Search

Introduction: Low vision has a significant global health problem that impacts the personal, economical, psychological, and social life of an individual. Each year around 684 000 individuals die from falls, 80% of these deaths occur are in low- and middle-income countries. The risk of falling significantly increases with visual impairment. This review aimed to determine the global pooled prevalence of fall and associated factors among individuals with low vision., Methods and Materials: Systematic search of published studies done on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL and, Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to report the findings. Quality of studies was assessed using the modified Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using a random-effects method using the STATA™ Version 14 software., Result: Thirty-five (35) studies from different regions involving 175,297 participants included in this meta-analysis. The overall pooled global prevalence fall among individual with low vision was17.7% (95% CI: 16.4-18.9) whereas the highest prevalence was 35.5%; (95% CI: 28.4-42.5) in Australia and the lowest was 19.7%; (95% CI: 7.6-31.8) seen in South America. Fear of falling (OR: 0.16(95%CI 0.09-0.30), and severity of visual impairment (OR: 0.27(95%CI (0.18-0.39) increases the odds of falling., Conclusion: As one cause of accidental death, the prevalence of falls among individuals with low vision is high. Fear of falling and severity of falling increases the odds of falling. Different stakeholders should give due attention and plan effective strategies to reduce the fall among this population., Competing Interests: NO authors have competing interests The authors have declared that no competing interests exist., (Copyright: © 2024 Ekemiri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Low vision is an uncorrectable form of visual impairment that affect millions of people worldwide. Low vision care and rehabilitation are essential to improving the independence of affected individuals. Even though sub-Saharan Africa has one of the highest burdens of low vision globally, there are inadequate care and rehabilitation services in most countries and in some cases they are non-existent This scoping review aimed to identify the barriers and enablers to low vision care and rehabilitation in sub-Saharan Africa and assess these within the global context. The review was conducted using the five-step Arksey and O'Malley framework. Search terms were formulated based on the research questions and a search strategy was designed to search for eligible research articles from electronic databases; Pubmed, Ovid, Medline, and Embase. The data was screened by two members of the research team in accordance with set inclusion and exclusion criteria. Twenty-five out of 260 articles satisfied the inclusion criteria for the study. Inadequate low vision care infrastructure and supplies, non-standardised training of low vision care providers, health system failure and poor awareness of low vision care were the main barriers noted by eye care practitioners. Patients living with low vision cited the cost and availability of low vision aids, societal stigma, and poor awareness of services as the main barriers. No direct enablers were identified in sub-Saharan Africa; however, practitioners suggested improved training in low vision as a potential enabler. The barriers to low vision care and rehabilitation services identified were not unique to sub-Saharan Africa when viewed within a global context. Adopting and adapting solutions from other countries may therefore assist in improving low vision care and rehabilitation in sub-Saharan Africa.

Self-emulsifying drug delivery systems (SEDDSs) are lipid-based systems that are superior to other lipid-based oral drug delivery systems in terms of providing drug protection against the gastrointestinal (GI) environment, inhibition of drug efflux as mediated by P-glycoprotein, enhanced lymphatic drug uptake, improved control over plasma concentration profiles of drugs, enhanced stability, and drug loading efficiency. Interest in dermal spontaneous emulsions has increased, given that systems have been reported to deliver drugs across mucus membranes, as well as the outermost layer of the skin into the underlying layers. The background and development of a double spontaneous emulsion incorporating four anti-tubercular drugs, clofazimine (CFZ), isoniazid (INH), pyrazinamide (PZY), and rifampicin (RIF), are described here. Our methods involved examination of oil miscibility, the construction of pseudoternary phase diagrams, the determination of self-emulsification performance and the emulsion stability index of primary emulsions (PEs), solubility, and isothermal micro calorimetry compatibility and examination of emulsions via microscopy. Overall, the potential of self-double-emulsifying drug delivery systems (SDEDDSs) as a dermal drug delivery vehicle is now demonstrated. The key to success here is the conduct of preformulation studies to enable the development of dermal SDEDDSs. To our knowledge, this work represents the first successful example of the production of SDEDDSs capable of incorporating four individual drugs.

Self-emulsification is considered a formulation technique that has proven capacity to improve oral drug delivery of poorly soluble drugs by advancing both solubility and bioavailability. The capacity of these formulations to produce emulsions after moderate agitation and dilution by means of water phase addition provides a simplified method to improve delivery of lipophilic drugs, where prolonged drug dissolution in the aqueous environment of the gastro-intestinal (GI) tract is known as the rate-limiting step rendering decreased drug absorption. Additionally, spontaneous emulsification has been reported as an innovative topical drug delivery system that enables successful crossing of mucus membranes as well as skin. The ease of formulation generated by the spontaneous emulsification technique itself is intriguing due to the simplified production procedure and unlimited upscaling possibilities. However, spontaneous emulsification depends solely on selecting excipients that complement each other in order to create a vehicle aimed at optimizing drug delivery. If excipients are not compatible or unable to spontaneously transpire into emulsions once exposed to mild agitation, no self-emulsification will be achieved. Therefore, the generalized view of excipients as inert bystanders facilitating delivery of an active compound cannot be accepted when selecting excipients needed to produce self-emulsifying drug delivery systems (SEDDSs). Hence, this review describes the excipients needed to generate dermal SEDDSs as well as self-double-emulsifying drug delivery systems (SDEDDSs); how to consider combinations that complement the incorporated drug(s); and an overview of using natural excipients as thickening agents and skin penetration enhancers.

Although chemotherapeutic treatment regimens are currently available, and considerable effort has been lavished on the development of new drugs for the treatment of tuberculosis (TB), the disease remains deeply intractable and widespread. This is due not only to the nature of the life cycle and extraordinarily disseminated habitat of the causative pathogen, principally Mycobacterium tuberculosis ( Mtb ), in humans and the multi-drug resistance of Mtb to current drugs, but especially also to the difficulty of enabling universal treatment of individuals, immunocompromised or otherwise, in widely differing socio-economic environments. For the purpose of globally eliminating TB by 2035, the World Health Organization (WHO) introduced the "End-TB" initiative by employing interventions focusing on high impact, integrated and patient-centered approaches, such as individualized therapy. However, the extraordinary shortfall in stipulated aims, for example in actual treatment and in TB preventative treatments during the period 2018-2022, latterly and greatly exacerbated by the COVID-19 pandemic, means that even greater pressure is now placed on enhancing our scientific understanding of the disease, repurposing or repositioning old drugs and developing new drugs as well as evolving innovative treatment methods. In the specific context of multidrug resistant Mtb , it is furthermore noted that the incidence of extra-pulmonary TB (EPTB) has significantly increased. This review focusses on the potential of utilizing self-double-emulsifying drug delivery systems (SDEDDSs) as topical drug delivery systems for the dermal route of administration to aid in treatment of cutaneous TB (CTB) and other mycobacterial infections as a prelude to evaluating related systems for more effective treatment of CTB and other mycobacterial infections at large. As a starting point, we consider here the possibility of adapting the highly lipophilic riminophenazine clofazimine, with its potential for treatment of multi-drug resistant TB, for this purpose. Additionally, recently reported synergism achieved by adding clofazimine to first-line TB regimens signifies the need to consider clofazimine. Thus, the biological effects and pharmacology of clofazimine are reviewed. The potential of plant-based oils acting as emulsifiers, skin penetration enhancers as well as these materials behaving as anti-microbial components for transporting the incorporated drug are also discussed.

Background: The increase in online learning during the pandemic has been linked to various ocular complaints. This study determined the prevalence and factors associated with ocular complaints among schoolchildren aged 12-19 years during the COVID-19 lockdown in Trinidad and Tobago (T&T)., Methods: A cross-sectional study was conducted between January and May 2021, during the COVID-19 lockdown in T&T among secondary school students studying remotely. A two-stage cluster sampling method was employed. A modified web-based Computer Vision Syndrome questionnaire was administered to students. Data on demography, duration of digital device use, and ocular complaints were collected, and multilevel logistic regression was used to determine factors associated with ocular complaints among school children, 12-19 years of age in T&T., Results: A total of 435 schoolchildren (mean age, standard deviation, 15.2 ± 1.9 years range 12-19 years) responded to the questionnaire. The prevalence of self-reported symptoms of headache, blurred vision, dry eyes, itchy eyes, and double vision were 75.0%, 65.1%; 56.8%; 46.4%; and 33.5%, respectively. Schoolchildren aged 18-19 years, those that used spectacles for correction of their refractive errors, and spent more than 6 h on average on digital devices, reported a high prevalence of any ocular complaints. Analysis also revealed that age (14-15 years) was associated with dry eyes, blurred vision, and headaches, while gender (more prevalently females) was associated with blurred vision and headache. Those that had an eye examination in the last year and schoolchildren that took action to resolve ocular complaints were more likely to experience nearly all ocular complaints., Conclusions: During the COVID-19 lockdown, over three in four students in T&T reported ocular complaints from digital devices for online learning. Tailored interventional messages to reduce all forms of ocular complaints should target older students, particularly females, those who laid down when learning online via their devices and people who regularly examine their eyes., Competing Interests: The authors declare that they have no competing interests., (© 2022 Ekemiri et al.)

Background: The training of optometrists aims to prepare practitioners with critical thinking skills who utilise their education and experience to solve clinical problems in real-life practice. Professional competencies should inform assessment, and as such, assessment methods for learning should encompass a wide range of approaches. The objective of this scoping review is therefore to map assessment approaches utilised within optometry education programmes globally., Methods: This study is a scoping review based on the PRISMA methodology. The review will be guided by the following research question, "What are the assessment approaches that inform optometry training globally?". This was validated by the Population-Concept-Context framework according to the methodology for Joanna Briggs Institution Scoping Reviews. Relevant peer-reviewed studies and grey literature conducted during the last 10 years will be identified from electronic databases including CINAHL, PubMed, PROquest and ERIC. The search strings using keywords such as "Optometry students and staff", "Assessments" and "Optometry education" will be conducted using Boolean logic. An independent reviewer will conduct all title screening, two independent reviewers will conduct abstract and full article screening, followed by data extraction. Thereafter, a thematic analysis will be conducted. The Mixed Method Appraisal Tool version 2018 will be used for quality appraisal of mapped studies., Discussion: The review will document evidence of assessment approaches utilised in optometry training globally. Considering the exit level competencies required in the basic job function of an optometrist, a coherence in assessment approaches and relevant rationale for these would be expected, if the accredited (regulated) training programmes follow a competency-based model., (© 2022. The Author(s).)

Obesity affects millions of children worldwide and can often impact their academic performance. This longitudinal study, conducted over seven years, determines the effects of excessive weight and obesity on the academic performance of primary school boys, taking into account their socio-economic status (SES). The study forms part of a seven-year (2010-2016) longitudinal study, the North-West Child-Health-Integrated-Learning and Development (NW-CHILD) study, which includes a baseline measurement and two follow-up measurements of the 181 participants from varying areas in the North West Province. Two-way frequency tables, repeated measure ANOVA's and Spearman rank order correlations were used to analyze the data. The Body Mass Index (BMI) of the participants reported an increase from 2010-2016. Nearly all of the school subjects reported small to large correlations between BMI and academic performance ( r ≥ 0.1 and r ≥ 0.3), except for Afrikaans in 2013 ( r = -0.06). Only two subjects (English and Language as tested with the ANA test) reported medium effects ( r ≥ 0.3), whereas the other subjects only reported small effects ( r ≥ 0.1). No statistically significant relationships ( p ≥ 0.05) were observed between the BMI values and academic subjects, however SES and school subject scores reported several statistically significant relationships, especially regarding Language (English and First Additional Language) and Mathematics ( p = 0.02). Overweight and obese primary school boys in the North West Province of South Africa reported a higher academic performance in comparison to boys of a normal weight, even when SES was taken into consideration. Further studies are recommended to verify current findings regarding weight, obesity and academic performance.

There is a rampant increase in diabetes prevalence globally. Sub-Saharan Africa (SSA) is projected to carry the largest burden of diabetes (34.2 million) by 2030. This will inevitably cause a parallel increase in diabetes-associated complications; with the predominant complications being blindness due to diabetic retinopathy and diabetic cataracts. Eye programs in developing countries remain inadequate, existing as stand-alone programs, focused on the provision of acute symptomatic care at secondary and tertiary health levels. Over 60% of people with undiagnosed diabetes report to eye care facilities with already advanced retinopathy. While vision loss due to cataracts is reversible, loss of vision from diabetic retinopathy is irreversible. Developing countries have in the last two decades been significantly impacted by infectious pandemics; with SSA countries committing over 80% of their health budgets towards infectious diseases. Consequently, non-communicable diseases and eye health have been neglected. This paper aimed to highlight the importance of strengthening primary health care services to prevent diabetes-related blindness. In SSA, where economies are strained by infectious disease, the projected rise in diabetes prevalence calls for an urgent need to reorganize health systems to focus on life-long preventative and integrated measures. However, research is critical in determining how best to integrate these without further weakening health systems.

Universal eye health is a component of universal health care, which member states of the World Health Organization have supported in principle through their endorsement of the Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment (2014-2019). While much of the world's attention has been on addressing the needs of developing countries which suffer significant shortcomings in terms of effective and accessible eye care services, similar access inequities exist in developed nations such as Canada. The Canadian health system is based on the principle of universal health coverage; yet, for the majority of the population, access to primary eye care services such as an eye examination and spectacles is an out-of-pocket expense. Therefore, despite the global call for universal eye health, Canada has still not made relevant policy shifts in terms of addressing the structural barriers to all its citizens accessing primary eye care services within its health system, despite active advocacy efforts of key stakeholder groups in eye health. There is, therefore, an inescapable reality of unmet eye care needs, which Canada must address if it is to meet the World Health Organization's goals of universal eye health.

A quality-by-design and characterization approach was followed to ensure development of self-emulsifying drug delivery systems (SEDDSs) destined for topical delivery of the highly lipophilic clofazimine. Solubility and water-titration experiments identified spontaneous emulsification capacity of different excipient combinations and clofazimine. After identifying self-emulsification regions, check-point formulations were selected within the self-emulsification region by considering characteristics required to achieve optimized topical drug delivery. Check-point formulations, able to withstand phase separation after 24 h at an ambient temperature, were subjected to characterization studies. Experiments involved droplet size evaluation; size distribution; zeta-potential; self-emulsification time and efficacy; viscosity and pH measurement; cloud point assessment; and thermodynamic stability studies. SEDDSs with favorable properties, i.e., topical drug delivery, were subjected to dermal diffusion studies. Successful in vitro topical clofazimine delivery was observed. Olive oil facilitated the highest topical delivery of clofazimine probably due to increased oleic acid levels that enhanced stratum corneum lipid disruption, followed by improved dermal clofazimine delivery. Finally, isothermal microcalometric experiments studied the compatibility of excipients. Potential interactions were depicted between argan oil and clofazimine as well as between Span ® 60 and argan-, macadamia- and olive oil, respectively. However, despite some mundane incompatibilities, successful development of topical SEDDSs achieved enhanced topical clofazimine delivery.

Background: Contact lens usage is becoming increasingly popular amongst young people. Assessing their knowledge, attitudes and practices in relation to contact lens wear is therefore important, so that gaps in understanding or incorrect practices can be rectified to promote continued safety and success of contact lens wear., Objectives: This study aimed to assess and describe the knowledge, attitudes and practices of contact lens wearers aged 18 to 30 years, in the greater Durban area of South Africa., Methods: A semi-structured questionnaire was used to assess the knowledge, attitudes and practice of the participants. Results: Two hundred and forty six participants completed the survey. Young contact lens wearers in this sample generally had poor knowledge with regards to appropriate hygiene and contact lens wear complications. Despite wearers exhibiting a positive attitude with satisfactory hand hygiene and lens cleaning practices, important aspects such as lens case hygiene, storage and lens removal practices were found to be unsatisfactory. Compliance with after-care visits was also unsatisfactory., Conclusion: There is a need for contact lens practitioners to educate young contact lens wearers regarding appropriate contact lens-related care, to promote long term ocular health and contact lens-related safety., (© 2020 Khoza N et al.)

Background: Decentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN's College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector., Discussion: DCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce 'fit-for-purpose' graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training., Conclusion: While the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.

Aims: To determine if nisin F has an effect on the bacterial population in the gastro-intestinal tract., Methods and Results: Six male C57BL/6 mice were intraperitoneally injected with 200 μl sterile saline and six with nisin F (200 μl, equivalent to 640 arbitrary units). Fecal samples were collected before injection and 8, 24 and 48 h after injection, and the bacteria amplified by PCR-DGGE using 16S rDNA primers. The composition of the bacterial population in the gastro-intestinal tract (GIT) of mice that were injected with saline changed during 48 h, whereas the bacterial population in the GIT remained relatively unchanged in animals injected with nisin F., Conclusions: These results suggest that nisin F inhibits the growth of specific bacteria in the GIT within the first 4 h. Furthermore, the species remained repressed for at least 44 h after one intraperitoneal injection with nisin F., Significance and Impact of the Study: This is the first report suggesting that nisin F may have a stabilizing effect on the bacterial population in the gastro-intestinal tract., (© 2011 The Authors. Letters in Applied Microbiology © 2011 The Society for Applied Microbiology.)

Objective: To systematically review the evidence on the effect of continuous passive motion, combined with usual physiotherapy management, on increasing shoulder joint range of motion and muscle strength, and reducing shoulder pain in adults following rotator cuff repair, compared with standard physiotherapy., Data Sources: A comprehensive search in available bibliographic electronic databases was undertaken to locate eligible studies. Reference tracing was also used to locate studies., Review Methods: Randomized controlled trials reporting on the effect of continuous passive motion on increasing shoulder joint range of motion and muscle strength and reducing shoulder pain in adults following rotator cuff repair were included in the review. The PEDro scale was used to determine the methodological quality of the studies. Data were summarized in a narrative form because of their heterogeneity., Results: Four randomized controlled trials were eligible for this review. One Japanese article was excluded as the text was unavailable in English. The methodological quality of the included studies averaged 7.67. Continuous passive motion was found to improve shoulder range of motion in two studies. One study found a decrease in pain in the intervention group and one study found that continuous passive motion improves muscle strength., Conclusion: Continuous passive motion is safe to use with physiotherapy treatment following rotator cuff repair surgery. It may help to prevent secondary complications post operatively.

Total serum homocysteine and cholesterol levels were determined in 163 male patients with typical angina who were subjected to coronary angiography. The prevalence of homocysteinemia in coronary heart disease (CHD) was 41.9%. Serum homocysteine levels were significantly elevated (p less than 0.05) in patients with major occlusion in two or three coronary arteries. Furthermore, the prevalence of homocysteinemia correlated positively (p less than 0.05) with the number of coronary vessels that were occluded. The prevalence of hypercholesterolemia was 34.9%, but, in contrast to homocysteinemia, no graded strength of association with the number of stenotic coronary arteries could be demonstrated. The results suggest that homocysteinemia may contribute significantly to the development of coronary heart disease.

Paracetamol clearance has been measured from serial serum samples in 49 healthy black Africans from a village in Southern Africa. The subjects are minimally exposed to known environmental inducing or inhibiting agents and the staple diet consists of maize cereal and greens. The mean clearance (+/- SD) was 4.98 +/- 1.61 ml min-1 kg-1, which is significantly faster than the values found in previous investigations with paracetamol in whites and Asian immigrants in London. The mean half-lives were fairly similar but the apparent volumes of distribution were also found to be larger in the present study. The ethnic difference in paracetamol kinetics identified in this study is possibly genetically controlled.

The numbers of patients treated for seven types of carcinoma during 1977 at 10 hospitals in South Africa have been reviewed. The total number of patients admitted to the 10 hospitals in 1977 was 286 373. Slightly more than 1%, namely 3 409, of these patients suffered from carcinoma of the cervix, oesophagus, breast, lung, liver, stomach or colon. Carcinoma of the cervix was commonest among Black patients and carcinoma of the colon among Whites. The relative incidence of the different types of carcinoma among Whites was almost the opposite of the sequence among Blacks.

An isolated traditional-living tribe has been identified in Southern Africa. The lifestyle, eating habits and socio-economic conditions have been studied intensively and are being correlated with the pattern of health and disease of the people. Physical examination, urinalyses, biochemical studies and X-ray investigations show a remarkable absence of the diseases normally associated with a Western lifestyle and yet no evidence of malnutrition was found. Those findings are compared with the results of investigations on urbanized black people. The aim of the study is to determine the long-term effects of inevitable westernization on this tribe.

The doctor rendering primary care in a hospital is the key to the whole realm of medical science to the patient. Primary evaluation and emergency care must be accurate, efficient and comprehensive. The traditionally unpopular work in a casualty department and polyclinic can be interesting and provide work satisfaction to family practice trainees if these are well organized. Delegation of routine work to ancillary staff is an important time-saver.

Myocardial infarction has been found to be a significantly frequent cause of unexpected sudden death in Black males in Pretoria and its vicinity. A study of 758 autopsies performed for unexplained sudden death in Blacks revealed 39 fatal infarcts in 511 males but only 1 in 247 females. The condition became evident in the third decade, rose sharply in the fourth and declined gradually thereafter.

Ainhum is an ancient disease described in 1821 by Messum and its origin is still unknown. It is a tropical or semitropical disease seen in Blacks, Whites and Indians which affects the 5th and sometimes the 4th toe and causes spontaneous amputation. Females are more often affected than males, and there is a tendency to geographical clustering of cases and familial occurrence.

The basic principles of the placing and planning of consulting rooms are discussed. Emphasis is placed on optimal use of expensive floorspace by using walls for shelves, and having compact furniture and sliding doors. The effective circulation of doctors and patients in the complex should be a prime consideration. Communication appliances should be planned from the outset. Certain pitfalls are mentioned. Different practices have varying needs but certain basic principles apply to all. Doctors should give careful personal attention to the planning of their consulting rooms and not merely leave it to supposed experts in this field.

Osteoarthrosis occurs in all population groups throughout the world. However, the pattern of the condition may differ considerably amongst various developing, traditionally living people, perhaps because of their different living habits, occupational factors and genetics. The distribution and prevalence of osteoarthrosis in a developing African population are reported in this paper. A radiological survey of the hands and feet of 543 adult respondents was undertaken. The prevalence of multiple osteoarthrosis and Heberden's nodes was very low. There was a sharp rise in the prevalence of osteoarthrosis after the age of 40 years. The prevalence in males and females was very similar; a finding which agrees with previous African studies but is in contrast to Caucasian surveys. We also found more distal interphalangeal involvement in males than in females. The incidence of proximal interphalangeal involvement was very similar to that reported in other published studies.

Throat swabs taken from a group of traditionally living people in a remote area of Venda, with no symptoms of sore throat, revealed the presence of Group A beta-haemolytic streptococci in 1,62% of subjects in the 5 - 25-year age group. This is significantly different from the picture in an urban population in Pretoria where the carrier rate was found to be 16,8%. The incidence is apparently not influenced by the low economic level in the rural area. The organisms in the rural area were found to be less sensitive to sulphafurazole than those in the urban area.

We report the findings of an epidemiological study of the prevalence of rheumatoid arthritis (RA) in a rural population. The study was conducted in Venda, a very remote part of South Africa. Much of the population still follows an age old traditional lifestyle. A detailed hut-to-hut survey of 543 respondents comprising 97% of the population of one village was conducted. This included clinical, serological and radiological studies. This was supplemented by questioning local traditional doctors and showing them photographs of typical hand deformities to ascertain if they knew of any cases with these deformities. The 3 hospitals draining the area were also surveyed. The detailed survey of 543 respondents revealed no cases of definite or probable RA using a modification of the Rome criteria. No cases were recognized by the traditional doctors. The 3 hospitals together had 14 cases of definite RA out of a population of about 520,000. This gave a prevalence of 0.0026%. The marked difference in the prevalence of RA in this population as opposed to other Southern African studies as well as American and European studies is discussed.

Antipyrine clearance has been measured from serial serum samples in 49 healthy black Africans from a village in Southern Africa. The subjects follow a lifestyle which minimally exposes them to environmental inducing or inhibiting agents. Food is mainly maize cereal with a protein content of only about 8.8%, together with greens. Antipyrine clearance, half-life and apparent volume of distribution (mean +/- SD) were, respectively, 0.538 +/- 0.163 ml min-1, kg-1, 14.81 +/- 6.5 h and 0.626 +/- 0.075 litre/kg. These results do not differ significantly from the mean values found in a group of lactovegetarian Indo-Pakistani immigrants to Britain. This would suggest that the major environmental determinant influencing hepatic mixed-function oxidase activity is the presence or absence of meat in the diet. However, the relative contributions of environment and heredity will be difficult to determine.

A study was performed in Pretoria on 232 unselected patients who presented with the complaint of sore throat. A throat swab was positive for Lancefield group A beta-haemolytic streptococci in 33,2% of these patients. The incidence was significantly higher in Black patients (45,5%) than in White patients (23,2%) and 12,1% of healthy controls showed a positive culture. No seasonal variation was detected. Throat swabs kept overnight at room temperature were falsely negative for beta-haemolytic streptococci in 43,2% of cases. A correlation was found with certain clinical signs.

Immunological differences between a rural under-developed black population with a low incidence of rheumatoid arthritis, and living according to old traditional ways have been compared with an urban black and urban Caucasian population with a high incidence of the disease. A delayed skin hypersensitivity test for cell-mediated immunity with seven antigens and control was used. The rural group showed a statistically significant inhibition of cell-mediated immunity with 37% showing an anergic response. A matched Caucasian group showed a more marked response while an urban black group occupied an intermediate position. The 37% anergic response in our rural group was seen despite the fact that they were very healthy and their immune systems resisted multiple parasitic and infective onslaughts. From this data interpretation of an anergic response to multiple skin antigen tests in peoples from under-developed populations must be approached with great caution. Whether this altered cell-mediated immunity plays a role in the low incidence of rheumatoid arthritis in under-developed peoples is still speculative.