List of Titles

A single centre study evaluating adherence to methotrexate monitoringguidelinesin patients with rheumatoid arthritis

Authors: Genevieve, Olivier
Date: 2023-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9690 , vital:74612
Description: Introduction: Methotrexate (MTX) is considered a first-line agent for the treatment of rheumatoid arthritis (RA) and regular blood test monitoring is advised in treatment guidelines to identify potential toxicity. Failure to adhere to monitoring guidelines for methotrexate use may compromise patient care. Identifying and correcting variability in care may optimise the safe use of this medication and improve patient outcomes. Aims: This study aimed to evaluate adherence to guidelines on methotrexate safety monitoring in rheumatoid arthritis patients at an Eastern Cape hospital and to establish whether a dedicated rheumatology outpatient department (OPD) performs this task more effectively than a general medical outpatient department (MOPD). Method: This retrospective cross-sectional single-centre study was conducted at Frere Hospital in the Eastern Cape over one year from 1 January 2019 to 31 December 2019. Adult patients over the age of 18 years who received methotrexate for rheumatoid arthritis during the study period and attended either the rheumatology OPD or the MOPD at Frere Hospital were included in the study population. Permission to undertake this study was obtained through the Faculty of Health Sciences Research Ethics and Bio-safety Committee at Walter Sisulu University and the Cecilia Makiwane and Frere Hospitals Research and Ethics Committee. The random sample generator tool on Microsoft Excel was used to select patients from the Frere Hospital Pharmacy Database who was prescribed methotrexate for rheumatoid arthritis. Laboratory test results were accessed through the Labtrak system of the National Health Laboratory Service (NHLS). The number and type of blood test done as recommended in a South African Methotrexate use guideline by Hodkinson et al, was documented on a data collecting sheet. Two or more blood tests done within a three-to six month period was considered adherent to the guideline. The hospital management system version two (HMS2) was used to see which clinic the patient attended. iii Results: There was 53% adherence (95% Confidence Interval 42-65%) overall to guideline. In the study sample, 64% of patients were from Rheumatology OPD and the remainder were from MOPD. There was 78% (95% CI 62-89%) adherence in the Rheumatology OPD compared to 22% (95% CI 11-38%) in MOPD. No significant association was found between the number of FBC tests and the site of testing (p-value = 0.346) or for Creatinine tests (p-value = 0.078). However, a significant association was found with ALT tests and the site of testing (MOPD or rheumatology OPD) with p-value = 0.010, although this is likely a chance finding. Conclusion: Adherence to a South African guideline for methotrexate safety monitoring was found to be suboptimal at the study centre. Adherence was better in the dedicated Rheumatology OPD compared to a general medical OPD. Education regarding the correct use of guidelines in different health settings by medical professionals is advised. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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Date Issued: 2023-00

An audit of patients with new onset stroke and associated barriers to thrombolysis of hyperacute strokesat a tertiary level hospital in the Eastern Cape

- Pasio, Roswyn Claire

Authors: Pasio, Roswyn Claire
Date: 2023-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9891 , vital:74639
Description: Globally and in South Africa stroke is a leading cause of morbidity and mortality. In 2006, the Joint World Congress of Stroke declared stroke a ‘catastrophic illness’ in South Africa. This declaration aims to focus the attention of policymakers on the impact of stroke and engage with them to intervene. Local stroke data is needed to make informed and relevant policy changes. Data is also required to start multi-level initiatives regarding stroke prevention and care. This study aims to analyse the demographic profile of stroke and assess the quality of stroke care using time-based performance measures at Livingstone Tertiary Hospital in the Eastern Cape. Methodology The study is a descriptive, retrospective chart review of patients presenting with an acute stroke to Livingstone Tertiary Hospital Emergency Department over a 12 month period. Demographic data, stroke risk factors, patient comorbidities and mode of transport were collated and analysed. Time parameters were used to ascertain delays within the stroke care pathway of patients and factors precluding patients from thrombolysis were identified. Results The study included 403 eligible patients, 54% of the patients of whom were female. The majority of those were of Mixed-race ethnicity (49%) and aged between 50 and 79 years. Hypertension (71%) was the most common comorbidity followed by smoking (31%) and diabetes mellitus (24%). The median time from onset of symptoms to presentation to hospital was 12 hours 23 minutes (I.Q 20hrs 34min). The average time from arrival to being III seen by a doctor was 1 hour 57 minutes (I.Q 1hr 59min) and the time from arrival to radiological imaging was 17 hours 6 minutes (I.Q. 8hrs 28min). 375 patients had radiological imaging, 58% (n=217) had evidence of an ischaemic stroke compared to 21% (n=80) who had signs of an intracranial haemorrhage. Of the study cohort, 99 (25%) of all stroke patients presented within the 4.5hr thrombolytic window, 68 (32%) of which were ischaemic strokes. However, in-hospital time delays precluded 35% of these patients from thrombolysis. A further 33% of patients had other contraindications to thrombolysis and 32% were not offered thrombolysis based on the clinical discretion of the doctor. Conclusion This study highlights the burden of stroke within Port Elizabeth, located in the Western Region of the Eastern Cape. Risk factor modification and disease control is imperative in reducing the prevalence and impact of stroke. The major precluding factor in stroke patients not being offered thrombolysis is a delay in arrival to hospital. Public education and awareness initiatives need to focus on addressing this issue. The clinical discretion of the treating physician significantly influences the decision to thrombolyse patients with an acute stroke. In-service training can address physicians’ perceptions regarding the benefits of thrombolysis as a treatment option. , Thesis (Masters) -- Faculty of Medicine and Health Sciences in brach of emergency medicine, 2023
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Date Issued: 2023-00

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Prevalence and risk factors of imaging confirmed neurological complication amongst patients withhypertensive disorders in pregnancy admitted at Nelson Mandela Academic Hospital

- Sabona, Ncumisa

Authors: Sabona, Ncumisa
Date: 2023-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9868 , vital:74635
Description: Hypertensive disorders in pregnancy (HDP) are the world's second leading cause of maternal mortality and morbidity, with sub-Saharan Africa taking the lead. The prevalence of HDP in Africa is 10%, remarkably higher than the reported global range of 5.2-8%. This study aimed to determine the prevalence and associated risk factors of CT-confirmed neurological complications in patients managed at the labour ward at Nelson Mandela Academic Hospital (NMAH) over two years. Methodology: A retrospective cross-sectional study was conducted on obstetric patients with clinical files at NMAH from January 2018 to December 2020. We tracked and merged hospital admission data and radiological (brain CT) findings in patients managed for HDP at the labour ward at NMAH within the specified period. Descriptive analysis, bivariate and multivariate logistic regression analysis was performed to identify associated clinical risk predictors of neurological complications. Major findings: Of the 5119 patients with HDP, 153 underwent CT scans. Our study found that 78.2% of the scanned patients with HDP were between 18 and 34 years old. Patients younger than 18 years accounted for 10% of the 154 patients who underwent CT-scan. We found that 81.1% had abnormal CT-brain findings, while 18.9% were normal. The most common abnormal finding was posterior reversible encephalopathy syndrome (PRES) (25.1%), followed by cytotoxic oedema (16,5%), neurocysticercosis (15.1%), and dural sinus thrombosis (7.9%). The most common neurological findings on admission were headache (82%), low GCS (60.1%), fits (55.6%), blindness (28.8%), and focal signs (11.5%). In addition, the following risk predictors were statistically associated with PRES: post-partum onset ( aOR=6.26,95% CI 1.02-38.83, p-value0.049 ), blindness (aOR=3.19, 95% CI; 1.07-9.59, p=0.038) and fits (aOR=0.20, 95% CI: 0.64-0.63, p-value=0.006. Recommendations and clinical implications: The most common radiological finding among obstetric patients with HDP in this study is PRES. The most significant risk predictors for PRES are the post-partum onset of symptoms and blindness. As PRES is | 3 associated with significant morbidity and mortality, vigilance and aggressive management should be continued and include the post-partum period. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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Date Issued: 2023-00

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Prevalence and Risk Factors of Traumatic Lumbar Puncture in Children at Nelson Mandela Central Hospital, Mthatha, Eastern Cape Province, South Africa

- Ghu, Pumza

Authors: Ghu, Pumza
Date: 2023-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9879 , vital:74636
Description: Traumatic lumbar puncture signals improper procedural and proceduralist factors working on existing patient attributes. Occurrence is very common though believed to be overestimated and cut-off definitions are vague. Complications that follow incurs economic implications to the hospital setting due to high admission rate, long hospital stay and unnecessary use of antibiotics. None of these concepts around this topic is known in the present setting thus necessitating this research. The findings thereof would cause a fundamental change in the manner in which this procedure is performed in the present setting. Aim To determine the prevalence and risk factors of traumatic lumbar punctures, with the secondary goal of developing a protocol for performing appropriate lumbar punctures in order to reduce the rate of traumatic lumbar punctures. Methods An analytical cross-sectional data using retrospective data of 82 lumbar punctures performed over a four (4) month period from March to June 2022 at the paediatric emergency department of Nelson Mandela Central Hospital. Results Demographics characteristics: The median age was two (2) years (IQR = 0.83 – 3.35 years) and the highest proportion (53.66%) was observed for the age group two years and younger. Males constituted more than half (63.41%) of the population. Clinical features: Most of the children presented with seizures (56.10%) and high fever (46.34%). The top three conditions diagnosed were febrile seizures (40.24%), meningitis (17.07%) and acute gastroenteritis (9.78%). More females (20% p=0.047) suffered from acute gastroenteritis than males (3.8%). , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2023
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Date Issued: 2023-00

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Factors leading to Complications following Traditional Male Circumcision among Initiates reporting at Mthatha Regional Hospital, South Africa

- Zokwe, Mendi Prince

Authors: Zokwe, Mendi Prince
Date: 2022-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9923 , vital:74643
Description: Traditional male circumcision, a prestigious practice, and pathway to a sense of belonging and manhood among AmaXhosa has left unforgettable pains in the same society that admires it. The pains are due to the irreversible aftermaths such as death and loss of the penis that often accompanies it. Anecdotal evidence suggests that an increasing number of AmaXhosa males though still prefer TMC, only partakes in the cultural lessons at the initiation schools then go for medical male circumcision. But, who is to be blamed? The news reports of the deaths following traditional male circumcision (TMC) are heard and the fears for sure are real. This study was carried out to provide evidence-based knowledge on the prevalence of complications following TMC and factors that lead to such complications. Aim: To find out the types of complications and medical outcomes following TMC among initiates reporting at Mthatha Regional Hospital. Method: A retrospective study design was used. The study population included 23 initiates who sought medical intervention at Mthatha Regional Hospital from June to December 2018. The variables of interest were collected from the admission records and analysed. Results: The mean age of participants was 18.5 years (standard deviation = 1.4 years). The majority (65.2%) of the participants were in the age group 18-21 year, were circumcised in summer (52.2%), waited for 10-20 days before seeking medical intervention (47.8%), and were admitted in the male surgical ward (69.6%). xiv The mean and standard deviation of length of hospital stay was 22.2±20.3 days. During hospitalisation, antibiotics were given to 33.3% and wound dressing to 60.5%. Other medico-surgical interventions wee rehydration therapy (28.1%), analgesics (26.3%), penile reconstruction with a skin graft (23.7%), re-circumcised (5.3%) or had a dorsal slit (5.3%). Grade 3 septic circumcision was the most prevalent (43.5%) among the initiates and 26.1% had Grade 4 septic circumcision. The three main factors leading to TMC-related complications were wound sepsis (32.4%), dehydration (21.1%), and septic shock (12.7%). No variables were associated with TMC complications in the study population. Most (78.3%) of them were treated and discharged. Two (8.7%) participants died, one from septic shock and the other from severe dehydration. Though 82.6% were alive with no deformity at discharge, 4.8% had an artificial penis and another 4.8 percent loss of the penis. Conclusion: Complications following TMC are real. Severe septic complications were common following TMC. There is a need to explore how to transform the harmful aspects of the initiation ritual while promoting the positive ones. There is a need to also determine possible ways of interaction and partnership between traditional leadership and the Department of Health. , Thesis (Masters) -- Faculty of Medicine and Health Sciences, 2022
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Date Issued: 2022-00

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perception of male university students regarding the relationshinship between masculinity and gender based violence: A health promotion enquiry

- Fosi, Mziwabantu

Authors: Fosi, Mziwabantu
Date: 2022-00
Subjects: Medicine
Language: English
Type: Masters theses , text
Identifier: http://hdl.handle.net/11260/9637 , vital:74606
Description: Globally, Gender Based Violence (GBV) refers to harmful act directed at an individual based on their gender, power and positions within a given society. According to Statistics South Africa report 2021, one in five women (21%) had experienced physical violence by a partner. GBV is rooted in gender disparities, the abuse of power and harmful norms. Both men and women to some extent experience GBV and suffer from discrimination if they deviate from societal expectations of masculinities. Men’s violence, whether directed at women, people with diverse sexual orientations and gender identities or other men, is inextricably linked to hegemonic and toxic masculinity. The aim of the study was to investigate perception of male university students regarding the relationship between masculinity and gender-based violence. This study adopted qualitative phenomenological approach. The research was conducted at WSU, Mthatha campus, Eastern Cape, South Africa. Purposive sampling was used to select 24 participants. Semi-structured, in-depth, face to face interviews were used to gather data. The collected qualitative data was analysed utilizing thematic analysis method with the assistance of NVIVO software. Ten overarching themes were identified using thematic method and reported and categorised as factors associated with GBV and suggested action plans to fight against GBV and these includes: (1) Gender discrimination as a contributing factor towards GBV; (2) Impact of association on GBV; (3) Perception of males on how the law handles GBV cases; (4) Dark figures and unreported cases escalate GBV (5) Influence of materialistic things on “blesser/blesse” relationship; (6) Social norms or community common practices misconception that still promote gender differences; (7) Poor decision making based on wrong assumptions about what other people thinks or do (8) Sexual education gaps on deciding when to start sex in a relationship; (9) Suggested preventative actions to prevent GBV. This study concluded with discussion and recommendations of further study to support participants recommendations for continuous health education and strengthen increase on youth friendly GBV programs to empower males in the university and further suggested development of comprehensive health promotion strategies to reduce gender-based violence. This study concluded with discussions and recommendations of the required comprehensive health promotion program to curb GBV and as well suggestions for further research studies to focus on developing health promotion intervention to prevent causes of GBV. , Thesis (Masters) -- Faculty of medicine and Health Sciences, 2022
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Date Issued: 2022-00

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