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Dissertation submitted in partial compliance with the requirements for the Master's Diploma in Technology: Homoeopathy, Technikon Natal, 1994. / The purpose of the study was to determine the efficacy of simillimum treatment and Natrum muriaticum and Rhus toxicodendron on the treatment of recurrent cutaneous Herpes Simplex I with reference to patients response to treatment and patients perception of the effectiveness of treatment in order to determine the efficacy of the treatment methods in the management of recurrent Herpes Simplex I attacKS. Thirty one patients with recurrent cutaneous Herpes Simplex I were admitted to the study if they suffered from frequently recurring cutaneous Herpes Simplex lat least three times a year.Patients were recruited by means of advert ising in local newspapers, shoppi ng centres and libraries. Age group was 5-65 years. After an initial consultation including a case history and physical examination, a double-blind, random procedure ensured that the 31 patients were allocated to one of the two experimental groups.One group recei ved simillimum treatment and the other group received Natrum muriaticum and Rhus toxicodendron for a period of five months.Treatment only started at the beginning of a recurrent attaCK. At the time of recurrence details of the HSV llesion were obtained and a patient perception questionnaire / M

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Class of 2012 / Specific Aims: The primary aim of this study was to determine the time to appropriate therapy for all patients with candidemia and/or bacteriemia (due to either Enterococcus or Streptococcus species) during a one year period in relation to time of blood culture, time of Gram-stain result, time of PNA FISH species result, and time of final species determination result. The secondary and third aims were to compare the time to appropriate therapy based on clinician group that was notified of Gram-stain result and PNA FISH result and compare the time to appropriate therapy based on PNA FISH assay results reported during the day and night microbiology laboratory shifts. Methods: This Institutional Review Board approved project is a retrospective, chart review evaluation of the 24 hour/ 7 days a week use of PNA FISH assays with therapeutic interventions by infectious diseases pharmacists and physicians on patient outcome measures and time to appropriate therapy. All patients admitted to an academic medical center during a one year period (April 2010-March 2011) with either Enterococcus, Streptococcus, or Candida species isolated from blood were included. Main Results: A total of 168 subjects were identified with Candida species isolated from 31 subjects and Enterococcus/Streptococcus species isolated from blood in 137 subjects. Conclusions: While reporting conditions can affect interpretation and intervention rates, rapid species identification assays such as PNA FISH can be used by pharmacists to provide antimicrobial therapy recommendations based on the species identification and to decrease the time to appropriate antimicrobial therapy.

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Azole-resistance in Candida albicans is becoming common and is associated with the widespread prophylactic use of azoles. Resistance to one azole is usually associated with resistance to other structurally dissimilar azoles. C.albicans is also inherently resistant to a wide range of eukaryotic inhibitors such as cycloheximide and gentamycin. Certain studies have shown that azole-resistance in some strains of C.albicans is associated with alterations in the cell membrane. This project has sought to determine whether azole-resistance in C.albicans strain 3302 was due, at least in part, to a multidrug resistance mechanism. An assay was developed using the fluorescent dye Rh123 to measure P-glycoprotein like activity. Active efflux of Rh123 has been shown to correlate with P-glycoprotein activity in a number of organisms. Results from this assay suggest that an energy-dependent efflux mechanism for Rh123 is present in azole-resistant strain 3302 but not in azole-sensitive strain 3153. The P-glycoprotein inhibitor, reserpine, inhibited Rh123 efflux. However, azoles did not appear to compete with Rh123 for efflux in the azole-resistant strain 3302, suggesting that azole-resistance in this strain is not mediated by a P-glycoprotein like mechanism. Southern analysis showed that sequences homologous to MDR genes existed in C.albicans. A PCR strategy was used to clone gene fragments containing the Walker motif which is found in MDR genes.

A Research Report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the degree of Master of Medicine in the branch of Internal Medicine. / Background. Primary immune thrombocytopenia (ITP) is a rare disease causing significant morbidity. South Africa has a high prevalence of HIV infection which may be associated with immune thrombocytopenia. There is a paucity of clinical, management and outcome data on immune thrombocytopenia in the local South African setting. Objectives. To compare the demographics, clinical presentation, management and treatment outcomes of immune thrombocytopenia in HIV positive and HIV negative patients and to compare the treatment outcomes with established international guidelines. Methods. This was a retrospective comparative study conducted at Charlotte Maxeke Academic Hospital, Johannesburg, from January 2003 to December 2014. Adults (≥ 18 years) with confirmed diagnosis of ITP were included. Hospital charts of eligible patients were reviewed to extract data on their clinical presentation, diagnosis, HIV status, treatment and outcomes. A comparison was made between HIV positive and negative patients. Descriptive analysis was performed on the data and results were presented graphically. The P-value of <0.05 was regarded as significant. Results. A total of 250 patients were screened, of which 154 patients met eligibility criteria for the study. 91% of the patients were female, 58% were HIV negative and 42% were HIV positive. The 25-35 year age-group comprised the highest percentage of HIV positive patients (42%). There was no difference in the presentation of symptoms between HIV positive and HIV negative patients. Response to first line therapy was not significantly different between the HIV positive and HIV negative patients (p=0.1370). The patients who went on second line therapy, showed excellent response with approximately 80% reaching complete response. There was no difference in HIV positive and HIV negative groups. Conclusion. In a large central hospital in a high HIV prevalence setting, there is no significant difference between HIV positive and HIV negative patients in terms of clinical presentation, treatment and outcomes in confirmed patients with immune thrombocytopenia. The management of ITP at the CMJAH is comparable to that of published guidelines. / MT2017

Thesis (M.Med. (Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Background Cryptococcus is a life-threatening opportunistic infection; data is limited regarding early infection. Treatment of cryptococcal antigenaemia may impact on disease progression. Screening those most at risk for cryptococcal antigenaemia is necessary to be cost effective. The prevalence of cryptococcal antigenaemia in patients hospitalised with community acquired pneumonia (CAP) at Chris Hani Baragwanath Academic Hospital (CHBAH) was evaluated. Methods 200 patients admitted to CHBAH with presumed CAP were enrolled. Clinical and laboratory data were collected and a Cryptococcal Lateral Flow Immunoassay was done on whole blood. Results Of the 200 patients, 185 (92.5%) were HIV-infected. Amongst the HIV-infected group, the median CD4 cell count was 47 cells/mm3 and 111 subjects (60%) had a CD4 cell count < 100 cells/mm3. The prevalence of cryptococcal antigenaemia was 0.5% (CI 0.01-2.75). Conclusion The prevalence of cryptococcal antigenaemia amongst inpatients with CAP was low. Routine screening of this group would not be cost-effective.