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A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
(2020) Ngulube, A.; Ntoto, C.O.M.; Matsika, D.; Ndebele, W.; Dube, N.S.; Gapu, P.
INTRODUCTION: Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. PRESENTATION OF CASE: A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. DISCUSSION: Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully under stood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. CONCLUSION: Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
A case report of complete appendiceal duplication on the normal site of a single caecum: A new variant?
(Elsevier, 2020) Ngulube, A.; Ntoto, C.O.M.; Ndebele, W.; Matsika, D.; Dube, N.S.; Gapu, P.
Abstract Introduction Duplicated appendix is an uncommon entity, typically discovered as an incidental finding during surgery for appendicitis or other abdominal pathologies. It may be associated with other congenital malformations. We report a case of a male neonate incidentally discovered to have an unrecognized variant of duplicated appendix during a laparotomy plus diversion colostomy for imperforate anus at 4 days of age. Presentation of case A baby delivered at home from an unbooked pregnancy at term, was referred from a primary care clinic to a specialist referral hospital, with a fever and suspected neonatal sepsis on day 1 of life. The patient had not passed meconium and physical examination revealed an imperforate anus. After initiating treatment for sepsis, the patient underwent a laparotomy where a situs inversus totalis and complete appendiceal duplication was found, with both appendices on the normal site of a single caecum. The appendices were left in situ and a diversion colostomy was performed. The patient did well following surgery and was discharged on postoperative day 10 to await definitive surgery. Discussion Appendiceal malformations have been reported either in isolation or in association with other congenital anomalies. Duplicated appendix occurs rarely and the pathogenesis is not fully understood. This case adds more evidence that the classification of appendiceal abnormalities should continue evolving as newer types are described. Conclusion Surgeons operating on patients with congenital anomalies must exercise extreme vigilance to identify and document other rare pathologies that may later pose challenges thus avoid morbidity, mortality and potential medicolegal pitfalls.
A mathematical model for the prediction of the prevalence of allergies in Zimbabwe
(World Allergy Organization Journal, 2021-05-21) Mushayi, C.; Nyabadza, F.; Chigidi, E.; Mataramvura, H.; Pfavayi, L.; Rusakaniko, S.; Sibanda, E.N.
Background The prevalence of allergies has been observed to be increasing in the past years in Zimbabwe. It is thus important to consider the long term prevalence of allergies. Our interest is in investigating the trends of allergies in the next 2 decades. Method We formulate a deterministic model with 6 compartments to predict the prevalence of allergies in Zimbabwe. The human population is divided into 4 distinct epidemiological, classes based on their exposure to 2 allergen groups (food and inhalants), represented by 2 compartments. The model is used to predict the prevalence of allergen sensitization. The number of human allergen groups in each compartment are tracked through a system of differential equations. Model parameters were obtained by fitting observed data to the model. Graphical solutions of the model were developed using Matlab and Excel. Results The rate of sensitisation to food allergen sources is found to be lower than the rate of sensitisation to inhalant allergens. The rate at which individuals develop tolerance to food allergen sources is found to be almost twice the rate of developing tolerance to inhalant allergies. The equilibrium solutions (the long-term states of the populations) of the model are found to be non-zero implying that there will never be an allergy-free population. Our results also show that the prevalence of food allergy is likely to increase in the next 2 decades while inhalant allergy prevalence is expected to decrease. Conclusion Our long-term solutions show endemicity in allergies in Zimbabwe. So, allergy will be endemic in the Zimbabwean population; hence there is a need for allergy care and management facilities to be increased. These results are critical in policy development and planning around allergies in the near future.
Accessibility to and utilization of maternal, neonatal and child health (MNCH) services by rural women: A case study of health centres in Mutare district based on the 3 delays model
(Academic Journals, 2022) Ndhlovu-Ncube, N.P.; Mavondo, G.A.; Moyo, O.; Chikuse F. F.; Ndhlovu, T.C.; Mavondo, J.; Mkhwanazi, B. N.; Musarurwa, C.; Chaibva, C.N.
High maternal, neonatal and child mortality rate constituting about 70% of the population in Zimbabwe. Zimbabwean rural women have faced challenges in accessing and utilizing Maternal, Neonatal and Child Health (MNCH) services. Rural areas in Zimbabwe have had high prevalence of home deliveries and pregnancy related complications associated with lack of access to and utilization of MNCH services, resulting in high maternal, stillbirths, new-born, neonatal and infant mortality rates. Access to and utilisation of MNCH services and facilities by rural based pregnant women has been limited by several issues that have been explored and assessed in the Primary Health Care clinics. However, the 3 delays (seek, access and receive health service) effects on the factors affecting health care and outcomes remain largely unclear in rural settings. Qualitative and quantitative methods research was conducted in Mutare district, Manicaland Province, Zimbabwe. Data collection tools including interviews questionnaires and focus group discussion guides were used to show how the three delays affected health service access in the district. GraphPad InStat Software and Statistical Package for Social Science were used for data analysis. Religious and cultural beliefs contributed to patient delays in seeking healthcare. With long distances and lack of transport attributed to Delays 1 and 2 with, drug unavailability, up-to date equipment and delay causing Delay 3. The patient, the provider and health systems were critical in accessibility, utilization and linkages of MNCH with other health services being crucial for achieving 4th and 5th Millennium Development Goals the targets.
Adaptation and implementation of local maternity dashboards in a Zimbabwean hospital to drive clinical improvement
(World Health Organisation, 2013-11-27) Crofts, J.; Moyo, J.; Ndebele, W.; Mhlanga, Samson; Draycott, T.; Sibanda, T.
Problem:The Commission on Information and Accountability for Women’s and Children’s Health of the World Health Organization (WHO) reported that national health outcome data were often of questionable quality and “not timely enough for practical use by health planners and administrators”. Delayed reporting of poor-quality data limits the ability of front-line staff to identify problems rapidly and make improvements. Approach: Clinical “dashboards” based on locally available data offer a way of providing accurate and timely information. A dashboard is a simple computerized tool that presents a health facility’s clinical data graphically using a traffic-light coding system to alert front-line staff about changes in the frequency of clinical outcomes. It provides rapid feedback on local outcomes in an accessible form and enables problems to be detected early. Until now, dashboards have been used only in high-resource settings. Local setting: An overview maternity dashboard and a maternal mortality dashboard were designed for, and introduced at, a public hospital in Zimbabwe. A midwife at the hospital was trained to collect and input data monthly. Relevant changes: Implementation of the maternity dashboards was feasible and 28 months of clinical outcome data were summarized using common computer software. Presentation of these data to staff led to the rapid identification of adverse trends in outcomes and to suggestions for actions to improve health-care quality. Lessons learnt: Implementation of maternity dashboards was feasible in a low-resource setting and resulted in actions that improved health-care quality locally. Active participation of hospital management and midwifery staff was crucial to their success.
Allergy education and training for physicians
(World Allergy Organization Journal, 2021-09-08) Barker, S.; Daniels, L.; Chang, Y.S.; Chikovani, T.; DunnGalvin, A.; Gerdts, J.D.; Van Wijk, R.G.; Gibbs, T.; Gonzalez, R.V.V.; Guzman-Avilan, R.I.; Hanna, H.
The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of “allergy” as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence to manage mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required of physicians working with allergic patients and provides recommendations to promote harmonization of allergy training and practice worldwide.
Antimalarial Phytochemicals: Delineation of the Triterpene Asiatic Acid Malarial Anti-Disease and Pathophysiological Remedial Activities - Part I
(Scholarena, 2018-05) Mavondo, Greanious Alfred; Kasvosve, Ishmael
Malaria is a composite condition of the Plasmodium parasite infection and accompanying pathologies. Parasite induced red blood cell perturbations and immunological response to infection drive various organ-specific syndromes accounting for a huge percentage of deaths amongst children <5 years and pregnant women. The multi-factorial pathophysiology includes acute renal failure, hypoglycaemia, severe malaria anaemia, acute respiratory distress syndrome/ acute lung injury and cerebral malaria as some of the prominent presentations of the disease. Current malaria treatment has largely remained “anti-parasite” or “anti-infection” necessitating discovery of “anti-disease” drugs that will ameliorate immunological aberrations, inflammation and metabolic disturbances which are ultimately the cause of high morbidity and mortality. Asiatic acid, a phytochemical, has well known curative properties on other conditions which share disease manifestations with malaria. However, the influence of Asiatic acid on malaria has not yet been reported. This review unravels the different facets of Asiatic acid and their possible remedial effects on molecular and biological changes introduced by the disease with emphasis on how this relates to glucose metabolism, acute renal failure, severe malaria anaemia, acute respiratory distress syndrome/ acute lung injury and cerebral malaria.
Asiatic acid-pectin hydrogel matrix patch transdermal delivery system influences parasitaemia suppression and inflammation reduction in P. berghei murine malaria infected Sprague-Dawley rats
(Elsevier, 2016-10-12) Mavondo, Greanious Alfred Alfrd; Tagumirwa, Musabayane Cephas
Objective: To report the influence of transdermal delivery of asiatic acid (AA) in Plasmodium berghei-infected Sprague Dawley rats on physicochemical changes, %parasitaemia and associated pathophysiology. Methods: A topical once-off AA (5, 10, and 20 mg/kg)- or chloroquine (CHQ)-pectin patch was applied on the shaven dorsal neck region of Plasmodium berghei-infected Sprague Dawley rats (90- 120 g) on day 7 after infection. Eating and drinking habits, weight changes, malaria effects and %parasitaemia were compared among animal groups over 21 d. Results: AA-pectin patch application preserved food and water intake together with %weight gain. All animals developed stable parasitaemia (15%-20%) by day 7. AA doses suppressed parasitaemia significantly. AA 5 mg/kg patch was most effective. AA and CHQ displayed bimodal time-spaced peaks. CHQ patch had a longer time course to clear parasitaemia. Conclusions: AA influences bio-physicochemical changes and parasitaemia suppression in dose dependent manner. In comparison by dose administered, AA has much better efficacy than CHQ. AA may be a useful antimalarial. AA and CHQ displays bimodal peaks suggesting possible synergism if used in combination therapy
Association of academic stress, anxiety and depression with social-demographic among medical students.
(Redfame Publishing, 2018) Dube, A.; Chamisa, J.A.; Gundani, P.M.; Bako, C.; Lunga, M.C.
Background: Medical education programmes aim at producing wholesome of competent and skilled graduates, research have shown that students experience stress which impacts on their health, academic performance and social functioning. This paper aims to determine the extent of academic stress, depression and anxiety among medical undergraduates and to explore the correlation between academic stressors, psychological stress and socio-demographic background among first year medical students at National University of Science and Technology. Method: This descriptive cross-sectional study was undertaken by first-year medical students in 2016 at NUST Division of Social Medical Sciences. A validated and standardised survey Depression Anxiety Stress Scale (DASS 42) questionnaire was used. Data was analysed by SPSS version 21.0. Results: Nineteen first-year midwifery students participated in the study. Males were 63.1% while females were 38.8%. Seventy-three per cent of the participants experienced stress during the programme, of which forty-nine percent were females. Female students showed severe stress of 6±1.15 as compared to their male counterparts who scored extremely severe stress of 3.81±1.53. Academic, health-related and psychosocial problems were the chief sources of stress. Conclusion: Stress impacts negatively on undergraduate students. Midwifery students need guidance, mentorship and educational integration support to identify and monitor their own well-being. These measures should promote a balance in selection of positive strategies to overcome stress, managing workload and time effectively during study period.
Bwakura-Dangarembizi, M., Szubert, A.J., Mumbiro, V., Kityo, C.M., Lugemwa, A., Doerholt, K., Chabala, C., Nyathi, M., Nduna, B., Burger, D. and Shakeshaft, C.
(medRxiv, 2024-04-15) Bwakura-Dangarembizi, M.; Szubert, A.J.; Mumbiro, V.; Kityo, C.M.; Lugemwa, A.; Doerholt, K.; Chabala, C.; Nyathi, M.; Nduna, B; Burger, D.; Shakeshaft, C.
Background Children living with HIV requiring second-line antiretroviral therapy (ART) have limited options, an unmet need considering children require life-long ART. Methods Children from Uganda, Zambia, Zimbabwe were randomised to one of four second-line anchor drugs: dolutegravir(DTG), ritonavir-boosted darunavir(DRV/r), atazanavir(ATV/r), or lopinavir(LPV/r) in the factorial CHAPAS-4 trial (second randomisation to tenofovir alafenamide fumarate(TAF) or standard-of-care(SOC) backbone, reported elsewhere). Dosing followed WHO weight-bands. The primary endpoint was viral load(VL) <400copies/mL at week-96, analysed using logistic regression, hypothesising that DTG and DRV/r would be superior (threshold p=0.03) to LPV/r and ATV/r arms combined and ATV/r would be non-inferior to LPV/r(12% margin). Secondary endpoints included immunology and safety. Analyses were intention-to-treat. Results 919 children, median(IQR) age 10(8-13) years, 54% male, baseline VL 17,573(5549,55700) copies/mL, CD4 669(413, 971) cells/mm, weight-for-age Z-score -1.6(-2.4,-0.9), had spent median(IQR) 5.6(3.3,7.8) years on first-line ART. At week-96, DTG was superior (by 9.7%(95% CI 4.8%, 14.5%); p<0.0001) and DRV/r showed a trend to superiority(by 5.6%(0.3%, 11.0%); p=0.04) compared to LPV/r and ATV/r arms combined. ATV/r was non-inferior to LPV/r(+3.4%(-3.4%,+10.2%); p=0.33). CD4 counts increased with no differences between arms. Toxicity was lowest with DTG. All arms except LPV/r showed age-appropriate weight/height gains at week-96. DTG was not associated with excess absolute weight-gain(<1kg) vs. DRV/r or ATZ/r, irrespective of backbone randomisation. Conclusions DTG-based regimens are safe and cost-effective for second-line ART. DRV/r and ATV/r are also good options. Fixed-dose combinations of DTG, DRV/r or ATV/r with nucleoside/nucleotide-reverse-transcriptase-inhibitors(NRTIs) would increase access to robust, essential second-line options for children.(ISRCTN22964075)
Chlorpyrifos- and dichorfos-induced oxidative and neurogenic damage elicits neuro-cognitive deficits and increases anxiety-like behaviors in wild-type rats
(Creative commons, 2018-10-16) Imam, Aminu; Sulaiman, Nafeesah Abdulkareem; Oyewole, Aboyeji Lukuman; Chengetanai, Samson; Williams, Victoria; Ajibola, Musa Iyiola; Folarin, Royhaan Olamide; Muhammad, Asma’u Shehu; Shittu, Asma’u Shehu; Ajao, Salihu Moyosore
The mechanization of agricultural activities has led to indiscriminate deposition of toxic xenobiotics, including organophosphates in the biomes, and this has led to intoxication characterized with deleterious oxidative and neuronal changes. This study investigated the consequences of oxidative and neurogenic disruptions that follow exposure to two organophosphates, chlorpyrifos (CPF) and dichlorvos (DDVP) on neuro-cognitive performance and anxiety-like behaviors in rats Thirty-two adult male Wistar rats (150 – 170g) were randomly divided into 4 groups, orally exposed to normal saline (NS), DDVP (8.8mg/kg), CPF (14.9mg/kg) and DDVP+CPF for 14 consecutive days. On day 10 of exposures, anxiety-like behaviors andamygdala dependent fear learning were assessed using Open Field and Elevated Plus Maze paradigms respectively, while spatial working memory was assessed on day 14 in the Morris water maze paradigm, following 3 training trials each on days 11, 12 and 13. On day 15, the rats were euthanized, and their brains excised, hippocampus and amygdala removed, 5 of which were homogenized and centrifuged to analyze nitric oxide (NO) metabolites, total reactive oxygen species (ROS), and acetylcholinesterase (AChE) activity, and the other three processed for histology 43 (cresyl violet stain) and proliferative marker (Ki67 immunohistochemistry). Marked (p≤0.05) loss in 44 body weight, AChE depletion, and overproduction of both NO and ROS were observed after repeated exposure to individual and combined doses of CPF and DDVP. Insults from DDVP exposure appeared more severe owing to the observed greater losses in the body weights of exposed rats. There was also a significant (p≤0.05) effect on the cognitive behaviors recorded from the exposed rats, and these deficits were related to the oxidative damage and neurogenic cell loss in the hippocampus and the amygdala of the exposed rats. Taken together, these results provided an Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 16 October 2018 doi:10.20944/preprints201810.0359.v1 © 2018 by the author(s). Distributed under a Creative Commons CC BY license.2 of 16 insight that oxidative and neurogenic damages are central to the severity of neuro-cognitive dysfunction and increased anxiety-like behaviors that follow organophosphate poisoning
The contributions of muscarinic receptors and changes in plasma aldosterone levels to the anti-hypertensive effect of Tulbaghia violacea
(Biomed Central, 2013) Raji, Ismaila A.; Mugabo, Pierre; Obikeze, Kenechukwu
Background: Tulbaghia violacea Harv. (Alliaceae) is used to treat various ailments, including hypertension (HTN) in South Africa. This study aims to evaluate the contributions of muscarinic receptors and changes in plasma aldosterone levels to its anti-hypertensive effect. Methods: In the acute experiments, methanol leaf extracts (MLE) of T. violacea (30–120 mg/kg), muscarine (0.16-10 μg/kg), and atropine (0.02 - 20.48 mg/kg), and/or the vehicle (dimethylsulfoxide (DMSO) and normal saline (NS))were respectively and randomly administered intravenously in a group of spontaneously hypertensive (SHR) weighing 300 to 350 g and aged less than 5 months. Subsequently, T. violacea (60 mg/kg) or muscarine (2.5 μg/kg) was infused into eight SHRs, 20 min after atropine (5.12 mg/kg) pre-treatment. In the chronic (21 days) experiments, the SHRs were randomly divided into three groups, and given the vehicle (0.2 ml/day of DMSO and NS), T. violacea (60 mg/kg/day) and captopril (10 mg/kg/day) respectively into the peritoneum, to investigate their effects on blood pressure (BP), heart rate (HR), and plasma aldosterone levels. Systolic BP and HR were measured using tail-cuff plethysmography during the intervention. BP and HR were measured via a pressure transducer connecting the femoral artery and the Powerlab at the end of each intervention in the acute experiment; and on day 22 in the chronic experiment. Results: In the acute experiments, T. violacea, muscarine, and atropine significantly (p < 0.05) reduced BP dose-dependently. T. violacea and muscarine produced dose-dependent decreases in HR, while the effect of atropine on HR varied. After atropine pre-treatment, dose-dependent increases in BP and HR were observed with T. violacea; while the BP and HR effects of muscarine were nullified. In the chronic experiments, the T. violaceatreated and captropril-treated groups had signicantly lower levels of aldosterone in plasma when compared to vehicle-treated group. Compared to the vehicle-treated group, significant reduction in BP was only seen in the captopril-treated group; while no difference in HR was observed among the groups. Conclusion: The results obtained in this study suggest that stimulation of the muscarinic receptors and a reduction in plasma aldosterone levels contribute to the anti-hypertesive effect of T. violacea.
Determinants of eclampsia in women with severe preeclampsia at Mpilo Central Hospital, Bulawayo, Zimbabwe
(Elsevier, 2021-07-15) Ngwenya, S.; Jones, B.; Mwembe, D.; Nare, H.; Heazell, A.E
Objective: Globally, preeclampsia is a significant contributor to adverse maternal outcomes. Once women develop eclampsia, they face considerable risks especially in countries with limited resources to deal with such a life-threatening complication. This study was carried out to investigate determinants of eclampsia in pregnant mothers with severe preeclampsia. Study design. This institutional based study was completed at Mpilo Central Hospital, a quaternary referral unit from 1st January 2016 – 31st December 2018. In this study, pregnant women with severe preeclampsia/eclampsia were the study participants. The independent variables included socio-demographic and clinical characteristics, and maternal outcomes. Multivariable logistic regression analyses were used to determine independent association with p < 0.05 taken as statistically significant with 95% Confidence Interval (CI). Main outcome measure. Eclampsia. Results: Development of eclampsia was more frequent in women aged 14–19 years compared to women aged ≥ 35 years (adjusted odds ratio (AOR) 6.64, 95% CI 1.20–22.06, p = 0.02) and in primiparous women compared to women with parity ≥ 3 (AOR 2.76, 95% CI 1.48–5.15, p = 0.001). Eclampsia was more frequent in women with diastolic blood pressure of 131–150 mmHg (AOR 5.48, 95% CI 1.05–28.75, p = 0.04), and ≥ 150 mmHg (AOR 5.78, 95% CI 1.05–31.78, p = 0.04) compared with those with diastolic blood pressure of ≤ 110 mmHg. Symptoms of visual disturbances were also associated with eclampsia (AOR 2.13, 95% CI 1.08–4.18, p = 0.03). Conclusions: This study has identified independent determinants of eclampsia which can be used to identify which women should receive magnesium sulphate prophlyaxis or more intensive monitoring to prevent deterioration in maternal condition.
Determining the burden of fungal infections in Zimbabwe
(Springer Nature, 2021-06-24) Pfavayi, L.T.; Denning, D.W.; Baker, S.; Sibanda, E.N.; Mutapi, F.
Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and ‘at-risk’ populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.
Effects of aqueous leaf extract of Asystasia gangetica on the blood pressure and heart rate in male spontaneously hypertensive Wistar rats
(BioMed Central, 2013-09-26) Mugabo, Pierre; Raji, Ismaila A.
Background: Asystasia gangentica (A. gangetica) belongs to the family Acanthaceae. It is used to treat hypertension, rheumatism, asthma, diabetes mellitus, and as an anthelmintic in South Africa, India, Cameroun, Nigeria, and Kenya respectively. It has also been reported to inhibit the angiotensin I converting enzyme (ACE) in-vitro. Therefore, the aim of this study is to investigate the in-vivo effect of aqueous leaf extract (ALE) of A. gangetica on the blood pressure (BP) and heart rate (HR) in anaesthetized male spontaneously hypertensive rats (SHR); and to elucidate possible mechanism(s) by which it acts. Methods: The ALE of A. gangetica (10–400 mg/kg), angiotensin I human acetate salt hydrate (ANG I, 3.1–100 μg/kg) and angiotensin II human (ANG II, 3.1–50 μg/kg) were administered intravenously. The BP and HR were measured via a pressure transducer connecting the femoral artery to a Powerlab and a computer for recording. Results: A. gangetica significantly (p<0.05), and dose-dependently reduced the systolic, diastolic, and mean arterial BP. The significant (p<0.05) reductions in HR were not dose-dependent. Both ANG I and ANG II increased the BP dose-dependently. Co-infusion of A. gangetica (200 mg/kg) with either ANG I or ANG II significantly (p<0.05) suppressed the hypertensive effect of both ANG I and ANG II respectively, and was associated with reductions in HR. Conclusions: A. gangetica ALE reduced BP and HR in the SHR. The reduction in BP may be a result of actions of the ALE on the ACE, the ANG II receptors and the heart rate.
Effects of concurrent chloroquine and ethanol administration on the rat kidney morphology
(African Field Epidemiology Network, 2018-01-18) Abdulkadir, Abdurrahman; Mbajiorgu, Ejikeme. F; Nyirenda, Trust
The use of antimalarial chloroquine in malaria-endemic regions of Africa is rampant and it is not uncommon to find individuals taken the drug concurrent with alcohol. Effects of anti-malarial drug chloroquine (Chq) and ethanol (Et) combination on kidney volume and function using rat model was investigated. Methods: 32 adult male rats were randomly distributed into four groups of 8 rats each. Group C serve as control and received vehicle only, while Q is Chq treated only, E is Et treated and QE is Et and Chq treated. Chq was administered intraperitoneally at 1mg/100g body weight weekly and 6% Et in drinking water provided ad libitum. Urine volume was collected before the treatment began and after the treatment. After eight weeks, all animals were euthanized; kidneys were harvested and fixed in 10% neutral formalin. The fixed left kidneys were scanned with computed tomography and the scan slices were used to estimate 3-dimensional kidney volume on ImageJ. Results: Total kidney volume was none significantly increased in Q, E and QE treated compared to control groups (p = 0.5150). Also, microscopic analysis showed increased proximal tubule diameter (p = 0.1426) and epithelial hypertrophy (p = 0.2530) and significant urinary space shrinkage (p = 0.00001). The initial urine volume was not significantly different between the control and treated groups (p = 0.9864) however, following treatment urine volume was significantly reduced in QE rats group (p = 0.0029). Conclusion: The results suggest chloroquine and ethanol combination as potential cause of kidney injury through structural damage and function derangement
Factors leading to the late diagnosis and poor outcomes of breast cancer in Matabeleland South and the Bulawayo Metropolitan Provinces in Zimbabwe
(PLOS ONE, 2023-11-03) Magara, M.S.; Mungazi, S.G.; Gonde, P.; Nare, H.; Mwembe, D.; Madzikova, A.; Chagla, L.S.; Pereira, J.; McKirdy, M.J.; Narayanan, S.; Grimsey, L.
Introduction Breast cancer (BC) is the leading cause of female cancer deaths in Africa, and in Zimbabwe, >80% present with advanced disease. A Needs Project (NP) was carried out to determine the key factors responsible for delayed diagnosis and poor BC outcomes and to investigate possible solutions in 6 rural and urban districts of Matabeleland South and Bulawayo Metropolitan Provinces. Methods A mixed method approach was used to collect data in 2 phases. Phase 1: an exploration of key factors leading to poor BC outcomes with >50 professional stakeholders and patient representatives. Phase 2: (i) Quantitative arm; validated questionnaires recording breast cancer knowledge, demographic information and perceived barriers to care administered to women and their relatives (Group 1) and health professionals (HPs) (Group 2). (ii) Qualitative arm; 10 focus group discussions with medical specialists and interested lay representatives (Group 3). The Cochran sample size formulae technique was used to determine the quantitative sample size and data was aggregated and analysed using SPSS Version 23™. Purposive sampling for the qualitative study selected participants with an understanding of BC and the NP. Focus group discussions were recorded and a thematic analysis of the transcriptions was conducted using NVivo9™. Results Quantitative analysis of Group 1 data (n = 1107) confirmed that younger women (<30years) had the least knowledge of breast cancer (p<0.001). Just under half of all those surveyed regarded breast cancer as incurable. In Group 2 (n = 298) the largest group of health workers represented were general nurses and midwives (74.2%) in keeping with the structure of health provision in Zimbabwe. Analysis confirmed a strong association between age and awareness of BC incidence (p = 0.002) with respondents aged 30–39 years being both the largest group represented and the least knowledgeable, independent of speciality. Nearly all respondents (90%) supported decentralisation of appropriate breast surgical services to provincial and district hospitals backed up by specialist training. Thematic analysis of focus group discussions (Group 3) identified the following as important contributors to late BC diagnosis and poor outcomes: (i) presentation is delayed by poorly educated women and their families who fear BC and high treatment costs (ii) referral is delayed by health professionals with no access to training, skills or diagnostic equipment (iii), treatment is delayed by a disorganised, over-centralized patient pathway, and a lack of specialist care and inter-disciplinary communication. Conclusion This study confirms that the reasons for poor BC outcomes in Zimbabwe are complex and multi-factorial. All stakeholders support better user and provider education, diagnostic service reconfiguration, targeted funding, and specialist training.
Foreign body of the spleen from percutaneous entry
(Elsevier, 2019) Mungazi, S.G.; Ndebele, W.; Zimunhu, T.; Magara, M.; Mbuwayesango, B.; Muchuweti, D.; Muguti, E.G.; Gwini, G.; Gandanhamo, D.
Foreign body (FB) aspiration and ingestion are fairly common in children. Sharp foreign bodies may also enter the body by penetration. In penetrating foreign bodies, commonly skin and the gastrointestinal tract are the affected organs. An impacted foreign body in the spleen is rare. The diagnosis can be challenging without a history of penetration. Herein, we report a case of an infant with a sewing needle that accidentally punctured the spleen after penetrating through the skin of the subscapular area. A history of FB penetration and imaging were essential to confirm the diagnosis. The sewing needle was successfully removed laparoscopically.
Fungal allergic sensitisation in young rural Zimbabwean children: Gut mycobiome and seroreactivity characteristics
(Current Research in Microbial Sciences, 2021-11-12) Pfavayi, L.T.; Sibanda, E.N.; Baker, S.; Woolhouse, M., Mduluza, T. and Mutapi, F; Mduluza, T.; Mutapi, F.
Background The prevalence of allergic diseases has increased over the last few decades, with sensitisation to fungal allergens and gut microbiome dysbiosis implicated in this trend. The fungal community in the gut (mycobiome) has yet to be characterised and related to fungal allergic sensitisation. Thus, we characterised the gut mycobiome and related it to fungal sensitisation and seroreactivity among Zimbabwean children. We further determined the effect of host age, sex, Schistosoma haematobium infection and mycobiome composition on fungal sensitisation and seroreactivity. Methods Using shotgun metagenomic sequencing, we characterised the gut microbiome of stool samples of 116 preschool aged children (PSAC) (≤5 years old, 57(49.1%) male and 59 (50.9%) female). Sensitisation to common fungi in Zimbabwe was assessed using skin prick tests (SPTs). Allergen-specific IgM, IgA, IgG, IgE and IgG4 antibodies were quantified by ELISA. We analysed the relationship between fungal genera and SPT reactivity by ANOVA; fungal genera and IgE antibody reactivity by linear regression; variation in mycobiome abundance with host and environmental factors by PERMANOVA; SPT reactivity and host and environmental factors by logistic regression; seroreactivity and host and environmental factors by ANOVA. Results The mycobiome formed <1% of the sequenced gut microbiome and 228 fungal genera were identified. The most abundant genera detected were Protomyces, Taphrina, and Aspergillus. S.haematobium infection had a significant effect on fungal genera. Prevalence of SPT sensitisation to ≥1 fungal species was 96%, and individuals were frequently sensitised to Saccharomyces cerevisiae. Antibodies were detected in 100% of the population. There was no relationship between mycobiome abundance and IgE titres or IgE/IgG4 ratios for each fungal species; no significant differences between SPT reactivity and abundance of fungal species except for S. cerevisiae; and fungal seroreactivity did not significantly differ with age. There were some sex (m>f for, Epicoccum nigrum and Penicillium chrysogenum) and SPT reactivity –related differences in seroreactivity. Conclusion This is the first comprehensive characterisation of gut mycobiome and fungal allergic sensitisation of rural children in Zimbabwe. Although reported allergic disease is low there is a high percentage of sensitisation. Further studies with larger populations are required to understand the role of the mycobiome in allergic diseases.
Harmonizing allergy care–integrated care pathways and multidisciplinary approaches
(World Allergy Organization Journal, 2021-08-26) Daniels, L.; Barker, S.; Chang, Y.S.; Chikovani, T.; DunnGalvin, A.; Gerdts, J.D.; Van Wijk, R.G.; Gibbs, T.; Villarreal-Gonzalez, R.V.; Guzman-Avilan, R.I.; Hanna, H.
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.

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