Bio

PDF Upload: 

Publications


Submitted

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

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

2010

Otieno, CF, KAYIMA JK, MBUGUA PK, AMAYO AA, MCLIGEYO SO.  2010.  Prognostic factors in patients hospitalised with diabetic ketoacidosis at Kenyatta National Hospital, Nairobi. Abstract

In spite of many advances in the management of diabetes in the last 25 years, the mortality associatedwith diabetic ketoacidosis (DKA) remains high, especially in the developing countries. The mortality appears greatest in the first 24-48 hours of their treatment. Most of the previous studies on DKA focused on children and the precipitating factors thereof but not particularly on clinical predictors of outcomes. OBJECTIVE: To determine the clinico-laboratory predictors of outcomes of patients hospitalised with diabetic ketoacidosis who were undergoing treatment. DESIGN: Cross-sectional descriptive study. SETTING: The accident and emergency department and medical wards of the Kenyatta National Hospital. SUBJECTS: Fifty one patients hospitalised with diabetic ketoacidosis over a nine month period were evaluated clinically and by laboratory tests. They were managed in the standard way with insulin, intravenous fluids and appropriate supportive care. Main outcome measures: Serial assays of serum electrolytes, glucose and blood pH, HbA1c and clinical outcome of either discharge home or death. RESULTS: Of the 51 patients enrolled, 47 were included in the final analysis. Fourteen (29.8%) patients died,andthe deaths occurred within less than48 hours of hospitalisation and treatment. Of the patients who died, all (100%) had altered level of consciousness at hospitalisation, 71.4% had abnormal renal functions, 64.3% were newly diagnosed and an equal proportion of 64.3% were females. The alteration in the level of consciousness was significantly associated systolic hypotension and severe metabolic acidosis, (p < 0.001). Patients with altered level of consciousness also had poorer renal function. CONCLUSION: Apparently DKA still carries high mortality during treatment in hospital. Altered level of consciousness, which is an obvious and easily discernible clinical sign, was a major predictor of mortality in our study patients. The majority of patients with altered level of consciousness also had systolic hypotension, severe metabolic acidosis and impaired renal function. Even where and when detailed laboratory evaluation is elusive, clinical signs, especially altered level of consciousness and systolic hypotension are very important markers of severity of DKA that may be associated with unfavourable outcomes. Further studies are necessary to establish why DKA still carries high mortality in the patients who are already receiving treatment in hospitals in developing countries

2009

2008

K, DRKAYIMAJOSHUA.  2008.  Njoroge GK, Njagi EN, Orinda GO, Sekadde-Kigondu CB, Kayima JK.Environmental and occupational exposure to lead.East Afr Med J. 2008 Jun;85(6):284-91.. East Afr Med J. 2008 Jun;85(6):284-91.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. DESIGN: Cross sectional study. SETTING: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. SUBJECTS: Three hundred and eight children and adults participated. RESULTS: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65 microg/dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9 microg/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9 microg/dl. Blood lead levels above 10 microg/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10 microg/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 +/- 13.4 microg/dl. Among the workers, 89% had BLLs above 10 microg/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15 microg/dl. The covariate group at Olkalou had a mean BLL of 1.3 +/- 0.9 microg/dl. CONCLUSION: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended.

2007

K, DRKAYIMAJOSHUA.  2007.  Maritim M. C., Joshi M. D., Kayima J. K., Amayo A. and Jowi J. O. Prevalence of Peripheral arterial disease among chronic kidney disease patients at Kenyatta National Hospital. (Abstract) Cardiovasc J. Afr (Abstract) 2007; 18 (2): 112.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. DESIGN: Cross sectional study. SETTING: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. SUBJECTS: Three hundred and eight children and adults participated. RESULTS: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65 microg/dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9 microg/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9 microg/dl. Blood lead levels above 10 microg/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10 microg/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 +/- 13.4 microg/dl. Among the workers, 89% had BLLs above 10 microg/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15 microg/dl. The covariate group at Olkalou had a mean BLL of 1.3 +/- 0.9 microg/dl. CONCLUSION: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended.

2005

K, DRKAYIMAJOSHUA.  2005.  Mwendwa FM, Otieno CF, Kayima JK, Amayo EO, Otieno PO.Risk factor profile and the occurrence of microvascular complications in short-term type 2 diabetes mellitus at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S163-72.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
BACKGROUND: Type 2 diabetes has a long pre-clinical period before diagnosis, during which there may be development of complications, both of microvascular and macrovascular types. OBJECTIVE: To determine the risk factor profile of hyperglycaemia, hypertension and dyslipidaemia in patients with short-term (=/ < 2 years) type 2 diabetes. DESIGN: Cross-sectional descriptive study over six months. SETTING: Outpatient diabetic clinic of Kenyatta National Hospital. SUBJECTS: Ambulatory patients with type 2 diabetes. RESULTS: One hundred patients were included. The mean (SD) duration of diabetes was 10.3 (7.5) months. There were 66% of the study subjects with obesity, 50% with hypertension, 29% had ideal glucose control and less than 40% had high LDL-cholesterol. Twenty eight (28%) who had polyneuropathy had significant differences in their older age, higher total and LDL-cholesterol compared with those who did not have polyneuropathy. Twenty five (25%) of the study patients had micro-albuminuria and only 1% had macro-albuminuria. There were no significant differences in the selected characteristics between study patients with and those without albuminuria. Only 7% of the study patients had retinopathy on direct ophthalmoscopy. CONCLUSION: Microvascular complications occurred in patients with type 2 diabetes of short duration of not more than two years. The risk factors of hypertension, poor glycaemic control, dyslipidaemia and cigarette smoking were present in a fair proportion of the study patients. Patients with type 2 diabetes should be actively screened for complications and the risk factors thereof, even if the diabetes was of recent onset.
K, DRKAYIMAJOSHUA.  2005.  Otieno CF, Vaghela V, Mwendwa FW, Kayima JK, Ogola EN.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. East Afr Med J. 2005. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVES: To determine the proportion of specific cardiovascular risk factors in ambulatory patients with type 2 diabetes and the levels of control achieved in them. DESIGN: Prospective, cross-sectional study over a six month period. SETTING: Out-patient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Two hundred and eleven patients with type 2 diabetes. MAIN OUTCOME MEASURES: Sociodemographic attributes, duration of diabetes, levels of glycaemia, body weight, blood pressure, fasting lipids and modes of treatment. RESULTS: A total of 211 patients were enrolled, 57.3% were females. The mean (SD) age for women was 54.45 (9.44) and that of men was 55.8 (9.02) years. About 77% of the study population were on oral glucose-lowering agents with or without insulin but less than 30% achieved HbA1c < 7%; 15% were active cigarette smokers; about 50% were hypertensive with female predominance but 65% of them did not achieve desired blood pressure level inspite of treatment. Just over 50% had raised LDL-cholesterol and over 75% had raised total cholesterol but only three men were on statins without achieving desired targets. Body mass index above 30 kg/m2 as a measure obesity was found in 32% of females and 16% males. Most of the study patients admitted use of Aspirin at certain times in the course of their diabetes. CONCLUSION: The study showed that specific cardiovascular risk factors of hyperglycaemia, dyslipidaemia, hypertension and obesity were prevalent although not adequately controlled to targets. Statin use was extremely low in people who already needed them. Regular Aspirin use was infrequent because many patients did not quite understand its role in their diabetes treatment. It is recommended that a more pro-active approach in multifactorial address of cardiovascular risk factors be used in high-risk patients with type 2 diabetes to forestall future cardiovascular events.
K, DRKAYIMAJOSHUA.  2005.  Mbugua PK, Otieno CF, Kayima JK, Amayo AA, McLigeyo SO.Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi. East Afr Med J. 2005 Dec;82(12 Suppl):S191-6.. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
OBJECTIVE: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). DESIGN: Prospective cross-sectional study. SETTING: Inpatient medical and surgical wards of KNH. SUBJECTS: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. RESULTS: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) for females, range of 12 to 77 years. Half of the patients were newly diagnosed. More than 90% had HbA1c > 8%, only three patients had HbA1c of 7-8.0%. More than 90% had altered level of consciousness, with almost quarter in coma, 36% had systolic hypotension, almost 75% had moderate to severe dehydration. Blunted level of consciousness was significantly associated with severe dehydration and metabolic acidosis. Over 65% patients had leucocytosis but most (55%) of them did not have overt infection. Amongst the precipitating factors, 34% had missed insulin, 23.4% had overt infection and only 6.4% had both infection and missed insulin injections. Infection sites included respiratory, genito-urinary and septicaemia. Almost thirty (29.8%) percent of the study subjects died within 48 hours of hospitalisation. CONCLUSION: Diabetic ketoacidosis occurred in about 8% of the hospitalised diabetic patients. It was a major cause of morbidity and mortality. The main precipitant factors of DKA were infections and missed insulin injections. These factors are preventable in order to improve outcomes in the diabetic patients who complicate to DKA.
K, DRKAYIMAJOSHUA.  2005.  Otieno CF, Kayima JK, Omonge EO, Oyoo GO.Diabetic ketoacidosis: risk factors, mechanisms and management strategies in sub-Saharan Africa: a review. East Afr Med J. 2005 Dec;82(12 Suppl):S197-203. Review. Cardiovasc J. Afr.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

BACKGROUND: Diabetic ketoacidosis is the most common hyperglycaemic emergency in patients with diabetes mellitus, especially type 1 diabetes. It carries very high mortality in sub-Saharan Africa, both in the treated patients and those who are presenting to hospital with diabetes for the first time. OBJECTIVE: To review the risk factors, mechanisms and management approaches in diabetes ketoacidosis in published literature and to discuss them in the context of why a significant proportion of patients who develop diabetic ketoacidosis in sub-Saharan Africa still have high mortality. DATA SOURCE: Literature review of relevant published literature from both Africa and the rest of the world. DATA SYNTHESIS: The main causes or precipitants of DKA in patients in SSA are newly diagnosed diabetes, missed insulin doses and infections. The major underlying mechanism is insulin deficiency. Treated patients miss insulin doses for various reasons, for example, inaccessibility occasioned by; unavailability and unaffordability of insulin, missed clinics, perceived ill-health and alternative therapies like herbs, prayers and rituals. Infections also occur quite often, but are not overt, like urinary tract, tuberculosis and pneumonia. Due to widespread poverty of individuals and nations alike, the healthcare systems are scarce and the few available centres are unable to adequately maintain a reliable system of insulin supply and exhaustively investigate their hospitalised patients. Consequently, there is little guarantee of successful outcomes. Poor people may also have sub-optimal nutrition, caused or worsened by diabetes, more so, at first presentation to hospital. Intensive insulin therapy in such individuals mimics 're-feeding syndrome', an acute anabolic state whose outcome may be unfavourable during the period of treatment of diabetic ketoacidosis. CONCLUSIONS: Although mortality and morbidity from diabetic ketoacidosis remains high in sub-Saharan Africa, improved healthcare systems and reliable insulin supply can reverse the trend, at least, to a large extent. Individuals and populations need empowerment through education, nutrition and poverty eradication to improve self-care in health and living with diabetes.

2003

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  2003.  Otedo A. E. O., McLigeyo S.O., Okoth F.A. and Kayima J. K. Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country South African Medical Journal, 93 (3): 380-384; 2003. South African Medical Journal, 93 (3): 380-384; 2003. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

BACKGROUND: Patients with end-stage renal disease (ESRD) on maintenance dialysis are predisposed to hepatitis B virus (HBV) infection for a number of reasons. In a similar way, the prevalence of anti-hepatitis C virus (HCV) antibodies among patients on chronic haemodialysis and peritoneal dialysis is consistently higher than in healthy populations. There are few published data on these diseases in patients undergoing maintenance dialysis in sub-Saharan Africa. OBJECTIVE: To determine the seroprevalence of HBV and HCV in patients on maintenance dialysis. SETTING: Renal Unit, Kenyatta National Hospital, the largest public referral and teaching hospital in Kenya. DESIGN: Cross-sectional descriptive study. STUDY POPULATION: All 100 patients on maintenance dialysis during the 9-month study period were evaluated. METHOD: The following information was obtained from all the patients: socio-demographic data, date of diagnosis of ESRD and commencement of dialysis, and number of blood transfusions. Additionally, a history suggestive of hepatitis in spouses was looked for and physical examination for tattoos and other scars was carried out. Laboratory investigations included urea, electrolytes and serum creatinine, liver enzymes, hepatitis B surface antigen (HBsAg), immunoglobulin M anti-hepatitis B core antibody (IgM anti-HBc), hepatitis B e antigen (HBeAg) and anti-HCV antibodies. Student's t-test was used to assess the significance of the data collected. RESULTS: The results were expressed as mean (+/- SD). Fifty-seven males and 43 females were studied. Mean age was 44.3 +/- 14.6 years. Ten patients (10%) had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (> 40 U/l for both). HBsAg was found in 8 patients (8%), IgM anti-HBc in 2%, and HBeAg in none. Anti-HCV antibody was found in 5%. Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. Longer duration of dialysis and the number of blood transfusions were associated with an increased seroprevalence of HBV and HCV. CONCLUSION: There is a low seroprevalence of HBV and HCV in our dialysis population. This should not lead to complaisance in screening for these potentially lethal complications.

2002

K, DRKAYIMAJOSHUA.  2002.  Amayo EO, Kayima JK, Joshi MD.Platelet functions in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2002 Aug;79(8):405-7.. East African Medical Journal, 79(7): 390-393; 2002.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. 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.
K, DRKAYIMAJOSHUA.  2002.  Onyango J. F., Kayima J. K. and Owen W. O. Rhinocerebral mucormycosis: case report East African Medical Journal, 79(7): 390-393; 2002. East African Medical Journal, 79(7): 390-393; 2002.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.
K, DRKAYIMAJOSHUA.  2002.  Kayima J.K. The changing spectrum of Type 2 Diabetes Mellitus East African Medical Journal (Editorial), 79: 397-398; 2002. East African Medical Journal (Editorial), 79: 397-398; 2002 Comment on: East Afr Med J. 2002 Aug;79(8):399-404.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

BACKGROUND: Patients with end-stage renal disease (ESRD) on maintenance dialysis are predisposed to hepatitis B virus (HBV) infection for a number of reasons. In a similar way, the prevalence of anti-hepatitis C virus (HCV) antibodies among patients on chronic haemodialysis and peritoneal dialysis is consistently higher than in healthy populations. There are few published data on these diseases in patients undergoing maintenance dialysis in sub-Saharan Africa. OBJECTIVE: To determine the seroprevalence of HBV and HCV in patients on maintenance dialysis. SETTING: Renal Unit, Kenyatta National Hospital, the largest public referral and teaching hospital in Kenya. DESIGN: Cross-sectional descriptive study. STUDY POPULATION: All 100 patients on maintenance dialysis during the 9-month study period were evaluated. METHOD: The following information was obtained from all the patients: socio-demographic data, date of diagnosis of ESRD and commencement of dialysis, and number of blood transfusions. Additionally, a history suggestive of hepatitis in spouses was looked for and physical examination for tattoos and other scars was carried out. Laboratory investigations included urea, electrolytes and serum creatinine, liver enzymes, hepatitis B surface antigen (HBsAg), immunoglobulin M anti-hepatitis B core antibody (IgM anti-HBc), hepatitis B e antigen (HBeAg) and anti-HCV antibodies. Student's t-test was used to assess the significance of the data collected. RESULTS: The results were expressed as mean (+/- SD). Fifty-seven males and 43 females were studied. Mean age was 44.3 +/- 14.6 years. Ten patients (10%) had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (> 40 U/l for both). HBsAg was found in 8 patients (8%), IgM anti-HBc in 2%, and HBeAg in none. Anti-HCV antibody was found in 5%. Six of the HBsAg-positive patients were on haemodialysis, the other 2 on continuous ambulatory peritoneal dialysis (CAPD). There was no coexistence of HBV and HCV markers. Longer duration of dialysis and the number of blood transfusions were associated with an increased seroprevalence of HBV and HCV. CONCLUSION: There is a low seroprevalence of HBV and HCV in our dialysis population. This should not lead to complaisance in screening for these potentially lethal complications.

1998

K, DRKAYIMAJOSHUA.  1998.  Amayo EO, Kayima JK, Amayo AA.Transient focal neurological deficits in patients with hypoglycaemia and hyperglycaemia: report of four cases. East Afr Med J. 1998 Jan;75(1):53-4. Review.. East African Medical Journal, 75: 30-34; 1998. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
A case of hypoglycaemia and three cases of hyperglycaemia presenting with focal neurological deficits are presented. The focal presentations were hemiparesis and focal convulsion that returned to normal upon correction of the blood sugar. Elderly patients not uncommonly present with transient focal neurologic deficits related to abnormalities in blood sugar levels. In these patients correction of blood sugar levels per se may ameliorate symptoms and signs making it unnecessary to investigate for cerebrovascular disease. In diabetic patients on insulin or oral hypoglycaemic agents focal neurologic deficit should alert the clinician on the possibility of hypoglycaemia.
K, DRKAYIMAJOSHUA.  1998.  Oliech J.S., Kayima J.K., Otieno L.S. Urinary tract stone disease in Nairobi East African Medical Journal, 75: 30-34; 1998. East African Medical Journal, 75: 30-34; 1998. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery.

1997

Muraguri, P, KAYIMA JK, MCLIGEYO SO.  1997.  The Prevalence Of Proteinuria, Haematuria, Other Urinary Abnormalities And Hypertension In Secondary School Students In Nairobi, Kenya. Abstract

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

K, DRKAYIMAJOSHUA.  1997.  Kayima J.K. Utility of mass screening programmes in health.East African Medical Journal(Editorial), 74(8): 465 - 466; 1997. East African Medical Journal(Editorial), 74(8): 465 - 466; 1997 Comment on: East Afr Med J. 1997 Aug;74(8):467-73.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

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

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1997.  Muraguri P., McLigeyo S.O., Kayima J.K. Proteinuria, other selected urinary abnormalities and Hypertension among teenage secondary school students in Nairobi, Kenya. East African Medical Journal, 74(8): 467 - 473; 1997. East African Medical Journal, 74(8): 467 - 473; 1997. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract

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

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1997.  Ngugi N., McLigeyo S.O., Kayima J.K. Treatment of hyperkalaemia by altering the transcellur gradient in patients with renal failure: effect of various therapeutic approaches East African Medical Journal, 73(8): 503 -504; 1997. East African Medical Journal, 73(8): 503 -504; 1997. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Ten patients with acute and 60 with chronic renal failure (both groups having hyperkalaemia), were managed at Kenyatta National Hospital in the medical wards and Renal Unit between August, 1995 and January, 1996. They were divided into seven different treatment groups, each consisting of ten patients. Treatment A glucose 25g i.v. with insulin 10 units i.v., treatment B 50 mmol of 8.4% sodium bicarbonate infusion, treatment C 0.5mg of salbutamol i.v. in 50mls 5% dextrose, treatment D was a combination of treatments A and B, treatment E was a combination of treatment B and C, treatment F was a combination of treatments A and C while treatment G was a combination of treatments A and B and C. Serum potassium was measured, 30 minutes, 1 hour, 2 hours, 4 hours and 8 hours after treatment. Plasma glucose concentration was measured before treatment was given and 1 hour after in all patients. Electrocardiography was done before treatment on all patients and repeated 30 minutes and 1 hour after treatment for the patients with hyperkalaemic changes on the initial recording. All treatment modalities had satisfactory potassium lowering effects. Of the single therapeutic approaches, treatment A and C were equieffective, but better than treatment B (P < 0.001). Amongst the two regimen combinations, treatment D and F were more efficacious than treatment E and all the single therapeutic approaches (P < 0.001). Treatment G was the most efficacious in lowering serum potassium in this study. All treatment modalities had maximum serum potassium lowering effect at 1-2 hours. A fall in plasma glucose concentration was a notable feature of treatments A and D, but significant hypoglycaemia occurred in 20% of patients receiving treatment A and in none on treatment D. The ECG changes of hyperkalaemia did not correlate with serum potassium levels. The normalisation of hyperkalaemic ECG alteration occurred within the first 30 minutes after treatment. In conclusion, combination therapies for hyperkalaemia appear to be more efficacious than single therapeutic approaches. Inclusion of salbutamol seems to protect against insulin induced hypoglycaemia. The maximum potassium lowering effect is observed 1-2 hours of administration of either agents. The potassium reducing effect remains significant compared to baseline values even after 8 hours. If dialysis cannot be instituted early enough it seems reasonable to repeat treatment every 4-6 hours to sustain the effect. Repeated administration of glucose with insulin may not be safe because of the hypoglycaemic effect. Other single and combination therapies can theoretically be repeated regularly until dialysis is initiated although this requires further clinical evaluation.

1996

K, DRKAYIMAJOSHUA.  1996.  Mcligeyo SO, Kayima JK, Oliech JS, Monda SM.Chronic ambulatory peritoneal dialysis in a patient with end-stage renal disease following radiotherapy and surgery for transitional cell carcinoma. Nephron. 1996;74(2):495-6. No abstract available.. African Journal of Health Sciences V ol. 3(3):84-90, 1996.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Renal transplantation is not readily available in the majority of countries in Africa. It is expensive and difficult to sustain on the meagre funds allocated to health. We report our short experience with fifteen living donor recipients followed in our unit for at least 24 months, range 26 - 48 (mean 35 months) post-transplantation. The donors and recipients were mostly young adults with mean ages of 36.7 years and 32.6 years respectively. The majority of the donors and recipients were males. The donors in most cases were siblings. Within this time, one graft has been lost at one year and the patient restarted on haemodialysis. Three patients died, two within the first year, the third at 23 months after transplantation, all with functioning grafts. The one year graft and patient survival rates were 93% and 86.6% respectively. The second year graft survival rates remained at 93% and the patients survival rate 80%. The nature and frequency of complications seen in these patients is comparable to those in other centres. Of all medical complications, bacterial infections contributed 69.4% of all infections. Cardiovascular complications comprised 31.25% of the complications. Hypertension seen in 85.5% of the patients accounted for 65% of the cardiovascular complications. Acute rejections were common and occurred in seven patients. Transplantation is a viable mode of renal replacement therapy (RRT) in our environment. The practice should be supported to make it more readily available to the many young end stage renal failure (ESRF) patients.
K, DRKAYIMAJOSHUA.  1996.  Kayima JK, McLigeyo SO, Were AJ, Luta M.Kidney transplantation: recent medical experiences from the Kenyatta National Hospital, Nairobi. East Afr Med J. 1996 Sep;73(9):614-8.. African Journal of Health Sciences V ol. 3(3):84-90, 1996.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Renal transplantation is not readily available in the majority of countries in Africa. It is expensive and difficult to sustain on the meagre funds allocated to health. We report our short experience with fifteen living donor recipients followed in our unit for at least 24 months, range 26 - 48 (mean 35 months) post-transplantation. The donors and recipients were mostly young adults with mean ages of 36.7 years and 32.6 years respectively. The majority of the donors and recipients were males. The donors in most cases were siblings. Within this time, one graft has been lost at one year and the patient restarted on haemodialysis. Three patients died, two within the first year, the third at 23 months after transplantation, all with functioning grafts. The one year graft and patient survival rates were 93% and 86.6% respectively. The second year graft survival rates remained at 93% and the patients survival rate 80%. The nature and frequency of complications seen in these patients is comparable to those in other centres. Of all medical complications, bacterial infections contributed 69.4% of all infections. Cardiovascular complications comprised 31.25% of the complications. Hypertension seen in 85.5% of the patients accounted for 65% of the cardiovascular complications. Acute rejections were common and occurred in seven patients. Transplantation is a viable mode of renal replacement therapy (RRT) in our environment. The practice should be supported to make it more readily available to the many young end stage renal failure (ESRF) patients.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1996.  Mheta Koy, McLigeyo S.O., Kayima J.K., Waiyaki P.G., Urinary tract Infection in patients with short-term indwelling urinary bladder catheters. African Journal of Health Sciences V ol. 3(3):84-90, 1996.. African Journal of Health Sciences V ol. 3(3):84-90, 1996.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Significant asymptomatic bacteriuria is an important cause of pyelonephritis and gram negative septicaemia among certain predisposed individuals, such as diabetics. We investigated the incidence of asymptomatic urinary tract infections (UTIs) among our diabetic patients and the type and antibacterial sensitivity patterns of the organisms causing these UTIs. One hundred and thirty five patients submitted midstream urine specimens for culture. Fifteen patients had positive cultures showing the incidence of asymptomatic UTI to be 11.1%. There were ten female and five male patients with UTI. The commonest organism isolated was Escherichia coli at 40%. Gram negative bacilli made up 66.7% of the isolates. Isolates were poorly sensitive to the regularly available antibiotics-ampicillin (33% sensitive, cotrimoxazole (33% sensitive). Nitrofurantoin inhibited growth in 93% of the isolates. Other antimicrobials with over 80% sensitivity level included: gentamicin, ceftazidime, augmentin, cefuroxime and norfloxacin. They are expensive or require parenteral administration. The incidence of asymptomatic UTI is high among diabetics and although the organisms isolated are those usually isolated in UTIs, they are not that sensitive to the commonly available and antibacterial agents.
K, DRKAYIMAJOSHUA.  1996.  Kayima J.K., Twahir A., Njenga Asyptomatic bacteriuria among diabetics attending Kenyatta National Hospital East African Medical Journal, 73(8): 524-26; 1996. East African Medical Journal, 73(8): 524-26; 1996. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Significant asymptomatic bacteriuria is an important cause of pyelonephritis and gram negative septicaemia among certain predisposed individuals, such as diabetics. We investigated the incidence of asymptomatic urinary tract infections (UTIs) among our diabetic patients and the type and antibacterial sensitivity patterns of the organisms causing these UTIs. One hundred and thirty five patients submitted midstream urine specimens for culture. Fifteen patients had positive cultures showing the incidence of asymptomatic UTI to be 11.1%. There were ten female and five male patients with UTI. The commonest organism isolated was Escherichia coli at 40%. Gram negative bacilli made up 66.7% of the isolates. Isolates were poorly sensitive to the regularly available antibiotics-ampicillin (33% sensitive, cotrimoxazole (33% sensitive). Nitrofurantoin inhibited growth in 93% of the isolates. Other antimicrobials with over 80% sensitivity level included: gentamicin, ceftazidime, augmentin, cefuroxime and norfloxacin. They are expensive or require parenteral administration. The incidence of asymptomatic UTI is high among diabetics and although the organisms isolated are those usually isolated in UTIs, they are not that sensitive to the commonly available and antibacterial agents.

1995

K, DRKAYIMAJOSHUA.  1995.  Kayima JK, Anderton JL, Swainson CP.Persistent microcytosis and its association to the recovery of anaemia after kidney transplantation. Afr J Health Sci. 1995 Feb;2(1):220-222. Afr. J. Medical Pract. 2(1) 8-9, 1995. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Persistent microcytosis was noted among a number of post renal transplant patients attending the transplant clinic at the Western General Hospital Edinburgh. We retrospectively looked at the pattern of recovery of the anaemia of chronic renal failure following successful renal transplantation with good graft function (Creatinine less than 250 (mol/l). Comparisons were made between those patients with persistent microcytosis and those with normal mean cell volume (MCV). Patients with microcytosis tended to have a slower recovery compared to those with normal MCV especially from week 12 to 21 after transplantation with corresponding Hb changes of 108+ 20 to 126+/-20 g/l vs 128+ 17 to 144+/-19 g/l ([P < 0.05], 95% confidence limits). The microcytic groups also tended to have had poorer graft function with serum creatinines significantly higher than those with normal MCV from week 8 to 21, 182+/- 62 to 173+/- 51 (mol/1 vs 139+/- 40 to 149+/- 38 (mo1/L ([P < 0.05] 95% confidence limits). In both groups haemoglobin concentration was negatively correlated to serum creatinine. (r=-0.54, [P < 0.05]). Body iron status studies had not been done in these patients. Persistent microcytosis though a non sensitive marker of iron deficiency may be a marker of disordered iron metabolism in patients with poorer graft functions.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1995.  McLigeyo S.O., Kayima J.K., Were A.J.O. Severe malaria in a renal transplant patient Afr. J. Medical Pract. 2(1) 8-9, 1995. Afr. J. Medical Pract. 2(1) 8-9, 1995. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Renal transplantation is not readily available in the majority of countries in Africa. It is expensive and difficult to sustain on the meagre funds allocated to health. We report our short experience with fifteen living donor recipients followed in our unit for at least 24 months, range 26 - 48 (mean 35 months) post-transplantation. The donors and recipients were mostly young adults with mean ages of 36.7 years and 32.6 years respectively. The majority of the donors and recipients were males. The donors in most cases were siblings. Within this time, one graft has been lost at one year and the patient restarted on haemodialysis. Three patients died, two within the first year, the third at 23 months after transplantation, all with functioning grafts. The one year graft and patient survival rates were 93% and 86.6% respectively. The second year graft survival rates remained at 93% and the patients survival rate 80%. The nature and frequency of complications seen in these patients is comparable to those in other centres. Of all medical complications, bacterial infections contributed 69.4% of all infections. Cardiovascular complications comprised 31.25% of the complications. Hypertension seen in 85.5% of the patients accounted for 65% of the cardiovascular complications. Acute rejections were common and occurred in seven patients. Transplantation is a viable mode of renal replacement therapy (RRT) in our environment. The practice should be supported to make it more readily available to the many young end stage renal failure (ESRF) patients.

1994

K, DRKAYIMAJOSHUA.  1994.  Amayo E.O., Kayima J.K., McLigeyo S.O. and Kioy P.G. Autonomic nervous function in patients with chronic renal failure at the Kenyatta National Hospital. East African Medical Journal, 71(4): 253-5; 1994.. African Journal of Health Sciences 1(4): 185-191, 1994.. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Persistent microcytosis was noted among a number of post renal transplant patients attending the transplant clinic at the Western General Hospital Edinburgh. We retrospectively looked at the pattern of recovery of the anaemia of chronic renal failure following successful renal transplantation with good graft function (Creatinine less than 250 (mol/l). Comparisons were made between those patients with persistent microcytosis and those with normal mean cell volume (MCV). Patients with microcytosis tended to have a slower recovery compared to those with normal MCV especially from week 12 to 21 after transplantation with corresponding Hb changes of 108+ 20 to 126+/-20 g/l vs 128+ 17 to 144+/-19 g/l ([P < 0.05], 95% confidence limits). The microcytic groups also tended to have had poorer graft function with serum creatinines significantly higher than those with normal MCV from week 8 to 21, 182+/- 62 to 173+/- 51 (mol/1 vs 139+/- 40 to 149+/- 38 (mo1/L ([P < 0.05] 95% confidence limits). In both groups haemoglobin concentration was negatively correlated to serum creatinine. (r=-0.54, [P < 0.05]). Body iron status studies had not been done in these patients. Persistent microcytosis though a non sensitive marker of iron deficiency may be a marker of disordered iron metabolism in patients with poorer graft functions.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1994.  McLigeyo S.O., Kungu A., Kayima J.K., Sitati S.M., Were A.j.: Glomerular disease in KEnya - Another look at the disease characterised by Nephrotic Proteinuria. African Journal of Health Sciences 1(4): 185-191, 1994.. African Journal of Health Sciences 1(4): 185-191, 1994.. : Ochieng P. O., McLigeyo S. O., Amayo E. O., Kayima J. K. and Omonge E. O. Abstract
Persistent microcytosis was noted among a number of post renal transplant patients attending the transplant clinic at the Western General Hospital Edinburgh. We retrospectively looked at the pattern of recovery of the anaemia of chronic renal failure following successful renal transplantation with good graft function (Creatinine less than 250 (mol/l). Comparisons were made between those patients with persistent microcytosis and those with normal mean cell volume (MCV). Patients with microcytosis tended to have a slower recovery compared to those with normal MCV especially from week 12 to 21 after transplantation with corresponding Hb changes of 108+ 20 to 126+/-20 g/l vs 128+ 17 to 144+/-19 g/l ([P < 0.05], 95% confidence limits). The microcytic groups also tended to have had poorer graft function with serum creatinines significantly higher than those with normal MCV from week 8 to 21, 182+/- 62 to 173+/- 51 (mol/1 vs 139+/- 40 to 149+/- 38 (mo1/L ([P < 0.05] 95% confidence limits). In both groups haemoglobin concentration was negatively correlated to serum creatinine. (r=-0.54, [P < 0.05]). Body iron status studies had not been done in these patients. Persistent microcytosis though a non sensitive marker of iron deficiency may be a marker of disordered iron metabolism in patients with poorer graft functions.

1993

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1993.  McLigeyo S.O. and Kayima J.K.: Evaluation of Nephrology in East Africa in the last seventy years - Studies and practice. East African Medical Journal 70(16): 260-266, 1993.. East African Medical Journal 70(16): 260-266, 1993. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1993.  Kayima, J.K. and McLigeyo S.O.: The influence of Sodium, Pattassium, Calcium, VItamin D and Parathyroid hormone on the blood pressure in humans - A review Article. East African Medical Journal 70(4): 235-237, 1993.. East African Medical Journal 70(4): 235-237, 1993.. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.
K, DRKAYIMAJOSHUA.  1993.  Kayima J.K. Strategies aimed at retarding the progression of renal failure. Medicus, 12:306-309, 1993. Medicus, 12:306-309, 1993. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1993.  S.O. McLigeyo, J.K. Kayima Evolution of nephrology in East Africa in the last seventy years . East African Medical Journal, 70(6): 362 - 368; 1993. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Interest in renal disease and practice in East Africa started as far back as the first quarter of this century. Work in this colonial era concentrated on establishing the existence of renal diseases and identifying the nature and incidence of these diseases. This was achieved by case identification and reporting as well as retrospective studies on post mortem and medical notes. The post independence period has not only identified the existence of even more renal diseases but also concentrated on getting a deeper understanding of the aetiology, nature, pattern, regional variations, complications and outcome of these diseases as seen in our environment. Apart from the better understanding of the prevalent renal diseases, emphasis has also been put on the expansion and delivery of renal services. Investigative and treatment facilities have been improved and a lot has been put into the training of the required local team of experts to man these services. This article reviews what has gone on in the last 70 years from the pure case-report and postmortem reports era to the era of locally available modern facilities including haemodialysis, peritoneal dialysis and kidney transplantation.

1992

K, DRKAYIMAJOSHUA.  1992.  Kayima J.K., Otieno L.S., Gitau W., Mwai S. Thyroid hormone profiles in patients with chronic renal failure on conservative management and regular haemodialysis East African Medical Journal, 69(6): 333-336; 1992. East African Medical Journal, 69(6): 333-336; 1992. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Patients with chronic non-thyroid illness (NTI) generally show biochemical features of hypothyroidism despite their being clinically euthyroid. Using assays that employ the antibody coated tubes technique, we measured thyroid hormone levels in 52 patients with chronic renal failure. 30 of the patients were on conservative management while 22 were on regular haemodialysis (HD) for a mean period of 14.2 +/- 9.9 months. The findings were compared to those of 14 healthy controls. All patients were clinically euthyroid. Only 3 patients on HD had goitres. The mean value of total thyroxine (TT4) total triiodo thyronine (TT3), free thyroxine (FT4) and the free triiodothyronine (FT3) were low in patients compared with controls (P less than 0.01). The mean basal thyroid stimulating hormone (TSH) levels were significantly higher in patients than in controls (P less than 0.001). There were no significant differences in all parameters between the patients on conservative management and those on haemodialysis (P greater than 0.05). Although all patients were clinically euthyroid, the biochemical features suggest hypothyroidism.

1991

O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1991.  Ngugi P.N., McLigeyo S.O., Kayima J.K., Otieno L.S., Mogere R. Vascular access for Haemodialysis. East African Medical Journal, 68(6): 442-447; 1991.. East African Medical Journal, 68(6): 442-447; 1991. : East African Medical Journal.71(4): 253-5; 1994. Abstract
In a fifteen month period (August 1987 to November 1988) forty patients requiring haemodialysis had 83 angioaccess procedures performed. Arteriovenous (AV) shunts and arteriovenous fistulae were the commonest procedures, comprising 56 (67%) and 20 (24%) of the patients respectively. Subclavian catheters and artificial grafts were used less frequently. Nephrologists and senior house officers attached to the Renal Unit were responsible for fashioning A-V shunts and inserting subclavian catheters while the A-V fistulae were fashioned by the urologists and vascular surgeons. The commonest complication of A-V shunts were clotting, occurring in 31 (55.4%) followed by bleeding in 14 (25%). Eight (32%) of the A-V fistulae never functioned from the beginning. It is noted that we are still very dependent on A-V shunts for vascular access in end stage renal disease (ESRF) patients and this is associated with an unacceptable level of complications. This dependency on A-V shunts in ESRD patients should be stopped or phased out. A-V fistulae should be used more frequently. Their constructions should be well thought out, executed and supervised by the few surgeons who are versed in them together with their follow-ups.

1990

K, DRKAYIMAJOSHUA.  1990.  Kayima J.K, Otieno L.S, McLigeyo S.O, Kyobe J. Platelet function in nephrotic syndrome patients at the Kenyatta National Hospital. East Afr Med J. 1990 Feb;67(2):109-12.. East African Medical Journal, 67(6): 387-395; 1990. : East African Medical Journal.71(4): 253-5; 1994. Abstract
Platelet function was assessed in 40 patients with nephrotic syndrome but without renal failure in order to establish whether or not there is any haemostatic disorder lending to hypercoagulable state. The findings were compared with those from 40 normal controls. There was no clinical evidence of thromboembolic phenomena in the patients. Values for the mean platelet counts and clot retraction were similar (P less than 0.05), whereas significant decrease of platelet adhesiveness (P less than 0.001) as well as prolonged platelet aggregation time (P less than 0.001) were noted. This is different from some reports in literature which have frequently reported enhanced platelet function. There may be a difference in the way platelets metabolise arachidonic acid to potent aggregating agents, in the African patients as compared to patients studied elsewhere. The hypercoagulable state in our nephrotic syndrome may be explained by alterations in other haemostatic parameters rather than in platelet function.
O, PROFMCLIGEYOSETH, K DRKAYIMAJOSHUA.  1990.  Otieno L.S., McLigeyo S.O., Kayima J.K., and Sitati S. Management of lupus nephritis at the Kenyatta National Hospital East African Medical Journal, 67(6): 387-395; 1990. East African Medical Journal, 67(6): 387-395; 1990. : East African Medical Journal.71(4): 253-5; 1994. Abstract
In 7 years (1981-1988) at the Kenyatta National Hospital (KNH), Nairobi the diagnosis of systemic lupus erythematosus (SLE) was made in 67 patients. In 23 of these patients lupus nephritis complicated the SLE. Lupus nephritis was diagnosed through renal biopsy, haematuria and proteinuria in urine with positive lupus erythematosus (LE) cell phenomenon. The histology found in these patients included 5 patients with minimal lesion, 7 patients with membranous, 3 with focal, 4 with diffuse, 3 with crescenteric and one with membranoproliferative glomerulonephritis. While patients with minimal, membranous and focal nephritis had general good outlook on low dose maintenance or intermittent high dose steroid therapy the others with diffuse, crescenteric and membranoproliferative nephritis had poor prognosis. Patients with diffuse proliferative, membranoproliferative and crescenteric nephritis tended to have septicaemia, pulmonary oedema, fluid overload and chronic renal failure with poor prognosis. These patients responded poorly to oral and parenteral steroid therapy whether high or low dose.

1981

Dr Kayima, JK.  1981.  Platelet functions, plasma fibrinolytic activity And coagulation screen findings in africans with nephrotic syndrome without uraemia, as seen at the kenyatta national hospital (kne. Abstract

In a nine months period,from March 1987 to November

1987, inc1usiv€, studies on p1ac21et functions, pla$ma fibrinolytic activity and coagulation screen were carried out in 40 patients (30 males and 10 females) with the nephrotic syndrome and 40 matches controls at the Kenyatta
National Hospital. The age range was S-Sl years, mean + SD

20.5+11.6.

patients had unchanged platelet counts and clot retraction compared to controls (p>O.OS), whereas platelet adhesiveness and platelet agg~egation to adenosine diphosphate U",DP) were significantly reduced among patients (P0.05) as well as between plasma fibrinogen concentration and total cholesterol (r=0.25, P>0.05).
It is concluded that our patients have a degree of hype-rcoagulability. Whether the factors for and against hypercoagulabiJ .ity compensate f cr each other in the causation of complications need to be verified. A larger populatibn and more detailed haemostatic study will in future be needed to cover more nephrotic patients in different areas of the country. It is also necessary to folIo w up ou r pat ient s f or complicat ions resul ting from
this hypercoagulable state, like thromboembolic events and

is.c!haemic heart diseas.e to find ou.t.. their pre...lence .

and

contr.ibutionto morbidity and mortality among Africans with

nephrotic syndrome.

UoN Websites Search