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2015

Freund, JE, Yuko-Jowi C, Freund MW.  2015.  Transcatheter embolization of a large aneurysm in a congenital coronary cameral fistula from the left coronary artery to the right ventricle., 2015 Feb 15. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 85(3):435-9. Abstracttranscatheter_embolization_of_a_large_aneurysm_in_a_congenital_coronary_cameral_fistula_from_the_left_coronary_artery_to_the_right_ventricle_abstract.pdfWebsite

A congenital coronary cameral fistula (CCCF) is characterized by left ventricular dysfunction, electrocardiographic changes due to a reduced left coronary blood flow and impaired physical activity. CCCF's with a giant aneurysm are very rarely seen. The presence of a giant aneurysm imposes even greater health risks. We report a case of a CCCF from the left coronary artery to the right ventricle with a large distal aneurysm in a 20-year-old woman that we closed percutaneously with coils for the closure of ventricular septal defects (VSD) and persistent ductus arteriosus (PDA).

2012

G. K. Korir1, B. O. Ochieng, J. S. Wambani, I. K. Korir, Jowi YC.  2012.  RADIATION EXPOSURE IN INTERVENTIONAL PROCEDURES . Radiat Prot Dosimetry (2012) doi: 10.1093/rpd/ncs072 . Abstract

Abstract

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2®) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm2, while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification.

2010

Yuko-Jowi C, Mukhwana R, FE. O.  2010.  Multifocal pheochromocytoma in early childhood: case report.. East Afr Med J. 2010 Jun;87(6):269-72.. Abstract

Abstract

A three and a half year old male with multifocal phaeochromocytoma involving the right adrenal gland and an intrathoracic mass is presented. Twenty four hour vanillylmandelic acid (VMA) was negative despite suggestive symptomatology. The diagnosis was made on serial CT scans of the head, thoracic inlet and pelvis. He underwent right adrenalectomy and thoracotomy to remove the abdominal and intrathoracic mass. The diagnosis was confirmed by histology. He remained hypertensive on hefty antihypertensive doses throughout his lifespan and finally succumbed to status epilepticus at the age of ten, six years from the time of diagnosis.

PMID:
23057270
[PubMed - indexed for MEDLINE]

2009

Lang'o MO, Githanga JN, CA. Y-J.  2009.  Prevalence of iron deficiency in children with cyanotic heart disease seen at Kenyatta National Hospital and Mater Hospital Nairobi. . East Afr Med J. 2009 Dec;86(12 Suppl):S47-51.. Abstract

Abstract
OBJECTIVE:

To establish the prevalence of iron deficiency among children with cyanotic heart disease.
DESIGN:

Cross-sectional study.
SETTING:

The study was carried out at Kenyatta National Hospital and Mater Hospital from August to December of 2007. A total of 112 children meeting the eligibility criteria were recruited from the wards and the cardiac clinics.
SUBJECTS:

These were children less than 18 years of age, with cyanotic heart disease confirmed on ECHO, presenting at the paediatric cardiac clinic of the two hospitals or admitted in the wards at Kenyatta National Hospital. These were patients who had not undergone surgical correction.
RESULTS:

The prevalence of iron deficiency was found to be 16.9% (95% CI 9.8-24.1%).
CONCLUSION:

There is a high prevalence of iron deficiency among patients with congenital heart disease with cyanosis in the two institutions. Routine screening for iron deficiency is recommended for these children and those found to be deficient should be treated.

PMID:
21591509
[PubMed - indexed for MEDLINE]

Shiroya-Wandabwa M, Yuko-Jowi C, Nduati R, Obimbo E, D. W.  2009.  Risk factors for cardiac dysfunction in children on treatment for cancer at Kenyatta National Hospital, Nairobi. . East Afr Med J. 2009 Dec;86(12 Suppl):S52-7.. Abstract

Abstract
OBJECTIVE:

To determine the point prevalence of abnormal cardiac function and to assess the risk factors for cardiac dysfunction in paediatric oncology patients on treatment at Kenyatta National Hospital.
DESIGN:

Descriptive cross-sectional study with a nested case control.
SETTING:

Kenyatta National Hospital between February and April 2006.
MAIN OUTCOME MEASURES:

Left ventricular dysfunction if ejection fraction (EF) <55% or fractional shortening (FS) <29% defined cases. Controls had EF >55% or FS >29%.
RESULTS:

One hundred and eleven patients were enrolled of whom 32 had abnormal cardiac function and were classified as cases while 79 had normal cardiac function. About a third, point prevalence 29% (95% CI 21.2-37.9), had cardiac dysfunction. Cumulative anthracycline dose was a risk factor for cardiac dysfunction in this population. Above 200 mg/m2 the attributable risk percentage of cardiac dysfunction was 77%.
CONCLUSIONS:

Serial echocardiography should be performed to identify patients at risk. Alternative treatment protocols should be used when the cumulative anthracycline dose exceeds 200 mg/m2 due to the high attributable risk. Studies to further assess the other associated risk factors and long term effects of anthracycline are recommended.

PMID:
21591510
[PubMed - indexed for MEDLINE]

2005

YUKO-, DRJOWICHRISTINEA.  2005.  Echocardiographic patterns of juvenile rheumatic heart disease at the Kenyatta National Hospital, Nairobi. East Afr Med J . 2005 Oct; 82 ( 10 ): 514-9 . PMID: 16450679 [PubMed - indexed for MEDLINE] Yuko-Jowi C, Bakari M.. East Afr Med J . 2005 Oct; 82 ( 10 ): 514-9 .. : uon press Abstract
Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya. OBJECTIVE: To describe the echocardiographic features of children with rheumatic heart disease seen at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: The Kenyatta National Hospital Heart Unit. SUBJECTS: Patients aged 20 years and less with echocardiographic diagnosis of rheumatic heart disease. RESULTS: Two hundred and twenty four echocardiograms were analysed. Seventy six point four of cases were aged between 5 and 15 years, while on 3% were less than five years. The combinations mitral and aortic regurgitation was the most common lesion followed by isolated mitral regurgitation. Isolated aortic regurgitation was as rare as isolated mitral stenosis in the paediatric age group 1.8% and 2.7% respectively. When seen in the younger age group, the leaflet morphology in mitral regurgitation was predominantly thickening and clubbing of the leaflets while in the older children the pathology was of marked fibrosis of the sub-valvular apparatus. Leaflet prolapse and commissural fusion was the major pathology in aortic regurgitation. Pulmonary hypertension was the most common complication commonly seen in mitral valve disease. Calcification was a rare encounter in this age bracket. CONCLUSIONS: Rheumatic heart disease in the paediatric age commonly presents as isolated mitral regurgitation or in combinations of mitral and aortic regurgitation. The complications of pulmonary hypertension was predominant in mitral valve disease. Valvular calcification is rare in juvenile rheumatic heart disease. PMID: 16450679 [PubMed - indexed for MEDLINE]

2004

YUKO-, DRJOWICHRISTINEA, E DRSIMIYUMAJORD.  2004.  C. Yuko-Jowi, DE Simiyu, RN Musoke : Ectopia cordis : a report of two cases East Afr Med J 81:486-498; 2004.. a report of two cases East Afr Med J 81:486-498; 2004.. : uon press Abstract
Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya. OBJECTIVE: To describe the echocardiographic features of children with rheumatic heart disease seen at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: The Kenyatta National Hospital Heart Unit. SUBJECTS: Patients aged 20 years and less with echocardiographic diagnosis of rheumatic heart disease. RESULTS: Two hundred and twenty four echocardiograms were analysed. Seventy six point four of cases were aged between 5 and 15 years, while on 3% were less than five years. The combinations mitral and aortic regurgitation was the most common lesion followed by isolated mitral regurgitation. Isolated aortic regurgitation was as rare as isolated mitral stenosis in the paediatric age group 1.8% and 2.7% respectively. When seen in the younger age group, the leaflet morphology in mitral regurgitation was predominantly thickening and clubbing of the leaflets while in the older children the pathology was of marked fibrosis of the sub-valvular apparatus. Leaflet prolapse and commissural fusion was the major pathology in aortic regurgitation. Pulmonary hypertension was the most common complication commonly seen in mitral valve disease. Calcification was a rare encounter in this age bracket. CONCLUSIONS: Rheumatic heart disease in the paediatric age commonly presents as isolated mitral regurgitation or in combinations of mitral and aortic regurgitation. The complications of pulmonary hypertension was predominant in mitral valve disease. Valvular calcification is rare in juvenile rheumatic heart disease. PMID: 16450679 [PubMed - indexed for MEDLINE]

1999

YUKO-, DRJOWICHRISTINEA.  1999.  Percutaneous balloon mitral valvotomy: initial experience in Nairobi using a new multi-track catheter system.1: East Afr Med J. 1999 Feb;76(2):71-4.. East Afr Med J. 1999. : uon press Abstract
OBJECTIVE: To determine efficacy and safety of the new multi-track catheter system for percutaneous baloon mitral valvotomy. DESIGN: Open, non-randomised intervention. SETTING: Cardiac catheterisation Laboratories of Mater Misericordiae Hospital (1997) and Kenyatta National Hospital, Nairobi(1994). PATIENTS: Twenty four consecutive patients with symptomatic severe pure mitral stenosis (less than 2+ mitral regurgitation) and suitable mitral valve apparatus(leaflets, chordae and papillary muscles) for successful commissurotomy. INTERVENTION: Percutaneous mitral baloon valvotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Transeptal left atrial entry using standard septal puncture technique and left ventricle position secured by single long-stiff guide-wire. Double-baloon mitral valvotomy on single guide-wire using multi-track baloon catheters. MAIN OUTCOME MEASURES: Mitral valve area, left atrial pressures, mitral regurgitation grade. RESULTS: Mitral valve area increased from 0.65 +/- 0.15cm2 to 1.98 +/- 0.34cm2 (P < 0.01), left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1mmHg (P < 0.01). No significant change in mitral regurgitation grades. No complications related to multi-track technique. CONCLUSION: Percutaneous baloon mitral valvotomy using the multi track technique is effective and safe.
YUKO-, DRJOWICHRISTINEA.  1999.  Percutaneous Balloon mitral valvotomy using multritrack technique, initial experience in Kenya. Yonga G. O, Bonhoeffer P, Jowi C. EAMJ, Vol 76, no 2 1999.. EAMJ, Vol 76. : uon press Abstract
Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya. OBJECTIVE: To describe the echocardiographic features of children with rheumatic heart disease seen at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: The Kenyatta National Hospital Heart Unit. SUBJECTS: Patients aged 20 years and less with echocardiographic diagnosis of rheumatic heart disease. RESULTS: Two hundred and twenty four echocardiograms were analysed. Seventy six point four of cases were aged between 5 and 15 years, while on 3% were less than five years. The combinations mitral and aortic regurgitation was the most common lesion followed by isolated mitral regurgitation. Isolated aortic regurgitation was as rare as isolated mitral stenosis in the paediatric age group 1.8% and 2.7% respectively. When seen in the younger age group, the leaflet morphology in mitral regurgitation was predominantly thickening and clubbing of the leaflets while in the older children the pathology was of marked fibrosis of the sub-valvular apparatus. Leaflet prolapse and commissural fusion was the major pathology in aortic regurgitation. Pulmonary hypertension was the most common complication commonly seen in mitral valve disease. Calcification was a rare encounter in this age bracket. CONCLUSIONS: Rheumatic heart disease in the paediatric age commonly presents as isolated mitral regurgitation or in combinations of mitral and aortic regurgitation. The complications of pulmonary hypertension was predominant in mitral valve disease. Valvular calcification is rare in juvenile rheumatic heart disease. PMID: 16450679 [PubMed - indexed for MEDLINE]
YUKO-, DRJOWICHRISTINEA.  1999.  The effects of Percutaneous balloon mitral Valvotomy on pulmonary venous flow. Yonga G, Bonhoeffer P, Jowi C. EAMJ, Vol 76, No 1 , Page 28 ,1999. EAMJ, Vol 76, No 1 , Page 28. : uon press Abstract
OBJECTIVE: To study the effect of percutaneous balloon mitral valvotomy (PBMV) on the deranged systolic and diastolic pulmonary venous flows in mitral stenosis. DESIGN: Open, non-randomised, case-control study. SETTING: Mater Misericordiae Cardiac Catheterisation Laboratory and Kenyatta National Hospital Cardiac Catheterisation Laboratory. PATIENTS: Twelve consecutive patients with severe symptomatic mitral stenosis with valve characteristics suitable for PBMV on echocardiographic evaluation. INTERVENTION: Percutaneous baloon mitral valvotomy. MAIN OUTCOME MEASURES: Peak systolic and diastolic pulmonary flow velocities and velocity time integrals (VTI). RESULTS: Peak sytolic pulmonary flow velocity increased from 29.8 +/- 9.6 to 46.1 +/- 8.5 cm/s p < 0.01) and systolic VTI from 2.6 +/- 1.0 to 5.5 +/- 0.9 cm (p < 0.01). Peak diastolic flow velocity increased from 39.3 +/- 5.7 to 43.0 +/- 6.9 cm/s (p < 0.05) and diastolic VTI from 3.9 +/- 1.5 to 4.8 +/- 1.6 cm (p < 0.05). Mean mitral valve area increased from 0.65 +/- 0.15 to 1.98 +/- 0.34 cm2 (p < 0.001) and mean left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1 mmHg (p < 0.001). CONCLUSIONS: In patients with severe mitral stenosis and sinus rythm, left atrial filling is biphasic with diastolic preponderance. Successful PBMV causes predominant increase in atrial systolic filling.

1995

YUKO-, DRJOWICHRISTINEA.  1995.  Joshi, Micheal Mugo, Jean Kachner,Lucio Parenzan.Journal of catherterization and cardiovascular diagnosis.36;189-193 1995.. Journal of catherterization and cardiovascular diagnosis.36;189-193 1995. : uon press Abstract
OBJECTIVE: To determine efficacy and safety of the new multi-track catheter system for percutaneous baloon mitral valvotomy. DESIGN: Open, non-randomised intervention. SETTING: Cardiac catheterisation Laboratories of Mater Misericordiae Hospital (1997) and Kenyatta National Hospital, Nairobi(1994). PATIENTS: Twenty four consecutive patients with symptomatic severe pure mitral stenosis (less than 2+ mitral regurgitation) and suitable mitral valve apparatus(leaflets, chordae and papillary muscles) for successful commissurotomy. INTERVENTION: Percutaneous mitral baloon valvotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Transeptal left atrial entry using standard septal puncture technique and left ventricle position secured by single long-stiff guide-wire. Double-baloon mitral valvotomy on single guide-wire using multi-track baloon catheters. MAIN OUTCOME MEASURES: Mitral valve area, left atrial pressures, mitral regurgitation grade. RESULTS: Mitral valve area increased from 0.65 +/- 0.15cm2 to 1.98 +/- 0.34cm2 (P < 0.01), left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1mmHg (P < 0.01). No significant change in mitral regurgitation grades. No complications related to multi-track technique. CONCLUSION: Percutaneous baloon mitral valvotomy using the multi track technique is effective and safe.
YUKO-, DRJOWICHRISTINEA.  1995.  Mitral dilatation with the Multi-Track system: an alternative approach.1: Cathet Cardiovasc Diagn. 1995 Oct;36(2):189-93. Cathet Cardiovasc Diagn. 1995. : uon press Abstract
We developed a simple and versatile new technique (Multi-Track) for percutaneous mitral valvotomy using two two separate balloon catheters positioned on a single guidewire. The first catheter, with only a distal guidewire lumen and a proximal balloon, is introduced over the guidewire into the vein and then advanced into the mitral valve orifice. Subsequently, a normal balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side. The balloons are then inflated simultaneously. The technique was applied in 12 patients between 10 and 44 years of age (mean, 27.1) and weighing 24-80 kg (mean, 50.3). Valve area increased from 0.66 cm2 (range, 0.3-0.9 cm2) to 1.97 cm2 (range, 1.3-3.1 cm2) and mean left atrial pressure dropped from 31 mmHg (range, 18-52 mmHg) to 12 mmHg (range, 5-22 mmHg). Mitral dilatation with the Multi-Track system gives results comparable to those with previously described techniques and uses simpler and less costly catheters.

1994

YUKO-, DRJOWICHRISTINEA.  1994.  Percutaneous transluminal balloon valvuloplasty for pulmonary valve stenosis: report on six cases. East Afr Med J . 1994 Apr; 71 ( 4 ): 232-5 . PMID: 8062769 [PubMed - indexed for MEDLINE] Yonga GO, Bonhoeffer P, Yuko-Jowi C, Shori A, Aseso H.. East Afr Med J . 1994 Apr; 71 ( 4 ): 232-5 .. : uon press Abstract
Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya. Percutaneous transluminal baloon valvuloplasty is currently the treatment of choice for most cases of pulmonary valve stenosis. In the first series of cases performed at Kenyatta National Hospital, six patients aged 4 to 24 years with severe pulmonary valve stenosis and no other associated cardiac lesions were selected for the procedure. Immediately following baloon valvuloplasty, the pressure gradients across pulmonary valve measured by both echo-Doppler technique and cardiac catheterisation dropped very significantly (P < 0.001). Catheterisation peak systolic gradients (psg) dropped from 162.5 +/- 23.7 to 56.5 +/- 19.0 while echo-Doppler pressure gradients dropped from 112.0 +/- 11.9 to 42.8 +/- 16.0. No complications occurred during or after the procedure. This initial short-term experience in our set-up confirms the safety and effectiveness of this procedure. Furthermore, this procedure is much cheaper and technically easier to perform than cardiac surgery. PMID: 8062769 [PubMed - indexed for MEDLINE]

1990

Awuor, CY.  1990.  The prevalence and some clinical characteristics of bacterial infections in preterm neonates having respiratory distress at Kenyatta National Hospital. Abstract

Fifty eight preterm neonates having respiratory distress within the
first forty eight hours of life were studied. Seven had positive
blood cultures for bacteria giving a prevalence rate for infection
of 12.1%.
Nineteen infants (32.8%) were suspected to have sepsis based on
clinical and laboratory criteria .. The remaining thirty two (56%)
had no evidence of sepsis.
These infants were studied with respect to their maternal antenatal
clinic attendances, maternal fever, duration of rupture of
membranes, Iiquor characteristics and mode of del ivery. Al so
studied were their clinical examination findings, degree of
respiratory distress, hematological, radiological and
bacteriological characteristics.
Seventy six percent (76%) of the mothers were below 25 years (age
range 15-45 years). A majori ty of the mothers (65.5%) attended
antenatal clinics. Twenty eight (42.2%) of the mothers had
ruptured membranes for less than eleven hours before delivery while
13 (22.4%) and 17 (29.4%) had ruptured membranes between eleven and
twenty four hours, and for greater than 24 hours respectively.
Forty six infants (79.3%) were delivered in clear liquor; of these
6 (13.1%) had positive bacterial cultures. Seven infants (12.1%)
delivered in offensive liquor had suspected infection. Of the five
(8.6%) delivered in meconium stained liquor, two had some evidence
of infection.
Spontaneous vertex delivery was the commonest mode of delivery in
all the three groups of infants; occurring in 5 (71%) of the
infants with proven sepsis, 14 (73.7%) of the infants with

suspected sepsis and 24 (75%) of those with no sepsis. None of
the infants delivered by caesarian section had confirmed sepsis.
Infants del ivered by breech extraction had either suspected or
confirmed sepsis.Maternal fever and infant Apgar scores did not
appear to affect the outcome of the infants in this study.
On hematology the ratio of immature to total polymorphs
correlated best with sepsis as higher values of more than 0.2 were
seen mainl y in infants with confirmed sepsis. Total whi te cell
counts were also useful since normal range of counts were only seen
in infants with no evidence of sepsis.
Infant chest radiology helped eliminate other causes of
respiratory distress like pneumothorax, congenital heart disease
and lung collapse. None of the infants with confirmed sepsis had
normal radiological findings.
The orqanisms isolated were of high virulence and multipleantibiotic
resistance. Amikacin and cefotaxin enjoyed higher
sensitivity rates of 71.4% and 88.8% respectively.

YUKO-, DRJOWICHRISTINEA.  1990.  Study of the prevelenceof bacterial sepsis in preterm neonates presenting with respiratory distress in the Newborn unit , Kenyatta National Hospital. A dessertation being part of the fulfillment of the M_Med programme U.N.O June 1990.. A dessertation being part of the fulfillment of the M_Med programme U.N.O. : uon press Abstract
Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya. Percutaneous transluminal baloon valvuloplasty is currently the treatment of choice for most cases of pulmonary valve stenosis. In the first series of cases performed at Kenyatta National Hospital, six patients aged 4 to 24 years with severe pulmonary valve stenosis and no other associated cardiac lesions were selected for the procedure. Immediately following baloon valvuloplasty, the pressure gradients across pulmonary valve measured by both echo-Doppler technique and cardiac catheterisation dropped very significantly (P < 0.001). Catheterisation peak systolic gradients (psg) dropped from 162.5 +/- 23.7 to 56.5 +/- 19.0 while echo-Doppler pressure gradients dropped from 112.0 +/- 11.9 to 42.8 +/- 16.0. No complications occurred during or after the procedure. This initial short-term experience in our set-up confirms the safety and effectiveness of this procedure. Furthermore, this procedure is much cheaper and technically easier to perform than cardiac surgery. PMID: 8062769 [PubMed - indexed for MEDLINE]

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