Heterogeneity of smooth muscle cells in tunica media of aorta in goat (Capra hircus)

Knowledge of the characteristics of vascular smooth muscle cells is important in understanding physicomechanical properties, functions, mechanisms of development, remodelling, regeneration of blood vessels, development and progression of their diseases like atherosclerosis. As the latter diseases become more common, there is need to understand their pathogenesis to inform mitigation strategies. Goat is a suitable model for vascular studies but the organization of vascular smooth muscle cells in its aorta have not been elucidated. This study therefore examined the characteristics of smooth muscle cells in the aorta of goat. Materials were obtained from aortae of six healthy young adult male domestic goats (Capra hircus) [age range 12 – 36 months]. Specimens from thoracic aorta were fixed in glutaraldehyde, post fixed in osmium tetroxide and processed for ducurpan embedding. Ultrathin sections stained with uranyl acetate, counterstained with lead citrate were examined by transmission electron microscope. The aortic tunica media contained several phenotypic dispositions of smooth muscle cells; spindle shaped or elongated organelle - poor cells; irregularly shaped cells rich in rough endoplasmic reticulum, mitochondria and a prominent nucleus. The smooth muscle cells also ran in various directions: transverse, oblique and longitudinal. These findings reveal that the smooth muscle cells of the tunica media of goat aorta are phenotypically heterogeneous and run in multiple directions. These characteristics probably confer mechanical strength and functional plasticity to the aortic wall. Designers of aortic substitutes should bear this in mind.Keywords: Vascular, Smooth Muscle Cells, Heterogeneity, Aort

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

Preliminary data from a de novo trauma registry

Background: Trauma remains a significant cause of morbidity and mortality globally. Trauma registries are a key component of trauma systems in developed countries which have promoted improvement of patient care and outcomes. The experience with trauma registries in low income countries is limited. The current study shares preliminary data from the Kenyatta National Hospital Trauma Registry whilst documenting the process of design to implementation.Methods: A de novo registry dataset was designed based on previous studies and programmed as a custom application for deployment to the site. Scope of data collected was demographic, details of injury, pre-hospital events, hospital care and outcomes. Data were summarized as percentages and means for analysis.Results: The development of the registry from concept to operational software took 12 months. Preliminary data revealed an average completion rate of 88.6%. Majority of patients were young males who were referred to the hospital. Accidental injury at home or on the roads was the most common cause of admission with majority of patients not receiving any pre-hospital care. Sixteen percent of patients died while admitted.Conclusion: The data obtained from this de novo registry largely aligns to previous institutional reports while revealing data points for increased focus during training for registry abstraction. This experience may form the platform for trauma quality improvement initiatives at the institution as well as scaling to other institutions to allow for collation of regional trauma data.Keywords: Trauma; Registry; LMIC; Keny

Factors Influencing Research Activity among Medical Students at University of Nairobi

Background Undergraduate student research activity facilitates their independent thinking, interest in evidence based practice and preparation for graduate programmes. Reports from African Universities are, however, scarce. This study aimed at describing the factors that influence research among medical students in a Kenyan University. Subjects and Methods This descriptive cross sectional study involved medical students at the School of Medicine, University of Nairobi. An open questionnaire regarding research activity was administered to 150 medical students. Responses were analyzed for year of study, attitude, participation, stimulants, deterrents and publication output. Results One hundred and twenty two (81.3%) responses were analyzed. Majority (50.8%) were in fifth year. Of the respondents 81.6% expressed interest in participating in research, but only 38.4% of them had participated in research with 13.7% taking part in writing a research paper. Stimulants included contribution to advancement of knowledge (54.1%) and fulfillment of academic requirements (51.4%). Major deterrents were lack of research mentors (51.9%), knowledge of research methods (37.7%) and funding (29.9%). Of 41 published papers, 85.4% were co-authored with faculty. Conclusion Lack of mentors, training in research methodology and funding are main deterrents. Inclusion of research methodology in curricular, enhanced faculty involvement and budgetary support for research are recommended. The Annals of African Surgery, Volume 6, 201

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

Length of Coronary Sinus in a Black Kenyan Population: Correlation with Heart Length

Length of coronary sinus is important in the design of cannulation devices used in cardiac resynchronization therapy and percutaneous mitral valve annuloplasty. It displays gender and population variations that may account for the failure rate of these procedures. Cardiac conditions requiring these procedures are common in black African populations. Studies of the coronary sinus from African populations, however, are scarce and altogether absent for Kenya. The aim of the current study was to determine the length of coronary sinus among black Kenyans. Coronary sinuses of seventy-four hearts (43 males and 31 females) of adult age range (20-70years) black Kenyans obtained during autopsy were studied at the Department of Human Anatomy, University of Nairobi, Kenya. Heart samples were classified into male and female and weighed. Lengths of the heart, left atrio-ventricular groove and coronary sinus were measured in millimeters. The mean coronary sinus length was 39.55±5.32 mm while that of heart was 139.73±13.86 mm. The length of left atrio-ventricular groove length was 66.12±9.97 mm. The sinus occupied 60% of the groove and correlated positively with the length of the groove. The coronary sinus of the study population is shorter than those reported for Caucasian populations. The length correlated with that of the atrioventricular groove and the heart.Key words: Length, Coronary sinus, heart, black African

Anatomical Measurements of the Distal Clavicle in a Kenyan Population

Anatomical measurements of the distal clavicle are important in the design of clavicular implants for fixing clavicular fractures and reconstruction of the coraco-clavicular complex in acromio-clavicular joint dislocations. These measurements show population variations however, little data exists from the African population and none for the Kenyan one. One hundred and eighty unpaired dry adult human clavicles were obtained from the Department of Human Anatomy, University of Nairobi. The length of clavicle and distance of conoid and trapezoid tuberosities from the distal end were measured using a ruler. The superoinferior thickness of the distal end was measured using a vernier caliper. The mean clavicle length was  148.57±12.63mm. The left clavicle was longer (150.4mm) than the right one (146.8mm). Conoid tubercle (CT) and trapezoid tuberosity (TT) were 39.52±5.93mm and 17.96±3.42mm respectively from the lateral edge of clavicle. These distances correlated positively with the  length of clavicle and occupied 0.3 and 0.15 of total clavicular length respectively. The supero-inferior thickness of the lateral edge was 10.09±2.36mm. The distance of CT and TT positively correlated with clavicular length. The CT lies at a junction of lateral one third and medial 2/3 while the TT is midway between CT and lateral end. Designers of clavicular implants should consider these measurements and surgeons involved in fixation of acromoclavicular joints fractures.Key words: Clavicle, conoid tubercle, trapezoid tuberosity

Topography and distribution of ostia venae hepatica in the retrohepatic inferior vena cava

Background : Openings of hepatic veins into the retrohepatic surface of the inferior vena cava (ostia venae hepatica) play a part in controlling hepatic circulation by acting as collateral channels in obstruction. Their topography and distribution must be taken into account during catheterization and liver transplantation. This anatomy is however little known among Kenyans. Objectives: To study the position, number and distribution of ostia venae hepatica in a selected Kenyan population Materials and methods: Eighty fresh postmortem liver specimens were obtained from the Chiromo Mortuary. The hepatic IVC was isolated from the lower border of caudate lobe to the diaphragmatic opening, with the liver in position. The vein was opened posteriorly by a vertical incision along its whole length and the lateral flaps reflected laterally. The topography of the ostia was studied using the Sahni model. The number and patterns of the ostia were also studied. The patterns of openings of the left, right and middle hepatic veins were studied as well as the distances between them. Results : A total of 584 ostia were identified, an average of 7.3 per liver. The ostia were distributed on the lateral portions of the vein, with an avascular plane at the centre. Major veins terminated in the upper third of the hepatic inferior vena cava, with little extraparenchymal course. The mean distance between the right hepatic vein and middle hepatic vein was 1.7cm Conclusion : The numerous ostia venae hepatica identified in these subjects offer collateral flow channels during hepatic venous obstruction in Budd-Chiari syndrome. The topography and patterns of distribution of the openings suggest the advantage of an avascular virtual plane, which is a safe dissecting path for hepatovascular surgeons

Variations in the formation of supraclavicular brachial plexus among Kenyans

Objective: To describe the pattern and prevalence of variations that occur in the supraclavicular part of the brachial plexus in a Kenyan population. Study design: Descriptive cross-sectional study. Materials and methods: Ninety-four brachial plexuses from forty-seven formalin fixed cadavers were displayed by gross dissection. Results: The presence of at least one variation from the classical anatomy was observed in 73 (77.7%) of the 94 plexuses. The roots and trunks were involved in 32 (34%) of the plexuses . Preand postfixed roots were present in 23 (24.7%) and 3 (3.2%), respectively. The presence of four trunks, and trunks passing between the scalene medius and posterior were also noted. The long thoracic nerve was variant in 51 (54.3%) of the plexuses. Unusual relations of the phrenic nerve to scalene muscles and the subclavian vein were encountered. Conclusion: The presence of four trunks and an accessory phrenic nerve passing through the subclavian vein are probably described and reported for the first time. However, most of the variations of the BP among Kenyans are similar to those reported in the other populations

Risk Factor Profile of Motorcycle Crash Victims in Rural Kenya

Background: Road traffic injuries involving motorcycles are increasing  especially in rural Kenya resulting in both human and economic loss. This study was done to identify the risk factors and the host characteristics associated with motorcycle injury victims in rural setting so as to instituteappropriate interventions for prevention of these incidents.Methods: A descriptive cross-sectional study conducted at Kangundo District Hospital between 1st July and 31st December 2011.Results:167 crash victims (136 (81.4%) males, 31 (18.6%) females) were seen. Mean age was 29 years; most victims (94.2%) being aged 16-40  years. Cyclists comprised 61 (36.5%) while 79 (47.3%) were passengers. All cyclists were men; more women were passengers (p, 0.03), while  pedestrians were mostly children below 10 years. Most victims (74.3%) didnot wear helmets while 72.1% did not wear jackets with reflectors. Alcohol use was recorded in 22.8% of cyclists. About 71.9% of cyclists lacked valid driving licenses. Overloading was common, with 74.8% of the cyclists carrying two or more passengers.Conclusion: Poor driving skills, reluctance to use protective gear, alcohol use and overloading of passengers were the main risk factors observed.  Our observations call for more stringent regulations and aggressive road safety campaigns. Injury prevention and safety promotion campaigns should focus more on the risk factors for motorcycle accidents.Key Words: Motorcycles, Crash, Risk factors, Rura