This study was conducted in order to determine the effectiveness of ischaemic compression and myofascial dry needling in the treatment of lower back pain due to an active trigger point in the quadratus lumborum muscle. It was also conducted in order to compare the effects of ischaemic compression to the effects of myofascial dry needling of an active trigger point to determine which of the two treatment protocols was superior. It was hypothesised that ischaemic compression and myofascial dry needling would have a positive outcome on the subjective and objective findings in patients with lower back pain. Participants were recruited into the study by the use of advertisements placed in local newspapers and at the University of Johannesburg’s Chiropractic Day Clinic. Thirty patients who conformed to the specified limitations and diagnostic criteria were accepted. These patients were randomly placed into two groups of fifteen patients each. Group one received ischaemic compression and group two received myofascial dry needling. Each patient received six treatments over a three week period, therefore two treatments per week. The subjective data, which was the patients lower back pain was assessed using the Numerical Pain Rating Scale. The objective data was obtained from the readings on the algometer, measuring the pressure threshold of trigger points. All the algometer readings were statistically analysed using repeated measures tests. These tests were conducted on a 95% confidence level (P<0.05). The results of this study indicate that both treatment protocols were very effective for the treatment of quadratus lumborum myofascial trigger points and lower back pain. Based on the results of this study, ischaemic compression and myofascial dry needling are suggested treatments for myofascial trigger points associated with lower back pain, however ischaemic compression proved to be significantly the most effective. / Dr. S. Wilcox Dr. M. Moodley

M.Tech. (Homoeopathy) / This is a study which has involved the treatment of individuals, manifesting with depressed symptoms, using homoeopathic medication. Each patient was first seen by a clinical psychologist who made her own diagnosis of the patient's depressed condition. Each patient then attended a three hour initial case-taking session where the researcher gathered much information about that patient's life story. The researcher was interested in all physical, emotional and mental symptoms that patients were experiencing. Thus, the approach was a holistic one, i.e. where all aspects of the individual are seen as a totality. The case-taking was then followed by analysis of the patient's case using homoeopathic tools of a repertory and materia medica to find that remedy which matched that patient's totality, their similimum. This remedy was prescribed and a patient's progress noted through follow-up sessions. where prescriptions may have been altered. The treatment lasted six months. Thereafter, the same clinical psychologist, again saw the patients individually and made her diagnosis of every patient's condition. This study was an attempt to remain true to the principles of classical homoeopathy. Thus, the researcher did not categorise patients with suitable depressive terms and their treatment was totally specific for each patient. The aim was to show that treatment should be individualised, which is the basis of homoeopathy, irrespective of the illness being treated. It was also an attempt to provide an alternative treatment which was neither non toxic nor suppressive to the human body.

No description available.

Class of 2013 Abstract / Specific Aims: To describe the characteristics of patients who were switched to or prescribed posaconazole or voriconazole for the treatment of coccidioidomycosis including duration of previous anti-fungal treatment and rationale for changing from the first-line agents to posaconazole or voriconazole. Methods: This was a retrospective medical chart review of all patients admitted to an academic medical center with a diagnosis of coccidioidomycosis and prescribed posaconazole or voriconazole between January 2008 and December 2011. Subjects for the study were identified by ICD-9 codes for coccidioidomycosis (114.0-114.9) and through the pharmacy system for orders for posaconazole or voriconazole. Data collected included demographic information, antifungal prescription data, and outcome of fungal infection, if available. Main Results: A total of 41 subjects were identified as being prescribed either voriconazole or posaconazole for a diagnosis for coccidioidomycosis. The majority of subjects were prescribed voriconazole (93%) rather than posaconazole. While the majority of subjects were diagnosed with only pulmonary disease, 44% of subjects’ coccidioidomycosis diagnoses were classified as disseminated and 46% were admitted to an intensive care unit. The median (range) duration of first-line antifungal therapy was 3 (2-10) days for the posaconazole group and 3 (0-25) days for the voriconazole group. Overall, the reason(s) for switching antifungal therapy was listed as: failure of first-line therapy (26%), adverse drug event (4.3%), other (35%), and unknown (35%). Conclusion: There was no significant difference in baseline or disease characteristics between patients who were prescribed voriconazole or posaconazole for coccidioidomycosis. The main limitation of this retrospective evaluation is that the reason for use of voriconazole or posaconazole rather than first-line agents was often not easily determined based on the documentation in the medical records.

Class of 2013 Abstract / Specific Aims: The purpose of this study was to retrospectively evaluate sulfamethoxazole concentrations obtained in adult patients with varying degrees of renal function. The first study aim was to identify sulfamethoxazole serum concentrations obtained from patients who received high-dose trimethoprim/sulfamethoxazole. The second aim is to examine the relationship between sulfamethoxazole concentrations, trimethoprim/sulfamethoxazole doses prescribed, and subjects' estimated renal function. Methods: This institutional review board approved study examined sulfamethoxazole serum concentrations in adult patients with varying renal function. Subjects selected had recorded sulfamethoxazole blood concentrations while receiving high-dose sulfamethoxazole/trimethoprim between June 2006 and May 2012 while admitted to an academic medical center. For the first study aim, patients were grouped by renal function with estimated creatinine clearance exceeding 30 ml/min, creatinine clearance of 15 to 30 ml/min, and creatinine clearance of less than 15 ml/min. For the last group, dosing practices were described since few recommendations for this degree of renal function exist. For the first two groups, adherence to literature recommendations was evaluated. The second aim was addressed with a population pharmacokinetic analysis. A one compartment model was used with first-order elimination. Oral dosing was incorporate a separate administration compartment with first order transfer to compartment 1. Intravenous dosing was handled as a rate input into compartment 1. For patients with estimated creatinine clearance greater than 60 ml/min, all doses within the prior 48 hours were entered while those with estimated creatinine clearance less than 60 ml/min only the prior 96 hours of doses before a concentration were entered. Sulfamethoxazole concentrations were assessed in context of trimethoprim/sulfamethoxazole dose and renal function. Main Results: A total of 77 subjects who had a total of 206 sulfamethoxazole concentration(s) obtained while receiving high-dose sulfamethoxazole/trimethoprim. The sulfamethoxazole concentrations ranged from undetectable to 316.8 mcg/mL with a median value of 79.6 mcg/mL. The number of sulfamethoxazole concentrations obtained per subject ranged from 1 to 8 concentrations. The pharmacokinetic analysis of these sulfamethoxazole concentrations based on subjects’ estimated renal function and doses prescribed is in progress. Conclusion: To be determined.

Magister Scientiae Dentium - MSc(Dent) / The development of a uniform method of epidemiological assessment and grading of malocclusion has been of interest for several decades. Recently, Daniels and Richmond (2000) proposed a new orthodontic index namely the Index of Complexity, Outcome and Need (ICON). Their aim was to develop a single index for assessing treatment inputs and outcomes.The aim of this study was to critique the ICON and to assess to the extent to which each component of the ICON fulfils the ideal requirements of the ideal index as identified in a World Health Organization Report (WHO, 1966). The study was performed in three parts: 1) a gold standard was established to test reliability and validity of the ICON; 2) to assess ease of use and simplicity of the index; 3) and to test the applicability of the index on patients and study casts. The results showed that the ICON identified 25% of the cases as &lsquo;no treatment&rsquo;, as apposed to the 100% of the gold standard. Validity of the index was shown to be &lsquo;poor&rsquo; for complexity (? = 0.2) and degree of improvement (? = 0.34) and &lsquo;excellent&rsquo; for outcome. Reliability was high for all the components except for treatment need (? = 0.63). This study concluded that except for complexity and degree of improvement, the index performed well with respects to reliability, validity (of treatment outcome), ease of use and simplicity and applicability to patient and study casts. / South Africa

Magister Legum - LLM / South Africa

The case-study method of psychological research was applied to the brief psychodynamic therapy of a narcissistically disordered female patient. The aim of this research was to explore, clarify and explain certain diagnostic and psychodynamic anomalies to emerge in the course of treatment, using a conceptual framework derived from select psychoanalytic object relations theorists in the area of narcissistic pathology. The author, discovering that there was no diagnostic or explanatory object relations model adequate to the therapeutic data, formulated his own diagnostic category narcissistic neurosis and an eclectic object relations model in order to explain the anomolous research findings. Narcissistic neurosis was defined as a form of psychopathology in which a primarily neurotic character structure presents with a distinctly narcissistic profile. The narcissistic false self-structure serves the functional purpose of protecting the psyche from a repressed negative self-representation derived from a destructive bipolar self-object introject. The primary etiological factor to emerge was that of a narcissistic mother conditional affection and self-object target child necessitated adaptive whose insensitivity, relationship with the premature self-sufficiency and the defensive emergence of a narcissistic surface self-representation. It was proposed that narcissistic neurosis and narcissistic personality disorder are two discrete forms of pathology differing in terms of severity, psychodynamics, defensive structure, mode of object relating, therapeutic accessibility and prognosis. Assessment criteria were proposed in order to differentiate the two areas of narcissistic pathology and assess suitability for psychotherapeutic treatment. Positive treatment results in this case-study suggest that narcissistic neuroses may receive long-term benefit from short-term psychodynamic therapy.

Tuberculosis(TB) was declared to be a global emergency in 1993, with South Africa declaring it to be the country’s top health priority in 1996, but ineffective treatment strategies have led to fewer than half of all treated patients in South Africa being cured. At present,paediatric treatment remains a problem, as the antitubercular preparations of rifampicin, isoniazid and pyrazinamide, that are currently available, were not initially designed for the treatment of paediatric TB patients, providing a motivation for this project. The aim of this project is thus the development of a microemulsion dosage form for the oral delivery of RIF(Rifampicin), INH(Isoniazid) and PZA(Pyrazinamide) in combination. RIF, INH and PZA were adequately characterised with reference to the monograph standards referenced and were found to be sufficiently pure to be used in subsequent work. A chromatographic system and conditions were selected and validated as being optimal for HPLC analysis of RIF, INH and PZA in combination, with a drug partitioning method for miglyol 812 developed and validated. Ternary and pseudo-ternary phase diagrams were constructed and reported, all employing miglyol 812 as the lipid. It was undoubtedly the imwitor 308 and crillet 3 combination o/w microemulsion system that proved most successful, maintaining homogeneity on dilution. The microemulsion used in formulation comprised imwitor 308 (27.63%), crillet 3 (27.63%), miglyol 812 23.68%) and water (21.06%). The stability of RIF, INH and PZA was investigated in aqueous solution, miglyol 812, corn oil, 10%m/v cremophor RH, 5%m/v imwitor 308, 10%m/v crillet 3 and 70%m/v sorbitol solution. Trends in the stability assessments conducted on RIF, INH and PZA were noted, with slight variation depending on the formulation component being evaluated. RIF invariably demonstrated temperature and oxidation dependent degradation in all vehicles, with a definite distinction possible between samples stored at 25, 40 and 600C over a 7 day trial period. A definite advantage of storing RIF solutions under nitrogen was observed, with these solutions showing less degradation over the course of the trial, than those stored under air. INH produced a pronounced increase in the degree of degradation of RIF, whereas PZA had a negligible effect on it’s stability. INH proved to be most stable in the 70%m/v sorbitol solution with no significant oxidation or temperature dependent degradation indicated. Temperature dependent degradation was only noticable when INH was in combination with RIF, most significant in crillet 3 solution. PZA was the most stable of the three drugs, remaining relatively unaffected by temperature and the presence of air, independent of the vehicle employed, although the drug remaining did decrease slightly in the presence of RIF.Due to drug dose specifications and solubility limitations, the final formulation assessed, only contained RIF and INH, despite INH and PZA having no significant effect on the stability of each other. The solubility of PZA in the lipid and aqueous components of the microemulsion was not great enough to achieve the required 500 mg/10ml dose, while RIF and INH could achieve the respective 150mg/10ml and 100mg/10ml dose. RIF stability was improved, as anticipated, with the incorporation of RIF into the internal phase decreasing contact with INH which has been shown to affect it’s stability. RIF behaved as predicted, possessing greater stability than shown in the individual formulation components, however, INH did not, being less stable in formulation in the absence of antioxidant, than in it’s presence. A novel microemulsion formulation capable of delivering the incompatible RIF and INH in combination, with numerous microemulsion systems mapped,with the ability of being used for the delivery of other lipophilic drugs and drug combinations, was produced.The final formulation provided valuable information into possible future improvements of the microemulsion to improve drug stability.

A dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic at Technikon Natal, 2002. / Tension-type headache is generally accepted as the most common form of headache and has been shown to have a great impact on work and social activities (Shwartz et al. 1998). Tension-type headache occurs in 39% of people who suffer from headache symptoms with a higher incidence among females, and a peak in the 25-44 year old age group (Wong et al. 1995). The purpose of this study was to investigate the relative effectiveness of 1000mg acetaminophen (paracetamol) combined with 130mg caffeine as opposed to cervical manipulation as a treatment for tension-type headache. / M