Renal outcome of type 2 diabetes in South Africa - a 12-year follow-up study

Aims. Previous studies of type 2 diabetes mellitus have indicated a benign renal outcome after long-term  follow-up. The aim of this study was to determine how often renal failure due to diabetic nephropathy was  a cause of death in patients with type 2 diabetes.Methods. Prospective observational study of 59 South African patients with type 2 diabetes over a 12-year period. During the study repeated clinical evaluations were accompanied by measurements of serum creatinine, serum cholesterol, random blood sugar, and urine protein/ creatinine ratios.Results. The mean duration of diabetes at the end of the study was 17.8 years. There was a wide variation in the time from clinical diagnosis of diabetes to macroprQteinuria (mean 9.7 years, SD 5.9, range 0- 21) and the rate of deterioration of renal function. This rate correlated with poor control of blood pressure, a glucose level of> 14 mmol/1, heavy proteinuria, a high retinopathy score, a body mass index of < 28 and the number of pack years of smoking. At the end of the study 47 patients (79.7%) had died. Of these deaths 17 (28.8%) were due to chronic renal failure.Conclusions. In contrast to other studies we have shown that in a developing country renal failure in  type 2 diabetic patients is a major cause of death. Determining the prognosis for an individual patient is difficult as there are wide ranges in the time of onset of proteinuria, the rise in serum creatinine and the time to ultimate progression to end-stage renal failure

Lost & Found Dark Matter in Elliptical Galaxies

There is strong evidence that the mass in the Universe is dominated by dark matter, which exerts gravitational attraction but whose exact nature is unknown. In particular, all galaxies are believed to be embedded in massive haloes of dark matter. This view has recently been challenged by surprisingly low random stellar velocities in the outskirts of ordinary elliptical galaxies, which were interpreted as indicating a lack of dark matter (Mendez et al. 2001; Romanowsky et al. 2003). Here we show that the low velocities are in fact compatible with galaxy formation in dark-matter haloes. Using numerical simulations of disc-galaxy mergers, we find that the stellar orbits in the outer regions of the resulting ellipticals are very elongated. These stars were torn by tidal forces from their original galaxies during the first close passage and put on outgoing trajectories. The elongated orbits, combined with the steeply falling density profile of the observed tracers, explain the observed low velocities even in the presence of large amounts of dark matter. Projection effects when viewing a triaxial elliptical can lead to even lower observed velocities along certain lines of sight.Comment: Letter to Nature, 13+15 pages, 2+11 figures, improved text, extended Supplementary Information adde

The Formation of the First Massive Black Holes

Supermassive black holes (SMBHs) are common in local galactic nuclei, and SMBHs as massive as several billion solar masses already exist at redshift z=6. These earliest SMBHs may grow by the combination of radiation-pressure-limited accretion and mergers of stellar-mass seed BHs, left behind by the first generation of metal-free stars, or may be formed by more rapid direct collapse of gas in rare special environments where dense gas can accumulate without first fragmenting into stars. This chapter offers a review of these two competing scenarios, as well as some more exotic alternative ideas. It also briefly discusses how the different models may be distinguished in the future by observations with JWST, (e)LISA and other instruments.Comment: 47 pages with 306 references; this review is a chapter in "The First Galaxies - Theoretical Predictions and Observational Clues", Springer Astrophysics and Space Science Library, Eds. T. Wiklind, V. Bromm & B. Mobasher, in pres

Should health care money in South Africa be spent on drotrecogin alfa?

GesondheidswetenskappeInterne GeneeskundePlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected]

Effects of Maternity Care Coordination on Pregnancy Outcomes: Propensity-Weighted Analyses

BACKGROUND: Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination on pregnancy outcomes in North Carolina. METHODS: Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received Maternity Care Coordination (MCC) services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to conventional OLS analyses. RESULTS: The unadjusted preterm birth rate was lower among women who received MCC services (7.0 percent compared to 8.3 percent among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 percentage point reduction in preterm birth risk; p<0.05). MCC services were also associated with lower pregnancy weight gain (p=0.10). No effects of MCC were seen for birthweight. CONCLUSIONS: These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome