Assessment of serum Zinc, Copper and Selenium in non-symptomatic Sickle-Cell Anaemia patients at the University Teaching Hospital, Lusaka, Zambia

Background: Zinc, copper and selenium are known important trace elements playing a vital role as cofactors of enzymes such as superoxide dismutase and glutathione peroxide. They form part of the first line antioxidants enzymes in red blood cells and plasma. The study aimed at determining the serum levels of zinc, copper and selenium in asymptomatic sickle-cell anaemia patients. Methods: This was a case control study conducted from the specialist Haematology and Oncology Clinic 4 at the University Teaching Hospital, Lusaka, Zambia. 5mls of whole blood was collected from 46 sickle-cell anaemia patients and 46 healthy controls from Out-Patient Department after consent. Using Atomic Absorption Spectrometry, serum levels of zinc, copper and selenium was determined. Independent t-test was used to compare the means and a binary logistic regression for the likelihood of developing a sickling crisis, using SPSS version 20.Results: The mean serum levels of zinc in patients were lower 86.92±20.46mg/L against 91.33±43.23mg/L; p<0.028 of controls. Copper mean levels were 149.85±54.82mg/L against 134.32±54.16mg/L; p<0.191 of controls. Selenium mean levels were 0.100±0.041mg/L against 0.081±0.032mg/L; p<0.380 in patients compared to controls. The odds of developing one sickling crises in the past year given the levels of zinc, copper and selenium was [B = -.340, zinc Exp(B) =1.011, copper Exp(B) = 1.008, selenium Exp(B) = .000, DF = 1].Conclusion: Zinc is reduced in sickle-cell anaemia patients. The probability of developing a sickling crisis is lower in patients with higher serum levels of zinc and copper by 1.1% and 0.8% respectively.

Effects of Steganotaenia Araliacae Root Extract on Contractile Function of Isolated Rat Ileum

Background: Various parts of a small tree, Steganotaenia araliacaeare used as medicine in local traditional settings in Zambia to initiate and augment parturition although very little is documented about its physiological and pharmacological effects. Steganotaenia araliacaecold extract has been observed to cause contractions of uterus in rats but its effect on non-uterine muscle is unclear. The aim of this study was to establish the contractile effect of Steganotaenia araliacaecold extract on isolated rat ileum smooth muscle.Method: Animals were sacrificed by cervical dislocation. Abdominal incisions were made to expose and dissect three ileum segments from each rat. The ileum segments were immediately transferred and mounted in the organ bath containing Tyrode solution. The contractile effects of acetylcholine (a reference agonist) and Steganotaenia araliacaecold extract on ileum segments were investigated starting with the least effective doses, thereafter doubling the doses until maximal tissue response was observed. Antagonists that include atropine, indomethacin, mepyramine, ondansetron and nifedipine in the presence and absence of Steganotaenia araliacaecold extract were also investigated to establish the mechanism of actionResults: Steganotaenia araliacaecold extract increased the contractile force of isolated rat ileum in a dose-response manner but had no significant effects on the frequency of the spontaneous contractions. Pre-treating the tissue with atropine, indomethacin, mepyramine or ondansetron did not inhibit the contractile force of Steganotaenia araliacaecold extract, while pre-treating the tissue with nifedipine inhibited its contractile force by 100% (p<0.05)Conclusion: The cold root extract of Steganotaenia araliacae induced contractions on isolated rat ileum smooth muscle in a dose response manner by probable activation of calcium channels. It is possible that SAEᶜif used in high doses may cause severe abdominal cramps an effect that needs to be noted as it is being used in parturition.

Trends of Anticholinergics and Antipsychotics Prescribing at Chainama Hills College Hospital, Lusaka-Zambia

Introduction:Antipsychotics are the main pharmacological treatment for psychosis. Anticholinergic drugs are sometimes prescribed with antipsychotics to treat or as prophylaxis for extrapyramidal side effects. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for extrapyramidal side effects to patients using antipsychotic drugs, but only when there is high risk or evidence of extrapyramidal side effects, as they can cause significant central and peripheral side effects which have a potential to affect treatment outcomes. The objective of the study was to assess the trends in the prescribing of antipsychotics and anticholinergics.Methods:A cross sectional study was conducted at Chainama Hills College Hospital in Zambia. An open-ended questionnaire was administered to 26 prescribers and 311 files for patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute for Health and Care Excellenceguidelines as a gold standard.Results:The antipsychotic distribution showed that 76.1% were prescribed a typical antipsychotic, 18.1% an atypical antipsychotic and 5.8% were on both typical and atypical antipsychotic. 28.2% of the patients on antipsychotics were prescribed anticholinergics (Trihexyphenidyl). 46.2% of the prescribing clinicians stated that they prescribe anticholinergics when a patient develops extrapyramidal side effects rather than concurrently with antipsychotics or when a high dose of antipsychotics has been prescribed.Conclusion:The trend in antipsychotic and anticholinergic prescribing in Lusaka-Zambia were not consistent with recommended guidelines. Majority of patients are on typical antipsychotics rather than atypical antipsychotics. Most patients were administered above optimal dose of antipsychotics though polypharmacy was solemnly practiced. Recommend that further studies to explore factors contributing to this trend are conducted.

A Crossover Design for Comparative Efficacy: A 28 Days-Randomized Clinical Trial of Cognitive Behavioral Therapy for Chronic Pain of Degenerative Conditions

In physiotherapy practice, a number of patients are known to suffer from chronic pain which results in reduced activity levels, interference in sleep, enjoyment of life, mood, and relations with others. Cognitive behavioral therapy, in this aspect will provide a holistic approach to the available treatment. Cognitive behavioral therapy has also been shown to target cognitive distortions such as pain catastrophizing, fear avoidance, overgeneralizing and others, all the while improving physical health, activity levels and quality of life. This study assessed the efficacy of cognitive behavioral therapy in the management of patients with chronic pain at the University Teaching Hospitals in Zambia. A randomized clinical trial utilizing a crossover design was utilized for the study. A random sample of 32 participants was used in the study after fulfilling the study criteria. Data was analyzed using ANCOVA with alpha of 0.05. The study recorded small effects in the reduction of pain intensity in both phase one and two. In phase one, it also recorded small effects in general work interference, sleep interference and enjoyment of life interference but recorded medium effects in normal work interference and mood interference. Phase two of the study recorded small effect size in reduction of general work interference, normal work interference, mood interference, relations with others interference, sleep interference and Enjoyment of Life interference. Cognitive behavioral therapy ensures the management of chronic pain addresses areas in which an individual is affected by pain and which in turn exacerbate the chronic pain. Physiotherapy provides a more holistic approach when used in conjunction with cognitive behavioral therapy.

Effect of Physical Activity on Pain and Functional Abilities in Patients with Rheumatoid Arthritis at an Autoimmune Clinic in Accra, Ghana

Background: Rheumatoid arthritis is a chronic systemic disease that affects the joints, connective tissues, tendons, and fibrous tissues. Despite early interventions, there is significant activity limitation due to moderate and high pain intensities in majority of affected individuals.The study set out to determine the effect of physical activity on pain and functional ability among rheumatoid arthritis patients.Methods:A pre-test, post-test quasi experimental study conducted among 60 rheumatoid arthritis patients (divided into intervention and control groups) were recruited from the Autoimmune clinic of Korle Bu Teaching Hospital for this quasi-experimental study. The international physical activity questionnaire, multidimensional health assessment questionnaire and numerical pain rating scale were used to obtain data. Pedometers and a stationary cycle were used for physical activity (intervention). Paired t-test was used to compare outcomes between the level of physical activity in relation to pain and functional ability and outcomes between pre and post functional abilities at a 0.05 level of significance.Results: Majority 24 (80.0%) of participants from the intervention group reported low, while 6 (20.0%) reported moderate physical activity levels. Thirteen (43.4%) and 10 (33.3%) participants from the intervention and control groups reported moderate pain on NPRS before intervention, which reduced to 7 (23.3%) in the intervention group, as compared to 9 (30%) in the control group. There was a significant difference (p<0.05) for functional ability among the intervention group before and after the intervention programmes but no significant differences (p>0.05) for most domains of functional ability except health concern (p = 0.034) among the control group.Conclusion: Patients with RA have a relatively low physical activity level but benefit significantly from a moderate intensity aerobic exercises such as cycling and walking by improving pain levels, functional ability and general health.Clinicians should promote and encourage patients with RA to engage in physical and recreational activities.

HIVPrEP, Associated Risk Behaviour and Practices Among University Students;A Case of Nkrumah University

Background: The use of Pre-exposure prophylaxis to prevent HIV infections has become widespread, so are concerns that PrEP leads to risky behaviour that can results into infections. While it is standard protocol for the healthcare personnel to conduct routine HIV screenings, no standardized procedure for educating people exists. PrEP gives an opportunity for adolescents and young adults to access a prevention option that respects their particularities and vulnerabilities.The objective of the study was to assess the Knowledge, Attitudes and Practices of students towards PrEP and if it is associated health risk behavior Methods: A cross sectional quantitative research design was used to determine the knowledge, attitudes and practices of students towards PrEP and its’ associated risk behaviour using a self-administered questionnaire. The data was analyzed using a computer Soft-Ware-Statistical Package for Social Sciences.The sample size was 367 students of Nkrumah University student in Central Province Results: There is an existing gap in comprehensively knowing and understanding PrEP and guidelines. About 36.8% of the respondents indicates they had poor knowledge on PrEP further, the results indicate 61% of the respondents had general negative attitude towards PrEP.Conclusion: More effort by government and stakeholders is needed to educate and inform students on PrEP. There is need to establish ways of dispelling myths and improve the perception towards PrEP thus reducing stigmatization.

Prevalence of HIVInfection inPatients with TBSpine Admitted to the University Teaching Hospital, Lusaka, Zambia

Background: Extra pulmonary TB is an AIDS defining opportunistic infection in patients with HIV infection. TB spine is the commonest form of bone TB and whose clinical picture depends on the site and the presence of HIV infectionMethod: This was a retrospective review of patient records (n=101) over a two-year period (2008-2010) at the University Teaching Hospital, Lusaka, Zambia. Clinical and radiological features, laboratory data were analyzed Results: One hundred and one patients (57 male: 44 female) had TB spine in this period. The mean age was 37.22 ± 14.29 years. The main presenting complaint was backache in 71(70.3%) patients and the mean duration of symptoms was 2.68 ± 1.23 months. The Gibbus was present in 77 (76.24%) of the patients while neurological deficit was identified in 32 (31.6%) patients. The lumbar spine the most affected in 64(63.4%) patients. The mean ESR was determined to be 59.43 ± 32.23 mm/hour. The prevalence rate of HIV infection in the patients with TB spine was 24.8 %. The average CD4 count was found to be 262± 121.3 cells/μl.Conclusion: The prevalence rate of HIV infection (24.8%) is higher than that obtaining in the Zambian general population (13.7%) but lower than the general prevalence of HIV infection in patients with TB (68%).

Effects of Aerobic Exercise on Fasting Blood Glucose and Blood Pressure Levels of Diabetic-Hypertensive Clients at a Diabetes Clinicin Accra, Ghana

Background: Hypertension and diabetes are associated with an increased risk of cardiovascular diseases. Effective interventions are therefore relevant in reducing the morbidity and mortality associated with hypertension and diabetes. We set out to determine the effect of aerobic exercise on type-2 diabetic-hypertensive clients at a diabetes clinic in Accra.Method: Twenty-one participants were recruited from the National Diabetes Management and Research Center in Korle-Bu in Accra.Participants undertook 30 minutes of aerobic exercise comprising, warm up, ergonomic cycling and cool down, three times a week for a period of eight weeks. Fasting blood glucose and blood pressure levels were measured and changes with respect to exercise were analysed. The mixed model ANOVA was used to test for the differences in the weekly blood pressure and blood glucose levels while the paired t-test was used to compare the baseline and final readings of blood pressure and blood glucose levels. Pearson’s correlation test was used to determine the relationship between age and change in blood pressure and blood glucose levels after eight weeks of exercise.Results: Mean systolic blood pressure reduced from 142mmHg to 135mmHg while the mean diastolic blood pressure also reduced from 89mmHg to 84mmHg post exercises. The baseline and eighth week post exercise average blood glucose level were 8.0 mmol/L and 5.2 mmol/L respectively. There were significant differences in baseline and week eight systolic (p = 0.0017), and diastolic (p = 0.006) blood pressure as well as blood glucose (p=0.0027) levels. There was also a significant positive correlation between age and change in blood glucose level (p = 0.036).Conclusion: Aerobic exercise reduces the fasting blood glucose level and blood pressure in type-2 diabetic-hypertensives. Diabetic-hypertensives should therefore be encouraged to participate in aerobic exercises.

Reasons Women Request for Termination of Pregnancy at a Rural Hospital in Zambia; A Cross Sectional Study at Mansa General Hospital, Mansa District, Zambia

Background: Globally, it is estimated that unsafe abortions contribute to 8% of maternal deaths. Sub-Saharan Africa has the highest regional estimate of abortion related mortality at 90 per 100, 000 live births. In Zambia the reasons for the termination of pregnancy is enshrined in the Termination of Pregnancy Act of 1972 which states that an abortion may legally take place if the continuation of the pregnancy involves a risk to the pregnant woman's life, physical or mental health; a risk to the physical or mental health of any existing children; or if there is a substantial risk that the child will be born with birth abnormalities. The Termination of Pregnancy Act further specifies that the pregnant woman's actual or reasonably foreseeable environment may be considered. In this study, we set out to assess the reasons women give when requesting for a termination of pregnancy at Mansa General Hospital of Luapula province of Zambia.Methods: We carried out a descriptive cross-sectional study of 66 women’s medical records who requested termination of pregnancy in 2018 January and 2019 December. The records were retrieved from Mansa General Hospital in Luapula province, Zambia. The case notes and consent forms were used to determine the characteristics and the reasons women requested a termination of pregnancy.Results: Out of the 66 retrieved records of women who requested a termination of pregnancy from the registry of the hospital, 58 had their request of a termination of pregnancy successfully done and 8 never went further to terminate their pregnancy while 1 of the 66 records had the information missing on whether their request was met or not for a termination of pregnancy.Mean age was 25 (SD 7.3) with a minimum of 13 and maximum of 44. Average gestation age was 7.5 weeks (SD 2.8). Fifty percent (50%) of women had one living child and 32.7% were married. Forty one percent (41%) were in their first pregnancy. Sixty eight percent (68.2%) of patients had secondary education whereas 27.3% had a tertiary education. Median parity was 2. The commonest reason for termination was the need to advance in education (27.5%). The second was poor economic home situation (20.3%). The third was medical reasons(13.0%).Conclusion: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Zambia

Burden of Silicosis in the South African Mining Sector and its Effects on Migrant Labor from Neighboring Countries

Background: Among other minerals, South Africa has an abundance of asbestos and crystalline silica. Due to dust particles from these minerals, exposure causes respiratory diseases in particular silicosis. Most researches on silicosis have largely been of a cross sectional nature with no or limited long-term patterns reported.Objective:This review aims to analyse silicosis patterns in the gold, diamond and platinum workers over a period of 30 years, and to investigate possible causative factors for mining sector employees leading to them developing respiratory diseases associated with silica.Methods:This review article is a product of analysis of published reports and studies from South Africa published in the last decades. The EliScholar digital platform and Google scholar were used, and the focus publications were those that related to “silicosis”, “migrant workers”, silica dust” and autopsy. The review also allowed articles that were generalized, not merely focusing on one mineral. Autopsy reports obtained from the National Institute for Occupational Health database on miners were used for three sub-studies that are the subject of this review.Conclusion:The silicosis trends in miners at autopsy show a clear system failure by the mining sector in controlling and managing occupational respiratory diseases