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THYROID CARCINOMA AT KING EDWARD VIII HOSPITAL, DURBAN, SOUTH AFRICA
No full textBackground: Western literature depicts papillary carcinoma as the most common thyroidmalignancy foltowed by follicular carcinoma.Objective: To assess the clinical pattern of Uyroid carcinoma among African and Indianpatients.Setting: King Edward VIII Hospital, Durban, South Africa.Design: A retrospective study.Subjects: One hundred patients with thyroid carcinoma treated at a tertiarj teachinghospital hctween 1Y'lO and 1997.Result: Seventj scven patients were Africans and 23 were Indians. The male to female ratiowas L:6. Ninety eight patients presented with goitre with or without regional lymph nodeintolvernent or distant disease. The duration of symptoms ranged from one to 360 months.Thr mean agc at presentation was 48.6t116.0 years. Follicular carcinoma was the mostcommon malignancy among African patients (68%), followed by papillary carcinoma( 16 Vr 'r. anaplartic carcinun~ii ( 13 % ) and medullary carcinoma (2.6% 1. Papillary carcinomawas the n~ust common rnalignat~cy among Indian patients (5770 j rollowed by follicularcarcinoma and mc.dullar> carcinoma. There was no anaptastic carcinoma among Indianpatients. Fifty five patients undemcnt lobectomy with 3Lunder~oingsubsequtnt completionthyroideclumy. Ninc patients had near total Ihyroidectorny, 27 were offered totalthyroidecton~y as primary surgery and eight had biopsv only. Thc in-hohpital tnortality was8%. Recurrence ratc was 870.Conclusion: Most patients present long after the de*rlvprncnt of synlptnms. Follicularcarcinoma is the mast common thyroid malignancy anlong Africans. Further studies arerequired to cxplain this phcnommon
VITAMIN A LEVELS IN HIVIAIDS
No full textObjective: To study the correlation of vitamin A concentrations in patients with AIDS, HIVpositive symptom free and HIV negative symptom free men and women.Design: A cross-sectional study.Subjects: Male and female volunteers aged between 15 and 60 yean willing to undergo anHIV-test.Setting: Participants came from different backgrounds within the city of Ndola. Some wereurban while others were peri-urban dwellers. They were included in the study only if theywere willing to undergo the HIV test regardless of their place of residence.Main outcome measures: After obtaining consent blood samples were taken from theparticipants using needle and syringe. Whole blood was used to measure haematologicalindices while serum was used to measure vitamin A concentrations and HIV status.Results: One hundred and thirty five participants were recruited for the study. Vitamin Awas analysed in eighty seven HIV negative symptom free, forty one HIV-positive symptomfree and seven AIDS cases. 'There was a significant difference (p<O.OS) in the variance ofvitamin A levels in the three groups. Vitamin A deficiency is defined as blood concentrationsbelow 30 Wdl. Using this cut-off point, the Odds Ratio for deficiency if HIV-positive wasfound to be 6.3 (2.5,16.7 p<0.0001). The Odds Ratio for HIV and serum vitamin A def~iencywas approximately the same for males and females. There was a modest correlation betweenvitamin A concentrations and haemoglobin (r=0.34,95 % CI 0.18,0.48, p<0.0001).Conclusion: Vitamin A concentration is lowered in HIV infection. The depletion of vitaminA seems to increase with progression of the infection leading to AIDS disease. Whetherregular supplementation of vitamin A to the HIV infected individual can lead to a delayedprogression to AIDS needs to be explored
ARCOBACTER BUTZLIERI STRAINS FROM POULTRY ABATTOIR EFFLUENT IN NIGERIA
No full textABSTRACTObjective:To investigate the prevalence, species distribution and genetic diversity of zoonoticArcobacter species.Design: Prospective study.Setting: Drainage system of a cosmopolitan chicken abattoir in Lagos, Nigeria.Methods : One hundred and fifity drainage water samples were enriched in a minimalantibiotics-containing medium at room temperature and bacteria then isolated by use of amembrane filtration method.Results: Twenty six (14%) of samples were positive for Arcobacter spp. Of these, 20 wereexamined by a comprehensive probabilistic identification scheme for Epsilobacteria and allstrains identified as A. butzleri. AFLP analysis of these strains revealed considerable geneticdiversity among the strains, with 12 genotypes defined at the 90% similarity level.Conclusion: The prevalence of A. butzleri in Nigerian poultry abattoir effluent indicates thisspecies may constitute a public health problem in this country. AFLP profiling could be auseful tool for molecular epidemiological and population genetic studies of this organism.This is the first known report of A. butzleri in Nigeria, and first application of AFLP analysisfor genotyping the species
SPECIES DISTRIBUTION AND ANTIFUNGAL SENSITIVITY PATTERNS OF VAGINAL YEASTS
No full textObjectives: To identify yeast isolates in vaginal specimens to species level and determine their antifungal susceptibility patterns.Design: Cross-sectional laboratory-based study.Setting: The Aga Khan University Hospital (AKUH), Nairobi.Subjects: Yeast isolates from high vaginal swabs presented to the laboratory for culture and sensitivity were identified to species level using the API Candida system and subjected to broth microdilution susceptibility testing.Main outcome measures: Frequency tables and graphs were used to summarise the data.Susceptibility data was analysed by the non-parametric Fisher’s exact test. P<0.05 was considered statistically significant.Results: A total of 101 yeasts were studied. C.albicans was the prominent species (69.3%) followed by C. glabrata (12.9%), C. famata (5.0%), C. krusei (3.0%), Trichosporon species (3.0%) and S.cerevisiae (3.0%), C.parapsilosis (1.0%). Three (3.0%) of the isolates had profiles that fell between C. glabrata and C. famata. The percentages of C. albicanssusceptible to flucytosine, amphotericin B, fluconazole and itraconazole were 94.3, 92.9, 100 and 90 respectively; that of non-albicans isolates were 93.5, 80.6, 77.4 and 29 respectively. There was no significant difference (p>0.05) between the susceptibility of C.albicans and non-albicans isolates to flucytosine and amphotericin B, howeverthere was a significant difference (p<0.05) to fluconazole and itraconazole.Conclusions: C. albicans was the predominant cause of vulvovaginal candidiasis in this study, and demonstrated good susceptibility to antifungal agents tested. A significant number of non-albicans yeasts were identified; these demonstrated reduced susceptibility to all drugs, in particular to the azoles which are commonly used for treatment of vaginal candidiasis. The isolation of non-albicans yeasts may have clinicalimplication given their reduced susceptibility to antifungals
LOW BIRTHWEIGHT BABIES: SOCIO-DEMOGRAPHIC AND OBSTETRIC CHARACTERISTICS OF ADOLESCENT MOTHERS AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To compare some socio-demographic and obstetric factors between adolescentmothers (aged below 20 years) and older mothers of low birthweight (birthweight<2000gm) babies.Design: Cross sectional descriptive study.Setting: The Newborn Unit of the Kenyatta National Hospital.Results: Sixty nine adolescent mothers and 73 older mothers were studied. Adolescentmothers were more likely to be unmarried (p = 0.0001) have less formal education(p<0.0001) be unemployed and be primigravida (76.5% compared to 36% of oldermothers). Although the obstetric factors of antenatal clinic attendance, prematurerupture of the membranes, pre-eclamptic toxaemia, infections and interventronaldelivery tended to be more frequent among the adolescent mothers, non of thesedifferences were significant probably due to the small numbers of patients studied.Conclusion: This study does suggest mothers of very low birthweight babies tend tohave unfavourable socio-demographic and obstetric factors like being single parentshaving less formal education, being unemployed and having obstetric risks for poorpregnancy outcome
MANAGEMENT OF CANCER OF THE STOMACH IN MULAGO HOSPITAL KAMPALA, UGANDA
No full textObjective: To determine the cIinical presentation, mode of investigation and management ofgastric cancer at New Mulago Hospital.Design: Prospective descriptive study.Settings: Three general surgical wards, Department of Surgery, New Mdago Hospital.Subjects: Thirty five patients were studied within 12 months.Result: Gastric cancer was found to be prevalent in tribe inhabiting volcanic areas of southwestern Uganda especially the Banyankole (25% 'c) The commonest mode of clinicalpresentation was epigastric pain, weight loss, constipation, epigastric tenderness, palpable+gastric mass and anaemia. The most accurate mode of investigation was by endoscopyfollowed by barium meal. The cun~nbonest Imality was thepyloricatrium (40%) histologicallyadenocarcinun~a (95.5 Tc) predominated. Gastric cancer was found to be more common inpatients with blood group O+ve. All patient* had been subjected to some kind of medicaltreatment especially with at~tiacids, Hz receptor antagonists which contributed to the deIayin presentation. The majority of patients (94.5%) presented with advanced disease and nocurative surgery was possible.Conclusions: These results show that early diagnosis of gastric cancer is still a dream atMulago hospital since most patients present with advanced disease. To address this problem,all health workersshauld besensitisedonsympbrnsrndsignsfor early aggressiveinvestigationor an early referral tn cnable early diagnosis of gastric cancer. The investigatory capacity ofrural hospitals shouid be boosted to enable early detection of gastric cancer
VERTEBRAL BONE COLLAPSE IN SICKLE CELL DISEASE: A REPORT OF TWO CASES
No full textWe describe two female children both nine years of age with sickle cell anaemia andcompression deformity of three successive lumbar vertebrae in one child and collapse of onelumbar vertebra in the other. Management for the two children included analgesics,antibiotics and application of a lumbar jacket for stabilisation of the spine. In both patientsthe vertebral bodies remodelling with re-generation of the tissue. This report is being madeto highlight the improved chances of response with early detection and adequate management
FACTORS INFLUENCING ACCEPTABILITY OF VOLUNTARY COUNSELLING AND TESTING FOR HIV IN BUSHENYI DISTRICT OF UGANDA
No full textObjective: To understand the factors influencing choice of voluntary counselling andtesting (VCT) for HIV with a view of suggesting measures for increased uptake.Design: Focus group discussions were used to elicit reasons for carrying out VCT anda cross sectional survey to estimate the proportion of people who undertake VCT.Setting: Bushenyi district, Uganda.Participants: A cluster random sample of 219 people and four purposively selected focusgroup discussions with 32 participants.Main outcome measures: Elicited attitudinal beliefs, self-efficacy expectations, and socialinfluences that are probably associated with VCT for HIV based on the Attitude Socialinfluence self-Efficacy (ASE) Model. The proportion of people who had ever undertakenVCT for HIV was also determined.Results: Thirty-eight(17%) of the 219 people interviewed had ever undergone HIV. Thefactors influencing VCT for HIV were consequences of a test result, influences froma sexual partner, cost of VCT, physical accessibility of VCT, awareness, risk of HIVinfection, need for linking VCT with care (especially availability of anti-retrovirals) andperceived quality of care of VCT services.Conclusions: Increased mobilisation and access for VCT, reducing costs of VCT, linkingof VCT with care, and emphasising the positive consequences of VCT as well as providinghigh quality VCT services may increase the number of people seeking VCT
AN UNUSUAL ORIGIN OF SUPERNUMERARY RENAL ARTERIES: CASE REPORT
No full textPatent left and right supernumerary inferior polar renal arteries were found in a dissectionroom cadaver. Both arteries originated from the left 1 :ommon iliac artery. This is an unusualform of origin of these arteries in the presence of an apparently normal ascent and positionof the two kidneys