Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%–83.1%). Poor sleep quality was associated with depressive symptoms (PR = 1.28; 95%CI: 1.17-1.39), anemia (PR = 1.18; 95%CI: 1.04-1.34) and uremia (PR = 1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients. / brucepemar@gmail.com / Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer los potenciales factores asociados a ella. Materiales y métodos Estudio transversal analítico que enroló a pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluada mediante la escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés, reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57,5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79,3% (IC 95%: 75,6-83,1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP = 1,28; IC 95%: 1,17-1,39), anemia (RP = 1,18; IC 95%: 1,04-1,34) y compromiso urémico (RP = 1,26; IC 95%: 1,17-1,36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes. / Revisión por pares

Orientador: André Luís Balbi / Resumo: A Doença Renal Crônica (DRC) é caracterizada pela perda progressiva e irreversível da função renal. Distúrbios metabólicos e condições catabólicas relacionadas à doença renal e à terapia de diálise afetam negativamente o estado nutricional de pacientes com DRC, deixando-os permanentemente propensos ao protein energy wasting (PEW). O wasting pode resultar de uma dieta inadequada, mas na doença renal, existem outros fatores que resultam nessa condição. Alterações no gasto energético desta população contribuem de forma importante para o prejuízo nutricional. Sendo assim, o objetivo do estudo foi avaliar, de modo evolutivo, o Gasto Energético de Repouso (GER) e parâmetros nutricionais de pacientes com DRC na fase pré dialítica, dialítica inicial e dialítica tardia, estudando pacientes submetidos a hemodiálise e a diálise peritoneal. Além disso, comparar os valores de GER medidos pela Calorimetria Indireta (CI) aos valores estimados pela fórmula de Harris & Benedict. Foram estudados os pacientes com taxa de filtração glomerular estimada <15ml/min/1,73m² e avaliados de acordo com Protocolo de Avaliação Nutricional e medida do GER por CI. Foram consideradas três avaliações realizadas previamente: nos pacientes em estágio 5 não dialítico, no início da diálise, após 30 dias do início da terapia dialítica e incluído no estudo atual, uma última avaliação, após 1 ano do início da diálise. Os dados foram descritos em média, desvio padrão ou mediana. Foi aplicado modelo misto em medidas re... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: Jacqueline Costa Teixeira Caramori / Resumo: A hiperfosfatemia está associada com maior risco de doenças cardiovasculares, eventos ateroscleróticos, hiperparatireoidismo secundário e doença óssea, e pode ser tratada pela combinação de aconselhamento dietético, uso de quelantes e diálise. Aditivos que contêm fosfato estão cada vez mais sendo adicionados nos alimentos processados, e uma importante abordagem para limitar a ingestão de fosfato seria o reconhecimento destes aditivos e a restrição dietética do fosfato inorgânico. Ensaios clínicos mostraram que educação nutricional, utilizando materiais educativos impressos e tecnologia, auxilia no manejo da hiperfosfatemia de pacientes renais crônicos, especialmente aqueles em diálise. OBJETIVO: Verificar o impacto da educação nutricional, focada em aditivos alimentares, na hiperfosfatemia de pacientes com doença renal crônica (DRC) em tratamento hemodialítico. MÉTODOS: Ensaio clínico randomizado controlado de intervenção, com pacientes em hemodiálise, no qual se realizou orientação nutricional direcionada a restrição de alimentos processados contendo aditivos para controle da fosfatemia, durante seis meses, na Diálise do Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP. Os pacientes foram randomizados em Grupo Intervenção (GI) e Controle (GC). Nos início e final do seguimento foram realizadas coletas de dados completas e aplicados inquéritos alimentares: Registros Alimentares de três dias (RA3) e Questionários de Frequência Alimentar para Fosfato (QFA). No ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Hyperphosphatemia is associated with greater risk of cardiovascular diseases, atherosclerotic events, secondary hyperparathyroidism and bone disease), and can be treated by a combination of dietary counseling, chelation and dialysis. Phosphate-containing additives are increasingly being added in processed foods, and an important approach to limiting phosphate intake would be to focus on the dietary restriction of the inorganic phosphate of these additives. Clinical trials have shown that nutritional education, utilizing printed educational materials, aids in the management of hyperphosphatemia of renal disease patients, especially those on dialysis. OBJECTIVES: To verify the impact of nutritional education focused on food additives on parameters of mineral and bone disorders and dietary intake in hemodialytic patients, during six months. METHODS: A controlled randomized clinical trial of intervention, with patients in chronic hemodialytic treatment, in which nutritional guidance, focused on restricting processed foods containing additives, was performed in order to control phosphatemia, for six months, in the Dialysis Unit at the Hospital of Clinics of the Botucatu School of Medicine – UNESP. Patients were randomized into Intervention and Control Group. At the beginning and end of follow-up, complete data collections were performed. In Intervention Group (IG), patients received, nutritional education focused on the consumption of processed foods containing additives with exhi... (Complete abstract click electronic access below) / Doutor

Introdução: A Doença Renal Crônica (DRC) possui múltiplos fatores de risco, revelando a necessidade de uma abordagem integral e interdisciplinar e sendo imprescindível a atuação dos profissionais da Atenção Básica à Saúde (ABS) para sua detecção precoce. A preparação desses profissionais torna-se prioridade para o estabelecimento da prevenção da DRC. Objetivos: Identificar os problemas prioritários em relação à prevenção da DRC, destacados pela equipe de saúde da atenção básica, na qual o enfermeiro se insere; implementar um plano de ação organizado pela equipe de saúde e pesquisadores que busca solucionar os problemas identificados sobre a prevenção da DRC; avaliar as ações relacionadas à prevenção da DRC realizadas junto à equipe participante da pesquisa. Percurso Metodológico: Foi utilizada a abordagem metodológica qualitativa baseada na pesquisa-ação, sendo que, na coleta de dados, foram utilizadas a técnica de observação participante e a entrevista semiestruturada. A coleta de dados foi realizada com 11 profissionais de uma equipe de saúde da família da região oeste de Ribeirão Preto/SP, entre maio e julho de 2011. A análise dos dados resultante das observações e das entrevistas foi feita por meio da Análise de Conteúdo Temática de Minayo. Baseando-se nos problemas prioritários levantados, foi planejada, implementada e avaliada a ação educativa junto à equipe de saúde da família. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto - Universidade de São Paulo. Resultados e Discussão: Os problemas prioritários relacionados à prevenção da DRC apresentados pela equipe de saúde da atenção básica emergiram da análise e interpretação dos relatos contidos nas entrevistas, originando duas categorias: \"Aspectos teóricos acerca da prevenção da DRC\" e \"Aspectos da prática assistencial acerca da prevenção da DRC\". A primeira categoria foi dividida em duas subcategorias: \"Definições da DRC e sua prevenção\" e \"Prevenção da DRC e a atenção básica à saúde\". Da mesma forma, a segunda categoria originou outras duas subcategorias: \"O trabalho cotidiano e a prevenção da DRC\" e \"Intervenções diretas acerca da prevenção da DRC\". Então, definimos e elaboramos o plano de ação a ser desenvolvido para tentarmos solucionar os problemas levantados. Em abril de 2012, foi implementada a ação educativa utilizando duas estratégias: uso da cartilha educativa e apresentação da aula expositiva dialogada. Posteriormente, foi realizada a avaliação do processo pelos participantes da pesquisa. Considerações Finais: A equipe de saúde da família na qual o enfermeiro se insere possui potencialidades para atuar na prevenção da DRC. É essencial adotar estratégias para organização e preparação dessas equipes, a fim de que realizem intervenções que favoreçam a prevenção da DRC. / Introduction: Chronic Kidney Disease (CKD) has multiple risk factors, which indicates the need for an integral and interdisciplinary approach and the essential work of health professionals in the Primary Health Care (PHC) service to detect it early. Therefore, qualifying these professionals becomes a priority in the establishment of CKD preventive actions. Objectives: To identify priority issues related to the prevention of CKD highlighted by the PHC team in which nurses are included; to implement a plan action organized jointly with the health team to solve problems identified in relation to CKD; to evaluate the actions related to the prevention of CKD performed jointly with the studied team. Method: A qualitative methodological approach was used in the action research. Participant observation and semi- structured interviews were used in data collection. Data were collected from 11 professionals from a family health team in the west region of Ribeirão Preto, SP, Brazil between May and July 2011. The results of observations and interviews were analyzed through Thematic Content Analysis proposed by Minayo. An educational action based on the priority problems was planned, implemented, and evaluated jointly with the family health team. The project was approved by the Ethics Research Committee at the University of São Paulo at Ribeirão Preto, College of Nursing. Results and Discussion: the priority problems related to the prevention of CDK presented by the health team in the PHC service emerged from the analysis and interpretation of reports contained in the interviews and originated two categories: \"Theoretical aspects concerning the CDK prevention\" and \"Aspects of care practice concerning the prevention of CDK\". The first category was divided into two subcategories: \"Definitions of CDK and its prevention\" and \"CDK prevention and PHC\". Two other two subcategories emerged from the second category: \"Daily work and CDK prevention\" and \"Direct interventions concerning CDK prevention\". Hence, we defined and developed an action aimed to resolve the problems identified. An educational plan was implemented in April 2012 through two strategies: an educational booklet and an interactive lecture. Afterwards, the study\'s participants evaluated the process. Final Considerations: The family health team in which nurses are included has potential to work in the prevention of CDK. The adoption of strategies to organize and qualify these teams is essential to enable interventions that favor the prevention of CDK

Chronic kidney disease (CKD) is growing global public health problem affecting 1 in 10 adults in developed countries and recognised as an important risk factor for cardiovascular disease (CVD) development. CVD is the main cause of death among CKD patients. Endothelial injury and dysfunction are critical steps in atherosclerosis, a major CVD. Oxidative stress (increased level of reactive oxygen species, ROS) has been associated with CVD development. Intravenous (IV) iron preparations are widely used in the management of CKD mediated anaemia, and have been associated with increased oxidative stress and cellular dysfunction. This study examined the effect of pharmacologically-relevant concentrations of IV Venofer (iron sucrose) or IV Ferinject (Ferric carboxymaltose, FCM) on primary human umbilical vein endothelial cell (HUVEC) activation/damage and on intracellular ROS generation as well as studying the potential mechanisms responsible. Data from TUNEL assay and Annexin V-FITC/PI staining showed that, IV FCM had no effect, but IV iron sucrose increased HUVEC apoptosis at 24hr. IV iron sucrose inhibited cell proliferation and reduced cell viability. Both compounds induced EC activation through sustained activation of p38 MAPK and up-regulation of ICAM-1 and VCAM-1. Additionally, the compounds induced significant increase in total ROS and superoxide anion production, which was attenuated by the anti-oxidant N-acetylcysteine (NAC). P38 MAPK showed up-regulation of pro-apoptotic protein Bax and down-regulation of antiapoptotic Bcl-2 protein in HUVEC treated with IV iron sucrose and p38 inhibition reversed these effects. In summary, these results suggest that IV iron sucrose causes more severe EC injury than IV FCM. However, both IV iron preparations induced intracellular ROS and superoxide anion generation in HUVEC leading to EC activation/dysfunction, providing a potential explanation for vascular damage in CKD patients.

Bakgrund: Kronisk njursvikt (uremi) är ett av världens största hälsoproblem. I Sverige tillkommer cirka 1100 personer varje år som är i behov njurtransplantation eller dialysbehandling. Vid kronisk njursvikt genomgår personen behandling tre till fyra gånger i veckan och är uppkopplad till en dialysmaskin i fyra till fem timmar per gång. Många timmar i hemodialysbehandling (HD) kan innebära förändringar i det vardagliga livet och dess rutiner. Syfte: Syftet var att beskriva personers upplevelser av att leva med hemodialysbehandling. Metod: En beskrivande design med litteraturstudie som datainsamlingsmetod.    Resultat: Resultatet presenteras utifrån tre teman och sex underkategorier. Resultatet visar på känslor av meningslöshet och hopplöshet inför det livslånga behovet av hemodialys. Känslor av att livet begränsas då de inte kan resa och att inte hinna med eller orka spendera tid med familj och vänner gav också en känsla av otillräcklighet. Rädsla och oro inför en osäker framtid, men också hopp om en njurtransplantation eller önskan om att få leva med barn och barnbarn, bidrog till att orka fortsätta framåt i hemodialysbehandling.         Slutsats: Personer beskriver inledningsvis känslan av chock och frustration över beskedet om att behöva hemodialys och innebörden av livslång behandling. Upplevelsen av att beskedet kom som en blixt från klar himmel och utan förvarning visar på behovet av ytterligare forskning om hur patienter med risk för kronisk njursvikt upplever information och förberedelser inför eventuell start av hemodialysbehandling. / Background: Chronic renal failure (uremia) is one of the world's largest health problems. In Sweden, approximately 1100 people are added in need of kidney transplant or dialysis treatment each year. In case of chronic renal failure, the person undergoes treatment three to four times per week and is connected to a dialysis machine for four to five hours each time. Many hours in hemodialysis can result in changes in everyday life and its routines. Aim: The aim of the study was to describe the experience of people living on hemodialysis. Method: A descriptive design with a literature study as a data collection method. Result: The result is presented based on three themes and six subcategories. The result shows feelings of meaninglessness, and hopelessness for the lifelong need of hemodialysis. Feelings that life is limited when they can not travel, do not have the energy, or have the time to spend with family and friends also gave a sense of inadequacy. Fear and concern for an uncertain future, but at the same time hoping for a kidney transplant or the desire to live with children and grandchildren, helped to accept and move forward in hemodialysis treatment. Conclusion: Individuals initially describe the feeling of shock and frustration about the announcement of needing hemodialysis, and the meaning of a lifelong treatment. The experience that the announcement came like a lightning from clear skies and without warning shows the need for further research on how patients with a risk of having chronic renal failure experience information and preparations for a possible start of hemodialysis.

A Insuficiência Renal Crônica (IRC) é uma alteração sistêmica, relativamente comum, onde os principais fatores de risco estão representados pelo diabetes e pela hipertensão. A disfunção acarreta redução ou limitação da capacidade de filtração glomerular dos rins, causando uremia, alterações sistêmicas diversas, especialmente cardiovasculares (hipertensão arterial, aterosclerose, pericardites, cardiomiopatias, arritmias cardíacas e hipertensão pulmonar), anemia, problemas hemostáticos e linfocitopenia. Também podem ser observadas alterações ósseas e bioquímicas, além de distúrbios gastrintestinais e dermatológicos. No âmbito bucal várias alterações tem sido descritas, tanto em tecidos moles quanto em tecidos duros (hálito urêmico, pH salivar mais alcalino; aumento na capacidade-tampão, elevada formação de cálculo dentário, aumento do número de cáries e incidência de doença periodontal), associadas aos distúrbios fisiológicos. Além disso, os pacientes portadores de enfermidades crônicas são frequentemente afetados por maiores níveis de estresse emocional, decorrente da necessidade de tratamento contínuo e limitação de suas atividades sociais, com consequente prejuízo de sua qualidade de vida. Este trabalho teve como objetivo caracterizar as manifestações orais destes pacientes, buscando estabelecer correlações entre o estado de ansiedade e depressão, qualidade de vida, valorização da saúde oral; características biodemográficas e status da insuficiência renal dos indivíduos incluídos no estudo. Nosso plano foi o de examinar pacientes que frequentam instituições especializadas em hemodiálise (duas) e, paralelamente, compor grupo controle, não portador de IRC, tabulando as variáveis propostas na investigação. A metodologia desenvolveu-se com a aplicação de questionários referentes a qualidade de vida (Sf36), indicativo de depressão (Inventário de Beck) e percepção de saúde bucal ( OHIP-14). Os dados foram coletados com o auxílio de ficha clínica específica. Os resultados indicaram níveis maiores de ansiedade e depressão, declínio na qualidade de vida e percepção de saúde bucal. Houve diferença estatisticamente significante no índice PSR quando comparados grupo teste (GT) e controle (GC). Houve maior número de queixas bucais nas mulheres do GC. Em ambos os grupos e gêneros houve relação inversa entre escore de xerostomia e nível de fluxo salivar. Conclui-se que a menor qualidade de vida influencia negativamente o sintoma de depressão que, por sua vez, reduz a percepção de saúde oral. O ciclo se fecha pela influencia negativa do distúrbio metabólico (e as sequelas medicamentosas) sobre a saúde bucal. / Chronic Kidney Disease (CKD) is a relatively common systemic dysfunction which main risk factors are represented by diabetes and hypertension. CKD implies in reduction or limitation of kidneys\' glomerular filtration capacity, causing uremia, various systemic disturbances, particularly cardiovascular (hypertension, atherosclerosis, pericarditis, cardiomyopathies, cardiac arrhythmias and pulmonary hypertension), anemia, lymphopenia and hemostatic problems. Biochemical changes in calcium metabolism can also be observed, as well as gastrointestinal and dermatological disturbances. Oral cavity disturbances may be represented either by soft tissue as hard tissue diseases (uremic breath, more alkaline saliva pH, increase in buffering capacity, high formation of dental calculus, increase in the incidence of tooth decay and periodontal disease). In addition, patients with chronic diseases are often affected by higher levels of emotional stress as a result of the need of continuous treatment that limits their social activities, impairing their quality of life as a consequence. This study aimed to characterize oral and systemic manifestations of these patients in order to establish correlations among anxiety and depression state, quality of life, appreciation of oral health, biodemographic data and the status of renal failure of the individuals included in the study. Our plan was to examine patients attending specialized institutions in hemodialysis and compare this population to a control group, no IRC. The data collected were discussed descriptively and analyzed according to appropriate statistical tests. The methodology was developed with the use of questionnaires regarding quality of life (SF36), indicative of depression (Beck Depression Inventory), and perception of oral health (OHIP-14). Data were collected with the assistance of medical record. The results indicated higher levels of anxiety and depression, impairment of quality of life and perception of oral health. There was a statistical significant difference when compared with the PSR index test (GT) and control group (CG). There was a higher number of oral complaints in women in CG. In both groups and genders there was an inverse relationship between scores of xerostomia and salivary flow rate. We conclude that the lower quality of life negatively influences depression level which, in turn, reduces the perception of oral health. The cycle completes by the negative influence of metabolic (and drug sequels) on oral health quality.

A Insuficiência Renal Crônica (IRC) é uma alteração sistêmica, relativamente comum, onde os principais fatores de risco estão representados pelo diabetes e pela hipertensão. A disfunção acarreta redução ou limitação da capacidade de filtração glomerular dos rins, causando uremia, alterações sistêmicas diversas, especialmente cardiovasculares (hipertensão arterial, aterosclerose, pericardites, cardiomiopatias, arritmias cardíacas e hipertensão pulmonar), anemia, problemas hemostáticos e linfocitopenia. Também podem ser observadas alterações ósseas e bioquímicas, além de distúrbios gastrintestinais e dermatológicos. No âmbito bucal várias alterações tem sido descritas, tanto em tecidos moles quanto em tecidos duros (hálito urêmico, pH salivar mais alcalino; aumento na capacidade-tampão, elevada formação de cálculo dentário, aumento do número de cáries e incidência de doença periodontal), associadas aos distúrbios fisiológicos. Além disso, os pacientes portadores de enfermidades crônicas são frequentemente afetados por maiores níveis de estresse emocional, decorrente da necessidade de tratamento contínuo e limitação de suas atividades sociais, com consequente prejuízo de sua qualidade de vida. Este trabalho teve como objetivo caracterizar as manifestações orais destes pacientes, buscando estabelecer correlações entre o estado de ansiedade e depressão, qualidade de vida, valorização da saúde oral; características biodemográficas e status da insuficiência renal dos indivíduos incluídos no estudo. Nosso plano foi o de examinar pacientes que frequentam instituições especializadas em hemodiálise (duas) e, paralelamente, compor grupo controle, não portador de IRC, tabulando as variáveis propostas na investigação. A metodologia desenvolveu-se com a aplicação de questionários referentes a qualidade de vida (Sf36), indicativo de depressão (Inventário de Beck) e percepção de saúde bucal ( OHIP-14). Os dados foram coletados com o auxílio de ficha clínica específica. Os resultados indicaram níveis maiores de ansiedade e depressão, declínio na qualidade de vida e percepção de saúde bucal. Houve diferença estatisticamente significante no índice PSR quando comparados grupo teste (GT) e controle (GC). Houve maior número de queixas bucais nas mulheres do GC. Em ambos os grupos e gêneros houve relação inversa entre escore de xerostomia e nível de fluxo salivar. Conclui-se que a menor qualidade de vida influencia negativamente o sintoma de depressão que, por sua vez, reduz a percepção de saúde oral. O ciclo se fecha pela influencia negativa do distúrbio metabólico (e as sequelas medicamentosas) sobre a saúde bucal. / Chronic Kidney Disease (CKD) is a relatively common systemic dysfunction which main risk factors are represented by diabetes and hypertension. CKD implies in reduction or limitation of kidneys\' glomerular filtration capacity, causing uremia, various systemic disturbances, particularly cardiovascular (hypertension, atherosclerosis, pericarditis, cardiomyopathies, cardiac arrhythmias and pulmonary hypertension), anemia, lymphopenia and hemostatic problems. Biochemical changes in calcium metabolism can also be observed, as well as gastrointestinal and dermatological disturbances. Oral cavity disturbances may be represented either by soft tissue as hard tissue diseases (uremic breath, more alkaline saliva pH, increase in buffering capacity, high formation of dental calculus, increase in the incidence of tooth decay and periodontal disease). In addition, patients with chronic diseases are often affected by higher levels of emotional stress as a result of the need of continuous treatment that limits their social activities, impairing their quality of life as a consequence. This study aimed to characterize oral and systemic manifestations of these patients in order to establish correlations among anxiety and depression state, quality of life, appreciation of oral health, biodemographic data and the status of renal failure of the individuals included in the study. Our plan was to examine patients attending specialized institutions in hemodialysis and compare this population to a control group, no IRC. The data collected were discussed descriptively and analyzed according to appropriate statistical tests. The methodology was developed with the use of questionnaires regarding quality of life (SF36), indicative of depression (Beck Depression Inventory), and perception of oral health (OHIP-14). Data were collected with the assistance of medical record. The results indicated higher levels of anxiety and depression, impairment of quality of life and perception of oral health. There was a statistical significant difference when compared with the PSR index test (GT) and control group (CG). There was a higher number of oral complaints in women in CG. In both groups and genders there was an inverse relationship between scores of xerostomia and salivary flow rate. We conclude that the lower quality of life negatively influences depression level which, in turn, reduces the perception of oral health. The cycle completes by the negative influence of metabolic (and drug sequels) on oral health quality.

Thesis (M.Sc. (Medical Sciences)) -- University of Limpopo, 2018 / Microalbuminuria (MA) is considered to be a strong and independent risk factor for cardiovascular disease (CVD), chronic kidney disease (CKD) and end-stage renal disease (ESRD). Cross sectional studies have indicated that microalbuminuria is also associated with cardiovascular risk factors such as dyslipidaemia and low grade inflammation. Hence, the aim of this study was to investigate the association of microalbuminuria with serum lipids [Total cholesterol (TC), Triglycerides (TG), High Density Lipoproteins Cholesterol (HDL-C), Low Density Lipoproteins Cholesterol (LDL-C), Lipoprotein a (Lp (a)] and inflammatory markers [C-reactive protein (CRP) and Interleukin-6 (IL-6)] in a rural black population. Methods: This is a cross-sectional study conducted in Dikgale Health and Demographic Surveillance System (HDSS) site and quantitative methods were used. The present study is part of a study titled “Prevention, control and integrated management of chronic diseases in a rural area, South Africa” conducted in the Department of Medical Sciences, University of Limpopo. In the above study blood samples were collected from 816 people aged 15 years and above. For the present study participants with HIV, macroalbuminuria, creatinine ≥170 μmol/land diabetes mellitus were excluded from the 816 people. Six hundred and two (602) participants fitted the inclusion criteria of the present study. Of the 602 participants 255 were men and 377 were women. From these participants, creatinine and albumin concentrations were measured in a morning spot urine sample and the albumin/creatinine ratio (ACR) was calculated. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using OMRON M5-I. Serum lipids (TC, TG, HDL-C, and LDL-C) and glucose were determined using ILAB 300 plus. Lp (a) and hs-CRP were determined using IMMAGE 800 Immunochemistry System. Insulin and IL-6 were determined using ACCESS 2 Chemistry System. Data was analysed using SPSS version 22.0. Statistical tests used included Student T-test, ANCOVA, ANOVA, linear regression and logistic regression. Results: The levels of serum lipids and inflammatory markers in this study were similar in participants with and without microalbuminuria. In a linear regression model TG was the only lipid vi | P a g e parameter found to be associated with microalbuminuria (p = 0.018). Inflammatory markers were not associated with microalbuminuria. In a logistic regression model CRP and HDL-C showed negative association with microalbuminuria in men while in women no association was found. However men with a high CRP and a high TG were found to be more likely to have microalbuminuria (p = 0.007). Conclusion: A linear positive association was observed between microalbuminuria and TG in men and in women. The OR of having microalbuminuria was lower in participants with a high CRP, low HDL-C or in women with a high glucose. Women with a low HDL-C had higher OR of having MA and men with a high CRP and a high TG were found to be more likely to have microalbuminuria.

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in group 1 and 165 in group 2 respectively). The Kaplan-Meier estimate of the median cumulative proportion of patients still hospitalized for the group 1 was 4 days and in group 2 was 5 days (log-rank test; P=0.67). In univariate analysis, Cox PH regression showed unadjusted hazard rate of discharge from hospital was slightly higher in group 1 than group 2 but was statistically non-significant (HR=1.08; P=0.70). In multivariate Cox model analysis, creatinine at the time of admission when greater than 1.6mg/dL (P=0.75), LVEF (P= 0.14), total twenty-four hours dose of intravenous Furosemide given (P=0.98) and interaction between Furosemide dose and Creatinine level (P=0.79) were not significant predictor of hospital discharge. Adjusted hazard rate for discharge from hospital was 12% higher in group 1 than group 2 but still statistically non-significant (HR=1.12; P=0.60). Since the length of hospital stay is similar between two groups, we suggest the goal of diuresis to be less than 2400mL in first twenty-four hours to prevent excessive dehydration.