108 research outputs found
A Study of Cardiovascular Autonomic Neuropathy in Adult Patients with Diabetes Mellitus at Levy Mwanawasa University Teaching Hospital
No full textCardiac autonomic neuropathy (CAN) is the diminished capacity of autonomic regulation of the cardiovascular system occurring in the presence of diabetes mellitus (DM) and in the absence of other aetiologies. Diabetes mellitus is a well-known cause of peripheral neuropathy. However, in comparison to somatic neuropathy, autonomic neuropathy is an under-diagnosed and under-treated chronic complication of diabetes mellitus despite its serious and significant contribution to morbidity and mortality in the diabetes mellitus population. A variety of tests, based on evaluation of the cardiovascular reflexes triggered by performing specific provocative manoeuvres, have been proposed to measure autonomic function. This study used four cardiovascular reflex tests to estimate appropriate autonomic function by examining heart rate, heart rate variation and the baroreceptor reflex. The aim of this study was to determine the presence of cardiovascular autonomic neuropathy in adult patients with diabetes mellitus at Levy Mwanawasa University Teaching Hospital in Lusaka, Zambia. Adult patients with diabetes mellitus, aged between 21 and 70 years, participated in this cross-sectional study. Four, non-invasive, cardiac autonomic reflex tests to assess for cardiac autonomic neuropathy were employed according to Ewing’s method. The parasympathetic function was analysed based on the heart rate response to paced deep breathing and to Valsalva manoeuvring. The sympathetic function was assessed by measuring heart rate and blood pressure response to postural change. Ewing`s criteria was used for the categorisation of cardiac autonomic neuropathy. Data were analysed using SPSS version 20. Continuous data were presented as means and standard deviation. Categorical data were analysed using a Fishers’ Exact Test (χ2) and a logistic regression was performed to verify the effects of diabetes mellitus’ duration, sex and age on the probability that the participants have cardiac autonomic neuropathy. A total of 52 patients participated in the study. The prevalence of Cardiac autonomic neuropathy was 48.1%. Out of 52 patients, 42.3% had definite cardiac autonomic neuropathy and 5.8% had severe cardiac autonomic neuropathy. Early cardiac autonomic neuropathy was observed in 34.6% of patients while 17.3% had no signs of cardiac autonomic neuropathy. The mean age of patients with cardiac autonomic neuropathy was 54.44 ± 10.90 years and the mean duration of diabetes mellitus from diagnosis was 5.36 ± 6.78 years. The probability of developing cardiac autonomic neuropathy increased with increasing age and hypertensive participants were more likely develop cardiac autonomic neuropathy (ѵ = 5.82, p = .001).
In conclusion, cardiac autonomic neuropathy was present in a significant proportion of adult patients with diabetes mellitus at Levy Mwanawasa University Teaching Hospital, reflecting the increased morbidity encountered by this population. In order to improve patient quality of life and reduce disease burden, screening for cardiac autonomic neuropathy should be implemented using cardiovascular autonomic reflex tests which are relatively simple, safe and affordable
Paul Goma: (r)evoluţia modelului
No full textThis paragraph examines the impact of Creangă’ narrative modelon Paul Goma’s prose. The relationship between the character and the author, the narrative figures, the stylistic dominants of the story „Amintiri din copilărie” by Ion Creangă and the novel „Din calidor”by Paul Goma are analysed. It examines the dialogical poetics of the novel, the dialectical relations of the bivoc word, the hybrid construction, plurilingvism, the instinctive genius sense of the language, the intrinsec elements of the narrative model in the line of the Creangă-Sadoveanu tradition.Costin, Iraida. Paul Goma: (r)evoluţia modelului / I. Costin // Tradiţie şi inovare în cercetarea ştiinţifică, Ediţia a 8-a: Materialele Colloquia Professorum din 12 oct. 2018. – Bălţi : US "Alecu Russo", 2019. – P. 36-43. – ISBN 978-9975-50-235
Haemodynamic changes and peripheral vascular characteristics associated with pathophysiological alterations in Preeclampsia patients at the University Teaching Hospital, Lusaka, Zambia
No full textBackground: The circadian blood pressure changes in pregnancy are poorly documented though the severity of hypertensive disorders especially in pregnancy is said to be better detected by 24hour blood pressure monitoring. The contribution of peripheral vascular variations to these alterations is yet to be elicited. The association of these changes to the renal pathological dysfunction is also not fully understood.Materials and method: Ambulatory blood pressure measurements and kidney function tests (i.e. creatinine, protein, sodium and uric acid) were done in patients admitted to UTH for hypertension in second and third trimesters of pregnancy. The Complior was used to determine the pulse waveform, pulse wave velocity (PWV) and augmentation index (Aix) as surrogate parameters for peripheral vascular compliance.Results: Twenty-six (26) women, between 22-42 years old and 24-36 gestational weeks, participated in this study. The majority of our population were either non- or reverse dippers (91.6%). The type A pulse waveform was dominant in all three groups indicating endothelial dysfunction. Dippers had a higher creatinine concentration in both urine and serum and uric acid in serum than non-dippers (7.051mmol/24hrs; 108.703ìmol/L;0.507mmol/L; respectively p<0.0001). The observed association of diurnal variations inhemodynamic parameters and dipping status indicates significant vascular pathology that may herald these individuals' increased risk of cardiovascular complications. The dominance of the type A pulse waveform in this population is indicative of significant endothelial dysfunction.Conclusion: The association seen between elevated blood pressure readings and proteinuria indicates a possible common pathophysiological process that leads to increased porosity at the glomeruli.
Keywords: Diurnal blood pressures, preeclampsia, arterial stiffness, pulse wave velocit
Paul Goma: (r)evoluţia modelului [Articol]
No full textThis paragraph examines the impact of Creangă’ narrative modelon Paul Goma’s prose. The relationship between the character and the author, the narrative figures, the stylistic dominants of the story „Amintiri din copilărie” by Ion Creangă and the novel „Din calidor”by Paul Goma are analysed. It examines the dialogical poetics of the novel, the dialectical relations of the bivoc word, the hybrid construction, plurilingvism, the instinctive genius sense of the language, the intrinsec elements of the narrative model in the line of the Creangă-Sadoveanu tradition
Enhancing Harmonization to Ensure Alignment of Partners, Implementation and Priorities for Provision of Quality Primary Healthcare to Communities in Rural Zambia
No full textGoma 1994: Notes from the Field
No full text This article reflects on the varied and complex dynamics faced by humanitarian agencies working in the Goma area during a six-week period from mid-July 1994, shortly after the exodus of an estimated 850,000 refugees fleeing Rwanda who settled in the vicinity of Goma town in eastern Zaire, until the end of August 1994, which marked the period when the emergency phase of the humanitarian action in support of this refugee population began to stabilize. It considers three main dynamics, which were salient at the time: (1) the speed and size of the emergency; (2) the political environment inside the camps; (3) the traumas affecting the humanitarian environment. It covers the period when the author was assigned to support the emergency response to the crisis, and so combines personal reflections with reviews of some of the academic critique of the response by the international community. The article identifies the action as being critical to the evolution of international humanitarian response over the following two decades and concludes with a reflection on some of the lessons learned. </jats:p
Developing Tools for Needs Assessment for Children in Sub-Saharan Africa: The validation and Application of the PaedsQ4 and NEC Tools in the Zambian Paediatric Population
No full textAccess to Palliative Care Services: A Qualitative Study of Experiences of Children and Families Attending University Teaching Hospital in Lusaka
No full textATSA synthesis : Zambia chapter
No full textPre-publication copyWhile waiting for anti-tobacco legislation, some new efforts to enforce the existing laws are in progress. Most existing legislation is vague and weak, and requires re-development. There is a growing movement sponsored through the African Tobacco Situational Analyses (ATSA) initiative to enforce the smoke-free laws in Lusaka, which has received widespread public support including from high-level officials and the media. Zambia has signed and ratified the Framework Convention on Tobacco Control (FCTC), and has the political will in several key sectors to take on new tobacco control challenges
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