Thesis (M.D.)--University of Hong Kong, 1991.

Thesis (M.D.)--University of Hong Kong, 1991. / Also available in print.

Thesis (M. Res.)--University of Hong Kong, 2005.

No description available.

No description available.

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by disease flares and damage accrual. The increased longevity allows SLE patients to accrue damage which has retarded their survival improvement since the 1980s. In the first study of this thesis, meta-analyses of observational studies revealed that renal and neuropsychiatric damage has been adversely affecting the survival of lupus patients in the past fifty years. While confirmatory studies are required, targeting at renal and neuropsychiatric involvement early might hopefully further improve the survival of SLE patients. As the survival of SLE patients improves, their psychosocial well-being becomes increasingly important. In the second study, anxiety symptoms were found to be significantly more frequent in lupus patients than those with other common inflammatory rheumatic conditions. Additionally, damage accrual and cumulative glucocorticoids accurately predicted anxiety in SLE patients. Related to neuropsychiatric damage, event-related functional brain imaging in the third study showed that new-onset SLE patients had poorer strategic planning skill that required compensatory cortical recruitment for executing comparable cognitive function as in healthy subjects. Even after sufficient control of SLE, they remained to demonstrate inferior strategic planning skill which necessitated compensatory recruitment of cortical areas to boost their executive function. These findings illustrated that cognitive dysfunction persists even after adequate control of SLE. Early recognition of the prognostically challenging renal, cardiovascular and musculoskeletal damage and their predictors is imperative. The fourth study revealed that failure to achieve complete renal remission 12 months after renal presentation predicted renal damage, irrespective of age and the choice of immunosuppressants. As to whether mycophenolate (MMF) or cyclophosphamide (CYC) is better; by meta-analysis, the fifth study concluded that MMF offers similar efficacy as CYC in inducing renal remission and preventing renal damage. As for the cardiovascular system, endothelial dysfunction exerts its impact very early during atherogenesis. As shown in the sixth study, SLE patients na?ve for cardiovascular disease had significantly poorer endothelial function than demographically and anthropometrically matched healthy controls. Higher serum high-sensitivity C-reactive protein level independently predicted poorer endothelial function in SLE patients. Osteoporotic fracture is a major lupus musculoskeletal damage which occurred in 9% of SLE patients as found in the seventh study. Increasing age and duration of corticosteroid use independently predicted osteoporotic fracture. While hormonal replacement therapy appeared fracture protective, its unfavorable long-term consequences limit its indication for fracture prevention. Mitigating fracture risk before fractures occur is the current management strategy. The eighth study found that the significantly higher FRAX? 10-year risk of major osteoporotic and hip fractures amongst SLE patients na?ve for clinical fracture compared with their demographically and anthropometrically matched healthy counterparts was driven by chronic glucocorticoid use and premature menopause. Modifiable factors including low hip bone mineral density (BMD), cumulative glucocorticoids and higher serum anti-dsDNA level independently predicted higher fracture risks. Finally, the relationship between lumbar bone loss and endothelial dysfunction was hitherto identified. Although potential drivers of this relationship remain to be identified, our findings serve to alert physicians to early atherosclerosis in lupus patients particularly in those with low lumbar BMD. / published_or_final_version / Medicine / Master / Doctor of Medicine

Thesis (M. Phil.)--University of Hong Kong, 2009. / Includes bibliographical references (leaves 61-82) Also available in print.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1984. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Objective: Systemic Lupus Erythematosus (SLE) is a multi‐system disease that predominately affects women. Considering the lack of data on health related quality of life (HRQoL) especially in sub‐ Saharan Africa, we undertook a literature review on HRQoL of SLE patients in developing countries to collate the existing evidence and identify information gaps. A mixed methods qualitative and quantitative study of lived experiences of South African women with SLE was performed. Methods: A literature search was conducted on medical databases using MeSH terms pertaining to HRQoL amongst SLE patients in the developing or low income countries to identify articles published between January 1975 and February 2018. The main study included 25 consenting SLE patients attending two tertiary hospitals in Johannesburg and Cape Town. Individual in‐depth interviews, using a topic guide, were conducted and analysed using NVivo software. In addition, participants completed the Short Form‐36 (SF‐36), Functional Assessment Instrument (FAI) and functional assessment of chronic illness therapy (FACIT) for fatigue questionnaires. The questionnaires were analysed per each tool's scoring method and SPSS software was used to calculate mean, standard deviations and correlations. Results The review of 31 articles, from 11 countries indicated that SLE women have a poor general HRQoL. In addition, we found relationships between disease factors including disease activity, organ damage, functioning, and mental health. Poor socioeconomic status worsened SLE outcomes by limiting patients' access to health care and psychosocial services. In the main study, the majority (72.0%) were black Africans, unemployed (76.0%), with low formal educational level and singlehood status (72.0%). The mean (SD) mental and physical composite SF‐36 scores were poor (50.9 (22.1) and 49.1 (20.5) respectively), and 68.0% of women had FACIT scores of severe fatigue. The mean (SD) FAI was 1.33 (0.8), showing that activities of daily living (ADL) were performed with difficulty. Major themes expressed were fatigue, pain, impaired functioning, depression, pregnancy, aesthetic concerns and sexuality issues. Disease chronicity, fatigue and pain were described by many participants as ‘taking over life' and impacting on performing ADL and career opportunities contributing to indigence. Negative pregnancy outcomes were frequently exacerbated by poor sexual relationships and miscommunication between patient and health care workers. Lack of understanding of SLE by patients, community and family as well as suicidal ideations and depressive symptoms were expressed. Although the quantitative tools measured these aspects, they were unable to explore complexities such as limitations in job acquisition, suicidal ideations, disease understanding and support systems. Conclusion This study underscores the complex, chronic and challenging life experiences, often exacerbated by poverty, of SA women with SLE. Quantitative tools may be inadequate in capturing important aspects of HRQoL that emerged from the qualitive interviews. Awareness of these limitations, together with psycho‐social support and education, might improve HRQoL. This thesis recommends multi‐centred, interventional longitudinal studies that incorporate mixed methods and focus on strategies to improve the negative outcomes in SLE.

Includes bibliographical references / Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease commonly affecting females of child-bearing age, hence hormonal changes in pregnancy are thought to play a role in disease activity - often necessitating changes in immunosuppression therapy. SLE is common in Cape Town, however, the effect of pregnancy on SLE and vice versa has not been well characterised. The aim of this study is to report on the pregnancy outcomes of patients with SLE presenting to the maternity department of Groote Schuur Hospital, Cape Town. Methods: This study was designed as a retrospective review of records of pregnant women known with SLE and followed up at the maternity section of Groote Schuur Hospital. The duration of the survey was from 1 January 2003 to 31 December 2013. Records were identified using the attendance registers in the relevant departments. Results: There were 61 pregnancies reviewed in 49 patients; 80.3% of the pregnancies were in patients of mixed ancestry and the rest (19.7%) in black African patients. The mean age at presentation of the current pregnancy was 27215.0 years. Mean gestational age at presentation and delivery was 13.0 ± 6.0 weeks and 28.9 ± 9.8 weeks respectively and 47.5% of the pregnancies were in patients with lupus nephritis (LN). Thirty-nine (63.9%) pregnancies reached the third trimester and 11.5% of all pregnancies ended in the first trimester. There was a lower number of live births to mothers of African ancestry than to those of mixed ancestry (p=0.001). In 55.7% of the pregnancies, no flare was reported while a renal flare was reported in 23%. Pregnancies in patients with LN had higher frequencies of flares (58.6% vs 31.3%; p=D.O32), pre-eclampsia (34.5% vs 12.5%; p=D.O41), longer stay in hospital (12.0 ± 9.1 days vs 6.1 ± 5.1 days; p=0.DO-4) and low birth weight babies (1.94 ± 1.02 kg vs 2.55 ± 0.95 kg; p=D.O46) than in patients without LN. Only 36 (59%) of the neonates were discharged home alive and of these 2 (5.6%) were to mothers of black African ancestry (p=0.001). Conclusion: Increased lupus activity in pregnant SLE patients may account for the increased deaths of neonates born to SLE mothers. Patients of black African descent and those with LN tend to have a poorer outcome. A multi-disciplinary approach to the management of SLE patients (of child-bearing age or pregnant) needs to be further evaluated.