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- Volume 15, Issue 1, 2010
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 15, Issue 1, 2010
Volume 15, Issue 1, 2010
Author Aslam AmodSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less
The Society of Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) was inaugurated in 1959, and is arguably the oldest medical society in South Africa. The annual SEMDSA congress started in 1966. On behalf of the SEMDSA Local Organising Committee (LOC) it is my pleasure to welcome you to our 45th Annual Congress at the Southern Sun Elangeni Hotelin Durban. The year 2010 will undoubtedly be remembered for the FIFA World Cup but we hope that our congress will leave an equally indelible memory for all of you. To this end we are delighted to have a host of world-renowned international speakers who are at the pinnacle of their ''game''. The John Terry, Fernando Torres and Cristiano Ronaldo of the ''endocrinology world'' are Professors David Matthews from the Oxford Centre for Diabetes Endocrinology & Metabolism, Kenneth Polonsky from Washington University School of Medicine and Paul Stewart from Birmingham. They certainly need no introduction to our society.
Author Amanda WentSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less
The primary role of the diabetes educator is to safely bridge the gap, between the patient with diabetes who stands on the side doing nothing, and that same patient who now climbs on the train, to a new way of living, with a new mind set and appropriately empowered to utilise all of the resources available.
Author D.J. BlomSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 11 –17 (2010)More Less
The bulk of plasma triglycerides are carried by chylomicrons in the fed and very low-density lipoproteins in the fasted state. These triglyceriderich lipoproteins are metabolised to remnant lipoproteins by lipoprotein lipase (LPL). Hypertriglyceridaemia results if triglyceride-rich lipoproteins accumulate either due to defective clearance, overproduction or a combination of both mechanisms. Genetic and environmental factors interact in the genesis of hypertriglyceridaemia but occasionally a single factor may be dominant. At a molecular level the most common cause of severe primary hypertriglyceridaemia is loss of function mutations in both alleles of LPL. The most common environmental contributors include diabetes, diet, alcohol and medications (including oestrogen, steroids, retinoids and protease inhibitors). Severe hypertriglyceridaemia can trigger acute pancreatitis while mild to moderate hypertriglyceridaemia is an independent cardiovascular risk factor. Treatment strategies are determined by the severity and aetiology of hypertriglyceridaemia as well as the patient's cardiovascular risk profile. General strategies include lifestyle modifications with restriction of dietary fat intake, cessation of alcohol intake and increased exercise. Contributing metabolic disorders should be controlled and aggravating medications withdrawn or reduced where possible. Moderate hypertriglyceridaemia may be treated with high doses of omega-3 fatty acids (4 g/day), fibrates, niacin or statins. Fibrates are the agents of choice in severe hypertriglyceridaemia.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 31 –35 (2010)More Less
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 36 –41 (2010)More Less
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 42 –44 (2010)More Less
Obesity, which is described clinically by a body mass index (BMI) of > 30 kg/m2 is increasing at an alarming rate, and is recognised as a chronic disease by the World Health Organization (WHO). This epidemic decreases life expectancy, and its prevalence is increasing within the global paediatric and adult populations in most African countries, South Africa included. Research has revealed the importance of the genetic component of obesity, with much emphasis to date having been placed on monogenic disease. Polymorphisms within the gene encoding for the melanocortin-4 receptor (MC4R), a hypothalamic receptor with the primary function of regulating food intake, are a significant cause of severe human obesity. Studies have shown a correlation between the degree of MC4R dysfunction and the severity and age of onset of obesity. The accepted mode of inheritance for MC4R mutations is co-dominance with modulation of penetrance and expressivity, which would explain why homozygous carriers are more obese than heterozygotes. MC4R mutation frequency is also dependent on the ethnicity of the population. The use of genetic markers for diagnostic strategies and as predictors of therapeutic outcome will be of importance in the future management of obesity.
Author M. YoungSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 45 –47 (2010)More Less
Motivational Interviewing (MI) is designed to motivate people to change by helping them to recognise and resolve the difference between a behaviour problem and personal goals and values. There are several challenges of health behaviour change in MI, as well as traps that the health care provider and patient can easily fall into. During the MI approach, a patient should be guided through the change model, providing him the chance to participate. There are several general principles in the MI approach as well as different interaction techniques. The efficacy of MI has been widely published in the literature.
Author M.R. DaveySource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 49 –51 (2010)More Less
The concerns raised by the findings of the Women's Health Initiative study resulted in many practitioners no longer considering the use of menopausal hormone therapy for the treatment of osteoporosis. Subsequent re-analyses of this study, recent publications on the use of lower doses and different modes of delivery of hormone therapy, and data suggesting that certain women will receive longer-term fracture prevention even with short-term use have resulted in a reappraisal of the use of oestrogen and oestrogen plus progestin therapy for the prevention and treatment of osteoporosis. These issues are discussed, and based on these more recent analyses it is suggested that menopausal hormone therapy could still be considered a first-line option for osteoporosis prevention and treatment in certain patients.
Serum resistin levels in nonalcoholic fatty liver disease and their relationship to severity of liver disease : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 53 –56 (2010)More Less
Background: Resistin is a hormone that is linked to the development of insulin resistance (IR), but information on the direct relationship of resistin levels in humans with nonalcoholic fatty liver disease (NAFLD), and their effect on the histological severity of NAFLD, is lacking.
Objective: The aim of the current study is to determine the circulating resistin levels obtained from patients with NAFLD and to correlate them with insulin resistance and hepatic histological features.
Methods: Blood samples were collected from 30 consecutive patients with liver-biopsy-proven NAFLD and 30 subjects as controls. Serum resistin levels were measured. Body mass index (BMI) was calculated for all subjects, and serum insulin, C-peptide, and lipoprotein levels were also measured.
Results: Mean serum resistin level and BMI in the NAFLD group were significantly higher than in the controls (both P < 0.001). Both men and women in the NAFLD group had higher mean serum resistin levels than did the men and women in the control group (all P < 0.001). Multivariate analysis showed that the percentage of hepatic steatosis, sex, BMI, and homeostasis model assessment of insulin resistance [HOMA(IR)] were related to serum resistin levels.
Conclusion: These data suggest increased resistin levels in NAFLD patients which are related to histological severity of the disease. These findings support the link between resistin, insulin resistance and BMI in these patients.