Browsing by Faculty "Faculty of Health Sciences"

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    A 12 week pre-season fitnes training programme for senior male high school rugby players : the effect of supervision on anthropometric, physiological and physical performance variables
    (1998) Clark, David Rodney; Lambert, Michael I
    The study comprises of two sections; i) a survey to determine the attitude towards fitness training for rugby and the current fitness training habits of elite high school rugby players in their penultimate year at school, ii) a training study on a sample of the same population group, to measure the effect of a 12 week fitness training programme, based on scientific principles, on anthropometric, physiological and performance variables. The training study also measured the efficacy of training supervision compared no supervision on these variables.
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    30 day outcomes of 1000 consecutive laparoscopic cholecystectomies across four Cape Metropole hospitals in Cape Town
    (2024) Kariem, Maahir; Kloppers, Jacobus
    Background: Laparoscopic Cholecystectomy (LC) is the standard of care for symptomatic gallstone disease. It has a steep learning curve and can associated with significant post operative morbidity and mortality. LC carries a morbidity of 1.6 – 5.3%, mortality of 0.05 – 0.14% and readmission rates of 3.3% (0-11.7%). We aimed to evaluate the 30 day outcomes of LC across four metropole hospitals in the Western Cape (WC) including mortality, length of stay, readmissions and complications according to the Clavien-Dindo Classification system. Methods: A retrospective review of a prospective database was performed. The data collection was collected between September 2019 and July 2022. Relative clinical, operative findings and post operative outcomes were analysed. Results: There were 1000 consecutive LC included in this study. The mean post operative length of stay was 1.92 days. Fifty-one patients developed surgical complications of which the most common surgical complication was a bile leak (n = 14) and intra-abdominal collections (n=11). Seven patients with bile leaks required reintervention. Four (0.4%) bile duct injuries (BDI) were reported in our series. Twenty-five percent of post operative complications were graded Clavien-Dindo IIIa and 28% were graded Clavien-Dindo IIIb. The 30 day readmission rate was 3.8% (n=38). Thirty-five surgical complications were noted of which 22 (62.8%) required reintervention. There were three reported mortalities (0.3%). Conclusion: Laparoscopic Cholecystectomy is considered the standard of treatment for gallstone disease and has potential serious complications. Our outcomes reported in this series is similar to that of other studies.
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    The 341C/T polymorphism in the GSTP1 gene is associated with increased risk of oesophageal cancer
    (BioMed Central Ltd, 2010) Li, Dongping; Dandara, Collet; Parker, M Iqbal
    BACKGROUND: The Glutathione S-transferases (GSTs) comprise a group of enzymes that are critical in the detoxification of carcinogens. In this study the effects of polymorphisms in these genes on the risk of developing oesophageal squamous cell carcinoma (OSCC) were evaluated in a hospital-based case-control study in two South African population groups. Genetic polymorphisms in GSTs were investigated in 245 patients and 288 controls samples by PCR-RFLP analysis. RESULTS: The GSTP1 341T variant was associated with significantly increased risk of developing OSCC as observed from the odds ratios for the GSTP1 341C/T and GSTP1 341T/T genotypes (OR = 4.98; 95%CI 3.05-8.11 and OR = 10.9; 95%CI 2.43-49.1, respectively) when compared to the homozygous GSTP1 341C/C genotype. The risk for OSCC in the combined GSTP1 341C/T and T/T genotypes was higher in tobacco smokers (OR = 7.51, 95% CI 3.82-14.7), alcohol consumers (OR = 15.3, 95% CI 1.81-12.9) and those using wood or charcoal for cooking and heating (OR = 12.1, 95% CI 3.26-49) when compared to those who did not smoke tobacco, or did not consume alcohol or user other forms of fuel for cooking and heating. Despite the close proximity of the two GSTP1 SNPs (313A>G and 341C>T), they were not in linkage disequilibrium in these two population groups (D':1.0, LOD: 0.52, r2: 0.225). The GSTP1 313A/G polymorphism on the other hand, did not display any association with OSSC. The homozygous GSTT1*0 genotype was associated with increased risk of OSCC (OR = 1.71, 95%CI 1.18-2.46) while the homozygous GSTM1*0 genotype was associated with significantly decreased risk of OSCC in the Mixed Ancestry subjects (OR= 0.39, 95%CI 0.25-0.62). CONCLUSIONS: This study shows that the risk of developing OSCC in the South African population can be partly explained by genetic polymorphisms in GST coding genes and their interaction with environmental factors such as tobacco smoke and alcohol consumption.
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    3D approximation of scapula bone shape from 2D X-ray images using landmark-constrained statistical shape model fitting
    (2016) Wasswa, William; Mutsvangwa, Tinashe E M; Douglas, Tania S
    Two-dimensional X-ray imaging is the dominant imaging modality in low-resource countries despite the existence of three-dimensional (3D) imaging modalities. This is because fewer hospitals in low-resource countries can afford the 3D imaging systems as their acquisition and operation costs are higher. However, 3D images are desirable in a range of clinical applications, for example surgical planning. The aim of this research was to develop a tool for 3D approximation of scapula bone from 2D X-ray images using landmark-constrained statistical shape model fitting. First, X-ray stereophotogrammetry was used to reconstruct the 3D coordinates of points located on 2D X-ray images of the scapula, acquired from two perspectives. A suitable calibration frame was used to map the image coordinates to their corresponding 3D realworld coordinates. The 3D point localization yielded average errors of (0.14, 0.07, 0.04) mm in the X, Y and Z coordinates respectively, and an absolute reconstruction error of 0.19 mm. The second phase assessed the reproducibility of the scapula landmarks reported by Ohl et al. (2010) and Borotikar et al. (2015). Only three (the inferior angle, acromion and the coracoid process) of the eight reproducible landmarks considered were selected as these were identifiable from the two different perspectives required for X-ray stereophotogrammetry in this project. For the last phase, an approximation of a scapula was produced with the aid of a statistical shape model (SSM) built from a training dataset of 84 CT scapulae. This involved constraining an SSM to the 3D reconstructed coordinates of the selected reproducible landmarks from 2D X-ray images. Comparison of the approximate model with a CT-derived ground truth 3D segmented volume resulted in surface-to-surface average distances of 4.28 mm and 3.20 mm, using three and sixteen landmarks respectively. Hence, increasing the number of landmarks produces a posterior model that makes better predictions of patientspecific reconstructions. An average Euclidean distance of 1.35 mm was obtained between the three selected landmarks on the approximation and the corresponding landmarks on the CT image. Conversely, a Euclidean distance of 5.99 mm was obtained between the three selected landmarks on the original SSM and corresponding landmarks on the CT image. The Euclidean distances confirm that a posterior model moves closer to the CT image, hence it reduces the search space for a more exact patient-specific 3D reconstruction by other fitting algorithms.
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    3D cine DENSE MRI: ventricular segmentation and myocardial stratin analysis
    (2013) Auger, Daniel A; Spottiswoode, Bruce S
    Includes abstract. Includes bibliographical references.
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    4D flow and displacement sensitive MR imaging of upper arm arterio-venous connections for haemodialysis
    (2016) Jermy, Stephen; Meintjes, Ernesta M; Franz, Thomas; Auger, Daniel A
    Chronic Kidney Disease (CKD) is a disease that causes kidney damage, often leading to the patient requiring haemodialysis treatment. Haemodialysis treatment requires a vascular access method, commonly Arteriovenous (AV) fistulae and grafts. These access methods must be regularly assessed to ensure the access remains unblocked and the flow rate is normal. Phase Contrast MRA (PC-MRA) is a versatile Magnetic Resonance Imaging (MRI) modality which is capable of imaging and quantifying blood flow in vivo. It is for this reason that this imaging technique was used to image blood flow in the vasculature of the upper arm of volunteers and haemodialysis patients with either an AV fistula or graft. This imaging technique is capable of producing temporally resolved Three-dimensional (3D) datasets (known as "Four-dimensional (4D)" flow) of blood flow in major vessels. Velocities are phase encoded between -π and π based on the chosen Velocity Encoding Constant (venc). To successfully characterise all velocities in the volume it is necessary to set the venc to be approximately equal to the highest velocity found in the vessel. Any lower venc value will cause phase wrapping, an imaging artefact causing all higher velocities to be wrapped by a multiple of 2 π. However, the increase in sensitivity to high velocities reduces the overall specificity of the velocities, especially for low velocities. Due to the pulsatile nature of blood flow in arterial vessels, a large range of velocities are encountered, while venous flow is more constant but lower than the peak arterial flow value. For this reason and due to the length of the 4D flow scans, 20-30 minutes, it would be preferable to perform one scan at a relatively low venc and correct any phase wrapping during post-processing. In this study, we performed both Two-dimensional (2D) PC-MRA scans at various locations in the upper arm and 4D PC-MRA scaans with similar venc settings. The purpose of the study was to implement and test several methods of phase unwrapping to remove phase wrapping artefacts from affected areas within the PC-MRA datasets.
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    50 years of Emmonsia disease in humans: the dramatic emergence of a cluster of novel fungal pathogens
    (Public Library of Science, 2015) Schwartz, Ilan S; Kenyon, Chris; Feng, Peiying; Govender, Nelesh P; Dukik, Karolina; Sigler, Lynne; Jiang, Yanping; Stielow, J Benjamin; Muñoz, José F; Cuomo, Christina A; Botha, Alfred; Stchigel, Alberto M; De Hoog, G Sybren
    New species of Emmonsia-like fungi, with phylogenetic and clinical similarities to Blastomyces and Histoplasma, have emerged as causes of systemic human mycoses worldwide. They differ from classical Emmonsia species by producing a thermally-dependent, yeast-like phase rather than adiaspores, and by causing disseminated infections, predominantly in immunocompromised patients and often with high case-fatality rates. Such differences will be important for clinicians to consider in diagnosis and patient management, and for microbiologists who may encounter these fungi with increasing frequency.
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    The 52 and 60 kD Ro/SS-A : antigens where are they? : do anti-Ro/SS-A autoantibodies cause cutaneous disease?
    (1998) Yell, Jennifer Anne
    Systemic lupus erythematosus, considered a multifactorial autoimmune disease, is a disease affecting many systems, with associated immunological abnormalities. It has a striking diversity of clinical patterns, pathologies and prognoses. Genetic factors determine the inherited baseline, on which environmental, hormonal and infectious triggers act to produce autoantibodies. Ro antibodies have been considered pathogenic in subacute cutaneous and neonatal lupus erythematosus. I affinity-purified antibodies to the 52 kD Ro from immunised rabbits (whole 52 kD protein) and human sera (using two immunodominant regions of the protein). I affinity-purified antibodies to the 60 kD Ro from immunised rabbits (whole 60 kD protein) and human sera (using two immunodominant regions of the protein, as well as the total "native" protein). Using these purified antibodies, with immunofluorescence on normal neonatal human keratinocytes, I showed that the 52 kD Ro is mainly cytoplasmic and the 60 kD Ro is mostly nuclear, with some fine cytoplasmic staining. I looked at the capacity of these purified antibodies to penetrate living keratinocytes under various conditions (hormones, drugs and vitamins). No antibody penetration was found, although one whole serum gave low levels of intracellular fluorescence. I studied the putative membrane translocation of 52 kD and 60 kD Ro under conditions of stress (UV A or UVB with or without hormones, drugs, vitamins and heat shock). I could not identify translocation of the 52 or 60 kD antigens with purified antibodies, although some whole sera showed fluorescence. I can find no evidence that antibodies directed against the 52 and 60 kD Ro antigens cause cutaneous disease.
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    9β Polymorphism of the Glucocorticoid Receptor Gene Appears to Have Limited Impact in Patients with Addison’s Disease
    (Public Library of Science, 2014) Ross, Ian Louis; Dandara, Collet; Swart, Marelize; Lacerda, Miguel; Schatz, Desmond; Blom, Dirk Jacobus
    BACKGROUND: Addison’s disease (AD) has been associated with an increased risk of cardiovascular disease. Glucocorticoid receptor polymorphisms that alter glucocorticoid sensitivity may influence metabolic and cardiovascular risk factors in patients with AD. The 9β polymorphism of the glucocorticoid receptor gene is associated with relative glucocorticoid resistance and has been reported to increase the risk of myocardial infarction in the elderly. We explored the impact of this polymorphism in patients with AD. Materials and METHODS: 147 patients with AD and 147 age, gender and ethnicity matched healthy controls were recruited. Blood was taken in a non-fasted state for plasma lipid determination, measurement of cardiovascular risk factors and DNA extraction. RESULTS: Genotype data for the 9β polymorphism was available for 139 patients and 146 controls. AD patients had a more atherogenic lipid profile characterized by an increase in the prevalence of small dense LDL (p = 0.003), increased triglycerides (p = 0.002), reduced HDLC (p<0.001) an elevated highly sensitive C-reactive protein (p = 0.01), compared with controls. The 9β polymorphism (at least one G allele) was found in 28% of patients and controls respectively. After adjusting for age, gender, ethnicity, BMI and hydrocortisone dose per metre square of body surface area in patients, there were no significant metabolic associations with this polymorphism and hydrocortisone doses were not higher in patients with the polymorphism. CONCLUSIONS: This study did not identify any associations between the 9β polymorphism and cardiovascular risk factors or hydrocortisone dose and determination of this polymorphism is therefore unlikely to be of clinical benefit in the management of patients with AD.
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    A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South-African provinces
    (2023) Vlok, Neville; Stassen, Willem; Wylie Craig
    Introduction: Helicopter Emergency Medical Services (HEMS) forms an important role in integrated modern emergency medical services and have a suggested mortality benefit in certain patient populations, such as those affected by severe trauma or with time-sensitive pathologies in rural areas. Despite this, HEMS is an expensive resource used in South Africa and appropriate use and feasibility in low-to-middle income countries (LMIC) is highly debated. To maximise benefit, it is essential that the right patients be selected for HEMS. In order to evaluate this, the current practices first need to be described. The aim of this study was to describe a population of patients being transported by HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis and clinical characteristics and interventions. Methods: A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a private, single aeromedical operator in South Africa, over a 12-month period (July 2017 – June 2018) in Gauteng, Free State, Mpumalanga and North-West. Results: A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT)). The majority of the patients were male (n=548, 59.8%), suffered blunt trauma (n=379, 41.4%) followed by medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%). Most flights occurred in daylight hours (n=729, 79.6%). Median mission times were 1-hour 53minutes for primary missions, and 3 hours 10 minutes for IFT cases. Median on-scene times were 26 minutes for primary cases and 55 minutes for IFT cases. Although many patients were transported with an endotracheal tube (n=428, 46.7%), more than a third did not have an advanced airway and received supplemental oxygen via other means (n=348, 37.9%). Almost half of patients received no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Almost all patients received intravenous fluid therapy (n=867, 94.7%). The administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%) were also common interventions. Conclusion: By describing current HEMS transport practices in one of the largest cohorts in Africa to date, a better understanding is gained of how HEMS is utilised daily. Apart from the lack of universal call out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. Due to the lack of coordinated coronary care networks, it seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.
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    A 12-month retrospective, descriptive study of Hout Bay Volunteer Emergency Medical Service, Cape Town, South Africa
    (2019) Kahle, Jurgen Werner; Cunningham, Charmaine; Fleming, Julian; Hodkinson, Peter
    Background There is a growing need for Emergency Medical Services (EMS) globally and in Africa, as health services develop. The establishment and continued operation of volunteer ambulance services might assist with this need. This study provides a comprehensive overview of the operational activities of a volunteer ambulance service and forms a first step for further studies of this and other volunteer ambulance services. Objectives This study describes and quantifies the operational activities of Hout Bay Volunteer Emergency Medical Service (Hout Bay EMS) a volunteer ambulance service in Cape Town, South Africa for a one year period from 1 January to 31 December 2016. Methods This retrospective study describes call-outs, shifts and service demographics of Hout Bay EMS for 2016, using Provincial EMS dispatch data and shift records from Hout Bay EMS. Performance comparisons are drawn between Hout Bay EMS and Provincial EMS. Outcomes In the study period, there were 682 call-outs involving Hout Bay EMS, a total mission time of 951 hours worked over 119 shifts by 31 active members in 2016. Assault was the leading call-out type (18.40%); 58.24% of call-outs were Priority 2 (less urgent), and 39.30% of call-outs ended in no patient transport. Response times to Priority 1 call-outs were generally shorter for Hout Bay EMS than those of Provincial EMS within the Hout Bay area. Members largely preferred night shift to day shift by a factor of 4:1; the majority of shifts were worked by Basic Life Support (28.57%) and Intermediate Life Support (57.98%) qualified members compared to the relatively few shifts (13.44%) worked by Advanced Life Support members. This study shows that a small volunteer ambulance service mostly active on weekends can successfully complement the efforts of the larger, full-time provincial ambulance service it is dispatched by. This model could be replicated elsewhere to meet the growing need for emergency medical services.
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    A 15-year retrospective review of urodynamic studies in Children at Red Cross War Memorial Childrens Hospital (RCWMCH), Cape Town, South Africa
    (2022) Mosalakatane, Thembisile Dintle; Coetzee, Ashton; Wright, Anne; Raad, Jeanette; Lazarus, John; Nourse, Peter; Howlett, Justin; McCulloch, Mignon
    Background: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.
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    A 23-year retrospective review of heart transplant donor and recipient referrals to Groote Schuur hospital between 1997 and 2019
    (2025) Kanyongo, Rusununguko; Pennel, Timothy
    Background. Heart transplantation in South Africa faces numerous challenges related to organ scarcity and unequal access to advanced heart therapy. There is an urgent need to analyse the current transplant referral pathway to optimise equitable access to transplantation. Objectives. To provide an audit of heart transplant referrals to Groote Schuur Hospital, Cape Town, over a 23-year period, focusing on patient demographics, indications for referral, waiting-list dynamics, and transplant referral outcomes. Methods. The study utilised a retrospective patient folder review for the period 1 January 1997 - 31 December 2019 and audited the trends in heart transplant referrals and associated outcomes of the referral at a tertiary academic hospital. Results. A total of 625 recipients were referred for heart transplantation, with the majority being male (n=412; 65.9%), while gender was undocumented for 69 cases (11.0%). The mean age was 38.1 (14.6) years, and 153 (24.5%) were listed for transplant, while 215 (34.4%) were deemed ineligible for listing. Contraindications for listing included social (n=106; 49.3%), medical (n=83; 38.6%) and psychological (n=26; 12.0%) factors, while 134 patients (21.4%) were considered too well. Poor social circumstances (n=38; 39.6%), poor insight (n=28; 29.2%) and poor compliance (n=21; 21.9%) were the most common non-medical reasons for not listing recipients, while obesity (n=30; 31.3%) and smoking (n=23; 24.0%) were notable medical contraindications. Forty-nine patients (7.8%) died during work-up, while 130 (85.0%) of the listed patients received a heart transplant. Of the 429 donor referrals, 139 (32.4%) were accepted for organ procurement. Reasons for declining donors included unsuitability for transplantation (30.3%), lack of capacity (1.8%), and recipient-donor mismatch (66.9%). Conclusion. Three-quarters of the referred patients were deemed unsuitable for heart transplantation for medical and/or social reasons. The ratio of referral to listing has decreased over time. However, once listed, the likelihood of receiving a transplant was high.
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    A 40-50kDa Glycoprotein Associated with Mucus is Identified as α-1-Acid Glycoprotein in Carcinoma of the Stomach
    (2012) Chirwa, Nthato; Govender, Dhirendra; Ndimba, Bongani; Lotz, Zoe; Tyler, Marilyn; Panieri, Eugenio; KAHN, DELAWIR; Mall, Anwar S
    Background and Aim: Secreted gastric mucins are large O-glycosylated proteins of crude mucus gels which are aberrantly expressed in malignancy. An albumin associated 55-65kDa glycoprotein was previously shown in mucus gels in gastric cancer. The aim of this study was to investigate its expression and identification in human gastric tissue. Methods: Mucins were purified from crude mucus scrapings of 16 partial and 11 total resections and a rabbit polyclonal antibody was raised to the 55-65kDa glycoprotein. The location and expression of the glycoprotein was examined in normal gastric mucosa (n=20), intestinal metaplasia (n=18) and gastric cancer (n=27) tissue by immunohistochemistry. Mucins were analyzed by isoelectric focusing (IEF) on 2-D polyacrylamide gels. Identification of the 40-50kDa glycoprotein was by MALDI-TOF MS technique. Plasma levels were examined by Western blotting. Results: Extensive SDS-PAGE analysis gave a PAS positive glycoprotein in the 40-50kDa range, in patients with gastric cancer but not normals. It was expressed in parietal and columnar cells of normal gastric tissue and intestinal metaplasia respectively, and in 22 of 27 gastric cancer specimens. In 2-D PAGE stained with Coomassie Blue there were 3 spots positively identified as alpha-1-acid glycoprotein (AGP) by MALDI-TOF MS technique. PAS staining revealed a single bright spot in the same position but could not be identified. Preliminary measurements showed slightly higher levels of AGP in plasma of patients with gastric carcinoma. Conclusion: AGP levels are increased in gastric tissue and in the plasma of those with carcinoma of the stomach.
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    A 52-Week Placebo-Controlled Trial of Evolocumab in Hyperlipidemia
    (2014) Blom, Dirk J; Hala, Tomas; Bolognese, Michael; Lillestol, Michael J; Toth, Phillip D; Burgess, Lesley; Ceska, Richard; Roth, Eli; Koren, Michael J; Ballantyne, Christie M; Monsalvo, Maria Laura; Tsirtsonis, Kate; Kim, Jae B; Scott, Rob; Wasserman, Scott M; Stein, Evan A
    BACKGROUND Evolocumab, a monoclonal antibody that inhibits proprotein convertase subtilisin/ kexin type 9 (PCSK9), significantly reduced low-density lipoprotein (LDL) cholesterol levels in phase 2 studies. We conducted a phase 3 trial to evaluate the safety and efficacy of 52 weeks of treatment with evolocumab. METHODS We stratified patients with hyperlipidemia according to the risk categories outlined by the Adult Treatment Panel III of the National Cholesterol Education Program. On the basis of this classification, patients were started on background lipid-lowering therapy with diet alone or diet plus atorvastatin at a dose of 10 mg daily, atorvastatin at a dose of 80 mg daily, or atorvastatin at a dose of 80 mg daily plus ezetimibe at a dose of 10 mg daily, for a run-in period of 4 to 12 weeks. Patients with an LDL cholesterol level of 75 mg per deciliter (1.9 mmol per liter) or higher were then randomly assigned in a 2:1 ratio to receive either evolocumab (420 mg) or placebo every 4 weeks. The primary end point was the percent change from baseline in LDL cholesterol, as measured by means of ultracentrifugation, at week 52. RESULTS Among the 901 patients included in the primary analysis, the overall least-squares mean (±SE) reduction in LDL cholesterol from baseline in the evolocumab group, taking into account the change in the placebo group, was 57.0±2.1% (P<0.001). The mean reduction was 55.7±4.2% among patients who underwent background therapy with diet alone, 61.6±2.6% among those who received 10 mg of atorvastatin, 56.8±5.3% among those who received 80 mg of atorvastatin, and 48.5±5.2% among those who received a combination of 80 mg of atorvastatin and 10 mg of ezetimibe (P<0.001 for all comparisons). Evolocumab treatment also significantly reduced levels of apolipoprotein B, non-high-density lipoprotein cholesterol, lipoprotein(a), and triglycerides. The most common adverse events were nasopharyngitis, upper respiratory tract infection, influenza, and back pain. CONCLUSIONS At 52 weeks, evolocumab added to diet alone, to low-dose atorvastatin, or to high-dose atorvastatin with or without ezetimibe significantly reduced LDL cholesterol levels in patients with a range of cardiovascular risks.
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    A biregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa
    (2011)
    BackgroundTo better understand the need for paediatric second-line antiretroviral therapy (ART), an ART management survey and a cross-sectional analysis of second-line ART use were conducted in the TREAT Asia Paediatric HIV Observational Database and the IeDEA Southern Africa (International Epidemiologic Databases to Evaluate AIDS) regional cohorts.MethodsSurveys were conducted in April 2009. Analysis data from the Asia cohort were collected in March 2009 from 12 centres in Cambodia, India, Indonesia, Malaysia, and Thailand. Data from the IeDEA Southern Africa cohort were finalized in February 2008 from 10 centres in Malawi, Mozambique, South Africa and Zimbabwe.ResultsSurvey responses reflected inter-regional variations in drug access and national guidelines. A total of 1301 children in the TREAT Asia and 4561 children in the IeDEA Southern Africa cohorts met inclusion criteria for the cross-sectional analysis.Ten percent of Asian and 3.3% of African children were on second-line ART at the time of data transfer. Median age (interquartile range) in months at second-line initiation was 120 (78-145) months in the Asian cohort and 66 (29-112) months in the southern African cohort. Regimens varied, and the then current World Health Organization-recommended nucleoside reverse transcriptase combination of abacavir and didanosine was used in less than 5% of children in each region.ConclusionsIn order to provide life-long ART for children, better use of current first-line regimens and broader access to heat-stable, paediatric second-line and salvage formulations are needed. There will be limited benefit to earlier diagnosis of treatment failure unless providers and patients have access to appropriate drugs for children to switch to.
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    A biscuit fortified with iron, iodine and B-carotene as a strategy to address micronutrient deficiencies in primary school children
    (2001) Van Stuijvenberg, Martha Elizabeth; Hussey, G. D.; Benade, A. J. S
    Deficiencies of vitamin A, iron, and iodine continue to be prevalent in developing countries worldwide and can, in addition to the classic consequences such as nutritional anaemia, goitre, cretinism, xerophthalmia and blindness caused by severe deficiencies, also affect the growth, development and immunity of young children. The various internationally acknowledged strategies for combating micronutrient deficiencies include high-dose supplementation, food fortification, dietary diversification and nutrition education. The aim of this research was to evaluate a micronutrient-fortified biscuit as a strategy to address micronutrient deficiencies in primary school children from a poor rural community. The research comprised three phases. During the first phase the effect of a biscuit fortified with iron, iodine, and B-carotene on the vitamin A, iron and iodine status of 115 children was evaluated and compared with 113 controls, in a randomised placebo-controlled trial. To enhance the absorption of iron a vitamin C-fortified cold drink was given together with the biscuit. Anthropometric status, cognitive function and morbidity were assessed as secondary outcomes. The 12-month intervention resulted in a significant improvement in serum retinol, serum ferritin, transferrin saturation, haemoglobin and urinary iodine excretion. Morbidity and cognitive function, particularly the cognitive function in the children presenting with low iron status and with goitre! at baseline, were also favourably affected. Linear growth was positively affected only in the children with marginal iron stores at baseline. During the second phase of this study the long-term effectiveness of the biscuit programme, in terms of elimination of micronutrient deficiencies, compliance, acceptability and sustainability, was evaluated in a longitudinal study over a period of 30 months. In addition, cross-sectional data on vitamin A and iron status from subsequent studies conducted in the same school at 33, 42 and 45 months after the start of the original biscuit intervention, during which time the fortified biscuit continued to be distributed at the school, are reported. Although micronutrient status improved significantly during the 12 months of the first study, all variables (except urinary iodine) returned to pre-intervention levels when the schools reopened after the summer holiday. Serum retinol increased again during the next nine months, but was significantly lower in a subsequent survey, carried out directly after the summer holiday; this pattern was repeated in two further cross-sectional surveys. Iron status showed no recovery during a subsequent intervention period when the vitamin C-fortified cold drink was supplied on a less frequent basis, or during the period that ferrous bisglycinate was used as iron fortificant. Because of the compulsory iodisation of salt, that came into effect halfway through the first phase of the study, improved iodine status, as measured by urinary iodine excretion, was maintained. In the third phase of the research, red palm oil, a rich natural source of B-carotene, was examined as an alternative vitamin A fortificant in the biscuit. This study contained elements of both a randomised placebo-controlled trial and an equivalence trial. The biscuit with a red palm oil-based shortening was shown to be as effective as the biscuit with fl-carotene from a synthetic source in improving the vitamin A status of these children. In conclusion, the results of the studies described in this thesis showed that a micronutient-fortified biscuit is a feasible, practical and effective way of improving the micronutrient status of primary school children from a poor rural community. Long-term evaluation of this programme, however, showed that improved micronutrient status is not sustained during the long summer school holidays, and it is suggested that the biscuit programme is supplemented with other strategies, such as local food production programmes and nutrition education. Red palm oil, with all of its additional qualities (i.e. no trans fatty acids; rich source of antioxidants), appears to be an attractive alternative for use as a vitamin A fortificant. The choice of the iron compound to be used in the biscuit, however, needs further investigation.
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    A case for integrating human rights in public health policy
    (2006) London, Leslie
    In a global environment where human rights and well-being are coming under increasing threat, both from the spectre of terrorism and from the counter-reaction to it,1 and where international governance systems continue to pay lip service to poverty reduction while encouraging unbridled private accumulation of wealth resulting in huge inequalities between and within countries,2,3 the need to make human rights considerations an integral part of how public health policies are formulated cannot be overemphasised. Contestation over entitlements to socio-economic rights has troubled health care systems worldwide, from resource-poor settings in Africa, where questions have been raised as to whether human rights approaches are best suited to addressing the problem of AIDS in Africa,4,5 through to the over-consumptive USA where universal access to health care remains a policy objective doomed to unfulfilment under market-fixated economic systems.6,7
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    “A case study evaluating the effectiveness of adherence clubs in Gugulethu as a strategy for mobilizing and engaging men in HIV treatment”
    (2022) Ncube, Petronella; Colvin, Christopher J; Mbokazi, Nonzuzo
    The existing global literature shows that men living with HIV need efficient antiretroviral treatment (ART) delivery. Adherence clubs (ACs) have been identified as one way to improve retention of stable patients living with Human Immunodeficiency Virus (HIV). ACs are among several strategies that have been said to potentially assist in the engagement and mobilization of men in HIV services. However, very few have been evaluated to see whether they are effective in this regard. This qualitative study examines the facilitating factors that help retain and engage men in HIV services by trying to understand the perceived effectiveness of the Adherence Club in Gugulethu. The study employs a qualitative approach to explore the facilitating factors which help retain and engage men in HIV services. A total of 12 participants participated in in-depth telephonic interviews. The participants included stakeholders of the AC such as the health workers (facilitators, nurse, community health worker (CHW) and adherence counsellors), men attending the club and family members who are indirectly involved in supporting participants engagement in the AC as patients. Interviews were conducted in IsiXhosa and for data analysis, they were translated to English, and a thematic analysis was done. The findings show facilitating factors in all stages of the socio-ecological model with the patient level being the vital stage which allows for the integration of other level factors. This study shows that when men properly utilize the different resources provided for their HIV treatment, their engagement and retention in the AC improves. It is therefore key for policy makers to consider planning for male-focused health services to ensure that men view health services as spaces which are inclusive and tailored for them to improve their engagement and retain them in health services.
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    A case study exploring an occupational perspective of social inclusion among young adults dually afflicted with substance use disorder and HIV/AIDS in Zimbabwe
    (2021) Nhunzvi, Clement; Galvaan, Roshan; Langhaug, Lisa; Harding, Richard
    Background: Curtailing adverse social determinants of health is pivotal to achieving the 2030 Agenda for Sustainable Development`s vision for a healthy and inclusive society. In Zimbabwe, fulfilling Vision 2030 may involve adopting socially inclusive approaches, particularly for young people dually afflicted with HIV and substance use disorders. However, social inclusion remains conceptually unclear and underutilized in relation to marginalized groups in low resource settings. This study sought to explore and understand how dually afflicted young adults with substance use disorders and HIV in Zimbabwe experienced and negotiated their social inclusion. Methods: This study utilised a qualitative instrumental case study design. Primary qualitative and quantitative data were collected to develop a thorough understanding of the case of an occupational perspective of social inclusion among dually afflicted young adults in Zimbabwe. The multiple methods used in this study included: i) narrative inquiry with five dually afflicted young adults; ii) in-depth interviews with five key informants; iii) document analysis of seven policies; and, iv) exploratory cross-sectional survey of social inclusion and associated factors (n=105). These multiple methods and sources contributed to the study`s trustworthiness. Multi-level case study analysis was applied as follows; 1st level: narrative analysis of each of the five young adults` stories, descriptive analysis of key informant interviews, document analysis and descriptive statistical analysis of the cross-sectional survey data. 2nd level: thematic case analysis drawing from all four data sources. 3rd level: theorised conceptual occupational constructs. Findings: Five narratives illustrated how using agency and having occupational choices were central to the young adults` experience and negotiation of social inclusion. The overarching Case theme was “Navigating an already troubled life: Striving for belonging and well-being”. This consists of three categories: 1) Dealing with a context of mixed realities, 2) Trying to adjust to new challenges and, 3) Life on the margins. These findings show how dually afflicted young adults in Zimbabwe respond and resist the influences of dominant discourses through dynamic and interconnected actions that shape their realities. Conclusion: The study describes and explains how dually afflicted young adults experienced and negotiated their social inclusion. The data affirms the role of agency and proposes a more critical view of occupational choice, activist occupational choice, in understanding social inclusion. As an emergent concept it is categorized by occupational choices, largely defying standard norms of engagement, and aims to break away from oppressive systems and problematic situations. Recognising the diverse manifestation of agency yields an appreciation for how occupations that are indigenous, collective, and resist oppression contributes to experiences of social inclusion.