Chronic Ileocecal Intussusception Secondary to Non-Hodgkins Lymphoma

Chronic intussusception is a distinct clinical entity which is unfortunately poorly recognized due to its atypical presentation. A 5½ year old female  patient presented with a 5 month history of abdominal pain associated with occasional vomiting, anorexia and progressive weight loss. 5 days prior to admission she developed loose, non-mucoid, non-blood stained stool associated with refusal to feed and irritability. Systemic examination, an abdominal ultrasound and abdominal radiograph were non-contributory.During treatment for malnutrition and dehydration she was noted to clinically improve, however, 6 days post-admission she developed  abdominal pain, a palpable sausage-shaped abdominal mass, and currant-jelly stool. Emergency laparotomy revealed an ileocecal  intussusception with oedematous nonviable, aperistaltic terminal ileum and mobile cecum, a cecal mass and mesenteric lymphadenopathy was found. We performed a right hemicolectomy with an ileocolic anastomosis and mesenteric lymph node sampling. Histology results revealed the cecal  mass as a lymphoproliferative neoplasm with a diagnostic consideration of intermediate to large cell Non-Hodgkins Lymphoma; and reactive  hyperplasia of mesenteric lymph nodes. There is need for a highindex of suspicion in children with non-specific abdominal symptoms for which no cause can be found. Further, all suspicious masses should haveimmunohistological histological evaluation.Key Words: Chronic Ileocecal Intussusception, Non Hodgkins Lymphom

Genotyping for point mutations in selected codons of pfcrt and pfmdr-1 genes of Plasmodium falciparum among patients with uncomplicated malaria in Mbita district Kenya.

Background Malaria remains a leading cause of morbidity and mortality in Kenya, especially in young children and pregnant women. Due to widespread resistance of Plasmodium falciparum to drugs such as Chloroquine (CQ) and Sulfurdoxine-Pyrthamine (SP), Artemisisnin Combination Therapy (ACT) was adopted in Africa as a means of improving treatment efficacy and slowing the spread of resistance. The development of drug resistance by the parasites for the various malaria drug regimens that have been in use before has been attributed to point mutations within the parasite genome. Therefore this study investigated the prevalence of point mutations in selected codons of the pfcrt and pfmdr-1 genes of Plasmodium falciparum. It is however unclear whether ACT will be effective in preventing the selection of resistant parasites in Africa, where parasite transmission rates are generally much higher with parts of Asia and Africa already reporting a reduction in sensitivity to ACT. Methods The dot-blot/probe hybridization technique was used to identify point mutations in codons 74, 75 and 76 of the pfcrt gene and codons 1034, 1042 and 1246 of the pfmdr-1 gene in Mbita a malaria holoendemic site in Kenya. In the pfcrt gene, 76T mutation was found to be in 91 (79.83% CI 63.1-88.5) of 114 samples while the, the wild type allele 76K was present in 23 (20.17% CI 9.0-22.0) samples. Codons 1246 showed allelic variation with 1246D the wild type allele being 72.8% (CI 52.0-89.1). This was a significant increase in the 76K allele (p=0.001) in comparison to the year 2005 where prevalence of 76K was 6%.   Conclusion There’s an expansion of the wild-type allele 76K of the pfcrt gene and no significant difference in the 1246D allele of the pfmdr1 gene, moreover the prevalence of 76T allele is still high in Mbita hence it’s beneficial to continue using AL as treatment for uncomplicated malaria. Keywords: Malaria, Drug Resistance, Point Mutations

Association between thrombocytes count and Plasmodium falcipurum infection among children under five years attending Kombewa Sub-County Hospital

Malaria is a leading cause of morbidity and mortality especially among children, expectant women and continues to be a global health burden. Haematological changes mark some of the most common complications in malaria as they play a major role in malaria pathology. Thrombocytes in particular, have been shown to bind infected erythrocytes and kill intracellular malaria parasites thereby indicating a protective function of platelets in the early stages. However, the mechanism that leads to low thrombocytes count in malaria infected individuals is not clear. Understanding the mechanism of platelet reduction during pathogenesis of malaria infection will be fundamental in malaria severity classification, monitoring of platelet count during infection and prompt initiation of anti-malarial therapy. In trying to understand these facts, this study sort to establish the association between platelet count and P. falciparum infection amongst children less than five years. This was a retrospective case-control study, n=549. Children below the age of five years that attending Kombewa Sub -County Hospital were recruited. Study participants were identified using the inclusion criteria and followed horizontally to retrieve platelet count from complete blood count results. The respective malaria blood film reads were then recorded, stratified to give case and control from which random sampling was done. Chi-square test and Tukey’s multiple comparison tests from Graph pad prism 5 were used in the analysis. The odds of exposure to low platelet count were then established with a confidence level of 95%. We found significant difference between the cases and controls in regard to parasite density (Chi square=157.5, p value <0.05), mean parasite density in controls =2042.1/?l compared to cases= 142880/?l. The odds of cases being exposed to malaria was 12 times more than controls (OR=12.382, 95%). We also found no variation in thrombocytes counts in relation to gender, children with thrombocytopenia were having higher parasite density, parasite density as a result of P.falciparum infection is not dependent on gender and children that suffered malarial infection were twelve times likely to develop thrombocytopenia. Further studies are then recommended to establish the effects of incorporation of platelet aggregation inhibitors such as aspirin in malaria treatment.Key Words: Plasmodium falciparum, thrombocytopenia, infectio

Medication diaries do not improve outcomes with highly active antiretroviral therapy in Kenyan children: a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>As highly active antiretroviral therapy (HAART) becomes increasingly available to African children, it is important to evaluate simple and feasible methods of improving adherence in order to maximize benefits of therapy.</p> <p>Methods</p> <p>HIV-1-infected children initiating World Health Organization non-nucleoside reverse transcriptase-inhibitor-containing first-line HAART regimens were randomized to use medication diaries plus counselling, or counselling only (the control arm of the study). The diaries were completed daily by caregivers of children randomized to the diary and counselling arm for nine months. HIV-1 RNA, CD4+ T cell count, and z-scores for weight-for-age, height-for-age and weight-for-height were measured at a baseline and every three to six months. Self-reported adherence was assessed by questionnaires for nine months.</p> <p>Results</p> <p>Ninety HIV-1-infected children initiated HAART, and were followed for a median of 15 months (interquartile range: 2–21). Mean CD4 percentage was 17.2% in the diary arm versus 16.3% in the control arm at six months (p = 0.92), and 17.6% versus 18.9% at 15 months (p = 0.36). Virologic response with HIV-1 RNA of <100 copies/ml at nine months was similar between the two arms (50% for the diary arm and 36% for the control, p = 0.83). The weight-for-age, height-for-age and weight-for-height at three, nine and 15 months after HAART initiation were similar between arms. A trend towards lower self-reported adherence was observed in the diary versus the control arm (85% versus 92%, p = 0.08).</p> <p>Conclusion</p> <p>Medication diaries did not improve clinical and virologic response to HAART over a 15-month period. Children had good adherence and clinical response without additional interventions. This suggests that paediatric HAART with conventional counselling can be a successful approach. Further studies on targeted approaches for non-adherent children will be important.</p

Comparison of least absolute shrinkage and selection operator and maximum likelihood estimators to establish determinants of immunization in Trans - Nzoia County

The client factors that influence under-five child guardian compliance to the immunization schedule are interlinked based on household characteristics, socioeconomic status, and maternal health practices. An incentive to motivate the mothers to prioritize their child’s health practices especially on vaccination, works perfectly towards the achievement of full immunization coverage. A randomly sampled study carried out within Weonia Location–Trans Nzoia County in March 2014 with target population of under-five children showed the vital role an incentive innovation plays towards immunization coverage. Multinomial logistic regression model was used to analyze the determinant of partial or none-immunized and the parameters estimated using the maximum likelihood estimator (MLE) and the shrinkage estimator-Least Absolute Shrinkage and Selection Operator (LASSO). The shrinkage estimator method gave a sparse model that was easy to interpret and increased the estimated predictability accuracy. Maternal health practices and access to a motivating intervention are significant factors that ensure a guardian’s compliance to their child immunization

Evaluation of a two-way SMS messaging strategy to reduce neonatal mortality: rationale, design and methods of the Mobile WACh NEO randomised controlled trial in Kenya

Abstract: Introduction Globally, approximately half of the estimated 6.3 million under-5 deaths occur in the neonatal period (within the first 28 days of life). Kenya ranks among countries with the highest number of neonatal deaths, at 20 per 1000 live births. Improved identification and management of neonates with potentially life-threatening illness is critical to meet the WHO’s target of ≤12 neonatal deaths per 1000 live births by 2035. We developed an interactive (two-way) short messaging service (SMS) communication intervention, Mobile Solutions for Neonatal Health (Mobile women’s and children’s health (WACh) NEO), focused on the perinatal period. Mobile WACh NEO sends automated tailored SMS messages to mothers during pregnancy and up to 6 weeks post partum. Messages employ the Information-Motivation-Behaviour Skills framework to promote (1) maternal implementation of essential newborn care (ENC, including early, exclusive breast feeding, cord care and thermal care), (2) maternal identification of neonatal danger signs and care-seeking, and (3) maternal social support and self-efficacy. Participants can also send SMS to the study nurse, enabling on-demand remote support. Methods and analysis We describe a two-arm unblinded randomised controlled trial of the Mobile WACh NEO intervention. We will enrol 5000 pregnant women in the third trimester of pregnancy at 4 facilities in Kenya and randomise them 1:1 to receive interactive SMS or no SMS (control), and conduct follow-up visits at 2 and 6 weeks post partum. Neonatal mortality will be compared between arms as the primary outcome. Secondary outcomes include care-seeking, practice of ENC and psychosocial health. Exploratory analysis will investigate associations between maternal mental health, practice of ENC, care-seeking and SMS engagement. Ethics and dissemination This study received ethical approval from the University of Washington (STUDY00006395), Women and Infants Hospital (1755292-1) and Kenyatta National Hospital/University of Nairobi (P310/04/2019). All participants will provide written informed consent. Findings will be published in peer-reviewed journals and international conferences

Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort

<p>Abstract</p> <p>Background</p> <p>Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.</p> <p>Methods</p> <p>HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.</p> <p>Results</p> <p>Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log₁₀copies/ml. Twenty children (13.4%) died at a median of 35 days post-HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in first 4 months and 1.0 deaths/100 child-years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) <9 g/dl, weight-for-height z-score (WHZ) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb <9 g/dl HR 3.00 [95% C.I. 1.21-7.39], p = 0.02, WHZ < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight-for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).</p> <p>Conclusion</p> <p>High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.</p

Predictors of Poor CD4 and Weight Recovery in HIV-Infected Children Initiating ART in South Africa

Objective: To identify baseline demographic and clinical risk factors associated with poor CD4 and weight response after initiation of antiretroviral therapy (ART) in a cohort of human immunodeficiency virus (HIV)-infected children in KwaZulu-Natal, South Africa. Methods: We performed a retrospective cohort study of 674 children initiating antiretroviral therapy at McCord and St. Mary’s hospitals in KwaZulu-Natal, South Africa, from August 2003 to December 2008. We extracted data from paper charts and electronic medical records to assess risk factors associated with CD4 and weight response using logistic regression. Results: From the initial cohort of 901 children,10 years old initiating ART between August 2003 and December 2008, we analyzed 674 children with complete baseline data. Viral suppression rates (,400 copies/ml) were 84 % after six months of therapy and 88 % after 12 months of therapy. Seventy-three percent of children achieved CD4 recovery after six months and 89 % after 12 months. Weight-for-age Z-score (WAZ) improvements were seen in 58 % of children after six months of ART and 64 % after 12 months. After six months of ART, lower baseline hemoglobin (p = 0.037), presence of chronic diarrhea (p = 0.007), and virologic failure (p = 0.046) were all associated with poor CD4 recovery by multivariate logistic regression. After 12 months of ART, poor CD4 recovery was associated with higher baseline CD4 % (p = 0.005), chronic diarrhe