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Factors associated with lactic acidosis in HIV patients on antiretroviral therapy in Harare city- 2012
No full textIntroduction: Antiretroviral medicines have side effects that can be life threatening. An unpublished study by Malunga in Harare City, showed a high incidence of hyperlactatemia in patients on stalanev. This research therefore aimed to determine the proportion of HIV patients on stalanev, the burden of lactic acidosis and factors associated with developing lactic acidosis in Harare City.
Methods: An analytic cross sectional study was carried out at Harare City’s Wilkins and Beatrice road hospitals. A total of 250 HIV positive participants who had been on ART for more than four months were purposively selected. In addition to interviewer administered questionnaires blood samples were analysed for lactate levels. The frequencies of hyperlactemia and lactic acidosis were determined. Risk factors were determined by multivariate logistic regression.
Results: Of the 250 participants, 5.2%(13) had lactic acidosis and 29.2% (73) had hyperlactatemia. Patients on stalanev were 76% (190). Being on stalanev (p: 0.003) and having a low CD4 count of < 100cells/ml on ART initiation were found to be associated with developing lactic acidosis.
Discussion: HIV patients with CD4 counts of ≤ 100 cells/μl before the inception of ART were at risk of developing lactic acidosis. Monitoring of lactate levels may be useful during management of HIV patients
Heteromorpha trifoliata (Dombwe) accelerates acetic acid-induced peptic ulcers: A preliminary study in the rat
No full textObjectives: To investigate the effect of H. trifoliata on: (a) acetic acid-induced ulcers, (b) food intake, (c) water intake, (d) weight gain, (e) gastric acid secretion in rats. Design: Comparative study. Setting: Laboratory. Subjects: 20 female Sprague Dawley rats (220 to 250g) with acetic acid-induced peptic ulcers randomly assigned to test and control groups (n=10). The test rats were allowed water and normal rat diet comprising 20% H. trifoliata (‘Dombwe) and ‘Imfe nkulu’ in Shona and Ndebele respectively) for 17 days after ulceration while control rats were allowed water and normal rat diet for 17 days after ulceration. Thirty six other rats were prepared to study the effect of H. trifoliata on gastric and acid secretion stimulated by histamine, gastrin and carbachol. Main Outcome Measures: Photographs of the gross anatomy and hisotology of test and control rat stomachs were taken. Daily food and water intake, weekly weight gain and gastric acid secretion were measured in the test and control rats. Results: 17 days following the consumption of the H. trifoliata containing diet, macroscopically, no ulcen were found on the outer surface of the stomach walls of test rats. However, histological examination revealed traces of ulcer at the sites where ulcers were induced previously. In contrast, 70% of the control rats still had ulcers on the surface of their stomach walls. Histological examination showed massive denuded mucosa and submucosa at the ulcer sites which are signs of severe ulceration. Food intake in both groups was not significantly different except during the first three days when test rats consumed significantly less food (p< 0.01) than control rats. Daily water intake and weekly weight gain were also not significantly different in the test and control groups. H. trifoliata had no significant effect on gastric acid secretion stimulated by histamine, gastrin and carbachol. Conclusions: H. trifoliata does not affect daily food and water intake and weekly weight gain in rats. It also does not affect histamine, gastrin and carbachol-stimulated acid secretion in rats. However, H.trifoliM accelerates the healing of acetic acid-induced peptic ulcer in rats. This may validate the use of H. trifoliatt in the treatment of peptic ulcer in humans
Experiences and coping strategies 3 months post-stroke of patients in Harare and Chitungwiza: 3 months follow-up prospective study
No full textBackground and purpose: Problems encountered by survivors of stroke need to be
adequately addressed to promote the individual’s well being. In Zimbabwe it is not known
to what extent survivors of stroke are affected by disability resulting from stroke and
whether the current services are adequate to address the challenges faced. There is also
scarcity of documented information on coping methods used by victims of stroke. Therefore
the main aim of the study was to determine experiences of a patient suffering from stroke
in Harare and Chitungwiza three months post-stroke and how they cope with the challenges
that they encounter.
Methodology: A cross-sectional study design was used to carry out this study. Eighty (80)
patients with a clinical diagnosis of stroke were conveniently recruited from Parirenyatwa,
Harare and Chitungwiza Central Hospitals. Baseline information of participants was
collected during recruitment and follow-up was done at 3 months. An interviewer
administered questionnaire was used to obtain information from participants.
Results: The occurrence of stroke during the period under review at the three hospitals was
higher in females (N = 56, 70%) than males (N = 24, 30%) ratio 2.3:1. The mean age of the
participants was 60.6 years (SD 17.1). Thirty eight (47%) participants were found at followup,
27 (34%) had died and 15 (19%) were lost to follow-up. Physical problems e.g. mobility
were common soon after stroke onset while psychosocial problems e.g traditional roles
were more common at 3 months post-stroke. Family assistance, acceptance, changes in
family roles and prayer helped most participants to cope with devastating effects of stroke.
Conclusion and recommendations: Stroke can result in high fatalities. Health care team
needs to focus on both the physical and psychosocial problems faced by a stroke survivor
The HIV profile of patients with invasive cervical cancer at Harare's Central hospitals
No full textA cross sectional, descriptive study of Invasive Cervical Cancer(ICC) patients managed at Harare’s 2 central hospitals. The association of HIV with ICC has been investigated by several studies, however there is no published local data on patients with both disease entities. This study aimed to produce data that would provide a better understanding of the magnitude of the problem of ICC and HIV currently, in order to inform policy and identify further research potential. One hundred and ten women were recruited between February and December of 2013 and data was obtained using a standard questionnaire by participant interview and extracted from treatment records. The main findings were that 41.8% of the participants were HIV seropositive.
The HIV positive patients were significantly younger than the HIV negative patients, with a mean age of 42.7, s.d= 8.0 years versus mean age of 53.0 years, s.d=12.7 years(p<0.001). Of the HIV positive participants 35(76.1%) were on HAART. The majority(63%) of HIV positive participants had CD4 cell counts greater than 350 cells/ul. HIV positive patients were more likely to have advanced disease, that is FIGO stage 2b or greater O.R 1.23(C.I 0.41-3.68). This study found a large proportion of ICC patients to be HIV positive. The majority of HIV positive participants with ICC were also accessing HAART implying a possible missed opportunity for screening. Therefore provision for screening may be considered within the setting of opportunistic infections clinics.Global AIDS Coordinator and The US Department of Health and Human services Grant Number TW008881
Forgarty International Center, National Institutes of Health NIH, USA) Through the International Clinical, Operational Health services and Training Award (ICOHRTA) Grant Number 2U2RTW00736
Faculty Development Workshop Summary Notes 26-28 July 2011
No full textThe workshop was made possible with financial support from the National Institute of Health (NIH),under the Medical Education Partnership Initiative (MEPI).University 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.National Institute of Health (NIH); University of Zimbabw
The relationship between perceived quality of provider initiated testing and counselling service and disclosure among urban antenatal mothers aged 18 – 40 years in Makoni district
No full textAntenatal mothers on the PMTCT programmes appear to be having problems in disclosing their HIV status. The purpose of this descriptive correlational study was to examine the relationship between perceived quality of PITC service and disclosure among urban antenatal mothers aged 18 to 40 years in Makoni district. King’s model of Goal Attainment was used to guide this study. A sample of 80 participants was recruited using the convenience sampling method. Data were collected using face to face interviews and structured questionnaires developed by the investigator. The research instruments comprised the Demographic Data Questionnaire, The Disclosure Questionnaire and the Perceived Quality of PITC Services Questionnaire. Data analysis was done using the SPSS computer software package. The results showed that the partial disclosure pattern was the most common for 65 (81.3%) of the participants. The level of disclosure was generally low. A total of 71 (88.8%) scored low level disclosure scores of between 1 and 10 out of 14. The perceived quality of PITC services was average for 43 (53.8%) of the sample. Pearson correlation analysis showed a statistically non significant and weak person correlation coefficient (r = .193). Although not statistically significant, the correlation analysis showed a weak linear relationship and therefore confirmed that to some extent, perceived quality of PITC services have a linear association with level of disclosure. Therefore, as perceived quality of PITC increases. Level of disclosure also increases. Existing PITC services need to be strengthened to increase the level of disclosure. In addition, further research is necessary to identify more causes for the low levels of disclosure
The effect of simvastatin and rosuvastatin on relieving the symptoms of alzheimer's disease in a mouse model
No full textBackground: Alzheimer's disease (AD) is the most common form of dementia affecting
nearly 36million people globally. None of the currently approved drugs prevent or even
slow the course of the disease.
Objective: To investigate effects of simvastatin and rosuvastatin in relieving symptoms of
AD in mice.
Methods: The design was experimental using a mice model. A total of 72 Balbc male mice
aged 8-12 weeks were divided into 9 groups with 8 mice in each group. Scopolamine
1mg/kg/day was given intraperitoneally over a period of 2 weeks to induce AD. Study
groups were control, simvastatin 5mg/kg/day, simvastatin 10mg/kg/day, simvastatin
20mg/kg/day, rosuvastatin 10mg/kg/day, rosuvastatin 20mg/d/day, rosuvastatin 40mg/kg/day and donepezil 5mg/kg/day administered by oral gavage for 2 weeks. Y-maze to assess short term memory and Novel Object Recognition test to assess cognition, short-term, intermediate and long-term memory were administered starting 24 hours after the last dose of the experimental drugs. Parametres assessed with Y-maze were total arm entries, same arm entries, alternate arm entries, percentage spontaneous arm alternations. Data were analysed using One way or Two way ANOVA with an appropriate post hoc where required. An a priori alpha level of 0,05 was set for all statistical analysis.
Results: All 8 mice in simvastatin 20mg/kg group died therefore this group was excluded from statistical analysis. There was no significant difference in the parameters used in the Y-maze test across all treatment groups. Total Arm Returns (F=0.5708, d.f. = 6; 28, p= 0,9396), Same Arm Returns (F= 0.4762, d.f= 6; 28, p=0.820), Alternate Arm Returns (F=0.4272, d,f 6,28, p= 0,8545) and percentage spontaneous alternation ( F=0,2911, d,f= 6,28, p= 0.9361). Similarly, no significant difference were noted in the time spent exploring familiar objects across the experimental groups (F=0.4578, d.f=6;28, p=0.7453). However, significant differences were noted on the time spent exploring novel objects across the treatment groups (F=5.755, d,f= 6,28, p= 0.0005). The discrimination indices were found to be different between groups (F= 8.031, d,f= 6,28, p< 0,001; Kruscal-Wallis test .2= 20,46; p=0,0023.
Conclusion: Repeated dosing of simvastatin and rosuvastatin had no effect on memory in mice. No dose response relationship in reversing symptoms of AD with these statins was observed
Prevalence of diabetic retinopathy at Parirenyatwa hospital
No full textBACKGROUND: There is a global epidemic of diabetes mellitus. Diabetes mellitus causes a myriad of microvascular and macrovascular complications.
Diabetic retinopathy is one of the main microvascular complications. It is preventable. However the extent of diabetic retinopathy in Zimbabwe is unknown.
METHODS: This was a cross-sectional study carried out on consenting participants, = 18years old at Parirenyatwa Group of Hospitals Diabetic Clinic. Retinopathy was assessed taking retinal photographs using an iExaminer ® which is a device comprising of a Welch Allyn Pan-optic, an indirect ophthalmoscope attached to an iPhone 4 using an adapter. Retinopathy was classified as: No Retinopathy, Non-proliferative Diabetic Retinopathy and Proliferative Diabetic Retinopathy.
RESULTS: 150 study participants were recruited with a mean age of 52.6 ± 16.4 years. The prevalence of diabetic retinopathy was observed to be 38% (n = 57) with 30.7% (n = 46) having non-proliferative diabetic retinopathy and 7.3% (n = 11) with proliferative retinopathy. Significant risk factors for diabetic retinopathy were hypertension OR 2.8 (95% CI 1.23 – 6.42), p = 0.015; age O.R 1.02 (95% CI 1.00 -1.04), p = 0.048; Diet OR 4.71 (95% CI 1.80 – 12.34), p = 0.002 and Exercise OR 11.33 (95% CI 2.62 – 49.05), p =
0.001.
CONCLUSION: The prevalence of diabetic retinopathy was 38%. Diabetic retinopathy is therefore common and largely unrecognised. Regular and appropriate easy to use screening methods are highly recommended for early detection of diabetic retinopathy so as to reduce progressive visual impairment
Determining the rate, nature and predictors of adverse drug reactions associated with the use of Highly Active Antiretroviral Therapy (HAART) in a resource limited setting (Zimbabwe)
No full textBackground: Dilemmas exist between balancing cost and toxicity of antiretroviral therapy (ART) in resource limited settings (RLS). Most pharmacovigilance programmes in RLS are unable to monitor adverse drug reactions (ADRs) due to inconsistent support systems. The study was carried out to implement a 3-step approach in identifying ADRs in patients on ART. The study was also designed to determine the rate nature and predictors of toxicities associated with ART in a RLS (Zimbabwe).
Methods: The 3-step approach involved a pharmacist, physician and a drug regulatory agency (Medicines Control Authority of Zimbabwe, MCAZ) at each respective step. The pharmacist (investigator) was responsible for collecting data of suspected ADRs from the patient charts. The physician documented patient information in the patient charts, while the drug regulating body ascertained the causality of the suspected ADRs. The 3-step approach was used in ascertaining causality of cutaneous ADRs in 221 patients. To determine the rates and predictors of ADRs, 388 HIV positive adults stable on first line ART dispensed from Parirenyatwa Hospital, Harare, Zimbabwe were interviewed and their respective patient charts were consulted. Data analysis was carried out using the Statistical Analysis System (Version 9.2, Cary, North Carolina, USA). Three regression models, one multiple linear regression model and two logistic regression models were run to identify predictors of ADRs.
Results: Of the 221 patient case report forms that were reviewed for causality assessment by the MCAZ, 39 patients had cutaneous drug eruptions. The rates of ADRs that were observed in the population included peripheral neuropathy (42%), skin rash (26%), lipodystrophy (3%), abdominal pain (8%), gastro-intestinal symptoms (7%) and headache (3%). Peripheral neuropathy and skin rash were mainly observed with stavudine (93%) and nevirapine (88%) based regimens respectively. Lipodystrophy occurred only in participants on stavudine based therapy. 161(58%) ADRs were grade 1 events (World Health Organization’s ADR grading system), 96(34%) were grade 2, 15(7%) were grade 3 and 1(0.3%) was grade 4. One patient on a nevirapine containing regimen had grade 4 Stevens - Johnson syndrome. In a logistic regression model, two indigenous herbal remedies were associated with the occurrence of ADRs in participants. Rates of toxicities were higher in the population receiving stavudine and nevirapine based therapies.
Conclusion: Implementation of the 3-step approach in a RLS can an accurate technique in implementing pharmacovigilance programmes in RLS. The results of this study showed that 3 in every 4 patients initiated on first-line HAART in the government roll-out programme experienced a clinical adverse drug event