Authors:T. van der Made, M. van de Vyver, M. Conradie-Smit, Magda Conradie Pages: 1 - 8 Abstract: Background: The association between hyperemesis gravidarum (HG) and abnormal thyroid function is well known. Aims: The prevalence, aetiology and course of thyrotoxicosis in women with hyperemesis gravidarum (HG) were studied. Methods: Women admitted for HG, who underwent thyroid function evaluation between 1 August 2016 and 30 April 2019, were studied. Laboratory data included baseline human chorionic gonadotropin (hCG) and baseline (t1), discharge (t2) and follow-up (t3) thyroid function tests (thyroid stimulating hormone [TSH] and free thyroxin [fT4]). Available TSH receptor antibody status was assessed. Results: Eighty-two patients were included. The incidence of thyrotoxicosis was 49% based on local laboratory TSH range and 48% if trimester-specific ranges used. In the majority of normal pregnancies, thyrotoxicosis was hCG-mediated (72.5%), 15% were confirmed to have Graves’ disease and 12% had a molar pregnancy. Very high fT4 levels (> 40 pmol/l) at baseline [t1] were documented in 24% of women with hCG-mediated thyrotoxicosis. Clinical features were absent in a third of women with Graves’ disease and the diagnosis was reliant on positive antibody status. Free T4 values declined from (t1) to later in gestation (t3) (p < 0.001). Conclusion: The incidence of thyrotoxicosis in women with HG is high. Free-T4 values decrease with clinical stabilisation of HG, suggesting a contribution of dehydration to the large variation in baseline fT4 measurements. Testing for TSH-receptor antibodies should be considered in women with TSH < 0.01 pmol/l and persistent fT4 elevation on follow-up. Final review of thyroid function should be performed after 15 weeks’ gestation. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Authors:Cassandra Bruce-Brand, Abraham C. van Wyk Pages: 9 - 15 Abstract: Introduction: A substantial proportion of phaeochromocytomas and paragangliomas are associated with underlying germline mutations, of which the majority are due to mutations in one of the genes in the succinate dehydrogenase (SDH) complex. A commercially available immunohistochemical stain for SDHB has excellent correlation with SDH gene mutation status when staining is lost. This abnormal loss of staining can identify potential familial tumours and tumours with a higher risk of malignant behaviour. The prevalence of SDH deficiency in the South African setting has not been published previously. Methods: A retrospective laboratory-based study at Tygerberg Hospital in Cape Town used immunohistochemistry on archived tumour tissue to assess loss of SDHB staining in phaeochromocytomas and paragangliomas submitted to the histopathology laboratory (National Health Laboratory Service) between 2005 and 2015. Results: Tumour tissue from 52 patients was tested. In total, 36% showed loss of staining. Loss of staining was significantly correlated with a younger age at presentation (z = −3.59, p < 0.001). The median age of those who showed loss of staining was 26 years (IQR 21–41), compared with 50.5 years (IQR 36–61) for those who showed retained staining. The interobserver agreement in the interpretation of the immunohistochemical stain was excellent (Cohen’s kappa = 0.917; 95% confidence interval, 0.81–1, p < 0.001). Conclusion: Approximately one-third of phaeochromocytomas and paragangliomas in our setting are likely to be associated with germline mutations in one of the SDH genes. Immunohistochemical testing of tumour tissue can identify this group to allow better prognostication and appropriate genetic testing and counselling. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Authors:M. Budge, W. Conradie, K. Beviss-Challinor, L. Martin, M. Conradie, A. Coetzee Pages: 16 - 23 Abstract: Background: Increased bone resorption is a well-described consequence of primary hyperparathyroidism (PHPT). In South Africa, little is known about the impact of PHPT on skeletal health. Objective: To determine the prevalence of decreased bone mineral density (BMD), vertebral fractures and osteitis fibrosa cystica in patients with PHPT who underwent parathyroidectomy. Methods: Retrospective study of patients who underwent parathyroidectomy for PHPT at Tygerberg Hospital in Cape Town, from January 2010 to December 2019. Clinical, biochemical and BMD parameters are described. Results: Final analysis included 56 patients (median age 63.5 years; 80.4% female). Initial calcium, parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) levels were 2.93 mmol/l, 19.4 pmol/l and 34.0 nmol/l, respectively. Of the total cohort, 71.4% had decreased BMD. The prevalence of osteoporosis and osteopenia in postmenopausal women and men ≥ 50 years was 50.0% and 39.1% respectively; low bone mass for age in premenopausal women and men < 50 years was 20.0%. Vertebral fractures were seen in 21.2% of patients on radiography. Osteitis fibrosa cystica was present in five patients (9.6%). PTH levels were significantly elevated in patients with osteoporosis compared with those with normal BMD (36.4 vs. 16.1 pmol/l; p = 0.02). Conclusion: Two-thirds of patients who underwent parathyroidectomy for PHPT had decreased BMD, with osteoporosis present in 50% of postmenopausal women and older men. One in five had vertebral fractures. These findings underscore the importance of skeletal assessment in the management of PHPT. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Authors:Dominic Hicks, Robert C. Hickner, Usha Govinden, Takshita Sookan Pages: 24 - 28 Abstract: Background: Exercise interventions improve type 2 diabetes (T2D). Published randomised control trials and crossover control trials were systematically examined to establish the differences in the effect of single-bout exercise on glucose control and insulin sensitivity in individuals with type 2 diabetes. Methods: Using PRISMA guidelines on three electronic databases, studies that tested the effects of a single bout of exercise on glucose control and insulin sensitivity in T2D were identified. To be included, studies had to meet the PRISMA criteria and contain data on the effects of a single bout of exercise on blood glucose and/or insulin resistance in individuals with T2D. Results: Three of the 205 articles met the inclusion criteria. All of the studies prescribed a single bout of continuous aerobic exercise at 40–60% heart rate reserve (HRR), 60% HRR, or 73% VO2 peak. Aerobic exercise was associated with improved glucose control when compared with resistance exercise. Continuous aerobic exercise significantly lowered average glucose during the first 24 hours post-exercise. Interval walking decreased mean and maximal blood glucose when compared with that in control. Conclusions: In conclusion, the findings of this review suggest high-intensity interval training to be the most effective form of exercise. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Authors:M. Esaadi, F. Paruk, B. Cassim Pages: 29 - 33 Abstract: Objectives: There are limited data on vertebral fractures (VFs) in South Africa (SA). Therefore a study was undertaken to compare the demographic profile, clinical risk factors and bone mineral density (BMD) in subjects aged 60 years and over with and without morphometric VFs. Patients and methods: In a descriptive case-controlled study, demographic data, clinical risk factors (CRF) and BMD were collected. Morphometric VFs were identified using the semi-quantitative Genant method. Descriptive analysis was undertaken using Student’s t-test, the Mann–Whitney U-test and the chi-square test. Results: In the 197 subjects enrolled, the median age was 72.0 years (IQR 67.0–78.5 years) and morphometric VFs were identified in 41 subjects (20.8%). The prevalence of VFs increased with age, and while more common in women compared with men (23.8% vs. 13.0%), this was not significant (p 0.095). There was no difference in the prevalence of VFs between African and Indian subjects (23.4% vs. 17.4%; p 0.240), nor CRFs between subjects with and without VFs. Subjects with a VF had a significantly lower BMD at the spine (p = 0.020), but not at the neck of femur and total hip. Conclusion: This study highlights the need for adequate screening and management protocols for osteoporosis in all ethnic groups in SA. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Authors:Melanie Pienaar, Marianne Reid, Mariette Nel Pages: 34 - 39 Abstract: Objective: To establish the impact of a face-to-face peer-support intervention on adults with type 2 diabetes in South Africa. Methods: A cluster randomised controlled trial was conducted involving 288 adults with type 2 diabetes from six communities in the Free State province. Individuals (n = 141) in three communities were randomly allocated to the intervention group, and individuals (n = 147) in another three communities were randomly allocated to the control group. Trained community health workers led monthly group sessions and home visits. The control group received the usual care. The primary outcome of the study was glycated haemoglobin (HbA1c), measured at baseline and endpoint after four months. Secondary outcomes included blood pressure, body mass index and waist circumference, measured at baseline and endpoint. Descriptive statistics were calculated per group. Results: No significant changes from baseline were found between groups regarding HbA1c (p = 0.87), body mass index (p = 0.21), waist circumference (p = 0.24) and systolic blood pressure (p = 0.13). Compared with the control group, the intervention group had a significant improvement in diastolic blood pressure (p = 0.02). Conclusions: The face-to-face peer-support intervention delivered by trained community health workers in a semi-urban rural area resulted in a significant improvement in diastolic blood pressure of adults with type 2 diabetes. PubDate: 2021-08-31 Issue No:Vol. 26, No. 1 (2021)
Open Access journal
[261 journals]
