Cardiogenic shock – a look at acute functional mitral incompetence

A 44-year-old man presented with cardiogenic shock secondary to acute functional mitral incompetence as well as septic shock related to pneumonia. The patient  deteriorated haemodynamically despite adequate medical therapy. An echocardiogram revealed a massive mitral incompetence and an ejection fraction of 32%. An intra-aortic balloon pump was placed and the patient improved dramatically. On day 6 after admission the echocardiogram was repeated, revealing a mild mitral incompetence and an ejection fraction of 58%

Investigating nystagmus in patients with traumatic brain injury: A systematic review (1996 - 2016)

Background. Traumatic brain injury (TBI) is a health and socioeconomic concern worldwide. In patients with TBI, post-traumatic balance problems are often the result of damage to the vestibular system. Nystagmus is common in these patients, and can provide insight into the damage that has resulted from the trauma.Objective. To present a systematic overview of published literature regarding nystagmus in patients with TBI.Methods. Nine databases and platforms were searched during October 2016 for articles published between 1996 and 2016. Studies of any research design and published in English that focused on nystagmus in patients with TBI were considered for inclusion. A total of 110 articles were screened once duplicates had been removed, and 29 full-text articles were assessed. Eleven articles were included in the quality appraisal phase (using the McMaster tool), after which 10 articles were included in this review.Results. This review describes nystagmus in 713 patients, and all articles reviewed described the type of assessment method that was used. However, the results lacked comprehensive data regarding the assessment, measurement and description of nystagmus in TBI patients, or the possible link and relationship between nystagmus and TBI.Conclusions. This systematic review indicated that: (i) there is a growing body of evidence that benign paroxysmal positional vertigo should be considered during the medical examination of all patients suffering from head trauma; (ii) all patients with TBI should undergo visual (eye movement) and vestibular examination; and (iii) future studies should include quantitative measurements of eye movements and nystagmus.

Serum prostate-specific antigen as surrogate for the Histological diagnosis of Prostate cancer

Introduction. To determine whether there is a cut-off value of serum prostate-specific antigen (PSA) which can be used confidently to make the diagnosis of prostate cancer, thereby obviating the need for biopsy.Patients and methods. During the period October 1991 to March 1998 the Department of Chemical Pathology at Tygerberg Hospital performed a total of 6 733 serum PSA assays on 3960 patients. The histopathological and clinical diagnoses of these patients were obtained from records in the departments of Anatomical Pathology, Urological Oncology and Radiation Oncology. The serum PSA levels were correlated with the histopathology reports, using different PSA cut-off values ranging from 5 to 500 ng/ ml, to calculate the sensitivity, specificity, and positive and negative predictive values of each cut-off value of PSA in predicting the presence of prostate cancer.Results. In total, 3 837 (57%) of the 6 733 serum PSA assays were ≤ 4 ng/ ml, 1 045 (15.5%) of the assays were ≥50 ng/ ml, and 798 (11.9%) were~ 100 ng/ ml. Of the total of 3 960 individual patients, 531 (13.4%) had a serum PSA ≥50 ng/ ml and 423 (10.7%) had a PSA ≥ 100 ng/ ml. A serum PSA of ≥ 30 ng/ml had a positive predictive value (PPV) of 90% at a specificity of 87% and sensitivity of 78%, while a PSA ≥ 60 ng/ ml had a PPV of 98% at a specificity of 98% and sensitivity of 65% for the presence of prostate cancer. The PPV reached 99% at a PSA ≥ 100 ng/ ml and 100% at a PSA ≥ 500 ng/ ml, with a specificity of 99% and 100%, but sensitivity of only 53% and 19%, respectively.Conclusions. A serum PSA ≥ 60 ng/ ml has a PPV of 98% for the presence of adenocarcinoma of the prostate, and may be used as a surrogate for histological diagnosis where facilities for obtaining prostatic biopsies are not readily available, thus decreasing costs and patient morbidity

Early diagnosis of prostate cancer in the Western Cape

Background. Early stage prostate cancer does not cause symptoms, and even metastatic disease may exist for years without causing symptoms or signs. Whereas early stage prostate cancer can be cured with radical prostatectomy or radiotherapy, the prognosis of patients with locally advanced or metastatic cancer is significantly poorer.Objectives. ln view of the high incidence of advanced and therefore incurable prostate cancer seen at the oncology clinic of the Department of Urology, Tygerberg Hospital, we started a prostate clinic with the aim of detecting early stage prostate cancer which is potentially curable. A secondary objective was to investigate the question whether there is a higher incidence of prostate cancer among black African men.Patients and methods. Men aged 50 - 70 years were invited by means of media communications (newspaper and radio) to attend our prostate clinic for a free physical examination, including a digital rectal examination (DRE) and serum prostate specific antigen (PSA) assay. If the DRE was clinically suspicious of malignancy and/ or the serum PSA was > 4 ng/ ml, the patient was appropriately counselled and referred for transrectal ultrasound (TRUS)-guided sextant prostate biopsy.Results. In the period June 1997- September 1999 a total of 1056 men attended the prostate clinic. Biopsies were indicated in 160 cases, and were obtained in 114 (71.3%, i.e. 10.8% of the entire cohort). Prostate cancer was detected on first biopsy in 3.5% of the entire group of men (in 35.9% of those with a clinically abnormal DRE, in 41.3% of those with a serum PSA > 4 ng/ ml and in 88.6% of those with an abnormal DRE and serum PSA > 4 ng/ ml. In the 37 men with prostate cancer, the clinical tumour stage was T1 - 2 in 83.8% and T3- 4 in 16.2%. ln the group of patients with clinical stage T1 - 2 tumours, the treatment was watchful waiting in 62.5% of cases, radiotherapy in 20.8% and radical prostatectomy in 16.7%. Analysis of the data according to race showed that in the group of 47 black men there was a higher percentage of clinically abnormal DRE, PSA > 4 .0 ng/ ml and biopsies showing malignancy, and a higher overall prostate cancer detection rate (8.5%).Conclusions. Our prostate cancer detection rate of 3.5% is slightly lower than that reported in larger studies (4.7%), which may be due to the fact that prostate biopsy was performed in only 71% of those who had an indication for biopsy. ln the men diagnosed with clinically localised prostate cancer, potentially curative treatment was given in only 37.5% of cases. This compares unfavourably with the historical cohort of men seen at our oncology clinic, where 53% received potentially curative treatment, and a large European study where potentially curative treatment was given in 89% of cases. Our finding that black men had a higher percentage of clinically abnormal DRE, PSA > 4.0 ng/ ml and biopsies showing malignancy and a higher overall detection rate of prostate cancer should be interpreted with caution, since black men comprised only 4.5% of our overall study cohort.

The impact of global economic crisis and austerity on quality of working life and work- life balance: a capabilities perspective

This paper draws on the capabilities approach as a framework for examining the impact of the global economic crisis and austerity on quality of working life and work-life balance. Our paper focuses on Greece, an extreme case of a country in economic crisis, characterised by a weak institutional basis. We build on the work of Barbara Hobson and colleagues who first applied the capabilities approach to explore work-life balance capabilities. Our study contributes to the development of theory by emphasising the sense of entitlement concept within the capabilities approach and by proposing a modified conceptual framework that encapsulates the link between capabilities, agency, and the sense of entitlement, where the latter acts as a cognitive ‘filter’ that enhances or weakens an individual’s perception of her/his agency to enact on her/his capabilities. Drawing on the accounts of twenty Greek professional and managerial workers, we illustrate how the crisis and austerity measures have eroded working conditions and thus the sense of entitlement, leading to the weakening of our participants’ agency and capabilities to achieve quality of working life and work-life balance

The impact of global economic crisis and austerity on quality of working life and work- life balance: a capabilities perspective

This paper draws on the capabilities approach as a framework for examining the impact of the global economic crisis and austerity on quality of working life and work-life balance. Our paper focuses on Greece, an extreme case of a country in economic crisis, characterised by a weak institutional basis. We build on the work of Barbara Hobson and colleagues who first applied the capabilities approach to explore work-life balance capabilities. Our study contributes to the development of theory by emphasising the sense of entitlement concept within the capabilities approach and by proposing a modified conceptual framework that encapsulates the link between capabilities, agency, and the sense of entitlement, where the latter acts as a cognitive ‘filter’ that enhances or weakens an individual’s perception of her/his agency to enact on her/his capabilities. Drawing on the accounts of twenty Greek professional and managerial workers, we illustrate how the crisis and austerity measures have eroded working conditions and thus the sense of entitlement, leading to the weakening of our participants’ agency and capabilities to achieve quality of working life and work-life balance

The impact of global economic crisis and austerity on quality of working life and work- life balance: a capabilities perspective

This paper draws on the capabilities approach as a framework for examining the impact of the global economic crisis and austerity on quality of working life and work-life balance. Our paper focuses on Greece, an extreme case of a country in economic crisis, characterised by a weak institutional basis. We build on the work of Barbara Hobson and colleagues who first applied the capabilities approach to explore work-life balance capabilities. Our study contributes to the development of theory by emphasising the sense of entitlement concept within the capabilities approach and by proposing a modified conceptual framework that encapsulates the link between capabilities, agency, and the sense of entitlement, where the latter acts as a cognitive ‘filter’ that enhances or weakens an individual’s perception of her/his agency to enact on her/his capabilities. Drawing on the accounts of twenty Greek professional and managerial workers, we illustrate how the crisis and austerity measures have eroded working conditions and thus the sense of entitlement, leading to the weakening of our participants’ agency and capabilities to achieve quality of working life and work-life balance

Collaboration Towards a More Inclusive Society: The Case of South African ICT4D Researchers

In this study, research collaboration in the context of South African Information and Communication for Development (ICT4D) researchers was investigated using a mixed methods approach. South Africa, a country with stark development challenges and on the other hand a well-established ICT infrastructure, provides an appropriate context for ICT4D research. Firstly, a quantitative analysis of South African research collaboration between 2003 and 2016 was conducted to determine the existing research collaboration patterns of South African ICT4D researchers. This is based on the publications in three top ICT4D journals namely the Electronic Journal of Information Systems in Developing Countries (EJISDC), Information Technologies & International Development (ITID), and Information Technology for Development (ITD). The results show that most co-authored papers were intra-institutional collaborations, with limited inter-institutional collaboration between South African authors or between South African and other African authors. Secondly, interviews were conducted with South African researchers who emerged as inter- and intra-institutional collaborators to gain insight into the technology, drivers and barriers affecting South African research collaboration. We report our findings and discuss the implications for employing research collaboration as a mechanism for addressing inequality and supporting inclusion.School of Computin

Retrospective outcome analysis of urethroplasties performed for various etiologies in a single South African centre

This is the author’s version of a work that was accepted for publication of the article: African Journal of Urology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in African Journal of Urology, VOL 18, Issue 3, 2012, DOI: 10.1016/j.afju.2012.03.001.Objectives: To compare the results of anastomotic versus augmentation urethroplasty (buccal mucosa graft (BMG) onlay), as well as dorsal versus ventral BMG techniques. Methods: A retrospective audit of 69 patients who underwent urethroplasty at Eersteriver Hospital in Cape Town, South Africa between October 2004 and July 2011 was undertaken. Analysis included stricture etiology, location and length, type of surgery performed as well as complication rates over the follow-up period. Results: The predominant stricture etiologies were traumatic and infective causes (55%), with a mean stricture length of 3 cm (0.5–15 cm). Forty two patients had bulbar urethra strictures (61%), with 8 (11%) located in the posterior, and penile & bulbar regions, respectively. The remaining strictures were located in the penile urethra (16%). Surgery performed included bulbar (12) and membranous anastomotic (8) urethroplasty, ventral (13) and dorsal (22) buccal mucosa onlay grafts (BMG), and 2-stage urethroplasty (14). Overall stricture recurrence was seen in 9 patients (13%), including 1 patient (8%) of the anterior end-to-end anastomotic group compared to 2 patients (6%) of the onlay BMG group (p = 0.77). The re-stricture rates were 5% and 8% in the dorsal (1/22) and ventral BMG onlay groups (1/13), respectively (p = 0.72)