Total hip replacements at Kikuyu Hospital, Kenya

Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, improving their quality of life. It is a highly cost-effective procedure. Many patients deserving this operation cannot afford it in this part of the world and hence do not have it done. Objective: To analyse total hip replacement surgical procedures done in a mission orthopaedic hospital in Kenya with emphasis on early complications. Design: A retrospective hospital based study Setting: Kikuyu hospital Methods: Medical records of patients who underwent primary total hip arthroplasty between June 2006 and January 2008 in a sample of 97 patients done surgery at Kikuyu hospital. The patient’s medical records were looked at from the time a patient is first seen at the clinic by an orthopaedic surgeon and is recommended for a total hip arthroplasty and is followed up until 6 months after the operation. The difficulties encountered either by the surgeon or the patient during this period were recorded and analysed. Results: Of the 97 patients seen 99 operations were done and there were, two dislocations, two superficial and one deep wound infections, one upper gastro intestinal bleeding, two Deep Vein Thrombosis, one sciatic nerve neuropraxia, one haematoma formation and one intraoperative femoral fracture. Out of the 97 patients 40 of them had the surgery performed more than six months after a proper diagnosis was made and hip arthroplasty recommended. This is mainly due to lack of finances. At operation two cases were really difficult and took longer than the usual timing. Conclusion: Total hip arthroplasty is a safe operation even in the third world with satisfactory results. Just like in any other surgical procedure difficulties and complications are bound to occur. East African Orthopaedic Journal, Vol. 4: September 201

Outcome of management of humerus diaphysis non-union

Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a major functional problem. The main of our study was to document the outcome of management of non united diaphyseal humerus fractures with plate or plate and rush pin fixation.Methods: A 4 year retrospective study was undertaken at Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April 2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were reviewed. Four cases were lost to follow up. The rest were treated with a single posterior, anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion and complications. Radiological assessment for union was also done.Results: A total of 46 patients with humerus diaphysis non union met the inclusion criteria. Their ages ranged from 23 to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6 months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a loose plate and screws following replating. The third case went to nonunion. Three cases of postoperative radial nerve palsy all of which resolved within six weeks were documented. All four treated with a plate and rush pin construct healed uneventfully.Conclusion: The results of this study indicate that our standard surgical procedure for treatment of nonunion of the humeral shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush pin construct is useful in dealing with nonunion involving osteoporotic bone

Morals, morale and motivations in data fabrication: Medical research fieldworkers views and practices in two Sub-Saharan African contexts

AbstractData fabrication, incorrect collection strategies and poor data management, are considered detrimental to high-quality scientific research. While poor data management have been occasionally excused, fabrication constitutes a cardinal sin – scientific misconduct. Scholarly examinations of fabrication usually seek to expose and capture its prevalence and, less frequently, its consequences and causes. Most accounts centre on high-income countries, individual senior researchers and scientists who are portrayed as irrational, immoral or deceptive.We argue that such accounts contain limitations in overlooking data collected in ‘the field’, in low-income countries, by junior researchers and non-scientists. Furthermore, the processes and motivations for fabrication and subversive practices are under-examined. Drawing on two separate ethnographies, conducted in 2004–2009 in medical research projects in sub-Saharan Africa, this paper investigates fabrication among fieldworkers using data from observations and informal conversations, 68 interviews and 7 Focus Group Discussions involving diverse stakeholders. Based on an interpretative approach, we examined fieldworkers' accounts that fabrications were motivated by irreconcilable moral concerns, faltering morale resulting from poor management, and inadequate institutional support. To fieldworkers, data fabrication constituted a ‘tool’ for managing their quotidian challenges. Fabrications ranged from active to passive acts, to subvert, resist and readdress tensions deriving from employment inequalities and challenging socio-economic conditions.We show that geographical and hierarchical distance between high-ranking research actors and fieldworkers in contemporary configurations of international medical research can compartmentalise, and ultimately undermine, the relationships necessary to produce high-quality data. In focusing on fieldworkers, we argue for the inclusion of wide-ranging perspectives in examinations of data fabrication

Volkmann's Ischaemic Contracture following acute compartment syndrome - a case report

Background: Compartment syndrome involving the extremities is one of orthopaedic emergencies. If not well managed it can lead to serious damage to soft tissues rendering the limb non functional. Design: A case report Setting: PCEA Kikuyu hospital Methods: An eight year old boy was treated and followed up after he had suffered compartment syndrome on his left forearm. This occurred after he fell and sustained fractures of both radius and ulnar. He was put in a cast at a peripheral hospital. East African Orthopaedic Journal, Vol. 4: September 201

Melorheostosis

This case study is a report on the rare mesodermal disorder typically characterized by abnormalities of the skeleton and soft tissues. We present a 56 years old woman who was diagnosed with melorheostosis affecting the left arm. Chronic pain odema and cosmetic deformities were her presenting problems. Melorheostosis is a bony dysplasia with characteristic X-ray appearance resembling wax dripping down one side of the candle. Soft tissue calcification and even ossification may rarely be seen. In some rare and complicated cases corrective surgery or amputation may be done in very painful and ischemic limbs (1). Until very recently the aetiology of melorheostosis was unknown but now it has been established that melorheostosis is due to a loss-of-function mutation in LEMD 3 gene (also called MAN 1), which encodes an inner nuclear membrane protein (2). This is the first reported case in this region. The purpose of this case report is to describe the presentation and course of the disease. A comprehensive review of literature describing etiology, clinical aspects, diagnosis and treatment is included. Patients symptoms vary considerable in melorheostosis and consequently their treatment should be individualized

Revelation or confirmation? The ‘fake probe’ in global health

Fakes have become a matter of concern across global health. Commissioning inquiry into presumed fake practices in global health requires both a pre-existing sense of what would constitute real provision and a suspicion that it is not being offered. In this Position Piece, we analyse the research methods being used to identify and reveal other—presumed—fakes in global health provision. We put forward the concept of the ‘second-order fake’—the fake that is used to reveal a fake—to draw attention to the methodological politics at stake in the use of the fake. By reviewing historical cases of the creation of methods of deception, we analyse the assumptions they bring into global health from other disciplines. We foreground the promises of revelation that are embedded in probes that rely on fakes to uncover fakes. We suggest that despite the growing prevalence of methods which themselves deploy fakes to find fakes, these techniques bring us no closer to understanding the lived ambiguities of everyday practices of fakery

Exploring the willingness toward HIV immediate test and treat among MSM in Nairobi and its environs: a cross-sectional study.

Background: In the test and treat initiative, high-risk populations are screened for human immunodeficiency virus (HIV) infection and start early treatment if diagnosed positive. This study explores factors associated with willingness to initiate testing and immediate treatment among men who have sex with men (MSM) in Nairobi and its environs. The study was informed by a conceptual framework combining the AIDS Risk Reduction Model (ARRM) and the Modified Social Ecological Model. Methods: This cross-sectional exploratory study targeted MSM (aged 18–60 years) reporting active engagement in anal or oral sex with men in Nairobi and its surrounding areas. Purposive sampling was used to identify data collection sites, and then snowballing was employed to reach the respondents. Data analysis was performed using SPSS version 23, and binary logistics regression was used for inferential analysis. Results: Between July 2018 and June 2019, 391 MSM were recruited to fill out a self-administered questionnaire, out of which 345 complete questionnaires were analyzed. Never been tested for HIV, private/NGO as the facility of the last HIV test, and had unprotected anal sex were listed as the reasons for taking the most recent test, and the results of the most recent HIV test and seeking a post self-test confirmation were associated with a higher likelihood of accepting the immediate HIV test and treat initiative. Additionally, a preference for a health provider as the first source of support, belief in the efficacy of ARVs, and disclosure about being on ART were the other reasons. Additionally, being aged 25+ years, having more than 60 USD monthly income, and having inconsistent condom use during sex were associated with a higher likelihood of accepting the immediate HIV test and treat initiative. Barriers to the immediate test and treat strategy included stigma from healthcare providers and concerns about disruptions in lifestyle through antiretroviral therapy (ART) use. Conclusion: Interventions aimed at increasing the HIV test and treat initiative in Kenya may need to take into account the demographic and social characteristics of MSM, including age, lack of habitual HIV testing, and lifestyle changes before and upon enrollment in ART. Projects should also consider working closely with healthcare facilities to strengthen treatment preparation, especially for asymptomatic MSM and those who may not be immediately willing to choose the test and treat strategy

Misdirection – Magic, Psychology and its application

The art of magic relies on deception and illusions to create human experiences that appear impossible. Misdirection lies at the heart of this deceptive art, and yet there is little consensus as to what this concept aims to describe. The concept of misdirection is not limited to magic, and its principles are applied to wide aspects of our lives (e.g., politics, public health, marketing). In recent years, scientists have started to examine the psychological mechanisms that underpin misdirection and new theoretical frameworks have been developed to help understand the concept itself. This paper provides two different perspectives on misdirection. In the first section we will discuss its use in magic and examine some of the key features involved in using misdirection to create magical illusions. This section will examine some common misconceptions of misdirection. The second section will provide a psychological perspective that discusses the key psychological mechanisms that are involved in misdirection (perception, memory, reasoning). The third section examines the uses of misdirection in other domains. This paper aims to provide a clearer understanding of how misdirection is used in magic which can serve as the basis for its use in other domains, such as public health

"You have to keep fighting": maintaining healthcare services and professionalism on the frontline of austerity in Greece.

BACKGROUND: Greece has been severely affected by the 2008 global economic crisis and its health system was, and still is, among the national institutions most shaped by its effects. METHODS: In 2014, this qualitative study examined these changes through in-depth interviews with 22 frontline healthcare professionals in five different locations in mainland Greece. These interviews with nurses, doctors and pharmacists explored perceptions of austerity and how ideas of professionalism were challenged and revised by these measures. RESULTS: Participants reported working conditions characterised by dramatic increases in public hospital admissions alongside decreases in personnel, consumables, materials, and also many hospital closures. Many drew on analogies of war and fighting to describe the effects of healthcare reforms on their working lives and professional conduct. Despite accounts of deteriorating conditions and numerous challenges, healthcare professionals presented themselves as making every effort to meet patients' needs, while battling to resist guidelines which they perceived diminished their roles to production-line operatives. CONCLUSIONS: Participants considered it their duty to defend their professional ethos and serve patients without compromising standards, even if this meant liberal interpretation and implementation of regulations. These professionals regarded themselves on the frontline of healthcare provision but also the frontline defence in a war on their professional standards from austerity