Includes bibliographical references. / Tuberculosis (TB) and HIV are dual epidemics and a public health crisis in Southern Africa. An estimated 2.5 million children are living with HIV, of which 2.3 million live in Sub-Saharan Africa, with an estimated 230 000 child deaths from AIDS. In 2010 there were an estimated 8 million incident cases of tuberculosis (TB) globally, 1.2 million amongst people living with HIV. Over 1 million TB related deaths occurred, a third of which occurred amongst people living with HIV.[4] The African region accounts for 26% of the global TB burden and 82% of the TB cases among people living with HIV. TB and HIV are a deleterious combination. TB is a common cause of acute and chronic respiratory disease and a leading cause of death amongst HIV infected children in TB endemic areas.

Background: Despite the undeniable diagnostic benefits of urodynamic studies (UDS), their adoption into clinical practice in Africa has been slow. This study aimed to review the use of invasive UDS in children at a tertiary paediatric hospital in South Africa. Methods: A retrospective analysis of 1108 UDS was conducted. Patient demographic characteristics, primary diagnosis, indication and urodynamic outcomes were reviewed. Presence of urodynamic high-risk features were documented, and a comparison was made between the first study and follow-up study. Results: This study revealed increasing trends in the use of UDS from 2015. Referrals were from Urology (37.7%), Spinal defects clinic (34.4%), Nephrology (20.8%) and other departments (7.0%). The most common reason for referral was review of medical treatment (36.5%). Spinal dysraphism (58.3%) accounted for the majority of conditions seen. Majority (59.1%) of the patients were receiving more than one type of bladder treatment at the time of their first study, with clean intermittent catheterisation (46.5%) being the most common form of bladder management. 97.5% of studies were performed using transurethral bladder catheterization. Urodynamic diagnosis was neurogenic in 74.0%, anatomical (12.2%), functional (8.8%) and normal (5.0%). There was statistically significant improvement in bladder compliance, detrusor leak point pressure and detrusor sphincter dyssynergia between the first study and a subsequent study following therapeutic intervention. Conclusion: The unique ability of UDS to demonstrate changes in detrusor pressures, which is a common reason for therapy failure, makes UDS an invaluable tool in the diagnosis and management of children with lower urinary tract dysfunction.

Background: Portal hypertension (PH) is a common complication of chronic liver or portal vein pathology in children. It is defined as a pathological increase in the pressure of the portal venous system. There are two leading causes for PH in children, pre and post sinusoidal liver disease and pre-hepatic non-cirrhotic portal vein obstruction, also referred to as extrahepatic portal vein obstruction (EHPVO). Management of EHPVO is primarily surgical, with surgical portosystemic shunting representing a safe and effective method for the long-term management of portal hypertension in the paediatric population. Although different shunts have been proposed for EHPVO, both the MesoRex shunt and distal splenorenal shunt have shown the most promising results as effective and definitive approaches to alleviating EHPVO. Aim: To review surgical management of extrahepatic portal vein obstruction (EHPVO) at Red Cross War Memorial Children's Hospital (RXH) and compare MesoRex shunt (MRS) with distal splenorenal shunt (DSRS). To determine and compare the shunt success rate, defined as longterm patency at 24 months of the MesoRex shunt and distal splenorenal shunt, the factors that could have influenced the patency of the Rex vein and the effect of these procedures on the long-term synthetic liver function. Methods: This study followed a retrospective study design, conducted at a single centre documenting pre- and post-operative data in 21 children, 14 MRS and 7 DSRS, All patients presented to RCWMCH with EHPVO over an 18-year period (2001-2019) were eligible for inclusion either for MRS or DSRS. Exclusion criteria included patients lost to follow up, patients who had atypical shunts not falling into either the DSRS or MRS operation and those with insufficient or missing clinical records over 18 years. Details of patient demographics included age, gender, aetiology, preoperative symptomatology, Rex vein patency, history of neonatal umbilical vein catheterization (UVC), age at shunt surgery and shunt patency were compiled over an average follow up period of 11 years (2-18). Bloodwork analysis included albumin, prothrombin time (PT), partial thromboplastin time (PTT), International normalized ratio (INR), fibrinogen, total bilirubin, liver enzymes and platelets prior to and two-years-post shunt surgery. Rex vein patency was assessed preoperatively. Statistical significance was determined at P<0.05 following a two-tailed t-test. Results: Out of 23 patients presenting with EHPVO, two children lost follow up immediately after diagnosis and were excluded. Twenty-one patients were operated on and followed up long term, with 14 patients (66%) in the MesoRex shunt group and seven patients (33%) in the distal splenorenal shunt group. Fourteen of the 15 MesoRex procedures (93%) were deemed successful in comparison to five out of seven (71%) in the distal splenorenal shunt group. Significant improvements were seen in MesoRex shunt recipients regarding the levels of Albumin, PT, PTT, and platelets. The other liver functions measured, including INR, fibrinogen, total bilirubin, ALT, AST, GGT, and ALP, were within the normal physiological range. The distal splenorenal shunt cohort only yielded a significant improvement in the platelet count, increasing from a mean value of 100 to 149.83 (P = 0.02). Out of those who showed successful surgical intervention in the long term (14 in MRS and 5 in DSRS cohorts), only one child with MRS experienced 2 episodes of variceal bleeding despite having patent shunt with adequate flow (more than 20cm/second). However, no further surgical intervention was needed, and the bleeding resolved spontaneously. Conclusion: This study highlights that MesoRex shunt has a better long-term outcome in extra hepatic portal vein obstruction and improves liver synthetic function and must be considered as the primary definitive intervention. DSRS does control variceal bleeding due to extra hepatic portal hypertension but may have a negative effect on liver function on long term and is only considered when MRS is not technically feasible or as a salvage procedure when MRS fails.

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Faculty of Health Sciences, WITS University, as partial fulfillment for the requirements of the degree of Master of Medicine in Dermatology Johannesburg 2017 / Introduction: Atopic Dermatitis (AD) is a chronic relapsing inflammatory skin condition affecting 5-20% of children under 11 years of age, characterised by intense pruritus, redness and discomfort. Research suggests that AD has been shown in quality of life assessments to be rated among the worst in term of its effect on sleep. There is no research on the effects of sleep loss on the natural history and time course of skin disorders either, especially in South Africa. Aims: The objectives of this study were: 1. to describe the various sleep disturbances associated with AD in children up to and including 12 years of age and 2. to compare the characteristics of children with sleep problems to those without sleep problems in AD Patients and Methods: This was a prospective observational / descriptive hospital based study conducted at the paediatric dermatology outpatient department at Chris Hani Baragwanath Academic Hospital (CHBAH). Questionnaire technique was used consisting of the children’s sleep habits questionnaire (CSHQ), a useful parent-reported instrument validated to identify both behaviourally based and medically based sleep problems in 4-12 years old school age children. Results: The prevalence of sleep problems in paediatric patients with AD was found to be 61.3%. There was no significant difference between males and females. Snoring as well as apnoea and snorting were significantly different in the rhinitis versus non-rhinitis group. The overall sleep disturbance rate was significantly different in those with rhinitis versus those without. Conclusions: While Atopic Dermatitis is often regarded by health professionals as a minor problem, in this study, 61.3% of children with AD have disturbed sleep. / MT2017

<p><strong>Abstract</strong></p><p>The aim of this study was to investigate the reason why students contact adults if they are involved in any kind of bullying, what support they had received and wished for, as well as to investigate why student don’t contact adults. About of 150 students, 50 girls and 56 boys (70%) had experienced bullying of different kinds; some had more than one kind of experience. The students expressed that they had contacted adults when they “felt unwell” and to “stop bullying”. There were no statistical significant differences between bullied, bullies and bystanders or girls and boys regarding their contacts with adults and their satisfaction with received support. When the students had evaluated their contacts with adults 32 of 40 were content with the support. Regarding support from adults, students wish for “concrete solutions” and “that adults would listen more”. Reasons why student had not contacted adults were that they “dared not” and “did not know who to talk to”. To stop the bullying the students proposed “better knowledge and efficient actions against bullying” as well as “zero tolerance to bullying”.</p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p><strong> </strong></p><p><strong> </strong></p><p><strong> </strong></p><p><strong> </strong></p><p><strong> </strong></p><p><strong> </strong></p><p><strong>Keyworld: </strong>school students, bullying, adult support</p><p> </p><p> </p><p><strong> </strong></p>

Abstract The aim of this study was to investigate the reason why students contact adults if they are involved in any kind of bullying, what support they had received and wished for, as well as to investigate why student don’t contact adults. About of 150 students, 50 girls and 56 boys (70%) had experienced bullying of different kinds; some had more than one kind of experience. The students expressed that they had contacted adults when they “felt unwell” and to “stop bullying”. There were no statistical significant differences between bullied, bullies and bystanders or girls and boys regarding their contacts with adults and their satisfaction with received support. When the students had evaluated their contacts with adults 32 of 40 were content with the support. Regarding support from adults, students wish for “concrete solutions” and “that adults would listen more”. Reasons why student had not contacted adults were that they “dared not” and “did not know who to talk to”. To stop the bullying the students proposed “better knowledge and efficient actions against bullying” as well as “zero tolerance to bullying”.                                   Keyworld: school students, bullying, adult support

No description available.