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

M.Tech.

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.

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.

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

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.

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.

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.

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.

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