Browsing by Author "Davids, Mogamat Razeen"

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    Bolus administration of intravenous glucose in the treatment of hyperkalemia : a randomized controlled trial
    (Karger, 2014-02) Chothia, Mogamat-Yazied; Halperin, Mitchell L.; Rensburg, Megan A.; Hassan, Mogamat Shafick; Davids, Mogamat Razeen
    Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K + ]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose- only bolus lowers serum [K + ] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K + ] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K + ] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K + ] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K + ] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K + ] without any episodes of hypoglycemia.
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    Development and usability evaluation of a multimedia e-learning resource for electrolyte and acid-base disorders
    (Stellenbosch : Stellenbosch University, 2015-03) Davids, Mogamat Razeen; Halperin, Mitchell L.; Chikte, Usuf M. E.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine. General Internal Medicine.
    ENGLISH ABSTRACT: We have developed an innovative multimedia e-learning resource, the Electrolyte Workshop, to provide students and clinicians with instruction and the opportunity for simulated practice in managing electrolyte and acid-base disorders. Our teaching approach is built around relevant physiology and makes use of real cases and storytelling to engage the learner. We have documented the challenges encountered during the development process and have made recommendations for the managing of similar projects. While there are many factors that must be in place to ensure successful e-learning, this dissertation focuses on an important but under-appreciated factor, namely the usability of the computer interface. Usability describes how easy technology interfaces are to use and is routinely evaluated and optimized in the software development industry. This is not yet the case with e-learning, especially in the area of medical education. Poor usability limits the potential benefit of educational resources, as this means that learners will struggle with the interface as well as with the challenges of the content presented. A comprehensive usability evaluation of our Electrolyte Workshop was completed. This included testing with typical end-users, where data were collected via standardized questionnaires and by observing and analysing their interactions with our application. We employed heuristic evaluation as an additional approach and assembled a panel of experts to evaluate our application against a set of heuristics, or principles of good interface design. Many serious usability problems were identified, thus severely limiting the potential educational impact of our Electrolyte Workshop. There was a striking disconnect between the objective measures of usability and self-reported questionnaire data. Our user-testing data make a useful contribution to the debate on how many users are required to find most of the usability problems in an interface. Heuristic evaluation proved to be a very efficient approach. However, both user testing and heuristic evaluation detected serious problems which were missed with the other method. These evaluations informed a comprehensive revision of our application and we could then compare the original with an optimized version in a randomized trial. We found large improvements in objective usability measures, which are likely to increase the satisfaction and motivation of learners. There were similar scores on measures of learning. This was not surprising as our participants were all relatively high-knowledge learners and not novices as regards the subject matter. Our study clearly indicates that the usability evaluation of e-learning resources is critical, and provides an example of how clinician-teachers can improve the usability of the resources they develop. Usability should be evaluated as a routine part of the development and implementation of e-learning materials, modules and programmes. This should start with the earliest versions of the resource, when making changes is easier and less costly. We have demonstrated that a combination of methods should be employed and have highlighted the utility of heuristic evaluation. An iterative approach should be followed, with several cycles of testing and re-design. User testing should always include the study of objective usability measures and not rely only on self-reported measures of user satisfaction.
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    Effect of improving the usability of an e-learning resource : a randomized trial
    (HighWire, 2014-06) Davids, Mogamat Razeen; Chikte, Usuf M. E.; Halperin, Mitchell L.
    Optimizing the usability of e-learning materials is necessary to reduce extraneous cognitive load and maximize their potential educational impact. However, this is often neglected, especially when time and other resources are limited. We conducted a randomized trial to investigate whether a usability evaluation of our multimedia e-learning resource, followed by fixing of all problems identified, would translate into improvements in usability parameters and learning by medical residents.
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    Guidelines for the prevention, detection and management of the renal complications of COVID-19 in Africa
    (African Association of Nephrology, 2020) Elsayed, Hesham M.; Wadee, Shoyab; Zaki, Mohamad S.; Were, Anthony J. O.; Ashuntantang, Gloria E.; Bamgboye, Ebun L.; Davids, Mogamat Razeen; Hafez, Mohamed H.; Mahamat, Maimouna; Naicker, Saraladevi; Niang, Abdou; Seck, Sidy M.; Swanepoel, Charles R.; Tannor, Elliot K.; Twahir, Ahmed; Yao, K. Hubert
    ENGLISH ABSTRACT: Africa trails the rest of the world in COVID-19 cases and deaths. However, as the pandemic spreads through the continent, we expect increases in community infection in the months ahead. Patients with kidney infection, especially those with end-stage kidney disease and those with kidney transplants, are at high risk for acquiring the disease and dying from it. While there is limited evidence for the benefit of interventions, we have the advantage of learning from the experiences of those in China, Europe and the Americas. This document sets forth guidance for dealing with our patients who have acute and chronic kidney disease, including those on renal replacement therapy and the staff involved in their care. Emphasis is placed on preparedness and prevention strategies. As evidence and experience accumulate, it is likely that updated guidance will be needed. L’Afrique suit le reste du monde en termes de nombre de cas et de décès dus à COVID-19. Cependant, alors que la pandémie se propage à travers le continent, nous prévoyons une augmentation de l’infection communautaire dans les mois à venir. Les patients atteints d’une maladie rénale, en particulier ceux atteints d’une maladie rénale chronique en phase terminale et ceux ayant subi une transplantation rénale, courent un risque élevé de contracter la maladie et d’en mourir. Bien que les preuves d’interventions soient limitées, nous avons l’avantage de tirer des enseignements des expériences de ceux qui se trouvent en Chine, en Europe et dans les Amériques. Ce document présente des conseils pour traiter nos patients atteints d’insuffisance rénale aiguë et chronique, y compris ceux sous thérapie de suppléance rénale et le personnel impliqué dans leurs soins. L’accent est mis sur les stratégies de préparation et de prévention. Au fur et à mesure que les preuves et l’expérience s’accumulent, il est probable que des directives actualisées seront nécessaires.
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    Human resources for nephrology in South Africa : a mixed-methods study
    (Public Library of Science, 2020-02-13) Hassen, Muhammed; Archer, Elize; Pellizzon, Adriano; Chikte, Usuf M. E.; Davids, Mogamat Razeen
    Introduction: The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. Methods: A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. Results: A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists’ training, excessive workloads with inadequate remuneration, and challenging work environments. Conclusion: There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
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    Hypodipsic-hypernatremia syndrome in an adult with polycythemia : a case report
    (BMC (part of Springer Nature), 2018-12-27) Chothia, Mogamat-Yazied; George, Kiran; Sheik, Muhammed; Davids, Mogamat Razeen
    Background: Hypernatremia is a very common electrolyte disorder and is frequently encountered in out-patient as well as in-hospital settings. We describe an adult who was found to have unexplained relative polycythemia and episodic hypernatremia. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and the patient was managed with a water-drinking schedule. Case presentation: A 24-year-old South African-Indian man was found to have polycythemia in association with episodes of hypernatremia. Investigations indicated that he had relative polycythemia. He experienced no thirst at a time when his serum sodium concentration was found to be 151 mmol/L. Further testing indicated that his renal response to arginine vasopressin was intact and magnetic resonance imaging of his brain revealed no hypothalamic lesions. A diagnosis of idiopathic hypodipsic-hypernatremia syndrome was made and he was managed with a water-drinking schedule that corrected his hypernatremia. Conclusion: Hypodipsia should always be considered when a patient without physical or cognitive disability presents with unexplained episodic hypernatremia or with relative polycythemia.
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    Oral v. pulse intravenous cyclophosphamide : a retrospective analysis of adverse events in a setting with a high burden of infectious disease
    (Health & Medical Publishing Group, 2015) Pretorius, Elmo; Davids, Mogamat Razeen; Du Toit, Riette
    Background. Cyclophosphamide (CPM) is still considered to be the first-line treatment for many life-threatening autoimmune conditions. It does, however, carry a significant risk of serious adverse events, especially infections. At present CPM is administered as either a daily oral dose (DOC) or an intravenous pulse (PIVC). There is uncertainty regarding the safety profiles of both regimens in settings with a high burden of infectious diseases. Objective. To compare the frequency and nature of adverse events related to the use of DOC and PIVC in such a setting. Methods. A cohort of patients treated with CPM for autoimmune diseases at Tygerberg Academic Hospital, Cape Town, South Africa, from 1 January 2008 to 31 May 2013 was studied. We compared participants receiving DOC and PIVC with regard to disease characteristics and the occurrence of major adverse events. Results. A total of 134 participants (92 DOC and 42 PIVC) were included. Participants in the DOC group were treated for longer (174 v. 101 days; p<0.01) and with higher cumulative doses (17 276 v. 3 327 mg; p<0.01). Risk of infection was similar in the two groups, although there were 6 deaths from leucopenic sepsis in the DOC group (v. 0; p=0.18). Nadir leucocyte counts were also lower in the DOC group (median 3.8 v. 5.3 × 109/L; p=0.02). Conclusion. Infection rates in the two groups were similar, but DOC was associated with longer treatment duration, greater cumulative CPM doses and more severe leucopenia. If resources allow and available literature provides support for efficacy, consideration should be given to greater use of PIVC.
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    Pseudohypokalaemia and pseudohypoxaemia in a patient with acute myeloid leukaemia
    (African Association of Nephrology, 2020) Chothia, Mogamat-Yazied; Davids, Mogamat Razeen
    ENGLISH ABSTRACT: Spurious laboratory results are frequently encountered in patients with haematological disorders and lead to unnecessary additional laboratory investigations and inappropriate treatment. An 80-year-old woman, known with acute myeloid leukaemia, was admitted with suspected sepsis. Laboratory tests revealed a leukocyte count of 358 x 109/L, serum potassium concentration of 2.6 mmol/L and partial pressure of arterial oxygen of 5.3 kPa. The patient did not display any clinical or electrocardiographic features of hypokalaemia and there were no signs of respiratory distress. A diagnosis of pseudohypokalaemia and pseudohypoxaemia was made and inappropriate therapeutic interventions were avoided. Pseudohypokalaemia and pseudohypoxaemia should always be a consideration in patients with hyperleukocytosis due to haematological malignancies, especially when there are no clinical features to support these findings. The inappropriate administration of potassium in such cases may cause serious cardiac arrythmias.
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    Survival of South African patients on renal replacement therapy
    (European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), 2020-10) Jardine, Thabiet; Wong, Esther; Steenkamp, Retha; Caskey, Fergus J.; Davids, Mogamat Razeen
    Background The majority of South Africans rely on a resource-constrained public healthcare sector, where access to renal replacement therapy (RRT) is strictly rationed. The incidence of RRT in this sector is only 4.4 per million population (pmp), whereas it is 139 pmp in the private sector, which serves mainly the 16% of South Africans who have medical insurance. Data on the outcomes of RRT may influence policies and resource allocation. This study evaluated, for the first time, the survival of South African patients starting RRT based on data from the South African Renal Registry. Methods The cohort included patients with end-stage kidney disease who initiated RRT between January 2013 and September 2016. Data were collected on potential risk factors for mortality. Failure events included stopping treatment without recovery of renal function and death. Patients were censored at 1 year or upon recovery of renal function or loss to follow-up. The 1-year patient survival was estimated using the Kaplan–Meier method and the association of potential risk factors with survival was assessed using multivariable Cox proportional hazards regression. Results The cohort comprised 6187 patients. The median age was 52.5 years, 47.2% had diabetes, 10.2% were human immunodeficiency virus (HIV) positive and 82.2% had haemodialysis as their first RRT modality. A total of 542 patients died within 1 year of initiating RRT, and overall 1-year survival was 90.4% [95% confidence interval (CI) 89.6–91.2]. Survival was similar in patients treated in the private sector as compared with the public healthcare sector [hazard ratio 0.93 (95% CI 0.72–1.21)]. Higher mortality was associated with older age and a primary renal diagnosis of ‘Other’ or ‘Aetiology unknown’. When compared with those residing in the Western Cape, patients residing in the Northern Cape, Eastern Cape, Mpumalanga and Free State provinces had higher mortality. There was no difference in mortality based on ethnicity, diabetes or treatment modality. The 1-year survival was 95.9 and 94.2% in HIV-positive and -negative patients, respectively. One-fifth of the cohort had no data on HIV status and the survival in this group was considerably lower at 77.1% (P < 0.001). Conclusions The survival rates of South African patients accessing RRT are comparable to those in better-resourced countries. It is still unclear what effect, if any, HIV infection has on survival.
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    Trends in the nephrologist workforce in South Africa (2002–2017) and forecasting for 2030
    (Public Library of Science, 2021) Kumashie, Dominic Dzamesi; Tiwari, Ritika; Hassen, Muhammed; Chikte, Usuf M. E.; Davids, Mogamat Razeen
    Background: The growing global health burden of kidney disease is substantial and the nephrology workforce is critical to managing it. There are concerns that the nephrology workforce appears to be shrinking in many countries. This study analyses trends in South Africa for the period 2002–2017, describes current training capacity and uses this as a basis for forecasting the nephrology workforce for 2030. Methods: Data on registered nephrologists for the period 2002 to 2017 was obtained from the Health Professions Council of South Africa and the Colleges of Medicine of South Africa. Training capacity was assessed using data on government-funded posts for nephrologists and nephrology trainees, as well as training post numbers (the latter reflecting potential training capacity). Based on the trends, the gap in the supply of nephrologists was forecast for 2030 based on three targets: reducing the inequalities in provincial nephrologist densities, reducing the gap between public and private sector nephrologist densities, and international benchmarking using the Global Kidney Health Atlas and British Renal Society recommendations. Results: The number of nephrologists increased from 53 to 141 (paediatric nephrologists increased from 9 to 22) over the period 2002–2017. The density in 2017 was 2.5 nephrologists per million population (pmp). In 2002, the median age of nephrologists was 46 years (interquartile range (IQR) 39–56 years) and in 2017 the median age was 48 years (IQR 41–56 years). The number of female nephrologists increased from 4 to 43 and the number of Black nephrologists increased from 3 to 24. There have been no nephrologists practising in the North West and Mpumalanga provinces and only one each in Limpopo and the Northern Cape. The current rate of production of nephrologists is eight per year. At this rate, and considering estimates of nephrologists exiting the workforce, there will be 2.6 nephrologists pmp in 2030. There are 17 government-funded nephrology trainee posts while the potential number based on the prescribed trainer-trainee ratio is 72. To increase the nephrologist density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middle-income countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year. Conclusions South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets. density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middleincome countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year. Conclusions: South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets.