Showing papers by "University of Zambia published in 1995"

The impact of human immunodeficiency virus on mortality of patients treated for tuberculosis in a cohort study in Zambia

Abstract: We have examined the impact of human immunodeficiency virus (HIV) on mortality of patients treated for tuberculosis in a prospective study in Lusaka, Zambia. Patients with sputum smear-positive, miliary, or meningeal tuberculosis were prescribed 2 months' daily streptomycin, thiacetazone, isoniazid, rifampicin, and pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. 239 patients (65 HIV-negative and 174 HIV-positive) were followed to 2 years from start of treatment. The crude mortality rate ratio for HIV-positive compared with HIV-negative patients over 2 years was 5.00 (95% confidence interval 2.30-10.86). Median survival for HIV-positive patients from the start of treatment was 22 months. At least 34% of HIV-positive patients for whom cause of death was known died from tuberculosis, three-quarters of these during the first month of treatment. Risk factors for death in HIV-positive patients included multi-site tuberculosis, history of prolonged diarrhoea or fever, oral thrush, splenomegaly, anergy to tuberculin, low weight, anaemia or lymphopenia, and poor compliance with regimens containing rifampicin and pyrazinamide. Tuberculosis, even treated, was a major cause of death in patients with HIV infection.

Childhood cancers in Zambia before and after the HIV epidemic.

Abstract: Human immunodeficiency virus (HIV) related cancers in children are not as common and as well described as in adults. An HIV epidemic has been prevalent in Zambia since 1983-1984. To study the effect of the epidemic on the epidemiology of cancers in children a retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia. All the histopathological records from 1980 to 1992 were reviewed and all cases of cancers in children less than 14 years of age were analysed. In order to define the effect of the HIV epidemic, the epidemiological features of various childhood cancers occurring before (during the years 1980-1982) and after (during the years 1990-1992) the onset of the HIV epidemic were compared. A significant increase in the occurrence of total childhood cancers was found. This is mostly due to a highly significant increase in the incidence of paediatric Kaposi's sarcoma (p = 0.000016), which is causally related to HIV infection, and a significant increase in the incidence of retinoblastoma (p = 0.02), which has an unknown relation to HIV infection. Though not yet statistically significant, there has also been a gradual and sustained increase in the incidence of non-Hodgkin's lymphoma, nasopharyngeal carcinoma, and rhabdomyosarcoma. There has been a significant reduction in the incidence of Burkitt's lymphoma. A prospective in depth epidemiological study of HIV related childhood cancers in Africa is urgently needed.

Influence of HIV epidemic on the incidence of Kaposi's sarcoma in Zambian children.

Abstract: Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (KS) is well documented in adults. However, very little information is available about KS in the pediatric age group. A retrospective study was undertaken at the University Teaching Hospital (UTH), Lusaka, Zambia, to define the incidence

Impact of immunodeficiency virus (HIV) on Fournier's gangrene: observations in Zambia.

Abstract: The results of a prospective study in the University Teaching Hospital Lusaka Zambia on the impact of human immunodeficiency virus (HIV) on the incidence and prognosis of Fourniers gangrene is presented; Zambia has been in the grip of an HIV epidemic since the early 1980s. A total of 10 patients with an average age of 32 years was observed during a 14-month period (March 1992-April 1993); 8 patients had associated HIV infection. A contributory factor to the development of Fourniers gangrene was also present in 7 patients of which 6 involved the urinary tract. All patients were managed by early surgical debridement under antibiotic cover. Two patients died only one of whom had associated HIV disease. This study has recorded a significant rise in the prevalence of Fourniers gangrene in Zambia since the advent of the HIV epidemic. It has also been documented that provided aggressive treatment along established lines is initiated without delay the coexisting HIV infection does not adversely affect the prognosis of Fourniers gangrene. (authors)

The impact of human immunodeficiency virus on response to treatment and recurrence rate in patients treated for tuberculosis: two-year follow-up of a cohort in Lusaka, Zambia.

Abstract: To examine the effect of HIV on response to treatment and recurrence rate in patients with tuberculosis (TB), we have followed 239 previously untreated, adult, TB patients in a prospective cohort study in Lusaka, Zambia. One hundred and seventy-four (73%) were HIV-1 antibody positive. Patients with sputum smear positive, miliary, or meningeal TB were prescribed 2 months daily streptomycin, thiacetazone, isoniazid, rifampicin, pyrazinamide followed by 6 months thiacetazone and isoniazid; others, 2 months streptomycin, thiacetazone and isoniazid followed by 10 months thiacetazone and isoniazid. Thirty-five per cent of HIV-positive (HIV+ve) and 9% of HIV-negative (HIV-ve) patients were known to have died before the scheduled end of treatment. Surviving HIV+ve patients showed weight gain and improvement in symptoms and laboratory and radiological findings similar to HIV-ve patients. The risk of cutaneous drug reaction was 17% (95% CI: 12-25%) in HIV+ve, and 4% (1-13%) in HIV-ve patients. Severe rashes were attributed to thiacetazone. Recurrence of active TB was examined among 64 HIV+ve and 37 HIV-ve patients who successfully completed treatment, with mean follow-up after the end of treatment of 13.5 and 16.8 months, respectively. The rate of recurrence was 22/100 person years (pyr) for HIV+ve patients and 6/100 pyr for HIV-ve patients, giving a recurrence rate ratio of 4.0 (95% CI 1.2-13.8, P = 0.03).

Bacterial infections: bone and joint tuberculosis

Abstract: In many countries of the world, there is now a dual epidemic of tuberculosis and HIV disease. HIV specifically eliminates the tissue macrophages and CD4 lymphocytes, the very cells that provide immunity against tuberculosis. Tuberculosis is one of the more virulent opportunistic infections and it therefore appears fairly early in HIV disease. For the same reasons, bone and joint tuberculosis is becoming much more common. The disturbances of the lymphocyte count, ESR and antigen skin tests associated with HIV, now often make tuberculosis difficult to distinguish from other inflammatory lesions. The only change in the pattern of disease that we have so far registered is an increased incidence of disease affecting the lumbar spine. HIV-positive patients respond poorly to chemotherapy and are subject to drug sensitivity reactions. Major surgery is fraught with infectious complications and should be avoided. Once Pott's paraplegia has developed, the demise of the HIV-positive patient is rapid.

Tuberculin sensitivity and HIV-1 status of patients attending a sexually transmitted diseases clinic in Lusaka, Zambia: a cross-sectional study

Abstract: A cross-sectional study to estimate the prevalence of latent tuberculosis (TB) in a group of Zambians at high risk of human immunodeficiency virus type 1 (HIV-1) infection and to examine the effect of HIV-1 infection on the tuberculin response was conducted in the University Teaching Hospital in Lusaka, Zambia during July to September 1990. Patients were selected from those presenting to the out-patient clinic for first referral with either sexually transmitted or skin disease. 268 adults were included in the study; 158 (59%; 95% confidence interval [CI] = 53-65%) were HIV-1 antibody positive. Of 82 HIV-1 negative participants who returned for Mantoux skin test reading, 51 (62%; 95% CI = 57-67%) had a positive test reaction (diameter > or = 10 mm) after receiving 2 units of RT-23 tuberculin. Of 106 HIV-1 positive participants who returned, only 32 (30%; 95% CI = 26-34%) had a diameter > or = 10 mm. Nine (28%) of the HIV-1 positive and Mantoux positive participants had large reactions > or = 30 mm, compared to 4 (8%) of the HIV-1 negative, Mantoux positive participants (P = 0.03). Results in the HIV-1 negative group indicated a prevalence of latent TB of 62% in this population. HIV-1 infection was associated with a much higher frequency of negative response to tuberculin and with a few large skin test responses. Thus, in populations where HIV seropositivity is high, Mantoux skin tests cannot be used to assess those with latent TB who might benefit from chemoprophylaxis.

Monoclonal antibodies against Haemophilus ducreyi lipooligosaccharide and their diagnostic usefulness.

Abstract: Monoclonal antibodies against the lipooligosaccharide ofHaemophilus ducreyi were produced. Two of them, MAHD6 and MAHD7, were found to be relatively, although not absolutely, specific and reacted with nearly all strains ofHaemophilus ducreyi tested: 59 of 60 and 60 of 60, respectively. The diagnostic usefulness of MAHD7 was assessed. Clinical specimens collected in Zambia from patients with genital ulcers were tested using indirect immunofluorescence (IF), enzyme immunoassay (EIA), the polymerase chain reaction (PCR) and bacterial culture. Compared with culture, IF had a sensitivity of 100 %; compared with PCR, sensitivity was 89 %. The corresponding figures for the EIA were 83 % and 74 %, respectively. The sensitivity of culture compared with PCR was 63 %. The results suggest that IF on genital smears using M AH D7 might be an excellent tool for the diagnosis of chancroid in high-prevalence populations. However, further evaluation of the specificity of this test is needed.

Viral infections: musculoskeletal infection in the human immunodeficiency virus (HIV) infected patient

Abstract: HIV disease has reached epidemic proportions in Africa over the last decade and is severely stretching the health services of the many poor countries of the region. Increased sepsis during fracture surgery and the late infection of implants impels us to rethink many standard methods of treatment. Musculoskeletal infections, including tropical pyomyositis and long bone haematogenous osteomyelitis, are now common manifestations of advanced HIV disease in adults. Despite their severe infections, such patients may survive for more than 5 years and certainly cannot be written off as terminally ill. Treatment is often prolonged and, in the case of osteomyelitis, may necessitate amputation. These patients now occupy many of the available orthopaedic beds.

Childhood tuberculosis and infection with the human immunodeficiency virus.

Abstract: TB in HIV-infected individuals is a major cause of morbidity and mortality in developing countries and poses enormous problems to the health services. Despite the availability of curative therapy, the incidence of TB in children and adults is increasing at an alarming rate and poses a grave threat to TB control programmes in developing countries. Prospective studies to define basic clinical, microbiological and epidemiological features of the resurgence of childhood TB in the light of the HIV epidemic are required.

Quality of care in sexually transmitted diseases in Zambia: patients' perspective.

Abstract: The aims of this study were to describe Zambian STD patients response to treatment, compliance with partner notification, and further to measure patients' satisfaction with the health care received The majority of 179 STD patients (92 men, 87 women) interviewed twice at an urban health centre were not satisfied with the care received Their response to treatment and compliance with partner notification were not satisfactory Thirteen patients had not been able to buy medicines, since they had no money One hundred and twenty-five patients had asked 134 sexual partners to come for treatment but only 60 percent of them had received treatment To get free medicines, to have privacy, to get injections instead of tablets, to be examined before treatment, and to be informed about the diagnosis were judged most important for good quality STD care Health workers must improve their communication and counselling skills to understand the needs of their patients, who are the ultimate evaluators of the quality of care

Urban schistosomiasis in Lusaka, Zambia: a preliminary study.

Abstract: A preliminary survey was conducted in Lusaka, Zambia to determine the extent of schistosomiasis transmission in the city. Stool and urine samples were collected from 240 children from seven schools selected to give a cross-sectional representation of the various socio-economic neighbourhoods of the city. In addition to the parasitological examination, students were questioned with respect to their knowledge of the disease and other epidemiological factors. In addition, water bodies near the schools were examined for the presence of snail hosts. Results of the survey suggest that schistosomiasis is actively transmitted within Greater Lusaka. An overall prevalence of 20.9% for S. haematobium was observed, but only one case of S. mansoni was detected. Prevalence rates for S. haematobium in individual schools ranged from 7.5 to 37.5%.

Variations in thickness of articular cartilage in the human sacroiliac joint

Abstract: Differences in articular cartilage thickness in the sacroiliac joint were investigated in different regions of the sacral and the iliac articular surfaces in the embalmed cadavers of five males and six females. The mean thickness of the sacral articular cartilage was greater than that of the iliac articular cartilage (P < 0.001) and the sacral articular cartilage of the female was thicker than that of the male (P < 0.02). Differences between thicknesses of the iliac articular cartilage in the male and female and in different regions of the sacral and iliac articular cartilages were found to be not significant. © 1995 WiIey-Liss, Inc.

Arnica montana (Mountain Arnica): In Vitro Culture and the Production of Sesquiterpene Lactones and Other Secondary Metabolites

Abstract: Arnica montana (mountain arnica) is a very old medicinal plant. The flower and flower heads are widely used in phytotherapy in numerous preparations. They have a broad spectrum of effects: bacteriostatic, fungistatic, antiinflammatory, antirheumatic, cardiotonic, and antihyperlipidemic (Willuhn 1991).

Observations on worm population dynamics in calves naturally infected with Schistosoma mattheei.

Abstract: The evolution of faecal egg output, worm burdens and tissue egg counts in young calves was monitored during the first year of natural exposure to Schistosoma mattheei infection on a Zambian farm. According to the duration of their stay on the farm, these calves were classified into 2 groups of 14 temporary tracers (TT calves) which were introduced on a 2-monthly basis for residential periods of 2 months, and 12 permanent tracers (PT calves) introduced either at the beginning of the experiment (Group A) or 2 months later (Group B) and gradually removed after residential periods of 2, 4, 6, 8, 10 and 12 months on the farm. Worm counts in the TT calves showed that infection occurred throughout the year on the farm and that levels of infection acquired during each period of 8 weeks correlated well with the respective infected snail densities observed at the main transmission site. Marked differences in worm population dynamics were recorded between the 2 groups of PT calves. In Group B animals which apparently were initially exposed to heavy transmission, according to the results from TT calves, much higher worm counts and greater susceptibility to reinfection were observed than in Group A animals initially exposed to lighter exposure. These results suggest that the development of resistance to natural infection with S. mattheei may depend on the initial exposure to the parasite. Low initial exposures may lead to resistance whereas high initial exposures may result in decreased immune responses resulting in susceptibility to infection.

Electrochemical properties of apatite and other minerals of Zambian phosphate ores in aqueous solution

Abstract: A microelectrophoresis technique was used to study the electrochemical properties of apatite, quartz and hornblende from Chilembwe phosphate ore;and apatite, calcite and magnetite from Kaluwe phosphate ore. The tests were conducted in distilled water and the water near the source of the phosphate ores under study.

Validation of schistosomiasis morbidity symptoms in schoolchildren of Siavonga, Lake Kariba, Zambia.

Abstract: (1995). Validation of schistosomiasis morbidity symptoms in schoolchildren of Siavonga, Lake Kariba, Zambia. Annals of Tropical Medicine & Parasitology: Vol. 89, No. 4, pp. 439-442.

Perspectives on Literacy, Gender and Change: A Case for Zambia.

Abstract: Using in-depth interviews, observations and discussions, and focusing on two sites (one rural and the other urban) in Zambia, the study highlights the outcomes of literacy training as perceived by the participants in basic and functional literacy programmes. The major findings are that literacy training has demonstrable results which affect changes in feelings, attitudes, cognition and economic well being of participants. It also shows that participants are affected by fears and a sense of insecurity in both private and public life which must be addressed in order to bring freedom to ‘illiterates’.

Low-temperature fracture toughness of a heat-treated mild steel

Abstract: Specimens from a 0.14 % C mild steel were austenitized at 1000 °C for 1 h and thereafter furnace-cooled or isothermally transformed at 700 °C for 0.5,2, and 8 h. The microconstituents present in the as-received material were ferrite and pearlite and their amounts did not substantially change even after heat treatment. The impact energy of the as-received and the furnace-cooled materials increased from 4 to 89 J and from 4 to 108 J, respectively, when the temperature was changed from - 196 to 23 °C. For these materials, the failure mode was by ductile fracture at 0 and 23 °C and by quasicleavage fracture at - 196 and - 40 °C. The fracture toughness did not show any significant change with isothermal transformation time at 700 °C. The failure mode of the isothermally transformed materials was always by quasicleavage fracture.