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CLINICAL CHARACTERISTICS OF BURKITT’S LYMPHOMA FROM THREE REGIONS IN KENYA
No full textObjectives: To describe the clinical characteristics of Burkitt’s lymphoma (BL) from three regions in Kenya at different altitudes with a view towards understanding the contribution of local environmental factors.Design: Prospective cross-sectional study.Setting: Kenyatta National Hospital and seven provincial hospitals in Kenya.Method: Histologically proven cases of Burkitt’s lymphoma in patients less than 16 years of age were clinically examined and investigated.Main outcome measures: For every case the following parameters were documented: chief complaint(s); physical examination, specifically pallor, jaundice, oedema,lymphadenopathy, presence of masses, splenomegaly and hepatomegaly. Reports of evaluation of chest radiograph, abdominal ultrasound/scan, bone marrow aspiration, cerebral spinal fluid cytology, liver and kidney function tests, urinalysis, stool occult blood and full blood count results. Stage of disease was assigned A, B, C or D. Cases of BL from three provinces of Kenya with diverse geographical features were analysed:Central, Coast, and Western.Results: This study documented 471 BL cases distributed as follows: Central 61 (males 39 and 22 females), M:F ratio 1.8:l; Coast 169 (111 males and 58 females), M:F ratio 1.9:1; and Western 241 (140 males and 101 females), M:F ratio 1.4:1. The major presenting complaints were: abdominal swelling - Central 36%, Coast 4% and Western 26%; swellingon the face - Central 31%, Coast 81% and Western 64%; and proptosis - Central 3%, Coast 1% and Western 9%. The mean duration of these complaints in weeks were Central 6.9, Coast 6.08, and Western 5.05. The initial physical finding was a tumour mass in 39%, 72% and 54% of cases for Central, Coast and Western respectively. Tumour stage at diagnosis was: stage A - Central 21%, Coast 43% and Western 34%; stage B - Central 10%, Coast 5% and Western 10%; stage C - Central 41%, Coast 34% and Western 30%; and stage D - Central 28%, Coast 17% and Western 26%. For the age and sex matched cases the results show that commonly involved sites were: abdomen - Central 35%, Coast9% and Western 14%; jaw (mandible) - Central 24%, Coast 22% and Western 31%; maxilla - Central 6%, Coast 24% and Western 11%; and lymph nodes - Central 10%, Coast 4% and Western 8%. The disease stage was A - Central 33%, Coast 44% and Western 36%; stage B - Central 11%, Coast 10% and Western 27%; stage C - Central 39%, Coast 34% and Western 27%; and stage D-Central 21%, Coast 13% and Western 37%.Conclusion: This study shows that clinical features of childhood BL vary withgeographical region. The variations are documented in proportion of jaw, maxilla, abdominal and Iymph nodal sites involvement. The differences observed are potentially due to the local environmental factors within these provinces. BL cases from Western province had features, intermediate between endemic and sporadic. Coastal province BL cases were similar to endemic BL, while BL cases from Central province resembledmore or less sporadic BL subtypes. Strategies to explain and investigate the local environmental factors associated with the observed differences may certainly contribute towards improved understanding and clinical management of BL
EARLY POSTOPERATIVE OUTCOMES OF PATIENTS UNDERGOING PROSTATECTOMY FOR BENIGN PROSTATIC HYPERPLASIA AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textABSTRACTObjective: To describe early postoperative complications of prostatectomy.Design: A descriptive prospective study.Setting: Kenyatta National Hospital between 6th October 2003 and 21st June 2004.Subjects: Eighty five men undergoing prostatectomy for the relief of lower urinarytract obstruction due to benign prostatic hyperplasia. Procedures included suprapubictransvesical prostatectomy, retropubic prostatectomy and transurethral resectionof the prostate (TURP).Main outcome measures: Co-morbidity, intra-operative and early postoperativecomplications, need for re-operation, 30-day mortality, duration of postoperativecatheterisation, and duration of postoperative hospital stay.Results: Eighty five patients were included in the study and their age range was 46-85years (mean 66 years). Sixty nine (81%) of the patients underwent open prostatectomy,and sixteen (19%) underwent TURP. Twenty six patients had co-existing medicalconditions, the most common being hypertension (29%) and diabetes mellitus (13%).The most common intra-operative complication during prostatectomy washaemorrhage which occurred in ten patients (11.8%). One patient had perforation ofthe bladder during transurethral resection and required a laparotomy to repair thebladder. Wound sepsis was the most common postoperative complication followingopen prostatectomy (35%, n=69), and an association was found between wound sepsisand diabetes mellitus. Complications common to both open prostatectomy and TURPwere urinary tract infection (15%), clot retention (10%), pyrexia (10%) and pneumonia(8.2%). Three patients (4.4 %) required re-operation due to complications related towound sepsis. The duration of postoperative catheterisation ranged from 1-14 days(mean 6.66 days) while postoperative hospital stay ranged from 3-24 days (mean 8.16days). There was no postoperative mortality at 30 days.Conclusions: Open prostatectomy is the most performed procedure for the relief oflower urinary tract obstruction due to benign prostatic hyperplasia at KenyattaNational Hospital. Wound sepsis is the commonest early postoperative complicationand the presence of diabetes mellitus significantly increases the risk of developmentof wound sepsis
ApproAches to AdvAncing Blood sAfety through hAemovigilAnce: A revieW
No full textBackground: Blood transfusion is always associated with some level of risk.haemovigilance is a risk monitoring system integral to the practice of transfusionmedicine whose ultimate purpose is to improve the quality and safety of transfusiontherapy.Objective: to examine the contribution of haemovigilance to blood safety, includingthe approaches that some countries have taken to institute haemovigilance, and exploreroutes through which countries without such systems can achieve them.Data sources: the internet and journals on the topic of haemovigilance and developmentof haemovigilance systems in the english language.Data selection: reputable journals on the topic of haemovigilance were examined forabstracts and papers. Abstracts based on known credible and distinguished sourceswere selected.Data extraction: information on haemovigilance and the processes of developinghaemovigilance in various countries was reviewed.Data synthesis: the information from selected papers and abstracts was used forwriting this paper.Conclusion: varying processes for haemovigilance have been adopted by differentcountries. the more advanced systems have national/regional co ordinating mechanisms.Availability of haemovigilance data has given transfusion services a clear understandingof problems associated with transfusion that need to be solved so as to improvetransfusion safety. Although countries in sub-saharan Africa have made considerableprogress in enhancing blood safety in the recent past, nationally coordinatedhaemovigilance systems are lacking. focus on haemovigilance systems is consideredthe next frontier to be conquered in enhancing blood safety in the region
POST PARTUM EMOTIONAL DISTRESS IN MOTHERS OF PRETERM INFANTS: A CONTROLLED STUDY
No full textABSTRACTObjectives: To investigate whether mothers of preterm infants experience morepsychological distress than mothers of normal full term infants in the immediatepostpartum period.Design: Cross sectional prospective study of postpartal women using the Beck DepressionInventory(BDI) and the GHQ-30.Setting: Neonatal intensive care units and the obstetric units of Wesley Guild Hospital,Ilesa or Multipurpose Health Centre, Ilesa(These are component Units of ObafemiAwolowo University Teaching Hospitals Complex, Osun State Nigeria).Results: Of the 60 postnatal women recruited into the study, 33 mothers of pretermneonates formed the index group and 27 mothers of full term normal infants constitutedthe control group. More mothers of preterm neonates(27.3%) had GHQ-30 scores whichcategorised them as having significant emotional distress than mothers of full termnormal infants(3.7%). Similarly more mothers of preterm neonates(15.1%) were moredepressed than mothers of full term normal infants(3.7%). These differences were foundto be statistically significant when the mean scores of the two groups on the instrumentswere compared.Conclusion: These problems are not usually detected nor appropriately referred by thepaediatrician/obstetrician to the psychiatrist. This has a number of implications forpreventive psychiatry. A multidisciplinary approach is therefore essential in the detectionand management of these problems
BOOK REVIEW MEDICINAL PLANTS OF EAST AFRICA. 3RD EDITION
No full textJohn. O. Kokwaro, 2009, University of Nairobi Press (WWW.uonbi.ac.ke/press, Nairobi. xviii, 478 pp, 35 pp ill. (col.), 248 x 172, ISBN 9966846840, soft cover. Price Ksh. 1500 in East Africa and US$ 35 in other countries
Psychiatric morbidity in two urban communities in Nigeria
No full textBackground: There is a welter of evidence for an inverse relationship between socio-economic status (SES) and mental health. The relationship is grossly under researched in the developing countries.Objective: To ascertain rates of gross psychiatric morbidity and some demographic correlations in two communities with different socio-economic standards.Design: A cross-sectional community based study.Subjects: Random samples of two socio-economically dissimilar communities (N1 = 189, N2 = 148) were assessed for psychiatric morbidity.Results: Rates of psychiatric morbidity obtained for the lower status community (Ajegunle) and the higher status community (Victoria Island/Ikoyi) on the GH Q-12 were 26.5 and 14.2 respectively and the corresponding figures on the SRQ (non-psychosis) were 41.8 and 18.2 and on the SRQ (psychosis) 61.5 and 31.7. A large number of positive socio-demographic correlations between cases and non-cases were obtained on SRQ and GHQ-12 in both communities. Family history of psychiatric illness significantly differentiates cases from non-cases on all measures of morbidity.Conclusion: The socio-economic inequality demonstrated should be minimised by evolving a social welfare policy in Nigeria and other developing countries that is responsive to the survival needs of the populace and ensures equitable distribution of resources across socio-economic strata. There is dire need for further research into the complex bearings of the link between social status and psychological wellness in the developing world
PSYCHOMETRIC PROPERTIES OF AN AFRICAN SYMPTOMS CHECK LIST SCALE: THE NDETEI – OTHIENO – KATHUKU SCALE
No full textObjectives: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyanand similar social-cultural situations.Design: Cross-Sectional quantitative study.Setting: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up.Subjects: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members.Results: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL–90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733.Other item statistics and correlations of the scale are discussed.Conclusion: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victimsof all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive
VALIDATION OF C-REACTIVE PROTEIN IN THE EARLY DIAGNOSIS OF NEONATAL SEPSIS IN A TERTIARY CARE HOSPITAL IN KENYA
No full textObjective: To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya.Design: Cross-sectional study.Setting: Newborn Unit, Kenyatta National Hospital.Subjects: All neonates admitted to Newborn Unit, Kenyatta National Hospital duringthe study period with suspected sepsis based on specified clinical criteria.Results: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes ofprobable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2%in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, aspecificity of 85.3%, positive predictive value of 80.6%, and a negative predictive valueof 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive valueof 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy inproven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysisshowed a lower positive predictive value (61.5%) for early onset sepsis compared to93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the29 with proven/probable infection had a ten-fold increase in CRP levels, but levels werenoted to be low or reducing in seven (24.1%) babies showing signs of improvementclinically. Using a receiver operator characteristic curve, the optimal cut-off point forCRP was found to be 5 mg/dl.Conclusions: Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity,specificity and predictive values, at the standard cut-off of 5. CRP is a better screeningtest for late-onset than early-onset neonatal sepsis. The standard recommended CRPcut -off point of 5 is appropriate for local use
ZIDOVUDINE: A TARGETED THERAPY FOR ENDEMIC BURKITT'S LYMPHOMA
No full textBackground: Although cyclophosphamide based regimens can produce remission rates approaching 60 to 80% in endemic Burkitts lymphoma, relapses and refractory disease are fairly common in developing countries, due to advanced stage disease and costconstraints in the implementation of optimal chemotherapeutic protocols.Objective: To evaluate an affordable, tolerable and targeted approach to chemotherapy for endemic Burkitt’s Iymphoma as would be desirable in resource poor settings such as Africa.Method: We present data and review pertinent literature that indicates that the antiviral agent Zidovudine specifically targets this tumour through a unique and novel mechanism.Data Source: Our original studies, publications original and review articles searched in Pubmed indexed for Medline.Data Extraction: A systematic review to identify studies relating to Zidovudine, EBV+ and Burkitt’s lymphoma, indicating antiviral agents zidovudine targeting BL in a unique and novel mechanisms.Data Synthesis: Our data and a qualitative assessment of the relevant literature was undertaken, given the heterogenicity of the study types making it inappropriate to pool results across studies.Conclusion: Our data suggests that the incorporation of Zidovudine into Burkitt’s regimens may enhance tumour kill and abbreviate the duration of treatment necessary for this disease. Furthermore, the addition of the widely available and inexpensive agent hydroxyurea, markedly potentiates the tumorcidal activity of Zidovudine in Epstein Barr virus positive Burkitt’s lymphomas. We recommend that further clinical studies in patientsafflicted with this disease are needed to clearly define this potential use of Zidovudine
APPLICATION OF IMMUNOHISTOCHEMISTRY IN CLINICAL PRACTICE: A REVIEW
No full textABSTRACTBackground: Immunohistochemistry (IHC) has radically altered the practice of diagnostichistopathology. It is increasingly being applied for more accurate and precise diagnosis, theranosticsand prognostics in the management of tumours. Unfortunately clinicians and pathologists inresource-constrained settings may not be exposed to its clinical utility.Objectives: To provide a review of the principles and utility of IHC in diagnosis as relevant tohistopathological diagnosis in clinical practice.Data sources: A retrospective PubMed search was used to find most recent studies and reviewspublished on immunohistochemistry. Popular anatomical pathology textbooks and online resourceswere also searched.Study selection: The searches for articles were limited to the MeSH terms “humans” and “Englishlanguage”. Emphasis was placed on recent review and original articles that are dealing directlywith respective technical aspects and immunohistochemical stains of interest.Data extraction: Both authors searched and reviewed related articles separately.Data synthesis: The extracted information was compared so as to include the most updatedinformation available.Conclusions: Immunihistochemistry has become an essential component of histopathology.Clinicians need to be conversant with developments in IHC in order to liaise appropriately withpathologists for the benefit of their patients. There is a need for urgent establishment of IHCpractice within resource-constrained countries in order to meet current diagnostic standards intumour pathology