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Aim: We investigated the prognostic potential of pretherapy measurement of the neutrophil/lymphocyte ratio (NLR) in patients (n = 56) with non-small-cell lung cancer deemed suitable for treatment with nivolumab., Materials & Methods: This was a multicenter, noninterventional, retrospective data analysis, involving five oncology centers., Results: Patients with prenivolumab NLR values of <5 and ≥5 had respective median overall survival (OS) values of 14.5 and 7.02 months (p = 0.0026). Patients with ≤2 and >2 metastatic sites had median OS values of 11.4 and 6.1 months, respectively (p = 0.0174). A Cox multiple regression model revealed baseline NLR ≥5 as the only variable significantly associated with decreased OS (p < 0.0447)., Conclusion: Pretreatment elevated NLR values are associated with poor outcomes in patients with recurrent metastatic non-small-cell lung cancer treated with nivolumab., Competing Interests: Financial & competing interests disclosure BL Rapoport reports personal fees from Merck and Co, grants and personal fees from BMS, grants and personal fees from Roche South Africa, personal fees from AstraZeneca, during the conduct of the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The final manuscript was supported in its entirety by the investigators. No writing assistance was utilized in the production of this manuscript., (© 2020 Rapoport BL.)

Two sisters in a Hei//om family of the southern African Khoisan race in Namibia were found to have Wd(a+) red blood cells. Wda is a low-frequency antigen identified so far only in a European family in Canada and a family in Holland. The Wda gene may have had an independent origin in the Khoisan. Alternatively, the Hei//om population may have acquired it through miscegenation.

Inherited disorders transmitted by simple genetic mechanisms are documented, with discussion of those notable for their unusually high or low prevalence.

The prevalence of serum antibodies which probably indicate infection with a human T-cell leukaemia virus type I was determined among random population samples of more than 100 healthy black individuals in several localities in Transvaal. The percentage of seropositive subjects increases northwards and eastwards, where geoclimatic conditions are similar to those of endemic areas elsewhere in the world. The comparatively higher prevalence among females in the Kruger National Park suggests that this is predominantly a sexually transmitted disease.

The frequency distributions of HLA antigens in 25 juvenile-onset diabetics (JOD) and 56 maturity-onset diabetics (MOD) belonging to a southern African black tribe (Xhosa) were compared with those of 153 non-diabetic Xhosa blacks. Unlike the findings in white JODs, there was no increase of B8 or B15 nor a reduced frequency of B7 but an apparently, significantly increased frequency of Bw35 and A2 in both Xhosa JODs and Xhosa MODs respectively. This is the first ethnic group in which an HLA antigen marker has been found for MOD. Furthermore, these findings suggest that diabetes, both JOD and MOD, in white people is a different genetic disease from the diabetes among the Xhosa tribe.

Antibodies which probably indicate infection with human T-cell leukaemia virus type I (HTLV-I) were determined in three species of non-human primates from several localities. A significant prevalence among chacma baboons and vervet monkeys was confirmed. According to sero-epidemiological evidence that HTLV-I infection is predominantly sexually transmitted between adult animals; comparison of prevalence rates between localities or species should therefore take sexual maturity into account. It appears unlikely that transmission from non-human primates to humans is frequent.

Genetic, geographic and socio-economic diversity has resulted in disparity in the relative prevalence of many inherited disorders and congenital conditions in the populations of southern Africa. In the first section of a 3-part article an account is given of the historical and demographic background in relation to factors which influence the presence and frequency of faulty genes in the black community. In addition, inherited haematological conditions--in particular haemoglobinopathies, red-cell enzyme and membrane defects--are discussed in terms of their clinical, genetic and anthropological significance. The conditions transmitted by simple genetic mechanisms are documented in Part II, with discussion of those notable for their unusually high or low prevalence. In the final section multifactorial, chromosomal and non-genetic congenital disorders are reviewed and a number of unusual conditions of obscure aetiology are mentioned. In this 3-part overview an attempt has been made to document present knowledge and to provide a bibliography for inherited and congenital disorders in the black population.

The incidence of multiple gestation has increased as a result of ovulation stimulation in recent years. The early diagnosis by ultrasonography of the quintuplet gestation and the institution of special treatment to prevent the most common complications are discussed. The patient was delivered of five male infants at caesarean section after early rupture of membranes. Routine scanning during the first trimester plays an important role in the diagnosis of multiple gestation early in pregnancy. In the present case ultrasonography was used extensively in conjunction with other parameters. We feel that this management may have contributed largely to the successful outcome.

Serological evidence for HTLV-I infection in the South African population has now been confirmed by the isolation of the virus from the peripheral blood lymphocytes of an adult Tsonga male. The subject was an indigenous black man from the south-eastern Transvaal who had suffered from Kaposi's sarcoma for a decade and in whom serum antibodies against HTLV-I were demonstrated. T-lymphocyte cell lines were established from his peripheral blood lymphocytes and shown to be productively infected with HTLV-I as evidenced by: the characteristic cell morphology; the typical viral morphogenesis on ultra-thin section electron microscopy; the viral genome in DNA extracted from the cell lines; characteristic reverse transcriptase activity and viral specific proteins in the cell culture supernatant fluids. Spread of infection occurs through sexual intercourse, from mother to child, and by blood transfusion. Donated blood should be screened to contain the spread of HTLV-I infection.

Certain genetic disorders occur with unusually high frequency in the Afrikaner population of southern Africa. Conditions of this type (reviewed in Part I of this article) include familial hypercholesterolaemia, progressive familial heart block, Huntington's chorea, porphyria variegata, Gaucher's disease, cystic fibrosis and familial colonic polyposis. This genetic situation is explicable to some extent on the basis of the demographic development of the Afrikaner population during the 14 generations since the arrival of the first immigrants from Holland more than 330 years ago.

A sample of 250 unrelated members of the Greek community of Cape Town was studied in order to establish the prevalence of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency in the community. A gene frequency of 0,067 in males and a prevalence of 6,7% are estimated for this group. It is recommended that persons with G-6-PD deficiency should have access to a list of medicinal agents which have the potential for precipitating acute haemolytic crises and that they should wear Medic-Alert discs bearing information concerning the disorder.

Vascularised transplantation of the Fallopian tube is a technically feasible operation, but its functional result remains questionable. This article documents a pregnancy after vascularised contralateral autotransplantation of the oviduct in a ewe.

Two Cape Coloured persons of mixed White, Khoikhoi, Malay, Black parentage in Cape Town whole red cells were found to be S--s--U-- establish that the rare Su allele is present in this population group. The most likely source of the Su allele in them is the non-indigenous Black slaves who were brought to the Cape in the early years of White settlement there. In two paternity suits involving Cape Coloured persons, maternal and paternal exclusions were present unless the inheritance of an MSu or an NSu chromosome was postulated, and MS, NS and Ns chromosomes were seen to accompany He+ alleles in them.

In addition to the genetic conditions reviewed in Part I of this article, sclerosteosis, spondyloepimetaphyseal dysplasia, lipoid proteinosis, keratolytic winter erythema and various haematological disorders also occur in high frequency in the Afrikaner community. The recognition of the presence of these serious inherited disorders is important in differential diagnosis and is fundamental to the establishment of public health programmes for amelioration and prevention.

Huntington chorea is rare in ethnically pure blacks; 8 South African black patients, 6 adults and 2 children, from 4 families are described. The symptoms do not appear to differ materially from Huntington chorea in other races. Increased awareness of the disease in this population group is warranted.

The cord blood of 1,207 randomly selected neonates from the Cape Coloured population of South Africa was analysed for the presence of Hb Barts. 40 individuals (3.3%) had detectable Hb Barts levels with values ranging from 1.1 to 7.3%. Restriction enzyme analysis of DNA from subjects with Hb Barts showed that 85% of the cases studied had the genotypes -alpha 3.7/alpha alpha or -alpha 3.7/-alpha 3.7. The observed frequency of the -alpha/alpha alpha genotype was much lower than the expected frequency which suggests that this genotype is often not associated with detectable levels of Hb Barts. Mapping of the sigma-globin locus in three subjects with HbH disease revealed the presence of the--SEA/alpha-thalassaemia determinant in this population.

A survey of the thalassaemias has been undertaken in the Greek community of Cape Town. In a sample of 250 persons 3 were found to have the alpha-thalassaemia trait, and its prevalence can therefore be estimated to be 1,2%. Neither haemoglobin H disease nor homozygous alpha-thalassaemia was encountered, but 2 persons with homozygous beta-thalassaemia (thalassaemia major) who were not part of the survey were traced through the Western Province Blood Transfusion Service. Twenty-three of the 250 subjects were found to have heterozygous beta-thalassaemia (thalassaemia minor), the prevalence of which could be calculated at 9,2%, with a gene frequency of 0,046. The thalassaemias therefore warrant consideration whenever an individual of Greek stock in Cape Town presents with an anaemia.

Cape Town has a Greek community of about 5000, of whom approximately 75% originate from the island of Lesbos. In a survey of inherited haematological conditions in this population, 250 unrelated volunteers were investigated. The prevalence of heterozygous beta-thalassaemia was found to be 6.4%, with a gene frequency of 0.033. G6PD deficiency was detected in 10 males and it can be estimated that the prevalence in the male members of this population is 6.7%, with a gene frequency of 0.067. Hereditary spherocytosis was found in three respondents and this represents a prevalence of 1.2%, with a gene frequency of 0.006. One subject was heterozygous for the sickle cell trait (HbS) and another volunteer had haemoglobin Lepore, which had already been diagnosed in Greece. Our findings with respect to beta-thalassaemia and G6PD deficiency are similar to those reported from regions in Greece where malaria is not highly endemic.

The San, a physically, culturally and linguistically distinctive people, have been shown by archaeological records anciently to have inhabited the whole of Eastern and Southern Africa. They, in common with the Khoi, the other members of the Khoisan race, are confined now to Southern Africa and principally to Botswana and South West Africa, though a number are also found in Angola. Sero-genetic data concerning seven South West African groups are presented in this study, and confirm a shared overall genetic profile characteristic of the San in general, slightly different from that of the Khoi and in significant contrast with that of the Negroes.

Measles antibody titres and HLA antigens were determined in 71 White and 11 Coloured multiple sclerosis (MS) patients and 71 White and 11 Coloured age and sex-matched controls. Measles antibody titres were determined by the hemagglutination inhibition test and HLA antigens were determined serologically by a micro-lymphocytotoxicity test. Measles antibody titres were significantly higher in MS than in control cases and this was true for both female and male patients. No association was observed between the HLA antigens, especially HLA-A3 or HLA-B7 and measles antibody titres in the sera of MS patients or controls.

Transplantation of the Fallopian tube is a technically feasible operation. Previous authors have reported pregnancies following turbo-ovarian transplants, but there appears to be no record of gestation following transplantation of the isolated oviduct. This communication illustrates the method that we have used to perform Fallopian tube transplants in the ewe and documents our first full-term pregnancy following this operation. It provides further evidence of the technical feasibility of Fallopian tube transplants.