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Congenital duplex gallbladder anomaly presenting as gangrenous perforated intrahepatic cholecystitis mimicking a gas forming liver abscess: A case report and literature review
No full textBackground: Ectopic intrahepatic gallbladder is a rare phenomenon. Gallbladder duplication is an even rarer phenomenon. Pathological processes arc more common in congenital anomalies of the gall bladder than normal gallbladders due to poor drainage. Case Report: We present a case of duplex gallbladder with one component intrahepatic and the other extra- hepatic, the duo draining via a common cystic duct into the common bile duct. Both gallbladder moieties were diseased. The intrahepatic moiety was gangrenous and perforated thus mimicking an intrahepatic abscess by a gas forming organism .The extra-hepatic moiety was chronically inflamed and packed with gallstones of the same physical and biochemical characteristics as the intrahepatic moiety. The definitive diagnosis was only- made at emergency laparotomy. Stone gathering and debridement of the ruptured, gangrenous intrahepatic moiety and cholecystectomy for the extra-hepatic moiety was done. On tabic cholangiography, though desired, was not available. The patient fully recovered after post-operative intensive care. Conclusion: An extensive internet literature search did not reveal any previously described case. This could be the first such case described in the world literature. Though rare, congenital anomalies of the gallbladder must be known to surgeons as they can present unexpectedly and pose diagnostic and operative surgical challenges with serious clinical implications. The management challenges experienced and literature review is presented
The relationship between knowledge levels of complications of hypertension and health seeking behaviours among hypertensive patients aged 46-45 years at Parirenyatwa group of hospitals
No full textThis correlational study was premised on the basis that increasing knowledge levels of
complications of any disease directly translates into concomitant health seeking behaviors. A sample of 80 hypertensive patients, conveniently selected, aged between 45 and 65 years at a major referral hospital, Parirenyatwa Group of Hospitals in
Zimbabwe, was used to determine any potential relationship between knowledge levels of complications of hypertension and health seeking behaviors. A questionnaire, which was divided into three sections, was used to collect data during the month of April 2014. Approval to carry out the study was granted by the study site and relevant research ethics committees. A written informed consent was obtained from prospective participant. Data was collected using a questionnaire. Descriptive statistics such as frequencies, percentages and means were used to analyze demographic data, health seeking
behaviors and knowledge levels of complications of hypertension. Inferential statistics, in particular Pearson’s correlation analysis and linear regression analysis were used to determine the relationship between knowledge levels of complications of hypertension at 5% significance level. Findings showed that there is a weak, positive statistically significant correlation between knowledge levels of complications of hypertension and health seeking behaviors (r=0,345**, R2 = 11.9%, p<0.01). This prompts a need to increase public awareness on hypertension, its complications and other hitherto neglected non communicable diseases (NCD’s) in Zimbabwe. Medical-surgical nurses are therefore implored to vigorously educate hypertensive patients and the community in
general, about complications of hypertension thereby increasing patients’ knowledge levels hence improving health seeking behaviors
Stigma and discrimination: Coping behaviours of people living with HIV and AIDS in an urban community of Mabvuku and Tafara, Harare, Zimbabwe
No full textObjectives: To assess how people living with HIV and AIDS reacted to the knowledge of the infection and hovv they are coping with stigma and discrimination. Settings: The study was conducted in the two high density urban suburbs of Mabvuku and Tafara in Harare,
Zimbabwe. Design: The study w as a descriptive cross sectional survey.Subjects: A total of 600 participants (160 men and 440 women) who had received their HIV results after Voluntary Counselling and Testing for HIV at the Zimbabwe AIDS Prevention and Support Organization (ZAPSO) Mabvuku/Tafara Voluntary Counselling and Testing Centre were interviewed. Main Outcome Measures: Reactions to the diagnosis of HIV, disclosure of sero-status, experiences of self, family and community induced stigma and discrimination, coping mechanisms and desired interventions to reduce stigma. Results: The majority, 61.7%, had been diagnosed HIV positive less than two years at the time of the study. While 33.3% felt hurt, 41% were immediately depressed when they discovered they were HIV positive. Eighty five percent had not disclosed their sero-status to anyone. While 55% experience self induced stigma, 56.7% experienced family induced and 38.3% experienced community induced stigma. People living with HIV and AIDS were coping with stigma through withdrawal (60%); joining support groups (83.3%); seeking counselling (95%) and praying (86.7%). Encouraging community counselling and HIV testing with disclosure of status was perceived by 98.3% of the respondents as an effective method to reduce HIV and AIDS related stigma and discrimination. Conclusion: While non disclosure of sero status is still high, self, family and community induced stigma pose a big challenge. Withdrawal (used mostly by men), seeking counselling and joining support groups (used mostly by older women) are the common coping behaviours being used by HIV positive clients. There is need to improve counselling capacities so as to meet the demands from a stigma reduction perspective as well as from a coping perspective
Experiences of health science students during clinical placements at the University of Zimbabwe
No full textBackground: Clinical placement is an essential component of training in health sciences because it is where theory and practice interface. Objective: To explore experiences of health sciences students during clinical placement in terms of supervision, challenges and coping strategics. Design: It was a cross sectional survey. Setting: University ofZimbabwe, College of 1 lealth Sciences. Participants: 179 multidisciplinary health science students. Materials and Methods: A cross-sectional survey was conducted using a self-administered questionnaire. Ethical clearance was obtained. Descriptive statistics were used for analysis. Main Outcome Measures: These were perceptions of students with regard to supervision, challenges faced during clinical placement and coping strategics used. Results: 179 participants responded to the questionnaires. Participants enjoyed linking theory to practice. Perceptions on supervision were both positive and negative. Inadequate supervision and inappropriate behaviours by supervisors were some of the challenges faced. Almost 89% used stress-relieving strategies such as focusing on why they were doing the clinical placement and the importance of successful completion. Ninety-one per cent had never used cannabis/mbanje but 41% had engaged in sexual activity to cope with challenges. Conclusion: This study found that the perceptions of health sciences students about supervision clinical placement, challenges faced and the coping strategics arc almost the same as those found elsewhere. It is therefore important to plan clinical placement with the involvement of clinical educators. Recommendations: .Supervisors' workshops should be held to create a forum to discuss clinical placement issues. Follow-up of students by academics is recommended. Students should be empowered to cope with challenges
Faculty Development Workshop Summary Notes 26-28 July 2011
No full textUniversity of Zimbabwe, College of Health Sciences under the NECTAR programme conducted a
three day Faculty Development training workshop. The workshop which was facilitated by Associate
Professor Eva Aagaard, Professor Nancy Madinger, and Dr. Jake Gray from the University of
Colorado Denver, USA recorded an average of 50 participants on a daily basis. The objective of the
workshop was to introduce and acquaint participants to basic knowledge on: Curriculum Development;
Team Based Learning; Bedside Clinical Teaching and Lecture methods. The workshop was officially
opened by Professor Midion Chidzonga, the current Dean of the College of Health Sciences. The
workshop was conducted in sessions with each of the 3 instructors facilitating specific sessions. This
report is a summary of how the workshop unfolded.
Workshop Objectives:
To introduce faculty to the theory and practice of:
• Curriculum Development
• Medical Education Pedagogies
• Student Assessment
SessionNational Institute of Health (NIH),
under the Medical Education Partnership Initiative (MEPI
Ethics in reproductive health: Clinical issues in Zimbabwe
No full textReproductive health can present heal th practitioners with ethical problems because of the complex interaction between cultural practices, the laws of the country and individual personal preferences. In particular, the problems of pregnancy, sexually transmitted infections, family planning, sexual violence, and domestic abuse require a good knowledge of the laws of the country and the culture in which they operate. The practitioner should at all times respect the patient's autonomy and serve their best interests, whilst keeping in mind the legitimate interest of their partners, spouses, parents or guardians
Factors associated with paediatric ART uptake in Bindura and Guruve districts, Zimbabwe 2015
No full textPaediatric ART coverage in Zimbabwe remains low despite effort to improve it. Currently it stands at 56.7% compared to an adult ART coverage above 75%. Major reasons for this are largely unknown although assumptions are these children are not being tested for HIV. This is a presentation of the results of a study on factors affecting paediatric ART uptake among children aged one to fourteen years in Bindura and Guruve districts of Mashonaland Central Province.
Methods
An analytic cross sectional study was conducted among caregivers of HIV positive children and health workers in Bindura and Guruve Districts. Data were collected on socio-demographic, socio-economic, psychological and programmatic factors associated with pediatric ART uptake. Quantitative data were analysed using Epi info to calculate odds ratios. Stratified and multivariate analyses were done to check and control for effect modification and/or confounding.
Results
A total of 213 caregivers were interviewed. Control of household finances [aPOR=11.7 (95% CI 4.71 – 29.23)], sex of caregiver [aPOR=11.2 (95% CI 3.48 – 36.28)] and ethnicity [aPOR=8.38 (95% CI 3.01 – 23.31)] were the independent risk factors associated with up taking paediatric ART. Age of child [aOR=0.26 (95% CI 0.07 – 0.97)] was the independent protective factor associated with up taking paediatric ART.
Conclusion
Socio-demographic factors were significantly associated with uptake of paediatric ART among respondents. Education on the importance of paediatric ART for caregivers who visit the PMTCT needs to be reinforced by the nurses attending to the caregivers on their review dates
Severe Metabolic Acidosis and “Muti” (traditional herbal medicine) ingestion in young children
No full textTwenty infants ami young children admitted with severe metabolic acidosis and a positive history of ‘muti’ ingestion were investigated. All had accompanying gastroenteritis and significant dehydration. Biochemical data was diagnostic of high anion / gap metabolic acidosis in the majority (70 per cent). Further biochemical data indicated that lactic acidosis and pre-renal azotaemia resulting from severe hypovolaemia were likely causes of the high anion GAP metabolic acidosis. There was no evidence to suggest that the ingested muti per se was associated directly with the acidosis or acute renal failure seen in these childre
Prevalence and intensity of the schistosomiasis situation along the Zimbabwean urban and peri-urban shoreline of Lake Kariba
No full textThe potential health impacts of Lake Kariba were recognised before the construction of Kariba Dam.1 A medical team that assessed health impacts associated with the construction of the dam did not consider schistosomiasis as a major problem around the dam site because the incidence of the disease in the population living along the Zambezi River was low. Furthermore, it was believed that transmission would not take place at the proposed dam site because it was rocky and therefore unsuitable for snail colonisation. It was. however, realized that most dam construction employees were drawn from distant areas in Malawi. Zambia and the then Rhodesia where schistosomiasis was endemic. Thus, all immigrants were screened for S. haematobium and those found infected were treated.' The medical report, however, did not mention
S. mansoni nor the intermediate host snail tBiomphalaria pjcijferii involved in its transmissio
The relationship between CYP2D6 polymorphisms and Tardive Dyskinesia in black Zimbabwean psychotic patients on typical antipsychotics
No full textCYP2D6 polymorphisms have been associated with different drug efficacies and adverse effect profiles including Tardive Dyskinesia (TD). The occurrence of these polymorphisms has also been noted to be different amongst different racial or ethnic groups. In Asians and Caucasians CYP2D6*10 and CYP2D6*3, *4 and *5 have been positively associated with TD respectively. In Africans no clear relationships with the prevalent reduced function CYP2D6 genotypes has been shown.
The objective of this study was to determine whether occurrence of TD is associated with the most prevalent reduced function CYP2D6 genotypes in black Zimbabweans – CYP2D6*17 and *29. AIMS scoring and CYP2D6 genotyping was carried out on patients exposed to first generation or typical antipsychotic medications at Parirenyatwa Annexe and Harare Psychiatric units in an unmatched case control study.
The main outcome measures were CYP2D6*17 and *29 genotypes. The relationship between TD and mutant CYP2D6*17 homozygote and heterozygote genotypes was not statistically significant with p values of 0.740 and 0.442 in the haloperidol exposed and 0.587 and 0.150 in those exposed to haloperidol, FD and CPZ respectively. No CYP2D6*29 result could be determined due to a failure in genotyping for this SNP. The results presented suggest no association between the major reduced function CYP2D6 allele *17 and TD in black psychotic Zimbabwean patients