Identification of a subgroup of black South Africans with type 1 diabetes who are older at diagnosis but have lower levels of glutamic acid decarboxylase and islet antigen 2 autoantibodies.

AIMS: To compare the age at diagnosis and prevalence of islet autoantibody [glutamic acid decarboxylase (65 kDa) 65 and islet antigen 2] positivity in black and white participants with type 1 diabetes in South Africa, and to analyse the relationship between age at diagnosis and the presence of autoantibodies. METHODS: Participants were recruited from diabetes outpatient departments and autoantibodies to glutamic acid decarboxylase (65 kDa) and islet antigen 2 were measured by enzyme-linked immunosorbent assay. RESULTS: We recruited 472 (353 black and 119 white) participants with type 1 diabetes. Age at diagnosis of diabetes was later in black (19.7 ± 10.5) than in white participants (12.7 ± 10.8 years; P < 0.001) with a median (interquartile range) disease duration of 5.0 (2.0-10.0) and 8.5 (4.0-20.0) years (P < 0.001), respectively. An older age at diagnosis (≥ 21 years) was more frequent in black (152 of 340, 45%) than in white participants (24 of 116, 21%; P < 0.001). The prevalence of islet antigen 2 autoantibodies was 19% (66/352) in black and 41% in white participants (48/118; P < 0.001). There was no significant difference in glutamic acid decarboxylase (65 kDa) autoantibody positivity between black (212/353, 60%) and white participants (77/117, 66%; P = 0.269). In black, but not white, participants the prevalence of both glutamic acid decarboxylase (65 kDa) and islet antigen 2 autoantibody positivity was significantly lower in participants diagnosed at age ≥ 21 years (P < 0.001 for both comparisons). CONCLUSIONS: The older age at diagnosis, lower prevalence of islet antigen 2 autoantibodies and a distinct subgroup of participants with type 1 diabetes with age at diagnosis of > 20 years in the black compared to white population suggest a difference in the immunological aetiology of type 1 diabetes in these two population groups.

Protein and fat meal content increase insulin requirement in children with type 1 diabetes - Role of duration of diabetes.

BACKGROUND AND OBJECTIVE: Hyperglycaemia remains a challenge in type 1 diabetes since current regimes used to determine meal insulin requirements prove to be ineffective. This is particularly problematic for meals containing high amounts of protein and fat. We aimed to determine the post-prandial glycaemic response and total insulin need for mixed meals, using sensor-augmented insulin pumps in children with type 1 diabetes. METHODS: Twenty-two children with type 1 diabetes, aged 4-17 years on insulin pump therapy completed this home-based, cross-over, randomised controlled trial. Two meals with identical carbohydrate content - one with low fat and protein (LFLP) and one with high fat and protein (HFHP) contents - were consumed using normal insulin boluses. Blood glucose monitoring was done for 10 h post-meal, with correction bolus insulin given two-hourly if required. RESULTS: The HFHP meal required significantly more total insulin (3.48 vs. 2.7 units) as a result of increased post-meal correction insulin requirement (1.2 vs. 0.15 units) spread over a longer duration (6 vs. 3 h). The HFHP meals significantly increased the time spent above target glucose level. Duration of diabetes and total daily insulin use significantly influenced the post-prandial blood glucose response to the two meals. CONCLUSION: When consuming carbohydrate-based mixed meals, children with type 1 diabetes on insulin pump therapy, required significantly more insulin over a longer period of time than the insulin requirement calculated using current regimes. This additional amount required is influenced by the duration of diabetes and total daily insulin use.

Organochlorine pesticide levels in Clarias gariepinus from polluted freshwater impoundments in South Africa and associated human health risks.

There are increasing concerns regarding the safe human consumption of fish from polluted, freshwater impoundments. The aim of this study was to analyse the muscle tissue of the sharptooth catfish Clarias gariepinus for selected organo-chlorine pesticides (OCPs) and to perform a human health risk assessment using a standard protocol described by the United States Environmental Protection Agency (US EPA). Fish were collected from the polluted Roodeplaat-(RDPD), Rietvlei-(RVD) and Hartbeespoort (HBPD) Dam impoundments located in the north-eastern regions of South Africa. GC-MS analyses showed levels of various OCPs in fish muscle samples from all three impoundments. For fish collected from the RDPD, p,p'-DDE, endosulfan, lindane and ß- and δ-HCH were the most prevalent OCPs detected, while p,p'-DDE and endosulfan were the most predominant in fish from the RVD. Lindane and ß- and δ-HCH were the main OCPs detected in fish from the HBPD. Dieldrin was the only OCP detected at concentrations for which a cancer risk and a hazard index above the acceptable risk levels were estimated. This was the case for fish from both the RDPD and RVD impoundments. No toxic risk was estimated should fish from the HBPD be consumed.

Liver histopathology of the sharptooth catfish Clarias gariepinus as a biomarker of aquatic pollution.

This paper reports on a comparative perspective of liver histopathological data of the sharptooth catfish Clarias gariepinus. The data was collected from a spectrum of relatively un-impacted and isolated, to polluted, eutrophic freshwater ecosystems. Results were compared between regional areas, by combining data from freshwater systems which has a similar pollution status and/or is located within the same geographical region. Measurements included necropsy observations, semi-quantitative liver histopathology (Liver Index), and selected biometrical indices. The aim was to establish whether the results of these measurements would differ between, and/or reflect the pollution status of, the different freshwater aquatic ecosystems. The histopathological analysis showed a higher prevalence of toxicopathic non-neoplastic, and pre-neoplastic alterations in C. gariepinus from the polluted sites. We also found a significant difference between the Liver Index, hepatosomatic index, and condition factor values of fish inhabiting impoundments known to be polluted, compared to the same species from the selected reference sites. Fish from polluted sites also had more macroscopic liver abnormalities. The results suggest that the liver histopathology of this bio-indicator fish species could be a useful biomarker of freshwater aquatic pollution.

Intersex in feral indigenous freshwater Oreochromis mossambicus, from various parts in the Luvuvhu River, Limpopo Province, South Africa.

This study reports on intersex in Oreochromis mossambicus, an indigenous fish species inhabiting most aquatic systems throughout South Africa (SA). Male fish were collected from three sites in the Luvuvhu River, Limpopo Province, SA: Albasini Dam (AD), Nandoni Dam (ND), and Xikundu Weir (XW). The latter two sites are situated in a currently dichloro-diphenyl-trichloroethane (DDT) sprayed area. A laboratory-bred reference group (Aq R) were included for a histological comparison. 48% of the fish at AD were intersex individuals compared with 63% at ND, and 58% at XW. The Aq R fish had no cases of intersex. o,p'- and p,p'-DDT and metabolites dichlorodiphenyldichloroethane (DDD) and -dichlorodiphenyldichloroethylene (DDE) were detected in fat samples, indicative of contamination of the aquatic environment and subsequent exposure of fish to these chemicals. Although some of the fat samples contained levels of DDTs no association could be established between intersex and chemical contaminants in fish.

DDT contamination from indoor residual spraying for malaria control.

The insecticide DDT is still used in specific areas of South Africa for indoor residual spray (IRS) to control malaria vectors. Local residents could be exposed to residues of DDT through various pathways including indoor air, dust, soil, food and water. The aims of this study were to determine the levels of DDT contamination, as a result of IRS, in representative homesteads, and to evaluate the possible routes of human exposure. Two villages, exposed (DV) and reference (TV) were selected. Sampling was done two months after the IRS process was completed. Twelve homesteads were selected in DV and nine in TV. Human serum, indoor air, floor dust, outside soil, potable water, leafy vegetables, and chicken samples (muscle, fat and liver) were collected and analyzed for both the o,p'- and p,p'-isomers of DDT, DDD and DDE. DDT was detected in all the media analyzed indicating a combination of potential dietary and non-dietary pathways of uptake. DV had the most samples with detectable levels of DDT and its metabolites, and with the exception of chicken muscle samples, DV also had higher mean levels for all the components analyzed compared to TV. Seventy-nine percent of participants from DV had serum levels of DDT (mean [summation operator]DDT 7.3microg g(-1) lipid). These residues constituted mainly of p,p'-DDD and p,p'-DDE. [summation operator]DDT levels were detected in all indoor air (mean [summation operator]DDT 3900.0 ng m(-3)) and floor dust (mean [summation operator]DDT 1200.0 microg m(-2)) samples. Levels were also detected in outside soil (mean [summation operator]DDT 25.0 microg kg(-1)) and potable water (mean [summation operator]DDT 2.0 microg L(-1)). Vegetable sample composition (mean [summation operator]DDT 43.0 microg kg(-1)) constituted mainly p,p'-DDT and p,p'-DDD. Chicken samples were highly contaminated with DDT (muscle mean [summation operator]DDT 700.0 microg kg(-1), fat mean [summation operator]DDT 240,000.0 microg kg(-1), liver mean [summation operator]DDT 1600.0 microg kg(-1)). The results of the current study raise concerns regarding the potential health effects in residents living in the immediate environment following DDT IRS.

Histopathological alterations in the liver of the sharptooth catfish Clarias gariepinus from polluted aquatic systems in South Africa.

There is a need for sensitive bio-monitoring tools in toxicant impact assessment to indicate the effect of toxicants on fish health in polluted aquatic ecosystems. Histopathological assessment of fish tissue allows for early warning signs of disease and detection of long-term injury in cells, tissues, or organs. The aim of this study was to assess the degree of histopathological alterations in the liver of C. gariepinus from two dams in an urban nature reserve, (Gauteng, South Africa). Two dams (Dam 1 and Dam 2) were chosen for their suspected levels of toxicants. Water and sediments were sampled for metal and potential endocrine disrupting chemical analysis. A quantitative and qualitative histology-based health assessment protocol was employed to determine the adverse health effects in fish. The analysis of blood constituents, fish necropsy, calculation of condition factors, and hepatosomatic indices were employed to support the findings of the qualitative and quantitative histological assessment of liver tissue. Assessment of the liver tissue revealed marked histopathological alterations including: structural alterations (hepatic cord disarray) affecting 27% of field specimens; plasma alterations (granular degeneration 98% and fatty degeneration 25%) of hepatocytes; an increase in melanomacrophage centers (32%); hepatocyte nuclear alterations (90%); and necrosis of liver tissue (14%). The quantitative histological assessment indicated that livers of fish collected from Dam 1 were more affected than the fish livers collected from Dam 2.

Histological changes in the liver of Oreochromis mossambicus (Cichlidae) after exposure to cadmium and zinc.

The toxic effects, of two heavy metals, cadmium (Cd) and zinc (Zn), on the histology of the liver of the southern African freshwater fish Oreochromis mossambicus, were investigated. The goal was to identify whether metal concentrations and exposure period influence the degree and nature of histological changes in the liver of exposed fish. Selected fish were exposed to a mixture of 5% concentrations of the LC(50) of cadmium and zinc and to a mixture of 10% concentrations of the LC(50) of cadmium and zinc, over both short- and long-term exposure periods. Similar histological changes occurred in the livers of specimens exposed to both 5% and 10% concentrations, indicating a definite toxic response to both the metal concentrations. These histological changes included hyalinization, hepatocyte vacuolation, cellular swelling, and congestion of blood vessels. The intensity of these histological changes was, however, influenced by the extent of the exposure period.

[Methylmalonic aciduria. A case report]. / Metielmalonielasidemie. 'n gevalbespreking.

A Black girl aged 19 months presented with vomiting, dehydration and severe acidosis without apparent cause. Further investigation revealed urinary excretion of large amounts of methylmalonic acid. The literature on methylmalonic aciduria is briefly reviewed. Seven possible biochemical defects have been described. Our patient did not improve with vitamin B12 therapy but the response after instituting a low-protein diet was excellent. The condition may be life-threatening if left untreated.