Dissertations / Theses on the topic 'Ochlar manifestations of general diseases'

Thesis (MTech(Medical Technology))--Cape Technikon, Cape Town, 1996
Haematol.ogical defects observed in cl.onal deletions of mtDNA and the inhibition of mitochondrial function by benzene and chloramphenicol., suggest a role for mtDNA in the pathogenesis of radiation - induced preleukaemia (MDS). The fact that leukaemia cell.s contain abnormal mitochondria and abnormally structured mtDNA, makes it reasonable to assume mtDNA mutations could be central to the pathogenesis of both MDS and l.eukaemia. It was decided to examine MDS patients for the presence of mtDNA length mutations (dimers and cocantameres). Such topol.ogical forms have already been reported in the literature in association with human leukaemia. These steric considerations suggest that mtDNA dimers are probably non-functional due to supercoil.ing. Thus, it was felt that a progressive accumulation of non-functional dimers in the haematopoietic compartment could account for many of the cl.inical. features associated with MDS. Transmission electron microscopy was used to examine haematopoietic mtDNA in the bone marrow of six patients with MDS. Abnormal mtDNA dimer formation was found in al.l instances. The proportional. number of these dimers were found to roughly correlate with the Myeloid/ Erythroid cell. ratio in the bone marrow, and it appeared likely that the dimers were generated in the myeloid compartment during early MDS. Control.l.ed radiation studies were performed on 20 wistar rats in an attempt to elucidate the approximate time when abnormal mtDNA dimer formation occurred, fol.l.owing fractionated gamma or gamma-neutron irradiation. Gamma-irradiated rats demonstrated abnormal mtDNA dimer formation at the time hypoplastic marrow recovery was first observed.

 Neuropsychiatric systemic erythematosus (NPSLE) is a complicated complication of systemic erythematosus (SLE). Asian patients are associated with high prevalence of systemic disease and mortality It increases patients’ morbidity and mortality (Samanta et al., 1991). But the detailed pathology and pathogenesis are still remained unclear. Our study’s purpose is to use advanced functional imaging method, including diffusion tensor imaging (DTI) and magnetic resonance spectroscopy imaging (MRSI) to detect intracranial volumetry, functional and other metabolite changes in NPSLE patients. We recruited 3 age-matched female groups, one patient group with NPSLE (20 patients), one patient group with SLE (20 patients) and one control group (15 normal controls). Each patient was applied to structural 3D-T1 and axial T2, DTI and MRSI. Whole brain volumetry and hippocampus volumetry were analyzed by FSL and MARINA software from T1 images. White matter hyperintensity was calculated manually. Whole brain FA and other indices were collected. Regional FA was also collected and was collected with MRS over corpus callosum slice. The result showed no significant whole brain atrophy in NPSLE patients and SLE patients compared with controls. But with segmentation of grey matter, white matter and CSF, NPSLE patients showed significant decrease volume from SLE patients in white matter. Left hippocampus showed significant decreased volume in white matter and grey matter compared with control, while right hippocampus showed significant decreased volume in white matter. No other significant difference was found between NPSLE vs SLE and SLE vs controls. Whole brain FA was significantly decreased in NPSLE compared to SLE and controls, but not significantly different between SLE and controls. MD, λ∥ and λ⊥ were significantly increased in NPSLE and SLE compared with controls, but not significantly different between SLE and controls. White matter hyperintensity score was consistent with MD, λ∥ and λ⊥ results, showed significantly higher scores in two patients groups compared to controls. Regional FA, involving frontal lobes and corpus callosum, periventricular regions adjacent to centrum semiovale and posterior lateral temporal lobe, confirmed the regional FA decrease showed in whole brain FA statistical color map and NPSLE patients’ regional FA decrease correlated with MRS metabolic changes. N-acetyl aspartate (NAA)/ Creatine (Cr), the marker of neurons, decreased significantly in NPSLE patients compared with SLE and controls. Choline (Cho)/Cr showed significant increase of tendency of significant increase in NPSLE and SLE patients in some ROIs compared with controls. Our finding suggested that, although the whole brain atrophy is not obvious in NPSLE, the hippocampus and white matter suffered atrophy in NPSLE patients. These atrophy in white matter of whole brain and hippocampus combined with functional imaging results of DTI and MRS, indicated that NPSLE endured more severe axonal damage than SLE, which might be due to a variety of lesions, such as demyelination, microangiopathy, large vessel thrombosis, cytokine, etc. Varying ratio of NAA/Cr and Cho/Cr may be associated with the severity of axonal damage, probably due to demyelination in the background of inflammatory/ischemic/vasculitic changes.
published_or_final_version
Diagnostic Radiology
Master
Master of Philosophy

Thesis (Mnutr)--University of Stellenbosch, 2003.
ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be the occurrence of opportunistic infections with micro-organisms such as oral Candida. Objective: The aim of this study was to determine the nutritional status of children with oral complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional status. Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South Africa. The nutritional status of the children was assessed over a maximum period of six months by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral examination on admission and at discharge from hospital. Results: Children with HIVand TB infection presenting with or without oral lesions were similarly malnourished throughout the period of hospitalization. There was no improvement in the nutritional status as indicated by height and weight measurements. Throughout the time of hospitalization, 7% of the children had a combination of stunting, underweight and wasting. Average nutrient intake was not found to be higher than the Recommended Dietary Allowance (RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate intake provided most of the daily energy (36% and 42%, the difference not being statistically significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission was higher than at time of discharge. Selected sub-optimal biochemical values were prevalent among the children studied, with 45% and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels below normal values. Serum ferritin levels below normal values were present in almost all the children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues below the normal range whereas at time of discharge 17% of the children had values below normal (p=O.04). A total of 29% children presented with oral complications on admission. These included oral herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher (p=O.057) among the children who were not diagnosed with oral complications. Conclusions: This study confirmed that malnutrition is not only a common and serious problem associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation where Opportunistic Infections are present. The severity of malnutrition depends on various factors including oral complications. Additionally, appropriate management and treatment of tuberculosis did not appear to affect the nutritional status significantly. Recommendations: On the basis of these findings, and because of the increased risk of growth failure and developmental delays, children should be referred for full nutritional evaluation as soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention programmes to identify the immediate underlying causes of malnutrition and the ways in which such causes interact, in order to ensure that such interventions increase the resistance of HIV infected infants and children to the disease.
AFRIKAANSE OPSOMMING: Probleemdefiniëring: Binne die konteks van MIVNIGS is wanvoeding bykans universeelonder kinders en van die nadelige effekte van proteïen energie wanvoeding is die voorkoms van opportunistiese infeksies (Ol) met mikro-organismes soos orale candida die algemeenste. Doelwit: Die doel van dié studie was om die voedingstatus van kinders met orale komplikasies in verhouding tot MIVNIGS en die effek van orale letsels op voedingstatus, te bepaal. Proefpersone/omgewing: 'n Groep van 24 kinders, met beide tuberkulose en MIVNIGSinfeksie, wat agtereenvolgend in die kindersaal van Brooklyn Bors-Hospitaal in Kaapstad, Suid- Afrika opgeneem is, is bestudeer. Vir 'n periode van ses maande is die kinders se voedingstatus geassesseer deur middel van voedingstofinname, antropometriese status en biochemiese parameters met opname in en ontslag uit die hospitaal. Kliniese en orale ondersoeke was op elke kind uitgevoer met opname sowel as ontslag. Resultate: Kindres met HIV en tuberkulose, met of sonder orale letsels, het soortgelyke wanvoeding tydens hospitalisering ervaar het. Volgens antropometriese metings was daar geen verbetering in die voedingstatus nie. 'n Kombinasie van belemmerde groei, ondergewig en uittering het in 7% van die kinders tydens hospitalisering voorgekom. Nie een van die gemiddeldes van die voedingstowwe was hoër as die Aanbevole daaglikse toelatings (ADT) in enige van die kinders wat bestudeer is nie. Met opname sowel as ontslag, was koolhidraatinname die grootste energieverskaffer met onderskeidelik 36% en 42% (alhoewel die verskil nie statisties beduidend was nie). Daar was 'n beduidende toename in energie-inname (p=O.04) en 'n afname in totale vetinname (p=O.03) met ontslag. Alhoewel nie beduidend nie, was die gemiddelde proteïeninname hoër met ontslag. Die voorkoms van geselekteerde sub-optimale biochemiese waardes met toelating en ontslag wys dat onderskeidelik 45% en 41% van die kinders lae serum albumienwaardes «2.9g/dL) getoon het. Subnormale plasma retinol het in 79% van die kinders met toelating voorgekom, terwyl slegs 21% gebrekkige waardes (p=O.03) met ontslag getoon het. Tydens opname, sowel as met ontslag, was 38% van die kinders se hemoglobienvlakke laer as die normale. Serum ferritienvlakke was amper by al die kinders laer as die normale vlakke te bespeur, met sinkvlakke wat op soortgelyke lae vlakke voorkom. Met toelating was 29% van die kinders se Vitamien C-waardes laer as normaal en met ontslag was sowat 17% se waardes steeds laer as die normaal (p=O.04). Met toelating het 29% van die kinders orale komplikasies getoon. Ingeslote hierby was orale herpes, orale sproei, refluks, bloeiende tandvleise en stomatis/ angulêre cheilose. Slegs twee kinders was asimptomaties met orale Candida van die mondholte gediagnoseer. Die gemiddelde proteïeninname was hoër (p=O.057) onder die kindres wat nie orale komplikasies getoon het nie. Gevolgtrekking: Hierdie studie bevestig dat wanvoeding me net 'n algemene en ernstige probleem is wat met MIV en VIGS geassosieer word nie, maar ook in die teenwoordigheid van opportunistiese infeksies, die voedingsprobleem nie in isolasie gehanteer kan word nie. Die graad van wanvoeding hang af van ander faktore, insluitende orale komplikasies. Voldoende behandeling van TB het ook nie 'n beduidende effek op voedingstatus gehad nie. Aanbevelings: Op hierdie bevindings gebaseer, en as gevolg van die verhoogde risiko VIr belemmerde groei en vertraagde ontwikkeling wat al die liggaamstelsels van MIV -positiewe kinders affekteer, moet kinders so gou as moontlik nadat die MIV-infeksie gediagnoseer is, vir volle voedingsevaluasies verwys word. Daarmee gepaardgaande is daar 'n behoefte aan programme wat die onmiddellike onderliggende oorsake van wanvoeding identifiseer, asook om interaksie van hierdie oorsake met HIV vas te stel, ten einde intervensies wat weerstand van HIVkinders en-babas verbeter, positieftoe te pas.

Thesis (M.Sc. (Optometry)) --University of Limpopo (Turfloop Campus), 2010
Human Immunodeficiency Virus (HIV) and the associated Acquired Immunodeficiency Syndrome (AIDS) are major public health concerns worldwide and present socioeconomic burden to many governments. To combat this scourge, a deep knowledge about this pandemic is required as one of the preventive methods. Also, the knowledge can serve as a tool to help those who are infected. HIV/AIDS is common among adolescents; therefore, one of the aims of this study is to establish the knowledge of basics of HIV/AIDS among high school learners in the Capricorn district of the Limpopo Province, South Africa.HIV/AIDS also affects the eye; identification of the ocular problem can sometimes help with the diagnosis of HIV/AIDS the condition. Therefore may have both sight and life-saving implications. The school curriculum and HIV/ AIDS awareness campaigns in South Africa do not include basic knowledge of the effects of HIV/AIDS on the eye; therefore an additional aim of this study was to establish the basic knowledge of the effects of HIV/AIDS on the eye among the participants, so that an informed recommendation can be made for the inclusion of the eye component in the awareness campaign and school curriculum. Methodology Following relevant research and ethics approval of the proposal, relevant permissions were obtained before the study commenced. A quantitative survey design was used for the study. Stratified random sampling method was used to select high schools and students that took part in the research. The participants were learners from 18 selected high schools in the Capricorn district of the Limpopo Province. A questionnaire containing demographic data, information on general and ocular effects of HIV/AIDS was used to collect information from the learners, following a pilot study involving 20 high school learners. Data was analyzed with Statistical Packages for Social Sciences (SPSS) computer program version 16. Descriptive statistics (range, mean, standard deviations and frequencies) was used to describe the findings, and analysis of covariance (ANCOVA) model was used to model the scores on each of the dependent variables i.e. general knowledge of HIV/AIDS and basic knowledge of the effects of HIV/AIDS on the eye. Results The participants were 2659 black South African learners in grades 10 to 12 in the high schools. Eighty eight percent were from rural high schools and (12%) were from a semi-urban high school. Their ages ranged from 14 to 28 years with a mean age of 17.82 and SD of ±1.766 years. The participants included (46.4%) males,(53.1%) females, and (0.5%) learners did not indicate their gender.The meaning of the acronym HIV was known by 63.6% of the participants, and these included 65.8% of the females and 61.5% of males. A lesser proportion (61.5%) knew what the acronym AIDS stands for. They included 70.9% of the females and 60.8% of the males. Knowledge about the different modes of HIV transmission varied from 87.0% (transmission through unprotected sex) to 62.5% (transmission from mother-to–child during pregnancy). Regarding the misconception on the modes of HIV/AIDS transmission, a majority (81.5%) of the learners knew that HIV/AIDS could not be transmitted from one person to another through hugging a person infected with HIV; this percentage includes 82.6% of the females and 80.3% of the males.Only two respondents (0.1%) out of the total population knew the meaning of window period in HIV and they were both females. Only about a third (33.2%) knew the difference between HIV positive and negative results. Majority (85.9%) knew that it is important for one to know his or her HIV status. However, only 5.6% knew the reason why people should know their HIV status. Many (60.1%) knew that the manifestation of HIV symptoms can take many years to develop on an HIV infected person, and 54.9% knew that immune system suppression is the first effect of HIV on the body. Knowledge of the effects of HIV on the body during the seroconversion phase (acute phase), varies from 29.9% (HIV can cause continuous nausea) to 73.0% (HIV can cause tiredness). On the facilities that can be used to test for HIV status, knowledge of the participants varied from 93.4% (knew that HIV test can be done at a hospital) to 34.2% (HIV test can be done at the offices of family general medical practitioner). Only a few (27.8%) knew that HIV/ AIDS can affect the eye. Many (65.5%) of the participants knew that an ophthalmologist or an optometrist should be consulted for ocular problems that are related to HIV/AIDS. Knowledge on the effects of HIV on the eye ranges from 20.6% (HIV can cause an itching and burning sensation in the eye) to 58.6% (HIV can cause severe headaches). Forty six percent knew that HIV can cause blindness. Less than half of the participants (46.9%) knew that exchanging contact lenses with the infected person could not transmit HIV from an HIV positive person. Generally the performance was poor on the ocular manifestation of HIV/AIDS. Young learners were more knowledgeable than the older ones, for both general knowledge of HIV/AIDS and knowledge of the effect of HIV/AIDS on the eye (p < 0.05). Gender of the participants was not statistically significant for both components of the survey (p > 0.05). The pattern of performance among the grades across the schools was not consistent for both components of the survey. Also ages of the learners and their grades did not correspond in terms of performance in this study. Conclusion and recommendations General knowledge of HIV/AIDS was fairly good, but the basic knowledge of the effects of HIV/AIDS on the eye was poor. Therefore, to improve the knowledge about HIV/AIDS of the target population people, there is a need for more awareness campaigns in the rural areas of South Africa. Also, it is recommended that basic knowledge of the effects of HIV/AIDS on the eye should be included in the awareness campaigns (e.g. TV, newspapers, radio, magazines, fliers and HIV/AIDS workshops) and should also be integrated into HIV education syllabus as early as primary level. Educators teaching life orientation and life skills should have regular continuing educational programmes to increase their knowledge on the subject of HIV/AIDS and its effects on organs of the body such as the eye.
University of Limpopo

In the context of HIV high infection rate in South Africa, an assumption can be made that there is a high prevalence of HIV-associated neurocognitive disorders or cognitive linguistic deficits. The aim of this study was to determine assess whether highly active antiretroviral therapy (HAART) affected the cognitive – linguistic abilities of individuals living with HIV and AIDS before and after HAART use; and to determine whether their functional performance in terms of engaging in activities of daily living was affected by HAART use. Adults living with HIV and AIDs were recruited through purposive convenience sampling to participate in the study. They were divided into three groups. The experimental and cross sectional group included participants who were HIV infected and initiated HAART. The comparison group included participants who elected not to start HAART. Participants in all three group were assessed using the Cognitive – Linguistic Quick Test and were also required to fill out a structured interview scale at baseline, four and eight months. For the experimental group 55 participants were tested at baseline, 55 at four months and 52 at eight months after HAART initiation. The comparison group included 21 participants who tested at baseline, ten at four months and nine at eight months. The cross sectional group included different participants who recruited at baseline (55) before HAART initiation, then again at four (44) and eight months (42) after HAART initiation. Descriptive analysis revealed that the mean scores for both the Cognitive – Linguistic Quick Test (CLQT) and the structured interview schedule (IS) in all the cognitive domains increased for all three groups from four and eight months after testing. However the severity ratings provided by the CLQT indicated that neurocognitive deficits were still prevalent among the participants after HAART intiation. The most impaired cogntive – linguistic ability was executive functions and the least impaired was language. One way ANOVA analysis on the CLQT and IS revealed that was a signiifcant difference in performance between the three groups at baseline, four and eight months. Repeated measures analysis revealed significant differences or improvements within participants across the three time periods. The greatest improvement was observed from baseline to eight months especially on the CLQT. ANCOVA analysis on the Cognitive- Linguistic Quick Test indicated that education had a major impact on cognitive – linguistic abilities followed by age and CD4 count. However, ANCOVA analysis on the structured interview scale revealed that the effect of time, participant group and to a lesser extent age influenced the participants cognitive – linguistic abilities when it came to perfroming activities of daily living. Quantitave inquiry using content analysis showed that participants in all three groups cited attention, followed by visual and language problems as hindering their abilities to perform activities of daily living. The implications from this study revealed that even though HAART improves cognitive –linguistic abilities, neurocognitive deficits were still prevalent. Therefore findings suggest that health professionals need to monitor the neurocognitive impairments of their patients so as determine levels of functional performance.

Indiana University-Purdue University Indianapolis (IUPUI)
Medication adherence remains a problem among Type-2 diabetes (T2D) patients despite availability of effective treatments. Three analyses of extant data sets were conducted to examine barriers to using medication as prescribed as an alternate method to assess medication adherence: 1) development and psychometric evaluation of the Murage-Marrero-Monahan-Medication barriers (4M) scale to assess patients’ perceived barriers; 2) patient demographic factors associated with barriers to using medication as prescribed, and 3) the association between patients’ perceived barriers to medication use and cardiovascular disease (CVD) risk factor control.Twelve focus groups and a cross-sectional study of 362 T2D patients contributed to develop and evaluate psychometric properties of the 4M scale. A cross-sectional survey of 964 T2D patients was used for the other two studies. Analysis of covariance identified demographic factors associated with reported barriers. Multivariable logistic regression was used to identify barriers associated with CVD risk factors (glucose, blood pressure and lipids) categorized as either poor or good control. Exploratory factor analysis with Varimax rotation resulted in a 19-item 4M scale with acceptable psychometric properties. As a five-domain (or single-domain) structure, coefficient alpha ranged from 0.70 to 0.83 (0.92). Both structures demonstrated discriminant validity and known-group validity. Age was inversely associated with all identified barriers while income was inversely associated with poor communication with providers and side effects. A unit increase in the overall barrier mean score on the 4M scale was associated with 92% increase in the odds of having poor control of two or more CVD risk factors compared to good control of all three risk factors (adjusted OR=1.92, 95% CI: 1.16–3.17; p<0.05). The 4M scale demonstrated acceptable psychometric properties in assessing barriers to using medication among T2D patients. Poor medication adherence has been previously associated with CVD risk. In this study, greater barriers were associated with poorer control of CVD risk factors making barriers a potential alternative to medication adherence, whose current assessment methods are limited. The 4M scale has the advantage to identify specific barriers inhibiting medication use that can facilitate patient-provider discussions and the development of targeted interventions.
Some parts of this dissertation work were jointly funded by Program Announcement 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).