DR. KARARI EMMA MUTHONI

Background:
Co-morbid depression is a serious condition in patients with diabetes that negatively affects their self-management, including drug adherence, consequently, the treatment outcomes and quality of life are also affected.
Objective:
To determine the burden of co-morbid depression in ambulatory patients with type 2 diabetes at the Kenyatta National Hospital (KNH) and to document their socio-demographic and
clinical characteristics and any associated risk factors.
Methods:
This was a cross-sectional study done on patients living with type-2 diabetes on follow-up at the diabetes out-patient clinic (DOPC) at the KNH. Systematic sampling method was used to recruit 220 study subjects. The PHQ-9 questionnaire was used to assess for co-morbid depression. Socio-demographic and clinical details were obtained both from the subjects and their medical records. Physical examination was done, including blood pressure and BMI determined. Blood samples were collected from the cubital fossa to measure HbA1C in COBAS INTEGRA system with its reagent in the pre-dilution cuvette for automated analysis of glycated hemoglobin (HbA1c). Statistical associations of patients’ characteristics and co-morbid depression were determined using Chi-square test and Odds Ratios.
Results:
The prevalence of co-morbid depression in patients with type 2 diabetes at the DOPC of KNH using the PHQ-9 was
32.3% (95% CI 26.4-38.6%). Of these, depression was mild in 42.3%,moderate in 40.8% and severe in 16%. Subjects with co- morbid depression were: aged 65years and above (p = 0.006), over-weight/obese (p = 0.035), and had longer duration of diabetes of 5years and above. The presence of co-morbid depression was significantly associated with poor glycaemic control, (OR = 3.3,
95% CI, 1.6 - 6.8, p = 0.001).
Conclusion:
About one-third (32.3%) of the study subjects with type 2 diabetes had co-morbid depression. Patients with type 2 diabetes who are at higher risk (older age of 65 years and above, long duration of diabetes, poor glycaemic control and presence of diabetes-related complications,) should be screened for co-morbid

Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS morbidity and mortality, however long-term metabolic consequences including dysglycaemia and dyslipidemia have raised concern regarding accelerated cardiovascular disease risk. To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-infected patients. Cross-sectional comparative group study. Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility. Consecutive HIV- positive adult patients. Dyslipidemia: presence of raised total or LDL cholesterol or low HDL cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, out of 342 screened patients, 295 were recruited and 58% were females. One hundred and thirty four (45%) were on HAART, 82% of whom were on stavudine, lamivudine and either nevirapine or efavirenz. Overall prevalence of dyslipidemiawas 63.1% and dysglycaemia was 20.7%. High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917). HDL levels were low in 14.6% and 51.3% among HAART and HAART naive patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 CI 0.688-2.037). Among patients on HAART compared to HAART naive patients, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22), respectively. HIV- infected patients demonstrated a high prevalence of dyslipidemia. HAART use was associated with high levels of total, and LDL cholesterol and high triglyceride levels, an established athrogenic lipid profile. However, HAART was not associated with low HDL cholesterol and had no significant effect on dysglycaemia.

BACKGROUND: Peptic ulcer disease (PUD) occurs in up to one fourth of patients with chronic renal failure (CRF). Some of the factors implicated in its causation include hypergastrinaemia, secondary hyperparathyroidism, drugs and, recently, Helicobacter pylori infection. Studies on the latter have been few, with none having been carried out in Kenya. OBJECTIVE: To evaluate the upper gastrointestinal tract endoscopic findings and to determine the prevalence of H. pylori in CRF patients with dyspepsia. STUDY DESIGN AND POPULATION: A prospective study of seventy seven consecutive patients with CRF and dyspepsia compared with consecutive age, sex and socio-economically matched seventy seven controls (no CRF) with dyspepsia. SETTING: Kenyatta National Hospital (KNH), the major referral and teaching hospital, Nairobi, Kenya. METHODS: In both the study population and the controls, upper gastrointestinal endoscopy was carried out. H. pylori was tested for using the biopsy urease test and histology. Patients were considered to have H. pylori if they tested positive on both tests. OUTCOME MEASURES: Findings at endoscopy and presence of H. pylori. RESULTS: Inflammatory lesions (gastritis, duodenitis) (42%) and duodenal ulcers (18.4%) were the commonest findings in the two groups combined. The prevalence of H. pylori in the 154 subjects studied was 54.5%. There was no statistically significant difference between the prevalence of H. pylori in CRF patients (53.2%) and the controls (55.8%) (p = 0.746). Patients with endoscopically proven PUD had a very high prevalence of H. pylori (87.3%) regardless of their renal function status. CONCLUSION: Dyspepsia in patients with or without CRF was due to multiple causes and over 50% were attributable to H. pylori. The prevalence of H. pylon in dyspeptic CRF patients was similar to that in dyspeptic patients with normal renal function.