A study of the causes of liver enlargement amongst black patients at King Edward VIII Hospital, Durban, South Africa has revealed that congestive cardiac failure (36.7%), amoebic liver abscess (7.1%), hepatocellular carcinoma (5.8%) and cirrhosis (5.4%) are the most common causes in this population. Liver biopsy was needed to determine the cause in 28.7% of patients studied. The diagnostic yield of percutaneous liver biopsy was increased by obtaining 2 or 3 consecutive specimens for histological examination by redirecting the biopsy needle through a single entry site. This benefit was achieved without an increase in morbidity or mortality. Fatalities and complications associated with liver biopsy were more frequent at this hospital than in hospitals in Europe, The United Kingdom and North America. The complication rates after percutaneous or peritoneoscopic biopsy were 2.0% and 2.3% respectively. A total of 6 deaths was recorded. The morbidity and mortality rates were not increased when more than one specimen was taken during percutaneous biopsy. In the majority of patients in whom biopsy was carried out, after-care was either non-existent or inadequate. The "Tru-Cut" needle was used for all percutaneous liver biopsies at King Edward VIII Hospital. Two techniques, including the method recommended by the manufacturer, have been found to be incorrect; the needle must be used correctly if an adequate biopsy specimen is to be obtained for histological examination and if serious complications are to be avoided. Hepatic tuberculosis was diagnosed in 9% of patients with unexplained hepatomegaly who were subjected to liver biopsy. This disease did not yield any consistent clinical findings. In addition, liver function tests were of little diagnostic value and results of hepatic imaging techniques were often normal. Accordingly, a high index of suspicion is needed and liver biopsy is essential in patients with unexplained hepatomegaly or hepatospienomegaly, or pyrexia of unknown origin since biopsy provides the only means of diagnosing hepatic tuberculosis. The accuracy of both ultrasonography and scintigraphy in distinguishing between normal and diseased livers was low (68% and 74% respectively). These techniques performed better at detecting focal than diffuse liver disease; the sensitivity of ultrasonography and scintigraphy in focal and diffuse disease were 88% and 92%, and 27% and 54% respectively. The specificity of both procedures was high for both types of liver disease (range 91-96%). Overlap between the ultrasonographic features of amoebic liver abscess, hepatocellular carcinoma and metastatic carcinoma resulted in a correct final diagnosis being made in only 81% of patients with amoebic liver abscess, 29% with hepatocellular carcinoma and 43% of patients with metastatic carcinoma who had an ultrasound scan. Neither technique was capable of determining the cause of diffuse liver disease. Therefore, when diffuse parenchymal liver disease is suspected, liver biopsy is needed to determine the presence and nature of the disease. In addition, liver biopsy or aspiration is usually required to determine the cause of focal disease in selected patients in whom space-occupying lesions are detected on hepatic imaging studies. / Thesis (M.D.)-University of Natal, Durban, 1990.

M.Tech. (Homoeopathy) / Hypertension is one of the major cardiovascular diseases worldwide. It is a major cause of morbidity and mortality and this is mainly caused by heart and renal diseases (Alhalaiqa et al., 2011). Hypertension is common in South Africa. About a quarter of all South Africans, 15 years and older, suffer from hypertension (Steyn, 1998). There are 6.1 million people with a blood pressure equal to or above 140/90 mmHg, 23% of South African men are hypertensive and for women the equivalent prevalence is 16% (South African Demographic and Health Survey, 1998). Allopathic anti-hypertensive drugs are not always effective or well tolerated due to their many harmful side effects (Ahmad, 1999). Homoeopathy though, does not have unwanted side effects (Digby, 1997). The aim of this study is to ascertain the efficacy of a homoeopathic complex containing Crataegus oxycantha 6CH, Viscum album 6CH, Glonoine 6CH and Digitalis purpurea 6CH in treating essential hypertension in black adults between the ages of eighteen and fifty five years. The study was a randomised double-blind placebo controlled study and thirty male and female participants were recruited and divided into the treatment and the placebo group. Three participants withdrew from the study during the trial period and therefore twenty seven participants were in this study. The treatment group was administered the homoeopathic complex remedy and the placebo group was administered the placebo. Participants received medication which they took for six weeks according to proper instructions. They were requested not to make any substantial changes to their lifestyle and diet. The blood pressure readings were monitored every two weeks for the six weeks duration of the study. Collected data was analysed using the analysis of variance (ANOVA) test to determine the statistical significance of changes in the mean systolic and diastolic blood pressure and in the symptoms that the participants had during the study. The analysis compared the variables between and within the two groups. The inter-group statistical analysis was done using the Mann-Whitney Test. The intra-group statistical analysis was done using the non-parametric test (Friedman Test). The difference between the two groups over time was done using the Post-Hoc Test. The Post-Hoc test analysis with Wilcoxon The homoeopathic remedy complex provided a statistically significant decrease in systolic blood pressure readings compared to the placebo. The diastolic blood pressure of the treatment group also decreased, and that of the placebo group decreased gradually. In the treatment group the most significant symptomatic relief was from headaches and vertigo. The other symptoms slightly decreased in the second week and then remained constant. In the placebo group there was a slight relief of the headache and vertigo symptoms but it was not significant. The homoeopathic complex remedy provided a statistically significant decrease in systolic blood pressure readings. This provides a safe and effective alternative treatment for essential hypertension.

The aims and objects of this work, as outlined in the introduction, were to a s s e s s the necropsy incidence of deaths due to heart failure in the African in Durban, to a s s e s s the necropsy incidence of the various aetiological types of heart failure with particular reference to right ventricular hypertrophy and failure, and to compare and contrast the incidence, complications, morbidity and mortality of heart disease in the Natal African with the same in other African and racial groups, both in South African and elsewhere. Many of the points emerging from this work merely confirm what has long been known, but others refute previous concepts. The all-age average necropsy incidence of deaths from heart failure in the African in Durban is of the order of 8%. This percentage does not, unfortunately, lend itself to straight comparison with most other series because of the high infant mortality shown in the present study. However, in considering deaths due to heart failure in the 10-plus age groups, the African still shows a lower mortality from heart disease in comparison with figures obtained for Indians or those reported for the Coloured and White races in South Africa. There are six major causes of heart disease in the African, which in order of frequency are, rheumatic heart disease, hypertensive heart disease, cardiomyopathy, cor pulmonale, pericarditis, and syphilitic heart disease. While little difference is apparent in the incidence of rheumatic and hypertensive heart disease, and possibly cor pulmonale, among the various races, cardiomyopathy, pericarditis and syphilitic heart disease are far more important causes of heart failure in the African by contrast with the other racial groups in South Africa. Although coronary a r t e r y disease is by comparison very uncommon in the African, cardiomyopathy, pericarditis, and syphilitic heart disease together claim as many deaths from heart failure in these people as does coronary heart disease among the Indian and White races in the Republic. Except for minor variations in the incidence of certain aetiological types, and the geographical distribution of endomyocardial fibrosis and cardiomyopathy/. . cardiomyopathy, the g e n e r a l p a t t e r n of h e a r t d i s e a s e among the Africans in Natal a p p e a r s to be s i m i l a r to that r e p o r t e d from other P r o v i n c e s in South Africa and most other c o u n t r i e s on the continent. Rheumatic h e a r t d i s e a s e is r e s p o n s i b l e for 21. 5% of all deaths from congestive h e a r t failure in the African in Durban. The immediate and the l a t e c a r d i a c complications of r h e u m a t i c fever in the Durban African a r e , on the whole, found to be no different from those r e p o r t e d in W e s t e r n communities. The findings in t h i s study t h e r e f o r e refute the view that r h e u m a t i c h e a r t d i s e a se i s infrequent in the African after the age of 40 y e a r s , and failed to support the suggestion that the d i s e a s e affects them m o r e s e v e r e l y or that death from r h e u m a t i c heart d i s e a s e o c c u r s at an e a r l i e r age in t h i s r a c e . While it is a g r e e d that s e v e r e valvular deformity in young African subjects (under 15 y e a rs of age) o c c u r s c o m p a r a t i v e l y m o r e frequently, it must be stated that this is in no way p e c u l i a r to the African, similar lesions being o b s e r v e d in Indian s u b j e c t s of c o r r e s p o n d i n g age. Hypertensive h e a r t d i s e a s e is common among the African in Durban, accounting among t h em for 18. 9% of all deaths from congestive h e a r t f a i l u r e. While both e s s e n t i a l and secondary forms of h y p e r t e n s i o n occur in the local indigenous population, the former appears to be m o r e common, with a peak incidence in the seventh decade of life. Secondary hypertension, mostly r e n a l in origin, is an i m p o r t a n t cause of h y p e r t e n s i v e congestive c a r d i ac f a i l u r e in the fourth decade. The wide v a r i a t i o n s in the type of h y p e r t e n s i on r e p o r t e d from the different regions in Africa, and the doubt e x i s t i n g as r e g a r ds the significance of focal lesions in the kidneys, point towards the need for g e n e r a l l y accepted c r i t e r i a in the diagnosis of r e n a l hypertension, p a r t i c u l a r ly with r e g a r d to chronic phylonephritis. Cardiomyopathy c l a i m s 15. 8% of all deaths from congestive heart f a i l u r e in the local African population. While many of the pathological changes o c c u r r i n g in the h e a r t in t h i s d i s e a s e were found to be s i m i l a r to those of other i n v e s t i g a t o r s , c e r t a i n f e a t u r e s , relating to c a r d i a c hypertrophy and s t r u c t u r a l a l t e r a t i o n s in the pulmonary v e s s e l s , have been e s p e c i a l ly i n v e s t i g a t e d / . . . investigated and results obtained in this series of cases show that whereas pure right ventricular hypertrophy is uncommon in cardiomyopathy biventricular hypertrophy with predominance of the right ventricle is the most frequent form of cardiac enlargement in such cases. Equal hypertrophy of the ventricles is the next common form of enlargement; left ventricular predominance is by far the least frequent, and no case of exclusive left ventricular hypertrophy was encountered. Although structural alterations in the pulmonary a r t e r i e s , indicating pulmonary a r t e r i a l hypertension, were observed in a large number of cases investigated, such changes were in no way specific to cardiomyopathy, since similar changes were observed in cor pulmonale due to emphysema and also in some cases of hypertensive congestive heart failure. Structural alterations in the small muscular pulmonary a r t e r i e s and arterioles were also identical with those found in emphysema. Whereas fresh pulmonary emboli and infarcts were frequently encountered and were often of such degree as to be the immediate cause of death, chronic pulmonary thrombo-embolism of an extent sufficient to have been the cause of right ventricular predominance was seldom found. It is suggested that the cause of the pulmonary hypertension and certain pathological changes in the heart in cardiomyopathy may lie in some form of exogenous toxin, possibly related to the practice of herbal medication among the African people, which acts as an a r t e r i a l vasoconstrictor in both the pulmonary and systemic circulations. This would suggest that the a r t e r i a l changes observed in the lungs are probably the result and not the cause of pulmonary hypertension. The incidence of cor pulmonale as a cause of congestive heart failure among the African in Durban is of the order of 12%. It has been shown that almost one quarter of all cases of right ventricular failure remains undiagnosed, as regards aetiology, at routine necropsy. The latter finding pointed towards the need for an investigation of the causes of right ventricular failure in the African. Such a study was undertaken and special methods of investigation w e r e / . . . were used as aids towards a more conclusive diagnosis. This study showed fibrosing lung disease, due particularly to the late complications of pulmonary tuberculosis, to be the most important cause in the production of chronic cor pulmonale in the African in Durban. The development of cor pulmonale in such cases depends not only on the presence of pulmonary parenchymal damage by fibrosis, but also on the associated pleural thickening, adhesions between chest cage and diaphragm, emphysema, and the curtailment of the pulmonary a r t e r i a l bed. In this series, all cases of fibrosing lung disease with cor pulmonale investigated for cardiac hypertrophy by means of separate weighing of the ventricles, showed evidence of pure right ventricular enlargement, indicating no significant chronic burden on the left ventricle of a diastolic overload through bronchial shunting. Thrombo-embolic cor pulmonale, hitherto believed to be r a r e in the African, emerges as the most important cause of acute cor pulmonale and the second most common cause of the more chronic varieties of the disease. The usual pathological type of pulmonary thrombo-embolic disease observed in this study is one in which fairly large pulmonary a r t e r i e s , as opposed to those of microscopic size, were involved and in consequence infarction was frequent. The lack of completely organised lesions, and the relatively small increase in total heart weights (majority below 400 Gms) suggest a rapid course in these cases, measured in months rather than in years. The usual source for pulmonary emboli was found to be the veins draining the lower limbs, particularly the deep calf veins. Whereas a predisposing factor for the development of venous thrombosis was found in just over half the number of cases investigated, in 44% of all cases of thrombo-embolic cor pulmonale in this study no cause was found at necropsy for the peripheral venous thrombosis. Of the predisposing causes encountered a posteriorly placed amoebic liver abscess emerges as an interesting aetiologic factor in the development of thrombo-embolic cor pulmonale because of its ability to produce hepatic vein and inferior vena caval thrombosis. Emphysema, usually in association with chronic bronchitis, was found to be the third most common cause of chronic cor pulmonale among Africans/ . . . Africans in Durban, and was encountered mainly in its mixed form (centrilobular and panlobular). Although structural alterations in the pulmonary a r t e r i es were noted in a significant number these were sometimes of insufficient degree to be the cause of pulmonary hypertension, thereby suggesting some other factor in the production of a raised pulmonary a r t e r i a l p r e s s u r e . Results of separate ventricular weighing in these cases show exclusive right ventricular hypertrophy, again indicating strain solely on the right ventricle. Bilharzial cor pulmonale, although one of the r a r e r causes of cor pulmonale in the African in this series, is suspected to be probably more frequent than hitherto believed. The lack of obvious macroscopic changes in the lungs of such cases is stressed, and while this may account for omissions in diagnosis, a sudden recent increase in the incidence of bilharzial cor pulmonale might also suggest that the disease is becoming more severe. Primary pulmonary hypertension as a cause of cor pulmonale in the African is r a r e , being suspected in only one case in this series. In keeping with the generally high incidence of infective diseases in the African, pericarditis as a complication of tuberculosis and hepatic amoebiasis, and the cardiac complications of syphilitic aortitis still occupy major positions among the causes of congestive heart failure in this population; together accounting for 12.4% of all deaths from congestive heart failure. Tuberculosis and amoebiasis are important not only in the production of p e r i c a r d i t i s , but, as mentioned, also play an important part in the development of cor pulmonale. Syphilitic heart disease, besides being a significant factor in the production of congestive heart failure, is the most important cause of a sudden cardiac death in the African. In conclusion it may be said that while little can be achieved with regard to the control of diseases for which no cause has as yet been found, the elimination of infective conditions such as tuberculosis, amoebiasis and syphilis will result in a significant drop in the incidence of death and disability from heart failure in the African in Natal. / Thesis (M.D.)-University of Natal, Durban, 1967.

The thesis is comprised of a comparative study of iron metabolism with particular reference to iron deficiency in the Indian and the African; Europeans were included when naterlal was available. Fifty four patients with iron deficiency anaemia were studied. There ware 43 Indians as compared with 11 Africans although the overall proportion of Indians to Africans admitted to the same ward was 1 : 4. Amongst the Indians the commonest cause of anaemia from blood loss was peptic ulceration (6 patients); while 3 had cirrhosis of the liver, one had hookworm anaemia and one was a case of ulcerative colitis. Gynaecological lesions were found in 2 patients, one had a proliferative endometrium and the other had endometrial polypi. Idiopathic iron deficiency anaemia was found in 60.5% of the Indian patients (both male and female). Amongst the Africans on the other hand, there were 2 cases of hookworm anaemia and 2 of cirrhosis of the liver while peptic ulceration was suspected in one patient who alao had amoebic dysentery and urinary hllharsiesis. None of the Africans had Idiopathic iron deficiency anaemia with the possible exception of one who had 4 Caesarean sections in rapid succession. There were 175 Indians, 175 Africans and 139 Europeans who were studied haematologlcally during pregnancy. The Incidence of iron deficiency anaemia among them was 26.7%, 2% and 4% respectively. The third aspect of the thesis is confined to an analysis of necropsy materiel for iron stores. Two hundred Africans and 58 Indians were studied. It was found that the incidence of *siderosis" in the African was high. There was a significant difference in the iron concentrations in the stores of the 2 racial groups. It was concluded that iron deficiency anaemia is common in the Indian. Diet appears to play an important role in its production. / Thesis (M.D.)-University of Natal, Durban, 1963.

Thesis (MSc (Genetics))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Oesophageal cancer (OC) is the sixth leading cause of cancer related deaths in the world with approximately 300 000 new cases reported each year. OC may be characterized into two forms with 90% of cases presenting as squamous-cell carcinoma (SCC) and the remaining 10% as adenocarcinoma (ADC). Several factors have been attributed to the development of OC, including oesphageal injury and/or irritation, chronic inflammation and excess iron associated with enhanced tumour growth. The HAMP gene codes for a 25 amino-acid protein found to be primarily expressed in the liver and crucial to regulation of bodily iron status. Defects occurring in the HAMP gene could therefore lead to the dysregulation of the gene, resulting in an iron overload status. Iron overload is a previously described risk factor in the development of various cancers, including OC, and therefore the aim of this study was to investigate whether dysregulation of the HAMP gene may be involved in the cancer phenotype exhibition. The study cohort comprised of 48 unrelated patients presenting with SCC and a control group of 51 healthy, unrelated population-matched individuals. Mutation detection techniques included polymerase chain reaction (PCR) amplification, heteroduplex single-stranded conformation polymorphism (HEX-SSCP) analysis and bi-directional semi-automated DNA sequencing analysis. Screening of the 5’ regulatory region (5’UTR) of the HAMP gene revealed one known (-582A/G) and two novel (-188C/T and -429G/T) variants with the -429G/T variant showing statistically significant reduction in expression in patients relative to controls. Iron parameters were correlated between patient and control cohorts, as well as for variant presence and absence within individuals. Luciferase reporter constructs were used to investigate the functional implications of the presence of a variant on HAMP gene expression, and how these results correlated to the iron parameter statistics obtained. Luciferase reporter assay results indicated the -188C/T and -429G/T variants to result in under-, and the -582A/G variant to result in over-expression at the basal level, relative to the respective wild-type sequence constructs. Correlation of the luciferase data with the iron parameter statistics, indicate the -429G/T variant to be coupled to significantly higher levels of ferritin and C-reactive protein (CRP) and significantly lower levels of serum-iron and transferrin when compared to individuals without the variant. Considering only the patient group, the presence of the -188C/T and -429G/T variants were coupled to significantly lower levels of transferrin in patients with either variant, compared to patients without. The variants found within the HAMP promoter region are therefore able to alter gene regulation to an extent where iron parameters deviate between healthy and OC afflicted individuals, and also between patients with and without a variant. This dysregulation in iron homeostasis may play a role in the development and/ or progression of OC. Characterisation of the 5’ UTR of the HAMP gene may contribute to linking iron regulation to the establishment of an effective screening program, facilitating the early detection of OC. / AFRIKAANSE OPSOMMING: Slukdermkanker (SK) is die sesde grootste oorsaak van kanker-verwante sterftes in die wêreld, met sowat 300 000 nuwe gevalle wat aangemeld word elke jaar. SK kan geklassifiseer word in twee vorme, waar 90% van die gevalle plaveisel-selkarsinoom (SSC) vorm en die oorblywende 10%, adenokarsinoom (ADC). Verskeie faktore word toegeskryf aan die ontwikkeling van SK, insluitend slukderm beserings en/ of irritasie, chroniese inflammasie en oormatige ystervlakke wat geassosieer word met verhoogde gewasgroei. Die HAMP geen kodeer vir 'n 25 aminosuur proteïen wat hoofsaaklik in die lewer uitgedruk word en noodsaaklik is vir die regulering van ystervlakke in die liggaam. Defekte wat in die HAMP geen voorkom kan dus die onreëlmatige regulering van die geen tot gevolg hê, wat lei tot yster-oorlading. Yster-oorlading is voorheen beskryf as ‘n risiko faktor in die ontwikkeling van verskillende vorme van kanker, insluitend SK en gevolglik was die doel van hierdie studie om te bepaal of die wanregulering van die HAMP geen betrokke mag wees by die uitdrukking van die kanker fenotipe. Die studiepopulasie het bestaan uit 48 onverwante pasiënte met SSC en ‘n kontrole-groep van 51 gesonde, onverwante soortgelyke individue. Die mutasie opsporingstegnieke wat gebruik is, het polimerase kettingreaksie (PKR) amplifisering, heterodupleks enkelstring-konformasie polimorfisme (HEX-SSCP) analise en bidireksionele semi-outomatiese DNS volgordebepaling-analise van die geïdentifiseerde variante ingesluit. Sifting van die 5’ regulerende area (5'UTR) van die HAMP geen het een bekende (-582A/G) en twee nuwe (-188C/T en -429G/T) variante opgelewer, met die -429G/T variant wat statisties beduidend onderdruk is in pasiënt uitdrukkings vlakke relatief tot 'n gesonde kontole-groep. Yster-parameters van alle pasiënt en kontole individue is gekorreleerd tussen pasiënt en kontrole groepe, sowel as vir teenwoordigheid of afwesigheid van variante in elke individu. Luciferase verklikker konstrukte is gebruik om die funksionele implikasies van die teenwoordigheid van ‘n variant op HAMP geenuitdrukking te ondersoek, en hierdie resultate te korreleer met yster-parameter statistieke wat verkry is. Luciferase verklikkertoetse dui aan dat die -188C/T en -429G/T variante tot verminderde, en die -582A/G variant lei tot die verhoogte uitdrukking op die basale vlak lei, relatief tot die onderskeie wilde-tipe konstukte. Korrelasie van die luciferase data met die yster-parameter statistieke, dui aan dat die -429G/T-variant gekoppel is aan aansienlik hoër vlakke van feritien en C-reaktiewe proteïen (CRP) en beduidend laer vlakke van serum-yster en transferrien in vergelyking is met individue sonder die variant. Met oorweging van slegs die pasiënt-groep, is die teenwoordigheid van die -188C/T en -429G/T variante beduidend gekoppel aan laer vlakke van transferrien in pasiënte met die variant, in vergelyking met pasiënte daarsonder. Variante binne die HAMP promotor is dus in staat om geenregulasie te verander tot so 'n mate dat die yster-parameters afwyk tussen gesonde en SK geaffekteerde individue, sowel as tussen pasiënte met en sonder ’n variant. Hierdie wanregulering in yster homeostase kan 'n rol speel in die ontwikkeling en/ of die progressie van SK. Karakterisering van die 5’ regulerende area van die HAMP geen kan grootliks bydra om ysterregulasie te verbind met die implementering van ‘n effektiewe siftingsprogram, en sodoende die vroeë opsporing van SK fasiliteer.

The first two official AIDS cases were diagnosed in South Africa in 1982. During the same period of the 1980s, the black/African population was experiencing an accelerated fertility decline, following a period of accelerated mortality decline. Demographers invoked the demographic transition theory to explain the observed mortality and fertility decline. According to the demographic transition theory, mortality and fertility rates would continue declining to low, post transitional levels with increasing modernization. The relatively higher prevalence of HIV/AIDS estimated among black/African South Africans is expected to alter their demographic transition. This research investigated the impact of HIV/AIDS on the demographic transition of black/Africans by 2021.

The first two official AIDS cases were diagnosed in South Africa in 1982. During the same period of the 1980s, the black/African population was experiencing an accelerated fertility decline, following a period of accelerated mortality decline. Demographers invoked the demographic transition theory to explain the observed mortality and fertility decline. According to the demographic transition theory, mortality and fertility rates would continue declining to low, post transitional levels with increasing modernization. The relatively higher prevalence of HIV/AIDS estimated among black/African South Africans is expected to alter their demographic transition. This research investigated the impact of HIV/AIDS on the demographic transition of black/Africans by 2021.