Jessica Garlick

Jessica Garlick

Degree: MSc (Med) Applied Anatomy
 
Thesis title: Variations in the circulus arteriosus cerebri, Circle of Willis, in a South African sample and the potential to predispose people to aneurysms and ischaemic stroke.
 
Supervisors: Professor Graham Louw and Dr Kentse Mpolokeng
 
Thesis Description:  The brain is an organ with high metabolic demands and requires a continuous supply of oxygenated, nutrient-rich blood. As a result, the vasculature supplying the brain is unique (Javed, Reddy & Das, 2021) since it consists of four main arteries (two internal carotid and two vertebral arteries) that are joined by a central anastomosis at the base of the brain. This system is called the circulus arteriosus cerebri (CAC) (Dumitrescu et al., 2020) and has a protective function through multidirectional blood flow between the two anterior vessels and two posterior vessels as well as flow across the midline (left to right; right to left). Therefore, allowing for rapid compensation of blood flow when there is hindered movement of blood any of the vessels (Vrselja et al., 2014; Pascalau et al., 2019). However, particular variations hinder this protective function and may predispose patients to cerebral aneurysms and their rupture (haemorrhagic stroke). 
 
In 1994 the perceptive, South African leader Nelson Mandela said, “If you wait for textbook conditions, they will never occur” (Mandela, 1994). To an extent, the CAC can be held to this, since studies consistently indicate fewer than 50% of samples had the textbook configuration. The high prevalence of variations in the CAC is the reason for this study being conducted. Although the CAC is present in all individuals, the CAC may present one or more variations that make it asymmetric or incomplete. Any variation that deviates from optimal branching has the potential to increase the probability of developing aneurysms and their eventual rupture (Pascalau et al., 2019).
 
Therefore, the aim of this study is to determine if there is a correlation between variations in the circulus arteriosus cerebri and the development of aneurysms of the cerebral arteries. If correlations between variations and aneurysm development are observed, an analysis of which variations potentially predispose patients to aneurysm formation and potential rupture (haemorrhagic stroke) will be performed. Furthermore, the presence of hypoplasticity and obstruction of vessels will be analysed if observed in the sample.
 


Daniël Kotze

Daniël Kotze

Degree: MSc (Med) Biological Anthropology

Thesis title: Assessing the applicability of the pulp/tooth area ratio method for estimating adult age-at-death in a South African sample: A comparative study using digital periapical radiography and stereomicroscopy

Supervisors: A/Prof. Victoria Gibbon and Mr Calvin Mole

Thesis description: Establishing the age at which an individual died (age-at-death) is an essential component of many biological anthropological investigations. However, in South Africa, anthropological methods routinely employed for adult skeletal age-at-death estimation are deficient and problematic (Krüger et al., 2018; Algee-Hewitt, 2017). These conventional osteological methods carry numerous limitations and are often unreliable and unable to provide precise age estimates for older individuals (Cameriere et al., 2006; D'Ortenzio et al., 2018). This diminishes our ability to provide useful adult age estimates for forensic human identification and confounds our understanding of older individuals in bioarchaeological research (D’Ortenzio et al., 2018), leaving an unexplored window into South African history. Therefore, incorporating additional, more reliable adult ageing techniques, such as those derived from teeth (de las Heras, 2019), is necessary. Doing so can help to narrow age estimates obtained from conventional methods and provide a more holistic approach with better-informed results.

Despite the demonstrated reliability and accuracy of teeth for the estimation of adult age, research investigating the use of dental ageing techniques for South African adults is still in its infancy (Ackermann and Steyn, 2014; Chandler and Phillips, 2018). These limited validation studies suggest that these techniques do not perform as well in South Africans, emphasising the need for method validation and/or population-specific standards. Cameriere et al. (2004, 2007a, 2007b) introduced a non-invasive radiographic dental technique for adult age estimation based on the apposition of secondary dentine, known as the 'pulp/tooth area ratio method'. The method has demonstrated relatively high accuracy and superior performance compared to traditional skeletal techniques (Marroquin et al., 2017; Zelic et al., 2020), addressing several of their limitations. Despite its advantages and potential value, this method is not currently utilised in South Africa, nor has it been validated for its appropriateness within the population.

In this study, I aim to assess the applicability of the pulp/tooth area ratio method for estimating adult age-at-death when applied to a South African cadaveric sample using maxillary canines. Both radiographic and stereomicroscopic techniques will be utilised and compared for their accuracy.

Contact details: Email


Reagobaka Lichaba

Reagobaka Lichaba

Degree: MSc Applied Anatomy

Title: A morphometric study of the brain ventricles of patients diagnosed with Chronic Hydrocephalus at Groote Schuur Hospital.

Registered in: Depart of Human Biology

Supervisor: A/Prof Delva Shamley

Co-supervisors: Dr Kentse Mpolokeng (CABA) and Dr Sally Rothemeyer (Neurosurgery)

Thesis description

Chronic hydrocephalus is a multifactorial, cerebrospinal fluid accumulation disease that eventually leads to ventricular expansion. When left untreated, chronic hydrocephalus can have detrimental effects on cerebral structures and cause various neurological symptoms, diseases such as strokes, or result in death. However, when treated early, a cerebrospinal fluid shunt or the endoscopic third ventriculostomy procedure may improve symptoms. Therefore, correct, and early diagnosis is essential.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used during patient examination to assist in the diagnosis of chronic hydrocephalus, where specific cerebral and ventricular radiological features are assessed. This has led to the development of chronic hydrocephalus criteria utilising these radiological features. However, to confirm chronic hydrocephalus, invasive methods such as measuring intracranial pressure (ICP) are currently being used. Measuring ICP puts the brain at risk of infection or haemorrhage, thus, having less invasive methods would be helpful.

Therefore, this study aims to further understand and describe the morphological patterns of ventricular and cerebral radiological features observed on MRI scans. These MRI scans belong to infant and adult patients previously diagnosed with chronic hydrocephalus at Groote Schuur Hospital. Furthermore, to explore the possibility of developing a non-invasive diagnostic tool.

Mbalentle Madolo , Masters student

Mbalentle Madolo
MSc Med majoring in Applied Anatomy
Title: A dissection and angiographic study of anatomical variations of the anterior communicating artery complex in a South African sample.
Supervisor:  Dr Kentse Mpolokeng
Co-supervisors: A/Prof Geney Gunston and Dr Stuart More
Division of Clinical Anatomy and Biological Anthropology
Department of Human Biology
University of Cape Town
Thesis description: As of 2018, cerebrovascular diseases have increased in ranking and are reported to be ranked third amongst the top ten leading natural causes of mortality in South Africa (1). Cerebral aneurysms are described as weak focalised regions of cerebral arteries that are dilated and filled with blood (2). Rupture of these cerebral aneurysms not only cause subarachnoid haemorrhages (SAH) but lead to high mortality and morbidity (3). In an African context, epidemiology of intracranial aneurysms remain poorly understood as these cerebral aneurysms remain underdiagnosed and inadequately treated (4). Evidence from Morocco and South Africa show cerebral aneurysms as predominant in females, where prevalence in females was recorded at 54% across the study cohorts (4). In a 2014 South African study, it was identified that out of all the intracranial aneurysms that were present in the study, 53% of the cases were anterior communicating aneurysms (5,6). The exact cause of intracranial aneurysms is said to be unknown. However, It has been previously reported that there is a clear correlation between variations in cerebral arterial circulation and cerebral aneurysm development (2). The A1 and A2 segments of the ACA and the ACoA are collectively referred to as the anterior communicating artery complex (ACAC) (6). The ACoA is said to be the most frequent site of cerebral aneurysms and many studies have highlighted that A1 and A2 segment variations are the most frequent variations that accompany ACoA aneurysms (7,8). Hence, there seems to be a link between the prevalence of intracranial aneurysms and ACAC variations. Gaining and understanding the knowledge behind ACAC variations will be of great use to clinicians and neurosurgeons for the diagnosis of cerebral conditions such as aneurysms and strokes.  Additionally, this knowledge will aid in the efficacy of neurosurgical and interventional procedures (7,9–11). Thus, this study aims to investigate the morphological and morphometrical aspects of the ACAC (A1 segment, A2 segment and ACoA) in a South African population. Origin, course, branching pattern and the variations of the ACAC will be assessed and the presence or absence of aneurysms will also be assessed by means of human dissections that will take place at the Department of Human Biology, University of Cape Town, and magnetic resonance angiograms that will be obtained from the Department of Radiology of Groote Schuur Hospital, Cape Town.
References
1.    Stats SA. Mortality and causes of death in South Africa: Findings from death notification [Internet]. Statistics South Africa; 2018. Available from: https://www.statssa.gov.za/publications/P03093/P030932018.pdf
2.    Kayembe KN, Sasahara M, Hazama F. Cerebral aneurysms and variations in the circle of Willis. Stroke. 1984 Oct;15(5):846–50. 
3.    D’Souza S. Aneurysmal Subarachnoid Hemorrhage. J Neurosurg Anesthesiol. 2015 Jul;27(3):222–40. 
4.    Tetinou F, Kanmounye US, Sadler S, Nitcheu I, Oriaku AJ, Ndajiwo AB, et al. Cerebral aneurysms in Africa: A scoping review. Interdisciplinary Neurosurgery. 2021 Dec 1;26:101291. 
5.    Blignaut G, Loggenberg E, Vries C de. The radiological appearance of intracranial aneurysms in adults infected with the human immunodeficiency virus (HIV). South African Journal of Radiology. 2014 Apr 4;18(1):4. 
6.    Luckrajh JS, Harrichandparsad R, Satyapal KS, Lazarus L. A clinical investigation of the anatomy of the proximal anterior cerebral artery and its association with anterior communicating artery aneurysm. Translational Research in Anatomy. 2022 Jun 1;27:100200. 
7.    Gunnal SA, Wabale RN. Variations of anterior cerebral artery in human cadavers. Neurology Asia. 2013;249–59. 
8.    Tahir RA, Haider S, Kole M, Griffith B, Marin H. Anterior Cerebral Artery: Variant Anatomy and Pathology. J Vasc Interv Neurol. 2019 May;10(3):16–22. 
9.    Iqbal S. A Comprehensive Study of the Anatomical Variations of the Circle of Willis in Adult Human Brains. J Clin Diagn Res. 2013 Nov;7(11):2423–7. 
10.    Castro MA, Putman CM, Sheridan MJ, Cebral JR. Hemodynamic Patterns of Anterior Communicating Artery Aneurysms: A Possible Association with Rupture. AJNR Am J Neuroradiol. 2009 Feb;30(2):297–302. 
11.    Jou LD, Lee DH, Mawad M. Cross-flow at the anterior communicating artery and its implication in cerebral aneurysm formation. Journal of biomechanics. 2010 May 1;43:2189–95. 
 


Sandile Ntuli

Mr Sandile Ntuli
Degree: MSc (Med) Anatomy
Thesis title: A morphological and histological analysis of vascular conduit options for coronary artery bypass grafting
Supervisor: Ms Jeshika Luckrajh Co-supervisor: Dr Geney Gunston 

Thesis Description: Cardiovascular disease is the leading cause of death worldwide and coronary artery disease (CAD), largely attributed to occluded coronary arteries, is the most common cardiovascular disease. In such cases where the coronary arteries are occluded by plaques and fatty deposits on the walls of the blood vessels (known as atherosclerosis), the myocardium becomes oxygen deprived and symptoms such as angina manifest. Coronary artery bypass grafting (CABG) is considered the gold standard invasive intervention to treat CAD. This procedure involves grafting a blood vessel from elsewhere in the body to the affected coronary artery to bypass the site of occlusion. This vascular conduit may be obtained from various sites. CABG is one of the most effective and lasting therapies for CAD; however, an important decision for the surgeon to make is which vessel to use as a conduit. The choice of conduit is generally based on the surgeon’s preference, hospital protocols, patient history and importantly, the morphological compatibility of the conduit and the coronary artery. For the CABG to be durable, patent, and well-functioning, the morphological characteristics such as the length, luminal diameter and wall thickness of the conduit need to be in line with that of the coronary artery. 

Aim: The study will determine which conduit is the most morphologically similar to the coronary arteries. This will be done by determining the length, luminal diameter, and wall thickness of commonly used conduits (ie. internal thoracic artery, saphenous vein, radial artery, right gastroepiploic artery) and comparing these parameters to those of the coronary arteries. This analysis will be of value to surgeons in determining which conduit would be most suitable from a morphological viewpoint.
 

Contact details: Email


Luthando Swaai

Mr Luthando Swaai
Degree: MSc (Med) Anatomy
Thesis title: The anatomical variants of the ulnar nerve and incidence of perioperative ulnar neuropathy medico-legal cases in the Southern African region
Supervisor: Ms Jeshika Luckrajh
Co-supervisor(s): A/Prof Geney Gunston; Ms Kerri Keet


Ulnar neuropathy has been described as a common yet unexplained perioperative complication. According to the American Society of Anaesthesiologists, it accounts for a third of all iatrogenic nerve related injuries. Due to the severe nature of this injury which commonly leads to chronic pain and disability, malpractice litigation is often pursued by patients. Incorrect positioning of the arm during surgery may stretch or compress the ulnar nerve leading to neuropathy. However, there are also several anatomical variations of the ulnar nerve-cubital tunnel complex which may lead to entrapment of the ulnar nerve. Furthermore, osteological variation such as an enlarged coronoid process of the ulnar bone may compromise blood supply to the nerve. Predisposing anatomical variations may contribute to the aetiology of ulnar neuropathy and it is therefore necessary for these factors to be taken into account during the investigation of medicolegal cases. In addition, the level of awareness towards ulnar neuropathy by surgeons may also be a contributing factor.
The study brought forward these research questions: What are the anatomical parameters of the ulnar nerve? What is the incidence of variations of the ulnar nerve? What is the incidence of perioperative ulnar neuropathy medico-legal lawsuits in Southern African region?
Therefore, to answer these questions, this project will utilise embalmed bodies to investigate anatomical parameters of the ulnar nerve and access Southern African medico-legal databases to document the incidence of medico-legal cases of perioperative ulnar neuropathy in the Southern African region. 
 

Contact details: Email


Chelsey Voegt

Chelsey Voegt
 
Degree: MSc Biological Anthropology

Title: Gender and life stage as risk factors of perimortem injuries in South African medicolegal death investigations (MDIs).

Supervisors: Assoc. Prof Victoria Gibbon and Dr. Elizabeth Dinkele

Thesis description: In 2021, 4.4 million lives were lost due to intentional and unintentional injuries, constituting approximately 8% of the global deaths that year. Understanding the aetiology of injury-related death is challenging as it is a multifactorial problem with several contributing factors including but not limited to, demographic, social, economic, and cultural factors. In particular, gender and life stage are consistently identified as significant risk factors of injury-related mortality with higher risk noted in men and adolescents. The same injury risk trends have been reported in South Africa, however, the issue is exacerbated. A large body of provincial and national data on the prevalence of injury mortality in the epidemiological and forensic-based literature is available in South Africa however further insight is needed to understand the determinants of injuries within the South African context. Given the prevalence of violent crimes, injury-related deaths, and gender-based violence in South Africa further insight into risk factors of perimortem injuries is needed to plan interventions to promote safety, security, and social justice.

Therefore, the aim of my research is to assess the factors associated with life stage and gender that influence perimortem injuries encountered in South African medicolegal death investigations, using a biocultural synthesis approach. I hope that the findings produced from this research will contribute to the knowledge available about the risk factors associated with injury in the South African context. Furthermore, I hope the findings can be applied to the realm of public health whereby it can be used to advocate for better policing, more effective policies, and preventative measures to protect the most vulnerable and improve the health and safety of all South Africans.

Contact details: Email


Graduated Masters Students

2022. Sadiyah Malek. MSc (Med) (Biological Anthropology). Assessment and improvement of current sex estimation standards for application in Holocene San and Khoekhoe populations. Supervisors: A/Prof Victoria Gibbon; Prof Judith Sealy (Department of Archaeology, UCT).

2021. Athi Baliso. MSc (Med) (Biological Anthropology). Identification of the deceased: A retrospective review of Forensic Anthropology Cape Town casework. Supervisors: A/Prof Victoria Gibbon & Dr. Laura Heathfield (Department of Pathology, UCT).

2020. Tarryn Haikney. MPhil (Pathology). Investigation into DNA recovered from human teeth for forensic applications. Supervisors: Dr. Laura Heathfield (Department of Pathology, UCT) & A/Prof Victoria Gibbon.

2020. Christie Putter MSc (Med) (Biological Anthropology). Black River Excavation: A forensic anthropological investigation of the skeletal remains recovered from a historic cemetery. Supervisors: Dr Jacqui Friedling & Dr Mary Patrick.

2019. Tafadzwa Tawha. MPhil (Pathology). Geometric morphometric analyses to assess the accuracy of the zygoma for estimating ancestry in a South African population. Supervisors: A/Prof Victoria Gibbon, Elizabeth Dinkele & Calvin Mole (Department of Pathology, UCT).

2019. Kyle Paulssen. MSc (Med) (Anatomy). Axillary web syndrome after treatment for breast cancer: a correlation of clinical variables with imaging data focusing on fascial changes before and after physiotherapy treatment. Supervisors: A/Prof Delva Shamley & Dr. Charles Slater.

2018. Elizabath Dinkele.MSc (Med) (Biological Anthropology). Ancestral variation in mid-craniofacial morphology of a South African sample. Supervisor: Dr Jacqui Friedling.

2018. Chandra Longden-Thurgood. MPhil (Pathology). Optimisation of DNA Extraction from Teeth Submerged in Seawater in False Bay, South Africa. Supervisor: A/Prof Victoria Gibbon & Dr. Laura Heathfield (Department of Pathology, UCT).

2018. Liesl Arendse. MSc (Med) (Biological Anthropology). Stature estimation: Evaluating regression formulae for different population groups in South Africa. Supervisor: Dr. Jacqui Friedling.

2016. Schwab Petra. MPhil (Pathology). The importance of a protocol in the recovery and handling of burned human remains in a forensic context. Supervisors: Dr. Jacqui Friedling and Dr. S Maistry.

2015. Clarke Carrie. MSc (Med) (Biological Anthropology). Does variation in facial fatness affect soft tissue thickness standards? Supervisors: Prof. Alan G. Morris and Dr. Jacqui Friedling.

2014. Du Toit Francesca. MSc (Med) (Applied Anatomy). Circulus arteriosus cerebri: Anatomical variations and their correlation to cerebral aneurysms. Supervisor: Prof. Graham Louw.

2014. Sadler Max. MSc (Med) (Applied Anatomy). Variations in the insertions of tibialis posterior muscle and the structure of the medial longitudinal arch. Supervisor: Prof. Graham Louw.

2013. Maass Petra. MSc (Med) (Biological Anthropology). The bony pelvis: With specific attention to the areas of occurrence of the scars of parturition. Supervisor: Dr. Jacqui Friedling.

2013. Meyer Anja. MSc (Biological Anthropology). An assessment of metabolic bone disease in the skeletal remains of Chinese indentured mine labourers from the Witwatersrand. Supervisors: Prof. Maryna Steyn and Prof. Alan G. Morris. University of Pretoria.

2013. Rip da Silva. MSc (Med) (Applied Anatomy). Anatomical study of the variation in the branching patterns and histology of the aorta in a South African population. Supervisors: Dr Geney Gunston and Dr R Alexander.

2013. Van der Berg Kerri. MSc (Med) (Applied Anatomy). An investigation of the brachial plexus and surrounding anatomical structures in a Southern African cadaver sample. Supervisor: Prof. Graham Louw.

2012. Speed Belinda. MSc (Med) (Biological Anthropology). South African standards for age estimation of children between 0 and 13 years using radiographs of the hand and wrist. Supervisor: Prof. Alan G. Morris.

2010. Rossouw Lache. MSc (Med) (Biological Anthropology). A forensic anthropological investigation of skeletal remains recovered from a 1000 year old archaeological site in North-western Namibia. Supervisor: Prof. Alan G. Morris.

2010. Dembetembe Kundisai. MSc (Med) (Biological Anthropology). Age estimation using epiphyseal closure at the wrist joint: an investigation of individuals of African origin, age 14 to 22.  Supervisor: Prof. Alan G. Morris.

2008. Gangata Hope. MSc (Med) (Applied Anatomy). An investigation into the parameters related to the equinus ankle in children with hemiplegic and diplegic forms of cerebral palsy. Supervisor: Supervisor: Prof. Graham Louw.

2008. Jenkins C. MPhil (Orthopaedics). Can a ‘one off’ physiotherapy intervention help patients who have difficulty kneeling after unicompartmental knee arthroplasty? Supervisor: Dr. Delva Shamley. Oxford Brookes University.

2008. Manyaapelo Thabang. MSc (Med) (Biological Anthropology). An odontological analysis of 18th and 19th century burials from in and around Cape Town. Supervisor: Prof. Alan G. Morris.

2006. Dlamini Nonhlanhla. MSc (Med) (Biological Anthropology). An assessment of the health status by non-specific stress indicators of the early farming populations from central and southern Africa. Supervisor: Prof. Alan G. Morris.

2003. Friedling L Jacqui. MSc (Med) (Biological Anthropology). Dental modification practices on the Cape Flats in the Western Cape. Supervisor: Prof. Alan G. Morris.

2002. Sanders Victoria. MSc. (Med) (Applied Anatomy). An assessment of muscle insertion sites and biomechanical beam analysis in living subjects. Supervisors: Prof. Alan G. Morris and Prof. Graham Louw.

2000. Nyati L. MSc (Med) (Applied Anatomy). Cross-sectional observations of growth and maturation in children with Down Syndrome. MSc, University of Pretoria. Supervisors:  Prof. Maryna Steyn and Prof. Graham Louw.

1998. Apollonio H. MA (Med) (Archaeology). Identifying the dead: 18th century mortuary practices at Cobern Street, Cape Town. Supervisors: Prof. Martin Hall and Prof. Alan G. Morris.

1997. Botha W. MSc (Med) (Biomedical Engineering). An anthropometric survey of female nurses working in the Western Cape: implications for equipment and workspace design. Supervisors: Bob Bridges and Prof. Alan G. Morris.

1994. Bell Christine. MSc (Med) (Applied Anatomy). Clinically-defined osteoarthritis, sex and age: their influence on the geometry, morphology and biomechanics of the upper cervical spine. Supervisor: Prof. Alan G. Morris.

1993. Kovacs Jonathan. MSc (Med) (Biological Anthropology). The post-cranial remains of Papio ursinus and fossil baboons from South African Australopithecine sites. Supervisor: Prof. Alan G. Morris.

1989. Patrick Mary K. MA (Med) (Archaeology). An archaeological and anthropological study of the human skeletal remains from the Oakhurst Rock Shelter, George, Cape Province, South Africa. Supervisor: Prof. Alan G. Morris.