Profile of congenital lower limb defects in a rural Kenyan hospital and literature review

Knowledge of the profile of congenital limb defects in a population is important in informing their prevention, management and rehabilitation strategies. The profile displays geographical and ethnic variations. There are few reports from African countries, most of them being case reports. This study aimed at reporting congenital defects of lower limb observed in a rural hospital in Kenya. Records from PCEA Kikuyu Hospital were examined retrospectively for the period 2002-2011. Visible physical defects recorded, age and gender of the victims were analyzed. Images of some remarkable defects were examined. Literature review has been done regarding the defects. Ten varieties of congenital defects were identified. The most common of them were tibial pseudoarthrosis (6) followed by polydactyl, (5) and congenital talipes equinovarus (4). The mean age at presentation was 9 years and there were more males than females. Most of the cases occurred in isolation, with only a few occurring in combination. There is wider variety of lower limb defects in a Kenyan hospital than is usually reported in other studies. Tibial pseudoarthrosis is most common defect. Medical personnel should be aware of this wider scope of limb defects. In addition, greater emphasis should be given to systemic examination of the affected children and rehabilitative management.Keywords: Diplopodia, cleft foot, macrodactyly, pseudoarthrosis, polydactyly, syndactyly

An evolutionary computation attack on one-round TEA

AbstractIn this work, one-round Tiny Encryption Algorithm (TEA) is attacked with an Evolutionary Computation method inspired by a combination of Genetic Algorithm (GA) and Harmony Search (HS). The system presented evaluates and evolves a population of candidate keys and compares paintext-ciphertext pairs of the known key against said population. We verify that randomly generated keys are the hardest to derive. Keys composed of words containing all on-bits are more difficult to break than keys composed of words containing all off-bits. Keys which have repeated words are easiest to derive. Finally, the present EC strategy is capable of deriving degenerate keys; this is most evident when keys are front loaded so that the first byte of each word has the highest density of on-bits

Regional Differences in the Tunica Media of the Uterine Artery of Domestic Pig (Sus Scrofa Domesticus): Basis for Uterine Blood Flow Regulation

This study aimed at describing the structure of tunica media of the uterine artery of domestic pig, since this structure influences the pattern of blood flow and reproductive performance. Specimens were obtained from main trunk, broad ligament segment and the terminal portion of twelve healthy adult domestic pigs (Sus scrofa domesticus) age range 6 – 18 months. They were fixed in 10% formaldehyde solution, and routinely processed for paraffin embedding and sectioning. Seven micron thick sections were stained with Hematoxylin & Eosin, Mason’s Trichrome and Weigert resorcin fuchsin counterstained with Van Gieson stains. Tunica media comprising predominantly smooth muscle occupied approximately fifty percent (50%) of the volume of the entire wall with vasa vasora present deep into its inner zone. It showed zonal and regional variation in that in the main trunk and broad ligament segments was divided into inner two thirds having   predominantly circular smooth muscle orientation while outer third was  preponderantly fibroelastic with longitudinally disposed smooth muscles. The terminal segment had only circular layer. Density of vasa vasora  declined distally. The predominantly muscular tunica media of the uterine artery in pigs shows zonal and regional suggesting segmental   differentiation of function. The main trunk of this artery, due to its  additional longitudinal layer of smooth muscle may be involved in  regulation of blood flow to the uterus depending on the functional  demands of the uterus

Foot complications among diabetics attending a district hospital in Kenya: Predisposing factors and possible intervention

OBJECTIVES: To relate skin health, footwear practices and foot care education with occurrence of foot complications among diabetics attending a district hospital in Kenya. PATIENTS AND METHODS: Two hundred and nineteen patients attending the diabetic clinic at the Kikuyu Mission Hospital (99 males, 120 females) were studied. They were examined for the presence, type and cause of foot complication, skin health, education on foot care and footwear. RESULTS: Twenty nine point two percent of the patients had foot complications, with 95% of these presenting with diabetic ulcer, the rest had Charcot’s foot or cellulitis. The diabetic foot ulcer was traumatic in 75.4% and spontaneous in 24.6%. Fifty seven percent of the patients had risky footwear, associated with development of foot ulcer (p = 0.001). Ninety eight percent of the patients with foot complications had either atrophic or dry skin (p = 0.001). Fifty two point four percent had not received foot care education, with males who had received education being more than females (p = 0.05). CONCLUSION: The rate of foot complications among diabetics is higher than previously observed. Diabetic foot ulcer, the commonest complication, is mostly traumatic. Patients with foot care education, proper footwear and good skin health had lower incidence of traumatic diabetic foot ulcer. Dissemination of foot care education and use of right footwear for diabetics may reduce the incidence of complications

Multiple SOFMs Working Cooperatively In a Vote-based Ranking System For Network Intrusion Detection

AbstractProtection from hackers on networks is currently of great importance. Recent examples of victims include the recent repeated hacking of Sony PS3, which involved 24.6 million customer accounts being vulnerable, and the hacking of websites both includ-ing US and Canadian government sites. Thus there is a drear need for effective Intrusion Detection and Prevention systems. Anomaly intrusion detection is a popular method of detecting Intrusions on Computer Networks. In 2011, Wilson and Obimbo proved that the use of Self-Organized Feature Maps (SOFM) could be used to increase the performance on KDD-99 dataset. This paper introduces a vote-based ranking system for intrusion detection based on SOFM. The experimental results are promising and are an improvement in both Wilson and Obimbo's system and the Winning system of the KDD IDS Competition

Assessment of knowledge on neonatal resuscitation amongst health care providers in Kenya

Introduction: Competence in neonatal resuscitation, which represents the most urgent pediatric clinical situation, is critical in delivery rooms to ensure safety and health of newly born infants. The challenges experienced by health care providers during this procedure are unique due to different causes of cardio respiratory arrest. This study aimed at assessing the knowledge of health providers on neonatal resuscitation. Methods: Data were gathered among 192 health providers drawn from all counties of Kenya. The clinicians were asked to complete questionnaires which were in two parts as; demographic information and assessment of their knowledge by different scenarios which were formatted in the multiple choice questions. Data were analyzed using SPSS version 15.0 for windows. The results are presented using tables. Results: All the participants were aged 23 years and above with at least a certificate training. Most medical providers had heard of neonatal resuscitation (85.4%) with only 23 receiving formal training. The average duration of neonatal training was 3 hours with 50% having missed out on practical exposure. When asked on steps of resuscitation, only 68 (35.4%) of the participants scored above 85%. More than 70% of them considered their knowledge about neonatal resuscitation inadequate and blamed it on inadequate medical training programs. Conclusion: Health providers, as the key personnel in the management of neonatal resuscitation, in this survey seem to have inadequate training and knowledge on this subject. Increasing the duration and quality of formal training should be considered during the pre-service medical education to ensure acceptable neonatal outcome

Comparative regional morphometric changes in human uterine artery before and during pregnancy

Introduction Uterine artery undergoes structural modifications at different physiologic states. It is expected that due to its unique course, hemodynamic stresses in the vessel would vary resulting in differences in arterial dimensions. The objective of this study was to investigate regional morphometric changes in the human uterine artery. Methods Twenty four uterine arteries (12 each from non-gravid uteri and gravid uteri) were obtained during autopsy after ethical approval from women aged between 21 to 47 years. Sections from proximal, middle and distal segments of the artery taken within 72 hours were processed for paraffin embedding, sectioned and stained with Mason’s Trichrome. Micrographs of the slides were analyzed using Scion Image Multiscan software. Data were entered into and analyzed with Statistical Programme for Social Sciences. Results The pregnancy related increase in diameter and wall thickness are most pronounced in the proximal segment. In the distal segment, however, wall thickness reduces significantly (p<0.05). Intimal thickness was lesser in pregnancy compared to non-gravid state in all the segments. Conclusion Regional morphometric changes in the uterine artery during pregnancy may be designed to regulate blood flow to the uterus and placenta during pregnancy.Pan African Medical Journal 2012; 13:3

Hypo-phosphataemia in children under five years with kwashiorkor and marasmic kwashiorkor

Background: Severe malnutrition contributes up to 50% of childhood mortality in developing countries is frequently characterised by electrolyte depletion, including low total body phosphate. During therapeutic re-feeding, electrolyte shift from extracellular to intra-cellular compartments may induce hypo-phosphataemia (hypo-P) with resultant increased morbidity and mortality. This biochemical imbalance isunder-recognised, and the frequency of this problem among African malnourished children is unclear.Objectives: To determine the magnitude of hypo-phosphataemia in children under five years of age presenting to Kenyatta National Hospital with kwashiorkor and marasmic kwashiorkor and to evaluate the relationship between hypo- phosphataemia and nutritional intervention during the first five days of treatment.Design: Short longitudinal survey.Setting: The General Paediatric wards of the Kenyatta National Hospital (KNH), Nairobi.Subjects: Children under five years of age presenting with kwashiorkor or marasmic kwashiorkor at KNH were recruited into the study. Main outcome measures: Low serum phosphate level

Correlation Between Placental Histomorphology and Umbilical Cord Coiling Index in Preeclampsia

BACKGROUND Preeclampsia is a common hypertensive disorder of pregnancy and one of the leading causes of maternal health complications and death globally. Both preeclampsia and abnormal umbilical coiling have been reported to alter the structure of the placenta significantly. Cases of preeclampsia and either of the two abnormal coiling states; hypercoiling or hypocoiling, occurring in the same pregnancy have been documented. The type of abnormal coiling associated with preeclampsia varies in different populations. The extent of changes in the placenta in preeclampsia coupled with either of the two is unknown. The current study aimed at determining which of the coiling state significantly alters the structure of the placentae of mothers with preeclampsia and therefore, predisposes them to more adverse perinatal outcomes.   METHODs An unmatched case-control study was carried out in Kenyatta National Hospital labor ward and maternity theatre. Seventy (70) placentae from mothers with diagnosis of preeclampsia (cases) and mothers without complicated pregnancy (controls) were collected. The length of the cord and the number of coils was measured to calculate the coiling index. A gross placental examination was carried out followed by biopsy and tissue processing for light microscopy. Slides were photographed and several histological features analyzed in the terminal villi. Data from this study was input into SPSS (Version 21.0) where mean values, standard deviations, and frequency tables were obtained. Appropriate parametric and non-parametric tests were used where needed. A P-value of <0.05 was considered statistically significant.   RESULTS In the current study, the mean umbilical cord coiling index (UCI) in cases and controls was 0.40 ± 0.18 and 0.22 ± 0.08 coils/cm respectively. Cases had a significantly greater UCI than controls (P = < 0.001). All placentae in the case hypocoiled subdivision had infarctions and were meconium stained. The mean placental weight was 519 g and 578 g respectively in cases and controls and the difference was found to be significant (p = 0.031). In cases and controls, the gross placental volume was 542 cm3 and 638 cm3, respectively. There was a significant difference in placental volume between cases and controls, and between subdivisions (p = < 0.001 and 0.028 respectively). The case hypocoiled subdivision had the highest absolute volume of villous stroma, fibrin deposition, syncytial knots and the lowest fetal capillary surface area.   CONCLUSION Hypocoiling was associated with alteration of the structure of the placenta in preeclampsia more than it was observed in hypercoiling. Early detection of hypocoiling using ultrasound in pregnancies complicated with preeclampsia may help clinicians in identification of cases that warrant close antenatal and intrapartum monitoring thus reducing adverse perinatal outcomes. &nbsp