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Negative appendicectomy: evaluation of ultrasonography and Alvarado score
No full text1.1 BACKGROUND
High negative appendicectomy rates are no longer acceptable with improvements in imaging techniques and clinical prediction rules. The use of ultrasound and CT scan in addition to clinical assessment and blood investigations has greatly reduced the negative appendicectomy rate to less than 10%. The aim of this study was to assess the negative appendicectomy rate at the two University Teaching Hospitals in Harare.
1.2 OBJECTIVES
The aim of the study was to determine the negative appendicectomy rate at the two major teaching hospitals in Harare and to evaluate the accuracy of the Alvarado score and ultrasound scan in diagnosing acute appendicitis.
1.3 DESIGN
Prospective observational, cross sectional study
1.4 SETTING
Parirenyatwa Group of Hospitals and Harare Central Hospital, in Zimbabwe
1.5 MATERIALS AND METHODS
A total of 206 patients undergoing appendicectomy at the two major teaching hospitals in Harare were included in this study between June 2012 and May 2013. Information recorded included: age, sex, clinical features, investigations and treatment. Alvarado score was calculated from the data in the case notes and ultrasound scan results were also captured. All appendices removed at operation were sent for histopathological examination. Appendicitis was confirmed at histology. The positive predictive value of Alvarado score and sensitivity and specificity of ultrasound scan were calculated.
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1.6 RESULTS
The overall negative appendicectomy rate was 16.5%. The negative appendicectomy rate for men was 13.3% and that for females was 29.9%. The negative appendicectomy rate for Parirenyatwa Group of Hospitals was 19.0% and that for Harare Central Hospital was 12.1%. The mean age for the study was 28 years (SD 12.8). Appendicitis was diagnosed commonly in the second and third decades of life. Sensitivity of ultrasound scan in diagnosing acute appendicitis was 89.5% with a positive predictive value of 77.2%. Females were 2.6 times more likely to have an ultrasound scan done to diagnose appendicitis than males. Alvarado score had a sensitivity of 95.3% with a positive predictive value of 90.3%.
1.7 CONCLUSION
Negative appendicectomy rate (16.5%) at the two University Teaching Hospitals in Harare is relatively high when compared with modern trends. Alvarado score had a high sensitivity (95.3%) and predictive value (90.3%). Ultrasound scan had a high sensitivity (89.5%) and a relatively low predictive value (77.2%) in diagnosing acute appendicitis. Regular use of these assessment modalities should contribute substantially to reduction in the negative appendicectomy rate in our practice
Implementing Zimbabwean projects in the Zambezi Valley
No full textProjects such as the Kazungula-Kasane Bridge, Victoria Falls North Bank Power Station, Hwange 7 and 8 Thermal
Power Station Extension, Batoka Gorge Hydro-electric Scheme, Zambezi-Bulawayo Water Supply Scheme, Devil's
Gorge Hydro-electric Scheme, Gokwe North Thermal Power Station, Kariba South Bank Power Station Extension and
Mupata Gorge Hydro-electric Scheme have been on the Zimbabwean infrastructure development cards for a long time
but are yet to see the light of day.
The objective of the Paper is to highlight some of the opportunities and challenges that each Project presents to
policy/decision makers and potential developers utilising information in the public domain, interviews held with
relevant potential developers and from the author's experiences and knowledge of the Projects. Some of the
opportunities cited relate to the availability of the production raw materials, markets for the end products whilst the
challenges include environmental concerns, politics, trust and confidence between development partners and
technical issues.Zimbabwe Institution of Engineer
Cost-effective ownership of ICT infrastructure equipment and systems in the financial services sector: A case of old Mutual (2009 to 2013)
No full textInformation Communication Technologies (ICTs) have become an indispensable resource in enabling functionality and efficiency in the financial services sector where Old Mutual Zimbabwe is a major player. The company relies heavily on ICTs for service delivery. ICT infrastructure is needed everywhere, be it for frontline customer oriented operations in banking, property management, insurance or internal support services such as HR, Finance, Risk and Audit. As the use of ICT infrastructure at all stages of the service delivery process increases, the computing resources that Old Mutual needs also go up. The huge infrastructure associated with getting a computer on every workstation brings up problems like machine failure, hard drive crashes, software bugs, and more importantly effective utilisation of these resources. This is a big headache for Old Mutual which, like most leading enterprises, must strive to reduce its costs through models such as virtualization. In developed countries, this demand to reduce computing costs (and subsequently lower product selling price to customers), has led to the development and growth of Cloud Computing. Cloud computing is a paradigm shift in which computing is moved away from personal computers and even the individual enterprise application server and server farms (in data centres) to a ‘cloud’ of computers. Innovations like this are necessary to ride the inevitable tide of change. Cloud Computing is the sum of SaaS and Utility Computing which offers better computing through improved utilization and reduced administration/infrastructure costs. The concept of Cloud Computing is still at its infant stage and a very new technology for the enterprises and as such, most enterprises are not very confident to adopt it.
This research assesses the preparedness and efficacy of implementing this technology for Old Mutual in terms of cost and security. It discusses the benefits and drawbacks Old Mutual can have while adopting Cloud Computing. In the end, the research concludes that Cloud Computing is better for Old Mutual in terms of both cost and data security
An evaluattion of the adoption levels of green IT practices and their implications on competitiveness: The case of NMB Bank Limited (2007 to 2013)
No full textOrganisations across the world together with governments have recently been giving unprecedented attention to environmental issues. Green IT has emerged as one key element in efforts to reverse global warming, and reducing the environmental footprint as organisations conduct business. These initiatives come in the form of improving efficiencies of ICT hardware systems in order to reduce emissions into the environment; ICTs replacing traditional environmental polluters; and offering ICT based solutions in all facets of life in order to eliminate or reduce environmental impact. Green IT does not only benefit the environment, but has a triple bottom line effect of environmental (planet), social (people), and economic (profit) benefits. Such technologies like virtualisation and VoIP over computer networks, combined with practices like printing reduction, and switching off computer equipment when it is not in use, are all Green IT aspects that can significantly reduce energy consumption thereby reducing carbon emissions in the power generation process. Green IT offers business opportunities of improving operational efficiency, reducing costs, and green branding, all of which can provide sustainable competitive advantages. This study sought to investigate the adoption levels of Green IT practices and the implications on competitiveness in NMB Bank, which operates in Zimbabwe. The study also looked at practices already in place that are Green IT compliant, as well as assessing the competitiveness of the bank, and the challenges being faced in implementing Green IT initiatives. The case study approach was used with focus being on the period from the year 2007 to 2013. The study concluded that there are some practices and technologies in NMB Bank that are Green IT compliant. However the level of adoption of Green IT is generally low mainly because there is no clear Green IT governance framework and strategy in the bank. The bank is generally highly competitive in its industry and can ride on existing infrastructure and systems to implement Green IT initiatives and become even more competitive. The study recommends a decentralised Green IT governance structure, and the environmental cost leadership strategy of Green IT. Follow up studies can be done on whether statutory bodies responsible for environmental management in Zimbabwe have embraced Green IT and what is it that they are doing to promote Green IT adoption by banks
Effects of Plasma cutting on surface integrity of mild steel
No full textPersistent fatigue failure observed in vibrating screen side plates motivated this investigation to determine the effects
of plasma cutting on the surface integrity and hence fatigue performance of mild steel plates. Fatigue crack initiation
and propagation was reported to have occurred in a number of vibrating screen side plates in which bolt holes had
been produced using plasma cutting. This cutting technique had been introduced to reduce bolt hole production
times thus replacing the traditional hole drilling technique previously used. This inadvertently modified the surface
conditions of the material. Since fatigue is largely a surface phenomenon due to a number of factors such as stress
concentration and surface roughness, fatigue strength was unintentionally compromised. A proper assessment is
always required to test the effect of new processing techniques on service performance before implementation.
Although full scale fatigue testing is too expensive, low cost surface integrity tests can be conducted to assess the
impact of the new technique on anticipated fatigue performance. Experimental assessments done on the plasma-cut
mild steel plate using microstructure and micro-hardness testing techniques revealed clear evidence of material
hardening. Since increased hardening implies increased notch sensitivity, it was therefore concluded that plasma
cutting has the effect of reducing the fatigue strength of mild steel components hence the observed fatigue failures in
vibrating screen side plates.Zimbabwe Institution of Engineer
Breast cancer and HIV: a single institution review of a non-AIDS defining cancer in women in the setting of high HIV prevalence
No full textBACKGROUND
The prevalence of HIV infection is high in sub Saharan Africa. However the impact of this high prevalence on breast cancer incidence, pathogenesis, age, stage at presentation, treatment response and toxicity in the HIV infected and uninfected female remains unknown.
OBJECTIVES
The study sought to characterise breast cancer in patients with a known HIV status as well as compare treatment tolerability and outcomes in HIV determinate and indeterminate patients.
METHODS
A search through the case notes of 382 patients with a diagnosis of breast cancer diagnosed between January 2008 and December 2011 was carried out to identify female patients with an HIV test result .Data collected from these patients included age at cancer diagnosis, demographics, breast cancer and HIV risk factors, histology, stage, CD4 count and use of antiretroviral drugs in HIV positive patients, treatment, toxicity and outcome.
RESULTS
A total of 92 patients were identified, 67 HIV negative and 25 HIV positive. All patients were black African. Median age at diagnosis was 42 (Range 34 to 58) for the HIV positive and 50 (Range 30 to 88) for the HIV negative patients. Median CD4 at breast cancer diagnosis was 440cells/microlitre and median known duration with HIV was 3 years for the HIV infected patients. Mode of HIV infection was confirmed heterosexual transmission in 2 patients. Seventy two percent of HIV positive patients were receiving non protease inhibitor antiretroviral drug regimens. There was no difference in presentation and pathologic features between the HIV negative and positive patients. None of the patients had a history of prior screening. All stages of breast cancer were seen with the majority of the patients presenting with advanced stage disease with no statistically significant differences in stage at presentation between the HIV positive and negative patients. Hormone receptor and Her 2 neu status was available for a total of 21/92(22.8%) patients, with 3/17(17.7%) HIV negative and1/4(25%) HIV positive patients being triple negative. HIV positive patients were more likely to have ER and PR negative and HER2 neu positive breast cancer with HIV negative patients more likely to have ER and PR positive and HER 2 neu negative disease and this difference was statistically significant. Choice of chemotherapy was not determined by HIV status in these patients. Myelosuppression was present in both HIV negative and positive patients during chemotherapy but was more pronounced in the HIV positive patients. Two of the latter had progression of HIV on treatment manifested by development
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of an opportunistic infection on treatment. Radiotherapy was well tolerated in both the HIV positive and negative patients. Default to follow up was high in this cohort.
CONCLUSIONS
This study suggested that whilst there was no difference in histology and stage at presentation, the natural history of breast cancer in the setting of HIV infection was worse than in the HIV uninfected patient with younger age at presentation, poor prognostic tumour biology and poor treatment tolerability. Chemotherapy for breast cancer also had an adverse impact on the natural history of HIV infection. HIV infection and immunosuppresion did not appear to have a permissive role in breast cancer development. Although the incidence of breast cancer is not increased in HIV positive women, the high prevalence of the two diseases in our population makes their coexistence in the same patient more probable
The role of dental practitioners in Provider Initiated HIV Counseling and Testing (PITC) for patients attending dental practices in Harare, Zimbabwe
No full textObjective: To assess the role o f Zimbabwean dental practitioners in Provider Initiated H IV Counseling and Testing (PITC). Design: A cross-sectional analytic study was conducted. A structured interviewer administered questionnaire was used to collect data from participants. Setting: Harare private and public dental practices. Subjects: Forty dental practitioners practicing in Harare and two hundred and ninety three patients attending dental practices in Harare were interviewed. Main Outcome Measures: Dental practitioners' practices on HIV counseling and testing for dental patients, acceptability of HIV testing in dental settings and missed opportunities for HIV counseling and testing in dental settings were assessed. Results and Conclusion: Half of the dental practitioners (20) interviewed reported offering HIV counseling to dental patients during their clinical duties. The majority 62% only referred their patients for HIV testing when they presented with oral manifestations of HIV infection. Seventy three percent (29) of practitioners interviewed were not aware of the Ministry of Health and Child Welfare guidelines on HIV counseling and testing. Eighty seven percent (255) of dental patients in this study reported not being counseled nor referred for HIV counseling and testing by their dental practitioner during their dental visits. More than a third (36.5%) of the dental patients experienced repeated missed opportunities for accessing HIV counseling and testing in health settings. The minimal that the dentists may need to be involved with in PITC is counseling their patients and improve referral for care. There is need for continued medical education for dentists on issues related to new HIV interventions or protocols such as PITC
A CRITICAL ANALYSIS OF TRANSBOUNDARY WATER MANAGEMENT IN SADC: CASE OF THE LIMPOPO BASIN
No full textIn this study the focus was on the importance of identifying the drivers, processes and outcomes of transboundary water management in Southern Africa Development Community (SADC) and to establish the relationship with regional integration in SADC. It aimed to present a dimension to a basic typology of regional integration by studying the Limpopo basin transboundary water management in a SADC context. Transboundary water management was taken as a sector approach adopted in SADC regional integration. The objectives of the study were to analyse transboundary water management in SADC through the Limpopo Agreement of 2003; to establish the relationship of the Limpopo Basin’s transboundary water management and regional integration in SADC; to analyse the influence of international forces on regional water governance trends; and to investigate the impact of river basin organizations on regional peace, security and sustainable development. The hypothesis in this study was that transboundary water management in the Limpopo Basin is an opportunity to understand regional integration in SADC. The methodology of study evolved on an issues based approach framed in defining driving forces and pressures (rational) and outlining impacts on states and the responses which have been manifest through various interstate agreements. It traces the movement from bilateral to multilateral cooperation usually in the form of river basin organisations. However, it is noted that bilateral agreements between states continue to be relevant in defining context specific solutions. The research hinged on locating governance and socio economic factors. Governance was about its architecture, river basin organisation resilience and water legislation. Socio economic indicators are linked to economic interdependency, societal well-being and vulnerability. The study enables the identification and explanation of principles, concepts and instruments in the Limpopo basin agreements and SADC regional water sector. Subsequently, state sovereignty has been challenged in SADC through transboundary water management. Comparative approaches are taken from the historical legacies of commission operation of the Permanent Indus Commission, the Niger River Authority and the International Commission for the Protection of the River Elbe. Apparently the major lessons arrived at are that transboundary water management is useful in consensus building and presents opportunities for cooperation, development and integration rather than to conflict. It is concluded that the immense value of Limpopo Watercourse Commission (LIMCOM) is still futuristic although it represents efforts and growth towards regional integration. It is recommended that SADC and LIMCOM can play an important role in securing and maintaining a commitment to best practices, cost-effective management, democracy and stability from which greater regional co-operation and thus global integration can be launched. The stability of the region is seen as critical to the success of its own transition
An evaluation of the state of information technology governance in the financial services sector: A case of indigenous commercial banks in Zimbabwe (2007 - 2013)
No full textInformation Technology has developed from just supporting business to being a business enabler. Technology has continuously transformed, bringing new opportunities and consequently fresh challenges such as increased expenditures and risks. For organizations to take advantage of the technologies and get maximum value from IT value there is need for business and IT alignment. Information Technology Governance is considered as the instrument through which businesses can exploit technology but still manage the challenges associated with the technology. Given Information Technology’s critical role in today’s businesses and its pervasiveness, attention must be afforded to the Information Technology Governance discipline.
The research evaluated the state of Information Technology Governance in twelve indigenous commercial banks of Zimbabwe. A total of 30 questionnaires consisting of 33 questions were completed and returned. A number of interviews were conducted to probe for further information. The study examined the IT governance practices that have been implemented, the effectiveness of the practices and the Information Technology Governance frameworks/standards that have been employed. A number of findings of the study revealed some shortcomings that are in the indigenous commercial banks of Zimbabwe’s Information Technology Governance implementations
eLearning for a Developing Economy
No full texteLearning, although not entirely new, has taken on a renewed form and focus with the advent
of new technologies like Web 2.0 which allow for easier collaboration and the growth of social
media. As with any new technology being introduced into a very traditional formal sector like
Education, there are a number of barriers to ICT in education and the progress is cautiously
slow. In addition outcomes of eLearning are very different from traditional outcomes and are
difficult to measure with the current techniques, which further complicates or distracts from
implementation and the evaluation.
Advocates of eLearning need to embrace that this is complimentary to current educational
techniques and should be intended to enhance a learners experience and not completely
replace it. Opponents need to appreciate that the new technology is able to assist in producing
better equipped students with new 21st Century skills, at the same time opening a learner to a
more global perspective.
Developing Economies stand to gain significant benefits in advancing their education sector
with the correct and careful implementation of eLearning structures. Although much of the
focus for eLearning implementation is on access to technology, there are a number of other
factors that have to be considered to effectively implement an eLearning program;
1. Shared Vision and Policies aligned to social and economic desired impacts
2. 21st Century Pedagogy requirements
3. Foundational ICT Skills
4. Curriculum Framework
5. Contingency Planning
6. Skilled Personnel and continued professional development
7. Suitable equipment
8. Technical Support
9. Assessment and Evaluation
eLearning is essential for a developing country. The process requires a long term plan and
commitment but the end result could allow us to not only leap-frog but surpass other countries
in having adequately prepared graduates for the 21st Century