Magister Scientiae (Medical Bioscience) - MSc(MBS) / The prostate is prone to three pathological processes that include inflammation, benign prostate hyperplasia (BPH) and tumors. According to the center for Disease and Control 1999-2012 report, prostate cancer is the second leading cause of death in the United States. Scientific evidence suggests that up to 30% of men in the general population aged from 50 years and above, irrespective of geographic origin, have foci of prostate neoplastic growth. Unbalanced ROS production and a dysregulated antioxidant defence system have been implicated in prostate cancer development. The transformation of a normal cell into cancer takes a very long period. This observation provides the advantage of using nutraceuticals to prevent, arrest or reverse the cellular and molecular processes of carcinogenesis. Based on scientifically observed positive health roles of green tea (Cameli sinensis) and rooibos (Aspalathus linearis) on major diseases like atherosclerosis, hepatitis and certain types of cancer, this thesis evaluated the effects of these two teas on benign (RPWE 1) and malignant (LNCaP) prostate cells. This was done through the quantification of reactive oxygen species (ROS) using a fluorescence dye 5,6 CM-H2DCFDA, total prostate specific antigen (PSA) levels using a PSA ELISA kit, cell viability using the MTT assay, apoptosis using Tali annexin V stain and cell imaging studies using a Zeiss axiovert 200M inverted fluorescence microscope. Statistical analysis was done using graphpad prism. The findings of this study show that aqueous extracts of green and black tea, fermented and unfermented rooibos and their active compounds epigallocatechin gallate (EGCG) and aspalatin, respectively, are cytotoxic in malignant (LNCaP) prostate cells but exert protective effects in benign (RPWE 1) prostate cells. This thesis implicates the pro-oxidant and anti-oxidant properties of the plant extracts, respectively, for the above mentioned effects. In this regard, tea and rooibos promoted ROS production in malignant (LNCaP) prostate cells, which subsequently promoted cell death of the malignant cells through apoptosis and necrosis. Further to this, tea and rooibos used in this thesis, protected normal prostate cells from the adverse effects of ROS. In this regard, fluorescence microscope photographs showed RPWE 1 cells with low DCF fluorescence compared to the malignant prostate cells. Low magnification light microscope photographs showed RPWE 1 cells with flat polygonal shapes and increased adherence both at low and high concentrations of tea and rooibos. On the contrary, high concentrations of tea and rooibos on malignant (LNCaP) prostate cells induced stress, which made the cells attain irregular shapes and as the stress levels increased, cells became detached and appeared dead. Flow cytometry confirmed the presence of apoptotic and necrotic cell in malignant (LNCaP) prostate cells. In this thesis, EGCG and aspalathin were responsible for the high rates of apoptosis observed whereas green tea and unfermented rooibos induced the highest rate of necrosis. Further to this, tea and rooibos and the main active compounds EGCG and aspalathin, respectively, significantly promoted the reduction of total serum prostate specific antigen (PSA) in malignant prostate cells. In normal prostate cells, these plant extracts maintained the total serum PSA at its basal physiological level. In this thesis, to the best of our knowledge, we report for the first time the cell-specific effects of fermented rooibos, unfermented rooibos and their main active component aspalathin, on prostate cancer cells. We showed that rooibos and aspalathin exert pro-oxidant effects on malignant LNCaP cells and anti-oxidant effects on benign RPWE 1 cells. In conclusion, tea (C. sinensis) and rooibos (A. linearis) and their respective main active compounds, epigallocatechin gallate and aspalathin, are cytotoxic to malignant prostate cells whereas in normal prostate cells, they have protective effects against ROS induced stress. The pro-oxidant and anti-oxidant effects are responsible for the aforementioned effects respectively. The decrease in total serum PSA demonstrate the strong therapeutic effects that tea and rooibos have on malignant (LNCaP) prostate cells. / Malawi Government: Department of Human Resources Development and Management

Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending. This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence. In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.

Magister Chirurgiae Dentium (MChD) / Introduction: Defects in the mandible and maxilla have various etiological factors. These include trauma, inflammatory diseases or pathology such as benign and malignant tumours. Patients that are exposed to these factors are often left with compromised function and aesthetics which could have a deleterious effects on the patients’ quality of life if not adequately restored with reconstructive surgery (Goh et al. 2008). Reconstruction should aim to allow rehabilitation of normal stomatognathic function, facial contour and aesthetics, obliteration of dead space left after ablation, and the need to examine the area for recurrence (Kim and Ghali 2011). The fibula free flap has become the gold standard for maxillofacial reconstruction. This flap offers various advantages that makes it suitable, especially for reconstructing defects of the mandible (Anne-Gaelle et al. 2011). The success of rehabilitation of these patients should however also take into consideration the patient’s ability to use a dental prosthesis (conventional or implant retained) post-operatively. This remains challenging (Kramer and Dempf 2005). The effective placement of a dental prosthesis relies on the basic principles of retention, stability and support. With the altered anatomy caused by the graft, placement of dental implants is used to enhance retention and stability. Quality of life (QoL) is a measure of a patient’s satisfaction with their current situation in regards to function and other factors compared to a perceived or expected ideal. The subjective component linked to quality of life means that it could vary from one locality to another, and therefore gathering data that will establish a baseline for these patients that have undergone tumour ablative surgeries. This could be invaluable to healthcare practitioners that operate in this specific field.

No description available.

Bakgrund   Icke-maligna prostataförändringar är ett utbrett samhällsproblem och en vanlig anledning till att människor söker sjukvård. Prostatit och benign prostatahyperplasi är två icke-maligna förändringar som kan te sig på olika sätt och kan orsaka lidande hos de drabbade, ofta genom ”lower urinary tract symptoms” och smärta som är vanliga symtom. Att lindra lidande är vårdens uppgift och en sjuksköterskas ansvar.     Syfte Syftet med denna litteraturöversikt var att belysa hur det är att leva med en icke-malign prostataförändring.    Metod  Metoden som användes var icke-systematisk litteraturöversikt där 18 artiklar analyserades.    Resultat Resultatet efter att ha analyserat de inkluderad studierna visade att icke-maligna prostataförändringar kan ha inverkan på samliv och relationer, ge upphov till känslor av skam, rädsla och oro, att det finns faktorer som kan vara mer eller mindre gynnsamma vid dessa tillstånd samt att det finns rum för förbättring vid mötet med sjukvården.   Slutsats Resultatet i denna litteraturöversikt visar på att leva med icke-maligna prostataförändringar och symtomen de ger upphov till kan ha en tydlig inverkan på drabbade personers liv och livskvalitet i ett flertal aspekter / Background Non-malignant prostatic conditions are a prevalent problem in society and a common reason as to why people seek medical care. Prostatitis and benign prostatic hyperplasia are two examples of non-malignant conditions that can appear in different ways and that could cause the afflicted person suffering, oftentimes through symptoms like pain and lower urinary tract symptoms. Alleviating suffering is an undertaking of health-care professionals’ and a nurse’s responsibility.     Aim The aim of this literature review was to illuminate what it is like to live with a non-malignant prostatic condition.    Method Non-systematic literature review where 18 articles were analyzed.     Results The results of the included and analyzed studies show that non-malignant prostatic conditions can influence intimate relationships, cause feelings of shame, fear and worry, that there are factors that can be more or less favourable in relation to these conditions and that there is room for improvement in the meeting with healthcare professionals.    Conclusions The results in this non-systematic literature review show that living with non-malignant prostatic conditions, and the symptoms they cause, can have a significant influence on the affected persons’ lives and quality of life in several aspects.

Benign prostatahyperplasi (BPH) är ett tillstånd som drabbar nästintill samtliga män över 80 år och vilket medför urologiska besvär som kan ha inverkan på livs¬kvaliteten och det dagliga livet. Syftet med denna litteraturstudie var att redogöra för hur män med benign prostatahyperplasi upplever sitt dagliga liv samt hur deras livskvalitet påverkas. En litteraturstudie gjordes utifrån ett systematiskt tillväga¬gångssätt. Litteratursökningen utfördes i databaserna Cinahl, PsycInfo, PubMed samt The Cochrane Library. Både kvantitativa och kvalitativa studier inkluderades vilka kvalitetsgranskades av båda författarna oberoende av varandra med hjälp av ett modifierat granskningsprotokoll. Resultatet visar på att män med BPH har en störd sömn på grund av nykturi, begränsar sitt sociala liv och upplever genans över de urologiska symtomen och en negativ påverkan på det sexuella samlivet. Män med BPH tycks också utveckla copingstrategier för att bemästra sin vardag som att t ex reducera vätskeintaget, prata om besvären och acceptera tillståndet. Det verkar också vara vanligt förekommande att livskvaliteten hos män med BPH är sämre än hos män utan BPH. Fler studier med både kvalitativ och kvantitativ metodansats behövs för att finna en djupare förståelse för män med BPH och för att stärka evidensen avseende livskvalitet och dagligt liv. / Benign prostatic hyperplasia (BPH) is a condition which causes urology bother that might have an impact on quality of life and daily living in almost all men over the age 80. The aim of this study was to report on how men with benign prostatic hyperplasia experiencing their daily lives and how their quality of life is affected. A systematic review was made in accordance to a systematic procedure. The literature searching was made in the databases CINAHL, PsycInfo, PubMed and The Cochrane Library. Both quantitative and qualitative studies were included and the quality was assessed by both authors independently of each other using a modified audit protocol. The results show that men with BPH have disturbed sleep due to nocturia, limiting their social lives and experiencing embarrassment over the urological symptoms and a negative impact on the sexual life. Men with BPH also seems to develop coping strategies to overcome their daily lives such as reducing fluid intake, talk about the complaint and accept the condition. It also seems that it is more common for men with BPH to rank their quality of life lower than men without BPH. More studies using both qualitative and quantitative approach are needed to find a deeper understanding of men with BPH and to strengthen evidences about quality of life and daily life.

Bakgrund: Benigna gynekologiska åkommor är något som påverkar kvinnors hälsa och livskvalitet. Hysterektomi är den andra vanligaste operationen inom gynekologin och kvinnor som är drabbade av benigna gynekologiska åkommor kan genomgå en hysterektomi som behandling. Livskvaliteten påverkas även av att genomgå en hysterektomi. Syfte: Att beskriva livskvaliteten efter genomgången hysterektomi för kvinnor som drabbats av benigna gynekologiska åkommor. Metod: En litteraturöversikt baserad på 14 artiklar har utförts. Artiklarna är publicerade mellan 2000-2016 och är från olika länder. Sökningar har gjorts i databaserna PubMed, Cinahl, Web of Science och psykINFO. Resultat: Resultatet presenteras i sju kategorier där undertexten handlar om kvinnors livskvalitet efter hysterektomi. Kategorierna presenterar livskvalitetens olika aspekter och om förbättring eller försämring i symtom kan ses. Kategorierna är: smärta och blödning kan kvarstå, för tidig menopaus inträder, det sexuella samlivet, förlust av fertilitet, faktorer som kan påverka livskvaliteten relaterat till total hysterektomi, psykiska upplevelser av att ha genomgått en hysterektomi och informationsbehov. Slutsats: Livskvaliteten förbättras för de allra flesta kvinnor efter genomgången hysterektomi. Vissa symtom kan kvarstå, även om de blir förbättrade. / Background: Benign gynecologic condition are something that affects women's health and quality of life. Hysterectomy is the second most common surgery in gynecology and women who suffer from benign condition may undergo a hysterectomy as treatment. The quality of life is also affected by undergoing a hysterectomy. Aim: To describe the quality of life after a hysterectomy for women who suffers from benign gynecologic condition. Method: A literature review based on 14 articles have been performed. The articles are published between 2000-2016 and are from different countries. Searches have been made in the databases PubMed, CINAHL, Web of Science and psykINFO. Results: The result are presented in seven categories and the sub-texts describes women's quality of life after hysterectomy. The results present quality of life in different aspects, and if the symptoms gets worse or improves. The categories are: early menopaus, the sexual life, loss of infertility, factors that affects the quality of life related to total hysterectomy, psychological experience of undergoing hysterectomy and information needs. Conclusion: Quality of life were improved for most women after the hysterectomy. Some symptoms may persist, although the most were improved.

Pas de résumé français / Pas de résumé anglais

No description available.

A Reabilitação Vestibular (RV) é um programa de tratamento realizado por exercícios, associado a um conjunto de medidas relacionadas à mudança de hábitos e esclarecimentos sobre os sintomas associados à alteração do equilíbrio. É um método de terapia fisiológico, inócuo e coerente, que pretende trabalhar o paciente vertiginoso aliviando os sintomas e aumentando seu limiar de sensibilidade para a vertigem. A Vertigem Postural Paroxística Benigna (VPPB) é a mais comum das vestibulopatias periféricas em adultos, principalmente em idosos do sexo feminino, apresentando como etiologia mais comum a degeneração da mácula utricular. Nos idosos, caracteriza-se por tontura rotatória e nistagmo posicional à mudança de posição da cabeça ou por determinada posição do corpo e, como conseqüência, pode ocorrer quedas e limitações na qualidade de vida dos mesmos, tornando-os limitados físico e emocionalmente. O presente estudo teve como objetivo avaliar prospetivamente a Reabilitação Vestibular como tratamento da VPPB com acometimento de canal semicircular posterior e seu efeito na qualidade de vida em indivíduos idosos. Participaram do estudo 23 voluntários com hipótese diagnóstica otorrinolaringológica de VPPB de canal semicircular posterior por ductolitíase, com faixa etária entre 60 e 91 anos, com média de 70,69 anos e desvio padrão de 9,24. Quanto ao gênero 17 (73,9%) eram do sexo feminino e 6 (26,1%) do masculino. No tratamento da VPPB por meio da reabilitação vestibular em 17 (73,9%) dos voluntários, utilizou-se a manobra de Epley; 6 (26,08%) com manobra de Epley associada ao exercício de Brandt e Daroff . O tempo de tratamento variou de 2 a 6 semanas. Aplicou-se um questionário (Dizziness Handicap Inventory - DHI brasileiro) pré e pós RV para quantificar a tontura quanto aos aspectos: físico, emocional, funcional e geral. Quanto ao aspecto físico, emocional, funcional e geral observou-se diferença estatisticamente significativa (p<0,0001) entre os escores pré e pós RV. Concluímos que os escores dos aspectos avaliados no DHI brasileiro melhoraram após intervenção fonoaudiológica pela RV nos pacientes com VPPB de canal semicircular posterior, havendo um incremento na qualidade de vida dos voluntários estudados. / Vestibular rehabilitation is a treatment?s program based on exercises, associated with a factor?s collection related to changing habits and guidance about symptoms associates to unbalance. It is harmless, coherent and physiologic therapy method that intends to work the dizzy patient, relieving the symptoms and increasing his vertigo?s threshold. The Benign Paroxysmal Positional Vertigo is the one most frequent adult?s pathologies of the peripheral vestibular?s system. It is caused by the utricle?s degeneration. In aged people, is characterize by vertigo and positional nystagmus provoked by certain cephalic movements or body movements and, as sequelae, can take to falls and life quality restriction, physical and emotional. This study?s purpose was evaluate the Vestibular Rehabilitation in posterior canal?s BPPV?s treatment and its effect in the elderly life?s quality. Twenty three volunteers with BPPV ?s posterior canal?s canalith diagnoses pointed out by otorhinolaryngologist, aged between sixty to ninety one years old, average of 70,69 years and deviation of 9,24. Seventeen volunteers (73,9%) were female and six (26,1%) were male. In BPPV?s treatment by vestibular rehabilitation, thirteen (56,52%) were submitted to Epley maneuver, six (26,08%) used the Epley maneuver associated to Brandt- Daroff exercises and four patients (17,39%) were submitted only to the Brandt- Daroff exercises. The treatment?s time lasted from 2 to 6 weeks. A questionnaire (Dizziness Handicap Inventory Portuguese- DHI Portuguese) was used in order to dizziness quantity in the physical, emotional, functional and general aspects, which was observed a significant statistical difference (p<0,001) between the scores previous and after Vestibular Rehabilitation. Concluding that the aspects? scores evaluated improved after Vestibular Rehabilitation therapy in the posterior canal?s BPPV?s patients, occurring an improvement in volunteers? life quality.