Rheumatic fever in an urban community.

Forty-six children with acute rheumatic fever were admitted to Coronation Hospital, Johannesburg, between April 1981 and December 1984; 4 of them were admitted twice during this period. Their ages ranged from 4.5 years to 12.4 years. Carditis was present in 26 patients, arthritis in 22, chorea in 14, subcutaneous nodules in 3 and erythema marginatum in 2. Three patients died and a further 3 had to undergo emergency valve replacement for intractable cardiac failure. Thirty-five developed rheumatic heart disease; they all had mitral regurgitation. Compliance with prophylaxis was acceptable in only 22 cases.

Paediatricians in the RSA, 1981-2000.

A survey of all paediatricians registered with the South African Medical and Dental Council in July 1981 was conducted and the results were correlated with the child population as determined by the 1980 census. There were 201 active paediatricians, of whom 55% were employed in hospitals and 45% in private practice; 83% were resident in areas in which there were teaching hospitals, while only 23% of the total number of children resided in these areas. Sixty per cent of the children (95% of whom were Black) lived in predominantly rural areas where there were no paediatricians. The number of paediatricians in South Africa is expected to rise rapidly during the next 2 decades. We are therefore faced with the problem of having a paediatrician corps which although adequate in number is badly distributed, resulting in the rural population being grossly under-serviced. Possible solutions are presented.

Early introduction of milk feeds in acute infantile gastro-enteritis. A controlled study.

A blind controlled trial was performed to test the hypothesis that early introduction of full-strength cow's milk (FCM) during an attack of acute infantile gastroenteritis does not prolong the course of the illness. A total of 74 children matched for age was admitted to the trial, which compared the effect of FCM with that of graduated milk (the strength of which was gradually increased). Thirteen children (17.5%) were withdrawn because of lactose malabsorption; of those remaining, 29 were given FCM and 32 graduated milk. The mean duration of diarrhoea was 2,62 days for those on FCM and 2,64 days for those given graduated milk (P = 0,71, not significant). Early introduction of FCM therefore does not prolong the course of acute infantile gastroenteritis. Because of the prevalence of malnutrition in South Africa the practice of giving clear fluids or diluted milk during an attack of gastro-enteritis is unnecessary and dangerous.

Facilities for children in state and provincial hospitals.

A limited survey of provincial and state hospital facilities for children in the RSA was carried out through a questionnaire. Replies were received from 195 hospitals from the provinces of the Cape, Transvaal and Natal as well as from the independent homeland of Ciskei. These hospitals represented 90.3% of the beds in these areas. It was found that there were many more black children per available bed than white (632 v. 416) and that beds for black children had a much higher occupation rate than those for whites (+/- 85% v. +/- 50%). Rural black children were considerably worse off than their urban counterparts. Many hospitals did not have full-time medical officers to look after their paediatric patients. It is recommended that future resources be directed at improving facilities for rural black children and opening lines of communication between existing rural hospitals and the large academic hospitals.

Self-healing juvenile cutaneous mucinosis in a patient with nephroblastoma.

Self-healing juvenile cutaneous mucinosis is characterized by an early age of onset, the presence of plaques and nodules in a characteristic distribution, and rapid onset followed by spontaneous resolution of the lesions within a period of weeks to months. Only four previous cases have been reported. The patient in this study was an 8-year-old child who developed cutaneous lesions characteristic of self-healing juvenile cutaneous mucinosis while undergoing chemotherapy for a nephroblastoma. This is the first case described of self-healing juvenile cutaneous mucinosis associated with a neoplasm.

Pharyngeal carriage of group A beta-haemolytic streptococci in coloured and Indian schoolchildren.

Throat swabs for group A beta-haemolytic streptococci were taken from 120 Coloured children and 126 Indian children at approximately 3-monthly intervals during 1980. The prevalence of positive throat swabs was related to crowding at home as measured by the number of people per bedroom. Coloured homes were much more crowded than Indian homes, but no statistical relationship was found between the number of persons per bedroom and the positivity rates. Both groups of children had high positivity rates in summer (24,4% and 21,3% for Coloureds and Indians respectively) but low rates in spring (4,3% and 3,4% respectively). These positivity rates do not support the provision of primary prophylaxis against acute rheumatic fever for these children.

Serum transferrin values in White and Black toddlers: a comparative study.

Serum albumin and transferrin levels were measured and compared in healthy White and Black toddlers and a significant difference was found. Black girls had significantly higher transferrin levels than White girls. No significant correlation was found between serum transferrin and either body weight, haemoglobin or serum albumin. These findings seem to question the validity of transferrin as a sensitive parameter for the detection of subtle protein energy malnutrition.

Beta-thalassaemia--the Johannesburg experience.

Twenty-nine patients with beta-thalassaemia major were treated in two Johannesburg hospitals between 1979 and 1984. They belonged to two ethnic groups--Mediterranean and Asian--and 53% were under the age of 6 years, the oldest being 20 years. Eight patients underwent splenectomy. All were regularly transfused and their quality of life greatly improved. The complication of regular transfusions is iron overload, which contributes to morbidity and mortality. Despite adequate iron excretion as a result of subcutaneous desferrioxamine (DFO) infusions, the patients showed significant iron overload, which suggested poor compliance in the home use of DFO and was the main long-term problem in the treatment of beta-thalassaemia major. Education needs to be directed at communities at risk and their doctors so that new cases can be prevented and the financial and emotional cost eased. If patients are given full support in complying with therapy, their life expectancy should be greatly increased.

Thalassemia: lung function with reference to iron studies and reactive oxidant status.

Pulmonary function tests were performed in 15 thalassemic patients (age 5 years 8 months to 18 years 6 months), receiving both regular transfusions and desferrioxamine, to determine the presence and nature of any abnormalities in lung function. Reactive oxidant production from neutrophils was measured simultaneously to ascertain if a causal relationship existed between free radical production and tissue damage in the lungs. Mean total lung capacity, mean residual volume, and mean forced vital capacity were significantly reduced, indicating a restrictive pattern of lung function abnormality. In addition, the carbon monoxide diffusion was low, and hypoxemia was present in 6 of 13 patients tested. These pulmonary function abnormalities did not correlate with age, cumulative volume of transfusion, or serum ferritin levels. In addition, neutrophil reactive oxidant status did not correlate with these or with pulmonary function parameters. These results indicate that neutrophil-derived oxygen free radicals do not appear to be a major cause of lung function abnormalities in thalassemics.