The reference range of serum magnesium substance concentration among healthy young adults at Makerere University College of Health Sciences 2012

Background: Magnesium is the second most abundant intracellular cation, with only a small proportion of the body’s content being in the extracellular fluid. It is required for the active transport of other cations such as calcium, sodium and potassium across the membrane by active transport system. It is also needed for many intracellular metabolic pathways. This study was carried to establish the reference intervals for serum magnesium substance concentration among healthy medical students in Uganda.Methods: This was purposive study in which ante-cubital venous blood samples were drawn without stasis from 60 healthy, natively Ugandan pre-clinical medical students and analysed without delay using Cobasintegra 400/700/800 automated analyser which flagged each result using the in-built seemingly temperate reference range of 0.65-1.05 mmol/L.Results: The distribution of serum magnesium substance concentration was unimodal, leptokurtic, and positively skewed with empirical range of 0.86 – 1.32 mmol/L. There was no result flagged as low. Twenty-six out of sixty (43.3%) results were flagged as high values while none approached 2.0 mmol/L, considered the threshold of hypermagnesaemia symptoms. Using the central 95 percentile, the reference range was set as 0.81 – 1.29 mmol/L which is higher and slightly broader than the 0.65 – 1.05 mmol/L often quoted for populations in temperate regions and in-built in automated analysers exported even to the tropics.Conclusion: Reference ranges were higher in the studied healthy young adults in Uganda than those in the temperate regions. Effort should therefore be made to enable our laboratories establish their own reference values

HEPATOPROTECTIVE EFFECT OF CYMBOPOGON CITRATUS ESSENTIAL OILS AGAINST NEVIRAPINE-INDUCED HEPATIC DAMAGE IN WISTAR ALBINO RATS

Background: The use of nevirapine in the management of Human Immunodeficiency Virus (HIV) infections is greatly limited by its fatal hepatotoxicity. In sub-Saharan African, traditional medicine involving use of plant materials has been proposed to counteract liver damage, albeit with no scientific evidence. The aim of the present study was to determine the hepatoprotective effect of Cymbopogon citratus essential oils against nevirapine induced hepatic oxidative damage in Wistar albino rats. Materials and Methods: Five groups of rats received a daily oral dose of 36mg/kg nevirapine for 4 consecutive weeks. After 15 minutes, rats in three of the groups were given 200mg/kg, 400mg/kg and 800mg/kg of Cymbopogon citratus essential oil extract. The positive control group received nevirapine and 200mg/kg of silymarin while the normal control group received only 2ml of distilled water. Blood was used to determine the levels of liver function parameters and liver sections were used for histological studies. Results: The results revealed that oral administration of nevirapine (36mg/kg b.w. p.o) for 4 weeks significantly (

Comparison of rose bengal plate test, serum agglutination test, and indirect enzyme-linked immunosorbent assay in brucellosis detection for human and goat samples

Background: In Uganda, detection of brucellosis in goats and humans is more frequently done using rose bengal plate test (RBPT) in comparison to other serological tests such as serum agglutination test (SAT) and indirect enzyme-linked immunosorbent assay (i-ELISA). Aim: This study aimed at estimating the degree of agreement, specificity and sensitivity of RBPT, SAT, and ELISA in brucellosis detection in human and goat samples. Materials and Methods: An analytical study was conducted involving parallel testing of 425 goat samples and 177 human samples to compare RBPT, SAT, and i-ELISA tests of brucellosis detection. Results: A seroprevalence of 14.82% in animals and 11.86% in humans was detected using RBPT, 7.06% in goats and 5.09% in humans using SAT, and 6.35% in humans and 4.52% in animals using i-ELISA. The degree of agreement between the three tests in humans and animals was compared using Fleiss' kappa statistics where a moderate agreement (MA) was obtained for both with kappa value 0.57 in animals and 0.51 in humans and p<0.001. Kappa values in animals were 0.52 (MA) for RBPT and i-ELISA, 0.61 (MA) for RBPT and SAT, and 0.82 substantial agreement (SA) for SAT and i-ELISA. The kappa values in humans were 0.52 (MA) for RBPT and i-ELISA, 0.57 (MA) for RBPT and SAT, and 0.82 (SA) for SAT and i-ELISA, respectively. The study revealed a significant agreement in the tests for all the three tests, but there was SA between SAT and i-ELISA in both animal and human samples. Sensitivity and specificity of RBT and SAT were estimated using i-ELISA as a gold standard as follows, in goats RBPT: 100 and 91% and SAT: 100 and 99%, respectively, and in humans RBPT: 100 and 92% and SAT: 88 and 99%, respectively. Conclusion: It appears that RBPT is good as a screening test, whereas SAT and i-ELISA are good for diagnosis purposes or confirmatory test

IMMUNOMODULATORY ACTIVITY OF THE CHENOPODIUM OPULIFOLIUM TOTAL CRUDE EXTRACT IN WISTER ALBINO RATS

Background: Chronic disease conditions like cancer, diabetes, malnutrition and HIV/AIDS compromise the immune system thus necessitating immune boasting. The use of medicinal herbs in immunomodulation is now common, albeit with limited evidence regarding efficacy. We therefore investigated the immunomodulatory activity of the total crude leaf and stem extract of Chenopodium opulifolium in mice. Materials and methods: An experimental study was conducted using four groups of rats each with 6 animals with treatments administered daily for 29 days. Group one served as the positive control and received 20mg/kg of levamisole. Group 2, the negative control received 2 ml of an olive oil and normal saline mixture. Groups 3 and 4 received 100mg/kg and 200mg/kg bwt of the total crude leaf and stem extract respectively. On the 15th day, whole blood was collected for complete blood count and delayed type hypersensitivity response determination, haemagglutination antibody titer assay was done on blood collected on the 29th day. Results: Results revealed that the extract had a significant (P< 0.05) effect on haemagglutination antibody titers with the highest response observed in the extract group at 200mg/kg (30.67±1.33). The mean WBC (3.13±0.71×103/μl), neutrophil (0.93±0.48 cells/ μl) and lymphocyte (2.20±0.00 cells/ μl) counts in the 200mg/kg bwt extract group were elevated to levels comparable to the positive control. Conclusion: The total crude extract of Chenopodium opulifolium exhibits immunomodulatory activity in a dose dependent manner. Future studies utilizing pure extracts in order to pin point to the extract mechanism responsible for Immunomodulation are required for more conclusive results

Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda.

BACKGROUND: HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS) and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP). TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women. METHODS: This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP) in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR. RESULTS: Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW). Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used. CONCLUSION: Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a considerable impact on the burden of LBW in this population

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

An Experimental Study Determining Levels of Lead Contamination of Dioscorea Spp. (Yams) From Selected Regions of Kampala Capital City, Uganda.

Background: Heavy metal toxicity is a growing concern and often an unknown root cause of a number of serious health issues. Due to bio-accumulation, heavy metals are passed up the food chain from plants to humans. The objectives of this study were to determine the quantity of lead in yams from selected swamps and upland gardens, to compare lead contamination in yams from swamps to those from upland gardens, and compare the levels of lead in yams from swamps and upland gardens to the FAO/WHO acceptable limits. Methods: Ready to eat/mature yams were harvested from swamps and upland gardens respectively and their lead content was determined using an atomic absorption spectrophotometer (AAS). Results: Yams collected from RS, a swamp site had the lowest amount of lead at a mean lead level of 1.110 mg/kg. Yams collected from KCU which was an upland garden had the highest amount of lead with a mean lead concentration of 2.324mg/kg. Yams obtained from upland gardens contained a higher concentration of lead at a mean lead concentration of 1.7858 mg/kg compared to a mean lead concentration of 1.6172 mg/kg which was found in yams collected from the swamp sites. However, there was no statistically significant difference in lead contamination of the yams obtained from either site. The concentration of lead in both yams collected from swamps and those obtained from upland gardens was higher than the FAO/WHO acceptable limit of lead in food. Conclusion: The level of lead contamination in yams is not dependent on the agricultural site where they are grown. Concomitantly, lead levels in yams regardless of their site of growth, were above the FAO/WHO maximum acceptable limits of lead in food and thus suggested that yams pose a significant route of human exposure to lead once they are consumed

Sero-prevalence and associated risk factors of Brucellosis among Malaria negative febrile out-patients in Wakiso district, Central Uganda

Abstract Objective Brucellosis is a zoonotic disease usually acquired through direct contact with the infected animals and consumption of contaminated milk and meat products. In humans Brucellosis presents similar signs with other febrile diseases like Malaria, typhoid and other febrile conditions. This study was carried out to determine the prevalence of Brucella abortus among patients with fever but were negative for Malaria. Results A cross-sectional study was carried out in Namayumba Health Centre IV, Wakiso district involving 200 participants. Blood samples was screened for B. abortus using Serum Agglutination Test and confirmed with Tube Agglutination test. A questionnaire was used to collect data on socio-demographic characteristics and human Brucellosis related risk factors. Human B. abortus sero-prevalence was at 7.5% (n = 200). The prevalence was high among participants aged 18–35 years (13.3%), muslims 12 (14.0%), those with no formal education (33.3%) and divorced 2 (14.3%). Consuming of raw milk (OR 2.162, 95% CI 0.021–1.379) and being a Muslim (OR 6.101, 95% CI 1.601–23.248) were associated with increased risk of Brucella abortus. It was concluded that human Brucella infection due to Brucella abortus is commonly associated with consumers of raw milk products and muslims in Wakiso district

Lowland grazing and Marburg virus disease (MVD) outbreak in Kween district, Eastern Uganda

Abstract Background Uganda is one of the few countries in Africa that has been experiencing outbreaks of viral hemorrhagic fevers such as Ebola, Marburg and Crimean-Congo Hemorrhagic fevers. In 2017 Uganda experienced a Marburg Virus Disease (MVD) outbreak with case fatality rate of 100% in Kween district. Although hunting for wild meat was linked to the MVD outbreak in Kween district, less was reported on the land use changes, especially the changing animal grazing practices in Kween district. Methods Through Makerere University One Health graduate fellowship program with attachment to Uganda Red Cross Society, a study was conducted among the agricultural communities to elucidate the risk behaviors in Kween district that can be linked to the 2017 Marburg disease outbreak. Results Results show that although a few elderly participants ascribed fatal causes (disobedience to gods, ancestors, and evil spirits) to the MVD outbreak during FGDs, majority of participants linked MVD to settling in caves (inhabited by Fruit Bats) during wet season as upper belts are extensively used for crop production leaving little space for animal grazing. Members also noted side activities like hunting for wild meat during this grazing period that could have predisposed them to Marburg Virus. Conclusions There is need to integrate One Health concepts within agricultural extension service provision in Uganda so as to enhance the management of such infectious diseases

Nutraceutical and antinutritional properties of wild edible plants consumed by pregnant women and school-age children (6-12 years) in Najjembe sub-county, Buikwe district, Uganda

Wild edible plants (WEPs) immensely contribute to the diets and livelihoods of rural and marginalised communities. In rural Uganda, they play an important role as break tea packages for school-age children and due to their perceived nutraceutical significance, they are always added to the diets of pregnant women. In this study, it was hypothesised that Basella alba L. (Malabar spinach, Ceylon spinach, Indian spinach, Vine spinach, Malabar nightshade), Termitomyces microcarpus (Berk. & Broome) R. Heim (Cendawan Tali; Cendawan Taugeh) Cucurbita pepo L. (Courgette, Marrow, Pumpkin, Summer squash, Table queen squash, Vegetable Marrow, Zucchini) and Solanum anguivi L. (Forest bitter berry, African eggplant) have high nutraceutical significance and could contribute to the diets of school-age children and pregnant women. Using the standard Association of Official Analytical Chemists (AOAC) methods (method 935.14 and 992.24), the nutraceuticals and antinutrients in B. alba, T. microcarpus, C. pepo, and S. anguivi were investigated. All analyses and measurements were done in triplicate to increase the validity and reliability of the results. Solanum anguivi had the highest crude fibre (25.22±0.08 %), fat (6.55±0.05 %), and energy (371.37±1.17 Kcal) content. Termitomyces microcarpus had the highest protein (21.99±0.16 %) and moisture (10.71±0.35 %) content. Basella alba and C. pepo had the highest ash (19.39±0.01 %) and total carbohydrate (69.15±0.62 %) content. In comparison with the recommended dietary daily intakes for pregnant mothers and school-going children, all the plants had high Potassium, Phosphorous contents (except for T. Microcarpus which had low K contents), iron, copper, zinc, and manganese., but with selenium content being below the detection limit. All the analysed species were good in antioxidants, C. Pepo being the best with an IC50 of 11.78±0.47 mg/ mL followed by B. alba (14.69±0.74 mg/ mL). Solanum anguvi and T. microcarpus had the highest amount of phenols (14.48±0.02 mg/g GAE) and tannins (0.42±0.00 mg/g GAE). Basella alba had the highest amounts of flavonoids (2.45±0.01 mg/g RAE). All the plant species had low contents of phytates ranging from (0.40±0.01 for S. Anguivi to 0.72±0.08 for B. Alba). Cadmium and lead concentrations were below the permissible limit recommended by FAO/WHO Expert Committee in Food Additives. Thus, the analysed WEPs are a rich source of important nutrients and can be used to complement staple foods to ensure balanced nutrition for pregnant women and school-age children. Nonetheless, further comprehensive antinutrients and heavy metals analyses should be conducted to ensure that they do not affect the bioavailability of the nutrients. For value addition, nutrient-dense cocktails / phytonutraceuticals should be developed to alleviate malnutrition-related illnesses in vulnerable groups of people