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Publications

2016

JOSHI, MD, Oesterling BM, Wu C, Gwizdz N, Pais G, Briyal S, Gulati A.  2016.  Evaluation of liposomal nanocarriers loaded with ETB receptor agonist, IRL-1620, using cell-based assays., 2016 Jan 15. Neuroscience. 312:141-52. Abstract

One common feature of most neurodegenerative diseases, including Alzheimer's disease (AD) and stroke, is the death of neuronal cells. Neuronal cell death is associated with apoptosis, generation of reactive oxygen species and oxidative stress. Neuronal cell death pathways can be reversed by endothelin B receptor agonist, IRL-1620, which was found to enhance neuroprotection by promoting vascular and neuronal growth in a rodent stroke model. Previous studies conducted at our institution indicated that the treatment with IRL-1620 significantly improved neurological and motor function while reducing oxidative stress and overall infarct area. IRL-1620 is a hydrophilic, 15 amino acid peptide and has a molecular weight of 1820Da. In this study, we have encapsulated IRL-1620 in PEGylated liposomes in order to enhance its efficacy. Each batch of liposomes encapsulating IRL-1620 was evaluated for particle size, polydispersity index, and charge (zeta potential) over a period of time to determine their stability. A dose-response bar graph was plotted based on the effect of neuroprotection by free IRL-1620 on differentiated neuronal PC-12 cells. The 1nM concentration was found to have the highest cell viability. The liposomes loaded with IRL-1620 were tested on differentiated neuronal PC-12 cells for their neuroprotective ability against apoptosis caused by removal of nerve growth factor (NGF) against free (non-encapsulated) IRL-1620. The liposomal IRL-1620 was found to proliferate the growth of serum-deprived differentiated PC-12 cells significantly (p<0.0001). In the western blot analysis, the expression of the anti-apoptotic marker, BCL-2 was found to be increased, and that of pro-apoptotic marker, BAX was found to be decreased with liposomal IRL-1620. The effects were found to be independent of the NGF levels. Finally the free IRL-1620 was found to cause neuronal outgrowth equivalent to the 75ng/ml NGF treatment.
Mwavua, SM, Ndungu EK, Mutai KK, Joshi MD.  2016.  A comparative study of the quality of care and glycemic control among ambulatory type 2 diabetes mellitus clients, at a Tertiary Referral Hospital and a Regional Hospital in Central Kenya. BMC research notes. 9(1):1-8. AbstractWebsite

Background

Peripheral public health facilities remain the most frequented by the majority of the population in Kenya; yet remain sub-optimally equipped and not optimized for non-communicable diseases care.
Design and methodology

We undertook a descriptive, cross sectional study among ambulatory type 2 diabetes mellitus clients, attending Kenyatta National Referral Hospital (KNH), and Thika District Hospital (TDH) in Central Kenya. Systematic random sampling was used. HbA1c was assessed for glycemic control and the following, as markers of quality of care: direct client costs, clinic appointment interval and frequency of self monitoring test, affordability and satisfaction with care.
Results

We enrolled 200 clients, (Kenyatta National Hospital 120; Thika District Hospital 80); Majority of the patients 66.5 % were females, the mean age was 57.8 years; and 58 % of the patients had basic primary education. 67.5 % had diabetes for less than 10 years and 40 % were on insulin therapy. The proportion (95 % CI) with good glycemic was 17 % (12.0–22.5 respectively) in the two facilities [Kenyatta National Hospital 18.3 % (11.5–25.6); Thika District Hospital 15 % (CI 7.4–23.7); P = 0.539]. However, in Thika District Hospital clients were more likely to have a clinic driven routine urinalysis and weight, they were also accorded shorter clinic appointment intervals; incurred half to three quarter lower direct costs, and reported greater affordability and satisfactions with care.
Conclusion

In conclusion, we demonstrate that in Thika district hospital, glycemic control and diabetic care is suboptimal; but comparable to that of Kenyatta National Referral hospital. Opportunities for improvement of care abound at peripheral health facilities.
Keywords
Diabetes mellitus Glycemic control Africa Quality care

2015

Prabhu, RH, Patravale VB, Joshi MD.  2015.  Polymeric nanoparticles for targeted treatment in oncology: current insights., 2015. International journal of nanomedicine. 10:1001-18. Abstract

Chemotherapy, a major strategy for cancer treatment, lacks the specificity to localize the cancer therapeutics in the tumor site, thereby affecting normal healthy tissues and advocating toxic adverse effects. Nanotechnological intervention has greatly revolutionized the therapy of cancer by surmounting the current limitations in conventional chemotherapy, which include undesirable biodistribution, cancer cell drug resistance, and severe systemic side effects. Nanoparticles (NPs) achieve preferential accumulation in the tumor site by virtue of their passive and ligand-based targeting mechanisms. Polymer-based nanomedicine, an arena that entails the use of polymeric NPs, polymer micelles, dendrimers, polymersomes, polyplexes, polymer-lipid hybrid systems, and polymer-drug/protein conjugates for improvement in efficacy of cancer therapeutics, has been widely explored. The broad scope for chemically modifying the polymer into desired construct makes it a versatile delivery system. Several polymer-based therapeutic NPs have been approved for clinical use. This review provides an insight into the advances in polymer-based targeted nanocarriers with focus on therapeutic aspects in the field of oncology.
Prabhu, RH, Patravale VB, Joshi MD.  2015.  Polymeric nanoparticles for targeted treatment in oncology: current insights., 2015. International journal of nanomedicine. 10:1001-18. Abstract

Chemotherapy, a major strategy for cancer treatment, lacks the specificity to localize the cancer therapeutics in the tumor site, thereby affecting normal healthy tissues and advocating toxic adverse effects. Nanotechnological intervention has greatly revolutionized the therapy of cancer by surmounting the current limitations in conventional chemotherapy, which include undesirable biodistribution, cancer cell drug resistance, and severe systemic side effects. Nanoparticles (NPs) achieve preferential accumulation in the tumor site by virtue of their passive and ligand-based targeting mechanisms. Polymer-based nanomedicine, an arena that entails the use of polymeric NPs, polymer micelles, dendrimers, polymersomes, polyplexes, polymer-lipid hybrid systems, and polymer-drug/protein conjugates for improvement in efficacy of cancer therapeutics, has been widely explored. The broad scope for chemically modifying the polymer into desired construct makes it a versatile delivery system. Several polymer-based therapeutic NPs have been approved for clinical use. This review provides an insight into the advances in polymer-based targeted nanocarriers with focus on therapeutic aspects in the field of oncology.
Mattei, J, Malik V, Wedick NM, Hu FB, Spiegelman D, Willett WC, Campos H.  2015.  Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative., 2015. Globalization and health. 11:23. Abstract

The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources.
Nour, HA, Oyoo GO, JOSHI MD, Otsyeno FMT, Muriithi IM.  2015.  PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL . East African Orthopaedic Journal. 8(2):60-63. Abstract

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in subSaharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease. Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease. Design: A cross-sectional descriptive study. Methods: we examined patients with knee, hip and hand osteoarthritis to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also studied to determine the prevalence of obesity in this cohort of patients. Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA (45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007. Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well as halting the progression of OA.

2014

Jain, SA, Basu H, Prabhu PS, Soni U, Joshi MD, Mathur D, Patravale VB, Pathak S, Sharma S.  2014.  Parasite impairment by targeting Plasmodium-infected RBCs using glyceryl-dilaurate nanostructured lipid carriers., 2014 Aug. Biomaterials. 35(24):6636-45. Abstract

Antimalarial therapy is a major contributor to declining malaria morbidity and mortality. However, the high toxicity and low bioavailability of current antimalarials and emerging drug resistance necessitates drug-delivery research. We have previously developed glyceryl-dilaurate nanolipid carriers (GDL-NLCs) for antimalarial drug delivery. Here, we show evidence that GDL-NLCs themselves selectively target Plasmodium-infected red blood cells (iRBCs), and cause severe parasite impairment. The glyceryl-dilaurate lipid-moiety was important in the targeting. GDL-NLCs localized to the parasite mitochondrion and uptake led to mitochondrial-membrane polarization and Ca(2+) ion accumulation, ROS release, and stage-specific iRBC lysis. GDL-NLC treatment also resulted in externalization of iRBC-membrane phosphatidylserine and enhanced iRBC clearance by macrophages. GDL-NLC uptake disrupted the parasite-induced tubulovesicular network, which is vital for nutrient import by the parasite. Laser optical trap studies revealed that GDL-NLCs also restored iRBC flexibility. Such restoration of iRBC flexibility may help mitigate the vasculature clogging that can lead to cerebral malaria. We demonstrate the suitability of GDL-NLCs for intravenous delivery of antimalarial combinations artemether-clindamycin and artemether-lumefantrine in the murine model. Complete parasite clearance was achieved at 5-20% of the therapeutic dose of these combinations. Thus, this nanostructured lipid formulation can solubilize lipophilic drugs, selectively target and impair the parasite-infected red cell, and therefore constitutes a potent delivery vehicle for antimalarials.
S Masoud, AK, JOSHI MD, Otieno CF, Acharya K.  2014.  P24 Quality of glycemic control among insulin treated ambulatory patients with diabetes mellitus at Kenyatta national hospital. Diabetes Research and Clinical Practice. 103:s39. AbstractWebsite

Methods: Retrospective study was done and analysed by SPSS programm version 15, whereby a total of 652 patients aged above 18 years, tested for lipids profile and using HAART for not less than 9 months were recruited from 5 care and treatment centres out of 15 centres from Ilala district in Dar es salaam. This study was done for one year from January, 2011 to December 2011. Results: Out of 652 people living with HIV/AIDS 332 (50.9%) were females and 320 (49.1%) were males. About 60% of participants were obese, and about ...
Ogola, EN, Machira BW, Joshi MD, Njeru E.  2014.  PM325 Cardivascular risk factors in young adult university students in Nairobi, Kenya. Global Heart. 9(1) AbstractWebsite

Cardiovascular diseases (CVD) are rapidly increasing in Africa due to epidemiologic transition. Many risk factors are acquired in chidhood and early adulthood. University students are exposed to multiple lifestyle influences. Understanding the dynamics of risk factors in this population provides a platform for early intervention.
Joshi, MD, Ayah R, Njau EK, Wanjiru R, Kayima JK, Njeru EK, Kip K.  2014.  Prevalence of hypertension and associated cardiovascular risk factors in an urban slum in Nairobi, Kenya: a population-based survey. BMC public health. AbstractWebsite

Background

Urbanisation has been described as a key driver of the evolving non-communicable disease (NCD) epidemic. In Africa, hypertension is the commonest cardiovascular problem. We determined the prevalence and risk factor correlates of hypertension in the largest Nairobi slum.
Methods

In 2010 we conducted a population-based household survey in Kibera, a large informal settlement in Nairobi City; utilising cluster sampling with probability proportional to size. Households were selected using a random walk method. The WHO instrument for stepwise surveillance (STEPS) of chronic disease risk factors was administered by trained medical assistants, who also recorded blood pressure (BP) and anthropometric measures. BP was recorded using a mercury sphygmomanometer utilising the American Heart Association guidelines. Hypertension was defined as per the 7th Report of the Joint National Committee or use of prescribed antihypertensive medication. Those with hypertension or with random capillary blood sugar (RCBS) >11.1 mmol/l had an 8 hours fasting venous blood sugar sample drawn. Age standardised prevalence was computed and multivariate analysis to assess associations.
Results

We screened 2200 and enrolled 2061 adults; 50.9% were males; mean age was 33.4 years and 87% had primary level education. The age-standardised prevalence of hypertension (95% CI) was 22.8% (20.7, 24.9). 20% (53/258) were aware of their hypertensive status; 59.3% had pre-hypertension; 80% reported high levels of physical activity and 52% were classified as harmful alcohol drinkers; 10% were current smokers and 5% had diabetes. Majority of males had normal BMI and waist circumference, whereas a third of females were obese or overweight and 40% had central obesity. Older age, higher general and central obesity were independently associated with hypertension and higher SBP and DBP readings.
Conclusions

Our findings of high prevalence of hypertension, in association with excess body weight in this poor urban slum community, point to the need for greater awareness and implementation of primary preventive strategies.
Keywords
Hypertension prevalence Urban health Poverty areas Africa South of the Sahara Non-communicable diseases

2013

Ayah, R, Joshi MD, Wanjiru R, Njau EK, Otieno CF, Njeru EK, Mutai KK.  2013.  A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya. Abstract

Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi’s largest slum. Methods We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment. Results Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45–54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women. Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco. Conclusions This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.

2010

Kiarie, GW, ABINYA NO, JOSHI MD, LULE GN, Muthuma GZ.  2010.  Familial Clustering of Cancer in Two Tertiary Care Hospitals in Nairobi, Kenya. East Afri Med Journal. 87(1):9-13., Nairobi: East African Medical Journal 2009; 87:1-5.Website

2009

ACHIENG’, L, M. D. JOSHI, OGOLA EN, KARARI E.  2009.  Adequacy of Blood Pressure Control, and Level of Adherence to Antihypertensive therapy at Kenyatta N Hospital. East Afri Med Journal. 86(11):499-506.: East African Journal 2009; 86:510-516.Website
Nguchu HK, Joshi MD, OCF.  2009.  Acute Coronary Syndromes amongst Type 2 Diabetics with Ischemic Electrocardiograms presenting to Kenyatta N Hospital Accident & Emergency Department.. : East African Medical Journal

2008

DAVID, PROFJOSHIMARK.  2008.  Fertiltiy Rate of Epileptic Women in Kenyatta N Hospital. Kariuki JG, Joshi MD, Adam AM, Kwasa TOO, Machoki M.. East Afri Med J.2008;85:341-346. : East African Medical Journal.
DAVID, PROFJOSHIMARK.  2008.  High-sensitivity C-reactive protein in type 2 diabetic patients with and without the metabolic syndrome. East Afr Med J. 2008 Apr;85(4):178-186. : East African Med J Abstract
{ OBJECTIVE: To describe the distribution of serum high-sensitivity C-reactive protein (hsCRP) in type 2 diabetes mellitus outpatients, and relate it to cardiovascular disease risk. DESIGN: Cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral hospital. SUBJECTS: One hundred and ninety seven type 2 diabetic outpatients and fifty age- and sex-matched non-diabetic hypertensive outpatients. RESULTS: The distribution of hsCRP in the diabetic population was skewed, with a mean of 4.33 mg/L and a median of 2.53 mg/L. The majority (42%) of diabetics had hsCRP levels in the high-risk category (hsCRP > 3 mg/L). The median hsCRP was non-significantly higher in the diabetic patients with metabolic syndrome compared to those without (2.68 vs 2.30 mg/L
DAVID, PROFJOSHIMARK.  2008.  Prevalence of dyslipidemia and dysglycaemia in HIV infected patients. East Afr Med J. 2008 Jan;85(1):10-17. : East African Journal 2009; 87:1-5. Abstract
BACKGROUND: Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS morbidity and mortality, however long-term metabolic consequences including dysglycaemia and dyslipidemia have raised concern regarding accelerated cardiovascular disease risk. OBJECTIVE: To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-infected patients. DESIGN: Cross-sectional comparative group study. SETTING: Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility. SUBJECTS: Consecutive HIV- positive adult patients. MAIN OUTCOME MEASURES: Dyslipidemia: presence of raised total or LDL cholesterol or low HDL cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, out of 342 screened patients, 295 were recruited and 58% were females. One hundred and thirty four (45%) were on HAART, 82% of whom were on stavudine, lamivudine and either nevirapine or efavirenz. Overall prevalence of dyslipidemiawas 63.1% and dysglycaemia was 20.7%. High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917). HDL levels were low in 14.6% and 51.3% among HAART and HAART naive patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 CI 0.688-2.037). Among patients on HAART compared to HAART naive patients, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22), respectively. CONCLUSIONS: HIV- infected patients demonstrated a high prevalence of dyslipidemia. HAART use was associated with high levels of total, and LDL cholesterol and high triglyceride levels, an established athrogenic lipid profile. However, HAART was not associated with low HDL cholesterol and had no significant effect on dysglycaemia.

2007

David, JM.  2007.  High Sensitivity CRP Type 2 Diabetics at Kenyatta N Hospital..
DAVID, PROFJOSHIMARK.  2007.  Prevalence of Peripheral Arterial Disease among Chronic Kidney Disease patients at Kenyatta N. Hospital.. Cardiovascular Journal of Africa. : Cardiovascular Journal of South Africa. 2007; 2: 112. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.
DAVID, PROFJOSHIMARK.  2007.  Dyslipedemia in HIV Infected patients at CCC Kenyatta N Hospital. Manuthu EM, Joshi MD, Lule GN, Karari E.. Cardiovascular J of South Africa. 2007;2:112. : East African Medical Journal. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.
DAVID, PROFJOSHIMARK.  2007.  High Sensitivity CRP Type 2 Diabetics at Kenyatta N Hospital.. Cardiovascular J of South Africa. 2007;2:123. : East African Medical Journal. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.
DAVID, PROFJOSHIMARK.  2007.  Incidence of chemotherapy-related tumour lysis syndrome at Kenyatta National Hospital, Nairobi. Busakhala W, Joshi MD, Abinya NO, Amayo A, Abwao HO.. East Afr Med J. 2007 Mar;84(3):100-109.. : East African Medical Journal. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.
DAVID, PROFJOSHIMARK.  2007.  Total lymphocyte count as a surrogate marker for CD4+ t cell count in initiating antiretroviral therapy at Kenyatta National Hospital, Nairobi.Gitura B, Joshi MD, Lule GN, Anzala O.. East Afr Med J. 2007 Oct;84(10):466-72.. : East African Medical Journal. Abstract
OBJECTIVE: To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker for CD4 + T cell count in antiretroviral (ARV) treatment initiation in a Kenyan population of HIV seropositive patients at Kenyatta National Hospital. DESIGN: Cross-sectional descriptive study. SETTING: Kenyatta National Hospital, HIV treatment and follow-up outpatient facility; Comprehensive Care Centre, Nairobi, Kenya. SUBJECTS: Two hundred and twenty five HIV Elisa positive, ARV naive patients visiting the Comprehensive Care Centre between January 2006 to March 2006. RESULTS: A significant linear correlation was found between TLC and CD4 cell count for the whole group with a Spearman rank correlation of 0.761 (p < 0.01); and was also independently observed in the four WHO clinical stages. The classification utility of TLC 1200 cells/mm3 cut-off was suboptimal; sensitivity 37% specificity of 99% and the NPV of 56%. The receiver operator characteristics (ROC) curve generated an optimal TLC cut-off of 1900 cells/mm3 cut-off to be of greatest utility with a sensitivity of 81.1%, specificity of 90.3%, PPV of 90.8% and NPV of 80.2%. This implies that a TLC cut-off of 1900 cells/mm3 correctly classify eight out of ten HIV positive patients as having a CD4 < 200 cells/mm3 and only misclassify two such patients. Serial CD4 testing can then be performed on the minority of patients who despite a TLC > or = 1900 cells/mm3 are, on basis of clinical data, suspect of more advanced disease warranting ARV therapy. This would reduce the number of patients tested for and focus the application of CD4 testing and thus reduce attendant cost in care provision in CD4 resource poor settings. CONCLUSION: Our data showed a good positive correlation between TLC and CD4 cell count, however the WHO recommended TLC cuto-ff of 1200/mm3 was found to be of low sensitivity in classifying patients as having a CD4 counts < 200 cells/mm3. This would result in underestimation of advanced stage of disease and to withholding ARVs treatment to persons who need treatment. We recommend a TLC cut-off of 1900 cells/mm3 for our population to classify patients as either above or below the CD4 count cut-off of 200 cells/mm3 as an indicator of when to start antiretroviral therapy.

2006

DAVID, PROFJOSHIMARK.  2006.  Homocysteine as a Risk Factor for Deep Venous Thrombosis At Kenyatta N Hospital,Nairobi. Magada A, Joshi MD, Ogola EN, Lule GN.. Healthline. 2006;10:48-51. : Institute of Health Research & Services Abstract
OBJECTIVE:To determine the aetiological role of Hyperhomocysteinemia in Deep Venous Thrombosis. STUDY DESIGN: Case Control Study STUDY SETTING: Tertiary National Referral Hospital; Kenyatta N Hospital. STUDY SUBJECTS: Cases: patients with a Compression Doppler Ultrasonography (CDU) index diagnosis of lower limb DVT; Controls: staff & out-patients with no clinical evidence or diagnostic suspicion of DVT. Main Outcome Measure: Odds ratio for Hyperhomocysteinemia Methods: Consecutive patients with a clinical suspicion of Index DVT underwent CDU by a single sonography, if positive were recruited with an equal number of matched controls.. Fasting plasma homocysteine levels were assayed, and level > 10umol/l was defined as Hyperhomocysteinemia (HH). Traditional DVT risk factors were evaluated and an Odds ratio for HH calculated. Results: Between September 2000 to March 2001 60 consecutive patients were screened and 57 recruited with 50 healthy hospital staff & 7 non DVT out patients as controls. Mean case age was 36.4 yrs  10.0 with of 18 to 63 yrs range. 94.7% were female and all native Africans. The most prevalent traditional risk factor was hormonal contraceptive use (33.4%); 14 patients (24.6%) had more than one risk factor. Mean case homocysteine levels was 13.2  4.9 mols/l and 11.1  3.49 mols/l. in controls. Odds Ratio for HH 1.58, (95% CI 0.068-3.65). Conclusions: DVT risk factors in our patient population is multifactorial and Hyperhomocysteinemia is associated with a 58% relative risk for DVT.
DAVID, PROFJOSHIMARK.  2006.  Letter to Editor;To observe the association between the staple Ethiopian diets and cancer of the oesophagus. Joshi MD. East Afr Med J. 2006 May;83(5):292.. : East African Medical Journal. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.
DAVID, PROFJOSHIMARK.  2006.  Cardiovascular risk factors in patients with type 2 diabetes mellitus in Kenya: levels of control attained at the Outpatient Diabetic Clinic of Kenyatta National Hospital, Nairobi. Joshi MD, Amayo EO.. East Afr Med J. 2006 Jul;83(7):405-6;. : East African Medical Journal. Abstract
OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.

2005

DAVID, PROFJOSHIMARK.  2005.  Prevalence of HCV and HCV/HIV co-infection among volunteer blood donors and VCT clients. Karuru J, Lule GN, Joshi MD, Anzala O.. East Afr Med J. 2005;82:166-169. : Institute of Health Research & Services Abstract
Department of Internal Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya. OBJECTIVE: To determine the prevalence of HCV infection and HCV/HIV co-infection among voluntary blood donors at the National Blood Transfusion Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counseling and Testing (VCT) Centre. DESIGN: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital and the National Blood Transfusion Services Centre, Nairobi. SUBJECTS: Volunteer blood donors and VCT attendants. RESULTS: The prevalence of HCV/HIV co-infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients tested positive for HCV. The incidence of risk factors in the persons with HCV and/or HIV infection(s) was low. CONCLUSION: The prevalence of HCV infection among pre-screened volunteer blood donors was low. However the current practice of screening all donated blood for HCV remains indispensable to prevent its transmission to blood recipients.
DAVID, PROFJOSHIMARK.  2005.  Prevalence of HCV and HCV/HIV co-infection among in-patients at Kenyatta N Hospital. Karuru J, Lule GN, Joshi MD, Anzala O.. East Afr Med J. 2005;82:170-172. : Institute of Health Research & Services Abstract
Department of Internal Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya. OBJECTIVE: To determine the prevalence of HCV and HCV/HIV co-infection among medical in-patients at the Kenyatta National Hospital. DESIGN: Prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient department SUBJECTS: HIV/AIDS and HIV negative in-patients at KNH medical wards. RESULTS: Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and HIV was 3.7%. The incidence of risk factors in persons with HCV and/or HIV infection(s) was low. CONCLUSION: This study found the prevalence of HCV infection among medical in-patients to be similar in HIV positive and HIV negative group of patients. The co-infection rates were low, as were the risk factors for transmission of these infections. PMID: 16122083 [PubMed - indexed for MEDLINE]

2004

DAVID, PROFJOSHIMARK.  2004.  Coronary Artery Disease and Symptoms of Depression in Kenyan Population. Njenga FG, Kamotho CG, Joshi M.D, Gikonyo DK, Wanyoike M.. East Afri Medl Jl; 2004; 81:611-619. : East African Medical Journal. Abstract
BACKGROUND: Depression and heart disease are replacing the traditional enemies of Africa such as infectious diseases and malnutrition as the increasing causes of disability and premature death. Little is known about the co-morbidity of heart disease and depression in Africa. OBJECTIVE: To describe the prevalence of depression in Black Africans with and without Coronary Artery Disease as documented on coronary angiography at the Nairobi Hospital. DESIGN: Prospective comparative study. SETTING: A private not for Profit 210 bed hospital, catering for fee paying middles class clintele. RESULTS: Of the eighteen patients with an abnormal angiogram, the highest score on the BDI was 9 while the average was 2.11. Of the seven with normal angiograms, the highest BDI was 5, and the average was 1.71. There was no statistical significance in these differences. CONCLUSION: While African scientists must continue to concentrate on the urgent medical priorities of today (AIDS, malaria, measles, etc), cognisance has to be made of the other emerging epidemic, of the co-morbidity of coronary artery disease and depression. That no significant difference in depression score between the two groups was found could be due to a number of reasons including the small sample size achieved in this first study of its kind in Kenya.
N, PROFOGOLAELIJAHS, DAVID PROFJOSHIMARK.  2004.  Cardiovascular risk factor profile of black Africans undergoing coronary angiography. Kamotho C,Ogola E N,Joshi M D,Gikonyo D. East Afr Med J.2004;81:82-86.. : Institute of Health Research & Services Abstract
{ BACKGROUND: Coronary artery disease (CAD) is a growing epidemic on the African continent. It remains uncertain whether the risk factors identified as contributing to CAD in white populations contribute to a similar extent to CAD incidence in black populations. No data of the local population exists that is based on the coronary angiogram (CA). OBJECTIVES: To analyse the relationship of conventional cardiovascular risk factors with presence of CAD in black Africans. DESIGN: This was a dual-armed study, consisting of retrospective and prospective comparative arms. SUBJECTS: Black Africans who underwent coronary angiography. SETTING: Nairobi Hospital, Cathereterization laboratory. MAIN OUTCOME MEASURES: The conventional risk factors: age, male gender, hypertension, obesity, smoking, diabetes mellitus, dyslipidaemia, alcohol use and interventricular septum (IVS) hypertrophy, as a marker of LVH. RESULTS: One hundred and sixty nine patients fulfilled the inclusion criteria; 144 in the retrospective arm and 25 in the prospective. The larger retrospective arm showed that the group with CAD, compared to the normal group, was significantly older, with a higher mean age of 54.4 years compared to 49.8 years (P=0.005); had significantly more males, with a male to female ratio of 5.5:1 compared to 2.3:1 (P=0.045); had a very significantly larger proportion of diabetics (38.5% compared to 12%

2002

DAVID, PROFJOSHIMARK.  2002.  Platelet functions in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi. Amayo EO, Kayima JK, Joshi MD.. East Afr Med J. 2002 Aug;79(8):405-7.. : East African Medical Journal. Abstract
OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

1999

DAVID, PROFJOSHIMARK.  1999.  Basics of Clinical Epidemiology: Part I Joshi M.D. HealthLine,1997;1:15-19. : Institute of Health Research & Services Abstract
OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

1998

DAVID, PROFJOSHIMARK.  1998.  Basics of Clinical Epidemiology: Part III. Joshi M.D. HealthLine, 1998; 2:40-42.. : Institute of Health Research & Services Abstract
OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

1997

DAVID, PROFJOSHIMARK.  1997.  Basics of Clincal Epidemiology: Part II. Joshi M.D. HealthLine, 1997; 1:66-68.. : Institute of Health Research & Services Abstract
OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

1995

DAVID, PROFJOSHIMARK.  1995.  Mitral Dilatation with the Multi-track System:an Alternative Approach. Bonhoeffer P, Piechaus JF, Sidi D, Yonga G, Jowi C, Joshi M.D, Mugo M, Kachaner J, Parenzan L.. Cathet Cardiovasc Diagn. 36:189-193, 1995. : Institute of Health Research & Services Abstract
Mitral dilatation with multi-track system: an alternative approach. We developed a simple and versatile and new technique (Multi-Track) for percutaneous mitral valvotomy using two separate balloon catheters positioned on a single guidewire. The first catheter, with only a distal guide wire lumen and proximal balloon, is introduced over the guide wire into the vein and then advanced into the mitral valve orifice. Subsequently, a normal balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side. The balloons are then inflated simultaneously. The technique was applied in 12 patients between 10 and 40 years of age (mean 27.1) and weighing 24-80kg (mean 50.3). Valve area increased from 0.66 cm2 (range, 0.3-0,9 cm2) to 1.97cm2 ( range, 1.33-3.1cm2) and mean left atrial pressure dropped from 31mmHg ( range, 18-52mmHg) to 12mmHg ( range, 5-22mmHg). Mitral dilation with the Multi-Track system gives results comparable to those with previously described techniques and uses simpler and less costly catheters. PMID: 8829845 [PubMed-indexed for MEDLINE]

1993

DAVID, PROFJOSHIMARK.  1993.  Cardiovascular features in adolescents and adults with sickle cell anaemia.. East Afr Med J. 1993 May;70(5):270-6.. : Institute of Health Research & Services Abstract
Fifty five sickle cell anaemia (SCA) patients at the Kenyatta National Hospital were studied with a view to elucidating their cardiovascular status. Their age range was 13 to 27 years (median 18.9 years). They comprised 27 males and 28 females and their mean haemoglobin concentration was 8.5 +/- 1.4 g/dl. Haemoglobin level of 8.0-9.9 g/dl seen in 30 patients was noted to confer the lowest incidence of exertional dyspnoea and palpitation. Similarly, patients with this haemoglobin level had the lowest mean heart rate. The mean blood pressure was 114.9 +/- 9.9 mmHg systolic and 64.6 +/- 10 mmHg diastolic. Blood pressures, ejection fraction (EF) and differential fibre shortening (%D) were found to be directly related to haemoglobin level, whereas cardio-thoracic index (CTI) and left ventricular dimensions were inversely related to haemoglobin level. Mean echocardiographic measurements were within normal limits and left ventricular functions were found to be normal in 80.9% of the patients indicating that the majority of SCA patients at the Kenyatta National Hospital have good cardiac function.

1989

DAVID, PROFJOSHIMARK.  1989.  Cryptococcal hepatitis and meningitis in a patient with acquired immunodeficiency syndrome: a case report. East Afr Med J. 1989 Jan;66(1):69-73.. East Afr Med J. 1989 Jan;66(1):69-73.. : Institute of Health Research & Services Abstract
A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

1988

Joshi, MD.  1988.  Changes in the Upper Gastrointestinal track in patterns with chronic renal failure. Abstract

Between February and July 1987, some 40 consecutive patients with established chronic renal failure, on either maintenance dialysis or conservative management, were studied to determine the nature and incidence of upper gastrointestinal tract mucosal disease. Serum assays for gastrin, bombesin and gastric inhibitory polypeptide were also done.

Endoscopic gastritis was evident in 27.5%, duodenitis in 20%, bile reflux in 17.5%, distorted duodenal bulb in 17.5% oesophangitis in 5% and duodenal ulcer in 5%. In 32.5% of the patients there was no endoscopic abnormality noted. No patient had active gastrointestinal bleeding. Gastrin and gastric inhibitory polypeptide were significantly elevated in all study cases when compared to the controls. None of the cases had conditions, other than chronic renal failure to account for fasting hypergastrinemia. Fasting serum gastrin levels did not correlate significantly with endoscopic diagnosis, serum creatinine or creatinine clearance. A statistically significant correlation was found between serum gastrin and bombesin levels.

The results indicate a high prevalance of inflammatory and hypertrophic mucosal changes in chronic renal failure but not peptic ulcer disease, and suggest that these changes may be a consequence of hypergastrinemia.

It is r~ded that all chronic renal failure patients with significantupper gastrointestinal symptomatology and all pre­ renal transplant patients undergo upper gastrointestinal endoscopicassessement.
DAVID, PROFJOSHIMARK.  1988.  Upper gastrointestinal tract in chronic renal failure as seen at Kenyatta National Hospital, Kenya. East Afr Med J. 1988 Aug;65(8):541-6.. East Afr Med J. 1988 Aug;65(8):541-6.. : Institute of Health Research & Services

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