ABSTRACT Objective: To evaluate factors associated with Pregnancy-related Kidney Injury (PRAKI) in women admitted to high dependent care unit at Women and Newborn Hospital in Lusaka, Zambia Methodology: This was an unmatched case-control study conducted in the high-dependent care unit at Women and Newborn Hospital in Lusaka. Study participants were recruited consecutively by convenient sampling. Participants’ medical records were reviewed to capture serum creatinine levels; while a structured questionnaire was administered to eligible and consented study participants to capture data on sociodemographic, obstetric and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaning and Stata v13 used for analysis. Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was used and p value of <0.05 was considered significant. Results: The study comprised of 185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3% (139) of the study participants were in marriage relationships. Pre-existing hypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle cell disease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most prevalent condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetric factors such as eclampsia (AOR = 5.12, 95% CI [2.14 – 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 – 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI. Conclusion: Thus the development of PRAKI was mainly associated obstetric factors such as eclampsia, preeclampsia, and post-partum haemorrhage.
【摘要】目的:评估赞比亚卢萨卡妇女和新生儿医院高依赖性护理病房住院妇女妊娠相关性肾损伤(PRAKI)的相关因素。方法:这是一项在卢萨卡妇女和新生儿医院高依赖性护理病房进行的无与伦比的病例对照研究。研究参与者采用方便抽样的方式连续招募。研究人员回顾了参与者的医疗记录，以获取血清肌酐水平;同时对符合条件和同意的研究参与者进行结构化问卷调查，以获取有关社会人口、产科和医疗因素的数据。血清肌酐水平高于84µmol/l作为PRAKI的分类标准。使用Excel进行数据清理，使用Stata v13进行分析。对所有变量进行描述性统计，然后进行单变量和多变量逻辑回归以确定相关性。采用95% CI, p值<0.05为显著性。结果:该研究包括185名研究参与者，分为85名PRAKI女性(病例)和100名非PRAKI女性(对照组)。年龄中位数为29岁，四分位数间距为11岁。75.3%(139)的研究参与者处于婚姻关系中。既往高血压是病例(51.8%)和对照组(38%)中最普遍的医疗状况。镰状细胞病的发病率要低得多，在病例中为1.2%，对照组为8%。在产科疾病中，先兆子痫是最常见的疾病，分别占病例和对照组的77.6%和60%。子痫发生率为38.8%，对照组为11%。脓毒症最不常见，占4.7%。本研究发现产科因素如子痫(AOR = 5.12, 95% CI [2.14 - 12.23];p≤0.0001)，先兆子痫(AOR = 2.46, 95% CI [1.12 - 5.39];p = 0.025)，产后出血与PRAKI的发生有关。医疗状况与PRAKI无关。结论:PRAKI的发生主要与产科因素有关，如子痫、先兆子痫和产后出血。
{"title":"An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to High Dependent Care Unit at Women And Newborn Hospital, Lusaka-Zambia.","authors":"Karen Mutemwa Imasiku, L. Kasonka","doi":"10.55320/mjz.49.2.977","DOIUrl":"https://doi.org/10.55320/mjz.49.2.977","url":null,"abstract":"ABSTRACT \u0000Objective: To evaluate factors associated with Pregnancy-related Kidney Injury (PRAKI) in women admitted to high dependent care unit at Women and Newborn Hospital in Lusaka, Zambia \u0000Methodology: This was an unmatched case-control study conducted in the high-dependent care unit at Women and Newborn Hospital in Lusaka. Study participants were recruited consecutively by convenient sampling. Participants’ medical records were reviewed to capture serum creatinine levels; while a structured questionnaire was administered to eligible and consented study participants to capture data on sociodemographic, obstetric and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaning and Stata v13 used for analysis. Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was used and p value of <0.05 was considered significant. \u0000Results: The study comprised of 185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3% (139) of the study participants were in marriage relationships. Pre-existing hypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle cell disease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most prevalent condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetric factors such as eclampsia (AOR = 5.12, 95% CI [2.14 – 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 – 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI. \u0000Conclusion: Thus the development of PRAKI was mainly associated obstetric factors such as eclampsia, preeclampsia, and post-partum haemorrhage.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"211 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76500038","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 bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.
{"title":"Ultrasound Imaging of a Bicornuate Uterus with a Pregnancy and an Intrauterine contraceptive device in different Horns: A Case Report from Zimbabwe","authors":"L. Mutandiro, B. Chinene, Damian Murambasvina","doi":"10.55320/mjz.49.2.1001","DOIUrl":"https://doi.org/10.55320/mjz.49.2.1001","url":null,"abstract":"A bicornuate uterus is a congenital abnormality that results from the incomplete lateral fusion of the two müllerian ducts. The WHO eligibility criteria for contraceptive use, states that the use of intrauterine devices (IUCDs) is contraindicated for women with uterine abnormalities. However, in most cases, the presence of the bicornuate uterus is not known at the time of IUCD insertion. We herein report a case of a 41-year-old woman who had a bicornuate uterus with an IUCD in situ in the left horn and a live pregnancy in the right horn. The aim of this case report is to highlight the important role ultrasound imaging can play in the diagnosis of congenital uterine abnormalities in patients using IUCDs. Furthermore, the report also discusses the ultrasound imaging techniques that a diagnostician can adopt to optimize the diagnosis.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78435839","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: There is a significant shortage of medical subspecialists in Zambia. The government of Zambia, through programmes at the Ministry of Health, spends considerable resources to send patients outside the country for subspecialist medical treatment. The objective of this analysis was to evaluate the current situation pertaining to medical subspecialty training at the University of Zambia School of Medicine (UNZASOM) and to illustrate the new programmes that are to be introduced.
Methods: We collected data from formal desk reviews on the state of medical specialisation in Zambia, the UNZASOM graduation archives and patient referral records at the Ministry of Health (MoH). In addition, information on planned subspecialist programmes is presented.
Results: From the first graduates in 1986up to 2019,UNZASOM produced 351medical specialists, 63 (18%) in Internal Medicine, 77 (22%) in Obstetrics &Gynaecology, 82 (23%) in Paediatrics&Child Health, 68 (19%) in General Surgery, 17 (5%) in Anaesthesia & Critical Care, 20 (6%) in Orthopaedics &Trauma and 8 (2%) in Urology. The remaining graduates were in Ophthalmology, Psychiatry, Infectious Diseases, Paediatric Surgery and Pathology contributing 1% each. To enhance medical subspecialist training at UNZASOM, new curricula for Breast Surgery, Urology, Glaucoma, Vitreo-retinalSurgery, Adult Gastroenterology, Forensic Pathology, Dermatology & Venereology, Ophthalmology, Gynaecological Oncology and Paediatric anaesthesia, Infectious Diseases, and Gastroenterology were developed. Since 2013, only 44% of patients requiring subspecialist treatment out of Zambia got assisted with the remainder still on the waiting list or having had bad outcomes.
Conclusions: These programmes will provide an opportunity for accessible and affordable medical subspecialization training for Zambia and its neighbouring countries. With enhanced infrastructural support, the subspecialists will contribute toward enhanced healthcare provision and improvement in patient outcomes. They will also form a cohort of trainers to expand the space for quality training and skills building of specialists and subspecialists in the region and beyond.
{"title":"Initiatives to enhance medical subspecialist training in Zambia: A cross-sectional analysis.","authors":"Violet Kayamba, Selestine Nzala, Moses Chikoti Simuyemba, Cosmas Zyambo, Emmanuel Musenge, Ruth Wahila, Victoria Mwiinga Kalusopa, Christabel Mwiinga, Linda Kampata-Olowski, Marjory Kabinga Makukula, Patricia Katowa-Mukwato, Elliot Kafumukache, Fastone Goma","doi":"10.55320/mjz.49.1.36","DOIUrl":"https://doi.org/10.55320/mjz.49.1.36","url":null,"abstract":"<p><strong>Introduction: </strong>There is a significant shortage of medical subspecialists in Zambia. The government of Zambia, through programmes at the Ministry of Health, spends considerable resources to send patients outside the country for subspecialist medical treatment. The objective of this analysis was to evaluate the current situation pertaining to medical subspecialty training at the University of Zambia School of Medicine (UNZASOM) and to illustrate the new programmes that are to be introduced.</p><p><strong>Methods: </strong>We collected data from formal desk reviews on the state of medical specialisation in Zambia, the UNZASOM graduation archives and patient referral records at the Ministry of Health (MoH). In addition, information on planned subspecialist programmes is presented.</p><p><strong>Results: </strong>From the first graduates in 1986up to 2019,UNZASOM produced 351medical specialists, 63 (18%) in Internal Medicine, 77 (22%) in Obstetrics &Gynaecology, 82 (23%) in Paediatrics&Child Health, 68 (19%) in General Surgery, 17 (5%) in Anaesthesia & Critical Care, 20 (6%) in Orthopaedics &Trauma and 8 (2%) in Urology. The remaining graduates were in Ophthalmology, Psychiatry, Infectious Diseases, Paediatric Surgery and Pathology contributing 1% each. To enhance medical subspecialist training at UNZASOM, new curricula for Breast Surgery, Urology, Glaucoma, Vitreo-retinalSurgery, Adult Gastroenterology, Forensic Pathology, Dermatology & Venereology, Ophthalmology, Gynaecological Oncology and Paediatric anaesthesia, Infectious Diseases, and Gastroenterology were developed. Since 2013, only 44% of patients requiring subspecialist treatment out of Zambia got assisted with the remainder still on the waiting list or having had bad outcomes.</p><p><strong>Conclusions: </strong>These programmes will provide an opportunity for accessible and affordable medical subspecialization training for Zambia and its neighbouring countries. With enhanced infrastructural support, the subspecialists will contribute toward enhanced healthcare provision and improvement in patient outcomes. They will also form a cohort of trainers to expand the space for quality training and skills building of specialists and subspecialists in the region and beyond.</p>","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"49 1","pages":"67-74"},"PeriodicalIF":0.0,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10470851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10523567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution. Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance. Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively. Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.
{"title":"Accuracy of Mid-Trimester Ultrasound Scan in Foetal Gender Determination at the University College Hospital, Ibadan Nigeria","authors":"Janet A Akinmola, Olaolu O. Oni, O. Bello","doi":"10.55320/mjz.49.1.1112","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1112","url":null,"abstract":"Objectives: This study aimed to determine the accuracy of prenatal sonographic gender determination during foetal anomaly ultrasound and the overall sensitivity pattern in our institution. \u0000Materials and Methods: A cross-sectional study of 520 consenting pregnant women who presented for foetal anomaly scans within a one-year period in our institution. The diagnostic accuracy of gender determination during the anomaly and delayed scans were determined by comparing the sonographic gender with the birth gender and calculating sensitivity, specificity, positive predictive value and negative predictive value. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics, frequencies, Mc-Nemar chi-square test were used at 5% level of significance. \u0000Results: The mean maternal age was 31.51 ±5.02years. Of the 520 consenting pregnant women studied, 16(6.0%) women were having twin gestation. Four hundred and ninety-seven (92.7%) genders were determined during foetal anomaly scan. The accuracy of the ultrasonography (US) examination performed by the resident doctors was 98.02% while the accuracy of the scan performed by the consultant radiologists was 100%. Overall, the accuracy of the gender determination on ultrasound was 98.69%. The general specificity and sensitivity of the US were 98.71 % and 98.68% respectively while the positive and negative predictive value were 99.01 % and 98.29% respectively. \u0000Conclusion: The accuracy of ultrasound examination in detecting foetal gender during foetal anomaly ultrasound is high with equally high predictive values and therefore it is recommended as a mandatory variable during anomaly scans. There is need for continuous training of resident doctors or operators in lower cadre to improve their competency in foetal gender determination.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78225021","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}
S. Munsaka, Benson M. Hamooya, M. Sinkala, M. Malumani, S. K. Masenga
Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%. Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertensionin PLWH wereincreasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment ofh ypertension among PLWH.
{"title":"Correlates of Hypertension among Persons Living with HIV at Livingstone Central Hospital: A Crosssectional study","authors":"S. Munsaka, Benson M. Hamooya, M. Sinkala, M. Malumani, S. K. Masenga","doi":"10.55320/mjz.49.1.1096","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1096","url":null,"abstract":"Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. \u0000Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. \u0000Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%. \u0000Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertensionin PLWH wereincreasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment ofh ypertension among PLWH.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90368980","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}
Objectives: To explore the factors that influence small for gestational age outcome among HIV exposed infants delivered at the Women and Newborn Hospital, Lusaka, Zambia. Materials and Methods: This was a facility-based unmatched case control study nested in the Zambia Preterm Birth Prevention Study (ZAPPS) conducted at the Women and Newborn Hospital in Lusaka district between October 2017 and February 2021. Convenience sampling was used to select all the 53 HIV exposed small for gestational age infants (as cases) and 152 HIV unexposed small for gestational age infants (as controls). An excel data extraction tool was used to extract categorised variables from the ZAPPS data set into Stata version 19. Chi-square test was used to test for association, foetal and maternal variables with a p-value of 0.2 at univariate analyses were entered into a multiple logistic regression model. Results: The proportion of SGA, though not statistically significant, was found to be 19.9% among the HIV exposed infants compared to 17.3% in the unexposed group (p= 0.34). More than three quarters of participants in both the HIV positive arm (71.7%) and HIV negative arm (81.3%) were aged between 20-35 years. On multivariate analysis, Maternal chronic illness [AOR: 4.39, 95% CI: (1.66 - 11.6), p=0.003] and spontaneous preterm delivery [AOR: 1.58, 95% CI: (1.02 - 2.46), p=0.040] had a strong association with small for gestational age. Tertiary Level of education [AOR: 0.45, (0.24 - 0.85), p=0.014] was found to be significantly protective against small for gestational age. Maternal factors such as married status [AOR: 0.74, (0.48 - 1.13), p=0.164], secondary level of education [AOR: 0.82, (0.54 - 1.24), p=0.743], history of stillbirth [AOR: 1.31, (0.92-1.85), p=0.123] and the Mid-upper arm circumference [AOR: 0.96, (0.92-1.00), p=0.064] was not associated with small for gestational age. Conclusion: There was no association between maternal HIV infection and SGA. Maternal chronic illness and spontaneous preterm birth increase the odds of SGA outcome while tertiary level of education is protective. Further research is needed to broaden the evidence base for addressing small for gestational age as a gateway to improve perinatal mortality, and for policy implementers to devise cost-effective and sustainable ways of reaching the at-risk population.
{"title":"Determinants of small for gestational age among HIV exposed infants delivered at the Women and Newborn hospital, Lusaka, Zambia","authors":"Augustus Ndui, L. Kasonka, B. Vwalika","doi":"10.55320/mjz.49.1.984","DOIUrl":"https://doi.org/10.55320/mjz.49.1.984","url":null,"abstract":"Objectives: To explore the factors that influence small for gestational age outcome among HIV exposed infants delivered at the Women and Newborn Hospital, Lusaka, Zambia. \u0000Materials and Methods: This was a facility-based unmatched case control study nested in the Zambia Preterm Birth Prevention Study (ZAPPS) conducted at the Women and Newborn Hospital in Lusaka district between October 2017 and February 2021. Convenience sampling was used to select all the 53 HIV exposed small for gestational age infants (as cases) and 152 HIV unexposed small for gestational age infants (as controls). An excel data extraction tool was used to extract categorised variables from the ZAPPS data set into Stata version 19. Chi-square test was used to test for association, foetal and maternal variables with a p-value of 0.2 at univariate analyses were entered into a multiple logistic regression model. \u0000Results: The proportion of SGA, though not statistically significant, was found to be 19.9% among the HIV exposed infants compared to 17.3% in the unexposed group (p= 0.34). More than three quarters of participants in both the HIV positive arm (71.7%) and HIV negative arm (81.3%) were aged between 20-35 years. On multivariate analysis, Maternal chronic illness [AOR: 4.39, 95% CI: (1.66 - 11.6), p=0.003] and spontaneous preterm delivery [AOR: 1.58, 95% CI: (1.02 - 2.46), p=0.040] had a strong association with small for gestational age. Tertiary Level of education [AOR: 0.45, (0.24 - 0.85), p=0.014] was found to be significantly protective against small for gestational age. Maternal factors such as married status [AOR: 0.74, (0.48 - 1.13), p=0.164], secondary level of education [AOR: 0.82, (0.54 - 1.24), p=0.743], history of stillbirth [AOR: 1.31, (0.92-1.85), p=0.123] and the Mid-upper arm circumference [AOR: 0.96, (0.92-1.00), p=0.064] was not associated with small for gestational age. \u0000Conclusion: There was no association between maternal HIV infection and SGA. Maternal chronic illness and spontaneous preterm birth increase the odds of SGA outcome while tertiary level of education is protective. Further research is needed to broaden the evidence base for addressing small for gestational age as a gateway to improve perinatal mortality, and for policy implementers to devise cost-effective and sustainable ways of reaching the at-risk population. ","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"18 6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83193691","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: Castleman disease (CD) is a heterogeneous group of lymphoproliferative disorders of uncertain cause presenting with lymphadenopathy. There are three generally described immunological disorders of CD that occur in individuals of all ages and share a similar microscopic lymph node appearance but different immunohistochemical profile. Oftentimes, diagnosis can be challenging where histology is not done, with most patients being presumptively treated as tuberculous (TB) adenitis. Method & Results: We present three case reports of CD, one is of an Human Immunodeficiency Virus (HIV) naive patient, the other two are in HIV positive patients. All three patients presented with fever, recurrent anemia and generalized lymphadenopathy. W hole body Computed Tomography (CT) scans as well as excision biopsies (for histopathology and immunohistochemical staining for Human Herpes Virus-8 (HHV-8) were done on all three patients. Case 1: Idiopathic Multicentric Castleman Disease in a 20 year old male patient who also developed TAFRO syndrome (Thrombocytopenia, Ascites, myelo Fibrosis, Renaldys functionand Organomegaly) in the course of the illness. Case 2 & 3: HHV-8 associated Multi centric Castleman Disease in HIV positive 42 year and 27 year old female patients respectively. The 42 year old received chemotherapy for six months, and had symptomatic relief and remission, while the 27 year old was yet to commence chemotherapy. Discussion: Most cases of CD go undiagnosed or mostly misdiagnosed for other common causes of lymphadenopathy in Zambia. These are the first case reports in our hospital, with notable backgrounds of physicians having suggested TB treatment from the referring facilities. Conclusion: Both HHV-8 and none-HHV-8 associated CD may be very common in our population, and there is need for prompt biopsy, reporting and treatment of all patients presenting with lymphadenopathy in our hospitals.
{"title":"Multicentric Castleman Disease a Diagnostic Dilemma: A Case Series of T hree Patients Seen at a Tertiary Health Facility in Zambia","authors":"F. Mukonde, F. Musonda, N. Liusha","doi":"10.55320/mjz.49.1.1109","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1109","url":null,"abstract":"Background: Castleman disease (CD) is a heterogeneous group of lymphoproliferative disorders of uncertain cause presenting with lymphadenopathy. There are three generally described immunological disorders of CD that occur in individuals of all ages and share a similar microscopic lymph node appearance but different immunohistochemical profile. Oftentimes, diagnosis can be challenging where histology is not done, with most patients being presumptively treated as tuberculous (TB) adenitis. \u0000Method & Results: We present three case reports of CD, one is of an Human Immunodeficiency Virus (HIV) naive patient, the other two are in HIV positive patients. All three patients presented with fever, recurrent anemia and generalized lymphadenopathy. W hole body Computed Tomography (CT) scans as well as excision biopsies (for histopathology and immunohistochemical staining for Human Herpes Virus-8 (HHV-8) were done on all three patients. \u0000Case 1: Idiopathic Multicentric Castleman Disease in a 20 year old male patient who also developed TAFRO syndrome (Thrombocytopenia, Ascites, myelo Fibrosis, Renaldys functionand Organomegaly) in the course of the illness. Case 2 & 3: HHV-8 associated Multi centric Castleman Disease in HIV positive 42 year and 27 year old female patients respectively. The 42 year old received chemotherapy for six months, and had symptomatic relief and remission, while the 27 year old was yet to commence chemotherapy. \u0000Discussion: Most cases of CD go undiagnosed or mostly misdiagnosed for other common causes of lymphadenopathy in Zambia. These are the first case reports in our hospital, with notable backgrounds of physicians having suggested TB treatment from the referring facilities. \u0000Conclusion: Both HHV-8 and none-HHV-8 associated CD may be very common in our population, and there is need for prompt biopsy, reporting and treatment of all patients presenting with lymphadenopathy in our hospitals.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82765633","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: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.
背景:有报道称COVID-19肺炎、疾病严重程度和肾功能障碍的发展之间存在重要联系。方法:采用巢式回顾性研究方法，对确诊的COVID-19肺炎患者的医疗档案进行调查。结果变量为肾功能不全(定义为肾功能指标超出正常范围)及相关因素。采用多因素logistic回归确定肾功能不全的相关因素。结果:179例患者入组，平均年龄58.3岁(SD 16.5)，女性49.0%。肾功能不全的发生率分别为51.9%和39.3%，这些患者的eGFR<60 mL/min/1.73m2，男性高于女性(59.3% vs. 44.3%)，有高血压的患者高于血压正常者(60.5% vs. 39.5%)，有慢性肾脏疾病(CKD)的患者高于无高血压的患者(90% vs. 10%)。在调整了年龄、男性性别、COVID-19危重症和白细胞计数后，高血压是肾损害的独立预测因子，AOR为1.54 (95% CI [1.06-2.23]，p=0.022)。存在HIV或糖尿病与肾功能不全无统计学意义。结论:本研究显示COVID-19肺炎住院患者肾功能不全发生率高，存在高血压可导致肾功能损害近2倍。
{"title":"Prevalence and associated factors for kidney dysfunction in hospitalized patients with COVID-19 pneumonia in Zambia","authors":"Justor Banda","doi":"10.55320/mjz.49.1.1108","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1108","url":null,"abstract":"Background: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection \u0000Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. \u0000Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. \u0000Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88134146","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}
Infants and young children are commonly referred for medical imaging for suspected aspirated or inhaled foreign bodies (Fbs). FB aspirations are potentially life-threatening and immediate diagnosis and treatment are vital to avert fatalities.Chest radiography is the first-line imaging method indicated to evaluate suspected aspirated FB. This can be supplemented withothermedical imaging modalities, such as fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI). However, the lack of specialised medical imaging modalities in developing countries impends timely diagnosis of aspirated FB. We report a case of a 7-year-old girl with airway metallic FB not visible on the initial chest radiograph. This case report highlights the challenges low-income health institutions are facing in the diagnosing of airway FBs and other complicated conditions which require advanced imaging. In the absence of specialised medical imaging modalities, radiographers and clinicians should have high indexes of suspicion to avert deaths. In addition, specialised training of radiographers in the absence of radio lo gists might contribute to improved patient outcomes.
{"title":"Is It Possible to Miss a Metallic Airway Foreign Body on a Chest Radiograph? Imaging Case Report from Zambia","authors":"O. Bwanga, M. Mulenga, Ethel C Jere, J. Sichone","doi":"10.55320/mjz.49.1.1111","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1111","url":null,"abstract":"Infants and young children are commonly referred for medical imaging for suspected aspirated or inhaled foreign bodies (Fbs). FB aspirations are potentially life-threatening and immediate diagnosis and treatment are vital to avert fatalities.Chest radiography is the first-line imaging method indicated to evaluate suspected aspirated FB. This can be supplemented withothermedical imaging modalities, such as fluoroscopy, computed tomography (CT), and magnetic resonance imaging (MRI). However, the lack of specialised medical imaging modalities in developing countries impends timely diagnosis of aspirated FB. We report a case of a 7-year-old girl with airway metallic FB not visible on the initial chest radiograph. This case report highlights the challenges low-income health institutions are facing in the diagnosing of airway FBs and other complicated conditions which require advanced imaging. In the absence of specialised medical imaging modalities, radiographers and clinicians should have high indexes of suspicion to avert deaths. In addition, specialised training of radiographers in the absence of radio lo gists might contribute to improved patient outcomes.","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72805067","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}
M. Bwalya, Ndanji Ivy Chikasa, O. Bwanga, Ziche Makukula, Ngosa Chanda, Ernest Chanda, Kelvin Chitarnya
Medical imaging plays a significant role in the detection of foetal anomalies, such as the Pentalogy of Cantrell (POC). POC is a congenital anomaly involving five or fewer body malformations: ectopia cordis (EC), tetralogy of fallot (TOF), sternal defects, diaphragmatic defects, and abdominal wall defects. The commonly used imaging modality in the detection of POC during pregnancy is ultrasound because it uses non-ionising radiation, is cheap, and is available in most medical facilities. We report a rare case of POC from a medical imaging standpoint in Zambia. Two obstetric ultrasound scans were performed in the 3rd trimester. The initial scan revealed, among other things, unappreciated abdominal contents, while the second scan revealed a foetal heart sited partially external to the thoracic cavity, with external herniation of the liver and bowels. Our case was classified as incomplete POC because not all five main malformations were present. This case report highlights the importance of having well-organised obstetric ultrasound imaging services both in urban and rural parts of the country to improve antenatal care. ABBREVIATIONS EC - Ectopia Cordis IUFD - Intrauterine Foetal Death POC - Pentalogy of Cantrell TOF - Tetralogy of Fallot VSD - Ventricular Septal Defect
{"title":"Medical Imaging of Pentalogy of Cantrell: A Case Report from Zambia","authors":"M. Bwalya, Ndanji Ivy Chikasa, O. Bwanga, Ziche Makukula, Ngosa Chanda, Ernest Chanda, Kelvin Chitarnya","doi":"10.55320/mjz.49.1.1110","DOIUrl":"https://doi.org/10.55320/mjz.49.1.1110","url":null,"abstract":"Medical imaging plays a significant role in the detection of foetal anomalies, such as the Pentalogy of Cantrell (POC). POC is a congenital anomaly involving five or fewer body malformations: ectopia cordis (EC), tetralogy of fallot (TOF), sternal defects, diaphragmatic defects, and abdominal wall defects. The commonly used imaging modality in the detection of POC during pregnancy is ultrasound because it uses non-ionising radiation, is cheap, and is available in most medical facilities. We report a rare case of POC from a medical imaging standpoint in Zambia. Two obstetric ultrasound scans were performed in the 3rd trimester. The initial scan revealed, among other things, unappreciated abdominal contents, while the second scan revealed a foetal heart sited partially external to the thoracic cavity, with external herniation of the liver and bowels. Our case was classified as incomplete POC because not all five main malformations were present. This case report highlights the importance of having well-organised obstetric ultrasound imaging services both in urban and rural parts of the country to improve antenatal care. \u0000ABBREVIATIONS \u0000EC - Ectopia Cordis \u0000 \u0000IUFD - Intrauterine Foetal Death \u0000POC - Pentalogy of Cantrell \u0000TOF - Tetralogy of Fallot \u0000VSD - Ventricular Septal Defect","PeriodicalId":74149,"journal":{"name":"Medical journal of Zambia","volume":"100 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79322776","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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