Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study

Background: Adrenomedullin (ADM) regulates vascular tone and endothelial permeability during sepsis. Levels of circulating biologically active ADM (bio-ADM) show an inverse relationship with blood pressure and a direct relationship with vasopressor requirement. In the present prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock 1 (, AdrenOSS-1) study, we assessed relationships between circulating bio-ADM during the initial intensive care unit (ICU) stay and short-term outcome in order to eventually design a biomarker-guided randomized controlled trial. Methods: AdrenOSS-1 was a prospective observational multinational study. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use, and need for renal replacement therapy. AdrenOSS-1 included 583 patients admitted to the ICU with sepsis or septic shock. Results: Circulating bio-ADM levels were measured upon admission and at day 2. Median bio-ADM concentration upon admission was 80.5 pg/ml [IQR 41.5-148.1 pg/ml]. Initial SOFA score was 7 [IQR 5-10], and 28-day mortality was 22%. We found marked associations between bio-ADM upon admission and 28-day mortality (unadjusted standardized HR 2.3 [CI 1.9-2.9]; adjusted HR 1.6 [CI 1.1-2.5]) and between bio-ADM levels and SOFA score (p < 0.0001). Need of vasopressor/inotrope, renal replacement therapy, and positive fluid balance were more prevalent in patients with a bio-ADM > 70 pg/ml upon admission than in those with bio-ADM ≤ 70 pg/ml. In patients with bio-ADM > 70 pg/ml upon admission, decrease in bio-ADM below 70 pg/ml at day 2 was associated with recovery of organ function at day 7 and better 28-day outcome (9.5% mortality). By contrast, persistently elevated bio-ADM at day 2 was associated with prolonged organ dysfunction and high 28-day mortality (38.1% mortality, HR 4.9, 95% CI 2.5-9.8). Conclusions: AdrenOSS-1 shows that early levels and rapid changes in bio-ADM estimate short-term outcome in sepsis and septic shock. These data are the backbone of the design of the biomarker-guided AdrenOSS-2 trial. Trial registration: ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015

An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans

Human, animal, and in vitro research indicates a beneficial effect of appropriate amounts of omega-3 (n-3) polyunsaturated fatty acids (PUFA) on bone health. This is the first controlled feeding study in humans to evaluate the effect of dietary plant-derived n-3 PUFA on bone turnover, assessed by serum concentrations of N-telopeptides (NTx) and bone-specific alkaline phosphatase (BSAP). Subjects (n = 23) consumed each diet for 6 weeks in a randomized, 3-period crossover design: 1) Average American Diet (AAD; [34% total fat, 13% saturated fatty acids (SFA), 13% monounsaturated fatty acids (MUFA), 9% PUFA (7.7% LA, 0.8% ALA)]), 2) Linoleic Acid Diet (LA; [37% total fat, 9% SFA, 12% MUFA, 16% PUFA (12.6% LA, 3.6% ALA)]), and 3) α-Linolenic Acid Diet (ALA; [38% total fat, 8% SFA, 12% MUFA, 17% PUFA (10.5% LA, 6.5% ALA)]). Walnuts and flaxseed oil were the predominant sources of ALA. NTx levels were significantly lower following the ALA diet (13.20 ± 1.21 nM BCE), relative to the AAD (15.59 ± 1.21 nM BCE) (p < 0.05). Mean NTx level following the LA diet was 13.80 ± 1.21 nM BCE. There was no change in levels of BSAP across the three diets. Concentrations of NTx were positively correlated with the pro-inflammatory cytokine TNFα for all three diets. The results indicate that plant sources of dietary n-3 PUFA may have a protective effect on bone metabolism via a decrease in bone resorption in the presence of consistent levels of bone formation

Klinies-fisiologiese parameters vir die evaluering van femurnek-frakture

Proefskrif (Ph.D. Med.) -- Universiteit van Stellenbosch, 1985.Een kopie mikrofiche.Full text to be digitised and attached to bibliographic record

Delegering as noodsaaklike komponent van effektiewe skoolhoofskap : 'n onderwysadministratiewe beskouing

Gevorderde werkstuk (M. Ed.) -- Universiteit van Stellenbosch, 1986.Full text to be digitised and attached to bibliographic record

The clinical significance of phospholipids in lung pathology

The original publication is available at http://www.samj.org.zaCITATION: Van Papendorp, D. H. & Engelbrecht, F. M. 1981. Die kliniese belang van fosfolipiede longpatologie. South African Medical Journal, 60:176-180.The phospholipid composition of 35 human lungs with pathological lesions was analysed by means of thin-layer chromatography and densitometric scanning. The pathological conditions studied were: bronchopneumonia, myocardial infarction, chronic heart failure, chronic obstructive airway disease and tuberculosis. The phospholipid composition was compared with that of a control group consisting of sudden death cases (due to unnatural causes), i.e. relatively normal lungs. The phospholipid composition of the lungs in a specific pathological group showed the same pattern. However, significant differences were observed between corresponding phospholipid fractions from lungs in the various pathological groups. Compared with the lipid fractions from relatively normal lungs, these differences were even more marked. From the results it would appear that the abnormal composition of the phosholipid fractions might possibly be a cause of lung pathology. The increase and/or decrease in individual fractions and abnormal ratios between fractions might indicate abnormalities in the biosynthesis and catabolism of the lung phospholipids. Further research is necessary to elucidate the association of phospholipids with lung pathology. Phospholipid analysis of lung lavages and lung biopsies could be helpful in the diagnosis of lung diseases. Phospholipids in aerosol form could perhaps be used in treating certain lung disorders.Publisher’s versio

Beleidsontleding met ekonometriese modelle en die Lucas-kritiek

Tesis (M. Com.) -- Universiteit van Stellenbosch, 1992.Een kopie mikrofiche.Full text to be digitised and attached to bibliographic record

Report: The student health services at the University of Pretoria from 2000 to 2005

The University of Pretoria's Student Health Services provides free, voluntary, family-medicine-orientated health services with an emphasis on offering preventative medicine and health education to enrolled students. Students are examined and/or educated by skilled personnel familiar with the University's environment and demands. Apart from the family medicine services, the Student Health Services also educates students concerning contraception and sexually-transmitted diseases, carries out HIV/AIDS counselling and provides a comprehensive dietetic service. During the period 2000 to 2005 the percentage of students visiting the Student Health Services, of the total number of students enrolled at the University, remained almost constant at 12.5%. A large percentage of the students making use of these services do belong to a medical aid and it is estimated that during the past six years the University of Pretoria has subsidised an amount of about R2.4 million towards the medical costs of students belonging to a medical aid. Keywords: Student Health Services; University of Pretoria Health SA Gesondheid Vol. 12 (1) 2007: pp. 48-5

The student health services at the University of Pretoria from 2000 to 2005

The University of Pretoria’s Student Health Services provides free, voluntary, family-medicine-orientated health services with an emphasis on offering preventative medicine and health education to enrolled students. ABSTRAK Die Universiteit van Pretoria se Gesondheidsdienste voorsien gratis, vrywillige gesins-medisyne-georiënteerde gesondheidsdienste met die klem op voorkomende medisyne en gesondheidsopvoeding aan ingeskrewe studente