Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation. OBJECTIVE: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital. DESIGN: Descriptive cross-sectional study. SETTING: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005. RESULTS: Twenty nine patients had been diagnosed and managed for TMJ dislocation. Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature. The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accounting for fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposing factors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderance with bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons' why conservative modalities are least employed in the management of TMJ dislocation in our setup and what can be done about it.

E-procurement has recently been introduced in the Kenyan public sector due to the many practical advantages it brings. Usage of the system is still at a very nascent stage. This paper sought to predict e-procurement utilization by analyzing the constructs of the Extended Technology Acceptance Model. The study administered a questionnaire to 229 employees of the 11independent commissions in the country. Regression analysis was done to describe the significance and the strength of relationships between variables. The analysis yielded important findings that partially support research hypotheses. The results indicated that subjective norm and reliability of the system influence utilization of the system while compatibility was insignificant. All the identified elements have correlations with the model elements and in turn impact on the behavioral intention to use the system. This study would influence government technology plans through implementation of policies that enhance adoption of emerging technologies in the public sector.

A century ago, Cajal noted striking similarities between the neural circuits that underlie vision in vertebrates and flies. Over the past few decades, structural and functional studies have provided strong support for Cajal’s view. In parallel, genetic studies have revealed some common molecular mechanisms controlling development of vertebrate and fly visual systems and suggested that they share a common evolutionary origin. Here, we review these shared features, focusing on the first several layers - retina, optic tectum (superior colliculus) and lateral geniculate nucleus in vertebrates, and retina, lamina and medulla in fly. We argue that vertebrate and fly visual circuits utilize common design principles, and that taking advantage of this phylogenetic conservation will speed progress in elucidating both functional strategies and developmental mechanisms, as has already occurred in other areas of neurobiology ranging from electrical signaling and synaptic plasticity to neurogenesis and axon guidance.

A century ago, Cajal noted striking similarities between the neural circuits that underlie vision in vertebrates and flies. Over the past few decades, structural and functional studies have provided strong support for Cajal's view. In parallel, genetic studies have revealed some common molecular mechanisms controlling development of vertebrate and fly visual systems and suggested that they share a common evolutionary origin. Here, we review these shared features, focusing on the first several layers-retina, optic tectum (superior colliculus), and lateral geniculate nucleus in vertebrates; and retina, lamina, and medulla in fly. We argue that vertebrate and fly visual circuits utilize common design principles and that taking advantage of this phylogenetic conservation will speed progress in elucidating both functional strategies and developmental mechanisms, as has already occurred in other areas of neurobiology ranging from electrical signaling and synaptic plasticity to neurogenesis and axon guidance.

Virus Research Centre, Kenya Medical Research Institute, Nairobi, Kenya. PMID: 8903238 [PubMed - indexed for MEDLINE]

OBJECTIVES: To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa. METHODS: Before the start of a pre-exposure prophylaxis trial, HIV-1 negative volunteers were screened for sexually transmitted infection (STI) including CT and NG, using a highly sensitive and specific nucleic acid amplification test. Samples positive for CT by Aptima testing, were evaluated for the presence of lymphogranuloma venereum (LGV) serovars using an in-house PCR assay. All men were asked to submit a urine specimen, and all had a rectal swab collected by a clinician. Men were asked if they had dysuria, urethral or rectal discharge, or rectal pain. RESULTS: 43 HIV-1 negative MSM were screened, of whom 13 reported sex with men only; the majority (27/43) reported sex work. One volunteer had dysuria and another, rectal pain. Eleven MSM (26%, 95% CI 14% to 41%) had infections with either or both pathogens. Homosexual men had a higher prevalence of any infection than bisexual men (46% vs 17%, p=0.04), and all cases of rectal infections, including one with CT, two with NG and two with CT/NG co-infection. All patients with CT were negative for LGV. One patient with a rectal NG infection reported rectal pain. CONCLUSIONS: A remarkably high burden of STI infection was found among HIV-1 negative MSM. Most (12/13) infections, including three of four rectal NG infections, were subclinical. These findings suggest that high-risk MSM will benefit from effective STI screening in Kenya.

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.

n/a

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

No abstract available.

Mwaura F, K M Mavuti and W N Wamicha. . :

Department of Veterinary Medicine, Faculty of Veterinary Medicine, Makerere University, Kampala, Uganda. Pulmonary oedema is a common sign of East Coast fever (ECF, Theileria parva infection) of cattle. A trial was conducted on farms in Uganda to compare a product containing both the antitheilerial compound parvaquone and the diuretic compound frusemide with one containing only parvaquone, in the treatment of ECF. The trial involved 40 clinical cases of ECF, some of them complicated by other infections, in cattle of all ages and on several farms. Confirmed cases were treated with either parvaquone+frusemide (P+F) or parvaquone alone (P). Survival after treatment with P+F was 77% compared with 71% with P. Five of the 10 fatalities were complicated cases. The cure rate for severe but uncomplicated ECF was 89% with P+F and 40% with P. Pulmonary signs were resolved within 24-48 h after treatment with P+F and clinical recovery was noticeably more rapid than with P. The antiparasitic effect of the two treatments was similar. P+F could be particularly useful when reporting, diagnosis or laboratory confirmation of ECF is delayed, because advanced cases are more likely to be encountered under these circumstances.

Objective: To determine the pattern of breast disease at Kenyatta National Hospital (KNH) Study design:    Retrospective descriptive study Study setting:    Kenyatta National Hospital, a University teaching and National Referral Hospital Patients: Records of 1172 patients were reviewed. Results: An average 469 new patients per year or 11 new patients per clinic visit were seen at the clinic over a two and a half year period. Females predominated (98.9%) in this series. The mean age was 34.71 years (range 1 to 96 years). The average age at menarche was 14.49 years and the mean duration of symptoms was 6.86 months. Only 2.6% of 843 patients had a positive family history of breast disease. Fibroadenoma was the commonest diagnosis made (33.2%) followed by ductal carcinoma (19.7%). Gynaecomastia was the most common lesion seen in males. Two thirds of patients presenting with tumors had masses measuring more than 5cm.  Overall five conditions (fibroadenoma, ductal carcinoma, breast abscesses, fibrocystic disease and mastalgia) accounted for over 85% of all breast ailments. Surgery formed the main stay of care in over 80% of patients. Conclusions: The pattern of breast diseases at KNH closely mirrors those reported in other studies in the region and beyond. This study indicates that a large proportion of patients presenting with breast disease are treated initially by surgery. It may be wise to consider other alternative forms of therapy where appropriate. The Annals of African Surgery: 2008 June; Vol 2, pg 97-101.

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

No abstract available.

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

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

No abstract available.

Ministry of Health, Government of Kenya, Nairobi.
In 1982, a study of health worker knowledge, attitudes and practices with respect to breastfeeding was undertaken in Kenya. A breastfeeding promotion campaign ensued, in which training of health workers was a major component. In 1989, the impact of this campaign was evaluated through a survey examining changes in health worker knowledge, attitudes and practices. The survey showed that considerable improvements in knowledge and substantial improvements in hospital practices have occurred, although none of these could be attributed to any single element of the breastfeeding promotion programme. Particularly undesirable practices which were common in 1982, such as separation of mother and baby, formula feeding and use of bottles have virtually disappeared from Kenyan hospitals. Recommendations regarding future programme directions are made.
PMID: 1433448 [PubMed - indexed for MEDLINE]

No abstract available.

No abstract available.

Mwaura F, K M Mavuti and W N Wamicha. . :

Department of Veterinary Medicine, Faculty of Veterinary Medicine, Makerere University, Kampala, Uganda. Pulmonary oedema is a common sign of East Coast fever (ECF, Theileria parva infection) of cattle. A trial was conducted on farms in Uganda to compare a product containing both the antitheilerial compound parvaquone and the diuretic compound frusemide with one containing only parvaquone, in the treatment of ECF. The trial involved 40 clinical cases of ECF, some of them complicated by other infections, in cattle of all ages and on several farms. Confirmed cases were treated with either parvaquone+frusemide (P+F) or parvaquone alone (P). Survival after treatment with P+F was 77% compared with 71% with P. Five of the 10 fatalities were complicated cases. The cure rate for severe but uncomplicated ECF was 89% with P+F and 40% with P. Pulmonary signs were resolved within 24-48 h after treatment with P+F and clinical recovery was noticeably more rapid than with P. The antiparasitic effect of the two treatments was similar. P+F could be particularly useful when reporting, diagnosis or laboratory confirmation of ECF is delayed, because advanced cases are more likely to be encountered under these circumstances.

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

No abstract available.

Objective: To determine the extent and nature of delayed presentation of patients treated for breast cancer at  Kenyatta National Hospital (KNH). Design : Prospective cross sectional study. Setting: Kenyatta National Hospital (KNH) which is a Tertiary, Teaching and Referral hospital in Nairobi, Kenya Patients and methods: All patients attending the KNH breast clinic or admitted to the 3 surgical wards for the first time with a cytologically or histologically proven diagnosis of late stage breast cancer (Manchester Classification  1940 stage III and IV) were entered into the study. The study covered a two and a half year period starting the 1st of October 2003. Results:  A total of 166 patients were recruited into the study.  The mean age was 47 years with a range between 17 and 88 years. Females constituted 98.8%. The female study population had an average of 4.5 children per subject with a median of 4 and a range of 0-11. A lump as the first noticed symptom was seen in 87.3% and 52.1% were pre-menopausal.  Only 11 (6.62%) patients presented within 30 days of discovering their breast symptom, 34 (20.4%) presented between thirty and ninety days and the remaining 115 (73.1%) presented three months after noticing their symptom. Three reasons accounted for 67.5% of the delay. 33 (19.9%) kept away fearing that they would be told they had cancer while 39 (23.5%) presented late because their breast symptom was painless.  Another 40 (24.1%) said they had earlier visited medical personnel who had reassured them that their symptoms were benign. Conclusion:  Majority of patients treated for advanced breast disease presented to the health care providers at KNH more than three months after noticing their breast symptom and a sizeable number of patients are being reassured falsely that they have benign disease without the benefit of biopsy.   East African  Medical Journal Vol. 87 No. 4 April 2010

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

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

No abstract available.

Ministry of Health, Government of Kenya, Nairobi.
In 1982, a study of health worker knowledge, attitudes and practices with respect to breastfeeding was undertaken in Kenya. A breastfeeding promotion campaign ensued, in which training of health workers was a major component. In 1989, the impact of this campaign was evaluated through a survey examining changes in health worker knowledge, attitudes and practices. The survey showed that considerable improvements in knowledge and substantial improvements in hospital practices have occurred, although none of these could be attributed to any single element of the breastfeeding promotion programme. Particularly undesirable practices which were common in 1982, such as separation of mother and baby, formula feeding and use of bottles have virtually disappeared from Kenyan hospitals. Recommendations regarding future programme directions are made.
PMID: 1433448 [PubMed - indexed for MEDLINE]

No abstract available.

Management Sciences for Health, Boston, MA 02130, USA.
An increasing number of countries are exploring the introduction or expansion of autonomous hospitals as one of the numerous health reforms they are introducing to their health system. Hospital autonomy is one of the forms of decentralization that is focused on a specific institution rather than on a political unit. It has gained much interest because it is an attempt to amalgamate the best elements of the public and private sectors in how a hospital is governed, managed and financed. This paper reviews the key elements of the concept of hospital autonomy, the reasons for its expanded use in many countries and a specific example of making a major teaching hospital autonomous in Kenya. A review of the successful experience of Kenyatta National Hospital and its process of introducing autonomy, with regard to governance, operations and management, and finances, lead to several conclusions on replicability. The legal framework is a critical element for successfully structuring the autonomous hospital. Additionally, success is highly dependent on the extent to which there is adequate funding during the process of attaining autonomy due to the length of the transition period needed. Autonomy must be granted within the context of the national health system and national health objectives and be consistent with those aims and their underlying societal values. Finally, as with decentralization, success is dependent upon the preparation done with the systems and management necessary for the proper governance and operation of autonomous hospitals.
PMID: 10538935 [PubMed - indexed for MEDLINE]

No abstract available

Mwaura F, K M Mavuti and W N Wamicha. . :

Department of Veterinary Medicine, Faculty of Veterinary Medicine, Makerere University, Kampala, Uganda. Pulmonary oedema is a common sign of East Coast fever (ECF, Theileria parva infection) of cattle. A trial was conducted on farms in Uganda to compare a product containing both the antitheilerial compound parvaquone and the diuretic compound frusemide with one containing only parvaquone, in the treatment of ECF. The trial involved 40 clinical cases of ECF, some of them complicated by other infections, in cattle of all ages and on several farms. Confirmed cases were treated with either parvaquone+frusemide (P+F) or parvaquone alone (P). Survival after treatment with P+F was 77% compared with 71% with P. Five of the 10 fatalities were complicated cases. The cure rate for severe but uncomplicated ECF was 89% with P+F and 40% with P. Pulmonary signs were resolved within 24-48 h after treatment with P+F and clinical recovery was noticeably more rapid than with P. The antiparasitic effect of the two treatments was similar. P+F could be particularly useful when reporting, diagnosis or laboratory confirmation of ECF is delayed, because advanced cases are more likely to be encountered under these circumstances.

Department of Veterinary Medicine, Faculty of Veterinary Medicine, Makerere University, Kampala, Uganda. Pulmonary oedema is a common sign of East Coast fever (ECF, Theileria parva infection) of cattle. A trial was conducted on farms in Uganda to compare a product containing both the antitheilerial compound parvaquone and the diuretic compound frusemide with one containing only parvaquone, in the treatment of ECF. The trial involved 40 clinical cases of ECF, some of them complicated by other infections, in cattle of all ages and on several farms. Confirmed cases were treated with either parvaquone+frusemide (P+F) or parvaquone alone (P). Survival after treatment with P+F was 77% compared with 71% with P. Five of the 10 fatalities were complicated cases. The cure rate for severe but uncomplicated ECF was 89% with P+F and 40% with P. Pulmonary signs were resolved within 24-48 h after treatment with P+F and clinical recovery was noticeably more rapid than with P. The antiparasitic effect of the two treatments was similar. P+F could be particularly useful when reporting, diagnosis or laboratory confirmation of ECF is delayed, because advanced cases are more likely to be encountered under these circumstances.

No abstract available.

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

No abstract available.

Ministry of Health, Government of Kenya, Nairobi. In 1982, a study of health worker knowledge, attitudes and practices with respect to breastfeeding was undertaken in Kenya. A breastfeeding promotion campaign ensued, in which training of health workers was a major component. In 1989, the impact of this campaign was evaluated through a survey examining changes in health worker knowledge, attitudes and practices. The survey showed that considerable improvements in knowledge and substantial improvements in hospital practices have occurred, although none of these could be attributed to any single element of the breastfeeding promotion programme. Particularly undesirable practices which were common in 1982, such as separation of mother and baby, formula feeding and use of bottles have virtually disappeared from Kenyan hospitals. Recommendations regarding future programme directions are made. PMID: 1433448 [PubMed - indexed for MEDLINE]

No abstract available.

If we are committed to the health and development of children, we need to recognize that the vast majority of the world's women are working women. In Africa, 80% of the women are actively engaged in economic activities outside the home. The "economic miracle" in Southeast Asia was made possible by the nimble fingers of thousands of women working in textile and electronics factories. There is need for pre-day-care advocacy for infants, through promotion of breast feeding and maternity leave. When the mother returns to work, the standard of the International Labor Organization should be applied, namely" ...the care of children while the parents are working cannot be ignored because it forms a focal point on which three main concerns of development policy–work, health, and education–converge." Several principles emerged from the presentations in the international panel: 1. Child-care programs must be community based, using the resources of the families and the community organizations themselves. 2. Programs require the active involvement of the communities, women's groups, and other partners. 3. Programs are modified by innovations created by community organizations, universities, and other groups. 4. Programs require the mobilization of trained young men and women into the field of early childhood education and development. This international panel provided an overall uniting theme, that throughout the world the hope for the survival and better life for children unites parents of every country and every creed. This is one of the most powerful and strongest motivational resources in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract available

The extra hepatic portion of the portal vein has been known to physiologically act as a capacitance vessel while its intra hepatic portion behaves as a resistance vessel. However, the histological basis for these observations has not been clearly defined. The aim of this study was therefore to describe the histological organization of the portal vein in reference to the observed functional differences in its intra- and extra hepatic portions. Sections of the portal vein were harvested from 24 livers during autopsies at the Chiromo funeral parlor, University of Nairobi, Kenya. They were processed for light microscopic histological evaluation. The structure of both portions was then noted and described. The extra hepatic portion had circular, oblique and longitudinal muscle bundles in its tunica intima, media and adventitia respectively. On the other hand, the intra hepatic portion had abundant fibro-elastic fibers with longitudinal smooth muscles scattered in their tunica media and adventitia. From the results of the current study, the functional differences of both the extra-hepatic and intra-hepatic portions of the PV are accounted for by their different histological structures.

This retrospective study aimed to determine the incidence of fractures affecting the distal limbs of racehorses and their outcomes. A total of 387 radiographs each showing at least one significant bone lesion were examined. These radiographs were from racehorses examined in the period starting 1st January 2005 to 31st December 2014 at the Equine Clinic of the Jockey Club in Kenya. Radiographs showing all types of fractures were retrieved from the records archive and evaluated. Fractures accounted for 23.5% (91/387) of the cases studied and out of these, 56.0% (n=51) were of the distal limb. The commonest distal limb fractures occurred in the phalangeal bones (47.1%, n=24), followed by the proximal sesamoid bones (27.4%, n=14), metacarpal bones (19.6%, n=10) involving mainly metacarpus IV (50.0%, n=5) and metacarpus III (40.0%, n=4), navicular bones (3.9%, n=2) and metatarsal bone (2.0%, n=1). Of the phalangeal fractures, 45.8% (n=11) were chip fractures, while 41.7% (n=10) were single line fractures. Overall, horses with fractures involving the distal limb had a higher incidence for retirement (74.5%, n=38) compared to those that returned to racing (25.5%, n=13). Out of these distal limb fractures, those of the proximal sesamoid bones had a higher incidence for retiring from racing at 85.7% (n=12), while cases of navicular bone fractures that were only 2 retired from racing. The study concluded that among the distal limb fractures occurring in racehorses in Kenya, phalangeal fractures are the commonest particularly those affecting the third phalanx. Racehorses with distal limb fractures in Kenya have a high likelihood of retiring

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

In this paper, we report an outbreak of bovine trypanosomiasis in Kurmuk District, Blue Nile State, Sudan that involved an infection with four Trypanosoma species in cattle. The outbreak occurred in June 2010 when indigenous cattle, mainly Kenana and Fulani breed types, crossed the national Sudanese border to Ethiopia and returned. A veterinarian was notified of massive deaths in the cattle populations that recently came from Ethiopia. All animals involved in the outbreak were from the nomadic Fulani group and resident local cattle were not infected and no death has been reported among them. A total of 210 blood samples were collected from the ear vein of cattle. A few samples were also collected from other domestic animals species. Parasitological examinations including hematocrit centrifugation techniques (HCT) and Giemsa-stained thin blood films were carried out. ITS1-PCR, which provides a multi-species-specific diagnosis in a single PCR, was performed.

Theileria parva is a parasitic protozoan that causes East Coast fever (ECF), an economically important disease of cattle in eastern, central and southern Africa. In South Sudan, ECF is considered a major constraint for livestock development in regions where the disease is endemic. To obtain insights into the dynamics of T. parva in South Sudan, population genetic analysis was performed. Out of the 751 samples included in this study, 178 blood samples were positive for T. parva by species-specific PCR, were collected from cattle from four regions in South Sudan (Bor = 62; Juba = 45; Kajo keji = 41 and Yei = 30) were genotyped using 14 microsatellite markers spanning the four chromosomes. The T. parva Muguga strain was included in the study as a reference. Linkage disequilibrium was evident when populations from the four regions were treated as a single entity, but, when populations were analyzed separately, linkage disequilibrium was observed in Bor, Juba and Kajo keji. Juba region had a higher multiplicity of infection than the other three regions. Principal components analysis revealed a degree of sub-structure between isolates from each region, suggesting that populations are partially distinct, with genetic exchange and gene flow being limited between parasites in the four geographically separated populations studied. Panmixia was observed within individual populations. Overall T. parva population genetic analyses of four populations in South Sudan exhibited a low level of genetic exchange between the populations, but a high level of genetic diversity within each population.

n/a

Every clinical trial should be planned. This plan should include the objective of trial, primary and secondary end-point, method of collecting data, sample to be included, sample size with scientific justification, method of handling data, statistical methods and assumptions. This plan is termed as clinical trial protocol. One of the key aspects of this protocol is sample size estimation. The aim of this article is to discuss how important sample size estimation is for a clinical trial, and also to understand the effects of sample size over- estimation or under-estimation on outcome of a trial. Also an attempt is made to understand importance of minimum sample to detect a clinically important difference. This article is also an attempt to provide inputs on different parameters that impact sample size and basic rules for these parameters with the help of some simple examples.

Every clinical trial should be planned. This plan should include the objective of trial, primary and secondary end-point, method of collecting data, sample to be included, sample size with scientific justification, method of handling data, statistical methods and assumptions. This plan is termed as clinical trial protocol. One of the key aspects of this protocol is sample size estimation. The aim of this article is to discuss how important sample size estimation is for a clinical trial, and also to understand the effects of sample size over- estimation or under-estimation on outcome of a trial. Also an attempt is made to understand importance of minimum sample to detect a clinically important difference. This article is also an attempt to provide inputs on different parameters that impact sample size and basic rules for these parameters with the help of some simple examples.

Every clinical trial should be planned. This plan should include the objective of trial, primary and secondary end-point, method of collecting data, sample to be included, sample size with scientific justification, method of handling data, statistical methods and assumptions. This plan is termed as clinical trial protocol. One of the key aspects of this protocol is sample size estimation. The aim of this article is to discuss how important sample size estimation is for a clinical trial, and also to understand the effects of sample size over- estimation or under-estimation on outcome of a trial. Also an attempt is made to understand importance of minimum sample to detect a clinically important difference. This article is also an attempt to provide inputs on different parameters that impact sample size and basic rules for these parameters with the help of some simple examples.

n/a

n/a

n/a

The negative appendicectomy rates have remained high. The integration of clinical scores into the diagnostic process in acute appendicitis has had the purposes of improving decision making and reducing the negative rates in this common condition. The performance of these score systems have however, not been uniform.

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.

CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce.

Background
The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges.
Method
Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was mortality while secondary outcomes included recurrence rates, time to recurrence and the patient, disease and treatment factors associated with mortality and recurrence. Kaplan Meir charts were charted for survival trends.
Results
Half of the lesions were located in the rectum. There was no relationship between the sub-site location and recurrence and mortality. The mean follow-up period was 15.9 months. Overall recurrency and mortality rates were 37.5% and 29.4% respectively. Most recurrences occurred within one year of surgery. Recurrence was not influenced by age, gender, sub-site, chemotherapy receipt or presence of comorbidity.
Factors significantly associated with mortality included the
male gender ( p 0.04), presence of co-morbidity (p 0.029), recurrence (p 0.001), curative intent (p 0.01), disease stage (p 0.036) and receipt of chemotherapy ( p< 0.01).
Conclusion
Follow up of colorectal cancer patients is still challenging. The mortality and recurrence rates are high for the short follow up periods. Further studies are needed to explore the determinants of both survival and recurrences, especially with longer follow ups.

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.

Hollow fiber membrane is the latest and advanced gas separation technology currently employed in the gas industries. Malaysia which is rich in natural resources has huge natural gas reserves amounting to more than 5 Trillion Standard Cubic Feed (5 TSCF). Membrane Research Unit has produced a hollow-fiber module by using locally made spinneret which is capable of producing hollow fiber membranes using a wet-spinning method. This module contains hollow fiber membranes with surface area of 72.22cm2. The module is utilised in the existing membrane gas separation pilot plant (MGSPP) for performance test. The performance of third module was based on its permeation rate and selectivity for each pure gases tested namely N2, CO2 and O2. Based on the result obtained the module has the capability to separate CO2 from natural gas, helium recovery in Enhanced Oil Recovery (EOR), nitrogen and oxygen recovery in the production of urea.

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30 year old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored.

BACKGROUND: The onset of colorectal cancer appears to be two to three decades earlier in developing countries. Data on whether colorectal cancer in the young has worse prognosis than in older patients is conflicting.
METHOD: Clinical charts of 70 patients ≤40 years old were reviewed to determine clinical and pathological patterns and treatment outcomes. Their data were compared with a
larger group of older patients treated between 1993-2005 at Kenyatta National Hospital in Nairobi, Kenya.
RESULTS: The data retrieval was highest for sub-site distribution and lowest for pathology information. Patients ≤ 40 years of age comprised 27.3% of all colorectal cancer
cases treated over the study period. There were 41 males (58.6%) and 29 (41.4%) females patients. The most common symptoms were abdominal pain (76.9%), change in bowel habit
(71.4%) and rectal bleeding (54.3%). The mean duration of symptoms was 24.6 ± 30 months. The rate of advanced colorectal disease (Duke C and D) was 73.5%. Mean follow-up time was 5.8 months with median survival of only 6.9
months. The Duke staging, histology, symptom duration, locations of tumours, follow-up and the complication rates were similar for young and older patients.
CONCLUSION: Younger patients form a significant proportion of colorectal cancer burden. Both the clinico-pathological
characteristics and treatment outcome correspond to older individuals. It is suggested that the concluded colorectal symptoms in younger patients should also be aggressively
evaluated including early endoscopy. A prospective follow-up study of patients with the disease will unravel the true survival picture.

The functional significance of myocardial bridging remains controversial. The bridge morphology and structure of the tunneled vessels may modify its ultimate clinical effects.

n/a

OBJECTIVE: To evaluate the clinical and epidemiological data on automobile injuries and to assess the adequacy of road trauma documentation at the Nairobi Hospital. DESIGN: A retrospective descriptive study. SETTING: The Accident and Emergency Centre of the Nairobi Hospital. SUBJECTS AND METHOD: Medical records of randomly selected road trauma patients who presented at The Accident Centre between 1st July 1997 and 31st August 1998 were analysed. RESULTS: The mean age was 32 years with a peak incidence in the 21-30 year age group. Males comprised 63.1% of the injured. The predominant category of the road user injured was the vehicle occupant (70%). Pedestrians only constituted 21.3%. Major city roads or highways were the commonest scenes of injury (38.3%). Most of the responsible vehicles were small personal cars (65.8%). The public service minibuses (popularly known as matatu) caused 20% of the injuries. Most of the injuries were mild and transport of the injured to hospital was uniformly haphazard. A quarter of the injuries were severe enough to warrant admission. Trauma documentation was poor with less than 30% accuracy in most parameters. CONCLUSION: The pre-hospital and initial care of the injured is not systematized. The study calls for re-orientation of trauma care departments to the care of the injured.

n/a

Background: Elderly patients have worse outcomes for similar severity when compared to younger trauma patients. Elderly patients form smaller proportions of the trauma population in the developing world in comparison to high in-come countries. Due to limited data capabilities, elderly trauma has been infrequently studied. Objective: To describe the common injuries that afflict elderly trauma patients associated resource utilization and the determinants of outcome in Kenyan urban hospital. Methods: Seventy two patients aged 60 years and older admitted for trauma from diverse mechanisms, were recruited over a period of one year (November 2009-December 2010). Data on the specific mecha-nism and type of injury, age, sex, intensive care unit (ICU) use, hospital length of stay, and cost were recorded. Survi-vors and those who died during admission were compared to determine associated factors. Elderly patients were also compared to younger trauma patients to determine significant group peculiarities using X2 analysis or Fisher’s exact test as appropriate. Results: Elderly trauma cases (mean age 70.5 + 9.1 years) formed 4.5% of all trauma admissions during the study period. The intent was accidental in 84.7% of cases. The predominant mechanisms of injury were traf-fic (44.4%) and falls (41.7%). Females comprised 41.7% of all patients and lower limb fractures predominated (54.9%). The average injury severity score was 7.82 + 4.4. (median 9.0). The proportion admitted to the ICU was 6%. The me-dian length of hospital stay was 24 days, cost of treatment Kshs. 27,153 Kenya shillings and overall hospital mortality rate was 13.9% (25% for ISS > 15). Only gender and head injury were predictors of mortality. Conclusions: Traffic and falls are the predominant mechanisms in geriatric trauma in Kenya. Unique features of geriatric trauma are higher fe-male involvement, prolonged length of hospital stay and fewer predictors of mortality compared to younger patients.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy.