Wits Journal of Clinical Medicine
Wits Journal of Clinical Medicine is a peer-reviewed open-access scientific journal (ISSN 2618-0189; eISSN 2618-0197), created to share the scientific research from the School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, and from the Clinical Medicine Departments in other institutions in South Africa and internationally. Our objective is to be the primary diffusion portal for Clinical Medical scientists from Southern Africa, using standards that accredit the process of scientific publication.
| Publisher | Wits University Press |
|---|---|
| Frequency | Tri-annually |
| Coverage | Volume 1 Issue 1 2019 - current |
| Language | English |
| Journal Status | Active |
| Collection(s) |
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More LessOn 30 January 2020, the World Health Organisation (WHO) declared the novel coronavirus (Covid-19) outbreak a global public health emergency of international concern, this after 98 confirmed cases in countries outside China and 4 confirmed cases of human-to-human transmission. A week later, the number of cases outside China had risen to 270 in 24 countries with 1 death confirmed in the Philippines. Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, stated in the press conference that the reason for the declaration of emergency was not the gravity of the situation in China, which is expected to contain the outbreak, but rather the possibility of spread of the virus to countries with weaker health systems. It is fair to say that many healthcare systems in Africa meet the criteria for this designation and may not have the capacity to cope effectively with epidemic transmission on the continent.
Background: Chronic primary mitral regurgitation (CPMR) is characterized by progressive myocardial hypertrophy, fibrosis and dilatation. Although molecular markers of adverse left ventricular (LV) remodelling have been identified in the progression from compensated to decompensated heart failure in these patients, serum markers that could guide the optimal timing of intervention in these patients are still needed. Here we describe the correlation between the levels of expression of several genes important in adverse LV remodelling in CPMR and the serum levels of these markers.
Methods: We performed echocardiography, cardiac catheterization, endomyocardial biopsy (EMB) and serum analysis in patients with severe CPMR during the preoperative workup for mitral valve surgery. Serum levels of N-terminal-pro hormone B-type natriuretic peptide, suppression of tumourigenicity 2, tumour necrosis factor a, Interleukin 6, FS-7-associated surface antigen (FAS), FAS ligand, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of matrix metalloproteinases (TIMP)-1 and TIMP-4 were determined using commercially available enzyme-linked immunosorbent assays. Myocardial levels of expression of the genes encoding these proteins were determined by multiplex gene expression analysis.
Results: Serum and EMBs were obtained from 12 patients with CPMR at the time of preoperative cardiac catheterization. Overall, there was no significant correlation between the serum levels and gene expression levels for the markers evaluated in this study. A non-significant inverse correlation between serum MMP-2 and myocardial MMP-2 was noted (r = −0.343, P = 0.263).
Conclusion: We found a poor correlation between the myocardial gene expression levels of several markers of adverse LV remodelling in patients with CPMR and the serum levels of these markers sampled at the same time.
Methods: We performed echocardiography, cardiac catheterization, endomyocardial biopsy (EMB) and serum analysis in patients with severe CPMR during the preoperative workup for mitral valve surgery. Serum levels of N-terminal-pro hormone B-type natriuretic peptide, suppression of tumourigenicity 2, tumour necrosis factor a, Interleukin 6, FS-7-associated surface antigen (FAS), FAS ligand, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of matrix metalloproteinases (TIMP)-1 and TIMP-4 were determined using commercially available enzyme-linked immunosorbent assays. Myocardial levels of expression of the genes encoding these proteins were determined by multiplex gene expression analysis.
Results: Serum and EMBs were obtained from 12 patients with CPMR at the time of preoperative cardiac catheterization. Overall, there was no significant correlation between the serum levels and gene expression levels for the markers evaluated in this study. A non-significant inverse correlation between serum MMP-2 and myocardial MMP-2 was noted (r = −0.343, P = 0.263).
Conclusion: We found a poor correlation between the myocardial gene expression levels of several markers of adverse LV remodelling in patients with CPMR and the serum levels of these markers sampled at the same time.
Background: Minimal change nephropathy (MCN) is amongst the commonest causes of nephrotic syndrome worldwide, accounting for up to 15% of cases of primary nephrotic syndrome in adults. Limited data is available in African subjects.
Methods: We retrospectively reviewed the demographic, clinical profile and treatment outcomes of adult patients presenting with primary MCN at the Witwatersrand Academic Complex between 2001 and 2010.
Results: Forty-seven cases of MCN (2.9%) were diagnosed in 1618 patients undergoing native kidney biopsy. The patients with MCN were predominantly of Black race (83%), the male-to-female ratio was 1.04:1 and the mean age was 31.8 ± 12.1 years. Records of treatment and outcomes were available for 28 patients, all of whom received initial corticosteroid therapy (average dose of prednisone 0.8 mg/kg/day). The mean duration of steroid therapy was 24.8 ± 19.0 months. About 57.1% of patients achieved remission with no further relapse and 39.2% had probable steroid resistance. The mean time to relapse was 27.8 ± 19.4 months with 83% of patients relapsing within 48 months. The mean time to relapse was significantly longer in males (39.3 ± 17.5 months) compared to females (18 ± 16.9 months) (P = 0.09).
Conclusion: MCN is rare amongst adult Black Africans but should be considered in the differential diagnosis of nephrotic syndrome. The disorder in these patients may be less responsive to corticosteroids and a longer course of therapy may be required to induce remission. Males may be more likely to remain in remission for a longer period.
Methods: We retrospectively reviewed the demographic, clinical profile and treatment outcomes of adult patients presenting with primary MCN at the Witwatersrand Academic Complex between 2001 and 2010.
Results: Forty-seven cases of MCN (2.9%) were diagnosed in 1618 patients undergoing native kidney biopsy. The patients with MCN were predominantly of Black race (83%), the male-to-female ratio was 1.04:1 and the mean age was 31.8 ± 12.1 years. Records of treatment and outcomes were available for 28 patients, all of whom received initial corticosteroid therapy (average dose of prednisone 0.8 mg/kg/day). The mean duration of steroid therapy was 24.8 ± 19.0 months. About 57.1% of patients achieved remission with no further relapse and 39.2% had probable steroid resistance. The mean time to relapse was 27.8 ± 19.4 months with 83% of patients relapsing within 48 months. The mean time to relapse was significantly longer in males (39.3 ± 17.5 months) compared to females (18 ± 16.9 months) (P = 0.09).
Conclusion: MCN is rare amongst adult Black Africans but should be considered in the differential diagnosis of nephrotic syndrome. The disorder in these patients may be less responsive to corticosteroids and a longer course of therapy may be required to induce remission. Males may be more likely to remain in remission for a longer period.
Background: Candidaemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans Candida (NAC) species are increasing in incidence as well as resistance to azoles. Very low birthweight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidaemia.
Methods: A retrospective case–control study of candidaemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital between 1 January 2015 and 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidaemia, commonest Candida species, antifungal susceptibility profiles and outcomes (death) were identified. A total of 71 infants with confirmed positive blood cultures for candidaemia from the National Health Laboratory Services database were selected, and each case was allocated 3 controls; the final sample comprised 284 infants.
Results: Bacterial sepsis, chronic lung disease, necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidaemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidaemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases, respectively. The difference in death between the two groups was not statistically significant.
Conclusions: The study demonstrated an increasing rate of candidaemia, predominance of NAC isolates and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented.
Methods: A retrospective case–control study of candidaemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital between 1 January 2015 and 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidaemia, commonest Candida species, antifungal susceptibility profiles and outcomes (death) were identified. A total of 71 infants with confirmed positive blood cultures for candidaemia from the National Health Laboratory Services database were selected, and each case was allocated 3 controls; the final sample comprised 284 infants.
Results: Bacterial sepsis, chronic lung disease, necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidaemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidaemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases, respectively. The difference in death between the two groups was not statistically significant.
Conclusions: The study demonstrated an increasing rate of candidaemia, predominance of NAC isolates and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented.
Up to the 1970s, the only treatment for breast cancer (BC) was surgery and radiation therapy (DXT). The first step in the search for systemic treatment began with the discovery of oestrogen in 1929. Adolf Buterandt and Edward Doisy working independently isolated and purified oestrone from the urine of pregnant women. Further laboratory research led to the extraction of a complex of oestrogens from pregnant mare urine. This was marketed in 1939 as Premarin, which is currently still prescribed for postmenopausal symptoms.
