Early outcome of vascular lower limb amputations at a National Referral Hospital in Kenya

BACKGROUND: Majority of lower limb amputations performed in the African setting have been reported to be mainly due to trauma and neoplasms. These affect mainly young and therefore, fit individuals with lower risks of complications. Recent local studies show an increase in the incidence of cardiovascular diseases including peripheral vascular diseases. These are associated with higher rates of both systemic and amputation stump-related complications. There is however little published data in Africa on the outcomes of vascular lower limb amputations. OBJECTIVE: To determine the early outcome of vascular lower limb amputations. DESIGN: Descriptive prospective study, conducted between July 2003 and June 2004. SETTING: The Kenyatta National Hospital, the largest referral and teaching hospital in Kenya. SUBJECTS: All patients with gangrene of the lower limb due to occlusive peripheral vascular disease not caused by trauma or inappropriate limb splintage who were amputated at Kenyatta National Hospital during the study period were included. OUTCOME MEASURES: These included the wound healing time, number of stump revisions, number of conversions to a higher amputation level, the thirty-day post-operative mortality and the hospitalization period. CONCLUSION: While the findings of this study compare with other series, the prolonged hospital stay is of concern considering the younger average age of the patients

Laporan Kasus: Gambaran Patologi Anatomik pada Adenokarsinoma Gaster Stadium Lanjut pada Usia Lanjut dengan Gejala Gastroesophageal Reflux Disease (GERD)

AbstrakKarsinoma gaster adalah neoplasma epitelial ganas terdiri atas grup tumor yang secara biologik dan genetik heterogendengan etiologi multifaktorial, umumnya ditemukan pada laki-laki, dekade ke-5 hingga ke-7 dengan keluhan nyeriepigastrium, dispepsia, anemia dan penurunan berat badan. Seorang pasien laki-laki 65 tahun datang ke rumahsakit dengan keluhan dada dan tenggorokan terasa sakit hilang timbul sejak enam bulan yang lalu. Hasil biopsimenunjukkan adenokarsinoma intramukosa disertai metaplasia intestinal dan Helycobacter pylori. Reseksi gaster/distal gastrektomi dilakukan tiga minggu kemudian dengan hasil histopatologik karsinoma gaster tipe tubular/intestinal infiltratif hingga lapisan muskularis (pT2N0). Hasil histopatologik ini sesuai dengan kulminasi dariinflamasi – metaplasia – displasia – karsinoma dikenal dengan correa cascade of multistep gastric carcinogenesis.Kata kunci: karsinoma gaster, histopatologik, stadium lanjut, karsinogenesis. AbstractGastric carcinoma is a malignant epithelial neoplasm consists of both biological and genetic heterogenous groupwith multifactorial etiologies, men predominant (2:1) in fifth to seventh decade. Symptoms are epigastric pain,dyspepsia, anemia and weight loss. Male 65 years old complaining of chest pain and heartburn with suspected GERD.Gastroscopy and biopsy results showed intra mucosal adenocarcinoma. Intestinal metaplasia and Helycobacterpylori both are positive. Partial distal gastrectomy was performed with histopathology reports showed tubular/intestinal adenocarcinoma that invades muscularis propria (pT2N0). These histopathologic findings are suitablewith culmination of an inflammation – metaplasia – dysplasia – carcinoma sequence known as correa cascade ofmultistep gastric carcinogenesis.Key words: gastric carcinoma, histopathologic, advanced stage, carcinogenesis

Unusual Bones Articulating With the Pelvic Girdle

We report a case of a 44 year old man who presented with right gluteal pain following trivial trauma, associated with unusual bones, with all the characteristics of clavicles articulating with the pelvic girdle. The pain on that side was completely relieved by excision of the bone. The Annals of African Surgery, Volume 6, 201

The prevalence and importance of malaria infections during pregnancy not detected by microscopy or rapid diagnostic testing

With the advent of rapid diagnostic tests (RDT) for malaria detection, parasitological confirmation of malaria diagnoses has become more readily accessible and increasingly more affordable. However, questions are being asked about how useful they are in screening programmes, particularly for pregnant women who very often may harbour placental malaria infections which may not be detected by peripheral blood smear microscopy. It is also necessary to examine how many malaria infections go undetected by RDTs and whether such undetected infections have any negative consequences for women who carry such RDT-negative infections. This sub-study was conducted as part of a large multi-country trial of intermittent preventive treatment with sulfadoxine pyrimethamine versus intermittent screening and treatment of malaria in pregnancy which in Burkina Faso, Gambia, Ghana and Mali. The study enrolled 5,354 primi- and secundigravidae who attended antenatal clinics at study sites in the four countries from May 2010 to October 2011. The sensitivity of the RDT to detect peripheral malaria in pregnancy using PCR as the reference declined from 89.3% (95% CI 85.5-92.4) on the day of enrollment to 57.7% (95% CI 46.5-73.0) at delivery. However, the sensitivity of the RDT to detect placental malaria was lower when placental histology was used as the reference ranging from 72% (95% CI 63.3-79.7) for any woman who tested RDT positive at any scheduled ANC visit, to 35.4% (95% CI 26.6-45.0) at the delivery visit. The prevalence of sub-RDT malaria was highest at delivery (6.3%). There was no significant association between sub-RDT malaria infection and low birth weight. Of the women in a sub-sample who were seen at first ANC visit, 39.0% had malaria infections out of which 1.7% were non-falciparum infections presenting as mono-infections or mixed infections with P. falciparum. Clinical symptoms and signs were not sensitive enough to predict a positive RDT test and therefore the presence of malaria parasites. Women whose malaria infections get missed by RDTs are not at great risk of developing adverse pregnancy outcomes when compared with women who had no malaria. All pregnant women should be screened with RDT if IST was considered to replace IPTp-SP in areas where SP resistance is too high or transmission intensity is very low

Travel behaviour and perception of mode public transportation among users in Malaysia

Shared mobility can be defined as the transportations that are shared among users such as public transit (e.g. bus, commuter, LRT, MRT), taxis, bike sharing, car sharing, and e-hailing services (e.g. Grab) to obtain short-term access. Shared mobility sits within the broader phenomenon that has been termed as ‘sharing economy’, in which wide spread usage of emerging information and communications technology (ICT), particularly smartphones, enables new forms of market interactions that can enable both new services and improved efficiency in asset utilization [1, 2]. This scenario has given many benefits especially towards e-hailing services where the users can order a driver to pick up himself or herself at a designated area and send them to the destination that they want only using an application on smartphones. Other than that, it also gives a revolution of public transportation such as bus by purchasing the ticket through online system. This are the transformations and the trend changes from oldest system to further system

RELATO DE EXPERI?NCIA DO ESTUDO DE CI?NCIAS NO FUNDAMENTAL II: A TABELA PERI?DICA EM SALA DE AULA

O presente trabalho tem por objetivo relatar a experi?ncia docente desenvolvida em sala de aula por meio de uso de metodologias tradicionais e ativas de ensino em uma turma do nono ano do fundamental II, desenvolvendo materiais instrucionais dentro de uma abordagem de conte?do com foco em Ci?ncias/Qu?mica. Por serem assuntos complexos e de grande incompreens?o, os conte?dos de ci?ncias dificultam a absor??o de entendimento. Por este motivo foram ministradas aulas utilizando de ambas metodologias com o objetivo de desenvolver o assunto da Tabela Peri?dica em sala de aula como forma de incentivar um entendimento aos alunos de modo mais efetivo. As abordagens de aprendizagem ativa estimulam o dom?nio, a criatividade e a autonomia do aluno, abordando as dimens?es cognitiva, sustent?vel, est?tica e social do trabalho, e as abordagens tradicionais fornecem um norte te?rico para seu crescimento e aprendizado, fornecendo fundamentos, conceitos, conhecimento e boa colabora??o na hora de criar a tabela peri?dica. O uso de metodologias tradicionais e ativas podem trazer uma contribui??o importante para o processo de ensino de ci?ncias naturais. Especialmente quando aplicado de forma intrincada e harmoniosa. Por meio de ambas abordagens, foi poss?vel estimular o interesse dos alunos pelas ci?ncias promover o protagonismo estudantil em seu pr?prio aprendizado e desenvolver aptid?es essenciais para a vida acad?mica e pessoal

Managing Primary Health Care in the South - South Geo Political Zone of Nigeria

Management of Primary Health Care (PHC) is one of the main pillars of a health system through Human Resources. Furthermore, the quality of health services depends to a large extent on the people who manage the services. The paper reviews the role of stakeholders in the management of primary health service provisioning in general and in Primary Health Care in particular, it examines brief historical review of the gradual introduction of new cadres of health managers into the health system in response to perceived health needs, training and deployment of health during the colonial era, establishment of the advance schools for health workers, events at third national development plan and the unfortunate decline of community nursing and community midwifery, etc. It further analyzes factors and challenges of leadership which affect the performance of health managers. It also discussed case studies of proven innovative approaches and best practices in the management of human resources in sub – Saharan Africa and Nigeria. Data used in this paper is derived from secondary sources. An urgent need for a comprehensive database on the Human Resource for Health (HRH) situation in Primary Health Care should be developed. The current Human Resource situation indicates that the availability and distribution of HRH and PHC is far from being adequate. The need to mobilize communities to get them to take ownership of primary health care delivery and its maintenance is important. The morale and motivation of personnel have major implications for their performance. In the case of Human Resource for PHC in Nigeria, data is not easilyavailable and when available tends to be incomplete and/or contradictory. The distribution and availability of HR and PHC is also a major concern in most parts of Nigeria. The poor distribution and inadequate number of the various health personnel required for an effective PHC in Nigeria is compounded by the brain drain, poor motivation among health personnel and inappropriate policies among others

Laporan Kasus: Gambaran Patologi Anatomik pada Adenokarsinoma Gaster Stadium Lanjut pada Usia Lanjut dengan Gejala Gastroesophageal Reflux Disease (GERD)

Karsinoma gaster adalah neoplasma epitelial ganas terdiri atas grup tumor yang secara biologik dan genetik heterogen dengan etiologi multifaktorial, umumnya ditemukan pada laki-laki, dekade ke-5 hingga ke-7 dengan keluhan nyeri epigastrium, dispepsia, anemia dan penurunan berat badan. Seorang pasien laki-laki 65 tahun datang ke rumah sakit dengan keluhan dada dan tenggorokan terasa sakit hilang timbul sejak enam bulan yang lalu. Hasil biopsi menunjukkan adenokarsinoma intramukosa disertai metaplasia intestinal dan Helycobacter pylori. Reseksi gaster/ distal gastrektomi dilakukan tiga minggu kemudian dengan hasil histopatologik karsinoma gaster tipe tubular/ intestinal infiltratif hingga lapisan muskularis (pT2N0). Hasil histopatologik ini sesuai dengan kulminasi dari inflamasi – metaplasia – displasia – karsinoma dikenal dengan correa cascade of multistep gastric carcinogenesi

Grizzly bear monitoring by the Heiltsuk people as a crucible for First Nation conservation practice

Guided by deeply held cultural values, First Nations in Canada are rapidly regaining legal authority to manage natural resources. We present a research collaboration among academics, tribal government, provincial and federal government, resource managers, conservation practitioners, and community leaders supporting First Nation resource authority and stewardship. First, we present results from a molecular genetics study of grizzly bears inhabiting an important conservation area within the territory of the Heiltsuk First Nation in coastal British Columbia. Noninvasive hair sampling occurred between 2006 and 2009 in the Koeye watershed, a stronghold for grizzly bears, salmon, and Heiltsuk people. Molecular demographic analyses revealed a regionally significant population of bears, which congregate at the Koeye each salmon-spawning season. There was a minimum of 57 individual bears detected during the study period. Results also pointed to a larger than expected source geography for salmon-feeding bears in the study area (\u3e 1000 km²), as well as early evidence of a declining trend in the bear population potentially explained by declining salmon numbers. Second, we demonstrate and discuss the power of integrating scientific research with a culturally appropriate research agenda developed by indigenous people. Guided explicitly by principles from Gvi’ilas or customary law, this research methodology is coupled with Heiltsuk culture, enabling results of applied conservation science to involve and resonate with tribal leadership in ways that have eluded previous scientific endeavors. In this context, we discuss the effectiveness of research partnerships that, from the outset, create both scientific programs and integrated communities of action that can implement change. We argue that indigenous resource management requires collaborative approaches like ours, in which science-based management is embedded within a socially and culturally appropriate context. We emerge not only with a set of guiding principles for resource management by the Heiltsuk, but a broadly applicable strategy that fosters intimacy with traditional lands and resources and provides a powerful engine for conservation