Clinical and socio-demographic profile of patients on treatment for osteoporosis in Nairobi, Kenya

Background: Osteoporosis is a chronic, progressive disease of multifactorial aetiology and one of the most common metabolic bone diseases worldwide. There is a paucity of data on osteoporosis in Africa as it’s generally thought not to affect the non-Caucasian population. We sought to describe the population with osteoporosis in a Nairobi rheumatology clinic.Objective: To evaluate the clinical characteristics of patients with osteoporosis seen at a rheumatology clinic in Nairobi.Methods: Clinical, with emphasis on musculoskeletal manifestations, treatment and selected comorbidities in 56 patients diagnosed with osteoporosis were followed up and evaluated in the Nairobi Arthritis Clinic.Results: The age distribution was 31- 95 years with majority being above the age of 60 years at 71.5%. Majority were female (89.3%). The main musculoskeletal manifestations were polyarthralgia (30.4%) followed by lower back pain (19.6%) and pathological fractures (12.5%). The types of osteoporosis were grouped as primary (9%), secondary (44.6%) and post-menopausal (46.4%). The most common clinical association being rheumatoid arthritis (39.3%) followed by steroids therapy (25%). Other comorbidities included osteoarthritis, fibromyalgia, systemic lupus erythromatosus and diabetes. Seven study participants had history of fracture with lumbar spine fractures leading at 42.8%. None of the study participants were smokers. The number of patients on calcium supplements was at 71.4% and bisphosphonates was low at 32%.Conclusion: The findings of this study from age to comorbidities on osteoporosis are in keeping with literature. The number of patients on bisphosphonates was low which differed from Western literature. Persons at increased risk for osteoporosis in this set-up include post-menopausal women with debilitating chronic illness causing reduced mobilization over time and presenting with bone pains.These patients should be investigated for osteoporosis and effective treatment administered early.Keywords: Osteoporosis, Clinical profile, Nairobi, Keny

Simultaneous adsorption and biodegradation of synthetic melanoidin

Molasses spent wash contains melanoidin, a dark brown recalcitrant compound. It is not easily biodegraded and causes a number of problems such as reduction in photosynthetic activities and dissolved oxygen when discharged to aqueous environment. Being an antioxidant, melanoidin removal through purely biodegradation has been inadequate. Consequently, in the current study, simultaneous adsorption and biodegradation (SAB) was employed in a stirred tank system to remove melanoidin from synthetic wastewater. Mixed microbial consortium was immobilized onto 200 g of activated carbon and used to degrade 3.5 L of melanoidin solutions with varying chemical oxygen demand (COD) concentrations. The effects of the initial COD level, pH and temperature on COD removal were then studied. Ultimately, the SAB performance was compared to that of batch adsorption or biodegradation carried out independently. After 48 h of operation, the SAB process yielded the best COD removal efficiency of 75% as compared to 49.3 and 51.9% for adsorption and biodegradation, respectively, for the initial COD value of 10800 mg/ L at a temperature of 296 K and pH 6.97. This therefore showed that the SAB process can successfully be applied to enhance the removal of melanoidin from wastewater.Key words: Adsorption, biodegradation, melanoidin, SAB, wastewater

A Push-Pull System to Reduce House Entry of Malaria Mosquitoes.

Mosquitoes are the dominant vectors of pathogens that cause infectious diseases such as malaria, dengue, yellow fever and filariasis. Current vector control strategies often rely on the use of pyrethroids against which mosquitoes are increasingly developing resistance. Here, a push-pull system is presented, that operates by the simultaneous use of repellent and attractive volatile odorants. Experiments were carried out in a semi-field set-up: a traditional house which was constructed inside a screenhouse. The release of different repellent compounds, para-menthane-3,8-diol (PMD), catnip oil e.o. and delta-undecalactone, from the four corners of the house resulted in significant reductions of 45% to 81.5% in house entry of host-seeking malaria mosquitoes. The highest reductions in house entry (up to 95.5%), were achieved by simultaneously repelling mosquitoes from the house (push) and removing them from the experimental set-up using attractant-baited traps (pull). The outcome of this study suggests that a push-pull system based on attractive and repellent volatiles may successfully be employed to target mosquito vectors of human disease. Reductions in house entry of malaria vectors, of the magnitude that was achieved in these experiments, would likely affect malaria transmission. The repellents used are non-toxic and can be used safely in a human environment. Delta-undecalactone is a novel repellent that showed higher effectiveness than the established repellent PMD. These results encourage further development of the system for practical implementation in the field

Clinical presentation of patients with adult onset still’s disease in Nairobi: case series

Introduction: Adult Still’s Disease (ASD) is a systemic inflammatory disorder of unknown etiology, typically characterized by a clinical triad (daily spiking high fevers, evanescent rash, arthritis), and a biological triad (hyperferritinemia, hyperleukocytosis with neutrophilia and abnormal liver function test). Objective: This case series set out to describe the clinical characteristics of patients with ASD seen at a rheumatology clinic in Nairobi. Results: After a record search, 8 patients were noted to have ASD. Fever and arthritis were noted to be most predominant presenting features with almost all the patients having hyperferritinemia

Clinical patterns of juvenile idiopathic arthritis: A single tertiary center experience in Kenya

Background: Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of disorders with different disease manifestations among various populations. There are few reports of JIA among indigenous Africans in sub-Saharan Africa. We present herein the clinical patterns of JIA encountered at a rheumatology clinic, Nairobi, Kenya.Method: Medical records of patients with a diagnosis of chronic arthritis with onset at the age of 16 years or less presenting to the Nairobi Arthritis Clinic were reviewed between January 2009 and January 2016. They were retrospectively reviewed and reclassified as Juvenile Idiopathic Arthritis (JIA) based on the International League of Associations for Rheumatology (ILA R) JIA diagnostic criteria.Results: A total of 68 patients were recruited, the females gender was predominant in all categories of JIA apart from Enthesitis related arthritis. The overall female to male ratio was 2.4:1. The range of age at onset of symptoms was between 2 years and 15 years and the mean age at JIA onset was 8.45 ± 4.37 years. The mean age of presentation at the clinic was 10.22± 3.79 years. Polyarticular rheumatoid factor negative arthritis was most common at 38.2%, followed by oligoarticular 23.5%, polyarticular rheumatoid factor positive 17.6%, systemic JIA at 14.7% and enthesitis associated arthritis at 5.9%. Large joints were affected in 85.2%, small joints 44% and fever was present in 73.5% of patients. One patient had the typical rash of systemic onset JIA (Still’s) and another had uveitis. The ESR was raised in all categories of JIA with a mean of 44.35mm/hr while the haemoglobin was reduced with a mean of 10.82mg/ dl. Positive Rheumatoid Factor (RF) was found only in RF positive polyarticular JIA. NSAIDs were used in all the patients. NSAIDS were combined with corticosteroids in 38/68 (55.9%) patients while NSAIDs, corticosteroids and methotrexate were used in 16/68 (23.5%) patients and biologics were received by 6/68 (8.8%) patients at different and varying length of time.Conclusion: This is the first study of JIA undertaken in Kenya. Our patients had a delayed presentation, were predominantly female and sero negative polyarticular arthritis. Challenges experienced in this setting include late presentation to rheumatologists and inadequate resources (personnel, finances, equipment and drugs).Keywords: Juvenile idiopathic arthritis, ILAR, Kenya, Clinical patterns, Treatmen