Browsing by Author "Stefan, Daniela Cristina"

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    Aggressive desmoid fibromatosis : first case in a Rwandan child
    (Health & Medical Publishing Group, 2013-08-30) Kanyamuhunga, Aimable; McCall, Natalie; Tuyisenge, Lisine; Mumena, Crispus; Stefan, Daniela Cristina
    Desmoid tumours are a rare group of locally aggressive, non-malignant tumours of fibroblastic origin that can result in significant morbidity due to local invasion. Facial involvement in children with aggressive fibromatosis is uncommon. We present the case of a 14-month-old Rwandan child with an aggressive desmoid tumour involving the left mid-facial region. The patient presented with severe stertor due to massive nasal obstruction. After intensive supportive care the diagnosis was confirmed histopathologically. Treatment consisted of eight courses of chemotherapy with vincristine, actinomycin-D and cyclophosphamide followed by surgical removal of the remaining mass. The outcome was impressive and encouraging.
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    Childhood cancer survival rates in two South African units
    (Health & Medical Publishing Group, 2014-07) Stones, David K.; De Bruin, Gerhard P.; Esterhuizen, Tonya M.; Stefan, Daniela Cristina
    Introduction. Childhood cancer is relatively rare, but there is a very good chance of cure. While overall survival rates of >70% are reported from developed countries, survival is much less likely in developing countries and unknown in many countries in Africa. Objective. To analyse survival rates of childhood cancers in two South African paediatric oncology units. Methods. This retrospective review included all children (0 - 15 years) admitted with a malignancy at two paediatric oncology units (Universitas Hospital Academic Complex in Bloemfontein, Free State, and Tygerberg Hospital in Cape Town, Western Cape) between 1987 and 2011. The protocols used in the units were similar, and all the diagnoses were confirmed histologically. Results. There were 3 241 children, 53.5% of whom were males. Median follow-up was 17 months. The most common cancers were leukaemia (25.0%), brain tumours (19.5%), lymphoma (13.0%) and nephroblastoma (10.0%). The prevalences of neuroblastoma and retinoblastoma were similar at 5.8% and 5.7%, respectively. Overall survival was calculated to be 52.1%. Lymphoma and nephroblastoma had the highest survival rates at 63.9% and 62.6%, respectively. Brain tumours had the lowest survival rate at 46.4%. A comparison between ethnic groups showed white children to have the highest survival rate (62.8%); the rate for children of mixed racial origin was 53.8% and that for black children 48.5%. Conclusions. Overall survival rates for children admitted to two paediatric cancer units in South Africa were lower than data published from developed countries, because many children presented with advanced disease. New strategies to improve cancer awareness are urgently required.
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    The cost of nephroblastoma treatment in South Africa : a very cost-effective investment with guidelines for the rest of Africa
    (Health & Medical Publishing Group, 2014-11-13) Stefan, Daniela Cristina; Stones, D. K.; Van Zyl, A.; Uys, R.
    Background. Nephroblastoma is one of the most common childhood malignancies in Africa, but with a survival rate significantly lower than in developed countries. In African countries with a small gross domestic product (GDP) per capita, the cost of treating nephroblastoma may be prohibitive. Objectives. To determine the direct costs of treatment of nephroblastoma in South Africa (SA) and to propose a more cost-effective approach to investigations and treatment for the disease in Africa. Methods. Data from 2000 - 2010 from two SA paediatric oncology units were retrospectively analysed. The costs included investigations, chemotherapy and radiotherapy, comparing early-v. advanced-stage disease. In both units, the nephroblastoma International Society of Paediatric Oncology (SIOP) protocol was used. Results. Stage I disease was the most common, followed by stage IV. The total cost of diagnosis, staging and treatment of stage I disease was ZAR9 304.97 (EUR882.80 or USD1 093.40), compared with a five-times higher cost for stage IV (ZAR48 293.62 (EUR4 581.9 or USD5 674.9)). Treating one patient averted more than 32 disability adjusted life years. The investigation and treatment of early- and advanced-stage disease is very cost-effective when compared with the local GDP per capita. Conclusion. The cost of investigation and treatment of nephroblastoma remains a challenge everywhere, but especially in Africa. However, it is a very cost-effective disease to treat and children in Africa should not be denied treatment.
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    Developing a framework for an undergraduate haematology curriculum in a Faculty of Health Sciences
    (Stellenbosch : University of Stellenbosch, 2010-03) Stefan, Daniela Cristina; Bitzer, E. M.; Cilliers, F.; University of Stellenbosch. Faculty of Education. Dept. of Curriculum Studies.
    ENGLISH ABSTRACT: The Faculty of Health Sciences at Stellenbosch University adopted a new set of guidelines for curriculum design in 1997, emphasising an orientation towards the requirements of the public sector general practice, a holistic approach and exposure to community lifestyle and disease patterns specific to various communities. In order to ensure the anchoring in the realities of the general practice, a family medical practitioner, appointed by the Academy of Family Practice, was included in the curriculum control structure of the faculty. It was further recommended that a family medical practitioner should be included in the curriculum committee of each discipline, where appropriate. The present research, starting from the assumption that the opinion of a single family practitioner is insufficient to determine the adequacy of the curriculum for general medical practice, aimed to conduct a comprehensive needs analysis of all stakeholders in the undergraduate haematology training programme at the Faculty of Health, Stellenbosch University, and to compare the findings with the existing curriculum. To this purpose, the opinions of five adult medicine haematologists, ten paediatric haematologists, four laboratory haematologists, ten interns, fourteen students and twenty general practitioners were surveyed. An open-ended questionnaire on the usefulness of the haematology module for hospital and independent general practice was analysed, using the “coding technique” method. On this basis, a list of subjects was drawn and, using a Delphi method, the participants in the study were asked to rate their importance for practice. The answers to the open-ended questionnaires revealed a few overarching concepts, the most important being the need to structure the material taught in the form of “approaches”, supporting the differential diagnosis, which is the most frequent task of a general practitioner. Among the outcomes identified in the panellists‟ answers, the need to adequately detect and assess the “red flag” signs for haematological cancers was proposed for consideration as an outcome in the next curriculum. The Delphi survey indicated a group of subjects which were rated as most important for practice and another group designated as devoid of utility. The remaining subjects, rated as of moderate importance, could be further classified as diseases usually managed by the general practitioner and pathology which would be referred to a specialist for management. These iv findings were compared with the existing curriculum and the discrepancies were analysed, resulting in a set of proposals towards a framework for a new undergraduate haematology curriculum. For the first time in the literature, as far as can be determined, this research presents outcomes and content for an undergraduate haematology course which were defined and rated for importance by consensus of the curriculum developers, specialists in the field and graduates of the course. The methods tested in this process and some of the trends revealed might be useful for curriculum development in other medical disciplines.
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    Epidemiology of childhood cancer and the SACCSG tumour registry
    (Health and Medical Publishing Group (HMPG), 2010-07) Stefan, Daniela Cristina
    Childhood cancer is relatively rare, comprising less than 1% of cases of malignant disease. Cancer is the second most common cause of death in children in Western countries, while in Africa it is not even ranked among the 10 most common causes of death. Infections, nutritional disease, HIV and tuberculosis remain the most important paediatric health problems in developing countries. In developed countries, more than 80% of children with malignancies can be cured, but unfortunately most children with cancer live in developing countries, where the cure rate is much lower. In 2009 South Africa’s population was approximately 49 million, of whom 15 500 000 were in the age group 0 - 14 years. This translates to over 31% of the population, while in the USA and Western Europe the corresponding figures are 20%4 and 17%,5 respectively.
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    Nephroblastoma - a 25 year review of a South African unit
    (PubMed Central, 2014-09-15) Visser, Yolandi Thelma; Uys, Ronelle; Van Zyl, Anel; Stefan, Daniela Cristina
    Rationale: To determine the outcome of patients with nephroblastoma in a South African hospital. Objective: To determine if there is a difference in the outcome of patients with nephroblastoma comparing two treatment protocols SIOP (Société International D’Oncologie Pédiatrique Protocol) versus NWTS (National Wilms’ Tumour Study Protocol). Methods and results: A retrospective audit of 25 years (1983-2007), of children diagnosed with nephroblastoma in Tygerberg Hospital. One hundred and seven patients were included in the study and 98 were analyzed. The average age at diagnosis was 3.8 years. Most patients (37%) presented with stage 1 of the disease, followed by patients with stage 3 (27%). Most patients were treated according to the SIOP protocol (61%). Gender and race did not influence the outcome. Patients with stage 1 and 2 of the disease had the best outcome (76% versus 43% for stages 3 and 4). The SIOP group had a better outcome than the NWTS group (p value 0.001). The two groups had an equal distribution of the stage of presentation. The tumor volumes were bigger in the NWTS group (1004cm3 compared to 613cm3). Nutritional status did not influence the outcome although more patients were underweight for age in the SIOP group. The statistical methods used were: Kaplan Meier, Gehan’s Wilcoxon Test, Chi –square test and the Fisher exact test.