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COMPARISON OF SONOGRAPHY WITH VENOGRAPHY IN THE DIAGNOSIS OF DEEP VENOUS THROMBOSIS
No full textABSTRACTObjective: To compare the findings of venous sonography with contrast venography in the detectionof deep venous thrombosis (DVT) of the lower limbs.Design: Prospective study.Setting: The Kenyatta National Hospital, a teaching and referral hospital in Nairobi.Subjects: Fifty five limbs in 44 patients with clinical suspicion of DVT were evaluated during theseven months study period (October 2002-April 2003). The ethics committee in the institutiongranted approval for the study and participants gave written informed consent.Intervention: Venous sonography in which a three step protocol involving B-mode gray scalecompression sonography, colour and colour Doppler sonography was obtained after contrastvenography in patients with clinical suspicion of DVT. The ultrasound examination was donewithin 24 hours of the contrast venogram.Results: The overall sensitivity of venous sonography was 88.9%, specificity 91.8% and accuracy90.9%. Considering only DVT above the calf, the sensitivity improved to 100%. An alternativediagnosis was found by ultrasound in 48.6% of the negative for DVT cases.Conclusion: The accuracy of venous sonography as done locally is high and comparable to thatin developed countries. We recommend that for patients with clinical suspicion of DVT, venoussonography be done as the initial imaging investigation and venography be reserved for thosepatients with equivocal or inadequate sonography results
CHRONIC SUPPURATIVE OTITIS MEDIA IN SCHOOL PUPILS IN NIGERIA
No full textABSTRACTObjective: To compare the prevalence of CSOM among two population of school children.Design: A survey-demographic data collection and otoscopy - was carried out amongthe two populations of school children.Setting: A rural government primary school and an urban private primary schoolParticipants: Six hundred and ninety nine school pupils in the rural school and twohundred and seventy pupils in the urban school.Results: Six percent (6%) of the pupils in the rural schools had CSOM as evidencedby persistent perforation of tympanic membrane of more than three months duration.No tympanic membrane perforations were observed in the children in the urban schoolat the time of this study. The difference in the prevalence of CSOM between the twopopulations is statistically significant (P<0.001).The difference in socio-economic status between the two populations is statisticallysignificant in relation to the prevalence of CSOM in the two populations. The poorerrural population had a significantly higher prevalence of CSOM (P<0.001).Conclusion: The two study populations are just 7km. apart geographically but thereis a world of difference in their socio-economic status, availability of social infrastructureand health facilities. This presumably had reflected in the marked difference in theprevalence of CSOM between the two study populations. A collective effort ofgovernment and well meaning indigenes of rural communities in Nigeria can helppromote the socio-economic status and enhance the availability of social infrastructureand health facilities of rural areas. This we hope will lead to a decline in the prevalenceof CSOM in the rural areas
MATERNAL IMMUNE RESPONSES AND RISK OF INFANT INFECTION WITH HIV-1 AFTER A SHORT COURSE ZIDOVUDINE IN A COHORT OF HIV-1 INFECTED PREGNANT WOMEN IN RURAL KENYA
Get PDFObjective: To investigate the effects of short-course nucleoside reverse transcriptaseinhibitor (Zidovudine, ZDW/AZT) on maternal immune responses and risk of infantinfection with HIV-1 among rural-based mothers in western Kenya.Design: A prospective cohort study involving HIV-1 seropositive pregnant mothers andtheir infants.Subjects: One hundred and seven HIV-1 seropositive asymptomatic pregnant womenand their infants.Methods: After informed consent, the women were enrolled at gestation age between16-24 weeks. For cultural and economic reasons, all mothers were allowed to breastfeed their infants. Short-course antepartum regime of AZT was administered to allmothers starting at 36 weeks gestation until start of labour. Maternal absolute CD4+T cell subset assays were performed before 3rd trimester (about 36 weeks gestation)and after a 4-week therapy of AZT (at least one month post-nuptially). Infant HIV-1 status was determined by HIV-1 DNA polymerase chain reaction (PCR) on samplessequentially taken at 1, 2, 3, 4, 6 and 9 months and confirmed by serology at 18 monthsof age.Interventions: Antepartum short-course orally administered AZT: 300mg twice-dailystarting at 36 weeks gestation until start of labour, 300mg at labour onset and 300mgevery three hours during labour until delivery.Main Outcome Measures: Maternal CD4+ T cell counts before and after AZT treatment.Determination of infant HIV-1 infection status.Results: Among 107 women sampled, only 59 received full dose of AZT and thus qualifiedfor present analysis. Of these, 12 infected their children with HIV, while 47 did not.Comparison of CD4+ T cells before and after AZT treatment scored a significant risein all mothers (P = 0.01). This increase in CD4+ T cells was not significant amongmothers who infected their infants with HIV-1 (P = 0.474). However, a significant risein CD4+ T cells following AZT therapy was observed only in mothers who did nottransmit HIV-1 to their infants (P=0.014).Conclusion: These data suggest that a rise in the CD4+ T cell counts following shortAZT regimen, now widely in use in resource-weak countries, may be evidence of theactive suppression of the replication of HIV. However, further studies to examine themulti-factorial effect of CD4+ lymphocytes and pregnancy on MTCT of HIV need tobe carried out to help fully explain the effect of AZT on immune response and whetherthe CD4+T cell count can be used as a true test of immunological normalisation duringantiretroviral therapy
Prevalence of adverse drug reactions in adult patients on antiretrovirals at Kenyatta National Hospital, comprehensive Care Centre
Get PDFBackground: There has been an increased access to anti-retrovirals in resourceconstrainedsettings. However, few studies have addressed the area of adverse drugreactions in these settings.Objective: To determine the prevalence of adverse drugs reactions in HIV-infectedpersons receiving anti-retrovirals.Design: A retrospective cohort study.Setting: Kenyatta National Hospital, Comprehensive Care Centre.Subjects: Adult patients receiving anti-retroviral drug during the four year periodbetween January 2003 and December 2006.Main outcome measures: The primary outcome was a documented adverse drug reactionafter exposure to antiretrovirals.Results: Systematic random sampling was used to pick 350 patients’ files. There were219 recorded adverse drug reactions in 170 (48.6%) patients (some patients had morethan one adverse drug reaction). Peripheral neuropathy was the most common adversedrug reaction with a prevalence of 28.9% followed by lipid abnormalities at 14.3%.Conclusion: This study indicates a high prevalence of adverse drug reactionsamong HIV/AIDS patients on anti-retroviral therapy at Kenyatta National Hospital,Comprehensive Care Centre
TONSILLECTOMY AND ADENOTONSILLECTOMY IN SUDANESE PATIENTS
No full textObjectives: To highlight the indications for and complications of tonsillectomy oradenotonsillectomy operations in Sudanese patients and to find out whether any correlationcan bededuced between routinely requested pre-operative investigations and thecomplicationswhich may arise.Design: A prospective study.Setting: Khartoum ENT Teaching Hospital, Khartoum, Sudan.Subjects: One hundred and twenty patients, 55% females and 45% males, age range 3 to 50years. Pre-operative investigations consisted of a complete blood count and bleeding andclotting times., AS0 titres and urinalysis.Interventions: Consisted of tonsillectomy or adenotonsillectomy performed on in-patients byone of the authors under general anaesthesia.Main outcome measures: High erythrocyte sedimentation rate (ESR) or AS0 titres shouldnot deter an indicated tonsillectomy operation which can still be carried out if meticuloushaemostasis is observed.Results: Three or more episodes of exudative tonsillitis per year and upper airway obstructionwere the commonest indications for tonsillectomy or adenotonsillectomy accounting for72.5% and 16.7% of the operations. Intra-operative bleeding occurred in 63 (52.5%) of thepatients. Low figures of reactionary and secondary haemorrhages were seen.Conclusion: It is concluded that as bleeding, both intra- and post-operative is the maincomplication of tonsillectomy, its incidence can be reduced to minimal levels by carefulselection of patients, in whom the operation is carried out under general anaesthesia withgentle handling of tissues and detention of the patients post-operatively for two to three days.We also found out that coagulation tests need not be routinely requested and reserved forpatients with a history of bleeding tendencies
MINOR SURGERY AT HOSPITALS AND CLINICS IN A KENYAN DISTRICT
No full textBackground: Minor surgical operations are performed at almost all hospitals, health centresand dispensaries in Africa. A large proportion of the operations are urgent, prompted byinjuries and acute infections. They are rarely recorded and reported systematically, andrates and patterns are poorly known.Objective: To describe of all minor surgery performed on a rural African population duringone year.Design: Prospective recording and analysis of minor surgical procedures and of the patientsundergoing the same procedures.Setting: Hospitals, health centres, dispensaries and mission clinics in Meru district, Kenya.Results: Out of 26,858 minor operations performed (2,0661100,000 peoplelyear) 22,838 weredone at the five hospitals in the district while 2,510 were done at 49 mission clinics (4.3lcliniclmonth), 764 at ten health centres (6.4lhealth centrelmonth) and 620 at 29 dispensaries (1.81dispensarylmonth). The most common operations were episiotomy, tooth extraction, woundsuture and incision and drainage of abscess. More minor surgery is done on women than onmen, and the difference is related to obstetrical procedures.Conclusions: Relatively few operations were performed at health centres, dispensaries andmission clinics. Possible explanations include perceived quality of care, staff motivation,poor service access outside office hours and service charges
PITUITARY APOPLEXY: REPORT OF TWO CASES
No full textPituitary apoplexy is a common clinical syndrome characterised by acute headache, ophthalmoplegia, diminished visual acuity and altered mental status caused by the sudden haemorrhage or infarction of the pituitary gland. The two cases reported highlight the variability in presentation which underscores the need for a high index of suspicion and the need for MRI in patients presenting with a thunderclap headache and 'normal' initial investigations
MOLECULAR CHARACTERISATION OF THE ROTAVIRUS STRAINS PREVALENT IN MAUA, MERU NORTH, KENYA
No full textBackground: Rotavirus is the most common cause of severe infantile diarrhoea disease in infants and young children below five years worldwide. Rotavirus is associated with high cases of morbidity and mortality and it is estimated that up to 650,000 deaths in young children occur annually in the less developed countries and approximately 150,000-200,000 deaths occur in Africa alone.Objective: To characterise the circulating rotavirus strains in Maua, Meru North district, Kenya.Design: A prospective study to investigate and characterise rotavirus serotypes/ genotypes and electropherotypes in infants and children with severe diarrhoea hospitalised and/or attending the outpatient department of Maua Methodist Hospital during the period April 2004 to September 2005.Setting: Maua Methodist Hospital, Meru North, Kenya.Subjects: Faecal samples were collected from 135 infants and children with acute diarrhoea and were screened first for the presence of human Group A rotavirus antigen using commercially available enzyme linked immunosorbent assay kit (ELISA). The positive samples were evaluated by sodium dodecyl polycrylamide gel electrophoresis (SDS-PAGE) to determine the viral RNAelectropherotype profile. Rotavirus strains were also genotyped using reverse transcriptase polymerase chain reaction (RT-PCR) of the VP7 gene.Results: Assay of these samples with commercial ELISA showed that 17.8% (24/135) were positive for group A rotavirus antigen. Twenty of these ELISA positive samples were also analysed by SDS-PAGE of which 75% (15/20) gave detectable electropherotype pattern with the long electropherotype being predominant 80.0% (12/15) followed by the short RNA profile 20.0% (2/15). Seventeen of the ELISA positive samples were genotyped for VP7 and the results showed that G9 was the most predominant genotype comprising 47.1% (8 /17) followed by G8 29.4 % (5/17), GI 17.4% (3/17) and the mixed genotype was G8/G9 5.9% (1/17). Most patients with rotavirus infection were of the age of 3 - 60 months, with 79% being less than 18 months old.Conclusion: The overall prevalence of rotavirus infection in young children with diarrhoea hospitalised and/or attending the out-patient department of Maua Methodist Hospital was 17.8% with the predominant serotype being G9. These results show that rotavirus plays an important role in severe viral diarrhoea in young children in Maua, Meru North district, Kenya. Furthermore, this high G9 rotavirus prevalence in Kenya may require vaccine trials to be held in Kenya so as to determine the efficacy of new rotavirus vaccine candidates that do not include the G9 serotype
PLUMMER VINSON SYNDROME: CASE REPORT
No full textPlummer Vinson syndrome is characterised by dysphagia, iron deficiency, anaemia andoesophageal web or webs. This is a case report of a 33 year old Asian female who presentedwith slowly progressive dysphagia and a long history of iron deficiency anaemia. Theanaemia was confirmed on repeated haemograms and a barium swallow revealed an upperoesophageal web. Upper gastrointestinal endoscopy and forceful dilatation were necessaryto effect relief of dysphagia
ASSESSMENT OF DIABETIC RETINOPATHY IN NEWLY DIAGNOSED BLACK KENYAN TYPE 2 DIABETICS
No full textObjective: To determine the prevalence and pattern of diabetic retinopathy in newly diagnosed black African patients with type 2 diabetes mellitus and the associatedrisk factors.Design: Cross-sectional hospital-based study.Setting: Eye clinic of Kenyatta National Hospital, Nairobi, Kenya.Subjects: Africans aged 20 years and above with newly diagnosed type 2 diabetes mellitus of up to 12 months duration.Results: One hundred and forty one eyes of 71 patients were included in this study, while slides of 92 eyes of 65 patients were of good enough quality for evaluation. The mean duration of diabetes was 11.7 weeks (SD 16.6) and 11.3 (SD 10.1) in men and women respectively. Overall, the prevalence of diabetic retinopathy and clinically significant macula oedema was 30.4% and 8.7% respectively. There was a positive association between diabetic retinopathy and systolic blood pressure.Conclusion: The prevalence of diabetic retinopathy in newly diagnosed Africans with type 2 diabetes in Kenya is very high. This suggests longstanding undiagnosed diabetes