Does cancer risk increase with HbA1c, independent of diabetes?

BACKGROUND: The risks for several cancer types are increased in people with diabetes. Hyperglycaemia, hyperinsulinaemia, inflammation and altered hormonal concentrations are common characteristics between the two diseases and can all be linked to hyperglycaemia. METHODS: Here, we use glycated haemoglobin (HbA1c) as a biomarker for chronic hyperglycaemia. We explore whether cancer risk increases with HbA1c, independent of diabetes, and, therefore, if risk is already increased below the diabetic HbA1c range, by analysing data from current studies linking HbA1c to risk of several cancer types. RESULTS: The data reveal that chronic hyperglycaemia correlates with increased cancer risk for a number of cancers, except prostate cancer. Evidence is also provided that risk is already increased in the pre-diabetic and normal ranges for several cancers. CONCLUSIONS: These results merit urgent investigation into the risks and advantages of updating recommendations for stricter glycaemic control in diabetic and non-diabetic subjects, as this could help reduce the risk of cancer incidence and mortality.

Evaluating postcranial macromorphoscopic traits to estimate population variation among modern South Africans.

Population overlap and the variation within and among populations have been globally observed but is often difficult to quantify. To achieve this, numerous different methods need to be explored and validated to assist with the creation of an accurate biological profile. The current lack of databases for postcranial macromorphoscopic traits indicates the need to further investigate if the method can be employed repeatably in a forensic context. The current study aimed to assess the prevalence of eleven postcranial macromorphoscopic traits in a South African sample. A total of 271 postcrania of adult black, coloured, and white South Africans were assessed. The intra- and inter-observer agreement ranged from fair to almost perfect except for the accessory transverse foramen of C1, which had poor agreement between observers. Only seven traits differed significantly between at least two of the groups. Univariate and multivariate random forest models were created to test the positive predictive performance of the traits to classify population affinity. The classification accuracies for the univariate models ranged from 33.3% to 53.0% and ranged from 54.6% to 62.1% for the multivariate models. Based on the variable importance, the traits assessing spinous process bifurcation were the most discriminatory variables. The results indicate that the postcranial MMS approach does not outperform current methods employed to estimate population affinity. Further research needs to be done for the method to have practical applicability for medicolegal casework in South Africa.

Distinct genital tract HIV-specific antibody profiles associated with tenofovir gel.

The impact of topical antiretrovirals for pre-exposure prophylaxis on humoral responses following HIV infection is unknown. Using a binding antibody multiplex assay, we investigated HIV-specific IgG and IgA responses to envelope glycoproteins, p24 Gag and p66, in the genital tract (GT) and plasma following HIV acquisition in women assigned to tenofovir gel (n=24) and placebo gel (n=24) in the CAPRISA 004 microbicide trial to assess if this topical antiretroviral had an impact on mucosal and systemic antibody responses. Linear mixed effect modeling and partial least squares discriminant analysis was used to identify multivariate antibody signatures associated with tenofovir use. There were significantly higher response rates to gp120 Env (P=0.03), p24 (P=0.002), and p66 (P=0.009) in plasma and GT in women assigned to tenofovir than placebo gel at multiple time points post infection. Notably, p66 IgA titers in the GT and plasma were significantly higher in the tenofovir compared with the placebo arm (P<0.05). Plasma titers for 9 of the 10 HIV-IgG specificities predicted GT levels. Taken together, these data suggest that humoral immune responses are increased in blood and GT of individuals who acquire HIV infection in the presence of tenofovir gel.

Synthesis of high-purity precipitated calcium carbonate during the process of recovery of elemental sulphur from gypsum waste.

We recently showed that the production of elemental sulphur and calcium carbonate (CaCO3) from gypsum waste by thermally reducing the waste into calcium sulphide (CaS) followed by its direct aqueous carbonation yielded low-grade carbonate products (i.e. <90 mass% as CaCO3). In this study, we used the insight gained from our previous work and developed an indirect aqueous CaS carbonation process for the production of high-grade CaCO3 (i.e. >99 mass% as CaCO3) or precipitated calcium carbonate (PCC). The process used an acid gas (H2S) to improve the aqueous dissolution of CaS, which is otherwise poorly soluble. The carbonate product was primarily calcite (99.5%) with traces of quartz (0.5%). Calcite was the only CaCO3 polymorph obtained; no vaterite or aragonite was detected. The product was made up of micron-size particles, which were further characterised by XRD, TGA, SEM, BET and true density. Results showed that about 0.37 ton of high-grade PCC can be produced from 1.0 ton of gypsum waste, and generates about 0.19 ton of residue, a reduction of 80% from original waste gypsum mass to mass of residue that needs to be discarded off. The use of gypsum waste as primary material in replacement of mined limestone for the production of PPC could alleviate waste disposal problems, along with converting significant volumes of waste materials into marketable commodities.

Patterns of individual coping, engagement with social supports and use of formal services among a five-country sample of resilient youth.

BACKGROUND: Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being. METHOD: For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset. RESULTS: The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are to provide interventions and case management. Young people's patterns of navigation were shown to be contingent upon the individual's risk exposure, his or her individual capacity to cope, and the quality of the formal and informal supports and services that are available and accessible. CONCLUSION: Differing amounts of formal resources in low-, middle- and high-income countries influence patterns of service use. Implications for better coordination between formal mental health services and social supports are discussed.

Conversion of calcium sulphide to calcium carbonate during the process of recovery of elemental sulphur from gypsum waste.

The production of elemental sulphur and calcium carbonate (CaCO3) from gypsum waste can be achieved by thermally reducing the waste into calcium sulphide (CaS), which is then subjected to a direct aqueous carbonation step for the generation of hydrogen sulphide (H2S) and CaCO3. H2S can subsequently be converted to elemental sulphur via the commercially available chemical catalytic Claus process. This study investigated the carbonation of CaS by examining both the solution chemistry of the process and the properties of the formed carbonated product. CaS was successfully converted into CaCO3; however, the reaction yielded low-grade carbonate products (i.e. <90 mass% as CaCO3) which comprised a mixture of two CaCO3 polymorphs (calcite and vaterite), as well as trace minerals originating from the starting material. These products could replace the Sappi Enstra CaCO3 (69 mass% CaCO3), a by-product from the paper industry which is used in many full-scale AMD neutralisation plants but is becoming insufficient. The insight gained is now also being used to develop and optimize an indirect aqueous CaS carbonation process for the production of high-grade CaCO3 (i.e. >99 mass% as CaCO3) or precipitated calcium carbonate (PCC).

Atherosclerotic lesions in the thoracic aorta: a South African anatomical and histological mortuary study.

BACKGROUND: Worldwide, the prevalence of cardiovascular diseases such as atherosclerosis is on the increase. Younger people may be especially vulnerable owing to their exposure to risk factors such as drug abuse and HIV. METHODS: The thoracic aortas of 149 South Africans under the age of 50 years were collected at the Salt River Mortuary, Cape Town, and examined macroscopically and microscopically for evidence of anomalies. The sample comprised predominantly males, and included black, coloured and white individuals. RESULTS: A significantly higher level of macroscopic pathology was found in coloured males, although overall prevalence of pathology in this sample was lower than expected. A positive association was also found between body mass index and vascular pathology in the black and coloured population groups. Microscopic anomalies were common and present at high levels, irrespective of age and racial grouping. CONCLUSIONS: The widespread prevalence of microscopic anomalies in all groups suggests that these are normal variations that result from haemodynamic forces. The higher prevalence of atherosclerotic lesions in coloured males, however, probably results from specific genetic conditions such as hypercholesterolaemia or lifestyle factors such as diet or tik abuse. The findings suggest that coloured individuals may be at increased risk of developing cardiovascular disease.

Incidence of seropositive myasthenia gravis in Cape Town and South Africa.

BACKGROUND: Myasthenia gravis (MG) is a treatable autoimmune disease characterised by fatiguable weakness of skeletal muscles. More than 85% of MG patients have antibodies to the acetylcholine receptor (AChR) at the neuromuscular junction or are seropositive for MG (SPMG). In the developed world the incidence of MG has increased, particularly among older individuals, but no epidemiological studies have been done on SPMG in Africa. OBJECTIVES: To determine the annual incidence rate (IR) of SPMG in the Cape Town (CT) municipality, and the crude annual IR of SPMG for the whole of South Africa (SA). METHODS: Positive AChR antibody tests were identified between 1 January 2003 and 1 January 2005 for patients living in CT, and the age- and sex-specific incidences were calculated. To determine the national crude annual IR over the same period, positive assays were identified from the laboratories that process AChR assays for SA. National Census 2001 population statistics formed the denominators. RESULTS: There were 65 positive assays in CT, and 230 nationwide. Based on these figures the annual IR for CT was 11.2 per million per year (95% confidence interval (CI) 8.7 - 14.3), and for South Africa 2.6 per million/year (95% CI 2.2 - 2.9). After a questionnaire response from CT neurologists regarding the routine use of the AChR antibody assay, the annual IR for CT was adjusted to 12.6 per million (95% CI 9.9 - 15.9) to incorporate those presumed to have SPMG without a confirmatory test. In CT, the IR in females was 15.3 per million/year (95% CI 11.2 - 20.4), and in males, 6.8 per million/year (95% CI 4.1 - 10.7). The CT IRs for blacks, coloureds and whites were not statistically different after adjusting for age and gender. The IR of SPMG in CT was 6 times greater in those presenting after the age of 50 years than in those with earlier disease onset (95% CI 3.7 - 9.7). CONCLUSIONS: The annual IR of SPMG in CT is much the same as rates recorded recently in other developed countries, but the rest of SA has a much lower IR. A preponderance of MG starting after the age of 50 years reflects a worldwide trend, although the CT data showed a relatively lower-than-expected incidence for older males. IRs for SPMG vary widely in different regions in SA; this is likely to be related to differences in regional health care delivery, and underdiagnosis.

Intracranial Arterial Dissection Related to HIV Infection. A Case Report with Histology.

SUMMARY: There are many reasons for patients infected with human immunodeficiency virus (HIV) to develop cerebrovascular disease. The HIV virus itself however may be a cause of vessel wall pathology. We present a clinical and pathological study of a patient who was HIV positive and presented with a subarachnoid haemorrhage. Cerebral angiography and later histology confirm that there was extensive vessel wall injury with dissection and a false aneurysm of the right middle cerebral artery.