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COLPOSCOPIC EVALUATION OF PATIENTS WITH ABNORMAL CERVICAL CYTOLOGY
No full textBackground: With stringent cervical cytology screening programs for women in reproductiveage group, cervical cancer is, to a large extent, preventable. Back-up confirmatory colposcopicevaluation is necessary in order for cytology to have impact on cervical cancer-related morbidityand mortality.Objectives: To track the management outcomes of abnormal cervical cytology and hence confercredence to the value of colposcopy in management of abnormal cervical cytology.Design: Retrospective descriptive study.Setting: Kenya Medical Women Association Colposcopy Clinic.Main outcome measures: Correlation of cervical cytologic abnormalities with colposcopic outcomesand eventual management outcomes.Results: The population was young, with 50.6% being 25-34 years old, and 59.3% less than 35 yearsof age. Parity was also low, with nearly 75% being para three or less. A substantial proportion ofwomen had normal colposcopic findings (42.0, 26.7, 18.6 and 11.1% for cytologic abnormalities CINI, CIN II, CIN III and invasive carcinoma respectively). Colposcopic abnormality detection rate,irrespective of the severity of the lesion, increased with severity of cytologic lesion (from 58.0%CIN I to 89.0% for invasive carcinoma). The sensitivity of cervical cytology was 58, 59 and 65%for CIN I,II and III respectively, while respective specificity was 72, 71 and 85%. The concordancerates between cytological and colposcopic findings were 38.6, 32.5 and 60% for CIN I, II and IIIrespectively. The eventual management outcome was operative (LEEP and Hysterectomy) in greaterfrequency as the severity of the cytologic lesion increased.Conclusion: Colposcopy has significant impact on the management outcomes of abnormal cervicalcytology and is therefore an invaluable procedure in management of abnormal cervical cytology.For this reason, it is imperative that governments avail these services to all women, in addition toenforcing regular cytologic screening for cervical cancer
CORONARY HEART DISEASE AND ITS ELECTROCARDIOGRAPHIC MANIFESTATIONS IN WESTERN KENYA
No full textABSTRACTObjective: To review the literature on coronary heart disease (CHD) and itselectrocardiogram (ECG) manifestations in Eastern Africa and provide medical educationby increasing awareness and strengthening recognition skills of myocardial infarction(MI) through discussion of key features from representative ECGs selected from theMoi Teaching and Referral Hospital (MTRH) ECG service in Eldoret, Kenya.Data source: Peer reviewed published articles found using a Medline search. ECGs werereproduced with one complex from each of the 12 standard leads, without patient’sname or other identifying information.Conclusion: CHD and its risk factors are increasing in prevalence in Eastern Africaover recent years. The ECG remains integral to the diagnosis of acute coronarysyndromes, including MI. Representative ECGs from MTRH demonstrate the variousfeatures of the common anatomical distributions of MI, enabling medical education.Recognition of CHD and its ECG manifestations is one step on the path to decreasingresultant morbidity and mortality
Campylobacter enteritis in Ilorin, Nigeria
No full textBackground: Campylobacter jejuni/coli is one of the most commonly identified bacterial causes of acute gastroenteritis worldwide. In Nigeria, it has been reported in the northern part of the country, extensive work has also been done in the south-west leaving behind the middle-belt of the country.Objective: To determine the role of Campylobacter jejuni/coli as an agent of diarrhoea in the middlebelt of Nigeria.Design: A prospective case control study.Setting: University of Ilorin Teaching Hospital (UITH), private hospitals and primary health centers all in Ilorin, Nigeria.Subjects: Three hundred and six children with diarrhoea and 100 without diarrhoea were randomly selected.Main outcome measures: Isolation of Campylobacter jejuni/coli from stool samples. Biological characteristics of the isolates.Results: Twenty five (8.2%) of the patients and none of the controls had the organism. Campylobacter jejuni and C. coli were 56% and 44% respectively. All the isolates were susceptible to erythromycin and ciprofloxacin. None of the isolates harboured plasmids.Conclusion: C. jejuni/ coli is an important diarrhoea agent in our geographic environment, further characterisation is desired of these local strains
SERUM LEPTIN CONCENTRATION IN A RURAL AFRICAN POPULATION
No full textObjective: To determine the serum leptin concentration in a cohort of healthy rural Africans,it's relation to the commonly used anthropometric measures of obesity and its relation to thepatterns of distribution of fat in the body.Design: A cross-sectional population survey.Setting: Baziya area, Transkei region, South Africa.Subjects: One hundred and thirty five(79 females and 56 males) healthy adults from theBaziya location, Transkei aged 17-70 years were selected by stratified random sampling.Measurements: Anthropometric measurements of height, weight, and skinfold thickness atthe biceps, triceps, subscapular and suprailiac sites and derived total body fat and ratios offat distribution. Fasting serum leptin using the sandwich ELISA method.Results: Skinfold measurement wassignificantly higher in the females than the males throughoutthe age range. Centralisation of body fat to the trunk was significantly greater in the males thanin the females. Serum leptin concentration was higher in the females (mean = 13.5 ng/ml; 95 %confidence interval = 10.0 - 16.8) than in the males (mean = 5.2 ng/ml; 95 % confidence interval= 2.8 - 7.6) (p<0.001). The gender difference in leptin concentration persists when expressed asserum leptin per kilogram of fat mass (serum leptin (ng/ml)/FM). The mean value for the maleswas 5.1 ng/ml/kg (95 % confidence interval = 2.9 - 7.3) compared to the mean value for femalesof 6.9 ng/ml/kg (95 % confidence interval = 5.4 - 8.3)(p<0.05). In the females BMI and body fatwere significant contributors to the variance in serum leptin. In the males the upper-to-lowertrunk skinfold thickness ratio and BMI were the significant contributors to the variance inserum leptin concentration. Deposition of fat in the abdomen did not have a significantcontribution to the variance in circulating leptin in both sexes.Conclusion: Serum leptin concentration in rural Africans is similar to that observed in othercommunities with the exception that regional fat distribution has a significant influence onthe leptin levels in the males
CHILDHOOD POISONING AT THE QUEEN ELIZABETH CENTRAL HOSPITAL, BLANTYRE, MALAWI
No full textObjectives: To record the number of children with poisoning admitted to the Queen ElizabethCentral Hospital over one year; to note the causes, clinical and laboratory findings andoutcome of each poisoning event and; to highlight any preventable pattern in such events.Design: A one year prospective study was undertaken of all children admitted to the QueenElizabeth Central Hospital with a history or clinical evidence of acute poisoning. Sociodemographic,clinical and laboratory data were recorded and outcome noted for each childon specially prepared forms. Data were entered and then analysed in Epi-Info 6.Setting: Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi.Interventions: Children were treated for poisoning according to national guidelines; supportivecare and active antidote were given as necessary.Main outcome measures: Length of stay in hospital and mortality were primary outcomemeasures.Results: One hundred and forty four cases were admitted, 118 (82%) were accidental, in 19cases the reason was unknown and six (4.2%) were non accidental. Carbonate poisoningcaused 32% (n=46) of admissions and paraffin 16.7% (n=24). The age range of poisonedchildren was three weeks to 14 years with a mean of four years and eight months. Elevendeaths occurred, six of which were due to traditional medicine intoxication.Conclusion: Most poisoning were preventable and the public needs to be made aware of thedangers of household agents, advised how to store them in the home and what to do if a childingests a poisonous substance. Traditional medicines are particularly dangerous to give toinfants less than one year old and carry a high mortality
LOWER LIMB AMPUTATIONS AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the causes and pattern of lower limb amputations at the Kenyatta NationalHospital.Design: Descriptive prospective study.Setting: The Kenyatta National Hospital between July 2003 and June 2004.Results: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age rangedfrom seven months to 96 years (mean 44.8 ± 22.5). Forty six patients (62.1%) were male. Majority ofthe patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with39% self employed in the informal sector. Peripheral vascular diseases were the main indication forLLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) hadtumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%)of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulationsand seven (9%) were foot amputations.Conclusion: This study found peripheral vascular diseases unrelated to diabetes to be the mainindication for lower limb amputations at Kenyatta National Hospital contrary to previousinstitutional and loco-regional studies which report trauma as the leading cause. Furtherinvestigation into vascular causes is therefore recommended
PATTERN OF MAXILLOFACIAL AND ASSOCIATED INJURIES IN ROAD TRAFFIC ACCIDENTS
No full textABSTRACTBackground: 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 countriesRTAs are the leading cause of maxillofacial injuries. In an attempt to reduce RTAs, the governmentof Kenya has enacted a legislation requiring mandatory fitting of speed governors and safety beltsby passenger service vehicles.Objective: To describe the characteristics and pattern of maxillofacial and associated injuriessustained in road traffic accidents.Setting: Kenyatta National Hospital (KNH).Design: A cross-sectional study.Subjects: All patients involved in RTAs brought to casualty and the dental department of KNH aswell as accident victims admitted to the KNH mortuary over a four- month period from September2004 to December 2004.Results: Four hundred and thirteen (85.7%) had non-fatal injuries whereas 69 (14.3%) had sustainedfatal injuries. Males in the 21-30-year age group were the most affected. Most accidents occurredduring weekends with pedestrians being the leading casualties in 59.5% and 71.4% of non-fataland 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-useof safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatalcategory 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial regionwith facial cuts being the majority (69.2%). Two hundred and seventy three (66.1%) incidents ofother STIs than those of the head region were noted, the lower limbs accounting for 45.4% ofthese. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacialskeleton. 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 accountingfor 37.7% of the cases followed by head and chest injuries combined which were responsible for13% of the cases.Conclusion: Injuries to the maxillofacial skeleton appear to be uncommon in this series. Pedestriansin their third decade of life are most affected with passenger service vehicles being responsiblein the majority of the cases.Recommendations: Interventional programmes targeting pedestrians and those in the third andfourth decades of life should be enacted
LOWER LIMB AMPUTATIONS AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textBackground: Lower limb amputations continue to be widely performed despite attempts to managerisk factors such as diabetes mellitus and peripheral vascular diseases. The incidence of vascularmajor lower limb amputations is higher in the developed countries than that reported in thedeveloping ones mainly due to the ageing population. In developing countries, poor access tobasic healthcare due to poverty impacts negatively on health seeking behaviour with conditionsotherwise preventable or easily manageable complicating to warrant amputation. There has been arise in the number of patients with diabetes being managed at Kenyatta National Hospital (KNH).However, the impact of this disease on the overall rates and pattern of lower limb amputations inKNH has not been studied.Objective: To determine the causes and pattern of lower limb amputations at the Kenyatta NationalHospital.Design: Descriptive prospective study.Setting: The Kenyatta National Hospital between July 2003 and June 2004.Results: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age rangedfrom seven months to 96 years (mean 44.8 ± 22.5). Forty six patients (62.1%) were males. Majority ofthe patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with39% self employed in the informal sector. Peripheral vascular diseases were the main indication forLLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) hadtumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%)of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulationsand seven (9%) were foot amputations.Conclusion: This study found peripheral vascular diseases unrelated to diabetes to be the mainindication for lower limb amputations at Kenyatta National Hospital contrary to previousinstitutional and loco-regional studies which report trauma as the leading cause. Furtherinvestigation into vascular causes is therefore recommended
COMPARISON OF BLOOD SMEAR MICROSCOPY TO A RAPID DIAGNOSTIC TEST FOR IN-VITRO TESTING FOR P. FALCIPARUM MALARIA IN KENYAN SCHOOL CHILDREN
No full textObjective: To compare the diagnostic performance of microscopy using Giemsastained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. Design: Children enrolled in a feeding intervention trial were tested for malaria using microscopy and RDT at baseline, one, and two years. Ongoing morbidity data on study children was collected through interviews with caretakers regarding signs and symptoms and physical inspection. Setting: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons/year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. Subjects: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a feeding intervention trial from 1998-2001. Main outcome measures: Percent positive and negative P. falciparum malaria status, sensitivity, specifi city, and positive and negative predictive values of RDT. Results and conclusion: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the “gold standard,” RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specifi city was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations
POLYCYSTIC KIDNEY DISEASE IN A PATIENT WITH ACHONDROPLASIA: CASE REPORT
No full textSUMMARYAutosomal dominant polycystic kidney disease is a multisystem disease involving manyorgans. An association with other diseases such as tuberous sclerosis, von Hippel-Lindaudisease and Marfan syndrome have been previously described. We describe a 35 yearold female with achondroplasia who developed polycystic kidney disease involving bothkidneys and progressing to end-stage renal disease. To the best of our knowledge thisis the first such case described in the literature. We also delve, briefly, into the possibilityof the genes and chromosomes involved in Marfan syndrome, polycystic kidney disease,tuberous sclerosis and achondroplasia playing a role in the co-occurrence of theseentities