Prevalence of pain symptoms suggestive of endometriosis among adolescents in Kenya

Objective: To determine the prevalence of pain symptoms suggestive of Endometriosis among adolescent Kenyans and their impact on quality of life.Study Design: Analytical cross- sectional studySetting: Dual centered study at Githunguri Girls High School (Rural) and Moi Girls High School Nairobi (Urban).Subjects: Three hundred and thirteen adolescents were interviewed with even distribution between rural (50.8%) and urban (49.2%) schools.Outcome Measure: The primary outcome measure was the prevalence of pain symptoms suggestive of endometriosis.Results: Dysmenorrhea was the most prevalent symptom at 72% with severedysmenorrhea reported at 29%. Regular absenteeism was reported at 4% in those with dysmenorrhea, 1% was due to acyclic pelvic pain and 1% reported intermenstrual pain limiting their daily activities. In the students’ interviewed, 94% had not heard of endometriosis, of whom 70% were interested to know more about it. The dysmenorrhea and pelvic pain that interfered with ordinary chores was most likely due to endometriosis.Conclusion: Majority of adolescent girls with chronic pelvic pain, not corresponding to conventional therapy have endometriosis. Endometriosis appearing in adolescence is more likely to progress and if not treated, may progress beyond pain to infertility. Endometriosis in adolescence is a hidden progressive and severe disease that deserves attention, not just compassion

Influence of Performance Management and Compensation Practices on Employee Retention in Research Institutes in Kenya

This study sought to establish the influence of employee performance management and compensation on employee retention and the moderating effect of management style on employee retention in research institutes in Kenya. This study was informed by the dynamic and competitive environment in which research institutes in Kenya operate, the fact that talent and technical skills are in short supply and the difficulty in retaining valued employees. Data was collected from 236 employees in specific categories identified in 5 public research institutes in Kenya formed under the Science, Technology and Innovation Act (repealed), 2013 using self-administered questionnaires. Data was analyzed using using Predictive Analytics Software (PASW) version 23 formerly Statistical package for social sciences (SPSS) to generate descriptive and inferential statistics. The study found that performance management and compensation have a significant positive influence on employee retention and management style had a significant moderating effect on the relationship between the selected HRM practices in research institutes in Kenya at p≤.05 level of significance. The study recommends active participation of relevant actors and provision of prompt feedback as regards to performance management and the need to undertake periodic salary review, ensuring external equity of salaries and provision of competitive benefit packages in research institutes in Kenya. Keywords: Performance management, compensation, Management style and employee retention.

Topical fl uorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial

Background Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly aff ecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the eff ect of fl uorouracil 1% eye drops after surgery on recurrence. Methods We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fl uorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratifi ed by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). Findings Between August, 2012, and July, 2014, we assigned 49 participants to fl uorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in fi ve (11%) of 47 patients in the fl uorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07–0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little eff ect (odds ratio 0·23; 95% CI 0·07–0·75; p=0·02). Adverse eff ects occurred more commonly in the fl uorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fl uorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus fi ve, and eyelid skin infl ammation occurred in seven versus none. Interpretation Topical fl uorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended

Topical fl uorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial

Background Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly aff ecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the eff ect of fl uorouracil 1% eye drops after surgery on recurrence. Methods We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fl uorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratifi ed by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). Findings Between August, 2012, and July, 2014, we assigned 49 participants to fl uorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in fi ve (11%) of 47 patients in the fl uorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07–0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little eff ect (odds ratio 0·23; 95% CI 0·07–0·75; p=0·02). Adverse eff ects occurred more commonly in the fl uorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fl uorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus fi ve, and eyelid skin infl ammation occurred in seven versus none. Interpretation Topical fl uorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended

Clinical Presentation of Ocular Surface Squamous Neoplasia in Kenya.

IMPORTANCE: There is a trend toward treating conjunctival lesions suspected to be ocular surface squamous neoplasia (OSSN) based on the clinical impression. OBJECTIVE: To describe the presentation of OSSN and identify clinical features that distinguish it from benign lesions and subsequently evaluate their recognizability. DESIGN, SETTING, AND PARTICIPANTS: Prospective multicenter study in Kenya from July 2012 through July 2014 of 496 adults presenting with conjunctival lesions. One histopathologist examined all specimens. Six additional masked ophthalmologists independently examined photographs from 100 participants and assessed clinical features. EXPOSURES: Comprehensive history, slitlamp examination, and photography before excision biopsy. MAIN OUTCOMES AND MEASURES: Frequency of clinical features in OSSN and benign lesions were recorded. Proportions and means were compared using χ2, Fisher exact test, or t test as appropriate. Interobserver agreement was estimated using the κ statistic. Examiners' assessments were compared with a reference. RESULTS: Among 496 participants, OSSN was the most common (38%) histological diagnosis, followed by pterygium (36%) and actinic keratosis (19%). Patients with OSSN were slightly older (mean [SD] age, 41 [11.6] vs 38 [10.9] years; P = .002) and tended to have lower levels of education than patients with benign lesions (P = .001). Females predominated (67% of OSSN vs 64% of benign lesions; P = .65). Human immunodeficiency virus infection was common among patients with OSSN (74%). The most common location was the nasal limbus (61% OSSN vs 78% benign lesions; P < .001). Signs more frequent in OSSN included feeder vessels (odds ratio [OR], 5.8 [95% CI, 3.2-10.5]), moderate inflammation (OR, 3.5 [95% CI, 1.8-6.8]), corneal involvement (OR, 2.7 [95% CI, 1.8-4.0]), leukoplakia (OR, 2.6 [95% CI, 1.7-3.9]), papilliform surface (OR, 2.1 [95% CI, 1.3-3.5]), pigmentation (OR, 1.5 [95% CI, 1.0-2.2]), temporal location (OR, 2.0 [95% CI, 1.2-3.2]), circumlimbal location (6.7% vs 0.3%; P < .001), severe inflammation (6.7% vs 0.3%; P < .001), and larger mean (SD) diameter (6.8 [3.2] vs 4.8 [2.8] mm; P < .001). All OSSN signs were also observed in benign lesions. There was slight to fair interobserver agreement in assessment of most signs and diagnosis (κ, 0.1-0.4). The positive predictive value of clinical appearance in identifying OSSN was 54% (interquartile range, 51%-56%) from photographs in which prevalence was 32%. CONCLUSIONS AND RELEVANCE: With overlapping phenotypes and modest interobserver agreement, OSSN and benign conjunctival lesions are not reliably distinguished clinically. Point-of-care diagnostic tools may help

Risk factors for ocular surface squamous neoplasia in Kenya: a case-control study.

OBJECTIVE: To determine modifiable risk factors of ocular surface squamous neoplasia (OSSN) in Kenya using disease-free controls. METHODS: Adults with conjunctival lesions were recruited at four eye care centres in Kenya and underwent excision biopsy. An equal number of controls having surgery for conditions not affecting the conjunctiva and unrelated to ultraviolet light were group-matched to cases by age group, sex and eye care centre. Associations of risk factors with OSSN were evaluated using multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Continuous variables were compared using the t-test or the Wilcoxon-Mann-Whitney U-test depending on their distribution. RESULTS: A total of 131 cases and 131 controls were recruited. About two-thirds of participants were female, and the mean age of cases and controls was 42.1 years and 43.3 years, respectively. Risk factors for OSSN were HIV infection without antiretroviral therapy (ART) use (OR = 48.42; 95% CI: 7.73-303.31) and with ART use (OR = 19.16; 95% CI: 6.60-55.57), longer duration of exposure to the sun in the main occupation (6.9 h/day vs. 4.6 h/day, OR = 1.24; 95% CI: 1.10-1.40) and a history of allergic conjunctivitis (OR = 74.61; 95% CI: 8.08-688.91). Wearing hats was protective (OR = 0.22; 95% CI: 0.07-0.63). CONCLUSION: Measures to prevent and control HIV, reduce sun exposure such as wearing hats and control allergic conjunctivitis are recommended

Toluidine Blue 0.05% Vital Staining for the Diagnosis of Ocular Surface Squamous Neoplasia in Kenya.

IMPORTANCE: Clinical features are unreliable for distinguishing ocular surface squamous neoplasia (OSSN) from benign conjunctival lesions. OBJECTIVE: To evaluate the adverse effects, accuracy, and interobserver variation of toluidine blue 0.05% vital staining in distinguishing OSSN, confirmed by histopathology, from other conjunctival lesions. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study in Kenya from July 2012 through July 2014 of 419 adults with suspicious conjunctival lesions. Pregnant and breastfeeding women were excluded. EXPOSURES: Comprehensive ophthalmic slitlamp examination was conducted. Vital staining with toluidine blue 0.05% aqueous solution was performed before surgery. Initial safety testing was conducted on large tumors scheduled for exenteration looking for corneal toxicity on histology before testing smaller tumors. We asked about pain or discomfort after staining and evaluated the cornea at the slitlamp for epithelial defects. Lesions were photographed before and after staining. MAIN OUTCOMES AND MEASURES: Diagnosis was confirmed by histopathology. Six examiners assessed photographs from a subset of 100 consecutive participants for staining and made a diagnosis of OSSN vs non-OSSN. Staining was compared with histopathology to estimate sensitivity, specificity, and predictive values. Adverse effects were enumerated. Interobserver agreement was estimated using the κ statistic. RESULTS: A total of 143 of 419 participants (34%) had OSSN by histopathology. The median age of all participants was 37 years (interquartile range, 32-45 years) and 278 (66%) were female. A total of 322 of the 419 participants had positive staining while 2 of 419 were equivocal. There was no histological evidence of corneal toxicity. Mild discomfort was reported by 88 (21%) and mild superficial punctate keratopathy seen in 7 (1.7%). For detecting OSSN, toluidine blue had a sensitivity of 92% (95% CI, 87%-96%), specificity of 31% (95% CI, 25%-36%), positive predictive value of 41% (95% CI, 35%-46%), and negative predictive value of 88% (95% CI, 80%-94%). Interobserver agreement was substantial for staining (κ = 0.76) and moderate for diagnosis (κ = 0.40). CONCLUSIONS AND RELEVANCE: With the high sensitivity and low specificity for OSSN compared with histopathology among patients with conjunctival lesions, toluidine blue 0.05% vital staining is a good screening tool. However, it is not a good diagnostic tool owing to a high frequency of false-positives. The high negative predictive value suggests that a negative staining result indicates that OSSN is relatively unlikely

Topical fluorouracil after surgery for ocular surface squamous neoplasia in Kenya: a randomised, double-blind, placebo-controlled trial.

BACKGROUND: Ocular surface squamous neoplasia (OSSN) is an aggressive eye tumour particularly affecting people with HIV in Africa. Primary treatment is surgical excision; however, tumour recurrence is common. We assessed the effect of fluorouracil 1% eye drops after surgery on recurrence. METHODS: We did this multicentre, randomised, placebo-controlled trial in four centres in Kenya. We enrolled patients with histologically proven OSSN aged at least 18 years. After standard surgical excision, participants were randomly allocated to receive either topical fluorouracil 1% or placebo four times a day for 4 weeks. Randomisation was stratified by surgeon, and participants and trial personnel were masked to assignment. Patients were followed up at 1 month, 3 months, 6 months, and 12 months. The primary outcome was clinical recurrence (supported by histological assessment where available) by 1 year, and analysed by intention to treat. The sample size was recalculated because events were more common than anticipated, and trial enrolment was stopped early. The trial was registered with Pan-African Clinical Trials Registry (PACTR201207000396219). FINDINGS: Between August, 2012, and July, 2014, we assigned 49 participants to fluorouracil and 49 to placebo. Four participants were lost to follow-up. Recurrences occurred in five (11%) of 47 patients in the fluorouracil group and 17 (36%) of 47 in the placebo group (odds ratio 0·21, 95% CI 0·07-0·63; p=0·01). Adjusting for passive smoking and antiretroviral therapy had little effect (odds ratio 0·23; 95% CI 0·07-0·75; p=0·02). Adverse effects occurred more commonly in the fluorouracil group, although they were transient and mild. Ocular discomfort occurred in 43 of 49 patients in the fluorouracil group versus 36 of 49 in the placebo group, epiphora occurred in 24 versus five, and eyelid skin inflammation occurred in seven versus none. INTERPRETATION: Topical fluorouracil after surgery substantially reduced recurrence of OSSN, was well-tolerated, and its use recommended. FUNDING: British Council for Prevention of Blindness and the Wellcome Trust

Study Protocol: The Simulated Ocular Surgery (SOS) Trials: Randomised-Controlled Trials Comparing Intense Simulation-Based Surgical Education for Cataract and Glaucoma Surgery to Conventional Training Alone in East and Southern Africa

There is a huge need to perform high volumes of surgery in sub-Saharan Africa, to tackle the backlog of avoidable blindness. There is a great need to train many eye surgeons safely, efficiently, effectively, and to an acceptable level of competence. There is also a need to maintain and improve the quality and outcomes of surgery. Currently, surgical training is often conducted using the traditional "apprentice model", where a trainee observes a qualified surgeon and learns from them, and then the surgeon supervises the trainee performing surgery on a patient. We believe that this conventional model has substantial limitations and drawbacks, making surgical training less efficient and less safe. We will test the hypothesis that intense modular simulation-based ophthalmic surgical education is superior to conventional training for the initial acquisition of competence. Pilot studies have been conducted in Malawi, Uganda, and South Africa to develop, test and refine aspects of modular simulation-based ophthalmic surgical training in cataract and glaucoma surgery. Assessment tools have been developed and validated for use in this simulation-based training (see Appendices 3a and 3b). Subsequent to these pilot and validation studies, we are now able to test the efficacy of focussed modular simulation-based ophthalmic surgical training in two separate parallel-group randomised controlled trials. We will conduct two independent trials of intense simulation-based ophthalmic surgical education for training ophthalmologists in the procedures for cataract, and separately for glaucoma: the two leading causes of blindness in sub-Saharan Africa. Trainee eye surgeons will be randomised to the 'intervention' of focussed simulation-based surgical training (in addition to, and as an enhancement to conventional training), or to the 'control' group of current conventional training alone. The 'control' group participants will receive the same simulation training, only after a period of one year. Follow-up assessments will measure whether the trainees have gained in surgical competence (objectively assessed using a specific and validated grading score), knowledge, their perceived confidence as a surgeon, and in terms of the benefit to their patients (the quality and quantity of surgery performed). All the training within the 'educational intervention' of this study will be performed using simulation. There is no testing or surgical training on patients within the study educational-intervention of both training trials. The only times when patients are indirectly involved is entirely as part of standard, regulated, and supervised clinical training within a Nationally accredited and registered ophthalmology training programme. When three anonymised and non-identifiable recordings of cataract surgical procedures are video-recorded (at three months, year one, and then another three at fifteen months), patients will be informed of the planned recording, and invited to sign a standardised informed consent as for any clinical image recording within standard clinical practice. Live surgery recordings or assessments for the GLASS trial intervention and control groups will be conducted in individual circumstances where the local Consultant Ophthalmologist deems the participant competent to perform (and record) SUPERVISED live surgery during the year post-intervention

Shaping the microbial landscape: parasitoid-driven modifications of Bactrocera dorsalis microbiota

DATA AVAILABILITY : The datasets generated during and/or analyzed during the current study are available in the Sequence Read Archive (SRA) at NCBI under Bioproject: PRJNA1042921.ESM 1 : Online resource 1. Table showing the relative abundance of the bacterial phyla of B. dorsalis larval guts post-parasitisation by Diachasmimorpha longicaudata and Psyttalia cosyrae.ESM 2 : Online resource 2. Table showing the percentage relative abundance of the most common bacterial genera in Bactrocera dorsalis. It includes the unparasitised larvae (control) and those parasitised by Diachasmimorpha longicaudata (BD-DL) and Psyttalia cosyra (BD-PC).ESM 3 : Online resource 3. Relative abundance of selected bacterial genera across the different Bactrocera dorsalis larval groups (Control, parasitized by Diachasmimorpha longicaudata and those parasitized by Psyttalia cosyrae).ESM 4 : Online resource 4. Differential abundance of bacterial ASVs and their taxonomic assignment in Diachasmimorpha longicaudata -parasitised Bactrocera dorsalis larvae compared to the control. Statistical significance of ASVs is assigned at a p-adjusted (padj) value less than 0.05.ESM 5 : Online resource 5. Differential abundance of bacterial ASVs and their taxonomic assignment in Psyttalia cosyrae -parasitised Bactrocera dorsalis larvae compared to the control. Statistical significance of ASVs is assigned at a p-adjusted (padj) value less than 0.05.ESM 6 : Online resource 6. Differential abundance of bacterial ASVs and their taxonomic assignment in Psyttalia cosyrae -parasitised Bactrocera dorsalis larvae compared to those parasitised by Diachasmimorpha longicaudata. Statistical significance of ASVs is assigned at a p-adjusted (padj) value less than 0.05.ESM 7 : Online resource 7. Percentage relative abundance of the most common bacteria genera in female Diachasmimorpha longicaudata and Psyttalia cosyrae.ESM 8 : Online resource 8. Percentage relative abundance of the most common fungal phyla in Bactrocera dorsalis. It includes the unparasitised larvae (control) and those parasitised by Diachasmimorpha longicaudata (BD-DL) and Psyttalia cosyrae (BD-PC).ESM 9 : Online resource 9. Percentage relative abundance of the most common fungal genera in Bactrocera dorsalis. It includes the unparasitised larvae (control) and those parasitised by Diachasmimorpha longicaudata (BD-DL) and Psyttalia cosyrae (BD-PC).Koinobiont endoparasitoids regulate the physiology of their hosts through altering host immuno-metabolic responses, processes which function in tandem to shape the composition of the microbiota of these hosts. Here, we employed 16S rRNA and ITS amplicon sequencing to investigate whether parasitization by the parasitoid wasps, Diachasmimorpha longicaudata (Ashmaed) (Hymenoptera: Braconidae) and Psyttalia cosyrae (Wilkinson) (Hymenoptera: Braconidae), induces gut dysbiosis and differentially alter the gut microbial (bacteria and fungi) communities of an important horticultural pest, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae). We further investigated the composition of bacterial communities of adult D. longicaudata and P. cosyrae to ascertain whether the adult parasitoids and parasitized host larvae share microbial taxa through transmission. We demonstrated that parasitism by D. longicaudata induced significant gut perturbations, resulting in the colonization and increased relative abundance of pathogenic gut bacteria. Some pathogenic bacteria like Stenotrophomonas and Morganella were detected in both the guts of D. longicaudata-parasitized B. dorsalis larvae and adult D. longicaudata wasps, suggesting a horizontal transfer of microbes from the parasitoid to the host. The bacterial community of P. cosyrae adult wasps was dominated by Arsenophonus nasoniae, whereas that of D. longicaudata adults was dominated by Paucibater spp. and Pseudomonas spp. Parasitization by either parasitoid wasp was associated with an overall reduction in fungal diversity and evenness. These findings indicate that unlike P. cosyrae which is avirulent to B. dorsalis, parasitization by D. longicaudata induces shifts in the gut bacteriome of B. dorsalis larvae to a pathobiont-dominated community. This mechanism possibly enhances its virulence against the pest, further supporting its candidacy as an effective biocontrol agent of this frugivorous tephritid fruit fly pest.The German Agency for International Cooperation; the International Development Research Centre (IDRC) and the Australian Centre for International Agricultural Research (ACIAR); the Norwegian Agency for Development Cooperation (NORAD), the Section for Research, Innovation, and Higher Education; the Swedish International Development Cooperation Agency (Sida); the Swiss Agency for Development and Cooperation (SDC); the Australian Centre for International Agricultural Research (ACIAR); the Federal Democratic Republic of Ethiopia; and the Government of the Republic of Kenya. Open access funding provided by University of Pretoria.https://link.springer.com/journal/248hj2024Zoology and EntomologySDG-03:Good heatlh and well-bein