Doctoral Degrees (Anatomy and Histology)

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Browsing Doctoral Degrees (Anatomy and Histology) by Author "Geldenhuys, Elsje-Marie"

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    A morphological assessment of the health status of a cadaver population at the Faculty of Health Sciences, Stellenbosch University, with special reference to tuberculosis (TB) Lesion distribution
    (Stellenbosch : Stellenbosch University, 2014-12) Geldenhuys, Elsje-Marie; Kotze, Sanet; Burger, Elsie Helena; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences: Anatomy and Histology.
    ENGLISH ABSTRACT: Tuberculosis (TB) is a chronic pulmonary infection characterized by granulomatous inflammation, caseating necrosis and a propensity to develop fibrosis and cavitations. Pulmonary TB (PTB) lesions may develop in a variety of ways and can be grouped into primary, secondary, progressive primary and miliary TB based on their pathogenesis and morphological appearance. The Western Cape Province, South Africa, has a high TB burden with increasing TB notification rates. At Stellenbosch University (SU), approximately 90% of cadavers used for medical dissections come from impoverished communities where TB is a major health problem in terms of morbidity. The aim of the present study was to assess the health status of a cadaver population (n=127) at the Faculty of Medicine and Health Sciences (FMHS), SU, with special reference to TB lesion distribution and prevalence. For this study, full-body digital X-rays of 127 cadavers (87 males; 40 females; average age, 47.1 years) were obtained with the Lodox® Statscan® Imaging System after embalming and prior to dissection. A complete pathology report of six organ systems including the skeletal system was used in combination with histological examination, molecular analysis and radiological findings to investigate the prevalence and association between TB and systemic pathology. Samples for histological purposes were removed from organs with pathology lesions. For molecular studies, five different nucleic acid extraction methods were used to extract DNA from the formalin-fixed paraffin-embedded cadaver samples. Pulmonary samples were subjected to a line probe assay (LPA) and polymerase chain reactions (PCR) to determine mycobacterial genotypic distribution. Two independent radiologists examined the chest X-rays and their findings were compared with the pulmonary findings. PTB was a common finding in the cadaver population (76.4%) with males more commonly affected. A female predilection was observed for extrapulmonary TB. Statistically, TB was associated with pulmonary pathology, including pneumonia and bronchiectasis. Systemic pathology commonly encountered in the present study included neoplasms, coronary artery disease, colonic diverticula, hepatic triaditis, cirrhosis, glomerulosclerosis, pyelonephritis and a variety of healed maxillofacial and appendicular skeletal fractures. Extracted nucleic acid concentrations, as determined with the NanoDrop® spectrophotometer, ranged between 10ng/μl and 1000ng/μl. The standard salting-out method was found to be the most cost-effective and therefore the preferred method for nucleic acid extraction. The HAIN® MTBDRplus® kit was effective in determining the presence of mycobacterial species belonging to the Mycobacterium tuberculosis complex (MTBC). The sensitivity to first-line drugs could not be determined as a result of DNA degradation. Spoligotyping was unsuccessful, as incomplete and unidentifiable hybridization of the 43 spacers occurred. The RD105 and MUB02/RD105 PCR results were non-reproducible and non-specific. Pulmonary cavitation and pleural thickening were the only findings that were positively correlated with the radiological findings (p<0.05). To our knowledge, this is the first study to extensively investigate TB and systemic pathology including histopathology, molecular techniques and postmortem radiology in cadavers from low socio-economic backgrounds from a high TB burden area. This study therefore provides a more complete and thorough understanding of the prevalence, distribution and morphology of TB lesions as well as the association between TB and systemic pathology.