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An evaluation of the efficacy of a homeopathic complex, Premenstron, in the treatment of premenstrual syndrome in terms of the patients' perceptionSarawan, Shanie January 2001 (has links)
Dissertation submitted in partial compliance with the Requirements for the Master's Degree in Technology: Homeopathy, Technikon Natal, 2001. / The purpose of this double -blind placebo-control1ed study was to evaluate the efficacy of a homeopathic complex, Premenstron\xAE, in the treatment of premenstrual syndrome in terms of the patients' perception of the efficacy of the treatment. Thirty-four patients were selected from volunteers who met the diagnostic criteria developed by Dalton (1984: 19). Of these patients thirty completed the study. These patients were divided into two groups according to simple random sampling. Data was collected at the Homeopathic Day Clinic at Technikon Natal. Half of the patients received a placebo and the other half received the homeopathic complex. Patients were treated over a period of approximately two months (three consultations ). The patients completed the Moos Menstrual Distress Questionnaire at each consultation. The questionnaire consists of 47 symptoms grouped into eight subscales. Results were analysed statistically using the Mann Whitney unpaired test (inter-group comparison) and the Wilcoxon's sign rank test (intra-group comparison). When the three questionnaires for each patient were compared, it was found that the placebo group did improve in the second consultation (P= 0.016) but the placebo effect did not last through to the third consultation. The treatment group / M
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Spinal manipulation in the chiropractic management of patellofemoral pain syndrome17 June 2009 (has links)
M.Tech.
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Clinical profile of patients presenting with acute coronary syndrome to the Ladysmith Provincial Hospital emergency departmentMumpi, Bonnard Ewanguam 22 April 2015 (has links)
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Sciences in Medicine (Emergency Medicine)
Johannesburg, 2014 / Background: Patients with acute coronary syndrome (ACS) may present with a wide range of symptoms that may easily be misdiagnosed.
Methods: This cross-sectional, hospital-based, descriptive, retrospective audit of medical records was based at the Ladysmith Provincial Hospital ED and consisted of the last 160 consecutive patients (from the date of initiation of data collection) with accessible medical records and with a final hospital discharge diagnosis of ACS.
Results: The frequency of patients presenting with ACS was approximately 53 patients per annum. There was a male to female ratio of 1.3: 1. The mean age was 55.8 years (SD 12.8 years). The study population consisted of Asian (103/160, 64.4%), black (36/160, 22.5%) and white (21/160, 13.1%). The majority of the study patients were unemployed (98/160, 61.25%), urban resident (143/160, 89.4%), not alcohol users (137/160, 85.6%), and not smokers (88/160, 55.0%). Risk factors and comorbidity included previous acute coronary syndrome (44/160, 27.5%), family history (29/160, 18.1%), previous cardiovascular surgery (10/160, 6.25%), obesity (45/160, 28.1%), hypercholesterolemia (49/160, 30.6%), diabetes (42/160, 26.25%), hypertension (76/160, 47.5%), and renal failure (27/160, 16.9%). Approximately three quarters (119/160, 74.4%) of the study patients had typical chest pain, 16.3% (26/160) had atypical chest pain, and 9.4% (15/160) had no chest pain. The median length of hospital stay was 3 days and the in-hospital mortality was 8.1 % (13/160).
Conclusion: The relatively high frequency of ACS reported in this study, when compared to other similar studies, is concerning. Also of concern in this study, is the alarming proportion of Asians that presented with ACS.
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Effect of alcohol on global and locus specific DNA methylation in spermatozoa: implications for fetal alcohol spectrum disorders (FASD)Patel, Sanam 24 April 2013 (has links)
Fetal alcohol spectrum disorders (FASD) is an umbrella term that describes a range of
symptoms associated with prenatal alcohol exposure. Fetal Alcohol Syndrome (FAS) is the
most severe disorder in the spectrum and is a major health problem in South Africa, with a
prevalence rate of 68.0-89.2 per 1000 children of school-going age. The primary cause of
FAS is in utero alcohol exposure. However, secondary factors that contribute to the
syndrome include various genetic, epigenetic and additional environmental factors. The
proposal that paternal preconception alcohol exposure has adverse effects on offspring
development is supported by children born with FASD-like characteristics whose mothers did
not drink but whose fathers were alcoholics. Mouse models further support these findings.
One of the main epigenetic factors that have been shown to be affected by alcohol is DNA
methylation. This chemical modification of DNA is associated with developmentally important
genes known as imprinted genes. Imprinted genes are expressed in a parent of origin
specific manner. Methylation occurs at specific regions in these genes known as
differentially methylated regions (DMRs) or imprinting control regions (ICRs). Alcohol’s ability
to alter DNA methylation at imprinted genes raises the possibility that epigenetic disruption
could contribute to the clinical features seen in FASD.
The main aim of this research was to examine global DNA methylation and locus specific
H19 ICR DNA methylation in spermatozoa, related to alcohol exposure. This was done using
the luminometric methylation assay (LUMA) and bisulfite based quantitative pyrosequencing,
respectively. In this study there was no significant correlation between alcohol exposure and
global DNA methylation (p = 0.17), nor was there a significant correlation with drinking
frequency (p = 0.31). Although not significant, a slight trend towards decreased global DNA
methylation in alcohol-exposed spermatozoa was observed. This suggests that either
alcohol does not affect global sperm DNA methylation or that the technique used in this study was not sensitive enough to detect minor changes in global DNA methylation
percentage.
There was also no significant correlation between alcohol exposure and average H19 ICR
DNA methylation (p = 0.051), nor was there a significant correlation with drinking frequency
(p = 0.47). There was no significant correlation between alcohol exposure and DNA
methylation at individual CpG sites except for CpG 3, where there was a significant increase
in DNA methylation in the drinking group (p = 0.03).
The findings of this study together with the findings of significant selective demethylation at
individual CpG sites within the IG-DMR from another study on the same sperm samples,
suggest that alcohol may have the ability to affect DNA methylation levels in spermatozoa at
certain loci within the sperm genome. However, these loci-specific effects are not reflected in
global DNA methylation levels. These findings do not disprove the hypothesis that there is
an epigenetic mechanism responsible for the paternal effects seen in FASD. Instead they
suggest that the techniques used in this study were not sensitive enough to detect these
changes in DNA methylation or alternatively, alcohol may be exerting its effects through
other epigenetic mechanisms.
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Clinical and microbiological characterisation of invasive enteric pathogens in a South African population: the interaction with HIVKeddy, Karen Helena January 2017 (has links)
A Thesis Submitted to the School of Public Health,
Faculty of Health Sciences,
University of the Witwatersrand,
in fulfilment of the requirements for the degree of Doctor of Philosophy
Johannesburg, South Africa 2016. / Introduction
Human immunodeficiency virus (HIV) has been associated with invasive enteric infections in
HIV-infected patients, since it was first described in the 1980s. In South Africa, HIV remains
an important health challenge, despite the introduction of antiretroviral therapy (ART) in
2003. In association with this, is an ongoing problem of invasive enteric infections, including
those due to Shigella and Salmonella, including Salmonella enterica serovar Typhi
(Salmonella Typhi). There are few South African data available as to the incidence of
invasive disease due to these pathogens and how these data may contrast with the
presentation and outcome in HIV-uninfected patients. The associated risk factors for
mortality due to invasive enteric pathogens and whether there has been a response with ART
as an intervention also needs further elucidation.
Aims
This work was undertaken to better describe the burden of invasive enteric infections
(Shigella, nontyphoidal Salmonella and Salmonella Typhi) in association with HIV, define
risk factors for mortality and establish whether the introduction of ART has impacted on
disease burdens due to these pathogens.
Methods
Laboratory-based surveillance for enteric pathogens was initiated in 2003. Basic
demographic details (age and gender) were collected on all patients where possible. In 25
hospital sites in all nine provinces, additional clinical information was collected by trained
surveillance officers, including HIV status, data reflecting severity of illness, other immune
suppressive conditions, antimicrobial and antiretroviral usage and outcome (survival versus
death). Laboratories were requested to transport all isolates to the Centre for Enteric Diseases
(CED) at the National Institute for Communicable Diseases of the National Health
Laboratory Service (NHLS) in Johannesburg for further characterisation, including
serotyping, antimicrobial susceptibility testing and molecular typing where relevant (whether
isolates could respectively be classified as Salmonella Typhimurium ST313 and Salmonella
Typhi H58). Additional cases were sought through audits of the Central Data Warehouse
(CDW) of the NHLS.
Annual incidence rates were calculated according to published estimates of population by age
group by the Actuarial Society of South Africa for the Department of Statistics of the South
African government. Analyses were specifically directed at invasive shigellosis, Salmonella
meningitis, typhoid fever in South Africa and nontyphoidal salmonellosis in Gauteng
Province, South Africa. Data were recorded in an Access database and analysed using chisquared
test to establish differences between HIV-infected and uninfected individuals and
univariate and multivariate analysis to compare risk factors for mortality. Data in the number
of patients accessing ART were derived through audits of the CDW, by using the numbers of
patients on whom viral loads were done annually as a proxy.
Results
Between 2003 and 2013, a total of 10111 invasive enteric isolates were received by CED. For
patients for whom sex was recorded, 3283/6244 (52.6%) of patients presenting with invasive
enteric infections were male; invasive disease was predominantly observed in children less
than five years of age (1605/6131; 26.2%) and those who were aged between 25 and 54 years
(3186/6131; 52.0%), with the exception of typhoid fever where the major burden was in
patients aged 5 to 14 years (302/855; 35.3%).
KH Keddy 81-11384 PhD
iv
More HIV-infected adult women were observed with invasive shigellosis (P=0.002) and with
typhoid fever compared with adult men (P=0.009). Adults aged ≥ 15 years were more likely
to die than children aged < 15 years (invasive shigellosis, odds ratio [OR]=3.2, 95%
confidence interval [CI]=1.6 – 6.6, P=0.001; Salmonella meningitis, OR=3.7, 95% CI=1.7 –
8.1, P=0.001; typhoid fever, OR=3.7, 95% CI=1.1 – 14.9, P=0.03; invasive nontyphoidal
salmonellosis, OR=2.0, 95% CI=1.6 – 2.5, P<0.001).
HIV-infected patients had a significantly higher risk of mortality compared with HIVuninfected
patients (invasive shigellosis, OR=4.1, 95% CI=1.5 – 11.8, P=0.008; Salmonella
meningitis OR=5.3, 95% CI=1.4-20.0, P=0.013; typhoid fever, OR=11.3, 95% CI=3.0 – 42.4,
P<0.001; invasive nontyphoidal salmonellosis OR=2.5, 95% CI=1.7 – 3.5, P<0.001). In all
patients, severity of illness was the most significant factor contributing to mortality (invasive
shigellosis, OR=22.9, 95% CI=2.7 – 194.2, P=0.004; Salmonella meningitis OR=21.6, 95%
CI=3.5 – 133.3, P=0.01; typhoid fever, OR=10.8, 95% CI=2.9 – 39.5, P<0.001; invasive
nontyphoidal salmonellosis OR=5.4, 95% CI=3.6 – 8.1, P<0.001). Between 2003 and 2013,
ART was significantly associated with decreasing incidence rates of invasive nontyphoidal
salmonellosis in adults aged 25 - 49 years (R=-0.92; P<0.001), but not in children (R=-0.50;
P=0.14).
Conclusion
Decreasing incidence rates of invasive nontyphoidal salmonellosis and shigellosis suggest
that ART is having an impact on opportunistic enteric disease in HIV. Further work is
necessary however, to fully understand the associations between age, sex and invasive enteric
pathogens. Specifically, this work would include typhoid fever, Shigella transmission from
child to adult carer, development of invasive enteric infections in HIV-exposed children and
whether the decreasing incidence rates can be sustained. Moving forward, an understanding
of invasive enteric infections in the HIV-uninfected patient may assist in targeting severity of
illness as a risk factor for mortality. / MT2017
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A profile of patients with minimal change nephropathy between 2001 and 2010 at the Witwatersrand Academic ComplexMkandawire, Mercy Juliet 07 September 2015 (has links)
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Internal Medicine
Johannesburg, 2015 / Available literature on primary minimal change nephropathy (MCN) predominantly reflects Western and Asian populations, with little data describing the disease in black patients. We therefore studied the demographic and clinical profile of patients presenting with MCN at the Witwatersrand Academic Complex.
The results of 1,618 renal biopsies performed at our centre between 2001 and 2010 were reviewed; 47 patients with MCN were identified (prevalence of 2.9%).The patients were predominantly of black race (83%), the male : female ratio was 1.04:1 and the mean age was 31.8± 12.1 years. The majority of patients (90%) fitted the criteria for the nephrotic syndrome. 18% of patients had elevated serum creatinine levels and 6.4% had associated hypertension. An association was found between gender and age; with a predominance of males amongst younger patients (less than 30 years) compared to a predominance of females amongst the older patients.
Records of treatment and outcomes were available for 28 patients, all of whom received initial corticosteroid therapy (average dose of prednisone 0.8mg /kg/day). The average duration of therapy was 29 weeks. 57.1% achieved remission with no further relapse. No clinical or demographic parameters were identified that predicted response to corticosteroid therapy. 39.2% of patients had probable steroid dependance/resistance. Of these patients, 58.3% had a single relapse and 41.7% had double relapses. The mean time to relapse was 27.8±19.4 months with 83% of patients relapsing within 48 months; the mean time to relapse was longer in males (39.3±17.5 months) as compared to females who relapsed in 18±16.9 months, which was significant at the 10% level (P = 0.09).
MCN is rare amongst Black Africans but should be considered in the differential diagnosis of nephrotic syndrome. The disorder in these patients may be less responsive to corticosteroids and a longer course of therapy may be required to induce remission. Males may be more likely to remain in remission for a longer time period.
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The effect of carpal tunnel syndrome pain on sleep architectureMdluli, Dalingcebo Christopher 24 January 2013 (has links)
Carpal tunnel syndrome (CTS) is a neuropathic condition commonly caused by the
entrapment of the median nerve. The most common complaint presented by the CTS
patients is pricking sensation, numbness, pins and needles, burning sensation as well
as in the hand and sometimes the arm/s distribution of the affected side. The patients
with CTS usually complain of nocturnal periodic sleep disruption caused by the pain
discomfort. In my dissertation, I explore the extent to which the CTS pain influences
sleep architecture using neurophysiological measurements like an overnight
electroencephalogram (EEG), conduction tests as well as subjective questionnaires. I
initially conducted a pilot research study on 33 patients with CTS using subjective
questionnaires. The CTS patients reported sleep disturbance. I also demonstrated that
they (patients) had a minimal mood and psychological disturbance. I was prompted
therefore to investigate the influence of the CTS pain on the sleep architecture using
more objective empirical instruments like the polysomnogram as well as subjective
measurements such as Beck Depression Inventory, Profile of mood states, Visual
analogue scales as well as the McGill pain questionnaire to further investigate
changes. The patients were required to spend four nights in the sleep laboratory
divided into two nights before surgery and two nights at least two to six weeks
following the CTS surgery. The CTS surgery is commonly used to release the
compression of the median nerve at the wrist. The changes in subjective and objective
variables were compared before and after CTS surgery. The age and gender-matched
control group was introduced into the research study. The control group was required
to spend the same number of nights in the sleep laboratory as the CTS group. The
control group was also going to have a non-painful procedure of the same magnitude
as the experimental subjects. The conclusion I reached on this study was that the CTS
patients reported poor sleep quality. I also demonstrated that there were not many
changes in the polysomnogram and that there were minimum changes shown on the
nerve conduction studies variables as might have been expected based on the severity
of the carpal tunnel syndrome. Another important finding was that there was a
relationship between pain and depressive mood in CTS patients. The removal of pain
in CTS patients showed that there was a subsequent subjective improvement in mood
and psychological status and no significant improvement in subjective measurements.
There were no significant changes noted on the control subjects who were pain-free.
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The prevalence of the metabolic syndrome in men presenting with erectile dysfunction at a South African tertiary care centreWood, Bradley Ryan 22 October 2010 (has links)
MMed (Urology), Faculty of Health Sciences, University of the Witwatersrand / The metabolic syndrome has recently become one of the major public health challenges and results from the increasing prevalence of obesity. Erectile dysfunction (ED) affects up to half of men over the age of forty. Men with co-morbid disease and risk factors including cardiovascular disease, hypertension, dyslipidaemia and depression all report a higher prevalence of ED. The current study investigated the prevalence of the metabolic syndrome in one hundred men with (ED) presenting to the Male Sexual Dysfunction Clinic at the Johannesburg Hospital.
Participants underwent a thorough history taking and examination session which included the International Index of Erectile Function Score. Several fasting biochemistry and hormonal tests were performed. Participants were divided by race into three groups. Data was recorded in EXCEL and reported as mean±std or as a number (frequency). Where applicable, correlation between variables was determined.
The prevalence of the metabolic syndrome was 39%, with the highest prevalence (54%) in the group comprising Asian, Coloured and Chinese participants. Eighty percent of participants had moderate-severe (ED), with a mean duration of 3,8 years. Glucose and HbA1c were strong predictors of ED duration. Severity of ED was not influenced by the presence of the metabolic syndrome. Men presenting with ED may represent an ideal patient group to screen for the metabolic syndrome, and therefore for cardiovascular disease, especially for those men within the asymptomatic period.
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Burden of respiratory disease among paediatric patients infected with HIV/AIDSDa Cunha, Natalia Cristina Picarra 19 January 2012 (has links)
HIV is a prominent infection in society and its health implications are seen in the
paediatric wards daily. Despite its multi-system effect on the body, it particularly
results in many respiratory infections. Effective understanding of the disease profile
and management of patients with HIV relies on correct statistics and proper use of
resources.
Since the introduction of anti-retrovirals in 2004 in South Africa, the impact of
HIV/AIDS on respiratory disease needs to be re-evaluated. The purpose of the study
is to understand the disease profile of children with HIV/AIDS with regard to the
presence of respiratory conditions with which they present, the need for chest
physiotherapy and their health status.
Of the 125 patients recruited in this study 55% were boys, average age was 20.55
months (SD= 23.64), average length of hospital stay of 2 ½ weeks (mean=18.76,
SD=19.19), 80% discharged and 9.6% died. The most common respiratory
conditions presented included bacterial pneumonia (66.4%), tuberculosis (48%) and
pneumocystis jirovecii pneumonia (23.2%). The least common condition was
lymphoid interstitial pneumonitis (4.8%). Two thirds of the children (68.8%)
presented with a high burden of disease. Physiotherapy treatment was indicated for
96% of the patients mainly due to excess secretions and poor air entry. About forty
percent (40.8%) of children were taking anti-retrovirals with an average length of use
of 9.81 months (SD=11.61). Three out of four (75%) mothers were not involved in a
PMTCT program. The analysis of immune status revealed a mean CD4 percentage
17.33% (SD=10.96), CD4 absolute 631.36 cell/mm3 (SD=610.36) and viral load 2.6
million copies /ml (SD=9.08 million copies/ml).
A higher burden of disease was related to the use of anti-retrovirals, a lower
immunity, female patients, longer length of hospital stay and incidences of mortality
occuring at later periods of hospital stay. Results of this study highlight the characteristics of respiratory disease burden
among children with HIV in a South African setting in a post HAART era.
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An exploratory study to determine the attitudes of professional nurses in a state school for the retarded toward Down's Syndrome (mongolism)Carter, Georgia Bratcher January 1966 (has links)
Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01
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