Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

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Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.

This paper deals with the derivation of logistic model for cattle, sheep and goats in a commercial ranching system in Machakos District, Kenya, a savannah ecosystem with average annual rainfall of 589.3  159.3mm and an area of 10,117ha. It involves modeling livestock population dynamics as discrete-time logistic equations wiyh fixed carrying capacities. The fixed carrying capacities are generated endogenously using time-series ranch data, covering a period of 15 years, from 1987 to 2001, in a commercial ranching enterprise. The model incorporates interaction parameters, generated endogenously. The estimation of the logistic models involves estimation of econometric models for each livestock species, followed by the recovery of the logistic model mathematically. Optimisation procedures are employed to determine the optimal stocking levels and the optimal off-take levels. The model-generated carrying capacities are 2,985, 791 and 201 animal units (AU) for cattle, sheep and goats, respectively. Optimal stocking levels are 1,369, 154 and 69 Aus for cattle, sheep and goats, respectively, while the optimal off-take levels are 857, 88 and 63 for cattle, sheep and goats, respectively. This shows that the logistic model-based system analysis is applicable to the management of mixed-species commercial ranching enterprises.

Vaccines based on recombinant Bm86 gut antigen from Boophilus microplus are a useful component of integrated control strategies against B. microplus infestations of cattle. The capacity of such vaccines to control heterologous infestations by two African tick species was investigated. The mean weight of engorged female ticks and mean egg mass per tick were significantly reduced in B. decoloratus infestations, but there was no effect of the vaccine against adult Rhipicephalus appendiculatus. We cloned, sequenced and expressed two Bm86 homologues (Bd86) from B. decoloratus. Amino acid sequence identity between Bd86 homologues (Bd86-1 and Bd86-2) and Bm86 was 86% and 85%, respectively, compared to 93% identity between the variants. Native Bd86 protein in B. decoloratus tick mid-gut sections and recombinant Bd86-1 reacted strongly with sera from TickGARD vaccinated cattle. TickGARD can therefore protect against a heterologous tick species with multiple antigen sequences. Epitope mapping using sera from TickGARD-vaccinated cattle identified two linear peptides conserved between the Bd86 homologues and Bm86. These epitopes represent candidate synthetic peptide vaccines for control of Boophilus spp. and the pathogens transmitted by these tick vectors.

Pneumonia accounted for 15% of the 6.3 million deaths among children younger than five years in 2013, a total of approximately 935,000 deaths worldwide. Routine vaccination against common childhood illnesses has been identified as one of the most cost-effective strategies to prevent death from pneumonia.

Vaccine-preventable or potentially preventable diseases commonly linked with respiratory tract infections include Streptococcus pneumoniae, Haemophilus influenza type-b (Hib), pertussis, influenza, measles, and tuberculosis. Although here have been great strides in the development and administration of effective vaccines, the countries that carry the largest disease burdens still struggle to vaccinate their children and newer conjugated vaccines remain out of reach for many.
The Global Vaccine Action Plan (GVAP) has identified priority areas for innovation in research in all aspects of immunization development and delivery to ensure equitable access to vaccines for all.

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

The effect of herpes simplex virus type 2 (HSV-2) suppression on human immunodeficiency virus type 1 (HIV-1) RNA in the context of prevention of mother-to-child transmission (PMTCT) interventions is unknown. Methods. Between April 2008 and August 2010, we conducted a randomized, double-blind trial of twice daily 500 mg valacyclovir or placebo beginning at 34 weeks gestation in 148 HIV-1/HSV-2 coinfected pregnant Kenyan women ineligible for highly active antiretroviral therapy (CD4 > 250 cells/mm3). Women received zidovudine and single dose nevirapine for PMTCT and were followed until 12 months postpartum. Results. Mean baseline plasma HIV-1 RNA was 3.88 log10 copies/mL. Mean plasma HIV-1 was lower during pregnancy (−.56 log10 copies/mL; 95% confidence interval [CI], −.77 to −.34) and after 6 weeks postpartum (−.51 log10 copies/mL; 95% CI, −.73 to −.30) in the valacyclovir arm than the placebo arm. Valacyclovir reduced breast milk HIV-1 RNA detection at 6 and 14 weeks postpartum compared with placebo (30% lower, P = .04; 46% lower, P = .01, respectively), but not after 14 weeks. Cervical HIV-1 RNA detection was similar between arms (P = .91). Conclusions. Valacyclovir significantly decreased early breast milk and plasma HIV-1 RNA among women receiving PMTCT.

The effect of herpes simplex virus type 2 (HSV-2) suppression on human immunodeficiency virus type 1 (HIV-1) RNA in the context of prevention of mother-to-child transmission (PMTCT) interventions is unknown.

The effect of herpes simplex virus type 2 (HSV-2) suppression on human immunodeficiency virus type 1 (HIV-1) RNA in the context of prevention of mother-to-child transmission (PMTCT) interventions is unknown.

isolated from preterm neonates during the outbreak of gastroenteritis in hospital in Nairobi, Kenya, were resistance to trimethoprin-sulfathoxaxole, Chloramphenicol, oxytetracycline and ampicilin, but only a few strains were resistant to cefazolin, cefamandole, cefataximine, amikacin and nalidixic acid. Fourteen different antimicrobial resistance patterns were observed in the 229 strains of E.coli analyzed. Eighty-two percent of the EPEC strains belonged to two resistance patterns. There was no consistent relationship between palsmid profile group and antimicrobial resistance pattern, although one resistance pattern was more frequently observed in EAF-positive strins belonging to the dominant plasmid profile group. Nine percent of the EPEC strins were resistant to gentamicin compared to 37% in the non-EPEC group. No correlation was observed between administration of gentamicin and percentage of resistant strains isolated. None of the nine neonates receiving gentamicin died during the outbreak. Gentamicin resistance was observed in E.coli strains from six out of these nine neonates. Five out of fourteen neonates who received other antimicrobials, or no antibiotic at all, died. Key words: Enteropathogenic Escherichia Coli; antimicrobial resistance;

A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

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To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. DESIGN: Cross-sectional study. SETTING: Newborn Unit, Kenyatta National Hospital. SUBJECTS: All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. RESULTS: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. CONCLUSIONS: Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use

To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. DESIGN: Cross-sectional study. SETTING: Newborn Unit, Kenyatta National Hospital. SUBJECTS: All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. RESULTS: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. CONCLUSIONS: Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use

Precipitation is one of the major components of the earth’s climate system. Many countries in the tropics depend on rainfall for the agricultural and hydrological activities which are dominant in their economies. Rainfall information is a crucial aspect not only for sustainable social-economic development of many countries but also for study of atmospheric circulations, climate analysis and global energy balance. Hence it is important to use reliable and accurate rainfall data in any planning. This study aims at validating satellite-derived rainfall estimates
retrieved from TRMM’s monthly rainfall retrieval algorithm, (3B-43 algorithm), over Kenya. The study analyzes eleven years of monthly rainfall estimates (1998-2008) produced by Tropical Rainfall Measuring Mission (TRMM)’s 3B-43 algorithm and compares them with gridded monthly rainfall totals from 26 synoptic and Agrometeorological stations in Kenya for the same period. Preliminary results suggest that satellite rainfall estimates can be modeled to represent areal rainfall in areas with inadequate ground based rainfall observations, especially over Northwestern, Northern, Northeastern and Southern Kenya.

Key words: Agrometeorology, rainfall data, remote sensing

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

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To translate and to validate the metrological properties of the Dallas Pain Questionnaire, an instrument designed to evaluate the impact of low back pain on four aspects of patients' lives: daily activities, work and leisure activities, anxiety/depression and social interest.

BACKGROUND: The 'Ten Questions' Questionnaire (TQQ) is used to detect severe neurological impairment in children living in resource-poor countries. Its usefulness has been established in Asia and the Caribbean, but there are a few published studies from Africa. We evaluated the TQQ as part of a larger study of neurological impairment in a rural community, on the coast of Kenya. METHODS: The study was conducted in two phases from June 2001 to May 2002; in phase one, a community household screening of 10,218 children aged 6-9 years using the TQQ was performed. Phase two involved a comprehensive clinical and psychological assessment of all children testing positive on the TQQ (n = 810) and an equivalent number of those testing negative (n = 766). Data were interpreted using the impairment-specific approach. RESULTS: Overall, the sensitivity rates for screening the different impairments were: cognitive (70.0%), motor (71.4%), epilepsy (100%), hearing (87.4%) and visual (77.8%). All the specificity rates were greater than 96%. However, the positive predictive values were low, and ranged from 11 to 33%. CONCLUSIONS: These results are similar to those from other continents and provide evidence that the TQQ can be used to compare the epidemiology of moderate/severe impairment in different parts of the world. Furthermore, the TQQ can be used to screen for moderately/severely impaired children in resource-poor countries; however, the low positive predictive values mean that other assessments are required for confirmation. Copyright 2004 S. Karger AG, Basel

Patients with diab etes mellitus in Kenya come to the hospital for followup visits very infrequently. For most of these patients their blood glucose monitoring is done only on the day of visit to the doctor. Objective: To determine how well the physician - based morning random blood level determines or reflects the quality of glycaemic control. Design: Cross - sectional study (morning, random blood glucose taken between 8.00 a.m. and 12.00 noon). Setting: Out - patient diabetic clinic of Kenyatta National Hospital. Subjects: Patien ts with diabetes mellitus either type 1 or type 2 attending the out - patient clinic. Main outcome measures: Random blood glucose (morning) and glycated haemoglobin (HbA1c). Results: The morning random glucose level had a linear relationship with glycated ha emoglobin levels taken simultaneously. A blood glucose level of 7 mmol/l had 92.7% sensitivity for good control (HbA1c£7.8%) on a blood sample which was taken simultaneously and 59.8% specific for the same. When blood glucose cut - off level was raised to 10 mmol/l sensitivity fell to 66.3% for HbAlc£7.8%, and 83.2% specificity for poor glycaemic control (HbAlc>7.8%). There was marked fall in sensitivity of rising random blood glucose level in predicting good glycaemic control in our study, with concomitant r ise in specificity of those high cut - off levels of blood glucose in predicting poor glycaemic control. Conclusion: Morning random blood glucose in the ambulatory diabetic patients related well to simultaneously assayed HbAlc. Blood glucose within usual the rapeutic targets of 4 - 8mmo1/1 predicted good glycaemic control (HbAlc£7.8%) with high sensitivity at the range of 86.3 - 98.4%. In resource - poor settings, the morning random blood glucose assay, which is done in patients who may attend the diabetic clinic in the morning hours, may be used to predict the quality of their diabetic control. However caution should be exercised in its widespread use because its overall applicability may be clinic - specific depending largely on the average metabolic control of the d iabetic population using that clinic. Further studies need to be done to relate HbAlc to blood glucose levels obtained at different times of the day in this population to determine the best predictor of good glycaemic control

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

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Better dairy production could reduce poverty and improve nutrition in western Kenya, but the requisite technologies have not been widely adopted. This study collected dairy cow attributes from 630 households to evaluate what factors influence smallholder farmers to adopt technologies. Conjoint analysis was used to compute the marginal rate of substitution between attributes, marginal willingness to pay, and marginal willingness to accept. Two ethnic groups had the highest willingness to pay for cattle with a high milk yield and low feed requirement. The highest marginal rate of substitution for cattle with a high disease resistance and a low feed requirement was from households with off-farm income, from areas with a good agro-climate, and from areas where cattle had cultural functions. The results suggest that farmers are more likely to choose cross-bred than high grade cows, and that extension services have little effect on their adoption of dairy technology. Kenya’s breed policy and infrastructure may need to be revised to reflect farmersâ€

Interest rate derivatives form part of the largest portion of traded financial instruments. Hence, it is important to have models that describe their dynamics accurately. This study aims at pricing Quanto caps and floors using the multi-curve cross-currency LIBOR market model (MCCCLMM) dynamics. A Black Scholes MCCCLMM Quanto caplet and floorlet formula is first derived. The MCCCLMM parameters are then calibrated to exactly match the USD and GBP cap market prices. The estimated model parameters are then used to price the Quanto options in the Black MCCCLMM Quanto caplet and floorlet formula. These prices are then compared to the Quanto cap and floor prices estimated via Monte Carlo simulations so as to ascertain its pricing accuracy

Rural households greatly depend on non-timber forest products (NTFPs) to sustain livelihoods, more so in meeting household basic daily needs. Specifically in Kakamega forest households depend on NTFPs such as firewood to meet household energy needs, herbal medicines for ailment treatment, pastures to feed household stock, thatch grass to maintain shelters, and fruits and vegetables for food. Since these direct products are obtained from the forest free of charge and have no efficient market, their economic contribution to rural household economy remains unknown yet their role is factually immense. Establishing the economic value of NTFPs consumed by households therefore becomes very necessary in understanding the actual contribution NTFPs make in the sustenance of rural livelihoods. This study estimated and compared economic value of NTFPs consumed by rural households living around Kakamega forest using three valuation approaches namely: substitutes’ prices method direct prices method and opportunity cost of time method. Socioeconomic, institutional and geophysical data that included household characteristics such as age, gender, household sizes, occupations, land and liverstock ownership, NTFPs consumption quantities (and that of coresponding substitutes), time expended on extraction, time values, prices of NTFPs (and the substitutes)on local retail markets, distances to the forests and forest management regimes were collected in the areas surrounding Kakamega forest using a semi-structured questionnaire. Results show that the substitute value is highest followed by directly priced value and lastly by the value generated through the opportunity cost of time, with an annual average consumption of US $120, US$92 and US$78, respectively, per household. The paper concludes with important policy recommendations for conservation of Kakamega forest.

The valuation of waterfront properties along the coastline of Kenya Kenya is one of the coastal states that lie in the eastern part of Africa. For a long time now Kenyan valuation practice has been concentrated on land-based resources. Valuation of farms, houses, offices, industries etc. are now quite familiar in everyday life. However, a "new" era is now becoming important in world resources affairs, an area in which the valuation profession in Kenya can also participate. This area is the coastal or marine environment, where many sectors of the economy such as energy, transport and research are now increasingly turning to use. Whereas professional valuers in other countries have expanded their scope into these environments, the valuation profession in Kenya has been slow to realise its potential in the same. And because the full economic potential of the resources of the Kenyan coast is not known with certainty, it is logical to carry out studies of their estimation. Unlike land-based resources waterfront properties along the coastline Possess somewhat peculiar characteristics which imply that a free market or a purely price competitive mechanism will not allocate these resources properly. It is even worse for the methods of valuation which can be employed in such cases. Identification and exploitation of resources have to be enhanced by proper methods of the resources' estimation for them to be worthwhile. Two notable characteristics of the waterfront properties located along the Kenyan coastline are the extremitie in values of similar properties, sometimes even in the same localities, and the exclusive use of the market comparison method in such property valuations. This study contends that extremities in values have arisen from the use of improper methods for valuieing waterfront properties. And the method being used currently in the valuation disregards a number of important factors, most of which are difficult to quantify using the market comparison method. This study aims, therefore, to present better ways of valuing waterfront lands . .The valuation of waterfront lands 1.'3 influenced by both site- oriented, such as size and non-site-oriented variables like reasons for sale, date of transaction and so on. Evidence from the valuation pr ac t i.ce s in the study area suggests that only site-oriented characteristics of property are considered during valuations and this leads to either under valuation or overvaluation of these properties. Although some factors are not directly on the property being valued, they· are actually significant influences of value, and disregarding them altogether is not reasonable. The valuation method proposed in this study considers both site and non-site oriented factors. Using conventional multiple regression analysis (CMRA) it has been shown here that the choice of value- influencing variables is more scientific, more reasonable and less subjective than in the ordinary Comparison Method . Choice of influencing variables for valuation purposes is a necessary step if proper values have to be estimated. Many valuations have had faults because of inability to identify and measure these factors. Several regressiGn methods of valuation have been tried in this study, ranging from the simple mul tiple regression analysis to rank transformation regression. Each of- the methods has its merits and demerits, in most cases in terms of their usefulnes and accuracy involving waterfront lands. Conventional Multiple Regression Analysis (CMRA) and Rank Transformation Regression (RTR) were foun.d ·to be the best of the lot, accounting for 49% and 51% of the variation in property values in the area respectively. However, RTR seems to have the methodological problem of how to rank factors affecting value before using them in the procedure. While it is appealing and quite rational to rank factors, the criteria to be used for the ranking is contentious. CMRA was, therefore, found to be a 'better' method, because it produced better results in all the various tests the models underwent. For example, CMRA had a relatively high R2 of 49.1%, a relatively low MSE value of 13612 and the smallest Cp value of 277. CMRA's ability to rank the independent variables within itself during analysis can easily be understood by both the valuer and client, and is applicable in practice. Using the same methods, it was found that SIZE of property is the most important factor affecting value in the study area. The larger the size, the higher the value, although other factors such as width of the beach area (AREA), VIEW of the ocean waters, availability of water SPORTS on the beach etc, have also to be considered. Furthermore, no single factor alone can be used as the only basis for estimating values of waterfront lands. Despite the study advocating for the use of CMRA in waterfront valuations, _there are very few instances where the valuer will not use some form of comparison in the valuation process. Whether it is in the choice of independent variables or in the measurement of these variables, the principles of comparison have to be utilised to arrive at objective values. After all, valuation is all about the market, and if the valuer disregards the market trends then his valuation will be somewhat incomplete.

Many studies, including Anchimbe (2007), Whiteley (1974) and UNESCO (1953) have sought to establish that language loyalty or the lack of it does relate to the presence or death of linguistic identity. Further, it has been claimed that it is within the context of language contact that people become aware of the status of their language against another’s language. People may also observe a greater degree of loyalty to the language of an ethnic group to which they do not belong, because of value they may attach to it compared to their own language and the benefits they may deem to accrue by this allegiance. If this state of affairs is left unchecked, the resultant language shift may lead to the death of the less prestigious of the languages in question. A purposeful value addition and attitude change according to Paulston (1994:16-17) will regenerate and reverse the loss and “give new life to a dead language” especially if there is increased use of the language, as a result of change of attitude and increased functions for general communication, literacy and education.
In this chapter I will highlight factors that led to the marginalization of Kitharaka. Further, I will give examples of other currently or formally marginalized languages of Kenya. I will then narrow down to specifically examine and illustrate the role played by literacy and on-going mother tongue education programme in the revitalization of Kitharaka.

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The Kenyan poultry industry is characterized by dualism, comprised of both smallholder and large-scale poultry producers. The industry is characterized by two main production systems namely (i) the commercial hybrid poultry production system and (ii) the indigenous poultry production system. This study examines the poultry industry in Kenya with the aim of identifying the actors, assessing poultry and poultry product flows, and highlighting some of the policies and regulations relevant to potential outbreaks of highly pathogenic avian influenza (HPAI) in Kenya. Specific aims included: i) Characterizing the structure of the value chain; ii) Assessing the relative importance of specific flows of poultry and poultry products; iii) Identifying the various actors involved in the poultry trade and their linkages; iv) Providing insights on potential pathways of HPAI introduction in the value chain The study was conducted in Kikuyu and Ndeiya Divisions in Kiambu District, Vihiga and Sabatia Divisions in Vihiga District, Nakuru and Rongai Divisions of Nakuru District, and Kikambala and Ganze Divisions of Kilifi District. The study areas were selected based on their relative density of poultry populations. A value chain approach was employed that entailed the use of semi-structured interviews and focus group discussions with various stakeholders including hatcheries, farmers, input sellers, processors, retailers and other intermediaries in four different value chains: commercial broilers, commercial layers/eggs, indigenous chicken, and guinea fowl/ducks.

Studies that address the deeply rooted uncertainty in identifying planning sectors and profiling required
competencies in preparing plans, especially in the urbanization sector (US), are scanty. This is due in part to
the lack of concerns for the effectiveness of the plans and competencies of the planners. The value chain (VC)
model was appraised to provide a framework for ascertaining relevance and accuracy of planning sectors and
concurrence with required competencies. Data on planning sectors and required competencies was collected at
five stakeholder consultative fora, 23 key informant (KI) institutions and seven working sessions. The framework
of the model facilitated analyzing the data through disaggregation. The urbanization sector (US), which is the
main primary activity (MPA) in the model, was assigned the role of the main planning sector (MPS) and expressed
as “MPS:US” in the urbanization value chain. MPS:US was disaggregated into four planning sectors in the value
chain, and each sector ascertained through disaggregation from level 1 to 3. It was found that the structure of
the model and its function provide appropriate framework for ascertaining relevance and accuracy of planning
sectors, and also concur with competencies that are similarly ascertained. Second, the two expressions for
disaggregation to ascertain planning sectors and required competencies each respectively combine into one
expression for simultaneous disaggregation. The paper concludes that the structure and function of VC model and
the expression for simultaneous disaggregation provides a framework of methodology for systematic ascertaining
of planning sectors and competencies, and allows variation of number of planning sectors any one value chain
represents. The paper recommends adopting the structure and functions of the VC model, and the expression for
simultaneous disaggregation as a framework for ascertaining planning sectors and competencies, starting with
the conduct of planning studios in the training of planners

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Web-based learning systems give students the freedom to determine what to study based on each individual learner’s learning goals. These systems support learners in constructing their own knowledge for solving problems at hand. However, in the absence of instructors, learners often need to be supported as they learn in ways that are tailored to suit a specific learner. Adaptive web-based learning systems fit in such situations. In order for an adaptive learning system to be able to provide learning support, it needs to build a model of each individual learner and then to use the attribute values for each learner as stored in the model to determining the kind of learning support that is suitable for each learner. Examples of such attributes are learner knowledge level, learning styles and learner errors committed by learners during learning. There are two important issues about the use of learner models. Firstly, how to initialize the attributes in the learner models and secondly, how to update the attribute values of the learner model as learners interact with the learning system. With regard to initialization of learner models, one of the approaches used is to input into a machine learning algorithm attribute values of learners who are already using the system and who are similar (hence called neighbors) to the learner whose model is being initialized. The algorithm will use these values to predict initial values for the attributes of a new learner. Similarity among learners is often expressed as the distance from one learner to another. This distance is often determined using a heterogeneous function of Euclidean and Overlap measures (HOEM). This paper reports the results of an investigation on how HOEM compares to two different variations of Value Difference Metric (VDM) combined with the Euclidean measure (HVDM) using different numbers of neighbors. An adaptive web-based learning system teaching object oriented programming was used. HOEM was found to be more accurate than the two variations of HVDM

Web-based learning systems give students the freedom to determine what to study based on
each individual learner's learning goals. These systems support learners in constructing
their own knowledge for solving problems at hand. However, in the absence of instructors,
learners often need to be supported as they learn in ways that are tailored to suit a specific
learner. Adaptive web-based learning systems fit in such situations. In order for an adaptive
learning system to be able to provide learning support, it needs to build a model of each

Traditional medicine has utilized plants to palliate, cure and/or prevent diseases in both humans and
animals. The acquisition of knowledge has been through trial and error, and observation. Today, the enhanced search for botanical drugs throughout the world has increased the need for accurate means of identifying plants with possible pharmacological and biological activity. A number of methodologies have been used in selecting plants likely to possess pharmacological properties, but many have recorded low success rates. Data reported in this paper reveal that the accuracy of identification of these herbal drugs for pertinent ailments using ethnobotanical data is almost as accurate as techniques applied in modern medical practice. This paper discusses the value of ethno - botanical data in the preliminary search for potential drug plants.

Over a six-month-period, from 1st March 1988 to 30th September 1988, 127 patients suspected of having ectopic gestation at the Kenyatta National Hospital (KNH) were referred for sonographic examination, of whom 100 (78.7%) had enough data for a final diagnosis. During sonography, ectopic pregnancy was diagnosed in 31 (31%) patients, out of whom 15 (48.4%) were confirmed to have ectopic gestation at laparotomy. Of the 69 who were thought to have other gynaecological disorders at sonographic examination, 2 (2.9%) were later found to have other ectopic gestation at surgery. Of the 17 patients who had ectopic gestation finally, extrauterine gestational sac with a demonstrable foetal pole were observed in only 6 (35.3%) cases, thus allowing a confident diagnosis of ectopic pregnancy by sonography. An empty, bulky uterus, demonstrable adnexal mass, pseudo-gestational sac and fluid in the culde-sac, together improved the sonographic positive predictive value to 67.0%. This study has shown that sonography can be used in the diagnosis of ectopic pregnancy at the KNH. However, in order to improve its reliability, further studies are recommended involving a combination of pregnancy test and sonography. PIP: Between March and September 1988 at the Kenyatta National Hospital in Nairobi, Kenya, clinicians included all patients (127) referred for ultrasonography due to suspected ectopic pregnancy (age range, 18-45 years) in a study to determine whether ultrasonography can be used to accurately diagnose ectopic pregnancy. The researchers examined only the records of 100 patients who had data adequate enough to make a final diagnosis. Based on sonography, clinicians believed 31 women had an ectopic pregnancy, but laparotomy confirmed that just 15 (48.4%) of these women actually had an ectopic pregnancy. Based on sonography, they did not suspect ectopic pregnancy in the other 69 patients, but laparotomy revealed that 2 patients (2.9%) did indeed have an ectopic pregnancy. Thus, the overall ectopic pregnancy rate among the 100 women was 17%. The remaining 83 women had other gynecological conditions. 52.9% of the women with an actual ectopic pregnancy had a pseudogestational sac, which had a positive predictive value of 53% and a negative predictive value of 90%. A pseudogestational sac had a sensitivity of 53% and specificity of 90%. Just 6 ectopic pregnancy cases (35.3%) had an extrauterine gestational sac with a clear fetal pole and a fetal heart beat. An enlarged uterus was more common in women with an ectopic pregnancy than in those with other conditions (82.4% vs. 51.8%; p .05). Every ectopic pregnancy case had a complex adnexal mass compared to just 48.2% of those with other conditions (p .001). When a woman had all these conditions combined–an empty, enlarged uterus; distinct adnexal mass; a pseudogestational sac; and fluid in the cul-de-sac-sonography's positive predictive value increased to 67%. The researchers recommended additional studies using a combination of the urinary pregnancy test and sonography to improve sonography's reliability. PMID: 8181431 [PubMed - indexed for MEDLINE]

Over a six-month-period, from 1st March 1988 to 30th September 1988, 127 patients suspected of having ectopic gestation at the Kenyatta National Hospital (KNH) were referred for sonographic examination, of whom 100 (78.7%) had enough data for a final diagnosis. During sonography, ectopic pregnancy was diagnosed in 31 (31%) patients, out of whom 15 (48.4%) were confirmed to have ectopic gestation at laparotomy. Of the 69 who were thought to have other gynaecological disorders at sonographic examination, 2 (2.9%) were later found to have other ectopic gestation at surgery. Of the 17 patients who had ectopic gestation finally, extrauterine gestational sac with a demonstrable foetal pole were observed in only 6 (35.3%) cases, thus allowing a confident diagnosis of ectopic pregnancy by sonography. An empty, bulky uterus, demonstrable adnexal mass, pseudo-gestational sac and fluid in the culde-sac, together improved the sonographic positive predictive value to 67.0%. This study has shown that sonography can be used in the diagnosis of ectopic pregnancy at the KNH. However, in order to improve its reliability, further studies are recommended involving a combination of pregnancy test and sonography. PIP: Between March and September 1988 at the Kenyatta National Hospital in Nairobi, Kenya, clinicians included all patients (127) referred for ultrasonography due to suspected ectopic pregnancy (age range, 18-45 years) in a study to determine whether ultrasonography can be used to accurately diagnose ectopic pregnancy. The researchers examined only the records of 100 patients who had data adequate enough to make a final diagnosis. Based on sonography, clinicians believed 31 women had an ectopic pregnancy, but laparotomy confirmed that just 15 (48.4%) of these women actually had an ectopic pregnancy. Based on sonography, they did not suspect ectopic pregnancy in the other 69 patients, but laparotomy revealed that 2 patients (2.9%) did indeed have an ectopic pregnancy. Thus, the overall ectopic pregnancy rate among the 100 women was 17%. The remaining 83 women had other gynecological conditions. 52.9% of the women with an actual ectopic pregnancy had a pseudogestational sac, which had a positive predictive value of 53% and a negative predictive value of 90%. A pseudogestational sac had a sensitivity of 53% and specificity of 90%. Just 6 ectopic pregnancy cases (35.3%) had an extrauterine gestational sac with a clear fetal pole and a fetal heart beat. An enlarged uterus was more common in women with an ectopic pregnancy than in those with other conditions (82.4% vs. 51.8%; p .05). Every ectopic pregnancy case had a complex adnexal mass compared to just 48.2% of those with other conditions (p .001). When a woman had all these conditions combined–an empty, enlarged uterus; distinct adnexal mass; a pseudogestational sac; and fluid in the cul-de-sac-sonography's positive predictive value increased to 67%. The researchers recommended additional studies using a combination of the urinary pregnancy test and sonography to improve sonography's reliability. PMID: 8181431 [PubMed - indexed for MEDLINE]

Investors will always want to invest in projects than can guarantee higher returns than others, holding risk constant. They therefore tend to employ strategies that will contribute to the realization of higher returns. One of the most frequently used strategies is value investing where investors purchase value stocks rather than growth stocks in order to be benefit from potential long term performance of value stocks in the form of superior average returns. In finance, the word value premium refers to the excess return expected as a result of investing in value stocks as opposed to growth stocks. This study sought to find out whether there exists a value premium at the NSE when stocks are sorted on the basis of book to market value, and whether
industry type plays a role in value premium. It’s indicative from the study that value stocks outperformed growth stocks for the period under study. This is consistent with other studies done in Kenya. Muhoro (2004) tested a value premium of 0.64 for the period 1999-2002 at the NSE and Ngigi (2006) also tested the existence of value premium at the NSE. The result of the test in this study , conducted at 0.05 confidence level is that there exist value premium at the NSE. When stocks are grouped according to industries, there still exists value premium. Industrial and allied sector have the highest value premium of 4.125 while agricultural sector have the lowest value premium of -1.162. Therefore for a value strategist at the NSE, industrial and allied sector stocks are the best to invest in while agricultural sector stocks are the worst to invest in. The findings are also consistent with findings from similar studies in other markets in the world. Previous studies show that for 60 plus years value has outperformed growth. The conclusion of this study is that there exists a value premium at the N.S.E when stocks are sorted on the basis of B/M ratio . However there exists no significant difference in value premium across industries. This implies industry type is not a significant determinant of value premium.

Abstract
Objective

To describe the relationship between number and distribution of valves.
Methods

Sixty-six popliteal vein specimens were used for the study after routine dissection at the Department of Human Anatomy, University of Nairobi. The extents of the popliteal vein were identified at the adductor hiatus and soleal arch, cut at these points and then longitudinally sliced open. The number and distribution of valves were then recorded. Data were presented using photomacrographs and tables.
Results

The median number of valves was 1 (mean 0.8; range 0–2), with the lower part of the popliteal vein as the most consistent valve position. Most striking was the valve absence noted in 27 (41%) of the veins.
Conclusion

These findings suggest that a significant proportion of popliteal veins do not have valves thus providing a credible structural link that may predispose the popliteal vein to deep venous thrombosis in the study population.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

OBJECTIVE–To determine the efficacy of the nonoxynol 9 contraceptive sponge in preventing sexual acquisition of the human immunodeficiency virus (HIV). DESIGN–Prospective, randomized placebo-controlled trial. SETTING–Research clinic for prostitutes in Nairobi, Kenya. PATIENTS AND INTERVENTIONS–One hundred thirty-eight HIV-seronegative women were enrolled, of whom 74 were assigned to nonoxynol 9 sponge use and 64 to placebo use. These two groups did not significantly differ with respect to demographic characteristics, sexual practices, or prevalence of genital infections at enrollment, except for a lower number of sex partners per week and a higher initial prevalence of genital ulcers among women assigned to nonoxynol 9 sponge use. Among the 116 women who returned for follow-up, the mean durations of follow-up were 14 and 17 months for the two groups, respectively. MAIN OUTCOME MEASURE–HIV seroconversion. RESULTS–Nonoxynol 9 sponge use was associated with an increased frequency of genital ulcers (relative risk [RR], 3.3; P less than .0001) and vulvitis (RR, 3.3; P less than .0001) and a reduced risk of gonococcal cervicitis (RR, 0.4; P less than .0001). Twenty-seven (45%) of 60 women in the nonoxynol 9 sponge group and 20 (36%) of 56 women in the placebo group developed HIV antibodies. The hazard ratio for the association between nonoxynol 9 sponge use and HIV seroconversion was 1.7 (95% confidence interval [CI], 0.9 to 3.0). Using multivariate analysis to control for the presence of genital ulcers at enrollment, the adjusted hazard ratio for the association between nonoxynol 9 sponge use and seroconversion was 1.6 (95% CI, 0.8 to 2.8). CONCLUSIONS–Genital ulcers and vulvitis occurred with increased frequency in nonoxynol 9 sponge users. We were unable to demonstrate that nonoxynol 9 sponge use was effective in reducing the risk of HIV infection among highly exposed women.

Participatory research on bovine trypanosomiasis was conducted with Orma pastoralists in Tana River District, Kenya. The use of participatory methods to understand local perceptions of disease signs, disease causes, disease incidence by cattle age group, seasonal patterns of disease and preferences for indigenous and modern control methods are described. Results indicated that local characterization of diseases called gandi and buku by Orma pastoralists was similar to modern veterinary knowledge on chronic trypanosomiasis and haemorrhagic trypanosomiasis (due to Trypanosoma vivax), respectively. The mean incidence of gandi varied from 10.2% in calves to 28.6% in adult cattle. The mean incidence of buku varied from 3.1% in calves to 9.6% in adults. Pearson correlation coefficients for disease incidence by age group were 0.498 (P < 0.01) and 0.396 (P < 0.05) for gandi and buku, respectively. Informants observed cases of trypanosomiasis in 24.1% of cattle (all age groups); these cases accounted for 41.8% of all sick cattle during the preceding 12-month period. Eight indigenous and three modern trypanosomiasis control methods were identified. Results indicated that an integrated approach to trypanosomiasis control based on private, individual action was well established in the assessment area. When presented with four different trypanosomiasis control methods, community representatives selected 'better use of trypanocides' as the most preferred intervention and 'community-based tsetse control' as the least preferred intervention. This finding prompted researchers to modify the original project activities. Constraints facing the sustainability of community-based tsetse control are discussed.

Red Cross Children's Hospital, Rondebosch, 7701, Cape Town, South Africa.

OBJECTIVE: To draw attention to the sub-optimal care that HIV-infected children are receiving in Africa. DATA SOURCES: Relevant published literature. DATA SYNTHESIS: Sub-optimal response to paediatric HIV infection has aggravated the negative impact that the epidemic has had on child health in Africa. Recently the African Network for the Care of Children Affected by HIV/AIDS (ANNECA) released an advocacy statement that called for the optimisation of prevention, diagnosis, treatment and care for children affected by the AIDS pandemic. Effective prevention strategies if comprehensively implemented, could prevent more than 500 000 paediatric infections per annum at current antenatal HIV prevalence rates. Improved care that includes universal utilisation of early diagnostic testing systems, cotrimoxazole prophylaxis, nutritional support and the timely introduction of antiretroviral therapy could improve the quality of life and lifespan of most infected children. CONCLUSION: Political leaders, public health officials and fellow child health professionals are urged to redouble their efforts to reverse the magnitude of the paediatric epidemic in Africa.

PMID: 17685215 [PubMed - indexed for MEDLINE]

Vangueria infausta burch subsp. infausta (Rubiaceae) produces fruits eaten by humans and animals. The leaf, fruit, stem bark and root bark are used as a remedy for many ailments and the roots are used to treat malaria. In this study, concentrations of fractions of the V. infausta root bark extract that produce 50% inhibition (IC50) are determined using the ability of the extract to inhibit the uptake of [G3H]-hypoxanthine by P. falciparum cultured in vitro. The root bark extract showed antimalarial activity against Plasmodium berghei in mice. It gave a parasite suppression of 73.5% in early infection and a repository effect of 88.7%. One fraction obtained from a chloroform extract gave an IC50 value of 3.8±1.5 μg/mL and 4.5±2.3 μg/mL against D6 and W2 strains of P. falciparum, respectively, and another from the butanol extract gave an IC50 value of 3.9±0.3 μg/mL against the D6 strain. Chloroquine had an IC50 value of 0.016 μg/mL and 0.029 μg/mL against D6 and W2 strains, respectively. The plant showed the presence of flavonoids, coumarins,
tannins, terpenoids, anthraquinones and saponins.

Soil physical degradation is a gradual process of many steps beginning from structural deterioration and ending in differential loss of finer particles through erosion. Control of the degradation remains a challenge to many scientists due to lack of proper assessment protocols. This study developed a sequential protocol with emphasis on definition of physical degradation and successive soil testing to determine the stages of degradation development. The protocol was tested in Cambisols, Arenosols, and Ferralsols in Eastern Kenya. Soil physical degradation due to 10 years land use change was defined as more than 25% drop in infiltration and water retention characteristics and aggregate stability and more than 30% increase in bulk density and silt content. Then a soil testing model was sequentially applied to identify physical degradation phases. Visual assessment of degradation symptoms, RUSLE model, and diffuse infrared spectral reflectance were used in the soil testing model as predictors of physical degradation. Visual assessment was found to be cheap and fast method for identifying final stages of physical degradation with 60% accuracy. Visual assessment combined with RUSLE model improved the assessment accuracy to 80%. Infrared spectral reflectance, which is sensitive to subtle changes in soil physical conditions, was also found as a potential surrogate predictor of early-warning signs of soil physical degradation. Inclusion of spectra into the assessment model improved the accuracy to 95%. This protocol is effective in identifying phases of soil physical degradation, which are useful for planning degradation control and monitoring schemes. Its further testing and worldwide application is recommended.

Soil physical degradation is a gradual process of many steps beginning from structural deterioration and ending in differential loss of finer particles through erosion. Control of the degradation remains a challenge to many scientists due to lack of proper assessment protocols. This study developed a sequential protocol with emphasis on definition of physical degradation and successive soil testing to determine the stages of degradation development. The protocol was tested in Cambisols, Arenosols, and Ferralsols in Eastern Kenya. Soil physical degradation due to 10 years land use change was defined as more than 25% drop in infiltration and water retention characteristics and aggregate stability and more than 30% increase in bulk density and silt content. Then a soil testing model was sequentially applied to identify physical degradation phases. Visual assessment of degradation symptoms, RUSLE model, and diffuse infrared spectral reflectance were used in the soil testing model as predictors of physical degradation. Visual assessment was found to be cheap and fast method for identifying final stages of physical degradation with 60% accuracy. Visual assessment combined with RUSLE model improved the assessment accuracy to 80%. Infrared spectral reflectance, which is sensitive to subtle changes in soil physical conditions, was also found as a potential surrogate predictor of early-warning signs of soil physical degradation. Inclusion of spectra into the assessment model improved the accuracy to 95%. This protocol is effective in identifying phases of soil physical degradation, which are useful for planning degradation control and monitoring schemes. Its further testing and worldwide application is recommended.

The anatomy of the right iliac fossa was reappraised with the intention of improving, open appendicectomy. The surface anatomy was studied on volunteers and the internal topography was examined during the operation of appendicectomy. Our findings vary slightly from prevailing knowledge which is mostly based on cadaver anatomy. Our findings suggest that McBurney's point is very close to the rectus sheath in some individuals and in most subjects it does not overly base of appendix. Surgical teaching through most of the 20th century stressed safety and recommended large incisions with generous exposure, allowing surgeons to operate yet not appreciate these variables. An attempt is made to provide a precise account of the variables in right iliac fossa anatomy to help surgeons operate using smaller, minimally invasive incisions with the inevitable reduced exposure of local anatomy. The proximity of the base of the appendix to the ileocaecal junction raises concern that burial of the appendicular stump might distort local anatomy.

Buffalo-derived Theileria parva can 'break through' the immunity induced by the infection and treatment vaccination method (ITM) in cattle. However, no such 'breakthroughs' have been reported in northern Tanzania where there has been long and widespread ITM use in pastoralist cattle, and the Cape buffalo (Syncerus caffer) is also present. We studied the exposure of vaccinated and unvaccinated cattle in northern Tanzania to buffalo-derived T. parva using p67 gene polymorphisms and compared this to its distribution in vaccinated cattle exposed to buffalo-derived T. parva in central Kenya, where vaccine 'breakthroughs' have been reported. Additionally, we analysed the CD8+ T cell target antigen Tp2 for positive selection. Our results showed that 10% of the p67 sequences from Tanzanian cattle (n = 39) had a buffalo type p67 (allele 4), an allele that is rare among East African isolates studied so far. The percentage of buffalo-derived p67 alleles observed in Kenyan cattle comprised 19% of the parasites (n = 36), with two different p67 alleles (2 and 3) of presumptive buffalo origin. The Tp2 protein was generally conserved with only three Tp2 variants from Tanzania (n = 33) and five from Kenya (n = 40). Two Tanzanian Tp2 variants and two Kenyan Tp2 variants were identical to variants present in the trivalent Muguga vaccine. Tp2 evolutionary analysis did not show evidence for positive selection within previously mapped epitope coding sites. The p67 data indicates that some ITM-vaccinated cattle are protected against disease induced by a buffalo-derived T. parva challenge in northern Tanzania and suggests that the parasite genotype may represent one factor explaining this.

Variant anatomy of renal arteries is important in renal transplant, vascular reconstruction, and uroradiological procedures. The variations show ethnic and population differences. Data from Africans are scarce and altogether absent for Kenyans. OBJECTIVE: To describe patterns of origin, trajectories and branching of renal arteries in a Kenyan population. STUDY DESIGN AND SETTING: Descriptive cross-sectional study conducted in the Department of Human Anatomy, University of Nairobi. MATERIAL/METHODS: Three hundred and fifty six kidneys from 178 cadavers and postmortem specimens were used in the study. Aorta, renal arteries and kidneys were exposed by dissection. Number, trajectories, level of branching, number of branches and point of entry into the kidney were recorded. Data was analyzed using SPSS version 16.0, and presented using macrographs, tables, and bar charts. RESULTS: Additional arteries occurred in 14.3% of the cases. In 82.4% of these, there was one additional artery. Fifty nine point five per cent of the double renal arteries were parallel and 7.1% crossed. Of the 305 single arteries, 76.4% showed hilar, 21.6% prehilar and 2% intraparenchymal branching. In the hilar branching, ladder type was present in 65% and fork type in 35%. Bifurcation and trifurcation were present in 59.6% and 33.1% respectively. Polar arteries were present in 16.9% cases. CONCLUSIONS: Over 14% of the Kenyan population may have additional renal arteries while more than 20% show early branching. Several trajectories and hilar branching patterns exist which renal transplant surgeons and radiologists should be aware of to avoid inadvertent vascular injury.

Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended

Knowledge of variant anatomy of the sciatic nerve is important in avoiding inadvertent injury during operations in the gluteal region and interpreting nondiscogenic sciatica. This variant anatomy may cause piriformis syndrome and failure of sciatic nerve block. The variations differ between populations but data from Africans is scarce. This study, therefore, investigated variations of sciatic nerve in a black Kenyan population. One hundred and sixty-four sciatic nerves from 82 cadavers of black Kenyans were exposed by dissection at the Department of Human Anatomy, University of Nairobi, Kenya. The level of bifurcation, relationship to piriformis, and topographic relations between the branches were studied. The results were analysed by SPSS version 16.0 and are presented by macrographs. In 33 (20.1%) cases division occurred in the pelvis, while in 131 (79.9%) it occurred outside the pelvis. A single trunk sciatic nerve exited below the piriformis muscle in 131 (79.9%) cases. In cases of pelvic division, the tibial nerve was always infrapiriformic, while the common peroneal nerve passed below piriformis in 16 (9.8%) cases, pierced the piriformis in 13 (7.9%), and passed above it in 4 (2.4%). For those in which division was extrapelvic, 110 (67.1%) were in the popliteal fossa, 17 (10.4%) in the middle third of the thigh, and 4 (2.4%) in the gluteal region. Where the division was pelvic, in 19 (11.6%) cases they continued separately, in 8 (4.9%) the two nerves reunited, and in 6 (3.7%) they were connected by a communicating nerve. The sciatic nerve in the Kenyan population varies from the classical description in over 30% of cases, with many high divisions, low incidence of piriformic course of common peroneal nerve, reunion, and unusual connection between common peroneal and tibial nerves. These variations may complicate surgery and interpretation of sciatic neuropathy. Preoperative nerve imaging and extra operative diligence in the gluteal region and the back of the thigh are recommended.

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.

Background:
Jugular foramen lesions are among the major complications
of skull base surgery. Morphological variations in the structure are pertinent
during interpretation of skull base radiographs and in surgical procedures
within the foramen. This study therefore aimed at describing the
morphology of the jugular foramen in a Kenyan population.
Methods:
One
hundred and five adult skulls from the Nairobi National Museums were
used. Jugular foramen septation, dome and dimen sions were studie d
extracranially. Statisti cal analysis was performed using SPSS (Version
21.1 IBM).
Results:
Septation was present in 202 (96.2%) jugular
foramina, type I partial septation being the most common (78.7%). A
dome was observed in 81 (38.6%) jugular foramina. Respectively, the
mean right and left anteroposterior dimensions were 11.17
±
2.05mm
vs.8.88
±
2.30mm (p <0.001), mediolateral dimensions 17.47
±
2.18mm vs.
15.30
±
2.53mm (p <0.001), jugular dome depth 12.38
±
2.64 mm vs.
11.25
±
2.15 mm (p=0.054), posterior wall thickness7.95
±
2.20mm vs.
9.68
±
1.98mm (p <0.001) and medial wall thickness 3.73
±
1.10 mm vs.
3.73
±
0.98mm (p = 0.992).
Conclusion:
Partial septation, asymmetry in
dimensions and a wide range in the dome depth of the jugular foramen
were frequent. Preoperative imaging of jugular foramen morphology is
therefore recommended to avoid inadvertent injury to its contents and
surrounding structures owing to variability.

Surface mapping of the liver before invasive procedures depends on a proper understanding of its segmental vasculature. The right portal vein ramification and lengths show marked variations and these mostly involve its right posterior sectoral branch. Their incidence is variable among populations and altogether undocumented among Africans. One hundred livers obtained during autopsies and dissections at the Department of Human anatomy, University of Nairobi, were used in this study. Gross dissection was done to reveal and determine the branching pattern of the right portal vein and the origin of the right posterior sector branch. The lengths of the right portal vein were also measured and recorded. When present, the right portal vein terminated by bifurcation in 61% of the cases, trifurcated in 20.8% and quadrifircated in 18.2%. Its length was between 0.5cm and 4cm. The right posterior sector vein was given off the main portal vein in 34 cases, the common left portal vein trunk in 15 cases, and the right portal vein in 42 cases. In 9 cases, it was not observed at the porta hepatis. We report significant different incidences of the variant anatomy of the right portal vein compared to those found in previous studies and this should be borne in mind when doing surgical interventions

Surface mapping of the liver before invasive procedures depends on a proper understanding of its segmental vasculature. The right portal vein ramification and lengths show marked variations and these mostly involve its right posterior sectoral branch. Their incidence is variable among populations and altogether undocumented among Africans. One hundred livers obtained during autopsies and dissections at the Department of Human anatomy, University of Nairobi, were used in this study. Gross dissection was done to reveal and determine the branching pattern of the right portal vein and the origin of the right posterior sector branch. The lengths of the right portal vein were also measured and recorded. When present, the right portal vein terminated by bifurcation in 61% of the cases, trifurcated in 20.8% and quadrifircated in 18.2%. Its length was between 0.5cm and 4cm. The right posterior sector vein was given off the main portal vein in 34 cases, the common left portal vein trunk in 15 cases, and the right portal vein in 42 cases. In 9 cases, it was not observed at the porta hepatis. We report significant different incidences of the variant anatomy of the right portal vein compared to those found in previous studies and this should be borne in mind when doing surgical interventions

Surface mapping of the liver before invasive procedures depends on a proper understanding of its segmental vasculature. The right portal vein ramification and lengths show marked variations and these mostly involve its right posterior sectoral branch. Their incidence is variable among populations and altogether undocumented among Africans. One hundred livers obtained during autopsies and dissections at the Department of Human anatomy, University of Nairobi, were used in this study. Gross dissection was done to reveal and determine the branching pattern of the right portal vein and the origin of the right posterior sector branch. The lengths of the right portal vein were also measured and recorded. When present, the right portal vein terminated by bifurcation in 61% of the cases, trifurcated in 20.8% and quadrifircated in 18.2%. Its length was between 0.5cm and 4cm. The right posterior sector vein was given off the main portal vein in 34 cases, the common left portal vein trunk in 15 cases, and the right portal vein in 42 cases. In 9 cases, it was not observed at the porta hepatis. We report significant different incidences of the variant anatomy of the right portal vein compared to those found in previous studies and this should be borne in mind when doing surgical interventions

Variant anatomy of the testicular artery is important for safe surgery in the retroperioneal area, and
accurate diagnosis of testicular and renal disease. The pattern of origin, number, course and branching
display ethnic and geographical variations. Data from black African populations and especially Eastern
Africa is scarce. The objective of this study was, therefore, to describe the topography of the intraabdominal
part of testicular artery in a sample of the Kenyan population. This was a descriptive crosssectional
study on one hundred (100) testicular arteries at the Department of Human Anatomy, University
of Nairobi. The samples were obtained from autopsy cases and cadaveric specimens. Standard midline
abdominal incisions were made, flaps of the anterior abdominal wall reflected and the intestines,
mesentery and pariental peritoneum retracted systematically to expose the testicular arteries. Their site
and level of origin, number, course and branching were examined. Macrographs of representative
variations were taken using a high resolution digital camera. The results were analysed using SPSS
version 21, and are presented using macrographs and frequency tables. Thirty three (33%) of the arteries
displayed a variant anatomy, with regard to their site of origin (8%), number (4%), course (14%) and
branching pattern (7%). Among the 14 cases of aberrant course, five (5%) arched over the left renal
vein, eight (8%) were retrocaval and one (1%) had a retroureteric course. Seven (7%) bifurcated within
the abdomen. The level of origin along the aorta varied from 1 centimetre above the renal arteries to 5.5
centimetres below them while the vertebral level of origin ranged from T12 to L4. This shows that the
testicular artery among Kenyans displays a high prevalence of variant anatomy characterized by origin
from the accessory renal artery, high level of aortic origin, duplication, retrocaval course and
intraabdominal; division. Preopertaive evaluation of renal and gonadal vasculature is recommended to
minimize misdiagnosis and inadvertent injury retroperitoneal surgery.

To investigate the uterine artery's origin, branching patterns, and relation to the ureter in a Kenyan population.

To investigate the uterine artery's origin, branching patterns, and relation to the ureter in a Kenyan population. METHOD: The uterine arteries of the bodies of 53 girls and women were dissected at the University of Nairobi Department of Human Anatomy to study these patterns. Data were analyzed for frequency and the patterns are presented via digital macrographs. RESULTS: The uterine artery consistently originated as a branch of the internal iliac artery. It formed the second or third branch of the anterior trunk in 70.8% of cases; it ascended as a single branch, or from a bifurcation, or from a trifurcation in 76.4%, 17.1%, and 6.7% of cases; and lay posterior to the ureter in 3.8% of cases. In all, 46.2% of the uterine arteries studied varied from the classic description. CONCLUSION: About half of the uterine arteries had a nonclassic origin, branching pattern, or relation to the ureter-as a posterior relation to the ureter had not been previously described. Surgeons operating in the pelvis should be aware of this variant anatomy to avoid injury to the ureter and other organs

14.00 800x600 Normal 0 false false false EN-GB X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13% and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended.

Branching pattern of common femoral artery is important during artery catheterization, orthopaedic,
plastic and general surgery in the proximal thigh. Frequency of variant branching shows ethnic
variation but there are no data for black African populations. Since atherosclerotic diseases are
increasing and femoral artery catheterization is rising, variation in branching of common femoral artery
was studied by dissection in a black Kenyan population. 208 femoral arteries in 104 limbs were studied.
Bifurcation occurred in only 72.1% of cases. Trifurcation into superficial femoral, profunda femoris and
lateral circumflex femoral arteries occurred in 27.9% of cases. Trifurcation of common femoral artery
is a common variation in the black Kenyan population. Pre – operative ultrasonic evaluation of the
femoral arterial system is recommended to minimize inadvertent arterial injury during catheterization or
surgery.

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Variant origin of lateral circumflex femoral artery (FA) is important during harvesting of anterolateral thigh flaps, aortopopliteal by-pass, coronary artery grafting, and vascularised iliac transplant. The frequencies of variant origins display ethnic variations, but reports from black Africans are scarce. This study, therefore, aimed to describe the variant origins of lateral circumflex FA in a black Kenyan population. Eighty-four (42 right and 42 left) lateral femoral circumflex arteries from 42 cadavers (31 male and 11 female) were exposed by dissection of the femoral triangles at the Department of Human Anatomy, University of Nairobi. The arteries were then traced proximally to their parent trunks. Sites of origin were recorded and representative images of the variations taken using a high-resolution digital camera. Data were analysed using Statistical Program for Social Scientists version 16.0 for Windows and presented in tables and macrographs. The lateral circumflex artery was a branch of the profunda femoris in only 65.5% of cases. Variant origins included from a common trunk with medial circumflex artery (14.3%), with profunda femoris (10.7%), as a trifurcation with profunda femoris and medial circumflex FA (7.1%), and from FA (2.4%). Variant origin of the lateral circumflex FA occurred in nearly 35% of the Kenyan population studied, much lower than in oriental populations. The most frequent variant origin is as a common trunk with medial circumflex femoral and profunda femoris, with a very low prevalence of origin from FA. The unusual origins make the artery more vulnerable to iatrogenic injury during surgery and catheterisation. Preoperative angiographic evaluation of the femoral arterial system is recommended.

Variant origin of lateral circumflex femoral artery (FA) is important during harvesting of anterolateral thigh flaps, aortopopliteal by-pass, coronary artery grafting, and vascularised iliac transplant. The frequencies of variant origins display ethnic variations, but reports from black Africans are scarce. This study, therefore, aimed to describe the variant origins of lateral circumflex FA in a black Kenyan population. Eighty-four (42 right and 42 left) lateral femoral circumflex arteries from 42 cadavers (31 male and 11 female) were exposed by dissection of the femoral triangles at the Department of Human Anatomy, University of Nairobi. The arteries were then traced proximally to their parent trunks. Sites of origin were recorded and representative images of the variations taken using a high-resolution digital camera. Data were analysed using Statistical Program for Social Scientists version 16.0 for Windows and presented in tables and macrographs. The lateral circumflex artery was a branch of the profunda femoris in only 65.5% of cases. Variant origins included from a common trunk with medial circumflex artery (14.3%), with profunda femoris (10.7%), as a trifurcation with profunda femoris and medial circumflex FA (7.1%), and from FA (2.4%). Variant origin of the lateral circumflex FA occurred in nearly 35% of the Kenyan population studied, much lower than in oriental populations. The most frequent variant origin is as a common trunk with medial circumflex femoral and profunda femoris, with a very low prevalence of origin from FA. The unusual origins make the artery more vulnerable to iatrogenic injury during surgery and catheterisation. Preoperative angiographic evaluation of the femoral arterial system is recommended.

Variant origin of lateral circumflex femoral artery (FA) is important during harvesting of anterolateral thigh flaps, aortopopliteal by-pass, coronary artery grafting, and vascularised iliac transplant. The frequencies of variant origins display ethnic variations, but reports from black Africans are scarce. This study, therefore, aimed to describe the variant origins of lateral circumflex FA in a black Kenyan population. Eighty-four (42 right and 42 left) lateral femoral circumflex arteries from 42 cadavers (31 male and 11 female) were exposed by dissection of the femoral triangles at the Department of Human Anatomy, University of Nairobi. The arteries were then traced proximally to their parent trunks. Sites of origin were recorded and representative images of the variations taken using a high-resolution digital camera. Data were analysed using Statistical Program for Social Scientists version 16.0 for Windows and presented in tables and macrographs. The lateral circumflex artery was a branch of the profunda femoris in only 65.5% of cases. Variant origins included from a common trunk with medial circumflex artery (14.3%), with profunda femoris (10.7%), as a trifurcation with profunda femoris and medial circumflex FA (7.1%), and from FA (2.4%). Variant origin of the lateral circumflex FA occurred in nearly 35% of the Kenyan population studied, much lower than in oriental populations. The most frequent variant origin is as a common trunk with medial circumflex femoral and profunda femoris, with a very low prevalence of origin from FA. The unusual origins make the artery more vulnerable to iatrogenic injury during surgery and catheterisation. Preoperative angiographic evaluation of the femoral arterial system is recommended.

Knowledge of variant origin of the superior cerebellar
artery is important during neuroradiological
and neurosurgical procedures at the basilar termination
and clivus regions, and may influence the
occurrence of atherosclerosis and aneurysms.
These variations show ethnic differences, but there
are hardly any reports on the black African population.
This study therefore examined the various
origins of 394 superior cerebellar arteries from 173
brains of black adult Kenyans, obtained during autopsy
at the Department of Human Anatomy, University
of Nairobi, Kenya. The cranial cavity was
opened and the brain removed en bloc. Arachnoid
matter was gently removed to expose the arteries
at the base of the brain. The distal third of the basilar
artery was exposed and superior cerebellar
artery identified as that which supplied the superior
surface of the cerebellar hemispheres. It was
traced to its origin and the source recorded. Representative
patterns were photographed with a
high resolution digital camera. The data were analyzed
for frequency and are presented in macrographs
and a table. The conventional single artery
origin from the basilar artery was present in only
284 (72.1%) cases. In the remainder, it was duplicated
in 84 (21.3%), originated from posterior cerebral
artery in 16 (4.0%) and from common trunk
with posterior cerebral artery in 10 (2.5%) cases.
Variant origin of the superior cerebellar artery occurred
in nearly 28% of cases studied. This influences
the pattern of termination of the basilar artery,
may complicate posterior cranial fossa surgery
and predispose to atherosclerosis and aneurysms.
Preoperative evaluation of the superior cerebellar
artery is recommended.

n/a

n/a

14.00 800x600 Normal 0 false false false EN-GB X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13% and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended.

Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13%, and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended

Variant termination of basilar artery influences occurrence of atherosclerosis and aneurysms, and is also important during cerebrovascular surgery and interventional neuroradiology at the basilar bifurcation, interpeduncular fossa and clivus. There are, however, hardly any reports on these patterns. The purpose of this study was to describe the pattern of termination of the basilar artery in a black Kenyan population. One hundred and seventy three (99 male; 74 female) adult cadaveric and autopsy brains of black Kenyans (age range 20-79) were examined. The basilar artery was exposed in its entire length, terminal branches identified and termination pattern recorded. Representative patterns of variations were photographed with a high resolution digital camera. Data were analyzed for frequency and are represented in a pie chart and macrographs. Bifurcation occurred in 142 (82.1%) of cases. In some of these cases, the superior cerebellar and posterior cerebral arteries had a common trunk of origin. Variant terminations included trifurcation (18, 10.4%), quadrifurcation (10, 5.8%) and pentafircation (3, 1.7%). All the variants were related to duplication and/or point of origin of the superior cerebellar artery and occurrence of common trunk of origin for superior cerebellar and posterior cerebral artery. Variant termination of the basilar artery occurs in 17.9% of cases. These variations are related to the pattern of origin of superior cerebellar artery. Anticipation of these variations is important during neuroradiology, cerebrovascular surgery and interpretation of posterior circulatory stroke.

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Knowledge of variant termination of common carotid artery is important to prevent inadvertent
vascular injury during surgical, interventional and diagnostic radiological neck procedures. The
variations show population differences but there are scanty data from the black African populations.
Further, though trifurcations have been reported, quadrifurcations and pentafurcations are hitherto
undocumented. This study therefore examined the pattern of termination of 208 left common carotid
arteries in the black Kenyan population by cadaveric dissection at the Department of Human Anatomy,
University of Nairobi. The conventional bifurcation into internal and external carotid arteries occurred in
only 128 (61.5%) of cases. Trifurcation occurred in 66 (31.7%), quadrifurcation in 11(5.4%) and
pentafurcation in 3 (1.4%). In all cases of trifurcation, superior thyroid artery was the third branch.
The common carotid artery quadrifurcated into external, internal carotid, superior thyroid and
ascending pharyngeal arteries. The pentafurcations comprised internal carotid, external carotid,
superior thyroid, occipital and posterior auricular arteries. These findings imply that the black Kenyan
population has over 38% frequency of variant termination of common carotid arteries comprising
trifurcation, quadrifurcation and pentafurcation which may complicate radical neck dissection, vascular
surgery, carotid catheterization and selective embolization. Surgeons and radiologists should approach
the common carotid bifurcation with extra caution.

Variant termination of the left coronary artery is
important in interpreting effects of its occlusion,
a n d in guiding cardiac surgery and intervention
procedures. It also constitutes a geometric risk
factor for atherosclerosis. These features show
ethnic variations, but data from African populations
are scarce. This study therefore aimed at
describing the variant patterns of termination of
the left coronary artery in an indigenous Kenyan
population. Left coronary arteries of 208 formalinfixed
hearts were studied by dissection at the
Department of Human Anatomy, University of
Nairobi. The number of terminal branches was
recorded. Images of representative patterns were
taken using a high resolution camera. Frequencies
were calculated. Results are presented using
tables and macrographs. Single left coronary arteries
from the left aortic sinus were present in all the
208 hearts studied. The most frequent termination
pattern was bifurcation (54.8%), followed
by trifurcation (32.2%), quadrifurcation (9.6%)
and pentafurcation (3.4%). Over 45% of left coronary
arteries have variant patterns of termination.
Pentafurcation is not uncommon. This calls
for extra caution during interventional coronary
artery angiography, instrumentation and surgery.
Preoperative angiographic evaluation is recommended.

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BACKGROUND Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya. METHODS Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions. RESULTS The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86). CONCLUSION All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.

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Guyana and Suriname have made important progress in reducing the burden of malaria. While both countries use microscopy as the primary tool for clinical diagnosis, malaria rapid diagnostic tests (RDTs) are useful in remote areas of the interior where laboratory support may be limited or unavailable. Recent reports indicate that histidine-rich protein 2 (PfHRP2)-based diagnostic tests specific for detection of P. falciparum may provide false negative results in some parts of South America due to the emergence of P. falciparum parasites that lack the pfhrp2 gene, and thus produce no PfHRP2 antigen. Pfhrp2 and pfhrp3 genes were amplified in parasite isolates collected from Guyana and Suriname to determine if there were circulating isolates with deletions in these genes. Pfhrp3 deletions were monitored because some monoclonal antibodies utilized in PfHRP2-based RDTs cross-react with the PfHRP3 protein. We found that all 97 isolates from Guyana that met the inclusion criteria were both pfhrp2- and pfhrp3-positive. In Suriname (N = 78), 14% of the samples tested were pfhrp2-negative while 4% were pfhrp3-negative. Furthermore, analysis of the genomic region proximal to pfhrp2 and pfhrp3 revealed that genomic deletions extended to the flanking genes. We also investigated the population substructure of the isolates collected to determine if the parasites that had deletions of pfhrp2 and pfhrp3 belonged to any genetic subtypes. Cluster analysis revealed that there was no predominant P. falciparum population substructure among the isolates from either country, an indication of genetic admixture among the parasite populations. Furthermore, the pfhrp2-deleted parasites from Suriname did not appear to share a single, unique genetic background.

Microfilaremic dogs, developing ascites acutely following a reaction to diethylcarbamazine therapy, had similar protein concentrations in their ascitic fluid and plasma. In contrast, in dogs chronically infected with Dirofilaria immitis, the protein concentrations of ascitic fluid were found to be significantly lower than plasma protein concentrations. The acute development of ascites in such dogs is associated with high ascitic protein levels.

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Towers are typical structures that can be found in many urban and rural landscapes the world over. From their basic design, they are usually exposed to severe environmental loads. It is therefore prudent to carry out periodic maintenance that includes checking that they are correctly aligned. This paper describes a method that was used for the re-alignment of a guyed tower in Limuru, Kenya. Angular and distance observations, made from two observation points detected a vertical misalignment that was larger than the acceptable tolerance of l/400. An iterative re-alignment procedure was then applied, resulting in an acceptable final misalignment of 1 / 520.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

The world is today faced with the global pandemic of HIV/AIDS that has evolved rapidly since it was first described. The pandemic has been termed the greatest development challenge for sub Saharan Africa and is rapidly evolving in the Asian continent. The pandemic ha had a significantly negative impact on individual families through loss of loved ones, communities by increasing the burden of caring for the ill, and countries through reduced productivity.     As we look forward to the 21st century, the human population is reminded that even in an age where drugs to treat most ailments are available, human behaviour and individual aspirations are critical in the control of disease. Factors that affect human and social behaviour, such as poverty, discrimination and disenfranchisement have to be addressed on a global basis if the HIV/AIDS epidemic is to be controlled. The HIV/AIDS epidemic presents special challenges and new frontiers for public health interventions and research. HIV/AIDS has revealed the gaps in the understanding of how human behaviour is motivated and how it can be changed.     In this publication we present a review of some of the programs that are specifically targeting the youth with HIV/AIDS prevention activities in the countries of   This publication records the stories of men and women in Eastern Africa, who have tremendous commitment to the work they do even with minimal resources, because they have a vision for the youth of the African continent. It is a story of innovation, creativity, determination and partnership between adults and youth, communities and governments, countries, aid agencies and NGOSs.

Variations in the branching of posterior cord are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of branching show population differences. Data from the African population is scarce.

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Variations in the anatomy of ansa cervicalis

Variations in the anatomy of ansa cervicalis

Variations in the anatomy of ansa cervicalis

With the emerging utilisation of ansa cervicalis in nerve reconstructive surgery, it is important for surgeons to be conversant with the anatomy of these nerves. This descriptive cross sectional study aimed at describing the morphology and topographic anatomy of ansa cervicalis. We examined 38 adult human formalin-fixed cadavers. The superior root was present in 38 (100%) cases and 37 (97%) cases, on the right and left sides, respectively. More than half (56%) of these roots were located superior to the posterior belly of the digastric muscle. The inferior root, on the other hand, was present in 34 (89.5%) cases on the right side and 31 (81.6%) cases on the left side. Of all the inferior roots, 81.5% were located lateral to the internal jugular vein. The loop was seen in all the cases that had the inferior root, and was mostly (64.6%) located above the superior belly of the omohyoid muscle. Knowledge of the anatomy of ansa cervicalis is not only important for nerve reconstruction surgeries, but also for operations in the neck, so as to avoid injuring the great vessels that are closely related to it.

14.00 800x600 Normal 0 false false false EN-GB X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} Variant anatomy of the superior thyroid artery is important during surgical procedures, interpretation of angiograms, and interventional radiography in the neck. Pattern of the variations shows population differences but there is no data from the Kenyan population. This study therefore investigated the variations in origin of the superior thyroid artery in a Kenyan population. Forty six necks (36 males and 10 females) from 46 cadavers of black Kenyans in Department of Human Anatomy University of Nairobi, Kenya were bilaterally dissected to expose the origin of the superior thyroid artery. Pattern of origin of the vessel was determined on both sides in males and females. It originated from the external carotid artery common carotid artery and linguo-facial trunk in 80%, 13% and 6.5% of the cadavers respectively on the right side. All but one of the superior thyroid arteries were ventral branches. There was asymmetric origin in 6.5% of cases. Origin from the common carotid artery was associated with high carotid bifurcation. Nearly 20% of superior thyroid arteries showed variant origin. Of these, 6.5% arose from the linguo-facial trunk, much higher than in the Caucasian and Oriental populations. Origin from common carotid artery is substantially lower than prevailing figures from other populations. These findings support ethnic variations. Preoperative angiographic evaluation is recommended.

To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a Kenyan population The presence of four trunks and an accessory phrenic nerve passing through the subclavian vein are probably described and reported for the first time. However, most of the variations of the BP among Kenyans are similar to those reported in the other populations

Objective: To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a
Kenyan population.
Study design: Descriptive cross-sectional study.
Materials and methods: Ninety-four brachial plexuses from forty-seven formalin fixed cadavers were displayed by gross
dissection.
Results: The presence of at least one variation from the classical anatomy was observed in 73 (77.7%) of the 94 plexuses. The roots and trunks were involved in 32 (34%) of the plexuses . Preand postfixed roots were present in 23 (24.7%) and 3 (3.2%), respectively. The presence of four
trunks, and trunks passing between the scalene medius and posterior were also noted. The long thoracic nerve was variant in 51 (54.3%) of the plexuses. Unusual relations of the phrenic nerve to scalene muscles and the subclavian vein were
encountered.
Conclusion: The presence of four trunks and an accessory phrenic nerve passing through the subclavian vein are probably described and reported for the first time. However, most of the
variations of the BP among Kenyans are similar to those reported in the other populations.

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

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