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OPEN SIMPLE PROSTATECTOMY AND BLOOD TRANSFUSION IN NAIROBI
No full textABSTRACTBackground: Open simple prostatectomy has long been associated with large bloodlosses; hence allogeneic blood transfusion in this procedure is a standard practiceworld over. A review of literature suggests significant association between perioperativeblood loss accompanying open simple prostatectomy and certain patientfactors.. The shortage of blood and blood products in our blood transfusion centresas well as the alarming risks of transfusion reactions and disease disseminationdemanded a review of these factors with the aim of reducing morbidity associatedwith peri-operative blood loss and blood transfusion.Objectives: To assess blood loss, determine blood transfusion rate, and define someof the factors associated with peri-operative blood loss and blood transfusion in opensimple prostatectomy.Design : A prospective cohort study.Settings: The urology units of Kenyatta National Hospital, Kenya.Results: Ninety five patients who underwent open simple prostatectomy for benignprostatic hyperplasia were enrolled into the study. Their median age was 70 years(Range 50 to 97). The mean decrease in haemoglobin concentration, which was themain indicator of peri-operative blood loss, was 2.1g/dl (± 1.4). The peri-operativeblood transfusion rate was 36.8%. Twenty four (68.6%) of the patients who receivedeither one or two units of blood had a pre-operative haemoglobin level above 13.5g/dl and a post-operative haemoglobin level above 11.5g/dl, while 11 (31.4%) hadsevere peri-operative bleeding, that necessitated immediate surgical re-intervention.A total of 68 units of blood was transfused, 42 (61.8%) allogeneic and 26 (38.2%)autollogous blood. The post-operative median hospitalisation time was eight days(Range 4 to 35). There were two (2.1%) post-operative deaths and both patients hadintractable intra- and post-operative bleeding, massive blood transfusion anddisseminated intravascular coagulopathy. The factors that were significantlyassociated with peri-operative blood loss and blood transfusion in open simpleprostatectomy were patient’s aged above 70 years, pre-operative use of acetylsalicylateor warfarin sodium, pre-operative systolic blood pressure above 140mmHg,general anaesthesia, Freyer’s (transvesical) technique and the weight of resectedprostatic tissue above 70 grams.Conclusion: Open simple prostatectomy performed under spinal anaesthesia usingMillin’s (retropubic) technique is associated with minimal blood loss. The perioperativeblood transfusion rate was 36.8%
CONTRIBUTION OF VACCINATIONS TOWARDS REDUCING MORBIDITY AND MORTALITY AMONG CHILDREN IN DEVELOPING COUNTRIES
No full textDETERMINANTS OF IMMUNISATION COVERAGE AMONG CHILDREN IN MATHARE VALLEY, NAIROBI
No full textObjective: To establish the factors that determine the levels of immunisation coverage amongchildren under five years in Mathare Valley.Design: A crars-sectional study describing the situation at a point i n time.Setting: Mathare Valley slum with a population of 50,000 people in the city of NairobiSubjects: The study population was mothers with children under five years in MathareValley and had been resident there for a period not less than five yt ars prior to the study.Outcome measures: Level of immunisation coverage among children in the study populationand the factors that contribute to the low immunisation coverage.Results: Knowledge on immunisation was high with 90% of the reslmndents able to defineimmunisation. The attitude on immunisation was positive (74.4'6) and immunisationcoverage stood at 62.2%. Age, level of education, attitude and know1 edge on immunisaiionamong the residents were sigdicant determinants of immunisation coverage.Conclusion: Immunisation coverage was lower than the national aver age in Mathare Valley.Advanced mother's age, low level of education and relative lackof know ledge on immunisationwere responsible for the low coverage
INTESTINAL HELMINTHS AND SCHISTOSOMIASIS AMONG SCHOOL CHILDREN IN A RURAL DISTRICT IN KENYA
No full textObjective: To determine the extent of intestinal schistosomiasis, ascariasis, trichuriasis andhookworm infections among school children of Usigu and Bondo divisions of Bondo District.Design: A cross sectional study.Setting: Fifty out of 130 primary schools in Usigu and Bondo divisions, Bondo District.Subjects: Randomly selected school children (n= 3158) aged five to 20 years, were examinedfor intestinal helminths and schistosomiasis using Kato thick smear technique.Results: The overall prevalence and geometric mean egg counts per gradfaeces forSchistosorna mansoni were 31.6% and 3.1; hookworm 36.8% and 4.1; Trichuris trichiura21.8% and 1.5, and Ascaris lurnbricoides 16.5% and 2.5. More girls (34.9%) than boys(28.6%) were infected with S. mansoni whereas more boys (39.0%) than girls (34.5% ) wereinfected with hookworm. The prevalence of S. mansoni and hookworm infections increasedwith age but Ascaris and Trichuris infections decreased with age without any sex differences.Children under ten years of age tended to be more heavily infected with ascariasis,trichuriasis and hookworm than the older ones, while the intensity of S. mar2soni increasedgradually with age. There were positive relationships between different infections except fora significant negative correlation between Schistosorna rnansoni and hookworm infections.0niy four cases out of 789 had S. haemalobiurn infection.Conclusion. Schistosorna manso~zi and geohelminths were endemic in Bondo District, wheretwo thirds of the school children suffered from these parasites, Polyparasitism was alsocommon. There was a little overlap in the distribution of Schistosornaman,sorzi and hookworm,whereas ascariasis and trichuriasis were fairly distributed in the district
SUPRAPUBIC TRANSVESICAL PROSTATECTOMY IN A RURAL KENYAN HOSPITAL
No full textObjective: To evaluate the effectiveness, safety and complications of suprapubic transvesicalprostatectomy in a rural Kenyan hospital.Design: A prospective audit of suprapubic transvesical prostatectomy.Setting: Africa Inland Church, Kijabe Hospital, Kijabe, Kenya.Subjects: One hundred and six men with lower urinary tract obstruction, clinically due tobenign prostatic hyperplasia, undergoing suprapubic transvesical prostatectomy.Interventions: Suprapubic prostatectomy.Main outcome measures: Age, presentation, comorbidity, type of anaesthesia, pathology,bladder irrigation time, Foley time, post-operative stay, complications-mortality, bloodtransfusion rate, return to theatre for bleeding, incontinence, urine leak, urinary retention.Results: One hundred and six men entered the study with a mean age of 72.8 years. Seventyeight per cent were in retention and 25% had significant medical problems. Spinal anaesthesiawas used in 94%. The mean prostate weight was 70.4g and 11% had carcinoma. The Foley'scatheter was removed at a mean of 4.2 days after surgery and the mean post-operative staywas 6.0 days. The 30 day mortality was 0.9%, the blood transfusion rate was 4.7%, the returnto theatre for bleeding rate was 0.9% and 4.7% of patients developed a urine leak.Conclusion: Suprapubic transvesical prostatectomy, performed under spinal anaesthetic,by general surgeons in rural Kenya, is a safe and effective way of managing benign prostatichyperplasia and its complications
EXPERIENCE WITH LAPAROSCOPIC SURGERY AT THE AGA KHAN HOSPITAL, NAIROBI
No full textABSTRACTObjective: To outline the experience of laparoscopic surgery at the Aga Khan Hospital,Nairobi, and to determine the acceptability and outcome of the various proceduresundertaken laparoscopically.Design: A retrospective case analysis.Subjects: Four hundred and seventy eight cases of laparoscopic surgery were undertakenin Nairobi from May 2000 to May 2002 in the presence of the principal author, ofthese 408 cases (85.35%) were performed at the Aga Khan Hospital in Nairobi. A reviewof these cases and their outcomes are analysed and presented.Exclusions: Loss of client records, or follow up, all diagnostic procedures and allprocedures performed at the three other private hospitals, namely; Nairobi Hospital,Nairobi Womens’ Hospital and the M.P. Shah Hospital, have been excluded in this reviewResults: Minimal access surgery will in time find its place amongst the institutions inKenya. In the last two years 408 cases were undertaken at the Aga Khan Hospital,Nairobi, involving a pool of 48 consultants obstetricians and gynaecologists and generalsurgeons. The case load increased from 7.0 cases per month in 2000 to 22 cases permonth in 2001. Sixty four point four six percent of the patients spent one night inhospital, while 1.96% had conversion to laparotomy intraoperatively. Thirty nine pointseven percent of the patients had no previous surgery. The surgical proceduresperformed included laparoscopic adhesiolysis (34.55%) and tuboplasty (17.89%) forprimary or secondary infertility, 33 cases (8.08% ) for the management of ectopicpregnancies, laparoscopic myomectomy (15.44%), ovarian cystectomy (16.91%), ovariandrilling (4.65%), laparoscopic assisted vaginal hysterectomy (15.19%) and totallaparoscopic hysterectomy (2.20%). All cases were reviewed by the consultant pool oneweek after discharge. The major complications encountered included bladder injury(0.49%) and gut injury (0.73%).Conclusions: Minimal access surgery in gynaecology and general surgery is gainingremarkable ground worldwide and has tremendous potential in Kenya. It is evidentthat in trained hands, the common gynaecological operations and certain generalSurgical procedures can be undertaken safely, laparoscopically. Minimal access surgeryis acceptable to the patients and significantly favourable outcomes have been establishedin all the cases undertaken, thus far. Patient compliance has been excellent in this series
CAUSES AND PATTERN OF UNILATERAL HAND INJURIES
No full textObjective: To assess the causes and pattern of hand injuries in patients with isolated unilateral acute hand injuries managed at the Kenyatta National Hospital (KNH).Design: A prospective cross-sectional descriptive study.Setting: Kenyatta National Hospital, Nairobi, Kenya, between May and August 2006.Subjects: All patients with isolated unilateral acute hand injuries who presented at the casualty department.Results: A total of 99 patients were recruited. The mean age was 28.2 years with the modal age being 21-30 years. More males were injured than females. Occupational injuries and assaults were the most prevalent causes of hand injury. Majority of the injuries included lacerations, fractures and tendon injuries. The distal phalanges of the ring and long fingers were the most common sites of injury on the digits.Conclusion: Occupational hand injuries, a largely preventable problem, are the most prevalent cause of hand injury. This offers opportunity for strategies in preventing a large number of hand injuries by initiating safety measures at the work place
OCCUPATIONAL NOISE-INDUCED HEARING LOSS AMONG WORKERS AT JOMO KENYATTA INTERNATIONAL AIRPORT, NAIROBI
No full textBackground: Occupational noise induced hearing loss (NIHL) occurs among workers exposed to excessive amounts of noise for long durations. The average level of noise in some locations at Jomo Kenyatta International Airport (JKIA) was above the safelimit of 85dB hence workers were thought to be at risk.Objective: To determine the occurrence and socio demographic attributes for NIHLat JKIA.Design: Cross sectional descriptive study.Setting: Jomo Kenyatta International Airport, Nairobi, Kenya.Results: Mean age of respondents was 37 years with range 22 to 62, SD 8.98. Mean duration of exposure to noise was 10.7 years with range 1 to 40, SD 8.15. Prevalence of NIHL was 15.3%, with ground crew at 14.8% and air crew 16.1%. Ground crew had significantlypoorer mean hearing threshold level at 3, 4 and 6 kHz than air crew (p=0.015). Male workers were affected more than female counterparts with a male to female ratio of 4:3.97% of those affected were non-managers, 3% managers while 68% of those affected resided in Embakasi Division close to the airport. Hearing threshold level at 4 kHz deteriorated with increasing age whereby those aged 50 years and above had a 13.7times higher relative risk than those aged 20 to 29 years. Duration of exposure more than 10 years also had significantly higher risk (p<0.01) for hearing loss at 4 kHz.Conclusion: Occupational noise induced hearing loss occurs at JKIA and that ground crew and older workers are more vulnerable. We recommend that prevention programmesbe put in place
QUANTITATIVE ANALYSIS OF GAIT PATTERN IN HEMIPARETIC PATIENTS
No full textObjective: To characterise gait pattern in hemiparetic patients quantitatively usingclinical footprint method.Design: A case control study.Subjects: Sixteen hemiparetic patients (12 males and 4 females) aged 16 to 64 yearswho attended neurological clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi.Main outcome measures: Stride length, step width, foot rotation angle measured usingfootprint method.Results: The difference in mean values of the three variables of gait between affectedand unaffected sides in hemiparetic patients was not significant. However, strides weresignificantly longer in controls than in patients (P<0.001) while patients had significantlybroader steps (P<0.02). In the controls, foot was rotated externally in 87.7% of stepsand internally in 14.3% of steps. In the hemiparetic patients, intoeing pattern wasobserved in 41.3 % of steps. The difference in variability of stride length and foot anglebetween affected and non-affected sides of patients was not significant. Stride-to-stridevariability in stride length in patients was 1.6 times higher than in controls. Variabilityof step width and foot progression angle was 1.4 and 1.6 times higher in patients thanin controls.Conclusion: Footprint method provides fast and inexpensive tool for clinical gait analysisand is suitable for evaluation of hemiparetic patients. Our findings suggest that areasof emphasis for physical therapy of hemiparetic patients should include increasing stridelength and decreasing step width and internal rotation of foot, particularly on theaffected side
ACCIDENTAL INJURIES AND CUTANEOUS CONTAMINATIONS DURING GENERAL SURGICAL OPERATIONS IN A NIGERIAN TEACHING HOSPITAL
No full textABSTRACTBackground: During surgical operations cutaneous, percutancous and mucous membraneexposures to patients blood or body fluid occurs commonly. These events may predisposethe operating personnel to the acquisition of HIV and hepatitis virus infections. Theseroprevalence of HIV in the developing countries like ours is increasing; the risk ofseroconversion after needle stick injuries involving infected blood has also been documented.There is a need to know the incidence of needle stick injuries and body contaminationduring surgical operation in our hospital, for appropriate preventive measures can bedeveloped. This study was aimed at determine the prevalence of accidental injuries andbody contaminations among the operating pesonnel during general surgical operation,those involved, the circumstances surrounding the injuries or body contaminations andthe factors affecting the prevalence. It is hoped, that this will assist in designing andestablishing appropriate precautionary measures in our environment.Study design: Patients operated for general surgical conditions in a unit of a TeachingHospital Complex ddring a period of 2 years (1997-98) were eligible for participationin the study. A proforma was designed to enter personal biodata, preoperative and intrapostoperativeclinical information of all the patients. All types of general surgical operationswere included, emergency or elective, major or minor, carried out during the day or atnight. A resident doctor not participating in operation was instructed to watch out foraccidental injuries, glove failure and other body contamination, operating personnel werealso instructed to report injuries, glove failure and body contamination.Results: Operating personnel sustained 62 sharp injuries (10.5), these were caused bysuture needle in 57 cases (92.0%), towel clips in 3(4.8%), Knife cut in 2(3.2%). Operatingphysicians sustained 56 cases of sharp injuries (90.3%) and Scrub Nurses in 6(9.7%).Self-inflicted sharp injury in 49(79%) and in 12 cases (21%) injuries were inflicted bythe by the surgeons on their assistants. Left hand was injured in 39 cases (63%) andright in 23 ) (37%). Cutaneous or mucosa membrane contamination with blood or bodyfluid occurred in 232 cases (39.4%). These were made up of wet gown contaminationin 124 (53.5%), glove failure in 72(31%) and splashing of blood or fluids into the faceor eyes in 36 crises (15.5%). Contamination occurred in more than one operatingpersonnel in more than half of the cases. Operating surgeons were affected in 211 cases(91%). The risks of accidental injuries and blood and body fluid contamination weresignificant, if the duration of the operation is more than 1 hour, among the operatingsurgeons and if the operation was a major operation (p<0.05).Conclusion: This study has demonstrated that cutaneous, percutancous, and mucousmembrane exposure to patients’ blood and body fluids are common events duringgeneral surgical operations. Most accidental injuries were due to solid suture needlesticks,mostly injured personnel were the primary operating surgeons, injuries occurredpredominantly on the left hand. This way poses a significant risk of infection with bloodborne pathogens when operating on infected patients