Department of Medical Biochemistry

Association between Human Resource Factors and Utilization of IQCare System for Clinical Decision Support in HIV Care Clinics in Nakuru County, Kenya

2024-03-13T16:46:46Z

Association between Human Resource Factors and Utilization of IQCare System for Clinical Decision Support in HIV Care Clinics in Nakuru County, Kenya Komen, Christopher Cherutich; Onyango, Patrick; Anyona, Samuel Bonuke; Kirui, Benard Electronic medical records (EMR) are computerized medical information systems that are used to collect, store, and display patient information. EMR systems can strengthen pathways of care and close gaps in patient tracking, care, and management of chronic diseases such as HIV&AIDS. Conventionally, health care workers (HCWs) face difficulties in locating, sorting, and identifying key information in paper records. To counter these challenges, in the year 2010 the Ministry of Health in Kenya approved the use of two EMR platforms, namely the International Quality Care (IQCare) system and the KenyaEMR. These systems were initially set to support HIV&AIDS clinical decision making. In 2014, Nakuru County was among the first counties to roll out the utilization of IQCare system for clinical decision support (CDS). In its implementation, appropriate support was provided, which included human resource and ICT infrastructure. Despite the substantial investment in IQCare in Nakuru County, its utilization for CDS remained low. As such, this study investigated the influence of human resource factors on the utilization of IQCare for CDS in the provision of HIV&AIDS care services in health facilities in Nakuru County. This cross-sectional study was conducted in 13 health facilities where IQCare had been deployed since January 2014 and enrolled 81 HCWs. Data was collected using questionnaires and focus group discussions. The results from the study revealed a significant association between human resource factors and utilization of IQCare for CDS. Specifically, IQCare training (p=0.023) and mentorship support (p=0.049) were significantly associated with use of IQCare for CDS. These results showed that staff training on IQCare and mentorship support are drivers to utilization of IQCare for CDS in Nakuru County. The study recommends that decision-makers at facility, county and national level should invest in HCWs training and mentorship support to guarantee optimal utilization of IQCare systems for CDS. The article can be accessed in full via: https://tudr.org/id/eprint/2240.

Optimised germination protocol for jackfruit seeds and evaluation of methods for extraction of DNA suitable for genetic analysis

2023-10-15T11:08:46Z

Optimised germination protocol for jackfruit seeds and evaluation of methods for extraction of DNA suitable for genetic analysis OJWANG, RA; ADAN, AA; NYABOGA, EN; MUGE, EK; MBATIA, BN; OBIERO, GO; OGOYI, DO Jackfruit (Artocarpus heterophyllus) is an underutilised plant that is promising in curbing food and nutritional security in sub-Saharan Africa. However, high level of secondary metabolites in its tissues significantly hampers its genetic characterisation for breeding purposes. Primarily, the compounds react with DNA during the extraction process, thus reducing its yield and quality. The utilisation of leaves from jackfruit seedlings is a potentially effective approach of addressing the challenge, however, limited information is available on efficient jackfruit seed germination procedures. Elucidating effective methods of jackfruit seed germination, and optimising protocols for DNA extraction is crucial in promoting its genetic characterisation studies for identification of superior varieties for propagation. The objective of this study was to evaluate methods of jackfruit seed germination, and DNA extraction procedures using jackfruit leaves. Pre-treatment of seeds with 3% hydrogen peroxide was effective in enhancing seed germination within a short time, compared to distilled water and 3% hydrochloric acid. We optimised a DNA extraction technique by combining CTAB-SDS based approach with an enhanced solvent extraction method. The technique yielded high quantity and quality of DNA from jackfruit leaves, which was appropriate for downstream polymerase chain reaction analysis. The sequence-related amplified polymorphism (SRAP) and simple sequence repeat (SSR) amplifications confirmed the effectiveness of the optimised CTAB-SDS based protocol for extraction of high quality DNA. https://doi.org/10.4314/acsj.v30i3.1

Genetic diversity and relationships among populations of jackfruit, an underutilized nutrient-rich climate-smart fruit tree crop in Kenya and Uganda

2023-10-15T09:45:40Z

Genetic diversity and relationships among populations of jackfruit, an underutilized nutrient-rich climate-smart fruit tree crop in Kenya and Uganda OJWANG, Redemtor Awuor; MUGE, Edward K; NYABOGA, Evans N; MBATIA, Betty N; OGOYI, Dorington O Jackfruit (Artocarpus heterophyllus Lam.) is an underutilized fruit tree crop in East Africa. Despite its importance for food and nutritional security, only limited information exists on the extent of genetic variability among Ugandan and Kenyan jackfruit populations. This study was aimed at analyzing the extent of genetic diversity in jackfruit germplasm from selected regions of Kenya and Uganda. A total of 30 mature fruit samples were collected randomly from three districts (Kampala, Wakiso and Mbale) in Uganda and five counties (Siaya, Kwale, Mombasa, Busia, and Murang’a) in Kenya. Genetic characterization was using six simple sequence repeat (SSR) and nine sequence-related amplified polymorphism (SRAP) markers. The results revealed that 62.50% of the loci for SSR and 82.14% for SRAP markers were polymorphic. The average polymorphism information contentwas 0.48 for SSR and 0.56 for SRAP markers. The Jaccard’s similarity coefficient ranged from 0.55 to 1.0 for SSR and from 0.33 to 0.93 for SRAP markers, indicating considerable genetic diversity among jackfruit germplasm. Based on combined SSR and SRAP data, analysis of molecular variance revealed greater genetic diversity within the populations (76%) than among the eight populations (24%). Dendrogram and principal coordinate analysis separated the germplasm into two clusters, with several intermediates. The germplasm distribution among the clusters and sub-clusters was not associated with the geographical region. The significant genetic variability existing in Ugandan and Kenyan jackfruit germplasm can be used to improve jackfruit through breeding. The substantial genetic diversity should enable jackfruit breeders to develop high-yielding varieties with improved quality traits. https://doi.org/10.1080/15427528.2021.1997849

Human NCR3 gene variants rs2736191 and rs11575837 influence susceptibility to the longitudinal development of pediatric severe malarial anemia

2023-03-10T13:51:19Z

Human NCR3 gene variants rs2736191 and rs11575837 influence susceptibility to the longitudinal development of pediatric severe malarial anemia Onyango Clinton O, Qiuying Cheng, Elly O Munde, Evans Raballah, Samuel B Anyona, Benjamin H McMahon, Christophe G Lambert, Patrick O Onyango, Kristan A Schneider, Douglas J Perkins, Collins Ouma Plasmodium falciparum malaria is a leading cause of pediatric morbidity and mortality in holoendemic transmission areas. Severe malarial anemia [SMA, hemoglobin (Hb) < 5.0g/dL] is the most common clinical manifestation of severe malaria in such regions. Although innate immune response genes are known to influence the development of SMA, the role of natural killer (NK) cells in malaria pathogenesis remains largely undefined. As such, we examined the impact of genetic variation in the gene encoding a primary NK cell receptor, natural cytotoxicity-triggering receptor 3 (NCR3), on the occurrence of malaria and SMA episodes over time. DOI: https://doi.org/10.21203/rs.3.rs-2207577/v1

Immunization of Rabbits with a Quadrivalent Shigella Bioconjugate Vaccine Induces Functional Antibodies Reactive with Shigella Isolates from Kenya

2022-11-15T16:54:10Z

Immunization of Rabbits with a Quadrivalent Shigella Bioconjugate Vaccine Induces Functional Antibodies Reactive with Shigella Isolates from Kenya Odundo, A Elizabeth , Hailey P Weerts, Lillian Musila, Lilian Ogonda, Anita M Dreyer, Joerg Schneider, Paula Carranza, Robert W Kaminski Diarrheal diseases are a leading cause of global morbidity and mortality, disproportionately affecting children in resource-limited settings. Although improvements in hygiene and access to clean water are helpful, vaccines are considered essential due to the low infectious dose of Shigella species and increasing antibiotic resistance. Building on achievements with conjugate vaccines, a safe and immunogenic novel bioconjugate vaccine linking Shigella O-antigen to Pseudomonas aeruginosa exoprotein A has been developed to induce immunity against Shigella flexneri 2a, 3a, and 6 and S. sonnei. This study evaluated the breadth of reactivity and functionality of pooled serum from rabbits immunized with monovalent and quadrivalent Shigella bioconjugates formulated with or without an adjuvant against Shigella serotypes isolated in Kenya. Rabbit sera were assayed by colony blot for reactivity with 67 isolates of Shigella serotypes targeted by the vaccine, S. flexneri (2a, 3a, and 6) and S. sonnei, and 42 isolates of Shigella serotypes not targeted by the vaccine, S. flexneri (1b, 2b, 4a, and 4b), S. boydii, and S. dysenteriae. Shigella isolates testing positive in the colony blot assay were then used to assess functional activity using a bactericidal assay. Of the 41 Shigella isolates targeted by the vaccine, 22 were reactive with the adjuvanted quadrivalent and the respective monovalent rabbit sera. The S. flexneri 2a and 3a monovalent rabbit serum cross-reacted with S. flexneri 3a, 2b, and 2a, respectively. Immunization with the adjuvanted quadrivalent vaccine also induced cross-reactivity with isolates of S. flexneri 2b, 4a, and 4b. Collectively, these results suggest that the Shigella quadrivalent vaccine may be more broadly protective than designed, offering a promising solution to Shigella infections. https://journals.asm.org/doi/pdf/10.1128/msphere.01020-21

A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study

2022-04-22T09:12:10Z

A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study LynnMarie Jarratt, Jenny Situ, Rachel D King, Estefania Montanez Ramos, Hannah Groves, Ryen Ormesher, Melissa Cossé, Alyse Raboff, Avanika Mahajan, Jennifer Thompson, Randy F Ko, Samantha Paltrow-Krulwich, Allison Price, Ariel May-Ling Hurwitz, Timothy CampBell, Lauren T Epler, Fiona Nguyen, Emma Wolinsky, Morgan Edwards-Fligner, Jolene Lobo, Danielle Rivera, Jens Langsjoen, Lori Sloane, Ingrid Hendrix, Elly O Munde, Clinton O Onyango, Perez K Olewe, Samuel B Anyona, Alexandra V Yingling, Nicolas R Lauve, Praveen Kumar, Shawn Stoicu, Anastasiya Nestsiarovich, Cristian G Bologa, Tudor I Oprea, Kristine Tollestrup, Orrin B Myers, Mari Anixter, Douglas J Perkins, Christophe Gerard Lambert Background: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico’s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the “UNM Global Health COVID-19 Intelligence Briefing.” Objective: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty.

The Potential of Differentiation-Related Gene-1 (DRG1) as a Biomarker for Metastasis of Estrogen Receptor-Positive Breast Cancer

2022-02-15T11:44:41Z

The Potential of Differentiation-Related Gene-1 (DRG1) as a Biomarker for Metastasis of Estrogen Receptor-Positive Breast Cancer Hillary Bor , Esther N. Maina , Benson Nyambega , Kirtika Tushar Patel , Charles Ochieng’ Olwal , Walter Nalyanya and Yahaya Gavamukulya Breast cancer is major burden worldwide and the majority of breast cancers express estrogen receptors (ER) suggesting a high dependence on estrogen hormone. Age is among the major determinants of breast cancer development, however, although Western Kenya is one of the areas with high breast cancer cases, age distribution of ER-positive breast cancer in the sub-region remains largely undocumented. Differentiation-related gene-1 (DRG1) is a metastasis suppressor and thus a potential biomarker for predicting level of metastasis but its potential application in assessing extent of metastasis of ER positive breast cancer has not been fully explored. This study therefore investigated the age distribution and the potential of expression of DRG1 in assessing metastasis of ER positive breast cancer.

Duffy Antigen/Receptor for Chemokines (DARC): Is There a Role in Prostate Cancer?.

2022-02-09T12:03:04Z

Duffy Antigen/Receptor for Chemokines (DARC): Is There a Role in Prostate Cancer?. Samuel B.AnyonaBS, ShiyanZhengMD,ThomasWheelerMD,MichaelIttmannMD, Teresa G.HayesMD, Martha P.MimsMD, Introduction: The Duffy blood group antigens function as chemokine receptors and as receptors for several species of malarial parasites. Approximately 70% of African Americans are Duffy negative as a result of a single nucleotide polymorphism in the promoter region of the Duffy antigen/receptor for chemokines (DARC) gene in a consensus-binding site for GATA 1. This mutation abolishes the promoter activity in erythrocytes, impairing the expression of DARC on red blood cells. Other than resistance to certain species of malaria, the functional consequence of Duffy negativity is unclear; however, it has recently been proposed that the Duffy antigen acts as a biological ‘sink' to clear pro-inflammatory chemokines from tissue microcirculation. Further it has been suggested that since the incidence of prostate cancer in African Americans is 60% higher than in Caucasians, absence of the Duffy antigen might predispose African Americans to prostate cancer by impairing downregulation of proinflammatory cytokines. We tested the hypothesis that lack of expression of DARC on erythrocytes predisposes African American men to develop prostate cancer. https://doi.org/10.1182/blood.V106.11.4394.4394

Reduced systemic bicyclo-prostaglandin-E2 and cyclooxygenase-2 gene expression are associated with inefficient erythropoiesis and enhanced uptake of monocytic hemozoin in children with severe malarial anemia

2022-02-09T09:59:11Z

Reduced systemic bicyclo-prostaglandin-E2 and cyclooxygenase-2 gene expression are associated with inefficient erythropoiesis and enhanced uptake of monocytic hemozoin in children with severe malarial anemia Samuel B Anyona, Prakasha Kempaiah, Evans Raballah, Gregory C Davenport, Tom Were, Stephen N Konah, John M Vulule, James B Hittner, Charity W Gichuki, John M Ong'echa, Douglas J Perkins In holoendemic Plasmodium falciparum transmission areas, severe malaria primarily occurs in children aged <48 months and manifests as severe malarial anemia [SMA; hemoglobin (Hb) < 6.0 g/dL]. Induction of high levels of prostaglandin-E2 (PGE2) through inducible cyclooxygenase-2 (COX-2) is an important host-defense mechanism against invading pathogens. We have previously shown that COX-2-derived PGE2 levels are reduced in children residing in hyperendemic transmission regions with cerebral malaria and in those with mixed sequelae of anemia and hyperparasitemia. Our in vitro studies further demonstrated that reduced PGE2 was due to downregulation of COX-2 gene products following phagocytosis of malarial pigment (hemozoin, PfHz). However, as COX-2-PGE2 pathways and the impact of naturally acquired PfHz on erythropoietic responses have not been determined in children with SMA, plasma and urinary bicyclo-PGE2/creatinine and leukocytic COX-2 transcripts were determined in parasitized children (<36 months) stratified into SMA (n = 36) and non-SMA (Hb ≥ 6.0 g/dL; n = 38). Children with SMA had significantly reduced plasma (P = 0.001) and urinary (P < 0.001) bicyclo-PGE2/creatinine and COX-2 transcripts (P = 0.007). There was a significant positive association between Hb and both plasma (r = 0.363, P = 0.002) and urinary (r = 0.500, P = 0.001)] bicyclo-PGE2/creatinine. Furthermore, decreased systemic bicyclo-PGE2/creatinine was associated with inefficient erythropoiesis (i.e., reticulocyte production index; RPI < 2.0, P = 0.026). Additional analyses demonstrated that plasma (P = 0.031) and urinary (P = 0.070) bicyclo-PGE2/creatinine and COX-2 transcripts (P = 0.026) progressively declined with increasing concentrations of naturally acquired PfHz by monocytes. Results presented here support a model in which reduced COX-2-derived PGE2, driven in part by naturally acquired PfHz by monocytes, promotes decreased erythropoietic responses in children with SMA. Am. J. Hematol., 2012. © 2012 Wiley Periodicals, Inc. https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.23253

Reduced interferon (IFN)-α conditioned by IFNA2 (− 173) and IFNA8 (− 884) haplotypes is associated with enhanced susceptibility to severe malarial anemia and longitudinal all …

2022-02-09T09:50:25Z

Reduced interferon (IFN)-α conditioned by IFNA2 (− 173) and IFNA8 (− 884) haplotypes is associated with enhanced susceptibility to severe malarial anemia and longitudinal all … Prakasha Kempaiah, Samuel B Anyona, Evans Raballah, Gregory C Davenport, Tom Were, James B Hittner, John M Ong’echa, Douglas J Perkins Severe malarial anemia (SMA) is a leading cause of pediatric morbidity and mortality in holoendemic Plasmodium falciparum transmission areas. Although dysregulation in cytokine production is an important etiology of SMA, the role of IFN-α in SMA has not been reported. As such, we investigated the relationship between IFN-α promoter polymorphisms [i.e., IFNA2 (A-173T) and IFNA8 (T-884A)], SMA, and functional changes in IFN-α production in children (n = 663; <36 months) residing in a holoendemic P. falciparum transmission region of Kenya. Children with SMA had lower circulating IFN-α than malaria-infected children without severe anemia (P = 0.025). Multivariate logistic regression analyses revealed that heterozygosity at −884 (TA) was associated with an increased risk of SMA [OR 2.80 (95 % CI 1.22–6.43); P = 0.015] and reduced IFN-α relative to wild type (TT; P = 0.038). Additional analyses demonstrated that carriage of the −173T/−884A (TA) haplotype was associated with increased susceptibility to SMA [OR 3.98 (95 % CI 1.17–13.52); P = 0.026] and lower IFN-α (P = 0.031). Follow-up of these children for 36 months revealed that carriers of TA haplotype had greater all-cause mortality than non-carriers (P < 0.001). Generation of reporter constructs showed that the IFNA8 wild-type −884TT exhibited higher levels of luciferase expression than the variant alleles (P < 0.001). Analyses of malaria-associated inflammatory mediators demonstrated that carriers of TA haplotype had altered production of IL-1β, MIG, and IL-13 compared to non-carriers (P < 0.050). Thus, variation at IFNA2 −173 and IFNA8 −884 conditions reduced IFN-α production, and increased susceptibility to SMA and mortality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665420/