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Leaming Objective 1: Identify areas of nursing and midwifery education that need to be strengthened in order to increase nurse and nurse faculty capacity
in Sub-Saharan Africa.
Learning Objective 2: Discuss global and local solutions that strengthen nurse and nurse faculty capacity in Sub-Saharan Africa.
There is a critical shortage of nurses in the developing world with an average of only 11 nurse per 10,000 population. Efforts to increase the number of
nurses are hampered in part because of a lack of facility, material, electronic and human resources in Sub-Saharan Africa. In order to gain a better
understanding of the problems and issues in Africa, a focus group with 25 senior African nurse educators was conducted at the biennial conference of the
African Midwives Research Network (AMRN) held in Oar Es Salaam in December 2009. These nurse educators identified what they believed needed to
be strengthened related to nursing and midwifery education. Areas identified included: Intemet Accessibility and Information Technology; Educational
materials such as data bases, journals, texts; Resources such as improved skills labs, computer rooms, libraries, clinical facilities; Transportation for
community experiences; Quality standards; Faculty and faculty development. Proposed solutions included: Virtual and satellite colleges; Student leaming
outcomes focused curriculum; Standardized and appropriate leveling of curriculum; Visiting professors from established programs; Enhanced career
pathways (e.g., RN to BSN). Although large intemational groups such as the World Health Organization are developing policy briefs related to solving this
crisis and others are funding some solutions, it is essential to have dialogues about nurse shortages and nurse faculty shortages between nurse
educators both in-country and internationally. There is much nurses educators from developed countries can do working side by side with those from

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The identification of five novel compounds, pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-N-demethylerythromycin A-6,9-hemiketal, 5-O-beta-D-desosaminylerythronolide A and 15-nor-erythromycin C, in mother liquor concentrates of Streptomyces erythraeus is described. The pseudo-erythromycin derivatives are characterized by a 12-membered macrocyclic ring as a result of C13––C11 trans-lactonization. The five compounds have very little antimicrobial activity.

Climate and litter quality are primary drivers of terrestrial decomposition and, based on evidence from multisite experiments at regional and global scales, are universally factored into global decomposition models. In contrast, soil animals are considered key regulators of decomposition at local scales but their role at larger scales is unresolved. Soil animals are consequently excluded from global models of organic
mineralization processes. Incomplete assessment of the roles of soil animals stems from the difficulties of manipulating invertebrate animals experimentally across large geographic gradients. This is compounded by deficient or inconsistent taxonomy. We report a global decomposition experiment to assess the importance of soil animals in C mineralization, in which a common grass litter substrate was exposed to natural decomposition in either control or reduced animal treatments across 30 sites distributed from 431S to 681N on six continents. Animals in the mesofaunal size range were recovered from the litter by Tullgren extraction and identified to common specifications, mostly at the ordinal level. The design of the trials enabled faunal contribution to be evaluated against abiotic parameters between sites. Soil animals increase decomposition rates in temperate and wet tropical climates, but have neutral effects where temperature or moisture constrain biological activity. Our findings highlight that faunal influences on
decomposition are dependent on prevailing climatic conditions. We conclude that (1) inclusion of soil animals will improve the predictive capabilities of region- or biomescale decomposition models, (2) soil animal influences on decomposition are important at the regional scale when attempting to predict global change scenarios, and (3) the statistical relationship between decomposition rates and climate, at the global scale, is robust against changes in soil faunal abundance and diversity.

Keywords: climate decomposition index, decomposition, litter, mesofauna, soil biodiversity, soil
carbon, soil fauna

New Directions in water legislation in Kenya?. A Paper presented as the National Workshop on environmental Governance in kenya, held at the UNEP Headquarters Gigiri, Nairobi, March 29-30. 2000

The profound advances in the biomolecular sciences over the last decades have enabled similar advances in biomedicine. These advances have increasingly challenged our abilities to deploy them in an equitable and ethically acceptable manner. As such, it has become necessary and important to teach biomedical and scientific ethics to our students who will become the researchers, medical professionals, and global citizens of the future. As advances in the biosciences and medicine are made, developed, and used across the globe, our survival on an endangered planet requires global dialog and consensual action. To that end, a group of us from around the world have come together to describe the differing foundations of our ethical beliefs, and how ethical issues in biomedicine and in science are described and confronted in our countries. We hope to show the commonality in our beliefs and practices.

J. O. Midiwo, A. Yenesew, B. F. Juma, S. Dereses, J. A. Ayoo, A. Aluoch and S. Guchu There are several described medicinal plants in Kenya from a flora of approximately 10,000 members. Strong cross-medical information from the 42 ethnic groups points to the high potential of some of these species. The Myrsinaceae are well established ethno-anthelmintics and anti-bacterials. They are harbingers of long alkyl side chain benzoquinones which clearly have a protective function from their histochemical disposition. The main benzoquinone in the sub-family Myrsinodae is embelin while for the Maesodae it is maesaquinone together with its 5-acetyl derivative; the distribution of these benzoquinones by their alkyl side chain length or the presence/absence of a 6-methyl group is in accord with morphological sub-family de-limitation. The benzoquinones showed anti-feedant, anti-microbial, phytotoxic, acaricidal, insecticidal and nematicidal activity. Many other benzoquinones of medium and minor concentration were also isolated and characterised. Some plants belonging to the Polygonaceae which are widely used as ethno-anthelmintics have been studied. The common anthelmintic anthraquinones were obtained from all five Rumex species while the naphthalenic acetogenin derivative, nepodin was more selectively distributed. The leaf of Polygonum senegalense is up to 17% surface exudate; about thirteen non polar flavonoid derivatives (chalcones, dihydrochalcones, flavanones and a flavone) have been isolated from it. From the internal aerial tissues of this plant, the major flavonoids were common flavonoids, quercetin, kaempferol, luteolin and their glycosides. The only unique compound isolated from this plant was 2prime-glucosyl-6prime-hydroxy-4prime-methoxydihydrochalcone whose aglycone, uvangolatin is part of the exudate mixture. Other leaf exudate plants studied include the stomach-ache medicine, Psiadia punctulata (Compositae) from which novel methylated flavonoids, kaurene and trachyloban diterpenes have been found

OBJECTIVE: To study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. DESIGN: A retrospective survey. SETTING: Kenyatta National Hospital, Nairobi between January 1982 and December 1991. SUBJECTS: Three hundred and forty five patients who underwent V-P shunt placement for non-tumour hydrocephalus. RESULTS: Three hundred and forty five patients underwent V-P shunt placement for non-tumour hydrocephalus. There were 107 infection episodes involving 85 patients. The ages of these patients ranged from three months to 12 years. Most of the patients had congenital hydrocephalus. The infection rate was high (24.6%) although comparable to infection rates reported for clean surgery in the hospital. Fever, septic wounds and features of shunt malfunction were the main presenting features. Bacteriological studies confirmed Staphylococcus aureus and coagulase negative staphylococci as the two most commonly isolated micro-organisms. CONCLUSION: This study emphasises need to reduce infection rate in ventriculoperitoneal shunt surgery at the Kenyatta National Hospital. Definitive surgical treatment for hydrocephalus was in most cases delayed and this problem was also observed during revision of infected shunts. Late presentation was often due to ignorance and the fact that many patients went for traditional forms of treatment first before going to hospital.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

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This first module provides some insight into the need for better use of animal genetic resources (AnGR) in the context of projected demand for food in developing countries until 2020. Worldwide, about a billion people do not have enough to eat; a livestock revolution is currently underway to meet the nutritional needs and improve the livelihood of poor people. However, the recent international food and financial crises have again worsened the situation for many of the world’s poor. The module provides the background, facts and reasons for increased attention to improved utilization and maintenance of AnGR for food and agriculture in developing countries. It also provides a list of some key literature. References and links are made to web resources and to other parts of this resource. Some case studies on breed resources and other relevant components of this resource (CD and web version) help illustrate the issues presented.

This handbook has deliberately opted to use Standard Kiswahili because this is the dialect that has largely given Kiswahili international status (the language is taught in most major world Universities) and which is bound to take it to greater heights. Standard Kiswahili is the dialect that is taught in schools and colleges and is used in formal trade and official circles. As stated by Chimerah (2000) Standard Kiswahili is the mainstream Kiswahili. This handbook holds the view that Kiswahili is a Bantu language. Greenberg (1966) states that the African region has four main language families namely: Niger-Kordofanian, Nile-Saharan, Afro-Asiatic and Khoisan. Under Niger-Kordofanian there is the Benue-Congo sub-family from which Bantu languages emanate. One of the major distinctions of the Bantu languages is that their noun-class systems portray concordial agreement. Kiswahili is a mobilizing tool that is spoken in the East African Coast from Brava all the way to Mozambique. Encarta Africana [Ms Encyclopedia (2005)] remarks that this coastal strip measures about 2,000 miles (approximately 3,200KM).Kiswahili has its place now and in the future. In the year 2003, for example, Kiswahili was declared as one of the working languages of the African Union. It has also been adopted as a language for the East African Community by the Heads of State Summit of member countries.

The Global Positioning System or GPS is the oldest and most widely used GNSS system, and as such will be extensively discussed in this and the next chapter. The development of GPS satellites dates from the 1960s.

PURPOSE:

Vision impairment is a leading and largely preventable cause of disability worldwide. However, no study of global and regional trends in the prevalence of vision impairment has been carried out. We estimated the prevalence of vision impairment and its changes worldwide for the past 20 years.

DESIGN:

Systematic review.

PARTICIPANTS:

A systematic review of published and unpublished population-based data on vision impairment and blindness from 1980 through 2012.

METHODS:

Hierarchical models were fitted fitted to estimate the prevalence of moderate and severe vision impairment (MSVI; defined as presenting visual acuity <6/18 but ≥ 3/60) and the prevalence of blindness (presenting visual acuity <3/60) by age, country, and year.

MAIN OUTCOME MEASURES:

Trends in the prevalence of MSVI and blindness for the period 1990 through 2010.

RESULTS:

Globally, 32.4 million people (95% confidence interval [CI], 29.4-36.5 million people; 60% women) were blind in 2010, and 191 million people (95% CI, 174-230 million people; 57% women) had MSVI. The age-standardized prevalence of blindness in older adults (≥ 50 years) was more than 4% in Western Sub-Saharan Africa (6.0%; 95% CI, 4.6%-7.1%), Eastern Sub-Saharan Africa (5.7%; 95% CI, 4.4%-6.9%), South Asia (4.4%; 95% CI, 3.5%-5.1%), and North Africa and the Middle East (4.6%; 95% CI, 3.5%-5.8%), in contrast to high-income regions with blindness prevalences of ≤ 0.4% or less. The MSVI prevalence in older adults was highest in South Asia (23.6%; 95% CI, 19.4%-29.4%), Oceania (18.9%; 95% CI, 11.8%-23.7%), and Eastern and Western Sub-Saharan Africa and North Africa and the Middle East (95% CI, 15.9%-16.8%). The MSVI prevalence was less than 5% in all 4 high-income regions. The global age-standardized prevalence of blindness and MSVI for older adults decreased from 3.0% (95% CI, 2.7%-3.4%) worldwide in 1990 to 1.9% (95% CI, 1.7%-2.2%) in 2010 and from 14.3% (95% CI, 12.1%-16.2%) worldwide to 10.4% (95% CI, 9.5%-12.3%), respectively. When controlling for age, women's prevalence of blindness was greater than men's in all world regions. Because the global population has increased and aged between 1990 and 2010, the number of blind has increased by 0.6 million people (95% CI, -5.2 to 5.3 million people). The number with MSVI may have increased by 19 million people (95% CI, -8 to 72 million people) from 172 million people (95% CI, 142-198 million people) in 1990.

CONCLUSIONS:

The age-standardized prevalence of blindness and MSVI has decreased in the past 20 years. However, because of population growth and the relative increase in older adults, the blind population has been stable and the population with MSVI may have increased

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The purpose of this paper is three-fold. We present two multidisciplinary applications of
global (stochastic) optimization problems in aerospace design which range from preliminary
to advanced design. One application involves the preliminary sizing code FLOPS, and the
other, high-fidelity aerodynamics and structural mechanics analyses codes. We look at the
viability of the stochastic optimization method, simulated annealing (SA) for these
applications. In the high-fidelity application, we use a proof-of-concept problem to …

This book synthesizes current knowledge of regional-global linkages in four regions to demonstrate that study of environmental change on a regional scale can enhance understanding of global-scale environmental changes. The atmospheric circulation over Southern Africa links regional nutrient and pollutant sources to distant sinks affecting both regional and global ecosystem functioning. Extended human modification of land cover in East Asia has altered the complex surface-atmosphere exchanges impacting the Asian monsoon system. Biogenic and anthropogenic emissions over South Asia are implicated in changes in global tropospheric ozone and oceanic biogeochemical balances. Economic globalisation has negatively impacted regional environments of Southeast Asia.

Keywords » biogeochemical cycling - climate change - environmental change - global change - land use

coming soon at the webstie

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Antibody responses to a conventional rabies preexposure regimen of a new purified Vero cell rabies vaccine (PVRV) and a human diploid cell vaccine (HDCV) were compared in 80 healthy Kenyan veterinary students. Forty-three of the students received the PVRV and 37 received the HDCV on days 0, 7, and 28. Antibody responses were monitored using the rapid fluorescent-focus inhibition test (RFFIT) and an inhibition enzyme immunoassay (INH EIA) on days 0, 7, 28, and 49. Both vaccines elicited a rapid antibody response. A good correlation between the RFFIT titers and the INH EIA titers was obtained (r = 0.90). Our results also showed that the INH EIA was more reproducible and might therefore be a suitable substitute for the more expensive and less reproducible RFFIT. The geometric mean titers determined by both tests in the two groups of students were statistically similar during the test period. The RFFIT and the INH EIA gave comparable geometric mean titers, which differed significantly only on day 28 in the PVRV group. The effect of the new PVRV is comparable to that of the more expensive HDCV, as determined by the present test systems. The PVRV could therefore be the vaccine of choice, especially in tropical rabies-endemic areas, where the high cost of the HDCV has confined its use to a privileged few.

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Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

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No abstract available.

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(11 Cell extracts and extracellular culture fluids of species of the yeast genus Schizosaccharomyces exhibited exo-beta-(1 leads to 3)- and exo-beta-(1 leads to 6)-glucanase (EC 3.2.1.-) activities. (2) Using a combination of Sephadex G-100 and DEAE-cellulose chromatography, the exo-beta-(1 leads to 3)-glucanases from the cell extracts and culture fluid of Schizosaccharomyces japonicus var. versatilis were purified extensively. The enzymes from either location exhibited similar purification and other properties. (3) The purified enzymes hydrolysed the beta-(1 leads to 6)-glucosidic linkage in addition to the beta-(1 leads to 3) linkage. Heat denaturation, inhibition and electrophoretic studies indicated that both hydrolytic activities were properties of a single protein. Laminarin and pustulan hydrolysis followed Michaelis-Menten kinetics. The Km and V for laminarin hydrolysis were 6.25 mg/ml and 350 mumol of glucose released/min/mg protein, and for pustulan they were 166 mg/ml and 52 mumol of glucose released/min/mg protein. (4) The exo-beta-glucanase was assigned a molecular weight of 43 000. (5) the purified enzyme failed to hydrolyse isolated cell walls from either baker's yeast or Schizosaccharomyces pombe or to induce protoplast formation from intact cells of S. japonicus var. versatilis or Saccharomyces cerevisiae.

Twenty-five Penicillium species isolated from Egyptian soil were examined for their ability to produce gluconic acid in surface culture. Of the eight species capable of producing gluconic acid, Penicillium puberulum gave the maximum yield (91% gluconic acid from glucose after 7 days of fermentation with 3% CaCO3). Peptone was the best nitrogen source for acid fermentation and glucose was superior to sucrose. Addition of low concentrations of KH2PO4 and MgSO4 - 7 H2O stimulated acid production. An initial pH of 6.1 was most favourable for acid accumulation and addition of CaCO3 was necessary for maximum acid production.

Background: Diabetes mellitus (DM) is a chronic metabolic disease that is characterized by persistent hyperglycemia. Monitoring of glycaemic control ir individuals with DM is currently done by a combination of short term, that is daily monitoring of blood glucose and long term biochemical tests especially glycatec haemoglobin(HbA1c) which is done every 2-4 months. Glycated albumin (GA) is a new test for intermediate glycaemic control. It measures averaged plasma gluCOSE level over two to four weeks. This enables closer monitoring and evaluation ot treatment regimen faster than HbAlc.
Objectives: To compare glycated haemoglobin to glycated albumin levels as a measure of monitoring glycaemic control in diabetic patients.
Design: A prospective comparative study.
Methods: The study was carried out on diabetic patients attending the diabetic clinic
at Kenyatta National Hospital.
Results: A total of 260 patients were enrolled into the study. The mean age was 52 years with a standard deviation of 12.3. There was a female preponderance of 60.4%, Random blood sugar analysis showed that, the population with good glycaemic control constituted 156 (60%). Majority of the patients had good glycaemic control 170 (65.4%) based on the HbAlc assay, compared to 39.4% in GA.There was a good correlation between HbAlc and glycated albumin with R2value of 0.64.
Conclusion: More patients showed good glycaemic control based on HbAlc compared to glycated albumin. There was correlation between .HbAlc and glycated albumin with R2 value of 0.64. There is need to introduce glycated albumin as a method of intermediate glycaemic control in the hospital.

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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.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Two groups of 6 rats each received subcutaneous injections of 2.3 mg/kg or 5.0 mg/kg of quinuronium, respectively, on two consecutive days, while 5 rats injected with physiological saline served as controls. Clinical signs of muscular tremors, jumps, enlarged and hyperemic eyeballs, lacrimation, depression and anorexia were observed following administration of quinuronium. One rat receiving 5 mg/kg died before termination of the study. When killed 48 h after the first injection, the quinuronium-treated rats had a higher liver weight/body weight ratio compared to the controls. Quinuronium resulted in hepatic centrilobular fatty degeneration, but no depletion of hepatic glutathione (GSH). The present findings suggest that glutathione depletion does not seem to be involved in quinuronium hepatotoxicity.

Introduction to Philosophy of Religion, University of Nairobi, 1988

 Journal of Civil Engineering, Jomo Kenyatta University of Agriculture and Technology Vol.7 PP

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

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SUMMARY LIII)' lIIorpllOlogiClI changcs ill the goat ,csris after:. sillgle illlraperilOlieal injec,ioll of ethalle ,lillie' I.:lIIeslll"llOnarc (EI )S) werc investigatcd mint; (1Orh liglH alld deCll'On microscopy. The (olllpolind was ;almillistered at two dose Icvels: 75 mgll

SUMMARY LIII)' lIIorpllOlogiClI changcs ill the goat ,csris after:. sillgle illlraperilOlieal injec,ioll of ethalle ,lillie' I.:lIIeslll"llOnarc (EI )S) werc investigatcd mint; (1Orh liglH alld deCll'On microscopy. The (olllpolind was ;almillistered at two dose Icvels: 75 mgll

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Adult female Sprague-Dawley rats were injected with corn oil or 5 mg, 20 mg, 25 mg or 30 mg per kg body weight of heptachlor solution every other day for up to 18 days. The rats were killed at the end of the experimental period, and blood samples were assayed for progesterone and oestrogen by radioimmunoassay. Ovarian cells from the rats were isolated and incubated either on their own, or in the presence of LH or FSH, and production of progesterone and oestrogen determined. Control incubations consisted of cells from corn oil-treated rats. The latter were also incubated on their own or in the presence of LH or FSH. Heptachlor significantly suppressed blood progesterone and oestradiol levels (P < 0.05 to P < 0.001), the degree of suppression depending on the dose and the stage of the oestrous cycle in which samples were obtained. Production of oestradiol by ovarian cells from heptachlor-treated rats was lower than for corn oil-treated controls. Cells from rats treated with low doses of heptachlor (5 mg per kg body weight) showed an increased production of progesterone, while high doses (> 20 mg per kg body weight) suppressed production.

Department of Orthopaedics and Trauma, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya. mutisovm@yahoo.com

p6nadotropins were measured by radioimmunoassay of urine samples from 285 privileged Nairobi adolescents and from 238 rural peripubertal Kenyan boys and girls who had had moderate malnutrition during childhood. Gonadotropins were reduced at all ages in the rural adolescents, but pubertal stage-matched comparisons showed no differences between children of the two study areas in middle or late phases of sexual maturity. These results document the pattern of gonadotropin changes in an environment of reduced caloric intake and confirm the presumed hypothalamic-pituitary origin of the delayed adolescence that occurs under such circumstances.

PMID: 6431069 [PubMed - indexed for MEDLINE]

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

Neisseria gonorrhoeae cervicitis and human immunodeficiency virus (HIV) type 1 frequently coinfect core transmitter populations, such as female sex workers. Gonococcal cervicitis is associated with increased viral shedding and plasma viremia in HIV-1-infected women and increased HIV-1 susceptibility in uninfected women. We studied the influence of gonococcal cervicitis on CD8(+) interferon (IFN)-gamma responses to HIV-1 and cytomegalovirus (CMV) epitopes in HIV-1-infected and in highly-exposed, persistently seronegative (HEPS) female sex workers. In HIV-1-infected women, gonococcal cervicitis was associated with reduced IFN-gamma responses in bulk CD8(+) lymphocyte populations, and intracellular cytokine staining, combined with class I major histocompatibility complex (MHC)-peptide tetramer studies, demonstrated reduced IFN-gamma production by HIV-1 epitope-specific CD8(+) lymphocytes. In HEPS sex workers, cervicitis was associated with the transient loss of systemic HIV-1-specific CD8(+) responses and with reduced function of CMV-specific CD8(+) lymphocytes. Impaired function of virus-specific CD8(+) lymphocytes may partly explain the deleterious effects of gonococcal cervicitis on HIV-1 immune control and susceptibility.

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Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Fine-needle aspiration (FNA) is a well-recognized technique for sampling solid organs. It is used in renal transplantation to clarify the cause of a poorly functioning graft. Differential scoring techniques with respect to peripheral blood cell populations, and immunocytochemistry have been employed in this context. We describe the use of simple morphological criteria alone in renal transplant FNA. We compare these with needle biopsy and clinical parameters and show their value in the detection of active cellular rejection. Their limitations are discussed within the framework of other patterns of transplant pathology.

The identification of five novel compounds, pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-erythromycin A-6,9-hemiketal, 8,9-anhydro-pseudo-N-demethylerythromycin A-6,9-hemiketal, 5-O-beta-D-desosaminylerythronolide A and 15-nor-erythromycin C, in mother liquor concentrates of Streptomyces erythraeus is described. The pseudo-erythromycin derivatives are characterized by a 12-membered macrocyclic ring as a result of C13––C11 trans-lactonization. The five compounds have very little antimicrobial activity.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

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Capecitabine (5-fluorouracil prodrug) is being evaluated for the management of hepatocellular carcinoma, and is associated with a peculiar skin reaction called hand and foot syndrome (HFS). We describe one patient with HCC and drug-induced HFS.

The proceedings of a conference organised by students are reported. The present standing of the general practitioner and his need in different societies are equated and the obvious deficiencies are considered. Such themes as maldistribution, service and education are discussed. Resolutions derived from the conference are reported in full.

Normal 0 false false false EN-GB X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} This study compared the efficacy and tolerability of stavudine at the two dose levels in patients attending HIV Comprehensive Care Centre, in the largest public hospital in Kenya. Data on CD4 cell counts, drug adverse events and opportunistic infections were collected retrospectively from the records of 810 adult patients distributed in three study groups: patients weighing ≥ 60 kg receiving 40 mg BD stavudine; patients weighing ≥ 60 kg receiving 30 mg BD stavudine; and patients weighing < 60 kg receiving 30 mg BD stavudine. Fewer stavudine related adverse effects were seen in patients weighing ≥ 60 kg treated with 30 mg stavudine compared to those who received 40 mg stavudine in the same weight category (4.2 % vs 16.7 %, p < 0.001). Patients weighing < 60 kg were more likely to experience drug toxicity than those ≥ 60 kg when given 30 mg stavudine (12.8% vs 4.2 %, p<0.001). Occurrence of any adverse drug reactions was also significantly associated with age greater than 45 years (HR = 2.16, CI:1.41-3.31, p<0.001), co-morbidities (HR = 2.16, CI:1.06-4.38, p < 0.001), treatment with isoniazid (HR = 2.07, CI:1.09-3.96, p<0.001) and severe (WHO stage IV) immunosuppression (HR=1.45,CI:0.86-2.45, p<0.001). The onset of drug related toxicities, for all study arms, was principally in the first year of commencing therapy, for example 76 % of all cases of peripheral neuropathy were diagnosed within 12 months of treatment. The study demonstrated similar immunologic outcomes in the treatment groups given either 30 or 40 mg stavudine, with median CD4 cell counts after 12 months of treatment more than doubling for patients in all the study cohorts. The findings support the use of combination antiretroviral therapy regimens containing low dose stavudine in Kenya. Key words Low-dose stavudine, combination antiretroviral therapy, HIV, stavudine tolerability

coming soon at the webstie

Background:

Obstetric fistula has been defined as an ‘abnormal communication’ between the vagina and the bladder or rectum of a woman which results in continuous leakage of urine and/or faeces. The most common cause of obstetric fistula is obstetric trauma. Obstetric fistula is a highly stigmatising condition; often the women are neglected and or ostracised.
Aim:

To establish the knowledge and awareness of fistula among men and women living in an area where fistula prevalence is rising.
Methods:

In this cross-sectional study, women and their partners were recruited purposefully in two counties Kenya: Nyamira and Kisii and interviewed using structured interviews. Data were cleaned and entered into Excel. SPSS was used for descriptive data analysis. Chi2 test was conducted to compare responses according to gender and level of education.
Results:

Three hundred participants (253 women and 47 men) were interviewed over a 3-month period. Responses from women and men were similar. Few (32%) participants reported having seen a woman with fistula in their community. Just over half (53%) said that they knew what causes fistula, of which 89% said they knew that fistula could be treated. Only 27% said that the health care provider mentioned fistula during health education talks. Participants educated to a level above secondary school were more knowledgeable about fistula.
Conclusion:

Fistula information is lacking among community members. There is a need to scale up training and community awareness campaigns to help eradicate fistula from Kenya.
Keywords: Fistula, Obstetric, Survey, Kenya, Women, Men

Gracilis muscle flap was used to treat a seven year old boy with a one year history of recurrent rectal prolapse. Initial perineal surgery in form of Thiersch stitch resulted into failure to control rectal prolapse and damage to anal sphincter. Graciloplasty corrected both problems.

BACKGROUND: Low vitamin E levels are often found in HIV-1 infection, and studies have suggested that higher levels may decrease the risk of disease progression. However, vitamin E supplementation has also been reported to increase CCR5 expression, which could increase HIV-1 replication. We hypothesized that vitamin E levels at HIV-1 acquisition may influence disease progression. METHODS: Vitamin E status was measured in stored samples from the last pre-infection visit for 67 Kenyan women with reliably estimated dates of HIV-1 acquisition. Regression analyses were used to estimate associations between pre-infection vitamin E and plasma viral load, time to CD4 count <200 cells/muL, and mortality. RESULTS: After controlling for potential confounding factors, each 1 mg/L increase in pre-infection vitamin E was associated with 0.08 log10 copies/mL (95% CI -0.01 to +0.17) higher set point viral load and 1.58-fold higher risk of mortality (95% CI 1.15-2.16). The association between higher pre-infection vitamin E and mortality persisted after adjustment for set point viral load (HR 1.55, 95% CI 1.13-2.13). CONCLUSION: Higher pre-infection vitamin E levels were associated with increased mortality. Further research is needed to elucidate the role vitamin E plays in HIV-1 pathogenesis.