Rates of colon cancer are much higher in African Americans (65:100,000) than in rural South Africans (<5:100,000). The higher rates are associated with higher animal protein and fat and lower fiber consumption, higher colonic secondary bile acids, lower colonic short chain fatty acid quantities and higher mucosal proliferative biomarkers of cancer risk in otherwise healthy middle aged volunteers. Here we investigate further the role of fat and fiber in this association. We performed two-week food exchanges in subjects from the same populations, where African Americans were fed a high-fiber, lowfat African-style diet, and rural Africans a high-fat low-fiber western-style diet under close supervision. In comparison to their usual diets, the food changes resulted in remarkable reciprocal changes in mucosal biomarkers of cancer risk and in aspects of the microbiota and metabolome known to affect cancer risk, best illustrated by increased saccharolytic fermentation and butyrogenesis and suppressed secondary bile acid synthesis in the African Americans.

Heightened clinicopathological awareness of the expanding anatomical distribution of myopericytoma is critical to its diagnosis when it presents in unusual and novel locations. Myopericytoma should be added to the range of external auditory canal neoplasms, especially those characterised by an admixture

Background and Aim The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. Methods This was a cross‐sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti‐tissue transglutaminase antibody (tTG), anti‐endomysial antibody (EMA), and anti‐gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. Results Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. Conclusion The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.

Over the past decade, there has been an increase in new anti-asthma medications, particularly in biological agents recommended for adult asthmatics. [1] Despite the increased access to novel agents, there has been a dearth of data and recommendations on the positioning of these drugs in the paediatric arena. Although children with severe asthma are a smaller component of the total asthmatic population (˂5%), there is a need for evidence-based recommendations for the use of these novel drugs in asthmatic children, as they consume a disproportionate amount of healthcare resources. [2,3] Biological agents are typically recommended for use in specific asthma phenotypes and endotypes, with predefined criteria predicting treatment response. [4,5] The role of asthma comorbidities and asthma education has been emphasised in the most recent international guidelines, with patient adherence and motivation forming a critical part of a package of care for asthma management and successful therapy. [1] The purpose of this continuing medical education article is to review the current literature on novel asthma drugs and to assess the evidence for their use or avoidance in the paediatric age group. The role of asthma education and strategies to improve asthma outcomes are also reviewed. Methods The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 to review the current available literature on novel treatments of asthma and asthma self-management plans (Appendix A). The scientific literature was assigned evidence levels according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system (Appendix B). Novel asthma molecules in South Africa Fluticasone furoate/vilanterol Few studies have been done in children with the new combination agent of an inhaled corticosteroid (ICS) and an ultra-long-acting beta-agonist. In 5-11-year-old patients with well-controlled asthma, fluti ca sone furoate/ vilanterol has a similar tolerability, safety profile, pharmacodynamic effect and pharmacokinetic profile as fluticasone furoate alone. [6,7] The new combination drug is currently registered for children >12 years of age and recommended for children with moderate to severe asthma (evidence level B) Tiotropium bromide Tiotropium bromide is a once-daily long-acting anticholinergic drug initially approved for chronic obstructive pulmonary disease This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Among patients with T1DM in this study, there was a high prevalence of coexistent AITD and gastric autoimmunity. Screening for hypothyroidism and thyroid autoimmunity should be undertaken in all patients at initial presentation. However, to assess the feasibility and optimal timing of subsequent testing in the African setting with limited resources, more collaborative research with longitudinal studies is required.

Background The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. Objectives To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. Methods Community pharmacists’ across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. Results Six hundred and sixty-four pharmacists’ responded to the online survey. Seventy-five percent of pharmacists’ reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. Conclusions This study provides baseline data for policy makers on pharmacists’ readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

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