Four hundred and three teenage secondary school students (50.6% males) from two girls' and two boys' Nairobi City Schools, selected by stratified sampling, were screened to determine the prevalence of proteinuria, haematuria, nitrituria and hypertension. Nine students (2.2%) had significant proteinuria while 14 (3.5%) had microscopic haematuria. Two students had combined proteinuria and haematuria. There was no statistically significant difference in the prevalence of proteinuria and/or haematuria between the sexes. Other urinary abnormalities detected were leucocyturia in 14(3.5%) and nitrites in four (1%). Leucocyturia was commonner in females (p = 0.001). Cloudy urinary appearance was significantly associated with the presence of leucocyturia (p = 0.0028) and proteinuria (p = 0.0276). Neither personal history of recurrent sore throat and skin infections nor family history of hypertension, diabetes mellitus or kidney disease was significantly associated with proteinuria or haematuria. Blood pressure tended to increase with age. Mean systolic and diastolic blood pressures were significantly higher in boys than girls in the age group 15-18 years (P < 0.001). Of the 397 students whose blood pressures were measured, four (1%) were found to be hypertensive. Weight and body mass index were strong positive correlates of blood pressure. The prevalence of proteinuria, haematuria, other urinary abnormalities and hypertension ranges between 1% and 3.5% among teenage secondary school children. The majority are asymptomatic and have no significant associations. It is recommended that routine urinalysis and blood pressure measurements should be part of the school health service so as to identify asymptomatic students who require close monitoring and/or intervention.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

{ BACKGROUND: Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99% of deaths in developing countries. Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income settings is often outdated. Our aim was to determine if a simple one day newborn resuscitation training (NRT) alters health worker resuscitation practices in a public hospital setting in Kenya. METHODS/PRINCIPAL FINDINGS: We conducted a randomised, controlled trial with health workers receiving early training with NRT (n = 28) or late training (the control group

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In 7 years (1981-1988) at the Kenyatta National Hospital (KNH), Nairobi the diagnosis of systemic lupus erythematosus (SLE) was made in 67 patients. In 23 of these patients lupus nephritis complicated the SLE. Lupus nephritis was diagnosed through renal biopsy, haematuria and proteinuria in urine with positive lupus erythematosus (LE) cell phenomenon. The histology found in these patients included 5 patients with minimal lesion, 7 patients with membranous, 3 with focal, 4 with diffuse, 3 with crescenteric and one with membranoproliferative glomerulonephritis. While patients with minimal, membranous and focal nephritis had general good outlook on low dose maintenance or intermittent high dose steroid therapy the others with diffuse, crescenteric and membranoproliferative nephritis had poor prognosis. Patients with diffuse proliferative, membranoproliferative and crescenteric nephritis tended to have septicaemia, pulmonary oedema, fluid overload and chronic renal failure with poor prognosis. These patients responded poorly to oral and parenteral steroid therapy whether high or low dose.

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William O. Ogara¹, Nduhiu J. Gitahi¹, Samuel A. Andanje² , Nicholas Oguge³, Dorcas W. Nduati¹ and Alfred O. Mainga¹

¹Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Kenya

²Kenya Wildlife services, Nairobi, Kenya

³Earthwatch Institute, Nairobi, Kenya

This study determined the prey base for four main carnivores found in Samburu Community group ranches and grazing area, Lion (Panthera leo), Leopard (Panthera pardus), Wild dog (Lycaon pictus) and Hyaena (Crocuta crocuta, and Hyaena hyaena). A total of 96 scat samples including, 8 from Lion, 16 Leopards', 2 Wild dogs', and 70 Hyaenas' were collected, identified and microscopically analyzed for prey hair characterisation. At least 50 different hairs from every scat sample were mounted on slides and microscopically characterized using details from reference hairs. Hairs from 18 depredated species both domestic and wild ungulates were recovered from the scat samples. Predated species were identified, as either domestic (Cow, Sheep, Goat, Donkey, and Camel) or wild ungulate prey (Grant's gazelle, plain zebra, Grevy's Zebra, Impala, Waterbuck, Dikdik, Eland, lesser Kudu, greater Kudu, Baboon, rock Hyraxes, Elephant and Oryx). The carnivores showed a relatively high kill of wild ungulate prey compared to domestic prey. Camel was the most preferred cow and donkey respectively. Grevy's zebra contributed highest to the lion's diet while the Plain zebra was most preferred by the leopard. Both the hyaena and Wild dog had a preference for the waterbuck. The Hyaena had the highest domestic depredation, while all the other big cats depredated more on wild ungulates.

Key words: Scat, group ranch, domestic, wild ungulate, prey, depredation.

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

No abstract available

A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

Extensive research in developed countries has established that very low birth weight (VLBW) infants are particularly vulnerable to the effects of early nutritional deficiencies. There is, however, little information from poor countries on the long-term effects of these deficiencies in such infants.

Determine the association between neonatal feeding regimens and post-discharge morbidity/ mortality and neurological abnormalities at the age of two years for a cohort of VLBW infants.

One hundred and seventy five VLBW infants were recruited over a consecutive period of one year and followed up to the age of two years corrected for gestation. With neonatal feeding regimes as the exposure variable, post-discharge re-hospitalization, mortality and Saigal and Rosenbaum's functional disability assessment scores were compared as the outcome variables.

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One hundred twenty black patients with mild to moderate essential hypertension participated in a double-blind placebo-controlled crossover study of the efficacy and tolerability of slow release oxprenolol versus chlorthalidone singly and in combination. Oxprenolol as monotherapy produced no effect on blood pressure as compared with placebo even after doubling the dose. Chlorthalidone as monotherapy produced a significant decrease in blood pressure (p less than 0.01). Combining oxprenolol with chlorthalidone yielded hypotensive effects in excess of those of either of the components given singly. Oxprenolol produced a significant decrease in plasma renin activity (PRA) whereas chlorthalidone produced a significant increase in PRA. These results indicate that a beta-blocking agent alone is ineffective in lowering blood pressure in hypertensive blacks, even when the dose is high. Oxprenolol may increase the hypotensive effect of chlorthalidone by counteracting the hypokalemic effect of the diuretic and by attenuating the diuretic-induced increase in plasma renin activity.

Science News 2, 125-132.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

A model based on reaction kinetics and elemental diffusion is pro­posed to account for the presence of double inflection in the hardness profiles of the heat-affected zone (HAZ) in weld­ments of AI-Li-X alloys tested without postweld heat treatment (PWHT). Such profiles are particularly evident when 1) the base metal is in the peak-aged (T8 or T6) temper condition prior to welding; 2) the welding process is a high-heat input process, i.e., gas tungsten arc (GTA), gas metal arc (GMA) or plasma arc (PA) welding; and 3) a filler alloy deficient in lithium (i.e., AA 2319) is used. In the first part of this paper, the theoretical mechanisms are presented. It is proposed that the double inflection appears due to complete or partial reversion of the semi-coherent, plate-like precipitates (i.e., ө', T₁ or S'); coarsening of the platelike precipitates at constant volume fraction; precipitation of d' as a result of natural aging; and diffusion of lithium from the HAZ into the weld pool due to the concentration gradient between the weld pool and the base metal. In the second part (to be published in next month's Welding Journal), experimental validation of the model is provided using weld-ments of the AI-Li-Cu Alloy 2095.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

 

 No abstract available.

Autonomic nervous function was assessed in twenty two patients (16 males and 6 females) with chronic renal failure on conservative management. The presenting symptoms were postural dizziness in 10(45%), impotence in 4(18%) patients and 1 patient each with diplopia, urinary urgency and nocturnal diarrhoea. The following autonomic function tests were performed; valsalva manoeuvre, heart rate response to deep breathing, heart rate response to posture and postural change in blood pressure. Fifteen (68%) patients had abnormal autonomic function tests. Out of these patients, 14(93%) had abnormalities of the parasympathetic system and only one had abnormalities in the sympathetic system. There was a negative correlation between the creatinine levels and the following; valsalva ratio (r = -0.72 p < 0.001), heart rate response to standing (r = -0.56 p < 0.01) and heart rate response to deep breathing (r = -0.45 p < 0.05).

Fresh blood lymphocytes from nine health donors have been compared with samples from the same donors, recovered after period of 2 to 21 months storage in liquid nitrogen, for the capacity to respond to a range of mitogens in vitro. A microculture assay was used, requireing aliquots of only 25,000 cells. The mean levels of 14C-thymidine uptake for fresh and frozen samples were closely comparable when the cells had been stimulated by PHA, Pokeweed or mitomycin-C-treated allogeneic lymphoblastoid cells. Lymphocytes from six East African donors, frozen by a very simple technique, were recovered after 3 or more years storage in liquid nitrogen. Five of the samples were in good condition as judged by cell viability and the capacity to form spontaneous 'E' rosettes with sheep erythrocytes. These five samples also responded extremely well to PHA, PWM and mitomycin-C-treated allogeneic lymphoblastoid cells using the microculture assay. This study extends the range of applications of cell banks in which small aliquots of blood lymphocytes are stored in liquid nitrogen for periods of several years.

Nyambok, I.O.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

No abstract available

In a one year period (March 1990 to March 1991) the pattern of diseases in geriatric patients (over 60 years of age) admitted to the medical wards at Kenyatta National Hospital (KNH) was studied. In all, there were 1296 patients (M:F = 1.7:1) in this age group forming 11.5% of all admissions during the study period. 1008 (77.8%) of the geriatric patients were between 60 and 79 years of age. Most of the admissions (86.4%) were first admissions. The mean number of diseases per geriatric patient was 1.4. Hypertension and Cardiomyopathy were the commonest single diseases recorded, making up 43.9% of all diseases in this patient population. The commonest neurological diagnosis was stroke, which occurred in a setting of hypertension or cardiomyopathy in all the patients in whom it was diagnosed. The mean duration (+/- 2SD) of stay in the hospital in this patient population was 43 (+/- 19) days. Eighty eight (6.8%) of the patients died, the commonest cause of death being heart failure due to cardiomyopathy or hypertensive heart disease. It is concluded that geriatric patients form a sizeable proportion of our medical admissions and that a large proportion suffer from diseases of the cardiovascular system. It is thus recommended that further studies be carried out on the pattern of diseases in such patients and optimal management strategies for their ailments be outlined.

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Herbert O. Oburra, Tobias Sholz,  Jochen A. Werner,  Isaac M. Macharia,  Peter Masinde,  Joyce Aswani,  Anselmy Opiyo MEDICOM The African Journal of Hospital and Scientific Medicine, (2010) Vol  25: 33 - 36 Abstract Head and neck cancer occupies over 50% of in-patient beds at the Ear, Nose and Throat-Head and Neck Surgery Unit of the Kenyatta National Hospital. Laryngeal cancer is the third most common head and neck cancer after nasopharyngeal and oral cancers. Aim: To determine the demographic features, symptomatology, morbid anatomy, histology and disease stage of laryngeal cancer, and to assess the efficiency of the hospital facility in coping with initial work-up and diagnosis of the patients with laryngeal cancer from 1996 to 2001. Setting: Department of Ear, Nose and Throat/Head and Neck Surgery at The Kenyatta National Hospital Study design: Retrospective review of case notes of 100 patients admitted to the unit between 1996 and 2001. Results: Male to female ratio was 24:1. The peak age at presentation was 50 to 70 years with a mean of 60.6 years. Duration of delay between onset of symptoms and presentation to the unit was 4 to 300 weeks with a mean of 50 weeks. Long history of hoarseness of voices and respiratory stridor were the most frequent symptoms. Preoperative tracheostomy rate was 81%. Vocal cords were involved in 54% of cases, 33% supraglottic, 6% subglottic and 7% indeterminate. Delay in obtaining histological results after biopsy ranged from 1 to 71 days with a mean of 43 days. Ninety five per cent of cases had various grades of squamous cell carcinoma. GI differentiation was found in 36%, G2 in 25% and G3 carcinomas involving the vocal cords tended to be well differentiated.  

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The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

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As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Acute renal failure (ARF) complicated the use of traditional herbal remedies in six adult patients seen at Kenyatta National Hospital in a 2-year period (August 1984 to August 1986). This comprised 10.9% of all the cases of ARF and 24% of the cases of ARF due to medical causes. All the patients were oliguric and the period of oliguria in the four patients who survived ranged between 19-57 days (mean 26.3 days). Five of the patients had evidence of fluid overload. The blood urea nitrogen and serum creatinine were elevated in all the patients. The serum sodium was normal in all, while the serum potassium was elevated in 2 cases. Identity of the herbal medication was unknown in all the cases. The indication was abdominal pain in 4 cases, infertility and abdominal pain in one and prophylaxis against witchcraft in the other. All the patients were started on haemodialysis, two of them having had periods of peritoneal dialysis for 12 and 16 days. Two patients died. Of the four surviving patients, follow up has been carried out for 8, 6, 5 and 4 months. At four months follow up the creatinine clearance in the 4 surviving patients have been 54, 63, 51 and 43 ml/min.

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Oyieke H.A. and Misra A.K:

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

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.

We have reviewed the literature relating to the use of monoclonal antibodies in acute renal allograft rejection. More emphasis has been placed on Orthoclone OKT3 which has been more commonly used and summarise our experience with its use as rescue therapy in renal allograft rejection.

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Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

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.

Program in International Nutrition, University of California, Davis, CA 95616, USA.

Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient status of undernourished populations has not been assessed. Supplemental meat (60-85 g/d), milk (200-250 mL/d) or energy (isocaloric with the meat and milk, 240-300 kcal/d) were randomly assigned to 555 undernourished school children aged 5-14 y in a rural malaria-endemic area of Kenya, at one school meal daily for one school year. Blood and stool samples were collected at baseline and after 1 y to assess stool parasites, malaria, hemoglobin, serum or plasma C-reactive protein, ferritin, iron, zinc, copper, vitamin B-12, folate and retinol, and erythrocyte riboflavin. At baseline, there was a high prevalence of micronutrient deficiencies (iron, zinc, vitamins A and B-12 and riboflavin), yet plasma ferritin was low in few children, and none had low serum copper. At the end of the year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the Meat or Milk meal; prevalence of severe plus moderate deficiency fell from 80.7% at baseline to 64.1% in the Meat group and from 71.6 to 45.1% in the Milk group, respectively. No significant improvement was observed in the status of other micronutrients compared to the Energy and Control groups, although malaria and other infections may have obscured effects. Supplementation with small amounts of meat or milk reduced the high prevalence of vitamin B-12 deficiency in these children.

PMID: 14672298 [PubMed - indexed for MEDLINE]

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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Warenius LU, Faxelid EA, Chishimba PN, Musandu JO, Ong'any AA, Nissen EB.

Division of International Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. Linnea.Warenius@ki.se

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

PMID: 16713886 [PubMed - indexed for MEDLINE]

Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam, The Netherlands. The use of Chewing sticks (Miswaki) in the third world for control of dental plaque is very popular. Some of the studies that have been conducted on this subject have reported marked decrease in the incidences of dental caries and periodontal diseases in the users of Miswaki, when compared to the users of the conventional toothbrush living under similar conditions. Various mechanisms by which the Miswaki contributes to this phenomenon have been suggested. The purpose of the present study was to investigate in vitro, the anti-microbial action, the potential acid buffer capacity and fluoride content of crude aqueous extracts of eight commonly used chewing sticks from three regions in Kenya. The results obtained in the study, showed that one of the Miswaki had remarkable antibiotic activity against three stains of oral bacteria. Three of the Miswaki had significant acid buffer capacity. None of the eight Miswaki showed any significant fluoride release.

One hundred children comprising of 57 males and 43 females aged between 8 and 24 months entered the study. 46 children had single and 54 children had multiple helminth infections. All children received albendazole 200 mg (10 ml) suspension as a single dose. Albendazole proved very effective and safe in the treatment of single and multiple helminth infections in children under 2 years of age, achieving cure rates of 100% in both Ascaris lumbricoides and Necator americanus respectively, 83% in Trichuris trichiura and 66% in Hymenolepis nana. Treatment of polyparasitism appears to be of benefit in improving nutritional status using haemoglobin concentrations as an index.

PMID: 2591328 [PubMed - indexed for MEDLINE]

Wycliffe Omanya, Development Communication Consultant womanya@gmail.com & Dr. William O. Ogara, College of Agriculture and Veterinary Sciences, University of Nairobi wogara@uonbi.ac.ke Abstract:   This paper seeks to explore tacit knowledge in the light of knowledge transfer. Specifically it looks at the technique of mentoring as a process through which this highly personalized knowledge can be replicated in any organisation. It also introduces knowledge acquisition process as innate and broadly presents various existing models of tacit knowledge transfer. In addition, it explores the significance of mentoring to all key actors in the process of knowledge transfer while also providing some case scenarios in which this strategy has been successfully used to ensure competitive advantage based on developed long standing knowledge.   Key words: Knowledge management, Tacit Knowledge, explicit knowledge, knowledge transfer, mentoring, transfer models.

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Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.

OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

G O Matete, J M Gathuma, G Muchemi, W Ogara, N Maingi, W Maritim* and B Moenga* Faculty of Veterinary Medicine, University of Nairobi P.O Box 29053, Nairobi, Kenyageorge.matete@gmail.com* Ministry of Livestock Development P.O Kabete 00625 Kangemi, Nairobi, Kenya   Abstract Livestock Identification and Traceability Systems (LITS) contribute to reduction, control or eliminated safety scares that result from transbounadry diseases outbreaks.  Recent studies on LITS in Kenya have been focused on testing  innovative technology, information and traceability system management, and examining the determinants for effective implementation. This paper analyzes the strengths and limitations of the operating a LITS institutional and organisational mechanisms in Kenya.   The result revealed that a disarticulated intitutional and organisational environment was the main constraint to effective implementation of LITS.  It proposes that for successful implemenation, a regional approach covering multiple countries, substantial private sector involvement and intensive stakeholder education are essential. Keywords: Institutional and organisational mechanisms, livestock identification, traceability  

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

Teenage pregnancies lower average birthweight. In the NBS, teenage mothers had significantly lower average birthweight of 2 920 +/- 553 g compared with 3 133 +/- 533 g among women in the general population. A high rate of LBW on the infants of the teenage mothers was the significant factor in lowering the average birthweight. In both NBS and the PMHS the incidence of LBW 18% and 15% respectively as well as the rate of preterm delivery of 24% and 23% respectively were high. In PMHS although the numbers were small, the incidence of LBW was high (13%) in the 14-year-olds and in the 15-year-olds it was 4.8% which was much lower than that for 17- and 18-year-olds. In a large series in Nigeria the incidence of LBW was 27% in mothers aged less than 15 years, 26% in mothers aged 15-19, 20% in those aged 20-24 and least (18%) in the 25-29 year age group. Many unfavourable socioeconomic circumstances and lack of adequate antenatal supervision contribute to these high rates. Some of the teenage mothers-particularly the very young, below 16 years-are physically immature and are still growing children themselves. Their nutrient intake is shared between their own growth needs and those of their foetuses. In the Nigerian study, administration of folic acid and iron together with antimalarials to pregnant mothers resulted in increased maternal height as well as foetal growth, thus stressing the importance of nutritional care for the teenage mothers.

PIP: Teenage pregnancies lower average birth weight. In the Nairobi Birth Survey (NBS), teenage mothers had significantly lower average birth weight of 2920 +or- 553 gm compared with 3133 +or- 533 gm among women in the general population. A high rate of low birth weight (LBW) in those infants born to teenage mothers was the significant factor in lowering that figure. In both the NBS and the Pumwani Maternity Hospital Study (PMHS), the incidence of LBW was 18% and 15%, respectively, and the rate of preterm delivery 24% and 23%, respectively. In the PMHS, although the numbers were small, the incidence of LBW was high (13%) in the 14-year-old group and it was 4.8% in the 15-year-old group; these figures were much lower than those for ages 17 and 18. In a large series in Nigeria, the incidence of LBW was 27% in mothers aged less than 15, 26% in mothers aged 15-19, 20% in those aged 20-24, and least (18%) in those 25-29. Many unfavorable socioeconomic circumstances and lack of adequate antenatal supervision contribute to these high rates. Some teenage mothers–particularly those under age 16–are physically immature and are themselves still growing. Their nutrient intake is shared between their own growth needs and those of their fetuses. In the Nigerian study, administration of folic acid and iron together with antimalarials to pregnant mothers resulted in increased maternal height as well as fetal growth, thus stressing the importance of nutritional care for teenage mothers. author's modified

PMID: 3868931 [PubMed - indexed for MEDLINE]

A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

OBJECTIVE: To compare the morbidity and outcome of low birthweight babies (birthweight < 2000 gm) of adolescent (age < 20 years) and older mothers. DESIGN: Cross sectional descriptive study. SETTING: The newborn Unit of the Kenyatta National Hospital. MAIN OUTCOME MEASURES: All babies weighing less than 2000 gm at birth whose mothers consented to the study had their gestational age verified using the Dubowitz scoring system. They were then followed up by daily clinical assessment until discharge, death or up to one month in the ward. The babies were divided into two groups according to their mother's age and then compared with respect to episodes of illness, duration of hospital stay, and overall outcome. RESULTS: One hundred and forty two babies were studied. Of these, 64 were born to adolescent mothers. Babies of the adolescent mothers tended to be more premature (p = 0.0174), be lower in weight (p = 0.0078), had more occurrences of respiratory distress and anaemia (probably reflecting their increased prematurity) and had frequent multiple morbidity events They also had longer hospital stay and they were more likely to die (57.7% compared to 42.3% of babies of older mothers). CONCLUSION: Low birthweight babies of the adolescent mothers were found to be more likely to have increased morbidity and adverse outcome compared to similar babies of older mothers.

{ BACKGROUND: Birth asphyxia kills 0.7 to 1.6 million newborns a year globally with 99% of deaths in developing countries. Effective newborn resuscitation could reduce this burden of disease but the training of health-care providers in low income settings is often outdated. Our aim was to determine if a simple one day newborn resuscitation training (NRT) alters health worker resuscitation practices in a public hospital setting in Kenya. METHODS/PRINCIPAL FINDINGS: We conducted a randomised, controlled trial with health workers receiving early training with NRT (n = 28) or late training (the control group

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Thirty eight symptomatic and two asymptomatic patients seropositive for human immunodeficiency virus type-1 (HIV-1) were treated with a natural human interferon alpha (HuIFN alpha). Patients were given 2 IU/kg HuIFN alpha orally once daily in powdered maltose held in the mouth to promote mucosal absorption. This oral immunomodulating HuIFN alpha therapy resulted in an increase in CD4+ lymphocytes, an increase in weight, and a dramatic alleviation of clinical symptoms related to HIV-1 infection.

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As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

A 3D FEM computer program was developed to establish the stress distributions and SCFs in thick walled cylinders with radiused entry flush and non-protruding cross bores under internal pressure. The displacement formulation and eight noded brick isoparametric elements were used. The Frontal solution technique was used due to the limited computing facilities. The variation of SCF with entry radius to main bore radius ratio was established for varying cylinder outer radius to main bore radius ratio and cross bore to main bore radius ratio. For low values of cylinder outer radius to main bore radius ratio (≤2.25), the lower values of cross bore to main bore radius ratio resulted in lower SCFs. For high values of cylinder outer radius to main bore radius ratio (>2.25),  the lower values of cross bore to main bore radius ratio resulted in higher SCFs. The cylinder with cylinder outer radius to main bore radius ratio of 2.25 was found to be a transition geometry. For very small values of cross bore to main bore radius ratio, the SCFs converged to a value of 2.2 for entry radius to main bore radius ratio of 0.2. The cylinder outer radius to main bore radius ratio of 1.75 to 3 cylinders had a constant SCF value of 2.3 at cross bore to main bore radius ratio of 0.05 and entry radius to main bore radius ratio of 0.2. A new categorization of cylinders earlier proposed in the study of plain cross-bored cylinders is further validated.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

No abstract available.

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

Microanalysis of subcellular organelle marker enzymes was applied to cryopreserved lymphocytes (obtained and processed in the field) from East African blacks with moderate to severe malnutrition and subject to locally endemic parasitic and infectious diseases. An initial study demonstrated that activities of these enzymes, with the partial exception of catalase, were stable to cryopreservation. Cryopreserved and thawed lymphocyte specimens (1 to 3 X 10(6) viable cells) from 26 Africans and 20 Caucasian controls were studied. There was a highly significant decrease in 5'nucleotidase activity in these African subjects. Activity of another plasma membrane enzyme, gamma-glutamyl transferase, and of marker enzymes for other intracellular organelles, was not significantly different between the two groups, indicating that the nucleotidase alteration is highly specific. 5'Nucleotidase activity in a group of 17 East African blacks of high socio-economic status lay between the values obtained in the other two groups and was not significantly different from either. Further studies on 5'nucleotidase showed no evidence that the enzyme is functionally different in Africans. The differences in activity of this enzyme in Africans may reflect the known immuno-suppressive effects of infectious disease and malnutrition or may have a genetic basis which may in turn be associated with the pathogenesis of secondary immunodeficiency.

The practice of physicians at the Nakuru Provincial General Hospital (NPGH), Kenya, when dealing with cerebral malaria is reviewed over a 4-month period. The definition, management, and outcome of patients labelled to have cerebral malaria is presented and criticism of their practice offered in a manner applicable to other rural hospitals in Kenya.

Nyambok, I.O.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

No abstract available

In a six month period at the Kenyatta National Hospital, 46 patients (30 males) with chronic renal failure (CRF) and 22 healthy subjects have had a clinical and echocardiographic study of their cardiovascular systems. The patients with CRF were further classified as stable or in end stage renal disease (ESRD), the latter group requiring dialysis. Hypertension and circulatory congestion were the commonest clinical cardiovascular findings in patients with CRF. The patients with ESRD had significantly higher blood urea nitrogen and serum creatinine than the ones with stable CRF. Echocardiographically right ventricular size, left atrial size, aortic root diameter, left ventricular internal diameters, left ventricular end diastolic and systolic volumes, stroke volume, cardiac output, left ventricular posterior wall and interventricular septal thickness, ejection time and mitral and aortic peak flow rates were significantly higher in patients with CRF than in controls. In contrast, the circumferential fibre shortening and the ejection fraction were reduced in patients with CRF. Global left ventricular dysfunction was found in 47.8% of the patients. Using doppler flow studies, valvular incompetence was detected in a number of patients, mitral regurgitation being found in 84%.76% of the patients with CRF had varying degrees of pericardial effusion. The echocardiographic abnormalities and the pericardial effusions responded six weeks of haemodialysis in a variable manner.

Fracture mechanics principles have been used to study the effects of welding on the rate of fatigue crack growth (FCG) in a low-carbon structural steel. The steel concerned is used widely in the fabrication of the structural frame-work of passenger buses. Tests were carried out on the base metal (BM), heat affected zone (HAZ) and weld metal (WM). Both the near threshold and midrange regimes of crack growth were studied. In the midrange regime, the FCG rate was highest in the HAZ and lowest in the WM. Near the threshold, the FCG rate was highest in the BM and lowest in the WM. The results are explained in terms of microstructural changes due to welding, welding residual stresses, and fracture mechanisms. Recommendations to reduce the incidence of fatigue cracking have been made.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

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As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Department of Medicine, College of Health Sciences, University of Nairobi. Characteristics of 14 patients above 12 years of age with congenital polycystic liver disease attending liver clinic at KNH were analysed. The diagnosis was mainly based on ultrasonographic findings. The disease was found predominantly among the Kikuyu ethnic group with a female/male ratio of 6:1 and the peak age at presentation was in the 5th decade. The liver function tests were essentially normal in all cases with no complication directly relating to liver disease. Hypertension was found in 78.6% of cases and chronic renal failure in 35.7% of cases. There was an associated polycystic disease in at least one other abdominal organ in all cases.

Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologies. Five-thousand-three-hundred-sixty-eight children from 57 randomly chosen primary schools in Kiambu district were examined. Simple otoscopy was performed by clinical officers with specialty training in ENT, and hering testing was performed by trained nurses, using a hand held field audiometer. Microbiological specimens were obtained from those children with CSOM. Five-point-six percent of the children had a hearing impairment of > 30 dB HL in one or both ears, with 2.2% having bilateral hearing impairment. Two-point-four percent had at least one perforated tympanic membrane, and 1.1% had CSOM. Eight-point-six percent of the children had wax obstructing the tympanic membrane. There is evidence of a relationship between hearing impairment and both CSOM and wax obstructing the tympanic membrane. The most common organisms found were Pseudomonas spp. (34%), Proteus spp. (34%) and Eschericia coli (19%). These results are comparable with other studies in Africa and indicate a considerable burden of ear disease in Kiambu district, Kenya.

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Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

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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.

We have reviewed the literature relating to the use of monoclonal antibodies in acute renal allograft rejection. More emphasis has been placed on Orthoclone OKT3 which has been more commonly used and summarise our experience with its use as rescue therapy in renal allograft rejection.

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Oyieke H.A. and Misra A.K:

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Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

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.

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 20956-00202, Nairobi, Kenya. BACKGROUND: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs. OBJECTIVES: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them. DESIGN: Cross section survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy five neonatal survivors. RESULTS: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula. The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48 (28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15 g/kg/day while 70% and 78% grew in head circumference and length at < 0.5 cm/week respectively. At term weight, head and linear growth faultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P < 0.001) and absence of neonatal morbidity (P < 0.001). Infants who were appropriate for gestational age at birth also had better catch up growth at term compared to those born small for gestation (P < 0.001) but their neonatal growth itself was not significantly better. CONCLUSION: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns. RECOMMENDATIONS: Routine fortification of mother's milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth. PMID: 16771104 [PubMed - indexed for MEDLINE]

The mean fasting insulin level in 30 apparently normal Kenyan Africans was determined by Radio-Immuno Assay (RIA) technique based on coat A-count. The mean value was found as 16.33 microIu/ml with a standard deviation (s.d) of 10.51 microIu/ml. The mean at 95% confidence interval (CI) for the population studied was 16.33 +/- 1.92. The findings are similar to what have been reported among the caucasians. This paper also reports on a case of insulinoma in a young female patient at Kenyatta National Hospital (KNH).

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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BACKGROUND: The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. METHODS: We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. FINDINGS: By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. INTERPRETATION: Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries. PIP: 524 children aged 5-15 years with chronic suppurative otitis media (CSOM) were enrolled in a study to determine the effectiveness of different treatment regimens. The subjects were from 145 primary schools in Kenya's Kiambu district. 201 children received dry mopping treatment, 221 received dry mopping with topical and systemic antibiotics and topical steroids, and 102 received no treatment. Participating schools were matched on factors thought to be related to their socioeconomic status. 29 children were withdrawn from the trial for taking non-trial antibiotics, with no evidence observed of differences in the timing of withdrawals between the two groups. At 16 weeks of follow-up, otorrhoea had resolved in a weighted mean proportion of 51% of children who received dry mopping with antibiotics, 22% of children who received dry mopping alone, and 22% of untreated children. Similar differences were observed at 8 and 12 weeks of follow-up. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% in the dry-mopping plus antibiotics group, 13% in the dry-mopping alone group, and 13% in the control group. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times.

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.

Department of Psychiatry, UCLA Medical School 90024.

The purpose of this study was to determine whether nutritional factors, family characteristics, and the duration of schooling were associated with cognitive and attentional capacities in children growing up in rural Kenya. Food intake was measured by direct observation and weighment twice monthly over the course of a year. Families were characterized in terms of socioeconomic status and the literacy of the parents. Children who were better nourished had higher composite scores on a test of verbal comprehension and the Raven's matrices. Better-nourished females were more attentive during classroom observations than malnourished female schoolchildren. Family characteristics and duration of school participation were associated with cognitive abilities for both boys and girls. For the children considered as a group, cognitive scores were best predicted by a combination of factors including duration of schooling, food intake, physical stature, and SES.

PMID: 2515042 [PubMed - indexed for MEDLINE]

Four hundred and three teenage secondary school students (50.6% males) from two girls' and two boys' Nairobi City Schools, selected by stratified sampling, were screened to determine the prevalence of proteinuria, haematuria, nitrituria and hypertension. Nine students (2.2%) had significant proteinuria while 14 (3.5%) had microscopic haematuria. Two students had combined proteinuria and haematuria. There was no statistically significant difference in the prevalence of proteinuria and/or haematuria between the sexes. Other urinary abnormalities detected were leucocyturia in 14(3.5%) and nitrites in four (1%). Leucocyturia was commonner in females (p = 0.001). Cloudy urinary appearance was significantly associated with the presence of leucocyturia (p = 0.0028) and proteinuria (p = 0.0276). Neither personal history of recurrent sore throat and skin infections nor family history of hypertension, diabetes mellitus or kidney disease was significantly associated with proteinuria or haematuria. Blood pressure tended to increase with age. Mean systolic and diastolic blood pressures were significantly higher in boys than girls in the age group 15-18 years (P < 0.001). Of the 397 students whose blood pressures were measured, four (1%) were found to be hypertensive. Weight and body mass index were strong positive correlates of blood pressure. The prevalence of proteinuria, haematuria, other urinary abnormalities and hypertension ranges between 1% and 3.5% among teenage secondary school children. The majority are asymptomatic and have no significant associations. It is recommended that routine urinalysis and blood pressure measurements should be part of the school health service so as to identify asymptomatic students who require close monitoring and/or intervention.

No abstract available. PMID: 163952 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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Renal transplantation is not readily available in the majority of countries in Africa. It is expensive and difficult to sustain on the meagre funds allocated to health. We report our short experience with fifteen living donor recipients followed in our unit for at least 24 months, range 26 - 48 (mean 35 months) post-transplantation. The donors and recipients were mostly young adults with mean ages of 36.7 years and 32.6 years respectively. The majority of the donors and recipients were males. The donors in most cases were siblings. Within this time, one graft has been lost at one year and the patient restarted on haemodialysis. Three patients died, two within the first year, the third at 23 months after transplantation, all with functioning grafts. The one year graft and patient survival rates were 93% and 86.6% respectively. The second year graft survival rates remained at 93% and the patients survival rate 80%. The nature and frequency of complications seen in these patients is comparable to those in other centres. Of all medical complications, bacterial infections contributed 69.4% of all infections. Cardiovascular complications comprised 31.25% of the complications. Hypertension seen in 85.5% of the patients accounted for 65% of the cardiovascular complications. Acute rejections were common and occurred in seven patients. Transplantation is a viable mode of renal replacement therapy (RRT) in our environment. The practice should be supported to make it more readily available to the many young end stage renal failure (ESRF) patients.

Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

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The currently available evidence suggest that diuretics and/or low dose dopamine increases renal blood flow (RBF), glomerular filtration rate (GFR) and natriuresis in experimental animals, and limits ATP utilisation and oxygen needs in nephron segments at high risk of ischaemic injury, actions that could potentially limit renal injury and accelerate recovery in acute renal failure (ARF). These effects have indeed been confirmed in most experimental animals while using mannitol or low dose dopanime. Frusemide, however, for unknown reasons, has been effective in some animal models, but not others. In humans, it can be said that diurectics have a limited value to prevent, reverse or speed recovery from acute renal failure. Most clinical studies have failed to demonstrate convincingly that low dose dopamine either prevents ARF in high risk patients or improves renal function or outcome in patients with established ARF. This confusing scenario is further complicated by the fact that both diuretics and low dose dopamine can result in severe metabolic and cardiovascular complications in critically ill patients.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

{ BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. DESIGN: Descriptive cross-sectional study. SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria. Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay. RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis. Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively. Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L

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Treatment of HIV infections has involved the use of antiviral drugs as well as those drugs that act against opportunistic infections. Immune modulators have also been used. A review of these drugs is reported emphasizing on those which have great promise in the clinical management of HIV infections in the light of our present knowledge on immunopathology of the disease.

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One of the major constraints to increased dairy production is lack of adequate feed. The Government of Kenya has encouraged the development of forage technology for adoption to address this constraint. The low adoption has been due to inappropriate technologies and cost of forage production. Data used in the analysis were collected from farmers in Vihiga and Sabatia division of Vihiga District, Western Kenya. Both on-farm experimental and formal survey data were utilized. A sample of 180 farmers was randomly selected using systematic sampling techniques. Cost Benefit analysis was done using Cost-Benefit Ratio (CBR) and Net Present Value (NPV) while regression analysis techniques were used to estimate optimal nutrient levels.   The results of the Cost-Benefit analysis showed most forage technologies were economically viable to adopt. Farmers also ranked highly forage technologies with high economic returns. Based on these findings, research and extension of forage use should emphasise evaluation of forage production technologies as an aid to increasing dairy production and surplus stock food for sale.   Key Words:    Forage technology, Nutrients, Maragoli People, Economic Returns, Smallholder Dairy, Zero Grazing.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

No abstract available

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

PIP: A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute diarrhea was conducted between 1982-1983 to determine the benefits of oral rehydration therapy (ORT) in treatment of diarrheal illness. At admission, specimens of stool, blood and urine were collected and examine for bacterial, parasitic, and viral agents (including malaria), serum electrolytes, urea, white cell counts and hematocrit. Children were started on oral rehydration solution (ORS) unless severly dehydrated, in which case intravenous therapy was initiated. 84% of the children were successfully treated with ORS alone regardless of etiological agent found; 15% required IV therapy initially, then were placed on ORS. Average hospital stay was 56.2 hours. Cost of treatment by ORT is less than 20% the cost of IV therapy. When investigators surveyed other health institutions, they found that ORT was used alone in less than 10% of all children seen with diarrhea. A side benefit of ORT is the utilization of mothers in preparation and administration of solution, reducing the demand on hospital staff. Since 20% of all pediatric admissions at Kenyatta are due to acute diarrheal disease, use of ORT would reduce costs tremendously. Initiation of ORT at home may prevent development of dehydration altogether.

Review of electroencephalography (EEG) requests at KNH over a 3 year period is presented. Majority of patients were aged between 0 and 10 years. None was older than 80 years. The epilepsies were the commonest reason for requesting EEG (58.5%). SSPE had the highest positivity rate of 91.7% followed by convulsive states of uncertain aetiology. The symptom of headache by itself was the least rewarding to study by EEG. It was more rewarding to first attempt to make a diagnosis of the headache. Hysteria had an EEG positivity rate of 40%, most of them being epilepsy. EEG picture for petit-mal, epilepsy focal seizure and generalized seizures are included in the text.

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Weights and heights of 674 consecutive non-insulin dependent diabetics and 358 control urban healthy Kenyans were recorded prospectively. Weights and heights of a further 162 healthy rural adults were compared retrospectively. The body mass index (weight/height2) of the non-insulin dependent diabetic was lower than that of the corresponding urban control subject. The body mass index of the rural folk was consistently lower than that of the urban dweller. This study concluded that obesity may not be a significant factor in non-insulin dependent diabetes in the African black.

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

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Asiatic acid (AA) is a pentacyclic triterpene found in Centella asiatica. In the present study, the mechanism of anticancer effect of AA on skin cancer was investigated. AA decreased viability and induced apoptosis in human melanoma SK-MEL-2 cells in a time- and dose-dependent manner. AA also markedly increased intracellular reactive oxygen species (ROS) level and enhanced the expression of Bax but not Bcl-2 protein in the cells. In addition, AA-induced activation of caspase-3 activity in a dose-dependent manner. Pretreatment with Trolox, an antioxidant, significantly blocked the induction of Bax and activation of caspase-3 in AA-treated cells. Furthermore, Ac-DEVD-CHO, a specific caspase-3 inhibitor, and Trolox prevented the AA-induced apoptosis. AA did not elevate p53 nuclear protein levels that are present in a mutant form in SK-MEL-2 cells. These results suggest that AA-induced apoptosis may be mediated through generation of ROS, alteration of Bax/Bcl-2 ratio and activation of caspase-3, but p53-independent. These results further suggest that AA may be a good candidate for the therapeutic intervention of human skin cancer.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

No abstract available

In a six month period at the Kenyatta National Hospital, 46 patients (30 males) with chronic renal failure (CRF) and 22 healthy subjects have had a clinical and echocardiographic study of their cardiovascular systems. The patients with CRF were further classified as stable or in end stage renal disease (ESRD), the latter group requiring dialysis. Hypertension and circulatory congestion were the commonest clinical cardiovascular findings in patients with CRF. The patients with ESRD had significantly higher blood urea nitrogen and serum creatinine than the ones with stable CRF. Echocardiographically right ventricular size, left atrial size, aortic root diameter, left ventricular internal diameters, left ventricular end diastolic and systolic volumes, stroke volume, cardiac output, left ventricular posterior wall and interventricular septal thickness, ejection time and mitral and aortic peak flow rates were significantly higher in patients with CRF than in controls. In contrast, the circumferential fibre shortening and the ejection fraction were reduced in patients with CRF. Global left ventricular dysfunction was found in 47.8% of the patients. Using doppler flow studies, valvular incompetence was detected in a number of patients, mitral regurgitation being found in 84%.76% of the patients with CRF had varying degrees of pericardial effusion. The echocardiographic abnormalities and the pericardial effusions responded six weeks of haemodialysis in a variable manner.

Fracture mechanics principles have been used to study the effects of welding on the rate of fatigue crack growth (FCG) in a low-carbon structural steel. The steel concerned is used widely in the fabrication of the structural frame-work of passenger buses. Tests were carried out on the base metal (BM), heat affected zone (HAZ) and weld metal (WM). Both the near threshold and midrange regimes of crack growth were studied. In the midrange regime, the FCG rate was highest in the HAZ and lowest in the WM. Near the threshold, the FCG rate was highest in the BM and lowest in the WM. The results are explained in terms of microstructural changes due to welding, welding residual stresses, and fracture mechanisms. Recommendations to reduce the incidence of fatigue cracking have been made.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

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As part of a study to assess zoonotic milk-borne health risks, seasonal survey data and unpasteurized milk samples were collected between January 1999 and February 2000 from randomly selected informal milk market agents (220 and 236 samples in the dry and wet seasons, respectively) and from households purchasing raw milk (213 and 219 samples in the dry and wet seasons, respectively) in rural and urban locations in Central Kenya and screened for antibiotics, Brucella abortus (B. abortus) and presence of Escherichia coli (E. coli 0157:H7).The latter was assessed based on samples from consumer households only. Antibodies to B. abortus were screened using the indirect antibody Enzyme Linked Immunosorbent Assay (ELISA) and the Milk Ring Test (MRT). The presence of E. coli 0157:H7 was assessed by culture, biochemical characterization, serological testing for production of verocytotoxin one (VTI) and two (VT2) and polymerase chain reaction (PCR) analysis for the presence of genes encoding for the toxins.                                                                                                         The prevalence of antibodies to B.abortus varied considerably ranging from none in milk sold in small units and originating from intensive production systems to over 10% in samples that were bulked or originating from extensive production systems. E. coli 0157:H7 was isolated from two samples (0.8%), one of which produced VTI. All urban consumers (100%) and nearly all rural consumers (96%) of marketed milk boiled the milk before consumption, mainly in tea, thus reducing chances of exposure to live pathogens and potential health risks.

Department of Medicine, College of Health Sciences, University of Nairobi. Characteristics of 14 patients above 12 years of age with congenital polycystic liver disease attending liver clinic at KNH were analysed. The diagnosis was mainly based on ultrasonographic findings. The disease was found predominantly among the Kikuyu ethnic group with a female/male ratio of 6:1 and the peak age at presentation was in the 5th decade. The liver function tests were essentially normal in all cases with no complication directly relating to liver disease. Hypertension was found in 78.6% of cases and chronic renal failure in 35.7% of cases. There was an associated polycystic disease in at least one other abdominal organ in all cases.

OBJECTIVES: To determine the frequency of adenotonsillectomy in a sample of Kenyan hospitals and to review indications, timing and complications in 97 cases of adenotonsillectomy done by the authors. DESIGN: Retrospective, descriptive study. SETTING: Kenyatta National, Nairobi, Aga Khan, Gertrude and Mater Hospitals. RESULTS: Adenotonsillectomy is the most frequent otolaryngologic surgical operation. Indications for surgery were upper airway obstruction in 61.3%, recurrent tonsillitis in 28.7% and both in 7.5%. Surgery was indicated during the acute stage in 6.8% of cases. There was one case of post-operative acute airway obstruction. Post operative bleeding from the tonsillar bed was encountered in 2.1% of cases. CONCLUSION: Adenotonsillectomy is the most common otolaryngologic surgical operation in our set-up. The low frequency of complications and a short hospital stay puts up a case for routine adenotonsillectomy as a day surgery procedure.

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Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

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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.

In 7 years (1981-1988) at the Kenyatta National Hospital (KNH), Nairobi the diagnosis of systemic lupus erythematosus (SLE) was made in 67 patients. In 23 of these patients lupus nephritis complicated the SLE. Lupus nephritis was diagnosed through renal biopsy, haematuria and proteinuria in urine with positive lupus erythematosus (LE) cell phenomenon. The histology found in these patients included 5 patients with minimal lesion, 7 patients with membranous, 3 with focal, 4 with diffuse, 3 with crescenteric and one with membranoproliferative glomerulonephritis. While patients with minimal, membranous and focal nephritis had general good outlook on low dose maintenance or intermittent high dose steroid therapy the others with diffuse, crescenteric and membranoproliferative nephritis had poor prognosis. Patients with diffuse proliferative, membranoproliferative and crescenteric nephritis tended to have septicaemia, pulmonary oedema, fluid overload and chronic renal failure with poor prognosis. These patients responded poorly to oral and parenteral steroid therapy whether high or low dose.

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Oyieke H.A. and Misra A.K:

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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.

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 20956-00202, Nairobi, Kenya. BACKGROUND: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs. OBJECTIVES: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them. DESIGN: Cross section survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy five neonatal survivors. RESULTS: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula. The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48 (28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15 g/kg/day while 70% and 78% grew in head circumference and length at < 0.5 cm/week respectively. At term weight, head and linear growth faultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P < 0.001) and absence of neonatal morbidity (P < 0.001). Infants who were appropriate for gestational age at birth also had better catch up growth at term compared to those born small for gestation (P < 0.001) but their neonatal growth itself was not significantly better. CONCLUSION: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns. RECOMMENDATIONS: Routine fortification of mother's milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth. PMID: 16771104 [PubMed - indexed for MEDLINE]

Department of Paediatrics, College of Health Sciences, University of Nairobi, Kenya. Sodium supplementation was done on 41 very low birth weight (VLBW) preterm infants with 25 other infants of similar weight status as controls. All the infants were fed on their own mothers milk whose sodium and potassium content was determined. Serum and urinary sodium, potassium and creatinine levels were determined in both groups during the study period of six weeks. Determination of weight gain, length gain and head circumference gain showed that these anthropometric parameters are significantly increased by sodium supplementation while sodium and potassium concentrations were not significantly affected. There were no cases of either hypernatraemia or hyponatraemia though renal excretion of sodium was very high in the supplemented group. Conclusions drawn from the study are that very little weight gain could have been due to fluid retention and that though sodium supplementation does not affect sodium profiles in these infants it has significant effect on their growth rate which may be due to its indirect/direct association with bone and protein metabolism.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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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.

University of California, Los Angeles.

This study explored the extent to which morbidity in 110 mildly to moderately malnourished Kenyan toddlers was associated with developmental outcomes. Morbidity information was collected from the 18th to 30th months. Concurrent assessments of vocalization, play, and performance on the Bayley scales were obtained. At 5 years, a follow-up battery of cognitive tests was administered. Female toddlers who suffered more illness generally performed less well on developmental measures than their healthier female peers. These children vocalized and played less and performed less well on the Bayley Mental scales at 30 months and on the cognitive battery at 5 years. For the boys, development was largely independent of morbidity. Morbidity was related to patterns of care giving for both boys and girls, but it was not associated with socioeconomic status or food intake. However, girls who were ill more often were shorter and lighter. Relations between morbidity and development in the girls remained statistically significant when other variables, which were also related to development (such as care giving, socioeconomic status, parental IQ and literacy, food intake, and anthropometry) were considered. This suggests that morbidity, in these female toddlers, had an effect on development above and beyond other variables typically associated with malnutrition.

PMID: 1945634 [PubMed - indexed for MEDLINE]

We present two cases of neurofibromatosis type 1 (NF-1), one a 35 year old male who first recognised his problem at the age of fifteen years and at the time of assessment, satisfied the National Institute of Health (NIH) diagnostic criteria for NF-1 and had a nodular plexiform neurofibroma involving the left fifth dorsal nerve root and a diffuse plexiform neurofibroma involving the left lower limb. The second patient, a 45 year old female recognised her problem at the age of 39 years, did not quite satisfy the NIH diagnostic criteria for NF 1 and had diffuse plexiform neurofibroma involving both lower limbs and buttocks almost symmetrically, a finding which has not previously been described to the best of our knowledge. The scarcity of management options are briefly outlined.

PMID: 614126 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Naisho JN, Ongaya L, Musandu JO. PIP: In highlighting the role of traditional birth attendants (TBAs) in the implementation of primary health care (PHC) in Kenya, the following topics are discussed: characteristics of TBAs as reported in studies, the training program, program objectives, content, the training process, resources for training, the role of TBAs in PHC, and evaluation. The definition of midwife is given as midwives trained in a community setting to assist in delivery within the confines of accepted cultural beliefs. A study of 28 midwives from different regions in Kenya in 1980 found that most were illiterate women between 24 and 68 years olds received no monetary gain, had a variety of occupational backgrounds, and provided varying amounts of advice but little pre- or postnatal care. Almost all advised mothers to breast feed for at least 2 years. 80% of mother use TBAs for delivery. In order to minimize maternal (5-20/1000 live births on the average) and infant mortality, many countries have or are developing training programs for TBAs. Inadequacies in TBA care may be little prenatal care, too little postnatal care, and deficits in promoting child spacing; other unsafe practices may be improper washing of hands and severing the umbilical cord with unsterile objects. Other advantages of training TBAs involve less cost, less need for transportation, personalized setting in the home, source of health education in the community, and rapport with her clients. The training program goal is to reduce mortality by eliminating bad practices. The objectives are to reduce maternal deaths or illness from hemorrhage, infection, and toxemia; to encourage better nutrition; to reduce perineal or vaginal tears which may lead to longterm disability from urinary or rectal fistula; to reduce the number of pregnancies or exposure to risk; and to reduce neonatal tetanus asphyxia, infection, diarrhea, and malnutrition. Activities entail educating adolescent girls and pregnant women on menstruation and sexuality within cultural norms, prenatal care and delivery and postnatal care, maternal care, and educating mothers about personal hygiene, nutrition, child spacing, and immunization, and acknowledgement of the valuable service TBAs contribute to the community. Programs have operated for 10 years and evaluation is underway. PMID: 2630785 [PubMed - indexed for MEDLINE]

Sixty two black patients who had confirmed but untreated hypertension participated in a double blind clinical trial of the efficacy and tolerability of slow-release oxprenolol in a daily dose of 160 mg initially and 320 mg subsequently versus chlorthalidone 50 mg daily. Thereafter, a combination of oxprenolol with chlorthalidone in an initial dose of 160 mg and 25 mg and a subsequent dose of 320 mg and 50 mg, respectively, was administered and the effects compared with those of the same drugs given singly. The trial lasted for 3 years, but each participant took active medication for 1 year. Oxprenolol as monotherapy had no effect on the blood pressure, irrespective of the dose. Chlorthalidone as monotherapy produced a significant fall in blood pressure (p less than 0.01). Combining the 2 drugs enhanced their blood pressure lowering effects (p less than 0.001). Oxprenolol as monotherapy and as part of combination therapy was well tolerated by all patients. Chlorthalidone as monotherapy was well tolerated by most patients while a fraction of the patients developed biochemical derangements. These results confirm the findings that a beta-blocker alone may be ineffective in lowering blood pressure in hypertensive blacks. The results also show that the efficacy and tolerability of a beta-blocker and a diuretic are enhanced by their combined administration. Finally, the results show that increasing the dose of a beta-blocker or a diuretic does not produce a further increase in its blood pressure lowering effect.

No abstract available

G O Matete, J M Gathuma, G Muchemi, W Ogara, N Maingi, W Maritim* and B Moenga* Faculty of Veterinary Medicine, University of Nairobi P.O Box 29053, Nairobi, Kenyageorge.matete@gmail.com* Ministry of Livestock Development P.O Kabete 00625 Kangemi, Nairobi, Kenya   Abstract Livestock Identification and Traceability Systems (LITS) contribute to reduction, control or eliminated safety scares that result from transbounadry diseases outbreaks.  Recent studies on LITS in Kenya have been focused on testing  innovative technology, information and traceability system management, and examining the determinants for effective implementation. This paper analyzes the strengths and limitations of the operating a LITS institutional and organisational mechanisms in Kenya.   The result revealed that a disarticulated intitutional and organisational environment was the main constraint to effective implementation of LITS.  It proposes that for successful implemenation, a regional approach covering multiple countries, substantial private sector involvement and intensive stakeholder education are essential. Keywords: Institutional and organisational mechanisms, livestock identification, traceability  

The currently available evidence suggest that diuretics and/or low dose dopamine increases renal blood flow (RBF), glomerular filtration rate (GFR) and natriuresis in experimental animals, and limits ATP utilisation and oxygen needs in nephron segments at high risk of ischaemic injury, actions that could potentially limit renal injury and accelerate recovery in acute renal failure (ARF). These effects have indeed been confirmed in most experimental animals while using mannitol or low dose dopanime. Frusemide, however, for unknown reasons, has been effective in some animal models, but not others. In humans, it can be said that diurectics have a limited value to prevent, reverse or speed recovery from acute renal failure. Most clinical studies have failed to demonstrate convincingly that low dose dopamine either prevents ARF in high risk patients or improves renal function or outcome in patients with established ARF. This confusing scenario is further complicated by the fact that both diuretics and low dose dopamine can result in severe metabolic and cardiovascular complications in critically ill patients.

No abstract available. PMID: 11957248 [PubMed - indexed for MEDLINE]

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

We aimed to investigate provision of paediatric care in government district hospitals in Kenya. We surveyed 14 first-referral level hospitals from seven of Kenya's eight provinces and obtained data for workload, outcome of admission, infrastructure, and resources and the views of hospital staff and caretakers of admitted children. Paediatric admission rates varied almost ten-fold. Basic anti-infective drugs, clinical supplies, and laboratory tests were available in at least 12 hospitals, although these might be charged for on discharge. In at least 11 hospitals, antistaphylococcal drugs, appropriate treatment for malnutrition, newborn feeds, and measurement of bilirubin were rarely or never available. Staff highlighted infrastructure and human and consumable resources as problems. However, a strong sense of commitment, support for the work of the hospital, and a desire for improvement were expressed. Caretakers' views were generally positive, although dissatisfaction with the physical environment in which care took place was common. The capacity of the district hospital in Kenya needs strengthening by comprehensive policies that address real needs if current or new interventions and services at this level of care are to enhance child survival.

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Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Louwesweg 1, 1066 EA Amsterdam, The Netherlands. The use of Chewing sticks (Miswaki) in the third world for control of dental plaque is very popular. Some of the studies that have been conducted on this subject have reported marked decrease in the incidences of dental caries and periodontal diseases in the users of Miswaki, when compared to the users of the conventional toothbrush living under similar conditions. Various mechanisms by which the Miswaki contributes to this phenomenon have been suggested. The purpose of the present study was to investigate in vitro, the anti-microbial action, the potential acid buffer capacity and fluoride content of crude aqueous extracts of eight commonly used chewing sticks from three regions in Kenya. The results obtained in the study, showed that one of the Miswaki had remarkable antibiotic activity against three stains of oral bacteria. Three of the Miswaki had significant acid buffer capacity. None of the eight Miswaki showed any significant fluoride release.

G O Matete, N Maingi*, G Muchemi, W Ogara and J M Gathuma Department of Veterinary Public Health, Pharmacology and Toxicology, University of Nairobi P.O Box 29053-00625, Nairobi, Kenyageorge.matete@gmail.com* Department of Veterinary Pathology and Parasitology, University of Nairobi, P.O Box 29053-00625, Nairobi, Kenya Abstract Traceability systems offer strong incentives to livestock and meat exporting countries by altering their productive and industrial processes in order to access premium meat markets globally.  Kenya, whilst acknowledged as one of the countries within the horn of Africa with a reasonably credible veterinary service, has very limited access to beef and livestock markets in importing countries due to perceived risk or suspicions of presence of trans-boundary animal diseases (TADs) such as Rift Valley Fever (RVF) and Foot and Mouth Disease (FMD), lack of capacity to prove the absence of TADs and absence of an effective traceability system that acts as proxy for quality assurance.  The objective of this study was to report on the processes through which a model traceability system was designed for pastoral production systems of Northeastern Kenya.   The study reports that industry-wide consultation is a critical ingredient in the design process that encompassed simple drop down menus, low price and phased process of implementation. The use of a single central database reduced considerably the cost of implementation and minimized response time for impact analysis. Key words: Design, electronic traceability systems

The antihypertensive effect of the fixed combination of timolol, a beta-blocking agent, hydrochlorothiazide, a thiazide diuretic, and amiloride, a potassium sparing agent, was compared against that of methyldopa in an open study lasting 16 weeks in 32 ambulatory African patients with previously untreated diastolic blood pressure of 95-120 mm Hg. A significant fall in mean diastolic and systolic blood pressure was achieved in both groups up to 8 weeks of treatment and was sustained in the timolol-hydrochlorothiazide-amiloride group during the entire follow-up. In the methyldopa group, mean diastolic and systolic blood pressure rose during follow-up. At 16 weeks the fall in mean diastolic and systolic blood pressure was significantly greater in the timolol-hydrochlorothiazide-amiloride treated patients than in the methyldopa group. Adverse reactions were more frequent and severe in the methyldopa group than in timolol-hydrochlorothiazide-amiloride treated patients. It is concluded that the fixed drug combination of timolol-hydrochlorothiazide-amiloride (Moducren) is effective in controlling mild to moderate hypertension in Africans and is better tolerated than methyldopa in these patients. It is further noted that hypertensive patients can be treated with a combination tablet once a day. This is of crucial significance as it would promote better compliance and, hence, minimize the sequelae of poorly controlled hypertension.

No abstract available.

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

Two major etiological agents, hepatitis B virus and aflatoxin B1, are considered to be involved in the induction of liver cancer in Africa. In order to elucidate any synergistic effect of these two agents we conducted a study in various parts of Kenya with different liver cancer incidence in order to establish the rate of exposure to aflatoxin and the prevalence of hepatitis infections. Of all tested individuals 12.6% were positive for aflatoxin exposure as indicated by the urinary excretion of aflatoxin B1-guanine. Assuming no annual and seasonal variation, a regional variation in the exposure was observed. The highest rate of aflatoxin exposure was found in the Western Highlands and Central Province. The incidence of hepatitis infection nationwide as measured by the presence of the surface antigens was 10.6%, but a wide regional variation was observed. A multiplicative and additive regression analysis to investigate if hepatitis and aflatoxin exposure had a synergetic effect in the induction of liver cancer was negative. However, a moderate degree of correlation between the exposure to aflatoxin and liver cancer was observed when the study was limited to certain ethnic groups. The study gives additional support to the hypothesis that aflatoxin is a human liver carcinogen.

The purpose of this study was to determine if Mycobacterium leprae is an opportunistic pathogen in immunosuppressed subjects with HIV infection. Ninety six leprosy patients at Infectious Diseases Hospital (IDH), Nairobi were screened for, HIV-1 antibody between January 1991 and June 1992. The patients included 15 who were diagnosed during the study period and 81 who were previously diagnosed and were on anti-leprosy treatment. Blood was screened for HIV antibody by first ELISA and double positive samples were confirmed by a second ELISA. The HIV seronegative patients were re-tested serologically every 3 months. Smears from skin slits were used to determine bacterial index and the patients were classified according to criteria described by Ridley and Jopling. The patients were re-assessed clinically monthly. The mean age of the patients was 40 years and ranged from 13 to 78 years. Forty seven percent had paucibacillary and 53% had multibacillary leprosy. The HIV seroprevalence was 8% in previously diagnosed patients and zero in the newly diagnosed patients. There were no changes in clinical spectrum in HIV seropositive patients during follow up period; neither reversal reactions nor erythema nodosum leprosum were observed. The study suggests that M. leprae may not be an opportunistic pathogen in immunosuppressed subjects with HIV infection.