Teses / dissertações sobre o tema "Moosach"

Der etwa sechsminütige Liederzyklus für Singstimme und Violoncello, komponiert 2019, verwendet drei Gedichte der Kölner Schriftstellerin Carola Moosbach.:1. Einsammlung 2. Sonntagsgebet 3. Urlaubsgebet

'Kirchentag' ist ein 2016 komponierter Kantatensatz für Solisten, Chor und Kammerorchester (3 Oboen, Fagott, Streicher) nach dem gleichnamigen poetischen Kommentar von Carola Moosbach zur Bach-Kantate 'Ein feste Burg ist unser Gott' BWV 80.

Cette thèse réalise une analyse structurale du récit "Mémoires d'un dinar" du docteur Danesh. Dans la première partie, nous étudions les unités narratives qui constituent la matière diegetique du récit. La diégèse est ainsi décomposée en chaînons narratifs, représentant chacun la quête d'un personnage. Motivé par des mobiles sociaux comme la pauvreté, un actant opposant se manifeste pour freiner l'action de quête du personnage, entraînant par conséquent son échec. Ceci est une signification d'une mauvaise réalité sociale : il s'agit d'une société en crise. Dans la deuxième partie, nous nous intéressons à la structure des personnages, montrant les cercles de leurs relations, leurs actants et leurs acteurs. Nous avons remarqué que le narrateur présente des personnages non évolués classés selon une perspective morale : bénéfique ou maléfique. Dans la troisième partie, nous traitons la structure du temps dans le récit. Dans l'étude de la relation entre le temps du récit et celui de l'histoire, nous avons suivi les relations d'ordre, de durée et de fréquence. Dans la quatrième partie, nous envisageons le problème de la structure du lieu romanesque. En effet, le lieu romanesque occupe une place majeure dans la structure des mémoires, jouant un rôle efficace dans la narration et contribuant à produire une illusion du réel. La cinquième partie traite d'abord les différentes perspectives du récit : idéologique, psychologique, spatio-temporelle et expressive. Elle montre ensuite que le dinar était un narrateur interne, participant et omniscient. Dans le dernier chapitre, nous soulignons le rôle qu'a joué le récit des "Mémoires d'un dinar" dans l'évolution de la littérature romanesque arabe
Our aim in this study is to establish a structural analysis of the novel 'Memoirs of a dinar' written by Danesh in 1946. In the first part, we study the narrative units which build this story. Thus, 'Memoirs of a dinar' is divided into narrative chains : each of them shows a character looking for something, motivated by social reasons like the poverty. An opposite agent always thwarts this act of search and induces its failure. This permanent failure aims at showing a society in moral crisis. In the second part, we analyse the characters of the novel, screening their relationships, actors and agents. We deduce that all characters are stable and could be ranked, according to moral standards, as good or bad. In the third part, we follow the time in 'Memoirs of a dinar'. The relations of order, duration and frequency are studied when comparing between the time of the novel and the time of the story. In the fourth part, we study the place in the novel. We find that it has a leading role by marking us feel the reality of events. The last part analyses the different perspectives of this novel : ideological, psychological. Spatiotemporally and expressive, we demonstrate that the dinar is an intern narrator, participating to the events and wise. At this end, we conclude by highlighting the leading role played by 'Memoirs of a dinar' in the evolution of the Arabic story

E-crime has impacted consumer behavioural habits within the banking industry. This affects both the customer and business value, where customers have considered alternatives and the business not realising the return of investment due to diminishing usage. Combating the illegal activities of perpetrators of crime is seen as a cost to business without any reward. However, proactively acting against e-crime does alter the perception of the channel, returning the trust to customers. However, going beyond the scope and addressing other factors that influence perception provides a competitive edge. There are at least six factors that influence perception, namely that minds are limited, minds hate confusion, minds constantly evaluate risks (monetary and functional), minds don't adopt to change easily (they prefer a comfort zone), minds are affected by past experience or communication, and minds lose, focus. These are not restricted to the science of consumer behaviour, but need to be considered in both technical decisions and change management. By influencing the perception of consumers, technology changes and ecommerce threats, which continuously evolve, do not have the same impact. Consumers become aware of their existence and are empowered to deal with the issue at hand. Probable the greatest influence on perception is knowledge and education. Having a strategy that educates consumers about the operating environment is investing in an organisation's customers lifetime value.
Thesis (M.B.A.)--North-West University, Potchefstroom Campus, 2008.

Zyklus für Sopran, Bariton, achtstimmigen Chor und Orgel nach Texten von Martin Luther, Carola Moosbach und Detlev Block. Das ca. 16-minütige Werk hat einen symmetrischen Aufbau. Das Zentrum bildet 'Die Lutherrose' (Text: Detlev Block). Darum gruppieren sich zwei Luther-Lieder und Vertonungen der Gedichte 'Vermisst' und 'Ostergruß' von Carola Moosbach. Das Werk entstand aus Anlass des Reformationsjubiläums 2017.:Aus tiefer Not (M. Luther) Vermisst (C. Moosbach) Die Lutherrose (D. Block) Ostergruß (C. Moosbach) Christ lag in Todesbanden (M. Luther)

A pharmaceutical dosage form is an entity that is administered to patients so that they receive an effective dose of an active pharmaceutical ingredient (API). The proper design and formulation of a transdermal dosage form require a thorough understanding of the physiological factors affecting percutaneous penetration and physicochemical characteristics of the API, as well as that of the pharmaceutical exipients that are used during formulation. The API and pharmaceutical excipients must be compatible with one another to produce a formulation that is stable, efficacious, attractive, easy to administer, and safe (Mahato, 2007:11). Amongst others, the physicochemical properties indicate the suitability of the type of dosage form, as well as any potential problems associated with instability, poor permeation and the target site to be reached (Wells & Aulton, 2002:337). Therefore, when developing new or improved dosage forms, it is of utmost importance to evaluate the factors influencing design and formulation to provide the best possible dosage form and formulation for the API in question. Delivery of an API through the skin has long been a promising concept due to its large surface area, ease of access, vast exposure to the circulatory and lymphatic networks, and non-invasive nature of the therapy. This is true whether a local or systemic pharmacological effect is desired (Aukunuru et al., 2007:856). However, most APIs are administered orally as this route is considered to be the simplest, most convenient and safest route of API administration. Since ibuprofen is highly metabolised in the liver and gastrointestinal tract, oral administration thereof results in decreased bioavailability. Furthermore, it also causes gastric mucosal damage, bleeding and ulceration. Another obstacle associated with oral API delivery is that some APIs require continuous delivery which is difficult to achieve (Bouwstra et al., 2003:3). Therefore, there is significant interest to develop topical dosage forms for ibuprofen to avoid side effects associated with oral delivery and to provide relatively consistent API levels at the application site for prolonged periods (Rhee et al., 2003:14). The aim of this study was to determine the influence of selected formulation factors on the transdermal delivery of ibuprofen. In order to achieve this aim, the physicochemical properties of ibuprofen had to be evaluated. The aqueous solubility, pH-solubility profile, octanol-water partition coefficient (log P-value) and octanol-buffer distribution coefficient (log D-values, pH 5 and 7.4) of ibuprofen were determined. According to Naik et al., (2000:319) the ideal aqueous solubility of APIs for transdermal delivery should be more than 1 mg.ml-1. However, results showed that ibuprofen depicted an aqueous solubility of 0.096 mg.ml-1 ± 25.483, which indicated poor water solubility and would therefore be rendered less favourable for transdermal delivery if only considering the aqueous solubility. The pH-solubility profile depicted that ibuprofen was less soluble at low pH-values and more soluble at higher pH-values. Previous research indicated that the ideal log Pvalues for transdermal API permeation of non steroid anti-inflammatory drugs (NSAIDs) are between 2 and 3 (Swart et al., 2005:72). Results obtained during this study indicated a log P-value of 4.238 for ibuprofen. This value was not included in the ideal range, which is an indication that the lipophilic/hydrophilic properties are not ideal, and this might therefore; contribute to poor ibuprofen penetration through the skin. Furthermore, the obtained log D-values at pH 5 and 7.4 were 3.105 and 0.386, respectively. Therefore, it would be expected that ibuprofen incorporated into a formulation prepared at a pH of 5 would more readily permeate the skin compared to ibuprofen incorporated into a formulation prepared at a pH of 7.4. A gel, an emulgel and a Pheroid™ emulgel were formulated at pH 5 and 7.4, in order to examine which dosage form formulated at which pH would deliver enhanced transdermal delivery. Obtained diffusion results of the different semi-solid formulations were furthermore compared to a South African marketed commercial product (Nurofen® gel) in order to establish if a comparable formulation could be obtained. An artificial membrane was used to conduct the membrane permeation studies over a period of 6 h, in order to determine whether ibuprofen was in fact released from the formulations through the membrane. Skin permeation studies were conducted using Franz diffusion cells over a period of 12 h where samples were withdrawn at specified time intervals. All the formulations exhibited an increase in the average cumulative amount of ibuprofen released from the formulations and that permeated the membrane when compared to Nurofen® gel. This increase was statistically significant (p<0.05) for the gel, emulgel and Pheroid™ emulgel at pH 7.4. The gel at pH 7.4 exhibited the highest cumulative amount of ibuprofen that permeated the membrane. Preparations formulated at a pH of 5, did not differ significantly from Nurofen® when the average cumulative amount of ibuprofen that permeated the membrane were compared. The following rank order for the average cumulative amount released from the formulations could be established: Gel (pH 7.4) >>>> Pheroid™ emulgel (pH 7.4) > Emulgel (pH 7.4) >>> Gel (pH 5)> Pheroid™ emulgel (pH 5) ≈ Emulgel (pH 5) > Nurofen® gel. On the other hand, all the formulations exhibited an increase in the average cumulative amount of ibuprofen that permeated the skin when compared to Nurofen® gel. This increase was statistically significant (p < 0.05) for the gel, emulgel and Pheroid™ emulgel at pH 5, as well as the emulgel and Pheroid™ emulgel at pH 7.4. The emulgel at pH 5 exhibited the highest cumulative amount of ibuprofen that permeated the skin. The following rank order for the average cumulative amount released from the formulations and that permeated the skin could be established: Emulgel (pH 5) >> Pheroid™ emulgel (pH 5) > Gel (pH 5) > Emulgel (pH 7.4)> Pheroid™ emulgel (pH 7.4) ≈ Emulgel (pH 7.4) >> Nurofen® gel > Gel (pH 7.4). From this rank order it was clear that a trend was followed where the pH of formulation also played a role in ibuprofen permeation. All the formulations exhibited a higher release rate and flux when compared to Nurofen® gel. This was statistically significant for the emulgel, gel and Pheroid™ emulgel at pH 7.4. The gel at pH 7.4 exhibited the highest release rate and flux. This was observed for the membrane and skin permeation studies. All the formulations (including Nurofen® gel) presented a correlation coefficient (r2) of 0.972 – 0.995 for membrane permeation studies, and 0.950 – 0.978 for skin permeation studies; indicating that the release of ibuprofen from each of the formulations could be described by the Higuchi model. Furthermore, all the formulations exhibited a prolonged lag time compared to Nurofen® gel which indicated that the ibuprofen was retained for a longer time by the base. This was statistically significant (p < 0.05) for the emulgel at pH 7.4, the gel and Pheroid™ emulgel at pH 5. The gel at pH 7.4 exhibited a lag time closest to that of Nurofen® gel and this difference could not be classified as statistically significant (p > 0.286). This was observed for the membrane and skin permeation studies. Nurofen® gel exhibited the highest ibuprofen concentration in the stratum corneum as well as in the epidermis followed by the gel at pH 7.4. However, results obtained for all the formulations indicated that topical as well as transdermal delivery of ibuprofen was achieved. The pH of a formulation plays an important role with respect to API permeation. Ibuprofen is reported to have a pKa value 4.4 (Dollery, 1999:I1); and by application of the Henderson-Hasselbach equation, at pH 5, 20.08% of ibuprofen will be present in its unionised form and at pH 7.4, 0.1% ibuprofen will exist in its unionised form. Since the unionised form of APIs is more lipid soluble than the ionised form, unionised forms of APIs permeate more readily across the lipid membranes (Surber & Smith, 2000:27). Therefore, it would be expected that ibuprofen formulated at pH 5 would be more permeable than formulations at pH 7.4. However, this did not correspond to the results (membrane studies) obtained in this study. It may be attributed to the solubility of ibuprofen in the different formulations. According to the pH-solubility profile of ibuprofen obtained in this study, it was more soluble at pH 7.4 than at pH 5. This was due to the fact that ibuprofen is a weak acidic compound, and for every 3 units away from the pKa-value, the solubility changes 10-fold (Mahato, 2007:14). However, with regard to the skin permeation studies, enhanced permeation was obtained with the formulations prepared at pH 5. This was in accordance with Corrigan et al., (2003:148) who stated that NSAIDs are less soluble and more permeable at low pH values, and more soluble and less permeable at high pH values. This was most probably due to the fact that unionised species, although possessing a lower aqueous solubility than the ionised species, resulted in enhanced skin permeation due to being more lipid-soluble. Finally, stability tests on the different semi-solid formulations for a period of three months at different temperature and humidity conditions were conducted to determine product stability. The formulations were stored at 25 °C/60% RH (relative humidity), 30 °C/60% RH and 40 °C/75% RH. Stability tests included: mass variation, pH, zeta potential, droplet size, visual appearance, assay, and viscosity. No significant change was observed for mass variation, pH, zeta potential and droplet size over the three months for any of the different formulations stored at the different storage conditions. In addition, no significant change in colour was observed for the gel and emulgel formulations at pH 5 and 7.4 over the three months at all the storage conditions. However, it was observed that the formulations containing Pheroid™ showed a drastic change in colour at all the storage conditions. This might have been due to oxidation of certain components present in the Pheroid™ system. Consequently, further investigation is necessary to find the cause of the discolouration and a method to prevent it. The gel formulated at pH 5 depicted the formation of crystals. This might have been due to the fact that the solubility of ibuprofen was exceeded, leading to it precipitating from the formulation. A possible contributing factor to the varying assay values obtained during the study might have been due to non-homogenous sample withdrawal. On the other hand, no significant change was observed for the emulgel and Pheroid™ emulgel formulated at pH 5 and 7.4. The emulgel and Pheroid™ emulgel formulated at pH 5 depicted relative instability (according to the International Conference on Harmonisation of Technical Requirements For Registration of Pharmaceuticals for Human Use, ICH) only at 40 °C/75% RH with a change in ibuprofen content of more than 5% (6.78 and 6.46%, respectively). The gel, emulgel and Pheroid™ emulgel at pH 7.4 exhibited the least variation in ibuprofen concentration at all of the storage conditions. This might indicate that the pH at which a semi-solid formulation is produced will have a direct influence on the stability of the product. No significant changes in viscosity (%RSD < 5) was observed for the gel and emulgel formulated at pH 7.4 and stored at 25 °C/60% RH. The remaining formulations at all of the specified storage conditions exhibited a significant change in viscosity (%RSD > 5) with a decrease in viscosity being more pronounced at the higher temperature and humidity storage conditions. A possible contributing factor to the change in viscosity over three months at the specified storage conditions might have been due to the use of Pluronic® F-127 (viscosity enhancer). This viscosity enhancer possesses a melting point of approximately 56 °C (BAST Corporation. s.a). The problem with this might have been the temperature (70 °C) at which the formulations were prepared. The higher preparation temperature might have caused the Pluronic® F-127 to degrade, thereby losing its ability to function appropriately. A balance must be maintained between optimum solubility and maximum stability (Pefile & Smith, 1997:148). Despite the lower skin permeation of the gel formulated at pH 7.4, this formulation performed the best, as it was considered stable (least variation during the 3 month stability test) and the obtained tape stripping results showed that this formulation depicted the highest ibuprofen concentrations in the stratum corneum and epidermis. Thus, topical as well as transdermal delivery were obtained.
Thesis (MSc (Pharmaceutics))--North-West University, Potchefstroom Campus, 2013.

Thesis (M.S.)--Kutztown University of Pennsylvania, 1997.
Source: Masters Abstracts International, Volume: 45-06, page: 2715. Typescript. Abstract precedes thesis as preliminary leaves [1-2]. Includes bibliographical references (leaves 76-80).

Includes abstract.
Includes bibliographical references.
The aim of this study is: to determine whether Emergency Physicians have knowledge to optimally mechanically ventilate the intubated patient.

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 Obstetrics and Gynaecology Johannesburg 2016
Background Postpartum depression is the most common psychopathology encountered in the period following childbirth. In addition to increasing the risk of maternal suicide and infanticide, it is associated with significant morbidity, adversely affecting the patient, infant and family. Despite postpartum depression being an important public health issue it remains poorly recognised and underdiagnosed. The current South African context in which obstetric care is delivered to patients focuses predominantly on physical health. No screening policy for postpartum depression is currently recommended in South Africa. The aim of this study was to determine the proportion of patients at risk of postpartum depression by screening mothers at six weeks postnatally using the Edinburgh postnatal depression scale. Methods Patients delivered by vaginal delivery and caesaerean section at Rahima Moosa Mother and Child Hospital were randomly selected from delivery records for recruitment to the study. A baseline sociodemographic, medical and obstetric questionnaire was completed at the enrolment visit in all patients that consented to participate. Participants were then contacted telephonically six weeks later. The Edinburgh postnatal depression scale was sent via text message to patients and they were allowed time to respond at their convenience. Participants were contacted to retrieve their responses and formulate scores. Screen positive patients were identified by a score of thirteen or greater on the Edinburgh postnatal depression scale or a positive response to thoughts of self or infant harm and were offered referral to the department of psychiatry. Results A total of 178 patients were screened for postpartum depression using the Edinburgh postnatal depression scale. The main outcome measured was the proportion of screen positive participants who exceeded the threshold score on the Edinburgh postnatal depression scale or responded positively to thoughts of deliberate self or infant harm. Forty-eight participants screened positive resulting in 27.0% of the study population being at risk of postpartum depression. Sociodemographic, medical and obstetric variables were analysed in screen positive compared to screen negative participants to establish possible correlations between these variables and outcome. None of the variables proved to be significantly associated with being screen positive for postpartum depression. Conclusion The results of this study when compared to the prevalence findings of local and international studies suggest that postpartum depressive symptomology is common in urban South Africa. Since this study did not establish a statistically significant relationship between possible predisposing factors and the risk of postpartum depression, no specific variables have been implicated in predicting postpartum depression in our study population. These findings support the need for universal screening for postpartum depression in South Africa. Further research to investigate risk factors for postpartum depression in a South African setting is recommended.
MT2017

A dissertation submitted to the Faculty of Health Sciences, University f the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics and Gynaecology Johannesburg, 2016.
Introduction Invasive prenatal testing is the gold standard of prenatal diagnosis of chromosomal abnormalities. Outcomes of invasive prenatal procedures have been studied previously, however it has not been looked at in a resource poor, tertiary setting in South Africa. Aim and objectives The aim of this study is to review the outcome of invasive prenatal testing at Rahima Moosa Mother and Child Hospital (RMMCH) from January 2014 to May 2016. The main objectives of the study were to evaluate invasive prenatal testing in terms of indications, ultrasound markers, cytogenetic diagnosis, complications and pregnancy outcome. Methods The study took place at RMMCH, a regional academic hospital in Johannesburg which performs approximately 12 000 deliveries annually. Charts were reviewed retrospectively for patients who underwent invasive prenatal testing. Results Ninety-seven patients were identified and 96 results obtained. The main indication for invasive prenatal testing was abnormal ultrasound findings followed by advanced maternal age. In total, 12,5% of test results were abnormal, including two patients with Trisomy 13, two with Trisomy 18, two with Trisomy 21, two with Klinefelter syndrome, one with a balanced translocation, one with cystic fibrosis, one with spinal muscular atrophy and one with Wolf-Hirschorn syndrome. The miscarriage rate was 1,5%. There were four terminations of pregnancy directly related to an abnormal invasive test result. Conclusion It is expected that in a resource restricted area where biochemical screening is not available that advanced maternal age and ultrasound findings are the main reasons to lead to invasive prenatal testing. The rate of abnormalities found is higher than internationally quoted and the miscarriage rate higher than the internationally accepted 0,5-1%, this is likely due to selection bias and sample size. The study shows that an invasive testing service can be successfully run in a resource restricted setting but ongoing education of the availability of the service in the public sector is needed.
LG2018

A Dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine November 2016
Children’s right to participate in decisions affecting them is still a challenge despite the laws and guidelines. In South Africa, this right has not received the attention it deserves, because of government’s commitment to issues like HIV/AIDS. The aim of the research was to understand the views of children, parents and health professionals with regards to decision- making at Rahima Moosa Mother and Child Hospital. A total of 51 health professionals, 28 children and 28 parents were interviewed using questionnaires. The study looked at participants’ knowledge of the right of children to participate in decisions and the way health professionals communicated with children and parents. Findings: There was good knowledge amongst health professionals, but most children (75%) did not know their right. Most children were not consulted about diagnosis (60%), procedures and treatment (71%). Health professionals lacked age appropriate ways of communicating with children. On the whole, children (71.4%) preferred doctors to speak to parents. Conclusion: There is a need to educate children about their rights and to train health professionals on effective communication with children. Health professionals need to give children a chance to express their opinion even if they do not make the final decision.
MT2017

MMed, Psychiatry, Faculty of Health Sciences, University of the Witwatersrand
Introduction: National and international child and adolescent mental healthcare policy and action advocate that the health and well-being of children in South Africa should be increasingly given greater attention. Child and adolescent services have recently been established at Rahima Moosa Hospital. The purpose of this study was to describe the scope, capacity and diagnostic profile of existing child and adolescent mental health and psychiatric services at Rahima Moosa Hospital within the context of the available infrastructure and service rendering and to describe the demographic and clinical profile of the users. Method: A descriptive, retrospective clinical audit study of the data from users‟ clinical files was performed. The study population comprised all users treated at the Rahima Moosa Hospital over a one-year period from January to December 2007. Descriptive statistical analyses of demographic and socio-economic variables were made and these variables were compared with the presenting clinical problems. P-values of less than 0.05 were regarded as significant. Odds ratios were also calculated for variables that showed a statistically significant association. Results: During this period a total of 303 users attended this clinic. Their age, gender, race and catchment area was reviewed. Socio-economic variables that were described included caregiver of user, placement, parents‟ well being and marital status, educational level of caregiver and household income. Most common disorders were Attention Deficit Hyperactivity Disorder (ADHD), Mood, Anxiety, Elimination, Attachment, Disruptive behaviour disorders and V-code diagnoses. Although not regarded as psychiatric diagnoses, V-codes are problems that are the focus of clinical attention. These include 5 sexual abuse, academic problems and parent-child relationship difficulties. Statistical comparisons between demographic data and disorders revealed that being male increased the likelihood of presenting with AHDH and disruptive behaviour disorders; being female increased the likelihood of being sexually abused. Race showed a significant association with parent-child relationship difficulties. Regarding socio-economic variables, the identity of the caregiver of the child influenced the risk of disruptive behaviour disorders, sexual abuse, neglect and academic problems. Placement was a risk factor for disruptive behaviour disorders, sexual abuse, neglect and academic problems. Whether the mother of a user was alive or deceased was related to ADHD and disruptive behaviour and whether the father of a user was alive or deceased was related to sexual abuse and academic problems. The education level of the caregiver showed a significant association with sexual abuse, neglect and academic problems; the marital status of the parents showed a significant association with bereavement. Household income was associated with sexual abuse, neglect and academic problems. Type of housing showed an association with the risk of sexual abuse. Discussion: This study clearly demonstrates the huge impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve on the socio-economic status of communities. Job creation and employment will lead to better outcomes and help lower the incidences of childhood illnesses. The focus should be on preventative measures, that is, improving the social well-being of both children and their parents, which will result in lower prevalence of disease. Moreover, interventions in schools and children‟s homes should be 6 implemented. The provision of psycho-education for the group in the catchment with regard to identification of mental health problems can contribute to the early detection of mental illness and early intervention leading to a reduction in disease. Conclusion: In spite of government‟s initiative to prioritise child and adolescent mental health services in South Africa, further endeavours are required to improve psychiatric services among this section of the population, including more clinics and child psychiatry training posts and extended social work services. Socio-economic factors influence the prevalence of childhood disorders. Hence, modifying the environment to which these children are exposed is an integral part of the holistic treatment approach

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology MMed(O&G) Johannesburg, April 2015
Background Pre-eclampsia and its complications remain a significant cause of maternal and perinatal morbidity and mortality on a global level. There are few data regarding the maternal and fetal outcome of pre-eclampsia at term. Studies suggest that poor maternal outcome is more prevalent as one approaches term, while there are conflicting findings regarding the outcomes of the babies born to term pre-eclamptic patients. Objective To determine the prevalence of pre-eclampsia in term pregnancies at Rahima Moosa Mother and Child Hospital (RMMCH), a hospital that provides district and higher level referral services, and to assess the severity of maternal disease in pre-eclampsia at term, as well as fetal outcomes. Methods This was a prospective cross-sectional, descriptive study on women giving birth at term with pre-eclampsia. All women were followed up until delivery. The indication for and mode of delivery, maternal progress and complications, as well as fetal outcome, were recorded. Results Seventy-eight patients were entered into the study, giving a hospital prevalence rate of pre-eclampsia at term of 1.2%. The major maternal complications were those of severe hypertension (75.6%), eclampsia (9%), HELLP syndrome (3.8%), and pulmonary oedema (7.7%). There was one maternal death. Fifty-one patients (65%) delivered by caesarean section. Major fetal complications encountered were respiratory distress (7.5%) and birth asphyxia (3.7%). There was one neonatal death from meconium aspiration.

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 Masters in Medicine (MMed), Johannesburg 2018
Background Induction of labour implies the artificial initiation of regular uterine contractions before the onset of spontaneous contractions with the purpose of achieving a vaginal delivery. This study aimed to compare the use of oral misoprostol and vaginal dinoprostone to determine differences in the labour process and the delivery methods. Maternal and fetal outcomes were also compared. Methods This is a prospective cross-sectional analytical study using medical record review at the Rahima Moosa Mother and Child Hospital (RMMCH) in Newclare, Johannesburg. This study included all women undergoing the induction process, who met inclusion criteria from 01 January 2016 to 30 April 2016. Results This study included 95 women. Forty-nine women received dinoprostone and 46 women received oral misoprostol. There was minimal heterogeneity between the demographics of the two groups. The differences in the indications for induction were statistically significant (p = 0.001). There was no statistical difference in the time from induction to delivery (p= 0.18), the duration of labour (p=0.10) or in the time from induction to onset of labour (p= 0.37). There was a caesarean section rate of 32.7% in the dinoprostone group and 43.5% in the oral misoprostol group (p=0.30). There was no statistical significance between fetal and maternal outcomes. Conclusions This study yielded no difference in the labour process, time to delivery, or maternal and fetal complications between the two groups. Labour was initiated in more patients in the dinoprostone group and dinoprostone resulted in fewer c/s than misoprostol, however this was not statistically significant. There was no difference in neonatal and maternal outcomes. The use of dinoprostone or misoprostol is therefore equally effective in our setting. A larger study or RCT is recommended to adequately assess neonatal and maternal complication rates.
XL2018

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 Science in Neurodevelopment Johannesburg, 2016
Context: Universal Newborn Hearing Screening (UNHS) is not routinely performed in South African state-run hospitals. Early identification of hearing impairments and subsequent early intervention, results in improved speech and language development and overall better cognitive outcomes. Objectives: We aim to investigate the number of neonates which could be screened for hearing deficits using the currently available staff and equipment, at a single institution over a set period of time, and to describe the outcomes of the screening test. Design, setting and patients: A prospective feasibility assessment conducting screening hearing tests on neonates born at a secondary level hospital in Johannesburg, South Africa, during a three month period. Methods: Hospital-based Audiologists conducted a risk factor assessment, otoscopic examinations and Distortion-Product Otoacoustic emissions (DPOAE) testing on the ears of eligible neonates. Repeat testing was carried out on neonates who presented with refer findings on the screening test. Testing time and challenges encountered were recorded. Analysis: Data was entered into Microsoft Office Excel ©, and later analysed using STATA I/C version 11©. v Results: Of 2740 neonates born during the study period, 490 (17.9%) were identified for screening and DPOAE testing was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat testing was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The presence of vernix caseosa and excessive ambient noise were factors negatively impacting on the screening process. No maternal or neonatal risk factors were found to be significantly associated with refer findings on the screening test. Conclusion: The existing staff was unable to screen a significant number of neonates using DPOAE testing during the study period. Implementation of UNHS under current circumstances at this research site would likely not be feasible. Key words: Universal Newborn Hearing Screening; feasibility study; resource-poor settings; otoacoustic emission; hearing loss.
MT2016

Research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Paediatrics. Johannesburg, 2015.
Urinary tract infections (UTIs) are an important cause of morbidity in children in developing countries and increasing antimicrobial resistance is reported in many countries. This retrospective study describes the performance of urine dipsticks, the aetiology and the antimicrobial susceptibility of paediatric UTIs at Rahima Moosa Mother and Child Hospital, Johannesburg. METHODS: We conducted a retrospective study of results from patients investigated for UTI over a four year period between January 2009 and December 2012 in the Department of Paediatrics & Child Health at Rahima Moosa Mother and Child Hospital. RESULTS: Escherichia coli was the commonest isolated uropathogen. Dipsticks sensitivity to identify UTI was 40% for leucocyte esterase and 34% for nitrites. The specificity was 94.6% for leucocyte esterase and 96% for nitrites. Malnutrition was associated with greater risk of having a UTI, with odds ratio of 2.06 (95% Confidence interval 1.4-2.9). In addition malnourished children tended to present with more resistant uropathogens. Resistance to sulphamethoxasole/trimethoprim and cephalexin has been progressively increasing between 2009 and 2012. From 64% to 79% for sulphamethoxasole/trimethoprim and from 24% to 63% for cephalexin. CONCLUSION: Positive urine dipsticks results allow immediate patient treatment but negative results need to be interpreted within the clinical context due to a high rate of false negatives. Malnourished children are significantly predisposed to urinary tract infections and tend to have more resistant uropathogens. Resistance to cephalexin is rising and studies to assess patient outcomes are needed to determine whether cephalexin still has a role in the treatment of paediatric UTI.

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 Diagnostic Radiology
INTRODUCTION: Cranial ultrasound is a cheap, effectiveand easy to use modality for the evaluation of cranial pathology in very sick paediatric population.It can be performed as a portable imaging investigation and repeated as many times as possible. New improvements in sonography equipment and technique make it possible for cranial ultrasound to compete with CTscanners in terms of identifying pathology. AIM: To determine the adequacy of cranial ultrasound requests and reports atCharlotte MaxekeJohannesburg Academic (CMJAH) and Rahima Moosa Mother and Child Hospitals (RMMCH) with regards to their completeness, accuracy and clinical relevance. METHOD: A retrospective review of 191 cranialultrasound requests and reportswas performed at two academic centres.A collection sheet (Appendix B)was developedby the principal investigator and supervisor guided by literature with regards to the information required within the cranial ultrasoundreport. A scoring method was then developed with a maximum score of 3 givenfor therequestadequacy and of 14for report adequacy. RESULTS: Only 49.74 % of the requests met the criteria for an adequate request.The mean report adequacy score was7.03 out of 14 withastandard deviation (2.02. Overall 50.26 % of the requests, scored average (2) and below average score. The most commonly reported variable was the presence or absence of hydrocephalus and the least reported was resistive index. vi CONCLUSIONS:Results demonstrate that requests and reportsof cranial ultrasoundare not adequateat both centres. A cranial ultrasound template was therefore developed to assist with the standardization ofreports.
GR2018

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 Obstetrics and Gynaecology. Johannesburg 2016
Introduction Endometrial cancer is the most common Gynaecological cancer in developed countries, however, in South Africa it is ranked only the eighth highest. Previous research has shown that black women are diagnosed at a younger age, have a higher incidence of type II endometrial cancer and uterine carcinosarcoma and have a worse overall survival than white women. Government hospitals are busy with large numbers of patients seen daily resulting in longer waiting times for patients requiring surgery and adjuvant treatment for cancer. Patients and Methods This was a retrospective cross sectional descriptive study of patients diagnosed with endometrial carcinoma and uterine carcinosarcoma at Rahima Moosa Mother and Child Hospital (RMMCH) between 2009 and 2013. Patient files from both RMMCH and Charlotte Maxeke Johannesburg Hospital (CMJAH) were reviewed. Patients were initially seen at RMMCH, some underwent surgery and they were then referred to CMJAH for adjuvant treatment. Files from both hospitals were reviewed. 55 files were obtained at RMMCH and 50 patients were referred to CMJAH for further treatment. Results The most common histological types of endometrial cancer were low grade adenocarcinoma (34.54%) and uterine carcinosarcoma (25.45%). 56.36% of patients presented with early disease (stage 1/2) and 43.64% with advanced disease (stage 3/4). The overall disease free survival was 75.67% at one year, with 8.10% of patients with metastases and 16.21% of patients having died within one year. 53.70% of patients waited less than 62 days until definitive management with 14.81% who waited for more than six months for surgery. Conclusion We found a high frequency of patients with uterine carcinosarcoma which may account for the low disease free survival at one year after adjuvant treatment together with the fact that a large proportion of our patients present with late stage disease. Our study found long waiting times between presentation and treatment with poor follow up by patients. Improved patient education and counselling together with ‘fast tracking’ of oncology patients may be instrumental in better patient adherence and outcomes.
MT2016