Journal of Medical Science and Technology

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.