Challenges in the Management of Omphalocele at University Teaching Hospital, Zambia

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Conjoined (Siamese) twins in Zambia

The university Teaching hospital is the main referral centre for Zambia a country that  has a population of over 11 million people. Fourteen sets of conjoined twins have been  seen between 1970 and 1999. Of these fourteen sets of twins, three cases were  stillborn (21.43%). The remaining 11 (78.57%) sets were brought in alive. Five (35.71%) of these eleven sets had multiple congenital abnormalities; and were not  subjected to operation. All five died within a period of two weeks. Six (42.86%) sets were successfully separated. An attempt has been made to establish the incidence of conjoined twins in Zambia. Basic principles of management have been suggested and constraints likely to be encountered in a third world country like Zambia have been  discussed. Key words: Conjoined, Siamese and twin

Challenges in the management of Benign Oesophageal strictures in Zambians

Background: Benign Oesophageal structures are common in Zambians and pose great challenge in their management. Infants and, children are more affected than adults. Conservative and surgical treatments have been deployed in this institute and each of these methods have their advantages and disadvantages.Methods: Operative technique consisted of 32 adult patients (15.6%) using isoperistaltic transverse colonic segment the length of which can be extended from ascending to descending colon depending on the distance between lower thyroid cartilage and the stomach. The transverse colon was passed subcutaneously. The first stage was feeding colostomy, which was followed by definitive operation.Results: Two hundred and five Zambians with benign oesophageal stricture caused by ingestion of corrosive substances were seen in a period of 20 years from 1985 to 2005 inclusive. The majority (84.4%) were Zambian infants aged below 3 years. The remaining 32 patients (15.6%) were adults aged from the ages of 15 to 64 years giving a mean age of 41 years. Corrosives were taken accidentally in 84.9% while in the remaining 31 (15.1%) drank corrosives in suicidal attempt. All the babies were treated conservatively using bouginage and gastrostomy. Five infants who came in irreversible shock died. The 32 (15.6%) had gastrostomy for feeding the patients with failed attempted bouginage and got anterior sternal transverse colon oesophageal replacement. Morbidity was high but mortality was nil. We found this operation suitable for third world countries since there was no need for parental feeds. The operation restored ability to take food orally in 80% as compared to 26% of patients with bouginage.Conclusion: Confident vascularity depending on middle colic and left colic is guaranteed by low incidence of stenosis. The functional results are excellent as compared to minor complications which can be corrected early

Sexual ambiguity and malformation in Zambia: challenges in surgical management

A medical research article on the challenges of managing sexual ambiguities in sexually deformed patients in a hospital in Zambia.This article addresses the complexity in diagnosis, gender assignment and management in patients with sexual ambiguity and malformed sexual organs. Between 1984 and 1993, nine children and 10 adult patients with this ailment were treated in the University Teaching Hospital, Lusaka, Zambia. All children had clitorovaginoplasty and adults had different surgical procedures such as feminisation and masculinisation operations. Methods, means and the manner in which we manage these patients in the midst of a scarcity of expert manpower and sophisticated equipment are discussed. Need for a specialized clinic for better management, teaching and research of this unfortunate and highly sensitive congenital defect has been emphasized

Reflection of Dublin principles in rural water supply approaches in Zambia

Water resources management (WRM) is a broad sector that comprises various sub sectors including rural water supply and sanitation (RWSS). Attempts have been made to articulate WRM at global level culminating into the development of the Integrated Water Resources Management (IWRM) approach defined by the Dublin Principles. However, these principles still need to be reflected in local actions that are used to implement the RWSS interventions. Hence, this paper focuses on identifying the extent to which IWRM is reflected in the RWSS implementation approach in Zambia known as the WASHE concept. The results of this assessment show that only two out of the four Dublin principles are adequately reflected in the WASHE concept. It is concluded that there is a need to integrate ground water management in IWRM and adapt catchment management to existing administrative governance systems in Zambia, and that the WASHE concept be revised and expanded accordingly

Assessing the potential for self-supply in Zambia

The Millennium Development Goal target for safe water supply is currently unlikely to be met in Zambia. In order to serve the population that is unlikely to be reached under conventional communitybased water supply programmes, alternative approaches to water supply service provision need to be explored. One such alternative is the SelfSupply approach which encourages households to develop and improve their own infrastructure incrementally. However, to ensure the actualisation of such an approach an enabling environment needs to be created that includes enabling policies, sufficient private sector capacity, access to appropriate technologies and technical advice, and effective financial mechanisms and markets. Drawing on the findings of a baseline survey in Luapula province it is concluded that there is significant potential for SelfSupply in Zambia and that an enabling environment largely exists. There is a need, however, to develop effective microcredit facilities that are accessible to rural households

The use of carboxymethylcellulose gel to increase non-viral gene transfer in mouse airways

We have assessed whether viscoelastic gels known to inhibit mucociliary clearance can increase lipid-mediated gene transfer. Methylcellulose or carboxymethylcellulose (0.25 to 1.5%) were mixed with complexes of the cationic lipid GL67A and plasmids encoding luciferase and perfused onto the nasal epithelium of mice. Survival after perfusion with 1% CMC or1% MC was 90 and 100%, respectively. In contrast 1.5% CMC was uniformly lethal likely due to the viscous solution blocking the airways. Perfusion with 0.5% CMC containing lipid/DNA complexes reproducibly increased gene expression by approximately 3-fold (n= 16, p<0.05). Given this benefit, likely related to increased duration of contact, we also assessed the effect of prolonging contact time of the liposome/DNA complexes by delivering our standard 80 μg DNA dose over either approximately 22 or 60 min of perfusion. This independently increased gene transfer by 6-fold (n=8, p<0.05) and could be further enhanced by the addition of 0.5% CMC, leading to an overall 25-fold enhancement (n=8, p<0.001) in gene expression. As a result of these interventions CFTR transgene mRNA transgene levels were increased several logs above background. Interestingly, this did not lead to correction of the ion transport defects in the nasal epithelium of cystic fibrosis mice nor for immunohistochemical quantification of CFTR expression. To assess if 0.5% CMC also increased gene transfer in the mouse lung, we used whole body nebulisation chambers. CMC was nebulised for 1 hr immediately before, or simultaneously with GL67A/pCIKLux. The former did not increase gene transfer, whereas co-administration significantly increased gene transfer by 4-fold (p<0.0001, n=18). This study suggests that contact time of non-viral gene transfer agents is a key factor for gene delivery, and suggests two methods which may be translatable for use in man

Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

BACKGROUND AND AIMS: There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period. METHODS: Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation. RESULTS: Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available. CONCLUSIONS: This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration

CpG-free plasmids confer reduced inflammation and sustained pulmonary gene expression.

Pulmonary delivery of plasmid DNA (pDNA)/cationic liposome complexes is associated with an acute unmethylated CG dinucleotide (CpG)-mediated inflammatory response and brief duration of transgene expression. We demonstrate that retention of even a single CpG in pDNA is sufficient to elicit an inflammatory response, whereas CpG-free pDNA vectors do not. Using a CpG-free pDNA expression vector, we achieved sustained (≥56 d) in vivo transgene expression in the absence of lung inflammation