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IMPACT OF EMERGENCY MASS IMMUNISATIONS ON MEASLES CONTROL IN DISPLACED POPULATIONS IN GULU DISTRICT, NORTHERN UGANDA
No full textObjective: To assess the impact of supplemental mass measles immunisations.Design: Retrospective study of hospital and health centre records.Setting: Gulu district, Northern Uganda, having approximately 81% of the population living in internally displaced persons' (IDPs) camps.Results: The mean age in months for 4,812 measles cases seen was 28.2 ± 46.0 (p<0.0001). Supplemental mass immunisations in 1997 and 2000 caused a 91% reduction of measles cases, 93% reduction of mortality, 91% reduction of bed-days and 79% reduction of outpatient cases. There was a 67% reduction in mean measles case admissions, 63% reduction in mean measles mortality, and 73% reduction in mean measles bed-daysfollowing district mass measles immunisations in 1997. However, following IDPs camps supplemental immunisations in 2000; there was 82% reduction of mean measles caseadmissions, 80% reduction of mean measles mortality and 88% reduction of mean measles bed-days.Conclusions: In similar situations, supplemental mass measles immunisations should be focused on IDPs camps with a wide age group in addition to improved routine immunization activities in the entire district
ELECTROCARDIOGRAPHIC J?lNDINGS IN ETHIOPIANS OPi PENTAVALENT ANTIMONY THERAPY FOR VISCERAL LEISHMANIASIS
No full textBackground: The old short course regimens of pentavalent antimonial (sbV) therapy ofvisceral leishmaniasis (VL) have largely been abandoned worldwide as they are associatedwith increasing problems of relapse and unresponsiveness. In Ethiopia, some hospitals stilluse the dd interrupted and short course regimen partly because of fear of drug toxicity.Objective: To evaluate the safety of the WHO recommended UI interrupted therapy at a doseof 20 mg sbv/kg for up to thirty days.Design: A prospective study.Setting: Patients were recruited from Addis Ababa hospitals and from Konso VL endemicarea in southern Ethiopia.Subjects: Forty nine patients who included, ten HN-positi~ e and 39 HIV-negative, wereenrolled for the study.Results: Twenty three HIV-negative patients got treatment for 20 days and the rest, 16 HIVnegativeand 10 HN-positive, were treated for 28 to 30 days. 1 Lmong HN-seronegatives, themean QT interval corrected for heart rate (QTc) at the end of therapy in patients treated for20 days and 28 - 30 days was comparable (0.419 k0.031 seconc Ls versus 0.424 k0.027 seconds,respectively). Among patients treated for 28 - 30 days, the mean QTc in HIV co-infectedpatients was comparable to that of HIV-negatives (0.416 A 0.018 seconds versus 0.424 +0.027). Comparable rates of new ECG changes involving the T waves were observed in twoHIV-positive (20%) and two HIV-negative (12.5%) patients treated for 28 - 30 days, and inseven (30.4%) HIV-negative patients treated for 20 days. 0 1 e d , only two (4.1 %) patients(all HIV-negative males) had QTc interval s.50 seconds at th e end of therapy. In one patient,the prolonged QTc was noted on the twentieth day with brs dycardia of 44Jminute.Conclusions: In Ethiopian VL patients with normal renal fun:tion, sbVtherapy at a M y doseof 20 mg /kg for up to 30 days is safe and only rarely assoc ~ated with clinically significantbradycardia which resolves after temporary cessation of t merapy. Furthermore, in areaswith limited facilities, monitoring the pulse rate during anti~nonial therapy may help detectimpending cardiotoxicity
PREVALENCE AND AWARENESS OF OBESITY AMONG PEOPLE OF DIFFERENT AGE GROUPS IN EDUCATIONAL INSTITUTIONS IN MOROGORO, TANZANIA
No full textABSTRACTObjective: To determine the prevalence rates and level of awareness of obesity amongpeople of different age groups in Morogoro Municipality, Tanzania.Design: A cross-sectional, descriptive study.Subjects: One hundred adults aged 19-50 years old and 40 pupils aged 14-18 yearsold.Setting: Four educational institutions in Morogoro Municipality were included in thestudy. The four institutions included a primary and a secondary school, a teacher'straining college and a university.Results: The prevalence of obesity among the sampled subjects in Morogoro Municipalitywas 25 %, whereby 15.7% had a Body Mass Index (BMI) of between 25 and 30, and9.3% had a BMI of more than 30. Age and occupation of all the subjects, togetherwith marital status of adult subjects, were significantly related with obesity status.Prevalence of obesity increased with the increased age whereby subjects in the 41-50years had the highest rate (45.4%). Employed subjects had higher rate of obesity (22.2%)than pupils or students. Similarly, married adults had higher rate of obesity (27.8%)than the single ones (4.7%). Unlike the old age group (41-50 years), 70% of the youngestsubjects were not aware about the harmful effects of obesity. On the other hand, morethan two thirds of all the subjects could not associate excess body weight with chronicnon-communicable diseases such as coronary heart disease, high blood pressure andbreathing problems.Conclusion: Results of the current study indicate that obesity is increasingly becominga public health problem in Morogoro Municipality, and probably in many other placesin Tanzania. There is need for more public awareness on the effect of obesity on people'shealth through information, education and communication. It would be of greatimportance if such interventions were introduced at early age of life, for example byinclusion in school curricula
LESSONS LEARNED FROM COLORECTAL MODEL OF TUMOURIGENESIS
No full textGenetic analytical techniques were carried out to identily mutations in adenomatouspolyposis coli (APC) gene and K-ras oncogene in colorectal tu mourigenesis. These two genesaresaid to be early mutation genes among other mutation genes that constitute the model forcolorectal tumourigenesis. To do this analysis, DNA was isolated from colorectal formalinfixed paraffin-embedded tumour tissue sections. The sections were deparaff~nised, digestedin proteinase-K, followed by DNA isolation. The DNA was a mplified by Polymerase ChainReaction (PCR), screened by using Denaturing Gradient C el Electrophoresis (DGGE) orSingle Strand Conformation Polymorphism (SSCP) and the] I sequenced. These results lendsupport to the fact that colorectal cancer and indeed cancel, in general develops through amulti-step process; also that accumulation of genetic mutatic Ins underlie the development ofneoplasia. We are in the process of extending this study to :ancer of oesophagus to see if asimilar or parallel model of carcinogenesis holds and in what sequence it is
ANTIBACTERIAL SUSCEPTIBILITY PATTERNS OF BLOOD STREAM ISOLATES IN PATIENTS INVESTIGATED AT THE AGA KHAN UNIVERSITY HOSPITAL, NAIROBI
No full textBackground: Microbial invasion of the blood stream can have serious immediate consequences and are a threat to every organ in the body. Timely detection and treatment is vital and necessitates hospital admission and immediate intervention.Objectives: To investigate aetiology and anti-microbial resistance patterns of bacterial isolates in blood stream infections.Design: A retrospective clinical-laboratory study carried over a five year period January 2003 to April 2008.Setting: The Aga Khan University Hospital, Nairobi, Department of Pathology, Division of Microbiology.Subjects: All blood culture specimens received from both in and out-patients’ at the Aga Khan University Hospital’s laboratory.Results: Rates of oxacillin resistance for Staphylococcus aureus were 21%. Streptococci were generally susceptible to beta-lactams. High-level gentamicin resistance was seen in 12% of Enterococci. Vancomycin resistance was conspicuously absent. Resistance rates of Pseudomonas aeruginosa to ciprofloxacin, gentamicin, amikacin, imipenemwere between 11% and 23%. Salmonella spp. showed multiple resistant patterns to co-trimoxazole, chloramphenicol and ampicillin with resistance rates of greater than 35%. One hundred and twenty three patients (11%) tested positive for HlV. Unlike in HlV negative individuals, Cryptococcus neoformans was an important isolate, positive in 5%. A number of HlV positive patients had Staphylococcus aureus and coagulasenegative staphylococcus isolates in their blood cultures. In such clinical circumstances it is difficult to determine the clinical significance of these isolates.Conclusion: Antimicrobial susceptibility patterns revealed high level resistance among the gram positive organisms and also amongst extended spectrum beta lactamase (ESBL) producing E.coli and Klebsiella spp. This study highlights the challenges of deriving empiric drug regimens in the current clinical scenario. However, we do know it is important to cover adequately for gram positive organisms
CHRONIC MYELOID LEUKAEMIA IN CENTRAL AFRICANS
No full textObjectives: To document the pattern of presenting clinical and haematological features ofchronic myeloid leukaemia (CML) in central Africans and evaluate the clinical consequencesof treating the disease with chemotherapy.Design: Prospective descriptive analysis of clinical and haematological data.Setting: Departments of Haematology of tertiary referral centres and teaching hospitals.Materials and Methods: Prospective clinical and haematological data were collected on 150central Africans (90 Zimbabweans and 60 Malawians) using modern Coulter counters andstandard up-to-date haematological procedures and the results analysed using predeterminedcriteria and the top-desk Scientific Calculator Model HP 48GX, Texas Instruments, USA.Results: There were 150 CML patients studied. Males predominated in a ratio of 1:5:1. Theyoungest patient was 10 years and the oldest 77 years with a mean ± s.d. of 38.9 ± 14.7 years.The peak age incidence of 47.3% occurred between 21 to 40 years. The Ph chromosome wasfound in 19 of the 20 patients studied. Although complaints attributed to splenic enlargementwere the most common symptoms, several unusual clinical features were encountered viz:hepatomegaly (26%), bleeding (12%), significant Iymphadenopathy (11.3%), purpura(3.3%), skin infiltration (2.7%), cardiac failure (2.7%) and 14.7% were diagnosed incidentally.Symptoms such as fatigue, headaches and weight loss were associated with greater degreesof leucocytosis, severe to gross splenomegaly and lower haemoglobin levels. The severe togross splenomegaly which occurred in 68(45.3%) suggests that patients in this part of theworld seek medical advice rather late in the disease. The median survival times of 65,47 and39 months respectively for alpha interferon, hydroxyurea and busulphan are in agreementwith those of previous larger series from other parts of the world.Conclusions: The study has revealed that the presenting pattern of clinical and haematologicalfeatures of CML is changing probably due to the advent of modern clinical practice coupledwith increased physician density, greater awareness of disease among clinicians besidesother reasons. However, optimal treatment is not possible for the majority of patients dueto lack of chemotherapeutic agents and supportive care.Recommendation: Referral centres in African health systems should be equipped for bettermanagement of CML patients
INEQUALITIES IN UNDER-FIVE MORTALITY IN MOZAMBIQUE: DIFFERENTIALS BY REGION OF RESIDENCE AND ETHNIC AFFILIATION OF THE MOTHER
No full textObjective: To explore regional and ethnic differentials in under-five mortality in Mozambique in relation to other determinants.Design: Retrospective follow-up study.Setting: Mozambique.Results: Compared to children of Xitsonga mother’s, children of Emakua and Cisena mother’s had a mortality risk of 1.47 (CI = 1.06-1.90) and 1.21 (CI = 1.00-1.62) respectively. The excess mortality risks were partly explained by demographic, household environment, socioeconomic factorsincluding region of residence.Conclusion: Ethnic affiliation of the mother (measured by the first language the mother spoke) was statistically associated with under-five mortality in Mozambique. Children of mothers of Emakua and Cisena ethnic affiliations and living in the North and Central regions had the worst survival chances. The relation between mother’s ethnicity and under-five mortality was largely explained by demographic, socioeconomic and environmental factors
HN INFECTION IN GENERAL SURGICAL PATIENTS AT THE GA-RANKUWA/MEDUNSA COMPLEX SOUTH AFRICA
No full textObjective: To assess the possible impact of HIV infection on the management of generalsurgical patients at the Ga-Rankuwa Hospital.Design: A prospective study.Setting: Ga-Rankuwa HospitallMedical University of Southern Africa (MEDUNSA)Academic Complex, Pretoria, South Africa.Subjects: Nine hundred and forty one patients admitted to general surgical wards.Main outcome measures: HIV infection and CD4 counts.Results: Nine hundred and forty one patients admitted to general surgical wards fromJanuary 1966 to December 1997 were tested for HIV infection. Twelve per cent testedpositive. HIV positive patients were significantly younger [33 f 10 versus 41 & 7 ( X + SD)years, Chi-square = 51, p<0.0001]. There was no correlation of HIV positivity to the patient'ssex (p=0.7). In forty three HIV positive patients treated surgically, mortality was attributedto HIVIAIDS in only one patient with a CD4 count of 471ul who died following laparotomyfor peritonitis. CD4 counts done during follow up in thirty one HIV positive patients revealeda count of d00lul in eleven patients.Conclusion: It is predicted that an increasing number of patients with HIVIAIDS will beadmitted to general surgery wards of the Ga-Rankuwa Hospital. Surgeons are advised totake universal precautions to prevent HIV infection
PROBLEMS IN DIAGNOSING ODONTOGENIC MYXOMA: CASE REPORT
No full textTumours and tumour-like growths arising from odontogenic tissues constitute a heterogenousgroup of lesions whose diagnosis can be particularly challenging on the part of both surgeons andpathologists. In children, these lesions are even more difficult to clinically and histopathologicallydiagnose definitively because of the concurrent diverse embryologic differentiation of dentaltissues. A case is presented of a 12 year-old boy who was subjected to inappropriate primarymanagement of a left mandibular mass, due apparently to inadequate consultation to establishan accurate diagnosis