Browsing by Author "Mankahla, Ncedile"

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    Open Access
    The Changing Face of Craniopharyngioma Treatment in Young Children and its Challenges at a Single Centre in a Developing World Context
    (2019) Mankahla, Ncedile; Figaji, Anthony
    Objective: To retrospectively review our institutional experience with the treatment of paediatric craniopharygiomas and assess the evolution in management and influence on patient outcomes. Patients and Methods: A retrospective review from January 1995 to December 2015 of children age <14 treated at a single institution. Data collected included admission clinical features, endocrine function, surgery performed, surgical outcome, intracystic therapy and radiotherapy. Long-term functional outcome was calculated considering hormonal dependence, level of independence and schooling. Results: There were 41 patients with a mean age of 84.2 months: 57% were female. Primary surgical resection was performed in 36 patients: 80.5% had subtotal resection, 11% had gross total resection and the rest had biopsy only. Of surgical approaches, 60,7% had pterional craniotomy and 39,2% supraorbital keyhole craniotomy. No surgical mortalities occurred but 2 patients had new post-operative neurological deficits. Stereotactic placement of intracystic catheters transitioned to endoscopic. Intracystic treatments transitioned from Yttrium (1) to Bleomycin (6) to Interferon Alpha (6). Radiotherapy was given in 30 patients, median dose 54Gy. Final Wen functional outcome was 21,8% Class I, 32% Class II and 46% Class III. There were no early deaths in the series but 5 patients died more than 6 years after diagnosis, mostly due to endocrine crises from poor chronic care. Conclusion: The findings reflect a multidisciplinary team approach consisting of maximal safe resection with radiotherapy, intracystic agents and endocrine support. For a cohort limited to young children, our results are similar in number and outcomes to other published series. Mortality remains low but lifelong dependence on endocrine replacement is a significant contributor to long-term morbidity and mortality. This has important implications for patients referred from large distances and where primary and secondary follow up care is poor.
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    Ventriculoperitoneal shunt insertion for hydrocephalus in human immunodeficiency virus-infected adults: a systematic review and meta-analysis protocol
    (BioMed Central, 2017-10-16) Loan, James J M; Mankahla, Ncedile; Meintjes, Graeme; Fieggen, A Graham
    Background: Hydrocephalus is a recognised complication of human immunodeficiency virus (HIV)-related opportunistic infections. Symptomatic raised cerebrospinal fluid pressure can be treated with ventriculoperitoneal shunt insertion (VPS). In HIV-infected patients however, there is a concern that VPS might be associated with unacceptably high rates of mortality. We aim to systematically review and appraise published literature to determine reported outcomes and identify predictors of outcome following VPS in relevant subgroups of HIV-infected adults. Methods: The following electronic databases will be searched: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, CINAHL (EBSCOhost), LILACS (BIREME), Research Registry (www.researchregistry.com), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and OpenSIGLE database. Any randomised studies, cohort studies, case-control studies, interrupted time series or sequential case series reporting survival following VPS in HIV-infected individuals will be included. If high-quality homogenous studies exist, meta-analysis will be conducted to determine 1-, 6- and 12-month mortality with comparison made between underlying aetiologies of hydrocephalus. Discussion and conclusion: This study will generate a comprehensive review of VPS in HIV-infected patients for publication. The primary outcome of meta-analysis is 12-month survival. If only low-quality, heterogeneous studies are available, this study will demonstrate this deficiency and will be of value in justifying and aiding the design of future studies. Systematic review registration: PROSPERO CRD42016052239
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    Ventriculoperitoneal shunt insertion in human immunodeficiency virus infected adults: a systematic review and meta-analysis
    (2020-04-17) Loan, James J M; Poon, Michael T C; Tominey, Steven; Mankahla, Ncedile; Meintjes, Graeme; Fieggen, A. G
    Abstract Background Hydrocephalus is a common, life threatening complication of human immunodeficiency virus (HIV)-related central nervous system opportunistic infection which can be treated by insertion of a ventriculoperitoneal shunt (VPS). In HIV-infected patients there is concern that VPS might be associated with unacceptably high mortality. To identify prognostic indicators, we aimed to compare survival and clinical outcome following VPS placement between all studied causes of hydrocephalus in HIV infected patients. Methods The following electronic databases were searched: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL Plus, LILACS, Research Registry, the metaRegister of Controlled Trials, ClinicalTrials.gov, African Journals Online, and the OpenGrey database. We included observational studies of HIV-infected patients treated with VPS which reported of survival or clinical outcome. Data was extracted using standardised proformas. Risk of bias was assessed using validated domain-based tools. Results Seven Hunderd twenty-three unique study records were screened. Nine observational studies were included. Three included a total of 75 patients with tuberculous meningitis (TBM) and six included a total of 49 patients with cryptococcal meningitis (CM). All of the CM and two of the TBM studies were of weak quality. One of the TBM studies was of moderate quality. One-month mortality ranged from 62.5–100% for CM and 33.3–61.9% for TBM. These pooled data were of low to very-low quality and was inadequate to support meta-analysis between aetiologies. Pooling of results from two studies with a total of 77 participants indicated that HIV-infected patients with TBM had higher risk of one-month mortality compared with HIV non-infected controls (odds ratio 3.03; 95% confidence-interval 1.13–8.12; p = 0.03). Conclusions The evidence base is currently inadequate to inform prognostication in VPS insertion in HIV-infected patients. A population-based prospective cohort study is required to address this, in the first instance.