Rohen Harrichandparsad - Academia.edu (original) (raw)

Papers by Rohen Harrichandparsad

Research paper thumbnail of The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

British journal of anaesthesia, 2018

The surgical safety checklist is widely used to improve the quality of perioperative care. Howeve... more The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (1...

Research paper thumbnail of Knowledge, Attitudes, Beliefs and Practices of the WHO Surgical Checklist in Neurosurgery at a Quaternary Referral Hospital, Durban, South Africa

Interdisciplinary Neurosurgery

Research paper thumbnail of Ophthalmic artery arising from the external carotid artery system: the middle meningeal artery in South African patients

BMC Ophthalmology, May 29, 2023

Background The ophthalmic artery is the first branch of the internal carotid artery. It arises fr... more Background The ophthalmic artery is the first branch of the internal carotid artery. It arises from the supraclinoid segment of the internal carotid artery within the subarachnoid space and enters the orbit via the optic canal. However, due to complex embryogenesis, the ophthalmic artery can arise from different parts of the internal carotid artery or the distal branches of the external carotid artery. This is usually associated with a variation in the course of the ophthalmic artery through the superior orbital fissure instead of coursing through the optic canal. The ophthalmic artery and its branches vascularise the eyeball and its contents. Consequently, information about its morphologic variation is essential for treating clinical conditions such as central retinal artery occlusion, retinoblastoma chemoembolization, and ophthalmic artery aneurysm. Case presentation We report on two cases of the ophthalmic artery arising from the middle meningeal artery in one adult (33-year-old Indian female) and one pediatric (2-year-old African male) South African patient examined by digital subtraction angiography. The patients were diagnosed with arteriovenous malformations and bilateral retinoblastoma, respectively. Conclusions The ophthalmic artery plays a vital role in vision generation. Thus, its anatomy is of clinical interest to neurosurgeons, ophthalmologists, and interventional radiologists.

Research paper thumbnail of Right vertebral artery arising from the right common carotid artery with an absent brachiocephalic trunk

Surgical and Radiologic Anatomy, May 23, 2022

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abno... more Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supraaortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Research paper thumbnail of Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients

Scientific Reports, Jun 9, 2021

The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the ... more The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.

Research paper thumbnail of World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Federation Assembly neurointerventional surgery safety checklist

Journal of NeuroInterventional Surgery

Research paper thumbnail of World federation of interventional and therapeutic neuroradiology (WFITN) federation assembly neurointerventional surgery safety checklist

Interventional Neuroradiology

Over the last 10 years, there has been a rise in neurointerventional case complexity, device vari... more Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of ‘checking off boxes’. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Feder...

Research paper thumbnail of Dept of Neurosurgery - IALCH - Peer Review Meeting 2014

Research paper thumbnail of The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

British Journal of Anaesthesia, 2018

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa ha... more Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration: NCT03044899.

Research paper thumbnail of Cervical spondylotic myelopathy : a prospective study of outcome after surgery

7 DECLARATION 10 ACKNOWLEDGEMENTS 11 ETHICAL CONSIDERATIONS 12 LIST OF FIGURES 13 LIST OF TABLES ... more 7 DECLARATION 10 ACKNOWLEDGEMENTS 11 ETHICAL CONSIDERATIONS 12 LIST OF FIGURES 13 LIST OF TABLES 14 ABBREVIATIONS AND DEFINITION OF TERMS 17 CHAPTER

Research paper thumbnail of Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

South African Journal of Radiology

Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASA... more Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASAH at 3 months. Increased number of haemosiderin zones on SWI correlated with older patient age (p = 0.0003). Clinical severity (World Federation Neurosurgical Societies Score) showed a tendency towards a statistically relevant relationship (p = 0.07). No statistically significant relationship was identified between the number of haemosiderin zones and initial CT modified Fisher score (p = 0.34) or the causative aneurysm location (p = 0.37). Conclusion: Susceptibility weighted imaging is sensitive in the detection of ASAH at 3 months, increasing in sensitivity with patient age and higher initial clinical severity. Contribution: In patients presenting in the subacute to chronic phase with a clinically suspicious history of previous aneurysm rupture but without convincing CT or spectrophotometry evidence, SWI can detect previous rupture. This can identify patients who could benefit from endovascular treatment and those who can safely undergo follow-up imaging.

Research paper thumbnail of The right vertebral artery arising from the right common carotid artery: report of a rare case

Surgical and Radiologic Anatomy, 2020

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abno... more Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supraaortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Research paper thumbnail of Author response: HIV status alters disease severity and immune cell responses in Beta variant SARS-CoV-2 infection wave

There are conflicting reports on the effects of HIV on COVID-19. Here, we analyzed disease severi... more There are conflicting reports on the effects of HIV on COVID-19. Here, we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (Beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV-negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

Research paper thumbnail of The potential of serum S100 calcium-binding protein B and glial fibrillary acidic protein as biomarkers for traumatic brain injury

Translational Research in Anatomy

Research paper thumbnail of Anterior Synostotic Plagiocephaly: A Quantitative Analysis of Craniofacial Features Using Computed Tomography

Journal of Craniofacial Surgery

I, Miss Nivana Mohan, declare as follows: 1) That the work described in this thesis has not been ... more I, Miss Nivana Mohan, declare as follows: 1) That the work described in this thesis has not been submitted to the University of KwaZulu-Natal or other tertiary institutions for purposes of obtaining an academic qualification, whether by myself or any other party. 2) That my contribution to the project as primary author and principal investigator was as follows: • collection of data needed for literature review; • collection, analysis, and interpretation of data; and • formulation of manuscripts and compilation of the research dissertation. 3) That the contributions of others to the project were as follows: • Prof L. Lazarus acted as the main supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done. • Prof A. Madaree acted as co-supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done. • Prof R. Harrichandparsad acted as co-supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done.

Research paper thumbnail of Anatomical variations of dominant anastomotic veins in the superficial cortical venous system

Translational Research in Anatomy

Research paper thumbnail of Fenestration of the vertebrobasilar junction detected with multidetector computed tomography angiography

Folia Morphologica, 2021

The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomic... more The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomical variations. It has been hypothesized that the formation of fenestrations are likely to occur due to the failure of regression of the bridging arteries that connect the longitudinal neural arteries during embryogenesis. Fenestration of the vertebrobasilar system is a rare anatomical variation that involves a luminal division of the artery, that has a single origin into two separate and parallel channels which are rejoined distally. Fenestrations are important anatomical variants in patients undergoing endovascular and invasive intracranial interventions. Vascular fenestration has been associated with aneurysms, arteriovenous malformations, neuralgia, and vertebrobasilar ischemia. We report on three cases of fenestration at the vertebrobasilar junction in one female and two male patients, respectively, using multidetector computed tomography angiography. The length of the fenestrated segment of the artery measured 4.41 mm, 3.90 mm, and 5.90 mm, respectively in the patients. Our report is clinically important as the presence of this anatomical variation may influence the management of cervical and intracranial pathologies. Increased awareness of the prevalence of anatomic variations contributes to the advancement of noninvasive imaging capabilities.

Research paper thumbnail of An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population

Surgical and Radiologic Anatomy, 2021

Introduction The most common type of vascular complication during cervical spine surgery is the v... more Introduction The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population. Materials and methods The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019. Results The VA exhibited morphological variation in its course....

Research paper thumbnail of Immunogenicity of SARS-CoV-2 infection and Ad26.CoV2.S vaccination in people living with HIV

SummaryBackgroundPeople living with HIV (PLWH) have been reported to have an increased risk of mo... more SummaryBackgroundPeople living with HIV (PLWH) have been reported to have an increased risk of more severe COVID-19 disease outcome and an increased risk of death relative to HIV-uninfected individuals. Here we assessed the ability of the Johnson and Johnson Ad26.CoV2.S vaccine to elicit neutralizing antibodies to the Delta variant in PLWH relative to HIV-uninfected individuals. We also compared the neutralization after vaccination to neutralization elicited by SARS-CoV-2 infection only in HIV-uninfected, suppressed HIV PLWH, and PLWH with detectable HIV viremia.MethodsWe enrolled 26 PLWH and 73 HIV-uninfected participants from the SISONKE phase 3b open label South African clinical trial of the Ad26.CoV2.S vaccine in health care workers (HCW). Enrollment was a median 56 days (range 19-98 days) post-vaccination and PLWH in this group had well controlled HIV infection. We also enrolled unvaccinated participants previously infected with SARS-CoV-2. This group consisted of 34 PLWH and 2...

Research paper thumbnail of Morphometric analysis of Kocher's and Frazier's points in a small sample taken from the South African scaphocephalic paediatric population: A preliminary study

Translational Research in Anatomy

Research paper thumbnail of The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

British journal of anaesthesia, 2018

The surgical safety checklist is widely used to improve the quality of perioperative care. Howeve... more The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (1...

Research paper thumbnail of Knowledge, Attitudes, Beliefs and Practices of the WHO Surgical Checklist in Neurosurgery at a Quaternary Referral Hospital, Durban, South Africa

Interdisciplinary Neurosurgery

Research paper thumbnail of Ophthalmic artery arising from the external carotid artery system: the middle meningeal artery in South African patients

BMC Ophthalmology, May 29, 2023

Background The ophthalmic artery is the first branch of the internal carotid artery. It arises fr... more Background The ophthalmic artery is the first branch of the internal carotid artery. It arises from the supraclinoid segment of the internal carotid artery within the subarachnoid space and enters the orbit via the optic canal. However, due to complex embryogenesis, the ophthalmic artery can arise from different parts of the internal carotid artery or the distal branches of the external carotid artery. This is usually associated with a variation in the course of the ophthalmic artery through the superior orbital fissure instead of coursing through the optic canal. The ophthalmic artery and its branches vascularise the eyeball and its contents. Consequently, information about its morphologic variation is essential for treating clinical conditions such as central retinal artery occlusion, retinoblastoma chemoembolization, and ophthalmic artery aneurysm. Case presentation We report on two cases of the ophthalmic artery arising from the middle meningeal artery in one adult (33-year-old Indian female) and one pediatric (2-year-old African male) South African patient examined by digital subtraction angiography. The patients were diagnosed with arteriovenous malformations and bilateral retinoblastoma, respectively. Conclusions The ophthalmic artery plays a vital role in vision generation. Thus, its anatomy is of clinical interest to neurosurgeons, ophthalmologists, and interventional radiologists.

Research paper thumbnail of Right vertebral artery arising from the right common carotid artery with an absent brachiocephalic trunk

Surgical and Radiologic Anatomy, May 23, 2022

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abno... more Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supraaortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Research paper thumbnail of Radiological anatomy of the intracranial vertebral artery in a select South African cohort of patients

Scientific Reports, Jun 9, 2021

The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the ... more The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and Caucasian) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Understanding the patterns of anatomical variations of the VAs will contribute significantly to the interpretation of ischemic areas and diagnosis of various diseases in the posterior circulatory territory.

Research paper thumbnail of World Federation of Interventional and Therapeutic Neuroradiology (WFITN) Federation Assembly neurointerventional surgery safety checklist

Journal of NeuroInterventional Surgery

Research paper thumbnail of World federation of interventional and therapeutic neuroradiology (WFITN) federation assembly neurointerventional surgery safety checklist

Interventional Neuroradiology

Over the last 10 years, there has been a rise in neurointerventional case complexity, device vari... more Over the last 10 years, there has been a rise in neurointerventional case complexity, device variety and physician distractions. Even among experienced physicians, this trend challenges our memory and concentration, making it more difficult to remember safety principles and their implications. Checklists are regarded by some as a redundant exercise that wastes time, or as an attack on physician autonomy. However, given the increasing case and disease complexity along with the number of distractions, it is even more important now to have a compelling reminder of safety principles that preserve habits that are susceptible to being overlooked because they seem mundane. Most hospitals have mandated a pre-procedure neurointerventional time-out checklist, but often it ends up being done in a cursory fashion for the primary purpose of ‘checking off boxes’. There may be value in iterating the checklist to further emphasize safety and communication. The Federation Assembly of the World Feder...

Research paper thumbnail of Dept of Neurosurgery - IALCH - Peer Review Meeting 2014

Research paper thumbnail of The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

British Journal of Anaesthesia, 2018

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa ha... more Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration: NCT03044899.

Research paper thumbnail of Cervical spondylotic myelopathy : a prospective study of outcome after surgery

7 DECLARATION 10 ACKNOWLEDGEMENTS 11 ETHICAL CONSIDERATIONS 12 LIST OF FIGURES 13 LIST OF TABLES ... more 7 DECLARATION 10 ACKNOWLEDGEMENTS 11 ETHICAL CONSIDERATIONS 12 LIST OF FIGURES 13 LIST OF TABLES 14 ABBREVIATIONS AND DEFINITION OF TERMS 17 CHAPTER

Research paper thumbnail of Why SWI? The sensitivity of susceptibility weighted imaging in aneurysmal subarachnoid haemorrhage in the chronic phase

South African Journal of Radiology

Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASA... more Results: Susceptibility weighted imaging indicated a sensitivity of 95.7% in the detection of ASAH at 3 months. Increased number of haemosiderin zones on SWI correlated with older patient age (p = 0.0003). Clinical severity (World Federation Neurosurgical Societies Score) showed a tendency towards a statistically relevant relationship (p = 0.07). No statistically significant relationship was identified between the number of haemosiderin zones and initial CT modified Fisher score (p = 0.34) or the causative aneurysm location (p = 0.37). Conclusion: Susceptibility weighted imaging is sensitive in the detection of ASAH at 3 months, increasing in sensitivity with patient age and higher initial clinical severity. Contribution: In patients presenting in the subacute to chronic phase with a clinically suspicious history of previous aneurysm rupture but without convincing CT or spectrophotometry evidence, SWI can detect previous rupture. This can identify patients who could benefit from endovascular treatment and those who can safely undergo follow-up imaging.

Research paper thumbnail of The right vertebral artery arising from the right common carotid artery: report of a rare case

Surgical and Radiologic Anatomy, 2020

Anomalous origins of the vertebral arteries are uncommon and generally associated with other abno... more Anomalous origins of the vertebral arteries are uncommon and generally associated with other abnormalities of the supraaortic vessels. We present an extremely rare case where the right vertebral artery is arising from the right common carotid artery, with an absent brachiocephalic trunk, and the right common carotid artery as the first branch of the aortic arch followed by right subclavian artery, without any other abnormalities of the supra-aortic vessels. This vessel variation can affect endovascular procedures, surgical interventions and cause some unexpected clinical symptoms.

Research paper thumbnail of Author response: HIV status alters disease severity and immune cell responses in Beta variant SARS-CoV-2 infection wave

There are conflicting reports on the effects of HIV on COVID-19. Here, we analyzed disease severi... more There are conflicting reports on the effects of HIV on COVID-19. Here, we analyzed disease severity and immune cell changes during and after SARS-CoV-2 infection in 236 participants from South Africa, of which 39% were people living with HIV (PLWH), during the first and second (Beta dominated) infection waves. The second wave had more PLWH requiring supplemental oxygen relative to HIV-negative participants. Higher disease severity was associated with low CD4 T cell counts and higher neutrophil to lymphocyte ratios (NLR). Yet, CD4 counts recovered and NLR stabilized after SARS-CoV-2 clearance in wave 2 infected PLWH, arguing for an interaction between SARS-CoV-2 and HIV infection leading to low CD4 and high NLR. The first infection wave, where severity in HIV negative and PLWH was similar, still showed some HIV modulation of SARS-CoV-2 immune responses. Therefore, HIV infection can synergize with the SARS-CoV-2 variant to change COVID-19 outcomes.

Research paper thumbnail of The potential of serum S100 calcium-binding protein B and glial fibrillary acidic protein as biomarkers for traumatic brain injury

Translational Research in Anatomy

Research paper thumbnail of Anterior Synostotic Plagiocephaly: A Quantitative Analysis of Craniofacial Features Using Computed Tomography

Journal of Craniofacial Surgery

I, Miss Nivana Mohan, declare as follows: 1) That the work described in this thesis has not been ... more I, Miss Nivana Mohan, declare as follows: 1) That the work described in this thesis has not been submitted to the University of KwaZulu-Natal or other tertiary institutions for purposes of obtaining an academic qualification, whether by myself or any other party. 2) That my contribution to the project as primary author and principal investigator was as follows: • collection of data needed for literature review; • collection, analysis, and interpretation of data; and • formulation of manuscripts and compilation of the research dissertation. 3) That the contributions of others to the project were as follows: • Prof L. Lazarus acted as the main supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done. • Prof A. Madaree acted as co-supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done. • Prof R. Harrichandparsad acted as co-supervisor, aiding in the formulation of the research idea and study design, reviewing all work before submission, giving corrections and feedback on work done.

Research paper thumbnail of Anatomical variations of dominant anastomotic veins in the superficial cortical venous system

Translational Research in Anatomy

Research paper thumbnail of Fenestration of the vertebrobasilar junction detected with multidetector computed tomography angiography

Folia Morphologica, 2021

The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomic... more The complex embryonic origin of the vertebrobasilar system may result in a wide range of anatomical variations. It has been hypothesized that the formation of fenestrations are likely to occur due to the failure of regression of the bridging arteries that connect the longitudinal neural arteries during embryogenesis. Fenestration of the vertebrobasilar system is a rare anatomical variation that involves a luminal division of the artery, that has a single origin into two separate and parallel channels which are rejoined distally. Fenestrations are important anatomical variants in patients undergoing endovascular and invasive intracranial interventions. Vascular fenestration has been associated with aneurysms, arteriovenous malformations, neuralgia, and vertebrobasilar ischemia. We report on three cases of fenestration at the vertebrobasilar junction in one female and two male patients, respectively, using multidetector computed tomography angiography. The length of the fenestrated segment of the artery measured 4.41 mm, 3.90 mm, and 5.90 mm, respectively in the patients. Our report is clinically important as the presence of this anatomical variation may influence the management of cervical and intracranial pathologies. Increased awareness of the prevalence of anatomic variations contributes to the advancement of noninvasive imaging capabilities.

Research paper thumbnail of An anatomical investigation of the proximal vertebral arteries (V1, V2) in a select South African population

Surgical and Radiologic Anatomy, 2021

Introduction The most common type of vascular complication during cervical spine surgery is the v... more Introduction The most common type of vascular complication during cervical spine surgery is the vertebral artery (VA) injury. The presence of anatomical variation in the artery's morphology has been a significant factor for arterial injury during surgery. Therefore, physicians planning interventions in the craniospinal region need to be aware of the extents of variations. In addition to vascular injury, anatomical variations can predispose to some pathologies in the posterior circulation territory. To provide useful data to interventional radiologists, anatomists, and surgeons, we evaluated the anatomical features of the V1 and V2 segments of the VA in a South African population. Materials and methods The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian and White) who had undergone computed tomography angiography (CTA) from January 2009 to September 2019. Results The VA exhibited morphological variation in its course....

Research paper thumbnail of Immunogenicity of SARS-CoV-2 infection and Ad26.CoV2.S vaccination in people living with HIV

SummaryBackgroundPeople living with HIV (PLWH) have been reported to have an increased risk of mo... more SummaryBackgroundPeople living with HIV (PLWH) have been reported to have an increased risk of more severe COVID-19 disease outcome and an increased risk of death relative to HIV-uninfected individuals. Here we assessed the ability of the Johnson and Johnson Ad26.CoV2.S vaccine to elicit neutralizing antibodies to the Delta variant in PLWH relative to HIV-uninfected individuals. We also compared the neutralization after vaccination to neutralization elicited by SARS-CoV-2 infection only in HIV-uninfected, suppressed HIV PLWH, and PLWH with detectable HIV viremia.MethodsWe enrolled 26 PLWH and 73 HIV-uninfected participants from the SISONKE phase 3b open label South African clinical trial of the Ad26.CoV2.S vaccine in health care workers (HCW). Enrollment was a median 56 days (range 19-98 days) post-vaccination and PLWH in this group had well controlled HIV infection. We also enrolled unvaccinated participants previously infected with SARS-CoV-2. This group consisted of 34 PLWH and 2...

Research paper thumbnail of Morphometric analysis of Kocher's and Frazier's points in a small sample taken from the South African scaphocephalic paediatric population: A preliminary study

Translational Research in Anatomy