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

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Sixty two black patients who had confirmed but untreated hypertension participated in a double blind clinical trial of the efficacy and tolerability of slow-release oxprenolol in a daily dose of 160 mg initially and 320 mg subsequently versus chlorthalidone 50 mg daily. Thereafter, a combination of oxprenolol with chlorthalidone in an initial dose of 160 mg and 25 mg and a subsequent dose of 320 mg and 50 mg, respectively, was administered and the effects compared with those of the same drugs given singly. The trial lasted for 3 years, but each participant took active medication for 1 year. Oxprenolol as monotherapy had no effect on the blood pressure, irrespective of the dose. Chlorthalidone as monotherapy produced a significant fall in blood pressure (p less than 0.01). Combining the 2 drugs enhanced their blood pressure lowering effects (p less than 0.001). Oxprenolol as monotherapy and as part of combination therapy was well tolerated by all patients. Chlorthalidone as monotherapy was well tolerated by most patients while a fraction of the patients developed biochemical derangements. These results confirm the findings that a beta-blocker alone may be ineffective in lowering blood pressure in hypertensive blacks. The results also show that the efficacy and tolerability of a beta-blocker and a diuretic are enhanced by their combined administration. Finally, the results show that increasing the dose of a beta-blocker or a diuretic does not produce a further increase in its blood pressure lowering effect.

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.

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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.

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.

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.

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 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

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

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.

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" />

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.

Dept. of Human Pathol., Univ. of Nairobi, Kenya. PMID: 3180436 [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.

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No abstract available.PMID: 4345829 [PubMed - indexed for MEDLINE]

In a one year period (March 1990 to March 1991) the pattern of diseases in geriatric patients (over 60 years of age) admitted to the medical wards at Kenyatta National Hospital (KNH) was studied. In all, there were 1296 patients (M:F = 1.7:1) in this age group forming 11.5% of all admissions during the study period. 1008 (77.8%) of the geriatric patients were between 60 and 79 years of age. Most of the admissions (86.4%) were first admissions. The mean number of diseases per geriatric patient was 1.4. Hypertension and Cardiomyopathy were the commonest single diseases recorded, making up 43.9% of all diseases in this patient population. The commonest neurological diagnosis was stroke, which occurred in a setting of hypertension or cardiomyopathy in all the patients in whom it was diagnosed. The mean duration (+/- 2SD) of stay in the hospital in this patient population was 43 (+/- 19) days. Eighty eight (6.8%) of the patients died, the commonest cause of death being heart failure due to cardiomyopathy or hypertensive heart disease. It is concluded that geriatric patients form a sizeable proportion of our medical admissions and that a large proportion suffer from diseases of the cardiovascular system. It is thus recommended that further studies be carried out on the pattern of diseases in such patients and optimal management strategies for their ailments be outlined.

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.

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.

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In a 6 year period (1984-1989) we have had the opportunity to take care of five patients who had nephrotic syndrome and became pregnant. Four of them had mesangial proliferative glomerulonephritis while one had focal segmental glomerulosclerosis. Four of the pregnancies went to term while one was terminated at 34 weeks gestation because of deteriorating renal function in the mother. All the pregnancies ended in delivery of normal babies. However, two patients have since died of end stage renal disease, while the remaining three continue to be nephrotic with reduced levels of renal function following the deliveries.

Small hospitals sit at the apex of the pyramid of primary care in the health systems of many low-income countries. If the Millennium Development Goal for child survival is to be achieved, hospital care for referred severely ill children will need to be improved considerably in parallel with primary care in many countries. Yet little is known about how to achieve this. This article describes the evolution and final design of an intervention study that is attempting to improve hospital care for children in Kenyan district hospitals. It illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system, rather than an individual, level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question: does it work? Although there are increasing calls for more health systems research in low-income countries, the importance of strong, broadly based local partnerships and long-term commitment even to initiate projects is not always appreciated.

Department of Nutritional Biology, University of California, Davis, CA 95616, USA.

The high prevalence of vitamin B-12 deficiency in many regions of the world is becoming recognized as a widespread public health problem, but it is not known to what extent this deficiency results from a low intake of the vitamin or from its malabsorption from food. In rural Kenya, where a previous study identified a high prevalence of inadequate vitamin B-12 intakes, this study examined whether plasma vitamin B-12 concentrations were associated with dietary sources of the vitamin at baseline and could be increased by supplementation with animal source foods (ASF). The 4 experimental groups in 503 school children were: 1) control (no food provided); 2) githeri (a maize and bean staple with added oil); 3) githeri + meat (githeri + minced beef); or 4) githeri + milk (githeri + milk). Feedings were isocaloric. Dietary data were collected at baseline, and biochemical data at baseline and after 1 and 2 y of feeding. Baseline plasma vitamin B-12 concentration was 193.6 +/- 105.3 pmol/L and correlated with % energy from ASF (r = 0.308, P < 0.001). The odds ratio for low plasma vitamin B-12 (<148 pmol/L), which occurred in 40% of children, was 6.28 [95% CI: 3.07-12.82] for the lowest vs. highest ASF intake tertile (P < 0.001). Feeding ASF (meat or milk) greatly reduced the prevalence of low plasma vitamin B-12 (P < 0.001). The high prevalence of low plasma vitamin B-12 concentrations in these children is predicted by a low intake of ASF, and supplemental ASF improves vitamin B-12 status.

PMID: 17311959 [PubMed - indexed for MEDLINE]

Warenius LU, Faxelid EA, Chishimba PN, Musandu JO, Ong'any AA, Nissen EB.

Division of International Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. Linnea.Warenius@ki.se

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

PMID: 16713886 [PubMed - indexed for MEDLINE]

Sixty two black patients who had confirmed but untreated hypertension participated in a double blind clinical trial of the efficacy and tolerability of slow-release oxprenolol in a daily dose of 160 mg initially and 320 mg subsequently versus chlorthalidone 50 mg daily. Thereafter, a combination of oxprenolol with chlorthalidone in an initial dose of 160 mg and 25 mg and a subsequent dose of 320 mg and 50 mg, respectively, was administered and the effects compared with those of the same drugs given singly. The trial lasted for 3 years, but each participant took active medication for 1 year. Oxprenolol as monotherapy had no effect on the blood pressure, irrespective of the dose. Chlorthalidone as monotherapy produced a significant fall in blood pressure (p less than 0.01). Combining the 2 drugs enhanced their blood pressure lowering effects (p less than 0.001). Oxprenolol as monotherapy and as part of combination therapy was well tolerated by all patients. Chlorthalidone as monotherapy was well tolerated by most patients while a fraction of the patients developed biochemical derangements. These results confirm the findings that a beta-blocker alone may be ineffective in lowering blood pressure in hypertensive blacks. The results also show that the efficacy and tolerability of a beta-blocker and a diuretic are enhanced by their combined administration. Finally, the results show that increasing the dose of a beta-blocker or a diuretic does not produce a further increase in its blood pressure lowering effect.

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School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. paul.mcneill@unsw.edu.au

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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.

We aimed to investigate provision of paediatric care in government district hospitals in Kenya. We surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, and resources and the views of hospital staff and caretakers of admitted children. Paediatric admission rates varied almost ten-fold. Basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, although these might be charged for on discharge. In at least 11 hospitals, antistaphylococcal drugs, appropriate treatment for malnutrition, newborn feeds, and measurement of bilirubin were rarely or never available. Staff highlighted infrastructure and human and consumable resources as problems. However, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common. The capacity of the district hospital in Kenya needs strengthening by comprehensive policies that address real needs if current or new interventions and services at this level of care are to enhance child survival.

Department of Public Health, University of California, Los Angeles 90024-1772.

Because medical illness is associated with malnutrition, it might contribute to the poor outcomes seen in malnourished children. This study explored relations between frequency of mild illness and development in 133 mild-to-moderately malnourished school-age Kenyan children. Morbidity information was collected for one year. Concurrent assessments of cognitive status and playground behaviors were obtained. Nutritional and environmental variables were also assessed. Girls with more reported days of mild illness performed less well on developmental measures than did their healthier female peers. They were less cognitively advanced, and, on the playground, girls with more mild illness were less active, happy, and social. Furthermore, relations between frequency of mild illness and playground behaviors (but not cognitive score) in the girls remained statistically significant when other variables, such as socioeconomic status, parental literacy, food intake, and anthropometry, were considered. For the boys, frequency of mild illness was not related to cognition or play behaviors.

PMID: 1469106 [PubMed - indexed for MEDLINE]

Asiatic acid (AA) is a pentacyclic triterpene found in Centella asiatica. In the present study, the mechanism of anticancer effect of AA on skin cancer was investigated. AA decreased viability and induced apoptosis in human melanoma SK-MEL-2 cells in a time- and dose-dependent manner. AA also markedly increased intracellular reactive oxygen species (ROS) level and enhanced the expression of Bax but not Bcl-2 protein in the cells. In addition, AA-induced activation of caspase-3 activity in a dose-dependent manner. Pretreatment with Trolox, an antioxidant, significantly blocked the induction of Bax and activation of caspase-3 in AA-treated cells. Furthermore, Ac-DEVD-CHO, a specific caspase-3 inhibitor, and Trolox prevented the AA-induced apoptosis. AA did not elevate p53 nuclear protein levels that are present in a mutant form in SK-MEL-2 cells. These results suggest that AA-induced apoptosis may be mediated through generation of ROS, alteration of Bax/Bcl-2 ratio and activation of caspase-3, but p53-independent. These results further suggest that AA may be a good candidate for the therapeutic intervention of human skin cancer.

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.

Department of Paediatrics, University of Nairobi. To determine whether the "Baby Cloche" heat shield improves temperature control in low birth-weight infants we compared serial temperatures in 11 preterm infants nursed with or without the Cloche. Mean birth weights were 1490 and 1510 gm, mean weights at time of study 1680 and 1710 gm and mean postnatal age 20 and 27 days for study and control infants respectively. Serial measurements of rectal, abdominal skin, dorsum of the foot, Cloche wall and room temperature were recorded once or twice daily for 2 to 5 days. Mean rectal temperatures increased with increasing age from 35.3 in the first week of life to 37.0 degrees C by the third week (P less than 0.001). In infants nursed under the Cloche who were over 2 weeks of age mean rectal, abdominal and foot temperatures were 0.5, 0.6 and 1.6 degrees C higher (P less than 0.001); in younger infants there was no significant difference in any of the temperatures. Our findings suggest that the "Baby Cloche" improves temperature control in preterm infants over 1600 gm who are more than 2 weeks of age. PMID: 1628548 [PubMed - indexed for MEDLINE]

The relative bioavailabilities of three carbamazepine tablet formulations available in the Kenyan market (Temporal(R), Taver(R) and Carbamazepine Lincoln) compared with the innovator formulation (Tegretol(R)) were evaluated in seven healthy African volunteers (5 males, two females; aged 22-36 years), according to a randomised fourway crossover study design, following oral administration of single 200 mg doses with a three week washout period. In vitro dissolution profiles of the tablets were also evaluated. Relative bioavailabilities ((F)rel) of Temporal(R), Taver(R) and Carbamazepine Linocoln were 101.2%, 82.2% and 71.6% respectively, compared with Tegretol(R). Percent drug content dissolved in vitro after I hour were 91.3%, 75.9% and 39.3% for Temporal(R), Taver(R) and Carbamazepine Lincoln, respectively. It was concluded that Temporal(R) was bioequivalent to Tegretol(R) while Taver(R) and Carbamazepin Lincoln were bioinequivalent to Tegretol(R). Administration of Taver(R) or Carbamazepine Lincoln might lead to poor control of epileptic seizures.

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One hundred and ninety nine symptomatic and 5 asymptomatic patients seropositive for the human immunodeficiency virus type 1 (HIV-1) were treated with KEMRON, a natural human interferon alpha (nHIF alpha) stabilized in a complex polysacchariche carrier. Treatment was given for at least 10 weeks at a daily oral dose of approximately 2.0 IU of nHIF alpha per kg body weight. Karnofsky performance score increased from an average of 60.5 on entry into the study to 100 by the 10th week after treatment. Similarly, common clinical complaints associated with HIV-1 infection rapidly reduced per patient from an average of 3.8 to 0.05 and 0 by week 8 and 10 of treatment. Eighteen of the patients serodeconverted by both ELISA and western blot assays during the study period. These observations suggest that KEMRON used as recommended is beneficial in HIV-1 seropositive individuals.

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.

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Wycliffe Omanya, Development Communication Consultant womanya@gmail.com & Dr. William O. Ogara, College of Agriculture and Veterinary Sciences, University of Nairobi wogara@uonbi.ac.ke Abstract:   This paper seeks to explore tacit knowledge in the light of knowledge transfer. Specifically it looks at the technique of mentoring as a process through which this highly personalized knowledge can be replicated in any organisation. It also introduces knowledge acquisition process as innate and broadly presents various existing models of tacit knowledge transfer. In addition, it explores the significance of mentoring to all key actors in the process of knowledge transfer while also providing some case scenarios in which this strategy has been successfully used to ensure competitive advantage based on developed long standing knowledge.   Key words: Knowledge management, Tacit Knowledge, explicit knowledge, knowledge transfer, mentoring, transfer models.

Nyambok, I.O.

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.

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.

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.

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.

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A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

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.

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.

Oyieke H.A. and Misra A.K:

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.

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.

Renal function in five patients who were on a combination of Cyclosporin A (CyA) and Prednisone for 2-6 years following renal transplantation, were evaluated, in order to consider change from CyA-prednisone combination to conventional therapy. (Azathioprine-prednisone combination). This was necessitated by CyA nephrotoxicity, its high cost and unreliable monitoring. The maintenance dose of CyA ranged between 200 and 400 mg per day. The BUN levels during CyA treatment ranged from 6 to 15 mmol/l (normal 3.7-6.7 mmol/l), and plasma creatinine from 200 to 300 Umol/l (normal 67-107 Umol/l). The serum electrolytes were normal. The urine outputs were normal. Rejections were treated by pulses of one gram of methyl-prednisolone daily for 3 days. Maintenance prednisolone ranged from 10-15 mg per day. After tapering off the CyA and eventually stopping it, Azathioprine 100-150 mg daily with prednisolone 10-15 mg per day were instituted. There were significant drops in creatinine and BUN levels after the change over, with general well being and good urinary outputs. The patients refused consent for renal biopsy to prove CyA histologic toxicity.

Autonomic nervous function was assessed in twenty two patients (16 males and 6 females) with chronic renal failure on conservative management. The presenting symptoms were postural dizziness in 10(45%), impotence in 4(18%) patients and 1 patient each with diplopia, urinary urgency and nocturnal diarrhoea. The following autonomic function tests were performed; valsalva manoeuvre, heart rate response to deep breathing, heart rate response to posture and postural change in blood pressure. Fifteen (68%) patients had abnormal autonomic function tests. Out of these patients, 14(93%) had abnormalities of the parasympathetic system and only one had abnormalities in the sympathetic system. There was a negative correlation between the creatinine levels and the following; valsalva ratio (r = -0.72 p < 0.001), heart rate response to standing (r = -0.56 p < 0.01) and heart rate response to deep breathing (r = -0.45 p < 0.05).

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.

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.

No abstract available. PMID: 163952 [PubMed - indexed for MEDLINE]

In a one year period (March 1990 to March 1991) the pattern of diseases in geriatric patients (over 60 years of age) admitted to the medical wards at Kenyatta National Hospital (KNH) was studied. In all, there were 1296 patients (M:F = 1.7:1) in this age group forming 11.5% of all admissions during the study period. 1008 (77.8%) of the geriatric patients were between 60 and 79 years of age. Most of the admissions (86.4%) were first admissions. The mean number of diseases per geriatric patient was 1.4. Hypertension and Cardiomyopathy were the commonest single diseases recorded, making up 43.9% of all diseases in this patient population. The commonest neurological diagnosis was stroke, which occurred in a setting of hypertension or cardiomyopathy in all the patients in whom it was diagnosed. The mean duration (+/- 2SD) of stay in the hospital in this patient population was 43 (+/- 19) days. Eighty eight (6.8%) of the patients died, the commonest cause of death being heart failure due to cardiomyopathy or hypertensive heart disease. It is concluded that geriatric patients form a sizeable proportion of our medical admissions and that a large proportion suffer from diseases of the cardiovascular system. It is thus recommended that further studies be carried out on the pattern of diseases in such patients and optimal management strategies for their ailments be outlined.

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.

A double antibody enzyme linked immunosorbent assay for identification of thermostable muscle antigens of autoclaved meat samples is described. The assay differentiates heterologous thermostable muscle antigens from homologous at P 0.001. In model meat mixtures, the assay detects adulterants at the level of 1% at p0.001 even in phylogenetically related species such as buffalo and cattle.

Persistent microcytosis was noted among a number of post renal transplant patients attending the transplant clinic at the Western General Hospital Edinburgh. We retrospectively looked at the pattern of recovery of the anaemia of chronic renal failure following successful renal transplantation with good graft function (Creatinine less than 250 (mol/l). Comparisons were made between those patients with persistent microcytosis and those with normal mean cell volume (MCV). Patients with microcytosis tended to have a slower recovery compared to those with normal MCV especially from week 12 to 21 after transplantation with corresponding Hb changes of 108+ 20 to 126+/-20 g/l vs 128+ 17 to 144+/-19 g/l ([P < 0.05], 95% confidence limits). The microcytic groups also tended to have had poorer graft function with serum creatinines significantly higher than those with normal MCV from week 8 to 21, 182+/- 62 to 173+/- 51 (mol/1 vs 139+/- 40 to 149+/- 38 (mo1/L ([P < 0.05] 95% confidence limits). In both groups haemoglobin concentration was negatively correlated to serum creatinine. (r=-0.54, [P < 0.05]). Body iron status studies had not been done in these patients. Persistent microcytosis though a non sensitive marker of iron deficiency may be a marker of disordered iron metabolism in patients with poorer graft functions.

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Acute renal failure (ARF) complicated the use of traditional herbal remedies in six adult patients seen at Kenyatta National Hospital in a 2-year period (August 1984 to August 1986). This comprised 10.9% of all the cases of ARF and 24% of the cases of ARF due to medical causes. All the patients were oliguric and the period of oliguria in the four patients who survived ranged between 19-57 days (mean 26.3 days). Five of the patients had evidence of fluid overload. The blood urea nitrogen and serum creatinine were elevated in all the patients. The serum sodium was normal in all, while the serum potassium was elevated in 2 cases. Identity of the herbal medication was unknown in all the cases. The indication was abdominal pain in 4 cases, infertility and abdominal pain in one and prophylaxis against witchcraft in the other. All the patients were started on haemodialysis, two of them having had periods of peritoneal dialysis for 12 and 16 days. Two patients died. Of the four surviving patients, follow up has been carried out for 8, 6, 5 and 4 months. At four months follow up the creatinine clearance in the 4 surviving patients have been 54, 63, 51 and 43 ml/min.

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.

Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA 90095, USA. cneumann@mednet.ucla.edu

A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githeri as a midmorning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milk and Control groups (P < 0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat- vs. milk- vs. plant-based snacks on functional outcomes in children.

PMID: 17374691 [PubMed - indexed for MEDLINE]

Warenius LU, Faxelid EA, Chishimba PN, Musandu JO, Ong'any AA, Nissen EB.

Division of International Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. Linnea.Warenius@ki.se

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

PMID: 16713886 [PubMed - indexed for MEDLINE]

One hundred and ninety nine symptomatic and 5 asymptomatic patients seropositive for the human immunodeficiency virus type 1 (HIV-1) were treated with KEMRON, a natural human interferon alpha (nHIF alpha) stabilized in a complex polysacchariche carrier. Treatment was given for at least 10 weeks at a daily oral dose of approximately 2.0 IU of nHIF alpha per kg body weight. Karnofsky performance score increased from an average of 60.5 on entry into the study to 100 by the 10th week after treatment. Similarly, common clinical complaints associated with HIV-1 infection rapidly reduced per patient from an average of 3.8 to 0.05 and 0 by week 8 and 10 of treatment. Eighteen of the patients serodeconverted by both ELISA and western blot assays during the study period. These observations suggest that KEMRON used as recommended is beneficial in HIV-1 seropositive individuals.

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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

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This paper presents the findings of a study that explored the use of Monte Carlo simulation method to optimally manage inventory in the water equipment industry. The study treated both demand and lead time as stochastic. It proposes an inventory model that will minimize the total inventory costs through simulation analysis while demonstrating how simulation technique can be effectively used to solve inventory management problems

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.

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]

JG Kamau1, WO Ogara1, JJ McDermott2, PM Kitala*   1 Department of Public Health, Pharmacology and Toxicology, University of Nairobi, PO Box 29053 00625, Nairobi, Kenya 2 International Livestock Research Institute (ILRI), PO Box 30709, Nairobi, Kenya * Corresponding Author   Summary   We investigate the possibility of cross-infection by rabies between domestic animals and wild mammalian carnivores at a wild-domestic animal interface. The area was known to have a domestic-dog rabies but the involvement of wildlife was unknown. Four sublocations within a transect of approximately 20 km along the Nairobi-Mombasa highway were selected as the study area. A total of 202 households within the area were randomly selected and visited to collect information on wildlife abundance and habits, and for wild-life-domestic dog interactions. Forty of the 202 households were randomly selected for wildlife trapping. An eight-month long community-and road-kill-based rabies surveillance was implemented in the 4 sublocations. The white-tailed mongoose (Ischeumia albicauda), the genet cat (Genetta genetta), the common mongoose (Herpestes spp), the civet cat (Viverra civetta) and the bush squirrel (Paraxerus spp), were identified as the most prevalent species of wildlife in the area. Seventy-one percent (143/202) of the households reported having heard or witnessed their dogs fighting with unspecified wild animal species. White-tailed mongooses (11) and genet cats (11) were the species of wild carnivores trapped within the precincts of the households. The domestic dog accounted for 91% (20/22) of the rabies positive animal brain specimens collected in the community-based rabies surveillance. Only 6.2% (5/81) of the specimens from road-kills were positive for rabies including a domestic cat, a goat, a common mongoose (Herpestes spp), a genet cat, and an unidentified wildlife species.   This study has revealed that small wild carnivores are frequent in Kibwezi and interact with dogs. Dogs are currently the main species for transmission of rabies but there is some rabies in wildlife. The potential for wildlife to act as a reservoir for rabies as in other areas where dog rabies has been controlled needs further investigation.   Keywords: Rabies; Surveillance; Community-based; road-kills; 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.

Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.

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From July 1989 to February 1990, 17 non-pregnant patients with severe falciparum malaria, aged 14 years and above received an initial intravenous quinine dihydrochloride loading dose of 20 mg/kg in 500 mls of normal saline or 5% dextrose infused over 4 hours followed by 100mg/kg infused 8 hourly for at least 24 hours. Sixteen comparable controls were similarly treated but without an initial loading dose. Oral quinine bisulfate 10mg/kg 8 hourly was substituted for a total of 7 days when patients were well enough. There was no significant difference in clinical and parasitological response between the two groups. Fever clearance time in hours was 44.00 +/- 13.92 (mean +/- SD) in the study group and 51.43 +/- 19.63 (mean +/- SD) in the control group (p > 0.05). Parasite clearance time in hours was 42.40 +/- 9.75 (mean +/- SD) in the study group and 47.05 +/- 7.69 (mean +/- SD) in the control group (p > 0.05). One patient from each group died. Mild toxic effects were common in both groups. Transient partial hearing loss occurred significantly more in the study than control group (p < 0.05). Hypoglycaemia during treatment occurred in 3 (18%) patients in the study group and 1 (6%) in the control group. The mean trough and peak plasma quinine levels in 3 patients per group was persistently higher than 9mg/L after first infusion. We conclude that though fairly well tolerated, quinine loading dose appears to have no advantage over the standard treatment for severe falciparum malaria at Kenyatta National Hospital, Nairobi, Kenya.

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]

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.

A clinical, radiological, histological, and geographical study of carcinoma of the esophagus in Kenya is reported. It was found that this cancer is diagnosed more often in males than in females, with a ration of 8:1 (Kenya Cancer Registry). The most common age in males and females is 50 to 59 years. The regions of the esophagus most commonly involved are the middle and lower thirds, in almost equal proportions. An unexplained tendency for the tumor to be poorly differentiated towards the lower third is noted. In addition a review on the possible etiological factors is presented.

Nyambok, I.O.

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.

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.

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.

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.

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.

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A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

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.

In a previous paper (Ref. 1), details were presented of a theoretical model describing the evolution of the hardness profiles in the heat-affected zones (HAZ) of AI-Li-X weldments. The intent of the model was to qualitatively predict the general shape of such a profile, which indicates points of double inflection. In the present paper, experimental results are presented to validate the model. Panels of AI-Li-Cu Alloy 2095 in the peak aged (T8) condition were welded by the gas tungsten arc (GTA) process using AA 2319 filler metal. Conventional transmission electron microscopy (TEM) studies were conducted on specimens taken from specific points across the HAZ to estimate the relative ratios of T₁, (AI₂CuLi) and _d' (AI₃Li) precipitates, as well as incoherent grain boundary phases. Electron probe microanalysis (EPMA) was used to determine the variation of concentrations of elements across the HAZ, while the hardness profile was determined using Vickers micro-hardness measurements. The hardness profile and the associated pattern of phases present agree well with the information predicted qualitatively by the previously described model.<?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.

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:

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.

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 Clinical Chemistry, Kenyatta National Hospital, Nairobi, Kenya. Analysis of eleven biochemical laboratory tests was done during an International External Quality Assessment Scheme (IEQAS) in which the clinical chemistry laboratory at Kenyatta National Hospital participated. Technicon SMA II continuous flow system was used in the biochemical analyses apart from glucose which was assayed manually by the glucose oxidase method. Using the standard deviation index (SDI), twenty six percent of the results were found to be outside the two standard deviation (2SD) limit. However, when variance index score (VIS) was used, 42% of the results were found to be outliers. Overall, our laboratory performed poorly compared to other laboratories in both the IEQAS and the United Kingdom External Quality Assurance Scheme (UKEQAS). This poor performance is attributed to the use of improper equipment which is not regularly maintained, lack of diagnostic reagents, lack of quality control (QC) materials and inadequate staff training in the field of quality control.

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.

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.

PMID: 679868 [PubMed - indexed for MEDLINE]

Kenya is ranked among the top ten largest economies in Africa and bearing the tag
of middle income. This tag should motivate the country to have food security but
this does not seem to be the case as many small farmers, who are the backbone of
the economy, are not adding value to their agricultural produce. Adding value is an
entrepreneurial process that creates wealth for both the farmers and the country.
This study investigated the factors that influence value addition on small farms in
Kenya. The study employed a cross-sectional survey design and a multi-stage
sampling technique where 15 locations from Kiambu and Murang’a counties were
identified. 388 farms were selected by line transect technique for this study.
Descriptive statistics was used to estimate the extent of value addition in agribusinesses
on small farms. Linear Probability Model (LPM), Logit, and Probit
models were used to estimate the determinants of value addition on the small farms.
The study reveals that kenya’s agrarian economy is suffering from limited value
addition as the statistics show that 6% of small farmers add value to their
agricultural produce. It was discovered that farm sizes are negatively correlated with
value addition. The distance to the market and accessibility to loan facilities were
found to be the major determinants of value addition in Kenya. The study
recommended that the government should create rural markets for the farmers and
facilitate financial institutions to lend money to small farmers at reasonable interest
rates. Small and Micro Enterprises should be encouraged to play an active role of
value addition in the agri-businesses of the Kenyan middle-income economy.

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.

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.

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.

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No abstract available. PMID: 11957248 [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.

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.

With the exception of iodine and Fe, there is still very limited information on the effect of micronutrients on cognitive function, especially among school-age children. The present analysis evaluates the relationship between dietary Fe, Zn and B vitamins (B12, B6, folate and riboflavin) and gains in cognitive test scores among school children in rural Kenya. Data for the present study were obtained from The Child Nutrition Kenya Project, a 2-year longitudinal, randomised controlled feeding intervention study using animal source foods. Dietary nutrient values were based on monthly and bimonthly 24 h recall data collected during the study period. In longitudinal regression analyses, available Fe, available Zn, vitamin B12 and riboflavin showed significant relationships with improved cognitive test scores, after controlling for confounders such as energy intake, school, socio-economic status and morbidity. Available Fe intake was associated with significantly higher gains in Raven's Coloured Progressive Matrices test scores over time. Available Zn intake was associated with significantly higher gains in digit span-total test scores over time, while vitamin B12 and riboflavin intakes were each associated with significantly higher gains in digit span-forward test scores over time. This analysis demonstrates the influence of improved dietary micronutrient status on school children's cognitive function.

To explore structure and process factors which influence patients' perception of quality inpatient psychiatric nursing care at Mathari hospital. This was a cross-sectional study of 236 inpatients selected by stratified random sampling. Competence to give consent was determined by a minimum score of 24 on Mini Mental State Examination. Patients were interviewed using a semi-structured questionnaire. Differences in proportions of variables were determined by calculating confidence interval and summary chi-squared statistics. P-values of < or =0.05 were considered significant. Majority of patients (87%) were aged 20-49 years with 43% having stayed in the ward for over a month. Structure factors related to patients' perception of care included physical environment, being happy with the way the ward looked was significantly related to satisfaction with care (chi(2) = 5.506, P = 0002). Process factors significantly related to patients' satisfaction with care included nurses providing patients with information on prescribed medicines (chi(2) = 10.50, P = 00012). Satisfaction with care was positively related to ability to recommend someone for admission in the same ward (chi(2) = 20.2, P = 00001). Structure and process factors identified as influencing patients' perception of care were physical environment and nurses' qualities that fit within the characteristics of Peplau's Interpersonal Relations Theory.

From July 1989 to February 1990, 17 non-pregnant patients with severe falciparum malaria, aged 14 years and above received an initial intravenous quinine dihydrochloride loading dose of 20 mg/kg in 500 mls of normal saline or 5% dextrose infused over 4 hours followed by 100mg/kg infused 8 hourly for at least 24 hours. Sixteen comparable controls were similarly treated but without an initial loading dose. Oral quinine bisulfate 10mg/kg 8 hourly was substituted for a total of 7 days when patients were well enough. There was no significant difference in clinical and parasitological response between the two groups. Fever clearance time in hours was 44.00 +/- 13.92 (mean +/- SD) in the study group and 51.43 +/- 19.63 (mean +/- SD) in the control group (p > 0.05). Parasite clearance time in hours was 42.40 +/- 9.75 (mean +/- SD) in the study group and 47.05 +/- 7.69 (mean +/- SD) in the control group (p > 0.05). One patient from each group died. Mild toxic effects were common in both groups. Transient partial hearing loss occurred significantly more in the study than control group (p < 0.05). Hypoglycaemia during treatment occurred in 3 (18%) patients in the study group and 1 (6%) in the control group. The mean trough and peak plasma quinine levels in 3 patients per group was persistently higher than 9mg/L after first infusion. We conclude that though fairly well tolerated, quinine loading dose appears to have no advantage over the standard treatment for severe falciparum malaria at Kenyatta National Hospital, Nairobi, Kenya.

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{ BACKGROUND: Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99% of deaths in developing countries. Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income settings is often outdated. Our aim was to determine if a simple one day newborn resuscitation training (NRT) alters health worker resuscitation practices in a public hospital setting in Kenya. METHODS/PRINCIPAL FINDINGS: We conducted a randomised, controlled trial with health workers receiving early training with NRT (n = 28) or late training (the control group

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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.

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]

Wycliffe Omanya, Development Communication Consultant womanya@gmail.com & Dr. William O. Ogara, College of Agriculture and Veterinary Sciences, University of Nairobi wogara@uonbi.ac.ke Abstract:   This paper seeks to explore tacit knowledge in the light of knowledge transfer. Specifically it looks at the technique of mentoring as a process through which this highly personalized knowledge can be replicated in any organisation. It also introduces knowledge acquisition process as innate and broadly presents various existing models of tacit knowledge transfer. In addition, it explores the significance of mentoring to all key actors in the process of knowledge transfer while also providing some case scenarios in which this strategy has been successfully used to ensure competitive advantage based on developed long standing knowledge.   Key words: Knowledge management, Tacit Knowledge, explicit knowledge, knowledge transfer, mentoring, transfer models.

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.

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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.

Khat is the Celastraceus edulis plant, a flowering evergreen tree or large shrub, which grows in the Horn of Africa and southwestern Arabia. Khat use has been associated with development of oral cancer, but its molecular effects remain controversial. This study describes a novel cytotoxic effect of whole khat extract on three leukemia cell lines. Cells were exposed to khat extract and harvested for analysis by fluorescent and electron microscopy, trypan blue exclusion, as well as immunoblotting to characterize the mode of cell death. In a separate series, cells were pretreated with a panel of caspase inhibitors for possible inhibitory effects. Khat induced a rapid cell death effect in HL-60, Jurkat, and NB4 cells that occurred within 2 h of exposure. The treated cells retained their ability to exclude trypan blue dye, a key feature in the apoptotic process. Exposed cells consistently developed morphological features of manifest apoptosis. Z-VAD, a pan-caspase inhibitor, completely inhibited toxic activity for up to 8 h, with partial inhibition by other caspase-specific agents. Western blot analysis showed specific cleavage of caspase-3 in khat-exposed cells. This study shows that khat induces cell death by apoptosis in a process sensitive to inhibition by caspase inhibitors, suggesting that subcellular interactions could be of particular relevance for the biological effects of khat in the cell death process and possibly carcinogenesis

Fusarium head blight is a disease of small grain cereals that reduces yield and
causes mycotoxin contamination. The role of agronomic practices on the occurrence of
wheat agronomic practices was studied. In the experiment, a survey to determine wheat
production practices was conducted in four agro-ecological zones in 2013 cropping season.
Fusarium head blight incidence and severity was determined in four 1m2 quadrants by
counting infected heads and the proportion of diseased head respectively. Fungal

The anatomic position of the appendiceal tip is cited in many surgical and anatomical texts as being fixed in the retrocecal position in as many as two-thirds of cases studied. The reference most often quoted to support this observation is Wakeley (1933), but this frequency did not correspond to the clinical experience of the surgical staff at the authors' institution. Accordingly, a prospective survey of the in vivo location of the vermiform appendix was undertaken over a 6-month period. The results demonstrated that the retrocecal position was indeed the most common location, but occurred in only 33% of instances. This observation may encourage greater utilization of laparoscopic appendectomy, since it suggests that retroperitoneal dissection will not be necessary to locate the appendiceal tip in the majority of cases. © 1994 Wiley-Liss, Inc.

Extracts of dormant microcysts of Polysphondylium pallidum demonstrate pH optima for the hydrolysis of casein at 3.5 and 6.0. During germination the intracellular pH 6.0 caseinolytic specific activity does not change significantly. The pH 6.0 protease is also active on azo-albumin, revealing the same developmental pattern with this substrate. Both acid protease activities are excreted during the germination process. Addition of purified nonspecific protease to cultures speeds up germination, suggesting that the excreted protease may play a role in removal of the microcyst wall. When cycloheximide is added to cultures, complete germination (emergence) is stopped whereas the pH 6.0 protease activity still accumulates to between 50 and 60% of the maximum control activity. Although this suggests that post-translational controls might mediate the accumulation of a portion of the pH 6.0 protease increase, mixing and dilution experiments with cell extracts do not reveal the differential presence of soluble activators or inhibitors of this activity at different developmental stages. The presence of tightly bound enzyme-inhibitor complexes for protease B in dormant microcysts has not been ruled out and is currently under study.

OBJECTIVE: Screening and biochemical characterisation of trypanosome-lysing factor (trypanolysin) from non-vector insect, Schistocerca gregaria. DESIGN: Laboratory based experiment. SETTING: Department of Biochemistry, University of Nairobi. RESULTS: Lysis of isolated trypanosomes was demonstrated with midgut homogenates of natural vector Glossina morsitans centralis as well in non-vector insects. The highest trypanolytic activity was observed in midgut homogenate of the desert locust. Schistocerca gregaria followed by the cockroach, Periplaneta americana (L). Further studies on the S. gregaria trypanolytic factor showed its proteinaceous nature due to its sensitivity to temperatures above 40 degrees C and to proteases. Additionally, the factor showed lectin-like properties since the activity was blocked by D-glucosamine. CONCLUSION: The trypanolytic factor has the potential of being used to modulate tsetse fly vectorial capacity.

Introduction. Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function. Aim. To assess adult male circumcision's effect on men's sexual function and pleasure. Methods. Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya were uncircumcised, HIV negative, sexually active men, aged 18-24 years, with a hemoglobin >/=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized 1:1 to either immediate circumcision or delayed circumcision after 2 years (control group). Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. Main Outcome Measures. (i) Sexual function between circumcised and uncircumcised men; and (ii) sexual satisfaction and pleasure over time following circumcision. Results. Between February 2002 and September 2005, 2,784 participants were randomized, including the 100 excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range. For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24. Changes over time were not associated with circumcision status. Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," and 54.5% rated their ease of reaching orgasm as "much more" at month 24. Conclusions. Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function.

To determine the effects of plasma, genital, and breast milk human immunodeficiency virus type 1 (HIV-1) and breast infections on perinatal HIV-1 transmission, a nested case-control study was conducted within a randomized clinical trial of breast-feeding and formula feeding among HIV-1-seropositive mothers in Nairobi, Kenya. In analyses comparing 92 infected infants with 187 infants who were uninfected at 2 years, maternal viral RNA levels >43,000 copies/mL (cohort median) were associated with a 4-fold increase in risk of transmission (95% confidence interval [CI], 2.2-7.2). Maternal cervical HIV-1 DNA (odds ratio [OR], 2.4; 95% CI, 1.3-4.4), vaginal HIV-1 DNA (OR, 2.3; 95% CI, 1.1-4.7), and cervical or vaginal ulcers (OR, 2.7; 95% CI, 1.2-5.8) were significantly associated with infant infection, independent of plasma virus load. Breast-feeding (OR, 1.7; 95% CI, 1.0-2.9) and mastitis (relative risk [RR], 3.9; 95% CI, 1.2-12.7) were associated with increased transmission overall, and mastitis (RR, 21.8; 95% CI, 2.3-211.0) and breast abscess (RR, 51.6; 95% CI, 4.7-571.0) were associated with late transmission (occurring >2 months postpartum). Use of methods that decrease infant exposure to HIV-1 in maternal genital secretions or breast milk may enhance currently recommended perinatal HIV-1 interventions.

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OBJECTIVE–To determine the efficacy of the nonoxynol 9 contraceptive sponge in preventing sexual acquisition of the human immunodeficiency virus (HIV). DESIGN–Prospective, randomized placebo-controlled trial. SETTING–Research clinic for prostitutes in Nairobi, Kenya. PATIENTS AND INTERVENTIONS–One hundred thirty-eight HIV-seronegative women were enrolled, of whom 74 were assigned to nonoxynol 9 sponge use and 64 to placebo use. These two groups did not significantly differ with respect to demographic characteristics, sexual practices, or prevalence of genital infections at enrollment, except for a lower number of sex partners per week and a higher initial prevalence of genital ulcers among women assigned to nonoxynol 9 sponge use. Among the 116 women who returned for follow-up, the mean durations of follow-up were 14 and 17 months for the two groups, respectively. MAIN OUTCOME MEASURE–HIV seroconversion. RESULTS–Nonoxynol 9 sponge use was associated with an increased frequency of genital ulcers (relative risk [RR], 3.3; P less than .0001) and vulvitis (RR, 3.3; P less than .0001) and a reduced risk of gonococcal cervicitis (RR, 0.4; P less than .0001). Twenty-seven (45%) of 60 women in the nonoxynol 9 sponge group and 20 (36%) of 56 women in the placebo group developed HIV antibodies. The hazard ratio for the association between nonoxynol 9 sponge use and HIV seroconversion was 1.7 (95% confidence interval [CI], 0.9 to 3.0). Using multivariate analysis to control for the presence of genital ulcers at enrollment, the adjusted hazard ratio for the association between nonoxynol 9 sponge use and seroconversion was 1.6 (95% CI, 0.8 to 2.8). CONCLUSIONS–Genital ulcers and vulvitis occurred with increased frequency in nonoxynol 9 sponge users. We were unable to demonstrate that nonoxynol 9 sponge use was effective in reducing the risk of HIV infection among highly exposed women.

The human body louse, Pediculus humanus, showed eighteen midgut proteins ranging between 12 and 117 kDa, when analysed by SDS-PAGE electrophoresis. Seven of them (12 kDa, 17 kDa, 29 kDa, 35 kDa, 40 kDa, 55 kDa and 97 kDa) were major bands based on their intensity of staining. The immunization of rabbits with a midgut extract elicited the production of protective polyclonal antibodies. These antibodies reacted strongly with all major midgut proteins as well as with 63 kDa and 117 kDa proteins when tested by the Western blot technique. The analysis of the proteins revealed that the 12 kDa, 25 kDa, 29 kDa, 35 kDa, 45 kDa, 87 kDa and 97 kDa proteins are glycosylated and none of them contained a lipid moiety. By electroelution, the proteins of 35 kDa and 63 kDa were purified. On trypsinization, the proteins of 35 kDa and 63 kDa produced four major fragments (F1, F2, F3, and F4) when resolved on a 18% SDS-PAGE. The F1 fragment of the 35 kDa protein reacted with the polyclonal antibodies by the immunoblot technique.

We conducted a prospective study among women in Mombasa, Kenya, to determine whether Trichomonas vaginalis infection was associated with an increased risk of human immunodeficiency virus type 1 (HIV-1) infection. At monthly follow-up visits, laboratory screening for HIV-1 and genital tract infections was conducted. Among 1335 HIV-1-seronegative women monitored for a median of 566 days, there were 806 incident T. vaginalis infections (23.6/100 person-years), and 265 women seroconverted to HIV-1 (7.7/100 person-years). Trichomoniasis was associated with a 1.52-fold (95% confidence interval, 1.04-2.24-fold) increased risk of HIV-1 acquisition after adjustment for potential confounding factors. Treatment and prevention of T. vaginalis infection could reduce HIV-1 risk in women.

Untreated maternal syphilis during pregnancy will cause adverse pregnancy outcomes in more than 60% of the infected women. In Nairobi, Kenya, the prevalence of syphilis in pregnant women of 2.9% in 1989, showed a rise to 6.5% in 1993, parallel to an increase of HIV-1 prevalence rates. Since the early 1990s, decentralized STD/HIV prevention and control programmes, including a specific syphilis control programme, were developed in the public health facilities of Nairobi. Since 1992 the prevalence of syphilis in pregnant women has been monitored. This paper reports the findings of 81,311 pregnant women between 1994 and 1997. A total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996 and 3.8% (95% CI: 3.6-4.0) in 1997. In conclusion, a marked decline in syphilis seroprevalence in pregnant women in Nairobi was observed since 1995-96 (P<0.0001, Chi-square test for trend) in contrast to upward trends reported between 1990 and 1994-95 in the same population. PIP: This study presents the trend in syphilis prevalence among 81,311 pregnant women in Nairobi, Kenya, from 1994 to 1997. Clinic nurses performed syphilis serology using a rapid plasma reagin (RPR) card test in 10 NCC clinics and Chi square; these were used to study trends over time. Results showed that a total of 4244 women (5.3%) tested positive with prevalence rates of 7.2% (95% CI: 6.7-7.7) in 1994, 7.3% (95% CI: 6.9-7.7) in 1995, 4.5% (95% CI: 4.3-4.8) in 1996, and 3.8% (95% CI: 3.6-4.0) in 1997. Thus, a significant decrease in syphilis seroprevalence among pregnant women in Nairobi was observed since 1995-96, by contrast with the rising trend in syphilis prevalence reported in 1990 and 1994-95 in the same population. This decline was attributable in large part to the syphilis control program initiated in Nairobi in June 1992, which focused on sexual behavior modifications, changes in health care seeking behavior and improved health care services.

Routine procedures used to isolate Haemophilus ducreyi in a busy laboratory are reported. Identification was based on colony morphology and nutritional and biochemical properties of 120 fresh isolates of H. ducreyi. These isolates grew very well on Gonococcal Agar and Mueller-Hinton Agar incubated at 34 degrees C in candle extinction jars containing moistened filter paper. Colonies varied in size, giving a polymorphic appearance. They were smooth, dome-shaped, and buff-yellow to grey in colour, and measured 2 mm in diameter. They could be pushed intact across the agar surface. By microscopic examination of gram-stained smears the isolates were gram-negative coccobacilli arranged in short chains, clumps or whorls and occasionally in typical "rail track" arrangements. Individual bacteria showed bipolar staining. Colonies autoagglutinated in saline. All strains were catalase-negative and did not produce indole or H2S. They were oxidase- and beta-lactamase positive and required X but not V factor for growth. Now that reliable techniques have been developed and characteristics established it is possible for most clinical laboratories to isolate and identify this organism from most patients with chancroid.

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This paper looks at responses from participatory on-farm farmer participatory trials that are often measured as ratings (farmers score each given treatment on a scale that is ordered but arbitrary) or rankings (where farmers arrange the treatments in order from most preferred to least preferred). Simple methods such as the preference statistic that uses the proportion of responses, Kruskal-Wallis test which is a one-way analysis of variance by ranks and the Friedman test that is a two-way analysis of variance by ranks are outlined. The Bradley-Terry model for ranks which is a logit model for paired comparisons is described and used to fit models for plot level covariates.

The haemolymph of the tsetse fly, Glossina morsitans morsitans, contains a high (lipophorin) and a low molecular weight protein of high densities, 1.11 and 1.29 g/ml, respectively. The purification of the proteins was achieved by a combination of density gradient ultracentrifugation and reported gel permeation chromatography. The lipophorin is of high molecular weight (M(r) integral of 600,000) and consists of two apoproteins, apolipophorin I (M(r) integral of 250,000) and apolipophorin II (M(r) integral of 80,000) both of which are glycosylated. Lipophorin also has a pI of 6.1. However, electrophoresis under non-denaturing and denaturing conditions showed the low molecular weight protein to be a single polypeptide chain (M(r) integral of 23,000). Amino acid analysis revealed a relatively high content of the acidic amino acids as well as serine and glycine. The protein contained lipids as shown by Sudan Black staining but was unglycosylated. Using rabbit antiserum against the isolated protein in immunodiffusion and immunoblotting experiments, no cross-reactivity was detected with haemolymph samples from insects representing six orders. In conclusion, the finding of lipophorin suggests that, although flies primarily utilize proline for their energy needs, there is an active transport mechanism for the supply of lipid requirements. However, the results for the low molecular weight protein indicate that the protein is unique to Glossina, suggesting that it may have an important role in the physiology of this insect and is therefore a significant target for vector management.

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} This study was conducted in two seasons of2002 at Tigoni, Central Kenya to determine effectiveness of insecticides; neern  extract and mineral oil in managing potato aphids and their associated virus diseases. The treatments were arranged in  randomized complete block design (RCBD) with four replications. In each season, the number of aphids in five randomly  selected plants per treatment was recordced in situ. Virus symptoms (i.ncidence) were scored and expressed as a percentage  to the total plant population per plot. Forty-five days after emergence, 10 plants each from guard rows and inner rows were  randomly selected and serologically assayed for Potato Virus Y (PVY) and Potato Leaf Roll Virus (PLRV) using DAS ELISA test. Results showd that three aphid species Aphis gossypii (Glover), Macrosiphum euphorbiae (Thomas) and Myzus persicae (Sulzer) colonized on the variety with A. gossypii being the most dominant while M. persicae was least.  Higher aphid population coincided with the short rains experienced in one of the seasons. Synthetic insecticides (Bifethrin  and dimethoate) were the most effective among the treatments in reducing aphid infestation while the neem extract and mineral oil (DC- Tron) had no significant (P<0.05) difference. However, mineral-oil treated plots recorded the lowest PVY  incidence while bifenthrin-Ireated plots had the lowest PLRV incidence. It is suggested that a combination of synthetic  insecticides and mineral oil could playa major role in reduction of the aphids and their associated vectors. Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4

OBJECTIVE: To develop a standard procedure for male circumcision in a resource-poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high-risk populations. SUBJECTS AND METHODS: Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on "usual" medical procedures in Western Kenya. The follow-up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization. RESULTS: Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; approximately 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure. CONCLUSION: Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public-health measure.

Cervical and vaginal secretions from 17 women infected with human immunodeficiency virus type 1 (HIV-1) were evaluated daily through the course of one menstrual cycle for HIV-1 DNA (21-31 visits per woman). HIV-1-infected cells were detected in 207 (46%) of 450 endocervical swabs and 74 (16%) of 449 vaginal swabs. There was considerable variability in the percentage of positive swabs from each woman, ranging from 4% to 100% of endocervical swabs and from 0 to 71% of vaginal swabs. In multivariate analyses, plasma HIV-1 RNA was significantly associated with shedding of HIV-1-infected cells; each 1-unit increase in the log of plasma virus load was associated with a 5.6-fold increase in the odds of cervical shedding (95% confidence interval [CI], 2.1-14.8) and a 3.9-fold increase in the odds of vaginal shedding (95% CI, 2.1-7.2). There was no discernible pattern of genital tract shedding with phase of the menstrual cycle and no significant association with serum estradiol or progesterone levels.

A model for the establishment of a four-dimensional regional geodetic reference datum is presented. Starting from the three-dimensional integrated geodetic network model, formulations for the establishment of a four-dimensional regional datum are developed. Astronomic latitudes, astronomic longitudes, gravity values, gravity potential differences, gravity differences, and GPS-vectors are considered as observables. The estimated parameters defining the datura are point coordinates, deflections of the vertical and geoidai undulations, and velocities and accelerations on the positional coordinates. The network datum is considered observed over several epochs with parameters estimated from previous epochs being introduced into later epochs as stochastic prior information parameters.