Journal of Medical Science and Technology

192 - 195

Authors: Muhannad Fudeil Lababneh*, Osama Mahmoud Alshiyyab, Ethar Najeeb Ibrahim, Tariq Aref Alshoufi, Mohammad Abdelatif Adaileh

Objective of the study was to evaluate the postoperative pain relief effect between intraoperative intravenous administration of a mixture of paracetamol – tramadol and tramadol only in patients undergoing elective partial reconstructive osiculoplasty. This prospective, randomized and double blind study included 101 patients, of both sexes, aged 32-41 years, classed I-II by the American society of anesthesiologists and scheduled for elective partial reconstructive osiculoplasty under balanced general laryngeal mask airway anesthesia at Prince Ali hospital, Karak, Jordan during the period April 2011-Feb2015. Participants were divided into two groups. Group I patients (n=49) received intraoperative intravenous mixture of paracetamol (10mg/kg) and tramadol (1mg/kg). Group II patients (n=52) received intraoperative intravenous tramadol (1mg/kg) only. Postoperative visual analog score was used to compare the pain relief effect between the two regimens. 22 patients in group I were administered rescue analgesics and 12 patients in group II were administered rescue analgesics (P<0.05). The highest pain score was registered at 25 minutes in group II and at 45 minutes in group I. The combination of paracetamol with tramadol increased the pain relief effect more than tramadol only in patients assigned for partial reconstructive osiculoplasty.

201 - 206

Authors: Tumelo Muyenga*, L. T. M. Muungo, L. Prashar, A.G. Bwalya

Objective of this study was to determine the effect Kigelia africana fruit extract has on blood glucose levels of diabetes mice and its phytochemical profile. Mice were induced with diabetes using Alloxan monohydrate 90mg/kg. Blood glucose was checked before induction and 72 hours after induction to confirm diabetes. Treatment involved using oral administration of Kigelia fruit extract 1000mg/kg, Kigelia fruit extract 500mg/kg, Glibenclamide 0.25 mg/kg, Kigelia fruit extract 500mg/kg and Glibenclamide 0.25mg/kg and Normal Saline. The results showed a greater reduction in blood glucose of mice after treatment with Kigelia extract 1000mg/kg compared to Kigelia 500mg/kg [(5.3 +/- 0.5mmol/l) vs (6.3+/- 0.6mmol/l), (p= 0.005)]. Further, Glibenclamide 0.25mg/kg showed less reduction in blood glucose than Kigelia 1000mg/kg [(7.4+/-0.9mmol/l) vs (5.3 +/- 0.5), (p= 0.00)]. The mean blood glucose levels were lower in mice that received Kigelia extract than those that received both Kigelia extract and Glibenclamide [(5.3 +/- 0.5mmol/l) vs (7.8 +/- 0.6 mmol/l), (p=0.00)]. The fruit extract tested positive for Tannins, Saponins, Flavanoids, Alkaloids, Glycosides and Steroids. Findings of this study indicate that Kigelia africana fruit extract causes reduction in blood glucose of diabetes induced mice and gives better results when used alone than in concomitant use with Glibenclamide. The study also indicates that the fruit extract has alkaloids, saponins, steroids, glycosides, tannins and flavonoids.

211 - 215

Authors: Panji Nkhoma, Trevor Kaile, Geoffrey Kwenda, Clemence Marimo, Lydia Korolova, Hamakwa Mantina

Activated coagulation is a well-known feature of HIV infection and evidence has accrued indicating that it contributes to an increased risk of death. The aim of the study was to determine whether D-dimer levels, as a marker of predisposition to thrombosis, were higher in HIV positive individuals than in HIV negative individuals. A prospective cross-sectional study was carried out at the University Teaching Hospital in Lusaka, Zambia. D-dimers, triglycerides and cholesterol were assessed in HIV positive on ART, HIV positive ART- naïve and HIV negative control participants. Our results showed that HIV ART naïve participants had higher D-dimer concentrations (794.71 ± 318.07 ng/ml) than their counterparts on ART (514.39 ± 187.19 ng/ml) and the HIV negative control participants (375.08 ± 165.95 ng/ml) p =0.004 and p = 0.001 respectively. Triglyceride levels correlated to D-dimer levels in HIV positive ART naïve participants with statistical significance (r = 0.332; p < 0.020). This study showed that the levels of D-dimers were higher in HIV positive ART naïve individuals. This in part explains why they may be more at risk of thrombosis and cardiovascular associated complications which contribute to a high mortality rate in this group of individuals.

223 - 227

Authors: K. Sunil Naik, S.vijaya, Baswaraj Munge3

Chronic Renal Failure – End Stage Renal Disease is a multisystem disorder and affects all the systems in the body. 50 consecutive patients attending nephrology department of King George hospital with CRF were studied. All the patients CRF or those patients who attended the predialysis clinic were recruited. The patients were judged infection with helicobacter pylori if the urease slide test was positive or histopathological examinations showing helicobacter pylori bacilli. Out the total 23 helicobacter pylori positive patients only 18 patients 78% were culture positive. ESRD gastric colonization of helicobacter pylori is not more frequent than usual. Helicobacter pylori correlate positively with duodenal ulcer, gastric erosions. We recommend helicobacter pylori treatment before renal transplantation only in those patients with endoscopic duodenal ulcer or erosions but not as a routine. Helicobacter pylori colonization in duodenal ulcer patients with chronic renal failure is high when compared to non-ulcer chronic renal failure. Prevalence of helicobacter pylori is similar in chronic renal failure patients with duodenal ulcer to control group of duodenal ulcer patients. Helicobacter pylori prevalence in non ulcer dyspeptic chronic renal failure patients is higher than Non-ulcer dyspeptic controls.

85 – 91

Authors: Mumbula EM, Kwenda G, Samutela MT, et.al,

Klebsiella pneumoniae is one of the major causes of blood stream infections in neonatal intensive care units. Treatment has been a challenge due to the development of multidrug resistant strains, which are mainly attributed to the ability of the organism to produce extended spectrum β-lactamases that confer resistance to second and third generation cephalosporins. This laboratory-based cross-sectional study was aimed at determining the extent of extended spectrum β-lactamase production among invasive K. pneumoniae isolates from blood culture specimens at the University Teaching Hospital in Lusaka. The production of the extended spectrum β-lactamases was detected using the combination disc method, and by detecting genes encoding extended spectrum β-lactamases using Polymerase Chain Reaction. The drug resistance profile was determined using the Kirby-Bauer disc diffusion method against tetracycline, chloramphenicol, amikacin, gentamicin, co-trimoxazole, ciprofloxacin, cefotaxime, ceftazidime, cefpodoxime and imipenem. All the 45 isolates were found to be ESBL producers, and out of these 33/45 (73%) were found to have detectable ESBL-encoding genes: BlaSHV (27/45, 60%) and BlaTEM (6/45, 13%). No BlaCTX-Mgene was detected. Antimicrobial susceptibility testing revealed a high frequency of antimicrobial resistance: cefotaxime (100%), ceftazidime (100%), cefpodoxime (100%), co-trimoxazole (100%), tetracycline (100%),gentamycin (97.8%) and chloramphenicol (97.8%), and ciprofloxacin (95.6%). The antimicrobial resistance profile indicated that all the isolates were multidrug resistant, with each being resistant to at least 5 antibiotics. However, all the isolates were susceptible to amikacin andimipenem. In conclusion, there is high prevalence extended spectrum β-lactamases producing invasive K. pneumoniae isolates, which are also multidrug resistant, in the intensive care unit at the University Teaching Hospital. It is, therefore, recommended that all K. pneumoniae isolates should be screened for production of extended spectrum β-lactamases, and that infection control measures should be instituted at the University Teaching Hospital to curtail this problem.

97 - 103

Authors: Chabala F, Sijumbila G, Mweemba A, Kwangu M, Mpanga K, Banda N, Nyirendra S.

The main objective was to compare the Creatinine Clearance (CLcr) in HIV/AIDS patients on treatment with Tenofovir (TDF) based regimen to those on non- TDF- based regimen (Stavudine (D4T) and Zidovudine (AZT) after 1 year of initiation of therapy. An analytical cross- sectional designed was applied to data on files of 275 HIV/AIDS patients on TDF and 274 HIV/AIDS patients on either D4T or AZT making a total of 549 files. The median age of participants in the study group was 29 years (Q1:19 years, Q3: 35 years) while the median age of participants on D4T or AZT was 20 years (Q1:17 years, Q3: 30 year). CLcr was calculated at baseline and at 1 year of therapy using the Cockcroft- Gault formula from the Serum Creatinine (SCr), weight, age and gender of the patients. There was no significant difference between themedian baseline CLcr in the study group and control group and both were in the normal CLcr range according to Kidney Disease Outcome Quality Initiative (K/ DOQI) criteria; 99.39 mL/min verses 104.58 mL/min, P= 0.0574. It was also found that more patients on TDF developed abnormal creatinine clearance at 1 year from normal baseline kidney function compared to those on either D4T or AZT; 51 vs. 8. In logistics regression it was found that treatment with TDF increased the odds of developing abnormal kidney function to 8.77 times compared to AZT or D4T; P<0.001. Gender was not associated with increased odds of abnormal CLcr while with every unit increase in age, the odds of increased by 1.07, P= 0.001. In conclusion, treatment with TDF increased the odds of developing abnormal CLcr at 1 year of treatment from having normal CLcr at baseline and increase in age was associated with developing abnormal CLcr in treatment with TDF.

108 - 116

Authors: Monte IP, Buccheri S, Leggio S.

Aim of study was to identify echocardiographic parameters related to the development of future adverse events (AEs) in asymptomatic thalassemic patients (TM). A total of 74 TM patients (TM group) and 22 healthy subjects (HS group) were included in the study. All subjects underwent standard echocardiography with Tissue Doppler Imaging (TDI). The follow up was for 974 ± 275 days. When compared to HS, TM showed a significant increase of LV Mass index (LVMi), diastolic (LVEDV) and systolic (LVESV) volume (p=0.001, p=0.001 and p=0.023, respectively). TDI analysis identified a significant impairment of S’, E’ and A’ wave mean values (p<0.001, p<0.001 and p=0.002 respectively). Left atrial volume index and the E/E’ ratio were significantly increased in TM (p<0.001). LV ejection fraction was preserved. At follow up, 10 AEs were observed in TM: one death from cardiac cause, 6 patients developing heart failure, 3 new detected supra-ventricular arrhythmias. In TM, ROC curve analysis identified LVEDV>122 ml, LVESV >46 ml, LVMi >82.1 g/m2, E/A ratio>2.09, S’ wave<6.2 cm/sec, E’ wave<10 cm/sec, A’ wave<5 cm/sec and E/E’ ratio >7.82 as cut off-values differentiating TM patients with AEs. On multivariate logistic regression analysis, the E/E’ ratio (Exp (B) = 1.623, p=0.038) and the A’ velocity (Exp (B)=0.509, p=0.044) were independent predictors of AEs at follow up. The TDI derived parameters are useful for the prognostic stratification of asymptomatic TM and easy to use. Early identification of subclinical myocardial dysfunction based on these parameters could be useful for the optimization of therapeutic strategies and correct risk stratification.

125 – 132.

Authors: Sk Masenga SK, Kaile T, Kantenga T.

Lipoprotein(a) (Lp(a)) is a highly atherogenic independent risk marker for Cardiovascular disease (CVD). Current studies show that Highly Active antiretroviral Therapy (HAART) raises Lp(a) levels in HIV patients, thereby increasing their risk for CVD. However, data on Lp(a) levels in HIV positive patients on HAART in Zambia is limited. This study was conducted to provide Lp(a) distribution, prevalence of high Lp(a) and the factors associated with high Lp(a) levels in HIV patients on HAART. This cross sectional study was conducted between December 2014 and February 2015 at Livingstone General Hospital laboratory were routine fasting serum samples were collected and sent to the University Teaching Hospital Biochemistry laboratory for Lp(a) determination on Beckman coulter AU480 analyzer. Demographic and clinical data from patient files such as age, gender, ART combination and duration on ART were collected. Data was analyzed using STATA v.12 and Statistical Package for Social Sciences (SPSS) v.17. Sample size was 143 comprising of 57 (39.9%) males and 86(60.1) (%) females who had been on HAART for one to ten years. The study participant’s age ranged from 18-45 years. Cut off value denoting high Lp(a) concentration used in this study was ≥ 30mg/dL. Lp(a) concentration was normally distributed in the study population with mean 24.17mg/dL ±12.47mg/dL. Prevalence of high Lp(a) was 31.5% . Lp(a) was significantly higher with increasing age (p=0.009) and longer duration on HAART (P<0.001) irrespective of specific ART combination (p=0.086), however, those on AZT+3TC+NVP were 9.02 (AOR) (95%CI [1.41,57.54]) times more likely to have high Lp(a) levels compared to the group receiving TDF+FTC+EFV (p=0.020). The prevalence of high Lp(a) in HIV positive patients on HAART at Livingstone General hospital was high. Age, duration on HAART and AZT+3TC+NVP combination were significant predictors of high Lp(a) levels.

139 – 144.

Authors: Silpa S, Rao NM

The emergence and spread of multidrug resistant bacterial pathogens have substantially threatened the current antibacterial therapy, warranting the search for other alternatives. New antibacterial treatments are urgently needed. India is one of the twelve mega biodiversity centers having more than 45,000 plant species. A vast ethnobotanical lore exists in India from ancient time which can be of real use in the formulation of effective antimicrobials. Herbal world is continuously explored for natural therapeutics. In this paper a discussion is made on antimicrobial properties of plants. Evaluation of antibacterial properties of Vallaris solanacea was done. Anti bacterial activity of methanolic extracts of Vallaris solanacea was screened by agar disc diffusion method. The evaluated plant extract was found to exert a range of in vitro growth inhibitory action against the tested bacterial species, namely gram positive bacteria (Staphylococcus aureus) and gram negative bacteria (Escherichia coli). Plant extract displayed a potential antibacterial activity with MIC 100.0 μg/ml. To understand the mechanism of antimicrobial action, inhibition analysis of plant extract with para chloro mercury benzoate showed it was a cysteine protease.

148 – 151.

Authors: Kumar DA, Priya VS, Jaiprabhu J, Swaroopa R

Diabetes mellitus is associated with alterations in the metabolism of zinc (Zn) and magnesium (Mg). Direct associations of these two trace elements with Diabetes mellitus have been observed by many researchers. The aim of the present study was to estimate the serum levels of these trace elements in patients with type 2 diabetes. The study population consists of total ninety participants, out of whom 45 subjects were type 2 diabetic patients and 45 were healthy age matched controls. All the participants were in the age group of 40– 55 years. Blood samples were collected for the estimation of Fasting glucose, serum magnesium and zinc. The present study showed that mean serum zinc level was significantly low in diabetics as compared to control subjects. Our study recommends supplementation of with Zn and Mg may have beneficial role in Diabetes Mellitus as diabetic patients have lower serum magnesium and zinc levels when compared to healthy individuals.

161 – 177

Authors: Venyo AKG, Venyo LKG, Ahmed K

Tuberculosis of the breast is uncommon globally and its diagnosis may not be straightforward. The disease may present as breast lump, abscess or sinus and it may sometimes mimic breast cancer. A history of previous or recent tuberculosis is helpful with regard to suspicion of the diagnosis. Radiological investigations including chest X-ray, mammography, ultrasound scan of the breast, computed tomography scan and magnetic resonance imaging scan are useful tools in the investigation of the disease. The diagnosis can be achieved by demonstration of AFB in the breast tissue by Ziehl-Neilson stain or culture but not in all cases. Incorporation of PCR can aid in the confirmation of the diagnosis early. The disease is curable with anti-tubercular drugs, and surgery may rarely be required. The disease can be encountered in all countries globally. Confirmation of the diagnosis may be obtained by the use of Ziehl Neilson stain demonstration of Acid fast bacillus or culture of biopsy or aspirate specimen from the breast lesion or by means of PCR technique. It is curable with anti-tubercular therapy.

1 -2

Authors: Dr N Mallikarjuna Rao PhD

Swine flu has made its mark in Hyderabad. It is spreading in its favorable winter season throughout the Telugu speaking states of India from the common capital. So it’s time to know more about this disease and protect our self from this infection. A brief description of swine flu, its spread and preventive measures has been explained in this article for the benefit of nursing staff, lab technicians and other health care professionals.

19 – 25.

Authors: Samutela MT, Mwansa JCL, Kalonda A, et.,al.

Staphylococcus aureus is implicated in nosocomial infections worldwide and is associated with a variety of infections such as endocarditis, food poisoning, toxic shock syndrome, septicaemia, skin and soft tissue infections, and bone infections. The emergence and spread of multi-drug resistant strains of S. aureus, particularly methicillin-resistant strains, is worrisome as they are resistant to many antibiotics. However, there is sparse information on the burden of methicillin-resistant Staphylococcus aureus in Zambia. Knowledge of antimicrobial susceptibility patterns of bacterial pathogens is crucial for optimal treatment of patients. It is also important for monitoring the spread of resistant organisms in hospitals and communities. The objective of this study was to identify and determine the antimicrobial susceptibility patterns of methicillin-resistant Staphylococcus aureus at the University Teaching Hospital in Lusaka, Zambia. A total of 95 stored isolates of suspected methicillin-resistant Staphylococcus aureus from pus and blood specimens collected from June 2009 to December 2012 at the University Teaching Hospital were analysed. Conventional microbiological methods and Clinical Laboratory Standards Institute criteria were used to identify and determine the antimicrobial susceptibility of isolates. Of the 95 S. aureus isolates, 43% were identified as methicillin-resistant Staphylococcus aureus strains. These methicillin-resistant Staphylococcus aureus strains were resistant to trimethoprim/sulfamethoxazole (100%), ciprofloxacin (95%), penicillin (95%), erythromycin (79%), tetracycline (76%) and gentamicin (67%). Multi-drug resistance to a combination of, four, five, six and seven antibiotics was observed in 17.5%, 27.5%, 35%, and 17.5% of the methicillin resistant Staphylococcus aureus isolates, respectively. The prevalence of multi-drug resistant methicillin resistant Staphylococcus aureus at the University Teaching Hospital was found to be high. Regular surveillance for multi-drug infections is recommended for infection control and to guide treatment.

30 – 35.

Authors: Mushabati F, Goma FM, Lwiindi L, Siulapwa NJ, Siziya S.

Central arterial stiffness is a strong and independent predictor of cardiovascular events and mortality including hypertension in any given population. A few studies have found that being black could be associated with elevated arterial stiffness thereby accounting for the high prevalence of hypertension in them. The present study sought to determine and compare central arterial stiffness using Carotid femoral PWV (cfPWV) in a population of Zambian normotensive (NT) participants and hypertensive (HT) participants (both treated hypertensives (HTC) and untreated hypertensives (HTN)) between 30 – 65 years of age. CF PWV was measured in 146 participants. A Complior® Analyse device (Version 1.9 Beta 2013; ALAM-Medical, France) was used. Superficial pulses were accessed noninvasively over the carotid– femoral segment. The cfPWV values in HTN participants (N=23) were significantly higher than in NT (N=64) participants (11.4±4.2 vs 9.1±3.2, p=0.009). In HTC participants (N=59), their cfPWV values (10.4±5.6) tended to approach those in HTN participants, with no statistical differences between them (p > 0.500). Furthermore, the mean cfPWV found in NT participants was considerably higher than any found in previous studies. Carotid femoral PWV did not show significant age – related increase in all three blood pressure categories (r2 < 0.03, p > 0.100). These findings show that central elastic arteries of HT participants are stiffer and thus less compliant than those in NT participants adding to their burden of hypertension. Regrettably, HTC participants showed poor BP control inferring from their considerably high cfPWV values.

40 – 45

Authors: Lwiindi L, Goma F, Chongo K, Prashar L, Mushabati F.

The bark root of Steganotaenia araliacea Hochst (Umbelliferae) nicknamed “herbal pitocin” is used by traditional circle in Zambia to induce labour in pregnant women. This work was aimed at investigating the contractile stimulatory effects of the aqueous extracts of Steganotaenia araliacea (SAEª) on isolated smooth muscle preparations of the rat uterus to explain its reported local use. Objective of the study was to determine the physiological effect of SAEª root extract (nicknamed “herbal Pitocin’’) on pregnant and non-pregnant uterine muscle. This work examined the effect of the aqueous extract of SAEª extract on rat uterus pre-treated with 1 mg/kg stilboesterol for 24 h and also on the pregnant rat uterus. The effects of reference agonists like oxytocin (OT) and Acetylcholine (Ach) were used and also antagonists like atropine (AT), indomethacin (Indo) and Salbutamol (SBM) on the uterine contractile effect of the extract were investigated. In vitro studies of SAEª on uterine tissue showed contractile activity which was dose dependant similar to OT and Ach while pre-treating the tissue with atropine, indomethacin or Salbutamol before administering the extract showed the inhibitory effects of the drug Salbutamol on the activity of the extract. The inhibition of contractile effect of the crude aqueous extract of Steganotaenia araliacea shown by Salbutamol (p < 0.05) suggests the probable stimulation of the Oxytocin-like receptors of the uterus by the extract. These physiological finding justify the traditional use of the plant for its uterotonic properties.

55 – 57

Authors: Pravinkumar P, Pillai S, Michael M et. al.,

Pharmacological analysis of medicinal plants remains a challenging issue for analytical chemists as medicinal plants are a complicated system of mixtures. Many highly sophisticated separation techniques, for example, high performance liquid chromatography (HPLC), gas chromatography (GC) and mass spectrometry (MS) are amongst the most popular methods of choice used for quality control of raw material and finished herbal product. Comparatively, the application of, Fourier Transform Infra Red (FT-IR) spectroscopy in herbal research is limited. The present study was carried out to characterize the bioactive constituents present in the novel antiobesity Polyherbal formulation (PHF) using FT-IR spectroscopy. An aqueous extract of PHF consisting of the following plants Commiphora mukul (Stocks) Hook, Garcinia gummi-gutta(L.) Roxb, Plantago ovata Forrsk was prepared and supplied by Lanson Biotech, Chennai, subjected to FT-IR analysis. The results showed the detection of bands of various bio molecules, which has a variety of pharmacological effects on the living system.

62 – 68

Authors: Anthony Kodzo-Grey Venyo

Malakoplakia of the testis / epididymis is uncommon therefore most clinicians globally would be unfamiliar with the disease. Malakoplakia is an extremely rare chronic inflammatory disease which usually affects the genitourinary tract and it is often associated with Escherichia coli infection. Malakoplakia characterized by the observation of Von Hansemann cells and intracytoplasmic inclusion bodies called “Michaelis-Gutmann Bodies (M-G bodies).” The testes are affected in 12% of cases of malakoplakia and isolated malakoplakia of the epididymis is even rarer. To the knowledge of the author, less than 50 cases of malakoplakia of the testis and less than 15 cases of malakoplakia of the epididymis have been reported so far world-wide. Malakoplakia of the testis / epididymis may present with pain in the testicular area, fever, chills and or a hemi-scrotal mass. Malakoplakia of testis / epididymis is usually seen in middle aged men and they tend to appear clinically as epididymo-orchitis or testicular enlargement with fibrous consistency and some soft areas. Ultrasound scan findings of the testis are non-specific revealing hypo-echogenic or hyper-echogenicity with increased vascularity on Doppler scanning. A number of cases of malakoplakia of the testis and epididymis are associated with immunosuppression, renal transplantation and diabetes. Treatment of malakoplakia includes medical and surgical treatment. The quinolones and trimethoprim-sulfamethoxazole have been most commonly used. Orchidectomy has been the only way to differentiate malakoplakia from other malignant and infective processes. If a patient with malakoplakia of testis is immunosuppressed then a period of withdrawal may perhaps be beneficial to speed up the recovery process. With the knowledge that malakoplakia of the testis is more common in middle aged men and the fact that testicular tumours are uncommon in the middle aged group perhaps ultrasound guided biopsy of a hypo-echoic or hyper-echogenic testicular lesion with increased vascularity could be undertaken to establish the diagnosis if there is evidence of coliform urinary tract infection and a clinical diagnosis of epididymoorchitis has been made but the lesion has not resolved. In that case perhaps prolonged antibiotic treatment with quinolones may help the lesion to resolve and thus avoiding orchidectomy. Malakoplakia involving the testis and or epididymis is an uncommon chronic inflammatory condition which clinicians should consider in the differential diagnosis of testicular swellings. The disease tends to be associated with gram negative infections especially coliform infections.