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Metabolic effects of carbon dioxide insufflation during laparoscopic surgery: Changes in pH, arterial partial pressure of carbon dioxide (PaCO2) and end tidal carbon dioxide (EtCO2).
No full textPurpose: The purpose of this study was to assess the effects of low tidal volume ventilation
on patients undergoing laparoscopic surgery on partial pressure of carbon dioxide, arterial
to end tidal carbon dioxide gradient and acid base excess.
Methods: 30 patients undergoing laparoscopic surgery under General Anaesthesia were
ventilated with tidal volume of 6 ml/kg and respiratory rate of 12breaths/minute and End
tidal C02, PaC02, pH, Bicarbonate and ABE measurement was done before, during and after
C02 pneumoperitoneum and analyzed. Respiratory adjustments were done for End tidal CO2
levels above 60mmHg or haemodynamic changes attributable to elevated CO2.
Results: Pneumoperitoneum resulted in a significant elevation in PaCO2 (p<0.001) and a
fall of pH (p <0.001), ion bicarbonate (p = 0.011), and base excess (p <0.001). A correlation
was found between the EtCO2 and PaCO2 during pneumoperitoneum. No ventilatory
adjustments were instituted on any of the patients as they maintained EtCO2 below 60mmHg
throughout pneumoperitoneum.
Conclusion: Besides the expected respiratory acidosis, a metabolic acidosis can also be
present during pneumoperitoneum. EtCO2 is still a good non invasive monitor for estimation
of PaCO2 during low tidal volume ventilation during pneumoperitoneum
ANALYSIS ON THE BURDEN OF HELMINTHS-Plasmodium falciparum POLYPARASITISM, EFFECT ON ANAEMIA AND THE ROLE OF INTEGRATED SCHOOL BASED PARASITE CONTROL AND HEALTH EDUCATION IN ZIMBABWE.
No full textIntroduction: Globally, 207 million; 2 billion and 243 million people are infected with schistosomiasis (SCH), soil transmitted helminths (STH) and Plasmodium falciparum (P.f) respectively. Many of the affected people are primary school age children. Clinical outcomes of these parasitic infections include anaemia, impaired cognition and malnutrition. Although these parasites have different mechanisms through which they cause anaemia, data is scarce on the extent of helminths –Plasmodium polyparasitism and their effect on anaemia. We determined the extent of helminths-Plasmodium co-infections, their effect on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anaemia among primary schoolchildren in rural and farming areas in Zimbabwe.
Overall objective: To determine the prevalence of single and helminths–Plasmodium co-infections among primary schoolchildren living in rural and commercial farming areas, the effect of co-infections on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anemia.
Settings: The study was conducted in Nyamaropa rural area, Shamva districts and Burma Valley commercial farming areas in Mutare district, Zimbabwe.
Study design: The study was a longitudinal intervention trial, which involved treatment of infected children at baseline, 6, 12 and 33 months follow up surveys.
Methodology: Enrolled participants were screened for anaemia; schistosomiasis; STHs and P. falciparum (P.f) using the Hemocue machine, urine filtration technique, a combination of the Kato Katz and formal ether concentration techniques and Giemsa staining respectively at each survey.
Results: Helminths- Plasmodium co-infections were heterogeneously distributed and were observed in the commercial farming area only. Overall, the prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, that of S. mansoni was 12.4% and 22.7%.. P. f, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Hookworm and S. mansoni infections were associated with P. f (P < 0.001, OR = 2.48, 95% CI: 1.56-3.93 and P = 0.005, OR = 1.85, 95% CI: 1.20-2.87). Of the 475 children screened for all parasites and anaemia, received combined treatment at baseline and successfully followed up to 33 months post treatment survey, 11.2%; 10.9%; 1.3% and 5.1% had SCH + STHs; SCH + P. f; STH + P. f; SCH+ STH + P. f co-infections respectively at baseline. These co-infections declined to 6.3%; 2.1%; 0.4; 1.1%, respectively at 33 months follow up survey. Overall, anaemia declined from 45.7% at baseline to 15.4% at 33 months follow up survey after treatment intervention, p < 0.001. School health education increased the knowledge of grade 3 children about causes of helminths and P. falciparum
Conclusions: There is heterogeneity in the distribution of helminths –Plasmodium co-infections in diverse communities. Co-infections have a multiplicative effect on anaemia. Biannual combined school based treatment intervention reduces the prevalence of helminths-Plasmodium co-infections and anaemia. Determination of the extent of helminths –Plasmodium co-infection should be prioritized in planning allocation of limited resources for control. The Government of Zimbabwe nationalized this PhD work. The work also contributed towards the national policy formulation for the control of schistosomiasis, STH and other neglected tropical diseases in Zimbabwe
INTENTION TO HAVE AN HIV TEST: MODELING VOLUNTARY COUNSELING AND TESTING USING THEORY OF REASONED ACTION
No full textIntention to have an HIV test: Modeling voluntary counseling and testing using
Theory of Reasoned Action
Introduction
There is a low uptake of HIV test in Zimbabwe despite the population’s knowledge about
HIV/AIDS as shown in studies on knowledge, attitudes and practices (KAP). Success in
alleviating the spread of HIV/AIDS can only be fully realised if people take up HIV tests
on their decision. In order to solicit information from people on their intentions towards
HIV test, this study was carried out in two high-density suburbs of Harare namely Glen
View and Kuwadzana. The HIV will remain unabated if HIV-positive people who do not
know their HIV status take the initiative to make their status known. The study aims to
model determinants of intention to have an HIV test using the theory of reasoned action
framework.
Study design, participants and methods
An analytic cross sectional study was conducted in randomly selected enumeration areas
in Glen View and Kuwadzana high density suburbs of Harare, Zimbabwe. Data was
collected through a self-administered questionnaire distributed to 150 consenting
participants, men and women aged 15 to 49 years, who had never tested for HIV and who
reside in the two areas. The theoretical framework used was Theory of Reasoned Action
(TRA). Two types of response variables on intention to have an HIV test were used. The
first was dichotomous and used as a classification variable in discrimination analysis. The
second was a continuous variable derived as a score from items in the construct and used
in linear regression analysis.
Results
Data was analysed based on 134 questionnaires collected from participants, of which 61
(46%) were from Glen View and 73 (55%) Kuwadzana; 86 (65%) were females and 47
(35%) males. Sixty-nine (52%) were married and/or living together while 53 (40%) were
single and/or never married and 99 (76%) were not employed. Sixty-six (49%) had an
intention to have an HIV test within three months. Linear regression for intention on
attitudes and subjective norms based on scores from factor analysis showed that only
subjective norms [coefficient=0.67; 95% CI: 0.50 0.84] predicted intention. Linear
regression for intention on attitudes and subjective norms based on belief-based attitudes
and subjective norms showed that both attitudes [coefficient=0.14; 95% CI: 0.09 0.20]
and subjective norms [coefficient=0.21; 0.05 0.37] were predictors of intention. Attitudes
[coefficient=0.88] had a greater contribution in discriminating individuals into their
groups than subjective norms [coefficient=0.30].
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Conclusion
The study has shown that using factor analysis, the direct measure of the subjective
norms construct is the main determinant of intention to have an HIV test as compared to
attitudes. The same study has also shown that both belief-based subjective norms and
belief-based attitudes are determinants of intentions. Attitudes and subjective norms
obtained from scores based on Cronbach’s alpha predict intentions to HIV testing better
than those based on factor analysis. Using discriminant analysis, the study has shown that
the attitudes construct is better than the subjective norms construct in the discriminating
participants into the groups with intention to test and with no intention
The adoption of the holistic marketing concept as a customer retention strategy and its impact on customer retention in the financial industry: A case study of CABS Zimbabwe
No full textCustomer retention has gradually gained momentum as a vital tool for surviving in the highly competitive environments and increasing revenue. Most customer retention strategies adopted by banks have been over-used and some have since ceased to be as effective, hence the need to introduce a more innovative, coordinated and holistic approach to customer retention. The study, therefore explored the adoption of the holistic marketing concept as a customer retention strategy. The main objective was to establish the extent to which CABS had applied the holistic marketing concept as a customer retention strategy and its impact on customer retention.
Various theories and frameworks on the holistic marketing concept and customer retention as discussed by different authors were reviewed. The research was predominantly quantitative with aspects of the qualitative approach incorporated to ensure more depth in the collection of data. The case study strategy was adopted with CABS Zimbabwe being the company under study. Two sets of questionnaires were prepared and administered to customers and staff and a response rate of 93.3% was realised from the respondents.
The research results revealed that, though the customer satisfaction levels were high resulting in customers remaining loyal to CABS, the company needed to address the issues of brand visibility, product awareness, communication systems which were found to be lagging behind. Furthermore, the findings showed that there was positive correlation between the variables of the holistic marketing concept and customer retention. It was therefore concluded that CABS, to a large extent had applied the holistic marketing concept as a customer retention strategy and that banks could adopt the concept as a customer retention strategy and reap the benefits. It was recommended that CABS should establish an effective communication procedure for customers, carry out continuous market research and conduct continuous training workshops for staff to strengthen the current customer retention strategies and make them more effective
Factors Associated with Uptake of HIV Testing Among HIV Exposed Infants in Goromonzi District, 2012
No full textBackground: One of the national ART goals is elimination of pediatric AIDS through Early Infant Diagnosis (EID) and antiretroviral therapy where appropriate. National achievement for HIV test among HIV exposed infants between six and eight weeks of age (Dried blood spot) was 67% against a target of 60% for the year 2012. However, Goromonzi district achieved 12%. Two thirds of childhood deaths in Zimbabwe occur in infancy and Goromonzi district recorded 859 deaths in children under five years of age in 2012. The proportion of HIV exposed infants missing EID means pediatric ART cannot be scaled up. Factors associated with uptake of EID have to be established so as to increase pediatric ART and reduce childhood deaths.
Methods: A 1:2 case control study was conducted. A case was defined as an infant resident and born in Goromonzi district from the 5th of November 2011 up to the 4th of November 2012 (attained eight weeks of age in 2012) to HIV infected mother and did not have HIV test at six to eight weeks of age in 2012. A control was defined as an infant resident and born in Goromonzi district from the 5th of November 2011 up to the 4th of November 2012 (attained eight weeks of age in 2012) to HIV infected mother and had an HIV test at six to eight weeks of age in 2012. Primary care givers of HIV exposed infants were recruited for interviews to establish factors associated with uptake of DBS test among infants in Goromonzi district.
Results: 169 respondents were recruited, 54 were cases and 115 controls. Knowledge levels on HIV testing in infants among primary care givers were higher among controls than among cases (57% for cases, 79% for controls). Independent risk factors associated with non-uptake of HIV test among infants were belief that if a child is tested for HIV the child will be discriminated against O.R 3.61 (1.01; 12.9) and mother defaulted ART O.R 5.16 (1.48; 17.9). The independent protective factor associated with increased HIV test uptake was certainty on part of primary care giver that HIV test can be done to infants aged six to eight weeks in the district.
Conclusion: Knowledge levels among controls were better than among cases. Risk factors for infants not taking HIV test at six to eight weeks of age were the belief that once a child is tested the baby will be discriminated against and a mother who defaulted ART. The protective factor associated with increased HIV test uptake was certainty on the part of primary care giver that an HIV test could be done to infants in Goromonzi district
Abdominal compartment syndrome in abdominal surgical patients admitted to intensive care units of Harare teaching hospitals: Prevalence and clinical significance
No full textFactors 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
INVESTIGATION OF THE TOXICOLOGICAL AND PHARMACOLOGICAL ACTIVITY OF A HYDROETHANOLIC EXTRACT OF BOOPHONE DISTICHA BULB
No full textBoophone disticha is a highly poisonous bulb. It has been used systemically in traditional medical practice in Zimbabwe and neighbouring countries for the management of various central nervous system conditions including hysteria. Abuse of the plant by teenagers in Zimbabwe for its claimed hallucinogenic effects has also been reported, with the advent of serious toxicity in some cases.
The aim of the present work was to describe the symptomatology, neurotoxicological effects and lethality of acute and subacute ingestion and of a hydro-ethanolic plant extract of the bulb of Boophone disticha in rats. Initially, we set out to estimate the LD50 of this extract using a modified Up-and-down procedure for acute toxicity determination. We then used a Functional Observational Battery (FOB) to identify the neurotoxicological effects of the extract after both acute and repeated oral intake. Additionally we studied the genotoxic potential of the Boophone extract using the Ames test. Finally we sought to investigate the putative neuropharmacological effects i.e. anxiolytic-like and antidepressant-like activity in a murine model.
Findings in the acute toxicity and neurotoxicological assessment, showedan estimated oral LD50 of between 120 and 240 mg/kg. For doses of 240 mg/kg and less, signs of toxicity began approximately 10 minutes after gavage, and the most prominent initial signs were head tremors (at 50 mg/kg) and body tremors, severe body tremors(>360 mg/kg) followed by convulsions. Generally, symptoms of toxicity lasted approximately 2 hours for doses of 240 mg/kg and less; and 3 hours for doses over 240 mg/kg for animals that survived. These results point to a rapid gastrointestinal absorption of the active principles in the plant extract. The most prominent neurotoxicological effects were increased flaccid limb paralysis and spastic hind-limb paralysis. Tachypnoea was noted at low doses and higher doses produced laboured breathing. The retropulsion observed with higher doses could indicate the reported hallucinogenic effects of the plant extract.
Subacute assessment showed the similar profile symptoms as with acute toxicity.The main subacute toxic effects of Boophone disticha like the acute effects seem to be mediated via interference with the neuronal pathways especially the central dopaminergic and motor neurons. Target organs, as observed by changes in organ weight appear to be liver, small and large intestines, stomach, central nervous system and peripheral nervous system. Boophone disticha extract was genotoxic from concentrations 1000μg/plate and above with both TA98 and TA100 Salmonella typhimurium species irrespective of the metabolic status of the system. The 500μg/plate concentrations of the Boophone extract were not associated with any genotoxicity and 2500μg/plate concentration is potential cytotoxic which could have masked the genotoxic effects at this concentration.
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Boophone disticha extract showed Anxiolytic-like activity in the elevated plus maze test by significantly changing the percentage time spent in open arms, number of open arm entries, rearing, unprotected head dips and stretch attend postures. The 10m/kg dose had the most prominent effects compared to the higher dose which were comparable to the positive control. Repeated dosing enhanced the antidepressant-like activity of the Boophone extract.
Therefore from the pharmacological findings of our studies, despite being very toxic Boophone disticha proved to be an important source of lead compounds for future drug development. Therefore further investigations are necessary to determine the target site and efficacy of Boophone alkaloids with in vivo models
