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

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

Morphometric characteristics of the fibular incisura in adult Kenyans

To describe the morphometry of the fibular incisura in a sample Kenyan population, a total of 156 tibiae were obtained for the present study from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi. The height, width and depth of the fibular incisura as well as the length of the anterior and posterior incisural tubercles were measured using a digital pair of vernier calipers (SealeyProfessional ToolsTM). Average values for the height, depth and width of the fibular incisura were 32.35± 4.14mm, 3.44±0.87mm and 21.50±2.37mm respectively while average lengths of the anterior and posterior tubercles of the fibular incisura were 11.40±1.89mm and 16.11±2.08mm respectively. Majority of tibiae (75%) had a shallow concave fibular incisura (< 4.0mm). There were statistically significant differences between males and females in all these dimensions. Shallow fibular incisurae in the majority of the tibiae studied, as well as the predominant shallower, shorter incisurae in female subjects suggests an inherent osteological weakness in the tibiofibular syndesmosis. Data obtained in the current study provides baseline values to guide interpretation of diagnostic images.Key words: Fibular incisura, tibio-fibular syndesmosis

Tunica Adventitia of the Aorta is an Active Vascular Compartment

The tunica adventitia has previously been regarded as a passive connective tissue covering that offers only nutritive and physical support to the arterial wall. Recently, however, emphasis has been given to its role in atherosclerosis. Although the normal structure may bear the anatomical basis of these functions, microscopic anatomy of the tunica adventitia in normal arteries is seldom reported. These data are important in understanding disease process and potential areas of intervention. The goat is a suitable model for studying cardiovascular disease and the aorta is frequently afflicted by atherosclerosis. This study, therefore, aimed at describing the structure of tunica adventitia of normal aorta in goat. Materials for the study were obtained from abdominal aorta of 6 healthy young adult male goats (capra hircus) age range 12 – 24 months. Fresh specimens from euthanized animals were fixed in 3% phosphate buffered glutaraldehyde, post fixed in 1% phosphate buffered osmium tetroxide then embedded in durcupan. Ultrathin sections were stained with uranyl acetate counterstained with lead citrate and examined with electron microscope. Some specimens were processed routinely for paraffin embedding and sectioning. They were stained with Mason’s Trichrome and Weigert elastic/Van Gieson stains. The tunica adventitia was fibroelastic with numerous capillaries, arterioles and multiple cell types. The cells were active fibroblasts, phagocytic, perivascular and endothelial cells embedded in the fibrous stroma. These findings suggest that the tunica adventitia of the goat aorta is a metabolically active vascular compartment. These features namely microvasculature and multiple cell populations probably enable it to maintain structural and functional integrity and appropriately respond to vascular injury.Keywords: Tunica Adventitia, cells, Capillaries, Arterioles, Atherosclerosi

Hepatitis A Antibody Seroprevalence in a Selected Kenyan Pediatric Population

The incidence of infection by Hepatitis A virus shows regional variation being highest in developing countries. Determination of age specific Hepatitis A virus (HAV) seroprevalence and the associated risk factors would help better plan for national preventive strategies including vaccination. We carried out a cross-sectional study on 300 children from Nairobi city, Kenya during the years 2003-2004. The age range of the children was 2 - 14 years and were from low and high socioeconomic status (SES) families. The indicators of SES included employment status, residence, number of children per patient’s household, parents’ level of education and source of drinking water. SES was encoded and analysed using Statistical Program for Social Sciences (SSPS) version 16.0. Seroprevalence increased significantly with advancing age. Seropositivity of HAV antibodies was significantly higher among children of low SES, 77.6% by the age of 14 years compared to children of high SES, 38.9% by the same age. Crowded household and parental education were significantly associated with high seropositivity and seronegativity respectively. There is significant rate of seronegativity amongst the studied population especially those from richer backgrounds making them more susceptible to severe infection in future with concomitant complications. We propose that revision of national vaccination program should be considered to include Hepatitis A vaccination

Morphometry of Placentae of Anaemic and Non-anaemic Preeclamptic Patients

Background The etiology of preeclampsia (PE) still remains elusive. Nevertheless, early onset PE has been hypothesized to develop following defective implantation of the conceptus into the endometrium and subsequent placentation. Defective placentation leads to insufficient remodeling of spiral arteries thus hypoperfusion of the placenta and clinical manifestations. Anaemia is highly prevalent amongst pregnant women. It is postulated that hypoxia is one of the mechanisms by which PE develops. The severity of symptoms seen in patients with coexisting preeclampsia and anaemia has been linked to uteroplacental insufficiency. Few studies however, have defined the placental morphometry when the two conditions occur concurrently.   Methods This unmatched case-control study was carried out at the Kenyatta National Hospital where 42 placentae were obtained; 21 from preeclamptic mothers who had anaemia in the first and third trimesters of pregnancy (cases) and 21 from preeclamptic mothers without a history of anaemia in pregnancy (controls). The tissues were obtained and macroscopically and microscopically examined to determine relative differences. Photographs of the placentae were taken using a 12 MP (f/1.8, 26mm wide, 1/2.55", 1.4μm, dual pixel PDAF, OIS) camera. Photomicrographs were taken using a ZeissTM digital photomicroscope at ×400 magnification for stereological analysis. SPSS (Version 25.0) was used to input data where median values, interquartile ranges and frequency tables were obtained. Mann-Whitney U tests were run to compare differences in medians of the clinical, gross and histological features between the 2 groups. A p-value of ≤ _0.05 was considered statistically significant.   Results Hemoglobin levels in the anemic group ranged between 7.0-10.5 g/dl in the 1st trimesters and 7.6-10.9g/dl in the 3rd trimester with patients being mild to moderately anemic. Gross placental infarction was observed in 17/21 (81.0%) of the cases and 15/21 (71.4%) of the controls. The gross morphometric parameters that were lower in cases were the placental weight and volume (p-values of <0.001, 0.001 respectively). The histopathological features observed were extensive perivillous and intervillous fibrin deposition and larger volumes of syncytial knots in the case group. The harmonic mean thickness of the interhaemal membrane was higher in the cases when compared to controls (p -value: <0.001). The estimated mean morphometric diffusing capacity was higher in cases when compared to controls (p-value: 0.001).   Conclusion The frequency of gross and histopathological lesions seen in the PE placentae was increased when the patients had both preeclampsia and anaemia. Anaemia may thus exacerbate the pathology caused by preeclampsia. This may be the structural basis for the uteroplacental insufficiency observed when the two morbidities co-exist. It may therefore be prudent for clinicians to monitor maternal hemoglobin levels, in order to reduce the severity of preeclampsia when the two conditions co-exist. &nbsp

Placental Structure in Preterm Birth Among HIV-Positive Versus HIV-Negative Women in Kenya.

BackgroundPreterm birth (PTB) is a major cause of infant morbidity and mortality in developing countries. Recent data suggest that in addition to Human Immunodeficiency Virus (HIV) infection, use of antiretroviral therapy (ART) increases the risk of PTB. As the mechanisms remain unexplored, we conducted this study to determine whether HIV and ART were associated with placental changes that could contribute to PTB.SettingWe collected and evaluated placentas from 38 HIV-positive women on ART and 43 HIV-negative women who had preterm deliveries in Nairobi, Kenya.MethodsAnatomical features of the placentas were examined at gross and microscopic levels. Cases were matched for gestational age and compared by the investigators who were blinded to maternal HIV serostatus.ResultsAmong preterm placentas, HIV infection was significantly associated with thrombosis (P = 0.001), infarction (P = 0.032), anomalies in cord insertion (P = 0.02), gross evidence of membrane infection (P = 0.043), and reduced placental thickness (P = 0.010). Overall, preterm placentas in both groups were associated with immature villi, syncytial knotting, villitis, and deciduitis. Features of HIV-positive versus HIV-negative placentas included significant fibrinoid deposition with villus degeneration, syncytiotrophoblast delamination, red blood cell adhesion, hypervascularity, and reduction in both surface area and perimeter of the terminal villi.ConclusionsThese results imply that HIV infection and/or ART are associated with morphological changes in preterm placentas that contribute to delivery before 37 weeks. Hypervascularity suggests that the observed pathologies may be attributable, in part, to hypoxia. Further research to explore potential mechanisms will help elucidate the pathways that are involved perhaps pointing to interventions for decreasing the risk of prematurity among HIV-positive women

Remembering Prof. Hassan Saidi: the pillar for young anatomists and trainee doctors

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Reappraisal of the structure of arterial Tunica adventitia and its involvement in atherosclerosis

Tunica adventitia was previously considered an inert fibrous layer only involved in nutritional and physical support of the arterial wall. Recent studies reveal that it is an important dynamic layer actively involved in the regulation of vascular structure, function, response to injury and disease processes especially atherosclerosis. Many anatomical studies on arteries, however, still make only peripheral reference to it, without elucidating its detailed structure. Knowledge of the latter is important in understanding pathobiology and interventional approaches to atherosclerosis. This review, therefore, aims at consolidating contemporary literature on the structure and clinical significance of the arterial tunica adventitia. Google literature search was done using the key words tunica adventitia combined with: artery, aorta, cells, cell types, collagen, elastic fibres, vasa vasora, lymphatics, nerves, atherosclerosis. There is overwhelming evidence that the tunica adventitia comprises multiple types of collagen and elastic fibres arranged in various directions, a wide variety of cells including fibroblasts, smooth muscle, pericytes,  myofibroblasts, leukocytes, mononuclear phagocytic, defence, mesenchymal stem and mast cells; vasa vasora including  microvasculature, lymphatics and neural elements. The exact cellular, fibre composition and orientation vary between various arteries and regions of the same vessel. Its components are involved in the initiation, progression and complications of  atherosclerosis. In conclusion, the tunica adventitia is an active dynamic layer which, besides mechanical and nutritive  functions; has metabolic, regulatory and defence roles that are critical in arterial homeostasis and  atherosclerosis. Vascular studies should always include detailed analysis of the biology of the tunica adventitia.Key words: Tunica adventitia, cells, fibres, vessels, nerves, atherosclerosi