Partial recovery of renal function in black patients with apparent end-stage renal failure due to primary malignant hypertension.

We report the largest series in which 12 out of 54 patients with primary malignant hypertension requiring dialysis recovered sufficient renal function to allow withdrawal of dialysis. The patients were divided into recovery (RC; n = 12) and non-recovery (N-RC; n = 42) groups. The two groups were compared for variables which might predict RC. They were also assessed for survival. Nine of the RC and 6 of the N-RC patients presented with acute oliguria (p = 0.01). The initial mean arterial pressure was significantly higher in the RC than the N-RC group (178 +/- 17 vs. 160 +/- 27 mm Hg; p = 0.03). Although not statistically significant, more females recovered (8 of 12 vs. 16 of 42; p < 0.1). More patients presenting with serum creatinine concentrations < 1,000 mumol/l (11 mg/dl) recovered (p = 0.09), while the presence of microangiopathic-haemolytic anaemia occurred more frequently in the RC (7 of 10) than in the N-RC (15 of 35) group (p = 0.16)> Age, kidney size, and the presence of hypertensive retinopathy did not distinguish between the two groups. RC patients had a greater long-term survival (Mantel-Cox chi2 = 4.48; p = 0.03). The renal function RC may be related to the type of dialysis provided (intermittent peritoneal dialysis) and to the use of modern potent peripheral vasodilator antihypertensive agents. Potential renal function RC should always be considered in patients being dialyzed for primary malignant hypertension.

Zinc, copper and iron balance in the vitamin B-6-deficient rat.

Zinc (Zn), copper (Cu) and iron (Fe) balance was assessed over 8 weeks in 3 groups of young male Wistar rats receiving a daily pyridoxine hydrochloride (PN-HCl) intake of 45, 23 and 0 micrograms respectively. Although all 3 groups remained in a positive balance throughout the study the Zn and Cu balance, growth and food intake was significantly lower in the group receiving no PN-HCl (p < 0.05). The lowered Zn and Cu balance in this group resulted from a decreased food intake coupled with an increased excretion of Zn and Cu. The group receiving 23 micrograms/d of PN-HCl showed no significant difference in growth, food intake and Zn and Cu balance when compared to the group receiving 45 micrograms/d, indicating that subminimal levels of vitamin may still be exerting beneficial effects on the balance of these trace elements.

The prevalence of psychiatric disorders at a primary care clinic in Soweto, Johannesburg.

A pilot study to assess the prevalence of psychiatric disorders in a primary care clinic in Soweto was carried out at the Zola Community Health Centre in May 1991. Interviews were carried out by trained primary care clinic staff. The findings were reviewed and analysed by the authors. The prevalence of psychiatric disorders was found to be 14.38%. Methodological problems are listed and the results are discussed.

Racial differences in cell membrane ATPases and cellular cation content in urban South African normotensive and hypertensive subjects.

Platelet and erythrocyte membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase activities and platelet, erythrocyte and serum magnesium, calcium, sodium and potassium concentrations were determined in black (n = 52) and white (n = 24) essential hypertensive patients from the city of Johannesburg in South Africa. The hypertensive groups were matched for age and body mass with black (n = 52) and white (n = 26) normotensive controls. In the black group, platelet and erythrocyte membrane ATPase activities were significantly depressed in the hypertensive subjects. In the white group, there were no significant differences for any of the ATPases studied between the normotensive and hypertensive subjects. Platelet sodium and calcium were significantly increased and serum magnesium, serum potassium, platelet magnesium and erythrocyte magnesium significantly decreased in the black hypertensive group compared to the black normotensive group. In the white hypertensive patients, platelet sodium and calcium were significantly raised and platelet magnesium significantly decreased compared to the normotensive controls. In blacks, platelet magnesium and ATPase activity were negatively correlated with mean arterial pressure. Unlike whites, black hypertensives have widespread magnesium changes with associated cell membrane ATPase depression and cytosolic sodium and calcium accumulation. These results suggest possible racial differences in cellular cation regulation in essential hypertension.

Altered calcium binding to erythrocyte membranes in essential hypertension: relation to magnesium.

Abnormal cellular ion transport resulting in altered membrane control over intracellular calcium may be aetiologically related to essential hypertension. Cell membrane calcium binding, which is influenced by magnesium, is an important membrane system involved in cellular calcium regulation. In this study the relationships between erythrocyte calcium binding and extra- and intracellular calcium and magnesium concentrations were determined in essential hypertensive patients (52 black, 24 white) and normotensive controls (52 black, 26 white). Calcium depletion of the erythrocytes by MgCl2 and EDTA resulted in the removal of more calcium ions from the outer erythrocyte membrane in the hypertensive group compared with the normotensive group. This may be considered as evidence of increased calcium binding to the outer cell membrane in essential hypertension. Calcium binding was greater in the hypertensive males compared with the females. In black hypertensives, serum and erythrocyte magnesium concentrations were significantly increased. In white hypertensives, serum calcium was significantly decreased and erythrocyte calcium significantly raised. Serum and erythrocyte magnesium correlated inversely with the amount of calcium released from the membranes in the black hypertensive group. The results of this study suggest that changes in magnesium levels may contribute to altered cell membrane calcium binding in essential hypertension.

Thalassemia: lung function with reference to iron studies and reactive oxidant status.

Pulmonary function tests were performed in 15 thalassemic patients (age 5 years 8 months to 18 years 6 months), receiving both regular transfusions and desferrioxamine, to determine the presence and nature of any abnormalities in lung function. Reactive oxidant production from neutrophils was measured simultaneously to ascertain if a causal relationship existed between free radical production and tissue damage in the lungs. Mean total lung capacity, mean residual volume, and mean forced vital capacity were significantly reduced, indicating a restrictive pattern of lung function abnormality. In addition, the carbon monoxide diffusion was low, and hypoxemia was present in 6 of 13 patients tested. These pulmonary function abnormalities did not correlate with age, cumulative volume of transfusion, or serum ferritin levels. In addition, neutrophil reactive oxidant status did not correlate with these or with pulmonary function parameters. These results indicate that neutrophil-derived oxygen free radicals do not appear to be a major cause of lung function abnormalities in thalassemics.

A vaccination survey using the EPI methodology ot evaluate the impact of a child health outreach programme in an urban area of South Africa.

A community-based survey of the vaccination status of children aged 12-23 months was conducted to evaluate the impact of a child health outreach programme on vaccination coverage in Alexandra township, South Africa. The EPI cluster sampling technique was adapted for this purpose. The sample size, including the number of clusters and the number of units per cluster, was increased to permit stratification of the data and comparison of the results with those obtained in a study conducted prior to the introduction of the outreach services in 1988. At the time of the survey interview, 67% of the children were fully vaccinated (78% against measles) and by 1 year of age, 58% were fully vaccinated (69% against measles). The increase in coverage since the introduction of the programme was statistically significant only for measles (Student's t-test, P < 0.01). A total of 75% of children living in formal dwellings, compared with 51% living in informal dwellings, were fully vaccinated by interview (Fisher's exact test, two tailed, P < 0.0001). Mothers from informal dwellings had a 1.88 times greater chance of not knowing about the outreach services (P < 0.001). Children whose mothers knew where vaccinations were given, attended postnatal clinics, used the outreach services, possessed a road-to-health card from the Alexandra Health Centre, and who resided in a formal dwelling all had a higher chance of being vaccinated.

A vaccination survey using the EPI methodology to evaluate the impact of a child health outreach programme in an urban area of South Africa

A community-based survey of the vaccination status of children aged 12-23 months was conducted to evaluate the impact of a child health outreach programme on vaccination coverage in Alexandra township, South Africa. The EPI cluster sampling technique was adapted for this purpose. The sample size, including the number of clusters and the number of units per cluster, was increased to permit stratification of the data and comparison of the results with those obtained in a study conducted prior to the introduction of the outreach services in 1988. At the time of the survey interview, 67% of the children were fully vaccinated (78% against measles) and by 1 year of age, 58% were fully vaccinated (69% against measles). The increase in coverage since the introduction of the programme was statistically significant only for measles (Student's t-test, P < 0.01). A total of 75% of children living in formal dwellings, compared with 51% living in informal dwellings, were fully vaccinated by interview (Fisher's exact test, two tailed, P < 0.0001). Mothers from informal dwellings had a 1.88 times greater chance of not knowing about the outreach services (P < 0.001). Children whose mothers knew where vaccinations were given, attended postnatal clinics, used the outreach services, possessed a road-to-health card from the Alexandra Health Centre, and who resided in a formal dwelling all had a higher chance of being vaccinated

An evaluation of late attenders in labour in Alexandra.

To study why women present in late labour we interviewed 70 parturients in our labour room for a period of 8 days in March 1990. When presenting 19% were 8-10 cm dilated and 81% were 0-7 cm dilated. The group was stratified into those in early labour (0-7 cm of cervical dilatation) and in late labour (8 cm or more) and compared for all variables studied. Only a few differences were statistically significant. Early comers were less likely to have strong uterine contractions and more likely to have intact membranes at presentation. Late comers were more likely to report a number of delaying factors or to have financial worries. Twenty nine percent of Alexandra residents and only 6% of outsiders reported difficulty in finding transport to labour room after the onset of labour. Almost half of Alexandra residents did not have access to public transport, ambulance or own transport. The relative risk for late coming was: 9 for women reporting a number of delaying factors outside their control; 6 for those with financial worries or with ruptured membranes; 4 for unbooked cases or with current addresses in Alexandra; 3 for women with a normal past obstetric history or with a previous delivery outside the AHC; 2 for those worried with hospital referrals, with a previous rural address, for less than 1 year in Alexandra or with a normal current ANC. Women who came late in labour were more likely to need hospital referral or to have come to the labour unit walking.

Comparison of the safety and efficacy of a combination analgesic Myprodol and Ponstan in the treatment of dental pain.

A comparison of the efficacy of Myprodol, a combination analgesic (Ibuprofen, Paracetamol and Codeine phosphate) and Ponstan (Mefenamic acid) was undertaken in a randomised double blind trial of 52 patients who underwent surgical removal of impacted or unerupted teeth. Pain scores were measured for patients pre- and post operatively by means of a visual analogue scale and data was analysed using the BMPD package on the ISM main frame computer at the Medical Research Council. The results indicated that although Myprodol and Ponstan were equally adequate and well tolerated in the control of post operative dental pain, Myprodol exceeded Ponstan in duration of analgesia and in the degree of pain intensity control experienced by the patient.

Anti-calculus effects of dentifrice containing pyrophosphate compared with control.

A 3-month, double-blind, randomized, longitudinal, parallel clinical study was conducted to compare the effects on supragingival calculus deposits of a dentifrice containing soluble pyrophosphate to a control MFP dentifrice, which did not contain pyrophosphates. During the pre-test phase, 247 teachers were examined for presence of calculus on the lingual surfaces of the 6 lower anterior teeth, using the Periodontal Probe Method of Calculus Assessment (Volpe et al. 1965). Statistical methods employed were the two-way analysis of variance as well as the paired and unpaired t tests. The level of statistical significance chosen was p less than 0.05. At the end of the 3-month pre-test phase, 88 candidates with the highest calculus index scores met the initial criteria and were stratified into two balanced groups based on their age and sex. Each group received an oral prophylaxis and participants were assigned to use either the dentifrice containing the pyrophosphate or the MFP and instructed to brush their teeth twice daily at home for the next 3 months (test phase). The results showed that the group using the pyrophosphate dentifrice experienced a 20% greater reduction in calculus formation when compared to the MFP control There was also a greater number of calculus-free subjects and tooth surface sites in the soluble pyrophosphate group. The change in the Volpe-Manhold Index revealed significant differences for both the pyrophosphate group (change = 1.7111; p = 0.0010) as well as, though less prominent, for the control group (change = 1.4186; p = 0.0313).

Platelet and erythrocyte Mg2+, Ca2+, Na+, K+ and cell membrane adenosine triphosphatase activity in essential hypertension in blacks.

OBJECTIVE: To assess the relationship between intracellular Mg2+, Ca2+, Na+ and K+ and cell membrane adenosine triphosphatase (ATPase) activity in normotensive and hypertensive blacks. DESIGN: Intracellular cations and cell membrane ATPase activity were studied in black patients with untreated essential hypertension and age-, weight- and height-matched normotensive controls. Platelet, erythrocyte and serum Mg2+, Ca2+, Na+ and K+ levels as well as platelet and erythrocyte membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase activities were measured in all subjects. METHODS: Intracellular Na+ and K+ were measured by flame photometry and Mg+ and Ca+ by atomic absorption spectrophotometry. Cell membrane ATPase activity was determined by a colorimetric method. RESULTS: The hypertensive group consistently demonstrated depressed activity of each ATPase studied, with significantly lower serum Mg2+, serum K+, erythrocyte Mg2+ and platelet Mg2+ levels compared with the normotensive group. Platelet Na+ and Ca2+ and erythrocyte Ca2+ were significantly elevated in the hypertensive group. In the hypertensive group, mean arterial pressure (MAP) was inversely correlated with platelet and erythrocyte membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase. Serum Mg2+, serum Ca2+ and platelet Mg2+ were negatively correlated with MAP in the hypertensive group whilst erythrocyte and platelet Ca2+ were positively correlated. In the normotensive group, platelet Mg2+ and MAP were negatively, and erythrocyte Ca2+ and MAP, positively correlated. CONCLUSIONS: Black patients with essential hypertension have widespread depression of cell membrane Na+,K(+)-ATPase, Ca(2+)-ATPase and Mg(2+)-ATPase activities with serum and intracellular Mg2+ depletion and cytosolic Na+ and Ca2+ overload, which may reflect an underlying membrane abnormality in essential hypertension. These cellular abnormalities may be related to the defective transport mechanisms that in turn may be aggravated by Mg2+ depletion.

Preliminary results of exposure measurements and health effects of the Vaal Triangle Air Pollution Health Study.

The aim of the Vaal Triangle Air Pollution Health Study is to assess the adequacy of South Africa's air pollution control programme to protect human health. It is a longitudinal study of children aged 8-12 years which will evaluate exposure and effects of outdoor and indoor air pollution levels on the health of more than 10,000 white and black children living in Vanderbijlpark, Sasolburg, Vereeniging, Meyerton, Randvaal, and the Sebokeng/Sharpeville areas (Lekoa), Transvaal, RSA. Extensive data on outdoor and indoor levels of air pollution as well as personal exposures to total suspended particulate matter were collected. Preliminary results indicate that the levels of particulate matter exceed the USA health standards. A health questionnaire administered to 10,187 white children indicated that during the past year 65.9% had suffered from upper respiratory tract illnesses (URI) such as sinusitis, rhinitis and hay fever and 28.9% from lower respiratory tract illnesses (LRI) such as bronchitis, chronic cough and chronic chest illnesses. Parents who perceived that the air pollution in the region is serious had a higher reporting rate of URI/LRI for their children than parents who considered the air pollution not to be serious (77.4% v. 56.8% respectively for URI and 24.1% v. 16.3% respectively for LRI). The effect of this recall bias will be evaluated in later analyses. A statistically significant higher prevalence of LRI was reported in children exposed to parental smoking (25.7% for households where both parents smoked v. 20.8% in households without parental smoking) (odds ratio (OR) 1.32 (1.2-1.5)).(ABSTRACT TRUNCATED AT 250 WORDS)

Melatonin in chronic renal failure.

The melatonin status of patients in end-stage chronic renal failure (CRF) was evaluated by the determination of daytime plasma melatonin levels and by the investigation of the circadian rhythmicity of melatonin secretion. A significant increase in plasma melatonin concentration was found in all CRF patient groups investigated, i.e. CRF patients on conservative treatment (CT; n = 48), CRF patients on maintenance haemodialysis treatment (HD; n = 39) and CRF patients on peritoneal dialysis (PD; n = 32). Successful transplantation led to a marked reduction in plasma melatonin levels. The circadian rhythm of melatonin secretion would appear to be suppressed in CRF as the nocturnal secretory surge was absent in all HD patients and in 80% of the posttransplantation patients studied.

Intracellular Mg2+, Ca2+, Na2+ and K+ in platelets and erythrocytes of essential hypertension patients: relation to blood pressure.

Alterations in intracellular cation metabolism have been implicated in the pathophysiology of essential hypertension. Total magnesium, calcium, sodium and potassium levels were studied in serum erythrocytes and platelets, from 154 subjects (76 hypertensive and 78 normotensives; 104 blacks and 50 whites). In the combined black and white hypertensive group, platelet sodium and calcium and erythrocyte calcium were elevated and serum potassium, serum magnesium and platelet magnesium decreased. In the black hypertensive patients, platelet sodium and calcium and erythrocyte calcium were increased, whereas serum magnesium, serum potassium, platelet magnesium and erythrocyte magnesium were decreased. In the white hypertensive group, platelet sodium and erythrocyte calcium were raised and platelet magnesium was decreased. In the black hypertensive patients, serum and platelet magnesium and serum calcium were negatively and erythrocyte and platelet calcium positively correlated with mean arterial pressure. In the white hypertensive patients platelet sodium was directly related to mean arterial pressure. These results suggest that intracellular sodium and calcium overload and magnesium depletion may be important in the pathophysiology of hypertension. Magnesium disturbances are more consistent and widespread in black hypertensive patients than in white hypertensive patients.

Whole blood serotonin levels in chronic renal failure.

Whole blood serotonin levels were investigated in a control group (n = 35) and in a group of chronic renal failure patients (n = 127) on various treatment regimen i.e. conservative treatment (n = 39), maintenance haemodialysis (n = 35) and after renal transplantation (n = 53). The whole blood serotonin levels, as determined by high performance liquid chromatography, were significantly lower in the chronic renal failure patients than in the control group (p = 0.0001). Whole blood serotonin levels were significantly lower in the white subjects than in the black subjects of the study (p = 0.0001).

Early life nutrition in the Gelukspan Health Ward.

Breast-feeding, supplementary feeding and weaning practices as well as nutrition during the second year of life were studied in 210 black primiparas, who had cared for their own children through the first year, in a poor, one-crop (maize) rural area in Bophuthatswana. The sampling strategy was similar to the one recommended by UNICEF for assessment of vaccination coverage. Only 1 child had never been breast-fed and 60% were still breast-fed at the time of the interview during the second year of life. A number of factors were detected that seem important determinants of breast-feeding behaviour, e.g. marital status and level of formal education. Early supplementary feeding and early weaning were identified as major problems. Children were weaned onto commercial feeds or low-energy-dense staples, and there was also an obvious lack of energy-dense foods (e.g. butter, coconut oil) during the second year of life. Some determinants of these practices were recorded. The data have implications for the health services and should influence social and educational policy for the area. If properly implemented, the recommendations could result in significant financial saving for the study population. The health services should promote appropriate nutritional education, starting with antenatal care, early and frequent attendance at child health services should be encouraged and education concerning nutrition should be strengthened, and health education should encourage prolonged breast-feeding, discourage the use of commercial weaning foods, and encourage the use of natural multimixes (e.g. bananas, beans, cooking oil) for weaning. The importance of energy-dense foods should be emphasised to mothers and to health workers.

Evaluation of blood pressure screening at the Alexandra Health Centre.

A review of patient registers and records at the Alexandra Health Centre and University Clinic (AHC) revealed that less than 10% of the expected number of hypertensive subjects in Alexandra are attending the twice a week hypertension clinic. In the adult outpatient department most patients are not screened for hypertension. Patients are more likely to be screened if they have symptoms suggestive of high blood pressure and are seen in the morning by a primary health care nurse. Age and sex of patients are not important determinants of hypertension screening. It is thus apparent that primary care consultations at the AHC are not used as opportunities for screening for a serious and common illness for which there is ready treatment. However, before the AHC embarks on a massive case-finding programme there is a need to develop efficient and affordable treatment programmes.