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Letter by Omar on letter by Jassat et al. (Jassat W, Brey Z, Parker S, et al. A call to action: Temporal trends of COVID-19 deaths in the South African Muslim community. S Afr Med J 2021;111(8):692-694. https://doi.org/10.7196/SAMJ.2021.v111i8.15878); and response by Jassat et al.

Objectives Little is known about the long-term outcome and mortality patterns in systemic lupus erythematosus (SLE) in sub-Saharan Africa. We undertook a retrospective study of SLE in mainly black, unemployed patients, seen at a tertiary institution in Soweto, South Africa, to determine the causes and predictors of death. Methods Demographic, clinical and laboratory data and outcome were extracted from the case records of patients attending the Lupus Clinic at Chris Hani Baragwanath Hospital. Results Of the 270 case records with a diagnosis of SLE, 226 met the American College of Rheumatology classification criteria for SLE. The female to male ratio was 18 : 1. The mean (s.d.) age at presentation was 34 (12.5) yrs. Arthritis, nephritis and neuropsychiatric disease had a cumulative frequency of 70.4, 43.8 and 15.9% of patients, respectively. During the course of a mean follow-up period of 54.9 months, 193 (85.3%) and 89 (39.3%) patients were treated with oral corticosteroids and immunosuppressive agents, respectively. There were 55 (24.5%) known deaths and 64 (28.6%) patients were lost to follow-up. The estimated 5 yr survival rates were between 57 and 72%, depending on whether the group of patients lost to follow-up was classified in the analysis as either alive or dead. Infection (32.7%) was the commonest cause of death followed by renal failure (16.4%). Univariate analysis revealed that nephritis, neuropsychiatric disease and hypocomplementaemia were associated with an increased mortality, but multivariate analysis showed nephritis as the only significant predictor of mortality. Conclusion Our findings suggest that SLE in indigent South Africans not only carries a poorer prognosis but also the main cause of death, infection and renal failure differ from those reported recently in industrialized Western countries. Nephritis is common in our patients and is the only independent predictor of poor outcome.

Mortuary-based surveillance typically collates information from three sources: postmortem reports completed by forensic pathologists, police crime incident reports and chemical pathology laboratory results. The data are an important tool to inform prevention efforts and to monitor their effectiveness, and represent an underutilised source of descriptive epidemiological information to inform our understanding of fatal violence patterns, risk factors and groups at-risk. Following on earlier South African mortality surveillance initiatives, the current system provides a robust and simple surveillance tool that provides data that is congruent with, yet avoids the rigid confines of, the ICD10 coding system. We describe the process of consultation between participating research agencies to refine the data collection instrument, manual and automated data collection procedures and the systems institutionalisation with provincial government. The first complete non-natural mortality data for the Western Cape Province for 2007 will be presented, as well as the expected utility of these data in directing, monitoring and evaluating interventions to reduce the provincial burden of injury. The surveillance system has become a focal point of the Provincial Governments injury prevention and safety promotion efforts relating to its Burden of Disease Project. One important innovation has been the inclusion of an optional special interest variable describing fatal events that are either not readily available from ICD and other coding systems or difficult to record and analyse due to complex coding requirements. We explore the limitations of the current system and its possible improvement in line with best practices internationally.

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