FREDRICK DROTIENOCF. "
Acute aflatoxicosis: case report. East Afr Med J. 2005 Jun;82(6):320-4.". In:
East Afr Med J. 2005 Jun;82(6):320-4. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractThe objective of this presentation is to document the salient clinical findings in a case of aflatoxicosis and to review the literature on the same so as to increase the index of suspicion, enhance early diagnosis and improve management. The case was a 17-year-old schoolboy presenting with vomiting, features of infection and gastrointestinal tract symptoms. Examination revealed a very ill looking pale patient with abdominal distension, tenderness and rectal bleeding and easy bruisability. Investigations showed abnormal liver function tests, pancytopenia and elevated serum levels of aflatoxins. Management consisted of supportive care including antibiotics and antifungal therapy, transfusion of red blood cells and fresh frozen plasma. His recovery was uneventful. The literature on human aflatoxicosis shows that the presentation may be acute, subacute and chronic. The degree of emanating clinical events also conforms to status of the aflatoxicosis. Overall, the features are protean and may masquerade many other forms of toxaemias. In conclusion, the diagnosis of aflatoxicosis takes cognisance of geographical location, past events, staple diet and clinical features to exclude other infections. Also required are high index of suspicion and importantly serum levels of aflatoxin. Treatment strategies involved use of antimicrobials and supporting the damaged multi-organs.
FREDRICK DROTIENOCF. "
Diabetes care in Kenya–where are we and which way forward? East Afr Med J. 2005 Dec;82(12 Suppl):S161-2.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S161-2. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBACKGROUND: Type 2 diabetes has a long pre-clinical period before diagnosis, during which there may be development of complications, both of microvascular and macrovascular types. OBJECTIVE: To determine the risk factor profile of hyperglycaemia, hypertension and dyslipidaemia in patients with short-term (=/ < 2 years) type 2 diabetes. DESIGN: Cross-sectional descriptive study over six months. SETTING: Outpatient diabetic clinic of Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes. RESULTS: One hundred patients were included. The mean (SD) duration of diabetes was 10.3 (7.5) months. There were 66% of the study subjects with obesity, 50% with hypertension, 29% had ideal glucose control and less than 40% had high LDL-cholesterol. Twenty eight (28%) who had polyneuropathy had significant differences in their older age, higher total and LDL-cholesterol compared with those who did not have polyneuropathy. Twenty five (25%) of the study patients had micro-albuminuria and only 1% had macro-albuminuria. There were no significant differences in the selected characteristics between study patients with and those without albuminuria. Only 7% of the study patients had retinopathy on direct ophthalmoscopy. CONCLUSION: Microvascular complications occurred in patients with type 2 diabetes of short duration of not more than two years. The risk factors of hypertension, poor glycaemic control, dyslipidaemia and cigarette smoking were present in a fair proportion of the study patients. Patients with type 2 diabetes should be actively screened for complications and the risk factors thereof, even if the diabetes was of recent onset.
OMONDI DROYOOGEORGE, FREDRICK DROTIENOCF. "
Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review.East Afr Med J. 2005 Dec;82(12 Suppl):S197-203.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S197-203. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBACKGROUND: Diabetic ketoacidosis is the most common hyperglycaemic emergency in patients with diabetes mellitus, especially type 1 diabetes. It carries very high mortality in sub-Saharan Africa, both in the treated patients and those who are presenting to hospital with diabetes for the first time. OBJECTIVE: To review the risk factors, mechanisms and management approaches in diabetes ketoacidosis in published literature and to discuss them in the context of why a significant proportion of patients who develop diabetic ketoacidosis in sub-Saharan Africa still have high mortality. DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world. DATA SYNTHESIS: The main causes or precipitants of DKA in patients in SSA are newly diagnosed diabetes, missed insulin doses and infections. The major underlying mechanism is insulin deficiency. Treated patients miss insulin doses for various reasons, for example, inaccessibility occasioned by; unavailability and unaffordability of insulin, missed clinics, perceived ill-health and alternative therapies like herbs, prayers and rituals. Infections also occur quite often, but are not overt, like urinary tract, tuberculosis and pneumonia. Due to widespread poverty of individuals and nations alike, the healthcare systems are scarce and the few available centres are unable to adequately maintain a reliable system of insulin supply and exhaustively investigate their hospitalised patients. Consequently, there is little guarantee of successful outcomes. Poor people may also have sub-optimal nutrition, caused or worsened by diabetes, more so, at first presentation to hospital. Intensive insulin therapy in such individuals mimics 're-feeding syndrome', an acute anabolic state whose outcome may be unfavourable during the period of treatment of diabetic ketoacidosis. CONCLUSIONS: Although mortality and morbidity from diabetic ketoacidosis remains high in sub-Saharan Africa, improved healthcare systems and reliable insulin supply can reverse the trend, at least, to a large extent. Individuals and populations need empowerment through education, nutrition and poverty eradication to improve self-care in health and living with diabetes.
FREDRICK DROTIENOCF. "
Focus on delay as a strategy for care designs and evaluation of diabetic foot ulcers in developing countries: a review. East Afr Med J. 2005 Dec;82(12 Suppl):S204-8.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S204-8. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBackground: While foot care services for diabetic patients are necessary if limb morbidity and wastage are to be reduced, they may not be sufficient. Even when the few service centers and personnel that are available appear to be functioning relatively well, patients still face multiple barriers to derive maximum benefits from the services. OBJECTIVES: To review certain aspects of care of diabetes foot ulcers in developing countries with emphasis on causes of delay in care delivery. DATA SOURCES: Review of published literature on care of diabetic foot ulcers as well as our local experiences. MAIN OUTCOME MEASURES: Levels of potential or actual delay in care delivery and causes of such delay in pre-hospital phase, access to hospital and within-hospital phase of care. DATA SYNTHESIS AND CONCLUSIONS: The barriers or causes of delay are observed to occur at various levels: decision to seek care, reaching the treatment facility and receiving the desired optimal care. The usual main causative/ risk factors that include peripheral neuropathy causes inattention and delays the decision to seek care; peripheral vascular insufficiency and infection are both involved in initiation of diabetic foot ulcers and are also major causes of delay in ulcer healing process. Aside from the processes unique to diabetes, the health care providers and the facilities of care have had major contributions in delaying the desired care of the foot ulcers. This may arise from heavy workload, priority illnesses, shortage of required supply for standard care and/or just wrong attitudes. Patients' inadequate knowledge of self-care, unique socio-economic and socio-cultural characteristics are also contributors to the barriers that compound sub-optimal foot care. Care programme designs that lay emphasis on causes of delay are more likely to seek to eliminate such causes. Just like justice, footcare delayed is foot (care) denied.
FREDRICK DROTIENOCF, N PROFOGOLAELIJAHS. "
Lipid profile of ambulatory patients with type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S173-9.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S173-9. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBACKGROUND: Patients with type 2 diabetes are at high of cardiovascular events because they have abnormal lipid status compared to their non-diabetic counterparts. OBJECTIVE: To determine the quantitative lipid profile of ambulatory patients with type 2 diabetes mellitus. DESIGN: Prospective, cross-sectional descriptive study. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes but without obvious cardiovascular, renal or foot complications. RESULTS: A total of 213 patients with type 2 diabetes were studied, 56.8% were females. The age range of the study population was 34 to 86 years, mean(sd) age of females was 54.45 (9.4) years and that of males was 55.83 (9.3) years. The mean body mass index (BMI) of females was 27.85 (6.2) kg/m2 and 25.98 (5.8) kg/m2 for males. The female subjects were more obese than the males in this study. Over 70% of the study participants had total cholesterol > 4.2 mmol/l, 43.8% and 57.6% of the females and males respectively had LDL-C > 2.6 mmol/l , 25.6% of the females and 30% of the males had HDL-C < 1.00 mmol/l. Only a modest proportion of males (28.3%) and females (32.2%) had triglycerides > 1.7 mmol/l. The LDL-C showed a significant positive correlation with age, duration of diabetes, fasting blood glucose, and total cholesterol but no correlation with glycated haemoglobin, body mass index, gender and the mode of glucose-lowering treatment. CONCLUSION: There was significant proportion of quantitative dyslipidaemia in the study population especially with the Total–and LDL- cholesterols. Although treatment goals and lipid thresholds for cardiovascular risk in diabetes are not yet well-defined, even by the large randomized trials, high-risk patients with significant quantitative dyslipidaemia would require deliberate effort to correct the abnormal values to reduce the risk status. These high-risk patients without complications but already had significant dyslipidaemia, which enhances the risk of cardiovascular events, certainly required therapeutic intervention.
OLONDE PROFAMAYOERASTUS, FREDRICK DROTIENOCF. "
Mwendwa FM, Otieno CF, Kayima JK, Amayo EO, Otieno PO.Risk factor profile and the occurrence of microvascular complications in short-term type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi.East Afr Med J. 2005 Dec;82(12 Suppl):S163-72.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S163-72. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBACKGROUND: Type 2 diabetes has a long pre-clinical period before diagnosis, during which there may be development of complications, both of microvascular and macrovascular types. OBJECTIVE: To determine the risk factor profile of hyperglycaemia, hypertension and dyslipidaemia in patients with short-term (=/ < 2 years) type 2 diabetes. DESIGN: Cross-sectional descriptive study over six months. SETTING: Outpatient diabetic clinic of Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes. RESULTS: One hundred patients were included. The mean (SD) duration of diabetes was 10.3 (7.5) months. There were 66% of the study subjects with obesity, 50% with hypertension, 29% had ideal glucose control and less than 40% had high LDL-cholesterol. Twenty eight (28%) who had polyneuropathy had significant differences in their older age, higher total and LDL-cholesterol compared with those who did not have polyneuropathy. Twenty five (25%) of the study patients had micro-albuminuria and only 1% had macro-albuminuria. There were no significant differences in the selected characteristics between study patients with and those without albuminuria. Only 7% of the study patients had retinopathy on direct ophthalmoscopy. CONCLUSION: Microvascular complications occurred in patients with type 2 diabetes of short duration of not more than two years. The risk factors of hypertension, poor glycaemic control, dyslipidaemia and cigarette smoking were present in a fair proportion of the study patients. Patients with type 2 diabetes should be actively screened for complications and the risk factors thereof, even if the diabetes was of recent onset.
FREDRICK DROTIENOCF. "
Otieno CF, Vaghela V, Mwendwa FW, Kayima JK, Ogola EN.Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the Outpatient Diabetic Clinic of Kenyatta National Hospital, Nairobi. East Afr Med J. 2005.". In:
East Afr Med J. 2005 Jun;82(6):320-4. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractOBJECTIVES: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them. DESIGN: Prospective, cross-sectional study over a six month period. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Two hundred and eleven patients with type 2 diabetes. MAIN OUTCOME MEASURES: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment. RESULTS: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c < 7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30 kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes. CONCLUSION: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.
FREDRICK DROTIENOCF. "
Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S180-3.". In:
East Afr Med J. 2005 Dec;82(12 Suppl):S180-3. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractBACKGROUND: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. OBJECTIVE: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. DESIGN: Cross-sectional, prospective study. SETTING: Outpatient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. MAIN OUTCOME MEASURES: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. RESULTS: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85 (8.96) years and of the females was 55.68 (8.93) years. The mean (sd) total serum homocysteine for males of 12.97 (6.06) micromol/l was significantly higher than that of the females of 10.64 (4.41) micromol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. CONCLUSION: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.
FREDRICK DROTIENOCF. "
Vasculitis in HIV: report of eight cases. East Afr Med J. 2005 Dec;82(12):656-9.". In:
East Afr Med J. 2005 Dec;82(12):656-9. F.N. kamau, G. N Thothi and I.O Kibwage; 2005.
AbstractOBJECTIVE: To describe vasculitis in HIV patients, their CD4 levels, anatomical sites affected and clinical patterns. DESIGN: Prospective, descriptive study. SETTING: Kisumu District Hospital and Nairobi Rheumatology Clinic between January 2002 and May 2005. SUBJECTS: Eight patients with HIV and vasculitis. RESULTS: Eight patients (four males and four females) were recruited with an age range of 24-61 years, mean 33.13 years. Five had central nervous system vasculitis and three had peripheral vasculitis. The CD4 counts were low, range 2-200 cells/mm3 (mean of 79.25 cells/mm3), normal levels of CD4 are 355-1298 cells/mm3, indicating severe immunosuppression. Two patients tested positive for HBV (hepatitis B virus). CONCLUSION: HIV associated vasculitis is recognised and may be complicated by coinfection with hepatitis viruses. It occurs at low CD4 counts. Central nervous system involvement is a common site. Management is multidisciplinary.