Burkitt lymphoma at Chris Hani Baragwanath Academic Hospital: a decade long audit

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (Internal Medicine). Johannesburg, 2018.Introduction Non-Hodgkin Lymphoma (NHL) is the most common haematological malignancy encountered in adults in South Africa. After diffuse large B-cell lymphoma (DLBCL), Burkitt Lymphoma (BL) is the most frequent histological subtype seen. The incidence of NHL including BL has increased significantly in the era of the HIV pandemic. Burkitt Lymphoma is an aggressive, high grade B-cell malignancy, with a very high proliferative index and an aggressive clinical course. In adults, almost all the patients with BL, in the South African context are HIV sero-positive, presenting with the immunodeficiency related variant of BL. This retrospective study aims to determine the demographic, clinical, laboratory and therapeutic outcome of patients with BL, as seen at Chris Hani Baragwanath Academic Hospital (CHBAH), over a 10 year period. Patients and Methods Data was collected retrospectively on the demographic, clinical, and laboratory features, as well as the therapeutic interventions and outcome of patients with BL, from the haematology records of patients attending the Clinical Haematology Unit, Department of Medicine, CHBAH. Descriptive statistical methods were used to analyze the data. The Chi² test was utilized to evaluate the significance of observed differences in survival between different categories. Patients were considered to be evaluable if they survived longer than 4 weeks. Results A total of 137 patients were evaluable for the study. There were 75 females and 62 males, with a female to male ratio of 1.2:1. The mean age of the study population was 38 years. Ninety eight and a half percent of the patients were HIV sero-positive. The overwhelming majority of the patients (98.5%) were black Africans, in keeping with the demographics of the hospital. Most of the patients presented with a relatively good performance status (≤ 2). However, in contrast to this, the majority of the patients also had advanced stage disease, with bulky disease and extra-nodal disease being common. Lymphadenopathy was the most common clinical manifestation, occurring in more than 80% of the patients at presentation. The most common contributors to morbidity and mortality were disease progression, sepsis (often neutropaenic sepsis), and renal dysfunction. Discussion Females tended to outlive their male counterparts. Age and year of diagnosis did not confer any obvious advantage. A favourable performance status was the only demographic factor that showed a statistically significant survival advantage at diagnosis. The presence of Tuberculosis exposure seemed to confer a worse outcome. Patients on cART seemed to survive longer, and those with “B” symptoms tended to perform less favourably. Somewhat counterintuitively, the presence of CNS disease and bulk disease seemed to improve survival. Patients with classical Burkitt Lymphoma fared better than patients with “Intermediate” disease. Patients treated with a “Burkitt” protocol performed statistically significantly better than patients who were given a standard CHOP-based regimen. The use of Rituximab was shown to be beneficial. Conclusion The outcomes in this aggressive, high grade, B-cell NHL, occurring almost exclusively in HIV sero-positive individuals was poor, with a 2-year survival rate of only 7%. However, with better education, a high index of suspicion and expedited referral, timeous workup and staging, better attention to and prevention of complications, as well as an intensive multimodality approach to therapy, together with early and ongoing use of cART in HIV sero-positive individuals, the outlook is likely to be much brighter, with higher sustained response rates and improved long term outcomes. This should be the future goals in this devastating malignancy, until novel and significantly improved therapy for the disease, becomes a reality.LG201

Burkitt lymphoma at Chris Hani Baragwanath Academic Hospital: a decade long audit

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine (Internal Medicine). Johannesburg, 2018.Introduction Non-Hodgkin Lymphoma (NHL) is the most common haematological malignancy encountered in adults in South Africa. After diffuse large B-cell lymphoma (DLBCL), Burkitt Lymphoma (BL) is the most frequent histological subtype seen. The incidence of NHL including BL has increased significantly in the era of the HIV pandemic. Burkitt Lymphoma is an aggressive, high grade B-cell malignancy, with a very high proliferative index and an aggressive clinical course. In adults, almost all the patients with BL, in the South African context are HIV sero-positive, presenting with the immunodeficiency related variant of BL. This retrospective study aims to determine the demographic, clinical, laboratory and therapeutic outcome of patients with BL, as seen at Chris Hani Baragwanath Academic Hospital (CHBAH), over a 10 year period. Patients and Methods Data was collected retrospectively on the demographic, clinical, and laboratory features, as well as the therapeutic interventions and outcome of patients with BL, from the haematology records of patients attending the Clinical Haematology Unit, Department of Medicine, CHBAH. Descriptive statistical methods were used to analyze the data. The Chi² test was utilized to evaluate the significance of observed differences in survival between different categories. Patients were considered to be evaluable if they survived longer than 4 weeks. Results A total of 137 patients were evaluable for the study. There were 75 females and 62 males, with a female to male ratio of 1.2:1. The mean age of the study population was 38 years. Ninety eight and a half percent of the patients were HIV sero-positive. The overwhelming majority of the patients (98.5%) were black Africans, in keeping with the demographics of the hospital. Most of the patients presented with a relatively good performance status (≤ 2). However, in contrast to this, the majority of the patients also had advanced stage disease, with bulky disease and extra-nodal disease being common. Lymphadenopathy was the most common clinical manifestation, occurring in more than 80% of the patients at presentation. The most common contributors to morbidity and mortality were disease progression, sepsis (often neutropaenic sepsis), and renal dysfunction. Discussion Females tended to outlive their male counterparts. Age and year of diagnosis did not confer any obvious advantage. A favourable performance status was the only demographic factor that showed a statistically significant survival advantage at diagnosis. The presence of Tuberculosis exposure seemed to confer a worse outcome. Patients on cART seemed to survive longer, and those with “B” symptoms tended to perform less favourably. Somewhat counterintuitively, the presence of CNS disease and bulk disease seemed to improve survival. Patients with classical Burkitt Lymphoma fared better than patients with “Intermediate” disease. Patients treated with a “Burkitt” protocol performed statistically significantly better than patients who were given a standard CHOP-based regimen. The use of Rituximab was shown to be beneficial. Conclusion The outcomes in this aggressive, high grade, B-cell NHL, occurring almost exclusively in HIV sero-positive individuals was poor, with a 2-year survival rate of only 7%. However, with better education, a high index of suspicion and expedited referral, timeous workup and staging, better attention to and prevention of complications, as well as an intensive multimodality approach to therapy, together with early and ongoing use of cART in HIV sero-positive individuals, the outlook is likely to be much brighter, with higher sustained response rates and improved long term outcomes. This should be the future goals in this devastating malignancy, until novel and significantly improved therapy for the disease, becomes a reality.LG201

Design Optimization of a 2-Phase Gas/Liquid Separator

Today, oil and gas companies are focusing on developing smaller and more compact production facilities, hence the requirement for an optimized equipment design to fit this purpose. Separators are one of the main process equipment on the platform. Existing separator design normally results in large, heavy and expensive to purchase piece of equipment. Thus, it will affect the limited space and load requirements on the supporting platform. This will increase the material and installation costs of offshore structures. Hence, the objective of this project is to propose an optimum model of separator design that is fit for purpose. The scope of the project was to study on the separator design consideration and operational constraints used for a liquid gas separation. Case study was carried out on a specific separator using typical reservoir data and suggested area for improvements. The optimization models utilized existing separator design theories and relationships. The models are outlined and discussed in application of horizontal separator designs and its operation. Mathematical programs have been used to find the optimal separator design using the optimize separator model. The methodologies used are conducting literature review on the separator, critical review on the separator sizing rules and equations, performing flash calculation to characterize flow stream, simulating mathematical model and analyze the effect on the constraint design and dimension. The optimized design reduces the size to 30% size based the case study .The study found that the liquid level for the separator should be half of the diameter and the minimum slenderness ratio was found to be 3 and it give the least cost to manufacture

Human resource management. An example in public sector/ Farah Adilla Ab Rahman

Human resource management is defined as the policies and practices one needs to carry out the people or human resource aspects of a management position, including recruiting, screening, training, rewarding and appraising. The research discusses the practice of human resource management in the Department of Works Malaysia in managing its civil servants for the year 2009. The researcher had used primary and secondary data for example, interviews, reports and books

Phytochemical Screening and Antihyperglycaemic Activities of Cordyceps Sinensis and Its Based Product (esulin)

Diabetes mellitus merupakan satu gangguan metabolik umum dengan komplikasi vascular mikro dan makro yang mengakibatkan morbiditi dan kematian yang ketara. Kajian yang diterangkan di dalam tesis ini adalah satu usaha untuk menilai potensi antihiperglisemik ekstrak akues Cordyceps sinensis (C.sinensis) dan produk asasnya, Esulin. Tiga esperimen utama telah dijalankan untuk mencapai objektif umum. Diabetes mellitus is one of the common metabolic disorders with micro and macro vascular complications that result in significant morbidity and mortality. The present study described in the thesis is an effort to evaluate the antihyperglycaemic potentials of the aqueous extracts of Cordyceps sinensis (C.sinensis) and its based preparation namely Esulin. Three main experiments were conducted to achieve the general objective

PENGGUNAAN METODE FMECA (FAILURE MODES EFFECTS CRITICALITY ANALYSIS) DALAM IDENTIFIKASI TITIK KRITIS DI INDUSTRI KEMASAN

XYZ is a company engaged in packaging, especially for pharmaceuticals. The company has recorded an overall defective product known as end to end waste. During 2019 the average end to end waste was 12.37%, while the target of company management was 9%. The objective of this research is to minimize defective products and to find out what types of defects occur in the production process. The method used in this research is FMECA (Failure Modes, Effects and Critically Analysis), which is the development of the FMEA (Failure Mode and Effect Analysis) method which functions to make analyzes from production tools or processes, types of defects to the effects that arise as a result. of the defect, but also to determine the critical point. The results of the analysis that has been carried out using the FMEA method with RPN (Risk Priority Number) calculations, then analysis with the Pareto diagram and criticality matrix, the researcher gets 10 priority failure modes, namely the machine often stops due to a lot of paper dust, too high piles, unstable colors because there is a change in ink, the non-stop feeder is damaged, the front lay and side lay are unstable from the printing process, the side lay sensor does not work, the actual chiller temperature with the display is not the same, the paper is untidy from the printing process, the paper is untidy from the calendering process, and the chiller is leaking. The researcher also gave recommendations, namely making a Standard Operation Procedure (SOP) for handling dusty paper, submitting complaints to suppliers regarding paper quality, providing a printing unit, and training for dusty paper handling. Keywords: criticality matrix, FMECA, risk priory number, pareto diagra

Thermal survey in autoclave to determine the thermocouple and mould tool position / Farah Aliah Abd Rahman

An autoclave is a machine that acts like a pressure cooker. This pressure chamber is being used in many industries to carry out industrial process that required elevated pressure and temperature that different form the room temperature and ambient air pressure. Thermal survey is a ‘try and error’ method to determine the arrangement of the panels during curing process. Among the issue faced by the user in aerospace industries is the oversoaking of the panels due to uneven heat distribution. The purpose of this research is to analyse the heat distribution inside the autoclave during curing process using simulation techniques. The autoclave was drawn based on the actual model that being used in the industry by Composite Technology Research Malaysia Sdn. Bhd. (CTRM Sdn. Bhd.). The simulation by using Solidworks software was used to investigate the heat distribution on the design by taking consideration of the appropriate boundary conditions and various parameters. The boundary condition was set according to the actual specification given by the CTRM Sdn. Bhd. The flow was set to turbulence and the volume flow for inlet was set to 7 bar and the temperature was set to 265oC. The results shows, the heat distribution of the hot air gathered at the lower part and middle part of the device. This area receive more hot air than the other area. As a conclusion, this is the most possible and suitable position to place the mould tool so that it will receive a good amount of hot air. With this simulation, it gives benefit to the industry as it will save cost and time and does not need to run the actual survey to find the suitable position to place the mould tool

Authentic Leadership for Democracy in Schools

Authentic leadership is relatively a new concept. Extant literature puts forward the notion of authentic leadership as important trajectory of leadership in organizations. George (2004) argues that “leadership begins and ends with authenticity”. It is well established in literature that good leadership is essential for effective and better performing schools (Pashiardis, 2000). This paper argues that in the context of education authentic leadership is more important as it has the same set of values as democratic education. Objectives of the Study The main objectives of the study are: 1. To investigate the pattern of authentic leadership in schools in a developing country like Pakistan. 2. To propose a model for effective school leadership in to promote democratic practice in school

Significance of pyuria in the diagnosis of urinary tract infections in neonates

OBJECTIVES: To determine the significance of pyuria as a predictor of culture proven urinary tract infections (UTI) in neonates and to assess the frequency of urinary tract anomalies in neonates with pyuria. METHODS: Prospective study conducted at the neonatal intensive care unit of a tertiary care hospital; (Liaquat National Hospital Karachi) for a period of 4 months from April 2008 to August 2008. One hundred and ten consecutive infants \u3c or = 28 days of age admitted to the NICU of Liaquat National Hospital for medical reasons were included in the study. Information regarding age, gender, antenatal history, birth weight, clinical examination, laboratory findings and outcome were recorded on a questionnaire. Septic work up was performed and urine samples were collected using urethral catheterization. Patients showing any number of white blood cells on microscopy were included and their urine sent for culture. All patients had Ultrasound done during their hospital stay and those patients with any renal abnormality were further investigated with Micturating cyestoretherogram (MCUG) at 6 weeks. RESULTS: Out of one hundred and ten patients admitted, thirty five patients showed the presence of pus cells in urine and were included in the study. Of the 35 neonates with pyuria, 71.4% had no growth in urine cultures and 38.2 % neonates with insignificant pyuria (\u3c or = 9 cells in urine) showed a positive culture. The renal ultrasound was normal in 51.4% neonates with pyuria although it was abnormal in 100% of the subjects with higher number of pus cells in urine (\u3e 20 pus cells). CONCLUSION: Pyuria is not a useful marker for the diagnosis of culture proven UTI in neonates it cannot be used as an indicator of underlying renal abnormality, though it may have some utility in neonates with \u3e 20 /numerous pus cells