Pigmented villonodular synovitis of the knee: a case report

This case study is a report of a 21 year old female with one year history of non-traumatic left knee pain and swelling. Radiography and histology were in keeping with Pigmented Villonodular Synovitis (PVNS). This case highlights the clinical presentation of this rare disorder and emphasizes its consideration as a differential diagnosis in our set up when dealing with non-traumatic persistent knee pain and swelling. East African Orthopaedic Journal, Vol. 4: March 201

Operative management of ankle fractures during pregnancy: case series

Trauma affects approximately 5% of pregnancies and is the leading non-obstetric cause of maternal death. Ankle fractures occurring in pregnancy although minor, can nonetheless create diagnostic and therapeutic challenges for the patient and the surgeon. There is limited information on the operative management of ankle fractures during pregnancy in literature. We retrospectively reviewed hospital records of pregnant patients with ankle fractures who underwent surgery over a six month period from January to June 2013 in a private hospital in Nairobi. We present four cases of displaced ankle fractures in pregnancy that were fixed with good pregnancy outcomes. These case series highlight the management considerations of ankle fractures in pregnant women whose time to delivery is more than six weeks

Outcome of management of humerus diaphysis non-union

Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a major functional problem. The main of our study was to document the outcome of management of non united diaphyseal humerus fractures with plate or plate and rush pin fixation.Methods: A 4 year retrospective study was undertaken at Presbyterian Church of East Africa (PCEA) Kikuyu Hospital, Orthopedic Unit in Kenya from April 2004 to April 2008. Records of consecutive patients with nonunion of the humeral diaphysis were reviewed. Four cases were lost to follow up. The rest were treated with a single posterior, anterior or anterolateral plate while four with a plate and rush pin construct. Autogenous iliac crest bone graft was utilised in most of the cases. A clinical evaluation for union, range of motion and complications. Radiological assessment for union was also done.Results: A total of 46 patients with humerus diaphysis non union met the inclusion criteria. Their ages ranged from 23 to 95 years with a mean of 43.6 years. The overall healing rate was 92.8 % (39/42 cases) at 6 months follow up. 3 failures occurred of whom one was a smoker and diabetic, another had a loose plate and screws following replating. The third case went to nonunion. Three cases of postoperative radial nerve palsy all of which resolved within six weeks were documented. All four treated with a plate and rush pin construct healed uneventfully.Conclusion: The results of this study indicate that our standard surgical procedure for treatment of nonunion of the humeral shaft is reliable with a 92.8% union rate in our study with few complications. The plate and rush pin construct is useful in dealing with nonunion involving osteoporotic bone

Ankle Arthrodesis Using a Vertical Steinman’s Pin in a Severely Osteopenic Bone

Background: Ankle arthrodesis is generally considered the gold standard  for the treatment of a painful arthritic ankle not responding to conservative treatment. The goal is to eliminate pain and achieve a stable plantigrade foot. There are over 30 different methods of ankle fusion to date. Weutilized a technique of placing one smooth Steinman’s pin across the ankle joint after excising the articular cartilage and aligning the joint in patients with severely osteoporotic bone where screws did not have good purchase.Methods: A retrospective study was undertaken of patients done ankle fusion between 2007 and 2010 at PCEA Kikuyu Hospital. Biodata,  indications for surgery, complications, and functional as well as radiological outcome were analyzed.Results: Thirty three patients were evaluated, 17 males and 16 females. The age of the patients ranged from 11 to 80 years (mean 50). Ankle arthrodesis was done for ankle arthritis in most cases. Follow up period ranged from 2 to 5 years (mean 3 years and 2 months). At 12 weekspostoperatively 31(94%) joints were fused clinically and radiologically. The two (6%) cases of nonunion required revision surgery with bone grafting and screw fixation. However one of these patients declined further surgery. There was one case of pin site infection and one case of cellulitis. According to the Mazur ankle score at final follow-up, 22 patients (67%) had excellent results, 8 (24%) good, 2 (6%) fair and 1(3%) poor results.Conclusion: Ankle arthrodesis using a vertical Steinman’s pin is a reliable technique in low resource settings and in patients with severely osteoporotic bone.Key Words: Ankle, arthrodesis, osteopenia, Steinman’s pin

Oesophageal and gastric toxoplasmosis: rare presentation of an emerging zoonotic disease

Background: Toxoplasmosis a Zoonotic disease caused by Toxoplasma gondii. Toxoplasma gondii (T. gondii) is a protozoan parasite that infects most species of warm blooded animals including humans. It is an obligate intracellular parasite with a worldwide distribution. Sporozoites exist in oocysts and are found in the gut walls of definitive hosts the cat family (Felidae). Cats become infected with T.gondii by carnivorism or indigestion of oocysts.Humans can become infected by any of the 4 routes; Eating undercooked meat of animals harbouring tissue cysts, Consuming food or water contaminated with cat feaces or by contaminated environmental samples (such as fecal contaminated soil or changing the litter box of a pet (cat), Blood transfusion or organ transplantation, Transplacentally (from mother to fetus), Accidental inoculation of tachyzoites.Ocular Toxoplasmosis, a major cause of Chorioretinitis , may be as a result of congenital toxoplasmosis or acquired infection. Congenitally infected patients can remain asymptomatic until the second or third decades of life. Congenital Toxoplasmosis is subclinical in about 75% of infected newborn.Case Study: E.K a 62 year old lady presented with a 3 months history of odynophagia that progressed to dysphagia. She had dyspepsia that was non-responsive to proton pump inhibitors. She gave history of slight weight loss due to inadequate food intake, because of the odynophagia, dysphagia and dyspepsia. She was in good general condition a febrile (Temp 37.10 C), not pale, no jaundice, no significant lymphadenopathy, nor oedema.Results: Recent findings have suggested an association between T. gondii infection and various Neurologic diseases or Psychiatric Syndromes such as Schistozophrenia, Alzheimer’s disease and Suicide. 10% to 20% of patients with acute infection may develop cervical lymphadenopathy or flulike illness.Recommendations: Many of these aspects of disease may be delayed or prevented if treatment of toxoplasmosis is initiated antenatally and in the first 1 – 2 months after delivery.Diagnosis and treatment must be different for each clinical category. In general, diagnosis accomplished using serology and histology. Isolation of the parasite can be difficult.Cconclusion: This being the first case in our literature, highliting the fact that; though rare oesophageal and gastric Toxoplasma infection can occur, leading to dysphagia and dyspepsia, Carnivorism of cats makes it difficult to keep them free of disease.Immunodeficiency patients often have Central Nervous System (CNS) disease but may have Pericarditis or Pneumonitis. Toxoplasmosis in immunodeficiency syndrome patients may be due to reactivation of chronic infection or acquired. Toxoplasmosis in patients being treated with immunosuppressive drugs may also be due to newly acquired or reactivated latent infection

Perceptions of Female High School Students on Engineering

There is overwhelming evidence that females are underrepresented in engineering worldwide, and Kenya is not an exception. Recent study at School of Engineering (SOE), Moi University (MU) established that engineering parity ration was found to be 1.68 %, meaning that for every 59 students admitted to MU there was only one student admitted to SOE. Engineering female parity index was found to be 0.0038, meaning that, on average, for 260 female students admitted to MU, only 1(one) female student was admitted to SOE. Humankind depends on engineers to create new technologies, to find solutions to practical problems and to shape the world that people live in and the future they rely on. Yet young people have little or no perception of engineering and the understanding they do have is all too often confused with other careers, such as science. The perception of engineering as “masculine” and “too hard” is a contributing factor for the female minority in engineering. On the other hand there are very few studies on what high school students think about engineering. In view of the above, this paper will try to fill this gap of information, by exploring teenage girls’ perceptions of engineering as a subject for study and as a potential career choice. Furthermore, it will attempt to raise awareness about and improve the image of engineering, by providing fused notion of engineering to the potential broad audience of this paper. The study is significant and essential for deeper comprehension on the subject matter, and for proposing and designing effective strategies to increase females’ representation in engineering. Quantitative and qualitative methods have been used in this study. The researchers designed, administered and analyzed a 21-question questionnaire addressed to 100 female students at secondary school in Eldoret, Kenya (at their Form Four-final year of study). Qualitative Data Coding Techniques were applied to interpret the collected data. In addition, “Draw an Engineer Test” (DAET) was included as one of the questions in the questionnaire. The purpose of the test is to have students describe their perception about engineers via drawn responses. Each picture was analyzed for the images and artifacts contained in the drawings. The study established that majority of female pupils have a fairly good idea of what engineering is and they generally have a positive attitude towards it. The rest of the students, however, perceived engineering as largely dirty and noisy manual-work. To help changing that misconception, this study proposed several recommendations. The most important ones are: In order to attract much more females into engineering, both stereotypes (Engineering and Gender) should be challenged and, in the long run, changed; To make engineering a core-subject, differentiated from science, in the Secondary Schools educational curriculum; To offer students freedom of choice of future career, providing exposure to various career alternatives; and finally, students should choose a career that matches one’s personality. Keywords: gender, engineering, engineer, stereotype, perception

Viewpoint of Undergraduate Engineering Students on Plagiarism

Undoubtedly, plagiarism has been a global-concern, especially so, in institutions of higher-learning. Furthermore, over the past-decades, cases of student-plagiarism, in higher-education, have increased, substantially. This-issue cannot be taken, without due-consideration, and it is crucial for educators, and universities, at large, to find the best-ways, to discourage and reduce the acts of students’ plagiarism. The aim of this-study, therefore, was to address plagiarism in professional-university-education from undergraduate-engineering-students’ attitudinal-perspective. In particular, to ascertain how plagiarism is defined by the students; which factors, they perceive, exacerbate plagiarism; how they justify plagiarism; and severity and penalty related to the misconduct. This-paper illustrates a fraction of a larger-research on plagiarism at the School of Engineering. The study-design used a descriptive-survey-approach and a document-analysis. A designed confidential self-report-questioner was applied as the main-instrument for this-study, with the sample-size (N=25), and a response-rate (RR=84%). The tool was pre-tested to ensure its validity and reliability. The data-collection-instrument was subjected to the statistical-analysis to determine its reliability via Cronbach’s alpha-coefficient, and found high inter-item consistency (a > 0.9). The major-results of this-study revealed overall and widespread-deficiency in students’ understanding of plagiarism; also more than half of the students, in the-subject-sample, were not adequately-informed about plagiarism in academic-writing; 76% of the respondents agreed, that those who say, they have never plagiarized, are lying; and also that everyone else around are plagiarizing (e.g., students, researchers, and academic-staff); 48% of the respondents agreed, that they keep on plagiarizing, because they have not been caught yet, while 33% stated, that they are tempted to plagiarize because, even if caught, the punishment (if any) will be light (the reward outweighs the risk). Several-specific-recommendations, on how to fight plagiarism, were provided, alongside with identification of areas for further-research. This-study would offer awareness to the undergraduates, lecturers, and the faculty-administrators, on the gravity of plagiarism-acts and how to avoid it, in the university. The study also will make a contribution (in its small-way) to the body of knowledge on the subject-matter. Keywords: Plagiarism, undergraduate, engineering, students

Faculty Perceptions on Cheating in Exams in Undergraduate Engineering

Cheating in examinations transpires in every-country of the world, and it is a fraudulent-behavior that involves some-form of deception, in which a candidate’s efforts, or the efforts of other-candidates, are altered; it has negative educational, social and psychological-effects. Even though cheating is widespread, it has been observed that some-faculties rarely-discuss rules and consequences of academic-dishonesty with their-students. The main-objective of this-study is to comprehend, cheating-phenomena, on a deeper- level, by evaluating perception of the-trend from the faculty’ perspective, so that ways could be proposed for preventing it from happening. This-study is a fraction of a larger-research on cheating at the School of Engineering (SOE). The study-design used a descriptive-survey-approach and a document-analysis. A designed confidential self-report-questioner was used as the main-instrument for this-study, with the sample-size of 25-subjects and response-rate of 84%. The tool was pre-tested to ensure its validity and reliability. The study focused on the Attribution-Theory and Constructivist-paradigm of research that view knowledge as socially-constructed from the context of cheating in examinations. The data collection-instrument was subjected to the statistical-analysis to determine its reliability via Cronbach’s alpha-coefficient, and found high inter-item consistency (a > 0.9). The results of the survey, where 81% of the respondents agreed that students frequently indulge in examination-malpractice, clearly revealed that cheating, indeed, is a significant-problem in the SOE. The challenge for the school is, therefore, to tailor effective-strategies to prevent cheating-opportunities, and to establish and enforce valuable-means of dealing with particular-patterns and types of cheating. Specific-recommendations on how to deal with cheating in examinations are also highlighted. Keywords: cheating, engineering, faculty, questioner, integrit

Diagnostic value of plain radiographs in patients with low back pain of non-traumatic origin at a national teaching and referal hospital in Kenya

Background: Low back pain is a commonly recognized problem worldwide. Plain radiography is used in many of these patients as an initial investigative and evaluative tool. However, it was not known how truly useful this investigation was in making definitive diagnosis for non traumatic low back pain. The main objective of the study was to determine the value of plain radiographs in patients presenting with low back pain that is of non-traumatic origin.Methods: A prospective study 102 consecutive patients with low back pain was conducted at the Kenyatta National Hospital (KNH) from 1st February 2013 to 30th May 2013. Data was collected using a structured questionnaire and analyzed. Plain radiograph films were reviewed by two qualified radiologists.Results: The mean age of patients presenting with low back pain was 50.9years, with a male to female ratio of 1:2.4. Majority of the patient had chronic low back pain. There was a high rate of positive radiological findings (98%). The most common findings included muscle spasm, osteoporosis, reduced lumbar lordosis, spondylosis, disc degenerative disease and osteophytes. Assessment of inter-rater variability showed good level of agreement on presence of spondylolisthesis and vacuum phenomenon (k=0.71), moderate agreement on reduced disc space, reduced lumbar lordosis, spondylosis (k=0.42-0.56) and poor agreement on film quality, infections, tumor metastasis, osteophytes, prolapsed intervertebral disease (PID), osteoporosis, scoliosis, muscle spasm and sacroilitis (k=0.13-0.21)Conclusion: Most of the patients presenting to KNH with low back pain have a chronic type and therefore have increased probability of having positive radiological findings. There was a poor ability to diagnose infectious causes, inflammatory conditions, transitional vertebrae and tumor metastasis. In such cases, more advanced imaging such as CT scan and MRI may be required

CASE REPORT - Reactivated toxoplasmosis presenting with non-tender hepatomegaly in a patient with HIV infection

No Abstract African Journal of Health Sciences Vol. 14 (1-2) 2007: pp. 97-9