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2013

Cettomai, D, Kwasa JK, Birbeck GL, Price RW, Cohen CR, Bukusi EA, Kendi C, Meyer A-CL.  2013.  Screening for HIV-associated peripheral neuropathy in resource-limited settings., 2013 Oct. Muscle & nerve. 48(4):516-24. Abstract

Peripheral neuropathy is the most common neurological complication of human immunodeficiency virus (HIV) infection but is widely under-diagnosed in resource-limited settings. We investigated the utility of screening tools administered by nonphysician healthcare workers (HCW) and quantitative sensory testing (QST) administered by trained individuals for identification of moderate/severe neuropathy.

Meyer, A-CL, Boscardin JW, Kwasa JK, Price RW.  2013.  Is it time to rethink how neuropsychological tests are used to diagnose mild forms of HIV-associated neurocognitive disorders? Impact of false-positive rates on prevalence and power., 2013 Neuroepidemiology. 41(3-4):208-16. Abstract

Between 0 and 48% of normal HIV-uninfected individuals score below threshold neuropsychological test scores for HIV-associated neurocognitive disorders (HAND) or are false positives. There has been little effort to understand the effect of varied interpretations of research criteria for HAND on false-positive frequencies, prevalence and analytic estimates.

2010

Kwasa, JK, Amayo A, Ndavi PM, Kwasa TOO.  2010.  Bone metabolism in healthy ambulatory control premenopausal women and in epileptics on anti-convulsant drugs., 2010 Apr. East African medical journal. 87(4):151-5. Abstract

Long term anti-epileptic drug use causes multiple abnormalities in calcium and bone metabolism that have been documented in both institutionalised and ambulatory patients.

Kwasa JK, Amayo A, NPMKTO.  2010.  Bone metabolism in healthy ambulatory control premenopausal women and in epileptics on anti-convulsant drugs.. East Afr Med Journal. 87(4):151-155. Abstract

Abstract
BACKGROUND:
Long term anti-epileptic drug use causes multiple abnormalities in calcium and bone metabolism that have been documented in both institutionalised and ambulatory patients.
OBJECTIVE:
To assess bone metabolism in ambulatory females of reproductive age, on antiepileptic drugs.
DESIGN:
Cross sectional comparative study.
SUBJECTS:
Ambulatory females in reproductive age group with epilepsy and on regular follow up were compared to healthy females of similar ages not on any treatment.
RESULTS:
The mean duration of treatment for epilepsy was eight years (+/- 6.3). Majority of the patients were on enzyme inducing drugs like phenobarbital, phenytoin, carbamazepine and valproate, either alone or in combination with non-enzyme inducers like lamotrigine (98.2%). There was a significantly lower mean serum calcium and a higher alkaline phosphatase level among the patients (P = 0.002 and 0.0001 respectively) than among the comparators. The urinary marker of bone loss (mean urine calcium excretion) was also significantly raised among the patients (P=0.003). The mean lumbar BMDT-score results were not significantly different in the two groups.
CONCLUSIONS:
Long-term anti-epileptic drug use significantly affects biochemical parameters of bone metabolism. These effects on bone biochemistry markers were not reflected in lumbar spine BMD in this study.

Munyoki G, Edwards T, WKCKOVMSJWNBGNCRSTEG.  2010.  Clinical and neurophysiologic features of active convulsive epilepsy in rural Kenya: a population-based study.. Epilepsia. 51 Abstract

Abstract
PURPOSE:
Epilepsy is common in sub-Saharan Africa but is poorly characterized. Most studies are hospital-based, and may not reflect the situation in rural areas with limited access to medical care. We examined people with active convulsive epilepsy (ACE), to determine if the clinical features could help elucidate the causes.
METHODS:
We conducted a detailed descriptive analysis of 445 people with ACE identified through a community-based survey of 151,408 people in rural Kenya, including the examination of electroencephalograms.
RESULTS:
Approximately half of the 445 people with ACE were children aged 6 to 18 years. Seizures began in childhood in 78% of those diagnosed. An episode of status epilepticus was recalled by 36% cases, with an episode of status epilepticus precipitated by fever in 26%. Overall 169 had an abnormal electroencephalogram, 29% had focal features, and 34% had epileptiform activity. In the 146 individuals who reported generalized tonic-clonic seizures only, 22% had focal features on their electroencephalogram. Overall 71% of patients with ACE had evidence of focal abnormality, documented by partial onset seizures, focal neurologic deficits, or focal abnormalities on the electroencephalogram. Increased seizure frequency was strongly associated with age and cognitive impairment in all ages and nonattendance at school in children (p < 0.01).
DISCUSSION:
Children and adolescents bear the brunt of epilepsy in a rural population in Africa. The predominance of focal features and the high proportion of patients with status epilepticus, suggests that much of the epilepsy in this region has identifiable causes, many of which could be prevented.

2009

Mugambi-Nturibi E, Otieno CF, KTOOGOAK.  2009.  Stratification of persons with diabetes into risk categories for foot ulceration.. East Afr Med Journal. 86(5):233-239.. Abstract

Abstract
BACKGROUND:
Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.
OBJECTIVE:
To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.
DESIGN:
Cross-sectional descriptive study over five months period.
SETTING:
Diabetic outpatient clinic, at the Kenyatta National Hospital.
SUBJECTS:
Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.
RESULTS:
The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0--no neuropathy, 10% were placed in group 1--neuropathy alone, 16% were put in group 2--neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3--previous foot ulceration/amputation.
CONCLUSION:
More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (IWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally.

2008

Edwards T, Scott AG, MOVMCBKSLWNBGNCRGEE.  2008.  Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors.. Lancet Neurology. 7(1)(7(1)):50-56. Abstract

Abstract
BACKGROUND:

Few large-scale studies of epilepsy have been done in sub-Saharan Africa. We aimed to estimate the prevalence of, treatment gap in, and possible risk factors for active convulsive epilepsy in Kenyan people aged 6 years or older living in a rural area.
METHODS:

We undertook a three-phase screening survey of 151,408 individuals followed by a nested community case-control study. Treatment gap was defined as the proportion of cases of active convulsive epilepsy without detectable amounts of antiepileptic drugs in blood.
FINDINGS:

Overall prevalence of active convulsive epilepsy was 2.9 per 1000 (95% CI 2.6-3.2); after adjustment for non-response and sensitivity, prevalence was 4.5 per 1000 (4.1-4.9). Substantial heterogeneity was noted in prevalence, with evidence of clustering. Treatment gap was 70.3% (65.9-74.5), with weak evidence of a difference by sex and area. Adjusted odds of active convulsive epilepsy for all individuals were increased with a family history of non-febrile convulsions (odds ratio 3.3, 95% CI 2.4-4.7; p<0.0001), family history of febrile convulsions (14.6, 6.3-34.1; p<0.0001), history of both seizure types (7.3, 3.3-16.4; p<0.0001), and previous head injury (4.1, 2.1-8.1; p<0.0001). Findings of multivariable analyses in children showed that adverse perinatal events (5.7, 2.6-12.7; p<0.0001) and the child's mother being a widow (5.1, 2.4-11.0; p<0.0001) raised the odds of active convulsive epilepsy.
INTERPRETATION:

Substantial heterogeneity exists in prevalence of active convulsive epilepsy in this rural area in Kenya. Assessment of prevalence, treatment use, and demographic variation in screening response helped to identify groups for targeted interventions. Adverse perinatal events, febrile illness, and head injury are potentially preventable associated factors for epilepsy in this region.

Kariuki JG, Joshi MD, AAMKTOMM.  2008.  Fertility rate of epileptic women at Kenyatta National Hospital.. East Afr Med Journal. 85(7):341-346.. Abstract

Abstract
BACKGROUND:

Reproductive health issues of women with epilepsy (WWE) are complex and multifaceted, and both epilepsy and antiepileptic drug (AEDs) use may alter fertility and pregnancy outcomes in these women.
OBJECTIVE:

To determine the fertility rate of women with epilepsy at Kenyatta National Hospital (KNH).
DESIGN:

Cross-sectional study.
SETTING:

Neurology clinic, KNH, Nairobi, Kenya, between October 2006 and March 2007.
SUBJECTS:

A total of 191 women with epilepsy (aged 15-49 years) who had been epileptic for at least one year were interviewed regarding their pregnancy and birth histories, and the information validated with medical records where available.
RESULTS:

The general fertility rate (GFR) for reproductive-aged epileptic women for the three-year period (2003-2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.13-63.59).
CONCLUSION:

Fertility rate in epileptic women is decreased by two thirds (compared to that of general population of women in Kenya). Reasons for this are probably miltifactorial.

2003

FREDRICK, DROTIENOCF, O DRKWASATHOMASO.  2003.  Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi. East Afr Med J. 2003 Aug;80(8):406-10.. East Afr Med J. 2003 Aug;80(8):406-10.. : uon Abstract
BACKGROUND: Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. OBJECTIVE: To determine the glycaemic control of ambulatory diabetic patients. DESIGN: Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. SETTING: Kenyatta National Hospital. METHODS: Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. RESULTS: A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c < or = 8% while 60.5% had HbA1c > or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. CONCLUSION: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and deteriorating diabetes. There is need to empower patients with knowledge and resources to enhance their individual participation in diabetes self-care. Diabetes care providers and facilities also need capacity building to improve care of patients with diabetes.

2002

O, DRKWASATHOMASO.  2002.  Herpes zoster myelitis: report of two cases. East Afr Med J. 2002 May;79(5):279-80.. East Afr Med J. 2002 May;79(5):279-80.. : uon Abstract
Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.
O, DRKWASATHOMASO.  2002.  Amayo EO, Kwasa TO, Otieno CF. Herpes zoster myelitis: report of two cases. East Afr Med J. 2002 May;79(5):279-80.. East Afr Med J. 2002 May;79(5):279-80.. : uon Abstract
Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.
OLONDE, PROFAMAYOERASTUS, O DRKWASATHOMASO.  2002.  Amayo EO, Kwasa TO, Musau CK, Mugo N, Wambani J. Primary intracerebral haemorrhage complicated by cerebral abscess: case report. East Afr Med J. 2002 Mar;79(3):163-4.. East Afr Med J. 2002 Mar;79(3):163-4.. : uon Abstract
A case of primary intracerebral haemorrhage complicated by cerebral abscess is presented with a review of the literature.

1996

O, DRKWASATHOMASO.  1996.  Kokwaro GO, Kwasa TO, Indalo AA, Kibwage IO.Steady-state anticonvulsant drug levels in epileptic patients. East Afr Med J. 1996 Oct;73(10):679-82.. East Afr Med J. 1996 May;73(5):323-6.. : uon Abstract
Steady state concentrations of three anticonvulsant drugs (phenobarbitone, phenytoin and carbamazepine) were measured in plasma samples from fifteen patients (eight males and seven females; ages: 13-49 years; body weights: 44-70 kg), attending the outpatient Neurology Clinic at Kenyatta National Hospital. In addition, total protein and albumin levels were measured in plasma from patients taking phenytoin. Total protein levels were normal (range: 6.3-7.6 g/dl) in all patients except in one patient (10.7 g/dl). Albumin levels were also normal (range: 3.7-4.1 g/dl) in all patients except one (25.4 g/dl). One patient on phenobarbitone and three patients on phenytoin had no detectable drug levels in their plasma. In the remainder, phenobarbitone, phenytoin and carbamazepine steady state concentrations were 8.7-21.1 mg/L (N = 8), 9.3-27.3 mg/L (N = 6) and 10-19.7 mg/L (N = 5), respectively. The unbound fraction of phenytoin in plasma (fu) was normal(approximately 0.1) in six patients, but relatively high (0.2) in one patient. Most patients in the study complied with the prescribed treatment and their epilepsy was controlled. Cases where drug levels were undetectable probably arose from a lack of money to purchase all prescribed medicines rather than deliberate non-compliance. Routine monitoring of anticonvulsant drug levels may improve management of epileptic patients.
M, PROFBHATTSHRIKANTBABU, O DRKWASATHOMASO.  1996.  Mbuya SO, Kwasa TO, Amayo EO, Kioy PG, Bhatt SM. Peripheral neuropathy in AIDS patients at Kenyatta National Hospital. East Afr Med J. 1996 Aug;73(8):538-40.. East Afr Med J. 1996 Aug;73(8):538-40.. : uon Abstract
Between June and December 1992 forty AIDS patients as defined by the CDC criteria, admitted to the medical wards of the Kenyatta National Hospital, were studied to determine the prevalence and pattern of peripheral neuropathy. Their mean age was 33 +/- 3 years with a range of 16 to 55 years. Clinical and laboratory assessment were carried out both to confirm peripheral neuropathy and exclude other causes of peripheral neuropathy apart from AIDS. All the patients had nerve conduction and electromyographic studies done. Eighteen patients were asymptomatic while fourteen had both signs and symptoms. The commonest symptom was painful paresthesiae of the limbs (35%) while the commonest sign was loss of vibration sense (60%). When symptoms, signs, and electrophysiological studies were combined, all the patients fitted the definition of peripheral neuropathy. The commonest type of peripheral neuropathy was distal symmetrical peripheral neuropathy (DSPN) (37.5%). PIP: In Kenya, physicians evaluated 40 AIDS patients admitted to Kenyatta National Hospital during June-December 1992 to determine the prevalence and types of peripheral neuropathy in AIDS patients. 75% were 21-40 years old. 18 (45%) of the 40 AIDS patients had symptoms of peripheral neuropathy. Symptoms included increased sensitivity to stimulation (43%), hyperpathia (15%), and muscle or limb weakness (13%). 26 AIDS patients had signs of peripheral neuropathy, especially impaired sense of vibration (60%). 14 of these patients had both signs and symptoms. Electromyographic and nerve conduction velocity revealed peripheral neuropathy in 16 (40%) AIDS patients. The types of peripheral neuropathy included distal symmetrical peripheral neuropathy (37.5%), polyneuropathy, and mononeuritis multiplex. When the symptoms, signs, and electroneurophysiological test findings were considered, all 40 AIDS patients had evidence of peripheral neuropathy.
O, DRKWASATHOMASO.  1996.  Oluka MO, Mitema ES, Kibwage IO, Kwasa TO, Kokwaro GO. A comparative bioavailability of four Carbamazepine tablet formulations available in the Kenyan market. East Afr Med J. 1996 May;73(5):323-6.. East Afr Med J. 1996 May;73(5):323-6.. : uon Abstract
The relative bioavailabilities of three carbamazepine tablet formulations available in the Kenyan market (Temporal(R), Taver(R) and Carbamazepine Lincoln) compared with the innovator formulation (Tegretol(R)) were evaluated in seven healthy African volunteers (5 males, two females; aged 22-36 years), according to a randomised fourway crossover study design, following oral administration of single 200 mg doses with a three week washout period. In vitro dissolution profiles of the tablets were also evaluated. Relative bioavailabilities ((F)rel) of Temporal(R), Taver(R) and Carbamazepine Linocoln were 101.2%, 82.2% and 71.6% respectively, compared with Tegretol(R). Percent drug content dissolved in vitro after I hour were 91.3%, 75.9% and 39.3% for Temporal(R), Taver(R) and Carbamazepine Lincoln, respectively. It was concluded that Temporal(R) was bioequivalent to Tegretol(R) while Taver(R) and Carbamazepin Lincoln were bioinequivalent to Tegretol(R). Administration of Taver(R) or Carbamazepine Lincoln might lead to poor control of epileptic seizures.

1995

O, DRKWASATHOMASO.  1995.  Kwasa TO. Neurological manifestations of human immunodeficiency virus infection and acquired immune deficiency syndrome: a review. East Afr Med J. 1995 Oct;72(10):664-8. Review.. East Afr Med J. 1995 Oct;72(10):664-8.. : uon Abstract
Neurological manifestations of HIV/AIDS is reviewed and discussed. It is noted that neurological manifestations are some of the commonest modes of clinical presentation of HIV/AIDS. At autopsy, the prevalence approaches 100%. These manifestations include: involvement of the higher functions, craniopathies, spinal cord disease, peripheral neuropathy and muscle disease. It is therefore stressed that the central nervous system must be particularly assessed in patients with HIV/AIDS and where the clinician is not sure of the neurological diagnosis, a referral to the neurologist is recommended as some of these are treatable
O, DRKWASATHOMASO.  1995.  Kwasa TO. The diagnosis and management of migraine. East Afr Med J. 1995 Aug;72(8):477-8. No abstract available.. East Afr Med J. 1995 Aug;72(8):477-8.. : uon Abstract
Neurological manifestations of HIV/AIDS is reviewed and discussed. It is noted that neurological manifestations are some of the commonest modes of clinical presentation of HIV/AIDS. At autopsy, the prevalence approaches 100%. These manifestations include: involvement of the higher functions, craniopathies, spinal cord disease, peripheral neuropathy and muscle disease. It is therefore stressed that the central nervous system must be particularly assessed in patients with HIV/AIDS and where the clinician is not sure of the neurological diagnosis, a referral to the neurologist is recommended as some of these are treatable
O, DRKWASATHOMASO.  1995.  Kwasa TO, Jowi JO, Amayo EO.Efficacy and tolerability of oral sumatriptan in the treatment of acute migraine.East Afr Med J. 1995 Aug;72(8):479-82.. East Afr Med J. 1995 Aug;72(8):479-82.. : uon Abstract
An open prospective study of the efficacy and tolerability of oral sumatriptan in the treatment of acute migraine attacks at the Kenyatta National Hospital, Nairobi, Kenya, is presented. Thirty two patients were initially recruited and 24 completed the trial giving a drop-out rate of 25%. The age range was 17 to 55 years with a mean of 35 years. Sumatriptan was found to be effective in 22 (92%) out of 24 patients. Side effects occurred in 38% (9/24) patients. These were mild and transient and included nausea, vomiting, numbness of limbs, fever and a feeling of heat in the head. It is concluded that oral sumatriptan is an effective drug in the treatment of acute migraine headaches. It has few side effects and is well tolerated by majority of patients.

1994

O, DRKWASATHOMASO.  1994.  Munyao TM, Bwayo JJ, Owili DM, Ndinya-Achola JO, Kwasa TO, Kreiss JK. Human immunodeficiency virus- 1 in leprosy patients attending Kenyatta National Hospital, Nairobi. East Afr Med J. 1994 Aug;71(8):490-2.. East Afr Med J. 1994 Aug;71(8):490-2.. : uon Abstract
The purpose of this study was to determine if Mycobacterium leprae is an opportunistic pathogen in immunosuppressed subjects with HIV infection. Ninety six leprosy patients at Infectious Diseases Hospital (IDH), Nairobi were screened for, HIV-1 antibody between January 1991 and June 1992. The patients included 15 who were diagnosed during the study period and 81 who were previously diagnosed and were on anti-leprosy treatment. Blood was screened for HIV antibody by first ELISA and double positive samples were confirmed by a second ELISA. The HIV seronegative patients were re-tested serologically every 3 months. Smears from skin slits were used to determine bacterial index and the patients were classified according to criteria described by Ridley and Jopling. The patients were re-assessed clinically monthly. The mean age of the patients was 40 years and ranged from 13 to 78 years. Forty seven percent had paucibacillary and 53% had multibacillary leprosy. The HIV seroprevalence was 8% in previously diagnosed patients and zero in the newly diagnosed patients. There were no changes in clinical spectrum in HIV seropositive patients during follow up period; neither reversal reactions nor erythema nodosum leprosum were observed. The study suggests that M. leprae may not be an opportunistic pathogen in immunosuppressed subjects with HIV infection.

1993

O, DRKWASATHOMASO.  1993.  Kwasa TO, Townes B, Hill H, Carr J, Mwai S, Schaffer R. Related Articles, Links Behavioural mechanisms in AIDS patients under stress. East Afr Med J. 1993 Jan;70(1):43-5.. East Afr Med J. 1993 Jan;70(1):43-5.. : uon Abstract
Clinical observation at the Kenyatta National Hospital showed unusually rapid deterioration of patients testing seropositive to HIV infection and being moved to a side room for nursing. This pilot study tested the hypothesis that deterioration was at least partly, mediated by B-endorphins and other endogeneous opioids. The study design was a prospective and comparative study looking at 6 HIV seropositive and 10 control (HIV seronegative) patients matched for sex, age, and clinical status at time of study. The laboratory measures compaired were baseline, and daily serum B-endorphin and ACTH. A significant variation is noted between the two groups. The significance of this study is discussed. PIP: From among patients hospitalized at Kenyatta National Hospital, 6 subjects diagnosed as HIV positive by at least one HIV ELISA antibody test and 10 HIV negative control patients were enrolled into a study and matched for age, sex, level of education, and ethnic group. A baseline blood sample was obtained from each patient at 2.00 p.m. for complete blood count biochemical assays for B endorphin and adrenocorticotropic hormone (ACTH) as well as an HIV ELISA test. HIV positive patients were informed of ELISA test results and transferred to isolation rooms. Blood was drawn on the next 3 consecutive days. Concentration of ACTH was measured by radio-immunoassay. B-endorphin assay was almost the same as for ACTH. Assay sensitivity was 5 pg/ml with a range of 5-500 pg/ml. Multivariate and univariate analyses of variance with repeated measures were used to evaluate the differences in biochemical responses between HIV positive (under stress) patients and HIV negative (with no stress) patients. (ACTH and B endorphin concentrations in plasma were obtained on the day of diagnosis and at different times 1 and 72 hours thereafter. Change scores (pre-post 72 hours) in plasma ACTH and B- endorphin concentrations support the hypothesis that patients diagnoses to have AIDS experience stress mediated biochemical changes. The change score distributions predominantly indicated elevated concentrations of each neurohormone. By contrast, HIV, negative patients exhibited more random patterns of change following diagnosis. The results could be used in situations of stress-induced immuno-incompetency. Identification of significant effect of stress on neuroendocrine response and immune competence in patients diagnoses as HIV positive may suggest methods of prolonging the life of patients who otherwise have no definitive treatment. B endorphin antagonists such as Naltrexone may exert beneficial effects in selected HIV positive patients by modifying the endogenous opioid systems.

1992

O, DRKWASATHOMASO.  1992.  Kwasa TO, Muthingi PM. The experience with electroencephalography at the Kenyatta National Hospital, Nairobi. East Afr Med J. 1992 May;69(5):259-61.. East Afr Med J. 1992 May;69(5):259-61.. : uon Abstract
Review of electroencephalography (EEG) requests at KNH over a 3 year period is presented. Majority of patients were aged between 0 and 10 years. None was older than 80 years. The epilepsies were the commonest reason for requesting EEG (58.5%). SSPE had the highest positivity rate of 91.7% followed by convulsive states of uncertain aetiology. The symptom of headache by itself was the least rewarding to study by EEG. It was more rewarding to first attempt to make a diagnosis of the headache. Hysteria had an EEG positivity rate of 40%, most of them being epilepsy. EEG picture for petit-mal, epilepsy focal seizure and generalized seizures are included in the text.
O, DRKWASATHOMASO.  1992.  Kwasa TO. The pattern of neurological disease at Kenyatta National Hospital. East Afr Med J. 1992 May;69(5):236-9.. East Afr Med J. 1992 May;69(5):236-9.. : uon Abstract
A retrospective survey of neurological disease seen at KNH in medical wards and medical outpatients clinics is presented. Neurological diseases constituted 7.5% of all medical conditions seen over that period. Infections especially meningitis were found to be the commonest. The 3 commonest diseases were meningitis (23.1%), epilepsy (16.6%) and cerebrovascular diseases (15.0%). Neurosyphilis, trypanosomiasis, and leprosy only infrequently seen (1-2 cases annually). Multiple sclerosis seen regularly through infrequently since 1981. The trend of the 3 commonest conditions is presented and a downward trend is noted. The mortality patterns for the 3 commonest diseases is also presented.
O, DRKWASATHOMASO.  1992.  Oduor DO, Bwayo JJ, Bhatt SM, Kwasa TO, Maitha GM, Ombette JO. Multiple sexually acquired diseases occurring concurrently in an HIV positive man: case report, diagnosis and management. East Afr Med J. 1992 Jun;69(6):345-6.. East Afr Med J. 1992 Jun;69(6):345-6.. : uon Abstract

A case of an HIV positive man with multiple sexually acquired disease occurring concurrently is described. Risk behaviours that could have predisposed him to HIV infection are discussed. The factors which might have interacted to make the sexually acquired infections severe and difficult to treat are postulated.

PIP: The case of an HIV-seropositive man with gonorrhea, syphilis, genital warts, and chancroid is described. Multiple sexual partners, genital ulcer diseases, and lack of circumcision may have predisposed him to HIV infection. As indicated by his CD4/CD8 ratio of 0.5, his immunological status was not very compromised. Other factors were therefore probably behind these multiple sexually transmitted diseases (STD). This 30-year old man was inadequately treated for a long time for urethral discharge and genital ulcer disease, and ultimately collapsed on the job with a comprised central nervous system. Bacterial infection related to the multiple STDs could certainly have caused this collapse. The time demands of this man's work, the lack of medical facilities to diagnose and treat such conditions, his unprotected sexual behavior with multiple partners, and broader socioeconomic conditions which separate wage- earning males from their families in Africa conspire to produce multiply-afflicted cases such as these.

1991

OLONDE, PROFAMAYOERASTUS, O DRKWASATHOMASO.  1991.  Amayo EO, Kwasa TO.HIV and acute peripheral facial nerve palsy.East Afr Med J. 1991 Dec;68(12):948-51. East Afr Med J. 1991 Dec;68(12):948-51. : uon Abstract
Between April and December 1989, 32 consecutive patients referred to the neurology clinic with acute peripheral facial paralysis were studied. Patients with traumatic facial palsy, parotid gland disease, otitis media and meningitis were excluded. Each of the patients selected had HIV test done by ELISA and the positive ones confirmed by Western blot. 8 (25%) of the patients tested positive for HIV antibodies. Their mean age was 34 +/- 13 years with an age range of 15-53 years. 4 (50%) of the 8 seropositive patients had generalized lymphadenopathy, one herpes zoster, one generalized pruritic rash, two of the patients were asymptomatic. The seroprevalence of HIV antibodies in patients with acute peripheral facial paralysis is much lower than that reported in other African countries. PIP: Between April-December 1989, physicians at the neurology clinic of the Kenyatta National Hospital in Nairobi, Kenya recruited 32 patients who exhibited facial nerve palsy of lower motor neuron type and who did not have any trauma, inflammation of the middle ear, surgery, or disease of the parotid gland. 8 (25%) of the patients were HIV seropositive. Researchers did not retest any of the seronegative patients for HIV. 6 of the HIV seropositive cases had symptoms of early HIV infection: 4 generalized lymphadenopathy, 1 herpes zoster, and 1 generalized pruritic rash. The 2 other HIV seropositive patients did not have any symptoms other than facial paralysis. Several other studies have demonstrated an association between HIV infection and acute peripheral facial paralysis, especially in asymptomatic or AIDS related complex patients. In a study in Bangui, Central African Republic, HIV seroprevalence among patients with acute peripheral facial paralysis was 69%. The researchers could not identify the reason for the difference between the HIV seroprevalences of the 2 studies. Nevertheless physicians should expect to treat more cases of acute peripheral facial paralysis as the prevalence of HIV increases

1990

O, DRKWASATHOMASO.  1990.  Kwasa TO, Ogada SW. The management of cerebral malaria in a provincial general hospital in Kenya. East Afr Med J. 1990 Aug;67(8):568-72.. East Afr Med J. 1990 Aug;67(8):568-72.. : uon Abstract
The practice of physicians at the Nakuru Provincial General Hospital (NPGH), Kenya, when dealing with cerebral malaria is reviewed over a 4-month period. The definition, management, and outcome of patients labelled to have cerebral malaria is presented and criticism of their practice offered in a manner applicable to other rural hospitals in Kenya.
O, DRKWASATHOMASO.  1990.  Kwasa TO Stroke at Kenyatta National Hospital. East Afr Med J. 1990 Jul;67(7):482-6.. East Afr Med J. 1990 Jul;67(7):482-6.. : uon Abstract
Seventy two patients presenting with stroke to Kenyatta National Hospital were studied between January 1986 and January 1987. The majority were from the rural areas. There were about equal numbers between left and right sided hemipareses. The majority of the patients were in their 6th and 7th decades. 22 of the patients were hypertensive. Diabetes mellitus, cigarette smoking, alcohol consumption, and valvular heart disease were some of the other factors associated with strokes. 46% of the patients died while the remainder had residual neurological deficits.

1987

Kwasa, TOO.  1987.  A Study Of Clinical And Laboratory Features In Stroke Patients At The Kenyatta National Hospital.. Abstract

This is both a retrospective as well as a prospective study conducted from January 1986 to January, 1987 at KNH involving 72 stroke patients.
Thirty point four per cent of the patients were found to hypertensive. The majority were found to be from the Central Province- More patients were rural dwellers than urban dwellers. The majority y of the hypertensive patients were either first diagnosed at admission for stroke or had had poor control of their hypertension, Most hypertensive
patients were old, (> 45 years).
Laboratory investigations showed hypertriglyceridemia, hyperuricemia, renal insufficiency, and high ESR to be common amongst stroke patients. Syphilis was not found in any of the patients.
The young normotensive patients were examined and some possible aetiological factor identified in all except four.
Recommendations are made as to' further work
and prevention against stroke.

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