Pattern of stroke in a rural Kenyan hospital

BackgroundThe pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital.Patients and MethodsThe study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts.ResultsOut of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32 – 96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%).ConclusionIschaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population

Sex differences in diameter of the coronary sinus ostium: Correlation with weight of the heart

Diameter of the coronary sinus ostium is important in the designing of cannulation devices used in cardiac resynchronization  therapy and percutaneous mitral valve annuloplasty. Population variation of the diameter may account for the failure rate of these procedures. Studies of the coronary sinus ostium from African populations are scarce and altogether absent for Kenya. Therefore, this study aimed at determining sex differences in the diameter of coronary sinus ostium and its correlation with the weight of the heart. Seventy-four hearts of adult black Kenyans [43 male, 31 females; age range 20 – 70 years] obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya were weighed. The coronary sinus ostium was identified and its   transverse and supero-inferior diameters measured in millimeters. The measurements were analyzed using SPSS version 17. Sex  comparison was established using student’s t test. Association between diameter and heart weight was established using  Pearson’s correlation test and considered significant at a p-value of ≤0.05. Data were presented using scatter plots. Transverse and supero-inferior diameters of the ostium were 11.04±1.88mm and 9.50±1.80mm respectively. The mean diameter was 10.27 mm. These correlated positively with weight of the heart. When corrected for weight of the hearts, the transverse and supero-inferior diameters were larger in females (0.042 and 0.036 respectively) than in males (0.034 and 0.03 respectively). The diameter of coronary sinus ostium is larger in females and shows positive correlation with weight of the heart. These data should be considered during design and use of cardiac devices introduced through the coronary sinus.Key words: Coronary sinus, ostium, diameter, sex difference

Regional differences in the mural structure of the human coronary sinus

Regional differences in the mural structure of the coronary sinus are important in understanding its physico-mechanical properties and the basis for extent of atrial  fibrillation and ablation. These features are only scarcely reported. This study  therefore aimed at describing regional differences in the mural structure of coronary sinus among black Kenyans. This was a descriptive cross-sectional study on coronary sinuses from fifteen hearts obtained during autopsy on adult black  Kenyans at the Department of Human Anatomy, University of Nairobi.  Five-millimeter-long specimens were taken from the proximal, middle and terminal segments of the coronary sinus and processed routinely for paraffin embedding and sectioning. Seven-micron thick sections were stained with Masson’s Trichrome to demonstrate connective tissue and smooth muscle while Weigert’s Resorcin  Fuschin stain was used to demonstrate elastic fibres. The slides were examined  with a light microscope and photomicrographs taken with a high resolution digital camera. The results are presented in micrographs. The wall comprised three layers namely internal, middle and external. Regional differences were observed in the middle layer. In the proximal segment, there were concentrically oriented smooth muscles scattered within connective tissue. The middle and terminal segments on the other hand comprised cardiac muscle oriented both concentrically and  longitudinally. The muscle was separated by connective tissue rich in elastic fibres and abundant vasa vasora. The external layer comprised connective tissue. In conclusion the middle layer of the wall of the coronary sinus displays regional  differences. The smooth muscle at the proximal segment may confer contractility to enhance blood flow while the cardiac muscle in the other segments enables it to function in synchrony with the right atrium during atrial systole. The complex  arrangement of circular and longitudinal muscle facilitates blood flow and may also constitute a sphincter mechanism.Keywords: Coronary sinus, regional differences, smooth and cardiac muscl

Island singapore flap vaginoplasty of two adult cases of Mayer– Rokitansky–Küster–Hauser Syndrome Type I

Mayer–Rokitansky–Küster–Hauser Syndrome Type I is an emotionally distressful rare condition that limits normal sexual functioning and relationships. First described in 1989 by Wee and Joseph, the neurovascular island pudendal thigh flap (Singapore flap) has been variously utilized and modified for use in vaginal reconstruction. We report two adult cases of vaginal agenesis who underwent vaginal reconstruction using the Singapore flap. Both patients reported improved sexual lifestyle.Keywords: Island Singapore flap, Vaginoplasty, Mayer–Rokitansky–Küster–Hauser syndrome Type

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

Reduction of mammoplasty using inferior pedicle in heavy breasts (Macromastia).

Symptoms associated with heavy breasts are pain in the upper part of the body; back pains, poor body posture and headache. These patients also have difficulties in finding suitable clothes and experience poor self-image and problems such as establishing sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia. In all the patients except three, good results were achieved. One patient suffered nipple necrosis of the right breast and the other two had superficial wound infection of T-junction and were appropriately treated. The patient who lost the nipples had nipple reconstruction three months later

Gynaecomastia; management with liposuction and glandular excision

Gynaecomastia is caused by an increase in ductal tissue, stroma and fat in the male breast. Frequently it occurs at the time of hormonal changes during infancy, adolescence and old age. Galen, introduced the term gynaecomastia in the second century AD and surgical excision was first described by Pauli of Aegina in the seventh AD (1,2). Ultrasound assisted liposuction and surgical excision of glandular tissue through an inferior circumareolar incision is currently the best mode of treatment. In this study seven patients varying from the ages 17-45 years were operated on using this technique at the Aga Khan University teaching Hospital. Of these, four had drains inserted and the other three had none. Of the latter, two had seromas as a complication which was managed with serial aspiration. The group with drains healed without complication of seroma. Investigations done were limited and non exhaustive for patients with gynaecomastia

Acculturation and translocalism in an ethnically plural society: agricultural labour migrants in the Kenyan Rift Valley

This thesis explores the nexus of acculturation, translocalism and wellbeing of rural migrants in an ethnically plural society in the Kenyan Rift Valley. The study contains three interrelated essays. The first essay contests the overgeneralised representations that deny the diversity of migration outcomes. Building on the common themes of migration, "why people move" and "migrants' settlement experiences", the essay explores the diversity of rural-rural migration and settlement experiences and the extent to which migrants can settle in the Rift Valley. It uses in-depth interviews to characterise a broadly defined immigrant group such as migrants from western Kenya, based on their motivations for migration, premigration expectations, post-migration reality, and settlement trajectories. The results demonstrate how migrant characteristics and reasons for migration shape the degrees to which migrants settle in the destination localities, paying particular attention to the settlement trajectories taken by migrants who cannot permanently settle in the Rift Valley's rural milieu. The second essay brings in the analysis acculturation process for internal migrants in ethnically diverse societies; in doing so, it builds a more comprehensive picture of the dynamics of acculturation in the Rift Valley, a region in Kenya where internal migration is often a cause of hostility and deep-seated ethnic intolerance between internal migrants and their hosts. Data on the perceived relative importance of nine migrant characteristics to four acculturation preferences, namely marginalisation, separation, assimilation, and integration, is collected through a survey-based vignette experiment. The vignette experiment's data is analysed using a conditional logistic regression model. Perceptions arising from the results suggest that the factors exerting the most substantial influence on acculturation processes were levels of education and experience of ethnic discrimination. The chapter is concluded by relating the findings to policies designed to enhance the experience of acculturation in the hope of achieving more positive outcomes. The final essay analyses the nexus of translocal linkages, acculturation, and three dimensions of wellbeing: subjective, economic, and relational wellbeing, thus building on the theorisation that a more significant number of African migrants will continue to maintain ties to their rural origin provided that neither the wage level at destination nor the livelihood activities in the place of origin suffice to support an average migrant household. The chapter utilises cross�sectional data collected from a sample of 301 migrants in the Rift Valley. The marginal effects and the significance level of different translocal linkages and acculturation strategies affecting the subjective, economic and relational wellbeing were estimated using an unconstrained generalised ordered logit model. The results suggest that, although subjective, economic and relational wellbeing are affected differently by varied translocal linkages, employment status is of more substantial importance for wellbeing than translocal linkages and acculturation strategies

The Heimlich Valve for Pleural Cavity Drainage

Introduction: Traditional chest tube fixation and drainage has been undertaken using standard rigid chest tubes connected to under water seal bottles. These are bulky, cumbersome, expensive, and pose a risk of accidental air suction into the chest. One-way valve systems such as the Heimlich valve are small, portable apparatus that allow regulation of fluid flow and require minimal nursing care other than daily charting. Methods: A retrospective descriptive analysis of all chest drains connected to a Heimlich valve between January 2009 and December 2012. Data on indications, duration of drainage and frequency of complications was collected. Results: Fifty seven chest tubes connected to a Heimlich valve were inserted over the study period. Majority were for pleural effusions. No complications were encountered. Four patients (7%) required thoracotomy. The average duration to removal was 6 days and all patients reported satisfactory comfort and mobility. Conclusion: The Heimlich valve is a feasible and cheap alternative method of chest tube drainage with high rates of success and very low morbidity. We propose their usage in resource-constrained settings.Keywords: Thoracentesis, Heimlich, Thoracostom