Cholera Epidemiology in Zambia from 2000 to 2010: Implications for Improving Cholera Prevention and Control Strategies in the Country

Objective: To review the cholera epidemiology in Zambia from 2000 to 2010 in order to highlight the key lessons learned. Based on our findings, we make recommendations for improving cholera prevention and control in country.Design: Ten years descriptive cholera data was extracted from the national IDSR database and analysed.Setting: The study was conducted in Zambia using national epidemiology data which were disaggregated by Province.Subjects: NoneResults : Starting from 2003, there has been a progressive increase in yearly incidence of cholera in the country. In 2010, 6794 cases (500% increase compared to 2003) and 115 deaths (CFR 1.6%) of the disease were reported with Lusaka Province accounting for 85% of the total cases. Outbreaks start between epidemiological weeks 40 to 45 of the year and ends between weeks 20 to 25 of the following year (which correspondsto the Zambian rainy season). Outbreaks are largely confined to the peri-urban areas of Lusaka, Luapula, Southern and Copperbelt Provinces.Conclusion: In the last 10-20 years, the epidemiology of cholera in Zambia has changed; Laboratory confirmation of Vibrio cholerae in the country on a yearly basis in the last ten years suggests that the country is now endemic for cholera hence the need to review current cholera prevention and control strategies

Quality of life following a major lower limb ampu tation in Johann esburg, South Africa.

To determine the impact of lower limb amputation on qualityof life in people in the Johannesburg metropolitan area of South Africa, duringtheir reintegration to their society/community of origin.A longitudinal pre- test- post test design was utilized. Consecutive samplingwas used to recruit and interview participants (n=73) who met the inclusioncriteria. Ethical clearance was obtained. The hospitals and participants gaveinformed consent.The EQ-5D, Barthel Index, and Modified Household Economic andSocial Status Index were used to collect data. Participants were interviewed preoperatively and then followed upthree months post-operatively. Data were analysed using STATA version 10. Categorical data were analysedusing Chi-square/Fischer’s exact test and continuous data were analysed using Wilcoxon signed rank and medianregression.Most (n=21, 52.5 %) participants had no income. One participant was homeless, 17.5% (n=7) lived in shacks.The preoperative and postoperative median VAS of the EQ-5D was 60 and 70 respectively showing no significantimprovement in QOL (median EQ-5D VAS). The preoperative and postoperative median total BI score was 20 and 19respectively, showing a significant reduction in function (median total BI) three months postoperatively (p<0.001).Preoperative mobility was a predictor of postoperative quality of life. Being female was a predictor of higher qualityof life.The average EQ-5D VAS score and overall function (total BI) were generally scored high both preoperativelyand postoperatively but there was no significant improvement in EQ-5D VAS score and there was a significant reductionin function after three months. Higher scores in mobility preoperatively is a predictor of higher quality of lifepostoperatively

Determination of vigabatrin in human plasma by means of capillary electrophoresis with laser-induced fluorescence detection

A method has been developed for the quantitation of the antiepileptic drug vigabatrin in human plasma. It is based on capillary electrophoresis with laser-induced fluorescence (LIF) detection. The effect of the pH of the buffer and of N-methylglucamine addition to the background electrolyte constituent was investigated. The final background electrolyte consisted of 50 mM borate buffer, pH 9.0, with 100 mM N-methylglucamine and enabled separation within 12 min at 20 kV voltage. A solid phase extraction procedure was used for pre-treatment of biological samples, based on mixed-mode lipophilic \u2013 cation exchange cartridges, followed by a derivatisation step with 6-carboxyfluorescein-N-succinimidyl ester. Fluorescence was excited by an Ar-Ion laser (excitation wavelength = 488 nm). Linearity was observed in the 10-120 ng mL-1 plasma concentration range. Extraction yield was >96%, precision (expressed as RSD) was &lt;6.7%, accuracy (recovery) was between 97.0 and 101.6%. The method has been successfully applied to the analysis of vigabatrin in plasma of epileptic patients undergoing therapy with the drug

Enantioselective analysis of amisulpride in pharmaceutical formulations by means of capillary electrophoresis

A capillary electrophoretic method has been developed for the enantioselective analysis of amisulpride in pharmaceutical formulations, using &#946;-cyclodextrin sulfate as the chiral selector. Several parameters, such as cyclodextrin type and concentration, buffer concentration and pH and capillary temperature were investigated for method optimisation. Baseline enantioseparation of the racemic compound was achieved in less than 10 minutes using a fused silica capillary (50 &#956;m I.D. and 33.0 cm, 8.5 cm, total and effective length, respectively), filled with a background electrolyte consisting of a 10 mM citrate buffer at pH 3.5 supplemented with 0.22% (w/v) &#946;-cyclodextrin sulfate at 20\ub0C and applying a voltage of +15 kV. Formulation analysis was carried out after analyte extraction by methanol. The method was fully validated, with good results in terms of precision, selectivity, accuracy and amount of drug found with respect to the label claim. Thus, the method seems to be suitable for the enantiomeric analysis of amisulpride in pharmaceutical formulations

Application of capillary electrophoresis coupled to laser-induced fluorescence detection for the selective determination of vigabatrin in human plasma

Vigabatrin (4-amino-5-hexenoic acid) is an antiepileptic drug whose probable mechanism of action is the inhibition of GABA transaminase, which leads to reduced neuronal activity as a consequence of the increased GABA concentration. The drug is orally administered at doses ranging from 1.5 to 4 g/day and the commonly reported therapeutic plasma concentrations are between 20 and 60 &#61549;g/mL. Side effects such as fatigue, drowsiness, headache and weight gain are frequent, but also irreversible visual field defects may occur in long-term treated patients. In order to accurately and selectively determine Vigabatrin plasma levels in patients under treatment with the drug, a capillary electrophoretic method with laser-induced fluorescence (LIF) detection (laser wavelength 488 nm) has been developed. Sample pre-treatment is based on SPE with mixed-mode lipophilic-strong cation exchange (MCX) cartridges, that allowed the removal of interference and good extraction yield (>96%). Since the analyte is neither fluorescent nor UV-active, a fast (30 min) derivatisation procedure with 6-carboxyfluorescein-N-succinimidyl ester has been developed, allowing the selective determination of Vigabatrin by LIF. The BGE is composed of a pH 9 borate buffer, supplemented with N-methylglucamine in order to separate the analyte from labelling agent excess peaks. Good linearity was found over the 10-120 \ub5g/mL concentration range. The method shows good precision (RSD%&lt; 6.7). Finally, the method has been applied to the determination of the analyte in real plasma samples from patients undergoing treatment with Vigabatrin; accuracy assays gave all results between 97.0 and 101.6%. Thus, the method seems to be suitable for the therapeutic drug monitoring of Vigabatrin in epileptic patients

Analysis of pramipexole in human urine by CE-LIF after derivatisation with fluorescein isothiocyanate

Pramipexole (4,5,6,7-tetrahydro-N6-propyl-2,6-benzothiazolediamine) is a non-ergoline dopamine agonist, approved for the treatment of Parkinson\u2019s disease as a monotherapy or in combination with levodopa in advanced disease patients with reduced response to levodopa. Pramipexole is orally administered as the dihydrochloride salt, at a starting dose of 0.375 mg/day, which is gradually increased up to 4.5 mg/day. Common side effects are orthostatic hypotension, dyskinesias, constipation, asthenia, insomnia hallucinations and others. Pramipexole undergoes a minimum hepatic metabolism, therefore 90% of the drug is eliminated unchanged in the urine, which represents the main elimination pathway. Pramipexole clearance can be reduced in several cases, such as in the elderly and in patients with renal insufficiency. Only a few HPLC methods, and no capillary electrophoretic method, can be found in the literature for the determination of Pramipexole. In order to accurately determine urinary Pramipexole levels in patients undergoing treatment, a method based on capillary electrophoresis with LIF (laser-induced fluorescence) detection has been developed. The method employs uncoated fused silica capillaries (75 \ub5m internal diameter, 60 cm effective length) and a BGE composed of borate buffer containing tetrabutylammonium bromide and acetone. A complete removal of interference is obtained by means of a liquid/liquid extraction procedure with ethyl acetate, followed by derivatisation with fluorescein isothiocyanate at pH 9, which allows the detection by LIF (laser wavelength: 488 nm). A complete electrophoretic run lasts about 12 min when applying a 20 kV voltage, allowing the determination of Pramipexole in human urine. The method achieves satisfactory sensitivity, with LOD and LOQ values corresponding to 2 and 5 ng/mL, respectively. Preliminary results are very promising and the method is now undergoing validation

Separation of ethoxylated bisphenol A dimethacrilates in dental composite after derivatisation to ionisable amines by capillary zone electrophoresis

Bisphenol A ethoxylate dimethacrylates (Bis-EMA) are transformed into ionisable amines by derivatisation in order to make the analytes applicable to capillary electrophoresis. For this goal, piperidine was added onto the C=C double bond of the alpha,beta-unsaturated ester group forming a tertiary amine with pKa values between 9 and 10. Formation of the derivatives was confirmed by electrospray ionisation MS. Commercial Bis-EMA is a mixture of homologues with different number of ethoxy groups; it is characterised by the average number of the ethoxy groups in the chains. These homologues were resolved by capillary zone electrophoresis at pH 4. It is shown for the product with an average of four ethoxy groups per Bis-EMA molecule that about seven homologues can be baseline separated when differing by only one ethoxy group. For Bis-EMA with 30 ethoxy groups in average, about 23 homologues could be differentiated. The high resolution power of capillary zone electrophoresis enables characterisation of commercial dental composite material concerning the Bis-EMA constituents