Sedick Isaacs

Hepatitis E in South Africa : Evidence for sporadic spread and increased seroprevalence in rural areas

Hepatitis E virus (HEV) is a major cause of non‐A, non‐B hepatitis in developing countries. Factors influencing sporadic spread of hepatitis E are unclear. We examined anti‐HEV seroprevalence and demographic data from 407 urban and 360 rural black South African adults living in formal housing, squatter camps, or mud huts. Anti‐HEV seroprevalence ranged from 5.8% to 19.1% (mean 10.7%) in the different regions. Mean urban and rural rates were 6.6% and 15.3%, respectively (P = 0.0001). Rural mud hut dwellers, using unchlorinated river water, were at greater risk (17.4%) than rural villagers (5.3%; P = 0.008). A linear relation was found between seroprevalence and age, suggesting sporadic spread. The high prevalence in mud hut dwellers suggests that contaminated water plays a major role in HEV spread in South Africa. Routine chlorination or boiling of river drinking water before consumption may reduce HEV infection.

High prevalence of GBV-C hepatitis G virus infection in a rural South African population.

A novel virus, GBV‐C/hepatitis G virus (GBV‐C/HGV), has been cloned and characterised recently. GBV‐C/HGV global epidemiology and risk factors for acquisition are currently unclear. We aimed to establish the determinants of this infection in a rural South African (SA) population. The study population included two samples, namely a community‐based sample, and consenting persons from a nonspecialist outpatient department in the same district. A questionnaire regarding demographic details and putative risk factors was administered; blood samples were taken on which a polymerase chain reaction (PCR) was performed for both 5′NCR and NS5a regions of GBV‐C/HGV using commercially available primers and probes. Two hundred and forty‐nine people were studied with a mean GBV‐C/HGV prevalence of 10.4%. Outpatient department and community prevalences differed significantly (18.0% and 6.3%, respectively, P = 0.004). GBV‐C/HGV infection was associated with excessive alcohol consumption (P = 0.02; OR, 4.18) and a lack of waterborne sewerage (P = 0.04). PCR amplification of the NS5a region of all but two South African GBV‐C/HGV positive samples showed poor reactivity. The prevalence of GBV‐C/HGV in rural SA appears to be higher than that reported from Europe and North America. Infection appeared to be associated with excess alcohol intake and a history of previous blood transfusions. The discrepant NS5a and 5′NCR PCR sensitivity in this study raises the possibility of genetic differences in southern African GBV‐C/HGV. J. Med. Virol. 53:225–228, 1997.

Hypoparathyroidism after the treatment of laryngopharyngeal carcinoma

Thirty patients with squamous cell carcinoma of the laryngopharynx were treated with surgery (total laryngectomy and hemithyroidectomy) and radiotherapy. Group 1 (n = 7) patients had surgery only; Group 2 (n = 7) had radiotherapy followed by salvage surgery while Group 3 (n = 16) had surgery followed by radiotherapy. Parathyroid hormone and calcium levels were measured pre- and post-operatively and post-radiotherapy. In Group 1 no patients were hypoparathyroid. In Group 2, 29 per cent of patients preoperatively and 57 per cent post-operatively, were hypoparathyroid. In Group 3, no patients were hypoparathyroid pre-operatively, while 25 per cent were hypoparathyroid post-operatively and post-radiotherapy. Parathyroid hormone and calcium levels were averaged and compared within and between each group. There was no significant difference within each group, when comparing levels post-operatively and post-radiotherapy from those of pre-operatively. There was no significant difference in levels between each of Groups 1, 2 or 3 (p > 0.05).

Pre- and intra-operative staging of the neck in a developing world practice.

Most patients with squamous cancer of the head and neck treated at Groote Schuur Hospital are from a poor socio-economic background with a high prevalence of tuberculosis (TB), human immunodeficiency virus (HIV) and other infections that may cause cervical lymphadenopathy resulting in overstaging of the neck. A retrospective review of 186 patients requiring therapeutic and elective neck dissection was undertaken and the sensitivity and specificity of clinical and intra-operative staging of the neck determined. Results showed overall sensitivity of staging at 80.1 per cent. Specificity was 52.2 per cent. Staging of the N(1), N(2b) and N(2c) necks had positive predictive values of 53.2, 65.8 and 68.2 per cent respectively. Occult nodal metastases were present in 32 per cent elective neck dissections (END)s. Specificity of intra-operative staging of the N(0) neck was 33.3 per cent and sensitivity was 72.4 per cent. Conclusions were that our indications for elective neck dissection are appropriate. The high false positive rates for staging of the N(1), N(2b) and N(2c) necks, necessitate a change in management strategy.

Overt hypoadrenalism is uncommon in patients with stage 3 and 4 bronchogenic carcinoma

INTRODUCTION Lung cancer is the leading cause of cancer mortality in most countries. The adrenal glands are common sites of metastatic lung cancer as approximately 40% of subjects with stage 4 bronchogenic carcinoma have adrenal metastases. The prevalence of biochemical hypoadrenalism is, however, remarkably poorly documented. OBJECTIVES Our study aimed to determine the prevalence of primary hypoadrenalism, as defined by a subnormal cortisol response to the 250 micrograms adrenocorticotrophic hormone (ACTH) stimulation test, in patients with stage 3 and 4 lung cancer. METHODS Thirty patients with stage 3 and 4 bronchogenic carcinoma were prospectively recruited from the bronchus clinic. Demographic data and electrolytes were recorded and each patient had a 250 micrograms ACTH stimulation test to determine the prevalence of overt adrenal insufficiency, defined as a +30 minute cortisol of less than 550 nmol/l. RESULTS The median age and quartile deviation was 62 (10) years and the median basal cortisol was 429.5 (321) nmol/l. The median peak cortisol was 828.5 (342) nmol/l (range 536-1,675 nmol/l). Twenty-eight patients (93.3%) had an appropriate rise of cortisol to greater than 550 nmol/l following 250 micrograms ACTH stimulation. Two patients (6.7%) had mild primary adrenal failure with a peak cortisol between 500 and 550 nmol/l associated with a raised plasma ACTH concentration (131.4 and 10.5 pmol/l, normal 2.2-10 pmol/l). Twenty-eight patients (92.9%) were normonatraemic, while the two hyponatraemic patients had biochemical evidence of the syndrome of inappropriate antidiuretic hormone secretion. CONCLUSION In conclusion, despite evidence that the adrenal glands of patients with disseminated bronchogenic carcinoma are frequently affected by metastatic disease, biochemical evidence of clinically significant hypoadrenalism is relatively uncommon and is not accurately predicted by electrolyte abnormalities.