A cross-sectional study to ascertain the prognostic factors and symptoms associated with cryptococcal meningitis cases treated at the East London Hospital complex
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
A study of the prevalence of refractive errors and of patients requring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and O. R. Tambo districts of the Eastern Cape
- Authors: Webber, Fiona
- Date: 2012
- Subjects: Eye -- Refractive errors -- South Africa -- Eastern Cape , Cataract -- Surgery -- South Africa -- Eastern Cape , Refractive keratoplasty -- South Africa -- Eastern Cape , Community health services -- South Africa -- Eastern Cape , Eye -- Diseases -- South Africa -- Eastern Cape , Optometry -- South Africa -- Eastern Cape , Eyeglasses -- South Africa -- Eastern Cape , Nurses -- In-service training -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Nursing Science)
- Identifier: vital:11900 , http://hdl.handle.net/10353/d1001100 , Eye -- Refractive errors -- South Africa -- Eastern Cape , Cataract -- Surgery -- South Africa -- Eastern Cape , Refractive keratoplasty -- South Africa -- Eastern Cape , Community health services -- South Africa -- Eastern Cape , Eye -- Diseases -- South Africa -- Eastern Cape , Optometry -- South Africa -- Eastern Cape , Eyeglasses -- South Africa -- Eastern Cape , Nurses -- In-service training -- South Africa -- Eastern Cape
- Description: This is a study on the prevalence of refractive errors and patients requiring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and OR Tambo District Municipalities of the Eastern Cape. This is an area characterised by extreme poverty where the cost of an eye examination and prescription spectacles remains financially unobtainable for most. Optometry services are provided mainly by private optometrists who service the small proportion of the population that can afford them. Adults and children remain house bound or are labelled as dull and unproductive simply because they don’t have access to an eye examination and a pair of spectacles. Purpose The purpose of the study is to identify patients with refractive errors and those requiring refractive services at the 15 eye clinics in the Eastern Cape. Another purpose is to describe the refractive services that are available to patients attending health facilities, where the eye clinics are conducted. Lastly, the purpose is to explore the possibility of nurses providing refractive services independently or under the supervision of optometrists to supplement the lack to refracting and dispensing services. Study Method A quantitative and qualitative non-experimental descriptive design was used. Research involved the analysis of Vision Care’s eye clinic records collected from 15 eye clinics from January 2010-June 2010. Semi-structured interviews were conducted with 30 nurses working at the 15 health facilities where the eye clinics were conducted using purposive sampling. The quantitative data was analysed using excel spreadsheets and graphs and qualitative data was analysed using coding and categorizing methods. Conclusion According to Vision Care’s data of the patients assessed, 19.2 percent had a refractive error and 54 percent of the patients required refractive services. It is estimated that 71.41 percent of the patients had a refractive error according to the optometrist. Although there were some organisations active in the eradication of cataracts, there was little healthcare available in the form of refraction services. xiv Patients needed to travel an average of 63.8kms to access refraction services against the backdrop of poor roads, poverty and unemployment. 28 out of 30 nurses either ‘strongly agreed’ or ‘agreed’ that nurses could be trained to perform refractions and dispense spectacles. 29 out of 30 nurses thought that this would have a positive impact on eye care. Further research is necessary to assess the feasibility of implementing a nurse operated refractive program and whether it should be within their scope of practice to refract and dispense spectacles.
- Full Text:
- Date Issued: 2012
- Authors: Webber, Fiona
- Date: 2012
- Subjects: Eye -- Refractive errors -- South Africa -- Eastern Cape , Cataract -- Surgery -- South Africa -- Eastern Cape , Refractive keratoplasty -- South Africa -- Eastern Cape , Community health services -- South Africa -- Eastern Cape , Eye -- Diseases -- South Africa -- Eastern Cape , Optometry -- South Africa -- Eastern Cape , Eyeglasses -- South Africa -- Eastern Cape , Nurses -- In-service training -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Nursing Science)
- Identifier: vital:11900 , http://hdl.handle.net/10353/d1001100 , Eye -- Refractive errors -- South Africa -- Eastern Cape , Cataract -- Surgery -- South Africa -- Eastern Cape , Refractive keratoplasty -- South Africa -- Eastern Cape , Community health services -- South Africa -- Eastern Cape , Eye -- Diseases -- South Africa -- Eastern Cape , Optometry -- South Africa -- Eastern Cape , Eyeglasses -- South Africa -- Eastern Cape , Nurses -- In-service training -- South Africa -- Eastern Cape
- Description: This is a study on the prevalence of refractive errors and patients requiring refractive services at 15 eye clinics in the Amathole, Chris Hani, Joe Gqabi and OR Tambo District Municipalities of the Eastern Cape. This is an area characterised by extreme poverty where the cost of an eye examination and prescription spectacles remains financially unobtainable for most. Optometry services are provided mainly by private optometrists who service the small proportion of the population that can afford them. Adults and children remain house bound or are labelled as dull and unproductive simply because they don’t have access to an eye examination and a pair of spectacles. Purpose The purpose of the study is to identify patients with refractive errors and those requiring refractive services at the 15 eye clinics in the Eastern Cape. Another purpose is to describe the refractive services that are available to patients attending health facilities, where the eye clinics are conducted. Lastly, the purpose is to explore the possibility of nurses providing refractive services independently or under the supervision of optometrists to supplement the lack to refracting and dispensing services. Study Method A quantitative and qualitative non-experimental descriptive design was used. Research involved the analysis of Vision Care’s eye clinic records collected from 15 eye clinics from January 2010-June 2010. Semi-structured interviews were conducted with 30 nurses working at the 15 health facilities where the eye clinics were conducted using purposive sampling. The quantitative data was analysed using excel spreadsheets and graphs and qualitative data was analysed using coding and categorizing methods. Conclusion According to Vision Care’s data of the patients assessed, 19.2 percent had a refractive error and 54 percent of the patients required refractive services. It is estimated that 71.41 percent of the patients had a refractive error according to the optometrist. Although there were some organisations active in the eradication of cataracts, there was little healthcare available in the form of refraction services. xiv Patients needed to travel an average of 63.8kms to access refraction services against the backdrop of poor roads, poverty and unemployment. 28 out of 30 nurses either ‘strongly agreed’ or ‘agreed’ that nurses could be trained to perform refractions and dispense spectacles. 29 out of 30 nurses thought that this would have a positive impact on eye care. Further research is necessary to assess the feasibility of implementing a nurse operated refractive program and whether it should be within their scope of practice to refract and dispense spectacles.
- Full Text:
- Date Issued: 2012
Effect of stage of lactation on milk yield, somatic cell counts, mineral and fatty acid profiles in pasture-based Friesian, Jersey and Friesian × Jersey cows
- Nantapo, Carlos Wyson Tawanda
- Authors: Nantapo, Carlos Wyson Tawanda
- Date: 2012
- Subjects: Trace elements in animal nutrition , Genotype-environment interaction , Milk yield -- Testing , Lactation , Holstein-Friesian cattle , Jersey cattle
- Language: English
- Type: Thesis , Masters , MSc Agric (Animal Science)
- Identifier: vital:11819 , http://hdl.handle.net/10353/d1006810 , Trace elements in animal nutrition , Genotype-environment interaction , Milk yield -- Testing , Lactation , Holstein-Friesian cattle , Jersey cattle
- Description: The effect of stage of lactation on milk yield, somatic cell counts, mineral and fatty acid profiles in pasture-based Friesian, Jersey and Friesian × Jersey cows was investigated. Twenty Friesian, twenty Jersey and twenty Friesian × Jersey cows were randomly selected from a dairy herd. A total of 202 milk samples were collected and analysed in three stages of lactation. Genotypic differences were observed in milk yield and fat content. Friesian cows produced the highest yield and lowest fat content whereas the opposite was true for Jersey cows (P<0.01). No significant differences were observed in SCC in the different genotypes, but SCC levels were higher in mid and late lactation (P<0.001). There was no effect (P<0.005) of genotype and stage of lactation interaction on Ca, P, Mg, Na, Mn and Bo concentration. Jersey cows had the least concentration of Fe and Cu in all stages of lactation. Strong positive correlations were observed among Ca and P, Mg and Zn. Aluminium had a strong positive relationship with Bo, Fe, Mn and Zn (P<0.001). Generally, SCC had a weak positive relationship with macro elements but a significant negative relationship with microelements. Yield levels were negatively correlated with Mg, Na, Al, Mn and SCC. Pasture ALA, SFA, n-3, n-6/n-3 and PUFA/MUFA concentration did not differ across the study period. Linoleic acid was highest in the second phase which coincides with mid lactation in cows (P<0.001). Highest moisture content coincided with the least fat free dry matter content in early lactation (P<0.001). Significantly high fat content was observed in late lactation than in early lactation. Highest butyric, caproic, linoleic, n-6 and PUFA were observed for Friesian cows. All other fatty acids ratios were not significantly different among different genotypes. Highest CLA, ALA, LA, SFA, PUFA, n-6, and n-3 and atherogenicity index were observed in early lactation whereas desaturase activity indices were highest in late lactation. Strong positive correlations were observed among milk vaccenic, ALA, LA and CLA concentrations. Inverse relationships were observed between SFA and long chain fatty acids. It can be concluded, it may be of advantage to consume milk from early stage of lactation poses a lower risk to coronary diseases and are much safer to consume.
- Full Text:
- Date Issued: 2012
- Authors: Nantapo, Carlos Wyson Tawanda
- Date: 2012
- Subjects: Trace elements in animal nutrition , Genotype-environment interaction , Milk yield -- Testing , Lactation , Holstein-Friesian cattle , Jersey cattle
- Language: English
- Type: Thesis , Masters , MSc Agric (Animal Science)
- Identifier: vital:11819 , http://hdl.handle.net/10353/d1006810 , Trace elements in animal nutrition , Genotype-environment interaction , Milk yield -- Testing , Lactation , Holstein-Friesian cattle , Jersey cattle
- Description: The effect of stage of lactation on milk yield, somatic cell counts, mineral and fatty acid profiles in pasture-based Friesian, Jersey and Friesian × Jersey cows was investigated. Twenty Friesian, twenty Jersey and twenty Friesian × Jersey cows were randomly selected from a dairy herd. A total of 202 milk samples were collected and analysed in three stages of lactation. Genotypic differences were observed in milk yield and fat content. Friesian cows produced the highest yield and lowest fat content whereas the opposite was true for Jersey cows (P<0.01). No significant differences were observed in SCC in the different genotypes, but SCC levels were higher in mid and late lactation (P<0.001). There was no effect (P<0.005) of genotype and stage of lactation interaction on Ca, P, Mg, Na, Mn and Bo concentration. Jersey cows had the least concentration of Fe and Cu in all stages of lactation. Strong positive correlations were observed among Ca and P, Mg and Zn. Aluminium had a strong positive relationship with Bo, Fe, Mn and Zn (P<0.001). Generally, SCC had a weak positive relationship with macro elements but a significant negative relationship with microelements. Yield levels were negatively correlated with Mg, Na, Al, Mn and SCC. Pasture ALA, SFA, n-3, n-6/n-3 and PUFA/MUFA concentration did not differ across the study period. Linoleic acid was highest in the second phase which coincides with mid lactation in cows (P<0.001). Highest moisture content coincided with the least fat free dry matter content in early lactation (P<0.001). Significantly high fat content was observed in late lactation than in early lactation. Highest butyric, caproic, linoleic, n-6 and PUFA were observed for Friesian cows. All other fatty acids ratios were not significantly different among different genotypes. Highest CLA, ALA, LA, SFA, PUFA, n-6, and n-3 and atherogenicity index were observed in early lactation whereas desaturase activity indices were highest in late lactation. Strong positive correlations were observed among milk vaccenic, ALA, LA and CLA concentrations. Inverse relationships were observed between SFA and long chain fatty acids. It can be concluded, it may be of advantage to consume milk from early stage of lactation poses a lower risk to coronary diseases and are much safer to consume.
- Full Text:
- Date Issued: 2012
Evaluation of the possible application of cowpea genotypes in the farming systems of the Eastern Cape Province, South Africa
- Authors: Adeyemi, Samson Adebowale
- Date: 2012
- Subjects: Cowpea -- South Africa -- Eastern Cape , Cowpea , Plant diversity , Cowpea -- Genetics , DNA fingerprinting of plants
- Language: English
- Type: Thesis , Masters , MSc (Biochemistry)
- Identifier: vital:11274 , http://hdl.handle.net/10353/d1007539 , Cowpea -- South Africa -- Eastern Cape , Cowpea , Plant diversity , Cowpea -- Genetics , DNA fingerprinting of plants
- Description: Characterization studies on the genetic diversity among cultivated cowpea (Vigna unguiculata (L.) varieties are valuable tools to optimize the use of available genetic resources by farmers, local communities, researchers and breeders. Eight cowpea (Vigna unguiculata (L.) genotypes ( Vegetable cowpea, Ivory grey, Okhalweni, Fahari, Fahari dark, 97K-1069-8, IT93K-73h, and 129-3) were subjected to molecular, morphological and agronomical characterization. DNA amplification fingerprinting markers were used to evaluate the genetic diversity among the eight genotypes. Nine random arbitrary primers were used to screen the eight genotypes to assess their ability to reveal polymorphisms in cowpea, and seven of them were selected for use in characterizing the total sample. A total of 43 bands were generated which are all polymorphic. On the average, the primers generated a total of 6.1 polymorphic bands. The resulting data-matrix included 43 analysed bands with a total of 344 characters. Neighbour joining analysis was used to generate the dendrogram, clustering the genotypes into two groups at an agglomerate coefficient of 0.30 irrespective of their geographical origins. The results also showed the presence of significant differences in morphological and quality traits among the genotypes. Fahari yielded the highest concentration of crude protein (46.51 mg/mg dry leaf) while Vegetable cowpea yielded the lowest (24.41 mg/mg dry leaf). The influence of manure was also found to be effective by increasing the crude protein content of the genotypes as shown by Fahari dark with an average of 53.53 mg/mg dry leaf as opposed to 39.85 mg/mg dry leaf without manure application. Although some small clusters grouped accessions of the same growth habits, a general lack of agreement between clustering and morphological features was observed. It can therefore be concluded that the significant differences between the molecular genetic analysis using DAF-PCR markers, morphologic characters and yield traits can be important tools to identify and discriminates the different cowpea genotypes.
- Full Text:
- Date Issued: 2012
- Authors: Adeyemi, Samson Adebowale
- Date: 2012
- Subjects: Cowpea -- South Africa -- Eastern Cape , Cowpea , Plant diversity , Cowpea -- Genetics , DNA fingerprinting of plants
- Language: English
- Type: Thesis , Masters , MSc (Biochemistry)
- Identifier: vital:11274 , http://hdl.handle.net/10353/d1007539 , Cowpea -- South Africa -- Eastern Cape , Cowpea , Plant diversity , Cowpea -- Genetics , DNA fingerprinting of plants
- Description: Characterization studies on the genetic diversity among cultivated cowpea (Vigna unguiculata (L.) varieties are valuable tools to optimize the use of available genetic resources by farmers, local communities, researchers and breeders. Eight cowpea (Vigna unguiculata (L.) genotypes ( Vegetable cowpea, Ivory grey, Okhalweni, Fahari, Fahari dark, 97K-1069-8, IT93K-73h, and 129-3) were subjected to molecular, morphological and agronomical characterization. DNA amplification fingerprinting markers were used to evaluate the genetic diversity among the eight genotypes. Nine random arbitrary primers were used to screen the eight genotypes to assess their ability to reveal polymorphisms in cowpea, and seven of them were selected for use in characterizing the total sample. A total of 43 bands were generated which are all polymorphic. On the average, the primers generated a total of 6.1 polymorphic bands. The resulting data-matrix included 43 analysed bands with a total of 344 characters. Neighbour joining analysis was used to generate the dendrogram, clustering the genotypes into two groups at an agglomerate coefficient of 0.30 irrespective of their geographical origins. The results also showed the presence of significant differences in morphological and quality traits among the genotypes. Fahari yielded the highest concentration of crude protein (46.51 mg/mg dry leaf) while Vegetable cowpea yielded the lowest (24.41 mg/mg dry leaf). The influence of manure was also found to be effective by increasing the crude protein content of the genotypes as shown by Fahari dark with an average of 53.53 mg/mg dry leaf as opposed to 39.85 mg/mg dry leaf without manure application. Although some small clusters grouped accessions of the same growth habits, a general lack of agreement between clustering and morphological features was observed. It can therefore be concluded that the significant differences between the molecular genetic analysis using DAF-PCR markers, morphologic characters and yield traits can be important tools to identify and discriminates the different cowpea genotypes.
- Full Text:
- Date Issued: 2012
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