BACKGROUND: A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged >40 years. OBJECTIVES: To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey. METHODS: Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005. RESULTS: Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range -54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (-350 mL) than in stages 2 or 3 (-80 mL and + 140 mL, respectively; p<0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by >1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD). CONCLUSIONS: The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease.

BACKGROUND. An association between chronic airflow limitation (CAL) and a history of pulmonary tuberculosis (PTB) has been confirmee in epidemiological studies, but the mechanisms responsible for this association are unclear. It is debated whether CAL in this context should be viewed as chronic obstructive pulmonary disease (COPD) or a separate phenotype. OBJECTIVE. To compare lung physiology and high-resolution computed tomography (HRCT) findings in subjects with CAL and evidence oi previous (healed) PTB with those in subjects with smoking-related COPD without evidence of previous PTB. METHODS. Subjects with CAL identified during a Burden of Obstructive Lung Disease (BOLD) study performed in South Africa were studied Investigations included questionnaires, lung physiology (spirometry, body plethysmography and diffusing capacity) and quantitative HRCT scans to assess bronchial anatomy and the presence of emphysema (<-950 HU), gas trapping (<-860 HU) and fibrosis (>-200 HU). Finding; in subjects with a past history and/or HRCT evidence of PTB were compared with those in subjects without these features. RESULTS. One hundred and seven of 196 eligible subjects (54.6%) were enrolled, 104 performed physiology tests and 94 had an HRCT scan. Based on history and HRCT findings, subjects were categorised as no previous PTB (NPTB, n=31), probable previous PTB (n=33) or definite previous PTB (DPTB, n=39). Subjects with DPTB had a lower diffusing capacity (Δ=-17.7%; p=0.001) and inspiratory capacity (Δ=-21.5%; p=0.001) than NPTB subjects, and higher gas-trapping and fibrosis but not emphysema scores (Δ=+6.2% (p=0.021), +0.36% (p=0.017) and +3.5% (p=0.098), respectively). CONCLUSIONS. The mechanisms of CAL associated with previous PTB appear to differ from those in the more common smoking-related COPD and warrant further study.

Inter-godsdienstige verhoudinge was nog altyd problematies. Teologie van godsdiens en teologie van godsdienste is die wyse waarop die Christendom oor die teenwoordigheid en aard van ander godsdienste besin. Die kerkhervormers het ook 'n bepaalde verstaan van die bestaan van en verhouding tussen die Christendom en nie-Christelike godsdienste gehad. Hierdie bydrae probeer aantoon hoe die kerkhervormers verskil het in hulle benadering tot ander godsdienste. Martin Luther en Philipp Melanchthon het die moontlikheid van verhoudinge met ander godsdienste, in besonder Jode en Moslems voorgestaan, al was dit dan ook net n momentele mening van Luther. Daarmee verteenwoordig hulle n kategorie van 'moontlikheid'. Johannes Calvyn was meer afwysend teenoor die gedagte van moontlikheid van heil binne ander godsdienste en behoort daarom tot die kategorie van 'geslotenheid'. Die kerkhervormer Theodore Bibliander was oop vir gesprek en positief oor verhoudinge met Moslems alhoewel hy nie gedink het dat heil en verlossing buite die Christendom moontlik is nie. Vir Bibliander het verhouding met ander begin, met kennis van die ander. Hy verteenwoordig die kategorie van 'openheid'. Die kerkhervormers se verstaan van die verhouding met ander godsdienste lewer n bydrae tot n huidige besinning oor inter-godsdienstige verhoudinge.

BACKGROUND: The combined tuberculosis (TB) and HIV epidemics in South Africa (SA) have created enormous operational challenges for a health service that has traditionally run vertical programmes for TB treatment and antiretroviral therapy (ART) in separate facilities. This is particularly problematic for TB/HIV co-infected patients who need to access both services. OBJECTIVE: To determine whether integrated TB facilities had better TB treatment outcomes than single-service facilities in Cape Town, SA. METHODS: TB treatment outcomes were determined for newly registered, adult TB patients (aged >18 years) at 13 integrated ART/TB primary healthcare (PHC) facilities and four single-service PHC facilities from 1 January 2009 to 30 June 2010. A x² test adjusted for a cluster sample design was used to compare outcomes by type of facility. RESULTS: Of 13 542 newly registered patients, 10 030 received TB treatment in integrated facilities and 3 512 in single-service facilities. There was no difference in baseline characteristics between the two groups with HIV status determined for 9 351 (93.2%) and 3 227 (91.9%) patients, of whom 6 649 (66.3%) and 2 213 (63%) were HIV-positive in integrated facilities and single-service facilities, respectively. The median CD4+ count of HIV-positive patients was 152 cells/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/ul (IQR 67 - 260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p=0. 56) or for the sub-set of HIV-positive TB patients (p=0.58) CONCLUSION: This study did not demonstrate improved TB treatment outcomes in integrated PHC facilities and showed that the provision of ART in the same facility as TB services was not associated with lower TB death and default rates.

OBJECTIVE: To determine the population-based incidence of disseminated bacille Calmette-Guérin (BCG) disease in HIV-infected infants (aged < 1 year) in a setting with a high burden of tuberculosis and HIV infection coupled with a well-functioning programme for the prevention of HIV infection in infants. METHODS: The numerator, or number of new cases of disseminated BCG disease, was derived from multicentre surveillance data collected prospectively on infants with a confirmed HIV infection during 2004-2006. The denominator, or total number of HIV-infected infants who were BCG-vaccinated, was derived from population-based estimates of the number of live infants and from reported maternal HIV infection prevalence, vertical HIV transmission rates and BCG vaccination rates. FINDINGS: The estimated incidences of disseminated BCG disease per 100 000 BCG-vaccinated, HIV-infected infants were as follows: 778 (95% confidence interval, CI: 361-1319) in 2004 (vertical HIV transmission rate: 10.4%); 1300 (95% CI: 587-2290) in 2005 (transmission rate: 6.1%); and 1013 (95% CI: 377-1895) in 2006 (transmission rate: 5.4%). The pooled incidence over the study period was 992 (95% CI: 567-1495) per 100 000. CONCLUSION: Multicentre surveillance data showed that the risk of disseminated BCG disease in HIV-infected infants is considerably higher than previously estimated, although likely to be under-estimated. There is an urgent need for data on the risk-benefit ratio of BCG vaccination in HIV-infected infants to inform decision-making in settings where HIV infection and tuberculosis burdens are high. Safe and effective tuberculosis prevention strategies are needed for HIV-infected infants.

OBJETIVO: Determinar la incidencia poblacional de la infección diseminada por el bacilo de Calmette-Guérin (BCG) en lactantes (niños < 1 años) en un entorno de alta carga de tuberculosis e infección por VIH y de aplicación satisfactoria de un programa de prevención de la infección por VIH en los lactantes. MÉTODOS: El numerador, o número de nuevos casos de infección diseminada por BCG, se calculó a partir de datos de vigilancia multicéntricos reunidos prospectivamente sobre lactantes con infección confirmada por VIH durante 2004-2006. El denominador, o número total de lactantes infectados por el VIH y vacunados con la BCG, se calculó a partir de estimaciones poblacionales del número de lactantes vivos y de la prevalencia de infección materna por VIH, de las tasas de transmisión vertical del VIH y de las tasas de vacunación con BCG. RESULTADOS: Las incidencias estimadas de infección diseminada por BCG por 100 000 lactantes infectados por el VIH y vacunados con BCG fueron las siguientes: 778 (intervalo de confianza del 95%, IC95%: 361-1319) en 2004 (transmisión vertical del VIH: 10,4%); 1300 (IC95%: 587-2290) en 2005 (tasa de transmisión: 6,1%); y 1013 (IC95%: 377-1895) en 2006 (tasa de transmisión: 5,4%). La incidencia combinada a lo largo del periodo estudiado fue de 992 (IC95%: 567-1495) por 100 000. CONCLUSIÓN: Los datos de la vigilancia multicéntrica revelaron que el riesgo de infección diseminada por BCG en los lactantes infectados por el VIH era considerablemente superior al estimado anteriormente. Urge disponer de datos sobre la relación riesgo-beneficio de la vacunación con BCG en los lactantes infectados por el VIH a fin de fundamentar la adopción de decisiones en los entornos con alta carga de infección por VIH y de tuberculosis. Es preciso formular estrategias seguras y eficaces de prevención de la tuberculosis para los lactantes infectados por el VIH.

OBJECTIF: Déterminer l'incidence en population de l'infection disséminée par le bacille de Calmette-Guérin (BCG) chez les nourrissons infectés par le VIH (âge < 1 an) dans une situation caractérisée par une forte charge de tuberculose et d'infections à VIH, mais aussi par un bon fonctionnement du programme de prévention de l'infection par le VIH chez les nourrissons. MÉTHODES: Le numérateur, ou nombre de nouveaux cas d'infection disséminée par le BCG, a été déterminé à partir des données de surveillance multicentrique, collectées prospectivement au sujet des nourrissons présentant une infection à VIH confirmée au cours de la période 2004-2006. Le dénominateur, ou nombre total de nourrissons infectés par le VIH et vaccinés par le BCG, a été obtenu à partir d'estimations en population du nombre de nourrissons vivants et à partir de la prévalence rapportée des infections à VIH maternelles, des taux de transmission verticale du VIH et des taux de vaccination par le BCG. RÉSULTATS: L'incidence de l'infection disséminée par le BCG pour 100 000 nourrissons vaccinés par le BCG a été estimée à : 778 cas (intervalle de confiance à 95 %, IC : 361-1319) en 2004 (taux de transmission verticale du VIH : 10,4 %) ; 1300 cas (IC à 95 % : 587-2290) en 2005 (taux de transmission : 6,1 %) ; et 1013 cas (IC à 95 % : 377-1895) en 2006 (taux de transmission : 5,4 %). L'incidence globale sur l'ensemble de la période étudiée était de 992 (IC à 95 % : 567-1495) pour 100 000. CONCLUSION: Les données de surveillance multicentrique ont montré que le risque d'infection disséminée par le BCG chez les nourrissons infectés par le VIH était considérablement plus élevé qu'on ne l'avait estimé auparavant, bien que probablement encore sous-estimé. On a besoin d'urgence de données sur le rapport risque/bénéfice de la vaccination par le BCG chez les nourrissons infectés par le VIH pour étayer la prise de décisions dans des contextes où les charges d'infection à VIH et de tuberculose sont importantes. Des stratégies sûres et efficaces de prévention de la tuberculose sont nécessaires pour les nourrissons infectés par le VIH.