Laparoscopic cystogastrostomy in the management of pancreatic pseudocysts

Pancreatic pseudocysts develop following acute or chronic pancreatitis. Majority of the cases resolve spontaneously but some persist beyond six weeks. Active management of pancreatic pseudocysts involves draining of the fluid collection through open surgery, endoscopically, laparoscopically or percutaneously. In our setup, drainage has traditionally been done through open surgery. In this article we present a case of a 61 year old male who developed pancreatic pseudocysts secondary to chronic pancreatitis. Laparoscopic cystogastrostomy was performed and there was no recurrence after three months of follow up. The case presentation highlights the need to offer laparoscopic cystogastrostomy as a method of managing pancreatic pseudocysts in our setup.Keywords: Pancreatic Pseudocyst, Cystogastrostomy, Laparoscopic Drainag

Switch from 200 to 350 CD4 baseline count: what it means to HIV care and treatment programs in Kenya

Introduction: With the increasing population of infected individuals in Africa and constrained resources for care and treatment, antiretroviralmanagement continues to be an important public health challenge. Since the announcement of World Health Organization recommendation andguidelines for initiation of antiretroviral Treatment at CD4 count below 350, many developing countries are adopting this strategy in their countryspecific guidelines to care and treatment of HIV and AIDS. Despite the benefits to these recommendations, what does this switch from 200 to 350CD4 count mean in antiretroviral treatment demand? Methods: A Multi-centre study involving 1376 patients in health care settings in Kenya. CD4count was carried out by flow cytometry among the HIV infected individuals in Kenya and results analyzed in view of the In-country and the newCD4 recommendation for initiation of antiretroviral treatment. Results: Across sites, 32% of the individual required antiretroviral at <200 CD4Baseline, 40% at <250 baseline count and 58% based on the new criteria of <350 CD4 Count. There were more female (68%) than Male(32%).Different from <200 and <250 CD4 baseline criteria, over 50% of all age groups required antiretroviral at 350 CD4 baseline. Age groupsbetween 41-62 led in demand for ART. Conclusion: With the new guidelines, demand for ARVs has more than doubled with variations notedwithin regions and age groups. As A result, HIV Care and Treatment Programs should prepare for this expansion for the benefits to be realized.Key words: CD4, New criteria, HIV, AIDS, care and treatment, ARV initiatio

Identification, Characterization and Purification of MSC_0265, a Potential Immunogenic Antigen Homologue of Mycoplasma mycoides subsp. mycoides in Mycoplasma capricolum subsp. capripneumoniae

In silico identification and characterization of vaccine antigens has opened up new frontiers in the field of reverse vaccinology to mitigate the effects of livestock diseases by development of new subunit vaccines. This study aims to characterize, express and purify MSC_0265 for eventual use in immunoassays and inoculation in goats. Mycoplasma mycoides subs. mycoides (Mmm) and Mycoplasma capricolum capripneumoniae (Mccp) are similar pathogens on the genomic level and are the causative agents of Contagious Bovine Pleuropneumonia (CBPP) in cattle and Contagious Caprine Pleuropneumonia (CCPP) in goats respectively. In this study, BLAST was used to identify the homology of MSC_0265 in Mycoplasma capricolum capripneumoniae genome and the protein it is similar to. Characterization of MSC_0265 was also done using I-TASSER to predict secondary structure, solvent accessibility, normalised B-factor, 3D models and function. With cut off points of 0.0 for E-value, 100% for Query coverage and 90% for Identity, MSC_0265 a pyruvate dehydrogenase enzyme gave a high homology score on tBLASTn and BLASTp. It had earlier been cloned in pGS21a vector before proceeding with expression and purification of the His-tagged protein by Ni-NTA affinity chromatography. This study identified the homologue of MSC_0265 as protein WP_029333261.1 in the Mycoplasma capricolum capripneumoniae genome (Accession NZ_LN515398.1) using tBLASTn and BLASTp. Additionally, MSC_0265 was characterized and its optimal expression profile and estimated molecular weight verified

Evaluation of pre-screened sweet potato germplasm for biomass production under different cropping regimes and their potential as dual-purpose varieties in Kenya.

Six cultivars of sweet potato were grown on farms in five sites located in central, south and north rift valley regions of Kenya under rain fed conditions. Two sites each were located in the high and medium altitude areas while one was located in the low altitude area. All sites have warm climates except one in the high altitude that experiences cold climate. The cultivars included 103001, Gweri, Kemb 23, Kemb 36, Naspot 1 and Wagabolige. The vines of each variety were harvested at two different stages (75 and 150 days) post planting. The 75-day treatment was ratooned again at 150 day post planting. Agronomical observations were carried during the long rains seaso 2010. Harvesting vines twice significantly (P<001) increased forage yields but significantly (P<001) reduced root yield in all varieties. The Gweri variety realized the highest forage but lowest storage root yields indicating its potential as a forage variety. Kemb 23, Kemb 36 and Napsot 1 produced appreciable amount of vines and highest root storage yield making them potential dual purpose varieties. The effect of agro ecological zone (AEZ) varied with time of harvest. There was less interaction between the cultivars and the AEZ at 75 day harvest. Gweri, Kemb 23 and Kemb 36 showed some level of interaction with AEZ at 150 day harvest. Across AEZs dry vine yields (t DM/ha) ranged from 2.3,5.3 in 103001, 2.4,8.5 in Gweri, 1.9,8.4 in Kemb 23, 1.4,7.8 in Kemb 36, 1.8,7.4 in Naspot 1 and 1.2,7.4 in Wagabolige and dry storage root yields (t DM/ha) ranged from 0.7,2 in 103001, 0.3,1.2 in Gweri, 0.4,2.5 in Kemb 23, 0.9,1.5 in Kemb 36 , 1.7,2.3 in Naspot 1 and 0.5,1.8 in Wagabolige. The storage root yield: vine (R/V) ratio was determined by dividing the total root by vine dry matter yield. The R/V ratios significantly (P<005) varied between cultivar and harvesting stage. The mean R/V were 1.8 in 103001, 0.2 in Gweri, 0.6 in Kemb 23, 0.5 in Kemb 36, 1.5 in Naspot 1 and 0.7 in Wagabolige. The R/V ratios obtained classifies 103001 and Naspot 1 as low forage-high root production varieties, Wagabolige and Kemb 36 as low dual purpose and Kemb 36 and Gweri as forage varieties. Preference of different growers for forage vs. dual purpose types appears to vary by location

Assessment of phenotypic and genetic variation against pod borer among a subset of elite pigeonpea (Cajanus cajan) genotypes in Kenya

Molecular marker information supported by quality morphological data facilitates the choice of suitable parents for applied breeding. The main aim of this study was to assess genetic diversity among 55 cultivated yield elite pigeonpea lines using 21 simple sequence repeat (SSR) markers that are well distributed across the genome. Among the 55 pigeonpea genotypes, 16 medium duration were selected and evaluated in the field for response to pod borer resistance in varied agro-ecological zones of Kenya during long rains of April-October cropping season Twenty one primer pairs detected 80 alleles with a mean of 3.9 alleles per locus and polymorphism information content (PIC) ranging from 0.09 to 0.75 averaging to 0.39 suggesting a low genetic diversity. However, marker CcM1820 revealed the highest number of alleles (9) with a PIC value of 0.75. The genotype response to pod borer attack was significant (P≤0.05) with three genotypes (ICEAPs 01541, 01154-2 and 00902) revealing tolerance to pod borer. The markers based on Neighbor Joining, grouped the 55 genotypes into three main clusters based on parentage selection. Most genotypes developed from ICEAP 00068 as the maternal parent were grouped in Cluster I while cluster II comprised of improved genotypes and cluster III comprised genotypes developed from ICPL 87091 as maternal parent. The resistant genotypes identified in the field experiment were grouped in cluster I except ICEAP 00902 which grouped in cluster II. Future studies should focus on broadening genetic base by including more landraces and wild relatives to maximize selection and improve breeding work

Psychological and physiological stress and burnout among maternity providers in a rural county in Kenya: individual and situational predictors

Background: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors. Methods: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other sociodemographic, health, and work-related items. We also collected data on heart rate variability (HRV) and hair cortisol levels to assess stress-related physiologic responses to acute and chronic stress respectively. Multilevel linear regression models were computed to examine individual and work-related factors associated with stress, burnout, HRV, and cortisol level. Results: 85% of providers reported moderate stress and 11.5% high stress. 65% experienced low burnout and 19.6% high burnout. Average HRV (measured as the root mean square of differences in intervals between successive heart beats: RMSSD) was 60.5 (SD = 33.0) and mean cortisol was mean cortisol was 44.2 pg/mg (SD = 60.88). Greater satisfaction with life accomplishments was associated with reduced stress (β = − 2.83; CI = -5.47; − 0.18), while motivation to work excessively (over commitment) was associated with both increased stress (β = 0.61 CI: 0.19, 1.03) and burnout (β = 2.05, CI = 0.91, 3.19). Female providers had higher burnout scores compared to male providers. Support staff had higher HRV than other providers and providers under 30 years of age had higher HRV than those 30 and above. Although no association between cortisol and any predictor was statistically significant, the direction of associations was consistent with those found for stress and burnout. Conclusions: Most providers experienced moderate to high levels of stress and burnout. Individuals who were more driven to work excessively were particularly at risk for higher stress and burnout. Higher HRV of support staff and providers under age 30 suggest their more adaptive autonomic nervous system response to stress. Given its impact on provider wellbeing and quality of care, interventions to help providers manage stress are critical

Genetic diversity study of Kenyan cassava germplasm using simple sequence repeats

Cassava (Manihot esculenta Cranzt) is an important food security crop for resource poor rural communities particularly in Africa. Little is however known about molecular diversity of Kenyan cassava germplasm. This led to a study whose objective was to identify genetic constitution of cassava accessions from different regions of Kenya using molecular tools. Seven pairs of micro satellite (SSR) primers previously developed from cassava were used to detect polymorphic 21 alleles in a sample of 69 accessions. The cluster analysis of similarity matrix obtained at 68% with SSR data showed that the 69 accessions were grouped into five marker based groups. This study proved that SSRs could be used to identify cassava accessions as well as in the assessment of level of genetic relatedness among accessions.Keywords: Cassava, simple sequence repeat (SSR) markers, genetic diversity