Relation of the external laryngeal nerve to superior thyroid artery in an African population

The external laryngeal nerve runs parallel to superior thyroid artery and later crossing the artery either above or below the upper pole of the thyroid gland. This relatively high anatomic variability demonstrates inter-population differences. However, datum among the Kenyan population is lacking. Knowledge of normal and variant anatomy of these structures is important in surgical procedures within the neck. This study therefore aimed at describing the variant anatomical relations of the superior thyroid artery and external laryngeal nerve for the Kenyan population. Twenty formalin fixed cadavers obtained from the Department of Human Anatomy, University of Nairobi were dissected to expose the thyroid gland, superior thyroid artery and external laryngeal nerve. The relation of the superior thyroid artery to the external laryngeal nerve was noted. The external laryngeal nerve crossed the superior thyroid artery within 1cm above the upper pole of the thyroid gland in 25% of cases and more than 1 cm in 75% of cases. The level at which the external laryngeal nerve crosses the superior thyroid artery displays variations among Kenyans warranting care during surgical procedures of the thyroid gland.Key words: Superior thyroid artery, Nerv

Origin of thyroid arteries in a Kenyan population

Introduction: The thyroid gland receives blood supply predominantly from paired superior and inferior thyroid arteries. The superior thyroid artery originates from external carotid while the inferior thyroid artery is a branch of thyrocervical trunk. Unusual origins of superior thyroid artery include common carotid and cervical part of internal carotid arteries while those for the inferior thyroid artery are subclavian, common carotid or the vertebral arteries. These origins vary between populations. Knowledge of variant anatomy of these arteries is important in surgical procedures within the neck. This study describes variant origin of the thyroid arteries in a Kenyan population.Materials and Methods: Fifty formalin fixed cadavers from the Department of Human Anatomy, University of Nairobi were available for the study. Skin incisions were made from the chin to the supra-sternal notch, along the clavicle to the acromion and then to the mastoid process. Skin flaps and platysma muscle were refl ected for exposure of the anterior triangle of the neck. The sternocleidomastoid was cut close to its origins on the clavicle and reflected superiorly. The strap muscles were transected and reflected to expose the thyroid gland lying within the visceral fascia. The dissection field was cleaned by blunt and sharp dissection to expose the gland. The two thyroid arteries were identified from either pole of the gland and traced to their respective origins.Data Analysis: Data was coded, tabulated and analysed using SPSS 16.0 for windows® (SPSS Inc., Chicago, Illinois) for percentages and frequencies of the observed variations in origin and nerve relations. Results were presented in tables and macrographs.Results: Superior thyroid artery originated from external carotid and common carotid artery in 74.4% and 25.6 % of cases respectively. The right side displayed a higher frequency of origin from the common carotid artery. The inferior thyroid artery arose from thyrocervical trunk in 87.5% and from subclavian artery in 12.5% of cases. There was a higher incidence of the inferior thyroid artery originating from the subclavian on the left than the right side.Conclusion: Over 25% of superior thyroid arteries and 11 % of inferior thyroid arteries show variant origins. The common carotid and subclavian arteries were the most frequent variant sites of origin for superior and inferior thyroid arteries respectively. Bilateral asymmetry was observed. Neck surgeons should be aware of these variations during ligation and selective embolisation of thyroid arteries to avoid complications during surgery

Characterization of methomyl and carbofuran degrading-bacteria from soils of horticultural farms in Rift Valley and Central Kenya

The use of pesticides is very critical in protecting the farmers’ investment in seeds, fertilizer and labour since they provide a sure cover from damage by pests. The use of pesticides is therefore inevitable and the environmental pollution due to pesticides and their residues will continue to be a challenge. In this study, bacterial strains capable of degrading methomyl (S-methyl-N-[(methylcarbamoyl) oxy]-thioacetimidate) and carbofuran (2, 3-dihydro-2, 2-dimethyl-7-benzofuranyl methylcarbamate) were isolated from soils sampled from horticultural farms with a history of pesticide usage. High pressure liquid chromatography was used to monitor biodegradation of both methomyl and carbofuran using reference standards and acetonitrile and water as mobile phases. Partial 16S rDNA sequence analysis indicated that the carbofuran-degrading strains were closely related to members of the genus Pseudomonas and Alcaligenes while the methomyl degrading strains were closely related to members of the genus Flavobacterium and Alcaligenes. The morphological and biochemical characteristics of the isolates also confirmed the phylogenetic signature. The study established that the activities of the esterase and phosphatase enzymes correlated well with biodegradative capability and recommends possible application of the isolates in the in vivo bioremediation of pesticide contaminated soils.Key words: Pesticides, carbofuran, methomyl, biodegradation, bacteria

Asymptomatic Plasmodium falciparum malaria and gametocyte carriage are common in Coastal Kenya

Adequate malaria diagnosis and treatment remain a major problem in rural sub Saharan Africa. Molecular parasite detection has shown that submicroscopic Plasmodium falciparum asexual and gametocytes are common in patients, and can infect mosquitoes in low endemic areas. The significance of the infectious reservoir of malaria in the general population remains unknown. In this study we investigated submicroscopic asexual parasitaemia and gametocytaemia in inhabitants of areas of hypo-endemic and seasonal malaria in which no molecular analysis on malaria survey has been done before. Cross-sectional stuies during the staging of two clinical trials clinical trial in Mokowe and Lamu, Coastal Kenya were conducted in the dry and wet seasons of 2010. Finger prick blood samples used to determine the prevalence of Plasmodium falciparum parasites by microscopy, Fluorescence In-situ hybridization (FISH), rapid diagnostic test and real time nucleic acid sequence-based amplification (QT-NASBA). A total of 450 individuals participated in the surveys of whom, 2.7% had microscopically confirmed asexual parasites while 2.4% had gametocytes. In contrast, FISH revealed that 8.9% (29/327) and QT-NASBA 24.6% (59/240) of the individuals harbored asexual parasites and 29.2% (70/240) gametocytes. There were a few cases of mixed infection with Plasmodium malariae, 1.8% (8/ 450) by microscopy and 4% (13/327) by FISH. No age dependency or seasonality was observed in the submicroscopic parasite carriage. In conclusion, molecular detection techniques disclose that carriage of submicroscopic asexual parasite and gametocyte is relatively common in these low transmission areas and that submicroscopic gametocytaemia is likely to be responsible for maintaining malaria transmission in the study area.Keywords: submicroscopic, gametocytaemia, FISH, rapid diagnostic test, QT-NASBAAfr J Health Sci. 2013; 26:314-32

Extensive hyperpigmentation during pregnancy: a case report

Abstract Introduction Skin hyperpigmentation is common during pregnancy and often is due to endocrinological changes. Usual patterns include linea nigra, darkening of areola and melasma. We report a rare diffused hyperpigmentation condition in a pregnant woman of dark colored skin. Case presentation A 19-year-old Tanzanian primigravida at 32 weeks gestation presented at our antenatal clinic concerned about an insidious but progressive onset of unusual darkening of her abdominal skin and both breasts. Her antenatal record was unremarkable except for this unusual onset of abnormal skin color. Findings from her physical examination were unremarkable, and she had a normal blood pressure of 120/70 mmHg. Her abdomen was distended with a uterine fundus of 34 weeks. Almost her entire abdominal skin had darkly colored diffuse deep hyperpigmentation extending cephalad from both iliac fossae to involve both breasts to 2-3 cm beyond the areolae circumferentially. She had a fetus in longitudinal lie and cephalic presentation, with a normal fetal heart rate of 140 beats per minute. Other examination findings were unremarkable. The impression at this stage was exaggerated pigmentation of pregnancy. No medical treatment was offered but she was counseled that she might need medical treatment after delivery. She progressed well and had spontaneous labor and normal delivery at 38 weeks gestation. She was lost to follow up. Conclusion Unusual pregnancy-related skin hyperpigmentation can occur with no adverse consequences to pregnancy, although may worry a pregnant woman. Reassurance and conservative management may be all that is required to allay a patient's concerns.</p

Molecular screening for Plasmodium falciparum resistance markers for artemisinins in Mbita, Kenya

Artemisinins-based combination therapies (ACTs) are being recommended against uncomplicated malaria in endemic areas of Africa. However, in these areas data on their long term usefulness is limited. It has been demonstrated that ACTs resistance may be due to single nucleotide polymorphisms (SNPs) in the chemotherapeutic target, the SERCA-type ATPase protein (PfATPase6). This study analyzed PfATPase6 mutations in asymptomatic infections from samples collected from Mbita, a malaria endemic region in Kenya. Mutations in A623E and S769N residues were screened with gene specific primers followed by sequencing. The study demonstrates that there is no mutation in Mbita, Kenya because neither A623E nor S769N PfATPase6 mutations were detected. Resurgence of infections in this area could be due to re-infections and not drug failure. The study recommends that other sites be assessed for PfATPase 6 mutations to verify the long-term usefulness of ACT and monitor any emergency of resistance.Keywords: ACT (Artemisinins-based Combination Therapy), Molecular, Mutations, PfATPase 6doi: 10.4314/ajcem.v12i3.

Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

AbstractAccountability mechanisms help governments and development partners fulfill the promises and commitments they make to global initiatives such as the Millennium Development Goals and the Global Strategy on Women’s and Children’s health, and regional or national strategies such as the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA). But without directed pressure, comparative data and tools to provide insight into successes, failures, and overall results, accountability fails. The analysis of accountability mechanisms in five countries supported by the Evidence for Action program shows that accountability is most effective when it is connected across global and national levels; civil society has a central and independent role; proactive, immediate and targeted implementation mechanisms are funded from the start; advocacy for accountability is combined with local outreach activities such as blood drives; local and national champions (Presidents, First Ladies, Ministers) help draw public attention to government performance; scorecards are developed to provide insight into performance and highlight necessary improvements; and politicians at subnational level are supported by national leaders to effect change. Under the Sustainable Development Goals, accountability and advocacy supported by global and regional intergovernmental organizations, constantly monitored and with commensurate retribution for nonperformance will remain essential

SENSITIVITY OF MICROSCOPY COMPARED TO MOLECULAR DIAGNOSIS OF P. FALCIPARUM: IMPLICATIONS ON MALARIA TREATMENT IN EPIDEMIC AREAS IN KENYA

Detection of Plasmodium species by microscopy has been the gold standard for diagnosis of malaria for more than a century. Despite the fact that there is a significant decline in the number of positive cases reported from microscopy, anti-malarial drugs prescriptions are on continuous increase as patients present with symptoms of malaria. This makes it difficult to establish accuracy, sensitivity and specificity of light microscopy in diagnosis of malaria in epidemic areas. This study was designed to compare microscopy with polymerase chain reaction as diagnostic methods for malaria in three epidemic areas in Kenya. A total of 356 patients presenting with malaria symptoms were diagnosed by microscopy and dried blood filter paper spots were collected from patient in Kisii, West Pokot and Narok districts. Plasmodium falciparum DNA was extracted from the dried blood filter samples. Primers specific for the Plasmodium Species were designed and used in a two step amplification of the Pfmdr gene. The PCR products were analyzed in ethidium bromide stained 1.5% agarose gel. It was found that 72 out of 350 specimens diagnosed as negative were positive for P. falciparum by nested PCR, while 6 which were microscopy positive were confirmed so by nested PCR. This study demonstrates that there is a high level of misdiagnosis which may either lead to denial for deserved treatment or undeserved treatment. Nested PCR detection of malaria parasites is a very useful complement to microscopy although it is expensive and takes long time. Additionally, smear negative patients suspected to have malaria should be subjected to PCR diagnosis to improve rational drug use. The economic burden of misdiagnosis and mistreatment of malaria outweighs that of PCR diagnosis, hence this diagnostic mode could be tenable in the long run even in rural areas

Quality Of Antenatal Care In Rural Southern Tanzania: A Reality Check.

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications. The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping. Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions

Delivering at Home or in a Health Facility? Health-Seeking Behaviour of Women and the Role of Traditional birth attendants in Tanzania.

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health