African Ethnic Origin Research Articles

Clinical characteristics and treatment requirements of children with autosomal recessive pseudohypoaldosteronism.

Autosomal recessive forms of pseudohypoaldosteronism are caused by genetic defects in the epithelial sodium channel. Little is known about the long-term outcome and medication needs during childhood and adolescence. This study reports a single-centre experience of children affected with this ultra-rare condition over a 37-year period. We report the clinical presentation, growth, neuro-development, associated conditions, mortality and medication dosing and administration for 12 affected children from eight families. All children were presented within the first 2 weeks of life with life-threatening, severe hyperkalaemia and hyponatraemia. All parents were consanguineous and of South Asian, Middle Eastern or African ethnic origin. Eight children had homozygous mutations in the SCNN1A and SCNN1G genes, encoding the epithelial sodium channel subunits alpha and gamma, respectively, including one novel mutation. Three children died (25%) and two (16%) had severe neurological impairment post-cardiac arrest secondary to hyperkalaemia. One affected female had a successful pregnancy at the age of 28 years. Despite high mortality and morbidity in this condition, survival with normal physical and neurological outcome is possible, justifying intensive management to prevent electrolyte imbalance.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Next generation sequencing exome data analysis aids in the discovery of SNP and INDEL patterns in Parkinson's disease

Whole exome sequencing is an adept method to reveal novel and disease-related SNPs and INDELs as it screen the actionable areas of the genome. We evaluated the exome sequenced datasets of patients with Parkinson's disease (PD) in South African ethnic origin. The primary focus of this study was to discover the SNPs and INDELs patterns responsible for PD. The variant discovery was performed with genome analysis tool kit best practices variant detection pipelines. The SNPs were linked to the genes and categorized based on the filter-based annotation from ANNOVAR. We identified a total of 7955 SNPs and 9952 INDELs in all seven datasets together. A total of 130 missense nsSNPs were prioritized based on its damaging effect predicted from SIFT and Polyphen2 annotation. We noticed a novel nsSNP rs111655870 in gene LRRK2 that shows the mutation of a Leucine to Phenylalanine at position 208 which can alter the protein function. The study also filtered seven nsSNPs in genes NAGA, SULT4A1, MYH8, FLNA, TPM3, ATP13A1, CLN8 that have potentially deleterious effects predicted by various computational tools. This analysis suggested that the above filtered nsSNPs and INDELs have a functional impact and provide the footing for genetic studies related to PD. Further screening of these variations provides deeper insight for molecular mechanism of disease progression.

Growing up African Canadian in Vancouver: Racialization, Gender and Sexuality

Vancouver is one of the most diverse cities in North America, with 49% of the population identifying as people of colour. However, residents who are racialized as Black or claim an African ethnic origin make up just over 1% of the population. These residents may constitute a hyper-visible minority in the local context, but they are firmly embedded in discourses about Blackness that transcend local geographies. Based on interviews with 35 adult children of immigrants from sub-Saharan Africa, this paper explores some of the ways that gendered and sexualized discourses of Blackness shape the lives of men and women in metro Vancouver. Interactions in public spaces include challenges to competency, honesty, and respectability, while private lives are marked by differences in heterosexual desirability that enhance the romantic prospects of men and limit those of women. The following discussion illustrates that processes of racialization are simultaneously gendered and sexualized.

Enhancing the care of patients with sickle cell disease.

When typically round red blood cells intermittently elongate and become lodged in the body's microcirculation, this can result in painful vaso-occlusive crises, often referred to as 'sickle cell crises'. The sickling and unsickling process can result in acute pain, chronic anaemia, ischaemic injury and multiple organ damage. One of the main concerns raised by patients with sickle cell disease is the lack of knowledge and understanding of their condition among healthcare professionals in acute care settings. Therefore, this article aims to enhance nurses' understanding of sickle cell disease and the effective management of painful vaso-occlusive crises. While sickle cell disease was traditionally perceived to only occur in people of black African or African-Caribbean ethnic origin, this article seeks to challenge this belief and reconsider sickle cell as a public health concern for all.

Prediction of vaginal birth after cesarean delivery.

To examine factors associated with successful vaginal birth after cesarean (VBAC) and to validate a previously established prediction model. In a retrospective study, data were obtained for women with one prior low-transverse cesarean procedure who underwent a trial of labor with a cephalic singleton pregnancy at term at one UK hospital between January 2000 and August 2013. Univariate analysis and logistic regression analysis were used to identify maternal demographic characteristics significantly associated with successful VBAC and factors independently associated with this outcome, respectively. A prediction model was built, and predicted probabilities were compared with observed frequencies. For validation, probabilities were also calculated by a previous prediction model. Overall, 1463 women formed the cohort. Successful vaginal delivery was achieved in 1050 (71.8%) women. The only factors significantly associated with unsuccessful VBAC were Asian (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.14-2.23) or African (OR 1.80, 95% CI 1.23-2.64) ethnic origin, and previous cesarean for failure to progress (OR 6.39, 95% CI 4.81-8.49). The predicted and observed probability of successful VBAC were well correlated (Spearman ρ, 0.905; P=0.002). The established prediction model was less accurate. Previous cesarean performed for failure to progress and Asian/African ethnic origin were associated with unsuccessful VBAC. The performance of a previous prediction model was inferior.

Myeloma in Martinique; Characteristics and Overall Survival

IntroductionAfrican Americans (AA) are twice as likely to be diagnosed with multiple myeloma (MM) as Caucasian Americans (CA). Differences in overall survival have also been shown between those two populations with no consistent explanation with regard to social status or genetic profile given by gene expression profiling. In Martinique, where most of the population has African or French Caribbean ethnic origin with similar increased incidence in MM, we lack data about disease characteristics and survival as compared to French Caucasian patients.Material and methodsThe aim of this single center retrospective study was to evaluate characteristics, progression free and overall survival of this population. We analyzed 54 MM elderly patients consecutively treated in Fort de France Hematology department from March 2007 to March 2012. All patients received first line treatment with melphalan 0.2 mg/kg/d, prednisone 2 mg/kg/d and thalidomide 400 mg/d every 6 weeks according to French IFM guidelines. Disease characteristics and survival data were analyzed and compared to French Caucasian elderly MM patients included in first line IFM published trials.ResultsPopulation had a median age of 80 years (66 to 93). Concerning prognostic markers, International Scoring System (ISS) was of 3 (high) in 52% of patients and cytogenetic analysis showed rearrangements with translocation 14q32 in 22% with 7% of t(4;14). When considering deletion 13q, it was found in 41% and deletion 17p in 6%. With a median follow up of 35 months, survival features showed median overall survival (OS) of 48.6 months and progression free survival (PFS) of 28.9 months.DiscussionCompared to French Caucasian patients, our series showed that Martinique’s population was older and presented more aggressive disease based on ISS. Moreover, almost half patients presented with MDRD clearance lower than 60ml/min which conferred higher B2m and worse prognosis. We also confirmed results recently published by Weiss and all who described lower rate of IgH translocation in African American population with MM.Despite higher median age and ISS, median overall survival of our population was unexpectedly similar to French published studies with IFM 99 06 trial showing median OS and PFS in MPT arm of 51.6 and 27.5 months respectively. In IFM 01/01 trial where patients were aged more than 75 with lower doses of melphalan and thalidomide, survival data showed median OS of 44 months and median PFS of 24.1 months. In meta analysis published by European Myeloma Network, median OS was even lower with 39.3 months.Our data tend to show that French Caribbean patients with first line MM treated in Martinique appear to have similar overall survival as compared to French Caucasian patients despite higher median age and more adverse prognostic features which has not been reported so far. We plan to confirm those data with new analysis with longer median follow up and extensive clinical and biological disease characteristics evaluation. DisclosuresMoreau:celgene: Consultancy.

Boundaries of Frenchness: cultural citizenship and France’s middle-class North African second-generation

Based on 45 interviews in the Paris metropolitan area, I focus on the middle-class segment of France’s North African second-generation and use the framework of cultural citizenship to explain why these individuals continue to experience symbolic exclusion despite their attainment of a middle-class status. Even though they are successful in terms of professional and educational accomplishments and are assimilated by traditional measures, they nonetheless feel excluded from mainstream French society. Because of this exclusion, they do not feel they are perceived as full citizens. I also discuss how this segment of France’s second-generation draws boundaries around being French and how they relate to these boundaries. Despite their citizenship and their ties to France, they are often perceived as foreigners and have their ‘Frenchness’ contested by their compatriots. I argue they are denied cultural citizenship, because of their North African ethnic origin, which would allow them to be accepted by others as part of France. Applying cultural citizenship as an analytical framework provides an understanding of the socio-cultural realities of being a minority and reveals how citizenship operates in everyday life.

The preference for an endoscopist specific sex: a link between ethnic origin, religious belief, socioeconomic status, and procedure type

Background and aimThe sex of the physician performing the endoscopic procedure is one of the parameters influencing patient satisfaction. Our aim was to characterize patients’ preferences according to their sex, socioeconomic status, and religious beliefs and according to procedure-related variables.MethodsAll patients undergoing an endoscopic procedure at Sheba Hospital between April 2012 and September 2012 were asked to complete a questionnaire regarding their sex, ethnic background, socioeconomic status, religious practice, and preference for an endoscopist of a specific sex. Questionnaires were included for analysis only when more than 95% of the items were addressed.ResultsA total of 1,009 patients agreed to complete the questionnaires; of these 946 (94% [59% male]) were eligible for inclusion. Most patients (675 [70%]) expressed no preference for sex of the endoscopist, while 234 patients (25%) preferred a same-sex endoscopist, and only 55 (6%) preferred an other-sex endoscopist. Stepwise logistic regression analysis showed that in female patients, lower education (odds ratio [OR] = 1.28), non-Jewish religion (OR = 4.86), orthodox religious practice (OR = 2.28), African or Asian ethnic origin (OR = 2.44), scheduled for colonoscopy (OR = 1.90), and no previous endoscopy experience (OR = 1.88) were all associated with a preference for a same-sex endoscopist.ConclusionOne-quarter of patients preferred the physician performing their examination to be of particular sex. Most of these patients preferred a same-sex endoscopist. Education level, intensity of religious practice, ethnic origin, and type of endoscopic examination were associated with a preference for a same-sex endoscopist. Addressing patients’ preferences may improve the atmosphere in the clinical environment, reduce stress, and facilitate better treatment and adherence to endoscopic surveillance programs.

Opportunities and challenges for enhancing preconception health in primary care: qualitative study with women from ethnically diverse communities

Objective There is a growing interest in developing and offering more systematic preconception healthcare. However, it is unclear how this might be regarded by ethnically diverse communities at higher risk...

Medical versus surgical interventions for open angle glaucoma

Open angle glaucoma (OAG) is a common cause of blindness. To assess the effects of medication compared with initial surgery in adults with OAG. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2012), EMBASE (January 1980 to August 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2012), Biosciences Information Service (BIOSIS) (January 1969 to August 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to August 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), Zetoc, the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 1 August 2012. The National Research Register (NRR) was last searched in 2007 after which the database was archived. We also checked the reference lists of articles and contacted researchers in the field. We included randomised controlled trials (RCTs) comparing medications with surgery in adults with OAG. Two authors independently assessed trial quality and extracted data. We contacted study authors for missing information. Four trials involving 888 participants with previously untreated OAG were included. Surgery was Scheie's procedure in one trial and trabeculectomy in three trials. In three trials, primary medication was usually pilocarpine, in one trial it was a beta-blocker.The most recent trial included participants with on average mild OAG. At five years, the risk of progressive visual field loss, based on a three unit change of a composite visual field score, was not significantly different according to initial medication or initial trabeculectomy (odds ratio (OR) 0.74, 95% confidence interval (CI) 0.54 to 1.01). In an analysis based on mean difference (MD) as a single index of visual field loss, the between treatment group difference in MD was -0.20 decibel (dB) (95% CI -1.31 to 0.91). For a subgroup with more severe glaucoma (MD -10 dB), findings from an exploratory analysis suggest that initial trabeculectomy was associated with marginally less visual field loss at five years than initial medication, (mean difference 0.74 dB (95% CI -0.00 to 1.48). Initial trabeculectomy was associated with lower average intraocular pressure (IOP) (mean difference 2.20 mmHg (95% CI 1.63 to 2.77) but more eye symptoms than medication (P = 0.0053). Beyond five years, visual acuity did not differ according to initial treatment (OR 1.48, 95% CI 0.58 to 3.81).From three trials in more severe OAG, there is some evidence that medication was associated with more progressive visual field loss and 3 to 8 mmHg less IOP lowering than surgery. In the longer-term (two trials) the risk of failure of the randomised treatment was greater with medication than trabeculectomy (OR 3.90, 95% CI 1.60 to 9.53; hazard ratio (HR) 7.27, 95% CI 2.23 to 25.71). Medications and surgery have evolved since these trials were undertaken.In three trials the risk of developing cataract was higher with trabeculectomy (OR 2.69, 95% CI 1.64 to 4.42). Evidence from one trial suggests that, beyond five years, the risk of needing cataract surgery did not differ according to initial treatment policy (OR 0.63, 95% CI 0.15 to 2.62).Methodological weaknesses were identified in all the trials. Primary surgery lowers IOP more than primary medication but is associated with more eye discomfort. One trial suggests that visual field restriction at five years is not significantly different whether initial treatment is medication or trabeculectomy. There is some evidence from two small trials in more severe OAG, that initial medication (pilocarpine, now rarely used as first line medication) is associated with more glaucoma progression than surgery. Beyond five years, there is no evidence of a difference in the need for cataract surgery according to initial treatment.The clinical and cost-effectiveness of contemporary medication (prostaglandin analogues, alpha2-agonists and topical carbonic anhydrase inhibitors) compared with primary surgery is not known.Further RCTs of current medical treatments compared with surgery are required, particularly for people with severe glaucoma and in black ethnic groups. Outcomes should include those reported by patients.Economic evaluations are required to inform treatment policy.

Zidovudine-induced myopathy: A study in Indian patients

Context:Literature is replete with studies on zidovudine-induced myopathy after prolonged use (use beyond 270 days on an average). However, all these studies have been done on patients of Caucasian, American and African ethnic origin. No such study has been carried out in Indian patients to our knowledge.Aims:To determine the correlation of zidovudine usage with serum creatine phosphokinase (CK) levels, clinical muscular weakness and muscle histology in Indian patients, we studied 147 physically active, Human Immunodeficiency Virus infected men on prolonged zidovudine-based antiretroviral therapy (ART).Settings and Design:Cross-sectional study on hospital follow-up patients of HIV infection.Materials and Methods:All cases on ART who reported to our canter during a period of 18 months were evaluated for symptoms (muscle fatigue, myalgia), objective muscle strength (testing clinically) and serum CK levels, and a select group was evaluated by muscle biopsy. These patients were on zidovudine for 1 to 7 years.Results:None of the patients studied had significant symptoms or objective muscle weakness and only a small fraction (10.8% of cases) had marginally raised serum CK levels. All muscle biopsies were normal on light microscopy.Conclusions:Zidovudine myopathy may be a constraint for use of the drug in the western population; however, it is a well-tolerated drug as regards myopathy in our study on Indian patients.

Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: Relations with season, age, ethnic origin and psychiatric diagnosis

In a chart review at a psychiatric out-patient department, latitude 59.3°N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-OHD was 45 nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50 nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients’ psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated.

Ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome

To evaluate ethnic differences in considerations whether or not to participate in prenatal screening for Down syndrome and to relate these to differences in participation. The study population consisted of 270 pregnant women from Dutch, Turkish and Surinamese (African and South Asian) ethnic origin, attending midwifery or obstetrical practices in the Netherlands. Women were interviewed after booking for prenatal care. Considerations were assessed by one open-ended question and 18 statements that were derived from focus group interviews. Actual participation was assessed several months later. Women from ethnic minorities were less likely to participate in prenatal screening, which could be attributed to differences in age and religious identity. They more often reported acceptance of 'what God gives', low risk of having a child with Down syndrome and costs of screening as considerations not to participate in prenatal screening. They also reported many considerations in favour of participation, which did not differ from those of Dutch women but were less often consistent with actual participation in screening. Women from ethnic minorities should not be stereotyped as being uninterested in prenatal screening, but should be better informed about the consequences of prenatal screening and Down syndrome.

Prevalence of Mycoplasma genitalium in early pregnancy and relationship between its presence and pregnancy outcome

Mycoplasma genitalium is associated with cervicitis and pelvic inflammatory disease but little is known about its role in pregnancy. We investigated the prevalence of M. genitalium by polymerase chain reaction assay on urine specimens from 1216 pregnant women (mean age 31years) presenting before 10 weeks of gestation in 32 general practices. The prevalence of M. genitalium was 0.7% (6/915, 95% CI 0.1-1.2). It was more common in women aged < 20 years, women of Afro-Caribbean or black African ethnic origin, women in social classes 3-5 and single women. Only one woman with M. genitalium infection miscarried, and none of those followed up to term had a preterm birth, although the numbers were small. The low prevalence of M. genitalium infection suggests it is unlikely to be an important risk factor in adverse pregnancy outcome in healthy women in the community.

Alcohol use by young people from different ethnic groups: consumption, intoxication and negative consequences

Objective. To investigate alcohol consumption among mid‐adolescents from different ethnic groups and explore overall and gender variations in drinking behaviours. Methods. A survey of alcohol use by 609 14–16 year olds recruited from three schools in an ethnically diverse area of London. Approximately 70% of the sample was of White English, White Irish, Black Caribbean or Black African ethnic origin. Self‐report information was collected via a researcher‐administered structured interview. Results. There was a significantly lower prevalence of lifetime alcohol use among Black African respondents than among the other three ethnic groups. Black African males and males and females from the two White ethnic groups reported drinking above levels recommended by the English Department of Health. Among the recent drinkers, over half of the White Irish and White English groups and over a quarter of Black Caribbean and Black African groups had been intoxicated in the 90 days before interview. Approximately three quarters of the White English and White Irish recent drinkers, but only a half of Black Caribbean and Black African recent drinkers had experienced a negative drinking‐related consequence during the last year. Conclusions. The survey findings suggest that while young people of White English or White Irish ethnic origin from the populations studied are more likely to drink excessively and experience negative consequences from their drinking than Black African and Black Caribbean youth, a substantial minority of Black African and Black Caribbean youth also experience alcohol‐related problems.

Os estereótipos e o viés lingüístico intergrupal

Uma das principais evidências encontradas nos estudos atuais sobre os estereótipos é o denominado viés intergrupal, onde se indica uma tendência tanto a avaliar os membros do outgrup como mais homogêneo do que os membros do ingroup, como também a tendência correlata a favorecer os membros do ingroup em detrimento dos membros do outgroup. Este trabalho, de natureza experimental, procurou avaliar a extensão desse efeito em participantes de etnia branca e negra residentes na cidade do Salvador, Bahia. A variável dependente envolvia uma escolha forçada entre quatro alternativas, cada uma representando a codificação lingüística com um grau distinto de abstração (adjetivos; verbos de estado permanente; verbos interpretativos; verbos descritivos). Os resultados, ao contrário dos obtidos na literatura, não evidenciaram qualquer efeito da etnia do participante, da etnia do personagem retratado na cena e nem da interação das duas variáveis. As conclusões do estudo não devem ser consideradas, entretanto, um indicador da ausência de discriminação entre os participantes, devendo ser mais provavelmente interpretado como uma conseqüência dos limites dos instrumentos indiretos de mensuração dos estereótipos e preconceitos. Palavras-chave: estereótipos; preconceito; viés lingüístico intergrupal; relações intergrupais.

Gestational trophoblastic syndrome: an audit of 112 patients. A South African experience.

Gestational trophoblastic disease (GTD) represents a spectrum of histologically distinct entities including molar pregnancy and choriocarcinoma. The incidence of GTD varies in different parts of the world with high incidences in countries like Japan (2 / 1000 pregnancies). With the advent of sensitive assays for detection of serum beta human chorionic gonadotrophin (HCG) and ultrasound, GTD can now be detected earlier in pregnancy. To date no studies have been reported from South Africa regarding the epidemiology, management, and outcome of patients with GTD. This study was a retrospective audit based on 112 patients with GTD treated at King Edward VIII Hospital, Durban, South Africa. Clinical records of patients were reviewed with regards to presentation, investigation, management and outcome. Of 112 patients, there were 78 patients (70%) with hydatidiform mole and 34 patients (30%) with choriocarcinoma. The mean age of patients was 28.5 years (SD 8.1 years). The majority of patients were Black females (94.6%) while 4.4% were Asian and 1% Coloured females. The most common presenting symptom was vaginal bleeding (93.8%). There were 74 patients (66.7%) who had a previous normal term pregnancy and only two patients (1.8%) had previous molar pregnancies. Suction curettage was the main treatment modality for patients with molar pregnancy while choriocarcinoma was treated primarily with chemotherapy. A total of 72 percent of patients with molar pregnancy and 28 percent with choriocarcinoma had complete remission after initial treatment. Twelve patients died during the course of treatment mainly due to late presentation and advanced metastatic disease. Complete cure was achieved in 89% of patients. Age, parity, previous history, initial uterine size, presence of theca-lutein cysts, and initial betaHCG concentration was not found to be prognostic for persistent trophoblastic disease. In the present study, the incidence of molar pregnancy and choriocarcinoma was 1.2 / 1000 and 0.5 / 1000 deliveries, respectively. This is much lower than those quoted from countries such as Japan. However, the incidence quoted from our study may be overestimated as this was a hospital-based study and most of the uncomplicated deliveries occur in referring centers. Only 20% of patients in this study were above the age of 35 years with a mean age of 28.5 years. The majority of patients were of Black African ethnic origin mainly due to the fact that our hospital is a referral center for Black patients. Similar to other studies, the majority of patients with molar pregnancy were treated with suction curettage while the majority of patients with choriocarcinoma were treated with chemotherapy. Overall, spontaneous remission was achieved in 60% of patients with molar pregnancy and an overall complete cure was achieved in 89% of patients.

Gestational trophoblastic syndrome: An audit of 112 patients. A South African experience

Gestational trophoblastic disease (GTD) represents a spectrum of histologically distinct entities including molar pregnancy and choriocarcinoma. The incidence of GTD varies in different parts of the world with high incidences in countries like Japan (2/1000 pregnancies). With the advent of sensitive assays for detection of serum β human chorionic gonadotrophin (HCG) and ultrasound, GTD can now be detected earlier in pregnancy. To date no studies have been reported from South Africa regarding the epidemiology, management, and outcome of patients with GTD. This study was a retrospective audit based on 112 patients with GTD treated at King Edward VIII Hospital, Durban, South Africa. Clinical records of patients were reviewed with regards to presentation, investigation, management and outcome. Of 112 patients, there were 78 patients (70%) with hydatidiform mole and 34 patients (30%) with choriocarcinoma. The mean age of patients was 28.5 years (SD 8.1 years). The majority of patients were Black females (94.6%) while 4.4% were Asian and 1% Coloured females. The most common presenting symptom was vaginal bleeding (93.8%). There were 74 patients (66.7%) who had a previous normal term pregnancy and only two patients (1.8%) had previous molar pregnancies. Suction curettage was the main treatment modality for patients with molar pregnancy while choriocarcinoma was treated primarily with chemotherapy. A total of 72 percent of patients with molar pregnancy and 28 percent with choriocarcinoma had complete remission after initial treatment. Twelve patients died during the course of treatment mainly due to late presentation and advanced metastatic disease. Complete cure was achieved in 89% of patients. Age, parity, previous history, initial uterine size, presence of theca-lutein cysts, and initial βHCG concentration was not found to be prognostic for persistent trophoblastic disease. In the present study, the incidence of molar pregnancy and choriocarcinoma was 1.2/1000 and 0.5/1000 deliveries, respectively. This is much lower than those quoted from countries such as Japan. However, the incidence quoted from our study may be overestimated as this was a hospital-based study and most of the uncomplicated deliveries occur in referring centers. Only 20% of patients in this study were above the age of 35 years with a mean age of 28.5 years. The majority of patients were of Black African ethnic origin mainly due to the fact that our hospital is a referral center for Black patients. Similar to other studies, the majority of patients with molar pregnancy were treated with suction curettage while the majority of patients with choriocarcinoma were treated with chemotherapy. Overall, spontaneous remission was achieved in 60% of patients with molar pregnancy and an overall complete cure was achieved in 89% of patients.

An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales

Background: The number of patients with tuberculosis has been increasing slowly in England and Wales since the late 1980s. HIV infection has been a contributory factor to increases in tuberculosis...