Anatomy

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Microsatellite instability in colorectal and oesophageal cancer.
(1998) Naidoo, Richard.; Chetty, Runjun.
The development and progression of carcinogenesis is a major area of interest to many scientists. Numerous factors, including both environmental and genetic have been implicated in the causation of cancer. It is clear that both these factors and others contribute to neoplastic development and progression. Microsatellites are short tandem repeat sequences which are located in the intron segments of the genome. These noncoding sequences range from 2 to 6 base pairs. An increase or decrease in the number of repeat sequences is referred to as microsatellite instability, also referred to as genetic instability. It is thought that microsatellite instability arises as a result of defects in DNA repair process. During DNA synthesis, the DNA repair genes ensure that the correct nucleotide is incorporated into the newly synthesised DNA strand, so when a mismatch base is incorporated, this is promptly removed and replaced with the correct base. However, if the repair system is defective this would give rise to numerous genetic aberrations along that region of the genome. Recently, microsatellite instability and allelic imbalance/loss of heterozygosity have been shown to play an important role in the development of many cancers, especially colorectal cancer (CRC) associated with the hereditary nonpolyposis colorectal cancer (HNPCC) syndrome. This study was undertaken to investigate microsatellite instability and allelic imbalance in colorectal and oesophageal carcinomas in the KwaZulu Natal region of South Africa. The molecular analysis was correlated with clinicopathological data to establish a baseline level on which further studies could be performed. In addition, this study represents the first fluorescent based microsatellite analysis of these two common cancers in South Africa. Normal and tumour DNA was isolated from formalin fIxed paraffin embedded tissue. Fluorescent-based DNA technology using an automated DNA sequencer (Alf Express Automated DNA Sequencer) was employed. CY5 labelled primers for microsatellite markers (DCC, D18S34, D18S58, D3S659, D2S123 and D3S1255) were used. The data was captured and analysed using the Fragment Manager Software. The informativity of the microsatellite markers used in this study ranged from 50% to 71.8%. LOH/AI in the region of the DCC gene in the under 35 years of age CRC was 39.1%, while MSI in this region occurred in 31.25% of cases. The DNA repair gene status in these young patients was as follows: LOH/AI: 31.3% and MSI: 40.4%. In the over 50 years of age CRC, LOH/AI in the 18q region was 28% and MSI was 38%. The DNA repair genes (hMSH2 and hMLH1) in this cohort showed LOH/AI in 24% and MSI also in 24%. As regards oesophageal cancer, LOH/AI in the 18q region was 20.5% and MSI 7.7%. The repair genes showed LOH/AI in 17.9% and MSI in 10.25% of cases. When the molecular events were correlated with clinicopathological features, no statistically significant pattern emerged. However, it must be remembered that relatively small numbers of cases (39) were analysed.In conclusion: • No statistical correlation was found between clinicopathological characteristics and the molecular analysis in either CRC and oesophageal cancer. • LOH/AI and MSI was higher in the under 35 age group. • LOH/AI and MSI in 18q, 2p and 3p in sporadic CRC were similar to other fluorescent-based studies in patients over 50 years of age. • LOH/AI and MSI in 18q, 2p and 3p in oesophageal cancer was similar to studies from other geographical areas. • Finally, fluorescent-based microsatellite PCR and analysis was found to be an objective and efficient technique.
A clinically applied anatomical study of the coronary arteries in the South African population.
(2003) Lachman, Nirusha.; Satyapal, Kapil Sewsaran.; Acland, Robert D.
Interest in the anatomy of the coronary arteries dates as far back as the early 1500's, at a time when anatomical inquiry was being cautiously aroused. Whilst the later 1700's encouraged academic domination of anatomical study, significant documentation of the coronary arteries was only been established by the late 1800's to early 1900's. There is no doubt that this topic continues to remain dynamic, favoured for its value in applied clinical research. Indeed, technological advancement in the 21 st century has transformed modem day anatomy into more than just a simple descriptive exercise. Whether to update standard literature, create ethnically specific banks of anatomical data, abate technical difficulties associated with coronary artery surgery or provide exciting interventional possibilities for clinicians, revisiting the anatomy of the coronary arteries is clearly warranted. The objective of this investigation was to review the anatomy of the coronary arteries using a clinical approach in order to investigate the morphologic presentation of these vessels within the South African population. On a more clinically universal level, this study aimed to elucidate two focal areas of anatomical interest: extra-cardiac collaterals and myocardial bridges. The investigation was conducted by means of micro-dissection, angiography, histology and scientific evaluation. A total of 323 sets of coronary arterial patterns consisting of patient angiograms (n=212) and cadaveric dissections (n=95) were studied. Specimens were harvested at post-mortem and angiograms and surgical reports were obtained from clinical centers within KwaZulu-Natal. Results of this study confIrmed the standard anatomical description of the coronary arteries as documented. Within the South African population, the ramus marginalis artery was found to be present in 13.3% (Females: 10.7%; Males: 5.6% and Blacks: 18.0%; Indians: 6.6%; Whites: 1.4%). The LAD and LCX arteries arose from independent aortic ostia in 14.5%, (Females: 7.5%; Males: 15% and Blacks: 6.5%; Indians 50%; Whites: 35%). Right dominance was observed most frequently in 85.9% (Blacks: 82.3%; Whites: 83.6% and Indians: 86.4% and Males: 82.6%; Females: 89.2%). A bifId LAD artery was noted in 52%, (Females: 6.2%; Males: 8.7% and Blacks: 17.6%; Indians: 6.3 %; Whites: 4.5 %). In 27.7%, (Females: 24.0%; Males: 28.8% and Blacks: 29.5%; Indians: ·50%; Whites: 20%) the LCX artery failed to continue along the atrioventricular groove. The conus artery arose from a high position off the RCA in 19.2%, (Females: 16%; Males: 21% and Blacks: 19.7%; Indians: 100%; Whites: 10%); and from an independent ostium in 3.61%, (Females: 4.0%; Males: 3.8% and Blacks: 4.9% only). The LCA measured 0.82cm (0.27-2.4cm), (Females: 0.84cm, Males: 0.96cm and Blacks: 0.88cm; Indians: 0.53 cm; Whites: 0.78cm). Myocardial bridges were recorded on the RCA in 2.5% and on the LAD in 50.6%. The bridge pattern depicted myocardial loops to complete arterial investment and ranged in length from 3.0 to 20.02 mm. Scientiftc evaluation of the intramural LAD indicated positive correlation between a straight appearance ofthe LAD on angiogram and a deep myocardial position upon surgical observation (mean "tortuosity index" = 1.147 [1.373-1.045] where 1= baseline for straightness). Results were confIrmed in the correlated cadaveric investigation. Extra-coronary collaterals were observed in 100% (n=9). The arterial pattern consisted of 1 to 2 main stems with secondary anastomotic branches. The average external diameter was measured to be 0.6mm (OA-0.7mm), length 52.5mm (1883mm) with at least 5 secondary branches (3-9) of external diameter O.3mm (0.20.5mm). Results of the histopathological investigation (n=20) indicated the presence of atherosclerotic disease within the intramural LAD artery segment (15%). A 60% incidence was recorded in the pre-mural segment and 25% incidence in the post-mural arterial segments. When analysed in terms of severity, the intramural segment reflected only mild signs of intimal alteration. Although not statistically significant, mean values for coronary artery size differed between sexes. The findings were similar when evaluated in terms of the coronary artery anomalies studied. There were signifIcant differences between ethnic groups in terms of the length of the LCA. Mean values showed that Indians had the shortest LCA's when compared with Blacks and Whites. The highest incidence of the ramus marginalis branch was recorded amongst Blacks. Separate origin of the LCX and LAD was highest amongst Indians and high in comparison to reports documented in other countries. A high origin ofthe conus artery was found to be dominant amongst Blacks. A low incidence of separate origin of the conus from the aorta was recorded in the South African population. These findings are significantly lower than that reported in the literature. A right dominant system has the highest occurrence within this population. Statistical evaluation confirmed that neither sex, ethnicity, age nor height influenced dominance in a coronary arterial pattern. The presence and description of the bifid LAD has been recorded. Its occurrence is highest amongst Blacks. The anomalous path of the LCX has been documented and described. The significantly high occurrence of this disposition of the LCX within the South African population appears to be the highest reported fmd in the literature. In terms of the presence and patterns of myocardial bridges, there are no observable differences between ethnic groups or sex. Results ofthis study confirm a relationship between the straight appearance of the LAD on angiogram and its anatomical presence. Extra coronary collaterals have been successfully investigated and observed. Measurements of vessel dimensions and patterns have been recorded. Results of the histopathological investigation illustrate that the intra-mural LAD artery is relatively protected from vascular disease. It does not however support the theory that in such a sub-myocardial position, the LAD artery is never prone to the damaging effects of atherosclerosis. The "cardio-protective" effect of a muscular bridge, whilst prevalent, is dependant on the thickness and extent ofthe bridge itself The anatomy ofthe coronary arteries has been successfully documented and a bank of data, specific for a South African population has been presented. Significant aspects of coronary arterial patterns have been discussed and interpreted in terms of its clinical relevance. This study presents an original method for the investigation of EeC's using technologically advanced materials and equipment. In addition, a scientific method for confirmation of a "straight" appearance of the LAD artery has been developed in this study. Findings contribute to the bank of diagnostic indicators that may be used to predict myocardial bridges pre-operatively. Through the dissection experience of more than 150 hearts and observation of more than 200 angiograms, this study has been able to contribute to the anatomical description o fthe coronary arteries. In some ways new perspectives were afforded and on the same note, already existing concepts have been verified. The value of this study IS enhanced by the potential clinical impact that such data is envisaged to create.
An investigation of the medial branches of the cervical and thoracic sympathetic chain.
(2001) Pather, Nalini.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.
The number of peripheral segmental branches of the cervical and thoracic sympathetic chains are more variable and larger than assumed by textbooks and literature (Groen et al., 1987). This investigation aims to clarify and update the variable patterns of the cervical sympathetic chain, the incidence of fused thoracic ganglia and the contributions of the cervical and thoracic sympathetic chain to the cardiac plexus. The study involved the macro and micro-dissection of 89 cadaveric sides (foetal, 60 and adult, 29). The gross anatomy of the cervical sympathetic chain and variations is documented. This study confirms previous reports that the number of ganglia in the cervical region ranged from 2 (absent MCG) to four (double MCG) ganglia. A double MCG was found in 25.9%. This study reports the higher incidence of the normal/typical MCG (as per textbook definition) i.e. Type II MCG (46.6%) than the Type I MCG (27.6%) and Type III (32.8%). The number of thoracic ganglia in this study is 8-11. Fusion of ganglia was found to be more common in the lower thoracic chain than in the upper thoracic chain. This study reports the origin of cardiac rami from the thoracic sympathetic chain up to the interganglionic segment between T5 and T6 ganglia. The incidence if TCR5 was 60.4%. In 15/58 sides (25.9 %) TCR5 arose from the interganglionic segment of the chain, either above or below the ganglion. An accurate knowledge of the anatomy of the sympathetic nervous system and the adjacent structures is, inescapably a definite asset to the procedures used in interrupting the neural mechanism (Jamieson et al.) 1952). Successful sympathetic denervation of the heart, a field often beset with failure, is dependant on adequate morphological knowledge. It is hoped that this study using human foetuses as well as adult cadaveric specimens will draw the attention to important variations that are relevant to the surgeon. The intricate anatomical relations presented in this study attest the complex anatomy of the sympathetic nervous system.
The anatomical study of the osteochondral, vascular and muscular relations of the superficial and deep cervical plexuses.
(2010) Pillay, Pathmavathie.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.
In standard anatomical textbooks, the formation of the cervical plexus is well defined; however the accurate differentiation into superficial and deep plexuses, their emerging patterns, and gross anatomical relations are not documented as expansively. In order to obtain detailed anatomical knowledge of the superficial and deep cervical plexuses, the investigation aimed to clarify the anatomy and variations of these plexuses, define possible anatomical landmarks, and record the relationship of the external jugular vein and muscles of the posterior triangle of neck to the branches of the superficial cervical plexus, and the relationship of the common carotid artery, internal jugular vein, sympathetic chain, cervical verterbrae, and vertebral artery to the deep cervical plexus. The studies utilized the gross anatomical dissection, morphological and statistical analyses of forty fetal and fifteen adult cadaveric, formalinized specimens. The branches of the superficial cervical plexus emerged from the posterior border of the sternocleidomastoid muscle at the great auricular point (situated in the middle third of the muscle) and was described as ascending (lesser occipital, great auricular, transverse cervical nerves) and descending (supraclavicular nerves). Further, these branches were recorded according to their branching patterns, relations to the external jugular vein and variations. The branching patterns are described as single, duplicate and triplicate. The external jugular vein was constantly located inferior to the great auricular nerve, superior to the transverse cervical nerve and intertwined with the branches of the supraclavicular nerves. Variations of the branches of the superficial cervical plexus were observed only in fetuses and classified according to their course, branching patterns and communications. The emerging point of the branches of the superficial cervical plexus on the sternocleidomastoid muscle, were determined according to the seven types of “emerging pattern” classification by Kim et al., (2002). In order to record the deep cervical plexus, the sternocleidomastoid muscle was reflected with the following observation: the ventral rami of the second and third cervical nerves emerged between the scalenus anterior and scalenus medius muscles, and the third and fourth cervical nerves was located at the lateral edge of scalenus medius muscle. The deep cervical plexus was described as communicating, muscular, ansa cervicalis, and phrenic nerves. The superior cervical ganglion constantly communicated with the ventral rami of the cervical nerves; and the hypoglossal communicated with the superior root of the ansa cervicalis. The muscular branches were observed to the scalenus anterior and scalenus medius muscles with an anomalous branch to the sternocleidomastoid muscle. The ansa cervicalis demonstrated a degree of variation with regard to its origin, course and formation of the loops. The phrenic nerve arose from the ventral rami of the third, fourth and fifth cervical nerves and descended on the lateral border of the scalenus anterior muscle. The precise understanding of the anatomy of the superficial and deep cervical plexuses together with variations may assist anesthetists and surgeons to accurately identify the vascular, neural and muscular structures and reduce the risks of complications when performing neural blocks in regional anesthesia, facial rejuvenation surgery and parotidectomies.
An anatomical investigation of the sympathetic and parasympathetic contributions to the cardiac plexus.
(2011) De Gama, Brenda Zola.; Satyapal, Kapil Sewsaran.; Partab, Pravesh.; Lazarus, Lelika.
The cardiac plexus is “formed by mixed autonomic nerves” that are “described in terms of superficial and deep components, with the superficial located below the aortic arch and anterior to the right pulmonary artery, and the deep located anterior to the tracheal bifurcation (above the division of the pulmonary trunk) and posterior to the aortic arch” (Standring et al., 2008). This investigation aims to review and update the medial cardiac contributions of the cervical and thoracic sympathetic chains to the cardiac plexus and also the contributions from the vagus nerve and its counterpart, the recurrent laryngeal nerve. This study involved the macro and micro-dissection of 100 cadaveric sides of adult and fetal material. The number of ganglia in a cervical sympathetic chain varied from 2 to 5 in this study. This study confirms previous reports on the location of the two components of the cardiac plexus. The origin of the sympathetic contributions to the cardiac plexus in this study were either ganglionic, interganglionic or from both the ganglion and interganglionic chain of the respective ganglia. The superior cervical cardiac nerve had an incidence of 92% while the middle cervical cardiac nerve had an incidence of 65% in the specimens studied. This study also records a vertebral cardiac nerve that arose from the vertebral ganglion in 39% of the cases. The inferior cervical and cervicothoracic cardiac nerves had incidences of 21%, respectively. This investigation records the thoracic caudal limit of the sympathetic contributions to the cardiac plexus as the T₅ ganglion. The findings in this study indicate the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Reynaud’s Phenomenon and angina pectoris (Kalsey et al., 2000; Zhang et al., 2009).
Prevalence of impacted third molar teeth in the greater Durban Metropolitan population.
(2014) Ishwarkumar, Sundika.; Haffajee, Mohamed Rashid.; Pillay, Pamela.; Satyapal, Kapil Sewsaran.
Tooth impaction is a pathological condition in which a tooth is completely or partially unerupted and positioned against another tooth, bone or soft tissue, thus preventing further eruption. Many theories have been proposed to explain the prevalence of impacted third molars. These theories discuss relationship of jaw size to tooth size which is suggested to result from difference in genetics and dietary habits, as the latter differs from one region to another. The aim of this study is to investigate the prevalence of an impacted third molar tooth on a mixed population in the Greater Durban Metropolitan area. The third molar was classified using Winter’s and Pell and Gregory’s classification schemes. Various morphometric parameters of the mandible were measured and assessed in 320 digital panoramic radiographs (n=640). Each parameter recorded was statistically analyzed, using SPSS, to determine if a relationship existed between the aforementioned parameters and sex and age of each individual. 77.9% of cases presented with at least one impacted third molar, with the most prevalent type of impaction being mesio-angulation in the mandible and vertical angulation in the maxilla. In respect to the level of impaction, class IIB and class A was most frequent in the mandible and maxilla, respectively. For correlation with sex, only the length of the mandibular ramus was statistically significant (p-value=0.000). No statistically significant relationship was found between each morphometric parameter and age. However, these results correlated with previous studies indicating that impacted third molars are most prevalent in individuals between 20-25 years. In addition, all morphometric parameters in this study differed from that recorded in previous studies conducted in the Northern Hemisphere. The findings of this study may assist maxillofacial surgeons, dentists, anatomists, anthropologist and forensic investigators.
Frequency and predictors of failed spinal anaesthesia for caesarean section at Mthatha General Hospital.
(2016) Alabi, Adeyinka Abiodun.; Haffajee, Mohamed Rashid.; Pillay, Pamela.
Background: Reported incidences of failure of spinal anaesthesia during caesarean section and the contributory factors vary widely across practices. Paucity of national guidelines for benchmarking acceptable failure rate in South Africa will impact on assessment of quality of care. This study, therefore, assessed the frequency of and associated factors of failure of spinal anaesthesia at Mthatha General Hospital in Eastern Cape, South Africa. Methods: Consecutive spinal anaesthesia performed in emergency and elective caesarean sections (n=200) from May to August, 2013 were included. The primary end was an outcome of the spinal anaesthesia. Demographic, obstetric, and anaesthetic data were collected to determine the factors associated with failed spinal anaesthesia. Results: Of the 197 participants included in the analysis, the frequency of failure of spinal anaesthesia was 11.7% (12.3% in emergency and 9.35% in elective Caesarean section). Prior anaesthesia (Relative risk [RR], 4.7; 95% Confidence interval [CI], 1.1-19.5), obesity (RR, 13.7; 95% CI, 5.4-34.7), dry tap of CSF (RR, 6.2; 95% CI, 2.5-15.2), bloody CSF (RR, 7.2; 95% CI, 2.6-20.4), and duration of work experience less than one year (RR, 4.1; 95% CI, 1.6-10.5) were associated with failed spinal anaesthesia. Multiple puncture attempts were associated with failed spinal anaesthesia. Hypotension and shivering occurred at higher rates of 39.1% and 16.2%, respectively in comparison to failed spinal anaesthesia. Conclusion: High frequency of failed spinal anaesthesia was observed in our practice setting. Risk factors for failure of spinal anaesthesia were; obesity, prior anaesthesia, bloody CSF and dry tap, and multiple puncture attempts. Training in general anaesthesia and protocols for managing other complications of spinal anaesthesia should be implemented in the hospital.
Aortic valve replacement : anatomical considerations in a narrow aortic root.
(2015) Mushiwokufa, Willard.; Satyapal, Kapil Sewsaran.
Coronary artery ostial stenosis is a life threatening complication of aortic valve replacement (AVR) surgery. It occurs in 3-5% of all AVR operations. Most cases occur 1 to 6 months following AVR. However, some cases have been recorded during and immediately after operation and these have been attributed to embolization of calcium debris, coronary artery spasm, occlusion by the prosthetic valve and distortion of the anatomy of the aortic root. AVR is a standard procedure routinely performed to alleviate the symptoms of aortic valve stenosis and regurgitation. The standard procedure involves removing the diseased, poorly functioning valve cusps and implanting a mechanical or biological prosthesis whose size allows it to perform almost like a normal aortic valve. The size of the prosthesis may be determined through pre-operative echocardiographic assessment of the aortic root correlated to the body surface area of the patient. Intra-operative “sizing” of the aortic annulus is also performed using graduated obturators. The required size may not fit well in patients who have narrow aortic roots forcing the implantation of a smaller size prosthesis, a situation that is termed patient-prosthesis mismatch. To prevent patient-prosthesis mismatch surgeons have developed techniques to enlarge the aortic annulus and place larger prostheses. However, the operating surgeon may elect not to surgically enlarge the aortic annulus but forcibly implant or “shoe-horn” a larger prosthesis. The aim of this study was to investigate and document anatomical changes on the aortic root when a large size valve is implanted in a simulated AVR operation where the aortic root is considered to be narrow. The study also aimed to report the size of the aortic root and the influence of sex, race, body height and age. Additionally, the study demonstrates the difference between the pliability of the aortic annulus and sino-tubular junction. The study was conducted at Gale Street State Mortuary in Durban, KwaZulu-Natal, South Africa. A total number of 60 unfixed cadaveric heart specimens were selected for the investigations. For investigation of morphometry of the aortic root, 30 heart samples were selected for this study. The other 30 specimens were selected for the experimental study to investigate the effect of placing a large size valve. Ethics approval for the study was obtained from the University of KwaZulu-Natal Biomedical Research Ethics Committee (Ethics number 307/15). Of the 30 normal hearts, the mean aortic annulus diameter was 20.2mm and the mean sinotubular junction diameter was 21.8mm. There was a significant correlation between aortic root diameters and age but no association with sex, race or body height. The mean diameter of the left coronary ostium (LCO) was 6.1mm. The most common shapes of the LCO were circular (96.7%) and ellipsoidal (3.3%). The mean distance of LCO from the aortic annulus was 12.6mm. The LCO was located below, on and above the sino-tubular junction in 73.3%, 23.3% and 3.3%, respectively. The study showed clearly that when an oversized prosthesis is implanted into a normal aortic root, the LCO is distorted and displaced caudally towards the aortic annulus. A transverse ridge of aortic tissue, in the form of a tight bar was created above the LCO extending from the adjacent commissures. The sino-tubular junction was more pliable than the aortic annulus by a factor of 1.5.
A comparative cross sectional study of the morphological relationship between the superficial and deep gray matter structures in a random sample of cadaveric adult human brains in the Discipline of Clinical Anatomy at University of KwaZulu-Natal.
(2015) Haghegh, Eman Yacob.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.
Background: While various neurodegenerative diseases affect the cortical mass and mass of deep gray matter differently, finding an optimal and accurate method for measuring thickness and surface area of the cerebral cortex remains a challenging problem due to the highly convoluted surface of the cortex. We therefore investigated the superficial and deep gray matter thickness and surface area in a sample of cadaveric specimens at the Discipline of Clinical Anatomy, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa to provide some clue as to possible variations in these parameters. Materials and Method: With ethical approval, 60 brain samples were uniformly sectioned at 5mm thickness and eight slices containing the deep nuclei were taken from each brain and stained by Mulligan’s technique. Thickness was measured at selected angles 0º, 45º, 90º, 135º and 180º for both right and left cerebral hemispheres. The cortical thickness and surface area of selected slices for both the superficial cortex and the corresponding deep nuclei were measured. Results: Mulligan’s stain produced good gray mater differentiation and clear images that enabled manual delineation of structures. There was rightward asymmetry of cortical thickness of the selected slices at the suggested angles which corresponded to structurally and functionally important brain regions. There was a positive correlation between the mean surface area of superficial cortex and deep nuclei across the regions of interest (ROI). Discussion and Conclusion: Baseline data from 55 brain samples provided a range of means and 95% confidence intervals for the three parameters of cortical thickness, cortical surface area and surface area of deep nuclei to be made for a reference table comprising eight coronal slices taken at five angles. This allows an objective assessment of thinning of the cortex or loss of deep gray matter to be made from measurements of the same parameters for the equivalent slices from a postmortem brain slice or an appropriate radiographic image.
Renal histomorphological changes following highly active antiretroviral therapy : possible role of Hypoxis hemerocallidea in an experimental animal model.
(2015) Offor, Ugochukwu.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.
Background: Nephrotoxicity has become an important public health problem following highly active antiretroviral therapy (HAART), and there is paucity of literature reporting the attenuating influence of plant based adjuvants that can mitigate the effects. The study investigates the role Hypoxis hemerocallidea (H. hemerocallidea) extract following HAART in an experimental animal model. Materials and Method: Sixty- three adult male Sprague-Dawley rats were used for the study and were divided into 9 groups (A-I). Group A received HAART cocktail (Lamivudine, Stavudine & Nevirapine), Group B received HAART and H. hemerocallidea extract (100 mg/kgbw), Group C received HAART and H. hemerocallidea extract (200 mg/kgbw), Group D received HAART and vitamin C, Group E received HAART and vitamin E, Group F received HAART, vitamin C and vitamin E, Group G received H. hemerocallidea extract (100 mg/kgbw), Group H received H. hemerocallidea extract (200 mg/kgbw), and Group I received water as placebo. The experiment lasted for 56 days after which, the animals were sacrificed, the kidneys were harvested and prepared for haematoxylin and eosin (H&E) histological examination and blood samples were collected through cardiac puncture and centrifuged to get the serum for blood urea nitrogen and serum creatinine analyses. Results: Kidney weight changes were not significant except for group A that recorded a significant increase (p<0.05) and group B that recorded lowest body weight when compared with the control. Organbody weight ratios were significantly higher in group A and group F (p<0.05). Adjuvant treatment with H. hemerocallidea (in groups B and C) with HAART resulted in increased organ-body ratio, but however not significant. Serum Creatinine (SCR) and blood urea nitrogen (BUN) levels were statistically elevated in HAART-treated animals (p<0.05, 0.001). SCR levels in group D was significantly reduced (p<0.05) but however, significantly elevated in groups B, C, G and H (p<0.001). Groups B and C, as well as groups F and H resulted in higher BUN values (p<0.05). The histological appearance of group A was highly compromised. When treated concomitantly with H. hemerocallidea (at both dosages), no attenuating influence was seen. However, low dose of H. hemerocallidea showed improved histological layout as compared to the high dose. Co-administration of HAART and combined dose of vitamin C and E did not improve the histoarchitecture. Conclusion Adjuvant treatment with H. hemerocallidea extract did not attenuate the nephrotoxicity of HAART in this model.
Hepatic histomorphological changes following highly active antiretroviral therapy and the intervention of hypoxis hemerocallidea in an experimental animal model.
(2015) Kharwa, Salem.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.
Introduction Hepatotoxicity has remained a serious complication limiting the efficacy of highly active antiretroviral therapy (HAART) regimen. While this challenge continues to exist, finding possible solutions continues to attract scientific solutions. Materials and Method: Sixty- three adult male Sprague-Dawley rats were used for the study and were divided into 9 groups (A-I). Group A received HAART cocktail (Lamivudine, Stavudine & Nevirapine), Group B received HAART and H. hemerocallidea extract (100 mg/kgbw), Group C received HAART and H. hemerocallidea extract (200 mg/kgbw), Group D received HAART and vitamin C, Group E received HAART and vitamin E, Group F received HAART, vitamin C and vitamin E, Group G received H. hemerocallidea extract (100 mg/kgbw), Group H received H. hemerocallidea extract (200 mg/kgbw), and Group I received water as placebo. The experiment lasted for 56 days after which, the animals were sacrificed, the liver were harvested and prepared for histological examination and blood samples were collected through cardiac puncture and centrifuged to get the serum for biochemical assessment. Results While no mortality was reported, animals treated with adjuvant HAART and AP recorded least %body weight gain. Significant derangements in serum lipid profiles were exacerbated by treatment of with AP as LDL (increased p<0.03), TG (increased p<0.03) with no change in total cholesterol levels. Adjuvant AP with HAART recorded reduced LDL (p<0.05 and 0.03), increased HDL (p<0.05) and TG (p<0.05 and 0.001). Markers of liver injury assayed showed significant increase (p<0.003, 0.001) in AST in AP alone as well as HAART+ vitamins C and E groups respectively. Adjuvant HAART and AP and vitamins C and E also caused significant declines in ALT and ALP levels. Serum GGT were not markedly altered. Histopathological derangements ranged from severe hepatocellular distortions, necrosis and massive fibrosis following co-treatment of HAART with vitamins C and E as well as HAART alone. Conclusion The results warrant caution on the adjuvant use of H. hemerocallidea with HAART by PLWHAs as implications for hepatocellular injuries are suspect with untoward cardio metabolic changes. More vigilant monitoring of patients at risk of antiretroviral toxicity is necessary and may prove helpful.
Testicular morphological and biochemical perturbations in experimental animals under antiretroviral therapy and the role of Naringenin, a bioactive flavonoid.
(2018) Adana, Misturah Yetunde.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.
Declining male fertility is one of the neglected concerns of people living with HIV/AIDS in spite of a dual outlook of a social and a health dilemma. This issue of infertility is particularly relevant as majority of affected individuals are in their reproductive years. This thesis examines the impacts of the Fixed Dose Combination (FDC) of Highly Active Antiretroviral Therapy (HAART) Tenofovir/ Emtricitabine and Efavirenz (TDF/FTC/EFV) on the male reproductive capacity. It also explores the protective potentials of a bioactive flavonoid, Naringenin in testicular perturbations. The study was motivated by two major research questions namely: (1) what are the impacts of the recently approved first line antiretroviral therapy for adults FDC, TDF/FTC/EFV on the testes? (2) What is the role of Naringenin in alleviating testicular perturbations induced by HAART? Previous studies point to the negative impacts of the older generation of FDC of HAART on the semen quality and histomorphometry of the testes following a long-term use. The study addresses both the long-term and short-term use of antiretroviral drugs as observed in pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP). The research assesses the impacts of the drugs on the reproductive capability as well. Findings from this study support the argument that the negative effects of the drugs were consequent upon both the short-term and long-term use. To illustrate this hypothesis, the study was conducted in two distinct phases. The first phase which lasted a total of 28 days considered the duration of PEP or PrEP. The second phase which lasted a total of ten weeks captured all the stages of spermatogenesis in rats. In this phase male Sprague Dawley rats were exposed to fertile females after the treatments. The study thus advances an understanding of the mechanism of HAART-induced testicular injury. A therapeutic dose of TDF/FTC/EFV adjusted for animal weight was aministered on a total of 48 animals randomly divided into 6 equal groups each with a different treatment as follows; Group A: Control (Distilled water); Group B: HAART (TDF/FTC/EFV), Group C: Naringenin, 40 mg/kg; Group D: Naringenin, 80 mg/kg; Group E: HAART + Naringenin, 40 mg/kg; Group F: HAART+ Naringenin, 80 mg/kg. At the end of each phase, harvested testes were subjected to histomorphometry and ultrastructural analysis. The caudal epididymis was assessed for semen parameters and sperm mitochondrial DNA (mtDNA) fragmentation. Biochemical parameters such as serum levels of reproductive hormones (Luteinizing hormone and Testosterone) and intratesticular antioxidant enzyme activities were assayed. Contrary to prior beliefs, this research reveals that the immediate effects following short-term use of HAART are far more deleterious. This finding is consequent upon the significant drop in the sperm count (p˂0.001) and sperms with normal morphology (p˂0.001) compared to (p˂0.01) in the long-term. Histomorphometric analysis also revealed a significantly shrunken seminiferous tubule following a short-term use. These outcomes were associated with an increase in the mtDNA fragmentation in group B when compared to control (p˂0.05). Naringenin reversed abnormalities in groups E and F, displaying better semen parameters in both count and motility. Serum levels of testosterone were altered in both phases. The overall effects of all these changes were observed in the pregnancy rate which reduced in group B when compared to all the other groups. This study established that HAART has deleterious effects on the testicular microanatomy and function. These effects may impact on steroidogenesis and ultimately spermatogenesis. It consequently impairs fertility while Naringenin promises to be a potential complimentary adjuvant especially in the short term therapies. Keywords: HAART, semen parameters, reproductive hormones, testicular ultrastructure, 3 beta hydroxysteroid dehydrogenase.
The morphology and morphometry of the digastric muscle in a predomantly fetal South African population.
(2019) Guambe, Khayelihle.; Satyapal, Kapil Sewsaran.; De Gama, Brenda Zola.; Pillay, Pamela.
Introduction: The digastric muscle is a suprahyoid muscle made up of two muscle bellies namely, the anterior and posterior bellies. These bellies originate from the digastric fossa of the mandible and the mastoid notch of the temporal bone respectively and insert via a common intermediate tendon (IT) onto the hyoid bone. This study aimed to investigate and document the morphology and morphometry of the digastric muscle in cadaveric specimens in the South African population. Materials and methods: Macro-and micro-dissection was conducted on 40 fetuses (26 males, 14 females) between a gestational age range of 22-31 weeks old and 10 adults (8 males, 2 females) between the age range of 33-84 years old. Results: In fetuses, the anterior belly inserted via a narrow and broad belly onto the body, lesser – and greater horns of the hyoid bone. The posterior belly originated from the mastoid notch of the temporal bone as well as the lateral surface and tip of the mastoid process. Trifurcation of the posterior belly was reported in 2.5% of the cases. The IT location varied as it travelled on the superior and inferior border of the stylohyoid muscle in 5% and 2.5% of the specimens, respectively. In adults, the anterior accessory bellies were documented as they occurred unilaterally (20%) and bilaterally (30%). Conclusion: The fetal morphology reflected anatomical variations in the digastric muscle that have not been previously documented compared that of the adults. Comprehensive understanding of these anatomical variations may be of surgical relevance during corrective surgery and radiological imaging of the head and neck.
An anthropometric evaluation of the glenohumeral joint in a South African population.
(2018) Khan, Raeesa.; Satyapal, Kapil Sewsaran.; Lazarus, Lelika.; Naidoo, N.
The glenohumeral joint (GHJ), the most mobile yet unstable joint in the body, is comprised of a large humeral head which fits into the relatively smaller socket formed by the glenoid fossa. While this articulation allows for a wide range of motion, it predisposes the shoulder to injury. There is a paucity of literature on the biomechanics of the GHJ in the South African population. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process, glenoid fossa, bicipital groove (BG), long head of the biceps brachii tendon (LHBBT) and the transverse humeral ligament (THL). This study comprised of two subsets (n = 404), viz. (i) anthropometric evaluation of the scapula and proximal humerus [n=324: Scapula – Right (R): 80, Left (L): 84; Male (M): 68, Female (F): 96; Humerii – (R): 80, (L): 80; (M): 68, (F): 96] and (ii) cadaveric dissection of the LHBBT and THL [n=80: (R): 40, (L): 40; (M): 44, (F): 36], both of which focused on morphological and morphometric parameters. Results (i) (a) Shape of glenoid fossa = Type 1 (inverted comma): (R): 16.47%, (L): 10.98%; (M): 20.12%, (F): 7.32%; Type 2 (pear): (R): 14.02%, (L): 15.24%; (M): 18.29%, (F): 10.98%; Type 3 (oval) : (R): 18.29%, (L): 25.00%; (M): 27.44%, (F): 15.85%. (b) Notch type of glenoid fossa: Type 1 (without a notch): (R): 1.83%, (L): 7.32%; (M): 6.71%, (F): 2.44%; Type 2 (with one notch): (R): 46.95%, (L): 43.90%; (M): 59.15%, (F): 31.70%. (c) Mean parameters of coracoid process (mm): Length (CL): (R): 41.74±4.74, (L): 41.50±4.87; (M): 42.07±4.73, (F): 40.74±4.84; Width (CW): (R): 13.27±1.89, (L): 14.18±11.90; (M): 13.05±1.90, (F): 15.07±14.49. (d) Mean parameters of glenoid fossa (mm): Horizontal diameter 1 (HD1): (R): 18.40±3.27, (L): 17.51±2.87; (M): 18.23±3.29, (F): 17.38±2.60; Horizontal diameter 2 (HD2): (R): 24.45±2.88, (L): 23.64±2.63; (M): 24.22±2.74, (F): 23.68±2.83; Vertical diameter (VD): (R): 35.23±3.10, (L): 34.88±3.03; (M): 35.26±3.18, (F): 34.64±2.79. (e) Mean coracoglenoid distance (CGD) (mm): (R): 27.40±8.34, (L): 28.15±3.53; (M): 28.19±7.41, (F): 27.00±3.38 .(f) Mean dimensions of BG (mm): Length: (R): 66.64±9.06, (L): 68.31±11.52; (M): 67.44±9.12, (F): 67.53±12.25; Width: (R): 8.98±1.49, (L): 9.27±1.30; (M): 9.18±1.45, (F): 9.05±1.31; Depth: (R): 7.73±1.31, (L): 7.20±1.18; (M): 7.43±1.29, (F): 7.53±1.24. (ii) (a) Mean parameters of the LHBBT (mm): Length: (R): 81.99±21.28, (L): 79.73±17.27; (M): 79.82±19.66, (F): 82.14±19.03; Width: (R): 4.28±1.31, (L): 4.67±1.43; (M): 4.35±1.17, (F): 4.63±1.60. (b) Mean parameters of the THL (mm): Length: (R): 20.91±5.24, (L): 21.19±6.36; (M): 21.52±5.71, (F): 20.48±5.92; Width: (R): 16.65±6.92, (L): 16.63±7.49; (M): 16.83±6.65, (F): 16.40±7.84. In this study, Type 3 (oval) was observed to be most prevalent shape of the glenoid fossa, which corroborated the findings of previous studies. Type 2 (with one notch) was found to be the predominant notch type, differing from the literature reviewed. The mean VD, HD1, HD2, CL and CGD were larger in male individuals, while female individuals presented with larger means of CW. Both BG length and depth were increased on the right side; with the latter yielding a statistically significant difference thus suggesting that an increased depth is a common finding in the right side of individuals. Although the BG length and depth were noted to be greater in female individuals, male individuals presented with larger widths. The mean length and width of the THL were markedly smaller than those reported in previous studies. Any variation from the normal musculoskeletal composition of the GHJ is fundamental to understand rotator cuff disease, tendinitis and shoulder dislocation. This study may provide clinicians and biomechanical engineers with reliable anthropometric reference parameters of the GHJ for the design of prosthesis and may also act as diagnostic tools of degenerative pathology.
Investigating the effects of Cinnamomum-cassia nanoparticle conjugate on the Histomorphology of the kidney in type 2 diabetic rats.
(2019) Kouame, Koffi.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.; Peter, Aniekan Imu.
Introduction Diabetic nephropathy remains one of the biggest complications of diabetes. The incidence is increasing and more patients are experiencing progressive kidney failure due to lack of hyperefficient treatment. This study investigated the antidiabetic activity of Cinnamomum cassia silver nanoparticles (AgNPs) [(CcAgNPs)] and its effects on the kidneys of Sprague-Dawley rats induced with type 2 diabetes following administration of Streptozotozin. Materials and methods Adult healthy, pathogen-free male Sprague-Dawley rats, of a total number of 65 (N=65), weighing 250.0 ± 20 g were divided into 10 groups. Groups A-E (positive controls) consists of 30 rats, with 6 rats per group and the experimental groups F-J, consists of 35 rats, with 7 animals per group. Diabetes was induced in animals using Streptozotocin 60 mg/kg administered intraperitoneally. The animals were subjected to various treatments with Cc (100 mg/kg and 200 mg/kg) and CcAgNPs (5 mg/kg and 10 mg/kg). The treatments were administered orally using orogastric gavage and administration was carried out daily following treatment protocol for 56 days. The selected protocol for the experiment was officially approved by the Animal Ethics Committee (protocol reference number: AREC/74/016D). Cinnamomum cassia Silver Nanoparticles (CcAgNPs) was synthesized using the green option and characterized using UV (ultraviolet)–TEM (Transmission electron microscopy)-FTIR (Fourier-transform infrared spectroscopy) –XRD (X-ray powder diffraction), prior to administration. The animals were sacrificed on day 56. Blood and urine samples were collected for biochemical analysis. The kidneys were examined for histopathological changes using Hematoxylin and Eosin (H&E), periodic acid Schiff and Masson’s trichrome staining. Transmission Electron Microscope (TEM) and Stereological studies were carried out as well. Results Urinalysis showed extensive protein and albumin deposits in the urine. Ketones and nitrites levels which are markers of renal function were significantly lower (p< 0.05) in groups treated with CcAgNPs compared to negative controls. Urea and creatinine were also significantly (p < 0.05) reduced in treated groups compared to negative controls. The levels of reduced glutathione (GSH) was significantly different across all groups (p < 0.05). Serum Malondialdehyde (MDA) concentrations were significantly (p < 0.05) lower in CcAgNPs compared to controls. Liver enzymes (alanine aminotransferase) ALT was reduced significantly in groups treated with a low dose of CcAgNPs compared to negative controls. In the group treated with high dose (10 mg/kg) of CcAgNPs, (Aspartate transaminase) AST levels were significantly lower (p < 0.05), compared to the group treated with Cc (Cinnamomum cassia) and to the negative control. Stereological studies showed significantly decreased (p < 0.05) number of glomeruli and tubules in groups treated with Cc and CcAgNPs, compared to the negative control. Transmission Electron Microscope (TEM) revealed the thickness of glomerular basement membrane, in experimental groups, compared to positive controls. Histopathology of renal tissue showed severe glomerular distortion, tubular lesions with H & E and thickening of the basement membrane; pyknotic nuclei and vacuolization with PAS and MT, in the untreated negative control group. Positive controls showed regular glomeruli with normal Bowman’s capsular space, normal basement membrane and regular capillary network compared to negative controls. The degree of histopathological changes in the glomeruli and tubules appear to be dose-dependent. Conclusion Diabetes negatively alters the cytoarchitecture and biochemistry of the kidneys of Sprague-Dawley rats while Cinnamomum cassia Silver Nanoparticles have the potential to ameliorate these changes. The possible pathway involved CcAgNPs may provoke the release of insulin-like, as well as the thioredoxin (Trx), which is one of the central antioxidants that can alleviate renal injuries in diabetic nephropathy. Keywords: Cinnamomum cassia; silver nanoparticles; diabetes; histomorphology
Effects of momordica charantia on the kidney following antiretroviral therapy in male diabetic and non-diabetic animal model.
(2019) Offor, Ugochukwu.; Azu, Onyemaechi Okpara.; Naidu, Edwin Coleridge Stephen.
Introduction Management of HIV/AIDS has been successful with the use of antiretroviral therapy (ART). Consequently, the introduction of highly active antiretroviral therapy (HAART) has further increased the life expectancy of people living with HIV/AIDS and this has become a standard regimen in clinical practice. However, discordant views have been reported regarding its effects on the kidney; with a dearth of literature on the impact of HAART in a diabetic comorbid state on the renal morphology and the possible role of plant-based adjuvant. This study investigated the effect of mormodica charantia (M. charantia) on the kidney following HAART regimen (triplavar) and its impact in diabetic nephropathy (DN) in streptozotocin (STZ) induced diabetic rats. Materials and Methods 78 adult male Sprague-Dawley rats were divided into non-diabetic and diabetic groups. Rat models of diabetes were successfully established by intraperitoneal injection of STZ (45 mg/kg body weight). Animals were administered an adjuvant treatment of M. charantia and HAART regimen (triplavar) according to protocols. On the 10th week, animals were euthanized with an overdose of halothane and kidney tissues were harvested and processed for light microscopy and transmission electron microscopy (TEM). Blood samples were obtained via cardiac puncture and centrifuged to collect the serums for biochemical analysis. Urine samples were collected at 3weeks interval during the 10 weeks experimental period for analysis of renal function test. Body weight and blood glucose levels (BGL) were measured once a week during the 10 weeks treatment. Results In the non-diabetic group, HAART alone treated rats showed renal dysfunction which were characterized by raised levels of blood urea nitrogen (BUN) and serum creatinine (Scr), microalbuminuria and gross electrolyte disturbances (Sodium and Potassium) as well as urea retention. Also, levels of oxidative stress (superoxide dismutase-SOD, catalase-CAT and glutathione peroxidase-GPx) were significantly decreased in these groups together with an increased levels of thiobarbituric acid reactive substances (TBARS) resulting in free radical formation via auto-oxidation. More so, the histopathological results displayed severe glomerular capillary abnormalities with inflammatory cellular infiltrations. This correlated with TEM analysis that showed swollen mitochondrial in the endothelium and thickness of the basement membrane with overexpression of extracellular matrix. Furthermore, there were upregulation of circulating neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1) and tumor necrosis factor-alpha (TNF-α) following HAART alone treatment. In the diabetic groups consistent raised levels of blood glucose which remained peaked from the 5th week of experiment were seen in the diabetic control and HAART treated group. There were increased levels of both BUN and Scr. Renal function test showed leakage of albumin, retention of renal electrolytes (sodium and potassium) and high concentration of urea in the urine of diabetic control and HAART treated group. Activities of antioxidative enzymes (SOD, CAT) and levels of GSH were markedly decreased with an increased level of Malondiadehyde (MDA). Significant (p<0.05) upregulation of the gene expression profiles (NGAL, KIM-1 and TNF- α) were also seen. Qualitative light microscopic result using hematoxylin and eosin (H and E) stains showed glomerular capillary abnormalities and tubular epithelial damage. These findings correlated with other special stains (PAS and MT) which showed high proportion of glycogen, glycoproteins as well as mild deposition of collagen fibers and hyaline substances respectively. TEM analysis displayed an abnormally increased thickness of basement membrane which reflects the existence of endothelial damage (diabetic control). By contrast, following adjuvant treatment with M. charantia, (low and high dose) these abnormalities were significantly reduced thus suggesting a protective effect of M. charantia on the kidney. Conclusion M. charantia extract administration improved blood glucose levels, maintained renal electrolytes (Sodium and Potassium), reinstated renal function (BUN and Scr) restored histoarchitectural and ultrastructural patterns and prevented DN development in an STZ-induced diabetic rat model. Keywords: HAART, Nephrotoxicity, Diabetic nephropathy, TEM, M. charantia, Sprague-Dawley rats, Histoarchiteture
Anatomical classification of Tessier craniofacial clefts number 3 and number 4 in a South African population.
(2019) Omodan, Abiola Olugbenga.; Madaree, Anil.; Lazarus, Lelika.; Pillay, Pamela.; Satyapal, Kapil Sewsaran.
The craniofacial clefts are rare defects of the face with an incidence of 1.43 to 4.85 per 100,000 live births. In 2016, WHO reported a death rate of 303,000 new-borns before 4 weeks of age due to congenital anomalies of which craniofacial clefts are one. Surviving the defect is associated with long term disabilities which impacts the individual, families, the healthcare system and society. How much we know about these clefts is seriously hampered by the rarity and the variations of these defects, so much so, that its treatment and communication amongst researchers is affected. The understanding of the skeletal defects occurring in the clefts has long been postulated as a key to any successive reconstruction of the face. This study aimed to reveal the extent of our understanding of these clefts, document the anatomical basis for the craniofacial cleft number 3 and number 4 and generating a sub-classification based on this and also document the clinical presentation as well as associated clefts of these craniofacial clefts in our select South African population. The methods used to achieve these included conducting a scoping review of the literature on patients with Tessier cleft number 3 and number 4 using relevant identified studies from 1976 sourced from PubMed, Medline, EBSCOhost, Google Scholar and the Cochrane libraries. The result of the study was reported using the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). Likewise, CT scans of patients who had been treated for Tessier clefts number 3 and 4 at Inkosi Albert Luthuli Central Hospital in Durban South Africa between 2003 and 2017 were analysed. Measurements of the expected defects in each cleft were taken and compared with the unaffected side as reference points. Emerging patterns of their analysis were then used to generate a sub-classification for these clefts. Lastly the records of 8 patients who had been treated for either Tessier cleft number 3 or number 4 were reviewed and compared with 9 studies sourced from the literature. In addition to the defects recorded, associated clefts and other congenital malformations were also documented, and findings were compared. The scoping review had 33 studies that met the inclusion criteria. The majority were conducted in middle income countries (54.5%) while none were recorded in low income countries. Only 12.1% of the included studies reported on anthropometry. In understanding the skeletal defects, the presence of an alveolar cleft, the emerging patterns of comparison of the measurements of the maxilla and the orbits of the cleft side and the non-cleft side as well as absence of the bone were used to arrive at a sub-classification system using (a), (b). (c), (M+ O+), (M- O-), and (0). Clinical presentation of the patients who had been treated as cases of Tessier cleft number 3 and number 4 were compared to the reviewed literature and the different parameters were documented. In addition, associated clefts were also recorded, and this study found that the association pattern noted for Tessier cleft number 4 did not conform to its traditional counterpart. In conclusion, this study found that the knowledge of Tessier clefts number 3 and number 4 exist albeit not fully documented. Also, the study proposed a sub-classification for Tessier clefts number 3 and number 4 that will allow physicians to anticipate the extent and form of skeletal defect present before even seeing the patient. Lastly, it was concluded that however variable these clefts appear; they have a similar presentation worldwide and also that associated clefts do not conform to the original Tessier classification system.
Morphometric studies on sexual dimorphism, variations and dimension of foramen transversarium in a KwaZulu-Natal population, South Africa.
(2019) Zaw, Aung Khaing.; Naidu, Edwin Coleridge Stephen.; Rennie, Carmen Olivia.; Azu, Onyemaechi Okpara.
The foramen transversarium (FT) of the cervical vertebrae serves as an essential landmark in medical imaging procedure and surgery, owing to their anatomical structure in relation to the associated neurovascular bundles. The aim of this study was to analyse the morphometric parameters and variations of the FT with regards to sexual dimorphism, laterality and age within the KwaZulu-Natal (KZN) population, South Africa. One hundred and thirty (130) dried human typical cervical bones from KZN population of known sex and age (67 males and 63 females with age ranges from 12 to 89) without any degeneration or deformity were sourced from the bone collection at the Discipline of Clinical Anatomy, Nelson Mandela School of Medicine, University of KwaZulu-Natal (UKZN). The morphometric analyses were performed using Markus Bader (MB) Ruler, the digital screen ruler and subjected to RStudio statistical analysis. The results indicated that the morphometric parameters of the FT were greater in males compared to females (p< 0.05). The values of the right sides were higher than that on the left sides except, for the transverse diameter where higher values were observed on the left side of male specimens. Based on the shape of normal FT inspection, the type 1 was predominant (43.85%) shapes, followed by type 3 (23.08%) and least common were type 2 and type 7 (0.77%) on the left side. Type 1 had the higher value (46.16%) on the right side, followed by type 3 (20%) and, type 2 was the least in this study. The variation in number of FT in relation to sex revealed the presence of normal foramen (62.31%, male with 30.77% and female with 31.54%) and double foramen (36.92%, male with 20% and female with 16.92%). More so, it was also observed that, the frequency of bilateral double foramen was common in males (11.54%) compared to females (6.92%). The result of this study has demonstrated that risk of injury to neurovascular structures associated with FT may be common on the left side, in female and especially in age groups less than < 20 and ≥ 60 years of age. Keywords: Foramen Transversarium, Cervical vertebrae, Variations, Sexual Dimorphism, Morphometric.
Perceptions of academics and postgraduate students towards the use of plastinated specimens and their public exhibitions.
(2020) Bailey, Denvon Nathal.; Pillay, Pamela.; De Gama, Brenda Zola.
Background – The global scarcity of cadavers and prosected specimens for teaching, learning and research has led to plastinated specimens (plastinates) becoming a valuable tool in bridging this gap. Over the last decade, plastinates have been incorporated into the teaching and learning of iross anatomy within anatomy departments as a supplementary tool to cadaveric dissection. A paucity of information exists regarding the views of academics and postgraduate students on the use of plastinates for anatomy teaching and learning. This study aimed to investigate the perceptions of academics and postgraduate students on the use of plastinates in anatomy education and public exhibitions. Methods – Qualitative and quantitative methods of data extraction were employed using a questionnaire on a purposively sampled group of anatomy academics and postgraduate students at the Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal (UKZN) for data collection. Quantitative data from the questionnaire were analysed using descriptive statistics and the Mann-Whitney test (p < 0.05 considered statistically significant) to determine significant differences between sub-groups. To assess the perception on the use of plastinates for education and exhibitions, the quantitative responses of participants were grouped and then categorized into three categories i.e. good (10-7), average (6-4), and bad (0-3). Qualitative data from the questionnaire responses were analysed by the content analysis method to reflect emanating themes. Results- Questionnaires were completed by 43 of 62 participants (response rate 69%) i.e. seven academics and 36 postgraduate students completed the questionnaire. Academics (57.1%) and postgraduate students (63.9%) had a good perception on plastgnate use for education. Most academics (85.7%) and postgraduate students (94.4%) made use of plastinates for anatomy education. Various features of plastinates were highlighted, such as their ease of use, durability and ability to view structures clearly in three-dimensions (3D), which aids in understanding for students. However, ethical concerns were highlighted by academics (57.2%) and postgraduate students (55.6%) on the use of plastinates in public exhibitions. Conclusion: Positive reactions of academics and postgraduate students were generally noted, plastinates were found to support anatomy teaching and learning. This reflects that plastinates may become vital for anatomy instruction in South Africa and their more inclusive use is recommended.
Developmental changes of the facial skeleton from birth to 18 years within a South African cohort: a computed tomography study.
(2021) Niemann, Kristen.; Rennie, Carmen Olivia.; Lazarus, Lelika.
Introduction: The facial skeleton or viscerocranium has been recently noted as a method for age estimation as its development is influenced not only by the developing paranasal air sinuses and tooth eruption, but also the individual’s ancestry particularly population specific normative data. This study aimed to investigate the developmental changes of the facial skeleton in males and females from birth to 18 years within the South African population with African ancestry to estimate age. The facial skeleton was assessed according to five regions viz: - orbital, nasal, midfacial, maxillary and mandibular. Methods and materials: A retrospective study which consisted of 239 computed tomography (CT) scans of subadult individuals (0–18 years of age) of African ancestry (128 males; 111 females) was conducted. The scans were obtained from an online server utilised by a private medical facility in the eThekwini Muncipality. The DICOM images were viewed from an online Picture Archiving and Communication Systems server using Infinitt software (version 5.0.1.1) which is the standard software used by the practitioners. Linear parameters in the horizontal, sagittal, and vertical planes assessed the development of the viscerocranial regions. Results: a) Development: Most of the viscerocranial regions experienced a rapid increase in growth between 0–5 years of age viz: orbital (orbital height and width: 0–5 years; lateral orbital wall distance: 0–3.75 years), midfacial (zygomatic arch distance: 0–3.75 years), nasal (aperture height and width: 0–5 years); maxilla (length: 0–3.75 years), mandibular (mandible width: 0–5 years). Thereafter growth continued to increase at a slower rate in the orbital width (0.61–0.8 mm/year in females; 0.56–0.76 mm/year in males), lateral orbital wall distance (1.1 mm/year in females; 1 mm/year in males), zygomatic arch distance (1.6 mm/year in females; 1.8 mm/year in males), nasal aperture width (0.45 mm/year in females; 0.4 mm/year in males) and height (0.63 mm/year in females; 0.77 mm/year in males), maxillary length (0.7 mm/year in females; 0.81 mm/year in males), mandible width (1.1 mm/year in females; 1.5 mm/year in males) and mandible head widths (right: 0.42 mm/year in females, 0.49 mm/year in males; left: 0.52 mm/year in females, 0.68 mm/year in males). Additionally, in the orbital region, the orbital width underwent two periods of rapid growth i.e., 0–5 and 10–18 years of age, whilst the anterior interorbital distance noted no significant increase after 7.5 years of age. xiv b) Sexual dimorphism: Males displayed overall larger measurements than females in all the parameters, except for the anterior interorbital distance and the zygomatic arch lengths (ZAL) on the right and left, as females displayed larger measurements. Although these differences were not statistically significant (p>0.05). The only measurements which displayed statistically significant differences between males and females were the left orbital height (p = 0.048), nasal aperture height (p = 0.048) and the mandible width (p = 0.05), in which males displayed larger measurements than females. c) Age estimation: The measurements which displayed the strongest correlation to age were the ZAD (r = 0.8842, p<0.001), ZAL (right: r = 0.8929, p<0.001; left: r = 0.8656, p<0.001) and the mandible width (r = 0.8444, p<0.001). Formulas were derived for the measurements which could be used to estimate age. Discussion and conclusion: The findings from this study have outlined the development of the viscerocranium in subadult individuals with African ancestry. This study discussed the correlation between the development patterns of each viscerocranial region with age. The data from this study can be a useful addition to the existing data on the skeletal developments of subadult South African individuals. Forensically the development of formulas for subadult individuals could be utilised in the age estimation of skeletal remains.

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