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An assessment of the current status and possible future dynamics of the domestic animal species is a critical step in the management of Animal Genetic Resources (AnGR). Permanent extinction of livestock breeds is considered to be the main reason for the loss of genetic diversity (Scherf, 2000). So far, the pace of the extinction process of livestock breeds has outstripped the creation of new breeds leading to a remarkable loss of genetic diversity (Gandini et al., 2004). The FAO’s Global Databank for AnGR predicts the loss of breeds at one breed per month (DAD-IS web). In this paper, the terms evolution and extinction are defined and illustrated using examples from the Swedish cattle breeds. Thereafter, the dynamics of the Swedish cattle breeds mentioned in DAD-IS and the status given as regards their endangerment/extinction are described. In addition, an analysis on the actual situation was conducted, to verify whether the breed is really endangered, extinct or has just evolved in one way or another for sustainable use.

Postpartum haemorrhage remains the leading cause of maternal mortality globally. Mortality and severe morbidity due to postpartum haemorrhage is highest in lower-resource settings. Tranexamic acid is an anti-fibrinolytic drug that has been in use in humans for nearly five decades. It is a structural analogue of lysine that binds irreversibly to plasminogen, thereby inhibiting the binding of plasmin to fibrin. This in turn inhibits fibrinolysis, thus stabilizing blood clots. Tranexamic acid has been shown to improve outcomes in trauma-related bleeding. New research has shown that early use of tranexamic acid (within 3 hours of birth), in addition to standard care, safely reduces deaths due to bleeding in women with clinically diagnosed postpartum haemorrhage, regardless of the mode of birth.

Keywords: anti-fibrinolysis,maternal mortality,postpartum haemorrhage,tranexamic acid

Transcultural psychiatry, whose scientific founder Emil Kraepelin is considered as, in its 100 years of tradition has not only developed a varied range of methods but has also brought about a change in the respective scientific questions as well as in related research and clinical applications. Whereas transcultural research on the psychopathology of depression contributed to the further development of psychiatric nosology, transcultural psychiatry has recently been increasingly faced with issues concerning phenomena of social change and globalization. One region, where such conditions can be observed in particular is Africa, where the dissolving of traditional standards and support systems and growing economic insecurity causes a considerable burden especially on women. As an example, results from a cross-sectional study on East African women using a two step design as well as qualitative and quantitative, standardized psychiatric methods are discussed concerning the association of social change, psycho-social risk factors and the development of depressive disorders. Efficient clinical methods towards diagnosis and treatment of new risk groups will have to be developed, of which an important aspect will be crisis intervention

Cryptosporidium was conducted with 20 farmers randomly selected from the 29 farmers in the wider survey who were considered at high risk because of farming system. We found that around 1 in 80 urban households kept dairy cattle with an average of three cattle per household. Cross-breeds of exotic and local cattle predominate. Heads of dairykeeping households were significantly less educated than the heads of non-dairy neighbours, had lived in Dagoretti for significantly longer and had significantly larger households. There was a high turnover of 10 % of the cattle population in the 3-month period of the study. Cattle were zero grazed, but productivity parameters were sub-optimal as were hygiene and husbandry practices. In conclusion, dairy keeping is a minor activity in urban Nairobi but important to households involved and their community. Ecohealth approaches are well suited to tackling the complex problem of assessing and managing emerging zoonoses in urban settings. Keywords Urban dairy . Cryptosporidiosis . Ecohealth . Kenya

Cryptosporidium was conducted with 20 farmers randomly selected from the 29 farmers in the wider survey who were considered at high risk because of farming system. We found that around 1 in 80 urban households kept dairy cattle with an average of three cattle per household. Cross-breeds of exotic and local cattle predominate. Heads of dairykeeping households were significantly less educated than the heads of non-dairy neighbours, had lived in Dagoretti for significantly longer and had significantly larger households. There was a high turnover of 10 % of the cattle population in the 3-month period of the study. Cattle were zero grazed, but productivity parameters were sub-optimal as were hygiene and husbandry practices. In conclusion, dairy keeping is a minor activity in urban Nairobi but important to households involved and their community. Ecohealth approaches are well suited to tackling the complex problem of assessing and managing emerging zoonoses in urban settings. Keywords Urban dairy . Cryptosporidiosis . Ecohealth . Kenya

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).

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Nitric oxide levels may exert control on the persistence of pulmonary myofibroblasts cells in pulmonary fibrosis. This study examined the regulation of NO levels by transcription factors that influence the endothelial nitric oxide synthase (eNOS3) gene expression. Using a pGL3-Basic vector plasmid DNA, rat and human eNOS3 gene promoters were inserted upstream of a luciferase reporter gene and cloned in competent E. coli cells (DH5α). Transfection assays were performed and the cells treated with potential regulators of eNOS3 gene. Promoter activity of eNOS3 gene was assayed using the Dual Luciferase reporter gene assay. The results indicated that the rat NOS3 promoter was active in the cells with the human NOS3 promoter showing little or no activity.The results demonstrated that transforming growth factor-β ,EGTA and lipopolysaccharide up regulated transcriptional activity while Phorbol 12-myristate 13- acetate, 23187 and S-nitroso-N-acetylpenicillamine, suppressed eNOS3 transcriptional activity. Treatment with Nw-Nitro-L-arginine methyl ester, had no effect on the gene expression. The results of this study demonstrates that high concentrations of Nitric Oxide (NO) inhibit NOS3 gene activity hence an enhanced expression of eNOS in response to pharmacological interventions using some transcriptional factors from these study could provide protection against interstitial pulmonary.

Background: Nitric oxide (NO) levels may exert control on the persistence of pulmonary myofibroblast cells in
pulmonary fibrosis.
Objective: This study set out to examine the regulation of NO levels by transcription factors that influence the
expression of the endothelial nitric oxide synthase (eNOS3) gene.
Methods: Using a pGL3-Basic vector plasmid DNA, rat and human eNOS3 gene promoters were inserted upstream of a luciferase reporter gene and cloned in competent E. coli cells (DH5α). Transfection assays were performed and the cells treated with potential regulators of eNOS3 gene. Promoter activity of eNOS3 gene was assayed using the Dual Luciferase reporter gene assay.
Results: The results indicated that the rat NOS3 promoter was active in the cells, with the human NOS3 promoter showing little or no activity. The results demonstrated that transforming growth factor-β, EGTA and
lipopolysaccharide up-regulated transcriptional activity while Phorbol 12-myristate-13-acetate, 23187 and S-nitroso-N-acetylpenicillamine, suppressed eNOS3 transcriptional activity. Treatment with Nw-Nitro-L-arginine methyl ester had no effect on the gene expression.
Discussion: The results of this study demonstrates that high concentrations of NO inhibit NOS3 gene activity, hence an enhanced expression of eNOS in response to pharmacological interventions using some transcriptional factors from these study could provide protection against interstitial pulmonary.
Key words: Nitric oxide, transcription, NOS3 gene promoter, pulmonary fibrosis

A KeSoBAP Publication ©2013.
All rights reserved. ISSN 2303-9841

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Gastroscopy with air insufflation was performed in 10 ponies, after which a transcutaneous ultrasound examination of the stomach and duodenum was performed immediately and at 1, 2, and 4 h postgastroscopy, and 24 h after feeding. Stomach measurements included the dorsoventral and craniocaudal dimensions, as well as the stomach depth from the skin surface and stomach wall thickness at the different time periods. Gastric wall folding was observed in one pony, becoming most distinct 2-4 h postgastroscopy. An undulating stomach wall was noted in eight other ponies postgastroscopy. These observations appeared to be a response to the deflation of the stomach as the insufflated air was released gradually. Gas was detected in the duodenum after the gastroscopy. The parameters measured were noted to be useful to evaluate the extent of stomach distension due to air or feed. The ultrasonographic appearance of the stomach can, therefore, be altered by gastroscopy and this should be borne in mind when examining horses with suspected gastric disease.

An ecosystem approach was applied to study the links between malaria and agriculture in Mwea Division, Kenya. The study was organized into five phases. Phase I had two components including a stakeholder workshop conducted with community representatives and other key stakeholders, and the collation of data on common diseases from outpatient service records at the local hospital. Phase I aimed at an a priori needs-assessment in order to focus the research agenda. Workshop participants directly contributed to the selection of two villages with rice irrigation and two non-irrigated villages for detailed health studies. In Phase II, various Participatory Rural Appraisal (PRA) tools were used to gather more detailed qualitative information from the study villages. The qualitative results indicated that Mwea residents considered malaria and lack of clean drinking water to be their most important health problems, and this was corroborated by local hospital records. Phase III consisted of a comprehensive household survey developed with inputs from Phases I and II. Phase IV involved a comparative evaluation of entomological and parasitological aspects of malaria in the villages with and without rice irrigation. The malaria parasitological survey found an average Plasmodium falciparum parasite rate of 23.5% among children up to 9 years of age. Results of the entomological evaluation showed a 30-300-fold increase in the number of the local malaria vector, Anopheles arabiensis, in villages with rice irrigation compared to those without irrigation yet malaria prevalence was significantly lower in these villages (0-9% versus 17-54%). The most likely explanation of this 'paddies paradox' in Mwea appeared to be the tendency for A. arabiensis in irrigated villages to feed overwhelmingly on cattle. The results suggested that zooprophylaxis was potentially a practical option for long-term malaria control in the rice irrigated areas, in spite of the large number of A. arabiensis. Phase V consisted of end-of-project workshops for the dissemination of research results and participatory decision-making regarding follow-up actions. Owing to the utilization of a transdisciplinary and participatory approach to research, it was possible to identify opportunities for maintaining zooprophylaxis for malaria in Mwea, through the integration of agroecosystem practices aimed at sustaining livestock systems within a broader strategy for rural development.

We investigated the transepithelial potential (TEP) and its responses to changes in the external medium in Alcolapia grahami, a small cichlid fish living in Lake Magadi, Kenya. Magadi water is extremely alkaline (pH = 9.92) and otherwise unusual: titratable alkalinity (290 mequiv L-1, i.e. HCO3 - and CO3 2-) rather than Cl-(112 mmol L-1) represents the major anion matching Na? = 356 mmol L-1, with very low concentrations of Ca2? and Mg2? (\1 mmol L-1). Immediately after fish capture, TEP was ?4 mV (inside positive), but stabilized at ?7 mV at 10–30 h post-capture when experiments were performed in Magadi water. Transfer to 250% Magadi water increased the TEP to ?9.5 mV, and transfer to fresh water and deionized water decreased the TEP to-13 and-28 mV, respectively, effects which were not due to changes in pH or osmolality. The very negative TEP in deionized water was attenuated in a linear fashion by log elevations in [Ca2?]. Extreme cold (1 vs. 28 C) reduced the positive TEP in Magadi water by 60%, suggesting blockade of an electrogenic component, but did not alter the negative TEP in dilute solution. When fish were transferred to 350 mmol L-1 solutions of NaHCO3, NaCl, NaNO3, or choline Cl, only the 350 mmol L-1 NaHCO3 solution sustained the TEP unchanged at ?7 mV; in all others, the TEP fell. Furthermore, after transfer to 50, 10, and 2% dilutions of 350 mmol L-1 NaHCO3, the TEPs remained identical to those in comparable dilutions of Magadi water, whereas this did not occur with comparable dilutions of 350 mmol L-1 NaCl— i.e. the fish behaves electrically as if living in an NaHCO3 solution equimolar to Magadi water. We conclude that the TEP is largely a Na? diffusion potential attenuated by some permeability to anions. In Magadi water, the net electrochemical forces driving Na? inwards (?9.9 mV) and Cl- outwards (?3.4 mV) are small relative to the strong gradient

We investigated the transepithelial potential (TEP) and its responses to changes in the external medium in Alcolapia grahami, a small cichlid fish living in Lake Magadi, Kenya. Magadi water is extremely alkaline (pH = 9.92) and otherwise unusual: titratable alkalinity (290 mequiv L(-1), i.e. HCO(3) (-) and CO(3) (2-)) rather than Cl(-) (112 mmol L(-1)) represents the major anion matching Na(+) = 356 mmol L(-1), with very low concentrations of Ca(2+) and Mg(2+) (<1 mmol L(-1)). Immediately after fish capture, TEP was +4 mV (inside positive), but stabilized at +7 mV at 10-30 h post-capture when experiments were performed in Magadi water. Transfer to 250% Magadi water increased the TEP to +9.5 mV, and transfer to fresh water and deionized water decreased the TEP to -13 and -28 mV, respectively, effects which were not due to changes in pH or osmolality. The very negative TEP in deionized water was attenuated in a linear fashion by log elevations in [Ca(2+)]. Extreme cold (1 vs. 28°C) reduced the positive TEP in Magadi water by 60%, suggesting blockade of an electrogenic component, but did not alter the negative TEP in dilute solution. When fish were transferred to 350 mmol L(-1) solutions of NaHCO(3), NaCl, NaNO(3), or choline Cl, only the 350 mmol L(-1) NaHCO(3) solution sustained the TEP unchanged at +7 mV; in all others, the TEP fell. Furthermore, after transfer to 50, 10, and 2% dilutions of 350 mmol L(-1) NaHCO(3), the TEPs remained identical to those in comparable dilutions of Magadi water, whereas this did not occur with comparable dilutions of 350 mmol L(-1) NaCl-i.e. the fish behaves electrically as if living in an NaHCO(3) solution equimolar to Magadi water. We conclude that the TEP is largely a Na(+) diffusion potential attenuated by some permeability to anions. In Magadi water, the net electrochemical forces driving Na(+) inwards (+9.9 mV) and Cl(-) outwards (+3.4 mV) are small relative to the strong gradient driving HCO(3) (-) inwards (-82.7 mV). Estimated permeability ratios are P (Cl)/P (Na) = 0.51-0.68 and [Formula: see text] = 0.10-0.33. The low permeability to HCO(3) (-) is unusual, and reflects a unique adaptation to life in extreme alkalinity. Cl(-) is distributed close to Nernst equilibrium in Magadi water, so there is no need for lower P (Cl). The higher P (Na) likely facilitates Na(+) efflux through the paracellular pathway. The positive electrogenic component is probably due to active HCO(3) (-) excretion.

We investigated the transepithelial potential (TEP) and its responses to changes in the external medium in Alcolapia grahami, a small cichlid fish living in Lake Magadi, Kenya. Magadi water is extremely alkaline (pH = 9.92) and otherwise unusual: titratable alkalinity (290 mequiv L−1, i.e. HCO3 − and CO3 2−) rather than Cl− (112 mmol L−1) represents the major anion matching Na+ = 356 mmol L−1, with very low concentrations of Ca2+ and Mg2+ (<1 mmol L−1). Immediately after fish capture, TEP was +4 mV (inside positive), but stabilized at +7 mV at 10–30 h post-capture when experiments were performed in Magadi water. Transfer to 250% Magadi water increased the TEP to +9.5 mV, and transfer to fresh water and deionized water decreased the TEP to −13 and −28 mV, respectively, effects which were not due to changes in pH or osmolality. The very negative TEP in deionized water was attenuated in a linear fashion by log elevations in [Ca2+]. Extreme cold (1 vs. 28°C) reduced the positive TEP in Magadi water by 60%, suggesting blockade of an electrogenic component, but did not alter the negative TEP in dilute solution. When fish were transferred to 350 mmol L−1 solutions of NaHCO3, NaCl, NaNO3, or choline Cl, only the 350 mmol L−1 NaHCO3 solution sustained the TEP unchanged at +7 mV; in all others, the TEP fell. Furthermore, after transfer to 50, 10, and 2% dilutions of 350 mmol L−1 NaHCO3, the TEPs remained identical to those in comparable dilutions of Magadi water, whereas this did not occur with comparable dilutions of 350 mmol L−1 NaCl—i.e. the fish behaves electrically as if living in an NaHCO3 solution equimolar to Magadi water. We conclude that the TEP is largely a Na+ diffusion potential attenuated by some permeability to anions. In Magadi water, the net electrochemical forces driving Na+ inwards (+9.9 mV) and Cl− outwards (+3.4 mV) are small relative to the strong gradient driving HCO3 − inwards (−82.7 mV). Estimated permeability ratios are P Cl/P Na = 0.51–0.68 and PHCO3/PNa = 0.10–0.33. The low permeability to HCO3 − is unusual, and reflects a unique adaptation to life in extreme alkalinity. Cl− is distributed close to Nernst equilibrium in Magadi water, so there is no need for lower P Cl. The higher P Na likely facilitates Na+ efflux through the paracellular pathway. The positive electrogenic component is probably due to active HCO3 − excretion.

A double antibody enzyme linked immunosorbent assay for identification of thermostable muscle antigens of autoclaved meat samples is described. The assay differentiates heterologous thermostable muscle antigens from homologous at P 0.001. In model meat mixtures, the assay detects adulterants at the level of 1% at p0.001 even in phylogenetically related species such as buffalo and cattle.

Selecting the right solid modeling software is a complex, multi-criteria decision making problem.
There are many issues a decision-maker needs to take into account, such as ease of learning,
educational materials built into the software, learning curve issues, performance of the software
for different solid modeling functions, operations and utilities, and cost. Beyond selecting the
right software, the decision-maker should also be concerned about (1) conceptual learning of the
solid modeling topics while “the right software” is being used, and (2) transfer of conceptual
learning between solid modelers. This is because a sound conceptual learning might increase the
probability of learning another solid modeling software in less time.

Accordingly this paper investigates the impact of icon recognition as an aid to transfer
conceptual learning between solid modelers. The investigation includes a review of the literature
on icon design and usage as it relates to solid modeling, in addition to an experiment in which
the icon recognition correctness and duration for over 20 operation icons were compared across
two modelers. The results shed light into the impact of icon designs on the transfer of learning
between solid modelers using the correct recognition counts as the transfer measure.

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

A model for the establishment of an integrated geodetic datum covering a region is treated. The integrated geodetic datum is understood here to comprise the geoid, the reference ellipsoid, and the positional coordinates. A comprehensive unified solution model including the three parameters comprising the datum is considered. The estimation model adopted rigorously incorporates determined prior information in the estimation of the datum parameters. Mathematical models together with the pertinent observation equations are presented, followed by a description of the procedure for the aetual setting up of the datum. The observational scheme is based on a system of modular traverses anchored on a trilateration of GPS baselines.

Kenya’s Vision 2030 requires a functionally literate adult population which can effectively contribute to economic production and participate in the democratic processes of the country. It is unfortunate that the 7.8 million (38.5%) of Kenya’s adult population is still illiterate (Kenya literacy survey 2007). With this current situation, adult learner retention should hold the attention of all adult educators in every type of program. The rate of relapsing into illiteracy is also high. An estimated 33.6% of those surveyed who indicated to have completed primary level education were found to be illiterate at the time of the survey. According to the Kenya National Adult Literacy Survey (2007) only 29.6% of the 61.5% literate adults had attained the desired mastery level of literacy and would therefore be considered able to participate effectively in the realization of this Vision. This study examined the fit of the transformational/transactional leadership paradigm to voluntary adult educators in Eastern Province, Kenya. The study also sort to establish whether the leadership style had any effect on the rate of drop out among adult learners in the same province. The sample consisted of 104 voluntary adult educators of the certificate in adult education and community development class of the University of Nairobi (Meru class) The Multifactor Leadership Questionnaire Form 5X was administered to the sample during the face to face session that took place at a Mulanthakari multi-purpose hall to determine the effect of perceived District Adult Educator leadership on the outcome variables of effectiveness, satisfaction and adult learners drop out rate in the district. Multivariate statistical techniques were used to analyze the transformational leadership variables: idealized influence (attributed), idealized influence (behavioral), inspirational motivation, intellectual stimulation, and individual consideration. The results of the study were consistent with previously published studies and demonstrates the applicability of the transformational leadership paradigm to adult education in eastern province.

It is undisputed that success or failure of any organization depends on its leadership. School efficiency that is measured by factors such as students’ academic performance and discipline is not an exception. A lot of blame has been attributed to the leadership styles used by the secondary school principals. This has created disharmony between the principals and other stakeholders. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. One kind of leadership behaviour that has been a topic of debate among scholars for the past decade is transformational leadership. Whether or not this kind of leadership is present in principals who have been in the profession for long or less years would be of interest to many scholars. This study endeavoured to establish the differences between transformational leadership practices by school principals based on their professional experience in selected secondary schools in Kenya. The participants were administered Kouzes and Posner’s leadership Practices Inventory which identified the principal leadership practices in each of the five dimensions of “challenging the process”, “inspiring a shared vision”, “enabling others to act”, “modeling the way” and “encouraging the heart”. The sample consisted of 387 participants from 49 secondary schools in Kenya. Leadership behaviour was measured using the Leadership Practices Inventory-(“Self” and “others”). The findings indicated that principals who had professional experience of less than one year scored higher in three transformational leadership practices (modeling the way, enabling others to act, and encouraging the heart) than their counterparts who had over 9 years of professional experience. Pearson correlation showed a positive statistical significant correlation professional experience of principals and their LPI scores. It was recommended that there is need for retraining of practicing principals in transformational leadership so that they can match the changing trends in the modern society.

Key words: transformational leadership, challenging the process, inspiring a shared vision, enabling others to act, modeling the way, encouraging the heart, professional experience

Kenya through its vision 2030 aims to become a middle-income industrialized country. In this vision, education and training has been isolated as a supreme vehicle that will take the country to the desired level of development. Although the government of Kenya has invested a lot of funds in education, it is sad that many schools do not provide teaching and learning in the most efficient way. A lot of blame has been attributed to the leadership styles used by the secondary school principals. This has created disharmony between the principals and other stakeholders. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. School leaders have tried many leadership approaches with the aim of improving school efficiency. In the last two decades, Instructional and Transformational leadership theories have been frequently mentioned and researched in educational leadership. In the 1980s and early 1990s, Instructional leadership paradigm was thought to have served the schools well. Although this theory was said to have been the most popular in educational leadership, modern demands for educational reforms have made school leaders to look for an alternative. Just as societal and school demographics have changed in recent decades, so has the type of leadership needed to successfully lead the rapidly changing schools. A recent theory that has been embraced by many school leaders is transformational leadership. This study sought to establish the extent to which public school principals have embraced “modeling the way” characteristic of transformational leadership in comparison to the private school principals in Kenya. The study further investigated the relationship between this transformational leadership characteristic to students academic performance in both categories of schools. The sample consisted of 387 participants from 49 secondary schools in Kenya. Co relational research design was employed in data analysis. The findings indicated that principals in private schools scored higher (53.63) than the principals who were in public schools (51.79). The analyses indicated a negative correlation between “Modeling the way” transformational characteristic of principals in public schools and in private schools. Pearson correlation analysis also showed a significant correlation between Modeling the way" characteristic and students’ academic performance. Based on these findings, it is important to ensure that the principals feel totally in control of their institutions.

Key words: Transformational leadership, Principals, modeling the way, school ownership

Leadership is an area that many would not want to take for granted because of established correlations between success or failure of any organization and its leadership. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. One kind of leadership behaviour that has been a topic of debate among scholars for the past decade is transformational leadership. This study endeavoured to establish the effect of transformational leadership on academic performance in selected secondary schools in Kenya. The participants were administered Kouzes and Posner’s leadership Practices Inventory which identified the principal leadership practices in each of the five dimensions of “challenging the process”, “inspiring a shared vision”, “enabling others to act”, “modeling the way” and “encouraging the heart”. The sample consisted of 387 participants from 49 secondary schools in Kenya. Leadership behaviour was measured using the Leadership Practices Inventory-(“Self” and “others”). Co relational research design was employed in data analysis. Pearson correlations were used to establish if there was a relationship between transformational leadership practices and academic performance. Pearson correlation indicated statistical significance between total LPI scores and students’ academic performance. A further analysis of the leadership domains showed there was a positive correlation between three transformational characteristics (Inspiring a Shared Vision, Challenging the process and Encouraging the Heart) and Students’ academic performance. There was however a weak but not statistically significant correlation between transformational leadership in two characteristics (Modeling the way and Enabling Others to Act) and students’ academic performance. The principals whose schools obtained the minimum university entry mark (Above C+) scored higher in LPI scores than the principals whose schools obtained less than the university entry marks (Below C+). It was recommended that all learners undertaking their teacher training should be trained on transformational leadership since they are the ones that take over leadership roles in their career as teachers. All practicing school principals should learn and practice transformational leadership for effective learning and teaching in their schools.

ICT is a critical tool for expanding human skills and rests largely on a system of producing, distributing and utilising information and knowledge that in turn plays a great role in driving productivity and economic prosperity. Kenya as a developing country realizes this importance and has a ministry specifically dealing with ICT. The vision statement of the ministry of information and Technology as stated in its strategic plan 2013-2018 is to make Kenya a globally competitive knowledge-based economy. This vision aims at shifting the current industrial development path towards innovation where creation, adoption, adaptation and use of knowledge remain the key source of economic growth. Research has shown that countries which have invested a lot in their human capital are far ahead of others in development. This development is likely to be an illusion unless Kenya is able to achieve its educational goals. Education and training has been isolated in the vision 2030 as the only mechanism that will translate Kenya into a middle-income economy. This is because education is fundamental to development of human resource capacities for sustainable economic growth and development. Through impartation of new skills and knowledge in people, education is able to improve human capabilities and labour productivity. It is in this regard that the Kenyan government has invested a lot of funds in ICT infrastructure including digitization of educational materials through Kenya Institute of curriculum Development. Kenya’s vision of education service provision is to have a globally competitive quality education, training and research for Kenya’s sustainable development. This study focused on the influence of secondary school managers on integration of ICT in teaching and learning in Githunguri subcounty, Kiambu County in Kenya. The study targeted 40 schools with a total population of 245 male teachers and 282 female teachers. teachers. A researcher developed questionnaire was issued to all the 40 school managers and to 100 teachers for triangulation purposes. Data analysis was done using statistical package for social sciences (SPSS).The study sort to establish if there is a relationship between management support and ICT integration in teaching and learning. Pearson correlation coefficient was used in the analysis. A positive correlation coefficient of 0.560 was obtained between the level of school management support and the use of ICT in teaching and learning. The findings indicated that school managers influenced integration of ICT in teaching and learning. The study therefore suggested that effort should be made by all stakeholders to ensure that school managers come up with policies on ICT integration in their schools which should be in line with the National ICT policy. KEY word: ICT integration, Teaching and learning, school managers, transformational leadership, challenging the process, secondary schools

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We describe a case of a female who developed haemosiderosis, in the course of treatment for very severe unstable aplastic anaemia for fourteen years. She was 37 years old at the time of initial diagnosis. Her management consisted of regular blood transfusions aimed at haemoglobin above 8.5 g/dl, antimicrobials, oxymetholone, low dose prednisone and folate. She had received about seventy five units of blood at the start of 2 grams of desferrioxamine with every subsequent blood transfusion. Annual tests of serum ferritin showed progressive increase. She developed skin changes, diabetes mellitus, heart disease, recurrent infections, generalized joint and abdominal pains and liver failure. She died within six weeks of developing congestive heart failure coupled with liver failure due to haemosiderosis despite regular use of desferrioxamine.

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The paper considers a single-server queue with fixed-size batch Poisson arrivals and exponential service times, a model that is useful for a buffer that accepts messages arriving as fixed size batches of packets and releases them one packet at time. Transient performance measures for queues have long been recognized as being complementary to the steady-state analysis. The focus of the paper is on the use of the functions that arise in the analysis of the transient behaviour of the queuing system. The paper exploits practical modelling to obtain a solution to the integral equation encountered in the analysis. Results obtained indicate that under heavy load conditions, there is significant disparity in the statistics between the transient and steady state values.

The transient analysis of a queuing system with fixed-size batch Poisson arrivals and a single server with exponential service times is presented. The focus of the paper is on the use of the functions that arise in the analysis of the transient behaviour of the queuing system. These functions are shown to be a generalization of the modified Bessel functions of the first kind, with the batch size B as the generalizing parameter. Results for the case of single-packet arrivals are obtained first. The similarities between the two families of functions are then used to obtain results for the general case of batch arrival queue with a batch size larger than one.

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We describe the technique of splenic aspiration in 113 patients presenting with splenomegaly. It was used initially to establish a diagnosis, and in those patients with kala azar, to follow the response of the parasites to therapy until 'parasitological cure'. In all 671 aspirations were performed. No complications occurred in the 69 patients with active kala azar, who collectively had more than 600 aspirations. One patient in a moribund condition had a fatal haemorrhage. The aspirate suggested a lymphoma, confirmed at autopsy. In 68 of the 69 patients with active kala azar, the diagnosis was established at the first aspiration. The essentials of the technique are the use of a small calibre needle (21 G), and speed, the needle being in the spleen for less than a second, with the consequent procurement of a few drops of material only.

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The progression of HIV-related disease from infection to death is represented as a staged Markov model. Transitions between stages are considered reversible. The model is fitted to data from a cohort of African prostitutes by means of maximum likelihood. It appears that the progression to symptomatic disease (Centers for Disease Control stage IV) in this population is considerably more rapid than that reported from studies in Western countries. PIP: Identifying the incubation period of HIV infection is important for individual prognoses, for developing and testing intervention strategies, for determining the reproductive rate of the disease, and for prevalence of the disease. Mathematical modeling of HIV infection in Africa is necessitated because the disease is more widespread and the immune system is constantly active due to the exposure to diseases such as malaria and tuberculosis. The Markov model for this analysis was selected because parametric estimation is not based on the time a stage is entered, but on the duration between observations and the stages at the time of observation. The HIV infected female prostitutes in the Pumwani area of Nairobi, Kenya (a population primarily of Tanzanian origin) have been identified as a study population since 1985, and seen every 6 months in clinic, or as needed. Data are constricted by the movement out of the area in the end stage of disease, which is only partially solved by tracking with community health workers. The stages identified in incubation estimation are stage 1: seropositive but symptom free (CDC stage II); stage 2: generalized lymphadenopathy (CDC stage III); stage 3: symptomatic disease (CDC stage IV); and stage 4: death. Data reflect the movement back and forth between stage 1 and 2, between 2 and 3, so the model is not a pure Longini model but rather a timed homogeneous staged model with reversible stages called transition parameters computed in a numerical differentiation. The Fortran computer program for the analyses is available from the authors. The results suggest a quick transition between seroconversion and lymphadenopathy (2.4 months) and unlikely reversal, with the mean waiting time until passage to stage 3 is approximately 2.6 years and conversions are common. Since opportunistic infections are treatable, this makes sense. Assuming a correct model, the estimation of the transition time of 20 months of h34 value of .01 and .05, the mean passage time from stage 1, 2, 3 to 4 (death) is 9.1, 8.9, and 6.2 years 12.9, 12.7, and 10.1 years respectively. The implications are that 1) when infectiousness is hypothesized to be not uniform, peak infectivity occurs earlier in Africa than in the West at least among prostitutes, or 2) if infectivity is constant throughout the incubation period, then HIV transmission must be higher in Africa to explain the high rate of infection

AIDS. 1990 Aug;4(8):743-7.
Transition dynamics of HIV disease in a cohort of African prostitutes: a Markov model approach.
Nagelkerke NJ, Plummer FA, Holton D, Anzala AO, Manji F, Ngugi EN, Moses S.
Source
Kenya Medical Research Institute, Nairobi.
Abstract
The progression of HIV-related disease from infection to death is represented as a staged Markov model. Transitions between stages are considered reversible. The model is fitted to data from a cohort of African prostitutes by means of maximum likelihood. It appears that the progression to symptomatic disease (Centers for Disease Control stage IV) in this population is considerably more rapid than that reported from studies in Western countries.
PIP:
Identifying the incubation period of HIV infection is important for individual prognoses, for developing and testing intervention strategies, for determining the reproductive rate of the disease, and for prevalence of the disease. Mathematical modeling of HIV infection in Africa is necessitated because the disease is more widespread and the immune system is constantly active due to the exposure to diseases such as malaria and tuberculosis. The Markov model for this analysis was selected because parametric estimation is not based on the time a stage is entered, but on the duration between observations and the stages at the time of observation. The HIV infected female prostitutes in the Pumwani area of Nairobi, Kenya (a population primarily of Tanzanian origin) have been identified as a study population since 1985, and seen every 6 months in clinic, or as needed. Data are constricted by the movement out of the area in the end stage of disease, which is only partially solved by tracking with community health workers. The stages identified in incubation estimation are stage 1: seropositive but symptom free (CDC stage II); stage 2: generalized lymphadenopathy (CDC stage III); stage 3: symptomatic disease (CDC stage IV); and stage 4: death. Data reflect the movement back and forth between stage 1 and 2, between 2 and 3, so the model is not a pure Longini model but rather a timed homogeneous staged model with reversible stages called transition parameters computed in a numerical differentiation. The Fortran computer program for the analyses is available from the authors. The results suggest a quick transition between seroconversion and lymphadenopathy (2.4 months) and unlikely reversal, with the mean waiting time until passage to stage 3 is approximately 2.6 years and conversions are common. Since opportunistic infections are treatable, this makes sense. Assuming a correct model, the estimation of the transition time of 20 months of h34 value
of .01 and .05, the mean passage time from stage 1, 2, 3 to 4 (death) is 9.1, 8.9, and 6.2 years 12.9, 12.7, and 10.1 years respectively. The implications are that 1) when infectiousness is hypothesized to be not uniform, peak infectivity occurs earlier in Africa than in the West at least among prostitutes, or 2) if infectivity is constant throughout the incubation period, then HIV transmission must be higher in Africa to explain the high rate of infection.
PMID:
2175619
[PubMed - indexed for MEDLINE]

Kindly check later

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JASPA Working Paper, ILO, Addis Ababa

Journal of Eastern African Literary and Cultural Studies

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Communicating the concepts and practices of development by way of translation across languages and cultures is always intertwined with linguistic and conceptual tensions which blur meaning, distort communicative intention and nurture conceptual ambiguity in target paradigms. In order to create linguistically viable and functional cross-cultural communication, translation has to rely on myriad strategies entailing mediating meaning, that is, rendering cross-cultural communications in ways that make intended meaning accessible and usable. Meanings of concepts and their practices are subtly nuanced and understood in different languages and cultures. Meaning nuances as such denote tensions between incongruent linguistic and cultural interests and in situations of such tensions, translation provides a forte for mediating both linguistic and cultural differences of the interacting languages. This paper seeks to argue that translations of specialized terminologies in any field of human activity do not always result in explicit meaning equivalences, but rather in meanings that are contextually situated and culturally nuanced. Translating in such situations requires that we identify and account for how people and language communities make meaning of concepts on the basis of their own circumstances, worldviews and in their local languages. Thus, lack of linguistic equivalencies and the presence of meaning indeterminacy in translation is not a reflection of translational failure but rather, a calling to attention of the differences in the perceptions and interpretations of concepts across languages, which in subtle ways represent modes of thinking and communicating (Hoppers 2002). Successful and functional translation of specialized terminologies must be underpinned by the realization that conceptual meanings are always situated in cultural, contextual and temporal terms. Their transmission through translation into ‘new’ contexts can never be straightforward but rather mediated.

The sheep is a valuable model for cardiovascular studies and its aorta is frequently afflicted by
atherosclerosis and aneurysms. The structure of sheep aorta is, however, only seldom reported. This
study, therefore, aimed at describing the microscopic organization of the tunica media of the aorta in
sheep. Specimens obtained from the aortae of six healthy young adult sheep were fixed in 10%
formaldehyde solution and routinely processed for paraffin embedding and sectioning. Five micron
sections were stained with Weigert’s Resorcin Fuchsin/Van Gieson and examined with a light microscope.
Micrographs were taken with a high resolution digital camera. The tunica media in the ascending, arch
and thoracic regions comprised two zones namely a luminal elastic zone with continuous uniform elastic
lamellae and adventitial musculo-elastic one where there were muscle islands frequently interrupting the
elastic lamellae. The proportion of musculo-elastic zone with the muscle islands declined caudally. In the
abdominal region, however, the tunica media comprised regular continuous concentric elastic lamellae.
These results show that the aorta in sheep displays regional variations characterized by transmedial
zonation of the thoracic segments into an elastic luminal and musculo-elastic adventitial zones. These
differences may underpin the regional differences in physicomechanical properties and vulnerability of
the aorta to diseases such as atherosclerosis and aneurysm.

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Meckel-Gruber syndrome is a severe autosomal, recessively inherited disorder characterized by bilateral renal cystic dysplasia, developmental defects of the central nervous system (most commonly occipital encephalocele), hepatic ductal dysplasia and cysts and polydactyly. MKS is genetically heterogeneous, with three loci mapped: MKS1, 17q21-24 (ref. 4); MKS2, 11q13 (ref. 5) and MKS3 (ref. 6). We have refined MKS3 mapping to a 12.67-Mb interval (8q21.13-q22.1) that is syntenic to the Wpk locus in rat, which is a model with polycystic kidney disease, agenesis of the corpus callosum and hydrocephalus. Positional cloning of the Wpk gene suggested a MKS3 candidate gene, TMEM67, for which we identified pathogenic mutations for five MKS3-linked consanguineous families. MKS3 is a previously uncharacterized, evolutionarily conserved gene that is expressed at moderate levels in fetal brain, liver and kidney but has widespread, low levels of expression. It encodes a 995-amino acid seven-transmembrane receptor protein of unknown function that we have called meckelin.

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A five year old entire mixed breed dog was admitted to the University of Nairobi's small animal clinic with a 5-months history of subcutaneous masses. Physical examination revealed firm and mobile masses in the subcuticular tissues, on the mandible and the transverse processes of the lumbar vertebrae. Visual inspection of the prepuce also revealed a timorous mass. Surgical excision of the subcutaneous masses and the mass on the prepuce was performed while the dog was under surgical anesthesia. Microscopic examination of the subcutaneous masses revealed features consistent with canine transmissible venereal tumor. This paper provides a detailed account of the clinical findings, surgical procedure and outcomes of managing the case.

Rabies is still prevalent in most parts of the developing WOrld, with approximately 4 million people in Asia, Africa, and South America receiving post-exposure treatment and over 30 000 dying after being bitten by rabid dogs (WHO, 1992). In Kenya, rabies has been common in Machakos District for at least 40 years. We have undertaken several studies in recent years to collect information on dog ecology, dog population dynamics and rabies epidemiology required to improve rabies control in this district (Kitala et aI., 1993; Kitala and McDermott, 1995). Given this baseline data, mathematical models, often quite simple ones, can serve as a useful tool for predicting disease incidence under different natural and disease control scenarios (Anderson and May, 1991) and have been used to advantage in assessing rabies epidemiology, particularly in fox populations in Europe and North America (e.g. Anderson et al., 1981; Voigt et al., 1985). In this paper, we describe a simple deterministic model of rabies which incorporates both transitions between the main rabies disease states and dog populaton parameters. particularly thresholds for dog density. We compare model predictions to observed patterns of rabies in Machakos District and also explore the potential efficacy of different rabies control programmes.

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A prospective study involving ninety (90) transperineal TruCut Tm needle biopsies of the prostate in eighty (80) patients has revealed that the repeated use of this needle until it becomes ineffective does not affect its diagnostics accuracy, and is not associated with more complications. Each needle was used on five patients before being discarded. A positive correlation of 95% was found between the clinically malignant prostates on rectal examination and histopathologic diagnosis. Four biopsies did not provide adequate tissue for histological diagnosis giving an overall failure rate of 4.4%. No complications were reported except fro haematuria in two patients (2.5%) and a perineal haematoma in one patient (1.25%).

A prospective study involving ninety (90) transperineal TruCut Tm needle biopsies of the prostate in eighty (80) patients has revealed that the repeated use of this needle until it becomes ineffective does not affect its diagnostics accuracy, and is not associated with more complications. Each needle was used on five patients before being discarded. A positive correlation of 95% was found between the clinically malignant prostates on rectal examination and histopathologic diagnosis. Four biopsies did not provide adequate tissue for histological diagnosis giving an overall failure rate of 4.4%. No complications were reported except fro haematuria in two patients (2.5%) and a perineal haematoma in one patient (1.25%).

An highly structured TiO2/In(OH)xSy/Pb(OH)xSy/PEDOT:PSS/Au
device has been fabricated. It has been anaylsed for morphological
and optoelectrical properties by scanning electron microscopy,
surface photovoltage spectrscopy and temperature dependent JUT.
The device has been found to undergo thermally activated
recombination at high temperatures while tunneling enhanced
recombination dominates the process at low temperatures

Transport mechanism studies in TiO2/In (OH) xSy/Pb (OH) xSy/PEDOT: PSS eta solar cell have been carried out. The characterizations have been performed both in the dark and under varying illumination intensity for temperature range 200 K–320 K. The recombination process of the eta solar cell in the dark has been found to be tunneling enhanced, while under illumination it is thermally activated and takes place through exponentially distributed energy recombination levels. The illumination intensity and temperature have also been found to have a strong influence on the device conversion efficiency, with the highest efficiency being realized at 200 K

Naisho JN, Ongaya L, Musandu JO. PIP: In highlighting the role of traditional birth attendants (TBAs) in the implementation of primary health care (PHC) in Kenya, the following topics are discussed: characteristics of TBAs as reported in studies, the training program, program objectives, content, the training process, resources for training, the role of TBAs in PHC, and evaluation. The definition of midwife is given as midwives trained in a community setting to assist in delivery within the confines of accepted cultural beliefs. A study of 28 midwives from different regions in Kenya in 1980 found that most were illiterate women between 24 and 68 years olds received no monetary gain, had a variety of occupational backgrounds, and provided varying amounts of advice but little pre- or postnatal care. Almost all advised mothers to breast feed for at least 2 years. 80% of mother use TBAs for delivery. In order to minimize maternal (5-20/1000 live births on the average) and infant mortality, many countries have or are developing training programs for TBAs. Inadequacies in TBA care may be little prenatal care, too little postnatal care, and deficits in promoting child spacing; other unsafe practices may be improper washing of hands and severing the umbilical cord with unsterile objects. Other advantages of training TBAs involve less cost, less need for transportation, personalized setting in the home, source of health education in the community, and rapport with her clients. The training program goal is to reduce mortality by eliminating bad practices. The objectives are to reduce maternal deaths or illness from hemorrhage, infection, and toxemia; to encourage better nutrition; to reduce perineal or vaginal tears which may lead to longterm disability from urinary or rectal fistula; to reduce the number of pregnancies or exposure to risk; and to reduce neonatal tetanus asphyxia, infection, diarrhea, and malnutrition. Activities entail educating adolescent girls and pregnant women on menstruation and sexuality within cultural norms, prenatal care and delivery and postnatal care, maternal care, and educating mothers about personal hygiene, nutrition, child spacing, and immunization, and acknowledgement of the valuable service TBAs contribute to the community. Programs have operated for 10 years and evaluation is underway. PMID: 2630785 [PubMed - indexed for MEDLINE]

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A 28 year old male was screened, investigated and diagnosed as a case of true gender dysphoria. Subsequently he was operated and transsexual surgery successfully carried out. Four years after surgery, the patient has been followed up and found to be living a normal life as a female

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OBJECTIVE: To determine the prevalence of Xerophthalmia among Kenyan children aged four to seven years in high risk using Conjuctival Impression Cytology and transfer. DESIGN: A cross sectional community based study. SETTING: Mathare slum in Nairobi and Tiva/Ithiani area of Kitui. SUBJECTS: Children aged four to seven years residing in the above areas were assessed for both clinical and cytological features of vitamin A deficiency. RESULTS: Of the 342 children included in this study, 316 (92.0%) were normal, five (1.5%) had XN, 19 (5.9% had XIA and two (0.6%) had XIB. No signs of corneal Xerophthalmia were seen in this study. Conjuctival impression cytology and transfer (CICT) was used to asses for squamous metaplastic changes associated with Vitamin A deficiency (VAD). Seventy five (23.1%) of the children were normal by CICT while 249 (76.9%) were abnormal. In comparing the two areas of study, only 13.2% of the children in Mathare had normal CICT compared to 50% in Kitui. For each of the age groups studied there was significant difference between the two areas with children from Mathare being more deficient than those from Kitui. CONCLUSION: VAD is a significant health problem in the high risk areas assessed by CICT in this study.

Two thousand, seven hundred and ninety one normal and handicapped children aged 5-15 years were examined for traumatic dental injuries. Twelve percent had traumatised teeth while three percent had soft tissue injuries. More handicapped children (18%) than normal children (11%) had injuries. This study indicates that children need to be educated on preventive measures regarding traumatic dental injuries.

Two thousand, seven hundred and ninety one normal and handicapped children aged 5-15 years were examined for traumatic dental injuries. Twelve percent had traumatised teeth while three percent had soft tissue injuries. More handicapped children (18%) than normal children (11%) had injuries. This study indicates that children need to be educated on preventive measures regarding traumatic dental injuries.

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

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

Gender-based violence is any violence that exploits distinctions between individuals of different sexes. Sexual violence in the form of rape or mass rape is traumatic for the victim but can have significant physical consequences, such as traumatic fistula which can render the victim incontinent of urine and/or faeces. The physical consequences are compounded by psychological trauma and stigma. This article presents a case study of a 16-year-old girl affected by traumatic fistula. It explains the implications of such a condition and provides a brief explanation of surgery, giving health professionals a greater understanding of the context and surgical treatment.

Increasing resistance of Haemophilus ducreyi to antimicrobials necessitates further trials of new antimicrobial agents for treating chancroid. Enoxacin has excellent in vitro activity against H ducreyi, and a randomised clinical trial of three doses of enoxacin 400 mg at intervals of 12 hours compared with a single dose of trimethoprim/sulphametrole (TMP/SMT) 640/3200 mg was therefore conducted. Of 169 men enrolled in the study, 86 received enoxacin and 83 received TMP/SMT. Ulcers were improved or cured in 65/73 men treated with enoxacin and 57/70 men treated with TMP/SMT. This difference was not significant. At 72 hours after treatment, H ducreyi was eradicated from ulcers of 72/77 men treated with enoxacin and of 67/74 of those treated with TMP/SMT. Patients with buboes responded equally well to both treatments. Of 100 H ducreyi strains tested, all were susceptible to both 0.25 mg/l enoxacin and the combination of 0.25 mg/l TMP and 5 mg/l SMT. Although most men treated with either regimen were cured, neither regimen appeared to be the optimum treatment for chancroid. This study shows the efficacy of enoxacin for a soft tissue infection caused by Gram negative organisms.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Prolapsed intervertebral disk (PID) disease can be managed conservatively or surgically with different reported outcomes.Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital.Study Design: A retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH) a referral and teaching Hospital in Kenya.Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collecteddata was analyzed using the SPSS 17.0 for Windows.Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest.Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half ofthe study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively.Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Prolapsed lumbar intervertebral disk (PID) disease can be managed conservatively or surgically with different outcomes. Objective: The present study aimed at assessing the management and outcomes of slipped intervertebral disk disease at the Kenyatta National hospital. Design: A retrospective cross-sectional study. Setting: Kenyatta National Hospital (KNH) a referral and teaching hospital in Kenya. Patients and Methods: Consecutive files of all cases of slipped intervertebral disk disease from January 1997 to December 2007 were retrieved from the Medical records at the Kenyatta National Hospital. The biodata, management methods and the outcomes of the procedures were recorded. The collected data were analyzed using the SPSS 17.0 for Windows. Results: Six hundred and three cases were reviewed. All patients received analgesics and bed rest. Five percent of the patients were put on bilateral traction for two weeks while 4% of the patients had corsets. Thirty five per cent of the patients were surgically managed. Over a third of the surgically managed patients had laminectomies. Microdiscectomy was increasingly popular in the latter half of the study period. Of the managed patients 95% reported improvement while 92% were complication free. The rate of reherniation and reoperation was 1.5% and 1.2% respectively. Conclusion: The management of PID at Kenyatta National Hospital is largely successful with few cases of complications. In selected patients both conservative and surgical care are used in tandem. Microdiscectomy is an increasingly popular surgical procedure at the KNH.

Background: Multiple Myeloma (MM) is a
haematological cancer characterized by complications
of end-organ damage and subsequently high mortality.
Previously, there were few therapies available with
minimal survival benefit for most patients. Survival
was less than a year in many countries. The survival of
MM patients can range from 6 months to over 10 years,
with a median of 6 years, depending on stage of the
disease at diagnosis and prognostic factors. However,
with the advent of newer immune modulating agents
and novel therapies, there exists an opportunity to
improve the management of MM.
Objective: The purpose of this review is to discuss
the current chemotherapy and novel agents available
for treatment of Multiple Myeloma and highlight
emerging therapies in treatment of Multiple Myeloma,
some of which are now locally available in Kenya.
Data Sources: International Guidelines on Treatment
of Multiple Myeloma; Published articles from peerreviewed
journals; ESMO, NCCN guidelines on
Multiple Myeloma
Conclusion: New MM therapies have been shown to
improve progression-free survival and overall survival
of to upto 82% at four years. Some of these therapies
are now accessible locally through government
funding. In combination with a wholesome approach
which includes appropriate supportive care, there
exists an opportunity to improve the quality and
standard of care of MM patients in Kenya to replicate
the success of that in developed countries.
Key words: Multiple myeloma, Cancer

Treatment interruption (TI) has been safe and durable in some pediatric studies but none have compared TI to continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in TI versus continued ART among early-treated infants.

Treatment interruption has been well tolerated and durable in some pediatric studies but none have compared treatment interruption with continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

Acute metabolic acidosis is associated with increased morbidity and mortality because of its depressive effects on cardiovascular function, facilitation of cardiac arrhythmias, stimulation of inflammation, suppression of the immune response, and other adverse effects. Appropriate evaluation of acute metabolic acidosis includes assessment of acid-base parameters, including pH, partial pressure of CO(2) and HCO(3)(-) concentration in arterial blood in stable patients, and also in central venous blood in patients with impaired tissue perfusion. Calculation of the serum anion gap and the change from baseline enables the physician to detect organic acidoses, a common cause of severe metabolic acidosis, and aids therapeutic decisions. A fall in extracellular and intracellular pH can affect cellular function via different mechanisms and treatment should be directed at improving both parameters. In addition to supportive measures, treatment has included administration of base, primarily in the form of sodium bicarbonate. However, in clinical studies of lactic acidosis and ketoacidosis, bicarbonate administration has not reduced morbidity or mortality, or improved cellular function. Potential explanations for this failure include exacerbation of intracellular acidosis, reduction in ionized Ca(2+), and production of hyperosmolality. Administration of tris(hydroxymethyl)aminomethane (THAM) improves acidosis without producing intracellular acidosis and its value as a form of base is worth further investigation. Selective sodium-hydrogen exchanger 1 (NHE1) inhibitors have been shown to improve haemodynamics and reduce mortality in animal studies of acute lactic acidosis and should also be examined further. Given the important effects of acute metabolic acidosis on clinical outcomes, more intensive study of the pathogenesis of the associated cellular dysfunction and novel methods of treatment is indicated.