IMTU Medical Journal

Editorial

Felix Kisanga

No Abstract

Prevalence and patterns of depression among post myocardial infarction patients attending a tertiary care hospital

Reddy E Ananda, Venu Gopala Raju S Venkata, R Bhagawan, Tejaswini M Sri Sai

Background: Depression often affects the clinical outcome of Myocardial Infarction. Depression reduces the recovery rate of the individual and often deteriorates the condition. Knowledge regarding the prevalence of depression after myocardial infarction is necessary for treatment purposes. The present study is aimed to know prevalence and patterns of depression among post myocardial infarction patients.
Materials and methods: A cross sectional study was done on 50 patients who suffered from myocardial infarction at tertiary care hospital, Guntur. A socio demographic chart along with Zung’s depression inventory was used to collect the data from the individual patient.
Results: In our study, sample comprised of 27 (54%) male patients and 23 (46%) female patients. Symptoms for depression was observed 18 (36%) of the patients. Out of 50 patients 16 (32%) were in the group of mild depression and 2 (4%) patients were in the group of moderate depression, according to Zung’s Self Rating Depression Scale.
Conclusion: Depression is common among post myocardial infarction patients. Identifying the symptoms of depression and proper treatment will help the patient to improve the treatment outcome of Myocardial Infarction. So it will help in overall improvement of their quality of life.

Keywords: Depression, Myocardial infarction, Tertiary care hospital, Zung’s Self Rating Depression Scale.

Correlation of hematological and biochemical parameters to severity of disease in acquired immuno deficiency syndrome.

G Ramakrishna, Venu Gopala Raju S Venkata, G Chaitanya

Background: Acquired Immuno Deficiency Syndrome is a recognized emerging disease and rapidly established itself throughout the world. Hematological and biochemical abnormalities are common findings in patients with HIV infection. These includes anemia, thrombocytopenia, leucopenia, pancytopenia, altered liver function tests and renal function tests.
Objectives: To study hematological and biochemical manifestations in the patients with Acquired Immuno Deficiency Syndrome and to assess their correlation with the severity of disease.
Materials and Methods: 100 patients with Acquired Immune Deficiency Syndrome admitted in two tertiary hospitals in Davangere, Karnataka were included in the study. The peripheral blood samples were collected and the disease was confirmed by ELISA method.
Results: Out of 100 patients, 65% were in the age group of 26-45 years. Males (67%) were more commonly affected than females (33%). Fever was the predominant symptom seen in 59% of cases; followed by weight loss (53%). Physical findings included anemia (54%), oral candidiasis (30%), generalized lymphadenopathy (25%), and skin lesions (15%). Normocytic normochromic blood picture was seen in 51% of cases. Leucopenia was seen in 30% cases and thrombocytopenia in 21% of cases. Hemoglobin, neutrophils, lymphocytes were significantly reduced according to severity criteria (p < 0.05). Altered liver function tests were seen in 28% of cases. Altered renal function tests were seen in 15% of cases. Biochemical parameters were not in correlation with severity of the disease.
Conclusion: Hematological and biochemical abnormalities were common in patients with Acquired Immuno Deficiency Syndrome. Hemoglobin, neutrophils, lymphocytes were significantly reduced according to the severity criteria.

Keywords: Acquired Immuno Deficiency Syndrome (AIDS), Hematological manifestations, Liver function tests, Renal Function Tests.

The biomedical waste management in selected hospitals of Chittoor district, Andhra Pradesh, India.

Y Pradeep, Prabhu G Ravi, Venu Gopala Raju S Venkata

Introduction: Poor waste management practices pose a huge risk to the health of the public, patients, professionals and contribute to environmental degradation.
Aims and objectives: Our study was aimed to assess the present status of biomedical waste management in Government and Private Hospitals.
Materials and Methods: A cross sectional study was done in 10 Government and 10 Private hospitals and availability of the various color coded bags in the different locations of the hospital were assessed.
Results: Supply of various types of color coded bags for biomedical waste disposal and usage of disinfectants for treating biomedical waste has been better in the government hospitals than in private hospitals. Regular review meetings on Biomedical waste segregation; disinfection and disposal were held only in 30% of government hospitals and 20%of private hospitals.
Conclusion: A Committee on Biomedical waste management is to be established in every hospital for the implementation of the proper disposal of Biomedical Waste.

Keywords: Biomedical Waste, color coded bags, Hospital.

Proximal femoral nail: a minimally invasive treatment for intertrochanteric fractures.

A Srinivasa Rao, V Sarath, B Mrudhula

Background: Intertrochanteric fractures are the commonest fractures in elderly. Due to the increase in life expectancy and sedentary life style, more cases of such fractures are seen in day to day practice. Surgery is almost always the recommended treatment as morbidity and mortality associated with non-operative treatment is very high. Patients always have pre-existing co-morbidities that dictate the ultimate outcome. Our study was aimed at assessing the surgical management of inter trochanteric fractures using proximal femoral nail.
Materials and Methods: In our study patients who presented to department of orthopaedics, Katuri Medical College between January 2013 and December 2014, with intertrochanteric fractures were included and treated with Proximal Femoral Nail. Total of 82 patients were included in the study. Medically unfit patients and patients not willing for surgery were excluded from the study.
Results: 82 patients with intertrochanteric fractures with mean age of 68.8years,who underwent proximal femoral nailing between January 2013 and December 2014 were included in the study. Maximum age of the patient was 93 years, minimum age was 28 years. Majority of the patients were between 40-80 years. Of these 82 cases majority of the cases were due to slip & fall, with predominance of right side.52 % of cases were Boyd and Griffin type 2 fractures. Mean duration of hospital stay was 10.4 days. Mean time of full weight bearing was 13.6 weeks. Mean operation time was 40 .8minutes.Less blood loss of average 50.9 ml. Good to excellent results were seen in 91% of cases, with smaller incision, less blood loss, shorter operation time, early mobilisation of patient, decreased hospital stay, better wound healing & lesser postoperative complications.
Conclusion: From this study we consider all though Proximal Femoral Nail was technically demanding, with proper technique it gives excellent results. Proximal Femoral Nail was a minimally invasive excellent implant for treatment of intertrochanteric fractures.

Keywords: Intertrochanteric fracture, Minimally invasive treatment, Proximal Femoral Nail (PFN).

Non absorbable sutures in the urinary bladder resulting in intravesical calculi and recurrent urinary tract infection: a case report

S.V. Krishna Rao, Ramkishan Gonuguntla

We report an unusual case of a bladder stone formed on a “non-absorbable suture” in a woman with history of previous anti-incontinence procedure (colposuspension). After the removal of the bladder stones, a ring shaped prolene suture material encrusted in the bladder stone was unveiled. Based on the literature, most foreign bodies in the bladder are subject to stone formation on the bladder wall, but rarely become encrusted into a stone within the bladder. We suggest that bladder stone formation should be excluded in clinical evaluation of women with recurrent urinary tract infection.

A comparative study between manual small incision cataract surgery and phacoemulsification, in the improvement of visual outcome.

MR Chella, VR Ande, N Konindala

Background: Cataract extraction is the most frequently performed surgical procedure in patients above 60 years of age. Surgical outcome in terms of visual acuity depends on the surgical technique and Intra ocular lens used.
Aims and Objectives: Our study was aimed to compare the improvement in visual acuity, achieved by Phacoemulsification and by small incision cataract surgery.
Materials and Methods: A longitudinal study was done in 100 cataract patients who underwent Manual Small Incision Cataract Surgery with rigid PMMA (Group A: n=50) and Phacoemulsification with foldable intra ocular lens implantation (Group B: n=50). Visual acuity and Intraocular pressure in both eyes was assessed.
Results: Visual acuity was improved in both the groups, after the surgical procedure. Uncorrected Visual Acuity of better than 6/18 was seen in 60% in Group A and 72% in Group B; Best Corrected Visual Acuity of more than 6/18 was seen in 94% in Group A and 96% in Group B at the end of 6 weeks after the surgery.
Conclusion: The post operative improvement in visual acuity with small incision cataract surgery and with Phacoemulsification was good. Lower rate of surgically induced astigmatism was found with Phacoemulsification when compared to the Small Incision Cataract Surgery.

Keywords: Astigmatism, Cataract, Intra Ocular Lens (IOL), Phacoemulsification.

Acceptability of medical male circumcision among traidtionally non circumcising tribes attending health care services in Makambako hospital, Njombe, Tanzania.

Asteria V. Mpoto, Cornel M. Wambura, Felix S. Kisanga

Background: Male circumcision (MC) can reduce men’s risk of contracting Sexually Transmitted Infections (STIs) including HIV/AIDS for at least 50% or even as high as 66%. With this regard, WHO and UNAIDS urge international community to scaled-up MC among uncircumcised men especially in HIV hard hit regions. Residents of Makambako mainly the Bena Kinga do not have a circumcision custom.
Objectives: This study examined acceptability of MC among traditionally non-circumcising males accessing health care in Makambako Hospital, Njombe Region, Tanzania.
Methods: This was a quantitative descriptive cross-sectional study. Some 118 uncircumcised males were randomly selected to participate. In addition, 9 health care workers (HCW) and 8 community members were purposively recruited to participate in a qualitative survey. Kiswahili semi-structured questionnaires were administered to the uncircumcised males, and Focus Group Discussions (FGDs) were held with both HCWs and Community members.
Results: About 70 % uncircumcised males indicated that MC is acceptable, while 97% understand the health importance of MC, signifying that MC is gradually gaining acceptance in the study population. Majority (84%) preferred medical circumcisers over traditional ones due to safety procedure. Data from FGD revealed readiness to undergo
MC, and both HCW and Community members urged for reduced costs for such services. Recommendations: For sustainability of MC scaling–up, health education should be a permanent agenda to reach the uncircumcised individuals in Njombe District.

KEY WORDS: Acceptability, sexually transmitted diseases, male circumcision scale-up

Challenges of monitoring reproductive health services: a case study of antenatal clinics in Kinondoni municipality, Dar Es Salaam

Achilles Kiwanuka, Ezekiel Mbao, Achilles Kiwanuka

Introduction: Antenatal Care (ANC) is one of the interventions that have the potential of significantly reducing the maternal mortality rate when properly conducted.
Objectives: The purpose of this research was to assess the challenges of monitoring and evaluation of reproductive health services using ANC clinics as a case study and identify strategies for addressing the challenges.
Methods: The study was descriptive cross sectional employing both qualitative and quantitative methods. The sample population included nurse-midwives who manage ANC clinics in Kinondoni Municipality.
Results: Of the 30 respondents, 24 respondents noted the need to improve monitoring of the ANC services. Challenges noted were low information use, inadequate human resource, and lack of feedback data from higher authorities.
Conclusion: There is need to improve information flow and use, have frequent supportive supervision visits, seminars and workshops to update nursemidwife managers with knowledge and skills of monitoring and evaluation, and development of a culture of information.

Keywords: challenges, monitoring, reproductive health, antenatal care

Child sexual abuse and possible health consequences among secondary school students in urban Tanzania

Felix Kisanga, David Urassa, Nora Hogan, Jessie Mbwambo

Background: Child sexual abuse (CSA) is a global public health concern especially in developed countries and where legal measures take unprecedented time. The aim of this study was to estimate the prevalence of different forms of CSA, and the perceived health consequences among secondary school students in Tanzania.
Methods: A cross-sectional survey was performed in Dar es Salaam using a random sample of 15 public and 8 private schools, each having participants from one randomly selected class. A self-administered questionnaire was supervised by research assistants to collect data and. Multivariate logistic regression analysis was used to identify CSA risk factors the perceived health consequences.
Results: A total of 827 girls (61%) and 532 boys (39%) with a median age of 16 years participated. Those who experienced at least one incident of sexual abuse in their life time.were 376 (27.7% n=1359). Prevalence of any CSA and forced penetrative sex among boys and girls was 26% and 30% and 8.7% and 9.8% respectively. Of those exposed to CSA, 20% were exposed at least four times..
Conclusions: CSA constitutes a public health problem in Tanzania. Awareness of sexual abuse incidents and associated health consequences need to be introduced to respective teaching curricula

Contributions of socio-economic and cultural factors in Tungiasis at Kwakombo village in Korogwe district, Tanzania

Background: Tungiasis is an ectoparasitosis caused by the female sand flea, Tunga penetrans, or jiggers, which is an important, but not easily seen public health problem. Tungiasis is prevalent in many developing countries, in South America, Caribbian and Sub-Saharan Africa, including Tanzania.
Objectives: To describe tungiasis and possible contributing socio-economic and cultural factors at Kwakombo Village in Korogwe District, Tanzania.
Methodology: This was a cross-sectional descriptive study, which used quantitative and qualitative data collection methods. The sample included, randomly selected 720 villagers from a total of 3500 residents of Kwakwombo Village, surveyed for presence of Tungiasis infestation followed by a description of the 300 Tungiasis affected people Thirty four village leaders and 4 healthcare workers of the Village participated in the qualitative survey.
Results: Out of the sample of 720 300 (41.7%) had infestation with Tunga penetrans, the majority of whom 207(69%) were males. The most vulnerable age group was 5-14 years (47%) and majority (95%) live in houses that are roofed with grass,with muddy floors and muddy walls, as well as share their houses with domestic animals, and 58% don’t wear shoes.
Recommendations: More research is needed to establish the prevalence of the disease in the rest of Korogwe and Tanzania. Ministry of Health and Social Welfare and social leaders in Korogwe should be made aware and active against the disease.

Aerobic bacteriological profile and antibiotic resistance of surgical site infections in surgery ward of Teritiary care hospital Mahaboobnagar

K. Fathimunnisa, B. Nagaraju, B. Sreekanth Reddy, Manisha Singh, Vasanti Kabra

Background: Surgical Site Infections (SSI) constitutes a major fraction of nosocomial infections and occurs in superficial incisional, and organ/ space locations. In developing countries, surgical site infections (SSIs) are imposing a heavy and potentially preventable burden on both patients and healthcare providers.
Objectives: The aim of this Study was to isolate and identify organisms from SSI and to study their antibiotic resistance pattern.
Methods: This prospective study was conducted in Microbiology department associated with tertiary care hospital S.V.S Medical College and Hospital over a period of 24 months (from November 2010 to December 2012) were included. Isolates were identified according to the standard protocols and antibiotic sensitivity was done by Kirby Bauer disc diffusion technique.
Results: Out of 752 samples 150 samples were culture positive. In that Staphylococcus aureus (49.33%) is most common followed by CONS (14%), Pseudomonas sps (9.33%), Acinetobacter (5.33%), Citrobacter and Klebsiella sps (4.66%), E.coli and Proteus sps (4%). Enterococci sps (2.66%) and Streptococci sps (2%). Staphylococcus aureus showing nearly 56.75% resistance to Cefoxitin. Majority of Gram negative organisms are resistant to third generation cephalosporins like Ceftazidime, Cefotaxime (51%) and are uniformly sensitive to Imipenem and Tigecycline (100%).
Conclusions: Emerging antibiotic resistance in the clinical isolates of Surgical Site Infections is a serious issue which has to be dealt with appropriate antimicrobial therapy and proper management.

Resolute large scale mining company contribution to health services of Lusu ward, a rural community, in Nzega district, Tabora region, Tanzania.

Mariam R Mavura, Jacqueline L. Bundala, Richard K. Arap Towett, Fariji D Mtango

Introduction: In 1995 Tanzanian Government reformed the mining industry and the new policy allowed an involvement of multinational companies but the communities living near new large scale gold mines were expected to benefit from the industry in terms of socio economic, health, education, employment, safe drinking water, irrigation, livestock and agriculture, better shelter, and environmental protection. Objective was to assess the contribution of one of the corporate mining companies in Tanzania as a social responsibiliy towards surrounding rural communities of Lusu Ward, Nzega District, Tabora Region , Tanzania
Methodology: The study employed a case study approach using a questionnaire to a random and purposive sample of 200 households. The questionnaire was administered to the 200 household heads and 16 community leaders. The data were analyzed using Scientific Package for Social Science (SPSS).
Results: There was evidence that the company (RSL) had brought about social changes to the community in the form of improvement in housing (mud bricks houses roofed with grass for 74.% of the households and mud bricks houses roofed with iron sheets for 26%. There were also improvements in agriculture whereby mixed farming together with livestock had risen to 44% of respondents, a dispensary and one biogas plant were built and free drugs were provided to one dispensary. The mine employed only 0.9% of the community. RSL also supported an HIV screening survey in of the villages. The prevalence of communicable diseases, however, appeared unaffected and HIV prevalence was higher than national average in females (11%) in males (7%) and among mining workers (9%).
Conclusions: The RSL has made significant contributions to the wellbeing of surrounding communities, however, health problems are very big and more is needed to be done.
Recommendations: The policy should state clearly what the large scale mining companies should contribute to the community

Seroprevalence of Hepatitis B surface antigen and associated factors among pregnant women attending clinic at Mafiga health center, Morogoro, 2014.

Ratna K Koneru, Goodluck Eliakim Mwanga, Felix Kisanga

Background: Hepatitis B virus (HBV) infection is one of the global public health problem; estimated to affect 400 million individuals, chronically infected, which results in nearly 1 million deaths each year from cirrhosis or hepatocellular carcinoma. Tanzania is one of the sub-Saharan countries with high endemicity levels with seroprevalence of HBs Ag among pregnant women varying between 4 to 6%
Objective. To determine seroprevalence of Hepatitis B and associated factors among antenatal women attending clinic at Mafiga health centre, Morogoro
Methodology: This is a cross-sectional study conducted at the antenatal clinic at Mafiga health centre between 16 June and 15 July 2014. A structured questionnaire was used and blood specimen was collected for screening of HBs Ag, syphilis and HIV antibodies by using commercial rapid test. Ethical clearance and informed consent were obtained prior to the enrolment in the study.
Results:- A total of 252 pregnant women were recruited and the HBV seroprevalence was 3.6%, while seroprevalence of HIV and syphilis were 4.1% and 3.1%, respectively. One (14.3%) had HBV and syphilis The HBs Ag/Syphilis coinfection prevalence was 11.1% which was the same as the HBs Ag/HIV. The risk factors for HBV were age group 35-39 yrs, married and multiple partners.
Conclusions: The prevalence of HBs Ag among women of child bearing age suggests that vertical transmission of HBV continue to be a public health problem in Mafiga Health Centre’s catchment population. There is need for having in place mechanism for control of vertical transmission of the disease.

Health services provision to elderly people at Tandale dispensary, Kinondoni municipality, Dar es Salaam Tanzania

Rose Temu, Richard K, Arap Towett, Fariji Mtango

Background: Health services for the elderly are very crucial for these people have unique diseases which need special attention and treatment
Objectives: To study the awareness , acceptability and utilization of health services by the elderly people at Tandale Dispensary, Kinondoni Municipality, Dar es Salaam.
Methods: This was a descriptive cross-sectional study whereby 154 persons aged 60 years and above , who attended Tandale Dispensaryin Tandale Ward, Dar es Salaam were interviewed in June 2012. At the same time, data was sought from 30 health workers of the facility and 16 Tandale community leaders through in depth interview and focus group discussion
Results: Majority of the elderly (85%) had never had any free medical services at Tandale and (88%) were not covered by any health insurance scheme. Only 33% were aware of the National Aging Policy. The majority (84%) were unemployed, while 96% had no pension. A majority of health workers (93%) had not attended any training on managing special health problems of the elderly.
Recommendations: The elderly should be made aware of their privileges according to the Aging Policy. Health service providers should be given appropriate education on special needs of the elderly and be empowered for the same

Liquid chromatographic determination of pyrethroid insecticide, cypermethrin, residues in cabbage, cauliflower and capsicum

Rama Mohana Rao Chilumuru, Cyril Arun Kumar Lakkineni, Chandra Bala Sekharan

A new high performance liquid chromatography (HPLC) method for the quantitative analysis of cypermethrin in vegetable samples has been described. The determination of cypermethrin was carried out on Kromosil C18 analytical column (250 mm × 4.6 mm I.D., 5 μm particle size), under reversed phase chromatographic conditions in isocratic mode with acetone and cyclohexane (5:95 v/v) as mobile phase. The flow rate was 1.0 ml/min and eluent was monitored at 254 nm. The retention time of cypermethrin was 5.35 min. Under the optimized experimental conditions, Beer’s plot showed good correlation in the concentration range of 0.5–3 μg/ml. The method is validated with respect to sensitivity, selectivity, precision and accuracy. The method is found to be sensitive, accurate and precise and successfully applied to the determination of cypermethrin in vegetable samples like cabbage, cauliflower and capsicum. Cypermethrin was detected in all the selected vegetable samples.

Key words: Pyrethroid insecticide, High Performance Liquid Chromatography, Analysis, Vegetable samples.

Quantification of narcoleptic drug, Modafinil, by high performance liquid chromatographic method

A stability indicating HPLC method was developed and validated for modafinil quantification in bulk and tablet dosage forms. Aligent zorebax SB C18 analytical column (250 mm x 4.6 mm, 5 μm particle size) was used with mobile phase consisting of 0.1 M sodium dihydrogen phosphate and methanol in ratio 60:40 (v/v), flow-rate 1.0 ml/min, UV-detection at 230 nm and controlled temperature at 30°C. The linearity was found in the concentration range of 5-150 μg/ml. The method was validated as per the ICH guidelines. The drug was exposed to acidic, basic, oxidation, photo degradation and dry heat conditions. As the developed method can efficiently separate the modafinil from its degradation products, it can be employed as stability-indicating method.

Key words: Modafinil, stability indicating HPLC, method development, validation, tablet dosage forms

Development and validation of stability indicating studies of paliperidone hydrochloride by RP-HPLC method

A simple and sensitive stability indicating HPLC method is developed for the quantification of paliperidone in bulk and tablet dosage form. Chromatographic separation was achieved on a Supelco C8 (Hypersil, 250mm x 2.5mm i.d., 5 μm) column. The mobile phase consists of 10 mM ammonium formate buffer (pH 4.0): acetonitrile (73:27 v/v) and was delivered at a flow rate of 1 ml/min. The method was validated as per ICH guidelines. The linearity is obtained in the range of 1-15 μg/ml. The paliperidone was subjected to stress conditions for the assessment of the stabilityindicating nature of the method. Degradation products resulting from the stress studies have no interfere with the detection of paliperidone. The recovery of paliperidone in tablet dosage form was satisfactory. The developed method was proved adequate for quantitative determination of paliperidone in presence of its degradation products.

Key words: Analysis, HPLC, Paliperidone, Stability indicating, Tablets.

Use of electrophilic coupling reagents, 3-methyl-2-benzothiazolinone hydrazone hydrochloride and 4-amino antipyrine, for the spectrophotometric analysis of vardenafil in tablet dosage forms

Two new spectrophotometric methods (MBTH and AP) are developed for the determination of vardenafil in bulk and in tablet dosage forms. The MBTH method involves oxidative coupling of vardenafil with 3-methyl-2-benzothiazolinone hydrazone hydrochloride in presence of ferric chloride in acidic medium, yielding green colored chromogen with absorption maxima at 625 nm. The AP method is based on the oxidation of 4-aminoantipyrine by potassium periodate, which subsequently couples with vardenafil in an alkaline medium to form a red colored product having absorption maxima at 530 nm. The absorbance concentration graphs were rectilinear over the range of 4-40 μg/ml for MBTH method and 4-60 μg/ml for AP method. The developed methods were fully validated as per the guidelines prescribed by ICH. The application of the proposed methods in the determination of vardenafil in their commercial tablet dosage forms was successful showing good percentage recoveries.

Key words: vardenafil, electrophilic coupling agent, MBTH, aminoantipyrine, analysis.