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Type 2 Diabetes Mellitus in Black Zimbabweans - Metabolic Factors and Molecular Genetics.
No full textObjectives: The main objectives of the study were (i) to determine the prevalence of the metabolic syndrome disorders, (ii) to determine the frequency, of ApoE gene polymorphism at codons 112 and 158, of the ACE gene 287-bp insertion/deletion polymorphism, of the -308GöA mutation in the 5! region of the TNF-alpha gene, and (iii) to investigate the effects of these polymorphisms on the components of the metabolic syndrome in type 2 diabetic patients.
Methods: Dyslipidaemia, obesity, hypertension, microalbuminuria, hyperinsulinaemia and insulin resistance, all intermediate traits and metabolic components found in type 2 diabetes mellitus, were determined in diabetic patients as well as non-diabetic participants. Apolipoprotein E (ApoE) gene polymorphism of the amino acid substitutions of cysteine and arginine at codons 112 and 158, angiotensin converting enzyme (ACE) gene 287-bp insertion/deletion polymorphism and the -308GöA mutation in the 5! region of the tumour necrosis factor alpha (TNF-alpha) gene were determined by the polymerase chain reaction (PCR). Polyacrylamide and agarose gels were used to electrophoretically identify the genotypes from the PCR DNA products. The genotypes from the 3 different polymorphisms were related to lipid metabolism, anthropometric measurements, microalbuminuria, hypertension, insulin resistance or hyperinsulinaemia.
Results: The data in the current study clearly demonstrates a rather high prevalence of the metabolic syndrome (36%) in Black Zimbabweans with type 2 diabetes mellitus, characterised by hypertension (69%), microalbuminuria (62%), insulin resistance (57%), dyslipidaemia (47%) and obesity (31%). The nucleotide substitutions in codons 112 and 158 of the ApoE gene reveal that Zimbabweans have an unusually high frequency of e4 (29%) and e2 (11%) alleles, compared to general Caucasian and Asian populations. The E4/4 genotype has a statistically significant influence on blood total cholesterol (p < 0.05), and low density lipoprotein cholesterol (p < 0.05) in this Black population compared to other genotypes. The ApoE polymorphism has a marked influence on triglycerides and high density lipoprotein cholesterol even if this is not statistically significant. Although Black Zimbabweans have a high D (deletion) allele frequency (64%), the ACE 287-bp insertion/deletion (I/D) polymorphism, blood pressure and microalbumin levels were not statistically significant in hypertensive versus non-hypertensive and microalbuminuric versus non-albuminuric patients, respectively. The I allele had a relationship with hypertension, insulin and BMI, although this was not statistically significant. The AA genotype compared to the AG and GG genotypes of the Nco I-sensitive polymorphism (-308 GöA) in the promoter region of the TNF-alpha gene is significantly associated with BMI (p < 0.01), diastolic blood pressure (p < 0.05), and uric acid (p < 0.05) in this populace.
Discussion: In the last few years it has been demonstrated that metabolic disorders investigated in this study are aetiological factors for cardiovascular and cerebrovascular disease. Obesity, insulin resistance, hyperinsulinaemia and nephropathy may aggravate the atherogenic lipid profile in most of these patients. Therefore, it may be critical to modify these risk factors in this population through therapeutic and nutritional interventions where possible, so as to reduce the risk of complications of macrovascular disease. The high prevalence of the e2 and e4 alleles is likely to be a heavy genetic burden as it has been shown to enhance susceptibility to diabetic nephropathy, coronary artery disease and Alzheimer disease in several populations. The ACE 287-bp insertion/deletion (I/D) polymorphism does not seem to play a major role in influencing blood pressure or diabetic nephropathy, despite the fact that Black Zimbabweans have a high D allele frequency. However the relation of the I allele with hypertension, insulin and BMI, although not statistically significant, suggests that its conferred risk may be much higher in the Zimbabwean Black population. Data from the current study suggests that TNF-alpha gene polymorphism may have a complex relationship with T2DM and that it may be a useful tool in determining subjects at high risk of developing the metabolic syndrome.
Conclusion: The data in the current study categorically shows that genetic polymorphisms contribute to biological variation in various target tissues, and one can deduce that they are capable of influencing disease susceptibility and progression. Taken together, the findings in this study suggest that these polymorphisms could be used as potential markers in T2DM subjects at risk of developing certain metabolic complications and that they may be useful in the determination of severity of these disorders. The multiple molecular mechanism whereby these polymorphisms induce the metabolic disorders is not well understood and requires further investigation
The prevalence and morbidity associated with ectopic pregnancies at Harare central and Parirenyatwa hospitals
No full textIntroduction
Ectopic pregnancy is amongst the top causes of maternal morbidity and mortality in the first
trimester of pregnancy. It represents one of the commonest gynaecological surgical
emergencies in Zimbabwe and other developing countries because most of the women
present to health care facilities after rupture has occurred.
Objectives
i. To determine the prevalence of ectopic pregnancy at Harare and Parirenyatwa
Hospitals.
ii. To determine the risk factors associated with ectopic pregnancy at Harare and
Parirenyatwa Hospitals.
iii. To determine the morbidity and mortality associated with ectopic pregnancy.
Design
Cross-sectional study.
Setting
Harare and Parirenyatwa Central Hospitals in Harare, Zimbabwe.
Subjects
Women attending the two hospitals with suspected ectopic pregnancy from 01 December
2012 to 30 April 2013.
Methods
All women with a suspected ectopic pregnancy who consented to participate in the study
were recruited. They were managed by the attending team in the acute phase of the illness.
Face to face interviews were conducted to collect information and probe for risk factors of
ectopic pregnancy. The management offered to the patient was then analysed using patient’s
notes. An HIV test was done on all consenting subjects after pre-counseling. The mortalities
were noted and the morbidity was assessed by checking the pre-operative haemodynamic
state of the patient, pre-operative haemoglobin count, use of blood or its products, need for
intensive care post-operatively and the mean hospital stay.
Results
During the study period there were a total of 11239 deliveries attended at the two hospitals. A
total of 138 suspected cases of ectopic pregnancy were recruited into the study. Of these, 126
(91.3%) were surgically confirmed as ectopic pregnancies and the remainder (12) were
wrongly diagnosed. The overall incidence of ectopic pregnancy was found to be 1.12%. Most
women were in the 21-30 year age group and had 2 children or less. The risk factors
identified were a reported history of sub-fertility, previous history of STI, previous abdominal
or pelvic surgery and a previous ectopic pregnancy. There was one maternal death due to
rupture (case fatality rate of 0.8%). The morbidity was significant with 87.3% presenting
after rupture, 38.8% being attended with signs of shock, 11.1% requiring intensive care
admission and 77% being transfused with blood. The mean hospital stay was 5 days
following salpingectomy via laparatomy. The prevalence of HIV amongst those with ectopic
pregnancies who were tested was 13.1%.
Conclusion
The morbidity associated with ectopic pregnancy remains high in young women of low parity
as the majority present after rupture. The subsequent impact on future fertility of these
women could be improved significantly if health strategists focused on primary prevention
and early diagnosis to prevent tubal rupture. This means ensuring universal reproductive
health care access thereby working towards achieving Millennium Development Goal 5
(MDG 5) by 2015
Factors associated with Adherence to Anti-retroviral therapy among HIV clients, Kadoma city, Zimbabwe 2015
No full textAbstract
Introduction: Adherence is defined as the extent to which patient follows prescribed health care regimen. Non-adherence is associated with resistance and the risk of resistance is 80-90% with incomplete adherence. A review of the ART registers during one of the ART clinics in Kadoma City showed that 40% of ART clients were not adhering to their medication. Key informant discussions and records showed an increase in the number of patients in adherence classes. Methods: An analytical cross sectional study was carried out using an interviewer administered questionnaire to collect information. Record review was also conducted to verify information that was given by the study participants. Key informant interviews were conducted for more information on the running of the ART program. Patients 18 years and above accessed ART services in Kadoma City for more than 3 months were recruited. Random sampling method was used to select participants as they visited the health facilities for their ARV resupply. Results: A total for 227 HIV clients patients were recruited, 67% were females. The median age of the participants was 37 years (Q1=18; Q3=44) .Use of memory aids was reported by 200 (88%) of the participants. Among the participants 45 (20%) took alcohol and 33 (15%) had experienced stigma. In multivariate analysis paying to travel to the health centre (OR 0.16 95%CI 0.06-0.43) and taking Cotrimoxazole (OR 2.38 95% CI 1.04-5.47) were independent factors associated with ART adherence. Self reported adherence among the participants was 87%. Adherence based on pill count among 80 participants was 65%. Conclusion: The self reported ART adherence was high among the participants but was low using pill count. The findings suggest that taking alcohol and having side effects were barriers to ART adherence. Having memory aide to taking medication enhanced adherence. Paying consultation fee was an independent factors associated with adherence to ART. Key Words: Adherence, ART, HIV, Kadoma Cit
Development, safety and efficacy evaluation of actinic damage retarding nano-pharmaceutical treatments in oculocutaneous albinism
No full textIntroduction: There are at least 17 000 Persons living with albinism (PLWA) in Zimbabwe. Oculocutaneous albinism (OCA) is a congenital amelanistic pigmentation disorder that affects all known vertebrates and has no known cure. Melanogenesis is the body’s primary protection from actinic damage, which summarizes all the acute and chronic solar induced adverse dermatological conditions. This impairment therefore makes PLWA highly susceptible to all forms of this damage.
Problem statement: Commercial products for actinic damage in PLWA are not readily available. Chemical sunscreens used by PLWA are ineffective and do not treat symptoms of actinic damage. The possible use of promising broad spectrum physical sunscreens in albinistic treatments is hindered by their opaque and un-aesthetic nature.
Research hypothesis: A treatment based on nanometric TiO2 and ZnO incorporating the active extracts of A. excelsa, T. emetica and M. flabellifolia will be aesthetic, efficacious and safe in retarding and alleviating all forms of actinic damage in PLWA.
Research aims: To develop albinistic actinic damage treatments, using nano TiO2 and ZnO as sun-blocks and incorporating selected herbs. The dermato-pharmacokinetics, stability, efficacy, toxicity and aesthetics of the resultant formulation on albinistic skin types were also investigated in this study.
Materials and methods: Emulsion formulation was done according to FDA-CFSAN, COLIPA, and OECD mandated technical guidelines and testing methods. Formulation skin sensitivity were evaluated through Draize ocular and skin sensitivity tests as well as in-vivo patch tests guided by OECD 428/404 technical guidelines and opinion SCCNFP 0750/03. Percutaneous absorption and albinistic skin dermato-pharmacokinetics were evaluated ex-vivo using Franz diffusion tests and sequential adhesive tape stripping respectively according to OECD guidelines 428 and SCCNFP opinions as well as related work done by A O Gamer and Diembeck et al as guides. Analysis for Ti and Zn were done by ICP-AES and Flame AAS respectively. Efficacy and SPF testing was done as per FDA–CFSAN, Colipa and OECD M389/EN mandated test methods.
Principal Results: SPF 16, aesthetic and stable emulsions were formulated. Negligible irritation indices for the treatment were recorded for Draize and human patch testing. No percutaneous absorption was observed for ex-vivo diffusion tests and sequential tape stripping tests. Different skin reservoir properties were observed at different skin sites
Conclusions: The studies demonstrate, direct evidence that neither Zn nor Ti can penetrate actinic damaged skin regardless of anatomical site and that albinistic dermato-pharmacokinetics are depended on anatomical region and extent of UVR exposure. The high extraction yields and the phyto-constituents of the selected herbs show a correlation with the traditional uses of the plants in traditional medicine. All sensitivity tests showed negligible irritation potential. Based on the foregoing, it is concluded that, incorporation of nanometric TiO2, ZnO and herbs in treatments to retard actinic damage in PLWA is feasible, aesthetic, efficacious, and commercializable and does not pose any health risk.Harare Institute of Technology.
University of Zimbabwe Research Grant.
ICF Grant from the Government of Zimbabwe
Haematologic features of the Human Immunodeficiency Virus (HIV) infection in adult Zimbabweans
No full textObjective: To describe the haematologic features of the HIV infection in adult Zimbabweans and compare the features in the different clinical stages of the disease. Design: Descriptive cross sectional study. Setting: Parirenyatwa Hospital, a tertiary and referral medical centre in Harare, and the blood donor clinics of the Blood Transfusion Service in Harare. Subjects: Patients attending HIV outpatients clinics or receiving inpatient care at Parirenyatwa Hospital and asymptomatic persons donating blood at the BTS Harare. Main Outcome Measures: Full blood counts and bone marrow cell counts and morphology. Results: Blood cytopenia was found in 47.5% of adults with HIV infection. The most frequent abnormalities were lymphopenia (31.5%); anaemia (30.8%); neutropenia (29.6%); thrombocytopenia (24.7%); eosinophilia (23.5%) and leucopenia (11.7%). Frequency of anaemia in the AIDS and symptomatic groups (43.4% and 24.5% respectively) was greater than in the carriers (6.7%), while the frequency of other cytopenias and of eosinophilia was about the same in all groups. There was also a general lack of association between the severity of haematologic abnormalities and the clinical stage of the disease. Conclusion: Severe haematologic changes occur frequently in HIV infection and AIDS but routine full blood count may not be helpful in the monitoring of the disease or the prediction of onset of AIDS
Determinants of multidrug resistance amongst turberculosis patients in Matabeleland North and Bulawayo Metropolitan provinces, 2013
No full textIntroduction: Multidrug resistance tuberculosis is an emerging threat to the management of TB in Zimbabwe. The aim of the study was to investigate the determinants of MDR-TB in Matabeleland North and Bulawayo Metropolitan Provinces of Zimbabwe.
Methods: A case control study was conducted. Eighty cases and two hundred and forty controls were enrolled into the study. Cases were randomly selected from a line list of MDR-TB cases diagnosed via susceptibility testing between 2011 and 2013. Controls were randomly selected from those who had tested negative for MDR-TB via sensitivity testing. Bivariate analysis and stratified analysis were conducted. Stepwise forward logistic regression was used to control for confounding and assess for effect modification.
Results: Risk factors for MDR-TB were: history of contact with MDR-TB case (AOR= 4.46, 95% CI; 2.02-9.88), history of hospitalization (AOR= 2.91 95% CI; 1.62-5.23) and travel outside Zimbabwe (AOR= 2.68 95% CI; 1.46-4.91). Protective factors were: “successful outcome” on previous treatment (AOR= 0.05 95% CI; 0.02-0.11), history of prior treatment supervision by a Health Worker or Village Health Worker (AOR= 0.34 95% CI; 0.19-0.60) and having been treated not more than once before for TB (AOR= 0.18 95% CI; 0.08-0.38). There was no association between HIV infection and MDR-TB (AOR=1.00 95% CI; 0.53-1.88). Patients with a CD4 of less than 200 were more likely to develop
MDR-TB (AOR= 4.62 95% CI; 2.49-8.53).
Conclusion: Treatment interruption, contact with MDR-TB cases, history of travel outside Zimbabwe, history of hospitalization, two or more previous TB episodes and history of previous TB medicines side effects are significant risk factors for MDR-TB in Bulawayo and Matabeleland South provinces. A successful outcome during previous treatment and being supervised by a Health Worker or a Village Health Worker are significantly protective against having MDR-TB in both provinces. To reduce the MDR-TB burden in Zimbabwe, contact tracing for all MDR-TB patients and continuous adherence counseling during TB treatment need to be strengthened. All TB patients need to be supervised by either Health Workers or Village Health Workers during TB
Mercury poisoning: Prevalence, knowledge and frequency of gold panning and doing retort among alluvial gold panners in Chiweshe and Tafuna communal lands in Zimbabwe
No full textObjectives: To estimate the prevalence of mercury poisoning, to estimate the knowledge level that mercury can be a poison, and to establish the frequency of gold panning and doing retorts.
Design: Cross sectional study.
Setting: Chiweshe and Tafuna communal lands.
Subjects: Gold panners.
Main Outcome Measure: Mercury levels in blood and urine.
Results: Totals of 23 respondents from Chiweshe and 43 respondents from Tafuna were recruited. Four out of 43 respondents in Tafuna and seven out of 23 respondents in Chiweshe had levels of mercury greater than 0.05 mg/L in blood (p=0.040). Out of 43 respondents in Tafuna, four (9.3%) had levels of mercury of more than 0.01 mg/L in urine. Totals of 18 out of 37 and seven out of 22 respondents from Tafuna and Chiweshe, respectively, did not know that mercury could be a poison. Altogether, 35 (56.5%) out of 62 respondents were full time gold panners. Significantly more respondents in Chiweshe (14/19) than in Tafuna (8/29) did less than four retorts per month (p=0.005). Respondents who did four or more retorts per month were 3.21 (95%CI 1.06 to 9.72) times more likely to have had raised levels of mercury in their blood compared with persons who did less than four retorts per month.
Conclusion: Mercury poisoning among gold panners in Chiweshe and Tafuna communal lands is of public health importance. Panners should be educated on the possibilities of mercury being a poison. A low cost and safe technology to separating mercury from the amalgam should be introduced to the panners
Hypertension in Harare hospital out-patients: drugs prescribed, drugs taken and control achieved.
No full textPatient-retained records supplemented by patieni interviews were used to evaluate hypertension management at Harare Hospital. One hundred and one successive hypertensive out-patients were studied. In over a third of patients diagnosis had been established during medical examination fa an unrelated problem. Only one third of 431 recorded 'on treatment' diastolic blood pressures were less than 100 mm Hg, and one fifth were greater than 119 mm Hg. Thiazides, Methl-dopa and Reserpine were the most commonly prescribed antihypertensives. A step-wise approach to management was evident where two drugs were used, but the choice of a third a fourth drug showed great variation. Thirty percent of patients identified a daily regimen that was different from their recorded prescription. Identification of dosage lower than that prescribed correlated with poor control. Better practitioner-patient interaction and stricter adherence to defined regimens are needed to improve blood pressure control. Patient-retained records can provide useful information for health service evaluation in developing countries
Liver and kidney function tests in normal and pre-eclamptic gestation: A comparison with non-gestational reference values
No full textObjective: To compare liver and kidney function tests in pre-eclampsia and in uncomplicated pregnancy and to relate the results to physiological reference values. Design: Prospective cross sectional study. Setting: Antenatal clinic and antenatal labour wards. Harare Hospital, Zimbabwe. Subjects: 38 pre-eclamptic and 72 normal women of similar parity, gravida and gestational age. Main Outcome Measures: Serum albumin, total bil irubin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and gamma-glutamyl transaminase (GGT) were used as indices of hepatic function. Serum creatinine, urea and uric acid were used to assess renal function. Results: Albumin, bilirubin and ALT did not show any differences between the pre-eclamptic and normotensive pregnant women. The activities of the following enzymes, ALP (p<0.001), AST (p=0.001) and GGT (p<0.01) were significantly elevated in pre-eclamptic women. The renal indices, creatinine, urea and uric acid were significantly raised in pre-eclampsia (p<().()() 1). No significant differences were observed in the haematological parameters, haemoglobin (Hb), white blood cell count (WBC), red blood cell count (RBC), mean corpuscular volume (MCV) and platelet count. Almost all the biochemical and haematological parameters were lower in normal pregnancy compared to the physiological reference values used in our maternity unit. Conclusion: Liver and kidney function is modified by normal pregnancy. However, the majority of the liver and kidney function tests between pre-eclamptic and normal pregnancy exhibited significant differences. The physiological reference values that are currently in use are different from those of women with uncomplicated pregnancies and may not be entirely suitable for management of pre-eclampsia which has hepatic and renal involvement
Lung pathology in Human Immunodefiency Virus positive patients an autopsy study
No full textAim:
To accurately describe the lung pathology occurring in deceased Human Immunodeficiency Virus (HIV) positive individuals by way of an autopsy study and to attempt to do a clinicopathological correlation.
Materials and methods
Sixty one subjects were autopsied at Parirenyatwa Hospital with forty two (42) showing lung pathology; thus the sample size used for the study was forty two (42). Lungs were preserved with formalin and three (3) sections per lobe taken and subjected to hematoxylin and eosin (H&E) stain. Additional special stains were applied as required after review of the H&E.
Results:
By histopathological analysis bronchopneumonia was the leading cause of death from lung disease observed in eleven cases (26%), followed by pneumocystis jiroveci pneumonia seven (17%) then pulmonary tuberculosis (PTB) six (14%) cases. Mixed disease of pulmonary tuberculosis, bronchopneumonia and pneumocystis jiroveci pneumonia (PTB/BPN/PJP) and pulmonary tuberculosis and bronchopneumonia (PTB/BPN) were seen in two (5%) instances Pulmonary embolism (PE) was a surprising find accounting for six cases (14%) with an additional two (5%) cases being found mixed with hilar node tuberculosis (PE/PTB) and bronchopneumonia (PE/PTB).
3
Conclusion:
There is a tendency to favour diagnosing pulmonary tuberculosis over PJP , two diseases with similar presenting signs and symptoms but very different treatment regimes. All cases of PJP were diagnosed as PTB. There is a reluctance to start treatment despite there being lack of further tests such as BAL to rule out PJP. Such reluctance is not shown with antituberculosis treatment. Pulmonary embolism remains under diagnosed in HIV. Methods to identify and stratify risk in HIV positive patient need to be devised