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    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.
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    Investigation of acute systemic inflammatory response and myocardial injury after cardiac surgery in patients infected with human immunodeficiency virus
    (2016) Gojo, Mawande Khayalethu Edson; Prakaschandra, Rosaley
    Introduction: The immediate post-cardiopulmonary bypass (CPB) immune responses and organ injuries in immune- compromised patients remain poorly documented. We conducted a prospective clinical study to determine whether or not human immunodeficiency virus (HIV) seropositive patients generate higher acute systemic inflammatory response and suffer greater myocardial injury, compared to HIV seronegative patients. Methodology: Sixty-one consecutive patients i.e. Thirty HIV seropositive patients and Thirty-one seronegative, undergoing elective cardiac valve(s) replacement were enrolled, over a period of nine months from a single center hospital, after informed consent was acquired. The C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) were used as biomarkers of acute inflammatory response, and cardiac troponin I (cTnI) as a biomarker for measuring postoperative myocardial injury. Single tests were measured preoperatively and postoperatively, in both groups, and these were compared and correlated to perioperative events and CPB parameters. Results: The mean age group was similar between the HIV seropositive and negative group (37.8 and 37.1 years, respectively). Preoperatively both groups had relatively equal CRP levels (p=0.388), ESR levels (p=0.817) and cTnI (p=0.489). The CPB events and durations were significantly different between the two groups, CPB duration (p=0.021). Other CPB events include, clamp aortic duration (p=0.026), CPB blood transfusion (p=0.013), CPB total urine output (p=0.035) and CPB peak lactate (p=0.040). Postoperatively we observed significant increased biomarkers level in both groups, with no significant difference between the groups: mean CRP (p=0.115), mean ESR (p=0.214) and cTnI (p=0.363). We observed a significant negative correlation between the mean change in CRP levels and mechanical ventilation (r=- 0.548, p=0.002) in the seropositive group, but not in the uninfected group (r=0.025, p=0.893). The correlation between the difference in CRP and ICU stay was not significant between in both group (r=-0.231, p=0.229 and r=0.25, p=0.975, respectively). A significant positive correlation between postoperative cTnI and the inotropic support duration (r=0.384, p=0.040) was seen in the seropositive groups, but not in the negative group (r=0.092, p=0.622). Furthermore we observed a significant drop in CD4 cells postoperatively (p=<0.001) in the HIV seropositive group. Antiretroviral treatment appeared to influence the degree of change in CD4 cells postoperatively. Conclusion: We conclude that HIV positive patients’ postoperative reactions to cardiac surgery supported by CPB are similar to those of HIV seronegetive patients. We further report non-paralleling correlations between the biomarkers and perioperative events; however these do not seem to affect the overall outcomes between the two groups.