http://hdl.handle.net/10386/195 2013-05-19T16:01:22Z http://hdl.handle.net/10386/774 Title: Comparative study of vitamin B12 and holotranscobalamin or active B12 as a marker for vitamin B12 deficiency at Dr George Mukhari Hospital Authors: Murray, Louise M. Abstract: Abstract Aim: This study was undertaken to compare the diagnostic sensitivity and specificity of total vitamin B 12 analyses to active B 12 (holoTC) analyses in a population of patients attending the Dr George Mukhari Hospital in Pretoria. Methods: Routine serum folate, full blood count (FBC), thyroid function test, homocysteine, serum total vitamin B 12 and active B 12 analyses were performed on 30 samples. Results: Serum folate was determined in all patients and 96% of the patients had a normal folate value. When looking at the FBC results it is important to note that three times as many males as females presented with anemia (36% versus 16%). Thyroid function tests were normal in 90% of patients. When the total vitamin B 12 test was preformed only 10% of patients tested positive for vitamin B 12 deficiency, in contrast to the active B12 analyses where 16% of patients tested positive for vitamin B12 deficiency. Both tests had a diagnostic sensitivity of 50%. The diagnostic specificity for total vitamin B12 was 93% in comparison with the 86% obtained by the active B12 analyses; when homocysteine was used as the true marker for vitamin B12 deficiency. Conclusion: Diagnostic sensitivity was the same and the total vitamin B12 test's specificity was better in comparison to the active B 12 analyses. Thus the active B 12 assay cannot be recommended for routine use, since it has no benefit. Description: Thesis (M Med (Chemical Pathology)) -- University of Limpopo, 2012. 2012-01-01T00:00:00Z http://hdl.handle.net/10386/671 Title: The usefulness of the adenosine deaminase assay for diagnosing tuberculosis pleuritis in immunocompromised patients at Dr George Mukhari tertiary laboratory, Pretoria Authors: Molaudzi, Mulalo Abstract: Mycobacterium tuberculosis is the most common cause of death world-wide and its incidence has been steadily increasing, which is more evident when comparing the global tuberculosis (T8) incidence of 9.24 million in 2006 to 9.27 million cases in 2007. African countries are the second most affected by the epidemic and South Africa is among the 22 highest burden countries most affected by T8 with a very high number of cases relative to the total population. The early diagnosis of tuberculosis and screening of contacts is the cornerstone for controlling spread of active T8 infection. T8 diagnosis becomes even more challenging in patients with immunosuppression (for example in human immunodeficiency virus (HIV) infected), in the case of latent infection and extra pulmonary T8 such as pleural T8. The definitive diagnosis of pleural T8 depends on the demonstration of M. tuberculosis in sputum, pleural fluid and pleural biopsy. Although acid fast bacilli (AF8) microscopy is a rapid, inexpensive and relatively simple method, it has low sensitivity. The culture method is more sensitive than AF8 microscopy, detecting 25-37% of all pleural tuberculosis cases however it takes 4 to 8 weeks for a visible growth on a solid medium. Therefore it is important to find a rapid and reliable test for the diagnosis of pleural T8 particularly in developing countries such as South Africa where there is a high T8 incidence and HIV infection rate. Description: Thesis (MSc (Med)(Microbiology)) -- University of Limpopo, 2012. 2012-01-01T00:00:00Z http://hdl.handle.net/10386/460 Title: Prevalence of primary adrenal insufficiency in patients diagnosed with tuberculosis at the Dr George Mukhari and Kalafong hospitals in South Africa Authors: Broodryk, Jaco Abstract: Objectives: Tuberculosis (TB) is a major health problem in South Africa with disease rates more than double those observed in other developing countries and up to 60 times higher than those currently seen in the USA or Western Europe. Seventy years ago, it was demonstrated that approximately 70% of patients with primary adrenal insufficiency (PAI) was due to TB and this remains a major cause of PAI in developing countries. With these figures in mind it is of great concern that patients with TB are not screened for adrenal insufficiency more often. The aim of the study was to investigate the prevalence of adrenal insufficiency in patients diagnosed with TB. Study population: Seventy three patients at the Dr George Mukhari- and Kalafong hospitals in Gauteng, South Africa, aged 20-91 years, were included. 49 Females and 24 males were recruited. All patients had positive TB microscopy. Metods: High dose adrenocorticotropic hormone (ACTH) stimulation tests were done on all patients, a post stimulation cortisol concentration of > 500nmol/L was considered a normal response. Baseline ACTH determination was also done on all patients. ACTH determination was performed using the Siemens Immulite 2000 ACTH assay, whilst cortisol determination was done on a Beckman Coulter UniCel DxI 800 immunoassay system. Results: 68 patients had a normal response. 5 patients had a post ACTH stimulation cortisol of less than 500nmol/L. Conclusion: Five patients (6.85%) had a blunted response to the ACTH stimulation test which identifies some form of adrenal insufficiency. None of the patients had an increased ACTH concentration. This finding excludes PAI and the normal ACTH concentrations in these 5 patients are highly suggestive of secondary-or tertiary adrenal insufficiency. Description: Thesis (M Med(Chemical Pathology))--University of Limpopo (Medunsa Campus), 2010. 2010-01-01T00:00:00Z http://hdl.handle.net/10386/418 Title: The expression of E-cadherin and β-catenin in squamous cell carcinoma of the esophagus Authors: Nkosi, Cornelius Muzi Abstract: Background Esophageal squamous cell carcinoma (SCC) remains a disease of poor prognosis. Early diagnosis is compromised by the delayed onset of symptoms. By the time of surgical intervention metastases and organ infiltration have already occurred this reduces the prognosis significantly and the 5-year survival rate of operative advanced esophageal SCC remains poor. In order to select an appropriate therapeutic regime and guard against both over- and under treatment, reproducible prognostic markers are needed at the time of diagnosis. The study evaluates the phenotypic expression of E-cadherin and β- catenin in SCC of the esophagus. Methods: The expression patterns of both β-catenin and E-cadherin was determined using immunohistochemistry technique in patients with esophageal SCC with the application of the Broders and Brynes grading systems in assessing clinical outcome. Forty four cases were randomly selected, one case was esophagectomy, and 43 were endoscopic biopsies with one case of Broders Grade I, 37 Grade II and 6 Grade III and 9 cases had pattern 2 and 35 had pattern 3 with Brynes Grade. Results: The reduced expression of E-cadherin and β-catenin was 45.5% and 47.7% respectively. No significant level was observed with E-cadherin (P= 0.20) and for β-catenin (P= 0.18) but the low protein level of both biomarkers was associated with tumor cell differentiation with Broders classification. The reduced expression of E-cadherin on invasive tumor front was 27% and 57% for reduced expression of β-catenin. The level of significance was found to be (P=1.00) for E-cadherin expression and (P=0.02) for β-catenin. E-cadherin and β-catenin showed reduced expression on invading tumor front and β-catenin was associated with tumor cell invasiveness. Conclusion: The expression of E-cadherin and β-catenin with regard to Broders classification showed no significance on tumor cell differentiation and these expressions do not play a role in guiding nor predict the behavior or progression of the tumor. However, the assessment β-catenin on the tumor invasive front (Brynes) shows a high correlated with tumor behavior as it is involved in regulation E-cadherin function. Description: Thesis (M Med (Anatomical Pathology))--University of Limpopo, 2010. 2010-01-01T00:00:00Z