Browsing by Author "Setshedi, Mashiko"

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    Consumption of Aloe to improve health outcomes in adults with irritable bowel syndrome: A systematic review and meta-analysis
    (2019) Fong, Francisco J; Engel, Mark E; Setshedi, Mashiko
    PART A is a research protocol which describes the background and proposed methodology of this systematic review and meta-analysis. This section details the quantitative and qualitative methods to be used when analysing the effect of Aloe in the treatment of patients with irritable bowel syndrome (IBS). PART B is an extended literature review which expands on some of the topics raised in the background section of the protocol. A more in-depth explanation of the epidemiology of IBS, is presented, as well as the strengths and limitations of current treatment options in order to understand the context around the proposed research. PART C presents this research in the form of a journal manuscript in a format suitable for submission to Plos ONE. This manuscript includes a background to the research followed by the results section which is then discussed. Lastly, implications for clinical practice are posited and suggestions for further research are offered.
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    Helicobacter pylori Infection: Antibiotic Resistance and Solutions for Effective Management in Africa
    (Multidisciplinary Digital Publishing Institute, 2023-05-26) Setshedi, Mashiko; Smith, Stella I.
    Helicobacter pylori. pylori infection is ubiquitous worldwide, with prevalence rates of greater than 70% in Africa. Symptomatic patients present with foregut gastrointestinal symptoms which can be readily diagnosed with standardized non-invasive or invasive tests. The biggest challenge, however, is in the management of this condition with rising antimicrobial resistance rates to most of the antibiotics recommended for therapy. This is a problem worldwide, but more specifically in Africa, where the socio-economic and political climate is such that eradication of this organism seems impossible. Furthermore, the recommended antimicrobial susceptibility testing for drug resistance is not widely available in Africa due to the lack of infrastructural as well as human resources. With the widespread unregulated use of antibiotics in some parts of Africa, the figures of antimicrobial resistance are likely to soar. In the face of these significant challenges, this ‘perspectives’ article aims to address the issue of antimicrobial resistance in Africa, by providing achievable and targeted goals to curb the spread of infection and rising antimicrobial resistance.
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    Impairments in signaling cascades mediating the progression of liver disease from chronic hepatitis to hepatocellular carcinoma in animal and human models
    (2011) Setshedi, Mashiko; De la Monte, Suzanne M
    The most common risk factors for chronic liver disease, cirrhosis, and hepatocellular carcinoma (HCC) include chronic alcohol abuse and infection with hepatitis B (HBV) or hepatitis C (HCV) virus. Growing evidence from human studies and experimental models suggests that pre-degenerative and premalignant abnormalities include disturbances in intracellular signaling and ongoing injury with oxidative stress, inflammation, and lipotoxicity. The major signal transduction pathways affected in both degenerative and neoplastic disease states in liver include: insulin/IGF, Wnt/β-catenin, and others.
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    Indications and outcomes of abdominal surgery in patients with Crohn s Disease attending a tertiary hospital: a single centre study
    (2024) Mabobo, Ndumbwe; Setshedi, Mashiko; Boutall Adam
    Background: Crohn's disease is a chronic inflammatory and heterogenous condion affecting predominantly the small bowel. Despite optimal medical therapy, it is associated with lifethreatening complications related to inflammation or fibro-stenotic disease that often require surgery. The aim of this study was to describe the characteristics of a cohort of patients with Crohn's disease requiring abdominal surgery. Methods: This was a retrospective study of adults attending at the colorectal unit of a teaching hospital. Relevant demographic and clinical data were collected from multiple sources from January 2010 to June 2020. Results: Sixty nine patients (4.6%) of the total cohort of IBD patients with Crohn's disease underwent abdominal surgery. The mean age at disease diagnosis was 27.9 ± 13.3 and mean age at time of surgery 43±13.2. Sixty-eight percent were females and 66% smokers. Thirty-three percent and 18.9% had fistulizing and stricturing disease respectively. Pre-operatively, 22% of patients were on steroids, 47% on azathioprine and 10% on biologics. The commonest indication for surgery was small bowel obstruction (37.6%), followed by fistulizing disease (18.8%). Sixty one percent of patients had one surgery, with a quarter needing more than two surgeries in the study period. Post-operative clinical recurrence occurred in 50%. Conclusions: Fifty two percent of patients had penetrating and/or stricturing disease necessitating surgery in a high proportion of patients. The commonest indication was small bowel obstruction. Post-operative recurrence was the commonest complication in half the patients. This data together speaks to the aggressive phenotype of CD in this cohort, and the important role that surgery still plays in the management of CD. A multi-disciplinary team is crucial in the management of these patients.
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    Pneumatic balloon dilatation versus laparoscopic Heller's myotomy in idiopathic achalasia
    (2015) Hlatshwayo, Sabelo Jabulani; Myer, Landon; Thomson , Sandie; Setshedi, Mashiko
    Background Both laparoscopic Heller's myotomy (LHM) and pneumatic balloon dilatation (PBD) are widely used in the management of achalasia, but there is still no clarity as to which of these interventions is the best treatment for patients with the condition. Methods Newly diagnosed achalasia patients were randomised into PBD or LHM. The severity of achalasia symptoms in all participants was documented using the Eckardt score, a clinical symptom score whose components are dysphagia, chest pain, regurgitation and weight loss. The Eckardt score ranges from 0 in those with no symptoms to 12 in patients with pronounced symptoms. The primary outcome, therapeutic success, was defined as a drop in the Eckardt score to <3 or subsequent need for alternative intervention. The secondary outcome was the complication rate, including mortality, in the two treatment arms.
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    Risk of malignancy in patients with inflammatory bowel disease treated with Azathioprine or 6-mercaptopurine : the Cape Town experience
    (2008) Setshedi, Mashiko; Myer, Landon; Watermeyer, Gill
    The benefits of the use of Azathioprine (AZA) and its metabolite 6-mercaptopurine (6-MP) in the treatment of Inflammatory Bowel Disease (IBD) are well established. However, concern regarding the long-term use of these agents in the induction of certain malignancies particularlty lymphoma and skin cancer has been reported in renal transplant and rheumatoid arthritis patients. In IBD patients hoever, several retropsective and prospective studies have been conducted (including two meta-analyses) with divergent results. The primary objective of this study was to compare the incidence of cancer in IBD patients treated with AZA/6BMP with those not treated. Secondary objectives were to assess if skin cancer had a higher incidence of occurrence than other cancers, and to determine the independent risk factors associated with cleveloping any malignancy.
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    The yield of colonoscopy in patients attending a tertiary hospital in Cape Town, South Africa
    (2021) Elhenghari, Emad; Setshedi, Mashiko; Thomson, Sandie
    Background: Colonoscopy is widely used for diagnosis, therapeutic intervention of conditions of the lower gastrointestinal tract and colorectal cancer screening. Given its widespread use and complications, colonoscopy should be performed for appropriate indications. The aim of this study was to determine the yield and appropriateness of colonoscopy at a tertiary hospital. Methods: Demographic, clinical and endoscopic data was retrieved from a prospective endoscopy database from 01 Jan 2014 to 31 December 2019. The variables collected were patient details (age, sex), clinical indication, symptoms, urgency of colonoscopy, sedation used, quality of bowel preparation, and findings. Results: The total number of patients was 4033 with median age of 56 (IQR 18-85), of whom 59.6% were female. Colonoscopy was performed for appropriate indications in 98% of cases (according to EPAGE II criteria). Older patients were more likely to be investigated for anaemia (OR=0.55, CI 0.43-0.70, p=0.000), and surveillance postpolypectomy (OR=0.57, CI 0.37-0.85, p=0.005), while patients under 50 had a colonoscopy for an IBD flare (OR=1.98, CI 1.49-2.6, p=0.000), or surveillance for HNPCC (OR=3.0, CI 2.1-4.3, p=0.000). Rectal bleeding was the commonest symptom (16.5%). Patients younger than 50 were more likely to present with abdominal pain (OR=1.3, CI 1.07-1.6, p=0.006), and diarrhoea (OR=1.8, CI 1.5-2.3, p=0.000), whilst those older than 50 were more likely to present with alteration of bowel habit (OR=0.63, CI 0.43-0.9, p=0.012), and loss of weight (OR=0.45, CI 0.33-0.60, p=0.000). Polyps were the commonest finding (15.4%); the prevalence of colorectal cancer and diverticular disease was 3.6% and 6.5% respectively. Patients younger than 50 were more likely to have inflammation (OR=2.6, CI 2.18-3.15, p=0.000), whilst those older than 50 were more likely to have diverticulae (OR=0.08, CI 0.05-0.14, p=0.000), polyps (OR=0.43, CI 0.35- 0.53, p=0.000) or a tumour (OR=0.47, CI 0.29-0.72, p=0.000). Although 69% of the bowel preparation was reported as good or adequate, there was no difference in the detection of lesions when compared to poor bowel preparation. The adjusted caecal intubation rate was 95.1%. Conclusion: Colonoscopy was performed in a relatively young cohort, predominantly for symptoms not screening. The study provides some epidemiologic data on common lower gastrointestinal conditions in a referral center, but also highlights some inefficiencies in the system. Furthermore, this study serves as an audit on the clinical service, a baseline from which improvements can be made.