A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.

A study that devised a modified method of reporting antibiotic sensitivity results was undertaken. Enterobacteriaceae and Gram positive cocci were tested for drug sensitivity by a disc diffusion method. Zones of bacterial growth inhibition were measured, dividing the isolates into four groups: the highly sensitive, the moderately sensitive, the slightly sensitive and the resistant ones. The slightly sensitive isolates were taken as indicators of antibiotic resistance acquisition. By that system, when more than 50% of the isolates fell into the slightly and resistant groups, that meant that the antibiotic concerned would be discontinued for some time until the bacteria reverted to being moderately sensitive. The study also provided a method of making antibiotic discs from local blotting papers, and a sample of a form on which antibiotic sensitivity results could be recorded was presented. The method is considered to be easy and very appropriate for developing countries in detecting gradual and abrupt acquisition of antibiotic resistance by bacteria.

Understanding how individuals with a high degree of HIV exposure avoid persistent infection is paramount to HIV vaccine design. Evidence suggests that mucosal immunity, particularly virus-specific CTL, could be critically important in protection against sexually acquired HIV infection. Therefore, we have looked for the presence of HIV-specific CD8+ T cells in cervical mononuclear cells from a subgroup of highly HIV-exposed but persistently seronegative female sex workers in Nairobi. An enzyme-linked immunospot assay was used to measure IFN-gamma release in response to known class I HLA-restricted CTL epitope peptides using effector cells from the blood and cervix of HIV-1-resistant and -infected sex workers and from lower-risk uninfected controls. Eleven of 16 resistant sex workers had HIV-specific CD8+ T cells in the cervix, and a similar number had detectable responses in blood. Where both blood and cervical responses were detected in the same individual, the specificity of the responses was similar. Neither cervical nor blood responses were detected in lower-risk control donors. HIV-specific CD8+ T cell frequencies in the cervix of HIV-resistant sex workers were slightly higher than in blood, while in HIV-infected donor cervical response frequencies were markedly lower than blood, so that there was relative enrichment of cervical responses in HIV-resistant compared with HIV-infected donors. HIV-specific CD8+ T cell responses in the absence of detectable HIV infection in the genital mucosa of HIV-1-resistant sex workers may be playing an important part in protective immunity against heterosexual HIV-1 transmission.

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There are four hypotheses which have been advanced to explain the pathophysiology of severe and complicated malaria such as cerebral malaria. However, none of them adequately explains all the features of cerebral malaria in man. One such hypotheses is Disseminated Intravascular Coagulation (DIC). To determine whether this condition occurs in patients with uncomplicated malaria, the authors conducted a study on fibrinogen and its degradation products, euglobulin lysis time and parasite counts in 30 cases of uncomplicated malaria. By spectrophotometric method, plasma fibrinogen in patients with uncomplicated malaria was found to be normal as compared to normal healthy adults. There were no fibrinogen degradation production (FDP) detected in either patients or healthy controls, using latex agglutination tests at a dilution of 1:5. This method for FDP estimation is significant in that a serum agglutination with 1:5 dilution indicates a concentration of FDP in the original serum in excess of 10g/ml, designated as positive results of experiment. High values of euglobulin lysis time (ELT) were noted in patients with low parasitaemia. Analysis of these results showed that disseminated intravascular coagulation did not occur in uncomplicated cases of malaria. In this study on cases of uncomplicated malaria and low parasitaemia the biochemical parameters relating to to DIC have been essentially normal, although DIC is thought to be a primary stage in the development of cerebral malaria. According to Reid, DIC is an important intermediate mechanism in the pathophysiology of severe and complicated malaria such as cerebral malaria.

For a long time, it has been generally assumed that the level of blindness and need for prevention of blindness services in Africa is too high and there is no justifi cation for committing the little available resources in conducting community based surveys. Blindness surveys are relatively expensive in the short term but cost-effective in the long term. Exaggeration on the burden of blindness and visual impairment when planning may lead to wastage of scarce resources while underestimation may deny essential services to needy communities. Evidence from resent district surveys conducted in Kenya indicate that this general assumption may no longer be applicable and hence the need for more accurate baseline data before implementation of community interventions in the country; and probably in Africa. The global estimates we have been using may no longer be accurate. The only national blindness survey data we have since the inception the of the Kenya Ophthalmic Programme (KOP) in 1956 was collected in the 1980s.1 Results of two resent rapid assessments of avoidable blindness (RAAB) conducted in Nakuru2 and Kerich- Bomet-Bureti comprehensive eye services (CES) project and one rapid assessment cataract surgical services (RACSS) conducted in Embu and published in this journal (East Afr. Ophthalmol. J 2006; 13(3)estimated the prevalence of blindness in people aged >50 years at 2% in all the surveyed districts. This is much lower than the planning estimate of between 5% and 9% previously assumed. Blindness due to age related cataract was found to be lower than previously thought but the proportion of patients with good surgical outcome was low. Cataract surgical coverage (CSC) for cataract bilaterally blind people was also found to be high which implies that we should now give more emphasis to improvement of our cataract surgical outcomes as we increase our cataract surgical rates (CSR). Inadequate continuing skills update training, lack of biometry equipment (majority of eye clinics still implant standard intraocular power) and vitrectomy machines (poor vitreous loss management) are among the short term handicaps which need to be addressed. A survey conducted in Kibera slums in 2002 indicated that even the overall prevalence of blindness (0.6%) may be lower than the national average (0.7%) and the VISION 2020 estimate (1%) the KOP has been using for strategic planning. The authors of this article and others have just fi nalized an eye disease and blindness survey in Kibera and Dagoretti Divisions of Nairobi which form the Sight Savers supported Nairobi CES project area. The preliminary report estimates the prevalence of blindness at 0.1%. We hope that ongoing surveys in Nairobi City and several rural districts plus regular schools and schools for the blind will provide valuable additional information. The fi ndings of phase I and the ongoing phase II Kenya national trachoma survey (and in other endemic countries of Africa) indicate that this forgotten tropical disease which is “a manifestation of poverty through the eyes” is still a public health problem4. In some districts of Kenya, the prevalence is higher than previously assumed while in some previously assumed endemic districts (like Meru North and greater Laikipia); the prevalence has been found not to be a public health problem. The WHO forecasts a downward trend of blindness due to infectious causes like trachoma. The recent evidence makes us conclude that the trend may be different in Kenya and probably in Africa.6 Information from colleagues from other parts of Africa including Tanzania, Ethiopia, Niger, Nigeria and Eritrea among others carry the same message: Trachoma is a public health problem among very poor communities of Africa. The recommended treatment for districts where active trachoma is endemic is mass azithromycin distribution in the whole population excluding children below one year and pregnant mothers. Evidence from the National survey conducted in Tanzania and published in this journal (East Afr. Ophthalmol. J 2006; 13(3), indicates that this practice of excluding children below one year during azithromycin mass distribution may leave a signifi cant source of active infection in the treated communities. There are many barriers to utilization of eye care services but top on the list is the community member’s inability to pay for services. Economical use of little available resources is important so that one can serve more people within a fi xed budget. To be able to do this, we need accurate facts during planning for prevention of blindness.2,7,8 It is our humble submission that we need accurate scientifi c data and not “common knowledge” in eye care project planning in Kenya to avoid wastage of resources and denying funding to the very poor communities.

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Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, GA 30333. An epidemic of meningococcal disease occurred in Nairobi, Kenya, during 1989, outside the "meningitis belt" of sub-Saharan Africa. About 3800 cases occurred between April and November (250/100,000 population). The case-fatality rate was 9.4% among hospitalized patients. Areas that included Nairobi's largest slums had particularly high attack rates. The epidemic displayed an unusual age distribution, with high attack rates among those 20-29 years old. A vaccination campaign was conducted. By early January, the weekly case count had fallen to 25 from a high of 272 (in September). A case-control study estimated the vaccine efficacy to be 87% (95% confidence interval, 67%-95%). A model estimated that the vaccination campaign reduced the number of cases by at least 20%. Multilocus enzyme electrophoretic typing demonstrated that the strain responsible for this large epidemic is closely related to strains that caused other recent epidemics, documenting further spread of what may be a particularly virulent clonal complex of group A Neisseria meningitidis.

This article identifies and comments on some of the major problems attending the management of the diplomatic services in small states like Kenya. It notes some important developemnts in managing Kenya's diplomacy such as the framing of a strategic, and the existence of a written document on the foreign policy of Kenya.

Many organizations in Kenya have adopted and tried to implement the total quality management (TQM) programmes. Many of these firms have failed to achieve the expected results for various reasons. This study examines how TQM implementation is influenced by leadership in a large organization. The result show that control systems, involvement of employees in decision making and the provision of a conducive psychological environment are quiet difficult to provide for by the leadership in a large organization. It is suggested that creating smaller organization and/or autonomous Divisions of firm will help to address these challenges.

The identification of five novel compounds, pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-N-demethylerythromycin A-6,9-hemiketal, 5-O-beta-D-desosaminylerythronolide A and 15-nor-erythromycin C, in mother liquor concentrates of Streptomyces erythraeus is described. The pseudo-erythromycin derivatives are characterized by a 12-membered macrocyclic ring as a result of C13––C11 trans-lactonization. The five compounds have very little antimicrobial activity.

Introduction The Centre for Open and Distance Learning has been established to facilitate the Internal Faculties in launching and managing their programmes using distance mode with a view to increasing access to university education and provide equity in higher education to the learners all over the country. Operational Strategies The operational strategies that have been set up involve collaborative arrangements between the CODL and the Internal Faculties in the development of Study Materials and Learner support Services for off-campus students. The professional in open and distance learning are availed by the Centre to serve the Faculties as trainers while the Faculties provide academic expertise who are facilitated through participatory methods involving application of knowledge, skills and strategies to develop study materials in their respective subjects. Focus The Centre is currently working with Faculties of Science, Commerce and Arts. The Material development process involves training, writing, reviewing and editing followed by conversion to e-content and audio modes. Conclusion These collaborative arrangements will increase access to higher education make significant contribution in the realization of educational Millennium Goals in Kenya where only 20% of all those who qualify obtain admission in the public universities.

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

The factors responsible for the explosive spread of human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa continue to be identified and debated. One of the most controversial factors has been male circumcision. This cross-sectional study was conducted to measure the association between circumcision status and infection with HIV-1 among men with genital ulcer disease. Eight hundred and ten men participated in the study, of whom 190 (23%) were HIV-1-positive. A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) and with a history of urethral discharge (adjusted OR, 2.0; 95% CI, 1.4-2.8). This association could not be explained by measures of sexual exposure to HIV-1 among this population. Male circumcision should be considered as an intervention strategy for AIDS control.

{ OBJECTIVE: To establish a cohort of high-risk individuals suitable for HIV-prevention trials, and to measure changes in sexual behaviour and sexually transmitted disease (STD) incidence after a behavioural intervention. DESIGN: Prospective cohort study in trucking company depots in Mombasa, Kenya. PARTICIPANTS: A total of 556 male HIV-seronegative employees of trucking companies. INTERVENTIONS: HIV serological testing, individual counselling, condom promotion, STD diagnosis and management. MAIN OUTCOME MEASURES: Sexual risk behaviour and symptomatic STD incidence. RESULTS: Using time-trend modelling, significant declines in self-reported high-risk sexual behaviour were demonstrated during a 1-year follow-up. The percentage of men reporting any extramarital sex during the 3-month period prior to a follow-up visit decreased from 49% durig the first quarter of follow-up to 36% during the last quarter (P < 0.001). The decline in reported female sex worker contact was from 12% to 6% (P = 0.001). Approximately 30% of men reported consistent condom use during extramarital sex and this percentage remained unchanged during the study period. The incidence of STD declined from 34 per 100 person years (PY) during the first quarter to 10 per 100 PY during the last quarter (P = 0.001). Significant reductions in gonorrhoea (15 to five cases per 100 PY

AIDS. 1997 Jun;11(7):875-82.
Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: results of a randomized controlled trial.
Hawken MP, Meme HK, Elliott LC, Chakaya JM, Morris JS, Githui WA, Juma ES, Odhiambo JA, Thiong'o LN, Kimari JN, Ngugi EN, Bwayo JJ, Gilks CF, Plummer FA, Porter JD, Nunn PP, McAdam KP.
Source
Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, UK.
Abstract
OBJECTIVES:
To determine the efficacy of isoniazid 300 mg daily for 6 months in the prevention of tuberculosis in HIV-1-infected adults and to determine whether tuberculosis preventive therapy prolongs survival in HIV-1-infected adults.
DESIGN AND SETTING:
Randomized, double-blind, placebo-controlled trial in Nairobi, Kenya.
SUBJECTS:
Six hundred and eighty-four HIV-1-infected adults.
MAIN OUTCOME MEASURES:
Development of tuberculosis and death.
RESULTS:
Three hundred and forty-two subjects received isoniazid and 342 received placebo. The median CD4 lymphocyte counts at enrolment were 322 and 346 x 10(6)/l in the isoniazid and placebo groups, respectively. The overall median follow-up from enrolment was 1.83 years (range, 0-3.4 years). The incidence of tuberculosis in the isoniazid group was 4.29 per 100 person-years (PY) of observation [95% confidence interval (CI) 2.78-6.33] and 3.86 per 100 PY of observation (95% CI, 2.45-5.79) in the placebo group, giving an adjusted rate ratio for isoniazid versus placebo of 0.92 (95% CI, 0.49-1.71). The adjusted rate ratio for tuberculosis for isoniazid versus placebo for tuberculin skin test (TST)-positive subjects was 0.60 (95% CI, 0.23-1.60) and for the TST-negative subjects, 1.23 (95% CI, 0.55-2.76). The overall adjusted mortality rate ratio for isoniazid versus placebo was 1.18 (95% CI, 0.79-1.75). Stratifying by TST reactivity gave an
adjusted mortality rate ratio in those who were TST-positive of 0.33 (95% CI, 0.09-1.23) and for TST-negative subjects, 1.39 (95% CI, 0.90-2.12).
CONCLUSIONS:
Overall there was no statistically significant protective effect of daily isoniazid for 6 months in the prevention of tuberculosis. In the TST-positive subjects, where reactivation is likely to be the more important pathogenetic mechanism, there was some protection and some reduction in mortality, although this was not statistically significant. The small number of individuals in this subgroup made the power to detect a statistically significant difference in this subgroup low. Other influences that may have diluted the efficacy of isoniazid include a high rate of transmission of new infection and rapid progression to disease or insufficient duration of isoniazid in subjects with relatively advanced immunosuppression. The rate of drug resistance observed in subjects who received isoniazid and subsequently developed tuberculosis was low.
PMID:
9189212
[PubMed - indexed for MEDLINE]

Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.

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Fusarium wilt caused by Fusarium udum Butler, is an economically important disease of pigeonpea (Cajanus cajan (L.) Mill). Information on the mechanisms of resistance to this disease in pigeonpea is limited. To study the role of vascular occlusion in wilt resistance, isolates of F.udum were inoculated onto resistant and susceptible varieties of pigeonpea and observed under light and transmission electron microscopes. The presence of F. udum in wilt susceptible plants was characterized by mycelia and conidia in the xylem vessels, plugging in some vessels, disintegration of xylem parenchyma cells in the infected areas, and the formation of cavities due to heavy colonization in the pith cortex vascular bundle. Resistance to F. udum in the roots and stems of wilt resistant plants was associated with low fungal colonization and high occlusion due to tyloses and gels in the xylem vessels. There were significant differences (P = 0:05) in the number of xylem vessels occluded by tyloses in resistant and susceptible plants with a maximum of 22.5% and 8.0% occlusion, respectively. It is probable that tyloses and gels formed as a result of F. udum interaction in wilt resistant plants are part of a resistance mechanism. Key words: Fusarium wilt,cajanus cajan, resistance, tylose, vascular occlusion

Quercetrin (3-0-beta-L-rbamnosyl 3', 4', 5, 7 tetra hydroxy flavone) was isolated from the
stem of Clematis brachiata Thunberg. The yield was 0.029 % w/w of dried stem powder.

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Recent epidemiologic studies have implicated genital/anorectal ulcer disease as an important cofactor for acquisition and transmission of human immunodeficiency virus (HIV) during sexual intercourse. To better understand the mechanism for the association between genital ulcers and HIV, exudates from 62 genital ulcers of 56 HIV-seropositive prostitutes in Nairobi (Kenya) were cultured for HIV. Twenty-six ulcer cultures could not be evaluated for the presence of HIV because of bacterial or fungal contamination. HIV was isolated from 4 (11%) of the 36 remaining uncontaminated ulcer cultures (2 introital, 1 vaginal, and 1 cervical) from 4 separate women. HIV was isolated from the cervical os from only 2 of the 4 women. HIV p24 antigen was detected in exudate from 1 of the 4 culture-positive ulcers and 0 of 32 culture-negative ulcers. Genital ulcers in seropositive patients should be regarded as potential sources of HIV, which could be important in transmission of HIV during intercourse. Public health measures aimed at controlling sexually transmitted genital ulcer diseases should be an integral part of acquired immunodeficiency syndrome (AIDS) prevention programs

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East African Medical Journal Vol. 84 No. 11 (supplement) November 2007 Authors: E.K. Kangethe, J.O. Onono, B. McDermott and M. Arimi   Objective: To estimate the prevalence of E.coli O157:H7 in milk and cattle feacal samples from dairy ad non dairy neighbouring households and to relate this prevalence to risk to human health. Design: Cross sectional study design Setting: Urban and peri urban households of Dagoretti division, Subjects: Dairy farming households and non dairy farming neighbouring households. Results: E.coli O157:H7 was isolated from milk samples at three of 136 non dairy neighbour households (2.2% C.I 0.5%, 6.3%) but was not found in any of the milk samples from the 260 milk samples from dairy households (0%, C.I 0.0%, 1.4%). E.coli O157:H7 was also found in fifteen of 285 pooled household cattle feacal samples (5.2%, C.I 3.1%, 8.7%). One of the feacal isolates was found to have the marker for the production of VT1. Discussion with focus groups revealed that the participants had limited knowledge about E.coli O157:H7.Focus group discussions and household questionnaire revealed practices increasing risk of E.coli infections to humans associated with milking hygiene, drinking water sources and treatment, and manure handling. Conclusions: E.coli O157:H7 exist in urban setting and continuous surveillance is needed in case conditions and practices change favouring an increase in its prevalence and transmission to people.

Quaternary alkaloids of two Kenyan medicinal plant belonging to the genus Zanthoxylum, Z. usambarense and Z_ chalybeum, were examined using ion-pair HPLC. Both plants contained similar alkaloids, but colored protoberberines were found only in Z. chalybeum. From the stems of Z. usambareni e a new alkaloid named usambanoline (I) was isolated and characterized,

A new β-carboline alkaloid named sacleuximine A (1) together with known compounds palmatine (2), isotetrandrine (3), trans-N-feruloyltyramine (4), trans-N-caffeoyltyramine (5), yangambin (6), syringaresinol (7), sesamin (8), (+) epi-quercitol (9), 4-hydroxybenzaldehyde (10), β-sitosterol (11), quercetin 3-O-rutinoside (12) and myricetin 3-O-β-glucose (1→6) α-rhamnoside (13) have been isolated from methanol extract of Triclisia sacleuxii aerial parts. Compounds 1–10 were evaluated for their cytotoxicity against human adenocarcinoma (HeLa), human hepatocarcinoma (Hep3B) and human breast carcinoma (MCF-7) cells lines and also for antibacterial activities against both Gram-positive and Gram-negative bacteria. The cytotoxicity (IC50) values ranged between 0.15 and 36.7 μM while the minimum inhibitory concentrations were found to be in the range of 3.9 and 125 μM, respectively. This is the first report of antibacterial compounds and the isolation of lignans together with a β-carboline alkaloid from T. sacleuxii.
Keywords: Triclisia sacleuxii, Menispermaceae, secondary metabolites, cytotoxicity, antibacterial, aerial parts

The aerial parts of Nicandra physaloides plant collected from Kenyatta National Hospital grounds were dried and subjected to acid-base extraction and partitioned to obtain alkaloidal and non-alkaloidal extracts. The non-alkaloidal extract yielded three compounds; withanicandrin, β-sitosterol and stigmasterol after column chromatography. Withanicandrin exhibited antifungal activity against Saccharomyces cerevisiae and Candida albicans but lacked antibacterial activity.

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

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This work deals with the isolation and pharmacological investigations of compounds of Euphorbia matabelensis. After multiple separation process, including thin layer chromatography (TLC), vacuum liquid chromatography, preparative TLC, and high-performance liquid chromatography, 1 diterpene (ingenol) and 2 flavonoids (naringenin and eriodictyol) were obtained from the methanol extracts prepared from the stems and roots of the plant. The structures of the isolated compounds were determined by nuclear magnetic resonance (NMR) and MS measurements and comparison with literature data. All compounds were isolated for the first time from the plant. Eriodictyol was detected for the first time from a Euphorbia species. The compounds were tested for their antiproliferative (on HeLa, C33a, MCF-7, and MDA-MB-231 cell lines) and GIRK channel blocking activities. None of the compounds proved to be active in these test systems.

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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Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.

                                    Abstract

Group B streptococci (GBS) were isolated from bovine bulk milk and from vaginas and throats of antenatal and postnatal women using TKT and rapid GBS media. Sixty three of 529 (12%) bovine milk samples, 9 of 48 (19%) vaginal and 3 of 48 (6%) throrat samples were positive. Both bovine and human beta hemolytic isolates were characterized biochemically and serologically. Pigment production was characteristic of both human and bovine beta haemolytic isolates. The majority (88%) of human isolates fermented salicin and not lactose and most bovine isolates were either lactose positive/salicin positive (41%) or lactose positive/salicin negative (38%). Human and bovine isolates were 100% and 85% typable respectively. Serotype distribution was similar in the bovine and human populations with serotype Ia, Ic and III being most common in both. Fermentation of sugars showed major differences between bovine and human isolates but similarity in serotype distribution suggests some genetic relationship.

Background: Antichloramphenicol antibodies can be produced in small or large animals depending on the requirement of the researcher. Previously most researchers have raised antibodies in small animals such as rabbits due to their easy availability and handling. In the present study antichloramphenicol antibodies were produced in large animals because large volumes of serum was needed for various studies.

Objective: The objective of the present study was to isolate and characterize antichloramphenicol antibodies produced in camels, donkeys and goats for development of a CAP Enzyme Linked Immunosorbent Assay.

Methods: The methods employed were SDS-PAGE electrophoresis which involved the analysis of crude and purified goat, camel and donkey antichloramphenicol antibodies. Purification of the antichloramphenicol antibodies was carried out by precipitation using ammonium sulphate. Immunization of experimental animals was carried out using standard immunological methods.

Results: The results indicated that the crude anti-CAP antibody produced in camels, goats and donkeys showed 7 protein bands of molecular sizes 11.7, 40, 61.6, 134.3, 145, 169.5 and 182 kda. However the protein band of molecular weight 11.7 kda was not observed in the purified antibody from the 3 animal species. The protein bands of the camel appeared smaller and were more distinct as compared to those of donkeys and goats.

Conclusion: From this study it was concluded that purified camel antibodies are smaller and more specific followed closely by goat antibodies and donkey antibodies.

Keywords: anti-chloramphenicol (CAP) antibodies, camels, goats and donkeys

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Aim
The main aim of the study was to evaluate the incidence of redisplacement of distal radial
fractures in children aged between 6 and 15 years and factors contributing to it at the
Kenyatta National Hospital.
Methodology
'If This was a prospective study carried over eight months from the 22nd June 2005 to 28th
February 2006.0ne hundred patients were recruited. The fracture was reduced by the
plaster technicians, the usual personnel who reduce these fractures at casualty; reduction
was acceptable if the dorsal or volar angulation was less than 20°. The patients were then
followed up in the fracture clinic in the next two weeks with another x-ray. It was
determined at this point whether there was presence of healing or redisplacement.
Redisplacement was regarded as the presence of dorsal volar angulation of greater than
20° or translation greater than 50%. The end point of the study was at week four, x-ray of
the distal forearm either showed evidence of redisplacement or evidence of healing at
week four in other remaining patients. The data was collected and entered into statistical
package for social sciences (SPSS) 12.0 version.
It was analyzed using odds ratio, Fisher's exact test and Chi-square test where
appropriate. The difference within the variables was taken to be significance if the p
value was less than 0.05.
Results
One patient had fracture of both distal radial bones making the total number of fractures
to be 101. Thirty-seven of which were female and thirty four sustained their fractures as a
result of involvement in games. Ninety two fractures involved the metaphysis and nine
were in the distal third of the radial diaphysis, sixty five were complete fractures while
thirty two were torus and only four were greenstick fractures. Fifty nine were angulated
(fifty eight dorsal and one volar) and forty two were non-angulated. There were fifty nine
displacements, (fifty six dorsal, one volar and two bayonet apposition) and forty two nondisplaced
fractures. There were fifty one fractures with no translation of one fragment on
the other, thirty five fractures having less than 50% translation and fifteen having greater
than 50% translation. Fifty four fractures were judged to be as a result of bending forces
and fifteen as a result of shear forces and thirty two as a result of compression forces.
Ninety nine patients got below elbow cast while only one had above elbow. Twenty two
patients were given analgesics/sedation at reduction while seventy eight had the reduction
under no analgesia! sedation.
At week two nine (seven patients did not turn up and two did not have check x- rays)
patients were not accounted for; and at week four another nine patients (five did not turn
up and four did not have check X rays) were not accounted for. At week two, thirteen
fractures redisplaced and were remanipulated, and at week four two of the thirteen
remanipulated at week two maintained their reduction but four other fractures which had
not redisplaced at week two redisplaced making them fifteen all of whom were admitted
for operative reduction.
In consideration of the whole population seen with isolated distal radial fractures, the
incidence of redisplacement would be 14.1% at week two and 18.1 % at week four, but
considered as a percentage to the complete and greenstick (which are the fractures at risk
of red isplacement) it would be 20.3% at week two and 21.9% at week four. The
determinants of redisplacement were; angulation with a p value of 0.021, translation with
a p value of 0.009 , completeness of fracture with a p value of 0.004, displacement with a
p value of 0.006 and imperfect reduction with p value of 0.003 .
Conclusion
The incidence of redisplacement of isolated distal fracture in children 6-15 years as seen
in this study is comparable to international figures. The factors contributing to
redisplacement are completeness of the fracture, initial displacement, translation and
imperfect reduction. These factors constitute risk factors to redisplacement of the
complete fractures.

Description
Phytochemical investigation of Tephrosia vogelii seedpods led to the isolation of twelve compounds: vogelisoflavone A (1), vogelisoflavone B (2), isopongaflavone (3), onogenin, luteolin, 4′,7-dihydroxy-3′-methoxyflavanone, trans-p-hydroxycinnamic acid, tephrosin, 2-methoxygliricidol, dehydrorotenone, 6a,12a-dehydro-α-toxicarol and pinoresinol. Compounds 1 and 2 are reported as new natural products. Isopongaflavone (3) was structurally modified using hydrazine to pyrazoisopongaflavone (4). These compounds were characterized based on their NMR and HRESIMS data. Further, four compounds (1–4) were evaluated for their anti-inflammatory effects in lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMCs). Treatment of the LPS-stimulated PBMCs with the compounds at a concentration of 100 μM suppressed the secretion of interleukin IL-1β interferon-gamma (IFN-γ …

A new isoflavone, 8-prenylmilldrone (1), and four new rotenoids, oblarotenoids A–D (2–5), along with nine known compounds (6–14), were isolated from the CH2Cl2/CH3OH (1:1) extract of the leaves of Millettia oblata ssp. teitensis by chromatographic separation. The purified compounds were identified by NMR spectroscopic and mass spectrometric analyses, whereas the absolute configurations of the rotenoids were established on the basis of chiroptical data and in some cases by single-crystal X-ray crystallography. Maximaisoflavone J (11) and oblarotenoid C (4) showed weak activity against the human breast cancer cell line MDA-MB-231 with IC50 values of 33.3 and 93.8 μM, respectively.

The factors responsible for the explosive spread of human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa continue to be identified and debated. One of the most controversial factors has been male circumcision. This cross-sectional study was conducted to measure the association between circumcision status and infection with HIV-1 among men with genital ulcer disease. Eight hundred and ten men participated in the study, of whom 190 (23%) were HIV-1-positive. A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) and with a history of urethral discharge (adjusted OR, 2.0; 95% CI, 1.4-2.8). This association could not be explained by measures of sexual exposure to HIV-1 among this population. Male circumcision should be considered as an intervention strategy for AIDS control.

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

Purpose
This paper presents the experience and impact of implementing the ISO 9001:2008 Standard at the University of Nairobi, in relation to effectiveness on service delivery, operational performance, automation, implementation challenges and related emerging issues.

Design/methodology/approach
The paper adopted a case study design approach based on qualitative analysis of internal audit reports, internal surveys and feedback, surveillance audits conducted by the certifying body, and rankings by external bodies, over a period of seven years.

Findings
Significant achievements have been realized with regard to institutionalization of quality into the university processes, work environment, documentation and record management, customer satisfaction, infrastructure and facilities, use of ICT as a prime mover of performance improvement, and ranking of the university. Opportunities for Improvement as well as critical success factors are presented.

Practical implications
The paper reports successes that may encourage other institutions of higher learning that are not certified to implement quality management systems according to ISO 9001 Standard by focusing on specific factors.

Originality/value
This paper shows how an ISO 9001 certified Quality Management System can improve internal institutional practices and avoid frequently experienced drawbacks.

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The Rose-Bengal plate test (RBPT) was performed on 488 patients with flu-like symptoms from Narok district. There was poor agreement between RBPT results from four health facilities in Narok and from the central veterinary laboratory (CVL). Agreement was poorer for the three rural dispensaries than for the District Hospital. On the other hand, for tests conducted at the CVL, there was good agreement between RBPT, serum agglutination test (SAT) and complement fixation test (CFT) results, indicating that all these tests were probably performing well. Better training and quality control and the use of white rather than a clear background surface for judging agglutination results are recommended to improve the performance of test results in Narok District health facilities.

Background: The pattern of stroke displays ethnic and geographical variations. In Sub-Saharan Africa there is
scarcity of data from Eastern and Central Africa.
Objective: To describe the characteristics of patients with ischemic cortical stroke in a Kenyan referral hospital.
Study design and set up: Retrospective study at Kenyatta National Hospital, Nairobi Kenya.
Patients and methods: Records of adult black Kenyan patients seen with ischemic cortical stroke at Kenyatta
National Hospital, Nairobi, Kenya between January 2007 and December 2011 were examined for age, sex, site,
comorbidities and outcome. Only files with complete data were included. Data were analyzed by SPSS version 17.0
for Windows and presented in tables and bar charts.
Results: Three hundred and seven cases of ischemic cortical stroke were analyzed. Mean age was 54.7 years,
with 20.6% of cases occurring below 40 years. The male: female ratio was 1:1.2 with female predominance in all
age groups. Brain regions most commonly affected were fronto-parietal (32.8%) and parietal (31.6%), while 11.6%
involved extensive regions of the cerebral cortex. Predominant single comorbidities were hypertension (64.1%),
smoking (19.2%), alcohol (13.4%), HIV infection (6.8%) and bacterial infections (6.8%). Multiple risk factors were
implicated in 42.4% cases. Two hundred (65.1%) suffered paralysis; 70 (22.8%) clinically recovered and 37 (12.1%)
died within 90 days.
Conclusion: Ischemic cortical stroke occurs in young individuals in over 20% of the study population and is
female predominant. Hypertension, cigarette smoking and infections including HIV are the leading comorbidities,
and it causes high morbidity. Control measures comprising regulation of blood pressure, reduction of smoking and
prudent management of infections should be instituted from early in life.

Background: Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. Objective: To highlight the benefits of humor as a medical therapy. Materials and methods: Review of literature identified through Medline Entrez-Pubmed search. Results: Laughter increases the secretion of the natural chemicals, catecholamines and endorphins that make people feel good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. In addition, laughter has superb muscle relaxant qualities. Humor is also an excellent antidote to stress and an effective social lubricant. Conclusion: Laughter has many clinical benefits, promoting beneficial physiological changes and an overall sense of well-being.

Background: Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. Objective: To highlight the benefits of humor as a medical therapy. Materials and methods: Review of literature identified through Medline Entrez-Pubmed search. Results: Laughter increases the secretion of the natural chemicals, catecholamines and endorphins that make people feel good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. In addition, laughter has superb muscle relaxant qualities. Humor is also an excellent antidote to stress and an effective social lubricant. Conclusion: Laughter has many clinical benefits, promoting beneficial physiological changes and an overall sense of well-being.

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Objective To assess whether the risk of complications is higher in HIV-1-infected women compared with non-infected women in the two years following insertion of the intrauterine contraceptive device. Design Prospective cohort study. Population Six hundred and forty-nine women (156 HIV-1-infected, 493 non-infected) in Nairobi, Kenya who requested an intrauterine contraceptive device and met local eligibility criteria. Methods We gathered information on complications related to the use of the intrauterine contraceptive device, including pelvic inflammatory disease, removals due to infection, pain or bleeding, expulsions, and pregnancies at one, four, and 24 months after insertion by study physicians masked to participants’ HIV-1 status. Cox regression was used to estimate hazard ratios. Results Complications were identified in 94 of 636 women returning for follow up (14.7% of HIV-1-infected, 14.8% of non-infected). The incidence of pelvic inflammatory disease was rare in both infected (2.0%) and non-infected (0.4%) groups. Multivariate analyses suggested no association between HIV-1 infection and increased risk of overall complications (hazard ratio=1.0; 95% CI 0.6-1.6). Infection-related complications (e.g. any pelvic tenderness, removal for infection or pain) were also similar between groups (10.7% of HIV-1-infected, 8.8% of non-infected; P=0.50), although there was a non-significant increase in infection-related complications among HIV-1-infected women with use of the intrauterine contraceptive device longer than five months (hazard ratio=1.8; 95% CI 0.8-4.4). Neither overall nor infection-related complications differed by CD4 (immune) status. Conclusions HIV-1-infected women often have a critical need for safe and effective contraception. The intrauterine contraceptive device may be an appropriate contraceptive method for HIV-1-infected women with ongoing access to medical services.

For over 100 years the recognized surface marking for the appendix has been McBurney's point (the junction of the lateral and middle thirds of a line joining the umbilicus with the right anterior superior iliac spine (ASIS)). In order to test its validity, the relationship between McBurney's point and the appendix was determined on 275 double contrast barium enemas (DCBE). A wide spread of distribution of the site of the appendix base was seen. Only 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were more than 10 cm distant. Seventy-five per cent of appendix bases were below and medial to a line joining the umbilicus with the right ASIS. These findings are in agreement with world-wide studies conducted by the World Organisation of Gastroenterology which showed that less than half of all patients with appendicitis have tenderness maximal over McBurney's point. A record was also made in 93 cases of the position of the appendix in relation to the caecum. The importance of these results in the diagnosis and management of patients with suspected appendicitis is discussed.

JASPA Working Paper, ILO, Addis Ababa

Background: Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. Objective: To highlight the benefits of humor as a medical therapy. Materials and methods: Review of literature identified through Medline Entrez-Pubmed search. Results: Laughter increases the secretion of the natural chemicals, catecholamines and endorphins that make people feel good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. In addition, laughter has superb muscle relaxant qualities. Humor is also an excellent antidote to stress and an effective social lubricant. Conclusion: Laughter has many clinical benefits, promoting beneficial physiological changes and an overall sense of well-being.

Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates.

Arthroplasty is an established management of various joint disorders in developed countries. Poverty has caused African countries to remain behind in this sphere of management and condemned sufferers to a life of misery and immobility. In this review, the viability of total hip arthroplasty (THR) is examined. The need, constraints and difficulties encountered in this field of surgery are examined. There are only a few cases of THR done previously and literature on this has been scarce. It is hoped that if the arrangement suggested in this review is established it will be possible to carry out this branch of Orthopaedic surgery in various countries of our region.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Introduction: The use of innovative ways of teaching anatomy as well as shortage of cadavers for dissection
have raised questions as to whether dissection should continue to be used in teaching anatomy. This study
aimed to assess the views of medical and dental students on the importance of dissection in learning gross
anatomy, and whether they would prefer other ways of learning anatomy instead of cadaveric dissection.
Materials and Methods: First‑ and second‑year students enrolled at the University of Nairobi (Kenya) were
asked to fill an online questionnaire. Data gathered were analyzed using Statistical Package for Social Sciences.
Results: Ninety‑eight (83 medical and 15 dental) students participated in the study. All students agreed dissection was useful in learning anatomy. Up to 95.2% of medical and 86.7% of dental students favored dissection. Most students strongly agreed or agreed that dissection helped them to develop three‑dimensional (3D) awareness of the human body (94.9%), work as a team (89.8%), learn medical terminology (85.7%), and learn how to use basic surgical instruments (80.6%). Dissection was preferred to use of 3D models, prosected specimens, computer‑aided learning techniques, or modern imaging techniques by 63.3%, 60.3%, 37.7%, and 34.4% of the students, respectively.
Conclusion: Dissection is an important resource for learning anatomy. Other teaching techniques should be
used to supplement dissection rather than replace it.

Key words: Anatomy, cadaveric dissection, medical students

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.

PMID: 614126 [PubMed - indexed for MEDLINE]

OBJECTIVE: The purpose of this study was to assess the efficacy of an insulin priming dose with a continuous insulin infusion versus two continuous infusions without a priming dose. RESEARCH DESIGN AND METHODS: This prospective randomized protocol used three insulin therapy methods: 1) load group using a priming dose of 0.07 units of regular insulin per kg body weight followed by a dose of 0.07 unit x kg(-1) x h(-1) i.v. in 12 patients with diabetic ketoacidosis (DKA); 2) no load group using an infusion of regular insulin of 0.07 unit . kg body weight(-1) x h(-1) without a loading dose in 12 patients with DKA, and 3) twice no load group using an infusion of regular insulin of 0.14 x kg(-1) x h(-1) without a loading dose in 13 patients with DKA. Outcome was based on the effects of insulin therapy on biochemical and hormonal changes during treatment and recovery of DKA. RESULTS: The load group reached a peak in free insulin value (460 microU/ml) within 5 min and plateaued at 88 microU/ml in 60 min. The twice no load group reached a peak (200 microU/ml) at 45 min. The no load group reached a peak (60 microU/ml) in 60-120 min. Five patients in the no load group required supplemental insulin doses to decrease initial glucose levels by 10%; patients in the twice no load and load groups did not. Except for these differences, times to reach glucose {\textless}or=250 mg/dl, pH {\textgreater}or=7.3, and HCO(3)(-) {\textgreater}or=15 mEq/l did not differ significantly among the three groups. CONCLUSIONS: A priming dose in low-dose insulin therapy in patients with DKA is unnecessary if an adequate dose of regular insulin of 0.14 unit x kg body weight(-1) x h(-1) (about 10 units/h in a 70-kg patient) is given.

BACKGROUND: An 'opt-out' policy of routine HIV counseling and testing (HCT) is being implemented across sub-Saharan Africa to expand prevention of mother-to-child transmission (PMTCT). Although the underlying assumption is that pregnant women in rural Africa are able to voluntarily consent to HIV testing, little is known about the reality and whether 'opt-out' HCT leads to higher completion rates of PMTCT. Factors associated with consent to HIV testing under the 'opt-out' approach were investigated through a large cross-sectional study in Kenya. METHODS: Observations during HIV pre-test information sessions were followed by a cross-sectional survey of 900 pregnant women in three public district hospitals carrying out PMTCT in the Busia district. Women on their first antenatal care (ANC) visit during the current pregnancy were interviewed after giving blood for HIV testing but before learning their test results. Descriptive statistics and multivariate regression analysis were performed. RESULTS: Of the 900 women participating, 97% tested for HIV. Lack of testing kits was the only reason for women not being tested, i.e. nobody declined HIV testing. Despite the fact that 96% had more than four earlier pregnancies and 37% had been tested for HIV at ANC previously, only 17% of the women surveyed knew that testing was optional. Only 20% of those surveyed felt they could make an informed decision to decline HIV testing. Making an informed decision to decline HIV testing was associated with knowing that testing was optional (OR = 5.44, 95%CI 3.44-8.59), not having a stable relationship with the child's father (OR = 1.76, 95%CI 1.02-3.03), and not having discussed HIV testing with a partner before the ANC visit (OR = 2.64 95%CI 1.79-3.86). CONCLUSION: High coverage of HIV testing appears to be achieved at the cost of pregnant women not understanding that testing is optional. Good quality HIV pre-test information is central to ensure that pregnant women understand and accept the reasons for testing and will thus come back to collect their test results, an important prerequisite for completing PMTCT for those who test HIV-positive.

Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

A study to compare the profitability of rearing sheep and goats under natural trypanosomosis challenge was carried out on Galana ranch in south-eastern Kenya between July 1996 and October 1997. Seventy-nine male weaner sheep and 79 male weaner goats were monitored monthly for weight changes and fortnightly for trypanosomosis. The animals of each species were divided into two groups. Group 1 was an untreated control, while group 2 was treated with isometamidium chloride (Samorin) at 0.5 mg/kg body weight every 3 months. In both groups, trypanosome infections were detected by microscopy and treated with diminazene aceturate (Veriben), at 3.5 mg/kg body weight, when the packed cell volume reached 17% or below. The profitability of each drug regime was expressed as the marginal revenue over the cost of trypanosomosis (MOT). There were greater losses occasioned by trypanosomosis in sheep than in goats. Animals of both species on chemoprophylaxis gave higher MOT values than those that received chemotherapy on diagnosis. However, the MOT values for the chemoprophylactic regime were higher for sheep than for goats, suggesting that the greater weight gain by sheep more then compensated for the higher cost of maintaining them under high trypanosomosis challenge. Thus, a Galana rancher would be better off keeping sheep rather than goats, other things being equal. The marginal revenue per dose of Samorin was lower than that of Veriben for both species, suggesting that strategic use of Samorin timed to precede the peak incidence of trypanosomosis might be a better option to raise the overall profitability in sheep and goats.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

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Present study demonstrates the efficacy and significance of routine screening assays used for HBsAg testing in donor blood in different blood banks of Delhi city. Blood from professional donors already screened in blood banks were cross checked using micro-ELISA technique developed at All India Institute of Medical Sciences and the results were compared. HBsAg carrier rate in these professional donors was found to be 11.7% by micro ELISA as against only 6% reported in blood banks using RPHA and latex agglutination assays. Thus, assays used in blood banks were found to be missing nearly 50% HBsAg positive cases as compared to micro-ELISA. A small group of professional donors was also screened for anti-HBs and results explained in comparison of normal values.

By means of simple and specific ELISA techniques, the plasma concentrations of soluble fibronectin and C3d, a breakdown product of C3 complement, were determined in patients with amoebic liver abscesses (ALA) and in healthy controls. The mean plasma fibronectin concentrations in 23 patients with ALA and in 20 controls were found to be 441 +/- 89 mg/l and 442 +/- 66 mg/l, respectively. The difference between these two values was not statistically significant. The mean C3d value in 21 patients with ALA, however, was found to be 84 +/- 14 AU/l which was significantly different from the value of 12 +/- 4.7 AU/l noted in 20 healthy persons. Plasma concentrations of these two proteins are discussed in relation to their possible implications in the immunopathogenesis of amoebic liver abscess.