Nephrotoxicity of amphotericin B in the treatment of cryptococcal meningitis in acquired immunodeficiency syndrome patients

Objectives: To describe the incidence of renal dysfunction, hypokalaemia and hypomagnesaemia in AIDS patients with cryptococcal meningitis and on amphotericin B treatment. Secondary objective was to determine all-cause mortality in the same group.Design: Prospective, observational study.Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.Subjects: Seventy consecutive patients with AIDS and cryptococcal meningitis on amphotericin B.Results: About 58.6% of the patients had at least 100% rise in the creatinine level. Thirty eight point six per cent of patients experienced a rise in serum creatinine of at least 50%. Ninty three per cent of the patients developed hypokalaemia and 80% had hypomagnesaemia at trough magnesium level. Only 54.3% of patients completed the intended 14-day treatment. Thirty point five per cent of patients died within the two week follow-up period.Conclussion: The incidences of amphotericin B associated nephrotoxicity, hypokalemia and hypomagnesaemia were high in this studied populatio

Agenesis of the corpus callosum with associated inter-hemispheric cyst and right frontal pachygyria presenting with psychiatric symptoms in a Kenyan

This case report presents a 26 year old man who had a history of childhood onset seizures, mild cognitive slowing and social withdrawal. He gradually developed symptoms of depression and attempted suicide once. He presented to the authors following a recurrence of his seizures. On examination they noted a normal general and neurological examination apart from some frontal lobe signs on mental status examination. He also had features of psychosis and labile mood. On CT brain scan he had agenesis of the corpus callosum (CC) with associated interhemispheric cyst and right frontal pachygyria. The authors suggest that clinicians in developing countries should be alert to organic disorders presenting with psychiatric symptoms. South African Psychiatry Review Vol. 9(4) 2006: 229-23

Clinical Features and Patterns of Imaging in Cerebral Venous Sinus Thrombosis at Kenyatta National Hospital

Background: Cerebral venous sinus thrombosis (CVST) is an uncommon neurological deficit. It shows a wide range of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnosis. Imaging plays a key role in the diagnosis.Objective: To evaluate the clinical characteristics and patterns of  neuroimaging findings in patients with radiologically confirmed CVST.Design: A retrospective study.Setting: Kenyatta National Hospital, a tertiary referral and teaching hospital in Nairobi Kenya.Subjects: Fifty one patients treated for CVST in the hospital were studied.Results: Fifty one patients with CVST were seen over the last five years. The median age of 30 years. The most common age group affected was 25-34 years. Females were more affected (n=38, 74.5%) than males (n=13, 25.5%). The most common presenting clinical features documented were headache, seizures and neurological deficits. Aetiological factors commonly seen included infection (n=20, 39.2%), pregnancy and  puerperium (n=7, 13.7%) and oral contraceptive use (n=2, 3.9%). The most common NECT scan findings were hyperdense sinus and  parenchymalchanges. MRI showed loss of signal void in the sinus, gyral swelling and parenchymal signal change.Conclusion: CVST is most commonly seen in young adult females due to infection, pregnancy, puerperium and oral contraceptive use. The most common clinical finding in patients with CVST is headache, followed by seizures, neck pain, neurological deficits and visual disturbance. Infective cause is much more common in our population and other developed countries compared to the developed world

Prevalence of Fibromyalgia at the Medical out Patient Clinic, Kenyatta National Hospital

Background: Fibromyalgia syndrome is a disorder that is associated with significant morbidity. Despite its existence worldwide there is hardly any epidemiological data in Africa and none in Kenya.Objectives: To determine the prevalence of fibromyalgia, chronic regional pain and chronic widespread pain in patients attending the medical outpatient and rheumatology clinic at Kenyatta National Hospital and to investigate the frequency of fibromyalgia symptoms and to document the primary diagnosis and cormobid conditions in the these patients.Design: A Cross sectional descriptive study.Setting: The medical outpatient and rheumatology clinic at The Kenyatta National Hospital.Subjects: Three hundred and eighty four patients with musculoskeletal pain.Results: The prevalence of fibromyalgia, chronic regional pain and chronic widespread pain amongst patients with chronic musculoskeletal pain (n = 384) in the medical outpatient clinic and rheumatology clinic of Kenyatta National Hospital was 13% (n = 50), 76% (n = 291) and 11% (n = 43) respectively. The overall three month prevalence of fibromyalgia in the general medical outpatient clinic was 1% , chronic widespread pain 1.2% and chronic regional pain 6.7% .The mean age of patients with fibromyalgia was 48.5 years SD 2.6 [95%CI 43.1-53.8]. There was a female predominance of 97.7% (n = 42). Mean duration of illness was 5.8 years SD 0.8 [95%CI 4.1 - 7.4]. Rheumatoid arthritis was the most frequent primary diagnosis at first consultation in the clinics [30.2% (n=13/43)]. Hypertension was the most common cormobid disease [53.5 %( n=23/43)] The mean total FIQR score for fibromyalgia patients was 55.94% SD (2.85)95%CI 50.19-61.68. The most frequent symptoms were pain, fatigue, stiffness, depression, and unrefreshing sleep while balance problems, headache and increased sensitivity to the environment were the least reported symptoms.Conclusion: Fibromyalgia is prevalent among patients with musculoskeletal complains in the medical outpatient and rheumatology clinics at the Kenyatta National Hospital. These patients frequently have other cormobid illnesses and the primary diagnosis is often missed. Therefore, there is need to sensitise care givers on this conditio

Prevalence of anti-cyclic citrullinated peptide antibodies in patients classified as rheumatoid and undifferentiated arthritis at Kenyatta National Hospital

Background: Rheumatoid arthritis(RA) is a debilitating condition.Early diagnosis of RA can be difficult as the disease may initially be indistinguishable from Undifferentiated arthritis(UA). American College of Rheumatology criteria(ACR)is not suitable for early diagnosis as its characteristics are fulfilled when bone damage has already taken place.Anti-cyclic citrullinated antibodies(Anti-CCP) are highly specific for RA and have been used to confirm early diagnosis.Objective:To determine the prevalence and clinical utility of Anti-CCP antibodies in patients with rheumatoid and undifferentiated arthritis at presentation to KNH medical clinics.Design: A cross-sectional descriptive study.Setting: Kenyatta National Hospital Medical Outpatient Clinics (MOPCs) between the month of October 2008 to February 2009.Results :A total of 95 patients were recruited.The mean age of the patients studied in the RA and UA was 44.7 and 41.2(p=0.356) respectively.Sixty four patients(64) satisfied ACR criteria.The overall prevalence of Anti-ccp antibodies in the population studied was 47.4%.The prevalence of Anti-ccp antibodies in patients who satisfied the ACR criteria was 62.5% .The prevalence of Rheumatoid Factor (RF) in patients who satisfied the ACR criteria was 50% compared to 9.7% for those who did not(p=0.000).The male to female ratio of subjects studied was 1:11Conclusion:Anti-ccp antibodies are more prevalent in this cohort of patients with rheumatoid and undifferentiated arthritis than RF. It was also concluded that ACR characteristics correlated well with Anti-ccp and RF. A greater percentage of patients who were RF negative were Anti-ccp positive

Drug susceptibility pattern of Helicobacter pylori in patients with dyspepsia at the Kenyatta National Hospital, Nairobi

No Abstract. East African Medical Journal Vol 82(12) 2005: 603-60

Patterns of homocysteine in Kenyans with type 2 diabetes without overt cardiovascular disease at Kenyatta National Hospital, Nairobi

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study. Setting: Outpatient diabetic clinic of the Kenyatta National Hospital. Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention. East African Medical Journal Vol. 82(12) 2005: S180-S18

Cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital

Background: Rheumatoid arthritis is associated with excessive cardiovascular morbidity and mortality. This is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Traditional cardiovascular risk factors as well as extra articular disease have been associated with occurrence of myocardial infarction. Objective: To identify cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital and compare with healthy controls. Design: This was a comparative cross sectional survey. Setting: Kenyatta National Hospital medical outpatient clinic. The study population were patients with rheumatoid arthritis and the controls were individuals without RA age and sex matched staff of KNH. All those who consented were enrolled and a clinical evaluation was done as per the study protocol. Results: One hundred patients with RA were screened out of which 80 were enrolled. The prevalence of hypertension among RA patients was 41.3%, diabetes 6.3%, dyslipidemia 71.3%, smoking 5%, obesity 22.5%, abnormal WHR 33.8%, family history of sudden death 5%, no family history of stroke or heart attack was reported. In the control group one hundred and five were screened and twenty five were excluded. The prevalence of hypertension was 22.5%, diabetes 5%, dyslipidemia 73.8%, smoking 2.5%, obesity 32.5%, abnormal WHR 33.8% family history of sudden death 10%, stroke 1.3% no history of heart attack was reported. Eighty percent of patients with RA were on at least one DMARD, 57.5% were on steroids and 37.5% were on NSAIDS. Conclusion: There was a high prevalence of hypertension among RA patients (41.3%) than in the controls (22.5%) and this was statistically significant (OR 2.42 (95 CI 1.22-4.81) P = 0.017). Hypertension was also significantly associated with the use of DMARDS OR 2.189 (95% CI 1.111-4.312) P= 0.022 and steroids OR 2.06(95% CI 1.008-4.207) P= 0.022. No significant difference between patients with RA and controls in other risk factors including diabetes, dyslipidemia, smoking, obesity, abnormal waist hip ratio and family history of cardiovascular events was found. Recommendations: Clinicians should keenly look out for hypertension in patients with RA for early identification and if necessary aggressive management of hypertension. Screening of cardiovascular risk factors in patients with RA should be done routinely and a larger study with normal controls from the general population should be undertaken in order to measure this cardiovascular risk factors and cardiovascular disease in this population. Key words: Cardiovascular, rheumatoid arthritis, Kenyatta National Hospita

Prevalence and characteristics of articular manifestations in human immune virus infection

Background: Articular manifestations have been reported in HIV infection with a prevalence ranging from 2.5 to 68%.Objectives: To determine the prevalence, types and characteristics of articular manifestations in the anti-retroviral treatment naive HIV infected patients.Design: Cross sectional descriptive study.Setting: Comprehensive care clinic (HIV outpatient clinic) at the Kenyatta National Hospital (KNH) from October 2007 to March 2008.Subjects: One hundread and ninety three patients; 135 females and 58 males, aged between 19 to 65 years with Human immunodeficiency virus (HIV) infection who were naive to anti - retroviral drug therapy.Main outcome measure: Presence of articular manifestations that included HIV associated arthritis, HIV associated spondyloarthropathies, HIV associated arthralgia, painful articular syndrome and avascular necrosis.Results: Thirty three of these 193 patients had articular manifestation with a prevalence of 17.1 %. The type prevalence was; HIV associated arthralgia, 15.6%; undifferentiated spondyloarthropathy, 1 % and HIV associated arthritis; 0.5%. Their mean age was 36± 9 years, range 23-63 years; majority were female, male to female ratio of 1: 2.3 and themajority were in World health organization (WHO) clinical staging of HIV infection, class II and III with a mean CD4 cell count of 330 cells/mm3. Seventeen (51.5%) of the patients with articular disease had oligo - articular presentation, 10(30.3%) mono - articular while 6(18.2%) had poly - articular presentation. The mean duration of joint pains was 53.3 days (range of 2-365 days). Six (18.2%) of these 33 patients missed work,home making activities or school due to the articular disease.Conclusion: Articular manifestations are common in HIV infection with a prevalence of 17.1 %. HIV associated arthralgia was the most common manifestation. Majority of these patients were female, male to female ratio of 1: 2.3. The mean age of these patients was 36 years with a mean CD4 cell count of 330 cells/mm3 with 18.2 % of them missing school or work