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ANTlMICROBlAL SUSCEPTIRILITY AND PLASMIDS FROM ESCHERICHIA COLI ISOLATED FROM RATS
No full textObjectives: To determine if antimicrobial resistance occurs in E. coli isolated from rats andif this resistance is transferable via plasmids.Methods: Sixty Escherichia coli isolates obtained from 215 rats trapped in and aroundNairobi, Kenya, were analysed for antimicrobial susceptibility to eleven commonly usedantimicrobials. Piasmid DNA analysis and in-vitro conjugation tests were conducted ontwenty two resistant isolates.Results: A total of 12 (20%) E. coli were resistant to at least one of the commonly used drugsincluding ampicillin, sulphamethoxazole and streptomycin. Eight (13.3 %) isolates were multidrugresistant. The drug resistant E. coli fell into five plasmid profie groups with plasmidsranging between two and 98 megadaltons (Mda). Resistance to ampicillin was transferable.Conclusion: The results of this study show that rats from the study area may form animportant reservoir for drug-resistant E. coli that could pose a public health hazard
PATTERN AND OUTCOME OF ABDOMINAL INJURIES AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To establish the pattern and results of interventions in patients with abdominal injuries requiring admission.Design: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management as either discharged or deceased.Setting: Kenyatta National Hospital, a tertiary teaching and referral hospital in Nairobi, Kenya, from November 2004 to February 2005 in the adult general surgical wards.Patients: Eighty consecutive admissions of adult patients with either blunt or penetrating abdominal injuries.Main outcome measures: Type and cause of injury, demographic data, temporalparameters, morbidity and mortality.Results: The 80 patients had a male to female ratio of 12.3:1, the majority were in the third decade of life with a range 15-56 years and mean of 28.2 years. Penetrating to blunt abdominal injuries had 2:1 ratio with the leading causes of injury being stab wounds, gunshot wounds and road traffic accidents. Blunt abdominal injuries had a higher tendency to extra-abdominal injuries. Duration prior to presentation to hospital and surgery depended on severity of injury. Modes of management varied between attending surgical firms. There was a 20% change in the mode of management and a 16.1% rate of negative laparotomy. Penetrating injuries had a better interventional outcome. Penetrating abdominal injuries had higher rates of complications while the blunt injuries had higher rates of mortality. Overall, both the complication and mortality rates were 12.5%. Correlates of mortality included delay before surgery, associated injuries, need for blood transfusion, admission to intensive care unit and duration prior to admission. Abdominal injury patients stayed an average of 6.4 days with the blunt injuries with complications staying close to twice as much as their penetrating counterparts.Conclusion: Abdominal injuries are a predominantly male disease with the majority in the third decade of life. As opposed to previous studies, gunshot wounds are now a significant cause of abdominal injuries in Kenyatta National Hospital (KNH). The rate-of negative laparotomies has come down by 10% over the past 15 years. The outcome of management depends on the severity and type of injury sustained
FOURNIER'S GANGRENE COMPLICATING VASECTOMY
No full textABSTRACTQuality of care of services provided to family planning clients is a source of majorconcern in reproductive health care, especially in resource-poor settings. It may bemeasured in terms of safety of the method or service provided and may be influencedby the knowledge, skills and experience of the service providers, the environment inwhich the services are provided and the care thereafter. As a result of various effortsby the government and other stake-holders there have been tremendous developmentsin the family planning programme in Malawi in the past ten or so years. Thecontraceptive prevalence rate (CPR) more than doubled between 1992 and 2000.Secondly there has been expansion of facilities providing contraceptive services and themethod mix such as introduction of voluntary surgical contraception (VSC) for bothfemales and males. The increased demand for contraceptive services has outstrippedthe available services and as a result led to lapses in the quality of care. These haveresulted in some apparently healthy individuals either dying in the course of or followingservice provision or suffering serious morbidities. This paper presents two cases ofFournier's gangrene following vasectomy in previously healthy male adults in Malawi.It discusses their diverse management and results thereof, and explores the potentialimpact on the programme in Malawi, in the context of adverse publicity on contraceptives.The possible operational factors for the complications are explored and preventivestrategies proposed to ensure sustenance of the already registered gains in fertilitycontrol in Malawi
NEUROFIBROMATOSIS TYPE 1: REPORT OF TWO CONTRASTING CASES
Get PDFWe present two cases of neurofibromatosis type 1(NF-1), one a 35 year old male whofirst recognised his problem at the age of fifteen years and at the time of assessment,satisfied the National Institute of Health (NIH) diagnostic criteria for NF-1 and hada nodular plexiform neurofibroma involving the left fifth dorsal nerve root and adiffuse plexiform neurofibroma involving the left lower limb. The second patient, a45 year old female recognised her problem at the age of 39 years, did not quite satisfythe NIH diagnostic criteria for NF 1 and had diffuse plexiform neurofibroma involvingboth lower limbs and buttocks almost symmetrically, a finding which has notpreviously been described to the best of our knowledge. The scarcity of managementoptions are briefly outlined
COMBINATION OF BLEACH AND FLOURESCENT MICROSCOPY: A MILESTONE IN THE DIAGNOSIS OF SMEAR NEGATIVE TUBERCULOSIS
No full textABSTRACTBackground: The reliability of direct smear microscopy for diagnosis of tuberculosis has frequentlybeen questioned due to low sensitivity. Treatment of sputum with sodium hypochlorite (NaOCI)has been used to increase sensitivity in many settings. However, no study has established the effectof NaOCI on fl uorescent microscopy.Objective: To establish whether NaOCI concentration method enhances positivity of fl uorescentmicroscopy smear negative sputum for diagnosis of tuberculosis.Design: A prospective study.Setting: Mbagathi District Hospital and Centre for Respiratory Diseases Research, Kenya MedicalResearch Institute.Results: Forty fi ve (22%) specimens were culture positive. Fluorescent microscopy sensitivitywas 28.9% and 22.2% after centrifugation and sedimentation with 3.5% NaOCI, respectively (P >0.05). Sensitivity was 24.4% and 17.8% after centrifugation and sedimentation with 5% NaOCI,respectively (P > 0.05). Although there was no statistical signifi cance difference between the twoNaOCI concentration methods, 3.5% NaOCI with centrifugation indicated a higher yield.Conclusion: Use of NaOCI signifi cantly enhances positivity of smear negative sputum for diagnosisof tuberculosis when used with fl uorescent microscopy. This approach could be recommendedfor screening all tuberculosis suspects especially in settings with potential smear negativetuberculosis
FOLLOW UP OF OESOPHAGEAL CANCER THERAPY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the pattern of follow-up for oesophageal cancer patients followinghospital discharge and reviewing followup results of the differctnt treatment modalities withemphasis on oesophagectomies.Design: A retrospective hospital based study covering the per od January 1987 to January2001.Setting: Surgical outpatient clinic, Kenyatta National Hospital, Nairobi.Main outcome measures: Determination and the comparison of the one, two and three-yearfollowup rates for the different treatment modalities and theil. median follow-up period inaddition to reviewing the common variables associated with fc~llow-up.Results: The median followup for patients managed by oesopha gectomy was 9.5 months witha 43%, 22% and 10% one-. two- and three-year followup rates respectively. This comparedto a median of two months and a 7% and 3% one-, and two- yeir follow-up rate for patientsmanaged by intubation, and a 3-month median followup with a one- and two- year followuprate of 12% and 4% respectively for radiotherapy treatetl patients. Oesophagectomypatients had a better followup compared to intubations and radiotherapy (pc.00001).Oesophagectomy for stage T4 tumours had an apparently better follow-up compared to bothstage TI-3 tumours and patients managed with intubations (p =.002 and .02 respectively)
CONTRACEPTIVE PRACTICE AMONG MARRIED MARKET MEN IN NIGERIA
No full textABSTRACTBackground: Until recently, family planning researchers and service providers hadfocused almost exclusively on women. Men are often seen as uncooperative anduninterested in family planning or reproductive health.Objective: To investigate the contraceptive knowledge, attitude and practice amongmarried market men.Design: A cross-sectional survey.Setting: llesa Main Market, Osun State, Nigeria.Subjects: Four hundred and fifty married market men were interviewed betweenNovember 2000 and January 2001.Main Outcome Measures: Level of awareness and utilisation, reasons for non-use,influence of socio-demographic variables.Results: All the men were aware of family planning and 60.9% are currently usinga form of contraception with their spouse. Reasons for non-contraceptive use by 39.1%of the respondents include: family size not yet complete, religious opposition, afraidof contraceptive failure, still searching for a male sex. Christianity and education weresignificantly associated with contraceptive use and knowledge (p< 0.05).Conclusion: Men favour contraceptive use in Nigeria. Involving men by family planningproviders is a winning strategy with benefits to both men and women
DENTAL INJURIES IN 0-15 YEAR OLDS AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the pattern of occurrence of dental injuries in the 0-15 year-olds.Design: A retrospective study.Setting: Kenyatta National Hospital, Nairobi.Subjects: Five hundred and five patient records with dental injuries were retrieved and analysed.Results: A total of 505 patient records with dental injuries were retrieved and analysed. Most of the injuries were recorded in the year 1999 (22.2%). Boys were more affected (63.0%) than girls (37.0%).The main presenting complaint recorded was pain (75.8%).The majority of the patients (69.5%) presented for treatment during the same day or the day after trauma. Falls were the leading cause of injuries (73.5%). Most injuries involved two teeth (47.1%) and the maxillary central incisors were the most affected teeth bothin the primary (67.5%) and permanent (64.0%) dentitions. Luxation injuries were the most common type of dental trauma with 47.5% occurring in the permanent teeth and 77.3% in the primary teeth. The main radiographic investigation performed was intraoral periapical views (52.9%) following which dental extraction (34.4%) was the main treatment modality offered.Conclusion: Prospective cross-sectional studies to determine the prevalence of dental injuries are needed. Furthermore improving the knowledge of dental practitioners through continuing dental education programmes would help in updating them on current trends in managing these injuries
METHYLERGOMETRINE POISONING IN THE NEWBORN: REPORT OF TWO CASES
No full textMethylergometrine is probably the most commonly used drug in obstetric care at all levels of the health care system. Many communities in Africa lack skilled birth attendants and adequate health systems; medication errors are more likely to occur and go unreported in these settings. The morbidity and mortality that result from these errors can be reduced if health care workers are better informed. We report two cases of medication error with methylergometrine and suggest guidelines for health care workers at the primary and secondary levels of health care
CHARACTERISATION OF A HEPARAN SULFATE PROTEOGLYCAN HOMOLOGUE OVPG-1 FROM ONCHOCERCA VOLVULUS
No full textObjective: To determine the role of an immunodominant antigen OvPG-1 in human onchocerciasis.Design: Cross-sectional study of subjects living in three onchocerciasis endemic areas.Setting: Mbonge and Tubah divisions of Western Cameroon and in Esmeralda Province of Ecuador.Subjects: There were 94 and 99 subjects from the Cameroon rain forest and savannah respectively, and 83 endemic residents from Ecuador.Results: The IgG2 anti-OvPG-1 responses of visually impaired and microfiladermic patients were significantly higher than for their age and sex matched counterparts with normal vision and no microfiladermia (p=0.024). Furthermore, the isotype specificity of anti-OvPG-I responses varied for the various onchocerciasis endemic zones. IgG1, IgG2, IgG3 and IgE levels correlated with the presence of microfilariae in Cameroon, but not in Ecuador.Conclusion: Increased IgG and IgE levels to the antigen OvPG-1 seem to correlate with the development of onchocercal eye pathology. The present results suggest that the OvPG1 is a dominant antigen of Onchocerca volvulus with a significant role in the pathogenesis of onchocerciasis