Background: This systematic review aimed to assess the quality of published economic evaluations of ultrasound-guided intra-articular injections for symptomatic management of osteoarthritis, explore their scope and diversity, and determine their cost-effectiveness. Methods: Relevant electronic databases were systematically searched for studies published from January 2009 to June 2019. Keyword searches and Boolean operators were used to retrieve relevant literature. The PICOTS framework was utilized to define key research questions and guide the literature search. Duplicate removal, title and abstract screening were conducted to exclude irrelevant articles. Data from each study were extracted using a standardized form and summarized in an Excel spreadsheet. The SIGN quality appraisal tool for economic evaluations was employed to assess the quality of each study. Results: The initial database search yielded 238 articles, with 35 duplicates removed. Following title and abstract screening, an additional 198 articles were excluded due to not meeting the inclusion criteria. Full-text manuscripts of the remaining 5 articles were reviewed. Based on the quality appraisal, 4 out of the 5 studies were excluded. One study was not a primary study, one was still ongoing, and two were not economic evaluations. Due to the limited number of included studies, no subgroups were identified. Conclusions: This study provides evidence that ultrasound-guided intra-articular injections significantly improve clinical outcomes and enhance cost-effectiveness in the management of osteoarthritic joints. However, the scarcity of relevant studies highlights the need for further research to strengthen this finding.
{"title":"A Systematic Review on the Cost-Effectiveness of Intra-Articular Injections for Pain Relief in Symptomatic Patients with Osteoarthritis","authors":"Alex Lwando, B. Chiluba","doi":"10.55320/mjz.50.2.421","DOIUrl":"https://doi.org/10.55320/mjz.50.2.421","url":null,"abstract":"Background: This systematic review aimed to assess the quality of published economic evaluations of ultrasound-guided intra-articular injections for symptomatic management of osteoarthritis, explore their scope and diversity, and determine their cost-effectiveness. Methods: Relevant electronic databases were systematically searched for studies published from January 2009 to June 2019. Keyword searches and Boolean operators were used to retrieve relevant literature. The PICOTS framework was utilized to define key research questions and guide the literature search. Duplicate removal, title and abstract screening were conducted to exclude irrelevant articles. Data from each study were extracted using a standardized form and summarized in an Excel spreadsheet. The SIGN quality appraisal tool for economic evaluations was employed to assess the quality of each study. Results: The initial database search yielded 238 articles, with 35 duplicates removed. Following title and abstract screening, an additional 198 articles were excluded due to not meeting the inclusion criteria. Full-text manuscripts of the remaining 5 articles were reviewed. Based on the quality appraisal, 4 out of the 5 studies were excluded. One study was not a primary study, one was still ongoing, and two were not economic evaluations. Due to the limited number of included studies, no subgroups were identified. Conclusions: This study provides evidence that ultrasound-guided intra-articular injections significantly improve clinical outcomes and enhance cost-effectiveness in the management of osteoarthritic joints. However, the scarcity of relevant studies highlights the need for further research to strengthen this finding.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":" 81","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139137666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Obese patients are increasingly being referred for medical imaging examinations across the world. Obese patients require a modified standard of care to compensate for challenges caused by both technical and psychological issues related to their weight and body habitus. There have been research studies conducted on this issue, but no systematic review has brought the findings of these studies together to inform training and practice. Aim: This study was aimed at synthesising primary studies on the challenges faced by radiographers and radiography students in imaging obese patients to guide the training and practice in Zambia. Methods: This qualitative systematic review was conducted using the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two databases (PubMed and ScienceDirect) were systematically searched to identify relevant literature. This was supplemented by other sources: radiography journals, grey literature, and cited references. Data from the included studies were assessed for quality, extracted, and synthesised using thematic analysis. Results: Five studies were identified and included in this review. Following data analysis, four themes related to challenges faced in imaging obese patients in general radiography emerged: difficulties in communicating without causing psychosocial distress, manual handling risks, limitation of the equipment, and difficulties in positioning and determining the exposure factors for diagnostic radiographic images. Conclusion: This review provides an in-depth understanding of the challenges faced by radiographers and radiography students in imaging obese patients. Strategies to enhance radiography training and practice have been identified to help educators and radiographers.
{"title":"Challenges of Imaging Obese Patients in General Radiography: A Qualitative Systematic Review to Guide the Training and Practice in Zambia","authors":"O. Bwanga, M. Bwalya","doi":"10.55320/mjz.50.1.350","DOIUrl":"https://doi.org/10.55320/mjz.50.1.350","url":null,"abstract":"Background: Obese patients are increasingly being referred for medical imaging examinations across the world. Obese patients require a modified standard of care to compensate for challenges caused by both technical and psychological issues related to their weight and body habitus. There have been research studies conducted on this issue, but no systematic review has brought the findings of these studies together to inform training and practice. \u0000 Aim: This study was aimed at synthesising primary studies on the challenges faced by radiographers and radiography students in imaging obese patients to guide the training and practice in Zambia. \u0000Methods: This qualitative systematic review was conducted using the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two databases (PubMed and ScienceDirect) were systematically searched to identify relevant literature. This was supplemented by other sources: radiography journals, grey literature, and cited references. Data from the included studies were assessed for quality, extracted, and synthesised using thematic analysis. \u0000Results: Five studies were identified and included in this review. Following data analysis, four themes related to challenges faced in imaging obese patients in general radiography emerged: difficulties in communicating without causing psychosocial distress, manual handling risks, limitation of the equipment, and difficulties in positioning and determining the exposure factors for diagnostic radiographic images. \u0000 Conclusion: This review provides an in-depth understanding of the challenges faced by radiographers and radiography students in imaging obese patients. Strategies to enhance radiography training and practice have been identified to help educators and radiographers.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"32 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction TB-LAM tests were introduced in the TB program in Zambia in 2019, to aid in diagnosis of TB. We carried out a study to determine the impact that TB lipoarabinomannan (LAM) test has had on case identification and notification at a tertiary hospital in a city with a high prevalence of HIV. We also compared sensitivity, specificity, positive predictive value and negative predictive of TB LAM tests and X-pert MTB RIF test in HIV positive and HIV negative patients. Method Retrospective analysis of the TB laboratory as well as the TB notification registers to determine the number of TB cases identified by TB LAM and Xpert MTB-RIF. We identified patients who had both TB LAM and X-pert MTB RIF tests to determine sensitivity, specificity, positive and negative predictive values of TB LAM and Xpert MTB RIF, using TB notification and commencement of anti-tuberculosis treatment as the gold standard for comparison. Results Between January 2019 and June 2022, there were a total number of 2353 notified cases of Tuberculosis. A total of 511 cases of Tuberculosis were identified on the basis of positive TB LAM. This accounted for 59% of all bacteriologically confirmed cases of TB. The sensitivity and specificity of TB LAM in diagnosis of TB in the study population was 55.8% and 91.4% respectively. Positive and Negative predictive values for TB LAM were 84.5% and 69.6% respectively. The sensitivity and specificity of Xpert MTB RIF in diagnosis of TB in the study population was 29.2% and 98.2% respectively. Positive and Negative predictive values for Xpert MTB RIF were 93.5% and 60.4% respectively. Positivity yield was higher for TB LAM as compared to Xpert MTB RIF (19% versus 9% in 2019; 36% versus 10% in 2020 and 38% versus 10% in 2021). Conclusion TB LAM identified 59% of all bacteriologically confirmed cases of tuberculosis at Levy Mwanawasa University Teaching Hospital. Contrary to what has been found in other studies, the sensitivity of TB LAM was much higher than that of Xpert MTB RIF. In addition, the sensitivity of TB LAM was higher in HIV negative as compared to HIV positive, which is contrary to what has been established in similar studies.
{"title":"Impact of introduction of TB LAM in the TB testing algorithm at Levy Mwanawasa University Teaching Hospital on case detection and notifications","authors":"Ireen C. Bwalya, O. Chilyabanyama","doi":"10.55320/mjz.50.1.374","DOIUrl":"https://doi.org/10.55320/mjz.50.1.374","url":null,"abstract":"Abstract \u0000 \u0000Introduction \u0000TB-LAM tests were introduced in the TB program in Zambia in 2019, to aid in diagnosis of TB. We carried out a study to determine the impact that TB lipoarabinomannan (LAM) test has had on case identification and notification at a tertiary hospital in a city with a high prevalence of HIV. We also compared sensitivity, specificity, positive predictive value and negative predictive of TB LAM tests and X-pert MTB RIF test in HIV positive and HIV negative patients. \u0000 \u0000Method \u0000Retrospective analysis of the TB laboratory as well as the TB notification registers to determine the number of TB cases identified by TB LAM and Xpert MTB-RIF. We identified patients who had both TB LAM and X-pert MTB RIF tests to determine sensitivity, specificity, positive and negative predictive values of TB LAM and Xpert MTB RIF, using TB notification and commencement of anti-tuberculosis treatment as the gold standard for comparison. \u0000 \u0000Results \u0000Between January 2019 and June 2022, there were a total number of 2353 notified cases of Tuberculosis. A total of 511 cases of Tuberculosis were identified on the basis of positive TB LAM. This accounted for 59% of all bacteriologically confirmed cases of TB. The sensitivity and specificity of TB LAM in diagnosis of TB in the study population was 55.8% and 91.4% respectively. Positive and Negative predictive values for TB LAM were 84.5% and 69.6% respectively. The sensitivity and specificity of Xpert MTB RIF in diagnosis of TB in the study population was 29.2% and 98.2% respectively. Positive and Negative predictive values for Xpert MTB RIF were 93.5% and 60.4% respectively. Positivity yield was higher for TB LAM as compared to Xpert MTB RIF (19% versus 9% in 2019; 36% versus 10% in 2020 and 38% versus 10% in 2021). \u0000Conclusion \u0000TB LAM identified 59% of all bacteriologically confirmed cases of tuberculosis at Levy Mwanawasa University Teaching Hospital. Contrary to what has been found in other studies, the sensitivity of TB LAM was much higher than that of Xpert MTB RIF. In addition, the sensitivity of TB LAM was higher in HIV negative as compared to HIV positive, which is contrary to what has been established in similar studies. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 ","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"116 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Teething has been attributed to various childhood ailments and physical disturbances since ancient times. Due to this some of the organic childhood diseases may go untreated thereby harming the child’s general health. Taking this negative impact into account, this review article aims at informing the medical community of the systemic symptoms that are associated with teething
{"title":"Systemic symptoms associated with tooth eruption in children: A narrative review","authors":"K. Sohal, Reema Mukesh Ruparellia","doi":"10.55320/mjz.50.1.346","DOIUrl":"https://doi.org/10.55320/mjz.50.1.346","url":null,"abstract":"Teething has been attributed to various childhood ailments and physical disturbances since ancient times. Due to this some of the organic childhood diseases may go untreated thereby harming the child’s general health. Taking this negative impact into account, this review article aims at informing the medical community of the systemic symptoms that are associated with teething","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"55 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Musonda Makasa, W. Mutale, M. Lubeya, Tepwanji Mpetemoya, Mukambo Chinayi, Benedictus Mangala, Musole Chipoya, P. Kaonga
Objective: We aimed to assess determinants of stillbirths among women who delivered from the five general hospitals of Lusaka city, Zambia. Methods: We conducted an unmatched case-control study. Cases were consecutively enrolled, and controls were randomly selected within 24 hours of occurrence of a case. A structured questionnaire was used to collect data, and multiple regression was used to assess determinants of stillbirths. A p-value of <0.05 was considered sufficient evidence of an association between stillbirth and independent variables. Results: A total of 58 cases and 232 controls were included in the analysis. Compared with women who delivered babies with birth weight <2500 grams, the risk of stillbirth for women who had babies with birth weight ≥2500 was higher (AOR= 4.49; 95% CI: 2.84 – 8.99); antepartum haemorrhage (AOR = 3.18; 95% CI: 1.21 – 8.09); previous experience of stillbirth (AOR=3.99; 95% CI: 1.73 – 6.73) compared with their counterparts without. Additionally, women with parity > 2 (AOR = 3.02; 95% CI: 1.07 – 7.54) had higher odds of stillbirth compared to those with parity ≤ 2. Conclusion: Birth weight ≥2.5 kg, antepartum haemorrhage, previous stillbirth were determinants of stillbirth. Program implementers should consider strategies that can mitigate these determinants to reduce stillbirth.
{"title":"Determinants of stillbirth in the Five General Hospitals of Lusaka, Zambia: A Case-Control study","authors":"Musonda Makasa, W. Mutale, M. Lubeya, Tepwanji Mpetemoya, Mukambo Chinayi, Benedictus Mangala, Musole Chipoya, P. Kaonga","doi":"10.55320/mjz.50.1.395","DOIUrl":"https://doi.org/10.55320/mjz.50.1.395","url":null,"abstract":"Objective: We aimed to assess determinants of stillbirths among women who delivered from the five general hospitals of Lusaka city, Zambia.\u0000Methods: We conducted an unmatched case-control study. Cases were consecutively enrolled, and controls were randomly selected within 24 hours of occurrence of a case. A structured questionnaire was used to collect data, and multiple regression was used to assess determinants of stillbirths. A p-value of <0.05 was considered sufficient evidence of an association between stillbirth and independent variables.\u0000Results: A total of 58 cases and 232 controls were included in the analysis. Compared with women who delivered babies with birth weight <2500 grams, the risk of stillbirth for women who had babies with birth weight ≥2500 was higher (AOR= 4.49; 95% CI: 2.84 – 8.99); antepartum haemorrhage (AOR = 3.18; 95% CI: 1.21 – 8.09); previous experience of stillbirth (AOR=3.99; 95% CI: 1.73 – 6.73) compared with their counterparts without. Additionally, women with parity > 2 (AOR = 3.02; 95% CI: 1.07 – 7.54) had higher odds of stillbirth compared to those with parity ≤ 2.\u0000Conclusion: Birth weight ≥2.5 kg, antepartum haemorrhage, previous stillbirth were determinants of stillbirth. Program implementers should consider strategies that can mitigate these determinants to reduce stillbirth.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"54 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdulwahab Lawal, Wuraola Salawu, Oluwanifemi Makanjuola, Ambali Ambali, Oreoluwa Alabi, Ahmed Kareem., Chijindu Nnaemeka, Maryam Akande, T. Akande
INTRODUCTION The lack of access to skilled healthcare services during childbirth remains a major factor for high maternal mortality in developing countries, as traditional birth attendants (TBAs) continue to serve as the predominant providers of maternal health care in rural communities. This study explores the knowledge and utilization of TBAs by women of reproductive age in a rural community of Ilorin, kwara state Nigeria. METHODSThis study is a descriptive cross-sectional study which was conducted using a well-structured interviewer based questionnaire, administered to 212 women of reproductive age-group to collect data on their knowledge and utilization of the services of TBAs. Analysis was done using Statistical Product and Service Solutions (SPSS) software version 20. RESULTS One hundred and fifty three respondents (72.2%) had background knowledge of TBAs, 91 (40.8%) had visited a TBA at least once to carry out their deliveries, of which 73 (80.2%) of them had successful deliveries, while 18 (19.8%) had complications during their deliveries, and 7 (7.7%) were referred to health care facilities for expect management. The study showed statistical significance between the level of education of respondents and their patronage of TBAs with a p-value of 0.041, and showed no statistical significance with their level of income. CONCLUSION This study showed adequate knowledge and utilization of the services of TBAs by members of the community. The practice of TBAs has continued to thrive in rural communities; integrating their services with the standard healthcare system as well as continuous sensitization of rural communities on their roles and limitations would go a long way in reducing maternal morbidity and mortality associated with the use of poorly trained TBAs
由于传统助产士(tba)仍然是农村社区孕产妇保健的主要提供者，因此在分娩期间缺乏获得熟练保健服务的机会仍然是发展中国家孕产妇死亡率高的一个主要因素。本研究探讨了尼日利亚夸拉州伊洛林农村社区育龄妇女对TBAs的知识和利用情况。方法本研究采用描述性横断面研究，采用结构良好的访谈问卷，对212名育龄妇女进行调查，收集她们对传统助产士服务的了解和利用情况。采用SPSS (Statistical Product and Service Solutions)软件进行分析。结果153名受访妇女(72.2%)具有TBA背景知识，91名(40.8%)至少到TBA进行过一次分娩，其中73名(80.2%)分娩成功，18名(19.8%)分娩过程中出现并发症，7名(7.7%)被转诊到卫生保健机构进行预期管理。研究发现，被调查者的受教育程度与他们对TBAs的赞助之间存在统计学意义，p值为0.041，而与他们的收入水平之间没有统计学意义。结论本研究显示社区成员对TBAs的服务有充分的了解和利用。传统医学在农村社区继续蓬勃发展;将它们的服务与标准保健系统结合起来，并不断使农村社区认识到它们的作用和局限性，将大大有助于减少与使用训练不足的传统助产士有关的产妇发病率和死亡率
{"title":"Knowledge and utilization of Traditional Birth Attendants by Women of Reproductive Age in Alanamu Community Ilorin, Northern Nigeria","authors":"Abdulwahab Lawal, Wuraola Salawu, Oluwanifemi Makanjuola, Ambali Ambali, Oreoluwa Alabi, Ahmed Kareem., Chijindu Nnaemeka, Maryam Akande, T. Akande","doi":"10.55320/mjz.50.1.345","DOIUrl":"https://doi.org/10.55320/mjz.50.1.345","url":null,"abstract":"INTRODUCTION\u0000The lack of access to skilled healthcare services during childbirth remains a major factor for high maternal mortality in developing countries, as traditional birth attendants (TBAs) continue to serve as the predominant providers of maternal health care in rural communities.\u0000This study explores the knowledge and utilization of TBAs by women of reproductive age in a rural community of Ilorin, kwara state Nigeria.\u0000METHODSThis study is a descriptive cross-sectional study which was conducted using a well-structured interviewer based questionnaire, administered to 212 women of reproductive age-group to collect data on their knowledge and utilization of the services of TBAs. Analysis was done using Statistical Product and Service Solutions (SPSS) software version 20.\u0000RESULTS One hundred and fifty three respondents (72.2%) had background knowledge of TBAs, 91 (40.8%) had visited a TBA at least once to carry out their deliveries, of which 73 (80.2%) of them had successful deliveries, while 18 (19.8%) had complications during their deliveries, and 7 (7.7%) were referred to health care facilities for expect management. The study showed statistical significance between the level of education of respondents and their patronage of TBAs with a p-value of 0.041, and showed no statistical significance with their level of income.\u0000CONCLUSION This study showed adequate knowledge and utilization of the services of TBAs by members of the community. The practice of TBAs has continued to thrive in rural communities; integrating their services with the standard healthcare system as well as continuous sensitization of rural communities on their roles and limitations would go a long way in reducing maternal morbidity and mortality associated with the use of poorly trained TBAs","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"119 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: People with Osteoarthritis (OA) of the hip and knee have difficulties in performing basic activities of daily living. These problems arise from disturbed biomechanics, pain and loss of range of motion. Both pain and stiffness prevent deep knee flexion, a movement that is important in the use of both the toilet and the bathing facilities. The aim of this study was to determine the challenges faced by patients with osteoarthritis of the hip and knee in using their bathrooms in Lusaka, Zambia. Methods: A cross sectional, descriptive quantitative study was done. The study was conducted at the University Teaching Hospital in the Department of Physiotherapy. Fifty six participants with hip or knee osteoarthritis were recruited in the study. Portions of the ICF were used to determine the level of difficulty in using both the bathtub for bathing and the toilet. A visual analogue scale and manual goniometer were used to measure the intensity of pain and range of motion respectively. Data were analysed using SPSS version 25.0. Chi Square test was used to determine if there was a relationship between severity of pain and the ranges of motion in the hip and knee at the significance level of 0.05. Results: Participants in this study had a mean age of 53.39 years (SD=9.210). Majority were females (79%) and 21% males. The participants had mild problems with (52%, n=29) followed by moderate problems with bathing (32%, n=18). More than half of the participants had moderate problems (55% while a few (7%) had severe problems with toileting. During bathing and toileting, 80% and 62% of the participants experienced moderate to severe pain in the knee and hip respectively. There were significant associations between the severity of pain and the ranges of motion in hip flexion, hip extension and knee flexion (P = 0.01, 0.001 and 0.02). Conclusion: Patients with OA of the knee and the hip have moderate to severe challenges with bathing and toileting. Pain may be the main factor contributing to the challenges in bathing and toileting. Physiotherapy needs to take the bathing and toileting facilities into account when managing patients with OA of the knee and hip.
{"title":"Challenges faced by patients with Osteoarthritis of the Hip and Knee in using their Bathrooms in Lusaka, Zambia","authors":"Billiat Chongo, Chese Ngulube, Marjorie Mwansa, Dominic Sashi, Fair Banji Mwiinga","doi":"10.55320/mjz.50.1.383","DOIUrl":"https://doi.org/10.55320/mjz.50.1.383","url":null,"abstract":"Introduction: People with Osteoarthritis (OA) of the hip and knee have difficulties in performing basic activities of daily living. These problems arise from disturbed biomechanics, pain and loss of range of motion. Both pain and stiffness prevent deep knee flexion, a movement that is important in the use of both the toilet and the bathing facilities. The aim of this study was to determine the challenges faced by patients with osteoarthritis of the hip and knee in using their bathrooms in Lusaka, Zambia. \u0000Methods: A cross sectional, descriptive quantitative study was done. The study was conducted at the University Teaching Hospital in the Department of Physiotherapy. Fifty six participants with hip or knee osteoarthritis were recruited in the study. Portions of the ICF were used to determine the level of difficulty in using both the bathtub for bathing and the toilet. A visual analogue scale and manual goniometer were used to measure the intensity of pain and range of motion respectively. Data were analysed using SPSS version 25.0. Chi Square test was used to determine if there was a relationship between severity of pain and the ranges of motion in the hip and knee at the significance level of 0.05. \u0000Results: Participants in this study had a mean age of 53.39 years (SD=9.210). Majority were females (79%) and 21% males. The participants had mild problems with (52%, n=29) followed by moderate problems with bathing (32%, n=18). More than half of the participants had moderate problems (55% while a few (7%) had severe problems with toileting. During bathing and toileting, 80% and 62% of the participants experienced moderate to severe pain in the knee and hip respectively. There were significant associations between the severity of pain and the ranges of motion in hip flexion, hip extension and knee flexion (P = 0.01, 0.001 and 0.02). \u0000Conclusion: Patients with OA of the knee and the hip have moderate to severe challenges with bathing and toileting. Pain may be the main factor contributing to the challenges in bathing and toileting. Physiotherapy needs to take the bathing and toileting facilities into account when managing patients with OA of the knee and hip. \u0000 \u0000 ","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"109 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sydney Mpisa, E. Sinkala, Wamundila Kawana, Brown Kamanga
The occurrence of other autoimmune conditions in primary biliary cholangitis (PBC) patients is documented in literature and thyroid disease is such an example. Such cases are however rarely seen in the African setting and particularly in Zambia. Here we report a case of a 36-year-old black Zambian female patient who was diagnosed with PBC in 2014 at the University Teaching Hospital(UTH), Lusaka, Zambia. She was lost to follow-up until November 2020 when she presented with a flare of PBC. During the flare the patient reported a 2-weeks history of pruritus, fatigue, passing dark urine and pale stools, coupled with progressive weight loss. Examination revealed moist skin, scleral jaundice, generalised scratch marks, wasting with a body mass index (BMI) of 15kg/m2, a small goitre with a bruit heard over it and fine tremors. She did not have proptosis, finger clubbing or cervical lymphadenopathy or pretibial myxoedema. File review showed no prior goitre. Ultrasound of the neck confirmed the homogenous thyroid gland with increased vascularity. Blood tests revealed a suppressed thyroid stimulating hormone (TSH) (<0.005Uiu/ml) elevated free triiodothyronine (FT3) (10.9pmol/l) and elevated free thyroxine (FT4) (53.4pmol/l). TSH receptor antibodies were also elevated. The clinical features and blood tests led to the confirmation of Graves’ disease in a patient with PBC. Our patient was subsequently started on carbimazole, propranolol and continued ursodeoxycholic acid with great clinical response to treatment of both the PBC and Graves’ disease. Our patient managed to gain weight within six months of commencement of Graves’ hyperthyroidism treatment, with her BMI improving to normal, at 22.6 Kg/m2. One year into her treatment she developed agranulocytosis likely from the carbimazole which was subsequently stopped resulting in her thyroid hormones going up again. The patient could not take propylthiouracil (PTU) in view of the liver disease as such radio-active iodine (which is not readily available) was the only feasible option. Our case report contributes to the body of knowledge that PBC tends to coexist with autoimmune thyroid disease and should be looked out for with a high index of suspicion especially in patients with PBC who report weight loss despite doing well on PBC therapy. We also seek to highlight the challenges in management and follow up of such patients in low resource setting. Although PBC is not so common in Black Africans, it should be suspected in patients who present with cholestatic jaundice especially in young female patients.
{"title":"The association of Primary biliary cholangitis and Graves’ disease coupled with management challenges: a case report of a 36-year-old black Zambian female patient.","authors":"Sydney Mpisa, E. Sinkala, Wamundila Kawana, Brown Kamanga","doi":"10.55320/mjz.50.1.382","DOIUrl":"https://doi.org/10.55320/mjz.50.1.382","url":null,"abstract":"The occurrence of other autoimmune conditions in primary biliary cholangitis (PBC) patients is documented in literature and thyroid disease is such an example. Such cases are however rarely seen in the African setting and particularly in Zambia. Here we report a case of a 36-year-old black Zambian female patient who was diagnosed with PBC in 2014 at the University Teaching Hospital(UTH), Lusaka, Zambia. She was lost to follow-up until November 2020 when she presented with a flare of PBC. During the flare the patient reported a 2-weeks history of pruritus, fatigue, passing dark urine and pale stools, coupled with progressive weight loss. Examination revealed moist skin, scleral jaundice, generalised scratch marks, wasting with a body mass index (BMI) of 15kg/m2, a small goitre with a bruit heard over it and fine tremors. She did not have proptosis, finger clubbing or cervical lymphadenopathy or pretibial myxoedema. File review showed no prior goitre. Ultrasound of the neck confirmed the homogenous thyroid gland with increased vascularity. Blood tests revealed a suppressed thyroid stimulating hormone (TSH) (<0.005Uiu/ml) elevated free triiodothyronine (FT3) (10.9pmol/l) and elevated free thyroxine (FT4) (53.4pmol/l). TSH receptor antibodies were also elevated. The clinical features and blood tests led to the confirmation of Graves’ disease in a patient with PBC. Our patient was subsequently started on carbimazole, propranolol and continued ursodeoxycholic acid with great clinical response to treatment of both the PBC and Graves’ disease. \u0000Our patient managed to gain weight within six months of commencement of Graves’ hyperthyroidism treatment, with her BMI improving to normal, at 22.6 Kg/m2. One year into her treatment she developed agranulocytosis likely from the carbimazole which was subsequently stopped resulting in her thyroid hormones going up again. The patient could not take propylthiouracil (PTU) in view of the liver disease as such radio-active iodine (which is not readily available) was the only feasible option. \u0000Our case report contributes to the body of knowledge that PBC tends to coexist with autoimmune thyroid disease and should be looked out for with a high index of suspicion especially in patients with PBC who report weight loss despite doing well on PBC therapy. We also seek to highlight the challenges in management and follow up of such patients in low resource setting. Although PBC is not so common in Black Africans, it should be suspected in patients who present with cholestatic jaundice especially in young female patients.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"114 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lumamba Mubbunu, Edwell Mwaanga, Bernard Hang'ombe, S. Siziya, Humphrey Simukoko
Background: Respiratory mucosal surface is continuously exposed to inhaled pathogens, and a protective layer of secreted mucus acts as the first line of defense against infection through a mechanism called mucociliary clearance. Mucus hypersecretion can negatively affect mucociliary clearance. Although ARBs and ACEIs are associated with induction of cough and angioedema as their side effects, no studies were found that show the effects of these drugs on Mucin-5ac, Mucin-5b, and Forkhead box protein A2. Mucin-5ac and mucin-5b are the main mucins in respiratory mucus and the viscoelasticity properties of respiratory mucus depends on them. Methods: This study used a hamster as an animal model to investigate the effects of ARB and ACEI on respiratory mucin-5ac, mucin-5b, and Forkhead box protein A2. Enalapril and Losartan were used as representative drugs for ACEIs and ARBs, respectively. The concentrations of mucin-5ac, mucin-5b, and Forkhead box protein a2 were measured using ELISA. Dunnet’s t-test was used to analyze the results. Results: Enalapril and Losartan increased mucin-5ac and mucin-5b, but the increase was not significant compared to the control (p > 0.05). However, enalapril and Losartan decreased the concentration of Forkhead box protein a2, but the decrease was not significant compared to the control (p > 0.05). Conclusions: The study found that, administration of enalapril or losartan did not have a significant effect on the concentration of Mucin-5ac, Mucin-5b, and Forkhead box protein A2. Therefore, the administration of these drugs will not reduce mucociliary clearance of the respiratory tract through the impairment of mucus production.
{"title":"Effects of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors on respiratory Mucin-5ac, Mucin-C5b and Forkhead box protein-A2 of a hamster tracheal mucosa.","authors":"Lumamba Mubbunu, Edwell Mwaanga, Bernard Hang'ombe, S. Siziya, Humphrey Simukoko","doi":"10.55320/mjz.50.1.386","DOIUrl":"https://doi.org/10.55320/mjz.50.1.386","url":null,"abstract":"Background: Respiratory mucosal surface is continuously exposed to inhaled pathogens, and a protective layer of secreted mucus acts as the first line of defense against infection through a mechanism called mucociliary clearance. Mucus hypersecretion can negatively affect mucociliary clearance. Although ARBs and ACEIs are associated with induction of cough and angioedema as their side effects, no studies were found that show the effects of these drugs on Mucin-5ac, Mucin-5b, and Forkhead box protein A2. Mucin-5ac and mucin-5b are the main mucins in respiratory mucus and the viscoelasticity properties of respiratory mucus depends on them.\u0000Methods: This study used a hamster as an animal model to investigate the effects of ARB and ACEI on respiratory mucin-5ac, mucin-5b, and Forkhead box protein A2. Enalapril and Losartan were used as representative drugs for ACEIs and ARBs, respectively. The concentrations of mucin-5ac, mucin-5b, and Forkhead box protein a2 were measured using ELISA. Dunnet’s t-test was used to analyze the results.\u0000Results: Enalapril and Losartan increased mucin-5ac and mucin-5b, but the increase was not significant compared to the control (p > 0.05). However, enalapril and Losartan decreased the concentration of Forkhead box protein a2, but the decrease was not significant compared to the control (p > 0.05). \u0000Conclusions: The study found that, administration of enalapril or losartan did not have a significant effect on the concentration of Mucin-5ac, Mucin-5b, and Forkhead box protein A2. Therefore, the administration of these drugs will not reduce mucociliary clearance of the respiratory tract through the impairment of mucus production.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"74 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A case of an accidental overdose in a body packer or drug courier is reported. It highlights a health hazard of deglutitioned controlled drugs. A clinico-pathological aspect of the body packer syndrome is discussed.
{"title":"Body Packer Syndrome: a health hazard of deglutitioned controlled drugs","authors":"Dr K Saasa, K. Saasa¹, Mss Patel²","doi":"10.55320/mjz.50.1.397","DOIUrl":"https://doi.org/10.55320/mjz.50.1.397","url":null,"abstract":"A case of an accidental overdose in a body packer or drug courier is reported. It highlights a health hazard of deglutitioned controlled drugs. A clinico-pathological aspect of the body packer syndrome is discussed.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"121 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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