PhD Graduates 2016
PhD CITATIONS – 14 April 2016
1. A Ajith
Supervisor: Prof T Naicker and AJ Moodley
Title: The Role of Peripheral Natural Killer in Immune Compromised Pre-Eclamptic and Normotensive Pregnant Black South Africans.
HIV and pre-eclempsia are the leading causes of maternal morbidity and mortality in South Africa. The qualification of peripheral natural killer (pNK) cells and Th1/Th2 cytokines in HIV associated pre-eclampsia is novel. The study of the candidate supports the hypothesis that the levels of pNK cells are higher in the pre-eclamptic compared to the normotensive group. The study suggests neutralisation effect of the Th1/Th2 cytokins in HIV associated pre-eclampsia. CD69 was higher in the pre-eclamptic compared to the normotensive group and GM-CSF was significantly different across the study groups. Further studies may implicate CD 69 and GM-CSF as biomarkers for the early diagnosis of pre-eclampsia.
2. F Ally
Supervisor: Prof K Satyapal
Title: A morphological and morphometric analysis of the development of the calcaneus, talus and first metatarsal bone in KwaZulu-Natal population group: newborn to early adulthood.
The candidate’s study mapped the skeletal maturation process of the calcaneus, talus and first metatarsal from birth to twenty years in a KwaZulu-Natal Black population group, thus producing a novel population-based repository of radiographic data from the foot of living individuals. The repository will provide much needed population specific data that may aid in the forensic and legal settings in the creation of age profiles of unidentified corpses as well as living individuals without birth records.
3. N Dlamini
Supervisor: Prof N Gqaleni
4. N Dookie
Supervisor: Prof P Moodley
Title: Antibiotic resistance in Mycobacterium tuberculosis: The role of genetic mutations in resistance conferring genes and efflux transporters.
Drug resistant tuberculosis is a public health crisis, exacerbated by its interaction with HIV/AIDS. This is particularly significant in KwaZulu-Natal, South Africa, where the impact of the convergent epidemics is most severe. We demonstrated that the strains circulating in our setting display a combination of previously observed mutations, each mediating resistance to a different drug and the ability of efflux inhibitors to reverse low-level resistance induced by efflux activity, providing evidence of efflux mediated resistance.
5. N Dukhi
Supervisor: Dr Chhagan and Prof Taylor
Title: Burden of malnutrition in children aged 0-59 months in iLembe district, KwaZulu-Natal.
South Africa is currently undergoing a nutrition transition, with the co-existance of cover and undernutrition, affecting child nutritional status. There are major gaps and new data is required for the implementation, monitoring and evaluation of nutrition interventions. This study identified low levels of wasting, with high prevalence of stunting and overweight/obesity that is consistent with the literature. Therefore a multisectoral approach is required to address the burden of childhood malnutrition at a community level.
6. N Ferreira
Supervisor: Prof C Aldous and Dr L Marais
Title: The Outcome of Tibial Non-Union Treatment Using a Revised Definition, Classification System and Management Strategy.
The management of tibial non-unions is challenging for orthopaedic surgeons, with no standard treatment regimens available. The candidate proposed a new definition for non-union and introduced a novel concept of ‘potential non-union’ to emphasise the importance of early recognition and treatment. Additionally he developed a tibial non-union treatment algorithm. From the prospective evaluation, it appears that the tibial non-union treatment algorithm may produce high union rates across a diverse group of tibial non-union subtypes.
7. S Gounden
Supervisor: Prof A Chuturgoon and Dr D Moodley
Title: Hpyerglycaemic-Induced Regulation of SIRT3 and Downstream Antioxidant Profile.
Type 2 diabetes mellitus (DMII) has reached epidemic promotions and affects 3.5 million South Africans. It is characterised by chronic hyperglycaemic-induced mitochondrial dysfunction that must be improved to ameliorate patient outcomes. Sirtun 3 (SIRT3), a deacetylase, improves mitochondrial function and oxidative stress-induced metabolic disorders. The candidate’s study showed how SIRT3 can be a potential cytoprotective factor that may be modulated by curcumin and metformin to improve disease outcomes. For articles from the work were published in peer reviewed journal form.
8. R Gunda
Supervisor: Prof Chimbari
Title: The burden of malaria and related household economic costs in Gwanda District, Zimbabwe.
The candidate studied the burden of malaria in Gwanda District, Zimbabwe, a rural malaria endemic area. He used the Disability Adjusted Life Years (DALYs) metric to measure the disease burden. He showed a declining trend in the burden of the disease explained by intensive malaria control activities in the District. However, the economic burden was very high particularly in poor and vulnerable households. His results demonstrated that using local level data to assess burden of disease provides better insights on the extent and severity of impacts of malaria at community level.
9. T P Gwetu
Supervisor: Dr Chhagan and Prof Taylor
Title: Anaemia and its relation to school achievement and growth impairment in children from KwaZulu-Natal, South Africa
Disparities within and between populations are often due to adverse experiences during early life. Dr Gwetu’s research addressed some fundamental questions regarding anaemia as an avoidable cause of growth, developmental, educational problems and other adverse effects on children’s academic potential. She built a detailed picture of the high prevalence of anaemia in children of KwaZulu-Natal and found that there is scope to prevent the associated long-term developmental and growth impairments in school-aged children.
10. S Hamid
Supervisor: Dr V Singaram
Title: An Investigation of the Role of Fortigenic Factors in Enhancing Academic Success amongst Health Science Students.
This quantitative study developed within the Fortigenic paradigm, aimed to identify wellness monitoring tools for formative self-assessment by medical students, particularly first years. Of the 3 validated instruments investigated, the Fortitude and Motivated Strategies for Learning are recommended for adoption and use as a Wellbeing Inventory for first year students. Both these instruments correlated significantly with academic performance and highlighted the need for more focused support on female students and those coming from disadvantaged schooling backgrounds.
11. P M Jeena
Supervisor: Prof M Adhikari
Title: The impact and management of viral infection in the lungs of HIV infected and uninfected children.
In his thesis Professor Jeena emphasises the role of various organisms in HIV associated pneumonia in children. Initially, it was believed that only bacteria were the significant pathogens responsible for morbidity and mortality in these children. Following on his work, it became clear that viruses especially CMV played a significant role in the morbidity and mortality associated with pneumonia in the HIV infected children requiring mechanical ventilation. Professor Jeena has shown that combined antiretroviral therapy and ganciclovir together with improved ventilator strategies has helped improved the outcome of these children. The outcomes of these children are now similar to HIV uninfected children and hence they should not be denied access to ICU care on the basis of their HIV status.
12. KC Koofhethile
Supervisor: Prof T Ndung’u/Dr C Thobakgale
Title: Protective HLA class I alleles: investigation of viral control and lack of control in chronic HIV-1 subtype C infection.
Some HIV-1 infected individuals can control virus replication without antiretroviral drugs. The candidate found that highly functional cytotoxic T cells against the HIV Gag protein are associated with control and that loss of these responses eventually leads to high viral load. A subset of individuals who appear to have alternative, non-cytotoxic T cell mechanisms of viral control were identified. These controllers may hold the key to an effective HIV vaccine.
13. VC Korb
Supervisor: Prof A Chuturgoon
Title: An investigation into TB/HIV manipulation of the T-Cell immune response.
South Africa has the highest TB/HIV co-infection rates in the world. Both mono-infections are driven by pathogenic dysregulation of CD4 T-cells, uncharacterised in co-infection. The candidate’s study investigated the pro-inflammotory Th17 and anti-inflammatory T-regulatory lymphocyte response in TB/HIV pleural fluids. Co-infection reduced T-regulatory stability, Th17 proportion and monocyte mediated skewing towards Th17 polarisation, despite suppressed localised immunity. This findings of the study have been published in 4 peer reviewed journals.
14. S Kumar
Supervisor: Prof P Moodley
Title: Improving the efficiency of bacillus calmette guerin vaccine by concomitant inhibition of T regulatory and T helper 2cells.
Mycobecterium tuberculosis infect 9 million individuals and kills almost 2 million people every year. The only vaccine available, Bacillus Calmette-Guerin (BCG), has been used since its development in 1921. Although BCG induces host protective T helper 1 (Thl) cell immune responses, which play a central role in host protection, it also induces Th2 and Treg responses (these subsets facilities the pathogenesis during MTB infection). The resultant protective immunity is therefore neutralized. Additional methods to enhance protective immune responses are therefore needed.
15. M Macherera
Supervisor: Prof M Chimbari
Title: Indigenous knowledge systems on malaria in Gwanda district, Zimbabwe.
The candidate studied indigenous knowledge systems on malaria in Gwanda District, Zimbabwe. Her study focused on the prediction of malaria in a semi-arid malaria endemic area using community participation. Her work demonstrated how indigenous knowledge systems can be used to develop a community centred malaria early warning systems based on indigenous knowledge systems in Gwanda District, Zimbabwe. The work has shown how community participation and use of local knowledge can complement conventional health systems in the control of malaria.
16. NR Maharaj
Supervisor: Prof AA Chuturgoon
Title: An investigation into the clinical, biochemical, immunological and epigenetic factors in black South African women with preeclampsia and HIV.
In South Africa, Preeclampsia and HIV/AIDS contribute to maternal mortality in Black South African pregnant women. The relationship between preeclampsia, HIV and HAART is not well understood. The candidate’s study found no adverse association of HIV/HAART on the clinical/biochemical features of preeclampsia, except for hepatic function changes. HAART modulated the proinflammatory cytokines and epigenetic factors such as microRNA-27a and microRNA-146a in obesity and severe preeclamptic pregnant women.
17. OH Mahomed
Supervisor: Dr A Voce
Title: The Impact and stustainability of an integrated chronic disease management model at primary care level in South Africa.
Non-communicable Diseases and patients on antiretroviral treatment are amongst the most common reason for patient repeated consults at primary healthcare clinics. In order to deal with this dual epidemic, there is a requirement for a paradigm shift in the management of patients with chronic diseases. Dr Mahomed’s research has transformed the landscape of delivery of services for patients with chronic diseases with the development of an integrated chronic disease management model that shifts the management towards a patient centric approach. This model has been accepted as a model of care for South Africa and is currently being implemented across all clinics via the Ideal clinic model.
18. TM Manyangadze
Supervisor: Prof MJ Chimbari/Dr M Gebreslasie
Title: Spatial and temporal modelling of schistosomiasis transmission at micro-scale in Southern Africa: A case of Ndumo area in Umkhanyakude Health District in South Africa.
The candidate showed how GIS and Earth Observation tools can be used in modelling the spatial and temporal distribution of schistosomiasis at micro-geographical scale in Southern Africa based on data from Ndumo area of uMkhanyakude in KZN. He observed schistosomiasis infections hotspots across the landscape. This pattern was determined by socio-economic, environmental and climatic factors which expose the population to risk of schistosomiasis infection. This knowledge can be used in schistosomiasis control and management programmes at community level as it enhances understanding of the spatial and temporal dynamics of schistosomiasis transmission at a local scale.
19. LC Marais
Supervisor: Prof C Aldous
Title: An Integrated approach to Adult chronic Osteomyelitis.
Chronic osteomyelitis is a difficult disease to treat because of the different triaging options for patients warranting different treatment regimens based on their age and health status. Dr Marais studied the various classification systems available for the disease and highlighted their strenghts and shortcomings. Based on these finding he designed a new treatment algorithm where C-hosts are defined according to the presence of certain predetermined risk factors and making the anatomical classification prior to the surgery rather than afterwards. A retrospective review of patients treated under this new algorithm shows that a higher success rate is achieved in chronic osteomyelitis.
20. JH Mazorodze
Supervisor: Dr AJC Steyn
Title: Mycobacterium tuberculosis reprograms host energy metabolism during infection: imaging and mechanistic insights.
Mycobacterium tuberculosis infection results in host metabolic reprogramming leading to acidosis. The role of lactate as one of the key products of altered metabolism was studied in the context of immunomodulation. Acidosis was demonstrated by (1) imaging (2) metabolomic profiling of Mtb-infected vs na?ve subjects (3) immunohistochemistry demonstrating altered metabolism and (4) specific inhibitors of metabolic pathways to pharmacologically re-directed metabolism. Taken together, these results demonstrate metabolic shifts in the host, which alters immune cell function.
21. K Moodley
Supervisor: Prof I Macraj
Title: The biological effects of Tulbaghia violacea in a salt-sensitive, hypertensive and diabetic rat model.
Despite the significant advancement in pharmacotherapeutic strategies, the prevalence of both these diseases places a major burden on health care system globally. The use of traditional phytotherapy has therefore become increasingly important in the management and treatment of these life-threatening diseases. Dr K Moodley’s study focused on blood pressure and glucose lowering effects of the indigenous medicinal plant Tulbhaghia violacea. She found that the plant demonstrated antihypertensive, nephroprotective and antidiabetic effects in salt-sensitive and diabetic rat models. Her findings contribute to an alternative management strategy for these lifestyle diseases.
22. Y Moodley
Supervisor: Prof BM Biccard
Title: Peri-Operative studies of Hypertension.
The impact of a pre-operative history of hypertension on the incidence of poor peri-operative outcomes in South African non-cardiac surgery patients is not well described. Through several clinical studies, this research found that a pre-operative history of hypertension does not independently contribute to higher peri-operative risk in South African non-cardiac surgery patients. However, pre-operative use of certain anti-hypertensive medications is an important determinant of poor peri-operative outcomes in hypertensive South African patients undergoing non-cardiac surgery.
23. T Mpofana
Supervisor: Dr MV Mabandla/Prof WMU Daniels
Title: The effects of caffeine on a maternally separated Parkinsonian rat model
Parkinson’s disease is a disorder of the basal ganglia characterised by loss of dopaminergic neurons in the substantia nigra. Environmental factors such as early life stress play a role in the development and progression of Parkinson’s disease. The study investigated the neuroprotective effects of caffeine in a maternally separated animal model of Parkinson’s disease. Caffiene provided neuroprotection by promoting the survival of dopamine neurons, overcoming the negative effects stress.
24. H Mulol
Supervisor: Prof A Coutsoudis
Title: A Longitudinal Study of Breast Milk Intake Volumes in African Infants in Typical Urban Disadvantaged Community.
Using her chemistry background Mrs Mulol set up and mastered the deuterium dilution technique to accurately determine the breast milk intake of infants. This is the first time that this technique for measuring breast milk intake has been used in South Africa. The study showed that HIV infected women produce equivalent amounts of breast milk to that of HIV uninfected women and that infants who are exclusively breastfed for 6 months have more muscle mass at one year of age compared to those not exclusively breastfed.
25. S Nagiah
Supervisor: Prof A Chuturgoon/Dr A Phulukdaree
Title: A biochemical assessment of stress response following acute and prolonged exposure to antiretroviral drugs (nucleoside reverse transcriptase inhibitors) in vitro.
Long term antiretroviral therapy causes adverse health outcomes. The liver, central to drug metabolism, is susceptible to oxidative insult. The mitochondrial, oxidative and ATP-dependent stress responses were determined after acute and prolonged exposure to Zidovudine, Stavudine and Tenofovir in liver cells. The ARVs reduced mitochondrial function and increased oxidative stress markers (after prolonged antiretroviral exposure); ATP-dependent protein homeostatic responses and cellular efflux proteins were compromised.
26. CC Naidoo
Supervisor: Dr M Pillay
Title: Fitness of multi-and extensively drug-resistant Mycobacterium tuberculosis clinical strains.
The F15/LAM4/KZN genotype was responsible for the largest outbreak of extensively drug-resistant tuberculosis which took place in KwaZulu-Natal in 2005. Using genome sequencing and fitness assays, Dr Naidoo demonstrated that the enhanced transmission of these strains which still continue today, are attributed to compensatory and resistance-conferring mutations associated with no fitness costs. Furthermore, extensively drug-resistant strains were shown to be strongly associated with the induction of multiple proinflammatory cytokines, and may represent a unique mechanism of host evasion.
27. K Naidoo
Supervisor: Prof SS Abdool Karim
Title: Challenges in the integration of TB and HIV care: Evidence for improving patient management and health care policy.
Integration of HIV and TB treatment is key to reducing mortality in co-infected patients, especially in sub-Saharan Africa where TB-HIV co-infection rates reach 80%. Many obstacles impede effective scale-up of HIV-TB integration, extending from the clinical complexities in individual patient management, to impediments in health service organization and prioritization. We assessed and identified strategies to overcome clinical and programmatic challenges when integrating HIV and TB care to reduce co-infection mortality.
28. S Ngcapu
Supervisor: Profs Q Abdool-Karim/ J Passmore
Title: Impact of injectable hormone contraceptives on the innate immune environment in the genital tract in women at high risk of HIV.
This study investigating the impact of DMPA (Depo-Provera), an injectable hormonal contraceptive commonly used in sub-Saharan Africa, on HIV acquisition demonstrated that down modulation of cytokine and epithelial barrier factors in the genital tract rather than epithelial thinning might underlie the altered HIV-1 acquisition risk in DMPA (Depo-Provera) users in KwaZulu-Natal.
29. WN Onkoba
Supervisor: Prof M Chimbari
Title: Host immune response to Palsmodium berghei ANKA and trichinella Zimbabwensis infection in BALB/c mice.
The study investigated metabolic and differential immune responses induced in BAL/c mice mono-and co-infected with Trichinella zimbabwensis and Plasmodium berghei ANKA. It was concluded that primary T. zimbabwensis infection alters host food and water intake and glucose metabolism. During co-infection with P. berghei ANKA, the Trichinella parasite ameliorates malaria immunity, disease outcome and improves survival of infected mice by 42.85%. The study provides new information on host metabolic and differential immune responses, effects of antihelminthic treatment, parasite-parasite and parasite-host interactions in BALB/c mice mono-and co-infected with the tissue-dwelling nematode T. zimbabwensis and P. berghei ANKA.
30. N Padayatchi
Supervisor: Prof M Taylor
Title: Factors influencing treatment outcomes in Multi ad Extensively drug resistant tuberculosis [M(X) DR-TB] patients co-infected with HIV in KwaZulu-Natal.
KwaZulu-Natal is the epicenter of both the HIV and [M(X)DR-TB]. This candidate investigated factors, that impact on treatment outcomes in M(X) DR-TB patients with HIV co-infection. He found that early initiation of ART in such patients significantly reduced mortality, Xpert MTB/RIF, a new TB diagnostic tool, reduced the time to MDR-TB treatment from 3 months to 3 weeks and Clofazimine improved culture conversion.
31. S Paruk
Supervisor: Prof JK Burns
Title: Risk factors associated with adolescent onset psychosis in KwaZulu-Natal, South African
This candidate’s study was the first prospective study in Africa to examine the impact of the 2 risk factors for psychosis, cannabis use and family history of mental illness, on the clinical variables of early onset psychosis. Findings suggest that socio- cultural factors may influence the impact of cannabis and genetic vulnerability on clinical presentation in adolescents. In addition, the study reported on the different motivation and patterns of cannibis use in pyschotic and non-psychotic mentally ill youths.
32. R Phili
Supervisor: Prof Q Abdool Karim
Title: Feasibility of implementation of medical circumcision in public sector health facilities in KwaZulu-Natal as part of a comprehensive HIV risk reduction package.
This field-based operational research study provides important insights into the feasibility of integrating Voluntary Medical Male Circumcision (VMMC) into a comprehensive HIV risk reduction strategy that includes optimising efficiencies in access and acceptability of service delivery through different entry points in public sector health facilities in KwaZulu-Natal from user and provider perspectives. Furthermore it advances efforts to introduce new technologies and interventions in public sector health facilities.
33. P Pillay
Supervisor: Prof M Taylor and Dr EF Kjetland
Title: Female Genital Schistosomiasis (FGS) as risk factor for squamous cell atypia in an epidemiological longitudinal cohort of young women in KwaZulu-Natal.
Women and girls in Africa are at risk of having female genital schistosomiasis, a potential risk factor for the acquisition of cervical squamous cell atypia and HIV. It is recommended that regular mass drug administration for schistosomiasis is implemented and public health interventions raising awareness of cervical cancer are instituted targeting young women and men in endemic populations.
34. L Qulu
Supervisor: Dr M Mabandla/Prof WMU Daniels
Title: Exposure to Early Life Stressors Enhances the Prevalence of Febrile Seizures in Young Rats.
Febrile seizures are a paediatric disorder affecting approximately 10-18% of children in certain parts of Africa and are by far the most common convulsive disorder. Predisposition to low-socio economic status, psycho social exposure to trauma during pregnancy are regarded as prenatal stress and have been shown to exacerbate disease progression in the offspring. Current treatment for febrile seizures has unfavourable side effects. Using an animal model (rats) the candidate’s findings showed that Searsia reverses the effects of prenatal stress and febrile seizures.
35. P Ramkaran
Supervisor: Prof A Chuturgoon/Dr A Phulukdaree/Dr S Khan
Title: Genetic and microrna polymorphisims in young South African Indians with coronary artery disease.
Indians have the highest prevalence of early-onset coronary artery disease (CAD) in South Africa. This candidate’s study was the first investigation of genetic (MTHFR) and SIRT1) and epigenetic (miR-146a and miR-499) polymorphisms in young SA Indians with CAD. The frequency of variant alleles was predominant in SA Indians and may predispose towards the development of early-onset CAD by regulating the pathogenesis of CAD. This work has been published in 5 publications reputable journals.
36. MM Schaan
Supervisor: Prof M Taylor
Title: Exploring factors which may contribute to pregnancy among women living with HIV in Botswana
Unplanned/unwanted pregnancies occur frequently among women living with HIV and pose threats to maternal and child morbidity and mortality, in addition to possible HIV transmission. The candidate’s aimed to uncover and understand factors that contribute towards pregnancy among women living with HIV in Botswana. The collective results from a mixed-method study articulated the complexity of sexual and reproductive behaviour and described numerous interlocking factors, giving rise to a theoretical framework inspired by the complexity theory.
37. U Singh
Supervisor: Dr ML Gordon
Title: Acquired and transmitted drug resistance in HIV-1 Subtype C: implications of novel mutations on replication capacity, cleavage and drug susceptibility.
Dr Singh studied acquired and transmitted drug resistance in HIV-1 subtype C. She identified 4 novel mutations in HIV-1 Gag associated with resistance to protease inhibitors and showed that low frequency transmitted drug resistance mutations can impact treatment outcomes in acute HIV-1 infection. Her findings have important implications on future treatment strategies for low-income countries and will be used to advocate for genotypic testing prior to HIV treatment initiation in South Africa.
38. P Sobia
Supervisor: Prof P Moodley
Title: TlyA has an essential virulence role in Mycobacterium tuberculosis pathogenesis.
Tuberculosis remains a leading cause of mortality throughout the world. The candidate study showed that the TlyA protein of Mycobacterium tuberculosis is one of the virulence factors involved in the pathogenesis of TB. We observed that TlyA causes M.tb to escape from the phagolysosomal compartment into the cytosol of macrophages, and modulates the host immune response.
39. C Tiloke
Supervisor: Prof A Chuturgoon/Dr A Phulukdaree
Title: The antiproliferative and apoptosis inducing effects of moringa oleifera aqueous leaf extract and its synthesized gold nanoparticles-modulation of oncogenes and tumour suppressor genes in human cancer cell lines.
The incidence of eosophageal and lung cancer is increasing in SA. Moringa oleifera (MO), medicinal plant, has anti-cancer properties. Gold nanoparticles (GNPs) were synthesised using MO leaf extract (MOE). The leaf extract and the GNPs showed antiproliferative effects in both cancer cells types. MOE increased oxidative stress, DNA damage and induced apoptosis. The GNPs show promise as chemotherapeutic drugs as they modulated oncogenes and tumour suppressor genes.
40. BY Yota
Supervisor: Prof B Ncama
Title: Access to and acceptability of HIV/AIDS treatment and care services in Wolaita Zone, Southern Ethopia: A socio-ecological perspective.
The candidate’s study showed that access to and acceptability of HIV/AIDS treatment and care services (HATCS) were associated with health system responsiveness, service quality, client satisfaction, financial fairness and transportation accessibility. In addition, socio-ecological factor such as client, community and health system based and macro factors interplayed and impacted HATCS. Eventually, the study developed a socio-ecological model of access and acceptability of HATCS that can be further tested and improved.
PhD Citations – 14 April 2016
Supervisor: Prof BP Ncama
Title: A grounded theory analysis of the Philosophy of care for children with HIV/AIDS in Nigeria.
The challenges of HIV diagnosis among children are enormous for the caregivers, family members and the healthcare system; therefore, nurses and stakeholders in health must administer care in a compassionate manner. The antecedents of denial of HIV, fear of diagnosis, psychological stress/tension, stigma and discrimination let to the conceptualization of the emphatic-supportive care theory in the spirit of ubuntu. Giving supportive care to the children under the context of communal living, religious acceptances and family-centred care would enhanced their quality of life.
Supervisor: Dr PMO Oriwa
Title: Effects of naringin on hyperglycemia-induced biochemical and structural defects in the myocardium of rats in type 1 diabetes model.
Diabetic cardiomypathy is characterized by biochemical and structural defects arising from hyperglycemia-directive oxidative damage. Currently, treatment of this condition is inadequate due to dearth effective therapies. Therefore this work investigated potential therapeutic benefit that narangin may have on the biochemical and structural damage.
Supervisor: Dr PMO Oriwa
Title: The effect on naringin on HIV-1 nucleoside reverse transcriptase inhibitors-induced metabolic complications and mitochondrial dysfunction in experimental rat model.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs) have improved outcomes of HIV infection. However their use is limited by metabolic complications. Available options in the management of these complications have, so far, produced controversial results, thus necessitating further research into newer agents with promise. Therefore, the candidate’s study investigated the potential therapeutic benefits of naringin on NRTI-induced complications.
Supervisor: Dr Jill Hanass-Hancock/ Prof H Myezwa
Title: Development of a Model of Care for Rehabilitation of People Living with HIV in a Semi-Rural Setting in KwaZulu-Natal, South Africa.
An Integrated Learning in Action approach was used to develop a model of care that addresses the rehabilitation needs of PLHIV within a healthcare setting. Three phases led to the development of the model. The first phase included a review of rehabilitation models. In phase two an enquiry into the perspectives of stakeholders’ revealed barriers to rehabilitation. The final phase focused on reaching a consensus with experts on the elements needed for the model.
Supervisor: Dr. S Singh/Prof. NG Myburgh
Title: A critical analysis of the impact of the primary health care philosophy on district oral health service delivery in KwaZulu-Natal, South Africa.
The study reported on the extent to which primary health care (PHC) philosophy is implemented in district oral health services in KwaZulu-Natal. The study findings indicate that although PHC philosophy is expressed in strategic documents, there was little evidence of implementation. This study represents one of the first detailed analyses of oral health policy and clearly identified policy to practice gaps, thus making a significant contribution to public oral health literature and implementation science.
Supervisor: Dr. J Naidoo
Title: The outcomes of the Department of Health Mental Clinical Guidelines for the Management of Psychiatric Patients at Primary Health Care Clinics.
The study aimed to establish strategies to improve management and care of people with mental health conditions at primary health care (PHC) clinics. It looked at the practice adopted and implemented by PHC nurses when they are managing people with mental health conditions focusing on attitudes, knowledge and beliefs. Although quality of care was found to be compromised the attitudes and beliefs of nurses towards people with mental illness were positive. However the nurses had inadequate knowledge to manage psychiatric patients.
Supervisor: Prof RWE Joubert
Title: An Evidence-Based Clinical Algorithm for the Assessment of Hypotonia in Children.
The clinical assessment of children with hypotonia presents a diagnostic challenge for clinicians. To address this problem the candidate developed a clinical assessment tool in the form of an algorithm towards assisting clinicians in more accurate assessments. Funded by the Medical Research Council of South Africa and the National Research Foundation this research culminated in eight publications, five of which have been published in high impact journals and papers have been presented at conferences in Africa, Japan, Spain and Texas.
Supervisor: Prof BP Ncama
Title: Infant Feeding and HIV: Ethnographic assessment of decision outcomes on prevention of mother to child transmission, experiences of HIV positive mothers in Lusaka, Zambia.
HIV infection from the mother to her child has changed the way of feeding new-born babies in resource poor settings. This enthnographic study was conducted among HIV-positive mothers in Lusaka, Zambia. The work led to the development of a model for follow up of HIV-positive mothers during the first six months after giving birth in order to promote safer infant feeding practices and contribute to efforts in achieving a global goal for HIV-free survival among children.
Supervisor: Dr. GA Koffuor/ Prof P Ramkissoon
Title: Ocular Anti-Inflammatory, Anti-Cataract, Hypotensive Effect and Safety Assessment of Aqueous Extract of Heliotropium Indicum Linn in Rodents.
Dr Osei used whole genome sequencing to investigate the clonality, epidemiology and mechanisms of multi-drug resistance in carbapenem-resistant Enterobacteriaceae from the private health sector in Durban, South Africa. Resistance to carbapenems, tigecycline and colistin, which are last resort antibiotics was rife. Some carbapenem resistance genes were limited to certain clones. Others such as the New-Delhi-metallo beta-lactamase had proliferated in several bacterial species, in unrelated clones and on diverse genetic determinants of resistance. A number of mutations were evident in genes conferring resistance to colistin and tigecycline – the former mainly related to lipid A synthesis on the cell surface membranes and the latter related to efflux pumps and their regulatory genes. Colistin and tigecycline resistant Enterobacteriaceae co-expressing resistance to all ß-lactams, rifampin, fosfomycin, all aminoglycosides and fluoroquinolones is evident in the private sector in South Africa. This is indicative of the absence of effective antibiotic reserves, notably those used in combination therapy for carbapenem-resistant infections.
Supervisor: Prof M Soliman
Title: Insight into glycosidases using bioinformatics and molecular modeling tools.
Glycosidases catalyze the hydrolysis bonds in glycosides. Inhibition of these enzymes has widespread applications in the treatment of viral infections such as influenza and HIV, cancer, diabetes and lysosomal storage disorders. The candidate’s work reports on computational findings from the molecular dynamics of Bacillus circulans xylanase, and a highly pathogenic, drug-resistant H5N1 influenza virus, neuraminidase. Four papers from the work were published in peer reviewed journals.
Supervisor: Prof BR Bhengu
Title: The development of a predictive model on the factors affecting survival times and AIDS-related events in HIV and AIDS patients on HAART in rural and urban Southern Malawi.
Mr Ngwale, biostatistacian, used a retrospective cohort of urban and rural patient records randomly selected from a HAART database in southern Malawi. A prospective follow-up for one year with all patients that were still alive after two years was done. Stratifying data by residence, Kaplan-Meier and Cox Proportional Hazards analyses were performed to determine survival times and develop prognostic predictive models for survival. The study concluded that factors associated with survival /mortality of patients on HAART are; area of residence, age, body mass index, viral load, CD4 count, WHO staging of disease and adherence to ART. The candidate developed a predictive statistical model for estimating survival times for patients on highly active antiretroviral therapy in southern Malawi.
Supervisor: Dr P Naidoo
Title: An investigation into traditional, complementary and alternative medicines utilization and health outcomes amongst HIV/AIDS patients attending public health facilities in different communities of KwaZulu-Natal.
Even though ARV has proved to be effective and accessible for the management of HIV/AIDS. The concomitant use of TCAM with or without ARV is still prevalent. This has raised concerns as not much data is available to support this combination and not much is known with regards the extent to which TCAM is used by HIV infected patients, and their resultant health outcomes. Using structured questionnaires and medical chart reviews, Dr Nlooto was able to extract this information.
J Osei Sekyere
Supervisor: Prof SY Essack
Title: Phenotypic and genotypic characterization of carbapenemase-producing enterobacteriadceae isolated from the private health sector in Durban, South Africa.
48 The candidate subjected Enterobacteriaceae isolates to WGS and multiplex PCR for molecular characterization of their resistance mechanisms. A higher prevalence of NDM-1 ,GES-5, tigecycline and colistin resistance was observed, especially in clonal K. pneumoniae ST101 and S. marcescenes SA1 and multiclonal E. cloacae strains. NDM-1 and GES-5 were commonly found on Tn3-like transposons and class 1 integrons respecively. There is increasing prevalence of pandrug resistant Enterobacteriaceae in South Africa.
Supervisor: Prof P Clarke-Farr and Prof K Naidoo
Title: Prevalence of visual impairment and development of a child eye care plan in South Darfur State of Sudan.
The candidate determined the prevalence of visual impairment and development of childhood eye care plan for South Darfur State (Sudan). The findings indicated that the prevalence of visual impairment was 4.4%. Refractive error was the cause in 57% retinal disorders (13.1%), amblyopia (5.6%), and (3.7%). The prevalence of mypia was 6.8%, hypermetropia (1.9) and astigmatism (2.5%). The barriers affecting access to childhood eye care were financial, clinical and knowledge.
Supervisor: Dr S Singh
Title: A framework for integrated school oral health promotion within the Health Promoting Schools Initiative in KwaZulu-Natal.
The candidate developed a framework using a multi-level approach to critically assess the viability of including oral health promotion activities within the Health Promoting Schools Initiative in KwaZulu-Natal. This is the first study in KZN to address school-based oral health promotion using elements of systematic planning and evaluation. This framework could also be applied to other areas of integrated school-based health promotion activities.
Supervisor: Dr. R Karpoormath
Title: Design, Synthesis of Biological Evaluation of Novel Carbazole Deravatives as Antimicrobial and Antimycobacterial Agents.
In this doctoral research work, a series of novel hybrid heterocyclic molecules containing Carbazole scaffold were synthesized and evaluated against a panel of microorganisms including mycobacterium tuberculosis. A total of 49 novel compounds compromising of thiazolyl substituted carbazole hydrazine analogues, 8-methoxy-N-substituted-9H-carbozole-3-carboxamide derivatives and carbazole tethered rhodanine derivatives were synthesized and characterized. These newly synthesized compounds displayed potential in-vitro antibacterial, antifungal and antimycobacterial (anti-TB) activity. One of the compound from these series has been selected for P-II second level anti-TB testing at the Division of Microbiology and Infectious Diseases, NIAID, National Institute of Health, USA. This work has resulted in three peer reviewed international publications and further investigation is in progress for mechanistic understanding of these compounds at molecular level. In conclusion these hybrid molecules containing carbazole scaffold can be further exploited in developing potential anti-TB agents to counter the rise in emergence of resistant strains of mycobacterium tuberculosis.
Supervisor: Prof T Govender/HG Kruger
Title: Mass spectrometric investigations and drug distribution studies of some selected anti-tubercular drugs.
Tuberculosis meningitis is the most common form of extra pulmonary TB within HIV co-infected patients. The morbidity and mortality remain high in affected adults and children. It is crucial to understand which drugs would best serve to treat this disease. The candidate’s study used the advanced technique of mass spectrometric imaging to study the most promising of the TB pipeline drugs. The work has been published in eight international scientific journals.
Supervisor: Dr A McKune
Title: Effects of a combined progressive resistance training program and whey protein intake on maximal strength, body composition, immunity, cardiometabolic disease risk and quality of life in HIV infected individuals receiving antiretroviral therapy.
The study examined the effects of combined progressive resistance training and whey protein intake on maximal strength, body composition, immunity cardiometabolic disease risk and quality of life in HIV infected individuals receiving antiretroviral therapy. Maximal strength increased irrespective of whey protein intake, however whey protein was able to maintain maximal strength gains during a period of detraining. The progressive resistance training programme was also able to decrease circulating levels of interleukin-10. High level of this T helper 2 cytokine has been linked to HIV disease progression. Quality of life improved in the physical, social and environmental domains. The study concluded that a progressive resistance training programme and whey protein supplementation was an efficacious and sustainable intervention in HIV-infected individuals reviving antiretroviral therapy.
Supervisor: Dr R Hansraj
Title: Towards the Development of Strategies to Address Near Vision Anomalies in Black High School Students in South Africa.
Near vision anomalies are refractive, non-strabismic accomadative and vergence anomalies which affects clarity, binocularity, impair comfort and effeciency of visual performance of an individual when near task such as reading and working on the computer is performed. For the school-aged child and especially high school students, near vision anomalies and associated symptoms tend to increase as the child progresses through school when demand increases on the visual system for sustained clear vision due to prolonged reading and increased information processing. The study was conducted to determine the characteristics of near vision anomalies and symptoms in order to develop a strategy to identify and treat these anomalies before the child registers for tertiary education which has even greater near tasks demand. The strategy document developed will facilitate screening for these vision anomalies at school settings where larger number of students could be screened. Overall, the study fills a gap in literature providing data for near vision anomalies in high school students, and developed a strategy document to address these anomalies.