Acute Non-Traumatic Abdominal Pain in Childhood at Kenyatta National Hospital, Kenya

Background The assessment and diagnosis of acute abdominal pain in childhood is clinically challenging. The epidemiologic correlates differ for different paediatric age groups and settings. Objectives To determine the clinical spectrum of acute abdominal pain in childhood at a referral Kenyan public hospital. Design Cross-sectional observational prospective study of 390 children presenting at the paediatric filter Clinic and wards at Kenyatta National Hospital. Results Boys were majority (62.4%). The mean patient age was 4.3 years. One hundred and thirty one patients (33.6%) were admitted and 74 of these (56.5%) underwent surgery. Majority of the children presented after 48 hours of onset of the abdominal pain. Surgical causes constituted 14% of all cases seen in the filter clinic. The most common causes of surgical abdominal pain were intussusceptions (25.7%) and appendicitis (30%) in infants and children > 6 years of age respectively. Of non surgical causes, upper respiratory tract infections (21%), gastroenteritis (15.6%) and non-specific abdominal pain (9.2%) predominated. Conclusions Medical causes are the leading cause of Acute Abdominal Pain in our locality but important and life threatening surgical causes must be recognized. Intususception is a leading diagnosis in the infant while appendicitis is a top etiology in older children. History and physical examination remain the cornerstones in the approach to a patient with acute abdominal pain

The Contribution of Occult Precipitation to Nutrient Deposition on the West Coast of South Africa

The Strandveld mediterranean-ecosystem of the west coast of South Africa supports floristically diverse vegetation growing on mostly nutrient-poor aeolian sands and extending from the Atlantic Ocean tens of kilometers inland. The cold Benguela current upwelling interacts with warm onshore southerly winds in summer causing coastal fogs in this region. We hypothesized that fog and other forms of occult precipitation contribute moisture and nutrients to the vegetation. We measured occult precipitation over one year along a transect running inland in the direction of the prevailing wind and compared the nutrient concentrations with those in rainwater. Occult deposition rates of P, N, K, Mg, Ca, Na, Al and Fe all decreased with distance from the ocean. Furthermore, ratios of cations to Na were similar to those of seawater, suggesting a marine origin for these. In contrast, N and P ratios in occult precipitation were higher than in seawater. We speculate that this is due to marine foam contributing to occult precipitation. Nutrient loss in leaf litter from dominant shrub species was measured to indicate nutrient demand. We estimated that occult precipitation could meet the demand of the dominant shrubby species for annual N, P, K and Ca. Of these species, those with small leaves intercepted more moisture and nutrients than those with larger leaves and could take up foliar deposits of glycine, NO3-, NH4 + and Li (as tracer for K) through leaf surfaces. We conclude that occult deposition together with rainfall deposition are potentially important nutrient and moisture sources for the Strandveld vegetation that contribute to this vegetation being floristically distinct from neighbouring nutrient-poor Fynbos vegetation

Epidemiology of hepatitis B, C and D in Malawi:systematic review

BACKGROUND:Viral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps. METHODS:We searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model. RESULTS:Searches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3). CONCLUSIONS:Hepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi

Acute, sub-chronic and chronic toxicity of Solanum incanum L in sheep in Kenya

A study was carried out to determine the toxicity of unripe fruits of Solanum incanum L in sheep. The sheep were orally drenched with dried unripe fruits powder of S. incanum L at dose rates varying from 1,200mg to 3,600 mg/Kg /day for 9 weeks. Clinical signs were observed daily while blood with and without anticoagulant was taken weekly for haematological and biochemical analysis. Clinical signs started on day two with bloat. All  sheep groups showed bloat and coughing. Signs of cerebellar hyperplasia were manifested in 25%, 75% and 25% of sheep in groups 2, 3, and 4 respectively, manifested by staggering gait, lateral recumbency, leg paddling movements, coma and death. The mortality rate was 25% for group 2 and 100% for groups 3 and 4. All sheep groups had pneumonia, froth in the bronchi, lung emphysema and congestion in the brain, liver and kidneys while groups 3 and 5 had hemorrhagic ulcers on distal abomasum to proximal duodenum and hemorrhagic enteritis from duodenum to colon. On histology, all sheep showed necrosis of the Purkinje cells of the cerebellum and Wallerian degeneration of neurons; lung emphysema and interstitial pneumonia, hemorrhagic enteritis, tubular necrosis in the kidneys and hepatocyte necrosis. The results indicate that S. incanum L is highly toxic to sheep and allowing sheep to graze on the plant is dangerous to their health