Bien que la spirométrie incitative (SI) face partie intégrante des soins périopératoires, son utilisation et impact chez les patients demeurent incertaines, particulièrement lorsqu’elle est initiée en préopératoire. Dans cette étude clinique randomisée prospective à simple insu, l'objectif primaire était de déterminer si un programme préopératoire d'exercice inspiratoire basé sur la SI avait un impact sur les complications pulmonaires après une chirurgie thoracique. Un total de 141 patients à risque de complications pulmonaires a été analysé, soit 72 dans le groupe SI + soins usuels et 69 dans le groupe soins usuels. L'incidence de complications pulmonaires était de 38,3%. Une diminution significative de l’atélectasie pulmonaire avec impact clinique a été observée chez le groupe SI + soins usuels en comparaison au groupe soins usuels (SI + soins usuels 9,7% vs soins usuels 23,2%, p = 0,031). L'impact semblait bénéficier davantage aux patients ayant eu une VATS ou lobectomie pulmonaire. Dans une analyse multivariée tenant compte des facteurs confondants, le groupe soins usuels développait plus d’atélectasie pulmonaire avec impact clinique que le groupe SI + soins usuels (OR 3,046, IC95% :1,108 - 8,372). L'incidence des autres complications pulmonaires était similaire entre les deux groupes. Le séjour hospitalier était de < 3 jours dans 34,7% du groupe SI + soins usuels et dans 20,3% du groupe soins usuels (p = 0,062). Donc, l'initiation de la spirométrie incitative en préopératoire chez les patients à risque de complications pulmonaires pourrait faire partie des stratégies de prévention utilisées en préhabilitation. / Although incentive spirometry (IS) is an integral part of perioperative care, its impact on pulmonary complications remains unclear, particularly when initiated preoperatively. In this randomized, single-blind prospective clinical study, the primary objective was to determine if a preoperative inspiratory exercise program based on IS had an impact on pulmonary complications after a thoracic surgery. A total of 141 patients at risk of pulmonary complications were analyzed, 72 in the IS + usual care group and 69 in the usual care group. In our study, the incidence of pulmonary complications was 38.3%. A significant decrease in pulmonary atelectasis with clinical impact was observed in the IS + usual care group compared to the usual care group (IS + usual care 9.7% vs usual care 23.2%, p = 0.031). The impact seemed to benefit patients who had a VATS or pulmonary lobectomy. In a multivariable analysis considering confounding factors, the usual care group developed more pulmonary atelectasis with clinical impact than the IS + usual care group (OR 3.046, 95%CI:1.108 - 8.372). The incidence of other pulmonary complications was similar between the two groups. The hospital stay was < 3 days in 34.7% of the IS + usual care group and in 20.3% of the usual care group (p = 0,062). In conclusion, the initiation of IS preoperatively in patients at risk of pulmonary complications could be part of the prevention strategies used in prehabilitation.

Chez l'humain, les cytochromes P450 possèdent un rôle d'importance dans l'élimination des médicaments. Il existe plusieurs facteurs physiopathologiques qui sont en mesure d'affecter leur expression et leur activité. La présente étude a pour but de mieux comprendre le rôle de l'obésité à risque et du diabète de type II sur l'activité et l'expression des enzymes de biotransformation de la sous-famille CYP3A chez notre modèle, le cobaye. Les résultats de la présente étude suggèrent que l'activité enzymatique des CYP3A hépatiques et intestinaux serait diminuée en présence de l'état physiopathologique du diabète du type II et en présence d'une obésité à risque. Par conséquent, une biotransformation des substrats de la sous-famille CYP3A abaissée pounait par ailleurs entraîner au niveau clinique une augmentation des effets pharmacologiques, l'apparition d'effets indésirables, voire de la toxicité.

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

This study examined the relationship between executive and psychosocial functioning in 45 children and adolescents age 6 to 17 years who had been treated for a brain tumor. Executive functioning deficits can profoundly impact an adult's ability to function successfully in life. The purpose of the study was to evaluate the potential impact of executive functioning deficits on the day-to-day functioning in a pediatric population. The domains of executive functioning assessed included cognitive flexibility, conceptual thinking, sustained attention, and response inhibition. Psychosocial functioning was assessed using both parent and child report. Several significant relationships were found for adolescents ages 15 and older, with effect sizes ranging from medium to large. In particular, cognitive flexibility and conceptual thinking were significantly related to parent report of depression and adaptive functioning. Fewer significant relationships with smaller effect sizes were found for younger children. The results may reflect the developmental emergence of executive functioning abilities and late effects of executive functioning deficits upon psychosocial functioning. The correlational design of this study precludes definitive statements regarding the temporal nature of the relationship. Additional research, including longitudinal research and replicatory studies, will be needed to further investigate the developmental consequences of executive functioning impairment.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

A quantitative, descriptive and cross sectional study was conducted in four (4) health care facilities to determine whether pregnant women attending antenatal care are aware of danger signs of obstetric complications. The objectives of the study were to assess awareness of danger signs of obstetric complications and to associate demographic and obstetric factors with awareness of danger signs of obstetric complications among pregnant women attending antenatal care in Eastern Wollega zone. Data was collected by means of structured questionnaire from 384 pregnant women attending antenatal care in the 4 health facilities and analysed using the Statistical Package for Social Sciences (SPSS) 16 computer program. The findings revealed that the proportion of women who were aware of danger signs of obstetric complications was inadequate. Recommendations were made in line with the research findings / Health Studies / Health Studies / M.A. (Public Health)

We present a case of a previously asymptomatic 63-year-old woman who presented with worsening dyspnoea for 3 weeks. Initial transthoracic and later transoesophageal echocardiography confirmed biventricular non-compaction cardiomyopathy and a large secundum atrial septal defect (ASD) measuring 1.4 cm. Additionally, there was a haemodynamically significant left to right shunt causing acute decompensated systolic heart failure. She eventually underwent closure of the septal defect using a AMPLATZER Septal Occluder device. Decision to close the defect was made as the left to right shunt was causing severe pulmonary hypertension and acute heart failure. Since most heart failure treatments involve lowering of the LV afterload there was consideration that this could cause right to left shunting and could cause an Eisenmenger physiology. Hence the AMPLATZER Septal Occluder device was placed to eliminate the shunt through the ASD. The ASD combined with the non-compaction posed significant treatment challenge in this case.

Although axillary artery injury occurs frequently with dislocations of the shoulder and fractures of the clavicle, it is rarely associated with fractures of the proximal humerus. If the axillary artery is damaged, prompt recognition and treatment are necessary to salvage the involved extremity.

Diabetes mellitus is a chronic disease affecting millions of people worldwide. The degenerative changes caused by diabetes can, however, be controlled through the correct treatment. The outcome of diabetes mellitus depends mainly on the patient's self-management. Health professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes for self-management. The purpose of this study was to identify diabetic patients and family members' knowledge and views about diabetes mellitus and its treatment regimen. A quantitative descriptive survey design was used. Questionnaires were used to collect data from a convenient sample of diabetic patients and family members. Data was analysed by a computer program called Statistical Package for Social Sciences. Findings revealed that patients and family members lack adequate knowledge on diabetes mellitus and its treatment. Recommendations regarding the required information and assistance to be given to diabetic patients and their family members were formulated. / Health Studies / (MA (Health Studies))

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: In recent years, HIV-associated cancers have proven to be the bane of our time, since HIV is decimating humanity across the globe, even in the twilight of the last century. Cancer rates continue to rise in developing countries, where 95% of the world’s HIV-infected population lives, yet less than 1% have access to antiretroviral therapy. HIV-infected individuals have a higher proclivity to develop cancers, mainly from immunosuppression. An understanding of the immunopathogenesis of HIV-related cancers (HRC) is therefore a major prerequisite for rationally developing and/or improving therapeutic strategies, developing immunotherapeutics and proplylatic vaccines. In this study, we explore the pathology of HIV-related cancer malignancies, taking into account the pathogenic mechanisms and their potential for improving the treatment of management of these malignancies especially in developing countries. We mathematically model the dynamics of malignant tumors in an HIV-free environment, investigate the impact of cancer malignancies on HIV-positive patients and explore the benefits of various therapeutic intervention strategies in the management of HIV-related cancers. We present two deterministic models of infectious diseases to implement these, and they were analysed. We use HIV-related lymphomas in the Western Cape of South Africa as a case study. We validated the proposed models using lymphoma incidence data from the Tygerberg Lymphoma Study Group (TLSG), Tygerberg Hospital, Western Cape, South Africa. We show that the increasing prevalence of HIV increases lymphoma cases, and thus, other HIV-related cancers. Our models also suggests that an increase in the roll-out of the HAART program can reduce the number of lymphoma cases in the nearest future, while it averts many deaths. Furthermore, the results indicate that a highly crucial factor to consider in the prognosis of the incidence of lymphoma (and other cancer types) in HIV-infected patients is their CD4 cell count, irrespective of whether the patient has developed an HRC or not.