Metabolic Syndrome Disorders In Urban Black Zimbabweans With Type 2 Diabetes Mellitus

A CAJM field study.Objective: The main aim of the study was to determine the prevalence of metabolic syndrome disorders and their interrelations in black Zimbabwean type 2 diabetic patients. Study Design: Prospective cross sectional study. Setting: Outpatient diabetic clinics at Harare and Parirenyatwa tertiary hospitals. Main Outcome Measures: We recruited 109 adult diabetic subjects attending a tertiary hospital Diabetic Clinic. Anthropometric and metabolic parameters were measured by standard methods. Eighty percent of the patients were hypertensive, 32% dyslipidaemic, 32% obese, 50% hyperinsulinaemic, 61% had poor • glycaemic control and 43% of the participants had the metabolic syndrome. The means of BMI and triglycerides were significantly different in hyperinsulinaemic versus non-hyperinsulinaemic patients (p<0.001 and 0.041 respectively), and diastolic blood pressure was significantly raised in the obese group (p=0.043). The following significant associations were observed, hyperinsulinaemia with the metabolic syndrome (odds ratio=3.9, p<0.001) as well with obesity (odds ratio=4.8, p<0.001), however, only a weak association was observed between hypertension and hyperinsulinaemia (odds ratio=2.5, p=0.064). Patients exhibiting three metabolic disorders (dyslipidaemia, hypertension and obesity) were five times more likely to be hyperinsulinaemic (p=0.025) and hypertensive patients were almost three times more likely to, be hyperinsulinaemic. Conclusion: In comparison to their counterparts from certain ethnic groups, this urban diabetic population is also burdened with a variety of metabolic disorders which are risk factors for coronary artery disease. In this population, hyperinsulinaemia has a relatively weak association with hypertension and the relationship between obesity versus diastolic blood pressure as well as hypertriglyceridaemia versus serum insulin levels requires further investigation

Hepatitis C virus in Zimbabwe

A research article on the prevalence of the Hepatitis C virus in ZimbabweLiver disease is an important cause of morbidity and mortality in Zimbabwe, accounting for more than six per cent of the deaths in three medical wards of Harare Central Hospital (IT Gangaidzo, 1994, unpublished observations). In western countries, HCV infection is the most common cause of chronic viral hepatitis and ranks a slight second below chronic alcoholism as a cause of cirrhosis, liver failure and hepatom

Hepatitis B and C infection at a large public sector hospital clinic: is it a burden?

Background: Co-infections have become significant causes of morbidity and mortality in Human Immunodeficiency Virus (HIV) infected people. Due to shared routes of transmission, co-infection of HIV with Hepatitis B (HBV) and/or Hepatitis C (HCV) should be expected. In Zimbabwe, screening for both viruses in HIV infected people prior to treatment is not routinely practised despite the World Health Organisation (WHO) guidelines (2013) prioritising treatment where these co-infections exist.Objective: To determine the prevalence of HBV and HCV infection in HIV infected adults at a public sector HIV clinic in Zimbabwe and to determine risk factors associated with these infections.Design and Setting: An analytical cross-sectional survey carried out among systematically randomly sampled HIV infected patients coming for treatment between March and July 2012 at Parirenyatwa Hospital Opportunistic Infection Clinic.Materials and Methods: Blood samples were tested for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibodies (anti-HCV). Demographic data and exposure to risk factors were collected.Results: 228 antiretroviral therapy (ART) naive adults were enrolled. 7.9% (18/228) were HBsAg positive and 0.9% (2/228) were anti-HCV positive. None of the participants were infected with both viruses. Conclusions: The prevalence of HBV has not changed during this HIV era and there is no significant HCV infection in this public sector clinic which serves quite a large sector of the population that lives in Harare, Zimbabwe. Based on these results, there is no need for HCV screening but HBV screening prior to ART initiation may be required

Hepatitis B and C infection at a large public sector hospital clinic: Is it a burden?

Background:  Co-infections have become significant causes of morbidity and mortality in Human Immunodeficiency Virus (HIV) infected people. Due to shared routes of transmission, co-infection of HIV with Hepatitis B (HBV) and/or Hepatitis C (HCV) should be expected. In Zimbabwe, screening for both viruses in HIV infected people prior to treatment is not routinely practised despite the World Health Organisation (WHO) guidelines (2013) prioritising treatment where these co-infections exist.Objective: To determine the prevalence of HBV and HCV infection in HIV infected adults at a public sector HIV clinic in Zimbabwe and to determine risk factors associated with these infections.  Design and Setting:  An analytical cross-sectional survey carried out among systematically randomly sampled HIV infected patients coming for treatment between March and July 2012 at Parirenyatwa Hospital Opportunistic Infection Clinic.Materials and Methods:  Blood samples were tested for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibodies (anti-HCV).  Demographic data and exposure to risk factors were collected. Results: 228 antiretroviral therapy (ART) naive adults were enrolled. 7.9% (18/228) were HBsAg positive and 0.9% (2/228) were anti-HCV positive. None of the participants were infected with both viruses.Conclusions: The prevalence of HBV has not changed during this HIV era and there is no significant HCV infection in this public sector clinic which serves quite a large sector of the population that lives in Harare, Zimbabwe. Based on these results, there is no need for HCV screening but HBV screening prior to ART initiation may be required

Platelet activation and inflammation markers as emerging risk factors for cardiovascular diseases in HIV

Background: HIV infection is associated with increased risk of Cardiovascular Diseases (CVD) and risk calculators underpredict these outcomes in infected individuals. The underlying mechanisms leading to high CVD risk are not yet clear. Low-grade inflammation and platelet abnormalities which persist even after individuals undergo successful antiretroviral therapy have been implicated in the development of CVDs in individuals with HIV infection.Objective: This study evaluated plasma levels of platelet activation and inflammation markers in HIV uninfected, HIV infected subjects receiving Anti-retroviral Therapy (ART) and those naïve to ART.Materials and Methods: A total of 284 adults comprising of subjects receiving ART (187), ART naïve (32) attending an HIV treatment center and HIV uninfected blood donors (65) were investigated in this analytical cross sectional study. Platelet activation and inflammation markers were assessed by measuring plasma levels of sP-selectin, platelet factor 4 (PF4), IL-6 and tumor necrosis factor alpha (TNF-α).Results: HIV infected patients had higher levels of sP- selectin, PF4 and IL-6 than uninfected controls (p&lt;0.001). ART naïve subjects had higher levels of PF4 as compared to the individuals receiving ART (p&lt;0.001). Levels of TNF-α did not differ across groups by HIV (p=0.992) or ART status (p=0 993). A positive correlation was observed between IL-6 and sP-selectin levels in HIV infection (r=0.2690; p=0.001) but lacked in the HIV uninfected (r=-0.1065; p=0.5825).Conclusion: Levels of platelet activation and inflammation markers were elevated in HIV infected individuals regardless of ART and significance of this in HIV- related cardiovascular risk should be investigated further

Iron and alcohol content of traditional beers in rural Zimbabwe

No Abstract. Central African Journal of Medicine Vol. 45 (6) 1999: pp. 136-14

Iron overload in Africans and African-Americans and a common mutation in the SCL40A1 (ferroportin 1) gene

The product of the SLC40A1 gene, ferroportin 1, is a main iron export protein. Pathogenic mutations in ferroportin 1 lead to an autosomal dominant hereditary iron overload syndrome characterized by high serum ferritin concentration, normal transferrin saturation, iron accumulation predominantly in macrophages, and marginal anemia. Iron overload occurs in both the African and the African-American populations, but a possible genetic basis has not been established. We analyzed the ferroportin 1 gene in 19 unrelated patients from southern Africa (N = 15) and the United States (N = 4) presenting with primary iron overload. We found a new c. 744 C\u2192T (Q248H) mutation in the SLC40A1 gene in 4 of these patients (3 Africans and 1 African-American). Among 22 first degree family members, 10 of whom were Q248H heterozygotes, the mutation was associated with a trend to higher serum ferritin to amino aspartate transferase ratios (means of 14.8 versus 4.3 \u3bcg/U; P = 0.1) and lower hemoglobin concentrations (means of 11.8 versus 13.2 g/dL; P = 0.1). The ratio corrects serum ferritin concentration for alcohol-induced hepatocellular damage. We also found heterozygosity for the Q248H mutation in 7 of 51 (14%) southern African community control participants selected because they had a serum ferritin concentration below 400 \u3bcg/L and in 5 of 100 (5%) anonymous African-Americans, but we did not find the change in 300 Caucasians with normal iron status and 25 Caucasians with non-HFE iron overload. The hemoglobin concentration was significantly lower in the African community controls with the Q248H mutation than in those without it. We conclude that the Q248H mutation is a common polymorphism in the ferroportin 1 gene in African populations that may be associated with mild anemia and a tendency to iron loading