Population Pharmacokinetics of Piperaquine in Young Ugandan Children Treated With Dihydroartemisinin-Piperaquine for Uncomplicated Malaria.

This prospective trial investigated the population pharmacokinetics of piperaquine given with dihydroartemisinin to treat uncomplicated malaria in 107 Ugandan children 6 months to 2 years old, an age group previously unstudied. Current weight-based dosing does not adequately address physiological changes in early childhood. Patients were administered standard 3-day oral doses and provided 1,282 capillary plasma concentrations from 218 malaria episodes. Less than 30% of treatments achieved 57 ng/mL on day 7. A three-compartment model with first-order absorption described the data well. Age had a statistically significant effect (P < 0.005) on clearance/bioavailability in a model that accounts for allometric scaling. Simulations demonstrated that higher doses in all children, but especially in those with lower weight for age, are required for adequate piperaquine exposure, although safety and tolerance will need to be established. These findings support other evidence that both weight- and age-specific guidelines for piperaquine dosing in children are urgently needed.

Emergency Ultrasound Predicting the Need for Therapeutic Laparotomy among Blunt Abdominal Trauma Patients in a Sub-Saharan African Hospital.

Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient's evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC. Results. In total, 195 patients were evaluated; M : F ratio was 6 : 1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%. Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings.

Initial attempt to establish population reference values for blood glucose and lipids in Makerere University undergraduate students.

UNLABELLED: The purpose of this study was to establish blood glucose and lipid profile of Makerere University undergraduate students. STUDY DESIGN: This was a cross-sectional study. MATERIALS AND METHODS: A total of 183 students participated in the study. Capillary blood glucose was read instantly on a finger prick sample off Sensorex glucose analyzer. Venous blood from the antecubital vein was used for lipid assays. Total cholesterol was assayed by the oxidase-peroxidase enzyme system. Plasma triacylglycerols were analyzed using the glycerokinase-oxidase reagents. HDL and LDL cholesterol were analyzed using homogeneous enzymatic methods. Concentration results for each variable were plotted in histograms and the type of distribution established. Summary statistics were then calculated non- parametrically to set reference values. RESULTS: Empirical ranges were: Cholesterol 2.1-7.2 mmol/L; triacylglycerols 0.4-6.87 mmol/L; HDLC 0.09-2.13 mmol/L; LDLC 0.95-5.38 mmol/L and capillary blood glucose 2.72-9.21 mmol/L. The reference ranges covering the central 95 percentile were: Cholesterol 2.65-5.15 mmol/L, triacylglycerols 0.61-4.03 mmol/L; HDLC 0.58-1.97 mmol/L; LDLC 1.25-3.57 mmol/L and capillary blood glucose 3.11-7.55 mmol/L. CONCLUSION: The established reference values for the age group 20-26 years were: Total Cholesterol 2.65-5.15 mmol/L, LDL 1.25-3.57 mmol/L, HDL 0.58-1.97 mmol/L, TG 0.61-4.03 mmol/L and capillary blood glucose 3.11-7.55 mmol/L which differed from set international values. RECOMMENDATIONS: We recommend the establishment of indices for the indigenous populations, conscientiously planned diets, and regular exercise.

Blood pressure profiles among Makerere University undergraduate students.

UNLABELLED: The purpose of this study was to set reference values for spot blood pressure and its derivatives among Makerere university undergraduate students. STUDY DESIGN: This was a cross- sectional study. MATERIALS AND METHODS: A total of 183 undergraduates including 63 females and 120 males participated in the study. Blood pressure was measured, with the respondent seated, using a sphygmomanometer. Mean arterial pressure was determined as the average of the systolic and diastolic values. Pulse pressure was the difference between systolic and diastolic values. Dividing systolic by diastolic values gave the required ratio. Histograms and cumulative percentages of these results were plotted and used to set the central 95 th percentile range as the reference values. RESULTS: Empirical ranges were: systolic BP 100-179 mmHg; diastolic BP 60-139 mmHg; systolic: diastolic pressure ratio 1.20-2.30 mmHg, mean arterial pressure 80-159 mmHg and pulse pressure 20-85 mmHg. The reference ranges covering the central 95 percentile were: systolic BP 100-150 mmHg, diastolic BP 64-100, systolic: diastolic BP ratio 1.29-2.03, the mean arterial pressure 85121 mmHg, and pulse pressure 25-70 mmHg. According to the systolic pressure, 35% were normal, 54% pre-hypertensive and 11% hypertensive. According to diastolic values, 48% were normotensive, 43% pre-hypertensive and 18% hypertensive. The mean arterial pressure was distributed like the parent pressures. The pulse pressure and the systolic:diastolic ratio were trimodally distributed with the three peaks corresponding to normotension, pre-hypertension and hypertension. CONCLUSION AND RECOMMENDATION: Reference values for the university student population have been derived and they are recommended for application in clinical evaluation.