No description available.

No description available.

No description available.

No description available.

Despite many studies on the action of yellow light in acne, it is still unclear whether it improves inflammatory acne or has photoimmunologic activity against pro-inflammatory pathways like toll-like receptor 2 (TLR2) and its down-stream cytokines e.g. TNF-α. This work sought to determine whether 530 nm IPL could cause a clinical improvement in acne and if its photo-mechanism of action involved modifications of the expressions of TLR2, TNF-α, IL-10 and IL-8. Twenty-eight adult patients with mild to moderate acne vulgaris involving their backs received four 530-950 nm IPL treatments at two-week intervals. Assessments performed at baseline and one week after the final IPL session included inflamed and non-inflamed lesion counts, Leeds assessments and sebum excretion rate (SER). Biopsies within the treatment area were taken at these two time points and two days after the first irradiation. TLR2 expression was examined by immunohistochemistry and TaqMan® Low Density Arrays were used to measure changes in expression of TNF-α, TNFR, IL-8 and IL-10. The data from 21 patients was included in the final clinical analyses. Inflamed lesions fell significantly by 28.0% (p = 0.002), but was not associated with significant changes in the Leeds score, SER or non-inflamed lesions. TNF-α expression fell by 17.6% (p = 0.031) at the end of therapy, and appeared to correlate with the percentage change in lesion counts in the subjects evaluated. TLR2 expression fell by 2.6% (p < 0.001) a week after the final irradiation, but bore no relationship to lesion counts. Neither IL-10 nor IL-8 was significantly affected. Though 530nm IPL significantly reduces inflammatory lesions, treatment efficacy will have to be improved to make it a viable treatment option. Its mechanism seems to include an anti-TNF-α effect, independent of IL-10 up-regulation. This is a novel mechanism, not been previously described for 530nm IPL. Updated hypotheses are suggested in order to explore this phenomenon further.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Technikon Natal, 2001. / The aim of this study was to determine what role a homoeopathic eczema complex (Herpin 2\xAE) has to play in the management of atopic eczema. A sample of thirty patients was obtained by means of convenience sampling from the greater Durban area. From this sample fifteen were treated with the homoeopathic eczema complex and the remaining fifteen received placebo treatment. The double blind protocol was used to conduct this study with all medications being dispensed by a neutral party. Every four weeks for the duration of the two-month trial, the percentage body surface area affected by eczematous lesions was measured and recorded and questionnaires regarding the patients' perception of the treatment were completed. The subjective data obtained from the questionnaires, and the objective data obtained from the measurement of the percentage body surface area were statistically analysed by means of the Mann-Whitney U-test and the Wilcoxon's signed ranks test. In each case a was set at 0.05 specified level of significance. The null hypothesis, with respect to the Mann-Whitney U-test, was accepted if p ~ a and it was rejected if p < a. For the Wilcoxon's signed ranks test, the null hypothesis was accepted if a and it was rejected if p/2 < a. (p= reported pvalue) iii The results of the study indicate that there is no statistical difference between the placebo and treatment groups with regards to the subjective and objective / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Technikon Natal, 1997. / The purpose of this placebo-controlled study was to evaluate- the degree of prcfolency of homoeopathic similirnum treatment in atopic eczema, in terms of its clinical manifestations and patients perception of the treatment. Itwas hypothesized that the patients treated with homoeopathic similirnum would respond favourably in terms of the presenting condition and that their perception of the treatment would be positive. In this experimental study the single variable design was used for its 'before-andafter with control'. Thirty patients were selected from the greater Durban area, according to the diagnostic criteria of atopic eczema as identified by Hanifin and Rajka (1980) and divided into two groups according to simple random sampling. Data were collected at the Homoeopathic Day Clinic at Technikon Natal. Group 1 received placebo and group 2 received homoeopathic similirnum treatment Patients received 4 treatments over a period of 3 months and data were obtained at the first and last consultation. The Patient's Perception Questionnaire and the General Well-Being Schedule were completed by the patients in the presence of the researcher. The Oinical Evaluation Index was completed by the researcher. / M

No description available.

In a move towards a more informed understanding of the concept of satisfaction, this study aims to explore how thirty dermatology patients describe what it means to be satisfied with their healthcare. This was undertaken by adopting a qualitative research approach, using an in-depth semi-structured interview methodology. It was conducted within the context of a randomised controlled trial of telemedicine in dermatology (RCT). A secondary aim was to evaluate the extent to which the methodological approach of the study (interpretative phenomenological analysis) was successful in eliciting such descriptions. The findings reveal patient satisfaction as being a complex and fluid construct underpinned by a range of values, beliefs, attitudes and experiences. Individual participant descriptions of satisfaction emphasise the importance of 1) receiving a diagnosis treatment and cure, 2) minimum waiting time for appointments and treatment 3) the need to receive adequate information and explanations 4) receiving individualised personal care and 5) the need for participants to feel as though they were being taken seriously and 6) the importance of practitioner characteristics/good communication. Perhaps the most significant observation was the sequential nature of satisfaction, which was defined, redefined and re-evaluated by participants throughout the interview process. This study also identified a continuum of satisfaction across patients' definitions of being 'satisfied' as opposed to 'very satisfied' with healthcare. The method of data analysis (interpretative phenomenological analysis-IPA) was a useful approach to guide the analysis identifying and exploring themes relevant to eliciting the meaning of satisfaction. However, limitations to this methodology were apparent over the course of the study, and alternative methodology, contextualised interpretative phenomenological analysis has been postulated. It is suggested that the journey for a definitive notion of patient satisfaction, can only be meaningfully directed by accepting some form of refinement of phenomenological methods as a means of adding sophistication to existing quantitative studies.

Background: Necatoriasis is a neglected tropical disease caused by the insidious parasite Necator americanus. This hookworm infects and reinfects approximately 500 million individuals worldwide, with a further 5.1 billion at high risk for acquiring the infection. Despite the high level of reinfection, no lasting immunological memory develops in the host. Albeit the profound health implications, chronicity and public health burden in developing countries, many aspects of human Necator americanus infection, particularly early events at the interface with the host immune system, are under researched. These figures and facts highlight the need for new research elucidating the molecular interactions between Necator americanus and the innate immune system. This will aid in the rational design of innovative and more efficient intervention strategies against hookworm infection, which is an essential measure for disease prevention. Objectives: In the context of Necatoriasis, this thesis studied the physical interaction between infective Necator americanus larvae (L3) with human dendritic cells (DCs) and epidermal keratinocytes, investigating the biological consequences. In addition, the development of a platform consisting of human keratinocytes, fibroblast and DCs on a 3D scaffold was constructed as an in vitro model of human skin. Results: The present thesis provides new insights into early immunological events at the interface of DCs and Necator americanus larvae and could explain how L3 affect immunity upon initial interaction with antigen presenting cells. For the first time, the data presented illustrates the sequestration of human DCs onto the sheath of L3 infective Necator americanus larvae, triggering the hookworm to exsheath. Intriguingly, the exposed cuticle of the larvae had negligible interaction with the free DCs. The findings also illustrate that the interaction between DCs and the larvae is mediated via a mandatory interaction with C-type lectin receptors, dendritic cell-specific intercellular adhesion molecule-3 grabbing non-integrin (DC-SIGN) and mannose receptor (MR). Blocking of either receptors with antibodies resulted in an inhibition of DC sequestration and aggregate formation. This demonstrates the biological relevance of previously identified lectin binding molecules on the Necator americanus larvae (L3) sheath in the context of interacting with DCs. These findings allude to a disparity between the surface chemistry of the sheath and larvae that could explain their differential ability to interact with DCs. While the exact nature of differences in the surface properties of the larvae and sheath are yet to be characterised, this data clearly indicates the presence of distinct chemical signatures on the cuticle sheath that attract DCs. However, this not only induces exsheathing but also enables larvae migration without being recognised or challenged by antigen presenting cells. A potential escape mechanism through which the larvae could bypass the immune cells, creating a possible site of ‘temporary immune privilege’. DCs incubated with viable axenic larvae exhibited an immature phenotype as evidenced by the low expression of the maturation markers CD80, CD83, CD86, CD40, and HLA-DR. Subsequently, the ability of DCs to acquire a mature phenotype in response to co-stimulation with lipopolysaccharide (LPS) in the presence of Necator americanus was assessed. These data show that DCs treated with the larvae will remain responsive to LPS stimulation. Additionally while the axenised larvae do not induce any cytokine production by DCs, they seem to suppress LPS induced cytokine expression, however these changes were not statistically significant (p value ≤0.3). Furthermore, the cell-free culture media from DCs, matured in the presence of LPS, had no visible effects on the larvae. Intriguingly, matured DCs in LPS-free culture media render the larvae non-viable through a lysing mechanism, alluding to a modified paracrine signalling response by mature immune cells in culture with the parasite. Interestingly, in the presence of epidermal keratinocytes, ex-sheathing was not mandatory to enable larval burrowing. In fact, only a small number of the larvae sheaths were recoverable from the apical surface of the keratinocyte layer; indicating preferential ensheathed larval burrowing. The data also illustrated the novel behavioural strategies promoting host invasion by Necator americanus larvae, in the presence of epidermal keratinocytes. Larvae were notably slower to exsheath in culture with keratinocytes and exhibited no vigorous movements as observed in DC cultures. This was thought to prevent early exsheathing, as the advantage of larvae maintaining their sheath during the initial stages of infection is in theory highly beneficial. Finally an immunocompetent tri-culture was developed on 3D layered PET scaffolds, encompassing epidermal keratinocytes and dermal fibroblasts, interspersed with DCs cultured at air liquid interface. A functional barrier was optimised, following which immune cell migration within the tri-culture system was observed successfully. Conclusion: Collectively, the sequestration of DCs onto the larvae sheath, suppression of maturation and cytokine expression, provides a possible explanation for the lack of a lasting immune response. These data provide novel insights into early immunological events at the interface of DCs, epidermal keratinocytes and Necator americanus larvae, which could explain how L3 evade immunity upon initial interaction with antigen presenting cells.