Central African Journal of Medicine https://www.ajol.info/index.php/cajm <p>The <em>Central African Journal of Medicine</em> is a quarterly refereed general medical journal which seeks to promote the practice and science of medicine in Africa. Emphasis is placed on general medical topics, reflecting common and important conditions in the region. The journal also covers related medical fields. Submissions are encouraged in the form of research articles, reviews, case reports and letters.</p> en-US Copyright for articles published in this journal is retained by the journal. gangaidz@gmail.com (Prof IT Gangaidzo) cajm@medsch.uz.ac.zw (Crathilwe Nyathi [Office Manager]) Tue, 02 Nov 2021 11:28:09 +0000 OJS 3.1.2.4 http://blogs.law.harvard.edu/tech/rss 60 Evaluation of renal function in type 2 diabetes <i>mellitus</i> patients with diabetic retinopathy at SekuruKaguvi Eye Hospital https://www.ajol.info/index.php/cajm/article/view/216835 <p><strong>Background</strong>: Diabetic Retinopathy (DR) and diabetic nephropathy are the leading causes of blindness and chronic kidney disease worldwide respectively and the most significant long-term complications in terms of morbidity and mortality in patients with diabetes.<br><strong>Objective</strong>: To determine the prevalence of renal failure in type 2 diabetic patients presenting with diabetic retinopathy at Sekuru Kaguvi Eye Hospital out-patients department.<br><strong>Study Design</strong>: Hospital based cross sectional.<br><strong>Setting</strong>: Sekuru Kaguvi Hospital (SKH) out-patients unit.<br><strong>Materials and Methods</strong>: Convenience sampling, whereby patients coming to the outpatients department with type 2 diabetic retinopathy were enrolled into the study from June 2017 to May 2018. All participants had their medical history taken guided by an interviewer administered questionnaire. Fundus examination including general eye examination was done to stage the retinopathy whilst urine and blood samples were taken to evaluate proteinuria and estimated glomerular filtration rate respectively.<br><strong>Results</strong>: One hundred and seventy diabetic patients with retinopathy were evaluated. The prevalence of proteinuria in diabetics with retinopathy was found to be 62.9%. The prevalence of impaired renal function amongst patients with diabetic retinopathy attending SKH was 46.5%. Diabetic retinopathy worsens with worsening of diabetic nephropathy such that it is 40 times more common to find impaired renal function in advanced diabetic retinopathy than it is in very mild non-proliferative diabetic retinopathy (95% CI, p=0.000).<br><strong>Conclusion</strong>: The high prevalence of renal impairment in type 2 Diabetes mellitus (DM) patients presenting with diabetic retinopathy calls for the need to strengthen screening of diabetic patients for both retinopathy and renal impairment to facilitate early treatment and reduce the morbidity and mortality associated with these complications.</p> S. Mangombe, F.A. Mukome Copyright (c) https://www.ajol.info/index.php/cajm/article/view/216835 Tue, 02 Nov 2021 00:00:00 +0000 Characterisation of <i>enterobacteriaceae</i> isolates from urinary tract infections in Harare, Zimbabwe https://www.ajol.info/index.php/cajm/article/view/216838 <p><strong>Objective</strong>: To characterise and determine the prevalence of <em>Enterobacteriaceae</em> members causing Urinary Tract Infections (UTIs) in a Zimbabwean populace.<br><strong>Design</strong>: A descriptive cross-sectional study of urine specimens from patients diagnosed with UTIs at a local private laboratory. Clear-mid-stream urine specimens from patients diagnosed with UTIs were cultured on Cysteine Lactose Electrolyte Deficient agar (CLED) and Blood Agar (BA). Enterobacteriaceae family antimicrobial susceptibilities were determined using the Mindray TDR 300B Auto-Microorganism identification and analysis machine. Isolates were also screened for extended spectrum beta lactamase production using the double disc diffusion method.<br><strong>Setting</strong>: The study was conducted at Premier Service Medical Investments Clinical Laboratory (PSMICL) situated in the city of Harare. The laboratory receives urine specimens from different medical centres around the city and also areas surrounding the city such as Norton, Chitungwiza, Marondera, Kadoma, Bindura and Chinhoyi.<br><strong>Inclusion Criteria</strong>: All patients diagnosed with urinary tract infections which were caused by a member of the Enterobacteriaceae family<br><strong>Exclusion Criteria</strong>: All patients diagnosed with a urinary tract infections that were caused by organisms other than the Enterobacteriaceae members (<em>Candida sp, Parasites (Schistosoma haematobium),</em> <em>Staphylococcussp, Streptococcus sp, Enterococcussp</em> among other causative agents)<br><strong>Results</strong>: Out of the 3933 patient specimens that were included into the study 715 (18.2%) had positive urine cultures, with 538 (75.2%) being confirmed Enterobacteriaceae members. The study showed that ESBL production was a common mode of resistance appearing in 23.4% of the isolates while AmpC production appeared in 22.3%.<br><strong>Conclusion</strong>: Enterobacteriaceae members are the major causative agents of urinary tract infections with <em>E coli</em> being the leading causative agent. In the case of infections which are caused by isolates that are non ESBL and AmpC producers, fluoroquinolones and aminoglycosides can still be employed as empirical treatment. However for infections caused by ESBL and AmpC producing Enterobacteriaceae, carbapenems and amikacin can be employed for management of such infections.</p> T. Masimbe, F. Chinowaita, B. Mukundu, S. Mazando Copyright (c) https://www.ajol.info/index.php/cajm/article/view/216838 Tue, 02 Nov 2021 00:00:00 +0000 A quality improvement initiative on blood culture processing in a Paediatric Oncology Unit (POU) at Parirenyatwa Group of Hospitals (PGH) in Zimbabwe https://www.ajol.info/index.php/cajm/article/view/216844 <p><strong>Objective:</strong> Quality intervention to improve blood culture services on the Paediatric Oncology Unit (POU) at Parirenyatwa Group of Hospitals (PGH).<br><strong>Design</strong>: Quality Intervention (QI).<br><strong>Setting</strong>: Paediatric Oncology Unit in ward A4 at PGH.<br><strong>Subjects</strong>: Health care workers on POU, laboratory personnel and admitted patients on the POU requiring a blood culture during study period (October 2018 to October 2019).<br><strong>Main Outcome Measures</strong>: Increased access to blood culture kits, increased positive blood culture yield and reduction of contamination.<br><strong>Results</strong>: A Standard Operating Procedure (SOP) on aseptic collection of peripheral blood was updated for the hospital. Monthly educational sessions were conducted for rotating Medical Officers (MOs) on the POU between October 2018 and October 2019 on the SOP. Ready-to-use blood culture kits were availed on the ward and placed within easy access for the MOs. A total of 190 episodes of fever were investigated using a blood culture during the study period. Of the total, 28 (14.7%) episodes of fever yielded positive growth while 15 (7.8%) yielded what were considered as contaminants. One sample did not meet acceptance criteria and the rest were negative. A decreasing trend of contamination mainly due to Coagulase Negative <em>Staphylococcus</em>(CoNS) was observed during the study period.<br><strong>Conclusion</strong>: Continuous quality interventions at both clinical and laboratory interfaces are associated with positive results on key performance indicators of blood culture processing such as yield of pathogens and reduction of contamination.</p> W. Tshaka, Z. Chiwodza, L. Thikatali, T. Magombeyi-Majinjiwa, V. Robertson, I. Chitsike Copyright (c) https://www.ajol.info/index.php/cajm/article/view/216844 Tue, 02 Nov 2021 00:00:00 +0000 Comparative Analysis of Genexpert MTB/Rif version 4 and Genexpert MTB/Rif Ultra on Frozen Sputum https://www.ajol.info/index.php/cajm/article/view/216847 <p><strong>Objectives</strong>: The aim of this study was to carry out a comparative analysis using Genexpert MTB/Rif Ultra (Ultra) on clinical samples of frozen sputum previously analyzed on Genexpert MTB/Rif version 4 (Xpert)and Mycobacterium Growth Indicator Tube (MGIT) culture.<br><strong>Design</strong>: The study employed both retrospective and prospective cross sectional design.<br><strong>Setting</strong>: Mutare Provincial Hospital Manicaland, Zimbabwe.<br><strong>Subjects</strong>: One hundred and nine de-identified frozen sputum.<br><strong>Interventions</strong>: Ultra test.<br><strong>Main Outcome Measures</strong>: Ultra results.<br><strong>Results</strong>: There was 96/109 (88%) concordance and 10/109 (9.2%) discordance between Xpert and Ultra. Sputum frozen for 7 years then analyzed on Ultra performed better than 7 years previously when it was analyzed as raw sputum on Xpert using MGIT as gold standard (95.6% and 93.2% respectively).The results were comparable and statistically significant, kappa analysis between Xpert and frozen sputum Ultra was not statistically significant showing a slight level of agreement of 0.147 (p value =0.079), 95% CI (-0.1078, 0.4018).<br><strong>Conclusion</strong>: Results of Ultra on frozen sputum correlate reasonably well. The study findings show that TB positive frozen sputum from presumptive DRTB, run on Ultra after 7 years freezing can perform better than previously run Xpert results compared to MGIT as gold standard. In light of the research findings, potential implication are that to save on cost, comparison of performance of newly diagnosed tests can be done using frozen sputum, pre run on panel of TB tests.</p> K. Zvinoera, J. Mutsvangwa, S. Zinyowera, M. Pepukai, E. Chikaka, S. Mharakurwa Copyright (c) https://www.ajol.info/index.php/cajm/article/view/216847 Tue, 02 Nov 2021 00:00:00 +0000