CD4 + Cell Response to Anti-Retroviral Therapy (ARTS) In Routine Clinical Care Over One Year Period in a Cohort of HAART Naive, HIV Positive Kenyan Patients

Background: Untreated HIV/AIDS leads to severe immune depletion with opportunistic                                                                    infections and other co-morbidities. Highly active anti-retroviral therapy (HAART) enhances immunity by sustained HIV- viral suppression, increase in CD4+ cell count and immune restoration. HAART reduces risk of neutropaenia, anaemia and accompanied decrease in incidence of opportunistic infections.Objectives: To study the CD4+ cell response in patients with severe HIV/AIDS disease over one year period while on HAART.Design: Observational, descriptive, longitudinal study.Setting: Kisumu District Hospital (Medical outpatient clinic, medical and surgical wards), Nairobi Rhematology clinic and The Mater Hospital between July 2001 and March 2007.Subjects: Four hundred and sixty three consenting patients were screened for the study.Intervention: The 103 patients included received HAART within one to four weeks and appropriate treatment for the opportunistic infections and other co-morbidities. Various HAART combinations including combivir/efavirenz, stavudine/lamivudine/nevirapine and triomune 30/40 (fixed dose combination of stavudine, nevirapine and lamivudine) were used. Some delayed HAART because of the co- morbidities which had to be managed first (severe anaemia, hepatitis and meningitis).Main outcome measures: CD4+ cell increase, new clinical events.Results: Four hundred and sixty three patients (256 males and 207 females) were screened. One hundred and three patients (55 males and 48 females) were included and 360 (201 males and 159 females) patients were excluded. Mean age was 37.9 ± 9.0 years range of (15-70). The mean CD4+ cell counts over the study period were 141.7 ± 176.5 (1-1022), 192.4 ± 198.5 (3-1275), 221.2 ± 178.0 (3-1300), 247.2 ± 197.7 (1-1401) and 268.6 ± 189.9 (1-1390) cells/µl at 0,3,6,9 and 12 months respectively. Nine patients had higher CD4+ cell counts > 350 cells/µl (433-1022) at baseline and higher HIV-viral RNA range between  51,830-1million copies/µl. The patients had multiple co-morbidities,namely, had tuberculosis, sepsis, cryptococcus meningitis, herpes zoster virus, four had non- Hodgkinfs lymphoma, oral candidiasis, hepatitis B virus, pneumocytis jiroveci pneumonia and HIV with renal dysfunction. Seventy (68%) patients had . 2 opportunistic infections. Mean AST, ALT and haemoglobin levels were 127.8 ± 79.8 IU/L, 157.2 ± 50.1 IU/L and 9.1 ± 4.3 g/dl respectively. No patient tested positive foranti-HCV antibodies.Conclusion: The majority of patients had advanced HIV infection at baseline. There was a slow but steady increase in CD4+ cell count over one year. However only 30(29.1%) of patients achieved immune restoration. Seventy three (70.9%) of patients still had immune depletion with low CD4+ cell counts at one year of receiving HAART. Patients with low CD4 + cell counts at baseline had a steady increase of CD4+ cells over the first six months and this emphasises the need to initiate HAART early in public health policy strategy. Expedited HAART initiation should be done in  patients with CD4+ cell counts < 350 cells/µl. Delayed HAART, at low CD4+ cell counts, is associated with poor immune recovery/restoration

Mathematical symbolization: students’ proficiency in using symbols

This study examined the students’ proficiency in using mathematical symbols. The study objectives explored how learners connect symbols and their meanings, find out how learners use mathematical symbols in problem solving and ways in which learners’ problem-solving goals, activities and organization of results are influenced by mathematical symbols. The study was conducted in a public secondary school in Rarieda Sub-county in Western part of Kenya. It employed a qualitative approach with case study research design. The sampling techniques used to identify research location and recruit participants included convenience, purposive and stratified sampling where 2 secondary mathematics teachers and 8 secondary students were used as respondents. The primary data was collected using interviews, document observation and analysis. The data obtained was transcribed and the analysis followed the descriptive coding. Open coding was applied to develop initial codes and further axial coding was done to refine the codes and generate themes. The findings of the study indicated that different levels of conception of symbol and symbol meanings existed among the students,-some had difficulties in revealing meanings of symbols. Also the findings revealed that students had awareness of the role of mathematical symbols in saving time and shortening work; perceived effective learning of mathematics as requiring concerted effort and that symbols influenced problem solving procedures, goals and organization. Drawing from the findings, the recommendations are: Emphasis ought to be put on reading, writing and verbalizing symbols to enable comprehension of symbols and meanings; good instructional strategies ought to be employed by the instructors to reduce the cognitive load exerted by symbols on students

Element specific transfer from a parasite-fish host assemblage to children

Metalen in oppervlaktewater worden doorgegeven via aquatische voedselketens, waardoor de metalen accumuleren in vis die weer door mensen wordt geconsumeerd. De mechanismen waarop de doorgifte van metalen berust zijn veelal onbekend. Dit geldt met name voor de rol van parasieten, die vaak niet betrokken worden in voedselwebanalyses omdat het onopvallende organismen zijn waarvan wordt aangenomen dat ze in lage dichtheden voorkomen. Bekend is echter dat parasieten de metaalopname door hun gastheren kunnen beïnvloeden. Elijah Oyoo-Okoth richtte zich op de rol van parasieten bij de opname van elementen door vissen, en de doorgifte van deze elementen aan menselijke consumenten. Hij deed dit aan de hand van een vissoort die in het Victoriameer sterk geparasiteerd wordt door lintwormen. De vis maakt een belangrijk deel uit van het dieet van kinderen uit gemeenschappen langs de kust van het meer. Uit zijn resultaten blijkt dat de elementhuishouding van de vis sterk gemodificeerd werd door de lintworm. De concentraties essentiële metalen in geparasiteerde vis namen af door competitie tussen parasiet en gastheer, terwijl van de niet-essentiële metalen verhoogde concentraties in beide organismen werden aangetoond. De elementconcentraties in het haar en de nagels van de omwonende kinderen weerspiegelden hun consumptiepatronen. De parasiet modificeerde de elementverhoudingen van de vis, waardoor de doorgifte van elementen van de vis op de kinderen veranderde. Visparasieten modificeren daarmee de risico’s van metaalaccumulatie voor menselijke consumenten

Element profiles in hair and nails of children reflect the uptake from food and the environment

The present study evaluated if the element profiles in hair and nails of children from the Lake Victoria region in Kenya reflect uptake from food and the environment. To this purpose, the element concentrations in hair and nails were related to element concentrations measured in food items, water, and soil. The highest intake of most elements occurred via ingestion of the fish Rastrineobola argentea, which is consumed in higher quantities than other fish and food items. Element concentrations in hair and nails were correlated to food and soil in element-specific patterns. Multivariate analysis combining principal component analysis and multidimensional scaling enabled us to cluster individuals from specific sites and to relate differences between sites to food-consumption patterns and environmental exposures. Site-specific differences in macroelement concentrations among the children were attributed to patterns of food consumption, while those in microelement concentrations reflected differences in geochemical background. It is concluded that the simultaneous analysis of elements in human hair and nails allows separation of populations based on food consumption and geochemical background

Evaluation of sodium chloride (NaCl) for potential prophylactic treatment and its short-term toxicity to African catfish Clarias gariepinus (Burchell 1822) yolk-sac and swim-up fry

Disease and parasite outbreaks cause mortality of fish, affecting mostly early stages of fish cycle. The outbreaks are usually prevented using a number of chemicals including salt (NaCl) for which protocols are lacking. The purpose of this study was to determine the efficacy of NaCl as a potential prophylactic treatment and its short term toxicity on African catfish (Clarias gariepinus) yolk-sac and swim-up fry during a 24 h exposure period. Three-day-old yolk sac and six-day-old swim-up fry (n = 50 for each stage) were subjected to static bath dip treatment in increasing concentrations of NaCl (0.1, 0.2, 0.4, 0.8, 1.0, 2.0, 4.0, and 10.0 g/L) for 15, 30 and 60 min. Toxic ranges were tested by exposing the fry stages to concentrations of 0.25, 0.5, 0.75, 1.0, 1.25, and 1.50 g/L NaCl for 24 h. Controls were not subjected to any concentration of NaCl. All experiments were executed in triplicate. Regardless of the concentrations and duration of exposure, survival of fish in NaCl treatment differed significantly (P <0.05) from the untreated controls. Effective concentration ranges of NaCl were 0.2–0.8 g/L and 0.2–1.0 g/L in the yolk sac and swim-up fry respectively at exposure duration of 15 min. No fry survival was recorded at a concentration of 10.0 g/L for either stage of development. The mean 24 h LC50 values for the yolk sac and swim-up fry were 0.61 and 0.70 g/L NaCl respectively. Sodium chloride may be used as prophylactic treatment in early stages of C. gariepinus but could be toxic at longer exposure times. However, empirical tests on efficacy of NaCl on pathogens are recommended

Metal specific partitioning in a parasite-host assemblage of the cestode Ligula intestinalis and the cyprinid fish Rastrineobola argentea

When evaluating metal accumulation patterns in parasite-host assemblages species specific metal requirements should be taken into account. The aim of the present study was therefore to determine the metal specific partitioning in a parasite-host assemblage of the cestode Ligula intestinalis and the cyprinid fish Rastrineobola argentea and to determine the effect of the parasites on the metal balance of the fish. To this purpose the host-parasite assemblage was analysed for several metals at sites in the coastal zone of Lake Victoria differing in metal contamination. Our results showed that some elements (Ca, Sr, and Mg) reflected the physiological differences of bone formation and ionic balance and pointed to physiological disturbances of infested R. argentea. Other essential metals including Cu and Co were subject of element competition between fish and parasite, while only a micro-element (Cr) and a non-essential metal (Cd) displayed a partitioning with high concentration in the parasite. The present study clearly demonstrated the impact of the large cestodes on their small fish hosts and it is concluded that the partitioning of metals in the assemblage of R. argentea and L. intestinalis is subject to metal specific mechanisms for essential and non-essential elements