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AEROBIC PATHOGENIC BACTERIA IN POST-OPERATIVE WOUNDS AT MOI TEACHING AND REFERRAL HOSPITAL
No full textBackground: The emergence of bacterial antimicrobial resistance associated withacquired infections has made the choice of empirical therapy more difficult andexpensive, hence the need for continuous research to determine their sensitivity patterns.Objectives: To identify the common aerobic pathogenic bacteria in post-operative woundsat Moi Teaching and Referral Hospital (MTRH) and determine their sensitivity patternsto routine antibiotics used.Design: Cross-sectional study.Setting: Moi Teaching and Referral Hospital (MTRH) Surgical, Obstetrics and Gynaecologywards.Patients: Sixty three patients chosen by convenient sampling between May and June2001 were included in the study. A total of eighty four isolates were obtained fromthese patients.Materials and Methods: Isolation of pathogens and their antibiotic sensitivitydetermination was conducted in the Department of Medical Microbiology Laboratory,Faculty of Health Sciences, Moi University. The bacteria were cultured on blood agar,MacConkey and Nutrient agar followed by identification using biochemical tests (catalaseurease, coagulase, triple sugar iron). Disc diffusion method on Muller-Hinton agar wasused for sensitivity testing.Results: Staphylococcus aureus species were the most common pathogenic bacteriaisolated from the post-operative wounds. Other organisms included Proteus, Pseudomonasand Escherichia coli. There was a multi-drug resistance pattern observed, withminocyline being the most effective drug against S. aureus.Conclusion: There is need for review of policies on prescription practice on the useof existing therapeutics choice to limit the spread of resistance. This will ensure reducedpatient stay and cost incurred
DOMESTIC VIOLENCE AND INDUCED-ABORTION: REPORT OF THREE CASES
No full textDomestic violence not only violates women's rights, but is also associated with adverseconsequences ranging from physical injury to psychological morbidity. Several studies haveassociated domestic violence with risk of having an induced-abortion. The following threecases indicate that domestic violence may not cause unwanted pregnancy, but may be thereason that leads victims to resort to abortion
COMPARISON OF INTRAMUSCULAR ARTEMETHER AND INTRAVENOUS QUININE IN THE TREATMENT OF SUDANESE CHILDREN WITH SEVERE FALCIPARUM MALARIA
No full textObjectives: To compare the efficacy of intramuscular artemether and intravenous quininein the treatment of severe falciparum malaria.Design: An open randomized controlled clinical trial.Setting: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-January 2002.Subjects: Forty one male and female children; 21 on artemether and 20 on quinine.Main outcome measures: Fever clearance time, parasite clearance time, coma resolutiontime and side effects of the two drugs.Results: The two groups (artemether and quinine) were well matched in the admissionvariable. The mean ± (SD) fever clearance time was 30.5 ± (20.9) hours in the artemethergroup, while it was 18.0± (8.1) hours in the quinine group; the difference was highlysignificant (P=0.02). The mean parasite clearance time was shorter in the artemethergroup than in the quinine group, but it was not statistically significant, (16.0 vs. 22.4hours; p>0.05). In comatose patients (three in the artemether group, three in the quininegroup) the time of recovery from coma was significantly shorter in artemether groupthan in quinine group (12.5 vs. 20.16 hours; P<0.05). Recrudescence of P. falciparum(confirmed by polymerase chain reaction) occurred in one out of fifteen patients (6.6%)in the quinine group seen on day 28, which was successfully treated by sulphadoxinepyrimethamine.In the quinine group, one patient died and one patient developedhypoglycaemia.Conclusion: Artemether caused faster parasite clearance than quinine, but quininelowered the temperature in shorter time than artemether. The results obtained showthat artemether can be used as safe and effective alternative drug for the treatmentof severe falciparum malaria in the wake of the growing resistance to quinine in Sudan
POSSIBLE IMMUNOLOGICAL BASIS FOR RECURRENT SPONTAPlEOUS ABORTIONS: A REVIEW
No full textBuckground: In normal pregnancy, the pregnant mother parada xkdy tolerates the semiallogeneicfoetus until term. Experimental a d clinical data to exp lain such tolerance in manreflects the involvement of multiple mechanisms.Objective: To review the data perhikg to the experimental and clinical efforts to explainwhy the mother irnmundogically tolerates a semi-allogeneic p q pamy to ternDesign, setting and methods: A review of the literature oo state c b the art thinking amongresearchers and clinicians on recurrent spontaneous abortions is summarised.Results: A large body of recently published data strongly suggest that a breakdown inimmundogical maternal-foetal interactions may lead to oceashll or recurrent foetal loss.Immunoregulatory activities involving blocking antibodies, lpgulatc try factors, immunologicalcells, hormones, structural proteins and cytokines constitute the pregnancy-sustainingnetwork.Conclusion: The majority of theevidence reviewed points to the invo vementof immfactorsin successful pregnvrcies However, the underlying mechanisms are inadequatelyexplained, are largely speculative and require more focused H~vestigatioa A completeunderstanding of the meshanisms involved would enhance our q lacity to develop rationalways of addressing recurrent pregnancy losses
EXPRESSION OF OESTROGEN AND PROGESTERONE RECEPI ORS, Ki-67, p53 AND BCL-2 PROTEINS, CATHEPSIN D, UROKINASE PLASMINOGEN ACT1 VATOR AND UROKINASE PLASMINOGEN ACTIVATOR-RECEPTORS IN CARCINOMAS OF THE FEMALE BREAST IN AN AFRICAN POPULATION
No full textObjective: To determine the expression of oestrogen (ER) and proj ;esterone receptor (PgR),Ki-67, p53, bcl-2 proteins and the proteolytic enzymes cathe~lsin D (CD), urokinaseplasminogenactivator (uPA) and its receptor (uPA-R) in primary carcinomas of the breastfrom indigenous Tanzanian female patients by immunohistochenristry.Design: i'rospective cross-sectional study.Setting: Muhimbili Medical Centre, Dar es Salaam, Tanzania.Subjects: Sixty patients admited between 1995 and 1997.Results: Markers were found to be expressed as follows: ER (3: .3%), PgR (18.3%), p53(30%), bcl-2 (43.5%) and the median proliferation rate of Ki-67 was 15%. Proportion oftumours positive for ER, PgR and bcl-2 initially decreased to 12 nonths disease duration,after which it increased. The observed proliferation rate approaches that reported indeveloped countries. p53 expression did not influence the prolife ration rate nor did bcl-2expression. ER, PgR and bcl-2 were strongly co-expressed. CD was wedominantly expressedin stromal macrophages than in cancer cells.Conclusion: The low expression of ER and PgR and their strong co-expression with bcl-2might negatively influence response to hormonal therapy. The influence of bcl-2 on tumourresponse to anti-cancer therapy in patients with long disease duration requires urgentclarification. Determination of CD in stromal macrophages rathe~ than in cancer cells mayhave greatel- prognostic significance in patients of this region
ACUTE CORONARY SYNDROMES AMONGST TYPE 2 DIABETICS WITH ISCHAEMIC ELECTROCARDIOGRAMS PRESENTING TO ACCIDENT AND EMERGENCY DEPARTMENT OF A KENYAN TERTIARY INSTITUTION
No full textObjective: To determine the prevalence of acute coronary syndromes among type 2diabetic patients presenting to Accident and Emergency department.Design: Prospective cross-sectional study.Setting: Kenyatta National Hospital, a tertiary teaching and referral hospital.Subjects: Type 2 diabetic patients with ischaemic electrocardiograms (ECG).Main outcome measures: Demographics, clinical symptoms, cardiovascular status andrisk factors - central obesity, hypertension, dyslipidaemia, smoking.Results: From 12,307 accident and emergency attendees, 400 ( 33%) diabetics aged>30 years were screened with a resting ECG and 95 (24%) with ischaemic ECG wererecruited; age range 41-87 years, 60% were male; diabetes duration ranged 0-30 yearswith 8.4% being newly diagnosed. The commonest enrolling ECG feature was nonspecificST-T changes. The commonest presenting complaint were fatigue and dyspnoea.Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevatedLDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulinand OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) wereclassified as acute coronary syndrome (ACS); 29 ( 30.5%) acute myocardial infarction(ACS-AMI) and five (5.2%) unstable angina (ACS-UA). Majority (79.4%) of the ACSpresented more than six hours after symptom onset and majority had features of acuteleft ventricular failure.Conclusions: Acute coronary syndrome accounted for 35% of the morbidity in type 2diabetics with ischaemic ECG’s presenting to KNH accident and emergency department;patients presented late and 80% were not on CAD prophylactic therapy
ALLEGED CASES OF SEXUAL ASSAULT REPORTED TO TWO ADDIS ABABA HOSPITALS
No full textObjectives: To identify the demographic characteristics of victims, their relation tto thealleged assailants, the degree of physical injury, the incidence of pregnancy, the pattern ofreporting and the care given to these victims.Design: Cross-sectional prospective study.Setting: Tikur Anbessa and St. Paul's hospitals, Addis Ahaba, Ethiopia.Patients: One hundred and seventy reported cases of alleged sexual assault.Main outcome measures: Ilemographic characteristics, relation to the offender, the rate ofpregnancy, the degree of physical injury, time of reporting, and the care given at thehospitals.Results: Victims were mainly children aged less than fifteen years and less educated. Seventythree (42.9%) cases indicated that the offenders were strangers 46.9 (27.1%) were labelledas neighhours. The physical injury identified ranged from minor trauma over the genitaliato perineal injury of major degree. Eleven women (6.5%) were pregnant at the tiime ofreporting. There was significant delay in reporting to the health institution as well as to thepolice with a mean delay of 15.6 and 18.4 days respectively. The hospital care focussed on thehealing of physical injury but not the healing of the psychological traumaConclusion: Sexual assault is an important health and social problem affecting the youlng andless educated girls. The importance of early reporting for evidence collection as well as forprevention of the consequences of this aggression is not appreciated by the victims as well astheir relatives. There is need for more effort to prevent this crime as well as to improve thecare given to the survivors
PREVALENCE OF IRON DEFICIENCY IN CHILDREN WITH CYANOTIC HEART DISEASE SEEN AT KENYATTA NATIONAL HOSPITAL AND MATER HOSPITAL NAIROBI
No full textObjective: To establish the prevalence of iron deficiency among children with cyanoticheart disease.Design: Cross-sectional study.Setting: The study was carried out at Kenyatta National Hospital and Mater Hospitalfrom August to December of 2007. A total of 112 children meeting the eligibility criteriawere recruited from the wards and the cardiac clinics.Subjects: These were children less than 18 years of age, with cyanotic heart diseaseconfirmed on ECHO, presenting at the paediatric cardiac clinic of the two hospitalsor admitted in the wards at Kenyatta National Hospital. These were patients who hadnot undergone surgical correction.Results: The prevalence of iron deficiency was found to be 16.9% (95% CI 9.8-24.1%).Conclusion: There is a high prevalence of iron deficiency among patients withcongenital heart disease with cyanosis in the two institutions. Routine screening foriron deficiency is recommended for these children and those found to be deficientshould be treated