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Thesis (MPH.) -- University of Limpopo, 2021 / Background: Diabetes mellitus (DM) is a major public health problem, and it remains one of the global epidemics of non-communicable diseases. Diabetic retinopathy (DR) is a micro-vascular complication of DM due to a prolonged hyperglycaemia, and it is the most common cause of a visual loss in people living with DM. The global increase in the prevalence of DM has led to an increase in prevalence of diabetic complications, such as DR. The primary aim of this study was to investigate the prevalence and determinants of DR among the DM patients receiving treatment from Maruleng public healthcare facilities, Mopani District in the Limpopo Province. Methodology: A quantitative cross-sectional survey was used as a primary source data from the DM patients who were readily available at the selected public healthcare facilities to collect a chronic treatment during the time of the study. Selection of eligible DM patients was done through a convenient sampling technique for those who were readily available or willing to take part of the study after receiving all information about the study for them to consent freely without any form of coercion by researcher or any other person. All selected respondents had undergone face-to-face interviews and basic clinical screening for DR to collect a primary source data using piloted structured researcher-administered questionnaire to record data collected from respondents, and calibrated medical equipment were used to measure a clinical variables during clinical screening. Data analysis was carried out using Statistics and Data Analysis (STATA) version 15 software for windows. The characteristics of DM patients were summarised and analysed using a descriptive statistics. Inferential statistics were performed on dependent variable and independent variables using a logistic regression analysis to determine the strength of association between variables, where a potential predictors of DR among DM patients were identified at significant level of less than 0.05 (p<0.05). Results: Out of the 416 DM patients who participated in the study, the majority were females (n=315; 76%) and all DM patients were above the age of 18 years, with a mean age of 61 years (standard deviation [SD] =11.5). The overall prevalence of DR was 35.4% comprising 32% mild non-proliferative DR (NPDR) and 3.4% moderate NPDR. DR was found to be slightly more prevalent in females, at 35.9%, than in males, at 34.6%; particularly in those females with type 2 DM, at 35.1%, comprising 32.1% mild NPDR and 3% moderate NPDR. DR was more prevalent in older females, at 77.8%, comprising 55.6% mild NPDR and 22.2% moderate NPDR. The DM patients aged 55 years and above were found to be 2.7 times more likely to develop DR, at p<0.001, and DM patients with higher systolic blood pressure of 140 mmHg or more were found to be 1.4 times more likely to develop DR as compared to DM patients with a systolic blood pressure of 139 mmHg or less (≤139 mmHg), at p<0.05. Employed DM patients were 1.4 times more likely to develop DR as compared to unemployed DM patients, at p<0.001. Age of the DM patients, high systolic blood pressure (SBP) or a hypertension of 140 mmHg or more (≥ 140 mmHg), and employment status were significantly associated with higher risk of developing DR among DM patients. Gender, hyperglycaemic state, poor glycaemic control, smoking and high BMI were found to be associated with DR but this association was not statistically significant. Conclusion and recommendations: Slightly more than one third of the DM patients receiving treatment during the study period from the public healthcare facilities in the Maruleng sub-district had some form of DR, which means that nearly four in ten DM patients had some form of DR. Diabetic retinopathy was more prevalent in females, and in older DM patients. Age of the DM patient, employment status, and high systolic blood pressure were significantly associated with an increased risk of developing DR among the DM patients. There is an urgent need to implement a health promotional programmes to educate people about the complications of a diabetes mellitus such as DR, and also to establish a coordinated screening programme for DR among DM patients receiving a chronic treatment, which must be supported by the Department of Health in all public healthcare facilities. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Prevalence, Determinants / Health and Welfare Sector Education and Training Authority (HWSETA)

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Background: Streptozotocin (STZ) induced diabetes leads to various complications including cardiomyopathy. Recent data suggests transplanted bone marrow stem cells improve cardiac function in diabetic cardiomyopathy. However, whether modified ES, iPS cells, or factors released from these cells can inhibit apoptosis and fibrosis remains completely unknown. The present study was designed to determine the effects of transplanted ES cells overexpressing pancreatic transcription factor 1 a (Ptf1a), a propancreatic endodermal transcription factor, iPS cells, or their respective conditioned media (CM) on diabetic cardiomyopathy. Methods: Experimental diabetes was induced in male Sprague Dawley rats (8-10 weeks old) by intraperitoneal STZ injections (65 mg/kg body weight for 2 consecutive days). Animals were divided into six experimental groups including control, treated with sodium citrate buffer IP, STZ, STZ + ES-Ptf1a cells, STZ + iPS cells, STZ + ES-Ptf1a CM and STZ + iPS CM. Following STZ injections, appropriate cells (1 X 106/mL/injection/day) or CM (2 mL injection/day) were given intravenously for 3 consecutive days. Animals were sacrificed and hearts were harvested at day 28. Histology, TUNEL staining, and Caspase-3 activity were used to assess apoptosis and fibrosis. ERK1/2 phosphorylation was quantified using ELISAs. M-mode echocardiography fractional shortening was used to assess cardiac function. Results: Animals transplanted with ES cells, iPS cells, or both CMs showed a significant (p

Made available in DSpace on 2016-04-27T13:10:27Z (GMT). No. of bitstreams: 1 Isabel Redondo de Campos.pdf: 3029986 bytes, checksum: 846f67976c76d8135c8f94c088696392 (MD5) Previous issue date: 2015-09-23 / Diabetic Retinopathy (DR) is one of the complications of Diabetes Mellitus (DM). It is the leading cause of adult blindness in working age in developed countries. The study aimed to analyze the profile of diabetic patients, treated at the retina ambulatory at Sorocaba´s Ophthalmology Hospital and to identify the knowledge of those patients on DM and DR. A questionnaire was developed and applied by the researcher to 46 patients (n=100%) from January to March 2015. The results showed that from the 46 subjects (all coming from Sorocaba or region, with DM confirmed by medical record data), 27 (58.7%) are male. The median age was 62.5 years (range: 41-79 years). Twenty-two patients (47.8%) were retired and 34 (73.9%) reported earning between one and three times the minimum wage. Most of the subjects said that they are overweight (n = 19; 41.3%) or obese (n = 13, 28.3%) and believed their diabetes control was regular. Regarding education, 41.3% attended between one to eight years of school and 10.9% reported to be illiterate. Regarding the type of DM, 23 (50%) did not know the type. The data records were incomplete in this classification. The most reported complication was DR, with the total of 23 (50%) patients, while 17 (36.9%) claimed to have no complication of DM. Only 21.8% could name ophthalmoscopy as indicated for ophthalmic evaluation. The most mentioned reason for seeking treatment was for partial loss of vision (50%). Only 35.0% of patients have participated in an education group in DM. The patients showed low levels of knowledge about their chronic disease as well as on the DR, on the examination required for early detection of this complication and on the measure needed to preserve eye health, even by those who reported prior participation in education groups in DM. It can be said that these programs, besides reaching a small proportion of patients, had poor results in the appropriation of knowledge about DM by this group. It was concluded that systematic education programs must be implemented in all health care levels, due to gaps in the patients previous knowledge to revert the appropriation of new knowledge and attitudes about the DM / A Retinopatia Diabética (RD) é uma das complicações do Diabetes Mellitus (DM). É a principal causa de cegueira dos adultos em idade ativa nos países desenvolvidos. O estudo teve como objetivos analisar o perfil de amostra de pacientes diabéticos, atendidos no ambulatório de retina do Hospital Oftalmológico de Sorocaba e identificar o conhecimento desses pacientes sobre DM e RD. Foi desenvolvido um questionário, aplicado pela pesquisadora a 46 pacientes atendidos de janeiro a março de 2015. Os resultados mostraram que dos 46 sujeitos (todos procedentes de Sorocaba ou região, com DM confirmado por dados do prontuário), 27 (58,7%) são homens. A mediana de idade foi de 62,5 anos (variação: 41 79 anos). Vinte e dois pacientes (47,8%) são aposentados e 34 (73,9%) declararam receber entre um e três salários mínimos. A maior parte referiu sobrepeso (n=19; 41,3%) ou obesidade (n=13, 28,3%) e apontam seu controle como regular. Em relação à escolaridade, 41,3% frequentou a escola entre um a oito anos e 10,9% referiram ser analfabetos. Sobre o tipo de DM, 23 (50%) não sabiam o tipo. Os dados de prontuários estavam incompletos nessa classificação. A complicação mais referida foi a RD, somando 23 (50%) pacientes, enquanto 17 (36,9%) alegaram não ter nenhuma complicação do DM. Somente 21,8% soube nomear o exame de fundoscopia como o indicado para avaliação oftalmológica. O motivo mais citado para procurar tratamento foi por perda parcial de visão (50%). Apenas 35,0% dos pacientes já participou em grupo de educação em DM. Os pacientes apresentaram baixos níveis de conhecimento sobre sua doença crônica, bem como quanto à RD, ao exame necessário para detecção precoce desta complicação e às medidas indicadas para preservação da saúde ocular, mesmo naqueles que referiram participação prévia em grupos de educação em DM. Pode-se dizer que estes programas, além de atingirem uma parcela pequena de pacientes, tiveram resultados pouco expressivos na apropriação do conhecimento sobre DM neste grupo. Concluiu-se então que deve-se implantar programas de educação sistemáticos em todos os níveis de atenção à saúde, voltados às lacunas do conhecimento prévio dos pacientes para se reverterem na apropriação de novos conhecimentos e atitudes sobre o DM

Darbo tikslas - ištirti sergančių 1 tipo cukriniu diabetu sveikatos priežiūros poreikius, nustačius ir įvertinus diabetinių komplikacijų dažnį, respondentų vaistų vartojimo ypatumus, bei socio - ekonominių veiksnių įtaką, galimai sąlygojančią sergančiųjų požiūrį į gyvenimo kokybę. Uždaviniai: 1. Įvertinti diabetinių komplikacijų (retinopatijos, neuropatijos, nefropatijos) dažnį, bei pasiskirstymą ligos trukmės grupėse tarp sergančių cukriniu diabetu iki 15 m. ir >15 m. 2. Išsiaiškinti, sergančių 1 tipo cukriniu diabetu, galimas kardiovaskulinės sistemos ligas, bei pacientų požiūrį į šių ligų gydymą. 3. Išsiaiskinti pacientų vaist����� vartojimo ypatumus, žinias apie 1 tipo cukrinį diabetą, bei palyginti ligos trukmės grupėse tarp sergančių cukriniu diabetu iki 15 m. ir >15 m. 4. Įvertinti, kaip susirgimas 1 tipo cukriniu diabetu įtakoja socio - ekonominius veiksnius, respondentų kasdieninę veiklą, bei jų gyvenimo kokybę. Tyrimo metodika. Tyrimo objektas. Sergantys 1 tipo cukriniu diabetu, bei besigydantys VšĮ Kauno apskrities ligoninėje. Tyrimo metodai. Atsitiktiniu atrankos metodu buvo pasirinkta 20 respondentų besigydžiųsių VšĮ Kauno apskrities ligoninėje. Tyrimas buvo atliekamas naudojantis ligos istorijomis ir endokrinologų dokumentacija, bei apklausiant pacientus. Statistinės analizės metodai. Anketinės apklausos duomenų analizei naudota SPSS 13.0 versijos programa. Hipotezės apie požymių nepriklausomumą buvo tikrinamos naudojant chi kvadrato (χ2) kriterijų... [toliau žr. visą tekstą] / Objective is to research health needs of people with 1 type sugar diabetes, assess and value frequency of diabetes complication, respondents‘ peculiarity of medicine consumption and socio – economical factors influence for patients with 1 type sugar diabetes life quality. Goals: 1. Value diabetes complications (retinopathy, neuropathy, nephropathy) frequency and contrast between groups with illness duration till 15 year and duration over 15 year. 2. Research patients with 1 type sugar diabetes possible cardio-vascular system illnesses and patients’ view to cure of these illnesses. 3. To analyze peculiarities how patients takes medicines, their knowledge about 1 type sugar diabetes and compare it between groups with illness duration till 15 year and duration over 15 year. 4. Value how 1 type sugar diabetes influence socio – economical factors, respondents daily activity and their life quality. Methodology. Research object. People with 1 type sugar diabetes and people with this illness hospitalized in VSI Kaunas circle hospital. Methods. Accidentally were taken 20 respondents hospitalized in VSI Kaunas circle hospital. Research instrumentations are based on ill-histories, endocrinologic documentation and circulated questionaires between patients. Methods of statistical analysis. For data analysis was used statistical data analysis program SPSS 13.0 version. Hypothesis about independence of features was checked by using chi quadrat (χ2) canon. To check hypothesis was taken... [to full text]

[Truncated abstract] Cardiovascular reflex control of the vasculature is important in maintaining adequate tissue oxygenation in the face of disturbances in physiological homeostasis. Alterations in blood oxygen levels and blood distribution evoke integrated neural, mechanical and humoral responses which modulate peripheral vasomotor tone to maintain systemic cardiovascular integrity. The balance between the local effects of hypoxia and changes in chemoreflex control of vascular tone during hypoxia determine whether net vasoconstriction or vasodilatation is evident in the peripheral vasculature. The mechanisms contributing to hypoxic vasodilatation per se have not previously been defined in healthy humans. Study 1 of this thesis (Chapter 3) investigated the mechanisms contributing to vasomotor responses to chemoreflex activation in the human forearm ... Study 2 (Chapter 4a) investigated the mechanisms controlling vasomotor responses to isocapnic hypoxia in subjects with type 2 diabetes ... Study 3 (Chapter 5) compared the vascular responses to decreased venous return in individuals with and without right atrial afferent innervation ... The results of this thesis indicate that in healthy humans isocapnic hypoxia induces sympathetic vasoconstriction, which masks underlying β-adrenoceptor mediated vasodilatation. The normal vasomotor response to isocapnic hypoxia is impaired in subjects with type 2 diabetes. Despite intact vasoconstrictor responses, subjects with type 2 diabetes exhibited attenuated adrenaline-mediated vasodilatation compared to healthy control subjects, suggesting that the chemoreflex in these subjects is ill-equipped to respond to hypoxic stress. In clinical terms, impaired reflex vasomotor

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thesis (M. Pharm) -- University of Limpopo, 2019 / Diabetes mellitus (DM) is a major public health problem, challenging patients, healthcare professionals, health planners and policy makers worldwide. Its prevalence has been on the rise for the past four decades, with this trend expected to continue. With this challenge, the management of DM should be done following evidence-based guidelines to prevent or slow down the development of DM-related complications. According to the Society of Endocrinology Metabolism and Diabetes South Africa (SEMDSA) guidelines, it has been shown that strict glycaemic control and proper clinical monitoring can help with prevention and slowing down development of complications. If left untreated or poorly controlled, DM progresses into an array of complications which may increase morbidity and mortality. The prevalence and management of DM complications was investigated. Objectives: • To determine the prevalence of DM complications at Mankweng Hospital. • To evaluate the management of patients with DM complications at Mankweng Hospital. • To determine the factors contributing to the development of complications. • To determine preventive measures taken on non-complicated patients to prevent them from complicating. Method: A retrospective longitudinal review of 134 randomly selected patient records was conducted for a five-year period spanning from June 2012 to May 2017. A pretested DM complications checklist was used to collect data from the patient records. A cross-sectional study was conducted amongst healthcare professionals caring for patients with DM. A total of 41 healthcare professionals were included in the study where a self-administered questionnaire was used to obtain the data. Both sets of data obtained were analysed using IBM SPSS version 25. xiii Results: Retrospective study The study sample population was entirely consisted of African patients with 70.1% (n=94) females and 29.9% (n=44) males. In the sample, 17.2% were suffering from T1DM while 82.8% were suffering from T2DM. The complications with the highest prevalence were diabetic nephropathy, peripheral neuropathy and diabetic retinopathy with prevalence of 35.8%, 32.1% and 22.4% respectively. Vascular diseases, autonomic neuropathy and diabetic foot ulcer had prevalence of 9.7%, 9% and 6% respectively. The overall prevalence of complications in general was 67.2% which was very high. Cross-sectional study A self-administered questionnaire was distributed amongst 41 healthcare professionals (14 males and 27 females). This sample consisted of 9.8% doctors, 41.5% pharmacists, 17.1% professional nurses, 17.1% physiotherapists, 2.4% podiatrists and 12.2% optometrists. It was discovered that only 92.6% and 84.6% of the participants were compliant with the guidelines in terms of random blood glucose tests and blood pressure (BP) per every visit. Only 50% of the HCPs revealed that HbA1c tests should be done according to the guidelines. Merely 5.6%, 8.3%, 5.3% and 22.7% of the HCPs correctly indicated the frequency of foot examinations, eye examinations, renal function tests and lipogram tests respectively, as per the guidelines. Patient related factors were rated as the most contributory factors (56.4%) to the development of complications. Socio-economic and medication related factors had most of the HCPs (36.1% and 29% respectively) rating them as moderate in terms of how much they contribute to the development of complications. The factors rated the least were healthcare team (32.4%) and health system (33.3%) related factors. Conclusion: There was a high prevalence of overall complications in general, with diabetic nephropathy, peripheral neuropathy and diabetic retinopathy being the three highest individual complications. There was poor monitoring of patients with complications as the compliance with the SEMDSA guidelines was very low. Patient related factors xiv were rated the most contributory factors to the development of complications in patients with DM. Recommendations: There is need to implement patient-centred DM care which makes sure that the patient is involved in decision making so that they take responsibility of their own health. There is need for the development and implementation of institutional quality improvement programs where regular audits of the processes of DM care and outcomes are monitored. Limitations: • The limitations of the study are that the researcher completely relied on patient records. • The sample size for HCPs was very small and therefore the study results cannot be generalised. / HWSETA

Type 2 diabetes is a chronic metabolic disorder and the seventh leading cause of death in the United States. Type 2 diabetes is linked to many chronic diseases, including cardiovascular disease, stroke, and chronic kidney failure. African American adults have a high prevalence of Type 2 diabetes with early onset of diabetes complications. Poor dietary behavior is the primary cause of Type 2 diabetes and its complications, changing dietary behaviors can prevent the onset of diabetes complications or impede existing ones. The purpose of this phenomenological study was to explore patients' perceptions of diet-only therapy in the prevention of diabetes complications. Face-to-face interviews were conducted with six African American adults with Type 2 diabetes between 40 to 64 years using purposeful sampling method. Health belief model formed the conceptual framework of the study. I applied inductive coding process and manually analyze data for themes. Participants expressed fear of diabetes complications, acknowledged effectiveness of dietary therapy, physician communication and strong family support in Type 2 diabetes management. Findings can produce positive social change among African American adults with type 2 diabetes. Patients can be motivated to change their dietary behaviors to prevent disability and death from diabetes complications. Adherence to diet can reduce medical costs associated with Type 2 diabetes and its complications at the individual, family, community, and government levels. Health care providers can apply the findings in their interactions with patients to provide a more patient-centered education that integrates patients' cultural and dietary preferences to facilitate adoption of dietary interventions and long-term adherence.