Browsing by Subject "Clinical Laboratory Sciences"
Now showing 1 - 20 of 24
Results Per Page
Sort Options
- ItemOpen AccessA numerical protocol for death-time estimation(2021) Mfolozi, Sipho; Malan, Arnaud George; Bello-Ochende, Tunde; Martin, Lorna JeanA body's axial temperature distribution at death was experimentally demonstrated by the author to predict the postmortem temperature plateau (PMTP), which is known to affect the measured core temperature value and hence death-time estimation. Yet today's methods of death-time estimation apply only a single-point approximation of a body's core temperature in life as well as a single-point measurement of a body's core temperature after death. Four studies were carried out to understand the relationship between a body's axial temperature distribution and the PMTP. The first study numerically approximated antemortem temperature distribution in an MRI-built, high-definition, anatomicallys egmented 3D computational human phantom consisting of several hundred tissues. Metabolic heat generation (QQmm) and blood perfusion (wwbb) parameters were applied to all thermogenic tissue using the Pennes BioHeat Model. The study demonstrated that the antemortem axial temperature distribution was nonlinear, that tissue temperature distribution was inhomogeneous, and that the position and size of the antemortem central isotherm was predicted by the size, shape and location of the most thermogenic internal organ in a given axial plane. Numerical approximation of a body’s antemortem axial temperature distribution using this study’s materials and methods was proposed for death-time estimation. The second study examined postmortem axial heat transfer. The approximated antemortem axial temperature distribution constituted the initial condition. QQmm and wwbb were set to zero to simulate death. Postmortem cooling was simulated in still air, on a cold concrete floor and on a heated floor. The antemortem central isotherm that single-point core thermometry detects was the PMTP. Its size at death, body radius, axial thermometry-depth and length of the postmortem interval (PMI) all predicted PMTP length. The cold concrete floor shifted the central isotherm away from the floor, while the heated floor shifted it towards the floor. Ground temperature and material properties, along with the aforementioned PMTP predictors, result in variation in measured single-point core thermometry values, yet today’s death-time estimation methods do not measure, approximate or standardise them. This is a source of uncertainty. This study demonstrated that a body’s postmortem axial thermal profile was very specific to the PMI at which it exists, including during the PMTP that single-point core thermometry detects. This study proposed a body’s measured postmortem axial thermal profile for death-time estimation to reduce PMTP uncertainties. The study also proposed numerical modelling of the ground, its temperature and material properties. The third study proposed a multipoint axial thermometry (MAT) device to measure a body’s postmortem axial thermal profile. The author designed the device prototype. Its fabrication was outsourced. Empiric and numerical MAT studies were conducted on a cooling dummy and 3D human phantom, respectively. MAT curves indicated a parabolic shape. The fourth study proposed a numerical protocol for death-time estimation that iteratively tested a MAT profile measured at an unknown PMI from a decedent using the proposed MAT device against MAT profiles predicted by numerical simulations of sequentially longer candidate PMIs. A candidate PMI whose MAT profile matched was considered the PMI estimated by the protocol. The proposed protocol applied the exact historical meteorological temperatures that existed during the final estimated PMI. Application of the protocol was demonstrated using a fictitious scenario in which a candidate PMI within 120s of the final estimated PMI was excluded. Potential sources of uncertainty of the proposed protocol were discussed and concluding remarks on future research were made.
- ItemOpen AccessA retrospective investigation of sudden unexpected death in the young investigated at Salt River Mortuary, Cape Town(2020) Vandayar, Yuvika; Heathfield, Laura JaneSudden unexpected death in the young (SUDY) is the tragic fatality of seemingly healthy individuals aged between one and 40 years. Little is known about the demographics and risk factors of these cases at Salt River Mortuary (SRM), Cape Town. Therefore, this project aimed to retrospectively investigate the burden and profile of SUDY cases admitted to SRM, between 1 January 2016 and 31 December 2018. Of the total 11 588 cases admitted over this period, 833 (7.2 %) were SUDY cases, wherein males comprised the majority (64.3 %). Individuals were a median age of 31 ± 10.3 years at death, and the main location of death was ‘residential' (43.5 %). There were also significantly more males than females in the age category of 31 - 40 years who were found outdoors compared to all other locations (p < 0.001). Risk factors included physical activity, substance abuse, and co-morbidities with concomitant use of chronic medication. More than a third of individuals experienced breathlessness prior to death (45.0 %). Of cases with a confirmed natural cause of death, the main organ systems involved were pulmonary, cardiovascular, central nervous system and gastrointestinal, which parallels international trends. Akin to local studies, in analogous amounts, TB and pneumonia were the leading causes of death. Additionally, 21.1 % of cases were identified as candidates for genetic testing which may resolve undetermined cases or elucidate underlying predisposing factors to sudden death. Fortunately, 81.8 % had biological samples available for these retrospective analyses. Cases often had missing documentation which advocates for training to ensure compliance to standardised procedures. This study shows that males aged 31 ± 10.3 years with pulmonary and cardiac-related co-morbidities are the most vulnerable for SUDY whilst sleeping. Awareness interventions targeted at this population are thus needed in an attempt to reduce these tragic fatalities.
- ItemOpen AccessBuilding evidence for improving childhood immunisation coverage in Africa.(2012) Wiysonge, Shey Umaru Charles; Hussey, Gregory D; Schoub, Barry DThe Expanded Programme on Immunisation has the potential to substantially reduce child mortality and contribute to achieving the Millennium Development Goals. We assessed the programme’s performance in Africa, the reasons for poor performance, and effective interventions for improving its performance on the continent. We used a combination of methods including systematic reviews, bibliometric analyses, generalised linear models, and grading of the quality of evidence. We found that African countries have made extraordinary advances since childhood immunisation programmes began in 1974. However, there exist wide inter-country and intra-country differences, and the quality of immunisation data is poor. Besides, vaccines are administered well after the recommended ages in many countries; leaving children exposed to deadly vaccine-preventable diseases for long periods. In addition, Africa’s contribution to the global immunisation research output is minimal. There is no association between research productivity and immunisation coverage in Africa, which may signal lack of interactive communication between policymakers and researchers. Furthermore, individual and contextual factors (defined at community and country levels) are independently associated with low immunisation coverage; suggesting that immunisation system strengthening should address people and the communities and societies in which they live. Lastly, we found moderate-to-high quality evidence that interactive educational meetings, audit and feedback, supportive supervision; and use of community health workers, parent reminders, home visits, interactive communication, mass media, and material incentives have the potential to improve childhood immunisation coverage in Africa.
- ItemOpen AccessCharacterization of a unique sulfoxide synthase found in pathogenic trypanosomes(2013) Mashabela, Gabriel Tshwahla Makgotloduwa; Steenkamp, D J; Gammon, David WIncludes abstract. Includes bibliographical references.
- ItemOpen AccessCharacterizing the cellular latent reservoir of HIV-1 and the effect of immune activation on characteristics of the reservoir(2022) Ismail, Sherazaan Dineo; Burgers, Wendy A; Williamson, Carolyn; Riou, Catherine; Abrahams, Melissa-RoseSince the advent of antiretroviral therapy (ART) and the resultant suppression of viraemia in the majority of people living with HIV-1 (PLWH) on ART, HIV-1 infection has become manageable and PLWH have similar life expectancies as uninfected persons. However, ART is not curative, is needed lifelong, and its cessation leads to the recrudescence of viraemia. This is due to the formation of a latent reservoir that is long-lived and stable over time, precluding HIV-1 cure. The factors affecting reservoir formation, establishment, and kinetics are not fully understood. Furthermore, differences exist at the population level in disease progression in PLWH depending on ethnicity, biological sex, and infecting viral subtype. Similarly, differences in the latent reservoir of HIV-1 have been described, although less extensively. Understanding what shapes the latent HIV-1 reservoir is critical for developing strategies for cure. Furthermore, it is imperative that cure research is undertaken in diverse populations to ensure coverage of knowledge across different demographics. The latter will ensure that a cure strategy can be developed that will be globally implementable. In the Introductory chapter of this thesis, I provide a detailed review of the current literature and address the need for cure research in low-and middle- income countries. If a global cure is to be achieved, the burden of HIV-1 will need to be addressed in many different populations, most notably African women, as women bear the burden of HIV-1 globally. In South Africa, the country in the sub-Saharan African region with the highest prevalence of HIV-1, women are roughly twice as likely to be living with HIV than men (aged 15 to 49), with a prevalence rate 6% higher than the national average of 19%. Since women are underrepresented in HIV-1 research in general and more specifically in cure studies due to the paucity of research in countries outside of the global North, reservoirs and cure strategies ii need to be characterized in this context. Furthermore, while early treatment is the WHO standard of care for people diagnosed with HIV, a large majority of PLWH only initiated treatment in chronic infection. Since early ART is known to restrict formation of the latent reservoir of HIV-1, research in both early and late ART initiators is necessary. This research focused on characterising the viral reservoir in South African women in a well-established cohort of women who were recruited during acute HIV infection and followed until treatment initiation (which occurred during chronic infection) and beyond. Overall, this thesis focuses on characterising immune activation and inflammation during the course of both untreated and treated HIV-1 infection in a cohort of South African women and subsequently determining whether clinical or immune measures influence characteristics of the latent reservoir of HIV-1. T cell activation and the levels of soluble inflammatory cytokines in plasma were determined in forty-six women in the CAPRISA 002 Acute infection cohort. Chapter 2 describes the cellular immune activation and inflammation profiles of these participants throughout the course of infection at the following timepoints: acute infection, oneyear post-infection, and within a year preceding ART initiation, and two- and four- years postART initiation. T cell activation peaked in chronic infection and reduced dramatically after ART initiation. CD4+ and CD8+ T cell activation reached a post-treatment nadir by two years after ART initiation. Cytokine measures were within the ranges reported in the literature for PLWH. Notably CXCL-10 levels in plasma decreased significantly between two- and four years post-ART, indicating that it may be a sensitive marker of ongoing systemic inflammation in people on ART. In short, the T cell activation and inflammation profiles of the women in this study reflected what has been observed in other cohorts. iii The size of the replication-competent HIV-1 reservoir, measured by quantitative viral outgrowth assay after 5 years of suppressive antiretroviral therapy (ART), was quantified in twenty women of the cohort. In Chapter 3, the clinical and immunological correlates of reservoir size were investigated. Predictive modelling showed that the size of the replicationcompetent reservoir is directly related to viral load and CD4+ T-cell counts over the course of infection, although these measures do not fully predict reservoir size. We found that, in addition to viral load and CD4+ T-cell count, CD8+ T-cell activation within the year preceding ART, nadir CD4+ T-cell count, and baseline as well as on-treatment CD4:CD8 ratio at the time of sizing was associated with replication-competent reservoir size. We provide evidence that the late CD8+ T-cell activation level before treatment, together with viral loads and CD4+ T-cell counts, are directly related to the size of the replication-competent reservoir of HIV-1. Our results are consistent with the hypothesis that the host immune milieu near the time of ART initiation plays an important role in shaping the durable reservoir of HIV infection that persists on ART. Another characteristic of the HIV-1 reservoir is persistence: the presence of all forms of HIV1 within cells and tissues that contribute to pathogenesis, including defective, non-induced, and non-integrated forms of HIV-1. In Chapter 4, total HIV-1 DNA levels were measured as a proxy for viral persistence in thirty-one participants, and the correlates thereof investigated. The HIV-1 DNA levels in this cohort were similar to those reported in the literature for other cohorts where participants initiated therapy in late chronic infection. HIV-1 DNA levels did not differ significantly between two- and four years post-ART, but there was a trend to lower HIV-1 DNA when measuring pol versus gag gene frequencies in peripheral blood mononuclear cells (PBMC). These findings indicate that HIV-1 DNA decay rates may differ depending on the gene being measured, even when using the same assay. A weak significant correlation was iv found between CD4+ T cell counts at ART initiation and the change in HIV-DNA levels between two-and four years on ART. There was a significant correlation between residual CD4+ T cell activation at four years post-ART initiation and gag copies per million PBMC. A trend towards a correlation was found between CD4+ T cell activation and pol copies per million PBMC at the same timepoint. Finally, we found significant correlations between several cytokines at one-year post-infection and within one year pre-ART. These findings further solidify the hypothesis that the immune milieu around the time of ART initiation and after may play a complex role in formation of the viral reservoir of HIV-1. Our studies show a significant link between chronic immune activation and replication competent reservoir size, and also ongoing immune activation and viral persistence on ART. Further studies into whether these immune measures affect the timing of establishment and clonality of the reservoir in this cohort are ongoing and will inform the field about whether differences in cure strategies will need to be explored for those PLWH who had high levels of chronic immune activation before treatment initiation and subsequent shaping for the long-lived viral reservoir.
- ItemOpen AccessDevelopment of new bioorganometallic metallodendrimers as in vitro anticancer agents(2014) Govender, Preshendren; Smith, Gregory SThe clinical success of cisplatin and its derivatives for the treatment of different cancers has had a profound effect on the use of metal-containing agents in medicine. Despite the successes, the drawbacks of platinum-based therapy, such as drug resistance, toxicity and the emergence of unwanted side effects, have bred a need for effective and novel anticancer agents. Hence, the design and study of bioorganometallic complexes as potential therapeutic agents may eventually lead to the identification of new drug candidates. The purpose of this study was to synthesize and characterize a series of polynuclear transition-metal-containing complexes based on a (poly)propyleneimine dendritic scaffold, and investigate the in vitro antiproliferative activity of these complexes.
- ItemOpen AccessDevelopment of novel T cell assays and assessment of immune recognition to latency associated M.tuberculosis-specific antigens Rv2660 and Rv2659(2010) Govender, Lerisa; Hanekom, Willem A; Abel, BrianNearly 130 years have elapsed since the discovery of Mycobacterium tuberculosis (M.tb), the causative agent of tuberculosis, yet today it is estimated that 1 in every 3 of the worldʼs population is infected with this pathogen. In South Africa alone there were approximately 1000 new TB cases per 100 000 population in 2007, ranking the country second in incidence rate, globally. Hence research into new vaccine strategies to control the epidemic is vital. Current vaccines under development are prophylactic and designed to boost pre-existing immunity induced by the only licensed TB vaccine, BCG. A new approach is the development of a post-infection vaccine aimed at inducing an immune response that prevents progression to TB disease when administered to individuals latently infected with M.tb. This vaccine would have a dramatic impact on the worldwide TB burden. Our objective was to address 2 areas in TB vaccinology, firstly a novel postinfection TB vaccine strategy, and secondly, optimal measurement of vaccineinduced responses using a new immunological assay. The aim of the first study was to investigate human T cell responses to antigens that have been associated with M.tb latency. Rv2660 and Rv2659 were investigated, as these antigens are candidate antigens for a postinfection vaccine based on findings from in vitro models of M.tb suggesting preferential expression during latency in vivo. No information exists on the immune response to these antigens in M.tb infected or TB diseased individuals. Hence, we investigated the immune recognition of Rv2660 and Rv2659 in these 2 groups, and further characterised the nature of these antigen-specific T cell responses. We observed that (i) these antigens are significantly more likely to be recognised during M.tb infection compared with TB disease as shown by measurement of soluble IFN-γ in response to the specific antigens, (ii) M.tb infected persons had greater Rv2660- and Rv2659- specific CD4+ T cell proliferation and associated cytokine expression compared, with TB diseased persons. We propose that Rv2660 and Rv2659 may be candidates for incorporation into a post-infection vaccine.
- ItemOpen AccessDiagnostic yield of tuberculosis investigations on bone marrow biopsy samples in HIV positive patients at Groote Schuur Hospital(2023) Baloyi, Xikombiso; Moodley, Clinton; Verburgh EstelleBackground: Acid fast bacilli (AFB) staining on bone marrow samples has low sensitivity for diagnosing HIVassociated tuberculosis and Tuberculosis (TB) culture results may be delayed. The GeneXpert® MTB/RIF Ultra assay may provide a more sensitive diagnostic test on bone marrow biopsy samples. Methods: We conducted a two-stage study in a tertiary hospital in South Africa, initially assessing the retrospective yield of TB diagnoses on bone marrow biopsies in adult HIV-positive participants retrospectively from 01-01-2019 to 31-07-2020. Subsequently, determining the prospective yield and diagnostic performance of the GeneXpert® MTB/RIF Ultra assay on bone marrow aspirate and peripheral blood samples in adult HIV-positive participants undergoing bone marrow biopsy from 11- 08-2020 to 31-01-2021. Results: One hundred and twenty-two biopsies were analysed, of which 59/122 were performed for haematological malignancy staging. Granulomata with AFB were detected in six samples, and nine new lymphoma diagnoses were made. Bone marrow TB culture detected only one non-tuberculous mycobacterial infection. All 17 participants who had TB diagnosed from another clinical site were bone marrow TB culture negative. TB treatment was confirmed in 11/33 participants recruited prospectively. One trace positive GeneXpert® MTB/RIF Ultra result on peripheral blood was detected. All TB cultures on bone marrow aspirates and peripheral blood were negative. Conclusion: In a tertiary care hospital in South Africa, the utility of TB culture and GeneXpert® MTB/RIF Ultra on bone marrow aspirate specimens in HIV-positive participants was limited. We postulate that the initiation of empiric anti-tuberculosis treatment could have resulted in false negative results.
- ItemOpen AccessElevated levels of low molecular weight substances in the red cells of some mammalian species imply unsuspected antioxidant strategies(2009) Davids, Virginia; Harley, EricAn earlier observation by E.H. Harley (supervisor of this thesis) of curious metabolic anomalies in the red cells of black rhinoceros, and in particular a high free tyrosine level, suggested that a range of unusual, but presumeably physiological, processes might be found in mammalian red blood cells. As a follow-up to this, low molecular weight metabolites were examined in a range of mammalian species, using HPLC-based methods to compare levels in red cells with plasma levels. A remarkable interspecies diversity in red cell HPLC profiles was observed, with the unprecedented accumulation of substances including tyrosine, tryptophan, urate, and urate riboside occuring within the red cells of some species. Whereas novel evolutionary adaptations may characterise most of these species-specific variations, the ability of red cells to produce urate is proposed to be an inducible feature common to the red cells of many, or possibly even all, mammalian species. A surprisingly high degree of intraspecies genetic heterogeneity was evident in tyrosine and urate levels within horse, and urate riboside levels within cow red cells. This was in contrast with the greater homogeneity seen in levels of these and other low molecular weight substances in red cells from the other species evaluated. The next phase of investigation addressed the potential function(s) of these soluble substances accumulating within the red cell, particularly relating to a role in antioxidant defense. Using in vitro antioxidant assays such as the 'oxygen radical absorbance' (ORAC) and 'ferrous ion oxidation-xylenol orange' (FOX) assays, results were obtained consistent with a role for these substances as endogenous red cell antioxidants against a variety of reactive species produced by pathophysiological processes in the body. The demonstration that haemoglobin is involved in facilitating some of this activity further substantiates the idea that the red cell may be playing a crucial role in maintaining circulatory redox balance, and hence protecting other tissues from oxidative damage. If indeed such low molecular weight substances contribute to systemic antioxidant activity in some mammalian species, then apart from the intrinsic interest of such unexpected biological phenomena, these findings could pave the way for a plethora of further investigations, geared towards potential clinical applications (eg. as biomarkers or therapeutic approaches) in human and/or veterinary conditions associated with oxidative stress.
- ItemOpen AccessThe functional characterisation of murine CLEC-2 and analysis of the expression of its ligand, podoplanin, on macrophages(2009) Kerrigan, Ann; Brown, Gordon; Dennehy, KevinIncludes abstract. Includes bibliographical references (p. 109-125).
- ItemOpen AccessGenetic diversity and population structure within Botswana: association with HIV-1 infection(2021) Thami, Prisca Kerapetse; Chimusa, Emile; Gaseitsiwe, Simani; Novitsky, Vlad; Leteane, MelvinSouthern Africa is disproportionately affected by HIV-1, with Botswana being among the most affected countries. The interindividual heterogeneity in susceptibility or resistance to HIV-1 and progression upon infection is attributable to, among other factors, host genetic variation. Characterisation of human genetic variations can contribute towards understanding the genetic aetiology of HIV-1 and foster development of novel preventive and treatment strategies against HIV-1. Despite the high burden of HIV-1 in Botswana, the population of Botswana is significantly underrepresentation in genomics studies of HIV-1. Furthermore, the bulk of previous genomics studies evaluated common human genetic variations, however, there is increasing evidence of the influence of rare variants in the outcome of diseases which may be uncovered by comprehensive complete and deep genome sequencing. This research aimed to characterise human genomic variations of Batswana in order to elucidate mutation burden, assess population structure and evaluate the role of these genomic variations in susceptibility to HIV-1 and progression through bioinformatics analyses. Whole genome sequences (WGS) of 265 HIV-1 positive and 125 were HIV-1 negative unrelated individuals from Botswana were computationally analysed. The sequences were mapped to the human reference genome GRCh38. Population joint variant calling was performed using Genome Analysis Tool Kit (GATK) and BCFTools. Variant characterisation was achieved by annotating the variants with a suite of databases in ANNOVAR. The genomic architecture of Botswana was assessed through principal component analysis and structure analysis and FST. Cumulative effects of rare variant sets on susceptibility to HIV-1 and progression (CD4+ T-cell decline) were determined with optimized Sequence Kernel Association Test (SKAT-O). Functional analysis of the prioritized variants was performed through gene-set enrichment using databases in GeneMANIA and Enrichr. Variant characterization revealed 24 damaging variants with the most damaging variants being ACTRT2 rs3795263, HOXD12 rs200302685, ABCB5 rs111647033, ATP8B4 rs77004004 and ABCC12 rs113496237. There was admixture of Khoe-San, Niger-Congo and European ancestries observed in the population of Botswana, however, there was no evidence of overall substructure among the HIV-1 positive/negative individuals of Botswana, indicating similar genetic exposure among HIV-1 samples. No variant set was significantly associated with susceptibility to HIV-1, while sets of novel rare-variants within the ANKRD39 (8.48 x 10- 8 ), LOC105378523 (7.45 x 10-7 ) and GTF3C3 (1.36 x 10-6 ) genes were significantly associated with HIV-1 progression. Functional analysis revealed that the variants affected several pathways including chemokine signalling, glycolysis, glycosylation, HIV-1 and host receptor glycoprotein biosynthesis, intracellular transport of molecules and transcription pathways. These findings highlight the significance of whole genome sequencing in pinpointing rare variants of clinical relevance. This PhD thesis unravelled novel genes and novel rare variants that are putatively linked to HIV-1 progression. The thesis contributes towards a deeper understanding of the host genetics HIV-1 and offers promise of population specific interventions against HIV-1.
- ItemOpen AccessHuman myeloid cell and innate lymphocyte responses to mycobacterial vaccination or infection(2022) Murphy, Melissa; Nemes, Elisa; Scriba, Thomas JWe investigated immune responses beyond conventional T cells in the context of BCG vaccination and tuberculosis disease.
- ItemOpen AccessThe influence of maternal Nippostrongylus brasiliensis infection on immunity in offspring(2013) Mrdjen, Dunja; Horsnell, WilliamThis study investigates imprinting of the murine fetal immune system by maternal infection with the helminth Nippostrongylus brasiliensis (Nb) prior to pregnancy and its effect on control of the Salmonella enterica serovar typhimurium (STm) in offspring. We show that maternal Nb infection in BALB/c mice results in the transfer of Nb antigen (NES)-specific IgG1 in utero and through breastmilk, changes in lymphocyte populations and early germinal center formation in naive offspring. Maternal Nb infection does not interfere with control of STm in offspring in BALB/c mice, but may interfere with control of STm in C57BL/6 mice.
- ItemOpen AccessInvestigating the role of CD28 costimulation and IL-4/IL-13 responsive myeloid and lymphoid cells during helminth infections in mice(2013) Ndlovu, H Hlumani; Brombacher, Frank; Horsnell, WilliamThe aim of this study was to evaluate the importance of CD28 in initiating protective Th2 immunity against both primary and secondary infections with N. brasiliensis. Our findings demonstrate that CD28 is required for initiation of protective Th2 immunity against primary infection with N. brasiliensis. Furthermore, the absence of CD28 impairs development of memory CD4⁺ T cell responses resulting in failure to clear adult N. brasiliensis worms during secondary infection. Failure to resolve infection was associated with reduced production of Th2 cytokines particularly IL-13 and IL-4, abrogated humoral immunity and failure to expand CXCR5⁺ TFH cells.
- ItemOpen AccessInvestigating the views and expectations of pregnant women who undergo genetic counselling for age-related risk of aneuploidy(2020) Vorster, Nina; Wessels, Tina-Marie; Fieggen, Karen; Laing, NakitaBackground: Pregnancy at advanced maternal age (AMA) is associated with an increased risk of aneuploidy. In the Western Cape's public health sector maternal age alone is widely used to screen women for high risk of pregnancies affected by aneuploidy. The weekly pregnancy counselling clinic (PCC) at Groote Schuur Hospital (GSH) offers genetic counselling (GC) for women who are of AMA to inform them about their age-related aneuploidy risk, offer invasive diagnostic testing (IDT) and discuss the option of voluntary termination of an affected pregnancy. A recent audit at GSH showed that the uptake of IDT was low and other literature reports that South Africans tend to have a conservative view regarding termination of pregnancy (TOP). This study sought to understand what women expect from the GC service at PCC as well as what their experiences are of the service. Methods: This qualitative phenomenological study used a pragmatic approach and participants were recruited through purposive sampling. Semi-structured, in-person interviews were conducted after women had completed their GC sessions at PCC. Thematic analysis was used to analyse the data. Results: The results of this study suggest that participants (n=7) received very little information about their GC appointments at referring clinics, and that they generally did not have prior knowledge about age-related aneuploidy risks. Finding out about the age-related risk of aneuploidy was an emotional experience for the participants, but other factors, including normal ultrasound results, provided relief. The participants' choices regarding IDT and attitudes towards TOP reflected that of available literature as the uptake was low and most participants reported that they would not consider a TOP. The women reported that they would use the knowledge they gained during GC to educate other women in their communities about the pregnancy risks associated with increased maternal age. Generally, the participants believed that GC was useful and appreciated the opportunity. Conclusion: The participants in this study had limited health literacy and knowledge regarding AMA risks and GC. As a result, participants had no expectations of GC. However, the participants felt that GC was useful in helping them prepare for the possibility of a child with DS, and generally viewed the service in a positive light. Additionally, this study's results suggests that there is a need to educate women in local communities regarding AMA pregnancy risks.
- ItemOpen AccessAn investigation into improved HIV-1 subtype C envelope based vaccine design(2014) Margolin, Emmanuel Aubrey; Williamson, Anna-Lise; Rybicki, Ed; Chapman, Ros; Meyers, AnnIncludes abstract. Includes bibliographical references.
- ItemOpen AccessThe investigation of histopathological changes after the administration of vaccinia virus complement control protein in brain injured rats(2008) Van Wijk, Rochelle AnnIncludes bibliographical references (leaves 75-91).
- ItemOpen AccessMycothiol disulfide reductase as a drug target(2010) Mavumengwana, Vuyo Bhongolethu; Steenkamp, D J; Gammon, David WIncludes abstract. Includes bibliographical references (leaves 154-171).
- ItemOpen AccessPharmacogenetics of stavundine : role of genetic variation in mitochondrial DNA and polymerase gamma among adult Malawian HIV/AIDS patients(2013) Kampira, Elizabeth; Dandara, Collet; Kumwenda, JohnstoneInfectious diseases are endemic in Africa, especially tuberculosis (TB), malaria and human immunodefiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Genomics research has the potential to improve the health of Africans through identification of genetic markers associated with either disease susceptibility or therapeutic drug response. This project was set to investigate the genetic correlates for drugs associated with mitochondrial toxicity that are used as part of HIV therapy, especially nucleoside reverse transcriptase inhibitors (NRTIs). Toxicity from NRTIs manifests through metabolic diseases such as peripheral neuropathy, lipodystrophy, lactic acidosis and hyperlactatemia but show interpatient variability. Studying African populations is likely to open the door for the population to benefit from novel diagnostic tools and drugs developed on the basis of pharmacogenomics knowledge. In an effort to contribute to this knowledge, the role of variation in mitochondrial DNA (mtDNA) and polymerase gamma (POL-γ) on how patients respond to stavudine-containing antiretroviral therapy (ART) among adult Malawian HIV/AIDS patients was investigated.
- ItemOpen AccessStrategies that occupational therapists in the public health sector in KwaZulu-Natal use to navigate language discordance: a qualitative descriptive study(2022) Marshall, Emily; Ramafikeng, MatumoBackground: Language discordance, a challenge of miscommunication between health professionals and service users, is a concern for occupational therapy, a profession that foregrounds a client-centred partnership. Occupational therapy literature highlights language discordance as one of the biggest challenges encountered when working in the rural public health sector. Language discordance affects the quality of health services which results in misdiagnosis, informed consent violations, decreased service user satisfaction and safety risks, among others. Occupational therapy is not immune to these negative consequences. In a country as linguistically diverse as South Africa, the need to find effective ways to navigate language discordance in occupational therapy health care, is crucial. However, there is limited literature on language discordance and the strategies used to resolve the issue. Aim: The aim of this study was to describe strategies that occupational therapists working in the public health sector in KwaZulu-Natal use to navigate language discordance and to understand the subsequent role that language discordance has on the quality of occupational therapy care. Methodology: The study adopted a qualitative descriptive design using semi-structured interviews with eight participants recruited using purposive and snowball sampling. Thematic analysis was used to analyse data. Findings: Four themes emerged, namely; using various communication strategies concurrently, language definitely impacts that therapy process, factors perpetuating language discordance and I'm doing everything that I can, what more can I do? Conclusion: The impact of language discordance on the quality of occupational therapy care is undeniable. However, the participants showed agency in navigating language discordance using personal and institutional resources amidst the complexities of applying various strategies concurrently in order to provide the best care that they could.