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Evaluation of apolipoprotein b 100 against ldl-cholesterol in profiling cardiovascular disease risk in HIV infected patients
No full textBackground
This study was carried out to assess the potential clinical utility of measuring apo B 100 in evaluation of CVD risk. The study focused on measurement of the classic parameters of assessing CVD risk. LDL cholesterol and HDL cholesterol have been the cornerstone of stratifying CVD risk. LDL cholesterol is considered to be the major lipid risk factor but it has emerged that apo B 100, as a proxy for all atherogenic lipid particles, is a better marker for CVD risk. Risk of CVD in the HIV infected population appears to be relatively higher than in the general population and thus appropriate screening measures for CVD are needed. There is growing support that addition of apo B 100 measurement to the routine lipid panel would enhance patient management.
Methods
Sixty ART naive (35 females), 62 HIV positive on ART (47 females) and 64 HIV negative participants (52 females) were recruited from Harare Hospital adult OIC. These participants were aged between 18 and 65 years old and consented to participate in the study and the mean age was 38.4 + 10.4. A questionnaire eliciting socio-demographic and medical history was administered prior to collection of a blood sample for evaluation of lipid status. Total cholesterol, LDL cholesterol, HDL cholesterol, apo B and glucose were determined on the Dimension, Dade Behring analyser (Siemens Healthcare Diagnostics S.A). Ten-year CVD risk scores were calculated using an online calculator formulated by Dr Rupert Payne of the University of Edinburgh in May 2010.
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Results
There was an increase in mean total cholesterol, LDL cholesterol and apo B levels from HIV negative people to HIV positive ART naive patients and finally to HIV positive on ART patients which was statistically significantly different (p value< 0.001). There was a decrease in mean HDL cholesterol from 1.6 to1.4 to 1.1 mmol/L across the three groups which was also statistically significantly different (p value<0.001). Generally risk of CVD in the HIV infected population appeared to be relatively higher than the other two groups. Diabetes, age, gender, smoking, and systolic blood pressure had a positive effect on the lipid parameters. There was a weak positive significant correlation between Framingham risk score and apoB (r=0.26, p<0.001).There was no correlation found between Framingham risk score and LDL-c (r=0.144, p=0.11). A moderate positive significant correlation (r=0.44, p<0.001) was found between apo B and LDL-c.
Conclusion
In this study it was observed that ART increases lipid parameters like total cholesterol, LDL-c and apo B levels thereby increasing risk of CVD. HDL-c levels were decreased in patients on ART. ART therefore seem to affect lipid parameters. The current guidelines should recommend routine monitoring of lipid parameters in HIV patients on ART to actively investigate these changes. Apo B should be included in lipid profiles since there was a weak positive correlation with the Framingham risk score in assessing risk of developing CVD. Apo B also reflects the atherogenic particles not only LDL but also VLDL and IDL
Estimated glomerular filtration rate and C-reactive protein measures enhance the specificity for left ventricular hypertrophy detection using electrocardiographic criteria: paper presented at the 4th Congress of the African Federation of Clinical Chemists; Zimbabwe: 28-30 April 2015
No full textIntroduction: Left ventricular hypertrophy (LVH), the detection of which is recommended for routine risk prediction by all guidelines, is more prevalent in groups of African ancestry. This is in-part attributed to higher prevalence rates of obesity. The detection of LVH using standard electrocardiographic (ECG) criteria (ECG-LVH) has poor sensitivity and specificity and therefore needs modification in groups of African ancestry.
Aim: To assess the usefulness of independent associations between Left Ventricular Mass Index (LVMI) and estimated glomerular filtration rate (eGFR) or serum C-reactive protein (CRP) concentrations to complement ECG criteria for LVH detection in predominantly obese African populations.
Method: LVH determined by ECG using at least 12 different criteria (formulae) was compared to LVH determined by echocardiography (LV mass index>51g/m2.7) in a random sample of 358 participants from a prospective cohort from an urban, developing community of African ancestry in South Africa (41% obese) and used together with CRP concentrations and eGFR above or below the median for the sample.
Results: A combination of CRP concentrations and eGFR above or below the median for the sample respectively showed significant performance (AUC=0.61±0.03, p<0.0005), but a low specificity (ability to report negative results as negative) for LVH detection (77%). When eGFR and CRP concentrations were employed to complement the R wave amplitude of the electrocardiographic lead aVL (RaVL)the specificity increased (93%), although the overall performance did not improve (AUC=0.71±0.03, p<0.0005, RaVL alone: AUC=0.70±0.03). The sensitivity (ability to report positive results as positive) of 25% was however in-line with previously reported sensitivities for LVH detection using ECG criteria in alternative population samples. However, without changing overall performance, eGFR together with RaVL increased the specificity to 88% and CRP concentrations when considered together with RaVL increased the specificity to 87%.
Summary: Routine measurements of CRP and GFR can be used to enhance the specificity of electrocardiographic tests for LVH (especially the RaVL criterion) in obese African patients since these exhibit poor results from ECG alone.
Conclusion: In groups of African ancestry, obesity contributes toward a poor validity and performance of all voltage criteria for the detection of LVH, but the use of eGFR and/or CRP concentrations to complement ECG criteria increases the specificity without altering the overall performance. Learning Outcomes: This study reveals the extra importance and usefulness of routine clinical laboratory tests in enhancing specialist diagnostic procedures
The Constitutional Court of Zimbabwe’s unconstitutional approach of applying rules of locus standi.
No full textThis paper examines the rationality and legality of the rule of locus
standi introduced by the Constitutional Court of Zimbabwe to the
effect that no litigant is allowed to act in more than one capacity of
locus standi in one matter. This rule was initially suggested in Mudzuru
v Minister of Justice and was crystallised in Samuel Sipepa Nkomo v
Minister of Local Government. When evaluated against the provisions
of section 46 and section 85 of the Constitution, this rule is
inconsistent with the liberal approach to determining locus standi
and is therefore ultra vires the Constitution. At a conceptual level,
this rule is untenable and irrational as it is contradictory to the
theoretical foundations upon which the constitutional idea of judicial
review is based. It is also inconsistent with the trajectory set by the
same Court in its very first case of Jealous Mawarire v Robert Mugabe
An investigation of the factors influencing the choice of infant feeding methods among urban Zimbabwean women in the context of HIV transmission
No full textObjective: To determine the socio-economic and cultural factors influencing the choice of infant feeding methods in urban Zimbabwe women in the context ol HIV transmission. Study Design: A prospective survey. Setting: Clinics in Harare and Chitungwiza, Zimbabwe. Subjects: A total of 200 women attending eight baby clinics, with babies aged up to two years. Main Outcome Measures: Infant feeding methods used by mothers, number of women who had undergone HIV testing, those who knew the link between HIV and breast feeding, and those who were afraid to breast feed. The most common reasons for breast feeding and formula feeding. Results: Husbands had a greater influence on feeding practices than nurses, implying that social influences have a higher influence than the advice of medical personnel when choosing a method of feeding (58% and 42% respectively). Thirty three percent and 77% of women in Harare and Chitungwiza respectively knew the link between HIV and breast milk. Thirteen percent and 36% of the women were afraid to breast leed in Harare and Chitungwiza respectively. Conclusion: The level of education and employment status as well as the opinions of family members and health care personnel are the major factors that influence the choice of method of infant feeding. The multiplicity of factors complicate the decision making process, considering the benefits of breast feeding, which have to be weighed against the risk of transmitting HIV to the infant
A study to examine the relationship between knowledge levels on self-care practices and occurance of abortion among women of child bearing age admitted for post arbotal care at Gwanda gynaecology ward.
No full textAbortion is a major public health obstetric problem across the globe. Worldwide, twenty million unsafe abortions occur each year. Eighty thousand women die each year because of complications following unsafe abortions [WHO 2006]. In Zimbabwe it is estimated that ten to fifteen thousand abortions occur annually. It is one of the leading causes of maternal morbidity and mortality. In 2008 abortion complications resulted in 35% of maternal death and were ranked ninth out of Zimbabwe’s top ten diseases/conditions [MOHCW 2009].
The purpose of this study was to determine the relationship between knowledge levels on self-care practice and occurrence of abortion among women of childbearing age. The study utilized Orem’s self-care model. The concepts used were self-care deficit, supportive educative and self-care. A descriptive correlational design was used. A non-probability sampling which is convenience sampling was employed in the study. The sample size was seventy eight subjects. The instrument used to measure the variable was a questionnaire. Descriptive statistics were used to describe, analyze and summarize data on knowledge levels on self-care practice and occurrence of abortion. Pearson’s correlation coefficient was used to establish the relationship between knowledge levels on self-care practice and occurrence of abortion. A weak negative significant relationship was noted r = -.265*, p =< 0.05.
Midwifery practice should ensure that women should be empowered with knowledge on self-care practice to prevent occurrence of abortions. Empowering women addresses the millennium Development Goal 5 which targets to reduce maternal morbidity and mortality by ¾ by the year 2015
Hardly a harmless analgesic
No full textMembranous nephropathy (MN), the most common cause of nephrotic syndrome in adults, is usually idiopathic, with an identifiable cause in only about 20% of cases.1 Causes of secondary MN include various auto-immune diseases, neoplasms, infections, and drugs such as gold or penicillamine. Although minimal- change glomerulopathy associated with the use of nonsteroidal anti-inflammatory drugs (NS AIDS) is a well established clinical entity,2 3 the association between NSAID use and MN is less well known.
A review of the literature revealed 14 separate cases of MN associated with NSAID use.4-7 In each case, other known causes of MN were excluded, and prompt resolution of the nephrotic syndrome was noted after cessation ofN SAID therapy. The reported NSAIDs include diclofenac, ibuprofen, ketoprofen, phenylbutazone and sulindac.We report here our experience with a case of MN and discuss the possible pharmacological/toxicological mechanisms of how NSAIDs might cause this pathology
Low risk and high risk human papillomaviruses (HPVs) and cervical cancer in Zimbabwe: Epidemiological evidence
No full textObjective: To establish the prevalence of detectable low-risk and high-risk, oncogenic HPV types in cervical swabs of women with histologically proven cancer of the cervix. Design: Cross sectional study. Setting: Harare Central and Parirenyatwa Hospitals. Subjects: 119 women with histologically proven cervical cancer of whom 63 had the degree of differentiation of the tumour reported. Main Outcome Measures: Frequency of infection with high and low-risk human papillomaviruses. Results: The presence of HPV DN A was demonstrated in 63% (75/119) of cases. Low risk HPVs were present in 26% (31/119) and high-risk HP Vs were demonstrated in 51% (61/119) of samples tested. Co-infection with both low-risk and high-risk HPVs was observed in 14% (17/119) of the specimens. High-risk HPVs were detected in 55% (21/38) of poorly differentiated tumours while 60% (15/25) of moderately and well- differentiated tumours showed the presence of high-risk HPVs. Conclusion: High-risk human papillomaviruses are associated with cervical cancer. There was no significant difference in the frequency of high-risk HPV types in women with moderately to well-differentiated tumours and those with poorly-differentiated tumors
The Development of Community Care in Psychiatry
No full textThe theoretical considerations underlying the transfer of psychiatric care from the mental hospital to the community are discussed.
The principal provisions of the British programme are set out. viz.
1.The establishment of acute psychiatric units in District General Hospitals.
2. The construction of hostels and day care centres by local authorities.
• 1. The provision of a substantial increase in personnel.
4. The gradual rundown of the large mental hospitals.
Some of the difficulties encountered in each of these 4 areas are enumerated. The relevance of these problems to Zimbabwe is discussed and two local developments, viz. the establishment of psychiatric follow-up services and the opening of a rehabilitation unit are described
An echocardiography audit to determine and characterise rheumatic heart disease lesions seen in 2012
No full textIntroduction: Rheumatic heart disease is still a common problem in Zimbabwe. It has a significant mortality rate due to heart failure, stroke or endocarditis. Timely surgical interventions can reduce mortality. An echocardiography audit was performed to determine the proportion of patients referred for echocardiography who had a diagnosis of rheumatic heart disease, the pattern of valvular involvement and the presence of surgical indications on echocardiography.
Objective: To determine the number of echocardiograms done in 2012 and the proportion with a diagnosis of rheumatic heart disease. To determine which valve lesions were present and whether there were any echocardiographic indications for surgical intervention.
Method: A record review of all echocardiograms performed by the investigator during the period January to December 2012 was performed. A data collection form was used to extract the data and the findings were tabulated and analysed.
Results: Three hundred and eight (308) echocardiograms were performed by the investigator during the year of review. 236 of these were abnormal and rheumatic heart disease was diagnosed in 16% of them. The commonest valve lesion was mitral regurgitation and half of the patients had surgical indications. The common complications were pulmonary hypertension and left atrial enlargement.
Conclusion: This audit shows that rheumatic heart disease is still quite common in patients referred for echocardiography. Lesions are severe and the majority of patients are in need of surgical intervention