Determination of LDL-cholesterol: direct measurement by homogeneous assay versus Friedewald calculation among Makerere University undergraduate fasting students

The treatment of patients for coronary heart disease risk requires knowledge of the plasma lipid levels. Low density lipoprotein cholesterol (LDL) levels make a strong basis for therapeutic decisions. Although there are incongruities among values of LDL from different methods of determining LDL, the clinician is not routinely informed of the method used. The purpose of this study was to compare LDL levels determined by the Friedewald equation with those assayed by the Kyowa Madox method. The lipid results previously measured by Kyowa Madox method among Makerere University fasting students and reported earlier wereretrieved. The measured values of total cholesterol (TC), High Density Lipoprotein cholesterol (HDL) and triacylglycerols (TG) were used to calculate LDL using Friedewald equation in which LDL= TC-HDL-TG/2.2mmol/L. The values obtained were compared non parametrically with the assayed values previously reported. Our results showed a high value of correlation between measured and calculated LDL so that in general, the two methods can be used interchangeably in this population. However, in cases of dyslipidaemia, the calculated values tend to be lower than the assayed values. It is therefore recommended that clinical laboratories should report the LDL values along with the determination method used, the alert values, the reference ranges, the desirable ranges and the therapeutic targets. © 2010 International Formulae Group. All rights reserved.Keywords: Homogeneous assay, LDL cholesterol, direct measurement, Friedewald equation, comparison

Plasma levels of DDT/DDE and liver function in malaria control personnel 6 months after indoor residual spraying with DDT in northern Uganda, 2008

Objective. We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS). Method. This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrations of amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase (GGT) were analysed using routine clinical chemistry-automated methods (Konelab, Vantaa, Finland). Results. All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (±26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) µg/l. Conclusion. Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available

Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Pneumonia is a leading cause of children's deaths in developing countries and hinders achievement of the fourth Millennium Development Goal. This goal aims to reduce the under-five mortality rate, by two thirds, between 1990 and 2015.</p> <p>Few studies have examined the impact of zinc adjunct therapy on the outcome of childhood pneumonia. We determined the effect of zinc as adjunct therapy on time to normalization of respiratory rate, temperature and oxygen saturation. We also studied the effect of zinc adjunct therapy on case fatality of severe childhood pneumonia (as a secondary outcome) in Mulago Hospital, Uganda.</p> <p>Methods</p> <p>In this double blind, randomized, placebo-controlled clinical trial, 352 children aged 6 to 59 months, with severe pneumonia were randomized to zinc (20 mg for children ≥12 months, and 10 mg for those < 12 months) or a placebo once daily for seven days, in addition to standard antibiotics for severe pneumonia. Children were assessed every six hours. Oxygen saturation was normal if it was above 92% (breathing room air) for more than 15 minutes. The respiratory rate was normal if it was consistently (more than 24 hours) below 50 breaths per minute in infants and 40 breaths per minute in children above 12 months of age. Temperature was normal if consistently below 37.5°C. The difference in case fatality was expressed by the risk ratio between the two groups.</p> <p>Results</p> <p>Time to normalization of the respiratory rate, temperature and oxygen saturation was not significantly different between the two arms.</p> <p>Case fatality was 7/176 (4.0%) in the zinc group and 21/176 (11.9%) in the placebo group: Relative Risk 0.33 (95% CI 0.15 to 0.76). Relative Risk Reduction was 0.67 (95% CI 0.24 to 0.85), while the number needed to treat was 13. Among HIV infected children, case fatality was higher in the placebo (7/27) than in the zinc (0/28) group; RR 0.1 (95% CI 0.0, 1.0).</p> <p>Among 127 HIV uninfected children receiving the placebo, case fatality was 7/127 (5.5%); versus 5/129 (3.9%) among HIV uninfected group receiving zinc: RR 0.7 (95% CI 0.2, 2.2). The excess risk of death attributable to the placebo arm (Absolute Risk Reduction or ARR) was 8/100 (95% CI: 2/100, 14/100) children. This excess risk was substantially greater among HIV positive children than in HIV negative children (ARR: 26 (95% CI: 9, 42) per 100 versus 2 (95% CI: -4, 7) per 100); <it>P</it>-value for homogeneity of risk differences = 0.006.</p> <p>Conclusion</p> <p>Zinc adjunct therapy for severe pneumonia had no significant effect on time to normalization of the respiratory rate, temperature and oxygen saturation. However, zinc supplementation in these children significantly decreased case fatality.</p> <p>The difference in case fatality attributable to the protective effect of zinc therapy was greater among HIV infected than HIV uninfected children. Given these results, zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy</p> <p>naïve HIV infected children in our environment.</p> <p>Clinical trials registration number</p> <p>clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00373100">NCT00373100</a></p

Prevalence of dyslipidaemia and associated risk factors in a rural population in south-western Uganda : a community based survey

BACKGROUND: The burden of dyslipidaemia is rising in many low income countries. However, there are few data on the prevalence of, or risk factors for, dyslipidaemia in Africa. METHODS: In 2011, we used the WHO Stepwise approach to collect cardiovascular risk data within a general population cohort in rural south-western Uganda. Dyslipidaemia was defined by high total cholesterol (TC) ≥ 5.2 mmol/L or low high density lipoprotein cholesterol (HDL-C) 6% (men aOR=3.00, 95%CI=1.37-6.59; women aOR=2.74, 95%CI=1.77-4.27). The odds of high TC was also higher among married men, and women with higher education or high BMI. CONCLUSION: Low HDL-C prevalence in this relatively young rural population is high whereas high TC prevalence is low. The consequences of dyslipidaemia in African populations remain unclear and prospective follow-up is required

Thyroid hormones profile in students of Makerere College of Health Sciences in Kampala Uganda

Serum concentrations of thyroxine (T4), triiodothyronine (T3) and Thyroid Stimulating Hormone (TSH) are used to assess thyroid function. It is recommended that each laboratory or hospital should establish its own reference values of T4, T3 and TSH for their clients because these hormones vary with ethnicity, geographical and climatic conditions of a population. There is no documented study which has been done to determine the Thyroid hormones profile in Ugandan general population. This study is one of the first attempts to determine Thyroid hormones profile in healthy Ugandans. The main objective of this study was to determine the thyroid hormones profile of students of the Makerere College of Health Sciences in Kampala, Uganda. A cross sectional descriptive study was done involving 72 students, with the mean age of 24.17 ± 4.48 years. Subjects who volunteered to participate in the study were interviewed; their height and body weight measured, 5ml of blood withdrawn, and sera harvested. FT4 and T3 Radioimmuno Assay (RIA) were done and TSH was assayed using Immunoradiometric Assay (IRMA) technique. The mean serum concentration of FT4 was 17.016 ± 3.847 ρmol/L. For T3, mean serum concentration was 1.43 ± 0.825 nmol/L, and mean serum TSH level was 2.412 +2.284 μIU/ml. Variations of serum concentrations of FT4, T3 and TSH with sex, age, or region of origin were not statistically significant. Serum concentration of TSH increased with increased body mass index (BMI). It was 2.073 ± 1.907 μIU/ml for subjects with BMI of ≤ 24.9 Kg/m2, 3.588 ± 1.495 μIU/ml for subjects with BMI of 25 - 29.9 kg/m2 and 4.450 ± 0.593μIU/ml for subjects with BMI ≥ 30kg/m2 (P=0.009). However, BMI had no effect on serum concentrations of FT4 and T3. Serum concentrations of T4, T3 and TSH obtained from this study all differ with the values which are currently used as reference ranges in the country. We recommend a similar study involving a population representative of Ugandans to be conducted so as to establish normal reference values of T4, T3 and TSH for Ugandans. We also recommend BMI of patients to be taken into consideration during interpretation of serum TSH concentrations results

Thyroid hormones profile in students of Makerere College of Health Sciences in Kampala Uganda

Serum concentrations of thyroxine (T4), triiodothyronine (T3) and Thyroid Stimulating Hormone (TSH) are used to assess thyroid function. It is recommended that each laboratory or hospital should establish its own reference values of T4, T3 and TSH for their clients because these hormones vary with ethnicity, geographical and climatic conditions of a population. There is no documented study which has been done to determine the Thyroid hormones profile in Ugandan general population. This study is one of the first attempts to determine Thyroid hormones profile in healthy Ugandans. The main objective of this study was to determine the thyroid hormones profile of students of the Makerere College of Health Sciences in Kampala, Uganda. A cross sectional descriptive study was done involving 72 students, with the mean age of 24.17 ± 4.48 years. Subjects who volunteered to participate in the study were interviewed; their height and body weight measured, 5ml of blood withdrawn, and sera harvested. FT4 and T3 Radioimmuno Assay (RIA) were done and TSH was assayed using Immunoradiometric Assay (IRMA) technique. The mean serum concentration of FT4 was 17.016 ± 3.847 ρmol/L. For T3, mean serum concentration was 1.43 ± 0.825 nmol/L, and mean serum TSH level was 2.412 +2.284 μIU/ml. Variations of serum concentrations of FT4, T3 and TSH with sex, age, or region of origin were not statistically significant. Serum concentration of TSH increased with increased body mass index (BMI). It was 2.073 ± 1.907 μIU/ml for subjects with BMI of ≤ 24.9 Kg/m2, 3.588 ± 1.495 μIU/ml for subjects with BMI of 25 - 29.9 kg/m2 and 4.450 ± 0.593μIU/ml for subjects with BMI ≥ 30kg/m2 (P=0.009). However, BMI had no effect on serum concentrations of FT4 and T3. Serum concentrations of T4, T3 and TSH obtained from this study all differ with the values which are currently used as reference ranges in the country. We recommend a similar study involving a population representative of Ugandans to be conducted so as to establish normal reference values of T4, T3 and TSH for Ugandans. We also recommend BMI of patients to be taken into consideration during interpretation of serum TSH concentrations results

The interface between blood preparation and use in Uganda

Background and Objectives The interface between preparation and use of blood impacts directly on the outcome of hemotherapy. The present study explores the knowledge and opinions of key players at, practical realities at, and quality improvement strategies of this interface. Materials and Methods We surveyed clinicians (n = 81) and blood bank staff (n = 25) to assess their knowledge on key issues in their counterparts' working domains, the turnaround time on effecting a blood order from a hospital transfusion laboratory and strategies to improve communication of blood needs to blood banks. Results Out of 81 clinicians, 20 knew the four available blood products while only 17 knew the three uses of these products. Twenty-three blood bank staff reported the patient's condition as the main factor on which blood orders are based. Forty-four (54.3%) clinicians reported reception of a blood product within an hour of placing the order. Addressing infrastructure and human resource were some of the strategies suggested to improve this step of the transfusion chain. Conclusions The knowledge of staff at the extreme ends of the clinical interface in their counterparts' working domain is far from adequate. However, they have well formed opinions on strategies to improve this interface

Kidney function and DDT value comparison in pre- and post-spray plasma of the spray personnel in Northern Uganda in 2008

In-door residual spray of the insecticide dichlorodiphenyltrichloroethane was re-introduced for malaria control in Uganda and there was need to assess its health impact among the spray personnel. To compare kidney function and the insecticide values in pre-and post-spray plasma of spray persons in northern Uganda, heparinized blood samples were analyzed in the Department of Pathology, College of Health Sciences, Makerere University, for the insecticide and its main metabolite dichlorodiphenylethane using enzyme linked immunosorbent assay kits from AbraxisTM (USA). Urea and creatinine were analyzed on KonelabTM (Finland) chemistry analyzer. The 109 pre-spray samples had mean (SD) values of the insecticide/metabolite of 63 (19) while the 96 post-spray samples had mean (SD) of 77 (26) ppb. The 96 prespray samples had urea concentration mean (SD) of 3.50 (1.11) mmol/L while 119 post-spray samples had mean (SD) of 3.86 (1.07) mmol/L. The pre-spray samples had creatinine mean (SD) of 65.58 (12.05) μmol/L whereas the post-spray had mean (SD) of 79.82 (14.81) μmol/L. The post-spray urea and creatinine values were higher than the pre-spray (

Plasma vitamin C concentration in pregnant women with pre-eclampsia in Mulago hospital, Kampala, Uganda

Background: Oxidative stress plays a role in the aetiology of pre-eclampsia and vitamin C may prevent pre-eclampsia. Objective: To determine the association between plasma vitamin C and pre-eclampsia in Mulago Hospital, Kampala, Uganda. Methods: This case-control study was conducted at Mulago Hospital from 1st May 2008 to 1st May 2009; 207 women were the cases and 352 women were the controls. Plasma vitamin C was assayed in the women using a colorimetric method. An independent t test was used to find the difference in the means of plasma vitamin C and logistic regression was used to find the association between plasma vitamin C and pre-eclampsia. Results: The mean plasma vitamin C was 1.7(SD=0.7) x 103 μg/L in women with pre-eclampsia and 1.9(SD=0.7) x 103 μg/ L in women with normal pregnancy (P=0.005). Women with low plasma vitamin C were at an increased risk of pre-eclampsia (OR 2.91, 95% CI: 1.56-5.44). Conclusion: There was a strong association between low plasma vitamin C, and pre-eclampsia in women attending antenatal clinics at Mulago Hospital, Kampala. Health workers need to advise women at risk in the antenatal period about diet, especially foods which are rich in vitamin C to probably reduce pre-eclampsia

Bottlenecks of blood processing in Uganda

Aim: To identify where and why delays occur in Uganda blood banks. Background: The timely provision and supply of safe and efficacious blood components to hospitals depends on sound systems in the processing blood banks. Poorly managed systems lead to apparent blood shortages in hospitals and increase discard rates due to expiry before dispatch. Materials and methods: We reviewed records of 4126 units of whole blood delivered by the mobile collection teams to a major regional blood bank, in the period 1 March 2009 to 30 June 2009, to ascertain the time intervals between the critical steps in the blood processing chain. This was followed by interviews with staff in two blood banks to establish the causes of process delays. Results: The average duration between blood collection and final labelling (release from quarantine for final storage) was 15.4 (SD 10.8) days. In timeline, the step between matrix generation and grouping was (median duration 8 days) the longest, whereas grouping to labelling was the shortest (median duration 2 days). Blood expiry had the highest discard rate (0.17%) among the non-transfusion transmissible infection marker causes. A minimally facilitated small staff contributed to the process flaws. Conclusion: A considerable amount of blood does not reach hospitals because of process delays between collection and ultimate dispatch. This is caused by a thin staff working with inadequate materials, out-of-date methods and in an overcrowded environment. Provision of adequate staff and improved financial allocations to the Uganda Blood Transfusion Services will mitigate this situation