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Blastomycosis is an endemic systemic fungal infection that usually involves the lungs and superficial skin. Although head and neck involvement has been reported in the literature, no previous cases of neck mass resulting from direct extension of a pulmonary lesion have been published. We encountered an immunocompetent 31-year-old woman with a rapidly enlarging subcutaneous neck mass and a chronic upper lung infiltrate. Imaging studies showed contiguity between both lesions. Blastomyces dermatitidis was recovered from the sputum, and typical yeast was observed in fungal stains of needle aspirate from the neck mass. The patient responded favorably to a 6-month course of itraconazole. Blastomycosis should be considered in patients with subcutaneous neck masses in areas where this disease is endemic.

No description available.

Thesis (MSc)--Stellenbosch University, 2013. / Aminoquinolines are important class of drugs that have been used for malaria chemotherapy for centuries. However, long-term exposure to these drugs leads to extensive spread of drug resistance. As such, modified chloroquinoline derivatives are being studied as alternative antimalarial agents with the possibility to overcome drug resistance associated with chloroquine analogues. In this study, 15 aminoquinoline derivatives that are linked by a 1,4-disubstituted 1,2,3-triazole ring to an ethyl and propyl carbon spacer with a distal amine motif were designed and synthesized as novel antimalarial agents using the Cu(I)-promoted Huisgen reaction. The compounds have been synthesized from the 7-chloro-N-(prop-2-yn-1-yl)quinolin-4-amine alkyne precursor and the azides of ethyl and propyl amino moieties using a 1,3-dipolar cycloadditioncoupling in the presence of CuI catalyst to obtain moderate to good yields (53 – 85%). These compounds have been characterized by the combination of NMR, ESI+ HRMS and IR spectroscopic methods. The antiplasmodial activity of the compounds was investigated in vitro against P. falciparum strain NF54 using chloroquine as a reference drug together with a standard antimalarial drug artesunate. Of the 15 novel chloroquinoline derivatives, 11 have demonstrated to possess promising potency by way of the inhibition concentrations less than 250 nM with the lowest being 28 nM. The observed activities have been ascribed to the overall modifications such as the introduction of a triazole linker and changing of carbon chain length as these were the variables. The compounds are accordingly under further biological investigations and only the chloroquine sensitive results are reported in this work.

Bakgrund: Det naturliga åldrandet och intag av många läkemedel medför en ökad risk för läkemedelsbiverkningar. För att äldre personer ska känna sig trygga med sin läkemedelsbe-handling är det viktigt att få tillräckligt med information. Delaktighet är en förutsättning för partnerskapet i personcentrerad vård vilket innebär att vårdpersonal och patient ska dela på information, samtal och beslutsfattande.Syfte: Syftet med studien var att beskriva äldre personers upplevelser av delaktighet i läke-medelsbehandling.Metod: För studien valdes kvalitativ design. Semistrukturerade intervjuer genomfördes med 16 deltagare som var i åldrarna 75-94 år, 12 av deltagarna var kvinnor och 4 män. Samtliga av deltagarna bodde i eget boende. Insamlad data analyserades med hjälp av manifest och latent innehållsanalys enligt Graneheim och Lundman.Resultat: Efter analys av innehållet framkom ett tema, delaktighet – en balans mellan auto-nomi och kunskap, och fyra underliggande kategorier, att vara nöjd med sin läkemedelsbe-handling, att sträva efter mer kunskap, att vara en del i beslutsfattandet samt upplevelsen av delaktighet utifrån vårdpersonalens stöd och information.Slutsats: De äldre beskriver olika behov av att vara delaktiga i sin egen läkemedelsbehand-ling och därför bör alla patienter få möjligheten att välja graden av delaktighet. För att upp-fylla detta är det viktigt att personcentrerad vård tillämpas av vårdpersonal för att vården ska kunna anpassas efter individens behov. / Background: Natural aging and consumption of many drugs increases the risk of drug side effects. For older people to feel safe with their medication, it is important for them to get suf-ficient information. Participation is a precondition for partnership in person-centered care, which means that health professionals and patients have to share information, discussion and decision making.Aim: The aim of the study was to describe older people's experiences of participation in the drug therapy.Method: Qualitative design was chosen for the study. Semi-structured interviews were con-ducted with 16 participants who were aged 75-94 years, 12 of the participants were women and 4 were men. All of the participants lived in their own homes. Collected data were ana-lyzed using manifest and latent content analysis according to Granheim and Lundman.Result: After content analysis a theme appear: participation - a balance between autonomi and knowledge. Four underlying categories were identified: to be satisfied with their drug therapy, to strive for more knowledge, to be part of decision-making and the experience of participation on the basis of health care personnel support and information.Conclusion: The elderly describe different needs to be involved in their own drug therapy, and all patients should therefore have the opportunity to choose their degree of participation. To fulfill this objective, it is important that person-centered care is applied by medical profes-sionals so that care can be adapted to individual needs.

A thesis submitted to the Faculty of Medicine, University of the Witwatersrand, for the degree of Doctor of Philosophy in Medicine. / Despite having been initially described more than fifty years ago, sclerotherapy of oesophageal varices has only relatively recently became regarded as one of the primary modalities both to control bleeding oesophageal varices and to prevent recurrent bleeding. Sclerotherapy, however, ts associated with numerous complications and its exact mechanism of action, particularly that pertaining to its effect on haemostasis, has to date been poorly documented. One of the problems of comparing the various trials has been the diversity of both the technique and the type and concentration of the sclerosants used. (Abbreviation abstract) / Andrew Chakane 2018

A DISSERTATION SUBMITTED TO THE FACULTY OF MEDICINE, UNIVERSITY OF THE WITWATERSRAND, JOHANNESBURG, FR THE DEGREE OF MASTER OF SCIENCE IN MEDICINE. / The influence of iron on the outcome of various infections have been extensively reviewed. Clinical observations suggests that iron deficiency may be protective against malaria. Various researchers have shown that certain iron chelators blocked the proliferation of plasmodium falciparum in vitro and in vivo. (Abbreviation abstract) / Andrew Chakane 2018

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the Master of Science Degree in Epidemiology. / Antiretroviral therapy (ART) recommendations among HIV – infected pregnant women have been revised several times by the World Health Organization (WHO). Option B+, which is the latest recommendation continues to be rolled out in several countries across the globe but mostly in sub-Saharan Africa. Retention in care and adherence to antiretroviral (ARV) drugs taken by these women remains unclear in this new program. We assessed ability to stay in care (retention) and adherence to ART among HIV – infected women starting life-long treatment during pregnancy and after, at an HIV care and treatment clinic in Ifakara Tanzania. Our study provided an opportunity to understand the trends in adherence to ART and retention in care for this population. Methods We analyzed data of HIV-infected pregnant women registered and starting ART for the first time in the Kilombero and Ulanga Antiretroviral Cohort in 2009 and 2010 with a follow up period of up to two years to 2011 and 2012 respectively. Adherence was by patient self-report (PSR) and was sufficient (good) if the woman took all the prescribed pills of the issued batch or insufficient (poor) if she missed two or more pills. Women that missed two or more consecutive scheduled visits to the clinic were not retained while those that honored their scheduled visits were retained in care. Two sample t test and Wilcoxon rank sum test were used to test predictor outcome associations for continuous variables while Pearson’s and Fisher’s exact tests were used for categorical ones. Hazard ratios of each predictor variable were calculated using Cox regression. Student No: 737395 Page v Results A total of 1,282 HIV – infected women were registered in KIULARCO between 2009 and 2010. Fifty (50) were pregnant and started life-long ART upon registration in this period. Of these, 25 (50%) were registered in 2009 and the other 25 (50%) in 2010. Slightly more than half, 52.2% had CD4 cell counts above 350cells/mm3. Almost half, 49% of the women were registered in their final (third) pregnancy trimester. About 82% were in WHO stage one and 60% of all the 50 women were initiated on AZT/3TC/EFV regimen. Only 5.7% had secondary education while the rest had primary or no education at all. Of the women that reported their partners HIV state, 54.5% had partners that had never tested for HIV. Adherence for all participants was reported as sufficient (good) for the entire period the women were in care. No one had insufficient (poor) adherence. Retention in care was higher during pregnancy than after delivery. Generally, loss to follow up was 40%. About 30% were lost during pregnancy and the majority, 70% lost after they had delivered their babies. There was no evidence to prove that any of the factors studied independently predicted non retention. The most likely time to non retention was six months after delivery. Conclusions Our study, despite small sample size, shows that among women diagnosed HIV – infected and starting life-long ART during pregnancy (Option B+), adherence to ART is sufficient and retention in care similar during and after pregnancy. Counseling on the importance of staying in care especially around the first few months after delivery should be emphasized at ANC.