Background: Multiple myeloma (MM) is the second most common blood cancer after lymphomas, thereby... more Background: Multiple myeloma (MM) is the second most common blood cancer after lymphomas, thereby accounting for 10% of all haematological malignancies.
Background: Chronic diarrhoea is one of the most debilitating consequences of HIV infection in su... more Background: Chronic diarrhoea is one of the most debilitating consequences of HIV infection in sub-Saharan Africa and it carries a high mortality rate. We report unexpectedly low concentrations of circulating aldosterone in 12 patients (6 men, 6 women) in the University Teaching Hospital, Lusaka, who all had diarrhoea for over one month. Changes in serum electrolytes, blood pressure, Karnofsky score and serum aldosterone concentration were being monitored during a short study of responses to saline infusion (3 litres/24 h) over 72 hours. Findings: At baseline, 9/12 (75%) of the patients were hyponatraemic, 10/11 (91%) were hypokalaemic, and 6/12 (50%) had undetectable aldosterone concentrations. Blood pressure and Karnofsky score rose and creatinine concentration fell in response to the infusion. Conclusion: Circulating aldosterone concentrations were inappropriately low and complicate the profound electrolyte deficiencies resulting from chronic diarrhoea. Management of these deficiencies needs to be more aggressive than is currently practised and consideration should be given to a formal clinical trial of mineralocorticoid replacement in these severely ill patients. If the inappropriately low aldosterone reflects a general adrenal failure, it may explain a considerable proportion of the high mortality seen both before and after initiation of anti-retroviral therapy. Findings Rationale for the study Intestinal infection leading to diarrhoea is one of the most disabling and serious manifestations of AIDS. Although anti-retroviral therapy reduces the incidence and severity of diarrhoeal disease in HIV-infection, patients still present to Zambian hospitals with advanced disease, and mortality is still unacceptably high, even after initiating anti-retroviral therapy [1]. In our previous experience, mortality exceeds 20% per month, depending on the specific aetiological infection [2]. There have been many analyses of the spectrum of opportunistic pathogen in AIDS [3-5], but surprisingly little is known about the metabolic consequences of HIV infection in Africans. It would be anticipated that patients with persistent diarrhoea would have sodium and water depletion and hypokalaemia. During a series of studies of intestinal per
Background: The immune system of patients with haematological malignancies is suppressed during c... more Background: The immune system of patients with haematological malignancies is suppressed during chemotherapy. This renders them vulnerable to frequent infections especially of the bacterial type. Timely diagnosis of these infections is difficult, because a severe infection may be asymptomatic or manifest only in the form of fever or malaise. There is need for laboratory markers that can detect an infectious process at an early stage. This study was aimed at determining the value of using Procalcitonin (PCT) and C reactive protein (CRP), for early diagnosis of infection in patients with h a e m a t o l o g i c a l m a l i g n a n c i e s r e c e i v i n g chemotherapy. Methods: This was a cross sectional study consisting of sixty eight (68) patients with haematological malignancies. Data from each participant including sex, age, clinical and laboratory data were collected after obtaining informed consent. Blood specimens were then collected for measurement of PCT, CRP and bacteriological analysis. Patients were divided into two groups; those with a culture positive and negative result. PCT and CRP concentrations were compared between groups using t-test and nonparametric statistical tests respectively. The area under ROC curve, sensitivity, specificity, likelihood ratio, and Spearman's correlation coefficient were also calculated. Results: A total of 14 (20.6%) microorganisms were isolated, of which 10 were gram-positive bacteria and 4 were gram-negative bacilli. The mean values of PCT which were 6.1ng/mL in the bacteraemia group and 5.1ng/mL in the non-bacteraemia group, p=0.023 and median CRP values were 24.2 (6.43-48.15) in the bacteraemia and 23.5 (6.03-75.44) in the non-bacteraemia group, p=0.832. The area under curves was 0.52 (95% CI=0.57-0.84) for CRP and 0.70 (95% CI=0.35-0.69) for PCT. PCT value of greater than 4.7 ng/mL is diagnostic for infections (sensitivity 86%, specificity 54%) while that of CRP was 21mg/mL with the sensitivity and specificity of 64% and 44% respectively. Elevated levels of PCT as well as fever were significantly associated with bacteraemia. Conclusion: PCT was a more reliable and sensitive marker of bacteraemia among patients with
American Journal of Tropical Medicine and Hygiene, Apr 1, 2009
We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated... more We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Objectives: The objectives of the study were to compare plasma levels of IL-6 in HIV positive and... more Objectives: The objectives of the study were to compare plasma levels of IL-6 in HIV positive and HIV negative individuals and to correlate them with CD4 count Materials and methods: A cross-sectional study was carried out at the University Teaching Hospital in Lusaka, Zambia. IL-6 and CD4 were assessed in HIV positive on ART, HIV positive ART-naïve and HIV negative control participants. Results and Conclusion: Our study showed that HIV ART naïve participants had higher IL-6 concentrations (2.83 ± 1.60 ng/ml) than those on ART (2.49 ± 1.21 ng/ml) p = 0.020. HIV negative control participants however, had higher concentrations of IL-6 (3.24 ± 1.33 ng/ml) than HIV positive participants on ART (2.49 ± 1.21) p = 0.002. HIV positive ART naïve individuals therefore, had the highest IL-6 levels. The results also showed that ART lowers inflammation in HIV and this may explain why ART reduces the risk of developing opportunistic tumours and other infections in HIV.
International journal for research in applied sciences and biotechnology, Sep 30, 2020
Acute myeloid leukaemia (AML) is a highly malignant clonal hematopoietic disease caused by both i... more Acute myeloid leukaemia (AML) is a highly malignant clonal hematopoietic disease caused by both inherited and acquired genetic alterations. Current AML classification and prognostic systems incorporate genetic information but are limited to known abnormalities that have previously been identified with the use of cytogenetics, array comparative genomic hybridization (CGH), gene-expression profiling, and the resequencing of candidate genes. At diagnosis, most patients with AML harbour at least 1 chromosome aberration in their marrow blasts. With the targeted cytogenetic therapy, 30% of the patients achieve long-term cure. At University Teaching Hospital(UTH) however, the current diagnostic approach of acute leukaemia involves mainly cytomorphology and occasional flow cytometry. The cytomorphological blast characterization is not enough to provide a critical determination of prognosis and developing a treatment plan. Most of the AML patients at UTH die within few months after diagnosis despite being put on chemotherapy. To characterize AML according to WHO 2008 revised classification in patients at the University Teaching Hospital. This was a descriptive cross-sectional study conducted to characterize acute myeloid leukaemia (AML) according to WHO 2008 revised classification in patients at the UTH. Patients with AML were simultaneously analyzed for the presence of 4 genetic abnormalities, PML/RARα for t(15;17), AML1/ETO for t(8;21), CBFβ/MYH11 for inv(16)/t(16;16) and rearrangements of the MLL gene for 11q23 abnormalities. AML was classified using the new World Health Organization (WHO) classification for haematologic malignancies. The techniques used were standardized according to the recommendations of the European BIOMED-1 Concerted Action. The overall frequency of leukemia displaying one of the four recurrent cytogenetic translocations were 13 cases (46.5%) of which PML/RARα transcript was present in six(6) patients (21.4%) (3 were bcr1, 1 bcr2 and 2 bcr3). The AML1/ETO fusion transcript was detected in only one(1) case (3.6%) with M2 morphology, but other cases with M2 morphology were negative. CBFβ/MYH11 transcript was present in 2 cases (7.1%) and some of them displaying M4Eo morphology. Finally, 4 cases (14.3%) showed rearrangements of the MLL gene. By contrast, the frequency of AML not otherwise characterized which was 15 cases (53.6%) increased with age (13% for 6-35years age group, 20% for 36-65years age group and 67% for above 66years age group). Our results differ from those reported from the United States and North/Central Europe, particularly regarding the incidence of t(15;17) and t(8;21) translocations. In Zambia the frequency of t(15;17) is higher while that of t(8;21) is lower. This supports the view that geographic variations in tumor-associated aberrations in hematologic malignancies exist. Our study showed that chromosomal alteration PML/RAR t(15,17) which was 21.4% ,was the commonest, whereas AML1/ETO t(8,21) which was 3.6%,was the least common among patients presenting at UTH, Lusaka, Zambia. Our study showed that
Objectives: The aim of the study was to investigate the association between presence of haptoglob... more Objectives: The aim of the study was to investigate the association between presence of haptoglobin phenotypes and hypertension in indigenous Zambian patients attending outpatient medical clinic at the University Teaching Hospital in Lusaka, Zambia. Methodology: The study was a descriptive, noninterventional, analytical, cross-sectional study involving haptoglobin quantification and phenotyping of hypertensive and normotensive subjects. The clinical characteristics and serum parameters of the study population were recorded and the haptoglobin phenotypes were determined. Results: The average prevalence of the Hp polymorphisms was found to be Hp 1-1 (58%), Hp 2-1 (14%) and Hp 2-2 (28%). In the hypertensive group 31 (62%) had Hp1-1 phenotype compared to 27 (54%) of the normotensives. There was no statistically significant difference between the two groups with regard to the occurrence of the Hp 1-1 phenotype in the studied groups and it relation to hypertension. Conclusion: The study showed that there is no association between haptoglobin phenotype and hypertension.
Yes-associated protein-1 (YAP-1) is a Hippo system transcription factor, which serves as an oncog... more Yes-associated protein-1 (YAP-1) is a Hippo system transcription factor, which serves as an oncogene in squamous cell carcinoma, and several solid tumors when the Hippo pathway is dysregulated. Yet, the activity of YAP-1 in ocular surface squamous neoplasia (OSSN) has not been determined. Here, we investigate the relationship between YAP-1 overexpression and OSSN. Using a cross-sectional study design, we recruited 227 OSSN patients from the University Teaching Hospitals in Lusaka, Zambia. Immunohistochemistry was used to assess YAP-1 protein overexpression in tumor tissue relative to surrounding benign squamous epithelium. OSSN patient samples (preinvasive, n = 62, 27% and invasive, n = 165, 73%) were studied. One hundred forty-nine invasive tumors contained adjacent preinvasive tissue, bringing the total number of preinvasive lesions examined to 211 (62 + 149). There was adjacent benign squamous epithelium in 50.2% (114/227) of OSSN samples. Nuclear YAP- 1 was significantly overexp...
Background: Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negat... more Background: Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negative women. Vulvar neoplasia among women living with HIV has not previously been characterised in Zambia.Objective: This study determined the clinical and pathologic features of vulvar neoplasia among women living with HIV at the University Teaching Hospital, Lusaka, Zambia.Methods: We conducted a cross-sectional study of vulvar lesions among 53 women living with HIV who presented with vulvar lesions between July 2017 and February 2018. The study assessed clinical and histological characteristics and prevalence of high-risk human papillomavirus (HRHPV).Results: Twenty-one patients were diagnosed with vulvar squamous cell carcinoma (VSCC), 20 with usual vulvar intraepithelial neoplasm (uVIN), and the rest with either benign lesions or non-neoplastic lesions (NNL). Participants’ mean age was 40 years. Patients with VSCC were significantly older than those with NNL (mean (s.d.): 43 (21) vs 3...
HIV-1 entry requires not only CD4 molecule but also CCR5 (CD 195) and CXCR4 (CD 184) coreceptors.... more HIV-1 entry requires not only CD4 molecule but also CCR5 (CD 195) and CXCR4 (CD 184) coreceptors. A number of randomised controlled trials in Africa have reported that male circumcision (MC) reduces the risk of HIV-1 acquisition by up to 60%. Other studies have reported that sexually transmitted infections (STIs) increase the risk of infection by HIV via an inflammatory recruitment of more HIV target cells to the foreskin. Our aim was to compare the density of HIV-1 co-receptors (CCR5 and CXCR4) in naïve penile prepuce of neonates and penile prepuce of adults with and without history of ulcerative STIs at Male Circumcision Centres in Lusaka, Zambia. Twenty (20) fresh foreskin samples were included: five (5) from neonates, ten (10) from adult males without history of ulcerative STIs and five (5) from adult males with a history of ulcerative STIs. Immediately following MC, fresh foreskin specimens were fixed using 10% normal buffered formalin and transported to University Teaching Ho...
Langerhans cells (LCs) in epidermis function as sentinel antigen-presenting cells that can captur... more Langerhans cells (LCs) in epidermis function as sentinel antigen-presenting cells that can capture invading viruses like Herpes Simplex Virus, Varicella-zoster virus and Human Immunodeficiency Virus (HIV). This interaction between Langerhans cells and viruses is highly variable depending on the virus. Herpes Simplex induces apoptosis in LCs but HIV does not, instead it presents the HIV to T-cells in lymph nodes which in turn get infected. Langerhans cells in the prepuce are therefore, a portal of entry for HIV. Hence, world health organisation recommends male circumcision to reduce the densities of Langerhans cells. Fifteen fresh foreskins were obtained from adult males aged 18 years and above after circumcision, five had past history of ulcerative STI and five fresh foreskins were obtained from neonates. The specimens were fixed using 10% buffered formalin and transported to the histopathology laboratory where the tissues were grossed examined and embedded using paraffin wax. T...
A case study from the Katine parish in Uganda where the challenge of accessing antiretroviral dru... more A case study from the Katine parish in Uganda where the challenge of accessing antiretroviral drugs is exacerbated by abject poverty in the region. The article highlights the needs of the community members with HIV / AIDS in the region and the response of AMREF (the NGO working in the region) to addressing these issues.
B a c k g r o u n d : T h e r e i s e v i d e n c e t h a t multidisciplinary healthcare teams ca... more B a c k g r o u n d : T h e r e i s e v i d e n c e t h a t multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, communitybased experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74-87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.
Background: Thrombosis is a common complication in Type 2 Diabetes Mellitus (T2DM). Prolonged APT... more Background: Thrombosis is a common complication in Type 2 Diabetes Mellitus (T2DM). Prolonged APTT values have clinical relevance as an indicator of factor deficiency or the presence of coagulation inhibitors. However, there is mounting evidence that shortened APTT values in some cases may reflect a hypercoagulable state, which is potentially associated with increased thrombotic risk and adverse cardiovascular events. We set out a cross-sectional study to measure the haemostatic profiles of T2DM patients and to determine the suitability of PT-APTT as markers for hypercoagulability in T2DM patients using VWF as a gold standard.Methods: PT, APTT, VWF and Fibrinogen concentrations were measured in 213 T2DM patients and 172 non-diabetic healthy participants. VWF was used as a proxy marker for hypercoagulability in T2DM patients. Participants with VWF of >2.0 IU/ml , PT and APTT less than 11 and 30 seconds respectively, were regarded as being in hypercoagulable state.Results: The resu...
Objectives : The aim of the study was to investigate the association between presence of haptoglo... more Objectives : The aim of the study was to investigate the association between presence of haptoglobin phenotypes and hypertension in indigenous Zambian patients attending outpatient medical clinic at the University Teaching Hospital in Lusaka, Zambia. Methodology : The study was a descriptive, noninterventional, analytical, cross-sectional study involving haptoglobin quantification and phenotyping of hypertensive and normotensive subjects. The clinical characteristics and serum parameters of the study population were recorded and the haptoglobin phenotypes were determined. Results : The average prevalence of the Hp polymorphisms was found to be Hp 1-1 (58%), Hp 2-1 (14%) and Hp 2-2 (28%). In the hypertensive group 31 (62%) had Hp1-1 phenotype compared to 27 (54%) of the normotensives. There was no statistically significant difference between the two groups with regard to the occurrence of the Hp 1-1 phenotype in the studied groups and it relation to hypertension. Conclusion : The s...
Background: Multiple myeloma (MM) is the second most common blood cancer after lymphomas, thereby... more Background: Multiple myeloma (MM) is the second most common blood cancer after lymphomas, thereby accounting for 10% of all haematological malignancies.
Background: Chronic diarrhoea is one of the most debilitating consequences of HIV infection in su... more Background: Chronic diarrhoea is one of the most debilitating consequences of HIV infection in sub-Saharan Africa and it carries a high mortality rate. We report unexpectedly low concentrations of circulating aldosterone in 12 patients (6 men, 6 women) in the University Teaching Hospital, Lusaka, who all had diarrhoea for over one month. Changes in serum electrolytes, blood pressure, Karnofsky score and serum aldosterone concentration were being monitored during a short study of responses to saline infusion (3 litres/24 h) over 72 hours. Findings: At baseline, 9/12 (75%) of the patients were hyponatraemic, 10/11 (91%) were hypokalaemic, and 6/12 (50%) had undetectable aldosterone concentrations. Blood pressure and Karnofsky score rose and creatinine concentration fell in response to the infusion. Conclusion: Circulating aldosterone concentrations were inappropriately low and complicate the profound electrolyte deficiencies resulting from chronic diarrhoea. Management of these deficiencies needs to be more aggressive than is currently practised and consideration should be given to a formal clinical trial of mineralocorticoid replacement in these severely ill patients. If the inappropriately low aldosterone reflects a general adrenal failure, it may explain a considerable proportion of the high mortality seen both before and after initiation of anti-retroviral therapy. Findings Rationale for the study Intestinal infection leading to diarrhoea is one of the most disabling and serious manifestations of AIDS. Although anti-retroviral therapy reduces the incidence and severity of diarrhoeal disease in HIV-infection, patients still present to Zambian hospitals with advanced disease, and mortality is still unacceptably high, even after initiating anti-retroviral therapy [1]. In our previous experience, mortality exceeds 20% per month, depending on the specific aetiological infection [2]. There have been many analyses of the spectrum of opportunistic pathogen in AIDS [3-5], but surprisingly little is known about the metabolic consequences of HIV infection in Africans. It would be anticipated that patients with persistent diarrhoea would have sodium and water depletion and hypokalaemia. During a series of studies of intestinal per
Background: The immune system of patients with haematological malignancies is suppressed during c... more Background: The immune system of patients with haematological malignancies is suppressed during chemotherapy. This renders them vulnerable to frequent infections especially of the bacterial type. Timely diagnosis of these infections is difficult, because a severe infection may be asymptomatic or manifest only in the form of fever or malaise. There is need for laboratory markers that can detect an infectious process at an early stage. This study was aimed at determining the value of using Procalcitonin (PCT) and C reactive protein (CRP), for early diagnosis of infection in patients with h a e m a t o l o g i c a l m a l i g n a n c i e s r e c e i v i n g chemotherapy. Methods: This was a cross sectional study consisting of sixty eight (68) patients with haematological malignancies. Data from each participant including sex, age, clinical and laboratory data were collected after obtaining informed consent. Blood specimens were then collected for measurement of PCT, CRP and bacteriological analysis. Patients were divided into two groups; those with a culture positive and negative result. PCT and CRP concentrations were compared between groups using t-test and nonparametric statistical tests respectively. The area under ROC curve, sensitivity, specificity, likelihood ratio, and Spearman's correlation coefficient were also calculated. Results: A total of 14 (20.6%) microorganisms were isolated, of which 10 were gram-positive bacteria and 4 were gram-negative bacilli. The mean values of PCT which were 6.1ng/mL in the bacteraemia group and 5.1ng/mL in the non-bacteraemia group, p=0.023 and median CRP values were 24.2 (6.43-48.15) in the bacteraemia and 23.5 (6.03-75.44) in the non-bacteraemia group, p=0.832. The area under curves was 0.52 (95% CI=0.57-0.84) for CRP and 0.70 (95% CI=0.35-0.69) for PCT. PCT value of greater than 4.7 ng/mL is diagnostic for infections (sensitivity 86%, specificity 54%) while that of CRP was 21mg/mL with the sensitivity and specificity of 64% and 44% respectively. Elevated levels of PCT as well as fever were significantly associated with bacteraemia. Conclusion: PCT was a more reliable and sensitive marker of bacteraemia among patients with
American Journal of Tropical Medicine and Hygiene, Apr 1, 2009
We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated... more We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Objectives: The objectives of the study were to compare plasma levels of IL-6 in HIV positive and... more Objectives: The objectives of the study were to compare plasma levels of IL-6 in HIV positive and HIV negative individuals and to correlate them with CD4 count Materials and methods: A cross-sectional study was carried out at the University Teaching Hospital in Lusaka, Zambia. IL-6 and CD4 were assessed in HIV positive on ART, HIV positive ART-naïve and HIV negative control participants. Results and Conclusion: Our study showed that HIV ART naïve participants had higher IL-6 concentrations (2.83 ± 1.60 ng/ml) than those on ART (2.49 ± 1.21 ng/ml) p = 0.020. HIV negative control participants however, had higher concentrations of IL-6 (3.24 ± 1.33 ng/ml) than HIV positive participants on ART (2.49 ± 1.21) p = 0.002. HIV positive ART naïve individuals therefore, had the highest IL-6 levels. The results also showed that ART lowers inflammation in HIV and this may explain why ART reduces the risk of developing opportunistic tumours and other infections in HIV.
International journal for research in applied sciences and biotechnology, Sep 30, 2020
Acute myeloid leukaemia (AML) is a highly malignant clonal hematopoietic disease caused by both i... more Acute myeloid leukaemia (AML) is a highly malignant clonal hematopoietic disease caused by both inherited and acquired genetic alterations. Current AML classification and prognostic systems incorporate genetic information but are limited to known abnormalities that have previously been identified with the use of cytogenetics, array comparative genomic hybridization (CGH), gene-expression profiling, and the resequencing of candidate genes. At diagnosis, most patients with AML harbour at least 1 chromosome aberration in their marrow blasts. With the targeted cytogenetic therapy, 30% of the patients achieve long-term cure. At University Teaching Hospital(UTH) however, the current diagnostic approach of acute leukaemia involves mainly cytomorphology and occasional flow cytometry. The cytomorphological blast characterization is not enough to provide a critical determination of prognosis and developing a treatment plan. Most of the AML patients at UTH die within few months after diagnosis despite being put on chemotherapy. To characterize AML according to WHO 2008 revised classification in patients at the University Teaching Hospital. This was a descriptive cross-sectional study conducted to characterize acute myeloid leukaemia (AML) according to WHO 2008 revised classification in patients at the UTH. Patients with AML were simultaneously analyzed for the presence of 4 genetic abnormalities, PML/RARα for t(15;17), AML1/ETO for t(8;21), CBFβ/MYH11 for inv(16)/t(16;16) and rearrangements of the MLL gene for 11q23 abnormalities. AML was classified using the new World Health Organization (WHO) classification for haematologic malignancies. The techniques used were standardized according to the recommendations of the European BIOMED-1 Concerted Action. The overall frequency of leukemia displaying one of the four recurrent cytogenetic translocations were 13 cases (46.5%) of which PML/RARα transcript was present in six(6) patients (21.4%) (3 were bcr1, 1 bcr2 and 2 bcr3). The AML1/ETO fusion transcript was detected in only one(1) case (3.6%) with M2 morphology, but other cases with M2 morphology were negative. CBFβ/MYH11 transcript was present in 2 cases (7.1%) and some of them displaying M4Eo morphology. Finally, 4 cases (14.3%) showed rearrangements of the MLL gene. By contrast, the frequency of AML not otherwise characterized which was 15 cases (53.6%) increased with age (13% for 6-35years age group, 20% for 36-65years age group and 67% for above 66years age group). Our results differ from those reported from the United States and North/Central Europe, particularly regarding the incidence of t(15;17) and t(8;21) translocations. In Zambia the frequency of t(15;17) is higher while that of t(8;21) is lower. This supports the view that geographic variations in tumor-associated aberrations in hematologic malignancies exist. Our study showed that chromosomal alteration PML/RAR t(15,17) which was 21.4% ,was the commonest, whereas AML1/ETO t(8,21) which was 3.6%,was the least common among patients presenting at UTH, Lusaka, Zambia. Our study showed that
Objectives: The aim of the study was to investigate the association between presence of haptoglob... more Objectives: The aim of the study was to investigate the association between presence of haptoglobin phenotypes and hypertension in indigenous Zambian patients attending outpatient medical clinic at the University Teaching Hospital in Lusaka, Zambia. Methodology: The study was a descriptive, noninterventional, analytical, cross-sectional study involving haptoglobin quantification and phenotyping of hypertensive and normotensive subjects. The clinical characteristics and serum parameters of the study population were recorded and the haptoglobin phenotypes were determined. Results: The average prevalence of the Hp polymorphisms was found to be Hp 1-1 (58%), Hp 2-1 (14%) and Hp 2-2 (28%). In the hypertensive group 31 (62%) had Hp1-1 phenotype compared to 27 (54%) of the normotensives. There was no statistically significant difference between the two groups with regard to the occurrence of the Hp 1-1 phenotype in the studied groups and it relation to hypertension. Conclusion: The study showed that there is no association between haptoglobin phenotype and hypertension.
Yes-associated protein-1 (YAP-1) is a Hippo system transcription factor, which serves as an oncog... more Yes-associated protein-1 (YAP-1) is a Hippo system transcription factor, which serves as an oncogene in squamous cell carcinoma, and several solid tumors when the Hippo pathway is dysregulated. Yet, the activity of YAP-1 in ocular surface squamous neoplasia (OSSN) has not been determined. Here, we investigate the relationship between YAP-1 overexpression and OSSN. Using a cross-sectional study design, we recruited 227 OSSN patients from the University Teaching Hospitals in Lusaka, Zambia. Immunohistochemistry was used to assess YAP-1 protein overexpression in tumor tissue relative to surrounding benign squamous epithelium. OSSN patient samples (preinvasive, n = 62, 27% and invasive, n = 165, 73%) were studied. One hundred forty-nine invasive tumors contained adjacent preinvasive tissue, bringing the total number of preinvasive lesions examined to 211 (62 + 149). There was adjacent benign squamous epithelium in 50.2% (114/227) of OSSN samples. Nuclear YAP- 1 was significantly overexp...
Background: Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negat... more Background: Globally, women living with HIV have a higher risk of vulvar neoplasia than HIV-negative women. Vulvar neoplasia among women living with HIV has not previously been characterised in Zambia.Objective: This study determined the clinical and pathologic features of vulvar neoplasia among women living with HIV at the University Teaching Hospital, Lusaka, Zambia.Methods: We conducted a cross-sectional study of vulvar lesions among 53 women living with HIV who presented with vulvar lesions between July 2017 and February 2018. The study assessed clinical and histological characteristics and prevalence of high-risk human papillomavirus (HRHPV).Results: Twenty-one patients were diagnosed with vulvar squamous cell carcinoma (VSCC), 20 with usual vulvar intraepithelial neoplasm (uVIN), and the rest with either benign lesions or non-neoplastic lesions (NNL). Participants’ mean age was 40 years. Patients with VSCC were significantly older than those with NNL (mean (s.d.): 43 (21) vs 3...
HIV-1 entry requires not only CD4 molecule but also CCR5 (CD 195) and CXCR4 (CD 184) coreceptors.... more HIV-1 entry requires not only CD4 molecule but also CCR5 (CD 195) and CXCR4 (CD 184) coreceptors. A number of randomised controlled trials in Africa have reported that male circumcision (MC) reduces the risk of HIV-1 acquisition by up to 60%. Other studies have reported that sexually transmitted infections (STIs) increase the risk of infection by HIV via an inflammatory recruitment of more HIV target cells to the foreskin. Our aim was to compare the density of HIV-1 co-receptors (CCR5 and CXCR4) in naïve penile prepuce of neonates and penile prepuce of adults with and without history of ulcerative STIs at Male Circumcision Centres in Lusaka, Zambia. Twenty (20) fresh foreskin samples were included: five (5) from neonates, ten (10) from adult males without history of ulcerative STIs and five (5) from adult males with a history of ulcerative STIs. Immediately following MC, fresh foreskin specimens were fixed using 10% normal buffered formalin and transported to University Teaching Ho...
Langerhans cells (LCs) in epidermis function as sentinel antigen-presenting cells that can captur... more Langerhans cells (LCs) in epidermis function as sentinel antigen-presenting cells that can capture invading viruses like Herpes Simplex Virus, Varicella-zoster virus and Human Immunodeficiency Virus (HIV). This interaction between Langerhans cells and viruses is highly variable depending on the virus. Herpes Simplex induces apoptosis in LCs but HIV does not, instead it presents the HIV to T-cells in lymph nodes which in turn get infected. Langerhans cells in the prepuce are therefore, a portal of entry for HIV. Hence, world health organisation recommends male circumcision to reduce the densities of Langerhans cells. Fifteen fresh foreskins were obtained from adult males aged 18 years and above after circumcision, five had past history of ulcerative STI and five fresh foreskins were obtained from neonates. The specimens were fixed using 10% buffered formalin and transported to the histopathology laboratory where the tissues were grossed examined and embedded using paraffin wax. T...
A case study from the Katine parish in Uganda where the challenge of accessing antiretroviral dru... more A case study from the Katine parish in Uganda where the challenge of accessing antiretroviral drugs is exacerbated by abject poverty in the region. The article highlights the needs of the community members with HIV / AIDS in the region and the response of AMREF (the NGO working in the region) to addressing these issues.
B a c k g r o u n d : T h e r e i s e v i d e n c e t h a t multidisciplinary healthcare teams ca... more B a c k g r o u n d : T h e r e i s e v i d e n c e t h a t multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, communitybased experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74-87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.
Background: Thrombosis is a common complication in Type 2 Diabetes Mellitus (T2DM). Prolonged APT... more Background: Thrombosis is a common complication in Type 2 Diabetes Mellitus (T2DM). Prolonged APTT values have clinical relevance as an indicator of factor deficiency or the presence of coagulation inhibitors. However, there is mounting evidence that shortened APTT values in some cases may reflect a hypercoagulable state, which is potentially associated with increased thrombotic risk and adverse cardiovascular events. We set out a cross-sectional study to measure the haemostatic profiles of T2DM patients and to determine the suitability of PT-APTT as markers for hypercoagulability in T2DM patients using VWF as a gold standard.Methods: PT, APTT, VWF and Fibrinogen concentrations were measured in 213 T2DM patients and 172 non-diabetic healthy participants. VWF was used as a proxy marker for hypercoagulability in T2DM patients. Participants with VWF of >2.0 IU/ml , PT and APTT less than 11 and 30 seconds respectively, were regarded as being in hypercoagulable state.Results: The resu...
Objectives : The aim of the study was to investigate the association between presence of haptoglo... more Objectives : The aim of the study was to investigate the association between presence of haptoglobin phenotypes and hypertension in indigenous Zambian patients attending outpatient medical clinic at the University Teaching Hospital in Lusaka, Zambia. Methodology : The study was a descriptive, noninterventional, analytical, cross-sectional study involving haptoglobin quantification and phenotyping of hypertensive and normotensive subjects. The clinical characteristics and serum parameters of the study population were recorded and the haptoglobin phenotypes were determined. Results : The average prevalence of the Hp polymorphisms was found to be Hp 1-1 (58%), Hp 2-1 (14%) and Hp 2-2 (28%). In the hypertensive group 31 (62%) had Hp1-1 phenotype compared to 27 (54%) of the normotensives. There was no statistically significant difference between the two groups with regard to the occurrence of the Hp 1-1 phenotype in the studied groups and it relation to hypertension. Conclusion : The s...
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Papers by Trevor Kaile