Feracrylum does not Reduce the Incidence of Seroma Formation after Modified Radical Mastectomy

Background: Seroma formation, a common complication after mastectomy, may necessitate many hospital visits, carries an increased risk of infection and may delay adjuvant treatment. Many different unsuccessful procedures have been tried to prevent seroma. The aim of this study was to determine whether feracrylum can reduce seroma formation after mastectomy. Methods: A double blinded prospective randomized controlled study, with 2 groups of 24 patients each, was conducted with one exposed to feracryllum and the other a control group.Results: Seroma rate was 88% in the feracrylum group while it was 38% in the control group (p<0.0001). The mean volume of drainage was less with feracrylum 695ml vs. 1486ml (p<0001). There was significant reduction in the days of drain retention 5.9 vs. 12.8(p<0.0001), and the rate of wound related complications 8% vs. 7.1% in the feracrylum group (p<0.0001). Conclusion: Feracrylum does not reduce the incidence of seroma after mastectomy but it reduces the total volume of drainage and the rate of wound complications.Key Words: Seroma, Mastectomy, Breast cance

The effectiveness of Triclosan coated Polyglactin 910 in reducing surgical site infection in clean wounds

Background: Surgical site infection(SSI) is a major cause of morbidity, mortality and financial burden in healthcare. Worldwide it accounts for as much as USD 10 billion annually in direct and indirect medical cost.Many strategies have been developed to try and reduce SSI.Objective: To determine the effectiveness of triclosan coated polyglactin 910 sutures in reduction of superficial surgical site infection in clean wounds as well as infection rates in clean woundsDesign: A non-blinded randomised controlled trial.Setting: Kenyatta National Hospital (KNH), the minor theatre in clinic 24.Subjects: A total of 157patients underwent excision of breast lump.Results: The prevalence rate of SSI in the study group was 5%(4 of 79 patients) while in the control group it was 4%(3 of 78 patients). The difference between the two groups was not statistically significant(P-value 0.507).Conclusion: This study did not demonstrate a reduction of superficial surgical site when triclosan coated polyglactin 910 suture was used in clean wounds. Currently, the clinical role and indication for use of triclosan coated polyglactin 910 is yet to be fully defined

Utility of CT Scan and CA 19-9 in Predicting Non –Resectability in Malignant Obstructive Jaundice

Background: Most patients with malignant obstructive jaundice (MOJ)  present with non-resectable disease. Non curative laparotomy has been associated with adverse outcome. There is need to predict non-resectable disease and prepare patients for planned palliative procedures.Objective: To study the utility of Ca 19-9 serum levels and CT scan in predicting the non- resectability of MOJ tumours at Kenyatta National Hospital.Methods: Eligible consenting patients were recruited. All had a CT scan of the abdomen and serum CA 19-9 levels determined preoperatively and staging was done using the LRCC criteria. At surgery, intraoperative  findings were then compared in terms of non-resectability with the  preoperative CT scan prediction and the CA 19-9 levels.Results: A total of 49 patients were recruited into the study. During the study, 14 patients were later excluded due to inadequate information of imaging, non-surgical intervention or pre-operative death. At a confidence level of 95%, CA 19-9 level of 466 has 92.3% sensitivity and 100% specificity indicative of non resectability in MOJ lesions. When compared with intra-operative findings on non-resectability, the cut off level of 466 has a positive and negative predictive value of CA19-9 was 100% and 71.4%, respectively. CT scan had 85.2% sensitivity and 100% specificity on predicting non resectability of MOJ lesions, 84% sensitivity in detecting nodal involvement but predicted only 33% of liver metastases.Conclusion: Combining CA 19-9 levels and CT scan are useful tools in detecting non resectability of MOJ lesions preoperatively.Key words: Malignant obstructive jaundice, non-resectability, CA 19-9, CT scan

The utility of ultrasonography compared to surgical and pathology findings in evaluating suspected acute appendicitis at a tertiary institution in Kenya

Objective: To investigate the role of ultrasonography in evaluating patients with clinical suspicion of acute appendicitis.Design: A prospective descriptive study of patients clinically suspected to have acute appendicitis. The abdominal sonographic findings were correlated to the surgical and pathology results.Setting: Kenyatta National Hospital and the Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi.Subjects: Patients with a clinical suspicion of acute appendicitis referred for abdominal ultrasonography during the study period.Results: A total of 112 patients were recruited following ethical approval and informed consent. Males were 73 and females 39 giving a male to female ratio of 1.9:1. The age distribution was from 8 to 70 years with a median age of 27.1 years (IQR 11.5, Q1 = 19.6, Q3=37.1). All patients presented with abdominal pain which was localized at the right iliac fossa in 96 (86%) patients and generalized in 16 (14%). Ultrasound examination of abdomen showed that 97 (87%) patients had findings concerning for appendicitis. The rest (15) patients did not have sonographic features concerning for appendicitis. All patients underwent appendicectomy and 61(54.5%) had inflamed appendices, 32 (28.6%) perforated appendices, 27(24.1%) abscess and 5(4.5%) were gangrenous. The histology of the excised appendices resulted in accuracy, sensitivity, specificity, PPV and NPV of sonographic diagnosis of acute appendicitis to be 88.4%, 92%, 58.3%, 95% and 47% respectively. The overall negative appendicectomy rate was 10.7%.Conclusion: Abdominal ultrasonography using graded compression technique is a useful tool for evaluation of suspected acute appendicitis. However, the ultrasound findings should always be carefully correlated with clinical findings since its negative predictive value is quite low (47%)

Drains after Thyroidectomy for Benign Thyroid Disorders; Are Associated With More Pain, Wound Infection and Prolonged Hospital Stay

BackgroundProphylactic drainage after thyroidectomy has been a regular practice at Kenyatta National Hospital( KNH). This has been used for the potential to avert postoperative fluid accumulation (hematoma or seroma) and also for detection of continuing bleeding. This is aimed at preventing or delaying airway compression that has potential for serious morbidity and mortality. However their importance in these situations has been questioned in recent literature.ObjectiveTo evaluate the difference in outcomes in drained versus non-drained groups after thyroidectomy for benign thyroid disorders.Study designProspective randomized clinical study consisting of 90 patients who were admitted for total thyroidectomy and were randomized into two groups of 45 participants.SettingThe general surgical wards and theatres at Kenyatta National Hospital.MethodsNinety consecutive patients with benign thyroid disorders scheduled for total thyroidectomy or lobectomy, who met the inclusion criteria were recruited over a study period of 9 months from January to September 2011. They were randomly assigned to one group in whom closed drains were used and another in whom no drains were used after thyroidectomy. They were then evaluated postoperatively for hematoma and seroma formation, pain assessed by the visual analogue scale (VAS), duration of hospital stay and necessity for re-operation.ResultsThe mean VAS score was significantly lower in the non-drained group patients at 6, 12 and 24 hours postoperatively (p= 0.001). Four cases of hematoma (8.9%) occurred in the drained group, whereas none of patients in the non-drained group developed hematoma (p=0.04). None of the patients in the non-drain group had post-surgical wound infection whereas four (9%) of those who had drains developed wound sepsis. No participant required re-operation for any complication nor developed seroma and all complications were successfully managed conservatively.ConclusionProphylactic drainage after thyroidectomy for benign goiters does not show any benefit in hematoma prevention and is associated with increased hospital stay and post-operative pain

The Association Between Pitch Conditions and the Incidence of Injury in Rugby

Background: Environmental conditions have been shown to influence incidence of rugby injuries. Harsh weather conditions and detrimental effect on poor Kenyan rugby pitches create a unique environment for injury exposure. We conducted a whole population prospective cohort study to determine the association of pitch conditions with injury incidence and severity.Methods: The study was conducted on 364 registered Kenya Rugby Union (KRU) players throughout the 2010 15-aside season. The injury incidence was calculated as injuries per 1000 match player hours (mph). Pitches were categorized into good and suboptimal based on quality indicators of ground characteristics. Injuries were defined and recorded according to the Rugby International Consensus Group (RICG) protocol and compared between the pitches.Results: One hundred and two injuries were recorded in 60 league games (2400 mph). Twenty nine of the 60 league games were played in the category B (suboptimal condition) pitches. The overall incidence of injuries was 42.50/1000mph. Good pitches had an injury of 29.0 injuries/1000mph (95% CI 0.81- 1.61) compared to 56.9 injuries/1000mph (95% CI 1.76- 2.90) for suboptimal pitches.Conclusion: Although the overall Kenyan injury rate is comparable to the amateur level incidence from other studies, the higher rate associated with suboptimal pitches suggests interventions that can target pitch optimization.Keywords: Injury rate, Ground conditions, Rugby, Kenya

The effect of varied instructions on prison guard role behaviour expectations

The Stanford Prison Experiment (SPE) was conducted to determine the psychological and behavioural effects of adopting the roles of prisoners or prison guards. In various published research articles Zimbardo reported that he instructed the prison guards to maintain law and order (Haney, Banks, & Zimbardo, 1973). However, in the Quiet Rage video (Zimbardo, 1989), Zimbardo gave the prison guards additional detailed instructions. To examine the effects of these different instructions on expected prison guard role behaviour, first year Psychology students were requested to predict expected prison guard role behaviour under two different conditions. In the order condition, participants received the instructions used in published research articles. While in the fear condition, participants received the instructions from the Quiet Rage video (Zimbardo, 1989). Participants estimated the likelihood of 50 guard behaviours. Participants in the order condition predicted more pleasant behaviour, while participants in the fear condition predicted more unpleasant behaviours. This indicates that the different instructions influenced their intent to perform the different behaviours. There was no significant difference between the fear and order conditions, and the control behaviours. Participants in both the fear and order conditions rated the control items as expected prison guard role behaviour. Participants in both conditions indicated that they would behave in this manner. Gender had no significant influence on expected prison guard role behavior

Clinical Outcomes of Colorectal Cancer in Kenya

Background The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges. Method Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was mortality while secondary outcomes included recurrence rates, time to recurrence and the patient, disease and treatment factors associated with mortality and recurrence. Kaplan Meir charts were charted for survival trends. Results Half of the lesions were located in the rectum. There was no relationship between the sub-site location and recurrence and mortality. The mean follow-up period was 15.9 months. Overall recurrency and mortality rates were 37.5% and 29.4% respectively. Most recurrences occurred within one year of surgery. Recurrence was not influenced by age, gender, sub-site, chemotherapy receipt or presence of comorbidity. Factors significantly associated with mortality included the male gender ( p 0.04), presence of co-morbidity (p 0.029), recurrence (p 0.001), curative intent (p 0.01), disease stage (p 0.036) and receipt of chemotherapy ( p< 0.01). Conclusion Follow up of colorectal cancer patients is still challenging. The mortality and recurrence rates are high for the short follow up periods. Further studies are needed to explore the determinants of both survival and recurrences, especially with longer follow ups

Development and validation of the African Women Awareness of CANcer (AWACAN) tool for breast and cervical cancer.

BACKGROUND: Measuring factors influencing time to presentation is important in developing and evaluating interventions to promote timely cancer diagnosis, yet there is a lack of validated, culturally relevant measurement tools. This study aimed to develop and validate the African Women Awareness of CANcer (AWACAN) tool to measure awareness of breast and cervical cancer in Sub-Saharan Africa (SSA). METHODS: Development of the AWACAN tool followed 4 steps: 1) Item generation based on existing measures and relevant literature. 2) Refinement of items via assessment of content and face validity using cancer experts' ratings and think aloud interviews with community participants in Uganda and South Africa. 3) Administration of the tool to community participants, university staff and cancer experts for assessment of validity using test-retest reliability (using Intra-Class Correlation (ICC) and adjusted Kappa coefficients), construct validity (comparing expert and community participant responses using t-tests) and internal reliability (using the Kuder-Richarson (KR-20) coefficient). 4) Translation of the final AWACAN tool into isiXhosa and Acholi. RESULTS: ICC scores indicated good test-retest reliability (≥ 0.7) for all breast cancer knowledge domains and cervical cancer risk factor and lay belief domains. Experts had higher knowledge of breast cancer risk factors (p 0.7, and lower (0.6) for the cervical cancer risk subscale. CONCLUSION: The final AWACAN tool includes items on socio-demographic details; breast and cervical cancer symptom awareness, risk factor awareness, lay beliefs, anticipated help-seeking behaviour; and barriers to seeking care. The tools showed evidence of content, face, construct and internal validity and test-retrest reliability and are available for use in SSA in three languages.Research reported in this article was jointly supported by the Cancer Association of South Africa (CANSA), the University of Cape Town and the South African Medical Research Council with funds received from the South African National Department of Health, GlaxoSmithKline (GSK) Africa Non-Communicable Disease Open Lab (via a supporting grant Project Number: 023), the United Kingdom Medical Research Council (via the Newton Fund)

Seagrass coastal protection services reduced by invasive species expansion and megaherbivore grazing

Seagrasses provide an important ecosystem service by creating a stable erosion-resistant seabed that contributes to effective coastal protection. Variable morphologies and life-history strategies, however, are likely to impact the sediment stabilization capacity of different seagrass species. We question how opportunistic invasive species and increasing grazing by megaherbivores may alter sediment stabilization services provided by established seagrass meadows, using the Caribbean as a case study. Utilizing two portable field-flumes that simulate unidirectional and oscillatory flow regimes, we compared the sediment stabilization capacity of natural seagrass meadows in situ under current- and wave-dominated regimes. Monospecific patches of a native (Thalassia testudinum) and an invasive (Halophila stipulacea) seagrass species were compared, along with the effect of three levels of megaherbivore grazing on T. testudinum: ungrazed, lightly grazed and intensively grazed. For both hydrodynamic regimes, the long-leaved, dense meadows of the climax species, T. testudinum provided the highest stabilization. However, the loss of above-ground biomass by intensive grazing reduced the capacity of the native seagrass to stabilize the surface sediment. Caribbean seagrass meadows are presently threatened by the rapid spread of the invasive opportunistic seagrass, H. stipulacea. The dense meadows of H. stipulacea were found to accumulate fine sediment, and thereby, appear to be effective in reducing bottom shear stress during calm periods. This fine sediment within the invasive meadows, however, is easily resuspended by hydrodynamic forces, and the low below-ground biomass of H. stipulacea make it susceptible to uprooting during storm events, potentially leaving large regions vulnerable to erosion. Overall, this present study highlights that intensive megaherbivore grazing and opportunistic invasive species threaten the coastal protection services provided by mildly grazed native species. Synthesis. Seagrass meadows of dense, long-leaved species stabilize the sediment surface and maintain the seabed integrity, thereby contributing to coastal protection. These services are threatened by intensive megaherbivore grazing, which reduces the stability of the surface sediment, and opportunistic invasive species, which are susceptible to uprooting in storms and thereby can leave the seabed vulnerable to erosion.Environmental Fluid Mechanic