Background: The 4-variable Modification of Diet in Renal Disease (4-v MDRD) and Cockcroft-Gault (CG) equations are commonly used for estimating glomerular filtration rate (GFR); however, neither of these equations has been validated in an indigenous African population. The aim of this study was to evaluate the performance of the 4-v MDRD and CG equations for estimating GFR in black South Africans against measured GFR and to assess the appropriateness for the local population of the ethnicity factor established for African Americans in the 4-v MDRD equation. Methods: We enrolled 100 patients in the study. The plasma clearance of chromium-51–EDTA (51Cr-EDTA) was used to measure GFR, and serum creatinine was measured using an isotope dilution mass spectrometry (IDMS) traceable assay. We estimated GFR using both the reexpressed 4-v MDRD and CG equations and compared it to measured GFR using 4 modalities: correlation coefficient, weighted Deming regression analysis, percentage bias, and proportion of estimated GFR within 30% of measured GFR (P30). Results: The Spearman correlation coefficient between measured and estimated GFR for both equations was similar (4-v MDRD R2 = 0.80 and CG R2 = 0.79). Using the 4-v MDRD equation with the ethnicity factor of 1.212 as established for African Americans resulted in a median positive bias of 13.1 (95% CI 5.5 to 18.3) mL/min/1.73 m2. Without the ethnicity factor, median bias was 1.9 (95% CI −0.8 to 4.5) mL/min/1.73 m2. Conclusions: The 4-v MDRD equation, without the ethnicity factor of 1.212, can be used for estimating GFR in black South Africans.

One or more, high-quality single visit nurse-recorded auscultatory BP measurements may be equally as effective as ambulatory BP in predicting target organ damage in a population sample of African ancestry.

Primary dysmenorrhea is characterized by painful uterine cramps, near and during menstruation, that have an impact on personal life and productivity. The effect on sleep of this recurring pain has not been established. We compared sleep, nocturnal body temperatures, and hormone profiles during the menstrual cycle of 10 young women who suffered from primary dysmenorrhea, without any menstrual-associated mood disturbances, and 8 women who had normal menstrual cycles. Dysmenorrheic pain significantly decreased subjective sleep quality, sleep efficiency, and rapid eye movement (REM) sleep but not slow wave sleep (SWS), compared with pain-free phases of the menstrual cycle and compared with the controls. Even before menstruation, in the absence of pain, the women with dysmenorrhea had different sleep patterns, nocturnal body temperatures, and hormone levels compared with the controls. In the mid-follicular, mid-luteal, and menstrual phases, the dysmenorrheics had elevated morning estrogen concentrations, higher mean in-bed temperatures, and less REM sleep compared with the controls, as well as higher luteal phase prolactin levels. Both groups of women had less REM sleep when their body temperatures were high during the luteal and menstrual phases, implying that REM sleep is sensitive to elevated body temperatures. We have shown that dysmenorrhea is not only a disorder of menstruation but is manifest throughout the menstrual cycle. Furthermore, dysmenorrheic pain disturbs sleep, which may exacerbate the effect of the pain on daytime functioning.

Objectives To determine the effect of postnatal administration of the long-acting progestogen contraceptive, norethisterone enanthate, on postnatal depression and on serum hormone concentrations, and their association with depression.Design Double-blind randomised placebo-controlled trial.Setting A tertiary care hospital in Johannesburg, South Africa.Population Postnatal women using a non-hormonal method of contraception (n = 180). Methods Random allocation within 48 hours of delivery to norethisterone enanthate by injection, or placebo.Main outcome measures 1. Depression scores in the three months postpartum as rated by the Montgomery-hberg Depression Rating Scale (MADRS) and the Edinburgh Postnatal Depression Scale (EPDS); 2. serum 17P-oestradiol, progesterone, testosterone and the 17P-oestradio1:progesterone ratio at six weeks postpartum.Results There was a chance excess of caesarean section deliveries in the progestogen group. Mean depression scores were significantly higher in the progestogen group than in the placebo group at six weeks postpartum (mean MADRS score 8.3 vs 4.9; P = 0.01 11; mean EPDS score 10.6 vs 7.5; P = 0.0022). Mean serum 17P-oestradiol and progesterone concentrations were significantly lower in the progestogen group compared with the placebo group at six weeks postpartum. There were no correlations between any of the hormone parameters and depression at six weeks except in the formula feeding subgroup of the placebo group, where formula feeding and 17P-oestradiol concentrations were positively associated with depression.Conclusions Long-acting norethisterone enanthate given within 48 hours of delivery is associated with an increased risk of developing postnatal depression and causes suppression of endogenous ovarian hormone secretion.

No abstract

In this study, S-Cys C-based prediction equations appear to be more precise than those of S-Cr for those patients with mGFR > 60 mL/min/1.73 m(2) and may therefore be of benefit in the earlier detection of renal impairment.

Porphyria cutanea tarda is a skin disease caused by photosensitization by porphyrins whose accumulation is caused by deficiency of hepatic uroporphyrin- ogen decarboxylase activity. Mutations in the uroporphyrinogen decarboxylase gene are present in the low-penetrant, autosomal dominant familial form but not in the commoner sporadic form of porphyria cutanea tarda. We have investigated the relationship between age of onset of skin lesions and mutations (C282Y, H63D) in the hemochromatosis gene in familial (19 patients) and sporadic porphyria cutanea tarda (65 patients). Familial porphyria cutanea tarda was identified by mutational analysis of the uroporphyrinogen decarboxylase gene. Five previously described and eight novel mutations (A80S, R144P, L216Q, E218K, L282R, G303S, 402-403delGT, IVS2 + 2 delTAA) were identified. Homozygosity for the C282Y hemochromatosis mutation was associated with an earlier onset of skin lesions in both familial and sporadic porphyria cutanea tarda, the effect being more marked in familial porphyria cutanea tarda where anticipation was demonstrated in family studies. Analysis of the frequencies of hemochromatosis genotypes in each type of porphyria cutanea tarda indicated that C282Y homozygosity is an important susceptibility factor in both types but suggested that heterozygosity for this mutation has much less effect on the development of the disease.

Abstract-In high-Na ϩ , low-K ϩ diets, which suppress renin release in salt-sensitive groups, the mechanisms maintaining increases in renin-angiotensin-aldosterone system activation downstream from renin and renin-angiotensin-aldosterone system-induced effects on blood pressure (BP) are uncertain. Whether circulating angiotensinogen concentrations (AGT) or its determinants may contribute to maintaining serum aldosterone concentrations (aldosterone) and increases in BP on high-Na ϩ , low-K ϩ diets was evaluated in 579 participants of a community sample of African ancestry. Plasma renin concentrations were inversely related to BP (PϽ0.0001) and an index of salt intake (24-hour urinary Na ϩ /K ϩ , PϽ0.0001). An interaction between AGT and urinary Na ϩ /K ϩ was independently associated with aldosterone (PϽ0.001) and systolic BP (SBP; PϽ0.05). Independent of confounders, in participants with urinary Na ϩ /K ϩ at or more than the median for the sample, AGT was positively associated with aldosterone (PϽ0.0001) and SBP (PϽ0.005). No independent AGT-aldosterone or AGT-SBP relationships were noted in participants with urinary Na ϩ /K ϩ less than the median for the sample. Standardized ␤-coefficients (slopes) of AGT-aldosterone and AGT-SBP relationships were greater in participants with urinary Na ϩ /K ϩ at or more than the median (AGT-aldosteroneϭ0.30Ϯ0.06, AGT-SBPϭ0.16Ϯ0.05) compared with those with urinary Na ϩ /K ϩ less than the median (AGT-aldosteroneϭϪ0.04Ϯ0.06; AGT-SBPϭϪ0.03Ϯ0.05; PϽ0.01-0.0001 for comparison of slopes). The AGT-SBP relationship in participants with urinary Na ϩ /K ϩ at or more than the median for the sample was equivalent to the relationship between body mass index and BP. In conclusion, in participants of African ancestry, in the presence of high-Na ϩ , low-K ϩ diets, which suppress renin release, renin-angiotensin-aldosterone system activation and its impact on BP are maintained in part by AGT. (Hypertension. 2012;59:62-69.) • Online Data Supplement Key Words: renin-angiotensin-aldosterone system Ⅲ salt intake Ⅲ angiotensinogen D espite the well-recognized role of the renin-angiotensinaldosterone system (RAAS) in blood pressure (BP) control, high-sodium (Na ϩ ), low-potassium (K ϩ ) diets in salt-sensitive populations suppress renin release. [1][2][3][4] Consequently, RAAS blockers may not produce beneficial effects on BP in salt-sensitive populations, such as those of African ancestry, 5,6 and despite the benefits that may accrue from RAAS blockers, 7-9 they are not recommended as first-line therapy in these groups. 10,11 Nonetheless, despite a low renin state, populations of African ancestry tend to have a disproportionately high prevalence of end-organ damage, 12,13 and in previous studies conducted in groups of African ancestry, a somewhat perplexing dissociation exists between a low renin status and relatively higher aldosterone concentrations. 14 Indeed, in low renin states in salt-sensitive individuals, reductions in plasma aldosterone concentrations may be less than those predicted from t...