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BONE METABOLISM IN HEALTHY AMBULATORY CONTROL PREMENOPAUSAL WOMEN AND IN EPILEPTICS ON ANTI-CONVULSANT DRUGS
No full textBackground: Long term anti-epileptic drug use causes multiple abnormalities incalcium and bone metabolism that have been documented in both institutionalisedand ambulatory patients.Objective: To assess bone metabolism in ambulatory females of reproductive age, onantiepileptic drugs.Design: Cross sectional comparative study.Subjects: Ambulatory females in reproductive age group with epilepsy and on regularfollow 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). Majorityof the patients were on enzyme inducing drugs like phenobarbital, phenytoin,carbamazepine and valproate, either alone or in combination with non-enzyme inducerslike lamotrigine (98.2%). There was a significantly lower mean serum calcium and ahigher 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 calciumexcretion) was also significantly raised among the patients (P=0.003). The mean lumbarBMDT-score results were not significantly different in the two groups.Conclusions: Long-term anti-epileptic drug use significantly affects biochemicalparameters of bone metabolism. These effects on bone biochemistry markers werenot reflected in lumbar spine BMD in this study
TRACHEA STABILISATION WITH AUTOLOGOUS COSTAL CARTILAGE IN ACQUIRED TRACHEOMALACIA: REPORT OF TWO CASES
No full textPost-operative tracheomalacia is a life threatening condition whose management is challenging.Surgical procedures which have been suggested in the literature to manage the conditioninclude tracheostomy, staged thyroid reductions and the use of artificial stents either withinthe lumen of the tracheobronchial tree or as external support. We report the successfulmanagement of two patients using autologous costal cartilage to support the tracheal wall
DOES PREVENTIVE HEALTH CARE HAVE A CHANCE IN THE CHANGING HEALTH SECTOR IN TANZANIA?
No full textABSTRACTObjective: To investigate the status and practice of preventive health care (relativeto curative) in the health delivery system at the time when the health sectorreforms are taking place.Design: A cross-sectional, descriptive study. Health services that were considered to bepreventive included child immunisation, chemoprophylaxis, dental care, family planningservices and provision of health and nutrition education- Curative health servicesincluded chemotherapy, psychotherapy, physiotherapy, surgical treatment andradiography.Setting: The study was conducted in Morogoro District between January and May 1999whereby thirty-tour health facilities of varying nature were selected using purposivesampling technique. Care was taken to include all types of health facilities availableand operating in the area.Subjects: Eighty-six medical personnel and two hospital administrators from thirty-fourhealth facilities. The health facilities included twenty-five dispensaries, five health centresand four hospitals. Care was also taken to include health facilities owned by variousinstitutions and organisations, including governmental and Non governmental.Results: Generally, preventive health received little attention compared to the curativehealth measures whereby more than 80% of the medical personnel in some of thefacilities were assigned to curative services. Health personnel reported to spend anaverage of up to 6 hours per day providing curative services such as chemotherapy,surgical treatment, psychotherapy and radiography. On the contrary, they spent about4 hours or less on providing child immunisation and education on nutrition, health andfamily planning. As expected, the type of ownership of a health facility influenced theextent to which preventive measures were included. For example, while all thegovernment owned facilities did provide child immunisation, nutrition education andfamily planning services, some non-governmental facilities were lacking such services.Conclusion: It is obvious that while the provision of curative health care can be leftto the hands of the private suppliers, that of preventive health care needs stronggovernment involvement. It is suggested that deliberate efforts be taken to shift resourcesfrom curative to preventive measures. One way in which such a strategy can be attainedis for the government to set, as a condition for private operators, a minimum levelof preventive measures to be provided by every operator before a permit is issued.However, caution should be taken to ensure that such deliberations do not discourageinvestors in the health sector
MECKEL'S DIVERTICULITIS DUE TO TAENZA SAGZNATA: CASE REPORT
No full textA thirteen-year old girl presented with acute right lower quadrant abdominal pain for whichevaluation suggested appendicitis. At laparotomy, the appendix was normal but a Meckel'sdiverticulum with an impacted Taenia saginata(tapeworm) was found The diverticulum wasexcised and histopathology confirmed diverticulitis from the parasite. Though Meckel'sdiverticulitis due to parasites has been reported, this is usually from ascaris. Tapewormcausing this complication is rare
Gender-associated violence at a women’s hospital in Nairobi, Kenya
No full textObjective: To describe the pattern of gender-associated violence amongst adult survivors.Design: Descriptive case analysis of prospectively collected data.Setting: The gender violence and recovery centre (GVRC), a shelter and violence treatment facilityfor the gender-associated violence at the Nairobi Women’s hospital (NWH).Subjects: Data on 663 consecutive adult patients who presented to GVRC between February 2003 and April 2004 were evaluated.Results: The patients age ranged from 18 to 74 years (mean 27.7 years). Four hundred and eight patients (61.5%) presented following sexual assault. Most of assaults were perpetrated at night. A stranger was the assault perpetrator in 75.1% and 2% of sexual and non-sexual assault respectively. An intimate partner was the perpetrator in majority (86.5%) of nonsexual violence. Most physical injuries were minor bruises and swellings. The rate of positive spermatozoa from high vaginal swabs was only 15.9% in cases of sexual assault. Sexual assault was significantly associated withsingle status of the victim and assault by more than one assailant.Conclusions: Violence against women is a common public health problem in the city of Nairobi. Women are vulnerable both in and out of the home. More efforts, including massive public education, are needed to protect this vulnerable population
ONE-STAGE TREATMENT OF LEFT-SIDED LARGE BOWEL EMERGENCIES
No full textObjective: To evaluate the safety and benefits of left-sided colectomy and primary anastomosis without intraoperative colonic irrigation in the management of patients with colorectal emergencies.Design: Prospective descriptive analysis of patients with emergency left-sided colonic and rectal lesions requiring resection and primary anastomosis.Setting: A hospital based cohort over a five and a half year period at Jos University Teaching Hospital, Jos, Nigeria.Subjects: A total of 42 patients with left sided and rectal emergency lesions. Their ages ranged from 9-65 years with a mean of 43.1 years.Intervention: Twenty patients had sigmoid colectomy and primary colorectalanastomosis for sigmoid volvulus. Two patients with compound sigmoid volvulus had sigmoid colectomy as well as ileal resection and primary colorectal and ileoileal anastomosis. Transverse colectomy and primary colocolic anastomosis was carried out in six patients who had transverse colon tumour from gastric neoplasia. These six patients had in addition distal partial gastrectomy and gastrojejunal anastomosis to remove the primary gastric neoplasia. One patient had transverse colectomy andanother four left hemicolectomy and primary colocolic anastomosis for trauma. Left colectomy and colocolic anastomosis was performed in three patients with left colon tumour while anterior resection and colorectal anastomosis for rectosigmoid cancer was carried out in six patients.Main outcome measures: Manual decompression of the colon is as good as antegrade colonic irrigation in the management of left-sided large bowel emergency conditions in selected patients when undertaken by dedicated experienced surgeons.Results: There was one clinical anastomostic leak presenting as enteric fistula on the sixth postoperative day. The discharge was bilious and occurred in a patient with gastric mesenchymal stromal tumour who had distal partial gastrectomy and gastrojejunal anastomosis. He had no features of generalised peritonitis nor residual intra-abdominal abscesses. The fistula was managed non-operatively. A 12% wound infection rate was recorded. All infections were superficial and healed with conservativemeasures. We had no mortality in our series. The hospital stay ranged from 6 to 21 days with a mean of 7.5 days.Conclusion: Manual decompression of the colon alone is as good as colonic irrigation in the management of left-sided large bowel emergencies. However, on-table antegrade colonic irrigation should be reserved for the loaded colon that may interfere with the use of a stapling instrument, when the resection margins are limited as in low anterior resections and when left-side colonic emergencies are undertaken by non-dedicated, less experienced surgeons
HIV/AIDS: the first 25 years - a view from Nairobi
No full textHIV infections are zoonoses occurring in communities that hunt chimpanzees (HIV 1) and sooty mangabeys (HIV 2) in the forests of equatorial and West Africa respectively. Most cross species transmission to man probably fizzles out, but the transmission of HIV 1 type M around 1930eventually resulted in a pandemic that has spread around the world. HIV 2 types A and B have caused epidemics in West Africa. HIV infections are characterised by three phases (i) an initial, primary infective phase with rising viraemia, asymptomatic and silent, lasting for some 10 weeks,(ii) a long quiescent phase with the viraemia and illness mostly held in check by the immune response and lasting some 10 years in HIV 1 and 20 years or so in HIV 2 and (iii) a terminal third phase lasting some 10 months with rising viraemia, falling CD4 levels and multiple opportunisticinfections recognised in a community by the onset of a florid AIDS epidemic. The silent primary epidemic reached Nairobi around 1980, with the florid secondary AIDS epidemic peaking here around 1992 and overwhelming the hospitals and other health services. The introduction of highlyactive antiretroviral therapy (HAART ) has dramatically improved the prognosis for individual patients with AIDS, but it has been education and a changing attitude to condoms that has led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Modifying the immunological response during the quiescent phase with the hope of prolonging this phase indefinitely may be the way forward for those who are already infected. Steroids have been shown to have a possible role here rather than anti-retroviral drugs (ARVs) which are not curative and proneto the development of drug resistance. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out
CANCRUM ORIS IN AN ADULT WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION: CASE REPORT
No full textNew cases of cancrum oris in adults are rare and there are no previous reports in the literature from Kenya. Since noma is related to factors associated with poverty and immunosuppression, reducing the incidence of noma can be achieved with improvement in socio-economic status of communities and prevention of HIV infection. An unusual case of a human immunodeficiency virus (HIV) infected a 49 year old female with a full thickness cheek defect following a recent cancrum oris infection is reported. The disfiguring defect was successfully reconstructed using a two staged delto-pectoralflap with a satisfactory aesthetic and functional outcome
EFFECTS OF KHAT (CATHA EDULIS) CONSUMPTION ON REPRODUCTIVE FUNCTIONS: A REVIEW
No full textABSTRACTObjectives: To review research findings on the effects of khat (Catha edulis) chewingon reproductive functions.Data sources: Retrieval and critical review of relevant articles and abstracts cited ininternational and local journals, literature searches on Medline and Medchem from 1961to 2002.Data synthesis: Analysis of published data and limited interviews of regular khat usersrevealed that khat chewing lowers libido in humans and may also lead to sexualimpotence following long term use. In pregnant women, consumption of khat affectsgrowth of foetus by inhibiting utero-placental blood flow and as a consequence, impairsfoetal growth.Conclusion: Detailed studies on the effects of khat on reproduction are lacking. However,the limited available data reveal that chewing of khat has a negative impact on humanreproductive health. Khat is genotoxic and has teratogenic effects on the foetus ifregularly consumed by pregnant mothers. Since low birth weight is a well-establishedrisk factor for both perinatal and young infant death, khat chewing during pregnancymay be one of the factors contributing to infant mortality in communities where khatis commonly chewed. Khat consumption affects the potency of male sexuality by affectingspermatogenesis and plasma testosterone concentration. However, the precise mechanismsby which khat may affect the male reproductive physiology have not been elucidated
MANAGEMENT OF SOLITARY THYROID NODULES IN RURAL AFRICA
No full textABSTRACTObjectives: To review a simple protocol for the management of solitary thyroid nodulesand to document the spectrum of pathological diagnoses associated with this condition.Design: A retrospective review of all solitary solid thyroid nodules excised over a threeyearperiod from 1st January 1999 to 31st December 2001.Setting: A rural church-based hospital in Kenya.Subjects: All patients undergoing thyroidectomy for solitary solid thyroid nodule overa three-year period at Kijabe Hospital.Interventions: A simple protocol was used to manage this condition involving history,clinical examination, needle aspiration of the lesion, and excision when clinicallyindicated.Main Outcome Measures: Clinical diagnosis, tribe, operation performed, pathology, andcomplications of surgery.Results: Eighty-one operations were performed for a solitary thyroid nodule. The mostcommon operations were lobectomy and isthmusectomy. There were two complicationsaneck haematoma that required surgery and one recurrent laryngeal nerve injury. Thecommonest pathological diagnosis was multinodular goitre (42%). There was a 16%malignancy rate with eight papillary carcinomas, five follicular carcinomas, and onehurthle cell carcinoma.Conclusions: The simple protocol described gives good results in a rural African hospital.Solitary solid thyroid nodules should be routinely excised due to the 16% malignancyrate in this condition. There is a possibility that there is a shift in the ratio of papillaryto follicular carcinomas compared to older African studies and this would be aninteresting area for further study