An analysis of South Africa's statutory regime pertinent to the risks of hydraulic fracturing.

Thesis (LL.M.)-University of KwaZulu-Natal, Durban, 2013.The production of energy is vital for the survival of mankind –we rely on the supply of energy in all sectors of the economy, ranging from the generation of electricity which ensures the functioning of households and industries, to the manufacturing of petroleum and diesel from fossil fuels. Energy production largely depends on the burning of fossil fuels, such as coal, which contributes significantly to levels of pollution as well as environmental degradation. The supplementation of coal with the usage of natural gas that is located underground is viewed as being a more environmentally sound method of power generation. Hydraulic fracturing (or ‘fracking’) is the process applied in order to extract natural gas from deep below the earth’s surface. However, speculation has arisen regarding the environmental risks and consequences of the fracking procedure which has caused debate about how environmentally safe this method actually is. Subsequently, the need for legislative and regulatory mechanisms is essential in order to establish applicable procedures that govern hydraulic fracturing and to guarantee that fracking occurs in a manner that is not harmful to the environment, with remedies being available if such harm does transpire. The Karoo Basin in South Africa is an area facing the implementation of hydraulic fracturing.Currently, various national legislation exists that may govern fracking and its effects, however no distinct statute is available which specifically applies to hydraulic fracturing in its entirety. This research study will assess the adequacy of South Africa’s current legislative scheme in relation to hydraulic fracturing and its potential polluting effects, while discussing whether the legislative system is suitable in its application or whether it lacks relevance to those ecological ramifications

Effects of Short-Term High versus Continuous Moderate Intensity Training on Insulin Resistance in Overweight and Obese Adults: A Randomized Controlled Trial

International Journal of Exercise Science 12(3): 1057-1069, 2019. In long-term exercise training studies ( \u3e 6 weeks), improvements in insulin resistance (IR) are amplified by decreased body fat and/or increased cardio-respiratory fitness. This presents a challenge in studying the independent effects of exercise training. Our study purpose was to determine the effects of short-term continuous moderate intensity training (CMIT) and high intensity interval training (HIIT) on IR in overweight/obese adults. Participants were stratified into insulin sensitive (IS) and IR groups, and randomized into non-exercise control (CNT), CMIT and HIIT sub-groups that underwent baseline and post testing. Exercise sessions were 18-24 minutes for 10 consecutive days. The CMIT sub-group continuously cycled at 60-70% of peak oxygen consumption (V̇O2peak) while the HIIT sub-group performed 60s of cycling at 90-100% V̇O2peak interspersed with 30 seconds of rest. Ninety-five participants (mean age and BMI 23.9 + 3.9 years and 32.1 + 5.0 kg/m2) were enrolled into the study. Of these, 63% were IS and 37% had IR. CMIT or HIIT did not result in statistically significant improvements in IR. However, the reduction (32.4%) in IR observed with HIIT may be of clinical relevance. Cohen’s (d) effect size (ES) for HIIT on IR was large (ES: d = -0.9; 95% CI: -1.7, -0.1) while that of CMIT was unclear (ES: d = -0.2; 95% CI: -1.0, 0.6). In the current study, CMIT or HIIT did not result in statistically significant improvements in insulin resistance. Future large-scale studies to clarify and confirm our findings are warranted

Myotonic dystrophy : clinical and molecular spectrum in KwaZulu-Natal.

Thesis (M.Med)-University of KwaZulu-Natal, Durban, 2006.Myotonic dystrophy is the commonest form of adult muscular dystrophy. Myotonic dystrophy 1 and 2 (DM 1 and DM 2) are autosomal dominant inherited disorders with unusual multisystem clinical features characterized by myotonia, progressive muscle weakness and wasting, cataracts, hypogonadism, frontal balding, cardiac conduction defects and diabetes. Severity varies from asymptomatic to severely affected phenotypes. DM1 presents with predominantly distal weakness whereas DM2 have predominantly proximal weakness.98% of patients identified worldwide present with DM1. DM 1 is caused by the expansion of an unstable CTG trinucleotide repeat in the 3' untranslated region of the myotonic dystrophy protein kinase gene on chromosome 19ql3.3. DM 2 is linked to the long arm of chromosome 3q21. It is caused by a tranucleotide, CCTG expansion in intron 1 of the zinc finger protein 9(ZNF9) gene that interferes with processing of a variety of RNAs. All DM mutations can be detected using a combination of the Southern Blot and Polymerase Chain reaction (PCR) techniques. Aim: This study aims to characterize the clinical spectrum and molecular features of myotonic dystrophy patients in KwaZulu - Natal between 1989 and 2005. Methodology: Patients included in this study were obtained from the database of patients diagnosed with Myotonic Dystrophy at the Department of Neurology in KwaZulu-Natal from 1989 to 2005. Patients were subjected to clinical, radiological and neurophysiological assessment. Molecular testing was performed using PCR and Southern blot. Results: Thirty-seven patients with Myotonic Dystrophy were identified. Twenty patients consented and were included into the study. Eighty-five percent of patients were of Indian descent and the remaining fifteen percent were White. No African patients were identified. Sixty-five percent were male and thirty-five percent female. Myotonia was clinically present in all patients. Ninety-five percent of patients presented with predominantly distal weakness of which 40% demonstrated mild weakness, 35% moderate weakness and 25 % severe weakness. No patients were identified with predominantly proximal wasting or weakness. Southern blotting demonstrated expanded CTG repeats (DM1) in all 20 samples analysed. The PCR analysis was unable to demonstrate expanded alleles. Conclusion: This study identified patients presenting with Myotonic dystrophy to the Department of Neurology in KwaZulu-Natal and demonstrated that Myotonic Dystrophy Type 1 remains the commonest clinical and molecular presentation. In addition it substantiated previous research findings wherein no South African of African descent was found to be affected by the disease. There have been no reported cases of Myotonic Dystrophy in African Black patients presenting to the Department of Neurology in Durban, no African Black patients have been diagnosed with Myotonic Dystrophy over the past 20 years. However ,the predominance of Indians in this study is more likely a reflection of referral bias than differing incidence amongst sections of the population. PCR analysis cannot detect trinucleotide repeat expansions beyond 200 repeats and as a result Southern Blotting remains the gold standard in obtaining a molecular diagnosis. A clinical diagnosis is sufficient and molecular confirmation is not an absolute requirement

"A Woman Is A Strong Person”: The Lived Experiences Of Rural Women Activists

On 25 May 2021, the Land and Accountability Research Centre in cooperation with the Heinrich Böll Stiftung Cape Town hosted a virtual launch of the booklet: “A Woman Is A Strong Person”: The Lived Experiences Of Rural Women Activists. The booklet celebrates the stories of four rural female land activists and is written by LARC researchers Ayesha Motala and Nokwanda Sihlali

Lifestyle modification in the management of insulin resistance states in overweight/obesity: the role of exercise training

Physical inactivity is a major contributor to overweight/obesity and associated disorders including cardiovascular diseases (CVDs), diabetes, and insulin resistance (IR). Intensive lifestyle modification (ILM) is recommended as first-line treatment for obese individuals at risk for IR. Exercise is considered to be a critical component of ILM. This narrative review discusses the role of exercise in the management of IR in overweight/obesity. PubMed and Google Scholar were searched for articles published between January 1990 and January 2019 that examined mechanisms behind the effects of exercise on IR states associated with overweight/obesity. Studies examining and/comparing effects of exercise mode, volume and/intensity on IR were also retrieved. Medical Subject Headings (MeSH) used were ‘metabolic diseases’ OR ‘chronic diseases’ AND ‘exercise’ and their related terms. Text words used in conjunction with the MeSH terms were ‘aerobic training/exercise’ OR ‘resistance training/exercise’ OR ‘high intensity interval training/exercise’, OR ‘low volume training/exercise’. Reference lists of retrieved articles were also searched for appropriate studies. Aerobic exercise training (AET) and resistance exercise training (RET) appear to produce comparable effects on obesityinduced IR states. RET, however, appears to be associated with greater improvements in glucose disposal in skeletal muscle, which is usually the primary site for IR. This is partly attributed to greater increases in key proteins involved in the insulin signalling pathway including protein content of glucose transporter 4 (GLUT-4) following RET. A study on individuals with impaired glucose tolerance (IGT) showed that RET improved glucose disposal by 23%, primarily due to a 27% increase in non-oxidative glucose metabolism, suggesting that RET may delay the manifestation of diabetes in patients with IGT. Furthermore, studies reviewed here show that components of exercise including the mode, volume and intensity of exercise training are an integral element in exercise prescription and must be recommended in accordance with the desired outcome

Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years

Background: The mode of presentation, clinical, radiologic and laboratory characteristics of patients with acromegaly and the outcome following various modalities of treatment are not well documented in South Africa.Aim: To evaluate treatment outcome and follow-up of patients with acromegaly over a period of 10 years.Methods: The study is a retrospective record review of patients with acromegaly attending Inkosi Albert Luthuli Central Hospital, Durban, 2003–2013.Results: The study included 27 patients (16 female and 11 male) with a mean age at diagnosis of 44.2 ± 14.0 years. The mean growth hormone (GH) at diagnosis was 51.8 ± 32.6 μg/l and mean IGF-1 956.8 ± 432.9 μg/l. In 25 patients (92.5%) pituitary macroadenoma was identified; microadenoma was present in 2 (7.4%) patients. Trans-sphenoidal surgery was employed in 26 (96.3%) as the initial therapy; only 1 patient was treated medically. Adjunctive medical therapy was used in 23 (88.5%) and radiotherapy in 6 (22.2%). After a mean follow-up of 4.4 ± 3.4 years, 9 (33.3%) subjects were cured (normal age-matched and gender-matched IGF-1 and random GH < 1.0 μg/l). No deaths were recorded and post-procedural hypopituitarism developed in 22 (84.6%) patients.Conclusions: Patients with acromegaly in KwaZulu-Natal present with advanced clinical features and large pituitary adenomata. The overall cure rate is lower than reported from developed countries.Keywords: acromegaly, diagnostic criteria, medical and radiotherapy, modes of treatment (surgery

Rickets mimicker: A report of two cases of primary hyperparathyroidism in adolescence

The presentation of primary hyperparathyroidism (PHPT) in most Western countries has evolved from the classic description of ‘stones, bones, and groans’ to becoming increasingly asymptomatic as a result of more frequent serum calcium screening. However, many developing countries are still reporting predominantly symptomatic PHPT with the classic complications of skeletal disease and nephrolithiasis still being quite common. Furthermore, the exact prevalence of PHPT in children is not known but it is thought to be uncommon and the clinical presentation and outcomes in this subgroup of patients are not well described in the literature. Two cases of PHPT occurring in adolescent boys are reported. Both cases initially presented with chronic bone pain involving the lower limbs and had a long delay before the diagnosis of PHPT was confirmed. They developed progressive deformities of the lower limbs, which resembled rickets clinically. Radiological features were also suggestive of rickets. However, biochemistry confirmed parathyroid hormone mediated hypercalcaemia in both cases and after parathyroid surgery a parathyroid adenoma was confirmed histologically as the aetiology of hypercalcaemia. Therefore, PHPT occurring in adolescence may have a clinical presentation almost identical to that of rickets. All patients presenting with skeletal deformities including a rickets phenotype must have serum calcium and phosphate levels measured as part of the diagnostic workup

Characteristics and outcome of patients with pheochromocytoma at a tertiary endocrinology clinic in Durban, South Africa over 14 years

Objectives: To evaluate the characteristics and outcomes of treatment of patients with pheochromocytoma at Inkosi Albert Luthuli Central Hospital (ILACH) in Durban, South Africa over 14 years.Design: Retrospective chart review.Setting and subjects: Patients with pheochromocytoma attending the endocrinology clinic at IALCH between 2012 and 2016 were studied.Outcome measures: Clinical, biochemical and radiological data were collected at presentation, on discharge, one year and five years after surgical intervention; tumour characteristics, histopathological features and surgical outcome were also assessed.Results: The analysis included 35 patients (mean age 33.2 ± 15.7 years; 60% female). Headache (68.6%), palpitation (60%) and sweating (57.6%) were the three most common presenting symptoms; hypertension was the predominant clinical finding (85.7%). Most pheochromocytomas were sporadic (82.9%), adrenal gland tumours (68.6%) and benign (77.1%); of eight patients with malignant tumours, two were familial. Adrenalectomy was undertaken in the majority (n = 34; 97.1%); 55.2% were large tumours. The use of adjunctive radiotherapy (n = 4; 11.4%) and chemotherapy (n = 1; 2.9%) was low. There was low overall mortality (5.7%), but 57.6% developed intraoperative hypotension. At one year postoperatively, 80% (n = 28) of patients were defined as cure, biochemically in 23 (82.1%) and with radiology in five (17.9%).Conclusions: Most patients presenting to IALCH had large intra-abdominal tumours with high cure rate, low mortality but a high rate of perioperative complications. Late presentation and large tumour size was a feature.Keywords: pheochromocytoma , South Africa, surgical outcom

Microvascular complications in South African patients with long duration diabetes mellitus

Objective. To determine the prevalence of microvascular complications in South African black and Indian patients with long-duration diabetes mellitus (DM).Design. A retrospective analysis was undertaken of clinical records of 219 OM patients (132 black, 87 Indian) with longduration OM (over 10 years) attending a diabetes clinic in Durban. Data recorded on each subject included demographic details (age, gender, ethnic group, type of diabetes, age of onset and duration of diabetes), presence of retinopathy, markers of nephropathy and biochemical variables. The prevalence of complications and the clinical and biochemical parameters were evaluated for type 1 and type 2 diabetes and for each ethnic group.Results. Of the 219 patients, 47 had type 1 OM (36 blacks, 11 Indians) and 172 were classified as type 2 OM (96 blacks, 76 Indians). The mean age of onset of OM wa later in blacks than Indians, both for type 1 (P < 0.05) and type 2 OM (P < 0.01). In patients with type 1 OM, the prevalence of retinopathy was 53.2% (blacks 55.6%, Indians 45.5%), persistent proteinuria was found in 23.4% (blacks 25%, Indians 18.2%) and hypertension in 34%. 0 ethnic difference was found except for the prevalence of hyperten ion which was higher in blacks than Indians (41.7% v. 9.1%, P < 0.5). Onset of retinopathy from time of diabetes diagno is occurred earlier in blacks than Indians (13.0 ± 4.6 yrs v. 18.0 ± 4.6 yrs, P < 0.05). For the type 2 DM group, retinopathy was found in 64.5% (black v. Indian 68.8 v. 59.2%) and per istent proteinuria in 25% (black v. Indian 30.2 v. 1 .4%). Hypertension wa observed in 68% and wa more prevalent in blacks (84.4 v. 47.,*%, P < 0.01) There was an earlier onset of retinopathy (P < 0,05) and hypertension (P < 0.01) from time of diabetes diagnosis in blacks than Indians. In the type 1 OM group retinopathy was a sociated with a ignificantly longer duration of diabetes (P < 0.05) and higher glycated haemoglobin (HbA1) (P < 0.05). For type 2 DM subjects there was a significant association between retinopathy and longer duration of diabetes (P < 0.05) and higher systolic blood pressure (P < 0.05).Conclusion. 1his study has shown that there is a high prevalence of microvascular complications in South African patients with long-duration diabetes mellitus