Pathological fracture complicating squamous cell carcinoma: A case report

We report the case of a 65 year old female presenting with a 5 year history of a chronic ulcer with episodes of resolution and recurrence on the right leg. The radiograph of this patient showed a pathological fracture of the right tibia. The biopsy showed a differentiated squamous cell carcinoma. Malignant transformation of an ulcer is rare but changes in character of an ulcer should arouse suspicion of neoplastic transformation

Breast self examination and breast cancer: Knowledge and practice among female medical students in a Kenyan university

Background: Medical students play an important role in creating a supportive environment within their communities for screening behaviours in health promotion. Medical students must possess the appropriate knowledge concerning breast self examination (BSE) and breast cancer to be effective health educators. objective: To investigate the level of knowledge concerning BSE and breast cancer and to evaluate the practice of BSE among female medical students. Materials and methods: A crosssectional descriptive study conducted between March and June 2008 involving female students drawn from schools within the College of Health sciences, University of Nairobi. The questionnaires contained items on the biodata, knowledge and practice of BSE and knowledge on breast cancer. Responses on awareness on breast cancer were weighed using a 3-point Likert’s scale. Results: A total of 169 respondents were interviewed. Majority (94.6%) had heard about BSE with 114 (69.9%) having ever practiced it. Less than 20% of the respondents performed BSE regularly. There were no significant differences between clinical and preclinical students. Mass media was the most common source of information (45.2%). Relatives an formal lectures formed the least (7%) source of information for the respondents. Significant interschool differences on knowledge and practice are presented. Conclusion: Despite being aware, a significant proportion of female medical students do not practice BSE. Information dissemination regarding breast health is underprovided among family members. Recommendation: Programs targeting improved propagation of information and BSE especially among medical trainees should be instituted so as to strengthen health promotion in the community. Key words: Breast self examination, breast cancer, female medical student

Household survey of injuries in a Kenyan District

Objective: To determine the pattern and burden of injuries, their causes and action taken in a rural and urban community in Kenya.Design: Household interview survey and focus group discussions.Setting: Four rural villages and five urban clusters in Kiambu District, Kenya.Subjects: A total of 1,980 members of 200 rural and 230 urban households.Results: The number of reported injuries was 495, corresponding to 300,000 injuries per 100,000 people per year. Most common were cut or piercing (38.4%), followed by fall (16.2%), burn or scald (14.3%), animal bite or kick (10.1%), hit by moving object (5.9%) androad traffic accident (3.6%). Poisoning, sub-mersion/drowning and explosion were uncommon, each below three per cent. Of all reported injuries, 149 (30.1%) sought care from traditional healers, 91 (18.4%) were subject to self-care, 76 (15.4%) obtained service from drug shops, 22 (4.4%) were brought to a health facility for attention and 17 (3.4%) took no action at all. Additional information was obtained through focus group discussions with students, teachersand members of women groups. These generated detailed information about cases of sexual assault within and outside households which had not been captured during the previous household interviews.Conclusion: Injuries are very common but most of them are mild, prompting only home care or no action at all. Only one out of 25 injuries were brought to a health facility for attention. Some types of injury, such as domestic violence and sexual assault, are more likely to becaptured through focus group discussions than during household interviews. A combination of methods is likely to best reflect the pattern of injury at community level

Census and ear-notching of black rhinos (Diceros bicornis michaeli) in Tsavo East National Park, Kenya

This paper updates the status of the black rhino population in Tsavo East National Park (NP). Data were acquired through aerial counts of the black rhino between 3 and 9 October 2010 using three fixed-wing husky aircrafts and a Bell 206L helicopter in an area of about 3,300 km2. Based on previous sightings of rhinos, the area was divided into 14 blocks, with each block subdivided into 400 m transects. An aircraft flying at about 500 m above the ground was assigned to carry out the aerial survey following these transects within each block. Observers scanned for rhinos about 200 m on either sides of the flight paths. Intensive searches in areas with dense vegetation, especially along the Galana and Voi Rivers and other known rhino range areas was also carried out by both the huskies and the helicopter. The count resulted in sighting of 11 black rhinos. Seven of these individuals were ear notched and fitted with radio transmitters and the horns were tipped off to discourage poaching. Three of the seven captured rhinos were among the 49 animals translocated to Tsavo East between 1993 and 1999. The other four animals were born in Tsavo East. Two female rhinos and their calves were not ear-notched or fitted with transmitters. It is recommended that another count be carried out immediately after the wet season as the rhinos spend more time in the open areas while the vegetation is still green. The repeat aerail count is to include blocks north of River Galana

Drug resistance mutations among antiretroviral-treated female sex workers in Nairobi, Kenya

Antiretroviral drug resistance remains an important and a growing challenge in HIV management as it almost always lead to treatment failure. Sex workers face persistent exposures to the different HIV-1 variants and in turn pose a risk of transmission to the general population and measuring drug resistance in this population may serve as a measure for the risk of transmission of these strains to drug naïve populations. The objective of this study was therefore to determine the pattern and prevalence of HIV-1 drug resistance mutations in a cohort of female sex workers in Nairobi, Kenya. Plasma from 60 female sex workers on antiretroviral treatment for over six months was analyzed by amplification and sequencing of the reverse transcriptase - pol region. Five samples (8.3%) showed antiretroviral resistance-associated mutations. One sample (1.7%) showed mutations conferring resistance only to the NNRTI class, 2 samples (3.3%) showed mutations conferring resistance only to the NRTI class while 2 samples (3.3%) showed mutations conferring resistance to both NRTI and NNRTI classes. Phylogenetic analysis revealed HIV-1 subtype A1 (96.7%) and HIV-1 subtype D (3.3%). The prevalence rate of 8.3% for reverse transcriptase-associated resistance mutations was observed. This is a lower rate than has been reported from studies among antiretroviral (ARV)-treated individuals in the country.Afr J Health Sci. 2013; 26:291-30

Assessment of the genetic diversity of Kenyan coconut germplasm using simple sequence repeat (SSR) markers

Genetic diversity and relationship among 48 coconut individuals (Cocos nucifera L.) collections from the Coastal lowland of Kenya were analyzed using 15 simple sequence repeat (SSR) primer pairs. Diversity parameters were calculated using Popgene Software version 1.31. The gene diversity values ranged from 0.0408 (CAC68) to 0.4861 (CAC23) with a mean value of 0.2839. The polymorphic information content (PIC) values ranged from 0.0400 to 0.3680 with a mean value of 0.2348. Marker CAC23 had the highest PIC and revealed highest gene diversity values in this study. Analysis of the molecular variation indicated that within individual variation was 98% while among materials, variation was low at 2% suggesting that molecular variation was not defined by region of production. Cluster analysis was constructed using DARwin program version 6.0. Forty eight (48) coconut individuals were clustered into three groups.Keywords: Coconut palm (Cocos nucifera L., Arecaceae), germplasm, simple sequence repeat (SSR) markers, cluster analysis, diversit

Exploring experiences in peer mentoring as a strategy for capacity building in sexual reproductive health and HIV service integration in Kenya.

BACKGROUND: The Integra Initiative designed, tested, and adapted protocols for peer mentorship in order to improve service providers' skills, knowledge, and capacity to provide quality integrated HIV and sexual and reproductive health (SRH) services. This paper describes providers' experiences in mentoring as a method of capacity building. Service providers who were skilled in the provision of FP or PNC services were selected to undergo a mentorship training program and to subsequently build the capacity of their peers in SRH-HIV integration. METHODS: A qualitative assessment was conducted to assess provider experiences and perceptions about peer mentoring. In-depth interviews were conducted with twelve mentors and twenty-three mentees who were trained in SRH and HIV integration. Interviews were recorded, transcribed, and imported to NVivo 9 for analysis. Thematic analysis methods were used to develop a coding framework from the research questions and other emerging themes. RESULTS: Mentorship was perceived as a feasible and acceptable method of training among mentors and mentees. Both mentors and mentees agreed that the success of peer mentoring largely depended on cordial relationship and consensus to work together to achieve a specific set of skills. Mentees reported improved knowledge, skills, self-confidence, and team work in delivering integrated SRH and HIV services as benefits associated with mentoring. They also associated mentoring with an increase in the range of services available and the number of clients seeking those services. Successful mentorship was conditional upon facility management support, sufficient supplies and commodities, a positive work environment, and mentors selection. CONCLUSION: Mentoring was perceived by both mentors and mentees as a sustainable method for capacity building, which increased providers' ability to offer a wide range of and improved access to integrated SRH and HIV services

Ellipsometric measurements by use of photon pairs generated by spontaneous parametric down-conversion

We present a novel interferometric technique for performing ellipsometric measurements. This technique relies on the use of a non-classical optical source, namely, polarization-entangled twin photons generated by spontaneous parametric down-conversion from a nonlinear crystal, in conjunction with a coincidence-detection scheme. Ellipsometric measurements acquired with this scheme are absolute; i.e., they do not require source and detector calibration.Comment: 10 pages, accepted for publication in Optics Letter

Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities : multicentre randomised controlled trial

Objective: To evaluate the effectiveness and cost utility of a universally provided early years parenting programme. Design: Multicentre randomised controlled trial with cost-effectiveness analysis. Setting: Early years centres in four deprived areas of South Wales. Participants: Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control. Intervention: The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions. Main outcome measures: Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures. Results: There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up. Conclusions: Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains. Trial registration: The trial is registered with Current Controlled Trials ISRCTN13919732