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The South African Diabetes Prevention Programme (SA-DPP) is a lifestyle intervention targeting individuals at high risk of developing type 2 diabetes mellitus (T2DM). In this paper we describe the mixed-method staged approach that was used to develop and refine the SA-DPP intervention curriculum and the appropriate tools for local resource-poor communities. During the preparation phase, existing evidence on similar DPP interventions was reviewed, focus group discussions with individuals from the target population were conducted as part of a needs assessment, and experts were consulted. The curriculum booklet, a participant workbook and facilitator workbook were developed, and the content was evaluated by experts in the field. The design and layout of the booklet and workbooks needed to be culturally and contextually appropriate. The printed material was evaluated for readability and acceptability by participants of the target population; based on their feedback, the design and layout were refined and the printed material was translated. The suitability of the intervention was tested in a pilot study; based on feedback from the participants and facilitator, the curriculum was revised where needed and finalised. Through this process a context specific intervention and printed materials were developed. A complete evaluation of this culturally relevant model for T2DM prevention in South Africa is pending.

Introduction Measures of adiposity are related to cardiovascular disease risk , but this relationship is inconsistent in disease states, such as chronic kidney disease (CKD). This study investigated the relationship between adiposity and blood pressure (BP) by CKD status. Materials and Methods South Africans of mixed-ancestry (n=1,621) were included. Estimated glomerular filtration rate (eGFR) was based on the modification of diet in renal disease (MDRD) equation, and CKD defined as eGFR 0.100 for all). Contrary, in prevalent CKD (6%, n=96), only BMI was inversely associated with PP (p=0.0349). In multivariable analysis, only BMI and WC remained independently associated with SBP, DBP and MAP in the overall sample. Notably, the association between BMI, WC and LFM with SBP and PP, differed by CKD status (interaction: p

Oral diseases are preventable causes of poor health outcomes in people with chronic kidney disease (CKD). Investigate the association between dental and periodontal conditions with kidney function and determine whether inflammation mediate the association between periodontitis and CKD. Cross-sectional analysis of 1551 South African adults of mixed ancestry. CKD was classified as estimated glomerular filtration rate (eGFR) 0.282). In routine care of people with CKD, attention should be given to oral health.

IntroductionChronic kidney disease (CKD) is a significant health and economic burden, owing to its ever-increasing global prevalence. Due to the limitations in the current diagnostic methods, CKD is frequently diagnosed at advanced stages, where there is an increased risk of cardiovascular complications and end-stage kidney disease. As such, there has been considerable interest in microRNAs (miRNAs) as potential markers for CKD detection. This review seeks to identify all miRNAs associated with CKD and/or markers of kidney function or kidney damage in the general population and high-risk subgroups, and explore their expression profiles in these populations.Methods and analysisA systematic search of published literature will be conducted for observational studies that report on miRNAs associated with CKD or kidney function or kidney damage markers (serum creatinine and cystatin C, estimated glomerular filtration rate and urinary albumin excretion) in adult humans. The electronic database search will be restricted to English and French publications up to 31 October 2021. Two investigators will independently screen and identify studies for inclusion, as well as extract data from eligible studies. Risk-of-bias and methodological quality will be assessed by the Newcastle-Ottawa Quality Assessment Scale for observational studies and Grading of Recommendations Assessment, Development and Evaluation tools. Appropriate meta-analytic techniques will be used to pool estimates from studies with similar miRNAs, overall and by major characteristics, including by country or region, sample size, gender and risk-of-bias score. Heterogeneity of the estimates across studies will be quantified and publication bias investigated. This protocol is reported according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines.Ethics and disseminationThis study design does not require formal ethical clearance and findings will be published in a peer-reviewed journal.ConclusionThis review will provide the expression pattern of miRNAs associated with CKD. This will allow for further research into the identified miRNAs, which could later be used as biomarkers for prediction and early detection of CKD, monitoring of disease progression to advanced stages and as potential therapeutic targets.PROSPERO registration numberCRD42021270028.

The potential utility of microRNAs (miRNAs) as diagnostic or prognostic biomarkers, as well as therapeutic targets, for chronic kidney disease (CKD) has been advocated. However, studies evaluating the expression profile of the same miRNA signatures in CKD report contradictory findings. This review aimed to characterize miRNAs associated with CKD and/or measures of kidney function and kidney damage in the general population, and also in high-risk subgroups, including people with hypertension (HTN), diabetes mellitus (DM) and human immunodeficiency virus (HIV) infection. Medline via PubMed, Scopus, Web of Science, and EBSCOhost databases were searched to identify relevant studies published in English or French languages on or before 30 September 2022. A total of 75 studies fulfilled the eligibility criteria: CKD (n = 18), diabetic kidney disease (DKD) (n = 51) and HTN-associated CKD (n = 6), with no study reporting on miRNA profiles in people with HIV-associated nephropathy. In individuals with CKD, miR-126 and miR-223 were consistently downregulated, whilst in DKD, miR-21 and miR-29b were consistently upregulated and miR-30e and let-7a were consistently downregulated in at least three studies. These findings suggest that these miRNAs may be involved in the pathogenesis of CKD and therefore invites further research to explore their clinical utility for CKD prevention and control.

The burden of chronic kidney disease (CKD) in Africa remains poorly characterized, due partly to the lack of appropriate diagnostic strategies. Although in recent years the diagnostic and prognostic utility of microRNAs (miRNAs) have gained prominence in the context of CKD, its value has not been evaluated in African populations. We investigated the expression of whole blood miRNAs (miR-126-3p, -30a-5p, -1299, -182-5p and -30e-3p) in a total sample of 1449 comprising of 13.3% individuals with CKD (stage 1–5) and 26.4% male participants, as well as the association of these miRNAs with prevalent CKD, in a community-based sample of South African adults. We used Reverse Transcription Quantitative Real-Time PCR (RT-qPCR) to analyze miRNA expression. There was an increased expression in whole blood miR-126-3p, -30a-5p, -1299 and -182-5p in individuals with CKD, compared to those without (all p ≤ 0.036), whereas miR-30e-3p showed no significant difference between the groups (p = 0.482). Only miR-126-3p, -182-5p and -30e-3p were independently associated with increased risk of CKD (all p ≤ 0.022). This study showed for the first time that there is a dysregulation of whole blood miR-126-3p, -30a-5p, -1299 and -182-5p in South Africans of mixed-ancestry with CKD. More research is needed to ascertain their role in CKD risk screening in African populations.

Aims/hypothesis We sought to determine putative relationships among improved mitochondrial respiration, insulin sensitivity and altered skeletal muscle lipids and metabolite signature in response to combined aerobic and resistance training in women with obesity. Methods This study reports a secondary analysis of a randomised controlled trial including additional measures of mitochondrial respiration, skeletal muscle lipidomics, metabolomics and protein content. Women with obesity were randomised into 12 weeks of combined aerobic and resistance exercise training (n = 20) or control (n = 15) groups. Pre- and post-intervention testing included peak oxygen consumption, whole-body insulin sensitivity (intravenous glucose tolerance test), skeletal muscle mitochondrial respiration (high-resolution respirometry), lipidomics and metabolomics (mass spectrometry) and lipid content (magnetic resonance imaging and spectroscopy). Proteins involved in glucose transport (i.e. GLUT4) and lipid turnover (i.e. sphingomyelin synthase 1 and 2) were assessed by western blotting. Results The original randomised controlled trial showed that exercise training increased insulin sensitivity (median [IQR]; 3.4 [2.0–4.6] to 3.6 [2.4–6.2] x10−5 pmol l−1 min−1), peak oxygen consumption (mean ± SD; 24.9 ± 2.4 to 27.6 ± 3.4 ml kg−1 min−1), and decreased body weight (84.1 ± 8.7 to 83.3 ± 9.7 kg), with an increase in weight (pre intervention, 87.8± 10.9 to post intervention 88.8 ± 11.0 kg) in the control group (interaction p p p p p Conclusions/interpretation The major findings of our study were that exercise training altered specific intramuscular lipid intermediates, associated with content-driven increases in mitochondrial respiration but not whole-body insulin sensitivity. This highlights the benefits of exercise training and presents putative target pathways for preventing lipotoxicity in skeletal muscle, which is typically associated with the development of type 2 diabetes. Graphical abstract

Background and Aims Chronic kidney disease (CKD) is a global public health problem, disproportionately affecting individuals of African ancestry. Unfortunately, due to the lack of data in various African countries or the limitations of available data, the true magnitude of CKD on the continent is still unknown. Although there has been an increase in the number of reports on CKD prevalence in recent years, up to now there has been no coordinated effort to provide reliable estimates to adequately support the health service and policy solutions to address the adverse consequences of CKD in Africa. The Chronic Kidney Disease in Africa Collaboration (CKD-AFRICA Collaboration), which is an initiative of the South African Medical Research Council, seeks to address this issue by collating data, at individual participant data (IPD) level, from existing African studies. Thus, the main aims for establishing this platform are, (1) to utilize the available data from all relevant prevalence studies of CKD, to provide an updated and comprehensive synthesis on the burden of CKD in Africa, and (2) to bring together active investigators in the field of CKD epidemiology and prevention, by providing a platform to plan, in a more coordinated way, future observational and interventional studies on CKD across the continent. Method To establish the CKD-AFRICA Collaboration as a continental resource, a stepwise approach was utilized, which included, 1) the identification of data sources through various systematic literature searches and contacting health agencies to access publicly available population-based measurement surveys; 2) establishing a database platform, by inviting active CKD research groups to contribute data on CKD at IPD level; 3) data processing and quality control and 4) piloting the consortium, by using the data from existing studies to determine the prevalence of CKD in the African adult population, by two-stage IPD meta-analysis. Results Through extensive systematic literature searches, 134 potential collaborators were identified. These included studies conducted in general adult populations and high-risk sub-populations, such as those with HIV/AIDS, hypertension and diabetes. Of those identified, 101 principal investigators (PIs) were contacted, via email, to gauge their interest in collaborating in the consortium, as 33 PIs lacked contact information. Of the 101 PIs, 42 responded positively to the call and have agreed to participate in the consortium, spanning 12 African countries, namely Ghana, Kenya, Nigeria, Burundi, Cameroon, Maputo, Sudan, South Africa, Egypt, Uganda, Senegal and Tanzania (Figure 1). To date, the consortium has potential access to 27,346 IPD, with 11,810 IPD already received. Conclusion The strength of this Consortium has far-reaching potential for Africa. Indeed, by harnessing IPD from numerous African studies, important research questions can be explored, and by connecting active CKD researchers, this platform could aid a more coordinated way of developing future observational and interventional studies on CKD in Africa. The research obtained from this collaboration will therefore permit the exploration in understanding the diversity of clinical manifestations of CKD in Africa.

In 2012, the World Health Organization Global Status Report on noncommunicable diseases showed that 7.4 million deaths were due to ischemic heart disease. Consequently, cardiovascular disease is a significant health burden, especially when partnered with comorbidities such as obesity, metabolic syndrome, and type 2 diabetes mellitus. Of note, these diseases can all be induced or exacerbated by diet. Carbohydrates, in particular, fructose and glucose, generally form the largest part of the human diet. Accumulating evidence from animal studies suggests that if large amounts of fructose are consumed either in isolation or in combination with glucose (fructose-containing sugars), myocardial susceptibility to ischemia/reperfusion (I/R) injury increases. However, the underlying mechanisms that predisposes the myocardium to I/R injury in the fructose model are not elucidated, and no single mechanistic pathway has been described. Based on all available data on this topic, this review describes previously investigated mechanisms and highlights 3 main mechanistic pathways whereby fructose has shown to increase myocardial susceptibility to I/R injury. These pathways include (1) increased reactive oxygen species, resulting in reduced nitric oxide synthase and coronary flow; (2) elevated plasma fatty acids and insulin, leading to increased cardiac triglyceride content and lipotoxicity; and (3) disrupted myocardial calcium handling/homeostasis. Moreover, we highlight various factors that should be taken into account when the fructose animal model is used, such as rat strain, treatment periods, and doses. We argue that failure to do so would result in erratic inferences drawn from the existing body of evidence on fructose animal models.

Introduction Measures of adiposity are related to cardiovascular disease risk , but this relationship is inconsistent in disease states, such as chronic kidney disease (CKD). This study investigated the relationship between adiposity and blood pressure (BP) by CKD status. Materials and Methods South Africans of mixed-ancestry (n=1,621) were included. Estimated glomerular filtration rate (eGFR) was based on the modification of diet in renal disease (MDRD) equation, and CKD defined as eGFR 0.100 for all). Contrary, in prevalent CKD (6%, n=96), only BMI was inversely associated with PP (p=0.0349). In multivariable analysis, only BMI and WC remained independently associated with SBP, DBP and MAP in the overall sample. Notably, the association between BMI, WC and LFM with SBP and PP, differed by CKD status (interaction: p

We assessed differences in mitochondrial function in gluteal (gSAT) and abdominal subcutaneous adipose tissue (aSAT) at baseline and in response to 12-weeks of exercise training; and examined depot-specific associations with body fat distribution and insulin sensitivity (SI). Obese, black South African women (n = 45) were randomized into exercise (n = 23) or control (n = 22) groups. Exercise group completed 12-weeks of aerobic and resistance training (n = 20), while the control group (n = 15) continued usual behaviours. Mitochondrial function (high-resolution respirometry and fluorometry) in gSAT and aSAT, SI (frequently sampled intravenous glucose tolerance test), body composition (dual-energy X-ray absorptiometry), and ectopic fat (MRI) were assessed pre- and post-intervention. At baseline, gSAT had higher mitochondrial respiratory capacity and hydrogen peroxide (H2O2) production than aSAT (p 2O2 production and lower aSAT mitochondrial respiration were independently associated with lower SI (p I improved and gynoid fat decreased (p 2O2 production reduced in both depots, and mtDNA decreased in gSAT (p

A 16-year-old female confessed to having intentionally ingested 20–25, 225 mg extended-release capsules of propafenone (4.5–5.6 g) in a suicide attempt. She developed sudden generalized tonic-clonic seizure and markedly prolonged QRS duration with a Brugada-like pattern on ECG. Lorazepam, sodium bicarbonate, and intravenous lipid emulsion therapy were administered; her trachea was intubated for airway protection, and she was admitted to our pediatric intensive care unit for ongoing management. Because propafenone is highly protein-bound and not efficiently removed by hemodialysis, urgent therapeutic plasma exchange (TPE) was performed as an alternate modality. Although data were not available “real-time,” serum propafenone levels decreased from 2.2 mcg/mL pre-TPE to 0.7 mcg/mL post-TPE. She was successfully extubated the following day, transferred to the general care ward for continued medical observation, and discharged 2 days later to an inpatient psychiatric facility.

Hypertension prevalence in sub-Saharan Africa (SSA) is high, is rising and has emerged as the most prevalent cardiovascular disease risk factor. Research is required to provide evidence-based findings to prioritise hypertension prevention and control. This systematic review aims to describe the distribution of and trends in scientific outputs on hypertension prevalence in population-based studies in SSA over the last three decades. Relevant English-language articles documenting hypertension prevalence in population-based studies in SSA, published between 1 January 1990 and 25 April 2019, were identified through a comprehensive electronic search of MEDLINE. Of the 3 795 citations retrieved, 414 fulfilled the inclusion criteria. Scientific outputs increased incrementally per 10-year period: 1990 - 1999: n =32; 2000 - 2009: n =65; and 2010 - 2019: n =317. The greatest number of scientific outputs over the 30-year period originated from South Africa ( n =81) and Nigeria ( n =74). Increasing scientific outputs on hypertension prevalence in SSA have not translated into optimal hypertension management, which remains inadequate.

Aims Black Africans are disproportionally affected by type 2 diabetes, but the pathophysiology is poorly understood. The study aimed to examine the effect of sex and age on insulin sensitivity and insulin response in black South African adults. Methods This cross-sectional study included a random sample of 179 men and 260 women aged 25–74years with normal glucose tolerance from 5 peri-urban townships in Cape Town, SA. Insulin sensitivity (insulin sensitivity index, ISI 0,120 ) and response (insulinogenic index, IGI), and the disposition index (DI, ISI 0,120 ×IGI), derived from an oral glucose tolerance test, were measured. Results Although men were older (median [interquartile range]: 39 [30–48] vs. 35 [29–44], P =0.021) and had significantly lower BMI than women (22.6 [20.0–25.3] vs. 31.0 [25.9–35.7] kg/m 2 , P =0.001), DI was not different ( P =0.740), but ISI 0,120 was higher ( P =0.007) and IGI was lower ( P =0.074) in men than women, adjusting for age and BMI. With increasing age, DI ( β (95%CI): −24.4 (−36.3 to −12.5), P β (95%CI): −4.9 (−7.5 to −2.2), P 0,120 did not change ( β (95%CI): 0.005 (−0.20 to 0.03), P =0.675). Conclusion Black South African women with normal glucose tolerance have lower insulin sensitivity than their male counterparts, but increase their insulin response to maintain normoglycemia. With increasing age, insulin sensitivity remains unchanged, but the insulin response decreases at a similar rate in men and women.

ObjectivesThe objectives were to characterise the haematological profile of screen-detected chronic kidney disease (CKD) participants and to correlate the complete blood count measures with the commonly advocated kidney function estimators.MethodsThe current cross-sectional study used data, collected between February 2015 and November 2016, of 1564 adults of mixed-ancestry, who participated in the Cape Town Vascular and Metabolic Health study. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined as estimated glomerular filtration rate (eGFR) 2, and anaemia as haemoglobin level ResultsBased on the MDRD and CKD-EPI equations, the crude prevalence of CKD was 6% and 3%. Irrespective of the equation used, median red blood cell (RBC) indices were consistently lower in those with CKD compared with those without CKD (all pConclusionThough it remains unclear whether common kidney function estimators provide accurate estimates of CKD in Africans, the correlation of their estimates with deteriorating RBC profile, suggests that advocated estimators, to some extent approximate kidney function in African populations.

Background High-sensitivity C-reactive protein (hsCRP) is associated with metabolic risk, however it is unclear whether the relationship is confounded by racial/ethnic differences in socioeconomic status (SES), lifestyle factors or central adiposity. The aims of the study was, (1) to investigate whether hsCRP levels differ by race/ethnicity; (2) to examine the race/ethnic-specific associations between hsCRP, HOMA-IR and serum lipids [total cholesterol (TC), triglycerides (TG), high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C)]; and (3) to determine whether race/ethnic-specific associations are explained by SES, lifestyle factors or waist circumference (WC). Methods The convenience sample comprised 195 black and 153 white apparently health women, aged 18–45 years. SES (education, assets and housing density) and lifestyle factors (alcohol use, physical activity and contraceptive use) were collected by questionnaire. Weight, height and WC were measured, and fasting blood samples collected for hsCRP, glucose, insulin, and lipids. Results Black women had higher age- and BMI-adjusted hsCRP levels than white women (p = 0.047). hsCRP was associated with HOMA-IR (p

Objective:Thought it is generally accepted that measures of adiposity are related to cardiovascular disease risk, this relationship may not be consistent in disease states, particularly chronic kidney disease (CKD). This study aimed to investigate the relationship between measures of adiposity and b

Objectives: Hypertension is becoming increasingly prevalent in South Africa (SA), especially amongst the black population. Since body composition is a major risk factor for hypertension, it is important to investigate which parameter of body composition best predicts this disease. The aim of this study was to evaluate whether baseline and/or change in body composition, could predict the development of hypertension over a 10 year period in a sample of black SA woman. Research design and methods: This longitudinal study included 563 black SA women, aged 29-53 years, residing in Soweto, Johannesburg. Data on systolic and diastolic blood pressure, anthropometric, dual energy x-ray absorptiometry (DXA)-derived body composition and simple anthropometric measures were collected at baseline (2003) and at 10-year follow-up (2013). Results: Over the 10-year follow-up period, all anthropometric [eg. body mass index (BMI): 30.3±6.1 to 32.6±6.8, p

The current treatment options for soft tissue injuries remain suboptimal and often result in delayed/incomplete recovery of damaged muscle. The current study aimed to evaluate the effects of oral Prosopis glandulosa treatment on inflammation and regeneration in skeletal muscle after contusion injury, in comparison to a conventional treatment. The gastrocnemius muscle of rats was subjected to mass-drop injury and muscle samples collected after 1-, 3 h, 1- and 7 days post-injury. Rats were treated with P. glandulosa (100 mg/kg/day) either for 8 weeks prior to injury (up until day 7 post-injury), only post-injury, or with topically applied diclofenac post-injury (0.57 mg/kg). Neutrophil (His48-positive) and macrophage (F4/80-positive) infiltration was assessed by means of immunohistochemistry. Indicators of muscle satellite cell proliferation (ADAM12) and regeneration (desmin) were used to evaluate muscle repair. Chronic P. glandulosa and diclofenac treatment (p &lt, 0.0001) was associated with suppression of the neutrophil response to contusion injury, however only chronic P. glandulosa treatment facilitated more effective muscle recovery (increased ADAM12 (p &lt, 0.05) and desmin (p &lt, 0.001) expression), while diclofenac treatment had inhibitory effects on repair, despite effective inhibition of neutrophil response. Data indicates that P. glandulosa treatment results in more effective muscle repair after contusion.

*p < 0.05 vs the respective control; ***p < 0.001 vs the respective control. Analysis by two-way ANOVA, n = 6 per group.

Background: Black populations are disproportionately burdened with type 2 diabetes, but have a reduced risk for cardiovascular disease. Elevated C-reactive protein (CRP) levels, a marker of inflammation, have been associated with increased cardio-metabolic risk, including insulin resistance (IR) and elevated serum lipid levels. Although not consistent, several studies worldwide have reported higher circulating high-sensitivity CRP (hsCRP) levels in black compared to white women. However, it is not fully known whether the relationship between hsCRP and cardio-metabolic risk differs between ethnic groups, and whether these relationships may be confounded by differences in socioeconomic status (SES), lifestyle factors and/or central obesity. Aims: (1) To investigate whether hsCRP levels differ between black and white SA women; (2) to examine the ethnic-specific associations between hsCRP, insulin resistance (HOMA-IR) and serum lipids (total cholesterol (TC), triglycerides (TG), high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C)); and 3) determine whether any ethnic differences may be explained by differences in SES, lifestyle factors and/or central adiposity between black and white SA women. Methods: The study sample comprised 226 black and 179 white apparently healthy, premenopausal, South African women, aged 18-45 years. A questionnaire was administered that captured measures of SES (level of education, asset index and housing density) and lifestyle factors (smoking status, alcohol use, physical activity and contraceptive use). Weight, height and waist circumference (WC) were measured and fasting blood samples were drawn for the determination of hsCRP, glucose, insulin, and serum lipids. Results: Black women had higher age- and BMI-adjusted hsCRP levels than white women [2.5u00b5g/ml vs. 2.0u00b5g/ml; p=0.047]. Age- and ethnicity-adjusted multivariable analysis showed hsCRP was independently associated with HOMA-IR [u03b2(CI): 0.09 (0.05;0.13); p

Background and Methods Non-physician providers (NPPs) including nurse practitioners (NPs) and physician assistants (PAs) are important members of CF care teams, but limited data exist about the extent NPPs are involved in CF care. A subcommittee was established by the CF Foundation to gather information about current involvement of NPPs. Surveys were sent to adult, pediatric and affiliate CF program directors (PDs) and NPPs working in US CF programs. Results Responses were received from 108 PDs (49% pediatric, 34% adult, 17% affiliate). Overall, 53% of the 108 programs had NPPs and 70% had or planned to hire NPPs. Reasons for NPP use included ideal clinical role (75%), expansion of services (72%), and physician shortage (40%). The survey collected 73 responses from NPPs (96% NPs, 4% PAs) who worked in pediatric (49%), adult (29%), affiliate (3%), or multiple programs (19%). Training occurred on the job in 88% and from prior CF experience in 21%. NPPs provided coverage in outpatient clinics (82%), inpatient care (64%), and weekend and/or night call (22%). In addition to clinical roles, NPPs are involved in education (95%), research (81%), and leadership (55%). The major obstacle reported by PDs and NPPs was billing with only 12% of programs reporting NPP salaries covered by billing revenue alone. Salary support included hospital support (67%), billing (39%), center grant (35%), and other grant/contract (25%). NPPs bill for outpatient and inpatient care in 65% and 28% of programs, respectively. Conclusions NPPs are working with physicians in many centers and have the potential to help meet the increasing clinical workforce demands. Further evaluation of financial issues is indicated to continue the support of NPP jobs in CF. Roles and expectations need to be clearly defined. Initial and ongoing training standards and opportunities should be explored. Pediatr Pulmonol. 2013; 48:398–404. © 2012 Wiley Periodicals, Inc.

Diabetes mellitus is rampantly increasing and the need for therapeutics is crucial. In recognition of this, untested antidiabetic agents are flooding the market. Diavite™ which is a product consisting solely of the dried and ground pods of Prosopis glandulosa (Torr.) [Fabaceae] is currently marketed as a food supplement with glucose stabilizing properties. However, these are anecdotal claims lacking scientific evidence. The aim of this study was to determine the efficacy of Prosopis glandulosa as an antidiabetic agent.Male Wistar rats were rendered (a) type 1 diabetic after an intraperitoneal injection of STZ (40 mg/kg) and (b) insulin resistant after a 16-week high caloric diet (DIO). Zucker fa/fa ZDF rats were used in a pilot study. Half of each group of animals was placed on Prosopis glandulosa treatment (100mg/kg/day) for 8 weeks and the remaining animals served as age-matched controls. At the time of sacrifice, blood was collected for glucose and insulin level determination, the pancreata of the STZ rats were harvested for histological analysis and cardiomyocytes prepared from the DIO and Zucker fa/fa hearts for determination of insulin sensitivity.Type 1 diabetic model: Prosopis glandulosa treatment resulted in significant increased insulin levels (p0.001), which was accompanied by a significant decrease in blood glucose levels (p0.05). Additionally, Prosopis glandulosa treatment resulted in increased small β-cells (p0.001) in the pancreata. The body weight of the STZ animals decreased significantly after STZ injection, with Prosopis glandulosa treatment partially preventing this. Zucker fa/fa rats: Prosopis glandulosa treatment significantly reduced fasting glucose levels (p0.01) and improved IPGTT, when comparing treated to untreated animals. DIO insulin resistant model: Prosopis glandulosa treatment resulted in an increased basal (p0.01) and insulin-stimulated (p0.05) glucose uptake by cardiomyocytes prepared from this group.The present study showed that Prosopis glandulosa treatment moderately lowers glucose levels in different animal models of diabetes, stimulates insulin secretion, leads to the formation of small β-cells and improves insulin sensitivity of isolated cardiomyocytes.

Supplemental Digital Content is available in the text, Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria. This is a single center, 15-year analysis in ART-naïve patients. CKD was defined as the occurrence of estimated glomerular filtration rate (eGFR)

Chronic kidney disease (CKD) is fast becoming a major public health issue, disproportionately burdening low-income to middle-income countries, where detection rates remain low. We critically assessed the extant literature on CKD screening in low-income to middle-income countries. We performed a PubMed search, up to September 2016, for studies on CKD screening in low-income to middle-income countries. Relevant studies were summarised through key questions derived from the Wilson and Jungner criteria. We found that low-income to middle-income countries are ill-equipped to deal with the devastating consequences of CKD, particularly the late stages of the disease. There are acceptable and relatively simple tools that can aid CKD screening in these countries. Screening should primarily include high-risk individuals (those with hypertension, type 2 diabetes, HIV infection or aged >60 years), but also extend to those with suboptimal levels of risk (eg, prediabetes and prehypertension). Since screening for hypertension, type 2 diabetes and HIV infection is already included in clinical practice guidelines in resource-poor settings, it is conceivable to couple this with simple CKD screening tests. Effective implementation of CKD screening remains a challenge, and the cost-effectiveness of such an undertaking largely remains to be explored. In conclusion, for many compelling reasons, screening for CKD should be a policy priority in low-income to middle-income countries, as early intervention is likely to be effective in reducing the high burden of morbidity and mortality from CKD. This will help health systems to achieve cost-effective prevention.

Constipation that is unresponsive to conventional remedies is the primary symptom of congenital megacolon (ie, Hirschsprung's disease). The cause of congenital megacolon is lack of ganglion ceiis in the bowel. The laparoscopic Swenson pull-through procedure involves removing the aganglionic segment of the colon, bringing the normally decompressed bowel through the pelvic floor, and anastomosing the bowel to the anorectal verge. Advantages of the laparoscopic approach include shorter lengths of hospital stay and fewer complications resulting from disruption of skin integrity. AORN J 62 (Nov 1995) 727-736.