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2010

Mohamed, AS;, Mohamed AS.  2010.  The Prevalence Of Cardiac Arrhythjviias And Associated Risk Factors Among Patients With Chronic Obstructive Pulmonary Disease At Kenyatta National Hospital. Abstract

Background
Cardiac arrhythmias are common in COPD patients and are a major cause of morbidity and
mortality, especially the persistent supraventricular and ventricular rhythm disorders.
Multiple factors such as hypoxemia! hypercapnia, acidosis. right heart failure and medication
e.g. xanthene derivatives, steroids and β2 agonists have been implicated.
Recently P wave dispersion and QTc wave dispersion have been reported to predict the
development of atrial fibrillation and ventricular arrhythmias respectively.
Objective
To determine the prevalence of cardiac arrhythmias among patients with COPD, and describe
the associated factors.
Study Design
Cross-sectional descriptive study done over a period of six months prospectively
Setting
Outpatient Chest clinic and chest ward, Kenyatta National Hospital.
Study Population
COPD patients who met the eligibility criteria.
Results
A total of207 patients with COPD were studied. The male to female ratio was 2.3: I. The
mean (SO) age of the study population was 66.7(8.5.) years. The median duration of COPD
diagnosis was 1 year (range-0- 6 years) and the median duration of follow-up was also 1 year
(range- 0-5 years). Past smokers accounted for 99.8% while only 1% were current
smokers.The main occupation sited was agriculture at 72.9%.Most of the patients(97.1%)
were on medication with majority (35.7%) on a combination of LAB A, SABA, oral
theophylline, and inhaled steroids. A minority (21.6%) used the medications regularly; 'the
rest intermittently.
The prevalence of arrhythmia was 14% (95%C1 9.3-18.7). The commonest arrhythmia was
VPB (51.7%). Atrial fibrillation accounted for 24%. Atrial fib +VPB accounted for 10.3%,
while 13.8% had 3° heart block. Majority (96%) of those with arrhythmias were in stage III &
IV of COPD.
A higher COPD stage, Hypokalemia, hypomagnesaemia, hypoxia, hypercapnia, acidosis, and
longer QTc & P-wave dispersion was significantly associated with arrhythmias (p

2003

Sheikh, MA.  2003.  Colostomy closure as seen at kenyatta national hospital both retrospective and prospective study. Abstract

This is both a prospective study of thirty patients from March 2002 to February 2003 and a
retrospective study of eighty-five patients from January 1999 to February 2002 who underwent colostomy closure at the Kenyatta National Hospital. There was no significant difference in the
results of the two groups.
The main objective of the study was to analyse variables that determine outcome of colostomy
closure. All patients who met the inclusion criteria were recruited into the study.
The average age of patients in the prospective group was 34 (range, 15-85) years and 35 (range
16-87) years in the retrospective group. There were more males than females in the study with a
male to female ratio of 5:1 and 4.3:1 in the prospective and retrospective groups respectively.
The common indications for colostomy were colon injury and colon obstruction accounting for
more than eighty five percent (85%) of the patients.
Hartman's colostomy was the commonest type of colostomy fashioned accounting for fifty
percent (50%) and 44.7% of the colostomies in the prospective and retrospective studies
'respectively. Seventy percent (70%) of the colostomies in the prospective group and 58.8% of
those in the retrospective group were sited at the sigmoid colon. Mean time until colostomy
closure was 7.6 (range, 0.82 to 91) months in the prospective group and 5.3 (range, 0.79 to 29) ,
months in the retrospective group.
All the patients had mechanical bowel preparation. Seventy three percent (73%) in the
prospective group and 63.3% in the retrospective group had prophylactic systemic antibiotics.
All the patients had intraperitoneal closure of the colostomy. About ninety percent (90%) of the
patients in the study had two-layer anastomosis of the colon. About sixty percent (60%) of the
patients in the study had their colostomies closed in less than two hours. The average hospital
stay for patients in the prospective group was 7.1 (range, 2 to 18) days and 9.8 (range, 4 to 61)
days in the retrospective group.
The rate of developing early complications was 16.7% in the prospective group of which 13.4%
had wound infection and 15.3% in the retrospective group of which 11.8% had wound infection.
There was no death. There was a trend of increasing morbidity in patients who had colon
obstruction, colostomies sited at the sigmoid colon, Hartman's colostomy, operations lasting
more than two hours and those operated by Registrars.

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