High Risk Human Papillomavirus in Head and Neck Squamous Cell Carcinoma Patients at Kenyatta National Hospital, Kenya

 Background : Human Papillomavirus (HPV) has been associated with a subset of Head and Neck Squamous Cell Carcinoma (HNSCC) in particular Oropharyngeal Carcinoma. Objective: To determine the prevalence and Clinicopathological predictors of high-risk HPV among patients with HNSCC at Kenyatta National Hospital (KNH) Nairobi, Kenya. Materials: One hundred and sixty(160) patients who presented themselves to the ENT clinic between 2015 and 2017 with HNSCC had their history taken. A complete physical examination was done along with the appropriate haematological and radiological work-up. Two tissue biopsies were taken from the primary tumour for histology and real time polymerase chain reaction. Methodology: One hundred and sixty(160) patients with HNSCC aged 16 to 87 years were recruited and set in groups of six. These groups were based on the primary site of the tumour present such as; Oral cavity, Oropharynx, Nasopharynx, Hypopharynx, Larynx and Sinonasal. There were 117 (73.1%) males and 43 (26.9%) female participants. Twelve 12(7.5%) patients tested positive for high risk HPV. The HPV genotypes detected were 56, 52 and 33. There were no predictors for HPV positivity. Conclusion: High risk HPV prevalence was low among HNSCC patients at Kenyatta National Hospital. No HPV 16 nor 18. The positive patients did not have profiles that matched those of HPV-positive HNSCC globally. Key Words: Human papillomavirus, carcinoma, head and nec

Association Between Serum Sodium Abnormalities and Clinicoradiologic Parameters in Severe Traumatic Brain Injury

Background: Secondary brain insults after traumatic brain injury such as electrolyte dysfunctions are associated with poor outcomes. This study aimed at determining the incidence of serum sodium ion abnormalities and their association with clinicoradiological parameters. Methods: A prospective crosssectional study of one hundred and seventeen patients with severe head injury. Data collected included patient demographics, prehospital interventions, clinical examination findings, computed tomography (CT) scan head findings, serum sodium ion levels (at admission and 48 h later), and outcome (30 days). Results: At admission, 93(79.5%) patients had normal serum sodium ion levels. However, 48 h post-admission, hypernatremia was  prevalent in 56(63.6%) patients (p < 0.001). Hypernatremia was significantly associated with the use of mannitol (p = 0.036), lower Glasgow  Coma Score (p = 0.047), higher Injury Severity Score (p = 0.015), presence of subdural hematoma (p = 0.044), midline shift >5 mm (p = 0.048), compressed/absent basal cistern (p = 0.010), and higher Rotterdam CT Score (p = 0.003). Hypernatremia reported 48 h  postadmission was associated with a high 30-day mortality rate [odds ratio (OR) 3.55, p = 0.0095]. Risk of mortality associated with hyponatremia and hypernatremia at admission was not statistically significant. Conclusion: While both hyponatremia and hypernatremia can occur in serious TBI patients, hypernatremia predominates 48 hours post- admission and is associated with statistically significant increased risk of death

Cerebrospinal fluid ascites. a case report and literature review

Cerebrospinal fluid ascites is one complication of ventriculoperitoneal shunt surgery. This case reports a 7year old child with abdominal distention five years after ventriculoperitoneal shunt insertion for hydrocephalus secondary to aqueductal stenosis. The child had a history of multiple shunt revisions. Liver, cardiac and renal causes of ascites were diagnostically ruled out. Cerebrospinal fluid biochemistry was normal but ascitic fluid biochemistry and electrophoresis of the ascitic fluid were deranged. The ascites resolved gradually within two weeks of endoscopic third ventriculostomy. Cases recorded in literature are reviewed in the discussion

Analysis of Kenyan isolates of Fusarium solani f. sp. phaseoli from common bean using colony characteristics, pathogenicity and microsatellite DNA

Fusarium solani (Mart) f.sp. phaseoli (Burk) Synd. and Hans., is a plant pathogenic fungus that causes root rot in garden bean (Phaseolus vulgaris L.). To evaluate methods used in classifying strains of thispathogen, 52 Fusarium solani f.sp. phaseoli isolates from infected bean plants grown on different farms in Taita hills of Coast province, Kenya, were cultured and characterized using morphology, pathogenicity and microsatellite DNA. All the isolates showed high variability in aerial mycelial growth, mycelia texture, pigmentation (mycelia colour) when cultured on potato dextrose agar medium, and conidial measurements on Spezieller Nahrstoffarmer agar medium. Colonies were grouped intoluxuriant, moderately luxuriant and scanty on aerial mycelial growth; fluffy and fibrous based on mycelial texture; purple, pink and white based on mycelia colour; aid long, medium and short macroconidial length. All the isolates were pathogenic on GLP-2 (Rosecoco), a susceptible bean variety commonly grown in Kenya. DNA analysis showed that the isolates carried a high genetic diversity(gene diversity = 0.686; mean number of alleles = 9). Neighbour-Joining phylogenetic clusters reconstructed using microsatellite variation showed three major clusters. However, the microsatellitegroupings were independent of the altitude, colony characteristics and virulence of the isolates

Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

Background: Surgical site infections can occur adding to morbidity, mortality and costs, and can be particularly problematic in low and middle income countries. This includes infections in neurosurgical patients following surgery despite antimicrobial prophylaxis. The study aimed at measuring the incidence of surgical site infections (SSIs) and identifying factors that influence the effectiveness of antimicrobial prophylaxis in a leading hospital in Kenya. Methods: Prospective cohort study from April to July 2015 in the Neurosurgical ward of a leading referral hospital in Kenya. Adult head injury patients were recruited by universal sampling. Data was collected on prophylactic antibiotics and the occurrence of SSIs. Risk factors for infection were identified by logistic regression. Results: Eighty four patients were recruited, with 69 patients eventually analysed. Incidence of SSIs was 37.7% (n=26). The most common antibiotic used for prophylaxis was ceftriaxone. Patients on prophylaxis were less likely to be infected than those who did not receive prophylaxis; however, this was not statistically significant (RR 0.87, 95% CI 0.40-1.893). The presence of epidural haematoma was a risk factor for the development of SSIs (Crude RR 2.456, 95% CI 1.474-4.090). Overall, antimicrobial prophylaxis was effective only in patients who underwent evacuation of hematoma by craniotomy (risk reduction, 62.5% (CI, 29.0% -96.0%). Conclusion: Evacuation of haematomas through craniotomy increased the effectiveness of prophylaxis, and should be considered in the future. The rationale will be explored further to see if antibiotic prophylaxis can reduce SSIs in other patients with neuro trauma

Distribution of Cassava Bacterial Blight and Reaction of Selected Cassava Genotypes to the Disease in Kenya

Cassava bacterial blight (CBB) disease is an important bacterial disease of cassava. A study was carried out to determine the distribution of CBB in Kenya and to evaluate selected cassava genotypes for reaction to the disease. A survey was conducted in all the cassava growing regions within the country where cassava leaves showing symptoms of CBB were collected and isolated for biochemical characterization and PCR detection of the causal agent. The isolates were then used to determine the reaction of seven cassava genotypes to the disease. The disease was present in 17 out of the 21 counties surveyed. The bacteria extracted from the leaf samples conformed to all the biochemical and physiological tests specific to Xanthomonas axonopodis pv manihotis and to xanthomonads in general.  Polymerase chain reaction amplified the expected 500 base pairs fragment. Disease prevalence was highest in Kwale County at 100% Kilifi County recorded the highest incidence at 64%. All the genotypes evaluated in the greenhouse had area under disease progress curve (AUDPC) values higher than 52 which grouped them as susceptible. The study confirms the wide distribution of CBB in Kenya and the presence of the disease in the coast region, which was previously considered CBB free. The study also shows that some of the cassava genotypes being targeted for improvement by other projects are susceptible to the disease, and therefore the need consider resistance to CBB in developing improved cassava genotypes. Keywords: Cassava bacterial blight, Distribution, Resistance DOI: 10.7176/JNSR/9-4-0

Impact of neurosurgical site infections on patient expenditure at a national referral hospital in Kenya: a cost of illness study

Background: Neurosurgical site infections result in prolonged hospitalisation and increased treatment costs. Cost of illness studies are important in computing the total costs of treatment of disease, as they quantify the burden of disease in terms of direct costs, productivity losses and intangible costs. Neurosurgical site infections do not occur at a high rate in most clinical settings. Their economic impact has been assumed to be minimal, and most studies have not exclusively studied their economic impact. Objective: To assess the economic burden of treatment of surgical site infections among trauma patients admitted at the neurosurgical ward of Kenyatta National Hospital. Methods: A prospective cost of illness study was conducted between April 2015 and June 2015 as part of a larger prospective cohort study. The patient perspective was adopted. The time horizon was the hospitalization period of the patients, which was a median of ten days. No discounting was done because the study was done within a year. A micro costing approach was used to compute direct costs on medication, laboratory and radiologic tests, cost of surgical procedures and nursing care, and direct non-medical costs incurred by patients for the average 10 day hospitalisation period. Productivity losses were also computed. Results: The total median cost of treating patients with neurosurgical site infections was higher, at USD 203.95 than that of patients without infection at USD 141.20. The median cost on antibiotics was USD 18.70 while that of non- antibiotic drugs was USD 33.03. The total median cost on laboratory and radiologic tests was USD 20 and USD 55 respectively. The key cost drivers were expenditures on meropenem, phenytoin, urea, electrolyte and creatinine tests and CT scans. With regards to costs of services, care-giver costs accounted for the highest median expenditure, followed by costs of surgery and nursing care. Conclusion: Neurosurgical site infections increase hospitalisation duration and costs. Prevention of these will reduce patient expenditure. Key words: cost of illness, neurosurgical site infection, productivity losse

Patterns of antimicrobial use in the neurosurgical ward of Kenyatta National Hospital

Background: Antibiotics in neurosurgery are used for prophylaxis and treatment of already established infection.  Guidelines state that prophylactic antibiotics should be given for up to 24 hours. For treatment of already established infections, empiric therapy with intravenous antibiotics for four to eight weeks is indicated. Studies have shown no distinction between antibiotic use for prophylaxis and treatment of established infection in neurosurgery. Objectives: To identify antibiotic use patterns and medication errors and their association with development of surgical site infections. Methods: A prospective cohort study involving adult neurosurgical patients was carried out at Kenyatta National Hospital, between April 2015 and July 2015. Patient demographic data as well as data on surgical procedures carried out, antibiotics used and medication errors was collected. Descriptive data analysis was done for all variables. To test for association between antibiotic use patterns and development of surgical site infections, the Fischer exact Chi square test was used. Results: Out of the 84 participants recruited in the study, 87.2% (n=68) used antibiotics. Ceftriaxone was the most commonly used (63.7%, n= 44), followed by metronidazole (40.4%, n=23).  Medication errors that were noted involved inappropriate choice and use of antibiotics. There was no distinction between use of antibiotics for prophylaxis and treatment of infection. There was no statistically significant association between patterns of antibiotic use and development of surgical site infection. Conclusion: Antibiotic use patterns do not affect the incidence of neurosurgical site infections. Prescribing errors of various types were prominent. An antibiotic use protocol should guide antimicrobial selection and use in neurosurgery. Key words: antibiotic, prophylaxis, medication error

Systematic Review, Meta-Analysis and Grading of Evidence on the Effectiveness of Antimicrobial Prophylaxis for Neurosurgical Site Infections

Background: Antimicrobial prophylaxis is crucial for neurosurgical procedures, even though they are clean procedures. Observational studies have shown the effectiveness of different antibiotics in preventing neurosurgical site infections, but there remains paucity of systematic reviews and meta-analyses which have assessed their effectiveness in East Africa. Objectives: To generate and appraise the quality of evidence that would inform antimicrobial prophylaxis in neurosurgery. Methodology: A systematic review and meta-analysis was conducted between October 2014 and December 2015. Studies that involved the administration of systemic antibiotics for prophylaxis, use of antibiotic impregnated shunt catheters among adult patients aged over 18 years were included and subjected to abstract, title and full text screening. A meta-analysis was carried out using RevMan (Review Manager) version 5 software. The quality of evidence was evaluated using the GRADE system. Results: One systematic review of randomized controlled trials (n=17) and 11 randomised controlled trials were included in the study. From the first meta-analysis, use of systemic antibiotics demonstrated an overall protective effect of 52% from development of surgical site infections [OR 0.48 (95% CI 0.30, 0.79)]. In the second meta-analysis, the use of antibiotic impregnated shunt catheters was associated with a higher risk of mortality compared to use of the standard shunt [(OR 1.47(95% CI 0.82, 2.62)]. Following evaluation of quality of evidence, in the antibiotics versus placebo arm, the quality of evidence was moderate, while that for antimicrobial impregnated shunts was very low. Conclusion: Antimicrobial prophylaxis using systemic antibiotics or antimicrobial impregnated shunts is effective in preventing neurosurgical site infections. Antimicrobial impregnated shunts are too expensive for our study population. Key words: systematic review, meta-analysis, antimicrobial prophylaxi

Spatiotemporal trends in cetacean strandings and response in the southwestern Indian Ocean : 2000–2020

On behalf of SIF, we would like to thank the Seychelles partners (Alphonse Foundation, Desroches Foundation, Island Conservation Society, Farquhar Foundation, Seychelles Islands Foundation, Silhouette Foundation) for providing financial support to acquire and grant use of their data. Collection of data in Reunion was funded by DEAL Reunion and Region-Reunion.The south-western Indian Ocean (SWIO) is a region of global importance for marine mammal biodiversity, but our understanding of most of the species and populations found there is still rudimentary. The Indian Ocean Network for Cetacean Research (IndoCet) was formed in 2014 and is dedicated to the research of all cetacean species across the SWIO. Since 2019, there have been efforts to create a regional network for coordinated response to stranding events as well as training and capacity building in the SWIO region. The present analysis represents a first investigation of stranding data collected by various members and collaborators within the IndoCet network, covering over 14,800km of coastline belonging to nine countries/territories. Between 2000–2020, there were 397 stranding events, representing 1,232 individual animals, 17 genera and 27 species, belonging to six families: four balaenopterids, one balaenid, one physeterid, two kogiids, six ziphiids and 14 delphinids. Seven mass strandings were recorded: two were composed of three to 20 individuals and five composed of > 20 individuals. Spatial analysis of stranding events indicated that local spatio-temporal clusters (excessive number of events in time and geographic space) were present in all countries/territories, except for the Comoros. The only significant cluster was detected on the southwest coast of Mauritius, just west of the village of Souillac. The SWIO region predominantly comprises relatively poor countries/territories, but imminent Ocean Economy developments are prevalent throughout the region. This study highlights the importance of establishing baselines upon which any future potential impact from anthropogenic developments in the region can be measured.Peer reviewe