Prevalence and Antimicrobial Susceptibility of Bacteria Implicated in Neonatal Sepsis at Pumwani Maternity Hospital

Neonatal sepsis is one of the most common causes of morbidity and mortality among infants in developing countries. The etiology and antimicrobial sensitivity patterns of bacteria responsible vary in different hospitals. This study identified bacteria in blood cultures of neonates with clinically suspected septicemia and demonstrated their susceptibility patterns. A longitudinal design targeting all neonates at Pumwani maternity hospital with suspected sepsis was used. One hundred and fifty neonates were selected using consecutive sampling. Data was collected using a questionnaire. Out of 150 blood specimens cultured, the cases of confirmed bacterial sepsis were 48(32%). Gram-positive pathogens predominated with Staphylococcus aureus and Streptococcus viridans accounting for 70%. The only Gram-negative isolates were E. coli and Klebsiella spp. Gram-positive isolates showed high sensitivity (above 80%) to meropenem, gentamicin, ceftriaxone, ofloxacin, and amikacin. Gram- negative organisms were generally resistant to penicillins and absolutely sensitive to meropenem, ceftazidime and ciprofloxacin. Keywords: Prevalence, Antimicrobial susceptibility, Neonatal sepsi

Effect of Magnesium Sulphate in Mothers suffering from Toxemia of Pregnancy and their Neonates

Background: Severe pre-eclampsia is one of the major causes of high maternal mortality rate in both developed and developing countries. The goals of management are to prevent progression to eclampsia thus preventing convulsions, to control the blood pressure and to prevent untoward effects in the foetus. The first-line option for the treatment and prevention of eclamptic seizures is magnesium sulphate. Objective: To determine the serum magnesium, urea and electrolyte levels in neonates of mothers treated with magnesium sulphate and compare the findings with the levels in non-exposed neonates. Methodology: A quasi experimental design was adopted where test subjects were neonates of mothers suffering from preeclampsia and severe eclampsia and were being treated with magnesium sulphate just before delivery at Pumwani Maternity hospital. The control group comprised neonates of hypertensive mothers without preeclampsia being treated using other drugs. Blood samples were obtained from the mother at onset of labor and from the neonates at birth and analyzed in the clinical chemistry laboratory of the University of Nairobi. Results:  A total of 54 mothers and their neonates were enrolled with 27 in each arm of the study. The mean maternal serum magnesium in the test group was significantly higher than in the control group (p = 0.008). The mean neonatal serum magnesium in the test group was also significantly higher compared to the control group (p = 0.008). There were statistically significant differences in serum sodium (p = 0.015), urea (p = 0.043) and creatinine (p = 0.008) levels between the maternal test and control groups. There were significant differences in serum urea (p = 0.007) and chloride (p = 0.017) between the neonatal test and control groups. The calcium and potassium levels were elevated in the test group but not to significant levels. There was a positive correlation between maternal and neonatal serum magnesium levels in both groups stronger in the test group (r = 0.56, p = 0.003) as compared to the control group (r = 0.35, p = 0.087). Conclusion: Maternally administered magnesium sulphate raises urea and creatinine levels to significant levels in mothers. Calcium levels are also raised while in mothers not receiving magnesium sulphate they were slightly lower. In neonates the urea and chloride levels are elevated to significant levels while the calcium and potassium levels are not significantly elevated. We suggest monitoring of both in the immediate post-partum period. Keywords: Preeclampsia, eclampsia, magnesium sulphate, neonate, serum urea and electrolytes

Factors that influence adequacy of asthma control in children residing in Naivasha, a flower growing area in Kenya

Background: In Kenya, asthma affects 10% of the population. One of the modifiable risk factors contributing to asthma morbidity and mortality is environmental exposure. Naivasha flower farms introduce pesticides persistently into the environment and these may drift onto residential property or other areas where children play. Proximity of households to the pesticide treated farms may also increase exposure of children to the pesticides. Pesticide exposure has been shown to exacerbate already existing asthma, a relationship that has not been studied in Kenya. Objectives: To identify risk factors that exacerbate asthma and influence adequacy of Asthma control in children residing in a flower growing area in Kenya. Methodology: The design was a cross-sectional study that involved 150 asthmatic children aged 5-12 years residing a flower growing area.  The study was conducted between May and July, 2014 in Naivasha, which is home to Kenya’s largest horticultural flower farms.  Participants were interviewed using a structured questionnaire while asthma control was measured using a validated Asthma control tool. Logistic regression was done to identify variables that affected asthma control. Results: Majority of the asthmatic children were males (56.7%) while females were 43.33%. Risk factors that were found to be significantly associated with asthma control were; duration of stay in or near a flower farm (OR = 0.723, 95%CI (0.538-0.975), presence of a smoker in the family (OR = 0.463, 95%CI (0.094-22.629) and presence of household pet (OR = 4.358, 95%CI (1.182-16.057). There was no significant relationship between the child’s asthma control and age of child, sex of child, distance of school from flower, guardian’s level of education, guardian’s income, and guardian’s occupation as a flower farm worker, child’s age of diagnosis and use of indoor pesticides. Conclusion:  The use of Integrated Pest Management (IPM) should be promoted as it keeps environmental exposure pesticides to a minimum. Key words: asthma, household pet, flower farm, pesticide, smokin

Treatment of chronic heart failure in adults at a referral hospital in Kenya: adverse drug reactions and determinants of adherence

Background: Chronic Heart Failure is a major health problem with a prevalence of between 1 and 12% in USA and Europe, and approximately 5.7% in Sub-Saharan Africa, and has socio-economic relevance owing to its high prevalence, mortality and impact on young economically active individuals. In 1999 chronic heart failure constituted 3.3% of all medical admissions at Kenyatta National Hospital. Objective: The purpose of the current study was to determine factors that affect adherence to treatment among patients with Chronic Heart Failure at Kenyatta National Hospital and assess any association between any such factors Methodology: This was a descriptive cross-sectional study involving patients >18 years diagnosed with Chronic Heart Failure at Kenyatta National Hospital. Eighty three eligible and consenting study participants were recruited into the study using a convenient sampling technique. Data were collected by means of an interviewer administered questionnaire adapted from the Revised HF Adherence Questionnaire. Results: Data from 83 patients was analyzed majority (n=51, 61.4%) of whom were women. The age of the patients ranged from 18 to 80 years with the majority (n= 37, 44.6%), between 21-40 years. Majority (n=58, 68.9%) of the patients considered appointment keeping, compliance to medication (n= 64, 77.1%), dietary restriction (n=59, 72%), regular exercise (n=49 59.0%), smoking cessation (n=59, 71%), and alcohol cessation (n=58, 69.9%) as very important. Fifty three (63.9%) respondents had not failed to take their medicines at any time.  Majority (n=72, 86.8%) of the study participants were aware of the disease condition they were suffering from while valvular heart disease was the commonest comorbidity (n= 17 27.9%). The study revealed an association between sex and some adverse drug reactions using Pearson χ² test through bivariate analysis. Sleep disturbances and nausea occurred more in males than females while headache and drowsiness were more prevalent in females and in both cases the relationships were statistically significant (p< 0.05) Conclusions: Adherence to medicines among patients with Chronic Heart Failure is reasonably high at Kenyatta National Hospital despite patients’ knowledge level about the condition being generally low. Valvular heart disease was the most common comorbidity while hyponatremia was the most prevalent electrolyte disturbance, and tachycardia, vomiting and rash the most common adverse drug effects. Key words Chronic heart failure; adherence; compliance; adverse drug reactions

Predictors of non-adherence to antihypertensive therapy in a rural health facility in Kenya

Background: The effectiveness of antihypertensive medicines depends on whether the patient uses the drugs as instructed by the health care provider. Failure to adhere to therapy may lead to uncontrolled blood pressure and possibly preventable complications. The factors which may impact on adherence to medicines among patients in rural health facilities have not been adequately documented. Objective: To determine the predictors of non- adherence to antihypertensive therapy in Murang’a South Sub-county Hospital. Methods: A descriptive cross-sectional study design was used. One hundred and sixty-seven adult hypertensive patients who were on therapy at Murang’a South Sub-county Hospital were included. Participants who satisfied the inclusion criteria were selected using simple random sampling. Data was collected using a researcher administered questionnaire. Analysis was carried out using STATA version 14 statistical software and p</=0.05 was considered statistically significant. Permission to conduct the study was granted by the Kenyatta National Hospital-University of Nairobi Ethical and Research committee and the management of the hospital. Results: There was female predominance (124, 74.3%).One hundred and twelve (67.5%) participants were adherent to medications. The independent predictors of non-adherence were; lack of finances (p=0.000), inadequate knowledge on treatment (p=0.005), long duration of treatment (p=0.001), forgetfulness (p=0.003), side effects of drugs (p=0.019) and fear of dependence (p=0.008). Conclusion: Patient factors were major contributors to non- adherence. Clinicians should be encouraged to provide adequate counseling to improve adherence. Keywords: adherence, antihypertensive therapy, predictor

Patient factors impacting on oral anticoagulation therapy among adult outpatients in a Kenyan referral hospital

Background: Patients’ factors such as knowledge on warfarin use are important in achieving desirable anticoagulation outcomes. Objective: To assess the patient factors impacting on oral anticoagulation control among adult outpatients taking warfarin at Kenyatta National Hospital. Methodology: A cross-sectional survey of 147out-patients on warfarin at Kenyatta National Hospital was carried out between March and April 2015. Data were collected using a pre-designed interviewer administered questionnaire. The data included patient characteristics such as indication and duration of anticoagulation; knowledge on anticoagulation; and international normalized ratio tests. The Oral Anticoagulation Knowledge test was used with a score of ≥75% indicating sufficient knowledge. Logistic regression was used to determine independent variables associated with anticoagulation control. Results: Females were majority (74.9%) while optimal anticoagulation control was at 43.5%. Only 10.1% had sufficient knowledge on anticoagulation. Anticoagulation knowledge scores were associated with marital status (p=0.015), education level (p=0.014) and indication (p=0.032). Independent predictors of poor anticoagulation were female gender (p=0.011) and lower education level (p=0.005). Optimal anticoagulation control was, however, not associated with knowledge on anticoagulation (p=0.794). Conclusion: Knowledge and control of anticoagulation among the patients are poor. Female gender and lower education level were predictors of poor anticoagulation. Provision of information on anticoagulation to patients on was warfarin is recommended. Key words: Knowledge, Warfarin, Anticoagulation, International normalized rati

Identification and characterization of potential drug interactions in hypertensive patients in a Kenyan tertiary hospital

Background: Hypertensive patients are particularly at risk of drug-drug interactions resulting from the concomitant use of multiple drugs to control their blood pressure. The presence of comorbidities and advancing age are also likely to contribute to the use of many drugs, further increasing this risk. Drug related problems such as drug interactions in the management of hypertension increase morbidity and mortality but there are limited published data to characterize them especially among the African population. Objective: To identify and characterize potential drug interactions among adult hypertensive patients attending Kenyatta National Hospital. Methods: This was a descriptive cross-sectional study done among 313 adult patients between May to July 2016 at Kenyatta National Hospital. Ethical approval was sought from the institutional review board. Data on patient demographics, clinical characteristics and current prescriptions were extracted from patient records into predesigned data collection forms. Potential drug interactions were identified using an online Drug Interactions Checker. Results: There was female predominance at 60.7% and the mean age of the study population was 55.2 years (SD 15.9).  The mean number of drugs per prescription was 5.93 (SD 2.24). The prevalence of potential drug interactions was 92.7%. There was an average of 3.5 drug interactions per prescription. Majority (79.2%) of the potential drug interactions were categorized as moderate while major and minor interactions accounted for 4.1% and 16.8%, respectively. The most prevalent interacting drug pair was enalapril and furosemide (15.3 %). The most frequent major interaction found was between enalapril and spironolactone, which is associated with hyperkalaemia. Conclusions: There was a high prevalence of potential drug interactions. Prescribers should be encouraged to be vigilant during the management of hypertensive patients to avoid overt drug interactions which may compromise treatment outcomes and increase the health care costs. Keywords: Drug interactions, hypertension, prescriptions, Keny

Prostaglandin D2-supplemented “functional eicosanoid testing and typing” assay with peripheral blood leukocytes as a new tool in the diagnosis of systemic mast cell activation disease: an explorative diagnostic study

Background: Systemic mast cell activation disease (MCAD) is characterized by an enhanced release of mast cell-derived mediators, including eicosanoids, which induce a broad spectrum of clinical symptoms. Accordingly, the diagnostic algorithm of MCAD presupposes the proof of increased mast cell mediator release, but only a few mediators are currently established as routine laboratory parameters. We thus initiated an explorative study to evaluate in vitro typing of individual eicosanoid pattern of peripheral blood leukocytes (PBLs) as a new diagnostic tool in MCAD. Methods: Using the “functional eicosanoid testing and typing” (FET) assay, we investigated the balance (i.e. the complex pattern of formation, release and mutual interaction) of prostaglandin E2 (PGE2) and peptido-leukotrienes (pLT) release from PBLs of 22 MCAD patients and 20 healthy individuals. FET algorithms thereby consider both basal and arachidonic acid (AA)-, acetylsalicylic acid (ASA)-, and substance P (SP)-triggered release of PGE2 and pLT. The FET assay was further supplemented by analyzing prostaglandin D2 (PGD2), as mast cell-specific eicosanoid. Results: We observed marked PGE2-pLT imbalances for PBLs of MCAD patients, as indicated by a markedly enhanced mean FET value of 1.75 ± 0.356 (range: 1.14–2.36), compared to 0.53 ± 0.119 (range: 0.36-0.75) for healthy individuals. In addition, mean PGD2 release from PBLs of MCAD patients was significantly, 6.6-fold higher than from PBLs of healthy individuals (946 ± 302.2 pg/ml versus 142 ± 47.8 pg/ml; P < 0.001). In contrast to healthy individuals, PGD2 release from PBLs of MCAD patients was markedly triggered by SP (mean: 1896 ± 389.7 pg/ml; P < 0.001), whereas AA and ASA caused individually varying effects on both PGD2 and pLT release. Conclusions: The new in-vitro FET assay, supplemented with analysis of PGD2, demonstrated that the individual patterns of eicosanoid release from PBLs can unambiguously distinguish MCAD patients from healthy individuals. Notably, in our analyses, the FET value and both basal and triggered PGD2 levels were not significantly affected by MCAD-specific medication. Thus, this approach may serve as an in-vitro diagnostic tool to estimate mast cell activity and to support individualized therapeutic decision processes for patients suffering from MCAD

A Novel fry1 Allele Reveals the Existence of a Mutant Phenotype Unrelated to 5′->3′ Exoribonuclease (XRN) Activities in Arabidopsis thaliana Roots

International audienceBackgroundMutations in the FRY1/SAL1 Arabidopsis locus are highly pleiotropic, affecting drought tolerance, leaf shape and root growth. FRY1 encodes a nucleotide phosphatase that in vitro has inositol polyphosphate 1-phosphatase and 3′,(2′),5′-bisphosphate nucleotide phosphatase activities. It is not clear which activity mediates each of the diverse biological functions of FRY1 in planta.Principal FindingsA fry1 mutant was identified in a genetic screen for Arabidopsis mutants deregulated in the expression of Pi High affinity Transporter 1;4 (PHT1;4). Histological analysis revealed that, in roots, FRY1 expression was restricted to the stele and meristems. The fry1 mutant displayed an altered root architecture phenotype and an increased drought tolerance. All of the phenotypes analyzed were complemented with the AHL gene encoding a protein that converts 3′-polyadenosine 5′-phosphate (PAP) into AMP and Pi. PAP is known to inhibit exoribonucleases (XRN) in vitro. Accordingly, an xrn triple mutant with mutations in all three XRNs shared the fry1 drought tolerance and root architecture phenotypes. Interestingly these two traits were also complemented by grafting, revealing that drought tolerance was primarily conferred by the rosette and that the root architecture can be complemented by long-distance regulation derived from leaves. By contrast, PHT1 expression was not altered in xrn mutants or in grafting experiments. Thus, PHT1 up-regulation probably resulted from a local depletion of Pi in the fry1 stele. This hypothesis is supported by the identification of other genes modulated by Pi deficiency in the stele, which are found induced in a fry1 background.Conclusions/SignificanceOur results indicate that the 3′,(2′),5′-bisphosphate nucleotide phosphatase activity of FRY1 is involved in long-distance as well as local regulatory activities in roots. The local up-regulation of PHT1 genes transcription in roots likely results from local depletion of Pi and is independent of the XRNs.