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Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

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Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

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

This integrative review on the teaching of reading in Kenyan primary schools provides a foundation for the growing movement there to improve reading education. In gathering sources for this review, we took an inclusive historical stance. Thus, we did not dismiss research reports that lacked traditional indicators of quality such as being published in peer-reviewed journals. We used multiple methods to find relevant research and associated documents, including two trips to Kenya. The review is organized by six topics: (a) language of instruction, (b) reading instruction, (c) reading materials, (d) reading culture, (e) assessment, and (f) teacher development. The review concludes with six proposals for policymakers, educational researchers, and teacher educators for the development of reading instruction based on what we learned in reviewing the literature. The first proposals are intended specifically to address the teaching of reading in Kenya, but they may be relevant to other sub-Saharan nations. The final proposal encourages others to conduct similar reviews to make possible a handbook of reading in Africa.

Mice infected with Trypanosoma congolense developed a severe anaemia 1 week after infection, which persisted till treatment with diminazine aceturate when the packed cell volume (PCV) recovered to pre-infection levels. This was accompanied by a marked increase in the plasma levels of the acute phase proteins (APP), serum amyloid P-component (SAP) and haptoglobin (Hp). The initial peak levels of Hp and SAP were attained 7 and 12 days post-infection (DPI), respectively. Thereafter SAP levels decreased significantly to near pre-infection levels, but later increased even after treatment to give a second peak 34 DPI after which there was a decline till the study was terminated. The Hp levels on the other hand decreased to an intermediate level after the initial peak increasing to a second peak 22 DPI. Thereafter Hp decreased significantly following diminazine aceturate treatment to reach pre-infection levels within 5 days post-treatment. This indicates that T. congolense-infected mice develop severe anaemia accompanied by an acute phase response leading to an increase in SAP and Hp but that following treatment divergent responses occurred indicating differences in the pathways for stimulation of the APP. Haptoglobin was shown to be an earlier indicator of infection and a better marker in monitoring the response to treatment.

Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

A survey of antibiotic sale behaviour in retail chemist shops in Nairobi revealed that about 64% of chemists sell antibiotics without prescriptions from doctors. Most shops sold underdose drugs according to the request of the patient. The practice is more common in peri-urban than city centre chemists. Out of the 128 chemist shops visited, 82 sold the antibiotic, 33 sent the patients to go and see the doctors while 13 did both. Sixty eight per cent of the chemists in the city centre recommended the taking of full antibiotic course to the patients while only 46% in peri-urban centres did so. Even after the recommendation, some of the chemists still sold under dose drugs. Some of the drugs were sold in envelopes without any instruction at all and none of the drugs sold were fully labelled. Only seven chemists sold septrin, the brand of co-trimoxazole requested by the patients, the rest sold various brands of the drug some of whom still labelled the brands 'septrin'.

Heavily glazed office buildings in the Kenyan Capital City Nairobi, common in recent times does not augur well for a micro and macro architectural environment. This has a consequent negative impact on energy use in office spaces. By use of computer simulations, traditional tools and literature review glazing use in office fenestration is analysed and its implications for architectural design investigated. The results indicate a direct relationship between the variable parameters of glazing type and size, glazed opening orientation, shading devices and control of energy loads within the office spaces and the objective of human comfort in the office spaces. In conclusion it is recommended that optimum levels of glazing size and type as well as suitable glazing orientations for architectural use in office buildings in Nairobi.

A study that devised a modified method of reporting antibiotic sensitivity results was undertaken. Enterobacteriaceae and Gram positive cocci were tested for drug sensitivity by a disc diffusion method. Zones of bacterial growth inhibition were measured, dividing the isolates into four groups: the highly sensitive, the moderately sensitive, the slightly sensitive and the resistant ones. The slightly sensitive isolates were taken as indicators of antibiotic resistance acquisition. By that system, when more than 50% of the isolates fell into the slightly and resistant groups, that meant that the antibiotic concerned would be discontinued for some time until the bacteria reverted to being moderately sensitive. The study also provided a method of making antibiotic discs from local blotting papers, and a sample of a form on which antibiotic sensitivity results could be recorded was presented. The method is considered to be easy and very appropriate for developing countries in detecting gradual and abrupt acquisition of antibiotic resistance by bacteria.

   

This article reveals that the concept of education as a process of growth is a difficult one. Philosophers are, therefore, justified in being weary when pondering over its meaning, both in theory and practice. By way of conclusion, the article appreciates the complexities inherent in the growth theory of education, summarizing its major strength and weaknesses. Then it cautions educational planners and practitioners to be weary when, and if, they translate the theory into practice, so that they utilize the strengths inherent in the theory whilst paying attention to the dangers of its inherent weaknesses.

A study that devised a modified method of reporting antibiotic sensitivity results was undertaken. Enterobacteriaceae and Gram positive cocci were tested for drug sensitivity by a disc diffusion method. Zones of bacterial growth inhibition were measured, dividing the isolates into four groups: the highly sensitive, the moderately sensitive, the slightly sensitive and the resistant ones. The slightly sensitive isolates were taken as indicators of antibiotic resistance acquisition. By that system, when more than 50% of the isolates fell into the slightly and resistant groups, that meant that the antibiotic concerned would be discontinued for some time until the bacteria reverted to being moderately sensitive. The study also provided a method of making antibiotic discs from local blotting papers, and a sample of a form on which antibiotic sensitivity results could be recorded was presented. The method is considered to be easy and very appropriate for developing countries in detecting gradual and abrupt acquisition of antibiotic resistance by bacteria.

This article reveals that the concept of education as a process of growth is a difficult one. Philosophers are, therefore, justified in being weary when pondering over its meaning, both in theory and practice. By way of conclusion, the article appreciates the complexities inherent in the growth theory of education, summarizing its major strength and weaknesses. Then it cautions educational planners and practitioners to be weary when, and if, they translate the theory into practice, so that they utilize the strengths inherent in the theory whilst paying attention to the dangers of its inherent weaknesses.

A study that devised a modified method of reporting antibiotic sensitivity results was undertaken. Enterobacteriaceae and Gram positive cocci were tested for drug sensitivity by a disc diffusion method. Zones of bacterial growth inhibition were measured, dividing the isolates into four groups: the highly sensitive, the moderately sensitive, the slightly sensitive and the resistant ones. The slightly sensitive isolates were taken as indicators of antibiotic resistance acquisition. By that system, when more than 50% of the isolates fell into the slightly and resistant groups, that meant that the antibiotic concerned would be discontinued for some time until the bacteria reverted to being moderately sensitive. The study also provided a method of making antibiotic discs from local blotting papers, and a sample of a form on which antibiotic sensitivity results could be recorded was presented. The method is considered to be easy and very appropriate for developing countries in detecting gradual and abrupt acquisition of antibiotic resistance by bacteria.

A clinical, radiological, histological, and geographical study of carcinoma of the esophagus in Kenya is reported. It was found that this cancer is diagnosed more often in males than in females, with a ration of 8:1 (Kenya Cancer Registry). The most common age in males and females is 50 to 59 years. The regions of the esophagus most commonly involved are the middle and lower thirds, in almost equal proportions. An unexplained tendency for the tumor to be poorly differentiated towards the lower third is noted. In addition a review on the possible etiological factors is presented.

This article reveals that the concept of education as a process of growth is a difficult one. Philosophers are, therefore, justified in being weary when pondering over its meaning, both in theory and practice. By way of conclusion, the article appreciates the complexities inherent in the growth theory of education, summarizing its major strength and weaknesses. Then it cautions educational planners and practitioners to be weary when, and if, they translate the theory into practice, so that they utilize the strengths inherent in the theory whilst paying attention to the dangers of its inherent weaknesses.

BACKGROUND:

Active management of the third stage of labour reduces the risk of post-partum haemorrhage. We aimed to assess whether controlled cord traction can be omitted from active management of this stage without increasing the risk of severe haemorrhage.

METHODS:

We did a multicentre, non-inferiority, randomised controlled trial in 16 hospitals and two primary health-care centres in Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. Women expecting to deliver singleton babies vaginally (ie, not planned caesarean section) were randomly assigned (in a 1:1 ratio) with a centrally generated allocation sequence, stratified by country, to placental delivery with gravity and maternal effort (simplified package) or controlled cord traction applied immediately after uterine contraction and cord clamping (full package). After randomisation, allocation could not be concealed from investigators, participants, or assessors. Oxytocin 10 IU was administered immediately after birth with cord clamping after 1-3 min. Uterine massage was done after placental delivery according to local policy. The primary (non-inferiority) outcome was blood loss of 1000 mL or more (severe haemorrhage). The non-inferiority margin for the risk ratio was 1·3. Analysis was by modified intention-to-treat, excluding women who had emergency caesarean sections. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN 12608000434392.

FINDINGS:

Between June 1, 2009, and Oct 30, 2010, 12,227 women were randomly assigned to the simplified package group and 12,163 to the full package group. After exclusion of women who had emergency caesarean sections, 11,861 were in the simplified package group and 11,820 were in the full package group. The primary outcome of blood loss of 1000 mL or more had a risk ratio of 1·09 (95% CI 0·91-1·31) and the upper 95% CI limit crossed the pre-stated non-inferiority margin. One case of uterine inversion occurred in the full package group. Other adverse events were haemorrhage-related.

INTERPRETATION:

Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Scaling up of haemorrhage prevention programmes for non-hospital settings can safely focus on use of oxytocin.

FUNDING:
United States Agency for International Development and UN Development Programme/UN Population Fund/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research

A sample of 166 normal adult males and females was taken from different colleges of Assiut representing those living in upper Egypt. Each subject has been studied for measurements of stature (S), hand length (HL) and hand breadth (HB). The data were statistically analysed in order to assess the relationship between stature and hand measurements. The correlation matrix of the study indicates close similarity of the relationship between stature and hand measurements in both sexes and in both sides. A generalized multiple regression equation has been designed to estimate stature from values of hand length and hand breadth regardless of sex or side in the form: S = 34.5 + 5.77 HL + 2.7 HB +/- 5.1. This equation may be helpful to obtain approximate stature when there is difficulty in obtaining a direct measurement or where there is a chance print of a criminal or an amputated hand or arm.

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A sample of 166 normal adult males and females was taken from different colleges of Assiut representing those living in upper Egypt. Each subject has been studied for measurements of stature (S), hand length (HL) and hand breadth (HB). The data were statistically analysed in order to assess the relationship between stature and hand measurements. The correlation matrix of the study indicates close similarity of the relationship between stature and hand measurements in both sexes and in both sides. A generalized multiple regression equation has been designed to estimate stature from values of hand length and hand breadth regardless of sex or side in the form: S = 34.5 + 5.77 HL + 2.7 HB +/- 5.1. This equation may be helpful to obtain approximate stature when there is difficulty in obtaining a direct measurement or where there is a chance print of a criminal or an amputated hand or arm.

A sample of 166 normal adult males and females was taken from different colleges of Assiut representing those living in upper Egypt. Each subject has been studied for measurements of stature (S), hand length (HL) and hand breadth (HB). The data were statistically analysed in order to assess the relationship between stature and hand measurements. The correlation matrix of the study indicates close similarity of the relationship between stature and hand measurements in both sexes and in both sides. A generalized multiple regression equation has been designed to estimate stature from values of hand length and hand breadth regardless of sex or side in the form: S = 34.5 + 5.77 HL + 2.7 HB +/- 5.1. This equation may be helpful to obtain approximate stature when there is difficulty in obtaining a direct measurement or where there is a chance print of a criminal or an amputated hand or arm.

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Drug residues in foods are a major public health concern in many countries, especially where most food sales bypass official quality assurance channels. In common with many tropical countries, sales of unpasteurized milk in Kenya account for over 85% of marketed milk. This milk is either sold directly from producers to consumers or via various cadres of informal market agents. Besides residues that may arise from lack of adherence to withdrawal times following cow therapy, there have been concerns that some antimicrobial agents may be added to informally marketed milk to extend its shelf life. As part of a large study to assess public health hazards associated with marketed milk, samples were collected seasonally between January 1999 and January 2000 from raw (unpasteurized) milk consuming households and informal market agents of various cadres. Pasteurised milk samples were also collected from retail points and tested for comparison. All samples were screened for antimicrobial residues using charm AIM-96 and Charm-ROSA (Charm Sciences Inc, USA) tests. The former detects a wide range of anti-microbials, and the latter detects β-lactams and tetracyclines specifically, at levels above maximum residue limits (MRLS) recommended by the European Union (EU). The Charm-AIM screening test showed that 9.4% and 5.7% of samples from consumer households and market agents had antimicrobial residues above EU MRLS, respectively. It was concluded that antimicrobial residues were more likely to have originated at farm-level than because of poor market handling practices.

Drug residues in foods are a major public health concern in many countries, especially where most food sales bypass official quality assurance channels. In common with many tropical countries, sales of unpasteurized milk in Kenya account for over 85% of marketed milk. This milk is either sold directly from producers to consumers or via various cadres of informal market agents. Besides residues that may arise from lack of adherence to withdrawal times following cow therapy, there have been concerns that some antimicrobial agents may be added to informally marketed milk to extend its shelf life. As part of a large study to assess public health hazards associated with marketed milk, samples were collected seasonally between January 1999 and January 2000 from raw (unpasteurized) milk consuming households and informal market agents of various cadres. Pasteurised milk samples were also collected from retail points and tested for comparison. All samples were screened for antimicrobial residues using charm AIM-96 and Charm-ROSA (Charm Sciences Inc, USA) tests. The former detects a wide range of anti-microbials, and the latter detects β-lactams and tetracyclines specifically, at levels above maximum residue limits (MRLS) recommended by the European Union (EU). The Charm-AIM screening test showed that 9.4% and 5.7% of samples from consumer households and market agents had antimicrobial residues above EU MRLS, respectively. It was concluded that antimicrobial residues were more likely to have originated at farm-level than because of poor market handling practices.

Drug residues in foods are a major public health concern in many countries, especially where most food sales bypass official quality assurance channels. In common with many tropical countries, sales of unpasteurized milk in Kenya account for over 85% of marketed milk. This milk is either sold directly from producers to consumers or via various cadres of informal market agents. Besides residues that may arise from lack of adherence to withdrawal times following cow therapy, there have been concerns that some antimicrobial agents may be added to informally marketed milk to extend its shelf life. As part of a large study to assess public health hazards associated with marketed milk, samples were collected seasonally between January 1999 and January 2000 from raw (unpasteurized) milk consuming households and informal market agents of various cadres. Pasteurised milk samples were also collected from retail points and tested for comparison. All samples were screened for antimicrobial residues using charm AIM-96 and Charm-ROSA (Charm Sciences Inc, USA) tests. The former detects a wide range of anti-microbials, and the latter detects β-lactams and tetracyclines specifically, at levels above maximum residue limits (MRLS) recommended by the European Union (EU). The Charm-AIM screening test showed that 9.4% and 5.7% of samples from consumer households and market agents had antimicrobial residues above EU MRLS, respectively. It was concluded that antimicrobial residues were more likely to have originated at farm-level than because of poor market handling practices.

Drug residues in foods are a major public health concern in many countries, especially where most food sales bypass official quality assurance channels. In common with many tropical countries, sales of unpasteurized milk in Kenya account for over 85% of marketed milk. This milk is either sold directly from producers to consumers or via various cadres of informal market agents. Besides residues that may arise from lack of adherence to withdrawal times following cow therapy, there have been concerns that some antimicrobial agents may be added to informally marketed milk to extend its shelf life. As part of a large study to assess public health hazards associated with marketed milk, samples were collected seasonally between January 1999 and January 2000 from raw (unpasteurized) milk consuming households and informal market agents of various cadres. Pasteurised milk samples were also collected from retail points and tested for comparison. All samples were screened for antimicrobial residues using charm AIM-96 and Charm-ROSA (Charm Sciences Inc, USA) tests. The former detects a wide range of anti-microbials, and the latter detects β-lactams and tetracyclines specifically, at levels above maximum residue limits (MRLS) recommended by the European Union (EU). The Charm-AIM screening test showed that 9.4% and 5.7% of samples from consumer households and market agents had antimicrobial residues above EU MRLS, respectively. It was concluded that antimicrobial residues were more likely to have originated at farm-level than because of poor market handling practices.

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Background:
Marine invertebrates rely solely on innate immune mechanisms, the cellular component of which is characterized by hemocytes that phagocytize microbes and secrete soluble antimicrobial and cytotoxic substances. In this regard, marine invertebrates are a potential source of promising antimicrobial compounds with novel mechanisms of action.
Objective:
The objective of this study was to evaluate extracts of the gut, gonad, spines and mouth parts of the sea urchin Tripneustes gratilla for antimicrobial and haemolytic activities in vitro.
Methods:
Potentially bioactive metabolites were extracted using methanol and chloroform and tested for activity against Salmonella typhi, Escherichia coli, Shigella sonnei, Pseudomonas aeruginosa and Penicillium spp. using the agar disc diffusion method. Toxicity was determined by assaying for hemolysis against human red blood cells.
Results:
Bioactivity against the tested bacteria was observed mainly with the methanol and chloroform extracts of the gonads and gut. Higher antibacterial activity was present in the methanol extracts compared to chloroform extracts. Activity against the Penicillium spp was detected only in the methanol extracts, while the chloroform extracts showed no activity. The various extracts of the sea urchin lacked any detectable hemolytic activity against human erythrocytes.
Discussion:
These research findings suggest that marine echinoderms are a potential source of novel antimicrobial compounds.
Key words:
Tripneustes gratilla, antimicrobial activity, marine invertebrates

The global use of alcohol-based hand sanitizers (ABHS) as an important means of controlling the transmission of infectious disease has increased significantly as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. This paper discusses the interplay between ABHS input (formulation) factors and output (product performance) factors in the context of a multidimen-sional perspective using a novel representative paradigm. In the model, represented in the form of a three-dimensional tetrahedron, each of the faces represents inputs in the manufacturing of the ABHS product, which are the type and amount of alcohol, the inactive ingredients, the formulation and the manufacturing practices. The four corners of the tetrahedron represent the product per-formance factors which include product efficacy, sensory characteristics, usage and compliance and product safety. The multidimensional approach to the formulation and evaluation of ABHS shows that several factors contribute to the effectiveness and utility of these products. The paradigm provides a useful framework for manufacturers of ABHS and related healthcare products.

The paper deals with an extension of the previous work appearing in a past issue of this transaction by the authors on hybrid FEM/MOM technique for analyzing transmission properties of arbitrarily shaped apertures on a thick conducting screen. In the present work, the effect of placing different dielectric material slabs in the conducting screen cavity on the electromagnetic transmission parameters is first analyzed and, then, the effect of interchanging the positions of these dielectric slabs relative to the incident field. Validation results for rectangular and cross-shaped slots are presented. Close agreement between our data and published data is observed.  Further data has been generated for rectangular, circular, diamond-shaped and cross-shaped apertures.

Power utility companies are required to supply customers with power within specified voltage limits. Voltage rise in networks with distributed generators therefore poses a challenge. This paper presents a coordinated network controller whose objective is to maintain an optimal voltage profile across the power network. The operations of distributed generators, on-load tap-changing transformers and reactive power sources are controlled. The controller is modelled as an optimisation problem which is solved using Particle Swarm Optimisation. The IEEE 30-bus test network is then used to verify the effectiveness of the controller. The results obtained show that this controller can greatly improve the voltage profile of a power network by varying the parameters of existing generation and voltage control equipment.

Power utility companies are required to supply customers with power within specified voltage limits. Voltage rise in networks with distributed generators therefore poses a challenge. This paper presents a coordinated network controller whose objective is to maintain an optimal voltage profile across the power network. The operations of distributed generators, on-load tap-changing transformers and reactive power sources are controlled. The controller is modelled as an optimisation problem which is solved using Particle Swarm Optimisation. The IEEE 30-bus test network is then used to verify the effectiveness of the controller. The results obtained show that this controller can greatly improve the voltage profile of a power network by varying the parameters of existing generation and voltage control equipment.

Power utility companies are required to supply customers with power within specified voltage limits. Voltage rise in networks with distributed generators therefore poses a challenge. This paper presents a coordinated network controller whose objective is to maintain an optimal voltage profile across the power network. The operations of distributed generators, on-load tap-changing transformers and reactive power sources are controlled. The controller is modelled as an optimisation problem which is solved using Particle Swarm Optimisation. The IEEE 30-bus test network is then used to verify the effectiveness of the controller. The results obtained show that this controller can greatly improve the voltage profile of a power network by varying the parameters of existing generation and voltage control equipment.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

Hydro-distilled volatile oils from the leaves of Ocimum gratissimum L. (Lamiaceae) from Meru district in Eastern Kenya were analysed by gas chromatography-mass spectrometry (GC-MS) and also evaluated for antimicrobial activity. The oil was dominated by monoterpens which accounted for 92.48%. This monoterpene fraction was characterized by a high percentage of eugenol (68.8%). The other major monoterpenes were methyl eugenol (13.21%), cis-ocimene (7.47%), trans-ocimene (0.94%), β-pinene (1.10%) and camphor (0.95%). The sesquiterpenes present in fairly good amounts were germacrene D (4.25%) and trans-caryophyllene (1.69%). The minor sesquiterpenes were α-farnesene (0.85%) and β-bisabolene (0.74%). The antimicrobial activities of the essential oils were evaluated against both Gram positive (Staphylococcus aureus, Bacillus spp.) and Gram negative (Escherichia coli, Pseudomonas aeruginosae, Salmonella typhi, Klebisiella pneumoniae, Proteus mirabilis) bacteria and a pathogenic fungus Candida albicans. The oil had pronounced antibacterial and antifungal activities on all the microbes.

The purpose of this paper is to assess the pattern of findings in the Mediastinum in Computersied Tomography chest based on a study of major hospitals in Kenya. CT Scan chest was performed in patients suspected to have pathologies in the chest mediastinum. This was a one year prospective study done in four major radiological centres in Nairobi, namely Kenyatta National Hospital (KNH), the Nairobi Hospital, Medical Imaging and Therapeutic Centre (MITC) and the Aga Khan Hospital, Nairobi. It was carried out on diverse dates from May 1st 1999 to April 30th 2000. There were a total of 101 patients studied out of 376 done CT chest in these four centres. Out of these, 28 were from KNH, Nairobi Hospital 27, MITC 40, and Aga Khan 6 patients. The overall male: female ratio was 2.48:1 with an age range of 2 months to 80 years. Most patients were over 60 years (35.64%) and the commonest clinical presentation was chest pain (21.19%). The major finding was lymph node enlargement. In all patients, a chest radiograph had been done and the commonest finding was a widened mediastinum (34.11%). Majority of the patients referred for CT Scan (23.76%), the clinicians did not give a specific clinical diagnosis. CT scan was able to delineate these masses and give a near exact diagnosis in the majority of these cases. CT scan showed most of the masses in the middle mediastinum (51.49%) and these were mainly lymph node enlargement. Most of the mediastinal masses (53.47%) were benign. The study recommends that CT Scan chest should be done routinely in suspected chest mediastinal pathologies. The study contributes important knowledge to studies of the pathologies in the Mediastinum.

Increasing numbers of HIV-infected adults in Africa need hospital care. It remains unclear what impact this has on health care services or on how hospitals respond. The aim of this study was to describe the effects of a rising case load of adult HIV-related disease by comparing results from a prospective cross-sectional study of acute adult medical admissions to a government hospital in Nairobi conducted in 1992 with results from a previous study done in 1988 and 1989 in the same hospital, using the same study design and protocol. Data on age, gender, number admitted, length of stay, HIV status, clinical AIDS, final diagnosis, case mix, and outcome were compared. In 1992, 374 consecutive patients were admitted in 15 24-hour periods (24.9 patients/period) compared with the 1988 to 1989 study, which enrolled 506 patients in 22 24-hour periods (23.0 patients/period). Patients' age, gender, and length of hospital stay were similar in both studies. In 1992, 39% of patients were HIV-positive compared with 19% in 1988 to 1989 (p < 10(-6)); whereas seropositive admissions rose 123% between the two periods (p < .0001), HIV-negative admissions declined 18% (p < .05). Clinical surveillance for AIDS consistently identified <40% of HIV-positive patients. Irrespective of HIV status, tuberculosis and pneumococcal pneumonia were the leading diagnoses in both surveys. No change was found in the diagnoses recorded for HIV-positive patients, but in HIV-negative patients, reductions were significant in the case mix (p < .00001) and range of diagnoses (p < .001) seen in 1992. Outcome remained unchanged for HIV-positive patients with approximately 35% mortality in both surveys. Outcome significantly worsened, in relative and absolute terms, for HIV-negative patients: in 1992, mortality was 23%, compared with 13.9% in 1988 to 1989 (p < .005), with 3.5 deaths per 24-hour period in 1992 compared with 2.6 deaths per 24-hour period in 1988 to 1989 (p < .05, one-tailed). These data suggest that increasing selection for admission is taking place as demand for care increases because of HIV/AIDS. This process appears to favor HIV-positive patients at the expense of HIV-negative patients who seem to be crowded out and, once admitted, experience higher mortality rates. The true social costs of the HIV epidemic are underestimated by not including the effects on HIV-negative people. PIP: The impact of the escalating demand for HIV/AIDS-related care on hospital services in Nairobi, Kenya, was investigated in two prospective cross-sectional studies conducted at Kenyatta National Hospital. Data on age, gender, number of admissions, length of stay, HIV status, clinical AIDS, final diagnosis, case mix, and outcome were compared in a 1988-89 study that enrolled 506 consecutive patients in a total of 22 24-hour periods and in a 1992 study of 374 patients admitted in 15 24-hour periods. 18.7% of hospital patients in 1988-89 were HIV-positive compared with 38.5% in 1992, with a concomitant decline of 18% in the number of HIV-negative admissions. Clinical surveillance for AIDS consistently identified less than 40% of HIV-positive patients. Tuberculosis and pneumococcal pneumonia were the leading diagnoses in both surveys among HIV-positive and HIV-negative patients. Diagnoses recorded for HIV-positive patients did not change over time; however, among HIV-negative patients, there was a significant narrowing in the range of diagnoses seen. Mortality among HIV-positive patients remained constant at 35% in both surveys. Among HIV-negative patients, mortality increased from 13.9% in 1988-89 to 23% in 1992 (2.6 and 3.5 deaths per 24-hour period, respectively). These findings suggest that increasing demand for hospital care by HIV-positive patients has been accompanied by deteriorating conditions for HIV-negative patients, especially an admissions selection process that favors HIV/AIDS patients. Recommended to address the worsening crisis in health care delivery are general guidelines on admission criteria that neither crowd out HIV-negative patients nor discriminate against those with HIV/AIDS.

Aminoglutethimide (AG) 500 mg was administered orally to four normal volunteers and eight patients undergoing treatment for metastatic breast cancer. In each subject the acetylator phenotype was established from the monoacetyldapsone (MADDS)/dapsone (DDS) ratio. Acetylaminoglutethimide (acetylAG) rapidly appeared in the plasma and its disposition paralleled that of AG. A close relationship (P less than 0.01) was observed between the acetyl AG/AG and MADDS/DDS ratio suggesting that AG may undergo polymorphic acetylation like DDS. AG half-life was 19.5 +/- 7.7 h in seven fast acetylators of DDS and 12.6 +/- 2.3 h in five slow acetylators and its apparent metabolic clearance was significantly (P less than 0.01) related to the acetylAG/AG ratio. Over 48 h the fast acetylators excreted 7.7 +/- 4.4% of the administered AG dose in the urine as unchanged AG as compared to 12.4 +/- 2.8% in slow acetylators. A much smaller fraction of the dose was excreted as acetylAG: 3.6 +/- 1.5% by fast and 1.9 +/- 1.0% by slow acetylators respectively. After 7 days treatment with AG at an accepted clinical dose regimen to the eight patients there were significant reductions in the half-lives of AG (P less than 0.01) and acetylAG (P less than 0.01) and a trend (0.1 greater than P greater than 0.05) towards reduction of the acetylAG/AG ratio which became significant (P less than 0.05) if the one patient on a known enzyme inducer was omitted. The mean apparent volume of distribution was not significantly (P greater than 0.1) altered but the mean apparent systemic clearance of AG was increased (P less than 0.05). These changes are attributed to auto-induction of oxidative enzymes involved in AG metabolism.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

A simple rapid high-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and its acetylated metabolite acetylamidoglutethimide in plasma, saliva, and urine is described. This assay is suitable for pharmacokinetic studies in normal subjects and patients receiving other medication in addition to aminoglutethimide

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

Increasing numbers of HIV-infected adults in Africa need hospital care. It remains unclear what impact this has on health care services or on how hospitals respond. The aim of this study was to describe the effects of a rising case load of adult HIV-related disease by comparing results from a prospective cross-sectional study of acute adult medical admissions to a government hospital in Nairobi conducted in 1992 with results from a previous study done in 1988 and 1989 in the same hospital, using the same study design and protocol. Data on age, gender, number admitted, length of stay, HIV status, clinical AIDS, final diagnosis, case mix, and outcome were compared. In 1992, 374 consecutive patients were admitted in 15 24-hour periods (24.9 patients/period) compared with the 1988 to 1989 study, which enrolled 506 patients in 22 24-hour periods (23.0 patients/period). Patients' age, gender, and length of hospital stay were similar in both studies. In 1992, 39% of patients were HIV-positive compared with 19% in 1988 to 1989 (p < 10(-6)); whereas seropositive admissions rose 123% between the two periods (p < .0001), HIV-negative admissions declined 18% (p < .05). Clinical surveillance for AIDS consistently identified <40% of HIV-positive patients. Irrespective of HIV status, tuberculosis and pneumococcal pneumonia were the leading diagnoses in both surveys. No change was found in the diagnoses recorded for HIV-positive patients, but in HIV-negative patients, reductions were significant in the case mix (p < .00001) and range of diagnoses (p < .001) seen in 1992. Outcome remained unchanged for HIV-positive patients with approximately 35% mortality in both surveys. Outcome significantly worsened, in relative and absolute terms, for HIV-negative patients: in 1992, mortality was 23%, compared with 13.9% in 1988 to 1989 (p < .005), with 3.5 deaths per 24-hour period in 1992 compared with 2.6 deaths per 24-hour period in 1988 to 1989 (p < .05, one-tailed). These data suggest that increasing selection for admission is taking place as demand for care increases because of HIV/AIDS. This process appears to favor HIV-positive patients at the expense of HIV-negative patients who seem to be crowded out and, once admitted, experience higher mortality rates. The true social costs of the HIV epidemic are underestimated by not including the effects on HIV-negative people. PIP: The impact of the escalating demand for HIV/AIDS-related care on hospital services in Nairobi, Kenya, was investigated in two prospective cross-sectional studies conducted at Kenyatta National Hospital. Data on age, gender, number of admissions, length of stay, HIV status, clinical AIDS, final diagnosis, case mix, and outcome were compared in a 1988-89 study that enrolled 506 consecutive patients in a total of 22 24-hour periods and in a 1992 study of 374 patients admitted in 15 24-hour periods. 18.7% of hospital patients in 1988-89 were HIV-positive compared with 38.5% in 1992, with a concomitant decline of 18% in the number of HIV-negative admissions. Clinical surveillance for AIDS consistently identified less than 40% of HIV-positive patients. Tuberculosis and pneumococcal pneumonia were the leading diagnoses in both surveys among HIV-positive and HIV-negative patients. Diagnoses recorded for HIV-positive patients did not change over time; however, among HIV-negative patients, there was a significant narrowing in the range of diagnoses seen. Mortality among HIV-positive patients remained constant at 35% in both surveys. Among HIV-negative patients, mortality increased from 13.9% in 1988-89 to 23% in 1992 (2.6 and 3.5 deaths per 24-hour period, respectively). These findings suggest that increasing demand for hospital care by HIV-positive patients has been accompanied by deteriorating conditions for HIV-negative patients, especially an admissions selection process that favors HIV/AIDS patients. Recommended to address the worsening crisis in health care delivery are general guidelines on admission criteria that neither crowd out HIV-negative patients nor discriminate against those with HIV/AIDS.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

Aminoglutethimide (AG) 500 mg was administered orally to four normal volunteers and eight patients undergoing treatment for metastatic breast cancer. In each subject the acetylator phenotype was established from the monoacetyldapsone (MADDS)/dapsone (DDS) ratio. Acetylaminoglutethimide (acetylAG) rapidly appeared in the plasma and its disposition paralleled that of AG. A close relationship (P less than 0.01) was observed between the acetyl AG/AG and MADDS/DDS ratio suggesting that AG may undergo polymorphic acetylation like DDS. AG half-life was 19.5 +/- 7.7 h in seven fast acetylators of DDS and 12.6 +/- 2.3 h in five slow acetylators and its apparent metabolic clearance was significantly (P less than 0.01) related to the acetylAG/AG ratio. Over 48 h the fast acetylators excreted 7.7 +/- 4.4% of the administered AG dose in the urine as unchanged AG as compared to 12.4 +/- 2.8% in slow acetylators. A much smaller fraction of the dose was excreted as acetylAG: 3.6 +/- 1.5% by fast and 1.9 +/- 1.0% by slow acetylators respectively. After 7 days treatment with AG at an accepted clinical dose regimen to the eight patients there were significant reductions in the half-lives of AG (P less than 0.01) and acetylAG (P less than 0.01) and a trend (0.1 greater than P greater than 0.05) towards reduction of the acetylAG/AG ratio which became significant (P less than 0.05) if the one patient on a known enzyme inducer was omitted. The mean apparent volume of distribution was not significantly (P greater than 0.1) altered but the mean apparent systemic clearance of AG was increased (P less than 0.05). These changes are attributed to auto-induction of oxidative enzymes involved in AG metabolism.

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

Over the period November 1978 to October 1988, 46 cases of motor neuron disease were seen at Kenyatta National Hospital, Nairobi. One case was seen in private practice. A bimodal age distribution of the disease was identified with a peak in the fourth decade of life and another peak in the sixth decade of life. The disease seen in the fourth decade of life was different as seen in other parts of the world in that the majority of patients tended to present with very rapidly progressive disease despite the primary presentation with limb symptoms and signs. Serum cholinesterase activity in five of these patients and five of the classical motor neuron disease revealed no abnormalities. This unusually rapidly progressive disease in young adults has not been described anywhere. The disease seen in older age groups and especially in patients over fifty years of age was not different from the one seen in other parts of the world.

The prevalence of antibodies against Leishmania donovani in selected domestic and wild animal species in 2 villages in Sudan with active L. donovani transmission in humans was investigated. Screening of domestic animals (donkeys, cows, sheep, goats, camels and dogs) with the direct agglutination test (DAT) detected reaction rates above the cut-off titres in donkeys (68.7%), cows (21.4%) and goats (8.5%), and which were also found in wild rats (5.5%). Sera of sheep, camels and dogs had a weak agglutination reaction below the cut-off titre. Testing of the same sera by enzyme-linked immunosorbent assay (ELISA), against a lysate of L. donovani promastigotes, showed reaction rates above the cut-off optical density in cows (47.6%), goats (13.6%), and in rats (4.1%). No Leishmania parasite was isolated from spleen, liver, bone-marrow or spleen of Nile rats.

Aminoglutethimide (AG) 500 mg was administered orally to four normal volunteers and eight patients undergoing treatment for metastatic breast cancer. In each subject the acetylator phenotype was established from the monoacetyldapsone (MADDS)/dapsone (DDS) ratio. Acetylaminoglutethimide (acetylAG) rapidly appeared in the plasma and its disposition paralleled that of AG. A close relationship (P less than 0.01) was observed between the acetyl AG/AG and MADDS/DDS ratio suggesting that AG may undergo polymorphic acetylation like DDS. AG half-life was 19.5 +/- 7.7 h in seven fast acetylators of DDS and 12.6 +/- 2.3 h in five slow acetylators and its apparent metabolic clearance was significantly (P less than 0.01) related to the acetylAG/AG ratio. Over 48 h the fast acetylators excreted 7.7 +/- 4.4% of the administered AG dose in the urine as unchanged AG as compared to 12.4 +/- 2.8% in slow acetylators. A much smaller fraction of the dose was excreted as acetylAG: 3.6 +/- 1.5% by fast and 1.9 +/- 1.0% by slow acetylators respectively. After 7 days treatment with AG at an accepted clinical dose regimen to the eight patients there were significant reductions in the half-lives of AG (P less than 0.01) and acetylAG (P less than 0.01) and a trend (0.1 greater than P greater than 0.05) towards reduction of the acetylAG/AG ratio which became significant (P less than 0.05) if the one patient on a known enzyme inducer was omitted. The mean apparent volume of distribution was not significantly (P greater than 0.1) altered but the mean apparent systemic clearance of AG was increased (P less than 0.05). These changes are attributed to auto-induction of oxidative enzymes involved in AG metabolism.

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

A simple rapid high-performance liquid chromatographic assay for simultaneous estimation of aminoglutethimide and its acetylated metabolite acetylamidoglutethimide in plasma, saliva, and urine is described. This assay is suitable for pharmacokinetic studies in normal subjects and patients receiving other medication in addition to aminoglutethimide

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

Over a period of five years, November, 1983 to October, 1988 six cases of definite multiple sclerosis were identified at Kenyatta National Hospital. Four were females and two were males. Age of onset of disease ranged from 12 years to 30 years. Their mode of presentation, clinical features and prognosis is the same as that of multiple sclerosis seen at higher latitudes. The consequences of misdiagnosis to the patient is discussed. A theory is put forward to explain the increased numbers of MS seen recently as compared to the past decades.

An experimental chronic relapsing demyelinating neuropathy was produced by immunizing adult Lewis rats with bovine myelin in low (2.5 mg) and high (5 mg) doses, with and without Mycobacterium tuberculosis in the adjuvant. Each regime produced a similar disease course: acute severe hind limb weakness was followed by apparent recovery and then reappearance of mild neurological deficit with occasional spontaneous exacerbations. The partially recovered animals were relatively resistant to reimmunization with myelin. Immunization of four-week-old rats with myelin in complete adjuvant produced disease with a similar course. Subsequent immunization of these juvenile rats with adjuvant alone precipitated exacerbations. In the late stages, the prominent changes in peripheral nerves and nerve roots were axon loss, axonal regeneration and remyelination while inflammatory cell infiltration was confined to occasional foci. Onion bulb formation was extremely common in the dorsal root ganglia and affected in particular the nerve fibres close to the dorsal root ganglion cells. The cells forming the onion bulbs resembled the satellite cells surrounding the axon hillocks. Onion bulb formation also occurred in the portion of the ventral roots adjacent to the dorsal root ganglion but was rare elsewhere. Immunocytochemistry revealed only occasional lymphocyte infiltration but there was increased Class I and Class II MHC antigen expression throughout the peripheral nervous system. The results are relevant to the interpretation of biopsies from patients with chronic demyelinating neuropathy of possible inflammatory or autoimmune origin.

No abstract available.

Designers, architects and artists have invariably relied on their portfolios to record their work and to exhibit their capabilities. Unfortunately there is very little reference from which to draw tips on how to effectively utilize a portfolio. Sometimes the attention given to the production of the work is not complemented with strong oral and visual, presentations. The continued failure to pay due attention to portfolio has led to loss of job opportunities. The portfolio can open doors and close them with equal speed. To people shopping for jobs, it's a calling card, the advance guard, the marketing tool, often the only opportunity to make an impression. Many companies do not hire people but rather hire portfolios. When a prospective employer requests for a portfolio it is because they are seeking certain attributes or traits that may be of service to them. Typically, the employer will say they are looking for somebody "creative". How does your portfolio show that you are creative? Is it in the way it is organized? The work you have put in it? Or is it the bag/booklet? The answer to this is "all of the above". It does not do good work justice if it's put together in a tattered envelope. Neither can a very expensive bag/booklet camouflage bad work. There must be a sense of your presence in the work you do, the way you do it, the way you present it and what you want to do with it. And, not to forget, what you want the work to do for you.

The culture, values and standard of living of people is reflected in their art and design, and, for centuries art has been used to communicate and reflect the lives and times of people. Somewhere along the line, however, there has developed a belief that art and design parted ways with "people". On one hand, "people" have developed % belief that design is the preserve of a talented few, while, on the other hand, designer* claim that "...people do not understand us". Yet, design can only thrive where the community or people, is more artistic. Because of technological developments, the world around, has become one big homestead, the global village. The development of these high technologies is attributed to and spearheaded by the more developed countries. The rate of development of these technologies has been so high such that many of the less developed countries (LDCs) are left breathless and beaten. The United Nations (UN) in its concern for sustainable global development has in recent years sought to re-examine ways of pulling the LDCs into the mainstream of global development. The World Commission on Culture and Development (WCCD) that was established in 1992 provided 1jie framework to extend the development paradigm beyond economic criteria. Among other things, the WCCD "...explores many dimensions of culture and development -as well as their interactions -in an increasingly complex and interconnected and rapidly changing world". In the case of Africa, this has led to the wider special initiative for Africa. This initiative is deeply rooted in the belief that Africa has something to contribute to global development. The initiative seeks to identify aspects of Africa, be they cultural, environmental, craft or anything else, develop and package or repackage them and avail them to the rest of the world. UNESCO, has set out to intervene, initially, in the areas of Industrial, Textile and Graphic Design, Photography and Music. Textile and Graphic Design workshop was therefore, the first of these high level interaction of African artists in Development.

Traumatic anterior dislocation of the hip forms approximately 11% of hip dislocations and is divided into
superior and inferior types. Anterior superior hip dislocation accounts for 10% of anterior hip dislocations.
The clinical appearance of anterior superior hip dislocation resembles that of a fracture of the femoral neck,
whereas the radiological appearance resembles that of posterior hip dislocation.The objective of this article is to use three cases to describe the management of this condition and highlight pitfalls in the same. The article also points out unusual mechanisms causing this injury. Key words: Anterior dislocation, Hip joint, Open reduction, Iliofemoral ligament

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The decision to pay out earnings or retain dividends has been a subject of debate for many scholars. The effect of dividend on the firm value and cost of capital have been covered in attempt to resolve the dividend puzzle. This research paper tests the applicability of constant dividend model by companies listed at the Nairobi stock exchange. Data was collected from annual reports and share price schedules obtained from Nairobi stock exchange and Capital market Authority for a population of 20 companies that paid dividends consistently from 2002 to 2008. The data was then analyzed by re-computing the dividends that should have been paid if the dividend constant model was applied. This recomputed figure was later compared to the dividend as paid out by the companies thought the years of study. Paired sample t-test statistic was also performed to determine whether there is a significant difference between the two dividend figures. The findings of the research established that the dividend model was not employed by the companies listed at the Nairobi stock exchange. Most firms instead adopted stable and predictable policy where a specific amount of dividend per share each year was paid periodically. In some years there was a slight adjustment of the dividend paid after an increase in earnings, but only by a sustainable amount. The study shows that the relationship between the stock market prices and the dividend paid from the constant dividend model is uneven from one year to another and where there was a relationship it was insignificant. Though a share would be highly priced, a high dividend per share was not always declared.

The performance of an evaporator for a packaged air conditioning unit has been investigated. A heat transfer program ACOL5 validated in an earlier study, was used to predict the performance. Non-uniform velocity distribution measurements taken in a typical air conditioning unit were employed in the prediction of the evaporator performance. It was found that this maldistribution reduced the performance of an evaporator circuit, as compared to uniform flow. Circuits at the edges of the evaporator, where the velocity was low, did not perform well. With the refrigerants controlled by one thermostatic valve, the worst performing circuit affected the performance of the whole evaporator, the evaporator performance being reduced by as much as 35%. The performance of the evaporator, where the circuits had different numbers of passes, depended on the position of the circuit in the evaporator.

Forty seven patients with acute renal failure were studied prospectively over a two-year period at the Kenyatta National Hospital. There were 20 males and 27 females. The mortality rate was 40.4%. Most patients had medically oriented problems. Complications that were associated with a high mortality were infections and the presence of neuropsychiatric manifestations.

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From July 2004 to May 2012, about 1,700 sprites were recorded by ISUAL (Imager of Sprites and Upper Atmospheric Lightning). Most of them were singly occurring sprites that were not followed by other sprites; while about 7% of them were multi-sprites, which typically start with a sprite and then followed by another sprite that showed a spatial displacement relative to the preceding sprites. Almost all of these events show horizontal shifts between the preceding sprites and the follow-up ones, which previously have been called the dancing sprites. In contrast to the majority cases of dancing sprites with horizontal displacements, three follow-up sprites were found to exhibit a vertical displacement relative to the preceding sprites, which are termed as the secondary sprites in in this report. These three secondary sprites exhibit similar occurring sequences and characteristics; with the preceding clustering sprite spanning the altitudes of ~60-85 km, and then 30 ms or more later, a secondary sprite appears at ~40-65 km altitudes and seems to be connected to the dimming channels of the preceding sprite. From analyzing the spectral and the ULF data, possible generating mechanisms for dancing sprites and secondary sprites are proposed in this report. Several researches [Lyons, 1994; Lyons, 1996; Lu et al., 2012] had indicated that the successive sprite production in the dancing sprites aligned with the lateral leader propagation direction of lightning. We consider that the successively occurring dancing sprites and the secondary sprites are related to the extending leaders of the cloud-to-ground lightning, which are often followed by a continuing current or even a second stroke. The dancing sprites may be induced by the subsequent leaders in the cloud extending mainly in the horizontal direction, while the secondary sprites may be triggered by the leaders extending primarily in the vertical direction. In addition, a numerical quasi-electrostatic (QE) field model is developed with the aim to validate the occurring scenario of the secondary sprites. Based on the information inferred from the associate ULF data of a secondary sprite, salient parameters, including the charge, the charge height, and the discharging time constant, are estimated and used in the QE model calculations. Through performing QE modeling with the ULF inferred parameters, we find that the electric field in the region below the preceding sprites could be enhanced by the continuing current.

Joint exhibition of paintings and sculptures

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

Joint exhibition of paintings and sculptures

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

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.

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Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.