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HISTO AND CYTO-PATHOLOGIC DIAGNOSES AT A RURAL HOSPITAL IN KENYA
No full textBackground: Cancer has emerged as one of the common causes of morbidity and mortalityin rural areas and as a major cause of premature deaths.Objectives: To provide histo-pathology and cyto-pathology data in a rural district hospitaland highlight on the common malignancies seen in a rural setting in Kenya.Design: Prospective study.Setting: Histopathologv Department, Machakos Provincial Hospital, Machakos district,Kenya.Subjects: Two hundrend and sixty eight patients referred to Machakos laboratory forhistopathology, fine needle aspirate or pap smear cyto-pathology were analysed.Maill outcome measures: Staining with routine stains such Pap stain, Haeomatoxylin andEosin was effective method of making a primary accurate and definitive histo-pathology andcyto-pathology diagnosis in a rural district hospital setting.Results: Histo-pathology biopsies comprised 71.6% of the total slides seen. Pap smearcervical cytology cumprisd 13.8% while fine needIe aspirate and post- rnortem biopsiescomprised 12.39'~~ 2.2% respectivety. The commonest histo-pathology biopsies seen werebreastmmprising 24% ofthe total cases,fdowed by endometrium contributing 14.9%,thenfollowed by skin 1 1.58, tymph node 11S%, cervical 11 %, and gastrointestinal 6.3 %. Mostof pap smear cyto-pahology showed evidence of infection cornpising 54% while fine needleaspirate infections and malignancy showed equal rate 24% of d l cyto-pathology seen duringthis study.Conclusions: This is the first time histo-pathology and cyto-pathology data have beenprovided from a rural district hospital setting in Kenya. The malignant and pre-malignantpattern seen at hlachakos General Hospital may be used to gain a broader picture of thecommon malignant conditions prevalent in any defined population in this country. This alsoserves as an important cancer epidemiological data in this region during the period of study
SERUM LEPTIN CONCENTRATION IN A RURAL AFRICAN POPULATION
No full textObjective: Todetermine 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: Skinfoldmeasurement was significantly 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/mJ; 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
SPLENIC SIZE DETERMINATION IN SICKLE CELL ANAEMIA: AN ULTRASONOGRAPHIC STUDY
No full textObjectives: To examine the generally accepted concept of autospk nectomy in patients withsickle ceil anaemia, and determine the relationship between age, I he steady state PCV andsplenic size.Design: Case - control study.Setting: Sickle Cell Clinic, University of Ilorin Teaching Hospital, Ilorin, Nigeria.Subjects: Sickle cell anaemia patients aged three to 47 years, while the controls included ageand sex matched patients attending the General Outpatient Deparc ment for minor ailments.Interventions: Longitudinal and coronal sizes of the spleen were n reasured antemortem, byultrasonographic method, in 98 adult sickle cell anaemia patients a1 rd 48 control subjects andcompared. The splenic sue was correlated with age and PCV alnong sickle cell anaemiapatients.Main outcome measures: Determination of longitudinal and co~onal sizes of the spleen,comparison of mean splenic sizes of patients with those of controls by Student's t test, andcorrelation of age and PCV with splenic sues.Results: Both mean longitudinal and coronal diameters, and surf: Ice area were found to behigher in the sickle cell anaemia patients compared to the controls. While the longitudinaldiameter increased with age continuously, the coronal diameter c ecreased after the age of30 years. There were no significant correlations between the splenic sizes and PCV andnumber of crises per year.Conclusion: The general belief that sickle cell anaemia parients suffer anatomicalautosplenectomy was not confirmed. This could be due to the effect of malaria and improvedclinical care
EFFECTS OF THEOPHYLLINE ADMINISTRATION AND INTRACRANIAL ABNORMALITIES ON PROTECTIVE HEAD TURNING RESPONSE IN PRETERM INFANTS
No full textABSTRACTObjective: To determine effects of theophylline therapy for recurrent apnoea of prematurityand abnormal early (within the first 24 hours) cranial ultrasound abnormalities on protectiveneck turning response in preterm infants.Design: A cross sectional descriptive study.Setting: The Neonatal Unit of Hammersmith Hospital, London over a period of four months(February to May 1987) and the babies followed up for six months after discharge.Main Outcome Measures: Preterm babies of gestation 25 to 33 weeks confirmed by earlypostnatal Dubowitz assessment were studied. All infants had cranial ultrasound examinationwithin the first 24 hours of birth. Protective side turning response was recorded for each babyweekly until discharge. The pattern of maturation of the response was then analysed.Results: Thirty preterm infants (mean gestation 30 weeks) were studied. The babies treatedwith theophylline had significant (p=0.004) delay in the maturation of the response. Thisimproved within two weeks of stopping treatment. Eight infants had intracranial haemorrhageand seven had periventricular density. Both these groups were similar with respect to thematuration of the response. No significant interaction was found between theophyllinetherapy and abnormal cranial ultrasound as regards the protective side turning response. Sixmonths follow up showed no serious neurological abnormalities among the infants.Conclusion: Theophylline administration and perinatal brain injury may have a delayingeffect on protective head turning response in the neonatal period and therefore should betaken into account during neurological examination of the preterm neonate. This effect doesnot seem to result in any significant long-term neurological sequelae
UNUSUAL BLADDER OUTFLOW OBSTRUCTION: CASE REROPT
No full textSUMMARYHydatid disease, the parasitic infestation caused by the cestode, echinococcus granulosusinvolves mainly the liver and the lungs though no organ is immune. Genito urinaryinvolvement has been found mainly in the kidneys and rarely in other structures such as,bladder and epididymis. Isolated retrovesical location of the hydatid cyst is a very rarecondition whose manifestations appears after a long course of the disease and are due tocompression of bladder, causing the bladder out flow obstruction. Such rare case of bladderout flow obstruction is presented
CELLULAR AND MOLECULAR INTERACTIONS IN HIV INFECTIONS: A REVIEW
No full textObjective: To review the cellular and molecular interactions between HIV and the hostimmune system that lead to full-blown AIDS.Data Sources: Published reports on HIV/host interaction during a fifteen year periodbeginning from 1987.Study selection: Only those studies involving humans and non-human primates wereselected. The studies included original articles and state-of-the-art reviews covering in vivoand in vitro findings.Data extraction and synthesis: This article presents a critical review of the cellular andmolecular mechanisms of HIV infection and their relationship to the onset of AIDS.Conclusion: HIV has elaborated diverse and somewhat complicated mechanisms for thesubversion and evasion of the host immune defence strategies. These include escape throughmutation, prolonged latency of the infection, masking of the viral envelope proteins, downregulationof MHC-I and up-regulation of the Fas-ligand on infected cell surfaces. Thisreview enhances our understanding of HIV/AIDS disease and presents a basis on whichmanagement strategies could be developed
ANTIMICROBIAL RESISTANCE IN SALMONELLA SEROTYPES ISOLATED FROM SLAUGHTER ANIMALS IN KENYA
No full textObjectives: To isolate Salmonella from food animals and characterise the antimicrobial resistanceof the isolates.Design: A random sampling of slaughter animals was carried out.Setting: Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenyaand Institute for Animal Breeding, Neustadt-Mariensee, Germany.Subjects: Two hundred and eighty five samples, including faecal samples and carcass, cloacal andpharyngeal swab samples were analysed.Results: Sixteen (5.6%) of 285 samples were positive for Salmonella. The prevalence of Salmonellaon pig carcasses (19%) was higher than in faeces (8.6%). Three Salmonella enterica sub-speciesenterica serovars, namely Saintpaul (S. Saintpaul), Braenderup (S. Braenderup), and Heidelberg(S. Heidelberg), were identified, with S. Saintpaul being the predominant serovar. Antimicrobialresistance was found in 35.7% of all the isolates. The S. Heidelberg isolates were susceptible to allthe antimicrobial agents tested. Multidrug resistance was found in 7.1% of the resistant Salmonellaisolates. Plasmids were only detected in S. Heidelberg. Ampicillin resistance was based on expressionof a blaTEM gene, while chloramphenicol, streptomycin, and tetracycline resistances were encodedby the genes catAl, strA, and tet(A), respectively.Conclusion: Pigs may serve as reservoirs of antimicrobial resistant Salmonella and slaughterhousecross-contamination of pork may be a food safety risk. We recommended that slaughterhousehygiene be improved to minimise contamination of pig carcasses
VASCULITIS IN HIV: REPORT OF EIGHT CASES
No full textObjective: To describe vasculitis in HIV patients, their CD4 levels, anatomical sites affected and clinical patterns.Design: Prospective, descriptive study.Setting: Kisumu District Hospital and Nairobi Rheumatology Clinic between January 2002 and May 2005.Subjects: Eight patients with HIV and vasculitis.Results: Eight patients (four males and four females) were recruited with an age range of 24-61 years, mean 33.13 years. Five had central nervous system vasculitis and three had peripheral vasculitis. The CD4 counts were low, range 2-200 cells/mm3 (mean of 79.25 cells/mm3), normal levels of CD4 are 355-1298 cells/mm3, indicating severe immunosuppression. Two patients tested positive for HBV (hepatitis B virus).Conclusion: HIV associated vasculitis is recognised and may be complicated by coinfection with hepatitis viruses. It occurs at low CD4 counts. Central nervous system involvement is a common site. Management is multidisciplinary
Prevalence of hepatitis c virus and its genotypes among a cohort of drug users in Kenya
No full textBackground: Prevalence of hepatitis C virus and that of its main genotypes varies between the worlds geographic regions. The risk factors for infection with HCV include blood transfusion, tattoing and injecting drug use.Objectives: To examine the prevalence of HCV and determine its main genotypes among a cohort of drug users in Kenya.Design: A laboratory based study.Setting: Hepatitis research laboratory in the Centre for Virus Research at the Kenya Medical Research Institute, Nairobi.Subjects: Three hundred and fourteen male and 19 female intravenous and non-intravenous drug users aged between 15-55 years.Results: Seventy four (22.2%) out of 333 samples tested positive for anti-HCV. Sixty nine out of the 74 serum samples were assayed for HCV RNA and 38 (55.5%) were positive. The RNA positive samples were further subjected to sequencing and 19 (73%) of the samples were classified asgenotype la, while seven (27%) samples were classified as genotype 4. Genotypes 2, 3, 5 and 6 were not identified in this study.Conclusions: These results demonstrate a high HCV infection prevalence among this cohort of drug users (22.2 %) as compared to that of the general population, which is estimated to be 0.2- 0.9%. The study also confirms the presence of at least two major genotypes among Kenyan drugusers (genotypes 1 and 4)