Universit

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Recurrent pregnancy loss has been associated with autoimmune responses to membrane phospholipids and alloimmune reactions against paternally derived molecules on the trophoblast. The problem is psychologically and economically stressful as it undermines the capacity of some couples to reproduce and participate effectively in the day-to-day economic activities. This article reviews the adoption of intravenous immunoglobulin as a form of therapy for the clinical management of recurrent pregnancy loss and of selected autoimmune disorders. Side effects, contraindications and safety of use are discussed.

OBJECTIVE: To study re-association pattern of human placental eluate immunoglobulins with acid treated isologous and third party trophoblast derived placental microvesicles. DESIGN: Laboratory based experimentation. SETTING: Biological Sciences Department and Discipline for Reproductive Medicine University of Newcastle, Australia and the Department of Biochemistry, University of Nairobi, Kenya. RESULTS: Placental eluate immunoglobulins re-associated with isologous and third party acidified microvesicles in three distinct patterns. I: eluate immunoglobulins re-associated more strongly with isologous and third party acid treated placental microvesicles, II: eluate immunoglobulins re-associated strongly with isologous but weakly with third party acid treated placental microvesicles, III: eluate immunoglobulins did not show preferential re-association with isologous and third party acid treated placental microvesicles. CONCLUSION: Two types of antigenic epitopes I and II may be expressed on the human placentae. Type I antigens may be present on all human placentae while type II epitopes may be paternally derived hence unique to each pregnancy. Also, immunoglobulins produced to placental microvesicle antigens may be directed to some but not all antigenic epitopes expressed on the human placental trophoblast.

Health care professionals are absorbed daily in the practices of their professional areas of specialization. Pediatricians, for example spend most of their time catering to the needs of children, while nurses, pharmacists and dentists in their own areas. Medical Educators, however, spend their time catering to the educational needs of all health care professionals, whatever their specialization. A recent area of concern in the medical education curricula has been the inclusion of the topic

Health care professionals are absorbed daily in the practices of their professional areas of specialization. Pediatricians, for example spend most of their time catering to the needs of children, while nurses, pharmacists and dentists in their own areas. Medical Educators, however, spend their time catering to the educational needs of all health care professionals, whatever their specialization. A recent area of concern in the medical education curricula has been the inclusion of the topic

The Drug Analysis Research Unit
analysed 161 samples during the period
January 1991 and December 1992. Of the
samples ana lysed, 125 were locally manufactured
and 36 were imported. The
Central Medical Supplies Coordinating
Unit accounted for 100 samples while the
rest were from various hospitals and '
research institutions. 46 samples failed to
meet quality specifications. 37 of those
that failed were locally manufactured and
included two counterfeits, while 9 were
imported.

Introduction to Philosophy of Religion, University of Nairobi, 1988

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

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To evaluate strategies to reduce HIV-1 transmission through breastfeeding, a multicentre study including a nested randomized controlled trial was implemented in five research sites in West, East and South Africa (The Kesho Bora Study). The aim was to optimize the use of antiretroviral (ARV) drugs during pregnancy, delivery and breastfeeding to prevent mother-to-child transmission of HIV-1 (PMTCT) and to preserve the health of the HIV-1-infected mother. The study included long-term ARV treatment for women with advanced disease, and short-course ARV prophylaxis stopped at delivery for women with early disease. Women with intermediate disease participated in a randomized controlled trial to compare safety and efficacy of triple-ARV prophylaxis prolonged during breastfeeding with short-course ARV prophylaxis stopped at delivery. Between January 2005 and August 2008 a total of 1140 women were enrolled. This paper describes the study design, interventions and protocol amendments introduced to adapt to evolving scientific knowledge, international guidelines and availability of ARV treatment. The paper highlights the successes and challenges during the conduct of the trial. The Kesho Bora Study included one of the few randomized controlled trials to assess safety and efficacy of ARV prophylaxis continued during breastfeeding and the only randomized trial to assess maternal prophylaxis started during pregnancy. The findings have been important for informing international and national guidelines on MTCT prevention in developing countries where, due to poverty, lack of reliable and affordable supply of replacement feed and stigma associated with HIV/AIDS, HIV-infected women have little or no option other than to breastfeed their infants. (ISRCTN71468401).

The safety and immunogenicity of plasmid pTHr DNA, modified vaccinia virus Ankara (MVA) human immunodeficiency virus type 1 (HIV-1) vaccine candidates were evaluated in four Phase I clinical trials in Kenya and Uganda. Both vaccines, expressing HIV-1 subtype A gag p24/p17 and a string of CD8 T-cell epitopes (HIVA), were generally safe and well-tolerated. At the dosage levels and intervals tested, the percentage of vaccine recipients with HIV-1-specific cell-mediated immune responses, assessed by a validated ex vivo interferon gamma (IFN- ) ELISPOT assay and Cytokine Flow Cytometry (CFC), did not significantly differ from placebo recipients. These trials demonstrated the feasibility of conducting high-quality Phase 1 trials in Africa.

The increasing availability of HIV clinics providing highly active antiretroviral therapy (HAART) has dramatically reduced AIDS-related morbidity and mortality in resource-limited settings. However, the impact of HAART on development and progression of cervical neoplasia and invasive cervical cancer remains uncertain [ The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control1]. The longer life expectancy among HIV-infected women receiving HAART may actually increase the overall risk for cervical cancer, underscoring the need for prevention strategies for this high-risk population. A potentially cost-effective way of providing this “primary” care may be through HIV clinics, which are generally well staffed and have more resources than government or private clinics [ The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control2]. In addition to utilizing the staffing and infrastructure in place to provide HIV care and HAART, incorporating cervical cancer screening into an HIV clinic visit may increase screening uptake and follow up. One key element of cervical cancer prevention is the coupling of accurate screening methodologies with safe and effective outpatient treatment for cervical neoplasia. The loop electrosurgical excision procedure (LEEP) has better efficacy among HIV-infected women than cryotherapy [ The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control3], and although LEEP requires electricity, it has been used successfully in resource-limited settings [ The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control4]. However, LEEP is generally considered a surgical procedure to be performed by physicians or highly-trained midwives. We sought to establish the feasibility and safety of training midlevel HIV primary care providers to perform LEEP in an HIV care and treatment clinic in Kisumu, Kenya. Ethical approval was obtained from all collaborating institutions prior to initiation of screening and treatment. This evaluation took place at the Family AIDS Care and Education Services (FACES) clinic in Kisumu, Kenya. Kisumu, Kenya’s third largest city, has a population of 400 000. FACES partners with the Kenyan Government to provide free HIV care services as per Ministry of Health guidelines. Most visits are done by clinical officers (physician assistants), with medical officers available for consultation. As part of the cervical cancer screening program, all interested clinical officers at FACES were offered LEEP training. Between October 2007 and October 2009, 4 clinical officers underwent training and certification, and performed 181 LEEPs. Women were followed up for complications by telephone at 1 week and during a return visit at 1 month. All women were seen within 6 weeks of LEEP. Five women (3%) had procedure-related complications (Table 1). With the exception of the antibiotics, no additional treatment or referral was required. In our experience, LEEP was performed safely by clinical officers within an HIV-care clinic, expanding potential options for cervical cancer screening programs.

The clinical outcome of thyroidectomy may be influenced by among other things, the experience of the surgeon performing the procedure. Furthermore, auditing of any surgical procedure helps in monitoring the safety of the procedure in the hands of the operator. Objective This study is an audit of outcome of thyroidectomy performed by the author within the first 18 months of qualification from a local residency program. It aims to record the outcomes as baseline to facilitate future personal and institutional trends of thyroid disease, prevalent in the area. Setting Kapenguria District hospital in Kenya. The author was posted to this facility immediately after completion of surgical residency at the University of Nairobi. Design This was a retrospective audit from April 2007 to September 2008 Patients The patients who underwent thyroidectomy by the author from April 2007 to September 2008. The period was divided into three separate six month blocks of time (A-April to September 2007, B-October 2007 to March 2009, and C- April to September 2008. Main outcome measures Complications and length of stay. Results Thirty nine patients underwent thyroidectomy during this period. The most common type of goiter was multinodular goiter (69.2%, 27) while the most common type of surgery was total thyroidectomy (35.9%, 14). The number of days in hospital did not differ across the periods- 1.92 for period A, 1.75 for B and 1.07 for C. Two complications occurred during period A and were associated with total thyroidectomy Conclusion Subtotal and total thyroidectomy can be safely performed by general surgeons qualifying from our local training institutions. Institutional audits are important to document future improvements in outcomes.

Incorporation of biomolecular epitopes to malarial antigens should be explored in the development of straintranscending
malarial vaccines. The present study sought to determine safety, immunogenicity and cross-species
ef cacy of Plasmodium falciparumserine repeat antigen 5 polypeptide co-expressed with epitopes of BacilleCalmette
Guerin (BCG), tetanus toxoid (TT) and a chemokine gene. Olive baboons and BALB/c mice were randomly
assigned into vaccine and control groups. The vaccine group animals were primed and boosted twice with pIRES
plasmids encoding the SERA5+ BCG+ TT alone, or with either CCL5 or CCL20 and the control group with pIRES
plasmid vector backbone. Mice and baboons were challenged with P. bergheiANKA and P. knowlesiH strain
parasites, respectively. Safety was determined by observing for injection sites reactogenicities, hematology and
clinical chemistry. Parasitaemia and survivorship pro les were used to determine cross-species ef cacy, and T cell
phenotypes, Th1-, Th2-type, T-regulatory immune responses and antibody responses were assessed to determine
vaccine immunogenicity. The pSeBCGTT plasmid DNA vaccines were safe and induced Th1-, Th2-type, and Tregulatory
responses vaccinated animals showed enhanced CD4 + (P< 0.01), CD 8+ T cells (P< 0.001) activation and
IgG anti-SE36 antibodies responses ( P< 0.001) at week 4 and 8 post vaccination compared to the control group.
Vaccinated mice had a 31.45-68.69 % cumulative parasite load reduction and 60 % suppression in baboons ( P< 0.05)
and enhanced survivorship ( P< 0.001) with no clinical signs of malaria compared to the control group. The results
showed that the vaccines were safe, immunogenic and conferred partial cross-species protection.
Keywords: malaria, DNA vaccines, serine repeat antigen, chemokines, cross-species, protection, immunogenicity,
safety

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. 2007 Wiley-Liss, Inc

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. 2007 Wiley-Liss, Inc

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. 2007 Wiley-Liss, Inc

Background Aneurysms of the anterior cerebral and anterior communicating arteries are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Objective The purpose of this study was to evaluate variations of the anterior cerebral and anterior communicating arteries. Methods: Thirty six cadaveric brains (72 hemispheres) were studied by gross dissection for the pattern of arterial blood supply. Results The anterior cerebral artery (ACA) was observed to originate from the ipsilateral internal carotid artery (ICA) in all the cases studied. The most common type of termination of the ACA was bifurcation into pericallosal (PerA) and callosomarginal (CMA) arteries with the PerA-CMA junction being supracallosal (60%), infracallosal (27%) or precallosal (5%). Unique variations observed include an accessory ACA from the ACoA, 'bihemispheric pericallosal arteries', intertwining course of the A2 segments of the ACAs and crossing branches from 1 hemisphere to another. Variations of the ACoA were also observed including fenestration (26%) and duplication (13%). Conclusions The majority of ACA bifurcations, in the current study, were supracallosal suggesting the need for exploration of the interhemispheric fissure during surgical corrections of distal ACA aneurysms. Further, the incidence of the callosomarginal artery in this series appears to be at variance with other studies highlighting the need to standardize the definition of the artery. Anterior communicating artery fenestration was the most common variation raising concern as this has been shown to compromise collateral flow and predispose to aneurysm formation. Key Words: Anterior Cerebral artery, Anterior Communicating Artery, Kenya, Variations

BACKGROUND: CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce. OBJECTIVE: The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods. SETTING: The setting was Kenyatta National Hospital (KNH), a teaching and referral center. PATIENTS AND METHODS: A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant. RESULTS: The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data. CONCLUSION: CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.

Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were < or =5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.

Only 2% of patients with Meckel's diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient.

OBJECTIVE: To describe the emergency care of injuries at a main city hospital. DESIGN: A prospective study. SETTING: Data were collected between February 1st, 1999 and 30th April, 1999 from the records of the 2000 bed Kenyatta National Hospital (KNH) in Nairobi, Kenya. SUBJECTS: Two hundred and forty injury patients admitted at KNH were analysed. METHODS: All patients were analysed for demographics, environment of injury hospital arrival and Emergency Department times. The effects of injury severity, place of injury and time of day on these time intervals were analysed statistically. RESULTS: Road injury admissions formed 31% of all injury admissions. The mean age was 30 years. Males comprised 84.6% of all patients. The proportions of patients under 20 years of age was 20% with a peak age of 20-29 years. Majority (43.3%) of the injured resided in deprived neighbourhood of East Nairobi. The mean pre-hospital time was 2.56 hours. The Emergency Department disposition time was 3.36 hours. Injuries of all severities, as determined by the Injury Severity Score (ISS), were treated. The pace of care did not match severity of the injuries. Only 17.5% reached their areas of definitive care within sixty minutes. CONCLUSION: Injuries following road traffic accidents (RTAs) are common in Nairobi. The response to injury is slow and haphazard. The insitution of a care incorporating the city's health centers and pre-hospital triage may optimise care.

Only 2% of patients with Meckel's diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient.

Four hundred and seventeen tumours of salivary glands in Kenya were analysed. There is no evidence ofhig~~r incidence of salivary tumours than in non-African countries. The pattern of distribution 'differed from that of western countries, but in conformity with most African series showed a low proportion of tumours of the parotid gland and high proportion of tumours in the submandibular gland and the palate. The involvement of the palate by salivary gland tumour isvery prominent in the African series and particularly more so in the females. Malignant tumours of the palate and parotid glands were frequent but were lower than those reported in other African series. On the other hand malignant salivary gland tumours of the submandibular glands while lower than those of the western countries, were higher than those of other African series.

A mini review of contamination routes and limitations to effective control. Japanesegricultural Quarterly Journal 2010; 44 (1) 7-16.

The distribution of Salmonella typhi, S. paratyphi A. and S. paratyphi C. agglutinins among 364 sera from a randomly selected group of healthy individuals in Nairobi and Naivasha (Kenya) were analysed in relation to bacteriologically confirmed cases of typhoid fever at the Kenyatta National Hospital (KNH). Out of these, 30% of the healthy individuals had no detectable Widal titres. Overall agglutinin titres obtained for the healthy population showed that 96% of the individuals had low level reactivity with titres < 1:80 for both H and O antigens of S. typhi, while 4% had titres of 1:160 or above. Agglutinins for S. paratyphi A and C were rarely present in the sera tested. Age and sex were found to have no effect on antibody titre distribution in the two populations but differences in the water source may have affected the percentage of positive tests recorded. In this typhoid endemic region titres upto 1:80 are not uncommon but both H and O titres of 1:160 and above found in conjunction with the clinical picture may be taken to be suggestive of typhoid fever.

A total of 560 Salmonellae species were isolated from Jan-Dec 1985. Of these, 347 (62%) were from blood cultures, 180 (32%) from stools and 33 (6%) were from cerebrospinal fluid (CSF) and other body aspirates. S. typhimurium were the highest isolated. These were, 291 (52%) from blood cultures, 94 (17%) from stool cultures and 32 (6%) from CSF. S. typhimurium was also multi-drug resistant. More than 50% strains of S. typhimurium were resistant to ampicillin, tetracycline, kanamycin and chloramphenicol. The need for coordination between the laboratory and clinical staff to prevent the spill-over of infection with S. typhimurium and its epidemic spread is discussed.

1.1. The ability of the dik-dik antelope to survive while drinking saline solutions was tested in controlled laboratory experiments by providing drinking water containing up to 0.5 M NaCl.2.2. Fluid intake increased from 230.5 ml/day when fresh water was offered to a maximum of 373.9 ml/day when 0.3 M NaCl solution was offered.3.3. At concentrations higher than 0.3 M animals lost weight, were anorexic and developed diarrhoea.4.4. It is concluded that the dik-dik antelope will probably tolerate drinking water containing 0.24 M NaCl.

A Gram-negative obligate alkaliphilic bacterium (BOG6T) that secretes carotenoids was isolated from the outflow of Lake Bogoria hot spring located in the Kenyan Rift Valley. The bacterium is motile bymeans of a polar flagellum, and forms red colonies due to the production of xanthophyll carotenoid pigments. 16S rRNA gene sequence analysis showed this strain to cluster phylogenetically within thegenus Paracoccus. Strain BOG6T is aerobic, positive for both catalase and oxidase, and nonmethylotrophic. The major fatty acid of the isolate is C18: 1w7c. It accumulated polyhydroxybutyrategranules. Strain BOG6T gave astaxanthin yield of 0.4 mg/g of wet cells indicating a potential for application in commercial production of carotenoids. On the basis of its genotypic characteristics, fattyacid composition and physiological reaction profiles, it is proposed that the isolate may be assigned to the genus Paracoccus as Paracoccus bogoriensis sp. nov. The type strain is BOG6T (=DSM16578=LMG22798). The GenBank 16S rDNA nucleotide sequence accession number is AJ580352.

Determining the optimal sample size for a study assures an adequate power to detect statistical significance. Hence, it is a critical step in the design of a planned research protocol. Using too many participants in a study is expensive and exposes more number of subjects to procedure. Similarly, if study is underpowered, it will be statistically inconclusive and may make the whole protocol a failure. This paper covers the essentials in calculating power and sample size for a variety of applied study designs. Sample size computation for single group mean, survey type of studies, 2 group studies based on means and proportions or rates, correlation studies and for case-control for assessing the categorical outcome are presented in detail.

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.

This paper examines the role of institutions in the development process of African countries. It has been show that, whereas institutions have played a greater role in the economic development of several East Asian countries, in Africa they are weaker and ineffective because of poor enforcement of the rule of law, corruption, mismanagement, absence of strong civil society and political interference. It is argued that well-functioning institutions can promote growth and reduce poverty in Africa by providing a conducive environment for implementation and sustainable development programmes Therefore, African countries should Endeavour to establish effective, responsive and democratic institutions that will promote accountable and transparent governance and sustainable socioeconomic development.

This paper examines the role of institutions in the development process of African countries. It has been show that, whereas institutions have played a greater role in the economic development of several East Asian countries, in Africa they are weaker and ineffective because of poor enforcement of the rule of law, corruption, mismanagement, absence of strong civil society and political interference. It is argued that well-functioning institutions can promote growth and reduce poverty in Africa by providing a conducive environment for implementation and sustainable development programmes Therefore, African countries should Endeavour to establish effective, responsive and democratic institutions that will promote accountable and transparent governance and sustainable socioeconomic development.

Clay pots were analyzed as devices for sampling the outdoor resting fraction of Anopheles gambiae Giles (Diptera: Culicidae) and other mosquito species in a rural, western Kenya. Clay pots (Anopheles gambiae resting pots, herein AgREPOTs), outdoor pit shelters, indoor pyrethrum spray collections (PSC), and Colombian curtain exit traps were compared in collections done biweekly for nine intervals from April to June 2005 in 20 housing compounds. Of 10,517 mosquitoes sampled, 4,668 An. gambiae s.l. were sampled in total of which 63% were An. gambiae s.s. (46% female) and 37% were An. arabiensis (66% female). The clay pots were useful and practical for sampling both sexes of An. gambiae s.l. Additionally, 617 An. funestus (58% female) and 5,232 Culex spp. (males and females together) were collected. Temporal changes in abundance of An. gambiae s.l. were similarly revealed by all four sampling methods, indicating that the clay pots could be used as devices to quantify variation in mosquito population density. Dispersion patterns of the different species and sexes fit well the negative binomial distribution, indicating that the mosquitoes were aggregated in distribution. Aside from providing a useful sampling tool, the AgREPOT also may be useful as a delivery vehicle for insecticides or pathogens to males and females that enter and rest in them.

This paper argues that problems in education are caused by non-professional teachers who are employed when trained teachers move in search of promotion friendly activities or financially rewarding duties. This shift of focus means that policy makers in education act without adequate professional guidance. The problems in education, therefore, result from demands made on mainstream education based on misconceptions about what education can offer. It is argued that the implementation of e-learning in education faces the risk of developing on the basis of unproven theories. This scenario increasingly sees the replacement of formal education activities in institutions of learning with non-formal and informal education practices. Given that the contents and influences of non-formal and informal education are not under the control of the teacher, the experiences that learners bring to education settings are increasingly difficult to manage. The paper proposes that by integrating e-learning in teacher education and rewarding 'good teaching', there is a potential for a successful e-learning revolution in education.

This paper argues that problems in education are caused by non-professional teachers who are employed when trained teachers move in search of promotion friendly activities or financially rewarding duties. This shift of focus means that policy makers in education act without adequate professional guidance. The problems in education, therefore, result from demands made on mainstream education based on misconceptions about what education can offer. It is argued that the implementation of e-learning in education faces the risk of developing on the basis of unproven theories. This scenario increasingly sees the replacement of formal education activities in institutions of learning with non-formal and informal education practices. Given that the contents and influences of non-formal and informal education are not under the control of the teacher, the experiences that learners bring to education settings are increasingly difficult to manage. The paper proposes that by integrating e-learning in teacher education and rewarding 'good teaching', there is a potential for a successful e-learning revolution in education.

This paper argues that problems in education are caused by non-professional teachers who are employed when trained teachers move in search of promotion friendly activities or financially rewarding duties. This shift of focus means that policy makers in education act without adequate professional guidance. The problems in education, therefore, result from demands made on mainstream education based on misconceptions about what education can offer. It is argued that the implementation of e-learning in education faces the risk of developing on the basis of unproven theories. This scenario increasingly sees the replacement of formal education activities in institutions of learning with non-formal and informal education practices. Given that the contents and influences of non-formal and informal education are not under the control of the teacher, the experiences that learners bring to education settings are increasingly difficult to manage. The paper proposes that by integrating e-learning in teacher education and rewarding 'good teaching', there is a potential for a successful e-learning revolution in education.

E-learning emphasizes the development of students' self-study capabilities and habits. Based on constructivist theories, it is believed that a community of students can form learning teams able to share experiences online to achieve appropriate educational objectives. The scenario poses a challenge to curricula based teaching requirements, designed around instructional strategies, aimed at allowing students to learn certain things rather than others. This traditional approach is based on the assumption that not all learning experiences that students encounter are educative. The World Wide Web (WWW) from which online education draws it content is a 'network' of all conceivable knowledge and ideas that encourage informal, non-formal and formal education practices. The merger of the three forms of education is a new phenomenon occasioned by the inevitable integration of ICT in education. Since education is about acquisition of knowledge, skills and dispositions that are valued by society, its content is inherently selective. This study proposes that for e-learning to convert to online education, educators need to identify and harmonize principles that define online educational experiences.

E-learning emphasizes the development of students' self-study capabilities and habits. Based on constructivist theories, it is believed that a community of students can form learning teams able to share experiences online to achieve appropriate educational objectives. The scenario poses a challenge to curricula based teaching requirements, designed around instructional strategies, aimed at allowing students to learn certain things rather than others. This traditional approach is based on the assumption that not all learning experiences that students encounter are educative. The World Wide Web (WWW) from which online education draws it content is a 'network' of all conceivable knowledge and ideas that encourage informal, non-formal and formal education practices. The merger of the three forms of education is a new phenomenon occasioned by the inevitable integration of ICT in education. Since education is about acquisition of knowledge, skills and dispositions that are valued by society, its content is inherently selective. This study proposes that for e-learning to convert to online education, educators need to identify and harmonize principles that define online educational experiences.

As the school going age population increases in Africa, the demand for education rises while the number of trained teachers diminishes due to limited training resources. However, Africa has the potential to use e-learning technology, as a viable means of reaching large numbers of students, with reduced outlay of resources. E-learning therefore holds a pivotal position for achieving education for all in the 21st Century. There are educational principles that are universally agreed as worthwhile and which can be promoted through global online education. Such include scientific and technological advancement, environmental maintenance, healthy life style and social responsibility. Knowledge based on these can be harnessed for the common good and made available freely to all. Issues of contextual validity and adaptation can be resolved by local amendments appropriate to the prevailing conditions.The introduction of Course Management Systems or Virtual Learning Environments (VLEs) is the way forward towards globalization of higher education. This paper highlights the advantages of VLEs and explores the processes involved in successful deployment of course management systems as means of enhancing African universities' participation in global education networks.

This paper explores bringing e-learning to African universities through collaborative networks of public-private partnerships (PPPs). It is envisaged that this approach will solve the dual problem of infrastructural barriers and weak ICT policies. As technology is used more in education, the teachers' roles are increasingly integrated with those of support staff, administrators and technical staff. The needs of e-learning environments suggest the viability of a multi-stakeholder networks to share expertise and resolve issues related to training needs. The paper concludes that collaboration networks that include e-learning sponsors, policy makers, telecommunication network service providers and educators are required to solve the problems of online education in Africa.

This paper explores bringing e-learning to African universities through collaborative networks of public-private partnerships (PPPs). It is envisaged that this approach will solve the dual problem of infrastructural barriers and weak ICT policies. As technology is used more in education, the teachers' roles are increasingly integrated with those of support staff, administrators and technical staff. The needs of e-learning environments suggest the viability of a multi-stakeholder networks to share expertise and resolve issues related to training needs. The paper concludes that collaboration networks that include e-learning sponsors, policy makers, telecommunication network service providers and educators are required to solve the problems of online education in Africa.

This paper argues that problems in education are caused by non-professional teachers who are employed when trained teachers move in search of promotion friendly activities or financially rewarding duties. This shift of focus means that policy makers in education act without adequate professional guidance. The problems in education, therefore, result from demands made on mainstream education based on misconceptions about what education can offer. It is argued that the implementation of e-learning in education faces the risk of developing on the basis of unproven theories. This scenario increasingly sees the replacement of formal education activities in institutions of learning with non-formal and informal education practices. Given that the contents and influences of non-formal and informal education are not under the control of the teacher, the experiences that learners bring to education settings are increasingly difficult to manage. The paper proposes that by integrating e-learning in teacher education and rewarding 'good teaching', there is a potential for a successful e-learning revolution in education.

A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital-based health workers, particularly doctors, regardless of the location of the country or hospital they work in. OBJECTIVES: To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in Eritrea; with a view to putting in place quality standards and effective means of monitoring and evaluation. DESIGN: Qualitative study with a participatory and iterative/dynamic design. METHODS: Semi-structured interviews and focus group discussions were held with 34 members of the hospital staff; and a total of 30 patients in the medical, surgical and obstetric wards were interviewed. Direct observation of handwashing practice and facilities were also employed. RESULTS: Although only 30% of health workers routinely washed their hands between patient contact, the study revealed genuine interest in training and the need to reward good practice in order to motivate health workers. Educational intervention and technical training resulted in significant improvements in health workers' compliance with hospital infection prevention standards. Patient satisfaction with health workers' hygiene practices also improved significantly. CONCLUSION: Hospital-based health workers' handwashing practice needs to improve globally. There is no room for complacency, however, in Eritrea (as indeed in other African countries) where public health services need to keep patients' welfare at heart; particularly with respect to women in childbirth, as mothers continue to bear the lion's share of post-war rebuilding of lives, livelihoods, and the country as a whole.

Sixty-four patients atteending the Kenyatta National Hospital psychiatric clinic with minor p.yychiatric disorders were assessed using the Enugu Somatization Scale with a view of eliciting the nature and types of somatic complaints they had. A control group of 66, 5th year medical student, was used. The average scores for the head and body symptoms were 10.9 and 22.1 for the neurotics and 0.9 and 1.5 for the controls respectively. Overall the commonest complaints among the patients were vague, the highest positive scores in order a/frequency being. 'What worries me is not steady." . 3.7%), "parts of my body are out of order" (87.3%), "my whole body is not all right" (87.3%), ':feeling various parts of the body shiver" (85. 7%) and ':feeling dizzy" (84. 1 %). The complaints were not related to age, sex, education, occupation or p,\ychiatric diagno,yis. The average scores for the Kenyan neurotic, were higher than that obtained from the Nigerian (head: 8.14; body: 15.2) and Indian neurotics (head: 8.75: body: 11.78) in previous .ytudies. On the other hand the Kenyan controls had lower scores compared to the other 2 groups. The implication of these findings is discussed.

Sixty-four patients atteending the Kenyatta National Hospital psychiatric clinic with minor p.yychiatric disorders were assessed using the Enugu Somatization Scale with a view of eliciting the nature and types of somatic complaints they had. A control group of 66, 5th year medical student, was used. The average scores for the head and body symptoms were 10.9 and 22.1 for the neurotics and 0.9 and 1.5 for the controls respectively. Overall the commonest complaints among the patients were vague, the highest positive scores in order a/frequency being. 'What worries me is not steady." . 3.7%), "parts of my body are out of order" (87.3%), "my whole body is not all right" (87.3%), ':feeling various parts of the body shiver" (85. 7%) and ':feeling dizzy" (84. 1 %). The complaints were not related to age, sex, education, occupation or p,\ychiatric diagno,yis. The average scores for the Kenyan neurotic, were higher than that obtained from the Nigerian (head: 8.14; body: 15.2) and Indian neurotics (head: 8.75: body: 11.78) in previous .ytudies. On the other hand the Kenyan controls had lower scores compared to the other 2 groups. The implication of these findings is discussed.