Prevalence of cervical cytology abnormalities among HIV infected women at Rwanda Military Hospital

Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital.Design: Cross-sectional descriptive studySetting: Rwanda Military Hospital Kigali, RwandaSubjects: All HIV-positive women, 18-69 years who had been or were sexually active and were attending the HIV-clinic and consented to participate in the study.Results: Two hundred and ninety three women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical Squamous Intra epithelial Lesion (SIL) were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had Atypical Squamous Cells of Undetermined Significance (ASCUS), six (10.34%) had high-grade SIL, three (5.17%) had Squamous cell carcinoma ( SCC) and one (1.72%) had Atypical Glandular Cells of Undetermined Significance (AGUS). In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SILConclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital. Increased immune suppression was significantly associated with cervical SIL

Electronic Immunization Registry in Improving Vaccine Supply Chain Availability in Tanga City Council, Tanzania

BackgroundDespite the advantages of the electronic registry which has been explained in other areas of health and other parts of the world, there has been no empirical research conducted with the aim of assessing the impact of the electronic immunization registry practices on the availability of immunization commodities.ObjectivesTo assess the effect of electronic immunization registry practices on the availability of immunization commodities.MethodsA cross-sectional study was carried out to health facilities providing vaccination services in Tanga City Council. A total of 27 health care workers in 27 health facilities were interviewed for availability of vaccines and their experience in using electronic immunization system in supply chain system functioning using structured questionnaires. The data from the vaccines manual ledger and electronic TImR system were also collected administered in April-June, 2019 specifically for Bacillus-Calmette Guerin (BCG), Diphtheria-Pertussis-Tetanus-Hepatis B-Haemophilus influenza type b (DPT-HepB-Hib), bi-oral polio vaccine (bOPV), Measles-Rubella and Human Papilloma Virus Vaccine (HPV). These data were analyzed by statistical software SPSS using one sample T test and 95% confidence interval.ResultsThe study affirmed that the mean numbers of children registered at the health facilities using electronic immunization registry was 1.5-3 times higher than the target population for the three months preceding the study given by the National Bureau of Statistics (NBS). The number of doses for the studied vaccines (DPT-HepB-Hib, measles rubella, HPV, BCG and bOPV) were found to be different in the manual and electronic TImR systems. Also, the number of doses available at the health facilities increased significantly with the number of the electronic system registered children.ConclusionThis study found that the adoption of Electronic immunization registry has improved the health supply chain in terms of improving the vaccines availability. Rwanda J Med Health Sci 2021;4(2): 223-23

Production and characterization of spray-dried theophylline powders prepared from fresh milk for potential use in paediatrics

"This is the accepted version of the following article: Production and characterization of spray-dried theophylline powders prepared from fresh milk for potential use in paediatrics (2017). J Pharm Pharmacol, 69: 554–566, which has been published in final form at http://dx.doi.org/10.1111/jphp.12612 . This article may be used for non-commercial purposes in accordance with the Wiley Self-Archiving Policy [http://olabout.wiley.com/WileyCDA/Section/id-820227.html]."Objective: This work evaluates the potential of using fresh milk to deliver theophylline to children.Methods: Theophylline–fresh milk systems were prepared using different solids ratios (0 : 1–1 : 0) and three fat contents in commercial milks (low, medium and high), which were spray-dried at different inlet air temperatures (Tinlet – 105, 130 and 150 °C). The process was evaluated for yield and the resulting powders for moisture content (MC), particle size and shape, density and wettability. Theophylline–milk potential interactions (differential scanning calorimetry (DSC) and FT-IR) and chemical (theophylline content) and microbiological stability of powders (shelf and in-use) were also evaluated.Key Findings: The production yield (13.6–76.0%), MC (0.0–10.3%) and contact angles in water (77.29–93.51°) were significantly (P < 0.05) affected by Tinlet, but no differences were found concerning the mean particle size (3.0–4.3 μm) of the different powders. The milk fat content significantly (P < 0.05) impacted on the density (1.244–1.552 g/cm3). Theophylline content remained stable after 6 months of storage, before extemporaneous reconstitution. After reconstitution in water, low-fat milk samples (stored at 4 °C) met the microbial pharmacopoeia criteria for up to 7 days. No theophylline–milk components interaction was observed.Conclusion: Spray-dried milk-composed powders may be used as vehicles for theophylline delivery in paediatrics following further characterization and in-vivo evaluation.info:eu-repo/semantics/publishedVersio

Dust exposure and chronic respiratory symptoms among coffee curing workers in Kilimanjaro: a cross sectional study

Coffee processing causes organic dust exposure which may lead to development of respiratory symptoms. Previous studies have mainly focused on workers involved in roasting coffee in importing countries. This study was carried out to determine total dust exposure and respiratory health of workers in Tanzanian primary coffee-processing factories. A cross sectional study was conducted among 79 workers in two coffee factories, and among 73 control workers in a beverage factory. Personal samples of total dust (n = 45 from the coffee factories and n = 19 from the control factory) were collected throughout the working shift from the breathing zone of the workers. A questionnaire with modified questions from the American Thoracic Society questionnaire was used to assess chronic respiratory symptoms. Differences between groups were tested by using independent t-tests and Chi square tests. Poisson Regression Model was used to estimate prevalence ratio, adjusting for age, smoking, presence of previous lung diseases and years worked in dusty factories. All participants were male. The coffee workers had a mean age of 40 years and were older than the controls (31 years). Personal total dust exposure in the coffee factories were significantly higher than in the control factory (geometric mean (GM) 1.23 mg/m3, geometric standard deviation (GSD) (0.8) vs. 0.21(2.4) mg/m3). Coffee workers had significantly higher prevalence than controls for cough with sputum (23% vs. 10%; Prevalence ratio (PR); 2.5, 95% CI 1.0-5.9) and chest tightness (27% vs. 13%; PR; 2.4, 95% CI 1.1-5.2). The prevalence of morning cough, cough with and without sputum for 4 days or more in a week was also higher among coffee workers than among controls. However, these differences were not statistically significant. Workers exposed to coffee dust reported more respiratory symptoms than did the controls. This might relate to their exposure to coffee dust. Interventions for reduction of dust levels and provision of respiratory protective equipment are recommended

Quinine, an old anti-malarial drug in a modern world: role in the treatment of malaria

Quinine remains an important anti-malarial drug almost 400 years after its effectiveness was first documented. However, its continued use is challenged by its poor tolerability, poor compliance with complex dosing regimens, and the availability of more efficacious anti-malarial drugs. This article reviews the historical role of quinine, considers its current usage and provides insight into its appropriate future use in the treatment of malaria. In light of recent research findings intravenous artesunate should be the first-line drug for severe malaria, with quinine as an alternative. The role of rectal quinine as pre-referral treatment for severe malaria has not been fully explored, but it remains a promising intervention. In pregnancy, quinine continues to play a critical role in the management of malaria, especially in the first trimester, and it will remain a mainstay of treatment until safer alternatives become available. For uncomplicated malaria, artemisinin-based combination therapy (ACT) offers a better option than quinine though the difficulty of maintaining a steady supply of ACT in resource-limited settings renders the rapid withdrawal of quinine for uncomplicated malaria cases risky. The best approach would be to identify solutions to ACT stock-outs, maintain quinine in case of ACT stock-outs, and evaluate strategies for improving quinine treatment outcomes by combining it with antibiotics. In HIV and TB infected populations, concerns about potential interactions between quinine and antiretroviral and anti-tuberculosis drugs exist, and these will need further research and pharmacovigilance

Taste-masked quinine formulations for flexible pediatric drug dosing in oral treatment of malaria

De meeste geneesmiddelen worden specifiek gecommercialiseerd voor volwassenen waardoor het gebrek aan pediatrische geneesmiddelvormen specifiek ontwikkeld voor kinderen een wereldwijd probleem is. Bijgevolg zijn zorgverstrekkers vaak genoodzaakt om voor pediatrische toepassingen geneesmiddelen te gebruiken op een wijze die niet gedekt wordt door de licentie, ondanks het feit dat de veiligheid, doeltreffendheid en kwaliteit van deze geneesmiddelen niet getest werden voor deze pediatrische indicaties en/of toedieningswijzen. Een specifiek voorbeeld hiervan is malaria aangezien pediatrische formulaties van de meeste antimalaria geneesmiddelen ontbreken ondanks het feit dat malaria een grote bedreiging vormt voor de volksgezondheid in grote delen van de wereld. In tropisch Afrika zijn kinderen nochtans de meest kwetsbare groep aangezien 75% van alle sterfgevallen ten gevolge van malaria kinderen jonger dan 5 jaar zijn. Zij worden momenteel meestal behandeld door tabletten (ontwikkeld voor volwassenen) te breken in kleinere delen om de dosis aan te passen in functie van het lichaamsgewicht