would spread to other organs of the body Conclusion Even though penectomy surgery is a debilitating procedure and inevitably mutilating despite its therapeutic effectiveness, the pain and the illness that the participants were going through led them to take the decision to have the surgery. Outcomes were the relief of pain and healing from penile cancer. No recurrence of cancer was verbalised by the participants after the surgery.Item A retrospective registry of patients presenting with cardiac tachyarrhythmia at a tertiary academic hospital in South Africa(2022-05-13) Moodley, Kumeshin; Moses, J.; Prakaschandra, D. R.; Steyn, J.; Doubell, A. F.Background: Cardiac electrophysiology (EP) is a rapidly growing field in the health care sector globally. Evidence from European and American retrospective registries have shown that cardiac arrhythmias can be treated both medically and through intervention via catheter ablation. These registries have described disease burden, procedural success rates, and complication rates as well as patients' electrophysiological and clinical characteristics. Currently, there is minimal data describing these factors in South Africa (SA). Aims and objectives: The primary aim of this study was to describe the clinical characteristics, disease prevalence and the success and complication rates of EP procedures in the first year of a newly established service at a tertiary referral centre in SA. Methodology: Patients who were referred to the Tygerberg Hospital EP service in the year 2019 were retrospectively included. Clinical, electrophysiological, and echocardiographic data were anonymized, de-identified, and recorded into a password-protected Microsoft Excel case report form (CRF). For the continuous variables, means and standard deviations were used to analyse the data. For the categorical variables, the Pearsons chi-square tests and the Fisher exact tests were used. A p-value of <0.05 was regarded as statistically significant. Results: A total of 73 patients were retrospectively included in the study. Thirty-nine were males (53.0%) and 34 were females (47.0%). The mean age for this population was 49.5±14.3 years (males-mean 51.9±14.4 years; females-mean 46.8±13.7 years). Patients were symptomatic in the form of palpitations (n=55 [75.0%]), dyspnoea and pre-syncope (n=36 [49.3%] each). Beta-blockers were the most commonly used medication to treat patients in this study, being prescribed to 64 (87.6%) patients. There were 13 (17.8%) patients treated with medical therapy alone, and 60 (82.2%) patients were advised to undergo an EP study (EPS) with catheter ablation if indicated. Three patients declined this treatment, and 57 EPS were performed. Of the 57 patients undergoing an EPS, eight (14.0%) had diagnostic studies only, with four (7.0%) patients being non-inducible and four (7.0%) patients with arrhythmia substrate that were not ablated. The other 49 patients (86.0%) underwent catheter ablation. Twenty-one patients (39.6%) were diagnosed with atrial flutter (AFL), of which 19 (35.8%) underwent cavotricuspid isthmus (CTI) ablation. Twenty-nine (54.7%) patients were diagnosed with a paroxysmal supraventricular tachycardia (SVT). Of these 13 (24.5%) had atrioventricular nodal re-entry tachycardia (AVNRT), 15 (28.3%) had atrioventricular re-entry tachycardia (AVRT) and one patient had both AVNRT and AVRT. Atrial tachycardia (AT) was diagnosed in two patients (3.8%). In the 29 (54.7%) patients with SVT, 27 ablations were done in 26 patients, with 24 (92.3%) of the 26 patients having a successful procedure on the first attempt. Atrioventricular nodal ablations (AVNA) were performed on two patients with poorly controlled atrial fibrillation (AF). Only one (1.9%) patient underwent an EPS for ventricular tachycardia (VT) and this patient had a successful ablation for idiopathic right ventricular outflow tract (RVOT) VT. The success rate for ablation procedures in this cohort was 95.9%. Echocardiograms were available for 57 (78.1%) of the study population. As was to be expected, structural heart disease was more common in the AFL group compared to the SVT group, with this group having larger atria, larger ventricles, poorer LV function and more diastolic dysfunction than the SVT group (p<0.05 for all of these variables). At follow-up, patients reported a significant (78.6%) decrease in the prevalence of arrhythmia-related symptoms. Dyspnoea, palpitations, pre-syncope, and syncope were all significantly reduced, with a p-value <0.01. The need for cardioversion was also significantly reduced at follow-up with a p-value <0.01. Conclusion: This registry, the first of its nature in SA sought to identify disease prevalence, clinical characteristics of EP patients and the success and complication rates of ablation procedures. This provides novel setting-specific information. This study showed that referral for tertiary arrhythmia management was infrequent, with 73 patients referred in 2019. The most common arrhythmia was SVT, followed by AFL. Ablation procedures were safe and effective. Reasons for the low referral are likely to be multifactorial including lack of awareness on the part of patients and physicians, as well as logistical aspectsItem Predictors of insistent restenosis in patients undergoing percutaneous intervention(2022-05-13) Amod, Ameena; Adam, Jamila Khatoon; Gafoor, S. A.Introduction Coronary artery disease is one of the leading causes of morbidity and mortality worldwide. The first percutaneous coronary intervention was performed by Andreas Gruntzig on September 16, 1977. This procedure was performed on patients with arterial stenosis. The limitations of angioplasty, however, included an unpredictable acute result- due to early abrupt vessel closure- and relatively high rate of restenosis at the site of the treated lesion- due mainly to plaque prolapse, vessel recoil, and constrictive remodelling. A vessel without a stent can have restenosis due to vessel remodelling as well as elastic recoil. Drug eluting stents have helped in the reduction of in-stent restenosis, but this still poses a problem for interventional Cardiologist. Instent restenosis is an independent predictor for mortality during follow up, together with other relevant clinical factors as age, sex, diabetes mellitus, smoke habit, previous bypass surgery, and left ventricular ejection fraction. Restenosis is not random; certain patients seem to present with this complication, having a better understanding of this phenomenon would be useful to save on financial cost of interventional cardiology as a result of adjuvant medication and devices. To establish the exact incidence of restenosis is not easy, it depends on a number of different factors and variables. These include patient related factors, lesion related and procedure related. Drug eluting stents tend to drastically reduce the occurrence of severe neo-intimal proliferation, which is the dominant cause on in-stent restenosis. Optical coherence tomography (OCT) and intravascular ultrasound (IVUS) have played an important role in assisting with real time imaging of in-stent restenosis. Nevertheless, drug eluting balloons have been considered as the treatment of choice for in-stent restenosis. The study aims to determine the predictors of in-stent stenosis in patients undergoing percutaneous coronary intervention and to recommend measures to reduce the incidence of in-stent stenosis. This was a quantitative research study. It used the observational and descriptive retrospective approach focusing on patients who had in-stent restenosis after having percutaneous coronary intervention from June 2018 – February 2020. The study was conducted at a single practice called Dr Gafoor and Dr Soosiwala Inc. situated at the Ethekwini Heart centre, KwaZulu - Natal, Durban, South Africa. Permission to conduct the study was obtained from the hospital manager as well as the practice manager of Dr Gafoor and Dr Soosiwala Inc. The data was collected through patient’s files focusing on patients within the age group of 18 – 85 years. Statistical analysis The data was analysed using the SPSS Statistics 26.0 (Release August 2018) and Statgraphics centurion 15.1 (2006). The means standard deviation was analysed whereby a p value of less than 0.05 was considered statistically significant Results The collected data proved that the use of drug eluting stents improved the come backs of patients with in-stent restenosis, but this has not eradicated the problem. There has been a worldwide use of drug eluting stents being used in daily practice. Although management of drug eluting stent remains unclear, repeat percutaneous intervention remains the most frequently used treatment. Furthermore, baseline characteristics showed diabetic, hypertension and dyslipidemic patients had a higher risk of in-stent stenosis as compared to the other risk factors. (Diabetics 72%; hypertension 80% and dyslipidemia 78%). 4 out of 57 had acute and late stent thrombosis. 55% showed it was the left anterior descending artery that was affected most. Restenosis can be regarded as a complex disease, whereby, the pathophysiological mechanisms are not fully understood. The study showed restenosis was higher in diabetics, hypertension, dyslipidemia and the type of artery affected. However, not much difference was found in other patient risk factors such as age and smoking This study correlated with other research findings found in the literature. Nonetheless, longer-term work is required and further imaging of vessels should be used as well as studies to prove if this will help with eliminating further in-stent restenosis.Item An exploration of patient perception of the aesthetic presentation and physical characteristics of homeopathic medicine(2022-05-13) Nengovhela, Muphulusi; Alwar, Vanishree; Maharaj, MadhueshwareeBackground The British Homeopathic Association (2020) claims that homeopathy is a natural form of medicine used by over 200 million people across the globe to treat both acute and chronic conditions. It is based on a principle known as like cures like, which simply means that a substance that can produce symptoms of disease when administered in a healthy individual, can be given in a minimal dose to treat the same symptoms in the diseased individual (Burns and Burns 2002). Homeopathy was discovered in the 1800s by the German physician Dr. Samuel Hahnemann. Hahnemann homeopathically prepared remedies in different physical forms (liquid, solid, and semi-solid form) and dispensed and stored them in a neutral brown glass bottle (Kayne 2006). In the present day, various forms of homeopathic medicines are dispensed to patients in different types of aesthetic presentations and in different colours. However, there is a lack of studies aimed to explore patients' perception of the aesthetic presentation and physical characteristics of homeopathic medicine. Aim of the study This study aimed to explore the patient perception of the aesthetic presentation and physical characteristics of homeopathic medicine. Methodology A qualitative, explorative, and descriptive design was employed. A convenience sampling method was used. Twelve semi-structured interviews were conducted at the DUT main homeopathic community health centre (HCHC) and one selected homeopathic private practice. Data collection took place until a point of saturation was reached, but three additional participants were recruited after this point to confirm data saturation.Data were analysed using thematic analysis guided by Tesch’s eight steps of data analysis (Tesch 1990 cited in Creswell 2009). Results Patients' perceptions regarding the aesthetic presentation and the physical characteristics of homeopathic medicine were grouped into four major themes and several subthemes. The four major themes were: package appearance, package preference, physical characteristics and medium type preference. These themes emerged from homeopathic patients' responses. Participants discussed the appearance of the packages and expressed perception with regard to the sizes, shapes, colours and the lids of the packages. Dissatisfaction regarding the paper packages, the breakability of glass packages and the impact of plastic packages on land pollution were discussed by the majority of the participants. Amber bottles and glass vials were the most preferred packaging for medication by participants. Regarding the physical characteristics of the homeopathic medicine, participants outlined the challenges they encounter while swallowing pills. Homeopathic medications were perceived as tasting sweet, too sweet and bitter. Participants were unhappy with the powder medications as it was perceived by them that powder forms do not exert any therapeutic effect and it was also expressed that they were unfamiliar with granule forms of medications. Conclusion This study explores patients' perception of the aesthetic presentation and the physical characteristics of homeopathic medicine. Feedback regarding the types of medicine and packaging was discussed. Dissatisfaction with some of the packaging and physical characteristics of homeopathic medicines was expressed by the participants, but participants also provided constructive feedback on the areas needing improvement. The main recommendation is that the paper packages used for packaging powders should be replaced with plastic packaging.Item Clinical outcomes associated with intradialytic food ingestion in patients undergoing high volume online haemodiafiltration(2021-05-27) Nundlal, Archal; Memela, Mduduzi E.; Jamila K., AdamIntroduction: 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 CKDItem Patients experience of their first homeopathic consultation at Cato Ridge homeopathic community health centre, KwaZulu-Natal, South Africa(2021-05-27) Nyawose, Mzwandile Enerst; Couchman, IngridCato Ridge Homoeopathic Community Health Centre (CRHCHC) is situated at Cato Ridge, under the uMgungundlovu District-Mkhambathini municipality (Mkhizwana village). It is a multidisciplinary health care center consisting of specialties from the Durban University of Technology-Faculty of Health Sciences, namely: Nursing, Chiropractic, and Homoeopathy. These specialties provide comprehensive primary health care services which include screening tests for HIV, Diabetes, and Pregnancy, etc. They also offer referral letters to clinics/hospitals for all conditions beyond their scope of practice, management of minor/acute conditions, prescription of chronic medication, comprehensive homoeopathy and chiropractic treatment as well as patient management. The centre operates only on Wednesdays from 9h00 to 15h00 . CRHCHC was established in 2016 by Durban University of Technology (DUT), to help the Mkhizwana village community with a nearby community health centre where they will receive medical attention. This community centre is unique in that it is in a rural area and there are no nearby healthcare facilities. The closest healthcare facility is RK Khan, located 60 Km away from Mkhizwana village. Since this centre was recently opened, a survey on patient experience is important to assess the centre from the community’s perspective. Aim of the study The study aimed to determine the experiences of patients after their first Homoeopathic consultation and their satisfaction with service delivery at CRHCHC. Methodology A quantitative, descriptive, cross-sectional study design was used to guide the study. 100 consenting patients were selected randomly and given a questionnaire. The Data was analysed using Microsoft office Excel 2019 and SPSS version 25 software. Results The result showed a high degree of satisfaction on homoeopathic consultation. The majority of the participants were satisfied with the homoeopathic consultation which includes medication, information and advice, length of consultation, love and care shown by the homoeopathy students. Furthermore, the majority of the participants were satisfied with the manner in which the homoeopathic students conduct themselves as well as their professionalism. However, the majority of the participants highlighted that there is a need for a proper clinic and for the centre to operate every day rather than just one day a week.