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    The relationship between the Auriculotemporal nerve and middle Meningeal artery in a sample of the South African population.
    (2022) Moodley, Sherelle.; Pillay, P.; Ishwarkumar, Sundika.
    Introduction: Within the infratemporal fossa, the auriculotemporal nerve arises as two roots from the mandibular division of the trigeminal nerve and forms a buttonhole through which the middle meningeal artery courses. Thereafter, the two roots of the auriculotemporal nerve re-join and proceeds to provide sensory innervation to multiple structures of the head. The middle meningeal artery branches from the maxillary artery and enters the cranium through foramen spinosum. Variations of the auriculotemporal nerve and the middle meningeal artery have been documented in several populations. However, there is a paucity of literature regarding the South African population group. The aim of this study was to document the relationship between the auriculotemporal nerve and the middle meningeal artery and their variations (if any) within a South African population. Materials and methods: Sixteen (n=32) adult cadavers were dissected to reveal the infratemporal fossae regions. The auriculotemporal nerve and middle meningeal arteries were observed, and the morphology and morphometry were documented. Results: The auriculotemporal nerve arose as one to four roots. The most common variation was the two-root auriculotemporal nerve (14/32; 43.75%). The inferior alveolar nerve was observed to contribute to the formation of the auriculotemporal nerve in the majority of the individuals. The roots of the auriculotemporal nerve were either anterior, deep, or superficial to the middle meningeal artery. Although the V-shapes were present in 23/32 infratemporal fossae, only 13/32 middle meningeal arteries passed through them. In the South African cohort, the maxillary artery was found to course deep to the lateral pterygoid muscle in 19/32 (59.38%) individuals and superficial in 13/32 (40.63%). Fifteen accessory middle meningeal arterieswere present in 14/32 (43.75%) infratemporal fossae – one individual displayed a double accessory middle meningeal artery. The accessory middle meningeal artery originated from the middle meningeal artery or the maxillary artery in (8/15) 53.33% and (7/15) 46.67% of the individuals, respectively. Conclusion: This study showed numerous anatomical variations of the neurovasculature within the infratemporal fossa. Furthermore, this study provides novel information about the auriculotemporal nerve and middle meningeal artery in a South African population, which has not been previously reported. The results may be beneficial to medical professionals during surgical interventions to the infratemporal fossa.
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    Anterior synostotic plagiocephaly: a quantitative analysis of craniofacial features using computed tomography.
    (2021) Mohan, Nivana.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
    Anterior synostotic plagiocephaly (ASP) is caused by the premature fusion of one coronal suture, which results in severe craniofacial asymmetry that can be challenging to correct. The various methods of the surgical procedures, as well as the distinctive facial characteristics of ASP, have been well documented. However, there is a paucity of literature pertaining to the quantitative analysis of the craniofacial features that are affected in ASP. This study used preoperative computed tomography (CT) scans to document and compare the morphometry of the anterior cranial fossa (ACF), orbit, and ear on the ipsilateral (synostotic) and contralateral (non-synostotic) sides in a select South African population of patients diagnosed with ASP. The dimensions of the ACF, orbit and the position of the ear on the ipsilateral and contralateral sides were measured using a set of anatomical landmarks on two-dimensional (2D) CT scans of 18 consecutive patients diagnosed with non-syndromic ASP. The differences between the ipsilateral and contralateral sides were computed and expressed as a percentage of the contralateral side. The findings of this study revealed that there was side-to-side asymmetry in the ACF, orbit, and ear. All ACF parameters decreased significantly (t-test; p<0.001) on the ipsilateral side when compared to the contralateral side, resulting in the volume of the ACF being the most affected (-27.7%). In terms of the orbit, on the ipsilateral side, the length-infraorbital rim (IOR), height, and surface area parameters increased significantly (t-test; p<0.001), with the height being the most affected (24.6%). The remaining orbital parameters (length-supraorbital rim (SOR), breadth and volume) decreased significantly (t-test; p<0.001), with the length-SOR parameter being the most affected (-10.8%). Furthermore, the ipsilateral SOR was noted to be displaced more cranially by an average of 3.89mm from the contralateral SOR. With regards to the position of the ipsilateral ear, it was found to be displaced anteriorly (9.33mm) and caudally (5.87mm) from the contralateral ear. This study augments the existing literature by providing actual values to corroborate the hallmark characteristics of ASP. These measures may help surgeons plan the technique and extent of surgical correction of the affected craniofacial structures during corrective surgery as it will provide them with an indication of the extent of the deformity on the ipsilateral side as compared to the contralateral side. The results of this study have the potential to propose a grading system in ASP patients according to severity of the condition if the sample size is increased.
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    Scaphocephaly in a select South African population: a morphometric analysis of the cranial fossae and ventricular access points.
    (2021) Bisetty, Vensuya.; Lazarus, Lelika.; Madaree, Anil.; Harrichandparsad, Rohen.
    Scaphocephaly is a cranial deformity that results from premature fusion of the sagittal suture and is characterized by an elongated and narrowed skull. Patients with this condition present with varying clinical features including frontal bossing and occipital protrusion. This study comprised two subsets, analysing different aspects related to this cranial deformity. Most morphological and morphometrical studies in patients with scaphocephaly focus on the cranial vault. Literature on the morphometry of the cranial base and its fossae in these patients is sparse. Therefore, the first subset aimed to analyse and compare the morphometry of the cranial fossae in patients with scaphocephaly. Due to varying cranial morphology among patients with these deformities, ventricular access using conventional techniques is often a challenge. Although ventricular access may not be frequently required in paediatric scaphocephalic patients, it is vital that an ideal location of the access points be established for safe ventricular catheterization. Accordingly, the second subset aimed to document the morphometry of Kocher’s and Frazier’s points in scaphocephalic patients using known craniometric and surface anatomical landmarks. Dimensions of the anterior, middle and posterior cranial fossae (ACF, MCF and PCF) were measured using select anatomical landmarks on computed tomography (CT) scans of 24 consecutive patients diagnosed with scaphocephaly between 2014 and 2020, and 14 non-affected/ normal paediatric patients selected as controls. Parameters of Kocher’s and Frazier’s points were measured in relation to known cranial surface anatomical landmarks on scans of the scaphocephalic patients utilized in subset 1. The study found that ACF and PCF are most affected in scaphocephalic patients, with elongation along the anteroposterior (AP) plane (lengths) (ACF, p=0.041 and PCF, p=0.018). Minimal changes were observed in the transverse plane (widths) in scaphocephaly versus non-affected/normal controls. Regarding subset 2, Kocher’s point was located between 91.6mm and 140mm posterior to the nasion, and between 20.5mm and 34.6mm lateral to the midline in patients with scaphocephaly. Frazier’s point was located between 60.9mm and 82.8mm superior to the inion, and 25.9mm and 41.4mm lateral to the midline. Parameters measured in the AP plane were found to be more affected than those measured lateral from the midline. This study contributes to the literature by providing novel morphometric data based on a select South African population. Data obtained could aid craniofacial surgeons in understanding which cranial fossa is most affected in scaphocephaly and to what extent, to decide on the most appropriate method of treatment. Additionally, the study concluded that the traditional landmarks used for ventricular access are relatively unreliable in scaphocephalic patients. This study provides data for neurosurgical consideration regarding ventricular catheterization procedures in patients with scaphocephaly.
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    An anatomical investigation of intracranial meningiomas.
    (2021) Anirudh, Ezra Earl.; Lazarus, Lelika.; Harrichandparsad, Rohen.
    Meningiomas are generally benign, highly vascularised, slow-growing tumours arising from the arachnoid cap cells of the arachnoid villi. The clinical presentation of these tumours is usually location dependant due to the vast expanse covered by the meninges. Resection of a meningioma is generally performed after preoperative embolisation. A feeder vessel is selected and embolised in an attempt to reduce excessive blood loss and postoperative complications. However, embolisation requires a sound knowledge of the vasculature of the meninges since these vessels supply portions of the cranial nerves. Literature consulted have investigated anatomical features of meningioma’s; however, there is a scarcity of studies investigating patients specifically referred for preoperative embolisation. Therefore, this study aimed to investigate the anatomical features, namely the location, histology, volume and vascularity of intracranial meningiomas referred for preoperative embolisation. This entailed using Magnetic resonance imaging (MRI), Digital subtraction angiography (DSA), and the histological reports obtained from the data bank at the central regional hospital in Durban, South Africa. A retrospective chart review yielded 103 patients that met the inclusion criteria, of which 98 patients (subset 1) presented with a single meningioma and 5 patients (subset 2) presented with multiple meningiomas. The average age of patients (at the time of diagnosis) was reported within the 40–49-year group and primarily within the female population (subset 1: 67.3%; subset 2: 80%). The benign grade of meningiomas was reported as the most common (70.4%), of which the meningothelial subtype (48%) was predominant. Meningiomas were mostly observed within the supratentorial region (subset 1: 57.2%; subset 2: 91.7%) with almost equal incidences in subset 1 and a majority on the right side in subset 2. Regarding tumour volume, subset 1 revealed the largest meningiomas within the supratentorial region (90.9 cm3), and subset 2 revealed an average tumour volume of 43.9 cm3. In terms of meningioma vascularity, within the supratentorial region, the external carotid arteries were noted to be a common primary feeder vessel, for the skull base region the primary arterial supply is the internal carotid artery. This study provides insight into the anatomical basis of intracranial meningiomas within a select South African population as it has introduced a novel methodology of meningioma vascularity. This may assist endovascular surgeons in assessing the feeder vessel contributions of meningiomas and understand the prevalence of these anatomical parameters in this population.
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    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 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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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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).
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    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.
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    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.