1358 research outputs found
Sort by
Body fluid shifts in soldiers after a jogging/walking exercise in the heat: effects of water and electrolyte solution on rehydration
No full textObjectives: To examine the relationships between dehydration and body fluid shifts and the effects of ingesting water or oral rehydration solution or no fluid during and after exercise in the heat [mean (SE)] temperature, 40.5 (0.66)°C and 32 (3.7)% humidity. Design: PRE and POST three hours exercise comparative study. Setting: Zimbabwe National Army Wafa-Wafa Training Camp, Kariba, Zimbabwe. Subjects: 18 male soldiers volunteered to be studied during and after a 20 km (three hour) jogging/walking exercise in full kit. Main Outcome Measures: Body mass, total body water, extracellular water, intracellular water, plasma osmolality, plasma sodium, and volume changes compared using paired t-test. Results: Total body water decreased by 4.9 (0.38) 1 (p<0.02) in soldiers exercising without fluid, 1.5 (0.3) 1 (oral rehydration solution), 2.4 (0.8) 1 (water). Extracellular water decreased by 3.6 (0.3) 1 (p<0.05), 1.3 (0.2) 1, 1.7 (0.3) 1, and intracellular water decreased by 1.3 (0.1) 1, 0.2 (0.01) 1, 0.7 (0.01) 1 respectively in these groups. Plasma volume decreased by [mean (SE)] 16 (1.4)% on no fluid, three (0.3)% on oral rehydration solution, five (0.3)% on water. Plasma osmolality increased significantly from 285 (1.0) to 301 (2.3) mosmol.kg'1 (p<0.001) in subjects exercising without fluid and from 283 (2.0) to 291 (0.7) mosmol.kg'1 (p<0.02) in subjects taking oral rehydration solution. No significant increases were observed when taking water only. Conclusions: During dehydration, total body water loss was derived from both fluid compartments but extracellular water contributed the most. Effective rehydration depends on adequate replacement of electrolytes lost from each fluid compartment. Water alone may not provide adequate rehydration
Evaluation of the Cavidi Exavir load reverse transcriptase assay (version 3.0) for HIV viral load against the Roche Amplicor Monitor (version 1.5) for use in monitoring viral load in patients infected with the HIV -1 virus.
No full textTitle: Evaluation of the Cavidi ExaVir load Reverse Transcriptase Assay (version
3.0) for HIV Viral Load against the Roche Amplicor Monitor (version 1.5) for use in
monitoring viral load in patients infected with the HIV virus.
Introduction. There are two types of HIV, HIV-1 and HIV-2 and both types are
known to cause AIDS, although infection with HIV-1 is more common worldwide.
The concentration of HIV RNA in plasma is a critical marker for predicting disease
progression and for monitoring the efficacy of antiretroviral drug therapy. However,
most viral load assays are not readily available in Zimbabwe due to the complexity
and the need for nucleic acid amplification hence the need to explore other available
alternatives.
The objective of this study was to evaluate the Cavidi ExaVir load Reverse
transcription Assay Version 3.0 for quantifying HIV-1 viral load using the Roche
Amplicor monitor version 1.5 as the gold standard.
Method
This was a cross sectional comparative study of two kits where 21 whole blood
samples being submitted for viral load testing at Flow cytometry centre were
centrifuged and separated within 2 hours of collection and then stored for batched
testing with 2 aliquots per sample. The samples were then thawed for testing using the
Cavidi Exavir load v 3.0 at flow cytometry centre. The second aliquot was tested
using the Roche Amplicor Monitor v1.5 at UZ-UCSF laboratory. The results were
then correlated using STATA biostatistics software.
Results: There was a very strong linear correlation in viral load measurement
between the Cavidi Exavir Load v 3.0 and the Roche Amplicor Monitor v 1.5 ( r=0.94
and p < 0.05).
85.7% of the samples showed an agreement of 0.68 log 10 between the two
methods (fivefold) which is equal to the total variation that can be expected in viral
load measurements.
Conclusion: The Cavidi Exavir load v 3.0 correlates strongly with the Roche
Amplicor monitor v 1.5 in measuring plasma viral load concentrations and can be
used to monitor viral load in clinical specimens
Association of serum c-reactive protein concentrations with severity of preeclampsia and imminent eclampsia in pregnant women in Zimbabwe
No full textPreeclampsia is a hypertensive disorder in 3-7% of all pregnant women characterised by elevated blood pressure and proteinuria. It is a chief source of morbidity and mortality worldwide. The health of both the preeclamptic woman and her infant are dependent on how long she carries the foetus. To date, delivery of the child is the only cure for preeclampsia. C-reactive protein (CRP) is part of the innate immune system. It scavenges for chromatin released by dead cells during the acute phase, activates complement and acts as an opsonin for various pathogens. Elevation of CRP is still considered the beacon of the acute-phase response. It has been shown that C-reactive protein concentration is elevated in preeclampsia. Measuring the CRP concentration in preeclamptic women could help in understanding the best course of action for the pregnant woman and the foetus, especially if there is an association between CRP levels and severity of preeclampsia.
Objectives:
To determine the levels of C-reactive protein in Zimbabwean women who have preeclampsia during singleton pregnancy.
To determine the association of CRP concentration and blood pressure in pregnant women.
Materials and Methods: This was a cross sectional study conducted at Mbuya Nehanda Maternity Hospital Antenatal Ward and Antenatal Clinic including pregnant women with singleton pregnancy. Blood was collected to yield serum for the CRP assay, a particle enhanced turbidimetric immunoassay. Uric acid and blood pressure were also measured.
Results:
There was a positive correlation between CRP and mean arterial pressure (p=0.0137) and also between CRP and uric acid (p=0.0095).
Conclusion:
In conjunction with other biomarkers and clinical signs, CRP can help to give a fuller picture of the state of the pregnant women who has preeclampsia. The aetiology of preeclampsia is not well established but having more information about the condition will help in the monitoring and treatment of the pregnant woman to ensure she and her baby are well.
Setting up of HIV-1 Antiretroviral resistance testing methods and their clinical applications.
No full textFollowing the World Health Organization (WHO)’s 3 by 5 initiative, antiretroviral treatment (ART) for HIV disease management has been scaled up rapidly in resource limited settings such as Zimbabwe. First line treatment options include a three antiretroviral (ARV) drug regimens compromising of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside (NNRTI). There are fears that the use of SD NVP for PMTCT and rapid scale-up of ART will be followed by a rapid emergence of primary drug resistance in the population rendering the first line treatment options ineffective. Zimbabwe has instituted 90% coverage of SD NVP: ARVs became widely available in 2003 and currently about 200000 people are on treatment in both the
private and public sector. A cross-sectional study was conducted to determine the prevalence of primary drug resistance over a period of two years in a population where ART access is being rapidly scaled up.
This study was nested in a larger study on the HIV-1 Subtype C drug resistance and pathogenesis. Signed informed consents were obtained from eligible young pregnant (<25 years) women who were attending antenatal clinics in Chitungwiza,
Zimbabwe. Whole blood samples were collected in EDTA for CD4 counts, using Partec Cyflow, viral load using Roche HIV monitor Amplicor version 1.5, and estimation of period of infection using BED Calypte Assay as well as presence of HIV-1 drug resistance mutation using population sequencing. Sequence analysis for the prevalence of primary drug resistance was done using the Calibrated Population resistance software of the Stanford HIVDB and the Stanford Drug Resistance Mutations List. Sequences obtained in the analysis for drug resistance were also compared with other sequences from Southern Africa as well as other parts of the world where Subtype C is the dominant HIV-1 strain driving the epidemic.
Three hundred and three women with a mean age of 21 years (95% Confidence Interval, 21 to 22 years) were studied. The median CD4 count was 393 cells/uL, Interquartile range (IQR): 249-509 and among a subset of 107 women, median plasma
VL was 3.70 log10 copies/ml, IQR: 3.1-4.2. Thirty two percent (n=236) of the women were considered to be recently infected using the BED assay, (infected within 155 days of sample collection The median CD4 count in recently-infected women was significantly higher than in women with long term infections based on the BED results (p = 0.000). There were only two test specimens (0.85%) out of 236, with evidence of drug resistance. One specimen had the Y181C mutation associated with NNRTI resistance and a second had the I85V mutation associated with protease inhibitor (PI) resistance. There was no evidence of primary drug resistance in the recently infected women. No evidence of geographic clustering of sequences among subtype C Southern African sequences was
observed after phylogenetic analysis. Interestingly, subtype C sequences from India, Brazil, China and Ethiopia formed separate clusters distinct from the Southern Africa
sequences.
The lack of evidence of HIV-1 primary drug resistance in this population of young pregnant women suggests that the use of genotypic drug resistance data to select the most optimal treatment regimen may not yet be warranted. Currently there is no evidence of evolutionary compartmentalization of the HIV-1 Subtype C epidemic in Southern Africa. This may be indicative of the absence of selective pressure driving differentially adapted sub clusters
Antibiotic use in infants hospitalised with HIV-related pneumonia in Harare, Zimbabwe
No full textObjective : To describe the clinical features of infants admitted with HIV-related pneumonia and to describe antibiotic use in relation to recommended treatment guidelines. Design: Case series. Setting: Paediatric medical wards of two University Teaching Hospitals, Parirenyatwa and Harare Central Hospitals. Subjects: 100 infants aged one to 1.2 months admitted with HIV-related pneumonia Main Outcome Measures: Mortality and antibiotic use in the two hospitals. Methods: Records of 100 infants admitted for 48 hours or more with features of HIV-related pneumonia were analysed for clinical features and antibiotic use. Results: 77% of patients were in the first six months of life with a peak age of two months and a median of four months (C^ = 2, Q. = 6). The median age of children admitted to Parirenyatwa hospital was 5.5 months (Q1 = 3, Q,=7) and in Harare hospital it was three months (Q, = 2, Q,= 6). The difference was statistically significant, p=0.035. Fifty four percent of cases received penicillin, aminoglycoside and cotrimoxazole and overall only 30% of prescriptions complied with Essential Drug List of Zimbabwe (EDL1Z) recommendations for treatment of severe pneumonia in children with HIV infection. The overall mortality was 27.0%. The mortality in Harare Central Hospital was 40.4% and 15.7% in Parirenyatwa. The difference was statistically significant p= 0.005. Conclusion: The difficulties in establishing the cause of the pneumonia in infants with HIV infection was a contributory factor to lack of adherence to standard treatment guidelines. In countries with a high prevalence of HIV infection and with limited resources, a clinical case definition for Pneumocystis carinii pneumonia (PCP) is required as a measure to provide treatment for infants with HIV related pneumonia which is evidence based. This approach will also promote rational antibiotic prescribing and will contain cost
Hepatitis B virus markers in dental care personnel practising in Harare
No full textIn a seroepidemiologic study of 600 volunteers the authors detected serologic markers of hepatatis B surface antigen (HBs Ag) in 6 (6%) of the 100 denial-care markers representing a spectrum exposure to blood and patients. However, 67 (67%) and 1 (1%) were positive fa hepatitis B surface antibody (anti-HBs) and hepatitis Be antigen (HBe Ag) respectively. Two (8%) of the 25 practising dentists were found to be asymptomatic carriers of HBs Ag. One of these HBs Ag positive dental-care workers was HBe Ag positive. The seropositivity of HBs Ag, HBe Ag and anti-HBs among the general population of 500 was 47 (9,4%); 15 (3,0%) and 350 (70%), respectively. It was, therefore, concluded that there was no significant difference (p < 0,001) of HBs Ag or anti-HBs between dental care workers and the general population.
However, when the study group was subdivided into two ethnic groups, thus, Caucasian Zimbabwean and African Zimbabwean, the latter had a high prevalence (9,90%; 2,77%; 71,29%) of HBs Ag, HBe Ag and anti-HBs respectively
Factors associated with utilization of Adolescent Sexual and Reproductive Health services offered at Harare Youth Friendly Corner by the youths in Harare Urban District, 2013
No full textIntroduction:
Youth Friendly Corners were developed in Zimbabwe as a strategy to address Adolescent Sexual and Reproductive Health issues. Harare Youth Friendly Corner provides HIV/STI counseling and testing, pregnancy testing, contraception, post rape services, health education, and other serves to youths in Harare. There was a declining trend in utilization of services at Harare Youth Friendly Corner by youths in Harare from 0.15% in 2010, 0.25% in 2011 and 0.14% in 2012. The current rate of utilization of services of 0.2% is far below the expected 30% that was targeted when the YFC was set up. We therefore set out to find out the factors associated with utilization of the services at the Youth Friendly Corner.
Methods:
An analytic cross-sectional study was conducted at Harare Central Hospital in Harare, were 340 youths were randomly selected and interviewed using an interviewer administered questionnaire and focus group discussion guide.
Results:
Associated with utilization of the services were: Awareness of the Youth Friendly Corner [OR=6.2; 95%CI(2.41-16.18)], being employed [OR=5.72; CI(2.21-14.83)], staying alone [OR=3.51; CI(1.78-6.92)], and awareness of other places providing HIV/STI counseling and
iv
testing, pregnancy testing, contraception, post rape services, health education, and other serves services similar to Harare Youth Friendly Corner [OR=3.5; CI(1.59-7.71)].
Conclusion:
Youths who were employed, stayed alone, aware of Harare Youth Friendly Corner and places offering similar services were more likely to utilize services offered at Harare Youth Friendly Corner compared to those who were not
Outcomes of early post traumatic seizures in head injury patients at Parirenyatwa hospital
No full textPrimary Objective; To compare the outcome of Traumatic Brain Injury (TBI) patients who develop early post traumatic seizures with the outcome of patients with post traumatic seizures who do not develop early post traumatic seizures.
Secondary Objectives; To estimate the incidence and risk factors of early post traumatic seizures in traumatic brain injured patients at Parirenyatwa Hospital.
Study factors; Early post traumatic seizures were the main study factor. Other various clinical and radiological factors were also considered.
Study outcomes; The Glasgow outcome score was used to assess outcome. Patients with a GOS of 1,2 or 3 were considered to have a poor outcome whereas patients with GOS of 4 or 5 were considered to have a good outcome.
Subjects; 252 consecutive patients, regardless of age who were admitted at Parirenyatwa Hospital for traumatic brain injury from 01/10/2014 to 15/05/2015.
Methods; A prospective observational study. A data sheet was created which listed all study and outcome factors.
Statistics; Contingency tables and Chi-square statistics were used to compare the outcomes. Both univariate and multivariate analysis was carried out.
Results; 252 patients have been recruited so far. 200 were males and 63 females. 31 patients developed early post traumatic seizures during the course of the study, giving an incidence of 12.3%. 35 patients died giving a case fatality rate of 13.8%. 52 patients (20.6%) had poor outcome. Of the patients who fitted, 64.5% had bad outcome compared to 14.5% of those who did not fit. The association between fits and poor outcome was found to be statistically significant. The relative risk of poor outcome on univariate analysis in patients with early post traumatic seizures was 10.7 (CI 4.7-24.5) with a p-value of 0.000. Factors which were statistically significantly associated with poor outcome on univariate analysis were; fits, low Glasgow coma scale, age, male sex, anisocoria, alcohol ingestion, retained foreign body, acute epidural haematoma, intracerebral haematoma, multiple cerebral contusions and subarachnoid haematoma. Risk factors found to be associated with fits were; GCS, hemiparesis, retained foreign body, intracerebral haemorraghe, multiple contusions and subarachnoid haemorrhage.
Conclusion; The study demonstrated that early post traumatic seizures are strongly associated with poor outcome. It also showed that several risk factors may be associated with the development of seizures. Reducing the incidence of early post traumatic seizures should reduce the number of TBI patients with poor outcome. This can be done by giving seizure prophylaxis to TBI patients with risk factors for early post traumatic seizures on admission.