Thrombocytopenia in Haart naive HIV infected patients attending the comprehensive care clinic at Kenyatta national hospital

Background: Haematological abnormalities are common in HIV infected patients. Thrombocytopenia has been associated with progression of disease. The presence of thrombocytopenia is significantly associated with decreased survival and is a predictor of mortality.Objective: To determine the prevalence of thrombocytopenia and clinical characteristics of HIV infected patients who are HAART naive attending the Kenyatta National Hospital Comprehensive Care Clinic..Design: Cross-sectional descriptive Study.Setting: Kenyatta National Hospital Comprehensive Care Clinic.Subjects: HIV positive HAART naive patients.Results: Three hundred and forty HIV infected HAART naive patients with a mean age of 37.3years and range of 18years to 72years were recruited. The male to female ratio was 1:1.6.The study population comprised mostly of; young patients (39.9% between 30-40yrs), females (61.6%) in WHO clinical stage I (57.6%) and with CD4 count between 200-500 cell/mm3. The mean platelet count was 230,000 cells/ul. The prevalence of thrombocytopenia in this population was 3.8%. Most of the patients (66.7%) with thrombocytopenia had a bicytopenia with the rest having isolated thrombocytopenia or pancytopenia. Bleeding tendencies were observed more in the thrombocytopenia group (p= 0.011). Patients with CD4 count < 200cells/mm3 were more likely to have thrombocytopenia (p <0.050).Conclusion: The prevalence of thrombocytopenia is low among ambulant HIV infected HAART naive patients attending the Kenyatta National Hospital Comprehensive Care Clinic. This could be attributed to young age, predominant female gender and early disease WHO Stage 1 in the study population. Other studies found older age, male gender and advanced HIV infection population to be determinants where higher prevalence of thrombocytopenia have been reported

Nephropathy in patients with recently diagnosed type 2 diabetes mellitus black Africans

Background: Albuminuria is long recognised as a sign of renal disease in diabetes. In type 1 diabetes, renal disease occurs after a longer duration of diabetic state. In type 2 diabetes, it is more variable. Objective: To determine the prevalence and any risk factors of albuminuria in short­ term (≤2 yrs) type 2 diabetes. Design: Cross sectional, descriptive study. Microalbuminuria was assessed using micro II strips. Setting: Outpatient diabetic clinic at Kenyatta National Hospital, Nairobi. Subjects: Patients who were newly diagnosed or had had type 2 diabetes for two years or less. Main outcome measures: Microalbuminuria, lipids, glycated haemoglobin, fasting blood glucose and blood pressure. Results: One hundred and thirty nine patients who had type 2 diabetes mellitus for ≤2 yrs were seen, but only 100 patients were included in the study over a six month period. Their mean (SD) age was 53.7 (9.3) years. Mean (SD) duration of diabetes was 10.3 (7.5) months. Fifty per cent of the study patients were hypertensive. Only 48% had HbAic \u3c8% while 36% had HbAic \u3e9%. The lipid profile of total, LDL - HDL­ cholesterol and triglycerides were predominantly within normal limits. Twenty six per cent were established to have albuminuria of which one patient had macroalbuminuria. Blood pressure, glycated haemoglobin and lipid parameters were not significantly different from patients without albuminuria Conclusion: Albuminuria occurred in a significant proportion of patients with short term type 2 diabetes. Comparable to studies done elsewhere on short-term type 2 diabetes, albuminuria is both a sign of nephropathy and a cardiovascular risk factor. It should be looked for in all patients with type 2 diabetes attending this clinic, even at diagnosis

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Platelet function in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi, Kenya

Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. Results: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 ± 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. Conclusion: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness. (East African Medical Journal: 2002 79(8): 405-407

Irritable bowel syndrome in black Kenyans

Objective: To study the prevalence and clinical presentation of Irritable Bowel Syndrome (IBS) in Black Africans in Nairobi, Kenya. Design: A retrospective study Subjects: Case files of all patients presenting with abdominal pain Main Outcome Measures: Prevalence of IBS using modified Manning's Symptomatic criteria in 223 consecutive adult patients presenting with abdominal pain and discomfort who had normal clinical findings and normal general and gastrointestinal investigations Results: Out of the 3472 patient files screened, there were 281 patients who fitted the diagnosis of Irritable Bowel Syndrome giving an overall prevalence of 8%. The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male to female ratio of 1.4:1 being statistical significant at a p value of 0.010. There was not statistical significant difference between the males and females in constipation and diarrhoea at p value of 0.84 and 0.82 respectively. Fifteen percent of the patients were either on antidepressants or had been seen by a psychiatrist. Nine percent had undergone laparatomy for the abdominal pain. Conclusion: The Black African patient is equally as exposed to Irritable Bowel Syndrome as is his counterpart in the western world and has similar morbidity patterns. The syndrome may account for over 10% of patients with abdominal pain presenting to gastroenterologists in Africa. Proper attention to symptomatology may lead to clinching the diagnosis without resorting to many unnecessary and expensive investigations. (East African Medical Journal: 2002 79(7): 360-363

Headache associated disability in medical students at the Kenyatta National Hospital, Nairobi

Objective: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. Study design: Cross sectional survey. Results: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre and the Medical School of the University of Nairobi. Six hundred and twenty-five (87%) of the 711 students surveyed admitted having had at least one episode of headache in the last six months. Using the International headache society (IHS) case criteria 314 students (50%) had tension type headache, 240 (38%) migraine headache and 71 (12%) unclassified headache. Eighty-six percent of the students with headache had their working ability disturbed to various degrees. Eighty-five percent of the students reported that their social activities were interfered with by headache. Migraine headaches had the greatest impact on both the working and social activities at a p-value of 0.0005 and 0.0004 respectively. One hundred and forty-one students (23.6%) had missed at least one day of work or school in the last one-year as a direct result of the headache. There was an association between headache severity with working ability and social effect. There was no association between the days students missed work or classes with the severity of the headache. No gender difference was found in the headache associated disability. Conclusion: Headache is a prevalent condition with disability both in working and social activities. (East African Medical Journal: 2002 79(10): 519-523

Platelet Response To Methanolic And Aqueous Extracts Of Euphorbia hirta

Euphorbia hirta Linn (Fam: Euphorbiaceae) locally known as ‘ogwu ugwo' (eczema drug) in some Eastern parts of Nigeria is used locally to arrest bleeding in the event of an injury. The extracts (aqueous and methanolic) were administered orally to albino wistar rats. Platelet count, bleeding and clotting times were determined before and at different time intervals after administration of the extracts. The aqueous extract at 60 min reduced bleeding time by 54% compared to 49.5% for methanolic extract and was significant (

DRUG SUSCEPTIBILITY PATTERN OF HELICOBACTER PYLORI IN PATIENTS WITH DYSPEPSIA AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI

Objective: To determine drug susceptibility pattern of Helicobacter pylori to metronidazole, clarithromycin, amoxicillin and tetracycline in patients presenting with dyspepsia at the Kenyatta National Hospital.Design: Cross-sectional descriptive study.Setting: Kenyatta National Hospital, Nairobi.Subjects: Two hundred and sixty-seven patients aged 15 to 85 years, presenting with dyspepsia and referred for upper gastro-intestinal endoscopy were recruited into the study.Results: Between October 2003 and April 2004, 138 male and 129 female patients aged 15-85 years, with a mean age of 45.4 years were studied. Gastritis was the most common endoscopic finding, occurring in 55%, followed by normal-looking mucosa in 27% and peptic ulcer disease in 16% of the patients. The rapid urease test was positive in 184 patients (69%). The culture yield was 62% of these CLO (Campylobacter like organisms)positive biopsies. The MIC90 (minimum inhibitory concentration) was 256 mg/l for metronidazole, 1.5mg/l for clarithromycin, 1.5mg/l for tetracycline and 0.75 mg/l for amoxicillin. The MIC values for amoxicillin were significantly higher in the female patients (p = 0.02) but showed no significant variation for age. The MIC values for metronidazole, tetracycline and clarithromycin showed no significant difference for age or gender. MIC values for tetracycline were significantly higher for patients with duodenitis and duodenal ulcer p = 0.009 and 0.02, respectively.Conclusion: All isolated H. pylori organisms were resistant to metronidazole. The susceptibility of the H. pylori isolates was 93.6% for clarithromycin, 95.4% for amoxicillin and 98.1% for tetracycline. The MIC90 for amoxicillin and clarithromycin were found to be close to the upper limit of the  susceptibility range. There was a rising MIC90 for tetracycline and  metronidazole compared to that found in a previous study in 1991

Cardiovascular risk factors and carotid atherosclerosis in patients with systemic lupus erythematosus at Kenyatta National Hospital

Background: Cardiovascular disease is now acknowledged as a primary cause of morbidity and mortality in patients with Systemic Lupus Erythematosus (SLE). The risk of developing coronary artery disease in these patients is four to eight times higher than that in the normal population. Prior to this study there was no data regarding cardiovascular risk in SLE patients in our setting. Objective: To determine the prevalence of selected cardiovascular risk factors and carotid atherosclerosis in patients with systemic lupus erythematosus at Kenyatta National Hospital. Methods: This was a cross-sectional survey carried out in patients with SLE and age- and sex-matched controls at the Kenyatta National Hospital. The SLE patients underwent clinical assessment of their blood pressure, weight, height, waist and hip circumferences as well as laboratory testing to determine their fasting blood sugar and fasting lipid profile. In addition, measurement of carotid Intima-Media Thickness (IMT) and assessment for presence of carotid plaque was done for the lupus patients. The controls had similar clinical and laboratory assessment done as for patients. Carotid ultrasonography was however not done for controls. Results: Sixty six SLE patients and 66 healthy controls participated in this study. Mean age of the patients was 35.9 years, with a female to male ratio of 21:1 and median duration of illness of two years. Hypertension prevalence was 42.4% in the patients and 24.2% in the controls (p=0.027), dyslipidemia occurred in 74.2% of the patients and 62.1% of the controls (p=0.135) while diabetes prevalence was 4.5% in patients and 1.5% in controls (p=0.619). Obesity by Body Mass Index (BMI) assessment was found in 12.1% of patients and 21.2% of the controls (p=0.330) whereas abdominal obesity (by waist: hip ratio) occurred in 33.3% of patients and 24.2% of controls (p=0.249). Mean carotid IMT in SLE patients was 0.63mm (SD=0.15) with 9 (13.6%) patients having IMT readingsof 0.8mm and above. Carotid plaque was detected in 15 (22.7%) patients. Carotid IMT and BMI significantly correlated with disease duration (p values= 0.006 and 0.021 respectively). Conclusion: There was a high prevalence of atherosclerosis and selected cardiovascular risk factors in this population of SLE patients. Hypertension was significantly more common in the lupus patients than controls. Cardiovascular risk assessment and appropriate treatment of risk factors identified should be enhanced in patients with SLE. Key words: Systemic lupus erythematosus; Cardiovascular risk factors; Carotid intima-media thickness; Carotid plaqu

Nephropathy in patients with recently diagonised type 2 diabetes mellitus in black Africans

Background: Albuminuria is long recognised as a sign of renal disease in diabetes. In type 1 diabetes, renal disease occurs after a longer duration of diabetic state. In type 2 diabetes, it is more variable. Objective: To determine the prevalence and any risk factors of albuminuria in shortterm