Role of pharmacogenetics in rifampicin pharmacokinetics and the potential effect on TB–rifampicin sensitivity among Ugandan patients

BACKGROUND: Suboptimal anti-TB drugs exposure may cause multidrug-resistant TB. The role of African predominant SLCO1B1 variant alleles on rifampicin pharmacokinetics and the subsequent effect on the occurrence of Mycobacterium tuberculosis-rifampicin sensitivity needs to be defined. We describe the rifampicin population pharmacokinetics profile and investigate the relevance of SLCO1B1 genotypes to rifampicin pharmacokinetics and rifampicin-TB sensitivity status. METHODS: Fifty patients with TB (n=25 with rifampicin-resistant TB and n=25 with rifampicin-susceptible TB) were genotyped for SLOC1B1 rs4149032 (g.38664C>T), SLOC1B1*1B (c.388A>G) and SLOC1B1*5 (c.521 T>C). Steady state plasma rifampicin levels were determined among patients infected with rifampicin-sensitive TB. Data were analysed using NONMEM to estimate population rifampicin pharmacokinetics as well as the effect of SLOC1B1 genotypes on rifampicin pharmacokinetics and on rifampicin-TB sensitivity status. RESULTS: Overall allele frequencies of SLOC1B1 rs4149032, *1B and *5 were 0.66, 0.90 and 0.01, respectively. Median (IQR) Cmax and Tmax were 10.2 (8.1-12.5) mg/L and 1.7 (1.125-2.218) h, respectively. Twenty-four percent of patients exhibited Cmax below the recommended 8-24 mg/L range. SLOC1B1 genotypes, gender and age did not influence rifampicin pharmacokinetics or TB-rifampicin sensitivity. CONCLUSIONS: Although SLOC1B1 genotype, age and gender do not influence either rifampicin pharmacokinetics or rifampicin-TB sensitivity status, one in every four Ugandan TB patients achieve subtherapeutic plasma rifampicin concentrations

Effect of the ferrule design on fracture resistance of teeth restored with prefabricated posts and composite cores

Magister Scientiae Dentium - MSc(Dent)The treatment objectives in the restoration of an endodontically treated tooth are maximum retention of post and core and to create a design in which the tooth is preserved when the restoration fails. The ferrule effect in root treated teeth requiring cast post and core has been studied extensively and has been shown to greatly improve fracture resistance (Gluskin et al 1995, Libman & Nicholls, 1995. Hemmings et al, 1991. Barkhordar et al, 1989. Rosen & Partida-Rivera, 1986). Studies have also shown that in the case of cast post and core, the longer the ferrule, the greater the fracture resistance (Libman and Nicholls, 1995). The use of the new bonding agents, composite resin cements and core materials, have led to a more conservative approach to post and core restorations. However few studies have considered the effect of different ferrule designs on prefabricated post and composite core systems (Volwiler et al 1989, Al Hazaimeh and Gutteridge 2001). There is little information as to whether the ferrule is of additional value in providing reinforcement in these restorations. This study investigated the effects of different ferrule designs on the fracture resistance of teeth incorporating prefabricated posts and composite cores. In addition teeth restored with a composite core but with no prefabricated post were included in the study to assess the necessity of a post in the restoration of endodonticallytreated teeth. Sixty extracted maxillary incisors (centrals and laterals) and carunes were randomly assigned into three groups and restored. Two groups had a prefabricated post and composite core with varying ferrule designs. A third group had a core with composite packed into the root canal but no post. All teeth were restored with cast crowns to simulate the clinical situation. A Zwick universal testing machine was used to apply compressive loads progressively on the restored teeth until failure occurred as a result of either root, tooth or post fracture. Failure loads, modes of fracture, post and core systems and tooth preparation were recorded and statistically analysed. The results showed no significant difference in the amount of force needed to break the teeth in the different groups irrespective of whether the teeth had a ferrule or not. They also showed no significant difference in the amount of force needed to break the teeth in the different groups irrespective of whether the teeth had a post or not

Perceptions of undergraduate dental students at Makerere College of Health Sciences, Kampala, Uganda towards patient record keeping

Background. The creating, maintenance and storage of patients’ medical records is an important competence for the professional training of a dental student.Objective. Owing to the unsatisfactory state of dental records at the students’ clinic, the objective of this study was to obtain information from undergraduate dental students on the factors that affect this process and elicit recommendations for improvement.Methods. This qualitative cross-sectional study used focus group discussions with 4th- and 5th-year dental students for data collection. Data were captured through a written transcript and an audio recorder. The data were transcribed and analysed manually through developing themes, which were compared with the literature and interpreted.Results. Three themes emerged: (i) Poorly designed clerking forms. The clerking forms were deemed to have a poor design with inadequate space for clinical notes. It was recommended that they be redesigned. (ii) Inadequate storage space. Space for storing patient records was deemed inadequate and a referencing system for file retrieval was lacking. It was recommended that more space be allocated for storage, with a referencing system for easy file retrieval. (iii) Poor maintenance of records. Patients’ records, especially radiographs, were not well labelled and stored. It was recommended that drug envelopes be utilised to store radiographs. An electronic system was deemed the ultimate solution to this problem.Conclusion. The general perception was that the current paper-based record system at the clinic was unsatisfactory. Therefore, there is a need to improve the maintenance and storage of records, and to change to a more efficient electronic system. The students’ attitude towards record keeping was found to be questionable, with a need to be addressed as part of teaching and learning in the curriculum. Lecturers were deemed to have a bigger role to play in the record-keeping process

Alex Baine's women's emancipation in Uganda: a visual archive of the history of a new generation of women in Uganda

Alex Baine is a contemporary Ugandan woman artist who graduated from the Margaret Trowell School of Industrial and Fine Art (or MTSIFA) in 1989. During her final year, she painted a large work, Women's Emancipation in Uganda (Fig. 1) (1989), in which she represented women in domestic and nondomestic (conventional and unconventional) economies, spaces, and histories. Baine has not produced any other painting since her graduation. It is evident that Baine's art career, like those of several other female graduates of the Art School, has been interrupted by many issues including family, business, further education, and diversion into other professions. However, in this article I acknowledge that she championed women's emancipation in Uganda's contemporary art in the 1980s, a debate that I trace in her work