In addition to direct effects on virus infectivity, antibodies mediate antibody-dependent cellular cytotoxicity (ADCC), the killing of an antibody-coated virus-infected cell by cytotoxic effector cells. Although ADCC has been suggested to protect against HIV, the relationship between HIV-specific ADCC antibodies at the time of HIV exposure and infection outcome in humans remains to be assessed. We evaluated the ADCC activity of passively acquired antibodies in infants born to HIV-infected mothers. ADCC levels were higher in uninfected than infected infants, although not significantly. Increase in ADCC antibody activity in infected infants was associated with reduced mortality risk. Infant ADCC positively correlated with the magnitude of IgG1 binding, and IgG1 levels were associated with survival in infected infants. Infant IgG3-binding antibodies were not associated with infected infant survival. These data suggest a therapeutic benefit of pre-existing HIV-specific ADCC antibodies and support a role for eliciting ADCC-mediating IgG1 in HIV vaccines.

Abstract

This study presents past and projected temporal changes in mean temperature and rainfall around the Marsabit Forest Reserve (MFR), a sub-humid montane forest in Kenya. Rainfall data for the period 1961–2014 and temperature data for the period 1972–2011 were acquired from the Marsabit meteorological station. Future projections (2006–2100) were based on data from five models that participated in the Coupled Model Intercomparison Project Phase 5 (CMIP5) under Representative Concentration Pathways (RCPs) 4.5 and 8.5. Climate simulations for the 2071–2100 period were compared to the 1961–1990 IPCC baseline period to establish significant change. The MFR recorded a mean rainfall of 784 mm which declined annually at a rate of 6 mm over the period of the study. The long rains (March–May) recorded a mean of 379 mm and decreased annually by 10 mm while the short rains (October–December) recorded a mean of 269 mm and decreased annually by 2 mm between 1961 and 2014, with no statistically significant trend (p > 0.05).

The model ensemble reproduced the MFR bimodal rainfall pattern, but overestimated the short rains at 333 mm, compared to the actual mean of 269 mm, and underestimated the long rains at 331 mm, compared to the actual mean of 379 mm. The model ensemble simulated a historical mean rainfall of 651 mm compared to the actual mean of 784 mm. Annual rainfall is projected to increase under both scenarios with higher increases during the OND season compared to the MAM season and under RCP8.5 than under RCP4.5. The mean rainfall in the baseline year was 859 mm while the mean rainfall in the projection period for the RCP4.5 and RCP8.5 scenarios is expected to be 1022 (+19%) and 1105 (+28.7%) mm, respectively; significant enough to be characterized as climate change.

Temperatures are projected to increase at a rate of 0.2 °C and 0.5 °C per decade under RCP4.5 and RCP8.5, respectively. Between 2071 and 2100, the MFR is projected to have warmed by between 1.2–1.7 °C and 3.2–4.8 °C under RCP4.5 and RCP8.5, respectively. Extreme rainfall events are projected to increase under the RCP4.5 scenario (severe wetting 13.1%, severe drying 3%) and the RCP8.5 scenario (severe wetting 20.1%, severe drying 3%) compared to the baseline period (severe wetting 6.1%). Our results conform to the ‘East African climate paradox’, where the observed rainfall trends were declining compared to the scenario simulations projecting a wetting anomaly as local temperatures rise. Further studies to better understand the cause of the poor rainfall simulation in the general circulation models (GCMs) in the MFR and the larger East African region will be necessary.

Abstract

This study presents past and projected temporal changes in mean temperature and rainfall around the Marsabit Forest Reserve (MFR), a sub-humid montane forest in Kenya. Rainfall data for the period 1961–2014 and temperature data for the period 1972–2011 were acquired from the Marsabit meteorological station. Future projections (2006–2100) were based on data from five models that participated in the Coupled Model Intercomparison Project Phase 5 (CMIP5) under Representative Concentration Pathways (RCPs) 4.5 and 8.5. Climate simulations for the 2071–2100 period were compared to the 1961–1990 IPCC baseline period to establish significant change. The MFR recorded a mean rainfall of 784 mm which declined annually at a rate of 6 mm over the period of the study. The long rains (March–May) recorded a mean of 379 mm and decreased annually by 10 mm while the short rains (October–December) recorded a mean of 269 mm and decreased annually by 2 mm between 1961 and 2014, with no statistically significant trend (p > 0.05).

Abstract
Pasteurella multocida causes fowl cholera, a highly contagious and severe disease in chickens and water fowls. The disease is not well described in less intensive production systems, including scavenging family poultry production in developing countries. P. multocida was isolated from 25.9% of healthy-looking ducks and 6.2% of chickens from free-range family poultry farms and at slaughter slabs at market. On experimental infection with 1.2 to 2.0×108 organisms of the P. multocida type strain (NCTC 10322T), 12-week-old chickens expressed fowl cholera clinical signs significantly more times (372 signs) than those of 4-week-old, 8-week-old and 16-week-old chickens (173, 272 and 187 signs) and more signs were severe. In family ducks the 8-week-old birds expressed clinical signs significantly more times (188 signs) than those of the other age groups (117, 80, and 83 signs, respectively) and severe signs were more frequent. P. multocida transmitted from seeder birds (n=12) to sentinel birds (n=30), which developed clinical signs, and in some cases lesions of fowl cholera allowed bacterial re-isolation, whether infected ducks served as seeders for chickens or chickens served as seeder for ducks. This study has documented the occurrence of P. multocida among healthy-appearing family poultry in a tropical setting, and demonstrated that age susceptibility is highest in 12-week-old family chickens and 8-week-old family ducks when challenged with a low-virulent strain of P. multocida. It has further demonstrated that cross-transmission of fowl cholera may happen between family ducks and chickens, and vice versa.

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.

The Educational Mission of the Church: An African Perspective

The Educational Mission of the Church: An African Perspective

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This study provides an overview of changing climatic conditions in Kajiado County based on analysis of climatic data and perception of pastoralist on key climatic variables. It collates the two sources of knowledge on climate change, indicating the consistency and inconsistency between the two. Rainfall and temperature data of the study area for a period of 43 years
(1970-2013) was collected from Kenya Meteorological Service, organized and analyzed using Microsoft excel. The perception of Maasai pastoralist to climate change was determined using questionnaires, focus group discussions and key informant interview. Result shows that rainfall trend in Kajiado County have a high variability level (CV %) of 27.5% for Kajiado North, 21.5% for Kajiado West, 26.4% for Kajiado East and 25.2% for Kajiado Central. Although, there is no significant change for rainfall over the study period, result on perception revealed that 83% of respondent perceive that rainfall amount is reducing in the last 30 years. However, perception of pastoralist about years of extreme drought corroborates the meteorological trend of years with very low rainfall. A rise in minimum temperature (1.410C), maximum temperature (0.470C) and average temperature (0.940C) occurred between 1970 and 2013. This agrees with the perception of 81% of Maasai pastoralist, which perceived that temperature has been increasing in the last 30 years. Overall, the results of this study are in line with recent trend of global warming in the region as reported by the latest Intergovernmental panel on Climate Change (IPCC 2014) report.

Keywords: climate change, rainfall, temperature, perception

Department of Medical Physiology, University of Nairobi, P.O. Box 30197, Nairobi. OBJECTIVE: To report on the occurrence of clinical multiple sclerosis among indigenous Bantu African Kenyans who have never been out of the country. DESIGN: A retrospective study. SETTING: A private neurology and clinical electrophysiology clinic. SUBJECTS: All the patients referred to the clinic by neurologists and other specialists for electrophysiological tests with diverse neurological complaints. The patients examined and diagnosed as having multiple sclerosis on clinical grounds and established criteria are reported. RESULTS: Out of 2831 patients referred for electrophysiological tests over a ten year period, nine patients were diagnosed as having definite multiple sclerosis on clinical grounds. Four of these had supporting laboratory findings (MRI scans, CSF studies and visual evoked responses). The presenting symptoms were predominantly visual disturbances and somatic sensorimotor disturbances which were seen in all the patients. Cerebellar dysfunction was observed less frequently, in less than half of the patients while sphincter disturbances were conspicuously rare. The sex distribution was overwhelmingly in favour of the female at a ratio of 7:2. A part from two patients of Indo-asian ethnicity, all the others were indigenous Bantu Africans who had never travelled outside their country before the onset of the illness. CONCLUSIONS: Multiple sclerosis occurs amongst Bantu Africans and may not be as rare as previously suggested and its prevalence is certainly on the increase. The development of higher incidence rates in communities where the illness was previously unknown may present opportune settings for the study of aetiological factors of this illness as it emerges. There is a need therefore for proper epidemiological studies to evaluate these factors, especially environmental factors, as the new disease continues to appear. PMID: 11682954 [PubMed - indexed for MEDLINE]

During a 7 month period, April to October, 1984, 537 consecutive babies weighing upto 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +/- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001 to 1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants before discharge from hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In another 4 infants there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infants less than 1000 gm in the first few days of life before diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make definitive diagnosis.

Department of Paediatrics, College of Health Sciences, University of Nairobi, Kenya.

During a 7 month period, April to October, 1984, 537 consecutive babies weighing upto 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +/- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001 to 1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants before discharge from hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In another 4 infants there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infants less than 1000 gm in the first few days of life before diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make definitive diagnosis.

PIP: During a 7 month period, April-October 1984, 537 consecutive babies weighing up to 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these, 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +or- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001-1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants prior to discharge from the hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In the cases of 4 other infants, there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infant 1000 gm in the 1st few days of life prior to when the diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make a definitive diagnosis. author's modified

PMID: 1765017 [PubMed - indexed for MEDLINE]

Antibody responses to a conventional rabies preexposure regimen of a new purified Vero cell rabies vaccine (PVRV) and a human diploid cell vaccine (HDCV) were compared in 80 healthy Kenyan veterinary students. Forty-three of the students received the PVRV and 37 received the HDCV on days 0, 7, and 28. Antibody responses were monitored using the rapid fluorescent-focus inhibition test (RFFIT) and an inhibition enzyme immunoassay (INH EIA) on days 0, 7, 28, and 49. Both vaccines elicited a rapid antibody response. A good correlation between the RFFIT titers and the INH EIA titers was obtained (r = 0.90). Our results also showed that the INH EIA was more reproducible and might therefore be a suitable substitute for the more expensive and less reproducible RFFIT. The geometric mean titers determined by both tests in the two groups of students were statistically similar during the test period. The RFFIT and the INH EIA gave comparable geometric mean titers, which differed significantly only on day 28 in the PVRV group. The effect of the new PVRV is comparable to that of the more expensive HDCV, as determined by the present test systems. The PVRV could therefore be the vaccine of choice, especially in tropical rabies-endemic areas, where the high cost of the HDCV has confined its use to a privileged few.

J. O. Midiwo, A. Yenesew, B. F. Juma, S. Dereses, J. A. Ayoo, A. Aluoch and S. Guchu There are several described medicinal plants in Kenya from a flora of approximately 10,000 members. Strong cross-medical information from the 42 ethnic groups points to the high potential of some of these species. The Myrsinaceae are well established ethno-anthelmintics and anti-bacterials. They are harbingers of long alkyl side chain benzoquinones which clearly have a protective function from their histochemical disposition. The main benzoquinone in the sub-family Myrsinodae is embelin while for the Maesodae it is maesaquinone together with its 5-acetyl derivative; the distribution of these benzoquinones by their alkyl side chain length or the presence/absence of a 6-methyl group is in accord with morphological sub-family de-limitation. The benzoquinones showed anti-feedant, anti-microbial, phytotoxic, acaricidal, insecticidal and nematicidal activity. Many other benzoquinones of medium and minor concentration were also isolated and characterised. Some plants belonging to the Polygonaceae which are widely used as ethno-anthelmintics have been studied. The common anthelmintic anthraquinones were obtained from all five Rumex species while the naphthalenic acetogenin derivative, nepodin was more selectively distributed. The leaf of Polygonum senegalense is up to 17% surface exudate; about thirteen non polar flavonoid derivatives (chalcones, dihydrochalcones, flavanones and a flavone) have been isolated from it. From the internal aerial tissues of this plant, the major flavonoids were common flavonoids, quercetin, kaempferol, luteolin and their glycosides. The only unique compound isolated from this plant was 2prime-glucosyl-6prime-hydroxy-4prime-methoxydihydrochalcone whose aglycone, uvangolatin is part of the exudate mixture. Other leaf exudate plants studied include the stomach-ache medicine, Psiadia punctulata (Compositae) from which novel methylated flavonoids, kaurene and trachyloban diterpenes have been found

Suggested prediction for Rain attenuation in Terrestrial links based on growth modelling of the rain cell is validated from measurements.

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We investigated whether resistant pollen genotypes can be selected for when the maternal plants are infected and whether infection can result to changes in the pistil nutrient level influencing reproductive outcome. Both resistance and susceptibility come with costs that may affect pre- and post-fertilization reproductive functions. We performed the study by crossing zucchini yellow mosaic virus resistant and susceptible pollen (from a hybrid donor) to infected and healthy maternal plants. We also analysed the pistil nutrient content in both treatments and found an increase of the susceptible and not resistant genotypes when maternal plants were infected. The level of nutrients K, P and S was higher in the pistils of the infected maternal plants than the healthy ones. Pistil nutrient level did not affect pollen tube growth rates, as indicated by seed siring patterns along the fruit. We propose that the effect on the siring ability of pollen carrying the susceptible and resistant alleles occurred at the post-fertilization stage, possibly as an indirect result of different growth rates of the two embryo genotypes under elevated nutrient conditions. We discuss our results with respect to possibilities of differential selection, costs and reproductive implications.

Atherosclerosis is a leading cause of mortality and morbidity in the western world. It has been recognized for over a century, and the understanding of its pathogenesis has undergone many changes. Pathophysiological studies have unravelled the interactions of molecular and cellular elements involved in atherogenesis. The focus has shifted to the novel risk factors as well as characteristics and stability of atherosclerotic plaque; the genetic predisposition has further broadened the pathogenetic mechanisms. This review focuses on the molecular mechanisms involved in the evolution of the atherosclerotic plaque that may pave the way for selecting optimal therapies and preventing plaque complications. Atherosclerosis is no longer a disease attributed mainly to the high lipid content of the body. New insight into the disease pathology has shown it to be a disease of much greater ramifications. Endothelial damage and reactive oxygen species (and other free radicals) have predominantly emerged as factors in virtually all pathways leading to the development of atherosclerosis due to hyperlipidemia, diabetes, hypertension or smoking. Novel risk factors such as hyperhomocysteinemia, infections and systemic lupus erythematosus have emerged. Atherosclerosis has come to be regarded as a chronic inflammatory disease with an autoimmune component. The genetic basis of the disease assumes significance as candidate genes are identified and gene therapy becomes a promising new addition to the existing, less substantial conventional therapies.

The wide pathogenic variability occurring in phaeoisariopsis griseola, the causal agent of angular leaf spot of common bean (phaseolus vulgaris l.), is the greatest set-back to development and deployment of resistant bean varieties. The high pathogen variability dictates that new sources of resistance be continuously identified. This study was undertaken to evaluate reactions of selected bean germplasm to different races of p. griseola in an effort to identify potential sources of resistance to als. Selected bean lines/varieties from ecabren were separately inoculated with forty-four races of p. griseola and evaluated for disease development under greenhouse conditions. Isolates of p. griseola used in this study were collected from diverse bean growing areas in kenya and characterised into races based on the reactions of 12 differential bean cultivars. None of the varieties was resistant to all the races, indicating a high complexity of the pathogen population. eight varieties were resistant (disease grade 1 to 3) or moderately resistant (grade 4 to 6) to at least 40 (91%) of the races. bean lines ecab 0754 and ecab 0617 exhibited the highest level of resistance and were each susceptible to one race of p. griseola. all the resistant or intermediate resistant varieties were of the small- or medium-seeded bean types, whereas the commonly-grown large seeded varieties were generally susceptible. these results indicate that a number of bean varieties have varying levels of resistance that could be pyramided to provide durable resistance to angular leaf spot.

The wide pathogenic variability occurring in phaeoisariopsis griseola, the causal agent of angular leaf spot of common bean (phaseolus vulgaris l.), is the greatest set-back to development and deployment of resistant bean varieties. The high pathogen variability dictates that new sources of resistance be continuously identified. This study was undertaken to evaluate reactions of selected bean germplasm to different races of p. griseola in an effort to identify potential sources of resistance to als. Selected bean lines/varieties from ecabren were separately inoculated with forty-four races of p. griseola and evaluated for disease development under greenhouse conditions. Isolates of p. griseola used in this study were collected from diverse bean growing areas in kenya and characterised into races based on the reactions of 12 differential bean cultivars. None of the varieties was resistant to all the races, indicating a high complexity of the pathogen population. eight varieties were resistant (disease grade 1 to 3) or moderately resistant (grade 4 to 6) to at least 40 (91%) of the races. bean lines ecab 0754 and ecab 0617 exhibited the highest level of resistance and were each susceptible to one race of p. griseola. all the resistant or intermediate resistant varieties were of the small- or medium-seeded bean types, whereas the commonly-grown large seeded varieties were generally susceptible. these results indicate that a number of bean varieties have varying levels of resistance that could be pyramided to provide durable resistance to angular leaf spot.

The wide pathogenic variability occurring in phaeoisariopsis griseola, the causal agent of angular leaf spot of common bean (phaseolus vulgaris l.), is the greatest set-back to development and deployment of resistant bean varieties. The high pathogen variability dictates that new sources of resistance be continuously identified. This study was undertaken to evaluate reactions of selected bean germplasm to different races of p. griseola in an effort to identify potential sources of resistance to als. Selected bean lines/varieties from ecabren were separately inoculated with forty-four races of p. griseola and evaluated for disease development under greenhouse conditions. Isolates of p. griseola used in this study were collected from diverse bean growing areas in kenya and characterised into races based on the reactions of 12 differential bean cultivars. None of the varieties was resistant to all the races, indicating a high complexity of the pathogen population. eight varieties were resistant (disease grade 1 to 3) or moderately resistant (grade 4 to 6) to at least 40 (91%) of the races. bean lines ecab 0754 and ecab 0617 exhibited the highest level of resistance and were each susceptible to one race of p. griseola. all the resistant or intermediate resistant varieties were of the small- or medium-seeded bean types, whereas the commonly-grown large seeded varieties were generally susceptible. these results indicate that a number of bean varieties have varying levels of resistance that could be pyramided to provide durable resistance to angular leaf spot.

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

The stability of adrenaline ophthalmic solutions, at pH 5.8 and 7.4, to sterilization and storage conditions has been studied. Solutions sterilized by filtration or heating at 98 degrees C for 30 min showed no detectable degradation at either pH value, whilst sterilization at higher temperatures resulted in losses of up to 30%. Total degradation increased with increasing sterilization temperature at both pH values.

Two exotic fungal isolates, one of Beauveria bassiana (268–86) and another of Metarhizium anisopliae (100–82), three local isolates of B. bassiana (isolates I, II, III) and one of the entomogenous bacteria Serratia marcescens, were tested for pathogenicity against the banana weevil Cosmopolites sordidus. All four isolates of B. bassiana and the one of M. anisopliae were found to be pathogenic to third—instar larvae of C. sordidus, causing mortalities of 98–100% by 9 days post—exposure to dry fungal spores. M. anisopliae was the least pathogenic to larvae with LT50 of 4.2 days, compared to 3.5, 3.3, 3.6 and 4.0 respectively for isolates I, II, III and 268–86. B. bassiana was also pathogenic to adult C. sordidus, causing mortalities varying from 63–97% by 35 days post—exposure depending on isolate. As for larvae M. anisopliae exhibited low pathogenicity for the adult C. sordidus. In general, all the fungi tested were less pathogenic to adult weevils (LT50 = 17.5; 12.5; 8.0 and 22.0 days) for isolates I, II, III and 268–86 respectively, while isolate 100–82 failed to kill 50% of adults even by 35 days post—exposure. Incubation of dead weevils in a moist environment led to development of surface mycelia starting from intersegmental junctions. Histopathology revealed extensive destruction of internal organs by hyphae which invaded most of the organs. The LT50 for S. marcescens against C. sordidus larvae was 2.8 days. However, the bacterium did not kill adult C. sordidus even at 10 times the concentration applied on larvae.

ABSTRACT: Several strategies are employed in management of insect pests. Among these, chemical control is a priority to most farming communities where pest incidences occur while other existing options such as biological control are rarely considered. In coffee farming agro ecosystems, there are indigenous biological control agents such as the predacious phytoseiid mites, Euseius kenyae (Swirski and Ragusa) that have the potential to manage secondary pests like coffee thrips, Diarthrothrips coffeae Williams. This study was conducted to assess the population dynamics of E. kenyae and D. coffeae as well as theirinteractions under coffee agro ecosystems where various soil fertilizer sources and selective insecticides were applied as treatments. The populations of both E. kenyae and D. coffeae fluctuated during the three years study period. The E. kenyae suppressed the population of D. coffeae under various treated coffee blocks. There was negative correlation between E. kenyae and D. coffeae in year 2006 and 2008 where the increasing population of E. kenyae decreased that of D. coffeae. In year 2007, positive correlation between E. kenyae and D. coffeae was observed in some of the treatments where increased population of D. coffeae caused an increased population of E. kenyae. Euseius kenyae managed to contain the D. coffeae population to below economical injury levels (1-2 thrips per leaf) during the three years under the various coffee agro ecosystems. The use of chlorpyrifos never affected E. kenyae. Their survival and increased in number under chlorpyrifos treated coffee blocks indicated the development of resistance by the population of E. kenyae, hence the possibility of using them as a component in an Integrated Pest Management strategy in coffee.

An in vitro study of the antinematodal action of two groups of compounds which act on the receptor complex of the inhibitory neurotransmitter, Gamma-aminobutyric acid (GABA) in mammalian systems is described. The compounds, Ivermectin and two benzodiazepines, Diazepam and a water soluble Midazolam were tested singly or in combination against two microfilarial parasites Onchocerca lienalis (closely related to Onchocerca volvulus) and Brugia pahangi. The combination of ivermectin and diazepam at a concentration of 0.1 microgram/ml and 33 micrograms/ml respectively achieved the same effect on microfilarial motility as when ivermectin was given at 1 microgram/ml alone or diazepam at 66 micrograms/ml alone. Similarly when the combination of ivermectin at 0.1 microgram/ml and midazolam at 10 micrograms/ml was used it achieved the same effect as ivermectin at 1 microgram/ml alone or midazolam at 33 micrograms/ml alone. This showed that both benzodiazepines had a synergistic effect on the activity of ivermectin. The microfilariae of B. pahangi were insensitive to both groups of compounds at all concentrations used.

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Degenerative joint disease is a common and important disease that affects humans as well as domestic animals especially dogs and horses. The etiological factors for the disease in humans and animals are similar. The disease is characterized by progressive deterioration of the joint, thinning ofhyaline cartilage,joint effusion
and periarticular osteophyte formation. Trauma, sepsis, prolonged immobilization, immune-mediated disease, congenital malarticulation (e.g. hip dysplasia) or developmental diseases (eg. osteochondrosis), may incite the development of degenerative joint disease. The insults stimulate the release of degenerative enzymes from chondrocytes and these destroy the articular cartilage matrix. Two distinct functional process in injured chondrocytes are responsible for the positive
feed-back cascade that ultimately results in joint destruction. The catabolic process is induced by proinflammatory stimuli and causes secretion of proteases, suppression ofmatrix synthesis and inhibition
of chondrocyte proliferation. The anabolic program causes the increased production of extracellular matrix, protease inhibitors and cell replication. In the recent past a lot ofbasic and clinical research on degenerative joint disease has been conducted. Deeper understanding ofthe pathophysiology has resulted in the development of new treatment modalities for the disease. Practicing clinicians need to keep abreast with new knowledge and biomedical technology in order to
manage their patients in the best way possible. This paper collates the current knowledge ofthe pathophysiology and clinical management of degenerative joint disease with special reference to the canine species

There are many disorders/diseases that lead to changes in acid base balance. These conditions are not rare or uncommon in clinical practice, but everyday occurrences on the ward or in critical care. Conditions such as asthma, chronic obstructive pulmonary disease (bronchitis or emphasaemia), diabetic ketoacidosis, renal disease or failure, any type of shock (sepsis, anaphylaxsis, neurogenic, cardiogenic, hypovolaemia), stress or anxiety which can lead to hyperventilation, and some drugs (sedatives, opoids) leading to reduced ventilation. In addition, some symptoms of disease can cause vomiting and diarrhoea, which effects acid base balance. It is imperative that critical care nurses are aware of changes that occur in relation to altered physiology, leading to an understanding of the changes in patients’ condition that are observed, and why the administration of some immediate therapies such as oxygen is imperative.

There are many disorders/diseases that lead to changes in acid base balance. These conditions are not rare or uncommon in clinical practice, but everyday occurrences on the ward or in critical care. Conditions such as asthma, chronic obstructive pulmonary disease (bronchitis or emphasaemia), diabetic ketoacidosis, renal disease or failure, any type of shock (sepsis, anaphylaxsis, neurogenic, cardiogenic, hypovolaemia), stress or anxiety which can lead to hyperventilation, and some drugs (sedatives, opoids) leading to reduced ventilation. In addition, some symptoms of disease can cause vomiting and diarrhoea, which effects acid base balance. It is imperative that critical care nurses are aware of changes that occur in relation to altered physiology, leading to an understanding of the changes in patients’ condition that are observed, and why the administration of some immediate therapies such as oxygen is imperative.

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The incidence of ocular surface squamous neoplasia (OSSN) is strongly associated with solar ultraviolet (UV) radiation, HIV and human papilloma virus (HPV). Africa has the highest incidence rates in the world. Most lesions occur at the limbus within the interpalpebral fissure particularly the nasal sector. The nasal limbus receives the highest intensity of sunlight. Limbal epithelial crypts are concentrated nasally and contain niches of limbal epithelial stem cells in the basal layer. It is possible that these are the progenitor cells in OSSN. OSSN arises in the basal epithelial cells spreading towards the surface which resembles the movement of corneo-limbal stem cell progeny before it later invades through the basement membrane below. UV radiation damages DNA producing pyrimidine dimers in the DNA chain. Specific CC → TT base pair dimer transformations of the p53 tumour-suppressor gene occur in OSSN allowing cells with damaged DNA past the G1-S cell cycle checkpoint. UV radiation also causes local and systemic photoimmunosuppression and reactivates latent viruses such as HPV. The E7 proteins of HPV promote proliferation of infected epithelial cells via the retinoblastoma gene while E6 proteins prevent the p53 tumour suppressor gene from effecting cell-cycle arrest of DNA-damaged and infected cells. Immunosuppression from UV radiation, HIV and vitamin A deficiency impairs tumour immune surveillance allowing survival of aberrant cells. Tumour growth and metastases are enhanced by; telomerase reactivation which increases the number of cell divisions a cell can undergo; vascular endothelial growth factor for angiogenesis and matrix metalloproteinases (MMPs) that destroy the intercellular matrix between cells. Despite these potential triggers, the disease is usually unilateral. It is unclear how HPV reaches the conjunctiva.

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In the widespread trend for more participatory governance in public policy and planning (Cornwall and Coelho 2007; Nelson 2008; Gaventa and Mayo 2009), novel forms of engagement between private authority and civil society are also emerging, for example, in the development of private standards and monitoring systems (Giovannucci and Ponte 2005; Busch and Bain 2004). This chapter focuses on participation in private sector and value chain governance. In the late 1990s international NGOs and trade unions engaged with large retailers and brands to improve the content and implementation of labour codes, which had been initially written by companies in response to media, NGO and trade union pressure (Barrientos 2000, Hughes et al. 2007). The participation of private sector, trade unions, and NGO representatives and government observers in multistakeholder initiatives theoretically represents a new opportunity for improving the development and implementation of labour standards in global value chains (Tallontire 2007).

BACKGROUND: Hemostatic abnormalities have been reported in various hepatocellular diseases. We evaluated the hemostatic functions in patients with Budd-Chiari syndrome. METHODS: Biochemical liver function tests, and measurement of prothrombin time, activated partial thromboplastin time, and plasma levels of anti-thrombin III (antigen) and activity of protein C were done in 36 patients with Budd-Chiari syndrome. RESULTS: Liver biochemistry was abnormal in 34 patients. Plasma prothrombin time and activated partial thromboplastin time were prolonged in 17 (47%) and 23 (64%) patients, respectively. Antithrombin III antigen levels and protein C activity were reduced in 15 (50%) and 25 (83%) patients, respectively, among the 30 patients studied. Albumin levels showed significant correlation with coagulation test results, levels of anti-thrombin-III, and protein C activity. CONCLUSION: Hepatic synthesis of coagulation factors and anticoagulants is reduced in Budd-Chiari syndrome; this may play a role in recurrence of thrombosis.

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The Ministry of Health and partners should develop national standard operating procedures and IEC materials in renal nutrition counsellingfor harmonized messages. All patients with chronic kidney disease should get takeaway information leaflets with patient-specific simple nutrition messages to ensure the accuracy of nutrition information; All nutritionists and healthcare workers in renal units should participate in regular continuing nutrition education on most recent evidence-based nutrition information.

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OBJECTIVE: To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species. DESIGN: Prospective 6-month survey. SETTING: Tertiary care center in a developing country. PATIENTS: Pediatric and adult patients admitted with the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea. OUTCOME MEASURES: Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea. RESULTS: Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission. CONCLUSIONS: Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country. Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation. PIP: Researchers analyzed data on 667 patients admitted between March 9 and September 14, 1988 to the Kenyatta National Hospital in Nairobi, Kenya to verify the contribution of Salmonella and Shigella species to hospital acquired infections and to identify factors associated with admission and nosocomial infection. Laboratory personnel isolated Salmonella and Shigella in 12.5% (10% and 2.5% respectively) of the 360 patients with nosocomial diarrhea. Their overall prevalence was 3% and 2.5% respectively. These 2 bacteria were isolated from rectal swabs from 19 of the 27 hospital units. Most of the isolates were restricted to 5 units. All of the Salmonella isolates at admission were children under 13 years old (3.6% of 556 children). Shigella prevalence at admission was 2.5% for children and 3.6% for adults. The risk of nosocomial diarrhea caused by these 2 bacteria was much greater in children older than 6 months and younger than 6 years than in children of other ages (odds ratio [OR]=21.7; p=.006). The most significant variables which independently affected nosocomial diarrhea caused by these bacteria in children were recent antimicrobial therapy (OR=26.4; p=.001) and living in crowded homes (OR=1.2; p=.02). Another determinant was poor hair color indicating malnutrition (p=.03). Even though there were no significant differences between adults with nosocomial diarrhea caused by these bacteria and those with no nosocomial diarrhea, sharing a room with people with diarrhea, being in the hospital within the last 30 days, and being HIV-1 positive were factors that almost reached significance. In fact, 9 of their 22 (41%) adults with positive cultures of Salmonella were HIV=1 positive yet Salmonella was not isolated from any of the 70 HIV-1 positive patients at admission. Salmonella contributed greatly to nosocomial diarrhea at this hospital. The hospital should evaluate and redesign its control measures within available limited resources.

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Department of Pathology, University of Toronto, Ontario, Canada. Red blood cells and lysate products (erythrolysate) are observed consistently in lymph draining acute and chronic inflammatory reactions and from tissues subjected to trauma or surgical procedures. Using hemoglobin as a marker for erythrolysate, we have measured hemoglobin in lymph up to the 10(-6) M range in a number of pathophysiological states. Data demonstrate that erythrolysate alters the pumping characteristics of lymphatic vessels. To test the effects of erythrolysate on lymphatic pumping, bovine lymphatics were suspended in an organ bath preparation with the vessels cannulated at both inflow and outflow ends. By raising the heights of the Krebs reservoir and the outflow catheters appropriately, a transmural pressure that stimulated pumping activity could be applied to the vessels. With a fixed transmural pressure of 6 cm H2O applied to the ducts, sheep erythrolysate depressed pumping activity between 40% and 100%, with dilutions containing between 10(-8) and 10(-5) M hemoglobin. Although the active principle in the red blood cells has not been characterized, evidence from precipitation purification experiments suggests that hemoglobin is an important component. Once suppressed, pumping could be restored in many but not all vessels (often to control levels) by elevating the distending pressure above 6 cm H2O. The relation between transmural pressure and fluid pumping is expressed as a bell-shaped curve, with pumping increasing up to a peak pressure (usually 8 cm H2O) and declining at pressures above this level. By comparing pressure/flow curves, we were able to ascertain that hemoglobin shifted the lymphatic function curve to the right and, on average, reduced the maximum pumping capability of the vessels. We speculate that the presence of erythrolysate/hemoglobin in lymph may modulate the ability of lymphatic vessels to drain liquid and protein from the tissue spaces.

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{ This paper proposes a new theory, a theory of the memetic sphere; and outlines its main features, based on library research. In Dawkinsian parlance, memes are ideas, phrases and sentences with a gene-like capacity to replicate. The theory maps the chain-reaction in the form of which this replication becomes what we know as the information explosion, and attempts to show what lies beyond the explosion. No known study has highlighted the similitudes between the memetic sphere and the physical universe. The theory is summarized in an Einsteinian equation

Abstract
Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis P<0.001. Nulliparous patients significantly had a risk of having endometriosis p<0.001. The patients with menarche at 13 years and below had a significant risk of having endometriosis p=0.001. Physical findings on clinical examination of adnexal tenderness and findings of nodules in the pouch of Douglas were significant in relation to endometriosis p<0.001. The most common site of the histological endometriosis implants were on the Pouch of Douglas (30%) and the most common form of endometriosis was superficial (43%). Conclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.

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OBJECTIVE: To establish the pattern and results of interventions in patients with abdominal injuries requiring admission. DESIGN: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management as either discharged or deceased. SETTING: Kenyatta National Hospital, a tertiary teaching and referral hospital in Nairobi, Kenya, from November 2004 to February 2005 in the adult general surgical wards. PATIENTS: Eighty consecutive admissions of adult patients with either blunt or penetrating abdominal injuries. MAIN OUTCOME MEASURES: Type and cause of injury, demographic data, temporal parameters, morbidity and mortality. RESULTS: The 80 patients had a male to female ratio of 12.3:1, the majority were in the third decade of life with a range 15-56 years and mean of 28.2 years. Penetrating to blunt abdominal injuries had 2:1 ratio with the leading causes of injury being stab wounds, gunshot wounds and road traffic accidents. Blunt abdominal injuries had a higher tendency to extra-abdominal injuries. Duration prior to presentation to hospital and surgery depended on severity of injury. Modes of management varied between attending surgical firms. There was a 20% change in the mode of management and a 16.1% rate of negative laparotomy. Penetrating injuries had a better interventional outcome. Penetrating abdominal injuries had higher rates of complications while the blunt injuries had higher rates of mortality. Overall, both the complication and mortality rates were 12.5%. Correlates of mortality included delay before surgery, associated injuries, need for blood transfusion, admission to intensive care unit and duration prior to admission. Abdominal injury patients stayed an average of 6.4 days with the blunt injuries with complications staying close to twice as much as their penetrating counterparts. CONCLUSION: Abdominal injuries are a predominantly male disease with the majority in the third decade of life. As opposed to previous studies, gunshot wounds are now a significant cause of abdominal injuries in Kenyatta National Hospital (KNH). The rate-of negative laparotomies has come down by 10% over the past 15 years. The outcome of management depends on the severity and type, of injury sustained.

Background: Vermiform appendix performs function immunologically and acts like a tonsil. The objective of the study was to determine different positions of appendix in people of district Bannu. Methods: It was a cross-sectional descriptive study conducted in district Bannu from January 1, 2009 to December 31, 2009. Sample size was 500, including appendices during surgery in acute abdomen, postmortem, and among dissected bodies. Vermiform appendices were observed in situ and positions recorded accordingly. Results: The age ranges was 1 to 60 years. Retrocaecal position was highest (57%) followed by pelvic (28.6%), post-ileal (9.4%) and pre-ileal (4%). The paracaecal and ectopic varieties were 5%. Conclusion: Retrocaecal is the commonest position followed by pelvic appendix.

Acquired paediatric neck masses constitute a diagnostic challenge. Their pattern is important in formulating management protocol. Reports from developing countries including Kenya are scarce. This study describes the causes, location, clinical features and gender distribution of these masses in a Kenyan paediatric population. This prospective cross-sectional study was carried out in a regional Eastern and Central African referral centre in Kenya. Children aged 16 years and below with neck masses, who presented to various clinics and wards in a 5 month period were examined. One hundred and eighty four of 235 masses (78%) were acquired. Inflammatory cases were the most common (64%), followed by malignant neoplasm (32%). The most common inflammatory cases were abscesses, reactive lymphadenopathy and tuberculous adenitis. They mainly involved upper cervical and submandibular lymph nodes and were more prevalent in those aged less than 4 years. Lymphomas were the most common malignant masses (42%). Malignant masses were widespread in location; non-tender, and most frequent in those aged 4-8 years. In conclusion, inflammatory conditions consistent with upper airway infection cause most acquired paediatric neck masses, but malignant neoplasms constitute a significant proportion. Prudent management of infection and early confirmation of diagnosis are recommended.

The objective of this study was to describe the pattern of acute myocardial infarction in an African country. These data are important for prevention strategies but are scarce from sub-Saharan African countries and altogether absent from Kenya.

The objective of this study was to describe the pattern of acute myocardial infarction in an African country. These data are important for prevention strategies but are scarce from sub-Saharan African countries and altogether absent from Kenya.

Background: Reports on pattern of aneurysms among young people are scanty. These data are important for informing preventive and management strategies. This retrospective study at Kenyatta National Hospital, Nairobi. Kenya describes the pattern of aneurysms among young black Kenyans.
Patients and methods: Records of in-patients, aged up to 40 years, with a diagnosis of aneurysm between January 1998 and December 2007 were examined for localization, presentation, investigations, comorbidities, age and gender distribution. Data were analyzed by SPSS version 13.0 for Windows, and presented in tables and bar charts.
Results: One hundred and fifteen files were analyzed. Most frequent site was abdominal aorta (32.2%). Of these, majority (59.4%) were infrarenal. Other commonly affected arteries included thoracic aorta (11.3%), posterior communicating (7.8%), femoral (8.7%), brachial (8.7%), common carotid (6.1%) and internal thoracic (5.2%). They presented as pulsatile, often painful masses, and with pressure symptoms. Diagnosis was confirmed by ultrasound and angiography. Common comorbidities were hypertension,
smoking, Human Immunodeficiency Virus infection, alcohol, trauma, and connective tissue disorders. Mean age was 26.1 years and male: female ratio was 2.7:1.
Conclusion: Aneurysms are not uncommon in young Kenyans. They occur more commonly in males than females, and affect diverse vascular beds. Associated comorbidities comprise non communicable lifestyle factors, infection, inborn conditions and trauma. Lifestyle modification from early in life and control of infections are recommended.

We sought to describe the regional, age, and sex distribution; diagnosis; treatment; and outcome of aortic aneurysms in a Kenyan population.

We sought to describe the regional, age, and sex distribution; diagnosis; treatment; and outcome of aortic aneurysms in a Kenyan population.

{ OBJECTIVE: To establish a cohort of high-risk individuals suitable for HIV-prevention trials, and to measure changes in sexual behaviour and sexually transmitted disease (STD) incidence after a behavioural intervention. DESIGN: Prospective cohort study in trucking company depots in Mombasa, Kenya. PARTICIPANTS: A total of 556 male HIV-seronegative employees of trucking companies. INTERVENTIONS: HIV serological testing, individual counselling, condom promotion, STD diagnosis and management. MAIN OUTCOME MEASURES: Sexual risk behaviour and symptomatic STD incidence. RESULTS: Using time-trend modelling, significant declines in self-reported high-risk sexual behaviour were demonstrated during a 1-year follow-up. The percentage of men reporting any extramarital sex during the 3-month period prior to a follow-up visit decreased from 49% durig the first quarter of follow-up to 36% during the last quarter (P < 0.001). The decline in reported female sex worker contact was from 12% to 6% (P = 0.001). Approximately 30% of men reported consistent condom use during extramarital sex and this percentage remained unchanged during the study period. The incidence of STD declined from 34 per 100 person years (PY) during the first quarter to 10 per 100 PY during the last quarter (P = 0.001). Significant reductions in gonorrhoea (15 to five cases per 100 PY

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Intracranial aneurysms constitute a significant part of the caseload for any neurosurgical service. Despite the occurrence of intracranial aneurysms and the availability of advanced diagnostic tools and management options, there is a paucity of published data concerning aneurysm patterns in Kenya.

The pattern of chest radiograph findings were studied in 280 HIV positive individuals.
These were compared to 40 HIV negative patients who acted as controls. The
commonest disease seen was pneumonia 94 (33.9%), followed by pulmonary
tuberculosis 89 (3l.7%). Mixed infections were seen in 34 (12.2%) cases while PCP
occurred in 16(5.6%) cases. The pneumonia seen was more of bronchopneumonia than
lobar pneumonia in-patients with HIV (33.9) than HIV negative patients (23%).
The cases of pulmonary tuberculosis seen showed less upper lobe distribution than in
HIV negative patients. Most of the cases showed mid and lower zone distribution.
There are less cavitations than HIV negative patients. Also more cases with hilar and
mediastinal nodes were seen. There were 34 (12.2%) cases of mixed infection, which
constituted of 3 (1.1 %) cases of non-Hodgkin's lymphoma. These mainly presented
with hilar and mediastinal nodes. The clinical differentiating features were KS skin
nodules in-patients with pulmonary K.S.

The distribution of congenital neck masses varies between countries and is important in diagnosis and treatment modalities. Data from Africa is scarce, and altogether absent from Kenya.

Heart failure in children is a common cause of morbidity and mortality, with high socio-economic burden. Its pattern varies between countries but reports from Africa are few. The data are important to inform management and prevention strategies.

Peripheral aneurysms are important because of concurrence with aortic ones and potential to thromboembolise or rapture. Their distribution shows population variations yet reports from Africa are scarce and altogether absent from Kenya. Objective To describe the pattern of peripheral aneurysms in a Kenyan national referral hospital. Patients and methods Records of in-patients with a diagnosis of peripheral aneurysms at Kenyatta National Hospital between January 1998 and December 2007 were analyzed for presentation, diagnostic method, risk factors, site, age and gender distribution. Only records containing all these data were included. Data were analyzed using SPSS version 13.0 and presented using tables, and bar charts. Results Ninety six cases involved the femoral (24%), common carotid (15.6%); brachial (12.5%); brachiocephalic (11.5%) and popliteal (10.4%) arteries. They presented with pulsatile mass (37.5%), painful swelling (22.9%) and pressure on subjacent structures (13.5%). Diagnosis was confirmed by Doppler ultrasound (37.5%), conventional angiography (30.2%) and plain ultrasound (14.6%). Mean age was 45.6 years (range 13 – 79 years); with 50% of them occurring in individuals aged 40 years and younger. Common risk factors were trauma (39.6%), hypertension (13.5%) and atherosclerosis (9.4%). Male:female ratio was: 15:1 for femoropopliteal, 5:1 for brachial; 1:1 for common carotid and 1:2.6 for brachiocephalic trunk. Conclusion Characteristics of peripheral aneurysms in the Kenyan study population vary from those of Caucasians. They are more widespread, trauma related, and occur in younger individuals. Prudent management of risk factors is recommended.

Peripheral aneurysms are important because of concurrence with aortic ones and potential to thromboembolise or rapture. Their distribution shows population variations yet reports from Africa are scarce and altogether absent from Kenya. Objective To describe the pattern of peripheral aneurysms in a Kenyan national referral hospital. Patients and methods Records of in-patients with a diagnosis of peripheral aneurysms at Kenyatta National Hospital between January 1998 and December 2007 were analyzed for presentation, diagnostic method, risk factors, site, age and gender distribution. Only records containing all these data were included. Data were analyzed using SPSS version 13.0 and presented using tables, and bar charts. Results Ninety six cases involved the femoral (24%), common carotid (15.6%); brachial (12.5%); brachiocephalic (11.5%) and popliteal (10.4%) arteries. They presented with pulsatile mass (37.5%), painful swelling (22.9%) and pressure on subjacent structures (13.5%). Diagnosis was confirmed by Doppler ultrasound (37.5%), conventional angiography (30.2%) and plain ultrasound (14.6%). Mean age was 45.6 years (range 13 – 79 years); with 50% of them occurring in individuals aged 40 years and younger. Common risk factors were trauma (39.6%), hypertension (13.5%) and atherosclerosis (9.4%). Male:female ratio was: 15:1 for femoropopliteal, 5:1 for brachial; 1:1 for common carotid and 1:2.6 for brachiocephalic trunk. Conclusion Characteristics of peripheral aneurysms in the Kenyan study population vary from those of Caucasians. They are more widespread, trauma related, and occur in younger individuals. Prudent management of risk factors is recommended.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Objective: To describe the pattern of femoro-popliteal aneurysms in an African Kenyan population.
Patients and methods: Records of African in-patients with diagnosis of femoral or popliteal aneurysms admitted at the Kenyatta National Hospital, Nairobi, Kenya, from January 1998 to December 2007 were examined for presentation, diagnosis, risk/comorbid factors, site, age, and gender distribution. Data were analyzed using SPSS 13.0 and presented using tables.
Results: Femoro-popliteal aneurysms constitute 33 out of 96 of peripheral cases (34.4%). The most common presentations were pulsatile mass (48.5%) and pain and swelling (33.3%). Pain alone and bleeding occurred in 9.1% each. Diagnosis was performed through Doppler ultrasound (45.5%), angiography (30.3%) and ultrasonography (24.3%). Aneurysms were associated with trauma (51.5%), atherosclerosis (21.2%), smoking (9.1%) and hypertension (6.1%). Site distribution was common femoral (33.3%), superficial femoral (36.4%) and popliteal (30.3%). Mean age was 46 years (range 13-79 years); with 20 (60.6%) of them occurring in individuals aged 50 years and younger. Male:female ratio was 15:1.
Conclusion: In the present study, femoro-popliteal aneurysms constituted less than 40% of peripheral aneurysms, and superficial femoral artery was the most common site. They occurred predominantly in males aged 50 years and younger and were associated mainly with trauma and atherosclerosis. Prevalence, site and age distribution of these aneurysms in the Kenyan population differs from that described in studies of Caucasian populations.

Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce.

Hypertensive kidney disease is a major cause of morbidity and mortality. Its pattern displays geographical and ethnic variations. Data on these patterns are important for informing management and prevention strategies, but on Kenyans such data are scarce.

Gluteus Maximus Muscle: Implication in Prosthetic Hip Dislocation
Awori K.O. MBChB, MMed (Surgery), Dip. (SICOT), FCS (Orth) ECSA, Anne N. Pulei A.A. Bsc, MBChB, Gikenye G. MBChB, MMed,FCS(ECSA) Affiliation: Department of Human Anatomy, University of Nairobi, P.O. Box 30197 00100 Nairobi, Kenya. Correspondingauthor: KirsteenO.Awori,Tel.254-722812499,Email: karsto2005@yahoo.com
Abstract
Background: Dislocation is one of the most common complications after total hip arthroplasty. The posterolateral approach avoids disruption of the abductor mechanism but may denervate gluteus maximus as a basis for associated higher dislocation rates.
Objective: To determine the pattern of innervation of gluteus maximus Study design: Descriptive cross-sectional study
Materials and methods: Twenty four cadavers for routine dissection in the Department of Human Anatomy, University of Nairobi were used. Having exposed the gluteus maximus, the muscle was transected close to its distal attachment and reflected superiorly to expose the entry of the neurovascular structures into it from the greater sciatic foramen. The pattern of distribution of the inferior gluteal nerve to the muscle was
Introduction
Gluteus maximus (GM) is a powerful hip extensor inner- vated by the inferior gluteal nerve (IFN) and an impor- tant muscle in rising up from squatting position, climb- ing (1) and running (2). Its functions during running are to control flexion of the trunk on the stance-side (3) and to decelerate the swing leg. Low levels of GM activity may contribute to hip extension during stance, and to re- strain hip flexion during swing. During loading response of the gait cycle, in the frontal plane, activity in the up- per portions of the gluteus maximus, hip abductors and tensor fascia lata control drop of the contralateral pelvis, which is relative hip adduction (4).
Risk factors in prosthetic hip dislocation include patient- related ones such as neuromuscular disease (5) and sur- gical ones. Of the surgically-related factors, the approach has generated a lot of controversy. In the Moore posteri- or approach to the hip the incision starts 10 centimetres from the posterior superior iliac spine, is directed later- ally and distally to the back of the greater trochanter and extends for 10 or more centimetres, parallel to the shaft of the femur. The deep fascia is exposed and the iliotibial band is incised from the trochanter to the distal end of
noted and the left and right in the same cadaver compared
Results: In all the 48 cadaver sides, the inferior gluteal nerve exited
the pelvis via the infra-piriformic compartment of the greater sciatic foramen. In majority (43, 89.6%) of gluteal regions this nerve funned out in multiple equal branches to the GM. Only one branch crossed the upper border of piriformis muscle. In 5 cases, this single branch that crossed the upper border of piriformis was a major trunk almost equal in size to the parent nerve. One such case was bilateral.
Conclusion: A major branch of the inferior gluteal nerve to the upper part of GM, when present, could be injured in the posterior approaches to the hip to significantly weaken the upper part of this muscle increasing the risk of prosthetic hip dislocation.

The causes of limb amputation among children differ between and within countries. These data
are valuable in prevention and planning of rehabilitation strategies for the victims but are
scarcely reported. The aim of this study was to investigate the causes of amputation in children
and adolescents in rural Kenya. Records of patients aged 18 years and younger who underwent
major limb amputation in PCEA Kikuyu and Tenwek Hospitals between January 1998 and
December 2008 were analyzed retrospectively for cause and age. Data were analyzed by SPSS
(version 11.50). Only complete records for age and confirmed diagnosis were included. Eightyeight
of 290 (30.3%) amputation cases were in individuals aged 2 weeks to 18 years. Trauma was
the most common cause (42%), followed by congenital defects (29.5%), infection (12.5%), and
tumors (11.4%). Of the trauma cases, burns were the most common cause (27%), followed by
animal bites (18.9%), road traffic accidents (16.2%), and falls (13.5%). A total of 77.2% of the
patients presented after the age of 5 years. The male:female ratio was 2:1. These data imply that
more than 70% of amputations among rural Kenyan children result from preventable causes that
may be related to poor socioeconomic status. Improvement of living standards, formulation of
public health education, and planning for rehabilitation programs are recommended.

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by pdssenger service vehicles. Objective: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. Design: A cross-sectional study. Setting: Kenyatta National Hospital (KNH). Subjects: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. Results: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively, Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (5TIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1 %) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37}% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. Conclusion: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. Recommendations: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

Jaw cysts and cyst-like lesions cause facial deformity, destruction of dental tissues and af-fect masticatory and phonation functions. These ad-versely erode patients’ psycho-social status; create low self-esteem and may change one’s facial identity and appearance. Objective: To determine the histo- pathologic characteristics, variants and demographic pattern of jaw cysts and cyst-like lesions at the Uni-versity of Nairobi Dental Hospital. Material and Method: This was an analytical and verification study that involved microscopic re-examination of all available incisional/excisional biopsy samples from January 2000 to December 2009 for histo-patho- logical diagnosis at the University of Nairobi Dental Hospital. Results: 187 jaw cysts and cyst-like lesions were diagnosed at the University of Nairobi Dental Hospital over the ten-year period. Keratocystic odon- togenic tumours constituted 28%, dentigerous cysts 25%, nasopalatine duct cysts 19%, radicular cysts 15%, while calcifying odontogenic cysts comprised 4% of all the lesions. The rest of the lesions were be-tween 1% and 3% of all the lesion entities. Conclu-sion: Keratocystic odontogenic tumours and den-tigerous cysts were the most common developmental odontogenic cysts diagnosed in the ten-year period.

Jaw cysts and cyst-like lesions cause facial deformity, destruction of dental tissues and af-fect masticatory and phonation functions. These ad-versely erode patients’ psycho-social status; create low self-esteem and may change one’s facial identity and appearance. Objective: To determine the histo- pathologic characteristics, variants and demographic pattern of jaw cysts and cyst-like lesions at the Uni-versity of Nairobi Dental Hospital. Material and Method: This was an analytical and verification study that involved microscopic re-examination of all available incisional/excisional biopsy samples from January 2000 to December 2009 for histo-patho- logical diagnosis at the University of Nairobi Dental Hospital. Results: 187 jaw cysts and cyst-like lesions were diagnosed at the University of Nairobi Dental Hospital over the ten-year period. Keratocystic odon- togenic tumours constituted 28%, dentigerous cysts 25%, nasopalatine duct cysts 19%, radicular cysts 15%, while calcifying odontogenic cysts comprised 4% of all the lesions. The rest of the lesions were be-tween 1% and 3% of all the lesion entities. Conclu-sion: Keratocystic odontogenic tumours and den-tigerous cysts were the most common developmental odontogenic cysts diagnosed in the ten-year period.

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The jaws are host to a variety of cysts due in large part to the tissues involved in tooth formation. Odontogenic cysts (OCs) are unique in that they affect only the oral and maxillofacial region. There are few studies from sub-Saharan Africa. This study was aimed at describing the pattern of various types of cysts in the oral and maxillofacial region in a Kenyan population. This was done at the Departments of Oral and Maxillofacial Surgery and Oral Medicine and Pathology, University of Nairobi Dental Hospital. This was a retrospective audit. All histopathologic records were retrieved from 1991 to 2010 (19 years) and were counted. The following information was extracted and recorded in a data sheet: age, sex, and the type of cystic lesions. There were 194 cysts (4.56%) diagnosed of 4257 oral and maxillofacial lesions. Of these, 64.4% were from male and 35.6% were from female patients with an age range of 1 to 70 years (mean, 23.76 [SD, 14.05] years; peak and median of 20 years). The most common OCs (57.2%) were dentigerous and radicular, whereas the most common nonodontogenic cyst (42.8%) was nasopalatine duct cyst. Other soft tissue cysts reported were epidermoid, branchial, thyroglossal, dermoid, and cystic hygroma. Oral and maxillofacial cysts are not uncommon in this population, the majority being the OC, dentigerous cyst, followed by the nonodontogenic cyst, nasopalatine cyst. The cysts are male predominant and occur 10 to 15 years earlier compared with those in the white population.

The jaws are host to a variety of cysts due in large part to the tissues involved in tooth formation. Odontogenic cysts (OCs) are unique in that they affect only the oral and maxillofacial region. There are few studies from sub-Saharan Africa. This study was aimed at describing the pattern of various types of cysts in the oral and maxillofacial region in a Kenyan population. This was done at the Departments of Oral and Maxillofacial Surgery and Oral Medicine and Pathology, University of Nairobi Dental Hospital. This was a retrospective audit. All histopathologic records were retrieved from 1991 to 2010 (19 years) and were counted. The following information was extracted and recorded in a data sheet: age, sex, and the type of cystic lesions. There were 194 cysts (4.56%) diagnosed of 4257 oral and maxillofacial lesions. Of these, 64.4% were from male and 35.6% were from female patients with an age range of 1 to 70 years (mean, 23.76 [SD, 14.05] years; peak and median of 20 years). The most common OCs (57.2%) were dentigerous and radicular, whereas the most common nonodontogenic cyst (42.8%) was nasopalatine duct cyst. Other soft tissue cysts reported were epidermoid, branchial, thyroglossal, dermoid, and cystic hygroma. Oral and maxillofacial cysts are not uncommon in this population, the majority being the OC, dentigerous cyst, followed by the nonodontogenic cyst, nasopalatine cyst. The cysts are male predominant and occur 10 to 15 years earlier compared with those in the white population.

Background: Pattern of origin of anterior inferior artery is important in interpretation of posterior circulatory stroke
and during posterior cranial fossa surgery for aneurysms, arteriovenous malformations, tumors, posterior cerebral
revascularization, and in diagnostic as well as interventional neuroradiology. The pattern displays ethnic variation
but data from African populations are scanty. This study therefore aimed to describe the pattern of origin of anterior
cerebellar artery in a black Kenyan population.
Materials and Methods: One hundred and seventy three [99 male: 74 female] basilar arteries from adult formalin
fixed brains were studied at Department of Human Anatomy, University of Nairobi, Kenya. Site and pattern of origin
of anterior inferior cerebellar arteries were recorded. Data were analyzed by SPSS version 17.0 for Windows, and
presented in a table and macrographs.
Results: Anterior inferior cerebellar artery arose directly from basilar artery in 138 (79.8%), as common trunk with
labyrinthine artery in 24 (13.9%), from verterbral and labyrinthine arteries in 3% cases each.
Conclusion: In about 14% cases, anterior inferior cerebellar and labyrinthine arteries arise as common trunks
from basilar artery. These proportions differ with those in prevailing literature from Caucasian and oriental
populations. Extra care should therefore be exercised during surgery and neuroradiology in the posterior cranial
fossa, and in interpretation of signs of posterior circulation stroke. Pre-operative ultrasound evaluation of the
vascular bed is recommended.

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

Background
The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital.
Patients and Methods
The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts.
Results
Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32 – 96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%).
Conclusion
Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.

the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain.

the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain.