.

OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

There is a causal relationship between political leadership and economic development. There is evidence that the deterioration of economic conditions in African since independence is owed to poor management of public economic affairs by the incumbent state leadership. This argument implies that whereas the continent may not be very well endowed with natural resources, this may not be held solely responsible for the existing economic woes. Whatever resources exist are capable of generating economic development, indeed economic breakthrough, if they are harnessed and utilized effectively. Conversely, a country may be endowed with enormous natural and human resources, but may remain characterized by poverty and economic backwardness if it is not endowed with visionary, dedicated and rational political leadership capable of appropriating such resources for the purpose of national development and for the prosperity of the citizens.

Persons with congenital or acquired immunosuppression have long been known to have an increased incidence of lymphoproliferative disorders. Unsurprisingly, therefore, the acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is associated with an increased incidence of lymphoma. Three cases with HIV-associated lymphoma aged 30, 32 and 35 years respectively are presented. Two had cutaneous non-Hodgkin's lymphoma while one had Hodgkin's lymphoma. Standard chemotherapy for lymphoma was given with good tumour regression. Two of the patients died within six months of lymphoma diagnosis due to other complications of HIV.

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

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This research examines the relationship between commercial banks (CBs) and the small enterprise sector (SES) and identifies constraints' which impede the flow of financial assistance from the commercial banks to the latter in Kenya. The variables that were examined included; requirements for successful loan application, lending levels, degree of risk attached to small enterprise lending, levels of economic impact and stages in business development at which banks become willing to support. For the small enterprises, the study sought to profile the business and its owner and, to examine its financing. The sampling units were drawn from CBs and SES within Nairobi. In data collection, questionnaires, interview and document review was employed. The study found that high interest rates and long processing procedures kept small businesses away from banks. The study established that, on the part of the banks, the entrepreneurs lacked business management skills and did not keep proper records. Moreover, the banks experienced general reproach from the small business owners, based upon conventional beliefs.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress.  Opinions in current literature portray controversy in its management.  Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse.  Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children.  Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth.  The intended correction of facial disfigurement is therefore not achieved.  Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy.  This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress. Opinions in current literature portray controversy in its management. Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse. Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children. Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth. The intended correction of facial disfigurement is therefore not achieved. Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy. This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Effectiveness of dimethoate 40 EC and copper oxychloride in the management of legume pests and diseases was tested in field experiments during 2005 growing seasons. Grain legumes used were common bean (Phaseolus vulgaris L. var GLP 2), lima bean (Phaseolus lunatus L.), green gram (Vigna radiate L.), lablab (Lablab purpureus L.) and chickpea (Cicer arietinum). The experimental design was a randomized complete block design in a split plot replicated thrice. The parameters observed were insect pest incidence, number of pods per plant, percent seed damage and total grain yield. Pesticides spray significantly reduced the incidence of insect pests like flower thrips, African bollworm and legume pod borer. Pod and seed damage were significantly reduced in lablab, chickpea and green gram. Only lablab, chickpea and green gram showed significant increase in number of pods per plant and total seed yield resulting from pesticide spray. In addition, the quality of yield increased through reduction of shrivelled and discoloured seed due to diseases. The study showed that the use of dimethoate and copper oxychloride is beneficial for the management of the common insect pests and diseases in legumes. However, studies on the optimum number of sprays, time of application and use of other control measures that are ecologically viable for the management of the pests ought to be done.

PIP: Menstrual blood loss (MBL) was evaluated in 74 nulliporous Kenyan women aged between 20 and 27 years. The hemoglobin levels were all in normal range with the mean of 13.65 +or- 0.8, 13.84 +or- 1.2 and 13.04 +or- 1.2 g/100 ml respectively in 3 populations. The MBL was comparable in the 3 populations with the mean of 35.1 +or- 12.6, 30.6 +or- 8.7 and 32.2 +or- 9.4 ml respectively. There was no difference of statistical significance between the 2 periods studied per each individual. This study objectively assesses the menstrual blood loss in 3 population groups–2 urban and 1 rural. The data can be used to evaluate menstrual blood loss before and after initiation of various contraceptives used in Kenya. Subjects were volunteers who were not on any contraception except barrier or natural rhythm methods, not under psychological stress and who exhibited normal physical female characteristics on examination. Those who wished to drop out, became pregnant or desired contraception, were excluded. The study confirms the individual constancy of the menstrual blood loss in this population. This has important practical implications since a single determination of the menstrual blood loss may be a fairly good expression for the average blood loss in a woman. The immediate effect of various treatments such as IUD insertion or oral contraceptives on the MBL may easily be evaluated quantitatively by measurements in consecutive periods using only 1 period as a control. The quick method can be easily used in evaluating pathological conditions e.g. iron-deficiency due to heavy bleeding, IUD-associated hemorrhage, menorrhagia and uterine fibroid. PMID: 12267056 [PubMed - indexed for MEDLINE]

Radiation doses received by patients during dental x-ray examinations were measured in 95 patients referred to the X-ray Department of the Teaching Dental Hospital, University of Nairobi. The mean skin dose for single periapical films was 5.96 milligray (596 millirads) with the bitewing view recording a mean dose of 5.57 milligray (mGy). During a 14-film full-mouth periapical survey, mean doses ranged from 10.3-16.2 mGy for the upper jaw and 10.1-13.5 mGy for the lower jaw, respectively, depending on the region of dentition. In these full-mouth examinations, the distribution of skin dose over different parts of the dentition showed a characteristic pattern which may be explained by the overlap of radiation fields in the aggregated series of exposure. Orthopantomography recorded lower mean skin doses of 3.26 mGy in the molar region and 2.67 mGy at the posterior midline at the level of the 2nd cervical vertebra. The relative merits of intra-oral radiography versus orthopantomography are discussed, with radiation dosage as one of the factors to be considered. Some observations are made on measures to reduce patient dose.

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Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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The conventional cavity preparation in deep caries leslonsmav result in iatrogenic or caries exposure of the pulp. The treatment modalities may therefore be either direct or indjre~t pulp capping depending on the presenting symptoms. The objective of the study was to determine the success rate of pulp capping done over 1989-1993 period in the Department of Conservative and Prosthetic Dentistry of thp I tnilfPr<;ity of Nairobi. One thousand' and three hundrJ.~iles we're retrieved, out of "":hich ninety nine formed the sample of ages 20-45 years. Sixty three cases had direct pufp c3Ppulg'done, while thirty six had indirect pulp capping done. 78% of pulp capping were success¬ful with the highest success rate (81%), being among the 20 to 30-year aids. Conclusion: More direct pulp capping procedures were done than indirect pulp capping with a higher success rate for the former. Young patients showed better response to pulp capping

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Analysis of 110 records of patients who presented with impacted mandibular 3rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilateral impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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Drinking of fresh vegetable raw juices for both cleansing and cure therapy has become very common in Kenya. Fresh raw vegetable juices have been recommended because they can boost the required minerals and vitamins in the body. This work was carried out to evaluate the amount of labile aluminium content in fresh raw vegetable juices and compare it with the total aluminum in vegetables. In addition, another objective was to determine the amount of aluminum leached out from aluminium pots during cooking. Out of 18 different vegetables analyzed, total aluminium ranged from 0.096 mg g-1 to 1.06 mg kg-1; carrots contained the lowest values while parsley contained the highest values. Labile aluminium in fresh raw vegetable juice ranged from 0.003 mg ml-1 to 0.181mg ml-1 and this gave 1 to 30% of the total aluminium. The amount taken per day during juice therapy, either as a detoxifier or a cure, ranged from 0.95 mg day-1 to as high as 40.22 mg day-1. But levels as high as 321.78 mg can be consumed depending on the volume of the juice consumed per day. The total aluminium consumed during juice therapy was found to be higher than that recommended by WHO. Aluminium pots were found to leach out some aluminium and the amount leached out was found to depend on the storage time and the age of the pot.

Key Words: Aluminium in vegetables, Nairobi, Kenya, vegetable juices, total and labile aluminium.

OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

This paper reports on work which was done on the upper Tana in Eastern Kenya. The work revealed a number of iron-using sites which included smelting areas, so-called Gumba earth works and lot of pottery, belonging to triangular incised (TIW) and Kwale Ware. It is concluded that TIW post date Kwale Ware and it is likely the TIW makers/users were responsible for the iron working in the Area.

Persons with congenital or acquired immunosuppression have long been known to have an increased incidence of lymphoproliferative disorders. Unsurprisingly, therefore, the acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is associated with an increased incidence of lymphoma. Three cases with HIV-associated lymphoma aged 30, 32 and 35 years respectively are presented. Two had cutaneous non-Hodgkin's lymphoma while one had Hodgkin's lymphoma. Standard chemotherapy for lymphoma was given with good tumour regression. Two of the patients died within six months of lymphoma diagnosis due to other complications of HIV.

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

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.

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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.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

S.W. Guthua , D.L. Mwaniki and F.G. Macigo. Faculty of Dental Sciences, University of Nairobi , Kenya J. of Dental Research 1999, Vol. 78 Keloids are soft tissues growths which develop as a complication in later stages of wound healing. They occur more commonly in blacks in comparison to other racial groups. Although hereditary factors are implicated in individual selection and pathogenesis of keloids, the aetiology is unknown. The individuals who succumb to this disfiguring condition are usually psychologically traumatized thereby influencing their self-esteem. The management of these lesions is challenging and surgery alone without adjuvant radiotherapy shows high recurrence rate. 10 patients with keloids in the cervicofacial region are presented. The patients were divided in two categories. Category I patients (N=5) were managed with surgery and local steroid therapy. Category II patients (N=5) Received adjuvant superficial radiotherapy treatment (SXRT) after surgery. In two of the patients, in Category I, there was recurrence whereas in Category II, there was none. Complications observed in category I patients included; hypopigmentation and lipotrophy while in Category II patients, localized dermatitis, sloughing of the skin and local tissue necrosis (N=1) were observed. The complications related to SXRT improved and no invasive intervention was required. SXRT if meticulously fractionated and monitored seems to be the most favourable adjuvant modality in the management of keloids among the black population .

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

We demonstrate that a mutation in the homeobox gene, MSX1, causes a common developmental anomaly, familial tooth agenesis. Genetic linkage analyses in a family with autosomal dominant agenesis of second premolars and third molars identified a locus on chromosome 4p, where the MSX1 gene resides. Sequence analyses demonstrated an Arg31Pro missense mutation in the homeodomain of MSX1 in all affected family members. Arg 31 is a highly conserved homeodomain residue that interacts with the ribose phosphate backbone of target DNA. We propose that the Arg31 Pro mutatrion comprises MSX1 interactions, and suggest that MSX1 functions are critical for normal development of specific human teeth.

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress. Opinions in current literature portray controversy in its management. Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse. Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children. Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth. The intended correction of facial disfigurement is therefore not achieved. Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy. This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Field experiments were conducted to investigate the response of grain legumes to rhizobia inoculation, farmyard manure and inorganic fertilizer nitrogen. The grain legumes were common bean (Phaseolus vulgaris L.var GLP 2), lima bean (Phaseolus lunatus L.), green gram (Vigna radiate L.) and lablab (Lablab purpureus L.). The experimental design was a randomized complete block design with split plot arrangement and replicated thrice. Parameters determined were the number of nodules and nodule dry weight per plant, seed yield and yield components. Nitrogen fertilizer application significantly reduced the number of nodules in most of the legume species. In contrast, rhizobia inoculation increased number of nodules and nodule dry matter in most species but this was not translated into increase in plant growth or grain yield. Application of manure improved nodulation and grain yield only in the short rains. However, fertilizer application significantly increased dry matter in both seasons and total grain yield during short rains. The study indicated that the effect of rhizobia inoculation, farmyard manure and nitrogen fertilizer on grain legumes is variable depending on species, parameter being measured and other environmental factors. Keywords: Dry matter, grain legumes, grain yield, nitrogen source, nodulation.

PMID: 6595111 [PubMed - indexed for MEDLINE]

Loss of 1st and 2nd molars among adolescents due to dental caries is not uncommon in developing countries. Whilst their replacement is indicated, conventional methods of treatment, namely, bridging and dentures are in most cases inaccessible because of prohibitive cost. Given that it is in the same age group that diagnosis of unfavourably embedded wisdom teeth becomes feasible, autotransplantation of the latter to replace the unsalvageable 1st and 2nd molars could be an alternative treatment. Available literature suggests a success rate of over 82% based on follow-up studies of over ten years. Observations at the Dental School Clinic of the University of Nairobi, Kenya, indicate that the time it takes the transplant to 'take' and assume its functional position is 4 to 8 weeks and 2.5 to 3.5 months respectively. Since the method is relatively straightforward, we are of the view that training undergraduates and practising dental surgeons in this technique should enhance utilisation of otherwise "useless" teeth to replace the lost 1st and 2nd molars in occlusal rehabilitation.

S.W. Guthua* and D.L. Mwaniki** Afr. Dental Journal 1992, 6: 30-33 SUMMARY: Analysis of 110 records of patients who presented with impacted mandibular 3 rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilaterial impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions, 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3 rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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Road Traffic Accidents (RTAs) are a major cause of morbidity and mortality in Kenya. Victims may suffer multiple injuries including maxillofacial injuries. In most developing countries RTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the government of Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety belts by pdssenger service vehicles. Objective: To describe the characteristics and pattern of maxillofacial and associated injuries sustained in road traffic accidents. Design: A cross-sectional study. Setting: Kenyatta National Hospital (KNH). Subjects: All patients involved in RTAs brought to casualty and the dental department of KNH as well as accident victims admitted to the KNH mortuary over a four- month period from September 2004 to December 2004. Results: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustained fatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurred during weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fatal and fatal cases respectively, Most accidents were caused by passenger service vehicles (matatus) which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (5TIs) involving the craniofacial region with facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents of other STIs than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1 %) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37}% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases. Conclusion: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestrians in their third decade of life are most affected with passenger service vehicles being responsible in the majority of the cases. Recommendations: Interventional programmes targeting pedestrians and those in the third and fourth decades of life should be enacted.

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A new antiplasmodial coumarin, 5,7-dimethoxy-8-(3'-hydroxy-3'methyl-1'-butene)-coumarin (1), has been isolated from the roots of Toddalia asiatica. This finding supports the traditional use of this plant for the treatment of malaria.

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

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A sacred site is a place which is considered holy, and is partially or wholly reserved for magico-religious or ceremonial functions. Because of this it is venerated and revered and is kept free from contamination by sin and evil. Sacred sites vary in size from very small places covering a few square metres to large areas covering several hectares of land. They are usually characterized by the presence of artefacts, ecofacts and features that are unique to them; they may be in the open air, or in rockshelters, caves and forests. In many cases, sacred sites have frightening tales told about them, in order to scare off those who would want to destroy or defile them. In the archaeological record, sacred sites may initially be identifiable as burial sites, ceremonial sites or butchery sites. It is on the basis of such clues that other attributes that are typical of sacred sites can be identified, isolated and studied. It is against this background that this chapter discusses the Mijikenda kaya (pi. makaya) as a sacred site.

The femoral collodiaphyseal angle amongst selected Kenyan ethnic groups
Otsianyi, WK.*, Naipanoi, AP. and Koech, A.
University of Nairobi (Human Anatomy), Nairobi, Quénia *E-mail: wyksa2000@uonbi.ac.ke
Background: There is evidence suggesting that there is inter-populational differences of the femoral neck- shaft angle which has been attributed to disparity in the economic and physical activity levels. As knowledge of the collodiaphyseal angle (CDA) is important to orthopaedic surgeons, there is need to elucidate whether there is significant variation of this angle among the diverse ethnic groups in Kenya. Objectives: Describe the variability of the CDA among the different ethnic groups (whose economic and physical activity differ) in the Kenyan population. Setting: The study was conducted at the radiology department of Kenyatta National Hospital. Materials and methods: Normal pelvic radiographs of patients seen at Kenyatta National Hospital were grouped into five major ethnic groups and were used in this study. Three readings of the CDA were then measured using goniometry and the average recorded. Results: Four hundred and thirty-two femora were studied, 133 were female while 299 were male, and the age ranged from 16-95 years. The average CDA angle was found to be 127.56° + 3.75 (the range being 104-145°, the mode 130°). The CDA was 126.11° + 3.22 and 128.21 + 3.79 in females and males respectively. This angle was largest among the nomadic group (129.72 + 4.76) and smallest (127.25 + 4.15) among the highland Bantu (ANOVA revealed an F of 2.022, level of significance of 0.09). Conclusions: The average CDA described here is lower compared to what has been presented in other populations. Interethnic differences were observed and these differences could be explained by the varying activities of the different groups in their day to day life.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

S.W. Guthua , D.L. Mwaniki and F.G. Macigo. Faculty of Dental Sciences, University of Nairobi , Kenya J. of Dental Research 1999, Vol. 78 Keloids are soft tissues growths which develop as a complication in later stages of wound healing. They occur more commonly in blacks in comparison to other racial groups. Although hereditary factors are implicated in individual selection and pathogenesis of keloids, the aetiology is unknown. The individuals who succumb to this disfiguring condition are usually psychologically traumatized thereby influencing their self-esteem. The management of these lesions is challenging and surgery alone without adjuvant radiotherapy shows high recurrence rate. 10 patients with keloids in the cervicofacial region are presented. The patients were divided in two categories. Category I patients (N=5) were managed with surgery and local steroid therapy. Category II patients (N=5) Received adjuvant superficial radiotherapy treatment (SXRT) after surgery. In two of the patients, in Category I, there was recurrence whereas in Category II, there was none. Complications observed in category I patients included; hypopigmentation and lipotrophy while in Category II patients, localized dermatitis, sloughing of the skin and local tissue necrosis (N=1) were observed. The complications related to SXRT improved and no invasive intervention was required. SXRT if meticulously fractionated and monitored seems to be the most favourable adjuvant modality in the management of keloids among the black population .

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

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Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress. Opinions in current literature portray controversy in its management. Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse. Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children. Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth. The intended correction of facial disfigurement is therefore not achieved. Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy. This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Field studies were carried out in farmer-based seed potato production to determine the incidence of potato aphids and potato aphid-transmitted viruses in two potato-producing areas of Kenya. Parameters determined included aphid population, virus disease incidence and tuber yield. Aphid population was monitored on leaves and in water-pan traps. Virus infection was determined based on symptoms and the viruses were identified in tubers sprouts by DAS-ELISA. Tuber yield was determined for plants showing virus symptoms and healthy-looking plants. Five aphid species were identified, with the most abundant being M. euphorbiae and A. gossypii on leaves and M. persicae and A. gossypii in water traps. The average aphid population was between 1.4 and 4.2 aphids per three leaves and 4.68 and 9.64 aphids per water. Farms with higher population of M. persicae had higher virus disease incidence. The most prevalent viruses were PVS, PLRV and PVM. Healthy looking plants had a latent infection rate 57.2% compared to 76.6% for symptomatic plants. Virus infection reduced the number and weight of tubers by 74% and 62.7%, respectively. However, virus infection increased the number and weight of the chats grade. The results indicated that aphid infestation and virus disease incidence were higher than the recommended for seed potato production. Therefore, there is need to create awareness among the farmers on aphid and virus symptom recognition and use of clean certified seed potato.

Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, Kenya. The effect of a low-oestrogen combined pill, progestogen-only pill and medroxyprogesterone acetate on oral glucose tolerance test was studied in 29, 30 and 9 indigenous Kenyan women respectively. Glucose tolerance test was performed before treatment was started and then after 1,3 and 6 months in microgynon users. The mean areas under the glucose curves were also significantly elevated. Significant increase in blood glucose values were noted only at 30 minutes after 6 months of use of the progestogen-only oral contraceptive but the mean blood glucose values were higher than in the control after 1,3 and 6 months of use. However, the mean values of the areas under the glucose curves were significantly elevated after 1,3, and 6 months of use. Medroxyprogesterone acetate users showed significantly lower fasting blood glucose values at 60 and 90 minutes after 1 month of use, after which the blood glucose values returned to the pre-treatment values. The mean values of the glucose curve areas showed no significant change. It is concluded that both microgynon and minipill cause relative impairment of glucose tolerance test as early as after 1 month of use. Medroxyprogesterone acetate does not impair oral glucose tolerance for at least the first 6 months of use. The implications of these findings are discussed. PIP: Researchers followed 68 women who attended the Family Welfare Clinic at the Kenyatta National Hospital in Nairobi, Kenya to determine if the low estrogen combined oral contraceptive (OC) Microgynon, a progestogen only OC, and Depo-Provera induce changes in the oral glucose test. These women did not take any steroidal contraceptives before entry into the study. Blood glucose levels were significantly higher after 60, 90 and 120 minutes than the control levels for women taking Microgynon. In addition, the mean areas under the glucose curves were substantially elevated after 1, 3, and 6 months above the control (p.002, .005, and .01 respectively). The only significant change in blood glucose levels in women taking the progestogen only OC occurred at 30 minutes after 6 months. Yet the mean areas under the curve were significantly higher than the control after ,1 2, and 3 months (p.005, .05 and .002 respectively). As for Depo-Provera, significantly lowered blood glucose levels only occurred after 1 month at 30, 50, and 90 minutes although no significant changes occurred after 1, 3, and 6 months in the mean areas under the glucose curves. Metabolic change occurred earlier and more often in Microgynon users than progestogen only OC users. This could be due to the progestogen levonorgestrel which has been shown to interrupt glucose metabolism. These changes could possible adversely effect women who are predisposed to developing diabetes, since 1 woman did develop a diabetic curve after 1 month of using Microgynon. Nevertheless no pattern towards abnormal glucose tolerance existed. Standard deviations of areas under the curves indicated that the number of women who develop glucose intolerance may increase with duration of use.

Loss of 1st and 2nd molars among adolescents due to dental caries is not uncommon in developing countries. Whilst their replacement is indicated, conventional methods of treatment, namely, bridging and dentures are in most cases inaccessible because of prohibitive cost. Given that it is in the same age group that diagnosis of unfavourably embedded wisdom teeth becomes feasible, autotransplantation of the latter to replace the unsalvageable 1st and 2nd molars could be an alternative treatment. Available literature suggests a success rate of over 82% based on follow-up studies of over ten years. Observations at the Dental School Clinic of the University of Nairobi, Kenya, indicate that the time it takes the transplant to 'take' and assume its functional position is 4 to 8 weeks and 2.5 to 3.5 months respectively. Since the method is relatively straightforward, we are of the view that training undergraduates and practising dental surgeons in this technique should enhance utilisation of otherwise "useless" teeth to replace the lost 1st and 2nd molars in occlusal rehabilitation.

S.W. Guthua* and D.L. Mwaniki** Afr. Dental Journal 1992, 6: 30-33 SUMMARY: Analysis of 110 records of patients who presented with impacted mandibular 3 rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilaterial impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions, 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3 rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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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;} Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

Different grades and clones oftea from various parts ofKenya were analysed for total, acid and water labile fluoride using ion selectiveelectrode. It was found that, about 80-99% of total fluoride was acid labile while 40-90% of acid labile was water labile. The fluoridecontent was found to vary with the age of the leaves with the old leaves showing higher fluoride concentration indicate the values (orranges) of fluoride extracts and how they differed with age. High pH resistant clones were found to contain higher fluoride than lowpH resistant.

Myrica salicifolia Hoechst (Myricaceae) root extract was found to have analgesic activity in mice. In rats there was antipyretic but no antiinflammatory activity. Copyright 2002 John Wiley & Sons, Ltd.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

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Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

FG Macigo, DL Mwaniki and SW Guthua East Afr. Med. Journal 1995, 72: 778 - 782 SUMMARY: The prevalence of oral leukoplakia and related lesions in a Kenyan rural population was determined in a systematic house to house survey of individuals aged 15 years and above. Among the 803 individual examined, the following prevalence of lesions was observed: leukoedema (26%), melanosis (12.7%), leukoplakia (10.6%), palatal keratosis (6.4%), frictional keratosis (5.5%), pre-leukoplakia (4.1%), borderline leukoplakia (2.4%), cheek/lip biting (1.3%), and snuff dippers lesion (0.4%), 48.6% of the subjects had at least one of these lesions. Statistically significant preponderance was demonstrated for oral leukoplakia, palatal keratosis, leukoedema and frictional keratosis among males and melanosis among females. With regard to clinical classification of oral leukoplakia, the prevalence was 10% for homogeneous and 0.6% for non-homogeneous lesions. On the basis of aetiological classification, the prevalence was 8.3% for tobacco associated and 2.2% for idiopathic leukoplakia, 22.5% of leukoplakia lesions biopsied had evidence of epithelial dysplasia. In view of the premalignant potential of oral leukoplakia, our findings suggest a need for greater attention towards prevention and control of this lesion in the study community.

PIP: The effects of the triphasic oral contraceptive (OC) ethinyl estradiol (EE) and levonorgestrel (LNG) on lipid and lipoprotein metabolism were evaluated in 97 black Kenyan women. Subjects were recruited from the Family Planning Clinic and were followed for 12 months. There was an increase in fasting levels of total cholesterol. These changes were not statistically significant. However, the triglyceride increase was statistically significant at 9 months and 12 months (p0.05). The high density cholesterol remained unchanged. Thus, this triphasic OC was found to have minimal effect on lipid and lipoprotein metabolism. author's modified

Cancrum oris cases are occasionally treated in various hospitals in Kenya. Despite this, only one case has been reported in literature. Besides, no epidemiological or treatment studies of cancrum oris has been carried out in Kenya. We report an unusual case of a 17 year old Kenyan female with oral cutaneous fistula and tissue atrophy on the left cheek following cancrum oris infection in childhood. Since most cancrum oris cases are a sequela of acute necrotizing gingivitis (ANG), prevention of cancrum oris can be achieved by early and prompt remedial measures once a diagnosis of ANG is established. Failure to do this might lead to cancrum oris with its attendant disfiguring complications some of which might be impossible to treat in developing countries where the requisite personnel is lacking or inadequate.

Background: Multiple Myeloma (MM) is a
haematological cancer characterized by complications
of end-organ damage and subsequently high mortality.
Previously, there were few therapies available with
minimal survival benefit for most patients. Survival
was less than a year in many countries. The survival of
MM patients can range from 6 months to over 10 years,
with a median of 6 years, depending on stage of the
disease at diagnosis and prognostic factors. However,
with the advent of newer immune modulating agents
and novel therapies, there exists an opportunity to
improve the management of MM.
Objective: The purpose of this review is to discuss
the current chemotherapy and novel agents available
for treatment of Multiple Myeloma and highlight
emerging therapies in treatment of Multiple Myeloma,
some of which are now locally available in Kenya.
Data Sources: International Guidelines on Treatment
of Multiple Myeloma; Published articles from peerreviewed
journals; ESMO, NCCN guidelines on
Multiple Myeloma
Conclusion: New MM therapies have been shown to
improve progression-free survival and overall survival
of to upto 82% at four years. Some of these therapies
are now accessible locally through government
funding. In combination with a wholesome approach
which includes appropriate supportive care, there
exists an opportunity to improve the quality and
standard of care of MM patients in Kenya to replicate
the success of that in developed countries.
Key words: Multiple myeloma, Cancer

S.W. Guthua* and D.L. Mwaniki** Afr. Dental Journal 1992, 6: 30-33 SUMMARY: Analysis of 110 records of patients who presented with impacted mandibular 3 rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilaterial impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions, 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3 rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

n/a

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

Measurement of tooth lengths was carried out on 537 extracted human teeth. The teeth were collected from adults aged 17 years and above and preserved in formalin. The tooth lengths were obtained by taking measurements off calibrated graph paper. The lengths obtained in this study were comparable to previous data reported in the literature. However, this new data will provide useful guidelines in Kenya for the management of endodontic patients especially in the purchase and stocking of the most appropriate endodontic instruments.

There is no uniformity in the role of different aetiologic factors in mandibular fractures in different cities of the world. Cultural and socioeconomic factors appear to have important contribution to the aetiologies. The condyle and the angle-body regions are most commonly fractured. There is no obvious relationship between aetiology and the site of fracture. Structural considerations suggest that differences between dentate (open section structure) and non dentate (closed section structure) regions are important determinants of fracture sites. Some modifications of standard teaching materials are recommended.

During a project to determine the fluoride levels of milk in Lake Elementaita region, the authors were astonished by the high levels of fluorosis in children living in the area. With special reference to children, a study was designed to establish and describe the levels of dental fluorosis and also to determine other sources of fluoride to the community. The levels of dental fluorosis were recorded using Thylstrup and Fejerskov classification method (TF) for children aged between 2-14 years. Biodata information, feeding habits and details of fluoride history were collected using a questionnaire form filled out with the help of teachers and/or parents.

Results pertain to both continuous and non-continuous residents for both primary and permanent dentition. The high fluorosis level of 95.8% was associated with the fluoride concentration in the community water supply and food.

Food samples analysed for fluoride include cow’s milk (the major source of nutrients for the children in the area), vegetables and water. Fluoride levels in drinking water from different boreholes were high, varying from 2.0-20.9 ug1mL. Milk fluoride levels in samples from seven localities ranged from 0.05-0.22 ug/mL (mean) and an individual animal range of 0.02-0.34 ug/g. Vegetables had fluoride levels between 7.9-59.3 ug/g with an exception of one with 296.6 ug/g. The soils in which the vegetables are grown had over 1000 ppm. This being a landscape formed by the process of faulting and volcanic activity, the dust from Lake Elementaita also had high fluoride concentration of 2300 ug/g.

Key words: Dental fluorosis; Fluoride sources; Kenya; Milk; Water

Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

A methanol extract of Syzygium guineense bark inhibited intrinsic contractions of rabbit isolated ileum. The inhibition, at bath concentrations of 0.5 - 2.0 mg/ml, was dose-related but non-linear. It produced sustained hypotension in anaesthetized rats. A dose of 5 ug lowered systolic, diastolic and mean blood pressure by 16%, 22% and 17%, respectively below the pre-drug levels. Maximum effect was obtained at a dose of 40 ug when the systolic, diastolic and mean blood pressures fell by 23%, 36% and 28%, respectively below the pre-drug levels. The greater fall in blood pressure was in diastolic than systolic blood pressure. The extract caused a weaker but similar effect to isoprenaline on rabbit isolated heart. While the effect on rabbit isolated ileum supports the folkloric use of the plant as an antispasmodic, further work is required to confirm and categorize the observed pharmacological activities.

No abstract available. PMID: 11957248 [PubMed - indexed for MEDLINE]

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

PIP: The effects of the triphasic oral contraceptive (OC) ethinyl estradiol (EE) and levonorgestrel (LNG) on lipid and lipoprotein metabolism were evaluated in 97 black Kenyan women. Subjects were recruited from the Family Planning Clinic and were followed for 12 months. There was an increase in fasting levels of total cholesterol. These changes were not statistically significant. However, the triglyceride increase was statistically significant at 9 months and 12 months (p0.05). The high density cholesterol remained unchanged. Thus, this triphasic OC was found to have minimal effect on lipid and lipoprotein metabolism. author's modified

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

FG Macigo, DL Mwaniki and SW Guthua East Afr. Med. Journal 1995, 72: 778 - 782 SUMMARY: The prevalence of oral leukoplakia and related lesions in a Kenyan rural population was determined in a systematic house to house survey of individuals aged 15 years and above. Among the 803 individual examined, the following prevalence of lesions was observed: leukoedema (26%), melanosis (12.7%), leukoplakia (10.6%), palatal keratosis (6.4%), frictional keratosis (5.5%), pre-leukoplakia (4.1%), borderline leukoplakia (2.4%), cheek/lip biting (1.3%), and snuff dippers lesion (0.4%), 48.6% of the subjects had at least one of these lesions. Statistically significant preponderance was demonstrated for oral leukoplakia, palatal keratosis, leukoedema and frictional keratosis among males and melanosis among females. With regard to clinical classification of oral leukoplakia, the prevalence was 10% for homogeneous and 0.6% for non-homogeneous lesions. On the basis of aetiological classification, the prevalence was 8.3% for tobacco associated and 2.2% for idiopathic leukoplakia, 22.5% of leukoplakia lesions biopsied had evidence of epithelial dysplasia. In view of the premalignant potential of oral leukoplakia, our findings suggest a need for greater attention towards prevention and control of this lesion in the study community.

PIP: 125 black Kenyan women attending the Kenyatta National Family Welfare Clinic were randomly allocated to combined and fixed dose oral contraceptives (Eugynon: 500 mcg dl-norgestrel + 50 mcg ethinyl estradiol or Microgynon: 150 mcg levonorgestel + 30 mcg ethinyl estradiol). They were between 18-33 years of age with a mean of 25 +or- 7 years. The mean parity of this group was 3 and they had a mean education standard of 8 years. Fasting blood sampled were taken on recruitment (control cycle) and thereafter once for cycles 1, 3, 6, 9, and 12 during OC use. HDL-cholesterol was estimated in the sear. The 2 OCs elicited a significant decrease in levels of HDL-cholesterol (p0.01). author's modified

This study was done as part of a WHO international survey of orofacial mutilations and NOMA cases referred to out-patient clinic and care centers in 1992. Files of 16,000 patients who were treated at the Dental Unit of Kenyatta National Hospital (KNH) were scrutinized for the occurrence of NOMA and other ulcerative oral lesions. Of these, 30% had acute necrotizing ulcerative gingivitis with a male to female ratio of 5:1. 25% had aphthous ulcers with a male to female ratio of 3:2. Equal numbers of patients (10%) had angular cheilitis, aspirin burn and oral candidiasis. Similarly, equal numbers of patients (5%) had NOMA, atypical ulceration and radiotherapy induced ulceration. It was concluded that NOMA and other ulcerative oral lesions were rare among the patients who were treated at the Dental Unit of KNH.

S.W. Guthua* and D.L. Mwaniki** Afr. Dental Journal 1992, 6: 30-33 SUMMARY: Analysis of 110 records of patients who presented with impacted mandibular 3 rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilaterial impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions, 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3 rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

n/a

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

This study was carried out to evaluate the practice and depth of knowledge of root canal treatment and pulpotomy by dentists in Kenya. Questionnaires were prepared and mailed to 114 dentists whose addresses were available. Sixty seven (58.8%) dentists responded. Of these, 67.2% carried out root canal treatment (RCT) and 43.3% carried out pulpotomy. The main reasons given by most dentists in the public hospitals for not carrying out these procedures routinely were lack of facilities and materials. Furthermore, it was found that amongst those who carried out these procedures, some used outdated techniques and materials. In order to reduce the large number of teeth lost through extraction, materials and equipment should be made available to enable dentists carry out root canal treatment and pulpotomies routinely. It is also necessary to have continuing dental education amongst dentists to update their knowledge of these procedures.

There is no uniformity in the role of different aetiologic factors in mandibular fractures in different cities of the world. Cultural and socioeconomic factors appear to have important contribution to the aetiologies. The condyle and the angle-body regions are most commonly fractured. There is no obvious relationship between aetiology and the site of fracture. Structural considerations suggest that differences between dentate (open section structure) and non dentate (closed section structure) regions are important determinants of fracture sites. Some modifications of standard teaching materials are recommended.

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

There is a causal relationship between political leadership and economic development. There is evidence that the deterioration of economic conditions in African since independence is owed to poor management of public economic affairs by the incumbent state leadership. This argument implies that whereas the continent may not be very well endowed with natural resources, this may not be held solely responsible for the existing economic woes. Whatever resources exist are capable of generating economic development, indeed economic breakthrough, if they are harnessed and utilized effectively. Conversely, a country may be endowed with enormous natural and human resources, but may remain characterized by poverty and economic backwardness if it is not endowed with visionary, dedicated and rational political leadership capable of appropriating such resources for the purpose of national development and for the prosperity of the citizens.

Persons with congenital or acquired immunosuppression have long been known to have an increased incidence of lymphoproliferative disorders. Unsurprisingly, therefore, the acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is associated with an increased incidence of lymphoma. Three cases with HIV-associated lymphoma aged 30, 32 and 35 years respectively are presented. Two had cutaneous non-Hodgkin's lymphoma while one had Hodgkin's lymphoma. Standard chemotherapy for lymphoma was given with good tumour regression. Two of the patients died within six months of lymphoma diagnosis due to other complications of HIV.

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

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Gangrenous stomatitis (cancrum oris) is a lesion involving the orofacial structures that is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene. The general clinical features, associated etiologic factors, and ensuing complications in eight consecutive cases diagnosed between 1991 and 1995 are presented and discussed.

Background: Kenya has 12 million female adolescents and youths aged 10-34 years whose reproductive behavior will determine the growth and size of its population for the next decade. The anticipated momentum of births can be slowed by the use of long-acting reversible contraception (LARC) methods as they are more effective, need no user adherence, and hence have no risk of incorrect or inconsistent use. However, in spite of the many health and social benefits, LARC is underutilized because of myths and misconceptions. Kenya is in the ultimate decade towards Vision 2030 and investing in LARC can save costs of health care and accelerate the achievement of the development goal. The objective of this study was to establish factors associated with LARC use, with a view of establishing the potential for increasing demand.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This research examines the relationship between commercial banks (CBs) and the small enterprise sector (SES) and identifies constraints' which impede the flow of financial assistance from the commercial banks to the latter in Kenya. The variables that were examined included; requirements for successful loan application, lending levels, degree of risk attached to small enterprise lending, levels of economic impact and stages in business development at which banks become willing to support. For the small enterprises, the study sought to profile the business and its owner and, to examine its financing. The sampling units were drawn from CBs and SES within Nairobi. In data collection, questionnaires, interview and document review was employed. The study found that high interest rates and long processing procedures kept small businesses away from banks. The study established that, on the part of the banks, the entrepreneurs lacked business management skills and did not keep proper records. Moreover, the banks experienced general reproach from the small business owners, based upon conventional beliefs.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Temporomandibular joint (TMJ) ankylosis is a distressing affliction that denies the victim the benefit of normal diet, careers that require normal speech and causes severe facial disfigurement that aggravates psychological stress. Opinions in current literature portray controversy in its management. Hurried clinicians take shortcuts and partially treat symptoms and often make the condition worse. Others ignore shortcomings and erroneously prescribe their preferred techniques as absolute indication to the peril of the affected children. Gap arthroplasty if applied in a growing maxillofacial skeleton as in children, causes iatrogenic arrest of facial growth. The intended correction of facial disfigurement is therefore not achieved. Early detection and immediate psychological support by excision and reconstruction of ankylosed TMJ with a costochondral graft, improves patient comfort and rehabilitation when used as a planned part of a comprehensive therapy. This paper questions prior varied opinions and discusses scientific baseline considerations in management of long standing TMJ ankylosis in children in relatively affordable circumstances.

Mycotoxins are toxic secondary metabolites of fungal origin and contaminate agricultural commodities before or under post-harvest conditions. They are mainly produced by fungi in the Aspergillus, Penicillium and Fusarium genera. When ingested, inhaled or absorbed through the skin, mycotoxins cause lowered performance, sickness or death on humans and animals. Factors that contribute to mycotoxin contamination of food and feed in Africa include environmental, socio-economic and food production. Environmental conditions especially high humidity and temperatures favour fungal proliferation resulting in contamination of food and feed. The socio-economic status of majority of inhabitants of Sub-Saharan Africa pre-dispose them to consumption of mycotoxin contaminated products either directly or at various points in the food chain. The resulting implications include immuno-suppression, impaired growth, various cancers and death depending on the type, period and amount of exposure. A synergistic effect between mycotoxin exposure and some important diseases in the continent such as malaria, kwashiorkor and HIV/AIDS have been suggested. Mycotoxin concerns have grown during the last few decades because of their implications to human and animal health, productivity, economics of their management and trade. This has led to development of maximum tolerated limits for mycotoxins in various countries. Even with the standards in place, the greatest recorded fatal mycotoxin-poisoning outbreak caused by contamination of maize with aflatoxins occurred in Africa in 2004. Pre-harvest practices; time of harvesting; handling of produce during harvesting; moisture levels at harvesting, transportation, marketing and processing; insect damage all contribute to mycotoxin contamination. Possible intervention strategies include good agricultural practices such as early harvesting, proper drying, sanitation, proper storage and insect management among others. Other possible interventions include biological control, chemical control, decontamination, breeding for resistance as well as surveillance and awareness creation. There is need for efficient, cost-effective sampling and analytical methods that can be used for detection analysis of mycotoxins in developing countries.

PIP: Menstrual blood loss (MBL) was evaluated in 74 nulliporous Kenyan women aged between 20 and 27 years. The hemoglobin levels were all in normal range with the mean of 13.65 +or- 0.8, 13.84 +or- 1.2 and 13.04 +or- 1.2 g/100 ml respectively in 3 populations. The MBL was comparable in the 3 populations with the mean of 35.1 +or- 12.6, 30.6 +or- 8.7 and 32.2 +or- 9.4 ml respectively. There was no difference of statistical significance between the 2 periods studied per each individual. This study objectively assesses the menstrual blood loss in 3 population groups–2 urban and 1 rural. The data can be used to evaluate menstrual blood loss before and after initiation of various contraceptives used in Kenya. Subjects were volunteers who were not on any contraception except barrier or natural rhythm methods, not under psychological stress and who exhibited normal physical female characteristics on examination. Those who wished to drop out, became pregnant or desired contraception, were excluded. The study confirms the individual constancy of the menstrual blood loss in this population. This has important practical implications since a single determination of the menstrual blood loss may be a fairly good expression for the average blood loss in a woman. The immediate effect of various treatments such as IUD insertion or oral contraceptives on the MBL may easily be evaluated quantitatively by measurements in consecutive periods using only 1 period as a control. The quick method can be easily used in evaluating pathological conditions e.g. iron-deficiency due to heavy bleeding, IUD-associated hemorrhage, menorrhagia and uterine fibroid. PMID: 12267056 [PubMed - indexed for MEDLINE]

S.W. Guthua* and D.L. Mwaniki** Afr. Dental Journal 1992, 6: 30-33 SUMMARY: Analysis of 110 records of patients who presented with impacted mandibular 3 rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilaterial impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions, 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3 rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

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Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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BACKGROUND: CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce. OBJECTIVE: The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods. SETTING: The setting was Kenyatta National Hospital (KNH), a teaching and referral center. PATIENTS AND METHODS: A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant. RESULTS: The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data. CONCLUSION: CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.

Joint exhibition of paintings and sculptures

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Analysis of 110 records of patients who presented with impacted mandibular 3rd molars was carried out to determine the frequency of occurrence of unilateral and bilateral impactions and their characteristics. 68.2% of the patients had bilateral impactions. Among the patients with bilateral impactions, 72% had mesioangular impaction occurring either bilaterally or in combination with other types of impaction. Furthermore, 38.7% mesioangular impactions were observed on the right and left sides in the patients with bilateral impactions. Among the patients with unilateral impactions 40.2% presented with mesioangular impaction, while 25.7% presented with distoangular impactions. While these observations support the general consensus regarding aetiology of mandibular 3rd molar impactions as being tooth-tissue discrepancy, the possible influence of other factors is suggested.

Fusarium culmorum is an important pathogen of wheat causing seedling blight, foot rot, and head blight (FHB) or scab. The pathogen is dominant in cooler areas like north, central and western Europe. The fungus reproduces asexually by means of conidia, which form the main mode of dispersal. Head blight is by far the most serious concern of Fusarium infection on pre-harvest wheat and other small grain cereals. The significance of F. culmorum in wheat production is attributed to both head blight and mycotoxin contamination of the grain harvested from infected ears. Ear infection mainly occurs during anthesis and is favoured by wet weather or high humidity and warm temperatures. The major mycotoxins produced by F. culmorum are deoxynivalenol, nivalenol and zearalenone, which are a potential health hazard for both humans and animals. The mycotoxins, especially deoxynivalenol, are believed to play a role in disease development. Available options of managing Fusarium head blight include use of fungicides, cultural practices, resistant varieties and biological agents. However, no wheat variety is completely resistant to Fusarium head blight while fungicides are at most 70% effective against natural infection. This review seeks to document and infer information on F. culmorum, with special emphasis on wheat head blight infection process, mechanisms of mycotoxin production, the role the mycotoxins play in pathogenesis, and the possible management options.

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Analysis of water-labile fluoride in fresh vegetable juices from markets in Kenya was conducted by direct analysis with a fluoride ion selective electrode. Among 20 different vegetable juices, the fluoride content ranged from 1.2 mg FIL to 5.4 mg FIL. Some of the juices contained higher fluoride levels than the limits recommended by the World Health Organization for drinking water. Consumption of vegetable juices for healing therapy has become popular, and it is therefore important to consider the fluoride intake from this source. Calculation of the amount of fluoride that may be ingested from the juices based on the recommended formulations shows that the juices make a significant contribution to daily fluoride intake.

Keywords: Fluoride in juices; Fresh vegetables; Nairobi, Kenya; Vegetable juices; Water-labile fluoride.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

he distribution of cathinone and d-norpseudoephedrine in Catha edit/is plants from 2 different geographical localities has been investigated. There was no difference in the chemical constituents of Catha material from 2 locali-ties. D-norpseudoephedrine was present in all parts of the plant examined except the root but cathinone was only detected in the young shoots and bran-chlets. It is concluded that the psychostinaulant effect following chewing of young Catha shoots is due to both cathinone and d-norpseudoephedrine with the cathinone being more important since it is 7-10 times more potent than d-norpseudoephedrine.

OBJECTIVE: To determine the range of ablative surgery and rehabilitative procedures performed on maxillofacial structures. DESIGN: A retrospective descriptive study. SETTING: University of Nairobi Dental Teaching Hospital. SUBJECTS: Patients operated on at the institutions theatre, and followed up at the University of Nairobi Dental Teaching Hospital Oral Surgery Outpatient Clinic during the period February 1996, August 1998. RESULTS: Forty four patients underwent ablative surgery during the study period. Complete records were available for 38 patients, 27 females and 11 males aged 10 to 79 years (mean 32.6 years). Surgical procedures performed included: partial mandibulectomy, marginal mandibular resection, subtotal maxillectomy, sequestrectomy and enucleation. Six (15.8%) patients who underwent mandibular resection had rigid bone plating. Five (13.2%) patients who had maxillary involvement were given surgical obturators post-operatively with one receiving a complete denture after full recovery. A total of 22 (57.9%) patients who would have reaped benefits from prostheses therapy received none. Individual patient follow-up periods ranged from seven days for two patients who had cyst enucleation to two years for three cases with ameloblastoma, and two cases with squamous cell carcinoma. CONCLUSION: It is concluded that prosthetic rehabilitation of patients undergoing extensive surgery at the University of Nairobi Dental Teaching Hospital is largely inadequate.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

This paper reports on work which was done on the upper Tana in Eastern Kenya. The work revealed a number of iron-using sites which included smelting areas, so-called Gumba earth works and lot of pottery, belonging to triangular incised (TIW) and Kwale Ware. It is concluded that TIW post date Kwale Ware and it is likely the TIW makers/users were responsible for the iron working in the Area.

Persons with congenital or acquired immunosuppression have long been known to have an increased incidence of lymphoproliferative disorders. Unsurprisingly, therefore, the acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is associated with an increased incidence of lymphoma. Three cases with HIV-associated lymphoma aged 30, 32 and 35 years respectively are presented. Two had cutaneous non-Hodgkin's lymphoma while one had Hodgkin's lymphoma. Standard chemotherapy for lymphoma was given with good tumour regression. Two of the patients died within six months of lymphoma diagnosis due to other complications of HIV.

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

OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.

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Although multiple supernumerary teeth without any associated syndromes are rare, their occurrence can create a variety of clinical problems such as derangement of the occlusion, prevention of eruption of permanent teeth, damage to adjacent teeth, cystic degeneration and root resorption. Hence, clinical and radiographic evaluation of patients should always be thorough in order to detect their presence. Furthermore, because the clinical management of multiple supernumerary teeth poses a great challenge to clinicians, timely, appropriate consultation and interdisciplinary approach to treatment is extremely important. We report two cases, a 14 year-old boy with eight and a 13-year-old girl with seven supernumerary teeth not associated with syndromes. In the boy, the teeth were bilaterally distributed in all quadrants in the premolar regions, and in the girl they were distributed bilaterally in the premolar regions in the mandible and bilaterally distal to the upper third molars. The clinical implications and management are discussed.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment