Journal of Medical and Biomedical Laboratory Sciences Research

A review of Carbapenems Resistance in the Current World

Racheal Kimani — 2024-05-15

Carbapenems are a subgroup of beta-lactam antibiotics, which have been effective in treating Gram-negative bacteria. These groups of drugs are particularly effective for resistant Gram-negative bacteria that are multi-drug resistant mainly to all types of penicillins and cephalosporins. It is a reality now that there is a looming crisis due to emergence of resistance to these groups of drugs. Efforts to fight resistance is by new therapies that are combining cephalosporins with inhibitors such as vaborbactam, avibactam and relebactam. However, already resistance has been noted against ceftazidime-avibactam according to recent studies. The effectiveness of carbapenems has gone down due to beta-lactamases, production of efflux pumps and target modification. Commonly encountered carbapenemases conferring resistance to this group of drugs include KPCs (Klebsiella pneumoniae carbapenemases), which are class A beta lactamases, NDMs, in full New Dehli metallo-β-lactamases, VIM (Verona Integron encoded metallo-β-lactamases), IMPs (Iminpenemases) which are class B metallo-β-lactamases and OXA-48 (oxacillinases) which are Class D β-lactamases. This review gives a global distribution overview and the evolution of carbapenemases, which are spreading at a fast rate. There are measures to overcome this menace such as enhancing infection prevention control (IPC) measures. Another approach is implementing and upholding diagnosis and antibiotic stewardship especially in Low-middle-come-countries (LMICs).

Opportunities for Therapies for Graft-Versus-Host Disease Following Hematopoietic Stem Cell Transplantation: Is Africa Prepared?

Caroline Mangare — 2024-05-04

Hematopoietic stem cell transplantation is a therapeutic approach used to cure many malignant and non-malignant, acquired and congenital/genetic as well as benign disorders of the bone marrow. This procedure is considered to be among the major advances of modern medicine which has been marked by a growing need globally. Graft-versus-host disease (GVHD) and failure of engraftment continues to be major hurdles to the success of allogeneic hematopoietic stem cell transplantation (HSCT) as well as adoptive T cell causing high morbidity and mortality. The limited understanding of the pathogenesis of acute and chronic GvHD, coupled with the suboptimal response to front-line corticosteroid treatment and poor outcomes for patients with steroid-refractory disease, present major hurdles. Additionally, the inconsistencies in the design of prospective clinical studies evaluating new agents for GvHD have hindered progress, with few multicenter studies being conducted. While advancements have been made in grading GvHD and developing biomarkers for improved prognostic information, there is a critical need for uniform inclusion criteria and endpoints in prospective studies to facilitate multicenter research and advancements in GvHD prevention. In developing countries, HSCT is further limited by high cost, limited infrastructure, availability of HLA-identical donors and management of complications such as GvHD. Several modalities have been employed to curb GvHD such as (drugs), additional inventions have been employed that include molecular methods that will be described in this review.

Predictors of Non-Adherence to Type II Diabetes Management Among Adult Inmates in Machakos County Prisons, Kenya

EVABEATRICE NJOKA — 2024-04-26

ABSTRACT

Background: While the management of Type II diabetes continues to enjoy progressive changes, non-compliance with medications has emerged as a threat that could jeopardize public health gains. The incarcerated population best captures the 21^st-century concern, where the special group is faced with limited decision-making capabilities. The aim of this study was to establish the predictors that influence non-compliance to type II diabetes treatment among adult inmates in Machakos County Prisons.

Materials and Methods: A mixed methods was used to conduct interviews from 258 staff and 556 inmates. The study area encompassed inmates and staff of Yatta and Machakos GK prison in Machakos County. Data were collected through the use of structured questionnaires and KII. Data was analyzed using SPSS version 20 software, Chi square and logistical regression. Results were presented using tables, charts and bar graphs.

Results:The findings shows that involvement in treatment decisions has a significant influence on non-adherence to type II diabetes management (p=0.000). The respondents who are not involved in treatment decisions (OR= 0.154, 95%CI [0.061-0.385], p = 0.000) were more likely to be non-adherent to type II diabetes management as compared to those who are involved in treatment decisions. The findings indicates that doctors giving prisoners information on diabetes has a significant influence on non-adherence to type II diabetes management (p=0.000). The prisoners who don’t receive information on diabetes (OR= 6.577, 95%CI [3.043-14.213], p = 0.000) were more likely to be non-adherent to type II diabetes management as compared to prisoners who receive information on diabetes.

Conclusion: Doctors giving prisoners information on diabetes and involvement in treatment decisions, feeling comfortable to ask questions to the doctor had an influence on non-adherence to type II diabetes management

Recommendations: The study found that adult inmates were not involved in treatment decisions. This study therefore recommends that the doctors in prison clinics should spend adequate time with the inmates explaining important information on diabetes to help the patient understand his condition and encourage him to start and maintain therapy. Patient satisfaction and a good understanding of the content given by the provider improve compliance to type II diabetes management among adult inmates.

Keywords; Predictors, Patient-Provider relationship, Non- compliance

Determination of Diversity of Mold Species and Aflatoxins in Local Traditional Cereal Based Brews Within Nkubu Municipality, Meru County, Kenya

Lawrence Ireri — 2024-06-15

Background: Molds produce mycotoxins such as Ochratoxins, Deoxynivalenol, and Aflatoxins which contaminate more than 25% of the global food produced annually. Most traditional brews consumed in Kenya are produced from cereals contaminated with molds and mycotoxins. This poses a public health concern since it exposes consumers to the risk of nephrotoxicity, cancer, teratogenicity and immune-toxicity. However, data on local brew mycotoxin contamination in Nkubu municipality, Meru County remains limited. This study sought to determine the diversity of molds and aflatoxins in cereal based local brews in Nkubu municipality, Meru County, Kenya.

Methods: A total of sixty-two (62) Marua, seventeen (17) Busaa, and five (5) Chang’aa samples were randomly collected from different brewers in the study area and shipped in sterile containers to the Kenya Methodist University Mycology laboratory for isolation and identification of molds. Molds were isolated using culture method while Aflatoxins were detected using ELISA method.

Results: Marua brew 62/84 (73.8%) was the most common brew in Nkubu followed by Busaa 17/84 (20.2%), and chang’aa 5/84 (6.0%). Co-occurrence of Aspergillus, Penicillium, and yeast was reported in all the cereal based brews. Aspergillus plus yeast was the most abundant mold species in all the three types of brews: Marua (69.4%), Busaa (70.6%), and Chang’aa (60.0%). The co-existence of molds in Marua and Busaa varied significantly (P<0.001). Busaa had a marginally higher aflatoxin mean concentration, and range (6.40±2.45, [1.12-25.70] ppm) compared to Marua (5.74±3.29, [1.12-25.70] ppm) and chang’aa (2.35±3.07, [1.41-3.55] ppm), though this was not statistically significant (P=0.195). 21/62 (33.9%) and 6/17 (35.3%) of Marua and Busaa samples, respectively had aflatoxin levels > 10 ppb.

Conclusion: Occurrence of molds and Aflatoxins in cereal based brews in Nkubu municipality beyond the tolerable levels recommended by the Kenya Bureau of Standards warrants mycotoxicological quality control of cereal based brews to avoid exposing the consumers to high aflatoxins.

Distribution OF ABO Predicated Phenotypes among Voluntary Blood Donors applying Next Generation Sequencing - Insights from Kenya

Rachel Githiomi — 2024-05-10

Background: ABO system is a major determinant for blood transfusion and organ transplantation incompatibility. ABO histo-blood group antigens are sugars attached to glycolipids and glycoproteins on the surface of human cells and readily recognizable by antibodies which are naturally present in each person plasma/serum. Laboratory testing for ABO antigens and isoagglutinins is essential for safe and effective transfusion and transplantation. Testing for ABO antigens has traditionally depended on serologic testing which is limited in the determination of the weak subtypes risking the recipients to alloimmunisation especially those we are receiving ongoing transfusions with red cell such as sickle cell disease and oncology. . It has also impacted negatively in the management of rare red cell units. However, there is increasing need for evaluation of genetic analysis of ABO antigens, to enable evaluation of ABO blood group in cases where serologic testing may be ambiguous or impossible to accurately determine the presence of these antigens; plus having such data in a country. Thus, there is need to investigate the genotypes/Alleles responsible for ABO blood group phenotypes in the blood donor population to enhance safety in transfusion and transplantation practices.

Methods: The study site was Kenya National Blood Transfusion Service and Red Cross lifeblood Brisbane, experimental design was employed, sample size determination was determined using Slovin's Formula Sampling Techniques, and purposeful sampling method was employed to achieve a representative sample. Next generation sequencing was employed to determine red cell alleles and predicted phenotypes. Sequencing was performed using the Illumina MiSeq platform with 12-plex pools and standard 300-cycle V2 chemistry.

Results: Out of the total 119 samples sequenced, ten phenotypes combinations were predicted: O (52.3%), A1 (16.2%), B (10.5%), A1 or B (6.8%), A1 or A2 (5.8%), A1 or Ax/Aweak (1.6%), B or B3 (1.6%), A1B (2%) A2B (2%).and Bweak (0.5%). This can be expressed as (O> A1> B > A1 or B > A1 or A2 > A1 or Ax/Aweak > B or B3 > A1B > A2B > Bweak.

Conclusion: The study findings elucidated the genotypes that are responsible for the ABO thirteen phenotypes in the identified Kenyan population. This data forms the basis or evidence to advocate for a blood group reference laboratory and a red cell panel that is African specific.

Decoding Kidd (JK) Blood System Phenotype in Kenya: Unveiling the Diversity with Cutting-Edge Next-Generation Sequencing Technology

Rachel Githiomi — 2024-05-05

The Kidd blood group system plays a crucial role in transfusion medicine, and understanding the molecular basis of Kidd red cell alleles is essential for effective blood matching and preventing alloimmunization. In Africa there are limited reports on the phenotype distribution for the 45 blood group systems recognised by the ISBT. Most of the blood group determination is via serological methods however, only the major blood groups antigens are identified (ABO & RhD) despite the evidence of some of the rare blood group antigens such as Kidd types being associated with clinical significance in transfusions, pregnancy and transplantation. In adverse complicated undetermined cases, genomic typing has become useful in determining the involved red cell variant. The study sought to investigate the genotypic and phenotypic distribution of Kidd blood group alleles in the blood donor population to enhance safety in transfusion practice.

Methodology: The study site was Kenya National Blood Transfusion Service and Red Cross lifeblood Brisbane, experimental design was employed, sample size determination was by Slovin's Formula Sampling Techniques, and purposeful sampling method was employed to achieve a representative sample. Molecular genotyping were employed to determine red cell genotypes and phenotypes. Sequencing was performed using the Illumina MiSeq platform with 12-plex pools and standard 300-cycle V2 chemistry.

Results Of the 119 samples sequenced, thirteen JK genotype combinations were identified in the cohort, with the following predicted phenotype distribution: Jk(a+b-) 45.5%, Jk(a+b+) 25.7%, Jk(a+wb+) or Jk(a+b+w) 9.9%, Jk(a-b+) 9.4%, Jk(a+wb-) 5.8%, Jk(a+wb-) or Jk(a+b-) 2.1%, and Jk(a+wb+) 1.6%. These frequencies are consistent with global and sub-Saharan Kidd frequencies, highlighting the importance of population-specific data. Accurate genotyping and phenotype matching are essential to ensure safe and effective transfusions

Assessment of Morbidity Status of Children Aged 6-59 Months in Kericho County, Kenya

Daniel Kipngeno Cheruiyot — 2024-06-25

Background: The growth and well-being of a child is dependent on their eating habits. One of the leading causes of morbidity and mortality in Kenya and countries worldwide is poor nutritional status. There are few studies on factors affecting the nutritional status among children aged 6 and 59 months in Kenya, even though malnutrition is a major cause of illness and mortality in these groups. Consequently, this research set out to identify the factors that influence the nutritional status of children in Kericho County, Kenya, ranging from six months to five years.

Methods: The study utilized a cross-sectional analytical design to uncover factors influencing the nutritional status of children attending outpatient child welfare clinics at Kericho County Referral Hospital and Kapkatet Sub-County Hospital.

Results: A sample of 172 children was chosen through systematic random sampling, and data was collected using a structured questionnaire. Analysis involved ENA for SMART for anthropometric data and Statistical Package for Social Sciences version 27 for all other variables. Findings revealed that 75 (43.6%) children were aged between 24 and 59 months, and 88 (51.2%) were male. Additionally, approximately two-thirds of caregivers had attained secondary education (n=77, 44.8%). Stunting was prevalent in 25% of the children, while both wasting and underweight affected 23.8%. Morbidity data revealed that 45.3% of children had been sick in the past month, with varying durations of symptoms. Children whose caregivers lacked formal education were more likely to be underweight (AOR=0.70, 95% CI: 1.82-2.99, p = 0.01). Delayed introduction to complementary food reduced the likelihood of wasting and stunting (AOR = 0.25, 95% CI: 0.05-0.91, p = 0.03) and (AOR = 0.44, 95% CI: 0.16-1.08, p = 0.04) respectively. Children experiencing symptoms for over 6 days were more likely to be underweight (AOR = 1.27, 95% CI: 0.98-2.66, p = 0.01), and those not sick in the past month were less likely to be stunted (AOR=0.56, 95% CI: 0.27-0.89, p = 0.03).

Conclusion: Caregiver education level, childbirth method, timing of complementary feeding, and illness duration significantly influence child nutrition. Hence, implementing targeted nutrition interventions for children aged 6 to 59 months in Kericho County is imperative.