Master of Science / Department of Clinical Sciences / Gregory F. Grauer / Hyperthyroidism is the most common endocrinopathy of geriatric cats and has physiologic effects on almost every organ in the body. It specifically affects the kidneys by increasing renal blood flow and glomerular filtration rate. In addition, activation of the renin angiotensin aldosterone system (RAAS) is increased and ultimately leads to efferent glomerular arteriole constriction and potentially glomerular hypertension. The classic treatment modalities for feline hyperthyroidism (anti-thyroid medication, radioiodine or surgery) have been evaluated for their overall effects on renal function. Studies have demonstrated that glomerular filtration rate (GFR) declines and serum creatinine increases with hyperthyroid treatment independent of the treatment modality. Hill’s® Prescription Diet® y/d® Feline, a relatively new dietary treatment modality for feline hyperthyroidism with controlled iodine concentrations, reduced phosphorus and protein, and increased omega-3 fatty acids, has been shown to significantly decrease thyroid hormone levels. The research provided in this report is the first evaluating the posttreatment effects of y/d® Feline on renal function. In agreement with previous studies, our research found that y/d® Feline resulted in a significant decrease in thyroid hormone levels. However, in contrast to other treatment modalities, y/d® Feline did not result in a significant decline in GFR, and it did result in a significant decline in mean serum creatinine concentration. These data indicate that y/d® Feline, as a treatment for feline hyperthyroidism, does not have a negative effect on renal function.

Ce travail questionne la place du féminin dans l’expérience subjective des personnes atteintes de fibromyalgie, maladie touchant majoritairement des femmes et dont la douleur et la fatigue chroniques occupent le devant de la scène. Notre hypothèse principale nous conduit à investiguer l’existence d’un trouble primaire du féminin chez les personnes qui en sont atteintes. Ce trouble serait lié à un échec de l’accès à la voie passive. Le modèle identificatoire serait celui de la mère des premiers soins, mal différenciée, mais représentant un idéal de toute-puissance narcissique. Dans ce contexte, les éprouvés douloureux de la passivité primaire laisseraient la place à une difficulté majeure face à la position passive, comprise comme une défense contre l’emprise maternelle. Des travaux de recherche proposent de considérer cette maladie comme étant une manifestation moderne de l’hystérie de conversion. Nous mettons cette hypothèse à l’épreuve à travers les cas cliniques étudiés. Nous investiguons également la question de la dépression en suivant l’idée que la fatigue chez les fibromyalgiques pourrait être interprétée comme une forme de dépression, non réactionnelle, préexistante à la maladie et caractérisée par une susceptibilité mélancolique. Les douleurs éprouvées constitueraient ainsi la composante mélancolique de cette dépression. Notre travail s’appuie sur le cadre théorique de la psychopathologie psychanalytique et sur des outils d’investigation qui sont les entretiens cliniques de recherche et les épreuves projectives (Rorschach et TAT). / This work questions the place of the feminine in the subjective experience of people suffering from fibromyalgia, a disease that mostly affects women and which chronic pain and fatigue occupy center stage. Our main hypothesis leads us to investigate the existence of a primary disorder of the feminine in people suffering from this disease. This disorder would be linked to a failure of reaching the passive way. The role model would be the first care mother, poorly differentiated, but which represents an omnipotent narcissistic ideal. In this context, the pain felt in primary passivity would leave room for a major difficulty regarding the passive position which is seen as a defense against the mother’s control. Some research intends to consider this disease as a modern expression of conversion hysteria. We challenge this hypothesis through the clinical cases that we studied. We also investigate the question of depression by following the idea that the fatigue of fibromyalgic people could be interpreted as a form of depression, non-reactive, pre-existing from the disease and characterized by a melancholic susceptibility. Then, the pain would consist in the melancholic component of the depression. Our work is based on the theoretical framework of psychoanalytical psychology and on investigation tools which are clinical research interviews and projective tests (Rorschach and TAT).

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Chronic inflammation in response to Aß peptide deposits is a pathological hallmark of Alzheimer's disease (AD). The inflammatory environment includes populations of reactive and proliferating microglia and astrocytes and perturbed vasculature. However, the association between activated glial cells and cerebrovascular dysfunction remain largely unknown. This study has used Aß1-42 intrahippocampal injection as an animal model of inflamed AD brain to characterize mechanisms of glial-vasculature responses as a basis for chronic inflammation. Preliminary findings suggested Aß1-42-injected brain demonstrated vascular remodeling including evidence for formation of new blood vessels (angiogenesis). This result led to study of the effects of the anti-angiogenic/anti-inflammatory compound, thalidomide on activated glial cells and perturbations in the vasculature in an Aß1-42 peptide-injected rat model. First, Aß1-42 injection was found to cause perturbations in vasculature including new blood vessel formation and increased BBB leakiness. Second, thalidomide decreased the vascular perturbations and the glial reactivity and conferred neuroprotection. Overall, these results suggest that altered cerebral vasculature is integral to the overall inflammatory response induced by peptide. Experiments then examined the level of parenchymal plasma proteins in brain tissue from AD and nondemented (ND) individuals. AD, but not ND, brain tissue demonstrated high levels of fibrinogen immunoreactivity (ir). Aß1_42 injection into the rat hippocampus increased the level of parenchymal fibrinogen, which was reduced by treatment with the defibrinogenating agent, ancrod. In addition, ancrod also attenuated microglial activation and prevented neuronal injury. Overall, these results demonstrate that extravasation of blood protein and a leaky BBB are important in promoting and amplifying inflammatory responses and causing neuronal damage in inflamed AD brain. Microglial chemotactic responses to VEGF (vascular endothelial growth factor) receptor Flt-1 were next studied. Treatment with a monoclonal antibody to Flt-1 (anti-Flt-1 Ab) in the peptide-injected hippocampus diminished microglial reactivity and provided neuroprotection. Secondly, anti-Flt-1 Ab inhibited the AI3142-induced migration of human microglia. These results suggest critical functional roles for Flt-1 in mediating microglial chemotaxis and inflammatory responses in AD brain. The overall conclusion from my work is that AP deposits induce microglial reactivity which subsequently causes vascular remodeling resulting in an amplified inflammatory microenvironment which is damaging to bystander neurons. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

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The changes occurring in the red blood cells in infective illness are amongst the least carefully studied problems of haematology. In spite of the fact that these anamias are extremely common, it is difficult to find adequate literature to make possible even a clear description of the blood picture under these circumstances. Part of the difficulty is due to the fact that anaemias in infections are grouped together with other anaemia, in which many mechanisms undoubtedly active. Another major source of confusion is the fact that in many of the cases in which "secondary anaemia" occurs, complicating factors such as haemorrhage and liver disease are not adequately dealt with.

In 2015 acupuncture was introduced as an alternative intervention in the management of chronic pain, at the Chronic Pain Management Clinic of Groote Schuur Hospital, a tertiary academic hospital in Cape Town, South Africa. This study is a retrospective, cross-sectional analysis that aimed to investigate several aspects of the acupuncture intervention over a 12 month period. The main outcome measure, the Brief Pain Inventory (BPI), is a widely used, internationally validated questionnaire, containing pain intensity, pain interference, and total score. The main objective of this study was to determine if the acupuncture treatment lowered BPI scores after 6 to 9 intervention sessions. Additional objectives were to determine if there are any correlations between demographic and clinical factors and changes in BPI scores, and to describe the demographic and clinical characteristics of the study population. The data was obtained by folder reviews of 66 patients with chronic pain who were referred for acupuncture treatment between January 1, 2015 and December 31, 2015, and attended at least one treatment session. The full treatment course (6-9 sessions) was completed by 24 patients (36,3%), with an average post treatment decrease in BPI of 3,7 points. Responders (patients who obtained 2 and more point BPI decrease) comprised 70,6% of the patients who completed treatment. Decrease in BPI scores after completion of full acupuncture treatment proved to be statistically significant (p=0.002). Factors showing strongest correlation with BPI decrease were female gender and absence of medical and psychiatric co-morbidities.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, 2015 / Numerous factors influence the employment of people with chronic illness. At some point, these people withdraw from the labour market. This has both a direct and indirect cost to the person, their family and society as a whole. Aim: To explore the factors affecting sustained employment of people with chronic illness. A second component explored participants’ opinions regarding return to work in the future. Research Methods: The study was done in two phases: 1) The identification and validation of the research instrument; and 2) The administration of the research instrument. Descriptive statistics were utilised to analyse data obtained from the research instrument. Two sets of correlations were run to identify significant differences between the participants expecting to return to work and those who did not expect to return to work. Results: Descriptive statistics revealed no meaningful trend on self-reported factors. The Mann-Whitney U identified a number of significant differences between participants expecting to return to work and those who did not expect to return to work, in both personal and contextual factors. Conclusion: A broad range of factors were elicited regarding the barriers and accommodations required for sustained employment within both the personal and environmental constructs. Self-report questionnaires provided some useful information, but a broader understanding of the factors influencing work was obtained from a comprehensive interview. Significant differences were present between people expecting to return to work and those who did not expect to return to work regarding environmental and personal factors as well as factors supporting work.

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