Risk factors for gout: a hospital-based study in urban black South Africans.

The clinical features of 90 Black South African patients with gout seen at a large urban hospital were reviewed. The mean age of the patients was 54.3 and 55.3 years for men and women, respectively. The male:female ratio was 3.3:1. All except one of the women were postmenopausal. Seventy-nine percent of patients were from the lower income groups of "blue collar" workers, old-age pensioners or the unemployed. Polyarticular gout was observed in 44.4% of the patients. Tophi were noted in 51.1% of patients but none had a history of renal calculi. Risk factors were assessed by comparing the gouty patients to an equal number of age- and sex-matched hospital controls. Case-control analysis showed a "white collar" occupation (odds ratio = 7.4), obesity (odds ratio = 5.3), alcohol intake (odds ratio = 3.5) and hypertension (odds ratio = 3.3) to be significant risk factors for gout in the overall group of both men and women. In the subgroup of men only, obesity (odds ratio = 7.8), a "white collar" occupation (odds ratio = 6.4), hypertension (odds ratio = 4.9) and alcohol intake (odds ratio = 3.5) were similarly associated with gout. In women, a history of alcohol intake was the only significant risk factor associated with gout (odds ratio = 5.0). These findings suggest that in a population where gout was previously rare, changing dietary habits and lifestyle, together with improving socioeconomic conditions are contributing significantly to the increasing prevalence of the disease.

Screening for sexually transmitted diseases in rural South African women.

OBJECTIVE: This paper reports on a study undertaken in a rural area of South Africa, to develop a non-laboratory tool to screen for sexually transmitted diseases (STDs) among family planning clients. METHODS: A cross sectional study was performed of 249 consecutive women attending a family planning service between November and December 1994. A questionnaire was administered, and a clinical examination and laboratory tests conducted. Sociodemographic, clinical, and other non-laboratory variables that were significantly associated with laboratory evidence of infection were combined to produce non-hierarchical scoring systems for three "syndromes": gonococcal and/or chlamydial cervical infection, trichomoniasis, and cervical infection and/or trichomoniasis combined. The sensitivity, specificity, and predictive values of the scoring systems as a screening tool were assessed against the gold standard of laboratory tests. RESULTS: The prevalence of reproductive tract infections among the study participants was as follows: Chlamydia trachomatis 12%, Neisseria gonorrhoeae 3%, Trichomonas vaginalis 18%, and bacterial vaginosis 29%. Although vaginal discharge and other symptoms were frequently reported, symptoms bore no relation to the presence of infection. The following independent associations with gonococcal/chlamydial cervical infection were found: age less than 25 years and cervical mucopus and/or friability. Abnormal discharge on examination, visible inflammatory changes of the cervix (increased redness), no recent travel, and unemployment were associated with trichomoniasis. The combination of trichomonas and/or cervical infection ("STD syndrome") was associated with cervical mucopus/friability, unemployment, lack of financial support, and increased redness of the cervix. Of the three scoring systems developed on the basis of these associations, that of the "STD syndrome" achieved the best performance characteristics as a screening tool, with a sensitivity of 62%, specificity of 74%, and positive predictive value of 48%. CONCLUSION: STDs are common in a population of rural, sexually active women attending a family planning service. In resource poor settings, non-laboratory screening tools could play some role in identifying and treating infections in these women, especially since the majority would not otherwise have been reached. However, such screening tools cannot be viewed as the only way to identify STDs and should be considered as part of an overall strategy of STD control that includes, for example, good management of symptomatic individuals and their partners.

Autoantibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations.

The clinical features and autoantibody profile of 111 black South Africans (103 females and 8 males) with systemic lupus erythematosus were retrospectively analysed. The mean age of the patients was 35.1 years and mean duration of disease 3.5 years. The commonest clinical and laboratory features noted were arthritis (62.2%), hypocomplementaemia (61.2%), haematological abnormalities (60.5%) and malar rash (55%). The serological abnormalities included antinuclear antibodies (98.2%), anti-dsDNA (66.2%), anti-Sm (44.2%), anti-RNP (65.5%), anti-Ro (60.5%), anti-La (28.4%) and rheumatoid factor (10.1%). Positive clinicoserological associations observed included: combination of anti-dsDNA antibodies and low C4 levels with renal disease; anti-dsDNA antibodies with cutaneous vasculitis; anti-Sm antibodies with psychosis; anti-RNP antibodies with Raynaud's phenomenon; anti-Ro antibodies with renal disease, psychosis and malar rash. Anti-La antibodies showed a weak negative association with serositis and Raynaud's phenomenon. Most of these clinical correlates are consistent with past studies. The high frequency of anti-Sm and anti-RNP antibodies is similar to the observations in African-Americans and Afro-Caribbeans.

Autoantibodies in black South Africans with systemic lupus erythematosus: spectrum and clinical associations.

The clinical features and autoantibody profile of 111 black South Africans (103 females and 8 males) with systemic lupus erythematosus was retrospectively analysed. The mean age of the patients was 35.1 years and mean duration of disease 3.5 years. The commonest clinical and laboratory features noted were arthritis (62.2%), hypocomplementaemia (61.2%), haematological abnormalities (60.5%) and malar rash (55%). The serological abnormalities included antinuclear antibodies (98.2%), anti-dsDNA (66.2%), anti-Sm (44.2%), anti-RNP (65.5%), anti-Ro (60.5%), anti-La (28.4%) and rheumatoid factor (10.1%). Positive clinicoserological associations observed included: combination of anti-dsDNA antibodies and low C4 levels with renal disease; anti-dsDNA antibodies with cutaneous vasculitis; anti-Sm antibodies with psychosis; anti-RNP antibodies with Raynaud's phenomenon; anti-Ro antibodies with renal disease, psychosis and malar rash. Anti-La antibodies showed a weak negative association with serositis and Raynaud's phenomenon. Most of these clinical correlates are consistent with past studies. The high frequency of anti-Sm and anti-RNP antibodies is similar to the observations in African-Americans and Afro-Caribbeans.

Serum alpha-fetoprotein concentrations in urban and rural Southern African blacks with hepatocellular carcinoma.

The reason why only some hepatocellular carcinomas synthesize alpha-fetoprotein is not known. Both the frequency with which this foetal globulin is produced and the major aetiological associations of hepatocellular carcinoma vary between populations with high and low incidences of the tumour, raising the possibility that re-expression of the gene for alpha-fetoprotein is determined, or influenced by, the molecular genetic events that occur during hepatocellular carcinogenesis. This hypothesis could be tested by comparing serum alpha-fetoprotein concentrations in populations in which the major risk factors for hepatocellular carcinoma differ. Two such populations are urban and rural southern African blacks. We measured serum alpha-fetoprotein concentrations by radioimmunoassay in 234 southern African blacks with hepatocellular carcinoma: 78 of the patients were urban and they were age-matched with 156 patients born in rural areas, one-half of whom had remained in a rural environment (rural), whereas the others had migrated to the cities in adulthood (rural-urban). Urban patients were more likely than rural-born patients to have a normal serum alpha-fetoprotein value [23.1% (18/78) compared with 10.2% (16/156); p = 0.02]. There was no significant difference between the concentrations in rural and rural-urban patients. The absolute values of the raised serum alpha-fetoprotein values did not differ between urban (69,558 +/- 176,737 ng/ml; and rural-born patients (53,998 +/- 125,681 ng/ml), or between rural (69,207 +/- 159,975 ng/ml) and urban-rural patients (40,434 +/- 83,028 ng/ml). These findings are compatible with the hypothesis that re-expression of the alpha-fetoprotein gene in hepatocellular carcinoma is related to the aetiology or pathogenesis of the tumour.

The impact of a mobile dental system on a school community. Part I--Oral health status of schoolchildren.

This cross-sectional study was designed to compare the caries status of children 8-10 and 11-13 years of age, at schools visited by and schools not visited by the Mobile Dental System (MDS). A total of 918 children from six primary schools participated in the study. For the experimental schools, Noordgesig and Cavendish were paired in Group 1 (curative services and brushing programmes), while Riverlea and Wilhelmina Hoskins were combined in Group 2 (curative services and weekly fluoride mouthrinse programmes). Kliptown II and Ernest Hobbs were grouped together as the control schools (Group 3) where no services were provided by the MDS. Dental caries examinations were conducted using the WHO criteria (1987). Statistical analysis was done using chi-square tests, ANOVA and pairwise t-tests. A comparison of mean DMFT scores revealed differences between the control and both experimental groups in the 11-13 year old age group that were significant. The filled and missing components of the DMFT differed significantly for both age groups when experimental and control schools were compared, which clearly showed the impact of the service provided by the MDS. There were however, no differences in the decayed component indicating the limitations of the system in preventing or controlling the development of new carious lesions.