Knowledge of, attitudes toward and practices of ethics of war of the officers and soldiers of the Zambia Army

Since the end of the world wars, the demise of the Cold War and the end of liberation wars in Africa, the changing character of warfare has given birth to uncertainties about how states will respond to acts of aggression in the face of ethics of war, or the moral rules of war. It has become difficult for states to conduct permissible self-defence and other-defence against non-state actors or sub-state groups, which do not have a sovereign (political and territorial integrity) to protect. In the face of this reality, it is not known how much knowledge military personnel world over have on ethics of war, what their attitude towards ethics of war is, and how they practice these ethics of war during war and operations other than war. Research was therefore conducted to assess knowledge of, attitudes toward and practices of the ethics of war of officers and soldiers of the Zambia Army. A mixed method research was undertaken using explanatory sequential approach. A sample of 420 participants was drawn from officers and soldiers serving in the Zambia Army. Questionnaires were used to collect quantitative data, while focus group discussions and interviews were undertaken to collect qualitative data. The findings from the focus group discussions and interviews provided depth and understanding about how the officers and soldiers felt about ethics of war. The findings of focus group discussions and interviews also helped to explain the findings from the quantitative data. Quantitative data were analysed at two levels. The first level of analysis comprised descriptive statistics in the form of frequency distribution tables, means and percentages. The second level involved inferential statistics by applying the chi-square test in order to determine the relationship, if any, between the independent variables and the dependent variables using the Statistical Packaging for Social Sciences. Further, the research used Spearman’s rank correlation coefficient to measure the strength and direction of association between two ranked variables. Analysis of qualitative data begun during the data collection exercise by arranging the field notes according to salient themes in relation to the objectives. This was followed by pinpointing, examining and recording patterns within the data collected The conclusion of the study showed that, at the time, the majority of the Zambia Army officers and soldiers were reasonably acquainted with the knowledge of ethics of war. The study further concluded that Zambia Army officers and soldiers held very strong and positive attitudes towards the ethics of war at the time. In addition, the officers and soldiers also widely accepted and supported the ethics of war, as they considered them beneficial. It was evident from the research that the Zambia Army soldiers and officers practiced the ethics of war extensively and regularly during both local and international operations. However, more needs to be done to increase knowledge levels

4,5-Dimethoxy-2-nitrobenzohydrazides and 1-(1-Benzylpiperidin-4-yl)ethan-1-ones as Potential Antioxidant/Cholinergic Endowed Small Molecule Leads

The objective of this research is to generate leads for developing our ultimate poly-active molecules with utility in central nervous system (CNS) diseases. Indeed, poly-active molecules capable of mitigating brain free radical damage while enhancing acetylcholine signaling (via cholinesterase inhibition) are still being sought for combating Alzheimer’s disease (AD). We differentiate “poly-active” agents from “multi-target” ones by defining them as single molecular entities designed to target only specific contributory synergistic pharmacologies in a disease. For instance, in AD, free radicals either initiate or act in synergy with other pharmacologies, leading to disease worsening. For this preliminary report, a total of 14 (i.e., 4,5-dimethoxy-2-nitrobenzohydrazide plus 1-(1-benzylpiperidin-4-yl)ethan-1-one) derivatives were synthesized and screened, in silico and in vitro, for their ability to scavenge free radicals and inhibit acetylcholinesterase (AChE)/butyrylcholinesterase (BuChE) enzymes. Overall, six derivatives (4a, 4d, 4e, 4f, 4g, 9b) exhibited potent (\u3e30%) antioxidant properties in the oxygen radical absorbance capacity (ORAC) assay. The antioxidant values were either comparable or more potent than the comparator molecules (ascorbic acid, resveratrol, and trolox). Only three compounds (4d, 9a, 9c) yielded modest AChE/BuChE inhibitions (\u3e10%). Please note that a SciFinder substance data base search confirmed that most of the compounds reported herein are new, except 9a and 9c which are also commercially available

Neuroimaging abnormalities and seizure recurrence in a prospective cohort study of Zambians with human immunodeficiency virus and first seizure

In HIV-positive individuals with first seizure, we describe neuroimaging findings, detail clinical and demographic risk factors for imaging abnormalities, and evaluate the relationship between imaging abnormalities and seizure recurrence to determine if imaging abnormalities predict recurrent seizures. Among 43 participants (mean 37.4 years, 56% were male), 16 (37%) were on antiretroviral drugs, 32 (79%) had advanced HIV disease, and (28) 66% had multiple seizures and/or<em> status epilepticus</em> at enrollment. Among those with cerebrospinal fluid studies, 14/31 (44%) had opportunistic infections (OIs). During follow-up, 9 (21%) died and 15 (35%) experienced recurrent seizures. Edema was associated with OIs (odds ratio: 8.79; confidence interval: 1.03-236) and subcortical atrophy with poorer scores on the International HIV Dementia Scale) (5.2 vs. 9.3; P=0.002). Imaging abnormalities were not associated with seizure recurrence or death (P&gt;0.05). Seizure recurrence occurred in at least a third and over 20% died during follow-up. Imaging was not predictive of recurrent seizure or death, but imaging abnormalities may offer additional diagnostic insights in terms of OI risk and cognitive impairment

Mortality & recurrent seizure risk after new-onset seizure in HIV-positive Zambian adults

Abstract Background Recurrent seizure risks in HIV-positive people with new-onset seizure are largely unknown, making it challenging to offer optimal recommendations regarding antiepileptic drug (AED) initiation. Existing outcomes data is limited, and risk factor identification requires a diagnostic assessment, which is often unavailable in regions heavily effected by HIV, like sub-Saharan Africa. Methods HIV-positive Zambian adults with new-onset seizure were enrolled in a prospective cohort study to determine seizure recurrence and risk factors for recurrence. Seizure etiology was evaluated, and recurrent seizures and medication usage were assessed during clinic visits. Due to unexpectedly high mortality rates, predictors of death were evaluated using proportional hazards with Gray’s test to compare cumulative incidence functions for recurrent seizure across groups adjusting for the competing outcome of death. Results 95 patients were enrolled (mean age 37 years, 43% female, 83% with Karnofsky > 50) and followed for a mean of 293 days (median 241 (IQR: 29–532)). At presentation, 50 (53%) were in status epilepticus. The majority (91, 85%) had advanced HIV disease and 65 (68%) were not on combined antiretroviral therapy (cART). After extensive workup, seizure etiology remained unknown in 16 (17%). Average time to cART initiation after enrollment was 61 days. During follow up, 37 (39%) died and 23 (24%) had recurrent seizure. Most deaths (25/37, 68%) occurred in the first 60 days post-index seizure. Individuals with advanced HIV were more likely to die (HR: 19.1 [95% CI: 1.1–333.4]) as were those whose seizure etiology remained unknown (HR: 2.2 [95% CI: 1.1–4.4]). Among participants that survived from enrolment to the end of data collection on 10 May 2013 (n = 58), 20 (34%) experienced recurrent seizures. Conclusions New-onset seizure among HIV-positive Zambian adults is associated with high mortality despite good functional status prior to presentation. Advanced HIV infection and failure to identify an underlying seizure etiology are associated with greater mortality. Recurrent seizures occur in over a third of survivors within only 2 years of follow-up. This provides evidence to support AED initiation after first seizure in HIV-positive individuals with advanced HIV disease at the time of presentation though the risks of AED-cART interactions remain a concern and warrant further study

Clinical characteristics and outcomes after new-onset seizure among Zambian children with HIV during the antiretroviral therapy era

ObjectiveThis study describes clinical profiles including human immunodeficiency virus (HIV) disease history and seizure etiology among children living with HIV presenting with new-onset seizure during the era of antiretroviral therapy (ART) in Zambia. 30-day mortality and cause of death are also reported.MethodsChildren living with HIV (CLWHIV) with new-onset seizures were prospectively evaluated at one large urban teaching hospital and two non-urban healthcare facilities. Interviews with family members, review of medical records, and where needed, verbal autopsies were undertaken. Two clinicians who were not responsible for the patients’ care independently reviewed all records and assigned seizure etiology and cause of death with adjudication as needed.ResultsFrom April 2016 to June 2019, 73 children (49 urban, 24 rural) were identified. Median age was 6 years (IQR 2.2-10.0) and 39 (53%) were male children. Seizures were focal in 36 (49%) and were often severe, with 37% presenting with multiple recurrent seizures in the 24 hours before admission or in status epilepticus. Although 36 (49%) were on ART at enrollment, only 7 of 36 (19%) were virally suppressed. Seizure etiologies were infectious in over half (54%), with HIV encephalitis, bacterial meningitis, and tuberculous meningitis being the most common. Metabolic causes (19%) included renal failure and hypoglycemia. Structural lesions identified on imaging accounted for 10% of etiologies and included stroke and non-accidental trauma. No etiology could be identified in 12 (16%) children, most of whom died before the completion of clinical investigations. Twenty-two (30%) children died within 30 days of the index seizure.SignificanceDespite widespread ART roll out in Zambia, new-onset seizure in CLWHIV occurs in the setting of advanced, active HIV disease. Seizure severity/burden is high as is early mortality. Enhanced programs to assure early ART initiation, improve adherence, and address ART failure are needed to reduce the burden of neurological injury and premature death in CLWHIV.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172838/1/epi412595_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172838/2/epi412595.pd