A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic at Technikon Natal, 2000. / This study compared the relative effectiveness of low intensity laser therapy as opposed to dry needling in the treatment of active myofascial trigger points. The purpose of this study was to determine the more effective method of treating active myofascial trigger points, in terms of subjective and objective clinical findings. This study was a comparative, uncontrolled, unblinded pilot study. It was also intended to expand upon the little understood pathophysiology and treatment of muscular pain, in both chiropractic and medical curricula (Gatterman 1990: 285). / M

A dissertation in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic at Technikon Natal, 2000. / Myofascial trigger points are a common problem for patients as weJl as physicians. According to some authors Myofascial Pain Syndromes encompass the largest group of unrecognised and under-treated medical disorders. At present, needling techniques seem to be most effective in treating myofascial trigger points, however, many chiropractors claim that manipulation alone is sufficient for trigger point amelioration. The aim of this study was to determine the effectiveness of chiropractic manipulation to the level of main segmental nerve supply versus dry needling in the treatment of selected muscles with myofascial trigger points. / M

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1997. / Iliotibial Band Friction Syndrome is a common problem for patients as well as physicians. Many treatments have been devised for Iliotibial Band Friction Syndrome, but there is very little research to substantiate which of these treatments is most effective. Myofascial trigger points are a frequently overlooked and misunderstood phenomenon in the medical curriculae, yet with correct diagnosis and appropriate treatment the prognosis of these trogger points is usually excellent. The aim of this placebo-controlled study was to justify the hypotheses which stated that myofascial trigger point therapy would be effective in the treatment of Iliotibial Band Friction Syndrome (IBFS), as compared to detuned ultrasound as a form of treatment. / M

M.Tech. (Chiropractic) / The aim of this study was to compare the effectiveness of two different treatment methods for myofascial pain and dysfunction syndrome of the Gluteus Medius muscle. This was done in order to determine whether or not a combined treatment of the integrated neuromuscular inhibition technique (INIT) and sacroiliacjoint (SU) adjustive therapy was more effective than the INIT applied in isolation, in the treatment of the Gluteus Medius myofascial pain and dysfunction syndrome (OMMPDS). Participants were recruited using advertisement posters placed throughout the University of Johannesburg Doomfontcin Campus and were treated at the University of Johannesburg Chiropractic Day Clinic. Thirty participants, between the ages of eighteen and fifty years, who were suffering from lower back pain and presented with Gluteus Medius rnyofascial trigger points (Trl's) and an SIJ dysfunction were selected for the study. They wcre randomly assigned into one of two groups, consisting of fifteen subjects each. as they entered into thestudy. Group one received the INIT to the affected Gluteus Medius muscle. Group two received a combination of the INIT to the affected Gluteus Medius muscle and an SIJ adjustment. Patients attended four sessions over a period ofeight days and were treated on all of these sessions. Subjective and objective data were recorded on all sessions. Subjective data was recorded using the McGill Pain Questionnaire and the Numerical Pain Rating Scale. Objective data was recorded using the Universal Goniometer, to measure hip ranges of motion of the affected Gluteus Medius muscle, and the Wagner Pressure Algometer to measure pain-pressure threshold of the affected Gluteus Medius muscle Trl's, All of the data were statistically analyzed using Repeated Measures and Independent t-Tcsts, P-values were calculated to determine the statistical significance of the datu. The results of the study indicate that both treatment methods nrc effective in treating GMMPDS. However a combined treatment approach of INIT and SIJ adjustive therapy was more effective in achieving a greater therapeutic response compared to INIT alone.

M.Tech. (Chiropractic) / There is research to show that ischaemic compression is very effective in the treatment of myofascial trigger points (MFTP’s). It is less invasive when compared to other treatment methods such as dry needling however; according to Gulick (2010) there is a lack of randomised controlled studies with regard to standard ischaemic compression treatment protocols. This includes the appropriate amount of pressure, duration of compression or frequency of treatment (Gulick, 2010). This study was conducted in order to determine whether ischaemic compression that is applied at pain threshold would have a similar effect when compared to ischaemic compression at pain tolerance in the treatment of active rhomboid major and minor myofascial trigger points, using a hand held algometer. This study was specifically undertaken to provide more information regarding the most effective method of ischaemic compression with regard to the amount of pressure that is most suitable during treatment. The results of this study could potentially improve patient comfort and reduce pain during treatment by showing that treatment at pain threshold may be as effective as conventional ischaemic compression at pain tolerance. It was hypothesized that ischaemic compression applied at pain threshold may have a similar effect as application at pain tolerance by having a positive outcome on the subjective and objective findings in patients with active myofascial trigger points of the rhomboid major and minor muscles. Participants were recruited into the study by word of mouth as well as with the use of advertisements that were placed around the University of Johannesburg Doornfontein campus and clinic. Thirty participants that conformed to the specified limitations and diagnostic criteria were accepted to partake in this study. The participants were then placed in a random and stratified manner into two groups of 15, based on age and gender. Group A received ischaemic compression of the rhomboid major and minor muscles at pain threshold while Group B received ischaemic compression of the same muscles at pain tolerance. Ischaemic compression was administered over a 30 second duration. Each participant received 2 treatments a week for 3 weeks while a 7th and final visit served only for measurement taking.

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 1998. / Myofascial syndrome is a very common condition which is frequently encountered at Chiropractic clinics. It is also a very complex condition and as such is a very frustrating one to treat effectively. Tens is resegnised as a clinically effective modality in the treatment of Myofascial syndrome, however guidelines with respect to the most effective electrode placements are lacking. / M

A dissertation submitted in partial compliance with the Master's Diploma in Technology: Chiropractic at Technikon Natal, 1995. / The aim of this study was to determine whether the use of Interferential Current provided a non-invasive alternative to Dry Needling Agitation in the treatment of Myofascial Pain and Dysfunction Syndrome. A randomised Experimental Method of Single- Variable design was undertaken using the before-and-after-withcontrol design. / M

M.Sc. (Biochemistry) / Dry eye disease (DED) and keratoconus (KC) continue to affect the quality of life of many South Africans (and elsewhere) and in the case of KC often leads to blindness. It is estimated that DED affects 14% to 33% of the population worldwide, while 1 in 2000 of the worlds population is affected by KC. However, details of the etiology of these diseases and their biochemical ‘fingerprint’ remain uncertain. In this study, emphasis was placed on the investigation of immunological proteins in the precorneal tear film of DED and KC subjects and meibomian lipids in these individuals. Tear fluid and meibum were collected from control, DED and KC volunteers. Control subjects were non-contact lens wearers and free from ocular diseases, whereas DED subjects were diagnosed by means of an ocular surface disease index (OSDI) questionnaire. DED subjects were divided into two groups: ‘moderate DED’ and ‘severe DED’ based on OSDI. KC subjects were diagnosed by the use of a slit-lamp biomicroscopy exam. Enzymelinked immunosorbent assays were performed to quantitate secretory immunoglobulin A (sIgA), tumour necrosis factor-alpha (TNF-á) and matrix metalloproteinase-1 (MMP-1) in the collected tear fluid. Meibum was analysed with proton nuclear magnetic resonance (1H-NMR) spectroscopy and Fourier transform infrared spectroscopy (FTIR). Multivariate data analyses (PCA) were used to extract interpretable information from the multidimensional data generated from the aforementioned techniques and used to build a broad picture of the general lipidomic differences between DED, KC and healthy subjects. Tear levels of sIgA and MMP-1 were significantly decreased in patients with KC compared to control. In contrast, the tears of severe DED subjects were characterised by higher levels of TNF-á and lower levels of sIgA. In subjects with moderate DED, TNF-á levels were significantly elevated. The results of this study re-emphasize that KC and DED individuals are associated with differential expression of specific tear proteins and support the view that the severity of DED is reflected in the levels of immunological proteins present in basal tears. Differences in the chemical composition of meibum from subjects with severe DED and KC compared to control were observed, more specifically in the aliphatic region of 1H-NMR spectra and C-C rocking region of FTIR spectra. The results therefore point towards the saturated components of fatty acids (and their chemical environments) as key targets for future investigations to elucidate compositional differences between DED, KC and healthy meibum.

Acute coronary syndrome (ACS) is a continuum of disease that includes non-ST-segment elevation ACS and ST-segment elevation myocardial infarction. The purpose of this article is to define the developing role of ticagrelor in ACS and compare it to currently available P2Y12 receptor inhibitors. While clopidogrel remains the "workhorse" P2Y12 receptor inhibitor for many patients with ACS and prasugrel has an established role in select situations, clinicians must now assimilate the evolving role of ticagrelor. Although ticagrelor offers important advances in the management of ACS (eg, reversibility), there are also notable clinical considerations (eg, unique adverse effects such as dyspnea). Based on the current evidence, we propose an algorithm to aid clinicians in the selection of a P2Y12 receptor inhibitor for patients with ACS in various clinical situations.

Indiana University-Purdue University Indianapolis (IUPUI) / The study evaluated the effects of a mandibular repositioning appliance (MRA) in patients with obstructive sleep apnea. The MRA was designed to hold the mandible anteriorly in an attempt to maintain a patent airway. Eleven subjects completed a full-night polysomnogram wherein their normal sleep was recorded half the night without the appliance (control) and the other half with the appliance (test). The sequencing of test and control halves was randomly assigned to avoid bias. After seven subjects were tested with the MRA, the MRA was modified for four additional patients by placing anterior vertical elastics (MRA*) to minimize the opening of the mandible. The skeletal and soft tissue changes with both appliances were analyzed using lateral cephalometric radiographs. The MRA was found to have no significant effect on the obstructive sleep apnea patients as a group. Individual response to the appliance varied from noticeably worse to marked improvement. Subject #2A exhibited the reduction of a moderate-to-severe apnea (Apnea-hypopnea index 55.92) to a clinically acceptable level (Apnea-hypopnea index 9.57) with appliance wear. The treatment was considered successful. Significant cephalometric changes with appliance wear were increased lower facial height, a superiorly positioned hyoid bone relative to the mandibular plane, and a decreased posterior airway space. No cephalometric measurement could accurately predict the outcome of the treatment, and posterior airway space, commonly measured in sleep research, was not reliable. The mandibular repositioning appliance was effective in treating a small percentage of individuals with obstructive sleep apnea. A polysomnogram was needed to quantitatively measure the effectiveness of treatment. Under no circumstance should a subjective evaluation by the patient or the clinician be used to assess treatment results. Further investigation is required to evaluate the long-term effectiveness of this treatment. Periodic follow-up sleep studies are required for any patient treated with this appliance until more long term studies are completed.