In contrast with mammalian cells, little is known about the control of Ca2+ entry into primitive protozoans. Here we report that Ca2+ influx in pathogenic Trypanosoma brucei can be regulated by phospholipase A2 (PLA2) and the subsequent release of arachidonic acid (AA). Several PLA2 inhibitors blocked Ca2+ entry; 3-(4-octadecyl)-benzoylacrylic acid (OBAA; IC50 0.4+/-0.1 microM) was the most potent. We identified in live trypanosomes PLA2 activity that was sensitive to OBAA and could be stimulated by Ca2+, suggesting the presence of positive feedback control. The cell-associated PLA2 activity was able to release [14C]AA from labelled phospholipid substrates. Exogenous AA (5-50 microM) also initiated Ca2+ entry in a manner that was inhibited by the Ca2+ antagonist La3+ (100 microM). Ca2+ entry did not depend on AA metabolism or protein kinase activation. The cell response was specific for AA, and fatty acids with greater saturation than tetraeicosanoic acid (AA) or with chain lengths less than C20 exhibited greatly diminished ability to initiate Ca2+ influx. Myristate and palmitate inhibited PLA2 activity and also inhibited Ca2+ influx. Overall, these results demonstrate that Ca2+ entry into T. brucei can result from phospholipid hydrolysis and the release of eicosanoic acids.

Department of Medical Physiology, Moi University, P.O. Box 4606, Eldoret, Kenya. BACKGROUND: Khat is a plant whose young shoots and leaves are habitually used in Eastern Africa and the Arabian Peninsula as a drug of recreation. Although it is used without any control in these regions, it contains two controlled substances, cathinone (schedule I) which is present in fresh khat and cathine (schedule VI) which is a degradation product of cathinone abundant in old khat. OBJECTIVE: To determine the effect of khat on locomotor behaviour and seizures in rats. DESIGN: Experimental study. SETTING: University of Nairobi. SUBJECTS: Adult male rats in groups of six were given fresh khat, old khat, methylphenidate and saline at varying doses and observed over three hours. RESULTS: Fresh khat at low doses and old khat at high doses stimulated locomotor activity. High doses of fresh and old khat induced stereotype behaviour and seizures. CONCLUSION: The results show that khat stimulates locomotor and stereotypic behavioural activity and can induce seizures; results similar to those observed with amphetamine analogs. PMID: 17892196 [PubMed - indexed for MEDLINE]

Department of Medical Physiology, Moi University, P.O Box 4606, Eldoret, Kenya. erenoyungu2002@yahoo.co.uk ETHNOPHARMACOLOGICAL RELEVANCE: Catha edulis (khat) is a plant whose fresh young leaves are used by an estimated five million people in eastern Africa and the Arabian Peninsula as a drug of recreation. The fresh leaves and shoots are rich in cathinone, a psychostimulant with effects similar to those of amphetamines. Psychostimulants produce a dose-related excitation of the central nervous system which can lead to seizures and convulsions. However there are no reports on studies of the effect of this herb on brain excitability and seizures. This knowledge is useful for doctors who may prescribe drugs whose side effects include lowering seizure threshold because there could be additive proconvulsant effect among khat users. AIM OF THE STUDY: to determined whether khat lowers pentylenetetrazole (PTZ) seizure threshold. METHODOLOGY: Male Sprague dawley rats were given fresh aqueous khat extract, old aqueous khat extract (3 g/kg bw), methylphenidate or saline and the timed intravenous (PTZ) seizure threshold test was used to study its effect on seizure threshold. RESULTS: Fresh khat (3 g/kg) and methylphenidate (4 mg/kg) lowered PTZ seizure threshold. CONCLUSION: Khat lowers seizure threshold. PMID: 19056477 [PubMed - indexed for MEDLINE]

Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; text-align:justify; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

Ninety seven patients were examined for dental caries using two standard methods: (a) clinical examination based on WHO Basic Methods Oral Health surveys and (b) radiographic examination. Clinical examination method under records caries by upto 40%. Such under recording may give an impression of a decreasing caries prevalence in epidemiological studies.

Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; text-align:justify; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

Ninety seven patients were examined for dental caries using two standard methods: (a) clinical examination based on WHO Basic Methods Oral Health surveys and (b) radiographic examination. Clinical examination method under records caries by upto 40%. Such under recording may give an impression of a decreasing caries prevalence in epidemiological studies.

socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

n/a

n/a

n/a

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

A study of malaria on the Kano Plain, Kisumu District, Western Kenya, was carried out between April and August, 1985. The study included a knowledge, attitudes and practices (K.A.P.) survey on malaria illness and the mosquito vector. Overall knowledge about malaria illness was found to be good. However, treatment and prevention practices of malaria were found to be poor. Knowledge of the mosquito and its relationship to malaria was found to be high. Knowledge of methods of prevention of mosquito bites was also found to be high but actual use of the methods was low. Knowledge of traditional methods of prevention of mosquito bites was also found to be high. Actual use was again found to be low.

Recent efforts to develop ox-drawn equipment in Kenya arise out of the dilemma caused by unsuccessful efforts to promote tractors. The country has a number of about 10 000 tractors cultivating about 600 000 ha in the large-farm sector and 42 000 ha in the small-farm sector. The tractor market has slowed down to less than 1000 a year. The failure of tractor mechanization in small-scale farming coupled with the lack of ox-drawn equipment means that about 84% of smallholdings is using hand tools. In 1975, a workshop concluded that expanded ox-cultivation has a major part to play in increased agricultural production. After 4 years, the first 3 stages of development of ox-drawn equipment were accomplished. Aspects of local manufacture, training, extension and marketing are discussed.

Recent efforts to develop ox-drawn equipment in Kenya arise out of the dilemma caused by unsuccessful efforts to promote tractors. The country has a number of about 10 000 tractors cultivating about 600 000 ha in the large-farm sector and 42 000 ha in the small-farm sector. The tractor market has slowed down to less than 1000 a year. The failure of tractor mechanization in small-scale farming coupled with the lack of ox-drawn equipment means that about 84% of smallholdings is using hand tools. In 1975, a workshop concluded that expanded ox-cultivation has a major part to play in increased agricultural production. After 4 years, the first 3 stages of development of ox-drawn equipment were accomplished. Aspects of local manufacture, training, extension and marketing are discussed.

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

n/a

4 (

SUMMARY LIII)' lIIorpllOlogiClI changcs ill the goat ,csris after:. sillgle illlraperilOlieal injec,ioll of ethalle ,lillie' I.:lIIeslll"llOnarc (EI )S) werc investigatcd mint; (1Orh liglH alld deCll'On microscopy. The (olllpolind was ;almillistered at two dose Icvels: 75 mgll

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.

Plasmodium falciparum malaria causes 1-2 million deaths per year. Most deaths occur as a result of complications such as severe anemia and cerebral malaria (CM) (coma). Red cells of children with severe malaria-associated anemia (SMA) have acquired deficiencies in the complement regulatory proteins complement receptor 1 (CR1, CD35) and decay accelerating factor (DAF, CD55). We investigated whether these deficiencies affect the ability of erythrocytes to bind immune complexes (ICs) and regulate complement activation. We recruited 75 children with SMA (Hb < or = 6 g/dL) from the holoendemic malaria region of the Lake Victoria basin, western Kenya, and 74 age- and gender-matched uncomplicated malaria controls. In addition, we recruited 32 children with CM and 52 age- and gender-matched controls. Deficiencies in red cell CR1 and CD55 in children with SMA were accompanied by a marked decline in IC binding capacity and increased C3b deposition in vivo and ex vivo. Importantly, these changes were specific because they were not seen in red cells of children with CM or their controls. These data suggest that the declines in red cell CR1 and CD55 seen in children with SMA are of physiologic significance and may predispose erythrocytes to complement-mediated damage and phagocytosis in vivo.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

United States International University-Africa, Nairobi, Kenya. OBJECTIVE: To investigate the prevalence and pattern of substance use among an undergraduate population in a Kenyan university. DESIGN: Cross-sectional survey, cluster sampling of classrooms, self-administered questionnaires. SETTING: Private international university in Nairobi province, Kenya. PARTICIPANTS: Five hundred fifty eight undergraduate students of both sexes, age range 16-50 and mean age (S.E) of 21.1 +/- 0.2. MAIN OUTCOME MEASURES: Self-reported use of psychoactive substances. RESULTS: Percentages of lifetime prevalence rates of commonly used substances were tobacco, 54.7%; alcohol, 84.2%; cannabis, 19.7% and inhalants, 7.2%. The corresponding "past use" and "current use" rates were relatively lower but followed the same pattern. The percentage rates were significantly higher in males than females (p < 0.005). Rates for regular use (> 20 days/month) were higher for tobacco (24.7%) than alcohol (11.5%). The lifetime prevalence rates of other drugs (heroin, cocaine, mandrax, amphetamines and LSD) were low (< 5%), while modest rates were recorded for tranquilizers (10.8%), local brews (13.6%) and cough mixtures (35.1%). Less than 20% of respondents initiated substance use in lower primary school, while more than 50% started using in upper primary and secondary school and 11% to 25% started using substances at university. CONCLUSION: Substances most commonly used by respondents studied were of the licit variety (alcohol and tobacco). The rate of use of the two substances is rather high. The use of illicit drugs seems to be growing and may soon escalate to alarming levels. The findings suggest an urgent need to gather more data, which can be used to guide formulation of health promotion and prevention programmes.

United States International University-Africa, Nairobi, Kenya. OBJECTIVE: To investigate the prevalence and pattern of substance use among an undergraduate population in a Kenyan university. DESIGN: Cross-sectional survey, cluster sampling of classrooms, self-administered questionnaires. SETTING: Private international university in Nairobi province, Kenya. PARTICIPANTS: Five hundred fifty eight undergraduate students of both sexes, age range 16-50 and mean age (S.E) of 21.1 +/- 0.2. MAIN OUTCOME MEASURES: Self-reported use of psychoactive substances. RESULTS: Percentages of lifetime prevalence rates of commonly used substances were tobacco, 54.7%; alcohol, 84.2%; cannabis, 19.7% and inhalants, 7.2%. The corresponding "past use" and "current use" rates were relatively lower but followed the same pattern. The percentage rates were significantly higher in males than females (p < 0.005). Rates for regular use (> 20 days/month) were higher for tobacco (24.7%) than alcohol (11.5%). The lifetime prevalence rates of other drugs (heroin, cocaine, mandrax, amphetamines and LSD) were low (< 5%), while modest rates were recorded for tranquilizers (10.8%), local brews (13.6%) and cough mixtures (35.1%). Less than 20% of respondents initiated substance use in lower primary school, while more than 50% started using in upper primary and secondary school and 11% to 25% started using substances at university. CONCLUSION: Substances most commonly used by respondents studied were of the licit variety (alcohol and tobacco). The rate of use of the two substances is rather high. The use of illicit drugs seems to be growing and may soon escalate to alarming levels. The findings suggest an urgent need to gather more data, which can be used to guide formulation of health promotion and prevention programmes.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

n/a

n/a

n/a

n/a

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

n/a

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

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

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

n/a

n/a

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

In contrast with mammalian cells, little is known about the control of Ca2+ entry into primitive protozoans. Here we report that Ca2+ influx in pathogenic Trypanosoma brucei can be regulated by phospholipase A2 (PLA2) and the subsequent release of arachidonic acid (AA). Several PLA2 inhibitors blocked Ca2+ entry; 3-(4-octadecyl)-benzoylacrylic acid (OBAA; IC50 0.4+/-0.1 microM) was the most potent. We identified in live trypanosomes PLA2 activity that was sensitive to OBAA and could be stimulated by Ca2+, suggesting the presence of positive feedback control. The cell-associated PLA2 activity was able to release [14C]AA from labelled phospholipid substrates. Exogenous AA (5-50 microM) also initiated Ca2+ entry in a manner that was inhibited by the Ca2+ antagonist La3+ (100 microM). Ca2+ entry did not depend on AA metabolism or protein kinase activation. The cell response was specific for AA, and fatty acids with greater saturation than tetraeicosanoic acid (AA) or with chain lengths less than C20 exhibited greatly diminished ability to initiate Ca2+ influx. Myristate and palmitate inhibited PLA2 activity and also inhibited Ca2+ influx. Overall, these results demonstrate that Ca2+ entry into T. brucei can result from phospholipid hydrolysis and the release of eicosanoic acids.

The Educational Mission of the Church: An African Perspective

The elderly are predisposed to injuries due to consequences of ageing and presence of disease process commonly seen in the old people. Age-related deterioration of senses such as decrease in hearing capacity, presbyopia, changes in co-ordination, balance, motor strength and postural stability render the elderly vulnerable to environmental hazards. Diseases such as dementia, congestive cardiac failure, postural hypotension, osteoporosis and arthritis further contribute to compound problems of the elderly. Age and chronic factors further blunt the reserves to enable an elderly individual meet the demands of trauma. The challenge to the clinician is to be aware of the subtle changes and deviation from the norm that may suggest development of complications. With careful attention and appropriate physiological support the elderly patient has a good chance of survival. The primary condition must be assessed, necrotic tissues must be debrided by thorough surgical toileting, pus must be drained, wounds sutured and fractures must be set while cardiopulmonary activity must be monitored accurately. The patient should be re-assured, kept warm and adequate analgesia given to relieve pain. Intravascular volume and composition of extracellular fluid must be maintained. Nutritional support should be provided in amounts needed to meet the higher demands of trauma and preferably by oral feeding. Above all multidisciplinary approach to the traumatised elderly is mandatory involving surgeons, physicians, physiotherapists and other paramedical staff and relatives.

Fifteen yearling goats with similar weight were used to evaluate the potential of Zizyphus spina-christi leaves as a supplement to goats fed on Cynodon dactylon grass. Animals were randomly assigned to five feeding regimes and individually stall-fed for a preliminary period of 14 days, followed by 14 days of feeding to determine dry matter intake and digestibility, and a 3-month  feeding period to determine body weight changes. The treatments were formulated based on leaf: grass ratios of 0%, 25%, 50%, 75%, and 100%. Z. spina-christi leaves had higher crude protein and lower fibre content than C. dactylon grass (P<0.05). Dry matter intake, digestibility and body weight changes increased significantly (P < 0.05) as the level of supplementation increased. Thus, Z. spina-christi foliage is a potential feed supplement in the dry season, as the dry season grasses are deficient in the required nutrients and cannot meet goat requirements

J. O. Midiwo, A. Yenesew, B. F. Juma, S. Dereses, J. A. Ayoo, A. Aluoch and S. Guchu There are several described medicinal plants in Kenya from a flora of approximately 10,000 members. Strong cross-medical information from the 42 ethnic groups points to the high potential of some of these species. The Myrsinaceae are well established ethno-anthelmintics and anti-bacterials. They are harbingers of long alkyl side chain benzoquinones which clearly have a protective function from their histochemical disposition. The main benzoquinone in the sub-family Myrsinodae is embelin while for the Maesodae it is maesaquinone together with its 5-acetyl derivative; the distribution of these benzoquinones by their alkyl side chain length or the presence/absence of a 6-methyl group is in accord with morphological sub-family de-limitation. The benzoquinones showed anti-feedant, anti-microbial, phytotoxic, acaricidal, insecticidal and nematicidal activity. Many other benzoquinones of medium and minor concentration were also isolated and characterised. Some plants belonging to the Polygonaceae which are widely used as ethno-anthelmintics have been studied. The common anthelmintic anthraquinones were obtained from all five Rumex species while the naphthalenic acetogenin derivative, nepodin was more selectively distributed. The leaf of Polygonum senegalense is up to 17% surface exudate; about thirteen non polar flavonoid derivatives (chalcones, dihydrochalcones, flavanones and a flavone) have been isolated from it. From the internal aerial tissues of this plant, the major flavonoids were common flavonoids, quercetin, kaempferol, luteolin and their glycosides. The only unique compound isolated from this plant was 2prime-glucosyl-6prime-hydroxy-4prime-methoxydihydrochalcone whose aglycone, uvangolatin is part of the exudate mixture. Other leaf exudate plants studied include the stomach-ache medicine, Psiadia punctulata (Compositae) from which novel methylated flavonoids, kaurene and trachyloban diterpenes have been found

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA, the stain is highly resistant to sulphonamide ointment and other antibiotics. 90% of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns, thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants, antiseptics, and use of effective antibiotics when necessary.

n/a

Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Objective: To carry out an overview of prostate cancer in indigenous back Africans in sub-Saharan Africa and blacks of African ancestry in diaspora.
Data Source: Review of all published literature on prostate cancer on indigenous black Africans and Africans in diaspora was carried out through medline and index medicus searches.
Data Selection: Published data of prostate cancer in indigenous black Africans and black men in diaspora from 1935-2007 were included in the review.
Data Extraction: Abstracts of articles identified were assessed, read and analysed to determine their possible suitability and relevance to the title under review.
Data Synthesis: After establishing relevance from the abstract, the entire paper was read, and the significant points included in the review.
Conclusion: Prostate cancer incidence and magnitude in black Africans was grossly misunderstood and underestimated in the past. Prostate cancer incidence is on the increase and currently is perhaps the most common urological malignancy affecting black Africans. Its incidence and clinical characteristics is similar to that of the Africans in diaspora but different from all other races. There currently exists significant evidence which suggests a common enhancing genetic predisposition in black men to prostate cancer. There is very urgent need for further investigation of this phenomenon through randomised controlled muIticentre studies involving indigenous black Africans and black men in diaspora.

Overview of Principles and Application of Environmental Risk Assessment

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

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.

The World Health Organisation (WHO) Estimates that acute lower respiratory infections account for 4 million deaths per year. The rates are even higher in developing countries. However there is paucity of data on its epidemiology, seasonality and burden in most developing countries. In the contrary, Kenya (a developing country) has an elaborate national epidemio-surveillance network of influenza, where a lot of data is generated on the epidemiology and seasonality of influenza in Kenya and East African region. Several steps have been taken to control influenza in Kenya, including vaccination and surveillance programs. However, some challenges still exist. This article explores the pattern of influenza and existing interventions in Kenya, and highlights suggestions on what can be done to adequately control this virus in future.

The sub-surface is used in most parts of Africa as a repository of human waste and as a source of groundwater through pit latrines and shallow wells respectively. The wells provide freshwater to millions of people in Africa who are either not connected to the piped water or have intermittent supplies. These shallow wells are hand dug and therefore are mostly less than 20 meters in depth. This same sub-surface environment is also used as a repository of human waste through pit latrines. The water points and the sanitation facilities are mostly located close to each other. This study aimed at appraising the groundwater and sanitation challenges based on a rapid survey, sampling, interviews, existing literature review and historical borehole data in Kisumu city, Kenya. Previous studies in the area have shown that the number of shallow wells, city buildings, density of unimproved pit latrines and sanitary risks have increased tremendously between 1999 and 2019. Most of the wells are shallow and therefore prone to contamination by pollutants. Fluoride and chloride content in most boreholes are above the recommended WHO maximum values and the local KEBS standards. The study confirmed that the main water and sanitation challenges in Kisumu are poor and deteriorating water quality, poor waste disposal management systems and poor sanitation services. There is need for the introduction of new and sustainable groundwater approaches supported by scientific models and involving all stakeholders. Current deficiencies in the provision of adequate water and dignified sanitation to the poor in Kisumu can be remedied through improved knowledge on shallow aquifer dynamics and innovative research. It was noted that apart from the donor agencies and multi-national NGOs, the private investors are unwilling to invest in water projects in Kisumu due in part to government legislation that constrains the cost that may be levied on water

The sub-surface is used in most parts of Africa as a repository of human waste and as a source of groundwater through pit latrines and shallow wells respectively. The wells provide freshwater to millions of people in Africa who are either not connected to the piped water or have intermittent supplies. These shallow wells are hand dug and therefore are mostly less than 20 meters in depth. This same sub-surface environment is also used as a repository of human waste through pit latrines. The water points and the sanitation facilities are mostly located close to each other. This study aimed at appraising the groundwater and sanitation challenges based on a rapid survey, sampling, interviews, existing literature review and historical borehole data in Kisumu city, Kenya. Previous studies in the area have shown that the number of shallow wells, city buildings, density of unimproved pit latrines and sanitary risks have increased tremendously between 1999 and 2019. Most of the wells are shallow and therefore prone to contamination by pollutants. Fluoride and chloride content in most boreholes are above the recommended WHO maximum values and the local KEBS standards. The study confirmed that the main water and sanitation challenges in Kisumu are poor and deteriorating water quality, poor waste disposal management systems and poor sanitation services. There is need for the introduction of new and sustainable groundwater approaches supported by scientific models and involving all stakeholders. Current deficiencies in the provision of adequate water and dignified sanitation to the poor in Kisumu can be remedied through improved knowledge on shallow aquifer dynamics and innovative research. It was noted that apart from the donor agencies and multi-national NGOs, the private investors are unwilling to invest in water projects in Kisumu due in part to government legislation that constrains the cost that may be levied on water

The sub-surface is used in most parts of Africa as a repository of human waste and as a source of groundwater through pit latrines and shallow wells respectively. The wells provide freshwater to millions of people in Africa who are either not connected to the piped water or have intermittent supplies. These shallow wells are hand dug and therefore are mostly less than 20 meters in depth. This same sub-surface environment is also used as a repository of human waste through pit latrines. The water points and the sanitation facilities are mostly located close to each other. This study aimed at appraising the groundwater and sanitation challenges based on a rapid survey, sampling, interviews, existing literature review and historical borehole data in Kisumu city, Kenya. Previous studies in the area have shown that the number of shallow wells, city buildings, density of unimproved pit latrines and sanitary risks have increased tremendously between 1999 and 2019. Most of the wells are shallow and therefore prone to contamination by pollutants. Fluoride and chloride content in most boreholes are above the recommended WHO maximum values and the local KEBS standards. The study confirmed that the main water and sanitation challenges in Kisumu are poor and deteriorating water quality, poor waste disposal management systems and poor sanitation services. There is need for the introduction of new and sustainable groundwater approaches supported by scientific models and involving all stakeholders. Current deficiencies in the provision of adequate water and dignified sanitation to the poor in Kisumu can be remedied through improved knowledge on shallow aquifer dynamics and innovative research. It was noted that apart from the donor agencies and multi-national NGOs, the private investors are unwilling to invest in water projects in Kisumu due in part to government legislation that constrains the cost that may be levied on water

This analysis attempted to capture the key economic and financial trends in the budget in the 1995/6 year and to provide the rationale for them. These trends were linked to fundamental requisites for development and sustainable growth.

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.

OBJECTIVE: To identify factors affecting HIV-1 breastfeeding transmission. DESIGN: Longitudinal observational cohort study. METHODS: HIV-1 seropositive pregnant women and seronegative controls were enrolled at a maternity hospital in Nairobi. Women and their children were followed from birth, and data on HIV-1 transmission, breastfeeding, clinical illness, and growth were collected. Specimens for HIV-1 serology and/or polymerase chain reaction were obtained at birth, 2, 6, and 14 weeks, 6, 9, 12, and 18 months, and every 6 months thereafter. Children were classified as HIV-1 uninfected, perinatally, or postnatally infected. Potentially breastfeeding transmission related risk factors were compared between postnatally infected and uninfected children. RESULTS: Among children born to seropositive or seroconverting mothers, 317 were uninfected, 51 infected perinatally and 42 infected postnatally. Identified risk factors for postnatal transmission were maternal nipple lesions (OR = 2.3, CI 95% 1.1-5.0), mastitis (OR = 2.7, CI 95% 1.1-6.7), maternal CD4 cell count < 400 mm3 (OR = 4.4, CI 95% 1.9-9.9), maternal seroconversion while breastfeeding (OR = 6.0, CI 95% 1.8-19.8), infant oral thrush at < 6 months of age (OR = 2.8, CI 95% 1.3-6.2) and breastfeeding longer than 15 months (OR = 2.4, CI 95% 1.2-5.1). All factors, except maternal seroconversion due to its rarity, were independently associated with an increased postnatal transmission risk by multivariate logistic regression analysis. CONCLUSION: In addition perinatal antiretroviral therapies, public health strategies should address: (i) prevention of maternal nipple lesions, mastitis and infant thrush; (ii) reduction of breastfeeding duration by all HIV-1-infected mothers; (iii) absolute avoidance of breastfeeding by those at high risk, and (iv) prevention of HIV-1 transmission to breastfeeding mothers.

If human immunodeficiency virus type 1 (HIV-1) vaccines are to be highly effective, it is essential to understand the virologic factors that contribute to HIV-1 transmission. It is likely that transmission is determined, in part, by the genotype or phenotype (or both) of infectious virus present in the index case, which in turn will influence the quantity of virus that may be exchanged during sexual contact. Transmission may also depend on the fitness of the virus for replication in the exposed individual, which may be influenced by whether a virus encounters a target cell that is susceptible to infection by that specific variant. Of interest, our data suggest that the complexity of the virus that is transmitted may be different in female and male sexual exposures.

For a HIV vaccine to be effective, it will be essential that it protect against the virus variants to which individuals are most frequently exposed. HIV-1 is predominantly a sexually acquired virus, thus, variants in genital secretions are a potentially important reservoir of viruses that are transmitted. Because there are no data available on variants in the genital mucosa, we analyzed this provirus population and compared it to the proviruses in the blood of individuals chronically infected with HIV-1. A major genetic difference between variants within a patient were insertions, which were apparently created by duplication of adjacent sequences, that resulted in acquisition of new potential glycosylation sites in V1 and V2. Comparisons of mucosal and PBMC variants suggest that these tissues harbor distinct, but related populations of HIV-1 variants. In two of three patients, the mucosal variants were most closely related to a minor variant genotype in blood. In a third individual, viruses in both tissues were surprisingly homogeneous, but the majority of variants in the cervix encoded a V1 sequence with a predicted glycosylation pattern similar to a minor variant in blood. The V3 sequence patterns of the mucosal isolates indicate they may be predominantly macrophage-tropic viruses.

Background: Ovarian cancer is the third commonest cause of cancer death from gynaecologic tumors in Kenya. Early disease causes minimal, nonspecific, or no symptoms therefore, most patients are diagnosed when the disease is at an advanced stage. Overall, prognosis for these patients remains poor but has not been described in Kenya.
Objectives: To describe the histological types, therapeutic methods used, therapeutic outcome and the survival rate at 2 years.
Methods: This was a retrospective cross-sectional descriptive study undertaking a 10-year review of case records of patients treated for cancer of the ovary between 1998 and 2008 in Kenyatta National Hospital. Results: Majority of the patients (73.3%) presented with advanced stage of disease (stages III & IV). Epithelial tumors (86.2%) are the commonest histological type, with 45.7% of them being serous type. Chemotherapy was the most (46.0%) used therapeutic option, with vomiting and diarrhea being the leading morbidity associated with it. Survival at 2 yrs from diagnosis was 50% as per the Kaplan-Meier time survival estimate.
Conclusion: There is need to improve the quality of data on cancer care and information systems in general to provide a reliable source of information to guide research and policy in oncology. Further, the late presentation to hospital calls for innovative strategies to improve ovarian cancer awareness and uptake of screening tests. There is need to lobby Governments in resource limited setting to subsidize cancer of the ovary care and invest in lower level health facilities to promote early diagnosis and decongest the referral hospital.

As African countries scale-up couples HIV testing, little is known about sexual behaviors and HIV risk for HIV-uninfected partners in known HIV-serodiscordant relationships.

As African countries scale-up couples HIV testing, little is known about sexual behaviors and HIV risk for HIV-uninfected partners in known HIV-serodiscordant relationships.

Objective
To describe the presentation and surgical care of patients managed for cleft lips and palates during a surgical outreach program..
Study design
A five year retrospective chart study of the patients operated on between January 2005 to the 31st December 2009 in selected hospitals in Kenya.
Setting
Smile train-facilitated surgical outreach programs at the following hospitals: St Elizabeth Mission Hospital Mukumu, St Francis Mission Hospital, Mwiki, Embu Provincial General hospital , Isiolo District Hospital.and Alupe Subdistrict Hospital.
Subjects
One hundred and sixty three patients with cleft lips and palates.
Results
The male female ratio was 1.3 to 1. Left unilateral cleft lip was the most common malformation (34.6% of the patients) with modified Millards repair the most frequent surgical procedure. More than 30% of the patients operated on had attained their fifth birthday. There were eight complications for every 100 procedures. Palatal fistulae were the most common complications.
Conclusion
The overall pattern of deformity encountered and the morbidity profile correlate with other studies. There is need to intensify more outreach programs to capture younger patients and address the backlog of cleft cases in the community.

n/a

Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.