Background and purpose: Little is known about the epidemiological features of amyotrophic lateral sclerosis (ALS) in sub-Saharan Africa, and data from the region are limited to clinical series or case reports. The aim of the study was to investigate the incidence rate and presentation of ALS in an ethnically diverse region of South Africa. Methods: We performed a 4-year prospective incidence study in the Western Cape Province of South Africa between 1 July 2014 and 30 June 2018, and used a two-source capture-recapture method for case ascertainment. Age-and sex-adjusted incidence rates (ASAIRs) were calculated using the 2010 US population as the reference. Results: A total of 203 incident cases were identified over the study period, resulting in a crude incidence rate (IR) of 1.09 [95% confidence interval (CI) 0.94-1.24] per 100 000 person-years in the at-risk population (aged >15 years). Capture-recapture analysis resulted in an estimated IR of 1.11 (95% CI 1.01-1.22) per 100 000 person-years. The ASAIR was 1.67 (95% CI 1.09-2.26) overall; 1.99 (95% CI 1.60-2.39) for men and 1.37 (95% CI 1.06-1.68) for women. When analysed separately, there was a substantial difference in ASAIRs between the different population groups, with the highest in the European ancestry group (2.62; 95% CI 2.49-2.75), the lowest in the African ancestry group (0.56, 95% CI 0.0-1.23), and an ASAIR in between these two in the mixed ancestry group (1.09, 95% CI 0.80-1.37). Conclusion: The overall incidence of ALS in the Western Cape Province of South Africa appears to be lower than in North African and Western countries, but higher than in Asian countries. As suggested by previous epidemiological studies, ALS may be less frequent in people of African ancestry.

This case is the first report of an en bloc transplantation of a horseshoe kidney in South Africa. The graft anatomy included complete fusion of the lower poles of the two kidney units with a single artery and vein associated with each unit. The thick isthmus of the graft kidney was supplied by a single, large caliber anomalous artery. Bench work (total duration 160 minutes) included the preparation of a short segment of donor aorta and IVC (containing the renal vessels) which were anastomosed to the recipient common iliac artery and common iliac vein respectively. The artery of the isthmus was anastomosed to the recipient right internal iliac artery. The graft was placed intraperitoneally. Cold ischaemia time was 15 hours, warm ischaemia time 144 minutes, total procedure time 450 minutes and estimated blood loss 1100 ml. Renogram (99m Tc MAG-3) on days 1, 3 and 14 postoperatively revealed ATN. Hospital stay was 17 days and nadir creatinine at 6 weeks was 77 µmol/l.

Previous literature indicates that the detection of haematuria on urine microscopy, to exclude bladder invasion by cervical cancer, has a high specificity. It also aids the evaluation of whether a patient needs a staging cystoscopy or not. The purpose of this study was to replicate these findings, and also to determine whether a urinary dipstick test for microscopic haematuria can be used as a screening test to identify bladder invasion by cervical cancer. Methods: A prospective observational study was conducted from January 2015 until December 2016 at a tertiary referral centre. It included all patients with newly diagnosed stage 2 or higher cervical cancer who received a staging cystoscopy at the authors' institution. Urine was collected by means of catheterisation and sent for urinary dipstick test and urine microscopy. Microscopy results were compared with cystoscopy findings. Results: Urinary dipstick testing for microscopic haematuria was performed on 143 patients. The sensitivity of the test was 1 and the specificity was 0.85. The negative predictive value was 1 and the positive predictive value was 0.5. With urine microscopy for haematuria, if more than 10 000 erythrocytes per millilitre was used for defining microscopic haematuria, the sensitivity was 1, the specificity 0.8, the positive predictive value 0.43 and the negative predictive value 1. Conclusion:The presence of microhaematuria can be used as a screening test to predict possible invasion of the urinary bladder by cervical cancer, and can thus be used to identify patients needing cystoscopy. Urine dipstick testing (Bayer Multix 10SG dipstick) provided statistically similar results to urine microscopy (if >10 000 erythrocytes equates microhaematuria) to identify patients needing cystoscopy.

No abstract