Dissertations / Theses: 'Charlotte Maxeke Johannesburg Academic Hospital - Radiotherapy'

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Serobatse, Moilwa Denton. "The challenge of implementing health information systems : a case study in Charlotte Maxeke Johannesburg Academic Hospital." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80058.

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Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: This thesis investigates the complexities involved in Health Information Systems. The focus is on the factors of a) efficiency and b) usability. A case study is made of a recently implemented system in Charlotte Maxeke Johannesburg Academic hospital. The first objective of the research was to gain a deeper understanding of the complexities of Health Information Systems, and secondly to evaluate the situation at Charlotte Maxeke Johannesburg Academic Hospital. In Chapter 1 a detailed introduction of the thesis is offered. This includes, explaining what triggered the research, the objective of the research and the methodology used to conduct the research. In Chapter 2 the focus is on a literature review of Health Information Systems, system fundamentals and planning and implementation. It is clear that without a methodology, systems development becomes haphazard and subsequently a risky and expensive undertaking. While change is pervasive, introducing operational efficiencies sometimes may necessitate reviewing of information systems and business strategy, knowledge management and process orientation. In Chapter 3 the issue of usability is investigated. Several healthcare institutions have implemented information systems but evaluations of the usability of these systems are still under debate. For purposes of this research an evaluation method for system usability and survey questionnaires were developed. In Chapter 4 the case study of Charlotte Maxeke Johannesburg Academic Hospital is reported. The chapter also describes the data collection design, research limitations and delimitations, survey findings and interpretations. In Chapter 5 the implications and applications of Health Information Systems are discussed. After analysis of the survey results, it appears that the impact and benefits of the new Health Information System are only positive or realized in the patient administration division. The rest of the health professionals continue to manually capture clinical notes and other management information on pieces of papers, spread sheets and word documents. The thesis comes to the conclusion that despite widespread use of technology in other sectors, clinicians in hospitals do not use implemented automated systems. Implementation of systems is complex and problems associated with usability are not resolved and that traditional systems implementation methodologies may not apply.
AFRIKAANSE OPSOMMING: Die tesis ondersoek die faktore wat Gesondheidstelsels (HIC) ingewikkeld maak. Die fokus is op a) doeltreffendheid, en b) bruikbaarheid (uit gebruikersoogpunt). ‘n Gevallestudie word gemaak van ‘n stelsel wat onlangs by Chalotte Maxeke Johannesburg Akakdemiese Hospitaal in gebruik geneem is. Die eerste doelwit van die ondersoek was om die ingewikkeldheidsgraad van sodanige stelsels te probeer bepaal, en tweedens om die situasie in die hospitaal self te evalueer. In hoofstauk 1 word die agtergond en aanleiding tot die ondersoek uiteengesite, woel as die metodologiese keuses wat gemaak is. Hoofstuk 2 bied ‘n oorsig oor relevante literatuur ten ospigte van HIC. Dit is duidelik stlselontwikkeling riskant, onnodig duur en koersloos is as dit sonder ‘n duidelike metodologie geïmplementeer word. Verandering vind voortdurend plaas en die implementering van oprasionele doeltreffendheid mag vernadering in besigheidstrategie, informasiestelsels, kennisbestuur en processoriëntasie noodsaaklik maak. In hoofstuk 3 word bruikbaarheid ondersoek. Verskeie mediese instellings het soortgelyke stelsels in gebruik geneem, maar die bruikbaarheid daarvan is steeds onseker. Vir die doeleindes van hierdie tesis is ‘n eie evaluasiemetode ontwikkel en ‘n vraelys op grond daarvan opgestel. Hoofstuk 4 rapporteer die gevallestudie in Charlotte Maxeke Johannesburg Akademiese Horspitaal hospital. Datakolleksie, navorsingsafbakening en – beperkinge, sowel as vraelysresultate word aangebied. Hoofstuk 5 bespreek die implikasies en toepassings van HIC. Dit blyk dat die voordele van die stelsel slegs deur die pasiëntadministrasieafdeling geniet word. Alle ander afdeling gaan steeds voort met papiergebaseerde inligtingstelsels, aangevaul deur ad hoc gebruik van Excel en woordprossering. Die tesis kom tot die gevolgtrekking dat kliniese personeel avers is teen die gebruik van geoutomatiseerde informasiestelsels.

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Pule, Maleshwane Lettie. "Potential prognostic factors for cervical cancer patients undergoing radiotherapy at Charlotte Maxeke Johannesburg Academic Hospital: a retrospective analysis." Thesis, 2014. http://hdl.handle.net/10539/15512.

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Introduction: Although cervical cancer can be prevented through known interventions it still remains a major cause of mortality in developing countries. Currently in South Africa there is little literature on cervical cancer radiotherapy treatment and its prognostic factors. Knowledge of prognostic factors helps in understanding the determinants of a disease better and optimize treatment strategies. The aim of this study was to determine overall survival rate and to investigate potential prognostic factors for cervical cancer in patients who underwent radiotherapy during the period of 1 January 2004 to 31 December 2006 at the Division of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a retrospective cohort study of 900 patients who were treated with radiotherapy between 1 January 2004 and 31 December 2006. Patient and treatment related data was obtained from the hospital treatment records. Follow-up was then censored as of 31st of December 2008. Subjects of this study had either mono-therapy or a combination of therapies: external beam radiotherapy, brachytherapy and chemotherapy. A Cox regression model was fitted to determine the prognostic and predictive factors of cervical cancer. Kaplan Meier methods were used to establish the effect of different socio-demographic and clinic-pathological factors on overall survival. The overall two year survival was also determined. Results: At 2 years post-treatment for each individual patient, 26 out of 900 patients had died, 281 were still alive and 593 lost to follow up leaving 307 patients available for analysis. The overall 2 year mortality rate was 45 per 1000 person years and highest in the period of 0-6 months. In the final model, completion of brachytherapy remained a significant predictor of survival (HR=0.04, 95% CI: 0.01-0.11, p<0.001) after adjusting for all other factors. Furthermore, HIV status was the only significant prognostic factor (HR=3.23, 95% CI: 1.04- 10, p=0.042). Patients who had brachytherapy treatment prescribed and completed the prescription were 96% less likely to die compared to those who didn’t complete it at any point in time, after adjusting for age and HIV status. Patients who were HIV positive were approximately three times more likely to die as compared to HIV negative patients at any point in time after adjusting for age and completed brachytherapy. The overall 2-year survival rate was 92% for this group of patients. Conclusion: Completion of the brachytherapy prescription was a significant predictor of treatment outcome, while the patient’s HIV status was also a significant prognostic factor for treatment. Patients who were HIV positive were three-times more likely to die compared to HIV negative patients. The overall 2-year survival rate was 92%, however, these results need to be interpreted with caution due to the large loss to follow-up in this patient population. Prospective clinical trials are recommended in the future to confirm the validity of the findings of this work in a representative patient population. In addition this work puts forward some suggestions to optimize treatment of cervical cancer patients in typical university teaching public health centres in South Africa.

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Van, Wyk Bronwin Prince. "Analysis of set-up parameters in head and neck patients receiving radiotherapy at Charlotte Maxeke Johannesburg Academic Hospital: a review of current clinical practice." Thesis, 2013. http://hdl.handle.net/10539/12704.

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A dissertation submitted in accordance with the requirements for the degree of Master of Science in the Faculty of Science at theUniversity of Witwatersrand, Johannesburg, 2012.
AIM: This studied aimed at analysing the set-up error (margin) of head and neck cases, treated in a vacuum formed acrylic shell with an in-house immobilisation system. METHODS AND MATERIALS: Two population groups were studied, namely virtual simulated and intensity modulated radiotherapy (IMRT) cases. All cases were treated with the in-house immobilization system, which located centrally, but not longitudinally, to the treatment couch. Verification of the couch position, other than the isocentric angle, was not activated. The virtual simulated cases consisted of two lateral fields with a matched anterior neck field. The borders of these fields were chosen by the radiation oncologist. The IMRT cases were planned by a medical physicist and consisted of 6-9 fields of 3-4 intensity levels each. Digitally reconstructed radiographs (DRRs) of the 2 lateral fields and the anterior neck field for the virtual simulated cases, and the 2 lateral and anterior composite fields at the same isocentre for the IMRT cases, were printed and represented the ideal patient position. On the first day of treatment, megavoltage verification films were taken of the treated or positioning fields respectively. These verification films were compared to the DRRs and approved by a radiation oncologist. The absolute bed position in the vertical (Y), lateral (X) and longitudinal (Z) directions at the time of film approval, was used as the reference or ideal position. The absolute readings of the couch position that were captured daily over the course of treatment were then compared to the initial couch position to give an indication of the systematic and random errors. One linear accelerator was used in this study and weekly mechanical quality control (QC) was performed on it. RESULTS: The total number of daily fractions (F) studied in this thesis was 5644 and 600 for virtual simulated and IMRT cases respectively. The systematic error of this population was 4.7 and 4.4 mm for the virtual simulated and IMRT cases respectively. This compares well with published results using a similar immobilisation system. The random error of this population was 7 mm and 6.1 mm for the virtual simulated and IMRT cases respectively. This is three times larger than the results reported in the literature (using a similar immobilization device). CONCLUSION: Offline monitoring of couch position provides insight into setup margins and this can contribute to realistic institutional planning target volumes. Better results were obtained in the IMRT cases and this could be due to the requirement for weekly verification imaging. Lack of radiation therapist vigilance and insufficient training were most likely responsible for the individual cases with systematic variations of larger than 3 cm. The data confirm that the immobilisation system can be located to a fixed position on the tabletop; this will allow online verification of absolute bed position for treatment and further decrease the chance of incorrect setup.

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Nobecu, Lazola Jethro. "Cobalt teletherapy small field dosimetry." Thesis, 2017. http://hdl.handle.net/10539/23465.

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A research report submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in the field of Medical Physics. 2017
Aim The aim of this research was to contribute to clinical implementation of the small field dosimetry Code of Practice (CoP) that is due to be published by the International Atomic Energy Agency (IAEA) in collaboration with the American Association of Physicists in Medicine (AAPM) (1). A 6 cm × 6 cm virtual machine-specific reference (fmsr) field was established in a clinical 60Cobalt teletherapy beam used for conventional radiotherapy at Charlotte Maxeke Johannesburg Academic Hospital, and relative output factors were measured down to a set field size of 1 cm × 1 cm using three different models of Physikalisch-Technische Werkstatten (PTW) small field ionization chambers. Materials and Methodology The measurements were all performed on a Cobalt teletherapy unit (MDS Nordion Equinox, S/N 2009) in a PTW MP3 water phantom. The small field ionization chambers that were used were a PTW 31016 3D pinpoint 0.016 cm3, a PTW 31006 pinpoint 0.015 cm3 and a PTW 31010 semiflex 0.125 cm3. A calibrated PTW 30013 Farmer 0.6 cm3 ionization chamber was used to provide traceability for the cross calibration. A ―daisy chain‖ methodology was used to perform the cross calibration in a virtual fmsr field of 6 cm × 6 cm and then establish the absolute dose rate in a 4 cm × 4 cm field. Relative output factors as a function of field size were measured with each small field ionization chamber and then compared to published results. Results Small square fields from a 60Cobalt beam were created using the secondary collimators integrated into the unit. Equivalent square fields were calculated using the profiles obtained by the three ionization chambers during scanning and were in agreement with the ones that were programmed into the console. The coincidence of the central axis of the beam and the point of measurement for each detector was determined from the beam profiles. The cross calibration and daisy chain measurements resulted in a consistent dose rate of within + 0.6% in the 4 cm × 4 cm field when measured with the four different ionization chambers. For 6 cm × 6 cm, 4 cm × 4 cm, 3 cm × 3 cm and 2 cm × 2 cm field sizes, relative output factors obtained from the uncorrected detectors’ response agreed to within + 0.8 % between the three small field ionization chambers. The variation in the 1 cm × 1 cm field size was + 8.1 %. When compared to published data, large differences in field size correction factors were obtained. Conclusion Small field dosimetry in a 60Cobalt photon beam using three different PTW small field ionization chamber models was investigated. A cross calibration in a virtual msr field was done followed by a daisy chain process to determine the dose rate in a small field. Dose profiles and relative output factors were then measured and compared. The lack of lateral charge particle equilibrium and volume averaging effect was evident when using the PTW 31010 semiflex chamber in a 1 cm × 1 cm field. The PTW 31006 pinpoint and 31016 3D pinpoint were in close agreement for field sizes down to 1 cm × 1 cm with the 3D pinpoint performing as the best detector in this study. The optimal positioning of a detector should be determined from beam profile scans and not the engineering diagrams. The PTW 31016 3D pinpoint and PTW 31006 pinpoint are recommended for the determination of output factors in small field sizes. However, field output correction factors are required for both detectors in field sizes under 2 cm × 2 cm. Small field data published in the British Journal of Radiology (BJR) Supplement 25 (2) should not be used to benchmark dosimetry in modern 60Cobalt teletherapy units.
MT 2017

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Naidoo, Sudeshen Manickum. "Pattern of practice for palliative radiotherapy in oesophageal carcinoma - a retrospective analysis at Charlotte Maxeke Johannesburg academic hospital (2007-2012)." Thesis, 2016. http://hdl.handle.net/10539/21383.

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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 the branch of Radiation Oncology Johannesburg, 2016
Purpose: To assess the improvement in swallowing status, overall survival and treatment related complications in patients with Carcinoma of the Oesophagus treated with palliative radiotherapy. Methods: A retrospective analysis of patients with advanced squamous cell carcinoma of the oesophagus who were treated for palliation from May 2007 to June 2012 at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was done. Ninety- nine patients received palliative radiation therapy during this period, 63% were male and 37% female with a mean age of 60, 6 years. The predominant site of lesion was middle 3rd (56%) and 86, 9% of patients had lesions more than 5cm in length. Patients received palliative External beam irradiation (EBRT) with or without High dose rate brachytherapy (HDRBT) as per the CMJAH, Department of Radiation Oncology protocol. Results: There was an overall significant improvement in swallowing status (p<0,001). Eighty –four patients (85%) had an improvement in swallowing score after treatment. The effect of treatment was not significant in the relationship between the change in swallowing status and treatment group. Overall mean time to progression was 3, 7 months. The median overall survival was 7, 7 months. The type of treatment did not affect survival significantly, unadjusted (p=0, 31) or adjusted for prognostic parameters (age, sex, length of lesion, site of lesion, and pre-treatment swallowing status) (p=0.29). There were treatment related complications in 32% of cases, consisting of ulcerations (24%), tracheo- oesophageal fistula (5%) and strictures (3%). Conclusion: In patients with advanced squamous cell oesophageal carcinoma, palliative radiotherapy is an effective modality in improving a patient’s dysphagia and thus quality of life.
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Mudi, Abdullahi. "Renal side effects in children who have completed treatment for childhood cancers at Charlotte Maxeke Johannesburg Academic Hospital, South Africa." Thesis, 2015. http://hdl.handle.net/10539/17515.

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Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Medicine. Johannesburg, 2014
Background: The causes of renal dysfunction in children treated for childhood cancers are multifactorial and clinical manifestations of dysfunction include hypertension, proteinuria and varying degrees of renal insufficiency. This study aimed to determine the different residual effects of cancer therapy on the renal system and factors associated with the residual effects in children treated for childhood cancers. Patients and Methods: The study was a descriptive cross sectional study that assessed 130 children, between the age of 1 and 18 years, who had completed treatment at Charlotte Maxeke Johannesburg Academic Hospital and were being followed up at the paediatric oncology clinic of the hospital. Results: After a median follow-up post treatment of 2 years, the various manifestations of renal dysfunction identified in the survivors included; decreased GFR, hypomagnesaemia, hypophosphataemia, proteinuria, haematuria and hypertension. In total, 34 survivors (26.15%) had at least one manifestation of renal dysfunction after completing treatment. The most prevalent manifestation of renal dysfunction detected was decreased GFR (17.69%). Hypomagnesaemia and hypophosphataemia were present in 8 (6.15%) and 6 (4.62%) of the survivors respectively. Patients who had renal dysfunction pre-treatment were three times more likely to have renal dysfunction post-treatment. Ifosfamide, Carboplatinum, and nephrectomy were significantly associated with a reduction in GFR Conclusion: A significant number of the survivors had a decreased GFR while some of them had hypomagnesaemia and hypophosphataemia. There was a strong association between pre-treatment and post-treatment renal dysfunction. These findings are very important in terms of decision making for individual patients with respect to selecting treatment modalities and dosages and also with respect to instituting nephro-protective measures to avoid further damage to the kidneys during and after treatment.

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Ndumbalo, Jerry Rogers. "Incidence and treatment of hypercalcemia in cancer patients receiving radiotherapy: a retrospective review of practice at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 2012 to 2015." Thesis, 2018. https://hdl.handle.net/10539/25294.

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A research report submitted to the Faculty of Medicine in a partial fulfillment of the requirements for a degree of Master of Medicine in the specialty of Radiation Oncology (MMED Rad Onc) at the University of the Witwatersrand, Johannesburg October, 2017.
Background: Cancer induced hypercalcemia (CIH) is the most frequent metabolic oncologic emergency and occurs in up to 44.1% of all cancer patients at some time in their disease course. It occurs in patients with both solid and hematologic malignancies. CIH occurs mostly in patients with advanced cancer and is an indicator of poor prognosis. Timely diagnosis and intervention is lifesaving and also may enhance patient compliance with primary and supportive treatment and quality of life. This study aimed to describe the incidence, clinical patterns and treatment outcomes of hypercalcemia in cancer patients receiving Radiation therapy in Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg. Materials and Methods: This was a retrospective descriptive study, 125 patients who were admitted at the Radiation oncology ward CMJAH for hypercalcemia management from January 2012 to December 2015, were analyzed. Demographic data, relevant clinical information such as Stage of the disease, type of cancer, level of hypercalcemia, toxicity and Response to the treatment were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS_version 23). The incidence of hypercalcemia, clinical patterns, treatment outcomes and toxicities were evaluated. The study was approved by the Human Research Ethics Committee medical (HRECM) of the University of Witwatersrand with Clearance certificate number M140546. Results: Of the 125 patients analysed, males to females ratio was 1:1. The most frequent site of primary cancer diagnosis in patients with hypercalcemia was gynaecological malignancies 31 (24.8%), followed by head and neck cancers 23 (18.4%), prostate 19 (15.2%), breast cancer 17 (13.6%), gastrointestinal malignancies 12 (9.6%), multiple myeloma 5 (4%), lung cancer 3 (2.4%) and other malignancies 15 (12%). Most patients had metastatic disease and uncontrolled primary disease 78 (62.4%) compared to primary controlled disease 47 (37.6%). Bone metastasis were present in 51 (41%) of patients. Clinical presentation of patients with hypercalcemia was mainly Neuromuscular 41 (32.8%), nausea/vomiting 37 (29.6%), Polyuria 20 (16%), mental 16 (12.8) and Polydipsia 9 (7.2%). Most of patients had severe hypercalcemia with pre-treatment corrected serum calcium level of > 2.9 mmol/L 77 (61.6%), 28 (22.4%) had Corrected serum Calcium between 2.71-2.89 mmol/L and 20 (16%) had corrected serum calcium between 2.56-2.70 mmol/L. One hundred and four patients (83.2%) received hydration + bisphosphonates and 21 (16.8%) of patients received hydration alone and non-received haemodialysis. One week post treatment majority of patients had ≤2.55 mmol/L Serum level of Calcium 81 (64.8%), 11 patients (8.8%) had serum level of calcium 2.56-2.71 mmol/L, 23 patients (18.4%) had serum calcium between 2.71-2.89 mmol/L and only 10 patients (8.0%) had serum level of calcium ≥2.9 mmol/L. The corrected serum calcium was 2.4770 ± 0.34512 mmol/L one week after treatment. One month post treatment majority of patients 99 (79.2%) remains to have normal serum level of calcium ≤2.55 mmol/L and only about 11 (8.8%) patients had ≥2.9 mmol/L. Forty four patients (35.2%) had relapse in 33 days (median) time and were subsequently treated with hydration and bisphosphonates. As the patients were enrolled from radiation oncology ward, most were treated with either radiation alone 72 (57.6%) or Concurrent chemo radiation 15 (12.0%) as treatment modalities for their primary cancer. Patients who received chemotherapy first and then radiotherapy for the treatment for their primary cancer were 37 (29.6%). Fourteen (58%) patients with pre-treatment calcium level of 2.56-2.70 mmol/L received hydration alone and 76 (98%) of patients with serum pre-treatment calcium of ≥2.9 mmol/L were treated with hydration + bisphosphonates (P=0.001). Side effects to bisphosphonates were mainly gastrointestinal: Nausea/vomiting 42 (33.6%) patients, Constipation 14 (11.2%), abdominal pain 13 (10.4), Diarrhoea 11 (8.8) and anorexia 1 (0.8) patients. Other toxicities reported were fever 12 (9.6%) patients and hypocalcaemia 14 (11.2%). Eighteen patients (14.4%) did not report any side effect to treatment. Conclusion: Hypercalcemia of malignancy is a common finding in patients with advanced stage cancers. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and patients are therefore usually symptomatic. For acute management of hypercalcemia, rehydration is the mainstay of treatment because all patients tend to have dehydration. Bisphosphonates are potent calcium lowering agents, but they require careful administration and are contraindicated in patients with declined renal function. Common bisphosphonates toxicities are mainly gastrointestinal: Nausea/vomiting, constipation, abdominal pain, diarrhoea and anorexia. Other toxicities reported were fever and hypocalcaemia.
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Nascimento-Fonseca, Sandra Marques. "Outcomes of patients with stage IB1 and IB2 Cervical Cancer who have had Wertheim's Hysterectomies with or without adjuvant chemo-radiotherapy as primary treatment at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2018. https://hdl.handle.net/10539/25267.

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A research report submitted to the University of the Witwatersrand in partial fulfilment for the degree of Master of Medicine 2016.
Background Cervical cancer is the 3rd most common female malignancy worldwide. It is classified and managed according to stage as defined by the FIGO Committee on Gynaecology Oncology classification of 2009. Stage specific treatment is tailored according to prognosis and risk of recurrence as determined by tumour type, tumour size, tumour grade, lymph node metastases, lymphovascular space involvement (LVSI), parametrial spread and presence of any other metastatic deposits at presentation. This study only concentrated on patients who presented with Stage IB1 and 1B2 tumours managed by Class III / Meig’s Radical / Wertheim’s hysterectomy and bilateral pelvic lymphadenectomy. Aims Primary Outcome 1. Assess disease free interval and overall survival 2 years post-operatively. Secondary Outcomes 1. Assess adequacy of patient selection 2. Assess risk factors for recurrence 3. Compare recurrence risk of HIV positive patients versus HIV negative patients. 4. Determine surgical and post-surgical complication rate. Materials and Methods This was a retrospective institutional cohort study conducted at the Charlotte Maxeke Johannesburg Academic Hospital. All patients with Stage IB1 or IB2 cervical cancer treated with Wertheim hysterectomies between 2002 and 2012 were included. Surgical records, histology records, further postoperative management records and gynaecological outpatient follow up records were used to collect data for the patients. Histological findings post-operatively determined further management. Surgical margins had to be 10mm clear of tumour with no positive lymph nodes otherwise external beam radiotherapy and brachytherapy or chemo-radiotherapy were recommended in addition to primary surgical management. Results Of the 72 patients initially identified, 69 patients were suitable for study inclusion. The mean age of the study population was 45 years. Study population racial distribution: 68.12% were Black, 26.09% were White, 2.9% were Coloured and 2.9% were Indian. Average parity and gravidity of patients alive at the end of the study was 2.86 and 3.56; while average parity and gravidity of patients deceased at the end of the study was 2.5 and 2.8 respectively. Study population ECOG status: 16% were ECOG 0, 83% were ECOG 1 and 1% were ECOG 2. Overall survival at the end of the study was 86% and patients were disease free postoperatively for an average of 5 years. Thirty three percent of the patients were disease free for more than 5 years. Preoperative clinical staging and postoperative histological staging correlated only in 61% of cases. Correct management by Wertheim’s hysterectomy was rendered to 75% of patients whereas the remainder were incorrectly managed and should have had either a simple hysterectomy with no pelvic lymphadenectomy or radiotherapy only as primary therapy. More advanced stages, tumours ≥ 4cm, adenomatous cell type, > 5mm depth of invasion, >7mm lateral spread, higher number of nodes positive for metastatic disease, surgical margins  10mm, positive lympohovascular space, parametrial and pouch of Douglas (POD) involvement were factors that had a poorer prognosis with regards overall survival, disease-free interval or both. Poorly differentiated tumours were more likely to recur but did not have a poorer prognosis compared with regards to overall survival or disease free interval at 2 or more years compared to well and moderately differentiated tumours. Mortality of HIV reactive patients was 16.7% compared to 12.5% for HIV non-reactive patients. This difference was not statistically significant at the 95% confidence level. HIV status also did not increase risk of recurrence. Lower CD4 counts were shown to have a lower disease-free period and overall survival. Intra-operative surgical complication rate was 6%. Immediate post-operative complication rate was 16%. Of the patients who required DXT or DXT and chemotherapy 33% had side-effects or complications from adjuvant therapy. Patients treated with DXT and chemotherapy had had more side-effects than those treated with DXT only. Conclusion The mean age of the study population was 45 years. This was lower compared to other larger studies possibly due to younger presentation related to HIV disease. HIV positive patients with lower CD4 counts were shown to have poorer prognosis with regards to survival. HIV status was not shown to be a risk factor for recurrence. The overall survival and disease-free period at 5 years was similar to that of other international studies. Only two thirds of the patients were adequately selected for surgery according to the institution’s criteria for a Wertheim’s hysterectomy and therefore it may be necessary to reconsider the pre-operative assessment of these patients. More advanced stages, tumours ≥ 4cm, adenomatous cell type, poor differentiation, > 5mm depth of invasion, >7mm lateral spread, higher number of nodes positive for metastatic disease, surgical margins ≤ 10mm, positive lympohovascular space, parametrial and pouch of Douglas involvement were factors that had a poorer prognosis with regards to recurrence, overall survival and disease-free interval. However, the rates of recurrence were not statistically significant at a 95% confidence level.
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Godinho, Lee-Anne. "Clostridium difficile infection at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2016. https://hdl.handle.net/10539/25686.

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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 Internal Medicine 2016, Johannesburg
Background and objectives: In recent years, Clostridium difficile infection has become more common and more resistant to therapy resulting in significant in-patient morbidity and mortality. The aim of this study was to describe the characteristics of patients with Clostridium difficile infection at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Methods: This was a retrospective analysis of the records of 154 adult in-patients with confirmed Clostridium difficile infection on stool samples during the period 1 January 2013 to 30 June 2014. Patient demographics, clinical presentation, risk factors, HIV status, treatment, severity indicators and outcomes were analysed. Patients were catagorised as having either healthcare-associated or community-acquired Clostridium difficile infections. HIV-positive patients were compared with HIV-negative patients and the survivors were compared with the non-survivors. Results: Overall, 83 (53.8%) patients were female and the median age was 39 years (Interquartile range: 31-52). The most common symptom was watery diarrhoea (92.9%) followed by fever (27.3%). Overall, 145 (97.9%) patients had been exposed to antibiotics in the last 30 days, 54 (35.1%) to immunosuppressives, 48 (31.2%) to gastric acid suppressants and 65 (42.2%) patients had previous hospital admissions. In total 73 (47.4%) patients died. Only two cases of community-acquired Clostridium difficile infections were identified. There was no difference in outcomes of HIV-positive patients compared to HIV-negative patients. The non-survivors tended to have a greater number of severity indicators compared to the survivors. Conclusion: Patients with Clostridium difficile infection in this study were younger than expected with a higher mortality than that reported in the Western world. The number of iv community-acquired Clostridium difficile infections was less than reported in previous studies.
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Mofokeng, Salamina Mathabo. "Outcomes of retinal detachment surgery at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2018. https://hdl.handle.net/10539/25422.

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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 the branch of Ophthalmology. Johannesburg, 2018.
Purpose: The aim of this study was to determine the visual acuity and anatomical outcome of retinal detachment repair at Charlotte Maxeke Johannesburg Academic hospital. Methods: Retrospective record review (clinical audit) of outcomes in patients who had retinal surgery (pars plana vitrectomy) for either rhegmatogenous retinal detachment or diabetic retinal detachment (tractional detachment or combined tractional and rhegmatogenous detachment) at Charlotte Maxeke Johannesburg Academic hospital during the period from 1 January 2010 to 31 December 2014. Results: During the specified time period 941 pars plana vitrectomies (including repeat surgery) were performed at the hospital. After exclusion for indications other than retinal detachment repairs and for missing or incomplete records, a total of 164 records of 164 patients were reviewed. The patients were divided into two groups: a rhegmatogenous retinal detachment group (n=99) and a diabetic retinal detachment group (n=65). Rhegmatogenous retinal detachment Ninety nine patients with rhegmatogenous detachment were included in the study, 62% male and 38% female. The mean age (± standard deviation) was 48(±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37 % and 21% of all causes respectively. Sixty three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty three eyes (84%) obtained vision improvement or stabilization and retinal attachment. Forty eyes (40%) had visual acuity improvement, 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% (n=92) of eyes including those that needed a repeat surgery. Diabetic retinal detachment Sixty five patients with diabetic retinal detachment were included in the study. Sixty three percent (n=41) were males and the mean age (± standard deviation) was 54± 12.2 years. Sixty eight percent (n=44) had tractional retinal detachment and 32% (n=21) had a combined tractional and rhegmatogenous retinal detachment. Thirty two percent of patients had detachments associated with vitreous haemorrhage, and 60% had macular involving detachments. Forty six eyes (71%) obtained vision improvement or stabilization and attachment of the retina; 36.9% (n=24) had visual acuity improvement, 33.9% (n=22) retained the same visual acuity and 29.2% (n=19) lost vision. Eighty five percent (n=55) had successful anatomical reattachment of the retina and 15% (n=10) had re-detachments after surgery. Conclusions: This study found that the majority of patients, whose files were reviewed, benefited from surgical intervention for rhegmatogenous and diabetic retinal detachment in terms of stabilisation or improvement of vision. The major limitation of this study is the large number of missing or incomplete records. The results of this study are therefore not generalisable to our retinal detachment patient population.
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Diana, Nina Elisabeth. "A study of measles in adults at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2015. http://hdl.handle.net/10539/18515.

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A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine Johannesburg 2015
childhood illness, there are an increasing number of cases occurring in adults. Objectives The objectives were to describe the clinical characteristics and outcomes of adult patients admitted with measles and to compare these parameters in HIV-seropositive and HIV-seronegative cases. Methods A retrospective record review of adult patients confirmed to have measles admitted to the Infectious Disease Unit at Charlotte Maxeke Johannesburg Academic Hospital from 1 October 2009 to 31 March 2010 was conducted. Data collected included demographic, clinical, laboratory, radiographic parameters, and outcomes. HIV-positive and HIV-negative patients were compared with respect to the above parameters. Results Overall 33 patients were included in this analysis, of whom 18 (54.5%) were female, all were of black African descent and their mean age was 27.8 ± 5.8 years. Median duration of symptoms was 4 days (range 1 – 7 days). All patients had a morbilliform rash and conjunctivitis on presentation. Twelve patients (36.4%) had a clinical course complicated by pneumonia. Six of these patients (18.2% of the total group) were admitted to ICU/High care; three of whom developed respiratory failure requiring mechanical ventilation, and acute kidney injury. Other complications included purulent conjunctivitis (3%), pancreatitis (3%) and encephalitis (3%). Median length of hospital stay was 3 days (range 1 – 31 days). Three patients (9.1%) demised. A total of 24 patients were tested for HIV infection and 18 tested seropositive. More female patients tested positive for HIV infection. HIV-infected patients had a longer length of hospital stay (p = 0.03). Conclusion Measles continues to cause morbidity and mortality in adult patients. More severe consequences occur in HIV-positive patients.

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Jardine, Carla. "The use of Nasal CPap at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24738.

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This research report is submitted in partial fulfilment of the requirements for the degree of Master of Medicine in the Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg April 2015.
Inroduction: Nasal continuous positive airway pressure (NCPAP) is well established as a treatment for hyaline membrane disease (HMD) and other respiratory diagnoses in neonates. NCPAP is an affordable intervention which results in a reduction in the number of neonatal admissions to the intensive care unit (ICU) for ventilation. At the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) we have been using NCPAP since April 2006. Objectives: The aim of this study was to review the use of early NCPAP in our hospital setting. Methods: This was a retrospective descriptive study of all neonates ≥ 750g admitted to CMJAH between 1st January 2013 and 31st July 2014 who received NCPAP within 72 hrs of birth. The characteristics and the survival of all infants who received NCPAP was described using univariate analysis. Results: The NCPAP group (481) of neonates <1500g was significantly associated with surfactant use (p<0.0005), bronchopulmonary dysplasia (BPD) (p<0.0005) and late sepsis (p<0.0005). The survival to day 7 and to discharge of infants treated with NCPAP was significantly decreased (p<0.0005). NCPAP alone (without ventilation), improved the survival to discharge (p=0.001). The survival was 95.4% in the ≥1500g infants, compared to 87.6% in the very low birth weight (VLBW) infants (1000-1499g) and 55.2% in the extremely low birth weight (ELBW) infants (750-999g). Conclusion: NCPAP is an effective intervention for HMD; it is both cost effective and easy to use in a resource limited setting and reduces the morbidity and mortality associated with ICU admission.
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Onimonde, Yetunde Ajoke. "Audit of paediatric renograms performed at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2011.

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A research report submitted to the Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Nuclear Medicine. Johannesburg 2011
Paediatric Nuclear Medicine is associated with a high preponderance of nephro-urological investigations. This preponderance has been attributed to the relatively higher occurrence of urinary tract infections and their sequelae in children, as well as to improved antenatal detection of anomalies of the genitor-urinary tract. Nuclear Medicine is involved in the management of these children to assist with diagnosis, clinical decision-making and follow-up of global and relative renal function. As such, these scans need to be carried out as efficiently as possible. International protocols established by the European and American societies of Nuclear Medicine have been formulated to aid the Nuclear Medicine technologist and physician in performing these procedures and interpreting them correctly. Audits of Nuclear Medicine practice are performed in order to assess compliance with these guidelines. A clinical audit has been defined as “a systematic and critical analysis of the quality of medical care, including procedures for diagnosis and treatment.” An audit of the renal paediatric procedures carried out in the Division of Nuclear Medicine at the Charlotte Maxeke Johannesburg Academic Hospital was performed retrospectively on studies carried out from January 2006 - December 2009, as well as a prospective study of procedures from February – July 2010. Results showed overall conformity to most of the recommended practices of the EANM guidelines. As occurs in most institutions, each institution may adapt guidelines to comply with local circumstances.

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Mosehle, Setheme Daniel. "Invasive cancer of the vulva at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014. http://hdl.handle.net/10539/15082.

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Lownie, Claire Nicolette. "An audit of the surgical load at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2011.

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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 Science in Medicine in the field of Emergency Medicine Johannesburg 2011
The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) has a trauma unit which consists of the emergency treatment / resuscitation area, an Intensive Care unit (ICU) and a trauma ward. For non-trauma surgical admissions, a different management system is in place. There is a general medical emergency area where surgical patients are triaged and assessed then sent on for admission to the wards and / or operation as required. Currently the structures described necessitate a total of at least 4 medical officers and 2 registrars on duty in the hospital in addition to consultants and other staff on call from home. The potential exists for the unacceptably frequent rostering of doctors on call and therefore in terms of total hours worked by each. With a view to optimising the existing human resources and improving the quality of patient care by reducing the number of working hours of the doctors, an audit of the surgical workload inclusive of trauma at CMJAH was undertaken. The number of admissions and operations, both elective and emergency, were captured, for the trauma unit and three surgical wards at CMJAH for the 2009 calendar year. Total emergency admissions to all four wards combined were 13032 of which 86.1% were trauma admissions. An average of 15 patients per week (sometimes many more) were operated in the trauma unit. The burden of trauma is extremely heavy compared to that of the other surgical units. An important suggestion would be to look at restructuring the existing resources into a more organised system of practice such as an Acute Care Surgery Unit thus optimising both emergency and non-emergency care of surgical patients.

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Kalimba, Edgar Mutebwa. "Survival of extremely low birth weight infants at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014.

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DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR A MASTER OF MEDICINE DEGREE IN PAEDIATRICS AND CHILD HEALTH (MMED PAED)
Survival of extremely low birth weight (ELBW) infants in a resource limited public hospital setting is still low in South Africa. The study aimed at establishing the determinants of survival in this weight category of neonates who, due to limited intensive care facilities, were not mechanically ventilated.

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Ziki, Joyce Tukayi. "Malignancy in renal transplant recipients at Charlotte Maxeke Johannesburg academic hospital: 1990-2010." Thesis, 2016. http://hdl.handle.net/10539/22550.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Internal Medicine Johannesburg, August 2016
Introduction Post transplant malignancy (PTM) is a recognized long term complication in renal transplant recipients. Many studies have been conducted on this group of patients over the last 50 years to assess the impact of various immunosuppressant drug regimens, geographical locations, ethnicity, and age at the time of transplant on the risk of developing a PTM. The incidence of PTM has been shown from these studies to vary from 3% to 11%. Many inconsistencies exist in these studies, but the one common finding is that the incidence of malignancy is increased in renal transplant recipients compared to the general population. Aims and Objectives The objectives of this study were to determine the incidence of PTM at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in the period from 1990 to 2010; to calculate the mean time to diagnosis of PTM; determine the association of PTM and immunosuppressive drug regimens and identify risk factors associated with developing a malignancy post renal transplant. Methods The study design was a retrospective review of the medical records of patients transplanted between 01/01/1990 and 31/12/2010 at CMJAH, South Africa. All recipients above 18years of age transplanted during this study period were included in the review. All recipients who rejected, died or were transferred to other centres within six months of transplantation were excluded. A total of 668 records were included in this study for analysis. Information retrieved from the files included patient demographics (age at transplantation; gender; ethnic group, year of transplantation), aetiology of end-stage renal disease, the source of graft, the number of times treated for rejection, oncogenic viruses diagnosed, immunosuppressant regimens and outcomes of the recipients. For those recipients who developed a malignancy, the time from transplantation to diagnosis of cancer was calculated and the histological diagnoses documented. Results The incidence of PTM in this study was 7.0% (95% CI 5.2-9.4) for the era under review. The cumulative incidence of cancer from transplantation increased with follow-up time. The mean time to diagnosis of malignancy was: 3.4 years, 6.6 years, 7.4 years and 8.1 years for Kaposi Sarcoma (KS), post transplant lymphoproliferative disorder (PTLD), skin and solid organ malignancy, respectively. The distribution of post transplant malignancy (PTM) was skin cancers 44.7%; KS 23.4%; PTLD 14.9%; solid organ tumours 17.0 %. The recipients who developed cancer were significantly older at transplantation with a mean age of 42.9 years compared to those without PTM whose mean age was 36.3 years. Age and year of transplantation period 1996-2000 were independent risk factors for developing a malignancy in this cohort. Discussion There was no change in the incidence of PTM at CMJAH, occurring in 7% of the transplant recipients in the period of review (1990-2010) compared to 7.0% reported for the period 1966-1989, despite the change in the demographic patterns of the patients, immunosuppressive regimens and improved surveillance for cancers. No individual immunosuppressant drug appears to pose a risk for cancer significantly, instead, the prolonged general state of immune suppression in this group of patients seems to be the main risk factor of note. Recipients transplanted at an older age and those with long post renal transplantation follow-up should be closely monitored and routine surveillance for cancers done.
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Naidu, Kershlin. "Anaemia and heart failure: a retrospective study at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2013. http://hdl.handle.net/10539/12744.

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INTRODUCTION Anaemia has been associated with adverse outcomes in patients with chronic congestive cardiac failure in numerous international studies. There is a lack of local studies assessing the relationship between anaemia and heart failure. AIMS  To define the prevalence of co-morbid anaemia in patients attending the Heart Failure Clinic at Charlotte Maxeke Johannesburg Academic Hospital.  To evaluate the relationship between anaemia and severity of heart failure.  To compare anaemic and non-anaemic patient variables.  To define the aetiology of heart failure in patients attending the Heart Failure Clinic at Charlotte Maxeke Johannesburg Academic Hospital. METHODOLOGY This is a single centre retrospective study of patients attending the Charlotte Maxeke Johannesburg Academic Hospital Heart Failure Clinic from January to June 2011. The patient files were analysed specifically for the presence of anaemia, New York Heart Association (NYHA) functional class, furosemide dose, six minute walk test and Minnesota Living with Heart Failure Questionnaire score. In addition, demographic data (age, gender) and the aetiology of heart failure were recorded. Anaemia was defined by the World Health Organisation (WHO) criteria of a haemoglobin level <13 g/dl in men and < 12g/dl in women. The control group consisted of participants attending the clinic who were not anaemic. The two groups were compared using: a) Participant’s symptom scores; using the Minnesota Living with Heart Failure Questionnaire (MLHFQ - Appendix B). b) Objective measurements of the participant’s state of health:  Six minute walk test  Dose of furosemide (Lasix)  New York Heart Association (NYHA) functional class RESULTS A total of 282 files were reviewed over 6 months from the Heart Failure Clinic at Charlotte Maxeke Johannesburg Academic Hospital. Sixty-two files were excluded from the study due to lack of study data recorded in the file. Data was collected and entered into a database which was analysed using the Statistics/Data Analysis Program (STATA) Version 10.0. Mean age of the study group was 59.8 years (SD±12.2), with the youngest subject aged 22 years and the oldest 91 years. The mean haemoglobin concentration was 13.79 g/dl (SD±1.96). The mean haemoglobin in men was 13.83 g/dl (SD±1.97) and in females the mean haemoglobin was 13.79 g/dl (SD±1.96). The overall prevalence of anaemia in the sample population was 21.4% (47 anaemic patients). The prevalence of anaemia in males and females was 15.8% and 26.1% respectively. Seventy-two patients (32.7%) had ferritin levels recorded and one patient (0.01%), who happened to be female, was iron deficient based on serum iron studies (Ferritin < 15 μg/L). None of the male subjects was iron deficient. An insignificant inverse relationship between haemoglobin concentration and Minnesota score (p=0.452) was found. No correlation was found between haemoglobin concentration and furosemide dosage in this study (p=0.123). Analysis of haemoglobin concentration and the six minute walk test yielded a positive correlation which was statistically significant (p=0.001). The Analysis of Variance Test (ANOVA) showed a significant association between the haemoglobin level across the different NYHA functional classes (p=0.03). The prevalence of anaemia in NYHA class I, II and III was 9.2%, 12.1% and 51.7% respectively. None of the subjects were documented as being NYHA functional class IV. DISCUSSION The overall prevalence of anaemia in this study was 21.4%, which is consistent with international studies. Although an inverse relationship between haemoglobin concentration and Minnesota score was found, it was statistically insignificant (p=0.452). Lower haemoglobin levels are associated with higher Minnesota scores which reflect greater severity of heart failure based on patient’s symptoms. Anaemic patients with heart failure are more likely to have poorer quality of life scores. The finding of a positive correlation between haemoglobin concentration and the six minute walk test confirms that higher haemoglobin levels are associated with better effort tolerance and lower severity of heart failure, which is consistent with many international studies. No correlation was found between haemoglobin concentration and furosemide dosage in this study (p=0.123). One would have expected higher doses of furosemide with lower haemoglobin levels as higher furosemide doses are associated with more severe heart failure. The reason for this discrepancy is probably due to the fact that many of the patients in the heart failure clinic are treated with other diuretics (eg. spironolactone, hydrochlorothiazide) in addition to furosemide. The statistically significant association between NYHA functional class and haemoglobin supports the findings that anaemia is associated with poorer functional class. Patients classified as NYHA III had a mean haemoglobin of 11.9 g/dl, whereas NYHA I patients has a mean haemoglobin of 13.98 g/dl. The highest prevalence of anaemia (51.7%) was found in NYHA class III patients. Dilated cardiomyopathy was the commonest cause of heart failure (34.1%) followed by hypertensive heart disease (21.4%), ischaemic heart disease (18.6%) and alcoholic cardiomyopathy (8.6%). CONCLUSION The findings of this study confirm that anaemia is common in heart failure patients. The study also found anaemia to be more prevalent in patients with more advanced heart failure, thus making anaemia a potential prognostic factor in patients with heart failure.

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Senyolo, Mosha Piloane. "Facilities Management Strategy: A case study of the CHARLOTTE MAXEKE JOHANNESBURG ACADEMIC HOSPITAL." Thesis, 2018. https://hdl.handle.net/10539/26777.

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A research report submitted to the Faculty of Engineering and the Built Environment, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Building (Property Development and Management), 2018
In healthcare facilities, the Facilities Management Unit (FMU) generally advances the operational and managerial activities that provide support to the core clinical and medical diagnostic services. There is a knowledge gap within the field of healthcare Facilities Management (FM) regarding the appropriate strategy suited for South African public hospital facilities, from the structure through to the planning processes and measurement of service performance. The purpose of the study is to identify the existence of a documented FM strategy through a single case study approach at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to add empirical evidence to this subject. The main objectives are to gain insight into the arrangement of the FM strategic adoptions at CMJAH and to propose an FM strategy guideline in a South African public tertiary hospital context. By way of a mixed research approach, the data was collected through the administration of open-ended questionnaire surveys measured through descriptive statistics, content analysis of FM archives and supporting interviews. A total of 400 open-ended questionnaires were distributed among the selected patient sample, and 333 completed questionnaires were returned. Three and five respondents were targeted for interviews from the hospital’s FM department, equivalent to senior and middle management, respectively; only two responses were received from the senior management. The significant findings of the study indicate that the practice of FM in the CMJAH does not compare satisfactorily with the general best practice methods of the profession. Drawing on a theoretical analysis, in addition to input from the case study, an FM strategy guideline comprising eight stages was developed to assist the CMJAH to achieve best practice FM processes. A recommendation is made among other academics for further research to be conducted to validate the framework in similar public hospital institutions.
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Tsabedze, Nqoba Israel. "Periprocedural myocardial infarction following percutaneous coronary intervention at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24773.

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Original published work submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine (Internal Medicine) 18 October, 2017.
The very first coronary artery balloon angioplasty is reported to have been performed by Gruntzig in 1977.1 Subsequently to this, over the past 40 years, there have been significant advances in coronary angiography and intervention. Coronary artery interventional techniques have evolved and improved significantly. There have been considerable device developments, new generation stents and novel antiplatelet therapy which have all proved to reduce the incidence of the primary periprocedural complications associated with percutaneous coronary intervention (PCI). [No abstract provided. Information taken from introduction]
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Muhammad, Aminu Sakajiki. "Cardiovascular risk profile of kidney transplant recipients at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014.

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INTRODUCTION Cardiovascular diseases (CVD) are more common in kidney transplant recipients (KTRs) than in the general population. The high incidence of CVD in the KTRs can be attributed to traditional risk factors, additional risk factors associated with graft dysfunction and those specifically related to transplantation. Carotid intima-media thickness (cIMT) is a proven surrogate of atherosclerosis; it correlates with vessel pathology and is precisely imaged using ultrasound technology. This study was aimed at determining the prevalence and predictors of cardiovascular risk among KTRs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to examine the relationship between cardiovascular risk factors and carotid intima media thickness. METHODS Patients aged 18 years and above who received a kidney transplant at the CMJAH between January 2005 and December 2009 were recruited. A questionnaire that captured cardiovascular risk factors was administered. Patients records were assessed for information on their post transplant follow up. All patients had echocardiography and carotid doppler done for measurement of intima-media thickness. The Framingham Risk Score was used to categorize patients into low, moderate, high risk and very high risk groups. Results were analyzed using statistical package for social sciences (SPSS) version 17, p value of 0.05 was considered significant. RESULTS One hundred (KTRs) 63 male (63%) and 37 female (37%) were recruited ranging in age from 19 to 70 years, with a mean age of 42.2 ± 12.42. Thirty six patients (36%) were found to have high cardiovascular risk. Multiple regression showed proteinuria (p = 0.022), higher cumulative steroid dosage (p = 0.028), elevated serum triglycerides (p = 0.04) and the presence of plaques in the carotid artery (p = 0.012) as predictors of higher cardiovascular risk.Carotid intima-media thickness correlates with higher CVD risk. Fourteen patients (14%) had a carotid artery plaque. Twenty five patients (25%) had cIMT of >0.7 mm. CONCLUSION Kidney transplant recipients in CMJAH were found to have high cardiovascular risk (36%) and carotid intima-media thickness correlates with this high CVD risk. Routine follow up of KTRs should include measurement of cIMT as it provides a simple non-invasive assessment of subclinical atherosclerosis.

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Alves, Helena Maria Romeu. "Factors influencing mortality in major penetrating trauma: trauma unit Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirement for the degree of Master of Science in Medicine in Emergency Medicine, Johannesburg , 2013
To determine variables related to the patients with penetrating injuries, with a calculated New Injury severity Score (NISS) probality of survival equal to or greater than fifty percent (NISS P's≥50) to compare those who survived and those who died

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Herbst, Julie-Ann Melissa Elizabeth. "Preoperative fasting practices in adult elective surgery patients at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2016. http://hdl.handle.net/10539/23401.

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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 Anaesthesiology Johannesburg, 2016
The literature describing the implementation of the latest preoperative fasting guidelines by South African health care professionals is limited. Preoperative fasting of adult patients in the health care system has been observed to be unnecessarily long. Prolonged preoperative fasting may result in detrimental effects such as hypovolaemia, dehydration, headache and hypoglycaemia. These effects impact upon patient wellbeing and satisfaction with healthcare. The aim of this study was to describe preoperative fasting practices in adult elective surgery patients at CMJAH. A prospective, contextual, descriptive study design was used in this study. A sample size of 62 adult patients who required anaesthesia for elective surgery estimated the mean instructed and actual fasting times to an accuracy of within 0.5%. The researcher collected data on the day of surgery using a standardised data collection sheet. The study included 64 patients from four surgical disciplines. The median instructed fasting time was 10 hours with a minimum of 8 hours and a maximum of 12 hours. The mean actual fasting time was 14.92 (S.D. 2.50) hours. The difference between the actual and instructed fasting times was statistically significant. There was however no difference in fasting times between the four surgical disciplines. The mean instructed and actual fasting times for adult elective surgery patients at CMJAH were longer than the recommended guidelines. The mean actual fasting time compared closely with local paediatric and international adult studies suggesting that prolonged preoperative fasting is a widespread problem.
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Mailane, Dimakatso Lorraine. "The clinical outcome of macula hole surgery done at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24883.

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A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters of Medicine, In the division of Ophthalmology. Johannesburg, 2017.
Purpose: To describe and analyse demographics, clinical features, visual and anatomical outcomes of patients with macula hole (MH) treated at Charlotte Maxeke Johannesburg Academic Hospital. Methods: A retrospective review of pre- and post- operative findings of 39 patients who underwent MH surgery from January 2008 to 30 October 2012. Results: 39 patients were enrolled in the study. The mean age was 63 years. 49% were males and 51% were females. Majority were black, 59% of the participants. The average duration of symptoms was 12 months. The median preoperative Best corrected visual acuity (BCVA) was logMar1.0. At 1month following surgery, only 23 patients had records. The median BCVA was logMar1.3. About 60% had the same BCVA, 13% had an increase in BCVA and 17% had decreased BCVA. 65% had closed MH and 35% patients had open MH. At 3 months, 7 patients met the criteria and the rest were excluded due to lack of relevant data. 58% had no change in BCVA, 28% had improvement in BCVA and 14% had decreased BCVA. The median gain in BCVA between pre-op and 1 month to 3 month visit was logMar1.0, 1line improvement. The median pre-operative Inner hole diameter (IHD) was 377um and the Basal hole diameter (BHD) was 766um. 86% of patients had closed MH and 14% had open MH. Conclusion: Best corrected visual acuity and MH improved at 3 months following MH surgery in our African population. Patients demographics, clinical features and characteristics are similar to patients in other studies in different countries. A larger and longer duration study would be beneficial.
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Ndachi, Mbwéli. "Providing health care interpreting in the Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014.

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South African public hospitals face communication barriers between medical staff (more specifically doctors) and patients as a result of cultural and linguistic diversity. Consequently, medical staff and patients experience frustrations, errors in diagnosis have been recorded and multiple tests need to be run to determine patients’ conditions, all these at the expense of patients. The services of ad hoc untrained interpreters such as relatives (including children), other medical staff (including fellow doctors, nurses, cleaners and porters), and other patients are used to bridge communication barriers, since there is no statutory interpreting service. However, the use of ad hoc untrained interpreters has been shown to lead to more complications, including breach of patient confidentiality, distortion and/or omission of information, and patients turning to sangomas (traditional witchdoctors), only to return to the hospital when their conditions have worsened. In the first part of this study, conducted at the Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, semi-structured interviews were conducted with patients and medical staff members in order to obtain a clear picture of their linguistic profiles. Thereafter, in order to determine whether ad hoc interpreters such as nurses interpret better than trained interpreters, the interpreting performance of a professionally trained interpreter is contrasted with that of an ad hoc nurse interpreter, both interpreting in an oncology setting; and a thorough analysis of both performances is provided through the use of Conversation Analysis (CA). The present research report is therefore a first attempt to determine possible solutions to miscommunication in the South African health care setting in general and an oncology setting in particular, from the perspective of Interpreting Studies.

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Ramdin, Tanusha. "An audit of neonates admitted to the general ward at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2013.

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dissertation submitted to the Faculty of Health Sciences for the degree of Masters in Medicine in the University of the Witwatersrand, Johannesburg. August ,2013
South Africa is one of the countries in which neonatal mortality has either remained the same or decreased marginally over the past 20 years (1). Resource constraints result in early discharge of well newborns and curtailment of follow up home visits by nurses. This potentially high-risk group of infants may contribute to these neonatal deaths post hospital discharge. In addition, once a neonate has been home, they are no longer admitted to the neonatal unit but to the general paediatric wards that may lack specialized neonatal care. Numerous programs, algorithms, education drives and protocols have been devised in an attempt to improve the quality of healthcare offered to the newborn. These have led to a perceptible decline in the neonatal mortality and morbidity rates respectively. The neonatal mortality and morbidity rates remain unacceptably high however, particularly in resource poor settings. Aim: The aim was to determine the profile and outcome of neonates admitted to the general paediatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology: Audit of all newborns (<28days) admitted to the general wards from 1 January 2011 to 30 April 2011. Patients transferred from other tertiary hospitals were excluded. Patients with incomplete records were also excluded Results: There were a total of 73 neonates admitted with a mean weight of 3.2kg (SD 0.65). The median age for 0-7 days was 4 days and for 8-28 days was 17 days. The majority of neonates 41/73 (56.2%) were male and 21/73 (28.8%) were HIV exposed. In the HIV exposed group only 16/21 (76%) were on HIV prophylaxis. Although antenatal care (ANC) was received by 76.7% of mothers, this is lower than ANC received by the general population. Lack of ANC could possibly be a risk factor for admission of neonates. Possible risk factors for serious illness included 8 (11%) were ex premature infants and 11 (15.1%) had a low birth weight (<2.5 kg). Individual indicators for severity of illness by World Health Organization (WHO) Integrated Management of Childhood and Neonate Illness (IMCNI) were used. The most frequent indicators were tachypnoea (RR>60) 34 (46.6%), jaundice 30 (41.1%) and only 1 (1%) presented with convulsions. Respiratory distress was very sensitive (100%) and relatively specific (76%) for detecting bronchopneumonia (BRPN) with a LR of 3.98. The other clinical indicators were neither specific nor sensitive in detecting serious illness. Most 45 (61%) were referred from the local clinic. The commonest diagnoses were bronchopneumonia (BRPN) 20 (27.4%), neonatal sepsis (NNS) 22 (30.1%) and jaundice 22 (30.1%). Two patients died (2.7%). Their diagnoses were NNS and BRPN Conclusions: There are a significant number of newborns admitted to the general paediatric wards, although the mortality rate in this group was low. IMCNI guidelines remain the most sensitive indicator of the need for admission, and “routine” blood investigations are often non-contributory Community based care and education programmes as well as targeted neonatal care in hospitals for this group is warranted.

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Sabo, Umar Abba. "Impact of caregiver burden in paediatric epilepsy at Charlotte Maxeke Johannesburg Academic Hospital, South Africa." Thesis, 2018. https://hdl.handle.net/10539/25274.

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A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, 2018.
Background: Chronic health conditions such as epilepsy may impose a high level of stress on the caregivers. The burden of epilepsy can cause significant dysfunction in the affected families resulting in a negative impact on the child’s adaptation to the disease. This study seeks to evaluate the effects of caregiver burden on the health-related quality of life (HRQOL) of the caregivers and their family functioning as well as factors associated with high impact of the caregiver burden. Methods: The participants consisted of primary caregivers who were involved in childcare for at least six months before study onset. Informed consent was obtained. One hundred and nine eligible caregivers recruited over a three months’ period completed questionnaires providing information on their socio-demographic and epilepsy-related variables as well as paediatric quality of life (PedsQL) family impact module. High impact on HRQOL/ Family functioning was defined by Score below the inter-quartile range. Results: The median HRQOL score of the caregivers was 46.3 (IQR = 31.3, 67.5) while the median family functioning score was 46.9 (IQR = 31.3, 71.9). In participants categorized with high impact, raw scores ≤ 31.3 were obtained for both caregiver burden and family functioning. The family functioning score correlated strongly with the HRQOL score of the caretakers, ρ = 0.78 and p<0.001. Multivariate analysis identified lower caregiver education level and a high seizure frequency as independent predictor of high impact of caregiver burden after adjusting for age of the caregivers and the number of anti-epileptic drugs taken. Conclusion: The burden of caregiving for children with epilepsy in Johannesburg impacts negatively on family functioning. The burden of care was associated with high seizure frequency and lower level of caregiver education.
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Naidoo, Sudeshni. "Antimicrobial susceptibility of anaerobic organisms isolated from clinical specimens at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2010. http://hdl.handle.net/10539/7987.

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MSc Med, Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences,University of the Witwatersrand, 2009
Anaerobic bacteria cause serious life-threatening infections such as endocarditis, sepsis, intra abdominal, pleuro-pulmonary and central nervous systems infections. Most infections are polymicrobial and involve aerobes and anaerobes. Empiric therapy is generally based on the expected pathogens and the particular type of infection. Even when specimens are cultured and anaerobes identified, not all laboratories perform susceptibility testing. The clinician often relies on published surveillance data when selecting treatment regimens. Antimicrobial susceptibility of anaerobic bacteria is becoming increasingly unpredictable. Resistance can vary significantly and patterns differ geographically, and even within units of the same hospital. From June 2005 until February 2007, 180 consecutive anaerobes isolated from relevant, non- repetitive clinical specimens were tested routinely with the E test method for susceptibility to amoxicillin/ clavulanate (XL), clindamycin (Cm), metronidazole (Mz), penicillin (Pg), ertapenem (Etp), cefoxitin (Fx), ceftriaxone (Tx), chloramphenicol (Cl), and piperacillin/tazobactam (Ptc). The results were read after 48hr incubation in anaerobic conditions. Specimen distribution was as follows: abdominal fluid (3), abscess (7), abdominal abscess (4), aspirates (3), blood cultures (27), bone (3), breast (3), drainage fluid (2), empyema (1), fluids (36), other (4), placental (1), pleural fluid (2), pus (41), tissues (34), umbilicus (1) and unknown sites (8). Bacteroides fragilis was isolated from 81 (45%) clinically significant specimens, followed by Clostridium perfringens 23 (13%), Peptostreptococcus anaerobius 15 (8%) and Prevotella melaniniogenicus 15 (8%). B. fragilis demonstrated a 97.5% resistance to penicillin and 12.3% resistance to metronidazole. C. perfringens exhibited no resistance to penicillin and metronidazole while P. anaerobius had 40% resistance to penicillin and no resistance to metronidazole. P. melaninogenicus was resistant to penicillin in 60% and 6.7% to metronidazole. Overall, chloramphenicol, piperacillin/tazobactam, ertapenem and amoxicillin/clavulanate demonstrated the highest activity to anaerobic isolates, 100%, 99.4%, 97.2% and 96.7%, respectively. Among the 180 tested anaerobes a total of 8.9% resistance has been observed with metronidazole and 81.7% sensitivity with clindamycin. Periodic surveillance to monitor the susceptibility profile of the B. fragilis group and other anaerobic organisms is recommended to create empirical guidelines for appropriate use of antimicrobial agents.

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Sepeng, Letlhogonolo. "Audit of feeding practices in the neonatal wards at the Charlotte Maxeke Johannesburg academic hospital." Thesis, 2016. http://hdl.handle.net/10539/20076.

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This research report is submitted in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg. June 2015 (amended September 2015)
Background Breastfeeding is the preferred choice of feeding babies. The Baby-Friendly-Hospital-Initiative (BFHI) is a ten step plan to establishing successful breastfeeding and is adopted by public sector hospitals in Gauteng. Despite this, rates of breastfeeding in sick and preterm babies remain low. Aim To determine feeding practices for babies discharged from the neonatal wards of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology A retrospective review of the CMJAH neonatal database on the type of milk feed for babies discharged between 01/01/2013- 30/04/2013. Results There were 404 babies in the study, 98(24%) were very-low-birth weight, 120(29.7%) were low birth weight and 186(46%) were bigger babies. Only 94(23.2%) babies were discharged on exclusive breast milk feeds, 232(57.4%) babies were discharged on exclusive formula milk feeds and 78(19.3%) discharged on mixed feeds. Significant variables associated with feeding choices were HIV exposure, perinatal asphyxia and the need for resuscitation at birth. Conclusion Despite the fact that the CMJAH is involved in the BFHI, rates of exclusive breastfeeding remain low. This needs to be urgently addressed with employment of lactation consultants and improved counselling of mothers exposed to HIV, on the importance and benefits of breastfeeding.

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Vachiat, Ahmed Ismail. "Outcome of HIV positive patients presenting with renal failure at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2013. http://hdl.handle.net/10539/12295.

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Outcome of HIV positive patients presenting with renal failure at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Background The majority of the 33.4 million people infected with HIV worldwide reside in sub-Saharan Africa. The HIV prevalence amongst young South Africans (ages 15- 49) is 16%. HIV is the third leading cause of ESRD in African - Americans aged 20-64 in the United States. There is a paucity of data regarding the prevalence of acute kidney injury (AKI) in HIV patients in sub-Saharan Africa. Methods A retrospective review of 101 HIV positive patients presenting with renal failure at the CMJAH from 1st October 2005 until 31st October 2006 was undertaken. There were 50 HIV positive patients with presumed AKI that were compared to 90 HIV negative patients with AKI. Results A total of 684 patients presented with renal failure, 101(14.8%) of whom were HIV positive. Ninetynine of the HIV positive patients were black and 56 were male. The mean age of HIV positive patients with renal failure was 38 years. Fifty-seven patients presented with AKI (seven patients were excluded due to lack of records), 21 with acute on chronic renal failure and 23 with chronic renal failure. The causes of AKI in the HIV positive group included sepsis (62%), haemodynamic instability (20%), toxins (10%), urological obstruction (8%) and miscellaneous (10%). The common underlying aetiologies of the 90 HIV negative patients studied presenting with AKI were sepsis (43%), haemodynamic instability (17%), toxins (7%), urological obstruction (8%) and miscellaneous (23%). Forty-seven (52%) of these HIV negative patients recovered. Forty-two (47%) patients died, compared with 22 (44%) patients in the HIV positive group. Hyponatraemia, hyperkalaemia, hypochloraemia and acidosis were more common in the HIV positive patients. Dialysis was initiated in 36% of HIV positive patients with AKI. There were more HIV positive patients that recovered with supportive care, including fluid therapy when compared to HIV negative patients. Recovery was noted to be more rapid in the HIV positive group. Using survival and death as the outcome there was no difference between the HIV positive and the HIV negative group presenting with AKI (p<0.7173). Discussion HIV positive patients presented with renal failure at a younger age – a mean age of 38 years in this study. Previous studies have shown mean ages ranging from 35 years to 46.7 years. The majority of the HIV positive patients presenting with renal failure were black (98%). The racial predominance is different to that of other countries which might be due to epidemiological factors. The gender differences were similar when compared to other studies. Sepsis was the more common aetiological factor of AKI (62% of HIV positive patients compared to 43% of HIV negative patients). HIV positive patients with AKI presented at an advanced stage of immunosuppression (more than 50% had CD4<100cells/μl). Electrolyte disturbances were common in HIV positive patients with AKI. Conclusion HIV positive patients with AKI presented with advanced immunosuppression. Sepsis was the most common aetiology of AKI. Supportive management or renal replacement therapy resulted in recovery in a large number of patients.HIV positive patients should be treated acutely just as HIV negative patients and should not be excluded on the basis of their HIV status. Dialysis should be offered when indicated and aggressive fluid resuscitation should be emphasized. Outcomes were similar in HIV positive and HIV negative patients presenting with AKI.

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Mogajane, Tshiamo Paul. "Incidence and prognosis of critical congenital heart disease in neonates at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2018. https://hdl.handle.net/10539/25339.

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Background: A significant number of neonates with congenital heart disease present with a life-threatening illness in the neonatal period where survival depends on timely diagnosis, management and referral. Objectives: To determine the incidence and prognosis of critical congenital heart disease in neonates admitted to Charlotte Maxeke Johannesburg Academic Hospital, and to compare it with international data. Method: This was a retrospective, descriptive study of neonates with critical and non-critical congenital heart disease admitted to Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2006 and 31 December 2014. Results: There were 284 neonates diagnosed with congenital heart disease during the study period - 133 with critical congenital heart disease (8.2 per 1000 neonatal admissions) and 151 with non-critical congenital heart disease (9.3 per 1000 neonatal admissions). The mortality rate for neonates with critical congenital heart disease was 61/133 (45.9%). Conclusion: Critical congenital heart disease is not commonly diagnosed in neonates, however the mortality rate is high. Increased awareness and screening programs may improve early diagnosis and allow timeous intervention.
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Zachariah, Don. "Renal dysfunction and heart failure - cardiorenal syndrome: a retrospective study at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2017. https://hdl.handle.net/10539/24210.

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A Research report submitted to the Faculty of Health Sciences, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the Degree of Master of Medicine in the Division of Cardiology. 2017
INTRODUCTION The field of medicine has been challenged by the dual epidemic of heart failure and renal insufficiency. There is an increasing need to identify these patients at an early stage so as to delay progression to renal damage. Furthermore there is a lack of local data assessing the relationship between heart failure and renal dysfunction. AIMS • To identify the prevalence of renal dysfunction in patients attending the heart failure clinic at Charlotte Maxeke Johannesburg Academic hospital (Cardiorenal syndrome Type II) • To evaluate the relationship between severity of heart failure and severity of renal dysfunction • To compare heart failure with reduced ejection fraction (HFREF) variables between patients with and without renal dysfunction. METHODOLOGY This study is a single center retrospective study of patients attending Charlotte Maxeke Johannesburg Academic Hospital Heart Failure Clinic. Heart failure patients included in this study were those with an ejection fraction < 50% as this is an accepted definition for HFREF. Patients with HFREF were analyzed specifically for the following; presence of renal dysfunction, Ejection Fraction (EF), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Haemoglobin (HB), New York Heart Association (NYHA) functional class, furosemide dose , six minute walk test (6MWT) and Minnesota Living with Heart Failure Questionnaire (MLFQ) score . Presence of renal dysfunction was identified based on the glomerular filtration rate (eGFR) value of less than 60ml/min/1.73m2 as this is the threshold eGFR below which complications of renal impairment appear. The eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) abbreviated formula: (186.3 X serum creatinine) -1.154 x (age) -0.203 x (0.742 if female) x (1.212 if African) The control group consisted of patients attending the clinic who did not have renal dysfunction. RESULTS A total 242 files were reviewed. Forty-two files were excluded from the study due to lack of adequate study data recorded in the file. Data was collected and entered into a database, which was analyzed using the Statistics/Data Analysis Program (STATA) Version 10.0. The mean age of the study group was 53.3 years (SD± 15.05) with the youngest subject being 21 years old and the oldest subject aged 85 years. The mean SBP was 119mmHg and the mean DBP was 75mmHg. The mean eGFR was 72.01 ml/min/1.73m2. The overall prevalence of low eGFR (<60ml/min/1.73m2) in the sample population was 34.5 %. The prevalence in female and male patients with a low eGFR was 35% and 33.6% respectively. Analysis of MLFQ, 6MWT, DBP and age yielded a positive correlation with eGFR, which was statically significant (p<0.05). An insignificant correlation was obtained comparing eGFR with SBP (p=0.07), EF (p=0.69) and HB (p=0.79). The Analysis of Variance Test (ANOVA), showed a significant correlation between eGFR values across the different NYHA functional classes (p 0.012). Thus it was found that the higher the NYHA class (clinically worse) was associated with worse renal function. The mean eGFR for NYHA I was 77.05 ml/min/1.73m2, for NYHA II was 70.61 ml/min/1.73m2, for NYHA III was 64.13 ml/min/1.73m2 and NYHA IV was 50.02 ml/min/1.73m2. DISCUSSION The overall prevalence of low eGFR (<60ml/min/1.73m2) in this study was 34.5%, a finding consistent with international trials. The majority of patients in this study were in NYHA functional class I or II, thereby highlighting the fact that renal dysfunction is common in heart failure patients and starts early. Statistically significant values were also obtained between eGFR and 6MWT, MLFQ, furosemide dose, age and DBP. The patients with higher 6MWT have better effort tolerance, thereby classifying their heart failure as milder. This in effect confirms that higher eGFR patients have higher effort tolerance. Higher MLFQ scores and higher furosemide doses are inversely correlated to eGFR. The more subjective symptoms you have, and the higher doses of furosemide you need, is a reflection of the severity of the heart failure. With regards to age, there is a normal physiological decline in eGFR with increasing age. In this study a statistically significant negative correlation between eGFR and NYHA was found. Thus a higher NYHA class is associated with worse renal function. This suggests that the clinically more advanced the patient, the poorer the renal function. Also, the prevalence of low eGFR (<60ml/min/1.73m2) within each NYHA class, as expected, increased with increasing NYHA class. It was 27% for NYHA I, 38% for NYHA II, 40% for III, while class IV had 80% of low eGFR prevalence CONCLUSION The findings of this study confirm that the cardio-renal syndrome is common in a local cohort of heart failure patients. The study also suggests that renal dysfunction starts in the early stages of heart failure (NYHA I/II) and becomes more prevalent in patients with more advanced stages of heart failure. These findings highlight the need to treat heart failure patients early after presentation and more appropriately if we are to decrease complications such as renal dysfunction, thereby improving morbidity and mortality.
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Patchapen, Yvette. "A retrospective study evaluating the patterns of primary glomerular disease at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2017. http://hdl.handle.net/10539/23291.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Masters in Medicine (Internal Medicine) Johannesburg 2017
Background Glomerular disease is a frequent and important cause of renal dysfunction. Current data on the patterns of glomerular disease in South Africa is lacking. The aim of this study was to characterize the prevalence and nature of presentation of primary glomerular disease at Charlotte Maxeke Johannesburg Academic Hospital. Materials And Methods This single center, retrospective observational study was performed on adult native renal biopsies over a 10 year period from 2001 - 2010. A total of 1495 native renal biopsies were reviewed. After exclusion of common secondary causes, the results of 194 patients with primary glomerular disease were evaluated. Results The most frequent primary glomerular disease was FSGS (29.8%) followed by MN (19.5%), MPGN (18%), MCD (17%) and IgAN (3%). Nephrotic range proteinuria (60.5%) and unexplained renal dysfunction (24.2%) were the most common indications for biopsy. There was a 59.4% male predominance. From the 73.9 % of patients of African descent, 34.1% presented with FSGS. The majority of patients (62.9%) were aged between 18-49 years with 30.3% of them presenting with FSGS. FSGS presented with a median creatinine 183.5 [101 - 476] mmol/l and mean UPCR (0.89 ± 0.66) g/mmol. There were no statistically significant differences in albumin, haemoglobin and triglycerides between the glomerular disease subtypes. The highest urine leucocytes and dysmorphic red cells were from the IgAN subtype. Most patients, 56.8% had no casts observed, and 39.1% were hypertensive. No change in the pattern of glomerular injury was observed over the course of the study. Conclusion Glomerular pathology is more common in younger patients. FSGS is more common than other glomerular pathologies in our setting; which may partly be due to local biopsy practices and patient demographics. Clinical parameters do not adequately predict biopsy findings.
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Swart, Leanne. "Clinical presentation, management and outcome of thrombotic thrombocyopenic purpura at the Charlotte Maxeke Johannesburg academic hospital." Thesis, 2017. https://hdl.handle.net/10539/28101.

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A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in part fulfillment of the requirements for the degree of Master of Medicine in the branch of Haematology Johannesburg, 2017
This is a retrospective study of the clinical and laboratory features, management, and outcome of 41 adults diagnosed with thrombotic thrombocytopenic purpura (TTP) at the Charlotte Maxeke Johannesburg Academic Hospital. There were 45 TTP events during the five-year review period, 41 of which met the inclusion criteria. Most study patients were of black ethnicity (95.1%) and female gender (78.1%). TTP was most commonly secondary to human immunodeficiency virus infection (78.0%). Neurological (82.9%) and bleeding (78.1%) symptoms were frequent. Management included initial plasma infusion (78.1%), therapeutic plasma exchange (87.8%), intensive care admission (41.5%), renal dialysis (12.2%), highly active antiretroviral therapy (78.3%), corticosteroids (61.0%) and other immunosuppressive agents (4.9%). The median (range) number of therapeutic plasma exchanges was 10.0 (7.015.0). The relapse rate was low (8.9%), however refractory disease (70.7%) was frequent. Haemoglobin level, platelet count, lactate dehydrogenase, red cell distribution width and creatinine level were reliable therapeutic end-points (P < 0.05). The high mortality rate (29.3%) emphasises the importance of early diagnosis, referral and management of TTP.
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Padayachee, Natasha. "outcomes of neonates with perinatal asphyxia at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 2007-2011." Thesis, 2015. http://hdl.handle.net/10539/17341.

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A Research Report submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine in Paediatrics. 8 May 2014
Background: Perinatal asphyxia is a significant cause of death and disability. Aim: To determine the outcomes (survival to discharge and morbidity post discharge) of neonates with perinatal asphyxia at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods: This was a descriptive retrospective study. Patient information was obtained from the computerised neonatal database of neonates admitted to CMJAH within 24 hours of birth between 1 January 2006 and 31 December 2011 with a birth weight of >1800 grams and a 5 minute Apgar score <6. Results: 450 babies were included in the study; 185 females (41.1%). Mean birth weight was 3034.80 grams (SD 484.936) and mean gestational age was 39.11 weeks (SD 2.2). Most babies were inborn 391/450 (86.9%) and most were delivered by normal vaginal delivery 270/450 (60%). The overall survival was 390/450 (86.6%). There were 42 babies admitted to ICU. The ICU survival was 37/42 (88.1%). Significant predictors of survival were place of birth (p value 0.006), mode of delivery (p value 0.007) and bag mask ventilation at birth (p value 0.040). The duration of stay (p value 0.000) was significantly longer in survivors (6.49 days SD 6.6). The remaining factors were not significantly different between the two groups. The rate of perinatal asphyxia (Apgar score <6) was 4.68 per 1000 live births; while 3.61 per 1000 live births had evidence of hypoxic ischaemic encephalopathy (HIE). Of the 390 babies discharged from CMJAH, 113 had follow up records (28.97%) to a mean corrected age of 5.88 months (SD 5.03). The majority (90/113 – 79.64%) had normal development. Conclusion: i) The high overall survival and survival after ICU admission provides a benchmark for further care. ii) Obtaining adequate data for long term follow up was not possible with the existing resources and surrogate early markers of outcome and / or more resources to ensure accurate follow-up are needed and iii) the high incidence of HIE suggest that a therapeutic hypothermia service including long-term follow-up component would be beneficial.

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Dadoo, Zahedah. "An evaluation of retinopathy in very low birth weight babies at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2016. http://hdl.handle.net/10539/21539.

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Qualification: MBBCh (Wits), FCPaed (SA), PhD Paediatric neonatologist Charlotte Maxeke Johannesburg Academic Hospital Degree report submitted for: MMed (Paed) 25 May 2016
Background. Retinopathy of prematurity (ROP) is a leading cause of blindness for very low birth weight (VLBW, <1500g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment. Objectives. To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines, the grades of ROP found and the treatment modality received. Methods. This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH, whether inborn or transferred in. The babies were divided into 2 groups based on age at final outcome. Final outcome was defined as death, discharge or transfer out of the unit. The ‘early’ outcome group had their final outcome before day 28 of life. The ‘late’ outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening. Results. There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1127g (SD 244.75) and gestational age of 29 weeks (SD 2.743). The mean duration of stay was 29 days (SD 21.66) and there were 309 female babies. Of these 572 babies, 304 comprised the early outcome group and 268 comprised the late outcome group. 7 In the early outcome group babies that were transferred out of the unit or died were excluded, therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP Screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included 5 babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal anti-VEGF and 3 babies required surgery. Conclusions. More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented, therefore prevalence cannot be established.
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Ibebuike, Kaunda Emeka. "Presentation of intracranial meningiomas in Johannesburg (a 12-month prospective study at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Hospital)." Thesis, 2013. http://hdl.handle.net/10539/12548.

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The study aimed at determining the relative frequency of intracranial meningiomas among primary brain tumours; age, gender, ethnic distributions and their mode of presentation. This was a 12-month prospective study of 48 consecutive patients with histologically proven intracranial meningiomas seen at CMJAH and CHBH. Meningiomas accounted for 33.8% of all primary brain tumours. The mean age of patients was 45.7 ± 10.1 years with a female-to-male ratio of 3.8:1. The peak age range at presentation was in the fifth (41.7%) and sixth (27.1%) decades. The highest frequency was in Blacks (75%) and Sotho ethnic nationality (27.1%). The mean duration of symptoms and signs was 24.4 ± 26.5 months. The commonest presentations were headache (87.5%), visual impairment (64.6%), seizures (43.8%), motor deficit (37.5%), convexity meningiomas (25%), meningothelial subtypes (39.6%) and WHO grade I tumours (81.3%). This study showed that meningiomas are the most common primary intracranial tumours among adults in our environment.

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Lumu, Lavinia Deborah. "A retrospective review of pre-schoolers referred for psychiatric services at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014. http://hdl.handle.net/10539/15342.

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The study is a retrospective review of pre-schoolers 6 years old and younger who were referred to the Charlotte Maxeke Johannesburg Academic Hospital Child, Family and Adolescent Unit, Johannesburg for psychiatric intervention between 1 January 2006 and 31 December 2010. The study described and analysed demographics and the various characteristics of children 6 years old and under who were referred to the unit for psychiatric intervention. The several psychiatric conditions and interventions were also evaluated. One hundred and forty nine (149) pre-schoolers who were 6 years old and under presented to the Unit and the majority were male (77.2%;N=115). The mean age of presentation was 54 months (SD=12.59) and the majority of the pre-schoolers were referred to the Unit by medical professionals. Attention-Deficit/ Hyperactivity Disorder (ADHD) was the most common presenting condition. Girls were more likely to present with Anxiety disorders (44.1%;15/34) and Reactive Attachment Disorder (35.3%;12/34) and boys were more likely to present with Autism Spectrum Disorders (26%;30/115). There were no statistical differences in the rates of Attention-Deficit/ Hyperactivity Disorder between girls (38.2%;13/34) and boys (43.6%;65/115) with ADHD (x2=2.705; df=1; p=0.1001). A psychological assessment was conducted in 68.5 % (102/149) of referrals. Almost half the children (46.3%; N=69) received pharmacological intervention. The defaulting rate after the initial assessment was high. The study highlights the frequency of psychiatric illness in pre-schoolers and necessitates the need to conduct further research in this vulnerable age group at other clinical sites.

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Bolon, Jonathan Graham. "Beta-blocker target dosing and tolerability in a dedicated Heart Failure Clinic Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2017. https://hdl.handle.net/10539/24867.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Internal Medicine. Johannesburg, 2017.
BACKGROUND: The benefit of Beta-blockers in chronic heart failure with left ventricular dysfunction is well established. However, actual use in “real world” heart failure patients has been relatively poor. Beta-blockers have generally been underused and under-dosed, largely due to perceptions about intolerability. Ivabradine, a pure heart rate lowering agent has recently been advocated for heart failure patients with elevated heart rates who could not tolerate target doses of beta-blockers. AIMS: The aim of this study was to document beta-blocker target dosing and tolerability in a dedicated heart failure clinic at Charlotte Maxeke Johannesburg Academic Hospital and assess the proportion of patients who may require Ivabradine therapy. METHODS: The records of all patients attending the heart failure clinic between 2000-2014 were reviewed. Demographic, clinical and outcome data was recorded for 500 patients. RESULTS: At their last clinic visit, 489 out of 500 (97.80%) patients were taking a beta-blocker. Patients were stratified into categories according to guideline target doses, with 59.8% (n=299) achieving ‘target dose’, 28.0% (n=140) a ‘moderate’ dose, 5.4% (n=50) receiving ‘low dose’ of beta-blocker and 11 patients (2.2%) no dose. Beta-blocker “intolerant” patients numbered 61(7.6%). Conventional reasons for beta-blocker caution (bronchospasm/breathlessness, syncope, cardiac decompensation, hypotension) were found to be rare. Bradycardia was the commonest cause of inadequate uptitration. Only 53 patients (10.6%) were deemed to be “Ivabradine suitable”. CONCLUSIONS: Beta-blockers are well tolerated with perceptions around intolerability and concerns about safety largely unsupported by our experience. As a consequence, the role for Ivabradine therapy in patients with chronic heart failure is limited. Key words: Beta-blockers, Heart Failure, Ivabradine
LG2018

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Atiya, Yahya. "Submandibular gland tumours: A clinicopathological review at the Chris Hani Baragwanath and Charlotte Maxeke Johannesburg academic hospital." Thesis, 2014. http://hdl.handle.net/10539/15468.

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A Research Report (Neus7009) submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirement for the degree of Master of Medicine in Otorhinolaryngology (MFOSENTS60) Johannesburg 2014
Background: Reports relating to Submandibular gland tumours are sparsely reported in the literature. There are some reports of different patterns of tumour types in black/negroid patients, as compared to Caucasian patients1,2,11. Aim: To provide an audit of the histopathological types and the clinical presentations of submandibular gland tumours at our two academic hospitals. Method: An analytical cross sectional study using retrospective clinical data from in-patient ward registers, patient’s hospital records, operating room/theatre registers and the NHLS databases. The study was conducted in the ENT units at the Chris Hani Baragwanath Academic Hospital and the Charlotte Maxeke Johannesburg Academic Hospital, over a chosen period of 7 years from January 2005 to December 2011. All patients who had a submandibular gland excision by members of the ENT department at the two hospitals were included. A total of 61 patient records were examined, of which 26 met the inclusion criteria. Data collected included age, gender, race and histological diagnosis. Data was analysed using standard statistical methods. Results: Twenty six patients were included in this study, comprising 46% females and 54% males. The ages ranged from 22 to 65 years, with a mean of 42.5 years – the majority being in the 22-40 years age group. There was no statistical difference in the age of males and females (p=0.29), nor in black vs. white patients (p=0.29). Benign disease was found in 65.4% of patients, while 34.6% had malignancy. Black patients had a higher ratio of benign disease than white patients, and black males were more likely to have benign disease (83.33%) than black females (50%). However, there was no statistical difference in the ratio of benign to malignant tumours between blacks and whites. Histopathologically, pleomorphic adenoma was the most common benign tumour (82%), while adenoid cystic carcinoma was the most common epithelial malignancy (22%). There was a high incidence of lymphoma (56% of patients) in the malignant group. Local pain (p=0.03) and peripheral neurological deficit (p=0.05) was found to be significantly associated with malignancy. Conclusion: The rate of malignancy in Black patients was found to be lower than that reported in the Western literature, which is in keeping with other studies in non-Caucasian (Black, Asian and Hispanic) populations1,2,9,11. Additionally, Black patients presented at a younger age. Pain and local/peripheral neurological involvement were clinical indicators of malignant disease.

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Mokaya, Dr Momanyi. "Mode of delivery and outcome of patients with a previous scar at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2017. https://hdl.handle.net/10539/24660.

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Research report submitted to the University of the Witwatersrand in partial fulfilment for the degree of Masters of Medicine (Obstetrics and Gynaecology)
The setting of this study was at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) a tertiary referral and teaching hospital attached to the University of Witwatersrand situated in Parktown, Johannesburg. The hospital manages all high risk pregnancy including previous caesarean sections. This study evaluated women with one previous scar at CMJAH for their: antenatal choice of delivery method, eventual delivery method and pregnancy outcome. Over the years there has been a significant uptrend of caesarean sections and consequently also an increasing number of women with one previous scar with subsequent pregnancies. Objectives: 1) To obtain the indication for the mothers’ first caesarean section, 2) To determine the mothers’ choice of delivery method following their first caesarean section, 3) To determine the actual mode of delivery and factors that influenced it, 4) To establish short term neonatal outcome following delivery, 5) To establish short term maternal outcome following delivery. Methodology: The study was a prospective cohort study of women with one previous scar who attended the antenatal clinic at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The aim was to compare their antenatal choice of delivery to how they eventually delivered. 100 women were recruited from the antenatal clinic from 1st July 2016 to 30th September 2016. Data was collected via interviewing the mothers and also from hospital records; this was captured on a data sheet. Data was then analysed using STATA software. Results: One hundred women were followed up to delivery. 63 wanted to deliver via vaginal birth after caesarean section (VBAC) during their antenatal period, 35 wanted a repeat caesarean section and two were still undecided on their preferred mode of delivery. 22 women eventually managed to have VBAC (including 4 assisted deliveries). There were a total of 78 deliveries via caesarean section 46 being emergency caesarean sections and 32 being elective caesarean sections. The attempted VBAC success rate was 35% (including assisted deliveries) the remainder receiving emergency caesarean sections. Of the patients who wanted repeat caesarean section, 94.3% delivered by caesarean section. 76% of babies had no adverse short term outcome while 87% of mothers had no short term complications post-delivery. There was statistically no difference between short term complications of mother and foetus in both modes of delivery. VI Conclusion: Women who choose caesarean section delivery during their antenatal period are much more likely to deliver via their preferred mode compared to women who choose VBAC as their mode of delivery, statistically significant, P<0.001.The main reasons for conversion of a VBAC to caesarean section observed were foetal distress and poor progress. Overall outcomes of mother and foetus were not statistically significant between vaginal and caesarean section delivery routes, though the most severe maternal complications were observed in emergency caesarean section deliveries.
GR2018

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Groenewald, Engelina. "The subjective experience of children with anxiety disorders: a record review at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2014.

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To investigate the subjective experience of children diagnosed with anxiety disorders and the presenting complaints that children with anxiety disorders are referred with to a child and adolescent psychiatry unit.

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Harerimana, I. "Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg academic hospital (CMJAH)." Thesis, 2016. http://hdl.handle.net/10539/21317.

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Research report submitted in partial fulfilment of requirements for a Master of Medicine degree in Paediatrics and Child Health (MMed). November 2014
Background: Persistent pulmonary hypertension of the newborn (PPHN) is a clinical syndrome characterised by high pulmonary pressure, low systemic pressures and severe hypoxemia due to failure of circulation transition after birth. Objective: The aim of the study was to determine the incidence, describe the risk factors, patient’s characteristics, and treatment strategies for PPHN at CMJAH over the last 8 years and discuss the possible need of ECMO treatment in our settings. Patients and methods: This was a retrospective descriptive study. I reviewed the computer database and medical records of infants who had a discharge diagnosis of PPHN from January 2006 to December 2013. The study included term and preterm, inborn and outborn infants. PPHN diagnosis was mainly based clinical suspicion. Patients with congenital cyanotic heart defect were excluded. Results: The incidence of PPHN was estimated at 0.33 per 1000 live births in our unit. Out of 81 infants who had a discharge diagnosis of PPHN 72 patients were included in the study. Of the 72 patients 37(51.4%) were female, 38 (52.8%) born by vaginal delivery and 44(61.1%) were inborn. Most of them (75%) were born at term and had an appropriate weight for gestation age. The mean birth weight was 2.94 kg (SD 0.69) while mean gestation age was 38.2 weeks (SD3.3). Meconium aspiration syndrome (MAS) seen in 43 patients (59.7%) was the most frequent underlying disease followed by pneumonia that was seen in 9 patients (12.5 %). Of the 72 patients 67(93.1%) were treated with mechanical ventilation and only18.1% of them required high frequency oscillatory ventilation. Magnesium sulfate and Sildenafil were used in 12 patients (16.7%) and 9 patients (12.5%) respectively, while inhaled nitric oxide and extracorporeal membrane oxygenation were not available. Of the 72 patients 25(34.7%) died. The patients’ characteristics were similar between survivors and nonsurvivors. The need for inotropic support was associated with a poor outcome. Conclusion: PPHN was uncommon in our unit, but its management is still a challenge since it was associated with a high mortality. The leading cause of PPHN was MAS which can possibly be prevented by improving both antenatal and intrapartum obstetric care by good management of at-risk pregnancies. In our settings, the reduction of MAS incidence, adequate neonatal resuscitation, surfactant replacement therapy and early initiation of assisted ventilation for depressed infants with MAS could be cost- effective measures in preventing PPHN. ECMO therapy is very expensive and labour intensive, thus its use is limited in lowand middle- income countries including South Africa.
MT2016

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Mutsoane, Tsholofelo Desiree. "Patients treated with radical course of radiation therapy for carcinoma of larynxa at Charlotte Maxeke Johannesburg academic hospital." Thesis, 2014. http://hdl.handle.net/10539/15484.

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A research report submitted to the faculty of Health Sciences University of Witwatersrand, in partial fulfilment for the degree of Master of Medicine (M.Med) Radiation Oncology. Johannesburg 2014
Background Larynx preservation is the standard recommended treatment approach for cancer of the larynx. We looked at results of patient treated with larynx preserving approach at our institution. Objectives The study objectives included describing the demographics of the population in the study and comparing characteristics and outcomes for patients in the different treatment groups. We also assessed waiting time for treatment, treatment completion rates and overall treatment time for all the patients in the study group. Outcomes of patients at last follow up and survival for different stages of disease were described. Materials and Methods A retrospective study of patients with cancer of the larynx treated at Charlotte Maxeke Academic Hospital department of radiation oncology between the year 2007 and 2009. All patients who received radiotherapy including palliative and radical cases were assessed. Outcomes were measured from end of treatment to 1 year and 2 years follow up for survival. Results We identified 106 eligible patients. The mean age was 58.6 years (standard deviation of 10.051).Two thirds (67%) of the patients presented with stage IVa disease, 14% had stage IVb, 13% had stage III, and very few patients had stage I and II disease 4% and 2% respectively. One third of patients were treated with radical chemotherapy plus radiotherapy and majority of them received only 1 cycle of chemotherapy. The other 26 % of patients treated with radical intent received radiotherapy alone. A significant number of our patients (42 %) were treated with palliative intent of which 13 % were patients who had disease progression while awaiting treatment. The majority of patients (53%) had an improvement in symptoms while (5.7%) had died and (17%) were lost to follow-up. Conclusion Waiting time prior to radiotherapy is a major problem in our institution as our overall mean waiting time was 98.5 days. Patients who had disease progression as defined by change in the treatment intent from radical to palliative treatment (13%) had a mean waiting time of 187.9 days which was almost double our overall mean waiting time and significantly worse than that recommended by standard of care. Although this waiting time was not statistically significant when compared with other patients treated with radical intent, it is a concern for the department to have such long waiting time prior to therapy and is probably a reflection of inadequate statistical power. Of the radical cases those treated with chemotherapy and radiotherapy very few (2.9%) completed 3 cycles of chemotherapy therefore we had low treatment completion rates. Some patients did not receive their 2nd or 3rd cycle of chemotherapy due to low creatinine clearance other patients reasons for not completing chemotherapy was not documentation in their medical records. Although concurrent chemotherapy plus radiotherapy is the standard of care for larynx preservation, most of our patients received suboptimal treatment to the recommended schedule and a significant number of our patients were treated with palliative intent. Chemotherapy was not administered in some patients because of low CD4 count value. Unfortunately this was not recorded systematically and HIV status was not an entry or exclusion factor so no comparisons could be made. The chemotherapy schedule was not given to many patients at the recommended schedule of 3 cycles so we were not able to compare this with the literature. Resources constraints with regards to diagnostic and radiological facilities resulted in us not having measurable tumour volume increase to evaluate disease progression during waiting time and to evaluate response to treatment at follow-up. We have identified that patients are receiving inadequate treatment at the Department of Radiation Oncology with waiting times in excess of that recommended in the literature. Several reasons have been tentatively identified. Additional research in a form of prospective study is required in our department to assess if we could improve the number of patients treated with radical intent by giving induction chemotherapy during the waiting time for patients with advanced stage III & IV disease who have a good performance status. Protocols in our department need to be reviewed for patients with early disease to be treated with shorter regimen and a higher dose fractionation schedule of 2.25Gy as this will also reduce our overall treatment time and waiting time for treatment while improving local control.

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Minnis, Akin A. "A radiological assessment of the quality of reduction of distal radius fractures at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2018. https://hdl.handle.net/10539/26670.

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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 the branch of Orthopaedic Surgery, 2018
Distal radius fractures are one of the commonest injury types encountered by an orthopaedic surgeon. At Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), patients are exposed to a surgical staff with different levels of experience. Adequate assessment and management are of paramount importance in improving the chances of a good functional outcome. The primary purpose of this study was to assess the quality of reduction of acute distal radius fractures at our institution CMJAH using the universally accepted parameters of distal radius morphology, to determine if surgeon’s experience level influences the quality of reductions of distal radius fractures and secondarily, to ascertain if our surgeon based management reflects the suggested management of the IDEAL classification system. An observational prospective review was performed. Twenty-six (26) patients with DRF’s were treated at CMJAH over a six-month period and their pre- and postreduction radiographs were assessed for the adequacy of reduction using manual measurements with standardised goniometer and ruler. Comparisons were made between the various surgeons’ experience levels and the surgeons’ management strategy was compared to the IDEAL classification. Descriptive statistics, paired sample tests, tests of normality, analysis of variance, and paired proportions were used to analyse the data. All radiological parameters assessed demonstrated a statistically significant degree of reduction (p<0.05). There was good interobserver agreement in all of the radiographic parameters assessed except radial height and lateral articular gap (p>0.05). The surgeon’s choice of reduction method closely resembles that suggested by the IDEAL Classification System. We concluded that distal radius fractures presenting to CMJAH casualty over a sixmonth period were adequately reduced. The surgeon’s level of experience may impact the quality of reduction of the radial height. The IDEAL classification may prove v useful as an alternative in classifying and guiding management at our institution. Outcome studies of this cohort are required to determine if our statistically significant reductions are functionally significant.
XL2019

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Ayodele, Oluwakemi Zainab. "A review of surfactant use in neonates at Charlotte Maxeke Johannesburg academic hospital from January 2013 - June 2016." Thesis, 2019. https://hdl.handle.net/10539/29785.

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Master of Medicine (Paediatrics
Background: Surfactant replacement therapy (SRT) is an established treatment of respiratory distress syndrome globally. However, in sub-Saharan Africa there is limited recent information on the use of SRT. Objectives: To review the use of surfactant replacement therapy in neonates at Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a cross-sectional descriptive study. The population included all neonates, term and preterm, admitted within 72hours after birth at Charlotte Maxeke Johannesburg Academic Hospital between 1 January and 30 June 2016. Maternal and neonatal characteristics of neonates who received surfactant were compared to those who did not receive surfactant therapy. Results: A total of 5517 neonates were included in the study. Surfactant replacement therapy was strongly associated with birth weight – 69.7% (1179/1609) very low birth weight (<1500 g) neonates received surfactant compared to 16.3% (624/3828) LBW (p<0.001). In very low birth weight neonates, surfactant replacement therapy was associated with the presence of a patent ductus arteriosus (p=0.03), respiratory distress syndrome (p<0.001), the use of mechanical ventilation (p<0.001), the use of nasal CPAP (p<0.001) and supplemental oxygen at 28 days (p=0.012). In LBW, surfactant replacement was similarly associated with respiratory distress syndrome (p<0.001), the need for nasal CPAP (p<0.001) and resuscitation at birth (p=0.026). In all neonates, surfactant replacement was associated with increased duration of hospital stay. SRT was used in term and near-term neonates for the treatment of meconium aspiration syndrome (8.6%), persistent pulmonary hypertension of the neonate (4.3%) and congenital pneumonia (5.1%). This study confirms that most preterm neonates with respiratory distress syndrome in the study hospital were treated with surfactant replacement therapy and nasal CPAP. This is in keeping with global neonatal practices. Protocols to decrease neonatal mortality in low and middlee-income countries must include the provision of surfactant replacement therapy and nasal CPAP for the treatment of preterm infants.
MT 2020

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Rahmanian, Sadaf. "Outcomes of HIV-positive patients with renal insufficiency on treatment with HAART at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2015. http://hdl.handle.net/10539/18474.

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MBBCH (Wits) FCP (SA)
With the increasing use of HAART (Highly Active Antiretroviral Treatment), chronic kidney disease is becoming an increasingly important consideration for the clinician. In resource-limited settings like sub-Saharan Africa, predictors of outcome are important when deciding on the timing of HAART initiation. Methods The main objectives of this study included assessment of outcomes of HIV positive patients with chronic kidney disease (CKD) on HAART using mortality and changes in renal function and proteinuria over a one year period or longer; in addition, the impact of common co-morbid conditions and predictors of outcome were assessed. A retrospective study was done on 169 patients with CKD at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Group 1 (n = 87) were ART-naïve and had baseline pre-HAART initiation results available. Group 2 (n = 82) were on HAART prior to being referred to the HIV renal clinic. Results In Group 1, renal function improved from a median baseline eGFR of 20.8±SEM ml/min/1.73m² to 57.7±SEM ml/min/1.73m² (p<0.05) at 24 months. Median baseline proteinuria was 0.3±SEM g/mmol with a decrease to 0.08±SEM g/mmol at 24 months (p<0.05). In Group 2, the median time from initiation of HAART to presentation to HIV renal clinic was 25 months. Median baseline eGFR was 38.9±SEM ml/min/1.73m² with an increase to 47.3±SEM ml/min/1.73m² at 24 months (p=0.4256). Median baseline proteinuria was 3g±SEM g/mmol, with a decrease at 12 months to 1.1g±SEM g/mmol and subsequent increase to 0.21g±SEM g/mmol at 24 months. These findings suggest that renal function may plateau at around 24 months on HAART. HIV-associated nephropathy (HIVAN) and HIV immune complex disease (HIV-ICD) were the main histological findings and both improved with HAART. Factors associated with poor renal outcome were diabetes mellitus (OR 4.24, CI 1.02-17.5) (p 0.04) and lower starting eGFR (OR 1.01, CI 1-1.02) (p0.017). Conclusions Initiating HAART before severe renal dysfunction has developed improves renal outcomes and reduces the burden of HIV CKD.

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Ralise, Mantsebo Elizabeth. "Outcomes of Continuous Ambulatory Peritoneal Dialysis at Charlotte Maxeke Johannesburg Academic Hospital: impact of demographic and socioeconomic factors." Thesis, 2018. https://hdl.handle.net/10539/25384.

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A research report submitted in partial fulfilment of the requirements of the Master of Medicine at the University of Witwatersrand. Johannesburg, 16 April 2018.
Background: Chronic kidney disease and end stage kidney disease are becoming a huge health challenge. The optimal treatment is renal transplantation but due to low rates of transplantation most patients who are enrolled in the chronic renal replacement programme are on dialysis. This study aimed at investigating demographic and social factors that are associated with the outcomes of peritoneal dialysis (PD). The study also investigates how co-morbidity contributed to the outcomes of PD. Methods: The study makes use of retrospective analysis of demographic data (age, marital status, residential area, race) and socioeconomic status, level of education, family support, poor access to health care system as well as co-morbidities and underlying cause of ESKD, obtained from 167 patients who were enrolled on continuous ambulatory peritoneal dialysis (CAPD) over the period of 2008 - 2012 at the Charlotte Maxeke Academic Johannesburg Hospital (CMJAH). The data analysis for the present study was conducted using STATA version 14.0. To describe the demographic characteristics of the patients, frequency tables were computed for all categorical variables. For continuous variables, the Shapiro Wilk test for normality was used to assess the distribution of the data to report the appropriate central tendency measure i.e. mean±SD or median (IQR). To assess the contribution of demographic factors to the overall outcome of CAPD, a Fisher’s exact test of comparison was used to assess the difference between the proportions for each demographic factor and CAPD outcome. The Fisher exact test was used because the proportions for each frequency table included a proportion below five (<5). To assess how the relationship of demographic and co-morbid disease affects the outcome of the treatment, a multivariate logistic regression model was fitted adjusting for co-morbid disease for each of the demographic factors. Findings and interpretation: Of 167 patients enrolled, the majority were black with low levels of education, living in townships and 56% were on subsisting on disability grants. PD failure occurred in 53.3% of patients over the study period and 46.7% were successful on PD. Of the variables tested, age was statistically significant for CAPD outcomes [Fisher exact test (p= 0.004)], indicating a significant difference in the proportion of CAPD outcomes among different age categories). The univariate and multivariate logistic regression analysis did not show significant association with CAPD outcomes. Adherence also significantly impacted on outcomes in both univariate and multivariate analyses, showing that non-compliant patients were less likely to have successful outcomes on PD. In addition, the Fisher exact test showed no significant difference in the distribution of CAPD outcome with marital status while the multivariate analysis showed that single patients were three times more likely to succeed with PD compared to married patients. These could be due to chance, because of the small sample size, and require further investigation. Conclusions: Prospective studies are needed to fully understand the extent that demographic and socioeconomic factors impact on the outcomes of PD. This will assist in formulating comprehensive recommendations and ways to improve PD utilization and outcomes.
LG2018

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Hira, P. G. "A retrospective analysis of mandibular grafting using vascularised free fibula flaps at the Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2019. https://hdl.handle.net/10539/29849.

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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Dentistry (MFOS)
Introduction: Segmental mandibular defects following significant maxillofacial trauma and ablative tumour surgery often present reconstructive challenges from the resultant mandibular bone and soft tissue defects. The volume of bone and soft tissues lost often necessitates composite microvascular flap reconstruction to be able to optimally rehabilitate these patients. Vascularised free fibula flaps have the concomitant benefit of providing adequate bone and soft tissue coverage. Aims and objectives: The aims are to retrospectively evaluate the reconstructive outcomes of vascularised mandibular free fibula flaps and to identify factors associated with favourable and unfavourable outcomes. Methods and materials: Patients with vascularised free fibula flaps to the mandible were included in the study. Data collected was divided into various categories, namely, demographic details, defect aetiology, the number of segments in the fibula, adjunctive radiation therapy, the subsequent immediate or delayed placement of dental implants and associated complications. Results: Twenty patients (8 males and 12 females) were included in this study. The most common aetiology of mandibular defects was neoplasia. The overall complication rate was 40% and ranged from graft loss due to anastomosis failure to dehiscence and minor sepsis. No significant association was found between gender, aetiology of defect, radiation therapy and reconstructive outcome. Nine patients subsequently received dental implants. Conclusion: There was a 90% fibula graft success rate. A larger sample size and a longer follow-up in a multidisciplinary team is needed to assist in the development of a better treatment and follow-up protocol in patients treated with vascularised free fibula flap.
TL (2020)

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Suleman, Laila. "Primary focal segmental glomerulosclerosis in adults: presentation, prevalence and treatment outcomes in patients at Charlotte Maxeke Johannesburg Academic Hospital." Thesis, 2015. http://hdl.handle.net/10539/18646.

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A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in Internal Medicine Johannesburg, 2015
The presenting features and treatment of patients with Primary Focal Segmental Glomerulosclerosis (FSGS) were characterised in this study. Methods Adults with primary FSGS at Charlotte Maxeke Johannesburg Hospital from 2001-2010 were reviewed. 38 patients were identified; 8 were lost to follow-up after presentation and 30 were further characterised in terms of outcomes. Analysis was performed of the clinical presentation, therapeutic and cumulative outcomes. A p<0.05 was significant. Results The prevalence of primary FSGS was 7.2%, Blacks constituted 86.8% of cases and 65.7% were male. Most patients presented with the nephrotic syndrome and the most common histological subtype was the Classical variant. Black patients diagnosed with the disorder were younger (p=0.002); and had a predominance of the collapsing variant (p=0.95). Remission with first-line therapy was achieved in 73% of patients. A lower Glomerular filtration rate (eGFR) at presentation and poor cumulative end-point was noted (p=0.94). Conclusion Primary FSGS is a not-uncommon glomerular disorder in the South African Black population. Black patients present at a younger age and a high proportion have the collapsing subtype

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