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.

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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.

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JASPA Working Paper, ILO, Addis Ababa

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

Background
Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries.

Methods/design
The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up).

Discussion
Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization’s global recommendations on ACS use.

Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries.

Background: Effective interventions to reduce mortality and morbidity in maternal and newborn health already exist. Information about quality and performance of care and the use of critical interventions are useful for shaping improvements in health care and strengthening the contribution of health systems towards the Millennium Development Goals 4 and 5. The near-miss concept and the criterion-based clinical audit are proposed as useful approaches for obtaining such information in maternal and newborn health care. This paper presents the methods of the World Health Organization Multicountry Study in Maternal and Newborn Health. The main objectives of this study are to determine the prevalence of maternal near-miss cases in a
worldwide network of health facilities, evaluate the quality of care using the maternal near-miss concept and the criterion-based clinical audit, and develop the near-miss concept in neonatal health.

Methods/Design: This is a large cross-sectional study being implemented in a worldwide network of health facilities. A total of 370 health facilities from 29 countries will take part in this study and produce nearly 275,000 observations. All women giving birth, all maternal near-miss cases regardless of the gestational age and delivery status and all maternal deaths during the study period comprise the study population. In each health facility, medical records of all eligible women will be reviewed during a data collection period that
ranges from two to three months according to the annual number of deliveries.

Discussion: Implementing the systematic identification of near-miss cases, mapping the use of critical evidence-based interventions and analysing the corresponding indicators are just the initial steps for using the maternal nearmiss concept as a tool to improve maternal and newborn health. The findings of projects using approaches similar to those described in this manuscript will be a good starter for a more comprehensive dialogue with governments, professionals and civil societies, health systems or facilities for promoting best practices, improving quality of care and achieving better health for mothers and children.

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

International and interregional comparisons of average annual age-adjusted incidence rates for primary tumours of the nervous system showed marked variations. The highest rates were observed in those areas having high socioeconomic levels. In communities with multiple racial groups the highest rates were in Caucasians. Migrant populations retained rates close to those found in the country of origin. The majority of populations showed modest increases only while about one-third showed a decrease in the incidence rates during a period of approximately 15 years. Overall, there was a male excess. It is suggested that differences in medical practices (including availability of specialist expertise), diagnostic facilities and individual registry practices account for some of the variations observed. However, the possible aetiological roles of genetic, racial, hormonal and environmental factors need to be evaluated to explain the consistently higher incidence rates in Caucasians and in males of all races.

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 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

It has been the view of the Association of Surgeons of East Africa (ASEA) that, like primary health care, there is primary surgery. The unit of provision of primary surgery is the district hospital. The training of surgeons for district hospitals starts at the undergraduate level, leading to the attainment of Bachelor of Medicine and Bachelor of Surgery (M.B. Ch.B.) degree. After internship the doctor works in a district or provincial hospital for 2-3 years, then trains for the degree of Master of Medicine (M. Med. (Surg.)) for a period of 3 years. The training involves rotation through all branches of surgery, so that the surgeon should be able to handle all aspects of routine surgery in a district hospital. To equip the surgeon further, a period in an outside setting is considered advisable. There are arrangements for regional surgical colleges to standardise the form of surgical training in the ASEA region. To keep surgeons in touch with the outside world, specialist training is done outside the region, but arrangements are being made for localised specialised units to offer this training.

A model for the establishment of a four-dimensional regional geodetic reference datum is presented. Starting from the three-dimensional integrated geodetic network model, formulations for the establishment of a four-dimensional regional datum are developed. Astronomic latitudes, astronomic longitudes, gravity values, gravity potential differences, gravity differences, and GPS-vectors are considered as observables. The estimated parameters defining the datura are point coordinates, deflections of the vertical and geoidai undulations, and velocities and accelerations on the positional coordinates. The network datum is considered observed over several epochs with parameters estimated from previous epochs being introduced into later epochs as stochastic prior information parameters.

No abstract available.

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

   

 

 

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

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Fourteen patients received oral premedication of temazepam in soft gelatin capsules before minor surgery. The plasma concentrations of temazepam and its sedative, anxiolytic and amnesic effects were measured for 24 hours. Absorption was rapid and peak concentrations occurred 49 minutes after administration. Clinical effects were evident at 30 minutes and persisted for about 4 hours. The decline in plasma concentration was biexponential with a distribution half-life of 1.24 hours. The end of the distribution phase coincided approximately with the termination of its clinical effects. A relationship between plasma concentration and effect was observed; concentrations above 300 ng/ml produced measurable changes in tests of mental function. Patients had recovered fully from the effects of temazepam after 24 hours. This dose of temazepam is reliable and effective as premedication before surgery

Fourteen patients received oral premedication of temazepam in soft gelatin capsules before minor surgery. The plasma concentrations of temazepam and its sedative, anxiolytic and amnesic effects were measured for 24 hours. Absorption was rapid and peak concentrations occurred 49 minutes after administration. Clinical effects were evident at 30 minutes and persisted for about 4 hours. The decline in plasma concentration was biexponential with a distribution half-life of 1.24 hours. The end of the distribution phase coincided approximately with the termination of its clinical effects. A relationship between plasma concentration and effect was observed; concentrations above 300 ng/ml produced measurable changes in tests of mental function. Patients had recovered fully from the effects of temazepam after 24 hours. This dose of temazepam is reliable and effective as premedication before surgery

Fourteen patients received oral premedication of temazepam in soft gelatin capsules before minor surgery. The plasma concentrations of temazepam and its sedative, anxiolytic and amnesic effects were measured for 24 hours. Absorption was rapid and peak concentrations occurred 49 minutes after administration. Clinical effects were evident at 30 minutes and persisted for about 4 hours. The decline in plasma concentration was biexponential with a distribution half-life of 1.24 hours. The end of the distribution phase coincided approximately with the termination of its clinical effects. A relationship between plasma concentration and effect was observed; concentrations above 300 ng/ml produced measurable changes in tests of mental function. Patients had recovered fully from the effects of temazepam after 24 hours. This dose of temazepam is reliable and effective as premedication before surgery

The optimised design of project alternatives is a main challenge for the early stage of any real-world planning process. For participatory conservation planning procedures as required, e.g., by the CBD (Convention on Biological Diversity) Ecosystem Approach, it is essential to involve concerned stakeholders – and their values – as early as possible. We argue that the utilisation of choice experiments offers an attractive solution to the problem of an optimised design of project alternatives. In particular, we report experiences from two case studies employing choice experiments to generate policy advice. In both case studies, the necessity of dealing with the ambiguities of participatory planning processes led to the adoption of a payment vehicle format that includes WTP and WTA attribute levels. Like several other studies, we found evidence of WTP/WTA disparities that argue for reporting both values to stakeholders and administrators.

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.

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.

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.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

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