Archival Theses Collection

A study of trees and shrubs indigenous to Zimbabwe for the presence of human blood group specific haemagglutinins

2019-10-08T14:04:25Z

A study of trees and shrubs indigenous to Zimbabwe for the presence of human blood group specific haemagglutinins Moore, H. H. The results of haemagglutination tests carried out on 280 lectins extracted from the seeds of plants indigenous to Zimbabwe are recorded. These tests include bromelin enzyme and saline tube tests against human erythrocytes of all the common human blood groups. 142 lectins which failed to react with human erythrocytes were tested against horse, sheep, dog, cow, chicken, rabbit and chimpanzee erythrocytes as well as human group Oh (Bombay) U negative and neuraminidase and trypsin treated erythrocytes. One Anti-A + Anti-B -specific lectin from the seeds of Calpurnia aurea (previously reported) and three Anti-H specific lectins from the seeds of the Erythrina species are discussed. Two lectins, Pterocarpus angolensis and Ipomoea kituiensis, reacting only with cord erythrocytes and group Oh "(BombayJ^erythrocytes are reported on. Lectins are enumerated which are able to differentiate between the animal erythrocytes tested. Results of comparing lectin reactivity with total protein levels of extracts, mode of seed spread, seasonal appearance of seeds and botanical order of plants are evaluated

Carcinoma of the cervix in Zimbabwe- a review of patients' characteristics and outcome of treatment

2019-10-08T14:04:26Z

Carcinoma of the cervix in Zimbabwe- a review of patients' characteristics and outcome of treatment Ndhlovu, Ntokozo Carcinoma of the cervix accounts for over 30% of female malignancies in Zimbabwe. Aetiological factors include early age at first coitus, multiple sexual partners, poor hygiene and the human papilloma virus. Radiotherapy (RT) is the definitive treatment for most patients with this disease and involves both external beam therapy (EBT) and intracavitary treatment (ICT). A retrospective study was undertaken of all patients who presented to the Parirenyatwa Radiotherapy Centre (RTC) between November 1990 and December 1991 with a diagnosis of cervical carcinoma. This was an important developmental phase at the centre including the re-introduction of intra-cavitary treatment. The aim of the study was to document patient characteristics and outcomes of therapy and identify prognostic factors. Two hundred and seventy-three patients presented in this period. Of these, 52 were excluded leaving 221 patients who could be evaluated. Of the patients whose age was known (n = 190), 60% of these were in the age group 35-54 years with a range for the whole group of 21-80 years. Patients were divided into two groups according to whether they received radical RT including I.C.T. (group 1, 93 patients) or received EBT only (group 2, 128 patients). Fifty-one percent of the 221 patients presented with Stage III disease. In group 1, 77.4% were Stages I and II and 22.6% Stage III, whereas in group 2 the percentages were 12.5 and 72 respectively. The proportion of Stage III patients treated with ICT increased during the study period. Thirty-one percent of the whole group had no biopsy. Of those biopsied 95.4% had squamous cell carcinoma and 4.6% adenocarcinoma. Group 1 patient details were more reliable and so were analysed in more depth. Fifty nine percent of group I patients gave a history of 3-8 months ofsymptoms and 21.5% symptom duration longer than 1 year. The mean length follow-up time was 13.4 months for group 1 and 7.1 months for group 2. Complete remission (CR) rates at last follow-up were 49% for group 1 and 19% for group 2. Ninety-seven percent of group 1 patients achieving a CR had received 70Gy or more total dose to Point A. The CR rate was clearly inversely related to stage in group 2. In group 1 this trend was also seen though less clearly defined. Patients with both pelvic wall and lowerone third vaginal III patients. Treatment was in patients had no involvement did more poorly than other Stage general well tolerated: 78.5% of group 1 or only mild acute complications (mainly gastrointestinal) and only 2.1% had severe acute complications. The acute complication rate was higher in those who completed treatment in under 7 weeks. Follow-up was insufficient in the majority of the patients to assess late effects. Most local recurrences and metastases which occurred were seen within 1 year of completion of treatment. Health measures which could improve treatment results include: public education regarding early symptoms, medical education in early diagnosis and referral, accurate staging, more frequent use of a combination of EBT and ICT, avoiding prolonged treatment times, improved follow-up, better co-operation between gynaecologists and radiotherapists and more widespread cervical visualisation procedures in rural and district health centres areas to be reinforced in future by cytological screening

A study of high-dose-rate brachytherapy in the treatment of carcinoma of the uterine cervix

2019-10-08T14:04:25Z

A study of high-dose-rate brachytherapy in the treatment of carcinoma of the uterine cervix Oyesegun, A. R. AIM: To study the acute side effects associated with HDR brachytherapy and compare it with those of LDR. MATERIALS AND METHODS: Sixty two (62) patients treated with HDR studied. Seven (7) had had previous surgery. Thirty one (31) had HDR intracavitary insertion concomitant with EBT and twenty four (24) after. A total of 104 patients treated with LDR evaluated for comparison. RESULTS: Diarrhoea was the most frequent acute side effect noticed, mostly of low Grade - I & II - recorded in 18/31 (58%) of concomitant arm and 10/ 24 ( 42%) of after-EBT arm. Dysuria was uncommon in HDR patients. Diarrhoea was less frequent in LDR patients - 28/104 (26%) - while dysuria was more frequent - 30/104 ( 29%) - than in HDR patients. These symptoms in LDR patients were mostly of low- grade nature. Previous surgery was associated with a higher incidence of acute side effects - 6/7 (85%) patients had low grade diarrhoea and 2/7 (28%) patients had dysuria. CONCLUSION: Acute side effects associated with two insertions of 7 Gy HDR were low grade and tolerable. Literature review showed that larger numbers of insertions are better tolerated with reduced late complications comparable to those of LDR. Most late complications were associated with fraction sizes greater than 7 or 8 Gy. It is recommended that HDR afterloading treatment continues in Bulawayo using three fractions each of 6 Gy given at weekly intervals, the first two during the course of EBT and the third following completion of EBT, keeping overall time under seven weeks. Further work is indicated to assess the frequency of late complications.

A study of high-rate brachytherapy in the treatment of carcinoma of the uterine cervix

2019-10-08T14:04:29Z

A study of high-rate brachytherapy in the treatment of carcinoma of the uterine cervix Oyesegun, A. R. AIM: To study the acute side effects associated with HDR brachytherapy and compare it with those of LDR. MATERIALS AND METHODS: Sixty two (62) patients treated with HDR studied. Seven (7) had had previous surgery. Thirty one (31) had HDR intracavitary insertion concomitant with EBT and twenty four (24) after. A total of 104 patients treated with LDR evaluated for comparison. RESULTS: Diarrhoea was the most frequent acute side effect noticed, mostly of low Grade - I & II - recorded in 18/31 (58%) of concomitant arm and 10/ 24 ( 42%) of after-EBT arm. Dysuria was uncommon in HDR patients. Diarrhoea was less frequent in LDR patients - 28/104 (26%) - while dysuria was more frequent - 30/104 ( 29%) - than in HDR patients. These symptoms in LDR patients were mostly of low- grade nature. Previous surgery was associated with a higher incidence of acute side effects - 6/7 (85%) patients had low grade diarrhoea and 2/7 (28%) patients had dysuria. CONCLUSION: Acute side effects associated with two insertions of 7 Gy HDR were low grade and tolerable. Literature review showed that larger numbers of insertions are better tolerated with reduced late complications comparable to those of LDR. Most late complications were associated with fraction sizes greater than 7 or 8 Gy. It is recommended that HDR afterloading treatment continues in Bulawayo using three fractions each of 6 Gy given at weekly intervals, the first two during the course of EBT and the third following completion of EBT, keeping overall time under seven weeks. Further work is indicated to assess the frequency of late complications.

The pattern of meningitis in adult Zimbabweans

2019-10-08T14:04:28Z

The pattern of meningitis in adult Zimbabweans Bwakura, Tapiwanashe Over a six month period a total of sixty five patients (53 male, 12 female) with an average age of 32 years (range 20 - 61) were diagnosed as having meningitis. The commonest type was cryptococcal meningitis (52%) followed by tuberculous meningitis (25%) and pyogenic meningitis (23%). Overall HIV-seroprevalence rate was 82% (cryptococcal 100%, tuberculous 88% and pyogenic 53%) . Most clinical features were not helpful in distinguishing types of meningitis. However there was statistically significant paucity of features of meningism (Neck stiffness and Kernig's sign) in the cryptococcal meningitis group when compared to pyogenic meningitis ( p = 0.009). Cryptococcal meningitis was characterised by lack of an inflammatory response with significantly lower pleocytosis when compared to both pyogenic ( p = 0,00072) and tuberculous meningitis ( p<0,00009). CSF protein was overall lower in the cryptococcal meningitis group. The CSF glucose level was lower in the cryptococcal meningitis group, this being significant when compared to pyogenic meningitis (p<0,024). Clinical features as well as CSF results were similar in HIV-infected and non-HIV-infected patients in both the tuberculous and the pyogenic meningitis groups. The mean CD4 counts were higher in the tuberculous meningitis group compared to both cryptococcal and pyogenic meningitis groups although the difference did not reach statistical significance.

Epidemiological survey of penicillinase- producing neisseria gonorrhoeae (PPNG) in Zimbabwe

2019-10-08T14:04:30Z

Epidemiological survey of penicillinase- producing neisseria gonorrhoeae (PPNG) in Zimbabwe Sabeta, Claude Taurai The study involved an investigation into the plasmid types which confer resistance to penicillin in N. gonorrhoeae in Zimbabwe, and to determine the most occurring plasmid associated with PPNG. Specimens were collected from patients presenting with urethral discharge at chosen hospitals and clinics in Zimbabwe. These were then cultured on selective Thayer-Martin (TM) media. Presumptive gonococci were subjected to Gram stain, oxidase and carbohydrate fermentation tests. Beta-lactamase activity of the isolates was assessed by using commercial intralactam strips. Antibiotic sensitivity tests were done using discs incorporated with penicillin G, augmentin, erythromycin and tetracycline. Plasmid DNA was isolated using an alkaline selective denaturation technique that destroys chromosomal DNA whilst retaining small covalently closed DNA molecules. The DNA so obtained was checked for size, homogeneity and purity using agarose gel electrophoresis. The plasmid profiles were used to ascertain the most prevalent plasmid type which conferred resistance to penicillin in N. gonorrhoeae isolates. Four hundred and thirty six isolates of N. gonorrhoeae were isolated from the 865 specimens collected. Of these isolates 147 (34%) were R plasmid bearing. All beta-lactamase producing strains were resistant to penicillin G. In addition, seven non-beta-lactamase producing strains were also resistant to penicillin G, possibly indicating chromosomal resistance. Plasmid analyses indicated that of the 147 strains tested, 144 (98%) harboured the 2.6 Md cryptic plasmid, 56 (38%) the 3.2 Md plasmid, 66 (45%) the 4.5 Md plasmid. The 24.5 Md transfer plasmid existed in 61 (41%) of the strains. Eight isolates harboured both the 3.2 and 4.5 Md plasmids. The study demonstrated that resistance to penicillin in N. gonorrhoeae in Zimbabwe is equally confered by both the 3.2 Md and 4.5 Md plasmids.

Clinical presentation, aetiology, course and short term outcome of acute bacterial meningitis in children with and without clinical HIV infection

2019-10-08T14:04:30Z

Clinical presentation, aetiology, course and short term outcome of acute bacterial meningitis in children with and without clinical HIV infection Bwakura, M. F. A prospective descriptive study involving 55 patients between 1 - 60 months of age was undertaken at Harare Central Hospital to find out whether there are any differences in the clinical presentation, aetiology and short term outcome of bacterial meningitis in those with clinical HIV infection and those without. Clinical HIV infection was diagnosed in 24 (44%) of the children. There were no apparent differences in the clinical features or aetiology of meningitis. The case fatality rate (CFR) for the study population was 20% of which 45% had clinical HIV infection. The main predictor for mortality was unconsciousness on admission. Seizures occurring before and after admission were a significant risk factor for neurological abnormalities on discharge from hospital. Eight of the 27 (30%) seen on follow up had evidence of neurologic sequelae. Hearing loss was present in 4 of the 15 patients that were tested. Clinical HIV infection was not a risk factor for neurologic sequelae.Children who had clinical HIV infection responded well to the standard treatment given for acute bacterial meningitis and their short term outcome was not different from those without HIV infection.

Evaluation of the cervical cancer screening programme at Harare Central Hospital's postnatal clinic

2019-10-08T14:04:28Z

Evaluation of the cervical cancer screening programme at Harare Central Hospital's postnatal clinic Nyaumwe, Tendai J.

Is HIV infection associated with the clinical course of severe malaria

2019-10-08T14:04:27Z

Is HIV infection associated with the clinical course of severe malaria Zaal, Dirk Anne The malaria season 1995-1996 was the worst ever recorded in history in Zimbabwe regarding morbidity and mortality, especially in Matabeleland North.Particularly worrying was the observation that relatively mild cases of malaria rapidly progressed to severe and complicated malaria, and many of these patients died. The AIDS pandemic also affects Zimbabwe badly. Sentinel studies on ANC attenders in Binga and Hwange showed an increase in HIV seropositivity from 13.2% in 1993 to 21.5% in 1996. A research question: "Is HIV infection associated with the clinical course of severe malaria?" was formulated. The general objective of the study was to answer the research question. Specific objectives were: - to compare case fatality rates in HIV (+) and HIV (-) patients admitted for severe malaria- to compare length of stay in hospital in HIV (+) and HIV (-) severe malaria patients;- to compare the treatment given to HIV (+) and HIV (-) patients, and - if the findings so suggest, to come up with a recommendation regarding prevention of malaria in HIV (+) people. A cohort study was conducted in four hospitals in Matabeleland North Province, Zimbabwe, from 1/3/97-30/6/97. The subjects in the study were 100 patients, admitted for severe malaria, with a positive malaria slide, treated with parenteral quinine, and 15 years old or above. Results: From the 100 patients (59 male, 41 female) 59 were HIV (+) and 41 HIV (-). This HIV seropositivity rate in the study population (59%) was almost three times as high as that from the population it was drawn from (20%). 19/59 (32.3%) in the HIV (+) group died versus 6/41 (14.6%) in the HIV (-) group (RR 2.2; 95% CI 0.96-5.03; P-value = 0.078). Although not statistically significant- probably because of the small sample size- this case fatality rate for HIV (+) patients was more than twice the one for HIV (-) patients. The median stay in hospital was 5 days (3-7) for HIV ( + ) and 4 days (3-6) for HIV (-) patients. (P = 0.232) The findings suggest a possible association between HIV infection and the clinical course of severe malaria. As the answer to the research question has major public health implications, especially in areas with a high HIV prevalence, a large multicentre study along the lines of the present one is indicated.

Malnutrition and human immunodeficiency virus (HIV) in children admited to Harare Central Hospital

2019-10-08T14:04:26Z

Malnutrition and human immunodeficiency virus (HIV) in children admited to Harare Central Hospital Ticklay, I. M. H. ABSTRACT To determine whether HIV infection has altered the presentation, hospital course and mortality of malnutrition in Harare Hospital, children between 2 and 96 months of age were studied. Their sociodemographic, clinical presentation and immediate outcome were documented. Anthropomorphic parameters and physical findings were recorded. HIV (ELISA), serum potassium and albumen plus haematologic indices were measured. These findings were compared between HIV positive and HIV negative children. One hundred and eighty children were enrolled from December 1993 to February 1994. Mean age was 26.1 months (range 2-96) and the male to female ratio was 1.2:1. Fifty-four point five percent had kwashiorkor, 26.7% marasmic-kwashiorkor, 9.4% marasmus and 9.4% were underweight. During the study 73 children died giving an overall Case Fatality Rate (CFR) of 35% (73/210) . Thirty children with severe malnutrition died within 24 hours of admission and inadequate information was available therefore not included in the rest of the analysis. There was no significant difference in CFR between the different groups. Seventy-nine children were HIV positive and 80 HIV negative (no result obtained in 21) . The association of HIV positivity was significant in those with wasting and stunting (p<0.002) than with either stunting or wasting alone. Clinically, dehydration was more severe and oral thrush lymphadenopathy and ear discharge were present more frequently (p<0.001) . Haemoglobin and mean corpuscular volume were significantly lower (p<0.03 and p<0.001 respectively) Their hospital course was characterised by persistence of diarrhoea, lack of appetite and apathy (p <0.04). Mortality was marginally greater (p=0.055). These findings suggest that all children presenting with malnutrition should be screened for their HIV status and that prevention of AIDS needs to be included in efforts to reduce childhood malnutrition in Zimbabwe.