Validation of the Wells scoring scale for Deep Vein thrombosis in African patients

Background: Deep Venous thrombosis (DVT) is difficult to diagnose. Pre-test probability rules used in screening for DVT have not been validated in an African population.Objective: Validation of the Wells Rule in African patients suspected to have DVT.Design: Descriptive cross sectional study.Setting: Moi Teaching and Referral Hospital (MTRH), a tertiary referral centre in Eldoret, KenyaSubjects: Adult patients presenting with suspected DVT had their pre-test probability of DVT calculated using the Wells rule before undergoing compression ultrasound imaging of their legs to confirm the diagnosis.Results: Ninety-seven (97) patients were enrolled between April 2010 and January 2011: median age 38 years (IQR: 31, 48); 71 (73%) women; and 40 (44%) were HIV-infected. DVT was confirmed in 78/81 (96%) of patients with high probability and 2/16 (12%) in those with low probability. Sensitivity of the Wells score was 0.975(95%CI 0.940,0.992) and specificity was 0.824 (95%CI 0.657, 0.902). Likelihood ratio for a positive test was 5.525(95%CI2.743, 10.097) and 0.030 (95%CI 0.009, 0.092) for a negative test. We found strong agreement between the Wells score and Doppler ultrasound findings with a Kappa value of 0.817 (95%CI 0.611, 0.915).Conclusions: The Wells Rule has good sensitivity, specificity and likelihood ratios in the preliminary diagnosis of DVT in African patients

Risk factors for death in HIV-infected adult african patients recieving anti-retroviral therapy

Objective: To determine risk factors for death in HIV-infected African patients on anti-retroviral therapy (ART).Design: Retrospective Case-control study.Setting: The MOH-USAID-AMPATH Partnership ambulatory HIV-care clinics in western Kenya.Results: Between November 2001 and December 2005 demographic, clinical and laboratory data from 527 deceased and 1054 living patients receiving ART were compared to determine independent risk factors for death. Median age at ART initiation was 38 versus 36 years for the deceased and living patients respectively (p<0.0148). Mediantime from enrollment at AMPATH to initiation of ART was two weeks for both groups while median time on ART was eight weeks for the deceased and fourty two weeks for the living (p<0.0001). Patients with CD4 cell counts <100/mm3 were more likely to die than those with counts >100/mm3 (HR=1.553. 95% CI (1.156, 2.087), p<0.003). Patientsattending rural clinics had threefold higher risk of dying compared to patients attending clinic at a tertiary referral hospital (p<0.0001). Two years after initiating treatment fifty percent of non-adherent patients were alive compared to 75% of adherent patients. Male gender, WHO Stage and haemoglobin level <10 grams% were associated with time to death while age, marital status, educational level, employment status andweight were not.Conclusion: Profoundly immunosuppressed patients were more likely to die early in the course of treatment. Also, patients receiving care in rural clinics were at greater risk of dying than those receiving care in the tertiary referral hospital

Prevalence, treatment and control of hypertension among type 2 diabetic patients at Moi teaching and referral hospital, Eldoret, Kenya

Objectives: To describe the prevalence, treatment and control of hypertension among type 2 diabetic patients at Moi Teaching and Referral Hospital (MTRH) and to determine predictors of blood pressure (BP) control.Design: A cross-sectional study.Setting: Diabetic Outpatient Clinic at MTRH, Eldoret, KenyaSubjects: Type 2 diabetic patientsInterventions: The study collected socio-demographic (age, gender, employment status, monthly income, education level, marital status, cigarette smoking and alcohol use), clinical (BP, weight, height and waist circumference) and laboratory (serum fasting lipids and creatinine, urine proteins) data from type 2 diabetic patients. Good BP control was defined as <130mmHg systolic and <80mmHg diastolic. Association between BP control and social demographic, clinical and laboratory variables of study subjects was determined using the chi-square, T-test, fisher’s exact test and logistic regression.Results: We studied 218 type 2 diabetics: mean age 57±9 years; 122 (56%) were females. Average duration of diabetes was 11±7 years. Prevalence of hypertension was 185/218 (85%) out of who 40 (21%) had good BP control. Average duration of hypertension was 7±5 years. Of the 185 hypertensive diabetics: 92 (50%) had total cholesterol at goal; 102 (55%) had low density lipoproteins (LDL) at goal; 74 (40%) had triglycerides at goal; 65(35%) had high density lipoprotein (HDL) at goal and 85(45%) had Proteinuria. All hypertensive patients had >1 anti-hypertensive agent prescribed. Good BP control was associated with compliance to anti-hypertensives (OR= 0.342, 95% CI: 0.105- 1.432) and having HDL at goal (OR = 0.247, 95% CI: 0.126-0.845). Poor BP control was associated with a higher number of prescribed anti-hypertensive agents (OR=1.377, 95% CI: 1.112- 2.302).Conclusion: Prevalence of hypertension among type 2 diabetic patients in MTRH is high and BP control is poor despite anti-hypertensive treatment. Significant predictors of BP control include compliance to anti-hypertensives and control of HDL.