Thesis (doctor of medicine)--Universitetet i Lund.

Thesis (doctor of medicine)--Universitetet i Lund.

Th. univ.--Méd.--Reims, 1980. N°: 202.

Thesis (MFamMed)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction: Diabetes is the most prevalent endocrinology problem encountered in primary care practice. If recent trends showing a dramatic increase in prevalence (believed to be a consequence of a decline in physical activity and excessive caloric intake) continue, then the condition will soon affect nearly 20 million people in the U.S a reflection of the global trend. Effective management requires care that is thoughtful and meticulous, incorporating intensive patient education. Euglycemic control, with the level of glycosylated haemoglobin (HbA1c) kept below 7.0mmol/L, has emerged as a major treatment objective because of its association with a marked reduction in the risk for micro vascular complications. The primary physician is in the unique position to provide comprehensive care to the diabetic patient. Setting: The aim of this study is to evaluate the profile of complications arising due to diabetes mellitus among adult diabetics attending internal medicine outpatient department and family medicine/primary care outpatient department in the Dora Nginza hospital, PE hospital complex. Method: The study is a descriptive retrospective study in which names of patients were collated from clinic records of both clinics, files sought at the records department covering the period between Jan 2007 and Jan 2008 inclusive. Prevalence of statistical variables was generated using frequency tables, bar graphs, cross tabulations and chi square test. Results: Hyperglycemia was the major complication which predominantly was associated with high haemoglobin A1c (HbA1c) levels. However, some hyperglycaemic cases were also found to be associated with normal HbA1c. Complications were found to be more in type 2 diabetics. Patients with hypertension, obesity, smoking and alcohol use were observed to have a higher risk of developing diabetic complications. The findings on retinopathy in this study was inconclusive in view of the fact that patients sent for fundoscopy did not return with documented results from the sister hospital PE provincial hospital. Family Medicine outpatient department overall did better in patient care compared to the Internal Medicine outpatient department. Conclusion: The challenge for the primary care physician is to design a therapeutic program that is safe practical and acceptable to the patient. The ultimate goal of therapy is the prevention of micro vascular and macro vascular complications, consequence of diabetes that makes the condition a major risk factor for cardiovascular disease, stroke, visual impairment, renal failure, impotence, peripheral neuropathy, limb loss and ultimately death. These can be averted through appropriate education of both hospital staff, patients and their care givers. The recommendations made are based on the findings of the study. / AFRIKAANSE OPSOMMING: Nie beskikbaar.

Homoeopathy is a system of medicine used in obstetric prescribing to reduce the minor common complications of pregnancy (Cure, 1999). One such complication is haemorrhoids. Haemorrhoids are varicosities of the haemorrhoidal plexus in the rectum, and are often complicated by inflammation, thrombosis and haemorrhage (Beers & Berkow, 1999). The aim of the study was to determine the effect of homoeopathic similimum treatment on haemorrhoids in pregnant women. This was a quantitative, interventive and descriptive study spanning one month. The research method used homoeopathic similimum treatment and a participant administered questionnaire in a panel longitudinal, in-depth case study. Non-probability purposive sampling was used to select 12 primigravida or multigravida pregnant females, aged 18-35, from the 12th to 35th week of gestation, presenting with haemorrhoids, who met the inclusion criteria. The sample was obtained by advertisements placed in antenatal classes, private clinics and pharmacies; and by pamphlets handed out at Baby City shops and baby expositions to pregnant women; and referrals from health care providers. The similimum medicine was selected after an initial consultation and physical examination. The symptoms of the initial consultation were noted on a case taking form. The similimum medicine was prescribed in potency between 5CH and 200CH. Dosage was determined by the laws of similimum prescribing. Questionnaires relating to the patients symptoms were completed by the patient daily during the duration of the study. A follow up consultation and physical examination was conducted at the end of the 2nd week of treatment. As indicated by the symptoms at the follow up consultation, a new similimum was prescribed; the original similimum was continued; or it was decided to wait and watch the action of the medicine in the participant if there were signs of improvement. A final consultation and physical examination was conducted at the end of the 4th week of treatment to document the effectiveness of the treatment. The questionnaire was collected. The symptoms of both follow up consultations were noted on a follow up form. Data obtained from the questionnaires were analysed. An ordinal regression, time 1 vs. time t - 1 analysis, regression using sums and a reliability analysis were performed. The data from the individual consultations were used to write up an in depth case study. Eighty three percent (10/12) of the cases of haemorrhoids in pregnancy improved on homoeopathic similimum treatment. Homoeopathic similimum medicine had a significant effect on decreasing the severity of the pain (p < 0.00) and protrusion (p < 0.00). Besides the improvement to the haemorrhoids, there were also signs of improvement to some of the concomitant symptoms experienced by the participants. In conclusion, homoeopathic similimum treatment within a clinical setting is effective in relieving the symptoms of haemorrhoids in pregnant women. Further research needs to be conducted in order to verify these findings. / Dr. Candice Bodkin Dr. Elizabeth Solomon

A computer model is developed to study the fluid and protein redistribution after thermal injuries in rats. This model is derived by including the burned skin as a fourth compartment in the microvascular exchange model developed by Bert et al. [6]. The pathological changes that occur after thermal injuries are introduced into the burn model as perturbations. The simulations of short-term and long-term responses were then made in this four compartment (burn) model for two cases: 10% and 40% percent surface area burns. Appropriate ranges of the perturbations were estimated based on the available information in the literature. The perturbations for the 10% burn include: the plasma leak coefficient in the injured skin, the tissue pressure in the injured skin, the fluid exchange coefficients in the injured skin, the arterial capillary pressure in the injured skin and the lymph flow characteristics in the injured skin. The perturbations for the 40% burn include the perturbations for the 10% burn plus the plasma leak coefficients in the intact tissues, the fluid exchange coefficients in the intact tissues and the lymph flow characteristics in the intact tissues. The dynamic responses of the system using these perturbations were plotted. Comparisons between the simulation predictions and the experimental data were characterized in terms of sum-of-squares of differences between simulation results and experimental data. Compared to the limited amount of data available in the literature, the burn model describes microvascular exchange after thermal injuries reasonably well. The work in this thesis could easily be extended to account for fluid resuscitation following a thermal injury in rats and, it is hoped that this approach might eventually be applied to the resuscitation management of burn patients. / Applied Science, Faculty of / Chemical and Biological Engineering, Department of / Graduate

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2012 / Background: Rheumatoid Arthritis (RA) is a chronic auto-immune musculoskeletal disorder of unknown aetiology that can result in physical disability, chronic pain and impaired quality of life. RA is associated with an increased prevalence of depression. The presence of depression in RA is reported to be associated with pain, functional disability, high disease activity and mortality. This study aims to determine the prevalence of depressive symptoms in a cohort of Black South African patients attending a Rheumatology outpatient clinic at a public health center. It also aims to determine the association and correlation between the presence of depressive symptoms and the sociodemographic profile and RA clinical characteristics of the study population. Methodology: The study was conducted in a Rheumatology out patient clinic. The study sample consisted of 100 systematically selected participants of Black race. The participants completed the disability questionnaire (HAQ-DI), Visual Analogue Scales (VAS) for pain, fatigue and disease activity; and the depression and tension subscales of the Arthritis Impact Measurement Scale (AIMS). The MADRS was then administered to assess depressive symptoms. Study participants were clinically assessed for disability, joint status and disease activity. Data was analyzed using the SAS version 9.1 statistical program. Results: The majority of the sample was female (85%) and unmarried (66%). The prevalence of current depression was 13.2%, although a further 22.2% of the sample was already stable on antidepressant treatment. The mean RA disease duration was 12.5 ± 9.2 years. No significant associations were found between the presence of depression and the sociodemographic variables. MADRS scores were significantly associated and correlated with disability (p = 0.002, r = 0.30); fatigue (p = <0.001, r = 0.43); disease activity (p = 0.001, r = 0.32); AIMS-D (p < 0.001, r = 0.40) and AIMS-T (p < 0.001, r = 0.35). Upon adjusting for age and clinical status, significant associations remained with MADRS scores and all five above-mentioned RA variables although correlations weakened slightly. Conclusions: Co morbid depression is prevalent in South African Black patients with RA. In order to improve clinical outcomes in RA, depression must be actively sought and effectively managed.

Patients were selected for the study on the basis of 1: A diagnosis of systemic Lupus Erythematosus according to the 1982 revised American Rheumatology Association criteria47 and 2: An adequate biopsy defined as containing at least six glomeruli. Patients were biopsied at Groote Schuur Hospital during the period 1978 to 1988 and the indications for renal biopsy were clinical based on laboratory results of renal function. Patients were followed between 1 and 120 months with a mean observation period of 34 months. The clinical records were scrutinised and the following pa·rameters were noted at the time of biopsy: age, sex, race, time from diagnosis to biopsy, serum urea, creatinine, creatinine clearence and urinary 24 hour protein. Using the latest serum urea, creatinine, creatinine clearence and / or 24 hour urinary protein where available, outcome was graded as: 1: An improvement in renal function 2: A stable renal function 3: Deterioration in renal function 4: Patient on dialysis 5: Death due to disease.

Objectives: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery. Materials and Methods: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo a neurosensory test with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed. Results: 238 patients with 476 sides each of maxillary and mandibular procedures were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Objective neurosensory tests showed general reduced sensitivity in subjects with subjective NSD. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients a nd surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery. Conclusion: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Background and hypothesis. Edentulous patients may be at risk for malnutrition and cardiovascular disease even with well made dentures. Improvements in methods used to assess nutritional status suggest that functional biomarkers such as plasma homocysteine (tHcy), in addition to traditional methods, will provide a better quality assessment. The hypothesis is that there is an association between functional biomarkers of nutritional status and traditional cardiovascular disease risk factors in a community dwelling edentulous elderly population. / Methods. This was a cross-sectional study of the baseline characteristics of a convenient sample of 254 edentulous community dwelling elderly over 65 years. Measurements included anthropometric, body composition, homocysteine, vitamins and relevant blood components. Correlations, multiple regression models and Adjusted Odds Ratios (AOR) for tertiles were used to assess the relationship between vitamins and other parameters with hyperhomocystenemia, defined as THcy value of &ge; 14mmol/L. The independent effect of edentulism on hyperhomocysteinemia was sought using the NHANES III data. / Results. The prevalence of hyperhomocysteinemia was 49.2%. Effect of folate on hyperhomocysteinemia was significant (p = 0.037). Low folate tertile group had a 2.45 times higher odds (CI: 1.23, 4.87) of hyperhomocysteinemia than patients in the higher tertile (p = 0.019). Groups with normal folate did not have higher odds of hyperhomocysteinemia regardless of levels of vitamin B6 or B12. AOR for vitamin B12 tertiles in relation to hyperhomocysteinemia were 2.36 (CI: 1.18, 4.75) and 2.12 (1.07, 4.22) for lower vs. high. A weak inverse relationship existed between tHcy and vitamin C (r= -0.11, p= 0.045). A borderline negative correlation existed between HDL and THcy adjusted for age (r = - 0.12; P = 0.05). Significant correlation existed between THcy and BMI (r = 0.15, P = 0.02), small waist circumference (r = 0.22; p = 0.0004) and waist/hip ratio (r = 0.23, p = 0.0003). In a multivariate analyses, edentulism was associated with hyperhomocysteinemia (p = 0.012). / Conclusions. In this sample, homocysteine levels appeared much higher than one would expect with folate fortification, and were related to several cardiovascular risk factors. Using data from NHANES III, edentulism was found to independently predict hyperhomocysteinemia. The inverse relationship between homocysteine and vitamin C and the effect of folate on hyperhomocysteinemia suggests that increasing dietary intake of fruit and vegetables in edentulous individuals might be beneficial. Furthermore, the latter are at risk of developing hyperhomocysteinemia, a condition associated with cognitive impairment, dementia and coronary artery disease risk.