Food samples collected in Murang'a district, Kenya are known to be contaminated with a mycotoxin, aflatoxin B1 (AFB), and a positive correlation exists between the dietary intake of AFB and the incidence of liver cancer. When urine samples collected in this district were analyzed for the presence of 2,3-dihydro-2-(7'-guanyl)-3-hydroxyaflatoxin B1 (AFB-GuaI) by h.p.l.c., 6 of 81 samples had a detectable level of a compound whose fluorescence spectrum was identical to chemically synthesized AFB-GuaI as confirmed by photoncounting fluorescence spectrophotometry. These results are an indication of interaction between the ultimate carcinogenic form of AFB and cellular nucleic acids in vivo and further support the hypothesis that AFB may play an important role in the etiology of human liver cancer.

Nyambok, I.O.

OBJECTIVES: To determine the frequency of adenotonsillectomy in a sample of Kenyan hospitals and to review indications, timing and complications in 97 cases of adenotonsillectomy done by the authors. DESIGN: Retrospective, descriptive study. SETTING: Kenyatta National, Nairobi, Aga Khan, Gertrude and Mater Hospitals. RESULTS: Adenotonsillectomy is the most frequent otolaryngologic surgical operation. Indications for surgery were upper airway obstruction in 61.3%, recurrent tonsillitis in 28.7% and both in 7.5%. Surgery was indicated during the acute stage in 6.8% of cases. There was one case of post-operative acute airway obstruction. Post operative bleeding from the tonsillar bed was encountered in 2.1% of cases. CONCLUSION: Adenotonsillectomy is the most common otolaryngologic surgical operation in our set-up. The low frequency of complications and a short hospital stay puts up a case for routine adenotonsillectomy as a day surgery procedure.

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

n/a

n/a

We present two cases of neurofibromatosis type 1 (NF-1), one a 35 year old male who first recognised his problem at the age of fifteen years and at the time of assessment, satisfied the National Institute of Health (NIH) diagnostic criteria for NF-1 and had a nodular plexiform neurofibroma involving the left fifth dorsal nerve root and a diffuse plexiform neurofibroma involving the left lower limb. The second patient, a 45 year old female recognised her problem at the age of 39 years, did not quite satisfy the NIH diagnostic criteria for NF 1 and had diffuse plexiform neurofibroma involving both lower limbs and buttocks almost symmetrically, a finding which has not previously been described to the best of our knowledge. The scarcity of management options are briefly outlined.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

n/a

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

No abstract available.

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

University of Hawaii, Honolulu, HI 96813, USA. suzanne@crch.hawaii.edu

Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy.

PMID: 17374685 [PubMed - indexed for MEDLINE]

The currently available evidence suggest that diuretics and/or low dose dopamine increases renal blood flow (RBF), glomerular filtration rate (GFR) and natriuresis in experimental animals, and limits ATP utilisation and oxygen needs in nephron segments at high risk of ischaemic injury, actions that could potentially limit renal injury and accelerate recovery in acute renal failure (ARF). These effects have indeed been confirmed in most experimental animals while using mannitol or low dose dopanime. Frusemide, however, for unknown reasons, has been effective in some animal models, but not others. In humans, it can be said that diurectics have a limited value to prevent, reverse or speed recovery from acute renal failure. Most clinical studies have failed to demonstrate convincingly that low dose dopamine either prevents ARF in high risk patients or improves renal function or outcome in patients with established ARF. This confusing scenario is further complicated by the fact that both diuretics and low dose dopamine can result in severe metabolic and cardiovascular complications in critically ill patients.

Twenty nine patients with rickets were studied in a one year period. The majority of patients (17/29) were below 2 years of age. Most of them had nutritional rickets resulting from a combination of factors. Premature delivery, nonexposure to sunlight, nutritional marasmus and inappropriate dietary intake. Some had familial hypophosphataemic rickets, others had renal tubular acidosis while the rest had rickets with a familial tendency. Both the previous hospital records and the present study indicate that rickets is a persistent problem in children in the community and should be suspected in children who present with features of failure to thrive, among other conditions.

n/a

n/a

"

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Prior to the acquired immunodeficiency syndrome (AIDS) epidemic, one or two cases of adult Burkitt's lymphoma (BL) were seen annually at the Kenyatta National Hospital, the national referral medical center in Nairobi, Kenya. To investigate the influence of human immunodeficiency virus (HIV) infection in adult BL in Kenya, we conducted a national prevalence survey of all patients 16 years of age and older with BL. A systematic review of medical records of all patients diagnosed with BL between 1992 and 1996 was performed. The diagnosis of BL was based and confirmed on review of pathological material from time of original diagnosis. HIV serology was confirmed by enzyme-linked immunosorbent assay (ELISA). Twenty-nine adult patients with BL were identified during the 5-year study period. Of these patients, 17 (59%) were males, 12 (41%) were females, and the median age was 26 years. Nineteen patients (66%) with BL were HIV-seropositive. The proportion of men was similar in HIV-seropositive and -seronegative patients (58% vs 60%). HIV-seropositive BL patients were significantly older than seronegatives (median 35 vs 19.5 years, p < 0.001). HIV-seropositive patients uniformly presented with constitutional or B symptoms and advanced BL accompanied by diffuse lymph node involvement, whereas the clinical presentation of HIV-seronegative patients during this time period was reminiscent of the "typical" endemic pattern of disease with complete sparing of peripheral lymph nodes. The overall survival of HIV-seropositive cases was significantly worse than that of the HIV-seronegative cases; median survival in the HIV-seropositive patients was 15 weeks. There is an approximate 3-fold increase in the incidence of adult BL during the time period of this study, which is attributable to the AIDS epidemic. In this setting, patients often present with disseminated disease, diffuse peripheral lymphadenopathy and fever, the latter two of which heretofore have been commonly associated with non-lymphoproliferative disorders such as Mycobacterium tuberculosis and sexually transmitted diseases in Kenya. These observations warrant inclusion of AIDS-related BL in the differential diagnosis of the adult patient with unexplained fever and lymphadenopathy in Kenya. The corollary is that HIV infection is virtually excluded in an adult patient without peripheral lymphadenopathy and biopsy-proven BL. Copyright 2001 Wiley-Liss, Inc.

Oyieke H.A. and Misra A.K:

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Department of Psychiatry, Faculty of Medicine, University of Nairobi, Kenya.

A survey of battered children was carried out at Kenyatta National Hospital, Nairobi between 1st May 1989 and 30th April 1990. Twenty eight cases were identified and compared with twenty six controls, matched for age and sex. The battered children were likely to be aged between three and four years, with slight male predominance. The abusing parents tended to live in crowded environments, were younger in age, less educated and were less likely to be practising contraception. They were relatively new migrants to Nairobi and were socially isolated. The socio-economic and cultural issues are discussed.

PMID: 8033769 [PubMed - indexed for MEDLINE]

 

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

PMID: 7215256 [PubMed - indexed for MEDLINE]

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Thirty two critically ill patients were admitted to Kenyatta National Hospital with a diagnosis of HIV-1 seropositivity on both ELISA and Western Blot between October 1989 and January 1990. Sixteen of the patients received low dose oral interferon alpha while the other 16 patients received intensive supportive management alone. Of the 16 patients who received low dose interferon alpha, 14 were discharged from the Hospital within 2 to 4 weeks of admission in a reasonable state of health while two of the patients died after 18 and 42 days from the time of admission. All the 16 patients who received intensive supportive management alone were dead within 4 weeks of entering the Hospital, their mean (+/- SD) stay after admission being 8.6 +/- 6.8 days. These results suggest that low dose oral interferon alpha may be of value in the care of critically ill HIV-1 seropositive patients.

No abstract available

In a six month period at the Kenyatta National Hospital, 46 patients (30 males) with chronic renal failure (CRF) and 22 healthy subjects have had a clinical and echocardiographic study of their cardiovascular systems. The patients with CRF were further classified as stable or in end stage renal disease (ESRD), the latter group requiring dialysis. Hypertension and circulatory congestion were the commonest clinical cardiovascular findings in patients with CRF. The patients with ESRD had significantly higher blood urea nitrogen and serum creatinine than the ones with stable CRF. Echocardiographically right ventricular size, left atrial size, aortic root diameter, left ventricular internal diameters, left ventricular end diastolic and systolic volumes, stroke volume, cardiac output, left ventricular posterior wall and interventricular septal thickness, ejection time and mitral and aortic peak flow rates were significantly higher in patients with CRF than in controls. In contrast, the circumferential fibre shortening and the ejection fraction were reduced in patients with CRF. Global left ventricular dysfunction was found in 47.8% of the patients. Using doppler flow studies, valvular incompetence was detected in a number of patients, mitral regurgitation being found in 84%.76% of the patients with CRF had varying degrees of pericardial effusion. The echocardiographic abnormalities and the pericardial effusions responded six weeks of haemodialysis in a variable manner.

No abstract available. PMID: 11957248 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

OBJECTIVE: To compare a topical quinolone antibiotic (ciprofloxacin) with a cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis media in children. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: A total of 427 children with chronic suppurative otitis media enrolled from 141 schools following screening of 39 841 schoolchildren in Kenya. Intervention Topical ciprofloxacin (n = 216) or boric acid in alcohol (n = 211); child-to-child treatment twice daily for 2 weeks. MAIN OUTCOME MEASURES: Resolution of discharge (at 2 weeks for primary outcome), healing of the tympanic membrane, and change in hearing threshold from baseline, all at 2 and 4 weeks. RESULTS: At 2 weeks, discharge was resolved in 123 of 207 (59%) children given ciprofloxacin, and in 65 of 204 (32%) given boric acid (relative risk 1.86; 95% CI 1.48-2.35; P < 0.0001). This effect was also significant at 4 weeks, and ciprofloxacin was associated with better hearing at both visits. No difference with respect to tympanic membrane healing was detected. There were significantly fewer adverse events of ear pain, irritation, and bleeding on mopping with ciprofloxacin than boric acid. CONCLUSIONS: Ciprofloxacin performed better than boric acid and alcohol for treating chronic suppurative otitis media in children in Kenya.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

This paper reviews clinicopathological and hematological manifestations of sickle cell anemia as seen in Kenyan children in the first decade of life. The information is based on a study of 447 patients. The findings are similar to those that are well documented from America, West Africa, and other parts of Africa. However, local variations and complications such as malnutrition and topical infections that may affect prognosis are high-lighted.

PMID: 6180653 [PubMed - indexed for MEDLINE]

Department of Medicine, College of Health Sciences, University of Nairobi. Characteristics of 14 patients above 12 years of age with congenital polycystic liver disease attending liver clinic at KNH were analysed. The diagnosis was mainly based on ultrasonographic findings. The disease was found predominantly among the Kikuyu ethnic group with a female/male ratio of 6:1 and the peak age at presentation was in the 5th decade. The liver function tests were essentially normal in all cases with no complication directly relating to liver disease. Hypertension was found in 78.6% of cases and chronic renal failure in 35.7% of cases. There was an associated polycystic disease in at least one other abdominal organ in all cases.

n/a

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

n/a

OBJECTIVE: To compare some socio-demographic and obstetric factors between adolescent mothers (aged below 20 years) and older mothers of low birthweight (birthweight < 2000 gm) babies. DESIGN: Cross sectional descriptive study. SETTING: The Newborn Unit of the Kenyatta National Hospital. RESULTS: Sixty nine adolescent mothers and 73 older mothers were studied. Adolescent mothers were more likely to be unmarried (p = 0.0001) have less formal education (p < 0.0001) be unemployed and be primigravida (76.5% compared to 36% of older mothers). Although the obstetric factors of antenatal clinic attendance, premature rupture of the membranes, pre-eclamptic toxaemia, infections and interventronal delivery tended to be more frequent among the adolescent mothers, non of these differences were significant probably due to the small numbers of patients studied. CONCLUSION: This study does suggest mothers of very low birthweight babies tend to have unfavourable socio-demographic and obstetric factors like being single parents having less formal education, being unemployed and having obstetric risks for poor pregnancy outcome.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

The fatigue crack growth (FCG) characteristics of a cast Al-Cu alloy A206 in the T7 temper condition were studied in laboratory air at a frequency of 30 Hz and an R-ratio of 0.2. Two different (as cast) thicknesses and two different casting conditions (casting with and without a chill) were investigated with the aim of characterizing the effect of porosity on the FCG behavior. The level of porosity in each sample was determined by the point-counting method and varied from 2.4 to 4.0% before hot isostatic pressing (HIP).<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

 

The study covered both near-threshold and mid-range regimes of FCG. The results indicate that for this limited range of porosity, there exists no systematic relationship between casting conditions (i.e., chilled or non-chilled) or the as-cast thickness and the average level of porosity. However, in the near-threshold regime, the FCG resistance decreased as the level of porosity increased, while in the mid-range of FCG, the FCG rate was fairly independent of the amount of porosity.

Application of HIP led to a reduction in the porosity level from about 4% to less than 0.4%, but this was accompanied by improvement in the FCG resistance only, close to the threshold. The results are rationalized in terms of the effect of porosity on the micro-mechanisms of fatigue crack growth and the initiation of secondary cracks caused by the size, distribution and morphology, of the pores.

No abstract available.

In 7 years (1981-1988) at the Kenyatta National Hospital (KNH), Nairobi the diagnosis of systemic lupus erythematosus (SLE) was made in 67 patients. In 23 of these patients lupus nephritis complicated the SLE. Lupus nephritis was diagnosed through renal biopsy, haematuria and proteinuria in urine with positive lupus erythematosus (LE) cell phenomenon. The histology found in these patients included 5 patients with minimal lesion, 7 patients with membranous, 3 with focal, 4 with diffuse, 3 with crescenteric and one with membranoproliferative glomerulonephritis. While patients with minimal, membranous and focal nephritis had general good outlook on low dose maintenance or intermittent high dose steroid therapy the others with diffuse, crescenteric and membranoproliferative nephritis had poor prognosis. Patients with diffuse proliferative, membranoproliferative and crescenteric nephritis tended to have septicaemia, pulmonary oedema, fluid overload and chronic renal failure with poor prognosis. These patients responded poorly to oral and parenteral steroid therapy whether high or low dose.

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

Forty seven patients with acute renal failure were studied prospectively over a two-year period at the Kenyatta National Hospital. There were 20 males and 27 females. The mortality rate was 40.4%. Most patients had medically oriented problems. Complications that were associated with a high mortality were infections and the presence of neuropsychiatric manifestations.

n/a

BACKGROUND: In the time of evidence based medicine the analysis of the influence of demographic parameters and different environmental factors on the treatment concepts in a country is often neglected. This is also true for Otorhinolaryngology. METHOD: An evaluation of the situation concerning distribution of physicians, diagnostic procedures and epidemiology in Kenya has been performed. These factors are discussed in consideration of their effect on the incidence of different diseases and their treatment under the specific socio-economic conditions for the otolaryngological situation in Kenya. RESULTS: In Kenya 28 otolaryngologists are registered that concentrate on few urban regions. Chronic otitis media, malignant tumors in the head and neck region and AIDS associated diseases have meanwhile increased dramatically. Numerous instruments and equipment for diagnosis are missing. Bigger equipment for CT scans are nearly exclusively used by private hospitals. PERSPECTIVE: Beside a better provision with different equipment for diagnosis it is especially the organization of certain training programmes where local physicians are further educated that may lead to an optimised medical care in Kenya.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

OBJECTIVE: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). DESIGN: Prospective cross-sectional study. SETTING: Inpatient medical and surgical wards of KNH. SUBJECTS: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. RESULTS: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c > 8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. CONCLUSION: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA.

n/a

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Department of Paediatrics, University of Nairobi, Kenya. Sodium and potassium levels were measured weekly in mothers' milk and in serum and urine of 41 supplemented and 25 unsupplemented very-low-birth-weight infants whose mean birth weights were 1390g and 1332g, respectively (mean gestational age, 31 weeks). Sodium intake was 5.95mmol/kg/day for the supplemented group and 2.75mmol/kg/day for controls. None of the infants in either group was hyponatremic during the 6-week period of study. Urinary sodium in the supplemented group was 15.7mmol/L as compared with 7.5mmol/L in controls. Human milk sodium was significantly lower than reported elsewhere. Growth in the supplemented group was greater than in the unsupplemented group. Since no episode of hyponatremia occurred, it was concluded that routine sodium supplementation was unnecessary.

G O Matete, J M Gathuma, G Muchemi, W Ogara, N Maingi, W Maritim* and B Moenga* Faculty of Veterinary Medicine, University of Nairobi P.O Box 29053, Nairobi, Kenyageorge.matete@gmail.com* Ministry of Livestock Development P.O Kabete 00625 Kangemi, Nairobi, Kenya   Abstract Livestock Identification and Traceability Systems (LITS) contribute to reduction, control or eliminated safety scares that result from transbounadry diseases outbreaks.  Recent studies on LITS in Kenya have been focused on testing  innovative technology, information and traceability system management, and examining the determinants for effective implementation. This paper analyzes the strengths and limitations of the operating a LITS institutional and organisational mechanisms in Kenya.   The result revealed that a disarticulated intitutional and organisational environment was the main constraint to effective implementation of LITS.  It proposes that for successful implemenation, a regional approach covering multiple countries, substantial private sector involvement and intensive stakeholder education are essential. Keywords: Institutional and organisational mechanisms, livestock identification, traceability  

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Extensive research in developed countries has established that very low birth weight (VLBW) infants are particularly vulnerable to the effects of early nutritional deficiencies. There is, however, little information from poor countries on the long-term effects of these deficiencies in such infants.

Determine the association between neonatal feeding regimens and post-discharge morbidity/ mortality and neurological abnormalities at the age of two years for a cohort of VLBW infants.

One hundred and seventy five VLBW infants were recruited over a consecutive period of one year and followed up to the age of two years corrected for gestation. With neonatal feeding regimes as the exposure variable, post-discharge re-hospitalization, mortality and Saigal and Rosenbaum's functional disability assessment scores were compared as the outcome variables.

The currently available evidence suggest that diuretics and/or low dose dopamine increases renal blood flow (RBF), glomerular filtration rate (GFR) and natriuresis in experimental animals, and limits ATP utilisation and oxygen needs in nephron segments at high risk of ischaemic injury, actions that could potentially limit renal injury and accelerate recovery in acute renal failure (ARF). These effects have indeed been confirmed in most experimental animals while using mannitol or low dose dopanime. Frusemide, however, for unknown reasons, has been effective in some animal models, but not others. In humans, it can be said that diurectics have a limited value to prevent, reverse or speed recovery from acute renal failure. Most clinical studies have failed to demonstrate convincingly that low dose dopamine either prevents ARF in high risk patients or improves renal function or outcome in patients with established ARF. This confusing scenario is further complicated by the fact that both diuretics and low dose dopamine can result in severe metabolic and cardiovascular complications in critically ill patients.

Danish Bilharziasis Laboratory, Charlottenlund. The association between Schistosoma mansoni infection and kidney lesions was investigated in school children selected from three primary schools in Machakos District, Kenya, namely Miu (n = 159), Kitengei (n = 160) and Misuuni (n = 99) schools. The children were examined parasitologically for S. mansoni infection, clinically for enlargement of the liver and spleen, and biochemically for proteinuria and serum and urine creatinine. High prevalences of S. mansoni infection, ranging from 84-96%, were seen in all the schools, but the geometric mean intensity of egg excretion varied, being relatively low in Misuuni (31 eggs/g), medium in Miu (182 eggs/g) and high in Kitengei (413 eggs/g). The prevalence of pathological proteinuria (> or = 200 mg/l) in the schools ranged from 10.1% in Miu to 28.8% in Kitengei. No difference in the levels of proteinuria was noted between age or sex groups. No association between intensity of infection and pathological proteinuria was observed in any of the schools, nor was any correlation between organomegaly and proteinuria observed. However, significant correlations between malaria and organomegaly (p < 0.001) and between malaria and proteinuria (p < 0.05) were observed when pooling data from all schools. These findings suggest that S. mansoni induced nephrotic syndromes are not common in children from this highly endemic area of Kenya.

n/a

n/a

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Oyieke H.A. and Misra A.K:

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Department of Psychiatry and Psychology, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA. swhaley@mednet.ucla.edu

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Raven's Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan children's cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed.

PMID: 14672297 [PubMed - indexed for MEDLINE]

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

PMID: 7249984 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Eighty-four consecutive black patients who had confirmed but untreated hypertension participated in a double-blind randomized clinical trial involving potassium supplement (64 mmol/day) versus bendrofluazide (10 mg/day). Diastolic blood pressure (DBP) of the 42 patients receiving potassium supplementation (group A) decreased from a mean (+/- SD) of 108 +/- 3 to 88 +/- 4 mm Hg (p less than 0.001; paired t test) after 28 weeks of medication. DBP of the 42 patients receiving bendrofluazide (group B) decreased from a mean of 108 +/- 2 to 84 +/- 4 mm Hg (p less than 0.001; paired t test). There was no statistically significant difference between the magnitude of decrease in DBP in group A and B patients (unpaired t test). No clinical, biochemical, or ECG abnormalities occurred in group A patients. Eight group B patients showed hyperuricemia; 4 patients in the same group had hyperglycemia and 3 other patients had hypokalemia. The results support the notion that potassium supplementation may be an effective therapeutic approach to mildly hypertensive blacks.

Department of Pediatrics, UCLA School of Medicine.

Sera of 95 mothers and 129 children from Nairobi, Kenya, collected in 1976, and of 466 adults and 193 children of Embu District, Kenya, collected in 1984 and 1985, were analyzed for the presence of human immunodeficiency virus type 1 (HIV-1) antibodies. Although no HIV-1 seropositivity was demonstrated by western blot analysis in both study groups, 7% of Nairobi mothers and 10% of adult females from Embu District had false positive results by enzyme immunoassay (EIA) compared with less than 1% seroreactivity rates observed in adult males and children. False positive results were not due to simian T lymphotropic virus type III (STLV-IIIAGM)/human T lymphotropic virus type IV (HTLV-IV) seropositivity. Sixty-one percent of the HIV-1 EIA reactive sera could not be explained by cytotoxic activity to lymphocytes bearing the HLA-DR4 or HLA-DQw3 phenotype. We conclude that false positive HIV EIA tests are frequently encountered in East Africa. Seroprevalence rates in rural Africa must be interpreted with caution due to the decreased specificity of HIV EIAs.

PMID: 2840237 [PubMed - indexed for MEDLINE]

Forty females, age 14 to 35 years (mean 28.6 years) with chronic renal failure (CRF) were included in the study. Their menstrual patterns were noted. The function of their hypothalamo-pituitary-ovarian axis was assessed by the serum levels of follicle stimulating hormone (FSH), Luteinising hormone (LH), prolactin (PrL), estradiol (E2) and progesterone (P) at different phases of the menstrual cycle in patients who continued to have normal menses (Group 1) and at weekly intervals for six weeks in patients with menstrual disturbances (Group II). The mean hormone levels during the initial contact Luteal phase in group I were FSH 12.0 IU/L (N, 1.0-3.0 IU/L), LH 1.8IU/L (N 1.5-101U/L), PrL 652mIU/L (N, 100-600 mIU/L) mE2 160 pmol/L (N 400-1400 pmol/L) and P5 nmol/L (N 14-60 nmol/L) for group I. Corresponding values for group II were 1.2, 10.3, 250, 600 and 3.0 in relevant units. All patients (fourteen) with end stage renal disease (ESRD) had amenorrhoae. On the other hand, most patients with stable CRF (22/26) had normal menses. Following initiation of therapy (conservative or dialytic), there was no significant alteration in the hormonal profile or menstrual pattern. We conclude that other factors apart from the hormonal imbalances, may be responsible for the menstrual disturbances noted in patients with CRF.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

An isocratic liquid chromatographic method with UV detection at 215 nm, which is suitable for the analysis of azithromycin (AZT) in bulk samples, is described. AZT is separated from its synthesis intermediates and a degradation product as well as from six unknown impurities on an XTerra RP18 column at 70 degrees C using a mobile phase consisting of acetonitrile-pH 6.5 0.2M K2HPO4-water (35:10:55, v/v/v) at 1.0 mL/min. The XTerra stationary phase contains methyl groups that are incorporated in the bulk structure of the material. This allows for special selectivities. Robustness is evaluated by a full factorial design experiment. The method shows good selectivity, repeatability, linearity, and sensitivity.

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

Pubertal growth and development were compared in 342 privileged, urban children and 347 impoverished rural adolescents from Kenya. Measurements of height, weight, upper arm circumference, and triceps skinfolds revealed marked differences between the two study groups just before the onset of sexual maturation. These differences were also found in the early stages of puberty but notable catch-up was evident throughout the later period of the maturational process. Early stages of sexual maturity were delayed by 3 yr in malnourished boys with a 2.1-yr lag in the age of onset of menarche in rural girls. Derived estimates of body fat as well as direct anthropometry revealed that the onset of puberty is not size related under the circumstances of chronic childhood malnutrition.

PMID: 7113957 [PubMed - indexed for MEDLINE]

In a fifteen month period (August 1987 to November 1988) forty patients requiring haemodialysis had 83 angioaccess procedures performed. Arteriovenous (AV) shunts and arteriovenous fistulae were the commonest procedures, comprising 56 (67%) and 20 (24%) of the patients respectively. Subclavian catheters and artificial grafts were used less frequently. Nephrologists and senior house officers attached to the Renal Unit were responsible for fashioning A-V shunts and inserting subclavian catheters while the A-V fistulae were fashioned by the urologists and vascular surgeons. The commonest complication of A-V shunts were clotting, occurring in 31 (55.4%) followed by bleeding in 14 (25%). Eight (32%) of the A-V fistulae never functioned from the beginning. It is noted that we are still very dependent on A-V shunts for vascular access in end stage renal disease (ESRF) patients and this is associated with an unacceptable level of complications. This dependency on A-V shunts in ESRD patients should be stopped or phased out. A-V fistulae should be used more frequently. Their constructions should be well thought out, executed and supervised by the few surgeons who are versed in them together with their follow-ups.

A case of fanconi's anemia was referred to the Dental School from the Department of Pediatrics. The patient was a 24-year-old male and a product of a consanguineous marriage. His chief complaint was loose and falling teeth, which has started at the age of 16 years. The first teeth to fall out were the first permanent molars followed by mandibular and maxillary anteriors. General examination showed that the patient was of normal intelligence and small for his age. He had no palmar plantar hyperkeratosis and was not diabetic. A total of 19 teeth remained in the mouth, most of them with grade three mobility. The remaining molars and first maxillary premolars had grade three furcation involvement. Most of the teeth had periodontal pockets more than 10 mm deep. Full mouth intraoral periapical radiographs and orthopantomographic views showed severe horizontal bone loss uncommensurate with the patient's age. In view of the patient's history and severe bone loss at an early age, the diagnosis was juvenile periodontitis associated with Fanconi's anemia.

n/a

KEMRI Centre for Geographic Medicine Research-Coast, P,O, Box 43640, Nairobi, Kenya. sekela_mwakyusa@yahoo.com BACKGROUND: The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR) for district hospitals as a means of improving documentation of illness. METHODS: The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI) diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163) and from a 60% random sample of dates after intervention (n = 705) were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR. RESULTS: The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months. CONCLUSION: The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines. PMID: 16857044 [PubMed] PMCID: PMC1555611

Naisho JN, Ongaya L, Musandu JO. PIP: In highlighting the role of traditional birth attendants (TBAs) in the implementation of primary health care (PHC) in Kenya, the following topics are discussed: characteristics of TBAs as reported in studies, the training program, program objectives, content, the training process, resources for training, the role of TBAs in PHC, and evaluation. The definition of midwife is given as midwives trained in a community setting to assist in delivery within the confines of accepted cultural beliefs. A study of 28 midwives from different regions in Kenya in 1980 found that most were illiterate women between 24 and 68 years olds received no monetary gain, had a variety of occupational backgrounds, and provided varying amounts of advice but little pre- or postnatal care. Almost all advised mothers to breast feed for at least 2 years. 80% of mother use TBAs for delivery. In order to minimize maternal (5-20/1000 live births on the average) and infant mortality, many countries have or are developing training programs for TBAs. Inadequacies in TBA care may be little prenatal care, too little postnatal care, and deficits in promoting child spacing; other unsafe practices may be improper washing of hands and severing the umbilical cord with unsterile objects. Other advantages of training TBAs involve less cost, less need for transportation, personalized setting in the home, source of health education in the community, and rapport with her clients. The training program goal is to reduce mortality by eliminating bad practices. The objectives are to reduce maternal deaths or illness from hemorrhage, infection, and toxemia; to encourage better nutrition; to reduce perineal or vaginal tears which may lead to longterm disability from urinary or rectal fistula; to reduce the number of pregnancies or exposure to risk; and to reduce neonatal tetanus asphyxia, infection, diarrhea, and malnutrition. Activities entail educating adolescent girls and pregnant women on menstruation and sexuality within cultural norms, prenatal care and delivery and postnatal care, maternal care, and educating mothers about personal hygiene, nutrition, child spacing, and immunization, and acknowledgement of the valuable service TBAs contribute to the community. Programs have operated for 10 years and evaluation is underway. PMID: 2630785 [PubMed - indexed for MEDLINE]

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

n/a

{ BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. DESIGN: Descriptive cross-sectional study. SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria. Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay. RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis. Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively. Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

No abstract available.

In 7 years (1981-1988) at the Kenyatta National Hospital (KNH), Nairobi the diagnosis of systemic lupus erythematosus (SLE) was made in 67 patients. In 23 of these patients lupus nephritis complicated the SLE. Lupus nephritis was diagnosed through renal biopsy, haematuria and proteinuria in urine with positive lupus erythematosus (LE) cell phenomenon. The histology found in these patients included 5 patients with minimal lesion, 7 patients with membranous, 3 with focal, 4 with diffuse, 3 with crescenteric and one with membranoproliferative glomerulonephritis. While patients with minimal, membranous and focal nephritis had general good outlook on low dose maintenance or intermittent high dose steroid therapy the others with diffuse, crescenteric and membranoproliferative nephritis had poor prognosis. Patients with diffuse proliferative, membranoproliferative and crescenteric nephritis tended to have septicaemia, pulmonary oedema, fluid overload and chronic renal failure with poor prognosis. These patients responded poorly to oral and parenteral steroid therapy whether high or low dose.

n/a

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

A possible role of aflatoxin B1 (AFB) in the etiology of human liver cancer has been suggested from several epidemiological studies. This has been based upon the association between consumption of AFB-contaminated food and the liver cancer incidence in different parts of the world. To further establish the role of AFB as a major factor, we initiated a pilot study in three different districts of Kenya to determine the number of individuals exposed to significant amounts of AFB as measured by the urinary excretion of 8,9-dihydro-8-(7-guanyl)-9-hydroxyaflatoxin B1 (AFB-Gua), an adduct formed between the ultimate carcinogenic form of AFB and nucleic acids. This product has previously been detected in urine from rats treated with AFB. Urine collected at the outpatient clinics at the district hospitals were concentrated on C18 Sep-Pak columns and analyzed by high-pressure liquid chromatography under two different chromatographic conditions. The chemical identity of the samples showing a positive response in both chromatographic systems was verified by synchronous scanning fluorescence spectrophotometry. The highest number of individuals with detectable urinary AFB-Gua lived in either Murang'a district or the neighboring Meru and Embu districts. In Murang'a district a rate of 12% was observed in the January-March period, while only 1 of 32 patients (3%) had a detectable exposure in July-August.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of an HIV positive man with multiple sexually acquired disease occurring concurrently is described. Risk behaviours that could have predisposed him to HIV infection are discussed. The factors which might have interacted to make the sexually acquired infections severe and difficult to treat are postulated.

PIP: The case of an HIV-seropositive man with gonorrhea, syphilis, genital warts, and chancroid is described. Multiple sexual partners, genital ulcer diseases, and lack of circumcision may have predisposed him to HIV infection. As indicated by his CD4/CD8 ratio of 0.5, his immunological status was not very compromised. Other factors were therefore probably behind these multiple sexually transmitted diseases (STD). This 30-year old man was inadequately treated for a long time for urethral discharge and genital ulcer disease, and ultimately collapsed on the job with a comprised central nervous system. Bacterial infection related to the multiple STDs could certainly have caused this collapse. The time demands of this man's work, the lack of medical facilities to diagnose and treat such conditions, his unprotected sexual behavior with multiple partners, and broader socioeconomic conditions which separate wage- earning males from their families in Africa conspire to produce multiply-afflicted cases such as these.

Fracture mechanics principles have been used to study the effects of welding on the rate of fatigue crack growth (FCG) in a low-carbon structural steel. The steel concerned is used widely in the fabrication of the structural frame-work of passenger buses. Tests were carried out on the base metal (BM), heat affected zone (HAZ) and weld metal (WM). Both the near threshold and midrange regimes of crack growth were studied. In the midrange regime, the FCG rate was highest in the HAZ and lowest in the WM. Near the threshold, the FCG rate was highest in the BM and lowest in the WM. The results are explained in terms of microstructural changes due to welding, welding residual stresses, and fracture mechanisms. Recommendations to reduce the incidence of fatigue cracking have been made.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

No abstract available

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

n/a

n/a

Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologies. Five-thousand-three-hundred-sixty-eight children from 57 randomly chosen primary schools in Kiambu district were examined. Simple otoscopy was performed by clinical officers with specialty training in ENT, and hering testing was performed by trained nurses, using a hand held field audiometer. Microbiological specimens were obtained from those children with CSOM. Five-point-six percent of the children had a hearing impairment of > 30 dB HL in one or both ears, with 2.2% having bilateral hearing impairment. Two-point-four percent had at least one perforated tympanic membrane, and 1.1% had CSOM. Eight-point-six percent of the children had wax obstructing the tympanic membrane. There is evidence of a relationship between hearing impairment and both CSOM and wax obstructing the tympanic membrane. The most common organisms found were Pseudomonas spp. (34%), Proteus spp. (34%) and Eschericia coli (19%). These results are comparable with other studies in Africa and indicate a considerable burden of ear disease in Kiambu district, Kenya.

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.

n/a

n/a

"

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Oyieke H.A. and Misra A.K:

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 20956-00202, Nairobi, Kenya. BACKGROUND: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs. OBJECTIVES: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them. DESIGN: Cross section survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy five neonatal survivors. RESULTS: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula. The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48 (28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15 g/kg/day while 70% and 78% grew in head circumference and length at < 0.5 cm/week respectively. At term weight, head and linear growth faultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P < 0.001) and absence of neonatal morbidity (P < 0.001). Infants who were appropriate for gestational age at birth also had better catch up growth at term compared to those born small for gestation (P < 0.001) but their neonatal growth itself was not significantly better. CONCLUSION: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns. RECOMMENDATIONS: Routine fortification of mother's milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth. PMID: 16771104 [PubMed - indexed for MEDLINE]

A 50-year-old female presented with a five months history of recurrent attacks of dizziness, sweatiness, tremors and fainting with loss of consciousness. These were found to be due to hypoglycaemic episodes with blood sugars less than 1 mmol/l and were treated as such. A diagnosis of insulinoma was initially considered, but the patient turned out to have fibrosarcoma of the lung, a rare lung tumour. She also had finger and toe clubbing and features of hypertrophic pulmonary osteoarthropathy.

Dept. of Human Pathol., Univ. of Nairobi, Kenya. PMID: 3180436 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

n/a

n/a

Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam, The Netherlands. The use of Chewing sticks (Miswaki) in the third world for control of dental plaque is very popular. Some of the studies that have been conducted on this subject have reported marked decrease in the incidences of dental caries and periodontal diseases in the users of Miswaki, when compared to the users of the conventional toothbrush living under similar conditions. Various mechanisms by which the Miswaki contributes to this phenomenon have been suggested. The purpose of the present study was to investigate in vitro, the anti-microbial action, the potential acid buffer capacity and fluoride content of crude aqueous extracts of eight commonly used chewing sticks from three regions in Kenya. The results obtained in the study, showed that one of the Miswaki had remarkable antibiotic activity against three stains of oral bacteria. Three of the Miswaki had significant acid buffer capacity. None of the eight Miswaki showed any significant fluoride release.

One hundred children comprising of 57 males and 43 females aged between 8 and 24 months entered the study. 46 children had single and 54 children had multiple helminth infections. All children received albendazole 200 mg (10 ml) suspension as a single dose. Albendazole proved very effective and safe in the treatment of single and multiple helminth infections in children under 2 years of age, achieving cure rates of 100% in both Ascaris lumbricoides and Necator americanus respectively, 83% in Trichuris trichiura and 66% in Hymenolepis nana. Treatment of polyparasitism appears to be of benefit in improving nutritional status using haemoglobin concentrations as an index.

PMID: 2591328 [PubMed - indexed for MEDLINE]

Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

In a fifteen month period (August 1987 to November 1988) forty patients requiring haemodialysis had 83 angioaccess procedures performed. Arteriovenous (AV) shunts and arteriovenous fistulae were the commonest procedures, comprising 56 (67%) and 20 (24%) of the patients respectively. Subclavian catheters and artificial grafts were used less frequently. Nephrologists and senior house officers attached to the Renal Unit were responsible for fashioning A-V shunts and inserting subclavian catheters while the A-V fistulae were fashioned by the urologists and vascular surgeons. The commonest complication of A-V shunts were clotting, occurring in 31 (55.4%) followed by bleeding in 14 (25%). Eight (32%) of the A-V fistulae never functioned from the beginning. It is noted that we are still very dependent on A-V shunts for vascular access in end stage renal disease (ESRF) patients and this is associated with an unacceptable level of complications. This dependency on A-V shunts in ESRD patients should be stopped or phased out. A-V fistulae should be used more frequently. Their constructions should be well thought out, executed and supervised by the few surgeons who are versed in them together with their follow-ups.

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

Despite the high frequency of sickle cell disease in Europe, the disease is poorly managed. Critical periods are the hospital stays during which the anaesthesiologist plays an important role. Understanding the molecular basis of polymerization processes of haemoglobin S can help to avoid triggering a crisis. Differentiation of the various haemoglobin phenotypes helps to estimate the individual perioperative risk. Knowledge of the patient's history and the actual haemoglobin S level facilitates general anaesthesia, surgery and postoperative care. Damage to liver, spleen, eyes, bones, lung and central nervous system increases the perioperative risk. Preoperative preparation includes early admission, intravenous volume substitution, continuing pain therapy and prophylactic antibiotic medication. General anaesthesia seems to be better for patients with a high-risk profile rather than regional anaesthesia. Careful perioperative and postoperative monitoring should allow hypoxaemia, hypovolaemia, hypothermia, acidosis and overtransfusion to be avoided. Effective pain therapy includes a combination of opioids with peripherally acting analgesia.

We present what we believe is the first case of pregnancy occurring in a patient on CAPD, and indeed end stage renal disease (ESRD), in Kenya. Pregnancy progressed very well until the thirtieth week when foetal movements and heart sounds were noted to be absent and this was confirmed by sonography. A macerated still birth was delivered per vagina following induction of labour. We review the literature on this rare occurrence and discuss the possible causes of the unpleasant outcome in our patient.

Extensive research in developed countries has established that very low birth weight (VLBW) infants are particularly vulnerable to the effects of early nutritional deficiencies. There is, however, little information from poor countries on the long-term effects of these deficiencies in such infants.

Determine the association between neonatal feeding regimens and post-discharge morbidity/ mortality and neurological abnormalities at the age of two years for a cohort of VLBW infants.

One hundred and seventy five VLBW infants were recruited over a consecutive period of one year and followed up to the age of two years corrected for gestation. With neonatal feeding regimes as the exposure variable, post-discharge re-hospitalization, mortality and Saigal and Rosenbaum's functional disability assessment scores were compared as the outcome variables.

Naisho JN, Ongaya L, Musandu JO. PIP: In highlighting the role of traditional birth attendants (TBAs) in the implementation of primary health care (PHC) in Kenya, the following topics are discussed: characteristics of TBAs as reported in studies, the training program, program objectives, content, the training process, resources for training, the role of TBAs in PHC, and evaluation. The definition of midwife is given as midwives trained in a community setting to assist in delivery within the confines of accepted cultural beliefs. A study of 28 midwives from different regions in Kenya in 1980 found that most were illiterate women between 24 and 68 years olds received no monetary gain, had a variety of occupational backgrounds, and provided varying amounts of advice but little pre- or postnatal care. Almost all advised mothers to breast feed for at least 2 years. 80% of mother use TBAs for delivery. In order to minimize maternal (5-20/1000 live births on the average) and infant mortality, many countries have or are developing training programs for TBAs. Inadequacies in TBA care may be little prenatal care, too little postnatal care, and deficits in promoting child spacing; other unsafe practices may be improper washing of hands and severing the umbilical cord with unsterile objects. Other advantages of training TBAs involve less cost, less need for transportation, personalized setting in the home, source of health education in the community, and rapport with her clients. The training program goal is to reduce mortality by eliminating bad practices. The objectives are to reduce maternal deaths or illness from hemorrhage, infection, and toxemia; to encourage better nutrition; to reduce perineal or vaginal tears which may lead to longterm disability from urinary or rectal fistula; to reduce the number of pregnancies or exposure to risk; and to reduce neonatal tetanus asphyxia, infection, diarrhea, and malnutrition. Activities entail educating adolescent girls and pregnant women on menstruation and sexuality within cultural norms, prenatal care and delivery and postnatal care, maternal care, and educating mothers about personal hygiene, nutrition, child spacing, and immunization, and acknowledgement of the valuable service TBAs contribute to the community. Programs have operated for 10 years and evaluation is underway. PMID: 2630785 [PubMed - indexed for MEDLINE]

Forty-eight black patients with mildly increased blood pressure (BP) that had not yet been subjected to treatment took part in a double-blind clinical trial of the efficacy and tolerability of oral potassium supplements (64 mmol daily) versus a matching placebo (made of starch with coating) in a 16-week study. Potassium supplements produced a significant decrease in mean supine and standing BP within 4 weeks after treatment inception. Urinary potassium excretion increased significantly in the 24 patients who received potassium supplements (p less than 0.001). No significant changes occurred in plasma sodium and potassium concentrations or in urinary excretion of sodium during the study. All patients completed the trial without experiencing any notable untoward effects. These results are consistent with the premise that oral potassium supplements may exert hypotensive effects of clinically significant degree in patients with mild hypertension.

n/a

n/a

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

The inaccessibility of commercial software has necessitated the development of low-cost, general-purpose finite element method (FEM) computer programs for structural analysis. Using the FEM program, the elastic, elastic-plastic, residual and service stresses and displacements in a closed ended, thick-walled cylinder under internal pressure were established. The displacement formulation was implemented and eight-noded brick isoparametric elements chosen. The frontal solution technique and the incremental theory of plasticity were used, as only limited computing facilities were available. The results were found to be in very good agreement with the through-thickness analytical values. The benefits of autofrettage were demonstrated and an optimum overstrain of 16% established for a cylinder with a thickness ratio of 2. The material economy achieved through autofrettage and the limitations imposed are illustrated. The FEM program could therefore be reliably used for other complex geometries and load conditions.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

No abstract available.

One hundred consecutive patients with diabetic ulcers were studied in an 8-month-period. There were 58 females. The mean age was 59.9 years. Eighty three patients had non-insulin dependent diabetes mellitus. The mean duration of diabetes mellitus was 11.6 years. The mean duration of the ulcer was 8.5 months. Sixty nine of the ulcers were gangrenous. Over 50% of the ulcers involved the big toes. Neuropathic ulcers were found mainly in the sole of the feet. Roentgenograms showed evidence of osteomyelitis in 44 patients. There were 356 bacterial isolates (340 aerobes and 16 anaerobes) from the ulcers. There were 3.6 infecting organisms per ulcer in gangrenous ulcers, while in neuropathic ulcers, there were 3.4 infecting organisms per ulcer. In both types of ulcer Staphylococcus aureus and Escherichia coli were the commonest infecting organisms each being isolated in 88 of the 100 ulcers studied. In repeat bacterial cultures at 4 weeks there were 116 bacterial isolates. Staphylococcus aureus persisted in 63 ulcers despite therapy, while Escherichia coli persisted in 35. There were no new organisms isolated at repeat cultures and no ulcer was completely sterile. The Staphylococcus aureus was 100% sensitive to Augmentin (Amoxicillin plus clavulinic acid), Clindamycin, Novobiocin, and Amikacin while the gram negative bacilli were sensitive to Cefotaxime, Piperacillin, Amikacin and augmentin, Clindamycin, Chloramphenicol and Lincomycin inhibited the growth of anaerobes to a varying degree.

n/a

KEMRI Centre for Geographic Medicine Research, PO Box 230, Kilifi, Kenya. menglish@wtnairobi.mimcom.net

BACKGROUND: The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya. METHODS: Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and data documenting the management and care of admitted children were obtained by specially trained health workers. FINDINGS: Data from 14 hospitals were surveyed with routine statistics showing considerable variation in inpatient paediatric mortality (range 4-15%) and specific case fatality rates (eg, anaemia 3-46%). The value of these routine data is seriously undermined by missing data, apparent avoidance of a diagnosis of HIV/AIDS, and absence of standard definitions. Case management practices are often not in line with national or international guidelines. For malaria, signs defining severity such as the level of consciousness and degree of respiratory distress are often not documented (range per hospital 0-100% and 9-77%, respectively), loading doses of quinine are rarely given (3% of cases) and dose errors are not uncommon. Resource constraints such as a lack of nutritional supplements for malnourished children also restrict the provision of basic, effective care. INTERPRETATION: Even crude performance measures suggest there is a great need to improve care and data quality, and to identify and tackle key health system constraints at the first referral level in Kenya. Appropriate intervention might lead to more effective use of health workers' efforts in such hospitals.

PMID: 15194254 [PubMed - indexed for MEDLINE]

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

Two major etiological agents, hepatitis B virus and aflatoxin B1, are considered to be involved in the induction of liver cancer in Africa. In order to elucidate any synergistic effect of these two agents we conducted a study in various parts of Kenya with different liver cancer incidence in order to establish the rate of exposure to aflatoxin and the prevalence of hepatitis infections. Of all tested individuals 12.6% were positive for aflatoxin exposure as indicated by the urinary excretion of aflatoxin B1-guanine. Assuming no annual and seasonal variation, a regional variation in the exposure was observed. The highest rate of aflatoxin exposure was found in the Western Highlands and Central Province. The incidence of hepatitis infection nationwide as measured by the presence of the surface antigens was 10.6%, but a wide regional variation was observed. A multiplicative and additive regression analysis to investigate if hepatitis and aflatoxin exposure had a synergetic effect in the induction of liver cancer was negative. However, a moderate degree of correlation between the exposure to aflatoxin and liver cancer was observed when the study was limited to certain ethnic groups. The study gives additional support to the hypothesis that aflatoxin is a human liver carcinogen.

Neurological manifestations of HIV/AIDS is reviewed and discussed. It is noted that neurological manifestations are some of the commonest modes of clinical presentation of HIV/AIDS. At autopsy, the prevalence approaches 100%. These manifestations include: involvement of the higher functions, craniopathies, spinal cord disease, peripheral neuropathy and muscle disease. It is therefore stressed that the central nervous system must be particularly assessed in patients with HIV/AIDS and where the clinician is not sure of the neurological diagnosis, a referral to the neurologist is recommended as some of these are treatable

No abstract available

We have reviewed the literature relating to the use of monoclonal antibodies in acute renal allograft rejection. More emphasis has been placed on Orthoclone OKT3 which has been more commonly used and summarise our experience with its use as rescue therapy in renal allograft rejection.

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

n/a

Nyambok, I.O.

BACKGROUND: The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. METHODS: We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. FINDINGS: By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. INTERPRETATION: Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries. PIP: 524 children aged 5-15 years with chronic suppurative otitis media (CSOM) were enrolled in a study to determine the effectiveness of different treatment regimens. The subjects were from 145 primary schools in Kenya's Kiambu district. 201 children received dry mopping treatment, 221 received dry mopping with topical and systemic antibiotics and topical steroids, and 102 received no treatment. Participating schools were matched on factors thought to be related to their socioeconomic status. 29 children were withdrawn from the trial for taking non-trial antibiotics, with no evidence observed of differences in the timing of withdrawals between the two groups. At 16 weeks of follow-up, otorrhoea had resolved in a weighted mean proportion of 51% of children who received dry mopping with antibiotics, 22% of children who received dry mopping alone, and 22% of untreated children. Similar differences were observed at 8 and 12 weeks of follow-up. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% in the dry-mopping plus antibiotics group, 13% in the dry-mopping alone group, and 13% in the control group. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times.

n/a

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Four hundred and three teenage secondary school students (50.6% males) from two girls' and two boys' Nairobi City Schools, selected by stratified sampling, were screened to determine the prevalence of proteinuria, haematuria, nitrituria and hypertension. Nine students (2.2%) had significant proteinuria while 14 (3.5%) had microscopic haematuria. Two students had combined proteinuria and haematuria. There was no statistically significant difference in the prevalence of proteinuria and/or haematuria between the sexes. Other urinary abnormalities detected were leucocyturia in 14(3.5%) and nitrites in four (1%). Leucocyturia was commonner in females (p = 0.001). Cloudy urinary appearance was significantly associated with the presence of leucocyturia (p = 0.0028) and proteinuria (p = 0.0276). Neither personal history of recurrent sore throat and skin infections nor family history of hypertension, diabetes mellitus or kidney disease was significantly associated with proteinuria or haematuria. Blood pressure tended to increase with age. Mean systolic and diastolic blood pressures were significantly higher in boys than girls in the age group 15-18 years (P < 0.001). Of the 397 students whose blood pressures were measured, four (1%) were found to be hypertensive. Weight and body mass index were strong positive correlates of blood pressure. The prevalence of proteinuria, haematuria, other urinary abnormalities and hypertension ranges between 1% and 3.5% among teenage secondary school children. The majority are asymptomatic and have no significant associations. It is recommended that routine urinalysis and blood pressure measurements should be part of the school health service so as to identify asymptomatic students who require close monitoring and/or intervention.

n/a

n/a