Publications

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2014
P.L. P, G. M, M. W, J. O’ech, P. M. "The Cerebro-Placental ratio as a prognostic factor of foetal outcome in patients with third trimester hypertension." East and Central African Journal of Surgery . 2014;19(1):41-51.Website
2013
Abuya JM, Wambugu MN. "An Analysis of the Pattern of Findings on the Mediastinum in the Computerised Tomography Chest in Kenya." International Journal of Advanced Research (2013). 2013;1(3):11-19. Abstract

The purpose of this paper is to assess the pattern of findings in the Mediastinum in Computersied Tomography chest based on a study of major hospitals in Kenya. CT Scan chest was performed in patients suspected to have pathologies in the chest mediastinum. This was a one year prospective study done in four major radiological centres in Nairobi, namely Kenyatta National Hospital (KNH), the Nairobi Hospital, Medical Imaging and Therapeutic Centre (MITC) and the Aga Khan Hospital, Nairobi. It was carried out on diverse dates from May 1st 1999 to April 30th 2000. There were a total of 101 patients studied out of 376 done CT chest in these four centres. Out of these, 28 were from KNH, Nairobi Hospital 27, MITC 40, and Aga Khan 6 patients. The overall male: female ratio was 2.48:1 with an age range of 2 months to 80 years. Most patients were over 60 years (35.64%) and the commonest clinical presentation was chest pain (21.19%). The major finding was lymph node enlargement. In all patients, a chest radiograph had been done and the commonest finding was a widened mediastinum (34.11%). Majority of the patients referred for CT Scan (23.76%), the clinicians did not give a specific clinical diagnosis. CT scan was able to delineate these masses and give a near exact diagnosis in the majority of these cases. CT scan showed most of the masses in the middle mediastinum (51.49%) and these were mainly lymph node enlargement. Most of the mediastinal masses (53.47%) were benign. The study recommends that CT Scan chest should be done routinely in suspected chest mediastinal pathologies. The study contributes important knowledge to studies of the pathologies in the Mediastinum.

MN W, GN M, LP P, JO O'ech. "The Umbilical Artery Resistive Index and the Cerebro-Placental Ratio as a Predictor of Adverse Foetal Outcome in Patients with Hypertensive Disorders of Pregnancy during Third Trimester." East and Central African Journal of Surgery. 2013;18(3):94-97. AbstractWebsite

Background: Hypertensive disorders of pregnancy causes adverse effects both the maternal and faetal circulations. These circulations can be assessed safely and non-invasively by Doppler `ultrasound using arterial Doppler indices of umbilical artery alone or combining the umbilical
artery with the middle cerebral artery thus attaining the cerebroplacental ratio (ratio of the middle cerebral artery resistive index over that of the umbilical artery). The main objective of this study was to compare the Umbilical Artery Resistive index alone and the cerebroplacental ratio as a predictor of adverse fetal outcome in patients with hypertensive disorders of pregnancy in third trimester.
Methods: A prospective cohort study was carried out at the Kenyatta National Hospital (KNH) over a period of nine months. Gravid patients at least 32 weeks gestations by dates were recruited from labor ward. Consecutive sampling method was used. The Umbilical Artery Resistive Index was obtained and the cerebroplacental ratio was also calculated from the Umbilical Artery Resistive Index and Middle Cerebral Artery Resistive index.
Results: A total of 160 patients were recruited into the study. Among neonates of mothers with pregnancy induced hypertension with Umbilical Artery Resistive Index median (0.64), a fetal birth score < 7 was 0.5 (95% CI 0.3, 0.8; p <0.001) times more likely than a score > 7 and 6.6 (Odds Ratio 6.6; 95% CI 2.5, 17.3; p <0.001) times more likely relative to hypertensive mothers with Umbilical Artery Resistive Index > median (0.64). Combining Umbilical Artery Resistive Index and Middle Cerebral Artery Resistive Index (cerebroplacental ratio) improves the prognostic odds ratio from 6.6 to 82. The Umbilical Artery Resistive Index (/> median) had 80% (95% CI 63%, 90%) sensitivity, 62.3% (95% CI 54%, 70%) specificity, 33% positive predictive value, and 93.1% negative predictive value for neonatal adaption after birth as seen from the foetal birth score. Among infants of mothers with hypertensive disorder during pregnancy with Umbilical Artery Resistive Index median (0.64), low birth weight (<10th percentile of expected weight at gestation week) was 0.5 (95% CI 1.9, 7.3) times more likely than normal weight and 9.5 (Odds Ratio 9.5; 95% CI 3.1, 29.2; p<0.001) times more likely relative to infants of hypertensive mothers with Umbilical Artery Resistive Index > median (0.64). Combining Umbilical Artery Resistive Index and Middle Cerebral Artery Resistive Index (cerebroplacental ratio) does not improve the prognostic odds ratio. The Odds Ratio drops from 9.5 to5.6. This implies the Umbilical Artery Resistive Index is a better predictor of low birth weight. The Umbilical Artery Resistive Index (/> median) had 85.2% (95% CI 67.5%, 94%) sensitivity, 62.4% (95% CI 54%, 70%) specificity, 31.5% positive predictive value, and 95.4% negative predictive value for abnormal birth weight.
Conclusion • The Cerebroplacental ratio is a better predictor of faetal birth score < 7 as compared to Umbilical Artery Resistive Index.
• The Umbilical Artery Resistive Index is a better predictor of low birth weight as opposed to cerebroplacental ratio.
• Both cerebroplacental ratio and Umbilical Artery Resistive Index can be used in combination to get the best results on faetal birth score and foetal weight.

2012
Mwango GN, Salim SI, Wambugu MN, Aywak AA. "Role of abdominal ultrasound in evaluation of children with suspected upper gastrointestinal disease. ." EAMJ. 2012;89(6). Abstract

Objectives: To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and show the gastrointestinal disease patterns that can be evaluated by ultrasound.
Design: A descriptive prospective study.
Setting: Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi.
Subjects: Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of 1 year 5 months. Seventy-seven percent were two years and below.
Study duration: Six months.
Results: Of the 56 children, six were normal on sonography; 18 (32.1%) had intussusceptions, 16(28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejuno-ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male:female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with blood-stained stool. More than 2/3 of the children with gastroesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusceptions, jejuno-ileal atresia and enteric duplication cysts.
Conclusion: Transabdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionizing radiation. Findings in this study confirm that ultrasound is an accurate, reliable, and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.

2002
N DRWAMBUGUMILCAH. "Evaluation of Acute Pelvic/Lower abdominal pain in Women - Nairobi Journal of Medicine March 2002.". In: Nairobi Journal of Medicine March 2002. University of Nairobi.; 2002. Abstract

Operations Research techniques involving modelling a situation or a problem and finding an optimal solution for it. These tools are not designed nor intended to replace managerial decision making, but rather their purpose is to aid in the decision-making process by providing a quantitative basis for decision making. Unfortunately, the proliferation of OR tools in organizational decision making has been lacking, with concerns been expressed about the limited awareness of the business community of OR's potential and capability. Current study was based in the premise that students provide an appropriate avenue, as agent of change, in sensitizing and demonstrating the potential and capacity of OR tools/techniques in resolving various problems, both in public and private sector. Study aimed at evaluating the use of OR as tools of data analysis at MBA level. A sample of 100 MBA research projects undertaken between 2005 and 2007 was randomly selected and their objectives and selected data analysis tools recorded. Where OR tools were not used, the research evaluated if there was a possibility of using OR tools. Results indicated low usage of OR as data analysis, though there was a high potential for the use of OR tools.

1989
N DRWAMBUGUMILCAH. "Okoth FA, Ogutu EO, Lule GN, Wambugu MN. Some Aspects of Obstructive Jaundice at Kenyatta National Hospital (co author) East Afr Med J. 1989 Sep;66(9):594-7.". In: East Afr Med J. 1989 Sep;66(9):594-7. University of Nairobi.; 1989. Abstract
A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).
1988
N DRWAMBUGUMILCAH. "Lule GN, Ogutu EO, Okoth F, Were JB, Wambugu M. Sclerotherapy in the treatment of bleeding oesophageal varices: preliminary report. East Afr Med J. 1988 Jun;65(6):416-20. Review.". In: East Afr Med J. 1988 Jun;65(6):416-20. Review. University of Nairobi.; 1988. Abstract
A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).
N DRWAMBUGUMILCAH, M. PROFTOLEN. "Radiation protection and the unborn child. East Afr Med J. 1988 Nov;65(11):778-84.". In: East Afr Med J. 1988 Nov;65(11):778-84. University of Nairobi.; 1988. Abstract
A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).
1983
N DRWAMBUGUMILCAH. "The Ten Day Rule and its implementation at the Kenyatta National Hospital Dissertation for the award of the degree of Masters of Medicine University of Nairobi, 1983.". In: Dissertation for the award of the degree of Masters of Medicine University of Nairobi, 1983. University of Nairobi.; 1983. Abstract
A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).

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