Time to presentation and diagnosis of esophageal cancer in patients seen at the Kenyatta National Hospital

Background: Esophageal Cancer (EC) is one of the leading causes of cancer death in Kenya. Majority of the patients with esophageal cancer at Kenyatta National Hospital (KNH) present at an advanced stage limiting their treatment options. Objective: To determine diagnostic time lines and factors associated with delayed health care service delivery among patients with established histological diagnosis of EC at KNH. Design and Setting: A retrospective diagnostic cohort study was carried out at the Cardiothoracic, endoscopy and radiotherapy units at KNH.Results: Eighty-five participants with established histological diagnosis of EC consented and were enrolled into the study. Majority (89.4%) were diagnosed in stage III and IV of the disease. The median time to  histological diagnosis of EC was 90 days. The time to first presentation was more than 30 days among 78.8% of subjects. The median time from first consultation to referral to a diagnostic-capable facility was 30 days, with 76.5% of the participants taking more than 30 days to reach KNH. Those who could not afford transport and consultation were more likely to report delay to first presentation (OR 3.6 95% CI 1.2-11.3, p=0.022). Referral delay was associated with residence, with those living in the rural areas less likely to delay (OR 0.2, 95% CI 0.0-0.8, p=0.019). Conclusion: Overall this study found that there was significant delay in the diagnostic process of EC patients. Over 75% of the patients delayed in presenting for the first consultation, being referred to higher level facilities, getting an endoscopy done and receiving histological diagnosis.  Consequently, about 90% of the patients were diagnosed at an advanced stage of the disease

Cooperative Learning Method and Development of Pre-School Children’s Competences Acquisition in Mathematical Concepts in Kirinyaga County, Kenya

The research from which this paper is derived explored the effect of cooperative learning method on development of pre-schoolers’ competences in mathematical concepts. 20 pre-school teachers on their regular teaching in their pre-schools were observed teaching their 639 Pre-primary Two learners. The purpose of this study was to establish the difference between the mean score index of pre-school learners taught by a teacher who facilitates learning using the Cooperative Learning Method (CLM) and those taught by a teacher who does not. Data was collected through the use of observation schedule and teacher questionnaire. Each of the twenty pre-school teachers was observed by the researcher while facilitating mathematical concepts’ competences during number work lessons. A documentary analysis guide was used to access the pre-school teachers’ schemes of work and lesson plans to establish their level of preparation in line with CLM. Descriptive and inferential statistics were used to analyse the collected data and guided by the themes arising from the objective of the study the key findings were arrived at. The various levels of the teachers’ facilitation of CLM were tied to the pre-school leaners’ performance in the mathematical concepts competences achievement test. The findings emerging showed that those learners who were taught using CLM achieved higher mean score indices than those who were not. The implication here is that the use of CLM improves pre-school learners’ levels of achievement, indicating that it is a more effective method of teaching. Teachers’ facilitation of CLM seemed to have a significant positive influence on the learners’ Mathematical Concepts Competences Acquisition. These features were; availability of groupings and teacher preparedness, level of provision of learning resources, level of coordination, level of interaction, time taken in CLM activities. This implies that CLM imparts the required mathematical concepts competences better than traditional instructional methods. The study recommends that the Ministry of Education should develop programmes and policies that provide regular in-service training, in which CLM training forms a key part of the agenda and to refresh the mathematical concepts competences instructional skills of pre-school teachers. Keywords: Competences; Cooperative Learning Method; Mathematical Concepts DOI: 10.7176/JEP/12-32-05 Publication date: November 30th 202

Health related quality of life of patients on maintenance haemodialysis at Kenyatta National Hospital

Background: Health related quality of life is increasingly being recognised as a primary outcome measure in treatment of end-stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.Objective: To assess the health-related quality of life of patients on maintenance haemodialysis at the Kenyatta National Hospital.Design: Cross sectional descriptive study.Setting: Kenyatta National Hospital, Renal Unit.Subjects: The study was conducted on 96 patients with end-stage renal disease on maintenance haemodialysis. Socio-demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three subscale scores were calculated.Results: The mean physical composite summary and mental composite summary scores were 39.09±9.49 and 41.87±10.56 respectively. The burden of kidney disease subscale, symptom and problems subscale and effect of kidney disease on daily life subscale scores were 16.15±21.83, 73.46±18.061 and 67.63±23.45 respectively.Conclusion: Health-related quality of life of patients on maintenance haemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease subscale is the most affected subscale score

Transmission and evolutionary dynamics of human coronavirus OC43 strains in coastal Kenya investigated by partial spike sequence analysis, 2015-2016

Human coronavirus OC43 (HCoV-OC43) is a major contributor to seasonal outbreaks of acute respiratory illness (ARI). The origins of locally circulating HCoV-OC43 strains and characteristics of their genetic diversity are unknown for most settings despite significance to effective HCoV control strategies. Between December 2015 and June 2016, we undertook ARI surveillance in coastal Kenya in nine outpatients and one inpatient health facility (HF). Ninety-two patient samples tested HCoV-OC43 positive and forty (43.5%) were successfully sequenced in spike (S) gene region (2,864 long, ∼70%). Phylogenetic analysis confirmed co-circulation of two distinct HCoV-OC43 clades that closely clustered with genotype G (n = 34, 85%) and genotype H (n = 6, 15%) reference strains. Local viruses within the same clade displayed low genetic diversity yielding identical sequences in multiple HF. Furthermore, the newly sequenced Kenyan viruses showed close phylogenetic relationship to other contemporaneous sampled strains (2015–16) including those originating from distant places (e.g. USA and China). Using a genetic similarity threshold of 99.1 per cent at nucleotide level, the HCoV-OC43 strains sampled globally between 1967 and 2019 fell into nine sequence clusters. Notably, some of these clusters appeared to have become extinct, or occurred only sporadically in a few geographical areas while others persisted globally for multiple years. In conclusion, we found that HCoV-OC43 strains spread rapidly both locally and across the globe with limited genetic evolution in the spike gene. Full-genome sequences that are spatio-temporally representative are required to advance understanding of the transmission pathways of this important human respiratory pathogen

Free-running L-band VCSEL for 1.25 Gbps hybrid radio-fiber cloud optical interconnects

International audienceWe demonstrate a free-running directly-modulated 1580 nm VCSEL suitable for hybrid wireless/optical interconnects supporting cloud data centers. Error-free transmission at 1.25 Gbps was achieved after 6.5 GHz wireless link and 1 km bend-insensitive fiber

Estrogenic and Anti-Inflammatory Activities of a Steroidal Indoxyl

The estrogenic and anti-inflammatory activities of 3-methoxy-16, 17-seco-16-norestra-1,3,5-trien-15-(2'-indoxyliden)-17-oic acid is reported. After intraperitoneal administration, the dose of this compound required to reduce swelling of the rat paw by 50% (ED50) was 14.1 mg/kg using the carrageenan-induced rat paw oedema anti-inflammatory assay method. Indomethacin had an ED50 of 3.2 mg/kg in this assay while dexamethasone had an ED50 of 1.7 mg/kg. The estrogenic activity of the compound after intramuscular administration in rats was 0.72 relative to diethylstilbestrol, when the two compounds were assayed at three dose levels of 1.0, 0.3 and 0.1 mg/kg. Key Words: Steroidal indoxyl, synthesis, estrogenic, anti-inflammatory East and Central African Journal of Pharmaceutical Sciences Vol.5(3) 2002: 44-4

An intensive, active surveillance reveals continuous invasion and high diversity of rhinovirus in households

We report on infection patterns in 5 households (78 participants) delineating the natural history of human rhinovirus (HRV). Nasopharyngeal collections were obtained every 3–4 days irrespective of symptoms, over a 6-month period, with molecular screening for HRV and typing by sequencing VP4/VP2 junction. Overall, 311/3468 (8.9%) collections were HRV positive: 256 were classified into 3 species: 104 (40.6%) HRV-A; 14 (5.5%) HRV-B, and 138 (53.9%) HRV-C. Twenty-six known HRV types (13 HRV-A, 3 HRV-B, and 10 HRV-C) were identified (A75, C1, and C35 being most frequent). We observed continuous invasion and temporal clustering of HRV types in households (range 5–13 over 6 months). Intrahousehold transmission was independent of clinical status but influenced by age. Most (89.0%) of HRV infection episodes were limited to <14 days. Individual repeat infections were frequent (range 1–7 over 6 months), decreasing with age, and almost invariably heterotypic, indicative of lasting type-specific immunity and low cross-type protection

Molecular assays for antimalarial drug resistance surveillance: A target product profile.

Antimalarial drug resistance is a major constraint for malaria control and elimination efforts. Artemisinin-based combination therapy is now the mainstay for malaria treatment. However, delayed parasite clearance following treatment with artemisinin derivatives has now spread in the Greater Mekong Sub region and may emerge or spread to other malaria endemic regions. This spread is of great concern for malaria control programmes, as no alternatives to artemisinin-based combination therapies are expected to be available in the near future. There is a need to strengthen surveillance systems for early detection and response to the antimalarial drug resistance threat. Current surveillance is mainly done through therapeutic efficacy studies; however these studies are complex and both time- and resource-intensive. For multiple common antimalarials, parasite drug resistance has been correlated with specific genetic mutations, and the molecular markers associated with antimalarial drug resistance offer a simple and powerful tool to monitor the emergence and spread of resistant parasites. Different techniques to analyse molecular markers associated with antimalarial drug resistance are available, each with advantages and disadvantages. However, procedures are not adequately harmonized to facilitate comparisons between sites. Here we describe the target product profiles for tests to analyse molecular markers associated with antimalarial drug resistance, discuss how use of current techniques can be standardised, and identify the requirements for an ideal product that would allow malaria endemic countries to provide useful spatial and temporal information on the spread of resistance

Whole genome analysis of local Kenyan and global sequences unravels the epidemiological and molecular evolutionary dynamics of RSV genotype ON1 strains

The respiratory syncytial virus (RSV) group A variant with the 72-nucleotide duplication in the G gene, genotype ON1, was first detected in Kilifi in 2012 and has almost completely replaced previously circulating genotype GA2 strains. This replacement suggests some fitness advantage of ON1 over the GA2 viruses, and might be accompanied by important genomic substitutions in ON1 viruses. Close observation of such a new virus introduction over time provides an opportunity to better understand the transmission and evolutionary dynamics of the pathogen. We have generated and analyzed 184 RSV-A whole genome sequences (WGS) from Kilifi (Kenya) collected between 2011 and 2016, the first ON1 genomes from Africa and the largest collection globally from a single location. Phylogenetic analysis indicates that RSV-A transmission into this coastal Kenya location is characterized by multiple introductions of viral lineages from diverse origins but with varied success in local transmission. We identify signature amino acid substitutions between ON1 and GA2 viruses within genes encoding the surface proteins (G, F), polymerase (L) and matrix M2-1 proteins, some of which were identified as positively selected, and thereby provide an enhanced picture of RSV-A diversity. Furthermore, five of the eleven RSV open reading frames (ORF) (i.e. G, F, L, N and P), analyzed separately, formed distinct phylogenetic clusters for the two genotypes. This might suggest that coding regions outside of the most frequently studied G ORF play a role in the adaptation of RSV to host populations with the alternative possibility that some of the substitutions are nothing more than genetic hitchhikers. Our analysis provides insight into the epidemiological processes that define RSV spread, highlights the genetic substitutions that characterize emerging strains, and demonstrates the utility of large-scale WGS in molecular epidemiological studies

Multiplex quantitative PCR for single-reaction genetically modified (GM) plant detection and identification of false-positive GM plants linked to Cauliflower mosaic virus (CaMV) infection.

BACKGROUND:Most genetically modified (GM) plants contain a promoter, P35S, from the plant virus, Cauliflower mosaic virus (CaMV), and many have a terminator, TNOS, derived from the bacterium, Agrobacterium tumefaciens. Assays designed to detect GM plants often target the P35S and/or TNOS DNA sequences. However, because the P35S promoter is derived from CaMV, these detection assays can yield false-positives from non-GM plants infected by this naturally-occurring virus. RESULTS:Here we report the development of an assay designed to distinguish CaMV-infected plants from GM plants in a single multiplexed quantitative PCR (qPCR) reaction. Following initial testing and optimization via PCR and singleplex-to-multiplex qPCR on both plasmid and plant DNA, TaqMan qPCR probes with different fluorescence wavelengths were designed to target actin (a positive-control plant gene), P35S, P3 (a CaMV-specific gene), and TNOS. We tested the specificity of our quadruplex qPCR assay using different DNA extracts from organic watercress and both organic and GM canola, all with and without CaMV infection, and by using commercial and industrial samples. The limit of detection (LOD) of each target was determined to be 1% for actin, 0.001% for P35S, and 0.01% for both P3 and TNOS. CONCLUSIONS:This assay was able to distinguish CaMV-infected plants from GM plants in a single multiplexed qPCR reaction for all samples tested in this study, suggesting that this protocol is broadly applicable and readily transferrable to any interested parties with a qPCR platform