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In many African countries, tick control has recently been the responsibility of resource-poor farmers rather than central government veterinary departments. This has led to an increase in acaricide resistance, threatening the welfare of livestock farmers in sub-Saharan Africa. Resistance has evolved to the three classes of acaricides used most extensively in the continent, namely fourth-generation synthetic pyrethroids (SP), organophosphates (OP) and amidines (AM), in virtually all countries in which they have been deployed across the globe. Most current data are derived from research in Australia and Latin America, with the majority of studies on acaricide resistance in Africa performed in South Africa. There is also limited recent research from West Africa and Uganda. These studies confirm that acaricide resistance in cattle ticks is a major problem in Africa. Resistance is most frequently directly assayed in ticks using the larval packet test (LPT) that is endorsed by FAO, but such tests require a specialist tick-rearing laboratory and are relatively time consuming. To date they have only been used on a limited scale in Africa and resistance is often still inferred from tick numbers on animals. Rapid tests for resistance in ticks, would be better than the LPT and are theoretically possible to develop. However, these are not yet available. Resistance can be mitigated through integrated control strategies, comprising a combination of methods, including acaricide class rotation or co-formulations, ethnoveterinary practices, vaccination against ticks and modified land management use by cattle, with the goal of minimising the number of acaricide applications required per year. There are data suggesting that small-scale farmers in Africa are often unaware of the chemical differences between different acaricide brands and use these products at concentrations other than those recommended by the manufacturers, or in incorrect rotations or combinations of the different classes of chemicals on the market. There is an urgent need for a more evidence-based approach to acaricide usage in small-scale livestock systems in Africa, including direct measurements of resistance levels, combined with better education of farmers regarding acaricide products and how they should be deployed for control of livestock ticks.

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.
PIP:
This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction, and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A IUD; the injectable Depo-Provera; and the low-dose oral contraceptive Microgynon. A nonrandomized sample of volunteer participants was used. 1076 users were followed up for a period of 1 year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method-specific differences in users' characteristics. The OC users were younger and had fewer children than the IUD or Depo-Provera users. The Depo-Provera users were older and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of the IUD and Depo-Provera users were married. IUD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12-month period. Discontinuation rates were highest for OC users (80%), lowest for IUD users (20%), and intermediate for Depo-Provera users (39%). 90% of OC and Depo-Provera users and 86% of IUD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUDs have shown the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among young OC users

Mucosal specimens are essential to evaluate compartmentalized immune responses to HIV vaccine candidates and other mucosally targeted investigational products. We studied the acceptability and feasibility of repeated mucosal sampling in East African clinical trial participants at low risk of HIV and other sexually transmitted infections.

Ogutu EO. A 10-year (1976-1986) retrospective study was done on 30 cases with histological diagnosis of pancreatic carcinoma. The male to female ratio was 1.3:1 and the peak incidence was in the 6th and 7th decades. The head of the pancreas was involved in 96% of cases while solid adenocarcinoma of duct cell origin accounted for 73.3% of cases, followed by anaplastic carcinoma (23.3%). The commonest complications were distinct metastasis (86.6%), obstructive jaundice (73.3%) and upper gastrointestinal bleed (13.6%).

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.
PIP:
This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction, and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A IUD; the injectable Depo-Provera; and the low-dose oral contraceptive Microgynon. A nonrandomized sample of volunteer participants was used. 1076 users were followed up for a period of 1 year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method-specific differences in users' characteristics. The OC users were younger and had fewer children than the IUD or Depo-Provera users. The Depo-Provera users were older and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of the IUD and Depo-Provera users were married. IUD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12-month period. Discontinuation rates were highest for OC users (80%), lowest for IUD users (20%), and intermediate for Depo-Provera users (39%). 90% of OC and Depo-Provera users and 86% of IUD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUDs have shown the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among young OC users

A total of 138 households were interviewed on various aspects of camel milk and camel milk products using a single-visit multiple-subject diagnostic survey in Garisa, Wajir and Eastleigh the main urban centres with high camel milk consumption. 75% of the respondents generally take camel milk or milk products every day. Raw and sour milk are the most popular products. The most important purchasing criterion for raw camel milk was taste (19 and18%) while packaging was more important for pasteurized milk (18, 18 and 16%) for Wajir, Garisa and Eastleigh respectively. For Yoghurt, the most important purchasing criteria were taste (18%) and aroma (19%). The taste of sour milk is the most important attribute in both Garisa (30%) and Eastleigh (24%). To enhance marketing of camel milk, the appropriate attributes demanded by customers needs to be seriously addressed. Promotion of camel milk and products to non conventional consumers should be done in order to increase their consumption.

A total of 138 households were interviewed on various aspects of camel milk and camel milk products using a single-visit multiple-subject diagnostic survey in Garisa, Wajir and Eastleigh the main urban centres with high camel milk consumption. 75% of the respondents generally take camel milk or milk products every day. Raw and sour milk are the most popular products. The most important purchasing criterion for raw camel milk was taste (19 and18%) while packaging was more important for pasteurized milk (18, 18 and 16%) for Wajir, Garisa and Eastleigh respectively. For Yoghurt, the most important purchasing criteria were taste (18%) and aroma (19%). The taste of sour milk is the most important attribute in both Garisa (30%) and Eastleigh (24%). To enhance marketing of camel milk, the appropriate attributes demanded by customers needs to be seriously addressed. Promotion of camel milk and products to non conventional consumers should be done in order to increase their consumption.

A new impetus is emerging with regard to the potential role that agricultural producer associations might play in improving rural economies. For this study, the use of cereal banking to improve accessibility to premium markets was assessed and the factors influencing farmers' decisions to join them were evaluated. The methodology involved a baseline survey of 213 smallholder maize producers in Bungoma district, western Kenya, plus a logit model analysis to predict the probabilities of farmers joining a cereal bank. Membership of other local community-based organizations and the actual harvests achieved strongly influence farmers' decisions to join a cereal bank.

Introduction: In South Sudan few women have heard about the HIV. The prevalence of HIV infection in the country is 2.6%. Post abortion care (PAC) accounts for over 50% of all gynaecological admissions at the Juba Teaching Hospital (JTH). HIV testing is not routinely offered as part of PAC services.

Objective: To determine factors associated with acceptability of HIV testing among women receiving PAC at JTH.

Methods: This was a cross-sectional study, conducted at the Gynaecological Unit of JTH. Three hundred and forty patients were interviewed using a structured questionnaire.

Results: The mean age of the participants was 24.7 years with 50.5% aged <25years, 31.5% were employed, and 31.8% had no formal education. Acceptability of HIV testing was 70.9% and the prevalence of HIV was 2.7%. The most common reason for not accepting, was the belief, based on previous results, that they were HIV negative. Patients aged ≥25 years and those with primary and secondary education were twice as likely to accept HIV testing than those <25 years and those with no formal education, respectively. Employment status, religion and marital status were not statistically associated with acceptability of HIV testing. Patients previously tested for HIV were more likely to accept testing.

Conclusion: Routine HIV testing should be integrated into PAC services with efforts to increase awareness of HIV and importance of testing

Key words: HIV, abortion, post-abortion care, South Sudan

The factors responsible for the explosive spread of human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa continue to be identified and debated. One of the most controversial factors has been male circumcision. This cross-sectional study was conducted to measure the association between circumcision status and infection with HIV-1 among men with genital ulcer disease. Eight hundred and ten men participated in the study, of whom 190 (23%) were HIV-1-positive. A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) and with a history of urethral discharge (adjusted OR, 2.0; 95% CI, 1.4-2.8). This association could not be explained by measures of sexual exposure to HIV-1 among this population. Male circumcision should be considered as an intervention strategy for AIDS control.

Invasive cervical cancer (ICC) is common in areas where human immunodeficiency virus (HIV) is also prevalent. Currently, HIV seroprevalence as well as acceptability of HIV testing in ICC patients in Kenya is unknown. The objective of this study was to determine the acceptability of HIV testing among patients with ICC. Women with histologically verified ICC at Kenyatta National Hospital participated in the study. A structured questionnaire was administered to patients who gave informed consent. HIV pre- and posttesting counseling was done. Blood was tested for HIV using enzyme-linked immunosorbent assay. Overall, 11% of ICC patients were HIV seropositive. The acceptance rate of HIV testing was 99%; yet, 5% of the patients did not want to know their HIV results. Patients less than 35 years old were two times more likely to refuse the result of the HIV test (odds ratio [OR] 2.2). Patients who did not want to know their HIV results were three times more likely to be HIV seropositive (OR 3.1). Eighty four percent of the patients were unaware of their HIV seropositive status. The HIV-1 seroprevalence in ICC patients was comparable to the overall seroprevalence in Kenya. ICC patients were interested in HIV testing following pretest counseling. Offering routine HIV testing is recommended in ICC patients.

Invasive cervical cancer (ICC) is common in areas where human immunodeficiency virus (HIV) is also prevalent. Currently, HIV seroprevalence as well as acceptability of HIV testing in ICC patients in Kenya is unknown. The objective of this study was to determine the acceptability of HIV testing among patients with ICC. Women with histologically verified ICC at Kenyatta National Hospital participated in the study. A structured questionnaire was administered to patients who gave informed consent. HIV pre- and posttesting counseling was done. Blood was tested for HIV using enzyme-linked immunosorbent assay. Overall, 11% of ICC patients were HIV seropositive. The acceptance rate of HIV testing was 99%; yet, 5% of the patients did not want to know their HIV results. Patients less than 35 years old were two times more likely to refuse the result of the HIV test (odds ratio [OR] 2.2). Patients who did not want to know their HIV results were three times more likely to be HIV seropositive (OR 3.1). Eighty four percent of the patients were unaware of their HIV seropositive status. The HIV-1 seroprevalence in ICC patients was comparable to the overall seroprevalence in Kenya. ICC patients were interested in HIV testing following pretest counseling. Offering routine HIV testing is recommended in ICC patients.

Invasive cervical cancer (ICC) is common in areas where human immunodeficiency virus (HIV) is also prevalent. Currently, HIV seroprevalence as well as acceptability of HIV testing in ICC patients in Kenya is unknown. The objective of this study was to determine the acceptability of HIV testing among patients with ICC. Women with histologically verified ICC at Kenyatta National Hospital participated in the study. A structured questionnaire was administered to patients who gave informed consent. HIV pre- and posttesting counseling was done. Blood was tested for HIV using enzyme-linked immunosorbent assay. Overall, 11% of ICC patients were HIV seropositive. The acceptance rate of HIV testing was 99%; yet, 5% of the patients did not want to know their HIV results. Patients less than 35 years old were two times more likely to refuse the result of the HIV test (odds ratio [OR] 2.2). Patients who did not want to know their HIV results were three times more likely to be HIV seropositive (OR 3.1). Eighty four percent of the patients were unaware of their HIV seropositive status. The HIV-1 seroprevalence in ICC patients was comparable to the overall seroprevalence in Kenya. ICC patients were interested in HIV testing following pretest counseling. Offering routine HIV testing is recommended in ICC patients.

Invasive cervical cancer (ICC) is common in areas where human immunodeficiency virus (HIV) is also prevalent. Currently, HIV seroprevalence as well as acceptability of HIV testing in ICC patients in Kenya is unknown. The objective of this study was to determine the acceptability of HIV testing among patients with ICC. Women with histologically verified ICC at Kenyatta National Hospital participated in the study. A structured questionnaire was administered to patients who gave informed consent. HIV pre- and posttesting counseling was done. Blood was tested for HIV using enzyme-linked immunosorbent assay. Overall, 11% of ICC patients were HIV seropositive. The acceptance rate of HIV testing was 99%; yet, 5% of the patients did not want to know their HIV results. Patients less than 35 years old were two times more likely to refuse the result of the HIV test (odds ratio [OR] 2.2). Patients who did not want to know their HIV results were three times more likely to be HIV seropositive (OR 3.1). Eighty four percent of the patients were unaware of their HIV seropositive status. The HIV-1 seroprevalence in ICC patients was comparable to the overall seroprevalence in Kenya. ICC patients were interested in HIV testing following pretest counseling. Offering routine HIV testing is recommended in ICC patients.

Oyieke H.A. and Misra A.K:

Abstract

We studied the acceptability of isoniazid preventive therapy (IPT) in newly human immunodeficiency virus (HIV) infected Ugandan women. Women were followed in an out-patient clinic where they received HIV care including IPT. Of 52 women who were purified protein derivative-positive, 48 were eligible for IPT and 39 (81%) completed therapy. This completion rate was higher than reported in similar observational studies.

The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance.

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On attainment of political independence in 1963, the Government of Kenya (GoK), households and the private sector collectively endeavoured to enhance the development of education in the country. The rapid development of education and training in Kenya was an aftermath of the Sessional Paper No. 10 of 1965 on African Socialism and its Application to Planning in Kenya, which emphasized combating ignorance, disease and poverty. It was based on two long-standing concerns that: (i) every Kenyan child, irrespective of gender, religion and ethnicity, has the inalienable right to access basic welfare provision, including education; and (ii) the GoK has an obligation to provide opportunity to all citizens to fully participate in socio-economic and political development of the country and also to empower the people to improve their welfare. Development of education since independence has been marked by various changes and challenges. For nearly four decades therefore, the sector has undergone several reviews by special commissions and working parties appointed by the government, with the aim of improving efficiency and effectiveness of the education provision.

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The identification of five novel compounds, pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-N-demethylerythromycin A-6,9-hemiketal, 5-O-beta-D-desosaminylerythronolide A and 15-nor-erythromycin C, in mother liquor concentrates of Streptomyces erythraeus is described. The pseudo-erythromycin derivatives are characterized by a 12-membered macrocyclic ring as a result of C13––C11 trans-lactonization. The five compounds have very little antimicrobial activity.

The increasing land scarcity and the worsening trend of poverty in Kenya in recent years have raised concerns about the focus on land-based agriculture as the basis of growth in the rural areas. This paper combines two complementary data sets obtained from two locations in Kenya, drawn against distinctively different land availability patterns, to examine the diverse rural asset base and key sources of livelihood in the rural areas. The analysis reveals that while access to productive land is still an important determinant of livelihoods in the rural areas, even where land holdings are very small, growth in farm productivity alone may not guarantee households sufficient incomes to escape poverty. We find evidence to suggest that growth of non-farm sector is necessary and may be much more important in reducing risks and vulnerability to poverty and should be equally emphasized if households in such regions are to escape poverty. Off-farm earnings accounted for at least 50 percent of total household incomes in the two research locations. The study further revealed existence of significant barriers to entry to remunerative livelihoods both at farm and off-farm level. The study advocates for expansion of educational services, infrastructure and strengthening of rural institutions to spur broad-based development in the rural areas.

The increasing land scarcity and the worsening trend of poverty in Kenya in recent years have raised concerns about the focus on land-based agriculture as the basis of growth in the rural areas. This paper combines two complementary data sets obtained from two locations in Kenya, drawn against distinctively different land availability patterns, to examine the diverse rural asset base and key sources of livelihood in the rural areas. The analysis reveals that while access to productive land is still an important determinant of livelihoods in the rural areas, even where land holdings are very small, growth in farm productivity alone may not guarantee households sufficient incomes to escape poverty. We find evidence to suggest that growth of non-farm sector is necessary and may be much more important in reducing risks and vulnerability to poverty and should be equally emphasized if households in such regions are to escape poverty. Off-farm earnings accounted for at least 50 percent of total household incomes in the two research locations. The study further revealed existence of significant barriers to entry to remunerative livelihoods both at farm and off-farm level. The study advocates for expansion of educational services, infrastructure and strengthening of rural institutions to spur broad-based development in the rural areas.

The increasing land scarcity and the worsening trend of poverty in Kenya in recent years have raised concerns about the focus on land-based agriculture as the basis of growth in the rural areas. This paper combines two complementary data sets obtained from two locations in Kenya, drawn against distinctively different land availability patterns, to examine the diverse rural asset base and key sources of livelihood in the rural areas. The analysis reveals that while access to productive land is still an important determinant of livelihoods in the rural areas, even where land holdings are very small, growth in farm productivity alone may not guarantee households sufficient incomes to escape poverty. We find evidence to suggest that growth of non-farm sector is necessary and may be much more important in reducing risks and vulnerability to poverty and should be equally emphasized if households in such regions are to escape poverty. Off-farm earnings accounted for at least 50 percent of total household incomes in the two research locations. The study further revealed existence of significant barriers to entry to remunerative livelihoods both at farm and off-farm level. The study advocates for expansion of educational services, infrastructure and strengthening of rural institutions to spur broad-based development in the rural areas.

No abstract available.

No abstract available.

Access, sources and value of new medical information: views of final year medical students at the University of Nairobi.
Gituma A, Masika M, Muchangi E, Nyagah L, Otieno V, Irimu G, Wasunna A, Ndiritu M, English M
OBJECTIVE: To evaluate final year medical students' access to new medical information.
METHOD: Cross-sectional survey of final year medical students at the University of Nairobi using anonymous, self-administered questionnaires.
RESULTS: Questionnaires were distributed to 85% of a possible 343 students and returned by 44% (152). Half reported having accessed some form of new medical information within the previous 12 months, most commonly from books and the internet. Few students reported regular access; and specific, new journal articles were rarely accessed. Absence of internet facilities, slow internet speed and cost impeded access to literature; and current training seems rarely to encourage students to seek new information.
CONCLUSION: Almost half the students had not accessed any new medical information in their final year in medical school. This means they are ill prepared for a career that may increasingly demand life-long, self-learning.

Trop Med Int Health. 2009 Jan;14(1):118-22. doi: 10.1111/j.1365-3156.2008.02209.x.

To evaluate final year medical students' access to new medical information.

Patients who have an accessory pathway (AP) of atrioventricular (AV) conduction may develop circus movement tachycardia otherwise known as atrioventricular re-entrant tachycardia (AVRT). Orthodromic AVRT is the most common form. It occurs as a result of antegrade conduction through the normal AV conduction system and retrograde conduction to the atria via the AP. Less commonly, conduction occurs in the opposite direction resulting in antidromic AVRT. Tachycardia may also involve multiple APs which may provide both antegrade and retrograde conduction and may alternate antegradely or retrogradely. Tachycardia may occur in which the AP simply acts as a bystander, and does not participate in the tachycardia mechanism. When atrial fibrillation is conducted to the ventricles via and AP, the resultant ventricular rate may be extremely rapid, placing the patient at risk of developing ventricular fibrillation and cardiac arrest. This paper reviews the anatomical and physiological substrates involved in the pathogenesis of AVRT. The acute and long-term management of patients who suffer from these arrhythmias will then be discussed. The normal AV annulus is composed exclusively of electrically inert fibrous tissue. The AV node and His bundle normally act as the sole route of electrical conduction. Accessory pathways occur at all points along the AV ring, and usually occur as isolated abnormalities, although a proportion of patients have associated congenital abnormalities. This is particularly true of right-sided APs. Most APs exhibit non-decremental conduction properties, and conduct faster than normal AV conduction tissue. In many patients with APs the surface ECG reveals clear evidence of pre-excitation, and a good idea of pathway localization is possible using one or more of several algorithms which have been developed. Patients with latent pre-excitation, intermittent pre-excitation, and patients with concealed APs have not evidence of pre-excitation on a proportion or all of Their surface ECGs. Patients present with a history of paroxysmal palpitations, often with associated symptoms such as chest discomfort Syncope is a rare presenting symptom. Unless bundle branch block is present, patients with orthodromic AVRT exhibit a narrow complex tachycardia on the surface ECG. Patients with pre-excited tachycardia including antidromic AVRT, and other forms of SVT in which the AP conducts to the ventricles as a bystander but does not participate in the tachycardias mechanism, present as broad complex tachycardias on the surface ECG which may be difficult to distinguish from ventricular tachycardia. Adenosine is increasingly used for this purpose since it is highly efficacious and has an extremely short half-life. Adenosine is also very useful in the diagnosis of broad-complex tachycardia, and in unmasking latent pre-excitation during sinus rhythm. Electrophysiology study in these patients is frequently performed at the same time as an attempt at catheter ablation; it aims to diagnose, localize and determine the functional characteristics of an AP, and to characterize the role of the pathway in tachycardia. AVRT can be reliably terminated by effective AV nodal blockade. Drug therapy for the prevention of AVRT is useful for temporary control whilst awaiting more definitive measures and in certain cases as long-term management. No class of drug stands out as 'therapy of choice', and physician preference, pro-arrhythmic effects and associated conditions need to be taken into account such that an individual choice can be made in each patient. The management of patients with AVRT has been revolutionized in recent years with the advent of catheter-based techniques for their cure. Whilst this method of treatment is highly effective and has low complication rates, pathways in particular locations such as the septal region remain challenging.

No abstract available.

Detailed information on the situation of youth in Africa is not available. There is increasing concern that large sections of young people have become marginalized or are excluded from education, healthcare, housing, leadership and even promotion of talent based activities such as arts and sports which has great potential in shaping up their livelihood status and their dignity.

For the poor youth in Africa, doing nothing is not an option at times of acute basic needs such as food, housing and clothing. Capitalistic nature and lack of supportive welfare systems in urban areas is compounding the survival of the youth. Most Government are now recognizing the important role played by youth. Sports and entertainment sector is becoming a beacon of hope for alleviating challenges facing the youth.

The Paper uses ethnographic approach- whose intent is provision of a detailed, in-depth description of youth in everyday life and practice.

Paper Presented in College Des Benardins in Paris, France on 23rd/8/2011. Proceedings of Paris 2011-Homeless World Cup Symposium.

In 2002 the Danish Minister of Environment initiated a process to investigate the possibilities of establishing national parks in Denmark. For this purpose experts were mobilised to investigate the status and potentials of the areas in question. The national park process was extensive in scope and complex, and in theory such complexity is assumed to make it difficult for non-experts to understand all the relevant aspects of policy. This exclusion of non-experts may lead to scientification of politics. Furthermore politicisation of science might occur as experts might advocate political interests disguised as objective science, and policy-makers might select results that further their own interests. As a result policy-makers risk losing a source of legitimacy, scientists risk losing credibility and the citizens risk losing the possibility to hold policy-makers accountable for their decisions, which puts democracy at risk. This paper examines the accountability relationships that experts were a part of in the national park process. These include accountability towards the employer, towards the buyer and towards the general public. The purpose is to determine if these relationships were adequate to circumvent the problems associated with scientification of politics and to discuss how accountability relationships and thereby democracy could be strengthened. The empirical analysis shows that in the national park process experts were mainly accountable towards the National Forest and Nature Agency. There were formal accountability relationships between the experts and the local steering committees and the national advisory group, but these relationships were less significant. Moreover, despite the fact that the process was deemed unusually open to the public by the participants, the relationship between experts and the public cannot be characterised as an accountability relationship and could have been improved by including experts in the deliberative fora of the process.

Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance. This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.

Ogutu EO. A 10-year (1976-1986) retrospective study was done on 30 cases with histological diagnosis of pancreatic carcinoma. The male to female ratio was 1.3:1 and the peak incidence was in the 6th and 7th decades. The head of the pancreas was involved in 96% of cases while solid adenocarcinoma of duct cell origin accounted for 73.3% of cases, followed by anaplastic carcinoma (23.3%). The commonest complications were distinct metastasis (86.6%), obstructive jaundice (73.3%) and upper gastrointestinal bleed (13.6%).

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

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

No abstract available

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

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

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

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

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

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

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

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

No abstract available

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

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

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Fluoride in plant and vegetable samples has beendetermined using the ion selective electrode.The analysis was carried out after ashingthe samples onan open flame, adding perchloric acid and allowing the hydrogen fluoride to diffuse into a sodium hydroxide layer. The results obtained show that kale and pumpkins can accumulate more than ten times their normal values of fluoridewhile plants were found to accumulate upto 100 ug/g fluoride when exposed to high levels of fluoride in water or soil.

Accumulation, distribution and metabolism of ring labelled, "C-1,1,1, - trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT) in a model marine aquatic ecosystem consisting of sea water, sediment, oysters (Isognomonon alatus) and Humbug fish (Dascillus aruanus) were studied in the laboratory. "C-p,p'-DDT distributes rapidly in the ecosystem immediately after application on the water surface with reduction of its concentration in the water phase from 1.18 ng g"1 to 0.71 ng g'after 2 hours and an increase in its content in the sediment and oysters. The bioconcentration factor reached a maximum of 19x 10* in oysters, and 1657 in Humbug fish after 24 hours. The sediment concentration reached 117 ng g"1 after 168 hours from start of application. A peak bioconcentration factor of 111 x 103 was calculated after 120 hours when 0.24 mg kg"1 of '^>p,p'-DDT was maintained through dosing every 24 hours with 0.002 mg kg' of a mixture of labelled and non-labelled pesticide. The rate of depuration of accumulated "C-p,p'-DDT sediment residues was up to 78.3% after 24 hours while oysters lost only 14.0% during the same period. The loss in Humbug fish was only 22.2% in three days. Volatilisation and sorption losses from seawater alone (without sediment/biota) were found to be very high in the range of 73.8 - 91.5% over 24 h for p,p'-DDT in aerated and non-aerated ecosystem. Gas chromatograph and TLC analysis of water, sediment and oyster samples revealed presence of p,p'-DDT and substantial amounts of p,p'-DDE and p,p'-DDD three days after pesticide dosage.

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.

We tested the practical application of an anaemia scoring chart (the FAMACHA© chart) as a method for controlling Haemonchus contortus in goats kept under smallholder conditions in a sub-humid area of Central Kenya. The objectives were: (1) to test the accuracy of the FAMACHA© chart in identifying anaemic goats (PCV ≤ 18); (2) to quantify the proportion of goats left untreated at farm level when using the chart. On each of two farms, Small East African goats of various ages were allocated to two treatment groups; a FAMACHA© group (F1 (n = 34) and F2 (n = 31) on farms 1 and 2, respectively) and a control group (C1 (n = 34) and C2 (n = 30)). In F1 and F2 goats with a FAMACHA© score of 3, 4 or 5 were treated with anthelmintic after scoring. In C1 and C2 goats were treated every 4 weeks from 15 February to 20 July. Every 2 weeks all goats were scored with the FAMACHA© chart and weighed. Furthermore, faecal samples were collected for faecal egg counts (FEC) and blood samples were collected for packed cell volume (PCV) determination. H. contortus was found to be the predominant nematode on both farms. The mean FECs were higher on farm 1 compared to farm 2, while in contrast the mean PCV levels were lowest on farm 2. The latter was most likely due to the presence of Fasciola spp., flea and tick infections on farm 2. The accuracy of the chart was evaluated by using PCV as the gold standard for anaemia (PCV ≤ 18%). The mean percentage of false-negative scorings per sampling was 0.7% on farm 1 and 1.6% on farm 2, while the mean percentage of false-positive scorings was 9.7% and 21.4%, respectively. It is most likely that the accuracy of the chart was negatively affected by the concurrent parasite infections on farm 2. The mean proportion of untreated goats per sampling was 89% and 77% on farm 1 and farm 2. It was concluded that the FAMACHA© chart can be a valuable tool for decision-making in control of H. contortus in goats kept under smallholder conditions, without morbidity or mortality unacceptable to the farmer. The application may further reduce the risk of development of anthelmintic resistance by increasing refugia. However, caution should be taken under conditions where other anaemia-causing parasites are present (e.g. Fasciola spp. and ecto-parasites), since this possibly decreases the accuracy of the FAMACHA© chart

Abstract:
We tested the practical application of an anaemia scoring chart (the FAMACHA© chart) as a method for controlling Haemonchus contortus in goats kept under smallholder conditions in a sub-humid area of Central Kenya. The objectives were: (1) to test the accuracy of the FAMACHA© chart in identifying anaemic goats (PCV ≤ 18); (2) to quantify the proportion of goats left untreated at farm level when using the chart. On each of two farms, Small East African goats of various ages were allocated to two treatment groups; a FAMACHA© group (F1 (n = 34) and F2 (n = 31) on farms 1 and 2, respectively) and a control group (C1 (n = 34) and C2 (n = 30)). In F1 and F2 goats with a FAMACHA© score of 3, 4 or 5 were treated with anthelmintic after scoring. In C1 and C2 goats were treated every 4 weeks from 15 February to 20 July. Every 2 weeks all goats were scored with the FAMACHA© chart and weighed. Furthermore, faecal samples were collected for faecal egg counts (FEC) and blood samples were collected for packed cell volume (PCV) determination. H. contortus was found to be the predominant nematode on both farms. The mean FECs were higher on farm 1 compared to farm 2, while in contrast the mean PCV levels were lowest on farm 2. The latter was most likely due to the presence of Fasciola spp., flea and tick infections on farm 2. The accuracy of the chart was evaluated by using PCV as the gold standard for anaemia (PCV ≤ 18%). The mean percentage of false-negative scorings per sampling was 0.7% on farm 1 and 1.6% on farm 2, while the mean percentage of false-positive scorings was 9.7% and 21.4%, respectively. It is most likely that the accuracy of the chart was negatively affected by the concurrent parasite infections on farm 2. The mean proportion of untreated goats per sampling was 89% and 77% on farm 1 and farm 2. It was concluded that the FAMACHA© chart can be a valuable tool for decision-making in control of H. contortus in goats kept under smallholder conditions, without morbidity or mortality unacceptable to the farmer. The application may further reduce the risk of development of anthelmintic resistance by increasing refugia. However, caution should be taken under conditions where other anaemia-causing parasites are present (e.g. Fasciola spp. and ecto-parasites), since this possibly decreases the accuracy of the FAMACHA© chart.

This study aimed to estimate the level of relatedness within Ankole cattle herds using autosomal microsatellite markers and to assess the accuracy of relationship assignment based on farmers' memory. Eight cattle populations (four from each of two counties in Mbarara district in Uganda) were studied. Cattle in each population shared varying degrees of relatedness (first-, second- and third-degree relatives and unrelated individuals). Only memory-based kinship assignments which farmers knew with some confidence were tested in this experiment. DNA isolated from the blood of a subsample of 304 animals was analysed using 19 microsatellite markers. Average within population relatedness coefficients ranged from 0.010 ± 0.005 (Nshaara) to 0.067 ± 0.004 (Tayebwa). An exclusion probability of 99.9% was observed for both sire-offspring and dam-offspring relationships using the entire panel of 19 markers. Confidence from likelihood tests performed on 292 dyads showed that first-degree relatives were more easily correctly assigned by farmers than second-degree ones (p < 0.01), which were also easier to assign than third-degree relatives (p < 0.01). Accuracy of kinship assignment by the farmers was 91.9% ± 5.0 for dam-offspring dyads, 85.5% ± 3.4 for sire-offspring dyads, 75.6% ± 12.3 for half-sib and 60.0% ± 5.0 for grand dam-grand offspring dyads. Herd size, number of dyads assigned and length of time spent by the herder with their cattle population did not correlate with error in memorizing relationships. However, herd size strongly correlated with number of dyads assigned by the herder (r = 0.967, p < 0.001). Overall, we conclude that memorized records of pastoralists can be used to trace relationships and for pedigree reconstruction within Ankole cattle populations, but with the awareness that herd size constrains the number of kinship assignments remembered by the farmer.

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This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

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Plasma acetone turnover rates were measured with the primed continuous infusion of 2-[14C]acetone in patients with moderate to severe diabetic ketoacidosis. Plasma acetone turnover rates ranged from 1.52 to 15.9 mumol X kg-1 X min-1 (108-1038 mumol X 1.73 m-2 X min-1) and were directly related to the plasma acetone concentrations that ranged from 0.47 to 7.61 mM. The average acetone turnover rate was 6.45 mumol X kg-1 X min-1 (533 mumol X 1.73 m-2 X min-1), a value twice that obtained in a similar group of diabetic ketoacidotic patients via the single-injection technique of 2-[14C]acetone administration. Degradation of urine glucose revealed that 14C from administered 2-[14C )acetone was principally located in carbons 1, 2, 5, and 6 of the glucose molecule in five of six patients. This distribution is similar to that expected from 2-[14C]pyruvate, suggesting that acetone was converted to glucose through pyruvate. In one patient, label was located predominantly in glucose carbons 3 and 4, indicating that acetone metabolism may be different in some patients. Acetol (1-hydroxyacetone) and 1,2-propanediol (PPD), two possible metabolites of acetone, were detected in plasma of the patients. The concentrations of Acetol ranged from 0 to 0.48 mM and of PPD ranged from 0 to 0.53 mM. The concentrations of each metabolite were directly related to the plasma acetone concentrations. During the continuous infusion of 2-[14C]acetone, the specific activities of plasma glucose and PPD rose continuously but did not reach constant values. Estimates of the minimal percent plasma glucose and PPD derived from plasma acetone averaged 2.1 and 74%, respectively.

In this study, the investigation of hydralazine acetylator phenotype was undertaken for the first time in African hypertensives at Kenyatta National Hospital. A total of 25 randomly selected patients with moderate to severe hypertension (diastolic pressure 105-130 mmHg), participated in the phenotyping study. The phenotyping was done by administering oral standard hydralazine dose of 150 mg/day in three divided doses. The 24 hour urinary MTP/hydralazine ratio was used to categorize patients into slow and fast acetylators. Of the patients studied 69.9% were slow acetylators while 30.4% were fast acetylators. The mean 24 hour urinary MTP/hydralazine ratio for slow acetylators was 1.01 +/- 0.95. This was significantly different from the fast acetylators where the mean 24 hour urinary MTP/hydralazine ratio was 10.6 +/- 4.4 (P < 0.001). The acetylator phenotyping divided the patients into two distinct populations and no further arbitrary method was required to divide the patients into either group.

Thidiazuron (TDZ) effectively induced somatic embryogenesis in cultured hypocotyl explants of geranium (Pelargonium x hortorum Bailey) during only a 3-day period of induction. The presence of acetylsalicylic acid (ASA) during this period caused a two-fold increase in the number of somatic embryos and enhanced synchronization of embryo development compared to the TDZ treatment alone. Salicylic acid was ineffective in modulating similar embryogenic responses as ASA. The ASA-induced enhancement and synchronization of somatic embryogenesis could possibly be used as an experimental system to study the interplay of growth regulators in somatic embryogenesis

PIP: Menstrual blood loss (MBL) was evaluated in 74 nulliporous Kenyan women aged between 20 and 27 years. The hemoglobin levels were all in normal range with the mean of 13.65 +or- 0.8, 13.84 +or- 1.2 and 13.04 +or- 1.2 g/100 ml respectively in 3 populations. The MBL was comparable in the 3 populations with the mean of 35.1 +or- 12.6, 30.6 +or- 8.7 and 32.2 +or- 9.4 ml respectively. There was no difference of statistical significance between the 2 periods studied per each individual. This study objectively assesses the menstrual blood loss in 3 population groups–2 urban and 1 rural. The data can be used to evaluate menstrual blood loss before and after initiation of various contraceptives used in Kenya. Subjects were volunteers who were not on any contraception except barrier or natural rhythm methods, not under psychological stress and who exhibited normal physical female characteristics on examination. Those who wished to drop out, became pregnant or desired contraception, were excluded. The study confirms the individual constancy of the menstrual blood loss in this population. This has important practical implications since a single determination of the menstrual blood loss may be a fairly good expression for the average blood loss in a woman. The immediate effect of various treatments such as IUD insertion or oral contraceptives on the MBL may easily be evaluated quantitatively by measurements in consecutive periods using only 1 period as a control. The quick method can be easily used in evaluating pathological conditions e.g. iron-deficiency due to heavy bleeding, IUD-associated hemorrhage, menorrhagia and uterine fibroid.

Forty patients with cirrhosis of the liver and tense ascites were randomized to receive either aldactone 400 mg/day and furosemide 80 mg/day (n = 20) or repeated large volume paracentesis (LVP) and infusion of low molecular weight dextran (n = 20). Both treatment groups were similar in clinical and laboratory parameters. Complete mobilization of the ascitic fluid was achieved in all receiving LVP and dextran therapy within 1 week of the treatment, in contrast to the minimal mobilization of the ascitic fluid in patients receiving diuretics even after 2 weeks of therapy. Renal function, the clinical parameters of systemic hemodynamics, serum electrolytes, and hepatic function remained stable in patients receiving LVP and dextran and were similar to those in the diuretic-treated patients. We found no deterioration of these functions in the nonedematous patients treated by LVP and dextran even though the protective effect of edema against LVP was lacking in them. Plasma volume estimation in six nonedematous cirrhotic patients treated by LVP and dextran did not reveal any hypovolemia after complete mobilization of ascites. The frequency of complications and death were similar in the two groups. Dextran infusion is a safe, effective, and low-cost replacement therapy in patients with cirrhotic ascites treated by LVP.

Etiopathogenesis of acute hepatic failure (AHF) in Eastern and Western countries is distinct. In the East hepatitis viruses cause AHF in more than 95% of such cases, while causes of AHF in the West are quite heterogenous. Hepatitis E virus is the major etiological agent of AHF in countries like India where the virus is hyperendemic. Occult HBV infection may also be causing AHF in a sizable proportion of cases in areas where chronic HBV infection frequency is high. Paracetamol causes AHF in about 70% cases in the UK and about 20% cases in USA, whereas in France and Denmark, non-steroidal anti-inflammatory drugs are more frequently associated with AHF. Hepatitis B virus causes AHF in about one-third of cases in the latter two countries. Copyright 2002 Blackwell Publishing Asia Pty Ltd

BACKGROUND: Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, data are lacking on the prevalence of HAV antibody among patients with chronic liver disease in India. METHODS: Two hundred fifty-four patients attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi during the past 5 years and diagnosed to have either chronic hepatitis due to the hepatitis B virus (n = 76), hepatitis C virus (n = 84) or cirrhosis of the liver due to the hepatitis B (n = 47) or C (n = 47) virus were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). RESULTS: Two hundred forty-eight (97.6%) patients tested positive for IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with chronic hepatitis B (74, 97.4%), chronic hepatitis C (82, 97.6%), cirrhosis of the liver due to the hepatitis B (46, 97.8%) and hepatitis C (46, 97.8%) virus. CONCLUSION: Vaccination against HAV is not required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients.

We report a patient with fibrosing cholestatic hepatitis (FCH)-like syndrome in renal transplant recipient, who was negative for hepatitis-B and C-virus infection. The patient presented initially with extrahepatic biliary obstruction due to stricture at the lower end of the common bile duct. Cholestasis persisted inspite of effective biliary drainage. He was operated for empyema of the gallbladder and histological examination showed the presence of cytomegalovirus inclusions in the wall of the gallbladder. The patient died inspite of aggressive management; autopsy examination of the liver revealed evidence of FCH-like changes.

Chronic Calcific Pancreatitis of Tropics is a disease of unknown aetiology and is characterised by chronic pancreatitis with calcification in young persons who present with pain, diabetes, and/or steatorrhoea. ERCP performed on 42 patients with this condition revealed changes compatible with chronic pancreatitis. These changes were however, more marked and somewhat different from those seen in the alcoholic chronic pancreatitis. Cystic dilatation, tortuosity, and obstruction of the main pancreatic duct were similar to that in alcoholic pancreatitis. The features of CCPT that were different from those of latter, were large pancreatic calculi, absence of strictures/stenosis and absence of irregularity of the ductal wall. The calculi were predominantly in the head region of the pancreas causing maximal dilatation of the main pancreatic duct in the head of pancreas. The secondary branches were stunted, short and scanty but revealed a lower grade of changes, than the changes documented in the main pancreatic duct. The pancreatic ductal changes in CCPT seems to be different from that seen in chronic alcoholic pancreatitis and may be due to the difference in the pathophysiology of the underlying disease.

Hepatitis G virus (HGV)/GB virus-C (GBV-C) has been identified as a blood-borne agent with disputed pathogenicity. This virus belongs to the flaviviridae with a distant relationship to hepatitis C virus (HCV). Genetically divergent HGV isolates have been reported from different parts of the world. This study describes the prevalence of HGV in multitransfused thalassaemic children in India and genomic sequence variations in 11 HGV isolates from the same geographical location. Hepatitis G virus RNA was detected in 39.7% multitransfused thalassaemic children. The seroprevalence of hepatitis B virus (HBV) and HCV was 23.8% and 17.1%, respectively, and 11.4% had dual infection. The nucleotide sequence of a 166 bp HGV genomic segment from the putative capsid-envelope region (nucleotide; nt 578-743) from 11 Indian isolates was compared to the sequences available in the nucleotide databases. The isolates from India were 81.3-94.5% homologous to the isolates from other parts of the world. On phylogenetic analysis, it was observed that HGV isolates from India may belong to two genetically divergent types.

One hundred and seventy five subjects with chronic liver diseases which included patients with chronic active hepatitis (90), liver cirrhosis (31) and asymptomatic hepatitis B carriers (54), were included in the study. Hepatitis B virus (HBV) specific DNA-polymerase activity and HBe-markers were tested as markers of HBV-multiplication. In HBsAg positive samples, DNA-P activity was positive in 44.4% of the HBV carriers, 52.9% of the patients with chronic active hepatitis and 81.8% of the patients with liver cirrhosis. The corresponding figures for the presence of HBeAg in these groups were 18.5, 26.5 and 45.5% respectively. Virus multiplication was also observed in 41.1 and 44.4% patients with chronic active hepatitis and liver cirrhosis respectively, in the absence of HBsAg. The results of the present study show that hepatitis B virus is the most important etiological factor of chronic liver diseases in India. Most of our patients of chronic liver diseases seems to have contacted HBV infection as young adults and the mode of transmission is likely to be horizontal rather than vertical. The virus replicating markers correlate well with the severity of the liver injury and decreased with the age. DNA-P activity is a more sensitive marker of viral multiplication than HBeAg. Viral multiplication was also found to occur in the absence of the usual HBV markers. Continued viral multiplication in patients with chronic active hepatitis and liver cirrhosis is implicated in continued liver injury and progressive liver disease.

BACKGROUND/AIMS: Plasma fibronectin is an opsonic glycoprotein, normally synthesized by the liver, which decreases subsequent to severe liver damage and low levels of which may contribute to reticuloendothelial system dysfunction by compromising opsonic activity. This may result in an increased frequency of infection and death. The present study was conducted to evaluate the association of plasma fibronectin activity with infection and mortality in patients with fulminant hepatic failure. METHODS: Plasma fibronectin was estimated serially in 69 consecutive patients with fulminant hepatic failure, nine patients with uncomplicated acute viral hepatitis and 32 normal volunteers. RESULTS: Plasma fibronectin levels in patients with fulminant hepatic failure (85.6 +/- 75.8 micrograms/ml) were significantly lower than in patients with uncomplicated acute viral hepatitis (295.5 +/- 88.5 micrograms/ml) and healthy volunteers (362.6 +/- 69.2 micrograms/ml). Forty-nine (72%) patients with fulminant hepatic failure died. The initial values of fibronectin in fulminant hepatic failure did not correlate with mortality. Patients with fulminant hepatic failure who survived showed a progressive rise in the fibronectin levels compared to the absence of an increase in fibronectin levels in the non-survivors. The mortality in patients with fulminant hepatic failure with infection (24/27) was significantly higher (p < 0.05) compared to those without infection (25/42). Initial fibronectin levels in patients with infection (70.3 +/- 54.2 micrograms/ml) were significantly lower (p < 0.05) than in those without infection (92.3 +/- 64.4 micrograms/ml). We conclude that plasma fibronectin levels in patients with fulminant hepatic failure are decreased compared to healthy subjects and the absence of an increase in levels indicates a poor prognosis. Low levels of fibronectin are associated with an increased incidence of infection, which increases the mortality in these patients.

The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be implicated as the causative agent, and isolated HCV RNA could be detected in 7 (19%). Two hundred eighty eight (66%) patients died. Approximately 75% of those who died did so within 72 hours of hospitalisation. One quarter of the female patients with FHF were pregnant. Mortality among pregnant females, nonpregnant females, and male patients with FHF was similar (P > .1). Univariate analysis showed that age, size of the liver assessed by percussion, grade of coma, presence of clinical features of cerebral edema, presence of infection, serum bilirubin, and prothrombin time prolongation over controls at admission were related to survival (P < .01). The rapidity of onset of encephalopathy and cause of FHF did not influence the outcome. Cox's proportional hazard regression showed age > or = 40 years, presence of cerebral edema, serum bilirubin > or = 15 mg/dL, and prothrombin time prolongation of 25 seconds or more over controls were independent predictors of outcome. Ninety-three percent of the patients with three or more of the above prognostic markers died. The sensitivity, specificity, positive predictive value, and the negative predictive value of the presence of three or more of these prognostic factors for mortality was 93%, 80%, 86%, and 89.5%, respectively, with a diagnostic accuracy of 87.3%. We conclude that most of our patients with FHF might have been caused by hepatotropic viral infection, and non-A, non-B virus(es) seems to be the dominant hepatotropic viral infection among these patients. They presented with encephalopathy within 4 weeks of the onset of symptoms. Pregnancy, cause, and rapidity of onset of encephalopathy did not influence survival. The prognostic model developed in the current study is simple and can be performed at admission.

J Hepatol. 1993 Sep;19(2):291-300.Click here to read Links A prospective randomized double-blind study was conducted to evaluate the efficacy of propranolol in patients with portal hypertension undergoing long-term endoscopic sclerotherapy (EST) for recurrent variceal bleeding. Consecutive patients with portal hypertension (Child's class A or B) due to cirrhosis (n = 72), non-cirrhotic portal fibrosis (n = 29) and extrahepatic portal venous obstruction (n = 13) attending the liver clinic of a tertiary care center were included in the study. All patients had had at least one documented episode of variceal bleed in the previous 4 weeks. Fifty-eight patients received propranolol and 56 received placebo in addition to weekly EST. Rebleeding occurred in 12 (21%) patients in the placebo group and 10 (17%) patients in the propranolol group during a mean follow-up period of 24.4 +/- 10.4 months in the former and 23.8 +/- 9.2 months in the latter group (P > 0.1). The number of episodes of rebleeding (14 in the placebo and 12 in the propranolol group) were also similar (P > 0.1). The median bleeding-free period was more than 40 months in both treatment groups (P > 0.1). The mean transfusion requirements and the number of hospital admissions for rebleeding were also similar in the two treatment groups (P > 0.1). Complete obliteration of varices was achieved in 44 (78.9%) patients in the placebo group and 43 (75.5%) patients in the propranolol group (P > 0.1). Recurrence of new varices was seen in two patients in the placebo and in three of those in the propranolol group. Seven patients in the placebo group and five in the propranolol group died (P > 0.1). Complications related to EST were similar in the two treatment groups but additional adverse effects were observed in the propranolol group. The cumulative incidence of rebleeding in the placebo group was 12.7 and in the propranolol group it was 11.2 per 100 patient years of follow-up. It is concluded that the addition of propranolol in patients with portal hypertension and fair hepatic function on long-term EST does not confer any additional benefit.

The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.

J Hepatol. 1993 Sep;19(2):291-300.Click here to read Links A prospective randomized double-blind study was conducted to evaluate the efficacy of propranolol in patients with portal hypertension undergoing long-term endoscopic sclerotherapy (EST) for recurrent variceal bleeding. Consecutive patients with portal hypertension (Child's class A or B) due to cirrhosis (n = 72), non-cirrhotic portal fibrosis (n = 29) and extrahepatic portal venous obstruction (n = 13) attending the liver clinic of a tertiary care center were included in the study. All patients had had at least one documented episode of variceal bleed in the previous 4 weeks. Fifty-eight patients received propranolol and 56 received placebo in addition to weekly EST. Rebleeding occurred in 12 (21%) patients in the placebo group and 10 (17%) patients in the propranolol group during a mean follow-up period of 24.4 +/- 10.4 months in the former and 23.8 +/- 9.2 months in the latter group (P > 0.1). The number of episodes of rebleeding (14 in the placebo and 12 in the propranolol group) were also similar (P > 0.1). The median bleeding-free period was more than 40 months in both treatment groups (P > 0.1). The mean transfusion requirements and the number of hospital admissions for rebleeding were also similar in the two treatment groups (P > 0.1). Complete obliteration of varices was achieved in 44 (78.9%) patients in the placebo group and 43 (75.5%) patients in the propranolol group (P > 0.1). Recurrence of new varices was seen in two patients in the placebo and in three of those in the propranolol group. Seven patients in the placebo group and five in the propranolol group died (P > 0.1). Complications related to EST were similar in the two treatment groups but additional adverse effects were observed in the propranolol group. The cumulative incidence of rebleeding in the placebo group was 12.7 and in the propranolol group it was 11.2 per 100 patient years of follow-up. It is concluded that the addition of propranolol in patients with portal hypertension and fair hepatic function on long-term EST does not confer any additional benefit.

BACKGROUND/AIMS: Plasma fibronectin is an opsonic glycoprotein, normally synthesized by the liver, which decreases subsequent to severe liver damage and low levels of which may contribute to reticuloendothelial system dysfunction by compromising opsonic activity. This may result in an increased frequency of infection and death. The present study was conducted to evaluate the association of plasma fibronectin activity with infection and mortality in patients with fulminant hepatic failure. METHODS: Plasma fibronectin was estimated serially in 69 consecutive patients with fulminant hepatic failure, nine patients with uncomplicated acute viral hepatitis and 32 normal volunteers. RESULTS: Plasma fibronectin levels in patients with fulminant hepatic failure (85.6 +/- 75.8 micrograms/ml) were significantly lower than in patients with uncomplicated acute viral hepatitis (295.5 +/- 88.5 micrograms/ml) and healthy volunteers (362.6 +/- 69.2 micrograms/ml). Forty-nine (72%) patients with fulminant hepatic failure died. The initial values of fibronectin in fulminant hepatic failure did not correlate with mortality. Patients with fulminant hepatic failure who survived showed a progressive rise in the fibronectin levels compared to the absence of an increase in fibronectin levels in the non-survivors. The mortality in patients with fulminant hepatic failure with infection (24/27) was significantly higher (p < 0.05) compared to those without infection (25/42). Initial fibronectin levels in patients with infection (70.3 +/- 54.2 micrograms/ml) were significantly lower (p < 0.05) than in those without infection (92.3 +/- 64.4 micrograms/ml). We conclude that plasma fibronectin levels in patients with fulminant hepatic failure are decreased compared to healthy subjects and the absence of an increase in levels indicates a poor prognosis. Low levels of fibronectin are associated with an increased incidence of infection, which increases the mortality in these patients.

Hepatitis C virus (HCV) ribonucleic acid (RNA) was tested for in a group of 16 defined non-B chronic hepatitis patients using specific reverse transcription polymerase chain reaction (RT-PCR). These were chosen from amongst 56 biopsy proven cases of chronic hepatitis of which majority (40) were positive for hepatitis B virus infection. Hepatitis C virus RNA could be demonstrated in 12 (75%) of remaining 16 cases. These include all seven patients positive for antibody to HCV. Two of these patients had past history of blood transfusion and in another two the clinical course started with severe acute liver disease. This study establishes the association of HCV with severe liver disease. The clinical and biochemical profiles are also discussed. In view of limited sensitivity of the antibody assays it is justified to develop diagnostic testes based on local strains.

Hepatitis C virus (HCV) ribonucleic acid (RNA) was tested for in a group of 16 defined non-B chronic hepatitis patients using specific reverse transcription polymerase chain reaction (RT-PCR). These were chosen from amongst 56 biopsy proven cases of chronic hepatitis of which majority (40) were positive for hepatitis B virus infection. Hepatitis C virus RNA could be demonstrated in 12 (75%) of remaining 16 cases. These include all seven patients positive for antibody to HCV. Two of these patients had past history of blood transfusion and in another two the clinical course started with severe acute liver disease. This study establishes the association of HCV with severe liver disease. The clinical and biochemical profiles are also discussed. In view of limited sensitivity of the antibody assays it is justified to develop diagnostic testes based on local strains.

The present study describes the frequency of hepatitis viral markers in patients with uncomplicated acute viral hepatitis (AVH; n = 32) and in patients with severe liver diseases, including those with fulminant hepatic failure (FHF; n = 110), subacute hepatic failure (SAHF; n = 65), and chronic active hepatitis (CAH; n = 33). The results indicate that hepatitis A virus infection is quite rare, whereas hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the predominant causes of acute and chronic liver failure in India. The incidence of HBV infection in AVH, FHF, SAHF, and CAH groups was recorded in 3.7, 19.1, 23.1, and 69.7% of the cases, respectively. Similarly, HCV infection in these four groups was noted in 12.5, 45, 44.6, and 48.5% of the cases, respectively. Further analysis of HCV infection demonstrated that it was as frequent as single infection in acute cases, but more commonly found in association with HBV infection in chronic liver failure cases. Hepatitis D virus (HDV) infection, as indicated by the presence of IgM anti-HDV antibodies, was recorded in 7.3% of the cases with AVH, in 7.3% of the cases with FHF, in 9.2% of the cases with SAHF, and in 6.1% of the cases with CAH. HDV was associated with HBV both as superinfection as well as coinfection. Interestingly, nearly 2-6% of the cases in each group showed the presence of simultaneous HBV, HCV, and HDV infection. 83.3% of the AVH, 42.1% of the FHF, 37.0% of the SAHF, and 15.1% of the CAH patients had unknown viral markers.(ABSTRACT TRUNCATED AT 250 WORDS)

PCR was used to demonstrate the presence of a conserved region and to clone novel members of the cytochrome P-450 4A gene family from guinea pig, human and mouse cDNAs. This strategy is based on the sequences at nucleotides 925-959 and at the haem binding domain (nucleotides 1381-1410) of the rat CYP4A1 gene. Murine Cyp4a clones showed high sequence identity with members of the rat gene family, but CYP4A clones from human and guinea pig were equally similar to the rat/mouse genes, suggesting that the rat/mouse line had undergone gene duplication events after divergence from human and guinea-pig lines. The mouse Cyp4a-12 clone was localized to chromosome 4 using interspecific backcross mapping, in a region of synteny with human chromosome 1. The assignment of the human CYP4A11 gene to chromosome 1 was confirmed by somatic cell hybridization. An RNAase protection assay was shown to discriminate between the murine Cyp4a-10 and Cyp4a-12 cDNAs. Treatment of mice with the potent peroxisome proliferator methylclofenapate (25 mg/kg) induced Cyp4a-10 RNA in liver, and to a lesser extent in kidney; there was no sex difference in this response. Cyp4a-12 RNA was present at high levels in male control liver and kidney samples, and was not induced by treatment with methylclofenapate. However, Cyp4a-12 RNA was present at low levels in control female liver and kidney RNA, and was greatly induced in both organs by methylclofenapate. Guinea pigs were exposed to methylclofenapate (50 mg/kg), but there was no significant induction of the guinea-pig CYP4A13 RNA. These findings are consistent with a species difference in response to peroxisome proliferators between the rat/mouse and the guinea pig.

A simple and sensitive ELISA was developed to characterize the interaction between polymerised human serum albumin (pHSA) and HBsAg, using pHSA-coated polyvinylmicrotitre plates as solid phase and anti-HBs-coupled HRPO as the conjugate. The interaction was found to be specific and dependent on the size of albumin polymer. pHSA-binding activity (pHSA-BA) was studied in both HBsAg-negative and HBsAg-positive sera from various liver diseases including acute viral hepatitis, fulminant hepatitis, cirrhosis of liver, chronic active hepatitis, and healthy HBsAg carriers. pHSA-BA was detected only in HBsAg-positive sera. Analysis of HBsAg-positive sera indicated pHSA-BA in high proportions of patients sera as compared to sera from healthy HBsAg carriers. pHSA-BA was detected both in the presence and absence of HBe markers, though the mean BA was relatively high in presence of HBeAg. The effect of human serum immunoglobulins (IgG, IgA, and IgM) on the BA was investigated and a correlation between pHSA-BA and HBsAg-IgM complex positivity in sera was established. Finally, the probable role of human serum IgM in facilitating the binding process was discussed.

Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.

BACKGROUND. In developed countries as well as in Southeast Asia, the hepatitis B and C viruses are the main causes of chronic hepatitis. In India, however, there have been no major investigations on the aetiology of chronic hepatitis. (The hepatitis E virus which is responsible for half the sporadic and most of the epidemic cases of acute viral hepatitis in India does not cause chronic disease.) We, therefore, studied the profile of chronic hepatitis in India. METHODS. The clinical presentation, aetiology, serology and histological changes were studied prospectively in 48 patients with chronic hepatitis admitted to the All India Institute of Medical Sciences, New Delhi. Of these, 44 (92%) had chronic active hepatitis, 3 (6.3%) had chronic persistent hepatitis and 1 (2%) had chronic lobular hepatitis. RESULTS. The hepatitis B virus was the aetiological agent in 24 (50%) of these patients, the hepatitis D virus in association with hepatitis B virus in 10 (21%), the hepatitis C virus in 7 (15%) and the non-A, non-B viruses other than the hepatitis C virus in 6 (13%). One patient (2.0%) had autoimmune chronic active hepatitis. Jaundice at presentation was seen in 33 (69%) patients and more than half had hypoalbuminaemia (< 3 g/dl) with a prolonged prothrombin time. Alanine aminotransferase levels were less than 5 times above normal in over two-thirds of the patients. The highest alanine aminotransferase values were observed in patients with hepatitis D virus infection whereas the lowest were seen in patients with non-A, non-B related chronic active hepatitis. Histological examination revealed bridging necrosis in 40 (91%) patients with chronic active hepatitis indicating a severe form of disease. Replication of the hepatitis B virus was seen in 13 patients with chronic hepatitis, 5 of whom had hepatitis D virus-induced chronic hepatitis. Patients with hepatitis B virus replication had higher alanine aminotransferase values and more severe bridging necrosis than patients who did not have replicating viruses. Higher alanine aminotransferase values, ascites and oesophageal varices were encountered more frequently in patients with hepatitis B and D virus than in those with non-A, non-B related chronic hepatitis. CONCLUSION. Chronic hepatitis is not uncommon in India. It presents with evidence of severe disease and, as elsewhere, is most frequently caused by the hepatitis B virus.

Acute hepatic failure (AHF) in India almost always presents with encephalopathy within 4 weeks of the onset of acute hepatitis. Further subclassification of AHF into hyperacute, acute and subacute forms may not be necessary in this geographical area, where the rapidity of onset of encephalopathy does not seem to influence survival. Viral hepatitis is the cause in approximately 95-100% of patients, who therefore constitute a more homogeneous population than AHF patients in the West. In India, hepatitis E (HEV) and hepatitis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants are very important agents in cases where hepatitis B results in AHF in this country. Half of the patients with AHF admitted to our centre are female, one-quarter of whom are pregnant. Therefore, pregnant females who contract viral hepatitis constitute a high-risk group for the development of AHF. However, the outcome of AHF in this group is similar to that in non-pregnant women and men. No association with any particular virus has been identified among sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggressive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complications. Both fungal and gram-negative bacteria are major causes of sepsis. Among patients with AHF, despite the presence of sepsis, its overt clinical features (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identify patients suitable for liver transplantation.

HEV, a positive stranded RNA virus, is responsible for most of the epidemics of hepatitis in the developing world and is transmitted through contaminated water. It is the major aetiological agent for acute hepatitis and acute liver failure in endemic regions. It causes severe liver disease among pregnant females and patients with chronic liver disease. Serodiagnosis of HEV is now available and should be used routinely for diagnosis. The available evidence suggests that HEV may also be transmitted parenterally as well as vertically particularly in endemic areas. Experimental studies suggest that an HEV vaccine is a distinct possibility in the near future. In the absence of an effective vaccine, public health measures such as clean water supply, improved sanitation and public education are the major tools to prevent HEV epidemics in developing nations.

Six patients with PSC have been diagnosed and followed up at a centre in Northern India for periods up to 4 years. They all presented with cholestatic jaundice and cholangitis, but one of them subsequently presented with variceal haemorrhage. Cholangiographic features were the most characteristic and included irregular narrowing and segmental dilatation of the biliary radicles giving them a beaded appearance. Treating them was most frustrating. Two of them died of hepatic encephalopathy, others have also continued to be sick during the follow-up.

BACKGROUND: Preliminary reports indicate that hepatitis D virus (HDV) infection exists in India. However, its prevalence in patients with different types of liver diseases has not been studied in detail. The aim of this study was to evaluate the status of HDV infection in severe types of liver disease in India. METHODS: Using commercial kits for various hepatitis viral markers, the present study was undertaken to determine the serological status of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers in 208 patients with severe liver diseases. This total included 110 cases with fulminant hepatic failure (FHF), 65 cases with subacute hepatic failure (SHF) and 33 cases with chronic active hepatitis (CAH). RESULTS: The hepatitis B surface antigen (HBsAg) carrier population, indicated by the presence of HBsAg without IgM anti-HBc (hepatitis B core) in serum, was recorded in 23.6%, 24.6% and 60.6% cases of FHF, SHF and CAH groups, respectively. HBV infection, as indicated by serum positivity of IgM anti-HBc in the FHF and SHF groups and HBsAg and/or IgM anti-HBc in the CAH group, was detected in 19.1%, 23.1% and 69.7% of cases from these three groups, respectively. IgM anti-HDV, demonstrating active/recent HDV infection, was found in 8.1% cases of FHF and 9.2% cases of SHF patients. HDV as a superinfection in HBsAg carriers was noted in 4.5% and 4.6% cases, respectively of FHF and SHF groups. Similarly, HDV-HBV coinfection, diagnosed by simultaneous presence of IgM anti-HBc and IgM anti-HDV in the FHF and SHF groups, was recorded in 3.6% and 4.6% of cases from these two groups, respectively. In the CAH group, HDV infection was observed in 9.2% cases. CONCLUSION: HDV infection, recorded in less than 10% of patients with different liver diseases in India, seems to be an unimportant factor in inducing severe liver diseases in this country.

BACKGROUND: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used.

Viral hepatitis is a major public health problem in India, which is hyperendemic for HAV and HEV. Seroprevalence studies reveal that 90%-100% of the population acquires anti-HAV antibody and becomes immune by adolescence. Many epidemics of HEV have been reported from India. HAV related liver disease is uncommon in India and occurs mainly in children. HEV is also the major cause of sporadic adult acute viral hepatitis and ALF. Pregnant women and patients with CLD constitute the high risk groups to contract HEV infection, and HEV-induced mortality among them is substantial, which underlines the need for preventive measures for such groups. Children with HAV and HEV coinfection are prone to develop ALF. India has intermediate HBV endemicity, with a carrier frequency of 2%-4%. HBV is the major cause of CLD and HCC. Chronic HBV infection in India is acquired in childhood, presumably before 5 years of age, through horizontal transmission. Vertical transmission of HBV in India is considered to be infrequent. Inclusion of HBV vaccination in the expanded programme of immunization is essential to reduce the HBV carrier frequency and disease burden. HBV genotypes A and D are prevalent in India, which are similar to the HBV genotypes in the West. HCV infection in India has a population prevalence of around 1%, and occurs predominantly through transfusion and the use of unsterile glass syringes. HCV genotypes 3 and 2 are prevalent in 60%-80% of the population and they respond well to a combination of interferon and ribavirin. About 10%-15% of CLD and HCC are associated with HCV infection in India. HCV infection is also a major cause of post-transfusion hepatitis. HDV infection is infrequent in India and is present about 5%-10% of patients with HBV-related liver disease. HCC appears to be less common in India than would be expected from the prevalence rates of HBV and HCV. The high disease burden of viral hepatitis and related CLD in India, calls for the setting up of a hepatitis registry and formulation of government-supported prevention and control strategies.

Acute hepatic failure (AHF) in India almost always presents with encephalopathy within 4 weeks of the onset of acute hepatitis. Further subclassification of AHF into hyperacute, acute and subacute forms may not be necessary in this geographical area, where the rapidity of onset of encephalopathy does not seem to influence survival. Viral hepatitis is the cause in approximately 95-100% of patients, who therefore constitute a more homogeneous population than AHF patients in the West. In India, hepatitis E (HEV) and hepatitis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants are very important agents in cases where hepatitis B results in AHF in this country. Half of the patients with AHF admitted to our centre are female, one-quarter of whom are pregnant. Therefore, pregnant females who contract viral hepatitis constitute a high-risk group for the development of AHF. However, the outcome of AHF in this group is similar to that in non-pregnant women and men. No association with any particular virus has been identified among sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggressive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complications. Both fungal and gram-negative bacteria are major causes of sepsis. Among patients with AHF, despite the presence of sepsis, its overt clinical features (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identify patients suitable for liver transplantation.

Chronic Calcific Pancreatitis of Tropics is a disease of unknown aetiology and is characterised by chronic pancreatitis with calcification in young persons who present with pain, diabetes, and/or steatorrhoea. ERCP performed on 42 patients with this condition revealed changes compatible with chronic pancreatitis. These changes were however, more marked and somewhat different from those seen in the alcoholic chronic pancreatitis. Cystic dilatation, tortuosity, and obstruction of the main pancreatic duct were similar to that in alcoholic pancreatitis. The features of CCPT that were different from those of latter, were large pancreatic calculi, absence of strictures/stenosis and absence of irregularity of the ductal wall. The calculi were predominantly in the head region of the pancreas causing maximal dilatation of the main pancreatic duct in the head of pancreas. The secondary branches were stunted, short and scanty but revealed a lower grade of changes, than the changes documented in the main pancreatic duct. The pancreatic ductal changes in CCPT seems to be different from that seen in chronic alcoholic pancreatitis and may be due to the difference in the pathophysiology of the underlying disease.

Fifty consecutive patients with surgical obstructive jaundice were evaluated prospectively with ultrasonography (US), computed tomographic scans (CT scan) and cholangiography-percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangio-pancreaticography (ERCP). The diagnostic accuracy of ultrasound in defining the level of obstruction was 86% as compared to 86% and 94.8% for CT scan and cholangiography, respectively. To measure the etiology of the obstruction, the accuracy of ultrasound, CT scan and cholangiography were 84%, 86% and 75%, respectively. The sensitivity of CT scans and cholangiography in the diagnosis of choledocholithiasis was 100%, 81.8% and 90%, respectively, whereas specificity was 97%, 100% and 100%, respectively. Sensitivity for a diagnosis of malignant disease was 100% for both US and CT scans whereas specificity was 90% and 81%, respectively. Ultrasonography as a single radiological investigation is sufficient in the evaluation of the majority of patients with surgical obstructive jaundice. CT scan and cholangiography should be done only when US gives equivocal findings or if concomitant therapeutic procedures like basketing and stenting are also planned.

Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.

AIM: Passive immunotherapy using antibody against hepatitis B surface antigen (HBsAg) has been advocated in certain cases of Hepatitis B infection. We had earlier reported on the cloning and expression of a high affinity scFv derived from a mouse monoclonal (5S) against HBsAg. However this mouse antibody cannot be used for therapeutic purposes as it may elicit anti-mouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: We cloned the V(H) and V(L) genes of this mouse antibody, and fused them with CH1 domain of human IgG1 and C(L) domain of human kappa chain respectively. These chimeric genes were cloned into a phagemid vector. After initial screening using the phage display system, the chimeric Fab was expressed in soluble form in E. coli. RESULTS: The chimeric Fab was purified from the bacterial periplasmic extract. We characterized the chimeric Fab using several in vitro techniques and it was observed that the chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. This chimeric antibody fragment was further expressed in different strains of E. coli to increase the yield. CONCLUSION: We have generated a mouse-human chimeric Fab against HBsAg without any significant loss in binding and epitope specificity. This chimeric Fab fragment can be further modified to generate a full-length chimeric antibody for therapeutic uses.

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In terms of production, rice is the fourth most important cereal (after sorghum, maize and millet) in sub-Saharan Africa (SSA). It occupies 10 percent of the total land under cereal production and accounts for 15 percent of total cereal production (FAOSTAT, 2006). Approximately 20 million farmers in SSA grow rice and about 100 million people depend on it for their livelihoods (Nwanze et al., 2006). Rice is the staple food of a growing number of people in SSA: from 1961 to 2003 consumption increased at a rate of 4.4 percent per year (Kormawa, Keya and Touré, 2004). Among the major cereals cultivated, rice is the most rapidly growing food source in Africa: between 1985 and 2003, the annual increase in rice production was 4 percent, while production growth for maize and sorghum was only about 2.4 and 2.5 percent, respectively (Kormawa, Keya and Touré, 2004). The most widely grown rice species, Oryza sativa, is originally from Asia and was introduced into Africa only about 450 years ago. Another less well-known rice species, O. glaberrima (Steud), is originally from Africa and was domesticated in the Niger River Delta over 3 500 years ago (Viguier, 1939; Carpenter, 1978). As a result of their evolution, domestication and breeding history, both species have distinct and complementary advantages and disadvantages for use in African farming systems. The Asian rice (O. sativa) is characterized by good yields, absence of lodging and grain shattering, and high fertilizer returns – unlike its African counterpart (O. glaberrima). However, in contrast to Asian rice types, landraces of O. glaberrima often have good weed competitiveness and resilience against major African biotic and abiotic stresses (Koffi, 1980; Jones et al., 1997a). Dalton and Guei (2003) concluded that research into genetic enhancement of rice generated approximately US$360 million in 1998, compared with a total investment of just US$5.6 million. This is evidence that rice variety improvement has a potentially enormous impact on the economic development of SSA. Numerous conventional breeding efforts have been made to improve the performance of upland rice (O. sativa) for use in African farming systems. These efforts have had only limited success, partly because the Asian rice, O. sativa, lacks resistance or tolerance to many of the typical African stresses (Jones et al., 1997a).

Extracts of dormant microcysts of Polysphondylium pallidum demonstrate pH optima for the hydrolysis of casein at 3.5 and 6.0. During germination the intracellular pH 6.0 caseinolytic specific activity does not change significantly. The pH 6.0 protease is also active on azo-albumin, revealing the same developmental pattern with this substrate. Both acid protease activities are excreted during the germination process. Addition of purified nonspecific protease to cultures speeds up germination, suggesting that the excreted protease may play a role in removal of the microcyst wall. When cycloheximide is added to cultures, complete germination (emergence) is stopped whereas the pH 6.0 protease activity still accumulates to between 50 and 60% of the maximum control activity. Although this suggests that post-translational controls might mediate the accumulation of a portion of the pH 6.0 protease increase, mixing and dilution experiments with cell extracts do not reveal the differential presence of soluble activators or inhibitors of this activity at different developmental stages. The presence of tightly bound enzyme-inhibitor complexes for protease B in dormant microcysts has not been ruled out and is currently under study.

The interactions of ,{1 3+ -montmorillonite, Na+ - montmorillonite and Na+ -kaolinite with selected Hammett indicators have been reinvestigated. The use of a series of indicators with different acid strengths, Ho, to determine the activity of protons on the clay surface was basid on the assumption that the activity of H+ on the clay surface is equivalent to activity in solution. The results show that A13+- montmorillonite had the hiehest acid strength, especially after drying at 1lfc. Na+-kaolinite had Ih" lo*r"rt acid strength, at two moisture levels: befirre washing with ethanol and u{"l g1lporation of this alcohol. At all moisture levels the acid strength of A1'* -montmorillonite was greater than that of either Nai - montmorillonite or Na+ - kaolinite.

It has been established that H+ secretion can be maintained in frog stomach in the absence of exogenous CO2 by using a nutrient bathing fluid containing 25 mM H2PO4 (pH approximately equal to 4.5) or by lowering the pH of a nonbuffered nutrient solution to about 3.0-3.6. Exogenous CO2 in the presence of these nutrient solutions uniformly caused a marked decrease in H+ secretion, PD, adn short-circuit current (Isc) and an increase in transmucosal resistance (R). Elevation of nutrient [k+] to 83 mM reduced R significantly but transiently without change in H+ when nutrient pH less than 5.0, whereas R returned to base line and H+ increased when nutrient pH greater than 5.0. Acidification of the nutrient medium in the presence of exogenous CO2 results in inhibition of the secretory pump, probably by decreasing intracellular pH, and also interferes with conductance at the nutrient membrane. Removal of exogenous CO2 from standard bicarbonate nutrient solution reduced by 50% the H+, PD, and Isc without change in R; K+-free nutrient solutions reverse these changes in Isc and PD but not in H+. The dropping PD and rising R induced by K+-free nutrient solutions in 5% CO2 - 95% O2 are returned toward normal by 100% O2. Our findings support an important role for exogenous CO2 in maintaining normal acid-base balance in frog mucosa by acting as an acidifying agent.

OBJECTIVE: To review the normal human acid-base physiology and the pathophysiology and management of acid-base disturbances in a two-part presentation. DATA SOURCES: Articles and published peer-review abstracts and a review of studies reported from 1990 to 2000 and identified through a MEDLINE search of the English language literature on acid-base balance. SUMMARY OF REVIEW: Acid-base disorders are usually classified as metabolic (non-respiratory) or respiratory, depending on whether the primary change occurs in the plasma bicarbonate or the carbonic acid (i.e. carbon dioxide) concentrations, respectively. Respiratory or renal compensatory changes usually occur to minimise the effect of the primary disturbance. A metabolic acidosis arises from an abnormal process that generates non-carbonic acid or an abnormal loss of HCO3- and may be identified by an increase or normal anion gap, respectively. The arterial blood gas usually reveals a pH {\textless} 7.36, PCO2 {\textless} 35 mmHg and 'calculated' HCO3- {\textless} 18 mmol/L. In general, a high anion gap acidosis is managed by treating the disorder generating the acid (thereby ceasing the acid production) and enhancing the clearance of the acid anion (e.g. by metabolism or excretion) thereby regenerating the HCO3- reduced by buffering. A metabolic alkalosis arises from an abnormal process generating excess HCO3-. The arterial blood gas usually reveals a pH {\textgreater} 7.44, PCO2 {\textgreater} 45 mmHg and 'calculated' HCO3- {\textgreater} 32 mmol/L. As the kidney has a large capacity to excrete HCO3-, management usually requires treatment of the processes that are generating as well maintaining the alkalosis. Respiratory acidosis and alkalosis are usually caused by a primary disorder of carbon-dioxide excretion, and correction of the pH disorder only occurs with correction of the primary disease process. CONCLUSIONS: In man, acid-base disturbances are usually classified as either metabolic or respiratory. Correction of the underlying disorder is often all that is required to allow the body to metabolise or excrete the acid or alkali and return the buffer pair (HCO3- and PCO2) to normal.

OBJECTIVE: To review the normal human acid-base physiology and the pathophysiology and management of acid-base disturbances in a two-part presentation. DATA SOURCES: Articles and published peer-review abstracts and a review of studies reported from 1990 to 2000 and identified through a MEDLINE search of the English language literature on acid-base balance. SUMMARY OF REVIEW: Acid-base disorders are usually classified as metabolic (non-respiratory) or respiratory, depending on whether the primary change occurs in the plasma bicarbonate or the carbonic acid (i.e. carbon dioxide) concentrations, respectively. Respiratory or renal compensatory changes usually occur to minimise the effect of the primary disturbance. A metabolic acidosis arises from an abnormal process that generates non-carbonic acid or an abnormal loss of HCO3- and may be identified by an increase or normal anion gap, respectively. The arterial blood gas usually reveals a pH {\textless} 7.36, PCO2 {\textless} 35 mmHg and 'calculated' HCO3- {\textless} 18 mmol/L. In general, a high anion gap acidosis is managed by treating the disorder generating the acid (thereby ceasing the acid production) and enhancing the clearance of the acid anion (e.g. by metabolism or excretion) thereby regenerating the HCO3- reduced by buffering. A metabolic alkalosis arises from an abnormal process generating excess HCO3-. The arterial blood gas usually reveals a pH {\textgreater} 7.44, PCO2 {\textgreater} 45 mmHg and 'calculated' HCO3- {\textgreater} 32 mmol/L. As the kidney has a large capacity to excrete HCO3-, management usually requires treatment of the processes that are generating as well maintaining the alkalosis. Respiratory acidosis and alkalosis are usually caused by a primary disorder of carbon-dioxide excretion, and correction of the pH disorder only occurs with correction of the primary disease process. CONCLUSIONS: In man, acid-base disturbances are usually classified as either metabolic or respiratory. Correction of the underlying disorder is often all that is required to allow the body to metabolise or excrete the acid or alkali and return the buffer pair (HCO3- and PCO2) to normal.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.