Browsing by Author "Fagan, Johan"

Now showing 1 - 9 of 9
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    Aminoglycoside-induced hearing loss: South Africans at risk
    (2009) Bardien, Soraya; de Jong, Greetje; Schaaf, H Simon; Harris, Tashneem; Fagan, Johan; Petersen, Lucretia
    South Africa is currently experiencing a TB epidemic with an estimated incidence of 940/100 000 population/year, and the country has been ranked 4th among the 22 high-burden TB countries worldwide by the World Health Organization (WHO). A potentially devastating threat to TB control is the emergence of multidrug-resistant TB (MDR-TB) and, more recently, extensively drug-resistant TB (XDR-TB), mainly as a result of poor drug adherence by TB patients and incorrect management or treatment regimens by health providers; however, direct transmission of drug-resistant strains also plays an important role. The MDR/XDR-TB strains necessitate prolonged chemotherapy for up to 2 years or more, and the use of more toxic second-line drugs including the aminoglycoside (streptomycin, kanamycin and amikacin) and polypeptide (capreomycin) antibiotics. In South Africa, in accordance with WHO guidelines, streptomycin is used for retreatment of TB while kanamycin, amikacin and capreomycin are used to treat MDR/XDR-TB.
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    Do proton pump inhibitors reduce the incidence of pharyngocutaneous fistulae following total laryngectomy?
    (2013) Stephenson, Katherine Anna; Fagan, Johan
    Pharyngocutaneous fistula is a common complication of total laryngectomy. We hypothesised that perioperative proton pump inhibitor (PPI) treatment could reduce the incidence of pharyngocutaneous fistulae. This prospective placebo-controlled double-blind randomised controlled trial compared PPI treatment (14 days enteral omeprazole) with a placebo in patients undergoing primary total laryngectomy. The incidence of pharyngocutaneous fistula was recorded.
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    The effect of cloth stoma covers on the tracheal climate of laryngectomised patients
    (2014) Quail, Gavin; Raynham, J J; Fagan, Johan
    Includes summary. Includes bibliographical references.
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    How has the OSD affected our state hospitals?
    (2009) Parkes, Jeannette; Abratt, Raymond; Taylor, Allan; Le Feuvre, David; Murray, Elizabeth; Robertson, Barbara; Kotze, Tessa; Marais, David; Khan, Del; Kilborn, Tracy; Wieselthaler, Nicky; Gajjar, Himal; Handler, Lenny; Fagan, Johan; Spitaels, Ariane; Morrison, Adrian; Davidson, Alan; Salie, Shamiel; Urban, Mike; Rajkumar, Ash; Pretorius, Vincent; van Niekerk, Magriet; Ferreira, Germaine; Wolmerans, Marli; Cyster, Lyall; King, Darren; Okwuosa, Sebastian; van Staden, Sanet; van Niekerk, Margarethe; Winckler, Jana; Meissenheimer, Heinrich; Botes, Annie; Tait, Deon; Visagie, Jodine; Swarts, Steve; Klocke, Marina; Lomas, Vanessa; Marais, Ilke; Vijoen, Werner; Perry, Jennie; Nkosi, Nokwazi; Stuve, Katrin
    The long-awaited occupation-specific dispensation (OSD) process for state-employed doctors has now been concluded. The final offer, signed and accepted in the bargaining chamber despite being rejected by 92% of doctors in a SAMA survey, has not received much attention or fanfare. At the conclusion of this process, which has been drawn out over several years, many points have emerged that are extremely worrying for the future of health care in this country.
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    Juvenile onset Recurrent Respiratory Papillomatosis (JoRRP) at Red Cross War Memorial Children’s Hospital, Cape Town: A 2-year review
    (2019) Pretorius, Vincent; Peer, Shazia; Fagan, Johan
    Introduction: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is the commonest benign paediatric neoplasm. There is no curative treatment, but the condition is self-limiting. Current primary treatment is aimed at symptomatic relief, comprising of serial surgical debulking of obstructive papillomas along the respiratory tract, with voice preservation. Adjuvant therapy is indicated in severe cases. Objective: A review of children with JoRRP presenting to the ENT Department at Red Cross War Memorial Children’s Hospital (RCWMCH) over 2 years. Evaluation of the pattern of disease and factors that may contribute to disease severity were reviewed. Method: Retrospective folder review of children with histologically confirmed laryngeal papillomatosis over above the time period. Results: Twenty children were included. Nine were male, 11 were female. The median age at diagnosis was 2.4 years (11 - 109 months). Presentation at < 3 years was noted in 5/7 of the most severe cases. Nine of 20 were HPV serotyped; 5 were type 11, and 4 were type 6. Eighty percent (16/20) were HIV negative; 10% (2/20) HIV positive; and 10% (2/20) were unknown. A total of 90 surgical procedures were performed; the highest number of surgeries per child was 13. Inter-surgical time was 1 to 164 weeks (median 9 weeks). Four received Gardasil vaccination as adjuvant therapy, 3 of who showed a reduction in disease severity. Conclusion: JoRRP commonly presents around the first 3 years of life. Severe cases can be life-threatening, often with multiple hospital admissions for clearance of surgical papillomata. Severe cases presented before 3 years. Gardasil vaccination as adjuvant therapy has promise. No identifiable risk factors in our review were noted. HIV co-infection and HPV type were not risk factors for severity.
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    Open access atlas of otolaryngology, head & neck operative surgery
    (2014-09-17) Fagan, Johan
    This is a free illustrated operative surgery text, and is intended particularly for those surgeons practising in the Developing World who are unable to afford expensive textbooks. There are no copyright restrictions, and colleagues are welcome to use, copy and quote text as they wish. The textbook is still in evolution, and chapters will be added as they are completed over the coming months. Clicking on completed chapters (in blue)provides access the PDF document.
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    Open access guide to audiology and hearing aids for otolaryngologists
    (2014-09-17) Fagan, Johan
    This is a free textbook and is intended particularly for ENT surgeons practising in the Developing World who are unable to access audiology services or audiology textbooks. The textbook is still in evolution, and chapters will be added as they are completed over the coming months. Clicking on completed chapters (in blue) provides access the PDF documents. There are no copyright restrictions, and colleagues are welcome to use, copy and quote text as they wish.
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    Open Access Textbooks Personal Experience
    (2016) Fagan, Johan
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    A rapid method for detection of five known mutations associated with aminoglycoside-induced deafness
    (BioMed Central Ltd, 2009) Bardien, Soraya; Human, Hannique; Harris, Tashneem; Hefke, Gwynneth; Veikondis, Rene; Schaaf, H Simon; van der Merwe, Lize; Greinwald, John; Fagan, Johan; de Jong, Greetje
    BACKGROUND:South Africa has one of the highest incidences of multidrug-resistant tuberculosis (MDR-TB) in the world. Concomitantly, aminoglycosides are commonly used in this country as a treatment against MDR-TB. To date, at least five mutations are known to confer susceptibility to aminoglycoside-induced hearing loss. The aim of the present study was to develop a rapid screening method to determine whether these mutations are present in the South African population. METHODS: A multiplex method using the SNaPshot technique was used to screen for five mutations in the MT-RNR1 gene: A1555G, C1494T, T1095C, 961delT+C(n) and A827G. A total of 204 South African control samples, comprising 98 Mixed ancestry and 106 Black individuals were screened for the presence of the five mutations. RESULTS: A robust, cost-effective method was developed that detected the presence of all five sequence variants simultaneously. In this pilot study, the A1555G mutation was identified at a frequency of 0.9% in the Black control samples. The 961delT+C(n) variant was present in 6.6% of the Black controls and 2% of the Mixed ancestry controls. The T1095C, C1494T and A827G variants were not identified in any of the study participants. CONCLUSION: The frequency of 0.9% for the A1555G mutation in the Black population in South Africa is of concern given the high incidence of MDR-TB in this particular ethnic group. Future larger studies are warranted to determine the true frequencies of the aminoglycoside deafness mutations in the general South African population. The high frequencies of the 961delT+C(n) variant observed in the controls suggest that this change is a common non-pathogenic polymorphism. This genetic method facilitates the identification of individuals at high risk of developing hearing loss prior to the start of aminoglycoside therapy. This is important in a low-resource country like South Africa where, despite their adverse side-effects, aminoglycosides will continue to be used routinely and are accompanied with very limited or no audiological monitoring.