Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

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.

OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.

OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.

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

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

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

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

Tetralones were converted to tetralinylamines via Leuckart reaction.These were then used to protect carboxamide side-chains of glutamine and asparagine. Clevage studies using trifluoroacetic acid and boron tristrifluoroacetate were then done on these derivatives. The groups 1-tetralinyl, 5,7-dimethyl-1-tetralinyl and 7-methoxy-1-tetralinyl were found to be good carboxamide protecting groups in asparagine.

   

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

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

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

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

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

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

 

 

OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.

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

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

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

An increase in illness due to measles is one of the potential consequences of the human immunodeficiency virus (HIV) epidemic in Africa. During a study of perinatal HIV transmission conducted in Kenya, the risk of acquiring measles before vaccination (9 months of age) was found to be 3.8 times higher in infants born to HIV-seropositive mothers than in control infants (10 [9%] of 109 vs. 5 [3%] of 194 infants; P = .02; odds ratio, 3.8; 95% confidence interval, 1.2-13.2). The majority of infants who developed measles in this study had significant sequelae related to their measles infection. The increased risk of measles appeared to be related to relatively lower anti-measles antibody titers detected in cord blood samples of affected infants born to HIV-seropositive mothers. However, 94% of all infants were susceptible to measles on the basis of ELISA testing at age 6 months regardless of maternal HIV serology. These observations highlight the need for improved measles vaccination strategies in Africa and for studies to delineate the effects of HIV infection on the incidence,

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

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

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

 

 

A retrospective study of 42 patients with perforations of the oesophagus during the period 1981-1987 indicated that 57.1% of the perforations were iatrogenic. Diseases of the oesophagus and in contiguous structures and foreign bodies in the oesophagus caused perforations in 31% of the cases. Perforations in 35.7% of the patients were located in the middle third of the oesophagus. The lower and upper thirds were affected in 31% of the patients in each site. The presenting physical signs included tachycardia (78.6%), fever (76.2%) and dyspnoea (59.5%). The main accompanying symptoms were chest pain and coughs in 100% and in 50% of the patients respectively. Radiographic findings showed hydropneumothorax in 40.5% of the cases and consolidation in 38.1% of the patients. Oesophagoscopy was positive in 78% of cases tested while thoracocentesis was positive in all cases that were tested.

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

   

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

21) S. Derese, A. Yenesew, J.O. Midiwo, Heydenreich and M.G. Peter. (). ..

This publication bring together upto 15 papers presented at the inagural conference of the world Association of Sign Language Interpreters by experts form around the globe. the pares highlight the importance of of worjing together and sharing a global responsibility for the development of interpreting services worldwide. This is a valuable resource for all sign language interpreters, students and interpreter trainers, and contains much to interest those who wish to know more about the situation of Sign Language interpratation form an internation perspective.

This is a case report of a 23 year old multiparous woman who presented with intestinal obstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4 Kg spleen in the right lumbar region compressing the ascending colon. There was also ileal volvulus around the splenic pedicle. This is probably the first documented case of wandering spleen in the right hypochondrium, presenting as right large bowel obstruction, to be reported in our region. Wandering spleen is a rare condition, often asymptomatic, but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarely made. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971 only 350 cases had been reported in the western literature. Review of English literature from 1900 to 1991 reported only 51 cases in children. In our region 11 cases were reported in Uganda between 1968 and 1971. No other literature is available from our region. Clinical presentation, aetiology, investigation, and management of wandering spleen is discussed

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Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

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Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Colonial policy makers argued that they were  bringing civilization and better standards of living to Africans.  One perceived problem they had to contend with  was the “ignorance” of their subject peoples.  In health delivery, in particular, colonial administrators believed that ignorance accounted for the poor levels of health among Africans, and that knowledge and that knowledge and other preventive measures would greatly enhance standards of living, for instance, among urban Africans. In this paper we test this philosophy against colonial urban health policy’s and show that racism in the delivery of services  greatly undermined African and Asian health in order to afford  high quality services for Europeans in Nairobi.

Colonial policy makers argued that they were  bringing civilization and better standards of living to Africans.  One perceived problem they had to contend with  was the “ignorance” of their subject peoples.  In health delivery, in particular, colonial administrators believed that ignorance accounted for the poor levels of health among Africans, and that knowledge and that knowledge and other preventive measures would greatly enhance standards of living, for instance, among urban Africans. In this paper we test this philosophy against colonial urban health policy’s and show that racism in the delivery of services  greatly undermined African and Asian health in order to afford  high quality services for Europeans in Nairobi.

Colonial policy makers argued that they were  bringing civilization and better standards of living to Africans.  One perceived problem they had to contend with  was the “ignorance” of their subject peoples.  In health delivery, in particular, colonial administrators believed that ignorance accounted for the poor levels of health among Africans, and that knowledge and that knowledge and other preventive measures would greatly enhance standards of living, for instance, among urban Africans. In this paper we test this philosophy against colonial urban health policy’s and show that racism in the delivery of services  greatly undermined African and Asian health in order to afford  high quality services for Europeans in Nairobi.

To estimate the potential impact of an HIV/AIDS Vaccine in Kenya. Design: The Kenyan HIV/AIDS epidemic was modeled using the most current data from national sources including epidemiology and behavioral surveillance. The model’s baseline projection was validated against adult HIV prevalence at antenatal clinics and ge- neral population surveys. The model was used to analyze the effects of scaling up current pre- vention programs and adding potential HIV vac- cines with varying levels of effectiveness and coverage. Results: Even with full scale-up of currently available prevention, care and treat- ment programs, new infections will continue to burden Kenya. The introduction of a partially ef- fective AIDS vaccine could significantly alter the trajectory of the epidemic. Conclusion: The game changing impact that an AIDS vaccine could have on the AIDS epidemic in Kenya under- scores the importance of sustaining political support and financial investment to accelerate HIV/AIDS vaccine research and development.

Normal 0 false false false EN-GB X-NONE X-NONE /* 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:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; 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;} 1. Introduction Tephrosia Pers (Leguminosae-Papilionoideae) is a large tropical and sub-tropical genus estimated to contain about three hundred species (Waterman and Khalid, 1980; Abou-Douh et al., 2005) out of which thirty species are found in Kenya (Tarus et al., 2002). The extracts of some Tephrosia species have shown various biological activities including antiplasmodial (Muiva et al., 2009), antibacterial (Abou-Douh et al., 2005) anticancer (Santram et al., 2006) and insecticidal activities (Delfel et al., 1970). The taxon T. purpurea is among the most widely used Tephrosia species in traditional medicine (Damre et al., 2003). Various biological activities including antibacterial (Hegazy et al., 2009; Chinniah et al., 2009), antidiabetic and antioxidant (Pavana et al., 2009), immunomodulatory (Damre et al., 2003), anti-inflammatory (Damre et al., 2003) and cancer chemopreventive activities (Chang et al., 2000) have been reported for extracts and pure compounds from this plant. T. purpurea. is rich in prenylated flavonoids including flavones (Hegazy et al., 2009; Pelter et al., 1981), flavanones (Pelter et al., 1981; Gupta et al., 1980), chalcones (Chang et al., 2000; Pelter et al., 1981) and rotenoids (Ahmad et al., 1999). In the search for compounds with antiplasmodial activity from Kenyan plants, the stem of T. purpurea has been investigated. This report is on the isolation and characterization of a new prenylated flavone, named terpurinflavone (1), with antiplasmodial activity along with three known flavonoids. Normal 0 false false false EN-GB X-NONE X-NONE /* 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:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; 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;} The stem extract of Tephrosia purpurea showed antiplasmodial activity against the D6 (chloroquinesensitive) and W2 (chloroquine-resistant) strains of Plasmodium falciparum with IC50 values of 10.47  2.22 mg/ml and 12.06 2.54 mg/ml, respectively. A new prenylated flavone, named terpurinflavone, along with the known compounds lanceolatin A, -semiglabrin and lanceolatin B have been isolated from this extract. The new compound, terpurinflavone, showed the highest antiplasmodial activity with IC50 values of 3.12  0.28 mM (D6) and 6.26  2.66 mM (W2). The structures were determined on the basis of spectroscopic evidence.

Fresh water is one of the basic necessities without which human beings cannot survive since water is key to the sustainability of all kinds of lifeforms. Water has multiple uses namely; nutritional, domestic, recreational, navigational, waste disposal and ecological as it is a habitat for living and non-living organisms (biodiversity) etc. And, because it is indispensable to different sectors including manufacturing, agriculture, fisheries, wildlife survival, tourism and hydroelectric power generation, it is a vital factor of economic production. For many countries, most freshwater endowments encompass surface waters, groundwater, wetlands and glaciers.

The Internet and web-based technology has dramatically influenced the access to and dissemination of information among communities, locally and globally. This is no less true in the domain of geographic information systems (GIS) which have traditionally been constrained in terms of information access and the communities that use them. Geospatial data has traditionally been captured and managed within individual and separate organizational databases with access by a limited number of expert users. Now, with the integrated use of the web, not just geospatial data, but also the functionality of GIS can be accessed globally by citizens and non-experts.

In order to fully appreciate the contribution of geoinformatics in monitoring climate change caused by increase in temperature, a distinction between weather and climate, on one hand, and climate variability and climate change, on the other hand, is essential. Burroughs (2007) points out that weather is what is happening to the atmosphere at any given time (i.e., what one gets), whereas climate is what would be expected to occur at any given time of the year based on statistics built up over many years (i.e., what one expects).

The study of operators having some special spectral properties like Weyl's theorem, Browder's theorem
and the SVEP has been of important interest for some time now. The SVEP is very useful in the study of
the local spectral theory. In this paper, we explore the single-valued extension property (SVEP) for some
operators on Hilbert spaces. We characterize operators with or without SVEP at zero and those where
Weyl's and Browder's theorems hold. It is shown that if a Fredholm operator has no SVEP at zero, then
zero is an accumulation point of the spectrum of the operator. It is also shown that quasi similar Fredholm
operators have equal Weyl spectrum.

Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as new human immunodeficiency virus-1 (HIV-1) prevention approaches for HIV-1 serodiscordant couples. METHODS: Among Kenyan HIV-1 serodiscordant heterosexual couples participating in a clinical trial of PrEP, we conducted a cross-sectional study and used descriptive statistical methods to explore couples' willingness to use antiretrovirals for HIV-1 prevention. The study was conducted before July 2011, when studies among heterosexual populations reported that ART and PrEP reduced HIV-1 risk. RESULTS: For 181 couples in which the HIV-1-infected partner had a CD4 count ≥350 cells per microliter and had not yet initiated ART (and thus did not qualify for ART under Kenyan guidelines), 60.2% of HIV-1 infected partners (69.4% of men and 57.9% of women) were willing to use early ART (at CD4 ≥350 cells per microliter) for HIV-1 prevention. Among HIV-1 uninfected partners, 92.7% (93.8% of men and 86.1% of women) reported willingness to use PrEP. When given a hypothetical choice of early ART or PrEP for HIV-1 prevention, 52.5% of HIV-1-infected participants would prefer to initiate ART early and 56.9% of HIV-1-uninfected participants would prefer to use PrEP. CONCLUSIONS: Nearly 40% of Kenyan HIV-1-infected individuals in known HIV-1 serodiscordant partnerships reported reservations about early ART initiation for HIV-1 prevention. PrEP interest in this PrEP-experienced population was high. Strategies to achieve high uptake and sustained adherence to ART and PrEP for HIV-1 prevention in HIV-1 serodiscordant couples will require responding to couples' preferences for prevention strategies.

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.

Over the past three decades, agricultural watersheds in semi-arid Kenya have experienced some rapid decline in soil and crop productivity due to severe soil erosion, low soil water, low soil fertility and high soil crusting and compaction. Thus, the management of these watersheds requires some good understanding of agricultural drought, stratification of production zones according to slope, and suitable conservation options that include in-situ water conservation and runoff utilization. The planning of watershed conservation requires the application of runoff models in the selection of interventions that reduce upstream flood magnitude and downstream sedimentation. Successful interventions can be introduced under enabling conditions to farmers at various hierarchical policy levels. A few of these enabling conditions that are elaborated upon include agricultural policy, focus on smallholder agriculture and public¬community partnerships.

Over the past three decades, agricultural watersheds in semi-arid Kenya have experienced some rapid decline in soil and crop productivity due to severe soil erosion, low soil water, low soil fertility and high soil crusting and compaction. Thus, the management of these watersheds requires some good understanding of agricultural drought, stratification of production zones according to slope, and suitable conservation options that include in-situ water conservation and runoff utilization. The planning of watershed conservation requires the application of runoff models in the selection of interventions that reduce upstream flood magnitude and downstream sedimentation. Successful interventions can be introduced under enabling conditions to farmers at various hierarchical policy levels. A few of these enabling conditions that are elaborated upon include agricultural policy, focus on smallholder agriculture and public¬community partnerships.

Background: The knowledge of evolutionary patterns of the HA gene of the influenza virus is important in vaccinestrain selection.Objective: Genetic analysis of HA1 of influenza viruses isolated in Kenya during the 2010-2011 season with referenceto WHO vaccine strains.Methods: A total of twenty seven (27) influenza A (H1N1) pdm09, Nineteen (19) influenza A (H3N2) and Sixteen (16)influenza B virus isolates were analyzed. A partial HA1 gene was amplified by RT-PCR and sequenced.Results: Phylogenetic analyses revealed that influenza B viruses were closely related to B/Brisbane/60/2008 vaccinestrain while A (H1N1) pdm09 viruses were genetic variants of A/California/07/2009. The Kenyan A (H1N1) pdm09isolates had P83S, D97N, S185T, I321V and E374K amino acid substitutions. Influenza A/H3N2 isolates showed K62E,T212A and S214I simultaneous amino acid substitutions when compared to A/Perth/10/2009. The K62E changeoccurred at antigenic site E. Majority of the Kenyan H3N2 isolates further had S45N and K144N amino acidsubstitutions at sites C and A respectively, which introduced N-glycosylation motifs absent in the vaccine strain.Conclusion: The study showed that although the WHO 2010 vaccine strains recommendations for the southernhemisphere matched with influenza viruses which circulated in Kenya during the 2010-2011 season, the viruses hadevolved genetically from the vaccine strains.

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Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body's immune system increasing a patient's risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting that these extracts may be useful as adjuvants to conventional cancer therapies.

Cerebral venous sinus thrombosis is an uncommon yet potentially life threatening condition which is often under-diagnosed or misdiagnosed because of the variability of the clinical signs and symptoms. The imaging findings are often subtle thus the need for a high index of suspicion. The superior sagittal and transverse sinuses are the most frequently involved. The correct diagnosis of cerebral venous thrombosis relies on neuroimaging studies. The two cases reported highlight the fact that the radiologist may be the first clinician to suspect and diagnose this condition. This ultimately affects prognosis as early diagnosis and treatment reduces morbidity and mortality.

During a recent outbreak of Rhodesian sleeping sickness in the Lambwe Valley no asymptomatic Rhodesian sleeping sickness patients were found although 54% of the primary patients had mild symptoms and 9% were stuporous or comatose at presentation. The duration of symptoms was three months or less in 90% of the patients. Headache, weakness, joint and back pains and weight loss were claimed by at least 75% of the patients, while 82% of the females reported amenorrhoea and 70% of the males claimed impotency. Physical examination revealed lymphadenopathy in 86% but fever in only 36% of the patients, while chancres were found in only 16%. Patients had significantly lower levels of haemoglobin and thrombocytes than controls and their erythrocyte sedimentation rates were elevated. A comparison of both blood group and haemoglobin type between patients and controls yielded no significant differences. Fifty-seven per cent of the primary patients reporting mild symptoms had abnormal levels of leucocytes in their CSF. All relapse patients had abnormal CSF parameters. Levels of serum urea nitrogen were significantly elevated in patients, but SGOT, SGPT and total bilirubin were not. Levels of albumin and beta-globulin in patients were significantly lower than controls while gamma-globulin was elevated. Mean serum IgM levels in patients were elevated to nearly three-fold those of controls, but 35% of the individual patient values fell within the 95% range of control values. Some patients had extended prothrombin and thrombin times while fibrinogen levels were significantly elevated. No patients reported haemorrhage, and none was seen.

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.

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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coming soon at the webstie

coming soon at the webstie

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.

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Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, GA 30333. An epidemic of meningococcal disease occurred in Nairobi, Kenya, during 1989, outside the "meningitis belt" of sub-Saharan Africa. About 3800 cases occurred between April and November (250/100,000 population). The case-fatality rate was 9.4% among hospitalized patients. Areas that included Nairobi's largest slums had particularly high attack rates. The epidemic displayed an unusual age distribution, with high attack rates among those 20-29 years old. A vaccination campaign was conducted. By early January, the weekly case count had fallen to 25 from a high of 272 (in September). A case-control study estimated the vaccine efficacy to be 87% (95% confidence interval, 67%-95%). A model estimated that the vaccination campaign reduced the number of cases by at least 20%. Multilocus enzyme electrophoretic typing demonstrated that the strain responsible for this large epidemic is closely related to strains that caused other recent epidemics, documenting further spread of what may be a particularly virulent clonal complex of group A Neisseria meningitidis.

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Despite abundant literature on the social and economic benefits of encouraging tiny "informal" firms, scholars generally agree that larger enterprises create more unskilled jobs, use resources more efficiently, and are better at building technological capacity. Yet majority of firms will never grow beyond six workers. This paper argues that one very significant reason why small firms stay small is risk. In Nairobi, the economic and social consequences of business failure are extremely high. Entrepreneurs therefore to protect themselves from failure and, in the process, ensure that their firms remain small. Our research identified four risk-management strategies that work separately and together to discourage firm growth.• First, many entrepreneurs manage risk through flexibility. By working in rent-free quarters, using family labour and little capital, they minimise fixed costs and maximise opportunities for additional income. Second, many small manufacturers also avoid risk by manufacturing standard products for a known market. Third, successful entrepreneurs frequently diversify their income and assetsrather than expanding a single enterprise. Finally, most prefer to preserve their land and other assets unencumbered by debt. These rational responses to a risky 90 business environment ensure that most firms stay small and in the process work against formation of a dynamic manufacturing sector. Policy-makers are challenged to improve the "enabling environment" creating broad policies conducive to firm growth and by targeting specific policies and programmes to small-scale industry. Kenya needs macroeconomic and social policies that indirectly encourage firm growth by removing or reducing business and background risks. It also needs an industrial policy that provides positive incentives for enterprising business owners willing to expand employment, improve efficiency, and upgrade technology and their workers skills

Stem borers are a major source of pre-harvest maize crop losses in Kenya and many Sub-Saharan African countries. This menace needs to be addressed if food security is to be realized in this region. Seven local isolates of Bacillus thuringiensis (Bt) strains were isolated from soils collected from Kakamega and Machakos districts in Kenya. They were screened for toxicity against 1st and 2nd instar larvae of Chilo partellus, Sesamia calamistis and Busseola fusca through laboratory bioassays on artificial and natural diets. On farm Bt toxin potency trials were carried out only in Machakos using isolate 1M which was isolated from the area. The various isolates showed differences in their toxicity to the three stem borers. Isolates 1M and VM-10 (from Machakos district) were found to be the most potent against C. partellus with larval mortalities of 100 % within 72 h. Their LD50 values were 0.004 mg/ml and 0.04 mg/ml respectively. The most toxic isolates against S. calamistis were, 44M, VM-10 and 1M, with larval mortalities of 73%, 64% and 62% respectively after 72h at a concentration of 8.6 mg/ml through artificial diet bioassays on 1st instar larvae. Isolates 44M and K10-2 showed high toxicity against B. fusca with larval mortalities of 20% by artificial diet bioassays and 44% by maize leaf bioassays respectively. Leaf disk bioassays with all the insect species showed higher larval mortalities than those done with the artificial diet bioassays indicating the larval preference of natural diet. However leaf disk bioassays with B. fusca recorded higher larval mortalities with sorghum than maize leaves. Field trial results obtained from Machakos district using a biopesticide made from isolate 1M indicated that it was highly effective in stem borer control.

Developments in biogenetics, medical devices, information and communication technologies, and in environmental technologies will have a profound impact on health in the coming decades. However, there are major barriers to the appropriate and effective utilization of current and future technologies, particularly for developing countries. This paper intends to strike a balance between the exciting potential of technologies and the conditions that need to be fulfilled to ensure that technologies are utilized appropriately and effectively. It will emphasize the significance of knowledge associated with technologies, the importance of technology assessment and the need for a broad and comprehensive technology management policy.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

There is a marked shortage of surgical manpower all over Africa. General surgeons undertake a very wide range of surgical work because of the lack of specialists. Orthopaedic and general surgeons both care for accident injuries. Current training and recruitment programs are inadequate in correcting existing gross manpower deficiencies. The situation is further aggravated by a gross maldistribution of available manpower in favor of large urban centers. In many parts of rural Africa, minor surgical procedures are carried out by suitably trained, non-physician health workers, but facilities and resources for surgery outside urban centers are generally inadequate. The World Health Organization program on essential surgical and anesthetic procedures, which is currently under way in collaboration with the International Federation of Surgical Colleges, the World Federation of Societies of Anesthesiologists, and other professional bodies, should have a significant impact on these urgent needs for basic surgery in rural district hospitals.

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Background

The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our ‘insider’ interpretation of how the network is functioning as an intervention.
Methods

We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context–mechanism–outcome configuration.
Results

We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway.
Conclusions

We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised statement of our theory of change in a context–mechanism–outcome configuration. We hope this will complement a planned independent evaluation of ‘how things work’, will help others interpret results of change reported more formally in the future and encourage others to consider further examination of networks as means to scale up improvement practices in health in lower income countries.

A simple gas chromatographic assay utilising alkali flame ionisation detection is described for the estimation of cyclophosphamide as its trifluoroacetate derivative from plasma. Examination of five patients following intravenous cyclophosphamide gave values of 8.9 h (SD 2.7) for the half-life and 0.061 liters/h/kg (SD 0.011) for whole-body clearance of the drug.

Nutrient value assessments and ethnobotanical studies of three wild edible fruit species [Ziziphus spina-christi (L.) Desf., Balanites aegyptiaca (L.) Del., Grewia flavescens A. Juss.], were carried out from October 2009 through June 2010 in east Shewa Zone, Ethiopia. Field data collection was combined with laboratory food content analyses with the aim of identifying promising wild edible fruit plants. Also, optimal use of preferred wild edibles particularly in addressing future food security issues of rural people in the drylands was assessed. Composite fruit samples randomly collected in six sites of Fantalle and Boosast districts were subjected to standard laboratory chemical analyses. Values for total carbohydrates, crude protein, crude lipid, moisture and total ash contents of the fruit pulps ranged from 76.67-86.12%, 1.45-4.20%, 3.58-4.02%, 35.18-57.41%, 8.11-16.40% for Z. spina-christi, 85.55-89.61%, 0.001-003, 49.03-68.26%, 10.18-12.88% for B. aegyptiaca; 83.74-93.68%, 0.64-3.14%, 18.90-61.35%, 3.16-7.25% for G. flavescens, respectively. The calculated energy (based on total carbohydrates) was highest for G. flavescens (373.6 Kcal/100 g), followed by B. aegyptiaca (354.24) and Z. spina-christi (344.48 Kcal/100 g). The results indicated that these fruit species, which are popularly used by the local communities, contain appreciable amounts of nutrients and energy and thus are useful food supplements. These species should be integrated into dryland agroforestry systems for sustainable use and conservation, as well as, preservation of the associated knowledge through the positive practice of the indigenous bio-cultural knowledge. In this case, lessons can be drawn from some farmers of Boosat District, who are currently using two of the species in traditional agroforestry practices.

In recent years, Internet connectivity has greatly improved across the African continent. This article examines the consequences that this shift has had for East African firms that are part of global value chains (GVCs). Prior work yielded contradictory expectations: firms might benefit from connectivity through increased efficiencies and improved access to markets, although they might also be further marginalized through increasing control of lead firms. Drawing on extensive qualitative research in Kenya and Rwanda,including 264 interviews, we examine 3 sectors (tea, tourism, and business process outsourcing) exploring overarching, cross-cutting themes. The findings support more pessimistic expectations: small African producers are only thinly digitally integrated in GVCs. Moreover, shifting modes of value chain governance, supported by lead firms and facilitated by digital information platforms and data standards are leading to new challenges for firms looking to digitally integrate. Nevertheless, we also find examples in these sectors of opportunities where small firms are able to cater to emerging niche customers, and local or regional markets. Overall, the study shows that improving connectivity does not inherently benefit African firms in GVCs without support for complementary capacity and competitive advantages.

This paper presents an analysis of 568 jaw tumours and tumour-like conditions seen at the Kenyatta National Hospital over a period of fifteen years. For descriptive purposes, the term tumour is used here in its wider context to cover both neoplastic and dysplastic jaw lesions which present primarily as jaw swellings. The study reveals a pattern consistent with other African series and suggests a more aggressive progression and younger age at onset than elsewhere.

This was a cross sectional descriptive study to discuss the median age of menopause in a rural area of Western Kenya. The broad objective of the study was to describe the demographic and biophysical characteristics of the study population and determine the age of menopause. A review of the current and medieval records shows average age of menopause has remained relatively constant at 50 years in contrast to the receeding age of menarche. A total of 1078 women aged between 40-60 years were interviewed. The majority (98.8%) were from one ethnic group, the Luhya. Of the 1078 women, 880 (81.4%) were married and 198 (18.6%) were single. The average number of children per woman was 7.74. Most of the women (75.1%) had attained primary school education. Their husbands were unskilled workers in 30.1% of the cases. The mean weight and height of the women was 60.74 kg and 161.1 cm respectively. Using methods of probit analysis, the median and modal age of menopause was found to be 48.28 years in this group of western Kenya women. If generalised for the whole country, these results suggest that an average Kenyan woman lives for over ten years beyond menopause. It is recommended that more attention should be given to the special health problems of postmenopausal population. PIP: This study describes the demographic and biophysical characteristics of rural menopausal women in Western Kenya. Menopause occurs as the gradual unresponsiveness of the human ovary to gonadotropins, premature ovarian failure at under 40 years, and menopause following surgical procedures of the uterus and ovaries. A 3-phase process starts with low serum estradiol and progesterone, followed by a rise in follicle stimulating hormone, and a rise in luteinizing hormone. Clinical symptoms include vasomotor ones, genitourinary ones, osteoporosis and increased incidence of bone fractures, increased incidence of thromboembolic and ischemic heart disease, and psychological symptoms of anxiety, depression, and memory loss. The age of menopause varies with socioeconomic conditions, race, parity, height, weight, skinfold thickness, lifestyle, and education. Data were obtained for this study from a sample of 1078 women from 7 sublocations in Vihiga division, Kenya. Women were aged 40-60 years. The most populous ethnic group was the Luhya. 81.6% were married, 15.6% were widowed, and 0.7% were divorced. 4 women had never been married. 75.1% had a primary school education; 18.6% had not received any formal education. 30.1% had husbands who were unskilled workers, 28.8% had husbands who were farmers, and 20.6% had husbands who were skilled workers. 1.3% had no children, and 1 woman had 17 children. The average number of children was 7.74. 9 of the nulliparous women were menopausal. The mean height was 161.1 cm. The median age at menopause was 48.28 years. Almost all women were menopausal by 55 years. The total fertility period averaged 35 years. Female life expectancy was 59 years

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media. author's modified

In a prospective trial, the immediate and long-term haematological effects of amrinone were studied in sixteen patients with refractory cardiac failure. The platelet count was significantly and variably reduced in all patients and the reduction was related to log plasma amrinone concentration. Platelet survival was significantly reduced in those cases studied. No evidence of disseminated intravascular coagulation or intravascular platelet deposition was observed and the reduced platelet survival was not considered to be the result of an immunological process. Evidence of a marrow response to the reduced platelet count and survival was seen. Although no haemorrhagic symptoms were observed in the patients, the haematological side-effects were considered to be of such severity as to limit the use of this drug in clinical practice.    PMID: 6712864 [PubMed - indexed for MEDLINE]

Background: Di use In ltrative
Lymphocytosis Syndrome (DILS) is
characterised by a persistent CD8+
lymphocytosis and lymphocytic
in ltration of various organs. The exact
prevalence isn’t known but some studies
have reported between 0.85 – 3%, and
appears to be more common in African
population. Patients with DILS tend to have higher CD4 cell counts and survive
longer than those patients without DILS.
Most patients present with bilateral
parotid gland enlargement and features
of the Sicca syndrome. Common sites
of extra glandular involvement are the
lungs being the most common site,
followed by peripheral neuropathy and
liver. With the high incidence of HIV in
our population it is likely that DILS is
under diagnosed probably due to our
ignorance of this disease. Awareness of
its various presentations may bring to
light undiscovered patients with DILS.
Objective: To review pathogenesis,
diagnostic approach and current trends
in the management of di use interstitial
lymphocytic syndrome.
Data source:  Literature review of
relevant published literature from both
Africa and the rest of the world.
Data synthesis: Pathologically, under
light microscopy, DILS resembles the
focal sialadenitis seen with Sjogren’s
syndrome, although it tends to be less
destructive of the glandular architecture
than in Sjogren’s syndrome. Most of the
in ammatory in ltrate is composed
of CD8+ lymphocytes unlike Sjogren’s
which are CD4+. Lymphoepithelial
cysts are frequently observed in the
parotid glands of patients with DILS.
The variation in CD8+ count in the
course of HIV disease is less understood.
The variation in CD8+ lymphocytes is
implicated in the pathogenesis of a
number of clinical manifestations in HIV
diseases including Di use In ltrative
Lymphocytic Syndrome (DILS) and
HIV associated CD8+ lymphocytosis
syndrome. Parotid gland enlargement
in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware
that the pulmonary process associated
with DILS may mimic clinically and
radiographically the pneumonic process
caused by pneumocystis carinii. Other
manifestations of DILS to consider
include a severe form of peripheral
neuropathy; lymphocytic in ltration of
the liver, evident as hepatitis; myositis;
and lymphocytic interstitial nephritis.
Management of DILS is determined
by the severity of glandular and extra
glandular features. Data on therapeutic
trials are lacking although there are
isolated reports of good response to
antiretroviral and steroid therapy.
Conclusion: DILS, a subset of HIV
disease manifestation, may present as
parotid gland swellings. In general, an
HIV patient presenting with DILS has a
better prognosis than a patient with HIV
alone. With the high incidence of HIV
in our population it is likely that DILS is
under diagnosed probably due to our
ignorance of this disease. Awareness of
its various presentations may bring to
light undiscovered patients with DILS.
Clinicians should watch for the possible
transformation into B-cell lymphoma.
There is still paucity of data about
this disease from pathophysiology to
treatment to studies correlating the
plasma viral load with CD8+ lymphocyte
count in patients with HIV disease.

Department of Periodontology, University of Nairobi Dental School, Kenya. The gingival health of 201 schoolchildren aged 11-14 years was assessed at 6 sites on all the incisor and first molar teeth by recording separately the presence or absence of redness and bleeding on probing. Crowding of the incisor teeth was recorded as labio-lingual displacement and mesio-distal overlap. A 2nd examiner recorded the presence or absence of plaque at these sites and assessed mouthbreathing, lipseal and upper lip coverage of the maxillary incisors. Mouthbreathing, increased lip separation and decreased upper lip coverage at rest were all associated with higher levels of plaque and gingival inflammation. Multivariate analysis indicated that this association was statistically significant for mouthbreathing and lip coverage but increased lip separation was not independently related to plaque and gingivitis. The relationship of mouthbreathing and decreased upper lip coverage with gingivitis was most evident in the upper anterior segment and was still evident after covariate analysis to take account of variations due to gender, overcrowding and amount of plaque. However, allowance for these factors also suggested that the influence of mouthbreathing was restricted to palatal sites, whereas lip coverage influenced gingival inflammation at both palatal and labial sites.

Department of Dental Surgery, University of Nairobi. The prevalence of juvenile periodontitis was studied in a group of young adults aged 18 to 26 years from the National Youth Service. The study group consisted of a random sample of 350 trainees, 250 males and 100 females. The subjects were examined for plaque scores, gingivitis and pocket depths. Radiographs were used to show bone loss and confirm diagnosis of juvenile periodontitis. Only one subject was diagnosed as having juvenile periodontitis. This represents a prevalence of 0.28% which falls within the range of published prevalence of 0.1% to 3.4% among young adults.

Department of Periodontology/Community and Preventive Dentistry, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya. OBJECTIVE: To map out the pattern of periodontal disease in individuals who died before 1957 and were not exposed to formal dental services. DESIGN: Descriptive cross-sectional study. SETTING: National Museums of Kenya. SUBJECTS: The skeletons of people who died before independence are preserved at the National Museums of Kenya in Nairobi. Sixty four out of the 170 dry mandibles stored at the Museum were assessed for periodontal bone loss using a calibrated ruler. RESULTS: All the 64 mandibles assessed were of individuals who died before 1957. Two thousand two hundred and seventy four sites were examined. Most of the subjects were adults aged 30-45 years and the age range was 18-80 years. Majority of the mandibles examined were of the ethnic group from Central Kenya. Of the teeth examined, premolars and molars were the teeth most frequently preserved intact in the sockets. The total mean bone loss for all teeth was 2.51 (SD 1.15) with a range of 0.85-5.80. When the different sites were examined, values for bone loss were 2.59 for mesial surfaces; 2.55 buccal surfaces; 2.38 for distal surfaces. Three categories were identified as follows:- 70% of the individuals had minimal or no bone loss, 26.5% had 3-4 mm or moderate bone loss and 3.5% had >5 mm bone loss or advanced bone loss. Further analysis showed that when bone loss of >3 mm was examined, only 28.12% of the individuals were in this group, 10.93% had >4 mm bone loss and 3.12% had 5 mm or more bone loss. The first molars were the teeth most commonly affected by bone loss of 3mm or more followed by second molars then the premolars. CONCLUSIONS: In this group of individuals mainly from Central Kenya, the bone loss pattern showed that only a small number had experienced periodontal destruction as recorded by bone loss levels. Three groups were identified; those who had no or minimal destruction, those who had experienced moderate destruction and those where obvious bone destruction was evident. Thus susceptibility to periodontal disease is evident in a small proportion of individuals even in populations not exposed to modern diet and formal dental services. Periodontal destruction seems to affect a fraction of the population even when older populations are examined, thus it would save on resources both human and physical if these susceptible individuals could be identified early and treatment provided.

The objectives of this study were to determine the frequency of alveolar osteitis at Kenyatta National Hospital (KNH), most affected age group and the reasons for underlying extractions. Out of 8,393 extractions 273 (3.3%) developed alveolar osteitis. 98.5% of the teeth that developed alveolar osteitis were molars and premolars. 52% of the patients that developed alveolar osteitis were females and 48% were males. The mandible was more affected than the maxilla. The percentage distribution of alveolar osteitis according to age groups 10-19 year, 30-39 years, 40-49 years, 50-59 years and 60-69 years were 6.2%, 53.1%, 23.8%, 5.5%, 4.8% and 2.9% respectively. On the average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and average, patients reported with alveolar osteitis 5.7 days following extraction. Out of 8,393 extractions, 72.5% were due to dental caries, 18% were due to periodontitis and the rest were due to other causes. It was concluded that the frequency and pattern of development of a alveolar osteitis at KNH was similar to that reported in developed countries.

Department of Dental Surgery, University of Nairobi. The prevalence of juvenile periodontitis was studied in a group of young adults aged 18 to 26 years from the National Youth Service. The study group consisted of a random sample of 350 trainees, 250 males and 100 females. The subjects were examined for plaque scores, gingivitis and pocket depths. Radiographs were used to show bone loss and confirm diagnosis of juvenile periodontitis. Only one subject was diagnosed as having juvenile periodontitis. This represents a prevalence of 0.28% which falls within the range of published prevalence of 0.1% to 3.4% among young adults.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Department of Dental Surgery, College of Health Sciences, University of Nairobi. Behcet's syndrome is a disease of uncertain aetiology characterised by recurrent oral and genital ulcerations, ocular lesions and skin lesions. Although cases of this syndrome have been reported almost worldwide, the literature did not reveal any reports from this region. Management of this disorder is mainly palliative. However several treatment regimens have been tried. Following are some of the treatments considered effective. Azathioprine, corticosteroids, chlorambucil, transfusions of fresh blood or plasma and fibrinolytic therapy with phenformin and ethyloestrenol. The importance of multi-disciplinary management of such patients is emphasized.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Abstract An influenza pandemic caused by a novel influenza virus A(H1N1)pdm09 spread worldwide in 2009 and is estimated to have caused between 151,700 and 575,400 deaths globally. While whole genome data on new virus enables a deeper insight in the pathogenesis, epidemiology, and drug sensitivities of the circulating viruses, there are relatively limited complete genetic sequences available for this virus from African countries. We describe herein the full genome analysis of influenza A(H1N1)pdm09 viruses isolated in Kenya between June 2009 and August 2010. A total of 40 influenza A(H1N1)pdm09 viruses isolated during the pandemic were selected. The segments from each isolate were amplified and directly sequenced. The resulting sequences of individual gene segments were concatenated and used for subsequent analysis. These were used to infer phylogenetic relationships and also to reconstruct the time of most recent ancestor, time of introduction into the country, rates of substitution and to estimate a time-resolved phylogeny. The Kenyan complete genome sequences clustered with globally distributed clade 2 and clade 7 sequences but local clade 2 viruses did not circulate beyond the introductory foci while clade 7 viruses disseminated country wide. The time of the most recent common ancestor was estimated between April and June 2009, and distinct clusters circulated during the pandemic. The complete genome had an estimated rate of nucleotide substitution of 4.9 × 10− 3 substitutions/site/year and greater diversity in surface expressed proteins was observed. We show that two clades of influenza A(H1N1)pdm09 virus were introduced into Kenya from the \{UK\} and the pandemic was sustained as a result of importations. Several closely related but distinct clusters co-circulated locally during the peak pandemic phase but only one cluster dominated in the late phase of the pandemic suggesting that it possessed greater adaptability.

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Despite the focus on the importance of trees in Africa and the many projects that try to improve their management, there is very little research and few development projects which address tree related problems in a holistic manner. With respect to forest management arrangements, focus tends to be either exclusively on community forestry, or on private tree planting. Such a divided focus makes it difficult to understand the complementarities and possible synergetic effects of these two approaches in solving common problems and improving local livelihoods. The present article argues that interdisciplinary projects are needed to develop a holistic approach to tree management and to improve the use of trees. This argument builds on the results from the PETREA (People, Trees and Agriculture) research programme in Majawanga (Gairo, Tanzania). In this village, private and collective tree management is characterized by very different uses, opportunities and problems. Common woodlands play an important role in providing villagers with Non-Timber Forest Products (NTFP) from indigenous species that are important for local livelihoods as they provide food, medicine, and grazing areas. The constraints linked to the management of common woodlands pertain to group dynamics and resemble, at first glance, a “tragedy of the commons” as described by Hardin (1968). Private tree planting, on the other hand, provides both local services (including providing fruits, firewood or securing boundaries between fields) and cash from the selling of poles. The constraints characterizing private tree management are linked to land-tenure, tree seedling cost and season for planting. Land tenure is of paramount importance as trees cannot be planted on borrowed or rented land, or at the expense of cropland needed to sustain the household. The season for planting seedlings is a constraint because of a conflict with labour demands for crops needed to survive. Despite being characterized by very different uses and constraints, the management of private and common trees also share common constraints as both require that grazing is under control and that there exist clear rules and efficient institutions able to solve management conflicts. Both types of management should therefore be analyzed together as improving one can help relieve the pressure on the other.

BACKGROUND: Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The exact prevalence isn’t known but some studies have reported between 0.85 – 3%, and appears to be more common in African population. Patients with DILS tend to have higher CD4cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Common sites of extra glandular involvement are the lungs being the most common site, followed by peripheral neuropathy and liver. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS.
OBJECTIVE: To review pathogenesis, diagnostic approach and current trends in the management of Diffuse interstitial lymphocytic syndrome
DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world.
DATA SYNTHESIS:Pathologically, under light microscopy, DILS resembles the focal sialadenitis seen with Sjogren’s syndrome, although it tends to be less destructive of the glandular architecture than in Sjogren’s syndrome. Most of the inflammatory infiltrate is composed of CD8+ lymphocytes unlike Sjogren’s which are CD4+. Lymphoepithelial cysts are frequently observed in the parotid glands of patients with DILS. The variation in CD8 count in the course of HIV disease is less understood. The variation in CD8 lymphocytes is implicated in the pathogenesis of a number of clinical manifestations in HIV diseases including diffuse infiltrative lymphocytic syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome.Parotid gland enlargement in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware that the pulmonary process associated with DILS may mimic clinically and radiographically the pneumonic process caused by Pneumocystis carinii. Other manifestations of DILS to consider include a severe form of peripheral neuropathy; lymphocytic infiltration of the liver, evident as hepatitis; myositis; and lymphocytic interstitial nephritis.Management of DILS is determined by the severity of glandular and extra glandularfeatures.Data on therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy.

CONCLUSION: DILS, a subset of HIV disease manifestation, may present as parotid gland swellings. In general, an HIV patient presenting with DILS has a better prognosis than a patient with HIV alone.With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Clinicians should watch for the possible transformation into B-cell lymphoma. There is still paucity of data about this disease from pathophysiology to treatment to studies correlating the plasma viral load with CD8 lymphocyte count in patients with HIV disease.

BACKGROUND: Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The exact prevalence isn’t known but some studies have reported between 0.85 – 3%, and appears to be more common in African population. Patients with DILS tend to have higher CD4cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Common sites of extra glandular involvement are the lungs being the most common site, followed by peripheral neuropathy and liver. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS.
OBJECTIVE: To review pathogenesis, diagnostic approach and current trends in the management of Diffuse interstitial lymphocytic syndrome
DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world.
DATA SYNTHESIS:Pathologically, under light microscopy, DILS resembles the focal sialadenitis seen with Sjogren’s syndrome, although it tends to be less destructive of the glandular architecture than in Sjogren’s syndrome. Most of the inflammatory infiltrate is composed of CD8+ lymphocytes unlike Sjogren’s which are CD4+. Lymphoepithelial cysts are frequently observed in the parotid glands of patients with DILS. The variation in CD8 count in the course of HIV disease is less understood. The variation in CD8 lymphocytes is implicated in the pathogenesis of a number of clinical manifestations in HIV diseases including diffuse infiltrative lymphocytic syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome.Parotid gland enlargement in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware that the pulmonary process associated with DILS may mimic clinically and radiographically the pneumonic process caused by Pneumocystis carinii. Other manifestations of DILS to consider include a severe form of peripheral neuropathy; lymphocytic infiltration of the liver, evident as hepatitis; myositis; and lymphocytic interstitial nephritis.Management of DILS is determined by the severity of glandular and extra glandularfeatures.Data on therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy.

CONCLUSION: DILS, a subset of HIV disease manifestation, may present as parotid gland swellings. In general, an HIV patient presenting with DILS has a better prognosis than a patient with HIV alone.With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Clinicians should watch for the possible transformation into B-cell lymphoma. There is still paucity of data about this disease from pathophysiology to treatment to studies correlating the plasma viral load with CD8 lymphocyte count in patients with HIV disease.

BACKGROUND: Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The exact prevalence isn’t known but some studies have reported between 0.85 – 3%, and appears to be more common in African population. Patients with DILS tend to have higher CD4cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Common sites of extra glandular involvement are the lungs being the most common site, followed by peripheral neuropathy and liver. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS.
OBJECTIVE: To review pathogenesis, diagnostic approach and current trends in the management of Diffuse interstitial lymphocytic syndrome
DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world.
DATA SYNTHESIS:Pathologically, under light microscopy, DILS resembles the focal sialadenitis seen with Sjogren’s syndrome, although it tends to be less destructive of the glandular architecture than in Sjogren’s syndrome. Most of the inflammatory infiltrate is composed of CD8+ lymphocytes unlike Sjogren’s which are CD4+. Lymphoepithelial cysts are frequently observed in the parotid glands of patients with DILS. The variation in CD8 count in the course of HIV disease is less understood. The variation in CD8 lymphocytes is implicated in the pathogenesis of a number of clinical manifestations in HIV diseases including diffuse infiltrative lymphocytic syndrome (DILS) and HIV associated CD8+ lymphocytosis syndrome.Parotid gland enlargement in a patient with HIV infection should prompt clinicians to suspect DILS. In addition, clinicians should be aware that the pulmonary process associated with DILS may mimic clinically and radiographically the pneumonic process caused by Pneumocystis carinii. Other manifestations of DILS to consider include a severe form of peripheral neuropathy; lymphocytic infiltration of the liver, evident as hepatitis; myositis; and lymphocytic interstitial nephritis.Management of DILS is determined by the severity of glandular and extra glandularfeatures.Data on therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy.

CONCLUSION: DILS, a subset of HIV disease manifestation, may present as parotid gland swellings. In general, an HIV patient presenting with DILS has a better prognosis than a patient with HIV alone.With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. Clinicians should watch for the possible transformation into B-cell lymphoma. There is still paucity of data about this disease from pathophysiology to treatment to studies correlating the plasma viral load with CD8 lymphocyte count in patients with HIV disease.