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An incidental case of uterus didelphys and fibroids: Right sided myomectomy and left hemi-hysterectomy
No full textCongenital anomalies of the uterus occur due to agenesis or lack of fusion of the Mullerian ducts. The incidence of these anomalies is largely unknown since they are unlikely to be diagnosed in asymptomatic women. Uterine didelphys or double uterus occurs when the two Mullerian ducts fail to fuse resulting in duplication of the uterus and cervix. This report discusses a case of a 38-yearold woman who had presented with a longstanding history of abnormal uterine bleeding and cyclical pain. She had had two successful vaginal deliveries prior to presentation to our unit. Sonographic findings revealed large uterine myomas and was consented for open myomectomy. Intraoperatively she was found to have two uteri, both of which had intramural fibroids and two cervices
Stock management practices and supply chain performance of pharmaceutical companies in Nairobi, Kenya
No full textPurpose: The study was aimed at establishing stock management practices and performance in pharmaceutical firms in Nairobi. It was specifically aimed to establish how, EOQ, VMI, ERP, JIT and ABC analysis affects SC performance. The study used descriptive research design in its methodology. Design/Research method: The study was guided by Resource based view Theory and strategic choice theory. Data collection was effected by use of structured questionnaires. Supply chain managers, procurement managers and the equivalent were the targeted population. The targeted population was 38 pharmaceutical firms in Nairobi. These questionnaires were issued through drop and pick method, coded, keyed and analyzed using both descriptive and regression analysis. Finding: he findings of the study established that Pharmaceutical firms in Nairobi had adopted stock management practices to a large extent, which was indicated by a mean values greater than 3.0 on a scale of 1-5 for stock management practices. The results ascertained that stock management practices had a positive impact on performance. This was indicated by a positive correlation between the stock management practices and performance, which was measured by the values in the coefficients table. Limitation: The major limitation of the study is that it was based on pharmaceutical firms in Nairobi only. Implication: Future academicians should research on stock management practices in other firms rather than pharmaceutical firms in Nairobi Key words: Stock management practices, Supply chain management, procurement management practices, supply chain performance, pharmaceutical firm
Diversity and function of maternal hiv-1-specific antibodies at the time of vertical transmission
No full textInfants of HIV-positive mothers can acquire HIV infection by various routes, but even in the absence of antiviral treatment, the majority of these infants do not become infected. There is evidence that maternal antibodies provide some protection from infection, but gestational maternal antibodies have not yet been characterized in detail. One of the most studied vertically infected infants is BG505, as the virus from this infant yielded an Envelope protein that was successfully developed as a stable trimer. Here, we isolated and characterized 39 HIV-specific neutralizing monoclonal antibodies (nAbs) from MG505, the mother of BG505, at a time point just prior to vertical transmission. These nAbs belonged to 21 clonal families and employed a variety of VH genes. Many were specific for the HIV-1 Env V3 loop, and this V3 specificity correlated with measurable antibody-dependent cellular cytotoxicity (ADCC) activity. The isolated nAbs did not recapitulate the full breadth of heterologous or autologous virus neutralization by contemporaneous plasma. Notably, we found that the V3-targeting nAb families neutralized one particular maternal Env variant, even though all tested variants had low V3 sequence diversity and were measurably bound by these nAbs. None of the nAbs neutralized BG505 transmitted virus. Furthermore, the MG505 nAb families were found at relatively low frequencies within the maternal B cell repertoire; all were less than 0.25% of total IgG sequences. Our findings illustrate an example of the diversity of HIV-1 nAbs within one mother, cumulatively resulting in a collection of antibody specificities that can contribute to the transmission bottleneck.IMPORTANCE Mother-to-child-transmission of HIV-1 offers a unique setting in which maternal antibodies both within the mother and passively transferred to the infant are present at the time of viral exposure. Untreated HIV-exposed human infants are infected at a rate of 30 to 40%, meaning that some infants do not get infected despite continued exposure to virus. Since the potential of HIV-specific immune responses to provide protection against HIV is a central goal of HIV vaccine design, understanding the nature of maternal antibodies may provide insights into immune mechanisms of protection. In this study, we isolated and characterized HIV-specific antibodies from the mother of an infant whose transmitted virus has been well studied.
Keywords: antibody function; human immunodeficiency virus; maternal antibodies; monoclonal antibodies; mother-to-child transmission.
Copyright © 2020 American Society for Microbiology
Outcome of Gunshot Abdominal Injuries
No full textAim: To describe prevalence, management and factors determining outcomes in patients presenting with gunshot abdominal injuries.
Method: We retrospectively analysed all cases of gunshot to the abdomen received at Kenyatta National Hospital from October 2013 to October 2017. Patients’ demographic and clinical data were collected from their case notes. Data analysis used Fisher’s exact test and binary logistic regression. A p-value of <0.05 was considered statistically significant.
Results: A total of 1,588 records of patients with abdominal injuries were analysed. Of these, 209(15.3%) were cases of gunshot to the abdomen. The mean age was 31.5 years; male to female ratio was 8:1. Exploratory laparotomy was the preferred management in 161(77%) patients, selective nonoperative management in 11(5.3). Negative laparotomy rate was 8.7%, inpatient mortality 20% and complication rate 26%. Age, time from injury to admission, assisted breathing on admission, need for transfusion, and number of complications independently predicted mortality.
Conclusion: Gunshot abdominal injuries are commonly encountered at our setting and these are associated with significant mortality and development of complications. With careful selection, some patients can be successfully managed non-operatively
A case report on an unusual elongation of the Sustentaculum tali
No full textThe sustentaculum tali, as a horizontal shelf of the calcaneus serves as an attachment point for the
ligamentous support of the foot. Any variations on it has therefore been linked to instability factors of
the ankle joint. Studies have explored on the possible variations of this bony projection, but none have
been documented on an unusually long elongation of the same. This study examined an unusually
elongated sustentaculum tali found located on the left calcaneus of an adult Kenyan calcaneus. The right
pair did not bear the same variation. This elongation on the calcaneus revealed that it had a length of
11.68mm, height of 7.68mm and thickness of 2.83mm. This elongated sustentaculum tali, even though
a rare case should be considered in the cases of idiopathic subtalar joint instability
Prevalence, Incidence, and Distribution of Human Papillomavirus Types in Female Sex Workers in Kenya
No full textFemale sex workers (FSWs) have a notably high risk of acquiring human papillomavirus (HPV) infections. Relatively few studies address the type-specific prevalence and incidence of HPV among FSWs in sub-Saharan Africa. FSWs (n = 348) attending the Korogocho clinic in Nairobi, Kenya participated from August 2009 to March 2011. HPV DNA was detected using the SPF10-LiPA25 PCR assay. Baseline prevalence of HPV infection and cervical dysplasia were calculated, stratified by HIV-serostatus. Incidence rate (IR) of infection was calculated as number of new infections from baseline over person-months among 160 HPV-negative participants with complete 12-month follow-up. Baseline HPV prevalence was 23.6% for any HPV and 20.4% for high-risk HPV (hrHPV) types. Most prevalent types were HPV52 (10.1%), HPV35 (2.3%), and HPV51 (2.3%). A quarter (24%) of participants were HIV-positive. HPV prevalence was higher in HIV-positive (32.1%) than HIV-negative (20.8%) participants. hrHPV prevalence was higher in HIV-positive (27.4%) than HIV-negative (18.2%) women. During follow-up, HPV IR was 31.4 (95% CI: 23.8–41.5) for any HPV and 24.2 (95% CI: 17.9–32.8) for hrHPV types. HPV52 had the highest IR (6.0; 95% CI: 6.5–10.3). Overall HPV and hrHPV prevalence were lower than expected, but both prevalence and incidence were higher in HIV-positive than in HIV-negative women
Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.
No full textBACKGROUND:
Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya.
METHODS:
We drew on qualitative data collected from purposively selected women aged 15-49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12.
RESULTS:
Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals' and health facilities' capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare.
CONCLUSION:
Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care