Father and Daughter Graduate Together

Father and Daughter Graduate Together
Father and daughter, Dr Kantharuben Naidoo and Dr Reshania Naidoo, graduated together from UKZN in the medical field.

Father and daughter, Dr Kantharuben Naidoo and Dr Reshania Naidoo, graduated together from UKZN in the medical field.

Reshania graduated with an MBChB degree while her father graduated with his PhD in Medicine with a thesis titled: “The Ethical Dilemmas of Critical Care Physicians Encountered in the Admission of Patients with HIV Infection to Intensive Care”.

‘With South Africa having one of the fastest growing HIV epidemics in the world, there are 5.6 million people living with HIV/AIDS as a consequence of the delayed implementation of the ARV rollout and failure to control the epidemic,’ said Kantharuben.

‘Vast numbers of people living with HIV/AIDS who seek or need intensive care place a huge burden on precious, expensive and sparse intensive care unit facilities. Critical care specialists as a result are faced with complex challenges when making decisions about the provision of such care.’

The aim of Naidoo’s study was to develop the best practice criteria for admitting HIV-infected patients to intensive care.

The study was conducted using a comprehensive literature review of both legal and ethical frameworks that govern such decisions in South Africa as well as legal precedents and clinical best practice that could inform policy and practice in the country. An audit of ICU beds was also done to form a comprehensive and contemporary review of critical care facilities to place in context the ethical dilemmas faced by critical care specialists in the admission of HIV/AIDS infected patients to intensive care in a resource limited environment. 

Critical care practitioners’ responded to a standardised questionnaire that concerned ethical decisions and the provision of intensive care to five hypothetical clinical case scenarios. ‘It was found that there is limited ICU bed availability in South Africa and the problem is worse within the public sector with widespread variations across the provinces,’ said Kantharuben. ‘Also, the lack of skilled staff for ICU is insufficient for our needs in the public sector. For people living with HIV/AIDS, specific variables influence their survival in intensive care. The benefits of anti-retroviral treatment in intensive care are still being debated.  Clinical prediction tools should be considered as an aid about who to admit to intensive care.’

Reshania is currently serving her internship at King Edward Hospital V111, the same hospital where both she and her father did their medical internship training.

‘My father was my role model from a very young age,’ said Reshania. ‘Seeing him in his white coat when I was small, coming home after a long day of attending to patients - and then on my fourth birthday a gift of a doctor’s set - definitely influenced me!

‘He also used to take me along to hospital from time to time. Aside from that, as clichéd as it sounds, I do not know a profession which allows one to touch people’s lives like Medicine does. I guess you can say both Medicine and research run in the family! My father has always and continues to be my inspiration both in life and Medicine. I am extremely proud of him and if I can achieve even half of what he has in his lifetime I will be very happy.’

Reshania Naidoo is currently a Fogarty Fellow at the Centre for the AIDS Programme of Research in South Africa (CAPRISA) where she has been conducting research in the treatment of XDR-TB since her third year of study. She was also one of the first undergraduate students at the Medical School to do an oral presentation at an international conference - the Union World Conference on Lung Health and Tuberculosis in Malaysia - during her fourth year. 

Reshania is currently in the process of publishing her research.

-        Zakia Jeewa

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Thesis on Neuromuscular Scoliosis Earns Doctor Master of Medicine Degree

Thesis on Neuromuscular Scoliosis Earns Doctor Master of Medicine Degree
Dr Alberto Puddu.

A thesis titled: “Neuromuscular Scoliosis - Surgical Management and Outcomes”, secured Dr Alberto Puddu of Clinical Medicine at UKZN his Master of Medicine degree in Orthopaedic Surgery.

Scoliosis is a medical condition where a patient’s spine is curved from side to side. Neuromuscular scoliosis develops in patients who have multiple or underlying causes which are sometimes unknown.

Ninety-eight patients – 45 men and 53 women – took part in Puddu’s research.

The median age at surgery was 13.5 years, while the average age of patients at surgery was 15. A total of 14 patients were younger than 10 at the time of surgery, 78 patients were between the age of 11 and 20 and three patients were between 21 and 30.

Three of the the oldest patients (aged between 59 and 70) had Parkinson’s disease.

Spinomuscular atrophy and cerebral palsy were found to be the most common underlying diseases among the patients followed by myelomeningocoele and paralytic spinal cord injury.

The primary curve was corrected from 77.2 degrees to 32.5 degrees immediately post-operative - a correction of 66% - while the secondary curves were initially corrected from 44.2 to 25.5 degrees.

Puddu wrote his thesis while doing a Fellowship in Spinal Surgery at the University of Cape Town and it was published in the South African Orthopaedic Journal.

Puddu works at Greys and Edendale hospitals in Pietermaritzburg and is the only surgeon in a state hospital in Area 2 of KwaZulu-Natal.

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Anaesthesia for Childbirth the Focus of Doctoral Thesis

Anaesthesia for Childbirth the Focus of Doctoral Thesis
Dr Annette Theron.

Dr Annette Theron of the School of Clinical Medicine received her Masters of Medicine (MMed) degree in Anaesthetics with her dissertation titled: “Obstetric Anaesthesia at District and Regional Hospitals in KwaZulu-Natal: Human Resources, Caseloads and the Experience of Doctors”.

Obstetric anaesthesia involves anaesthesia for childbirth, mostly for caesarean sections. Theron’s study sought to determine the number of doctors who were providing obstetric anaesthesia at both district and regional hospitals within KwaZulu-Natal.

This study highlighted the lack of training and experience of doctors in obstetric anaesthesia while dealing with an increased workload. It also identified specific target groups for future training and support.

The training and experience as well as caseloads of doctors were analysed to identify specific groups that could be targeted for support and training.

‘KwaZulu-Natal has the largest number of deliveries within South Africa, with over 50% occurring at district hospitals,’ said Theron.  ‘From 2008 to 2010, KwaZulu-Natal had 15 anaesthesia-related deaths at district hospitals, three at regional hospitals and two at tertiary hospitals.

‘Through the use of two separate questionnaires, the study was directed independently to Medical Managers and doctors providing operative obstetric services. Doctors were asked to provide details of their qualifications, experience and current workload, while Medical Managers were asked for caseload and staffing data.’

Theron’s study included 48 hospitals, 12 of which were regional, and 36 which were district hospitals. Of the 48 medical managers, 38 responded while 266 doctors provided feedback.

It was found that anaesthesia skills or experience were not a prerequisite for 157 (59% of 266) responding doctors at the time of employment. Foreign-trained doctors were providing obstetric anaesthesia in 71% of the responding hospitals.  However, 24 (9% of 266) doctors reported no anaesthesia training during internship, all of these were foreign-trained doctors, thus one of the identified target groups.

‘Another target group was Community Service Medical Officers (CSMOs), who constitute 27% of full-time staff at rural district hospitals.  They are all expected to practice obstetric anaesthesia independently.  These doctors should be trained adequately and assessed during internship, while working in consultant supervised units.’

The study found there were very few practitioners with added qualifications in anaesthesia working in rural hospitals, with only 3% of the responding rural doctors, who had a Diploma in Anaesthesia (DA).  Only one district doctor had a DA and more than five years experience. These experienced doctors were also identified as a target, in order to enable them to aid in training and providing support to their junior colleagues.

It was established that sessional doctors were employed at 22 of 38 hospitals (58%) to provide obstetric anaesthesia - mostly district hospitals were reliant on these doctors.  They represented a group of doctors, who act as the “occasional” anaesthetist with low caseloads and uncertain skills and training - a group that needs to be assessed further and may also have special training needs.

Theron is an anaesthetic specialist, based at King Edward VIII Hospital and is hoping to produce another publication on the topic of Obstetric anaesthesia soon. Her study was supervised by Professor C Rout.

-        Zakia Jeewa

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New Study Interprets how Anaesthesia and Critical Care Specialists Manage Septic Shock in Patients

New Study Interprets how Anaesthesia and Critical Care Specialists Manage Septic Shock in Patients
Dr Komalan Govender graduated with an MMED degree in Anaesthetics.

Dr Komalan Govender graduated with a Masters of Medicine degree from UKZN’s College of Health Sciences with a thesis entitled: “A Survey of Corticosteriod Use for the Management of Septic Shock in South Africa”.

Corticosteroids are a naturally produced class of chemicals involved in a wide array of physiological processes such as stress and immune response.

In patients with low immune systems who are unable to deal with severe infection, septic shock is a resulting medical condition, which can consequently cause multiple organ failure or death if not properly treated. By administering a low dose of corticosteroid to these patients, it can result in faster shock resolution. There is, however, controversy regarding its outcome on patient mortality.

Govender’s study, supervised by Dr Reitze Rodseth, explained that critical illness is associated with pituitary-adrenal axis dysfunction, which controls reactions to stress in the body and may cause adrenal insufficiency. This can manifest as septic shock in the patient who is poorly responsive to fluid or inotropic therapy.

Through conducting a survey during the 2011 Annual Congress of the South African Society of Anaesthesiologists (SASA), to which 65 responded, Govender aimed to examine how respondents interpreted the current literature and their use of corticosteroids in patient management.

Govender said ‘questionnaires are very labour intensive and poorly responded to if not conducted in person. Also, on-going, ethics approved, patient information databases may be a better option for acquiring large amounts of information that are amenable to simple studies. Of the 65 correspondents, all but One specialist had a background in anaesthesia or critical care.’

Govender’s study found that respondents to the surveys used corticosteroids as they were recommended to by the Surviving Sepsis Campaign guidelines, but also extended this use to numerous clinical scenarios such as sepsis (inflammation of the whole body, which is fatal) without hypotension and non-septic shock, which might actually harm the patient. ‘When making clinical decisions, more emphasis should be placed on patient-important outcomes than on surrogate outcomes,’ said Govender.

Govender, who hopes to sub-specialise in Critical Care, is currently pursuing his Masters in Medical Law degree. ‘I try to balance work, studying and family time. I am currently doing advanced tuition on the mridangam, a percussion instrument of South Indian Karnatic music, under the guidance of Guru Sivanathan Pillay.’

 -        Zakia Jeewa

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Study Finds Complicated Sinusitis Relatively Common in KZN

Study Finds Complicated Sinusitis Relatively Common in KZN
Dr Kurt Schlemmer graduated with an MMED degree in Otorhinolaryngology.

“Complicated Sinusitis in a Developing Country, a Retrospective Review”, is the title of an article by UKZN’s Dr Kurt Schlemmer which he used as the dissertation for his Master of Medicine degree.

The article was published in an international peer-reviewed journal against a background of the incidence of complicated sinusitis in KwaZulu-Natal being among the highest in the world.

In his study, Schlemmer performed a retrospective analysis of 220 patients who were treated for complicated sinusitis over a four and a half year period at three referral hospitals in Durban between January 2006 and September 2009. This was done to try and identify possible predisposing factors as well as to ‘seek the most effective ways of not only treating these cases appropriately, but also to try and decrease the high morbidity and mortality associated with complicated sinusitis’.

His key findings were that complicated sinusitis remains a serious condition in the developing world with an overall mortality rate of 20%. Patients referred from rural areas were more than three times as likely to develop intracranial complications compared to patients in urban areas. Adolescent males were found to be most at risk for complications - a persistent headache beyond one week was seen as the most reliable warning sign of intracranial spread of infection.

The article was published in: Complicated Sinusitis in a Developing Country, A Retrospective Review. International Journal of Pediatric Otorhinolaryngology, 77(2013) 1174-1178

Schlemmer is currently involved in six other studies as an Honorary Lecturer in the Department of Otorhinolaryngology at UKZN.

An ear, nose and throat specialist in private practice at Hillcrest Hospital, he enjoys golf and photography in his spare time.

-        Zakia Jeewa

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Study Finds Internationally Recognised Quality Management Approach Highly Valuable in Health Care

Study Finds Internationally Recognised Quality Management Approach Highly Valuable in Health Care
Dr Logandran Naidoo graduated with his Masters in Public Health.

“The Impact of Lean Thinking on Operational Efficiency in a Rural District Hospital Outpatient Department in KwaZulu-Natal” was the thesis title of Public Health Master’s graduate, Dr Logandran Naidoo.

The subject matter of this quasi-experimental action research was unique in that a production industry management philosophy, pioneered by the Toyota Production System in Japan, was applied to a health service in a rural hospital fraught with operational issues and resource constraints.

“Lean” is a Toyota management practice that believes the expenses on resources for any goal other than the creation of value for the end customer, is wasteful,’ said Naidoo. ‘Value is thus defined by any action or process in which the customer is willing to pay for.’

The results of Naidoo’s study showed that Lean can be applied quite easily and with minimal resources but maximum benefit can be derived from the services (do more with less). This operational efficiency was measured by Lean’s impact on waiting times, cycle times and staff attitudes and morale at the study site.

Naidoo said ‘this has tremendous positive implications for public hospitals under severe resource constraints, in light of the Department of Health’s implementation of National Core Standards and focusing on improvements in six priority areas, one of which is patient waiting time in health care institutions. Lean can thus serve as a valuable management approach in gearing hospitals towards the phasic roll out of National Health Insurance.’

The research took the form of a before-and-after interventional study with mixed qualitative and quantitative approaches. Action research was conducted with the investigator and facilitator of Lean implementation being a person who is not an expert in Lean, but the study participants were still able to achieve the waiting and cycle time targets set by the kaizen (Japanese term for “continuous improvement”) team within a very short space of time - four months - with minimal resources.

Furthermore, routine patient care was never disrupted and the tools and techniques used were easily adaptable to a health care setting. ‘I was also intrigued by the fact that Lean has proven to be a scientifically sound and acceptable method for improvements in operational efficiencies in a rural district hospital,’ said Naidoo.

Naidoo, a Senior Manager of Medical Services at Grey’s Hospital in Pietermaritzburg, said after graduating with his MBChB cum laude and MBA cum laude, his ‘passion for quality management has grown ever since’, and he has now found a reliable and esteemed approach to forging ahead with his quality improvement goals in health care.

‘With the success of this research, I intend to use the approach to assist health care facilities in improving quality and efficiency of health care services delivered through management. Health care is my ocean, quality is my ship, and Lean is my rudder!’

-        Zakia Jeewa

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New Study Determines Management of Patients with Neurogenic Thoracic Outlet Syndrome

New Study Determines Management of Patients with Neurogenic Thoracic Outlet Syndrome
Dr Laura Redman graduated with a Masters in Medicine degree in Surgery.

Shoulder pain was the focus of a study which Dr Laura Redman presented for her Masters of Medicine degree in Surgery.

The title of her dissertation was: “Neurogenic Thoracic Outlet Syndrome: An In Depth Review”.

Neurogenic Thoracic Outlet Syndrome (TOS) is an overlooked and obscure cause of shoulder pain due to the compression of nerves or blood vessels which can occur between the neck and armpit.

‘It is a poorly defined and often sub optimally treated entity in Vascular (and General) Surgery,’ said Redman. ‘There is no specific cause for the condition, only numerous risk factors, and there is no single investigation that confirms these diagnoses. Treatment for this condition has evolved for over a century with multiple treatment options still being described for TOS patients.’

Redman says her study analysed risk factors, patient profiles and specifically, what investigations would actually contribute to the management of TOS patients. Records of 219 patients who had been submitted to surgery over a 10-year period (1999-2009) were reviewed from a database while a sub study was done on patients operated on over the past four years for whom details of the intra-operative anatomical findings were meticulously recorded.

‘What was really noteworthy was the finding that at surgery almost all the TOS patients had some anatomical abnormality within the brachial plexus.’ The brachial plexus is a network of nerve fibres which conduct signals from the spinal cord.

‘The majority of these anomalies involve the configuration of the brachial plexus. We strongly recommend that the supraclavicular approach be used in order to define anatomical aberrations. This finding is interesting as it may as well be an important contributing factor to the pathology in most cases,’ said Redman.

The findings notably suggested an essential, identifiable anatomical cause for the patient’s symptoms. Redman’s research has also allowed her to suggest ‘the best surgical approach - supraclavicular rather than axillary - as these abnormalities can be identified through this incision and the nerve trunks released and freed which will aid in symptom resolution’.

Redman is a Vascular Surgeon currently working in Cape Town in private practice, having specialised in general surgery with a subspecialty in vascular surgery.

Redman, who wants to continue with vascular research, enjoys playing the piano, sketching, doing sculptures, running and swimming when she has time.

-        Zakia Jeewa

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Study on HIV-Associated Dementia

Study on HIV-Associated Dementia
Mr Khayelihle Makhathini graduated with a Masters in Medical Sciences (Physiology).

HIV affects the central nervous system (CNS) and can initiate a progressive neurodegenerative process culminating in HIV-associated dementia (HAD), a UKZN study has revealed.

Mr Khayelihle Makhathini, who graduated with a Masters in Medical Science in Human Physiology, conducted the lab-based study titled: “Tat Protein Induced Neurocognitive Dysfunction”, which looked at how human immunodeficiency virus type 1 (HIV-1) is a major health threat in South Africa and worldwide.

Tat protein and gp120 are two of the viral proteins that have been linked to the neurotoxic effects of HIV, he said.

‘When a brain is infected by HIV, neurocognitive dysfunction leads to the loss of learning and memory,’ said Makhathini.

‘It is not easy to conduct the experiment directly on humans so we used an animal model to evaluate the effect of Tat protein.’

According to Makhathini’s study, which was supervised by Professor William Daniels, HIV has an impact on the central nervous system. The study gives clarity on the administration of highly active antiretroviral therapy (HAART) that has improved the quality of life of many HIV patients, although its overall efficacy for neuro-AIDS remains unsatisfactory.

‘Although infected patients take ARVs, those who develop HIV neurocognitive dysfunction (HAND) still have a loss of learning and memory.’

Makhathini, a young neuroscientist at UKZN,  actively participates in the annual Brain Awareness Week in which he and his colleagues visit UKZN campuses, primary and high schools.

‘During that week we make people aware of the importance of exercising, eating healthily, and inform them of other diseases that affect the brain,’ he said.

Makhathini is currently reading for his PhD in Human Physiology and preparing a thesis titled: “The Impact of Stress on Tat protein-induced effects in a rat’s brain”.

‘The main purpose of this study is to clarify the environmental stress we are usually exposed to and how this condition can cause exacerbation effects after infection with HIV.’

Makhathini grew up in rural Maphumulo in KwaZulu-Natal and was raised by his unemployed mother and grandmother.

‘It was difficult growing up there because there was very limited access to information about careers but my mother and grandmother were adamant that I continue with my studies after matric,’ Makhathini said.

- Nombuso Dlamini

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UKZN Study set to Revolutionise TB Detection Technology

UKZN Study set to Revolutionise TB Detection Technology
PhD graduate, Dr Mantha Makume’s study produces a novel way to diagnose TB.

Dr Mantha Makume who graduated with a PhD in Medical Microbiology from UKZN’s College of Health Sciences says her research has the potential to revolutionise TB detection technology.

Her thesis was titled: “The Development and Implementation of the Mycobacterium Tuberculosis Rapid Detection Assay Using Reporter Mycobacteriophages”.

Tasked to develop an assay that would make it simpler, easier and cheaper to detect TB in patient samples, Makume collaborated with the Albert Einstein College of Medicine research group in the United States to genetically manipulate bacteriophages to give off a signal, if and when TB bacteria were found in samples.

‘It is a novel way of diagnosing TB, which in turn will aid in getting patients treatment sooner. Also, the cost of doing such an assay will benefit those who do not have the money for more expensive tests,’ she said.

A lot of work and patience was required to develop something substantial, something that has clear potential for the country and continent as a whole,’ she said.

Makume is currently in the beginning phase of her Post-Doctoral Fellowship.

‘The project I was involved in with my PhD is so important that Professor A.W. Sturm and I found it worthwhile to see it through to the end,’ she said.

Makume’s interests have always been in education, especially of young Black girls, introducing them to the wider academia and science as a whole.

Her other interests include public health and policy-making in the public health arena: ‘Our health system in South Africa is making strides and I would like to be part of a team that takes it to a level of excellence.’

Both her parents are academics and have instilled in her the love of learning.  ‘My family has been my greatest support and given me the space to explore my love of science. I feel like I have been having fun the past few years of my academic life. The passion I have for laboratory work has helped me through the tough times when experiments don’t work,’ she said. 

‘The amount of passion one has for one’s chosen field of interest will always translate to high achievement. It is important to me that scientists be able to translate their research into something the community can understand and appreciate, or why are we doing it in the first place?’

-       Nombuso Dlamini

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Lesotho-Based Study by Masters Graduate Shows Promising Results for HIV Testing

Lesotho-Based Study by Masters Graduate Shows Promising Results for HIV Testing
Dr Stephen Olorunfemi graduated with a Master’s in Public Health at UKZN.

Lesotho was used as the base for a case study to analyse the response of people regarding the impact of HIV among pregnant women and what women did to protect themselves and young children from contracting HIV.

The research was done by Masters of Public Health graduate, Dr Stephen Olorunfemi, for  his Masters dissertation titled: “Factors Influencing the Uptake of Voluntary Counselling and Testing in the Prevention of Mother-to-Child Transmission for the Human Immune Deficiency Virus among Antenatal Clinics Attendees in Queen Elizabeth II Hospital in Maseru”.

‘With HIV/AIDS currently being a major public health problem in Lesotho and with mother to child transmissions being responsible for 95% of childhood HIV infections, voluntary counselling and testing in Prevention of Mother to Child Transmission has an important role to play in Lesotho’s response to the HIV epidemic among women of childbearing age. In fact, the cornerstone of a successful Prevention of Mother to Child Transmission intervention programme is to achieve a high rate of HIV testing among pregnant women,’ said Olorunfemi.

‘This is just the beginning of my research work as I am in my second stage of research to get a good understanding in the field which will enable me to contribute to the society and community as a whole after a good background for research. At present, this is my passion. After the thorough research background which I obtained from UKZN, the importance of good research has been imbedded in me.

Olorunfemi, a Medical doctor (MBCHB) with his Diploma in HIV from the South Africa College of Medicine, has worked at the Tsepong Hospital in Lesotho (PPIP), one of the largest hospitals in Maseru managed by NETCARE group. He obtained his Occupation Health and Safety certificate and Operation Management certificate from the University of Cape Town.

He is currently working in the Lesotho community as a doctor and working on his Master’s in Epidemiology through Stellenbosch University. He hopes to pursue his PhD in the near future.

Olorunfemi is also involved in raising HIV awareness among university undergraduates and has been a Clinical co-ordinator involved in HIV/TB management.

-        Zakia Jeewa

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United States Professor Graduates With PhD From UKZN

United States Professor Graduates With PhD From UKZN
Professor Michael Hoffman of the United States graduated from UKZN with a PhD in Behavioural Medicine.

Professor Michael Hoffman of the Universities of Florida and Central Florida in the United States graduated from UKZN’s College of Health Sciences with a PhD in Behavioural Medicine.

The aim of his study was to establish the significance of higher cortical function impairment in people suffering strokes.  It was titled: “Frontal Network Syndrome Testing: A Hierarchical and Time Orientated Approach”.

‘The thesis involved testing what is our highest human function - our executive brain or frontal networks,’ said Hoffman. ‘This has barely been done so far, probably because of complexity and because we have not had suitable tests up until now. However, the advent of overwhelming dementia worldwide necessitates an approach that also needs to be practical, relatively quick and easy to do.’

Hoffman devised a system for diagnosis of the three most common dementia syndromes - cognitive vascular disorders (CVD), Alzheimer’s disease (AD) and frontotemporal lobe disorders (FTLD). ‘Modern neuro-imaging helps a great deal and complements this relatively rapid yet accurate bedside testing of the frontal lobes, which was the main focus.’ Through an array of methods such as word list generation, five word memory testing and PET brain imaging, this helped distinguish the three most common dementia subtypes in patients.’

The thesis also incorporated research papers that have been focusing on the problem for about 20 years and concluded in a “tiered hierarchical approach” depending on the patient’s ability to participate and the severity of disease one is faced with. It was found that cognitive syndrome (CS) and frontal network syndrome (FNS) were common in stroke patients.

Hoffman explains that his next focus, with the help of his PhD, is a continuation of the study of frontal network function specifically into the origins and evolutionary underpinnings of spirituality, shamanism and religion and how they are affected by brain diseases such as dementia. This work includes a preview of a seminal work by a South African Lewis Williams who wrote the book The Mind in the Cave.

Hoffman is a Professor in Neurology at the University of Florida and the University of Central Florida.

Married with two children, he is currently writing a book on brain health called Brain Beat.

‘My roots in South Africa are my best memories and I would like to be more involved with UKZN and Wits where I studied to give back to those who taught me in the first place,’ he added.

-         Zakia Jeewa

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Number of Infants Testing HIV Positive in KZN is Decreasing, Research Finds

Number of Infants Testing HIV Positive in KZN is Decreasing, Research Finds
Dr Pravi Moodley, UKZN/NHLS HOD of Virology graduated with an MMED.

Clinical Virologist, Dr Pravi Moodley who graduated with a Master’s in Medicine (Virology) at UKZN’s College of Health Sciences, did research which showed the number of infants testing positive in KwaZulu-Natal is decreasing.

His research, titled “Reduction in Perinatal HIV Infections in KwaZulu-Natal, South Africa, in the Era of More Effective Prevention of Mother-to-Child Transmission Interventions (2004–2012)”, was published in the Journal of AIDS in July 2013.

The study describes a trend in perinatal HIV transmission associated with the implementation of rapidly changing prevention of mother-to-child transmission (PMTCT) interventions from 2004 to 2010 in KwaZulu-Natal.  

Moodley said with the help of his supervisor, Professor Daya Moodley from the Women’s Health HIV Research Unit at the Nelson R Mandela School of Medicine, and Dr Raveen Parboosing, who works with him in Virology at Inkosi Albert Luthuli Central Hospital as the co-author, they looked at a total of 35 333 HIV-exposed infants of 52 weeks of age who tested PCR positive.

The reduction rates in perinatal HIV infections in four- to eight-week old HIV-exposed infants decreased significantly by 48.9% following single-dose Nevirapine (2005 to April 2008); 68.5% with Zidovudine (AZT) from 28 weeks and single-dose Nevirapine (sdNVP) together with triple antiretroviral therapy (ART) for women with CD4+ cell count <200 cells/mm3 (May 2008 to April 2010); and 75.7% with AZT from 14 weeks, sdNVP and triple ART for women with CD4+ cell count <350 cells/mm3 (May to  December 2010).

‘We showed a fourfold reduction in mother-to-child transmission (MTCT) from 2004 to 2010 during a rapid implementation of more complex and robust PMTCT interventions,’ Moodley said.

He said the significant reductions in MTCT in the South African PMTCT programme were encouraging for a middle-income country with the second highest antenatal HIV prevalence in the world.

Moodley’s work was conducted by using a retrospective analysis of HIV PCR results of infants from 2004 to 2010 from archived data from a Laboratory Information System in KwaZulu-Natal. He said it was novel in that it was the first time in which a Laboratory Information System was used to extract and analyse data in PMTCT research.

‘The study did not require any funding and was fairly simple and straight-forward to do but provided high-impact information,’ he said.

He is currently a Head of Department at UKZN and NHLS Department of Virology. ‘I enjoy my work and what I do in the NHLS and at our University. The different situations which I encounter each day keep me energised.

Moodley is currently registered for a PhD in Higher Education at UKZN where he teaches Virology. ‘I am attending the PhD cohort supervision group, which is quite different and exciting for me,’ he said.’

Moodley comes from a family of mostly teachers and business and IT practitioners:  ‘My sister is a nurse in London and the other is a business analyst with Nedcor. My father is a retired education academic from the former University of Durban Westville and my mother - has always been my mother.’

- Nombuso Dlamini

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Original Study Develops Tools for Suicide Intervention in HIV-Infected Patients

Original Study Develops Tools for Suicide Intervention in HIV-Infected Patients
Dr Romona Govender graduated with her PhD in Family Medicine for her study on Suicide among HIV positive patients.

Dr Romona Govender completed her PhD in Family Medicine with a dissertation titled: “Identification of Suicidal Ideation in HIV-Infected Patients: Development of a Suicide Risk Assessment Tool and a Suicide Intervention Plan for HIV-Infected Patients Following Voluntary Counselling and Testing”.

With suicide and HIV/AIDS being two of the greatest healthcare issues globally, especially in low- and middle-income countries where approximately 85% of suicides occur, about one million people of all ages worldwide die annually from suicide.

HIV/AIDS patients have a higher suicide risk than the general population, with an increased frequency and severity of suicidal ideation, despite the introduction of ARVs.

‘The research addresses two major public health challenges in South Africa – HIV/AIDS and suicidal behaviour,’ said Govender. ‘I feel that it makes an important, relevant and original contribution to research and intervention. Relatively little is known regarding suicidal behaviour in South Africa, especially among HIV-positive persons, and interventions designed for these patients are non-existent.  ‘Furthermore, a high level of HIV/AIDS, especially in KwaZulu-Natal where the research was undertaken, gives this research the potential to positively influence the level of care for our patients.’

There were two innovations that Govender’s study demonstrated - a suicide risk screening scale and a brief suicide prevention intervention.

Her study sought to determine the prevalence of suicidal ideation in HIV-positive persons following voluntary HIV counselling and testing (VCT); as well as to develop and validate a suicide risk screening scale (SRSS) for use in HIV-infected persons post HIV diagnosis. Implementing and evaluating a brief suicide preventive intervention (BSPI) was used in the period immediately following HIV diagnosis.

There was seen to be an increase in suicidal ideation over a six-week period following a positive HIV diagnosis, from 17.1% to 24.1%.

‘Suicidal ideation was significantly associated with seropositivity, age and gender, with the majority of affected patients falling in the younger age category,’ said Govender. ‘Young males had an 1.8 times higher risk for suicidal ideation than females. Lower education and traditional beliefs were also significantly associated with an HIV-positive status upon testing. The SRSS was implemented and, despite certain limitations, was considered to be a valuable screening tool for suicidal ideation at VCT clinics.’

In her findings, there was an important link present between hopelessness, depression and suicidal ideation, as these served as significant markers that should alert healthcare professionals to underlying suicide risks in HIV-positive patients. ‘A routine screening for suicide risk and possible suicidal behaviour should form part of comprehensive patient care at VCT clinics to assist with effective prevention and treatment.

‘Healthcare workers at VCT clinics should also be trained in suicide prevention interventions and the importance of educating vulnerable HIV-positive patients on suicide-prevention strategies.

‘Doing a PhD thesis is long, gruelling years of hard work. I did my PhD via publications which is also very stressful waiting for months for feedback, but the proverbial “cherry on top” is when your manuscript is published…..what utter joy,’ said Govender.

Mother of two, Govender is a Family Physician working for the Department of Health. She hopes to present her research findings and have input in the post-test counselling to address the psychosocial issues that affect patients, particularly suicidal thoughts following HIV counselling and testing.

-                      Zakia Jeewa

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Three Medical Students Graduate Summa Cum Laude

Three Medical Students Graduate <em>Summa Cum Laude</em>
From left: Dr Christopher Naidu, Dr Dane Perumal and Dr Nisholini Naicker graduated summa cum laude.

Dr Christopher Pierre Andre Naidu, Dr Dane Perumal and Dr Nisholini Naicker of the Nelson R Mandela School of Medicine Class of 2013 graduated summa cum laude winning 12 awards between them!

The trio was honoured at an oath-taking and awards ceremony hosted by the College of Health Sciences.

 Perumal scooped six awards:  Top Student in the School of Clinical Medicine, the YK Seedat Prize, Academy of Family Practice for Best Student in Family Medicine, the Randles Road Medical Centre Prize in Family Medicine for the Highest Mark in Family Medicine, the Sammy Sacks Prize in Obstetrics and Gynaecology for the second highest mark in the final examination, and the Department of Paediatrics Prize for the Best Overall Student in Years three, four and five.

Perumal was overwhelmed by the awards and his achievements saying they were unexpected.  ‘I was not aware I was one of the top students but I do strive for excellence in whatever I do,’ he said.

He did not view his studying as work because it was his passion and love. ‘I am serving my internship at RK Khan Hospital and am using the time and the opportunity to decide what would be the best fit for me in terms of specialising. I love everything so much, I feel like all doors are opened but my internship will guide my decision.’

Naidu received awards for the Top Student in the School of Clinical Medicine, the YK Seedat Prize, the Servier Prize in Family Medicine for the second highest mark in Family Medicine, the KM Seedat Prize in Medicine for the second highest mark in the final examination in Medicine, and the Department of Paediatrics Prize for best final year student in Paediatrics.

Naidu said he was really excited about his achievement. ‘I am so grateful to my Lord and savior Jesus Christ. Without him nothing would have been possible.’

He thanked his wife, Celestina, who has been studying with him and supporting him, ‘A big thanks to my parents and my sister Crystal who have been there throughout the good and bad times. They encouraged me and provided me with a stable support. Crystal has been more than a sister, she spoiled me throughout my final year.’

Naidu is serving his internship at Gandhi Hospital and is considering specialising in Plastic Surgery once he has completed his internship.

Naicker received the YK Seedat Prize for the Top Student who obtained a summa cum laude degree.

She was overjoyed by her achievement: ‘I feel great, it was quite unexpected and it is what I have always wanted. I have put in a lot of hard work into my degree and I had great support from my family.’ She is doing her internship at Addington Hospital in Durban.

- Nombuso Dlamini

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Acute Kidney Injury and Trauma Patients Under the Spotlight

Acute Kidney Injury and Trauma Patients Under the Spotlight
Dr David L Skinner graduated with an MMED degree in Surgery.

“The Incidence and Outcomes of Acute Kidney Injury Amongst Patients Admitted to a Level I Trauma unit”, was the title of a thesis which earned Dr David Skinner, a UKZN Clinical Medicine graduate, a Masters of Medicine degree in Surgery.

This project was published as a paper in 2014 in Injury, Int. J. Care Injured 45 (2014) 259–264 Skinner’s study, supervised by Dr T Hardcastle, Professor  DJJ Muckart and Dr RN Rodseth; involved the analysis of all patients presenting to the Trauma Intensive Care Unit (ICU) at Inkosi Albert Luthuli Central Hospital and identifying the presence of renal dysfunction - the current modern terminology being acute kidney injury (AKI) -  and attempted to identify risk factors for this condition.

Skinner performed a retrospective observational study of 666 patients admitted to the Trauma ICU from March 2008 to March 2011 and conducted multivariable logistic regression to identify independent predictors for AKI and mortality. ‘We looked at the patient’s outcomes in terms of mortality and the utilisation of renal replacement therapy (dialysis). A small subset of patients who had developed renal failure as a result of sjambok injuries was also analysed,’ said Skinner.

He explains that ‘patients with sjambok injuries have severe renal dysfunction but seem to have better outcomes in terms of mortality relation to other patients with similar levels of renal dysfunction’.

The renal dysfunction resulting from injury with a sjambok is a uniquely South African problem. Because of this, it has led Skinner to develop more research questions directed around trauma related acute kidney injury within the South African context.

Renal replacement therapy, in the form of haemodialysis, is a precious resource in South Africa and further work is needed for decisions on rational distribution of this resource in critically ill surgical and trauma patients. It was found that ‘AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low base excess. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden’.

Skinner is a specialist surgeon and is currently working as a consultant at King Edward VIII Hospital in the Intensive Care Unit. He is also in the process of conducting further research on renal dysfunction in surgical and trauma patients and has completed a paper recently examining blunt cardiac injuries in patients who sustained blunt thoracic trauma.

-        Zakia Jeewa

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Phd Graduate Investigates Vision Loss in Cryptococcal Meningitis Patients

Phd Graduate Investigates Vision Loss in Cryptococcal Meningitis Patients
Dr Anand Moodley, Head of Neurology at Greys Hospital in Pietermaritzburg, graduated with a PhD from UKZN

A study by Dr Anand Moodley, Head of Neurology at Greys Hospital in Pietermaritzburg, examined the causes of vision loss through fungal infection of the brain and spine.

Moodley graduated with a PhD in Neurology from UKZN’s College of Health Sciences on 10th April with a thesis titled: “A Qualitative and Quantitative (MR) Diffusion Study Investigating the Pathogenesis of Cryptococcal Induced Vision Loss”.

Cryptococcal meningitis (CM), which causes vision loss through a fungal infection of the tissues that cover the brain and the spine, is an opportunistic infection found in HIV infected patients. Vision loss occurs in 35-48% of patients.

With conflicting reports concerning the cause of visual loss in CM, various authors have supported an optic neuritis (inflammation) model while others have preferred a papilloedema (raised intracranial pressure) model. Due to these conflicting models, effective strategies for prevention and treatment of visual loss in CM have been delayed.

The aim of Moodley’s study was to clarify the cause of cryptococcal-induced visual loss by using diffusion imaging of the optic nerve as an investigational tool. Diffusion imaging is a magnetic imaging technique which derives images based on diffusion on water in various tissues.

The study investigated 95 patients with CM and showed that optic neuritis (inflammation of the optic nerve) is uncommon, while papilloedema (swelling caused by intracranial pressure) occurs in 25% of patients, yet raised pressure was present in 71% of patients.

By using optic nerve diffusion imaging, Moodley was able to show that raised intracranial pressure played the primary role in CM induced visual loss. The raised pressure was more likely to cause an optic nerve compartment syndrome at the optic canal level rather than papilloedema as the main insult resulting in visual loss.

‘Optic nerve diffusion imaging has become a useful tool in investigating the micro-structure of optic nerve function,’ said Moodley. ‘Its applications have been mostly to optic neuritis and ischaemic optic neuropathy. This is the first time it has been applied to an infectious disease. The technique was reliable and reproducible and produced diffusion parameters equivalent to other investigators in the field.’

Moodley’s current focus is the supervision of MMED students and further development of neuro-ophthalmology.  In his spare time, he enjoys golf, squash, birding and… Mathematics!

- Zakia Jeewa

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DNA Damage Heightened Among Petrol Station Attendants, Research Finds

DNA Damage Heightened Among Petrol Station Attendants, Research Finds
Dr Mpho Makwela graduated with her Masters in Medicine (Occupational Medicine).

Masters research has shown that DNA damage is heightened among attendants at petrol stations.

The work was done by Dr Mpho Makwela who completed her Master’s in Medicine (Occupational Medicine) with a thesis titled: “Occupational Benzene Exposure and Genotoxicity Among eThekwini Municipality Petrol Attendants in 2011”.

Makwela explained that when lead was banned in petrol, chemical concentrations of benzene had been increased in fuel to hike the octane level.

Occupational exposure to petrol is considered a health hazard as benzene has carcinogenic and mutagenic effects on human health and benzene is categorised as a group 1 carcinogen, a substance directly involved in causing cancer.

Makwela’s research aimed to determine if there had been increased DNA damage among petrol attendants compared to the control group, which contained UKZN office workers without chemical exposures.

In this observational analytic cross sectional study, petrol attendants from 10 filling stations in the eThekwini Municipality were analysed at a mobile environmental monitoring station which was available to collect volatile organic compounds emissions. Their interviews where validated on questionnaires and blood samples were taken – a method of detecting DNA damage. Benzene biomarkers were taken from each petrol attendant, with Benzo (a) pyridol being the marker of exposure.

Makwela’s study, supervised by Professor NR Naidoo, searched for a correlation between benzene occupational exposure and albumin addicts Benzo-oxide and 1.4 Benzoquinone levels and this was correlated to the length of the DNA, which resembled a comet tail as a measure of DNA damage.

It was found that the petrol attendants had much greater damage in their DNA compared to those of the controls.

Makwela is an Occupational Medicine Specialist working at the National Department of Health at the Medical Bureau for Occupational Disease. In her spare time she enjoys reading and going to the gym.

-        Zakia Jeewa

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Humanitarian Awarded Honorary Doctorate

Humanitarian Awarded Honorary Doctorate
Dr Basil Kransdorff receives an Honorary Doctorate.

Dr Basil Kransdorff; a visionary and lobbyist for affordable, effective, bio-available nutrition that results in nutrient repleteness, received an Honorary Doctorate at UKZN’s College of Health Sciences Graduation ceremony.

Kransdorff’s vision is to ‘find every Einstein on the African continent’ through ensuring that people become nutrient replete. His commitment is to halt poverty using state-of-the-art understandings of nutrition to end micro nutrient deficiencies.

Speaking at the ceremony Kransdorff said: ‘Healthy, physiologically functional human beings are better able to participate in sustainable solutions in the development of communities. Nutrient replete children are better able to focus, co-ordinate and concentrate and therefore be educated.

‘Malnutrition is rampant across the continent, and with such population growth, it can only get worse. The magnitude and time frame means we have little time to find practical and affordable solutions to problems of malnutrition, health, poverty and sustainable development. We need to ensure thriving societies in South Africa and the continent.

‘Our species is at risk of destroying itself if we continue to use unsustainable past paradigms and part solutions to the enormous challenges ahead.’

As a social entrepreneur for the past 14 years, he has pioneered and developed the science of e’Pap Technologies, focused on achieving nutrient repleteness – redressing micro nutrient deficiencies in populations across Africa through fortified foods that are effective, affordable and tasty.

e’Pap is referred to as an African Solution and was chosen by the International Marketing Council of South Africa as a brand champion. It sells in 15 countries across Africa. Through word of mouth marketing (e’Pap Effect) up to 2 million food portions a month and over 150 million portions have been distributed since its inception.

Kransdorff’s message to UKZN’s graduates was, ‘The skills and knowledge this University has given you will be critical in helping us find the inter-connected solutions necessary to implement in the little time we have left. You have grown up politically free, with open, uncensored access to information and ideas, through social media and the Internet. You are far better equipped for “rapid change” than we were.

‘This prestigious University has provided a cocoon for your learning. Now - get ready to meet the reality of communities living in extreme poverty across our continent and especially, in your own back yard here in KwaZulu-Natal.’

Kransdorff is an Ashoka Fellow and internationally recognised for his work by Ashoka, a Washington based NGO focused on supporting social entrepreneurs who have developed important solutions to address poverty and health issues in communities.

He holds a BSC degree with majors in Chemistry and Geology and a BSC Honors in Chemistry from the former University of Natal (1969). In the field of nutrition he has written and researched on micronutrients and their bio-efficacy and works closely with international experts in the field.

He has published a number of articles on bio-available nutrition and its importance for corporate wellness programmes and productivity, education, nutrition as a management tool in TB, HIV and AIDS, stigma and denial.

- MaryAnn Francis

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Adrenal Lesions the Subject of Master of Medicine Thesis

Adrenal Lesions the Subject of Master of Medicine Thesis
Dr Vanesha Naidu graduated with an MMED in Radiology.

Dr Vanesha Naidu graduated with her Master of Medicine degree in Radiology with a thesis titled: “Adrenal lesions encountered in current medical practice - a review of their radiological imaging”.

Modern radiological techniques have altered the way adrenal lesions are currently being investigated. The modern radiologist has been projected to the forefront in the management of adrenal disease due to adrenal lesions being discovered from the increasing use of cross-sectional imaging in radiological studies carried out for non-adrenal related conditions. This occurrence is called the “adrenal incidentaloma”.

Naidu’s study discussed the imaging modalities which are available for the characterisation of these lesions, highlighting the current concepts and controversies in differentiating benign (a condition that is harmless in the long run) from malignant pathology (a condition that grows progressively worse over time).

Naidu also provided a brief overview of the spectrum of adrenal pathology commonly encountered in the adult population. ‘More and more adrenal lesions are being detected incidentally in radiological examinations performed for other abdominal, non-adrenal related conditions (the so-called “incidentalomas”). Many of these lesions can be malignant and life threatening. This poses a huge diagnostic challenge to the radiologist, clinician and patient alike.’

Her study aimed to explore these many diagnostic and therapeutic challenges encountered in daily practice. ‘I evaluated the characteristic radiological features of adrenal incidentalomas that are commonly encountered, and provided an integrated, comprehensive and pragmatic approach to incidentally detected adrenal lesions, which can assist both the clinician and radiologist in their daily practice.’

Naidu is currently working on a collaborative project investigating the radiological changes related to HIV lipodystrophy.

In her spare time, she enjoys travelling and photography. ‘As a Radiologist, I’m constantly surrounded with images, and photography seems a natural extension. With the recent completion of my MMed, I’ve finally found time to pursue this hobby more vigorously and have just completed a six-week photography course.’

-        Zakia Jeewa

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Study Finds Body’s Immune Proteins Can Block or Fight off HIV Infection

Study Finds Body’s Immune Proteins Can Block or Fight off HIV Infection
Dr Kavidha Reddy.

PhD in Virology graduate, Dr Kavidha Reddy, has received international recognition for her ground breaking research titled: “The Role of APOBEC3G in Acute and Early HIV-1 infection”.

Her study focused on how the body fights HIV infection and more specifically the workings of the body’s immune proteins that can block or fight off HIV infection.

Reddy received the International AIDS Society and the French National Agency for Research on AIDS, IAS/ANRS Young Investigator Award at the IAS Conference in Malaysia last year.

Her study focused on a new arm of the human immune system which is made up of proteins called host restriction factors (HRFs). HRFs are proteins found widely in human cells and are able to destroy or inactivate HIV.

‘The study of such factors may lead to development of new therapies or vaccines, particularly for heavily affected populations,’ she said.

Reddy investigated the HRF, APOBEC3G in a cohort of HIV-infected individuals in Durban, and the role it played in making people resistant to infection or to disease progression. 

This protein was shown in laboratory experiments to have the ability to inactivate or severely disable HIV. However, there was little evidence of its anti-HIV effects within the body.

‘I have studied people heavily affected by HIV/AIDS in South Africa. I previously identified various naturally occurring genetic variants/mutations of APOBEC3G, and some of these mutations that occur predominantly in populations of African descent were associated with rapid disease progression.

‘Interestingly, HIV also has a mechanism to defend itself from the attacks being made on it by the APOBEC3G protein. The HIV Vif protein is able to destroy APOBEC3G so that it is unable to attack the virus,’ she said.  

The study also looked at how the virus interacts with human proteins of the immune system. ‘I found that the HIV Vif protein from infected individuals in South Africa is changing itself to better destroy APOBEC3G, thereby inactivating immune defences against the virus.  These data point to mechanisms that could be exploited to develop a new class of drugs against HIV to block virus replication and slow down disease progression,’ said Reddy.

‘Within South Africa, KwaZulu-Natal is the epicentre of the HIV pandemic and continues to battle high HIV rates. Therefore finding a safe, effective and durable HIV vaccine remains a priority in the fight against HIV, it remains a great challenge,’ said Reddy. ‘Thus far, traditional vaccine approaches have focused on CTL and antibodies.’

‘During my PhD I have had the privilege and opportunity of travelling to labs in the United States for traineeships where I was able to learn new and exciting research techniques that I have been able to implement in our lab. I have also had the opportunity of travelling to international conferences to present my research.’

Reddy has taken on a post-doctoral research position at UKZN’s HIV Pathogenesis Programme (HPP), where she continues her research on HIV and host restriction factors.

‘I really enjoy doing research,’ she said, ‘but I would also enjoy the opportunity of being able to lecture, mentor and teach other research students.’

When she is not doing research, she bakes and enjoys doing crafts and anything that allows her to be creative.

She said her parents and husband were ecstatic about her achievement. ‘They have been my pillars of strength and have always encouraged and supported me,’ she said.

She said her PhD supervisor, Professor Thumbi Ndung’u, had been a great supervisor and mentor. ‘He always has an open door policy and was continuously willing to share his expertise and provided outstanding guidance and encouragement throughout my PhD.’

-       Nombuso Dlamini 

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Graduate explores Systemic Lupus Erythematosus and Thrombocytopaenia in her MMED study

Graduate explores Systemic Lupus Erythematosus and Thrombocytopaenia in her MMED study
Dr Neeta Patel graduated with an MMED from UKZN.

Dr Neeta Patel from UKZN’s Department of Rheumatology has graduated with her Masters of Medicine at UKZN, her thesis titled: “Acute Presentation of Thrombocytopaenia in Systemic Lupus Erythematosus is Associated with a High Mortality in South Africa”.

Patel said the objective of this study was to determine the pattern of presentation, response to treatment, and outcome in patients with systemic lupus erythematosus (SLE) and thrombocytopaenia (TCP).

SLE is a systemic auto-immune disease that can affect any part of the body and usually occurs when the immune system attacks the body’s cells and tissues, resulting in inflammation and tissue damage.

SLE often harms the heart, joints, kidneys, liver, lungs, blood vessels and the nervous system. TCP refers to the decrease in platelets in blood. Patients with SLE and TCP were reviewed for the study and a corresponding control group of SLE patients without TCP were also seen in the Rheumatology Department in Durban, South Africa.

Their demographic data, clinical findings, laboratory findings, treatment and outcome were recorded. There were 54 patients comprising 30 Indians and 24 Black African. There was a median age of 33 years and the female to male ratio was 5.8:1.

‘We examined the association of haematologic abnormalities in the disease lupus with mortality and found an association between low platelet counts in South African Black and Indian lupus patients. A group of eight patients who initially presented with idiopathic thrombocytopaenic purpura (ITP) and subsequently developed SLE were also analysed for the study, but separately,’ said Patel.

‘An acute presentation was noted in 31 patients (57%). Patients with an acute presentation had an increased prevalence of renal disease (77% VS 43.5%) and an increased number of deaths (38.7% VS 4.4%). The majority of patients responded to corticosteroids (68.5%) and splenectomy. There was an increased prevalence of renal disease (p=0.03) and deaths (p=0.004) among patients with TCP. The majority of deaths had an acute presentation (12/13; 92.3%) and were due to infection and active lupus. TCP with an acute presentation is associated with a high mortality and predicts survival in SLE.’

Patel is currently a Consultant Rheumatologist and Deputy Head of Department of Rheumatology at UKZN and IALCH. She is currently working on her Doctoral thesis which will focus on HIV and arthritis. Her study was supervised by Professor Girish Mody, former Dean of the Nelson R Mandela School of Medicine.

 In her spare time, she enjoys yoga, meditation and reading.

-        Zakia Jeewa

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Novel TB Research by PhD Graduate

Novel TB Research by PhD Graduate
Dr Nqobile Ngubane graduated with a PhD in Medical Microbiology.

Thabo Mbeki Leadership in Africa Scholarship recipient Dr Nqobile Ngubane graduated with a PhD in Medical Microbiology at UKZN’s College of Health Sciences after completing research in the field of Tuberculosis (TB) diagnosis. 

According to Ngubane, her study titled: “Development of Novel Reagents for the Detection of Tuberculosis”, was the first of its kind to use the combination of phage display combined with high-throughput sequencing for identifying molecular probes that bind to M. tuberculosis, the bacteria that causes tuberculosis.

‘To our knowledge there is no published data that identifies nucleic acid aptamers against the EsxG protein of M. tuberculosis which was also done during this study,’ she said.

The aim of the study was to use molecular biology tools, namely aptamers and phage display technology, to develop reagents that can be used to improve TB diagnosis, especially in resource-limited countries such as most on the African continent.

She said one of the primary reasons identified as a hindrance in controlling the spread of TB was that many cases of active disease go undetected or are discovered late.  

‘In our work we identified various reagents in the form of short peptides and nucleic acid aptamers that successfully recognise and bind to TB. This means that these reagents can be exploited in the development of new diagnostic tests for TB,’ she explained.

 The study has been presented in one international conference and two local conferences. Part of it was published in the internationally peer-reviewed journal, PloS One journal.

‘We ultimately hope that this work can contribute to the development of quick and accurate TB diagnostic tests that will enable timely intervention with treatment,’ she said.

Ngubane was supervised by Dr Alex Pym from K-RITH and two co-supervisors, Professor Eric Rubin from the Harvard School of Public Health and Dr M Khati from CSIR Biosciences. She spent most of her time during her PhD study in Dr Khati’s lab at the CSIR in Pretoria, on a CSIR PhD studentship.

‘I was proud to be part of what I believe is the first group in South Africa, at the CSIR, that specialises in this technology,’ said Ngubane. ‘As far as experiences are concerned, I would say the highlight of my PhD was working with experts in the TB field. I was humbled to work with Dr Alex Pym from KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH) at UKZN and Professor Eric Rubin from the Harvard School of Public Health (HSPH). The time spent in Professor Rubin’s lab was absolutely the highlight of the experience,’ said Ngubane.

‘The research culture and environment at Harvard University was an absolute inspiration,’ she said. ‘It all would not be possible if we didn’t have organisations like the CSIR, which I was part of during my PhD work, and Higher Education Institutions like UKZN that administer the Fogarty Scholarship, which funded my time at HSPH.’

Ngubane spent a year in Rubin’s lab in Boston.  ‘She brought to the lab her expertise on using novel methods to detect molecules that study tuberculosis,’ Rubin said.

According to Rubin, the experience prompted Ngubane to try to apply the methods she had learned, together with those that she developed, to discover new approaches to diagnosing TB. 

‘Her work was “proof-of-concept” - while she did not produce a new diagnostic, she did show that the types of methods she used could lead to very different ways to rapidly identify the causative bacteria in patient samples.  But, in addition to doing a great job on an innovative project, Nqobile was the first South African student in our department and was a very successful ambassador - we now have a South African postdoc and an increasing number of lab members spending time in South Africa.’

‘Many students wait for something to happen or be told what to do. But Nqobile was quite different. Her drive, determination and independence meant she was able to work across three laboratories and really benefit from the experience. I’m very happy that K-RITH was able to support her and contribute to her success’ said Pym.

After completing her PhD work, Ngubane joined the Technology Innovation Agency (TIA) as a candidate in their CHUMA Technology Commercialisation Programme.

‘I love technology; I believe in its power to transform people’s lives. So when I got an opportunity to be part of an organisation which aims to bring these technologies to life, that is, commercialise them, I couldn’t resist. It’s a fun programme which gives you exposure to the finance and legal environments that would usually take a lifetime to do by yourself.

‘Also, Dr Anitha Ramsuran, who runs the programme at TIA, is an absolute God-sent. She really takes her time to get to know the candidates and allocate them to assignments that will develop their area of interest in the technology transfer/commercialisation space. I have been really blessed,’ she said.

Ngubane loves research and the technology transfer and the commercialisation space that she is currently in. ‘It gives you the best of both worlds; keeping up with research and development from various fields, as well as related business development aspects which  is a lot of fun. I would like to keep doing this for a while, grow, and make my contribution to society in this field.’

Ngubane is an outdoors person who loves hiking, especially amid the silence of the mountains. The Drakensberg is her most loved place in the world.

Both her parents were school principals. Her late father loved reading and learning: ‘I think I get that from him. My mother is responsible and has high levels of integrity and perseverance. I hope I have a little bit of that too,’ Ngubane said.

Ngubane is from Esikhawini, the youngest of four siblings. She has a brother and two sisters. She said her fiancé, Siyabonga, has been most loving and supportive.

- Nombuso Dlamini

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Novel Technique Used in Study of Facial Wounds

Novel Technique Used in Study of Facial Wounds
Dr Shaheer Ballim graduated with an MMED in Ophthalmology.

Research by a Master of Medicine graduate examined knife wounds to the face and the removal of blades embedded in the eye.

The study was done by Dr Shaheer Ballim in the Department of Ophthalmology, who produced a thesis titled: “Intra-orbital knife-blade foreign body: A case series”.

The objective of Ballim’s study, supervised by Dr Linda Visser, was to describe cases of intra-orbital knife blade foreign body following stabs to the orbit, together with a new technique for removal. The orbit is the cavity in the skull in which the eye is situated. Foreign body refers to any object originating outside or intruding the body.

This was a retrospective case series of three patients who had knife blades embedded in the orbit as a result of assault. It was found that the blades assumed the same direction within the orbit of the patients, but with varying degrees of depth, with one causing serious vascular injury.

In two cases, the globes (eyeballs) were intact after foreign body removal, with good visual outcomes as a result. The third patient required enucleation which is the removal of the eye which leaves the eye muscles and remaining orbital contents intact.

Two of the three knife blades were removed using a “double bone nibbler” technique. The third patients orbit was embedded without a handle and required removal with minor manipulation of the globe. ‘It was found that thorough investigation for vascular injury must be done before any attempt to surgically remove the foreign object,’ said Ballim. ‘Visual outcomes can be good for the patient after the removal of the knife blade. The double bone nibbler technique proved promising for the controlled removal of embedded blades that were severely fixed.’

Ballim, an Ophthalmic surgeon, is currently in private practice at Parklands Hospital. ‘I think it is important to not doubt the value of one’s interesting clinical experiences. What may be considered by yourself as just part of your daily duties may actually be interesting publishable material.’

Ballim performs two sessional clinics: A Corneal ulcer clinic at St Aidan’s Hospital and the Keratoconus clinic at Inkosi Albert Luthuli Central Hospital.  Ballim spends most of his leisure time with his wife and two children.

-        Zakia Jeewa

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UKZN Researcher Develops Protocol Producing True Single Cell Suspension of M. Tuberculosis, a World First

UKZN Researcher Develops Protocol Producing True Single Cell Suspension of M. Tuberculosis, a World First
Nigerian born, Dr Olubisi Ashiru graduated with a PhD in Medical Microbiology.

Mycobacterium Tuberculosis causes tuberculosis (TB) in humans and the disease is a major health concern in the country, says UKZN PhD graduate.

According to Dr Olubisi Ashiru, South Africa is rated third after India and China, among the 22 high-burden countries in the world with TB, and first in Africa.

Ashiru conducted a study titled “Interaction between Mycobacterium Tuberculosis and Pulmonary Epithelium” using isolates from the culture collection of the TB unit in her department.

‘TB is a multifactorial disease and a better understanding of all its aspects is important in the quest to overcome it. The need to better understand the pathogenesis of M. Tuberculosis isolates resulted in this work,’ said Nigerian-born Ashiru.

According to Ashiru, M. Tuberculosis isolates such as the Beijing and F15/LAM4/KZN families dominate in patients. The emergence of extensively drug-resistant (XDR) M. tuberculosis isolates raises concern.

‘I investigated the interaction between different clinical isolates of Mycobacterium tuberculosis with human alveolar and bronchial epithelial cell lines and compared these with avirulent (H37Ra) and virulent (H37Rv) laboratory strains.’

She said her results, which were a first in the world, suggested that the higher adhesion and invasion of alveolar epithelial cells could contribute to the successful spread of the Beijing and KwaZulu-Natal families of M. Tuberculosis.

‘Mycobacterium Tuberculosis is notorious for clumping in cultures, making it difficult to obtain a single cell suspension. I was able to develop a protocol that produces a true single cell suspension of M. Tuberculosis without the use of detergents,’ she said.

In recognition for her work on the topic Ashiru received:

•           The Fiona Graham Prize for First Time accepted Abstract at the 49th Annual Meeting of the Microscopy Society of Southern Africa in Pretoria ­- 2011

•           A University of KwaZulu-Natal Doctoral Research Grant Award - 2010

•           A Graduate School Scholarship for academic achievement – 2007-2009

•           The Best Oral Presentation Award at the First National TB conference in Durban - 2008


Ashiru has been in South Africa since December 2004 and she thanks God for her achievements. ‘I thank God because I believe we were created to have it all - God, family, marriage and career.’ 

She said managing her career has been very challenging: ‘I look up to women like Hillary Clinton. She did not abandon one aspect of her life for another.’

Ashiru is currently a Postdoctoral Research Fellow at UKZN’s Department of Medical Microbiology and Infection Prevention and Control.

She is analysing the aetiology of infant mortality in relation to the vaccination programme in the KwaZulu-Natal Province, in an attempt to reduce mortality in children aged five and below.

This is in line with the Millennium Development Goal 4, which aims to reduce child mortality between 1990 and 2015 by two-thirds.

The focus of the study is to obtain an in-depth understanding of the vaccination programme. She also assists post-graduate students in the Department.

- Nombuso Dlamini

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Head of UKZN’s Trauma Surgery Training Unit graduates with a PhD

Head of UKZN’s Trauma Surgery Training Unit graduates with a PhD
HOD of UKZN’s Trauma Surgery Training Unit, Dr Tim Hardcastle, graduated with a PhD in Surgery.

Head of the UKZN Trauma Surgery Training Unit and the Deputy Director of Albert Luthuli Trauma Service and Trauma ICU, Dr Timothy Hardcastle, has graduated with a PhD having completed his study titled: “A Trauma System for KZN – local development for local need”.

Hardcastle’s study, a PhD by published papers, examines the care of trauma and the need for a trauma system relevant to the African scenario. He examined the burden of disease for trauma (injuries), more specifically penetrating and blunt assault, domestic/industrial accidents, and motor vehicle collision related admissions, across KwaZulu-Natal.

‘Trauma is the underdog of the burden of disease. Maternal-child health, diseases of lifestyle and HIV/AIDS get most of the attention, yet trauma is neglected, despite it being right in our face – every day we hear of vehicle collisions, stabbings, shootings, and other injuries, yet very little prevention is forthcoming.’

Hardcastle’s study assessed the facility and structural aspects of the hospitals to determine if they had the equipment to treat trauma efficiently.

His last paper examined the appropriateness of using the Inkosi Albert Luthuli Central Hospital (IALCH) major trauma referral centre and whether enlargement was required. ‘This revealed that trauma is as much of a burden as HIV/AIDS, with the additional aspect that most of it is entirely preventable.’

After this, Hardcastle developed a proposal for an ideal - a defensible trauma system for KwaZulu-Natal that should be fiscally possible. ‘There were other papers included in the submission around the history of trauma care in South Africa, the criteria for trauma services and some philosophical aspects, which also drew attention to the major problem that trauma creates in the Health Department, using underfunded resources and requiring multiple transfers of patients to get them to the right level of care.

‘It was found that almost half of the patients do not go directly to the correct level of care to be able to efficiently manage their injuries. The current system is therefore not optimal and should be changed.’

Hardcastle has continued his clinical work, outreach, as well as supervision of other MMed degrees. He co-ordinates a teaching block to fourth year undergraduates in acute care, which is in the stages of refinement and ongoing improvement. Hardcastle hopes to apply for promotion to Honorary Associate Professor at some point in the future and feels that ‘it would be great to be able to implement the Trauma System, but that depends on Department of Health’.

His study was supervised by Professor DJJ Muckart.

He spends a lot of time with his family and in his free time he enjoys building scale models with his son. One of his keen interests is history - the Second World War in particular.

-        Zakia Jeewa

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UKZN Produces the Youngest Medical Graduate in its History

UKZN Produces the Youngest Medical Graduate in its History
UKZN’s youngest Doctor, Dr Sandile Kubheka.

Dr Sandile Kubheka, graduated with his MBChB degree from UKZN’s College of Health Sciences at the young age of 20, making him the youngest MBChB graduate in its history.

Kubheka who hails from Newcastle in the province of KwaZulu-Natal, was ecstatic to be the youngest graduate and to have also attained a distinction in Obstetrics and Gynaecology. He was voted by his class as a recipient for the Yashiv Sham Bursary for having compassion and caring qualities and the Enid Gordon Jacob Good fellowship Prize for character and good conduct which in the eyes of his fellow classmates promoted good companionship.

Kubheka began his formal schooling at the tender age of five. He was promoted in April of his Grade 6 year to Grade 7 and completed his schooling at Siyamukhela High School at the age of 15. He then enrolled at UKZN’s Nelson R Mandela School of Medicine where he served in the Rural Development Club, in the Happy Valley Clinic and in the Medical Student’s Representative Council.

Kubheka volunteered much of his time, providing free medical treatment and advice to rural communities attending the Happy Valley Clinic and Madadeni hospital. He enjoys giving back to the community and had this to say, ‘I love working especially with rural communities that often don’t have easy access to medical treatment. I assisted in registering the Happy Valley Clinic as a Non-Profit Organisation during my student years and will continue to work with disadvantaged communities in the future.’

‘I’ve had a very humble upbringing and my mum has greatly assisted in keeping me grounded. My mum raised me on her own as well as my four siblings. I am the first to qualify as a doctor in my family.’

Kubheka is currently serving his internship at Northdale hospital in Pietermaritzburg. He hopes to eventually register for a Masters of Medicine degree, specialising in Internal Medicine and to super specialise at some stage in Endocrinology. Kubheka said he acquired an interest in Endocrinology after being inspired by UKZN’s Head of Department of Diabetes and Endocrinology, Professor Ayesha Motala, as well as having a family member who has type 2 Diabetes.

The Medical class of 2013 also voted Kubheka as most likely to be “the next Minister of Health”.

-       MaryAnn Francis

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Former Student Leader Graduates with Honours Degree

Former Student Leader Graduates with Honours Degree
Former President of the Central SRC Nelson Mabusela graduated with an Honours in Medical Science Physiology.

Former President of UKZN’s Central SRC Mr Nelson Mabusela has graduated with an Honours degree in Medical Science Physiology.

Mabusela said he pursued the degree because of the socio-economic background of the majority of South Africans. ‘I wanted to contribute to the field of laboratory medicine and make sure we can find natural medicines that are freely available to all people.’

While serving as the President of UKZN’s Central SRC he says he managed to balance student leadership and his studies. ‘I did that through maximum discipline. The lifestyle and access to many resources that comes with being President was very tempting but I knew what I wanted.’ He said time management was also a crucial factor in his success.

Executive Director Student Services Dr Sibusiso Chalufu congratulated Mabusela on his degree and also commended the 37 former and current members of the SRC who graduate this year. ‘UKZN’s student leaders have always shown themselves to be a cut above the rest and have defied the stereotype associated with student leaders by excelling academically and in their leadership responsibilities,’ said Chalufu.

Mabusela has the following advice for students: ‘Being a student is one of the biggest transitions young people get exposed to. To some  this may come as freedom to do anything they want to, however it is equally important that we realise this also marks one of our first steps towards being independent.’

‘Discipline, determination, focus and perseverance is what must mark student life,’ he said.

Mabusela plans to complete his master’s degree and then continue to his PhD.

He acknowledges his family for all the support they have given him throughout his studies.  ‘I also want to acknowledge the ANC for providing NSFAS which gives us the opportunity to study.’

He also acknowledged SASCO for ‘its tireless and endless militant fight for the right to learn and free and quality education’.

- Raylene Captain-Hasthibeer

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