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Cobalt-60 radiation beam verification in nasopharyngeal carcinoma: a Kenya experience
Kikwai, Richard Malakwen,
2012
Background and purpose The primary aim of this study was to analyse the accuracy and reproducibility of radiation treatment to patients with nasopharyngeal carcinoma at the only tertiary teaching and referral hospital in Kenya. The secondary objective was to review literature on quality assurance procedures that would result to provision of quality radiation treatment to this group of patients. Materials and method During the period May 2011 to March 2012, 35 patients with head and neck cancer comprising of 27 patients with nasopharyngeal carcinoma, 7 with paranasal sinus carcinoma and 1 with lymphoma falling within the enrolment criteria were treated using Equinox cobalt-60 unit with the same beam arrangement and were studied prospectively. Radical radiotherapy was delivered using conventional 2D technique in a routine dose of 60-66Gy to the primary and 50Gy to lymph nodes with additional dose to residual neck nodes. During the period of their treatment, a lateral portal image was taken once weekly. Four film image pairs were obtained per patient with each patient positioned and immobilised in an individualised Orfit thermoplastic mask and a head and neck support. The 4 portal images were compared to a corresponding simulator film taken during simulation planning. Deviations from the varied bony landmarks were measured on the portal images and simulator image from the centre of the radiation beam. These measurements were used to calculate systematic and random errors. Results The overall mean in beam alignment indicated systematic and random errors to be 4.4mm and 1.08mm respectively. Although the means are within the reported range by other studies, the difference between the simulator and the portal images of individual patients varied between no difference (0.0mm) as the minimum and 11mm as the maximum with the lower 95% confidence level (CL) of mean being 3.23mm, the upper 95% CL of mean being 5.58mm. Further, 37.5% (n=12) of the patient measurements were within 2mm, 56.25% (n=18) were within 4mm and 43.75% (n=14) indicated a difference greater than 4mm. Conclusion This prospective study has shown the probable range of systematic and random errors that occur in beam alignment during the course of radiation treatment to this group of patients at the study site. To ensure that radiation treatment is delivered as planned, portal imaging needs to be implemented on a routine basis in order to monitor, document and allow for mechanisms to correct observed errors through portal imaging QA and QC. The results of this study have shown the disparity of the delivered treatment from the planned, as a result of beam alignment errors, which indicate that certain measures need to be implemented at the study site in order to limit these errors to within international recommendation. This study has confirmed that the observed variations were considerably outside the limits of international standards in terms of systematic errors. These errors compromise the quality of treatments delivered at the study site. Recommendations for improved quality have been provided and the researcher is of the view that if the recommendations are adopted, the observed errors would be minimized to within the recommended 2mm.
http://hdl.handle.net/11189/1039
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Theses, dissertations, etc.
Brain compatible learning in the radiation sciences
Von Aulock, Maryna,
2003
Brain Compatible Learning (BCL), as its name suggests, is a type of learning which is aligned with how the human brain naturally learns and develops. BCL offers many different options and routes to learning as alternatives to conventional 'chalk and talk' methodologies. A BCL curriculum is planned to define the structure and content of a programme of learning, but it also provides opportunities for students to participate in activities, which encourage and enhance the development of an active and deep approach to learning. Using BCL approaches in the classroom thus creates both a stimulating and a caring environment for student learning. This project researches a BCL intervention in a Radiation Science course. The use of BCL techniques has tended to have been done predominantly in the social sciences; this research fills an important 'gap' in the research literature by examining how BCL might be implemented in a technical and scientific context. The research was conducted using an adapted Participatory Active Research methodology in which classroom interventions were planned (within a constructive framework), rather than implemented and then reflected on by all participants. The PAR method was supplemented with a series of detailed questionnaires and interviews. The broad findings of this study relate to students' experiences of BCL in Radiation Science in terms of 'process' and 'product" issues. In terms of process, or the methodology of BCL, students' responses were largely positive. Students enjoyed the varied learning experiences of the BCL classroom. There were, however, some students who experienced difficulty with BCL methodologies. This could be attributed to the nature of educational innovation in a context where students have mainly been exposed to a conventional, 'transmission' educational approach. There are two main conclusions with regard to the 'products' of the BCL intervention. Firstly, students' marks may improve (due to the interactive and reflective nature of the BCL program) and there may be an increase in students awareness of their own learning styles and preferences - with a resultant growth in the students' self confidence as learners. Other conclusions drawn from this study are that there are considerable strengths in the BCL when used in the technical and scientific context of Radiation Science. BCL facilitates a thorough grounding in core areas and the practical and analytical skills that are at the heart of Radiation Science II B. BCL contributes to a learning environment which is conducive to effective learning for individual students as well as for groups of students, and in which the responsibility for the effectiveness of learning from discussion in group activities lies with students, rather than the lecturer. BCL plays a role in increasing students' abilities to analyse complex problems by drawing on methods, which are closely aligned with the natural process of how the human brain learns and develops. There is a need to improve the quality of teaching, learning and assessment in Higher Education in South Africa There is also a need to increase the quantity of diplomates and graduates with technical and scientific qualifications. This study offers a contribution to the improvement of Higher Education by suggesting a way in which Higher Education staff could align their practices with how students learn. The report concludes that there is a place for BCL in teaching the subject Radiation Science to second year radiography students. Methods to introduce these changes are discussed further to show more varied approaches.
http://hdl.handle.net/11189/413
en
Peninsula Technikon
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Learning -- Physiological aspects
Brachytherapy in cancer of the cervix : an African perspective
Mucheusi, Longino Kabakiza,
2012
Introduction: Brachytherapy plays an essential role in the management of patients with cervical cancer. The high cervical cancer burden in Africa presents challenges with regard to provision and sustainability of these services. This study analysed treatment outcomes of two brachytherapy modalities, high dose rate (HDR) and low dose rate (LDR) intracavitary treatment for patients with cervical cancer, and evaluated the problems and challenges of the provision of these services within the African context. Methodology: The study was conducted using a case study approach with mixed methods at two sites in Africa, one in South Africa (Centre I) and the other in Kenya (Centre II). The study explored factors and issues affecting definitive radiotherapy of the patient with cervical cancer at the two sites with a focus on the brachytherapy treatment. The case study provided an opportunity to collect in-depth data consisting of quantitative and qualitative components that generated numeric and textual data. Treatment outcomes of one site treating with HDR and the other LDR intracavitary brachytherapy were retrospectively analysed for a maximum sample size of 193 (91%) patients in the HDR group and 49 (100%) patients in the LDR group. All patients were treated with external beam radiation therapy (EBRT) using parallel opposed beams (POP) for the patients that received LDR brachytherapy, and four field box technique or POP for those that received HDR brachytherapy. The linear quadratic formula was used to calculate the equivalent dose in 2 Gy fractions (EQD2) between the two groups. The primary endpoints assessed were pelvic relapse free survival, late radiation complications, and overall survival. Endpoints were estimated using the Kaplan-Meier method. Comparisons between treatment groups were performed using the log-rank test. The results were compared and considered against data from other relevant published research findings. Further to this, the implementation process of the HDR brachytherapy equipment was evaluated. The data was integrated and interpreted to answer the main research question of how well HDR brachytherapy has replaced LDR as an appropriate treatment strategy for cervical cancer within the African context. Findings: The findings showed several issues in regard to brachytherapy infrastructure, clinical outcomes between patients treated with HDR and LDR, and numerous challenges with regard to HDR implementation and use. The median follow-up for patients treated in the two groups (HDR and LDR) was 42.2 and 12.4 months, respectively. The actuarial 5-year pelvic relapse free survival in the HDR and LDR group was 65.8% and 53.9% (p = 0.84), respectively. The 5-year bladder and rectal (grade 3 and 4) complication rates for patients treated with HDR were 3.4% and 3.0%, whereas those treated with LDR were 0% and 25.0%, respectively. The difference in rectal complications was significant with a p-value of 0.0024. The 5-year overall survival for the HDR group was 50% with a median survival time of 49.2 months. There was no survival data for the LDR group. The evaluation showed management logistics with regard to the supply of HDR sources, lack of experience in HDR use, and technical issues of implementing an HDR programme as strong challenges at Centre II, while issues of machine maintenance were found to be similar for HDR and LDR equipment at both Centres. Recommendations: The results showed similarities between HDR and LDR treatments with regard to pelvic relapse free survival and bladder complications. This and the findings on overall survival in the HDR group, compared well with published literature. However, a high rectal complication rate was observed in the patients treated with LDR. This suggests that other factors such as the small sample size in the LDR group or the external beam technique might have influenced the outcome, as the results contradict other studies that report similar treatment outcomes between LDR and HDR. Overall, the results were comparable. Therefore based on these findings and the challenges that emerged from the evaluation on HDR implementation process at Centre II, this study recommends LDR/MDR (medium dose rate) brachytherapy as appropriate in this environment where adequate experience is available for this modality. This would be conditional on a strict maintenance programme being initiated with the equipment supplier, as this is no longer the case. A model treatment schedule is proposed that would enable an under-resourced Centre to treat as many patients on LDR as the Centre using HDR intracavitary brachytherapy. Though Co-60 based HDR would be considered better given availability of infrastructure, experience and oncology support systems. Conclusion: The evidence from Centre I in South Africa shows that HDR has replaced LDR, and can be used in Africa but with certain conditions of: infrastructure and support services, dedicated management and logistics in supply of sources, expertise in its use, and scheduled treatment times. The evidence from Centre II in Kenya shows that HDR has not replaced LDR /MDR, and cannot be used due to: lack of infrastructure and oncology support services, equipment expertise, experience and resources. These challenges encountered in HDR implementation may hinder the use of HDR in dealing with the high cervical cancer burden in Africa, despite its ability to treat many more patients compared to LDR/MDR. Nevertheless, despite these challenges and the statistical difference observed in rectal complications between HDR and LDR, the adequate experience in the use of LDR/MDR that is shown at Centre II, can be exploited to activate brachytherapy services at the Centre. This is due to the overall comparable study results and published literature that show both modalities give similar treatment outcomes. The study aim was to provide in-depth insight into the African situation through research at the two oncology sites. Suggestions and possible solutions to the challenge of accessibility of definitive radiotherapy treatment for the patient with cervical cancer within the African context are made, in order to contribute to management of the cervical cancer burden on the continent. There is however the question of advancement in technology favouring resource rich countries thereby creating a divide with poor countries such as African countries with limited resources and inadequate support systems. This concern is also raised by the International Atomic Energy Agency (IAEA) and is discussed in this study. Hence, there is the possibility that the findings and issues highlighted in this study may form a basis for further research to unravel the many issues affecting brachytherapy services in Africa. It is also envisaged that the recommendations and suggestions made, may contribute to solutions beyond the two study sites.
http://hdl.handle.net/11189/225
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Uterus -- Cancer
An evaluation of fetal growth in human immunodeficiency virus infected women at Khayelitsha and Gugulethu midwifery obstetric units in the Western Cape
Isaacs, Ferial,
2006
A prospective cohort study was done on Human Immunodeficiency Virus (HIV) infected and uninfected women attending Khayelitsha Midwifery Obstetric Unit (MOU) and Gugulethu MOU from June 2003 to December 2004, primarily to establish whether there is an association between HIV infection and Intra-uterine growth restriction (lUGR). B-Mode real time ultrasound imaging was used to monitor fetal growth from ±22 weeks to 36 weeks gestational age. Birth weight, gestational age at delivery, gender, placental weight, and maternal complications were also included. Maternal factors considered included age, weight parity, singleton versus multiple pregnancy, previous IUGR or preterm delivery, previous fetal abnormality, social habits viz. cigarette smoking, alcohol and drug use, and vascular disease viz. Diabetes, hypertension, renal disease, cardiac disease and collagen disease. A secondary objective was to establish whether the CD4 T-lymphocyte count possibly modulated the presence of IUGR. All HIV infected women were given antiretroviral therapy according to the standard Protocol of the Provincial Government of Western Cape (2002). The research questions were: • Does maternal HIV infection increase the risk of intrauterine growth restriction and associated preterm delivery? • Does the immune status of (CD4 T-lymphocyte count) of HIV infected pregnant women modulate fetal growth? The primary objective of this study was to establish whether there is an association between HIV infection and IUGR, and hence that HIV infection leads to an adverse perinatal outcome. Ultrasound was used as a diagnostic tool to establish normal or abnormal fetal growth patterns. Anecdotal reports from health workers in the obstetric field suggested that IUGR and preterm delivery may be associated with low birth weight infants in HIV infected pregnant women. However, preterm delivery is associated with various other factors including low socio-economic status (poor nutrition), cigarette smoking, drug and alcohol abuse, previous history of preterm delivery, over distention of the uterus (hydramnios, multiple gestation), premature rupture of membranes, cervical incompetence, vaginal infections (bacterial vaginosis) and maternal disease e.g. hypertension, heart disease (Lizzi, 1993: Symmonds, 1992; Odendaal et aI, 2002). HIV is now thought to be an added factor. Afier doing a systematic review and meta-analysis of 31 studies, Brocklehurst and French (1998) reported that there is an association (although not strong) between HIV infection and adverse perinatal outcome in developed countries; but in developing countries, there is an increased risk of infant death. By excluding or controlling for confounding variables that could affect fetal growth, this study aimed to determine whether there is a significant association between HIV and fetal growth by comparing fetal growth in HIV infected and uninfected women from midsecond trimester to the time of delivery. A secondary objective was to establish whether there is an association between the immune status (CD4 T-lymphocyte count) of the mother and IUGR. The immune status of the mother is probably one of the most important factors affecting the fetus and perinatal outcome. As the mother's viral load increases, her immune system is increasingly compromised, resulting in the occurrence of HIV-related diseases, and a concurrent increase in fetal complications. In this study a CD4 T-lymphocyte count was used to assess the level of immunodeficiency of all the HIV infected participants. Ideally the test should have been done each time the participant was scanned so that the CD4 T-lymphoc)1e count could be monitored simultaneously with the fetal growth parameters, however due to financial constraints and ethical considerations, one test was done on each HIV infected women. This study was based at two MOU's where different antiretroviral therapy (ARVT) regimens were used. The one MOU offered Zidovudine (ZDV) to mothers from 34 weeks gestation to the onset of labour, and the other MOU offered Nevirapine (NVP) as a single dose to the mother at the onset of labour and to the neonate within 72 hours of birth (Provincial Government Western Cape, 2002). This presented an opportunity to compare two groups of HIV infected women on different regimes. The intention was to establish whether ZDV had an adverse effect on fetal growth and resulted in low birth weight. However, 6 months after the study started a revised Prevention of Mother to Child Transmission (PMTCT) Protocol was implemented where women at both MOU's received the same ARVT i.e. ZDV and NVP. This objective was therefore abandoned due to a change in the PMTCT Protocol in the Western Cape. The study was based at two Midwife Obstetric Units (MOU) in the Western Cape where the prevalence of HIV in pregnant women is relatively high i.e. 20 - 24 % (Mother-to-child transmission Monitoring Team, 2001), viz. Gugulethu MOU and Khayelitsha MOU. A prospective cohort study was done with the intention of recruiting a sample of 400 pregnant women, 200 HIV infected and 200 uninfected. The actual sample size was 415. The study group was 194 HIV infected women and the control group was 221 uninfected women. Confounding variables such as cigarette smoking, alcohol and drug abuse. multiple gestation. grand multipara pregnancy, history of IUGR or preterm delivery. fetal abnormality detected at the time of the first scan in the current pregnancy, and maternal vascular disease - were excluded. Confounding variables such as maternal age, maternal weight and gestational age were controlled. Ultrasound imaging was used as a diagnostic tool to establish normal and abnormal fetal growth patterns. A B-mode real time ultrasound unit was used to confirm the gestation age and rule out any obvious fetal abnormalities at 20-24 weeks gestation. Fetal growth scans were done at 28 weeks, 32 weeks and 36 weeks gestation to compare fetal growth patterns in the study and control groups. Fetal biometry used to monitor fetal growth included biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and estimated fetal weight (EFW). Amniotic fluid index (AFI), placental thickness & placental grading were also included. The following variables were analyzed post delivery: • Gestation age at delivery: Normal term delivery is considered to be at 37 - 42 weeks and premature delivery is considered to be less than 37 weeks gestation. The HIV infected and uninfected groups were compared to assess if there \vas a significant difference in the number of preterm deliveries. • Birth weight: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of infants with low birth weight. • Perinatal complications: The HIV infected and uninfected groups were compared to assess if there was a significant difference in the number of perinatal complications and to assess if there was an association between the immune status (CD4 T-lymphocyte count) of HIV infected women and perinatal complications. Appropriate ethical principles in medical research were applied. The participant's autonomy, rights and best interests were always considered a priority. Informed consent was obtained from all the participants. Strict confidentiality was adhered to regarding any data collected throughout the study. The Research Ethics Committees at Cape Peninsula University of Technology and University of Cape Town granted ethics approval for the study. Statistical analysis was performed using the statistical package SPSS 12.0.
http://hdl.handle.net/11189/13
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Radiography
Measurement of absorbed dose for paediatric patients for the purpose of developing dose guidelines in paediatric radiology
Swart, Gillian,
2004
The radiation risks associated with children are higher than the risk for adults. Children have growing organs and they have a longer life expectancy than that of adults. As a consequence the effects of damage from radiation could be greater than in adults. Children who receive radiation damage may pass genetic damage onto future generations. This study was carried out to investigate the optimal effective x-ray dose young children need to receive who have radiographic examination to the chest at Tygerberg Hospital, South Africa. Chest radiographs are documented as being the most common radiographic examination done on children. The age groups of children participating in this study were 0-1 year, 1-5 years and 5-10 years. A total of 67 children were involved and the absorbed doses for 134 views of the anterior-posteria (AP) chest and lateral chest were measured. Entrance surface dose (ESD) values were determined, and measured mean ESD (mGy) and the ESD range was reported for each age group. This was done by attaching thermolurninescent dosirneters (TLD pellets) to the patients skin at the entrance point of the x-ray beam. The results were compared to similar studies done in Ireland and Nigeria From the ESD values obtained the absorbed doses ofthe eyes, heart, liver, thyroid and genitals could be calculated by using the "Childdose" programme ofthe NRPB. The ESD dose levels for South Africa compare favourably with Ireland. However the Nigerian values differed greatly from those of Ireland and South Africa It was very encouraging to note the comparative results achieved at Tygerberg Hospital especially due to the fact that this was the first time such study had been conducted in the Tygerberg Hospital Radiology Department. The results also compare favourable with that achieved by a group working in the United Kingdom. This group does similar surveys every five years as part of their radiation protection programme. The results were also in line with the UNSCEAR document of2000. v This study could serve as a valuable source of reference to radiographers and radiologists when performing paediatric radiology especially as the radiation absorbed dose could be used as a baseline to create awareness of size of dose received, and to limit deleterious radiation doses to patients and to prevent unnecessary exposures. A second significant outcome of the study was the effect that added filters had on the x-ray beam generated. Experiments were done in which the filtration filters were added sequentially. It was found that if the filtration was increased to 2mmAl the dose to the patient decreased by more than 20%. At 50 and 60 kV the density of the x-ray image on film only increased by 2%. From these results it may be concluded that an increase in filtration thickness used for paediatric chest x-rays should be giVIng reduced dose readings and assisting with radiation protection ofthe patient.
http://hdl.handle.net/11189/324
en
Peninsula Technikon
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Radiation -- Dosage
Professional communication practices of radiotherapists in the workplace and classroom in higher education in the Western Cape, South Africa.
Wyrley-Birch, Bridget Diana,
2008
The focus of this study is the professional communication practices of radiotherapists as clinical practitioners and as teachers of student/novice radiotherapists. The study was undertaken at a higher education institution and a radiation oncology department in South Africa and addressed the research question; what are the communication practices of radiotherapists in their professional practice and as higher education teachers. This work on professional communication was based on practice and discourse theory as relating to a local context of professional practice and education. Professional communication, seen in this sense, is a social practice which needs to be understood as operating within educational, work and social discursive practices of radiation therapy. A case study approach was chosen as the most appropriate research strategy for capturing the authentic communication practices of radiotherapists in clinical and educational practice. The professional communication practices of ten student and five qualified radiotherapists were investigated through typical teaching and learning interactions in a work integrated learning curriculum. The learning interactions were observed and video-taped in the classroom, tutorial, and demonstration room. Communication interactions were observed and audio taped in the clinical workplace. The research participants, using the video footage as part of their reflections, were interviewed about their communication practices. All interviews were audio taped and transcribed. Analysis of the data was by means of thematic analysis where the data was coded and categorised by means of pattern matching.
http://hdl.handle.net/11189/4828
en
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Ultrasound evaluation of the carotid artery in a population at high risk of type 2 diabetes mellitus
Isaacs, Ferial,
2015
BACKGROUND: Diabetic patients are at increased risk of cardiovascular events and stroke, and its prevention is therefore the desired goal. In the arsenal of available techniques, ultrasound plays a vital role in primary healthcare. It is reliable, cost-effective and a noninvasive diagnostic tool that may prove beneficial for screening individuals at risk of cardiovascular disease (CVD) and stroke in SA. OBJECTIVE: To determine the interrelationships between carotid ultrasound findings with glycaemia status and contributing risk factors of atherosclerosis in the selected population. METHODS: Initially blinded by the glycaemia status, blood results, contributing risks and patient demographics, both carotid arteries were evaluated with duplex ultrasound (DUS), during July 2010 – July 2011. Using graphs, figures, frequency tables, means and standard deviations for the selected study population, univariate, multivariate and stepwise regression analysis was done to determine the association between ultrasound findings and risk factors for atherosclerosis. The hypothesis tested in this study was to determine if there is an increased incidence of carotid artery intima-media thickening (CIMT), plaque formation and stenosis in patients diagnosed with T2DM and hyperglycaemia in a very specific sub-population of mixedancestory, residing in Bellville South Africa (BSA). RESULTS: Of 534 subjects, 375 were of mixed ancestry and ≥35yrs of age, which met the inclusion criteria for the carotid ultrasound substudy. The glycaemic status for each individual was established, and 44% (165/375) were diagnosed hyperglycaemic, of which 66.7% (110/165) were diabetic (T2DM) and 33.3% (55/165) were pre-diabetic (Pre-DM). Majority (56%:265/375) had a normal glycaemic status. The ultrasound measurement of the carotid wall thicknesses (Mean Rt. and Lt. CIMT) revealed a statistically significant rise from normal glycaemia status to DM status for both the males (p = 0.0115*; p = 0.0259*) and females (p < 0.0001**; p < 0.0001**) respectively. In terms of plaques and internal carotid artery (ICA) stenosis (124/375), when grouped into normal and hyperglycaemic sub-groups, indicated plaque presence and some form of narrowing. A <50% stenotic ratio noted in 61% (76/124) of the hyperglycaemic group, that was 1.6 times higher than those with normal glycaemia (48/124). Predisposing factors demonstrated significantly higher levels in the females than in the males. The univariate multiple regression analysis after adjusted R² of 0.3247 for all independent variables (predisposing /contributing risk factor markers) of age (yrs.), SBP (mmHg), hs-CRP (mg/L), S-Cotinine (ng/mL) and LDL (mmol/L) showed statistically significant positive associations with dependent variable of the mean carotid wall thickness (p < 0.0001**, p< 0.0001**, p = 0.0033*, p = 0.0409* and p = 0.0044)* respectively. Statistically significant positive differences and standard error (SE), for every unit of change (1yr.) of age (yrs.), as a contributing factor for herosclerosis, there was a change in the mean carotid wall thickness as predicted according to this model. The total contribution of independent risk factors to CIMT ultrasound measurements were calculated as 34.5% (Adjusted R² = 0.3247). In the multivariate stepwise regression analysis, the independent variables of age (p< 0.0001) ** and systolic blood pressure (p < 0.0001) ** showed the strongest positive association with carotid wall thickeness changes. The hs-CRP (mg/L) inflammatory markers (p = 0.0014)* and LDL (mmol/L) (p = 0.0208)* were the 2nd and 3rd highest positive associated contributory risk factors for carotid artery wall thickening. The hip circumference (p = 0.0008)* and waist circumference (p = 0.0 555) + risk factors related to obesity was significant and approached significance, respectively, with the predicted increase of carotid artery wall thickening. CONCLUSION: Subjects diagnosed with T2DM and hyperglycaemia had increased levels of CIMT, plaques and carotid artery stenosis, compared to those subjects without T2DM. Age and systolic blood pressure, inflammatory (raised hs-CRP) and LDL cholesterol changes, and central (truncal) waist circumference adiposity, were positively associated with increased carotid intima media thickness. Smoking (S-Cotinine) and gender also reflected a direct relationship with CIMT changes. The hip circumference adiposity and diastolic blood pressure measurements were not directly associated with an increase in CIMT, which are in keeping with hypertension and obesity formulas. These findings confirm the association of thickened CIMT, plaques and stenosis with ‘unhealthy’ T2DM subjects at higher risk of CVD and stroke. The total contribution of independent risk factors to CIMT measurements were calculated as 34.5% (Adjusted R² =0.3247). The gathered information, discussion of results, and concluding statements thereby supports the recommendation of carotid artery ultrasound evaluation, for screening and diagnosis in primary health care, for ‘flagging’ high risk individuals at risk of stroke, so that lifestyle changes and appropriate management is early adopted.
http://hdl.handle.net/11189/3163
en_ZA
Cape Peninsula University of Technology
http://creativecommons.org/licenses/by-nc-sa/3.0/za/
Doppler ultrasonography
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