Isolation and Characterization of Antichloramphenicol Antibodies using SDS Page

Background: Antichloramphenicol antibodies can be produced in small or large animals depending on the requirement of the researcher. Previously most researchers have raised antibodies in small animals such as rabbits due to their easy availability and handling. In the present study antichloramphenicol antibodies were produced in large animals because large volumes of serum was needed for various studies. Objective: The objective of the present study was to isolate and characterize antichloramphenicol antibodies produced in camels, donkeys and goats for development of a CAP Enzyme Linked Immunosorbent Assay. Methods: The methods employed were SDS-PAGE electrophoresis which involved the analysis of crude and purified goat, camel and donkey antichloramphenicol antibodies. Purification of the antichloramphenicol antibodies was carried out by precipitation using ammonium sulphate. Immunization of experimental animals was carried out using standard immunological methods. Results: The results indicated that the crude anti-CAP antibody produced in camels, goats and donkeys showed 7 protein bands of molecular sizes 11.7, 40, 61.6, 134.3, 145, 169.5 and 182 kda. However the protein band of molecular weight 11.7 kda was not observed in the purified antibody from the 3 animal species.  The protein bands of the camel appeared smaller and were more distinct as compared to those of donkeys and goats. Conclusion: From this study it was concluded that purified camel antibodies are smaller and more specific followed closely by goat antibodies and donkey antibodies. Keywords: anti-chloramphenicol (CAP) antibodies, camels, goats and donkey

Pattern of distribution of AIDS-related Kaposi’s sarcoma lesions in HIV patients in a referral hospital in Kenya

Background: Kaposi’s sarcoma (KS) is an angioproliferative malignancy caused by infection with human herpes virus -8 (HHV-8). The tumour has four subtypes including Classic KS, African- endemic, Iatrogenic and Acquired immunodeficiency syndrome (AIDS)-related KS. AIDS- related KS is the most common malignancy in patients with human immunodeficiency virus (HIV) infection and has variable clinical presentation with diverse distribution of lesions. Objective: To assess the pattern of distribution of KS lesions in patients with AIDS-related KS at Kenyatta National Hospital. Methods: We carried out a descriptive study on patients with HIV infection with histological diagnosis of KS. The study commenced upon approval by KNH-University of Nairobi Ethics and Research Committee. Following consent, clinical and demographic data was obtained from participants through verbal interviews and from medical records using a data capture form. Follow up was until 10 weeks. Management of patients was at the discretion of the attending clinician. Data was analyzed by a statistician using Instat Biostatistics program. Results Seventy-four participants aged between 13 to 55 years were enrolled into the study. Males were 42 (56.7%) and females 32 (43.2%). Mean age was 36.8 years. The distribution of KS lesions was variable. We demonstrate high predilection of lesions for skin and lymph nodes at 62.6%. Other sites were involved were the oral cavity 14.9%. Twenty-eight (38%) of the participants had multifocal lesions with a male predominance in skin and viscera with male to female ratio of skin 1.8:1 and viscera 7:1 respectively. Conclusion: We demonstrate reduced male: female ratio and multifocal distribution of AIDS-related KS lesions with predominance in skin and lymph nodes and male predominance in visceral lesions. Future studies should aim to determine what favours increase in, KS in women and visceral lesions in males among patients with HIV infection. Keywords: Kaposi’s Sarcoma, human immunodeficiency virus (HIV), Acquired Immunodeficiency Syndrome (AIDS

Abandonment of treatment and loss to follow up: a potential cause of treatment failure in patients with AIDS-related Kaposi’s sarcoma

Background: Management of patients with cancer is complex, multi-disciplinary, longitudinal and costly. Abandonment of treatment by patients and loss to follow up is a common scenario, especially in resource poor countries and severely compromises health outcomes. Objective: To assess the commitment to drug treatment protocol of patients with Acquired Immunodeficiency Syndrome (AIDS)-Related Kaposi’s Sarcoma at Kenyatta National Hospital, Kenya, over a 10 week period . Methods: The study design was prospective, observational, cross-sectional period prevalence study on patients infected with human immunodeficiency virus (HIV) with Kaposi’s sarcoma. Patients with histological diagnosis of Kaposi’s sarcoma were sequentially enrolled into the study as they attended either the Haematology or Radiotherapy clinic or during their admission in the wards. The choice of the treatment protocol was left at the discretion of the attending physician. A pretested data collection form was used to collect demographic and clinical information about the patients, including treatments prescribed and completion of follow up. Results: A total of 74 patients were enrolled into the study, 42 (56.8%) males and 32 (43.2%) females. The age ranged between 13 years to 55 years. Their treatment protocols included: Vincristine only, Vincristine plus Bleomycin, Vincristine plus Bleomycin plus Doxorubicin, Radiotherapy plus Vincristine and Radiotherapy only. Few of the patients were not assigned any antitumor treatment. Antiemetic and other conventional medicines were also prescribed when necessary. Fifty four (73%) of the patients abandoned treatment, five (6.8%) died, 15(20.3%) continued to attend clinic over the 10 week period.  There was no significant association between sex and outcome (p=0.661). Discussion: The results of this study demonstrate that abandonment of treatment is a major problem among patients on treatment for cancer in Kenyatta National Hospital in Kenya. Abandonment of treatment heavily contributes to poor clinical outcome hence complicating the burden of cancer in the country. It is therefore important to develop and establish follow-up systems to improve adherence to treatment for the cancer patients at Kenyatta National Hospital. Key words: Abandonment of treatment, Loss to follow up, AIDS-Related Kaposi’s Sarcom

Prevalence and Risk Factors for Medication Discrepancies on Admission of Elderly Diabetics at Kenyatta National Hospital, Kenya

Background: Medications discrepancies are defined as the variations in drug regimens during transition from one health care worker or hospital to another.  The elderly diabetic patients are at risk of medication discrepancies due to their multiple comorbidities resulting in different medications from the many healthcare providers they are likely to see and physiological changes as a result of advanced age; hence the need for medication reconciliation. Objectives: The main objective of the study was to measure the prevalence and identify risk factors for medication discrepancies at admission of inpatient elderly diabetics at Kenyatta National Hospital (KNH). Methods: The study design was cross sectional descriptive study in which patients aged 60 years and above were recruited at the time of admission at the medical wards in 2016. Convenient sampling was conducted. A comparison of the medication used before and after admission was done to determine the number of discrepancies if any.  Admitting clinicians were interviewed to determine if discrepancies were intentional or not. Linear regression was conducted to determine risk factors for the number of errors per patient. Results: Among the 163 patients recruited, 1089 medication discrepancies were identified, 63.2% of the patients had at least one unintentional discrepancy. The number of unintentional discrepancies per patient was 1.5 per patient. The most common discrepancy was omissions 236 (98.3%).  Independent risk factors for discrepancies were the number of medications prior to admission (adjusted β coefficient 1.377 (95% CI: 0.767, 1.987)), hypertension (β 0.992 (95% CI: 0.094, 1.890)) and those with discharge forms from other facilities (β 0.701 (95% CI: 0.010, 1.392)). Age had a negative association with medication discrepancies (β -0.755 (95% CI: -1.284, -0.226)). Conclusion: The prevalence of medication discrepancies was high hence the need for medication reconciliation to reduce these discrepancies. Key words: Medication Reconciliation, Unintentional discrepancies, Diabetes, Elderly diabetic

What makes international global health university partnerships higher-value? An examination of partnership types and activities favoured at four East African universities

BACKGROUND: There are many interuniversity global health partnerships with African universities. Representatives of these partnerships often claim partnership success in published works, yet critical, contextualized, and comparative assessments of international, cross-border partnerships are few. OBJECTIVE: The objectives of this paper are to describe partnerships characterized as higher-value for building the capacity of four East African universities and identify why they are considered so by these universities. METHODS: Forty-two senior representatives of four universities in East Africa described the value of their partnerships. A rating system was developed to classify the value of the 125 international partnerships they identified, as the perceived value of some partnerships varied significantly between representatives within the same university. An additional 88 respondents from the four universities and 59 respondents from 25 of the international partner universities provided further perspectives on the partnerships identified. All interviews were transcribed and analysed in relation to the classification and emergent themes. FINDINGS: Thirty-one (25%) of the partnerships were perceived as higher-value, 41 (33%) medium-value, and 53 (42%) lower-value for building the capacity of the four focus universities. Thirteen (42%) of the higher-value partnerships were over 20 years old, while 8 (26%) were between 3 and 5 years old. New international partners were able to leapfrog some of the development phases of partnerships by coordinating with existing international partners and/or by building on the activities of or filling gaps in older partnerships. Higher-valued partnerships supported PhD obtainment, the development of new programmes and pedagogies, international trainee learning experiences, and infrastructure development. The financial and prestige value of partnerships were important but did not supersede other factors such as fit with strategic needs, the development of enduring results, dependability and reciprocity. Support of research or service delivery were also considered valuable but, unless education components were also included, the results were deemed unlikely to last. CONCLUSION: International partnerships prioritizing the needs of the focus university, supporting it in increasing its long-term capacity and best ensuring that capacity benefits realized favour the focus university are valued most. How best to achieve this so all partners still benefit sufficiently requires further exploration.IS

Predictors of Adequate Ambulatory Anticoagulation among Adult Patients in a Tertiary Teaching and Referral Hospital in Kenya

Background: Local anticoagulation services are inadequate and substantially underutilized despite compelling evidence showing that their appropriate use significantly reduces the risk of thromboembolic complications. Objectives: To determine the predictors of adequate ambulatory anticoagulation services in Kenyatta National Hospital. Methodology: A cross sectional study between December 2014 and April 2015 among 102 adult outpatients on anticoagulation using consecutive sampling was done. Information abstracted into a predesigned data collection tool included participants’ sociodemographic characteristics, regular sources of supply of anticoagulant, clinic pre-appointment reminders, indications of treatment and international normalized ratio tests. Data were analyzed using IBM Statistical Package for Social Sciences version 21.0 and logistic regression was used to determine independent predictors of adequate anticoagulation, which was defined as international normalized ratio ranging 2 - 3. Results: Females were majority (76.5 %) and only 27.5 % of patients  had adequate anticoagulation control. The indication of warfarin for heart valve surgery (p=0.014) and deep venous thrombosis (p=0.021) were associated with adequate anticoagulation. Age above 60 years was associated with poor anticoagulation (p=0.006). Logistic regression revealed that the independent predictor of adequate anticoagulation was warfarin use due to heart valve surgery (OR=3.1; 95% CI: 1.2 – 7.9, p=0.017). Conclusions: Ambulatory anticoagulation control in the hospital is poor. Further investigation is required to find out the reasons behind adequate anticoagulation in heart valve surgery patients. Key Words: Ambulatory anticoagulation, anticoagulant, outpatient, international normalized ratio tests

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other

Potential Animal Sources of Antibodies for the Development of a Chloramphenicol Enzyme-Linked Immunosorbent Assay

Background: Chloramphenicol (CAP) is a cheap and effective broad-spectrum antibiotic that has been used in veterinary practice to treat septicaemia, pulmonary, urinary and digestive tract infections. However it has been found to be toxic to humans and may lead to an irreversible aplastic anaemia. Due to these side effects CAP was banned from use in food-producing animals. Objective: The objective of the present study was to produce and select a suitable anti CAP antibody from camels, donkeys or goats for development of a CAP Enzyme Linked Immunosorbent Assay. Method: The methods employed were immunological for immunization of experimental animals and conjugation for preparation of CAP- HRP (Horseradish Peroxidase) conjugate. Ammonium sulphate was used for purification of the antibodies. Results: Antibody production improved with subsequent boosters in camels whereas in donkeys initial immunization yielded significantly (P<0.05) higher titres of anti-CAP antibodies. The anti-chloramphenicol antibody produced in camels following the 11th booster (797 days after immunization) was found to be more specific and sensitive than that produced in donkeys and goats. Conclusion: From this study it was concluded that anti-CAP antibodies from camels were more suitable for the development of a chloramphenicol ELISA. Key words: anti-chloramphenicol antibodies, camels, goats, donkey

Predictors of Breast Cancer Treatment Outcomes in Kenyan Women

Background: Breast cancer is the most prevalent cancer among Kenyan women.  Worldwide data show that diverse factors including socio-economic status, co-morbidities, and expression of hormonal receptors, have effect on disease recurrence or metastasis following treatment. Most studies on breast cancer treatment outcomes have been undertaken in developed countries, and there is scarcity of data on predictive indicators of breast cancer treatment outcomes in Africa. Objective: This study was designed to determine the factors that predict the treatment outcomes in breast cancer patients in a Kenyan teaching and referral hospital. Methods: This hospital based retrospective descriptive study was designed to evaluate the effect of the occurrence of estrogen receptor, progesterone receptor, human epidermal growth factor and cancer stage among other factors on the outcome of breast cancer treatment. Patients diagnosed with breast cancer and who had their first visit at the KNH in the period 2007-2008 were identified. Quantitative variables were described with medians or means. Association effects were determined by use of Chi-square test. Categorical variables were summarized using proportions. The time to event analysis was estimated using the Kaplan–Meier product limit method. Results: The mean age of the 219 participants was 46.5 years (range 23 to 92 years), majority (36.1%) of whom were aged between 41 to 50 years. Most study participants had stage 2B (21.9%) cancer type, and the histological grade 3 breast cancer was predominant type (50.2%). Nearly half of the patients (46.1%) developed metastases. In bivariate analyses, cancer stage 2A (OR 0.29, 95% CI 0.12 to 0.77) and stage 2B (OR 0.41, 95% CI 0.21- 0.77), presence of estrogen receptors (OR 0.24, 95% CI 0.12 to 0.77), presence of progesterone receptor (OR 0.26, 95% CI 0.09 to 0.72), human epidermal growth factors (OR 0.05, 95% CI 0.003 to 0.84), and those on hormonal treatment (OR 0.34, 95% CI 0.19 to 0.62) were factors less likely to be associated with development of metastasis after treatment. In multivariate analysis, HIV positive status (OR 0.004, 95% CI 0.002 to 0.75), presence of estrogen (OR 0.23, 95% CI 0.08 to 0.64) and human epidermal growth factors (OR 2.53, 95% CI 1.64 to 3.91) receptors and obesity (OR 2.53, 95% CI 1.64 to 3.91) were independent factors influencing development of metastasis after treatment. Conclusion: This study showed that development of metastasis after breast cancer therapy has associations with the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor -2 (HER-2) as well as the stage of diagnosis.  This study demonstrates the need for enhanced screening for breast cancer to improve early diagnosis and the testing of ER, PR and HER-2 are crucial as they predict outcomes of therapy. Key words: Breast cancer, breast cancer treatment, cancer treatment outcomes, cancer treatment predictors