Division of Nephrology Department of Internal Medicine School of Clinical Medicine Faculty of Health Sciences University of Witwatersrand 7th June, 2017 / Objective Renal transplantation is the ideal therapeutic option for patients that reach end-stage renal failure. However, patients require long term immunosuppression following surgical transplantation to prevent graft rejection [1,2,4]. Mycophenolate mofetil (MMF) had proven to be an effective immunosuppressant in transplant patients[8,9,10], although it is associated with an increase in gastrointestinal adverse effects, which may result in dose adjustment or termination of use [22]. There is a paucity of data regarding gastrointestinal side effects of MMF in South Africa. This study attempts to describe the incidence of gastrointestinal complications, incidence of dose adjustment and discontinuation of MMF due to side effects, to compare the incidence of GI complications between those that had prior gastrointestinal ailments and those that had no prior gastrointestinal ailments and finally to determine possible risk factors (age, gender, ethnicity, donor type, pre-transplant GI diagnosis, pre-transplant diabetes and combination of MMF with tacrolimus) of gastrointestinal adverse effects. Method Data was collected retrospectively from the file records of the renal transplant unit at CMJAH (Charlotte Maxeke Johannesburg Academic Hospital) on adult patients who had received kidney transplants between 1998 and 2010 and who had received MMF as part of the immunosuppressive regimen for at least the one year post-transplant. Relevant data was captured in an anonymous fashion on a collection sheet. Descriptive analysis of the data was carried out. Time-to-event data were analysed by Kaplan-Meier survival analysis. The assessment of the effect of prior gastrointestinal ailments, as well as risk factors, was carried out by Cox Proportional Hazards regression to estimate the Hazard Ratios. Results A total of 188 patients were included in the study group, which comprised 65.4% males and 32.4% females (2.1% missing data). The mean age at transplant was 38.1 years. The patients were predominantly black (69.1%). Donors were predominantly deceased donors. Of the 24.5% of donors who were living donors, 76.1% were related living donors, while the rest were non-related living donors. The majority of patients (82%) were induced with MMF dose of 2 grams per day. After 5 years, 13.8% of patients discontinued MMF while 86.2% of the patients were still on MMF. 48.1% had a dose adjustment due to gastrointestinal side effects. 61% of patients had had a diarrhoeal adverse event by 5 years. 21.8% of the patients had gastrointestinal side effects other than diarrhoea by 5 years. The combination of tacrolimus and MMF was found to be a significant risk factor for diarrhoeal adverse events (Hazard Ratio 1.82; 95% CI 1.21-2.73). Having a living donor graft reduced the chance of non-diarrhoeal gastrointestinal adverse event (Hazard Ratio 0.33; 95% CI 0.13-0.84, p<0.02). A trend towards significance was seen in living donors having less diarrhoeal events although it did not reach statistical significance (Hazard Ratio 1.32; 95% CI 0.87-2.00, p=0.20). Conclusion As far as the authors are aware, this is the first local study on MMF and GIT adverse effect. We found the combination of MMF and tacrolimus is associated with increased risk of having diarrhoeal adverse events, which is consistent with international data[34,35]. Living donor graft is associated with a lower risk of developing non-diarrhoeal gastrointestinal events. Although non-significant, data suggest the same trend favoring living donor graft with regards to diarrhoeal events. / MT2017

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master or Medicine in the branch of Paediatrics Johannesburg, 2015 / Malnutrition and diarrhoea are major causes of childhood morbidity and mortality in the developing world. Lactose malabsorption has been associated with diarrhoea in malnourished children, but they are often managed with lactose containing feeds. This study quantified the prevalence of lactose malabsorption in children with severe acute malnutrition (SAM) and diarrhoea admitted to an urban South African hospital. Sixty-three Children with SAM and diarrhoea were included in the study and had their stool tested for reducing substances using the Benedict’s test. Fifty-nine percent had stool positive for reducing substances (≥0.5g%). After multivariate analysis, age of <12 months was the only factor found to significantly predict positive reducing substances (LR 4, p=0.046). Death was 4 times more likely in children with positive reducing substances (p=0.035). The role of lactose free feeds in children with SAM and diarrhoea has not been adequately explored.

Lactose intolerance is a common and inconvenient medical condition and can cause severe discomfort. People who experience lactose intolerance often take lactase enzyme supplements when they wish to consume dairy products. As a consequence, they normally consume dairy products that are rendered lactose free or else a lactase enzyme supplement is taken concurrently. Normally, these are pills or tablets that dissolve and release the enzyme in the stomach. However, the enzyme may be denatured in the low pH conditions of stomach. Hence, a higher dose is required to ensure that an effective concentration can survive and pass into the small intestine - the site of the enzyme ' s physiological action. This problem is being addressed by microencapsulation methods : surrounding the enzyme with protective materials in the form of small particles. These protect the enzyme in the stomach and allow release in the small intestine. The goal of this research was to investigate an appropriate microencapsulation method for this purpose. An oil - in - oil solvent evaporation method was used to produce microparticles containing BSA protein with a EUDRAGIT S 100 - methacrylic acid and methyl methacrylate copolymer. BSA was used as a cost - effective surrogate for lactase during the research. Sonification was employed during the emulsification step. The microparticles produced at different sonication amplitudes or power outputs were uniform with similar morphologies, typically spheres. Microparticle size decreased with sonicator energy output from 120 µ m to 12 µ m as the amplitude changed from 40 % to 70 %. The encapsulation efficiency at amplitude levels of 50 %, 60 % and 70 % was between 70 % and 80 %. However, the encapsulation efficiency recorded at the 40 % setting was much lower, around 40 %. The release profiles of those microparticles were studied at different pH. There was a slight leakage from the microparticles at low pH. Above pH 7, total release was achieved within 2 hours. The results of this research confirm that the microparticles could encapsulate lactase as part of a treatment of lactose intolerance. / Thesis (M.App.Sc.)--School of Chemical Engineering, 2005.

Thesis (M.App.Sc.)--University of Adelaide, School of Chemical Engineering, 2006. / "November 2005". Bibliography: leaves 64-69. Also available in print form.

Thesis (Ed. D.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains vi, 70 p. Includes abstract. Includes bibliographical references (p. 65-70).

Background Lactose intolerance is a common condition which individuals are not able to completely digest lactose. Each individual has varying degree of lactose intolerance varying level of symptoms experienced. Due to the symptoms of lactose intolerance, lactose intolerant individuals are likely to eliminate milk and dairy products from their diet. Actually, milk and other dairy products are the preferred food sources of calcium for most people. It is essential to maintain adequate calcium intake everyday for the proper growth and development of bones. Individuals who avoid milk and dairy products from diet may not meet the daily requirements for calcium. Therefore, the lactose intolerant individuals are at a higher risk of osteoporosis. Calcium supplementations are an alternative source of calcium for lactose intolerant individuals who have low calcium intake to meet their daily needs. Objectives This review is to assess the impacts and effect of calcium supplements on bone density and bone fracture risk in lactose intolerant individuals. Methodology HKU library database, PubMed, and reference screening for trials published in English from 1990 to May 2014. Randomized, controlled trials of individuals using calcium supplements (calcium carbonate and calcium citrate malate) and placebo group with bone fractures and bone mass density as outcome measure. Finding Adding calcium supplements into a low calcium diet reduces the rate of bone loss and prevents bone fractures. Evidence for calcium supplements in significant reduction of bone mass density; however, the impact of calcium supplements on bone fracture risk remains unclear. Conclusion Based on my review, it shows that there is an association between the use of calcium supplementations and retardation of the rate of bone loss as well as reduction in bone fracture risk in individuals with low dietary calcium and are generally compliance with the treatment. To get enough calcium through diet is encouraged over calcium supplements. / published_or_final_version / Public Health / Master / Master of Public Health

Abstract Primary lactose intolerance has been associated with a single nucleotide polymorphism located upstream of the lactase gene. The most common diagnostic tests for lactose intolerance are time-consuming and the patient is not allowed to eat and drink for 12 hours before the test is carried out. A method that can establish the genotype would be an easier way of diagnosing lactose intolerance compared to fenotypic lactose intolerance tests. Optimization and validation of a previously published method was performed with real-time polymerase chain reaction. We used whole blood from de-identified blood donors. During the optimization and validation we used a positive control, genotype C/T from Laboratoriemedicin Västernorrland, Sundsvall. The whole-blood was extracted using the MagNa Pure LC instrument. The reagent used was KAPA PROBE FAST qPCR Master Mix. The optimized program for real-time PCR was established to be 95°C 3min [95°C x 3sec, 55°C x 20sec, detection, 72°C x 15sec] x 50 cycles. Optimal probe concentration was found to be 0.2µM and primer concentration will be 0.5µM. This genotyping method is a good first-stage screening test for lactoseintolerance. Before it can be used as a routine method further validation will be necessary in order to ensure that the evaluation of the results can be done in an easy and secure way.

No description available.

O soro de leite é uma importante fonte de proteínas. Porém, no Brasil ainda há um grande número de laticínios que realizam o descarte deste subproduto da fabricação de queijos, gerando assim, desperdícios e um problema socioambiental. A busca por novas aplicações ao soro de leite pode aumentar o uso potencial deste subproduto como ingrediente lácteo em diversos alimentos. Este trabalho teve como objetivo a hidrólise da lactose do concentrado proteico de soro de leite (CPS) para aplicação como ingrediente lácteo em iogurte cremoso para intolerantes à lactose. A metodologia de superfície de resposta foi utilizada para investigar o efeito de dois parâmetros (tempo e concentração de enzima) na hidrólise da lactose do CPS e do leite para produção de iogurte com redução de lactose. A experimentação teve como objetivo definir as faixas ótimas de operação para as variáveis do processo, visando à maximização da hidrólise da lactose. As condições ótimas para a hidrólise da lactose foram: para o CPS, concentração de enzima 0,22% por 1680 minutos e para o leite, 0,13% de enzima por 120 minutos. Depois de hidrolisado, o CPS foi submetido à secagem por atomização e apresentou os valores de lactose, glicose, galactose e proteínas iguais a 2,98; 19,41; 15,89 e 36,7g. 100 g-1 de amostra, respectivamente; 5,00% de umidade e 8,06% de cinzas. Após a hidrólise, as amostras de leite foram fortificadas com diferentes concentrações de CPS e leite em pó desnatado (LPD) para produção de iogurte cremoso. A amostra controle e as amostras fortificadas com 2 e 4% de CPS apresentaram os menores valores de lactose: 0,05; 0,09 e 0,13 g. 100 g-1 de iogurte, respectivamente. Foram realizadas análises microbiológicas e físico-químicas no CPS em pó e nas amostras de iogurtes, e ambos estavam dentro dos padrões da legislação vigente. A partir da pesquisa, verificou-se ser possível o uso potencial do CPS hidrolisado na produção de iogurte com baixo teor de lactose, beneficiando os intolerantes à lactose, à indústria e o meio ambiente.

O soro de leite é uma importante fonte de proteínas. Porém, no Brasil ainda há um grande número de laticínios que realizam o descarte deste subproduto da fabricação de queijos, gerando assim, desperdícios e um problema socioambiental. A busca por novas aplicações ao soro de leite pode aumentar o uso potencial deste subproduto como ingrediente lácteo em diversos alimentos. Este trabalho teve como objetivo a hidrólise da lactose do concentrado proteico de soro de leite (CPS) para aplicação como ingrediente lácteo em iogurte cremoso para intolerantes à lactose. A metodologia de superfície de resposta foi utilizada para investigar o efeito de dois parâmetros (tempo e concentração de enzima) na hidrólise da lactose do CPS e do leite para produção de iogurte com redução de lactose. A experimentação teve como objetivo definir as faixas ótimas de operação para as variáveis do processo, visando à maximização da hidrólise da lactose. As condições ótimas para a hidrólise da lactose foram: para o CPS, concentração de enzima 0,22% por 1680 minutos e para o leite, 0,13% de enzima por 120 minutos. Depois de hidrolisado, o CPS foi submetido à secagem por atomização e apresentou os valores de lactose, glicose, galactose e proteínas iguais a 2,98; 19,41; 15,89 e 36,7g. 100 g-1 de amostra, respectivamente; 5,00% de umidade e 8,06% de cinzas. Após a hidrólise, as amostras de leite foram fortificadas com diferentes concentrações de CPS e leite em pó desnatado (LPD) para produção de iogurte cremoso. A amostra controle e as amostras fortificadas com 2 e 4% de CPS apresentaram os menores valores de lactose: 0,05; 0,09 e 0,13 g. 100 g-1 de iogurte, respectivamente. Foram realizadas análises microbiológicas e físico-químicas no CPS em pó e nas amostras de iogurtes, e ambos estavam dentro dos padrões da legislação vigente. A partir da pesquisa, verificou-se ser possível o uso potencial do CPS hidrolisado na produção de iogurte com baixo teor de lactose, beneficiando os intolerantes à lactose, à indústria e o meio ambiente.