BACKGROUND: Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID-19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA OBJECTIVES: To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID-19, and the level of medical control of these chronic diseases METHODS: We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID-19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID-19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV RESULTS: On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID-19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID-19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/μL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level >6.5% CONCLUSION: The study revealed a high prevalence of comorbid conditions among individuals with COVID-19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many had poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID-19 pandemic

By May 2021, South Africa (SA) had experienced two 'waves' of COVID-19 infections, with an initial peak of infections reached in July 2020, followed by a larger peak of infections in January 2021. Public health decisions rely on accurate and timely disease surveillance and epidemiological analyses, and accessibility of data at all levels of government is critical to inform stakeholders to respond effectively. In this paper, we describe the adaptation, development and operation of epidemiological surveillance and modelling systems in SA in response to the COVID-19 epidemic, including data systems for monitoring laboratory-confirmed COVID-19 cases, hospitalisations, mortality and recoveries at a national and provincial level, and how these systems were used to inform modelling projections and public health decisions. Detailed descriptions on the characteristics and completeness of individual datasets are not provided in this paper. Rapid development of robust data systems was necessary to support the response to the SA COVID-19 epidemic. These systems produced data streams that were used in decision-making at all levels of government. While much progress was made in producing epidemiological data, challenges remain to be overcome to address gaps to better prepare for future waves of COVID-19 and other health emergencies.

Abstract Introduction In surgical training, large animal models are more suitable as their anatomy is more similar to humans. In otology, there have been relatively few studies about large animal models for surgical training. Objective In this study, we aimed to do a neuroradiologic evaluation and surgical insertion of a cochlear implant electrode array on a sheep head model. Methods Twenty cadaveric sheep heads were studied. A computed tomography scan and neuroradiologic evaluation was performed on each head, obtaining measurements of the inner ear for each sheep. Sheep measurements were compared to those from temporal bone computed tomography scans from 20 female humans. Surgical procedures were first trained with 13 of the sheep temporal bones, after which cochlear implantation was performed on the remaining 7 temporal bones. The position of the inserted electrode array insertion was confirmed by computed tomography scan after the procedure. Results Neuroradiologic evaluation showed that, relative to the 20 female humans, the mean ratio for sheep was 0.60 for volume of cochlea, 0.70 for height of cochlea, 0.73 for length of cochlea; ratios for other metrics were >0.80. For the surgical training, the round window was found in all 20 sheep temporal bones. Computed tomography scans confirmed that electrode insertions were fully complete; the mean value of electrode array insertion was 18.3 mm. Conclusion The neuroradiologic and surgical training data suggest that the sheep is a realistic animal model to train cochlear implant surgery and collection of perilymph samples, but less so for surgical training of mastoidectomy due to pneumatization of the mastoid.

Resumo Introdução No treinamento cirúrgico, os modelos animais de grande porte são mais adequados, pois sua anatomia é mais semelhante à humana. Em otologia, existem relativamente poucos estudos com modelo animal de grande porte para treinamento cirúrgico. Objetivo Fazer a avaliação neurorradiológica e a inserção cirúrgica de um eletrodo de implante coclear em um modelo de ovelha. Método Vinte cabeças de cadáveres de ovelhas foram estudadas. Foram feitas tomografia computadorizada e avaliação neurorradiológica de cada cabeça, obtiveram‐se medidas da orelha interna de cada ovelha. As medidas das ovelhas foram comparadas às de tomografias computadorizadas do osso temporal de 20 mulheres. Os procedimentos cirúrgicos foram inicialmente treinados com 13 dos ossos temporais de ovelhas, após o qual o implante coclear foi feito nos 7 ossos temporais restantes. A posição de inserção do arranjo de eletrodos foi confirmada por tomografia computadorizada após o procedimento. Resultados A avaliação neurorradiológica mostrou que, em comparação às 20 mulheres, a proporção média para as ovelhas foi de 0,60 para o volume da cóclea, 0,70 para a altura da cóclea, 0,73 para o comprimento da cóclea; as proporções para as outras medidas foram > 0,80. Em relação ao treinamento cirúrgico, a janela redonda foi encontrada em todos os 20 ossos temporais de ovelhas. A tomografia computadorizada confirmou que as inserções dos eletrodos foram totalmente completas; o valor médio da inserção do arranjo de eletrodos foi de 18,3 mm. Conclusão Os dados do treinamento neurorradiológico e cirúrgico sugerem que a ovelha é um modelo animal realista para o treinamento da cirurgia de implante coclear e coleta de amostras da perilinfa, mas não tão realista para o treinamento cirúrgico de mastoidectomia devido à pneumatização da mastoide.

BACKGROUND. More comprehensive immunisation regimens, strengthening of HIV prevention and management programmes and improved socioeconomic conditions have impacted on the epidemiology of paediatric community-acquired pneumonia (CAP) in South Africa (SA). OBJECTIVES. To summarise effective preventive strategies to reduce the burden of childhood CAP. METHODS. An expert subgroup reviewed existing SA guidelines and new publications focusing on prevention. Published evidence on pneumonia prevention informed the revisions; in the absence of evidence, expert opinion was used. Evidence was graded using the British Thoracic Society (BTS) grading system. RECOMMENDATIONS. General measures for prevention include minimising exposure to tobacco smoke or air pollution, breastfeeding, optimising nutrition, optimising maternal health from pregnancy onwards, adequate antenatal care and improvement in socioeconomic and living conditions. Prevention of viral transmission, including SARS-CoV-2, can be achieved by hand hygiene, environmental decontamination, use of masks and isolation of infected people. Specific preventive measures include vaccines as contained in the Expanded Programme on Immunisation schedule, isoniazid prophylaxis for tuberculosis, co-trimoxazole prophylaxis for HIV-infected infants and children who are immunosuppressed, and timely diagnosis of HIV, as well as antiretroviral therapy (ART) initiation. HIV-infected children treated with ART from early infancy, and HIV-exposed children, have similar immunogenicity and immune responses to most childhood vaccines as HIV-unexposed infants. VALIDATION. These recommendations are based on available published evidence supplemented by the consensus opinion of SA paediatric experts, and are consistent with those in published international guidelines.

BACKGROUND. Pneumococcal conjugate vaccine (PCV) administration and other advances have been associated with a shift in the aetiological spectrum of community-acquired pneumonia, necessitating reconsideration of empiric antibiotic treatment guidelines. Management strategies have also evolved in the last decade. OBJECTIVES. To produce revised guidelines for the treatment of pneumonia in South African (SA) children, including ambulatory, hospital and intensive care management. METHODS. An expert subgroup, reviewing evidence on the management of childhood pneumonia, was convened as part of a broader group revising SA guidelines. Evidence was graded using the British Thoracic Society (BTS) grading system and recommendations were made. RESULTS. Antibiotic treatment depends on the child's age, possible aetiology, antimicrobial resistance patterns, previous treatment, as well as factors affecting host susceptibility, including HIV, and nutritional and vaccination status. All children with signs of severe pneumonia should receive antibiotics. Children <1 month of age with pneumonia should be hospitalised and treated with ampicillin and an aminoglycoside. For treatment of ambulatory children >1 month of age, high-dose amoxicillin remains the preferred antibiotic. For severe pneumonia in this age group, hospitalisation and empiric treatment with amoxicillin-clavulanate orally is recommended; if oral therapy is not tolerated, intravenous therapy is recommended. Generally, 5 days of therapy is proposed, but longer duration may be needed in cases of severe or complicated disease. A macrolide antibiotic should be used if pertussis, mycoplasma or chlamydia pneumonia is suspected. Most hypoxic children can receive oxygen via nasal cannulae, but respiratory support should be individualised and extends to non-invasive and invasive ventilation in some cases. Children should be fed enterally; if this is not possible, administer intravenous isotonic fluids at <80% of maintenance, with monitoring of sodium levels. Empiric antibiotic treatment is the same in HIV-infected, HIV-exposed uninfected and HIV-uninfected children, although treatment for pneumocystis pneumonia and/or cytomegalovirus pneumonia should be considered in HIV-infected infants, especially in the absence of combination antiretroviral therapy. CONCLUSIONS. Updated guidelines optimise the management of childhood pneumonia in the context of changing epidemiology, improvements in HIV prevention and new evidence on management.

BACKGROUND: Although immunisation services are available to all children in South Africa (SA), many children miss or have delays in receiving vaccines. There are limited data on factors associated with missed or delayed vaccination in children in this setting.OBJECTIVES: To assess vaccination coverage and factors associated with missed and delayed diphtheria-tetanus-pertussis vaccine third dose (DTP3) vaccination in children aged 12 - 59 months in two SA communities.METHODS: We used data from household-level healthcare utilisation surveys conducted in Soweto in 2012 and in Pietermaritzburg in 2013. Information on vaccination status was recorded from the Road to Health cards or vaccination history from clinics for children aged <5 years. Factors associated with missed or delayed DTP3 vaccination were assessed using unconditional logistic regression.RESULTS: Of a total of 847 eligible children aged 12 - 59 months, 716 had available vaccination information. Overall DTP3 vaccination coverage was high for both sites: 90.6% in Pietermaritzburg and 93.9% in Soweto. However, 32.6% and 25.2% of DTP3 vaccinations were delayed (received after 18 weeks of age) in Pietermaritzburg and Soweto, respectively. The median delay for DTP3 vaccinations was 4.7 weeks (interquartile range 1.7 - 23.0). Factors associated with delayed DTP3 vaccination included being born in 2010 (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 1.4 - 6.3) or 2011 (aOR 2.7, 95% CI 1.3 - 5.7) compared with being born in 2008, probably due to vaccine shortages; a low level of education of the primary caregiver, with children whose caregivers had completed secondary education having lower odds of delayed vaccination (aOR 0.5, 95% CI 0.3 - 0.9) than children whose caregivers only had primary education; and maternal HIV status, with unknown status (aOR 3.5, 95% CI 1.6 - 7.6) associated with higher odds of delay than positive status. Factors associated with missed DTP3 vaccination (not vaccinated by 12 months of age) included two or more children aged <5 years in a household (aOR 2.4, 95% CI 1.2 - 4.9) compared with one child, and household monthly income <ZAR500 (aOR 3.4, 95% CI 1.1 - 11.4) compared with >ZAR2 000.CONCLUSIONS: Despite high overall DTP3 coverage observed in two communities, many vaccinations were delayed. Vulnerable groups identified in this study should be targeted with improved vaccination services to enhance uptake and timeliness of vaccination.

BACKGROUND: Public health facilities are used by the majority of South Africans, and healthcare utilisation surveys have been a useful tool to estimate the burden of disease in a given areaOBJECTIVES: To describe care-seeking behaviour in a periurban site with a high prevalence of HIV infection, as well as barriers to seeking appropriate healthcareMETHODS: We conducted a cross-sectional household survey in 22 wards of the Msunduzi municipality in KwaZulu-Natal Province, South Africa, from October to December 2013 using a simple random sample of households selected from a 2011 census enumeration. A primary caregiver/adult decision-maker was interviewed regarding demographic data as well as health status and recent self-reported episodes of selected illnesses and healthcare utilisationRESULTS: Of the 2 238 eligible premises visited, 1 936 households (87%) with a total of 9 733 members were enrolled in the study. Of these, 635 (7%) reported one or more episodes of infectious illness during the study period. Public health clinics were most frequently consulted for all illnesses (361/635, 57%). Private healthcare (general practitioner, private clinic, private hospital) was sought by 90/635 of individuals (14%), only 13/635 (2%) reported seeking care from traditional healers, religious leaders or volunteers, and 71/635 (11%) did not seek any medical care for acute illnesses. Individuals in the lowest income group were more likely to seek care at public health facilities than those in the highest income group (70% v. 32%CONCLUSIONS: Public health facility-based surveillance may be representative of disease patterns in this community, although surveillance at household level shows that high-income individuals may be excluded because they were more likely to use private healthcare, and the proportion of individuals who died at home would have been missed by facility-based surveillance. Data obtained in such surveys may be useful for public health planning

Vaccination is the most effective strategy to prevent influenza. It is recommended that influenza vaccine be administered each year before the influenza season, i.e. from March to June, although for individuals at increased risk of severe influenza in whom vaccination was missed, vaccine may be administered later. For a review of the 2015 influenza season and ongoing real-time updates of the 2016 influenza season when it starts, refer to the website of the National Institute for Communicable Diseases of the National Health Laboratory Service (www.nicd.ac.za). In this article we provide recommendations for the use of influenza vaccines in anticipation of the 2016 southern hemisphere influenza season. Guidance is based on available evidence to assist clinicians in making decisions regarding influenza vaccination. It should be noted that this article includes general recommendations for vaccination with influenza vaccines available in South Africa and may differ from groups targeted in specific vaccination programmes, e.g. the National Department of Health Programme.

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OBJECTIF: Mettre au point un modèle permettant d'identifier les zones à haut risque d'épidémies sporadiques de rougeole, sur la base d'une analyse des facteurs associés à une épidémie nationale en Afrique du Sud, entre 2009 et 2011. MÉTHODES: Les données sur les cas survenus avant et pendant l'épidémie nationale ont été obtenues auprès du programme sud-africain de surveillance de la rougeole, et les données sur la vaccination contre la rougeole et la taille de la population auprès du système d'informations sanitaires des districts. Un modèle hiérarchique bayésien de Poisson a été utilisé pour étudier l'association entre le risque de rougeole chez les nourrissons dans un district et la couverture vaccinale pour la première dose, la densité de population, la prévalence sous-jacente de l'infection par le virus de l'immunodéficience humaine (VIH) et l'échec attendu de la séroconversion. Les projections du modèle ont été utilisées pour identifier les nouvelles zones à haut risque en 2012. RÉSULTAT: Un schéma spatial clair des zones à haut risque a été observé, avec de nombreuses zones interconnectées (c'est-à-dire voisines). Un risque accru d'épidémie de rougeole a été significativement associé à la constitution préalable d'une population vulnérable ainsi qu'à la densité de population. Le risque était aussi élevé lorsque plus de 20% des nourrissons dans une zone fortement peuplée n'avaient pas reçu une première dose du vaccin. Le modèle a été en mesure d'identifier les zones à haut risque d'épidémie de rougeole en 2012, ainsi que là où des mesures préventives supplémentaires pourraient être prises. CONCLUSION: L'épidémie de rougeole en Afrique du Sud a été associée à la constitution d'une population vulnérable (en raison d'une couverture vaccinale médiocre), à la prévalence élevée de l'infection par le VIH et à une forte densité de population. Le modèle prédictif développé pourrait être appliqué à d'autres contextes sensibles aux épidémies sporadiques de rougeole et à d'autres maladies qui peuvent être prévenues par la vaccination.

OBJECTIVE: To develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. METHODS: Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunization and population size, from the District Health Information System. A Bayesian hierarchical Poisson model was used to investigate the association between the risk of measles in infants in a district and first-dose vaccination coverage, population density, background prevalence of human immunodeficiency virus (HIV) infection and expected failure of seroconversion. Model projections were used to identify emerging high-risk areas in 2012. FINDINGS: A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. CONCLUSION: The South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.

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OBJETIVO: Desarrollar un modelo para identificar las áreas con riesgo alto de sufrir brotes esporádicos de sarampión en base a un análisis de los factores asociados a un brote nacional en Sudáfrica entre los años 2009 y 2011. MÉTODOS: Los datos de los casos ocurridos antes y durante el brote nacional se obtuvieron del programa de vigilancia del sarampión de Sudáfrica, y la información acerca de la vacunación contra el sarampión y el tamaño de la población, del sistema de información sanitaria por distritos. Se empleó un modelo de Poisson jerárquico bayesiano para investigar la relación entre el riesgo de sarampión en niños de un distrito con la cobertura de la primera dosis de la vacuna, la densidad de población, el historial de prevalencia de la infección por el virus de la inmunodeficiencia humana (VIH) y el fracaso previsto de la seroconversión. Las proyecciones del modelo se utilizaron para identificar áreas de alto riesgo nuevas en 2012. RESULTADOS: Se observó un patrón espacial claro de las áreas de alto riesgo con muchas zonas conectadas (esto es, colindantes). El riesgo superior de sufrir un brote de sarampión se asoció de modo significativo tanto con el crecimiento previo de un grupo de población vulnerable como con la densidad de población, y también fue elevado cuando más del 20% de los niños en un área populosa no había recibido la primera dosis de la vacuna. El modelo fue capaz de identificar las áreas con riesgo alto de sufrir un brote de sarampión en 2012 y donde podrían emprenderse medidas de prevención adicionales. CONCLUSIÓN: El brote de sarampión en Sudáfrica estuvo asociado con el aumento de un grupo de población vulnerable (debido a una cobertura de vacunación insuficiente), una prevalencia elevada de la infección por VIH y una densidad de población alta. El modelo predictivo desarrollado podría aplicarse a otros lugares susceptibles de sufrir brotes esporádicos de sarampión y otras enfermedades inmunoprevenibles.

Objective: The aim of this article is to compare the diagnosis, obtained through different methods and indicators, of nutritional risk in patients with cancer. Methods: It was assesed nutritional risk in of 144 oncology patients was assessed, making use of Subjective Global Assessment (SGA, Detsky 1987), Malnutrition Universal Screening Tool (MUST, 2003), Body Mass Index (BMI) and Serum Albumin. Statistical Analysis: Kappa, chi-square and McNemar tests. Results: It was found a high prevalence of malnutrition (MUST, 78.32%; SGA, 77.08%; serum albumin level< 3.5 g/dL, 45.60%; BMI < 20.0 kg/m², 36.11%) in patients with cancer. In general, there was a higher prevalence in patients with Gastrointestinal Tract Cancer (72.22%), with the stomach cancer being the most common one (29.17%). Tumors of the digestive tract presented with higher nutritional risk according to SGA (p < 0.0001), MUST (p < 0.01), BMI (p < 0,05) and serum albumin level < 3,0 g/dL (p < 0.05); these patients have twenty three times more chances of nutritional risk than patients with cancer in other organs. The patients that have also metastasis presented greater nutritional impairment, according to MUST (p < 0.05) and serum albumin level< 3,0 g/dl (p < 0,01). According to this study, we demonstrate that there is no difference between the Diagnosis of Nutritional Risk, according to MUST and SGA. However, these values are different when confronted with the ones of serum albumin level and BMI. Conclusion: The MUST and the Serum Albumin proved to be sensitive methods for the identification of nutritional risk in patients with metastatic cancer. The SGA and MUST tests are good diagnostic tests which presented convergence of results.

Objetivo: El objetivo de este artículo es comparar el diagnóstico de riesgo nutritivo en pacientes con cáncer, obtenido por diferentes métodos e indicadores. Métodos: Se evaluó el riesgo nutricional en 144 pacientes oncológicos, empleando la Valoración Global Subjetiva ( Subjetive Global Assessment, SGA, Detsky 1987), el Instrumento Universal de Despistaje de Malnutrición (Malnutrition Universal Screening Tool, MUST 2003), elÍndice de Masa Corporal (IMC) y la albúmina sérica. Análisis estadístico: Pruebas de Kappa, chi-cuadrado y McNemar. Resultados: Se encontró una alta prevalencia de malnutrición (MUST, 78,32%; SGA, 77,08%, concentración de albúmina sérica < 3,5 g/dl, IMC < 20,0 kg/m², 36,11%) en pacientes con cáncer. En general, la prevalencia era mayor en pacientes con cáncer del tracto gastrointestinal (72,22%), siendo el más frecuente el cáncer gástrico (29,17%). Los tumores digestivos tenían el mayor riesgo nutritivo según el SGA (p < 0,0001), MUST (p < 0,01), IMC (p < 0,05) y concentración de albúmina sérica < 3 g/dl (p < 0,05); estos pacientes tienen 23 veces más probabilidades de riesgo nutritivo que los pacientes con cáncer en otros órganos. Los pacientes que también tiene metástasis tienen mayor trastorno nutritivo, según el MUST (p < 0,05) y la concentración de albúmina sérica < 3 g/dl (p < 0,01). Según este estudio, hemos demostrado que no existen diferencias en el diagnóstico de riesgo nutricional entre el MUST y el SGA. Sin embargo, estos valores difieren cuando se comparan con la concentración de albúmina sérica y con el IMC. Conclusión: Demostramos que el MUST y la albúmina sérica son métodos sensibles para identificar el riesgo nutritivo en pacientes con cáncer metastásico. El SGA y el MUST son pruebas diagnósticas buenas que tienen resultados concordantes.

To determine the influence of residual ß-cell function on retinopathy and microalbuminuria we measured basal C-peptide in 50 type 1 diabetic outpatients aged 24.96 ± 7.14 years, with a duration of diabetes of 9.1 ± 6.2 years. Forty-three patients (86%) with low C-peptide (<0.74 ng/ml) had longer duration of diabetes than 7 patients (14%) with high C-peptide (<FONT FACE="Symbol">³</font>0.74 ng/ml) (9 (2-34) vs 3 (1-10) years, P = 0.01) and a tendency to high glycated hemoglobin (HBA1) (8.8 (6-17.9) vs 7.7 (6.9-8.7)%, P = 0.08). Nine patients (18%) had microalbuminuria (two out of three overnight urine samples with an albumin excretion rate (AER) <FONT FACE="Symbol">³</font>20 and <200 µg/min) and 13 (26%) had background retinopathy. No association was found between low C-peptide, microalbuminuria and retinopathy and no difference in basal C-peptide was observed between microalbuminuric and normoalbuminuric patients (0.4 ± 0.5 vs 0.19 ± 0.22 ng/ml, P = 0.61) and between patients with or without retinopathy (0.4 ± 0.6 vs 0.2 ± 0.3 ng/ml, P = 0.43). Multiple regression analysis showed that duration of diabetes (r = 0.30, r2 = 0.09, P = 0.031) followed by HBA1 (r = 0.41, r2 = 0.17, P = 0.01) influenced basal C-peptide, and this duration of diabetes was the only variable affecting AER (r = 0.40, r2 = 0.16, P = 0.004). In our sample of type 1 diabetic patients residual ß-cell function was not associated with microalbuminuria or retinopathy.