Surgical significance of brachial arterial variants in a Kenyan population
A Pulei, M Obimbo, K Ongeti, P Kitunguu, M Inyimili, J Ogeng’o

Abstract

Background: Knowledge of the variant anatomy of the brachial artery is important in radial arterial grafts for coronary bypass, percutaneous trans-radial approach to coronary angiography, angioplasty and flap surgery. These variations show ethnic differences but data from black populations are scarce. This study therefore describes the course in relation with median nerve, level and pattern of termination of brachial artery in a black Kenyan population.
Methods: This was a cadaveric dissection study of 162 upper limbs at the Department of Human Anatomy University of Nairobi, Kenya. The brachial artery was exposed entirely from the lower border of teres major to its point of termination. The course in relation to the median nerve and the level of termination were recorded. The results were analyzed using SPSS version 17.0 for Windows.
Results: 72.2% of the brachial arteries followed the classical pattern described in Gray’s Anatomy. Superfi cial brachioradial and superficial brachial arteries were present in 12.3% and 6.1% of the cases respectively. Brachial artery terminated at the radial neck in 79% of the cases, radial tuberosity (8.6%), and proximal arm (11.1%), mid arm (1.2%). Pattern of termination was either a bifurcation into the radial and ulnar arteries (90.1%) or trifurcation into radial, ulnar and common interosseous arteries (9.3%). We also report a case of trifurcation of the brachial artery into the profunda brachii, radial and ulnar arteries (0.6%).
Conclusion: Variations of the brachial artery in its relationship with the median nerve, level and pattern of termination are common. These may complicate arm surgical exposures, fl ap and vascular surgery. Pre-operative angiographic evaluation is recommended.

Keywords: brachial artery, bifurcation, trifurcation, superficial brachioradial artery

            Fluoride determinations were made with a fluoride ion selective electrode on 60 river water samples collected at readily accessible sites in Central and Nairobi provinces of Kenya. The highest fluoride concentration was 0.85 ppm in Laikipia District and the lowest was 0.08 ppm in Murang'a District. By region and district, the mean fluoride concentration ranged from 0.12 ppm for rivers in Laikipia to 0.24 ppm for rivers in Nairobi, with 0.32 ppm in the Upper Basin of the Athi River. The results indicate that the rivers are relatively low in fluoride and are therefore safe in this respect for domestic and industrial use.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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.

Aim: This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars.
Methods: The study was conducted in two rural divisions in Kenya, with 7 operators
randomly paired to a group of 8 assistants. A total of 804 children had each one proximal cavity in a primary molar restored using the ART approach. During the restoration 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were randomly used by the operators. The restorations were then followed for a period of 2 years.
Statistics: SPSS 14.0 was used to analyze and relate the data obtained to the method of
isolation used.
Results: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator.
Conclusions: Generally the survival rate of the proximal restorations in the present
study was very low, but the use of rubber dam resulted in a higher survival rate of the
restorations.

Tetracyclines have been among the most widely used antibiotics worldwide. Plasmid-mediated tetracycline resistance among hospital strains of bacteria has continued to rise and of major concern has been the transfer of resistance to pathogenic organisms. Bacteraemia due to hospital acquired S. typhimurium has been a major cause of morbidity at Kenyatta National Hospital (KNH), hence the need to study drug susceptibility pattern of this organism. This study also characterized the tetracycline resistance genes using oligonucleotide probes. Ninety seven S. typhimurium strains isolated from patients at KNH were used. Agar dilution method was used to determine minimum inhibitory concentration (MIC). Plasmids were isolated from each strain and the different plasmid profiles were grouped by their molecular weights into 6 patterns. Out of 97, 87 (88%) strains were resistant. MIC ranged from 1 microgram/ml to 128 micrograms/ml. Genes encoding for tetracycline resistance were located on plasmids of molecular weights 65 MDa, 5.2 or both. Plasmid-encoded antimicrobial resistance is likely to spread to other pathogenic organisms, reduce our ability to treat the infection and increase the cost and duration of treatment.

Root and stem extracts of Girardinia diversifolia exhibited varying degrees of activity against Bacillus pumilus, Staphylococcus aureus, Escherichia coli, Aspergillus niger, Candida albicans and Saccharomyces cerevisiae. Three compounds namely ~-sitosterol, 7bydroxysitosterol and 3-bydroxystigmast-5-en-7-one, were isolated from the petroleum ether root extract. The present study gives scientific credence to the traditional use of Girardinia diversifolia in the management of microbial infections.

Background: Kenya has 12 million female adolescents and youths aged 10-34 years whose reproductive behavior will determine the growth and size of its population for the next decade. The anticipated momentum of births can be slowed by the use of long-acting reversible contraception (LARC) methods as they are more effective, need no user adherence, and hence have no risk of incorrect or inconsistent use. However, in spite of the many health and social benefits, LARC is underutilized because of myths and misconceptions. Kenya is in the ultimate decade towards Vision 2030 and investing in LARC can save costs of health care and accelerate the achievement of the development goal. The objective of this study was to establish factors associated with LARC use, with a view of establishing the potential for increasing demand.

In a case of poisoning involving 70 cattle analysis of specimens obtained during post mortem examination showed that the toxic substances were arsenic and toxaphene. This was consistent with both the clinical and post mortem findings. Arsenic was detected in water from an abandoned cattle dip in the farm. Soil samples collected in the vicinity of the dip contained both arsenic and toxaphene.

{ The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size kappa (kappa n). We assessed the sensitivity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55

OBJECTIVE: To document the impact of fixed dose weight adjusted filgastrim (G-CSF) in cytotoxic-induced neutropaenia. DESIGN: A descriptive cross-sectional study. SETTING: Paediatric Oncology Unit at Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: All paediatric oncology patients who had developed cytotoxic-induced neutropaenia. MAIN OUTCOME MEASURES: The following were documented for every tissue proven case of malignancy; age, sex, type of malignancy, treatment regimen and schedule, initial blood count at the time of neutropaenia; subsequent blood counts daily for five days from day one of single dose filgastrim, and the calculated neutrophil incremental count. RESULTS: Initially eight patients with solid tumours previously treated with filgastrim revealed that cytotoxic induced neutropaenia could be ameliorated by a single dose of filgastrim. Subsequently, the study listed thirty patients. This cohort consisted of; 37% rhabdomyosarcoma, 30% Burkitts, 27% acute lymphoblastic leukaemia and 6% Hodgkin's lymphoma. Increased neutrophil count after 48 hours was documented in 26 (87%) patients, with absolute neutrophil counts range of 0.5 to 31.5 x 10(9)/L. This response was significantly influenced by gender (p>0.0001), malignancy type and chemotherapy regimen (p>0.001). CONCLUSION: The study shows that chemotherapy induced neutropaenia can be alleviated by a single dose of filgastrim without adverse effects on lymphoblastic leukaemia. This study suggests that a single dose of filgastrim should be first tried in cytotoxic induced neutropaenia in the paediatric age group. PMID: 18543524 [PubMed - in process]

BACKGROUND: Type 2 diabetes is a heterogeneous disease with multiple causes revolving around beta cell dysfunction, insulin resistance and enhanced hepatic glucose output. Clinical judgement based on obesity status, age of onset and the clinical perception of residual beta cell insulin secretory function (hence insulin-requiring or not), has been used to determine therapeutic choices for each patient. Further laboratory testing of the clinically defined type 2 diabetes unmasks the various aetiologic types within the single clinical group. OBJECTIVE: To determine the aetiological types of the clinically defined type 2 diabetic patients, their chosen therapies at recruitment and the quality of glycaemic control achieved. DESIGN: Descriptive cross-sectional study. SETTING: Diabetes out-patient clinic of Kenyatta National Hospital, Nairobi, Kenya. RESULTS: A total of 124 patients with clinical type 2 diabetes were included, 49.2% were males. The mean duration of diabetes in males was 26.09 (20.95) months and that of females was 28.68 (20.54) months. The aetiological grouping revealed the following proportions: Type 1A-3.2%, Type 1B-12.1%, LADA-5.7%, and "true" type 2 diabetes 79.0%. All the patients with Type 1A were apparently, and rightly so, on "insulin-only" treatment even though they did not achieve optimal glycaemic control with HbA1c % = 9.06. However the study patients who were type 1B and LADA were distributed all over the treatment groups where most of them did not achieve optimal glycaemic control, range of HbA1c of 8.46 -10.6%. The patients with "true" type 2 were also distributed all over the treatment groups where only subjects on 'diet only' treatment had good HbA1c of 6.72% but those in other treatment groups did not achieve optimal glycaemic control of HbA1c, 8.07 - 9.32%. CONCLUSION: Type 2 diabetes is a heterogeneous disease where clinical judgement alone does not adequately tell the various aetiological types apart without additional laboratory testing of C-peptide levels and GAD antibody status. This may partly explain the inappropriate treatment choices for the various aetiological types with consequent sub-optimal glycaemic control of those patients.

ABSTRACT: One of the sources of feacal contamination of rainwater harvested from roofs is wind-blown dust containing particulate matter from animal faeces, or through direct defecation. Since the primary habitat for Escherichia coli (E.coli) is the gastro-intestinal tract of mammals and birds (Atlas 1984), it's a good indicator of feacal contamination (Hazen, 1988). This study aimed to investigate the presence of E.coli. In rainwater samples collected from roofs in some areas around Nairobi, which have different levels of livestock density. Forty four of the 89 samples collected tested positive for the presence of E.coli from Ngong Division, which had a cattle density of 1446 per square Kilometre was, 55%, but it was not significantly different from both Kikuyu Division: cattle density of 166; both of which had 34% of the samples testing positive to E. coli (p=0.3094). It was concluded that rain water harvested from roofs for human consumption in the study area should be treated before use.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

Description
Oxytocin, a nonapeptide amide, was synthesized on a benzhydryl-resin using the Boc strategy. Benzyl group was used in the protection of sulfhydryl group of cysteine and tyrosine side-chain. Benzhydryl and tetralinyl groups were used in the protection of glutamine and asparagine side-chains respectively. TFMSA-TFA-thioanisole-1, 2-ethanedithiol (2: 20: 2: 1 v/v) was used on the peptide-resin under different cleavage conditions to obtain oxytocin in a one-pot reaction. The cleavage at 40 C for two hours gave oxytocin quantitatively. Oxytocin could be isolated in 56% yield.

Oxytocin, a nonapeptide amide, was synthesized on a benzhydryl-resin using the Boc strategy. Benzyl group was
used in the protection of sulfhydryl group of cysteine and tyrosine side-chain. Benzhydryl and tetralinyl groups were
used in the protection of glutamine and asparagine side-chains respectively. TFMSA-TFA-thioanisole-I,2-
ethanedithiol (2:20:2:1 v/v) was used on the peptide-resin under different cleavage conditions to obtain oxytocin in a
one-pot reaction. The cleavage at 40°C for two hours gave oxytocin quantitatively. Oxytocin could be isolated in
56% yield.

Oxytocin, a nonapeptide amide, was synthesized on a benzhydryl-resin using the Boc strategy. Benzyl group was
used in the protection of sulfhydryl group of cysteine and tyrosine side-chain. Benzhydryl and tetralinyl groups were
used in the protection of glutamine and asparagine side-chains respectively. TFMSA-TFA-thioanisole-I,2-
ethanedithiol (2:20:2:1 v/v) was used on the peptide-resin under different cleavage conditions to obtain oxytocin in a
one-pot reaction. The cleavage at 40°C for two hours gave oxytocin quantitatively. Oxytocin could be isolated in
56% yield.

n/a

Abstract The study reported data from 507 post-mortem records in the Department of Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi, Kenya. The records were from carcasses obtained from the peri-urban area of airobi during a 20-year period between 1990 and 2009. Approximately 80% (393/507) of the calf carcasses had their diagnosis made through post-mortem examination, while the rest (114/507) were incon-clusive. Just less than half (48.3%) of the calf carcasses presented had their age specified by the owners compared to 51.7% whose age was not specified. For calf carcasses whose age was specified by the owners, those indicated as more than 3 months were one-and-a-half times as many as those below 3 months old. The proportion of female carcasses (53.8%, 273/507) presented for post-mortem were slightly higher than the male carcasses (46.2%, 234/507). Diseases or conditions of the respiratory system were the most common 17.7% (97/507) while gastrointes- tinal tract (GIT) was second and affected 16.1 % (88/507) of the cases. Another small number, 3.3% (18/507), died from bloat giving the total cases associated with GIT as 19.4% (106/507). Severe calf malnutrition and septicaemia were the third most reported causes of calf mortality in similar proportions at 14.3% (78/507) and 14.4% (79/507), respectively. Other minor causes of calf mortality were tick-borne diseases 8.6% (47/507), helminthiasis and poisoning, 2.9% (16/507) and 1.8% (10/507), respectively.

Department of Pathology, College of Health Sciences, University of Nairobi, Kenya. Forty two children with aplastic anaemia were seen at Kenyatta National Hospital, Nairobi, over a period of 8 years (1980-1988). These have been analysed with respect to sex, age and area of geographical origin. The overall male:female ratio is 1:1 with a preponderance of Kikuyu patients. Repeated transfusions was the commonest presenting feature and rapid onset was associated with poor prognosis. Exposure to herbicides/pesticides and other agrochemicals is implicated in the aetiopathogenesis of childhood aplastic anaemia in Kenya.

The purpose of this study was to investigate how school characteristics affect the usage of the PM and the consequent impact on learner achievement in physics (LAP). Data was collected using Students Achievement Tests (SAT) and questionnaire for physics teachers. Stratified Sampling was applied to select 84 schools comprising boys, girls and mixed schools from seven provinces of Kenya. Statistical Package for Social Sciences (SPSS) was used to analyze the data. ANOVA, chi-square and multiple-regression were used to test the hypothesis. The key findings of the study were that PM enhances the learning of physics; Single sex schools performed better than mixed schools; the type of schools in terms of gender, whether day or boarding were not factors in the usage of project method. In view of these research findings, the researchers recommend that the government come up with a policy that enhances the establishment of more single sex schools, enhance resource mobilization for the teaching of physics, review the teacher training component so as to encompass the PM as an alternative teaching strategy, and in-service physics teachers on the role of school characteristics in the study of physics.

Frequently, forensic entomology is applied in the use of insect maggots for the identification of specimens or remains of humans. Maggot crop analysis could be valuable in criminal investigations when maggots are found at a crime scene and a corpse is absent. Human short tandem repeat (STR) has previously been used to support the association of maggots to a specific corpse but not in the period at which the body has been decomposing. The aim of this research was to assess the time period for successful STR analyses of human DNA from third instar maggots (Protophormia terraenovae) obtained from decomposing human corpses as well as to investigate the human DNA turnover and degradation in the maggot crop after they are removed from food and/or are fed on a beef (a new/different) food source. Results showed that the amount of human DNA recovered from maggots decreased with time in all cases. For maggots fed on beef, the human DNA could only be recovered up to day two and up to day four for the starved maggots. STR analyses of human DNA from maggots’ crop content using 16 loci generated profiles that matched those of reference samples although some of the alleles were not amplifiable therefore generating partial profiles for the samples starved for 4 days and those fed on beef. This may be due to nuclease activity present in the gut of larvae that may have caused degradation of DNA and consequently reduction in DNA yield. It was possible to identify the decomposing body using STRs as markers.

Frequently, forensic entomology is applied in the use of insect maggots for the identification of specimens or remains of humans. Maggot crop analysis could be valuable in criminal investigations when maggots are found at a crime scene and a corpse is absent. Human short tandem repeat (STR) has previously been used to support the association of maggots to a specific corpse but not in the period at which the body has been decomposing. The aim of this research was to assess the time period for successful STR analyses of human DNA from third instar maggots (Protophormia terraenovae) obtained from decomposing human corpses as well as to investigate the human DNA turnover and degradation in the maggot crop after they are removed from food and/or are fed on a beef (a new/different) food source. Results showed that the amount of human DNA recovered from maggots decreased with time in all cases. For maggots fed on beef, the human DNA could only be recovered up to day two and up to day four for the starved maggots. STR analyses of human DNA from maggots’ crop content using 16 loci generated profiles that matched those of reference samples although some of the alleles were not amplifiable therefore generating partial profiles for the samples starved for 4 days and those fed on beef. This may be due to nuclease activity present in the gut of larvae that may have caused degradation of DNA and consequently reduction in DNA yield. It was possible to identify the decomposing body using STRs as markers.

Key messages
Effective training is a key determinant for adopting online learning in educational institutions.
Transformational leadership characteristics are important in managing change that is required in learning
institutions during the COVID-19 pandemic and beyond.
Modelling the way is a necessity in university management of online teaching and learning through COVID-19 Season

After the World Health Assembly approved WHA 45.5 in 1992 addressing the nursing shortage by refocusing nurses and midwifes to meet community health needs, community demands for educated nurses and the needs of higher nursing education in developing countries increased.  Therefore in Kenyan a major university school of nursing initiated a collaborative study with a well established Japanese nursing college to determine the service-providers

Ganglion cells are the only retinal neurons communicating directly with the brain. It is well known that mammalian ganglion cells comprise more than a dozen types, clearly distinguishable from one another in structure and function. Each type also appears to send axons to a distinctive subset of the many central visual nuclei receiving direct retinal input. The implication is that each ganglion cell type forms a specialized channel sculpted by evolutionary pressures to fulfill specific visual functions. Though the outlines of this perspective have been clear for decades, many essential details are lacking. The goal of this chapter is to summarize the state of knowledge about where retinal axons are distributed in the brain and which types of ganglion cells contribute to these pathways. The primary focus is on ganglion cell types that appear to be conserved across mammalian phylogeny.

Memory B cells are long-lived and could contribute to persistence of humoral immunity by maintaining the plasma-cell pool or making recall responses upon re-exposure to an antigen. We determined the ability of a pneumococcal conjugate vaccine to induce anti-pneumococcal memory B cells. Frequencies of memory B cells against pneumococcal capsular polysaccharides from serotypes 1, 6B, 14, 19F and 23F were determined by cultured B cell enzyme-linked immunospot (ELISPOT) in 35 children aged 12-23 months who received pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV). The relationships between plasma antibodies and memory B cell frequencies were also assessed. After two doses of PHiD-CV, the proportion of subjects with detectable memory B cells against pneumococcal capsular polysaccharides increased significantly for serotypes 1 (3-45%; P < 0·01), 19F (21-66%; P < 0·01) and 23F (13-36%; P = 0·02), but not serotypes 6B (24-42%; P = 0·24) and 14 (21-40%; P = 0·06). Correlations between antibodies and memory B cells were weak. Carriage of serotype 19F at enrolment was associated with poor memory B cell responses against this serotype at subsequent time-points (day 30: non-carriers, 82% versus carriers, 0%, P < 0·01; day 210: non-carriers, 72% versus carriers, 33%, P = 0·07). PHiD-CV is capable of inducing memory B cells against some of the component pneumococcal capsular polysaccharides.

The Goals of the book are to:1,  Illustrate the process and rewards of mentoring for the organization, mentee,      and mentor.2.  Offer salient , tangible, subject-based lessons for new and experienced       leaders alike.3.  demonstrate that mentee-mentor competences are more readily gained      through personal example, channeled practice, or experience than      through pure education and training.At the end of every chapter there are reflective questions.

  The goals of the book are to:1. Illustrate the process and rewards of mentoring for the organization, mentee,and     mentor.2. Offer salient,tangible,subject-based lessons for new and experienced leaders    alike.3. Demonstrate that mentee-mentor competencies are more readily gained through     personal example, channeled practice, or experience than through pure     education and training. At the end of each chapter, there are reflective question. 

Abstract The study reported data from 507 post-mortem records in the Department of Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi, Kenya. The records were from carcasses obtained from the peri-urban area of airobi during a 20-year period between 1990 and 2009. Approximately 80% (393/507) of the calf carcasses had their diagnosis made through post-mortem examination, while the rest (114/507) were incon-clusive. Just less than half (48.3%) of the calf carcasses presented had their age specified by the owners compared to 51.7% whose age was not specified. For calf carcasses whose age was specified by the owners, those indicated as more than 3 months were one-and-a-half times as many as those below 3 months old. The proportion of female carcasses (53.8%, 273/507) presented for post-mortem were slightly higher than the male carcasses (46.2%, 234/507). Diseases or conditions of the respiratory system were the most common 17.7% (97/507) while gastrointes- tinal tract (GIT) was second and affected 16.1 % (88/507) of the cases. Another small number, 3.3% (18/507), died from bloat giving the total cases associated with GIT as 19.4% (106/507). Severe calf malnutrition and septicaemia were the third most reported causes of calf mortality in similar proportions at 14.3% (78/507) and 14.4% (79/507), respectively. Other minor causes of calf mortality were tick-borne diseases 8.6% (47/507), helminthiasis and poisoning, 2.9% (16/507) and 1.8% (10/507), respectively.

Abstract The study reported data from 507 post-mortem records in the Department of Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi, Kenya. The records were from carcasses obtained from the peri-urban area of airobi during a 20-year period between 1990 and 2009. Approximately 80% (393/507) of the calf carcasses had their diagnosis made through post-mortem examination, while the rest (114/507) were incon-clusive. Just less than half (48.3%) of the calf carcasses presented had their age specified by the owners compared to 51.7% whose age was not specified. For calf carcasses whose age was specified by the owners, those indicated as more than 3 months were one-and-a-half times as many as those below 3 months old. The proportion of female carcasses (53.8%, 273/507) presented for post-mortem were slightly higher than the male carcasses (46.2%, 234/507). Diseases or conditions of the respiratory system were the most common 17.7% (97/507) while gastrointes- tinal tract (GIT) was second and affected 16.1 % (88/507) of the cases. Another small number, 3.3% (18/507), died from bloat giving the total cases associated with GIT as 19.4% (106/507). Severe calf malnutrition and septicaemia were the third most reported causes of calf mortality in similar proportions at 14.3% (78/507) and 14.4% (79/507), respectively. Other minor causes of calf mortality were tick-borne diseases 8.6% (47/507), helminthiasis and poisoning, 2.9% (16/507) and 1.8% (10/507), respectively.