Prevalence of high risk HPV in HIV+ and HIV-women with cervical dysplasia at the Moi Teaching and Referral Hospital

Background: Cervical cancer, caused by Human Papillomavirus, is the second commonest cancer among women. HIV+ women are at a higher risk of acquiring HPV, developing pre-cervical cancer lesions (dysplasia) and cervical cancer. Early diagnosis is key to prevention of cervical cancer but reduced sensitivities and specificities of available screening methods pose challenges. The role of HPV in VIA related dysplasia has not been extensively interrogated. We sought to understand HPV infection in the context of HIV status and its relationship to VIA dysplasia Objectives: To compare prevalence of high risk HPV in HIV positive and HIV negative women with and without cervical dysplasia. Study Design: A cross sectional study design. Setting: AMPATH/MTRH cervical cancer and prevention program clinic located at the Moi Teaching and Referral Hospital provides cervical cancer screening services for women. Participants: Women attending cervical cancer screening clinics Results: A total of 88 women were enrolled into the study. HR HPV prevalence was 59.1% among HIV+ and 43.2% among HIV- women. Women below 25 years had higher HRHPV prevalence. HPV prevalence was higher in women with higher parity. Higher HRHPV prevalence in younger women attributed to early sexual debut. The higher prevalence of HRHPV in HIV+ women was as a consequence of depressed immunity and greater exposure to risk factors Conclusion: HIV+ women are more infected with HRHPV than their HIV- counterparts. Immune system related factors which affect the interpretation of screening tests like VIA require further investigation especially in immune compromised individuals

Provision of labour analgesia and its related barriers among maternal health care providers in Kenya: An institution-based descriptive survey.

Background: Although pain relief is a key component of modern obstetric care, it remains a poorly established service in sub-Saharan countries, such as Kenya. Maternal health care providers have an extensive role to play in meeting the analgesic needs of women, during childbirth. This study sought to examine the practice of labour pain relief and its deterrents among Kenyan maternal health care providers. Methods: This was an institution based, cross-sectional, descriptive survey. The study population included midwives, obstetricians, and anaesthesiologists working at the second largest tertiary facility in Kenya. A structured, self- administered questionnaire was used. The patterns of analgesic provision during labour, knowledge, attitude, and perceived barriers to labour pain management were described. Results: One hundred and seventeen respondents participated in the study, with a response rate of 97.5%. The prevalence of routine labour analgesia provision was 61.5%. The most common pharmacological method prescribed was non-opioids (13.4 %). Regional analgesia was provided by 4 (3.6%) of the respondents. Sex, cadre, and years of experience were significantly associated with the routine provision of labour analgesia. The majority of maternal healthcare providers (53.0%) had poor knowledge of labour pain management. Almost all (93.9%) of the respondents had a positive attitude towards the provision of labour analgesia. The non-availability of drugs and equipment (58.1%), lack of clear protocols and guidelines (56.4%), and absence of adequate skilled personnel (55.6%) were reported as the health system factors that hindered the provision of labour analgesia. Conclusions: More than half of maternal health care providers routinely relieved labour pain. Epidural analgesia is still relatively underutilized. There is a need for the development of institutional labour pain management protocols, to meet the analgesic needs of women during childbirth

Factors related to congenital heart disease in offspring from women with rheumatic heart disease: Case reports from Moi Teaching and Referral Hospital, Eldoret, Kenya

Maternal exposure to environmental factors has been reported to be associated with birth defects. Congenital heart defects are the most common and are associated with high morbidity and mortality in offspring. However, the relation of maternal rheumatic heart disease to congenital heart defects in the offspring is a rare event not yet reported. The authors report 2 cases of infants with congenital heart defects born from mothers with rheumatic heart disease. This study highlights factors related to congenital heart defects in both newborns

Challenges of diagnosis and management of postpartum choriocarcinoma In resource limited settings: A case report from a tertiary Hospital of Western Kenya

Choriocarcinoma is a rare occurrence in pregnancy. It is a highly curable malignant tumour that arises from trophoblastic cells within the uterus. However, the timely diagnosis of choriocarcinoma following birth is challenging, especially in low resource settings because most clinicians are not aware about the existence of the disease following uneventful pregnancy and birth. This report discusses the case of a 28 years old patient, para 2, diagnosed with choriocarcinoma two months after uneventful vaginal delivery at term. She underwent a total abdominal hysterectomy, followed by chemotherapy treatment; and succumbed to her disease. It highlights difficulties encountered on diagnosis and management of postpartum choriocarcinoma in particular context of resource-limited setting

Nasopharyngeal carcinoma in pregnancy: Management approach case report at Moi Teaching and Referral Hospital, Eldoret-Kenya

Nasopharyngeal carcinoma is an uncommon tumour, which raises management dilemma in pregnant women. The condition has a considerable effect on the pregnancy outcome, considering the risk of preterm delivery. This paper reports a case of 26 years old Gravida 7 Para 6 admitted at 28 weeks of gestation with epistaxis, hematemesis and a neck mass. The head CT scan showed a right paranasal space soft tissue mass with bony destruction and bilateral cervical adenopathy, consistent with neoplastic carcinoma. Histopathological examination confirmed the diagnosis of nasopharyngeal carcinoma. Deterioration of the patient’s condition, necessitated emergency caesarean delivery at 32 weeks to accommodate further management

Early second trimester twin-to-twin transfusion syndrome in monoamniotic twin pregnancy: The cause and management–a case report from resource limited settings

Monoamniotic twin pregnancies are the least common type of twin pregnancies, associated with high foetal death rates. In addition, twin-to-twin transfusion syndrome is a rare event in monoamniotic twins. The expectant management of early single-twin foetal demise is challenging due to risk to the surviving co-twin, and psychological impact on the mother. The authors report the case of early second trimester single-twin foetal demise, likely due to twin-to-twin transfusion syndrome in monochorionic twin pregnancy. The 22-year-old primigravida presented with vaginal bleeding in monoamniotic twin pregnancy. She then had sudden single-twin intrauterine demise at 16 weeks of gestation that ended with the delivery of viable growth restricted female neonate by caesarean section at 34 weeks

Maternal and perinatal outcomes in women with eclampsia by mode of delivery at Riley Mother Baby Hospital: A longitudinal case-series study

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital. Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as age, parity, medications, initiation of labour, mode of delivery, admission to the intensive care unit, admission to the newborn care unit, organ injuries, and mortality, were analysed using the Statistical Package for the Social Sciences software version 20.0. Quantitative data were described using frequencies and percentages. The significance of the obtained results was judged at the 5% level. The chi-square test was used for categorical variables, and Fisher’s exact test or the Monte Carlo correction was used for correction of the chi-square test when more than 20% of the cells had an expected count of less than 5. Results: During the study period, 53 patients diagnosed with eclampsia were treated and followed up to 6 weeks postpartum. There was zero maternal mortality; however, perinatal mortality was reported in 9.4%. Parity was statistically associated with an increased odds of adverse perinatal outcomes (p = 0.004, OR = 9.1, 95% CI = 2.0-40.8) and caesarean delivery (p = 0.020, OR = 4.7, 95% CI = 1.3–17.1). In addition, the induction of labour decreased the risk of adverse outcomes (p = 0.232, OR = 0.3, 95% CI = 0.1-2.0). Conclusion: There is no benefit of emergency caesarean section for women with eclampsia. Instead, it increases the risk of perinatal adverse outcomes, including the risk of admission to the newborn unit and perinatal death

Radical hysterectomy for operable early cervical cancer in HIV-positive and HIV-negative women in western Kenya

Radical hysterectomy is well tolerated with no increase in complications in HIV-infected women and is an appropriate form of treatment for early-stage cervical cancer in HIV-infected women

Clinical-pathological presentation, treatment and outcomes of ovarian cancer cases at moi teaching and referral hospital (mtrh), eldoret

Introduction: Ovarian cancer is the third most frequent cause of death amongst gynecological cancers both locally and globally. It presents with vague nonspecific symptoms and is histologically heterogeneous. Ovarian cancer management is primarily surgical followed by adjuvant chemotherapy depending on the histological type and the surgical stage. Objectives: To determine the clinical-pathological presentation, treatment and outcomes of ovarian cancer patients at Moi Teaching and Referral Hospital (MTRH), Eldoret. Methods: This was a retrospective chart review of ovarian cancer patients managed between January 2010 and August 2017 at MTRH. Data were analyzed using STATA version 15. Survival trends were generated using Kaplan Meier method. Results: A total of 124 medical charts of patients with ovarian cancer were retrieved, 29 had incomplete data and were excluded, and 95 were evaluable and included in this review. Over half, (63%) presented in stage 3 and 4 though there was no significant association between histology and stage of disease [X2(6) =4.72, p=0.58]. The median age at diagnosis was 47 years with 55-80 years being the modal age group (36%). Majority (57%) were married and 83.9% were unemployed. Only 66% had documented histopathology, with Epithelial Ovarian Cancer (EOC) being most common (70%), [serous (50%) and mucinous (11.4%)]. Sex cord stromal tumors 11%. Germ cell tumors amounted to 11% (dygerminomas 50%and Yolk sac tumors (25%) Bivariate analysis revealed significant association only between histology and parity [X2 (6) = 28.8, p\u3c0.001]. Those reviewed contributed a total of 138.2 person-years to the study and 11(12%) died, giving a diseasespecific mortality rate of 79.6 per 1,000 person years (95% CI: 44.1-143.8). Mortality was highest among those with epithelial histology 109 (95% CI: 48.8-241.9) per 1,000 person years and those who had neoadjuvant chemotherapy then surgery as a treatment option, 373.1 (95% CI: 93.3-1491.8) per 1,000 person years. Those who underwent upfront surgery followed by adjuvant chemotherapy and sex cord stromal cancer had higher survival probability. Conclusion: Ovarian cancer at MTRH is diagnosed at advanced stages III and IV of disease and has a lower median age at presentation. EOC is the commonest histological type and serous subtype is the most lethal. Mortality was highest among those with EOC and those who underwent neoadjuvant chemotherapy. Granulosa cell tumor is the only sex cord stromal type reported in our setting and it exhibited a higher survival probability. Germ cell tumors were mainly found in nulliparous women

Factors Related to Maternal Adverse Outcomes in Pregnant Women with Cardiac Disease in Low-resource Settings

Background: Cardiac disease is an important life-threatening complication during pregnancy. It is frequently seen in pregnant women living in resource-limited areas and often results in premature death. Aim: The aim of this hospital-based longitudinal study was to identify factors related to adverse maternal and neonatal outcomes in pregnant women with cardiac disease in low-resource settings. Methods: The study enrolled 91 pregnant women with congenital or acquired cardiac disease over a period of 2 years in Kenya. Results: Maternal and early neonatal deaths occurred in 12.2% and 12.6% of cases, respectively. The risk of adverse outcomes was significantly increased in those with pulmonary oedema (OR 11, 95% CI [2.3–52]; p=0.002) and arrhythmias (OR 16.9, 95% CI [2.5–113]; p=0.004). Limited access to care was significantly associated with adverse maternal outcomes (p≤0.001). Conclusion: Many factors contribute to adverse maternal and neonatal outcomes in pregnant women with cardiac disease. Access to comprehensive specialised care may help reduce cardiac-related complications during pregnancy