Situs inversus with renal neoplasm: a case report

This is a case report of a 43-year male patient who presented at the University  Teaching Hospital (UTH), Lusaka, Zambia with a histologically proven renal cell carcinoma and during the course of the investigations, the patient was also found to have situs inversus totalis

Association of HIV with Breast Abscess and Altered Microbial Susceptibility Patterns

Background: Breast abscesses account for 15% of surgical day cases seen in the University Teaching Hospital (UTH) in Lusaka, Zambia. Nearly all of these cases occur in lactating women. Pre-natal HIV prevalence among women seeking care at UTH was estimated at 25% as of 2004. Baseline surveys have shown that up to 60% of soft tissue infections presenting to the UTH are HIV related.Objectives: To determine if HIV infection is a risk factor for the development of breast abscesses in women presenting to the (UTH). Secondary objective was to identify bacteriological aetiologies and drug sensitivity patterns associated with breast abscesses at UTH.Study Design: A case-control study of 110 consecutive breast-feeding mothers diagnosed with breast abscess upon presentation to the UTH surgical service (cases) and 110 representative controls recruited from the UTH postnatal clinic.Main Outcomes: HIV seropositivity and CD4 counts (if HIV positive) among cases and controls.Results: Fifty-four out of 110 (49.1%) lactating women with breast abscess had positive serologic tests for HIV. Only 25 of 110 (23%) control women tested HIV positive. This difference was statistically significant, with an odds ratio of 3.28 (95% CI 1.83–5.87; p = 0.001). Mean CD4 counts in cases were lower than in controls (338 vs. 568, p<0.001). Staphyloccocus aureus was the main causative agent (91.8%) of isolates. Among S. aureus isolates, 70 of 101 (69.3%) were oxacillin susceptible. Forty-three of 50 (86.0%) specimens from HIV positive patients were resistant to SMX-TMP compared with only 61% of specimens from HIV negative patients (p=0.004).Conclusions: HIV infection appears to be a significant risk factor in the development of breast abscess in lactating women in Zambia. Staphylococcus aureus remains the main causative agent, with MRSA accounting for 30.7% of isolates. SMX-TPM resistance likely stems from the wide spread use of the drug for PCP prophylaxis in HIV positive patients. It therefore should not be used for treatment of acute bacterial infections. HIV related breast infections could be considered as a possible entry point to HIV treatment now that the CD4 treatment guidelines have been adjusted to 350cells/cmm, although this requires further studies for validation. Keywords: HIV, breast, abscess, drug resistance, Zambia, MRS

Pattern of Bladder Cancer at University Teaching Hospital, Lusaka, Zambia in the era of HIV Epidemic

Background: Human Immunodeficiency Virus (HIV) is endemic to Zambia and is associated with changes in the patterns of both AIDS and non- AIDS defining cancers. Bladder cancer is one malignancy that has been noted toincrease in the era of HIV/ AIDS epidemic. This study sought to describe the pattern of cancer of the bladder at UTH in the era of HIV/AIDS epidemic in respect with the epidemiological characteristics, prevalence of HIV infection and the histological types of bladder cancer in patients with cancer of the bladder.Patients and Methods: A prospective cross sectional, hospital based study was performed at the University Teaching Hospital (UTH), Lusaka, Zambia, between November 2009 and November 2010. Patients with bladder cancer who presented to the hospital during this period were recruited and  parameters studied included patients demographics, HIV status and pathology of cancer. Data collected was analyzed using SPSS 17.Results: A total of 53 patients with median age of 57.49 years who had histological confirmed bladder cancer were recruited during this one year period. The male to female ratio was 1.3 to 1. Of the 53 patients, HIV infection was found in six patients (11.3 %). Squamous cell carcinoma was the most common histological type (60.4%) followed by Transitional cell carcinoma (30.2%) and adenocarcinoma was least common type (9.4%).Schistosoma infection was found in 14 patients all had SCC. The study found a statistically significant reduction in the mean age of bladder cancer in HIV infected patients.Conclusions: Squamous cell carcinoma is still the most common histological type of bladder cancer in Zambia and it's strongly associated with schistosomia infection. Haematuria remains to be the most common presenting symptom in bladder cancer patients

Pattern of Bladder Cancer at University Teaching Hospital, Lusaka, Zambia in the era of HIV Epidemic

Background: Human Immunodeficiency Virus (HIV) is endemic to Zambia and is associated with changes in the patterns of both AIDS and non- AIDS defining cancers. Bladder cancer is one malignancy that has been noted to increase in the era of HIV/ AIDS epidemic. This study sought to describe the pattern of cancer of the bladder at UTH in the era of HIV/AIDS epidemic in respect with the epidemiological characteristics, prevalence of HIV infection and the histological types of bladder cancer in patients with cancer of the bladder.Patients and Methods: A prospective cross sectional, hospital based study was performed at the University Teaching Hospital (UTH), Lusaka, Zambia, between November 2009 and November 2010. Patients with bladder cancer who presented to the hospital during this period were recruited and parameters studied included patients demographics, HIV status and pathology of cancer. Data collected was analyzed using SPSS 17.Results: A total of 53 patients with median age of 57.49 years who had histological confirmed bladder cancer were recruited during this one year period. The male to female ratio was 1.3 to 1. Of the 53 patients, HIV infection was found in six patients (11.3 %). Squamous cell carcinoma was the most common histological type (60.4%) followed by Transitional cell carcinoma (30.2%) and adenocarcinoma was least common type (9.4%). Schistosoma infection was found in 14 patients all had SCC. The study found a statistically significant reduction in the mean age of bladder cancer in HIV infected patients.Conclusions: Squamous cell carcinoma is still the most common histological type of bladder cancer in Zambia and it's strongly associated with schistosomia infection. Haematuria remains to be the most common presenting symptom in bladder cancer patients.

A pilot study to compare HIV status, cervical and penile pathology among couples attending the urology unit at the University Teaching Hospital Lusaka, Zambia

Background: Cancer of the cervix is the most common malignancy in women of childbearing age in Zambia. It is known to be associated with HIV infection and oncogenic strains of HPV. However, there are few studies of penile lesions as a predictor of malignant and premalignant cervical lesions in female partners.Objectives: The aim of the study was to determine the association between men with penile lesions and premalignant cervical lesions in their female partners.Design: Thirty-seven couples were screened for penile and cervical lesions to determine the association between the two. The male partners had a biopsy and the female partners had a Pap smear.Results: Among 37 female partners, 29 (78.3%) had some type of cervical lesion. Two (5.4%) were undetermined and 6 (16.3%) of the females had normal Pap smears. Among the spouses with diseased cervices 22 (59.4%) were premalignant and 5 (13.5%) were malignant. The combined prevalence of malignant or premalignant cervical lesions among female partners was 73.0%. The HIV prevalence in the cohort was 88.9% (among those who agreed to be tested). The prevalence of premalignant or malignant cervical lesions was 75% in HIV positive and HIV negative females, and 66.7% in those who refused HIV testing.Conclusion: This small pilot study suggests a high prevalence of premalignant or malignant lesions in females whose partners have penile lesions. In this cohort, HIV infection was not associated with a higher risk of neoplastic cervical lesions.Keywords: Cervical cancer, penile cancer, HIV, Pap smear, Zambi

Pre-operative bladder irrigation with 1% Povidone iodine in reducing open prostatectomy surgical site infection (SSI) at university teaching hospital, Lusaka

Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group assignments.Methodology: One hundred and thirty patients were recruited from the waiting list of Urology unit II in the department of surgery during the period between July 2011 to December 2012. The non-probability convenience sampling technique was used. Any consenting patient who presented to the department of surgery for open prostatectomy and fulfills the inclusion criteria was selected. The patients were randomly allocated to each of the two groups. Each group had 65 patients. Patients in the study group had their bladder irrigated with 1% 50cc povidoneiodine which was drained upon opening the bladder followed by enucleating the adenomatous prostate gland. Hemostasis was ensured and a 3 way Foley's catheter inserted via the urethral into the bladder and ballooned appropriately for draining and irrigation. The bladder was sutured in 2 layers using 0 or 1 chromic catgut. In the control group povidone-iodine was not used. Both groups received pre-operative antibiotics 30 minutes before incision and post-operative for 5 days. Pre-operative, intraoperative and post-operative data were collected on a standardized data collection forms. Post-operative irrigation was done for 9 to 12 days after which the catheter was removed as an outpatient. Patients were followed up in the urological clinic at 1 week, 2weeks and at 4 weeks post-operatively to assess whether they had developed surgical site infections according to CDC guidelines. Data was analyzed using SPSS version 16.Results: The patients mean age was 71.1 in the control group and 71.4 in the study group with no statistically significant difference (t=0.318; p=0.75; df=126.89). The overall surgical infection rate was 16.2%. In the control group 15 out of 65 patients (23.1%) developed SSIs. While in the study group 6 out of 65 patients (9.2%) developed SSIs. The difference in the rates of SSI between the two groups was statistically significant (÷²; p<0.05; df=126.89) Escherichia coli was the most predominant organism 13/37 (35%), streptococcus 7/37 (18.9), Citrobacter koseri 5/37 (13.5%), Klebsiella sp 4/37 (10.8%). Escherichia coli, Streptococcus and Citrobacter were sensitive to ciprofloxacin; Pantoea agglomerans was sensitive to ceftazidime while Staphylococcus coagulase was sensitive to imipenem. Enterobacter cloace was resistant to all antibiotics used.Conclusion: The study found that irrigating the bladder with 1% povidone-iodine resulted in significant reduction in post prostatectomy surgical site infection, Escherichia coli as the most common causative organism, reduced morbidity and post-operative hospital stay in the povidone iodine group.Key words: Benign prostatic hyperplasia, transvesical prostatectomy, povidone iodine, surgical site infections

Solar photovoltaic energy progress in Zambia : a review

Abstract: Regionally, Southern Africa is facing many challenges with regard to the level of access to energy. The situation is most compounded in the rural areas where poverty and lack of development are taking place at a snail pace. In order to achieve and promote sustainable development, the use of solar energy has been regarded by the government of Zambia and the sub-Saharan African region as the best alternative to the current energy deficit that the region is facing. To begin with, the government of Zambia, in the last decade, has supported solar photovoltaic energy research and development. However, the country has had challenges with achieving the set targets of connecting 10,000 new household by 2013 and ended up reducing the target to 2500 households of which 500 household of the proposed target was connected in 2015. This review is a desktop study of the on-going research on the solar energy and policy analysis of Zambia. It reviews the current solar photovoltaic and renewable energy trends in Zambia based on secondary data collected from various literatures, reports, and local contacts. The paper also highlights some of the solar energy achievements and failures in Zambia such as the 50MW solar mini-grid with the lowest tariff of US$0.0602 unit per kilowatt-hour and as well as the efforts, the government of Zambia has made through the help of international donors and the World Bank to scale up initiatives. Finally, it has also discussed the Zambian government policies and initiatives to promote deployment of solar energy technologies in the country. The review of solar photovoltaic energy is vital, as it will help the decision makers and various stakeholders to understand the current renewable status, barriers and challenges in Zambia and find alternative ways to overcome these challenges and barriers

HIV and male fertility at the University Teaching Hospital Lusaka

Background: There has been anecdotal evidence of a declining male fertility in Zambia over the last 10 years1. This prospective study of men seen in the fertility clinic was designed to look for an association between the increasing HIV infection in the population and male fertility.Methods: This prospective study compared the prevalence of HIV in men with a confirmed diagnosis of infertility seen at the Urology Clinic, to the national HIV prevalence among men of child bearing age. The study was done from October 2006 to October 2007.Results: A total of 34 men were diagnosed with infertility and included in the study. Among these patients 9 were seropositive. This gave an HIV prevalence of 26%. There was a statistically significant difference with the normal population of 13% (p = 0.043).Conclusion: HIV infection is higher in men seeking fertility treatment than in the general population. Further studies are required to determine the precise relationship between HIV and Male Fertility at the University Teaching Hospital Lusaka

The Pattern of Urological Cancers in Zambia

Objective: To examine the pattern of urological malignancies, particularly cancer of the bladder, seen at the University Teaching Hospital (UTH) in Lusaka and to compare the findings with previous studies on the same parameters done at UTH. Material and Methods: A retrospective study of urological cancers in Zambia was performed, based on histopathology reports of specimens reviewed at the UTH Pathology Laboratory inLusaka, Zambia, between January 1990 and December 2005. The parameters studied were the histological type of the cancer, patient age and trends over a 15-year period. Results: In total, 8829 cancers were diagnosed during the study period, of which 749 (8.5%) were urological malignancies affecting the kidney, bladder, prostate, testis or penis. The maleto- female ratio of the urological cancers was 10.7 to 1. Cancer of the prostate was the most common urological malignancy (54.6%), followed by bladder cancer (21.1%) and penile cancer (18.6%). The histological type of bladder cancer was mainly squamous cell carcinoma (46.2%), transitional cell carcinoma (23.4%) and adenocarcinoma (22.2%); other types (8.2%) included rhabdomyosarcoma, small cell carcinoma and lymphoma. The majority of patients (79%) with bladder cancer were between 56 and 65 years of age. Whereas 20 years ago prostate cancer comprised only 26% of urological malignancies, it accounted for 55% of urological cancersdiagnosed in Zambia between 1990 and 2005. In contrast, cancer of the penis, kidney and testis have shown no change in frequency distribution compared to 20 years ago. Conclusion:Over the last 15 years there has been an increasing proportion of cancer of the prostate and squamous cell carcinoma of the bladder. This is associated with high levels of schistosomiasis, cystitis (some of which is HIV-related) and bladder stones. It may also be due to the extension of urological services and the diagnostic armamentarium (PSA, cystoscopy and histologicaldiagnosis) to indigent rural populations, where the incidence of squamous cell carcinoma is likely to be higher than in affluent urban populations

A Review of Outcome of Postgraduate Medical Training in Zambia

The University of Zambia School of Medicine was opened in 1966. Since inception, over 1200 undergraduate students have graduated with Bachelor of Medicine and Bachelor of Surgery. The postgraduate Master of Medicine (M.Med)programme was started in 19822 with the intention of providing district specialists in the rural and semi urban communities of Zambia. Additional hope was to stem the brain drain to other countries. This is a study to describe the deployment of graduates of the M.Med training programs at the University of Zambia School Of Medicine in relation to the objectives defined by the University of Zambia senate in 1981. It was found that the School of Medicine has produced 118 Master of Medicine graduates in 5 clinical programs over a period of 22 years. The average graduation rate is 5 students per annum. The largest specialist group has been in General surgery with 34 (29% ) of all graduates. The ratio of men to women was 3 to 1. The ratio of Zambian to Non Zambian ratio was 10:1. Of all students who have graduated over this period 13 (11%) have gone abroad and 7(6%) have died., Eighty-eight (75%) of the graduates are working along the line of rail in the 5 most urbanized towns in the country. Twenty-five ( 21%) are doing non clinical jobs which involve health programs administration and 12 (10%) are working in private practice. We concluded that external migration is not a major problem and, overall, the creation of a local postgraduate training program has reduced brain drain. The key challenge is internal brain drain