Foot complications among diabetics attending a district hospital in Kenya: Predisposing factors and possible intervention

OBJECTIVES: To relate skin health, footwear practices and foot care education with occurrence of foot complications among diabetics attending a district hospital in Kenya. PATIENTS AND METHODS: Two hundred and nineteen patients attending the diabetic clinic at the Kikuyu Mission Hospital (99 males, 120 females) were studied. They were examined for the presence, type and cause of foot complication, skin health, education on foot care and footwear. RESULTS: Twenty nine point two percent of the patients had foot complications, with 95% of these presenting with diabetic ulcer, the rest had Charcot’s foot or cellulitis. The diabetic foot ulcer was traumatic in 75.4% and spontaneous in 24.6%. Fifty seven percent of the patients had risky footwear, associated with development of foot ulcer (p = 0.001). Ninety eight percent of the patients with foot complications had either atrophic or dry skin (p = 0.001). Fifty two point four percent had not received foot care education, with males who had received education being more than females (p = 0.05). CONCLUSION: The rate of foot complications among diabetics is higher than previously observed. Diabetic foot ulcer, the commonest complication, is mostly traumatic. Patients with foot care education, proper footwear and good skin health had lower incidence of traumatic diabetic foot ulcer. Dissemination of foot care education and use of right footwear for diabetics may reduce the incidence of complications

Factors Influencing Research Activity among Medical Students at University of Nairobi

Background Undergraduate student research activity facilitates their independent thinking, interest in evidence based practice and preparation for graduate programmes. Reports from African Universities are, however, scarce. This study aimed at describing the factors that influence research among medical students in a Kenyan University. Subjects and Methods This descriptive cross sectional study involved medical students at the School of Medicine, University of Nairobi. An open questionnaire regarding research activity was administered to 150 medical students. Responses were analyzed for year of study, attitude, participation, stimulants, deterrents and publication output. Results One hundred and twenty two (81.3%) responses were analyzed. Majority (50.8%) were in fifth year. Of the respondents 81.6% expressed interest in participating in research, but only 38.4% of them had participated in research with 13.7% taking part in writing a research paper. Stimulants included contribution to advancement of knowledge (54.1%) and fulfillment of academic requirements (51.4%). Major deterrents were lack of research mentors (51.9%), knowledge of research methods (37.7%) and funding (29.9%). Of 41 published papers, 85.4% were co-authored with faculty. Conclusion Lack of mentors, training in research methodology and funding are main deterrents. Inclusion of research methodology in curricular, enhanced faculty involvement and budgetary support for research are recommended. The Annals of African Surgery, Volume 6, 201

Topography and distribution of ostia venae hepatica in the retrohepatic inferior vena cava

Background : Openings of hepatic veins into the retrohepatic surface of the inferior vena cava (ostia venae hepatica) play a part in controlling hepatic circulation by acting as collateral channels in obstruction. Their topography and distribution must be taken into account during catheterization and liver transplantation. This anatomy is however little known among Kenyans. Objectives: To study the position, number and distribution of ostia venae hepatica in a selected Kenyan population Materials and methods: Eighty fresh postmortem liver specimens were obtained from the Chiromo Mortuary. The hepatic IVC was isolated from the lower border of caudate lobe to the diaphragmatic opening, with the liver in position. The vein was opened posteriorly by a vertical incision along its whole length and the lateral flaps reflected laterally. The topography of the ostia was studied using the Sahni model. The number and patterns of the ostia were also studied. The patterns of openings of the left, right and middle hepatic veins were studied as well as the distances between them. Results : A total of 584 ostia were identified, an average of 7.3 per liver. The ostia were distributed on the lateral portions of the vein, with an avascular plane at the centre. Major veins terminated in the upper third of the hepatic inferior vena cava, with little extraparenchymal course. The mean distance between the right hepatic vein and middle hepatic vein was 1.7cm Conclusion : The numerous ostia venae hepatica identified in these subjects offer collateral flow channels during hepatic venous obstruction in Budd-Chiari syndrome. The topography and patterns of distribution of the openings suggest the advantage of an avascular virtual plane, which is a safe dissecting path for hepatovascular surgeons

Anatomical Variation of Position and Location of the Fibula Nutrient Foramen in Adult Kenyans

Background: The fibula though transmits insignificant force in walking, is an important bone for muscle attachment and significant source of bone grafts. Objectives: To determine the position, location and number of the nutrient foramina of the fibula among Kenyans. Design: Cross-sectional descriptive study. Subjects: Two hundred right and left dry fibulas for male and female Kenyans were obtained. Setting: Department of Human Anatomy, University of Nairobi and the Osteology Department, National Museums of Kenya, Nairobi. Methods: The number and position of the nutrient foramina were determined. The distance of the nutrient foramen from the styloid process of the head and the length of the fibula were measured by a tape. The data obtained was analyzed by a computer package, SPSS 11.5.0. The means of each value was compared between right, left and the gender groups. Results: Five point five percent of fibula did not have any nutrient foramen. Most (53.4%) of the nutrient foramina were located posteriorly. The average length of the fibula was 365±30 mm long while the nutrient foramen was located 153±24mm from the tip of the styloid process of the head of the fibula; it was 3 cm proximal to the mid length of the fibula. Conclusions: Fibula of 28.6 cm – 41.2 cm is available for grafting among Kenyans. The metric estimation of the position of the nutrient foramen of the fibula could assist in harvesting vascularised graft of the bone