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ABSTRACT Pulmonary Tuberculosis (PTB) rates in Kwa Zulu Natal (KZN) is amongst the highest in the South Africa and is often associated with Human Immunodeficiency Virus (HIV) co-infection. Bronchial Artery Embolisation (BAE) is an expensive, time consuming procedure requiring operator skill and is accompanied by risk to both patient and operator. Aim: To investigate the impact of HIV infection when superimposed on PTB (active or sequelae) on the success of BAE. Method: A retrospective cross sectional study with descriptive and analytical components of the BAE procedure between January 2006 and December 2007 was performed on sequential BAE studies. These were analyzed for procedural and clinical outcome and reasons for procedural failure were investigated. The impact of CD4 level on procedural and clinical failure was investigated for a subset of cases. Cases were included if they presented with massive or life threatening haemoptysis with a diagnosis of previous or active PTB (made clinically, radiologically or microbiologically) in whom HIV status is known and where the clinician assessed a need for BAE, but excluded any third or more attempt at the procedure for that patient. Results: The final sample size after exclusion of 91 cases is 107. Each attempt at BAE was viewed as an individual case. The study population is made up of 74 HIV positive and 33 HIV negative cases. The median CD4 level is 176 cells / microlitre. Statistically, procedural success does not imply clinically successful outcome.HIV status does not correlate significantly with clinical or procedural results of BAE.CD4 level does not correlate significantly with clinical or procedural results of BAE. There is no technical reason of statistical significance that impacts on the success of the procedure when correlated with HIV status. These include being unable to select, unable to subselect, unable to engage securely, reflux, presence of fistulae and the presence of spinal feeder arteries. The complication rate is not statistically significant when correlated with HIV status. The differences in follow up of clinically unsuccessful cases were not significant when correlated with HIV status. On imaging, all cases demonstrated pathology. No particular zone is significant when correlated with HIV status. The most common finding is parenchymal architectural distortion followed closely by features of active tuberculous infection and no statistical significance is attributed to either when correlated with HIV status. The detection of lymphadenopathy is noted in 19.1% of HIV positive cases and 42.4% of HIV negative cases, and is the only feature of significance when correlated with HIV status. Interpretation: Coinfection with HIV does not have an impact on the success of BAE in patients with active or sequelae PTB who present with massive or life threatening haemoptysis. The rate of technical failure of the procedure suggests that this needs to be performed by persons that are adequately trained. Technical success does not imply clinical success but this finding was not statistically significant when correlated with HIV status. Re-evaluation of the procedure technique and improvements in local practice may produce results that correlate better with international standards. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

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In 2010, the Royal College of Radiologists introduced workplace-based assessments to the postgraduate training pathway for clinical radiologists in the UK. Whilst the system served the purpose of contributing to high-stakes annual judgements about radiology trainees’ progression into subsequent years of training, it was primarily intended to be formative. This study was prompted by an interest in whether the new system fulfilled this formative role. Data collection and analysis spanned the first three years of the new system and followed a multi-methods approach. Descriptive statistical analysis was used to explore important parameters such as the timing and number of assessments undertaken by trainees and assessors. Using the literature and an iterative analysis of a large sample of trainee data, a coding framework for categories of feedback quality enabled assessors’ written comments to be explored using deductive and inductive qualitative analysis, with inferential statistical analysis of coded assessor feedback statements. For example, Ragin’s (1987, 2000, 2008) qualitative comparative analysis, QCA, was used to explore whether the assessments met necessary and/or sufficient conditions for high quality feedback. Pairs of assessor-trainee feedback comments were also analysed to establish whether any dialogic feedback interactions occurred. The study presents evidence that despite its intentions, the new system is generally failing to meet its primary, formative aim. As a consequence, the influence of negative washback on assessment practice was reflected in a number of findings. For example, there was evidence of trainees taking an instrumental approach to the assessments, undertaking only the prescribed minimum of assessments or completing assessments in the later stages of placements. Combined with evidence of retrospective assessment, i.e. after completion of the placements, the observed patterns of assessment over the three years are consistent with a box-ticking approach. This study explores the contextual policy and practice dimensions underpinning these and related findings and discusses the implications and recommendations for future arrangements.

<p>It has been observed that the radiation response of a cell line may positively correlate with baseline levels of reactive oxygen species (ROS) generation, which is facilitated, in part, by the function ofNADPH oxidase membrane proteins. Apocynin has been successfully used to inhibit ROS generation via NADPH oxidase for other uses. Here, the effectiveness of apocynin to improve sensitivity to radiation in the MATLyLu cell line was examined. MATLyLu-implanted Cop/Hsd rats undergoing lOGy/SfX radiation treatment demonstrated improved tumour control, as measured by survival time (to predetennined endpoints), when given apocynin orally throughout their radiation treatment, but not when given apocynin only before radiation. Rats given apocynin without radiation did not demonstrate improved survival over controls. MA TLyLu cells given apocynin in vitro, however, did not demonstrate improved response to radiation or a reduction in baseline ROS production on a per cell basis, and apocynin was found to inhibit growth when given alone. These contradictory in vivo and in vitro findings may be explained by certain proposed mechanisms of action for apocynin which requires it to be first synthesized into its dimer, diapocynin, before it will inhibit NADPH oxidase, and this synthesis may occur during ingestion. Further investigations with diapocynin and the MATLyLu cell line are required. Therefore the mechanism is uncertain, but it was concluded that apocynin and radiation administered together in vivo improves radiation response as compared to either treatment alone.</p> / Master of Science (MS)