Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

Background: Diabetic ketoacidosis (DKA) remains an important cause of hospitalisation and death in people with diabetes mellitus (DM) living in low- and middle-income countries. The clinical profile of patients with DKA varies, and maybe contributory to the outcomes observed globally. The aim of this study was to describe the clinical characteristics of people with diabetic ketoacidosis (DKA) seen at a clinic in The Gambia during a one-and-a-half-year period. Methods: This was a retrospective chart review that included people with DM who were seen from June 2017 to December 2018 at the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine. Biodata, anthropometric and admissions data were extracted for all patients from the electronic medical records system. Data were analysed for differences in clinical and biochemical characteristics on admission for DKA. Results: In total, 23 out of 103 admissions for people with DM were for a diagnosis of DKA during the study period. Sixteen of those included were females and the mean age of all patients was 35 ± 13 years. Two people had type 1 DM and 15 people were categorised as type 2 DM. DM was diagnosed for the first time during admission for DKA for 12 people and 6 people had confirmed sepsis. There were no significant differences in age at diagnosis of DM or biochemical characteristics. Conclusion: DKA was a common indication for admission for people with DM in the Medical Research Council the Gambia at London School of Hygiene and Tropical Medicine and the majority of patients with DKA had type 2 DM. Further studies are needed to describe DKA in this setting more accurately.

Developing capacity for implementation and evaluation of vaccine trials in Uganda: Perspective of the Makerere University Walter Reed Project

Introduction: Infectious diseases and neglected tropical diseases continue to be a major challenge in resource limited settings, causing significant morbidity and mortality. Although vaccines are a key biomedical prevention tool, resource limited settings often lack the infrastructure, regulatory frameworks, and skilled human resource to conduct vaccine clinical trials. To address this gap, the Makerere University Walter Reed Project (MUWRP) was established and has contributed to vaccine research in Uganda and globally. Methods: This was achieved through training a strong vaccine clinical trial workforce; development of requisite clinical trial infrastructure for research activities and management of investigational products; conducting phase I-III vaccine trials and contribution to national ethical and regulatory frameworks that protect participants. Results: As of 2022, MUWRP had successfully conducted and completed five phase I/II HIV vaccine clinical trials, five for Ebola and Marburg, while one phase I/II Schistosomiasis and one phase III COVID-19 vaccine clinical trial are ongoing. Discussion: The completed vaccine trials provided critical scientific knowledge on the safety and immunogenicity of investigational products which informed the design of better vaccines for diseases of global health importance. Conclusion: Academia, through establishment of appropriate partnerships can contribute to the identification of solutions to complex public health challenges

The covid-19 pandemic: research and health development in the World Health Organisation Africa region

Concerns have been expressed about the view point of WHO AFRO concerning research for health in the African Region. WHO AFRO considers research a critical component in the improvement of health in the Africa region. Ensuring the effectiveness of our strategies, policies and programmes requires evidence. In the context of the ongoing COVID-19 outbreak, WHO research interests cover key areas of the response. The WHO AFRO consider research as critical in our efforts at protecting people against health emergencies and pandemics like the COVID-19 and ensuring universal access to proven interventions. In view of this, the WHO has taken steps to strengthen capacity for research in the region. The results of these efforts may take time to manifest but will surely do as we persist in our drive, with support from our partners

Is 'decolonisation' a legitimate and appropriate value in biomedical research and teaching?

This article investigates the claim that decolonisation is an appropriate and legitimate value in the process of current-day biomedical research, particularly in Africa. Can we expect that the nature and effects of the decolonisation of research will be comparable and similar for all scientific disciplines (obviously including the biomedical disciplines), or does the claim to significant differences between the 'natural'and 'human' sciences have notable implications for our understanding of both the nature and the effects of decolonisation, as well as for our understanding of the biomedical disciplines themselves? In this article I firstly analyse the notion of decolonisation . Secondly, I investigate the legitimacy of holding and maintaining a conceptual difference between the natural and the human sciences. I do this in conversation with Charles Taylor and Jürgen Habermas, who have produced invaluable contributions in this regard. Thirdly, I apply these insights to the question as to whethethedecolonialist project (the general legitimacy of which I accept) is equally applicable to both the natural and the human sciencesin their traditional formats. Finally, I discuss the relevance of this debate for both the nature of the biomedical sciences and the question as to the extent to which the biomedical sciences can and ought to be successfully decolonised ­ a question that is answered in the affirmative

Knowledge and use of biostatistics among resident and junior doctors at the university of port harcourt teaching hospital, Port Harcourt

Background: The place of research in the generation of facts and evidence on which contemporary medicine can be based cannot be overemphasized. Medical and surgical research is now more crucial than ever before for advancement of clinical practice and career progression for medical professionals. This requires good understanding and application of biostatistics among clinicians. Aim: To assess the knowledge and use of biostatistics among resident doctors at the University of Port Harcourt Teaching Hospital, Port Harcourt. Subjects and Methods: This was a questionnaire-based study carried out in the University of Port Harcourt Teaching Hospital. Completed questionnaires were retrieved immediately after completion. The data were entered into an Excel spreadsheet, cleaned, and subjected to statistical analysis. Results: There were a total of 109 respondents. Sixty-nine (63.3%) respondents were included in the study. Fifty-five (79.7%) respondents indicated that they understood the basic concepts of biostatistics, and only 16 (23.2%) respondents can apply their knowledge practically in research. Conclusion: The level of appreciation and use of biostatistics among resident doctors in the University of Port Harcourt Teaching Hospital is inadequate. This may be a reflection of the situation with resident doctors in other institutions in the country. There is a need for a curriculum review both at the undergraduate and postgraduate levels to prepare medical professionals for the task of high-quality research and advancement of knowledge

Five decades lead in biomedical research: University of Khartoum tops Sudanese universities in PubMed articles

Introduction: University of Khartoum (U of K) is the largest and oldest university in Sudan (1). The recent rankings of international and local universities made by Webometrics Ranking of world Universities initiative in 2017 have placed University of Khartoum as number one University in Sudan and 1970 in rank Worldwide. This ranking system is based mainly on research activity and publications. Using PubMed we obtained data on all PubMed-indexed articles (from 1966 to 2016) affiliated to the four oldest and most established Sudanese universities: University of Khartoum, University of Gezira, Omdurman Islamic University, and Al-Neelain University.Methods: Using R Statistical environment, we compiled a unified dataset from multiple resources including PubMed data and impact factor data. This unified dataset was then used to calculate multiple article and authorship metrics including total number of articles and annual averages. We also applied text mining techniques to from indexed abstracts in order to explore the prevailing trends and research focus of some the most prolific authors and to visualize this trends though word clouds.Results: Since the earliest date of PubMed indexing in 1966, the University of Khartoum is by far the most affiliated Sudanese university in PubMed. Approaching 300 articles in 2016, the number of PubMed indexed articles has shown a promising rising trend over the past decade. Our results clearly indicate lead of University of Khartoum in published biomedical research. This trend is promising and shows the attention shift towards research activities among the major Sudanese universities in general and University of Khartoum in particular

Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system

One of the challenges in the process of ethical medical research in developing countries; including Ethiopia; is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate; relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community; with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system

Enhancing Domestic Molecular Biology for Viral Hepatitis in Cameroon

Background: Molecular biology (MB) is an essential tool for the diagnosis and evaluation of treatment efficacy against viral hepatitis. This tool was not available in Cameroon for viral hepatitis B and C; until recently. Blood samples to be examined were systematically sent abroad via the Centre Pasteur du Cameroun (CPC). Purpose: to assess the accuracy of the results from a domestic new laboratory of MB compared to those from a laboratory abroad. Methods: We included in the study; 15 subjects randomly selected from the queue of patients followed at viral hepatitis clinic of the Yaounde University Hospital Center. They were all carriers of chronic hepatitis C. Two blood samples of the same volume were sent the CPC and to a new MB laboratory at the Chantal Biya International Research Center (CIRCB). Neither the CPC nor the CIRCB were aware of the study. One of the two tests was free for all patients. To be acceptable to the result from the CIRCB should be the same from the outside or with than 12 IU / ml above. Results: We did not observe any significant differences from the results issued by the laboratories. Conclusion: These first results from a domestic MB laboratory are encouraging. One should promote Molecular biology should hence be promoted

Antibiotic sensitivity patterns of enterobacteriaceae isolated at King Faisal Hospital; Kigali - a three years study

Introduction: A great concern exists about the emergence of antibiotic resistant organisms. The goal of this study is to delineate antibiotic sensitivity patterns at King Faisal Hospital. Methods: A three years study; from Jan 2009 to Dec 2011 was conducted in the Microbiology unit; department of Laboratory; King Faisal hospital; Rwanda. All the specimens and antibiotic sensitivity were processed according to the standard guidelines. Microorganisms and their sensitivity data were reviewed and compiled by using hospital information system. Results: Over the 3-year period; several Enterobacteriaceae pathogens declined in susceptibility to various antimicrobial agents. A total of 2153 Enterobacteriaceae were isolated. Most common isolate was Escherichia coli check for this species in other resources (1413) followed by Klebsiella check for this species in other resources species (550); Enterobacter check for this species in other resources species (110); Proteus check for this species in other resources species (165); Citrobacter check for this species in other resources Species (79); Shigella check for this species in other resources species (110) and other species. Most notable were the decreased sensitivities to cefuroxime: E. coli (84 to 72); Klebsiella (78 to 33); Enterobacter (50 to 41) Proteus(67 to 59) and Shigella to ciprofloxacin (100 to 96). And also decreased sensitivities to Imipenem: E. coli (100 to 98) and Klebsiella species (100 to 94). Conclusion: These decreased antibiotic sensitivities reflect increased bacterial selection pressure as a result of widespread antibiotic use. A combined approach involving infection-control specialists; infectious disease physicians; and hospital administrators is necessary to address this increasingly difficult problem

Levels of Bifurcation of the Sciatic Nerve among Ugandans at School of Biomedical Sciences Makerere and Mulago Hospital Uganda

Background: The sciatic nerve is derived from the lumbo-sacral plexus; It is the thickest nerve in the whole body; it exits the gluteal region through the lower part of the greater sciatic foramen; it is the main innervator of the posterior thigh; the leg and foot; it usually ends halfway down the back of the thigh by dividing into the tibial and common peroneal nerves; and these terminal branches supply the leg and foot. The position of division of this nerve varies; it may occur within the pelvis; gluteal region; upper and ;mid thigh; and distal thigh ;Its injury if it involves the whole nerve; may lead to loss of sensation; in posterior thigh; whole leg and foot; with loss of function of all muscles in posterior thigh; whole leg and the foot. And this results into failure to dorsiflex the foot a condition referred to as foot drop. The level of bifurcation of the sciatic nerve above the transverse popliteal crease is useful during sciatic nerve block; hence the need for healthcare workers to have adequate appreciation of the applied anatomy of the nerve. The main objective of the study was to determine the level of bifurcation of the sciatic nerve above the transverse popliteal crease among Ugandans at Mulago Hospital Complex. Methods: This was a cross-sectional descriptive study conducted at the Department of Anatomy; School of Biomedical sciences; Makerere University and Mulago Hospital mortuary. Eighty adult cadavers were dissected in the gluteal region and posterior thigh to establish the level of furcation of the sciatic nerve above the transverse popliteal crease; and the distance from the crease was measured in cm using a caliper calibrated in millimeters. Results: Eighty left lower limbs of 56 male and 24 female adult cadavers were dissected to expose the sciatic nerve one side of the body was dissected to control for left to right variations; however in another study; the variations on two sides would be compared..; The heights of the cadavers ranged from 145 to 182 cm with a mean of 162.8 cm. The nerves bifurcated in the gluteal region and posterior thigh in 62 cadavers (77.5) and 18 in the pelvis (22.5). Of the 62 nerves that bifurcated her in the pelvis; the level of bifurcation ranged between 3.8 and 32.5 cm but most of the bifurcations occurred between 3.8 and 12 cm above transverse popliteal crease. In four of the nerves that exited the gluteal region after bifurcation; the nerves reunited before the final bifurcation occurred in the thigh. Conclusions: The Bifurcation of the sciatic nerve occurs at variable distances from the transverse popliteal crease and appreciation of these variations is essential. More than 22of all nerves leave the pelvis as two separate nerves and therefore the sciatic nerve trunk cannot be wholly traced or used for anesthetic block in the gluteal region or thigh for procedures in the leg and foot. Only 62 individuals (77.5) had sciatic nerves in the gluteal region and thigh; and within this group; the vertical distance of bifurcation ranged between 3.8 and 32.5 cm ransverse popliteal crease

The regulation of informed consent to participation in clinical research by mentally ill persons in South Africa: an overview

The article examines the legal requirements relating to the informed consent of mentally ill persons to participation in clinical research in South Africa. First; the juridical basis of informed consent in South African law is outlined; and second; the requirements for lawful consent developed in South African common law and case law are presented. Finally; the article deliberates upon the requirements for the participation of mentally ill persons in research as laid down by the Mental Health Care Act and its regulations; the National Health Act and its (draft) regulations; and the South African Constitution

The Internationalisation of South African Medical Research; 1975-2005

South Africa's record in the production of scientific knowledge in medicine is remarkable; but attempts have yet to be made to examine its distinctive characteristics. This is critical to the understanding of its nature; trends and the directions which it is taking today. Using the publication records extracted from the Science Citation Index (SCI) of the ISI Web of Science for a 3-decade period from 1975 to 2005; with 5-year windows; I have examined the salient characteristics of medical research in South Africa in terms of; (1) the number of publications; (2) type of publications (sole/co-authored); (3) collaboration (domestic/international); (4) affiliation sector of authors and collaborators; (5) regional origin of collaborators; (6) publication outlets and (7) citations; in comparison with `all subjects' covered in the database concerned. This analysis shows that the contribution of medical publications to the total output of South African scholars is shrinking (25in 1980 to 8in 2000). Papers produced in collaboration are growing in number (increased by 17during 1975-2005). While domestic collaboration declined by 24; international collaboration grew from 4of total papers in 1975 to 48in 2005. South African medical researchers now publish more in foreign-originated journals (from 20in 1975 to 75in 2005) than in local journals and work mostly in universities; hospitals and research institutes; they collaborate with overseas partners from as many as 56 countries. Significantly; collaboration with Western European partners has increased 45-fold from 1975-2005. This study showed that a marked degree of internationalisation (measured in terms of international collaboration; publications in foreign journals and the number of citations) of South African medical research is taking place and that this trend is likely to continue in the future

Enrolment and Retention of African Women in Biomedical Research: the Challenges

Background : In Africa; women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends andburden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting andretaining African women in biomedical research. Methods:Relevant biomedical research literatures on Human Research Participants from Scirus; Pubmed and Medline computerized search were critically evaluated and highlighted. Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria; Kwazulu-Natal; Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University; Washington DC. Results: Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception; cultural barriers; ignorance and fear of adverse event; limited autonomy to give consent; lack of confidentiality especially in sensitive trials; and improper research design. Conclusion:Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment; occurrence of unexpected sideeffects and delayed diagnosis and early treatment of disease

Enrolment and Retention of African Women in Biomedical Research: The Challenges

In Africa; women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends and burden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting and retaining African women in biomedical research. Relevant biomedical research literatures on Human Research Participants from Scirus; Pubmed and Medline computerized search were critically evaluated and highlighted. Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria; Kwazulu-Natal; Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University; Washington DC. Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception; cultural barriers; ignorance and fear of adverse event; limited autonomy to give consent; lack of confidentiality especially in sensitive trials; and improper research design. Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment; occurrence of unexpected sideeffects and delayed diagnosis and early treatment of disease

Recherche medicale en Afrique Subsaharienne:ses contraintes et ses potentialites

Un nombre; non exhaustif; de constats sur la situation actuelle de la recherche medicale en Afrique subsaharienne est rapporte ; la prise en compte de ces constats pourrait en permettre un meilleur developpement. Des reflexions concernant l'organisation de la recherche; ses financements; la necessaire sensibilisation des decideurs; le statut et le role du chercheur; ainsi que la structuration de la recherche; permettent de mieux cerner certains des freins actuels. Des suggestions sont formulees ; chacune d'entre elles doit etre adaptee au contexte de chaque pays. Il appartient aux seuls chercheurs du Sud de prendre les decisions adequates et de les developper en partenariat etroit et egalitaire avec d'autres chercheurs. Parmi les suggestions; citons : la potentialisation des moyens par le developpement de reels Reseaux; regionaux et internationaux; de chercheurs; la creation; au Nord; de postes virtuels d'Attaches de Recherche a titre Etranger; la publication d'une ou deux revues medicales africaines de haut niveau; et le developpement de la banque de donnees africaines

Prevalence of Chlamydia in Patients Attending Gynecological Clinics in South Eastern Nigeria

"Background: Chlamydia infections have been reported to cause silent infections in communities which becomes endemic and could remain unnoticed for a very long time. In most parts of Nigeria these organisms are not screened for; and hence relative information about frequencies of the organisms are sparse. Method: Five hundred and sixty five blood samples and ten umbilical cord fluids were collected from various patients attending clinics in South Eastern Nigeria and were screened for Chlamydia Complement Fixing Antibody (CCFA). Endocervical swabs and urethral discharges or swabs were collected from patients whose serum was positive and were cultured into embryonic eggs which was later observed; harvested and stained using the Romanowsky - Giemsa staining techniques. The positive sera were further confirmed by distinguishing the species of Chlamydia using the monoclonal antibody spot test kit. Result: Of the five hundred and sixty five (565) samples collected only three hundred and forty were positive to CCFA; of which 141 were males and 204 females. From the cultured samples 230 were positive for Chlamydia trachomatis and 99 positive to Chlamydia pneumoniae. Statistical analysis using the student's t test at 95confidence interval shows that there was no significant difference between the number of females and males that presented themselves for screening. Conclusion: Proper screening of patients to include Chlamydia should be encouraged at all levels of medical diagnosis in the country so as to proffer treatment. Otherwise the infection will remain a ""silent epidemic""; as is the case currently."

Quantitative pathology : historical background, clinical research and application of nuclear morphometry and dna image cytometry

Quantitative analysis of histo- and cytochemical components such as DNA, RNA or chromatin pattern on one hand (cytometry) and the quantitative analysis of geometric non-chemical cell and tissue components (morphometry and sterology) on the other, have developed somewhat independently. Today, many different techniques, such as morphometry, sterology, and static image and flow cytometry are well established and routinely used in diagnostic quantitative pathology. The potential significance of these techniques in the individualization of care in cancer patients include the objective distinction between benign, borderline and malignant lesions, objective grading of invasive tumours, prediction of prognosis, and therapy response

Medical Research : are we doing enough in Africa?

As we look forward to the end of this Century and the beginning of the next; our politicians are busy telling us about their plans to turn our countries into New Industrialised Nations (NINS) by the year 2010 (or is it 2020?). Most of us dismiss this as mere political rhetoric. But as medical researchers; perhaps we ought to look at this 2020 business more carefully. Let us assume that a few African countries will indeed become New Industrialised Nations by the year 2020. Shall we; as medical researchers; have contributed to this industrialisation process through our research efforts? Perhaps to answer this question one needs to look at the state of medical research in most African countries at the moment. In the majority of our countries; research output in the form of publications in reputable medical journals has fallen in recent years. Perhaps the only exception is research on AIDS/HIV; but only because of external funding and/or collaboration with other centres outside Africa. In addition; most of the prominent African medical scientists trained in the sixties and seventies have either retired or will soon retire. What they have left or will soon leave behind are institutions which are so run down due to lack of resources that proper research and training no longer takes place. The tragedy of all this is that Africa is not producing enough well trained young medical scientists to continue with the good work started by those retiring now. Some countries in South East Asia have become New Industrialised Nations through aggressive training programmes and incentives for their young scientists (including medical scientists). Can African medical scientists be optimistic about the year 2020; given the meagre resources we are operating with at the present time? I am not

The Eighteenth African Health Sciences Congress : Dissemination of Research Results for Utilisation

The African Health Sciences Congress for 1997 will be held in Cape Town; South Africa; from 14 to 18 April. This congress has been an annual event where scientists from across the world meet to present research results and to discuss meaningful approaches to solving some of the world's pressing health problems. The congress which is under the aegis of the African Forum for Health Sciences (AFHES); focusses special attention on ways of finding solutions for problems that afflict the African. The AFHES aims to accentuate; through these meetings; practical approaches that can be used by African governments to tackle health-related matters in order to improve the socio-economic status of the people on the African continent. The common health-related matters that one would be expected to be covered at such a congress are the six major tropical diseases identified by the World Health Organisation (WHO); namely malaria; filariasis; schistosomiasis; leishmaniasis; trypanosomiasis and leprosy. But now; there are other health-related problems on the continent that must be dealt with in order to ensure quality of life. Among them are the new and re-emerging diseases like the haemorrhagic fevers (Ebola and Marbug) and yellowfever; the sexually-transmitted diseases including HIV/AIDS; acute respiratory infections and reproductive health. Then there are the less often mentioned health-related problems currently afflicting the African continent that are not given so much attention as the others. These include sanitation; famine and drought; and malnutrition which arise from political upheavals leading to refugees. The consequences of these socio-economic difficulties further exacerbate the prevalence of the existing tropical and other diseases. Scientists working in Africa should play leading roles in tackling the many health problems that afflict the peoples of Africa. They are well placed to collect direct information on these health issues and to provide practical and meaningful strategies for their solution. The WHO Africa Region has taken a meaningful step towards finding mechanisms of eliminating female mutilation in Africa; and this is highlighted in the Newsdesk pages of this issue of the Journal. This; it is hoped; will be achieved through the use of the African traditional foundation and wisdom. Similarly; the African traditional culture of health should provide the basis for utilising the wisdom of the traditional healers and traditional midwives for dealing with primary health care matters on the African continent. The Journal congratulates all the scientists working in Africa; be they Africans or non-Africans; and those outside Africa; who work tirelessly to solve problems that will pave the way for an acceptable quality of life for the world's peoples. It is earnestly hoped that the scientists in Cape Town during the 18th African Health Sciences Congress will deliberate; discuss and dedicate themselves to solving Africa's pressing health problems. The Journal also acknowledges with gratitude; the organisers of this congress; namely the South African Medical Research Council; the Kenya Medical Research Institute and the Epidemiological Society of Southern Africa (ESSA); which; under the auspices of the African Forum for Health Sciences; have made it possible to hold the Congress in cape Town this year