10 research outputs found
Response to radioiodine in male hyperthyroid patients at Tygerberg Hospital
No full textThesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2009.ENGLISH ABSTRACT: Radioiodine therapy is reputed to yield poorer results in male patients than in females. We
retrospectively reviewed the records of 308 patients treated with radioiodine-131 (RAI) for Graves’
disease (n=266, 86.4%), toxic multinodular goitres (n=35, 11.4%) and toxic solitary nodules (n=7,
2.3%).
The mean age of the men was 44 ±13.6 years (range 14-77 years). Patients with GD were
predominantly in the younger age groups, while those with toxic nodular goitres were in the older
range. Two hundred and fifty-nine patients (84.1%) were treated with a single dose of RAI, while
49 (15.9%) required further doses. A second dose had to be administered to 38 patients, while 8
received 3 doses, 2 got 4 doses and 1 patient had 5 doses in all (these included a first dose received
prior to referral to our Thyroid Clinic). Cure was determined as euthyroidism or hypothyroidism at
the 3-month follow-up visit.
The average pre-treatment T4 value was 68.9 ± 31.8 pmol/L (range 5.7 – 155 pmol/L); while the
mean Tc-99m pertechnetate uptake value was 15.8 ± 10.9% (range 0.88 - 62.9).
Patients with GD presented with more severe hyperthyroidism than the other patients; mean free T4
of 71.9 ± 31.1 pmol/L compared to 51.4 ± 29.9 pmol/L for the TMG group of patients, and 39.6 ±
26.8 pmol/L for the TSN group (ANOVA p<0.0001, confirmed by the Kruskal-Wallis test). Patients
with TMG and TSN were treated with higher doses than patients with GD; mean first doses of
349.3 ± 88.5 MBq and 428.1 ± 28.6 MBq respectively, compared to a mean dose of 325.1 ± 69.3
MBq for patients with GD. Treatment with multiple doses of RAI correlated with higher values of
T4 and T3 at presentation (p<0.0001). However, none of the baseline variables of age, T4 and T3,
and first dose of RAI was significant predictors of free T4 outcome at 3 months. A consistently
higher dose was administered to the male patients, compared to female patients of similar age,
diagnosis and level of thyrotoxicosis (Tc-99m pertechnetate uptake). Despite this, male patients had
similar outcomes as the female patients 3 months after therapy.
Our findings lend weight to the theory that male patients are more difficult to treat than their female
counterparts, seeing that the former had similar outcomes despite the significantly higher doses of
RAI administered to the males.AFRIKAANSE OPSOMMING: Radiojodium terapie lewer na bewering swakker resultate in mans as in vroulike pasiënte. Die
inligting van 308 pasiënte met Grave se siekte (n=266, 86.4%), toksiese multinodulêre tiroïed
(n=35, 11.4%) en enkel toksiese nodules (n=7, 2.3%) wat met radiojodium (I-131) behandel is, is
retrospektief nagegaan.
Die gemiddelde ouderdom van die mans was 44 ±13.6 jaar (reikwydte 14-77 jaar). Die meeste
pasiënte met Grave se siekte was in die jonger ouderdomsgroep, terwyl dié met toksiese
multinodulêre tiroïed, ouer was. Tweehonderd nege-en-vyftig pasiënte (84.1%) is met ‘n enkel
dosis radiojodium behandel, terwyl 49 (15.9%) meer as een dosis benodig het. ‘n Tweede dosis is
aan 38 pasiënte gegee, terwyl agt 3 dosisse, twee 4 dosisse en 1 pasiënt 5 dosisse in totaal ontvang
het (wat ‘n eerste dosis voor verwysing na die tiroïedkliniek, ingesluit het). Herstel is gedefinieer as
eutiroïdisme of hipotiroidisme tydens die drie maande opvolgbesoek.
Die gemiddelde T4-waarde voor behandeling was 68.9 ± 31.8 pmol/L (reikwydte 5.7–155 pmol/L);
terwyl die gemiddelde Tc-99m pertegnetaatopname 15.8 ± 10.9% (reikwydte 0.88–62.9) was.
Pasiënte met Grave se siekte het met erger hipertiroidisme as die ander pasiënte gepresenteer; met
‘n gemiddelde vry T4 van 71.9 ± 31.1 pmol/L vergeleke met 51.4 ± 29.9 pmol/L vir die toksiese
multinodulêre tiroïedgroep en 39.6 ± 26.8 pmol/L vir die enkel toksiese nodule groep (ANOVA
p<0.0001, bevestig met die Kruskal-Wallistoets). Pasiënte met toksiese multinodulêre tiroïed en
enkel toksiese nodule, is met hoër dosisse as dié met Grave se siekte behandel; met ‘n gemiddelde
eerste dosis van 349.3 ± 88.5 MBq en 428.1 ± 28.6 MBq onderskeidelik, vergeleke met ‘n
gemiddelde dosis van 325.1 ± 69.3 MBq vir pasiënte met Grave se siekte. Behandeling met meer as
een dosis radiojodium het gekorreleer met hoër T4- en T3- waardes by (p<0.0001). Geen van die
basislyn veranderlikes (ouderdom, T4 en T3, en die eerste dosis radiojodium) was egter ‘n
betekenisvolle voorspeller van die vry T4 uitkoms op 3 maande nie. Die dosis wat aan manlike
pasiënte toegedien is, was konstant hoër, vergeleke met die vroulike pasiënte van dieselfde
ouderdom, diagnose en vlak van tirotoksikose. (Tc-99m pertegnetaatopname). Ongeag hiervan, was
die uitkoms by manlike en vroulike pasiënte 3 maande na terapie dieselfde.
Ons bevindinge dra by tot die teorie dat manlike pasiënte moeiliker is om te behandel as hul
vroulike eweknieë, aangesien mans soortgelyke uitkomste gehad het ten spyte van betekenisvol
hoër dosisse radiojodium
Outcome of Radioiodine Therapy in a West African Population
No full textHyperthyroidism continues to be a pressing public health concern in West Africa. Its prevalence in Africa has been quoted as 1.2%-9.9%, with Graves' disease as its most common cause. Radioiodine-131 (RAI) therapy of hyperthyroidism recently commenced in two government hospitals in Ghana and Nigeria. This is a retrospective analysis of consecutive patients treated with RAI for primary hyperthyroidism at the National Centre for Radiotherapy and Nuclear Medicine (NCRNM) from 2008-2013, and in the University College Hospital (UCH) from 2006-2013. Cure was defined as euthyroidism or hypothyroidism occurring at 6 months post-RAI. Data were analysed using SPSS version 21 and Epi Info version, categorical data were evaluated with the Chi-square test and Fisher's exact test. 94 patients were studied, aged 20-74 years; 78 were females, and 16 were males. 38 were Ghanaian and 56 Nigerian. The presence of thyroid-associated ophthalmopathy (TAO) made cure less likely (χ2 P = 0.006, odds ratio = 0.118; 95% confidence interval, 0.027-0.518). Other factors assessed proved to be insignificant. Our findings suggest that hyperthyroid patients with TAO will benefit from a higher RAI dose than their counterparts without TAO
Pattern of presentation of Graves� disease and response to radioiodine therapy in South African men
No full textThe Nigerian Enterprises Promotion Decrees (1972 and 1977) and indigenisation in Nigeria
No full textThe thesis is a comprehensive examination of the Nigerian
Enterprises Promotion Decrees of 1972 and 1977, and more broadly
of the process of indigenisation in Nigeria.
A brief introduction to the historical background of indigenisation
before 1970 is followed by an account of the timing of the Decrees
in the context of the oil boom in the country's economy. An
examination of the problems encountered in implementing the Decrees
and their effects, and an analysis of the distribution of benefits,
is informed by empirical research including interviews, carried out
by the author in Nigeria between 1982 and 1985.
The record shows that indigenisation has led to the consolidation
of an economy which accommodates the interests of ex-State personnel,
the State as an institution, private indigenous businessmen and
foreign capital, in an order which is far from certain to bring about
the national economic independence which, in official terms, is the
chief objective.
Nigeria's commitment to capitalism and the promotion of
Indigenous private enterprise, on the basis of resources generated
initially by the agricultural economy, between the 1940s and 1960s,
and then much more spectacularly and more significantly by oil
revenues in the 1970s, provides an instructive example of the limits
to what a post-colonial society in black Africa can achieve by trying
to indigenise the ownership structure of its economy
The role of the international patent system in the transfer of technology to West Africa : case studies : Ghana and Nigeria
No full textThe principal aim of this thesis is to undertake a critical
examination of the role of the international patent system in the
transfer of technology to West Africa, particularly Ghana and Nigeria.
It focuses mainly on the patent systans and technology regulatory
regimes of the two countries. The study is intended to identify and
evaluate the impact of the international patent system on the transfer
and development of technology in this area.
The first chapter provides a theoretical foundation to some of
the more practical issues to be discussed in the subsequent chapters.
The Paris Convention and the diplomatic revision exercise thereof, as
well as other efforts and policies regarding patents and technology
transfer at various levels are discussed in Chapter Two. Chapters
Three to Eight consider the two case-studies undertaken in this
thesis. Chapter Three begins with the historical development of the
patent system in both Ghana and Nigeria, and the remaining chapters
continue with a discussion of the present patent and technology
regulatory regimes of both countries. Based on facts and figures the
two case-studies examine critically the patent law and systems and
technology transfer laws of these two countries including other
related institutional measures highlighting their strengths and
weaknesses.
The study argues that if the patent systems of both countries
are to play a meaningful role in the transfer and developnent of
technology they nust be utilized as a tool of economic policy and also
be related to the technology transfer regimes which nust necessarily
be integrated into the national technology policy which should, in
turn, be made an integral part of the entire national developnent
plan. It is concluded that it is only in this way that the patent
system can effectively contribute to the transfer of technology and
the development of indigenous technological capabilities in the two countries
Recommended from our members
Dream of an elsewhere: contemporary African American travel writing
No full textAfrican American literature is infused with travel. Experiences of physical journeying have been pivotal to the story of men and women of African descent in the United States for hundreds of years, since the original traumatic forced displacement of the Middle Passage that generated a diasporic subjectivity intertwined with corporeal motion. The subsequent emancipatory journey to freedom, as recited in slave narratives, decentred the coercive migrations of the slave trade by coupling the subversive act of self-directed movement through geographical space with a collective understanding of liberty. Wanderings in the period after the Civil War, followed by the momentous collective Great Migratory journeys of the twentieth century, as well as the countless and ongoing voyages to the ancestral continent of Africa spanning four centuries, has only deepened the criticality of travel to African American history and cultural production. However, African American travel writing has received only a small amount of scholarly attention. Moreover, of that scant consideration, the focus has tended to be on narratives of involuntary or economically necessitated movement. Thorough academic study of the contemporary literature of African American travel beyond these domains is rare, despite the potential rewards of such an endeavour for researchers interested in the contemporary (re)construction of African American subjectivity and in the continuing artistic evolution of the changeable and indeterminate travel book form
A New Form of Authoritarianism? Rethinking Military Politics in Post-1999 Nigeria
No full textDespite the vast research that has been done on the Nigerian military, virtually all of these studies have failed to critically examine the accepted role of the military in the democratising phase. This is important because the relationship between the political elite and the military in post-military authoritarian states guarantees either democratic consolidation, or its reversal. In Nigeria, despite an appearance of significant progress in subordinating the military institution to democratic civilian authority, the military remains a crucial political actor in the polity. It appears that the military has yet to accept the core democratic principles of civilian oversight of the institution. This thesis, therefore, explores whether a new form of military authoritarianism is emerging in Nigeria, with the aim of understanding Nigeria’s military behaviour in a transitional phase, from prolonged military authoritarianism to democratisation. To examine this military behaviour, Alfred Stepan’s concept of military prerogatives that was used to understand the military’s behaviour in a transitional phase in Latin America is applied to Nigeria.
A crucial understanding of authoritarianism in Nigeria is initially discussed in this study using mainly document analysis strategy to examine whether multi-ethnic states, such as Nigeria, tend to have authoritarian systems. Six hypotheses form the core analysis of this thesis: first, that the military has retained significant military prerogatives; second, that retired military officers are gaining influential political and economic positions; third, autonomous military involvement in human rights abuses since 1999; and fourth, that civilian government oversight remains weak, and facilitates military authoritarianism. These hypotheses are primarily analysed using the elite interview technique. During the first half of 2011, the author conducted field research where serving and retired military officers were interviewed. The fifth hypothesis is that the military has intervened in politics post-1999. The examination of this hypothesis relies primarily on key security-related media reports (mostly newspaper editorials) on the military after 1999. The examination of the final hypothesis, that increases in military expenditures might facilitate a new form of military authoritarianism, relies primarily on descriptive statistical analysis. In addition, this study collated relevant historical materials that relate to the military, utilising national archival collections.
The empirical findings of this research did not identify a new form of military authoritarianism in Nigeria. The study, however, argues that the unrestricted institutional framework accorded the military has contributed significantly to authoritarian practices in the post-military era in Nigeria. This study discovered that there were similarities between the Brazilian and Nigerian militaries in regard to their military spending during their period in power. Both countries had lower defence budgets. Just as in Brazil, it appears that part of the reason the Nigerian military decided to relinquish power in 1999 had to do with its desire to gain a higher budget, something that was precluded in a military government struggling to retain a sense of legitimacy. The military needed a higher budget to modernise and re-professionalise its institution after more than a decade in power. This feature, which the Nigerian military shares with the Brazilian military, appears to justify the application to Nigeria of Alfred Stepan’s concept of military prerogatives.
International Impact of COVID-19 on the Diagnosis of Heart Disease
No full textBackground: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted
Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)
No full textObjectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p<0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p<0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology
Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)
No full textBackground: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p < 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures
