Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

M.Tech.

Cervical cancer is the leading cause of cancer related deaths and the second most common cancer amongst South African women. The key cause for cervical cancer development is sexual transmission and persistent infection with high-risk Human Papillomavirus (HPV). However, it takes several years from infection to cervical cancer development, suggesting that other factors contribute to the disease. Exposure of neoplastic epithelial cells to Seminal Fluid (SF) has been shown to promote cell proliferation in culture and growth of explants in mice injected with HeLa cervical adenocarcinoma cells. Since the majority of cervical cancer cases are squamous cell carcinoma, in this study, we examined the effect of SF on cancer cell proliferation, EMT, motility and gene expression using two squamous cell carcinoma cell line model systems, SiHa and Me180. This study shows that SF significantly enhanced cell proliferation in both cell lines. Using confocal microscopy and phalloidin staining, it was further shown that SF caused morphological changes and induced stress fibre formation. SF upregulated the expression of EMT transcription factors Snail, Twist and ZEB1. EMT induction was confirmed by the increase of N-cadherin and a decrease in E-cadherin protein expression. Additionally, results showed that the induction of EMT transcription factors Snail, Twist and ZEB1 by SF occurs via EP4 receptor, ERK1/2 and COX signaling pathways. To investigate the effect of SF on migration and invasion, transwell migration assays were used. SF significantly enhanced directional cell migration and invasion of SiHa and Me180 cells. Cell invasion was associated with an increase in MMP-2 and MMP-9. SF also induced proinflammatory and angiogenic gene expression in cervical squamous carcinoma cells. SF mediated induction of inflammatory and angiogenic genes was shown to be associated with AP-1 and NFkB transcription factors. A small molecule inhibitor of nuclear import, INI-43 inhibited the nuclear localization and activity of SF activated NF-kB as well as the expression of SF induced inflammatory and angiogenic genes. Employing ectocervical tissue biopsies, SF caused the upregulation of EMT transcription factors, MMPs, inflammatory and angiogenic genes. Taken together, these results suggest that SF may play a role in promoting EMT and enhances the migratory and invasive potential of cervical squamous cell carcinoma. These findings together implicate SF as a possible factor that may promote cervical cancer progression.

The management of women with mild and moderate dyskaryosis remains controversial. Any strategy must aim to be safe, efficient and cost effective. Two alternative strategies consist of immediate colposcopy for all women or a policy of cytological surveillance with colposcopy reserved for women with persistent dyskaryosis. Instead of a blanket policy for all women, selective approaches might be useful if accurate predictors of underlying high grade cervical intraepithelial neoplasia (CIN) were identified. Finally the effective treatment of women is important to prevent the development of invasive cancer. Large Loop Excision of the Transformation Zone or LLETZ is a relatively new treatment modality which has rapidly been established as the preferred treatment for women with CIN but it's efficacy has not been studied beyond a period of six months. The core of the thesis is description of a large prospective randomised study carried out in the University of Aberdeen. This was a four year project sponsored by the charity Birthright (now Well-being). Nine hundred and two women with a single smear showing mild or moderate dyskaryosis were recruited and allocated in a random fashion to either an immediate treatment group and one of three surveillance groups with periods of up to 24 months before treatment. Outcome measurements included the cytological and histological results. The cost effectiveness of two alternate management strategies for women with mild dyskaryosis is also described. The use of social factors and virological tests as secondary screening techniques is examined to determine if they might select women with high grade disease. Finally, the outcome of treatment of women including 400 women from the Birthright study using large loop excision of the transformation zone (LLETZ) is assessed.

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ABSTRACT: Whiplash-associated disorders are a common occurrence. Physiotherapy rehabilitation of such disorders include, among others, improving the recruitment ability of the deep cervical flexor muscles. Cervical proprioception, which has recently gained attention, is not commonly addressed. Evidence points to a possible link between cervical proprioception and deep cervical flexor recruitment ability. This study aimed to determine whether such a correlation exists. This is significant as it highlights the role that recruitment training of the deep cervical flexors has on cervical proprioception. A correlation study design was employed that involved 29 patients with whiplashassociated disorders. They were tested in their ability to perform the cranio-cervical flexion test and Revel’s test for proprioception. Linear regression was employed to interpret the results. This study concluded that a correlation exists between the ability to perform the craniocervical- flexion test and cervical proprioception.

MMed, Community Medicine, Faculty of Health Sciences, University of the Witwatersrand / INTRODUCTION: Cervical cancer continues to be a significant cause of morbidity and mortality, particularly in women in the developing world, due to the lack of effective population screening. It has proven difficult to implement and sustain cytological screening programmes as health systems in these settings are not functional. South Africa has adopted an organised cervical screening programme, and the goal is to screen 70% of women over 30 years nationally, within ten years of initiating the programme. However, it is also necessary to ensure that women with abnormal Pap smears are treated if we are to reduce cervical cancer incidence. Ensuring treatment of abnormal Pap smears is a challenge, and current data on this is needed to inform service delivery. AIM: The study aims to assess the current status of the cervical screening programme in the Johannesburg Metro District, specifically looking at screening coverage, and referral for treatment in women with abnormal Pap smears. METHODOLOGY: Secondary analysis of data in the District Health Information System was done; and registers at a sample of primary health care clinics and their referral colposcopy services were evaluated for the period April 2007 – March 2008. Descriptive statistics were employed to analyse the data. Multivariate analysis was also done to evaluate factors associated with colposcopy attendance. vi RESULTS: Screening coverage for the district was 6.3% for 2008 and the cumulative coverage from 2000 to 2008 was 35.8%, with significant variation between subdistricts. A high proportion (19%) of smears was done in women less than 30 years. Of 557 women with abnormal Pap smears requiring further treatment, 57% were informed of their results and referred, 38% had appointments for colposcopy, and only 28% attended these appointments. Women experienced long waiting times for appointments (up to 15 months), and there was inadequate record keeping and client tracing. HIV status and the sub-district and health authority where women were screened were associated with colposcopy attendance; the referral hospital was associated with length of waiting time between Pap smear and colposcopy. CONCLUSION: Cervical screening coverage is below target, and the referral for diagnosis and treatment remains a challenge. Unless referral and access to colposcopy services is improved, increasing screening coverage will not have an impact on decreasing cervical cancer incidence and mortality. It is hoped that this study will provide the data to target interventions to improve cervical screening coverage and effective referral and treatment in the district.

Thesis (MPH.) -- University of Limpopo, 2015 / Cervical cancer is a serious public health problem in both developed and developing countries. It is said to be the leading cause of death for women from developing countries as compared to other types of cancers. The aim of the study was to determine the initial clinical presentation of cervical cancer patients at the Pietersburg Hospital, Limpopo Province in South Africa. The objectives were to establish the demographic profile of cervical cancer patients, to identify the stage at initial clinical presentation, and to describe the factors that led to initial clinical presentation of cervical cancer patients at the Pietersburg Hospital in Limpopo Province, South Africa.The researcher conducted a quantitative retrospective cross-sectional survey by examining the records of cervical cancer patients seen for a period of three years from January 2012 to December 2014 at the Pietersburg. The results indicated that most patients, particularly the elderly, presented for the first time at the hospital with advanced stages of cervical cancer. Factors, such as age and place of residence contributed to this late presentation. There is a need for improved data capturing of information about marital status and parity to further assess the influence these two elements might have on the clinical presentation of cervical cancer. Furthermore, availability and facilities for screening should be improved because early detection of cervical cancer prevents progression to advanced stage of the disease. More awareness campaigns about risk factors of cervical cancer have to be implemented and a study is needed to establish why most patients with advanced stage cervical cancer are from Sekhukhune and Vhembe Districts, particularly the former Venda and Gazankulu Regions.

M.Tech. (Chiropractic) / The aim of this research study was to determine whether the adjustment of the cervical spine, specifically the atlanto-occipital joint, resulted in an increase in quadriceps muscle strength. Patients were recruited in response to advertisements placed in and around Technikon Witwatersrand (TWR), Doornfontein Campus. One hundred patients were included in the research (N=l00). The patients were then randomly divided into a treatment/adjustment group and a control group. Each group consisted of fifty patients. Both groups were then further divided into athletes without pain, athletes with pain, nonathletes without pain and non-athletes with pain. A full cervical spine regional examination was performed on each patient to isolate atlanto-occipital joint dysfunction and to rule out any contra-indications to treatment. The quadriceps muscle strength was measured three times at one-minute intervals in both groups. The treatment/adjustment group was then treated with a single chiropractic adjustment, specifically the superior condyle technique, to the atlanto-occipital joint and the control group rested for one-minute. Three quadriceps muscle strength readings were taken again in both groups. Each patient was treated once. The results from the two groups were then statistically analysed. It was hypothesised that the treatment group would benefit with regard to an increase in quadriceps muscle strength and that the control group would remain unchanged. The objective data was gathered using an isometric force-plate dynamometer and this was used to measure bilateral quadriceps muscle strength in kilograms. The objective data was analysed using Sign Test, Mann-Whitney U Test, One Sample t-Test and Independent Samples t-Test. The results of the study showed that the treatment group benefited with regard to quadriceps muscle strength, while the control group responded negatively and a decrease in quadriceps muscle strength was noted. The group with the greatest increase in quadriceps muscle strength was the non-athletic group with pain

M. Tech.