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  Submitted.  A Study Of Some Clinical And Laboratory Aspects Of The African Suffering From Duodenal Ulceration. Abstract

This is a prospective study of 50 patients with duodenal
ulcer proved by endoscopy. The clinical and laboratory features
of these patients were analysed and where possible compared to a
group of 30 control subjects.
It was found that a significant number of duodenal ulcer
patients do not present with the classical clinical picture. The
frequency of blood group Q was more in the duodenal ulcer patients as
compared to the controls and duodenal ulcer patients had higher basal
and maximal acid output values. An attempt at interpreting these results
in the Kenyatta Hospital set up has been made.

2014

Muriithi, RW, Muchiri LW, Lule GN.  2014.  Esophageal cytology sponge diagnostic test results in kenyatta national referral hospital, kenya., 2014. Acta cytologica. 58(5):483-8. Abstract

To describe the cytological findings of the esophagus using sponge cytology as a triage test in patients referred for esophageal endoscopy at Kenyatta National Hospital.

2013

McLigeyo, AA, Lule G, FREDRICK OTIENOCF, Kayima JK;, Omonge E;.  2013.  Human immunodeficiency virus (HIV) associated lipodystrophy: The prevalence, severity and phenotypes in patients on highly active anti-retroviral therapy (HAART) in Kenya. Journal of AIDS and HIV Research. 5(4):107-117. Abstract

Highly active antiretroviral therapy (HAART) is widely accessible to human immunodeficiency virus (HIV)-infected individuals in Kenya. Their long term use is associated with chronic complications such as lipodystrophy which may lead to stigmatization, reduced self esteem and poor adherence to HAART. This cross-sectional study described the prevalence of lipodystrophy, the phenotypes and severity among adult HIV infected patients on chronic HAART at a HIV clinic in Kenya. Data were collected using an investigator administered questionnaire and anthropometric measurements done using a protocol based on the Third National Health and Nutrition Examination Survey. The prevalence of lipodystrophy was 51.3% (confidence interval (CI) 45.6 to 57.6). Lipoatrophy occurred in 44%, lipohypertrophy in 15% and mixed syndrome in 41% of patients with lipodystrophy. Facial atrophy occurred in 75.7% of patients with lipodystrophy, upper limb atrophy in 48.5%, and lower limb atrophy in 36.8%. Abdominal obesity occurred in 40.4% of patients with lipodystrophy, breast enlargement in 30.9% and dorsocervical fat accumulation in 5.1%. Most patients had severe lipoatrophy, whereas lipohypertrophy was described as mild to moderate using the HIV out-patient study (HOPS) scale. HIV associated lipodystrophy was common in HIV-infected patients on chronic HAART. The main phenotype was lipoatrophy which majority of the patients described as severe.

Lule, G;, Omonge E;, Kayima JK;, Otieno FCF;, McLigeyo AA.  2013.  Metabolic factors associated with the development of lipodystrophy in patients on long-term highly active anti-retroviral therapy (HAART). Abstract

Dyslipidemia, insulin resistance and diabetes are frequent in patients on highly active anti-retroviral
therapy (HAART) and especially in patients with lipodystrophy, and may lead to atherosclerosis. This
study described the metabolic alterations associated with lipodystrophy in adults on chronic HAART in
Kenya. The prevalence of dyslipidaemia amongst the study participants was (211) 79.6%. Elevated total
cholesterol was found in 129, high low-density-lipoprotein cholesterol (LDL-C) in 107, low High-density
lipoprotein cholesterol (HDL-C) in 110 and high triglycerides in 131 participants. Lipodystrophic
patients were more likely to have dyslipidemia than normal lipids (55.4 versus 35.1%, p = 0.007 OR 2.2
CI 1.3 to 4.6) with 57, 45.9, 65.9 and 45.2% having elevated total cholesterol, elevated LDL-C, elevated
triglycerides and low HDL-C, respectively. Hypertriglyceridemia and hypercholesterolemia were
significantly associated with lipodystrophy (OR 3.8 CI 2.3 to 6.4; p = 0.000) and (OR 1.94 CI 1.2 to 3.2; p
= 0.008), respectively. The odds of lipodystrophy was 2.913 times higher for patients with elevated
triglycerides than for those with normal triglycerides (p < 0.001). Sixty-four (24.3%) participants had
dysglycemia, with 3.5% having diabetes and 20.8% having impaired fasting glucose (IFG). Among
patient with lipodystrophy, 69.8% had normal fasting glucose, 25.1% had IFG and 5.1% were diabetic.
Lipodystrophic patients were not more likely to have abnormal blood sugars than normal blood sugars
(p value 0.125).

2011

Kim, HN, Scott J, Cent A, Cook L, Morrow RA, Richardson B, Tapia K, Jerome KR, Lule G, John-Stewart G, Chung MH.  2011.  HBV lamivudine resistance among hepatitis B and HIV coinfected patients starting lamivudine, stavudine and nevirapine in Kenya., 2011 Oct. Journal of viral hepatitis. 18(10):e447-52. Abstract

Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV-HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg positive and anti-HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤ 10,000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV-HBV coinfected patients with low baseline HBV DNA levels.

H. N. Kim, J. Scott, CC2 MRTJALRA, K. R. Jerome, G. Lule J-SCGMH.  2011.  HBV Lamivudine resistance among Hepatitis B and HIV coinfected patients starting lamivudine, stavudine and nevirapine in Kenya . Journal of Viral Hepatitis. Volume 18( 10):e447–e452. Abstract

Summary.  Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV–HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg positive and anti-HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤10 000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV–HBV coinfected patients with low baseline HBV DNA levels.

C.S Ilovi, G.N Lule, OIAOHM.  2011.  Correlation of WHO Clinical Staging with CD4 Counts in Adult HIV/AIDS Patients at Kenyatta National Hospital, Nairobi. East African Medical Journal. 88(2):65-70. Abstract

Objective
To determine the degree of correlation between the WHO clinical staging and CD4 T cell counts in HIV/AIDS adults at Kenyatta National Hospital, Nairobi
Design
Cross Sectional Study
Setting
Kenyatta National Hospital, Nairobi
Subjects
One hundred and fifty two newly diagnosed HIV patients were recruited prospectively. Patients were first staged using the 2005 WHO clinical staging and then blood drawn for CD4 cell count.
Results
The mean age in the study was 35 years, with females comprising 52.6% 0f the study group. The mean CD4 counts were 455, 420, 203, and 92 for WHO stage 1, 2, 3, and 4 respectively. The sensitivity of the WHO clinical staging to predict CD4 of >350cells/uL was 63% with a specificity of 82%. The most common HIV clinical events were bacterial infections (33%), severe weight loss (28%) and tuberculosis (27%).
Conclusions
There was correlation between the WHO clinical staging and expected CD4T-cell count. However the sensitivity was low and missed over a third of the patients in need of HAART. Majority of the patients presented in severe disease in need of HAART at the onset of their HIV diagnosis with 107(70.3%) of the patients with stage 3 or 4 disease and 114(75%) of patients with CD4 Counts of <350 cells/uL

2009

LULE, GN.  2009.  Hepatitis E Virus. East African Medical Journal. :357.

2008

N, PROFLULEGODFREY.  2008.  Manuthu EM, Joshi MD, Lule GN, Karari E.Prevalence of dyslipidemia and dysglycaemia in HIV infected patients. East Afr Med J. 2008 Jan;85(1):10-7.. test. : test Abstract

BACKGROUND: Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS morbidity and mortality, however long-term metabolic consequences including dysglycaemia and dyslipidemia have raised concern regarding accelerated cardiovascular disease risk. OBJECTIVE: To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-infected patients. DESIGN: Cross-sectional comparative group study. SETTING: Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility. SUBJECTS: Consecutive HIV- positive adult patients. MAIN OUTCOME MEASURES: Dyslipidemia: presence of raised total or LDL cholesterol or low HDL cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, out of 342 screened patients, 295 were recruited and 58% were females. One hundred and thirty four (45%) were on HAART, 82% of whom were on stavudine, lamivudine and either nevirapine or efavirenz. Overall prevalence of dyslipidemiawas 63.1% and dysglycaemia was 20.7%. High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917). HDL levels were low in 14.6% and 51.3% among HAART and HAART naive patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 CI 0.688-2.037). Among patients on HAART compared to HAART naive patients, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22), respectively. CONCLUSIONS: HIV- infected patients demonstrated a high prevalence of dyslipidemia. HAART use was associated with high levels of total, and LDL cholesterol and high triglyceride levels, an established athrogenic lipid profile. However, HAART was not associated with low HDL cholesterol and had no significant effect on dysglycaemia.

2007

Kalebi, A;, Rana F;, Mwanda W;, Mwanda W;, Hale M.  2007.  Histopathological profile of gastritis in adult patients seen at a referral hospital in Kenya.
N, PROFLULEGODFREY.  2007.  Gitura B, Joshi MD, Lule GN, Anzala O.Total lymphocyte count as a surrogate marker for CD4+ t cell count in initiating antiretroviral therapy at Kenyatta National Hospital, Nairobi. East Afr Med J. 2007 Oct;84(10):466-72.. test. : test Abstract

OBJECTIVE: To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan population of HIV seropositive patients at Kenyatta National Hospital. DESIGN: Cross-sectional descriptive study. SETTING: Kenyatta National Hospital, HIV treatment and follow-up outpatient facility; Comprehensive Care Centre, Nairobi, Kenya. SUBJECTS: Two hundred and twenty five HIV Elisa positive, ARV naive patients visiting the Comprehensive Care Centre between January 2006 to March 2006. RESULTS: A significant linear correlation was found between TLC and CD4 cell count for the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was also independently observed in the four WHO clinical stages. The classification utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of 80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only misclassify two such patients. Serial CD4 testing can then be performed on the minority of patients who despite a TLC > or = 1900 cells/mm3 are, on basis of clinical data, suspect of more advanced disease warranting ARV therapy. This would reduce the number of patients tested for and focus the application of CD4 testing and thus reduce attendant cost in care provision in CD4 resource poor settings. CONCLUSION: Our data showed a good positive correlation between TLC and CD4 cell count, however the WHO recommended TLC cuto-ff of 1200/mm3 was found to be of low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3. This would result in underestimation of advanced stage of disease and to withholding ARVs treatment to persons who need treatment. We recommend a TLC cut-off of 1900 cells/mm3 for our population to classify patients as either above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when to start antiretroviral therapy.

2005

N, PROFLULEGODFREY.  2005.  Karuru JW, Lule GN, Joshi M, Anzala O. Prevalence of HCV and HCV/HIV co-infection among in-patients at the Kenyatta National Hospital. East Afr Med J. 2005 Apr;82(4):170-2.. East Afr Med J. 2005 Apr;82(4):170-2.. : test Abstract

OBJECTIVE: To determine the prevalence of HCV and HCV/HIV co-infection among medical in-patients at the Kenyatta National Hospital. DESIGN: Prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient department SUBJECTS: HIV/AIDS and HIV negative in-patients at KNH medical wards. RESULTS: Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and HIV was 3.7%. The incidence of risk factors in persons with HCV and/or HIV infection(s) was low. CONCLUSION: This study found the prevalence of HCV infection among medical in-patients to be similar in HIV positive and HIV negative group of patients. The co-infection rates were low, as were the risk factors for transmission of these infections.

N, PROFLULEGODFREY.  2005.  Karuru JW, Lule GN, Joshi M, Anzala O.Prevalence of HCV and HIV/HCV co-infection among volunteer blood donors and VCT clients.East Afr Med J. 2005 Apr;82(4):166-9.. East Afr Med J. 2005 Apr;82(4):166-9.. : test Abstract

OBJECTIVE: To determine the prevalence of HCV infection and HCV/HIV co-infection among voluntary blood donors at the National Blood Transfusion Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counseling and Testing (VCT) Centre. DESIGN: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital and the National Blood Transfusion Services Centre, Nairobi. SUBJECTS: Volunteer blood donors and VCT attendants. RESULTS: The prevalence of HCV/HIV co-infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients tested positive for HCV. The incidence of risk factors in the persons with HCV and/or HIV infection(s) was low. CONCLUSION: The prevalence of HCV infection among pre-screened volunteer blood donors was low. However the current practice of screening all donated blood for HCV remains indispensable to prevent its transmission to blood recipients.

N, PROFLULEGODFREY.  2005.  Lule GN. Helicobacter pylori eradication in peptic dyspepsia. East Afr Med J. 2005 Dec;82(12):601-2. No abstract available.. East Afr Med J. 2005 Dec;82(12):601-2.. : test Abstract

OBJECTIVE: To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan population of HIV seropositive patients at Kenyatta National Hospital. DESIGN: Cross-sectional descriptive study. SETTING: Kenyatta National Hospital, HIV treatment and follow-up outpatient facility; Comprehensive Care Centre, Nairobi, Kenya. SUBJECTS: Two hundred and twenty five HIV Elisa positive, ARV naive patients visiting the Comprehensive Care Centre between January 2006 to March 2006. RESULTS: A significant linear correlation was found between TLC and CD4 cell count for the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was also independently observed in the four WHO clinical stages. The classification utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of 80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only misclassify two such patients. Serial CD4 testing can then be performed on the minority of patients who despite a TLC > or = 1900 cells/mm3 are, on basis of clinical data, suspect of more advanced disease warranting ARV therapy. This would reduce the number of patients tested for and focus the application of CD4 testing and thus reduce attendant cost in care provision in CD4 resource poor settings. CONCLUSION: Our data showed a good positive correlation between TLC and CD4 cell count, however the WHO recommended TLC cuto-ff of 1200/mm3 was found to be of low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3. This would result in underestimation of advanced stage of disease and to withholding ARVs treatment to persons who need treatment. We recommend a TLC cut-off of 1900 cells/mm3 for our population to classify patients as either above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when to start antiretroviral therapy.

2004

N, PROFLULEGODFREY.  2004.  Lule GN.Spontaneous bacterial peritonitis. East Afr Med J. 2004 Mar;81(3):113. Review. No abstract available.. East Afr Med J. 2005 Apr;82(4):166-9.. : test Abstract

OBJECTIVE: To determine the prevalence of HCV infection and HCV/HIV co-infection among voluntary blood donors at the National Blood Transfusion Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counseling and Testing (VCT) Centre. DESIGN: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital and the National Blood Transfusion Services Centre, Nairobi. SUBJECTS: Volunteer blood donors and VCT attendants. RESULTS: The prevalence of HCV/HIV co-infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients tested positive for HCV. The incidence of risk factors in the persons with HCV and/or HIV infection(s) was low. CONCLUSION: The prevalence of HCV infection among pre-screened volunteer blood donors was low. However the current practice of screening all donated blood for HCV remains indispensable to prevent its transmission to blood recipients.

2002

N, PROFLULEGODFREY.  2002.  AliMohamed F, Lule GN, Nyong'o A, Bwayo J, Rana FS.Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi.East Afr Med J. 2002 May;79(5):226-. East Afr Med J. 2002 May;79(5):226-31.. : test Abstract

BACKGROUND: Human immunodeficiency virus (HIV) seropositive patients frequently experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H. pylori gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive patients at the Kenyatta National Hospital. OBJECTIVES: The aim of the study was to determine the prevalence of H. pylori gastric mucosal infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive patients. DESIGN: A hospital-based prospective case-control study. SETTING: Kenyatta National Hospital, Endoscopy Unit. SUBJECTS: Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as well as 52 HIV seronegative age and gender matched controls). INTERVENTION: Both cases and control subjects underwent upper GIT endoscopy and biopsies were taken according to a standard protocol. H. pylori detection was done by the rapid urease test and histology, and H. pylori gastric mucosal infection was considered to be present in the presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and CD4+ peripheral lymphocyte counts were determined using flow cytometry. RESULTS: H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and 84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori decreased with decreasing peripheral CD4+ lymphocyte counts. Median CD4+ lymphocyte count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%), which was often associated with presence of oral candidiasis and, together with erosions, ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT Kaposi's sarcoma, and one gastric lymphoma. CONCLUSIONS: H. pylori prevalence was not significantly different between HIV positive and HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive patients and was often associated with oral thrush.

FREDRICK, DROTIENOCF, N PROFLULEGODFREY.  2002.  Upper gastrointestinal findings in diabetic outpatients at Kenyatta National Hospital, Nairobi. East Afr Med J. 2002 May;79(5):232-6.. East Afr Med J. 2002 May;79(5):232-6.. : test Abstract

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia.
DESIGN: Cross-sectional study.
SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya.
SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

N, PROFLULEGODFREY, OLONDE PROFAMAYOERASTUS.  2002.  Lule GN, Amayo EO. Irritable bowel syndrome in Kenyans. East Afr Med J. 2002 Jul;79(7):360-3.. East Afr Med J. 2002 Jul;79(7):360-3.. : test Abstract

OBJECTIVE: To study the prevalence and clinical presentation of irritable bowel syndrome (IBS) in black Kenyans. DESIGN: A retrospective study. SETTING: Nairobi Hospital, an urban private institution. SUBJECTS: Case files of all patients presenting with abdominal pain. MAIN OUTCOME MEASURES: Prevalence of IBS using modified Manning's Symptomatic criteria in 223 consecutive adult patients presenting with abdominal pain and discomfort who had normal clinical findings and normal general and gastrointestinal investigations. RESULTS: Out of the 3472 patient files screened, there were 281 patients who fitted the diagnosis of irritable bowel syndrome giving an overall prevalence of 8%. The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male to female ratio of 1.4:1 being statistical significant at a p-value of 0.010. There was no statistical significant difference between the males and females in constipation and diarrhoea at p-value of 0.84 and 0.82 respectively. Fifteen percent of the patients were either on antidepressants or had been seen by a psychiatrist. Nine percent had undergone laparatomy for the abdominal pain. CONCLUSION: The Black African patient is equally as exposed to irritable bowel syndrome as is his counterpart in the western world and has similar morbidity patterns. The syndrome may account for over 10% of patients with abdominal pain presenting to gastroenterologists in Africa. Proper attention to symptomatology may lead to clinching the diagnosis without resorting to many unnecessary and expensive investigations.

2000

N, PROFLULEGODFREY.  2000.  Karari EM, Lule GN, McLigeyo SO, Amayo EO.Endoscopic findings and the prevalence of Helicobacter pylori in chronic renal failure patients with dyspepsia. East Afr Med J. 2000 Aug;77(8):406-9.. East Afr Med J. 2002 May;79(5):226-31.. : test Abstract

BACKGROUND: Peptic ulcer disease (PUD) occurs in up to one fourth of patients with chronic renal failure (CRF). Some of the factors implicated in its causation include hypergastrinaemia, secondary hyperparathyroidism, drugs and, recently, Helicobacter pylori infection. Studies on the latter have been few, with none having been carried out in Kenya. OBJECTIVE: To evaluate the upper gastrointestinal tract endoscopic findings and to determine the prevalence of H. pylori in CRF patients with dyspepsia. STUDY DESIGN AND POPULATION: A prospective study of seventy seven consecutive patients with CRF and dyspepsia compared with consecutive age, sex and socio-economically matched seventy seven controls (no CRF) with dyspepsia. SETTING: Kenyatta National Hospital (KNH), the major referral and teaching hospital, Nairobi, Kenya. METHODS: In both the study population and the controls, upper gastrointestinal endoscopy was carried out. H. pylori was tested for using the biopsy urease test and histology. Patients were considered to have H. pylori if they tested positive on both tests. OUTCOME MEASURES: Findings at endoscopy and presence of H. pylori. RESULTS: Inflammatory lesions (gastritis, duodenitis) (42%) and duodenal ulcers (18.4%) were the commonest findings in the two groups combined. The prevalence of H. pylori in the 154 subjects studied was 54.5%. There was no statistically significant difference between the prevalence of H. pylori in CRF patients (53.2%) and the controls (55.8%) (p = 0.746). Patients with endoscopically proven PUD had a very high prevalence of H. pylori (87.3%) regardless of their renal function status. CONCLUSION: Dyspepsia in patients with or without CRF was due to multiple causes and over 50% were attributable to H. pylori. The prevalence of H. pylon in dyspeptic CRF patients was similar to that in dyspeptic patients with normal renal function.

1999

Lule., GN.  1999.  Helicobacter Pylori..

1998

N, PROFLULEGODFREY.  1998.  Ogutu EO, Okoth FA, Lule GN.Colonoscopic findings in Kenyan African patients. East Afr Med J. 1998 Sep;75(9):540-3.. East Afr Med J. 2002 May;79(5):226-31.. : test Abstract

OBJECTIVE: To determine the types and prevalence of colonic diseases in Kenyan African patients referred for colonoscopy with lower gastrointestinal tract symptoms. DESIGN: A cross sectional survey conducted over a two year period. SETTING: Major private hospitals in Nairobi. PATIENTS: Two hundred forty seven consecutive patients of both sexes and all ages referred for colonoscopy between January 1996 and December 1997. Only Kenyans of African origin were included. Patients were referred from all over the country though the majority of cases were from Nairobi and its surrounding districts. RESULTS: The major indications for colonoscopy were lower abdominal pain (35.6%), non-bloody diarrhoea (22.3%), constipation (21.4%) and rectal bleeding (19.8%). Nearly 53% of patients colonoscoped had abnormal mucosal findings, with the main abnormalities being: proctocolitis (20.2%), colorectal cancers (12.1%), haemorrhoids (7.3%), colorectal polyps (6.5%) and diverticulosis (5.3%). The main histological diagnosis among patients whose colonic biopsy were done included normal colonic mucosa (29%), non-specific colitis (28.5%), adenocarcinoma (18.2%), benign colonic polyp (9.7%) and ulcerative colitis (7.3%). There was one case of Crohn's colitis and five cases (3%) of infective colitis. CONCLUSION: The study shows that the African colon has a number of pathological lesions contrary to previous reported literature.

1997

1995

Folds, JD, Cohen M, Lule G, Hamilton H, Hoffman I, Behets F, Dallabetta G, Schmitz JL, Jethwa HS.  1995.  Comparison of molecular and microscopic techniques for detection of Treponema pallidum in genital ulcers. AbstractWebsite

We compared the ability of direct immunofluorescent staining (DFA) and the PCR to detect Treponema pallidum in specimens from patients with genital ulcer disease. Touch preparations from 156 patients with genital lesions were fixed in acetone and stained with a fluorescein-labeled monoclonal antibody specific for the 37-kDa antigen of T. pallidum. After microscopic examination, the smear was removed from the slide with a swab. DNA was extracted with phenol-chloroform and precipitated with isopropanol. Ten microliters of the extracted DNA was amplified by PCR using primers for the gene encoding the 47-kDa protein of T. pallidum and hybridized to an internal probe. Twenty-two of 156 specimens were positive for T. pallidum by DFA and PCR, while 127 were negative by both methods, yielding a concordance of 95.5% (kappa = 0.84). Four specimens were positive by PCR and negative by DFA, while three specimens were negative by PCR and positive by DFA. The DFA-negative, PCR-positive specimens may have resulted from the presence of large numbers of leukocytes on the slides, obscuring visualization of treponemes. The DFA-positive, PCR-negative results were not due to inhibition of the PCR since purified T. pallidum DNA was amplified when added to aliquots of these specimens. Negative results in these specimens were most likely due to inefficient recovery of their DNA. These data suggest that DFA and PCR are equivalent methods for detection of T. pallidum on touch preparations of genital lesions. Further refinements of the PCR assay are necessary for it to significantly improve the detection of T. pallidum in genital lesions.

N, PROFLULEGODFREY.  1995.  Ilako FM, McLigeyo SO, Riyat MS, Lule GN, Okoth FA, Kaptich D. The prevalence of hepatitis C virus antibodies in renal patients, blood donors and patients with chronic liver disease in Kenya. East Afr Med J. 1995 Jun;72(6):362-4.. East Afr Med J. 1995 Jun;72(6):362-4.. : test Abstract

We tested serum samples from four categories of patients with nephrological problems (nephrotic syndrome, stable chronic renal failure, haemodialysis patients and renal transplant recipients), patients with chronic liver disease and volunteer blood donors for the presence of antibody to hepatitis C virus (HCV). Screening was done by second-generation enzyme linked immunosorbent assay (ELISA) and confirmation with second-generation recombinant immunoblot assay (RIBA). Of all the renal patients, only 6.3% of the transplant patients tested positive for anti-HCV, while in patients with chronic liver disease anti-HCV was detected in 2.6% of the patients with chronic hepatitis and in none with liver cirrhosis or hepatocellular carcinoma. This finding of low prevalence in these patient groups was not in keeping with findings in studies done elsewhere. Our anti-HCV prevalence of 0.9% in blood donors was comparable to that found in Europe, USA and Taiwan. We recommend that the low prevalence of anti-HCV in some of our high risk groups should not lead to complacence and hence further studies are necessary to evaluate the infectivity of anti-HCV positive patients and the potential for cross infection.

1994

N, PROFLULEGODFREY, OTIENO PROFOGUTUELLY.  1994.  Lule GN, Obiero ET, Ogutu EO.Factors that influence the short term outcome of upper gastrointestinal bleeding at Kenyatta National Hospital. East Afr Med J. 1994 Apr;71(4):240-5.. East Afr Med J. 1994 Jan;71(1):44-8.. : test Abstract

Between April 1990 to January 1991, a prospective study of 97 consecutive patients admitted to the medical wards of Kenyatta National Hospital with upper gastrointestinal haemorrhage was done. All the patients studied under went upper gastrointestinal endoscopy within 24 hours of presentation and a positive endoscopic diagnosis was possible in 90 (93%) of the patients studied. The leading causes of bleeding were oesophageal varices in 34 (35%) patients, duodenal ulceration in 17 (17.5%) patients, and superficial inflammatory lesions in 17 (17.5%) patients. 17 (17.5%) patients had multiple lesions with superficial inflammation and oesophageal varices as the commonest combination. In 86 (88%) patients, bleeding settled on simple conservative measures which included intravenous fluids, blood transfusion and antacids. Further haemorrhage was observed in 11 (11.3%) patients. Tachycardia (> 100/minute), hypotension (systolic BP < 100mm Hg) and low haemoglobin (< 8 g/dl) at admission were all correlated with a poor outcome. Variceal bleeding had the worst prognosis and the overall mortality rate was 5%.

N, PROFLULEGODFREY, OTIENO PROFOGUTUELLY.  1994.  Okoth FA, Lule GN, Ogutu EO, Pilczer S, Dubois C. Famotidine in the management of gastro-oesophageal reflux. East Afr Med J. 1994 Jan;71(1):44-8.. East Afr Med J. 1994 Jan;71(1):44-8.. : test Abstract

Famotidine has been used for the treatment of peptic ulcers and Zollinger Ellison syndrome and is also useful in reflux and erosive oesophagitis. To evaluate the effects of Famotidine 20 mg given twice daily in the symptomatic relief of gastro-oesophageal reflux disease with normal oesophagus or mild endoscopic oesophagitis, patients were followed over a period of six weeks. 70% of the patients had complete day-time heartburn relief during the study and 75% had complete night-time heartburn relief during the study. Famotidine was found to be safe and there were no serious clinical or laboratory adverse experiences.

1992

N, PROFLULEGODFREY.  1992.  Gilks CF, Otieno LS, Brindle RJ, Newnham RS, Lule GN, Were JB, Simani PM, Bhatt SM, Okelo GB, Waiyaki PG, et al. The presentation and outcome of HIV-related disease in Nairobi. Q J Med. 1992 Jan;82(297):25-32.. Q J Med. 1992 Jan;82(297):25-32.. : test Abstract

The range of clinical presentations of HIV-related disease in Africa has not been adequately described, despite the fact that many hospitals have to rely heavily on clinical diagnosis. Six hundred adult medical patients seen in the Casualty Department of the main Government hospital in Nairobi were enrolled in a study of the presentation and outcome of HIV-related disease: 506 of these patients were admitted, of whom 19 per cent (95) were HIV seropositive. The remaining 94 were dealt with as outpatients: 11 percent (10) of these were seropositive. A history of prior treatment for sexually transmitted disease and, if male, being uncircumcised, were associated with being seropositive. Three presentations were strongly associated with HIV infection: acute fever with no focus except the gastrointestinal tract (enteric fever-like illness), acute cough with fever (community-acquired pneumonia) and chronic diarrhoea with wasting. The WHO clinical case definition (CCD) for AIDS missed a substantial amount of HIV-related morbidity (sensitivity 39 per cent) and misidentified many seronegative patients (positive predictive value 59 per cent). In comparison with the Centers for Disease Control surveillance definition for AIDS, the CCD was specific (91 per cent) and sensitive (79 per cent) but only had a positive predictive values of 30 per cent: the CCD may therefore be a poor surveillance tool for AIDS. Seropositive patients were much more likely to die than were seronegative patients (39 per cent vs. 15 per cent mortality). Enteric fever-like illness was the presentation which most commonly proved fatal. A wider spectrum of disease is associated with underlying HIV immunosuppression than has previously been described in Africa.

1991

N, PROFLULEGODFREY.  1991.  Lule GN, Sang F, Ogutu EO.Helicobacter pylori in peptic ulcer disease in Kenya.East Afr Med J. 1991 May;68(5):324-7.. East Afr Med J. 1991 May;68(5):324-7.. : test Abstract

Sixty six patients with dyspeptic symptoms underwent upper gastrointestinal endoscopy and biopsies for Helicobacter pylori culture. The number of H. pylori isolated increased with age reaching a peak at 51 to 60 years of age. Antral gastritis closely followed by duodenitis accounted for the highest number of H. pylori isolated, (87.5% and 85.7% respectively). In patients with duodenal ulceration only, 57% had H. pylori isolated from their antral biopsies, a result that was just slightly higher than that where no endoscopic diagnosis was made (50%).

N, PROFLULEGODFREY.  1991.  Lule GN. Helicobacter pylori: an infectious agent in peptic ulcer disease? East Afr Med J. 1991 May;68(5):321-3. No abstract available. East Afr Med J. 1991 May;68(5):321-3.. : test Abstract

The range of clinical presentations of HIV-related disease in Africa has not been adequately described, despite the fact that many hospitals have to rely heavily on clinical diagnosis. Six hundred adult medical patients seen in the Casualty Department of the main Government hospital in Nairobi were enrolled in a study of the presentation and outcome of HIV-related disease: 506 of these patients were admitted, of whom 19 per cent (95) were HIV seropositive. The remaining 94 were dealt with as outpatients: 11 percent (10) of these were seropositive. A history of prior treatment for sexually transmitted disease and, if male, being uncircumcised, were associated with being seropositive. Three presentations were strongly associated with HIV infection: acute fever with no focus except the gastrointestinal tract (enteric fever-like illness), acute cough with fever (community-acquired pneumonia) and chronic diarrhoea with wasting. The WHO clinical case definition (CCD) for AIDS missed a substantial amount of HIV-related morbidity (sensitivity 39 per cent) and misidentified many seronegative patients (positive predictive value 59 per cent). In comparison with the Centers for Disease Control surveillance definition for AIDS, the CCD was specific (91 per cent) and sensitive (79 per cent) but only had a positive predictive values of 30 per cent: the CCD may therefore be a poor surveillance tool for AIDS. Seropositive patients were much more likely to die than were seronegative patients (39 per cent vs. 15 per cent mortality). Enteric fever-like illness was the presentation which most commonly proved fatal. A wider spectrum of disease is associated with underlying HIV immunosuppression than has previously been described in Africa.

1990

N, PROFLULEGODFREY, OTIENO PROFOGUTUELLY, OLONDE PROFAMAYOERASTUS.  1990.  Ogutu EO, Amayo EO, Okoth F, Lule GN. The prevalence of hepatitis B surface antigen (HBsAg), anti-hepatitis B surface (anti-HBs) and anti-hepatitis B core (anti-HBc) in patients with acquired immuno-deficiency syndrome (AIDS). East Afr Med J. 1990 May;67(. East Afr Med J. 1990 May;67(5):355-8.. : test Abstract

Forty one consecutive patients (24 males and 17 females) with AIDS had their blood assayed for HBsAg, anti-HBs and anti-HBc by Reversed Passive Haemagglutination (RPHA), Passive Haemagglutination (PHA) and Enzyme Linked Immunosorbent Assay (ELISA) techniques respectively. 5 (12.2%) were found positive for HBsAg. 10 (24.4%) for anti-HBs and 31 (75.6%) for anti-HBc. 32 (78%) out of 41 patients with AIDS had serological evidence of exposure to hepatitis B virus (HBV). The prevalence of HBsAg found in this study is not different from what has been found in the Kenyan community without AIDS, while that of anti-HBs is much lower than what has been reported in the general community.

N, PROFLULEGODFREY.  1990.  Gilks CF, Brindle RJ, Otieno LS, Bhatt SM, Newnham RS, Simani PM, Lule GN, Okelo GB, Watkins WM, Waiyaki PG, et al. Extrapulmonary and disseminated tuberculosis in HIV-1-seropositive patients presenting to the acute medical services in Nairobi. AIDS. 1990. AIDS. 1990 Oct;4(10):981-5.. : test Abstract

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested.

N, PROFLULEGODFREY.  1990.  Gilks CF, Brindle RJ, Otieno LS, Simani PM, Newnham RS, Bhatt SM, Lule GN, Okelo GB, Watkins WM, Waiyaki PG, et al. Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya. Lancet. 1990 Sep 1;336(8714):545-9.. Lancet. 1990 Sep 1;336(8714):545-9.. : test Abstract

During 6 months, 506 consecutive adult emergency admissions to hospital in Nairobi were enrolled in a study of bacteraemia and HIV infection. 19% were HIV-1 antibody positive. Significantly more HIV-seropositive than seronegative patients had bacteraemia (26% vs 6%). The predominant organisms isolated from the seropositive patients were Salmonella typhimurium and Streptococcus pneumoniae. Mortality was higher in the seropositive than in the seronegative bacteraemic patients. The findings suggest that non-opportunistic bacteria are important causes of morbidity and mortality in HIV-infected individuals in Africa.

1989

LULE, GN.  1989.  Advance in Gastroenterology. Website
N, PROFLULEGODFREY, OTIENO PROFOGUTUELLY.  1989.  Ogutu EO, Lule GN, Okoth FN, Were BO. The pattern of chronic gastric ulcer at Kenyatta National Hospital (K.N.H.). East Afr Med J. 1989 Jan;66(1):10-4.. East Afr Med J. 1989 Jan;66(1):10-4.. : test Abstract

Thirty consecutive patients with gastric ulcer diagnosed during upper gastrointestinal fibreoptic panendoscopy at both Kenya Medical Research Institute and Kenyatta National Hospital endoscopy rooms were studied. The male/female ratio was 5:1 with a peak prevalence in the 6th decade. 76.6% of the patients were from the Kikuyu ethnic group. Smoking habit was found in only 50% of patients with gastric ulcers. There were a total of 32 gastric ulcers in 30 patients. 84.4% of these were at the incisura angularis. All the incisural ulcers were benign. Two (6.25%) of the 32 ulcers were malignant (one at the cardia and the other at the antrum). Gastric ulcers whose diameter were greater than 30 mm had a higher tendency of being malignant. Five patients (16.7%) had both gastric (4 benign and 1 malignant) and duodenal ulcers while 4 (13.3%) patients had both gastric and pyloric ring ulcers. Apparent healing of a gastric ulcer while on an H2-antagonist does not totally exclude malignancy. Upper gastrointestinal bleed which was present in 53.3% of cases was the most frequent complication.

N, PROFLULEGODFREY.  1989.  Joshi MD, Gathua SN, Okelo GB, Lule GN, Musewe AO. Cryptococcal hepatitis and meningitis in a patient with acquired immunodeficiency syndrome: a case report. East Afr Med J. 1989 Jan;66(1):69-73.. East Afr Med J. 1989 Jan;66(1):69-73.. : test Abstract

A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

N, PROFLULEGODFREY, OTIENO PROFOGUTUELLY.  1989.  Ogutu EO, Lule GN, Okoth F, Mwai SJ. The clinical pattern of duodenogastric bile reflux in the Kenyan Africans. East Afr Med J. 1989 Jan;66(1):35-9.. East Afr Med J. 1989 Jan;66(1):35-9.. : test Abstract

Forty consecutive African patients found to have duodenogastric bile reflux at endoscopy were studied. Bile reflux was found more commonly among males than females, giving a male/female ratio of 2.3:1, with a peak age at 41-60 years. ABO blood groups had no significant influence on duodenogastric bile reflux. Flatulence and borborygmi were the most consistent symptoms other than the classical dyspeptic pain pattern. Bilious vomiting was a rare finding. Duodenogastric bile reflux was more commonly associated with endoscopic gastritis (67.5%), gastric ulcer (35%) and oesophagitis (30%) than with duodenal ulcer (22.5%), deformed pyloric ring (5%) or distorted duodenal bulb (2.5%). The dysfunction in the pyloric sphincter in people with duodenogastric bile reflux appears to be more of a physiological defect than structural.

N, PROFLULEGODFREY.  1989.  Faraj FJ, Lule GN, Mwai JS. Serum pepsinogen I in relation to some clinical features and complications of duodenal ulcer disease. East Afr Med J. 1989 Apr;66(4):255-8.. East Afr Med J. 1989 Apr;66(4):255-8.. : test Abstract

Fasting serum pepsinogen 1 was assayed in 60 patients seen at the Kenyatta National Hospital with endoscopy - confirmed active duodenal ulceration. Pepsinogen 1 values were also correlated with some clinical features and complications of this disorder. 54 (90%) of the patients had significantly elevated values when compared with age and sex matched controls. Although elevated values were found in patients with chronic dyspepsia, family history of ulcer dyspepsia, history of gastro-duodenal blood loss and in patients with virulent ulcers, this did not show statistical significance. The possibility of using serum pepsinogen I to identify duodenal ulcer patients and to predict the clinical course and complications of this disorder is discussed.

N, PROFLULEGODFREY.  1989.  Lule GN, Okoth F, Ogutu EO, Mwai SJ. HBV markers (HBsAg, HBSAb, HBCAb in 160 medical students at Kenyatta National Hospital. East Afr Med J. 1989 May;66(5):315-8.. East Afr Med J. 1989 May;66(5):315-8.. : test Abstract

In an exercise to study the immunogenicity and reactogenicity of the Engerix B vaccine, 160 medical students were screened for Hepatitis B Markers (HBsAg, HBsAb and HBcAb) with a view to vaccinating those that were negative. 18% were HBsAg + ve, 33% were HBsAb + ve and 38% were positive for the HBcAb. These figures were extremely high and obviated the need to vaccinate the students as they begin their clinical years.

N, PROFLULEGODFREY.  1989.  Okoth FA, Ogutu EO, Lule GN, Wambugu MN. Some aspects of obstructive jaundice at Kenyatta National Hospital. East Afr Med J. 1989 Sep;66(9):594-7.. East Afr Med J. 1989 Sep;66(9):594-7.. : test Abstract

A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).

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