Auto-immune haemolytic anaemia and paroxysmal nocturnal haemoglobinuria red cell 11 abnormality in the same patient

This report concerns a young Indian woman with idiopathic auto-immune haemolytic anaemia. The erythrocytes repeatedly gave positive tests for the paroxysmal nocturnal haemoglobinuria abnormality, as well as positive antiglobulin tests. The possible reasons for this unusual association are discussed.S. Afr. Med. J., 48, 2146 (1974)

Demographic and Social Factors Influencing Public Opinion on Prostitution: An Exploratory Study in Kwazulu-Natal Province, South Africa

This paper examines countervailing South African public opinion on the subject of prostitution in South Africa, and identifies the factors which might influence these attitudes. It also investigates the complex relationship between public opinion and the law. Whilst engaging in prostitution constitutes a criminal offence under the Sexual Offences Act 23 of 1957, it is generally ignored by the police, which results in a quasi-legalised reality on the ground. In recent years there has been growing demand for the decriminalisation of prostitution, and as a result the issue is currently under consideration by the South African Law Reform Commission. The Commission released a Discussion Paper on Adult ProSstitution in May 2009, and is expected to make recommendations to parliament for legal reform in this area. An exploratory survey of 512 South Africans revealed interesting correlations between opinion on prostitution and both demographic characteristics (including gender, age, race and education level) and so-called "social" characteristics (including religiosity, belief in the importance of gender equality, the acceptance of rape myths, and a belief that prostitutes have no other options). The survey reveals two key findings in respect of the attitudes of South Africans to prostitution. Firstly, an overwhelming majority of South Africans - from all walks of life - remain strongly morally opposed to prostitution, and would not support legal reforms aimed at decriminalising or legalising prostitution. Secondly, our data confirm that these views are strongly influenced by certain demographic and 'social' variables. In particular, race, gender, religiosity, cohabitation status, and socio-economic status were found to bereligiosity, cohabitation status, and socio-economic status were found to be statistically significantly related to opinions on prostitution, while other variables - particularly the belief in the importance of gender equality and the level of education - had no statistically significant relationship with tolerance of prostitution. Given that the proposed legal reforms, which will shortly be tabled before parliament, will [1]necessitate the consideration of public opinion, it is imperative that studies such as the one presented in this paper be conducted to gauge the likely response which such proposed reforms might face.   

Are anticardiolipin antibodies responsible for some of the complications of severe acute Plasmodium falciparum malaria?

What were first called simply false-positive Wassermann reactions and then lupus anticoagulant are now known as antiphospholipid or anticardiolipin antibodies (ACA). These are known to cause a tendency to thrombosis and are frequently present in many neurological conditions and infections. The pathological significance of these antibodies in acute infections, if any, is unknown. We investigated the presence ofthese antibodies in Plasmodium falciparum malaria in an endemic area in Natal/KwaZulu, and attempted to correlate  the presence of this antibody with cerebral manifestations. Immunoglobulin G-anticardiolipin antibodies measured by enzyme-linked immunosorbent assay occurred significantly more frequently in 62 patients with acute Plasmodium falciparum malaria (33,9%) than in 37 control subjects (2,7%) (P < 0,0001). There was no significant difference in the mean parasite loads in those patients who were positive for ACA (1,75%) and those who were negative (1,59%) (P = 0,83). No correlation was found between parasite load and ACA levels in the patient group, or between the number of cerebral manifestations in patients with and without the antibody. The frequency of  splenomegaly was not significantly different in patients with and without ACA (P =0,06). We conclude that there is a high prevalence of ACA in acute falciparum malaria. The pathological significance of this antibody and its relationship to complications, especially cerebral ones, warrant greater attention and may improve the understanding of cerebral malaria and its management

Prenatal ultrasonographic diagnosis and successful management of mediastinal teratoma A case report

A case of mediastinal teratoma, diagnosed in utero by realtime ultrasonography during a late 3rd trimester evaluation of polyhydramnios, is described. Prompt respiratory assistance to the infant at birth and early surgical intervention led to a successful outcome

The association of antiphospholipid antibodies with severe early-onset pre-eclampsia

Objective. To confirm the association of antiphospholipid antibodies with early onset of severe pre-eclampsia before 30 weeks' gestation.Study design. Thirty-four patients with diastolic blood pressure levels ≥ 110 mmHg and at least 2+ proteinuria before the 30th week of pregnancy were randomly chosen for inclusion in the study. Blood samples were taken for assessment of anticardiolipin antibodies (ACAs), lupus anticoagulant, syphilitic serology and antinuclear antibodies. Fifteen normal antenatal patients matched for age, parity and gestational age acted as control subjects.Results. Four of the 34 women (11,7%) in the study group had elevated levels of both ACAs and lupus anticoagulant, compared with none in the control group. This was not found to be statistically different.Conclusion. Given the low incidence of positive ACAs in early-onset severe pre-eclampsia it is unlikely that they are implicated in its pathogenesis. It is possible that they represent a small subset of patients with alternative or combined pathology

An adolescent with both Wegener's Granulomatosis and chronic blastomycosis

We report a case of Wegener's Granulomatosis (WG) associated with blastomycosis. This appears to be the first case report of WG co-existing with a tissue proven blastomycosis infection. The temporal correlation of the two conditions suggests that blastomycosis infection (and therefore possibly other fungal infections), may trigger the systemic granulomatous vasculitis in a predisposed individual; a provocative supposition warranting further study

Anti-neutrophil cytoplasmic antibodies:Current diagnostic and pathophysiological potential

Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome characterized by rapid deterioration of renal function occurring within days or weeks together with signs of glomerulonephritis, that is, proteinuria and hematuria with cellular casts. The syndrome is, in many cases, histopathologically manifested as fibrinoid necrosis of the capillary wall with extracapillary proliferation and crescent formation [1]. This so-called necrotizing crescentic glomerulonephritis (NCGN) is seen in 5 to 15% of renal biopsies in most series [1–3]. Although it is infrequent, the importance of the condition is illustrated by the fact that most cases of NCGN, if left untreated, develop renal failure within days or weeks [1]. Based on immunohistopathology NCGN can be subdivided into three distinct categories. The first one, occurring in 2 to 20% of the cases and characterized by linear staining of the glomerular capillary wall for immunoglobulin and complement, has classically been described as anti-glomerular basement membrane (GBM) disease. It is associated with autoantibodies to structural antigens of the GBM, in particular to the first globular noncollagen domain of collagen type IV [4]. The antibodies are considered of pathogenetic significance. The second category, comprising 15 to 50% of cases, is characterized by granular deposits of immunoglobulin and complement suggesting that immune complexes are pathogenetically involved. This type occurs in conjunction with systemic autoimmune diseases such as lupus erythematosus, in cases of post-infectious glomerulonephritis, IgA nephropathy or Henoch-Schönlein purpura, or as an idiopathic variety. The third group of NCGN, occurring in 40 to 80%, demonstrates only a few or no immune deposits and is designated as pauci-immune NCGN [1–3, 5, 6]. Pauci-immune NCGN occurs as part of Wegener's granulomatosis (WG) or related conditions, or without systemic vasculitis (idiopathic NCGN). The pathophysiology of this pauci-immune type of NCGN has not been elucidated. Within the last decade, however, it has been recognized that the condition is associated with autoantibodies to cytoplasmic components of neutrophils (anti-neutrophil cytoplasmic antibodies or ANCA).ANCA were first described in 1982 by Davies et al in a few patients with segmental necrotizing glomerulonephritis [7]. Only in 1985 did it become apparent that ANCA are a sensitive and specific marker for Wegener's granulomatosis (WG) [8]. Later on, ANCA were described in patients with microscopic polyarteritis [9]. Falk and Jennette, in 1988, showed that ANCA are also associated with the idiopathic form of pauci-immune NCGN [10]. These data have now been confirmed by many groups and support the view that ANCA-associated glomerulonephritis and vasculitis is, indeed, a distinct disease category. A number of studies, in addition, have suggested that ANCA are involved in the pathophysiology of the aforementioned disorders. As ANCA, however, have recently also been detected in a wide range of inflammatory and infectious conditions, a critical reappraisal of the diagnostic significance of ANCA-testing seems justified.In this review we will evaluate the current state of ANCA-testing as well as elaborate on the pathophysiological role of the autoantibodies in necrotizing glomerulonephritis and vasculitis. Data presented recently at the Fifth International Workshop on ANCA, held in Cambridge, United Kingdom, will be included [11]. As such, it adds to previous reviews on ANCA that were published following the Second [12], Third [13], and Fourth [14] Workshops on ANCA