Violence against women is an important cause of morbidity and mortality in South Africa and indeed the of world. Women and men are equal and must have equal guarantees of economic, social, civil, political cultural rights. Women who are denied basic right security cannot participate equally in society. Violence denies this basic human right. This study is descriptive and a retrospective analysis of rape survivors in Johannesburg from 1992, a prospective analysis of homicide victims from Cape from mid-1996 to end 1998. The results have been analysed into demographic variables and compared to trends from the rest of the world. The epidemiology and pattern of injury violent crimes have specifically targeted. The main findings were: 1. incidence of rape in Johannesburg in 1992 was 165 per 100 000 women. 2. Rape in Johannesburg is seasonable and occur mainly in young African women, by strangers. 3. Approximately one third of survivors sustain non-genital as well as genital injury. 4. Most injuries can be classified as minor or moderate and comprise contusion, abrasions and lacerations. 5. The incidence of rape homicide in Town is 7.2 per 100 000 women, which represents a fatal sexual rate 1.23%. 6. The majority of rape homicide victims were coloured women in the group 26 to 45 years. 6. Of those murdered by people known to them, a current or ex-intimate partner murdered 18.6%. 7. 98.3% of rape victims had non-genital injury, and 55.9% had evidence of genital injury. 9. Most rape homicides have evidence of mechanical asphyxiation included in the mechanism of death. 10. The body areas most targeted by perpetrators in sexual assault are the head, neck and upper limbs. 11. The majority of the minor genital injuries comprise abrasions and lacerations to the posterior fourchette and introitus.

Includes bibliographical references. / Fatty liver disease is a collective phrase for a spectrum of diseases characterised by increased liver fat content. It ranges from fatty infiltration of the liver to an inflammatory condition, steatohepatitis, which may lead onto cirrhosis. Although not associated with alcohol consumption, non-alcoholic steatohepatitis (NASH) has strong associations with obesity, diabetes and dyslipidaemia. Overlapping pathological mechanisms may be involved. The course of the disease will remain unpredictable, and specific treatment will only be able to be instituted once the pathogenesis is fully understood. This thesis reviews current understanding of the pathogenesis and explores the suitability of a recently defined obese diabetic mouse model for its value as a model in the heterozygous and homozygous states. Observations revealed that the db/wt phenotype has a larger mass than the wt/wt and responds with hyperglycaemia. Lipid accumulation occurs in this model when alcohol is administered and lipid peroxidation occurs but histological changes of steatosis and steatohepatitis do not occur. The db/db model is phenotypically distinguished by a large amount of fat storage, diabetes and macrovesicular steatosis that has more lipid peroxidation but no steatohepatitis even when alcohol further increases lipid peroxidation. The model, as explored, did not reveal steatohepatitis either alone, or with alcohol as a single additional stressor, but both the db/wt and db/db mouse model could be further investigated to explore whether additional stressors could induce steaotohepatitis in this model.

Includes bibliographical references (leaves 105-111). / Microsatellite markers were used to measure genetic diversity and population differentiation within and between domestic dog breeds. The German Shepherd Dog was compared with typical outbred mongrel dogs, Dachshunds, Staffordshire Bull Terriers and a cohort of other pedigreed dogs representing 30 recognised breeds. Although archaeological records report that grey wolves (Canis lupus) were domesticated approximately 14 000 years ago, mtDNA analysis suggests that domestic dogs (Canis familiaris) and grey wolves diverged in multiple events over 100 000 years ago. Subsequently, the movement of humans and their dogs resulted in extensive gene flow between dog populations for thousands of years. Breeding practices to obtain distinctive pnenotypic uniformity were recently introduced, resulting in pure-bred dogs becoming essentially closed gene pools. However, further mtDNA analyses have reported unexpectedly high levels of variability, supported by microsatellite loci with heterogeneities of between 36% and 55% being reported for some dog breeds. Microsatellite analyses of 15 polymorphic canine loci are reported. German Shepherd Dogs and outbred mongrel dogs expressed diversity values of 4.0 alleles per locus in the former and 6.4 in the later (corrected for population size by jack-knifing with 1 000 pseudoreplications), with expected heterozygosities of 62% and 83%, respectively. German Shepherd Dogs showed a moderate loss of genetic diversity relative to outbred dogs, but not sufficient to describe the breed as highly inbred. However, in comparison with other pure-bred dogs examined, they expressed the least genetic diversity, with Dachshunds having 5.2, Staffordshire Bull Terriers 4.8 and the composite group of pedigreed dogs 6.0 alleles per locus, with expected heterozygosities of 72%, 67% and 80%, respectively. Significant population differentiation (GST = 0.103; RST = 0.058) between German Shepherd Dogs and the outbred dogs illustrates the effect of genetic drift since the breed was established just over 100 years ago. This study would benefit future breeding programs, as management should be facilitated by knowledge of relative measures of inbreeding and differentiation, especially between various separate breeding stocks within the breed.

This dissertation validates a Beckman-Coulter DxC(R) assay for total bicarbonate in urine and then proceeds to design, prototype and cost an inter-laboratory comparison (ILC) program for the above urine bicarbonate based on the validation. Furthermore, this work serves as a case study for how to establish proficiency testing - and thereby achieve accreditation - for tests without external quality assurance because of analyte instability.

Pneumonia due to polymicrobial infection is known to increase the severity and risk of fatality among young children. A retrospective study was undertaken on Sudden Unexpected Infant Death cases occurring, between 1 May and 30 September 2009, which were admitted to a medico-legal mortuary servicing the Cape Town western metropole. Published studies have shown the risk factors for lower respiratory tract infection to include lack of breast feeding, prenatal and environmental tobacco smoke exposure, prematurity, immunosuppression, underlying medical conditions and overcrowding. The present study was aimed at determining which of the known epidemiological factors were associated with SUDI death types admitted to this mortuary and to describe the associated histopathology. In addition, in the knowledge that drugs, specifically Methamphetamine are widely used on the Cape Flats from where almost all this mortuary's SUDI cases are derived, this study has attempted to find out whether or not the usage of drugs by the caregiver at the time of infant death was another independent risk factor in SUDI deaths.

This project aims to investigate the role of multimeric (high molecular weight) adiponectin in the development of metabolic disease resulting from anti-retroviral therapy. Specifically, the aim is to quantify the circulating levels of both total and high molecular weight (HMW) adiponectin and to establish whether a link exists between HMW adiponectin levels and susceptibility to HIV-induced lipodystrophy. Although total adiponectin levels have been shown to be significantly reduced in patients with HIVinduced lipodystrophy, there is no information on whether HMW adiponectin, which appears to be the most biologically active form of adiponectin, is altered in HAARTinduced lipodystrophy, and whether patients with low levels of the HMW form are more susceptible to lipodystrophy.

Includes abstract. / Includes bibliographical references. / The WNT pathway is a major developmental pathway that plays an important role in the development of many tumours, including neuroectodermal and bone tumours. Ewing sarcoma (ES) / primitive neuroectodermal tumour (PNET) shows varying degrees of neuroectodermal differentiation and is the second commonest bone malignancy in childhood. A recent study on ES cell lines using RT-PCR analysis and biological response assays suggests that an intact WNT pathway exists in ES and that addition of exogenous WNT ligands enhances cell motility. Based on this we hypothesize that the WNT pathway may play a role in the biology of ES/PNET and we aim to investigate this by immunohistochemical stains on archival tissue.

Medulloblastoma is the most frequently occurring childhood malignant brain tumour, affecting 1 of 5 children presenting with a brain tumour, between the ages of 0 and 9 years. The basic prognostic stratification that relies on clinical and histological findings alone has proven unsatisfactory as an outcome predictor. Distinct molecular genetic profiles have been described, with four molecular variants of medulloblastoma with specific demographic and prognostic features. These are the WNT subgroup, SHH subgroup, Group 3 and Group 4 tumours. The aim of this study was to describe the expression status of β-catenin, and MYCN, using IHC and FISH respectively, and to correlate these findings with clinico-pathological and demographic characteristics and clinical outcome. Materials and Methods This study was a nested retrospective analytical study, reviewing 54 cases of childhood medulloblastoma diagnosed between 1988 and 2014. Results Classic histology accounted for 40.7% of cases, LCA 37%, ND 16.7% and 5.6% MBEN). Based on β-catenin IHC, the WNT subgroup accounted for 16.7% of cases. This group had no mortalities or recurrences. Seven patients showed amplification of MYCN gene. The SHH group, defined by ND/MBEN histology and/or MYCN amplification, accounted for 27.7% of patients. Non-WNT/non-SHH tumours 30 patients (55.6%) showed a male predilection, and accounted for 37.5% recurrences and 50%. mortalities also falling in this group. Conclusions Nuclear β-catenin identifies WNT tumours. Nodular desmoplastic morphology is useful in identifying some, but not all cases of SHH group medulloblastomas. MYCN positive tumours also showed classical, and LCA morphology.. Patients of all the beta-catenin positive cases were free of recurrence and alive at last follow up. Patients with MYCN amplification and non-ND histology (LC/A or classic) had poorer outcomes than patients with ND histology. One patient showed both MYCN amplification and nuclear β-catenin translocation, and had good clinical outcome. This finding requires validation with other molecular techniques.

Includes bibliographical references / Deaths in police custody are a global phenomenon which continues to beset policing services worldwide. Research into these deaths has provided insight into the complexity of detention and led to the institution of preventative strategies which have seen a reduction in mortality internationally. An improved understanding of the South African detention milieu may similarly assist in reducing the mortality burden in this country. This study retrospectively reviewed deaths in custody in the Cape Town Western Metropole between 2000 and 2009, with the aim of identifying local, modifiable factors to aid in death prevention. Sixty two (62) cases were reviewed. Males predominated (90.3%) in the sample, with the racial profile mirroring that of the general population. The median age of the detainees was 30.5 years. Unnatural causes of death accounted for 82% (n=51) of cases, with suicidal hanging the commonest cause (n=40). Items of clothing were used as ligatures in 80% of hangings, with gate and window bars the most common points of suspension. Time in detention averaged 863 minutes for the sample. Clinical signs of intoxication at the time of arrest was identified as a statistically significant determinant (p=0.02) of a shorter detention time (446 minutes). Ten (10) detainees were identified as either injured at the time of arrest or physically ill during detention, of which 9 succumbed to their injuries or disease. Only three of these detainees received medical attention. These findings highlight the need for urgent review of local police cell architecture to ensure an environment conducive to safe detention, with particular attention to reducing potential points of suspension for hangings. Further, the healthcare needs of detainees must be prioritised through effective training of police personnel with regard to the assessment and management of ill detainees, particularly those intoxicated at the time of arrest.

Introduction: Breast carcinoma is the most common malignancy amongst women in South Africa. Triple assessment has been pivotal in the work up and management of breast carcinoma. Breast cytology has been used as a component of the triple assessment. Although core needle biopsy (CNB) is the gold standard and the preferred diagnostic modality, there is still a role for fine needle aspirate cytology (FNAC) in resource limited settings. The present study was conducted at Groote Schuur Hospital in Cape Town, South Africa. Aims: 1. To assess the utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast FNAC five category stratifications in our institution. 2. To assess the respective risk of malignancy (ROM) for each category. 3. To assess the diagnostic yield of the breast FNAB at our institution by comparing it to the matched histopathology over a 12-month period. Methodology: A retrospective longitudinal descriptive study was done. A computerized search on TrakCare NHLS for the year 2019, identified 884 patients who had breast cytology and corresponding histology specimens. The cytology categories(C1-C5) were first reclassified according to the IAC Yokohama system. The new cytology category was then compared to the histological diagnosis for each patient. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and risk of malignancy (ROM) were calculated. Results: The sensitivity, specificity, PPV, and NPV were 83.10%, 93.01%, 88.86% and 89.13% respectively. The Cohen's kappa coefficient was 0.659 and percentage agreement was 80.85%. The ROM was calculated; insufficient (9.09%), benign (4.46%), atypia (45.28%), suspicious for malignancy (72.5%) and malignant (91,09%). Conclusion: Breast aspiration cytology performed at GSH has shown good correlation with histopathology as well a high sensitivity and specificity comparable to international standards. The ROM is comparable to previous similar studies. Overall, our results show that breast aspiration cytology is a rapid, accurate and cost-effective diagnostic procedure in our institution that is very useful in the diagnosis of benign and malignant breast lesions.