This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

Kent papers in POlitics and International Relations, Series 4, No. 4.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Kent papers in POlitics and International Relations, Series 4, No. 4.

Residue levels of the chlorinated hydrocarbons p,p'-DDT (2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane), p,p'-DDE (2,2-bis(p-chlorophenyl)-1,1-dichloroethane), hexachlorobenzene (HCB), alpha-, beta-, and gamma-hexachlorocyclohexane (HCH), aldrin, dieldrin, and polychlorinated biphenyls (PCBs) were determined in human milk of Kenyan mothers living in different areas of Kenya. The main organochlorine contaminants found in all the milk samples analyzed were p,p'-DDT and p,p'-DDE. Great regional differences were found, and mean levels of sum DDT and DDT/DDE ratio ranged from 1.1 to 18.7 mg/kg milk fat and from 0.7 to 5.7, respectively. In general, relatively low residue levels of HCB, alpha-HCH, beta-HCH, aldrin, and dieldrin were detected in 59, 37, 27, 37, and 19%, respectively, of all the milk samples analyzed. Quantifiable residue levels of PCBs and alpha-HCH were not found. The results were examined in relation to differences in living conditions with regard to agricultural activities, dietary habits, and reported use of pesticides in the various sampling areas.

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.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

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

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Sera from various wildlife ruminants coexisting in the same habitat with cattle had hemagglutiation-inhibition antibodies as high as those in cattle.  Sera from wildebeest, Kongoni, Thomson's gazelle, eland and African buffalo had titres ranging from 64 to 128.  Zebra, Bushbuck, Warthog and Oryx were negative to the H I test.  It was suggested that some of the wild ruminants with high titres could be possible reservoirs of para-influenza 3 virus.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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

While Diagnostic Radiology has become increasingly indispensible in sound clinical patient management the cost and maintenance of radiological equipment has continued to soar, reaching almost unaffordable levels in developing countries. As an attempt to provide some measure of remedy to the above problem, the World Health Organization in the early 80's introduced the basic radiological system (BRS) concept. The BRS is supposed to meet such criteria as being relatively cheap, of low maintenance cost easy operability and suitable in rural areas where electrical power supply may not be constant. In addition it should be able to perform 80% of all conventional radiological examinations. In this paper the author gives a critical account of the BRS experience in Kenya. Proposals for possible future considerations and modifications in order to achieve near ideal BRS X-ray machine are also advanced.

Effects of calcium supplementation in patient at risk of pregnancy induced Hypertension. (This was an experimental double blind randomized clinical trial.) J. Obset. Gynaecol. East Cent.Afr 2005, 18:49-59

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

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{ The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size kappa (kappa n). We assessed the sensitivity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.

A study was conducted in sixty-two randomly selected herds in Kikuyu division, Kiambu District in Central Kenyan Highlands to obtain prevalence, spectrum and intensity of gastrointestinal helminths in pigs kept by smallholder farmers. Faecal samples from a total of 598 pigs of various age-group categories (piglets, weaners, growers and adults) were taken during a period of a 4 months in 1999 ad examined for helminthes eggs (EPG) using modified McMaster technique. Gastrintestinal helminth eggs wewre observed in 57 (91.9%) of the herds. The Helminths observed were Strongles (35.1%). Ascarids (10%), Trichuris (4), Strongloids (3.2%) and Tapeworms (0.3%). The overall prevalence of the helminaths was 43.5%. the prevalence among the various age groups differed significantly (p<0.01) with the highest prevalence in the weaners (55.6%) and the lowest in the piglets (22.9%). The prevalence of Strongles and Strongloids differed significantly (p<0.01) among the age groups. The highest prevalence for Strongyles was in the growers (41.7%) and the lowest in the piglets (22.9%) while the highest prevalence for lowest in the adults (0.8%). The prevalence of Ascarids differed significantly (p<0.01) among the age groups with the highest prevalence in weaners (27.8%) and the lowest in the piglets (3.6%). The prevalence of Trichuris worms was significantly (p<0.5) higher in the weaners than in the piglets. The high prevalence of the Gatrointestinal helmnths observed indicates the need to control these parasites due to their detrimental effects on productivity and also due to their public health significance.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

The short-term farm level economic impact of Foot and Mouth Disease outbreak in a large-scale dairy scale dairy farm was assessed during the quarantine period (35 days) and 60 days after lifting of the quarantine. Direct and indirect areas that contributed to the financial losses were identified for the period of observation (85 days). The greatest direct financial impact was due to milk losses (42.0%) followed by purchase pf additional feeds (13.65) and culling of milking cows that developed chronic mastitis (12.5%). The other direct costs were; extra labout inputs (8.9%), veterinary fees (3.350, transport (3.05), death (3.0%), drugs (2.9%), abortions (1.4%) and chemicals (0.5%). The indirect costs (9.4%) were associated with the effects of the quarantine period on other farm enterprises. During the quarantine period there were no sales of pigs and hay, and the retained additional feeds. The overall short-term farm level direct and indirect costs associated to US$16,026 (1US$=75ksh). This colossal economic loss within such a short period of time indicates that the control of FMD is of paramount economic importance in the diary farming sector in Kenya. The factors that would determine the magnitude of the financial losses due to an outbreak of FMD are discussed

BACKGROUND: Exfoliative erythroderma (EE), (Synonyms: Exfoliative dermatitis, Red man syndrome) is a clinical syndrome characterised by generalised erythema and scale. It is an important cause of functional skin failure and associated high morbidity and variable mortality rates. OBJECTIVES: To study demographics, aetiology, complications and clinical outcomes of exfoliative erythroderma (EE) on patients attending Kenyatta National Hospital (KNH). DESIGN: Cross- sectional descriptive study. SETTING: Kenyatta National Hospital, Dermatology Unit. SUBJECTS: All available medical records on inpatients seen by qualified dermatologists at KNH with generalised erythema and scale from 1996 to 2006. MAIN OUTCOME MEASURES: Discharge or death. RESULTS: Incidence exfoliative erythroderma was documented in 146 out of all 123 admissions (13%) into the dermatology unit from 1996-2006. Demographic mean age was 47 years, M: F ratio was 3:2, 67% had no income and 53% and 30% were residents of Nairobi and adjacent districts respectively. Sixty three percent were due to skin diseases, 23% due to systemic diseases of which 20% were due to HIV/AIDS and 14% due to adverse cutaneous drug reactions. Ninety percent of patients were treated and discharged and 10% died; 50% of whom had dermatoses and 29% due to HIV associated antituberculous drugs. CONCLUSIONS: Exfoliative erythroderma is an important cause of morbidity, admission and mortality in patients attending KNH. Dermatoses and HIV / AIDS were the most frequent causes. The mortality rate was relatively low and attributable to controllable diseases.

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

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

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Kent papers in POlitics and International Relations, Series 4, No. 4.

During a 4 year period (January 1983 to December 1986), 418 requests for drug analysis were received in the Drug Analysis and Research Unit, Department of Pharmacy, University of Nairobi. Of these requests, 212 were from Medical Supplies Coordination Unit, 190 from Government hospitals and health research institutions, 11 from the Ministry of Health Headquarters (Director of Medical Services and Chief Pharmacist) and 5 came from local pharmaceutical manufacturers. Of the samples analysed, 70.8% were from local manufacturers, 26.1% were imported and 3.1% were from undeclared sources. Failure to comply with test for quality, as set out in official compendia (B.P. Eur. ph. Ip, etc.) were observed at 45.8% for locally manufactured drugs and 31.4% for imported drug products.

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.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

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.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

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

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

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{ The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size kappa (kappa n). We assessed the sensitivity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.

This case report describes an outbreak of acute dermatophilosis in a large scale dairy herd and highlights that the disease in Kenya could occur in outbreak proportions and in clinically severe form as has been reported in other countries in West and central Africa.We believe that this is the 1st documented outbreak of a severe form of bovine cutaneous dermatophilosis in exotic dairy animals in Kenya.

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Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

A study was conducted in sixty-two randomly selected herds in Kikuyu division, Kiambu District in Central Kenyan Highlands to obtain prevalence, spectrum and intensity of gastrointestinal helminths in pigs kept by smallholder farmers. Faecal samples from a total of 598 pigs of various age-group categories (piglets, weaners, growers and adults) were taken during a period of a 4 months in 1999 ad examined for helminthes eggs (EPG) using modified McMaster technique. Gastrintestinal helminth eggs wewre observed in 57 (91.9%) of the herds. The Helminths observed were Strongles (35.1%). Ascarids (10%), Trichuris (4), Strongloids (3.2%) and Tapeworms (0.3%). The overall prevalence of the helminaths was 43.5%. the prevalence among the various age groups differed significantly (p<0.01) with the highest prevalence in the weaners (55.6%) and the lowest in the piglets (22.9%). The prevalence of Strongles and Strongloids differed significantly (p<0.01) among the age groups. The highest prevalence for Strongyles was in the growers (41.7%) and the lowest in the piglets (22.9%) while the highest prevalence for lowest in the adults (0.8%). The prevalence of Ascarids differed significantly (p<0.01) among the age groups with the highest prevalence in weaners (27.8%) and the lowest in the piglets (3.6%). The prevalence of Trichuris worms was significantly (p<0.5) higher in the weaners than in the piglets. The high prevalence of the Gatrointestinal helmnths observed indicates the need to control these parasites due to their detrimental effects on productivity and also due to their public health significance.

A study was conducted in fourty randomly selected herds in a peri-urban area in the Central Kenyan highlands to obtain prevalence estimates of sarcoptic mange in pigs kept by smallholder farmers. A total of 476 pigs of various age-group categories were enrolled in the study. Diagnosis was based on physical examination for clinical signs indicative of mange infestation and on direct detection of Sarcoptes scabiei mites. Ninety per cent of the herds had clinical signs suggestive of sarcoptic mange and in 70% of the herds Sarcoptes scabiei var suis was positively identified. The results also indicated that 273 (57.3%) of the 476 pigs had clinical signs indicative of sarcoptic mange and 90 (18.9%) of the 476 pigs were positive for Sarcoptes scabiei var suis. The hypersensitive form of mange was more common than the chronic form. The direct examination technique to detect Sarcoptes scabiei var suis was more effective in weaners than in the other age categories of pigs. The results indicate that sarcoptic mange is a common problem in smallholder pig herds in Kikuyu Division of Kiambu District, Kenya.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

The present studies were designed and carried out to determine if hydrogen peroxide (H2O2) is involved in the regulation of erythropoietin (Epo) gene expression and stimulation of Epo production in the hepatocellular (Hep 3B) cells. Hep 3B cells were incubated with varying concentrations of H2O2 for periods of 6 hours or 24 hours. In other experiments Hep 3B cells were incubated for 24 hours with or without increasing concentrations of catalase and in the presence of H2O2. Culture medium levels of Epo were determined and quantitation of Epo mRNA was also made. The results indicate that H2O2 increases the levels of Epo mRNA and Epo hormone production in Hep 3B cells, and that catalase, the specific scavenger of hydrogen peroxide, inhibits Epo production in these cells. Based on these findings, it is concluded that H2O2 takes part in the signal transduction mechanisms in Epo production. It is recommended that further studies be undertaken to find out the source of the hydrogen peroxide in the hepatocellular carcinoma cells.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Kent papers in POlitics and International Relations, Series 4, No. 4.

Contents of tetracycline, its degradation products (epitetracycline, epianhydrotetracycline, anhydrotetracycline) and a fermentation impurity (2-acetyl-2-decarboxamidotetracycline) were determined in four raw materials, 12 batches of six ointment products, four eye ointment products and nine batches of five capsule products, all sampled from the Kenyan market. The analytical method was liquid chromatography on a column packed with a poly(styrenedivinyl-benzene) material (8-microns PLRP-S 100 A). All raw materials and finished products had tetracycline contents and impurity levels within the prescribed compendial limits.

Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Cathinone, a potent psychostimulant isolated from young shoots of Catha edulis was given to four human volunteers. Examination of urine collected from the volunteers at predetermined intervals showed the presence of unchanged cathinone, d-norpseudoephedrine, and two unidentified basic substances. The observed biotransformation of cathinone to the less potent psychostimulant, d-norpseudoephedrine involves reduction of a ketone group to alcohol, a common metabolic pathway in humans.

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.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

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

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

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OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.

A study to evaluate alternative health interventions for the control of sarcoptic mange and gastro-intestinal nematodes in smallholder pig herds was carried out in Kikuyu Division of Kiambu District, Kenya. A total of 40 herds were randomly allocated, by a simple random strategy, to 3 treatment groups and 1 control group. Each group comprised of 10 herds. Herds in group 1 (control) were treated with a placebo, physiological saline. In group 2, control of nematodes and mange was attempted through the use of ivermectin, while in group 3, nematodes and mange were treated through the use of an anthelmintic (piperazine hydrochloride) and an acaricide (amitraz), respectively. In group 4, nematodes and mange were treated by using an anthelmintic (levamisole hydrochloride) and an acaricide (amitraz), respectively. The anthelmintic activity of ivermectin was not different (p>0.05) from that of levamisole. The proportion of pigs positive for mites was not different (p>0.05) between the ivermectin and the amitraz treatment groups. The overall costs for the treatments were US$0.50 for the ivermectin treatment, US$0.31 for the piperazine/amitraz combination treatment and US$0.26 for the levamisole/amitraz combination treatment. Amitraz/levamisole drug combination was the most cost-effective against sarcoptic mange and gastro-intestinal nematodes of pigs in the studied smallholder herds.

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Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body`s immune system increasing a patient`s risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting   that these extracts may be useful as   adjuvants to conventional cancer therapies.   Key words: carcinogenesis; mice; mushroom extracts; pleurotus pulmunarius   Corresponding author: Ms Carolyne Wasonga, Department of Biochemistry, University of Nairobi, P.O. Box 30197, Nairobi,  Kenya. E-mail: carox27@yahoo.ca     Charles O.A. Omwandho, Susanne E. Gruessner, John Falconer, Hans-R Tinneberg, Timothy K. Roberts. IS OVINE PLACENTAL IGG TOXIC TO HUMAN PERIPHERAL BLOOD NATURAL KILLER CELLS?

A study was conducted in fourty randomly selected herds in a peri-urban area in the Central Kenyan highlands to obtain prevalence estimates of sarcoptic mange in pigs kept by smallholder farmers. A total of 476 pigs of various age-group categories were enrolled in the study. Diagnosis was based on physical examination for clinical signs indicative of mange infestation and on direct detection of Sarcoptes scabiei mites. Ninety per cent of the herds had clinical signs suggestive of sarcoptic mange and in 70% of the herds Sarcoptes scabiei var suis was positively identified. The results also indicated that 273 (57.3%) of the 476 pigs had clinical signs indicative of sarcoptic mange and 90 (18.9%) of the 476 pigs were positive for Sarcoptes scabiei var suis. The hypersensitive form of mange was more common than the chronic form. The direct examination technique to detect Sarcoptes scabiei var suis was more effective in weaners than in the other age categories of pigs. The results indicate that sarcoptic mange is a common problem in smallholder pig herds in Kikuyu Division of Kiambu District, Kenya.

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

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

The present studies were designed and carried out to determine if hydrogen peroxide (H2O2) is involved in the regulation of erythropoietin (Epo) gene expression and stimulation of Epo production in the hepatocellular (Hep 3B) cells. Hep 3B cells were incubated with varying concentrations of H2O2 for periods of 6 hours or 24 hours. In other experiments Hep 3B cells were incubated for 24 hours with or without increasing concentrations of catalase and in the presence of H2O2. Culture medium levels of Epo were determined and quantitation of Epo mRNA was also made. The results indicate that H2O2 increases the levels of Epo mRNA and Epo hormone production in Hep 3B cells, and that catalase, the specific scavenger of hydrogen peroxide, inhibits Epo production in these cells. Based on these findings, it is concluded that H2O2 takes part in the signal transduction mechanisms in Epo production. It is recommended that further studies be undertaken to find out the source of the hydrogen peroxide in the hepatocellular carcinoma cells.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Kent papers in POlitics and International Relations, Series 4, No. 4.

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.

Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Cathinone, a potent psychostimulant isolated from young shoots of Catha edulis was given to four human volunteers. Examination of urine collected from the volunteers at predetermined intervals showed the presence of unchanged cathinone, d-norpseudoephedrine, and two unidentified basic substances. The observed biotransformation of cathinone to the less potent psychostimulant, d-norpseudoephedrine involves reduction of a ketone group to alcohol, a common metabolic pathway in humans.

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.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

will be availed soon

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

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

Gluteus Maximus Muscle: Implication in Prosthetic Hip Dislocation
Awori K.O. MBChB, MMed (Surgery), Dip. (SICOT), FCS (Orth) ECSA, Anne N. Pulei A.A. Bsc, MBChB, Gikenye G. MBChB, MMed,FCS(ECSA) Affiliation: Department of Human Anatomy, University of Nairobi, P.O. Box 30197 00100 Nairobi, Kenya. Correspondingauthor: KirsteenO.Awori,Tel.254-722812499,Email: karsto2005@yahoo.com
Abstract
Background: Dislocation is one of the most common complications after total hip arthroplasty. The posterolateral approach avoids disruption of the abductor mechanism but may denervate gluteus maximus as a basis for associated higher dislocation rates.
Objective: To determine the pattern of innervation of gluteus maximus Study design: Descriptive cross-sectional study
Materials and methods: Twenty four cadavers for routine dissection in the Department of Human Anatomy, University of Nairobi were used. Having exposed the gluteus maximus, the muscle was transected close to its distal attachment and reflected superiorly to expose the entry of the neurovascular structures into it from the greater sciatic foramen. The pattern of distribution of the inferior gluteal nerve to the muscle was
Introduction
Gluteus maximus (GM) is a powerful hip extensor inner- vated by the inferior gluteal nerve (IFN) and an impor- tant muscle in rising up from squatting position, climb- ing (1) and running (2). Its functions during running are to control flexion of the trunk on the stance-side (3) and to decelerate the swing leg. Low levels of GM activity may contribute to hip extension during stance, and to re- strain hip flexion during swing. During loading response of the gait cycle, in the frontal plane, activity in the up- per portions of the gluteus maximus, hip abductors and tensor fascia lata control drop of the contralateral pelvis, which is relative hip adduction (4).
Risk factors in prosthetic hip dislocation include patient- related ones such as neuromuscular disease (5) and sur- gical ones. Of the surgically-related factors, the approach has generated a lot of controversy. In the Moore posteri- or approach to the hip the incision starts 10 centimetres from the posterior superior iliac spine, is directed later- ally and distally to the back of the greater trochanter and extends for 10 or more centimetres, parallel to the shaft of the femur. The deep fascia is exposed and the iliotibial band is incised from the trochanter to the distal end of
noted and the left and right in the same cadaver compared
Results: In all the 48 cadaver sides, the inferior gluteal nerve exited
the pelvis via the infra-piriformic compartment of the greater sciatic foramen. In majority (43, 89.6%) of gluteal regions this nerve funned out in multiple equal branches to the GM. Only one branch crossed the upper border of piriformis muscle. In 5 cases, this single branch that crossed the upper border of piriformis was a major trunk almost equal in size to the parent nerve. One such case was bilateral.
Conclusion: A major branch of the inferior gluteal nerve to the upper part of GM, when present, could be injured in the posterior approaches to the hip to significantly weaken the upper part of this muscle increasing the risk of prosthetic hip dislocation.

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

Effects of calcium supplementation in patient at risk of pregnancy induced Hypertension. (This was an experimental double blind randomized clinical trial.) J. Obset. Gynaecol. East Cent.Afr 2005, 18:49-59

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A case of primary intracerebral haemorrhage complicated by cerebral abscess is presented with a review of the literature.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body`s immune system increasing a patient`s risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting   that these extracts may be useful as   adjuvants to conventional cancer therapies.   Key words: carcinogenesis; mice; mushroom extracts; pleurotus pulmunarius   Corresponding author: Ms Carolyne Wasonga, Department of Biochemistry, University of Nairobi, P.O. Box 30197, Nairobi,  Kenya. E-mail: carox27@yahoo.ca     Charles O.A. Omwandho, Susanne E. Gruessner, John Falconer, Hans-R Tinneberg, Timothy K. Roberts. IS OVINE PLACENTAL IGG TOXIC TO HUMAN PERIPHERAL BLOOD NATURAL KILLER CELLS?

A longitudinal study was carried out in Kikuyu Division (a peri-urban area in central Kenyan highlands) between January 1999 and December 1999 to estimate the baseline parameters on reproductive performance of the sow, as well as health and productivity of grower and preweaning pigs of smallholder herds. Data were collected on 155 breeding pigs, 795 grower pigs and 801 preweaning piglets in 74, 50 and 40 smallholder herds, respectively, using record cards that were updated during monthly visits. The sow-level medians were: weaning-to-service interval 3 months; interfarrowing interval 6.4 months; number of live-born piglets 9.0; and number of piglets weaned per litter 7.5. The piglet crude morbidity incidence risk was 29%. The cause-specific incidence risks for the important health problems encountered in preweaned piglets were diarrhea (4.3%), pruritus (17.1%), and skin necrosis (4.2%). The estimated crude mortality incidence risk to 8 weeks of age was 18.7%. The cause-specific mortality incidence risks to 8 weeks of age for the important causes of mortality were overlying (9.9%), savaging (2.4%), unviable piglets (2.0%) and unknown (1.9%). Overall, 78.8% of the total live-born piglet mortality occurred during the first week postpartum with 69% of these deaths being caused by overlying. The grower-pig crude morbidity incidence risk was 20% and the cause-specific incidence risks of the important health problems encountered were gut edema (1.3%), pruritus (21.1%), and unknown (2.3%). The crude mortality incidence risk was 3.8% and the important causes were gut edema and unknown causes (cause-specific mortality incidence risks of 1.3 and 1.6%, respectively). The median weight:age ratio and average daily weight gain for the grower pigs were 5.1 kg/month of age and 0.13 kg/day, respectively. For preweaning pigs, the median average daily weight gain was 0.13 g/day.

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

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Kent papers in POlitics and International Relations, Series 4, No. 4.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Residue levels of the chlorinated hydrocarbons p,p'-DDT (2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane), p,p'-DDE (2,2-bis(p-chlorophenyl)-1,1-dichloroethane), hexachlorobenzene (HCB), alpha-, beta-, and gamma-hexachlorocyclohexane (HCH), aldrin, dieldrin, and polychlorinated biphenyls (PCBs) were determined in human milk of Kenyan mothers living in different areas of Kenya. The main organochlorine contaminants found in all the milk samples analyzed were p,p'-DDT and p,p'-DDE. Great regional differences were found, and mean levels of sum DDT and DDT/DDE ratio ranged from 1.1 to 18.7 mg/kg milk fat and from 0.7 to 5.7, respectively. In general, relatively low residue levels of HCB, alpha-HCH, beta-HCH, aldrin, and dieldrin were detected in 59, 37, 27, 37, and 19%, respectively, of all the milk samples analyzed. Quantifiable residue levels of PCBs and alpha-HCH were not found. The results were examined in relation to differences in living conditions with regard to agricultural activities, dietary habits, and reported use of pesticides in the various sampling areas.

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.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

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

Cathinone, a potent psychostimulant isolated from young shoots of Catha edulis was given to four human volunteers. Examination of urine collected from the volunteers at predetermined intervals showed the presence of unchanged cathinone, d-norpseudoephedrine, and two unidentified basic substances. The observed biotransformation of cathinone to the less potent psychostimulant, d-norpseudoephedrine involves reduction of a ketone group to alcohol, a common metabolic pathway in humans.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

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

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

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OBJECTIVE: In sub-Saharan Africa, many family planning programmes do not encourage advance provision of oral contraceptives to clients who must wait until menses to initiate pill use. Since some resistance to advance provision of pills is due to provider fears that the practice may be harmful, we conducted a study in Kenya in 1997 to compare pill-taking outcomes between 20 "advance provision" clients and 280 "standard" clients. DESIGN: Prospective observational study. SETTING: Six family planning clinics in Central and Western Kenya. SUBJECTS: Women presenting as new clients at MOH family planning clinics. INTERVENTIONS: Researchers used prospective tracking to compare indicators of pill-taking success between non-menstruating clients given pills to carry home for later use and menstruating clients who began pill use immediately. MAIN OUTCOME MEASURES: Pill-taking outcomes such as side effects, compliance, knowledge, satisfaction, and a continuation proxy. RESULTS: Among clients returning for re-supply, those receiving advance provision of pills did no worse than, and often had superior outcomes to, their counterparts who started taking pills immediately after the clinic visit. CONCLUSIONS: Advance provision of pills, already practiced worldwide, is safe and feasible. Explicit mention should be made of advance provision of pills in national family planning guidance documents and training curricula in Kenya and throughout sub-Saharan Africa.

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

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{ The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size kappa (kappa n). We assessed the sensitivity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body`s immune system increasing a patient`s risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting   that these extracts may be useful as   adjuvants to conventional cancer therapies.   Key words: carcinogenesis; mice; mushroom extracts; pleurotus pulmunarius   Corresponding author: Ms Carolyne Wasonga, Department of Biochemistry, University of Nairobi, P.O. Box 30197, Nairobi,  Kenya. E-mail: carox27@yahoo.ca     Charles O.A. Omwandho, Susanne E. Gruessner, John Falconer, Hans-R Tinneberg, Timothy K. Roberts. IS OVINE PLACENTAL IGG TOXIC TO HUMAN PERIPHERAL BLOOD NATURAL KILLER CELLS?

A longitudinal study was carried out in Kikuyu Division (a peri-urban area in central Kenyan highlands) between January 1999 and December 1999 to estimate the baseline parameters on reproductive performance of the sow, as well as health and productivity of grower and preweaning pigs of smallholder herds. Data were collected on 155 breeding pigs, 795 grower pigs and 801 preweaning piglets in 74, 50 and 40 smallholder herds, respectively, using record cards that were updated during monthly visits. The sow-level medians were: weaning-to-service interval 3 months; interfarrowing interval 6.4 months; number of live-born piglets 9.0; and number of piglets weaned per litter 7.5. The piglet crude morbidity incidence risk was 29%. The cause-specific incidence risks for the important health problems encountered in preweaned piglets were diarrhea (4.3%), pruritus (17.1%), and skin necrosis (4.2%). The estimated crude mortality incidence risk to 8 weeks of age was 18.7%. The cause-specific mortality incidence risks to 8 weeks of age for the important causes of mortality were overlying (9.9%), savaging (2.4%), unviable piglets (2.0%) and unknown (1.9%). Overall, 78.8% of the total live-born piglet mortality occurred during the first week postpartum with 69% of these deaths being caused by overlying. The grower-pig crude morbidity incidence risk was 20% and the cause-specific incidence risks of the important health problems encountered were gut edema (1.3%), pruritus (21.1%), and unknown (2.3%). The crude mortality incidence risk was 3.8% and the important causes were gut edema and unknown causes (cause-specific mortality incidence risks of 1.3 and 1.6%, respectively). The median weight:age ratio and average daily weight gain for the grower pigs were 5.1 kg/month of age and 0.13 kg/day, respectively. For preweaning pigs, the median average daily weight gain was 0.13 g/day.

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

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

The present studies were designed and carried out to determine if hydrogen peroxide (H2O2) is involved in the regulation of erythropoietin (Epo) gene expression and stimulation of Epo production in the hepatocellular (Hep 3B) cells. Hep 3B cells were incubated with varying concentrations of H2O2 for periods of 6 hours or 24 hours. In other experiments Hep 3B cells were incubated for 24 hours with or without increasing concentrations of catalase and in the presence of H2O2. Culture medium levels of Epo were determined and quantitation of Epo mRNA was also made. The results indicate that H2O2 increases the levels of Epo mRNA and Epo hormone production in Hep 3B cells, and that catalase, the specific scavenger of hydrogen peroxide, inhibits Epo production in these cells. Based on these findings, it is concluded that H2O2 takes part in the signal transduction mechanisms in Epo production. It is recommended that further studies be undertaken to find out the source of the hydrogen peroxide in the hepatocellular carcinoma cells.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

Kent papers in POlitics and International Relations, Series 4, No. 4.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Residue levels of the chlorinated hydrocarbons p,p'-DDT (2,2-bis(p-chlorophenyl)-1,1,1-trichloroethane), p,p'-DDE (2,2-bis(p-chlorophenyl)-1,1-dichloroethane), hexachlorobenzene (HCB), alpha-, beta-, and gamma-hexachlorocyclohexane (HCH), aldrin, dieldrin, and polychlorinated biphenyls (PCBs) were determined in human milk of Kenyan mothers living in different areas of Kenya. The main organochlorine contaminants found in all the milk samples analyzed were p,p'-DDT and p,p'-DDE. Great regional differences were found, and mean levels of sum DDT and DDT/DDE ratio ranged from 1.1 to 18.7 mg/kg milk fat and from 0.7 to 5.7, respectively. In general, relatively low residue levels of HCB, alpha-HCH, beta-HCH, aldrin, and dieldrin were detected in 59, 37, 27, 37, and 19%, respectively, of all the milk samples analyzed. Quantifiable residue levels of PCBs and alpha-HCH were not found. The results were examined in relation to differences in living conditions with regard to agricultural activities, dietary habits, and reported use of pesticides in the various sampling areas.

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.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

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

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Six Topi (Damaliscus korrigum) from the Masai Mara area of Kenya were examined.  All had lungworm nodules. The nodules were generalized in distribution among the lung lobes.  These nodules were essentially hepatized lung tissue with adult worms, larvae and eggs with marked cellular reaction accompanying the infection. The cell types were mostly lymphocytes, plasma cells, macrophages, giant cells and eosinophils. The worms were identified as protostrongylus africanus.

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

OBJECTIVE: To compare a topical quinolone antibiotic (ciprofloxacin) with a cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis media in children. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: A total of 427 children with chronic suppurative otitis media enrolled from 141 schools following screening of 39 841 schoolchildren in Kenya. Intervention Topical ciprofloxacin (n = 216) or boric acid in alcohol (n = 211); child-to-child treatment twice daily for 2 weeks. MAIN OUTCOME MEASURES: Resolution of discharge (at 2 weeks for primary outcome), healing of the tympanic membrane, and change in hearing threshold from baseline, all at 2 and 4 weeks. RESULTS: At 2 weeks, discharge was resolved in 123 of 207 (59%) children given ciprofloxacin, and in 65 of 204 (32%) given boric acid (relative risk 1.86; 95% CI 1.48-2.35; P < 0.0001). This effect was also significant at 4 weeks, and ciprofloxacin was associated with better hearing at both visits. No difference with respect to tympanic membrane healing was detected. There were significantly fewer adverse events of ear pain, irritation, and bleeding on mopping with ciprofloxacin than boric acid. CONCLUSIONS: Ciprofloxacin performed better than boric acid and alcohol for treating chronic suppurative otitis media in children in Kenya.

Effects of calcium supplementation in patient at risk of pregnancy induced Hypertension. (This was an experimental double blind randomized clinical trial.) J. Obset. Gynaecol. East Cent.Afr 2005, 18:49-59

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

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{ The Blantyre coma scale (BCS) is used to assess children with severe falciparum malaria, particularly as a criterion for cerebral malaria, but it has not been formally validated. We compared the BCS to the Adelaide coma scale (ACS), for Kenyan children with severe malaria. We examined the inter-observer agreement between 3 observers in the assessment of coma scales on 17 children by measuring the proportion of agreement (PA), disagreement rate (DR) and fixed sample size kappa (kappa n). We assessed the sensitivity and specificity of the scales in detecting events (seizures and hypoglycaemia) in 240 children during admission and the usefulness of the scales in predicting outcome. There was considerable disagreement between observers in the assessment of both scales (BCS: PA = 0.55

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.

A longitudinal study was carried out in Kikuyu Division (a peri-urban area in central Kenyan highlands) between January 1999 and December 1999 to estimate the baseline parameters on reproductive performance of the sow, as well as health and productivity of grower and preweaning pigs of smallholder herds. Data were collected on 155 breeding pigs, 795 grower pigs and 801 preweaning piglets in 74, 50 and 40 smallholder herds, respectively, using record cards that were updated during monthly visits. The sow-level medians were: weaning-to-service interval 3 months; interfarrowing interval 6.4 months; number of live-born piglets 9.0; and number of piglets weaned per litter 7.5. The piglet crude morbidity incidence risk was 29%. The cause-specific incidence risks for the important health problems encountered in preweaned piglets were diarrhea (4.3%), pruritus (17.1%), and skin necrosis (4.2%). The estimated crude mortality incidence risk to 8 weeks of age was 18.7%. The cause-specific mortality incidence risks to 8 weeks of age for the important causes of mortality were overlying (9.9%), savaging (2.4%), unviable piglets (2.0%) and unknown (1.9%). Overall, 78.8% of the total live-born piglet mortality occurred during the first week postpartum with 69% of these deaths being caused by overlying. The grower-pig crude morbidity incidence risk was 20% and the cause-specific incidence risks of the important health problems encountered were gut edema (1.3%), pruritus (21.1%), and unknown (2.3%). The crude mortality incidence risk was 3.8% and the important causes were gut edema and unknown causes (cause-specific mortality incidence risks of 1.3 and 1.6%, respectively). The median weight:age ratio and average daily weight gain for the grower pigs were 5.1 kg/month of age and 0.13 kg/day, respectively. For preweaning pigs, the median average daily weight gain was 0.13 g/day.

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

The short-term farm level economic impact of Foot and Mouth Disease outbreak in a large-scale dairy scale dairy farm was assessed during the quarantine period (35 days) and 60 days after lifting of the quarantine. Direct and indirect areas that contributed to the financial losses were identified for the period of observation (85 days). The greatest direct financial impact was due to milk losses (42.0%) followed by purchase pf additional feeds (13.65) and culling of milking cows that developed chronic mastitis (12.5%). The other direct costs were; extra labout inputs (8.9%), veterinary fees (3.350, transport (3.05), death (3.0%), drugs (2.9%), abortions (1.4%) and chemicals (0.5%). The indirect costs (9.4%) were associated with the effects of the quarantine period on other farm enterprises. During the quarantine period there were no sales of pigs and hay, and the retained additional feeds. The overall short-term farm level direct and indirect costs associated to US$16,026 (1US$=75ksh). This colossal economic loss within such a short period of time indicates that the control of FMD is of paramount economic importance in the diary farming sector in Kenya. The factors that would determine the magnitude of the financial losses due to an outbreak of FMD are discussed

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

Forty-two pigs in a herd of 117 displayed various clinical signs of progressive atrophic rhinitis. The main signs included sneezing, coughing, lachrymation, serous to mucopurulent nasal discharge, and nasal bleeding in 1 pig. Three pigs had lateral deviation of the snout, while 4 had brachygnathia superior with obvious deformation of the face. Four acutely affected weaner pigs appeared weak, while the 7 chronically-affected pigs appeared smaller than their apparently unaffected penmates of the same age. Treatment of the acutely affected pigs with long-acting oxytetracycline at 20 mg/kg body weight intramuscularly, repeated once after 7 days, reduced the severity but did not clear the sneezing from all the pigs. Fifteen pigs were slaughtered 2 months after the clinical diagnosis was made. The carcasses of the chronically affected pigs were about 15% lighter than those of the apparently normal pigs of the same age and from the same pen, which translated to a loss of 921.00 Kenya shillings per pig (US$13.7). Diagnosis of progressive atrophic rhinitis was confirmed by sectioning the snouts of randomly selected slaughtered pigs with obvious deformation of the snout. Sections were made at the level of the 1st/2nd upper premolar tooth. Varying degrees of turbinate atrophy, from mild to complete, were noted. Histopathology of the turbinates revealed metaplasia of nasal epithelium and fibrosis in the lamina propria.

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

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

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Kent papers in POlitics and International Relations, Series 4, No. 4.

During a 4 year period (January 1983 to December 1986), 418 requests for drug analysis were received in the Drug Analysis and Research Unit, Department of Pharmacy, University of Nairobi. Of these requests, 212 were from Medical Supplies Coordination Unit, 190 from Government hospitals and health research institutions, 11 from the Ministry of Health Headquarters (Director of Medical Services and Chief Pharmacist) and 5 came from local pharmaceutical manufacturers. Of the samples analysed, 70.8% were from local manufacturers, 26.1% were imported and 3.1% were from undeclared sources. Failure to comply with test for quality, as set out in official compendia (B.P. Eur. ph. Ip, etc.) were observed at 45.8% for locally manufactured drugs and 31.4% for imported drug products.