M.Tech. (Chiropractic) / Purpose: This study aims to ascertain the extent Chiropractic manipulative therapy increases ROM beyond the joint-separation induced ROM initially experienced via the cavitation phenomenon in the absence of neck pain. Method: Sixty participants between eighteen and thirty-five years of age, thirty male and thirty female whom met the inclusion of no neck pain and perceived decreased ROM were selected for participation. There was a single group with each participant‟s pre-adjustment readings acting as a baseline. Procedure: Participants were assessed for hypomobility and joint dysfunction. Those who met the inclusion criteria underwent a detailed history, physical and cervical spine regional examination on the initial consult. A pre-adjustment objective measurement was acquired using a cervical spine range of motion (CROM) device. Once the consent form was signed participants received Chiropractic cervical spine manipulative therapy to the area/s of the cervical spine found to be restricted on motion palpation by the researcher. Post-adjustment objective measurements were taken at one, twenty, forty and sixty minutes using the CROM device. Participants were required to remain in the researcher‟s examination room for 60 minutes post-adjustment with continuation of regular day to day activity and no strenuous activity during the twenty-four hour period of the study. The participant was required to return for a single follow up visit within a time frame of twenty-four hours of the initial visit. The follow-up visit required no treatment. At twenty-four hours, the participant was objectively measured for cervical spine ROM using the CROM. The results were based on objective data in the form of cervical spine ROM measurements. Results: Clinical analysis of the percentage change in cervical spine ROM values revealed that clinically and statistically significant improvement was seen in all ranges of motion post-adjustment. General consensus showed that a peak value of improved ROM was seen post-adjustment at the one minute interval for all ranges of motion except flexion. Flexion demonstrated a peak ROM value at the twenty minute post-adjustment interval.

M.Tech. (Chiropractic) / This study aimed to compare the immediate effects of a cervical spine adjustment on gait in participants who had asymptomatic cervical spine dysfunction. Method: This study consisted of 1 group of 60 participants between the ages of 18 and 50 years of age. The group was mixed unevenly in terms of gender. The potential participants were examined and accepted according to the inclusion and exclusion criteria. Each participant underwent a pre adjustment gait analysis followed by cervical spine adjustment and then a post adjustment gait analysis. Procedure: Treatment consisted of a single treatment. The objective data was recorded via the Win FDM system pre and post cervical spine adjustment. The measurements were taken this way to give a reliable, dynamic analysis of gait in an easy to read print out. Analysis of collected data was performed by a statistician. The manipulative techniques used were directed towards dysfunction cervical spine joints which were identified via motion palpation. Results: The results of the gait analysis were obtained from the WinFDM analysis and analyzed by STATKON. Objective data was collected from 60 participants of both genders. All participants underwent a pre and post adjustment gait analysis for comparison...

>Magister Scientiae - MSc / Different pathology associated with impacted wisdom teeth in the oral cavity showed that it is prevalent and may lead to varied dental complications. This study adopted a descriptive cross-sectional retrospective analytical design in order to examine hard tissue features associated with the presence of impacted third molars in a random sample of 2998 digital panoramic radiographs (DPRs) of patients' records in Tygerberg Oral Health Centre, Faculty of Dentistry, University of Western Cape. The specific objectives of the study were to categorize the type of impactions in the DPRs of patients and to determine the prevalence of distal cervical caries (DCC) in second molars, any radiolucent (RL) /radiopaque (RO) lesions or external root resorption (ERR) complications associated with impacted wisdom teeth. Results of the pantomographs and clinical records of patients indicated that the most prevalent type of impaction (TOI) is Mesioangular (MA) Impaction (65%) followed by Horizontal (H) Impaction (17%), Vertical (V) Impaction (15%), Transverse (TVS) Impaction (2 %) and Distoangular (DA) Impaction (1.2 %), respectively. The least prevalent type was Inverted (INV) Impaction with a frequency count of 0.5%. The results further indicated varied dental complications resulting from impaction, ranging from ERR with a frequency of 3% of which 66.70% was associated with MA type of impaction, followed by H with a frequency of 26.7%. The association of Gender and RL/ RO lesions was significant (p-value=0.04) while association between DCC and types of impaction was also significant (p-value =0.0017). The study concluded that the high prevalence of MA among all populations and genders over the years may be related to the anatomical normal inclination of the third molars to the mesial surface. The low prevalence of DA observed in the study sample on the other hand might be attributable to gender and demographic factors. Lastly, this study has only one radiopaque lesion and the high prevalence of RL lesions in males and in the older age group suggests that these complications take a while to develop. Future research is needed to raise more awareness and encourage patients to seek treatment of symptomatic and asymptomatic third molars before complications arise.

Background: Although subclinical persistent infections with the human polyomaviruses are ubiquitous worldwide, they are known to vary in relation to geographical location, diseases present and may associate with different human tumours, especially in immunocompromised patients. The current study hypothesised that there may be co-operativity between HPV and polyomaviruses, particularly in HIV positive women, that could influence the rate of progression to invasive cervical carcinoma. Patients and Methods: Novel PCR methods were developed for the detection of SV40, MCV, JCV and BKV polyomavirus DNA. These were used to test DNAs extracted from 220 cervical smears and 77 invasive cervical carcinomas (ICCs) from HIV positive and negative Kenyan women of known HPV status. An expression plasmid was constructed containing JCV Large T (LT) antigen and this, in addition to empty vector control, used to stably transfect HPV16 E6/E7 immortalised human keratinocytes. Expression of LT was analysed in transfected cell lines by PCR, immunocytology and Western blotting. These cells were then used to test for changes in Cell contact growth inhibition; Growth rate and Epithelial to Mesenchymal Transition (EMT). Screening of full transcriptome microarrays was carried out on vector and LT transfected cells and their sensitivity to the drug mefloquine tested by comparison of growth rates and live/dead cell assays. Results: PCR accurately detected ~18 copies of SV40, MCV, JCV and BKV DNA in addition to simultaneous detection of JCV and BKV. None of the clinical samples tested were positive for SV40, MCV, or BKV DNA. However, JCV DNA was detected in 24/297 (8%) of cervical specimens. Comparison of the incidence of JCV in cervical smears and ICCs showed a ~3-fold increase in samples from HIV positive women with ICC (P=0.025) whereas no significant difference was found between smears and ICCs from HIV negative women (P=0.553). Analysis of the consequences of ectopic expression of JCV LT in E6/E7 immortalised human keratinocytes showed no difference in either growth rates or contact inhibition and changes in the EMT marker vimentin were found to be related to cellular clonality. Microarray analysis showed LT related alterations in gene expression which could have bearing on its carcinogenic potential in addition to changes related to clonality. JCV LT expressing monoclonal cell were the most sensitive to mefloquine treatment. Conclusion: The simultaneous JCV/BKV detection method, described herein, is unique and has been evaluated by the WHO for this purpose. The results indicate the prevalence JCV and BKV with respect to the African geographical location and suggest that JCV may combine with high-risk HPV in a sub-set of HIV positive women to influence the rate of progression to invasive cervical carcinoma. In vitro JCV LT was found not to be an overt oncogene in the cell system used although cell cloning procedures clearly affected the assays. LT induced changes in total gene expression were consistent with neoplastic progression although a high proportion of genes with unknown function were dsyregulated with respect to clonality. The anti JCV drug mefloquine showed some selectivity for LT expressing cells and further investigation of this indication is warranted.

M.Tech. / Purpose: Acupuncture has been a controversial issue in the medical world for many years before the sceptic western medicine slowly adopted its idea. Some mechanisms for pain relief were clinically researched and proven to be valid as well as effective in treating tension-type headaches (Stux, Berman and Pomerantz, 2003) The purpose of this study was to assess and compare the effects of cervical spine manipulation and needling of acupuncture points in those patients with tension-type headache and suggest another complimentary treatment to the chiropractic manipulation, especially in those patients where manipulation is contraindicated to manipulation. If found to be effective, various mechanisms have been suggested in the formation of tension headache episodes. Those mechanisms may be alterations within the spinal cord and/or brainstem gating mechanisms as a result of facet joint dysfunction, sensitization of nociceptors in the peripheral structures of the body and psychological factors. Method: This study consisted of two groups, consisting of 16 subjects in each group. All participants were screened for tension-type headaches and accepted based on the inclusion and exclusion criteria. The subjects were between the ages of eighteen and thirty-five. Group 1 received chiropractic manipulation treatment to the most restricted levels in their cervical spine. Group 2 received treatment consisting of needling of acupuncture points to specific predetermined points. Procedure: Each successful candidate was treated six times over a 3 week period which included a total of seven sessions. Before the beginning of the treatment, the successful candidate completed the Vernon-Mior Neck Pain and Disability Index Questionnaire and the Numerical Pain Rating Scale. Readings for cervical spine ranges of motion were then taken with a CROM device. In group 1, chiropractic manipulation was then delivered to the most restricted segments in the cervical spine. In group 2, needling of six predetermined acupuncture points for relieving tension-type headache was performed bilaterally. The same treatment procedure was administered at sessions one through six, the CROM readings and questionnaires were taken in sessions one, three, five and seven. Results: The results were obtained by using the Mann-Whitney U and t-test. No statistically significant differences were identified between the groups, when comparing the 2 treatment methods at the visits. However, both groups showed a statistically significant improvement over time within each group individually for subjective measurements and for right lateral flexion in the objective measurements. Conclusion: The results were inconclusive with regards to the prolonged effects of chiropractic manipulation and needling of acupuncture points on cervical spine range of motion in patients with tension-type headache. However, it was concluded that both methods of treatment had beneficial effects on how the participants perceived their pain and disability. Due to the small group of subjects and relatively short duration of the study, accurate conclusions could not be formulated. The findings obtained were insignificant and further research needs to be performed on the effects of cervical spine manipulation and needling of acupuncture points on those suffering with tension-type headache.

M.Tech. (Chiropractic) / Aim: The aim of this study was to determine if a chiropractic adjustment had an effect on muscle strength. The study then aimed to compare the effects a resistance training protocol, to a chiropractic adjustment, to a combination of these two treatments on the neck strength of individuals with cervical facet syndrome. Method: This study consisted of three groups of 10 participants each. The participants were grouped by stratified sampling to balance the groups in terms of age and gender. The participants ranged in age from 22 to 28 years. There were 18 male and 12 female participants. Participants were examined and accepted into the trail according to inclusion and exclusion criteria. Treatment was allocated according to groupings. Group 1 received a resistance training protocol, group 2 received chiropractic adjustment only and group 3 received a combination of both treatments. Procedure: Treatment consisted of 6 treatment sessions and a 7th follow up session, over a three week period. Participants in group 1 and 3 were instructed to perform the demonstrated resistance training protocol 3 times a week for 3 weeks. Participants in group 2 and 3 received chiropractic adjustments to hypomobile cervical spine segments, twice a week for three weeks. Cervical range of motion (CROM) was mesured using a CROM device and strength readings were measured using a hand held isometric dynamometer. Measurements were recorded on the 1st, 4th and 7th visits. All participants were required to fill in a Vernon-Mior Neck Disability Index (NDI) on the 1st and 7th visits. The data collected was analysed by a statistician. Results: Analysis of the Vernon-Mior NDI intra-group results showed that all three groups were effective in reducing cervical pain and disability. There was no statistical difference in improvement between the groups. CROM results indicated that all three groups successfully increased cervical range of motion. The combination group had the greatestimprovement, followed by the adjustment group and lastly the resistance training group. The combination group showed statistical improvements in all ranges of motion at visit 4 while this was only achieved by the resistance training group at visit 7. In the adjustment group statistical changes in flexion, extension and lateral flexion were only noted at visit 7, however in rotation, statistical improvements were noted at visit 4. Isometric dynamometer analysis showed that all 3 groups did show a statistically significant increase in cervical muscle strength. The combination group provided the greatest gains, followed by the adjustment group. The smallest gains were seen in the resistance training group. Statistical changes in the resistance training group were only measured at visit 7, while in the combination and adjustment group, these changes were noted by visit 4. Conclusion: Chiropractic adjustment was effective in increasing neck strength. Of the 3 groups, the combination treatment proved to be the most effective method of improving neck strength in individuals with cervical facet syndrome. Of the two individual treatments, chiropractic adjustment was more effective in terms of both strength gains and time taken to achieve these results, than the resistance training protocol.

M.Tech. / Purpose: Heachaches are a very common complaint among society today, and as a result there are a vast number of individuals seeking medical treatment specifically for headaches (Alix and Bates, 1999). The impact that headaches have on a patients quality of life far exceeds that of other conditions such as osteoarthritis and hypertension. Primary headaches such as Cervicogenic, Cluster and Tension-type headaches have no specific underlying cause. However, it has been shown that spinal manipulative therapy (SMT) can be used as an effective tool in the treatment of these primary headaches (Brontford, Assendelft, Evans, Haas, and Bouter, 2001; Khoury, 2000 and Vernon, 1995). A Cervicogenic Headache is defined by the North American Cervicogenic Society (NACHS) as referred pain perceived in any region of the head caused by a primary nociceptive source in the musculoskeletal tissues innervated by cervical nerves. The aim of this study was to determine the efficacy of upper cervical spine manipulation in conjunction with Interferential current and Ultrasound therapy, compared to upper cervical spine manipulations alone as a treatment protocol for Cervicogenic headaches. Method: This study consisted of two groups; both Group 1 and Group 2 consisted of 15 participants with Cervicogenic headaches. The participants were between the ages of 18 and 55 years. Potential participants were examined and accepted based on the inclusion and exclusion criteria. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Group 2 received a combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine C1-C3 levels. Objective and subjective findings were based on the treatments. Procedure: The participants received six treatments in total over a three week period that is two treatments a week for three weeks followed by a seventh consultation visit where only subjective and objective measurements was taken. The participants completed a Numerical Pain Rating Scale and Headache Disability Index Questionnaire. Algometer readings were taken over the most sensitive trigger point in the Posterior Cervical muscles. Group 1 received spinal manipulative therapy over restricted segments in the upper cervical spine and Group 2 received a ten minute combination treatment with Interferential current and Ultrasound therapy over active myofascial trigger points in the Posterior Cervical muscles in conjunction with spinal manipulative therapy over restricted segments in the upper cervical spine. The same treatment procedures were administered over the study; subjective and objective readings were only taken at visits 1, 4 and 7. Results: In terms of objective measurements based on the pressure Algometer readings, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in muscle sensitivity between the two groups over time was revealed. However, Group 1 showed a larger overall clinically significant difference in Posterior Cervical muscle sensitivity. In terms of subjective measurements based on the Headache Disability Index Questionnaire scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. No statistically significant difference in terms of intensity, duration and frequency of the headaches between the groups over time was revealed. However, Group 1 had a greater clinical reduction in intensity, duration and frequency of headaches when compared to Group 2. In terms of subjective measurements based on the Numerical Pain Rating Scale scores, a statistically significant difference was revealed within both Group 1 and Group 2 individually over time. A statistically significant difference in terms of intensity of the headaches between the groups over time was revealed. The overall clinical improvement was similar for both groups however Group 1 had a slightly greater clinical reduction in headache intensity when compared to Group 1. Conclusion: Both groups showed an overall improvement in the headache symptoms as well as Posterior Cervical muscle sensitivity; however Group 1 showed a greater clinical improvement when compared to Group 2.

M.Tech. (Chiropractic) / Purpose: The purpose of this randomised comparative study was to establish the effects which these modalities had on pain perception and range of motion in patients with acute cervical facet syndrome. This was done by comparing manual cervical spine traction alone; to cervical spine adjustments alone to manual cervical spine traction applied post cervical spine adjustments. Method: A total of 30 participants were recruited for this study by placing advertisements in and around the University of Johannesburg, Doornfontein Campus. Participants had to meet the requirements of the inclusion criteria and were excluded if they were found to be unfit for this particular study. The 30 participants were asked to draw a number out of a bag which therefor randomly divided them into three groups of 10 participants each. Procedure: Participants in group A received manual cervical traction alone as their treatment. Participants in group B received cervical spine adjustments alone as their treatment. Finally, participants in group C were treated by performing manual cervical spine traction after the cervical spine adjustment. Each participant was treated a total of six times over a two week period. Measurements were taken on the first, fourth and a seventh consultation. Results: Regarding the Subjective readings, there was an improvement with regards to the Numerical Pain Rating Scale values for all three groups, but the combination group of manual cervical spine traction performed post cervical spine adjustment, showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. There was an improvement in Neck Pain Disability Index values for all three groups, but the cervical spine adjustment group showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. Regarding the Objective readings, there was an improvement in pressure algometer readings for all three groups, but the cervical spine adjustment group showed the greatest improvement over the trial period on intra-group analysis. No statistical significant changes were found on inter group analysis. There was an improvement in Cervical Range of Motion readings for all three groups, but the combination group of manual cervical spine traction performed post cervical spine adjustment showed the greatest improvement for flexion, extension and bilateral rotation on intra-group analysis. However, for bilateral lateral flexion, the cervical spine adjustment group showed the greatest improvement on intra group analysis. No statistical significant changes were found on inter group analysis. Conclusion: There were clinically significant improvements within each of the three groups on intra group analysis but no clinically significant differences were found on inter group analysis. Therefore, none of the groups could be singled out as being the best treatment approach for acute cervical facet syndrome. With regards to the Chiropractic profession the outcome of this study therefore suggests, that the chiropractic adjustment alone is sufficient in treatment of acute cervical facet syndrome as none of the groups proved to be superior.

Great disparities exist in women’s health outcomes in rural indigenous communities in Guatemala; indigenous women are less likely to utilize family planning and cervical cancer screening services. This pilot study assessed baseline women’s health knowledge and the effects of a comprehensive women’s health course on women’s health knowledge and behaviors. From February to November 2013, 61 participants in a seven-week language-appropriate women’s health curriculum were evaluated before and after the course using a 10-item knowledge assessment. Cervical cancer screening and contraceptive utilization rates were assessed by self-report before and after the course. Several women’s health knowledge deficits were noted: belief that contraception causes cancer, inability to name symptoms of STIs, lack of understanding of pap smears, and lack of familiarity with condoms. The average pre-test score was 54.6%; increasing to 83.7% on the post-test (p<0.0001). 79% had received a pap smear prior to the course; this increased to 92% at the post-test (p=0.013). 53% had utilized contraception prior to the course; at the time of the post-test the percentage was 54% (p=1). This study reveals important patterns in women’s health beliefs in rural Guatemala, and shows that a seven-week curriculum was effective in improving scores on a knowledge assessment.

PROJECT ONE Introduction HPV is detected in about 99.7% of cervical cancers. However, the HPV type distribution in South African women is unknown. Objectives To determine HPV-type distribution among women with cervical dysplasia in relation to oral contraceptive usage. Methods Prospective cross-sectional study of four groups of patients according to oral contraceptive usage: non-users, users of less than five years duration, users of between five years and ten years and users of more than ten years duration. Swabs of the cervix were analysed for HPV DNA using polymerase chain reaction method. Results A total of 124 women were recruited for the study. There were 75 HIV-infected patients (seroprevalence 61%). Of the 102(82%) HPV-positive patients, 79 patients had high-risk HPV DNA (78%). In terms of the four oral contraceptive groups, high-risk HPV DNA was detected in 70% (n=21), 79% (n=22), 90% (n=21) and 71% (n=15) of patients, respectively. The odds of having HPV DNA was six times higher for the combination of contraceptive users of less than 5 years duration/non-users (OR 5.9, 95% CI: 1.87 - 18.77). There was no change when adjustment was made for age (OR 6.1, 95% CI: 1.9 - 19.4). HPV DNA types 16 and or 18 was present in a total of 21 patients (49%) (non-contraceptive users and users < 5years duration) versus 15 patients (42%) who used oral contraceptives of more than 5 years duration (p=0.524). HPV type 16 was the commonest HPV type detected (20.2%) and HPV type 58 was the next commonest high-risk HPV type (16.1%). HPV types 58 and 33 was detected in a much greater percentage of our population and HPV 16 in a much smaller percentage of our population compared with a non-South African population. Conclusion The findings of this study demonstrate an interesting distribution of HPV types in a South African population. PROJECT TWO Introduction Various risk factors have been implicated in the causation of cervical cancer including human papillomavirus (HPV), the early genes (E6 and E7) of which encode the main transforming proteins. Studies have suggested that steroid hormones may enhance the expression of these genes leading to loss of p53 gene-mediated cell apoptosis. Methods A total of 120 cervical tissue samples were obtained from patients with proven cervical cancer. Patients who used depo-medroxyprogesterone acetate steroid contraception were recruited as part of the study arm. Only HPV DNA type 16 samples were used for the study. Controls included three cell lines (CaSki, SiHa,&C33A) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was used as an internal housekeeping gene. Of 120 patients, there were 111 patients with HPV type 16 identified. Of this number, RNA was present in 63 samples. There were 30 women (30/63) who used steroid contraception. In relation to patients who used contraception, HPV 16 E6 gene expression was present in 79% (n = 23) and 88% (n = 30) of steroid users compared to nonusers, respectively. In total there were 25 patients (40%) with expression of the HPV 16 E6*I gene and 30 patients with expression of the E6*II gene. There were 57% of steroid users (n = 17) who had expression of the E6*I/E6*II gene, compared to 52% (n = 17) of nonusers (P = 0.800). Conclusion From a molecular level, this study reflects almost similar distribution of the HPV 16 E6/E6*1 and E6*11 and does not confirm the role of injectable progesterones in cervical carcinogenesis. Further studies with larger patient numbers are needed. / Thesis (PhD)--University of Pretoria, 2011. / Obstetrics and Gynaecology / unrestricted