M.Tech.

Very little information exists about the acute presentation of overuse injuries specific to cycling. Although there are studies, mainly in the form of surveys, that do detail the incidence and prevalence of overuse injuries in cyclists or triathletes, they all take place weeks or even months after events or focus on a 1 year injury history. (Weiss 1985, Korkia et al. 1994, Wilber 1995, Manninen and Kallinen 1996 and Salai et al. 1999) The aim of this study was to describe the historical data obtained when patients presented to the Student Chiropractic Sports Council at the Pick ‘n Pay 94.7 Cycle Challenge from the years 2002 to 2004. The focus of the study was on the profile of injuries with which patients presented. This was a descriptive study of historical data obtained by students treating at the Pick ‘n Pay 94.7 Cycle Challenge from the year 2002 to 2004. The data was acquired in the form of SOAP (Subjective, Objective, Assessment, Plan) notes held by the Student Chiropractic Sports Council. The results of this study showed that the most common location of complaints were the anterior and posterior thigh. Musculotendinous strains were by far the most predominant injury with the hamstring being involved more commonly (33.8%) than any other muscle. Overall 72.8% of patients were diagnosed with musculotendinous strains. Further, the results also showed that 55.8% of patients complained of eck or back pain and 59.7% were diagnosed with cervical facet joint, thoracic facet joint, lumbar facet joint or sacroiliac joint dysfunction. / Dr. S. Wilcox Dr M. Moodley

M.A. / As medical technology and procedures continue to improve, traumatically brain injured persons who previously would not have lived through their injuries are managing to survive. The traumatically brain-injured person must learn to cope with the profound physical, cognitive, emotional, and personality changes that are produced from brain trauma. Within the family system, the members reciprocally influence one another. Major events that occur within the family system have an immense effect on the family relationships, dynamics, roles, and expectations. A traumatic brain injury, with its sudden onset and the inherent uncertainty regarding recovery and rehabilitation, can have a devastating effect on the family as a whole, and upon its individual members. Research on the familial effects of a member’s traumatic brain injury portrays a bleak image of the family in the aftermath of TBI, and for years afterwards. Grief, anger, guilt, blame, loneliness, depression, and isolation are often reported in the literature. The literature focuses mainly on the primary caregiver, usually the spouse of the TBI person, or the parent of a TBI child. Limited research has been conducted regarding the psychological effects on the offspring of parents who sustain traumatic brain injuries. Surely, children and adolescents will feel the effects of a parent’s brain injury differently than a spouse would. However the actual experience as perceived by the offspring has been neglected in research thus far. Adolescents were the focus of the current study. Being in a time of transition between childhood and adulthood, it was thought that they would experience the effects of a parental brain injury differently than younger children or adults within the family would. The existential-phenomenological approach employed as the research methodology allowed for a rich, in depth understanding of the adolescents as beings-in-the-world interpreting their own experiences of having a traumatically brain-injured parent. Six adolescent offspring of traumatically brain-injured parents were sourced from Headway Gauteng, and interviewed for the study. The four interviews that were used for the intense phenomenological analysis were transcribed verbatim. Themes were derived from the experience of each participant, and then integrated and related to the relevant available literature and within the wider context of existential phenomenology, in order to arrive at an in-depth understanding of the adolescent experience of a parent’s traumatic brain injury. The phenomenon of parental traumatic brain injury in the lifeworlds of the adolescents was characterized by numerous themes. Adolescents experienced (to varying degrees) denial, anger, grief, guilt, and anxiety. There was a tendency towards overprotectiveness of the injured parent, resulting in the parentification of the adolescents. Loneliness and a sense that nobody could understand their feelings were particularly strong themes, perhaps exacerbated by the importance of conformity during the adolescent period. Furthermore, the adolescents experienced drastic changes in their lives following their parents’ traumatic brain injuries. Not only were family roles and dynamics affected, but also the adolescents reported extensive changes in themselves. There were sudden increases in their responsibilities alongside a sense that they were forced to mature sooner than their peers. The adolescents coped using both approach and avoidance styles of coping. Religion was a theme in the lives of all four adolescents. Despite the professed negative impact of the experience of having a traumatically brain-injured parent, the adolescents in the current study managed to find some degree of positive meaning in having to cope with such a traumatic event and its consequences. Professionals working with brain-injured clients and their families will find value in the present study. The in-depth description of the experience of adolescents with brain-injured parents will be helpful in planning support programmes and interventions following familial brain injuries. The findings of this study have also been the basis for recommendations for future empirical investigations.

Magister Chirurgiae Dentium (MChD) / The literature shows that maxillofacial fractures in children are uncommon. Although the Department of Oral and Maxillofacial Surgery of the Faculty of Dentistry, of the University of the Western Cape, has been providing a service to the Red Cross Children’s Hospital (RXH) for the past twenty years, no study had been undertaken to determine the age, gender, number of patients per year, aetiology, patterns, and management of maxillofacial fractures at this institution. A retrospective records based study was undertaken to determine these features. This study accessed the records of patients seen at the trauma unit at RXH, from 1994 to 2003 inclusive, and referred for maxillofacial attention. One-hundred-and-five patient records were obtained and analyzed using the SPSS statistic package. One-hundred-and-twenty-seven fractures were recorded in one hundred and five patients. The age of the patients ranged from one to thirteen. Sixty-five male and forty female patients were seen. Dentoalveolar fractures were the most common fracture seen in both the midface and mandible. Midface fractures were more common than mandibular fractures. Falls, followed by motor vehicle accidents, were the most common cause of facial fractures. Most fractures were successfully managed by closed procedures. At this institution, nasal and frontal fractures have surprisingly little or no input from the Department of Oral and Maxillofacial Surgery. / South Africa

Objective: To describe the changes in plasma glucose concentration in severely injured, canine to canine bite wound cases admitted for veterinary treatment. The changes were measured over a period of 72 hours from the initiation of the trauma. Historical, signalment, clinical and haematological factors were investigated to determine their possible relationship to blood glucose concentration. Hypo- and hyperglycaemia have been associated with death from sepsis and acute injury. Method: Twenty dogs admitted to the Intensive Care Unit at Onderstepoort Veterinary Academic Hospital (OVAH) with severe bite wounds were evaluated. The time of injury was established by questioning the dogs’ owners. Blood was taken on admission for haematology and plasma glucose concentration. Haematology was repeated every 24 hours and glucose every 8 hours, measured from the time the dogs were first bitten. Results: On admission, 5% (1/20) of the dogs were hypoglycaemic, 40% (8/20) were normoglycaemic and 55% (11/20) were hyperglycaemic. No other dogs showed hypoglycaemia during the study period. The median glucose at each of the ten collection points, prior to the 56-hour collection point and at the 72 hour collection point, was in the hyperglycaemic range (5.8mmol/l to 6.2mmol/l). Puppies and thin dogs had considerably higher median plasma glucose concentrations than adult and fat dogs at 0 and 16 hours respectively (P < 0.05 for both). A high incidence of SIRS was encountered (65% to 80%). Fifteen dogs were alive at 72-hours. Thirteen dogs (81.3%) eventually made a full recovery. Three out of four dogs (75%) that were recumbent on admission, died, whereas all dogs (12/12) admitted with either an alert or depressed mental status survived (P = 0. 004). Clinical significance: The high incidence of hyperglycaemia may be explained by the ‘diabetes of injury’ phenomenon. The role of insulin therapy in the treatment of severe injuries should be explored in future studies, as its use in the treatment of human ICU cases, has resulted in a substantial reduction of fatalities resulting from acute injury. The high incidence of death and initial hyperglycemia in the collapsed group and the higher plasma glucose concentrations found in puppies and thin dogs warrants further investigation with a larger group of animals. / Dissertation (MMedVet (Small Animal Surgery))--University of Pretoria, 2007. / Companion Animal Clinical Studies / MMedVet / unrestricted

M.A. (Psychology) / The Post Traumatic Amnesic Syndrome, which follows a mild closed head injury, seems to be a common occurrence in the field of neuropsychology. The syndrome is primarily characterised by a transient memory loss of daily events, normally commencing within days after the injury. The symptoms include absent-mindedness, an inability to remember names, dates, numbers and faces, commands and orders given at work. Due to the relatively uncomplicated nature of a mild closed head injury, the syndrome is often overlooked and underestimated in terms of its intensity and psychological damage. Patients are sent home after a brief observation period and medical staff are of the opinion that the patients will recover successfully, without experiencing much psychological or cognitive strain. It is usually thought that the syndrome does not last for more than three to four months. The aim of the research was to determine the nature of the experience of not being able to remember daily events, as part of the post traumatic amnesic syndrome. The influence of the syndrome on the patients' support persons was also investigated

Purpose: Trigger points may occur when muscle is subject to direct trauma, sustained tension, fatigue, radiculopathy, joint dysfunction and emotional stress, which may cause aberrant nerve conduction and dysfunction of the motor neurons. Any of these factors may increase the possibility of overload stress to a muscle and may convert a latent trigger point to an active one. In humans, due to muscle attachments, spinal manipulation causes reflex relaxation of associated and distal musculature. The purpose of this study was to assess the effects of upper cervical spine manipulation, specifically C1, on pain tolerance of trigger points over the erector spinae muscles in show-jumping horses. Method: This study consisted of two groups, the experimental and the control group, each consisting of ten horses. Potential candidates were examined and accepted based on the inclusion and exclusion criteria. The only method of treatment that was administered to each horse was chiropractic manipulation to the most restricted side of the UPPER CERVICAL SPINE joint complex, from which the objective findings were based. Procedure: Both groups were examined for trigger points within the Erector Spinae muscles and these trigger points were assessed, via an algometer, for spot tenderness. All horses were then examined for a cervical restriction of the upper cervical spine. Only the experiment group had the restriction corrected by a chiropractic manipulation and thereafter both groups were reassessed two minutes later, and then again two weeks later, via an algometer, for spot tenderness within the same trigger points. Results: Statistically significant changes were found when comparing the algometer readings before the adjustment with the algometer readings after the adjustment on the right. Otherwise no statistically significant differences were found when comparing algometer readings before the adjustment with the algometer readings after the adjustment on the left, or when comparing the algometer readings before the adjustment with the algometer reading two weeks later bilaterally. Conclusion: The results were inconclusive with regards to immediate and prolonged effects of upper cervical spine manipulation, specifically C1, on pain tolerances over the erector spinae muscle. As this study was directed to a small group of subjects, accurate conclusions cannot be formulated due to the insignificant findings obtained from the study and further research needs to be performed on the effects of upper cervical spine manipulation on trigger points in horses. / Dr. Ashleigh Deall Dr. Alex Niven Dr. Chris Yelverton

In the Republic of South Africa, an autopsy is required in all cases of unnatural death, or in cases where the cause of death is unknown in terms of the Inquest Act of 1959. These are performed at the Salt River Medicolegal Laboratory by Forensic Pathologists and Registrars of the Department of Forensic Medicine and Toxicology of the University of Cape Town. The Salt River Medicolegal Laboratory serves the greater Cape Town area with a population of approximately 2,5 million, including the magisterial districts of Cape Town, Wynberg, Mitchell's Plain and Simonstown. Cape Town has one of the world's highest homicide rates and in 1986 the incidence was 56, 91 100000 population per annum. In contrast, Singapore has a homicide rate of only 2, 5/100 000, while the United States has an overall homicide rate of 7,7/ 100 000 population. In order to document the true impact of penetrating chest injuries, and to place mortality data in perspective, a retrospective descriptive study of all cases with fatal penetrating chest injuries admitted to the Salt River Medicolegal Laboratory in Cape Town during 1990 was undertaken. In 1990, a total of 5 758 cases was admitted to the Salt River Medicolegal Laboratory of which 1834 cases (39%) were the result of homicide. Of the homicide cases, 408 (22%) were the result of firearm injuries. A total of 2044 (35, 5%) cases admitted was deemed to have died of natural causes. This study identified a total of 841 cases of fatal penetrating injuries of the chest admitted during 1990, which constituted 22,6% of all non-natural cases admitted.

Thesis (Ph.D.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / In recent years, there has been a growing interest in natural and traditional medicines for the treatment of wounds. Attempts to find agents that promote wound-healing and that are affordable, effective and non-toxic have a long history. In South Africa, hundreds of different indigenous plants are used to treat wounds and burns. The merits of relatively few of these have been scientifically evaluated. Bulbine natalensis and Bulbine frutescens of the Asphodelaceae family are indigenous to southern Africa and are widely used as a skin remedy. This study aimed to investigate the in vitro and in vivo effect of Bulbine natalensis and Bulbine frutescens on cutaneous wound healing. In vitro cell culture study: In vitro studies were carried out on dermal fibroblasts and human keratinocytes cultured under standard conditions using Iscove’s Modified Eagles Medium (MEM) and Dulbecco’s MEM respectively. Confluent cultures of both cell lines were treated with varying concentrations of the leaf extracts of B. frutescens and B. natalensis. These cultures were subjected to the MTT, WST-1 and BrdU assays to determine the cytotoxicity and proliferation effect of the extracts. In addition, migration of cells across a score was analysed over a 48 hour period. In vivo animal study: Excisional and incisional wounds were created on the back of 12 domestic pigs. Mirror imaged wounds were created as control wounds. The excisional wounds were biopsied at days 2, 4, 7, 10 and 16 and the incisional wounds were biopsied at day 16. The rate of closure of the wounds was also recorded. Each excisional wound was analyzed for its biochemical composition by estimating the total amount of protein, DNA, collagen and hexosamine that was present in the wound tissue. The wound healing process was documented histologically (using haematoxylin and eosin and a Mallory’s trichrome stain) and immunohistochemically (using anti- α smooth muscle actin, vascular endothelial growth factor WitsETD and transforming growth factor β receptors I and II). The incisional wounds were used to test tensile strength of the healed wounds using a tensiometer.In the in vitro studies, neither extract caused cytotoxicity to either the fibroblast or keratinocyte cells. Cell proliferation was greater than 100% at 0.1-5 and 100-300 μg/ml for Bulbine natalensis and at 0.1μg/ml for Bulbine frutescens. There was no significant difference in the effects of the two leaf extracts on cell proliferation. The biochemical analysis of the wound tissue showed a significant increase in the collagen, protein and total DNA content of both B frutescens and natalensis treated wounds when compared to the untreated wounds. There was no significant difference in the hexosamine content of both B. frutescens- and B. natalensis-treated and untreated wounds. Analysis of the wound tissue displayed an increase rate of closure of the wound tissue treated with B. frutescens and B. natalensis when compared to the untreated wounds. Full re-epithelialisation of both treated wounds occurred earlier than in the untreated wounds. These findings have important implications for the use of these extracts to treat wound healing.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand Gauteng, 2017 / Background Soccer is a sport that is gaining in popularity in the elite and non-elite populations worldwide. As a result, the number of injuries in soccer is increasing. Hamstring injuries in particular, with a reported incidence rate as high as 63%, are of significant concern. Most hamstring injuries tend to occur during the swing phase of sprinting when hamstring activity is at its highest. As the speed of sprinting increases, greater mobility in the lumbo-pelvic area is required to maximise sprinting efficiency. Any abnormal or dysfunctional lumbo-pelvic movement during this phase could induce pain and hamstring injury. Lumbo-pelvic movement control dysfunction may therefore indirectly link abnormal lumbar spine movement to lumbo-pelvic pain and hamstring injury. The first aim of this study was to compare the performance of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles in soccer players, with and without recent hamstring injuries, while performing isometric contractions, a functional squat and sprinting. The study’s second aim was to compare lumbo-pelvic movement control in soccer players with and without recent hamstring injuries. Method Thirty soccer players were selected to participate in this study. Fifteen were assigned to the injured group and 15 to an uninjured group. The injured group comprised players who had sustained a hamstring injury six months prior to the research and who had partially returned to training, and the uninjured group comprised players with no recent hamstring injuries and who were actively involved in full training. Players were matched in respect of age, height, weight and playing position. All players gave informed written consent, completed the physical activity, training and injury questionnaire, and the Oslo hamstring injury questionnaire. Physical tests, which included isometric contraction of the erector spinae, gluteus maximus, hamstrings (biceps femoris) and quadriceps (rectus femoris) muscles, a functional squat and a thirty-metre sprint were done. Muscle activity during these tests was recorded via electromyography (EMG). To determine the lumbo-pelvic movement control of the players, the dorsal pelvic tilt, waiter’s bow, one leg stand and prone knee bend tests were used. Cohen's d (parametric) and Spearman’s correlation coefficient (nonparametric) were used to calculate the effect size, and the Chi-square test and Fisher’s exact to analyse the lumbopelvic movement control data. To establish a statistical significance, the p-value of the study was set at p<0.05. Results EMG muscle activity during isometric contractions was lower in the erector spinae muscles (p=0.04) and biceps femoris muscle (p=0.02) of the injured group. Both these findings were statistically significant. There was no statistically significant difference in muscle activity during the functional squat between the study and uninjured groups. The results of the EMG activity in the thirty-metre sprint were determined to be significant as they demonstrated that the hamstring muscle (p=0.01) activation in the injured group was decreased in comparison with the uninjured group. During the performance of the lumbo-pelvic test, no association was found between the two groups in the dorsal pelvic tilt and one leg stand. The performance of the waiter’s bow (p=0.01) and prone knee bend (p=0.004) revealed statistically significant differences between the study and uninjured groups. The majority of the players in the injured group performed both of these functional tests incorrectly (WB n=10; PKB n=14). Conclusion The study found that the hamstring muscle is at great risk of injury during eccentric contraction of the hamstring muscles. This can be associated with poor lumbo-pelvic movement control, as the load on the hamstring muscle is increased to provide intersegmental stability around the neutral zone, the area of high spinal flexibility. / MT2017