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

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

Anatomical Variation of Position and Location of the Fibula Nutrient Foramen in Adult Kenyans

Background: The fibula though transmits insignificant force in walking, is an important bone for muscle attachment and significant source of bone grafts. Objectives: To determine the position, location and number of the nutrient foramina of the fibula among Kenyans. Design: Cross-sectional descriptive study. Subjects: Two hundred right and left dry fibulas for male and female Kenyans were obtained. Setting: Department of Human Anatomy, University of Nairobi and the Osteology Department, National Museums of Kenya, Nairobi. Methods: The number and position of the nutrient foramina were determined. The distance of the nutrient foramen from the styloid process of the head and the length of the fibula were measured by a tape. The data obtained was analyzed by a computer package, SPSS 11.5.0. The means of each value was compared between right, left and the gender groups. Results: Five point five percent of fibula did not have any nutrient foramen. Most (53.4%) of the nutrient foramina were located posteriorly. The average length of the fibula was 365±30 mm long while the nutrient foramen was located 153±24mm from the tip of the styloid process of the head of the fibula; it was 3 cm proximal to the mid length of the fibula. Conclusions: Fibula of 28.6 cm – 41.2 cm is available for grafting among Kenyans. The metric estimation of the position of the nutrient foramen of the fibula could assist in harvesting vascularised graft of the bone

Clinical standards for drug-susceptible TB in children and adolescents.

BACKGROUND: These clinical standards aim to provide guidance for diagnosis, treatment, and management of drug-susceptible TB in children and adolescents.METHODS: Fifty-two global experts in paediatric TB participated in a Delphi consensus process. After eight rounds of revisions, 51/52 (98%) participants endorsed the final document.RESULTS: Eight standards were identified: Standard 1, Age and developmental stage are critical considerations in the assessment and management of TB; Standard 2, Children and adolescents with symptoms and signs of TB disease should undergo prompt evaluation, and diagnosis and treatment initiation should not depend on microbiological confirmation; Standard 3, Treatment initiation is particularly urgent in children and adolescents with presumptive TB meningitis and disseminated (miliary) TB; Standard 4, Children and adolescents should be treated with an appropriate weight-based regimen; Standard 5, Treating TB infection (TBI) is important to prevent disease; Standard 6, Children and adolescents should receive home-based/community-based treatment support whenever possible; Standard 7, Children, adolescents, and their families should be provided age-appropriate support to optimise engagement in care and clinical outcomes; and Standard 8, Case reporting and contact tracing should be conducted for each child and adolescent.CONCLUSION: These consensus-based clinical standards, which should be adapted to local contexts, will improve the care of children and adolescents affected by TB

Communication in obstetrics: where and when it matters

Although most clinical outcomes in obstetrics are generally good, poor and inaccurate communication may lead to unwanted obstetrics complications and medico-legal litigation. Effective communication therefore, is an important and integral part of holistic approach to good patient care and management. We present a case in which communication breakdown led to adverse yet preventable sequel

Correlation between morphometry of the uterine artery and estradiol levels in non pregnant domestic pigs (sus scrofa domesticus)

Background: Structure and morphometry of the uterine artery are important in influencing the pattern of blood flow to the uterus and may be affected by the levels of estradiol. Consequently these may have an effect on reproductive performance.Objective: This study aimed at describing the relation between morphometry of uterine artery from domestic pigs and 17 Beta estradiol.Design: Descriptive cross sectional study.Methods: Blood samples and specimens of uterine artery were obtained from twelve healthy female domestic pigs (Sus scrofa domesticus). They were fixed in 10% formaldehyde solution, and routinely processed for paraffin embedding. Seven micron thick sections were stained with Mason’s Trichrome. Morphometric parameters were measured using Scion image analyzer and estradiol levels assayed by enzyme linked immunoassay technique.Results: The thickness of uterine artery and its luminal diameter increased with advancing age. The level of 17 Beta - Estradiol also steadily rose with age and plateaued by 17th week of domestic pigs’ life. Estradiol had a positive effect on growth and development of the uterine artery wall components. Notably, it hada significant growth effect on the tunica media and the overall thickness of the uterine artery and had an apparent luminal narrowing effect.Conclusion: The present study reveals that estrogen may be considered as an important hormone in preservation of uterine arterial wall integrity. It is associated with changes in the uterine artery dimensions important in preparation for increased volume of blood flowing to the uterus prior to the reproductive act.Keywords: Uterine artery, Non pregnant, Pig, Morphometry, Estradio

Early menarche among urban Kenyan primary school girls

Background: Early menarche is associated with increased risk of developing gynecological cancer, cardiovascular and mental disease. Its prevalence shows ethnic and geographical variation, but there is barely any data from Kenya. Such data are important in informing school reproductive health programmes.Objective: This study aimed at describing early menarche among primary school girls.Methods: Two hundred and sixty two structured questionnaires were administered and analyzed to determine menarcheal age and its relationship with SES and academic performance among girls in 5 urban primary schools in Nairobi, Kenya.Results: Over 10% of the girls attained early menarche, with 2% being under 10 years. Of these, 64.3% lived in middle class residential areas where parents earned at least 15 USdollars a day. The rest lived in lower SES residences with household income less than 1 US dollar a day. 53.8% of the early menarcheal girls compared to 21.8% of normal menarcheal girls experienced decline in academic performance.Conclusions: Early menarche is a significant problem among urban primary school girls in Kenya especially those from higher income backgrounds and constitutes part of the causes of decline in academic performance. Further studies to identify the possible causes and mitigations including structured early reproductive health education as well as follow up of the victims for potential adverse health effects arerecommended.Keywords: Early menarche, Kenya, Academic performanc

Characteristics of women undergoing induced abortion in a Kenyan tertiary referral hospital

Background: Data on characteristics of women who undergo abortion is important to inform reproductive health education strategies. Such data from  sub-Saharan African countries is incomplete and inconsistent.Objective: The characteristics of women undergoing abortion at Kenyatta National Hospital, Nairobi, Kenya.Methods: This was a prospective study. A structured questionnaire was administered to all women who had attended follow-up outpatient gynecology clinics. The questionnaire examined age, socioeconomic status, highest level of education, marital status and religion. Data obtained were analysed for  frequencies and means using SPSS version 17.0 and presented in tables, pie charts and graphs.Results: The most commonly affected age group was 20-30 years (57.8%) while the least was 34-39 years. Majority (64.3%) of the victims were unemployed. Of these, 23.5% were students. The most commonly affected were those with secondary level of education (59.3%). Unmarried women comprised 66.9%. Eighty eight percent of the victims were Christians with 47.4% being Roman Catholics. Muslims comprised only 6.8%.Conclusion: Abortion occurs in women aged 15-40 years, peaking at 20-29 years, who are the  unemployed or students. Majority are single and had attained at least secondary education. More Catholics than Protestants were affected. Most of these characteristics differ from those reported in earlier studies from the region, suggesting changing characteristics.Key words: Abortion, Age, Socioeconomic status, Education, Keny

Pattern of limb amputation in a Kenyan rural hospital

Causes of limb amputations vary between and within countries. In Kenya, reports on prevalence of diabetic vascular amputations are conflicting. Kikuyu Hospital has a high incidence of diabetic foot complications whose relationship with amputation is unknown. This study aimed to describe causes of limb amputations in Kikuyu Hospital, Kenya. Records of all patients who underwent limb amputation between October 1998 and September 2008 were examined for cause, age and gender. Data were analysed using the statistical package for Social Sciences (SPSS) for Windows Version 11.50. One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended