Primary lumbar hernia in an elderly woman: case report

Lumber hernia is a rare posterior abdominal wall defect with fewer than 300 cases reported in literature. It accounts for less than 1.5% of total hernia incidence. Herniation is mainly through the inferior lumber triangle (Petit’s hernia) or through the superior lumber triangle (Grynfeltt’s triangle); with both these anatomical boundaries accounting for 95% of lumber hernias. Lumber hernias are classified as either congenital (20%) or acquired (80%), and the typical presentation is a patient with a protruding bulge in the back with a slow growth. Our patient was a 70-year-old woman who presented at the surgical outpatient department with a swelling on the right flank for two years. She revealed no known cause of the swelling that was progressively increasing in size, with a dull pain. Physical examination and ultrasonography revealed a defect in the posterolateral abdominal wall. Surgical dissection revealed a large hernial sac, which contained retro peritoneal fat, protruding through a 3-4 centimetres defect in the transversalis fascia lining the floor of the superior lumbar triangle. The hernia sac was reduced and the defect closed. There was no recurrence four months post-operative. Lumber hernias are rare, but a good history and physical examination is important to rule out most of the differential diagnoses. Early surgical management is recommended but the surgical approach should be individualised

Contribution of cassava and cassava-based products to food and nutrition security in Migori County, Kenya

The promotion of cassava as a staple and food security crop is widespread in Africa, Kenya included. Overreliance on cassava as a sole energy provider could lead to malnutrition. Consumption of high hydro-cyanide levels from cassava products could lead to health complications for consumers. This study sought to establish the contribution of cassava consumption to nutrition in Migori County. A cross-sectional survey was carried out and data collected on households’ cassava production and consumption practices. Two hundred and fifty-three households were randomly selected and household farming heads interviewed in West Kanyamkago, Orango Central and Kamgundho locations as areas where cassava is predominantly grown. Seven cassava flour samples of different cassava varieties grown in the area were obtained from farmers. Analyses were done to determine the moisture, cyanide and protein contents on flour and cooked stiff porridge (ugali). Results indicated that 99.1% of the households were farming. They highly depended on sale of farm and livestock produce as income. Ninety four percent of the households consumed cassava, of which 88.4% produced cassava on their farms. The most preferred cassava variety was ‘Rateng’. The main cassava productsconsumed were ugali (stiff porridge) and porridge. Majority of the households (95%) never consumed cassava leaves and were not aware that cassava leaves could be consumed. The cyanide level on average on dry flours was 53.23 mg/kg while on consumed cooked ugali was 13.44 mg/kg. These levels were above the maximum limit of 10 mg/kg recommended by WHO. Low average protein levels of <0.5 g/100 g were observed in the cooked ugali. This could pose a danger of protein energy malnutrition if no other sources are consumed by the household members. Cassava farming households in the study area require support to promote growth of low cyanide varieties in order to reduce intake

Serum vitamin D in patients with mild cognitive impairment and Alzheimer's disease

Objectives: To determine the relevance of Mini-Mental State Examination (MMSE), serum 25-hydroxyvitamin D (25(OH)D3), and 1,25(OH)2D3 concentrations to mild cognitive impairment (MCI) and various stages of Alzheimer's disease (AD). Materials and Methods: The study included 230 participants (>74 years) allocated to three main groups: 1-healthy subjects (HS, n = 61), 2-patients with MCI (n = 61), and 3- patients with Alzheimer's disease (AD) subdivided into three stages: mild (n = 41), moderate (n = 35), and severe AD (n = 32). The cognitive status was evaluated using MMSE. Serum 25 (OH)D3 (ng/ml) and 1,25(OH)2D3 concentrations (pg/ml) were determined by competitive radioimmunoassay. Results: MMSE scores and 25(OH)D3 were decreased in MCI and all stages of the AD in both genders. MMSE variability was due to gender in HS (11%) and to 25(OH)D3 in MCI (15%) and AD (26%). ROC analysis revealed an outstanding property of MMSE in diagnosis of MCI (AUC, 0.906; CI 95%, 0.847–0.965; sensitivity 82%; specificity, 98%) and AD (AUC, 0.997; CI 95%, 0.992–1; sensitivity, 100%; specificity, 98%). 25(OH)D3 exhibited good property in MCI (AUC, 0.765; CI 95%, 0.681–0.849; sensitivity, 90%; specificity, 54%) and an excellent property in diagnosis of AD (AUC, 0.843; CI 95%, 0.782–0.904; sensitivity, 97%; specificity, 79%). Logistic analyses revealed that, in MCI, MMSE could predict (or classify correctly) with 97.6% accuracy (Wald, 15.22, β, −0.162; SE, 0.554; OR = 0.115:0.039–0.341; p =.0001), whereas 25(OH)D3 with 80% accuracy (Wald, 41,013; β, −0.213; SE, 0.033; OR = 0.808: 0.757–863; p =.0001). 25(OH)D3 was the only significant predictor for the severe AD and contributed to MMSE variability. Age and gender were significant predictors only in the moderate AD. In patients with MCI, 25(OH)D3 and 1,25(OH)2D3 were correlated men, but in case of the AD, they were correlated in women. Conclusions: MMSE and serum 25(OH)D3 concentrations could be useful biomarkers for prediction and diagnosis of MCI and various stages of the AD. The results support the utility of vitamin D supplementation in AD therapy regimen. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc

EXISTING TRENDS IN FOREIGN EXCHANGE RATES OF KENYA’S MAIN TRADING CURRENCIES

Performance of a security market reflects the economic situation of a country as it is affected by both a country’s domestic and foreign economic events. Given the current increased level of cross borders transactions with the value of total exports growing by 25.6% between 2007 and 2008 and imports increasing by 27.4% between the same periods, it was likely that fluctuations in foreign exchange rate market continued to fuel changes in financial markets like Nairobi Securities Exchange market. Since securities markets trade on assets with varying degree of risks, foreign exchange rates fluctuations was believed to be a factor that affect the performance of financial markets. The purpose of this study was to determine the trend of foreign exchange rates fluctuation of Kenya’s main trading currencies, the US Dollar, the Euro and the UK Pound. The study used secondary data collected between the periods January, 2006 to December, 2010 from the Central Bank of Kenya website in establishing the existing trend of foreign exchange rates fluctuation in Kenya. Descriptive statistics, Pearson Product Moment Correlation and Trend Analysis were used in the study. The findings revealed the existence of positive trends in US dollar and the Euro exchange rates and negative trends in UK pound exchange rates. Therefore the study recommended that market players like corporate investors and investment mangers should closely monitor these trends as they are useful in predicting future financial market outcomes

Application of adaptive neuro-fuzzy inference system technique in design of rectangular microstrip patch antennas

The recent explosion in information technology and wireless communications has created many opportunities for enhancing the performance of existing signal transmission and processing systems and has provided a strong motivation for developing novel devices and systems. An indispensable element of any wireless communication system is the antenna. microstrip patch antenna (MPA) is well suited for wireless communication due to its light weight, low volume and low profile planar configuration which can be easily conformed to the host surface. In this paper, an adaptive neuro‐fuzzy inference systems (ANFIS) technique is used in design of MPA. This artificial Intelligence (AI) technique is used in determining the parameters used in the design of a rectangular microstrip patch antenna. The ANFIS has the advantages of expert knowledge of fuzzy inference system (FIS) and the learning capability of artificial neural network (ANN). By determining the patch dimensions and the feed point of a rectangular microstrip antenna, this paper shows that ANFIS produces good results that are in agreement with Antenna Magus simulation results.Key words: Artificial intelligence (AI), microstrip patch antennas (MPAs), adaptive neuro‐fuzzy inference system (ANFIS

Correlates of Behavior Management Strategies Among Learners With Autistic Spectrum Disorders In Primary Schools In Western Kenya

Practitioners handling learners with Autistic Spectrum Disorders (ASDs) often feel ill-prepared to effectively manage this disorder.  Quite often, when faced with cases of challenging behaviour, teachers use coping strategies which may be counter-productive. This paper reports the findings of a study that sought to determine factors that influence practitioners’ choice of behaviour management strategies among learners with ASDs in primary schools in Western Kenya. An exploratory analysis set out to determine the practitioners’ perception of challenging behaviour and its influence on the choice of management strategies. The findings of the study revealed that practitioners training, work experience, collaboration and networking with other professionals, staffing levels, and support received from parents of children with ASDs played a significant role in the choice of strategies in management of behaviour presented by learners with ASDs. Key words: Challenging behavior, Practitioners, Teachers, Autistic Spectrum Disorde

Higher Education funding, Justice and Equity - Critical Perspectives

How governments choose to fund students in higher education (HE) is inextricably linked to the sector’s sustainability and efforts to achieve a just and equitable HE experience and outcomes for all students. The way funding mechanisms are structured and subsequently enacted within the university, has far-reaching consequences, with the implications reaching far beyond the walls of the institution (Shermer, 2021). In the context of austerity, marketisation, credentialisation and related neoliberal conceptions of education and society, student funding models have greatly transformed the sector and its role in enabling or hindering efforts to achieve a more just and equitable society (Quinlan, 2014). However, despite well-intentioned global and national-level policy commitments to achieving justice and equity in and through HE, the persistent effects of geography, race, wealth, gender, and class-based disparities in patterns of access, participation and attainment rates have undermined the idea of HE as a vehicle for just and equitable futures and transformation (Boliver, 2017). Higher education institutions globally find themselves at a crossroads of trying to maintain their core purpose as a public good on the one hand and compliance with global neoliberal policies, which are foundational to the modern university on the other. The tension between these contested and seemingly contradicting paradigms is made visible in how universities respond to issues of inclusion, equity and in how and what they choose to fund