Lower frequency of NPM1 and FLT3-ITD mutations in a South African adult de novo AML cohort

INTRODUCTION

Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of hemopoietic progenitor cells diagnosed in individuals of any age, but with a median age of 67 years at presentation in adults. Assessment of the mutation status of nucleophosmin protein-1 (NPM1) and FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) is essential for the prognosis, and treatment of AML.

METHODS

A total of 160 de novo AML cases, both cytogenetically normal and abnormal, were analyzed for the presence of NPM1 and FLT3-ITD mutations, and the results assessed in conjunction with epidemiological, clinical, and laboratory findings.

RESULTS

Nucleophosmin protein-1 mutations were found in 7.5%, while FLT3-ITD was present in 12% of these cases. Both of these were lower than expected. The median age at diagnosis of AML was 41 years, and for the FLT3-ITD only cases, median age was 33 years; these ages were younger than expected.

CONCLUSION

The lower reported frequencies and younger median age at diagnosis of AML and these specific mutations may be contributed to by a number of factors including effects of race on age of presentation, inclusion of patients diagnosed with de novo AML only, and a generally younger median age of the South African population.

Asymmetrical soft palate cleft repair: preliminary results

The reconstructions of the asymmetrical soft palate cleft is a surgical challenge when it comes to achieving symmetry and optimal soft palate muscular function. Three different versions of the intravelar veloplasty have been used: the intravelar veloplasty (1969) (type I), the modification according to anatomical defects (1991) (type II), and the modification using part of Sommerlad's technique and part of Ivanov's technique (2008) (type III). The perioperative outcomes of the type II and type III intravelar veloplasty were assessed and compared in asymmetrical cleft cases. Two hundred and seventy-seven soft palate clefts were reconstructed: 153 type II and 124 type III. Of these, 49 were asymmetrical (17.7%); 23 underwent the type II procedure and 26 the type III procedure. Of the type II procedure cases, 30.4% remained asymmetrical postoperatively compared to 3.8% of the type III cases. The uvula appeared subjectively atrophic in 47.8% of the type II cases and in 7.7% of type III cases. Oro-nasal fistula occurred in 13.0% of the type II cases and 3.8% of the type III cases. Speech results will only be assessed after 4 years of age. The type III modified intravelar veloplasty has had a major beneficial impact on patients who had an asymmetrical soft palate cleft.

The relation between oral impacts on daily performances and perceived clinical oral conditions in primary school children in the Ugu District, Kwazulu Natal, South Africa

Few studies have related the common oral health related quality of life (OHRQoL) impacts in children to perceived causes.

OBJECTIVE

To assess the prevalence, extent and intensity of oral impacts in relation to perceived clinical conditions in primary school children in South Africa.

METHODS

Cross-sectional study of a random sample of children attending 26 schools. The Child Oral Impacts on Daily Performance (Child-OIDP) index, administered through individual face-to-face interviews, was used.

RESULTS

Sixty four per cent of the sample of 2610 children aged 11-13 years participated. 36.2% reported having one or more oral impacts on daily performances, 61.1% having one affected and 63.1% reporting impacts were of "very little" or "little" intensity. Eating was most commonly affected (22.8%) mainly related to decay (40%), followed by cleaning the teeth (17.2%). Toothache impacted on speaking (32.5%), whereas toothache (35.7%) and tooth decay (28.6%) influenced studying. Position of teeth impacted on smiling (19.2%), social (8.5%) and speaking (7.5%). Bleeding gums" and "tooth colour" affected cleaning teeth and smiling respectively.

CONCLUSIONS

The prevalence of oral impacts on the quality of life in this South African population of schoolchildren was relatively modest, as was the extent and intensity of the impacts, affecting mainly eating, cleaning of teeth and smiling.

How do I comment ethically on the work of colleagues?

Patients are entitled to know about their dental and oral health, and practitioners have an ethical duty to inform them on an honest and factual basis. If this can be done without denigrating one's colleagues in any way, both patients and practitioners can benefit. As professionals, our first obligation is to place the well-being of our patients ahead of our own interests. First and foremost and for patient autonomy, we must give patients complete and truthful information regarding their current oral health status. When asked to comment on another dentist's treatment, it is not unethical or unprofessional to remember that the burden of proof regarding faulty or bad treatment s demanding and a prudent dentist must exercise great caution before making comments about other dentist's treatment. Uninformed and unjustifiable criticism is disparaging and can lead to unpleasant consequences for the unwary professional. Comprehensive and accurate records would be needed by both dentists to support their clinical judgement, if this case ever resulted in a complaint.

Prevalence of mental disorders in a prison population in Durban, South Africa

OBJECTIVE

The aim of this study was to determine the prevalence of serious mental disorders in a prison population in Durban, South Africa, one of the largest prisons in the Southern hemisphere.

METHOD

193 prisoners were interviewed using the Mini Neuro-psychiatric Interview, a screening questionnaire and a demographic questionnaire.

RESULTS

The study demonstrated that 55.4% of prisoners had an Axis 1 disorder. The commonest disorder being substance and alcohol use disorders (42.0%). 23.3% of prisoners were diagnosed with current psychotic, bipolar, depressive and anxiety disorders. 46.1% were diagnosed with antisocial personality disorder. The majority of prisoners diagnosed as having an Axis 1 disorder in this study, were neither diagnosed nor treated in prison.

CONCLUSION

There is a high prevalence of mental disorders among prisoners in a prison population in Durban, South Africa. The majority of these prisoners are untreated in prison, related to non detection of the mental disorder. Greater mental health awareness and provision of mental health services focusing on staff training programmes to detect mental illnesses are needed and further research is recommended throughout South Africa.

Tuberculosis infection control in primary health clinics in eThekwini, KwaZulu-Natal, South Africa

SETTING

Primary health clinics in KwaZulu-Natal, South Africa.

OBJECTIVE

To assess and describe current practices in infection control at local government primary health clinics.

DESIGN

A descriptive study using a standardised tool to assess adherence to recommended infection control policies in 51 primary health clinics in 2009-2010. Administrative policies, engineering controls and personal respiratory protection were assessed by observations and interviews at the clinics.

RESULTS

Of 51 clinics, 11 (22%) had infection control policies, 13 (26%) triaged coughing patients and 16 (31%) had a dedicated nurse and a dedicated consulting room for treating tuberculosis (TB) patients. Study clinics treated a median of 99 patients (range 3-331) daily and a median of 15 TB patients (range 2-73) monthly. Of the rooms in the clinics, all of which rely on natural ventilation, half (149/284) had ≤12 air changes per hour. Eleven (22%) of 51 clinics had N95 masks available for staff use.

CONCLUSION

Limited infection control practices exist in clinics in a high TB burden setting in KwaZulu-Natal, South Africa. These practices need to be implemented more widely to minimise the spread of TB to non-infected patients and health care workers in primary health clinics.

The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements

Intentional and unintentional injuries were reported to be the second leading cause of Disability Adjusted Life Years in South Africa in 2000. We present household experiences of such injuries in 5 impoverished housing settlements in Johannesburg, Gauteng Province. Data for this study were extracted from the database of the Health, Environment and Development (HEAD) project. The incidence of reported intentional injuries was determined to be double that of unintentional injuries. Households in the Hospital Hill and Riverlea settlements reported the highest prevalence of stabbing and gunshot incidents. We concluded that impoverished South African neighbourhoods bear a high burden of intentional injury; surveillance mechanisms are required to inform prevention strategies at an individual, community and societal level.