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The Central African Journal of
Medicine
ABSTRACTS Vol.46, No.3
March 2000
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp.59-61
ORIGINAL ARTICLES
Aids is now the commonest clinical condition
associated with multilineage blood cytopenia in a central
referral hospital in Zimbabwe
E MALYANGU, EA ABAYOMI, J ADEWUYI, AM COUTTS
Abstract
Objective: To describe the clinical features
and diagnosis of patients hospitalised and found to have
multilineage peripheral blood cytopenias.
Design: Prospective cross sectional study.
Subjects: 231 consecutive patients whose blood
parameters revealed bi-or trilineage cytopenia during a
five month period in 1996.
Main Outcome Measures:
- Blood cytopenia was described as:
- Haemoglobin concentration = or <100g/L
- Total leucocyte count = or <3.5x10/L
- Platelet count = or <100x10/L
- Other clinical and diagnostic features.
Results: The highest percentage of multilineage
blood cytopenia was in the age braket 30 to 44 years and
the male to female ratio was 1.4:1. Pancytopenia was
found in 32.5% of patients, while bilineage cytopenia
occurred in 67.5%. The commonest bilineage pattern was
the combination of anaemia and thrombocytopenia occurring
in 46.3% of all study cases or 68.5% of bilineage
cytopenias. Anaemia was the most frequent cytopenia; it
was found in 95.2% of all study cases.
Conclusion: The commonest with which
multilineage blood cytopenia was associated with AIDS
which was diagnoses in 25.1% of the study cases.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 62-5
Chlamydia trachomatis in symptomatic and
asymptomatic men: detection in urine by enzyme
immunoassay
P R MASON, L GWANZURA, S GREGSON, D A KATZENSTEIN
Abstract
Background: Infection with Chlamydia
tractomatis is known to be a common cause of
urethritis and cervicitis. The standard methods of
detection require a collection of intra-urethral and/or
cervical swabs, which may be submitted for culture,
antigen detection or nucleic acid amplification. The
collection of swabs is suitable only within the context
of a health care facility. Recent reports have indicated
that antigen detection can be used with urine specimens,
and because these can be self-collected, this may be
particularly useful for the detection of asymptomatic
carriage.
Objective: To determine the sensitivity and
specificity of urine antigen assays in the detection of
chlamydial infection in men.
Setting: Two groups of men were investigated;
men with urethritis attending clinics or private
practitioners, and healthy adult men enrolled into either
urban or rural HIV prevention projects.
Methods: Urine samples from men in both groups
were collected and assayed for the presence of chlamydial
antigen using a commercial enzyme immunoassay (EIA) kit.
For symptomatic men an intra-urethral swab was also
collected and assayed for antigen detection using a
commercial EIA. For asymptomatic men, a ligase chain
reaction was carried out on the same urine sample.
Results: The prevalence of chlamydial antigen
in symptomatic men was 15% (39/257), and in asymptomatic
men was 4% (15/349). The sensitivity and specificity of
urine EIA for symptomatic men was 87% and 83%
respectively. For asymptomatic men, the sensitivity of
urine EIA was 86%, and the specificity was 100%.
Conclusion: Urine EIA is a relatively
inexpensive method for the detection of chlamydial
infections in men. The true specificity in symptomatic
men may be higher, as the “gold standard” that
we used may give false negative results. Antigen EIA for
examination of urine specimens from community surveys of
asymptomatic men may be particularly useful because of
the low cost of assays, and because urine samples can be
self-collected without discomfort to study subjects. The
prevalence of C. trachomatis that we describe here
is consistent with other studies of chlamydial
epidemiology in Zimbabwe.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 65-8
Nephroblastoma (Wilms' Tumour) diagnosed in the
Department of Anatomical Pathology Medunsa/Ga-Rankuwa
Hospital for the period 1980 to 1997
E J LANCASER, L BANACH, F P DEVILLIERS
Abstract
Objective: The aim of the analysis was to
describe the clinicopathological features of Wilms'
Tumour (WT) diagnoses in our Department and compare
results to other WT Registers.
Design: All cases of WT for the period 1980 to
1997 were retrieved from the Register of Renal Tumours of
Childhood.
Setting: The Medical University of Southern
Africa, Department of Anatomical Pathology and Department
of Paediatrics, Ga-Rankuwa Hospital.
Subjects: A total of 171 cases of WT (97% of
all renal tumours) were the subject of the analysis.
Result: The age of the patients ranged from
four to 216 months. The two sexes were represented
equally. Tumours were solid in 73.9%, cystic in 20% and
mixed in 6.1%. There were many tumours involving the
right kidney as those involving the left kidney. In nine
cases WT bilateral. Only 2.45 of tumours were in stage I
and II. The mass of the kidney with tumour ranged from
50g to 5400g and in a diameter from three to 28cm.
Histopathologically classic, blastemal and stromal type
were nearly equally represented. Follow up was very
inadequate and in 66% of cases the fate of the patient
remains unknown.
Conclusion: Occurrence of WT is similar to that
reported from other regions of the world. Cases are in a
more advanced stage than reported by SIOP and NWTS.
Follow up is highly inadequate.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 69-76
ETHICS
Understanding medical ethics
M LITTLE
Abstract
Moral thinking is embedded within cultures, and we use
ethics all the time in our dealings with one another.
Many functioning communities tend to share some values
that reflect a particular view of the importance of human
life in quantity and quality. Rights and duties form an
interconnected network of obligations that protect the
security of individuals and groups. In health care, the
motives and virtues of practitioners are important
sources of the determination to provide care for the ill
within limits of resource constraints. Ethics and the law
have similarities, but also significant differences that
may cause tension between the two systems. Health care is
morally grounded, and provides a bulwark against the
widespread fear of disease and suffering. The way in
which health care is delivered depends on both national
wealth and community values.
Ethical problems can be seen as dilemmas, in which
there are conflicting values. Modern ethical thinking in
health is complicated by the need to consider the values
and interests of many stakeholders – patients,
health care workers, families, politicians,
administrators, health bureaucrats and many others. There
are ways of ethical thinking that take account of these
often countervailing interests. No universally `right'
answers can be specified. The mode and the thoroughness
of ethical consideration, and the careful consideration
of local community values, will help to assure that we
make the best possible decisions for the time and place.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 76-9
What are ethics (more particularly medical
ethics)?
T J NUAPADA
Introduction
The issue of ethics has puzzled many academics,
philosophers, researchers and psychologists. There is no
general agreement how the word ethics or morality should
be used. Some people think of morality as a set of rules
laid down by God. Others think of it as a set socially
imposed rules with the function of reducing conflict on
society. Others say it is a set of principles about how
we ought to live that apply to everyone impartially or
which can be defended by appealing to the interests of
people in general.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 71-81
Teaching medical ethics
J MIEKLE
Introduction
Imparting principles and standards of behaviour to
students has always been of foremost concern to those
charged with the education of future health
professionals. Since the time of Hippocrates there have
been many attempts to capture on paper the essentials of
ethical values to health professionals, and this century
in particular has seen the burgeoning of medical ethics
as a discipline and a proliferation of academic
literature in the field. At the same time society at
large has assumed increasing interest in the protection
of individuals rights, which has led to scrutiny of
medical doctors' attitudes and actions by public and
private bodies, including courts of law in the case of
litigation. In many countries there has been a subsequent
loss of trust and status of the doctor as an individual
with integrity and impeccable moral standards. In
addition there has been a perceived decline in the
maintenance of respect for individuals by medical
professionals in some countries. In the field of human
rights the United Nations identifies health professionals
as particularly prone to and uneducated about human
rights abuses amongst individuals under their care.
Medical schools must take a share of responsibility for
what appear to be declining standards of behaviour among
their graduates, and seek means of rectifying this
situation. Undergraduates, postgraduates and
professionals practising in the community without direct
access to teaching institutions deserve to be considered
as separate categories.
The Central African Journal of
Medicine, Vol. 46, No. 3, 2000 pp. 81-6
REVIEW ARTICLE
Screening for cervical cancer, a priority in
Zimbabwe?
S RUTGERS, D VERKUYL
Abstract
In several (first word) countries many cases of the
cervix are prevented through regular screening of women
at risk by means of a Pap (anicolao) smear. The adage `prevention
is better than cure' suggests that mass screening
should also take place in Zimbabwe. A critical public
health viewpoint is presented which discusses the
complexity of a national cervical cancer screening
programme.
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