Submitted in fulfillment of the requirements for Masters in Technology: Clinical Technology Durban University of Technology, 2014. / Background The metabolic syndrome (MS) is a clustering of cardiovascular (CV) risk factors and is noted to be increasing globally. Several studies have shown a link between the MS, chronic kidney disease (CKD) and end-stage renal disease (ESRD) possibly through a process of inflammation. Dialysis therapy may increase inflammation and could worsen MS and increase CV risk and diseases in ESRD patients. ESRD has been associated with increased CV disease in dialysis patients. Although there have been several reports on the prevalence of MS from the general population as well as from other specific groups, there are no known studies in South Africa on the prevalence of MS in ESRD patients on chronic dialysis therapy. The prevalence and risk factors for CV diseases are also currently unknown in the dialysis population in Cape Town. Aim The aim of this study was to determine the prevalence of MS in the dialysis population at Groote Schuur Hospital in Cape Town, to determine the effect of dialysis on MS and its traits and to evaluate CV risk in this patient group. Methods A total of 143 prevalent chronic dialysis patients who consented were used for this study. Demographic and relevant clinical details including systolic and diastolic blood pressures, waist and hip circumference and body mass index were obtained from all patients. Blood was drawn in the fasting state for assessment of full lipogram, glucose, ferritin, iron, calcium and phosphate. The metabolic syndrome was defined using the Adult Treatment Panel III (ATPIII) criteria. To determine the impact of dialysis on MS and its traits in our patients, only incident (new) patients starting dialysis were followed up for assessment of MS traits at timed intervals (at baseline, at 6 months and at 12 months) following initiation of chronic dialysis. To evaluate CV risk in this study, common traditional CV risk factors were assessed and were stratified according to number of risk factors as low ( ≤ 1), moderate (2 – 4) or high ( ≥ 4). Relevant statistical methods were used for analysis. Results Of the 143 patients in the study, 67.8% were on haemodialysis (HD) and 32.2% were on peritoneal dialysis (PD). The mean age of all the patients was 38.5 ± 10.4 years. The MS was present in 37.1% of all patients (PD – 52.2%, HD 29.9%; p = 0.015) and the frequency of increased waist circumference and hypertriglyceridaemia were significantly higher in PD patients than HD patients (p < 0.0001 and p = 0.006 respectively). Hypertension was the most prevalent MS trait in all the patients (89.5%) and was also the most prevalent trait in males (92.4%), females (85.9%) and in HD and PD patients (91.3% and 88.7% respectively). The frequency of CV risk was 3.5, 75.5 and 21.0% respectively for low, moderate and high CV risk and there was no difference in CV risk in HD and PD patients. High CV risk correlated with body mass index (BMI), increased waist circumference (WC), hyperphosphataemia, raised calcium – phosphate product, raised parathyroid hormone (PTH) and elevated C-reactive protein (p < 0.05). There was no significant change in MS prevalence or prevalence of MS traits in patients who were followed up irrespective of gender or modality of dialysis (p > 0.05) Conclusion The prevalence of the MS is higher in dialysis patients compared to the general population in South Africa and among dialysis patients, the prevalence is higher in PD than HD patients. Patients with MS have significantly higher CV risk factors than those without MS. Although dialysis therapy appear to have no significant effects on the prevalence of the MS or its traits in this study, the increased prevalence of the MS and CV risk factors may be related to the underlying disease process associated with ESRD. There is therefore an urgent need to identify and treat dialysis patients with the MS in order to reduce CV morbidity and mortality in this group of patients. Further prolonged prospective studies are needed to clarify the impact of dialysis on the MS and its traits in the ESRD population.

Submitted in fulfillment of the Degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2011. / Background: Idiopathic dilated cardiomyopathy (IDC) is a primary myocardial disease of unknown cause characterized by left ventricular or biventricular dilatation and impaired myocardial contractility. Idiopathic dilated cardiomyopathy (IDC) is the second commonest cause of heart failure in Africa. Some patients with idiopathic dilated cardiomyopathy present with significant pulmonary hypertension (PHT) which maybe out of keeping with the usual degree of PHT seen in patients with this disorder. Methods and Material: This is a prospective and longitudinal follow-up study of 66 patients with IDC who were evaluated after satisfying the inclusion and exclusion criteria of this study. The clinical evaluation of each patient included a complete medical history, physical examination, 12 lead electrocardiogram, 2D-echocardiography, continuous wave (CW), pulsed wave (PW), and tissue Doppler imaging (TDI). Results: The mean age of all patients was 48.5 ± 12.8, with 39/66 (59.1%) patients being male. The prevalence of pulmonary arterial hypertension (PAH) was documented in 47 patients (71.2%, 95% CI: 59 - 83%). Mean left ventricular ejection fraction (LVEF) was 25.3 ± 8.8%, and mean left atrial volume index (LA volume) was 44.5±19.8 ml/m2. Mitral regurgitation (MR) occurred in 56/66 (84.8%) of patients with moderate or severe MR detected in 60.6% of all cases of IDC. The presence of a tricuspid regurgitant jet was found in 56/66 (84.9%), with (95% CI: 75 -93%). Right ventricular dilatation was found in 65/66 (98.5%), with (95% CI: 95 - 101%). ii Age, LA volume, LVEF and MR were included into a multivariate logistic regression model to predict PAH. Only MR presence was independently associated with PAH adjusted (OR 6.02, 95% CI: 1.15- 31.47) (p= 0.03). Conclusion: The study has shown that there is a significant prevalence of pulmonary arterial hypertension (PAH), right heart involvement and tricuspid regurgitant jet in IDC patients. The present study also showed that in patients with dilated cardiomyopathy, the degree of mitral regurgitation was a good predictor of PAH.

Submitted in partial fulfillment of the requirements for the degree of Doctor In Technology (Clinical Technology), Durban University of Technology, Durban, South Africa, 2016. / Erythropoietin (EPO) is widely used in patients with chronic renal failure and is a necessity. However, due to the cost implications and the medical complications in our population it is imperative to review the factors affecting the process of erythropoiesis and the analysis of cell proliferation and cell viability in the bioassay. Complications such as hypertension and risk of worsening a malignancy cannot be ignored. We had previously analysed variations of erythropoietin levels in haemodialysis patients over a six month period. This study aims to evaluate erythropoiesis in conjunction with various laboratory, demographic, clinical parameters and inflammatory markers, in the population of haemodialysis patients. EPO, antibody level and antibody activity were analysed in the population groups as EPO responsive and EPO sensitive patients. This is a prospective, experimental and controlled study. Fifty nine patients were randomly selected from haemodialysis units of Addington and King Edward VIII Hospitals following an informed consent and 15 healthy individuals were also selected as controls. Demographic parameters (age, sex), clinical parameters (weight, height, skin folding, EPO doses and blood pressures (BP) were recorded. Pre-dialysis serum was used to measure laboratory markers (haemoglobin, transferrin, ferritin, albumin, ESR, C reactive protein, creatinine and urea). EPO levels and antibody levels were measured by ELISA, the optical density of each well was determined within fifteen minutes using the microplate reader set at 450 nm. All results were statistically analysed using SPSS statistical package version 21 (IBMR). Patients requiring very high doses of EPO to reach Hb of 11g/dL, and they remained anaemic after at least three months of adequate EPO doses were considered to be EPO resistant. Those who responded to the usual EPO doses were labelled EPO sensitive. The bioassay was used to quantify cell proliferation and cell viability in the presence of EPO. The UT 7 cells were cultured in medium, in the presence of serum from the EPO resistant, EPO sensitive patients and the healthy, control subjects. Luminescence was read with the Glorunner Microplate Luminometer and was recorded in relative light units (RLU). The analysis revealed: a non-significant positive correlation between haemoglobin and erythropoietin levels. However, a strong negative correlation was found between CRP and albumin level (R= -0.591; (p=0.001), which was not significant. No correlation was found between haemoglobin or erythropoietin levels and CRP or albumin. There was a positive correlation with systolic and diastolic blood pressures and mean arterial pressures which was statistically significant (p <0.05). EPO dosages and Hb levels were correlated significantly (p < 0.05). No correlation of EPO levels and Hb; age and Hb was found to be significant (p = 0.08). The UT 7 cells cultured in serum in medium alone with RHuEPO containing cells were statistically significant (p <0.01)). Reduction of ATP stimulation between medium and serum was observed. However, mean arterial pressures had a significant association with EPO resistance (p = 0.041) odd ratio- 1.066. In conclusion, EPO level is not a useful tool for the monitoring of its use as it does not correlate with EPO goal of red blood production in our patients. The neutralizing antibodies did not correlate with any of our variables contributing to erythropoiesis, and are therefore not confirmed as playing a major role in erythropoiesis. From the analysis of our results the key contributing factors of EPO doses, malnutrition and age were more significant in erythropoiesis. However the higher doses of EPO significantly increased the blood pressures and the mean arterial pressures (MAP). The analysis of the bioassay showed lack of difference between EPO responsive and EPO sensitive patients. This observation warrants further studies to clarify the role of serum of haemodialysis patients in erythropoiesis. / D

Background: Cannabis among patients admitted in psychiatric units is higher than the general population and this has been shown in various countries where studies on cannabis use have been undertaken. Such an observation has been made by psychiatrists in South Africa and the association between cannabis use and psychotic presentation among these patients has also been observed. Cannabis use by patients with severe or chronic medical illnesses to ameliorate the symptoms of such illnesses has been documented in the literature. A study to explore use of cannabis among psychiatric inpatients as well as medical patients was undertaken. Purpose: The purpose of this study was to firstly determine the prevalence of cannabis use in psychiatric patients admitted to an acute admissions unit in King Edward VIII Hospital and to correlate it with the psychiatric diagnosis. Secondly, it was to compare the cannabis use in psychiatric patients admitted to an acute admissions unit to patients admitted in a medical ward at King Edward VIII Hospital. Thirdly, to assess self reporting of cannabis use by psychiatric and medical patients. Methods: A case control study was conducted at King Edward VIII Hospital, Durban, where cannabis use among 64 subjects included in the study admitted in a psychiatric ward was compared with a control group of 63 control subjects admitted in a medical ward. Both groups were tested for urinary cannabinoids and a questionnaire was filled. The questionnaire contained demographic details as well as a question on use of substances including cannabis. Results: 17 subjects (26.6%) in the study group tested positive for urinary cannabinoids and 2 subjects (3.2%) in the control group tested positive. Cannabis use was significantly higher among males when compared to females in both the study group and the control group. Only 7 subjects in the study group reported cannabis use and out of those 7 subjects, 4 subjects tested positive for urinary cannabinoids. The commonest diagnosis among the study group subjects were the psychotic disorders and schizophrenia being the most common psychotic disorder. Conclusion: Cannabis use is significantly higher among psychiatric patients as compared to medical patients and it is probably higher than in the general population. Self reporting of cannabis use among psychiatric patients is low and unreliable and psychiatrists treating these patients must continue to use objective measures such as objective testing as well as collateral information to determine such use. In this study most subjects who tested positive for urine cannabis were likely to have a psychotic disorder and tended to be of younger age groups. The low prevalence of cannabis use in the control group makes it unlikely that there was a significant number of subjects in this group who were using cannabis for medicinal purposes. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

M.Cur. (Psychiatric Nursing) / With modern psychiatric treatment, patients usually come into contact with as many as six different team members. These team members have their own particular treatment plans for patients. This has prompted the question: "How do patients experience their treatment by the interprofessional health team?" The aims of this study are as follows: • To explore psychiatric patients' experiences of their treatment by the interprofessional health team in a particular private psychiatric clinic. • To set basic guidelines which will promote the optimisation of treatment of psychiatric patients by the interprofessional health team, in order to prevent the aggravation of mental illness, emphasising the contribution of the psychiatric nurse.

M.A. (Clinical Psychology) / The focus of this study centres on the dynamics of psychiatric female acute locked ward. The aim of the thesis is to offer an additional view of a psychiatric locked ward,with the potential of opening new avenues of functioning or change. A systemic theoretical model is utilised in an attempt to reach such an understanding/perspective. The casestudy method was adopted which involved clinical observation by an intern clinical psychologist. The thesis demonstrated that individual behaviour and/or interaction between individuals on a psychiatric locked ward may be further related to the context or unit as a whole. In other words, understanding/perception may be extended to a further level of interpretation, namely, at a systemic or feedback of feedback level.

One of the challenges facing health care professionals today is the phenomenon of rendering care to children who have been orphaned in the AIDS pandemic. The number of AIDS orphans in South Africa has risen out of all proportion and is causing existing health and social structures to become stretched in providing care to this vulnerable population of children. The objectives of this study are to explore and to describe the lived experience of children living in a township who have become AIDS orphans and to develop broad guidelines for Primary Health Care Nurses (PHCN’s), related professionals and partners involved in the care of AIDS orphans living in a township. The theoretical grounding of this study is found in Kotze’s Theory on Nursing Accompaniment (Kotzé, 1998:3). The proposed research design was based upon a qualitative study using an explorative, descriptive, contextual and phenomenological strategy of inquiry. Data was collected by means of in-depth interviews from a purposively selected sample and then analysed using the steps of qualitative data analysis proposed by Tesch (in Creswell, 1994). Guba’s model was used to assess the trustworthiness of the qualitative data. Based upon the findings, guidelines were developed to assist PHCN’s related professionals and partners involved in the care of AIDS orphans living in a township. Through this study the goal of the researcher was to give a voice to AIDS orphans living in a township and to represent accurately their lived experience.

Ph.D. (Psychology) / In this study the illness behavior of people with a life threatening illness was described and the relationship between stress, affect and illness behavior investigated. An overview of the literature shows that the illness behavior patients exhibit is and should be an important consideration in the diagnosis of illness and treatment of patients. This is evident in reports of a high amount of ill people who do not receive treatment and the high amount of patients who seek treatment for minor ailments. It is further evident in the light of findings that illness behavior does not always accurately represent the physical disfunction and that it may even be present in :t- the absence of a physical disfunction. The paucity of research on the illness behavior of specific patient groups, and of information on the relative effects of physical versus psychological factors on illness behavior, indicate a void in the literature. The present study investigates this relationship in a group of patients with a life threatening illness. In the first phase of the study 15 kidney transplant patients were compared to themselves, under normal conditions and conditions of stress, regarding affect, the experiencing of stress and the reporting of physical symptoms. In the second phase of the study 15 kidney transplant patients were compared to 15 patients with acute but minor ailments regarding the reporting of physical symptoms, affect, the experiencing of stress and the psychosocial impact of the illness.

A research project submitted in fulfilment of the requirements for the degree of Master of Arts in Psychology through the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2016 / Background Chronic Kidney Disease (CKD) is a reality faced by many around the world. There has been much physiological study around factors associated with CKD, as well as many studies surrounding the psychosocial impacts of the disease, with relatively less attention given to neuropsychological effects the disease can have on sufferers. This paper investigates the cognitive impacts as well as psychological impacts simultaneously, impacting on sufferers of End Stage Kidney Disease (ESKD). Methods Sixteen medically stable patients aged (M = 40.56, SD = 12.52) years with ESKD, were investigated. Eight of the patients were evaluated before and after six months of successful kidney transplant, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which assessed immediate memory, visuospatial / constructional, language, and attention. They were also tested on a brief symptom inventory (BSI 18) to assess depression and anxiety in these patients. A further eight who remained on dialysis, and had not undergone renal transplant were evaluated in the same manner for comparative purposes. Results Between-group comparisons showed a statistically significant improvement in overall cognitive functioning, as well as in the specific cognitive domains of visuospatial / constructional, language and attention for participants who had undergone renal transplant surgery compared to their counterparts who had not. Results also found that there were no statistically significant differences between the levels of anxiety experienced between patients in the two groups. When assessing the differences in cognitive improvement within the transplant patient group before and after transplant, improvement in the delayed memory function of renal transplant patients post-transplant was found. Conclusion These data show improvements in delayed memory function of patients having undergone renal transplant therapy, while also highlighting a continued decline of overall cognitive functioning in patients remaining on hemodialysis therapy. / GR2017

Thesis (MCur)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: The Minister of Health identified tuberculosis as a National Health priority since the incidence of tuberculosis in South Africa is increasing. The researcher practiced as a community health nurse for seven years and was actively involved with the community. It was experienced that irrespective well qualified nursing staff and accessible and available health services, there was an increase in tuberculosis in the Western Cape. A non-experimental, descriptive, explorative study was conducted in a selected community in the Western Cape to address the research problem: What are the knowledge, perceptions, attitudes and treatment practices of tuberculosis patients; their resources for support; and community leaders? Structured interviews were held with 50 patients randomly selected from patients attending the health clinic. Focus interviews were held with community leaders purposefully selected for the research. A modified Photovoice technique was also applied to the patients where they had to draw a picture of their feelings when diagnosed with tuberculosis and the impact of the disease on themselves and their environment. The findings revealed a lack of information, major stigmatization of the disease, and many patients not adhering to their treatment regimes. Most of the patients had a negative idea of tuberculosis indicating that it always causes death. Community leaders were very committed to assist in combating the problems in their community. The findings indicated that health staff can be of more help to the patient although they were generally satisfied with the care they received. Recommendations include that health promotion programmes should be planned in co-operation with community members to ensure that programmes are appropriate and address the real needs of the community. / AFRIKAANSE OPSOMMING: Die Minister van Gesondheid het tuberkulose as 'n Nasionale Gesondheidsprioriteit geïdentifiseer aangesien daar 'n toename in die insidensie van tuberkulose in Suid-Afrika is. Die navorser het vir sewe jaar as 'n gemeenskapsverpleegkundige gepraktiseer en was aktief betrokke by die gemeenskap. Die navorser het gevind dat daar 'n toename in tuberkulose in die Wes-Kaap was ten spyte van goed gekwalifiseerde verpleegpersoneel asook toeganklike en beskikbare gesondheidsdienste. 'n Nie-eksperimentele, beskrywende, verkennende studie is gedoen op 'n geselekteerde gemeenskap in die Wes-Kaap om die navorsingsprobleem aan te spreek: Wat is die kennis, persepsies, houdings en behandelingspraktyke van tuberkulosepasiënte, hulle ondersteuningsbronne en gemeenskapsleiers? Gestruktureerde onderhoude is met 50 pasiënte gevoer wat ewekansig geselekteer is uit pasiënte wat die kliniek besoek het. Fokusonderhoude is met gemeenskapsleiers gevoer wat doelbewus geselekteer is. 'n Gemodifiseerde photo voice tegniek is ook toegepas waar pasiënte 'n skets moes maak van hulle gevoelens toe hulle die eerste keer met tuberkulose gediagnoseer is, asook die impak wat die siekte op hulself en hulomgewing het. Die bevindinge het gewys dat daar 'n gebrek aan kennis was, dat daar 'n grootskaalse stigmatisering van die siekte was en dat baie pasiënte nie by hulle behandelingsregimens hou nie. Die meeste van die pasiënte het 'n negatiewe idee van tuberkulose en het aangedui dat dit altyd die dood veroorsaak. Gemeenskapsleiers was baie hulpvaardig en alhoewel die meeste pasiënte aangedui het dat hulle tevrede was met die sorg wat hulle ontvang het, was daar tog aanduidings dat gesondheidspersoneel van meer hulp kan wees. Aanbevelings sluit in dat gesondheidsbevorderingsprogramme in samewerking met gemeenskapslede beplan moet word om te verseker dat die programme toepaslik is en die werklike behoeftes van die gemeenskap aanspreek.