Pancreatic cancer mortality in South Africa: A case-control study

BACKGROUND

There are variations in the numbers of pancreatic cancer deaths reported annually in South Africa (SA). Since pancreatic cancer deaths in SA from 1997 to 2016, the number of cases has hugely increased, and reached 23 581 in both sexes. Sex differences are likely to contribute to the variations in the strength of associations between the risk factors and pancreatic cancer mortality.

OBJECTIVE

To identify factors associated with an increased risk of pancreatic cancer mortality in SA.

METHODS

A matched case-control study with 1:1 matching was conducted using data collected by Statistics SA from 1997 to 2016. Controls were randomly selected to be as similar as possible to the cases, and matched by age, sex and year of death. Conditional logistic regression was used to identify factors associated with pancreatic cancer mortality.

RESULTS

This case-control study comprised a final selection of 23 581 cases (12 171 males and 11 410 females) and 23 581 controls (12 171 males and 11 410 females). A significantly increased risk of pancreatic cancer mortality was observed among males who were managers (odds ratio (OR) 2.99; 95% confidence interval (CI) 1.36 - 6.60; p=0.006) and craft and related trade workers (OR 1.89; 95% CI 1.14 - 3.14; p=0.013). Elevated risks of pancreatic cancer mortality were also found among females who were managers (OR 6.13; 95% CI 1.32 - 28.52; p=0.021), professionals (OR 2.12; 95% CI 1.24 - 3.63; p=0.006), clerical support workers (OR 3.78; 95% CI 1.79 - 7.98; p=0.001) and elementary occupation workers (OR 1.41; 95% CI 0.99 - 2.00; p=0.059). Smoking was significantly associated with pancreatic cancer mortality in females (OR 1.36; 95% CI 1.02 - 1.82; p=0.039). Working in several occupations was associated with an increased risk of pancreatic cancer mortality in males (OR 1.31; 95% CI 1.01 - 1.71; p=0.045) and females (OR 1.66; 95% CI 1.30 - 2.12; p<0.001).

CONCLUSION

Smoking and certain occupations increased the risk of pancreatic cancer mortality. Further research is needed to evaluate the associations between other extrinsic and intrinsic factors and pancreatic cancer mortality.

RETRACTED

BACKGROUND

Upon the addition of the numbers corresponding to various cancer anatomical locations in the report published by Statistics South Africa (StatsSA), the absolute number and proportion of deaths due to all cancers increased from 36 726 (8.0%) in 2013 to 40 460 (8.5%) in 2015. These high figures suggest that malignant neoplasms were in fact the second-most frequent cause of death in South Africa (SA) in 2013, and moved to the first rank in 2015.

OBJECTIVES

To support the initiative aimed at reducing cancer mortality in SA. To this purpose, we assessed trends in cancer mortality rates among males and females in SA from 1997 to 2016 to better understand the increasing threat of cancer mortality in SA.

METHODS

The general mortality data for the period 1997 - 2016, as captured from death certificates in SA, was retrieved from StatsSA. Agestandardised mortality rates (ASMR) for each year were computed using the world standard population structure proposed by Segi as the reference population. The adjusted rates were reported per 100 000 population per year. The years of potential productive life lost (YPPLL) due to cancer deaths were calculated for each age group and gender.

RESULTS

There were 681  689 total cancer deaths from 1997 to 2016, with 51.1% males and 48.9% females. Males had higher mortality rates than females. The ASMR ranged from 105.0 to 129.2 and 67.9 to 88.3 per 100 000 population per year among males and females, respectively. In 2004, the cancer mortality rate increased significantly among males (129.2 per 100 000 population), which was 1.5 times higher than in females (88.3 per 100 000 population). Among males, cancer of the lung had the highest YPPLL (394 779.3), followed by oesophageal (253 989.4) and liver (207 911.0). The YPPLL for cancer of the cervix (647 855.5) ranked first, followed by breast (483 863.6) and lung (146 304.6) in females.

CONCLUSION

Cancer mortality rates have increased since 1997, regardless of gender. Overall, there was a decline in YPPLL for cancer in the young population, while it increased in the adult population. A significant reduction in cancer deaths could be achieved by broadly applying effective interventions.

The reliability of the modified lower extremity functional scale among adults living with HIV on antiretroviral therapy, in Rwanda, Africa

Peripheral neuropathy (PN) is common among people living with HIV (PLHIV) on antiretroviral therapy (ART), and affects their daily functional ability and quality of life. Lower extremity functional ability, which is most commonly compromised in patients with PN, has not been clearly evaluated in an African setting, with regard to functional limitations. The lower extremity functional scale (LEFS) was originally developed and validated among elderly people in the USA, where the environment and activities of daily life are very different from those in Rwanda. The purpose of this study was to adapt and establish the reliability of LEFS, among adults living with HIV on ART, in a Rwandan environment. The study translated LEFS from English to Kinyarwanda, the local language spoken in Rwanda, the LEFS was then modified accordingly, and tested for test-retest reliability among 50 adult PLHIV on ART. An average Spearman rank order correlation coefficient, ρ ≥ 0.7, was considered optimal for reliability. Prior to the modification of the LEFS and in the initial testing of the translated LEFS, none of the activities was strongly correlated (ρ ≥ 0.8); most of the activities (90%, 18/20) were moderately correlated (ρ ≥ 0.5) and 10% (2/20) were weakly correlated (ρ ≤ 0.5). The ρ of most of the functional activities improved after modification by an expert group to ρ ≥ 0.7, establishing reliability and validity of LEFS among PLHIV on ART with lower extremity functional limitations, in this environment. In conclusion, this study demonstrated the importance of modifying and establishing test - retest reliability of tools derived from developed world contexts to local conditions in developing countries, such as in Rwanda. The modified LEFS in this study can be used in Rwanda by clinicians, specifically at ART clinics to screen and identify people with functional limitations at an early stage of the limitations, for treatment, rehabilitation and/or referral to appropriate health care services.

The outcome of mental health care users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002)

OBJECTIVE

To determine the outcomes of mental health care users (MHCU's) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes.

METHOD

The study was a retrospective record review of MHCU's, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22's during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records.

RESULTS

During the six-month study period, 718 MHCU's were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU's and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU's diagnosed with delirium were more likely to be admitted into a medical ward as compared to a psychiatric ward.

CONCLUSION

As has been the case in most countries where police services have been incorporated into mental health acts, South Africa's new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU's end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have the capacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU's presenting with such factors to appropriate treatment facilities without admitting them to the hospital.

Clade-related phenotypic switching among fluconazole resistant Candida albicans isolates

INTRODUCTION

C. albicans undergoes phenotypic switchng, a putative virulence trait assisting the organism to adapt to different environments. Although this switching has been studied among C. albicans isolates, not much is known about the process among various C. albicans clades (a group of genetic variants within a single species).

AIM

To determine whether phenotypic switching among fluconazole resistant C. albicans isolates is clade-related.

METHODS

Fifteen fluconazole resistant C. albicans isolates from different clades were studied. Phenotypic switching was determined by a method previously described. Switching behaviour and different colony morphologies among different clades were compared.

RESULTS

Phenotypic switching was observed in all clades, with clade SA exhibiting the most switching (75%), and clade NG the east (5.6%). Stipple was the most dominant phenotype observed in all clades (p = 0.024), occurring mostly in clade SA (35%). Irregular wrinkle phenotype was dominant in clade SA (62%).

CONCLUSION

Phenotypic switching was clade-related. Highest switching in clade SA isolates suggests better survival un der adverse conditions. Stipple and irregular wrinkle phenotypes among clade SA isolates need to be studied further.

Functional disability and health-related quality of life in South Africans with early rheumatoid arthritis

BACKGROUND

The severity and predictors of functional disability and health-related quality of life (HRQoL) in a cohort of South Africans with early rheumatoid arthritis (RA) were investigated.

METHODS

Changes in the Health Assessment Questionnaire Disability Index (HAQ) and the 36-Item Short Form Health Survey (SF-36) following 12 months of traditional disease-modifying anti-rheumatic drugs (DMARDs) were studied in previously DMARD-naïve adults with disease duration ≤ 2 years.

RESULTS

The majority of the 171 patients were female (82%), Black Africans (89%) with a mean (SD) symptom duration of 11.6 (7.0) months. In the 134 patients seen at 12 months, there were significant improvements in the HAQ and all domains of the SF-36 but 92 (69%) still had substantial functional disability (HAQ > 0.5) and 89 (66%) had suboptimal mental health [SF-36 mental composite score (MCS) < 66.6]. Multivariate analysis showed that female sex (p = 0.05) and high baseline HAQ score (p < 0.01) predicted substantial functional disability at 12 months. Unemployment (p = 0.03), high baseline pain (p = 0.02), and HAQ score (p = 0.04) predicted suboptimal mental health, with a trend towards a low level of schooling being significant (p = 0.08).

CONCLUSIONS

Early RA has a broad impact on HRQoL in indigent South Africans, with a large proportion of patients still showing substantial functional disability and suboptimal mental health despite 12 months of DMARD therapy. Further research is needed to establish the role of interventions including psychosocial support, rehabilitation programmes, and biological therapy to improve physical function and HRQoL in this population.

Response to traditional disease-modifying anti-rheumatic drugs in indigent South Africans with early rheumatoid arthritis

The clinical response to traditional disease-modifying anti-rheumatic drugs (DMARDs) in indigent South Africans with early rheumatoid arthritis was investigated. A cohort of patients with early (≤2 years) RA who were DMARD-naïve at inception were prospectively assessed for response to DMARDs using the Simplified Disease Activity Index (SDAI) over a 12-month period. Patients with low disease activity (LDA) at 12 months were compared to those with moderate and high disease activity with respect to demographic, clinical, autoantibody and radiographic features. The 171 patients (140 females) had a mean (SD) age of 47.1 (12.4) years, symptom duration of 11.7 (7.1) months and baseline SDAI of 39.4 (16.2). There was a significant overall improvement in the SDAI and its components in the 134 (78.4%) patients who completed the 12 months visit, but only 28.4% of them achieved LDA. The majority of patients (91%) were treated with methotrexate as monotherapy or in combination with chloroquine and/or sulphasalazine. Baseline features that independently predicted a LDA state at 12 months were lower Health Assessment Questionnaire Disability Index (p = 0.023) and a higher haemoglobin level (p = 0.048). Receiver operating characteristic curve analysis showed that the 6-month SDAI was better than the baseline SDAI in predicting the 12-month SDAI (area under the curve of 0.69 vs. 0.52, respectively, p = 0.008). In conclusion, less than a third of the patients achieved a low disease activity at 12 months on traditional DMARDs. Patients who have an inadequate response to traditional DMARDs at 6 months are unlikely to show further improvement on traditional DMARDs at 12 months. These findings underscore the need for better disease control by an aggressive tight control strategy, including intense patient education and biologic therapy.

Differences in characteristics between people with lower limb amputations who died before 12 weeks and those who survived: Short Report

The baseline determinants of survival following a non-traumatic lower limb amputation (LLA) in participants in the Johannesburg metropolitan area are unknown.The aim of the study was to establish the characteristics of participants who had died by three months after LLAA longitudinal pre- test- post test study utilized participant interviews (n=73).  Consecutive  sampling  was  used  to  select  participants  who  met  the  inclusion criteria. Ethical clearance was obtained. Permission was obtained from the hospitals. Participants gave consent before taking part in the study. A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI) and the Barthel Index (BI) were used, to collect data. Participants  were  interviewed  preoperatively  and  then  followed  up  three  months  post-operatively  to  establish survival/ existence. Twenty-four  participants  (33%)  had  died.  The  preoperative  median  Visual  Analogue  Scale  (VAS)  of  the  EQ-5D was 60 and 70 showing no significant difference in quality of life (QOL) between those who survived and those who  died  respectively.  The  preoperative  median  total  BI  score  was  20  and  19  showing  significantly  inferior  function for the deceased (p=0.01). The deceased were significantly older (p=0.009) used alcohol (p=0.02) and smoked tobacco (p=0.03).Being older, having poorer function, being a smoker and drinking alcohol preoperatively seem to decrease the chance of survival following LLA in Johannesburg.

Common lower extremity injuries in female high school soccer players in Johannesburg east district

Objectives. Soccer is one of the sports in South Africa which hasseen an increase in the participation of youth and adult female players. The aim of this study was to determine point and 1-year prevalence, profile of injuries that affect female soccer players, associations between injuries and player position, age, use of equipment, frequency of play, and training duration. Methods. A retrospective questionnaire-based descriptive survey of 103 first team high school female soccer players in the Johannesburg east district was conducted.Results. The 1-year prevalence for the participants who reportedinjuries was 46% (N=47) and the point prevalence was 33% (N=34). From these, a total of 78 and 42 injuries for the 1-year and point prevalence respectively were reported. An extended duration of skills (p=0.0001) and fitness (p=0.02) training in this population reduced the likelihood of incurring an injury. The older the participants, the more chance there was of sustaining injuries (p=0.01). The participants who wore shin guards were less prone to shin/leg injuries (p=0.01), the relative odds being 0.35. Themidfielders had more foot and toe injuries than the other players(p=0.05). Starting age (p=0.78), frequency of play (p=0.83), wearing of shoes (p=0.54) and stretching had no influence on injury. The knee and ankle were the main locations of injury, with defenders and midfielders mostly being injured. Conclusion. A decrease in the duration of training for both skills and fitness and not wearing shin guards are risk factors for injury in female soccer players in high school. The profile of injuries andthe risk factors determined from this study do not differ from the studies done in male adolescent and adult soccer players.

Osteoarticular tuberculosis in patients with systemic lupus erythematosus

BACKGROUND

Systemic lupus erythematosus (SLE) patients are at increased risk of developing tuberculosis (TB), particularly extrapulmonary TB (ExP-TB).

AIM

The present study was undertaken to investigate whether SLE patients showed increased susceptibility to develop osteoarticular TB (OA-TB).

DESIGN AND METHODS

We retrospectively reviewed and compared the frequency of ExP-TB, in particular OA-TB, in patients with SLE at a tertiary hospital in South Africa, to a non-SLE control TB group seen at the same hospital.

RESULTS

TB was diagnosed 111 times in 97 (17%) of the 568 SLE patients. The relative frequency of ExP-TB in the SLE group (25.2%) was significantly lower than in the control group (38.5%) (OR = 1.9, P = 0.006). In contrast, OA-TB was diagnosed in the SLE group in nine (8.1%) patients (seven with peripheral arthritis and two with TB spine) compared to 54 (0.4%) in the overall control group (OR = 20.8, P < 0.001) and 13 (0.2%) in the subgroup of known HIV positive patients in the control group (OR = 44.4, P < 0.001). Within the SLE group, Black ethnicity (P = 0.003), lymphopaenia (P = 0.001), C3/C4 hypocomplementaemia (P = 0.05), corticosteroids [maximum dose (P = 0.002) and duration of treatment (P = 0.02)] and immunosuppressive agents (P = 0.02) were risk factors for TB. Duration of corticosteroid therapy was the only risk factor for OA-TB (P = 0.04).

CONCLUSION

While the relative frequency of ExP-TB was lower in the SLE group compared to the control group, our findings suggest that SLE patients are at particular risk of developing OA-TB. Further prospective studies are needed to better understand the mechanisms that predispose SLE patients to OA-TB.

Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus isolates from South Africa

OBJECTIVE

Trends in the antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) are regularly investigated in many countries, but minimal countrywide data are available for South Africa. The aim of this study was to describe the antibiotic susceptibility patterns of MRSA isolates collected in South Africa.

DESIGN

Susceptibility testing of 248 MRSA isolates collected from 15 National Health Laboratory Services (NHLS) and 8 private laboratories against 17 antibiotics was performed using the disc diffusion method. Demographic data were collected and correlated with antibiotic resistance patterns.

RESULTS

Antibiotic resistance of MRSA to erythromycin, tetracycline, trimethoprim/sulfamethoxazole, gentamicin and ciprofloxacin ranged between 55% and 78%, while all isolates were susceptible to teicoplanin, linezolid, vancomycin and quinopristin/dalfopristin. A significant difference in the resistance pattern of the isolates towards certain antimicrobial agents was identified among adults and children, as well as between isolates collected from the private and NHLS laboratories.

CONCLUSION

This is the first extensive report on the antimicrobial susceptibilities of South African MRSA isolates. These data can assist treatment decisions and form a baseline for further surveillance.