Prevalence and risk factors for hepatitis b and c among end-stage renal disease patients on hemodialysis in Gaborone, Botswana.

BACKGROUND: Patients on maintenance hemodialysis (HD) are at risk of blood transmitted infections such as hepatitis B and C. OBJECTIVES: To determine the prevalence and risk factors for hepatitis B and hepatitis C virus infections among end-stage renal disease (ESRD) patients on maintenance hemodialysis in Gaborone, Botswana. MATERIALS AND METHODS: A cross-sectional study with a retrospective longitudinal approach involving all eligible public patients undergoing hemodialysis was carried out for a period of 3 months. Data on socio-demographic, clinical characteristics, and hepatitis serology was collected using a case report form. Statistical Software Package for Social Sciences (SPSS) version 24 was used for data entry, cleaning, and analysis. The risk factors associated with Hepatitis B and C infections were determined using bivariate logistic regression analyses. A P value of less than 0.05 was considered statistically significant. RESULTS: Of the 168 participants, 5 (2.98%) were HBsAg seropositive at the initiation of hemodialysis, whereas 2 (1.19%) were seropositive for anti-HCV antibodies at the initiation of hemodialysis. Two patients out of 163 (1.23%) were found to have seroconverted to HBsAg positivity during hemodialysis. One out of 166 patients (0.61%) seroconverted to HCV antibodies positivity during hemodialysis. The duration of hemodialysis, history of invasive procedures, HIV status, frequency of hospitalization, and blood transfusion were not associated with seroconversion for both Hepatitis B and C. CONCLUSIONS: The prevalence hepatitis B and C infections among ESRD patients on hemodialysis is low. There was no significant association between the identified risk factors and HBV/HCV infection. Regular audits on seroconversion status for hepatitis B and C are recommended as a way of assessing and supporting the current strategies for infection control among HD patients.

The prevalence of microalbuminuria and associated factors among patients with type 2 diabetes mellitus in Botswana.

BACKGROUND: Microalbuminuria (MA) has been established as an early marker of both diabetic nephropathy and vascular disease in patients with diabetes mellitus (DM). AIMS: This study was conducted to determine the prevalence of MA and associated factors among patients with type 2 DM in Botswana. SETTINGS AND DESIGN: Outpatient tertiary clinic. MATERIALS AND METHODS: A cross-sectional descriptive study involving 289 patients with type 2DM was conducted from January 2013 to June 2013 in Block 6 Reference Clinic, a tertiary clinic in Gaborone, Botswana. A random spot urine sample was collected from each patient with MA defined as urine albumin-to-creatinine ratio (ACR) between 3.0 and 30.0 mg/mmol. STATISTICAL ANALYSIS USED: Data analysis was done using STATA version 12 (College Station, TX, USA). Unpaired Student's t-test was used for compairing means and Chi-squared test was used for comparison of proportions between groups. A P value of <0.05 was considered statistically significant. RESULTS: The majority of recruited patients (191, 66.1%) were females, and the median age (interquartile range) of the patients was 52 (42-53) years. The mean glycosylated hemoglobin (HbA1c) for the study population was 8.43% with 70.6% of the population having HbA1c over 7%. MA was found in 129 (44.6%) of study participants. The duration of diabetes of 6-10 years, estimated glomerular filtration rate, HbA1c, and higher serum trigerycides levels were significantly associated with presence of MA. CONCLUSION: High prevalence of MA raises an urgent need for changes in the management of patients with type 2 DM in Botswana, with emphasis on prevention and reduction of MA to avoid development of overt diabetic nephropathy and ensuing cardiovascular morbidity and mortality.

The prevalence of chronic kidney disease and associated factors among patients admitted at princess marina hospital, Gaborone, Botswana.

BACKGROUND: Chronic kidney disease (CKD) has become a major public health problem worldwide. Due to the asymptomatic nature of CKD during earlier stages, patients tend to present late, missing opportunities for prevention. AIMS: This study was conducted to determine the prevalence and assess the risk factors associated with CKD in patients admitted at Princes Marina Hospital. SETTINGS AND DESIGN: Hospital inpatient setting. SUBJECTS AND METHODS: A case-matched comparison study was done involving 86 cases and 86 matches by gender and age (± 5 years) from March 21, 2014, to May 31, 2014. STATISTICAL ANALYSIS USED: SPSS software version 20 (SPSS Inc. Chicago Illinois) was used for data entry, cleaning, and analysis. Frequency, percentage, mean, and standard deviation were used to describe the data. Chi-squared test and odds ratio (OR) with 95% confidence interval (CI) were employed to analyze the associations of categorical variables. Logistic regression analysis was done to control for possible confounding variables. A P < 0.05 was considered statistically significant. RESULTS: In the study period, CKD prevalence was 74/550 (13.5%), and 23/99 (23.2%) of mortality occurred in patients with CKD. Over half of the 86 cases of CKD (53.5%) were not aware of their CKD status and were diagnosed during the index admission. Hypertension (HTN), diabetes mellitus, and HIV-positive status were significantly associated (P < 0.05) with CKD in the bivariate analysis, while HTN (adjusted OR [AOR] [95% CI]: 11.28 [4.56, 27.89]) and HIV-positive status (AOR [95% CI]: 8.68 [3.58, 20.99]) remained significant predictors of CKD in the multivariate analysis. CKD within the HIV-positive patients was significantly associated with duration of <3 years since HIV diagnosis and lower CD4 levels (P < 0.05). CONCLUSIONS: Significant admissions and mortality in medical wards are attributed to renal impairment. There is an urgent need to establish follow-up programs in high-risk populations (hypertensives, diabetes, and HIV) which aims to identify patients at early stages of CKD, and devise prevention mechanisms to reduce burden in terms of cost, morbidity, and mortality.

The triad of Iron deficiency anemia, hepatosplenomegaly and growth retardation with normal serum zinc levels in a 14-year-old boy.

A triad of iron deficiency anemia, hepatosplenomegaly and growth retardation occurring in tandem with zinc deficiency has been reported in the past as components of either Prasad's syndrome or hypopituitarism. There are no documented cases of such triad occurring in the presence of normal serum zinc levels. We report a case of a 14-year-old boy who presented with iron deficiency anemia, hepatosplenomegaly, geophagia and growth retardation with pubertal delay. Investigations ruled out hypopituitarism and coeliac disease. The patient improved dramatically and attained puberty within 15 months of intense nutritional intervention. In conclusion, iron deficiency anemia occurring in the triad without zinc deficiency as seen in this case report has not been reported before; this calls for more research to be able to explain the findings.

An audit of consent practices and perceptions of lumbar puncture, Botswana inpatient setting experience

Introduction:The epidemic of HIV/AIDS in sub-Saharan Africa has led to significant increases in the burden of meningitis; especially cryptococcal meningitis. Morbidity and mortality resulting from meningitis occur partly due to delays in performing lumbar punctures both for diagnostic and therapeutic purposes. This study was conducted with the primary objective of exploring the attitudes and concerns that patients have with regard to lumbar puncture; and also to assess current consenting practices of doctors with regard to lumbar puncture. Methods : A descriptive cross-sectional study was conducted in medical wards of Princess Marina Hospital; a tertiary hospital in Gaborone; Botswana. Data were collected by means of a questionnaire-based survey involving patients or their next of kin; and doctors. Other relevant information was obtained from patient charts. Data collection involved 12 patients and 23 doctors. Results :Of the 12 patients interviewed; four stated that the reasons for doing lumbar puncture (LP) were explained to them. One respondent stated that LP risks were mentioned; while two stated that they were given the option to refuse LP. Most patients' possible reasons for refusal of LP was attributed to fear of pain. Five (42.7) patients/next of kin had never heard of LP before; and most of the interviewed patients associated the procedure with death and paralysis; while none associated with meningitis or HIV. Twenty-two (95.7) of 23 doctors stated that they routinely consent patients for LP; 11 (47.8) mentioned risks; and nine (39.1) stated that the patient has the option to decline the procedure. Only 26 of doctors routinely used local anaesthesia while 22 routinely asked for written consent. Conclusion: Contrasting responses between doctors and patients indicates a need for standard consenting practices among doctors. Also; patients' attitudes and receptiveness to lumbar punctures can be improved through education on lumbar puncture indications; benefits; and risks

Pulmonary artery thrombosis in a patient with right-sided heart failure.

Pulmonary thromboembolism occurring either abruptly or insidious poses a greater challenge in diagnosis. A high index of suspicion is required to proceed with proper investigations in patients with nonspecific cardiac or respiratory presentation to make the diagnosis of pulmonary embolism (PE). Early diagnosis of PE with prompt initiating of anticoagulation therapy has been proven to have a positive impact in mortality reduction associated with recurrent episodes of this condition. We present a case of a 76-year-old man, known to have cardiac failure on regular treatment who presented with predominant features of right-sided heart failure accompanied with dizziness. He was diagnosed to have pulmonary artery thrombosis by computerized tomography. Anticoagulation therapy was initiated with marked clinical improvement.