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1. Clinical characteristics and outcomes of patients admitted with COVID-19 at a public-sector hospital over the first two waves of SARS-CoV-2 infection in Harare, Zimbabwe: A prospective cohort study.

Author

Arun Fryatt, Trevor Chivandire, Victoria Simms, Perseverance Chikide, Trymore Munorwa, Ellane Simon, Lovemore Nyasha Sigwadhi, Katharina Kranzer, Tsitsi M Magure, Aspect Maunganidze, Leolin Katsidzira, and Rashida A Ferrand

Subjects
Public aspects of medicine, RA1-1270
Abstract

BackgroundWe investigated the clinical profile, complications, and outcomes of inpatients with COVID-19 at Parirenyatwa Hospital, Harare, across the first two waves of SARS-CoV-2 infection, and factors associated with mortality.MethodsWe conducted a prospective cohort study on all patients admitted to the COVID-19 unit. Data were extracted from medical records and negative binomial regression with robust standard errors was used to assess the association between sociodemographic and clinical characteristics and mortality. Cox Regression was used for sensitivity analysis.ResultsOf 563 people admitted with COVID-19 between 2 July 2020 and 19 March 2021, 214 (38.0%) died, 340 were discharged and 9 transferred. The median age was 56 (IQR 44-68) years and 53.8% were male. Overall, 38.8% experienced a complication, the most common being acute kidney injury (17.9%) and hyperglycaemia (13.1%). The most common comorbidity was hypertension (41.3%) followed by diabetes (28.6%), HIV (12.1%), cardiovascular disease (10.9%) and chronic kidney disease (7.8%). Among participants who stayed in the ward for more than 1 night, mortality was higher in patients with comorbidity compared to those without any comorbidity (38.7% vs 25.5%, risk ratio (RR) = 1.52 (95% CI 1.11, 2.07), p = 0.008). After adjusting for oxygen saturation, comorbidities, sex and pregnancy, mortality was higher in the second wave than in the first (adjusted RR 1.23, 95% CI 1.00-1.51, p = 0.05). In the second wave 57/161 (35.4%) deaths were attributed to lack of resources, mainly human resources.ConclusionThe mortality rate was high and clinical COVID-19 care needs to pay careful attention to patient monitoring for complications and management of comorbidities. This will require addressing the critical health workforce shortage issues. Prevention of COVID-19 including vaccination particularly among individuals with comorbidities remains a high priority.

Published
2024
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2. Immune activation and inflammation in lactating women on combination antiretroviral therapy: role of gut dysfunction and gut microbiota imbalance

Author

Privilege Tendai Munjoma, Panashe Chandiwana, Jacqueline Wyss, Arthur John Mazhandu, Sebastian Bruno Ulrich Jordi, Rutendo Gutsire, Leolin Katsidzira, Bahtiyar Yilmaz, Benjamin Misselwitz, and Kerina Duri

Subjects
fecal calprotectin, microbial translocation, systemic inflammation, HIV, gut microbiota, lactating women, Immunologic diseases. Allergy, RC581-607
Abstract

IntroductionCombination antiretroviral therapy (cART) effectively controls HIV; however, chronic low-level viremia and gut microbiota dysbiosis remain significant drivers of gut and systemic inflammation. In this study, we explored the relationship between gut microbiota composition, intestinal inflammation, microbial translocation, and systemic inflammation in women on cART in Sub-Saharan Africa.MethodsWe conducted a study in HIV-infected and HIV-uninfected lactating women followed up at 6 weeks and 6 months postpartum in Harare, Zimbabwe. We used 16S ribosomal Ribonucleic Acid (rRNA) sequencing and MesoScale Discovery V-Plex assays to examine the gut microbiome and to quantify plasma inflammatory biomarkers, respectively. In addition, we measured fecal calprotectin, plasma lipopolysaccharide-binding protein (LBP), and soluble cluster of differentiation 14 (sCD14) by enzyme-linked immunosorbent assay to assess gut inflammation, microbial translocation, and monocyte/macrophage activation.ResultsA group of 77 lactating women were studied, of which 35% were HIV-infected. Fecal calprotectin levels were similar by HIV status at both follow-up time points. In the HIV-infected group at 6 weeks postpartum, fecal calprotectin was elevated: median (interquartile range) [158.1 µg/g (75.3–230.2)] in women who had CD4+ T-lymphocyte counts

Published
2023
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3. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

Author

Gill Watermeyer, Leolin Katsidzira, Bright Nsokolo, Olusegun Isaac Alatise, Babatunde M. Duduyemi, Chris Kassianides, and Phoebe Hodges

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.

Published
2023
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4. Investigating point-of-care diagnostics for sexually transmitted infections and antimicrobial resistance in antenatal care in Zimbabwe (IPSAZ): protocol for a mixed-methods study

Author

Michael Marks, Victoria Simms, Chido Dziva Chikwari, Katharina Kranzer, Tsitsi Bandason, Rashida Ferrand, Joseph Tucker, Francis Ndowa, Owen Mugurungi, David Bath, Leolin Katsidzira, Ethel Dauya, Anna Machiha, Constance R S Mackworth-Young, and Kevin Martin

Subjects
Medicine
Abstract

Introduction Sexually transmitted infections (STIs) can cause serious morbidity, including pelvic inflammatory disease, and adverse pregnancy outcomes. In low/middle-income countries, limited laboratory infrastructure has resulted in a syndrome-based approach being used for management of STIs, which has poor sensitivity and specificity, leading to considerable underdiagnosis and overtreatment. The WHO has called for development and evaluation of strategies to inform replacement of syndromic management by diagnostic testing.The aim of this project is to evaluate a strategy of point-of-care testing for six STIs in antenatal care (ANC) in Zimbabwe.Methods and analysis A prospective interventional study will be conducted in ANC clinics in Harare province, Zimbabwe. One thousand pregnant women will be recruited when registering for routine ANC. Alongside routine HIV and syphilis testing, participants will be offered an integrated screening package including testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and hepatitis B. All individuals with STIs will receive treatment, partner notification services, risk reduction counselling and referral if needed according to national guidelines. Gonorrhoea samples will be cultured and tested for antimicrobial resistance as per WHO enhanced gonococcal antimicrobial surveillance programme guidelines.The primary outcome measure is the composite prevalence of CT, NG, TV, syphilis and hepatitis B. A mixed-methods process evaluation and economic evaluation will be conducted to understand the acceptability, feasibility and cost-effectiveness of integrated STI testing, compared with standard of care (syndromic management).Ethics and dissemination The study protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board, and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policymaking bodies.Trial registration number NCT05541081

Published
2023
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5. Inflammatory bowel disease in sub-Saharan Africa: a protocol of a prospective registry with a nested case–control study

Author

Gerhard Rogler, Benjamin Misselwitz, Leolin Katsidzira, Wisdom F Mudombi, Rudo Makunike-Mutasa, Bahtiyar Yilmaz, Annika Blank, Andrew Macpherson, Stephan Vavricka, and Innocent Gangaidzo

Subjects
Medicine
Abstract

Introduction The epidemiology of inflammatory bowel disease (IBD) in sub-Saharan Africa is poorly documented. We have started a registry to determine the burden, phenotype, risk factors, disease course and outcomes of IBD in Zimbabwe.Methods and analysis A prospective observational registry with a nested case–control study has been established at a tertiary hospital in Harare, Zimbabwe. The registry is recruiting confirmed IBD cases from the hospital, and other facilities throughout Zimbabwe. Demographic and clinical data are obtained at baseline, 6 months and annually. Two age and sex-matched non-IBD controls per case are recruited—a sibling or second-degree relative, and a randomly selected individual from the same neighbourhood. Cases and controls are interviewed for potential risk factors of IBD, and dietary intake using a food frequency questionnaire. Stool is collected for 16S rRNA-based microbiota profiling, and along with germline DNA from peripheral blood, is being biobanked. The estimated sample size is 86 cases and 172 controls, and the overall registry is anticipated to run for at least 5 years. Descriptive statistics will be used to describe the demographic and phenotypic characteristics of IBD, and incidence and prevalence will be estimated for Harare. Risk factors for IBD will be analysed using conditional logistic regression. For microbial analysis, alpha diversity and beta diversity will be compared between cases and controls, and between IBD phenotypes. Mann-Whitney U tests for alpha diversity and Adonis (Permutational Multivariate Analysis of Variance) for beta diversity will be computed.Ethics and dissemination Ethical approval has been obtained from the Parirenyatwa Hospital’s and University of Zimbabwe’s research ethics committee and the Medical Research Council of Zimbabwe. Findings will be discussed with patients, and the Zimbabwean Ministry of Health. Results will be presented at scientific meetings, published in peer reviewed journals, and on social media.Trial registration number NCT04178408.

Published
2020
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6. Investigation on the hereditary basis of colorectal cancers in an African population with frequent early onset cases.

Author

Leolin Katsidzira, Anna Vorster, Innocent T Gangaidzo, Rudo Makunike-Mutasa, Dhiren Govender, Simbarashe Rusakaniko, Sandie Thomson, Jonathan A Matenga, and Raj Ramesar

Subjects
Medicine, Science
Abstract

BackgroundApproximately 25% of colorectal cancer patients in sub-Saharan Africa are younger than 40 years, and hereditary factors may contribute. We investigated the frequency and patterns of inherited colorectal cancer among black Zimbabweans.MethodsA population-based cross-sectional study of ninety individuals with a new diagnosis of colorectal cancer was carried out in Harare, Zimbabwe between November 2012 and December 2015. Phenotypic data was obtained using interviewer administered questionnaires, and reviewing clinical and pathology data. Cases were screened for mismatch repair deficiency by immunohistochemistry and/or microsatellite instability testing, and for MLH1, MSH2 and EPCAM deletions using multiplex ligation-dependent probe amplification. Next generation sequencing using a 16-gene panel was performed for cases with phenotypic features consistent with familial colorectal cancer. Variants were assessed for pathogenicity using the mean allele frequency, phenotypic features and searching online databases.ResultsThree Lynch syndrome cases were identified: MSH2 c.2634G>A pathogenic mutation, c.(1896+1_1897-1)_(*193_?)del , and one fulfilling the Amsterdam criteria, with MLH1 and PMS2 deficiency, but no identifiable pathogenic mutation. Two other cases had a strong family history of cancers, but the exact syndrome was not identified. The prevalence of Lynch syndrome was 3·3% (95% CI 0·7-9·4), and that of familial colorectal cancer was 5·6% (95% CI, 1·8-12·5).ConclusionsIdentifying cases of inherited colorectal cancer in sub-Saharan Africa is feasible, and our findings can inform screening guidelines appropriate to this setting.

Published
2019
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7. Novel gastrointestinal tools (GI Tools) for evaluating gut functional capacity in adults with environmental enteropathy in Zambia and Zimbabwe: A cross-sectional study protocol [version 1; peer review: awaiting peer review]

Author

Tracy N. Phiri, James W. Weatherill, Elena Monford-Sanchez, Jose-Ivan Serrano-Contreras, Callum Melvin, Mirriam Kunaka, Ian Chisenga, Perpetual Ngalande, Monica N. Mweetwa, Ellen Besa, Tafhima Haider, Nilanjan Mandal, Alex J. Thompson, Christine A. Edwards, Claire D. Burke, Ruairi C. Robertson, Joram M. Posma, Rosemary Banda, Mulima Mwiinga, Lydia Kazhila, Leolin Katsidzira, Mutsa Bwakura-Dangarembizi, Beatrice Amadi, Isabel Garcia-Perez, Kathryn Maitland, Julian R. Marchesi, Douglas J. Morrison, Gary Frost, and Paul Kelly

Subjects
Study Protocol, Articles, Environmental Enteric Dysfunction, Intestinal Absorption, Intestinal Permeability, Microbiome, Stable Isotopes
Abstract

Background Environmental enteropathy (EE) is a highly prevalent subclinical inflammatory intestinal disorder associated with growth failure, impaired neurocognitive development, poor response to oral vaccines, and micronutrient deficiencies. However, EE research and clinical trials are hampered by the lack of non-invasive tools for measuring intestinal function in detail. This study aims to develop new tools for the measurement of multiple domains of gut functional capacity. Methods The GI TOOLS project is a cross-sectional study that will recruit adults aged 18-65 years with EE in Lusaka, Zambia. Each participant will undergo assessment of gut functional capacity using novel near-point-of-care tools and provide multiple samples for detailed laboratory analyses. Participants will also undergo endoscopy for collection of duodenal biopsies. Novel techniques include stable isotopes approaches to measuring digestion, absorption, and bidirectional transmucosal amino acid flux, a non-invasive fluorescence tool for real-time evaluation of gut permeability, and assessment of reverse permeation of intravenous antibiotics to be carried out separately in Zimbabwe. Stool and duodenal microbiome sequencing using MinION sequencing, metabolome analysis applied to plasma and intestinal fluids, blood immune cell phenotyping, in vitro epithelial barrier models, and duodenal immunohistochemistry will also be used to explore EE in depth. These will all be integrated with gold standard histology and mucosal morphometry, alongside lactulose permeation data, and stool and plasma biomarker analysis. The protocol has been approved by ethics committees and regulators in Zambia, Zimbabwe, and the UK. Participants will give informed consent before they can participate Anticipated outcomes Based on this extensive phenotyping, tests will be developed which can be simplified and refined for use in adults and children with EE, and for clinical trials. Findings from this project will be disseminated through in-person meetings with caregivers and regulatory bodies, presentations at conferences and in peer-reviewed journals.

Published
2024
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9. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa

Author

C Wendy Spearman, Geoffrey Dusheiko, Eduard Jonas, Abdelmounem Abdo, Mary Afihene, Lina Cunha, Hailemichael Desalegn, Chris Kassianides, Leolin Katsidzira, Anna Kramvis, Philip Lam, Olufunmilayo A Lesi, Eileen A Micah, Emmanuel Musabeyezu, Gibril Ndow, Chidi V Nnabuchi, Ponsiano Ocama, Edith Okeke, John Rwegasha, Abate B Shewaye, Fatuma F Some, Christian Tzeuton, and Mark W Sonderup

Subjects
Aflatoxin B1, Carcinoma, Hepatocellular, Hepatology, Liver Neoplasms, Gastroenterology, Humans, Hepatitis C, Africa South of the Sahara
Abstract

Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Primary prevention is central to the management of hepatocellular carcinoma, especially in poorly resourced environments. Effective screening and surveillance programmes with recall policies need to be implemented, because detection and curative management of hepatocellular carcinoma is possible if it is detected at an early stage, even in countries with minimal resources, with appropriate upskilling of medical personnel. The establishment of centres of excellence with advanced diagnostic and therapeutic capabilities within countries should improve hepatocellular carcinoma outcomes and assist in driving the implementation of much needed systematic data systems focused on hepatocellular carcinoma to establish the accurate burden in sub-Saharan Africa. Such data would support the public health importance of hepatocellular carcinoma and provide a strong basis for advocacy, programme development, resource allocation, and monitoring of progress in reducing mortality.

Published
2022
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10. Inflammatory bowel disease in sub-Saharan Africa: epidemiology, risk factors, and challenges in diagnosis

Author

Gillian Watermeyer, Leolin Katsidzira, Mashiko Setshedi, Smita Devani, Wisdom Mudombi, and Chris Kassianides

Subjects
Hepatology, Risk Factors, Incidence, Gastroenterology, Humans, Inflammatory Bowel Diseases, Africa South of the Sahara
Abstract

Over the past century, the incidence of inflammatory bowel disease (IBD) in high-income countries has shown a sharp rise that then plateaued, and a similar trend has been observed in newly industrialised countries. IBD has long been considered uncommon in sub-Saharan Africa, possibly reflecting low exposure to environmental risk factors described in high-income populations. Alternatively, individuals living in sub-Saharan Africa might have a different genetic disposition. However, some cases of IBD might remain undetected in sub-Saharan Africa because of a lack of awareness, deficiencies in diagnostic and clinical capacity, and a substantial rate of misdiagnosis due to the high burden of infectious diseases. There are few published data describing the natural history of IBD in sub-Saharan Africa, and the true burden of the disease remains largely unknown, although there is some evidence that the incidence of IBD is rising in this region. This Series paper summarises the present understanding of IBD and challenges facing clinicians when diagnosing this disease in sub-Saharan Africa.

Published
2022
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11. Challenges in the management of inflammatory bowel disease in sub-Saharan Africa

Author

Gillian Watermeyer, Yaw Awuku, Ernst Fredericks, David Epstein, Mashiko Setshedi, Smita Devani, Wisdom Mudombi, Chris Kassianides, and Leolin Katsidzira

Subjects
Hepatology, Chronic Disease, Gastroenterology, Humans, Colitis, Ulcerative, Inflammatory Bowel Diseases, Africa South of the Sahara
Abstract

Inflammatory bowel disease (IBD) is generally considered a disease of high-income countries and is regarded as rare in sub-Saharan Africa. However, this assumption is almost certainly an underestimate, and the high burden of communicable diseases makes IBD in sub-Saharan Africa difficult to detect. Furthermore, some gastrointestinal infections can closely mimic IBD, contributing to delays in diagnosis and complicating therapeutic decision making. Constraints in endoscopic capacity alongside a scarcity of qualified diagnostic pathologists add to the difficulties. Implementing evidence-based guidelines recommended by international societies is challenging, mostly due to high costs and unavailability of medication. However, cost-effective approaches can still be implemented to manage IBD in sub-Saharan Africa as the predominant disease phenotype is mild-to-moderate ulcerative colitis, which often responds to treatment with basic medication. In this Series paper, we summarise the current management of IBD in sub-Saharan Africa and propose how it can be tailored to suit the epidemiological and socioeconomic specificities of the region. We also discuss measures required to address existing challenges, such as educating health-care workers about the diagnosis and management of IBD or improving endoscopic capacity.

Published
2022
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12. Epidemiology, risk factors, social determinants of health, and current management for non-alcoholic fatty liver disease in sub-Saharan Africa

Author

O S Ojo, C Wendy Spearman, Chris Kassianides, Ponsiano Ocama, Omolade Betiku, Christian Tzeuton, Bilal Bobat, Mary Afihene, Hailemichael Desalegn Mekonnen, Leolin Katsidzira, Imran Paruk, Mark W. Sonderup, and Lina Cunha

Subjects
Adult, Male, medicine.medical_specialty, Social Determinants of Health, Population, Disease, Chronic liver disease, Cost of Illness, Non-alcoholic Fatty Liver Disease, Risk Factors, Environmental health, Epidemiology, Prevalence, Humans, Medicine, Obesity, Social determinants of health, Renal Insufficiency, Chronic, Noncommunicable Diseases, education, Africa South of the Sahara, Dyslipidemias, Metabolic Syndrome, education.field_of_study, Hepatology, business.industry, Incidence, Fatty liver, Gastroenterology, Disease Management, Health Care Costs, Awareness, Middle Aged, Prognosis, medicine.disease, Gastrointestinal Microbiome, Diabetes Mellitus, Type 2, Hypertension, Female, Metabolic syndrome, business, Polycystic Ovary Syndrome
Abstract

Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect approximately 25% of the world's population. Data about the prevalence and incidence of NAFLD in Africa are scarce, but the prevalence is estimated to be 13·5% for the general population. This is likely to be an underestimate considering the increasing burden of non-communicable diseases, particularly the rising prevalence of obesity and type 2 diabetes, driven by the overlapping challenges of food insecurity, nutritional transition, and associated increased consumption of calorie-dense foods. Establishing the true prevalence of NAFLD, raising public awareness around the risk factors behind the increase in NAFLD, and proactively addressing all components of metabolic syndrome will be important to combat this silent epidemic, which will have long-term health-care costs and economic consequences for the region.

Published
2021
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13. Progress on the elimination of viral hepatitis in Zimbabwe

Author

Blessing Dzingirai, Maarten J. Postma, Nyashadzaishe Mafirakureva, Leolin Katsidzira, Celia Moffat Joel Matyanga, and Marinus van Hulst

Subjects
hepatitis C virus, Zimbabwe, medicine.medical_specialty, Hepatitis, Viral, Human, Hepatitis C virus, viral hepatitis, World Health Organization, medicine.disease_cause, World health, 03 medical and health sciences, 0302 clinical medicine, Virology, Epidemiology, medicine, Humans, Hepatitis B Vaccines, 030212 general & internal medicine, Strategic planning, Hepatitis B virus, Hepatology, Health Policy, Original Articles, Hepatitis B, medicine.disease, Vaccination, Infectious Diseases, Work (electrical), Family medicine, Original Article, 030211 gastroenterology & hepatology, Business, Viral hepatitis, hepatitis B virus
Abstract

Very few low‐income countries have developed national plans to achieve the viral hepatitis elimination targets set in the World Health Organization (WHO) strategy. We reviewed the policy environment, strategies and challenges on the fight against viral hepatitis in Zimbabwe. The review focussed on the Ministry of Health and Child Care (MoHCC) policy documents, strategic plans and reports. We performed key informant interviews to enhance evidence generated from the document review. Twelve documents were reviewed and interviews with 10 key informants were completed. The MoHCC established a technical working group to work towards elimination of viral hepatitis. The technical working group drafted a strategic plan for elimination of viral hepatitis; however, it is still awaiting implementation. Key strategies that are working well include screening of donated blood for transfusion, safe injection practices and hepatitis B virus (HBV) three‐dose vaccination. Current challenges in the drive towards elimination of viral hepatitis include poor to non‐existent surveillance systems, lack of epidemiological data, absence of the HBV vaccine birth dose and lack of systematic screening and treatment services for viral hepatitis. In conclusion, despite political will demonstrated towards achieving viral hepatitis elimination, substantial investment and work are required to implement the strategic plan and realize significant success.

Published
2021

14. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Epidemic in Zimbabwe: Quo Vadis?

Author

Lenon Gwaunza, James Hakim, and Leolin Katsidzira

Subjects
Zimbabwe, Microbiology (medical), 2019-20 coronavirus outbreak, Tuberculosis, Africasouth of Sahara, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Pandemic, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Socioeconomic status, SARS-CoV-2, business.industry, 010102 general mathematics, COVID-19, medicine.disease, Viewpoints, AcademicSubjects/MED00290, Infectious Diseases, Africa, business, Malaria, Healthcare system
Abstract

The trajectory and impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in sub-Saharan Africa are unclear, but they are seemingly varied between different countries, with most reporting low numbers. We use the situation in Zimbabwe to build an argument that the epidemic is likely to be attenuated in some countries with similar socioeconomic and cultural structures. However, even an attenuated epidemic may overwhelm weak health systems, emphasizing the importance of prevention. These prevention strategies should be tailored to the unique social and cultural networks of individual countries, which may facilitate the spread of SARS-CoV-2. It is also equally important to maintain services for the major infectious diseases in the region, such as tuberculosis and malaria. A breakdown of treatment and prevention services for these conditions may even overshadow the projected morbidity and mortality from coronavirus disease 2019 (COVID-19).

Published
2020
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15. Investigating point-of-care diagnostics for sexually transmitted infections and antimicrobial resistance in antenatal care in Zimbabwe (IPSAZ): protocol for a mixed-methods study

Author

Kevin Martin, Chido Dziva Chikwari, Ethel Dauya, Constance R S Mackworth-Young, David Bath, Joseph Tucker, Victoria Simms, Tsitsi Bandason, Francis Ndowa, Leolin Katsidzira, Owen Mugurungi, Anna Machiha, Michael Marks, Katharina Kranzer, and Rashida Ferrand

Subjects
General Medicine
Abstract

IntroductionSexually transmitted infections (STIs) can cause serious morbidity, including pelvic inflammatory disease, and adverse pregnancy outcomes. In low/middle-income countries, limited laboratory infrastructure has resulted in a syndrome-based approach being used for management of STIs, which has poor sensitivity and specificity, leading to considerable underdiagnosis and overtreatment. The WHO has called for development and evaluation of strategies to inform replacement of syndromic management by diagnostic testing.The aim of this project is to evaluate a strategy of point-of-care testing for six STIs in antenatal care (ANC) in Zimbabwe.Methods and analysisA prospective interventional study will be conducted in ANC clinics in Harare province, Zimbabwe. One thousand pregnant women will be recruited when registering for routine ANC. Alongside routine HIV and syphilis testing, participants will be offered an integrated screening package including testing forChlamydia trachomatis(CT),Neisseria gonorrhoeae(NG),Trichomonas vaginalis(TV) and hepatitis B. All individuals with STIs will receive treatment, partner notification services, risk reduction counselling and referral if needed according to national guidelines. Gonorrhoea samples will be cultured and tested for antimicrobial resistance as per WHO enhanced gonococcal antimicrobial surveillance programme guidelines.The primary outcome measure is the composite prevalence of CT, NG, TV, syphilis and hepatitis B. A mixed-methods process evaluation and economic evaluation will be conducted to understand the acceptability, feasibility and cost-effectiveness of integrated STI testing, compared with standard of care (syndromic management).Ethics and disseminationThe study protocol was approved by the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute Institutional Review Board, and the London School of Hygiene & Tropical Medicine Research Ethics Committee. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings and shared with participating communities and with national and international policymaking bodies.Trial registration numberNCT05541081

Published
2023
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16. Interactions between the environmental and human microbiota in the preservation of health and genesis of disease: symposium report

Author

Matsepo Ramaboli, Lucky Nesengani, Leolin Katsidzira, Dirk Haller, James Kinross, Soeren Ocvirk, and Stephen J.D. O’Keefe

Subjects
Diabetes Mellitus, Type 2, Microbiota, Gastroenterology, Humans, Obesity, Noncommunicable Diseases, Diet
Abstract

The purpose of this symposium was to bring thought leaders in the microbiome from the west to Africa to share their unique experiences with African investigators in order to build the foundations for scientifically rigorous explorations into the African human and environmental microbiome that may explain why disease patterns are different in Africa where the chief killers are infectious diseases, whereas noncommunicable diseases (NCDs) are the major threat to healthcare resources in the developed world.The application of new high throughput technologies to the investigation of the microbiome and its metabolome has revealed mechanisms whereby a traditional African high fiber diet can suppress NCDs which include colon cancer, inflammatory bowel diseases, obesity, type 2 diabetes and atherosclosis. There is concern that with migration and westernization, NCDs are becoming more common in Africa and that food security is becoming impaired by unbalanced obesogenic foods rather than inadequate food intake.There is an urgent need for the formation of combined African-Western research programs to identify what is good and bad in the African diet-microbiome axis to develop strategies to prevent the incidence of NCDs rising to western levels in Africa, at the same time offering novel prevention strategies against the #1 healthcare threat in the developed world.

Published
2022

17. Global multi-stakeholder endorsement of the MAFLD definition

Author

Nahum Méndez-Sánchez, Elisabetta Bugianesi, Robert G Gish, Frank Lammert, Herbert Tilg, Mindie H Nguyen, Shiv K Sarin, Núria Fabrellas, Shira Zelber-Sagi, Jian-Gao Fan, Gamal Shiha, Giovanni Targher, Ming-Hua Zheng, Wah-Kheong Chan, Shlomo Vinker, Takumi Kawaguchi, Laurent Castera, Yusuf Yilmaz, Marko Korenjak, C Wendy Spearman, Mehmet Ungan, Melissa Palmer, Mortada El-Shabrawi, Hans-Juergen Gruss, Jean-François Dufour, Anil Dhawan, Heiner Wedemeyer, Jacob George, Luca Valenti, Yasser Fouad, Manuel Romero‐Gomez, Mohammed Eslam, Maria Lorena Abate, Bahaa Abbas, Ahmed Amr Abbassy, Waleed Abd El Ghany, Amira Abd Elkhalek, Emad Abd ElMajeed, Mohammad Abdalgaber, Mohamed AbdAllah, Marwa Abdallah, Nourhan Abdallah, Shereen Abdelaleem, Yasser Abdelghani, Wael Abdelghany, Safaa Mohamed Abdelhalim, Wafaa Abdelhamid, Nehal Abdelhamid, Nadia A. Abdelkader, Elsayed Abdelkreem, Aly Mohamed Abdelmohsen, Awny Ali Abdelrahman, Sherief M Abd-elsalam, Doaa Abdeltawab, Abdulbaset Abduh, Nada Abdulhakam, Maheeba Abdulla, Navid Abedpoor, Ludovico Abenavoli, Fredrik Åberg, Omala Ablack, Mostafa Abo elftouh, Yousry Esam-Eldin Abo-Amer, Ashraf Aboubkr, Alaa Aboud, Amr M. Abouelnaga, Galal A. Aboufarrag, Ashraf Aboutaleb, Leticia Abundis, Gupse Adalı, Enrique Adames, Leon Adams, Danjuma Adda, Noor Adel, Nada Adel, Muhammad Adel Sayed, Taiba Jibril Afaa, Nawal Afredj, Gulnara Aghayeva, Alessio Aghemo, Carlos A. Aguilar-Salinas, Golo Ahlenstiel, Walid Ahmady, Wafaa Ahmed, Amira Ahmed, Samah Nasser Ahmed, Heba Mostafa Ahmed, Rasha Ahmed, Elmar Aigner, Mesut Akarsu, Maisam Akroush, Umit Akyuz, Mamun Al Mahtab, Tahani Al Qadiri, Yusriya Al Rawahi, Razzaq AL rubaee, Muna Al Saffar, Shahinul Alam, Zaid Al-Ani, Agustín Albillos, Mohamed Alboraie, Said Al-Busafi, Mohamed Al-Emam, Jawaher Alharthi, Kareem Ali, Basma Abdelmoez Ali, Mohammad Ali, Raja Affendi Raja Ali, Anna Alisi, Ali Raad AL-Khafaji, Maryam Alkhatry, Rocio Aller, Yahya Almansoury, Khalid Al-Naamani, Alaa Alnakeeb, Anna Alonso, Saleh A. Alqahtani, Leina Alrabadi, Khalid Alswat, Mahir Altaher, Turki Altamimi, Jose Altamirano, Mario R. Alvares-da-Silva, Elsragy Adel M. Aly, Amgad Alzahaby, Ahmed Alzamzamy, Keisuke Amano, Maysa A. Amer, Mona A. Amin, Sayed A. Amin, Ashraf A. Amir, Javier Ampuero, Noha Anas, Pietro Andreone, Soa Fy Andriamandimby, Mahmoud Anees, Peltec Angela, Manal Antonios, Wael Arafat, Jose Moreno Araya, Juan Armendariz-Borunda, Matthew J. Armstrong, Hassan Ashktorab, Patricia Aspichueta, Fathia Assal, Mira Atef, Dina Attia, Hoda Atwa, Reham Awad, Mohyeldeen Abd Elaziz Awad, Sally Awny, Obafemi Awolowo, Yaw Asante Awuku, Ibrahim Ayada, Than Than Aye, Sherif Ayman, Hedy Ayman, Hesham Ayoub, Hosny M. Azmy, Romiro P. Babaran, Omneya Badreldin, Ahmed Badry, İbrahim Halil Bahçecioğlu, Amira Bahour, Jiajia Bai, Yasemin Balaban, Muthuswamy Balasubramanyam, Khaled Bamakhrama, Jesus M Banales, Babu Bangaru, Jianfeng Bao, Jorge Suazo Barahona, Salma Barakat, Sandra Maria Barbalho, Bikwa Barbra, Beatriz Barranco, Francisco Barrera, Ulrich Baumann, Shamardan Bazeed, Eva Bech, Aourarh Benayad, Andreas Benesic, David Bernstein, Fernando Bessone, Susie Birney, Cyrille Bisseye, Martin Blake, Bilal Bobat, Leonilde Bonfrate, Dmitry S Bordin, Francisco Bosques-Padilla, Jerome Boursier, Boushab Mohamed Boushab, David Bowen, Patricia Medina Bravo, Paul N Brennan, Bisi Bright, Ilse Broekaert, Xabier Buque, Diego Burgos-Santamaría, Julio Burman, Luca Busetto, Chris D. Byrne, Patricia Anne I. Cabral-Prodigalidad, Guillermo Cabrera-Alvarez, Wei Cai, Francesca Cainelli, Ali Riza Caliskan, Ali Canbay, Ana Cano-Contreras, Hai-Xia Cao, Zhujun Cao, Andres Carrion, Francesca Carubbi, Teresa Casanovas, Marlen Ivón Castellanos Fernández, Jin Chai, Siew Pheng Chan, Phunchai Charatcharoenwitthaya, Norberto Chavez-Tapia, Kazuaki Chayama, Jinjun Chen, Lin Chen, Zhong-Wei Chen, Huiting Chen, Sui-Dan Chen, Qiang Chen, Yaxi Chen, Gang Chen, En-Quang Chen, Fei Chen, Pei-Jer Chen, Robert Cheng, Wendy Cheng, Jack Tan Wei Chieh, Imad Chokr, Evangelos Cholongitas, Ashok Choudhury, Abhijit Chowdhury, Evaristus Sunday Chukwudike, Stefano Ciardullo, Michelle Clayton, Karine Clement, Marie Michelle Cloa, Cecilia Coccia, Cristina Collazos, Massimo Colombo, Arif Mansur Cosar, Helma Pinchemel Cotrim, Joris Couillerot, Alioune Coulibaly, Gonzalo Crespo, Javier Crespo, Maria Cruells, Ian Homer Y. Cua, Hesham K. 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Dwawhi, Sho Eiketsu, Doaa El Amrousy, Ahmed El Deeb, Ghada El Deriny, Hesham Salah El Din, Salwa El Kamshishy, Mohamed El Kassas, Maissa El Raziky, Osama A Elagamy, Wafaa Elakel, Dina Elalfy, Hanaa Elaraby, Heba ElAwady, Reda Elbadawy, Hanaa Hassan Eldash, Manal S. Eldefrawy, Carol Lezama Elecharri, Amel Elfaramawy, Mohammed Elfatih, Mahmoud Elfiky, Mohamed Elgamsy, Mohamed Elgendy, Mohamed A. El-Guindi, Nagi Elhussieny, Ahmed Maher Eliwa, Zeineb Elkabbany, Hesham El-Khayat, Nehal M. El-Koofy, Alaa Elmetwalli, Amr Elrabat, Fathiya El-Raey, Fatma Elrashdy, Medhat Elsahhar, Esraa M. Elsaid, Shimaa Elsayed, Hany Elsayed, Aly Elsayed, Amr M. Elsayed, Hamdy Elsayed, Magdy El-Serafy, Ahmed M. Elsharkawy, Reem Yehia Elsheemy, Eman Elsayed Elshemy, Sara Elsherbini, Naglaa Eltoukhy, Reda Elwakil, Ola Emad, Shaimaa Emad, Mohamed Embabi, Ilkay Ergenç, Tatiana Ermolova, Gamal Esmat, Doaa M. Esmat, Enrique Carrera Estupiñan, Said Ettair, Tcaciuc Eugen, Mohammed Ezz-Eldin, Lidia Patricia Valdivieso Falcón, Yu-Chen Fan, Samah Fandari, Mahmoud Farag, Taghreed Mohamed Farahat, Eman M. Fares, Michael Fares, Eduardo Fassio, Hayam Fathy, Dina Fathy, Wael Fathy, Soheir Fayed, Dan Feng, Gong Feng, Miguel Fernández-Bermejo, Cristina Targa Ferreira, Javier Díaz Ferrer, Alastair Forbes, Rabab Fouad, Hanan M. Fouad, Tove Frisch, Hideki Fujii, Shuhei Fukunaga, Shinya Fukunishi, Hacer Fulya, Masato Furuhashi, Yasmine Gaber, Augusto Jose G. Galang, Jacqueline Cordova Gallardo, Rocío Galloso, Mahmoud Gamal, Reham Gamal, Hadeel Gamal, Jian Gan, Anar Ganbold, Xin Gao, George Garas, Tony Garba, Miren García-Cortes, Carmelo García-Monzón, Javier García-Samaniego, Amalia Gastaldelli, Manuel Gatica, Elizabeth Gatley, Tamar Gegeshidze, Bin Geng, Hasmik Ghazinyan, Salma Ghoneem, Luca Giacomelli, Gianluigi Giannelli, Edoardo G. 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Hawal, Jinfan He, Qiong He, Yong He, Fang-Ping He, Mona Hegazy, Adham Hegazy, Osama Henegil, Nelia Hernández, Manuel Hernández-Guerra, Fatima Higuera-de-la-Tijera, Ibrahim Hindy, Keisuke Hirota, Lee Chi Ho, Alexander Hodge, Mohamed Hosny, Xin Hou, Jiao-Feng Huang, Yan Huang, Zhifeng Huang, Yuan Huang, Ang Huang, Xiao-Ping Huang, Sheng Hui-ping, Bela Hunyady, Mennatallah A. Hussein, Osama Hussein, Shahinaz Mahmoud Hussien, Luis Ibáñez-Samaniego, Jamal Ibdah, Luqman Ibrahim, Miada Ibrahim, Ibrahim Ibrahim, Maria E. Icaza-Chávez, Sahar Idelbi, Ramazan Idilman Idilman, Mayumi Ikeda, Giuseppe Indolfi, Federica Invernizzi, Iram Irshad, Hasan Mohamed Ali Isa, Natacha Jreige Iskandar, Abdulrahman Ismaiel, Mariam Ismail, Zulkifli Ismail, Faisal Ismail, Hideki Iwamoto, Kathryn Jack, Rachael Jacob, Fuad Jafarov, Wasim Jafri, Helen Jahshan, Prasun K Jalal, Ligita Jancoriene, Martin Janicko, Hiruni Jayasena, Meryem Jefferies, Vivekanand Jha, Fanpu Ji, Yaqiu Ji, Jidong Jia, Changtao Jiang, Ni Jiang, Zong-zhe Jiang, Xing Jin, Yi Jin, Xu Jing, Qian Jingyu, Maia Jinjolava, FX Himawan Haryanto Jong, Alina Jucov, Ibecheole Julius, Mona Kaddah, Yoshihiro Kamada, Abobakr kamal, Enas Mohamed Kamal, Ashraf Sayed Kamel, Jia-Horng Kao, Maja Karin, Thomas Karlas, Mohammad Kashwaa, Leolin Katsidzira, Eda Kaya, M.Azzam Kayasseh, Bernadette Keenan, Caglayan Keklikkiran, William Keml, Deia K. 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A, Derbala, M, Desalegn, H, Desbois-Mouthon, C, Desoky, M, Dev, A, Di Ciaula, A, Diago, M, Diallo, I, Diaz, L, Dirchwolf, M, Dongiovanni, P, Dorofeyev, A, Dou, X, Douglas, M, Doulberis, M, Dovia, C, Doyle, A, Dragojevic, I, Drenth, J, Duan, X, Dulskas, A, Dumitrascu, D, Duncan, O, Dusabejambo, V, Dwawhi, R, Eiketsu, S, El Amrousy, D, El Deeb, A, El Deriny, G, El Din, H, El Kamshishy, S, El Kassas, M, El Raziky, M, Elagamy, O, Elakel, W, Elalfy, D, Elaraby, H, Elawady, H, Elbadawy, R, Eldash, H, Eldefrawy, M, Elecharri, C, Elfaramawy, A, Elfatih, M, Elfiky, M, Elgamsy, M, Elgendy, M, El-Guindi, M, Elhussieny, N, Eliwa, A, Elkabbany, Z, El-Khayat, H, El-Koofy, N, Elmetwalli, A, Elrabat, A, El-Raey, F, Elrashdy, F, Elsahhar, M, Elsaid, E, Elsayed, S, Elsayed, H, Elsayed, A, El-Serafy, M, Elsharkawy, A, Elsheemy, R, Elshemy, E, Elsherbini, S, Eltoukhy, N, Elwakil, R, Emad, O, Emad, S, Embabi, M, Ergenc, I, Ermolova, T, Esmat, G, Esmat, D, Estupinan, E, Ettair, S, Eugen, T, Ezz-Eldin, M, Falcon, L, Fan, Y, Fandari, S, Farag, M, Farahat, T, Fares, E, Fares, M, Fassio, E, Fathy, H, Fathy, D, Fathy, W, Fayed, S, Feng, D, Feng, G, Fernandez-Bermejo, M, Ferreira, C, Ferrer, J, Forbes, A, Fouad, R, Fouad, H, Frisch, T, Fujii, H, Fukunaga, S, Fukunishi, S, Fulya, H, Furuhashi, M, Gaber, Y, Galang, A, Gallardo, J, Galloso, R, Gamal, M, Gamal, R, Gamal, H, Gan, J, Ganbold, A, Gao, X, Garas, G, Garba, T, Garcia-Cortes, M, Garcia-Monzon, C, Garcia-Samaniego, J, Gastaldelli, A, Gatica, M, Gatley, E, Gegeshidze, T, Geng, B, Ghazinyan, H, Ghoneem, S, Giacomelli, L, Giannelli, G, Giannini, E, Giefer, M, Gines, P, Girala, M, Giraudi, P, Goh, G, Gomaa, A, Gong, B, Gonzales, D, Gonzalez, H, Gonzalez-Huezo, M, Graupera, I, Grgurevic, I, Gronbaek, H, Gu, X, Guan, L, Gueye, I, Guingane, A, Gul, O, Gul, C, Guo, Q, Gupta, P, Gurakar, A, Gutierrez, J, Habib, G, Hafez, A, Hagman, E, Halawa, E, Hamdy, O, Hamed, A, Hamed, D, Hamid, S, Hamoudi, W, Han, Y, Haridy, J, Haridy, H, Harris, D, Hart, M, Hasan, F, Hashim, A, Hassan, I, Hassan, A, Hassan, E, Hassan, M, Hassanin, F, Hassnine, A, Haukeland, J, Hawal, A, He, J, He, Q, He, Y, He, F, Hegazy, M, Hegazy, A, Henegil, O, Hernandez, N, Hernandez-Guerra, M, Higuera-de-la-Tijera, F, Hindy, I, Hirota, K, Ho, L, Hodge, A, Hosny, M, Hou, X, Huang, J, Huang, Y, Huang, Z, Huang, A, Huang, X, Hui-ping, S, Hunyady, B, Hussein, M, Hussein, O, Hussien, S, Ibanez-Samaniego, L, Ibdah, J, Ibrahim, L, Ibrahim, M, Ibrahim, I, Icaza-Chavez, M, Idelbi, S, Idilman, R, Ikeda, M, Indolfi, G, Invernizzi, F, Irshad, I, Isa, H, Iskandar, N, Ismaiel, A, Ismail, M, Ismail, Z, Ismail, F, Iwamoto, H, Jack, K, Jacob, R, Jafarov, F, Jafri, W, Jahshan, H, Jalal, P, Jancoriene, L, Janicko, M, Jayasena, H, Jefferies, M, Jha, V, Ji, F, Ji, Y, Jia, J, Jiang, C, Jiang, N, Jiang, Z, Jin, X, Jin, Y, Jing, X, Jingyu, Q, Jinjolava, M, Jong, F, Jucov, A, Julius, I, Kaddah, M, Kamada, Y, Kamal, A, Kamal, E, Kamel, A, Kao, J, Karin, M, Karlas, T, Kashwaa, M, Katsidzira, L, Kaya, E, Kayasseh, M, Keenan, B, Keklikkiran, C, Keml, W, Khalaf, D, Khalefa, R, Khamis, S, Khater, D, Khattab, H, Khavkin, A, Khlynova, O, Khmis, N, Kobyliak, N, Koffas, A, Koike, K, Kok, K, Koller, T, Komas, N, Korochanskaya, N, Koulla, Y, Koya, S, Kraft, C, Kraja, B, Krawczyk, M, Kuchay, M, Kulkarni, A, Kumar, A, Kumar, M, Lakoh, S, Lam, P, Lan, L, Lange, N, Lankarani, K, Lanthier, N, Lapshyna, K, Lashen, S, Laure, K, Lazebnik, L, Lebrec, D, Lee, S, Lee, W, Lee, Y, Leeming, D, Leite, N, Leon, R, Lesmana, C, Li, J, Li, Q, Li, Y, Li, L, Li, M, Liang, H, Lijuan, T, Lim, S, Lim, L, Lin, S, Lin, H, Lin, R, Lithy, R, Liu, Y, Liu, X, Liu, W, Liu, S, Liu, K, Liu, T, Lonardo, A, Lopez, M, Lopez-Benages, E, Lopez-Jaramillo, P, Lu, H, Lu, L, Lu, Y, Lubel, J, Lui, R, Lupasco, I, Luzina, E, Lv, X, Lynch, K, Ma, H, Machado, M, Maduka, N, Madzharova, K, Magdaong, R, Mahadeva, S, Mahfouz, A, Mahmood, N, Mahmoud, E, Mahrous, M, Maiwall, R, Majeed, A, Majumdar, A, Mak, L, Maklouf, M, Malekzadeh, R, Mandato, C, Mangia, A, Mann, J, Mansour, H, Mansouri, A, Mantovani, A, Mao, J, Maramag, F, Marchesini, G, Marcus, C, Marinho, R, Martinez-Chantar, M, Martins, A, Marwan, R, Mason, K, Masoud, G, Massoud, M, Matamoros, M, Mateos, R, Mawed, A, Mbanya, J, Mbendi, C, Mccolaugh, L, Mcleod, D, Medina, J, Megahed, A, Mehrez, M, Memon, I, Merat, S, Mercado, R, Mesbah, A, Meskini, T, Metwally, M, Metwaly, R, Miao, L, Micah, E, Miele, L, Milivojevic, V, Milovanovic, T, Mina, Y, Mishkovik, M, Mishriki, A, Mitchell, T, Mohamed, A, Mohamed, M, Mohamed, S, Mohammed, S, Mohammed, A, Mohan, V, Mohie, S, Mokhtar, A, Moniem, R, Montilla, M, Morales, J, Morata, M, Moreno-Planas, J, Morise, S, Mosaad, S, Moselhy, M, Mostafa, A, Mostafa, E, Mouane, N, Mousa, N, Moustafa, H, Msherif, A, Muller, K, Munoz, C, Munoz-Urribarri, A, Murillo, O, Mustapha, F, Muzurovic, E, Nabil, Y, Nafady, S, Nagamatsu, A, Nakajima, A, Nakano, D, Nan, Y, Nascimbeni, F, Naseef, M, Nashat, N, Natalia, T, Negro, F, Nersesov, A, Neuman, M, Ng'Wanasayi, M, Ni, Y, Nicoll, A, Niizeki, T, Nikolova, D, Ningning, W, Niriella, M, Nogoibaeva, K, Nordien, R, O Sullivan, C, O'Beirne, J, Obekpa, S, Ocama, P, Ochwoto, M, Ogolodom, M, Ojo, O, Okrostsvaridze, N, Oliveira, C, Omana, R, Omar, O, Omar, H, Omar, M, Omran, S, Omran, R, Osman, M, Owise, N, Owusu-Ansah, T, Padilla- Machaca, P, Palle, S, Pan, Z, Pan, X, Pan, Q, Papaefthymiou, A, Paquissi, F, Par, G, Parkash, A, Payawal, D, Peltekian, K, Peng, X, Peng, L, Peng, Y, Pengoria, R, Perez, M, Perez, J, Perez, N, Persico, M, Pessoa, M, Petta, S, Philip, M, Plaz Torres, M, Polavarapu, N, Poniachik, J, Portincasa, P, Pu, C, Purnak, T, Purwanto, E, Qi, X, Qian, Z, Qiang, Z, Qiao, Z, Qiao, L, Queiroz, A, Rabiee, A, Radwan, M, Rahetilahy, A, Ramadan, Y, Ramadan, D, Ramli, A, Ramm, G, Ran, A, Rankovic, I, Rao, H, Raouf, S, Ray, S, Reau, N, Refaat, A, Reiberger, T, Remes-Troche, J, Reyes, E, Richardson, B, Ridruejo, E, Riestra Jimenez, S, Rizk, I, Roberts, S, Roblero, J, Robles, J, Rockey, D, Rodriguez, M, Rodriguez Hernandez, H, Roman, E, Romeiro, F, Romeo, S, Rosales-Zabal, J, Roshdi, G, Rosso, N, Ruf, A, Ruiz, P, Runes, N, Ruzzenente, A, Ryan, M, Saad, A, Sabbagh, E, Sabbah, M, Saber, S, Sabrey, R, Sabry, R, Saeed, M, Said, D, Said, E, Sakr, M, Salah, Y, Salama, R, Salama, A, Saleh, H, Saleh, A, Salem, A, Salifou, A, Salih, A, Salman, A, Samouda, H, Sanai, F, Sanchez-Avila, J, Sanker, L, Sano, T, Sanz, M, Saparbu, T, Sawhney, R, Sayed, F, Sayed, S, Sayed, A, Sayed, M, Sebastiani, G, Secadas, L, Sediqi, K, Seif, S, Semida, N, Senates, E, Serban, E, Serfaty, L, Seto, W, Sghaier, I, Sha, M, Shabaan, H, Shalaby, L, Shaltout, I, Sharara, A, Sharma, V, Shawa, I, Shawkat, A, Shawky, N, Shehata, O, Sheils, S, Shewaye, A, Shi, G, Shi, J, Shimose, S, Shirono, T, Shou, L, Shrestha, A, Shui, G, Sievert, W, Sigurdardottir, S, Sira, M, Siradj, R, Sison, C, Smyth, L, Soliman, R, Sollano, J, Sombie, R, Sonderup, M, Sood, S, Soriano, G, Stedman, C, Stefanyuk, O, Stimac, D, Strasser, S, Strnad, P, Stuart, K, Su, W, Su, M, Sumida, Y, Sumie, S, Sun, D, Sun, J, Suzuki, H, Svegliati-Baroni, G, Swar, M, Taharboucht, S, Taher, Z, Takamura, S, Tan, L, Tan, S, Tanwandee, T, Tarek, S, Tatiana, G, Tavaglione, F, Tecson, G, Tee, H, Teschke, R, Tharwat, M, Thong, V, Thursz, M, Tine, T, Tiribelli, C, Tolmane, I, Tong, J, Tongo, M, Torkie, M, Torre, A, Torres, E, Trajkovska, M, Treeprasertsuk, S, Tsutsumi, T, Tu, T, Tur, J, Turan, D, Turcan, S, Turkina, S, Tutar, E, Tzeuton, C, Ugiagbe, R, Uygun, A, Vacca, M, Vajro, P, Van der Poorten, D, Van Kleef, L, Vashakidze, E, Velazquez, C, Velazquez, M, Vento, S, Verhoeven, V, Vespasiani-Gentilucci, U, Vethakkan, S, Vilaseca, J, Vitek, L, Volkanovska, A, Wallace, M, Wan, W, Wang, Y, Wang, X, Wang, C, Wang, M, Wangchuk, P, Weltman, M, White, M, Wiegand, J, Wifi, M, Wigg, A, Wilhelmi, M, William, R, Wittenburg, H, Wu, S, Wubeneh, A, Xia, H, Xiao, J, Xiao, X, Xiaofeng, W, Xiong, W, Xu, L, Xu, J, Xu, W, Xu, K, Xu, Y, Xu, S, Xu, M, Xu, A, Xu, C, Yan, H, Yang, J, Yang, R, Yang, Y, Yang, Q, Yang, N, Yao, J, Yara, J, Yaras, S, Yilmaz, N, Younes, R, Younes, H, Young, S, Youssef, F, Yu, Y, Yu, M, Yuan, J, Yue, Z, Yuen, M, Yun, W, Yurukova, N, Zakaria, S, Zaky, S, Zaldastanishvili, M, Zapata, R, Zare, N, Zerem, E, Zeriban, N, Zeshuai, X, Zhang, H, Zhang, X, Zhang, Y, Zhang, W, Zhang, Z, Zhao, J, Zhao, R, Zhao, H, Zheng, C, Zheng, Y, Zheng, R, Zheng, T, Zheng, K, Zhou, X, Zhou, Y, Zhou, H, Zhou, L, Zhu, L, Zhu, Y, Zhu, P, Ziada, E, Ziring, D, Ziyi, L, Zou, S, Zou, Z, Zou, H, Zuart Ruiz, R, and Global Multi-Stakeholder Consensus on the Redefinition of Fatty Liver Disease

Subjects
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Hepatology, Non-alcoholic Fatty Liver Disease, NAFLD, consensu, Gastroenterology, MAFLD, definition, Humans, MAFLD, NAFLD, Human medicine
Abstract

Contains fulltext : 252162.pdf (Publisher’s version ) (Closed access)

Published
2022
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18. Optimizing decision-making for initiating the treatment of hepatitis b virus infection in resource-limited settings: African consensus guidelines

Author

Charles Asabamaka Onyekwere, Oudou Njoya, Allah-Kouadio Emile, Ravishankar Ac, Alain Koffi Attia, Sanjay Hadigal, E.J. Gane, Leolin Katsidzira, Michael Charlton, Ismael Katjitae, Nadia Jacqueline Mandeng, and Abdel Karim Sermé

Subjects
Hepatitis B virus, medicine.medical_specialty, business.industry, medicine, medicine.disease_cause, Intensive care medicine, business, Limited resources
Published
2019
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19. Consensus recommendations on the diagnosis and treatment of hepatitis c virus infection in sub Saharan Africa

Author

Charles Asabamaka Onyekwere, Oudou Njoya, Allah-Kouadio Emile, Michael Charlton, Sanjay Hadigal, Leolin Katsidzira, Abdel Karim Sermé, Ismael Katjitae, Nadia Jacqueline Mandeng, E.J. Gane, Ravishankar Ac, and Alain Koffi Attia

Subjects
Sub saharan, business.industry, Hepatitis C virus, Medicine, business, medicine.disease_cause, Virology
Published
2019
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20. A case–control study of risk factors for colorectal cancer in an African population

Author

Innocent T. Gangaidzo, Sandie R Thomson, Zvifadzo Matsena-Zingoni, Rudo Makunike-Mutasa, Raj Ramesar, Jonathan A. Matenga, Tadios Manyanga, Simbarashe Rusakaniko, and Leolin Katsidzira

Subjects
Male, Zimbabwe, Cancer Research, Multivariate analysis, Epidemiology, Colorectal cancer, Population, Black People, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, 030212 general & internal medicine, Family history, education, Life Style, Socioeconomic status, education.field_of_study, business.industry, Public Health, Environmental and Occupational Health, Case-control study, Cancer, Odds ratio, Middle Aged, Prognosis, medicine.disease, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, Female, Colorectal Neoplasms, business, Follow-Up Studies, Demography
Abstract

The interplay between hereditary and environmental factors in the causation of colorectal cancer in sub-Saharan Africa is poorly understood. We carried out a community based case-control study to identify the risk factors associated with colorectal cancer in Zimbabwe. We recruited 101 cases of colorectal cancer and 202 controls, matched for age, sex and domicile. Potential risk factors including family history, socioeconomic status, urbanization, diabetes mellitus and previous schistosomiasis were evaluated. Conditional logistic regression was used to estimate the odds ratios associated with the different factors. Cases were more likely to have a tertiary education (32.7 vs. 13.4%, P

Published
2019
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22. Hepatitis C virus in sub-Saharan Africa: a long road to elimination

Author

Dennis A Ndububa, Nicolas Kodjoh, Lucy Marowa, Francis Alikah, Tony Akilimali Shindano, Christopher K Opio, Emmanuel Seremba, Mulinda Nyirenda, Leolin Katsidzira, Deborah U. Ehichioya, E. Thomson, Raimi Aboudou Kpossou, Lucy Asamoah-Akuoko, Peter John Finch, Yorou Chabi Orou Bagou, Ponsiano Ocama, Jean Damascene Makuza, Sulaiman Lakoh, Charles Nlombi Mbendi, Rajiv Shah, Adwoah Agyei-Nkansah, and Abdirahman Dhiblawe

Subjects
Sub saharan, Hepatology, business.industry, Incidence, Hepatitis C virus, Gastroenterology, virus diseases, Hepacivirus, medicine.disease_cause, Antiviral Agents, Hepatitis C, Virology, digestive system diseases, Humans, Medicine, business, Africa South of the Sahara
Abstract

The development of direct-acting antivirals against hepatitis C virus (HCV) has transformed the treatment landscape and underpinned the WHO goal of HCV elimination by 2030. However, as of 2021, few countries remain on track to achieve this goal. Reliable data remain scarce, especially those on national plans for HCV elimination in many regions of the world and particularly in sub-Saharan Africa, which accounts for around 11 million of 71 million people estimated to be living with HCV.

Published
2021
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23. Dietary patterns and colorectal cancer risk in Zimbabwe: A population based case-control study

Author

Leolin Katsidzira, Innocent T. Gangaidzo, Ria Laubscher, Sandie R Thomson, Tadios Manyanga, Simbarashe Rusakaniko, Rina Swart, Jonathan A. Matenga, Rudo Makunike-Mutasa, and Raj Ramesar

Subjects
Adult, Male, Rural Population, Zimbabwe, Low income, Cancer Research, Epidemiology, Colorectal cancer, BMI, body mass index, Population based, Logistic regression, Article, Colorectal neoplasms, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, FAO, Food and Agriculture Organization of the United Nations, Odds Ratio, medicine, Humans, Africa South of the Sahara, Aged, 2. Zero hunger, business.industry, Incidence, Incidence (epidemiology), digestive, oral, and skin physiology, 1. No poverty, Case-control study, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Diet, 3. Good health, OR, odds ratio, CI, confidence interval, Logistic Models, Risk factors, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, business, Demography
Abstract

Highlights • Three main dietary patterns in Zimbabwe; traditional African, urban and processed foods. • Traditional African diet associated with a reduced risk of colorectal cancer. • No association between colorectal cancer and the urban or processed food patterns., Background The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe. Methods One hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer. Results Three main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00–1.59), and a low income (OR1.48; 95% CI, 1.06–2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38–2.10), secondary (OR 1.30; 95% CI, 1.07–1.59) or tertiary education (OR 1.48; 95% CI, 1.11–1.97), and monthly incomes of $201–500 (OR 1.30; 95% CI, 1.05–1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05–1.92), and income >$1000/month (OR 1.48; 95% CI, 1.02–2.15). Conclusion A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.

Published
2018
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24. The shifting epidemiology of colorectal cancer in sub-Saharan Africa

Author

Raj Ramesar, Jonathan A. Matenga, Sandie R Thomson, Innocent T. Gangaidzo, Simbarashe Rusakaniko, and Leolin Katsidzira

Subjects
Adult, Male, Oncology, medicine.medical_specialty, Colorectal cancer, Population, MEDLINE, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Environmental health, Internal medicine, Epidemiology, Epidemiology of cancer, Humans, Medicine, Age of Onset, education, Life Style, Africa South of the Sahara, Preventive healthcare, education.field_of_study, Hepatology, business.industry, Incidence, Incidence (epidemiology), Gastroenterology, Middle Aged, medicine.disease, Diet, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Age of onset, Colorectal Neoplasms, business
Abstract

Summary The perception that colorectal cancer is rare in sub-Saharan Africa is widely held; however, it is unclear whether this is due to poor epidemiological data or to lower disease rates. The quality of epidemiological data has somewhat improved, and there is an ongoing transition to western dietary and lifestyle practices associated with colorectal cancer. The impact of these changes on the incidence of colorectal cancer is not as evident as it is with other non-communicable diseases such as diabetes. In this Viewpoint, we discuss the epidemiology of colorectal cancer in sub-Saharan Africa. Colorectal cancer in this region frequently occurs at an early age, often with distinctive histological characteristics. We detail the crucial need for hypothesis-driven research on the risk factors for colorectal cancer in this population and identify key research gaps. Should colorectal cancer occur more frequently than assumed, then commensurate allocation of resources will be needed for diagnosis and treatment.

Published
2017
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25. Differences in Fecal Gut Microbiota, Short-Chain Fatty Acids and Bile Acids Link Colorectal Cancer Risk to Dietary Changes Associated with Urbanization Among Zimbabweans

Author

James P. DeLany, Stephen J. O'Keefe, Leolin Katsidzira, Soeren Ocvirk, Annette Wilson, D. Soni, Jia V. Li, Erwin G. Zoetendal, Jeremy K. Nicholson, and C. B. Mahachi

Subjects
0301 basic medicine, Dietary Fiber, Male, Rural Population, Cancer Research, PROMOTES, Urban Population, Colorectal cancer, BUTYRATE-PRODUCING BACTERIA, Medicine (miscellaneous), Physiology, Gut flora, METABOLITES, Feces, 0302 clinical medicine, POPULATION, 2. Zero hunger, education.field_of_study, Nutrition and Dietetics, biology, Incidence (epidemiology), Middle Aged, Rural Sociology, 3. Good health, Butyrate-Producing Bacteria, Oncology, 030220 oncology & carcinogenesis, Female, Rurale Sociologie, Colorectal Neoplasms, Life Sciences & Biomedicine, COLITIS, Zimbabwe, Population, FIBER, Bile Acids and Salts, 03 medical and health sciences, Urbanization, parasitic diseases, medicine, Life Science, Humans, 1112 Oncology and Carcinogenesis, MolEco, Colitis, education, VLAG, Aged, 030109 nutrition & dietetics, Science & Technology, Nutrition & Dietetics, biology.organism_classification, medicine.disease, Fatty Acids, Volatile, TRENDS, Gastrointestinal Microbiome, 1111 Nutrition and Dietetics, sense organs
Abstract

The incidence of colorectal cancer (CRC) is gradually rising in sub-Saharan Africa. This may be due to dietary changes associated with urbanization, which may induce tumor-promoting gut microbiota composition and function. We compared fecal microbiota composition and activity in 10 rural and 10 urban Zimbabweans for evidence of a differential CRC risk. Dietary intake was assessed by a food frequency questionnaire. Fecal microbiota composition, metabolomic profile, functional microbial genes were analyzed, and bile acids and short chain fatty acids quantified. Animal protein intake was higher among urban volunteers, but carbohydrate and fiber intake were similar. Bacteria related to Blautia obeum, Streptococcus bovis, and Subdoligranulum variabile were higher in urban residents, whereas bacteria related to Oscillospira guillermondii and Sporobacter termitidis were higher in rural volunteers. Fecal levels of primary bile acids, cholic acid, and chenodeoxycholic acid (P

Published
2019

26. An unusual cause of a large fibrinous pericardial effusion: case report

Author

Andrew Chinogureyi, Leolin Katsidzira, Rudo Makunike-Mutasa, and Noleen Chengetai Tembani-Munyandu

Subjects
medicine.medical_specialty, Tuberculosis, business.industry, Tuberculous pericarditis, medicine.medical_treatment, General Medicine, medicine.disease, Pericardial effusion, Surgery, Hemangiosarcoma, Tuberculosis diagnosis, Pericardiocentesis, medicine, Angiosarcoma, Cardiology and Cardiovascular Medicine, business, Limited resources
Abstract

The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing less-common causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.

Published
2015
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27. Investigation on the hereditary basis of colorectal cancers in an African population with frequent early onset cases

Author

Simbarashe Rusakaniko, Dhiren Govender, Raj Ramesar, Leolin Katsidzira, Rudo Makunike-Mutasa, A. A. Vorster, Sandie R Thomson, Jonathan A. Matenga, and Innocent T. Gangaidzo

Subjects
Male, Oncology, Molecular biology, Colorectal cancer, Mismatch Repair, Biochemistry, Geographical Locations, Sequencing techniques, 0302 clinical medicine, Medicine and Health Sciences, PMS2, DNA sequencing, Prospective Studies, Age of Onset, education.field_of_study, Multidisciplinary, Incidence, Genomics, Middle Aged, Epithelial Cell Adhesion Molecule, Prognosis, Lynch syndrome, 3. Good health, Nucleic acids, MutS Homolog 2 Protein, Genetic Diseases, 030220 oncology & carcinogenesis, Medicine, Female, Microsatellite Instability, 030211 gastroenterology & hepatology, Anatomy, Colorectal Neoplasms, MutL Protein Homolog 1, Transcriptome Analysis, Research Article, Next-Generation Sequencing, Zimbabwe, Adult, medicine.medical_specialty, Amsterdam criteria, Colon, Science, Population, DNA repair, Black People, MLH1, 03 medical and health sciences, Internal medicine, Genetics, medicine, Humans, Genetic Predisposition to Disease, education, Germ-Line Mutation, Colorectal Cancer, Clinical Genetics, Biology and life sciences, business.industry, Autosomal Dominant Diseases, Rectum, Cancers and Neoplasms, Computational Biology, Microsatellite instability, Hereditary Nonpolyposis Colorectal Cancer, DNA, Genome Analysis, medicine.disease, Research and analysis methods, Gastrointestinal Tract, Molecular biology techniques, Cross-Sectional Studies, MSH2, People and Places, Africa, business, Digestive System
Abstract

BackgroundApproximately 25% of colorectal cancer patients in sub-Saharan Africa are younger than 40 years, and hereditary factors may contribute. We investigated the frequency and patterns of inherited colorectal cancer among black Zimbabweans.MethodsA population-based cross-sectional study of ninety individuals with a new diagnosis of colorectal cancer was carried out in Harare, Zimbabwe between November 2012 and December 2015. Phenotypic data was obtained using interviewer administered questionnaires, and reviewing clinical and pathology data. Cases were screened for mismatch repair deficiency by immunohistochemistry and/or microsatellite instability testing, and for MLH1, MSH2 and EPCAM deletions using multiplex ligation-dependent probe amplification. Next generation sequencing using a 16-gene panel was performed for cases with phenotypic features consistent with familial colorectal cancer. Variants were assessed for pathogenicity using the mean allele frequency, phenotypic features and searching online databases.ResultsThree Lynch syndrome cases were identified: MSH2 c.2634G>A pathogenic mutation, c.(1896+1_1897-1)_(*193_?)del , and one fulfilling the Amsterdam criteria, with MLH1 and PMS2 deficiency, but no identifiable pathogenic mutation. Two other cases had a strong family history of cancers, but the exact syndrome was not identified. The prevalence of Lynch syndrome was 3·3% (95% CI 0·7-9·4), and that of familial colorectal cancer was 5·6% (95% CI, 1·8-12·5).ConclusionsIdentifying cases of inherited colorectal cancer in sub-Saharan Africa is feasible, and our findings can inform screening guidelines appropriate to this setting.

Published
2019
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28. The incidence and histo-pathological characteristics of colorectal cancer in a population based cancer registry in Zimbabwe

Author

Innocent T. Gangaidzo, Margaret Borok, Leolin Katsidzira, Sandie R Thomson, Eric Chokunonga, Zvifadzo Matsena-Zingoni, Simbarashe Rusakaniko, Raj Ramesar, and Jonathan A. Matenga

Subjects
Adult, Male, Zimbabwe, Cancer Research, Epidemiology, Colorectal cancer, Population, Adenocarcinoma, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Signet ring cell carcinoma, Ethnicity, Medicine, Humans, Registries, Young adult, education, Aged, education.field_of_study, business.industry, Signet ring cell, Incidence (epidemiology), Incidence, Middle Aged, medicine.disease, Adenocarcinoma, Mucinous, 3. Good health, Cancer registry, Oncology, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Colorectal Neoplasms, Carcinoma, Signet Ring Cell, Demography
Abstract

Background Data on colorectal cancer (CRC) in sub-Saharan Africa is mainly based on hospital series which suggest low incidence and frequent early onset cancers. This study characterises colorectal cancer in a population-based cancer registry in Zimbabwe. Methods Cases of CRC recorded by the Zimbabwe National Cancer Registry between 2003 and 2012 were analysed. Demographic and pathological characteristics were compared according to ethnicity and age. Trends in age standardised incidence rates (ASR) were determined. Results There were 886 and 216 cases of CRC among black Africans and Caucasians respectively, and 26% of the black Africans were younger than 40 years. Signet ring cell carcinomas were more common among black Africans compared to Caucasians (4% vs 1%, p = 0.027). ASR increased by 1.9%/year and 3.9%/year among black African males and females respectively. Conclusion CRC incidence is rising among black Africans and has unique demographic and pathological characteristics.

Published
2016

29. HIV prevention in southern Africa: why we must reassess our strategies?

Author

James Hakim and Leolin Katsidzira

Subjects
medicine.medical_specialty, Traditional medicine, business.industry, Public Health, Environmental and Occupational Health, Psychological intervention, Human immunodeficiency virus (HIV), Developing country, medicine.disease_cause, Emtricitabine, Microbicides for sexually transmitted diseases, Infectious Diseases, Male circumcision, Family planning, Family medicine, Medicine, Parasitology, Young adult, business, medicine.drug
Abstract

Southern Africa continues to shoulder a disproportionate burden of the HIV epidemic with the number of new infections outstripping treatment initiation two- to threefold. Current prevention strategies have had a limited impact on the trajectory of the epidemic so far. The history of HIV prevention research is dominated by failed approaches, but recent developments have provided reason for hope. These include the successful male circumcision outcomes in trials in South Africa, Kenya and Uganda, the recent protective outcome of a tenofovir vaginal gel trial in South Africa and the proof that pre-exposure prophylaxis with oral combination tenofovir/emtricitabine can work in men. The latter positive outcome has however been shattered by the early closure of FEM-PrEP for futility. The challenge now is on how to best integrate emerging prevention methods with established strategies, recognising that some of the older methods have never been scaled up to saturation level.

Published
2011
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31. An unusual cause of a large fibrinous pericardial effusion

Author

Noleen Chengetai, Tembani-Munyandu, Rudo, Makunike-Mutasa, Leolin, Katsidzira, and Andrew, Chinogureyi

Subjects
Male, angiosarcoma, tuberculosis (TB), Biopsy, Hemangiosarcoma, Antitubercular Agents, Pericardiocentesis, Case Report, Unnecessary Procedures, Pericardial Effusion, Heart Neoplasms, Young Adult, Fatal Outcome, Treatment Outcome, Chemotherapy, Adjuvant, Predictive Value of Tests, Humans, Tuberculosis, Cardiac Surgical Procedures, Diagnostic Errors, Tomography, X-Ray Computed, fibrinous pericardial effusion
Abstract

The commonest cause of a large fibrinous pericardial effusion in sub-Saharan Africa is tuberculosis. There are, however, limited resources available for making a definitive diagnosis of tuberculous pericarditis. The diagnosis is largely based on clinical criteria. There is a risk of misdiagnosing lesscommon causes of large fibrinous pericardial effusions. We present a patient who had a pericardial angiosarcoma that was initially thought to be a tuberculous pericardial effusion, and discuss the challenges in making a definitive diagnosis of tuberculosis.

Published
2014

32. Cryptococcus gattii: A dilemma in diagnosis and treatment in sub-Saharan Africa an area with high HIV prevalence

Author

Vj, Robertson, Tk, Nyazika, Leolin Katsidzira, and Ti, Gutu

Subjects
Male, Zimbabwe, Adolescent, Meningoencephalitis, Prevalence, Humans, Cryptococcus gattii, HIV Infections, Meningitis, Cryptococcal, Immunocompetence
Abstract

Sub-Saharan Africa contributes at least 70% of the global cryptococcal meningoencephalitis cases each year and the majority of cases are caused by the Cryptococcus neoformans species. We present a case of meningoencephalitis due to Cryptococcus gattii in an 18 year old apparently immunocompetent male patient from Zimbabwe.

Published
2013

33. Acquired epidermodysplasia verruciformis due to multiple and unusual HPV infection among vertically-infected, HIV-positive adolescents in Zimbabwe

Author

M.N.C. de Koning, W. G. V. Quint, Shungu Munyati, R. Meys, Leolin Katsidzira, Robert F. Miller, Elizabeth L. Corbett, Rashida A. Ferrand, Sara Lowe, J. C. Sterling, Chiratidzo E. Ndhlovu, Christopher B Bunker, Jonathan R. Salisbury, and Kusum Nathoo

Subjects
Male, Zimbabwe, Microbiology (medical), medicine.medical_specialty, Adolescent, Genotype, Biopsy, medicine.medical_treatment, HIV Infections, Disease, Malignancy, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Electronic Article, Humans, Medicine, Sex organ, Child, Papillomaviridae, Skin, 030203 arthritis & rheumatology, Microscopy, medicine.diagnostic_test, Histocytochemistry, business.industry, HPV infection, virus diseases, Immunosuppression, Epidermodysplasia verruciformis, medicine.disease, DNA Fingerprinting, Dermatology, female genital diseases and pregnancy complications, Infectious Disease Transmission, Vertical, 3. Good health, Infectious Diseases, Epidermodysplasia Verruciformis, Skin biopsy, Immunology, business
Abstract

We have characterized the EV-like dermatosis of acquired HIV in 4 adolescents. Multiple HPV types were isolated in skin tissue samples, including β-HPV, but also high levels of HPV 1 and 2. ARV did not improve the EV eruption., Background. We have previously described the presentation of epidermodysplasia verruciformis (EV)–like eruptions in almost a quarter of hospitalized adolescents with vertically-acquired human immunodeficiency virus (HIV) infection in Harare, Zimbabwe, a region with a high prevalence of HIV infection. Methods. We performed a clinical case note review and skin biopsy from affected sites in 4 HIV-infected adolescents with EV-like lesions in Harare. Biopsies were processed for histology and for human papillomavirus (HPV) typing. Results. All patients had long-standing skin lesions that pre-dated the diagnosis of HIV by several years. The histology of skin biopsies from all patients was consistent with EV. In each biopsy, EV-associated β-HPV type 5 was identified (additionally, type 19 was found in 1 biopsy). Cutaneous wart–associated HPV types 1 and 2 were detected in all biopsies, together with genital lesion–associated HPV types 6, 16, and 52, (as well as ≥3 other genital lesion–associated HPV types). Despite immune reconstitution with combination antiretroviral therapy (cART), there was no improvement in EV-like lesions in any patient. Conclusions. EV is a disfiguring and potentially stigmatizing condition among this patient group and is difficult to treat; cART appears to have no impact on the progression of skin disease. Among adolescents with longstanding HIV-induced immunosuppression and with high levels of sun exposure, close dermatological surveillance for potential skin malignancy is required.

Published
2012

34. HIV prevention in southern Africa: why we must reassess our strategies?

Author

Leolin, Katsidzira and James G, Hakim

Subjects
Adult, Male, Acquired Immunodeficiency Syndrome, Adolescent, Anti-HIV Agents, Adenine, Organophosphonates, HIV Infections, Middle Aged, Condoms, Young Adult, Circumcision, Male, HIV Seropositivity, Humans, Female, Interdisciplinary Communication, Preventive Medicine, Condoms, Female, Tenofovir, Risk Reduction Behavior
Abstract

Southern Africa continues to shoulder a disproportionate burden of the HIV epidemic with the number of new infections outstripping treatment initiation two- to threefold. Current prevention strategies have had a limited impact on the trajectory of the epidemic so far. The history of HIV prevention research is dominated by failed approaches, but recent developments have provided reason for hope. These include the successful male circumcision outcomes in trials in South Africa, Kenya and Uganda, the recent protective outcome of a tenofovir vaginal gel trial in South Africa and the proof that pre-exposure prophylaxis with oral combination tenofovir/emtricitabine can work in men. The latter positive outcome has however been shattered by the early closure of FEM-PrEP for futility. The challenge now is on how to best integrate emerging prevention methods with established strategies, recognising that some of the older methods have never been scaled up to saturation level.

Published
2011

35. Retrospective study of colorectal cancer in Zimbabwe: Colonoscopic and clinical correlates

Author

Innocent T. Gangaidzo, Jonathan A. Matenga, Leolin Katsidzira, and Munyaradzi P Mapingure

Subjects
Adult, Male, Zimbabwe, medicine.medical_specialty, Colorectal cancer, Black People, Colonic Polyps, Colonoscopy, Gastroenterology, White People, Adenomatous Polyps, Asian People, Predictive Value of Tests, Risk Factors, Retrospective Study, Internal medicine, Weight Loss, Epidemiology, Odds Ratio, medicine, Humans, Referral and Consultation, Sigmoidoscopy, Aged, Retrospective Studies, Chi-Square Distribution, medicine.diagnostic_test, business.industry, Anemia, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, medicine.disease, Logistic Models, Predictive value of tests, Multivariate Analysis, Female, Colorectal Neoplasms, business, Chi-squared distribution
Abstract

AIM: To compare differences in the frequency of colorectal cancer at colonoscopy in Zimbabwe according to ethnicity. METHODS: All lower gastrointestinal endoscopic procedures performed between January 2006 and December 2011 at a gastroenterology clinic in Harare, Zimbabwe were reviewed. The demographic characteristics, clinical indications, differences in bowel preparation and the endoscopic and histological diagnoses were compared between different ethnic groups with emphasis on colorectal cancer. The clinical and demographic characteristics and the endoscopic findings were compared using the student t-test and the χ2 test, while the clinical indications associated with a diagnosis of colorectal cancer were determined by logistic regression. RESULTS: All colonoscopies and sigmoidoscopies performed in 1236 Caucasians, 460 black Africans and 109 Asians were analysed. Colorectal cancer was diagnosed more frequently in the black African patients compared to Caucasians or Asians (10% vs 3%, 10% vs 2%, P < 0.001). However, polyps were less common among black Africans (5%) compared to both Caucasians (8%) and Asians (9%) (P = 0.03). Among patients with colorectal cancer, black Africans tended to be younger than Caucasians, who were over-represented in the oldest age category; 32 % vs 2% were less than 50 years and 41% vs 78% were older than 60 years (P < 0.001). Anaemia and weight loss were associated with colorectal cancer in both black African [odds ratio (OR): 2.73 (95%CI: 1.33-5.61) and 3.09 (1.35-7.07)] and Caucasian patients [OR: 6.65 (95%CI: 2.93-15.09) and 3.47 (1.52-7.94)]. CONCLUSION: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians.

Published
2015
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36. Complete regression of early diffuse B-cell lymphoma in an HIV-positive patient on antiretroviral therapy alone

Author

Rudo Makunike-Mutasa, Leolin Katsidzira, Margaret Borok, and A Ramsay

Subjects
Adult, Male, Oncology, medicine.medical_specialty, Lymphoma, B-Cell, Anti-HIV Agents, Human immunodeficiency virus (HIV), HIV Infections, Dermatology, CHOP, medicine.disease_cause, Antiretroviral Therapy, Highly Active, hemic and lymphatic diseases, Internal medicine, Complete regression, medicine, Humans, Pharmacology (medical), B-cell lymphoma, Microscopy, Histocytochemistry, business.industry, Public Health, Environmental and Occupational Health, Antigens, CD20, Positive patient, medicine.disease, Immunohistochemistry, Antiretroviral therapy, Lymphoma, Non-Hodgkin's lymphoma, Infectious Diseases, Gastric Mucosa, Immunology, business
Abstract

There is no evidence that antiretroviral therapy (ART) alone may result in complete remission of aggressive non-Hodgkin's lymphomas even though it improves the overall prognosis. We report a case in which early diffuse large B-cell lymphoma regressed completely after ART alone, raising the possibility that this may be sufficient therapy in selected cases.

Published
2011
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37. Pneumomediastinum in an HIV-infected patient with cytomegalovirus pneumonitis

Author

Rudo Makunike-Mutasa, Rashida A. Ferrand, G T Fana, and Leolin Katsidzira

Subjects
Adult, Sexually transmitted disease, Human cytomegalovirus, Pediatrics, medicine.medical_specialty, Pneumonia, Viral, Congenital cytomegalovirus infection, Dermatology, Pneumocystis pneumonia, Diagnosis, Differential, Fatal Outcome, medicine, Humans, Pharmacology (medical), Pneumomediastinum, Mediastinal Emphysema, Pneumonitis, AIDS-Related Opportunistic Infections, business.industry, Respiratory disease, Public Health, Environmental and Occupational Health, virus diseases, medicine.disease, Pneumonia, Infectious Diseases, Cytomegalovirus Infections, Immunology, Female, Radiography, Thoracic, business, psychological phenomena and processes
Abstract

A pneumomediastinum is an unusual complication of respiratory infections in HIV-positive patients, usually reported in association with pneumocystis pneumonia. We describe a case of an HIV-positive patient with a pneumomediastinum who had cytomegalovirus pneumonitis. This is an important reminder to clinicians, since cytomegalovirus pneumonitis and pneumocystis pneumonia have a similar clinical and radiological presentation.

Published
2011
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38. A potentially treatable cause of dementia

Author

Leolin Katsidzira, Machiridza T, and Ndlovu A

Subjects
Fatal Outcome, Hypoparathyroidism, Brain, Calcinosis, Humans, Dementia, Female, Tomography, X-Ray Computed, Aged
Abstract

Idiopathic hypoparathyroidism is an uncommon medical condition, which may present with dementia. This may be misdiagnosed as 'senile dementia' in elderly patients. We report such a case, made more remarkable by associated extensive cerebral calcification and we review the background literature.

39. Cryptococcus gattii: A dilemma in diagnosis and treatment in sub-Saharan Africa an area with high HIV prevalence

Author

Robertson, V. J., Nyazika, T. K., Leolin Katsidzira, and Gutu, T. I.

Abstract

Sub-Saharan Africa contributes at least 70% of the global cryptococcal meningoencephalitis cases each year and the majority of cases are caused by the Cryptococcus neoformans species. We present a case of meningoencephalitis due to Cryptococcus gattii in an 18 year old apparently immunocompetent male patient from Zimbabwe.

40. Retrospective study of colorectal cancer in Zimbabwe: colonoscopic and clinical correlates.

Author

Katsidzira L, Gangaidzo IT, Mapingure MP, and Matenga JA

Subjects
Adenomatous Polyps ethnology, Adult, Aged, Anemia ethnology, Asian People, Black People, Chi-Square Distribution, Colonic Polyps ethnology, Colorectal Neoplasms ethnology, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Referral and Consultation, Retrospective Studies, Risk Factors, Sigmoidoscopy, Weight Loss ethnology, White People, Zimbabwe epidemiology, Adenomatous Polyps pathology, Colonic Polyps pathology, Colonoscopy, Colorectal Neoplasms pathology
Abstract

Aim: To compare differences in the frequency of colorectal cancer at colonoscopy in Zimbabwe according to ethnicity., Methods: All lower gastrointestinal endoscopic procedures performed between January 2006 and December 2011 at a gastroenterology clinic in Harare, Zimbabwe were reviewed. The demographic characteristics, clinical indications, differences in bowel preparation and the endoscopic and histological diagnoses were compared between different ethnic groups with emphasis on colorectal cancer. The clinical and demographic characteristics and the endoscopic findings were compared using the student t-test and the χ2 test, while the clinical indications associated with a diagnosis of colorectal cancer were determined by logistic regression., Results: All colonoscopies and sigmoidoscopies performed in 1236 Caucasians, 460 black Africans and 109 Asians were analysed. Colorectal cancer was diagnosed more frequently in the black African patients compared to Caucasians or Asians (10% vs 3%, 10% vs 2%, P<0.001). However, polyps were less common among black Africans (5%) compared to both Caucasians (8%) and Asians (9%) (P=0.03). Among patients with colorectal cancer, black Africans tended to be younger than Caucasians, who were over-represented in the oldest age category; 32 % vs 2% were less than 50 years and 41% vs 78% were older than 60 years (P<0.001). Anaemia and weight loss were associated with colorectal cancer in both black African [odds ratio (OR): 2.73 (95%CI: 1.33-5.61) and 3.09 (1.35-7.07)] and Caucasian patients [OR: 6.65 (95%CI: 2.93-15.09) and 3.47 (1.52-7.94)]., Conclusion: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians.

Published
2015
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