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PULMONARY TUBERCULOSIS IN THE CENTRAL PRISON OF DOUALA, CAMEROON
No full textObjective: To determine the prevalence of and factors associated with pulmonary tuberculosis (PTB) in an urban prison in sub-Saharan Africa.Design: A cross-sectional survey.Setting: The Central Prison of Douala, Cameroon.Results: Two thousand four hundred and seventy four (87.4%) out of 2830 inmates underwent screening. Twenty seven (1.1%) of the inmates were under treatment for smear-positive PTB on commencement of the survey while 60 (2.4%) were diagnosed with smear and/or culture-positive PTB during the active case finding, resulting in a point prevalence of PTB of 3.5%. HIV seroprevalence in inmates without clinical signs of PTB was 111/1067 (10.4%) while it amounted to 6/24 (25%) in PTB patients. In multiple stepwise regression analysis, a low BMl, a prison stay of £12 months, and a history of previous incarceration were positively associated with PTB.Conclusion: The study results confirm the high prevalence rates of PTB in prisonpopulations and underscore the need for urgent preventive measures
COMPARISON OF SONOGRAPHY WITH VENOGRAPHY IN THE DIAGNOSIS OF DEEP VENOUS THROMBOSIS
No full textObjective: To compare the findings of venous sonography with contrast venography in the detectionof deep venous thrombosis (DVT) of the lower limbs.Design: Prospective study.Setting: The Kenyatta National Hospital, a teaching and referral hospital in Nairobi.Subjects: Fifty five limbs in 44 patients with clinical suspicion of DVT were evaluated during theseven months study period (October 2002-April 2003). The ethics committee in the institutiongranted approval for the study and participants gave written informed consent.Intervention: Venous sonography in which a three step protocol involving B-mode gray scalecompression sonography, colour and colour Doppler sonography was obtained after contrastvenography in patients with clinical suspicion of DVT. The ultrasound examination was donewithin 24 hours of the contrast venogram.Results: The overall sensitivity of venous sonography was 88.9%, specificity 91.8% and accuracy90.9%. Considering only DVT above the calf, the sensitivity improved to 100%. An alternativediagnosis was found by ultrasound in 48.6% of the negative for DVT cases.Conclusion: The accuracy of venous sonography as done locally is high and comparable to thatin developed countries. We recommend that for patients with clinical suspicion of DVT, venoussonography be done as the initial imaging investigation and venography be reserved for thosepatients with equivocal or inadequate sonography results
DECISION-INTERVENTION INTERVAL IN RUPTURED UTERI IN ILE-IFE, NIGERIA
No full textObjective: To determine the decision-intervention interval in ruptured uterus with a viewof overhauling the management strategy thereby improving the maternal and perinataloutcome.Design: Cross-sectional survey based on secondary data done between 1990-1999.Setting: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.Subjects: One hundred and two consecutive women who had uterine rupture.Results: The decision-surgical intervention interval ranged from 30 minutes to 4.5 hours.The major reason for delay was unavailability of compatible blood (88.2%), followedby lack of electricity (4.9%), unsterile instruments (3.9%), waiting for ambulance toget senior obstetricians (2.9%), delay in arrival of anaesthetist (1.9%) and neonatologists(1.9%). The peri-natal mortality rate (PNMR) was 843 per 1000 total births and maternalmortality rate (MMR) 4902 per 100,000 births.Conclusion: The maternal and perinatal outcome in uterine rupture would be improvedby early diagnosis and avoidance of preoperative delay through availability of essentialobstetric services
HAEMATOXYLIN AND EOSIN STAINING IN THE DIAGNOSIS OF HODGKIN’S DISEASE IN UGANDA
No full textABSTRACTBackground: Whereas immunohistochemical methods have been widely used for thediagnosis and classification of Hodgkin’s Disease in the developed countries, there arevery few reports of their use in the developing countries where haematoxylin and eosinis the mainstay of diagnosis of Hodgkin’s disease. Yet the diagnostic accuracy ofhaematoxylin and cosin has not been assessed in Uganda.Design: Laboratory based cross sectional study.Objective: To determine the reliability of haematoxylin and eosin staining in the diagnosisof Hodgkin’s disease using immunohistochemistry as the reference standardMethodology: Two hundred and forty formalin fixed, paraffin embedded biopsies seenin the Makerere University, Department of Pathology from 1980-2000 were studied. Thetissue sections, were assessed and subjected to immunohistochemical methods usingmonoclonal antibodies including leucocyte common antigen, LCA (CD45), antibodies toReed-Sternberg cells (CD15, CD30) and antibodies to B cells (CD20). The sensitivity,specificity, positive predictive value and negative predictive value were assessed. Theoverall Kappa score was used to assess the agreement between the two diagnostic tests.Results: Of the 240 biopsies, 171(71.3%) were confirmed as Hodgkin’s disease byimmunohistochemistry. Using haematoxylin and eosin (H&E), only 131 of the 171 casesof Hodgkin’s disease were detected. The mean age of the 171 cases was 26.1 (SD 16.2)years, with a mode of 20.0 and median of 22.5 years. The 15-24 year age group wasthe most affected (47.2%). There were more males (65.9%) than females and most wereBaganda the dominant tribe in the central region. The sensitivity, specificity, positiveand negative predictive values of haematoxylin and cosin were 76.61%, 92.75%, 96.32%and 61.53% respectively. The agreement between the two tests was 81.25% with anoverall measure of agreement, kappa, of 0.602.Conclusion: Haematoxylin and cosin has relatively high efficacy in the diagnosis ofHodgkin’s disease. Use of haematoxylin and cosin is still recommended for the diagnosisof Hodgkin’s disease, reserving the expensive irrummohistochemistry for difficult cases
DISSEMINATED HISTOPLASMOSIS DIAGNOSED ON BONE MARROW ASPIRATE CYTOLOGY: REPORT Of fOuR CASES
No full textHistoplasmosis, caused by two varieties of dimorphic fungi, Histoplasma capsulatumvariant capsulatum and Histoplasma capsulatum variant duboisii is a systemic fungalinfection. It has a worldwide distribution and is shown to be more prevalent in NorthAmerica and Central America. Both variants occur in Africa. Disease spectrum rangesfrom asymptomatic primary infection to disseminated disease in immunocompromisedpatients. Since the upsurge of Acquired Immune Deficiency Syndrome (AIDS) anddespite the availability of High Active Anti-Retroviral Therapy (HAART) many patientsstill present with opportunistic infections of which histoplasmosis is one.four cases are presented; two infants and two adults. All had disseminated disease withmultiple organ involvement and the disease was not suspected clinically. Diagnosiswas made incidentally on bone marrow aspirate cytology. The two adult cases wereHIV positive, one with CD4 counts of 132 cells/microlitre and was not on HAART.The other was on HAART but the CD4 had not been determined. One of the infantstested HIV negative and the others status was unknown. A high index of suspicionis required for diagnosis as the disease may mimic tuberculosis(TB) and other causesof hepatosplenomegaly such as visceral leishmaniasis.Laboratory diagnosis includes culture, direct staining, antigen and antibody detection.Antibody detection may give false negative in the immunocompromised patient. Theinfection responds well to antifungal agents (amphotericin B is the drug of choice)and life long maintenance therapy may be required in AIDS especially if CD4 countsremain less than 150 cells/microlitre.Histoplasmosis should be a differential diagnosis in immunosuppressed patients withunexplained fever, weight loss, hepatosplenomegaly and chest findings especially ifnot responding to anti-TB treatment
PERCEPTIONS AND VIEWS OF REGULATORY PHARMACISTS ON THE REGISTRATION SYSTEM FOR GENERIC DRUGS FOR HUMAN USE IN KENYA
No full textBackground: Generic drugs play an important role in the delivery of healthcare servicesin Kenya because of their affordability and availability. The Pharmacy and Poisons Board (PPB) is the body mandated to regulate the manufacture and supply of all drugs in Kenya. Approximately 90% of all applications for registration of drugs in Kenya are for generic drugs; however, there are concerns about the quality of generic drugs supplied to patients in Kenya.Objective: The study aimed to investigate the perceptions and views of the regulatory pharmacists on the registration system for generic drugs in Kenya, and the role of the National Quality Control Laboratory (NQCL).Design: A cross-sectional survey was designed to collect the views and perceptions of regulatory pharmacists on the system for the registration of generic drugs for human use in Kenya.Setting: The survey was conducted in the capital city of Kenya, Nairobi from January to February 2007. Nairobi was selected because it has a high concentration of pharmaceutical manufacturers and distributors involved in drug registration.Participants: The sample included regulatory pharmacists working in the registration departments of pharmaceutical companies dealing in generic drugs for human use.A sample of 40 participants was recruited for the survey and a response rate of 60%was targeted.Results: Over half (55.6%) of the respondents reported satisfaction with the drug registration system while 33.3% were unsatisfied. The level of satisfaction did not seem to be associated with the length of time it takes to register a generic drug (p-value=0.74)or the gender of the respondent (p-value=0.94). The respondents had confidence in the analytical procedures carried out by NQCL but were less satisfied with its role in generic drug registration process. The respondents made a number of recommendations towards better drug registration mechanisms for generic drugs in Kenya.Conclusion: The study suggests that although the drug registration procedures appear to be working, there is need for improvement. One area in which the registration ofgeneric drugs in Kenya can benefit is in the observation of the operation of what other countries have done to streamline their drug registration systems
SEXUAL VIOLENCE AMONG FEMALE HIGH SCHOOL STUDENTS IN DEBARK, NORTH WEST ETHIOPIA
No full textObjectives: To assess the prevalence, outcome and awareness of sexual violence among highschool female students.Design: A school-based cross-sectional survey.Setting: Debark Town, north-west Ethiopia.Subjects: Two hundred and sixteen female high school students, grade 9-11 were included forthe quantitative study. For the qualitative data, 16 individuals for the focus group discussion(10 well-recognised female figures in the town and six high school students) and head of thepolice department for in-depth interview were enrolled.Results: Sixty two per cent of the respondents had heard of sexual violence committed onyoung females. Sexual violence was reported by 65.3% of the respondents. The prevalenceof performed and attempted rape were 8.8% and 11.5%, respectively. The age range ofperformed rape victims was between 12 and 21 years. Of the 19 (8.8%) who reported rapebeing performed on them, unwanted pregnancy, suicide attempt, vaginal discharge andabortion were the consequences in 21%, 15.8%, 10.5% and 5.3%, respectively.Conclusion: Sexual violence is a major public health problem with high rates of underreporting.Sex education should be given on a regular basis and policy making bodies and thepolice be well aware of this high magnitude and take strong measures to reduce it
RISK FACTORS FOR STROKE AND USE OF ECHOCARDIOGRAPHY IN DIAGNOSIS: A REVIEW
No full textABSTRACTBackground: Stroke is a prevalent disease in many communities. Cardiologists consultationand cardiac investigations are frequently requested to rule out cardiac source of embolicmanifestations. The heart has been reported to account for 20% of ischaemic strokes in theWestern community.Objective: To review risk factors for stroke and the use of echocardiography in its diagnosis.Methods: Medline review was done for reported causes of stroke, these causes were dividedinto major and minor and were discussed briefly as general physician need to determinewhen and what to ask for.Results: Some cardiac sources do have established roles in strokes but others havecircumstantial and/or secondary roles.Conclusion: While there exists evidence to recommend echocardiogram in stroke patientswith heart disease, it is routinely needed in all patients with stroke. In some circumstances,echocardiography may enhance the diagnosis but not necessarily change management