Idiopathic hypoparathyroidism in black South Africans

The spectrum of idiopathic hypoparathyroidism in black South Africans is described. Twelve patients were seen over a seven-year period. Major presenting features were tetany in 11, epilepsy in four, congestive cardiac failure in three, cataracts in four, neuropsychiatric disease in two, and basal ganglia calcification in four. Hypocalcaemia and hyperphosphataemia were apparent in all subjects at presentation. Parathyroid hormone levels were absent or inappropriately low in all. Important features highlighted were the long duration of symptoms before diagnosis, the suppression of tetany by treatment with diphenylhydantoin, the association of idiopathic hypoparathyroidism and epilepsy in adults, and the occurrence of reversible cardiac muscle dysfunction.     

Insulin-mediated glucose disposal in black South Africans with essential hypertension

We used the hyperinsulinaemic euglycaemic clamp method to assessinsulin-mediated glucose disposal in ten black South Africanpatients with newlydiagnosed essential hypertension, comparedto ten normotensive controls. The patients were all nonobesewith normal glucose tolerance. Comparisons were made beforeand 12 weeks after treatment with a long-acting ACE inhibitor.The mean glucose disposal (M) and disposal expressed as glucosesensitivity index (M/l) were significantly reduced in the hypertensivesvs. controls (M: 6.8±0.9 vs. 9.7±0.8 mg/kg/min;M1: 7.1±1.0 vs. 12.5±1.7 mg/kg/min/mU/lx100) (p=0.03and 0.01, respectively). Following therapy, M/l increased inthe patients to values not significantly different to thoseof the controls. Insulin resistance is an independent featureof essential hypertension in black South African patients, andis partially corrected by treatment with a long-acting ACE inhibitor.     

Factors affecting behaviours that address HIV risk among black and white South Africans

The aim of this study was to identify factors affecting HIV risk reduction among 150 Black and 150 White South Africans chosen by systematic random sampling. Main outcome measures included sexual behavior and condom use, knowledge about correct condom use, intention of condom use, behavioural norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS health beliefs, and HIV risk behaviour. Bivariate analysis gave positive significant relations among being single, age, HIV/AIDS perceived severity, HIV/AIDS prevention barriers and HIV risk behaviour. Further, bivariate analysis gave negative significant relations among age at onset of puberty, age at first vaginal intercourse, correct condom use knowledge, subjective norms, intention to use condoms and HIV risk behaviour. Regression analysis indicated that for subjective norm to use condoms, less intention for condom use, less condom use knowledge and younger age of first vaginal intercourse were predictive for HIV/AIDS risk behaviour. HIV prevention intervention programmes should include the identified factors and cultural diversity.     

Idiopathic Hypoparathyroidism in Black South Africans

The spectrum of idiopathic hypoparathyroidism in black SouthAfricans is described. Twelve patients were seen over a seven-yearperiod. Major presenting features were tetany in 11, epilepsyin four, congestive cardiac failure in three, cataracts in four,neuropsychiatric disease in two, and basal ganglia calcificationin four. Hypocalcaemia and hyperphosphataemia were apparentin all subjects at presentation. Parathyroid hormone levelswere absent or inappropriately low in all. Important featureshighlighted were the long duration of symptoms before diagnosis,the suppression of tetany by treatment with diphenylhydantoin,the association of idiopathic hypoparathyroidism and epilepsyin adults, and the occurrence of reversible cardiac muscle dysfunction.     

Heightened free radical activity in blacks with chronic pancreatitis at Johannesburg, South Africa

Four indices of free radical activity were measured in fasting serum/plasma samples from 14 consecutive blacks with clinically quiescent chronic pancreatitis and 15 outwardly healthy hospital personnel at Soweto, the township near Johannesburg in South Africa. The patients had higher serum levels than did controls of lipid isomerisation (P < 0.002) and peroxidation (P < 0.05) markers, with lower plasma levels of glutathione (P < 0.0001) and bioactive fraction of vitamin C (P < 0.002). Lipid peroxide and non-bioavailable vitamin C concentrations in Sowetan patients were significantly higher than in their counterparts from Manchester, UK (P < 0.0001, P < 0.0005, respectively). These differences mirrored those in controls in that outwardly healthy Sowetans had much higher serum lipid peroxide levels than Manchester controls (P < 0.001) and much lower plasma concentration of vitamin C (P < 0.001) and hence of the bioavailable fraction ascorbate (P < 0.0002). Heightened free radical activity is thus a common denominator in chronic pancreatitis irrespective of geography, or putative aetiological factors whether alcoholism or idiopathic, since that ratio was approximately 95:5 at Johannesburg and 50:50 at Manchester. The further finding of subclinical oxidative stress in Sowetan controls and the endemic nature of chronic pancreatitis in that area supports the hypothesis that oxidative stress may be involved in its pathogenesis.     

Estimating glomerular filtration rate in black South Africans by use of the modification of diet in renal disease and Cockcroft-Gault equations

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 ((51)Cr-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 (P(30)). RESULTS: The Spearman correlation coefficient between measured and estimated GFR for both equations was similar (4-v MDRD R(2) = 0.80 and CG R(2) = 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 m(2). Without the ethnicity factor, median bias was 1.9 (95% CI -0.8 to 4.5) mL/min/1.73 m(2). CONCLUSIONS: The 4-v MDRD equation, without the ethnicity factor of 1.212, can be used for estimating GFR in black South Africans.     

Pain in ambulatory HIV‐positive South Africans

We investigated the prevalence and intensity of pain, factors associated with having pain, and analgesic medications employed in a population consisting predominantly of Black African and female human immunodeficiency virus (HIV)‐positive individuals attending outpatient clinics in a rural (n = 125; 79% female; 100% Black African) and a metropolitan (n = 396; 75% female; 94% Black African) area of South Africa. Pain intensity, interference and treatment were assessed using the Wisconsin Brief Pain Questionnaire. Seventy‐two percent of rural participants and 56% of metropolitan participants had pain at the time of the interview, and this pain was moderate to severe in intensity in 60% of rural participants and 59% of metropolitan participants. Forty‐six percent of rural participants and 61% of metropolitan participants had multiple pain sites. The most common pain sites in rural participants were the abdomen (30%), chest (26%), head (19%) and genitals (15%), while in the metropolitan cohort the head (39%), feet (33%), chest (30%) and abdomen (20%) were the most common sites. In the rural cohort, antiretroviral therapy was independently associated with reduced risk of pain, while in the metropolitan cohort increasing age was weakly, but independently associated with having pain. Pharmacological management of pain was poor, with 29% of rural participants and 55% of metropolitan participants with pain not receiving any treatment. Of those receiving treatment, no participants were receiving strong opioids, and only 3% of metropolitan participants were receiving a weak opioid. Thus, HIV‐related pain is common and is poorly treated in both the rural and metropolitan setting in South Africa.     

The spectrum of symptoms among rural South Africans with HIV infection.

The vast majority of people infected with HIV in South Africa have no access to antiretroviral therapy, making palliative care the only treatment available. An important element of palliative care is symptom management. However, little is known about the range of symptoms and the distress associated with them among rural South Africans living with HIV/AIDS. A cross-sectional study was conducted to describe the spectrum of symptoms experienced by 64 HIV-positive patients who received palliative care from a rural home-based palliative care program. Data were determined using a questionnaire adapted from an HIV symptom list and HIV symptom profile. The physical symptoms of most immediate importance identified by the respondents were localized pain, skin problems, cough, vaginal discharge/infection, and fatigue. The psychological symptoms of the most immediate and overall importance were feelings of anger, loneliness, decreased support from family and friends, and a decreased sense of satisfaction. This study provides insight into the spectrum of HIV-associated symptoms in a rural South African HIV-positive population. Through improved symptom assessment and management, nurses can improve palliative care services to those suffering from the distressful symptoms associated with HIV infection.     

Endotherapy for chronic pancreatitis with intracanalar stones

Endotherapy for pancreatic stone is an emerging specialty. The judicious application of extracorporeal shock-wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) in selected groups of patients has increased the success rates of endotherapy, with excellent long-term results. In this review the authors share their vast experience of treating patients with pancreatic stones. The article will focus on the basic principles of pancreatic endotherapy, the instrumentation required, details of the ESWL technique and its applications, as well as the limitations, success rate, and complications of endotherapy in selected patients.     

Juxtaminorpapillary diverticulum associated with chronic pancreatitis.

A 69-years-old male with a juxtaminorpapillary diverticulum of Santorini in the duodenum and chronic pancreatitis is described. The patient had suffered from attacks of epigastric pain during the last 35 years. At recent admission to hospital he had also an elevated urinary amylase activity and a juxtaminorpapillary diverticulum, demonstrated by duodenoscopy and X-ray examination after administration of a contrast medium. Endoscopic retrograde cholangio-pancreatography (ERCP) showed changes of the pancreatic duct system compatible with chronic pancreatitis, a diagnosis which was confirmed by explorative laparotomy.