Reflections on trauma and violence-related deaths in Soweto, July 1990 - June 1991

This is a retrospective analysis of 5 600 deaths registered in Soweto from July 1990 to June 1991. The impact of trauma and violence on the overall mortality pattern was assessed. The majority of deaths occurred in people under the age of 50 years and more men died than women. In 40% of male deaths, the cause was stated as 'ill-defined' or 'unknown'; this was the case in an even higher percentage of female deaths (50,5%). Trauma or violence accounted for 28,5% of all deaths. The gender difference was particularly visible in the trauma category, viz. 89,5% and 10,5% in men and women respectively. Young men (20 - 29 years) were particularly affected by trauma and violence-related deaths (38,5%). The major types of injuries inflicted were gunshot wounds (33%), unspecified multiple injuries (32%) and stab wounds (27%). Motor vehicle accidents accounted for only 8% of deaths. The urgent need for intervention programmes to prevent unnecessary loss of life, targeted especially at young adults and children, is highlighted

Asbestos in the non-mining industry on the Witwatersrand, South Africa

Background and introduction. For many decades, and until fairly recently, asbestos was commonly found in most sectors of South African industry. Consequently there is a large but indeterminate pool of formerly exposed workers, some of whom will present to medical practitioners for evaluation of possible asbestosis, the pneumoconiosis caused by the fibre. Fundamental to the diagnosis of asbestosis is a history of asbestos exposure sufficient to cause the disease. Attending practitioners need to be aware of the common asbestosis inducing industries and jobs and the duration of exposure reported by patients if we are to obtain and interpret their exposures. This paper describes asbestos exposure in 141 cases of asbestosis. Methods. Cases were identified from patient records at the Occupational Medicine Clinic of the National Institute for Occupational Health (NIOH, formerly NCOH), for the years 1980 - 2000. Patients were only included in the series if they had no asbestos exposure in mining, if they had been certified with asbestosis by a compensation panel, and if on re-reading of the chest radiograph a radiologist reported irregular opacities (profusion 1/0 or greater on the International Labour Organisation (ILO) scale). Asbestos exposure was taken from the patient's records. Results. Only one patient was exposed in an industry where asbestos was incidental to the enterprise's operation, while 54% of cases arose from exposure in primary asbestos industries, i.e. companies selling, distributing, refining, milling or using raw asbestos to manufacture products. The mean reported duration of exposure was 17.5 years. Surprisingly, 21 cases (15%) reported less than 5 years' exposure. Unexpectedly, 7 cases had a latency period from first exposure to diagnosis of less than 6 years. Conclusion. The data presented should assist practitioners in the purposeful exploration of asbestos exposure and in interpretation of its significance with regard to asbestosis. S Afr Med J 2005; 95: 47-51

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure. Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA. Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors. Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality. Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop

Occupational respiratory diseases in South Africa results from SORDSA, 1997- 1999

Objectives. To describe the nature and extent of work-related respiratory diseases reported to the national Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) reporting scheme. The causative agents and industrial categories in which they occurred are also characterised.Design. Voluntary monthly reporting of newly diagnosed cases by pulmonologists, occupational medicine practitioners and occupational health nurses.Setting. Medical and occupational health referral centres in the nine provinces of South Africa.Subjects. Cases were workers from non-mining industries or ex-miners, suffering from a newly diagnosed occupational respiratory disease, reported to SORDSA between October 1996 and December 1999.Outcome measures. Frequencies of reported occupational respiratory disease by year, reporting source, province and sex. Frequencies of short- and long-latency diseases by industry and causative agent.Results. There was incomplete reporting coverage of the nine provinces in the first 3 years. Reporting was most comprehensive from Gauteng, KwaZulu-Natal and the Western Cape. Diseases with long latency periods made up 76.2% of the cases. Pneumoconiosis, even in non-mining industries, was the most frequently reported disease, followed by inhalation accidents. Occupational asthma was the fourth most reported disease. Apart from the prominence of pneumoconiosis, the results obtained by . SORDSA are similar to those from a British occupational lung disease surveillance scheme. This study showed that newly diagnosed cases of occupational lung disease occurred in many industries and were caused by a variety of agents.Conclusion. SORDSA has contributed insight into the nature, extent and distribution of occupational respiratory diseases in South Africa. It has also highlighted important causes of occupational respiratory diseases in South Africa, as well as hazardous industries. The data indicate that South Africa has a widespread occupational lung disease problem, and provide a platform for targeted prevention strategies

Survival of patients with Kaposi’s sarcoma in the South African antiretroviral treatment era: A retrospective cohort study

Background. When South Africa (SA) implemented its antiretroviral therapy (ART) programme in 2004, the model for treating HIV-positive Kaposi’s sarcoma (KS) patients shifted from symptomatic palliation to potential cure.Objective. To evaluate survival and changes over time in AIDS-KS patients treated at a tertiary academic hospital oncology unit (the Steve Biko Academic Hospital medical oncology unit) in Pretoria, SA, in the context of ART availability in SA.Methods. We conducted a retrospective review of electronic and paper records of KS patients who accessed cancer care between May 2004 and September 2012. We used Kaplan-Meier survival functions to estimate 1- and 2-year survival, and Cox regression models to identify changes over time and prognostic factors.Results. Our study included 357 AIDS-KS patients, almost all of whom were black Africans (n=353, 98.9%); 224 (62.7%) were men. The median age at cancer diagnosis was 37 (interquartile range (IQR) 30 - 43) years, and the median baseline CD4+ count was 242 (IQR 130 - 403) cells/µL. Most patients received ART (n=332, 93.0%) before or after KS diagnosis; 169 (47.3%) were treated with chemotherapy and 209 (58.6%) with radiation therapy. Mortality was 62.7% lower (adjusted hazard ratio (HR) 0.37, 95% confidence interval (CI) 0.19 - 0.73) in the late (2009 - 2012) than in the early (2004 - 2008) ART period. Receiving chemotherapy (adjusted HR 0.3, 95% CI 0.15 - 0.61) and poor-risk AIDS Clinical Trials Group KS stage (adjusted HR 2.88, 95% CI 1.36 - 6.09) predicted mortality.Conclusions. Our results show that large national ART roll-out programmes can successfully reduce KS-related mortality at the individual patient level. If ART coverage is extended, KS-associated morbidity and mortality are likely to drop.

Extracellular LGALS3BP regulates neural progenitor position and relates to human cortical complexity.

Basal progenitors (BPs), including intermediate progenitors and basal radial glia, are generated from apical radial glia and are enriched in gyrencephalic species like humans, contributing to neuronal expansion. Shortly after generation, BPs delaminate towards the subventricular zone, where they further proliferate before differentiation. Gene expression alterations involved in BP delamination and function in humans are poorly understood. Here, we study the role of LGALS3BP, so far known as a cancer biomarker, which is a secreted protein enriched in human neural progenitors (NPCs). We show that individuals with LGALS3BP de novo variants exhibit altered local gyrification, sulcal depth, surface area and thickness in their cortex. Additionally, using cerebral organoids, human fetal tissues and mice, we show that LGALS3BP regulates the position of NPCs. Single-cell RNA-sequencing and proteomics reveal that LGALS3BP-mediated mechanisms involve the extracellular matrix in NPCs' anchoring and migration within the human brain. We propose that its temporal expression influences NPCs' delamination, corticogenesis and gyrification extrinsically

Risk of mesothelioma from exposure to crocidolite asbestos: a 1995 update of a South African mortality study

OBJECTIVE—To find the risk of developing mesothelioma in a cohort born in 1916-36 in Prieska, Northern Cape Province, South Africa.
METHODS—A birth cohort mortality study was carried out in a small town in the Northern Cape Province, South Africa, with a history of crocidolite asbestos mining and milling. The cohort comprised all white births registered in the magisterial district of Prieska from 1916 to 1936, inclusive (2390). Causes of death due to mesothelioma and other cancers as recorded on medical certificates of cause of death were investigated. Person-years analysis was used to calculate mortalities due to mesothelioma, other respiratory cancers, and other non-respiratory cancers. Proportional cancer mortalities were also calculated for mesothelioma and other specific neoplasms.
RESULTS—The follow up rate for the cohort was 74.3% in 1995, and 683 traced members (38.6%) had died. Cause of death was unknown for 6.4% of deaths. There were 118 cases of cancer, 28 of them from mesothelioma, giving a cause specific mortality for mesothelioma of 277 (170-384) per 10(6) person-years. The rates for men and women were 366 and 172 per 10(6) person-years, respectively. The mortality for lung cancer (29( )deaths) was 287 (135-436) per 10(6) person-years, and that for other non-respiratory cancers (60( )deaths) was 593 (442-745). Two cases of laryngeal and four of colon cancer were observed. All cancer mortality, mesothelioma, and lung cancer proportional cancer mortality ratios were increased.
CONCLUSION—The mortality for mesothelioma in men was twice that in women, probably because men were more likely to have had both occupational and environmental exposure to asbestos. Nevertheless, the mortality in women was still high and is probably indicative of the environmental exposure as white women were rarely employed in the asbestos industry in the Prieska area. Due to the long latency from first exposure to diagnosis of the neoplasm, the cause specific mortality in this cohort could be expected to increase rapidly over the next 10( )years. 


Keywords: South Africa; asbestos; environmental exposure; occupational exposure; cohort; mesothelioma; lung cance

The prevalence and age distribution of peripheral pulmonary hamartomas in adult males - An autopsy-based study

This autopsy-based study defined the prevalence and age distribution of peripheral pulmonary hamartomas in 47635 southern African miners examined between 1975 and 1988. The prevalence rate for white miners was 7,5/1000 and for black miners 1,1/1 000. When directly standardised to the white men in the general population. the rates for white and black miners were 7,2 and 5,5/1 000, respectively. The prevalence of peripheral pulmonary hamartomas in both groups increased with age, from 0,8/1000 in the third decade to 12,0/1000 in the eighth decade. The study showed a much higher prevalence of peripheral pulmonary hamartomas for whites than previously reported. Furthermore, it documented the occurrence of these benign lung tumours in blacks, a fact that has previously been questioned. There appeared to be no significant difference in prevalence and age distribution between white and black miners, although the database for the black group was deficient for the later decades of life