Peripheral arterial disease in rheumatoid arthritis patients at the Kenyatta National Hospital, Kenya

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.Design: hospital based cross-sectional study.Setting: Kenyatta National Hospital Rheumatology outpatient clinic.Subjects: Rheumatoid Arthritis patients.Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detectionof PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients

Assessment of the genetic diversity of Kenyan coconut germplasm using simple sequence repeat (SSR) markers

Genetic diversity and relationship among 48 coconut individuals (Cocos nucifera L.) collections from the Coastal lowland of Kenya were analyzed using 15 simple sequence repeat (SSR) primer pairs. Diversity parameters were calculated using Popgene Software version 1.31. The gene diversity values ranged from 0.0408 (CAC68) to 0.4861 (CAC23) with a mean value of 0.2839. The polymorphic information content (PIC) values ranged from 0.0400 to 0.3680 with a mean value of 0.2348. Marker CAC23 had the highest PIC and revealed highest gene diversity values in this study. Analysis of the molecular variation indicated that within individual variation was 98% while among materials, variation was low at 2% suggesting that molecular variation was not defined by region of production. Cluster analysis was constructed using DARwin program version 6.0. Forty eight (48) coconut individuals were clustered into three groups.Keywords: Coconut palm (Cocos nucifera L., Arecaceae), germplasm, simple sequence repeat (SSR) markers, cluster analysis, diversit

MINIMISING FUNGICIDES BY ALTERNATING FORMULATIONS AND INTERVALS TO IMPROVE POTATO BLIGHT MANAGEMENT AND FARM RETURNS

Late blight ( Phytophthora infestans ) is one of the most devastating and economic disease impacting both ware and the seed potato industry. The disease causes huge crop losses, and its management attracts heavy expenses. Efficacy successes in chemical management, as opposed to biofungicides, has resulted in the development of a number of fungicide formulations to counter emergence of chemically insensitive P. infestans strains. The objective of this study was to evaluate the efficacy and cost-benefits of applying different fungicides in alternate; while varying the spray intervals to manage potato blight and improve on net farm returns. A survey was conducted in Nyandarua County in Kenya, using a structured questionnaire, administered to potato farmers. Milraz\uae (Propineb 700 g kg-1 + Cymoxanil 60 g kg-1), Ridomil\uae (Metalaxyl 4% + mancozeb 64%) and Mistress 72\uae (Cynamoxil 4% + Mancozeb 64%) were used in vitro and field experiments. Plated pea agar and detached leaflets were amended with the fungicides at concentrations of 0, 35, 70 and 100% of the manufacturers recommended rate before inoculating with P. infestans. In the field experiment, the fungicides were applied at intervals of 7, 14 and 21 days spray as single, two or three fungicides in alternations. Results showed that, mycelial and blight lesion growth was curtailed by concentrations of 70 and 100%; while 35% concentration of the fungicides reduced mycelial growth and lesion size by 53 and 2%, respectively. In the field experiment, there were no yield and AUDPC differences (P<0.05) among the fungicides and their combinations. However, spraying the fungicides at weekly and bi-weekly intervals gave the highest yields of 17.65 and 16.4 t ha-1, compared to tri-weekly and unprotected plots that recorded 7.93 and 0.43 t ha-1 , respectively. In addition, application of triple fungicides in alternation reduced late blight severity by 51%; while application of two fungicides in alternation reduced severity by 39% compared to single fungicide application (21%) on average. Maximum net benefit ratio was observed on plots protected using three fungicides (31.58); followed by two fungicides applications (26.81) applied biweekly in alternate relative to single fungicide applied weekly.Le mildiou (Phytophthora infestans) est l\u2019une des maladies les plus d\ue9vastatrices et \ue9conomiques affectant \ue0 la fois l\u2019industrie des pommes de terre de consommation et de semence. La maladie cause non seulement d\u2019\ue9normes pertes de r\ue9coltes, mais aussi, sa gestion attire de lourdes d\ue9penses. Les succ\ue8s d\u2019efficacit\ue9 dans la gestion chimique, par opposition aux biofongicides, ont abouti au d\ue9veloppement d\u2019un certain nombre de formulations de fongicides pour contrer l\u2019\ue9mergence de souches de P. infestans chimiquement insensibles. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer l\u2019efficacit\ue9 et les co\ufbts-avantages de l\u2019application de diff\ue9rents fongicides en alternance, tout en faisant varier l\u2019intervalle de pulv\ue9risation pour g\ue9rer la br\ufblure de la pomme de terre et am\ue9liorer les revenus nets de la ferme. Une enqu\ueate a \ue9t\ue9 men\ue9e dans le comt\ue9 de Nyandarua au Kenya, \ue0 l\u2019aide d\u2019un questionnaire structur\ue9, administr\ue9 aux producteurs de pommes de terre. Milraz\uae (Propineb 700 g kg-1 + Cymoxanil 60 g kg-1), Ridomil\uae (Metalaxyl 4% + mancozeb 64%) et Mistress 72\uae (Cynamoxil 4% + Mancozeb 64%) ont \ue9t\ue9 utilis\ue9s dans des exp\ue9riences in vitro et sur le terrain. La g\ue9lose aux pois sur plaque et la notice d\ue9tach\ue9e ont \ue9t\ue9 modifi\ue9es avec les fongicides \ue0 des concentrations de 0, 35, 70 et 100\ua0% du taux recommand\ue9 par les fabricants avant l\u2019inoculation avec P. infestans. Dans l\u2019exp\ue9rience sur le terrain, les fongicides ont \ue9t\ue9 appliqu\ue9s \ue0 un intervalle de 7, 14 et 21 jours de pulv\ue9risation en tant que simple, deux ou trois fongicides en alternance. Les r\ue9sultats ont montr\ue9 que la croissance des l\ue9sions myc\ue9liennes et de br\ufblure \ue9tait r\ue9duite par des concentrations de 70 et 100\ua0%\ua0; tandis qu\u2019une concentration de 35 % des fongicides a r\ue9duit la croissance myc\ue9lienne et la taille des l\ue9sions de 53 et 2 %, respectivement. Dans l\u2019exp\ue9rience sur le terrain, il n\u2019y avait pas de diff\ue9rences de rendement et d\u2019AUDPC (P<0,05) entre les fongicides et leurs combinaisons. Cependant, la pulv\ue9risation des fongicides \ue0 intervalles hebdomadaires et bihebdomadaires a donn\ue9 les rendements les plus \ue9lev\ue9s de 17,65 et 16,4 t ha-1, par rapport aux parcelles tri-hebdomadaires et non prot\ue9g\ue9es qui ont enregistr\ue9 7,93 et 0,43 t ha-1 , respectivement. De plus, l\u2019application de triples fongicides en alternance a r\ue9duit la gravit\ue9 du mildiou de 51 %; tandis que l\u2019application de deux fongicides en alternance a r\ue9duit la s\ue9v\ue9rit\ue9 de 39 % par rapport \ue0 l\u2019application d\u2019un seul fongicide (21 %) en moyenne. Le rapport b\ue9n\ue9fice net maximum a \ue9t\ue9 observ\ue9 sur les parcelles prot\ue9g\ue9es par trois fongicides (31,58) ; suivi de deux applications de fongicides (26.81) appliqu\ue9es toutes les deux semaines en alternance par rapport au fongicide unique appliqu\ue9 chaque semaine

Process performance evaluation of faecal matter treatment via black soldier fly

Sustainable management of faecal matter is a prevailing global challenge. In this study, we assessed black soldier fly (BSF) process performance during co-treatment of faecal matter using kitchen waste (FM:KW) to formulate five feeding substrates. About 1 kg of each feed substrate was treated utilizing 5 g of 5-day-old BSF larvae after which 100 larvae were randomly picked at 3-day intervals from each treatment to monitor the larval weight gain across the treatment process. Larval days to 50% pupation, mean pupal yield, waste reduction rate (WR), bioconversion rates (BRs), and feed conversion rates (FCRs) were monitored for the process performance. Study results showed that the substrate 1:1 attained the best measures of high WR, waste reduction index (WRI), BR, FCR, and overall pre-pupal yield within a shorter development time. Further, we modelled the BSF larval weight gain using the modified Gompertz model to assess the least time for optimal biomass conversion for animal feed processing. The BSF larvae exhibited an S-shaped growth curve and the modified Gompertz model adequately quantified the BSF larval growth performance. In the future, our methodology will pave the way for effective treatment and valorization of faecal matter from onsite sanitation facilities, manage organic municipal wastes and provide alternative animal feed and bio-fertilizer

A phase I trial to evaluate the safety and pharmacokinetics of low-dose methotrexate as an anti-malarial drug in Kenyan adult healthy volunteers

<p>Abstract</p> <p>Background</p> <p>Previous investigations indicate that methotrexate, an old anticancer drug, could be used at low doses to treat malaria. A phase I evaluation was conducted to assess the safety and pharmacokinetic profile of this drug in healthy adult male Kenyan volunteers.</p> <p>Methods</p> <p>Twenty five healthy adult volunteers were recruited and admitted to receive a 5 mg dose of methotrexate/day/5 days. Pharmacokinetics blood sampling was carried out at 2, 4, 6, 12 and 24 hours following each dose. Nausea, vomiting, oral ulcers and other adverse events were solicited during follow up of 42 days.</p> <p>Results</p> <p>The mean age of participants was 23.9 ± 3.3 years. Adherence to protocol was 100%. No grade 3 solicited adverse events were observed. However, one case of transiently elevated liver enzymes, and one serious adverse event (not related to the product) were reported. The maximum concentration (C_max) was 160-200 nM and after 6 hours, the effective concentration (C_eff) was <150 nM.</p> <p>Conclusion</p> <p>Low-dose methotraxate had an acceptable safety profile. However, methotrexate blood levels did not reach the desirable C_effof 250-400-nM required to clear malaria infection <it>in vivo</it>. Further dose finding and safety studies are necessary to confirm suitability of this drug as an anti-malarial agent.</p

AGNs on the Move: A Search for Off-nuclear AGNs from Recoiling Supermassive Black Holes and Ongoing Galaxy Mergers with the Zwicky Transient Facility

A supermassive black hole (SMBH) ejected from the potential well of its host galaxy via gravitational wave recoil carries important information about the mass ratio and spin alignment of the pre-merger SMBH binary. Such a recoiling SMBH may be detectable as an active galactic nucleus (AGN) broad-line region offset by up to 10 kpc from a disturbed host galaxy. We describe a novel methodology using forward modeling with The Tractor to search for such offset AGNs in a sample of 5493 optically variable AGNs detected with the Zwicky Transient Facility (ZTF). We present the discovery of nine AGNs that may be spatially offset from their host galaxies and are candidates for recoiling SMBHs. Five of these offset AGNs exhibit double-peaked broad Balmer lines, which may have arisen from unobscured accretion disk emission, and four show radio emission indicative of a relativistic jet. The fraction of double-peaked emitters in our spatially offset AGN sample is significantly larger than the 16% double-peaked emitter fraction observed for ZTF AGNs overall. In our sample of variable AGNs we also identified 52 merging galaxies, including a new spectroscopically confirmed dual AGN. Finally, we detected the dramatic rebrightening of SDSS 1133, a previously discovered variable object and recoiling SMBH candidate, in ZTF. The flare was accompanied by the reemergence of strong P Cygni line features, indicating that SDSS 1133 may be an outbursting luminous blue variable star

Endomyocardial Fibrosis: Still a Mystery after 60 Years

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either “endomyocardial fibrosis” or “endomyocardial sclerosis” in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution

"I think my body has become addicted to those tablets" Chronic heart failure patients' understanding of and beliefs about their illness and its treatment: a qualitative longitudinal study from Uganda

Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services.Serial qualitative in-depth interviews were conducted with Heart Failure patients who were purposively sampled and recruited in Mulago National Referral Hospital until thematic saturation was reached. In-depth interviews were conducted at three time points over the course of their illness with intervals of 3 months between interviews. A grounded theory approach was used in data analysis. The University of Edinburgh ethics committee, Mulago Hospital Research Ethics committee and the Uganda National Council of Science and Technology (Reference numbers D/GC/178; MREC 33, SS 3083 respectively) approved the research.A total of 40 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer), were conducted with 21 patients. The findings revealed that heart failure patients were unaware of the symptoms of the illness and their definition of illness differed from that of health professionals. Patients understood their diagnosis, cause of illness, prognosis and the importance of the medicines differently from health professionals, and had insufficient information on self-care. Lay beliefs were used to explain many aspects of the illness and treatments. All these influenced where patients sought care and their adherence to treatment, self-care and follow up leading to uncontrolled disease.There is a high level of health illiteracy among heart failure patients in Uganda. Patients rely on lay beliefs to make health decisions and medical information is often miscomprehended. There is an urgent need for health education using culturally appropriate information